Viewpoints: 'Blunders' On Ebola; McConnell's Strange Logic On Obamacare; Temporary Victory For Texas Women
USA Today: Hospital's Ebola Blunders Feed Fear: Our View
The point of this is not to flog Presbyterian, though a few lashes might help snap [Daniel] Varga and other administrators back to reality. Rather, it is to probe whether the hospital's dismal performance exposes more widespread weaknesses that could turn a few inevitable, isolated cases of Ebola into something much worse. From the earliest days of the crisis, CDC Director Tom Frieden has been relentlessly reassuring. He has insisted, among other things, that the nation's hospitals could identify and isolate Ebola patients — the indispensable first line of defense against an outbreak. The Dallas experience raises doubts (10/15).
USA Today: Why Ebola Drug Seems So Elusive: Column
The emergence of a third case of Ebola in Dallas shows us that the deadly infection, while less transmissible than viruses such as the flu, is still highly contagious. Though the U.S. health care system will prevent Ebola from becoming epidemic here, we could still face large outbreaks. At some point, the only thing that will reverse the global tide could be a vaccine or a drug that can treat infected patients (Scott Gottlieb, 10/15).
The Washington Post’s Post Partisan: A Little Ebola Panic Might Be Helpful
Now, now, let’s not panic. Yes, we have a second health-care worker infected with Ebola after treating the Liberian man who apparently concealed his exposure to this often-fatal disease, but this is no reason to panic. "It’s bad news that another person is sick," Dallas County Judge Clay Jenkins said Wednesday to MSNBC anchor Jose Diaz-Balart. Indeed (Kathleen Parker, 10/15).
The Wall Street Journal: The Ebola Twilight Of Public Institutions: The WHO And CDC Are Failing In Their Core Health Mission
On Wednesday the World Health Organization warned of the threat of a global plague, which can cause "vomiting, marked hypocalcemia, metabolic acidosis, convulsions and, in rare cases, even death." Ebola? No, the WHO culprit is the overconsumption of energy drinks. The Ebola catastrophe in West Africa has now claimed more than 4,500 lives and the disease continues to spread geometrically, while an outbreak in a major European or North American city would lead to more severe economic dislocation. But the tragedy is also ruthlessly exposing the decay of the once-eminent public institutions that were established to contain such transnational contagions—organizations both international and domestic (10/15).
The New York Times: Mitch McConnell And Alison Lundergan Grimes Take On The White House
Kentucky’s Democratic governor, Steve Beshear, got behind the Affordable Care Act, expanded Medicaid and set up a state health insurance exchange known as Kynect, which now benefits an estimated 500,000 Kentuckians. It’s working so well that even Mr. McConnell, who says he would "pull out" the health care law "root and branch," pretends that Kynect could survive even if the law were repealed. Such deception deserves an aggressive response. Unfortunately, Ms. Grimes does not provide one. Instead of explaining that Kynect depends on federal subsidies, she’s content to call Mr. McConnell's plan a "fantasy" and then pledge to fix the health care law. Her favorite improvement — allowing people to keep their old insurance plans even if those plans do not comply with the federal law’s standards — is a fantasy, too. Ms. Grimes is so loath to wade into the health care debate that she does not mention the law on her website (Juliet Lapidos, 10/15).
Los Angeles Times: An Expert's Heroic Fact-Checking Of Mitch McConnell On Obamacare
Senate Minority Leader Mitch McConnell (R-Ky.), who is facing a stiff reelection challenge this year, has stuck to his stated determination to repeal the Affordable Care Act if his party takes control of the Senate in the next election. This is a curious and delicate position for McConnell to hold, because his home state is one of the shining beacons of the ACA's rollout. The Kentucky health insurance exchange, Kynect, is enormously popular among Kentuckians. Some 527,000 residents have signed up for qualified health plans or Medicaid, which the state expanded (Michael Hiltzik, 10/15).
The New York Times: Resurrecting Smallpox? Easier Than You Think
On Oct. 16, 1975, 3-year-old Rahima Banu of Bangladesh became the last human infected with naturally occurring smallpox (variola major). When her immune system killed the last smallpox virus in her body, it also killed the last such smallpox virus in humans. In what is arguably mankind’s greatest achievement, smallpox was eradicated. ... the war is not over; the smallpox virus has now found a second host. It is not the pig. In fact, it is not even what we think of as a living thing. It is the computer (Leonard Adleman, 10/15).
The New York Times: The Supreme Court Acts For Texas Women
With a brief unsigned order on Tuesday, the Supreme Court acted to prevent Texas from enforcing two key parts of the state’s 2013 package of extreme new abortion restrictions. While the legal battle over the provisions continues, and is very likely to land back at the court before long, the order was a significant victory for women in Texas. The important result is that it will allow more clinics offering safe and legal abortion care to continue operating pending a final court resolution (10/15).
Bloomberg: The Vanishing U.S. Abortion Clinic
Abortion clinics are closing in the U.S. at a record pace. In four states — Mississippi, North Dakota, South Dakota and Wyoming — just one remains. American women were having fewer abortions before clinic closings accelerated in the last couple of years. So no one can be sure how much the push to restrict clinics in Republican-dominated states is connected to falling abortion rates. But the new strategy adopted by abortion opponents, and the court battles it has set off, may define how far abortion rights can be limited without being overturned (Esmé E. Deprez, 10/15).
Los Angeles Times: Insurers' Spending Against Prop. 45 Tips Scale In Its Favor
Proposition 45, which would allow California's insurance commissioner to regulate rates for certain medical plans, is a close call for this voter. On the one hand, the commissioner would be touching on — although not exactly duplicating — work already performed by the state entity created to administer Obamacare. That could slow down the work of Covered California in managing an exchange in which people can obtain health insurance under the Affordable Care Act. But on the other hand, the insurance industry is pouring barrels of money — $43 million the last time I looked — into the campaign to defeat Prop. 45. That tells me the insurers fear losing profits. And it indicates that policy buyers could gain in their pocketbooks (George Skelton, 10/15).
The Wall Street Journal: Shifting Views On Same-Sex Marriage, Marijuana And End-of-Life Issues
On the third issue, physician-assisted euthanasia, there has been a gradual increase in agreement with the proposition that "doctors should be allowed to end a person’s life by some painless means if a patient or his or her family request it." Gallup reports that support has climbed from less than 40% in the late 1940s, to 65% in 1990, to about 70% today. Support is lower when the issue is referred to as "physician-assisted suicide," but there is still majority support. ... Change in opinion is, of course, not always sufficient to change policy (Drew Altman, 10/15).
Each week, KHN's Shefali Luthra finds interesting reads from around the Web.
ProPublica: This Alabama Judge Has Figured Out How To Dismantle Roe v. Wade
In the nine years Parker has now served on the court, he has made the most of his opportunities. Child custody disputes, for instance, have made good occasions to expound on the role of religion in parental rights. ("Because God, not the state, has granted parents the authority and responsibility to govern their children, parents should be able to do so unfettered by state interference," he wrote in one case.) But Parker has been the most creative in his relentless campaign to undermine legal abortion. Again and again, he has taken cases that do not directly concern reproductive rights, or even reproductive issues, and found ways to use them to argue for full legal status for the unborn. Those efforts have made Parker a pivotal figure in the so-called personhood movement, which has its roots in a loophole in Roe v. Wade (Nina Martin, 10/10).
New York Times: To Become A Doctor
Daniel Sanchez, born and raised in Guatemala, is part of a remarkable migration that occurs every July. Hundreds of medical school graduates from across the United States and all over the world start their first-year residencies at New York City hospitals, ranging from community hospitals like Woodhull that serve the poorest New Yorkers, to large, elite institutions like Mount Sinai Beth Israel. The 21 young doctors in Woodhull's three-year program in internal medicine are an unusually diverse bunch. Nine were born in the United States. The rest are originally from Poland, Nepal, Ghana, Venezuela, India, Myanmar and Guatemala. Most were trained abroad; eight graduated from American medical schools. They were chosen from 6,300 applicants (Susan Hartman, 10/9).
The Atlantic: The Summer Cold That Became Something More
A month ago, enterovirus D68 (EV-D68) was a mild concern to parents around the country as kids headed back to school. The virus caused fever, runny nose, sneezing, coughing, and body aches in mild cases, and wheezing and difficulty breathing in severe cases. But the virus seemed to be isolated to the Southeast and parts of the Midwest and unlikely to be fatal. A month later, the landscape seems very different. ... While panicked school boards call emergency meetings and parents try to figure out how to protect their children, the unfortunate truth is that much about EV-D68 remains a mystery. And it's likely to remain that way (Jake Swearingen, 10/10).
Reason: How Cutting-Edge Medicine Might Have Spared Us The Ebola Epidemic
The first person diagnosed with Ebola in the United States died in Texas on Wednesday. Also on Wednesday, a nurse who contracted Ebola from a missionary priest being treated for the disease in Spain became the first known case ever of Ebola transmission outside of the West Africa hot zone. In the meantime, the number of people infected with Ebola in the West Africa outbreak now exceeds 8,000; 3,857 have died of the disease. Computer disease model estimates by Eurosurveillance suggest that the number of people with the illness could grow by an additional 77,181, to 277,124 cases by the end of 2014. The U.S. Centers for Disease Control and Prevention (CDC) calculates that if the rate at which infected people are isolated is not substantially increased, the number of cases could swell to somewhere between 555,000 and 1.4 million cases by mid-January. It could have been otherwise (Ronald Bailey, 10/10).
Vox: A Top Scientist Worries That Ebola Has Mutated To Become More Contagious
Peter Jahrling, one of the country's top scientists, has dedicated his life to studying some of the most dangerous viruses on the planet. Twenty-five years ago, he cut his teeth on Lassa hemorrhagic fever, hunting for Ebola's viral cousin in Liberia. In 1989, he helped discover Reston, a new Ebola strain, in his Virginia lab. Jahrling now serves as a chief scientist at the National Institute of Allergy and Infectious Diseases, where he runs the emerging viral pathogens section. He has been watching this Ebola epidemic with a mixture of horror, concern and scientific curiosity. And there's one thing he's found particularly worrisome: the mutations of the virus that are circulating now look to be more contagious than the ones that have turned up in the past (Julia Belluz, 10/13).
The New Yorker: The Empire Of Edge: How A Doctor, A Trader, And The Billionaire Steven A. Cohen Got Entangled In A Vast Financial Scandal
As Dr. Sid Gilman approached the stage, the hotel ballroom quieted with anticipation. It was July 29, 2008, and a thousand people had gathered in Chicago for the International Conference on Alzheimer’s Disease. For decades, scientists had tried, and failed, to devise a cure for Alzheimer’s. But in recent years two pharmaceutical companies, Elan and Wyeth, had worked together on an experimental drug called bapineuzumab, which had shown promise in halting the cognitive decay caused by the disease. Tests on mice had proved successful, and in an initial clinical trial a small number of human patients appeared to improve. A second phase of trials, involving two hundred and forty patients, was near completion. Gilman had chaired the safety-monitoring committee for the trials. Now he was going to announce the results of the second phase (Patrick Radden Keefe, 10/13).
Texans on both sides of the abortion issue are taking stock after the U.S. Supreme Court intervened in a lawsuit over controversial state requirements for clinics. The court issued an order late Tuesday saying 13 Texas clinics that had to close can re-open their doors for the time being.
The clinics had shut down Oct. 3 after a federal appeals court ruled that they had to comply the state law’s mandate that they meet the standards of ambulatory surgery centers. That court will also hear arguments on a lawsuit brought by the clinics arguing the law is unconstitutional. But the U.S. Supreme Court this week said those clinics can continue to operate while the law is appealed.
“I was really surprised and really delighted in a way I hadn’t expected,” said Amy Hagstrom Miller, founder and chief executive of Whole Woman’s Health. Whole Woman’s is the lead plaintiff in the lawsuit for this case. The company once had six clinics in Texas, but the law forced all but one to close.
Miller said she will re-open her clinic in McAllen by Friday, which serves low-income women in the Rio Grande Valley. They had been forced to travel to the nearest clinic in San Antonio, but many couldn’t afford the trip or take time off from work, she said.
“There were only two clinic facilities in the Rio Grande Valley and both of us had to close, which meant that women had to travel upwards of 250 miles round-trip in order to get an abortion safely,” Hagstrom said.
Hagstrom is also working to re-open a second clinic in Fort Worth.
But even with this ruling, the ongoing fight in Texas has permanently changed the landscape for abortion providers, and not all the clinics will re-open.
Miller’s clinic in Austin no longer has a lease or a state license. One Houston doctor got frustrated, closed his clinic at the end of September, and retired. Miller once had a clinic in Beaumont, but she closed it in March when doctors there can’t obtain admitting privileges at nearby hospitals, another requirement in the state law.
In addition, any clinic that re-opens might have to close again if the Fifth Circuit Court of Appeals eventually rules the Texas law can stand.
Planned Parenthood in Houston was one of only eight places left in the state to get an abortion after the non-compliant clinics closed Oct. 3.
“Limiting abortion access to eight [clinics] in Texas – eight simply isn’t enough,” said Rochelle Tafolla, a Planned Parenthood spokeswoman. “We were overwhelmed with phone calls.”
Texas is the country’s second most populous state, with about 26 million people.
When the other clinics closed, Planned Parenthood received more than 500 calls in just one day, about six times the normal volume. Some women whose appointments were cancelled drove straight to Houston.
“Women were scared, they were nervous, they didn’t understand what was happening,” Tafolla said. “We’re just thrilled the court stepped in to stop this terrible law and we hope that it will eventually and ultimately be overturned.”
The Supreme Court’s intervention means that the cycle of emergency motions is over. The Fifth Circuit has agreed to expedite the full appeal, which could be heard as soon as December.
Houston-based Texas Right to Life supports the law and its strict new rules for providers. Emily Horne, a legislative associate, says the surgery center rule will make abortion safer for women.
Horne said it’s discouraging that some clinics can now re-open because she believes they don’t offer good medical care. But she remains optimistic the law will stand in the long term.
“The encouraging thing for us is that this case is still before the Fifth Circuit, and the Fifth Circuit has already said a lot of positive things about the state’s merit and likelihood of success,” Horne said. “And none of that actually changed with what the Supreme Court said.”
This is the second lawsuit over the Texas abortion law, known as HB2. The law’s tempestuous passage in the summer of 2013 propelled the political rise of State Sen. Wendy Davis, who waged an unsuccessful filibuster over the law. She is now the Democratic candidate for Texas governor.
The first lawsuit focused on the part of the law requiring that doctors performing abortions obtain admitting privileges at nearby hospitals. The U.S. Supreme Court declined to intervene in that case.
The second lawsuit focuses primarily on the surgery center rule, according to attorney David Brown. He’s part of the legal team at The Center for Reproductive Rights in New York, which helped some of the Texas clinics file the lawsuit.
Brown said no one can say for sure why the Supreme Court chose to intervene this time around. But he noted the reality on the ground has changed since last fall.
“Now we have hindsight and so the courts are looking at not what could happen but also what already has,” Brown said.
Since last fall, more Texas clinics have closed, which made the “evidence” presented in the second lawsuit more compelling, Brown explained.
“We were able to show that when clinics have to comply with onerous restrictions that are designed to close them under the pretext of health, that they will in fact close, that compliance is impossible,” Brown said, “And that when women have to drive hundreds of miles to get to the nearest health clinic for abortion services, many of them won’t be able to do that.”
Brown said although the Fifth Circuit appeal could be heard in December it’s more likely it will take place early in 2015.
Kaiser Health News provides a fresh take on health policy developments with "Out Of Your Depth Chart?" by Nick Anderson.
And here's today's health policy haiku:
GET THE SHOT
Ebola's a source
of worry. A scare, for sure...
But flu's a threat, too.
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Today's headlines include reports about renewing health insurance on the federal health exchange as well as the latest news regarding the Ebola outbreak.
Kaiser Health News: Even With Insurance, Language Barriers Could Undermine Asian Americans’ Access To Care
Kaiser Health News staff writer Shefali Luthra reports: “Efforts to enroll Asian Americans in the health law’s marketplace plans have generally been touted as a success, but because coverage details are provided primarily in English or Spanish, those who depend on their native languages have encountered roadblocks as they try to use this new insurance” (Luthra, 10/16). Read the story.
Kaiser Health News: Capsules: Spike in ER, Hospitalization Use Short-Lived After Medicaid Expansion
KQED’s Lisa Aliferis, working in partnership with Kaiser Health News and NPR, reports: “While the Medicaid expansion may lead to a dramatic rise in emergency room use and hospitalizations for previously uninsured people, that increase is largely temporary and should not lead to a dramatic impact on state budgets, according to an analysis from the UCLA Center for Health Policy Research released Wednesday” (Aliferis, 10/15). Check out what else is on the blog.
The New York Times: U.S. Says Consumers Must Renew Health Insurance Policies
The Obama administration began notifying consumers on Wednesday that they should return to the federal health insurance marketplace to renew coverage for next year. In addition, the officials said, consumers should update information on their income and family size and should compare their current insurance with alternatives, which could offer better coverage at a lower cost (Pear, 10/15).
The Associated Press: 4 Questions To Ask Before Renewing Health Coverage
The health care overhaul makes renewing insurance so easy you don’t have to do a thing. However, there are many reasons to resist this temptation. More than 7 million people signed up for coverage through the overhaul’s public insurance exchanges after the first annual open enrollment window started last fall. Open enrollment returns starting Nov. 15, and experts say it brings with it the perfect chance to take stock in your insurance coverage, even if you like the plan you have this year. That coverage — or the cost of it — may change for 2015. Plus, new and better options also could be available in your market (10/15).
The Washington Post: Why The Debate Over Kentucky’s ‘Healthcare.Gov’ Site Matters
Kentucky's Republican senior senator, Mitch McConnell, is taking a bit of heat over a Web site. As part of his closely-watched race against Democrat Alison Grimes for that Senate seat, the Senate minority leader said Monday night that while he'd like to see Obamacare scrubbed from the face of the Earth, he's fine with the continued existence of Kynect, Kentucky's unfortunately named but nonetheless popular health insurance exchange site (Scola,10/15).
The Washington Post’s Fact Checker: Mitch McConnell’s Puzzling Claims On Insurance In Kentucky, Post-Obamacare
Many readers requested a fact check of McConnell’s Obamacare statements in his debate with the Democratic challenger, Alison Lundergan Grimes. It’s a very interesting set of statements, and we have puzzled over them till our puzzler was sore. McConnell has some difficulty with the Obamacare issue because the Kentucky version, known as Kynect, has been a huge success. About half a million Kentuckians signed up for health insurance, many receiving it for the first time. Fewer than 100,000 joined private insurance plans; that means the bulk of the population joined Medicaid, which was greatly expanded under the Affordable Care Act, a.k.a. Obamacare (Kessler, 10/16).
The Wall Street Journal: UnitedHealth Raises Outlook As Profit Tops Views
UnitedHealth Group Inc. raised its outlook for the year as it posted strong results in the most recent quarter. Earnings topped analysts’ expectations. The company said it now expects to post earnings of $5.60 to $5.65 a share for the year, up from its previous call of $5.50 to $5.60 a share. It had previously raised the bottom end of its guidance range because of strong results and improving trends (Calia, 10/16).
USA Today/Detroit Free Press: Medicare Enrollment Now Open — Are You Ready?
Medicare can be an alphabet soup of confusion. Have you signed up for Parts A and B? Does your Part C coverage cover drugs, or should you look into a Part D plan, too? If you're eyeballing a Medigap policy, which type — A through N — is best for you? Medicare's open enrollment started Wednesday and runs through Dec. 7 (Erb, 10/16).
The Wall Street Journal: HCA Raises 2014 Outlook, Buoyed By Better Quarterly Estimates
HCA Holdings Inc. raised its 2014 outlook as the hospital operator also projected third-quarter results that topped analysts’ estimates. Shares rose 5% to $68.10 in recent after-hours trading. For the year, the company raised its per-share earnings estimate to between $4.40 and $4.60 with revenue at $36.5 billion to $37 billion, from its previous estimate for per-share profit of $4 to $4.25 and revenue of $36 billion to $36.5 billion. For the current quarter, the company forecast per-share earnings of $1.16, including asset-sale losses of two cents a share, and revenue of $9.22 billion. Analysts polled by Thomson Reuters expected per-share profit of 97 cents and revenue of $9.04 billion (Stynes, 10/15).
The New York Times: C.D.C. Director Becomes Face Of Nation’s Worry And Flawed Response
Dr. Thomas R. Frieden, the nation’s top public health official, has always overcome obstacles. He stopped outbreaks of tuberculosis in New York City and made headway against the disease in India. He banned public smoking in New York when he was the city’s health commissioner. And at 49, he ascended to his dream job — director of the Centers for Disease Control and Prevention. … Now, Dr. Frieden, 53, has been pitched into the biggest test of his career. He has become the face of the Obama administration’s flawed response to Ebola in the United States, and on Thursday he is likely to face withering questions about his record during a congressional hearing. On his watch, two health workers in Dallas who were caring for a Liberian man with Ebola have become infected with the disease. And on Wednesday, health officials said the second worker had taken a flight shortly before she tested positive for Ebola, leaving officials scrambling to identify dozens of passengers (Tavernise, 10/15).
NPR: House Panel Hearing To Examine Public Health Response To Ebola Outbreak
On Capitol Hill today, the oversight subcommitttee of the House Energy and Commerce Committee, scheduled a hearing on Ebola. Panel members are expected to hear from Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, Dr. Daniel Varga, chief clinical officer and senior executive vice president at Texas Health Presbyterian Hospital and Dr. Anthony Fauci, the director of the National Institutes of Health. In prepared testimony, Fauci said Duncan's death and the infections of the two Dallas nurses and a nurse in Spain "intensify our concerns about this global health threat." He said two Ebola vaccine candidates were undergoing a first phase of human clinical testing this fall. But he cautioned that scientists were still in the early stages of understanding how Ebola infection can be treated and prevented (McCallister, 10/16).
The Wall Street Journal: Federal Health Agency Reviews Nurses’ Allegations Of Mishandled Ebola Case
A federal health-care agency said Wednesday it was reviewing allegations raised by a nurses union that the Dallas hospital grappling with Ebola mishandled its first case, putting patients and health-care workers at risk. David Wright, deputy regional administrator for the U.S. Centers for Medicare and Medicaid Services in Dallas, said it was “closely evaluating and reviewing” the allegations made by National Nurses United on behalf of what it said were an unnamed number of nurses at Texas Health Presbyterian Hospital Dallas (Frosch, 10/15).
USA Today: Ebola Raises Concerns Over Hospitals' Infection Controls
As public health authorities race to assess the U.S. medical system's ability to contain Ebola, the track record of the nation's hospitals in controlling other infections suggests a lot of them aren't prepared. From small, rural hospitals to sprawling urban medical centers, infection control has been a persistent and vexing problem in U.S. health care for decades (Eisler and Hoyer, 10/16).
Los Angeles Times: Obama Tells CDC He Wants Ebola 'SWAT Team' Ready To Go Anywhere
President Obama said Wednesday evening that he directed the U.S. Centers for Disease Control and Prevention to create a “SWAT team” to be ready to deploy anywhere in the country to help local healthcare systems respond to any Ebola cases. … At the same time, Obama assured Americans once again that the risk of a widespread Ebola outbreak in the U.S. remains very low and that the best way to prevent its spread is to control the outbreak in West Africa (Hennessey and Levey, 10/15).
The New York Times: Downfall For Hospital Where The Virus Spread
Some nurses donned layer after layer of protective garb but unknowingly raised their risk of exposure to the Ebola virus when taking the gear off. Some wore gowns that left their necks uncovered and haphazardly applied surgical tape to the bare spots. And it was two days after the Ebola victim Thomas Eric Duncan was admitted before personnel began wearing biohazard suits (Sack, 10/15).
Los Angeles Times: As Second Nurse Is Infected With Ebola, Her Air Travel Heightens Fears
After weeks of assertions that U.S. hospitals were well-prepared for Ebola, the latest developments illuminated lapses on several fronts: at Texas Health Presbyterian Hospital in Dallas, where two nurses contracted Ebola while treating Thomas Eric Duncan, a Liberian who died of the disease; at the U.S. Centers for Disease Control and Prevention in Atlanta, which says it could have reacted more aggressively to Duncan's case; and with a public health system that has no way of preventing potentially contagious people from boarding public transportation, even if they know they may have been exposed to Ebola (Hennessy-Fiske, Mohan and Susman, 10/15).
The Washington Post: Health-Care Worker With Ebola Was Allowed To Fly Despite Slight Fever
The experts had warned that fighting Ebola is hard, and Wednesday’s drumbeat of bad news proved them correct. The day began with a bulletin about another health-care worker stricken with the deadly disease, and the news got worse with the revelation that she had flown with a slightly elevated temperature from Cleveland to Dallas on a crowded airliner barely 24 hours before her diagnosis (Berman, Sun and Achenbach, 10/15).
The Wall Street Journal: In Ebola Cases, New Focus On Power To Control Travel
The revelation that a second Texas health-care worker diagnosed with the Ebola virus flew from Dallas to Cleveland and back has raised a looming question: Why wasn’t she quarantined before boarding a plane? The answer lies in a layered health-care system that relies on close coordination between state, local and federal authorities to be effective in stopping disease, health-law experts said (Palazzolo, 10/15).
Politico: Ebola Gaffes Fuel Quarantine Questions
The startling news Wednesday that an Ebola-infected nurse flew from Cleveland to Dallas earlier this week unleashed a new round of fears about the virus’s spread in the U.S. and whether the government’s legal authority to contain the illness by limiting travel is up to the task. For nearly a decade, officials have been warning that the country’s quarantine regulations are woefully outdated and badly need revising. The George W. Bush administration proposed “critical updates” to enhance the government’s authority to detain passengers, but never pushed the changes through before the effort was abandoned under the Obama administration (Gerstein, 10/16).
Politico: Obama, Ebola And Optics
Optics, which Obama and his staff dismiss as never being much on their minds, always means a lot to this White House. Aides in the past have pointed out that any abrupt changes to Obama’s schedule have the potential to convey more of a crisis than may exist. But facing the risk of embarrassing juxtapositions of dying health care workers while Obama was out campaigning, that’s exactly what they did (Dovere, 10/15).
The Washington Post’s Fact Checker: The Absurd Claim That Only Republicans Are To Blame For Cuts To Ebola Research
This ad is simply a more extreme version of a new Democratic talking point — that GOP budget cuts have harmed the nation’s ability to handle the Ebola outbreak. It mixes statistics — the budget for the Centers for Disease Control and Prevention (CDC) “cut” $585 million (the ad offers no date range) — with disturbing images of the outbreak and various Republican leaders saying variations of the word “cut.” A slightly more nuanced version of this theme was launched by the Democratic Congressional Campaign Committee, which in online advertising began to equate a congressional budget vote in 2011 with a vote for the House GOP budget in 2014 that supposedly protected special interests (Kessler, 10/15).
The New York Times: Texas Abortion Clinics To Reopen Despite A Future In Legal Limbo
A day after the Supreme Court blocked a Texas law that had forced abortion clinics to close, some of the shuttered facilities prepared to reopen, pleased at the reprieve but mindful that the legal fight was far from over (Eckholm, 10/15).
Los Angeles Times: Kaiser Leads HMOs In Providing Recommended Care In State
Kaiser Permanente was the only HMO to earn a top four-star rating for providing recommended care, according to California's latest report card on insurers and medical groups. The scores issued Wednesday focus on California's 10 largest HMOs, the six biggest preferred-provider organization plans and more than 200 physician groups covering 16 million consumers. Anthem Blue Cross, the state's largest for-profit insurer, and Cigna Corp. led the way among PPO plans with three-star ratings. The data is drawn from claims data and patient surveys in 2013 (Terhune, 10/15).
Los Angeles Times: Mission Hospital Halts Elective Surgeries After Patient Infections
One of Orange County's largest hospitals has halted all elective surgeries after its accreditation came under review following an outbreak of surgical infections. Mission Hospital performs about 7,000 surgeries a year, of which nearly 70% are elective (Jennings, 10/15).
The Wall Street Journal: Panel Backs Requiring Arkansas To Provide Drug
An advisory board recommended Wednesday that Arkansas’s Medicaid program eliminate restrictions on the use of an expensive cystic fibrosis drug made by Vertex Pharmaceuticals Inc. that are the subject of a legal battle in federal court. Members of the state’s Drug Utilization Review Board, which is made up of Arkansas doctors and pharmacists, recommended that the state adopt a revised set of criteria for prescribing the drug, called Kalydeco, that wouldn’t require that patients seeking the drug first prove their health worsened after taking two older, less-costly treatments (Walker, 10/15).
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By Richard Knox
Americans are seriously confused about how Ebola spreads. And it’s no wonder.
A new national poll from the Harvard School of Public Health finds that nearly 9 out of 10 Americans think someone can catch Ebola if an infected person sneezes or coughs on them.
Not so, according to all health authorities and 38 years of research on this virus. But maybe people can’t be blamed for thinking Ebola can be spread through the air as they see powerful images day after day of health workers clad in head-to-toe protective coverings and face masks.
And there’s little to no possibility that Ebola will mutate into a virus easily spread by aerosol droplets, like influenza or SARS, for reasons that Laurie Garrett of the Council on Foreign Relations recently pointed out in The Washington Post.
Similarly, all the attention on the imported Ebola case of a Liberian man in Dallas and subsequent infection of two of his nurses (so far) is apparently leading many Americans to overestimate their risk of getting the virus.
In contrast, the great majority (80 percent) think they’d survive Ebola if they got immediate care. That’s probably right — though no sure thing.
The Harvard poll, conducted between last Wednesday and Sunday, finds that a little over half of Americans worry there will be a large outbreak of Ebola in this country over the coming year.
More than a third worry they or someone in their immediate family will get Ebola.
Again, such fears are totally understandable given the saturation media coverage of such a scary virus. But — despite the worrisome lapses in infection control in Dallas — there’s no reason yet to anticipate widespread person-to-person-to-person spread of Ebola in America.
The reason: Despite (perhaps inevitable) slips, the vigilance, the resources and the ability to track and isolate infected people in this country (under force of law, if necessary) are light-years removed from Liberia, Sierra Leone and Guinea.
But what if you do get a significant exposure to Ebola — that is, come in contact with vomit, blood or feces from an infected person — or a surface contaminated with infected bodily fluids? Would you be able to stay in home quarantine for three weeks until the risk of your infection is past?
Nearly 6 in 10 Americans say that would be difficult for them. (No kidding!) That might be ominous in a situation when millions of Americans could be asked to observe quarantine — say, in the event of a killer bird-flu pandemic, which remains possible someday.
But will Ebola outbreaks put many Americans to that 21-day quarantine test? Not a chance.
A Boston-based insurance broker is rolling out a new policy for Ebola-related losses at hospitals and clinics across the country.
How much money might hospitals lose during an Ebola-related quarantine? And will patients use hospitals that treat the virus? Phil Edmundson at William Gallagher Associates developed Ebola insurance to address these risks.
“People may choose to put off their health care, or to get it at an alternative facility, if they feel there’s a reason to suspect Ebola in a given clinic or hospital,” Edmundson said.
Ebola policies could run half a million dollars or more for large hospitals. They will not cover the cost of closing off wards, training staff or overtime.
Other insurers are offering similar coverage for theaters, restaurants, hotels and other public spaces that may have to close if they have a customer with Ebola.
“All Massachusetts hospitals have general insurance policies and liability policies in place for extreme events,” the Massachusetts Hospital Association said in a statement.
The group said it’s aware that hospitals in the state may be evaluating whether “additional insurance for Ebola-specific events” is necessary.
Efforts to enroll Asian Americans in the health law’s marketplace plans have generally been touted as a success, but because coverage details are provided primarily in English or Spanish, those who depend on their native languages have encountered roadblocks as they try to use this new insurance.
About 35 percent of Asian Americans have limited English proficiency, according to a September report from the Center for American Progress, a left-leaning think tank.
The issue of language access gained attention last summer when the Obama administration notified thousands of people that their health insurance subsidies were at risk unless they updated their citizenship documentation because information on their initial applications could not be verified. Advocates said many of those in jeopardy did not speak English well and did not understand the paperwork they received.
This example is not an isolated one.
Asian Americans, with limited English who enrolled in plans with the help of bilingual navigators and in-person assisters, are now trying to understand a slew of documents – things like explanations of benefits packages or notifications about paperwork deadlines – that often are not translated.
Data measuring just how many enrollees have had trouble understanding their insurance material is hard to come by, said Jen Lee, director of community services and partnerships at the Association of Asian Pacific Community Health Organizations. But it’s not uncommon, especially for Asian Americans who seek insurance through a federal or state exchange, she said. “It becomes a huge issue moving forward,” she said.
Last year, Asian Americans generally enrolled in plans at a rate higher than expected. Federal officials have reported that 5.5 percent of those who signed up for marketplace plans were Asian Americans, while they make up just 5.1 percent of the population nationally.
The marketplace will “ask which language do you prefer – and for my clients that language is Korean. But they’re not receiving those notices in Korean,” said Minja Hong, program director at Korean Community Services, a New York-based assister agency.
In one case, she recalled, a Korean-speaking woman called the marketplace to find out why her plan was canceled. She came away from the call believing she had paperwork missing. When Hong followed up, it turned out the woman actually had never paid her premium.
This kind of language barrier could violate Section 1557 of the federal health law, said Priscilla Huang, policy director for the Asian and Pacific Islander American Health Forum. That provision, modeled on the 1964 Civil Rights Act, prohibits barring people from “any health program or activity, any part of which is receiving federal financial assistance, including credits, subsidies, or contracts of insurance” based on race, national origin, sex or ability.
Asian Americans – particularly those less comfortable with English – are often immigrants. For that reason, not providing in-language resources can be construed as discrimination based on national origin, Huang said, and the reference to “contracts of insurance” extends that protection to include private plans being sold on the marketplace. But, she added, the Department of Health and Human Services has not yet issued regulations on how to enforce Section 1557 – making it difficult to interpret or enforce the provision in cases such as these.
Huang, whose organization is in a consortium that advocates on behalf of Asian Americans and Pacific Islanders regarding health issues, said her group has been talking with HHS about having Section 1557 regulations issued before the next round of open enrollment, which starts Nov. 15. So far, though, there’s no timeline as to when that will happen.
“There are good intentions – however, we do want to see more action,” Huang said.
HHS will issue a Notice of Proposed Rulemaking regarding 1557 in coming months, according to the Centers for Medicare and Medicaid Services.
People who believe they have faced discrimination “on one of the bases” the provision protects can file a complaint through the agency’s civil rights webpage. HHS has been investigating complaints it has received, CMS said.
Some civil rights complaints have already been filed by groups that advocate for immigrants, including an Asian American group in Pennsylvania, specifically addressing messages HHS sent out discontinuing coverage. Those complaints assert that the notices didn’t take sufficient measures to warn customers in their native language that they could potentially lose their insurance.
Insurance plans do make an effort to reach consumers and help them use their new plans, said Susan Pisano, vice president of communications at American’s Health Insurance Plans, a lobbying group.
“When I talk to plans, they’re very focused on getting good information to new members – both about what their insurance options are and then also once enrolled, how to use their new benefits,” she said. “They’re paying particular attention to this where the issue of culture or the issue of language comes into play – but they understand that there’s still more work to do.”
Meanwhile, when consumers receive English-language packets, they usually return to the navigators who helped them enroll, Lee said. This fall, those navigators will be working to reach new customers while helping old ones re-enroll in their plans – so having to do translation work on top of that can strain already limited resources, she said.
“Our health centers – they are constantly working with folks who … are already enrolled and have questions,” she said.
Navigators and assisters across the board received less funding this year than last. In states with federally facilitated marketplaces, for instance, HHS awarded $60 million compared to 2013’s $67 million – and many assister programs last year reported working either near or at capacity.
In theory, people looking for help translating their insurance papers can turn to hotlines or the marketplace, Hong said. But, Hong added, those conversations can actually be detrimental. About 85 percent of people she sees are limited in speaking or understanding English.
“It becomes a three-way conversation that is very unwieldy,” she said. “Often the translator is not familiar with the language of insurance, and things get lost in translation.”
If unchecked, Hong said, such language disconnects could discourage Asian Americans from enrolling in or maintaining health insurance. And if people can’t understand plans, Lee added, just having coverage isn’t enough.
“How are they supposed to … understand the next step in accessing care,” Lee said, “if the packets and tools in the marketplace aren’t – for limited English proficiency folks – navigable?”
The UK is currently implementing Annex VI, Chapter 4, of the International Convention for the Prevention of Pollution from Ships. It has amended the Merchant Shipping Act to allow an Order in Council to be made to bring in regulations, but does not yet appear to have yet promulgated any. The European Union (EU) has also been actively working to curb emissions from ships, issuing Directives that Member States must implement and requiring new ships to be built according to newly issued energy efficiency standards. The UK government has met with industry stakeholders and EU representatives to explore ways to ensure compliance with the new regulations with minimal cost and regulation, secure EU financing to mitigate the significant investment costs for shipowners and ports, and guarantee fair and consistent enforcement of these regulations throughout the EU so that UK ports are not unfairly disadvantaged.
Visit http://www.loc.gov/law/help/marpol-convention/uk.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 will be highlights of recent and newly published reports. Follow along and share your favorites using the hashtag #LawLibraryReport.
Improving Federal Housing Programs Could Help More Children Grow Up in Safer, Higher-Opportunity Neighborhoods
This report examines the legislation governing judicial conduct in Mali, as compared to equivalent legislation in Cote d'Ivoire, Senegal, Burkina Faso, and Benin. Each of these countries has a specific statute governing the condition of judges, but Mali stands out as being the only country with a code of judicial ethics. These statutes, and Mali's Code of Ethics, contain measures aimed at preserving the independence of magistrates. This includes the independence of the judiciary as an institution, which is enshrined in these countries' constitutions as well as in their statutes, and the individual independence of magistrates. The statutes examined in this report also aim to promote the impartiality of magistrates, though they do so to varying degrees. The ideal of judicial integrity is promoted through the judge's duties of honor, sensitivity, and dignity. Competence is dealt with from a technocratic perspective rather than as an ethical duty. Mali appears to be the only country covered in this report to promote judicial diligence as an ethical duty.
Visit http://www.loc.gov/law/help/judicial-ethics/mali.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 will be highlights of recent and newly published reports. Follow along and share your favorites using the hashtag #LawLibraryReport.
One of my original goals for this project was: “Lower my cholesterol and triglycerides.” I’ve been doing some serious thinking about that lately, along with a bit of research, and I’d like to share the results with you.
The serious thinking started last spring, when I ran across the current controversy about the risks of statins in postmenopausal women. A growing number of physicians and researchers are arguing that, for some women like me, the risks of taking statins to lower cholesterol may outweigh the potential benefits. And the risks are scary: muscle pain (and, more rarely, permanent muscle damage), kidney and liver issues and – yikes! – increased risk of diabetes. Aside from being my own biggest fear, diabetes also, ironically, increases the risk of heart disease, the very thing statins are meant to prevent.
All this gave me pause, because my doctor had prescribed a statin a while ago, and my argument to the nurse practitioner (whom I actually see more often than the doctor) that I didn’t really want to take it had been met with a firm insistence that I should. Based on my numbers, she said – total cholesterol around 350, with an HDL (“good” cholesterol) of around 60 – there was no question.
So I took it for about a month, but I felt tired and achy – maybe just because of life in general, but the achiness felt worse than usual. So when I saw the new studies, I thought, “You know what? I’m just going to stop.”
And I did, and I felt better. But I’ve been avoiding going back to the nurse practitioner to tell her. All of which strikes me as the behavior of a naughty child, rather than a mature adult.
So, as a mature adult, this week I sought another opinion. My editor, Carey Goldberg, suggested I talk with Dr. Vikas Saini, a cardiovascular specialist and the president of the Lown Institute. He’s known for promoting the cause of “right care,” or “avoiding avoidable care” – that is, for arguing that modern medical practice too often overtreats patients, with frequently expensive and sometimes disastrous results. This seems self-evident to me, though it has been enough to create huge controversy in some circles.
In any case, I called Dr. Saini and talked with him about statins, in both general and personal terms. After noting that statins have become a fairly polarizing issue in the medical community, he asked a few questions about my personal and family history.
I gave him my numbers, which he agreed create a slightly increased risk – on paper, anyway. But when I told him that both my grandmothers had high cholesterol but lived into their 90s (and neither died of heart disease), and that neither of my parents, who also had high cholesterol, died of heart disease, either, he said that this history “makes me very, very suspicious of any attempt to paint your high cholesterol as a risk factor. It doesn’t add up.”
Well, hurrah. So I’m not being stupid to stop taking the statin?
“I don’t think that’s stupid at all,” Saini said. “I personally wouldn’t do much of anything except check your numbers.”
And, of course, keep increasing my commitment to exercise – “at least get it up to three times a week” – and eat your basic Mediterranean diet with plenty of olive oil, and work on stress reduction. All these factors, he noted, clearly help prevent heart disease.
But the problem is, Dr. Saini said, that no one has done a huge clinical trial comparing major lifestyle changes with statin use. The comparison is always with “usual” lifestyle changes, like going for a walk once in a while. So, he said, no one really knows how statins stack up against serious, major lifestyle changes.
I came away from this conversation with added motivation to keep moving, and to keep eating right. It’s pretty clear to me that the more rigorously I embrace real change, the more likely I am to avoid all the problems that statins are designed to prevent – and avoid the problems that I might invite by taking one.
I also came away with an important caveat. This recommendation is based on me: my numbers, my family history, my lack of any personal history of heart disease. For a woman my age with a different history, Saini said, his answer might well be different.
“Anybody with a [personal] history of coronary disease, it’s almost like a different disease,” he said. In such cases, “statins are definitely very helpful, but it’s still not a slam-dunk.”
Other factors that would argue more in favor of statins: high blood pressure (mine is thankfully low), high blood sugar, a more severe family history … all the things that make you you, as opposed to me. So I can’t say this strongly enough: Talk with your doctor before making a decision.
And I guess that goes for me, too. At least to check my numbers, and maybe even to ‘fess up.
Could Massachusetts be the only government in the world trying to persuade citizens to shop for health care? I’m scanning Google, trying to come up with another country, province, city…maybe some remote island that has decided: It’s time to learn how to get the best deal you can on care.
Nope, I can’t come up with any other place.
But here it is: Get The Deal on Care. In addition to the website, you may see ads on the T, Twitter or Facebook that will encourage patients to become more savvy consumers of health care.
“We’re at the beginning of a movement here,” said Barbara Anthony, undersecretary for consumer affairs and business regulation, referring to a provision in a Massachusetts law that took effect Oct. 1. It requires all insurers to make real-time prices available to members online and over the phone, and provide members their cost for the service, taking into account co-pays and deductibles.
“We hear about the dawn of patient-centered care,” she said. “We want to put patients in the driver seat. Well, you can’t put consumers or patients in the driver seat if they don’t have information.”
But most patients still don’t have much of a reason to compare costs. And those who do, because they have a high deductible plan, may not realize that prices vary a lot from one hospital or clinic to the next. And they may not connect health care with that gut level drive to find a good bargain. In health care, patients tend to think the most expensive place must be better, even though there is often not much difference in the quality that is measured.
“Patients aren’t used to shopping. That will take an adjustment in terms of attitude,” Anthony said.
Some major employer groups in Massachusetts say they will work to promote use of the new cost calculator tools as well.
“We have long argued that increased price transparency in costs and pricing was needed so that consumers could actually know what they are buying, and how much it was going to cost,” Jon Hurst, president of the Retailers Association of Massachusetts, said in a statement.
There is some controversy about the effect public pricing will have on doctors and hospitals who can now see what their competitors are paid by different insurers.
Hurst argues that public competition will lower prices. But some who study the Massachusetts market say posting prices may actually drive up the cost of health care.
“The providers at the low end of the totem pole, most of whom have zero leverage in the market, will look to have their reimbursements increased, while the folks at the top — and it’s no mystery who we’re talking about — will continue to charge whatever they want,” said Bob Carey, with RLCarey Consulting, a benefits consulting firm.
This week’s interview is with Glenn Ricci, lead information technology specialist in the Office of Strategic Initiatives at the Library of Congress. Glenn has produced videos and webcasts for various Law Library events. Most recently, he produced two videos related to the upcoming exhibition – Magna Carta: Muse and Mentor .
Describe your background.
I spent the first half of my life in Pittsburgh and the rest in D.C. and Baltimore. I’m one of those MARC train commuters who sleeps in Baltimore and works in D.C. In 1995, while still a graduate student at Georgetown, I was working at the American University Law Library (this being a law blog, that seems relevant!) when my boss heard about an opening in the American Memory project at the Library. I had been learning how to code web pages and manipulate digital images and had a few sites I was contributing to. Back then, that experience was new and rare, so it got my foot in the door. After doing web design for American Memory for a few years, I eventually led the site’s Web Team. As the Web became more multimedia-oriented, I learned about video production. That was just as everything was transitioning to digital, so it was yet another new field to get into. In 2000, I joined the ITS Multimedia group, first as a video editor, then as a coordinator.
What is your academic/professional history?
Because I was lucky enough to have a parent working at the University of Pittsburgh, I spent five years there as an undergrad taking courses for free. I majored in English writing, with minors in philosophy and psychology as well as a certificate in film studies. Learning the language of film has helped me in a lot of ways since. I first came to D.C. to get my MA in English from Georgetown. I was planning on going back to Pittsburgh afterwards, but ended up staying here. My current job turns out to be a nice combination of my background in photography, film, writing, and music. I just happened to get here through a fairly circuitous route.
How would you describe your job to other people?
My official title “Lead Information Technology Specialist” doesn’t tell people much, so I say that I’m basically a video producer at the Library. We have events happening all week that our team covers, and we fulfill a variety of other video needs for our clients all over the Library. Nearly all of it ends up on the Web. Demand has grown greatly over the years. It keeps us pretty busy processing hundreds of hours of video content every year.
Why did you want to work at the Library of Congress?
There is so much here and something new to discover every day. I like to discover new things and I get bored easily, so working at such a rich and diverse repository of knowledge means that I’ll never have to worry about getting bored. The field of digital video is also always changing, so I feel like I have a different job every few months.
What is the most interesting fact you’ve learned about the Library of Congress?
When the statues were commissioned for the Main Reading Room, the sculptors were all told to make their figures the same size. Paul Wayland Bartlett, who created the statue of Michelangelo, felt that Michelangelo was too important to be the same size as the others (who include Beethoven, Shakespeare, and Moses) so he made him just a bit bigger. I imagine Barlett was a very strong-willed artist.
What’s something most of your co-workers do not know about you?
Most of my colleagues know that I’m a music and sound designer for The ScareHouse in Pittsburgh, one of the highest rated haunted attractions in the country. Many don’t know that I also have had a long-standing fascination with immersive theatre. This year, I was awarded a Rubys Artist Grant through the Greater Baltimore Cultural Alliance to produce an immersive theatre piece based on the life and fiction of Edgar Allan Poe. For the next eight months, that will pretty much take up all the time that I am not at the Library.
The state's insurance exchange will cancel coverage for these people because they failed to prove their citizenship or legal residency. Under the health law, people living in the United States illegally are not eligible for Obamacare plans.
Los Angeles Times: California Will Cancel Obamacare Coverage For 10,000 Over Citizenship
California's health insurance exchange is canceling Obamacare coverage for 10,474 people who failed to prove their citizenship or legal residency in the U.S. Covered California, the state-run insurance exchange, enrolled more than 1.2 million people during the rollout of the Affordable Care Act this year. For most consumers, the exchange said, it could verify citizenship or immigration status instantly with a federal data hub (Terhune, 10/14).
The New York Times: California: 10,500 Could Lose Health Care
State officials plan to cancel coverage for about 10,500 people participating in the state health insurance exchange because they could not prove that they were citizens or legal residents of the United States. Covered California, the state-run insurance exchange, sent notices to nearly 150,000 people last month asking them to submit documentation to prove their legal status. Those living in the United States illegally are not eligible for insurance through the Affordable Care Act (Medina, 10/14).
The state's "Kentucky-style" system won't be ready until just days before open enrollment begins Nov. 15, while a third Colorado exchange official announces she's leaving. In Oregon, meanwhile, a consultant writes a blistering critique of that exchange and the governor's plan for its future.
Health News Colorado: Exchange COO Joins Exodus, New System Late
Colorado’s 2.0 “Kentucky-style” system that is supposed to simplify the way people get health insurance won’t be ready until days before the Nov. 15 open enrollment starts. And as Colorado’s health exchange enters its busy season, a third “chief” has announced she’s leaving Connect for Health Colorado. Chief Executive Patty Fontneau departed in August. Chief Financial Officer Cammie Blais left two weeks ago. And Chief Operating Officer Lindy Hinman announced her resignation and plans to leave next month after open enrollment begins (Kerwin McCrimmon, 10/14).
Oregonian: Report Cover Oregon Didn’t Want Submitted Shows Criticism Of Politics, Disagreement With Kitzhaber
A report that Cover Oregon officials privately asked a top consultant not to submit last month is an eye-opener: It provides a blistering critique of the health exchange's history, decries the politics of recent decision-making and significantly disagrees with Gov. John Kitzhaber's plan for the future of the exchange, according to documents obtained by The Oregonian (Budnick, 10/14).
Meanwhile, Virginia receives $9.3 million to sign people up for coverage -
The Associated Press: Virginia Receives Funds To Aid In Health Care Signups
Virginia is getting $9.3 million in federal funding to help residents sign up for health insurance. Gov. Terry McAuliffe said the money will help hire more than 100 people to help with enrollment that runs from Nov. 15 through Feb. 15. The governor's office says the grant will play a large role in helping McAuliffe implement his plan to expand health care to more than 200,000 Virginians. State officials say about 300,000 Virginians who are qualified for tax credits if they purchase insurance on the Federal Marketplace remain uninsured. The grant awarded by the Centers for Medicare and Medicaid Services allows Virginia to partner with the Virginia Community Healthcare Association and the Virginia Poverty Law Center (10/15).
And on the topic of Medicaid expansion -
St. Louis Post-Dispatch: Missouri Still Processing Medicaid Applications From Healthcare.gov
With just one month remaining until enrollment for 2015 opens on HealthCare.gov, the state of Missouri is still processing thousands of Medicaid applications left over from last year. Officials with the Missouri Department of Social Services said in an oversight hearing Tuesday that staffers are very close to processing the remaining 2,853 Medicaid applications from the federally facilitated online health insurance marketplace. In all, the department received 55,665 Medicaid applications from last year’s open enrollment period, which the department began receiving from the federal government in February 2014. Most of the applicants for Medicaid were ultimately deemed ineligible. Missouri officials say the federal government did not automatically kick out these ineligible applications and instead sent them to the state, which helped create a backlog (Liss, 10/15).
Richmond Times-Dispatch: Governor Placed Angry Call To Puckett Following Vote Scuttling Medicaid Expansion
A fuming Gov. Terry McAuliffe left a voice message for former state Sen. Phillip Puckett, D-Russell, after a June vote in the Virginia Senate that — due to Puckett’s resignation several days earlier — effectively [scuttling] the governor’s bid for Medicaid expansion. The call, one of at least two McAuliffe made to Puckett, and confirmed by Puckett’s attorney, reflected the governor’s personal rancor toward the former senator over the impact of his resignation. It allowed Republicans to block an attempt to draw down federal health care dollars that McAuliffe wanted to use to expand Medicaid coverage to thousands of uninsured Virginians (Nolan, 10/14).
A selection of health policy stories from California, Pennsylvania, Arizona, D.C., Texas and Missouri.
Kaiser Health News: California Prop. 46, Inspired By Tragedy, Pits Doctors Against Lawyers
Prop. 46 would make it mandatory for doctors to consult the database. California would become one of nine states requiring doctors to check before prescribing painkillers to first-time patients. After passing similar laws, Tennessee and New York saw a significant reduction in the number of narcotics prescriptions written. Studies have verified the correlation, but acknowledge that drug abusers may be turning to street drugs, like heroin. Many doctors in California like the database. Some have called it ‘indispensable.’ But they don’t like being told how to practice medicine (Dembosky, 10/14).
The New York Times: Philadelphia Teachers Hit By Latest Cuts
Money is so short at Feltonville School of Arts and Sciences, a public middle school here, that a nurse works only three afternoons a week, leaving the principal to oversee the daily medication of 10 children, including a diabetic who needs insulin shots. On the third floor filled with 200 seventh and eighth graders, one of two restrooms remains locked because there are not enough hall monitors. And in a sixth-grade math class of 33 students with only 11 textbooks to go around, the teacher rations paper used to print out homework equations. … The latest fund-raising effort came last week when the School Reform Commission, the state-appointed board that oversees the Philadelphia schools, unilaterally and abruptly canceled the union contract for teachers and required them to pay minimum health care premiums from $25 to $67 a month for a single person. Until now, teachers have not paid for health insurance (Rich, 10/14).
Arizona Central-Republic: Will Next Governor Keep Arizona’s Expanded Safety Net?
Gov. Jan Brewer took steps in recent years to restore Arizona's safety net by expanding health care for low-income Arizonans and beefing up funding for child welfare. Whether those key pieces of Brewer's legacy remain intact next year hinges in large part on the next governor, who will face an immediate budget deficit of more than a half-billion dollars when he takes office (Pitzl, 10/14).
Los Angeles Times: UCLA Study Offers Hope On Emergency Room Crowding
A new UCLA study has found that while people enrolled in low-cost, government-run health plans visit emergency rooms at high rates soon after becoming insured, the number falls dramatically within a year. That's good news, said study author and UCLA professor Dr. Gerald Kominski, because patients' long-neglected health problems are being "addressed during the first year, and because of that there's a drop-off." Some worry that the expansion of health coverage under the Affordable Care Act will not ease emergency room crowding as President Obama and others have predicted, but will instead encourage more people to go to the hospital (Karlamangla, 10/14).
The Washington Post: America’s Fastest-Growing Profession Is Joining A Very Public Fight For Higher Wages
Knowing what a difference higher pay can make, Reece has joined a new movement launching this week to raise wages and improve workplace protections for home health-care aides nationwide. Backed by the Service Employees International Union, the effort seeks to replicate the “Fight for 15,” a push earlier this year to raise the income of fast-food workers through high-profile strikes. On Wednesday, Reece will rally on D.C.’s Freedom Plaza to demand the same for home health-care aides. It’s part of actions in nine states aimed at putting the concerns of the nation’s fastest-growing workforce — one that’s 91 percent female, 56 percent non-white and highly dependent on public aid — on the political agenda. About 600,000 of the country’s 2.1 million home health-care aides are members of the SEIU (DePillis, 10/14).
Arizona Central-Republic: DOC Agrees To Major Improvements In Health Care
At first, the Arizona Department of Corrections refused to admit there was a dire problem with regards to the administering of health care to state prisoners. Today, a settlement agreement has been reached in a class-action lawsuit (Halloran, 10/14).
The Wall Street Journal: Arizona Agrees To Improve Prison Conditions In Settlement With ACLU
The state Department of Corrections will take more than 100 measures to change its practices on providing prisoners with medical and mental-health care, according to terms of the deal, filed Tuesday in the U.S. District Court of Arizona. The settlement covers Arizona’s state prison system, which holds more than 33,000 inmates. The new measures, according to the agreement, will allow mentally ill prisoners who are held in isolation to have better access to treatment and 19 hours a week outside their cells; will provide more medical and dental care for the overall prison population; and will restrict the use of pepper spray to situations that jeopardize the safety of prisoners or guards or compromise prison security (Lazo, 10/14).
Arizona Central-Republic: Prison Health-Care Settlement May Add To Ariz. Deficit
Arizona must significantly improve health-care and mental-health-care treatment for about 33,000 prison inmates under a proposed settlement of a class-action lawsuit brought in 2012 by prison-rights groups. That suit charged that the state unconstitutionally denies adequate care to inmates in state prisons and routinely keeps mentally ill prisoners in solitary confinement under brutal conditions. Under the settlement announced Tuesday, the state does not admit any wrongdoing. The settlement would reduce the amount of time mentally ill inmates spend in solitary confinement and would restrict guards' use of pepper spray to control those inmates. Spray could be used only to prevent serious injury or escape (Ortega, 10/14).
Dallas Morning News: CMS Approves Baylor’s Plan To Remove ‘Immediate Jeopardy’ Determination
The Centers for Medicare & Medicaid Services has approved Baylor University Medical Center’s plan to correct deficiencies that threaten its federal funding. CMS sent the hospital an “immediate jeopardy” warning last week after inspectors found several instances of psychiatric patients walking away from the emergency department before treatment concluded. After such warnings, hospitals have 23 days to fix the problems that jeopardize patient safety or else risk termination of Medicare eligibility. Medicare accounts for about $300 million of the medical center’s $1 billion in annual revenue (Jacobson, 10/14).
Kansas City Star: Carondelet Health To Sell Two Kansas City-Area Hospitals To Prime Healthcare Services
Carondelet Health, a part of the Ascension hospital chain, said Tuesday that it had signed a definitive agreement to sell its two Kansas City area hospitals to Prime Healthcare Services. St. Joseph Medical Center in Kansas City and St. Mary’s Medical Center in Blue Springs will become part of the for-profit Prime hospital chain, subject to regulatory approval. The two Carondelet hospitals are approved for 450 beds and have 900 physicians on their combined staffs. Ascension is a not-for-profit Catholic health care organization based in St. Louis. The Prime chain employs more than 30,000 and operates 27 hospitals in seven states — California, Michigan, Nevada, Pennsylvania, Rhode Island, Texas and Kansas. It previously acquired Providence Medical Center in Kansas City, Kan., and St. John Hospital in Leavenworth (Stafford, 10/14).
The Washington Post examines the efforts by Ohio Gov. John Kasich, a Republican, to redefine the GOP. While touting party orthodoxy on economic matters, he has embraced his own version of compassionate conservatism, among other things, implementing the health law's Medicaid expansion. And he is sailing to re-election in a key battleground state.
The Washington Post: Ohio’s John Kasich Wants To Redefine The Republican Party
If Kasich were to run in 2016, he would probably face some serious obstacles, in part because he has not spent the past year getting ready to run. GOP strategists suggest he would enter as a candidate at the top of the field’s second tier, as neither a purely establishment nor purely tea party candidate. He would carry baggage among conservatives for having expanded Medicaid under the Affordable Care Act but could point to success in Ohio as a sign of how he might do in general-election battlegrounds (Balz, 10/14).
Meanwhile, the health law continues to be a hot topic in the Arkansas Senate race -
The Associated Press: Cotton, Pryor Tangle Over Health Law’s Impact
Democratic U.S. Sen. Mark Pryor accused Republican Rep. Tom Cotton of having "no answer" for Arkansans receiving coverage under the federal health overhaul, a law that Cotton called a disaster that must be repealed as the two squared off in their second televised debate Tuesday. The two candidates in the hotly contested Arkansas Senate race faced off in their only head-to-head matchup, with less than a week to go before the first votes are cast for the November election. Early voting begins Oct. 20. Pryor accused Cotton of having no solution for the nearly 200,000 Arkansans receiving coverage through the state's "private option" compromise Medicaid expansion if the federal health law is repealed. Cotton criticized Pryor for his vote for the overhaul, and said repealing it would allow for reforming the health care system and giving states control over programs such as Medicaid. "I think we have to start over on health care reform because Obamacare is a disaster," Cotton said (DeMillo, 10/14).