COLORADO SPRINGS, Colo. — Jars labeled butterscotch, chocolate mint and caramel macchiato tea glisten inside the lit refrigerator. The shelf above is stacked with pizza, flatbreads and butter. The one below has lemon bars, brownies and cookies.
The fridge could be in any higher-end grab-and-go lunch stop. But to shop here, you must present a medical marijuana patient card. And the ingredient list includes the type of pot, along with flour, sugar, milk, etc.
This is Trichome Health Consultants, a medical marijuana dispensary tucked into a line of glass storefronts on a semi-commercial strip in Colorado Springs, Colorado. As Massachusetts prepares to open its first dispensary, possibly in April, this is a glimpse into the future.Medical Marijuana In Mass.
- Timeline: Key Dates In Massachusetts:
- 11/6/12: Medial Marijuana Legalized In Mass.
- 8/23/13: 181 Apply For Dispensary Licenses
- 1/31/14: 20 Dispensaries Approved
- 6/27/14: DPH Disqualifies 9 Planned Dispensaries
- 11/7/14: 4 More Dispensaries Approved
- 1/2/15: First Mass. Dispensary Cleared To Grow
- More Medical Marijuana Coverage:
- What’s In Your Medical Marijuana?
- 10 Things To Know Before Using
- What A Dispensary Worker Needs To Know
- Bracing For ‘Big Marijuana’
- Complete Coverage: Medical Marijuana
At first glance, it’s a dizzying array of options.
There 11 different kinds of chocolates, granola bars, dog treats, lotions, lip balms and salves along one wall. Colorful pipes, vaporizers and other marijuana accessories line shelves. A long glass case is filled with jars of the classic product: marijuana buds.
Customers are buzzed into Trichome’s sales room. There are security cameras at the front door and back door, and one that scans the room constantly.
All marijuana sold here is grown by Trichome.
“We don’t trust that someone didn’t use a pesticide or they may have powdery mold or pest issues,” says Cami Hall, the CFO and a Trichome co-founder. “If you don’t know how it’s grown, you don’t know how it’s going to affect your patients.”
Massachusetts requires that dispensaries grow the marijuana used in all products, a rule called “seed to sale.” Colorado is less strict. Trichome buys some of the products it sells — the bottled teas, for example — from another company.
Every jar, plastic bottle or wrapper has a label that traces the marijuana to a specific plant. In Massachusetts, labels will list the breakdown of cannabinoids — the chemical compounds in marijuana — in each product.
Prices vary a lot. Those flavored teas, with 300 milligrams of marijuana, may be the best value at $16 a bottle, says Hall. Some of the higher-end strains of dried buds go for $200 or more an ounce.
Health insurance does not cover marijuana in Colorado or Massachusetts, and the cost of treating pain or other ailments with the drug can add up.
Kevin Bailey spends $600-$700 a week treating headaches he says date back to a childhood head injury. At Trichome this day he’s buying a strain called Sour Diesel, which goes for $175 an ounce.
“That’s premium, that’s grade A,” says Bailey, who turns toward glass cookie-style jars filled with Grade B, or lower strength, marijuana buds at the other end of the counter. “It depends on what kind of potency that you need. For different people, some of these lower potencies aren’t good enough.”
Bailey has been prescribed various pain medications over the years, but he prefers marijuana.
“This for me is best for me,” he says. “Some people might feel like prescription pain pills is good for them, but in the long run that’s poison. I feel like it’s poison.”Map: Marijuana Dispensaries
Patients generally figure out which type of marijuana works for them, and the best way to take it, through trial and error. Trichome co-founder J. Card keeps a database of every patient, their ailment and the types of marijuana they’ve tried. He uses the information to help new patients find a useful strain.
“So whatever patients we had with Crohn’s disease we can go in there and see that 10 patients with Crohn’s habitually used these types of strains because they seemed to work more than other strains,” Card says.
Card is not required to track patient’s responses to marijuana and there is no such requirement in Massachusetts.
Bailey pays in cash, as do most patients at this dispensary. Trichome has been able to accept credit cards, but this is not a stable option. Credit card companies are not allowed, by federal law, to process illegal transactions. Marijuana sales are still illegal under federal law.
Trichome has had trouble finding a bank willing to handle its finances. The dispensary has opened, and been forced to close, six accounts since it opened in 2008.
Card says he’s worked hard to establish to Trichome’s professional image in the community and distance himself from the tie-dye T-shirt culture.
“Our consultants here wear medical scrubs,” he says. “They train every day on how to help people with ailments, on which strain helps them.”
Card only sells marijuana to registered patients and has no plans to expand to the recreational marijuana market, which is now legal in many counties in Colorado.
“My fear is that recreational [marijuana] is going to overcast medicinal and the true valuable aspects of the medicinal are going to be taken away because of the people who just want to use it to get high,” Card says.
That tension — between the supporters of medical marijuana and those building the recreational pot market — has not hit Massachusetts yet.
Here, more than two years after voters approved a medical marijuana law, there are no dispensaries open yet. The first may, if there are no further hitches, open this April or May in Salem. So far, there are 4,975 registered patients in Massachusetts, awaiting the dispensaries.
Making health insurance available and affordable to millions of people who buy their own coverage was a key goal for backers of the federal health law known as Obamacare.
But if the Supreme Court strikes down the insurance subsidies of millions of Americans who rely on the federal insurance marketplace, it could leave many worse off than they were before the law took effect, say experts.
“The doomsday scenario could materialize and it does impact everyone” — those getting subsidies, as well as those paying the full cost of their plans on the individual market in states using the federal exchange, said Christopher Condeluci, an attorney who worked for Iowa Republican Sen. Charles Grassley on the Senate Finance Committee staff during the drafting of the law.
That’s because millions of consumers likely would drop their policies, which they could no longer afford without subsidies.
Most insurers could not drop plans without giving one-to-three months’ notice. But the companies remaining in the market would likely seek sharp increases in premiums for the following year, anticipating that the consumers most likely to hold onto their plans would be those needing medical care.This KHN story can be republished for free (details).
One Rand analysis projects that unsubsidized premiums could increase by almost half — an average annual increase of $1,600 for a 40-year-old — and that 70 percent of consumers would cancel their policies.
Those price increases, in turn, would drive more people to drop coverage, spurring further price hikes and potentially leading to what insurance experts call “a market death spiral.”
“It’s not the subsidy market that will fall apart, it’s the whole market” for everyone who doesn’t get job-based insurance coverage, said Robert Laszewski, a consultant for the insurance industry who is no fan of the health law. “There will be millions of Republicans who are not subsidy-eligible who are also going to get screwed.”
At issue in King v. Burwell — slated to be argued before the Supreme Court March 4 — is the basis of subsidies that go to millions of low- and moderate-income Americans in the approximately three dozen states that rely on the federal marketplace. More than 85 percent of the 8.6 million people who purchased plans in those states qualified for subsidies, administration officials say.
The law’s challengers point to four words in the Affordable Care Act that say subsidies shall be distributed through marketplaces “established by the state.” They argue that that wording bars the government from subsidizing insurance purchased through a federally administered exchange.
Supporters of the law argue that Congress intended the subsidies be available through both federally run and state-run markets, which they say is clear in reading the overall bill.
The ruling would have no effect on the subsidies provided to residents through state-run markets, such as those in California, New York and Washington.
The Obama administration has declined to discuss contingency plans, expressing confidence that it will prevail with the justices. “Congress would not pass a law that 87 percent of folks would not get subsidies, but people in say, New York, would,” Health and Human Services Secretary Sylvia Mathews Burwell said Wednesday.
Experts say Congress could also apply “fixes,” such as voting to allow subsidies to continue through the rest of the year.
But whether a Republican-controlled Congress that has pledged itself to the law’s repeal would agree to that is uncertain.
Aetna spokeswoman Cynthia Michener said the insurer is talking with lawmakers from both parties “about how to make a grand bargain should the Supreme Court decide against federal exchange subsidies.” A decision to strike the subsidies would likely “spur bipartisan action to resolve the issue promptly,” she added.
At the state level, officials could decide to establish state-run marketplaces, but they would have to move fast before the start of open enrollment for 2016, tentatively set to begin Nov. 1. And lawmakers in many GOP-led states are likely to resist such steps, citing opposition to the law.
Governors in at least five of the states — Louisiana, Mississippi, Nebraska, South Carolina and Wisconsin — told Reuters they would not create their own exchanges if the court invalidated subsidies.
In another four — Georgia, Missouri, Montana and Tennessee — politics could make it very difficult to set up a state program, Reuters reported.
Florida and Texas, where there is strong opposition to the health law, but also large numbers of residents benefitting from subsidized coverage, officials would face even tougher decisions. “Florida has the highest number of enrollees in the federal marketplace and guess who is running for president? The former governor of Florida,” said Condeluci.
That might make Florida lawmakers more agreeable to a solution that would keep subsidies flowing, he said, noting that “Republicans are going to be blamed for the subsidies ceasing.”
Insurers that sell plans in the federal exchange states would find themselves in a drastically changed market.
Joel Ario, a managing director at consultancy Manatt Health Solutions, said insurers are already working on rates for 2016, which are scheduled for submission by April — two months before the court is expected to rule.
Some insurers have asked state regulators if they could submit two sets of rates for 2016, one that would reflect the subsidies being struck, he said. That idea was backed this week in a letter to the Obama administration by the professional society of the nation’s actuaries, who help insurers set rates.
As for the states, Ario estimated that perhaps one third would set up their own markets fairly quickly. If states move at the same rate as they have to expand Medicaid, it could take several years before two-thirds of states have their own markets he said.
Even if insurers wanted to drop coverage immediately in the event the high court struck the subsidies, most could not do so legally. State laws require anywhere from 30 days to 90 days’ notice for an insurer to exit a market. And, if they withdraw, they have to pull all their plans, not just those offered through the federal exchange. Under state rules, they may not be allowed back into the market for years, creating a disincentive to bail out, said Laszewski, whose clients include major insurers.
Many insurers don’t yet have contingency plans, he said, partly because it’s so hard to tell what may happen or what alternatives might be available.
“This is the nuclear option and there really isn’t a contingency plan for nuclear destruction,” Laszewski said.
Others don’t see a ruling against the administration in such dark terms.
“The Supreme Court generally doesn’t go out of its way to wreck the economy or the health system,” said Stuart Butler, a conservative scholar and senior fellow at the Brookings Institution.
He believes the court is likely to offer some temporary remedy, such as a grace period when the subsidies could continue to flow.
“The idea that there will be some cataclysm the day after is extremely unlikely,” Butler said. “We’ll see a number of states moving toward essentially setting up a state exchange. We could still see Texas and a few others saying no. But if two-thirds of states find a way to accommodate it, I don’t see that a critical mass for the collapse of the Affordable Care Act is there.”
Gov. Charlie Baker has asked for and received the resignations of four members of the state’s Health Connector board, including MIT economist Jonathan Gruber.
Gruber came under fire for saying it was “the stupidity of the American voter” that led to the 2010 passage of President Obama’s heath law. Gruber was called to testify before Congress in December. He told lawmakers that he was “inexcusably arrogant” when he made the statement.
Baker also asked for the resignations of board members George Gonser, John Bertko and Rick Jakious, all appointees of former Gov. Deval Patrick.
The board oversees the state’s health care law.
In a letter, Baker said he’s establishing a new leadership team and wants to take a fresh look at the Connector and improve the operation of that agency.
In a phone interview, Gruber told WBUR Baker’s move isn’t about politics.
“I think it’s about wanting to make sure that the people that are on the board align with his vision of where health care should go in Massachusetts,” Gruber said.
With reporting by The Associated Press and the WBUR Newsroom
Buying health care in America is like shopping blindfolded at Macy’s and getting the bill months after you leave the store, economist Uwe Reinhardt likes to say.
A tool that went online Wednesday is supposed to give patients a small peek at the products and prices before they open their wallets.
Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan?
Guroo.com shows the average local cost for 70 common diagnoses and medical tests in most states. That’s the real cost — not “charges” that often get marked down — based on a giant database of what insurance companies actually pay.
OK, this isn’t like Priceline.com for knee replacements. What Guroo hopes to do for consumers is limited so far.
It won’t reflect costs for particular hospitals or doctors, although officials say that’s coming for some. And it doesn’t have much to say initially about the quality of care.
Still, Guroo should shed new light on the country’s opaque, complex and maddening medical bazaar, say consumer advocates.
“This has the potential to be a game-changer,” said Katherine Hempstead, who analyzes health insurance for the Robert Wood Johnson Foundation. “It’s good for uninsured people. It’s good for people with high deductibles. It’s good for any person that’s kind of wondering: If I go to see the doctor for such-and-such, what might happen next?”
Guroo is produced by the Health Care Cost Institute (HCCI) working with three big insurance companies: UnitedHealthcare, Aetna and Humana, soon to be joined by a fourth, Assurant. The idea is to eventually let members of these plans use a companion site to see how differing provider prices affect their co-payments.This KHN story can be republished for free (details).
A nonprofit known for its cost and utilization reports, HCCI receives some industry funding but is governed by an independent board. This is its first tool for consumers.
Consumer advocates praised Guroo but cautioned that the movement toward “transparency” in medical prices is still in its very early stages. Data on insurer, employer or government Web sites are often limited or inaccurate. Consumer information from Fair Health, which manages another huge commercial insurance database, is organized by procedure code.
Even on Guroo, “the average user may not have a good sense of what they’re looking at and what they’re supposed to do with the resulting price,” said Lynn Quincy, a health care specialist at Consumers Union.
HCCI says its prices are what insurers pay for about 70 tests and “bundles” of services described in understandable terms so patients don’t need a medical textbook to figure out what they are. Users get the average as well as a range for local and national prices.
It plans to add more procedures later — all for “shoppable” services that can be scheduled, not emergency treatment of a heart attack.
“This at least arms consumers with information about the range of prices in their community [for] one of these care bundles,” said David Newman, HCCI’s executive director.
If you have a high deductible, for example, you might use Guroo as a starting point for checking prices from medical providers if your insurance company doesn’t provide such a tool.
That’s not the same as seeing provider-specific prices online, of course. But within a year, HCCI expects to let members of UnitedHealthcare, Aetna, Assurant and Humana track spending on a companion site and check how switching caregivers could lower their out-of-pocket costs.
Initially Guroo doesn’t have much information about quality of care, either, which is essential to help patients to make smart choices. Newman says that is coming, too. It’s also missing information for Alabama, Michigan and several other states.
BlueCross BlueShield of North Carolina set a high standard for disclosure recently by posting prices — doctor by doctor and hospital by hospital — based on its reimbursement rates, Quincy said. Guroo doesn’t do that.
Still, she said, it’s an important step.
Given its size, influence and openness, Guroo could become a dominant portal for health care prices, said Hempstead.
“Their stance as a neutral broker and the amount of data that they have and the amount of data that they’re going to have really puts them in a difference place,” she said.
Testimony of Robert Greenstein President, Center on Budget and Policy Priorities Before the House Committee on Agriculture
You’ve probably seen those scary maps showing a wave of obesity engulfing the country over the last generation, as state after state converts to more-overweight-than-not. The map above comes from a similar animation, only the wave is diabetes. Watch the states turn alarming colors over time here.
For many of us as we age, Type 2 diabetes is not so much a question of “if” as “when.” So even if you don’t have diabetes now, here’s a bit more inspiration to help fend it off with exercise: Researchers report that — in mice, at least — exercise appears to protect powerfully against a potentially fatal heart complication of diabetes.
The complication is called diabetic cardiomyopathy, and it can lead to heart failure. It may not be first on your list of fears (especially if you’ve never heard of it before, as I hadn’t), but these new findings serve as yet another demonstration of the countless ways that exercise may defend you against health harms. From the University of Virginia Health System’s press release:
“This is a proof of concept. It shows that an antioxidant coming from skeletal muscle that can be induced by exercise training can provide profound protection against an important detrimental disease condition,” said UVA researcher Zhen Yan, PhD. “The implication is if we can come up with a strategy to promote [this effect] in people who are vulnerable to, or already developing, diabetes, that could prevent the development of diabetic cardiomyopathy.”
Yan and his team used genetically modified mice to show that enhancing the production of a molecule called EcSOD – which is produced in skeletal muscle and promoted by regular exercise – would prevent the damaging effects of diabetic cardiomyopathy. These effects include stiffening and enlargement of the heart, which can lead to heart failure.
While the work amplified the expression of the molecule to levels beyond what normal exercise would produce, Yan said it’s an important demonstration of the concrete benefits of regular exercise in people. “Our studies show that even as little as two weeks of exercise could significantly elevate the level in the blood and the heart,” he said.
Yan says he’s also hoping to develop a pill that could help patients who can’t exercise, or boost the effect in people who can. Ah, yes, the eternal search for the exercise pill. Don’t hold your breath — better to huff and puff instead.