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In Arkansas' Private-Plan Medicaid Expansion Model, Enrollees May Have To Contribute To HSAs

Kaiser Health News - Wed, 08/20/2014 - 9:25am

Meanwhile, in Wisconsin, Gov. Scott Walker defended his Medicaid policy and decision not to pursue the health law's expansion.

Modern Healthcare: Arkansas May Make Medicaid Enrollees Fund HSAs
Arkansas, the first state to establish the conservative private-plan model for expanding Medicaid under the Patient Protection and Affordable Care Act, now is looking to join several other conservative-leaning states in requiring low-income beneficiaries to make monthly contributions to their health coverage in the form of a health savings account. The state has proposed to the CMS that, beginning in 2015, its Medicaid beneficiaries would have to contribute to Health Independence Accounts (PDF). Beneficiaries with annual incomes between 50% and 99% of the federal poverty level would contribute $5 a month to their accounts, while those earning between 100% and 138% of poverty would pay between $10 and $25. The state would provide a matching contribution of $15 into their accounts (Johnson, 8/19).

Related KHN coverage: Arkansas Weighs Plan To Make Some Medicaid Enrollees Fund Savings Accounts (Andrews, 7/22).

Green Bay Press-Gazette: Walker On Medicaid: Dems 'Living In Alternate Universe'
Gov. Scott Walker countered attacks against his Medicaid policy saying Wisconsin has a "very unique" approach that provides health coverage for all poor people without taking on additional financial risk. Walker came under fire this week by Democrats who solicited a report from the nonpartisan Legislative Fiscal Bureau that found the state could have saved $206 million in its current biennial budget and another $315 million in its 2015-17 budget if Walker accepted federal money to expand Medicaid. ... At a campaign stop in De Pere on Tuesday, Walker said the reports are based on hypothetical circumstances and assume the federal government will follow through with the full funding amount (Rodewald, 8/19).

Categories: Health Care

Md. Officials Vow To Have Marketplace Working In November

Kaiser Health News - Wed, 08/20/2014 - 9:25am
The online insurance website was plagued with problems during last year's enrollment season, but state officials say they are confident the $40 million reconstruction of the site will work.

The Washington Post: Md. Health Officials: Rebuilt Health Insurance Online Site Will Be Fixed By Nov.
Maryland Gov. Martin O'Malley's administration is confident that its rapid rebuilding of the state's health insurance Web site is progressing as planned and will be ready before the next enrollment period begins in November. The state's first attempt at launching a site was riddled with technical problems that made it much more difficult for residents to sign up for health insurance made possible by the Affordable Care Act. Maryland is now rebuilding the site using technology developed by Connecticut. The fix is estimated to cost at least $40 million, if not much more (Johnson, 8/19).

Baltimore Sun: Health Exchange Seeks To Re-Enroll All Who Bought Insurance Plans
Maryland health exchange officials plan to contact every person who bought one of their insurance plans last year to get them to re-enroll in November. Most of the nearly 79,000 people who gained private coverage in the state under the Affordable Care Act were subsidized, and they will lose that benefit if they don't sign back up manually. Most people who do nothing will be automatically re-enrolled in the same or equivalent plans, according to Dr. Joshua M. Sharfstein, state health secretary and chairman of the exchange board. Evergreen Health Co-op, one of four insurers on the exchange, changed its plans too significantly to roll anyone over, he said (Cohn, 8/19).

In other exchange news -

Dallas Morning News: Group: Nearly 400,000 Texas Adults Have 'Life Events' And Qualify To Sign Up For Obamacare Before November
Round two of Obamacare enrollment starts Nov. 15. But a group promoting signups wants Texas' 5 million uninsured adults between the ages of 18 and 64 to know that as many as 365,000 of them are eligible today to go online and enroll in the federally run health insurance marketplace. ... if you move to another county, get married, have or adopt a child or gain citizenship, you have had what the Affordable Care Act deems a life-changing event that triggers a special enrollment period — right now. On Tuesday, the group Enroll America and its Get Covered America campaign, which operates in Texas and 10 other states, released a report estimating that 365,691 uninsured adult Texans will experience one or more of those qualifying events in the 7 1/2 months between enrollment periods (Garrett, 8/19).

Los Angeles Times: Anthem Blue Cross Sued Again Over Narrow-Network Health Plans
Health insurance giant Anthem Blue Cross faces another lawsuit over switching consumers to narrow-network health plans — with limited selections of doctors — during the rollout of Obamacare. These types of complaints have already sparked an ongoing investigation by California regulators and other lawsuits seeking class-action status against Anthem and rival Blue Shield of California (Terhune, 8/19).

Categories: Health Care

Iowa Telemedicine Abortion Ban Stands After Ruling

Kaiser Health News - Wed, 08/20/2014 - 9:24am

Planned Parenthood of the Heartland had claimed the ban was meant to limit abortions for women who live in rural areas.

Des Moines Register/USA Today: Judge Rules Against Use Of Telemed Abortion System
Iowa regulators were within their authority when they voted to ban a first-in-the-nation videoconferencing system that allows doctors here to dispense abortion drugs to women in rural clinics, a Polk County District Court judge ruled Tuesday. Planned Parenthood of the Heartland had sued the Iowa Board of Medicine, contending that the board's decision to ban doctors from using its system was a blatant attempt to limit rural women's access to abortions (Leys, 8/19). 

Bloomberg: Planned Parenthood Loses ‘Telemedicine Abortion’ Ban Suit
An Iowa law barring doctors from remotely dispensing pregnancy-ending drugs withstood Planned Parenthood’s claim that it would impose a hardship on women living far from abortion providers. The decision by Polk County District Judge Jeffrey Farrell in Des Moines upholds an Iowa Board of Medicine rule requiring physicians to be present and to perform a physical examination before drugs are dispensed. Planned Parenthood of the Heartland Inc. claimed the restriction would compel women to travel farther to obtain abortions, leading to delays and a potential increase in illegal abortions. Farrell said the board had a legitimate basis for its measure (Harris, 8/19).

Categories: Health Care

Big Support For Insurance Rate Regulation Measure In California

Kaiser Health News - Wed, 08/20/2014 - 9:24am

A proposal to randomly drug test doctors and up the limit on medical malpractice lawsuit awards also has a strong show of support in the poll. 

The Sacramento Bee: Field Poll: Strong Support For California Health Insurance Rate-Regulation Measure
A California initiative on the fall ballot requiring that health insurance rate changes be approved by the elected insurance commissioner is receiving strong support from voters statewide, according to the latest Field Poll. Nearly 70 percent of registered voters back Proposition 45, while 16 percent say they would oppose it and 15 percent remain undecided ahead of the Nov. 4 election. Support came from 75 percent of Democrats, 73 percent of independents and 58 percent of Republicans. Meanwhile, a separate initiative mandating random drug testing of doctors and quadrupling the state’s $250,000 limit on medical malpractice awards was out ahead by a smaller majority. Proposition 46, which also would compel doctors to consult a state drug history database before issuing certain prescriptions, is supported by 58 percent, opposed by 30 percent and has 12 percent undecided (Cadelago, 8/20).

And California voter approval of the federal health care law grows --

The San Francisco Chronicle: Voter Approval Of Health Care Law Climbing, Poll Shows
Most California voters gave the state's rollout of the federal health law high marks and overall support of the Affordable Care Act is on the rise, according to a Field Poll released Tuesday. The survey of more than 1,500 registered voters between June 26 and July 19 found that by a 2-to-1 margin -- 60 percent to 30 percent - respondents thought the state was successful in implementing the law, results that contrasted with the federal effort. Less than half described the federal rollout, which was plagued with high-profile technical glitches, as successful. Moreover, statewide support of the Affordable Care Act is at its highest level since its introduction in 2010, with the Bay Area recording the highest rates of support of any region, the poll found (Colliver, 8/19).

The San Jose Mercury News: Obamacare Poll: Californians Of All Political Stripes Show Increased Support Of Health Care Law
The nation's new health care law is surging in popularity in the Golden State, according to a Field Poll, which finds more Californians today -- of all political stripes -- support the Affordable Care Act than at any time since it was signed into law four years ago. And by a 2-1 margin, they praise the successful way it's been rolled out in the state, compared to the federal government's glitch-ridden system. Still more now say they're satisfied with the way the health care system is working in the state, compared to a year ago (Seipel, 8/19).

Categories: Health Care

Advocates Decry Closing Of Mental Health Clinics In Chicago

Kaiser Health News - Wed, 08/20/2014 - 9:24am

But officials say the closings, which planned to shutter six of the city's 12 mental health clinics, actually expanded care for those with mental illnesses.

Chicago Tribune: Chicago Mental Health Clinic Closings Spark Opposing Views
Mayor Rahm Emanuel’s mental health care policies went on trial at City Hall Tuesday, with critics saying many patients ended up homeless, jailed or dead after the mayor closed half of the city’s clinics, while city officials maintained that care for the mentally ill actually has been expanded. Those opposing views were aired during nearly five hours of testimony before the City Council Health Committee, where advocates for reopening the closed clinics got the hearing they’ve been seeking for years. There was no clear verdict on what needs to be done, although all parties agreed on the need for expanded and improved mental health care for low-income city residents after years of local, state and federal cuts (Dardick, 8/19).

Chicago Tribune: Chicago Council To Hold Hearing On Closing Of Mental Health Clinics
More than two years after Mayor Rahm Emanuel closed six of the city’s mental health clinics, patients, unions and other critics that continue to oppose the move are getting a hearing on the matter. They contend many patients “fell into severe depression, addiction, psychosis, incarceration and general crisis due to losing their clinics and/or therapists,” according to a news release issued this morning. City officials, meanwhile, maintain that they worked to help all displaced patients find other options, either at clinics that remained open or at other nonprofit clinics that receive federal funding (Dardick, 8/19).

The Chicago Sun-Times: Mental Health Advocates Blast Emanuel’s Clinic Closings
Mayor Rahm Emanuel’s two-year-old plan to close six of the city’s 12 mental health clinics came under withering attack Tuesday, with advocates accusing the mayor of throwing Chicago’s most vulnerable residents to the wolves. Cut off from familiar therapists and forced to travel longer for treatment, thousands of patients fell through the cracks, sometimes tearful mental health advocates claimed. Some [dissolved] into depression or returned to past addictions. Others were arrested, turning Cook County Jail into, what Sheriff Tom Dart has called the “largest mental health hospital” where patients are “criminalized” instead of being given the care they desperately need (Spielman, 8/19).

Elsewhere, mental health care in San Antonio, Texas, is examined, and rural states use a different kind of counselor to deliver mental health care --

Kaiser Health News: Wrestling With A Texas County’s Mental Health System
Evans is the director of the Center for Health Care Services, the community mental health system in San Antonio and Bexar County. Texas ranks 49th out of 50 states in how much funding it commits to mental health. But under Evans’ leadership, Bexar County has built a mental health system considered a model for other cities across the country -- one that has saved $50 million over the past five years (Gold, 8/20).

Stateline: In Rural States 'Pastoral Counselors' Help Fill Mental Health Gap
Kentucky recently became the sixth state (joining Arkansas, Maine, New Hampshire, North Carolina and Tennessee) to allow pastoral counselors to become licensed mental health counselors. As of now, Kentucky only has 20 licensed pastoral counselors. But the hope is that licensing will increase those numbers by making it easier for pastoral counselors to receive health insurance reimbursement and by adding luster to the field (Ollove, 8/20).

Categories: Health Care

State Highlights: Audit Says $93M In Medi-Cal Payments Could Be Fraudulent; Mass. Insurers Press On Medicaid Pay

Kaiser Health News - Wed, 08/20/2014 - 9:23am

A selection of health policy stories from the District of Columbia, California, Massachusetts and Minnesota.

Los Angeles Times: Auditor Says $93 Million In Medi-Cal Payments Could Be Fraudulent
The audit released Tuesday reviewed billing data from July 2008 to December 2013 for Medi-Cal's Drug Treatment program, which reimburses rehabilitation clinics. The audit found the state's Department of Health Care Services and the Department of Alcohol and Drug Programs failed to administer the program "and created opportunities for fraud" (Karlamangla, 8/19).

Reuters: California May Have Paid Millions For Fraudulent Drug Treatments
A California program that covers addiction treatments for the poor may have paid $93.7 million in fraudulent claims, a state audit showed. The report released Tuesday by the California State Auditor showed that the state's Drug Medi-Cal program may have paid more than $3 million in claims for patients who were actually dead, and found serious deficiencies in the agency's records for 30 drug treatment program providers. The audit was spurred by a 2013 investigation by The Center For Investigative Reporting and CNN, which found questionable billing practices at drug-treatment clinics in Southern California. The program is a division of the state's healthcare program for the poor, known as Medi-Cal (Mendelson, 8/19).

The Boston Globe: Medicaid Insurers Prod State On Funds
Buckling from more than $140 million in losses since the start of the year, companies that insure Medicaid patients are pressing the Patrick administration to increase payments they receive from the state for serving low-income residents. The health insurers say the deficits are the result of an expensive new hepatitis C drug and a surge of nearly 190,000 new members -- many with serious medical issues -- assigned to the companies by MassHealth, the state Medicaid program. Insurers say the state did not budget enough money this year to cover the added costs (8/20).

The Associated Press: Medicaid Insurers Seek More From Massachusetts
Companies that insure Medicaid patients in Massachusetts are pressing for an increase in the payments they receive from the state for serving low-income residents. The health insurers say $140 million in losses since the start of the year are the result of an expensive new hepatitis C drug and a surge of nearly 190,000 new members assigned to the companies by MassHealth, the state Medicaid program. Insurers say the state did not budget enough money to cover added costs (8/20).

The Washington Post: Rare D.C. House-Call Doctor Straddles Two Washingtons
[Dr. Ernest] Brown is a rarity: a family medicine doctor who performs house calls. Working mostly in the District, he’s fully independent and unaffiliated with insurance programs. His work straddles two Washingtons. His paying patients are foreign and domestic travelers, including foreign dignitaries, staying at the city’s hotels. Treating those clients allows him to serve as the primary care doctor -- pro bono -- for more than a dozen elderly homebound residents in poorer neighborhoods (Najarro, 8/19).

The Star Tribune: National Group Tries To Halt Union Election Of Personal Home Care Providers In Minnesota
U.S. District Judge Michael Davis is expected to decide Wednesday whether to stop the biggest unionization election in Minnesota history. Davis said at a hearing Tuesday that he’ll decide by noon whether to issue a temporary injunction that would halt an election, now in progress, to determine if nearly 27,000 personal home health care workers will be represented by the Service Employees International Union (SEIU). The injunction is being sought by the National Right to Work Foundation, a Florida-based organization that has fought unionization. It sued on behalf of some home care providers who oppose the union (Furst, 8/19). 8/19).

Categories: Health Care

Viewpoints: Threat To Drug Development; GOP's Obamacare Criticism Tempered; Finding Doctors For Seniors

Kaiser Health News - Wed, 08/20/2014 - 9:23am

The Wall Street Journal: The Medical Innovation Threat
An invasive species has been introduced into the U.S. health innovation ecosystem, with a growing danger of permanent damage to the development of specialty drugs. The relentless assault on the price of Sovaldi is becoming a threat to the 30-year political balance that has energized the biomedical revolution (8/19).

Bloomberg: Obamacare Fades Right On Schedule
Obamacare is fading as a campaign issue. It hasn't disappeared entirely. But after totally dominating the ad landscape in the spring, Obamacare has dropped to just another issue in Republican ads. Health-care has also plummeted in polling on issues important to voters in this cycle. And as Greg Sargent has been documenting, Republican candidates have shifted to a more nuanced position -- they still almost all say they support repeal, but they weasel around the idea that various ACA programs and benefits will be included in that supposed repeal (Jonathan Bernstein, 8/19). 

The New York Times' The Conscience Of A Liberal: Beyond The Lies
The reason is fairly obvious, although it's not considered nice to state it bluntly: the attack on Obamacare depended almost entirely on lies, and those lies are becoming unsustainable now that the law is actually working. No, there aren't any death panels; no, huge numbers of Americans aren't losing coverage or finding their health costs soaring; no, jobs aren't being killed in vast numbers. A few relatively affluent, healthy people are paying more for coverage; a few high-income taxpayers are paying more in taxes; a much larger number of Americans are getting coverage that was previously unavailable and/or unaffordable; and most people are seeing no difference at all, except that they no longer have to fear what happens if they lose their current coverage (Paul Krugman, 8/19). 

The Fiscal Times: 6 Reasons Obamacare Can Win The Senate For The GOP
That ever happened to Obamacare -- the unpopular healthcare bill that was to be the Republicans big weapon as they battled for control of the Senate this fall? For sure, the Affordable Care Act has been pushed to the sidelines by the chaos in Iraq, Russia’s invasion of Ukraine, the surge in Central American minors across our border, the Veterans Administration scandal, the pestilential virus rampaging across the computers of the federal government, and so much more. … Now, the GOP should circle back (Liz Peek, 8/20).

Bangor Daily News: Maine Props Up 'Two Americas' With No Medicaid Expansion
The Affordable Care Act, as originally passed, holds tremendous promise to decrease health care costs and increase insurance coverage rates across rural states like Maine. But federal court opinions and repeated vetoes of Medicaid expansion are putting all that into jeopardy. Already, data is pointing to widening disparities between the states embracing health reform and those that have resisted — in the numbers of uninsured, in new health care jobs and in the finances of local hospitals (Christy Daggett, 8/19).

The Washington Post’s The Volokh Conspiracy: Constitutional Challenge To IPAB Dismissed, But Could Return
The U.S. Court of Appeals for the Ninth Circuit dismissed as unripe a challenge to the Independent Payment Advisory Board (IPAB). This Board was created by the PPACA to help control health care costs. Specifically, IPAB is authorized to develop self-executing recommendations for limits on Medicare reimbursement rates and other cost controls should the rate of Medicare spending growth exceed a specified target. In this case the plaintiffs argued that IPAB violates the non-delegation doctrine (Jonathan H. Adler, 8/19).

Bloomberg: Why Can't The Pentagon Stop Smoking?
Even the most oblivious member of Congress knows that smoking is bad for you. As it turns out, it's even worse for you if you happen to be a soldier. So why would Congress insist that the Pentagon sell cigarettes -- at a discount, no less? The rationale has long been that members of the military have to smoke because their jobs are so stressful (8/19).

Bloomberg: Wanted: More Doctors For Old People
One of the most glaring paradoxes in the U.S. health-care system is the persistent shortage of geriatricians. You've got a group of patients that is growing, and for whom the federal government guarantees health-care coverage. Yet slots in geriatrics programs go begging while people crowd into surgical specialties (Megan McArdle, 8/19).

JAMA Internal Medicine: Cancer Screening In Older Persons
Cancer screening in the 21st century ... is losing its luster. Increasing evidence suggests that many modalities of cancer screening may be far less beneficial than first thought. Screenings that used to be straightforwardly recommended, such as the prostate-specific antigen test, are now discouraged by many experts. Emerging mammography data show that we need to regularly reexamine even our most stalwart screening standards. Our sense of wonder has evolved into a sense of skepticism: Now we wonder whether screening tests are helping or hurting our patients. ... It is particularly important to question screening strategies for older persons (Dr. Cary P. Gross, 8/18).

JAMA Pediatrics: An Ethically Appropriate Strategy To Combat Obesity And Food Insecurity 
Doug Rauch, former president of Trader Joe’s grocery chain, announced his plans for the Urban Food Initiative (UFI). The goals are to address obesity, food insecurity, and food waste by opening nonprofit supermarkets in low-income neighborhoods and providing nutritious low-cost foods. To accomplish this, he proposed selling food gathered from the 11% of fresh produce and perishables that are discarded from other supermarkets, some of which is near or past the sell-by date. ... some have questioned whether the ethics of selling food that is near or past the sell-by date or best-by date to individuals living in low-income neighborhoods are objectionable. ... the UFI offers an innovative approach to combat obesity and food insecurity. ... The store's food will not be harmful, and the initiative is an ethically appropriate strategy to prevent obesity and food insecurity (Drs. Deepak Palakshappa, Genevieve Daftary and Chris Feudtner, 8/18).

Categories: Health Care

Political Cartoon: 'Admission Against Interest?'

Kaiser Health News - Wed, 08/20/2014 - 9:16am

Kaiser Health News provides a fresh take on health policy developments with "Admission Against Interest?" by Ron Morgan.

Meanwhile, here's today's haiku:


Opioid treatment?
Check. But we will not help you
with your HCV.
-Paige Kulie 

If you have a health policy haiku to share, please send it to us at and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Categories: Health Care

An Interview with Colleen Hybl, Daly Topp, and Shannon Wang

In Custodia Legis - Wed, 08/20/2014 - 8:09am

From left to right: Shannon Wang, Daly Topp, and Colleen Hybl

This summer Jolande Goldberg and I had three talented women working with us on the Indigenous Law Portal: Colleen Hybl, Daly Topp, and Shannon Wang. These interns were part of the LC Knowledge Navigators Program Non-paid Internship Program with the University of Virginia. During their time with us, they learned a great deal about LC Classification and Indigenous Law, and they helped gather information on over 350 tribes and aboriginal peoples in North America.

Describe your background.

Colleen: I was born and raised in Fredericksburg, Virginia. Currently, I still live in Fredericksburg when I am not at school at the University of Virginia in Charlottesville, Virginia. If I am not at home reading a book then I am usually at the library in Fredericksburg reading a book or volunteering at the library. I love books so much that I practically live in the library.

Daly: As an Army brat, I’ve lived in quite a few places around the United States. After graduating from high school in San Antonio, Texas, I attended the gorgeous University of Virginia. I am the oldest of four children, with my youngest sibling 13 years my junior. After my internship concludes, I hope to continue living in beautiful town of Charlottesville.

Shannon: My parents immigrated to the United States from China before I was born.  I was born and raised in Virginia and I am the oldest of three children. I grew up in the Fairfax area, attending Fairfax County Public Schools from elementary through high school. Currently I am studying at the University of Virginia.

What is your academic/professional history?

Colleen: I am going to be a third year at the University of Virginia in the Fall of 2014. I am an Environmental Sciences Major. I am still not sure what I want to do after I graduate from the University of Virginia, but over the last year an idea has been developing. I hope to go to graduate school to get a Library Sciences Degree, so I can become a librarian.

Daly: I graduated from the University of Virginia this past May with a Bachelor’s Degree in History and a minor in Religious Studies. In addition to my education, I worked as a lifeguard at the University’s aquatic center.

Shannon: I studied at James Madison University for the first two years of my undergrad. While I was there I worked at the Information Technology HelpDesk in customer support.  I transferred to the University of Virginia and I am currently pursuing a master’s degree through the Curry School of Education. This fall I will be starting my fourth year at UVA. Professionally in the past I have worked and volunteered at different camps, summer schools, and tutoring programs.  Interning at the Library of Congress this summer has definitely been a different direction for me.

Why did you want to work at the Library of Congress?

Colleen: I wanted to work at the Library of Congress, for I thought it was a neat idea! The Library of Congress is essentially an international hub of information, history, and practically anything else you can think of: they have it or if they do not, they can try and point you in the right direction to find whatever you are looking for that you cannot find anywhere else. I love books and I love learning! A place where they specialize in books and learning through research, why would I not work at the Library of Congress?

Daly: As a first year student, I was initially interested in United States’ colonial history. It was through these studies that I began exploring different aspects of our nation’s fledgling years, including any and all history about the indigenous people of the Americas. While researching different internships, the Library of Congress immediately stood out to me because of the nature of this particular project.

Shannon: I have always been fascinated by the library since I was young.  I love how there are endless amounts of possibilities. I volunteered at my regional public library when I was younger, where I was able to learn about how the library system worked and functioned. Ever since then, I have always wanted to work at the Library of Congress and be able to experience all that it has to offer.

What is the most interesting fact you have learned about the Library of Congress or the Law Library of Congress?

Colleen: I have learned so many interesting facts that I do not know if I can limit it to just one fact, but I will try. The most interesting fact that I found out about the Library of Congress is that it’s truly an international hub of information. About 50% of the collection is not even in English! They not only have information about the United States, but also information about other countries that not even the countries themselves have in their records! A perfect example of this was after the earthquake a few years back in Haiti, a man was trying to find a series of newspapers from a specific date, but he could not find them anywhere. He tried Haitian records, even though they were in turmoil with the earthquake. He tried France, and then he tried rare bookstores in Europe. He could not find them anywhere until someone told him to try the Library of Congress, which he did and found those newspapers. Also, because the Library of Congress contains information that is not in English, the Library has quite a number of employees that can speak, understand, and may even had either lived or been born in the countries where a particular language has been spoken. Some days when I walk in to work at the Library of Congress, it feels like a mini United Nations because there are people talking in different languages!

Daly: Of all the experiences that I have had at the Library, the one that has stood out to me the most is when I toured the stacks of the Law Library with my peers and supervisor. The extensive knowledge that this one room held was amazing and blew me away. Plus, what was extremely spectacular was seeing Roman law manuscripts from the 1600′s. It is just amazing to me how modern readers can still access thoughts from a single person in the 15th century and even prior, all due to the Library.

Shannon: The most interesting thing I have learned is how the Library of Congress acquires people from such vast and wide professions. From the physicist and chemist in the Preservation Department to the people who come from all over different cultures, speaking different languages to help interpret texts is so fascinating to me.

What’s something most of your co-workers do not know about you?

Colleen: When I am not reading, at school, or volunteering at the library, I am either working on a story that I started about a year ago, or I am drawing fashion designs.

Daly: Most of my co-workers do not know that I studied in Ireland during my 3rd year at UVA. Although I was the only one in my group who had never traveled abroad, the entire trip was exceptionally rewarding and an excellent learning experience.

Shannon: One thing my co-workers would not know about me is that I traveled to Florence, Italy, last summer to study abroad.  I was able to study and learn about the history, art, culture, and politics of Medici Florence.

Categories: Research & Litigation

Guest blogger gives a glimspe into the life of an intern.

Massachsuetts Trial Court Law Library - Wed, 08/20/2014 - 7:30am

My name is Melanie Dempster. I am a soon-to-be graduate of UMass Amherst, and was fortunate enough to have landed a summer internship in the Salem Superior Court for the Honorable Judge Lowy. As the only intern not yet in law school, on my very first day in Superior Court I was given a crash course on the dark side of human nature. I sat in on a trial where two men were being tried on charges relating to a bank robbery in Saugus, MA that led to a police chase and shootout, resulting in a fatality. The trial went on for 3 weeks. Victims and witnesses came and went, some on the stand for numerous days. After a short 45-minute deliberation, the jury found both defendants guilty on all charges, and the two men were sentenced to life in prison. Still shaken by the facts of that case, I went to observe a neighboring courtroom just in time to see the closing arguments in a trial where a young man (age 25) was charged with the gruesome murders of his mother and grandmother. In his closing argument, the prosecuting attorney gave a graphic retelling of the night of the murders. Pictures of the deceased hung in the background while he spoke to the jury, waving the same bloody knife that was used in the killings. Everyone in the courtroom was hypnotized and hanging on to his every word; it felt like a television courtroom drama. After deliberation, the jury found the defendant guilty of first-degree murder by extreme atrocity and cruelty, and the young defendant was sentenced to life in prison. As someone not yet desensitized to the realities of criminal court proceedings, the facts of these cases echoed in my head for days afterwards. Heinous crimes I would read about in the news or see on T.V. were being mapped out and argued right in front of me!
The best part about watching these trials were the discussions they sparked. Initially, I thought not being in law school put me at a disadvantage, but I was wrong. The law clerks, and other interns, dissected the issues at hand, the laws that applied, and the arguments made by each side. A lot of times I sat back, listened, and learned. One of the best parts of my internship at the courthouse is that I learn new things every day I’m here. All of the court staff, the judges, the law clerks, the law librarians, and court officers, are more than happy to stop what they are doing and help me with whatever I may need. At the hands of the law clerks, I have learned a few things they teach you in law school, for example, how to research and “shepardize” case law, draft a memo, or identify the issues at hand in any given case. Some people may find this painfully boring, but for a college student interested in a career in the legal field, I consider myself one of the luckiest college student. I have learned more than I ever imagined, and have been treated with nothing but kindness and respect. I wish I could stay all year!
Categories: Research & Litigation

First Edition: August 20, 2014

Kaiser Health News - Wed, 08/20/2014 - 7:03am

Today's headlines include a report from California that Anthem Blue Cross is being sued again regarding its narrow-network health plans as well as a prediction from Maryland officials regarding the state's online insurance marketplace.

Kaiser Health News: Wrestling With A Texas County’s Mental Health System
Kaiser Health News staff writer Jenny Gold reports: "Evans is the director of the Center for Health Care Services, the community mental health system in San Antonio and Bexar County. Texas ranks 49th out of 50 states in how much funding it commits to mental health. But under Evans’ leadership, Bexar County has built a mental health system considered a model for other cities across the country -- one that has saved $50 million over the past five years" (Gold, 8/20). Read the story, which also ran on NPR.

The Washington Post: Md. Health Officials: Rebuilt Health Insurance Online Site Will Be Fixed By Nov.
Maryland Gov. Martin O’Malley’s administration is confident that its rapid rebuilding of the state’s health insurance Web site is progressing as planned and will be ready before the next enrollment period begins in November. The state’s first attempt at launching a site was riddled with technical problems that made it much more difficult for residents to sign up for health insurance made possible by the Affordable Care Act. Maryland is now rebuilding the site using technology developed by Connecticut. The fix is estimated to cost at least $40 million, if not much more (Johnson, 8/19).

The Washington Post’s Wonkblog: Health Care Data Breaches Have Hit 30M Patients And Counting
The recent theft of 4.5 million medical records by Chinese hackers highlights one undeniable truth about health care data: it's valuable, and bad people want it. In this latest incident, hackers reportedly stole personal data from Community Health Systems patients, including their Social Security numbers, which is an especially coveted piece of information if you want to steal someone's identity. But it appears that patients' medical data and credit card numbers were not stolen in this case (Millman, 8/19).

The Wall Street Journal’s CIO Journal: Health Care CIOs Boosting Security In The Wake Of Breaches
A recent string of high-profile data breaches is leading some health-care CIOs to modify their approach cybersecurity. The new approach is partly influenced by executive boards demanding more communication from IT on security efforts. CIOs say they are implementing new security software and processes, hiring staff and meeting with their boards more regularly. But the industry may need to up its security spending to get results. Health-care providers generally have smaller IT budgets than private-sector companies (Boulton, 8/19).

The Associated Press: Analysis: Congress Can Still Do Deals When It Must
The must-do bills included $16 billion to improve veterans’ access to health care and a short-term $11 billion measure to prevent federal funding for highway projects and transit systems from drying up this month. Voting against either effort could have cost lawmakers in November’s elections. The veterans bill came together when Democrats agreed to lower the price tag and Republicans accepted adding the additional cost to the national debt. On the highway bill, Senate Democrats bowed to House Republicans on financing it through anticipated revenues the government might or might not reap a decade from now (8/18).

Los Angeles Times: Anthem Blue Cross Sued Again Over Narrow-Network Health Plans
Health insurance giant Anthem Blue Cross faces another lawsuit over switching consumers to narrow-network health plans — with limited selections of doctors — during the rollout of Obamacare. These types of complaints have already sparked an ongoing investigation by California regulators and other lawsuits seeking class-action status against Anthem and rival Blue Shield of California (Terhune, 8/19).

Los Angeles Times: Auditor Says $93 Million In Medi-Cal Payments Could Be Fraudulent
The audit released Tuesday reviewed billing data from July 2008 to December 2013 for Medi-Cal's Drug Treatment program, which reimburses rehabilitation clinics. The audit found the state's Department of Health Care Services and the Department of Alcohol and Drug Programs failed to administer the program "and created opportunities for fraud" (Karlamangla, 8/19).

The Wall Street Journal: Walgreen Shakeup Followed Bad Projection
A billion-dollar forecasting error in Walgreen Co.'s Medicare-related business has cost the jobs of two top executives and alarmed big investors. At an April board meeting, Chief Financial Officer Wade Miquelon forecast $8.5 billion in fiscal 2016 pharmacy-unit earnings, based partly on contracts to sell drugs under Medicare (Siconolfi, 8/19).

The Wall Street Journal: Broken Commitment Ruined Vascular Biogenics IPO
The events that led to the collapse of the IPO haven't been previously reported. The highly unusual event—many traders and investors struggled to recall another IPO being canceled in such a manner—was a major setback for a company seeking money to pay for clinical trials to complete its work on treatments for cancer and other diseases. For executives, it also raised questions about the role of underwriters in an offering (Demos, 8/19).

NPR: Cardiologist Speaks From The Heart About America's Medical System
As a young doctor working at a teaching hospital, Sandeep Jauhar was having trouble making ends meet. So, like other academic physicians, he took a job moonlighting at a private practice, the offices of a cardiologist. He noticed that the offices were quick to order expensive tests for their patients — even when they seemed unnecessary (8/19).

Los Angeles Times: Simple Measures Made Hospital Patients 70% More Likely To Quit Smoking
A free supply of nicotine replacement medication and a handful of automated phone calls made smokers who wanted to quit much more likely to succeed, according to results of a clinical trial published Tuesday in the Journal of the American Medical Assn. The researchers who designed the trial said they were looking for a simple and inexpensive way to aid smokers who were already motivated to kick the habit. They estimated that once their 90-day program was set up, it could be maintained at a cost of less than $1,000 per quitter (Kaplan, 8/19).

The Washington Post: Rare D.C. House-Call Doctor Straddles Two Washingtons
Brown is a rarity: a family medicine doctor who performs house calls. Working mostly in the District, he’s fully independent and unaffiliated with insurance programs. His work straddles two Washingtons. His paying patients are foreign and domestic travelers, including foreign dignitaries, staying at the city’s hotels. Treating those clients allows him to serve as the primary care doctor — pro bono — for more than a dozen elderly homebound residents in poorer neighborhoods (Najarro, 8/19).

Des Moines Register/USA Today: Judge Rules Against Use Of Telemed Abortion System
Iowa regulators were within their authority when they voted to ban a first-in-the-nation videoconferencing system that allows doctors here to dispense abortion drugs to women in rural clinics, a Polk County District Court judge ruled Tuesday. Planned Parenthood of the Heartland had sued the Iowa Board of Medicine, contending that the board's decision to ban doctors from using its system was a blatant attempt to limit rural women's access to abortions (Leys, 8/19). 

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Categories: Health Care

Wrestling With A Texas County’s Mental Health System

Kaiser Health News - Wed, 08/20/2014 - 6:56am

SAN ANTONIO -- Some people here just call Leon Evans “The Bear.” He is a massive man with a shock of white hair on both his head and face and wrists the size of a child’s thighs. The former All-Star wrestler earned his nickname after wrestling two living, breathing bears. “

San Antonio's program is the brainchild of Leon Evans, director of the community mental health system in Bexar County, Texas. Evans stands in front of a mural across the street from the Restoration Center in San Antonio (Photo by Jenny Gold/KHN).

“This is Bexar County” (pronounced “bear”), Evans says, “so my wife teases me about this being my third bear.”

Evans is the director of the Center for Health Care Services, the community mental health system in San Antonio and  Bexar County.

Texas ranks 49th out of 50 states in how much funding it commits to mental health.  But under Evans’ leadership, Bexar County has built a mental health system considered a model for other cities across the country -- one that has saved $50 million over the past five  years.

“In my entire career I’ve always understood the people who are the least valued, the people who society thinks the least of, are the people who have the most potential,” says Evans. “You reach out to them, they’ll do amazing things and nobody expects them to.”

Evans came to Texas in 1972 as a social worker, to help set up some of the very first community mental health systems, and he’s been in the state ever since. When he took over the Bexar county system 14 years ago, the county jail was so overcrowded -- packed with people in various states of psychoses -- that the state was getting ready to levy fines.

That’s not unusual. Across the country, about 20 percent of inmates and prisoners have a serious mental illness that includes psychosis, according to a study from the Justice Department’s Bureau of Justice Statistics.

Evans’ idea for reform was simple: for people with mental illness, treatment works. And jail does not.

“Even here in Texas, which is very conservative, we learned some time ago that nonviolent mentally ill offenders shouldn’t be in prison. They don’t make good prisoners, ” he says, In a state of psychosis, a prisoner is hearing voices and can’t follow rules, and that means he gets no time off for good behavior, Evans explains.  “They take up space for violent offenders.”

It’s also an expensive revolving door. When people with a serious mental illness are released from jail, many end up living on the street, sick and often addicted. And then almost invariably, they end up back in jail for a minor nuisance crime, like panhandling (which is illegal in San Antonio), urinating in public, digging in dumpsters or sleeping on someone’s porch.

That all sounds very familiar to Samuel Lott. For decades, he was a white collar worker,  most recently for the BNSF railway in Fort Worth. But in 2006, he lost his job.

Samuel Lott stands in the courtyard of the homeless shelter across the street from the Restoration Center in San Antonio, Texas (Photo by Jenny Gold/KHN).

“Whatever diagnosis I had – depression, alcoholism, that sort of thing kicked into high gear back then, and I spiraled down pretty quick and became homeless,” says Lott.

For four years, Lott lived on the streets and camped in the woods. He was estranged from his family, got infected with hepatitis C, and his untreated depression started to take on signs of psychosis.  He had frequent run-ins with the police.

On his laptop, Lott, 51 pulls a picture of himself from 2010, the last time he was in jail. “This person is angry, unhealthy, there’s malnutrition, there’s no direction. You can see from the sunken cheekbones,” he says, pointing to the screen.

Getting treatment for any of his health problems felt hopeless, especially without transportation. “It meant having to walk from one side of town– I mean, miles and miles to the other side of town -- maybe to get a referral, and then you take your referral and walk clear back over to some other side of town, and then maybe you can go and get the help,” Lott explains.

In addition to scattered services,  Leon Evans says there was another problem for this population: none of the county or city agencies and nonprofits that deal with people with serious mental illness was talking to one another. The jails, hospitals, courts, police and mental health department all worked in separate silos.

“People who fund these services only look at their little small piece of the pie and whether there is a return on investment,” says Evans.

So with the help of the county judge, Evans worked to get the funders together to talk about the money they were all spending on mental health.  It turned out to be the most challenging – and the most important – piece of the puzzle.

“If you think law enforcement and mental health workers have anything in common, we don’t, except people with substance abuse and mental health problems. We speak a different language, we have different goals, there’s not a lot of trust there,” he says.

So he hired Gilbert Gonzalez to take a look at the money that they were all spending on mental health.

“You know Brad Pitt in the movie Moneyball?” asks Gonzalez. “Well, the success in that movie was based on the data and analytics. We needed to do the same thing.”

Once they stopped looking at mental health as an isolated expense in the city budget, the players realized they were spending enormous sums of money to take care of people. And they were doing a bad job of it.   Pooling their resources instead, Gonzalez found, would offer significant savings.

The courts, the jails, the hospitals, the county government and the police department agreed to work together on the issue. Everyone provided funding– the police even contributed their drug seizure money – to build a system where people with mental illnesses could get better. 

The result is one centralized complex which offers many services. The Restoration Center is conveniently located across the street from San Antonio’s state-of-the-art homeless shelter.

“One thing that’s really important about the San Antonio approach is that they’ve integrated services together for mental health and substance abuse and homeless services,  because most people have overlapping needs,” says Laura Usher, a program manager at the National Alliance on Mental Illness who helps set up collaborations between law enforcement agencies and mental health departments.

The center has a 48-hour inpatient psychiatric unit, sobering and detox centers, outpatient primary care and psychiatric services, a 90-day recovery program, housing for people with mental illnesses, and even job training and a program to help people transition to supported housing.

Mental Health Services In San Antonio

“San Antonio realized that it’s more cost effective to provide mental health services and supports to people on the front end, rather than pay for jail beds and prison time,” says Usher.

More than 18,000 people pass through the Restoration Center each year and officials say the coordinated approach is saving the city more than $10 million each year. “There’s no wrong door,” says Evans. Some patients walk in off the streets or with their families. Others are brought in by police or diverted here from programs inside the jails.

“San Antonio is ahead of what’s a growing trend across the country to try to build a non-hospital alternative for people who are experiencing a psychiatric emergency, often with co-occurring alcohol or other drug abuse,” says Dr. Mark Munetz, a psychiatrist and professor at Northeast Ohio Medical University who toured the Restoration Center last year.

But he says the San Antonio model might not work for everyone.  The Restoration Center and homeless shelter, he says, felt like “a psychiatric oasis, removing the people from the most central part of the city, it felt a little like segregating people in that part of the city, especially with the homeless shelter next door. I’m not sure how that would fly in other parts of the country.”

Nonetheless, the rest of the country has started to notice. Every state in the country has sent delegates to San Antonio to see if they can model their own mental health systems after this one.

Samuel Lott found his way there in  2010. He walked over to the Restoration Center from his jail cell a block away.  He went through the detox program, then a 90-day in-patient recovery program, followed by treatment for hepatitis C, and finally medication to help control his mental illness.  The center helped place him in an apartment of his own and provided him with additional job training.

He pulls up another photo on his laptop, this one taken Thanksgiving of 2012, two years after he arrived at the center. It’s a picture of Lott with his arms around his family – mother, father, brother, niece and nephew. He looks like a different man.

“I’ll start crying if I talk about it,” says Lott, who is now healthy and employed at the center. “It felt so good to be home, with my mother and my dad. And I had expected them to be angry and hurt, but it was the exact opposite. They were so happy for a member of the family to come home. Now I email with them every single day, text, Facebook, make plans for gatherings.”

He says he’s helping other people find the kind of hope and healing that he has. 

Categories: Health Care

Pop Awake At Night? Researchers Blame ‘Sleep Switch’ In Your Aging Brain

CommonHealth (WBUR) - Wed, 08/20/2014 - 6:05am

(eflon via Compflight)

If you’re on the older side and find yourself popping hideously awake in the middle of the night or far-too-early morn, here’s your line for the next time it happens: “Oh, that darned ventrolateral preoptic nucleus of mine! How I miss my old galanin!”

Researchers have just reported in the journal Brain that they’ve found a group of neurons — in the aforementioned nucleus – that function as a kind of “sleep switch,” and whose degeneration over the years is looking very much like the cause of age-related sleep loss. It’s also looking pivotal in the insomnia that often causes nocturnal wandering in people with Alzheimer’s disease.

“This is the first time that anyone has ever been able to show in humans that there is a distinct group of nerve cells in the brain that’s critical for allowing you to sleep,” said the paper’s senior author, Dr. Clifford Saper, chair of neurology at Beth Israel Deaconess Medical Center and professor of neurology at Harvard Medical School.

You may well be wondering exhaustedly how soon this insight — based on the post-mortem analysis of 45 human brains — will lead to better sleeping pills for older folks. I asked Dr. Saper that, too. No promises with timeframes at this point, but he does see the prospect for better-targeted sleeping pills for seniors, with fewer side effects like Ambien’s balance-related problems.

Our conversation, lightly edited:

Can this group of neurons actually explain the lion’s share of sleep problems that older people and people with Alzheimer’s disease have?

It really can. Let me give you a little background. We discovered this cell group in the brains of rats in 1996. We found that there’s a group of of nerve cells in a part of the brain called the hypothalamus that fire when animals are asleep. And we later found that if you eliminate those nerve cells, that animals lose up to 50 percent of all their sleep time, and the remaining sleep is fragmented. They can’t sleep for long bouts at a time; they keep waking up all the time.

At that time, we weren’t sure whether this would be the same in other species. So we looked at the brains of half a dozen other species — of mice and cats and monkeys — and we found that all of them have this cell group and that the cells were active during sleep in all of them. In every species we looked at, this same cell group had a particular neurotransmitter in it, called galanin.

I’ve never heard of that neurotransmitter before…

Galanin is a peptide, It’s a small string of amino acids that is pretty well known, and it’s found in neurons in a number of places in the brain, but this particular spot in the brain, in all of the species we looked at, the cells that were sleep-active always had galanin in them.

We found a group in the same spot in the human brain, and we proposed that this might in fact be that cell group, and it might actually be important in keeping people asleep. And in fact, there were already some papers that had been done at that time looking at that cell group in human brains and showing that it degenerated with age.

Does it degenerate more than the rest of the brain?

It does. It degenerates more than other cell groups in the hypothalamus that are nearby.

Do we know why?

No, it’s really not known why this happens. The best work on this was done by a Dutch group, led by Dick Swaab, and he found that young people have about 30,000 nerve cells in this cell group, and by the time you reach 70 you have about 15,000 left. So you lose half of them between young adulthood and older adulthood.

In any case, we proposed that this might be the mechanism of sleep problems in older people, but we had no way to prove it at the time. And I was discussing that when I was giving a seminar at Rush Medical College in Chicago, and the person who heads their Memory and Aging Project, Dr. David Bennett, who’s a co-author on the paper, said, ‘We may have a way to solve that problem.’ They had a cohort of people, 1000 people, in a long term NIH study, and all of these people get annual evaluations.

The Memory and Aging Project is looking for triggers for developing Alzheimer’s and Parkinson’s disease. And one of the things the subjects do is wear a wrist bracelet every year for 10 days that measures their arm movement. It’s called an actigram. It gathers data on people’s movements, and it’s possible, by looking at the movement patterns, to determine what period of time they’re actually asleep. When they’re asleep, they don’t move their arm for periods of several minutes or more. It works.

So after validating that, we then analyzed the actigraphy from a large number of people, and then we looked at their brains after they died. Everyone in the study donates their brain when they die. And again, they’re mainly looking for Alzheimer’s and Parkinson’s disease, but we could look at the ventrolateral preoptic nucleus, this little cell group, and determine if the galanin cells were intact.

The brains were predominantly from people in their mid-80s, And what we found is that by the time you reach 85, you have even fewer of these cells left; you have in the typical range of 5,000 to 10,000 of these, though some people had even fewer than that. And then we correlated their sleeping behavior with the number of cells that each individual had.

What we found was that the people who had the fewest cells had the most difficulty sleeping. And the second finding was that the people who had the very fewest cells, the very tiniest numbers and the worst sleep, had Alzheimer’s disease — which surprised us. We didn’t expect that. But even the normal people who don’t have Alzheimer’s disease, their sleep behavior is still predicted by the number of cells left in this part of the brain.

So that’s powerful enough to make you say this isn’t just correlation, we think this is causation?

That’s the key. I think if you just had those data in humans it would be a great correlation but you couldn’t prove much from it. However, because we have the data where we selectively killed those cells in experimental animals and demonstrated the same effect, I think it’s pretty clear that this is very likely to be the cause of the loss of sleep as people age as well.

So what does this mean for drug development?

The tricky part is that we now know that the ventrolateral preoptic nucleus is important for sleep and we know what its neurotransmitters are: they contain galanin and they contain another, inhibitory neurotransmitter called GABA. Most of the drugs we use for sleep now act by mimicking the GABA and turning off the targets of the ventrolateral preoptic nucleus. That’s why they help you fall asleep. The downside of that is that there are GABA receptors in many other parts of the brain, and one part where they’re most prominent is the cerebellum, which is important for balance. So you take older people and give them a drug that inhibits the waking system, and you also cause them to fall down.

So that’s why you have the announcement that you have to cut back on the amount of Ambien you give older people, because it tends to make them fall more. So you’d like to develop drugs that are more specific, and one of the targets might be galanin, and another target might be looking at the specific types of GABA receptors in the particular parts of the brain where the ventrolateral preoptic nucleus causes sleep. It turns out there’s many, many different classes of GABA receptors and it’s possible to develop drugs that activate some but not others.

Has that work begun?

There are various groups in the pharmaceutical industry that are doing this kind of work. Unfortunately, there is no drug yet that makes this distinction.

But in the coming years, a drug could be developed that targets the right GABA or galanin?

There might be, and there’s another alternative, which is that what the ventrolateral preoptic neurons do is they turn off the waking systems, so you could have a drug that specifically targets the waking system. So for example, there’s a new drug that Merck has just released which is an orexin antagonist. And one of the things the ventrolateral preoptic neurons do is they inhibit the orexin neurons.

So all in all, this offers a bit more hope to all the seniors waking up at 3 and 4 a.m.?

It does. This is an incredibly common problem. And for people who have Alzheimer’s disease it’s even worse, because this is often what sends them into a nursing home. They can’t sleep at night and get up and wander. The caregivers can’t keep up with it after a while, and they have to put them into a nursing home.

Categories: Health Care

Leading Pediatrician: Sick Time Is Health Issue; Will Doctors Step Up?

CommonHealth (WBUR) - Tue, 08/19/2014 - 1:22pm

(Mary MacTavish/Compfight)

Call me Sherlock Holmes, but when a ballot measure has “sick” in its title, I get a sneaking suspicion that it may involve an issue of health.

As in Question 4 on the Massachusetts ballots this November, which the secretary of state titles “Earned Sick Time For Employees” and summarizes as a proposed law that “would entitle employees in Massachusetts to earn and use sick time according to certain conditions.”

It would guarantee up to 40 hours of paid sick time if you work for a large employer and up to 40 hours unpaid if you work for a small employer. (More details here.)

This referendum — and measures like it in other states and at the federal level — tend to be portrayed as labor issues, pitting employers against employees. But Dr. Mark Schuster, Chief of General Pediatrics at Boston Children’s Hospital and Professor of Pediatrics at Harvard Medical School, argues that sick days are a health issue — and no one knows that better than doctors.

In the New England Journal of Medicine, he and Dr. Paul Chung of UCLA discuss the risks inherent in an economy where about 40 percent of employees get no paid sick leave, and many cannot even take unpaid sick days without risking their jobs.

They begin with the big-picture public health problem of the 2009 H1N1 flu pandemic, when health authorities were begging sick people to stay home and some workers were responding that they simply couldn’t.

And then there are the human difficulties that play out every day:

Consider a mother who knows both how to assess her son’s asthma symptoms and when he needs to see a clinician. If his medicine doesn’t seem to be working on a weekend or at night, they go straight to the clinic, he receives treatment, and they avoid a hospital admission. But when the boy has an asthma attack on a weekday morning, his mother sends him to school, fearing that missing work will mean losing her job. Three times in 18 months, when she waits until after work to bring him to the clinic, his asthma worsens, and he ends up hospitalized. Each time, what should have been three hours in the clinic becomes three days in the hospital.

Or consider a young girl with a fever and flulike symptoms who is given Tylenol and sent to school by her father because he can’t miss work. Two days later, the girl develops the rash characteristic of fifth disease on her cheeks. Her whole class has been exposed, and because the teacher is pregnant, her fetus is at risk.

About half of American workers get no paid sick days that they can use to care for family members, they note. And they end with a call to action directed at other health care professionals: “At the intersection between health and work, the health care community needs to provide a voice for patients and their families.”

Will it, though?

At the individual level, if you ask a doctor whether a parent should be able to be with a sick child, “They’ll always say yes,” says Dr. Schuster. “But many are just not aware of this as a policy issue.”

It will be interesting to see how this plays out as November approaches and more people, in health care and beyond, become aware of Question 4. The Massachusetts Medical Society says it is considering its position on the measure. Please stay tuned. WBUR will cover the issue more fully in the coming weeks.

Categories: Health Care

Want To Become An Organ Donor? It’s Super-Easy In Mass. Now Do You?

CommonHealth (WBUR) - Tue, 08/19/2014 - 11:35am

(misscherryorchards via Compfight/Flickr)" href="">

(misscherryorchards via Compfight/Flickr)

Veronica Thomas
CommonHealth Intern

Pestering someone with the same question over and over again doesn’t usually get you what you want. But with organ donation, asking repetitively might just be the key to increasing the number of much-needed organ donors.

According to a new working paper from the National Bureau of Economic Research, providing more information and opportunities for people to become organ donors could boost registrations dramatically.

This increase in donors is needed more than ever. Each day, 18 people die while waiting for a transplant organ to become available. The waiting list is over 123,000 people deep but there were only about 29,000 organ transplants last year.

The new findings are based on a survey of Massachusetts drivers, which The Washington Post’s Jason Millman describes in One Way To Boost Organ Donations: Just Keep Asking. From the article:

Researchers surveyed 368 people with a Massachusetts driver’s license or ID card, including 156 people (42.4 percent) who were already registered organ donors. Of those who weren’t registered donors, 61 people in the study decided to sign up after researchers presented them with the chance to update their status. Just two people who had been registered donors asked to remove themselves from the registry.

“Put simply, asking again for organ donation generates more donors,” wrote Judd Kessler of the University of Pennsylvania’s Wharton School and Stanford University’s Alvin Roth. They said this suggests that policymakers should look for more opportunities to keep asking this question, like on income tax forms, as the researchers said some states are considering.

Asking more than once may work for a number of reasons. Millman explains:

People may have missed the opportunity to register the first time; or, repeat requests may signal the importance of organ donation, Kessler and Roth write. The “guilt factor” may also kick in after repeat requests. And there’s also the chance that people learned something that changed their minds. On that final point, Kessler and Roth found that just informing non-donors about what organs they could donate made them more willing to register.

So, here we go. Let’s test out this strategy and see if it works.

Do you want to become an organ donor?

If you live in Massachusetts, you can register online through the RMV. It took my coworker only two minutes to sign up this morning. All you need is your driver’s license, permit or ID number, your social security number, and an email address.

On the fence or want to learn more about becoming a donor? Check out the RMV’s list of frequently asked questions.

And hey, I know I just asked you this but, do you want to become an organ donor?

Categories: Health Care

Recent Law Library of Congress Report on National Funding of Road Infrastructure

In Custodia Legis - Tue, 08/19/2014 - 11:25am

According to a June 2014 report by the United States Congressional Budget Office (CBO), most of the annual spending by the federal government on surface transportation programs is in the form of grants to state and local governments. These grants are primarily financed through the federal Highway Trust Fund (HTF). After decades of stable balances to meet the federal contribution toward funding road infrastructure, the amounts credited to the HTF in recent years have fallen short of meeting annual spending needs, resulting in a growing fiscal imbalance. This has necessitated the transfer of funds from the U.S. Treasury’s general fund to the HTF in the years since 2008.

Several options have been put forward over the years to address this budgetary imbalance in the longer term.

West front of the Library of Congress Thomas Jefferson Building, Washington, D.C., with road construction and horse-drawn wagons in foreground (Nov. 27, 1895), Library of Congress Prints and Photographs Division,

A recent report by the Law Library of Congress, National Funding of Road Infrastructure, examines the sources of funding used by other countries for the development and maintenance of road infrastructure. The report is composed of individual studies on the laws of Australia, Brazil, Canada, China, England and Wales, France, Germany, Israel, Italy, Japan, Mexico, the Netherlands, South Africa, and Sweden. It provides an overview of the road infrastructure in each jurisdiction, including information on responsibilities for constructing and maintaining roads, and an examination of the relevant taxes or other funding sources for transportation infrastructure in the countries surveyed. If applicable, a discussion of reforms or new initiatives is also included.

Some of the surveyed countries tie at least part of the revenue derived from fuel taxes and other vehicle fees or taxes to dedicated road infrastructure funds, but in several countries the various transport-related taxes become part of the general revenue from which funding for road projects is then sourced. Most of the surveyed countries were also found to have toll-road systems, and arrangements involving private investment, concessions, or public-private partnerships appear to be increasingly common.

Other types of revenue sources that may contribute to financing roads in different countries include: a “congestion tax” on vehicles during certain hours; certain types of road-user charges; and charges levied based on a vehicle’s size, type, or age.

We invite you to read the full report on National Funding of Road Infrastructure on the  Law Library of Congress website. The report is posted under the “Legal Topics” section of the website. You may also be interested in reading additional reports on a variety of other topics in this section.

Categories: Research & Litigation

Some States Bristle At Lack Of Authority Over Medicare Advantage Plans

Kaiser Health News - Tue, 08/19/2014 - 9:55am

When Minnesota retiree Doug Morphew needed surgery last year, he expected his Humana Medicare Advantage plan to step up and pay the lion’s share of the bill.

Morphew said the health plan had told him over the phone he would owe just $450 for the two days he spent in a St. Paul hospital recovering from the operation to repair an aortic aneurysm.

Less than a month later, however, Humana hit him with a bill for $6,461.66, claiming the surgery was not covered because the hospital was “out of network,” according to an affidavit he filed with the Minnesota Attorney General’s Office last year.

“Considering that I was expecting a bill of $450, I was incredibly upset,” said Morphew, 68, who lives in Lonsdale, Minn., and works part time as a transportation industry consultant.

Morphew said that Humana paid the bill, but only after “several months of fighting” with him, and after he complained to state regulators.

In October 2013, Minnesota Attorney General Lori Swanson sent Morphew’s formal complaint, and about two dozen others, to Centers for Medicare and Medicaid Services (CMS) administrator Marilyn B. Tavenner. Swanson asked the federal official to “undertake an investigation of Humana’s practices and take appropriate remedial and punitive action.”

The letter sparked media coverage in the state. But nearly a year later, Swanson is not satisfied with the response.

“As far as I’m aware, there has been no formal enforcement action taken,” said Minnesota attorney general’s office spokesman Benjamin Wogsland. “We have very serious concerns that continue.”

Citing patient confidentiality laws, Humana spokesman Tom Noland declined to comment on specific cases. But he said that Humana “has worked actively with CMS to resolve the matters outlined in the letter.” CMS said it is satisfied that Humana has largely fixed any problems.

Medicare pays the privately run health plans -- an alternative to traditional Medicare -- a set monthly rate for each patient. About 16 million Americans have signed up, about one third of the elderly and disabled people eligible for Medicare, at an annual cost to taxpayers of more than $160 billion. A Center for Public Integrity investigation published in June found as much as $70 billion of improper payments to Medicare Advantage plans from 2008 through last year.

Many health plans also collect monthly fees directly from patients and may charge co-payments for medical services, such as $10 for a doctor’s office visit. The plans also can limit care to doctors and hospitals in their networks, so long as patients are advised of these restrictions.

Humana has pitched its plans in Minnesota through radio and television ads, telemarketing and the mail, typically telling seniors it offers more benefits than standard Medicare and will cost them less out of pocket.

But Humana “sometimes denies claims for services that are covered under original Medicare,” overcharges for copayments, “misrepresents” which doctors and hospitals patients can go to and hides behind “red tape and delay” to avoid paying claims, according to Swanson’s letter.

Swanson turned to CMS because state regulators lack the legal authority to impose sanctions on Medicare Advantage carriers. When Congress created the Medicare Advantage option in 2003, it gave CMS that power, thus preempting state laws and oversight.

Minnesota officials don’t believe CMS should have a “monopoly” on oversight. “We think states should have authority over improper determinations by Medicare Advantage plans,” Wogsland said. “If they (CMS officials) don’t take action, there’s no other remedy.”

Other state officials also have been frustrated by the limits on their authority. In October, Connecticut Attorney General George Jepsen called for federal officials to “aggressively scrutinize” UnitedHealthcare’s decision to drop a large number of doctors from its Medicare Advantage plans, a move that had caused an uproar from patients and medical groups.

Medicare has also reported its own difficulties keeping tabs on the fast-growing program.

In a little noticed proposal in March, CMS officials said they were “constrained in the number of program audits we can conduct each year, due to limited resources.” The agency is only able to audit about 30 Medicare Advantage companies a year -- about one in ten -- of the 300 operating.

CMS proposed that health plans conduct and pay for self-audits with the goal that each organization would be looked over at least every three years. But in May CMS backed off in the face of industry protests.

 “Ensuring that Medicare beneficiaries receive high quality care and timely services while enrolled in a Medicare Advantage plan is a top priority for CMS, an agency spokesman wrote in an email.  He said the agency “may finalize this proposal at a future date.”

“We were disappointed to see it rolled back,” said David Lipschutz, a senior policy attorney with the Center for Medicare Advocacy. He said the proposal “begged the question” of how often plans are audited.

“We have concerns across the board,” Lipschutz said. “It’s unfortunate that we have public dollars going toward a privatized program with relatively little oversight.”

CMS officials point out that they have taken enforcement action against health plans that fail to pay bills or provide necessary care for their patients.

The agency posts these actions on its website, though patients aren’t likely to spot them without considerable hunting around. Even if they do, the sanctions often are written in language that gives little clue to the actual infractions other than they pose a “serious threat to the health and safety” of patients.

From November of 2009 to this August, the agency levied 68 fines against Medicare Advantage plans for a total of about $9.8 million, a review of the CMS website shows.

In that time, CMS terminated four health plans, two of them because they had become insolvent. On 21 occasions, CMS suspended enrollment in health plans, usually after discovering that sales agents misrepresented the benefits to potential customers.

In the case of Humana’s performance in Minnesota, CMS officials said they had “not seen increases in complaints or other concerns” since receiving Swanson’s letter.

They said Humana “appears to have made significant progress addressing these issues, and we have been satisfied with Humana’s responses to date.”

But Minnesota official Wogsland called it “disappointing” that CMS had taken no formal action. His office continues to get complaints from patients, hospitals and other health care providers about unpaid bills. “That’s a problem,” he said.

Darlene Tucker, 75, of Bloomington, who said she got by on monthly Social security income of $1,271, is one.

In an affidavit, she said the Humana agent sold her a plan that was supposed pay the full cost of radiation therapy for breast cancer. But she said she was stuck with co-payments of $994.22, which she couldn’t afford.

The health plan never did pay, according to her affidavit. The center that performed the radiation treatments eventually wrote off the bill.

“My fight with cancer was enough for me to deal with at the time. I do not think I should have had to fight Humana for insurance coverage it promised to provide,” she said.
Categories: Health Care

Chinese Cyberattack Steals 4.5 Million Patients' Data From Hospital Records

Kaiser Health News - Tue, 08/19/2014 - 9:19am

Tennessee-based Community Health Systems, which runs 206 hospitals in 29 states, says no medical information was exposed, however.

The New York Times: Hack Of Community Health Systems Affects 4.5 Million Patients
Community Health Systems, a publicly traded hospital operator based in Franklin, Tenn., said that personal data, including names, Social Security numbers and addresses, for 4.5 million patients had been compromised in a Chinese cyberattack on its systems from April to June (Perlroth, 8/18).

Los Angeles Times: Hackers Stole 4.5 Million Patients' Data In Hospital Breach
A cyberattack suspected to have originated in China stole Social Security numbers and other personal data for 4.5 million patients whose records were in Community Health Services Inc.'s system, the company said Monday. The data breach included the names, addresses, birth dates, telephone numbers and Social Security numbers of patients who were referred for or received services from doctors affiliated with the hospital group in the last five years. It did not include patient credit card, medical or clinical information, the company said in regulatory filings (Garland, 8/18).

The Wall Street Journal: Community Health Systems Says It Suffered Criminal Cyberattack
The rural hospital operator and cybersecurity firm Mandiant believe the attacker was an "Advanced Persistent Threat" group originating from China, it said. The attacker, which used highly sophisticated malware and technology to attack the company's systems, was able to bypass Community Health Systems' security measures and to successfully copy and transfer certain data outside the company, it said (McCarthy, 8/18).

The Wall Street Journal: Investigators: We Don’t Know Why China Hacked Hospitals
Community Health Systems Inc. made headlines Monday when it announced Chinese hackers took records on 4.5 million patient records, according to a securities filing. But it remains unclear why the hacker group, which normally targets trade secrets like plane blueprints and health device designs, wanted personal data (Yadron, 8/18).

Bloomberg:  Why Would Chinese Hackers Steal Millions Of Medical Records
Security experts say it's unusual for accomplished thieves of corporate secrets to suddenly turn to stealing personal data on individuals, which is what you'd expect from Eastern European hacking gangs and cyber-crime rings. It's possible that the hackers were scraping all the data they could from Community Health's systems and wound up with personal data, without any intentions of selling or using it. The hackers could also have stolen the information for the purposes of locating new targets or adding private data to the profiles of existing targets. Perhaps the most likely theory is that rogue members, tempted by the money they could make, stole the data to sell it on the black market in actions not sanctioned by their superiors, according to a person familiar with the investigation, who spoke on condition of anonymity (Riley and Robertson, 8/18).

USA Today: Health Network Reports 4.5 Million Patients Had Information Hacked
Too few health care companies invest in computer security, said Philip Lieberman, president of Lieberman Software in Los Angeles. He noted the FBI had warned health care companies in April that the sector's cybersecurity was lax. HIPAA does little to protect patients and offers companies little incentive to invest in computer security — and too many haven't done so, he said. Still, says Trey Ford, a security strategist at Rapid7, a security analysis firm in Boston, "hospitals are arguably one of the hardest network environments to secure; their primary focus is on protecting and improving human life, and this often eclipses all other priorities," he said (Weise, 8/18).

Categories: Health Care

Amid Tumult And Turmoil, Health Care Sector Expected To Show Revenue Growth

Kaiser Health News - Tue, 08/19/2014 - 9:19am
The Wall Street Journal: Risks Create Tumult for Tech, Health-Care Firms
Seismic shifts in the technology and health-care sectors highlight why executives are divided or undecided about taking financial and strategic risks. … At the opposite end of the spectrum is the health-care industry. The still-evolving Affordable Care Act, has made many companies hire thousands and plow millions into their businesses. The health-care sector is expected to post revenue growth of 12.2%, the highest of any sector, and earnings growth of 15.9%, second only to the telecommunications industry. Health-care companies increased spending on buildings and equipment by 15%, the greatest surge of any sector and compared with a 24% decline in the second quarter last year, according to FactSet (Knox and Murphy, 8/18).
Categories: Health Care


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