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Con el fin de las licencias pagas por covid, empleados sienten la presión de ir a la oficina

Kaiser Health News - Tue, 11/30/2021 - 2:21pm

Tanto economistas como expertos en salud pública dicen que la licencia por enfermedad con goce de sueldo es una herramienta esencial, tanto como las pruebas, las máscaras y las vacunas, en el esfuerzo por prevenir la infección por covid-19 y mantener seguros los lugares de trabajo.

Sin embargo, Estados Unidos se encuentra en medio de otra temporada navideña con covid, y las leyes federales que ofrecían a sus trabajadores licencias pagas por enfermedad vinculadas a esta infección han expirado.

Colorado, Los Ángeles y Pittsburgh se encuentran entre una pequeña cantidad de lugares que han implementado sus propias protecciones contra covid. Pero alrededor del país, muchos trabajadores enfermos deben lidiar con difíciles cuestiones financieras y éticas al decidir si quedarse o no en casa.

“Millones de trabajadores no tienen acceso a licencias por enfermedad pagas y todavía estamos en una pandemia”, dijo Nicolas Ziebarth, economista experto en el mercado laboral de la Universidad Cornell.

Estados Unidos es uno de los pocos países industrializados que no tiene una política nacional de licencia por enfermedad paga. Por el contrario, Alemania, la patria de Ziebarth, ha tenido una durante casi 140 años.

La pandemia de coronavirus provocó un cambio a corto plazo. Según explicó Ziebarth, el Families First Coronavirus Response Act ordenó una licencia por enfermedad con goce de sueldo a nivel nacional, la primera en la historia del país.

La ley incluyó aproximadamente dos semanas de pago completo para los empleados que fueran puestos en cuarentena o que buscaran atención médica por síntomas similares a los de covid, y semanas adicionales con pago parcial para cuidar a un niño en cuarentena debido al virus.

Pero el mandato de licencia por enfermedad paga solo se aplicó consistentemente a los empleadores con 50 a 499 empleados, por solo nueve meses, y expiró a fines de 2020. Después, los empleadores pudieron decidir si querían seguir ofreciendo la licencia por enfermedad con goce de sueldo a cambio de créditos fiscales, aunque éstas expiraron a finales de septiembre.

Alrededor del 5% de los empleados en el país utilizaron esta protección federal, escribieron Ziebarth y sus colegas en la revista PNAS, y parece haber ayudado inicialmente a aplanar la curva de la pandemia. Pero no fue suficiente. La cantidad de personas que estaban enfermas, con cualquier enfermedad, pero que no podían tomarse un descanso pasó de unos 5 millones por mes antes de la pandemia a 15 millones a fines de 2020, incluso con la licencia federal vigente.

Las personas con los ingresos más bajos son las que tienen menos probabilidades de contar con licencias por enfermedad pagas, dijo la doctora Rita Hamad, epidemióloga social y médica de familia de la Universidad de California-San Francisco. “Nos quedamos con cualquier mosaico de políticas estatales y de empleadores que existían antes, que dejan a las personas más vulnerables menos cubiertas”, expresó.

La Ley Build Back Better, que fue aprobada en la Cámara de Representantes el 19 de noviembre y espera el voto del Senado, puede otorgar algunos permisos médicos y familiares pagos para que los trabajadores puedan lidiar con enfermedades de más largo plazo o con el cuidado de un ser querido, pero no incluye tiempo fuera del trabajo para recuperarse de una enfermedad de corto plazo.

Jared Make, vicepresidente de A Better Balance, una organización legal nacional sin fines de lucro que aboga por los derechos de los trabajadores, ha estado presionando a los legisladores federales, estatales y locales durante años para que amplíen la licencia por enfermedad con goce de sueldo y ha redactado una legislación modelo.

Make dijo que 16 estados, Washington, DC. y alrededor de 20 localidades tienen leyes permanentes de tiempo por enfermedad remunerado. Una de las más generosas, la de Nuevo México, entrará en vigencia en julio. Colorado, Massachusetts, Nevada, Nueva York y el Distrito de Columbia ofrecen licencias por enfermedad de emergencia específicas para covid, al igual que Pittsburgh y algunas ciudades de California, como Los Ángeles, Oakland y Long Beach.

En algunos lugares, los empleadores están tomando la iniciativa para abordar el problema. Una encuesta reciente de KFF con alrededor de 1,700 empleadores de todo el país halló que el 37% de los empleados trabajan en un lugar que expandió o comenzó a ofrecer licencias pagas, ya sea para recuperarse de una enfermedad o para ayudar a un familiar a recuperarse de una. Mientras tanto, al 1% de los trabajadores se les redujo o eliminó la licencia paga por enfermedad.

Aún así, las llamadas a la línea de ayuda legal gratuita de A Better Balance se han disparado desde que comenzó la pandemia, dijo Make. “Muchos trabajadores están arriesgando su trabajo o no tienen más remedio que ir a trabajar cuando están enfermos, y es un verdadero problema de salud pública”.

En agosto, los departamentos de salud pública locales en California pidieron a los líderes estatales que extendieran la licencia por enfermedad paga a todos los trabajadores, diciendo que no hacerlo desanimaba a las personas a recibir una vacuna contra covid y afectaba desproporcionadamente a las comunidades desfavorecidas.

Muchas personas que han evitado la vacunación temen sufrir efectos secundarios que las obligarán a faltar al trabajo durante uno o dos días, algo que no pueden permitirse, dijo Hamad.

Pero sin fondos federales para reembolsar a los empleadores, California y otros estados tendrían que encontrar dinero para pagar las licencias por enfermedad, y hay poco entusiasmo entre los legisladores por pasar los costos a las empresas.

“En nuestra opinión, es una brecha evidente que el gobierno federal no haya continuado con alguna forma de licencia por enfermedad de emergencia, ni siquiera por covid-19”, dijo Make. “Obviamente, es una gran deficiencia dado el punto en el que nos encontramos en la pandemia”.

Colorado, que está experimentando un aumento de casos de covid, aprobó el año pasado lo que Make, con sede en Denver, considera las protecciones de licencia por enfermedad por covid más sólidas que cualquier otro estado.

La ley, que permite a cualquier empleado ganar hasta seis días de licencia por enfermedad con goce de sueldo por año y entra en vigencia por completo en enero, dice que cuando los funcionarios locales, estatales o federales declaran una emergencia de salud pública, los empleadores deben complementar la licencia acumulada de los trabajadores para que el empleado pueda tomar hasta dos semanas de licencia por enfermedad paga por, en este caso, motivos relacionados con covid. La disposición de licencia de emergencia no vencerá al menos hasta febrero.

Sin embargo, algunos empleadores no la cumplen. A principios de noviembre, la División de Normas y Estadísticas Laborales de Colorado estaba investigando las quejas relacionadas con la ley de licencia por enfermedad que se presentaron contra 71 empleadores, según Eric Yohe, gerente de alcance. Eso representó alrededor del 8% de todas sus quejas salariales bajo investigación. Yohe dijo que su división ya había restablecido la licencia remunerada para “un buen número” de empleados bajo la nueva ley.

La ley de licencias de Colorado todavía tiene limitaciones. Los trabajadores no reciben “recargas” de la licencia por covid si se enferman de nuevo o un familiar se enferma: solo 80 horas en total desde enero de 2021 hasta que finalice la emergencia de salud pública. Y la ley permite que algunos lugares de trabajo obliguen a los empleados a utilizar su tiempo libre remunerado (PTO), siempre que notifiquen a los empleados con anticipación y ofrezcan al menos dos semanas de PTO a los empleados de tiempo completo.

Jamie Bradt, maestra de educación especial en una escuela secundaria en Mead, Colorado, se encontró en esa situación este mes después de dar positivo para covid. Bradt, que está completamente vacunada, pensó que podría aprovechar la licencia por enfermedad por covid sancionada por el estado. Pero su empleador, St. Vrain Valley Schools, le dijo que tendría que usar su PTO, que había estado guardando durante una década.

“Es tan frustrante que me estén castigando por acumular mi licencia”, dijo Bradt, que estuvo en cuarentena en su casa. El distrito no respondió a las preguntas.

Las políticas que obligan a los empleados a trabajar cuando están enfermos son contraproducentes, dijo Barbara Holland, asesora de la Society for Human Resource Management, un grupo comercial nacional. “Es una enfermedad contagiosa”, dijo. “No quieres que se presente en el lugar de trabajo”.

Desde que expiraron las disposiciones federales, Cristina Cuevas y sus colegas en una escuela de Minnesota deben usar su tiempo acumulado por enfermedad y vacaciones si contraen covid.

Recientemente, un compañero de trabajo de Cuevas fue a trabajar enfermo, asumiendo que era un resfriado. “De hecho, tuvo covid todo el tiempo”, dijo Cuevas. La escuela tuvo que cerrar brevemente y varios estudiantes se enfermaron, contó.

La corresponsal de California Healthline, Rachel Bluth, colaboró con esta historia.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Categories: Health Care

Omicron and Other Coronavirus Variants: What You Need to Know

Kaiser Health News - Tue, 11/30/2021 - 12:53pm

Americans, already weary of a pandemic nearly two years long, were dealt a new blow during the long Thanksgiving weekend: the announcement that a new coronavirus variant had emerged.

The omicron variant, officially known as B.1.1.529, surfaced in November in several southern African nations. It set off alarm bells worldwide when public health officials in South Africa saw it beginning to outcompete the previous reigning variant, delta. This suggested that omicron could eventually spread widely. Indeed, omicron has since been reported on multiple continents, likely due to international travel by people unknowingly infected.

After the emergence of omicron was announced, several nations imposed travel bans hoping to contain the virus. Whether those bans will effectively slow the spread remains unknown. “Travel bans don’t help once the horse is already out of the barn, as we’ve seen before and are seeing now,” said Tara Smith, a Kent State University epidemiologist.

Scientists caution that it’s still too early to say whether omicron will prove as dangerous as delta. Other variants that initially seemed worrisome have flamed out.

For now, here’s what we know, and don’t know, about the omicron variant.

What Is a Variant?

A variant of a virus is one that has mutated in a way that bolsters its spread or severity compared with the original strain that emerged in Wuhan, China. “RNA viruses like the coronavirus can mutate when they replicate, especially when circulating at high rates,” said Dr. Monica Gandhi, professor of medicine at the University of California-San Francisco.

Coronaviruses do not mutate as readily as influenza viruses do, but they do mutate over time. The variants generally produce the same range of symptoms as the original strain of the coronavirus. But the mutations may help the virus spread more effectively from person to person, or have an advantage in sneaking past either natural or vaccine immunity.

What Variants Were Already Circulating in the United States?

To date, public health officials have noted five “variants of concern,” plus two “variants of interest” not yet considered as worrisome. So far, no variants have emerged that fit the most worrisome of the three official categories — “variants of high consequence.”

The World Health Organization decided early this year to name the variants after Greek letters, both to simplify the discussion and to limit the stigma of having a variant named for a country.

The first four “variants of concern” — alpha, beta, gamma and delta — have been circulating in the United States for most of this year. But the most dominant variant has been delta, due to its ability to spread from person to person more quickly than other variants. For months, delta has accounted for more than 99% of coronavirus infections in the U.S.

There were no confirmed cases of omicron in the United States as of midday Nov. 29, but experts warn it’s just a matter of time. It could be in the U.S. already, merely undetected.

How Did Omicron Emerge?

Though scientists aren’t sure precisely where omicron first surfaced, it was most likely in a southern African nation.

Experts say low vaccination rates in that part of the world probably played a role in creating a favorable environment for the mutations that produced omicron. (It can be pronounced either AH-mi-crahn or OH-mi-crahn.)

"Many countries in Africa have populations with very low immunity — about 30% in South Africa are vaccinated," Smith said. "In a largely non-immune population, the virus can sweep through, and each new person infected is a chance for the virus to mutate."

Why Did Public Health Officials React So Urgently to Omicron?

The concern stems from the scope and nature of the new variant's mutations. South African health officials noted 50 notable mutations, 30 of which are on the spike protein, a key structure in the virus, New York magazine reported. That’s more than previous variants have had.

"If we were looking out for mutations that do affect transmissibility, it’s got all of them," University of Oxford evolutionary biologist Aris Katzourakis told Science magazine

Still, what’s uncertain at this point is how effectively those mutations will work together in creating a variant that can consistently outcompete delta.

What Do We Know About Omicron's Degree of Infectiousness?

The omicron variant is so new that scientists are just beginning to learn about its characteristics. Because of this, experts urge caution in drawing conclusions, especially from anecdotal evidence.

That said, scientists say they would not be shocked if omicron becomes as easily transmissible as delta. 

"The answer is uncertain, of course, but it looks as though it will be at least as infectious as delta," said Dr. William Schaffner, a professor of preventive medicine at Vanderbilt University School of Medicine.

One complicating factor, Schaffner said, is that the initial areas of fastest spread have been in areas of Johannesburg populated by young adults and college students, who tend to have lower vaccination rates. The vulnerability of these groups to infection may be exaggerating how rapidly omicron seems to be spreading.

What Do We Know About Whether Omicron Makes Patients Sicker?

The early evidence is somewhat conflicting, but there are signs that symptoms from omicron may not be more severe than previous variants. Dr. Angelique Coetzee, who chairs the South African Medical Association, has said that the early cases being seen among the unvaccinated are mild.

It remains to be seen, however, whether older and unhealthier patients will also see milder symptoms. Another caveat is that it may be too early in omicron’s spread to see cases that have seriously progressed.

Will Existing Vaccines Be Effective Against the Omicron Variant?

Scientists are cautiously optimistic that existing vaccines will also be effective against omicron, just as they have been against delta, at least in being able to prevent illness severe enough to require hospitalization.

"Scientists in South Africa and Israel, where the variant has also been detected, have indicated that they are not seeing severe disease among the vaccinated," Gandhi said.

Gandhi added that the immunity-providing B cells produced by the vaccines have been shown to produce antibodies against variants, and that T-cell immunity, which protects against severe disease, is robust and should not be at risk from the mutations being seen in omicron. The vaccines also produce polyclonal antibodies that work against multiple parts of the spike protein, she said. Finally, booster shots have been shown to be effective in strengthening immunity quickly.

"Most scientists believe we should still have protection against severe disease with vaccinations, and vaccination remains the mainstay of control," Gandhi said.

Bottom line: If you haven’t been vaccinated, and especially if you haven’t had the disease yet, get vaccinated. And if you’ve already been vaccinated, get a booster.

How Long Will It Be Before We Have a Better Handle on the Threat From Omicron?

Moderna, Pfizer-BioNTech and Johnson & Johnson are all testing the effectiveness of their existing vaccines against omicron in the lab, based on variant-analysis protocols developed early this year. Those results should be available in a week or two.

Other questions — including whether omicron makes you sicker, and whether it’s more transmissible — will take longer to answer because they require careful contact tracing and accurate diagnoses of those infected. 

To better answer those questions, Smith said, "I think, at a minimum, it will take a month to get some preliminary data, and quite possibly longer to really know the fuller picture. We also won’t know about real-world experience in vaccine breakthroughs until that time."

Can We Expect a Specific New Booster to be Developed for Omicron?

It’s unknown whether the omicron variant will require a reformulated booster. A newly formulated booster wasn’t necessary for delta, because researchers determined that the existing formulation was still effective.

That said, vaccine makers can jump in with a new booster quickly if they have to. 

In the event that such a variant emerges, Pfizer and BioNTech "expect to be able to develop and produce a tailor-made vaccine against that variant" within 100 days, pending regulatory approval, a Pfizer spokesperson told The Washington Post.

Dr. Matthew Laurens, a specialist in pediatric infectious diseases at the University of Maryland School of Medicine, said he’s confident boosters could be developed and tested quickly if needed, "likely within a few months."

What Happened to the Other Variants?

Between May 2021, when delta was named a variant of concern, and November 2021, when omicron was given the same label, two other variants were elevated to the lower "variant of interest" status: lambda from Peru and mu from Colombia. Other variants, such as one discovered in Nepal called "delta-plus," attracted notice during that period as well. But none of these managed to outcompete delta in a consistent way, so they were never elevated to "variant of concern."

This is the most hopeful outcome for omicron. The other variants "all had similar concerns around them, but they didn’t expand to any significant degree after the initial reporting," Gandhi said.

Is It Reasonable to Think the U.S. Is in a Better Position to Handle Omicron Than It Was for Delta?

Experts generally agreed that the United States should be better prepared to battle omicron than it was when delta emerged earlier this year.

"We are in a much better position since we have higher rates of vaccination, the availability of boosters for everyone over 18 and vaccine eligibility down to 5 years old," Gandhi said. "We also have higher rates of natural immunity in this country due to the delta variant’s spread since July 2021. And we have oral antiviral therapeutics on the horizon. So we have the tools to fight this new variant."

The challenge, Schaffner said, will be to make sure Americans continue to get vaccinated and boosted, and to make use of testing and maintain safe behavior in public.

"All these tools are available," he said. "The big question is how inclined the general public is to use these tools."

Is the Coronavirus Going to Be Around Permanently, Like the Flu?

Experts now believe it’s unlikely that the coronavirus will either be eradicated from the globe, like smallpox has been, or even eliminated in the United States, as polio was following near-universal vaccination. The combination of rapid mutations and too-low vaccination rates make it likely that covid-19 won’t follow smallpox and polio into submission.

"This will more likely be the influenza model, where we have to track mutations annually and alter the boosters accordingly," Schaffner said. In fact, he said, efforts to create combined coronavirus-flu shots are already underway.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Categories: Health Care

Email Alerts and Browse Page Updates: Congress.gov New, Tip, and Top for November 2021

In Custodia Legis - Tue, 11/30/2021 - 8:56am

Earlier this month, Robert shared news of the addition of the “Add to My Calendar” feature for upcoming committee hearings on Congress.gov. I have already used it several times to be reminded of when a hearing that I want to follow is scheduled.

Congress.gov continues to grow with new material. If you had done a global search six years ago there would have been about a million items in the results. Now there are almost 1.5 million items to search, including materials from the current Congress, over 90 years of the Bound Congressional Record, and hearing transcripts now starting with the 105th Congress.

We have made a number of enhancements with this month’s second release. We updated the old RSS and Email Alerts page to focus on the variety of alerts Congress.gov provides. See the new Get Email Alerts and Updates page for all the ways to subscribe. Also with this release, there is a new and improved appropriations alert under legislation on the page:

Appropriations Measures Considered by Congress
Email alerts when appropriations measures are considered by Congress. View Appropriations Status Table 

After you are signed in and select “Get alerts” on the site you will be subscribed and will receive an email update when any appropriations bill has action.

We added contextual links to alerts across the site. For example, if you are on the Most Viewed Bills or Enhancement Timeline you will now have an easy link to set up the respective alerts. We also added a new link to Get Email Alerts and Updates on the homepage.

New “Get Email Alerts and Updates” link on the Congress.gov homepage

In a recent update we added the option in the quick search and advanced search forms to default to modern legislation or also include historical legislation. With today’s release we are adding a similar historical check box to the Congressional Record quick search form. Checking the historical box will include the Bound Congressional Record in your search results.

Another section that we focused on enhancing this release is Browse. With the addition of earlier Congresses, the drop down list has been getting longer. This is now a type ahead field, which should be easier for the user. Interested in the 93rd Congress? Start to type 93 and it will be an option. Alternatively, you can type in a year like 1977 if you don’t know off the top of your head that it is in the 95th Congress. Also on the updated Browse pages is the specific date range for the Congress, so on the 95th Congress page you will see “January 4, 1977 – October 15, 1978.”

Newly Updated Browse Page with Type Ahead and Specific Date Range

We continued our quest to improve the accessibility of Congress.gov. The Glossary of Legislative Terms has been improved for accessibility purposes.

Enhancements

The following are the second set of Congress.gov enhancements for November.

Enhancement – Email Alerts and Updates – Appropriations Alert

  • Go to the redesigned Get Email Alerts and Updates page to see the full list of email alerts, updates and RSS feeds available for you to keep up with Congressional activity and current legislation.
  • To get alerts on appropriations legislation for the current fiscal year, use the “Get alerts” link under the heading Appropriations Measures Considered by Congress.
  • You will receive an email when new appropriations bills are introduced or when any current appropriations bills are updated.

Enhancement – Congressional Record – Search

  • Congress checkboxes on the Congressional Record search form give you the option to limit your search to 1995-2022 (Daily Edition issues) or Historical (1909-1994) (Bound Edition volumes).
  • Options for searching only headings and Members Remarks are disabled when you select only Historical Congresses.
  • Tooltips, visible when you move your cursor over the icon next to a Congress checkbox, display helpful reminders and link to the Congressional Record help page for more details.

Enhancement – Browse – Congress Type Ahead

  • Start typing to select a Congress on the Browse page, a directory of frequently-requested resources, lists of legislation and more.
  • Links to House and Senate calendars are available for previous Congresses under Congressional Activity.

Enhancement – Glossary of Legislative Terms – Improved Accessibility

  • Definitions are no longer collapsed in the Glossary of Legislative Terms, improving accessibility and allowing you to get the information you need with fewer clicks.

Enhancement – Congressional Record – Bound Edition

Congress.gov Tip

Did you know that you can search Congress.gov without a search term? Do a blank search and then use the filters (or facets) on the left to winnow your way down to a smaller results set. You can check the “Search Within” box in the search bar later on if you decide you want to add a search term to this results set. And, just a reminder, you can “Save this Search” and “Get Alerts.”

Most-Viewed Bills

The following is the most-viewed bills list for the week of November 21, 2021.

  1. H.R.3684 [117th] Infrastructure Investment and Jobs Act 2. H.R.5376 [117th] Build Back Better Act 3. H.R.4350 [117th] National Defense Authorization Act for Fiscal Year 2022 4. H.R.1319 [117th] American Rescue Plan Act of 2021 5. H.Res.789 [117th] Censuring Representative Paul Gosar. 6. H.Res.57 [117th] Impeaching Joseph R. Biden, President of the United States, for abuse of power by enabling bribery and other high crimes and misdemeanors. 7. H.R.1996 [117th] SAFE Banking Act of 2021 8. H.R.133 [116th] Consolidated Appropriations Act, 2021 9. S.1260 [117th] United States Innovation and Competition Act of 2021 10. H.Res.774 [117th] Providing for consideration of the bill (H.R. 5376) to provide for reconciliation pursuant to title II of S. Con. Res. 14; and for other purposes.

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Categories: Research & Litigation

With Federal Covid Sick Leave Gone, Workers Feel Pressure to Show Up at Work

Kaiser Health News - Tue, 11/30/2021 - 7:31am

Economists and public health experts alike say paid sick leave is an essential tool — like testing, masks and vaccines — in the effort to prevent covid-19 infection and keep workplaces safe.

Yet the U.S. is in the midst of another covid holiday season, and federal laws that offered covid-related paid sick leave to workers have expired. Colorado, Los Angeles and Pittsburgh are among a small number of places that have put in place their own covid protections, but many sick workers across the country must wrestle with difficult financial and ethical questions when deciding whether to stay home.

“Millions of workers don’t have access to paid sick leave, and we’re still in a pandemic,” said Nicolas Ziebarth, a labor economist at Cornell University.

The U.S. is one of only a few industrialized nations that have no national paid sick leave policy. By contrast, Germany, Ziebarth’s homeland, has had one for nearly 140 years.

The coronavirus pandemic led to short-term change. The Families First Coronavirus Response Act mandated paid sick leave nationally, a first in U.S. history, according to Ziebarth. The law included about two weeks of full pay for employees who were quarantined or seeking medical attention for covid-like symptoms and additional weeks at partial pay to care for a child stuck at home because of covid.

But the paid sick leave mandate consistently applied only to employers with 50 to 499 employees and lasted just nine months, expiring at the end of 2020. After that, employers could decide whether they wanted to continue offering paid sick leave in return for tax credits, though those expired at the end of September.

About 5% of U.S. employees used the federal covid sick leave protection, Ziebarth and his colleagues wrote in the journal PNAS, and it appears to have helped flatten the curve of the pandemic initially. But it wasn’t enough. The number of people who were sick with any kind of illness but couldn’t take time off went from about 5 million per month before the pandemic to 15 million in late 2020 — even with the federal leave in place.

People with the lowest incomes are the least likely to be covered by paid sick leave, said Dr. Rita Hamad, a social epidemiologist and family physician at the University of California-San Francisco. “We’re just left with whatever patchwork of employer and state policies that existed before, which leave the most vulnerable people least covered,” she said.

The Build Back Better Act, which is up for a vote in the Senate after passing the House on Nov. 19, may grant some paid medical and family leave so workers can deal with longer-term illnesses or caregiving, but it does not include time off for recovering from short-term illness.

Jared Make, vice president of A Better Balance, a national legal nonprofit advocating for worker rights, has been pushing federal, state and local lawmakers for years to expand paid sick leave and has drafted model legislation. He said 16 states, Washington, D.C., and about 20 localities have permanent paid sick time laws. One of the most generous, New Mexico’s, will take effect in July. Colorado, Massachusetts, Nevada, New York and the District of Columbia provide covid-specific emergency sick leave, as do Pittsburgh and a few cities in California, such as Los Angeles, Oakland and Long Beach.

In some places, employers are taking the initiative to address the problem. A recent KFF survey of about 1,700 employers from across the nation found that 37% of workers work in a place that expanded or started paid leave, either to recover from an illness or to help a relative recover from one. Meanwhile, 1% of workers had their paid sick leave reduced or eliminated.

Still, calls to A Better Balance’s free legal help line have skyrocketed since the pandemic began, Make said. “Many workers are either risking their job, or they have no choice but to go to work when they’re sick, and it’s a real public health concern.”

In August, local public health departments in California asked state leaders to extend paid sick leave to all workers, saying that failing to do so discouraged people from getting a covid vaccine and disproportionately affected disadvantaged communities.

Many people who have avoided vaccination are afraid they’ll suffer side effects that will force them to miss work for a day or two, which they can’t afford, Hamad said.

But without federal funds to reimburse employers, California and other states would have to find money to pay for sick leave — and there’s little enthusiasm among lawmakers for passing the costs on to businesses.

“It is a glaring gap, in our opinion, that the federal government hasn’t continued some form of even covid-19 emergency sick leave,” Make said. “It’s obviously a huge shortcoming given where we are in the pandemic.”

Colorado, which is experiencing a covid surge, passed last year what Denver-based Make considers the strongest covid sick leave protections of any state. The law, which allows any employee to earn up to six days of paid sick leave per year and takes effect fully in January, says that when local, state or federal officials declare a public health emergency, employers must supplement workers’ accrued leave so an employee can take up to two weeks of paid sick leave for, in this case, covid-related reasons. The emergency leave provision won’t expire until at least February.

However, some employers aren’t complying. As of early November, Colorado’s Division of Labor Standards and Statistics was looking into complaints related to the sick leave law that were filed against 71 employers, according to outreach manager Eric Yohe. That represented about 8% of all its wage complaints under investigation. Yohe said his division had already restored paid time off for “a good number” of employees under the new law.

Colorado’s leave law still has limitations. Workers don’t get “refills” of covid leave if they get sick again or a relative gets sick — just 80 hours total from January 2021 until the public health emergency ends. And the law allows some workplaces to force employees to use their paid time off instead, as long as they notify employees in advance and offer at least two weeks of PTO to full-time employees.

Jamie Bradt, a special-education teacher at a high school in Mead, Colorado, found herself in that situation this month after testing positive for covid. Bradt, who is fully vaccinated, thought she could tap into state-sanctioned covid sick leave. But her employer, St. Vrain Valley Schools, told her she would have to use her PTO, which she had been saving up for about decade.

“It is so frustrating that I’m being punished for accruing my leave,” said Bradt, who was isolating at home. The district did not respond to questions.

Policies that push employees to work when they’re sick are counterproductive, said Barbara Holland, an adviser at the Society for Human Resource Management, a national trade group. “It’s a communicable disease,” she said. “You don’t want them showing up in the workplace.”

Since the federal provisions expired, Cristina Cuevas and her colleagues at a Minnesota school have been required to use their accrued sick and vacation time if they come down with covid.

Recently, a co-worker of Cuevas’ went to work sick, assuming it was a cold. “She actually had covid the whole time,” Cuevas said. The school had to shut down briefly, Cuevas said, and several students got sick.

California Healthline correspondent Rachel Bluth contributed to this story.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Categories: Health Care

‘I Can Go Anywhere’: How Service Dogs Help Veterans With PTSD

Kaiser Health News - Tue, 11/30/2021 - 5:00am

It was supper time in the Whittier, California, home of Air Force veteran Danyelle Clark-Gutierrez, and eagerly awaiting a bowl of kibble and canned dog food was Lisa, a 3-year-old yellow Labrador retriever.

Her nails clicking on the kitchen floor as she danced about, Lisa looked more like an exuberant puppy than the highly trained service animal that helps Clark-Gutierrez manage the symptoms of post-traumatic stress disorder.

“Having her now, it’s like I can go anywhere,” Clark-Gutierrez said. “And, yes, if somebody did come at me, I’d have warning — I could run.”

A growing body of research into PTSD and service animals paved the way for President Joe Biden to sign into law the Puppies Assisting Wounded Servicemembers (PAWS) for Veterans Therapy Act. The legislation, enacted in August, requires the Department of Veterans Affairs to open its service dog referral program to veterans with PTSD and to launch a five-year pilot program in which veterans with PTSD train service dogs for other veterans.

Clark-Gutierrez, 33, is among the 25 percent of female veterans who have reported experiencing military sexual trauma while serving in the U.S. armed services.

Military sexual trauma, combat violence and brain injuries are some of the experiences that increase the risk that service members will develop PTSD. Symptoms include flashbacks to the traumatic event, severe anxiety, nightmares and hypervigilance — all normal reactions to experiencing or witnessing violence, according to psychologists. Someone receives a PTSD diagnosis when symptoms worsen or remain for months or years.

That’s what Clark-Gutierrez said happened to her after ongoing sexual harassment by a fellow airman escalated to a physical attack about a decade ago. A lawyer with three children, she said that to feel safe leaving her home she needed her husband by her side. After diagnosing Clark-Gutierrez with PTSD, doctors at VA hospitals prescribed a cascade of medications for her. At one point, Clark-Gutierrez said, her prescriptions added up to more than a dozen pills a day.

“I had medication, and then I had medication for the two or three side effects for each medication,” she said. “And every time they gave me a new med, they had to give me three more. I just couldn’t do it anymore. I was just getting so tired. So we started looking at other therapies.”

And that’s how she got her service dog, Lisa. Clark-Gutierrez’s husband, also an Air Force veteran, discovered the nonprofit group K9s for Warriors, which rescues dogs — many from kill shelters — and trains them to be service animals for veterans with PTSD. Lisa is one of about 700 dogs the group has paired with veterans dealing with symptoms caused by traumatic experiences.

“Now with Lisa we take bike rides, we go down to the park, we go to Home Depot,” said Clark-Gutierrez. “I go grocery shopping — normal-people things that I get to do that I didn’t get to do before Lisa.”

That comes as no surprise to Maggie O’Haire, an associate professor of human-animal interaction at Purdue University. Her research suggests that while service dogs aren’t necessarily a cure for PTSD, they do ease its symptoms. Among her published studies is one showing that veterans partnered with these dogs experience less anger and anxiety and get better sleep than those without a service dog. Another of her studies suggests that service dogs lower cortisol levels in veterans who have been traumatized.

“We actually saw patterns of that stress hormone that were more similar to healthy adults who don’t have post-traumatic stress disorder,” O’Haire said.

A congressionally mandated VA study that focuses on service dogs’ impact on veterans with PTSD and was published this year suggests that those partnered with the animals experience less suicidal ideation and more improvement to their symptoms than those without them.

Until now, the federal dog referral program — which relies on nonprofit service dog organizations to pay for the dogs and to provide them to veterans for free — required that participating veterans have a physical mobility issue, such as a lost limb, paralysis or blindness. Veterans like Clark-Gutierrez who have PTSD but no physical disability were on their own in arranging for a service dog.

The pilot program created by the new federal law will give veterans with PTSD the chance to train mental health service dogs for other veterans. It’s modeled on a program at the VA hospital in Palo Alto, California, and will be offered at five VA medical centers nationwide in partnership with accredited service dog training organizations.

“This bill is really about therapeutic, on-the-job training, or ‘training the trainer,’” said Adam Webb, a spokesperson for Sen. Thom Tillis (R-N.C.), who introduced the legislation in the Senate. “We don’t anticipate VA will start prescribing PTSD service dogs, but the data we generate from this pilot program will likely be useful in making that case in the future.”

The Congressional Budget Office estimates the pilot program will cost the VA about $19 million. The law stops short of requiring the VA to pay for the dogs. Instead, the agency will partner with accredited service dog organizations that use private money to cover the cost of adopting, training and pairing the dogs with veterans.

Still, the law represents a welcome about-face in VA policy, said Rory Diamond, CEO of K9s for Warriors.

“For the last 10 years, the VA has essentially told us that they don’t recognize service dogs as helping a veteran with post-traumatic stress,” Diamond said.

PTSD service dogs are often confused with emotional support dogs, Diamond said. The latter provide companionship and are not trained to support someone with a disability. PTSD service dogs cost about $25,000 to adopt and train, he said.

Diamond explained that the command “cover” means “the dog will sit next to the warrior, look behind them and alert them if someone comes up from behind.” The command “block” means the dog will “stand perpendicular and give them some space from whatever’s in front of them.”

Retired Army Master Sgt. David Crenshaw of Kearny, New Jersey, said his service dog, Doc, has changed his life.

“We teach in the military to have a battle buddy,” Crenshaw said. “And these service animals act as a battle buddy.”

A few months ago, Crenshaw experienced this firsthand. He had generally avoided large gatherings because persistent hypervigilance is one symptom of his combat-caused PTSD. But this summer, Doc, a pointer and Labrador mix, helped Crenshaw navigate the crowds at Disney World — a significant first for Crenshaw and his family of five.

“I was not agitated. I was not anxious. I was not upset,” said Crenshaw, 39. “It was truly, truly amazing and so much so that I didn’t even have to even stop to think about it in the moment. It just happened naturally.”

Thanks to Doc, Crenshaw said, he no longer takes PTSD drugs or self-medicates with alcohol. Clark-Gutierrez said Lisa, too, has helped her quit using alcohol and stop taking VA-prescribed medications for panic attacks, nightmares and periods of disassociation.

The dogs actually save the VA money over time, Diamond said. “Our warriors are far less likely to be on expensive prescription drugs, are far less likely to use other VA services and far more likely to go to school or go to work. So it’s a win-win-win across the board.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Categories: Health Care

How States Can Best Use Federal Fiscal Recovery Funds: Lessons From State Choices So Far

Center on Budget and Policy Priorities - Mon, 11/29/2021 - 10:08am
@media (min-width:768px) { .bleed-wrap { margin-left:-50%; width:150%; } .bleed-wrap > .bleed-reset { max-width:100%; width:940px; margin-right:0; margin-left:auto; } } Most states have started using their share of the $195 billion Fiscal Recovery Funds (FRF), created under the federal American Rescue Plan to help states and localities address the pandemic’s harmful effects. Many states are using their share of the Fiscal Recovery Funds constructively: to offset declines in their revenue collections, to address the health, economic, and fiscal impacts of the pandemic, and to start new long
Categories: Benefits, Poverty

New Report on Children and Data Protection Laws in Ireland

In Custodia Legis - Mon, 11/29/2021 - 9:30am

The following is a guest post by Clare Feikert-Ahalt, a senior foreign law specialist at the Law Library of Congress covering the United Kingdom and several other jurisdictions. Clare has written numerous posts for In Custodia Legis, including 100 Years of “Poppy Day” in the United Kingdom; Weird Laws, or Urban Legends?FALQs: Brexit Referendum; and The UK’s Legal Response to the London Bombings of 7/7.

The Law Library recently published a report titled Children’s Online Privacy and Data Protection for Ireland. This adds Ireland to the Law Library’s report on this subject that cover 10 jurisdictions: the European Union (EU) and its member states of DenmarkFranceGermanyGreecePortugalSpainSweden, and Romania, and the non-EU member of the United Kingdom (UK).

Title page of the Law Library’s report “Ireland: Data Protection and Children.”

As Ireland is a member of the European Union, it must follow the General Data Protection Regulation (GDPR), which took effect in all EU member states, plus the UK, on May 25, 2018. Ireland implemented the Data Protection Act in 2018 to give effect to certain aspects of the GDPR in its domestic laws. This Act also established the Data Protection Commission (DPC), which is the national independent authority in Ireland that supervises the GDPR and ensures it is implemented.

Children’s personal data is provided with special protection under both the 2018 Act and the GDPR. In December 2020, the DPC published a draft code, titled Fundamentals for a Child-Oriented Approach to Data Processing (known as “the Fundamentals”), under the Data Protection Act. The Fundamentals aim to clarify the principles in the obligations under the GDPR and set “high-level obligations” that organizations must take before processing children’s data, and highlight that the best interests of the child take precedence over any legitimate business interests.

Since the Law Library’s report was published, on November 19, 2021, the DPC published a report into the findings of the public consultation on the Fundamentals. In this report, the DPC concluded “[t]he best interests of the child must ground the actions of all data controllers, and there must be a floor of protection below which no user, and in particular no child user, drops” and that it is satisfied that the broad approach of applying the Fundamentals to services that are likely to be accessed by children is the correct one to take, but stated that it will add text to help clarify this, and some of the other Fundamentals, further.

The DPC stated that it will work to finalize the Fundamentals and publish them. It notes that once the Fundamentals are published in their final form they “will have immediate effect and there will be no lead-in period for compliance.” The DPC has stated that this is because the Fundamentals are not a statutory code, nor are they, in essence, new obligations for organizations, noting:

the GDPR is now more than 3 years into its application. Organisations which process children’s personal data – particularly in the digital sectors where business models are predicated upon the processing of personal data for the provision of services – should throughout that period, in line with their accountability obligations under GDPR, have been constantly keeping their child protective measures under review and revision in order to achieve the higher standards of protection which the GDPR requires in relation to the processing of children’s data.

Thus, once the DPC publishes the Fundamentals in their final form they will enter into effect and the DPC will consider an organization’s compliance with the Fundamentals when assessing whether it has met the obligations of the GDPR.

Subscribe to In Custodia Legis – it’s free! – to receive interesting posts drawn from the Law Library of Congress’s vast collections and our staff’s expertise in U.S., foreign, and international law.

Categories: Research & Litigation

Black Tech Founders Want to Change the Culture of Health Care, One Click at a Time

Kaiser Health News - Mon, 11/29/2021 - 5:00am

When Ashlee Wisdom launched an early version of her health and wellness website, more than 34,000 users — most of them Black — visited the platform in the first two weeks.

“It wasn’t the most fully functioning platform,” recalled Wisdom, 31. “It was not sexy.”

But the launch was successful. Now, more than a year later, Wisdom’s company, Health in Her Hue, connects Black women and other women of color to culturally sensitive doctors, doulas, nurses and therapists nationally.

As more patients seek culturally competent care — the acknowledgment of a patient’s heritage, beliefs and values during treatment — a new wave of Black tech founders like Wisdom want to help. In the same way Uber Eats and Grubhub revolutionized food delivery, Black tech health startups across the United States want to change how people exercise, how they eat and how they communicate with doctors.

Inspired by their own experiences, plus those of their parents and grandparents, Black entrepreneurs are launching startups that aim to close the cultural gap in health care with technology — and create profitable businesses at the same time.

“One of the most exciting growth opportunities across health innovation is to back underrepresented founders building health companies focusing on underserved markets,” said Unity Stoakes, president and co-founder of StartUp Health, a company headquartered in San Francisco that has invested in a number of health companies led by people of color. He said those leaders have “an essential and powerful understanding of how to solve some of the biggest challenges in health care.”

Platforms created by Black founders for Black people and communities of color continue to blossom because those entrepreneurs often see problems and solutions others might miss. Without diverse voices, entire categories and products simply would not exist in critical areas like health care, business experts say.

“We’re really speaking to a need,” said Kevin Dedner, 45, founder of the mental health startup Hurdle. “Mission alone is not enough. You have to solve a problem.”

Dedner’s company, headquartered in Washington, D.C., pairs patients with therapists who “honor culture instead of ignoring it,” he said. He started the company three years ago, but more people turned to Hurdle after the killing of George Floyd.

In Memphis, Tennessee, Erica Plybeah, 33, is focused on providing transportation. Her company, MedHaul, works with providers and patients to secure low-cost rides to get people to and from their medical appointments. Caregivers, patients or providers fill out a form on MedHaul’s website, then Plybeah’s team helps them schedule a ride.

While MedHaul is for everyone, Plybeah knows people of color, anyone with a low income and residents of rural areas are more likely to face transportation hurdles. She founded the company in 2017 after years of watching her mother take care of her grandmother, who had lost two limbs to Type 2 diabetes. They lived in the Mississippi Delta, where transportation options were scarce.

“For years, my family struggled with our transportation because my mom was her primary transporter,” Plybeah said. “Trying to schedule all of her doctor’s appointments around her work schedule was just a nightmare.”

Plybeah’s company recently received funding from Citi, the banking giant.

“I’m more than proud of her,” said Plybeah’s mother, Annie Steele. “Every step amazes me. What she is doing is going to help people for many years to come.”

Mission alone is not enough. You have to solve a problem.

Kevin Dedner

Health in Her Hue launched in 2018 with just six doctors on the roster. Two years later, users can download the app at no cost and then scroll through roughly 1,000 providers.

“People are constantly talking about Black women’s poor health outcomes, and that’s where the conversation stops,” said Wisdom, who lives in New York City. “I didn’t see anyone building anything to empower us.”

As her business continues to grow, Wisdom draws inspiration from friends such as Nathan Pelzer, 37, another Black tech founder, who has launched a company in Chicago. Clinify Health works with community health centers and independent clinics in underserved communities. The company analyzes medical and social data to help doctors identify their most at-risk patients and those they haven’t seen in awhile. By focusing on getting those patients preventive care, the medical providers can help them improve their health and avoid trips to the emergency room.

“You can think of Clinify Health as a company that supports triage outside of the emergency room,” Pelzer said.

Pelzer said he started the company by printing out online slideshows he’d made and throwing them in the trunk of his car. “I was driving around the South Side of Chicago, knocking on doors, saying, ‘Hey, this is my idea,’” he said.

Wisdom got her app idea from being so stressed while working a job during grad school that she broke out in hives.

“It was really bad,” Wisdom recalled. “My hand would just swell up, and I couldn’t figure out what it was.”

The breakouts also baffled her allergist, a white woman, who told Wisdom to take two Allegra every day to manage the discomfort. “I remember thinking if she was a Black woman, I might have shared a bit more about what was going on in my life,” Wisdom said.

The moment inspired her to build an online community. Her idea started off small. She found health content in academic journals, searched for eye-catching photos that would complement the text and then posted the information on Instagram.

I didn’t see anyone building anything to empower us.

Ashlee Wisdom

Things took off from there. This fall, Health in Her Hue launched “care squads” for users who want to discuss their health with doctors or with other women interested in the same topics.

“The last thing you want to do when you go into the doctor’s office is feel like you have to put on an armor and feel like you have to fight the person or, like, you know, be at odds with the person who’s supposed to be helping you on your health journey,” Wisdom said. “And that’s oftentimes the position that Black people, and largely also Black women, are having to deal with as they’re navigating health care. And it just should not be the case.”

As Black tech founders, Wisdom, Dedner, Pelzer and Plybeah look for ways to support one another by trading advice, chatting about funding and looking for ways to come together. Pelzer and Wisdom met a few years ago as participants in a competition sponsored by Johnson & Johnson. They reconnected at a different event for Black founders of technology companies and decided to help each other.

“We’re each other’s therapists,” Pelzer said. “It can get lonely out here as a Black founder.”

In the future, Plybeah wants to offer transportation services and additional assistance to people caring for aging family members. She also hopes to expand the service to include dropping off customers for grocery and pharmacy runs, workouts at gyms and other basic errands.

Pelzer wants Clinify Health to make tracking health care more fun — possibly with incentives to keep users engaged. He is developing plans and wants to tap into the same competitive energy that fitness companies do.

Wisdom wants to support physicians who seek to improve their relationships with patients of color. The company plans to build a library of resources that professionals could use as a guide.

“We’re not the first people to try to solve these problems,” Dedner said. Yet he and the other three feel the pressure to succeed for more than just themselves and those who came before them.

“I feel like, if I fail, that’s potentially going to shut the door for other Black women who are trying to build in this space,” Wisdom said. “But I try not to think about that too much.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Categories: Health Care

‘An Arm and a Leg’: How to Avoid the Worst Health Insurance

Kaiser Health News - Mon, 11/29/2021 - 5:00am

Can’t see the audio player? Click here to listen.

Click here for a transcript of the episode.

This episode kicks off with a wild ride: How one journalist nearly got roped into a scam.

While hunting for a new health insurance plan, award-winning journalist Mitra Kaboli got an offer that seemed too good to be true — and seemed to be coming from her current insurer. She was skeptical and, it turns out, had every reason to be. Dania Palanker of Georgetown University’s Center on Health Insurance Reforms unpacks this sketchy scheme and gives us the key to avoiding it: When you’re searching for health insurance, skip Google. Seriously.

Then, top health insurance nerds teach us the right way to shop for health insurance: where to find the fine print and how to read it.

They also deliver some good news (for once): The subsidies in the American Rescue Plan ensure that some deals this year are actually … deals! Meaning: Health insurance has become more affordable for lots of people.

To read all of those tips in one place, check out “First Aid Kit,” a newsletter in which we sum up all the practical stuff we’ve been learning since “An Arm and a Leg” podcast launched. 

“An Arm and a Leg” is a co-production of KHN and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

To hear all KHN podcasts, click here.

And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, StitcherPocket Casts, or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Categories: Health Care

California Joins States Trying to Shorten Wait Times for Mental Health Care

Kaiser Health News - Mon, 11/29/2021 - 5:00am

When Greta Christina fell into a deep depression five years ago, she called up her therapist in San Francisco. She’d had a great connection with the provider when she needed therapy in the past. She was delighted to learn that he was now “in network” with her insurance company, meaning she wouldn’t have to pay out-of-pocket anymore to see him.

But her excitement was short-lived. Over time, Christina’s appointments with the therapist went from every two weeks, to every four weeks, to every five or six.

“To tell somebody with serious, chronic, disabling depression that they can only see their therapist every five or six weeks is like telling somebody with a broken leg that they can only see their physical therapist every five or six weeks,” she said. “It’s not enough. It’s not even close to enough.”

Then, this summer, Christina was diagnosed with breast cancer. Everything related to her cancer care — her mammogram, biopsy, surgery appointments — happened promptly (like a “well-oiled machine,” she said), while her depression care stumbled along.

“It is a hot mess,” she said. “I need to be in therapy — I have cancer! And still nothing has changed.”

A new law signed by Gov. Gavin Newsom in October aims to fix this problem for Californians. Senate Bill 221, which passed the state legislature with a nearly unanimous vote, requires health insurers across the state to reduce wait times for mental health care to no more than 10 business days. Six other states — including Colorado, Maryland and Texas — have similar laws limiting wait times.

Long waits for mental health treatment are a nationwide problem, with reports of patients waiting an average of five or six weeks for care in community clinics, at Department of Veterans Affairs facilities and in private offices from Maryland to Los Angeles County. Across California, half of residents surveyed by the California Health Care Foundation in late 2019 said they had to wait too long to see a mental health care provider when they needed one.

At Kaiser Permanente, the state’s largest insurance company, 87% of therapists said weekly appointments were not available to patients who needed them, according to a 2020 survey by the National Union of Healthcare Workers, which represents KP therapists — and was the main sponsor of the California wait times legislation.

“It just feels so unethical,” said triage therapist Brandi Plumley, referring to the typical two-month wait time she sees at Kaiser Permanente’s mental health clinic in Vallejo, east of San Francisco.

Every day, she takes multiple crisis calls from patients who have therapists assigned to them but can’t get in to see them, she said, describing the providers’ caseloads as “enormous.”

“It’s heartbreaking. And it eats on me day after day after day,” Plumley said. “What Kaiser simply needs to do is hire more clinicians.”

Kaiser Permanente says there just aren’t enough therapists out there to hire. KP is an integrated system — it is a health provider and insurance company under one umbrella — and has struggled to fill 300 job vacancies in clinical behavioral health, according to a statement from Yener Balan, the insurer’s Northern California vice president of behavioral health.

Hiring more clinicians won’t solve the problem, said Balan, who suggested that sustaining one-on-one therapy for all who want it in the future wouldn’t be possible in the current system: “We all must reimagine our approach to the existing national model of care.”

Kaiser Permanente lodged concerns about the wait times bill when it was introduced. And the trade group representing insurers in the state, the California Association of Health Plans, opposed it, saying the shortage of therapists would make meeting the two-week mandate too difficult.

“The COVID-19 pandemic has only exacerbated this workforce shortage, and demand for these services significantly increased,” said Jedd Hampton, a lobbyist for the California Association of Health Plans, in testimony during a state Senate hearing for the bill in the spring.

Hampton referred to a University of California-San Francisco study that predicted California would have nearly 30% fewer therapists than needed to meet demand by 2028.

“Simply put, mandating increased frequency of appointments without addressing the underlying workforce shortage will not lead to increased quality of care,” Hampton said.

Lawmakers pushed back. State Sen. Scott Wiener (D-San Francisco), who authored the bill, accused insurers of overstating the shortage. State Sen. Connie Leyva (D-Chino) said that the therapeutic providers are out there but that insurers are responsible for recruiting them into their networks by paying higher rates and reducing administrative burdens.

If insurers want more young people to enter the mental health care profession, they must improve salaries and working conditions now, said state Sen. Richard Pan (D-Sacramento). (A 2016 KQED investigation uncovered multiple ways that insurers save money by keeping provider networks artificially small.)

As bipartisan support for the bill grew in Sacramento, insurers withdrew their formal opposition.

But whether other states have the political will, or the resources, to legislate a similar solution is unclear, said Hemi Tewarson, executive director of the nonpartisan National Academy for State Health Policy in Washington, D.C. Although California may be able to force insurers to hire more therapists, she said, places like New Mexico, Montana, Wyoming, and parts of the South don’t have enough therapists at any price.

“They don’t have the providers, so you could fine the insurers as much as you want, you’re not going to be able to, in the short term, make up those wait times if they already exist,” she said.

The new California law is a solid step toward improving access to mental health care, with communities of color standing to benefit the most, said Lonnie Snowden, a professor of health policy and management at the University of California-Berkeley. African Americans, Asian Americans and Latinos face the most barriers getting into care, Snowden said, and when people of color do come in for treatment, they are more likely to drop out.

Oversight and enforcement are needed for the new rules to work, said Keith Humphreys, a psychiatry professor at Stanford University. Kaiser Permanente has data systems that can track the time between appointments, but other insurers set up contracts with therapists in private practice, who manage their own caseloads and schedules.

“Who would keep track of whether people who’ve been seen once were seen again in 10 days, when it’s hard enough just to keep track of how many providers we have and who they are seeing?” he asked.

Questions like that one will fall to state regulators, primarily the California Department of Managed Health Care. The department has fined insurers $6.9 million since 2013 for violating state standards, including a $4 million penalty against Kaiser Permanente for excessive wait times for mental health care. Previous state law required insurers to provide initial mental health care appointments within 10 days, and the new law clarifies that they must do the same for follow-up appointments.

Greta Christina, who gets her care at a Kaiser Permanente facility, said she is desperate for the new law to start working. It takes effect on July 1, 2022. Christina thought about paying out-of-pocket in the meantime, to find a therapist she could see more often. But in a cancer crisis, she said, starting over with someone new would be too hard. So she’s waiting.

“Knowing that this bill is on the horizon has been helping me hang on,” she said.

This story is part of a partnership that includes  KQEDNPR and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Categories: Health Care

An Interview with Yunzhou Wang, Foreign Law Intern

In Custodia Legis - Fri, 11/26/2021 - 9:00am

Today’s interview is with Yunzhou Wang, a foreign law intern working virtually in the Global Legal Research Directorate of the Law Library of Congress under my supervision.

Yunzhou Wang, a foreign law intern at the Law Library of Congress. Photo courtesy of Yunzhou Wang.

Describe your background.

I was born in Huainan, a small city in China. I spent my first 18 years in that city. After I graduated from high school, I went to East China University of Political Science and Law (ECUPL) and chose law as my major.

What is your academic/professional history?

I received the bachelor of laws degree from ECUPL in Shanghai. During my undergraduate study, I discovered my passion for international law and comparative law. In my last year at ECUPL, I wrote a paper with Professor Guan Jianqiang, and the paper was published in the Chinese Review of International Law.

After graduating, I chose to pursue a master of laws degree (LL.M.) at Georgetown University. I am a general studies LL.M. student. I am the vice president of the Georgetown China Law Society.

How would you describe your job to other people?

I am an intern in the Global Legal Research Directorate and assist Laney with requests from the U.S. Congress, executive agencies, federal courts, and public clients on foreign law issues in several jurisdictions. Under Laney’s supervision, I conduct legal research on the legal issues in Mainland China, Hong Kong, Taiwan, Singapore, etc. I also draft articles on recent legal developments in these jurisdictions for the Global Legal Monitor.

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

The Library of Congress is the biggest library in the world, and the Global Legal Research Directorate has the responsibility of answering questions for Congress, the government, and the public. Working at the Law Library of Congress is an exciting opportunity to improve my legal research and writing skills. It also helps keep my eyes on new legal developments in China and facilitates my understanding of Chinese law.

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

The Library of Congress has the largest collection of books, drawings, photographs, and films in the world. I hope I will have a chance to visit the Law Library of Congress in person!

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

I am good at playing the traditional Chinese musical instrument, Erhu, and I love to cook Chinese food.

Categories: Research & Litigation

A Civil Body Politic: The Mayflower Compact and 17th-Century Corporations

In Custodia Legis - Wed, 11/24/2021 - 3:25pm

Last year, to mark the 400th anniversary of the Mayflower Compact, I wrote a post on this blog about the Compact’s origins and legacy in Early American history. In that post, I wrote that the Compact served as a place-holder to acknowledge that the colonists were operating outside the region of North America that their patent authorized them to settle. It did not solve the problem of their need for a new patent for their colony. It did, however, represent a best effort at coloring their actions as legal or quasi-legal.

The language of the Compact is at once concise and vague – in its brief 195 words, it does not propose specific laws or a form of government, and it characterizes the collective that the people aboard the Mayflower intended to create with a famous but somewhat opaque phrase: “civil body politic.” In this post, I’d like to talk about the expression “civil body politic” and what it probably meant to the settlers at that time.

At the time of the Mayflower Compact, the phrase “body politic” was routinely used in the law to refer to corporations of all sorts. The category of corporation was both more broadly conceived in the 17th century than the modern word corporation and more transitional. While the latter might generally refer to private for-profit companies that bear a number of traits, including shareholder ownership, professional management, limited liability, and indefinite lifespan, corporations in the 17th century included, for example, hospitals, charities, colleges, some trade guilds, towns, public utilities, and even certain individuals who occupied important posts in public institutions. (Sheppard, pp. 1-5.) Relatively fewer business endeavors benefited from incorporation at that time than now, especially among joint-stock companies. (Seavoy, pp. 46-47.) It was also a period in which the Crown experimented with the new directions in the use of the corporate form. (Guenther, p. 10.)

William Sheppard, an attorney and author of several books in the 17th century, wrote Of Corporations, Fraternities and Guilds (London, 1659), a brief work on the law of corporations. In the introduction, he writes about his subject, “…although art cannot altogether arrive at the perfection of nature; yet it has in this showed a fair adumbration, and given to man the nearest resemblance of his maker, that is, to be in a sort immortal.” Photo by Nathan Dorn.

The word corporation itself is derived from the Latin word corpus, which means body, via the verb corporare, which means to embody. This usage rests on the widespread and longstanding European tradition of using the metaphor of a body to describe human communities. One pervasive idea was that the people in a community acted together in such a way that they became the mutually dependent parts of a single living organism, with, the king, for instance, standing in as the head. This metaphor has roots in antiquity, and can be traced in various forms through medieval Europe and England where it was used for a variety of organizations, but especially the church and the state. (Chroust, pp. 451-452.) Along somewhat different lines, it was repeated by lawyers in Tudor England that the King has two bodies, a natural one, that is mortal and will die, and a “body politic,” an institutional personality representing his sovereignty that can never die. (Axton, p. 212.)

The idea that smaller collective bodies within the kingdom could have and benefit from distinctive traits such as corporate personality and perpetual life already appeared in English sources from the 13th century. (Baker, p. 213.) By the 17th century, the law regularly used the expression “body politic” to make a distinction between natural persons – i.e. even human beings who are not the king – and artificial persons, which were often secular organizations, companies, or associations.

William Sheppard, the first author to write a treatise of any kind on the law of corporations in England, expressed it in his book Of Corporations, Fraternities and Guilds (London, 1659) this way, “our law doth take notice of a body natural, and a body politic.” (Sheppard, p. 2.) A corporation, he explains, is “a body in fiction of law.” The anonymous author of the second treatise on corporations, The Law of corporations: containing the laws and customs of all the corporations and inferior courts of record in England (London, 1702), repeats this formula and expands somewhat on Sheppard’s language: “A corporation or an incorporation is a body framed by policy or fiction of law, and it’s called an incorporation or body incorporate because the persons are made into a body, which endureth in perpetual succession…” (The Law of Corporations, pp. 1-2.)

The anonymous author of The Law of Corporations (London, 1702), the first serious treatise on the law of corporations, remarks in his introduction about William Sheppard’s earlier book on the subject, “I remember not any treatise designedly written on this subject except a little duodecimo by Mr. Shepard (sic), which extends not to the fortieth part of matters relating to corporations.” Photo by Nathan Dorn.

Generally, the creation of a corporation required the state’s authority. Both of the treatises cited above followed the analysis of “the lawful authority of incorporation” that Sir Edward Coke presented in the 1612 Case of Sutton’s Hospital. (Holdsworth, p. 382.) A corporation could only be created in one of four ways, namely a) by the common law (the prime example of this was the king; the British monarch is still today a corporation sole); b) by the authority of parliament; c) by royal charter, and d) by prescription or custom. ((1612) 10 Co. Rep. 1a, 30b.)

The state was willing to extend the privilege of incorporation on the grounds that the companies promote its preferred public policies. (Williston, 105, 110.) For instance, to provide assistance for the needy, it incorporated hospitals and charities; or to grow markets, through the establishments of fairs and trade guilds. At the end of the 16th century, the Crown began experimenting with the use of the corporate form to confer exclusive rights to conduct trade in foreign lands. This led to the creation of the merchant trading companies: the Merchant Venturers (1551), the Muscovy Company (1555), the Levant Company (1581), the Cathay Company (1576) and the East India Company (1600). (Baker, p. 483.)

In the 17th century, the Crown chartered corporations to further its efforts to build colonies in foreign lands. (Osgood, p. 261.) As a result, the language of corporations appears in the charters of early American colonies. To name a few examples, the Charter of New England, issued in 1620, establishes that company as “one body politic and corporate.” The same phrase appears in A Grant of the Province of Maine to Sir Ferdinando Gorges and John Mason in 1622. The Charter of Massachusetts Bay of 1629 also creates that colony as “one body politic and corporate.” Likewise, when Parliament passed the act of incorporation for the Society for the Propagation of the Gospel in New England in 1649, it established it as “one body politic and corporate in law.” The Harvard Charter of 1650 (which was not a royal charter) also establishes “one body politic and corporate in law.” As for Plymouth, part of the long hoped-for solution to the colony’s need for official authorization came in the Charter of the Colony of New Plymouth Granted to William Bradford and his Associates in 1629, which likewise established “one body politic and corporate.”

The Mayflower Compact’s “civil body politic” may have been meant to refer to a body politic that was “civil” as opposed to “ecclesiastical,” which is a distinction that is found in corporations of the time (Kyd, p. 22.) And since some see the Compact as a civil parallel to the church covenants that were an important feature of the practice of the separatist community who settled Plymouth, this meaning is suggestive. Or it may have been meant as a civil corporation as opposed to an eleemosynary, or charitable one, which is another distinction that one encounters. (Kyd, p. 25.) Or it was “civil” in the sense of urban, as a township, which is an obsolete meaning of the word that is attested in the 17th century. Or the word “civil” simply relates to community and citizenship. In any event, lacking the authority of the Crown and the formalities that royal charters or parliamentary acts of incorporation required, the Compact did not create a corporation that was valid in England. It looks in retrospect like a founding of a different sort.

Early works on corporations law in the Law Library’s rare books collection include:

Sheppard, William, -1675? Of corporations, fraternities, and guilds, or, A discourse, wherein the learning of the law touching bodies politique is unfolded, shewing the use and necessity of that invention, the antiquity, various kinds, order and government of the same … London: Printed for H. Twyford, T. Dring, and J. Place, and are to be sold at their shops …, 1659.

The Law of corporations: containing the laws and customs of all the corporations and inferior courts of record in England. Treating of the essentials of, and incidents to, a corporation. Of mayors, bailiffs, serjeants, &. and their executing process… London, Printed by the assigns of R. and E. Atkins for I. Cleeve, 1702.

Kyd, Stewart, -1811. A treatise on the law of corporations. London: Printed for J. Butterworth …, 1793-1794.

Angell, Joseph K. (Joseph Kinnicut), 1794-1857. A treatise on the law of private corporations aggregate, by Joseph K. Angell and Samuel Ames. Boston, Hilliard, Gray, Little & Wilkins, 1832 [c1831].

Secondary Sources:

Axton, Marie. The Influence of Edmund Plowden’s Succession Treatise. Huntington Library Quarterly, Vol. 37, No. 3 (May, 1974), pp. 209-226.

Baker, John H. (John Hamilton). An introduction to English legal history. Fifth edition. Oxford: Oxford University Press, 2019.

Bilder, Mary Sarah. “The Corporate Origins of Judicial Review.” Yale Law Journal 116, no.3 (2006): 502-566.

Bilder, Mary Sarah. “English Settlement and Local Governance.” in The Cambridge History of Law in America. Eds. Michael Grossberg, Christopher Tomlins. New York: Cambridge University Press, 2007-2008. pp. 63-103.

Chroust, Anton-Hermann. The Corporate Idea and the Body Politic in the Middle Ages. The Review of Politics, Vol. 9, No. 4 (Oct., 1947), pp. 423-452.

Guenther, David B. “Of Bodies Politic and Pecuniary: A Brief History of Corporate Purpose,” Michigan Business & Entrepreneurial Law Review, Vol. 9, no. 1 (2020).

Kantorowicz, H. The King’s Two Bodies, A Study in Medieval Political Theology (Princeton: Princeton University Press, 2016 [1957]).

F.W. Maitland, ‘The Crown as Corporation’, in The Collected Papers, ed. H.A.L. Fisher, vol. 3. (Cambridge: Cambridge University Press, 1911).

Osgood, Herbert L. “The Corporation as a Form of Colonial Government.” Political Science Quarterly, Vol. 11, No. 2 (Jun., 1896), pp. 259-277.

Seavoy, Ronald E. The origins of the American business corporation, 1784-1855: broadening the concept of public service during industrialization. (Westport, Conn.: Greenwood Press, 1982).

Williston, Samuel. “History of the Law of Business Corporations Before 1800 I,” Harvard Law Review, 2, No. 3 (Oct. 15, 1888), pp. 105-124.

 

Categories: Research & Litigation

Cambodia’s Legal Professions

In Custodia Legis - Wed, 11/24/2021 - 10:30am

The following is a guest post by Pichrotanak Bunthan, a legal research fellow with the Law Library of Congress who is working under the supervision of Sayuri Umeda, a foreign law specialist covering Japan and other jurisdictions in East and Southeast Asia.

In my previous blog post, I described what legal education in Cambodia looks like. As a sequel to that post, the following will explore some common legal professions for LL.B. graduates in Cambodia. In general, they sit for an entrance exam to become either lawyers, magistrates (including both judges and prosecutors), court clerks, or notaries public. Entrance exams for each legal profession are conducted separately and one graduate may sit for more than one legal profession exam.

ECCC Court Room 20 July 2009. Photo by Flickr user Khmer Rouge Tribunal (ECCC), courtesy of Extraordinary Chambers in the Courts of Cambodia. July 20, 2009. Used under creative commons license, https://creativecommons.org/licenses/by/2.0/.

Lawyers

As a general rule, to be admitted to the Bar Association of the Kingdom of Cambodia (BAKC) as a qualified lawyer, an applicant must be a Khmer citizen holding (1) an LL.B. degree issued by an accredited law school, and (2) a Certificate of Lawyer’s Professional Skill, issued by the Center for Lawyers Training and Legal Professional Improvement, also known as the Legal Training Center (LTC). In addition, the applicant must not have been convicted of any misdemeanor or felony, or received any disciplinary sanction, administrative penalty, or dismissal for any act of moral turpitude or act contrary to honor. (Law on the Statutes of Lawyers of 1995 (English translation) art. 31.)

There are two main routes for a law graduate to be admitted to the BAKC: taking the bar exam or direct admission without taking the bar exam.

Bar Exam

An entrance exam to the LTC is referred to as the bar exam in Cambodia. An applicant must have completed an LL.B. before sitting for the exam. There is no fixed cycle for the bar exam schedule. The exam date will be publically announced on a case-by-case basis. Based on the February 2013 exam, it had two components: the essay test and the oral test. The essay component took one full day with three hours in the morning, with a few questions on civil law (both substantive and procedural), and another three hours in the afternoon, with a few questions on criminal law (both substantive and procedural). Those who passed the written test would be shortlisted for an oral test on a later date. During the oral test, an applicant randomly drew one of these topics: constitutional law, commercial law, and labor law, and would have to answer the examiners’ questions on the randomly selected topic.

There is no preparation course provided in Cambodia either by a private company or a law school and thus applicants generally self-study or organize their own study groups to prepare for the bar exam. The bar exam in Cambodia is highly competitive since a quota is set for each exam cycle. For example, the BAKC selected only 50 people out of 720 applicants in the February 2013 exam.

If an applicant passes the bar exam, they must go through academic training for about one year at the LTC and then practical training for another year. (Art. 35.) After completing the training, the applicant may receive the LTC certificate and request the BAKC for admission based on the general requirements above. Admitted lawyers must comply with the Codes of Ethics for Lawyers adopted in 2012, while the BAKC also has its own internal rules.

Direct Admission

There are a few exceptions that allow people to be admitted to the BAKC without taking the bar exam and the LTC training. First, the certificate from the LTC, and thus sitting for the bar exam, is not necessary for Khmer nationals who (1) have received an LL.B. and have been working in the legal or judiciary field (e.g. legal assistant to a lawyer, employee of the legal department of the government) for more than two years; (2) have received an LL.D.; or (3) are registered in another country’s bar. Furthermore, neither the LTC certificate nor the LL.B. is required if the applicant has served as a judge for two years with a law certificate or has served as a judge for five years without any legal education. (Art. 32.) An applicant who is qualified under these exceptions may submit a request to the BAKC for admission. This route, however, is less commonly availed.

Specialized Legal Practice

The admission to the BAKC through either route permits lawyers to practice throughout the country. However, additional certifications are required for acting as agents for their clients before a number of governmental bodies on specialized areas of law, such as trademark law (Prakas No. 045) and corporate law (Prakas No. 258) at the Ministry of Commerce, and tax law at the General Department of Taxation (Prakas No. 455). In contrast, one does not need to be a licensed attorney to get one of these specialized licenses.

Law Firms

As of August 22, 2017, the total number of law firms and offices in Cambodia was 485, with about 80% of them located in Phnom Penh. As of August 2, 2021, Cambodia (about 17 million people) has 1,855 active lawyers registered at the BAKC. Most lawyers remain in the cities, which is one of the reasons that people in rural areas have difficult access to legal services.

Law firms in Cambodia are exempted from the tax registration requirement for commercial firms, and instead must register with the BAKC. Without any tax registration, law firms are not required to report any income or expenses to the tax authorities. A few years ago, there was an attempt to subject law firms to tax registration and obligations like other commercial firms, but such legal requirement has been delayed indefinitely due to controversy.

Magistrates and Other Professions

The requirements to sit for the exams of other legal professions slightly vary from one to another, but they generally have Cambodian nationality, maximum age, noncriminal records, and some legal education (e.g., LL.B.) requirements. (See previous entrance exam announcements for magistracy, notary, and clerkship.) The Royal Academy for Judicial Professions (RAJP) announces the exam dates on a need-based basis. If an applicant passes any of the exams, they need to undertake training at one of the schools under RAJP in the respective profession for about two years. These schools include the Royal School for Magistracy, Royal School for Court Clerks, Royal School for Notary.

Particularly for the magistracy exam, the maximum age requirement is 35 years old (40 if the applicant is a public official), and the minimum education is an LL.B. Like other exams, the applicant must be Cambodian by birth without any criminal record. (Law on the Statutes of Judges and Prosecutors (English translation), art. 19). Generally, the magistracy entrance exam also has essay and oral test components, and only 50 candidates in total are selected annually for both judges and prosecutors. By way of example, the October 2017 exam’s essay component took two full days. Each day had a three-hour essay test in the morning and another in the afternoon, with testing on civil and criminal law (both substantive and procedural). About 620 candidates registered for the exam and only 55 were selected.

All selected candidates have to attend a training course together for about one year, after which they will be randomly appointed as either a judge or a prosecutor in training at a particular court for another year. (Law on the Statues of Judges and Prosecutors, arts. 24 & 83.) In rare cases, the practical training may be extended for one more year based on the candidate’s performance. (Arts. 25 & 84.) After successfully completing the practical training, the candidate will become a fully-appointed junior judge or junior prosecutor, respectively. (Arts. 25 & 84.)

Buddhist Monk with Yellow Umbrella Walking to Cambodian Supreme Court. Photo by Flickr user Amaury Laporte. January 18, 2016. Used under creative commons license, https://creativecommons.org/licenses/by/2.0/.

Women in Law

Female representation in the legal profession remains relatively low. Among all registered lawyers, only 437 are female, making up about 24 percent, while the female population is more than half of the country’s total population. The female representation in the judicial system is lower, with only about 14 percent of all judges being female, according to a 2018 report. The ratio is even smaller in higher courts. There are currently only two female judges in the Supreme Court out of 16 judges and two female judges in the appellate court out of 18 judges.

There are, however, programs intended to improve the number of female legal practitioners in Cambodia. For example, for about 10 years the Raoul Wallenberg Institute (RWI) has been sponsoring female students to enroll in the English Language Based Bachelor of Law program at Royal University of Law and Economics (RULE) with full tuition-fee scholarships. Similarly, Cambodian Legal Education For Women (CLEW) has been supporting young women from rural Cambodia with tuition, dorms, and allowances to study law in English and Khmer at RULE every year since 2010. Some CLEW-sponsored graduates now hold government positions. The Cambodian government also has the National Education for All program, leading to “a decrease in the gender disparity in primary school admission rates.”

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Categories: Research & Litigation

It Takes a Team: A Doctor With Terminal Cancer Relies on a Close-Knit Group in Her Final Days

Kaiser Health News - Wed, 11/24/2021 - 5:00am

The decisions have been gut-wrenching. Should she try another round of chemotherapy, even though she barely tolerated the last one? Should she continue eating, although it’s getting difficult? Should she take more painkillers, even if she ends up heavily sedated?

Dr. Susan Massad, 83, has been making these choices with a group of close friends and family — a “health team” she created in 2014 after learning her breast cancer had metastasized to her spine. Since then, doctors have found cancer in her colon and pancreas, too.

Now, as Massad lies dying at home in New York City, the team is focused on how she wants to live through her final weeks. It’s understood this is a mutual concern, not hers alone. Or, as Massad told me, “Health is about more than the individual. It’s something that people do together.”

Originally, five of Massad’s team members lived with her in a Greenwich Village brownstone she bought with friends in 1993. They are in their 60s or 70s and have known one another a long time. Earlier this year, Massad’s two daughters and four other close friends joined the team when she was considering another round of chemotherapy.

Massad ended up saying “no” to that option in September after weighing the team’s input and consulting with a physician who researches treatments on her behalf. Several weeks ago, she stopped eating — a decision she also made with the group. A hospice nurse visits weekly, and an aide comes five hours a day.

Anyone with a question or concern is free to raise it with the team, which meets now “as needed.” The group does not exist just for Massad, explained Kate Henselmans, her partner, “it’s about our collective well-being.” And it’s not just about team members’ medical conditions; it’s about “wellness” much more broadly defined.

Massad, a primary care physician, first embraced the concept of a “health team” in the mid-1980s, when a college professor she knew was diagnosed with metastatic cancer. Massad was deeply involved in community organizing in New York City, and this professor was part of those circles. A self-professed loner, the professor said she wanted deeper connections to other people during the last stage of her life.

Massad joined with the woman’s social therapist and two of her close friends to provide assistance. (Social therapy is a form of group therapy.) Over the next three years, they helped manage the woman’s physical and emotional symptoms, accompanied her to doctors’ visits and mobilized friends to make sure she was rarely alone.

As word got out about this “let’s do this together” model, dozens of Massad’s friends and colleagues formed health teams lasting from a few months to a few years. Each is unique, but they all revolve around the belief that illness is a communal experience and that significant emotional growth remains possible for all involved.

“Most health teams have been organized around people who have fairly serious illness, and their overarching goal is to help people live the most fulfilling life, the most giving life, the most social life they can, given that reality,” Massad told me. An emphasis on collaborative decision-making distinguishes them from support groups.

Emilie Knoerzer, 68, who lives next door to Massad and Henselmans and is a member of the health team, gives an example from a couple of years ago. She and her partner, Sandy Friedman, were fighting often and “that was bad for the health of the whole house,” she told me. “So, the whole house brought us together and said, ‘‘This isn’t going well, let’s help you work on this.’ And if we started getting into something, we’d go ask someone for help. And it’s much better for us now.”

Mary Fridley, 67, a close friend of Massad’s and another health team member, offered another example. After experiencing serious problems with her digestive system this past year, she pulled together a health team to help her make sense of her experiences with the medical system. None of the many doctors Fridley consulted could tell her what was wrong, and she felt enormous stress as a result.

“My team asked me to journal and to keep track of what I was eating and how I was responding. That was helpful,” Fridley told me. “We worked on my not being so defensive and humiliated every time I went to the doctor. At some point, I said, ‘All I want to do is cry,’ and we cried together for a long time. And it wasn’t just me. Other people shared what was going on for them as well.”

Dr. Hugh Polk, a psychiatrist who’s known Massad for 40 years, calls her a “health pioneer” who practiced patient-centered care long before it became a buzzword. “She would tell patients, ‘We’re going to work together as partners in creating your health. I have expertise as a doctor, but I want to hear from you. I want you to tell me how you feel, what your symptoms are, what your life is like,’” he said.

As Massad’s end has drawn near, the hardest but most satisfying part of her teamwork is “sharing emotionally what I’m going through and allowing other people to share with me. And asking for help. Those aren’t things that come easy,” she told me by phone conversation.

“It’s very challenging to watch her dying,” said her daughter Jessica Massad, 54. “I don’t know how people do this on their own.”

Every day, a few people inside or outside her house stop by to read to Massad or listen to music with her — a schedule her team is overseeing. “It is a very intimate experience, and Susan feels loved so much,” said Henselmans.

For Massad, being surrounded by this kind of support is freeing. “I don’t feel compelled to keep living just because my friends want me to,” she said. “We cry together, we feel sad together, and that can be difficult. But I feel so well taken care of, not alone at all with what I’m going through.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Categories: Health Care

Florida Sen. Rick Scott Off Base in Claim That Rise in Medicare Premiums Is Due to Inflation

Kaiser Health News - Wed, 11/24/2021 - 5:00am

An increase in Medicare Part B premiums means “America’s Seniors Are Paying the Price for Biden’s Inflation Crisis”

— The headline of a press release from Sen. Rick Scott (R-Fla.)

Republicans blame President Joe Biden for this year’s historic surge in inflation, reflected in higher prices for almost everything — from cars and gas to food and housing. They see last month’s 6.2% annual inflation rate — the highest in decades and mostly driven by an increase in consumer spending and supply issues related to the covid-19 pandemic — as a ticket to taking back control of Congress in next year’s midterm elections.

A key voting bloc will be older Americans, and the GOP aims to illustrate how much worse life has grown for them under the Biden administration.

Sen. Rick Scott (R-Fla.) issued a press release Nov. 16 suggesting that rising general inflation was behind the large increase in next year’s standard premiums for Medicare Part B, which covers physician and some drug costs and other outpatient services.

Sen. Rick Scott: America’s Seniors Are Paying the Price for Biden’s Inflation Crisis” was the headline. The senator’s statement within that press release said, “We need to be LOWERING health care and drug prices and strengthening this vital program for seniors and future generations, not crippling the system and leaving families to pay the cost.” The press release from Scott says he is “slamming Biden’s inaction to address the inflation crisis he and Washington Democrats have created with reckless spending and socialist policies, which is expected to cause significant price increases on [senior] citizens and Medicare recipients.” Scott’s statement in that same press release also says the administration’s “reckless spending” will leave U.S. seniors “paying HUNDREDS more for the care they need.”

We wondered whether these points were true. Was the climbing annual inflation rate over the past several months to blame for the increase in Medicare Part B premiums?

We reached out to Scott’s office for more detail but received no reply. Upon further investigation, we found there is little, if any, connection between general inflation in the past few months and the increase in Medicare Part B premiums.

What’s the Status of Medicare Premiums?

Medicare Part B premiums have been growing steadily for decades to keep up with rising health spending.

The U.S. inflation rate, for years held at bay, has been above 4% since April, hitting 6.2% in October, the highest rate in decades.

On Nov. 12, the Centers for Medicare & Medicaid Services announced that the standard monthly premium for Medicare Part B would rise to $170.10 in 2022, from $148.50 this year. The 14.5% increase is the largest one-year increase in the program’s history.

Scott’s press release refers to the CMS report.

CMS cited three main factors for the increase: rising health care costs, a move by Congress last year that held the premium increase to just $3 a month because of the pandemic, and the need to raise money for a possible unprecedented surge in drug costs. Inflation was not on that list.

In fact, half of the premium increase was due to making sure the program was ready in case Medicare next year decides to start covering Aduhelm, a new Alzheimer’s drug priced at $56,000 per year, per patient. It’s been estimated that total Medicare spending for the drug for one year alone would be nearly $29 billion, far more than any other drug.

How Big a Hit Will Seniors Feel?

The Part B premium is typically subtracted automatically from enrollees’ Social Security checks. Because Social Security recipients will receive a 5.9% cost-of-living increase next year — about $91 monthly for the average beneficiary — they’ll still see a net gain, though a chunk will be eaten away by the hike in Medicare premiums.

About 70% of Medicare beneficiaries won’t face a 14.5% increase, anyway, because a “hold-harmless” provision in federal law protects them from premium increases that exceed Social Security’s cost-of-living increase, said Gretchen Jacobson, a vice president of the nonpartisan Commonwealth Fund. So their increase will be limited to 5.9%.

Those not covered by the hold-harmless provision are mainly high-income beneficiaries (people with incomes over $91,000 for individuals), those newly enrolled in Medicare Part B, people who receive both Medicaid and Medicare, and enrollees not receiving Social Security because they are still working.

What Role Does Inflation Play?

Several Medicare experts said the spike in the general inflation rate has little or nothing to do with the Medicare premium increase. In fact, Medicare is largely immune from inflation, because the program sets prices for hospitals and doctors.

“This is so false that it is annoying,” Paul Ginsburg, a professor of health policy at the Sol Price School of Public Policy at the University of Southern California, said of Scott’s claim that general inflation is behind the premium increase. “The effect of the inflation spike so far on prices is zero because Medicare controls prices.”

Medicare Part B premiums, he said, reflect changes in the amount of health services delivered and a more expensive mix of drugs. “Premiums are tracking spending, only a portion of which reflects prices,” Ginsburg said. “I can’t see that the administration really had any discretion” in setting the premium increase due to the need to build a reserve to pay for the Alzheimer’s drug and make up for the reduced increase last year, he said.

Stephen Zuckerman, co-director of the Urban Institute’s health policy center, said a rise in wages caused by inflation could spur a small boost in Medicare spending because wages help determine how much the program pays providers. But, he said, such an increase would have to occur for more than a few months to affect premiums. Continued soaring inflation could influence 2023 Medicare premiums, not those for 2022. “The claim that premium increases are due to inflation in the last couple of months doesn’t make sense,” Zuckerman said.

CMS faced the challenge of trying to estimate costs for an expensive drug not yet covered by Medicare. “It is a very difficult projection to make, and they want to have enough contingency reserved,” said Jacobson, of the Commonwealth Fund.

Still, the 5.9% jump that will hit most enrollees is a relatively large premium increase, she added. Those beneficiaries will see an $8.76 monthly increase in premiums, or about $105 more for all of 2022.

Our Ruling

Scott said in a press release about the 2022 increase in Medicare Part B premiums that “America’s seniors are paying the price for Biden’s inflation crisis.”

Though his statement contains a sliver of truth, Scott’s assertion ignores critical facts that create a different impression.

For instance, Medicare policy experts said, current general inflation has little, if anything, to do with the increase in premiums. CMS said the increase was needed to put away money in case Medicare starts paying for an Alzheimer’s drug that could add tens of billions in costs in one year and to make up for congressional action last year that held down premiums.

And most seniors will not pay hundreds of dollars more for premiums because of the hold-harmless provision. About 30% of Medicare enrollees — those with high incomes and those who do not receive Social Security — will have to pay the full $21.60 a month, or about $259 for 2022, a 14.5% increase. People in this category either have higher incomes or are not yet receiving Social Security because they are still working.

The other 70% of enrollees will face a 5.9%, or $8.76 a month, increase. This means most Medicare enrollees will see a $105 increase in premiums for all of 2022, not hundreds of dollars.

We rate the claim Mostly False.

SOURCES:

Telephone interview with Stephen Zuckerman, co-director of the Health Policy Center at the Urban Institute, Nov. 19, 2021.

Telephone interview with Paul Ginsburg, professor of health policy at the Sol Price School of Public Policy at the University of Southern California, Nov. 18, 2021.

Telephone interview with Gretchen Jacobson, vice president of the Medicare program at the Commonwealth Fund, Nov. 18, 2021.

Telephone interview with Joe Antos, senior fellow with American Enterprise Institute, Nov. 18, 2021.

Sen. Rick Scott’s press release, Nov. 16, 2021.

Statista, monthly inflation rates, accessed Nov. 19, 2021.

Centers for Medicare & Medicaid Services press release about Medicare Part B premiums, accessed Nov. 19, 2021.

Medicareresources.org’s fact sheet about the Medicare hold-harmless provision, accessed Nov. 19, 2021.

Medicareresources.org fact sheet about high earners not subject to the hold-harmless provision, accessed Nov. 19, 2021.

Social Security blog about the hold-harmless provision, accessed Nov. 19, 2021.

AARP blog about the biggest-ever increase in Medicare Part B premiums, accessed Nov. 18, 2021.

Medicare Trustees Report, 2021 (see page 90 for Medicare Part B premiums by year since program inception).

KFF brief on the impact Aduhelm could have on Medicare costs, accessed Nov. 18, 2021.

CMS’ “2022 Medicare Parts A & B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts” report, accessed Nov. 12, 2021.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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KHN’s ‘What the Health?’: The Big Biden Budget Bill Passes the House

Kaiser Health News - Tue, 11/23/2021 - 2:55pm

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

President Joe Biden’s “Build Back Better” social spending bill passed the House last week, but the legislation faces a new and different set of hurdles in the Senate, where it will need the support of every single Democrat, plus approval by the Senate parliamentarian.

Meanwhile, covid-19 is surging again in Europe as well as in many parts of the United States, just as travel picks up for the holidays. And the Supreme Court prepares to hear oral arguments in an abortion case out of Mississippi that could lead to the weakening or overturning of Roe v. Wade — and could upend the political landscape in the U.S.

This week’s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and the Johns Hopkins School of Public Health, and Mary Agnes Carey of KHN.

Among the takeaways from this week’s episode:

  • There are roadblocks ahead in the Senate for the social spending plan. Some moderate Democrats may want to make changes, and parts of the bill could be challenged under tight Senate rules that require bills being passed using the budget reconciliation procedures — which prohibit filibustering — to show that the provisions have an effect on the budget.
  • Among the health provisions that could be affected are paid family leave and the restrictions on drug price increases for plans outside of the Medicare program.
  • As the bill passed by the House gets scrutinized, some of the smaller provisions that may not have garnered attention initially are now targets of debate and industry lobbying. Among them: a decision to tax vaping products, which some opponents suggest will lead users to continue to use cigarettes instead. Another is a mandate for nursing homes to have registered nurses in place 24/7, even though industry officials say they can’t recruit enough staff, which might lead some homes to close.
  • If Congress does approve the bill, it’s good to remember that passage is not the final word. Industry and advocates will continue to lobby the administration on regulations to implement the legislation, and those who are distressed by the law could take their grievances to court.
  • With the decision last week by the Food and Drug Administration and the Centers for Disease Control and Prevention to authorize covid vaccine boosters for all adults, public health messaging on the shots has shifted. While officials were much more nuanced when boosters first became available, they are now pushing hard for everyone to get the extra doses.
  • Public attitudes about covid also appear to be shifting, perhaps a result of pandemic fatigue. Where once Americans looked to vaccines to release them from the drudgeries of avoiding covid, many now acknowledge the virus will be around for a long time and are struggling to figure out how to return to a more normal life.

Also this week, Rovner interviews Mary Ziegler of the Florida State University College of Law about the Supreme Court’s upcoming oral arguments in the Mississippi abortion case.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The Wall Street Journal’s “Telehealth Rollbacks Leave Patients Stranded, Some Doctors Say,” by Stephanie Armour and Robbie Whelan.

Margot Sanger-Katz: The New York Times’ “Everything in the House Democrats’ Budget Bill,” by Alicia Parlapiano and Quoctrung Bui.

Joanne Kenen: Politico’s “VA Stats Show Devastating Covid Toll at Vets’ Nursing Homes,” by Joanne Kenen, Darius Tahir and Allan James Vestal.

Mary Agnes Carey: KHN’s “A Covid Head-Scratcher: Why Lice Lurk Despite Physical Distancing,” by Rae Ellen Bichell.

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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U.S. Funneling Billions of Dollars for Rural Health Care

Medicare -- New York Times - Tue, 11/23/2021 - 1:11pm
The Department of Health and Human Services has begun distributing $7.5 billion to more than 40,000 health care providers in rural areas of every state.
Categories: Elder, Medicare

Etching the Pain of Covid Into the Flesh of Survivors

Kaiser Health News - Tue, 11/23/2021 - 5:00am

It was Saturday morning at Southbay Tattoo and Body Piercing in Carson, California, and owner Efrain Espinoza Diaz Jr. was prepping for his first tattoo of the day — a memorial portrait of a man that his widow wanted on her forearm.

Diaz, known as “Rock,” has been a tattoo artist for 26 years but still gets a little nervous when doing memorial tattoos, and this one was particularly sensitive. Diaz was inking a portrait of Philip Martin Martinez, a fellow tattoo artist and friend who was 45 when he died of covid-19 in August.

“I need to concentrate,” said Diaz, 52. “It’s a picture of my friend, my mentor.”

Martinez, known to his friends and clients as “Sparky,” was a tattoo artist of some renown in nearby Wilmington, in Los Angeles’ South Bay region. A tattoo had brought Sparky and Anita together; Sparky gave Anita her first tattoo — a portrait of her father — in 2012, and the experience sparked a romance. Over the years of their relationship, he had covered her body with intertwining roses and a portrait of her mother.

Now his widow, she was getting the same photograph that was etched on Sparky’s tomb inked into her arm. And this would be her first tattoo that Sparky had not applied.

“It feels a little odd, but Rock has been really good to us,” Anita Martinez said. Rock and Sparky “grew up together.” They met in the 1990s, at a time when there were no Mexican-American-owned tattoo shops in their neighborhood but Sparky was gaining a reputation. “It was artists like Phil that would inspire a lot of us to take that step into the professional tattoo industry,” Rock said.

After Sparky got sick, Anita wasn’t allowed in her husband’s hospital room, an isolating experience shared by hundreds of thousands of Americans who lost a loved one to covid. They let her in only at the very end.

“I got cheated out of being with him in his last moments,” said Martinez, 43. “When I got there, I felt he was already gone. We never got to say goodbye. We never got to hug.”

“I don’t even know if I’m ever going to heal,” she said, as Diaz began sketching the outlines of the portrait below her elbow, “but at least I’ll get to see him every day.”

According to a 2015 Harris Poll, almost 30% of Americans have at least one tattoo, a 10% increase from 2011. At least 80% of tattoos are for commemoration, said Deborah Davidson, a professor of sociology at York University in Toronto who has been researching memorial tattoos since 2009.

“Memorial tattoos help us speak our grief, bandage our wounds and open dialogue about death,” she said. “They help us integrate loss into our lives to help us heal.”

Covid, sadly, has provided many opportunities for such memorials.

Juan Rodriguez, a tattoo artist who goes by “Monch,” has been seeing twice as many clients as before the pandemic and is booked months in advance at his parlor in Pacoima, an L.A. neighborhood in the San Fernando Valley. Memorial tattoos, which can include names, portraits and special artwork, are common in his line of work, but there’s been an increase in requests due to the pandemic. “One client called me on the way to his brother’s funeral,” Rodriguez said.

Rodriguez thinks memorial tattoos help people process traumatic experiences. As he moves his needle over the arms, legs and backs of his clients, and they share stories of their loved ones, he feels he is part artist, part therapist.

Healthy grievers do not resolve grief by detaching from the deceased but by creating a new relationship with them, said Jennifer R. Levin, a therapist in Pasadena, California, who specializes in traumatic grief. “Tattoos can be a way of sustaining that relationship,” she said.

It’s common for her patients in the 20-to-50 age range to get memorial tattoos, she said. “It’s a powerful way of acknowledging life, death and legacy.”

Sazalea Martinez, a kinesiology student at Antelope Valley College in Palmdale, California, came to Rodriguez in September to memorialize her grandparents. Her grandfather died of covid in February, her grandmother in April. She chose to have Rodriguez tattoo an image of azaleas with “I love you” written in her grandmother’s handwriting.

The azaleas, which are part of her name, represent her grandfather, she said. Sazalea decided not to get a portrait of her grandmother because the latter didn’t approve of tattoos. “The ‘I love you’ is something simple and it’s comforting to me,” she said. “It’s going to let me heal and I know she would have understood that.”

Sazalea teared up as the needle moved across her forearm, tracing her grandmother’s handwriting. “It’s still super fresh,” she said. “They basically raised me. They impacted who I am as a person, so to have them with me will be comforting.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Categories: Health Care

When the Eye on Older Patients Is a Camera

Kaiser Health News - Tue, 11/23/2021 - 5:00am

In the middle of a rainy Michigan night, 88-year-old Dian Wurdock walked out the front door of her son’s home in Grand Rapids, barefoot and coatless. Her destination was unknown even to herself.

Wurdock was several years into a dementia diagnosis that turned out to be Alzheimer’s disease. By luck, her son woke up and found her before she stepped too far down the street. As the Alzheimer’s progressed, so did her wandering and with it, her children’s anxiety.

“I was losing it,” said her daughter, Deb Weathers-Jablonski. “I needed to keep her safe, especially at night.”

Weathers-Jablonski installed a monitoring system with nine motion sensors around the house — in her mother’s bedroom, the hallway, kitchen, living room, dining room and bathroom and near three doors that led outside. They connected to an app on her phone, which sent activity alerts and provided a log of her mother’s movements.

“When I went to bed at night, I didn’t have to guess what she was doing,” Weathers-Jablonski said. “I was actually able to get some sleep.”

New monitoring technology is helping family caregivers manage the relentless task of looking out for older adults with cognitive decline. Setting up an extensive monitoring system can be expensive — Weathers-Jablonski’s system from People Power Co. costs $299 for the hardware and $40 a month for use of the app. With scores of companies selling such gear, including SentryTell and Caregiver Smart Solutions, they are readily available to people who can pay out-of-pocket.

But that’s not an option for everyone. While the technology is in line with President Joe Biden’s plan to direct billions of dollars toward helping older and disabled Americans live more independently at home, the costs of such systems aren’t always covered by private insurers and rarely by Medicare or Medicaid.

Monitoring also raises ethical questions about privacy and quality of care. Still, the systems make it possible for many older people to stay in their home, which can cost them far less than institutional care. Living at home is what most people prefer, especially in light of the toll the covid-19 pandemic took on nursing homes.

Technology could help fill a huge gap in home care for the elderly. Paid caregivers are in short supply to meet the needs of the aging population, which is expected to more than double in coming decades. The shortage is fueled by low pay, meager benefits and high rates of burnout.

And for the nearly 1 in 5 U.S adults who are caregivers to a family member or friend over age 50, the gadgets have made a hard job just a little easier.

Passive surveillance systems are replacing the “I’ve fallen and I can’t get up” medical alert buttons. Using artificial intelligence, the new devices can automatically detect something is wrong and make an emergency call unasked. They also can monitor pill dispensers and kitchen appliances using motion sensors, like EllieGrid and WallFlower. Some systems include wearable watches for fall detection, such as QMedic, or can track GPS location, like SmartSole’s shoe insoles. Others are video cameras that record. People use surveillance systems like Ring inside the home.

Some caregivers may be tempted to use technology to replace care, as researchers in England found in a recent study. A participant who had visited his father every weekend began visiting less often after his dad started wearing a fall detector around his wrist. Another participant believed her father was active around the house, as evidenced by activity sensor data. She later realized the app was showing not her father’s movement, but his dog’s. The monitoring system picked up the dog’s movements in the living room and logged it as activity.

Technology isn’t a substitute for face-to-face interaction, stressed Crista Barnett Nelson, executive director of Senior Advocacy Services, a nonprofit group that helps older adults and their families in the North Bay area outside San Francisco. “You can’t tell if someone has soiled their briefs with a camera. You can’t tell if they’re in pain, or if they just need an interaction,” she said.

In some instances, people being monitored changed their habits in response to technology. Clara Berridge, a professor of social work at the University of Washington who studies the use of technology in elder care, interviewed a woman who stopped her usual practice of falling asleep on the recliner because the technology would falsely alert her family that something was wrong based on inactivity deemed abnormal by the system. Another senior reported rushing in the bathroom for fear an alert would go out if they took too long.

The technology presents another worry for those being monitored. “A caregiver is generally going to be really concerned about safety. Older adults are often very concerned about safety too, but they may also weigh privacy really heavily, or their sense of identity or dignity,” Berridge said.

Charles Vergos, 92 and living in Las Vegas, is uncomfortable with video cameras in his house and wasn’t interested in wearing gadgets. But he liked the idea that someone would know if something went wrong while he was alone. His niece, who lives in Palo Alto, California, suggested Vergos install a home sensor system so she could monitor him from afar.

“The first question I asked is, does it take pictures?” Vergos recalled. Because the sensors don’t have a video component, he was fine with them. “Actually, after you have them in the house for a while, you don’t even think about it,” Vergos said.

The sensors also have made conversations with his niece more convenient for him. She knows he likes to talk on the phone while he’s in his chair in the den, so she’ll check his activity on her iPad to determine whether it’s a good time to call.

People making audio and video recordings must abide by state privacy laws, which typically require the consent of the person being recorded. It’s not as clear, however, if consent is needed to collect the activity data that sensors gather. That falls into a gray area of the law, similar to data collected through internet browsing.

Then there is the problem of how to pay for it all. Medicaid, the federal-state health program for low-income people, does cover some passive monitoring for home care, but it’s not clear how many states have opted to pay for such service.

Some seniors also lack access to robust internet broadband, putting much of the more sophisticated technology out of reach, noted Karen Lincoln, founder of Advocates for African American Elders at the University of Southern California.

The relief monitoring devices bring caregivers may be the most compelling reason for their use. Delaine Whitehead, who lives in Orange County, California, started taking medication for anxiety about a year after her husband, Walt, was diagnosed with Alzheimer’s.

Like Weathers-Jablonski, Whitehead sought technology to help, finding peace of mind in sensors installed on the toilets in her home.

Her husband often flushed too many times, causing the toilets to overflow. Before Whitehead installed the sensors in 2019, Walt had caused $8,000 worth of water damage in their bathroom. With the sensors, Whitehead received an alert on her phone when the water got too high.

“It did ease up a lot of my stress,” she said.

Sofie Kodner is a writer with the Investigative Reporting Program at the University of California-Berkeley Graduate School of Journalism. The IRP reported this story through a grant from The SCAN Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Categories: Health Care

Becerra Says Surprise Billing Rules Force Doctors Who Overcharge to Accept Fair Prices

Kaiser Health News - Mon, 11/22/2021 - 11:30am

Overpriced doctors and other medical providers who can’t charge a reasonable rate for their services could be put out of business when new rules against surprise medical bills take effect in January, and that’s a good thing, Health and Human Services Secretary Xavier Becerra told KHN, in defending the regulations.

The proposed rules represent the Biden administration’s plan to carry out the No Surprises Act, which Congress passed to spare patients from the shockingly high bills they get when one or more of their providers unexpectedly turn out to be outside their insurance plan’s network.

The law shields patients from those bills, requiring providers and insurers to work out how much the physicians or hospitals should be paid, first through negotiation and then, if they can’t agree, arbitration. Doctor groups and medical associations, however, have lashed out at the interim final rules that HHS unveiled last month, saying they favor insurance companies in the arbitration phase. That’s because, although the rules tell arbiters to take many factors into account, they are instructed to start with a benchmark largely determined by insurers: the median rate negotiated for similar services among in-network providers.

The doctor groups say giving the insurers the upper hand will let them drive payment rates down and potentially force doctors out of networks or even out of business, reducing access to health care.

The department has heard those concerns, Becerra said, but the bottom line is protecting patients. Medical providers who have taken advantage of a complicated system to charge exorbitant rates will have to bear their share of the cost, or close if they can’t, he said.

“I don’t think when someone is overcharging, that it’s going to hurt the overcharger to now have to [accept] a fair price,” Becerra said. “Those who are overcharging either have to tighten their belt and do it better, or they don’t last in the business.”

“It’s not fair to say that we have to let someone gouge us in order for them to be in business,” he added.

Nonetheless, Becerra said he did not foresee a wave of closures, or diminished access for consumers. Instead, he suggested that a competitive, market-driven process will find a balance, especially when consumers know better what they are paying for.

“We’re willing to pay a fair price,” he said. But he emphasized that “I’ll pay for the best, but I don’t want to have to pay for the best and then three times more on top of that and get blindsided by the bill.”

Becerra also pointed to a report on surprise medical bills that HHS was set to release Monday and that was provided to KHN in advance, highlighting the impacts of negotiation and arbitration laws already in effect in 18 states.

The report, which aggregates previous research, found people getting hit with surprise bills averaging $1,219 for anesthesiologists, $2,633 for surgical assistants, $744 for childbirth and north of $24,000 for air ambulances.

In the states that use benchmarks similar to what doctors are suggesting HHS use, such as New York and New Jersey, the report found costs rising. New York has a “baseball-style” system in which the arbiter chooses between the offers presented by the provider and the insurer, although the arbiter is told to consider the offer closest to the 80th percentile of charges. “Since the amount providers charge is typically much higher than the actual negotiated rate, this approach risks leading to significantly higher overall costs,” the report found. In New Jersey, billed charges or “usual and customary” rates are considered.

“When the arbitration process is wide open, no boundaries, at the end of the day health care costs go up, not down,” Becerra said of the methods doctors prefer. “We want costs to go down. And so we want to set up a system that helps provide the guideposts to keep us efficient, transparent and cost-effective.”

The system chosen by the Biden administration was expected to push insurance premiums down by 0.5% to 1%, the Congressional Budget Office estimated.

“Everyone has to give a little to get to a good place,” Becerra said. “That sweet spot, I hope, is one where patients … are extracted from that food fight. And if there continues to be a food fight, the arbitration process will help settle it in a way that is efficient, but it also will lead to lower costs.”

While the administration chose a benchmark that physician and hospital groups don’t like, the law does specify that other factors should be considered, such as a provider’s experience, the market and the complexity of a case. Becerra said those factors help ensure arbitration is fair.

“What we simply did was set up a rule that says, ‘Show the evidence,’” Becerra said. “It has to be relevant, material evidence. And let the best person win in that fight in arbitration.”

The interim final rules were published Oct. 7, giving stakeholders 60 days to comment and seek changes. More than 150 members of Congress, many of them doctors, have asked HHS and other relevant federal agencies to reconsider before the law takes effect Jan. 1. The lawmakers charge that the administration is not adhering to the spirit of the compromises Congress made in passing the law.

Rules that are this far along tend to go into effect with little or no changes, but Becerra said his department was still listening. “If we think there’s a need to make any changes, we are prepared to do so,” the secretary said.

The HHS report also noted that the law requires extensive monthly and annual reporting to regulators and Congress to determine if the regulations are out of whack or have undesirable consequences like those the physicians are warning of.

Becerra said he thinks the rules strike the right balance, favoring not insurers or doctors, but the people who need medical care.

“We want it to be transparent, so we can lead to more competition, and keep costs low — not just for the payer, the insurer, not just for the provider, the hospital or doctor, but for the patients especially,” he said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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