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Health Care

U.S. Rep. Ayanna Pressley Pushes Bill To Make Birth Control More Accessible

CommonHealth (WBUR) - Sat, 06/15/2019 - 11:36am
Supporters say the bill would expand access to affordable birth control while maintaining the FDA’s authority to determine the safety of drugs.
Categories: Health Care

Legislating Gummy Candy And Balms: Should Congress Pass A Law On CBD?

CommonHealth (WBUR) - Fri, 06/14/2019 - 1:43pm
The legal status of CBD, the cannabis-derived compound increasingly found in everything from gummy candies to coffee, is confusing. An editorial argues that a law could help clear it up -- and perhaps help rein in the general Wild West situation with dietary supplements.
Categories: Health Care

Must-Reads Of The Week From Brianna Labuskes

Kaiser Health News - Fri, 06/14/2019 - 1:40pm
The Friday Breeze

Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.

Happy Friday! Have drug prices gotten so bad that patients are now turning to robbing banks to afford them? It sounds like something out of a movie script, but it’s what a Utah man told police when he was accused of just that. While it’s unverified whether he, in fact, had any prescriptions, it doesn’t seem like much of a stretch for anyone paying attention to the state of drug prices in this country.

On to what you may have missed this week (including one of the wilder health stories I can recall reading in a while).

Lawmakers were busy, busy bees this week with hearings on health care issues.

The moment that drew perhaps the biggest spotlight was almost cinematic: A furious Jon Stewart took members to task in an almost nine-minute display of pointed, nonpartisan outrage over their feet-dragging on health care funding for 9/11 first responders and victims. Why is this “so damn hard?” the comedian asked. Firefighters, police and other first responders “did their jobs with courage, grace, tenacity and humility,” Stewart said. “Eighteen years later, do yours.” A bill allocating money to the fund for 70 years passed the House panel following the hearing.

The Associated Press: Jon Stewart Lashes Out at Congress Over 9/11 Victims Fund

The New York Times: How Jon Stewart Became a Fierce Advocate for 9/11 Responders

Reuters: House Panel Approves Permanent Sept. 11 Victims’ Compensation

But it wasn’t just made-for-TV drama on Capitol Hill this week. There was a flurry of activity related to health care. Here are some of the highlights, including a hearing on universal health coverage, which was heavy on fiery political rhetoric and light on substance:

The Hill: House Democrats Vote to Overturn Trump Ban on Fetal Tissue Research

CNN: Medicare for All Hearing Turns Into a Defense of Obamacare

Modern Healthcare: Arbitration for Surprise Medical Bills Splits House Panel

The Hill: Pelosi to Change Drug-Pricing Plan After Progressive Complaints

The Hill: Democrats Scuttle Attempt to Strike Hyde Amendment From Spending Bill

The Hill: House Panel Launches Investigation Into Juul

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Even if “Medicare for All” were to overcome the daunting political hurdles lying in its path, it’s likely it would face so many legal challenges it could be bled out before it’s ever implemented. “There could be a death by a thousand-lawsuits approach,” Georgetown law professor Katie Keith told Politico. Other experts note, though, that there’s a difference between forcing someone to buy a product and banning something, which makes Medicare for All less vulnerable legally than the health law.

Politico: ‘Death by a Thousand Lawsuits’: The Legal Battles That Could Dog ‘Medicare for All’

Over in Chicago at the American Medical Association’s annual meeting, a medical student-led push to get the organization to reverse its decades-long opposition to single-payer health care failed. But, there’s more to it than that! A fabulous thread on Twitter from Bob Doherty of the American College of Physicians explains how the fact that the vote percentages were so close is remarkable in and of itself. The outcome would have been “unimaginable” in years past, he says.

The Hill: Major Doctors Group Votes to Oppose Single-Payer Health Care

And read Doherty’s thread here.

When premiums shot up over the past several years, more and more people turned to health care sharing ministries — which essentially connect people of similar faiths and set up a cost-sharing arrangement among the members. Because these models are not technically insurance, they’re allowed to skirt health law regulations and aren’t regulated by state commissioners. All of that was seen as a point in their favor from supporters at the time they joined them. But now it means that when bills aren’t paid on time, or at all, consumers have little recourse and officials’ hands are tied in holding the organizations responsible for their promises.

The Wall Street Journal: As Sharing Health-Care Costs Takes Off, States Warn: It Isn’t Insurance

Meanwhile, the Trump administration continues to chip away at the health law with its latest rule on health reimbursement arrangements, which will allow small firms to use tax-free accounts to help workers pay for insurance.

The Hill: Trump Officials Issue New Rule Aimed at Expanding Health Choices for Small Businesses

If you took anything away from last week’s drama over former Vice President Joe Biden’s stance on the Hyde Amendment it was probably that it seems the parties are dead set on their positions on abortion. But a look at how the public feels about the issue reveals blurred lines and nuance that doesn’t always fit into pat sound bites and political declarations. Many Americans struggle with the moral complexities surrounding abortion and their opinions can change from one question to the next, depending on the wording.

The New York Times: Politicians Draw Clear Lines on Abortion. Their Parties Are Not So Unified.

A new poll does show, however, that despite the ever-increasing threat to Roe v. Wade a strong majority of Americans don’t want to see it overturned.

NPR: Abortion Poll: Majority Wants to Keep Abortion Legal, but With Restrictions

Actress Jessica Biel ignited a firestorm of criticism after speaking out about a controversial California bill that would give a state official the final say on medical exemptions from vaccines. Once the blaze was lit, Biel tried to clarify that her issue was not with the vaccines themselves, but rather with the legislation introducing bureaucrats into the process. California’s governor has even hinted at similar concerns. The blowback, though, highlights how inherently inflammatory the topic has become as measles cases continue to climb across the country.

The New York Times: Here Is What Jessica Biel Opposes in California’s Vaccine Bill

In New York — the state at the heart of the record-busting measles outbreak — lawmakers passed a bill banning religious exemptions to vaccines. The governor signed it minutes later.

The Associated Press: New York Set to Cut Religious Exemption to Vaccine Mandates

I have kept you on tenterhooks long enough! One of the wilder health stories I’ve read in a long time comes from gruesomely fascinating Arizona Republic reporting. It’s a look into the thriving for-profit world of whole-body donations following death. Critics deem the practice as no better than “back alley grave robbing.” “There’s a price list for everything from a head to a shoulder, like they are a side of beef. They make money, absolutely, because there’s no cost in getting the bodies,” lawyer Michael Burg told The Arizona Republic. Supporters, however, see it as an affordable way to dispose of the remains of loved ones (which can actually be very expensive for low-income families).

Either way, it garnered my favorite quote of the week, asked by one potential donor: “Will I have a head in heaven?”

The Arizona Republic: Arizona Is a Hotbed for the Cadaver Industry, and Potential Donors Have Plenty of Options

The Arizona Republic: Despite 2-Year-Old State Law, Arizona’s Body Donation Industry Still Unregulated

In a move that left Flint, Mich., residents stunned and frustrated, prosecutors dropped all criminal charges against officials over the city’s water contamination crisis. Although prosecutors said the old investigation was bungled and there will be new charges, the announcement came like a fist to the jaw to people who already have had their faith in the government shattered.

Detroit Free Press: All Flint Water Crisis Criminal Charges Dismissed by AG’s Office

In the miscellaneous file this week:

• If you ever think you’re having a bad day at work, read this story about how an employee’s small photocopier mishap triggered a series of events that undermined a pair of late-stage clinical trials and ultimately scrapped a development deal between pharma companies.

Stat: How a Mishap at a Photocopier Derailed Clinical Trials and a Development Deal

• I am fascinated by the anatomy of pandemics, and this is a great tick-tock of the start of the last one. They don’t play out as they would in Hollywood, but, to me, the reality is even more interesting (I can’t be the only one, right?!).

Stat: The Last Pandemic Was a ‘Quiet Killer.’ Ten Years After Swine Flu, No One Can Predict the Next One

• World health officials have been begging farmers to stop using antibiotics on healthy farm animals in an effort to combat the ever-looming threat of resistance (which, as you know, terrifies yours truly). The farmer,s though, also have drugmakers whispering in their ears — despite a public facade from pharma of wanting to help combat the problem.

The New York Times: Warning of ‘Pig Zero’: One Drugmaker’s Push to Sell More Antibiotics

• Are you a sufferer of “white coat hypertension”? You might think it’s just because you get stressed out when you visit the doctor (join the club!), but a study shows that those anxiety-induced numbers are linked to an increased risk of a cardiac event.

Stat: Those With ‘White Coat Hypertension’ More Likely to Die From Cardiac Events

That’s it from me! Have a great and restful weekend. (Truly, insomnia can kill!)

Categories: Health Care

Viewpoints: Stopping Surprise Medical Bills Might Be Easier Than It Looks; Waiting To See Whatever Happens Next In Flint Water Cases

Kaiser Health News - Fri, 06/14/2019 - 8:53am
Opinion writers weigh in on these health care topics and others.
Categories: Health Care

State Highlights: Virginia Governor Plans Public Talks On Gun Control; Abuse Occurred To 20% Of Medicare Patients During ER Transports In Eight States, Report Finds

Kaiser Health News - Fri, 06/14/2019 - 8:53am
Media outlets report on news from Virginia, Florida, Maryland, California, New York, Arizona, North Carolina, District Of Columbia, Minnesota, Colorado, Missouri, Ohio and Tennessee.
Categories: Health Care

Longer Looks: Health Care For The Undocumented; Health Care Drones; And The Heidi Group

Kaiser Health News - Fri, 06/14/2019 - 8:53am
Each week, KHN's Shefali Luthra finds interesting reads from around the Web.
Categories: Health Care

Judge Gives Preliminary Approval Of $215M Class-Action Settlement To Help Victims Of Former USC Gynecologist

Kaiser Health News - Fri, 06/14/2019 - 8:53am
The preliminary sign-off by U.S. District Judge Stephen V. Wilson is not expected to conclude USC’s payouts to female students and alumnae. More than 720 women are pursuing separate claims against the university in state court, and their lawyers have criticized the class-action agreement as paltry.
Categories: Health Care

Oklahoma Advocates Launch Campaign To Get Medicaid Expansion On The Ballot

Kaiser Health News - Fri, 06/14/2019 - 8:53am
The coalition will need to collect nearly 178,000 voter signatures to put the issue on the November 2020 ballot. "We're normal, everyday Oklahomans that care about this issue and we're growing every day," said Oklahomans Decide Healthcare spokeswoman Amber England. Medicaid news comes out of Louisiana and Ohio, as well.
Categories: Health Care

‘Our Lives Don’t Matter’: Flint Residents Left Stunned As Prosecutors Drop All Criminal Charges Against Officials

Kaiser Health News - Fri, 06/14/2019 - 8:53am
Some officials had been facing charges as serious as involuntary manslaughter in the case over the water contamination crisis that crippled the city of Flint, Michigan. The prosecutors say that the initial investigation was bungled and it is opting to launch a new but expanded probe. But the decision was a blow to residents who were already suspicious of the government.
Categories: Health Care

‘A Relief To Women’: Injectable Birth Control Does Not Raise HIV Risk, Study Finds, And Is As Safe As Other Methods

Kaiser Health News - Fri, 06/14/2019 - 8:53am
The safety rating for the hormone shot Depo-Provera was lowered several years ago, frustrating women in Africa who found it an easier method to hide and sometimes the only option offered. In other news on HIV: a new documentary and harmful syringe practices.
Categories: Health Care

Have App, Will Find Research Recruits: More Than 20,000 People Sign Up On Facebook For ‘Genes For Good’

Kaiser Health News - Fri, 06/14/2019 - 8:53am
Finding participants for research can be difficult, but it was relatively easy to find a large pool of people from across the country, the developers said, adding it's private, as well. Facebook doesn't have access to the data. New reports on public health news are on enteroviruses, time outdoors, insomnia, visual impairment, depression, Roundup and more.
Categories: Health Care

House’s $99.4B HHS Appropriations Bill Includes Amendment Reversing Ban On Developing Unique Patient PINs

Kaiser Health News - Fri, 06/14/2019 - 8:53am
Lawmakers previously argued a program to develop a national patient identifier could violate privacy issues or raise security concerns, while the medical community and insurers claimed the ban kept them from properly matching patients with the correct medical information--a major issue that health systems are struggling with.
Categories: Health Care

After Patient Dies From Fecal Transplant, FDA Halts Trials Until Testing Improves For Drug-Resistant Bacteria

Kaiser Health News - Fri, 06/14/2019 - 8:53am
The transplants have come into increasing use to treat severe intestinal orders and sometimes work quickly in patients wasting away. But the procedure to use stool from a healthy donor to restore the normal balance of bacteria and other organisms in the intestine is considered experimental by the FDA.
Categories: Health Care

First Edition: June 14, 2019

Kaiser Health News - Fri, 06/14/2019 - 6:20am
Today's early morning highlights from the major news organizations.
Categories: Health Care

A Proposal To Make It Harder For Kids To Skip Vaccines Gives Powerful Voices Pause

Kaiser Health News - Fri, 06/14/2019 - 5:01am

As California lawmakers attempt to tighten the rules on childhood vaccinations, they’re getting pushback from unexpected quarters: high-profile officials who support vaccines.

In the past few weeks, Democratic Gov. Gavin Newsom and the members of the Medical Board of California have questioned a bill that would give the California Department of Public Health authority to decide whether a child can skip routine vaccinations.

Anti-vaccine activists have capitalized on these moments, plastering Facebook pages and social media with praise for the officials’ statements.

But those officials are not against vaccinations. In fact, they have made clear they’re committed to vaccines, and to dealing with the problem the bill is supposed to fix — doctors providing kids with medical exemptions for reasons that don’t meet federal standards.

“Having been in public health for a long time, I am a huge supporter of vaccines,” said Dr. Michelle Bholat, a family medicine physician in Santa Monica and until recently a member of the medical board, which has oversight over physicians and their licenses.

What concerns her, she said at a late-May meeting of the board, was the measure’s potential effect on doctor-patient relationships and the particulars of who would qualify for a medical exemption.

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Pediatrician and state Sen. Richard Pan (D-Sacramento) introduced the bill to address a spike in the number of children who have been granted what he calls “fake” medical exemptions from vaccinations; more than five times as many kids have medical exemptions this past school year than in 2015-16.

SB 276 would give the final say on medical exemption applications to the state public health department, which would be required to follow guidelines established by the Centers for Disease Control and Prevention. Any exemptions provided by doctors would be subject to approval — or denial — by the department.

The only other state that gives control of vaccine exemptions to a public health agency is West Virginia.

The measure passed the state Senate in May and is awaiting consideration in the state Assembly.

The debate over the measure comes as new state data shows that the percentage of kindergartners who had all their recommended shots fell for the second straight year, largely due to an increase in medical exemptions written by doctors.

During the past school year, the share of fully vaccinated kindergartners dropped to 94.8%, down from 95.6% in 2016-17, putting the state in potentially dangerous territory — officials recommend 90-95% coverage for community immunity.

And as vaccination rates dip, measles is spreading nationwide. In the largest outbreak since 1992, more than 1,000 people have been infected across the country this year through June 5, including 51 in California.

Nearly three years ago, California enacted a law by Pan that bars parents from citing personal or religious beliefs to avoid vaccinating their children. Children could be exempted only on medical grounds if the shots were harmful to their health.

That ban improved vaccination rates, though progress has been slipping.

Today, many of the schools that had the highest rates of unvaccinated students before the law took effect still do. Doctors have broad authority to grant medical exemptions from vaccination; some wield that power liberally and sometimes for cash, signing dozens or hundreds of exemptions for children, sometimes in far-off communities.

Pan’s bill would crack down on this practice and has the strong support of the medical establishment. It was co-sponsored by two powerful doctor associations, the American Academy of Pediatrics, California, and the California Medical Association.

“We want to make sure unscrupulous physicians aren’t making medical exemptions for money,” said Dr. David Aizuss, the president of the California Medical Association. “The idea of the bill is to protect a real personal medical exemption, where kids are on chemotherapy or have an immunological response.” 

But it has its critics — and this time, they extend beyond the small but fervent group of people who continue to question the extensive scientific evidence that shows vaccines are safe. And although raising concerns is typical in the legislative process, their criticisms take on outsize importance with a subject as explosive as vaccines.

The biggest name among the new critics is Newsom, who said he’s worried about interfering with the doctor-patient relationship. “I like doctor-patient relationships. Bureaucratic relationships are more challenging for me,” he said at the state Democratic Party convention in early June.

“I’m a parent; I don’t want someone that the governor of California appointed to make a decision for my family.”

State Sen. Ben Allen (D-Santa Monica), a co-sponsor of Pan’s previous legislation, abstained from voting on the new measure last month, saying he’d made commitments during the previous fight to leave medical exemptions to the discretion of doctors.

Last month, the Medical Board of California offered just lukewarm support, and only to portions of the bill, after listening to 200 members of the public speak against it for more than two hours.

The board members called on Pan to address a variety of concerns, from the potential oversight role the state public health department might play, to the proposed guidelines for medical exemptions.

They agreed on one thing: It should be easier for the board to investigate complaints of questionable medical exemptions. To look into complaints, the board needs to see medical records. To get those records, it generally needs permission from patients or their guardians, something parents who have sought medical exemptions are often unwilling to provide. The bill would give the board access to these records.

One physician, Dr. Bob Sears in Orange County, a well-known opponent to vaccine mandates, was put on probation in 2018 for writing an exemption for a 2-year-old without taking any medical history. Since 2016, at least 173 complaints against physicians for inappropriate exemptions have been filed with the state medical board, with more than 100 currently under investigation, the board said.

Medical exemptions for California kids are clustered in certain communities and schools. In Humboldt County, 5.8% of kindergartners have medical exemptions from shots, according to the new state data. In Nevada County, the rate is 10.6%. All told, nearly one-third of the state’s counties have fallen below 95% immunity from measles. 

Aizuss of the California Medical Association said the organization is working with Newsom’s office and the medical board, among others, to update the bill so that it will be “workable, effective and supported by the governor.”

“I think that our goal is the same,” he said. “The idea of the bill is to protect … the sanctity of the true physician-patient relationship, as opposed to a relationship where physicians were granting the medical exemption for a fee, which is not a true physician-patient relationship.”

California Healthline reporter Ana B. Ibarra contributed to this report.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Categories: Health Care

Air Ambulance Costs Fly Around Fixes For Surprise Medical Bills

Kaiser Health News - Fri, 06/14/2019 - 5:00am

In April 2018, 9-year-old Christian Bolling was hiking with his parents and sister in Virginia’s Blue Ridge Mountains, near their home in Roanoke. While climbing some boulders, he lost his footing and fell down a rocky 20-foot drop, fracturing both bones in his lower left leg, his wrist, both sides of his nose and his skull.

A rescue squad carried him out of the woods, and a helicopter flew him to a pediatric hospital trauma unit in Roanoke.

Most of Christian’s care was covered by his parents’ insurance. But one bill stood out. Med-Trans, the air ambulance company, was not part of the family’s health plan network and billed $36,000 for the 34-mile trip from the mountain to the hospital. It was greater than the cost of his two-day hospitalization, scans and cast combined.

“When you’re in that moment, you’re only thinking about the life of your child,” said Christian’s mother, Cynthia Bolling, an occupational therapist. “I know that I am being taken advantage of. It’s just wrong.”

The rising number of complaints about surprise medical bills is spurring efforts on Capitol Hill and at the White House to help consumers. Over and over again, the high cost associated with air ambulance service gives patients the biggest sticker shock — the subject has come up at nearly every Capitol Hill hearing and press conference on surprise medical bills.

Yet air ambulance costs are not addressed in any of the proposals introduced or circulating in Congress. Even a congressional decision last year to set up a panel that would study air ambulance billing hasn’t gotten off the ground.

“We’re doing a disservice to patients if we protect them from hospital bills but bankrupt them on the way there,” said James Gelfand, senior vice president for health policy for the ERISA Industry Committee, known as ERIC, a trade association for large employers.

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The issue came up again Wednesday at a House Energy and Commerce subcommittee hearing where Rick Sherlock, president and CEO of the Association of Air Medical Services, the industry group for air ambulances, was among eight witnesses.

Rep. Ben Ray Luján (D-N.M.) sharply questioned Sherlock why costs for air ambulance services have risen by 300 percent in his state since 2006.

“I’m trying to get my hands around why this is costing so much and why so many of my constituents are being hit by surprise bills,” Luján said.

Sherlock said that reimbursements from Medicare and Medicaid do not cover the cost of providing services, so charges to private patients must make up that difference.

Air ambulances serve more than 550,000 patients a year, according to industry data, and in many rural areas air ambulances are the only speedy way to get patients to trauma centers and burn units. As more than 100 rural hospitals have closed around the country since 2010, the need has increased for air services.

More than 80 million people can get to a Level 1 or 2 trauma center within an hour only if they’re flown by helicopter, according to Sherlock.

The service, though, comes at a cost. According to a recent report from the Government Accountability Office, two-thirds of the more than 34,000 air ambulance transports examined were not in the patients’ insurance networks. That can leave patients on the hook for the charges their insurers don’t cover, a practice known as “balance billing.”

In 2017, GAO found that the median price charged nationally by air ambulance providers was around $36,400 for helicopter rides and even higher for other aircraft. The total generally includes the costs for both the transportation and the medical care aboard the aircraft.

Additionally, the ongoing “Bill of the Month” investigative series by Kaiser Health News and NPR has received more than a dozen such bills, ranging from $28,000 to $97,000.

Cynthia Bolling said her insurance company paid about a third of Christian’s air ambulance bill and the family settled this week with Med Trans by agreeing to pay $4,400 out-of-pocket.

Reid Vogel, director of marketing and communications for Med Trans, said the company cannot talk about a private patient because of privacy rules. But he added that the company works with patients to find “equitable solutions” when their bills are not covered by insurance.

Since nearly three-quarters of flights are for patients insured by low-paying Medicare, Tricare and Medicaid, he said, “providers must shift costs to insured patients.”

Private insurers usually will pay only an amount close to what Medicare reimburses, which is around $6,500. That gives air ambulance companies an incentive to remain out-of-network, according to a 2017 GAO report.

“A representative from a large independent provider noted that being out of network with insurance is advantageous to the provider because a patient receiving a balance bill will ask for a higher payment from the insurance company, which often results in higher payment to the air ambulance provider than having a pre-negotiated payment rate with the insurer,” the GAO said.

In an interview, Sherlock, of the trade association, disputed the report’s findings, saying his members are actively trying to be in-network in more places, although he couldn’t provide any specific numbers.

“I think that everywhere they can, they’re incentivized to be in-network,” he said.

States are hampered in their efforts to ease the strain for residents.

The Airline Deregulation Act of 1978, which was intended to encourage more competition, forbids states to regulate prices for any air carrier, which applies to air ambulances. What’s more, many large employers’ health insurance is not governed by states but regulated by the federal labor law, known as ERISA.

So a remedy likely has to come from Congress. And it’s proven to be a heavy lift.

For example, the committees that deal with regulation of the air industry — the Commerce Committee in the Senate and the Transportation Committee in the House — don’t make health policy or regulate health insurance.

Last year, some lawmakers sought to let states regulate air ambulances with a provision in the bill reauthorizing the Federal Aviation Administration.

But that measure was ultimately eliminated. Instead, the bill called for the creation of an advisory committee to study air ambulance prices and surprise bills.

“The air ambulance lobby did a very good job playing defense during FAA authorization,” said ERIC’s Gelfand.

The panel, which was supposed to be formed within 60 days of the law’s enactment date — Oct. 5 — still has not been created.

Representatives from the air ambulance industry don’t think congressional action is necessary, although they are calling for higher reimbursements from Medicare.

Chris Eastlee, vice president for government relations for the Association of Air Medical Services, said his group does not favor more congressional regulation of prices but would support mandatory disclosure of costs to the secretary of Health and Human Services. The organization argues that greater transparency will help companies negotiate more in-network contracts.

A fix for surprise bills supported by some researchers and advocates would require every provider within a medical facility to accept any insurance plan that contracts with that hospital. It might also help bring down air ambulance bills, said Loren Adler, associate director of USC-Brookings Schaeffer Initiative for Health Policy.

It would avoid the situation where someone picks an in-network hospital only to find out that a surgeon or anesthesiologist at that hospital doesn’t take their insurance. Air transport should also be included in the rule, he said.

“It’s the exact same situation as with the out-of-network emergency facility rates,” Adler said. “The same solutions should apply.”

Gelfand suggested also that the House Ways and Means Committee mandate that air ambulance companies seeking to participate in Medicare must charge in-network rates.

That would require only a small tweak of the legislative language, as he sees it. “Every proposal that includes something to address surprise bills for emergency care, all you have to do is add in the words ‘air ambulances,’” Gelfand said.

Right now, the closest any surprise billing proposal has come to addressing air ambulances is a draft legislative plan on medical costs from Sen. Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.). They would require bills for air ambulance trips to be itemized to show both medical charges and the transportation charges so patients and health plans can understand them better.

Categories: Health Care

Readers And Tweeters: No Rush To Judge Patients Who Leave The ER Without OK

Kaiser Health News - Fri, 06/14/2019 - 5:00am

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

At The ER, It’s Hurry Up And Wait

At least the patients mentioned in “As ER Wait Times Grow, More Patients Leave Against Medical Advice” (May 17) were allowed to leave. An emergency room may not be a safe place for people and they may wish to go. It is not always the patient who is being irresponsible; it is sometimes those who work in the hospital.

My significant other and I ended up in a situation at the University of New Mexico Hospital. We were there for an appointment with a doctor associated with the hospital, but while she was getting checked in, she fainted. She was out for a short time. They sent over a paramedic to take her to the ER. She did not wish to go to the ER but was not immediately able to get up and leave, even by wheelchair.

The paramedic and his assistant took elaborate measures to separate me from my significant other, for whom I am a caregiver, and they interrogated her. It seemed they wanted her to admit to drug usage. She was very frightened. Eventually, I was allowed to enter the ER, and when the paramedic saw me, he scattered like a roach.

Five hours is a long time to wait. That makes no sense. If people have to wait for five hours it means you really do not have enough staff to handle them all. In most cases, an ER is useless, anyway. They work for people who suffer a car accident, gunshot wound, broken leg or heart attack. For other things, they generally are not much help and often do not even have essential services manned, like ultrasound, MRI, etc. So, in most cases, it is basically a waste of time.

Look inward to figure out why people bolt.

— Sigmund Silber, Santa Fe, N.M.

ER wait times in CA and how more patients leave against medical advice. #1. What are we going for a pandemic. #2 This is policy choice. Can move finiancial incentives to train more primary care docs & for them to see more patients & late into evening.

— Dr. Ali Khan (@UNMC_DrKhan) May 28, 2019

— Dr. Ali Khan, Omaha, Neb.

There is a lot of discussion over the cost of health care, but people don’t realize how inefficient our system is. I have an 18-year-old son who was born with spina bifida and has had many other health issues. In mid-May, he had a pain in the left side of his back. Not common, and he does not complain about pain. The nurse at his school was concerned; my son looked pale, he came to her wanting to lie down — not typical. So I called his urologist’s office asking how to recognize kidney stones, which he has never experienced. The front desk personnel told me to take him to the ER.

We traveled almost an hour to Children’s Healthcare of Atlanta at Scottish Rite, where he has specialty docs. After running many tests, they told us he had a stomach virus, and we were sent home. On May 30, my son got his annual renal bladder ultrasound done in preparation for a mid-June spina bifida clinic appointment. Turns out, he had a kidney stone! It showed up on the ultrasound.

I am extremely frustrated since it is not the first time I have been told to take my son to ER only to be told “nothing is wrong” or “we can’t help him” even though there later proved to be a problem. What a BIG waste of time and money on our health care system. But you can’t get in to see doctors when you have a problem, so you almost always have to go to the ER. In my opinion, that is a waste of ER services, which I do not hear talked about in the news.

— Rebecca Joiner, Fayetteville, Ga.

"If we could just give all these people insurance cards, we can get them out of using the emergency room!" (Every ACA supporter in DC to me, 2009)

Not so much…

— Michael Bertaut (@MikeBertaut) May 20, 2019

— Michael Bertaut, Baton Rouge, La.

Give Midwives And Birth Centers A Chance

In your “Bill of the Month” piece about laughing gas, “Not Funny: Midwife Slapped With $4,836 Bill For Laughing Gas During Her Labor” (May 29), I wish your recommendations would have included seeking out birth centers as an alternative to hospital births. Given the embarrassing state of maternity care in the United States, it’s time to focus on the advantages of midwives and birth centers. They have proven statistically better outcomes at half the cost. As a former consultant to the American Association of Birth Centers, I was impressed when I learned that the AABC built a registry of data to track, measure and improve quality over 13 years ago. They recognized the need for a separate credentialing association, the Commission for Accreditation of Birth Centers, or CABC, and supported the development of its standards. Women need an alternative to our current standard options for low-risk maternity care.

— Linda Davis, Minneapolis

Editor’s note: This is a teachable moment. The following tweeter might have confused Kaiser Health News for Kaiser Permanente. KHN, the health care policy news source you’re currently reading, is not affiliated with the managed-care consortium, although both were named for innovative American industrialist Henry J. Kaiser. Any confusion shouldn’t diminish the strength of her argument, however.

This is great for navigating an inhumane hellscape if you have the time and resources to do so. But let's get serious, standard healthcare being for-profit must end. And Kaiser should be a part of that change.

— Edith Cranwrinkle's Tracksuit????️‍???? (@AllieKeeley1) June 2, 2019

— Allie Keeley, Richmond, Va.

What an awful system. Thank god i wasn’t born in the US.

— Tom Pink (@turdish) June 3, 2019

— Dr. Tom Pink, Geneva, Switzerland

In fact, there are positive developments in prenatal care. Several readers weighed in on our article about what to expect when you go through pregnancy with a group of other expectant parents.

Moms in the US are starved for community, in my observation.

— Lauren Lee White (@laurenleewhite) May 30, 2019

— Lauren Lee White, Los Angeles

At The Center Of Group Maternity Care

It was great to see your story on the centering model of maternity care (“The Unexpected Perk Of My Group Pregnancy Care: New Friends,” May 30), but how about some credit to Sharon Rising, the nurse who founded, tested and promotes this health-expanding approach? Nurses are rarely credited. She is an astonishing clinician-scientist who deserves being named in such stories. Thank you.

— Debbie Ward, Sacramento, Calif.

A tweeter in Portugal called her role in a group prenatal program a career highlight:

Facilitating a #centeringpregnancy group was on of the highlights of my career! via @khnews

— Justine Strand de Oliveira (@justinestrand1) June 1, 2019

— Justine Strand de Oliveira, Algarve, Portugal

Missing Tool In The Toolbox For Treating PTSD

I was grateful to see the recent story by Caroline Covington about treatment for PTSD (“For Civilians, Finding A Therapist Skilled In PTSD Treatments Is A Tough Task,” May 22). Unfortunately, she missed a huge piece of the puzzle. A therapy called Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for post-traumatic stress disorder, having been validated by more than 36 randomized controlled studies. Endorsed by the American Psychological Association, the Substance Abuse and Mental Health Services Administration, and the Departments of Defense and Veterans Affairs, it is used throughout the world to heal PTSD efficiently. It was developed in 1987 by Francine Shapiro. Please check out for research documentation. As a licensed psychotherapist and certified EMDR therapist, I have witnessed the dramatic healing effect of EMDR with my clients suffering from PTSD for many years. I appeal to Ms. Covington to look into this area and complete the story.

—Stephen Weathersbee, a licensed marriage and family therapist, Tyler, Texas

Shows ongoing need for suppliers of this treatment – For Civilians, Finding A #Therapist Skilled In #PTSD Treatments Is A Tough Task via @khnews #psychology

— Harry Stark, Ph.D. (@HarryStarkPhD) May 29, 2019

— Harry Stark, Woodland Hills, Calif.

As a short-term veteran (1988-90) diagnosed in 2016 with complex post-traumatic stress disorder, I wanted to add a couple of thoughts. As much as my story was influenced by having been in the military, I constantly found myself comparing my experiences with other veterans. I was always giving deference to the fact that my story wasn’t theirs, and that theirs was usually far more of a “good excuse” to have the condition. In treatment, that logic extended to my individual circumstances. I was constantly comparing my experiences, minimizing at every turn.

I’ve been through both Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), about two years apart; the PE was used more recently and, in my opinion, was more effective. I wanted to mention another therapy your missed, though: Eye Movement Desensitization and Reprocessing (EMDR). I am on a waiting list with Virginia’s Salem VA Medical Center to try this cutting-edge, light-based therapeutic tool. I even wrote to Samsung and Oculus corporations to suggest they work on making EMDR programs for their VR headsets, in conjunction with VA clinicians.

As you suggested in the article, the industry is catching up to both new methodologies as well as a new client base for PTSD that includes the civilian community. The influx of money and research capacity that comes with this new client base could be well used in advancing this method, and/or combining it for use with current methods.

I know your article concentrated on PTSD experienced by civilians and overcoming the stigma that this disease is somehow reserved for veterans. People need to understand that because we’re all different in our brains that this condition is never the same exact thing … even in two veterans who served side by side. Sure, someone always has it worse than you, but that doesn’t mean your symptoms don’t deserve help.

— Neil Marsh, Moneta, Va.

Spreading The Word (Correctly) About Measles

The United States did not declare measles “eradicated” (“How Measles Detectives Work To Contain An Outbreak,” June 10). It declared the disease “eliminated.” Big difference. In medical terms, “eradicated” means gone forever, as in smallpox. “Eliminated” means no sustained transmission over the period of a year.

— Linda Hultman, Louisville, Colo.

Editor’s note: Another teachable moment. We stand corrected. Thank you!

Dignity At The End Of Life

Something useful to add to Jenny Gold’s article “Will Ties To A Catholic Hospital System Tie Doctors’ Hands?” (April 29): I believe Catholic hospitals ignore patients’ end-of-life wishes. No advance medical directives. So, if I want a do-not-resuscitate (DNR) order, they can override that and insist I live my final days in agony or zoned out.

I always learn something in your newsletters. Keep up your good work!

— Gail Jackson, Waikoloa, Hawaii

Readers everywhere rejoiced over good news, for a change.

I love this story…….Thank you to "Pathway Church" – The power of the Church …
Church Pays Off $2.2 Million In Medical Debt For 1,600 Families, Instead Of Splurging On Easter Promotions #Church #USA #GivingTuesday #givingback #giving

— Oral Hazell (@globallifechurc) May 22, 2019

— Oral Hazell, St. Thomas, U.S. Virgin Islands

Good Work Restoring Faith In Humanity

The article “Churches Wipe Out Millions In Medical Debt For Others” (June 3) was one of the most uplifting and inspirational stories I have read in such a long time. Kudos to the author and your publication. This is a creative solution that not only stretches donation dollars but sets an example that other religious organizations could easily follow. Thank you.

Philip Heigl, New Cumberland, Pa.

The church rightfully deserves praise (ha!) but we should absolutely not lose focus on how obscene it is that we have such a rampant issue with medical debt that it needs to be packaged and sold like mortgages even though that worked out FINE

— The Good Florida Man (@ncwonk) June 3, 2019

— Chase McGee, Durham, N.C.

As Jesus paid our debt on the Cross, this church chose to pay off the medical debt for 1600 families this past Easter.

What a beautiful story!

Church Pays Off $2.2 Million In Medical Debt For 1,600 Families

— Don Purser (@DGPurser) May 5, 2019

— Don Purser, Marietta, Ga.

Helping Those With Developmental Disabilities Navigate Health Care

I have a 17-year-old son with cerebral palsy, so the article “For Those With Developmental Disabilities, Dental Needs Are Great, Good Care Elusive” (May 3) hits home. I would like to see more stories that shed light on the challenges of navigating the health care system for individuals with developmental disabilities. Along with a small share of the U.S. population, my son receives long-term services and supports (LTSS) through Arizona’s Medicaid program. According to a report from Truven Health Analytics, “The Growth of Managed Care Long-Term Services and Supports Program: 2017 Update,” approximately 1.78 million individuals are enrolled in the MLTSS program. Our health care system should do a better job easing the burden in navigating the system for this vulnerable population. I hope that by bringing more attention to these issues will result in policy changes.

— Son Yong Pak, Tempe, Ariz.

In response to the article by David Tuller on dental care for the disabled: I wanted him to know that Special Olympics Virginia provides free dental care (including treatment and procedures) for hundreds of special needs athletes at their Summer Games. Dozens of dentists donate their time for this free clinic. Special Olympics Virginia is able to do this with the support from the Virginia Dental Foundation, Virginia Commonwealth University and Missions of Mercy (MOM Project).

— Donnie Knowlson, Special Olympics Virginia board member, Chesterfield, Va.

The Other Side Of The Opioid Story

Your article “Opioid Prescriptions Drop Sharply Among State Workers” (May 20) draws from biased and highly inaccurate opinion. Here’s a contradicting view.

Massive reductions in opioid prescribing are not a measure of success but instead signal failures of pain medicine under a draconian and unjustified program of persecution of doctors by Drug Enforcement Administration and state regulatory agencies. Tens of thousands of patients have been deserted by physicians afraid of losing their licenses if they treat pain with the only therapies that work for the majority of those with severe pain.

In the article, Beth McGinty is quoted as follows: “These reductions … signal a reduction in the overprescribing practices that have driven the opioid epidemic in the U.S.” This assertion is false. Overprescribing has never substantially “driven” the opioid crisis in the U.S. Statistics on opioid deaths are grossly inflated, representing deaths where a prescription-type opioid is among several factors detected in postmortem “tox screens.” No less a figure than Dr. Nora Volkow, director of the National Institute on Drug Abuse, informs us that addiction is not a predictable outcome of prescribing, and is rare even in at-risk patients.

The article states “One major factor is that many health insurers have imposed limits on prescriptions, as recommended by the CDC in 2016.” The Centers for Disease Control and Prevention recently issued a clarification that the guideline was never intended to justify mandatory tapering of legacy patients. The American Medical Association also repudiated the fundamental logic of the guidelines in Resolution 235 of the November 2018 House of Delegates meeting. Practicing physicians do not consider the equivalent of 50 morphine milligrams (MME) a high dose. Minimum effective dosages can range from ~20 MME to over 1000 MME, depending on metabolism.

Kathy Donneson, chief of CalPERS’ Health Plan Administration Division, says the surest sign of success will be when patients with chronic pain are “kept pain-free in other ways.” However, the literature for such therapies is abysmal, offering weak evidence and no direct comparisons of “alternatives” to properly titrated opioids.

CalPERS is on a course of action that is deeply damaging to patients. The agenda is cost control, not patient care. The other side of the story involves deserted patients who are committing suicide every day.

— Richard Lawhern, Fort Mill, S.C.

Simply reducing opioid supply (as described here in #California) without reducing demand is a recipe for failure ht @KHNews

— Ben Miller (@miller7) May 20, 2019

— Ben Miller, Denver

Not News To Me

As someone who has worked as a health actuary and executive for major insurers, I am surprised that Rand Corp. or anyone else thought a study needed to be done on what private insurers pay compared with Medicare (“Market Muscle: Study Uncovers Differences Between Medicare And Private Insurers,” May 9). This is OLD, OLD news. Hospitals and other health providers have been demanding more from private payers for the past 30 years! No study needed to be done. Just ask any actuary or health executive who works on contracting with providers. Despite the protestations of health economists who don’t work for insurers, providers demand more from private payers to make up for insufficient payments from Medicare and Medicaid. I can’t believe that this is a surprise to KHN or anyone who is knowledgeable about how medical insurance works in this country.

— Roy Goldman, Jacksonville Beach, Fla.

Categories: Health Care

KHN’s ‘What The Health’: Who Will Pay To Fix Problem Of Surprise Medical Bills?

Kaiser Health News - Thu, 06/13/2019 - 1:55pm
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Can’t see the audio player? Click here to listen on SoundCloud.

Julie Rovner

Kaiser Health News


Read Julie's Stories Stephanie Armour

The Wall Street Journal


Read Stephanie's Stories Anna Edney



Read Anna's Stories Kimberly Leonard

Washington Examiner


Read Kimberly's Stories

Congress is finally getting down to real work on legislation to end “surprise” medical bills, which patients get if they inadvertently receive care from an out-of-network health providers or use one in an emergency. But doctors, hospitals, insurers and other health care payers can’t seem to agree on who should pay more so patients can pay less.

Meanwhile, the fight over women’s reproductive rights continues in both Washington, D.C., and the states. This week, governors in three states — Vermont, Illinois and Maine — signed bills to make abortions easier to obtain. At the same time, the Democratic-led U.S. House of Representatives took up a spending bill for the Department of Health and Human Services that still includes the “Hyde Amendment,” which bans most federal abortion funding — despite the fact that most House Democrats oppose the restriction. House Democratic leaders fear that the fight to eliminate the restriction would jeopardize the rest of the spending bill in the GOP-controlled Senate and at the White House.

This week’s panelists are Julie Rovner from Kaiser Health News, Stephanie Armour of The Wall Street Journal, Alice Miranda Ollstein of Politico and Kimberly Leonard of the Washington Examiner.

Among the takeaways from this week’s podcast:

  • Republicans on Capitol Hill and at the White House are just as eager as Democrats are to settle on legislation that would keep consumers from getting surprise medical bills. It would provide a nice counterpoint during the upcoming campaign to Democrats’ charges that the GOP has been undermining health care with its opposition to the Affordable Care Act.
  • A federal judge in Texas has struck down the ACA’s provision that health plans must cover contraception. That is at odds with another judge in Pennsylvania who earlier this year blocked the Trump administration’s plans to loosen the birth control mandate.
  • State insurance regulators are raising concerns about health care sharing ministries, which offer plans that provide coverage for some medical expenses. But consumers often don’t realize that the plans may not cover many health costs, including those from preexisting conditions.

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

Julie Rovner: The Washington Post’s “In Alabama — Where Lawmakers Banned Abortion for Rape Victims — Rapists’ Parental Rights Are Protected,” by Emily Wax-Thibodeaux

Alice Miranda Ollstein: The New York Times’ “Planned Parenthood to Host Women’s Health Forum for 2020 Democrats,” by Lisa Lerer

Stephanie Armour: NPR’s “You May Be Stressing Out Your Dog,” by Rebecca Hersher

Kimberly Leonard: Politico’s “Lost in Translation: Epic Goes to Denmark,” by Arthur Allen

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

Categories: Health Care

Research Roundup: State Health Scorecards; Caregivers And Veterans; And Artificial Light

Kaiser Health News - Thu, 06/13/2019 - 8:43am
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Categories: Health Care

Viewpoints: Rural Health Care Doesn’t Need To Keep Getting Worse; Lessons On How Red-Baiting Set The U.S. Behind On Health Care

Kaiser Health News - Thu, 06/13/2019 - 8:43am
Editorial writers weigh in on these health care topics and others.
Categories: Health Care


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