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Podcast: KHN’s ‘What The Health?’ Health Nerd Books For The Holidays

Kaiser Health News:HealthReform - November 20, 2018
Julie Rovner

Kaiser Health News

@jrovner

Read Julie's Stories Stephanie Armour

The Wall Street Journal

@StephArmour1

Read Stephanie's Stories Anna Edney

Bloomberg

@annaedney

Read Anna's Stories Joanne Kenen

Politico

@JoanneKenen

Read Joanne's Stories

The Food and Drug Administration took some serious steps toward curbing teen use of tobacco and nicotine products this month, including proposing a virtual ban on most flavors of the liquid used in e-cigarettes.

Meanwhile, open enrollment continues for individual coverage under the Affordable Care Act and Medicare. ACA sign-ups are slightly lagging behind last year’s. It is unclear why, but it’s still early in the six-week open-enrollment period.

And the new Democratic majority in the U.S. House faces big decisions about whether to pass a “Medicare-for-all” bill when it assumes control in January. First, the coalition must choose a speaker. Rep. Nancy Pelosi (D-Calif.), whose deal-making skills as speaker were instrumental in getting the ACA passed in 2010, is facing challenges from both wings of the party, although no single candidate has emerged to try to replace her.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Stephanie Armour of The Wall Street Journal, Joanne Kenen of Politico and Anna Edney of Bloomberg News.

Among the takeaways from this week’s podcast:

  • Several factors may have contributed to the drop in marketplace enrollment over last year’s tally. The midterm elections may have distracted customers, the government is doing less consumer outreach, the labor market is very tight so more people may be getting coverage through work, and people will not face a tax penalty in 2019 for not having coverage.
  • There’s also another open enrollment occurring: Medicare plans. Although seniors’ coverage is not on the line, they have a wealth of choices that can be confusing.
  • In both ACA and Medicare enrollment periods, it is important for consumers to check out their choices, because the best option may have changed.
  • As the FDA weighs new rules for tobacco products, it is walking a tightrope. E-cigarettes may be an important tool for adults who are looking to wean themselves from cigarettes, but officials are wary of the thrill they may hold for young people.
  • The push among progressive Democrats in the House to pass a bill to implement a “Medicare-for-all” plan may cost the party support in the critical suburban districts that members depended on this month for victory.

Plus, for extra credit this holiday week, the panelists recommend some of their favorite health policy books:

“The Heart of Power: Health and Politics in the Oval Office,” by David Blumenthal and James A. Morone

“Bad Blood: Secrets and Lies in a Silicon Valley Startup,” by John Carreyrou

“Sick: The Untold Story of America’s Health Care Crisis — and the People Who Pay the Price” by Jonathan Cohn

“Dreamland: The True Tale of America’s Opiate Epidemic,” by Sam Quinones

“An American Sickness: How Healthcare Became Big Business and How You Can Take It Back,” by Elisabeth Rosenthal

“The Immortal Life of Henrietta Lacks,” by Rebecca Skloot

“The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry,” by Paul Starr

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Buyers Of Short-Term Health Plans: Wise Or Shortsighted?

Kaiser Health News:HealthReform - November 20, 2018

Supporters of the nation’s health law condemn them. A few states, including California and New York, have banned them. Other states limit them.

But to some insurance brokers and consumers, short-term insurance plans are an enticing, low-cost alternative for healthy people.

Now, with new federal rules allowing short-term plans that last up to three years, agents said, some consumers are opting for these more risky policies. Adding to the appeal is the elimination of a federal tax penalty for those without comprehensive insurance, effective next year. Short-term health plans often exclude people with preexisting conditions and do not cover services mandated by the Affordable Care Act.

Colorado resident Gene Ferry, 66, purchased a short-term health plan this month for his wife, Stephanie, who will become eligible for Medicare when she turns 65 in August. The difference in the monthly premium price for her new, cheaper plan through LifeShield National Insurance Co. and the policy he had through the ACA is $650.

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“That’s a no-brainer,” said Ferry, who considers the ACA “atrocious” and supports President Donald Trump’s efforts to lower costs. “I was paying $1,000 a month and I got tired of it.”

He signed up his wife for a three-month plan and said that if she is still healthy in January, he will purchase another one to last six months. But Ferry, who is covered under Medicare, said if something happens to her before open enrollment ends — which in Colorado is in January — he would buy a policy through the exchange.

Dan Walterman, who lives in Iowa, says he chose a short-term policy for himself, his wife and their 3-year-old daughter because it was less expensive and provided the coverage he needed.(Courtesy of Dan Walterman)

There’s a lot of “political jockeying” over the value of short-term plans, said Dan Walterman, owner of Premier Health Insurance of Iowa, which offers such policies. “I think people can make their own choices.”

Walterman, 42, said he chose a short-term policy for himself, his wife and their 3-year-old daughter — at a sixth of the price of more comprehensive insurance. “The plan isn’t for everybody, but it works for me,” he said, adding that he gets accident coverage but doesn’t need such things as maternity care or prescriptions.

Essentially, short-term plans cost less because they cover less.

Some plans have exclusions that could blindside consumers, such as not covering hospitalizations that occur on a Friday or Saturday or any injuries from sports or exercise, said Claire McAndrew, director of campaigns and partnership for Families USA, a consumer advocacy group.

“People may see a low premium on a short-term plan and think that it is a good option,” she said. “But when people actually go to use a short-term plan, it will not actually pay for many — or any — of their medical expenses.”

The plans can exclude people with preexisting conditions such as cancer or asthma and often don’t cover the “essential benefits” required under the health law, including maternity care, prescription drugs or substance abuse treatment. They also can have ceilings on what they will pay for any type of care. Insurers offering such plans can choose to cover — or not cover — what they want.

“Democrats are condemning them as ‘junk plans,’ but the adequacy of the health plan is in the eye of the beholder,” said Michael Cannon, director of health policy studies for the libertarian Cato Institute. “The only junk insurance is a plan that doesn’t pay as it was promised.”

The plans originally were designed to fill brief gaps in insurance coverage for people in the individual market. When the ACA went into effect, the Obama administration limited short-term plans to three months, but the Trump administration this year expanded that to 364 days, with possible extensions of up to three years. Critics fear healthy people may abandon the ACA-compliant market to buy cheaper short-term plans, leaving sicker people in the insurers’ risk pool, which raises premiums for those customers.

But some agents said the policies may be good for healthy people as they transition between jobs, near Medicare eligibility or go to college — despite significant limitations.

“It’s hard to encourage those types of people to spend hundreds of dollars extra on a health insurance plan that they are rarely using,” said Cody Michael, director of client and broker services for Independent Health Agents in Chicago.

Michael said agents also get a higher commission on the plans, providing them with more of an incentive to sell them. But he advises clients that if they do have a chronic illness, they may face denials for coverage. “This is old-world insurance,” he said. “You basically have to be in perfect health.”

Dania Palanker, assistant research professor at Georgetown University’s Center on Health Insurance Reforms, said preexisting conditions aren’t always well understood — or well explained. A person might discover too late that, for example, they aren’t covered if they have a stroke because an old blood test showed they had high cholesterol.

But Ryan Ellis, a 40-year-old lobbyist and tax preparer in Alexandria, Va., who is considering a short-term plan for himself, his wife and his three children, said his decision will be made “very deliberately, with my eyes wide open knowing the advantages and disadvantages.”

Some agents said they offer the short-term plan as a last resort — only after warning clients that if they have an accident or get sick, they might not be able to renew their plan. That means they could be stuck without insurance while waiting for the next open-enrollment period.

“They could really be in a world of hurt,” said Colorado insurance agent Eric Smith. “This is just a ticking time bomb.”

Roger Abel, of Marion, Iowa, said he’s willing to take the risk. He has a short-term plan for his 2-year-old daughter. Abel said he pays about $90 a month for her, compared with more than $450 that he would have paid for comprehensive coverage. He and his wife have a separate policy from before the Affordable Care Act took effect.

California resident Neena Moorjani says she wanted to buy a short-term plan, but they are now banned in the state.(Courtesy of Neena Moorjani)

But Abel, who is an investment adviser, has a backup option. He said he could always start a group health plan under his company that would provide his daughter with more coverage.

Neena Moorjani, 45, said she wanted to buy a short-term plan but can’t because she lives in California, where they were prohibited under a law signed by Democratic Gov. Jerry Brown this year. Moorjani, a tax preparer in Sacramento, said she rarely gets sick and doesn’t need an ACA plan.

She decided on religious-based health coverage known as a Christian ministry plan. These cost-sharing programs use members’ fees to pay for others’ medical bills. Such programs are not regulated by government agencies and may not cover preexisting conditions or preventive care.

When California banned short-term plans, “I was really, really upset,” Moorjani said. “I wish I had the freedom to choose what health care insurance is appropriate for me.”

KHN's coverage in California is supported in part by Blue Shield of California Foundation.

Playing On Fear And Fun, Hospitals Follow Pharma In Direct-To-Consumer Advertising

Kaiser Health News:Marketplace - November 19, 2018

The scene is shadowy, and the background music foreboding. On the TV screen, a stream of beleaguered humans stand in an unending line.

“If you’re waiting patiently for a liver transplant, it could cost you your life,” warns the narrator.

One man pulls another out of the queue, signaling an escape. Both smile.

Is this a dystopian video game? Gritty drama? Neither. It is a commercial for the living-donor liver transplant center at the University of Pittsburgh Medical Center, an academic hospital embroiled in a high-profile battle with the region’s dominant health plan and now making a play to a national audience.

Hospitals are using TV spots like this one to attract lucrative patients into their hospitals as health care costs and industry competition escalate. Some institutions use them to build national and international brands on niche but high-priced health services. They’re often procedures involving expensive technology that benefit only a sliver of the population. But they could lure wealthy patients seeking high-end care and can also give hospitals some leverage with insurers.

“Hospitals are competing, just like any other business,” said Mark Fratrik, an economist at BIA Advisory Services, a media consulting firm.

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UPMC’s ad has been airing nationally this year during cable news shows. Advertising research company iSpot.tv estimates the campaign’s cost at more than $3 million since it first aired in early September. The commercial is aimed at the estimated 14,000 people on the United States liver transplant list, hospital officials said.

But some analysts worry that these hospital advertisements are incomplete or misleading.

“We have choices about where we seek medical care,” said Dr. Yael Schenker, an associate professor of medicine at the University of Pittsburgh, who has researched hospital advertising but was not involved with the liver transplant ad. “We want to spend our money wisely, and need information about the quality and cost of health care services. Health care advertising — which purports to offer that information and fill that need for consumers — really doesn’t.”

Last year, hospitals nationwide spent more than $450 million on advertising overall, according to figures from Kantar Media, a firm that monitors ad spending. That comes on the heels of a surge between 2011 and 2015, during which time hospitals and health systems upped their ad spending by 41 percent, according to figures published by Advertising Age, which tracks marketing trends. By 2015, hospital ad spending accounted for close to a quarter of all health care-related advertising, according to the Advertising Age report.

The UPMC ad is just one flavor. New York City’s Hospital for Special Surgery, an orthopedic hospital, launched its own national campaign this year — a minute-long spot featuring jaunty electronic music and people of all ages dancing, jogging and doing yoga and gymnastics. “How you move,” the text asserts, “is why we’re here.”

John Englehart, the hospital’s chief marketing officer, said the campaign is meant to introduce potential patients to HSS from around the country, but he said it should be viewed with other informational materials, such as independent rankings. He wouldn’t comment on how much the hospital has spent on its ad, though iSpot places its value at about $325,000.

A nationally broadcast ad for Yale New Haven Hospital, in Connecticut, shows a cancer survivor at a bicycle race telling viewers the hospital “did give me my life back.” That spot had a far shorter campaign life, and iSpot estimates its value around $11,000. The hospital did not provide comment, despite multiple requests.

Screengrab from the Hospital for Special Surgery commercial(iSpot.tv screengrab)

Screengrab from the Yale New Haven Hospital commercial(iSpot.tv screengrab)

Until now, hospital-to-patient marketing has stayed out of the spotlight, as politicians are focused on high drug costs and warn they will crack down on advertising by the pharmaceutical industry. (Pharma ads make up the bulk of paid health care marketing, though hospitals constitute the majority of health care spending.)

Unlike prescription drugs, whose commercials require special approval from the federal Food and Drug Administration, ads for hospitals and health systems are regulated by the Federal Trade Commission, which oversees the marketing of consumer goods.

Or as Schenker put it, “We’re treating them the same way we treat ads for cars and cereal.” But when it comes to health care versus other commodities, “it’s not as easy to figure out if we’ve made a good choice,” she said.

Direct marketing from hospitals and health care centers is by no means a new phenomenon. Billboards and TV ads for spinal surgery and cancer treatments date back years.

But “there’s more money in hospitals’ coffers these days to [market services] more. And why not?” said Robert Berenson, a health care expert at the Urban Institute, a think tank in Washington, D.C.

An ad like UPMC’s highlighting its live-donor liver transplant program signals prestige.

It caters to patients from around the country and even abroad who are often wealthier, or out-of-network, or covered by higher-paying private insurance, noted Paul Ginsburg, a health economist at the University of Southern California. All are more profitable audiences. (UPMC said it has provided live transplants to patients of all stripes, including those covered by Medicaid, which insures low-income people and pays hospitals less.)

Gerard Anderson, a Johns Hopkins health policy professor and expert on health care pricing, said the ad also can communicate to local consumers that, if they sign up with UPMC — as opposed to a competing hospital — they’re more likely to get better care.

“You’re differentiating yourself from everyone else by saying, ‘I can do this very sophisticated thing that no one else can do. Therefore, sign up with me,’” Anderson said.

Or as Berenson put it: “There are not that many people with liver transplants. There’s some halo effect. They’re trying to get people to recognize the name and go for other services.”

But there is no evidence to suggest that excelling in one particular, complex procedure tracks with providing good care overall.

UPMC casts its campaign as an outreach effort meant to inform people who need liver transplants of a potentially lifesaving option. It is not meant to imply anything further, hospital representatives said. “This is truly an awareness educational campaign,” said Dean Walters, UPMC’s chief marketing officer. He said 14,000 people in the United States need a liver transplant, and that number grows every year. “This is about making sure consumers are aware of this option.”

Walters would not disclose how much UPMC has spent on this particular campaign, though he acknowledged the hospital has made a “financial commitment” to promoting this service. According to Kantar, the marketing firm, UPMC spent more than $4 million on advertising in the first six months of 2018.

Englehart said HSS’ ad is meant to dispel any illusion that the hospital is catering to wealthy patients only — though he also said their campaign is meant to enhance HSS’ reputation both nationally and internationally.

Many health economists suggested the payoff can extend well beyond tapping into the market of potential American or foreign patients. A campaign like this one helps hospitals gain negotiating power in their ongoing struggle with insurers over reimbursement rates.

A hospital that successfully brands itself as excellent or prestigious — even in one procedure or specialty — can leverage that identity when bargaining with insurers.

“They want Hospital A in their network even more, which means Hospital A can extract more from insurers — mainly in the form of higher prices,” said Martin Gaynor, a health care economist at Carnegie Mellon University and former head of the FTC’s Bureau of Economics.

Must-Reads Of The Week From Brianna Labuskes

Kaiser Health News:HealthReform - November 16, 2018
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.

Welcome back to the Friday Breeze! Brace yourself, because with the midterms in the rear-view mirror (psshh, the 2018 elections are so five minutes ago), lawmakers, hopefuls and sideline experts are all barreling toward 2020. (I have only just this moment realized the vast opportunity for puns we’ll see when it’s over. Hindsight being … you get it.) First, though, everyone has to make it through two years of likely gridlock with a split Congress.

So what’s on the agenda for the newly empowered Democrats?

“Health care was on the ballot and health care won.” That’s House Minority Leader Nancy Pelosi’s assessment, at least. How it shakes out is trickier.

Some of the Dems’ top priorities are related to bandaging up the health law. Their efforts will likely include forcing a vote on a bill to protect preexisting conditions; shoring up the marketplaces, possibly by helping states pay for large medical claims; and pushing to get the House to intervene in the Texas lawsuit that challenges the law’s constitutionality.

At the same time, many of the party’s 2020 contenders are going to be on the trail going hard for “Medicare-for-all,” aka the litmus test for candidates who want to woo the more progressive wing of voters. The dissonance in the party that has been brewing since MFA gained popularity is at the very least going to require some complicated political maneuvering on all sides.

One Democratic agenda item many people (including President Donald Trump) seem to agree on, though? Reining in drug prices.

The New York Times: Democrats Won a Mandate on Health Care. How Will They Use It?

Politico: California’s New Governor Embodies Democrats’ Dilemma on Single Payer

The Friday Breeze

Want a roundup of the must-read stories this week chosen by KHN Newsletter Editor Brianna Labuskes? Sign up for The Friday Breeze today.

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New numbers out of Arkansas that detail just how many people have been dropped from the state’s Medicaid program since work requirements were enacted have experts increasingly alarmed. An additional 3,815 lost coverage in October for not reporting their hours, pushing the total number of people who have been affected by the state’s new requirements to over 12,000. And about 6,000 more residents are on their second strike and poised to lose coverage next month.

An outcry among health care experts prescribes the rules be suspended until officials figure out why the numbers are so startlingly high.

Modern Healthcare: Arkansas Drops 3,815 More Medicaid Enrollees Over Work Requirement

The Food and Drug Administration is cracking down on certain tobacco products and e-cigarettes that contribute to the emerging teen-vaping epidemic. But the ban on selling flavored e-cigarettes at brick-and-mortar stores (a ban that won praise when an early version of the rules was leaked) was conspicuously tempered. Stores will be allowed to sell the products if they can be kept in an age-restricted area.

The agency did come out swinging hard with a proposed ban on menthol. It could take years to enact, and the tobacco industry has hinted at a court battle, but if the ban does go through, it could have a profound effect on African-American males and young people who smoke menthol cigarettes at higher rates than other groups.

The Washington Post: FDA Unveils Sweeping Anti-Tobacco Effort to Reduce Underage Vaping and Smoking

The National Rifle Association has long been a Goliath among Davids when it comes to election spending. New numbers suggest, though, that the gun control movement may actually become a formidable foe for the political powerhouse.

The New York Times: Gun Control Groups Eclipse N.R.A. in Election Spending

It was not a friendly news week for the NRA in general. One of the organization’s tweet’s (a suggestion that doctors should “stay in their lane” on the gun debate) sparked viral outrage from providers. With the floodgates opened, stories of physicians’ firsthand experience with gun violence blanketed social media. “I see no one from the @nra next to me in the trauma bay as I have cared for victims of gun violence for the past 25 years,” tweeted one doctor (from the New York Times’ coverage). “THAT must be MY lane. COME INTO MY LANE. Tell one mother her child is dead with me, then we can talk.”

NPR: After NRA Mocks Doctors, Physicians Reply: ‘This Is Our Lane’

The wildfires continued to devastate California, with the death toll climbing to at least 63 and the number of missing people soaring to more than 600. Heartbreaking tales about elderly and young evacuees living in the harsh conditions of parking-lot tent cities serve as a reminder of just how long recovery will take after the fires are contained.

The (San Jose) Mercury News: Camp Fire: 63 Dead, 631 Missing; Second Origin Spot Probed

Los Angeles Times: Made Homeless by Flames, Camp Fire Evacuees Face Hardship, Disease And Desperation

Drug prices didn’t always used to be this bad. For a while, America was spending about what other wealthy countries did. Then something happened in the 1990s. To be fair, many factors are in play with our current pricing system, but the record number of new drugs that emerged in that decade likely set the stage for our current morass.

The New York Times: Something Happened to U.S. Drug Costs in the 1990s

Enrollment in Affordable Care Act plans was a bit slower at the start of this year’s sign-up season compared with last year’s. The reason this item appears so low in this newsletter, though, is that those numbers lack context (we, as a nation, were kind of preoccupied with a little thing called the midterms) and experts say it’s too early to call this a trend. Something to keep an eye on.

The Hill: ObamaCare Enrollment Down Compared to Last Year

Sick of medical bills? Yeah, doctors aren’t really fans of having to be debt collectors either. Especially when it comes to a patient. As premium costs shift more and more to employees, providers are no longer able to just deal with impersonal insurers and are instead having to go after the very people they’re trying to help.

Bloomberg: Doctors Are Fed Up With Being Turned Into Debt Collectors

Who in the family doesn’t get health care this year? Americans are having to make such tough decisions in an era where insurance plans can be price-tagged at more than $1,000 a month. Bloomberg offers a series that puts names and faces to the problem that has been a punch in the gut for many across the country.

Bloomberg: Soaring Health-Care Costs Forced This Family to Choose Who Can Stay Insured

As you can tell, this week was popping in terms of health news, so the miscellaneous file is going to be a bit more robust today:

Native American and Alaska Native women have been vanishing in high numbers, but the reporting on the depth and breadth of the problem is woefully lacking.

• The Associated Press: Report Cites Weak Reporting on Missing, Murdered Native Women

Who decides the parole of people who have been found not guilty by reason of insanity? In Oregon, where it’s a board that reviews the state’s cases, the balance between civil rights and safety has been praised. However, an analysis of 220 defendants found that about a quarter of them were charged with attacking others within three years of being released. And the board hasn’t changed its policies.

• ProPublica: Oregon Board Says Those Found Criminally Insane Rarely Commit New Crimes. The Numbers Say Otherwise.

So, it turns out a 150-pound pig is uncannily humanlike in organ size and function. This could go a long way in addressing our perpetual donated organ shortage.

The New York Times: 20 Americans Die Each Day Waiting for Organs. Can Pigs Save Them?

A sweeping study put a damper on all the “magical thinking” surrounding the benefits of fish oil and vitamin D.

The New York Times: Vitamin D And Fish Oils Are Ineffective For Preventing Cancer And Heart Disease

If it seems as if at least one kid in every classroom these days has a food allergy, that’s because they probably do. Could hypoallergenic food be the answer?

The Boston Globe: Allergies Change How We All Eat

A revealing series of jail conversations between Aaron Hernandez, who died by suicide in April 2017, and other football players details a grim culture of opioid abuse in the NFL.

The Boston Globe: In Jail Calls, Hernandez Discussed NFL’s Reliance on Painkillers With Former Teammates

In an era of medical malpractice suits, it feels rare to get an apology out of anyone health-related these days. But the widower of a woman who died of an asthma attack outside of a locked emergency department got one from the hospital. (It’s a tragic, yet recommended read overall.)

First lady Michelle Obama spoke candidly about her miscarriage and about how women often feel alone and isolated when it comes to fertility and pregnancy.

The Associated Press: Michelle Obama Had Miscarriage, Used IVF to Conceive Girls

Whew! Everyone was definitely busy before heading into the holidays. Speaking of, we’ll be off eating turkey next week, but will hit your inbox again on Nov. 30.

Happy holidays!

Secretary Azar Comments on Data Showing Rising E-Cigarette Use Among Youth

HHS Gov News - November 15, 2018

Health and Human Services Secretary Alex Azar issued the following statement regarding the sharp uptick in e-cigarette use among youth reported in the 2018 National Youth Tobacco Survey:

“America’s youth are facing a public health crisis that threatens an entire generation: skyrocketing use of nicotine products, brought on by access to flavored products in particular. Use of these products, including e-cigarettes, menthol cigarettes, and cigars, put our youth at risk for a lifetime of nicotine addiction.

E-cigarettes present an important, potentially lifesaving opportunity to help currently addicted adult smokers quit combustible cigarettes. But in trying to build this off-ramp from a deadly addiction, we cannot let e-cigarettes become an on-ramp for kids to enter a lifetime of nicotine addiction and tobacco use.

New data from the National Youth Tobacco survey show the number of teenagers using e-cigarettes almost doubling in just the last year. But we can use a targeted approach to tackle this challenge: The data also show that kids not only choose flavored products more often than adults do, but also that flavors are a major reason they use these products in the first place. Flavors increase the likelihood of kids progressing from experimentation to regular use, and a portion of them will go on to use combustible tobacco products, with the huge added dangers of tobacco-related disease.

FDA’s enforcement efforts and policy framework would restrict access to most flavored e-cigarettes and limit the chances of youth beginning to use these products, while ensuring the products are available to adult smokers as an alternative to combustible cigarettes.

Our obligation at HHS is always to the public health, and we believe FDA’s goals strike the right public health balance in addressing the multifaceted challenge we have before us today.”

Podcast: KHN’s ‘What The Health?’ Doctors, Guns And Lame Ducks

Kaiser Health News:HealthReform - November 15, 2018
Julie Rovner

Kaiser Health News

@jrovner

Read Julie's Stories Rebecca Adams

CQ Roll Call

@RebeccaAdamsDC

Read Rebecca's Stories Kimberly Leonard

Washington Examiner

@leonardkl

Read Kimberly's Stories Alice Ollstein

Politico

@AliceOllstein

Read Alice's Stories

Election Day was Nov. 6, but results remain undetermined in some races at the state and federal levels. Nonetheless, it is already clear that the election could have major implications for health policy in 2019.

The current Congress is back in Washington for a lame-duck session, and while the budget for the Department of Health and Human Services is set for the fiscal year that began Oct. 1, other health bills, including ones addressing AIDS and bioterrorism, are on the to-do list.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Kimberly Leonard of the Washington Examiner and Alice Ollstein of Politico.

Among the takeaways from this week’s podcast:

  • With the political divide between a Republican Senate and a Democratic House, getting legislation passed in the next Congress may prove hard. But bipartisan support could arise for bills to protect consumers from surprise medical bills and, perhaps, to control some drug prices.
  • The House will likely spend much of its time exercising oversight responsibilities, including possible probes of the Trump administration’s policies on separating immigrant children from their parents, changes in health law rules for contraception coverage, changes in Medicaid and the administration’s decision not to defend the Affordable Care Act in a key court case.
  • Among the issues on state ballots this month was a constitutional amendment in Alabama that makes it state policy to “recognize and support the sanctity of unborn life and the rights of unborn children.” Although abortion opponents hail such “personhood” measures, they have been defeated in other states because they could impinge on infertility treatments, such as in vitro fertilization. It’s not clear whether the Alabama measure will be challenged in court because of that.
  • On the ballot in Oregon and Washington were industry-backed measures that would stop localities from instituting soda taxes. The effort failed in Oregon and passed in Washington.
  • During Congress’ current lame-duck session, members will be looking to pass an appropriations bill for parts of the government. Although HHS already got its appropriations bill, other health measures — such as the renewal of the PEPFAR global HIV initiative, grants for states on bioterrorism and pandemic planning, and changes to Medicare’s doughnut hole funding — could be added.
  • A tweet by the National Rifle Association urging doctors to keep out of the gun control debate and “stay in their lane” has provoked a furor from doctors, who say they must deal with the ramifications of a flawed policy.

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

Julie Rovner: The New York Times’ “When Hospitals Merge to Save Money, Patients Often Pay More,” by Reed Abelson

Rebecca Adams: The New York Times’ “Something Happened to U.S. Drug Costs in the 1990s,” by Austin Frakt

Kimberly Leonard: Harper’s Magazine’s “Discovery, Interrupted: How World War I Delayed a Treatment For Diabetes and Derailed One Man’s Chance at Immortality,” by Jeffrey Friedman

Alice Ollstein: The Incidental Economist‘s “The Trump Administration Targets the Contraception Mandate,” by Nicholas Bagley

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Tick-Borne Disease Working Group Calls for More Resources for Research, Prevention, Diagnostics and Treatment

HHS Gov News - November 14, 2018

The Tick-Borne Disease Working Group, a federal advisory committee established by Congress in the 21st Century Cures Act, issued its first report today. The report recommends a multi-pronged response to address these diseases that affect more than 300,000 Americans each year.

Top recommendations included increases in federal resources to meet urgent research and patient care needs, such as enhanced surveillance, prevention, diagnostic and treatment options. The Working Group identified the following priorities:

  • Improve early and accurate diagnosis and treatment.
  • Strengthen national surveillance.
  • Understand immunological mechanism (for example, pathogen-host interaction) of immune protection for Lyme disease and other tick-borne diseases.
  • Develop new rapid and accurate lab tests.
  • Develop antibiotic combination and/or therapeutic options for treating acute and persistent illness.
  • Encourage the development of strategic plans for tick-borne disease federal investments.
  • Dedicate funding to tick-borne diseases and evaluate related activities using performance indicators and clear metrics for success.
  • Characterize how tick-borne disease affects U.S. national security, military readiness, and the health and wellness of active duty service members, veterans and their families.


“Patients whose lives are devastated by ongoing effects of tick-borne illnesses are counting on emerging scientific research, evidence-based policy and the healthcare establishment – including the federal government – to provide solutions,” said Adm. Brett P. Giroir, M.D., assistant secretary for health, U.S. Department of Health and Human Services. “I thank the Working Group for its efforts to produce this report, which will inform our efforts to prevent, diagnose, treat and cure these potentially debilitating diseases.”

Tick-borne diseases have become a serious, potentially deadly, and rapidly growing threat to public health. Lyme disease alone is estimated to affect more than 300,000 Americans each year, with the number of cases having doubled since 2004. However, only about one-tenth of those cases are reported to local and state health departments and the CDC. Many patients and advocates submitted comments to the Working Group, describing debilitating symptoms from tick-borne diseases that require prolonged treatment often resulting in large medical bills that are not reimbursed by medical insurers. New pathogens continue to be discovered, further increasing public health risks and costs for the U.S.

“This report is an important first step in bringing together all relevant stakeholders to develop solutions to this critical – and growing – public health problem in the U.S. today,” said Working Group Chair John N. Aucott, M.D., associate professor, Johns Hopkins University School of Medicine, and director, Johns Hopkins Lyme Disease Research Center. “The bottom line is: we need to find better ways to care for our patients and these recommendations will help us do that.”

The Working Group is administered by HHS. Its 14 members represent a variety of stakeholders, including providers, scientists and researchers, patients and family members, patient advocates and federal members. Members were charged with providing expertise and reviewing all HHS efforts related to tick-borne diseases to help ensure interagency coordination, minimize overlap, and to examine research priorities. The next Working Group report is due to Congress and the HHS Secretary by December 2020.

HHS Secretary Azar Declares Public Health Emergency in California due to Wildfires

HHS Gov News - November 14, 2018

Health and Human Services (HHS) Secretary Alex Azar today declared a public health emergency in California due to wildfires. The declaration follows President Trump’s emergency declaration for the state and gives the HHS Centers for Medicare & Medicaid Services beneficiaries and their healthcare providers and suppliers greater flexibility in meeting emergency health needs created by the wildfires.

“We are working closely with state health authorities and monitoring the needs of healthcare facilities to provide whatever they may need to save lives and protect health,” Secretary Azar said. “This declaration will help ensure that Americans who are threatened by these dangerous wildfires and who rely on Medicare, Medicaid, and the Children’s Health Insurance Program have continuous access to the care they need.”

So far, the wildfires have forced the evacuation of at least two hospitals and eight other healthcare facilities. A smoke advisory was issued for portions of Los Angeles County. Smoke can present a significant health threat for people with asthma and other lung conditions.

HHS has deployed regional emergency coordinators (RECs) to coordinate with state and local health authorities and emergency response officials. RECs serve as HHS’ primary representatives for emergency response and recovery throughout the country at the regional level and work with federal, state, local, tribal and territorial officials and healthcare representatives to plan for public health and medical emergencies.

Staff from HHS’ National Disaster Medical System and the U.S. Public Health Service Commissioned Corps are prepared to provide medical care and public health support if needed.

In addition, the Substance Abuse and Mental Health Services Administration’s Disaster Distress Helpline is available to assist residents in the impacted areas in coping with the stress of the wildfires. The Disaster Distress Helpline provides immediate 24/7, 365-days-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters. This toll-free, multilingual, and confidential crisis support service is available to all residents in the United States and its territories. Stress, anxiety, and other depression-like symptoms are common reactions in disasters. Call 1-800-985-5990 toll free or text TalkWithUs to 66746 to connect with a trained crisis counselor.

In declaring the public health emergency in California and authorizing flexibilities for CMS beneficiaries, Secretary Azar acted under his authority in the Public Health Service Act and Social Security Act. These actions and flexibilities are retroactive to Nov. 8, 2018.

With Hospitalization Losing Favor, Judges Order Outpatient Mental Health Treatment

Kaiser Health News:States - November 13, 2018

When mental illness hijacks Margaret Rodgers’ mind, she acts out.

Rodgers, 35, lives with depression and bipolar disorder. When left unchecked, the conditions drive the Alabama woman to excessive spending, crying and mania.

Last autumn, Rodgers felt her mind unraveling. Living in Birmingham, she was uninsured, unable to afford treatment and in the throes of a divorce. Although Rodgers traveled south to her brother’s house in Foley, Ala., for respite, she couldn’t escape thoughts of suicide, which one day led her to his gun.

“I hit bottom,” she recalled. But she didn’t pull the trigger.

Rodgers told her brother about the close call. News of the incident reached her mother, who then alerted authorities to Rodgers’ near attempt.

Within days, Rodgers was handcuffed and hauled in front of a judge who ordered her to undergo mental health treatment — but not a hospital commitment. Instead, the judge mandated six months of care that included weekly therapy sessions and medication, all while Rodgers continued living with her family.

Rodgers entered assisted outpatient treatment, also known as involuntary outpatient commitment.

Since its inception, the court-ordered intervention has generated controversy. Proponents say it secures the comprehensive care that people with severe mental illnesses might not recognize they need. Yet other health experts question the effectiveness of the intervention and suggest it represents a quick fix in a mental health system that is not adequately serving patients.

“It’s a stopgap measure that works in the short term,” said Dr. Annette Hanson, director of the University of Maryland Forensic Psychiatry Fellowship, who co-authored a book on the intervention. “But it’s not a good long-term solution because you still have lots of people who need voluntary care who can’t get” it.

Assisted outpatient treatment requires a judge’s order. While the eligibility requirements and compliance standards vary by state, participants typically have a history of arrests and multiple hospitalizations. They stay in their communities while undergoing treatment.

The American Psychiatric Association endorsed its use in 2015, saying assisted outpatient treatment has generally shown positive outcomes under certain circumstances. To effectively treat patients, the position paper said, the APA recommends that the intervention be well-planned, “linked to intensive outpatient services” and last for at least 180 days.

A key advantage to assisted outpatient treatment, supporters say, is that it provides care for people who might not recognize the severity of their illness.

A court’s involvement also increases the likelihood of a participant complying with the program, a phenomenon called the “black robe effect,” they add.

“That is really what we’ve found to be the secret sauce” for success, said John Snook, executive director of the nonprofit Treatment Advocacy Center.

But many areas do not have the necessary community mental health services to provide assisted outpatient treatment effectively, said Ira Burnim, legal director for the Judge David L. Bazelon Center for Mental Health Law.

He also said the law already provides options for hospital treatment for people considered a danger to themselves or others. Any person recommended for assisted outpatient treatment for these reasons should be in a hospital receiving intensive inpatient care, Burnim said, not in the community.

“You know, when people don’t take their medication,” he said, “that’s a clinical problem, not a legal problem.”

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Most States Allow The Programs

Assisted outpatient treatment gained popularity after Andrew Goldstein, who was diagnosed with schizophrenia but wasn’t taking his medication, pushed Kendra Webdale in front of an oncoming train in New York City in 1999, killing her. Webdale’s family fought for a change in the law after learning that Goldstein had repeatedly refused treatment while living on his own.

Today, 47 states and the District of Columbia have laws allowing localities to set up assisted outpatient treatment, according to the Treatment Advocacy Center, a nonprofit group that strongly supports assisted outpatient treatment.

Yet, there is no tally of the number of programs or the number of people involuntarily placed in one, said David DeVoursney, chief of the Community Support Programs Branch at the Substance Abuse and Mental Health Services Administration.

There is also little research on its effectiveness. Two randomized studies produced contradictory results about the intervention’s effect on hospitalization rates and the number of arrests afterward. However, other analyses have shown improved outcomes, particularly among participants in New York.

Despite the ambiguity, Congress created grants in 2014 that made up to $60 million available over four years to new assisted outpatient treatment programs. Additionally, the 21st Century Cures Act, passed in 2016 to accelerate drug development, allowed some Department of Justice funding for the intervention.

Experts acknowledge that the scarcity of mental health providers and treatment options causes many patients to go without care. Instead of doctors’ offices, many people with mental illnesses end up in jail — an estimated 2 million every year, according to the National Alliance on Mental Illness.

“What we say very often is basically we have a system that allows people to have heart attacks over and over again,” Snook said. “And then once they have that heart attack, we take them to jail. And then we wonder why the system isn’t working.”

Margaret Rodgers now sees a therapist once a week. A nurse at AltaPointe Health Systems Inc., a community health center, gives her a shot of an antipsychotic drug once a month. (Meggan Haller for KHN)(Meggan Haller for KHN)

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One recipient of federal funding is AltaPointe Health Systems Inc., a community health center that provides services to residents — including Rodgers — in two Alabama counties. The program has received nearly $1.1 million in federal funding, according to Cindy Gipson, assistant director of intensive services.

She said the center applied for the federal grant to reduce the number of hospitalizations among residents living with severe mental illnesses.

“We were having a lot of people who would go to the hospital, then be discharged,” she said. “And they’d do well for a couple of weeks — maybe even a month. Then, they’d go right back in.”

The program, which began in 2017, has served 71 patients, Gipson said. On average, patients stay about 150 days. And roughly 60 percent of referrals come from family members, she said. The majority of people entering have a history of multiple hospitalizations and arrests.

Rodgers said she had never been in handcuffs before the day the Alabama police officer came to her brother’s home and awakened her around 7 a.m. The sheriff gave her five minutes to change and brush her teeth. He then cuffed her wrists, placed her in the back of his car and drove her straight to court. After she was asked a few questions about how she was doing, Rodgers said, she sat down in front of a judge and learned about assisted outpatient treatment for the first time.

Despite how she entered care, Rodgers said the mandated treatment has brought her stability. She sees a therapist once a week, and once a month a nurse at the community health center administers a shot of the antipsychotic drug Abilify. She now is working part time cleaning condos and lives with her mother. She said she has learned strategies to not dwell on the past.

After her first six months of treatment, Rodgers and her care team decided to continue care through the rest of the year. She plans to return to Birmingham and find a better job after completing the program.

Right now, she said, “staying positive is the main thing I want.”

An Underused Strategy For Surge In STDs: Treat Patients’ Partners Without A Doctor Visit

Kaiser Health News:Marketplace - November 13, 2018

If patients return to Dr. Crystal Bowe soon after taking medication for a sexually transmitted infection, she usually knows the reason: Their partners have re-infected them.

“While you tell people not to have sex until both folks are treated, they just don’t wait,” she said. “So they are passing the infection back and forth.”

That’s when Bowe, who practices on both sides of the North and South Carolina border, does something doctors are often reluctant to do: She prescribes the partners antibiotics without meeting them.

Federal health officials have recommended this practice, known as expedited partner therapy, for chlamydia and gonorrhea since 2006. It allows doctors to prescribe medication to their patients’ partners without examining them. The idea is to prevent the kind of reinfections described by Bowe — and stop the transmission of STDs to others.

However, many physicians aren’t taking the federal government’s advice because of entrenched ethical and legal concerns.

“Health care providers have a long tradition of being hesitant to prescribe to people they haven’t seen,” said Edward Hook, professor at the University of Alabama’s medical school in Birmingham. “There is a certain skepticism.”

A nationwide surge of sexually transmitted diseases in recent years, however, has created a sense of urgency for doctors to embrace the practice. STD rates have hit an all-time high, according to the Centers for Diseases Control and Prevention. In 2017, the rate of reported gonorrhea cases increased nearly 19 percent from a year earlier to 555,608. The rate of chlamydia cases rose almost 7 percent to 1.7 million.

“STDs are everywhere,” said Dr. Cornelius Jamison, a lecturer at the University of Michigan Medical School. “We have to figure out how to … prevent the spread of these infections. And it’s necessary to be able to treat multiple people at once.”

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A majority of states allow expedited partner therapy. Two states — South Carolina and Kentucky — prohibit it, and six others plus Puerto Rico lack clear guidance for physicians.

A 2014 study showed that patients were as much as 29 percent less likely to be re-infected when their physicians prescribed medication to their partners. The study also showed that partners who got those prescriptions were more likely to take the drugs than ones who were simply referred to a doctor.

Yet only about half of providers reported ever having prescribed drugs to the partners of patients with chlamydia, and only 10 percent said they always did so, according to a different study. Chlamydia rates were higher in states with no law explicitly allowing partner prescriptions, research published earlier this year showed.

Because of increasing antibiotic resistance to gonorrhea, the CDC no longer recommends oral antibiotics alone for the infection. But if patients’ partners can’t go in for the recommended treatment, which includes an injection, the CDC said that oral antibiotics by themselves are better than no treatment at all.

“Increasing resistance plus increasing disease rates is a recipe for disaster,” said David Harvey, executive director of the National Coalition of STD Directors. The partner treatment is important for “combating the rising rates of gonorrhea in the U.S. before it’s too late.”

The CDC recommendations are primarily for heterosexual partners because there is less data on the effectiveness of partner treatment in men who sleep with men, and because of concern about HIV risk.

Bowe said that even though she writes STD prescriptions for her patients’ partners, she still worries about possible drug allergies or side effects.

“I don’t know their medical conditions,” she said. “I may contribute to a problem down the road that I’m going to be held liable for.”

Physician Crystal Bowe, who practices in North and South Carolina, said she occasionally writes prescriptions for her patients’ partners but worries about possible drug allergies or side effects. “I don’t know their medical conditions,” she says. “I may contribute to a problem down the road that I’m going to be held liable for.” (Courtesy of Crystal Bowe)

In many cases, doctors and patients simply do not know about partner therapy. Ulysses Rico, who lives in Coachella, Calif., said he contracted gonorrhea several years ago and was treated by his doctor. He didn’t know at the time that he could have requested medicine for his girlfriend. She was reluctant to go to her doctor and instead got the required antibiotics through a friend who worked at a hospital.

“It would have been so much easier to handle the situation for both of us at the [same] moment,” Rico said.

Several medical associations support partner treatment. But they acknowledge the ethical issues, saying it should be used only if the partners are unable or unwilling to come in for care.

Federal officials are trying to raise awareness of the practice by training doctors and other medical professionals, said Laura Bachmann, chief medical officer of the CDC’s office of STD prevention. The agency posts a map with details about the practice in each state.

Over the past several years, advocates have won battles state-by-state to get partner treatment approved, but implementation is challenging and varies widely, said Harvey, whose National Coalition of STD Directors is a member organization that works to eliminate sexually transmitted diseases.

The fact that some states don’t allow it, or haven’t set clear guidelines for physicians, also creates confusion — and disparities across state lines.

The Planned Parenthood affiliate that serves Indiana and Kentucky sees this firsthand, said clinical services director Emilie Theis. In Indiana, providers can legally write prescriptions for their patients’ partners, but they are prohibited from doing so in Kentucky, even though the clinics are only a short drive apart, she noted. A similar dynamic is at play along the South Carolina-North Carolina border, where Bowe practices.

California started allowing partner treatment for chlamydia in 2001 and for gonorrhea in 2007. The state gives medication to certain safety-net clinics, a program it expanded three years ago. However, “it has been an incredibly difficult sell” because many medical providers think “it’s a little bit outside of the traditional practice of medicine,” said Heidi Bauer, chief of the STD control branch of California’s public health department.

At APLA Health, which runs several health clinics in the Los Angeles area, nurse practitioner Karla Taborga occasionally gives antibiotics to patients for their partners. But she tries to get the partners into the clinic first, because she worries they might also be at risk for other sexually transmitted infections.

“If we are just treating for chlamydia, we could be missing gonorrhea, syphilis or, God forbid, HIV,” Taborga said. But if prescribing the drugs without seeing the patients is the only way to treat them, she said, “it’s better than nothing.”

Edith Torres, a Los Angeles resident, said she pressured her then-husband to go to the doctor after he gave her chlamydia several years ago: She refused to have sex with him until he did. Torres said she wanted him to hear directly from the doctor about the risks of STDs and how they are transmitted.

If he had taken the medication without a doctor visit, he wouldn’t have learned those things, she said. “I was scared, and I didn’t want to get it again.”

KHN's coverage in California is supported in part by Blue Shield of California Foundation.

HHS Releases Physical Activity Guidelines for Americans, 2nd edition

HHS Gov News - November 12, 2018

(Chicago) – Today, Adm. Brett P. Giroir, M.D., assistant secretary for health, announced the release of the U.S. Department of Health and Human Services’ second edition of the Physical Activity Guidelines for Americans at the American Heart Association’s Scientific Sessions meeting. The second edition provides evidence-based recommendations for youth ages 3 through 17 and adults to safely get the physical activity they need to stay healthy. There are new key guidelines for children ages 3 through 5 and updated guidelines for youth ages 6 through 17, adults, older adults, women during pregnancy and the postpartum period, adults with chronic health conditions, and adults with disabilities.

The United States currently has low levels of adherence to the guidelines -- only 26 percent of men, 19 percent of women, and 20 percent of adolescents meet the recommendations. According to the guidelines, these low levels of physical activity among Americans have health and economic consequences for the nation, with nearly $117 billion dollars in annual healthcare costs and 10 percent of all premature mortality attributable to failure to meet levels of aerobic physical activity recommended in the guidelines. Adults need 150 minutes of moderate-to-vigorous aerobic activity each week, with muscle strengthening activities on two days during the week to stay healthy. Youth ages 6 through 17 need 60 minutes of moderate-to-vigorous physical activity each day.

“The new guidelines demonstrate that, based on the best science, everyone can dramatically improve their health just by moving – anytime, anywhere, and by any means that gets you active,” said Adm. Giroir. “That’s why we need to come together as a nation to get Americans moving. When we move more, we have better cardiovascular health, we are stronger and less susceptible to disease, and we feel better. The updated guidelines include evidence-based strategies that leaders across the nation can use to help Americans fit more physical activity into their daily lives.”

The second edition, based on a comprehensive scientific review, reflects new knowledge about immediate and long-term health benefits from physical activity, as well as new evidence that physical activity can help manage chronic conditions that many Americans have.  

“The American Heart Association has long recognized physical activity as a proven way to lower chances of heart disease and live a longer, healthier life. Our organization is committed to developing programs and advocating for polices that make it easier for everyone to get more physically active, regardless of where they live,” said Ivor Benjamin, M.D., American Heart Association president. “In 2008, the American Heart Association adopted the Physical Activity Guidelines and again we are proud to lead the call for health groups across the country to view these guidelines as beneficial to both public health and a worthy tool for clinicians.”

Notable updates:

  • The previous guidelines stated that only 10-minute bouts of physical activity counted toward meeting the guidelines. This requirement has been removed because all activity counts.
  • There are immediate health benefits, attainable from a single bout of activity, including reduced anxiety and blood pressure, improved quality of sleep, and improved insulin sensitivity.
  • There are more long-term benefits from physical activity, including improved brain health, reduced risk of eight types of cancer (previously two), reduced risk for fall-related injuries in older adults, and reduced risk of excessive weight gain.
  • Physical activity helps manage more chronic health conditions.
    • It can decrease pain for those with osteoarthritis, reduce disease progression for hypertension and type 2 diabetes, reduce symptoms of anxiety and depression, and improve cognition for those with dementia, multiple sclerosis, ADHD, and Parkinson’s disease.
  • There are new key guidelines for preschool children to be active throughout the day to enhance growth and development. 

For more information about the latest Physical Activity Guidelines for Americans visit www.health.gov/paguidelines.

Fish Oil And Vitamin D Pills No Guard Against Cancer Or Serious Heart Trouble

Kaiser Health News:Marketplace - November 10, 2018

A widely anticipated study has concluded that neither vitamin D nor fish oil supplements prevent cancer or serious heart-related problems in healthy older people, according to research presented Saturday at the American Heart Association Scientific Sessions. Researchers defined serious heart problems as the combined rate of heart attacks, stroke and heart-related deaths.

Although hundreds of studies of these supplements have been published over the years, the new clinical trial — a federally funded project involving nearly 26,000 people — is the strongest and most definitive examination yet, said Dr. Clifford Rosen, a senior scientist at the Maine Medical Center Research Institute who was not involved in the research.

Doctors have been keenly interested in learning the supplements’ true value, given their tremendous popularity with patients. A 2017 study found that 26 percent of Americans age 60 and older take vitamin D supplements, while 22 percent take pills containing omega-3 fatty acids, a key ingredient in fish oil.

The new study also suggests there’s no reason for people to undergo routine blood tests for vitamin D, said Rosen, who co-wrote an accompanying editorial. (Both were published in the New England Journal of Medicine.). That’s because the study found that patients’ vitamin D levels made no difference in their risk of cancer or serious heart issues, Rosen said. Even people who began the study with clear vitamin D deficiency got no benefit from taking the supplements, which provided 2,000 international units a day. This amount is equal to one or two of the vitamin D pills typically sold in stores.

A recent Kaiser Health News story reported that vitamin D testing has become a huge business for commercial labs — and an enormous expense for taxpayers. Doctors ordered more than 10 million vitamin D tests for Medicare patients in 2016 — an increase of 547 percent since 2007 — at a cost of $365 million.

“It’s time to stop it,” said Rosen of vitamin D testing. “There’s no justification.”

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Dr. JoAnn Manson, the study’s lead author, agrees that her results don’t support screening healthy people for vitamin D deficiency.

But she doesn’t see her study as entirely negative.

Manson notes that her team found no serious side effects from taking either fish oil or vitamin D supplements.

“If you’re already taking fish oil or vitamin D, our results would not provide a clear reason to stop,” Manson said.

Manson notes that a deeper look into the data suggested possible benefits.

When researchers singled out heart attacks — rather than the rate of all serious heart problems combined — they saw that fish oil appeared to reduce heart attacks by 28 percent, Manson said. As for vitamin D, it appeared to reduce cancer deaths — although not cancer diagnoses — by 25 percent.

But slicing the data into smaller segments — with fewer patients in each group — can produce unreliable results, said Dr. Barnett Kramer, director of the cancer prevention division at the National Cancer Institute. The links between fish oil and heart attacks — and vitamin D and cancer death — could be due to chance, Kramer said.

Experts agree that vitamin D is important for bone health. Researchers didn’t report on its effect on bones in these papers, however. Instead, they looked at areas where vitamin D’s benefits haven’t been definitely proven, such as cancer and heart disease. Although preliminary studies have suggested vitamin D can prevent heart disease and cancer, more rigorous studies have disputed those findings.

Manson and her colleagues plan to publish data on the supplements’ effects on other areas of health in coming months, including diabetes, memory and mental functioning, autoimmune disease, respiratory infections and depression.

Consumers who want to reduce their risk of cancer and heart disease can follow other proven strategies.

“People should continue to focus on known factors to reduce cancer and heart disease: Eat right, exercise, don’t smoke, control high blood pressure, take a statin if you are high risk,” said Dr. Alex Krist, a professor of family medicine and population health at Virginia Commonwealth University.

Listen: Teen Vaping Sparks FDA Crackdown

Kaiser Health News:States - November 09, 2018

Federal regulators want to ban the sale of most flavored e-cigarettes at retail locations like gas stations and convenience stores. They also want to require anyone buying e-cigarettes online to verify their age. The new restrictions come as the Food and Drug Administration has been trying to rein in a dramatic increase in vaping by young people. Smoking of traditional tobacco cigarettes has fallen to a record low, but the popularity of e-cigarettes among youth is raising alarm bells.

Colorado Public Radio’s John Daley reports on the effort for Kaiser Health News and NPR’s All Things Considered.

KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

Trumpeted New Medicare Advantage Benefits Will Be Hard For Seniors To Find

Kaiser Health News:Insurance - November 09, 2018

For some older adults, private Medicare Advantage plans next year will offer a host of new benefits, such as transportation to medical appointments, home-delivered meals, wheelchair ramps, bathroom grab bars or air conditioners for asthma sufferers.

But the new benefits will not be widely available, and they won’t be easy to find.

Of the 3,700 plans across the country next year, only 273 in 21 states will offer at least one. About 7 percent of Advantage members — 1.5 million people — will have access, Medicare officials estimate.

That means even for the savviest shoppers it will be a challenge to figure out which plans offer the new benefits and who qualifies for them.

Medicare officials have touted the expansion as historic and an innovative way to keep seniors healthy and independent. Despite that enthusiasm, a full listing of the new services is not available on the web-based “Medicare Plan Finder,” the government tool used by beneficiaries, counselors and insurance agents to sort through dozens of plan options.

Even if people sign up for those plans, they won’t all be eligible for all the benefits. Advantage members will need a recommendation from a health care provider in the plan’s network. Then they may need to have a certain chronic health problem, a recent hospitalization or meet other eligibility requirements.

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Medicare counselors from California to Maine say key details are not included on the government’s website. In some cases, if insurers offer the new benefits, the plan finder “will indicate ‘yes’ or ‘no,'” said Georgia Gerdes a health care choices specialist at AgeOptions, the Area Agency on Aging in Oak Park, Ill., outside Chicago. That’s hardly enough, she said.

“There is a lot of information on the plan finder, but there is a lot of information missing that requires beneficiaries to do more research,” said Deb McFarland, Medicare services program supervisor at the Southern Maine Agency on Aging.

Nonetheless, officials say the added benefits will help Advantage members prevent costly hospitalizations. Federal approval of additional benefits is “one of the most significant changes made to the Medicare program,” Seema Verma, the head of the Centers for Medicare & Medicaid Services, told an insurers’ meeting last month. She said she expects plans to expand services in coming years.

Medicare Advantage plans, which are an alternative to traditional Medicare, serve 21 million beneficiaries and limit their out-of-pocket expenses. But they also restrict members to a network of doctors, hospitals and other medical providers. They often offer benefits not available in traditional Medicare, such as dental and vision care, hearing aids and gym memberships.

The federal government pays a set amount to the plans to help cover the cost of each member. The Trump administration gave insurers more money to spend on benefits next year — an average pay raise of 3.4 percent, seven times more than the rate of increase in 2018.

Enrollment is underway for Medicare Advantage plans, as well as for people in traditional Medicare who want to buy a policy for drug coverage. The deadline for choosing either type of plan is Dec. 7.

Among the new benefits that some Medicare Advantage plans said they will offer are:

  • Trips to the pharmacy or fitness center in addition to doctor’s appointments for plan members, depending on where they live or their health conditions.
  • A monthly or quarterly allowance for over-the-counter pharmacy products such as cold and allergy medications, eye drops, vitamins, supplements and compression stockings.
  • House calls by doctors or other health care providers, under certain conditions.
  • A home health care aide for a limited number of hours to help with dressing, eating and other daily activities, possibly including household chores and light housekeeping.

However, plans offering these and other services will likely have only some of the options and will have different eligibility criteria and other limitations. The same services likely won’t be available in every county the plan serves.

For example, next year an estimated 150,000 Humana Medicare Advantage members in Texas and South Florida — two of the 43 states Humana serves — who cannot be left alone at home will be able to get a free in-home personal care aide for up to 42 hours a year, so that their regular caregiver can get a break. And more than half of the members in Cigna-HealthSpring Advantage plans will have access to free transportation services in all but five of the 16 states and the District of Columbia where the company sells coverage.

To find these supplemental benefits, seniors can use the online plan finder. After they enter their ZIP code and get a list of plans available locally, they can click on a plan name. That will take them to another page that offers more details about coverage, including a tab for health and drug plan benefits. That page might say whether the new services are offered.

But often the website will simply indicate that specific benefits are available — and perhaps not name them — and advise consumers to contact the plan for more information. A Medicare spokesperson confirmed that there is currently not an indicator on the plan finder for plans offering these expanded health-related supplemental benefits.

In addition to extra benefits, other variables should be considered when choosing an Advantage plan, such as which health care providers and pharmacies participate in a plan’s network, which drugs are covered and the costs.

Where available, several insurers say the new services will be free with no increase in monthly premiums.

“We certainly believe that all of the ancillary benefits we provide will help keep our members healthy, which is good for them, and it’s good for us in the long run,” said Steve Warner, head of the Medicare Advantage product team at UnitedHealthcare, which insures about 5 million seniors or 1 in 4 Medicare Advantage members.

Insurers are betting that services will eventually pay for themselves.

Dawn Maroney, consumer president at Alignment Healthcare, which serves eight counties in Southern California, said it’s much cheaper to give an air conditioner to someone with congestive heart failure to keep that patient healthy than to pay for more expensive medical treatment.

But if the new benefits are such a good idea, they should be available to the majority of older adults in traditional Medicare, said David Lipschutz, a senior policy attorney at the Center for Medicare Advocacy.

For free help with Medicare Advantage and drug plan enrollment, contact the federally funded State Health Insurance Assistance Program (www.shiptacenter.org), the Medicare Rights Center, 800-333-4114 or its website, www.medicareinteractive.org. The Medicare Plan Finder website is available at https://www.medicare.gov/find-a-plan/questions/home.aspx or call 800-633-4227.

Montana’s Legislature Could Decide Medicaid Expansion’s Fate

Kaiser Health News:States - November 09, 2018

A ballot initiative that would have continued funding Montana’s Medicaid expansion beyond June 2019 has failed. But advocates say they’ll continue to push for money to keep the expansion going after that financial sunset.

“We now turn our attention to the legislature to maintain Montana’s bipartisan Medicaid expansion and protect those enrolled from harmful restrictions that would take away health insurance coverage,” said a concession statement Wednesday from Chris Laslovich, campaign manager with the advocacy group Healthy Montana, which supported the measure.

The initiative, called I-185, was the single most expensive ballot measure in Montana history. Final fundraising tallies aren’t in yet, but tobacco companies poured more than $17 million into Montana this election season to defeat the initiative. That’s more than twice as much cash as supporters were able to muster.

Most of the money in favor of I-185 came from the Montana Hospital Association. “I’m definitely disappointed that big money can have such an outsized influence on our political process,” said Dr. Jason Cohen, chief medical officer of North Valley Hospital in Whitefish.

The ballot measure would have tacked an additional $2-per-pack tax on cigarettes. It would have also taxed other tobacco products, as well as electronic cigarettes, which aren’t currently taxed in Montana.

Part of the expected $74 million in additional tax revenue would have funded continuation of Medicaid expansion in Montana.

Unless state lawmakers vote to continue funding the Medicaid expansion, it’s set to expire in June 2019. If that happens, Montana would become the first state to undo a Medicaid expansion made under the Affordable Care Act.

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In September, Gov. Steve Bullock, a Democrat, told the Montana Association of Counties that if the Medicaid initiative failed, “we’re going to be in for a tough [2019 legislative] session. Because if you thought cuts from last special session were difficult, I think you should brace, unfortunately, for even more.”

Republican State Rep. Nancy Ballance, who opposed I-185, disagrees with Bullock’s position. “I think one of the mistakes that was made continually with I-185 was the belief that there were only two options: If it failed, Medicaid expansion would go away; if it passed, Medicaid expansion would continue forever as it was.”

Ballance, who didn’t receive money to campaign against the initiative, said Medicaid expansion in Montana can be tweaked without resorting to a sweeping new tax on tobacco products.

“No one was willing to talk about a middle-ground solution where Medicaid expansion is adjusted to correct some of the things that we saw as issues or deficiencies in that program,” she said. “I think now is the time to roll up our sleeves and come up with a solution that takes both sides into consideration.”

Ballance said conservatives in the legislature want recipients of expansion benefits to face a tougher work requirement and means testing, so those with low incomes who also have significant assets like real estate won’t qualify.

In any event, Ballance said she suspects that if the initiative had passed, it would have immediately faced a court challenge.

North Valley Hospital’s Cohen said he hopes Montana will pass a tobacco tax hike someday. “We all know how devastating tobacco is to our families, our friends and our communities,” Cohen said. “And I think we also all know how important having insurance coverage is, and so I think people are dedicated to fighting this battle and winning it.”

This story is part of a partnership that includes Montana Public Radio, NPR and Kaiser Health News. Montana Public Radio’s Edward O’Brien contributed to the story.

Podcast: KHN’s ‘What The Health?’ Split Decision On Health Care

Kaiser Health News:HealthReform - November 08, 2018
Julie Rovner

Kaiser Health News

@jrovner

Read Julie's Stories Rebecca Adams

CQ Roll Call

@RebeccaAdamsDC

Read Rebecca's Stories Joanne Kenen

Politico

@JoanneKenen

Read Joanne's Stories Margot Sanger-Katz

The New York Times

@sangerkatz

Read Margot's Stories

Voters on Election Day gave control of the U.S. House to the Democrats but kept the U.S. Senate Republican. That will mean Republicans will no longer be able to pursue partisan changes to the Affordable Care Act or Medicare. But it also may mean that not much else will get done that does not have broad bipartisan support.

Then the day after the election, the Trump administration issued rules aimed at pleasing its anti-abortion backers. One would make it easier for employers to exclude birth control as a benefit in their insurance plans. The other would require health plans on the ACA exchanges that offer abortion as a covered service to bill consumers separately for that coverage.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Margot Sanger-Katz of The New York Times and Joanne Kenen of Politico.

Among the takeaways from this week’s podcast:

  • The Trump administration’s new contraception coverage rule comes after an earlier, stricter regulation was blocked by federal courts.
  • The insurance bills that the Trump administration is now requiring marketplace plans to send to customers for abortion coverage will be for such a small amount of money that they could become a nuisance and may persuade insurers to give up on the benefit.
  • House Democrats, when they take control in January, say they want to move legislation that will allow Medicare to negotiate drug prices. But fiscal experts say that may not have a big impact on costs unless federal officials are willing to limit the number of drugs that Medicare covers.
  • It appears that both Democrats and Republicans in Congress are interested in doing something to protect consumers from surprise medical bills. The issue, however, may fall to the back of the line given all the more pressing issues that Congress will face.
  • One of the big winners Tuesday was Medicaid. Three states approved expanding their programs, and in several other states new governors are interested in advancing legislation that would expand Medicaid.

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

Julie Rovner: Kaiser Health News’ “Hello? It’s I, Robot, And Have I Got An Insurance Plan For You!” by Barbara Feder Ostrov

Margot Sanger-Katz: Stat News’ “Life Span Has Little to Do With Genes, Analysis of Large Ancestry Database Shows,” by Sharon Begley

Joanne Kenen: The Washington Post’s “How Science Fared in the Midterm Elections,” by Ben Guarino and Sarah Kaplan

Rebecca Adams: The New Yorker’s “Why Doctors Hate Their Computers,” by Atul Gawande

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Measure To Cap Dialysis Profits Pummeled After Record Spending By Industry

Kaiser Health News:Marketplace - November 08, 2018

Record-breaking spending by the dialysis industry helped doom a controversial California ballot measure to cap its profits.

The industry, led by DaVita and Fresenius Medical Care, spent nearly $111 million to defeat Proposition 8, which voters trounced, 62 to 38 percent, and appeared to approve in just two of 58 counties. The measure also faced strong opposition from medical organizations, including doctor and hospital associations, which argued it would limit access to dialysis treatment and thus endanger patients.

The opposition presented a powerful message that “if you can’t get dialysis, you will die,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research. “If you didn’t know that, the commercials made it clear.”

Despite arguments about the outsize profits of dialysis companies, Kominski said the “Yes on 8” case wasn’t as clear. The measure, sponsored by the Service Employees International Union-United Healthcare Workers West, sought to cap dialysis clinic profits at 115 percent of the costs of patient care. Revenues above that amount would have been rebated primarily to insurance companies. Medicare and other government programs, which pay significantly lower prices for dialysis, wouldn’t have received rebates.

The union raised nearly $18 million — a large sum for most initiatives but about 16 percent of what the opposition mustered.

The proposition also was poorly written and difficult for voters to understand, said Erin Trish, associate director of health policy at the USC Schaeffer Center for Health Policy and Economics. Trish said she wasn’t surprised by the landslide defeat given the widespread ads against the initiative about the potential harms to patients. “The message came through loud and clear,”  she said.

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Trish said health care industry groups genuinely viewed Proposition 8 as a poor initiative — but they also didn’t want to see rate regulation. “This is not what most of these associations want to open the door to,” Trish said.

Generally speaking, said Jessica Levinson, a professor at Loyola Law School, voters’ default on initiatives is “no.” In addition, money spent against an initiative is usually more effective than money spent for it. Levinson said people weren’t 100 percent sure what they were voting on with Proposition 8. All of those factors made passage “an uphill battle,” she said.

Kathy Fairbanks, a spokeswoman for the opposition, credited the electorate for properly sorting out the facts. “Voters did their homework and saw who lined up on both sides,” Fairbanks said. “All the leaders of the medical community were against Proposition 8 because of the negative impact it would have had on patients and access to dialysis.”

Proponents of the measure argued that highly profitable dialysis companies don’t invest enough in patient care and that they need to hire more staff and improve clinic safety. Opponents said passage would have forced clinics to cut their hours or close altogether, resulting in more emergency room visits by dialysis patients.

SEIU-UHW said the opponents tried to “scare and mislead” voters. It vowed to continue targeting profitable dialysis companies with another measure on the 2020 ballot, as well as through legislation.

“We exposed problems within the dialysis industry and we put a spotlight on a sector that has operated in the shadow for far too long,” said Sean Wherley, spokesman for the “Yes” campaign. “But we are not finished yet. … The need is still there to hold this industry accountable.

He added that the union is proud to have put a spotlight on “the inflated charges that drive up health care costs for all California.”

Critics say that SEIU-UHW, which represents more than 95,000 workers in California, uses state and local ballot initiatives as a way to pressure legislators and gain bargaining power. They’ve sponsored measures on such topics as hospital and clinic funding, access to affordable insurance and training for in-home caregivers.

The union maintains its goal is simply to improve health care.

Two other Bay Area initiatives sponsored by SEIU, aiming to limit hospital pricing, also were defeated Tuesday, indicating that the ballot box may not be the best place to address concerns about costs in the health care industry.

“This is too complicated to do by ballot proposition,” Trish said.

Dialysis patients participated heavily in both the pro and con sides of the initiative, appearing in dramatic television ads and presenting their personal stories on social media.

Lili Hernandez, 27, who began treatment four years ago, showed up to her appointments at a DaVita clinic in Hollywood with “Yes on Prop. 8” placards even as  the clinic posted “No” signage, she said.

Hernandez supported the initiative because she believes the corporations should be held accountable, she said. “They take advantage of how much money they can charge, but don’t give the best service,” she said. “Too many people are at risk of infection and neglect.”

She woke up Wednesday feeling defeated. “I was awake last night, checked results online, had my cry and went to sleep,” she said, adding that she thinks people were confused about the initiative and believed the “false ads.”

Meanwhile, DeWayne Cox, a dialysis patient from Los Angeles, expressed relief. “This means that voters got the message, they understood,” he said.

Cox, 56, said he comes from a union family and believes in unions, but this was a “terrible” move by SEIU because it could lead to cutbacks in services. “Not only was this scary for me, but they made me angry,” he said. “If their motive was truly to help patients, they would have written a better, more precise measure.”

The measure became the most expensive race in California this year. Industry giants DaVita and Fresenius Medical Care, which operate nearly three-quarters of the chronic dialysis clinics in California, were responsible for more than 90 percent of the contributions in opposition to the measure

The California Medical Association, the California Hospital Association and the California chapter of the American College of Emergency Physicians all opposed Proposition 8. “Our concern was the impact on patient care,” said hospital association spokeswoman Jan Emerson-Shea. “If dialysis clinics were forced to close and patients needed care, we are the only place within the health care system that is open 24/7.”

Municipal ballot initiatives sponsored by SEIU-UHW targeted Stanford Health Care in Livermore and Palo Alto by attempting to cap prices at 115 percent of the “reasonable” cost of care. Under the initiatives, hospitals and other medical providers would have been required to pay back any charges above the cap each year to private commercial insurers. The initiatives failed dramatically, losing 77 to 23 percent in Palo Alto and in Livermore, 82 to 17 percent.

Voters did approve three statewide health care initiatives Tuesday, however:

  • Proposition 2 won 61 to 39 percent, allowing the state to issue $2 billion in bonds for housing for homeless people in need of mental health services. Bond money will be distributed to counties and repaid with proceeds from the Mental Health Services Act, which levies a 1 percent tax on personal incomes of $1 million and above.
  • Proposition 4, which won by the same margin, allows the state to distribute $1.5 billion in bonds to help the state’s 13 children’s hospitals’ pay for construction and equipment. It was the third time in 14 years that voters had agreed to subsidize the hospitals.
  • Proposition 11, passing with  59 percent of the vote, requires private ambulance employees to remain on call during their breaks — just as firefighters, policemen and other public emergency workers do.

Samantha Young and Harriet Rowan contributed to this report.

KHN’s coverage of these topics is supported by California Health Care Foundation and Blue Shield of California Foundation

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

California’s Top Lawyer Sees Election Win As Mandate To Sustain Trump Resistance

Kaiser Health News:HealthReform - November 08, 2018

California Attorney General Xavier Becerra has cemented his role as one of the nation’s top defenders of the Affordable Care Act, filing multiple lawsuits in the past two years to uphold key protections of the law and often clashing with the Trump administration.

Voters this week gave Becerra a clear mandate to continue that work, he said.

“Californians had a chance to register their opinion on the work that I’ve done,” Becerra told California Healthline on Wednesday, the day after voters overwhelmingly elected him to the state’s top law enforcement job — 61 percent to 39 percent over Republican Steven Bailey.

“My sense is there’s a pretty clear signal.”

Becerra has filed 44 legal challenges against the Trump administration in less than two years on cases involving immigration, birth control, health care, transgender rights, net neutrality, climate change and other issues.

Four of the lawsuits involve former President Barack Obama’s signature achievement, the 2010 federal health care law, which Trump and fellow Republicans have sought to dismantle. In one key case, Becerra is leading more than a dozen other Democratic attorneys general against a Texas-led GOP lawsuit challenging the law’s constitutionality.

“We’re defending health care protections and rights not just for the 40 million Californians, but for the 320 million Americans in the country, because the Trump administration elected to back out of their role in defending a federal statute,” Becerra said. “We stepped in and are now the lead state defending the Affordable Care Act. That’s a big undertaking.”

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Democratic Gov. Jerry Brown appointed Becerra to the top post at the state Department of Justice in December 2016 after Kamala Harris was elected to the U.S. Senate. So, Tuesday’s election was the first time that the 60-year-old Democrat, who previously served in Congress, won a statewide office.

Bailey had criticized Becerra for fighting Washington instead of focusing on California issues — not an argument that resonated with voters in a state that prides itself as the head of Trump resistance.

Becerra said he has sought to spotlight health care at the state Justice Department, creating a new “strike force” of attorneys who have expertise in health care issues.

Becerra, the son of Mexican immigrants, said he also is ready to defend California should state lawmakers decide to extend health care coverage to unauthorized immigrant adults (children already are eligible). That could spur a legal challenge and would not likely be supported by the Trump administration.

The state’s estimated 1.8 million unauthorized immigrants make up nearly 60 percent of the state’s remaining uninsured residents. Covering them is key to Democratic leaders’ goal of insuring all Californians.

Aside from tangling with Trump, Becerra also has taken on both the hospital and pharmaceutical industries.

This year, he filed a lawsuit against Sutter Health, the largest hospital system in Northern California, for anti-competitive practices, and he is investigating pharmaceutical manufacturers and the three largest opioid distributors over unlawful practices. In 2017, Becerra joined a federal lawsuit that charges six makers of generic drugs with an illegal conspiracy to increase prices for an antibiotic and a diabetes medication. All three cases are pending.

In the Sutter Health lawsuit, Becerra said evidence will show that the hospital chain overcharged for services. While he has made anti-competitiveness a priority, he would not say whether he planned similar lawsuits against other hospitals. But he didn’t rule it out.

“We’re going to be vigilant to make sure that everyone follows the law and does what they’re supposed to,” Becerra said. “If we find that there are people who are acting anti-competitively or overpricing or trying to take advantage of California health care consumers, we’ll be prepared to act.”

All of the investigations and litigation, he said, are slow-moving. He compared the process to a football game in which most of the plays yield small gains, with an endgame in sight.

“We’re looking to score some touchdowns,” he said.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

HHS activates aid for uninsured citizens of the Commonwealth of the Northern Mariana Islands needing medicine after Super Typhoon Yutu

HHS Gov News - November 08, 2018

Uninsured citizens of the Commonwealth of the Northern Mariana Islands (CNMI), a U.S. territory, are eligible for no-cost replacements of critical medications lost or damaged by Super Typhoon Yutu. This relief comes from the Emergency Prescription Assistance Program (EPAP), managed by the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR).

“We are committed to doing everything we can to protect Americans from the potential health impacts of disasters, and Emergency Prescription Assistance Program is one part of that effort,” said HHS Assistant Secretary for Preparedness and Response, Robert Kadlec, M.D. “EPAP provides vital assistance to people without insurance who rely upon certain prescription medicines and equipment to protect their health after disasters. I encourage citizens in Northern Mariana Islands who qualify for this assistance to take advantage of it.”

At no cost to uninsured patients, those needing certain prescription medications during an emergency can obtain a 30-day supply at any EPAP participating pharmacy through Nov. 24, 2018. Most prescription drugs are covered under the program.

Uninsured patients also may use EPAP to replace specific medical supplies or medical equipment, such as canes and walkers, damaged or lost as a direct result of Super Typhoon Yutu or as a secondary result of loss or damage caused while in transit from the emergency site to an emergency shelter.

More than 72,000 pharmacies participate nationwide. All of the pharmacies in the CNMI are open and the following pharmacies in Saipan participate in the EPAP:

  • Brabu Pharmacy, 101 Akari Road
  • Phi Pharmacy, 1 Navy Hill Road
  • Phi I, Joeten Dandan Center

Emergency Prescription Assistance Program provides an efficient mechanism for enrolled pharmacies to process claims for prescription medication, specific medical supplies, and some forms of durable medical equipment for eligible individuals in a federally identified disaster area. All pharmacies in the United States are eligible to participate. Pharmacies in the CNMI can call 888-571-8182, toll-free, to be added to the program.

Uninsured CNMI residents affected by Super Typhoon Yutu can call 855-793-7470, to learn if their medication or specific durable medical equipment is covered by EPAP and to find a participating pharmacy or visit www.phe.gov/epap.

HHS also has personnel from Disaster Medical Assistance Teams and the U.S. Public Health Service Commissioned Corps working alongside local healthcare providers to care for patients at CNMI clinics, shelters and community centers. In the initial days after the storm, these teams also provided emergency medical care at the hospital in Saipan. In the first two weeks, these personnel have seen more than 2,100 patients, primarily for clean-up related injuries such as lacerations and puncture wounds, and primary care needs.

The U.S. Food and Drug Administration has information available to help citizens understand the safe use of medical products, including insulin and devices, exposed to flooding or unsafe water after Super Typhoon Yutu. This information includes the safe use of temperature-sensitive drugs when refrigeration is temporarily unavailable.

Centers for Disease Control and Prevention subject matter experts are working with the territory health department to determine any long-term public health or environmental health effects of Super Typhoon Yutu and are making public health information available, such as tips on safe clean up and preventing common post-disaster diseases.

The Centers for Medicare & Medicaid Services (CMS) has taken measures necessary to give healthcare providers, facilities and suppliers the flexibility needed to provide continued access to care following the catastrophic storm. CMS temporarily waived or modified certain Medicare and Medicaid requirements. CMS has issued waivers as necessary, and the CMS Regional Office can grant other provider-specific requests for the hospital and other CNMI healthcare facilities.

CMS also worked with the Kidney Community Emergency Response network and dialysis providers to check on the well-being of dialysis patients and reschedule their dialysis services at open dialysis facilities after the super typhoon.

The Substance Abuse and Mental Health Services Administration (SAMHSA) activated its Disaster Distress Helpline, a 24/7, 365-day-a-year, national hotline dedicated to providing immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. The Disaster Distress Helpline is toll-free, multilingual, and confidential. Stress, anxiety, and other depression-like symptoms are common reactions after a disaster. Call 1-800-985-5990 to connect with a trained crisis counselor.

SAMHSA also has resources available to assist residents with the behavioral health impacts of disasters, including tips for parents and educators on talking with children after traumatic events. Children respond to trauma in many different ways, and the tips cover signs of stress reactions in different age groups and how to help.

Following President Trump’s emergency declaration for Super Typhoon Yutu, HHS Secretary Alex Azar declared a public health emergency in CNMI on Oct. 25, 2018, to authorize flexibilities for CMS beneficiaries. These flexibilities are retroactive to Oct. 24, 2018.

HHS, through its Office of the Assistant Secretary for Preparedness and Response (ASPR), leads the federal government’s public health and medical response and recovery support for states and territories after disasters. HHS works to enhance and protect the health and well-being of all Americans, providing for effective health and human services and fostering advances in medicine, public health, and social services. ASPR’s mission is to save lives and protect Americans from 21st century health security threats.

Information on disaster health and HHS actions is available on www.phe.gov/emergency. Public Service Announcements with post-storm health tips are available on https://www.cdc.gov/disasters/psa/index.html.

Trump Administration Issues Final Rules Protecting Conscience Rights in Health Insurance

HHS Gov News - November 08, 2018

Today, the Departments of Health and Human Services, Treasury, and Labor released two final rules to provide conscience protections for Americans who have a religious or moral objection to health insurance that covers contraception methods. Under the Affordable Care Act, employer-provided health insurance plans are required to cover certain “preventative services” – which were defined through guidance by the Obama Administration as including all contraception methods approved by the Food and Drug Administration, including methods viewed by many as abortifacients, and sterilization procedures.

In October 2017, the Trump Administration issued two interim final rules providing an exemption for those who had sincerely held religious or moral objections to such coverage, while seeking public comment on the rules. The first of today’s final rules provides an exemption from the contraceptive coverage mandate to entities that object to services covered by the mandate on the basis of sincerely held religious beliefs. The second final rule provides protections to nonprofit organizations and small businesses that have non-religious moral convictions opposing services covered by the mandate. The religious and moral exemptions provided by these rules also apply to institutions of education, issuers, and individuals. The Departments are not extending the moral exemption to publicly traded businesses, or either exemption to government entities.

Key Facts:

  • In May 2017, President Trump issued an executive order that the Departments consider amending existing regulations to address conscience-based objections to the contraceptive coverage requirements.
  • Obamacare already exempts tens of millions of people from the preventive services coverage mandate because the mandate does not apply to plans insured through grandfathered coverage that existed prior to the law.
  • The rules leave in place government programs that provide free or subsidized contraceptive coverage to low income women, such as through community health centers.
  • These regulations do not ban any drugs or devices or prohibit any employer from covering contraceptives.
  • The Departments estimate the exemptions should affect no more than approximately 200 employers with religious or moral objections.
  • The rules take effect 60 days after their publication in the Federal Register.

To read a fact sheet with additional information on the final rules, visit: https://www.hhs.gov/about/news/2018/11/07/fact-sheet-final-rules-on-religious-and-moral-exemptions-and-accommodation-for-coverage-of-certain-preventive-services-under-affordable-care-act.html

To read the final rule on exemptions for religious beliefs, visit: https://www.federalregister.gov/documents/2018/11/15/2018-24512/religious-exemptions-and-accommodations-for-coverage-of-certain-preventive-services-under-the

To read the final rule on exemptions for moral convictions, visit: https://www.federalregister.gov/documents/2018/11/15/2018-24514/moral-exemptions-and-accommodations-for-coverage-of-certain-preventive-services-under-the-affordable

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