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Election Canvassers Want Latinos to Know Voting Is Good for Their Health

Kaiser Health News:States - November 07, 2022

HUNTINGTON PARK, Calif. — Jonathan Flores spent a sunny Saturday in late October knocking on the doors of registered voters in this predominantly Latino working-class town in southeastern Los Angeles County. Most people weren’t home or didn’t come to the door. Some of those who did expressed strong opinions about Joe Biden and Donald Trump and took an interest in abortion rights and clean-air initiatives on the California ballot for the Nov. 8 election. One young man gave Flores the brush-off, saying he doubted his vote would be counted.

Like the other canvassers sent out that day by AltaMed Health Services Corp., a large chain of community clinics, Flores sported a black baseball cap and a T-shirt emblazoned with “My Vote. My Health.” Underneath, it read the same in Spanish, “Mi Voto. Mi Salud.” His mission was to urge residents to cast their ballots, even if they had never voted, so they could be fairly represented in city hall, Sacramento, and beyond.

“I feel like I’ve seen communities — people who look like me, like my parents — struggle through so much,” said Flores, 31, whose mother and father were born in Mexico and now live in the Central Valley. “So reaching out to them at the core of those issues is basically what got me doing this.”

Health care institutions across the United States have mounted get-out-the-vote efforts in recent years, inspired by a growing belief that voting improves the health of individuals and communities. The American Medical Association has endorsed that idea. AltaMed, with an active civic engagement department, has targeted more than a quarter-million registered voters in Los Angeles and Orange counties this election, most of them in Latino communities. It has offered early voting at a dozen clinics and plans to send canvassers out right up until Election Day.

“Our problems are often triggered — or exacerbated — by factors in our daily lives, whether it’s the air we breathe, where we live, the food we eat,” said Aliya Bhatia, executive director of Vot-ER, a nonprofit organization that works with 700 hospitals and clinics around the U.S., including AltaMed, to encourage patients and staff members to vote. “Vot-ER’s work helps patients be part of a process of going upstream to shape those policies that impact our health.”

Getting out the vote can be challenging in Latino communities despite their potential as an electoral force. The Latino population has quadrupled in the last four decades and now constitutes 19% of the U.S. population. In California, Latinos account for over 39% of the population, exceeding the share of non-Hispanic whites and making them the state’s largest ethnic or racial group.

However, voter participation among Latinos continues to trail other groups. Their turnout in the 2020 election was more than 14 percentage points below that of the state’s eligible voter population, according to data from the Center for Inclusive Democracy at the University of Southern California’s Sol Price School of Public Policy.

Researchers and Latino advocacy groups cite various factors that inhibit Latino voting, including feelings of cultural and linguistic marginalization, a mistrust of government, a disproportionately high poverty rate, and a younger-than-average population. Another key factor, they said, is a lack of outreach by political campaigns and other election organizations.

In a recent poll by the Latino Community Foundation, 71% of California Latino residents said they had not been contacted by a political party, campaign, or other organization this year.

“It makes a difference in whether they are actually going to turn out to vote,” said Mindy Romero, director of the Center for Inclusive Democracy.

In neighboring Los Angeles, mayoral candidate Rick Caruso, a billionaire developer, has made a strong effort to court Latinos, which could play a decisive role in his race to lead a city where they account for nearly half the population. After trailing by a double-digit margin early on, Caruso has pulled even with his opponent, U.S. Rep. Karen Bass, according to a recent poll published by the Southern California News Group.

Notably, 43.7% of Latino voters said they would back Caruso, compared with 29.4% for Bass.

“He is meeting us where we are, at our businesses, where we shop, where we eat. He is telling us he sees us and he hears us,” said Nilza Serrano, president of the Avance Democratic Club, a Latino organization in L.A. County that has drawn scrutiny over its endorsement of Caruso. “I think our community is fed up and a little exhausted from not being heard.”

In Huntington Park, where 97% of residents are Hispanic or Latino, predominantly of Mexican origin, the upcoming election wasn’t top of mind for some residents.

Maria Robles, 28, who was born here to Mexican immigrants, got confused when asked about her party affiliation. “I don’t know. Is it the Democrats?” she asked, speaking through her front screen door. Robles said she voted for Biden in the last election but regrets it now and, if she could do it over, would vote for Trump instead.

Surveys show that health care is a leading concern among Latinos, although it’s eclipsed by worries about inflation and the economy. Latinos are more likely than other residents to be uninsured. Nationally, they have high rates of diabetes and obesity. And their communities have been hit hard by covid-19.

But political campaigns repeatedly fail to link the health care concerns of Latinos to voting, Romero said.

One example is the Inflation Reduction Act, which, among many other things, caps the monthly cost of insulin for Medicare beneficiaries at $35. Democrats wanted the insulin cap to apply to privately insured people as well, but that provision was blocked by Republicans in the Senate, denying the benefit to millions.

“Yet very few Democrats are talking about it on the campaign trail,” said Rodrigo Dominguez-Villegas, director of research at UCLA’s Latino Policy and Politics Institute. “I mean, the ad pretty much writes itself: ‘We tried to pass this for everybody, but Republicans opposed this specific policy that was going to benefit your uncle, your grandma, your father, your cousin.’”

The environment is another significant concern. Residents of Huntington Park and neighboring cities, almost all with overwhelming Latino majorities, have lived for decades with air and soil pollution from the heavy industry nearby and the traffic along Interstate 710, a freeway corridor choked with diesel-powered trucks transporting cargo from the nation’s two busiest ports.

Bryan Martinez, a Huntington Park resident, grew animated when he learned about Proposition 30, a state measure that would impose an additional 1.75% tax on personal incomes above $2 million to subsidize zero-emission vehicle purchases, electric charging stations, and wildfire prevention programs.

“That’s something I’m really interested in,” said Martinez, 32. “It’s staggering how much pollution comes over here with the winds. I have a lot of friends who are asthmatic.”

Californians are also being asked to vote on an initiative, Proposition 1, that would cement the right to an abortion in the state’s constitution — a response to the U.S. Supreme Court decision that overturned Roe v. Wade. Numerous polls show Latinos strongly support abortion rights, including the Latino Community Foundation survey, in which 61% of Latinos in California favored Proposition 1.

Margarita Gallegos, a Huntington Park resident who was born in Mexico and immigrated to the United States nearly 50 years ago, expressed strong support for abortion rights.

“There are people who have been abused and don’t want to have the baby,” Gallegos, 68, said in Spanish. “Women should have the right to choose for themselves and should also be able to take what they need to take so they don’t become pregnant.”

Speaking to Flores and two of his AltaMed colleagues from her front porch, Gallegos said that it was important for people to vote and that she would definitely cast her ballot.

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

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

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Disability Community Remembers Pioneering Advocate Lois Curtis

HHS Gov News - November 04, 2022
HHS leadership and staff join the disability community in mourning the loss of one of our nation’s greatest advocates, Lois Curtis who passed away last evening.

Hospital Giant HCA Fends Off Accusations of Questionable Inpatient Admissions

Jennifer Smithfield felt weak and still had trouble breathing in February after nearly two weeks with covid-19. It was a Sunday, and her doctor’s office was closed. So her primary care physician suggested going to an emergency room to be safe.

Smithfield went to HCA Healthcare’s flagship hospital, near its corporate headquarters in Nashville, Tennessee, and thought she would be checked out and sent home. But that’s not what happened.

“Even though I did not feel well, I didn’t think it was bad enough to be hospitalized, especially not multiple days,” Smithfield said.

Over three days, Smithfield racked up $40,000 in charges for her inpatient stay and received a bill for $6,000 under the terms of her health insurance policy. “I could have walked out,” Smithfield said. “I wish I had walked out.”

While she was in the hospital, she said, the doctor who had directed her to the ER texted her repeatedly, asking why she’d been admitted.

For more than a decade, large health systems have faced scrutiny for admitting patients to costly hospital stays when less expensive treatments or short periods of observation in the ER would have been appropriate.

Commercial insurers pay handsomely for inpatient care, with room rates often hitting several thousand dollars a day — and that doesn’t include the charges that inevitably follow for bloodwork, consultations, and other exams that typically occur. Hospitals, like hotels, maximize revenue by keeping their beds full.

Critics allege that HCA sought to keep occupancy rates high by creating incentives for doctors to admit ER patients — whether those patients required admission or not. The accusation is particularly surprising because admission rates nationally have generally been declining as more conditions can be safely treated with telemedicine and home monitoring.

U.S. Rep. Bill Pascrell (D-N.J.) and the Service Employees International Union have been pressing the Department of Health and Human Services to investigate allegations against HCA as potential Medicare fraud. A spokesperson for the Centers for Medicare & Medicaid Services, Bruce Alexander, said the agency is reviewing a September letter from Pascrell that details the claims that HCA forced doctors to meet unofficial quotas, or targets, for the number of patients admitted to the hospital. And a previously sealed whistleblower case is shedding new light on such internal policies.

“Improper hospital admissions can have cascading effects on patients and workers,” Pascrell, chair of the House Ways and Means oversight subcommittee, wrote to HHS Secretary Xavier Becerra. “Unnecessary admissions expose patients to unnecessary treatments. This creates an added potential risk of complications and the possibility of new infections for patients.”

HCA spokesperson Harlow Sumerford refuted the accusations. “We categorically reject any allegation that physicians admit patients to our hospitals on the basis of anything other than their independent medical judgment and their patients’ individual conditions and medical needs,” he told KHN in a statement.

Pascrell’s concerns are based largely on a 58-page investigative report from the SEIU published in February. The national labor union has been challenging health systems on admissions for more than a decade as it attempts to organize in more for-profit hospitals and advocates for its members who work on the front lines. The SEIU estimates HCA overcharged the Medicare program at least $1.8 billion over roughly a decade through excessive admissions, according to the report.

The claims against HCA are similar to those the SEIU made that led to a $98 million settlement with Community Health Systems in 2014 and a $262 million settlement in 2018 with Health Management Associations. The government alleged that hospitals knowingly billed for inpatient services when lower-paying outpatient or observational services were warranted.

The government is in the best position to prove such claims, said Jacob Tubbs, an attorney based in Birmingham, Alabama, whose law firm, Price Armstrong, has represented plaintiffs in similar cases against hospitals. But he noted that proving that doctors willingly and systematically departed from today’s standard of care is difficult. It is particularly hard to show that a patient was overtreated.

Lawyers still have “a healthy amount of skepticism” about the potential for winning these cases, he said. “We know that what we’re going to have to ultimately prove is that the medical care was objectively unnecessary.”

In a 141-page court filing from 2018, Dr. Camilo Ruiz, a whistleblower at a 400-bed HCA hospital in suburban Miami, accused the health system of threatening his job if he didn’t admit more patients, instead of sending them home from the ER. HCA supervisors hounded him with warnings to start meeting established targets, he said in the court documents.

Ruiz’s attorneys used publicly available Medicare data to show that HCA hospitals nationwide routinely admitted patients for low-level maladies such as abdominal pain, lower respiratory problems, dizziness, and nausea while non-HCA hospitals sent patients with the same conditions home.

At 41 HCA hospitals with the highest admission rates — located in Florida, Texas, Nevada, Virginia, and California — the attorneys found that from 2013 through 2016, 84% of Medicare patients were admitted for eight common diagnoses, compared with 55% at non-HCA hospitals.

The Ruiz case was unsealed in 2020 when the federal government declined to take on the investigation. The Justice Department — which has intervened in similar cases that led to settlements — did not explain in court records why it passed on the Ruiz case and declined to comment to KHN.

Ken Nolan is an attorney with Nolan Auerbach & White, a firm that is based in Fort Lauderdale, Florida, and has successfully represented whistleblowers alleging fraudulent hospital admissions. Nolan said the government sometimes declines cases for reasons other than a lack of evidence.

The SEIU is continuing to push the government to investigate its broader allegations against HCA. The union incorporated data from the Ruiz suit in the report it’s been shopping around to government agencies, including the Securities and Exchange Commission.

In addition to asking HHS to investigate, Pascrell sent a letter directly to HCA’s CEO, Sam Hazen, demanding an explanation for elevated admissions numbers.

As the nation’s largest hospital company, HCA sets the pace for the U.S. health care system. Its profits approached $7 billion in 2021 even as other health systems struggled through the tail wind of the pandemic.

For Smithfield, her costly hospitalization not only threatened her wallet. It also broke her trust in a system in which she has long gotten care, including treatment for leukemia. She is disputing her bill.

Now, when she seeks medical care, she wonders whether her “best interests are being taken into account versus some other motive that the hospital administration might have.”

This article is from a partnership that includes Nashville Public Radio and KHN.

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

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Centene Showers Politicians With Millions as It Courts Contracts and Settles Overbilling Allegations

On Nov. 2, 2021, Nevada Gov. Steve Sisolak’s reelection campaign received 10 separate $10,000 contributions from what appeared to be unrelated health insurance plans from across the country.

The Buckeye Community Health Plan of Ohio, Louisiana Healthcare Connections, and Peach State Health Plan of Georgia were among the companies that sent money to the Democrat, according to state campaign finance records, even though only one, SilverSummit Healthplan, provided insurance in the Silver State.

But a thread connects the companies: Each is a subsidiary of Centene Corp., ranked 26th on the Fortune 500 list, and the nation’s largest private managed-care provider for Medicaid, the government insurance program for people with low incomes or disabilities.

Centene had already sealed Medicaid deals in Nevada through its SilverSummit subsidiary — yet a potential new line of business was on the horizon. Sisolak, who is up for reelection Nov. 8, had just approved a new public health plan option that would later open up to bidding from contractors such as SilverSummit.

And then, less than two months after Centene’s subsidiary contributions were made, Nevada settled with the company over allegations the insurer overbilled the state’s Medicaid pharmacy program. The state attorney general’s office did not publicly announce the $11.3 million settlement but disclosed it in response to a public records request from KHN.

Sisolak — who has accepted at least $197,000 from Centene, its subsidiaries, top executives, and their spouses since August 2018 — issued a statement through his campaign spokesperson Molly Forgey that said Medicaid contracts are awarded by an independent group. “There is zero correlation between Centene’s donations and how the governor legislates,” Forgey said. “The governor in no way acts unilaterally in decisions to award state contracts.”

The contract went before the Nevada Board of Examiners for final approval. Sisolak is one of three voting members.

Centene has similarly amplified campaign contributions to governors in New York and South Carolina, two states where it has profitable contracts and such giving by multiple subsidiaries is allowed. And despite having pledged to investors to disclose its political giving, Centene has revealed to shareholders only a portion of its contributions — omitting much of its subsidiary giving from reports on its website.

Under corporate law, each subsidiary is its own business, which allows companies to increase their political footprints in some states by giving the maximum allowed donations from more than one entity, said Ciara Torres-Spelliscy, a law professor at Stetson University in Florida.

“In some cases, they can increase it tenfold depending on how many subsidiaries and how much money they want to aim at a particular politician,” Torres-Spelliscy said. “They will exploit any loophole.”

Since 2015, the St. Louis-based insurance behemoth, its subsidiaries, its top executives, and their spouses have given more than $26.9 million to state politicians in 33 states, to their political parties, and to nonprofit fundraising groups, according to a KHN analysis of IRS tax filings and data from the nonpartisan, nonprofit group OpenSecrets. That total doesn’t include the millions of dollars Centene and its subsidiaries have given to state politicians’ political action committees because OpenSecrets doesn’t track those donations. The KHN analysis also does not include giving to congressional and presidential candidates.

It’s a purposeful political investment: Centene earns billions of dollars from governments and then uses its profits to back the campaigns of the officials who oversee those government contracts. The company has developed this sophisticated, multipronged strategy as it pursues even more state government-funded contracts and defends against sweeping accusations that it overbilled many of those very governments.

Centene declined to make a representative available for an interview and didn’t respond to specific questions about its political giving. But company spokesperson Suzy DePrizio said in a statement that the company follows all local, state, and federal laws and records all contributions from its political action committee. She said Centene’s contributions “are intended to serve as support to those who advocate for sound public policy healthcare decisions, which is evident by our nearly equal support of candidates from both parties.”

This year, according to IRS filings that go through Sept. 30, Centene has given $2.2 million, combined, to the Republican and Democratic governors’ associations, which help elect candidates from their respective parties. And Centene gave $250,000, combined, to the Republican Attorneys General Association and its Democratic counterpart.

Since last year, state attorneys general, whose campaigns are benefiting from the associations’ money, have negotiated massive settlements with Centene over accusations the company’s prescription drug programs overbilled Medicaid.

More than 20 states are investigating or have investigated Centene’s Medicaid pharmacy billing. The company has agreed to pay settlements to 13 of those states, with the total reaching about $596 million. And Centene told KHN in October that it is working to settle with Georgia and eight more states that it didn’t identify. It has denied wrongdoing in all the investigations.

KHN found that Centene, like many corporations, also pays dozens of lobbyists in state capitals across the country and in Washington, D.C. It courts officials with fundraising parties and perks such as tickets to sporting events like Sacramento Kings games. And it helps fund committees set up to pay for governors’ inaugural events — as it did for Sisolak, with a $50,000 donation, separate from its campaign contributions, according to the Nevada secretary of state’s office.

Executives and their family members make political contributions in their own names. For example, from 2015 through 2021, Centene’s then-CEO Michael Neidorff and his wife, Noémi, wrote at least $380,000 in personal checks to state candidates, with more than 60% going to California Gov. Gavin Newsom, a Democrat who governs a state where the insurer generated 11% of its revenue in 2019. The Neidorffs lived in St. Louis.

There’s no proof Centene’s contributions swayed politicians’ decisions, but campaign finance experts say money can translate into access and that can lead to influence.

“They’re trying to protect their market share,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research. “They see it as necessary to maintain good relations with the agencies and with the individuals who are involved in decision-making because that’s the way government works.”

Billing Question Surfaces in Ohio

Health care industry players — from insurers, to doctor lobbying groups, to drug companies — routinely make large political donations. Centene rival Elevance Health, formerly known as Anthem, has spent at least $21.8 million on state political contributions since 2015, according to KHN’s analysis.

What makes Centene stand apart from competitors is the massive share of its business that is funded by taxpayers. Founded as a nonprofit in 1984 by a former hospital bookkeeper, Centene earned $126 billion in revenue last year — up from $5 billion a decade ago, according to the company’s annual reports.

Its rocketing revenue has been fueled by its thriving Medicaid managed-care business, takeovers of competitors, and growth in its Medicare Advantage membership and in enrollment in health plans it sells via the Affordable Care Act health insurance marketplaces. Centene’s Ambetter plans, available on the exchanges, have the highest enrollment nationally. The company has also locked up lucrative deals to deliver health care to state prisoners, military members, and veterans.

Centene has reported that two-thirds of its revenue comes from state Medicaid contracts that cover about 15 million people across the country.

So when Ohio Attorney General Dave Yost sued Centene in March 2021 over what he called a complex scheme of “corporate greed” to “fleece taxpayers out of millions,” other states took notice.

Ohio investigators accused Centene of overcharging the state’s Medicaid program through the company’s pharmacy benefit managers, which provided medications to Centene-managed Medicaid patients. Pharmacy benefit managers, known as PBMs, act as middlemen between drugmakers and health insurers and as intermediaries between health plans and pharmacies.

Centene denied wrongdoing but faced immediate consequences. Ohio officials froze its application to renew its contract to offer insurance to state Medicaid enrollees.

“Ohio had Centene over a barrel,” said Antonio Ciaccia, a consultant who worked with the state on the dispute.

The company settled three months later for $88.3 million. Its application was soon unfrozen, and it won a Medicaid contract that summer for its subsidiary Buckeye Health, whose lobbyists include Michael Kiggin, a law school buddy of Republican Gov. Mike DeWine.

Dan Tierney, a spokesperson for DeWine, said the state’s competitive bidding process was reviewed by a court, which “noted Buckeye Health Plan scored highly in the bid process.”

Since last year, 12 other states have settled with Centene over pharmacy services: Arkansas, Illinois, Kansas, Louisiana, Massachusetts, Mississippi, Nebraska, Nevada, New Hampshire, New Mexico, Texas, and Washington.

Of the states that have reached settlements so far, at least five have subsequently awarded government contracts to the company. Louisiana settled with the insurer in November 2021 for $64.2 million and just three months later awarded a statewide Medicaid contract to Centene’s subsidiary Louisiana Healthcare Connections. KHN learned of the settlement, which was not previously publicly announced, in October through a records request.

Nebraska officials also hadn’t publicly announced the state’s $29.3 million settlement with Centene in December until they received a recent KHN public records request. Nine months after the settlement, the state awarded Centene subsidiary Nebraska Total Care a Medicaid contract.

One reason Centene keeps winning contracts, Kominski said, is that such large insurers don’t have much competition in some parts of the country. “It's not as if states can easily say, ‘OK, we're going to have an open competition’ and then they have hundreds of insurers willing to participate in the marketplace,” Kominski said. “Health care is not, in general, a very competitive marketplace.”

Some politicians are tired of that playbook. In Mississippi, the state House of Representatives voted in February to prohibit Republican Gov. Tate Reeves’ administration from awarding a contract to any company that the state had settled with for more than $50 million. Centene paid Mississippi $55.5 million the year before.

“I am for doing away with our business to a company who took $55 million of our money that was supposed to be spent on the poor, the sick, the elderly, the mentally ill, the disabled,” Republican state Rep. Becky Currie, who authored the amendment, told her colleagues on the House floor.

The House adopted Currie’s amendment, but the Senate stripped it out of the bill.

Reeves’ gubernatorial campaign committee has received $210,000 from Centene since 2015, according to OpenSecrets data, and Mississippi lawmakers and party organizations have reaped at least $600,000. Reeves’ office did not respond to multiple requests for comment about the donations.

In August, just over a year after the settlement, Mississippi awarded Centene subsidiary Magnolia Health Plan a new Medicaid managed-care contract.

Showing Up “as a Partner in the Market”

In Georgia, reports of Medicaid overbilling by insurers surfaced in 2018. The following year, Republican Gov. Brian Kemp retained Mississippi-based law firm Liston & Deas to investigate, according to a letter KHN obtained.

But three years later, while other states have settled with Centene, Georgia has not. Centene is also currently trying to renew a Medicaid managed-care contract in the state.

Meanwhile, the company, its subsidiaries, and employees have given at least $139,500 in contributions to Kemp since his first bid for governor started in 2017, according to state campaign records.

Georgia Attorney General Chris Carr’s campaign has received at least $53,000 in Centene-related giving just this year, with most coming from company executives, including Centene’s new CEO, Sarah London, who gave $10,000. Carr, a Republican whose office would oversee any potential Centene settlement, and his spokesperson Kara Richardson said the state Medicaid agency is reviewing the billing data.

Centene is also trying to renew Medicaid managed-care contracts in Florida, Texas, and New Mexico. In angling for those deals, London told investors in September that she’s spending more time in states talking to key leaders because “our state relationships are a critical part” of the business.

“In the conversations that I have been having with governors,” she added, “I hear a lot of positive feedback about the way that Centene shows up as a partner in the market.”

London, her fellow top executives, and their spouses have given just over half a million dollars since 2015 to gubernatorial and attorneys general candidates across the country. Their checks were often dated the same day for the same amount to incumbent politicians whose governments oversee Medicaid managed-care contracts in states, including in Arizona, Kansas, and North Carolina.

“The optics of this are pay to play when decisions are made,” said Aunna Dennis, executive director of Common Cause Georgia, a nonprofit watchdog group. “It could be perceived as this health care company buying influence from lawmakers and elected officials.”

Giving Down the Ballot

Centene brands its health plans under local names, such as Peach State Health Plan in Georgia and SilverSummit in Nevada. Because Centene has more than 300 U.S. subsidiaries, the insurer has many avenues for political giving.

As it did for Nevada’s governor, Centene lined up its health plans nationwide to support the governor of South Carolina — three times — while it had and renewed a Medicaid contract in that state.

In 2017, according to OpenSecrets data, Republican Gov. Henry McMaster’s campaign received $66,500, combined, from Centene and 17 of its subsidiaries. In 2019, Centene and 10 subsidiaries gave $38,500 on a single day. Then this year, on April 28, 11 Centene affiliates sent the governor a total of $36,000.

This year’s contributions to McMaster’s campaign weren’t included in reports that Centene has published about its political spending since 2020. The McMaster campaign did not respond to questions about the donations.

Also omitted from Centene’s published disclosures on its website were most of the contributions made by its California-based subsidiary Health Net, which is among Centene’s most politically active health plans and is a huge revenue maker for the company. Together, Health Net and another Centene subsidiary, California Health & Wellness, gave at least $3.8 million to ballot measure campaigns and state and local politicians from 2015 through Oct. 25, 2022, according to the California secretary of state’s office. Health Net also gave $50,000 to Newsom’s inaugural committee in 2018, according to the California Fair Political Practices Commission.

“We’d be surprised if it was an accident that contributions were not included in the website report to shareholders,” said Bruce Freed, president of the Center for Political Accountability, a nonprofit advocacy organization that rates companies on their disclosure of political donations.

Former Centene CEO Neidorff, who died this year, and his wife gave Newsom $240,800 from 2018 through 2020, according to the California secretary of state’s office. That’s on top of the $121,800 that Health Net has contributed to Newsom’s campaigns since 2015. All of those fell within state campaign contribution limits. Neither the governor’s office nor his campaign returned requests for comment.

The governor has pushed proposals expected to help Centene and other insurers — including expanding insurance subsidies, requiring Californians to have health insurance, and extending coverage to immigrants regardless of their legal status. Noémi Neidorff did not respond to requests for comment.

At the moment, the company has billions of dollars at stake in California: The state is among those currently investigating its pharmacy billing practices, KHN has reported. And the company is appealing the state’s decision this summer not to award key Medicaid contracts to Health Net in Los Angeles, Sacramento, and other counties.

While these decisions are pending, the company has continued to send checks to campaigns, including to dozens of local leaders — mayors, city council members, and county supervisors — in regions critical to its business.

Now, some of those local leaders are writing to state officials, asking them to reverse their decision and give Health Net a Medicaid contract locally, according to letters KHN obtained.

Sacramento County Supervisor Phil Serna and two of his fellow supervisors were among those whose campaigns received checks from Health Net. They declined to comment.

“It certainly doesn’t mean that we can’t use our meager bully pulpits to affect, perhaps, reconsideration of their selection,” Serna told a group of Health Net employees who showed up in pink T-shirts to testify at a public hearing in September.

He had written a letter to state officials urging them to reopen the bidding six days earlier.

Phillip Reese, an assistant professor of journalism at California State University-Sacramento, contributed to this article.

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

Methodology

KHN analyzed data from OpenSecrets, a nonprofit, nonpartisan organization that collects campaign finance data about political candidates and committees. Its state-level data was analyzed to determine how much money Centene Corp., its subsidiaries, its top executives, and their spouses gave to state candidate campaign committees and ballot measure campaigns across the country from Jan. 1, 2015, through Oct. 4, 2022.

OpenSecrets does not track state political action committees or have complete data for 2022 because of inconsistent state campaign finance reporting deadlines and other factors. So to find additional contributions and cross-check the ones in OpenSecrets’ data, KHN downloaded state-level campaign data, including for political action committees tied to specific candidates, directly from state election websites in Florida, Georgia, Tennessee, Mississippi, and Nevada, and searched the California secretary of state’s website for donations to both state and local officials. Those numbers are not included in the overall tally of contributions but are used to supplement KHN’s reporting.

By searching OpenSecrets’ database and Centene’s political activity reports, KHN identified eight nonprofit political groups that supported state candidates and received contributions from the company during the same time frame, including the national associations for electing governors and attorneys general from each party. To calculate the contributions Centene made to those nonprofits from 2015 through 2018, KHN relied on data compiled by OpenSecrets. For contributions from 2019 onward, KHN scoured the contribution and expenditure reports those nonprofits filed annually with the IRS, known as Form 8872, because the OpenSecrets data was not yet complete.

KHN identified Centene subsidiaries through the company’s annual reports to the U.S. Securities and Exchange Commission and the National Association of Insurance Commissioners. In some cases, subsidiaries made donations before they were acquired by Centene. Those donations were excluded from the analysis.

The findings of the analysis were compared with Centene’s corporate giving reports — which are posted on the company’s website and date back to Jan. 1, 2020 — and KHN determined that those reports did not show all the giving by Centene subsidiaries that KHN had documented from campaign finance data covering that time period.

KHN conducted the same analyses of OpenSecrets and IRS data for Centene’s competitor Elevance Health, formerly known as Anthem.

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

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This story can be republished for free (details).

KHN’s ‘What the Health?’: ACA Open Enrollment Without the Drama

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

It’s open enrollment time for Affordable Care Act health coverage. And for the first time, people are enrolling with comparatively little controversy, as most Republicans have moved on from trying to repeal the law.

On the campaign trail, meanwhile, Democrats are charging that if Republicans win majorities in the U.S. House or Senate, they will try to cut Social Security and Medicare.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, Tami Luhby of CNN, and Julie Appleby of KHN.

Among the takeaways from this week’s episode:

  • There are some big changes to the ACA from years past. The Biden administration used its authority to close the “family glitch” that had prevented many families of low- and moderate-income workers from getting subsidies to purchase insurance on healthcare.gov or state marketplaces.
  • Also new this year, states are required to offer “standardized” plans with the same benefits so consumers can better compare them.
  • Another important change: For the first time, people with low incomes (under 150 percent of the federal poverty level) can enroll in ACA plans anytime, instead of only during open enrollment. This could become particularly important in 2023, as many people are likely to lose their Medicaid coverage when the Biden administration ends the covid-related public health emergency.
  • Health overall has not been as big a campaign issue as usual. With a few exceptions, most Republicans on the campaign trail seem to have moved on from vows to repeal the Affordable Care Act.
  • Abortion was expected to be the top voter concern in this year’s elections, but it seems to have been trumped in most cases by inflation and the state of the economy. At least one Democratic candidate, Michigan Gov. Gretchen Whitmer, is trying to combine the issues. She is claiming that if voters in her state approve a constitutional amendment protecting the right to abortion, businesses in states with abortion bans will be more likely to move there. It’s unclear whether this will happen, though.
  • The Justice Department this week had its first-ever win in a criminal case alleging that labor antitrust rules had been violated. A Nevada staffing agency that supplies school nurses had an agreement with a similar agency in an adjacent county not to hire nurses across the county line, in an effort to prevent the nurses from seeking higher wages.  

Also this week, Rovner interviews KHN’s Arthur Allen, who wrote the latest KNH-NPR Bill of the Month, about an old but still very expensive cancer drug. Do you have an exorbitant or baffling medical bill you’d like to share with us? You can do that here.

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

Julie Rovner: Modern Healthcare’s “Elon Musk Bought Twitter. Should Healthcare Professionals Be Worried?” by Caroline Hudson

Joanne Kenen: Mountain State Spotlight’s “Stigmatize, Blame, Then Restrict: How This West Virginia City Responded to the Opioid Epidemic,” by Ellie Heffernan

Tami Luhby: The Washington Post’s “A Psychiatry Wait List Had 880 patients; a Hospital Couldn’t Keep Up,” by Rachel Zimmerman

Julie Appleby: KHN’s “‘Fourth Trimester’ Focus Is Pushed to Prevent Maternal Deaths,” by April Dembosky

Also mentioned in this week’s episode:

Politico’s “Michigan Democrats’ Pitch to Voters: Abortion Bans Are Bad for Business,” by Alice Miranda Ollstein

Bloomberg Law’s “DOJ Notches First No-Poach Win With Staffing Firm’s Sentencing,” by Dan Papscun

To hear all our podcasts, click here.

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

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

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California: propuesta de prohibición del tabaco aromatizado le abre paso a la pipa de agua

Kaiser Health News:States - November 03, 2022

LOS ÁNGELES – En 2019, los propietarios de negocios locales comenzaron a reunirse regularmente en el salón de pipas de agua (narguiles) de Arnie Abramyan, en las afueras de Los Ángeles, para luchar contra una propuesta estatal para prohibir la venta de tabaco aromatizado.

Desde el barrio de Tujunga, con una fuerte presencia de armenios, a los pies de las montañas de San Gabriel, Abramyan y otros propietarios de tiendas y cafés de narguiles comenzaron a correr la voz de que la prohibición, impulsada por una creciente epidemia de uso de cigarrillos electrónicos entre los adolescentes, podría dejarlos fuera del negocio y hacer desaparecer un preciado ritual social que muchos sienten como parte de su herencia.

“Íbamos a ser un daño colateral”, dijo Abramyan, ahora presidente de la National Hookah Community Association.

A medida que su movimiento crecía, los propietarios de los negocios contrataron a un cabildero y viajaron a Sacramento para reunirse con legisladores. Publicaron videos en YouTube sobre “la historia y la tradición centenaria” de fumar estas pipas de agua tan populares en Medio Oriente.

Su trabajo dio frutos: en agosto de 2020 los legisladores estatales aprobaron la prohibición de la venta de tabaco aromatizado, incluidos los cigarrillos mentolados, pero eximieron a los puros premium, el tabaco de pipa suelto y el “producto de tabaco de shisha aromatizado” utilizado en las pipas de agua.

Nunca entró en vigencia. Las grandes tabacaleras lanzaron rápidamente una campaña de referéndum y reunieron suficientes firmas para llevar el tema a las urnas. Este mes, los californianos decidirán, a través de la Propuesta 31, si mantienen o bloquean la ley, que haría ilegal la venta de cigarrillos, cigarrillos electrónicos y otros productos de tabaco aromatizados en comercios. También se prohibiría la venta de chicles o gomas de mascar que contengan nicotina y no estén aprobados por la FDA.

Si la ley se mantiene —los últimos sondeos indican que la mayoría de los votantes la apoyan—, California se convertiría en el segundo estado en eliminar de las tiendas los vaporizadores de sabores y los cigarrillos mentolados, que han contribuido a atrapar a millones de fumadores negros y latinos desde que las compañías tabacaleras empezaron a comercializarlos en los barrios urbanos hace medio siglo.

La cuestión de por qué California ha concedido una excepción a los fumadores de narguiles mientras prohíbe los cigarrillos mentolados, la elección del 85% de los fumadores afroamericanos, ha generado un debate sobre qué productos del tabaco —si es que hay alguno— merecen protección.

Hasta hace poco, los esfuerzos por prohibir los mentolados habían fracasado ante las agresivas tácticas de las tabacaleras, que han evitado pérdidas multimillonarias equiparando dichas prohibiciones con el racismo y la guerra contra las drogas.

Los grupos antitabaco advierten que esta estrategia se ha convertido en un modelo para evitar la interferencia del gobierno. Denuncian que la exención del narguile es el último ejemplo de cómo las empresas utilizan con éxito las políticas de identidad para seguir beneficiándose de un producto mortal.

“El narguile ha recibido un pase sin ninguna razón científica”, dijo Carol McGruder, cofundadora del African American Tobacco Control Leadership Council. McGruder, que lleva años librando una guerra contra las empresas tabacaleras por apuntar “de manera depredadora” a las comunidades negras con los cigarrillos mentolados, dijo que fumar narguile se ha puesto cada vez más de moda entre los jóvenes negros.

Muchos jóvenes creen erróneamente que fumar narguile es menos perjudicial que otras formas de fumar, pero los expertos afirman que el tabaco que se absorve a través de las pipas de agua es tan adictivo como el de los cigarrillos y contiene alquitrán, nicotina y metales pesados similares que provocan cáncer.

“Sacan una hermosa pipa de agua antigua y dicen que la pipa de agua tiene que ver con la familia y la comunidad”, dijo McGruder. “Pero todo es cuestión de dinero”.

Las propias grandes tabacaleras están atacando la exención del narguile, al decir que demuestra que la ley discrimina a los fumadores negros y latinos al prohibir los sabores mentolados, mientras que da “un trato especial a los ricos”, como argumenta una campaña publicitaria pagada por la industria.

“La Propuesta 31 aumentará la delincuencia y ampliará los mercados ilegales, recortará los ingresos para servicios básicos y podría volverse en contra de las mismas comunidades que sus los que la proponen dicen querer ayudar”, dijo Beth Miller, vocera de la campaña “No a la Propuesta 31”.

Más de 360 municipios, agrupados principalmente en California y Massachusetts, han restringido la venta de productos de tabaco aromatizados, incluidas las cápsulas de cigarrillos electrónicos de sabores que atraen a los niños —fresa, chocolatada y ponche rosa— que, según las autoridades sanitarias, han servido de puerta de entrada al consumo de tabaco entre los adolescentes.

Aproximadamente la mitad de las ordenanzas restringen el mentol, mientras que menos de 20, casi todas ellas en California, exime el tabaco para narguile y los bares de narguiles.

En 2021, el 80% de los estudiantes de secundaria y casi el 75% de los estudiantes de secundaria que habían usado un producto de tabaco en los 30 días anteriores informaron que usaban tabaco con sabor, según los Centros para el Control y la Prevención de Enfermedades (CDC). En 2019 y 2020, un brote de una dolencia pulmonar relacionada con el vaping, conocido como EVALI, mató a 68 personas.

La epidemia de vaping ha dado a los activistas antitabaco una oportunidad para ejercer presión contra los cigarrillos mentolados. Inventados en la década de 1920, su sabor fresco y a menta ayudó a los nuevos fumadores a adoptarlos más fácilmente que los cigarrillos sin sabor, y la industria los comercializó como una opción más saludable.

En los años 60, las tabacaleras apuntaron a la comunidad negra, repartiendo muestras gratuitas a jóvenes “comunicadores” de moda en barberías y bares. Los cigarrillos mentolados representan más de un tercio de los $80,000 millones del mercado estadounidense de cigarrillos.

Reynolds American, el mayor fabricante de cigarrillos con mentol del país, incluido Newport, batalla contra la prohibición de los mentolados dando dinero a la Red de Acción Nacional del reverendo Al Sharpton y a otros grupos de derechos civiles.

Cuando el Concejo de la Ciudad de Nueva York propuso una prohibición de los cigarrillos mentolados en 2019, Sharpton citó el caso de Eric Garner, un hombre negro que murió bajo custodia policial en 2014 después de que lo detuvieran por vender supuestamente cigarrillos sueltos y sin impuestos en la calle.

Pero el éxito de estos esfuerzos ha tenido un precio devastador, dicen expertos en salud pública. Los hombres afroamericanos tienen la mayor tasa de nuevos casos de cáncer de pulmón en Estados Unidos, según los CDC.

A principios de este año, la FDA anunció un plan para prohibir la venta de cigarrillos con sabor a mentol, una medida largamente esperada por las autoridades sanitarias y algunos líderes negros, incluso mientras se preparaban para una prolongada batalla legal con la industria del tabaco que podría retrasar la prohibición durante varios años.

Los activistas antitabaco se han centrado en el mentol durante años, dijo Valerie Yerger, profesora asociada de política sanitaria en la Universidad de California-San Francisco. “Nadie se centró en el narguile”, agregó.

Pero el uso de la pipa de agua entre los jóvenes ha aumentado en las últimas décadas.

En las contiendas de narguile que se celebran en Estados Unidos y Europa, los concursantes compiten por construir la pipa de agua más elaborada, a menudo con una banda sonora de hip-hop. Las pipas de agua elaboradas, con sus onduladas bocanadas de humo, suelen aparecer de forma destacada en los videos de rap.

“Es otra forma que ha encontrado la industria para mantener a nuestros jóvenes adictos a estos productos”, afirma Yerger.

Los proveedores de narguile argumentan que las prohibiciones generales ponen en peligro a los propietarios de pequeños negocios, muchos de ellos inmigrantes, y amenazan con borrar un “rico patrimonio cultural” al prohibir de hecho las pipas de narguile, que suelen formar parte de las reuniones y celebraciones de árabes, armenios, persas y otros originarios de Medio Oriente. Rechazan la afirmación de que su lucha es solo por dinero.

“Los salones de narguile son un distintivo de la comunidad”, afirma Rima Khoury, consejera general de Fumari, una empresa de tabaco para narguile con sede en San Diego.

Para Abramyan, fumar un narguile era un ritual adulto después de la cena que sus padres, de origen iraní, trajeron consigo cuando emigraron a Estados Unidos en la década de 1980. Las ornamentadas pipas de agua suelen tener varios metros de altura y tardan al menos 20 minutos en prepararse.

“Esto no es algo que los niños fumen en los baños de la escuela”, dijo. “No queremos que nuestros hijos fumen, pero ¿por qué no va a poder mi abuelo fumar su narguile en su patio?”.

Los grupos de estudio de la Biblia y la sección local del Rotary Club se reúnen regularmente en su salón de narguile de Tujunga, Garden on Foothill, que cuenta con quioscos al aire libre para familias y grupos. “Para los musulmanes que no beben alcohol o los que no quieren ir a clubes de striptease, este es un espacio seguro”, afirma.

Munchies Mart, la tienda que maneja a pocas cuadras vende pipas de narguile hechas a mano y tabaco de sabores como limonada de fresa, naranja pop y agua fresca, muy lejos del tabaco empapado de manzana que, recuerda, su abuela persa mezclaba en su cocina.

Utilizar las prácticas culturales para argumentar las exenciones de las políticas públicas no es nada nuevo, dijo Arnab Mukherjea, profesor asociado de salud pública en la Universidad Estatal de California-East Bay.

Pero dijo que las comunidades suelen sufrir cuando los intereses corporativos “utilizan la identidad cultural para comercializar un producto de consumo masivo”.

“Vas a cualquier ciudad universitaria”, dijo, “y los bares de narguile están llenos no de musulmanes practicantes, sino de chicos en edad universitaria que van allí a socializar, consumiendo sabores en goma de mascar y algodón de azúcar”.

Esta historia fue producida por KHN, que publica California Healthline, un servicio editorialmente independiente de la California Health Care Foundation.

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

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¿No has visto a tu médico en años? Es posible que tengas que buscar un nuevo doctor

Cuando Claudia Siegel sufrió un virus estomacal a principios de este año, contactó a su médico de atención primaria para que le recetara algo para aliviar la diarrea.

La residente de Philadelphia se sorprendió cuando recibió un mensaje en línea informándole que debido a que no había visitado a su médico en más de tres años, ya no era una paciente.

Y como no estaba aceptando nuevos pacientes, tendría que encontrar otro médico de atención primaria.

“Creo que es inconcebible”, dijo Siegel, observando que muchos pacientes no fueron al médico en los últimos años por la pandemia de covid. “No hubo ninguna notificación a los pacientes de que estaban a punto de perder a su médico”.

Ser eliminado de la lista de pacientes resulta desalentador, pero no algo es inusual.

El argumento para dejar “huérfano de médico” al paciente tiene cierto sentido. Dado que muchos médicos de cabecera tienen una lista de espera de potenciales pacientes, eliminar a los que rara vez ven abre espacios y mejora el acceso para otros.

“La mayoría de las prácticas de atención primaria están increíblemente ocupadas, en parte debido a la demanda acumulada por covid”, dijo el doctor Russell Phillips, director del Centro de Atención Primaria de la Facultad de Medicina de Harvard e internista general en el Centro Médico Beth Israel Deaconess.

“Aunque la continuidad de la atención es importante, si el paciente no ha venido y no sabemos si vendrá, es difícil dejarle espacio”, dijo.

Los pacientes a menudo se mudan o buscan un médico diferente cuando cambian de seguro sin notificar al consultorio, dicen expertos.

Además, los médicos pueden buscar clasificar a las personas que no han visto en mucho tiempo como nuevos pacientes, ya que su historial médico, familiar y social puede necesitar actualizarse, algo que lleva tiempo después de estos paréntesisen las visitas. El estado del paciente es un elemento que determina cuánto se les paga a los médicos.

Aún así, la transición puede ser difícil para los pacientes.

“Puedo entender completamente la perspectiva del paciente”, dijo Courtney Jones, directora senior de gestión de casos en la Patient Advocate Foundation. “Crees que tienes un equipo médico en el que has confiado anteriormente para ayudarte a tomar decisiones, y ahora tienes que encontrar otro equipo de confianza”.

Siegel dijo que rara vez iba al médico, siguiendo el consejo de su padre médico de que las personas no deberían ir a menos que estén enfermas. Aunque no había estado en persona en el consultorio de su médico recientemente, explicó que se había estado contactando con el personal del consultorio, incluso informándoles sobre su estatus de vacunación contra covid.

Después de recibir la notificación de que ya no era paciente a través del portal de Jefferson Health, Siegel llamó por teléfono. Le dijeron que tres años era el protocolo y que tenían que seguirlo.

“Pregunté, ‘¿Qué pasa con el paciente?’”, dijo Siegel. “No tuvieron respuesta”.

Pasó un mes antes de que Siegel, que tiene Medicare, pudiera ver a un médico que aceptara nuevos pacientes. En ese momento, los síntomas del virus estomacal ya habían desaparecido.

Jefferson Health no tiene una política sobre este tipo de situaciones, según un comunicado del vocero Damien Woods.

Sin embargo, dijo, “los pacientes que no han sido vistos por su proveedor durante tres años o más se clasifican en los registros médicos electrónicos como pacientes nuevos, según la guía del Centro de Servicios de Medicare y Medicaid (CMS). Siempre que sea posible, Jefferson trabaja con estos pacientes para mantenerlos con su proveedor de atención primaria y ofrece opciones para nuevos proveedores en ciertas circunstancias”.

Las guías de ética de la Asociación Médica Estadounidense (AMA) recomiendan que los médicos notifiquen a los pacientes con anticipación, para que tengan tiempo de encontrar otro doctor.

La lista de pacientes de un médico de atención primaria generalmente incluye a aquellos que han sido vistos en los últimos dos años, dijo Phillips, de Harvard. Los médicos pueden tener 2,000 o más pacientes, según muestran estudios. Mantener un número viable de pacientes es crucial, tanto para una atención eficaz de los pacientes como para los médicos.

“Los consultorios se dan cuenta de que uno de los principales contribuyentes al agotamiento de los médicos es tener más pacientes de los que se pueden atender”, dijo Phillips.

Se espera que la demanda de servicios médicos continúe superando la oferta en las próximas décadas, a medida que las personas envejecen y necesitan más atención al mismo tiempo que aumenta el número de médicos que se jubilan.

Según las proyecciones de la Asociación de Colegios Médicos Estadounidenses, para 2034 habrá una escasez de hasta 48,000 médicos de atención primaria.

Mantener una relación regular con un proveedor de atención primaria puede ayudar a las personas a controlar las afecciones crónicas e identificar rápidamente nuevos problemas.

El control regular también ayuda a garantizar que las personas reciban servicios de rutina esenciales, como inmunizaciones y controles de presión arterial, dijo el doctor David Blumenthal, ex médico de atención primaria y presidente de The Commonwealth Fund, una organización de investigación y políticas.

Las organizaciones de atención médica se enfocan cada vez más en exigir a los médicos que cumplan con ciertas métricas de calidad, como el control de la presión arterial alta de los pacientes o la atención integral de la diabetes. En este entorno, “podría ser problemático para los médicos ser responsables de la salud de los pacientes a los que no ven”, dijo Blumenthal.

El dinero también juega un rol. Las visitas constantes son buenas para el resultado final de una práctica. Las prácticas también pueden decidir no recibir nuevos pacientes de Medicare o aquellos con ciertos tipos de seguro porque los pagos son demasiado bajos, dijo Owen Dahl, consultor de Medical Group Management Association, una organización para administradores de atención médica.

En general, los médicos no están obligados a seguir atendiendo a un paciente. Un médico puede “despedir” a los pacientes porque no siguen las recomendaciones clínicas o cancelan o pierden citas de forma constante. El comportamiento beligerante también es motivo para eliminar a un paciente.

En ciertos casos, los médicos pueden ser legalmente responsables por “abandono del paciente”, una forma de negligencia médica.

Las reglas estatales varían, pero hay elementos comunes. Esas reglas generalmente se aplican cuando un médico daña a un paciente al dejarlo abruptamente en una etapa crítica del tratamiento. Por lo general, no se aplicaría si un paciente no ha visto al médico durante varios años.

Pero en cualquier caso se debe informar a los pacientes, dijeron expertos.

“Es realmente un buen servicio al cliente explicar la situación”, dijo Rick Gundling, vicepresidente senior de Healthcare Financial Management Association. En cuanto a Siegel, dijo: “Esta mujer no debe quedar en el limbo. Si usted es el paciente, el médico debe ser proactivo”.

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

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Colorado Voters to Decide Whether All Schoolkids Get a Free Lunch

Kaiser Health News:States - November 03, 2022

During most of the pandemic, in every public school cafeteria throughout the country, every kid could get a free lunch, not just those from the poorest homes. Everyone.

The program that fed 50.6 million U.S. students expired in September, but some states are figuring out ways to extend it. California and Maine have both passed legislation to fund universal free lunch.

In Colorado, a coalition of parents, teachers, and anti-hunger advocates are pushing to make permanent universal free school lunches, and lawmakers in the Democratic-controlled legislature put it on the ballot.

GlendaRika Garcia, a bilingual food assistance navigator for Hunger Free Colorado, strongly backs the idea.

“I think that the kids being able to eat for free at school is really important, for all families, all kids,” said Garcia, a widow and a single mom of four boys.

Two of them, Alonzo and Pedro, tossed a football around in front of their apartment building, as Garcia explained the Healthy School Meals for All proposal on the ballot.

“Kids can’t learn if they don’t have good nutrition,” said Garcia, whose job entails signing up people for benefits and making sure they’re eligible.

The measure, known as Proposition FF, would use state funds to offer free meals for all public school students. It would also fund pay increases for school cafeteria workers, helping schools deal with staff shortages, and would incentivize schools to buy Colorado-grown food. That has some families, workers, and farmers cheering.

But critics point to a steep price tag for a new government program, which raises $100 million annually from a tax on households that make $300,000 or more a year.

School-aged members of a family of four making less than about $51,000 a year are eligible for free lunch. But supporters of the measure say that right now more than 60,000 Colorado kids can’t afford school meals yet aren’t eligible.

Garcia sees the proposal as a game changer, an equalizer. Depending on her job, Garcia at times qualified for her sons to get free lunches and at times didn’t, a blow to her budget.

Another issue, Garcia said, is that some kids bully others for getting a free lunch. It happened to her as a child when she also qualified for free lunch, and it happened to one of her sons.

“They know that people can identify if they can’t afford it. It hurts my heart,” she said.

Her son Alonzo said that at his high school some kids avoid the lunchroom rather than admit they qualify for free lunch.

“I think that they get embarrassed because they can’t afford it,” he said.

Many Colorado districts reported a clear uptick during the pandemic of kids eating lunches provided for free at school.

“We were feeding kids that we have never fed before, and it was good to see them coming up, and not just buying junk food,” said Andrea Cisneros, the kitchen manager at West Woods Elementary School in Arvada.

Many students arrive at school without food, said Dan Sharp, the school nutrition director in Mesa County Valley School District 51 in Grand Junction.

The district saw a 40% year-over-year increase in meals served during the pandemic, said Sharp.

“I really believe there’s more households here and students that could qualify but don’t, due to the stigma that goes with applying for free and reduced meals,” he said.

Proponents said they did several food insecurity surveys throughout the pandemic and, according to a recent survey, 44% of respondents with kids at home reported struggling to have access to nutritious food.

Low-income students will keep receiving free meals through federal funding, whether the proposal passes or not. There’s no organized opposition to the measure, but it does have critics.

“Nobody wants to be evil enough to say it, but this is a really stupid idea,” said Jon Caldara, president of the Independence Institute, a libertarian think tank. “Most kids in Colorado do not need this. And in fact, those who do, already have this.”

The group’s voter’s guide recommends a no vote.

“This proposal is, ‘Hey, let’s get the rich guys to buy our kids’ lunch,’” he said. “This is another expansion of state bureaucracy that is just not necessary.”

The governor told Colorado Public Radio’s Colorado Matters he hasn’t made his mind up about how he’ll vote on it.

“I don’t have an objection to the funding mechanism, but at the same time I sort of ask myself, ‘If we had this, would it be better just to be able to pay teachers better, reduce class size?’” said Gov. Jared Polis, a Democrat. “Or is the best use of it lunches for upper-middle-income families?”

He added that the measure “doesn’t affect the state finances one way or the other because it’s effectively revenue-neutral with the mechanism.”

His Republican opponent seemed to lean toward supporting Proposition FF in her interview on the show.

“I haven’t had a chance to look at it, but I do want to make sure that every child has access to healthy food and lunches, so I’m certainly open to it,” said Heidi Ganahl.

The Common Sense Institute, a nonpartisan free-market think tank, analyzed the measure and raised several concerns, with modeling that showed it could be underfunded or raise more money than is needed.

“There needs to be some good oversight on the program so that costs are managed well, and also that they don’t develop a huge surplus,” said Steven Byers, the group’s senior economist.

Despite concerns about cost, universal free school lunch appears popular throughout the nation.

California allocated $650 million from its state budget to fund and support its universal free school meals program for the 2022-23 school year. Maine’s program was estimated by lawmakers to cost around $34 million a year.

Washington, Minnesota, Wisconsin, Ohio, Pennsylvania, New York, Massachusetts, and North Carolina introduced bills similar to the one on the Colorado ballot, most of them during the current legislative session. All of them are still in committee and have yet to go up for a vote.

A report published in June 2022 by the Urban Institute, a nonpartisan think tank focused on social and economic research, found that 76% of adults living with children enrolled in public school and 67% of adults not living with children enrolled in public school supported permanent free school meals.

This story is part of a partnership that includes Colorado Public RadioNPR, and KHN.

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

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California’s Proposed Flavored Tobacco Ban Gives Hookah a Pass

Kaiser Health News:States - November 03, 2022

LOS ANGELES — In 2019, local business owners began gathering regularly at Arnie Abramyan’s hookah lounge on the outskirts of Los Angeles to fight a proposed statewide prohibition on the sale of flavored tobacco.

From the heavily Armenian neighborhood of Tujunga in the foothills of the San Gabriel Mountains, Abramyan and other hookah shop and cafe owners began spreading the word that the ban, prompted by a burgeoning epidemic of e-cigarette use among teens, could put them out of business and extinguish a beloved social ritual that many feel is part of their heritage.

“We were going to be collateral damage,” said Abramyan, now president of the National Hookah Community Association.

As their movement grew, the business owners hired a lobbyist and traveled to Sacramento to meet with lawmakers. They posted YouTube videos on “the history and centuries-old tradition” of smoking the water pipes popular in the Middle East. Their work paid off: State lawmakers passed the ban in August 2020, which outlawed the sale of flavored tobacco, including menthol cigarettes — but exempted premium cigars, loose pipe tobacco, and the “flavored shisha tobacco product” used in hookah pipes.

It never went into effect. Big Tobacco quickly launched a referendum drive and gathered enough signatures to bring the issue to voters. This month, Californians will decide — via Proposition 31 — whether to uphold or block the law, which would make it illegal for brick-and-mortar retailers to sell flavored cigarettes, e-cigarettes, and other flavored tobacco products. Sales of gums or gummies that contain nicotine and are not approved by the FDA would also be prohibited.

If the law is upheld — recent polling indicates that a majority of likely voters support it — California would become the second state to rid stores of both flavored vapes and menthol cigarettes, which have helped hook millions of Black and Latino smokers since tobacco companies began marketing them in inner-city neighborhoods half a century ago.

The question of why California has granted hookah smokers an exception while banning menthol cigarettes, the choice of 85% of African American smokers, has sparked a debate about which tobacco products — if any — merit protection. Until recently, efforts to outlaw menthols had failed in the face of aggressive tactics by tobacco companies, which have staved off billions in losses by equating such bans with racism and the war on drugs.

Anti-tobacco groups warn that this strategy has become a model for fending off government interference. They decry the hookah exemption as the latest example of business successfully using identity politics to keep profiting from a deadly product.

“Hookah has been given a pass for no scientific reason,” said Carol McGruder, co-founder of the African American Tobacco Control Leadership Council. McGruder, who has spent years waging war against tobacco companies for their “predatory targeting” of Black communities with menthol cigarettes, said hookah smoking has become increasingly trendy among Black youths.

Many young people mistakenly believe that hookah smoking is less harmful than other forms of smoking, but experts say tobacco smoked through water pipes is just as addictive as cigarette tobacco and contains similar cancer-causing tar, nicotine, and heavy metals.

“They bring out a beautiful antique hookah pipe and they say that hookah is all about family and community,” McGruder said. “But it’s all about money.”

Big Tobacco itself is assailing the hookah exemption, saying it proves that the law discriminates against Black and Latino smokers by banning menthol flavors, while giving “special treatment to the rich,” as an ad campaign paid for by the industry argues.

“Prop. 31 will increase crime and expand illegal markets, cut revenue for critical services and could backfire on the very communities its proponents say they want to help,” said Beth Miller, a spokesperson for the “No on Prop 31” campaign.

More than 360 municipalities, clustered primarily in California and Massachusetts, have restricted the sale of flavored tobacco products, including e-cigarette pods in kid-friendly flavors — strawberry, chocolate milk, and pink punch — which health officials say have provided a gateway to teenage smoking. Roughly half of the ordinances restrict menthol, while fewer than 20 — nearly all of them in California — exempt hookah tobacco and/or hookah bars.

In 2021, 80% of high school students and nearly 75% of middle school students who had used a tobacco product in the previous 30 days reported using flavored tobacco, the Centers for Disease Control and Prevention reported. In 2019 and 2020, an outbreak of vaping-related lung disease, known as EVALI, killed 68 people.

The vaping epidemic has given anti-smoking activists an opening to lobby against menthol cigarettes. Invented in the 1920s, their cool, minty flavor helped new smokers adjust to them more easily than non-flavored cigarettes, and the industry marketed them as a healthier option. In the 1960s, tobacco companies turned to the Black community, handing out free samples to hip, young “communicators” in barbershops and bars. Menthol cigarettes account for more than a third of the $80 billion U.S. cigarette market.

Reynolds American, the country’s largest maker of menthol cigarettes, including Newport, has battled menthol bans by giving money to the Rev. Al Sharpton’s National Action Network and other civil rights groups. When the New York City Council proposed a menthol cigarette ban in 2019, Sharpton cited the case of Eric Garner, a Black man who died in police custody in 2014 after he was stopped for allegedly selling single, untaxed cigarettes on the street.

But the success of these efforts came at a devastating price, public health experts say. African American men have the highest rate of new lung cancer cases in America, according to the CDC.

Earlier this year, the FDA announced a plan to ban sales of menthol-flavored cigarettes, a long-awaited move hailed by health officials and some Black leaders, even as they braced themselves for a protracted legal battle with the tobacco industry that could delay the ban for several years.

For years, anti-smoking activists have been focused on menthol, said Valerie Yerger, an associate professor of health policy at the University of California-San Francisco. “Nobody was focused on hookah,” she said.

But water-pipe use among young people has been on the rise in recent decades.

At Hookah battles across the United States and Europe, contestants compete to build the most elaborate water pipe, often to a hip-hop soundtrack. Elaborate water pipes, with their billowing puffs of smoke, are often prominently featured in rap videos.

“It’s just another way the industry has found to keep our young people addicted to these products,” Yerger said.

Hookah purveyors argue that blanket prohibitions endanger small-business owners, many of them immigrants, and threaten to erase a “rich cultural heritage” by effectively outlawing hookah pipes, which are often part of gatherings and celebrations for Arabs, Armenians, Persians, and others hailing from the Middle East. They reject the claim that their fight is only about money.

“Hookah lounges are a hallmark of community,” said Rima Khoury, general counsel for Fumari, a San Diego-based hookah tobacco company.

For Abramyan, smoking a hookah was an after-dinner, adult ritual his Iranian-born parents brought with them when they immigrated to America in the 1980s. The ornate water pipes are often several feet tall and take at least 20 minutes to set up.

“This is not something kids are smoking in the bathrooms at school,” he said. “We don’t want our kids to smoke, but why shouldn’t my grandpa be able to smoke his hookah in his backyard?”

Bible study groups and the local Rotary Club chapter regularly meet at his Tujunga hookah lounge, Garden on Foothill, which features outdoor gazebos for families and groups. “For Muslims who don’t drink alcohol, or people who don’t like to go to strip clubs, this is a safe space,” he said.

The shop he runs a few blocks away, Munchies Mart, sells handmade hookah pipes and tobacco in flavors such as Strawberry Lemonade, Orange Pop, and Agua Fresca, a far cry from the apple-soaked tobacco he remembers his Persian grandmother mixing in her kitchen.

Using cultural practices to argue for public policy exemptions is nothing new, said Arnab Mukherjea, an associate professor of public health at California State University-East Bay.

But he said that communities often suffer when corporate interests “use cultural identity to market a product for mass consumption.”

“You go to any college town,” he said, “and the hookah bars are filled not with practicing Muslims, but with college-age kids who are going there to socialize, consuming flavors in bubble gum and cotton candy.”

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

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

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Haven’t Seen Your Doctor in a Few Years? You May Need to Find a New One

When Claudia Siegel got a stomach bug earlier this year, she reached out to her primary care doctor to prescribe something to relieve her diarrhea. The Philadelphia resident was surprised when she received an online message informing her that because she hadn’t visited her doctor in more than three years, she was no longer a patient.

And since he wasn’t accepting new patients, she would have to find a new primary care physician.

“I think it’s unconscionable,” Siegel said, noting that many patients may have stayed away from the doctor’s office the past few years because of the covid pandemic. “There was no notification to patients that they’re on the verge of losing their doctor.”

Though it is dismaying to learn you’ve been dropped from a physician’s practice because a few years have passed since your last visit, the approach isn’t uncommon. Exactly how widespread the experience is, no one can say. But specialists also do this.

The argument for dropping the occasional patient makes some sense. Since many primary care doctors have a waiting list of prospective patients, removing those they rarely see opens up patient slots and improves access for others.

“Most primary care practices are incredibly busy, in part due to pent-up demand due to covid,” said Dr. Russell Phillips, director of Harvard Medical School’s Center for Primary Care and a general internist at Beth Israel Deaconess Medical Center.

“Even though continuity of care is important, if the patient hasn’t been in and we don’t know if they’re going to come in, it’s hard to leave space for them,” he said.

Patients often move away or find a different doctor when their insurance changes without notifying the practice, experts say. In addition, physicians may seek to classify people they haven’t seen in a long time as new patients since their medical, family, and social history may require a time-consuming update after a lengthy break. Patient status is one element that determines how much doctors get paid.

Still, the transition can be trying for patients.

“I can completely understand the patient’s perspective,” said Courtney Jones, a senior director of case management at the Patient Advocate Foundation. “You believe you have a medical team that you’ve trusted previously to help you make decisions, and now you have to find another trusted team.”

Siegel said she rarely went to the doctor, adhering to her physician father’s counsel that people shouldn’t go unless they’re sick. Although she hadn’t been to her doctor’s office in person recently, Siegel said she had corresponded with the practice staff, including keeping them up to date on her covid vaccination status.

After receiving the online dismissal through the patient portal for the Jefferson Health system, Siegel called the family medicine practice’s patient line directly. They told her three years was the protocol and they had to follow it.

“I asked, ‘What about the patient?’” Siegel said. “They didn’t have an answer for that.”

It was a month before Siegel, who has coverage under Medicare’s traditional fee-for-service program, could see a doctor who was accepting new patients. By that time, her stomach virus symptoms had resolved.

Jefferson Health doesn’t have a policy that patients lose their doctor if they’re not seen regularly, according to a statement from spokesperson Damien Woods.

However, he said, “Patients not seen by their provider for three years or more are classified in the electronic medical records as new patients (rather than established patients), per Center for Medicare and Medicaid Services (CMS) guidance. Whenever possible, Jefferson works with these patients to keep them with their primary care provider and offers options for new providers in certain circumstances.”

American Medical Association ethics guidelines recommend that physicians notify patients in advance when they’re withdrawing from a case so they have time to find another physician.

But the organization, which represents physicians, has no guidance about maintaining a panel of patients, said AMA spokesperson Robert Mills.

The American Academy of Family Physicians, which represents and advocates for family physicians, declined to comment for this story.

A primary care physician’s panel of patients typically includes those who have been seen in the past two years, said Phillips, of Harvard. Doctors may have 2,000 or more patients, studies show. Maintaining a workable number of patients is crucial, both for effective patient care and for the doctors.

“Practices realize that a major contributor to physician burnout is having more patients than you can deal with,” Phillips said.

Demand for physician services is expected to continue to outstrip supply in the coming decades, as people age and need more care at the same time the number of retiring physicians is on the upswing. According to projections from the Association of American Medical Colleges, by 2034 there will be a shortage of up to 48,000 primary care physicians.

Maintaining a regular relationship with a primary care provider can help people manage chronic conditions and promptly identify new issues. Regularly checking in also helps ensure people receive important routine services such as immunizations and blood pressure checks, said Dr. David Blumenthal, a former primary care physician who is president of the Commonwealth Fund, a research and policy organization.

Health care organizations increasingly focus on requiring doctors to meet certain quality metrics, such as managing patients’ high blood pressure or providing comprehensive diabetes care. In this environment, “it could be problematic for physicians to be accountable for the health of patients who do not see them,” Blumenthal said.

Money also figures into it. Steady visits are good for a practice’s bottom line. Practices may also decide to avoid new Medicare patients or those with certain types of insurance because the payments are too low, said Owen Dahl, a consultant with Medical Group Management Association, an organization for health care managers.

In general, doctors aren’t obligated to continue seeing a patient. A doctor might dismiss patients because they aren’t following clinical recommendations or routinely cancel or miss appointments. Belligerent or abusive behavior is also grounds for dropping a patient.

In certain instances, physicians may be legally liable for “patient abandonment,” a form of medical malpractice. State rules vary, but there are common elements. Those rules generally apply when a doctor harms a patient by dropping them abruptly at a critical stage of treatment. It would generally not apply if a patient has not seen the physician for several years.

Even though quietly dropping a seldom-seen patient might not have an immediate medical consequence, patients ought to be informed, experts said.

“It’s really good customer service to explain the situation,” said Rick Gundling, senior vice president at the Healthcare Financial Management Association, an organization for finance professionals. As for Siegel, he said, “This woman should not be left hanging. If you’re the patient, the physician should be proactive.”

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

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This story can be republished for free (details).

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