From Medicine and Health

Viewpoints: GOP Health Plan Runs Contrary To Robin Hood’s Rules By Redirecting Funding From Poor To Rich; The Town Hall Duck And Run

A selection of opinions on health care from around the country.

The Washington Post: Trump’s Toxicity Has Republicans Running Away From Their Constituents
As recent town-hall meetings of GOP Reps. Tom McClintock of Elk Grove, Jason Chaffetz of Utah, Gus Bilirakis of Florida, Diane Black of Tennessee and others turn into well-publicized tongue-lashings, their colleagues are ducking and running. … The scene is reminiscent of the tea party summer of 2009, but the energy is on the other side this time. Now, as then, the victims say the perpetrators are outsiders – Chaffetz said those who protested him included “paid” people from out of state, an echo of Nancy Pelosi’s claim of “astroturfing” – but now, as then, the anger is real. (Dana Milbank, 2/15)

Los Angeles Times: Trump Tries To Save Obamacare Exchanges While Undermining Them
With the drive to “repeal and replace” Obamacare losing steam, the Trump administration quietly moved to shore up a key feature of the healthcare law this week: the state exchanges where people shop for non-group coverage. And to its credit, Trump’s Department of Health and Human Services zeroed in on some of the factors that have led a handful of major insurers to leave the exchanges. (Jon Healey, 2/16)

Bloomberg: A Sign That Obamacare Exchanges Are Failing
Yet more bad news for Obamacare this week: Molina Healthcare lost $110 million on the exchanges last year, and the CEO told investors, “There are simply too many unknowns with the marketplace program to commit to our participation beyond 2017.” At first glance, it’s hard to see why this piece of news is worth worrying about. UnitedHealth recently projected several times those losses, and it’s a bigger player on the exchanges. Why spend so much time looking at one modest-size insurer? Because Molina is one of the companies that has been repeatedly pointed to, by virtually every health-care-policy wonk in the business, as one of the “bright spots” on the exchanges. (Megan McArdle, 2/16)

The New England Journal Of Medicine: Adjusting Risk Adjustment — Accounting For Variation In Diagnostic Intensity
In the U.S. health care system, payments and performance measures are often adjusted to account for differences in patients’ baseline health and demographic characteristics. The idea behind such risk adjustments is to create a level playing field, so that providers aren’t penalized for serving sicker or harder-to-treat patients and insurers aren’t penalized for covering them. For example, the private insurance companies that participate in Medicare Advantage and the Affordable Care Act (ACA) exchanges receive risk-adjusted payments from the U.S. government, with the rationale that insurers should be reimbursed more for enrollees with higher expected costs. (Amy Finkelstein, Matthew Gentzkow, Peter Hull and Heidi Williams, 2/16)

RealClear Health: A Small HSA Fix Could Produce Big Results
As Congress and the Trump administration begin laying the foundation for their replacement plan for the Affordable Care Act (ACA), their starting point should be ensuring all Americans have a ready path for enrollment in health insurance that, at a minimum, provides protection against major medical expenses. They should also promote broadened enrollment in Health Savings Accounts (HSAs) as an important means for paying for care before insurance coverage kicks in. (James C. Capretta, 2/17)

Louisville Courier-Journal: Demand For Medicaid Waivers Exceeds Funds
The “most vulnerable of our society” is a phrase that gets thrown around a lot. Politicians employ it in speeches and press releases to describe constituents who cannot take care of themselves. People with intellectual and developmental disabilities fall under this banner of protection. (Amanda Beam, 2/16)

Sacramento Bee: California Provides Model To Replace The Affordable Care Act
The new administration and Congress are under intense pressure to craft a market-based alternative to the Affordable Care Act. It won’t be easy. To achieve the financial stability required to make the market work, reformers should heed some important lessons from California. Health plans and risk-taking medical groups essentially made a “deal” with Congress to participate in the ACA. They agreed to cover applicants with pre-existing conditions without charging higher premiums in return for: an expanded individual market driven by a federal mandate that everyone buy insurance; premium and cost-sharing subsidies financed by insurers and the government; and three federal risk-mitigation programs to help stabilize the new marketplaces. (Leonard D. Schaeffer and Dana Goldman, 2/14)

Orange County Register: California Job Losses From Obamacare Repeal? Fear Not!
Obamacare was a cash cow for providers, which now argue it was a program for jobs and economic growth. They now say that repealing Obamacare will kill California jobs. That grabs any politician’s attention, but it is not true. According to a study by the UC Berkeley Labor Center, which is promoted by the California Hospital Association, “The majority (135,000) of these lost jobs would be in the health care industry, including at hospitals, doctor offices, labs, outpatient and ambulatory care centers, nursing homes, dentist offices, other health care settings and insurers. (John R. Graham, 2/16)

Cleveland Plain Dealer: Boost Funding To An Ohio Foster Care System Increasingly Burdened By The Opioid Crisis
Ohio Gov. John Kasich has been in the thick of the battle against deadly opioids, signing a bill this year to tighten restrictions on prescription opioids, speaking at conferences about heroin and even sending an Ohio Highway Patrol superintendent in April to Trumbull County after beleaguered officials there begged for help in quelling a rising tide of opioid overdoses and deaths. (2/17)

The Des Moines Register: A Second Chance To Pass Aid-In-Dying Bills
In a Gallup Poll conducted May 4-8, 2016, respondents were asked: “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it?” Sixty-nine percent of respondents answered yes. (John S. Westefeld, 2/16)

Lexington Herald Leader: Whooping Cough Making A Comeback
In the past few weeks, there have been several confirmed cases of whooping cough, also known as pertussis, in Fayette County schools and other surrounding counties. Many parents are concerned about exposure and have questions about preventing pertussis infection or recognizing symptoms. (Jessica Murray, 2/16)

The New England Journal Of Medicine: Addressing The Fentanyl Threat To Public Health
Fentanyl, a powerful synthetic opioid, poses an increasing public health threat. Low production costs encourage suppliers to “cut” heroin with the drug, particularly white powder heroin sold in the eastern United States. Fentanyl also appears as a prevalent active ingredient in counterfeit OxyContin (oxycodone) tablets. The result is that fentanyl plays a major role in rising mortality due to heroin or opioid overdose. It poses a serious overdose risk because it can rapidly suppress respiration and cause death more quickly than do other opioids. (Richard G. Frank and Harold A. Pollack, 2/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Research Roundup: Medicaid Block Grants; Job Loss And The ACA; Growing HIV Coverage

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Urban Institute: What TANF Can Teach Us About Block Granting Social Services
White House officials and congressional leaders have talked about seizing the opportunity to pass sweeping changes to federal antipoverty programs. One potential change is to give block grants of federal funds to states and allow states greater flexibility …. House Speaker Paul Ryan has long contended that expanding the block grant model to other facets of the safety net — such as Medicaid and food stamps — would afford states the flexibility to drive innovation in combating poverty. But examining the results of welfare reform after two decades presents a more cautionary tale …. Simply put, all states ended up with far fewer funds and a diminished ability to meet their residents’ needs. (Hahn and Coffey, 2/7)

The Kaiser Family Foundation: Current Flexibility In Medicaid: An Overview Of Federal Standards And State Options
This brief provides an overview of current federal standards and state options in Medicaid to help inform upcoming debates about increasing state flexibility in the program as part of efforts to restructure Medicaid financing. Today, states operate their Medicaid programs within federal standards and a wide range of state options in exchange for federal matching funds that are provided with no limit. Each state Medicaid program is unique, reflecting states’ use of existing flexibility and waiver authority to design their programs to meet their specific needs and priorities. As proposals to restructure Medicaid financing develop, it will be important to examine what additional flexibilities they would provide to states and what standards, accountability and enrollee protections would remain for states to access federal funds. (Artiga et al., 1/31)

Urban Institute/Robert Wood Johnson Foundation: Recent Evidence On The ACA And Employment: Has The ACA Been A Job Killer? 2016 Update
We find no evidence to support claims that the ACA has been a job killer. Through 2016, the ACA had little to no adverse effect on employment and usual hours worked per week. For both measures, levels in 2014, 2015, and 2016 are statistically identical to our projections based on patterns existing before 2014, the year the major provisions of the ACA went into effect. Our conclusion applies to the full sample of nonelderly persons and to subgroups of nonelderly persons based on gender and educational attainment. Levels of part-time work (29 or fewer hours per week) have fallen since 2014, but remain at somewhat higher levels than would be expected given recent declines in the unemployment rate and overall economic improvement. (Garrett, Kaestner and Gangopadhyaya, 2/16)

The Kaiser Family Foundation: Insurance Coverage Changes For People With HIV Under The ACA
This brief provides the first national estimates of changes in insurance coverage among people with HIV since the implementation of the ACA. It is based on analysis of data from the Centers for Disease Control and Prevention (CDC). We find that coverage increased significantly for people with HIV due to the ACA’s Medicaid expansion; indeed, increased Medicaid coverage in expansion states drove a nationwide increase in coverage for people with HIV. In addition, the share relying on the Ryan White HIV/AIDS Program also increased. (Kates and Dawson, 2/14)

Brookings/USC Schaeffer Center for Health Policy & Economics: Re-Balancing Medical And Social Spending To Promote Health: Increasing State Flexibility To Improve Health Through Housing
The health impacts of interventions that improve economic conditions such as household income are still the subject of considerable debate. Some economists find little support to show that public transfer payments improve health outcomes, while others argue that federal assistance frees family income to spend on better access to health care, and thereby improves population health. Some researchers have identified evidence that stressful work environments and educational disparities are social mechanisms with a deleterious impact on health, but the evidence that increased public spending targeting these mechanisms will improve health outcomes is nascent. In contrast, the research showing that expenditures that improve access to safe, affordable housing improve population health is relatively strong. (Butler, Matthew and Cabello, 2/15)

Here is a selection of news coverage of other recent research:

MedPage Today: Study: Beware The Snippy, Snarky Surgeon?
The more complaints lodged at surgeons, the more likely it was for their patients to suffer complications after going under the knife, a study found, helping explain why operators with the least favorable reviews get sued the most. Surgeons who had a history of unsolicited patient reviews — often regarding rudeness and intimidation directed at patients and other healthcare professionals alike — were tied to greater risks of: Complications for patients …. Surgical complications …. Patient readmissions. (Lou, 2/15)

Reuters: Salt Reduction Policies Cost-Effective Even Without Healthcare Savings
Government policies designed to reduce how much salt people eat may be cost-effective even without considering the potential healthcare savings, a recent study suggests. That’s because efforts to curb salt use through policies like public education and industry agreements would not cost that much relative to their potential to reduce mortality and disability, researchers estimate. (Rapaport, 2/10)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Ga. Senate Panel Amends But OKs Surprise Medical Bill Measure; Conn. Non-Profit Hospitals Fight Bid To Make Them Pay Local Property Taxas

Outlets report on news from Georgia, Connecticut, Minnesota, Kansas, Texas, Massachusetts, Florida, Washington, Arizona, Wisconsin, Ohio and Louisiana.

Georgia Health News: After Tweak In Payment Formula, Senate Committee OKs Remedy For ‘Surprise’ Billing
A Georgia Senate panel Thursday passed legislation to halt ‘’surprise’’ medical billing – but not without a last-minute amendment that changed the contentious payment formula. The Health and Human Services Committee approved Senate Bill 8, which will address those situations in which patients get unexpected bills from providers who are not in their network, even though the hospital is a network facility. (Miller, 2/16)

The CT Mirror: CT Hospitals Launch TV Ad To Protest New Tax Proposal
Connecticut’s hospital industry launched a new television ad Thursday to protest Gov. Dannel P. Malloy’s proposal to end nonprofit hospitals’ exemption from local property taxation. The Connecticut Hospital Association announced the commercial will air starting today on network and cable television stations, and also can be seen at http://nomorehospitaltax.org. The commercial opens by listing a variety of occupations and one common thread among the people in all of them: they all pay a price when taxes rise on Connecticut hospitals. (Phaneuf, 2/16)

The CT Mirror: Budget Cuts Cost CT Medical Examiner’s Office Full Accreditation 
The Connecticut Office of the Chief Medical Examiner (OCME) has lost its full accreditation and was downgraded to provisional status because of staffing and facility shortcomings driven largely by budget cuts. The National Association of Medical Examiners (NAME), which ordered the downgrade, will reassess Connecticut’s status in September, the state office announced this week. (Phaneuf, 2/16)

The Star Tribune: Report On Minnesota Hospital Errors Sees Problems With Lost Tissue Samples 
The misplacing of irreplaceable biological specimens has proved to be a vexing problem for Minnesota hospitals, which reported 31 instances in the 12 months that ended last Oct. 6. The state’s 13th annual report on hospital “adverse events,” released Thursday, included 336 reportable mistakes, including operations on the wrong body parts and disabling medication errors. But few were as common as lost tissue samples, which also can have serious consequences. (Olson, 2/17)

KCUR: House Committee OKs Involuntary Hold Plan For Kansans In Mental Health Crisis 
A bill that would allow treatment centers to detain Kansans in mental health crisis for up to three days moved forward Thursday after months of work to develop a compromise. A similar bill proposed last year raised concerns that it would deprive Kansans with mental illnesses of their due process rights. A committee of law enforcement officers, treatment providers, mental health advocates and others met six times between legislative sessions to come up with a compromise bill that still fulfilled the original goal of providing short-term mental health care. (Wingerter, 2/17)

Stat: Texas Board Recommends Sanctions Against Stanislaw Burzynski
Along-running battle between the Texas Medical Board and controversial Houston doctor Stanislaw Burzynski could be coming to a head. The board said this week that it had proposed $380,000 in fines and a stiff set of sanctions for Burzynski’s failure to adhere to proper medical procedures in treating cancer patients. The decision is preliminary, and will be submitted and formally reviewed on March 3. (Tedeshci, 2/16)

Boston Globe: For This Hospital Chaplain, Work Is A Matter Of Life And Death 
As [Alyssa] Adreani, 41, likes to point out, [she] isn’t hanging out in the Newton hospital’s chapel and doesn’t wear a collar or a cross. She makes the rounds of the neonatal intensive care unit, oncology, ICU, orthopedics, and medical/surgical units, following her personal Golden Rule of chaplaincy: “Wear comfortable shoes.” The Globe spoke with Adreani about how hospital chaplains are considered part of the treatment team, sometimes even improving health outcomes. (Atoji Keene, 2/16)

Seattle Times: State Regulators Investigating Swedish’s Cherry Hill Hospital, Top Surgeon 
State health regulators have launched an investigation into the practices of Swedish Health Services’ Cherry Hill hospital, days after a Seattle Times report uncovered wide-ranging concerns about patient care at the facility. David Johnson, a spokesman with the state Department of Health, said Thursday a case-management team authorized the new investigation after reviewing The Seattle Times’ findings. Johnson added that the state Medical Commission, which handles issues involving specific doctors, was in the process of investigating complaints filed against Dr. Johnny Delashaw. (Baker, 2/16)

Arizona Republic: New Flu-Tracking App Uses Maricopa County As Beta Site
A California-based health diagnostics company has chosen Maricopa County as the pilot testing site for Communidy, a free web app that allows users to see the age and county of people who currently have the flu. The app, which displays real-time data from doctors’ offices, hospitals, clinics and labs, may encourage people to get vaccinated early, said Machrina Leach, nurse program manager at the Maricopa County Department of Public Health. (Bosch and Jha, 2/16)

Milwaukee Journal Sentinel: United Community Center Opens Third Residential Treatment Facility
This month, the United Community Center, commonly known as UCC, opened its third residential treatment facility for people working to overcome alcoholism and drug addictions. The $1.1 million residence, named Latinas Unidas II, will enable 16 more women to participate in UCC’s residential treatment program at any given time. The new residence, UCC’s second for women, also will treat women who are pregnant or who have infant children, and the program will include prenatal and post-partum care, child care coordination and parenting classes. (Boulton, 2/16)

Cleveland Plain Dealer: Summa Health Gift Establishes Traumatic Stress Chair 
Longtime philanthropists Jim and Vanita Oelschlager have donated more than $4 million to Summa Heath over the last three decades. This week, couple’s foundation provided another donation to Summa Health to establish a Chair in Traumatic Stress. Dr. Patrick Palmieri, director of the Traumatic Stress Center, will serve as the first Oelschlager Chair. As director of the Summa Health Traumatic Stress Center, Palmieri is responsible for the center’s clinical, training and research activities for patients experiencing post-traumatic stress disorder, anxiety and depression. (Becka, 2/16)

Health News Florida: Students Discover Lead In Tap Water May Be Common In Older Homes 
Last semester, the students in Laura Manke’s community cares class embarked on a project, collecting samples of tap water from their homes.  And testing provided by University of South Florida researchers revealed that all of the 46 samples contained lead.Fortunately, the amount of lead in the water in their homes fell below levels that would trigger action under Environmental Protection Agency standards. But experts, including the EPA, say any amount of lead is not good for the body, especially in children under six. Damage can be permanent. (Ochoa, 2/16)

Pioneer Press: Forest Lake Nurse Avoids Jail Time For Stealing Patient’s Medication
A Forest Lake nurse who pretended to check on a patient so he could steal the man’s medication evaded jail time for the offense. Gregory Thomas Welcher, 30, was sentenced in Ramsey County District Court Thursday to five years probation on one count of felony-level theft. He also was ordered to spend one day in jail, but was given credit for the day he already logged at the Ramsey County Correctional Facility. Welcher pleaded guilty to the charge this past December. (Horner, 2/16)

Shreveport Times: Workshop Lets Caregivers Take Care Of Themselves
Social workers seeking a moment of rest from careers steeped in others’ suffering participated in a free “Compassion Fatigue” workshop on Thursday. The workshop, presented by the Noel Memorial United Methodist Church’s arts program, aimed at offering those who take care of others a chance to center and to take care of themselves. (Talamo, 2/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

U.S. Urged China To Crack Down On Synthetic Opioids Killing Hundreds Here

China is believed to be a major source for bootleg opioids, including the potent carfentanil, that are brought into the U.S. and contribute to the painkiller epidemic. In related news on the crisis, Georgia lawmakers consider regulations for opioid treatment centers.

The Wall Street Journal: U.S. Authorities Pressed China For Action On Deadly Opioid
China’s crackdown on an extremely potent synthetic narcotic came amid pressure from U.S. authorities and evidence linking it to hundreds of U.S. overdose deaths since it first emerged in Ohio in July. The drug, carfentanil, has been connected to at least 700 fatalities in states including Ohio, Michigan and Florida, according to data compiled by The Wall Street Journal from county medical examiners and NMS Labs, a private laboratory outside Philadelphia that performs toxicology testing for counties around the U.S. (Kamp and Campo-Flores, 2/17)

WABE: Ga. Lawmakers Look To Tighten Regulations On Opioid Clinics 
Georgia lawmakers are considering a bill that would further regulate opioid treatment centers in the state. The bill, sponsored by state Sen. Jeff Mullis, R-Chickamauga, would put into place new requirements for those wanting to open up centers in Georgia. The centers offer medical-assisted treatment and counseling to help treat patients with addictions to heroin and other opioids. (Yu, 2/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Fla. Law Barring Docs From Discussing Guns With Patients Violates Free Speech, Court Rules

The 11th U.S. Circuit Court of Appeals, in a 10-1 ruling, said, “Florida does not have carte blanche to restrict the speech of doctors and medical professionals on a certain subject.”

The New York Times: Florida Doctors May Discuss Guns With Patients, Court Rules
A federal appeals court cleared the way on Thursday for Florida doctors to talk to their patients about gun safety, overturning a 2011 law that pitted medical providers against the state’s powerful gun lobby. In its 10-to-1 ruling, the full panel of the United States Circuit Court of Appeals for the 11th Circuit concluded that doctors could not be threatened with losing their license for asking patients if they owned guns and for discussing gun safety because to do so would violate their free speech. (Alvarez, 2/16)

Atlanta Journal-Constitution: Federal Appeals Court: Doctors Can Ask About Guns In The Home
A federal appeals court, in a case that has pitted the First Amendment against the Second Amendment, sided Thursday with free speech. The 11th U.S. Circuit Court of Appeals ruled Thursday that Florida’s so-called “Docs and Glocks” law, which prohibited doctors from asking patients about guns in the home, violated a physician’s free speech rights. (Cook, 2/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Mediocre Protection Rates Have Many Asking When We’ll Get A Better Flu Vaccine

Though it was no worse than previous ones, the fact that this year’s shot only cut the chance of infection in half highlights the need for a more effective vaccination.

Stat: Flu Vaccine Is Only Moderately Protective This Year, CDC Says
This year’s flu vaccine is offering moderate protection against the main family of viruses causing illness, data released Thursday by the Centers for Disease Control and Prevention show. The data come as what has been a pretty active flu season is near its apex in many parts of the country. “We won’t know when the peak has occurred until we’ve passed it and have a couple of weeks to look back,” said Lynnette Brammer, head of domestic influenza surveillance at the CDC. “We hopefully are approaching the peak but we may not be there yet.” (Branswell, 2/16)

Bloomberg: This Year’s Flu Shot Only Cut Infection Risk By Less Than Half 
Americans who rolled up their sleeves for a flu shot this year cut their chances of coming down with the aches and fever of influenza by almost half, a level of protection that is disappointing for a vaccine but still better than in some recent years. As the virus continues to sweep across the U.S. at epidemic levels, vaccine effectiveness level was 48 percent against acute respiratory illness from the end of November through Feb. 4, according to an analysis of 3,144 people enrolled in the U.S. Influenza Vaccine Effectiveness Network. (Cortez, 2/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Exclusive CRISPR Licenses ‘Bottleneck’ Innovation, Legal Experts Argue

Licensing deals cut by UC-Berkeley and Massachusetts’ Broad Institute may be limiting the potentially lie-saving applications of this gene-editing technology, according to assertions made by intellectual property experts in Friday’s issue of the journal Science.

Stat: Exclusive CRISPR Licenses Slow Development Of Therapies, Legal Experts Argue
The exclusive licenses granted to three for-profit companies on key discoveries about the revolutionary genome-editing technology CRISPR-Cas9 threaten to “bottleneck” its use “to discover and develop useful human therapeutics,” patent experts argued in a paper published on Thursday. What the exclusive licenses have done “is give an entire industry to … companies that will never be able to fully exploit it,” Jorge Contreras of the University of Utah, a co-author of the paper in Science, said in an interview. “And that may hold back the development of therapies.” (Begley, 2/16)

San Jose Mercury News: UC-Berkeley CRISPR License Could Hinder Innovation
A smart biotech company could have a great idea for how to use gene editing to develop a new lifesaving therapy — but because of the way licensing deals have been cut by UC-Berkeley and Massachusetts’ Broad Institute, it would never get a chance to try it. That’s the assertion of intellectual property experts in Friday’s issue of the journal Science, who criticize the licensing landscape around the taxpayer-funded and powerful new tool called CRISPR-Cas9, warning it could limit its promise. (Krieger, 2/16)

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Kansas Committee Expected To Take First Vote On Medicaid Expansion Today

The issue has been swatted down repeatedly since the health law went into effect, but after moderates ousted several conservatives in last fall’s elections, a legislative panel is scheduled to vote on a measure today. The committee’s chairman, Rep. Dan Hawkins, a Wichita Republican, says it will be close. News outlets also report on Medicaid developments in Ohio, Alabama and California.

KCUR (Kansas City, Mo., Public Radio): Close Vote Expected On KanCare Expansion Bill 
Kansas lawmakers are getting ready to do something they have never done before: vote on a Medicaid expansion bill. For the past three years, conservative Republicans who controlled the Legislature refused to allow a vote on the issue. Things are different this session due to the ouster of several conservative incumbents by moderate Republican and Democratic challengers. (McLean, 2/16)

Toledo Blade: After Expansion, Medicaid Attracts More Older Men
Those enrolled in Ohio’s expanded Medicaid program in partnership with the federal Affordable Care Act turned out to be older than expected. Barbara Sears, Gov. John Kasich’s Medicaid director and former state representative from Monclova Township, said Thursday she was a little surprised to see how the population skewed older. “But when we knew we weren’t getting the younger folks into the [federal Obamacare private insurance] marketplace, we knew they probably weren’t getting into [the Medicaid expansion],” she said after speaking to the legislative Joint Medicaid Oversight Committee. (Provance, 2/16)

Modern Healthcare: Alabama Could Lose Medicaid Funding For Allegedly Rejecting Eligible Enrollees
The CMS may cut Alabama’s Medicaid funding after learning state officials reject people eligible for Medicaid coverage if they are found to have engaged in fraud or abuse but were never convicted of any criminal act. The CMS said Alabama officials also had a practice of recouping funds from these individuals. Alabama has said it is simply trying to take action against those who lie on their applications about having been previously accused of criminal activity. (Dickson, 2/16)

California Healthline: Some Immigrants, Fearful Of Political Climate, Shy Away From Medi-Cal
Some foreign-born Californians are canceling their Medi-Cal coverage or declining to enroll in the first place, citing fears of a Trump administration crackdown on immigrants. Among those dropping coverage are people in the country legally but concerned about jeopardizing family members who lack permanent legal status, according to government officials, immigration attorneys and health care advocates. (Bazar, 2/16)

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Lawsuit Alleges United Healthcare Overcharged Medicare For Advantage Plan Customers

The lawsuit, which was unsealed Thursday after a five-year investigation by the Department of Justice, suggests the company may have improperly collected “hundreds of millions” of dollars by claiming patients were sicker than they actually were.

Modern Healthcare: DOJ Joins Medicare Advantage Fraud Lawsuit Against UnitedHealth
The U.S. Justice Department has joined a whistleblower lawsuit claiming that UnitedHealth Group and affiliated health plans have been gaming the Medicare program and fraudulently collecting millions of dollars by claiming patients were sicker than they really were. The lawsuit, initially brought in 2011 and unsealed Thursday after a five year-long investigation by the Justice Department, alleges that Minnetonka, Minn.-based UnitedHealth has inflated its plan members’ risk scores since at least 2006 in order to boost payments under Medicare Advantage’s risk adjustment program. (Livingston, 2/16)

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Lawmakers Move To Ease Obama-Era E-Cigarette Regulations

A proposal by Republican Reps. Tom Cole of Oklahoma and Sanford Bishop of Georgia would get rid of a “grandfather” clause that requires companies selling cigars, pipe tobacco, and vapor products such as e-cigarettes after Feb. 15, 2007 to disclose their ingredients and prove that their products meet the applicable public health standards set by the law.

Stat: E-Cigarettes Would Be Excluded From Some Regulations Under New Proposal
Congressional supporters of the tobacco industry have wasted no time in proposing legislation to help e-cigarette companies escape rules adopted under President Barack Obama. In what Republican Reps. Tom Cole (Okla.) and Sanford Bishop (Ga.) described as a “clarification,” the two introduced a bill Thursday that would revise Food and Drug Administration rules governing the sale and advertising of e-cigarettes and cigars. (Kaplan, 2/16)

In other news from Capitol Hill —

CQ Roll Call: Senate Appropriators Signal Interest In Mental Health Funding
Senate appropriators signaled an interest in supporting mental health funding at a hearing Wednesday, appearing particularly interested in finding a way to address provider shortages in underserved areas. Witnesses at the hearing of the Appropriations Subcommittee on Labor-HHS-Education told lawmakers that attracting professionals to the field is the most pressing need. Some urged Republicans to consider the importance of the Medicaid expansion under the 2010 health care law (PL 111-148, PL 111-152) in expanding coverage of mental health services. (Siddons, 2/15)

Kaiser Health News: Right-To-Die Fight Hits National Stage
Melissa Bailey reports: “Opponents of aid-in-dying laws are claiming a small victory. They won the attention of Congress this week in their battle to stop a growing movement that allows terminally ill patients to get doctors’ prescriptions to end their lives. The Republican-led effort on Capitol Hill to overturn the District of Columbia’s aid-in-dying law could fail by Friday. But advocates worry the campaign will catalyze a broader effort to fully ban the practice, which is legal in six states and being considered in 22 more.” (Bailey, 2/16)

Kaiser Health News: Congressman’s Ties To Foreign Biotech Draw Criticism
When a small Australian biotechnology company, Innate Immunotherapeutics, needed a clinical trial for an experimental drug it hoped to turn into a huge moneymaker, the company landed a U.S. partner where it had high-level connections: Roswell Park Cancer Institute in Buffalo, N.Y. The company is partly owned by Rep. Chris Collins, a wealthy Republican entrepreneur from Buffalo, whose enthusiasm for Innate helped persuade others to invest. (Bluth and Kopp, 2/17)

The Baltimore Sun: Cummings Contradicts Trump Over Meeting On Drug Prices
President Donald Trump blamed Rep. Elijah E. Cummings on Thursday for failing to schedule a meeting about the cost of prescription drugs, suggesting the Baltimore Democrat didn’t want to come to the White House because it was “bad politics.” Cummings, the top Democrat on the House Oversight and Government Reform Committee, disputed that characterization, saying the president had made it up. The congressman said he has been waiting to schedule a meeting until he has crafted a prescription drug bill for the president to consider. (Fritze, 2/16)

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‘Tsunami’ Of Alzheimer’s Cases Among Latinos Raises Concerns Over Costs, Caregiving

SACRAMENTO, Calif. — Florence Marquez liked to describe herself as a cannery worker, even though she was best known in her heavily Latino East San Jose neighborhood as a community activist.

She strode alongside Cesar Chavez in the farmworker movement during the 1960s and 70s. She helped build affordable housing for poor families near her local church.

But eight years ago, Florence, now 86, couldn’t find her way to the house she had lived in for 50 years. “That’s when we knew she needed 24-hour care,” said her oldest daughter, Barbara Marquez, 61.

Florence was diagnosed with Alzheimer’s disease, which robbed her of her memory and her fierce independence. Across the United States, stories like hers are becoming more common, particularly among Latinos — the fastest growing minority in the country.

With no cure in sight, the number of U.S. Latinos with Alzheimer’s is expected rise by more than eight times by 2060, to 3.5 million, according to a report by the USC Edward R. Roybal Institute on Aging and the Latinos Against Alzheimer’s network.

Advanced age is the leading risk factor for Alzheimer’s disease and the likelihood of developing Alzheimer’s doubles about every five years after age 65. As a group, Latinos are at least 50 percent more likely than whites to have Alzheimer’s, in part because they tend to live longer, the report notes.

Barbara Marquez visits her mother Florence Marquez at her nursing home on Friday, December 16, 2016. Barbara was her mother’s primary caregiver until the family decided to put their mother in a 24-hour care facility. (Heidi de Marco/KHN)

Barbara Marquez visits her mother Florence Marquez at her nursing home, Sagebrook Senior Living, in Carmichael, Calif., in December 2016. Barbara was her mother’s primary caregiver until the family decided to put their mother in a 24-hour care facility. (Heidi de Marco/KHN)

“This is an incoming tsunami,” said Dr. William Vega, one of the report’s authors and the Roybal Institute’s executive director. “If we don’t find breakthrough medication, we are going to be facing a terrible financial crisis.”

That tidal wave of Alzheimer’s cases is prompting some tough conversations in Latino families, who often pride themselves on caring for elders at home, rather than placing them in nursing homes.

Those talks come with a lot of guilt, Barbara said. Until recently, Barbara was her mother’s primary caregiver. Her sister and brother helped out.

“But it was more than I could have anticipated,” Barbara said, recalling sleepless nights as she tried to make sure Florence didn’t get up and wander off. “It impacts your health, it impacts your marriage. So we looked for help.”

About 1.8 million Latino families nationwide care for someone with Alzheimer’s and other types of dementia. And while the Roybal report shows that Latino families are less likely than whites to use formal care services, such as nursing home care, institutionalized care is becoming more common among these families.

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Between 1999 and 2008, the number of elderly Latinos living in U.S. nursing homes grew by about 55 percent, a rate that outpaced the growth of the overall Latino population during that time, according to research published in July 2011 in Health Affairs.

That can be costly. Nationwide, the average cost for basic services in an assisted living facility is $43,200 per year, according to the Alzheimer’s Association. Yearly nursing home care now averages more than twice that, at slightly more than $92,000.

For many Latino families, getting outside help isn’t an option. It’s often too expensive for seniors who aren’t eligible for Medi-Cal, California’s version of the Medicaid program for low-income people, which generally pays for nursing home care. Immigrants who are in the country unlawfully do not qualify for it, nor do people whose incomes are too high.

Florence’s children decided to take their mother out of her house in San Jose, and they brought her to live with her daughter Barbara in Fair Oaks, just outside Sacramento. They sold the San Jose house, thinking it would help pay for institutionalized care should their mom need it down the road.

She did not qualify for Medi-Cal, so she lived with Barbara for about three years. But after trying out a senior day care program outside of the house at a cost of about $78 a day, Barbara and her family placed Florence in a senior home in the Sacramento suburb of Carmichael, where she has been living for the past year.

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Dwindling Resources

The decision to institutionalize Florence Marquez left her children feeling both guilty and overwhelmed by the steep expense. Her care now costs $3,000 to $4,000 per month, they said. They pay extra for specialized services.

They had the proceeds from the sale of Florence’s house, “but those resources are dwindling,” Barbara said. “What do we do when that money is gone?”

Marquez, 85, was diagnosed with Alzheimer’s disease eight years ago. She lived in the same house for 50 years, but one day she couldn’t find her way back home. (Heidi de Marco/KHN)

Florence Marquez, 85, was diagnosed with Alzheimer’s disease eight years ago. She lived in the same house for 50 years, but one day she couldn’t find her way back home. (Heidi de Marco/KHN)

The Roybal study estimates that the cumulative economic impact of Alzheimer’s among Latinos will hit $2.35 trillion by 2060. That figure includes the costs of medical and long-term care, as well as the lost earnings of family members who provide unpaid in-home care, and of the Alzheimer’s victims themselves, according to the study.

Gustavo Lopez of Chicago cares for his mother, Agustina Lopez, 76, who was diagnosed with Alzheimer’s disease seven years ago.

Gustavo, 48, and his four siblings looked into assisted living but couldn’t afford it. Agustina, after moving between her children’s homes, eventually landed with Gustavo, her youngest.

When Gustavo first took on the role of primary caregiver, his mother still did most things on her own, he said. But she now relies on him to help her eat, bathe, dress and take her medication.

So Gustavo needs a job with flexible hours. He’s worked mostly as a waiter. Other employment opportunities have come his way, some with better pay, but caring for his mother comes first, he said.

Asking For Help

Gustavo does get some help from family friends who check in on his mom while he is at work. He also found Casa Cultural in Chicago, a social service agency that offers a day program for seniors. He can drop his mom off at the center for a few hours, giving him a respite.

Free or low-cost programs like these are available in many communities, but families need to do research and ask for help, said Constantina Mizis, president of the Chicago-based Latino Alzheimer’s and Memory Disorders Alliance.

The alliance, formed in 2009, focuses on family members who are primary caregivers. Mizis said she has met many caregivers who are near their breaking point. The nonprofit offers training for them, helps find resources to boost their own well-being and puts on community events for families.

When seeking support, the best place to start is at a local community group or center — a church, a nonprofit, a United Way office, or the local Alzheimer’s Association chapter, for example, Mizis said. These groups will most likely refer caregivers to a county’s Agency on Aging or a state’s Department of Aging.

There, families are assigned a social worker who can discuss what benefits are available. If an Alzheimer’s patient qualifies for Medicaid, these benefits could include caregiver training and payment through programs such as California’s In-Home Supportive Services. But benefits and eligibility vary by state.

In 2010, the Social Security Administration recognized early-onset Alzheimer’s as a medical condition eligible for disability income. That could help people whose Alzheimer’s disease is diagnosed before the age of 65, but many Latino families aren’t aware the program exists, Mizis said.

A Push For Awareness

Because Latinos are more likely to use informal and more affordable care options, the Roybal report calls for improving training and resources for families in both English and Spanish.

Among the caregivers who opt to keep a parent with Alzheimer’s at home is Julia Garcia, of Houston, Texas. She rotates with her three daughters to watch her mother, Marcela Barberena, 85, who was diagnosed with the disease last year.

Julia, who had been unfamiliar with Alzheimer’s, initially thought her mother’s forgetfulness and childlike behavior was due to age.

“Too often people will see Alzheimer’s as a result of old age, but this brain-deteriorating disease is not natural,” said Vega, co-author of the report.

Julia Garcia said she realized it was something more serious when her mother took a shuttle bus from Houston’s international airport without knowing her destination.

“We had agreed I’d pick her up, but she left on her own,” Julia said. “She ended up downtown. It was the scariest moment of my life.”

As a new caregiver, Julia reached out to her local Alzheimer’s Association chapter for information. While some resources are available in Spanish in the Houston chapter, Julia noticed very few Latinos attending the informational workshops or classes.

Barbara Marquez takes her mother, Florence Marquez, on a walk on Friday, December 16, 2016. (Heidi de Marco/KHN)

Barbara Marquez takes her mother, Florence Marquez, on a walk. (Heidi de Marco/KHN)

Spanish-language media provided little information about the disease. “You rarely hear anything about it on TV or the radio,” she said.

In addition, many Latinos, including the Marquez, Lopez and Garcia families, are often unaware of clinical trials through which families can gain access to experimental therapies and medications at little or no cost.

Latinos are underrepresented in clinical trials sponsored by the National Institutes of Health: They account for 17 percent of the U.S. population but only 7.5 percent of participants at the 32 NIH-funded Alzheimer’s research centers across the country, according to the Roybal study.

Latino volunteers for these trials are important in helping researchers develop Alzheimer’s treatments that work for all ethnic groups, the report says.

“This is why it is so important to invest in the education of these communities,” Mizis said.

Her group helps train promotoras, or community health educators, in regions with large Latino communities — including San Francisco, Los Angeles, Baltimore and New York. Going door-to-door, promotoras educate families about the disease.

“I see firsthand everyday how much help our communities need,” Mizis said. “And this need keeps growing.”

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

Categories: Aging, California Healthline, Mental Health, Public Health, Syndicate

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El “tsunami” de casos de Alzheimer entre latinos plantea inquietudes sobre el cuidado y los costos

SACRAMENTO, Calif. — A Florence Márquez le gustaba describirse a ella misma como una trabajadora de fábrica de conservas, a pesar que era conocida en su latinísimo vecindario del este de San José como una activista comunitaria.

Ella caminó junto a César Chávez en el movimiento de trabajadores agrícolas durante los años 60 y 70. Ayudó a construir viviendas asequibles para familias pobres cerca de su iglesia local.

Pero hace ocho años, Florence, ahora de 86, no pudo encontrar su camino a la casa en la que había vivido durante 50 años. “Fue cuando supimos que necesitaba atención las 24 horas”, dijo su hija mayor, Barbara Márquez, de 61 años.

Florence fue diagnosticada con la enfermedad de Alzheimer, que le robó su memoria y su feroz independencia. A lo largo de los Estados Unidos, historias como Florence Márquez se están convirtiendo en más comunes, particularmente entre los latinos, la minoría de más rápido crecimiento en el país.

Sin una cura a la vista, se espera que el número de latinos con Alzheimer aumente más de ocho veces para 2060, a 3.5 millones, según un informe del Edward R. Roybal Institute on Aging de la Universidad del Sur de California (USC) y de la red Latinos Against Alzheimer.

La edad avanzada es el principal factor de riesgo para la enfermedad de Alzheimer y la posibilidad de desarrollar el mal se duplica cada cinco años después de los 65. Los latinos son al menos 50% más propensos que los blancos no hispanos a tener Alzheimer, en parte porque viven vidas más largas, destaca el informe.

Barbara Marquez visits her mother Florence Marquez at her nursing home on Friday, December 16, 2016. Barbara was her mother’s primary caregiver until the family decided to put their mother in a 24-hour care facility. (Heidi de Marco/KHN)

Barbara Marquez, de 61 años, visita a su madre, Florence Marquez, de 85, en el hogar Sagebrook Senior Living, en Carmichael, Calif., el viernes 16 de diciembre de 2016. (Heidi de Marco/KHN)

“Este es un tsunami en marcha”, dijo el doctor William Vega, uno de los autores del informe y director ejecutivo del Roybal Institute. “Si no encontramos medicamentos innovadores, vamos a enfrentar una terrible crisis financiera”.

Esa marea de casos de Alzheimer está provocando algunas conversaciones difíciles en las familias latinas, que a menudo se enorgullecen de cuidar a sus ancianos en casa, en lugar de ponerlos en hogares para adultos mayores.

Esas charlas se presentan con mucha culpa, dijo Barbara Márquez. Hasta hace poco, Barbara era la principal cuidadora de su madre. Su hermana y su hermano ayudaban.

“Pero fue más de lo que yo podría haber previsto”, dijo Barbara, recordando las noches sin dormir mientras intentaba asegurarse de que Florence no se levantara y escapara. “Afecta tu salud, tu matrimonio. Así que buscamos ayuda”.

Alrededor de 1,8 millones de familias latinas en todo el país cuidan a alguien con Alzheimer y otros tipos de demencia, y mientras que el informe de la USC muestra que las familias latinas tienen menos probabilidades que los blancos no hispanos de usar servicios de atención formales, como un hogar, el cuidado institucionalizado se está convirtiendo en una opción más popular entre estas familias.

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Entre 1999 y 2008, el número de latinos seniors que vivían en hogares aumentó un 55%, una tasa que superó el crecimiento de la población latina en general durante ese período de tiempo, según una investigación publicada en julio de 2011 en Health Affairs.

A nivel nacional, el costo promedio de los servicios básicos en un centro de asistencia es de $43,200 al año, según la Asociación de Alzheimer. Los cuidados anuales en hogares de ancianos son, en promedio, unos $92,000, más del doble.

Para muchas familias latinas, obtener ayuda externa no es ni siquiera una opción. A menudo es demasiado costoso para las personas mayores que no son elegibles para el Medi-Cal, la versión de California del Medicaid para personas de bajos ingresos, que generalmente paga por el cuidado de enfermería en hogares de ancianos. Los inmigrantes que están en el país ilegalmente no califican, ni tampoco las personas cuyos ingresos son demasiado altos.

Después de probar un programa de cuidado de ancianos fuera de la casa a unos $78 al día, Barbara y su familia pusieron a Florence en una residencia para ancianos de la zona de Sacramento, donde ha estado viviendo durante el último año.

 Recursos en baja

La decisión de institucionalizar a Florence Márquez dejó a sus hijos no sólo sintiéndose culpables, sino también con una economía tambaleante por los elevados gastos. El cuidado de su mamá ahora cuesta de $3,000 a $4,000 por mes, dijeron. Pagan extra por servicios especializados.

Florence actualmente no califica para el Medi-Cal, por lo que la familia Márquez vendió la casa de su madre en San José para pagar por su atención. “Pero esos recursos están disminuyendo”, dijo Barbara. “¿Qué vamos a hacer cuando se acabe el dinero?”.

El informe de la USC estima que el impacto económico acumulado de la enfermedad de Alzheimer entre los latinos llegará a $ 2,35 mil billones en 2060. Esta cifra incluye los costos de atención médica y de largo plazo, así como la pérdida de ingresos de los miembros de la familia, y de las propias víctimas del Alzheimer, según el estudio.

Gustavo López, de Chicago, se preocupa por su madre, Agustina López, de 76 años, diagnosticada con la enfermedad de Alzheimer hace siete años.

Gustavo, de 48 años, y sus cuatro hermanos buscaron un centro de asistencia, pero no pudieron solventarlo. Agustina, después de vivir en las casas de todos sus hijos, eventualmente se quedó con Gustavo, el más joven.

Marquez, 85, was diagnosed with Alzheimer’s disease eight years ago. She lived in the same house for 50 years, but one day she couldn’t find her way back home. (Heidi de Marco/KHN)

Florence Marquez, de 85, fue diagnosticada con Alzheimer hace 8 años. Marquez vivió en la misma casa por 50 años, pero un día no pudo encontrar el camino a su hogar. (Heidi de Marco/KHN)

Cuando Gustavo asumió por primera vez el papel de cuidador principal, su madre todavía hacía la mayoría de las cosas por su cuenta, dijo. Pero ahora depende de él para comer, bañarse, vestirse y tomar su medicación.

Así que Gustavo necesita un empleo con horario flexible. Ha estado trabajando principalmente como camarero. Han aparecido otras oportunidades de empleo, algunos con mejor salario, pero el cuidado de su madre está primero, dijo.

 Pidiendo ayuda

Gustavo recibe ayuda de amigos de la familia que vigilan a su madre mientras está en el trabajo. También encontró Casa Cultural en Chicago, una agencia de servicios sociales que ofrece un programa de día para personas mayores. Puede dejar a su mamá en el centro por unas horas, lo que le da un respiro.

Programas gratuitos o de bajo costo como éstos están disponibles en muchas comunidades, pero las familias necesitan investigar y pedir ayuda, dijo Constantina Mizis, presidenta de la Latino Alzheimer’s and Memory Disorders Alliance, con sede en Chicago.

La alianza, formada en 2009, se centra en los miembros de la familia que son los principales cuidadores. Mizis dijo que ha conocido a muchos cuidadores que están al borde de quebrarse. La organización sin fines de lucro les ofrece capacitación, ayuda para encontrar recursos para impulsar su propio bienestar, y participación en eventos comunitarios para las familias.

Al buscar apoyo, el mejor lugar para comenzar es en un grupo o centro comunitario local: una iglesia, una organización sin fines de lucro, una oficina de United Way o el capítulo local de la Asociación de Alzheimer, por ejemplo, dijo Mizis. Es probable que estos grupos refieran a los cuidadores a la Agencia de Envejecimiento del condado o al Departamento de Envejecimiento del estado.

Allí, se les asigna a las familias un trabajador social que puede discutir qué beneficios están disponibles. Si un paciente de Alzheimer califica para Medicaid [Medi-Cal en California], estos beneficios podrían incluir capacitación para cuidadores y pago a través de programas de “efectivo y consejería”. Los Servicios de Apoyo en el Hogar de California es uno de esos programas. Sin embargo, los beneficios y la elegibilidad varían según el estado.

En 2010, la Administración del Seguro Social reconoció al Alzheimer de inicio temprano como una condición médica elegible para los ingresos por discapacidad. Eso podría ayudar a las personas cuya enfermedad de Alzheimer se diagnostica antes de los 65 años, pero muchas familias latinas no son conscientes de esto, dijo Mizis.

Un impulso para la concientización

Debido a que los latinos son más propensos a usar opciones de atención informales y más asequibles, el informe de la USC pide mejorar la capacitación y los recursos para las familias, tanto en inglés como en español.

Entre los cuidadores que optan por mantener a un padre con Alzheimer en casa está Julia García, de Houston, Texas. Ella se rota con sus tres hijas adolescentes y adultas para cuidar a su madre, Marcela Barberena, de 85 años, quien fue diagnosticada con la enfermedad el año pasado.

Julia, que no estaba familiarizada con el Alzheimer, pensó que el olvido y el comportamiento infantil de su madre se debían a la edad.

“Demasiado a menudo la gente ve al Alzheimer como resultado de la vejez, pero la enfermedad que deteriora el cerebro no es natural”, dijo Vega, coautor del informe de la USC.

Barbara visits her mother almost every weekend. Her mother's care now costs $3,000 to $4,000 per month, says Barbara. (Heidi de Marco/KHN)

Barbara Marquez saca a pasear a su madre, Florence Marquez, el viernes 16 de diciembre de 2016. (Heidi de Marco/KHN)

Julia García dijo que se dio cuenta de que era algo más serio cuando su madre tomó un micro desde el aeropuerto internacional de Houston sin saber su destino.

“Habíamos acordado que la recogería, pero ella se fue por su cuenta”, dijo Julia. “Terminó en el centro de la ciudad. Fue el momento más espantoso de mi vida”.

Como nueva cuidadora, Julia se acercó a la sede local de la Asociación de Alzheimer para obtener información. Aunque algunos recursos están disponibles en español en el capítulo de Houston, Julia notó que muy pocos latinos asistían a los talleres informativos o a las clases.

Lo mismo ocurre con los medios en español, que proporcionan poca información sobre la enfermedad. “Rara vez se oye nada en la televisión o en la radio”, dijo.

Muchos latinos, incluyendo las familias de Márquez, López y García, no saben sobre los ensayos clínicos y cómo pueden ayudar a sus seres queridos.

Los latinos están subrepresentados en los ensayos clínicos patrocinados por los Institutos Nacionales de Salud: representan el 17 por ciento de la población de los Estados Unidos, pero sólo el 7,5 por ciento de los participantes en los 32 centros de investigación de Alzheimer financiados por los INS en todo el país, según el informe de Roybal.

Los voluntarios latinos son importantes para ayudar a los investigadores a desarrollar tratamientos para el Alzheimer que funcionen para todos los grupos étnicos, según el informe de USC.

“Por eso es tan importante invertir en la educación de estas comunidades”, dijo Mizis.

Su grupo ayuda a entrenar promotoras o educadores comunitarios de salud en regiones con grandes comunidades latinas, incluyendo San Francisco, Los Ángeles, Baltimore y Nueva York. Al ir de puerta en puerta, las promotoras educan a las familias sobre la enfermedad.

“Veo de primera mano cuánto necesitan ayuda nuestras comunidades”, dijo Mizis. “Y esta necesidad sigue creciendo”.

Esta historia fue producida por Kaiser Health News, que publica California Healthline, un servicio editorial independiente de la California Health Care Foundation.

Categories: Aging, Mental Health, Noticias En Español, Public Health, Syndicate

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First Edition: February 17, 2017

Feb 17 2017

NOTE TO READERS: KHN’s First Edition will not be published Feb. 20. Look for it again in your inbox Feb. 21. Here’s today’s early morning highlights from the major news organizations.

Kaiser Health News: Congressman’s Ties To Foreign Biotech Draw Criticism
Rachel Bluth and Emily Kopp report: “When a small Australian biotechnology company, Innate Immunotherapeutics, needed a clinical trial for an experimental drug it hoped to turn into a huge moneymaker, the company landed a U.S. partner where it had high-level connections: Roswell Park Cancer Institute in Buffalo, N.Y. The company is partly owned by Rep. Chris Collins, a wealthy Republican entrepreneur from Buffalo, whose enthusiasm for Innate helped persuade others to invest.” (Bluth and Kopp, 2/17)

Kaiser Health News: Treatment Gaps Persist Between Low- And High-Income Workers, Even With Insurance
Michelle Andrews writes: “Low-wage workers with job-based health insurance were significantly more likely than their higher-income colleagues to wind up in the emergency department or be admitted to the hospital, in particular for conditions that with good primary care shouldn’t result in hospitalization, a new study found. At the same time, low-wage workers were much less likely to get preventive care such as mammograms and colonoscopies, even though many of those services are available without cost-sharing under the 2010 health law.” (Andrews, 2/17)

California Healthline: Some Immigrants, Fearful Of Political Climate, Shy Away From Medi-Cal
Emily Bazar reports: “Some foreign-born Californians are canceling their Medi-Cal coverage or declining to enroll in the first place, citing fears of a Trump administration crackdown on immigrants. Among those dropping coverage are people in the country legally but concerned about jeopardizing family members who lack permanent legal status, according to government officials, immigration attorneys and health care advocates.” (Bazar, 2/16)

Kaiser Health News: Right-To-Die Fight Hits National Stage
Melissa Bailey reports: “Opponents of aid-in-dying laws are claiming a small victory. They won the attention of Congress this week in their battle to stop a growing movement that allows terminally ill patients to get doctors’ prescriptions to end their lives. The Republican-led effort on Capitol Hill to overturn the District of Columbia’s aid-in-dying law could fail by Friday. But advocates worry the campaign will catalyze a broader effort to fully ban the practice, which is legal in six states and being considered in 22 more.” (Bailey, 2/16)

The Associated Press: GOP Leaders Unveil New Health Law Outline, Divisions Remain
At a closed-door meeting in the Capitol basement, House Speaker Paul Ryan, R-Wis., and other party leaders described a broad vision for voiding much of President Barack Obama’s 2010 statute and replacing it with conservative policies. It features a revamped Medicaid program for the poor, tax breaks to help people pay doctors’ bills and federally subsidized state pools to assist those with costly medical conditions in buying insurance. Lawmakers called the ideas options, and many were controversial. One being pushed by Ryan and other leaders would replace the tax increases in Obama’s law with new levies on the value of some employer-provided health plans — a political no-fly zone for Republicans averse to tax boosts. (2/16)

NPR: GOP Health Care Would Cut Coverage For Low-Income Families
The outline plan is likely to take away some of the financial help low-income families get through Obamacare subsidies, and also result in fewer people being covered under the Medicaid health care program for the poor. “In general this is going to result in fewer people covered nationwide,” says Caroline Pearson, a senior vice president at Avalere, a health care consulting group. (Kodjak, 2/16)

The Washington Post: House GOP Discusses Obamacare Replacement Ideas — But Doesn’t Call Them A Plan
According to numerous lawmakers and aides in the room, as well as a policy memo distributed afterward, the House leaders laid out elements of a repeal-and-replace plan — including long-standing Republican concepts like health savings accounts, tax credits and state high-risk pools for the chronically sick. But they did not detail how those elements would fit together or get passed into law. “It’s sort of a smorgasbord right now,” said Rep. Daniel Webster (R-Fla.). (DeBonis and Snell, 2/16)

The Wall Street Journal: House Republicans Lay Out Health-Care Plan
The proposal seeks in addition to revamp the individual insurance market where millions of Americans who don’t get employer coverage buy insurance. It would replace the health-law subsidies with tax credits Americans could use to help pay for private insurance, and it would allow for skimpier health plans not permitted under the ACA, which some say would help bring down costs. (Hackman, Peterson and Armour, 2/16)

The Wall Street Journal: GOP May Trim Tax Break For Employer-Backed Insurance
House Republicans, looking for ways to pay for their plan to repeal and replace the Affordable Care Act, are considering changing the special tax treatment for employer-provided health benefits. Capping how much of employees’ health benefits can be shielded from income and payroll taxes is one of the ways GOP lawmakers might offset the cost of their emerging health plan. (Peterson and Rubin, 2/17)

Reuters: Trump, Republicans Set Timeframe For Introducing Obamacare Replacement
Ryan told reporters on Capitol Hill that House Republicans would introduce legislation to repeal and replace Obama’s program after a 10-day recess that begins on Friday. “After the House returns following the Presidents Day break, we intend to introduce legislation to repeal and replace Obamacare,” Ryan said at a press conference. Presidents Day is on Monday and the House returns on Feb. 27. (Cowan and Morgan, 2/16)

Politico: House Republicans Still Apart On Obamacare Repeal-Replace
Newly confirmed Health and Human Services Secretary Tom Price told lawmakers at Thursday’s meeting that President Donald Trump “is all in on” repealing and replacing Obamacare at the same time. Earlier this week, the conservative House Freedom Caucus called on Republicans to repeal the law first and work on a replacement later. “Let’s not miss this opportunity,” Price said, according to a source in the room. “Let’s go shoulder to shoulder, arm to arm.” (Haberkorn, Cheney and Pradhan, 2/16)

The Washington Post: Medicaid Exposes Rifts Within The GOP Over The Program’s Future After The ACA
As congressional Republicans move from talking points to details of how to abolish the Affordable Care Act, behind-the-scenes jockeying over the future of Medicaid demonstrates the delicate trade-offs the GOP faces in trying to steer health policy in a more conservative direction. For years, many Republicans have railed against the ACA’s expansion of Medicaid, which has extended coverage to about 11 million people. But now that they have the political power to reverse those gains, internal disagreements have emerged. Some lawmakers want to preserve the federal money their states are getting under the expansion. Others argue that part of that money should be shifted to states that did not broaden their programs — or used for other purposes. (Eilperin, Goldstein and Snell, 2/16)

The New York Times: Trump Health Pick Says Medicaid Needs A Major Overhaul
President Donald Trump’s pick to run the government’s major health insurance programs said Thursday that Medicaid needs a full overhaul but she doesn’t support turning Medicare into a “voucher” plan. Indiana health care consultant Seema Verma testified before the Senate Finance Committee on her nomination to lead the Centers for Medicare and Medicaid Services, or CMS. The $1 trillion agency oversees programs that cover about 1 out of 3 Americans. (2/16)

Reuters: Trump’s Pick To Lead Health Agency Calls EpiPen Issue ‘Disturbing’
U.S. President Donald Trump’s choice to lead an important health agency said on Thursday that the way pharmaceutical companies classify products as generic or branded needs to be reviewed in order to help hold down government spending, as she cited Mylan NV’s EpiPen emergency allergy treatment. Seema Verma, Trump’s nominee to lead the Centers for Medicare and Medicaid Services (CMS), did not answer questions about whether the U.S. government should negotiate with pharmaceutical companies over drug prices. (Cornwell, 2/16)

USA Today: Seema Verma, Trump’s Pick To Head Medicare And Medicaid, Avoids Giving Policy Views
Sen. Orrin Hatch, the Utah Republican who chairs the Senate Finance Committee, which is vetting her nomination, told Verma she acquitted herself well and would be a strong and skilled leader at CMS. She is expected to be confirmed by the GOP-controlled Senate. Still, Oregon Sen. Ron Wyden, the panel’s top Democrat, said Verma needs to be more specific in the follow-up questions he will submit in writing.“It’s important to get more of a sense of how she would approach it,” Wyden told reporters after. “This is an agency that has a lot of discretion.” (Groppe, 2/16)

NPR: Is It Time To Test Presidents For Dementia?
At 70, Trump is the oldest American president to ever take office. Couple his age with a family history of dementia — his father Fred developed Alzheimer’s disease in his 80s — and one could argue that the question of baseline cognitive testing for the U.S. head of state has taken on new relevance. An assortment of fairly simple tests exist that can establish a reference point for cognitive capacity and detect early symptoms of mental decline. (Stetka, 2/16)

The Wall Street Journal: House Votes To Let States Strip Money From Planned Parenthood
House Republicans took the first step Thursday to strip federal funding from Planned Parenthood and other abortion providers, starting what will become a broader battle over funding for the women’s health-services agency. The House voted 230-188 to rescind a regulation that bans states from denying certain funds to health-care providers that perform abortions, in essence freeing states to refuse to give the funds to Planned Parenthood Federation of America Inc. and similar organizations. (Andrews and Hackman, 2/16)

The Wall Street Journal: Court Issues Temporary Order Keeping Cigna From Terminating Merger With Anthem
A Delaware judge on Wednesday issued a temporary restraining order that blocks Cigna Corp. from immediately terminating its troubled $48 billion merger with rival health insurer Anthem Inc. The development is the latest in what could be a long and bitter legal battle between the two companies in the wake of a federal judge’s ruling earlier this month that the proposed merger violates U.S. antitrust law. (Kendall, 2/16)

The Wall Street Journal: U.S. Authorities Pressed China For Action On Deadly Opioid
China’s crackdown on an extremely potent synthetic narcotic came amid pressure from U.S. authorities and evidence linking it to hundreds of U.S. overdose deaths since it first emerged in Ohio in July. The drug, carfentanil, has been connected to at least 700 fatalities in states including Ohio, Michigan and Florida, according to data compiled by The Wall Street Journal from county medical examiners and NMS Labs, a private laboratory outside Philadelphia that performs toxicology testing for counties around the U.S. (Kamp and Campo-Flores, 2/17)

The New York Times: Florida Doctors May Discuss Guns With Patients, Court Rules
A federal appeals court cleared the way on Thursday for Florida doctors to talk to their patients about gun safety, overturning a 2011 law that pitted medical providers against the state’s powerful gun lobby. In its 10-to-1 ruling, the full panel of the United States Circuit Court of Appeals for the 11th Circuit concluded that doctors could not be threatened with losing their license for asking patients if they owned guns and for discussing gun safety because to do so would violate their free speech. (Alvarez, 2/16)

NPR: Brown Recluse Spider Bites Are Often Misdiagnosed
The best way to diagnose a strange skin bump is often to decide what it’s not. So say the researchers who have devised a mnemonic device useful for determining that the lesion or lump isn’t a bite from a brown recluse spider — a diagnosis that can be very common and very false, they say. (Boddy, 2/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Veteran Teaches Therapists How To Talk About Gun Safety When Suicide’s A Risk

Jay Zimmerman got his first BB gun when he was 7, and his first shotgun when he was 10.

“Growing up in Appalachia, you look forward to getting your first firearm,” he said, “probably more so than your first car.”

His grandfather taught him to hunt squirrels and quail. Zimmerman, who lives in Elizabethton, Tenn., said pretty much everyone he knows has a gun. It’s just part of the culture.

“When I went into the military, that culture was reinforced,” he said. “Your weapon is almost another appendage. It’s part of who you are.”

Zimmerman served as a medic in the Army in the late 1990s and early 2000s, with stints in Bosnia, Africa and the Middle East. Since he came home, he’s struggled with PTSD and depression. It reached a crisis point a few years ago, when his best friend — the guy who had saved his life in a combat zone — killed himself. Zimmerman decided his time was up, too.

“I decided that I would have one more birthday with my daughter, one more Christmas with my daughter,” he said. “I had devised my own exit strategy for 16 February 2013.”

But then he bumped into a woman who used to ride the same school bus when they were kids. His exit date came and went. They’re married now.

Zimmerman still gets depressed, but now he’s a peer counselor at the Mountain Home VA Medical Center in Johnson City, Tenn. He also travels to conferences all over the country, sharing his story with therapists and with other vets, encouraging them to ask for help when they need it.

Even today, he explains at these conferences, if he’s not doing well, he disassembles his guns and stores them separately from ammunition, so he can’t make any rash decisions. And if things get really bad, Zimmerman has a special arrangement with a few friends.

“I call them and say, ‘Look, I’m feeling like it’s not safe for me to have firearms in my home. Can you store them for me for a couple days till I feel like I’m OK to have them back?’ ”

Suicide is often an impulsive act. Nearly half the people who survive an attempt say the time between their first thought of suicide and the attempt itself was less than 10 minutes. But the method can mean the difference between life and death: People who take pills have time to change their minds, or may still be alive when discovered. That’s not the case with guns.

Almost 70 percent of veterans who commit suicide do so with a gun, which prompted President Barack Obama to order the VA to talk to vets about gun safety and storage options like the ones Zimmerman uses.

But here’s the trouble: Most therapists aren’t gun people. They don’t know how to talk about guns and so they don’t.

“One obvious reason for that is that no one has taught them how,” explained Megan McCarthy, a psychologist and National Deputy Director in the Office for Suicide Prevention in the U.S. Department of Veterans Affairs.

McCarthy was invited to speak recently at a suicide prevention conference in San Francisco, aimed at therapists who work with vets.

“How many of you would say you feel really comfortable having a conversation with any of the people you work with about limiting access to all lethal means?” she asked the roomful of therapists.

Hardly anyone raised their hand.

“OK, so that’s why we’re here today,” she said.

Researchers recommend starting with a field trip to a shooting range. There, therapists can learn about different kinds of firearms, as well as gun locks, and get an introduction to gun culture.

When counseling vets, therapists have to ask more questions and be less directive, McCarthy said.

“We often conceive of ourselves as experts — as people who impart information to clients,” she said. But with vets, “it may take time to build trust. Telling them what to do the first time you’ve met them is probably not going to be a very effective approach.”

McCarthy presented a case study at the conference: A 28-year old, unmarried Army veteran who fought in Iraq told his VA psychiatrist that he had an argument with his girlfriend last week. He drove to an empty parking lot and sat with his loaded handgun in his lap, intending to kill himself.

He didn’t do it. A week later, the man told his psychiatrist things were still tense with his girlfriend. But he didn’t want to talk about suicide or storing his gun.

McCarthy asked the clinicians in the audience what they would do next, if they were this man’s psychiatrist.

“Why did he not do it? That would be my question,” one therapist said.

“I would want to see this individual again, within the same week,” said another. “I believe in strong intervention.”

Jay Zimmerman, the former army medic and peer counselor, stood up and explained his different perspective.

“Chances are the reason he’s not talking to you is because he’s afraid he’s going to lose his gun that he carries pretty much all the time,” Zimmerman said. “My buddies are the same way. We all carry — all the time.”

A lot of veterans would sometimes rather confide in a fellow vet than someone in a white coat, Zimmerman said. And that was an unusual takeaway for the professional counselors: Sometimes their role is not to intervene at all, but to be a facilitator. To make sure vets have someone to talk to outside the therapy office.

This story is part of a partnership that includes KQED, NPR and Kaiser Health News.

Categories: Mental Health, Public Health, Public Radio Partnership, Syndicate

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Congressman’s Ties To Foreign Biotech Draw Criticism

When a small Australian biotechnology company, Innate Immunotherapeutics, needed a clinical trial for an experimental drug it hoped to turn into a huge moneymaker, the company landed a U.S. partner where it had high-level connections: Roswell Park Cancer Institute in Buffalo, N.Y.

The company is partly owned by Rep. Chris Collins, a wealthy Republican entrepreneur from Buffalo, whose enthusiasm for Innate helped persuade others to invest. Former Rep. Tom Price, now secretary of Health and Human Services, bought Innate stock after Collins told him about it, Price said at his Senate confirmation hearing. Other shareholders include Collins’ campaign supporters, some of whom are key figures in Buffalo’s medical corridor, company and government documents reveal.

Federal money is in play, too: National Cancer Institute funds are being used to test an application for Innate’s drug that could make the company more attractive to potential buyers. Innate has said in presentations to investors that it hopes to sell itself to a major pharma company by the end of 2017.

The Roswell clinical trial, which could start this month, will investigate whether MIS416 might have an application as an ingredient in a vaccine for ovarian cancer. Innate’s primary strategy, however, is to develop the drug for advanced multiple sclerosis and it has told investors that the results of early-stage human trials in Australia and New Zealand against MS will be reported by this fall.

With its tangled web of medicine, politics and money, Innate’s story has proven irresistible for U.S. news media, whose initial reports in December that Price received discounts on Innate stock purchases helped place the secretary on the hot seat as he won confirmation. Now, the story is exploding half a world away, and the focus is shifting to Collins. The Australian newspaper’s website reported Feb. 6 that a former securities regulator there alleged Collins may have violated disclosure requirements in the country’s securities laws in acquiring his Innate stake and also by not reporting his close relationships with other large shareholders. The Australian government’s Takeovers Panel said Feb. 15 that it has not decided whether to convene a panel to investigate the allegations.

Innate CEO Simon Wilkinson said in a statement that company financial documents “fully informed” financial markets about Collins’ investments. The company was “not in the slightest bit concerned” about the allegations, which “are politically motivated and have been peddled by hack journalism,” he said.

Compared with Price, the potential conflicts could run even deeper for Collins who — along with two children — owns more than 21 percent of Innate’s shares. He is its largest shareholder, company reports show.

Collins, who is ranked by the Center for Responsive Politics as the 14th-wealthiest member of Congress, sits on the health subcommittee of the Energy and Commerce Committee, where he helps oversee health care funding. He was a member of President Donald Trump’s transition team and is a liaison between the new administration and Capitol Hill.

Congressional ethics rules do not prohibit Collins and other members from investing in companies whose businesses overlap with the committees they serve on and the government agencies those committees oversee, legal experts said. Even so, they added, members must take care to disclose possible conflicts of interest because they can erode the public’s trust in government.

“Members should not have large holdings in health care stocks while serving on committees that oversee health policy,” said Richard Painter, former chief ethics lawyer for President George W. Bush.

Collins’ spokesman said his boss has done nothing improper.

“Congressman Collins is not going to apologize because a company he has a relationship with is attempting to help conquer cancer,” said Collins communications director Michael McAdams. “It’s sad the media is attempting to launch partisan attacks insinuating otherwise.”

‘I Talk About It All The Time’

Collins has been candid about his promotional efforts on Innate’s behalf.

In an interview with CNN, Collins said he often talks to people about Innate. “I talk about it all the time, just as you would talk about your children,” he said.

Last month, Collins was overheard by reporters boasting on a cellphone call just off the House floor about the “many millionaires” he had made talking up Innate, according to Politico.

Innate’s drug is an immune response stimulator discovered in the 1990s that had initially been developed as a potential treatment for HIV/AIDS or to boost the efficacy of childhood vaccines.

Founded in 2000, the company later tried MIS416 in a number of medical uses, but never found a marketable niche, Innate’s financial reports and news reports show.

Collins’ ties to Innate go back to 2005 — seven years before he was first elected to Congress — when the successful Buffalo businessman decided to invest after meeting Wilkinson while the CEO was in the U.S. seeking investors, Wilkinson said.

Collins joined the board in 2006 and the company first sold shares to the public in 2013. From 2013 to 2016, he bought Innate shares then worth between $3.5 million and $16 million and has not sold any, according to his congressional disclosure statements. Collins now owns nearly 38 million shares of the company, worth about $25 million based on the stock’s recent closing prices on the Australian stock exchange. That price peaked at $1.35 a share on Jan. 25 and is now under $1.

Innate has never had a revenue-producing product and has relied mainly on investor capital for funds. The congressman made four personal loans to Innate in 2012 and 2013 totaling $1.3 million that were later converted to shares and options to buy more shares at discounted prices, according to company financial reports.

Collins also promoted Innate among people in his professional and social circles, drawing investors whose share purchases have helped keep the company afloat.

Americans own 44 percent of Innate, according to a company-funded research report on its website. Many of those shareholders seem to come from an interconnected circle of prominent Buffalo investors with Collins at the center, based on company documents, congressional disclosure statements and political contributions reported in Federal Election Commission filings.

Investors who bought stock in two private placements by Innate have contributed at least $105,000 to Collins’ congressional campaigns, according to the Public Accountability Initiative in Buffalo, a nonprofit that investigates politics and government, which compared an Innate shareholders’ document with FEC filings.

One was Glenn Arthurs, an executive in the Buffalo office of UBS, the Swiss financial services giant. Another was Paul Harder, who runs a private investment firm in Buffalo, CHEP II. Arthurs and CHEP II both ranked among Innate’s top 20 shareholders last year, according to the company’s annual report. Both have also contributed to Collins since 1998, the year of his first — and unsuccessful — congressional campaign, FEC records show.

Collins’ congressional chief of staff, Michael Hook, who began working for Collins early last year, bought shares of Innate 28 times last year, according to his disclosure statements. Sometimes he purchased thousands of dollars of stock multiple times in a single day, those filings show.

Bill Paxon, a former congressman from Buffalo and a lobbyist whose clients include PhRMA, the major drug makers’ trade group, has invested in Innate. So has Lindy Ruff, the former coach of the Buffalo Sabres hockey team, who is now head coach of the Dallas Stars. Both were identified in a public company document for shareholders.

Ruff declined to comment on his Innate investment. Paxon, Arthurs, Harder and Hook did not reply to repeated requests from KHN for comment.

Mark Lema, Roswell’s head of anesthesiology, told The Buffalo News recently that he became an Innate investor after overhearing Collins discussing it at a meeting for Buffalo visitors that Collins hosted in Washington, D.C. But he’s never discussed Innate or MIS416 with study researchers at Roswell, he said in a subsequent interview with KHN.

A Complaint In Australia

Recent published reports in the U.S. detailing Collins’ ties with Innate are what provoked Sydney lawyer — and Innate shareholder — James Wheeldon to question Collins’ adherence to Australian securities laws, according to the 10-page letter that he sent Feb. 3 to Innate and the Australian Securities and Investment Commission.

Wheeldon alleged that Collins failed to disclose his large holdings in Innate to the Australian Securities Exchange within two business days of becoming a substantial stockholder, as the country’s law requires.

Stating that Collins owned more than 15 percent of the company before Innate went public in December 2013, Wheeldon alleged that Collins did not inform the exchange how much he owned until almost 18 months later.

Wheeldon also said that published reports about Collins’ “family, professional, political and financial relationships” with other Innate shareholders like Price had never been disclosed to the Australian financial market to his knowledge, “but rather has only come to light as a consequence of these press reports.”

Collins, his children, political allies and his donors control at least 27.25 percent of the company — giving Collins greater influence over the company than has been disclosed to shareholders, Wheeldon wrote.

“Mr. Collins duty is not to enrich the business and political elite of Buffalo, New York. His overarching duty is to the company,” read Wheeldon’s letter.

The stakes may be high, but the data from the Roswell study might not produce strong conclusions. Twelve people will be in the study, which is to be completed in August 2018, according a listing on clinicaltrials.gov. The start of the trial has been postponed five times since July and is now scheduled for this month. Recruiting for participants has not started yet, according to the listing.

Innate and Roswell began collaborating in 2009 and as both sides tell the story, Collins — the man who first connected the Australian biotech firm to Buffalo — had nothing to do with it. According to Roswell, the doctor running the trial, Kunle Odunsi, learned about MIS416 that year when Wilkinson, the CEO, pitched the drug at a presentation in Buffalo to prospective collaborators. Roswell researchers have been testing the vaccine in mice with tumors since first receiving the National Cancer Institute grant in 2011.

The trial is called an “investigator-initiated” trial, meaning that Odunsi has an agreement with Innate to explore the use of MIS416 for a cancer vaccine for free. Innate donates the drug, Roswell sponsors for the trial and if it’s successful, researchers could approach a medical journal to publish the results.

“A publication by a reputable clinical center (e.g., Roswell) in a prestigious journal […] would almost certainly increase off-label usage, thus increasing sales,” Kenneth Kaitin, director of the Tufts Center for the Study of Drug Development, wrote in an email.

Wilkinson said Collins has played no role in lining up the clinical trial at Roswell or getting the NCI funds to pay for it. McAdams, Collins’ spokesman, said Collins had “zero involvement” in the grant.

Categories: Health Industry, Syndicate

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Treatment Gaps Persist Between Low- And High-Income Workers, Even With Insurance

Low-wage workers with job-based health insurance were significantly more likely than their higher-income colleagues to wind up in the emergency department or be admitted to the hospital, in particular for conditions that with good primary care shouldn’t result in hospitalization, a new study found.

At the same time, low-wage workers were much less likely to get preventive care such as mammograms and colonoscopies, even though many of those services are available without cost-sharing under the 2010 health law.

There’s no single reason for the differences in health care use by workers at different wage levels, said Dr. Bruce Sherman, an assistant clinical professor at Case Western Reserve University in Cleveland and the study’s lead author, which was published in the February issue of Health Affairs.

Michelle AndrewsInsuring Your Health

Finances often play a role. Half of workers with employer-sponsored insurance are enrolled in plans with a deductible of at least $1,000 for single coverage. As deductibles and other out-of-pocket costs continue to rise, low-wage workers may opt to pay the rent and put food on the table rather than keep up-to-date with regular doctor visits and lab work to manage their diabetes, for example.

Likewise, convenient access to care can be problematic for workers at the lower end of the pay scale.

“Individuals are penalized if they leave work to seek care,” Sherman said. “So they go after hours and their access to care is limited to urgent care centers or emergency departments.”

The study examined the 2014 health care claims, wage and other data of nearly 43,000 workers at four self-funded companies that offered coverage through a private health insurance exchange. Workers were stratified into four categories based on annual maximum wages of $30,000, $44,000, $70,000 and more than $70,000.

Workers in the lowest wage category were three times more likely to visit the emergency department than top earners, and more than four times more likely to have avoidable hospital admissions for conditions such as bacterial pneumonia or urinary tract infections. But they used preventive services only half as often, the study found.

There are no easy solutions. Varying premiums or deductibles based on workers’ wages could take some of the bite out of low-wage workers’ out-of-pocket costs, but very few employers have adopted that strategy, Sherman said. Offering plans that pay for certain services, such as care related to chronic conditions, before the deductible is met could boost the use of care. But preventive services are available without cost-sharing in most plans and many low-wage workers aren’t getting recommended services.

“Health literacy concerns are important,” said Sherman, but it may not be the only barrier. “Some focus groups I’ve participated in, employees have said, ‘I understand the services are free, but if an abnormality is found that requires further services, I’ll have to [pay for it]. So because I feel fine, I’m not going to go.’”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Insurance, Insuring Your Health

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Right-To-Die Fight Hits National Stage

Opponents of aid-in-dying laws are claiming a small victory. They won the attention of Congress this week in their battle to stop a growing movement that allows terminally ill patients to get doctors’ prescriptions to end their lives.

The Republican-led effort on Capitol Hill to overturn the District of Columbia’s aid-in-dying law could fail by Friday. But advocates worry the campaign will catalyze a broader effort to fully ban the practice, which is legal in six states and being considered in 22 more.

“The D.C. legislation has catapulted the issue of medical aid in dying onto the federal agenda at a time when Congress has the power to enact a ban on this end-of-life care option nationwide — even criminalizing the practice in the six states where this option is currently authorized,” warned Jessica Grennan, national director of political affairs and advocacy for Compassion & Choices, which supports right-to-die laws.

“If that happens, it will set the end-of-life care movement back to the last century,” Grennan said.

No matter how the effort plays out, both sides agree that the debate on Capitol Hill, featuring a Republican moral protest, could be only a taste of what’s to come.

In a vote that hewed closely to party lines, the Republican-controlled House Oversight Committee on Monday approved a bill that would knock down D.C.’s law, which won approval from the mayor and City Council in December. While D.C.’s law mirrors those passed in other states, Congress has unique power to intervene in D.C.’s affairs. Under the Home Rule Act of 1973, Congress has 30 legislative days to overturn any law D.C. passes.

“It’s of deep, personal moral conviction that I stand in opposition” to D.C.’s law, said Rep. Jason Chaffetz of Utah, who chairs the committee, in Monday’s hearing.

The clock is running out on his effort. Republicans in the House and Senate have introduced joint resolutions attempting to block D.C.’s law, but the bills would need to pass the full House and Senate and gain President Donald Trump’s signature. Trump has declined to take a public stance on the matter. If those steps don’t happen by Friday, D.C.’s law will take effect.

Dr. David Stevens, CEO of the Christian Medical & Dental Associations, which opposes medical aid in dying, said even if Republicans fail to overturn D.C.’s law, their efforts may have broader impact.

“As representatives and senators become more educated about the dangers of physician-assisted suicide,” Stevens said, “I wouldn’t be surprised” if members of Congress introduce laws to “prohibit or at least more closely regulate” the practice.

(Courtesy of Amazon.com)

(Courtesy of Amazon.com)

If Congress passes such a law, the only hope for advocates such as Grennan “would be for the Supreme Court to intervene,” she said. But she noted that Trump’s pick for the Supreme Court, Neil Gorsuch, a federal appellate judge on the U.S. Court of Appeals for the 10th Circuit, has published a book against aid-in-dying efforts. The book, she said, notes “the Supreme Court’s power to overturn the state medical aid-in-dying laws.”

Away from Capitol Hill, the aid-in-dying movement has gained steam: The practice is legal in Oregon, Washington, Vermont, Colorado, California and Montana.

Energized by victories in California and Colorado last year, aid-in-dying supporters are pushing ahead to battlegrounds nationwide. So far this year, 21 states have introduced aid-in-dying legislation, according to Compassion & Choices. And in South Dakota, proponents are trying to get the practice approved through a ballot initiative.

Hawaii, Maryland and Maine appear the most likely to pass new legislation this year, said Peg Sandeen, executive director of the Death With Dignity National Center, another national advocacy group.

But opponents have beaten back similar measures in many states in recent years. And in Alabama, South Dakota and New York, they have gone on the offensive, introducing bills to preemptively outlaw the practice or prohibit insurance from paying for the lethal drugs.

Chaffetz, who is leading the charge to overturn D.C.’s law, has enraged Democrats and D.C. officials, who accuse him of overreaching his power by meddling in local affairs. But Chaffetz and fellow House Republicans at Monday’s vote said moral concerns trump local autonomy.

“Only God gets to decide” when a person’s life ends, declared Rep. Paul Mitchell, a Michigan Republican, during the debate.

If Republicans fail this week, they could attack D.C.’s Death With Dignity law in April, when Congress approves D.C.’s proposed budget. D.C. has proposed to spend some local money to build a database tracking the assisted-dying program.

Republican Sen. James Lankford of Oklahoma, who introduced the Senate resolution blocking the bill, also made a legal argument, citing a 1997 law passed under President Clinton that bans the use of federal money for physician-assisted death. Because of that law, Medicare and the Department of Veterans Affairs do not pay for the lethal drugs, so patients must pay out-of-pocket or use private or state-funded insurance. Lankford challenged D.C. to show that its assisted-dying program wouldn’t conflict with that law.

Advocates dismissed that argument. Sandeen, of the Death With Dignity National Center, said D.C.’s program will not use any federal money to help people die. She called the legal argument a “red herring effort,” aimed at distracting attention from politicians’ true reasons for trying to strike down D.C.’s law.

“I’d rather that they said, ‘For religious purposes, I disapprove of this law,’” she said.

KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.

Categories: Aging, Mental Health, Syndicate

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Viewpoints: Will The IRS Do In Obamacare Or Is The Sweeping Health Law Here To Stay Despite Attack?

A selection of opinions on health care from around the country.

The Washington Post: Reality Dawns: Obamacare Might Be Here To Stay
The burgeoning crisis over President Trump’s and former national security adviser Michael Flynn’s connections to Russia makes the already difficult task of repealing and replacing the Affordable Care Act even more confounding for Republicans, who won the White House and both houses of Congress based on unrealistic expectations about an as-yet-unidentified replacement plan. (Jennifer Rubin, 2/15)

Bloomberg: A Rough 24 Hours For Obamacare
The last 24 hours have been one long string of bad news for Obamacare. Tuesday, the insurer Humana announced that it would be pulling out of the exchanges for next year. Then we found out that the IRS had responded to Trump’s executive order on Obamacare by quietly rolling back a new rule planned for this year, which would have required filers to indicate whether they had maintained coverage in 2016 or to pay a penalty. And on Wednesday, word came that Mark Bertolini, the CEO of Aetna, had told a Wall Street Journal conference that Obamacare was in a death spiral. This stands in pretty stark contrast to claims by Andy Slavitt, who ran the Center for Medicare and Medicaid Services under President Barack Obama, that things were shaping up splendidly for 2018, so long as Republicans didn’t screw anything up. (Megan McArdle, 2/15)

Los Angeles Times: Trump’s IRS Stages A Stealth Attack On Obamacare
The Internal Revenue Service has become the first agency to follow President Trump’s directive to start undermining the Affordable Care Act. In a quiet rule change, but an important one, the IRS has told tax preparers and software firms that it won’t automatically reject tax returns that fail to state whether the tax filer had health insurance during the year. That effectively loosens enforcement of the ACA’s individual mandate. It appears to be a direct response to Trump’s Jan. 20 executive order requiring federal agencies “minimize … the economic and regulatory burdens of the Act.” (Michael Hiltzik, 2/15)

The New York Times: Now You Can Do Your Taxes Without Filling Out The Insurance Question
If you want to keep your health insurance status a secret from the I.R.S., the Trump administration just made it a little easier. The policy change, confirmed by the I.R.S. on Wednesday after elements were reported by the libertarian magazine Reason, does not do away with the Affordable Care Act’s requirement that all Americans who can afford it obtain health insurance or pay a fine. But it might make it a little harder for the I.R.S. to figure out who is breaking the rules. (Margot Sanger-Katz, 2/15)

Forbes: 4 Ways GOP Medicare Reform Plan Will Hurt You
Now that Tom Price has been confirmed as Secretary of Health and Human Services, it’s time to examine what he has in store for Medicare. He backs “premium support,” which is the GOP’s backdoor plan to privatize the system. Although GOP leaders such as House Speaker Paul Ryan have said that privatization is the only way to save Medicare — it’s not — there are some dangerous drawbacks for retirees. (John Wasik, 2/15)

RealClear Health: High Risk Pools Solve The Problem Of Preexisting Conditions
One reason health insurance premiums exploded under the Affordable Care Act is the law’s requirement that health insurers accept anyone who applied for individual coverage, known as guaranteed issue. The provision destroys an insurance market because it allows people to wait until a medical incident has occurred to get coverage. (Merrill Matthews and Mark Litow, 2/16)

JAMA: Medical Liability Reform In A New Political Environment
The election of President Donald Trump and a Republican-controlled US Congress may once again thrust medical liability reform into the health care debate. One likely policy solution to be advocated for is to place a cap on noneconomic damages that plaintiffs can recover through lawsuits. This policy proposal is part of the GOP’s A Better Way health care platform and has been part of previous Republican proposals to limit medical malpractice torts despite concerns that federal medical liability reform, by preempting state laws, may potentially weaken successful state regulation in some cases. (Anand Parekh and G. William Hoagland, 2/15)

Bloomberg: The Big Abortion Question For Gorsuch
If the U.S. Supreme Court were to reverse Roe v. Wade, individual states could still permit abortion. But, in theory, the Supreme Court could go further, and rule that laws permitting abortion violate the equal protection rights of unborn fetuses. That may seem far-fetched — but in his book on assisted suicide and euthanasia, Judge Neil Gorsuch lays out an argument that could easily be used to this end. (Noah Feldman, 2/16)

JAMA: Should The Definition Of Health Include A Measure Of Tolerance?
In 1948 the World Health Organization officially defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The definition has remained unchanged for more than 60 years. When it was adopted, tools to measure health did not exist. Indeed, it was decades before a comprehensive set of tools to measure physical, mental, and social well-being were developed. (Robert H. Brook, 2/14)

The New York Times: Congress Says, Let The Mentally Ill Buy Guns
For all their dysfunction, the Republican Senate and House have managed to act with lightning speed in striking down a sensible Obama administration rule designed to stop people with severe mental problems from buying guns. President Trump, who championed the National Rifle Association agenda as a candidate, is expected to sign the regressive measure. This, despite the Republican mantra that tighter control of mentally troubled individuals — not stronger gun control — is the better way to deal with the mass shootings and gun carnage that regularly afflict the nation. (2/15)

The Wichita Eagle: Statewide Health Plan Could Cost Wichita Teachers
One promising idea in a state efficiency study was having school districts join a statewide health insurance plan. But as a new audit found, such a move is complicated and would not save as much money as previously suggested. What’s more, a big share of the potential savings would be cost shifts to schoolteachers, especially in Wichita. In fact, 40 percent of the projected savings would come from shifting costs to teachers and other district employees. And of the $25 million in net cost shifts statewide, nearly $24 million would come from Wichita school district employees. (2/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Longer Looks: A K Street Renegade; Dismantling Obamacare & Opioids In Sierra Leone

Each week, KHN’s Shefali Luthra finds interesting reads from around the Web.

The Wall Street Journal: The Rise And Fall Of A K Street Renegade
Few outside Washington had ever heard of Evan Morris. Yet in the capital of wheeling and dealing, he was one of its most gifted operators. From his start as an intern in the Clinton White House, he made powerful friends and at age 27 became a top Washington lobbyist for Roche Holding AG of Switzerland, one of the world’s largest pharmaceutical companies. (Brody Mullins, 2/13)

Vox: No Limits 
Timmy Morrison was delivered by emergency C-section, weighing in at 3 pounds, 9 ounces. Doctors put him under anesthesia within a week and into surgery within a month. Parts of his stomach sometimes made their way to his lungs. Workers in the intensive care unit frequently needed to resuscitate him. He arrived seven weeks premature — but, in a way, just at the right time. (Sarah Kliff, 2/15)

The Dallas Morning News: Severely Disabled Kids’ Lives At Risk, Parents Say, As Texas Enacts Medicaid Cost-Savings Plan
Amy Pratt drove her severely disabled son, Quinten, four-plus hours to Children’s Medical Center Dallas only to learn the insurance company that Texas hired to care for him had suddenly denied payment for an important procedure, one that could potentially save the 9-year-old’s life. In El Paso, 11-year-old Rudy Smith lost most of the therapy services that helped him cope with cerebral palsy and a severe form of epilepsy, which plagues him with 50 to 100 seizures a day. His mother says she’s having trouble getting prescriptions filled, and the insurance company keeps sending her incorrect or faulty medical supplies. (J. David McSwane, 2/13)

The New York Times: Will Obamacare Really Go Under The Knife?
Six days after he was sworn in as America’s 45th president, Donald J. Trump traveled to Philadelphia to address Republican lawmakers at their annual retreat. Standing behind a lectern emblazoned with the presidential seal, Trump predicted, “This Congress is going to be the busiest Congress we’ve had in decades.” Being Trump, he could not resist ad-libbing a superlative: “Maybe ever. Maybe ever. Think of that.” (Robert Draper, 2/14)

The Atlantic: Universal Health Care And The Future Of The Affordable Care Act 
The Senate confirmed Tom Price as secretary of health and human services at 2 a.m. on Friday. After a contentious confirmation process, the Trump administration and the Republican-controlled Congress had finally installed one of the leading generals in its war on Obamacare in the department that oversees its programs. Price is a titan in the GOP camp that wants to repeal the health law, and is perhaps one of the few Republican lawmakers with both the vision and the experience needed to begin the daunting task. (Vann Newkirk, 2/14)

The New Yorker: Another Planned Parenthood Protest Showdown
In January, 1993, the New York City Council moved unanimously to erect a sign at the intersection of Bleecker and Mott streets designating the small corner on the eastern edge of the West Village as Margaret Sanger Square. The bill, introduced by Kathryn Freed, noted that Sanger had opened America’s first birth-control clinic, in Brooklyn, in 1916, and that when she was arrested and jailed on obscenity charges she had taught her fellow-inmates about contraception. Her second birth-control clinic eventually became part of Planned Parenthood in New York City, which now serves more than fifty thousand patients each year and has been headquartered at the corner of Bleecker and Mott since 1992. (Jia Tolentino, 2/13)

Vox: How Repealing Obamacare Could Splinter Neighborhoods
Sure, it was billed as a policy that would make individual people healthier — and it ended up insuring 20 million people. But it also made neighborhoods healthier. It meant communities no longer had to fight over local tax dollars to care for the uninsured. It also meant there were fewer uninsured people who felt cast out and dehumanized by their communities. It lifted up our poorest and most vulnerable neighbors. (Alvin Chang, 2/13)

Al Jazeera: Opioids: Sierra Leone’s Newest Public Health Emergency
The dark street corner would have been silent if not for the grumble of a motorbike. It was nearing midnight, but for Ibrahim Sesay – a 27-year-old motorbike taxi driver in Freetown – the evening had just begun. He pulled four small pills from his breast pocket, gulped them down without water and set off into the night. (Cooper Inveen, 2/13)      

The Wall Street Journal: Computers Turn Medical Sleuths And Identify Skin Cancer
When it comes to melanoma, early detection is a matter of life and death. But it takes a trained eye to distinguish a harmless blemish from cancer, and many people around the world lack ready access to a dermatologist.Scientists have been seeking a solution for some time. In the latest sign that they’re succeeding, researchers at Stanford University have found a way to get a computer to identify skin cancer as reliably as board-certified dermatologists can. The hope is that, eventually, scientists can get this to happen on a smartphone anywhere in the world. (Daniel Akst, 2/10)

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State Highlights: Surprise Medical Bill Measure Progresses In Ariz. Legislature; Conn. Claims One Of The Lowest Rates Of Uninsurance Naitonally

Outlets report on news from Arizona, Connecticut, California, Missouri, Minnesota, Ohio, Georgia and Washington, D.C.

Arizona Republic: Arizona Lawmakers Propose Relief For Consumers From Unexpected Medical Bills
Health-care consumers who have been stung by surprise medical bills might soon find some relief from an unexpected source: the Arizona Legislature. The problem occurs when a consumer seeks care after checking to be sure a doctor, clinic or hospital is part of their insurance company’s network — only to be billed later by out-of-network providers such as anesthesiologists or surgical assistants who were part of the chain of care. That can sometimes result in a whopping medical tab, with the consumer caught between an insurance company that doesn’t want to pay more and a medical provider who refuses to accept less. (Alltucker, 2/15)

The CT Mirror: CT Uninsured Rate Among Lowest In The Country, Report Says
Connecticut had one of the lowest rates of uninsured residents in the country last year, according to estimates from a federal survey released this week. The estimates from the National Health Interview Survey, released by the National Center for Health Statistics, pegged Connecticut’s uninsured rate at 3.5 percent – but the authors warned that that figure should be used with caution because the potential for error “does not meet standards of reliability or precision.” (Levin Becker, 2/16)

KQED: California Prisons Fight To Reduce Dangerous ‘Valley Fever’ Infections Among Inmates
When the wind kicks up in the town of Coalinga, dust devils whirl over almond orchards and pumpjacks. You can even see the narrow brown funnels from the grounds of Pleasant Valley State Prison, on the outskirts of town.But at the prison itself, there’s hardly any dust. That’s evidence of years of work by the California Department of Corrections and Rehabilitation to reduce and control the San Joaquin Valley’s ubiquitous wind-borne dust. The dust carries the spores of the debilitating fungal disease known as coccidioidomycosis, or “valley fever.” (Klein, 2/15)

St. Louis Public Radio: Refugee Restrictions Disrupt Work Of St. Louis Disease Researchers 
President Donald Trump’s executive order last month reduced the cap of refugees allowed into the United States from 110,000 to 50,000. That means that fewer refugees will be resettled into areas like St. Louis. But the cap also is curtailing disease research across the country. To understand diseases that are widespread in poor, war-torn countries, scientists study refugees from those nations that are infected with those diseases. (Chen, 2/15)

The Star Tribune: Resident Dies After Eden Prairie Caregiver Forgot To Plug In Heart Pump
A distracted aide at an Eden Prairie assisted-living center failed to plug in a resident’s heart pump at bedtime, and the man didn’t live through the night, according to a state investigation released Wednesday. The state Health Department found the facility, Aging Joyfully, at fault in the July 10 death because it had no procedure to ensure the pump would keep operating when switched every night from batteries to electricity from an outlet. (Walsh, 2/15)

San Jose Mercury News: Sunnyvale School Grocery Program Provides Weekend Meals To Students 
For many parents, San Miguel Elementary School is not just a place to fill their children’s minds but their stomachs as well. Since 2015 the school has participated in the Weekend School Food Program organized by Sunnyvale Community Services in partnership with the Sunnyvale School District. The program allows parents and other residents to pick up 32 pounds of donated food twice a month on Fridays. (Kezra, 2/15)

The Washington Post: ‘Urgent Care On Wheels’: Fire Departments Rescuing Patients From Costly ER Trips
In the 15 minutes after firefighters and a nurse knocked at Thelma Lee’s Maryland townhouse, they checked her blood pressure, told her what foods would keep her blood sugar from skyrocketing and set up an appointment — and a ride — to visit her primary-care physician. They also changed the battery in her chirping fire alarm and put a scale in her bathroom so she could monitor her weight. Then they rolled out in an SUV to their next house call. (Bui and Williams, 2/15)

San Jose Mercury News: Palo Alto Marsh To Get Mosquito Control Treatment
Palo Alto’s flood basin and nearby areas will be sprayed Thursday, Feb. 23 with a pesticide in an effort to reduce the growth of salt marsh mosquitoes, which are known for being “very vicious biters.” Russ Parman, assistant manager of the Santa Clara County Vector Control District, said the day-biting salt marsh mosquitoes are not known to transmit diseases such as West Nile or Zika. Officials are concerned, however, that treatment delays caused by winter storms will result in a “big cohort of mosquitoes,” Parman said. (Lee, 2/15)

Cleveland Plain Dealer: 4th Ohio Child Dies Of Flu-Related Illness: What You Need To Know 
A 7-year-old Columbiana County boy who died on Saturday of flu-related illness marked the fourth such death in the state so far this flu season, coming only two days after the death of a Rocky River 6 year old. Eva Harris of Rocky River died February 9th after being admitted to the Cleveland Clinic with a high fever two days earlier. The Columbiana County child was the second from that county to die of flu-related illness since the January 25th death of a 6-year-old Salem boy. (Zeltner, 2/15)

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Cleveland Clinic Reports A 2016 Income Drop — Blames Obamacare Reimbursement Rates And High Drug Prices

Meanwhile, in Florida, Republicans are pushing to repeal the state’s certificate-of-need regulations, a Kansas House committee blocks a bill that would allow the Kansas University Health System to ban concealed firearms and the Florida-based Nemours Children’s Hospital awaits state regulators decision about its new heart and lung transplant center.

Cleveland Plain Dealer: Cleveland Clinic CEO Toby Cosgrove Reports Rough Financial Year For Hospital In 2016
The Cleveland Clinic suffered a nearly 50 percent decrease in operating income in 2016, falling to $243 million from a record high of $481 million the year before, according to a report released Wednesday. During his annual State of the Clinic address to employees, Clinic CEO Toby Cosgrove said the decrease was expected and was driven by falling reimbursement brought about by the Affordable Care Act as well as rising drug costs. (Zeltner, 2/15)

Tampa Bay Times: State Approval Of Increased Hospital Beds Could End This Year
When someone wants to build a new hospital or nursing home in Florida or add beds in an existing facility, the state has to agree that their community has a need for expanded health care. It’s a regulation meant to ensure that poor and rich communities alike have equal access to hospitals, hospices and other health facilities. But at $10,000 to $50,000 per facility application, it’s also costly and can lead to lengthy, even pricier lawsuits. (Auslen, 2/15)

KCUR: Bill Allowing KU Health System To Ban Guns Fails In Committee Vote 
A Kansas House committee narrowly rejected a bill Wednesday that would have allowed the University of Kansas Health System to continue banning concealed firearms. It failed to advance on an 11-11 vote. The chairman of the House Federal and State Affairs Committee, Republican Rep. John Barker of Abilene, chose not to vote to break the tie. A state law set to take effect in July will allow concealed weapons on university campuses and in public hospitals and government buildings unless security is in place to keep out guns. The bill would have exempted the KU Health System. (Koranda, 2/15)

Orlando Sentinel: Nemours Awaits State Decision On Heart Transplant Program
Nemours Children’s Hospital will find out on Friday if the state is going to give initial approval to its application for a new heart and lung transplant program, which would be Central Florida’s first and the fifth in the state. This is good news to parents such as Kelly Green, an Orlando resident whose 9-year-old son has congenital heart disease and might one day need a heart transplant. (Miller, 2/15)

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Public Health Roundup: Identifying Best Breast Cancer Treatment; Study Finds Wider Lead Exposure

Other news stories related to public health cover Zika, the status of a canceled climate change summit, the benefits of Vitamin D on the cold and flu, depression in new dads, cardiovascular disease, ADHD and more.

Stat: Mammograms Plus Genomic Testing Identify Best Breast Cancer Treatments
Critics of annual mammograms point to the issue of overtreatment. Just last month, for example, a report in the Annals of Internal Medicine showed that screening mammograms (those done for women without signs of breast cancer) often lead to unnecessary treatments. One in three women in the study whose breast cancer was identified by a screening mammogram had a potentially harmless disease that may not require treatment. That work has raised questions about the benefits of screening mammograms. The findings of screening studies, including mammography, can be influenced by certain biases in the study design. (Citrin, 2/16)

Modern Healthcare: Report Warns That Lead Contamination Could Be Greater Than Reported 
Current testing for lead contamination does not accurately measure exposure, according to a new report. That could mean providers are facing a whole generation of patients with long-term health effects. An analysis of lead levels in school water fountains across 16 states showed many schools had levels that exceeded the federal threshold of 15 parts per billion. Water from school drinking fountains has increasingly been tested for lead since the contamination crisis in Flint, Mich., sparked municipalities across the country to test their own water supplies. (Johnson, 2/15)

Stat: Zika Persists In Semen, But Shedding Typically Stops In Months
A new study suggests at least half of men who have been infected with Zika will emit traces of the virus in their semen, but in most cases that viral shedding stops after about three months. The research, conducted in Puerto Rico, found that 56 percent of men who had been infected had traces of virus in their semen but about half of them stopped emitting those viral traces by about a month after they first became ill. And by three months after the onset of symptoms, only 5 percent still had virus in their semen. (Branswell, 2/15)

Stat: CDC-Scrapped Climate Change Conference To Happen On Thursday
Remember how CDC officials abruptly cancelled their long-planned climate and health summit right before President Donald Trump took office? Well, an unofficial version featuring many of the same speakers will happen Thursday in Atlanta. After word spread last month of the summit’s cancellation, a group of advocates — led by former Vice President Al Gore — scrambled to put on an one-day version of the original three-day conference so experts in public health, public policy, and climate science could gather to talk about global warming and its impact on public health. (Blau, 2/15)

NPR: Vitamin D Can Reduce Colds And Flu, Study Finds
It’s long been known that Vitamin D helps protect our bones, but the question of whether taking Vitamin D supplements can help guard immunity has been more controversial. An analysis published online Wednesday in the British journal the BMJ suggests supplements of the sunshine vitamin can indeed help reduce the risk of respiratory infections — especially among people who don’t get enough of the vitamin from diet or exposure to sunlight. (Aubrey, 2/16)

Stat: Dads, Like Moms, Are At Risk Of Depression After A Child’s Birth
New dads are at risk of experiencing the same symptoms of postpartum depression as women who’ve just given birth — despite the fact that their bodies don’t go through the same sort of changes. A paper published Wednesday in JAMA Psychiatry finds that just over four percent of new fathers experience elevated symptoms of depression after their children are born. The idea of postpartum depression among new dads is a relatively new one, and the study’s authors say raising awareness about the issue is a critical first step. That, combined with screenings, could help catch symptoms of depression among new fathers and treat them early. (Thielking, 2/15)

The Washington Post: Survival Rate Improves For Extremely Premature Infants
Survival rates for very early preterm infants have improved slightly, according to a study published in the New England Journal of Medicine on Wednesday. Those who survive are also somewhat less likely to suffer from neurodevelopmental impairments, the study found. Researchers gathered survival and neurodevelopmental impairment data for 4,000 extremely premature infants by analyzing records from a National Institutes of Health research network. The infants were born between 22 and 24 weeks of gestation, rather than after a normal 40-week pregnancy. (Naqvi, 2/15)

The Philadelphia Inquirer: Progress In Saving Preemies On The Edge Of Viability
For premature babies born at the edge of viability, the chance of survival without serious health problems has gotten slightly better, at least at the nation’s top neonatal care centers — a small change with potential implications for the bitter abortion debate in  Pennsylvania and other states. Researchers from the 11 centers analyzed the records of more than 4,200 babies born at 22 to 24 weeks of pregnancy between 2000 and 2011. While the grim picture at 22 weeks did not change — 96 percent of newborns died — the outlook for the rest of the “periviable” infants improved over the 12-year period. (McCullough, 2/15)

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Brain Scans May Offer Scientists A Way To Predict Autism In Infancy

The key differences in the MRIs were in how a child’s brain grew in the first year of life. Meanwhile, The Washington Post fact checks President Donald Trump’s claim that the number of autism cases in the country is spiking.

Stat: Brain Scans Show Potential To Diagnose Autism In Infancy
Children with autism tend to be diagnosed around age 4, after a child begins to socialize and speak. But the earlier a child is diagnosed, the better. Early-intervention speech and behavioral therapy programs have shown promise at reducing symptoms. Now, new research shows such a diagnosis could be predicted as early as one year old — based on scans of infants’ brains. Still, the study’s findings need to be repeated with a larger sample size before they could be used in a clinical setting, the researchers noted. (Sheridan, 2/15)

The Star Tribune: U Researchers May Have Found Way To Predict Autism In Kids 
Tracking the brain growth of infants can predict the likelihood that they will be diagnosed with autism in their toddler years, according to new research that could give doctors a head start on treating the developmental disorder. The study, published Wednesday in the prestigious journal Nature, took place at four U.S. hospitals and was co-authored by two University of Minnesota researchers. (Olson, 2/15)

Minnesota Public Radio: New Autism Research From The U Of M Could Lead To Early Detection 
New research from the University of Minnesota could lead to early autism detection in children at high risk of developing the disorder. Using MRI brain scans, researchers across the country, including the U of M, were able to pinpoint changes in the brains of children who later developed autism. And they were able to predict that diagnosis with 80 percent accuracy. (Enger, 2/15)

The Washington Post: Trump’s Claim That There’s ‘Tremendous Amount Of Increase’ In Autism Cases
In a meeting with educators, Trump asked the principal of a center that serves students with disabilities about the prevalence of autism. The principal, Jane Quenneville, spoke about the increasing number of students with autism at the Kilmer Center, a Fairfax County public school. But Trump then claimed that there was a “tremendous amount of increase” in autism in general — “really a horrible thing to watch.” This exchange is especially noteworthy, because Trump wants to create a vaccine safety commission that could roll back vaccine laws based on the widely discredited theory that vaccines cause autism. (Lee, 2/16)

And a look at the president’s potential commission on vaccinations —

Stat: Trump’s Vaccine Commision Will Likely Move Forward
Prominent vaccine skeptic Robert F. Kennedy Jr. said Wednesday that he expects the Trump administration to move forward with a vaccine safety commission and that President Trump pledged that he was “not going to back down” if the drug industry objected to the commission. Kennedy said he had spoken with presidential aides three times since his January meeting with Trump. His understanding is that a commission is still being developed, he said. “Why would anybody not want a vaccine safety commission?” he said at an event with actor Robert De Niro at the National Press Club in Washington. (Scott, 2/15)

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One Doctor Can Set Patient On Trajectory Toward Opioid Abuse

Researchers found that doctors they identified as “high-intensity” prescribers sent one in four patients home with opioids. “Low-intensity” prescribers gave opioids to one in 14 patients. The patients who saw a high-intensity prescriber were 30 percent more likely to become long-term users.

The New York Times: Long-Term Opioid Use Could Depend On The Doctor Who First Prescribed It
Some emergency room doctors are far more likely than others even within their own department to prescribe opioids to treat pain in older people, and their patients are at greater risk of using the powerful drugs chronically than those who saw doctors who prescribe them less frequently, according to a large new study. The research was published Wednesday in The New England Journal of Medicine. (Hoffman, 2/15)

The Washington Post: The Doctor You See In The ER May Put You On A Path Toward Long-Term Opioid Use
The study also found a remarkable difference in opioid prescribing habits by doctors in the very same emergency rooms: “High-intensity prescribers” doled out narcotics during 24.1 percent of patient visits, on average, while “low-intensity prescribers” called for them only 7.3 percent of the time. In addition, patients who received a large dose of opioids at their initial visit were more likely to end up as long-term users. (Bernstein, 2/15)

Stat: Some ER Doctors Three Times More Likely Than Others To Prescribe Opioids
The study suggests that about 1 of every 48 people newly prescribed an opioid will become a long-term user – a number that constitutes a significant potential risk given nearly 300 million opioid prescriptions are written each year in the United States. The huge disparity in prescribing points to another problem. Despite intense scrutiny in recent years of physician prescribing of opioids, detailed clinical guidance on when to prescribe opioids, for what conditions, and in what amounts are lacking in many areas of health care. (Armstrong, 2/15)

In other news on the opioid crisis —

The Wall Street Journal: New Jersey To Limit Amount Of Opioid Pills In Prescriptions
New Jersey Gov. Chris Christie signed legislation Wednesday curtailing the quantity of opioid pills doctors can prescribe for acute pain, a restriction he said is necessary to curb the state’s addiction crisis. The new law lowers the limit on initial prescriptions for opioids to a maximum five-day supply from 30 days for acute pain and directs practitioners to prescribe the lowest effective dose of immediate-release opioid drugs. Mr. Christie, a Republican, has pledged to spend his final year as governor battling the state’s heroin and opioid epidemic. (King, 2/15)

Los Angeles Times: California State Senator Proposes Banning Prescriptions Of Powerful Painkiller Oxycodone For Those Under 21
Seeking to stem the growing opioid abuse crisis, a California state senator is proposing to prohibit prescriptions of the painkiller oxycodone for anyone under the age of 21. Sen. Anthony Portantino (D-La Cañada Flintridge) said his measure, SB 419, would stop younger people from getting early exposure to the highly addictive pain drug, commonly known by its brand name, OxyContin. (Mason, 2/15)

Houston Chronicle: ACA Repeal Could Threaten Treatment For Addiction, Mental Health 
More than 272,000 Texans could lose access to mental health and substance abuse treatment if one of the lesser known guarantees of the Affordable Care Act goes away with the law’s repeal and is not replaced. In Texas alone, 65,559 people with the most serious types of debilitating mental illnesses, such as bipolar disorder or schizophrenia, are now covered by individual plans offered under the health care law, according to a data analysis released this week by the Harvard Medical School and New York University. (Deam, 2/15)

The Courier-Journal: Obamacare Repeal May Threaten Drug Treatment Access
Repealing the Affordable Care Act would result in more than 61,400 Kentuckians with mental illness or substance use disorder losing coverage. That’s according to an analysis by two researchers from Harvard Medical School and New York University that also estimates that more than 133,500 Hoosiers would lose coverage for such behavioral health issues. (Carter, 2/15)

North Carolina Health News: Rural Health Providers Head To DC To Flex Newfound Political Clout
In the past six years, dozens of rural hospitals around the United States have discharged their final patients and turned out the lights, including three in North Carolina. The nation’s crisis of opiate addiction and overdose has been playing out most strongly in rural towns, where family and community ties are strong and overdose deaths hit hard. And research shows there’s a persistent gap in life expectancy between rural and urban communities,  with data showing that rural areas experience poorer health on almost every measure and have less healthcare infrastructure to support residents. (Hoban, 2/15)

The Courier-Journal: Louisville EMS Slammed With 151 Overdose Calls
The city’s top health official told some council members Wednesday that “Louisville needs to grow up” and offer more medication-assisted treatment since abstinence-based programs don’t work for everyone. Some treatment programs don’t allow methadone, Suboxone and Subutex to try to wean addicts off stronger drugs, said Dr. Joann Schulte, who heads the Metro Department of Public Health and Wellness. Critics of using drugs in treatment say this method can merely substitute one addiction for another. (Warren, 2/15)

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The Battle Is Heating Up Between Planned Parenthood And At Least 15 GOP-Controlled Legislatures

In those states, lawmakers are aiming to cut tens of millions of dollars received by the reproductive health organization through Medicaid. Also, abortion-related legislation advances in Indiana, Arizona and Texas.

Arizona Republic: Arizona Abortion Bill May Affect Other Births
A proposal from an Arizona lawmaker to require doctors to do everything possible to save the life of a baby born alive during an abortion could have far broader implications. Senate Bill 1367 would require hospitals and clinics providing abortions at 20 weeks or beyond to have medical equipment on site to care for a fetus delivered alive. If the delivered baby is breathing, has a heartbeat and is moving, doctors must use all available means and medical skills to save its life. But there are concerns that it also would require doctors to perform fruitless medical procedures on a fetus born early due to fatal abnormalities. (Beard Rau, 2/15)

Texas Tribune: Senate Panel Hears Testimony On 3 Abortion-Related Bills 
Senate Health and Human Services Committee members heard emotional testimony from reproductive rights and anti-abortion advocates on Wednesday over Senate Bill 8, Senate Bill 415 and Senate Bill 258. SB 8 and SB 258 would change how providers handle fetal tissue, while SB 415 would ban “dismemberment abortions,” a procedure anti-abortion advocates say involves removing an unborn baby from the womb limb by limb. (Evans, 2/15)

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