Tagged Uninsured

California’s Long-Shot Single-Payer Health Bill Advances

“It is time to say once and for all that health care is a right, not a privilege for those who can afford it,” said Democratic state Sen. Ricardo Lara of Bell Gardens, who wrote the bill along with Democratic state Sen. Toni Atkins of San Diego. However, an essential question is unanswered: Where will the money come from?

Los Angeles Times: California Single-Payer Healthcare Bill Passes First Committee Test
The Senate Health Committee approved the measure on a 5-2 vote after a nearly three-hour hearing, but Democrats and Republicans alike signaled unease with the major question still unanswered in the legislation: how the program would be paid for. The bill, SB 562, would establish a publicly run healthcare plan that would cover everyone living in California, including those without legal immigration status. The proposal would drastically reduce the role of insurance companies: The state would pay for all medical expenses, including inpatient, outpatient, emergency services, dental, vision, mental health and nursing home care. (Mason, 4/26)

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: Examining Minn. Measles Outbreak; Arizona Lawmakers Continue Efforts On Workers’ Comp Coverage For First Responders

Media outlets report on news from Minnesota, Arizona, Illinois, North Carolina, Ohio, Texas, California, Maryland, Pennsylvania and Massachusetts.

Arizona Republic: Arizona Firefighters Call For Expansion Of Health-Care Coverage
Arizona firefighters gathered outside the state Capitol on Tuesday to call for an expansion of health-care coverage to treat conditions that could arise later in life. Firefighters have been working with Arizona legislators for several months to pass House Bill 2161 and House Bill 2410, both of which would expand workers’ compensation insurance coverage for first responders. (Dantuono, 4/25)

The Star Tribune: Minn. Ruling On Abuse At Group Home Likely To Be Far-Reaching One 
Four years ago, a woman with severe mental illness poured a pot of boiling water over Michael Sorenson as he sat in his wheelchair at a Bloomington group home, leaving him with burns covering 35 percent of his body. This week the Minnesota Court of Appeals ruled that the group home operator cannot claim legal immunity under a 1967 state law and shield itself from more than $1 million in potential civil damages. (Serres, 4/25)

San Francisco Chronicle: Novato Oxygen Equipment Supplier Pays $11.4 Million In Settlement 
A major supplier of home oxygen equipment has agreed to pay $11.4 million to settle accusations that it profiteered by filing false reimbursement claims with the government and arranging kickbacks with sleep-testing clinics, federal officials said Tuesday. Justice Department and health care officials announced the settlement with Pacific Pulmonary Services, which is based in Novato and has more than 100 outlets in 20 states. (Egelko, 4/25)

Morning Consult: HHS Settles With Mobile Health Company Over Records
A mobile health company has reached a $2.5 million settlement with the Department of Health and Human Services, in the first case of its kind involving the protection of health records. CardioNet, a Malvern, Pa.-based subsidiary of BioTelemetry that operates a mobile monitoring system for patients diagnosed with cardiac arrhythmia, will pay the settlement for not properly securing sensitive patient data and for possibly violating federal privacy laws. (Reid, 4/24)

WBUR: ‘Trauma Teams’ To Help Boston Residents In Higher Crime Areas Cope In Wake Of Violence
The city of Boston will deploy “trauma response and recovery teams” to several neighborhoods in the aftermath of violent incidents, as part of a new program announced Tuesday. The teams will connect residents in Roxbury, Dorchester, Jamaica Plain, East Boston and Mattapan who have been victims of or exposed to violence — like homicides, shootings or stabbings — with mental health services and ongoing support. (Creamer, 4/25)

The Associated Press: Texas Advocates Push Longshot Pot Bills With Veterans, Moms
Medical marijuana advocates in Texas are promoting support from more conservative sources to push longshot legislation that would ease pot laws in a state that’s lagging behind much of the rest of the country on medical marijuana. Conservative Christian mothers of autistic children and veterans suffering post-traumatic stress disorder rallied outside the state Capitol on Tuesday, entreating the Republican-majority Legislature to advance two bills legalizing medicinal cannabis, one by San Antonio Democratic Sen. Jose Menendez and one by Rep. Eddie Lucio III, a Brownsville Democrat. (4/25)

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

Desafío para el sistema de salud: los hombres hispanos que no buscan atención médica

BALTIMORE – Peter Uribe dejó Chile a los 21 años con su esposa y su hija de 2, aterrizando en Baltimore y encontrando un trabajo estable en la construcción. Su vida social giraba alrededor del fútbol, deporte que practicaba ​​”seis o siete noches a la semana en distintos torneos”, contó.

Un par de años después de su llegada, se rompió el pie durante un partido y, temeroso de lo que le podía costar un tratamiento, no buscó atención médica.

“Algunos en mi familia me advirtieron que, si iba al hospital y no podía pagar la factura, tendría un historial de crédito malo”, dijo Uribe, de 41 años, que ganaba cerca de $300 por semana y no tenía seguro de salud. “Algún día quería comprar un auto o una casa”. En vez de eso, cojeó durante las horas de trabajo y permaneció fuera del campo de juego por tres años. Dos décadas después, el dolor que siente todavía lo paraliza.

Por razones económicas y culturales, los hispanos no quieren interactuar con el sistema de salud. Las mujeres de todas las razas tienen más probabilidades de buscar atención que los hombres. Pero la brecha de género en la comunidad hispana es especialmente preocupante para los proveedores de atención médica. Estudios muestran que los hombres latinos son mucho menos propensos que las latinas a recibir tratamiento.

Y esto es una verdad, aun cuando los hispanos son más propensos que los blancos no hispanos a ser obesos, tener diabetes o hipertensión. Aquellos que toman tienden a beber mucho, contribuyendo a mayores tasas de cirrosis alcohólica y muertes por enfermedad hepática crónica. Muchos toman trabajos de riesgo, como los obreros de la construcción y los jornaleros, y tienden a morir más a causa de lesiones en el trabajo que otros trabajadores, muestran datos del gobierno.

Use Nuestro Contenido

Los hispanos pasarán a ser un cuarto del total de la población para 2045. A medida que este número crece, los investigadores temen que el país podría enfrentar consecuencias costosas ya que las condiciones médicas que son ignoradas llevan a enfermedades más graves y a discapacidad.

“Podría literalmente quebrar el sistema de atención de salud”, dijo José Arévalo, presidente de la Junta de Médicos Latinos de California, que representa a médicos hispanos y a otros que atienden a latinos.

Y ahora, algunos médicos también temen los efectos de la represión del presidente Donald Trump contra los inmigrantes ilegales.

“Cuando la comunidad se enfrenta a este tipo de estrés, me preocupa que la gente haga cosas poco saludables, como abusar del alcohol, para enfrentar el problema”, dijo Kathleen Page, co-directora del Centro SOL, un centro de salud en el Johns Hopkins Bayview Medical Center, y fundadora del Latino HIV Outreach Program de la ciudad. “Eso significa que pueden no trabajar tanto”, agregó. Por lo que “tendrán menos dinero, lo que significa que es menos probable que busquen atención”.

Bienvenidos por funcionarios de Baltimore, los inmigrantes han impulsado la población hispana de la ciudad, triplicándola a 30.000 desde el año 2000.

Aquí, como en otros lugares, la evidencia sugiere que, para muchos hispanos, buscar atención médica es un evento extraordinario. Los datos de los hospitales muestran que son más propensos que las mujeres hispanas, y los hombres y mujeres blancos no hispanos a usar las salas de emergencia como su principal fuente de tratamiento, una señal de que esperan hasta no tener otra opción más que buscar ayuda.

Algunos proveedores de atención dicen que las instituciones médicas no han hecho lo suficiente para mantener a los hombres hispanos sanos, o para persuadirlos de hacerse exámenes regulares.

“Hay una necesidad continua de que las instituciones se adapten más culturalmente y sean más conscientes de los prejuicios”, dijo Elena Ríos, presidenta de la National Hispanic Medical Association, que representa a los 50,000 médicos latinos de la nación.

Hay algunas diferencias significativas en el riesgo de salud y las tasas de enfermedad entre los subgrupos hispanos, por ejemplo, los puertorriqueños son más propensos a ser fumadores. En comparación con los hispanos nacidos en los Estados Unidos, los nacidos en otros lugares tienen tasas mucho más bajas de cáncer, enfermedades del corazón y presión arterial alta. En general, los hispanos viven más que los blancos no hispanos.

Pero estas ventajas pueden disiparse a medida que los latinos se “americanizan” y adoptan hábitos no saludables como el tabaquismo y dietas ricas en alimentos grasos y procesados.

“Le digo a la gente que vivimos más tiempo y sufrimos más”, dijo Jane Delgado, psicóloga clínica cubanoamericana, quien es presidenta de la National Alliance for Hispanic Health.

Los expertos que investigan brechas en las pruebas de cáncer han descubierto que todos los grupos étnicos y géneros han visto una disminución en los diagnósticos de cáncer de colon en etapa terminal y las muertes en los últimos años, excepto en los hombres hispanos, que se hacen la colonoscopía en tasas más bajas que cualquier raza o grupo étnico.

A menudo, los problemas de salud surgen después de que los inmigrantes se enfrentan a una barrera con el seguro médico. Años después de que José Cedillo viniera a Baltimore desde Honduras, el cocinero de 41 años notó que sus piernas se entumecían y le dolían con frecuencia. Preocupado por el dinero, evitó el tratamiento y siguió trabajando, hasta que finalmente fue a una clínica, en donde le diagnosticaron diabetes.

En los siete años que han pasado desde entonces, su salud se ha deteriorado tanto que no puede trabajar, con frecuencia no tiene un techo en donde dormir y pasa largos períodos en el hospital. Como inmigrante que llegó a los Estados Unidos sin papeles, no es elegible para cobertura pagada por el gobierno o para recibir dinero por discapacidad. Y no puede pagar los medicamentos. En cambio, dijo: “Bebo para adormecer el dolor”.

El inmigrante hondureño de 41 años, quien solía trabajar como cocinero, fue diagnosticado con diabetes. Por su estatus migratorio no pudo conseguir seguro médico, y hoy tiene una salud precaria y muchas veces duerme en las calles de Baltimore. (Doug Kapustin para KHN)

Otra parte del problema es que los hispanohablantes están subrepresentados entre los profesionales médicos. Después de llegar aquí, a los miembros de la familia de Uribe los acompañaba un sobrino o sobrina que hablaba inglés cuando podían permitirse el acceso a médicos. De lo contrario, “íbamos lejos para encontrar un médico que hablaba español”, dijo.

Con frecuencia, los hospitales carecen de servicios multiculturales y de personal bilingüe, admiten los administradores. Aunque los latinos representan casi el 20% de la población, sólo el 7% de las enfermeras registradas y el 5% de los médicos son hispanos. La brecha se ha ampliado a medida que más hispanos han llegado a este país durante las últimas tres décadas, según un estudio de la Universidad de California en Los Ángeles publicado en 2015.

“Demasiado seguido, la gente no entiende lo que usted está diciendo, no sabe lo que usted va a cobrar, qué restricciones dietéticas les estamos aconsejando”, explicó James Page, vice presidente para diversidad en Johns Hopkins Medicine. “Esto crea un problema de confianza para los hispanos. Tenemos que mejorar la forma de atenderlos”.

Esto es particularmente cierto en la salud mental. Sólo el 1% de los psicólogos en los Estados Unidos son hispanos, lo que significa que los hombres de habla hispana que buscan terapia probablemente tendrán que esforzarse para encontrarla en su lengua materna.

En Baltimore, sólo hay un grupo de apoyo en español para hombres que sufren de ansiedad y depresión, dicen psicólogos locales y defensores de los latinos. La ciudad emplea a un consejero para abuso de sustancias que habla español. Un puñado de trabajadores sociales bilingües de la ciudad ofrecen sesiones de asesoramiento a tarifas reducidas y sólo tres psiquiatras ofrecen sesiones de terapia en español.

Para Peter Uribe, la clave para mantener la salud de su familia es conseguir ayuda para pagar la atención. Su esposa y su hermano sufren de ataques epilépticos, y Uribe contó que el desánimo de su hermano hizo que él mismo se deprimiera. En 2015, obtuvo seguro para su familia a través de un programa de caridad. Con la ayuda de medicamentos ahora asequibles, las convulsiones de su esposa disminuyeron, y él buscó ayuda para su depresión crónica. Como ahora habla inglés, encontrar consejería es más fácil.

En enero, después de la intervención de un grupo de defensa de los latinos, la caridad renovó la póliza de salud de los Uribe por dos años. Pedro Uribe lo llama una bendición:

“Sinceramente no tengo ni idea de lo que haríamos sin este seguro”.

Michael Anft es periodista y escritor, y vive en Baltimore. Su trabajo aparece regularmente en AARP: The Magazine, The Chronicle of Higher Education y otras publicaciones. Daniel Trielli, periodista especializado en datos en Capital News Service, en el Philip Merrill College of Journalism, contribuyó para este informe.

La cobertura de Kaiser Health News sobre disparidades de salud en el este de Baltimore es apoyada por  The Annie E. Casey Foundation.

Categories: Mental Health, Noticias En Español, Public Health, Uninsured

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Reluctant Patients, Hispanic Men Pose A Costly Challenge To The Health System

BALTIMORE — Peter Uribe left Chile at 21 with his wife and 2-year-old daughter, landing in Baltimore and finding steady work in construction. His social life revolved around futbol, playing “six or seven nights a week in soccer tournaments,” he said.

A couple of years after his arrival, he broke his foot during a game and afraid of the cost, didn’t seek medical care.

“Some of my family warned me that if I went to the hospital and couldn’t pay the bill, I’d get a bad credit record,” said Uribe, 41, who made about $300 a week and had no health insurance. “I wanted to buy a car or a house someday.” Instead, he hobbled through workdays and stayed off the field for three years; the residual pain is sometimes disabling, even two decades later.

For reasons both economic and cultural, Hispanic men are loath to interact with the health system. Women across all races are more likely to seek care than men. But the gender gap in the Hispanic community is especially troubling to health care providers. Studies show that Latino men are much less likely than Latinas to get treatment.

That is true even though Hispanic men are more likely than non-Hispanic whites to be obese, have diabetes or have high blood pressure. Those who drink tend to do so heavily, contributing to the group’s higher rates of alcoholic cirrhosis and deaths from chronic liver disease. Many take risky jobs such as construction workers and laborers, and are more likely to die from on-the-job injuries than other workers, government data show.

Hispanics’ share of the population is expected to widen from nearly a fifth now to a quarter by 2045. As that number grows, researchers worry that the nation could face costly consequences as long-ignored conditions lead to serious illness and disability.

“It could literally break the health care system,” said José Arévalo, board chairman of Latino Physicians of California, which represents Hispanic doctors and others who treat Latinos.

And now, some medical professionals fear the effects of President Donald Trump’s crackdown on illegal immigrants.

“When the community faces this kind of stress, I worry that people will do unhealthy things, like abuse alcohol, to deal with it,” said Kathleen Page, co-director of Centro SOL, a health center at Johns Hopkins Bayview Medical Center, and founder of the city’s Latino HIV Outreach Program. “That means they may not work as much,” she added. “They’ll have less money, which means they’re less likely to seek care.”

Welcomed by Baltimore officials, immigrants have driven the city’s Hispanic population, tripling it to 30,000 since 2000.

Here, as elsewhere, evidence suggests that for many Hispanic men, seeking health care is an extraordinary event. Hospital data show they are more likely than Hispanic women, white women and white men to go to the emergency room as their primary source of treatment — a sign that they wait until they’ve no choice but to get help.

Some care providers say medical institutions haven’t done enough to keep Hispanic men healthy, or to persuade them to get regular exams.

“There’s been an ongoing need for institutions to become more culturally attuned and aware of bias,” said Elena Rios, president of the National Hispanic Medical Association, which represents the nation’s 50,000 Latino physicians.

There are some significant differences in health risk and illness rates among Hispanic subgroups — Puerto Ricans are more likely to be smokers, for example. Compared with Hispanics born in the U.S., those born elsewhere have much lower rates of cancer, heart disease and high blood pressure. Overall, Hispanics live longer than whites.

But these advantages may be dissipating as Latinos become Americanized and adopt unhealthy habits such as smoking and diets high in fatty, processed foods.

“I tell people we live longer and suffer,” said Jane Delgado, a clinical psychologist and Cuban-American who serves as president of the National Alliance for Hispanic Health.

Researchers who investigate gaps in cancer testing have found that all ethnic groups and genders have seen a decrease in late-stage colon cancer diagnoses and deaths in recent years — except Hispanic men, who get screened at the lowest rates of any race or ethnic group.

Often, health problems arise after immigrants come up against an insurance barrier. A few years after Jose Cedillo came to Baltimore from Honduras, the 41-year-old cook noticed his legs were often numb or painful. Worried about finances, he eschewed treatment and continued to work, before finally going to a clinic where he was diagnosed with diabetes.

In the seven years since, his health has so deteriorated he can’t work, is frequently homeless and spends long stints in the hospital. As an immigrant who came to the U.S. illegally, he is not eligible for government-paid insurance or disability payments. And he can’t afford medicine. Instead, he said, “I’ll drink alcohol to numb the pain.”

Jose Cedillo, a 41-year-old former restaurant worker from Honduras struggles to get health care for his diabetes. His immigration status compounds his issues and often finds himself without a job and homeless on the streets of Baltimore. (Doug Kapustin for KHN)

Part of the problem is that Spanish speakers are underrepresented among medical professionals. After arriving here, Uribe’s family members frequently brought along an English-speaking nephew or niece when they could afford to see doctors. Otherwise, “we’d travel a long ways to find a doctor who spoke Spanish,” he said.

Hospitals frequently lack cultural understanding and bilingual staffing, administrators admit. Though Latinos make up nearly 20 percent of the population, only 5 percent of physicians and 7 percent of registered nurses are Hispanic. That gap has widened as more Hispanics have come to this country during the past three decades, according to a UCLA study released in 2015.

“Too often, people don’t understand what you’re saying, they don’t know what you’re going to charge them, what dietary restrictions you might place upon them,” said James Page, vice president for diversity at Johns Hopkins Medicine. “It creates a trust issue for Hispanics. We’ve got to get better at serving them.”

That is particularly true in mental health. Only 1 percent of psychologists in the U.S. are Hispanic, meaning that Spanish-speaking men who do seek therapy will probably struggle to find it.

In Baltimore, there is only one Spanish-language support group for men who suffer from anxiety and depression, local psychologists and Latino advocates say. The city employs one Spanish-speaking substance abuse counselor. A small handful of bilingual social workers citywide offer reduced-rate counseling sessions, and only three psychiatrists offer therapy sessions conducted in Spanish.

For Peter Uribe, the key to maintaining his family’s health is getting help paying for care. His wife and brother both suffer from epileptic seizures, and his brother’s despondency caused Uribe to become depressed, he said. In 2015, he obtained insurance for his family through a charity program. With the help of now-affordable medicines, his wife’s seizures waned, and he sought help for chronic depression. Since he now speaks English, finding counseling help is easier.

In January, after intervention from a Latino advocacy group, the charity renewed the Uribes’ policy for two years. Peter Uribe calls it a godsend:

“I honestly have no idea what we’d do without it.”

Michael Anft is a Baltimore-based journalist and writer whose work regularly appears in AARP: The Magazine, The Chronicle of Higher Education and other publications. Daniel Trielli, a data journalist at Capital News Service at the Philip Merrill College of Journalism, contributed to this report.

The Annie E. Casey Foundation supports KHN’s coverage of health disparities in east Baltimore.

Categories: Mental Health, Public Health, Uninsured

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Eager For A Victory, Trump Hypes Renewed GOP Health Plan; Lawmakers Remain Skeptical

The deal, which is being hashed out between Rep. Tom MacArthur (R-N.J.) and Freedom Caucus leader Rep. Mark Meadows (N.C.), would let states seek waivers on preexisting conditions and to set their own list of essential health benefits. Republican congressional aides, however, are throwing cold water on the optimism coming out of the White House.

The New York Times: White House Officials, Craving Progress, Push Revised Health Bill
White House officials, desperate to demonstrate progress on President Trump’s promise to repeal the Affordable Care Act, are pushing to resurrect a Republican health care bill before his 100th day in office next week. Some members of the president’s team have grown consumed by that deadline, worrying that appraisals of the president’s tenure will be brutal and hoping that a last push on health care might bring a measure of salvation. (Flegenheimer and Ableson, 4/20)

The Associated Press: White House Pushes Uncertain Bid To Revive Health Care Bill
The White House optimism is driven largely by a deal brokered by leaders of the conservative Freedom Caucus and the moderate Tuesday Group aimed at giving states more flexibility to pull out of “Obamacare” provisions. A senior White House official acknowledged that it was unclear how many votes Republicans had, but said House Speaker Paul Ryan, R-Wis., has told the White House that a vote could come together quickly. Yet GOP lawmakers and aides to party leaders, conservatives and moderates alike were skeptical that the House would vote next week on the health legislation. (Fram and Pace, 4/20)

The Washington Post: White House Turns Up Heat On Congress To Revise The Affordable Care Act
The fresh hopes for resuscitating the American Health Care Act are pegged to an amendment being offered by Rep. Tom MacArthur (R-N.J.) that aims to attract enough conservatives and moderates that the measure can pass in the House. White House officials said language would be circulated among members in the next few days, and the modifications will be discussed Saturday in a conference-wide call as Republicans prepare to return to Washington next week. The MacArthur amendment would allow states to obtain permission from the federal government to write their own list of essential health benefits and allow insurers to charge people with preexisting conditions higher premiums, as long as they also make a high-risk pool available to those patients — a change conservatives have demanded. As a concession to moderates, the amendment would also add back federal requirements for essential health benefits, which the measure’s current version instead leaves up to states. (Winfield Cunningham, Snell and Wagner, 4/20)

Los Angeles Times: Trump Is Trying To Repeal Obamacare Again, But He Still Doesn’t Have The Votes
Rep. Tom MacArthur (R-N.J.), a centrist who has been working on the new language, said in a Facebook post that sick patients would still be able to get coverage because states would be required to offer a special health plan, known as a high-risk pool, for people unable to get other coverage. “This amendment will make coverage of preexisting conditions sacrosanct for all Americans,” he said. But these high-risk pools were almost universally unsuccessful before the advent of Obamacare, and the new GOP proposals drew swift criticism from many patient advocates and others. (Levey, 4/20)

Politico Pro: Inside The Latest GOP Offer On Obamacare Repeal 
The GOP’s latest proposal is a concept called “invisible risk sharing,” which would effectively create a federal backstop for health insurers. The idea — modeled after a similar program in Maine — aims to keep everyone covered while lowering premiums and freeing states to eliminate key Obamacare insurance protections. “There’s no magic here,” said Rep. Tom MacArthur (R-N.J.), who is pushing the idea as a way to bridge the divide between GOP conservatives and moderates. “Either policyholders have to pay the bills or taxpayers have to pay the bills.” (Demko and Cancryn, 4/20)

NPR: GOP Health Proposal Could Ditch Protections For People Who Are Sick
The plan “would make coverage unaffordable for many older consumers and would segregate high-cost consumers in coverage that would likely be inadequate,” says Timothy Jost, a professor emeritus at Washington and Lee Law School who writes a health policy blog for Health Affairs. The proposal could also cause premiums to spike for people with medical issues, according to comments posted on Twitter by Topher Spiro, vice president for health policy at the left-leaning Center for American Progress. (Kodjak, 4/20)

The Hill: Trump On ObamaCare Repeal And Preventing Shutdown: ‘I Want To Get Both’ 
[A] number of GOP aides have suggested it might not be enough to get the bill through the House because of continued opposition from centrists. Rep. Dan Donovan (R-N.Y.), a moderate lawmaker, said on MSNBC Thursday that he is still opposed to the bill despite the latest changes. “It doesn’t actually address the concerns I have for the people I represent, the people of New York City,” Donovan said. “But I suspect it might get some folks on board that maybe weren’t before. But the hope is that they don’t lose other people.” (Fabian and Easley, 4/20)

The Hill: ObamaCare Replacement Deal Hits Major Speed Bumps 
“The question is whether it can get 216 votes in the House, and the answer isn’t clear at this time,” said a senior GOP aide, referring to the number of votes likely necessary to pass the legislation. “There is no legislative text and therefore no agreement to do a whip count on.” “I don’t know that the state of play has really changed over the recess,” said another House GOP aide. (Sullivan and Hellmann, 4/20)

CQ HealthBeat: Republicans Have No Deal On Obamacare Repeal But Talks Continue
“Republicans’ latest plan is to expose Americans with pre-existing conditions to staggering new health costs,” House Minority Speaker Nancy Pelosi, D-Calif., said in a statement. “Now, by gutting protections for people with pre-existing conditions, Republicans will make it all but impossible for millions of Americans fighting illness to afford the health coverage they desperately need.” (Williams, 4/20)

Politico: White House Pressures GOP Leaders On Obamacare Showdown Next Week
The White House does not schedule House floor votes. And while some senior administration officials suggested Thursday that a vote will occur next week, multiple House GOP sources told POLITICO that is unlikely. Indeed, the vote is not currently on the calendar. Nor do Republican insiders think it’s even possible, as Congress will reconvene Tuesday after a two-week Easter recess. That would leave them with one day to whip votes — an unlikely time frame for such a heavy legislative lift. (Bade, Dawsey and Cancryn, 4/20)

The Wall Street Journal: Trump, GOP Race To Avoid Government Shutdown As They Juggle Health-Care Revamp
The White House has thrust a new set of proposals into talks to avoid shutdown of the government next week, while also seeking to revive a health-care overhaul that had collapsed last month. With less than a week to pass legislation funding the government for the rest of the fiscal year, negotiations are beginning to take shape. Democrats are demanding that the legislation include money for insurance companies, without which fragile insurance markets could implode, while the White House in return wants additional money for defense, the border wall and border enforcement. (Radnofsky, Hughes and Peterson, 4/20)

The Baltimore Sun: Maryland Democrats Resist Latest Obamacare Repeal Effort 
Four Democratic members of the state’s congressional delegation told voters gathered at a town hall meeting in Baltimore on Thursday that they will continue to push back on Republican efforts to repeal Obamacare, including a new plan expected in coming days. “I don’t know that we’re going to be able to avoid to fight this every single month,” said Rep. John Sarbanes of Baltimore County, a member of the House Energy and Commerce Committee. “I pledge to you [that] we’re going to fight as hard as we can.” (Fritze, 4/20)

Politico Pro: Texas Lawmakers Weigh Reopening High-Risk Pool
Republican state lawmakers, closely tracking Obamacare repeal efforts in Washington, may look to reopen the state’s shuttered high-risk pool to insure Texans who can’t get coverage elsewhere. Bills in the Texas House and Senate would allow the state insurance commissioner to set up a temporary high-risk pool if federal funds become available. (Rayasam, 4/20)

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

Food For Thought: Ideas For The GOP On Pushing People Toward Coverage; And What If Some Places Have No Health Plans?

Editorial writers across the country contemplate different aspects of how Republicans continue to mull repealing and replacing Obamacare and how some states are continuing to consider and act on the Medicaid expansion.

The Wall Street Journal: How The GOP Could Nudge The Uninsured Toward Coverage
Republicans in Congress say they’ll keep working on health-care reform. It never made sense to give up after only a few months of trying, but their plan would have better prospects if they modified it to address the criticism that it would leave too many people without insurance. The solution is to enroll uninsured Americans automatically in no-premium health coverage. (James C. Capretta and Lanhee J. Chen, 4/18)

Los Angeles Times: Republicans Base Their New Obamacare Repeal On A Maine Program They Call A Success. Don’t Believe Them
When our hard-working members of Congress return to work next week refreshed from their 18-day Easter recess, they’re planning to take up healthcare reform again. This time, their Affordable Care Act repeal effort has been dressed up with a new provision known as “invisible risk sharing,” based on what they assert was a successful program in Maine. They’re blowing smoke. (Michael Hiltzik, 4/18)

The (Baton Rouge, La.) Advocate: Roll Out Of Medicaid Popular In State
Perhaps it sounds a little odd, but people both in Louisiana and elsewhere are sometimes fuzzy about the differences between the Affordable Care and Patient Protection Act, expanded Medicaid, and “Obamacare” — the politically charged term that involves the whole of the parts. … The survey, conducted by the LSU Public Policy Lab, found that Louisiana residents approve of the state’s decision to expand its Medicaid program last year under the auspices of the Affordable Care Act, or ACA — but respondents to the survey remain deeply divided over the ACA itself. … Many GOP members of [the] House and Senate balked at Medicaid expansion when it was a party litmus test during the terms of former Gov. Bobby Jindal; now, though, [Gov. John Bel Edwards] actions have provided a significant financial lifeline for working people in low-wage jobs who had no meaningful access to health care before. (4/19)

The Kansas City Star: Reconsider Medicaid Expansion Before Another Kansas Hospital Closes Its Doors
Let’s be clear: Expanding Medicaid might not have been enough to save St. Francis Health, the Topeka hospital that stands on the brink of closure. But few doubt that the millions of dollars that expansion would have brought to the nonprofit Catholic health center would have made a substantial difference. Most likely, the doors would have remained open for months longer. In the words of House Minority Leader Jim Ward, a “lifeline” would have been extended. (4/18)

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