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The San Jose Police Department is cracking down on violent crime after the city's 25th homicide this year.

KQED Launches Affordable Care Act Guide

Are you confused about Obamacare? KQED and The California Report created a guide to help answer your questions about the Affordable Care Act.

Ebola Outbreak Prompts Liberia to Close Borders

The world's largest outbreak of Ebola, which began earlier this year in Guinea, has spread to Liberia and Sierra Leone, killing over 670 people in West Africa. With no vaccine and no cure, the virus is deadly for up to 90 percent of those infected. Two U.S. aid workers are now being treated for the virus in Liberia. And on Sunday, Liberia announced it's shutting most of its border crossings after an infected man flew from there to Nigeria. We discuss the Ebola epidemic and the challenges in treating and containing it.

Disproportionate Rates of Melanoma Found in Marin County

A new study shows Marin County has disproportionately higher numbers of melanoma skin cancer than the rest of the Bay Area. The report from the Cancer Prevention Institute of California noted that melanoma incidence was 60 percent higher in Marin compared to the state as a whole. Experts join us to explain the findings and offer skin safety and screening tips for the summer.

PBS NewsHour

Next time you see him, give your doctor a fist-bump

Illustration by Getty Images

Illustration by Getty Images

Don’t shake your doctor’s hand — give her a fist-bump instead, advises a new study in the American Journal of Infection Control. Skipping the handshake could protect you from many types of harmful germs.

Scientists at Aberystwyth University in the United Kingdom tested the germ-exchange rates of handshakes, fist-bumps and high-fives to determine which mode of mano-to-mano contact spreads the most bacteria. In the study, one participant wore a sterile glove and exchanged various types of hand contact with other study participants. The sterile glove was analyzed and the number of bacteria present were counted.

The results showed that fist-bumps transferred a tiny fraction of the germs handed off during a handshake. High-fives transfer about half as many germs as a firm shake.

“Adoption of the fist-bump as a greeting could substantially reduce the transmission of infectious diseases between individuals,” said co-author, David Whitworth, PhD.

The handshake has been under fire by the medical research community as of late, with an article in JAMA calling for a ban on hand-to-hand greetings published in June.

Hand-hygiene in hospitals is a topic of intense study due to the emergence of more types of antibiotic-resistant bacteria, the negative environmental effects of antibacterial soaps and the realization that simple cultural changes could help to reduce the risks of infection in the first place.

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Marketplace shoppers discover new health plans have many limitations

Hisham Uadadeh enrolls in a health insurance plan under the Affordable Care Act at Leading Insurance Agency in Miami,
         Florida. Photo by Joe Raedle/Getty Images

Hisham Uadadeh enrolls in a health insurance plan under the Affordable Care Act at Leading Insurance Agency in Miami, Florida. Photo by Joe Raedle/Getty Images

Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.

“They said, ‘We take the old plan, but not the new one,’” says Perez, an attorney in Palo Alto, California.

In Plymouth, Indiana, Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.

Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect.

“It’s totally different,” said Pippenger, 57, whose new Anthem Blue Cross plan doesn’t pay for any care outside its network, although the job-based Anthem plan she had last year did cover some of those costs. “To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.”

Consumer groups argue many enrollees were misled. In California, consumers filed class-action lawsuits against some insurers, alleging they were given inaccurate information about their plans’ limitations and about which doctors and hospitals participate in them.Consumer groups argue many enrollees were misled. In California, consumers filed class-action lawsuits against some insurers, alleging they were given inaccurate information about their plans’ limitations and about which doctors and hospitals participate in them.

Nationally, regulators and insurance agents are inundated with complaints, while state lawmakers are considering rules to ensure consumers’ access to doctors. For 2015 plans which will be on sale beginning in November, the federal Department of Health and Human Services said it will more closely scrutinize whether networks are adequate.

Insurers say they are simply trying to provide low-cost plans in a challenging environment. The new federal health law doesn’t let them reject enrollees with health problems or charge them more just because they are sick. So they are using the few tools left to them — contracting with smaller groups of hospitals and doctors willing to accept lower reimbursements; requiring referrals for specialty care and limiting coverage outside those networks.

“Obamacare products have lower prices than they would have if they had had [larger] commercial networks,” said Robert Laszewski, an industry consultant and former insurance executive. “They’re one-size-fits-all networks designed for low-income people accessing insurance for the first time.”

Lower Prices, Limited Choice
Lower monthly premiums made such plans attractive to many consumers on the new exchanges. Some chose tightly managed plans — often called health maintenance organizations (HMOS) or exclusive provider organizations (EPOS) – specifically because of their cost, in some cases, without realizing the tradeoffs.

Others had no choice.

Anthem, one of the biggest sellers of individual insurance, offers only HMO-like plans through the new markets in six of the 14 states it serves, including New Hampshire, where it is the only insurer. In California, where the insurer is the target of two class-action lawsuits, it offers plans with no out-of-network benefits in Los Angeles, San Diego and San Francisco, although another type of plan is available in other counties.

Anthem spokeswoman Kristin Binns said the insurer decided to move heavily into managed care in many of its markets after research showed most consumers, especially those who were uninsured, cared about price first and foremost.

“HMOs give them much more access than they were afforded before,” Binns said.

Still, she said Anthem expects to roll out plans with out-of-network coverage in 2015 in some areas where it does not offer them. She would not specify the regions.

Other insurers made similar decisions, offering managed care plans as the only choice for residents buying through the new marketplaces in entire counties in Indiana, Georgia, South Carolina, Virginia, Florida, Wisconsin and Mississippi, according to government data analyzed by Kaiser Health News. Nationally, 43 percent of mid-level “silver” plans offered in California, New York and 34 states using the federal marketplace have no coverage outside their networks, a study by the American Cancer Society Cancer Action Network found.

“They’re all doing it,” says Wall Street analyst Ana Gupte of Leerink Swann, an investment bank. “Obamacare is putting pressure on their margins, so they’re on the hook to moderate costs.”

But along with consumers, lawmakers and regulators have begun to push back.

In California, managed care regulators are investigating Anthem and another insurer, Blue Shield of California, after receiving numerous complaints about access to doctors and hospitals.

Lawmakers in 22 states debated laws this year and last related to network adequacy, although the vast majority failed to pass, according to the National Conference of State Legislatures. In Washington state, administrative rules announced this spring require insurers to provide enough primary care doctors so enrollees can get an appointment within 10 days and 30 miles of their home or workplace. Directories of participating providers must be updated monthly.

“I have heard from many consumers … who were upset to find their health plan no longer included their trusted doctor or hospital … and some discovered this only after they enrolled,” Washington Insurance Commissioner Mike Kreidler said in an announcement of the rules in April.

Scrambling To Find Doctors

Brian Liechty of TCU Insurance in Plymouth, Indiana, said he has helped “hundreds” of clients sign up for tightly managed plans – including Pippenger, when her work-based plan was discontinued.

“For the right person who is willing to go where they must and live with rules, it allows them to buy a health insurance policy they could never touch before,” he said.

Patient advocates agree that managed care can be done well but caution that some policies could leave patients scrambling to find doctors – and on the hook for thousands of dollars if they go out of network.

“If highly specialized care — an academic medical center or a cancer center — is not available in a plan’s network … some plans will send you to an out-of-network provider, but it’s not required,” said Laura Skopec, senior policy analyst at the cancer action network.

Going out of a managed care plan’s network often means patients foot the entire bill, which can be financially devastating in cases of serious illness. In other types of insurance plans, a portion of the out-of-network bill might be covered, but consumers still face sharply higher costs than if they see a network provider.

Pippenger said that because she was in pain and knew she might need surgery, she checked the provider directory for her new plan, looking for an orthopedic surgeon within 30 miles. She found five who specialized in hips and knees, but felt anxious because she knew nothing about them.

“I want to go back to the doctor who did my other knee,” she said.

She paid for an initial consultation with him, but realized she couldn’t afford the cost of having him fix her second knee.

Adding to the problem this year were some plans’ incomplete or inaccurate lists of participating doctors and hospitals.

Perez, 46, bought her insurance through California’s state-run website. Before enrolling, the immigration attorney says she was assured by the plan and her doctors that they were in Anthem’s network. Only later did she find out that none of those affiliated with her local hospital, Stanford Medical Center, are in it.

Perez said she was unable to find a doctor affiliated with Stanford or another nearby hospital, so she filed a complaint with state regulators and was granted a waiver to switch plans.

“I’ve been paying a premium since March for medical care that I’ve never been able to access,” she said.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. This story also ran in USA Today.

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Second American tests positive for Ebola in Liberia

         of the international aid organization, Samaritan's Purse, put on protective gear at the ELWA hospital in Monrovia, Liberia.
         Dr. Kent Brantly, an American who was recently infected by Ebola, is currently being treated at the hospital's isolation center.

Staff of the international aid organization, Samaritan’s Purse, put on protective gear at the ELWA hospital in Monrovia, Liberia. Dr. Kent Brantly, an American who was recently infected by Ebola, is currently being treated at that hospital’s isolation center. Credit: AFP Photo/Zoom Dosso via Getty Images

A second American citizen working to treat Ebola patients in Liberia has tested positive for the deadly virus, an international aid organization reported Sunday, amid the outbreak that has ravaged West Africa since March. 

Nancy Writebol, a North Carolina woman and an employee of the Christian humanitarian group, Serving in Mission, contracted the disease while working at a hospital in Monrovia, Liberia. She has been working in the region since March.

On Saturday, the North Carolina-based Samaritan’s Purse said that Dr. Kent Brantley, 33, a Texas doctor working at the same hospital, also tested positive for Ebola and was undergoing treatment at the isolation center in Monrovia where he worked.

The center will continue to remain open, the aid organization said in a press release.

The organization’s website says Writebol has two children and Brantly has worked as a family practice physician in Forth Worth, Texas, and is married with two children.

Earlier this week, Sheik Umar Khan, a leading Ebola doctor in Sierra Leone, was also infected with the virus. 

Occurrences of aid workers contracting the diseases they were trying to treat are common — something Dr. Brantly spoke out about earlier this year.

“In past Ebola outbreaks, many of the casualties have been healthcare workers who contracted the disease through their work caring for infected individuals,” Brantly said.

West Africa’s Ebola epidemic is now the deadliest on record, according to the World Health Organization, which said the virus has a mortality rate of about 60 percent and has lead to more than 660 deaths.

Responding to the outbreak has been particularly challenging for international relief organizations, as they routinely encounter violence and mistrust among West African communities.

Earlier this month PBS NewsHour’s Jeffrey Brown spoke with Laurie Garrett of the Council on Foreign Relations about the buildup of resentment against health workers trying to contain the Ebola outbreak. 

“It is a general fearfulness from the population,” Garrett said. “Widespread crazy rumors, such as the doctors are infecting people … and you have to stay away because they are ruining hospitals. All of this is making the problem absolutely catastrophic.”

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Why automatic renewal of 2015 health coverage may backfire

         At A Health Clinic As Obamacare Exchanges Begin

Certified nurse practitioner Myra Tilson conducts a check-up on a patient at a Community Clinic Inc. health center in Takoma Park, Maryland, U.S., on Tuesday, Oct. 1, 2013. Health insurance experts say customers who opt for convenience by automatically renewing their coverage for 2015 are likely to receive dated and inaccurate financial aid amounts.

WASHINGTON — If you have health insurance on your job, you probably don’t give much thought to each year’s renewal. But make the same assumption in one of the new health law plans, and it could lead to costly surprises.

Insurance exchange customers who opt for convenience by automatically renewing their coverage for 2015 are likely to receive dated and inaccurate financial aid amounts from the government, say industry officials, advocates and other experts.

If those amounts are too low, consumers could get sticker shock over their new premiums. Too high, and they’ll owe the tax man later.

Automatic renewal was supposed to make the next open-enrollment under President Barack Obama’s health care overhaul smooth for consumers.

But unless the administration changes its 2015 approach, “they’re setting people up for large and avoidable premium increases,” said researcher Caroline Pearson, who follows the health law for the market analysis firm Avalere Health.

It could be a new twist on an old public relations headache for the White House: You keep the health plan you like but get billed way more.

“It was our preference for (the administration) to have the capacity to update people’s subsidy information, but they haven’t been able to get that built,” said Brendan Buck, a spokesman for the industry trade group America’s Health Insurance Plans.

Here’s the issue, in a nutshell:

To streamline next year’s open enrollment season, the Health and Human Services Department recently proposed offering automatic renewal to 8 million consumers who are already signed up.

But the fine print of the HHS announcement said consumers who auto enroll will get the “the exact dollar amount” of financial aid they are receiving this year.

That’s likely to be a problem for a couple of reasons, not to mention inflation.

First, financial aid is partly based on premiums for a current benchmark plan in the community where the consumer lives. Because more plans are joining the market and insurers are submitting entirely new bids for 2015, the benchmark in many communities will be different.

Second, financial aid is also based on household income. If your income goes down, you are entitled to a bigger health insurance tax credit. If it goes up, you get less. The 2014 amounts could well be out of date and incorrect for many people. Financial assistance is also affected by age, family size and where people live.

And that doesn’t get into another motivation for consumers to shop around: Premiums and choices for 2015 are changing, so your current plan may no longer be a good deal.

“Just continuing in the same plan with the same credit is not going to be the optimal outcome for most people,” said Judy Solomon of the Center on Budget and Policy Priorities, which advocates for low-income people. “Your 2014 credit is going to be lower in most cases, and in some cases it could be too high.”

About 8 in 10 of those who signed up for private coverage under the health care law are getting financial aid. In the 36 states served by the federal insurance exchange, the tax credits average $264 a month, reducing the average monthly premium of $346 to just $82.

Even with such generous subsidies, about 4 in 10 who bought a health law plan say they have trouble paying their premiums, according to a poll by the nonpartisan Kaiser Family Foundation.

Open enrollment starts Nov. 15, and consumers who already have a policy will have just about a month to renew or make changes to avoid a break in coverage Jan. 1. Millions of new customers are also expected to try to sign up for the first time.

New Health and Human Services Secretary Sylvia Mathews Burwell is hoping that auto renewal will simplify things, a welcome change from this year’s website problems.

But the subsidy scheme created by Congress to keep premiums affordable has so many moving parts that it’s turning out to be difficult for the government to administer.

Administration spokesman Aaron Albright says all consumers are encouraged to contact their health insurance exchange to update any changes in personal and financial details. You can do that at any time, before the open-enrollment crunch.

However, you will have to wait until the fall to change to a new plan for next year.

Even if the financial aid amounts are off the mark, some advocates say auto renewal is still a safeguard to keep some people from falling through the cracks.

“It is not a perfect solution, but I’m not sure that there is a better solution in terms of protecting people so they don’t lose health coverage,” said Ron Pollack, executive director of Families USA, an advocacy group supporting the overhaul.

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