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Obamacare Repeal Could Leave Millions Uninsured

Trump has vowed he will repeal Obamacare and replace it with something "better." This could affect millions of Californians. Specifics are scarce, but one plan Trump has outlined is to change how the federal government funds Medicaid, health coverage for low-income people.

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PBS NewsHour

Lawmakers seek to help e-cigarette makers escape new regulations

A man smokes an electronic cigarette vaporizer, also known as an e-cigarette, in Toronto, August 7, 2015. Many of the
         world's junior miners are laying down their picks and shovels to start new ventures ranging from egg exporting to e-cigarette
         company, as they as try to survive a crash in metals prices by shifting away from exploration. Picture taken on August 7,
         2015.    REUTERS/Mark Blinch - RTX1PBBR

A man smokes an electronic cigarette vaporizer, also known as an e-cigarette, in Toronto, August 7, 2015. Photo by Mark Blinch/Reuters

WASHINGTON — 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 Representatives Tom Cole (R-Okla.) and Sanford Bishop (D-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.

The “FDA Deeming Authority Clarification Act of 2017” is an attempt by the lawmakers to set FDA policy back to where it was before the agency asserted authority over cigars, pipe tobacco, and vapor products such as e-cigarettes.

The so-called deeming rule’s “grandfather” clause states that companies selling any such product after Feb. 15, 2007, must now disclose their ingredients and prove that their products meet the applicable public health standards set by the law.

Cole and Bishop’s proposal would get rid of the “grandfather” clause.

READ NEXT: FDA issues sweeping regulations for e-cigarettes for first time

“Vapor products offer a promising path for harm reduction for those seeking to quit or limit their smoking,” said Bishop in a statement. “This legislation would ensure the FDA’s regulatory process does not limit the availability of safer tobacco options for those seeking to make use of them.”

“The FDA effectively is making it more difficult for vapor products to come to market than cigarettes,” a statement from Cole’s office said.

The industry fought the FDA proposal for years, enlisting big-name lobbyists like former Sen. Mary Landrieu, among others, from big tobacco companies. Vapor shop owners and cigar makers and sellers also joined the fight.

Matthew L. Myers, president of the Campaign for Tobacco Free Kids, said he was not surprised by the re-appearance of the bill, which was also introduced last year.

“By working on what purports to be a technical change, “ Myers said, “ it leaves on the market the candy and fruit-flavored e-cigarettes that are so popular among young people.”

“You can put any gloss on it you want, this is the tobacco industry’s effort to continue to market flavored tobacco products to hook another generation of kids.”

This article is reproduced with permission from STAT. It was first published on Feb. 16, 2017. Find the original story here.

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Treatment gaps persist between low- and high-income workers, even with insurance

Photo via Getty Images

Treatment gaps still exist between workers at different wage levels. Photo via Getty Images

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.

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.’”

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. You can view the original report on its website. Please visit to send comments or ideas for future topics for the Insuring Your Health column.

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McConnell intends to replace ‘Obamacare’ without Democrats

Senate Majority Leader Mitch McConnell speaks with the media Feb. 17 at the U.S. Capitol in Washington, D.C. Photo by
         REUTERS/Aaron P. Bernstein .

Senate Majority Leader Mitch McConnell speaks with the media Feb. 17 at the U.S. Capitol in Washington, D.C. Photo by REUTERS/Aaron P. Bernstein .

WASHINGTON — Republicans will repeal and replace the health care law and overhaul the tax code without Democratic help or votes, Senate Majority Leader Mitch McConnell said Friday.

“It’s clear that in the early months it’s going to be a Republicans-only exercise,” the Kentucky senator said at a news conference before lawmakers left for a weeklong President’s Day recess. “We don’t expect any Democratic cooperation on the replacement of Obamacare, we don’t expect any Democratic cooperation on tax reform.”

READ MORE: House GOP documents outline plan to replace Obamacare

McConnell has condemned Democrats for passing Obamacare in the first place, in 2010, without any Republican votes, claiming the partisan exercise set the law up to fail. “The mess to come was inevitable,” McConnell wrote in his memoir last year.

But now he’s promising the same approach himself, in a sign that the partisanship and polarization dividing the country and Congress under President Donald Trump will not end anytime soon.

“Clearly this is not one of those bipartisan ‘Kumbaya’ moments, and so we, as Republicans, expect that both of those issues will be — which are very big issues — will have to be tackled Republican-only,” McConnell said.

A strictly partisan approach on major legislation is a departure in the Senate, where most significant bills require involvement by both parties. Republicans plan to use a parliamentary maneuver to get health care and tax legislation through the narrowly divided Senate as part of a budget bill that requires only a simple majority to pass and can’t be blocked by Democrats.

But McConnell said the polarization in Congress is Democrats’ fault because they haven’t come to terms with the fact that Trump won the election.

“I’m hopeful that, as I said earlier, when the fever breaks, that maybe we’ll be able to move on,” said McConnell, in a turn of phrase that former President Barack Obama sometimes used to express hope that opposition from the tea party right might recede, which it never did.

READ MORE: Trump administration ushers in changes to Obama health law

McConnell made his comments as the Senate confirmed Oklahoma Attorney General Scott Pruitt to lead the Environmental Protection Agency. It was the 14th Senate vote to approve Cabinet and Cabinet-level nominations by Trump, most of them pushed through on nearly party-line votes over angry Democratic protests.

“It is the worst Cabinet, I think, in the history of America, certainly in my lifetime,” Minority Leader Chuck Schumer of New York fumed ahead of the vote. “A swamp Cabinet, billionaires, bankers.”

But Democrats have been able to do little to stop the confirmations, though they have slowed the process to a crawl, and one Trump nominee, Andy Puzder, withdrew himself from contention for labor secretary, an outcome Democrats claimed as a victory.

Democrats may be similarly powerless to stop Republicans from repealing and replacing Obama’s health care law and overhauling the tax code, but on those issues, divisions within the GOP already threaten to derail the process. Key Senate Republicans have rejected the House GOP approach to paying for the tax overhaul, while important details are missing that could easily derail the House GOP health care plan, such as how much it will cost.

READ MORE: House GOP struggles for consensus on replacing health law

Overall, with the White House distracted and lurching from one crisis to another, Republicans lament they have little to show for their efforts at a point when Obama had already claimed major legislative accomplishments as his administration ended its first month.

“We’re three weeks into a new administration, and we’re not getting a hell of a lot done,” Rep. David Joyce, R-Ohio, said earlier this week.

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‘Deaths of despair’ are cutting life short for some white Americans

A recent survey is shedding light on how patients who get perscription
         painkillers  — drugs such as OxyContin, methadone or Vicodin — sometimes share or mishandle them. Photo by Education Images/UIG
         via Getty Images

Watch Video | Listen to the Audio

JUDY WOODRUFF: Now a look at a demographic trend that is surprising the experts.

Despite decades of advancements in health care, diet and safety, middle-aged white Americans are now living shorter, not longer, lives.

Our economics correspondent reports in the latest installment of Making Sense.

PAUL SOLMAN: Maysville, Kentucky, in the northeast corner of the state, just a short bridge away from Ohio, despite some merchants’ best efforts at cosmopolitan outreach, the downtown is struggling. But at one local establishment, business is brisk and growing.

DAVID LAWRENCE, Mason County Coroner: This is the Batesville 20-gauge steel protector.

PAUL SOLMAN: This one is Churchill blue.

DAVID LAWRENCE: Churchill blue. We can get this in a misty rose for the ladies.

PAUL SOLMAN: David Lawrence manages the Knox & Brothers Funeral Home, is also the county coroner. He’s been seeing a lot of dead white males of late, especially ages 45 to 54.

DAVID LAWRENCE: A lot of it due to alcohol or drug abuse.

DR. WILLIAM CRAIG DENHAM, Family Physician: There has been a Denham practicing medicine.

PAUL SOLMAN: Craig Denham wears multiple hats too.

DR. WILLIAM CRAIG DENHAM: This small bag is my grandfather’s medical kit.

PAUL SOLMAN: A fifth-generation Kentucky family physician.

DR. WILLIAM CRAIG DENHAM: My great-great-grandfather’s.

PAUL SOLMAN: He’s also medical director for the fire department’s emergency service.

DR. WILLIAM CRAIG DENHAM: In the past two, two-and-a-half years, we have had about a 300 percent increase in the drug-related overdose ambulance runs. And the prevalence of opiate addiction in this area continues to increase.

BECKY MANNING, Widow: He’s like, mom, it’s nothing that you did. It’s me.

PAUL SOLMAN: Becky Manning’s son got hooked on drugs. Fortunately, he’s still alive.

BECKY MANNING: Almost 40 now.

PAUL SOLMAN: But she blames the drugs in part for her husband’s suicide.

BECKY MANNING: He just carried this tremendous guilt for everything, for our son doing drugs. Then he started getting depressed, and then my husband took his own life.

PAUL SOLMAN: How did he do it?

BECKY MANNING: He blew his head off. I came home to that.

PAUL SOLMAN: Best friend Marcy Conner’s husband also killed himself.

MARCY CONNER, Widow: He developed alcoholism very young in life.

PAUL SOLMAN: An addiction he shared with lifelong friends.

MARCY CONNER: One died with a heart attack, but drug use and alcohol use played all the way through his life. Another one died of cancer, drank up to the very end. And my husband actually had a G-tube in, a feeding tube in, and poured alcohol down his feeding tube until he died.

BECKY MANNING: Alcohol poisoning.

PAUL SOLMAN: These cases fit a disturbing national pattern. Though U.S. life expectancy has been going up steadily over the last century, there’s now been a sudden and dramatic reversal, for just one demographic.

ANNE CASE, Economist: White non-Hispanics in America, middle-age, are dying in large numbers.

ANGUS DEATON, Economist: It was certainly a huge surprise to me.

PAUL SOLMAN: Economists Angus Deaton and Anne Case, who are married, published their finding just after Deaton won the 2015 Nobel Prize in economics.

The paper showed that, starting in 1999, the death rate of middle-aged white Americans has been going up, instead of down.

ANGUS DEATON: We thought we must have made an error. I mean, the whole world is getting better. This middle-aged group is the one that’s benefited most, at least since 1970, from advances in the treatment of heart disease, from people quitting smoking, all of those things. And then suddenly for this trend that’s going down just to reverse out seemed like it had to be wrong. But it wasn’t wrong.

PAUL SOLMAN: The big increase was in what Case calls deaths of despair, alcohol-related liver disease, suicide, drug overdose.

ANNE CASE: People kill themselves slowly with alcohol or drugs, or quickly with a gun. For people aged 50-55, for example, those rates went from 40 per 100,000 to 80 per 100,000 since the turn of the century.

And it’s people with a high school degree or less who are killing themselves in these ways in large numbers. That’s the group that’s getting hammered.

DR. ELLEN KUMLER, Mason County Health Department: And now the CDC is paying more attention to that age group and demographic.

PAUL SOLMAN: Ellen Kumler, a public health doctor for Mason County, Kentucky, says the latest data from the Centers for Disease Control pick up where the Case-Deaton study leaves off.

DR. ELLEN KUMLER: When we look at the suicide rate, when we look at unintentional injuries, a lot possibly related to substance abuse, as well as liver disease, the rates of those issues have actually increased.

PAUL SOLMAN: Marcy Conner is a nurse specializing in substance abuse who has experienced deaths of despair time and again in her own family.

MARCY CONNER: I had a brother that committed suicide, also.

PAUL SOLMAN: And two cousins, one of them a nurse.

MARCY CONNER: And he started telling me that his depression medication wasn’t working as well, and pain medication wasn’t working as well. And he lost his temper at work one night and got fired.

PAUL SOLMAN: Got fired.

MARCY CONNER: They found him hanging in his garage.

PAUL SOLMAN: And the other cousin?

MARCY CONNER: She overdosed.

PAUL SOLMAN: And why so much drug use and abuse? Anne Case and Angus Deaton found something else in their study.

ANNE CASE: Since at least the mid-1990s, people’s reports of pain, of sciatic pain, of neck pain, of lower back pain year on year have increased.

MAN: Our best, strongest pain medicines are the opioids.

PAUL SOLMAN: The mid-’90s was also when the opioid painkiller OxyContin was approved by the FDA, and began to be marketed aggressively to doctors.

MAN: They do not have serious medical side effects, and so these drugs, which I repeat, are our best, strongest pain medications, should be used much more than they are for patients in pain.

PAUL SOLMAN: Within five years, the drug’s maker, Purdue Pharma, was earning a billion-dollars-a-year profit on OxyContin, which soon rose to $3 billion. As for the lack of serious side effects? Well, it did have one.

ANGUS DEATON: It’s basically heroin in a pill with an FDA label on the front. So, people get addicted to this.

ELIZABETH EASTON, Recovering Painkiller Addict: I started on oxycodone, or OxyContin, in high school.

PAUL SOLMAN: Elizabeth Easton is now in recovery.

ELIZABETH EASTON: I unleashed something horrid in me many years ago from doing one — one pill. I went from taking them to snorting them to, yes, injecting, which is really, really horrid.

PAUL SOLMAN: Because you have got to have it.

ELIZABETH EASTON: You have to. It’s the only thing that makes you feel normal. And it’s the farthest thing from normal.

BECKY MANNING: It controls your life. You’re a different person.

PAUL SOLMAN: That’s what Becky Manning saw in her son.

BECKY MANNING: Seeking and finding the next high was his priority, no matter who he took down with him.

MARCY CONNER: The brain is telling you, I have got to have it again. I need more. So that’s where you end up with that craving. The craving ends up with, you know, seeking supply.

PAUL SOLMAN: And though lawsuits and a government crackdown have helped curb the supply of OxyContin, cheap heroin is more than filling the void.

DR. WILLIAM CRAIG DENHAM: If you can’t get your pain pills that you’re abusing, you’re going to find the source somewhere. And so people are turning to the street drug heroin, which is more dangerous, in the sense that you’re taking something made in somebody’s garage vs. something made in a factory.

CHRISTOPHER RUHM, Economist: In many areas, it’s cheaper to get high on heroin than it would be to get drunk.

PAUL SOLMAN: Economist Chris Ruhm.

CHRISTOPHER RUHM: This is a major health crisis. I mean, drug poisonings have become the biggest source of preventable premature death. So, for example, there are more drug poisoning deaths than car crash deaths. And that’s quite recent.

PAUL SOLMAN: And says Dr. Denham:

DR. WILLIAM CRAIG DENHAM: I’m seeing just as many middle-aged women as I am middle-aged men.

PAUL SOLMAN: Bucking a century-long improvement in white longevity.

DAVID LAWRENCE: People without jobs and people kind of just keeping themselves secluded from others.

PAUL SOLMAN: For the PBS NewsHour, economics correspondent Paul Solman, reporting grimly from Maysville, Kentucky.

JUDY WOODRUFF: And, next week, Paul returns to Maysville to ask the obvious question: Why the startling increase in deaths in white America?

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