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"title": "Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown",
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"content": "\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cstrong> Updated 10:30 a.m. Tuesday \u003c/strong>\u003c/p>\n\u003cp>After seven years of promising to repeal the Affordable Care Act, Republican efforts at passing a health care bill on their own may have ended Monday night as the bill working its way through the Senate was effectively blocked. Two more GOP senators — \u003ca href=\"https://www.lee.senate.gov/public/index.cfm?p=press-releases&id=988195A6-7C42-4878-A59F-3FA344D170C9\">Mike Lee\u003c/a> of Utah and \u003ca href=\"https://twitter.com/JerryMoran/status/887108026246803456\">Jerry Moran\u003c/a> of Kansas — came out in opposition to the bill, which means it cannot get enough support to pass.\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\n\u003cp dir=\"ltr\" lang=\"en\">My colleague \u003ca href=\"https://twitter.com/SenMikeLee\">@SenMikeLee\u003c/a> and I will not support the MTP to this version of BCRA. \u003ca href=\"https://twitter.com/hashtag/HealthcareBill?src=hash\">#HealthcareBill\u003c/a>\u003c/p>\n\u003cp>— Jerry Moran (@JerryMoran) \u003ca href=\"https://twitter.com/JerryMoran/status/887107267824406528\">July 18, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>Shortly afterward, President Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\">wrote\u003c/a>, “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!”\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\n\u003cp dir=\"ltr\" lang=\"en\">Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!\u003c/p>\n\u003cp>— Donald J. Trump (@realDonaldTrump) \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\">July 18, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>Senate Majority Leader Mitch McConnell put out a statement promising to do just that, pointing to a 2015 bill passed by Congress and vetoed by President Barack Obama. It would repeal the ACA with a two-year delay, giving a fixed deadline for Congress to replace the law. McConnell would still need 50 votes to bring that to the floor.\u003c/p>\n\u003cp>McConnell has previously said turning to Democrats to come up with fixes for the current health care system is his next step, and several senators who criticized the crafting of the current bill in private have called for such a bipartisan process.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One such senator is John McCain, R-Ariz., who was kept from returning to Washington this week due to unexpected surgery for a blood clot, requiring GOP leaders to delay their push for the overhaul bill. In a statement late Monday, McCain \u003ca href=\"https://www.mccain.senate.gov/public/index.cfm/press-releases?ID=B2B6EBD7-6DF4-4E2D-BB59-98B40EAAA784\">said\u003c/a>, “The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care.”\u003c/p>\n\u003cp>McCain has been among the more moderate Republicans who have joined several GOP governors in opposing the Republican health care bill’s proposed cuts to Medicaid. The bill would have represented a generational restructuring of the entitlement program. The Congressional Budget Office has not yet given its estimates on the impact of the latest Senate bill, but estimates on an earlier version showed the reductions in Medicaid coverage would have meant 15 million fewer Americans would have coverage under the program in 10 years.\u003c/p>\n\u003cp>In addition to paralyzing the GOP on its top political pledge for the better part of a decade, stalling on the health care bill could tie up the rest of the party’s agenda, including efforts at major tax reform. The health care bill has dominated work on Capitol Hill for the first six months of Trump’s term, typically the most potent period for an administration to move legislation, which is also the first period in a decade when the GOP has controlled both chambers of Congress and the White House.\u003c/p>\n\u003cp>On Tuesday Trump said he was deeply “disappointed” by the collapse of the GOP effort to rewrite Obama’s health care law.\u003c/p>\n\u003cp>Trump told reporters during a lunch with service members that Republicans have been talking for years about repealing and replacing “Obamacare,” and is disappointed they couldn’t deliver. He said it’s time to “Let Obamacare fail,” and says that “I’m not going to own it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Trump said letting Obamacare fail will encourage Democrats to come to the table and negotiate. He also says he does not blame Majority Leader Mitch McConnell for the decision by two more Republican senators to come out against the legislation, effectively killing the bill.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Republican+Health+Care+Bill+Falls+Short%2C+Dealing+Blow+To+Trump+Agenda&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong> Updated 10:30 a.m. Tuesday \u003c/strong>\u003c/p>\n\u003cp>After seven years of promising to repeal the Affordable Care Act, Republican efforts at passing a health care bill on their own may have ended Monday night as the bill working its way through the Senate was effectively blocked. Two more GOP senators — \u003ca href=\"https://www.lee.senate.gov/public/index.cfm?p=press-releases&id=988195A6-7C42-4878-A59F-3FA344D170C9\">Mike Lee\u003c/a> of Utah and \u003ca href=\"https://twitter.com/JerryMoran/status/887108026246803456\">Jerry Moran\u003c/a> of Kansas — came out in opposition to the bill, which means it cannot get enough support to pass.\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\n\u003cp dir=\"ltr\" lang=\"en\">My colleague \u003ca href=\"https://twitter.com/SenMikeLee\">@SenMikeLee\u003c/a> and I will not support the MTP to this version of BCRA. \u003ca href=\"https://twitter.com/hashtag/HealthcareBill?src=hash\">#HealthcareBill\u003c/a>\u003c/p>\n\u003cp>— Jerry Moran (@JerryMoran) \u003ca href=\"https://twitter.com/JerryMoran/status/887107267824406528\">July 18, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>Shortly afterward, President Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\">wrote\u003c/a>, “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!”\u003c/p>\n\u003cblockquote class=\"twitter-tweet\">\n\u003cp dir=\"ltr\" lang=\"en\">Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!\u003c/p>\n\u003cp>— Donald J. Trump (@realDonaldTrump) \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\">July 18, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>Senate Majority Leader Mitch McConnell put out a statement promising to do just that, pointing to a 2015 bill passed by Congress and vetoed by President Barack Obama. It would repeal the ACA with a two-year delay, giving a fixed deadline for Congress to replace the law. McConnell would still need 50 votes to bring that to the floor.\u003c/p>\n\u003cp>McConnell has previously said turning to Democrats to come up with fixes for the current health care system is his next step, and several senators who criticized the crafting of the current bill in private have called for such a bipartisan process.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One such senator is John McCain, R-Ariz., who was kept from returning to Washington this week due to unexpected surgery for a blood clot, requiring GOP leaders to delay their push for the overhaul bill. In a statement late Monday, McCain \u003ca href=\"https://www.mccain.senate.gov/public/index.cfm/press-releases?ID=B2B6EBD7-6DF4-4E2D-BB59-98B40EAAA784\">said\u003c/a>, “The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care.”\u003c/p>\n\u003cp>McCain has been among the more moderate Republicans who have joined several GOP governors in opposing the Republican health care bill’s proposed cuts to Medicaid. The bill would have represented a generational restructuring of the entitlement program. The Congressional Budget Office has not yet given its estimates on the impact of the latest Senate bill, but estimates on an earlier version showed the reductions in Medicaid coverage would have meant 15 million fewer Americans would have coverage under the program in 10 years.\u003c/p>\n\u003cp>In addition to paralyzing the GOP on its top political pledge for the better part of a decade, stalling on the health care bill could tie up the rest of the party’s agenda, including efforts at major tax reform. The health care bill has dominated work on Capitol Hill for the first six months of Trump’s term, typically the most potent period for an administration to move legislation, which is also the first period in a decade when the GOP has controlled both chambers of Congress and the White House.\u003c/p>\n\u003cp>On Tuesday Trump said he was deeply “disappointed” by the collapse of the GOP effort to rewrite Obama’s health care law.\u003c/p>\n\u003cp>Trump told reporters during a lunch with service members that Republicans have been talking for years about repealing and replacing “Obamacare,” and is disappointed they couldn’t deliver. He said it’s time to “Let Obamacare fail,” and says that “I’m not going to own it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Trump said letting Obamacare fail will encourage Democrats to come to the table and negotiate. He also says he does not blame Majority Leader Mitch McConnell for the decision by two more Republican senators to come out against the legislation, effectively killing the bill.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Republican+Health+Care+Bill+Falls+Short%2C+Dealing+Blow+To+Trump+Agenda&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain’s absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama’s health care law.\u003c/p>\n\u003cp>McCain’s office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain’s office says he’ll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a “crusty voice in Washington.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump added, “Plus, we need his vote.”\u003c/p>\n\u003cp>Trump brought up McCain while calling for the repeal of the national health care law during a trade event at the White House.\u003c/p>\n\u003cp>McCain’s absence has led Senate leaders to postpone action on the health care measure. It needs almost every Republican vote to pass.\u003c/p>\n\u003cp>But the postponement also gives McConnell and the White House more time to cut the deals they need to rescue the imperiled measure.\u003c/p>\n\u003cp>McConnell signaled Monday that days of bargaining and persuasion with reluctant colleagues lie ahead. He says the only way to prevail “is with continued hard work, and that’s just what we intend to do. ”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AARP is aiming TV and radio ads at undecided, moderate Republican senators in five states. From the right, Americans for Prosperity is rallying its members to urge senators to make the bill even more conservative.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain’s absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama’s health care law.\u003c/p>\n\u003cp>McCain’s office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain’s office says he’ll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a “crusty voice in Washington.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump added, “Plus, we need his vote.”\u003c/p>\n\u003cp>Trump brought up McCain while calling for the repeal of the national health care law during a trade event at the White House.\u003c/p>\n\u003cp>McCain’s absence has led Senate leaders to postpone action on the health care measure. It needs almost every Republican vote to pass.\u003c/p>\n\u003cp>But the postponement also gives McConnell and the White House more time to cut the deals they need to rescue the imperiled measure.\u003c/p>\n\u003cp>McConnell signaled Monday that days of bargaining and persuasion with reluctant colleagues lie ahead. He says the only way to prevail “is with continued hard work, and that’s just what we intend to do. ”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AARP is aiming TV and radio ads at undecided, moderate Republican senators in five states. From the right, Americans for Prosperity is rallying its members to urge senators to make the bill even more conservative.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Aaron Albaugh peers out from under the brim of his cowboy hat, surveying the acres of hay fields in front of him. The fourth-generation \u003ca href=\"http://www.frostyacres.net/index.html\">rancher\u003c/a> is raising about 450 cattle this year, in this remote corner of Lassen County.\u003c/p>\n\u003cp>His closest neighbor lives a half mile away. “And that’s my brother,” Albaugh says.\u003c/p>\n\u003cp>“If I want to go see a movie, it’s 70 miles round trip,” he adds. “If I want to go bowling, that’s 100 miles round trip.”\u003c/p>\n\u003cp>Living a half day’s drive from civilization, you learn to do without, he explains. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.\u003c/p>\n\u003cp>“Put a Band Aid on it,” Albaugh says. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So, when people are already used to doing without health coverage, it’s particularly annoying to have the government say you have to buy it, according to Albaugh and many of his neighbors in Lassen, Modoc and Shasta Counties.\u003c/p>\n\u003cp>While Obamacare is largely viewed as a success in California – the state marketplace, \u003ca href=\"http://www.coveredca.com/\">Covered California\u003c/a>, is one of the most financially stable in the country – it hasn’t worked as well for folks in this rural northeast corner of the state.\u003c/p>\n\u003cp>There are two insurers selling plans in each county here, but residents say that hasn’t created enough competition to bring down prices. Plus, a lot of the doctors they’re used to seeing don’t take the marketplace plans.\u003c/p>\n\u003cp>“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” says Modoc County resident Althia Cline, who decided to forego coverage – and a surgery she needed for her asthma.\u003c/p>\n\u003cp>Just like the movie theater and bowling alley, most medical specialists are miles away. In Modoc County, there’s nowhere to have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half away from home.\u003c/p>\n\u003cp>Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.\u003c/p>\n\u003cfigure id=\"attachment_353608\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-353608 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Tessa-front-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tessa Anklin says Covered California health plans are too expensive for her family. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Two years ago, they bought a plan through Covered California. With a subsidy, they paid just $2 a month for their premium, but their deductible was $10,000.\u003c/p>\n\u003cp>“We paid for all of our medical services and our prescriptions,” she says. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”\u003c/p>\n\u003cp>Then, last year, their monthly premium jumped to $600. The plan was the same, Anklin says, and their household income was the same. But they still faced the same hour and a half drive to see doctors they almost never needed.*\u003c/p>\n\u003cp>Anklin thought of all the other ways she could spend that money.\u003c/p>\n\u003cp>“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she says. “That’s a big difference, when you think about how little you actually use the health coverage.”\u003c/p>\n\u003cp>That’s the reason she decided to cancel her health plan this year and go without. But she’ll still have to pay a penalty when the next tax season comes around.\u003c/p>\n\u003cp>“It basically penalizes us one way or the other because we can’t afford the coverage,” she says. “So that’s kind of difficult, to be that middle-class person.”\u003c/p>\n\u003cp>Anklin says she’d be happy to see Republicans get rid of Obamacare.\u003c/p>\n\u003cp>“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck when they’re already trying to survive with what they have,” she says. “It should be an option.”\u003c/p>\n\u003cp>But the Republican repeal and replace plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the GOP plan, according to a recent \u003ca href=\"http://www.kff.org/health-reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/\">analysis\u003c/a> from the Kaiser Family Foundation. Anklin could end up paying more than $2,000 a month for coverage, according to Kaiser’s \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\">county-by-county projections\u003c/a>.\u003c/p>\n\u003cp>That’s not what she had in mind for a fix.\u003c/p>\n\u003cp>“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin says.\u003c/p>\n\u003cp>With the Republican bill now in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.\u003c/p>\n\u003cp>Democrats have also said if the Republican bill fails, they’d be willing to \u003ca href=\"https://www.statnews.com/2017/07/05/health-care-compromise/\">work together on solutions\u003c/a>, but it’s not clear the parties could agree on one that would help people like Anklin.\u003c/p>\n\u003cp>If they can’t, she says she has no choice but to continue to go without coverage. Financially it makes sense in the short term, but it still worries her.\u003c/p>\n\u003cp>“If I ever have a problem,” she says, “I know I will be paying for the rest of my life.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/07/2017-07-11b-tcr.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Aaron-car-768x576.jpg\" Title=\"Rural Californians Want Price Relief From GOP Health Bill – But Most Won’t Get It\" program=\"The California Report\"]\u003c/p>\n\u003cp>\u003cem>*Premiums in this region of the state went up an average of 10.6 percent in 2016, according to Covered California’s \u003ca href=\"http://www.coveredca.com/news/\" target=\"_blank\" rel=\"noopener noreferrer\">rate booklet\u003c/a>, and most premium increases are matched with an increase in subsidy, so the most likely explanation for why Anklin’s premium jumped this much is that she lost her subsidy. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Aaron Albaugh peers out from under the brim of his cowboy hat, surveying the acres of hay fields in front of him. The fourth-generation \u003ca href=\"http://www.frostyacres.net/index.html\">rancher\u003c/a> is raising about 450 cattle this year, in this remote corner of Lassen County.\u003c/p>\n\u003cp>His closest neighbor lives a half mile away. “And that’s my brother,” Albaugh says.\u003c/p>\n\u003cp>“If I want to go see a movie, it’s 70 miles round trip,” he adds. “If I want to go bowling, that’s 100 miles round trip.”\u003c/p>\n\u003cp>Living a half day’s drive from civilization, you learn to do without, he explains. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.\u003c/p>\n\u003cp>“Put a Band Aid on it,” Albaugh says. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So, when people are already used to doing without health coverage, it’s particularly annoying to have the government say you have to buy it, according to Albaugh and many of his neighbors in Lassen, Modoc and Shasta Counties.\u003c/p>\n\u003cp>While Obamacare is largely viewed as a success in California – the state marketplace, \u003ca href=\"http://www.coveredca.com/\">Covered California\u003c/a>, is one of the most financially stable in the country – it hasn’t worked as well for folks in this rural northeast corner of the state.\u003c/p>\n\u003cp>There are two insurers selling plans in each county here, but residents say that hasn’t created enough competition to bring down prices. Plus, a lot of the doctors they’re used to seeing don’t take the marketplace plans.\u003c/p>\n\u003cp>“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” says Modoc County resident Althia Cline, who decided to forego coverage – and a surgery she needed for her asthma.\u003c/p>\n\u003cp>Just like the movie theater and bowling alley, most medical specialists are miles away. In Modoc County, there’s nowhere to have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half away from home.\u003c/p>\n\u003cp>Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.\u003c/p>\n\u003cfigure id=\"attachment_353608\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-353608 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Tessa-front-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tessa Anklin says Covered California health plans are too expensive for her family. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Two years ago, they bought a plan through Covered California. With a subsidy, they paid just $2 a month for their premium, but their deductible was $10,000.\u003c/p>\n\u003cp>“We paid for all of our medical services and our prescriptions,” she says. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”\u003c/p>\n\u003cp>Then, last year, their monthly premium jumped to $600. The plan was the same, Anklin says, and their household income was the same. But they still faced the same hour and a half drive to see doctors they almost never needed.*\u003c/p>\n\u003cp>Anklin thought of all the other ways she could spend that money.\u003c/p>\n\u003cp>“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she says. “That’s a big difference, when you think about how little you actually use the health coverage.”\u003c/p>\n\u003cp>That’s the reason she decided to cancel her health plan this year and go without. But she’ll still have to pay a penalty when the next tax season comes around.\u003c/p>\n\u003cp>“It basically penalizes us one way or the other because we can’t afford the coverage,” she says. “So that’s kind of difficult, to be that middle-class person.”\u003c/p>\n\u003cp>Anklin says she’d be happy to see Republicans get rid of Obamacare.\u003c/p>\n\u003cp>“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck when they’re already trying to survive with what they have,” she says. “It should be an option.”\u003c/p>\n\u003cp>But the Republican repeal and replace plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the GOP plan, according to a recent \u003ca href=\"http://www.kff.org/health-reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/\">analysis\u003c/a> from the Kaiser Family Foundation. Anklin could end up paying more than $2,000 a month for coverage, according to Kaiser’s \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\">county-by-county projections\u003c/a>.\u003c/p>\n\u003cp>That’s not what she had in mind for a fix.\u003c/p>\n\u003cp>“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin says.\u003c/p>\n\u003cp>With the Republican bill now in flux, Democrats have been more willing to admit to Obamacare’s flaws. 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"content": "\u003cp>Thirty-one-year-old Rodolfo Silva, a second-year pediatric resident, thought he was prepared to handle death. In his first year of residency at Loma Linda University Medical Center, he felt he was prepared.\u003c/p>\n\u003cp>“This is part of the disease process. I think I’ll be OK,” he told himself. But then Silva watched as a terminally ill 4-year-old died and realized it was harder than he thought.\u003c/p>\n\u003cp>“It’s completely different when you’re actually in the moment and seeing the reactions of the family. I think that’s probably the harder part,” said Silva.\u003c/p>\n\u003cp>Death isn’t the only challenge young doctors-in-training face.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘Some of these residents were inconsolable. I would see them and they would pull me into an empty room and just sob.’\u003c/aside>\n\u003cp>“You have to deal with difficult families. You have to deal with you not being as available to your own friends and family, or missing out on things that other people who are not in medicine that are your age would be able to do,” said Silva.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In light of the many pressures on young doctors, the Accreditation Council for Graduate Medical Education, the accrediting organization that oversees teaching hospitals, now requires residents have 24/7 access to a mental health professional.\u003c/p>\n\u003cp>It’s part a new set of guidelines that went into effect on July 1. The rules also include a change in the number of hours first-year residents can work and more flexibility in their schedules.\u003c/p>\n\u003cfigure id=\"attachment_11549702\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11549702\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/DoctorRudy-800x538.jpg\" alt=\"Dr. Rudy Silva checks on one of his patients in the Pediatric Intensive Care Unit at the Loma Linda University Medical Center.\" width=\"800\" height=\"538\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-800x538.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-160x108.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-1020x686.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-1180x793.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-960x646.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-240x161.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-375x252.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-520x350.jpg 520w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Rudy Silva checks on one of his patients in the Pediatric Intensive Care Unit at the Loma Linda University Medical Center. \u003ccite>(Daryl Barker/KPCC)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At Loma Linda, Barbara Hernandez, the director of physician vitality, works to address physician stress before it becomes a bigger problem.\u003c/p>\n\u003cp>“If many of our physicians saw the kinds of things on the street that they see in the protected walls of the hospital, they would need treatment for PTSD,” said Hernandez.\u003c/p>\n\u003cp>She came to her job after a career as an intensive care unit nurse. In that work, she saw firsthand as overwhelmed residents struggled to deal with the pressures of caring for patients.\u003c/p>\n\u003cp>“Some of these residents were inconsolable. I would see them and they would pull me into an empty room and just sob,” she said.\u003c/p>\n\u003cp>Hernandez’ job is to make sure physicians, especially new ones, are developing health habits to deal with that stress.\u003c/p>\n\u003cp>Of course, these issues aren’t new to medicine. She said the profession has a tradition of a certain mindset of infallibility and self-sacrifice.\u003c/p>\n\u003cp>“Physicians have no needs, should not talk about emotions, should never complain. … When we have people to subscribe to that, it’s a quick recipe for burnout,” said Hernandez.\u003c/p>\n\u003cp>Burnout is more than fatigue. It can be dangerous. \u003ca href=\"http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2467822\" target=\"_blank\" rel=\"noopener noreferrer\">One study reported in 2015 in JAMA Psychiatry\u003c/a> found that 23 percent of first-year residents had suicidal thoughts. They can have high rates of other depressive symptoms, too.\u003c/p>\n\u003cp>[contextly_sidebar id=”fUY0PTmc0VdDDLo8D5eNflPn6ipLQWS1″]\u003c/p>\n\u003cp>Guidelines from the Accreditation Council aim to address this by making sure physicians have flexibility in their busy schedules. They’re encouraged not to work when they’re overly fatigued and to take time during the day to handle their own medical appointments. If they work on charts at home, they’re instructed to count those hours toward their maximum 80-hour workweek.\u003c/p>\n\u003cp>“It’s a recognition that physicians are human beings, and that we get tired, we get sad, we have problems in our social lives, just the way anyone else does,” said Dr. Daniel Giang, Loma Linda’s head of graduate education.\u003c/p>\n\u003cp>This year, first-year residents will be allowed to work 24-hour shifts. That’s an increase from the 16 hours they’ve been limited to since 2011. The longer shift puts their hours on par with older residents. The decision was based on research.\u003c/p>\n\u003cp>“A 16-hour limitation did not make it any safer for patients that we could determine,” Giang said.\u003c/p>\n\u003cp>Giang said residents didn’t report more satisfaction with the shorter shifts either.\u003c/p>\n\u003cp>For D’Artagnan DeBow, a fifth-year surgical resident, long shifts are part of on-the-job training for new doctors, some of whom haven’t had a job before.\u003c/p>\n\u003cp>“Now they’re working 80 hours and working a 24-[hour] shift on a Friday night with a busy trauma service, and going to the operating room and taking care of sick patients on the floor. You have to be able to triage your time appropriately,” said DeBow.\u003c/p>\n\u003cp>As an administrator, Giang sees the change in hours as a way to keep teams with different levels of experience together. He wants residents to find a work-life balance with the help of attending physicians.\u003c/p>\n\u003cfigure id=\"attachment_11549705\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11549705\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/DrCynthia-800x535.jpg\" alt=\"Attending physician Cynthia Tinsley on call at the Loma Linda University Medical Center.\" width=\"800\" height=\"535\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-800x535.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-1020x683.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-1180x790.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-960x643.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-240x161.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-375x251.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-520x348.jpg 520w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Attending physician Cynthia Tinsley on call at the Loma Linda University Medical Center. \u003ccite>(Daryl Barker/KPCC)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Cynthia Tinsley’s dual role comes into play here. She makes sure the residents she supervises understand the medicine they practice, but she also serves as someone they can seek out when they need help.\u003c/p>\n\u003cp>Tinsley includes wellness in her curriculum, teaching the residents coping strategies for stress and the warning signs to watch for when it’s time to seek help.\u003c/p>\n\u003cp>“One of the common things is when you have anger management issues, when you’re finding that you’re seeking alcohol — ‘I need a drink.’ If you’re not sleeping well, if you’re not eating well. You’re finding that you’re losing interest in life and you’re going through things in a mechanical way,” she said.\u003c/p>\n\u003cp>Over her career, Tinsley has seen doctors develop these weak coping behaviors. That’s why some of them have a poor bedside manner. She’s training physicians to be alert to those risks.\u003c/p>\n\u003cp>Having Tinsley and others to talk to has made a big difference for Dr. Silva. He said he’s living a healthier lifestyle this year than he did in his first year of residency and his program has been a big support in this.\u003c/p>\n\u003cp>“If you came in with no anxiety, no depression, and you’re leaving with depression and anxiety, that’s not going to do anyone any good, whether it be the physician or the patients that they take care of,” said Silva.\u003c/p>\n\u003cp>Loma Linda administrators say that’s the point.\u003c/p>\n\u003cp>“It is certainly very important to medical educators at all levels trying to decide, how can we help residents and medical students and junior physicians and even senior physicians take care of their health better, realize that’s part of their professional responsibility, to present themselves ready to give their best in caring for their patients,” said administrator Giang.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>He wants to make sure residents are doing their best for the patients they are treating both now and 15 years in the future.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Thirty-one-year-old Rodolfo Silva, a second-year pediatric resident, thought he was prepared to handle death. In his first year of residency at Loma Linda University Medical Center, he felt he was prepared.\u003c/p>\n\u003cp>“This is part of the disease process. I think I’ll be OK,” he told himself. But then Silva watched as a terminally ill 4-year-old died and realized it was harder than he thought.\u003c/p>\n\u003cp>“It’s completely different when you’re actually in the moment and seeing the reactions of the family. I think that’s probably the harder part,” said Silva.\u003c/p>\n\u003cp>Death isn’t the only challenge young doctors-in-training face.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘Some of these residents were inconsolable. I would see them and they would pull me into an empty room and just sob.’\u003c/aside>\n\u003cp>“You have to deal with difficult families. You have to deal with you not being as available to your own friends and family, or missing out on things that other people who are not in medicine that are your age would be able to do,” said Silva.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In light of the many pressures on young doctors, the Accreditation Council for Graduate Medical Education, the accrediting organization that oversees teaching hospitals, now requires residents have 24/7 access to a mental health professional.\u003c/p>\n\u003cp>It’s part a new set of guidelines that went into effect on July 1. The rules also include a change in the number of hours first-year residents can work and more flexibility in their schedules.\u003c/p>\n\u003cfigure id=\"attachment_11549702\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11549702\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/DoctorRudy-800x538.jpg\" alt=\"Dr. Rudy Silva checks on one of his patients in the Pediatric Intensive Care Unit at the Loma Linda University Medical Center.\" width=\"800\" height=\"538\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-800x538.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-160x108.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-1020x686.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-1180x793.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-960x646.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-240x161.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-375x252.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DoctorRudy-520x350.jpg 520w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Rudy Silva checks on one of his patients in the Pediatric Intensive Care Unit at the Loma Linda University Medical Center. \u003ccite>(Daryl Barker/KPCC)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At Loma Linda, Barbara Hernandez, the director of physician vitality, works to address physician stress before it becomes a bigger problem.\u003c/p>\n\u003cp>“If many of our physicians saw the kinds of things on the street that they see in the protected walls of the hospital, they would need treatment for PTSD,” said Hernandez.\u003c/p>\n\u003cp>She came to her job after a career as an intensive care unit nurse. In that work, she saw firsthand as overwhelmed residents struggled to deal with the pressures of caring for patients.\u003c/p>\n\u003cp>“Some of these residents were inconsolable. I would see them and they would pull me into an empty room and just sob,” she said.\u003c/p>\n\u003cp>Hernandez’ job is to make sure physicians, especially new ones, are developing health habits to deal with that stress.\u003c/p>\n\u003cp>Of course, these issues aren’t new to medicine. She said the profession has a tradition of a certain mindset of infallibility and self-sacrifice.\u003c/p>\n\u003cp>“Physicians have no needs, should not talk about emotions, should never complain. … When we have people to subscribe to that, it’s a quick recipe for burnout,” said Hernandez.\u003c/p>\n\u003cp>Burnout is more than fatigue. It can be dangerous. \u003ca href=\"http://jamanetwork.com/journals/jamapsychiatry/fullarticle/2467822\" target=\"_blank\" rel=\"noopener noreferrer\">One study reported in 2015 in JAMA Psychiatry\u003c/a> found that 23 percent of first-year residents had suicidal thoughts. They can have high rates of other depressive symptoms, too.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Guidelines from the Accreditation Council aim to address this by making sure physicians have flexibility in their busy schedules. They’re encouraged not to work when they’re overly fatigued and to take time during the day to handle their own medical appointments. If they work on charts at home, they’re instructed to count those hours toward their maximum 80-hour workweek.\u003c/p>\n\u003cp>“It’s a recognition that physicians are human beings, and that we get tired, we get sad, we have problems in our social lives, just the way anyone else does,” said Dr. Daniel Giang, Loma Linda’s head of graduate education.\u003c/p>\n\u003cp>This year, first-year residents will be allowed to work 24-hour shifts. That’s an increase from the 16 hours they’ve been limited to since 2011. The longer shift puts their hours on par with older residents. The decision was based on research.\u003c/p>\n\u003cp>“A 16-hour limitation did not make it any safer for patients that we could determine,” Giang said.\u003c/p>\n\u003cp>Giang said residents didn’t report more satisfaction with the shorter shifts either.\u003c/p>\n\u003cp>For D’Artagnan DeBow, a fifth-year surgical resident, long shifts are part of on-the-job training for new doctors, some of whom haven’t had a job before.\u003c/p>\n\u003cp>“Now they’re working 80 hours and working a 24-[hour] shift on a Friday night with a busy trauma service, and going to the operating room and taking care of sick patients on the floor. You have to be able to triage your time appropriately,” said DeBow.\u003c/p>\n\u003cp>As an administrator, Giang sees the change in hours as a way to keep teams with different levels of experience together. He wants residents to find a work-life balance with the help of attending physicians.\u003c/p>\n\u003cfigure id=\"attachment_11549705\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11549705\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/07/DrCynthia-800x535.jpg\" alt=\"Attending physician Cynthia Tinsley on call at the Loma Linda University Medical Center.\" width=\"800\" height=\"535\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-800x535.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-1020x683.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-1180x790.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-960x643.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-240x161.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-375x251.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/07/DrCynthia-520x348.jpg 520w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Attending physician Cynthia Tinsley on call at the Loma Linda University Medical Center. \u003ccite>(Daryl Barker/KPCC)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Cynthia Tinsley’s dual role comes into play here. She makes sure the residents she supervises understand the medicine they practice, but she also serves as someone they can seek out when they need help.\u003c/p>\n\u003cp>Tinsley includes wellness in her curriculum, teaching the residents coping strategies for stress and the warning signs to watch for when it’s time to seek help.\u003c/p>\n\u003cp>“One of the common things is when you have anger management issues, when you’re finding that you’re seeking alcohol — ‘I need a drink.’ If you’re not sleeping well, if you’re not eating well. You’re finding that you’re losing interest in life and you’re going through things in a mechanical way,” she said.\u003c/p>\n\u003cp>Over her career, Tinsley has seen doctors develop these weak coping behaviors. That’s why some of them have a poor bedside manner. She’s training physicians to be alert to those risks.\u003c/p>\n\u003cp>Having Tinsley and others to talk to has made a big difference for Dr. Silva. He said he’s living a healthier lifestyle this year than he did in his first year of residency and his program has been a big support in this.\u003c/p>\n\u003cp>“If you came in with no anxiety, no depression, and you’re leaving with depression and anxiety, that’s not going to do anyone any good, whether it be the physician or the patients that they take care of,” said Silva.\u003c/p>\n\u003cp>Loma Linda administrators say that’s the point.\u003c/p>\n\u003cp>“It is certainly very important to medical educators at all levels trying to decide, how can we help residents and medical students and junior physicians and even senior physicians take care of their health better, realize that’s part of their professional responsibility, to present themselves ready to give their best in caring for their patients,” said administrator Giang.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>He wants to make sure residents are doing their best for the patients they are treating both now and 15 years in the future.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California Sen. Kamala Harris toured the state Monday, rallying supporters against the Republican-backed health care plan in the Senate as she searched for stories to highlight when debate over the bill returns to Congress next week.\u003c/p>\n\u003cp>After speaking at a citizenship ceremony in Los Angeles, Harris held \u003ca href=\"http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-kamala-harris-greets-supporters-at-1499107605-htmlstory.html\" target=\"_blank\" rel=\"noopener noreferrer\">a rally\u003c/a> at the Harbor-UCLA Medical Center in Torrance to oppose the Better Care Reconciliation Act currently in Senate. She then flew to San Francisco to meet with seniors at the Institute on Aging.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Harris said she heard stories all day “from people who want to live with dignity, who want to work hard, but they want to afford to be able to pay for their asthma medication and also keep their home.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Without coverage, they can’t do both,” she said. \u003c/span>\u003c/p>\n\u003cp>The event in San Francisco focused on the impact the Senate bill would have on Californians who receive care through Medi-Cal, the state’s Medicaid program for the poor and disabled. The Senate proposal would reduce federal payments to Medicaid, leaving states on the hook for more of the cost.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Last week, the State Department of Health Care Services \u003ca href=\"http://www.dhcs.ca.gov/Documents/BCRA_Impact_Memo_062717.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimated \u003c/a>that the Senate plan would shift $30.3 billion of Medi-Cal costs to California over the next decade.\u003c/p>\n\u003cp>Harris attended a roundtable of patients and providers, who emphasized that Medi-Cal covers critical services that older Californians can’t get through Medicare, the health care program for the elderly.\u003c/p>\n\u003cp>“Home care is the most striking example,” said Jeff Wilkins, a social worker at the Institute. “Medicare does not pay for home care.”\u003c/p>\n\u003cp>The most memorable exchanges of the afternoon came from the handful of seniors who spoke with Harris as she toured the Institute.\u003c/p>\n\u003cp>Huiquing Chen told the senator through an interpreter that the biggest difference between the current Affordable Care Act, and the Republican plans in the House and Senate, is the lack of the word ‘affordable.’\u003c/p>\n\u003cp>“We’re getting old, which is becoming a pre-existing condition,” Chen quipped.\u003c/p>\n\u003cp>Clem McCoy, 83, chatted up Harris on a different topic.\u003c/p>\n\u003cp>“Y’all need to get the president up out of there!” he said.\u003c/p>\n\u003cp>“One day at a time,” Harris replied.\u003c/p>\n\u003cblockquote class=\"twitter-video\">\n\u003cp dir=\"ltr\" lang=\"en\">At \u003ca href=\"https://twitter.com/IOASFBAY\">@IOASFBAY\u003c/a>, 83 year old Clem McCoy tells \u003ca href=\"https://twitter.com/SenKamalaHarris\">@SenKamalaHarris\u003c/a> to get President Trump “up outta here.” \u003ca href=\"https://t.co/kuWgyFZ3QQ\">pic.twitter.com/kuWgyFZ3QQ\u003c/a>\u003c/p>\n\u003cp>— Guy Marzorati (@GuyMarzorati) \u003ca href=\"https://twitter.com/GuyMarzorati/status/881997765894590465\">July 3, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>The Republican plan in the Senate stalled over the July 4 holiday, with \u003ca href=\"https://www.apnews.com/769b99020b034b55a395e9e131003ac5/White-House:-Trump-backs-repeal-only-health-bill-as-'option'\" target=\"_blank\" rel=\"noopener noreferrer\">at least nine senators\u003c/a> opposing the bill. In response, President Trump has expressed some support for repealing the legislation without a replacement plan in place.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I’m frankly not clear on what their strategy is,” Harris said in response to that idea. “Over 30 million Americans, if it is repealed, will lose their coverage.” \u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Sen. Kamala Harris toured the state Monday, rallying supporters against the Republican-backed health care plan in the Senate as she searched for stories to highlight when debate over the bill returns to Congress next week.\u003c/p>\n\u003cp>After speaking at a citizenship ceremony in Los Angeles, Harris held \u003ca href=\"http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-kamala-harris-greets-supporters-at-1499107605-htmlstory.html\" target=\"_blank\" rel=\"noopener noreferrer\">a rally\u003c/a> at the Harbor-UCLA Medical Center in Torrance to oppose the Better Care Reconciliation Act currently in Senate. She then flew to San Francisco to meet with seniors at the Institute on Aging.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Harris said she heard stories all day “from people who want to live with dignity, who want to work hard, but they want to afford to be able to pay for their asthma medication and also keep their home.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Without coverage, they can’t do both,” she said. \u003c/span>\u003c/p>\n\u003cp>The event in San Francisco focused on the impact the Senate bill would have on Californians who receive care through Medi-Cal, the state’s Medicaid program for the poor and disabled. The Senate proposal would reduce federal payments to Medicaid, leaving states on the hook for more of the cost.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Last week, the State Department of Health Care Services \u003ca href=\"http://www.dhcs.ca.gov/Documents/BCRA_Impact_Memo_062717.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimated \u003c/a>that the Senate plan would shift $30.3 billion of Medi-Cal costs to California over the next decade.\u003c/p>\n\u003cp>Harris attended a roundtable of patients and providers, who emphasized that Medi-Cal covers critical services that older Californians can’t get through Medicare, the health care program for the elderly.\u003c/p>\n\u003cp>“Home care is the most striking example,” said Jeff Wilkins, a social worker at the Institute. “Medicare does not pay for home care.”\u003c/p>\n\u003cp>The most memorable exchanges of the afternoon came from the handful of seniors who spoke with Harris as she toured the Institute.\u003c/p>\n\u003cp>Huiquing Chen told the senator through an interpreter that the biggest difference between the current Affordable Care Act, and the Republican plans in the House and Senate, is the lack of the word ‘affordable.’\u003c/p>\n\u003cp>“We’re getting old, which is becoming a pre-existing condition,” Chen quipped.\u003c/p>\n\u003cp>Clem McCoy, 83, chatted up Harris on a different topic.\u003c/p>\n\u003cp>“Y’all need to get the president up out of there!” he said.\u003c/p>\n\u003cp>“One day at a time,” Harris replied.\u003c/p>\n\u003cblockquote class=\"twitter-video\">\n\u003cp dir=\"ltr\" lang=\"en\">At \u003ca href=\"https://twitter.com/IOASFBAY\">@IOASFBAY\u003c/a>, 83 year old Clem McCoy tells \u003ca href=\"https://twitter.com/SenKamalaHarris\">@SenKamalaHarris\u003c/a> to get President Trump “up outta here.” \u003ca href=\"https://t.co/kuWgyFZ3QQ\">pic.twitter.com/kuWgyFZ3QQ\u003c/a>\u003c/p>\n\u003cp>— Guy Marzorati (@GuyMarzorati) \u003ca href=\"https://twitter.com/GuyMarzorati/status/881997765894590465\">July 3, 2017\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cp>The Republican plan in the Senate stalled over the July 4 holiday, with \u003ca href=\"https://www.apnews.com/769b99020b034b55a395e9e131003ac5/White-House:-Trump-backs-repeal-only-health-bill-as-'option'\" target=\"_blank\" rel=\"noopener noreferrer\">at least nine senators\u003c/a> opposing the bill. In response, President Trump has expressed some support for repealing the legislation without a replacement plan in place.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I’m frankly not clear on what their strategy is,” Harris said in response to that idea. “Over 30 million Americans, if it is repealed, will lose their coverage.” \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Standing in his new apartment, on the top of a two-level building in Oakland, Daniel Yapo admits his journey from homelessness to housing took a lot of help.\u003c/p>\n\u003cp>Yapo spent years bouncing between temporary homes and jail, even spending time living on a roof in nearby Hayward. Service providers helped him find a place of his own, navigate treatment for mental illness and handle the tasks that come with independent living.\u003c/p>\n\u003cp>“Whatever problem I had, whether it be courts, or my license, or anything that I had a problem with, they assigned somebody to help me with that,” Yapo said. “They just keep on helping me!”\u003c/p>\n\u003caside class=\"pullquote alignright\">‘We really think that housing is health care.’\u003ccite>Maria X. Martinez, Whole Person Care\u003c/cite>\u003c/aside>\n\u003cp>A new program \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/12/23/california-hopes-3-billion-experiment-will-improve-health-of-neediest/\">launching\u003c/a> around the state this summer aims to help more Medi-Cal recipients like Yapo by using federal health dollars to pay for supportive housing services.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.dhcs.ca.gov/services/Pages/WholePersonCarePilots.aspx\">Whole Person Care\u003c/a> program represents a breakthrough in using health care money for housing services, which the federal government had long been wary of doing. The five-year pilot program allows local governments to pay for support services, but not actual rental costs, through a matching grant from Medicaid.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>State lawmakers are now hoping to take the program a step further, and fund rental assistance for vulnerable Medi-Cal recipients.\u003c/p>\n\u003cp>“We really think that housing is health care,” said Maria X. Martinez, who is running the Whole Person Care pilot in San Francisco. “There’s a small number of homeless folks who are not only very poor, they’re very sick, either from living on the streets for so long or maybe their illness precipitated their homelessness.”\u003cbr>\n[contextly_sidebar id=”OJIO66ohKoFH8HlklOnc7mRoHCaUe7dk”]\u003cbr>\nThe program could save taxpayers money by treating people early on, so they won’t end up requiring expensive emergency room care.\u003c/p>\n\u003cp>Counties and cities are planning to use the $1.5 billion of matching funds in a variety of ways — from creating a tool to evaluate the health of residents on the street and share that data among service providers, to boosting services to help the homeless find and stay in housing, In Alameda County, the grant will bring the total supportive housing slots in the county from 2,000 to 3,000.\u003c/p>\n\u003cp>It means that the newly housed homeless like Daniel Yapo can get help from local providers such as \u003ca href=\"http://www.abodeservices.org/\">Abode Services\u003c/a> that extend beyond traditional medical care.\u003c/p>\n\u003cp>“I feel like they enveloped me and took care of me,” Yapo says. “They took me to a lot of activities that I might of missed when I was a child. Simple things like movies, beach, plays, creative writing classes.”\u003c/p>\n\u003cp>The latter seems to have paid dividends for Yapo, who eagerly recited a poem he wrote entitled “Careful What You Wish For” about his journey out of homelessness.\u003c/p>\n\u003cp>[audio src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/06/Yapo-Poem.mp3\" Image=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/06/Daniel-Yapo-800x600.jpg\" Title=\"Daniel Yapo Reads ‘Careful What You Wish For’\" program=\"The California Report\"]\u003c/p>\n\u003cp>Services around supportive housing aren’t new, but the idea of paying for them with health care dollars had traditionally been rejected by the federal government. That changed when the federal Centers for Medicare & Medicaid Services approved California’s waiver to create the program in 2015. Other states, including New York and Washington, are taking a similar approach with federal waivers.\u003c/p>\n\u003cp>“Homelessness is considered a social determinant. It’s not really health related,” said Sharon Rapport, associate director for California policy with the Corporation for Supportive Housing. “But it is health related in that when somebody is homeless, they are going to experience health conditions, even if they were healthy before.”\u003c/p>\n\u003cp>Rapport said that state health officials were unable to convince the Obama administration to use Medicaid dollars to actually pay the rent of homeless Medi-Cal recipients.\u003c/p>\n\u003cp>“The federal government was really nervous about doing that,” she said.\u003c/p>\n\u003cp>As a result, participants in Whole Person Care will have to rely on a variety of categorical funding sources to pay rent, from the federal Department of Housing and Urban Development, to state sources like the Mental Health Services Act.\u003c/p>\n\u003cp>“It’s a doughnut,” said Dr. Kathleen Clanon, who is leading the Whole Person Care pilot in Alameda County, adding there’s a need to fill the “hole in the middle of our doughnut.”\u003c/p>\n\u003cfigure id=\"attachment_11540913\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11540913 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-520x347.jpg 520w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Asm. David Chiu (D-San Francisco) is hoping to fund rental assistance for homeless Californians on Medi-Cal. \u003ccite>(Guy Marzorati/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The effort to fill the funding doughnut has been adopted in the state Legislature by Assemblyman David Chiu (D-San Francisco). His \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB74\">Assembly Bill 74\u003c/a> would use general fund money to pay for rental assistance for Whole Person Care recipients.\u003c/p>\n\u003cp>An identical bill passed the Legislature last year, but was \u003ca href=\"https://www.gov.ca.gov/docs/AB_2821_Veto_Message.pdf\">vetoed\u003c/a> by Gov. Jerry Brown.\u003c/p>\n\u003cp>“While the goal of this bill is laudable and the policy could lead to savings in the health care system, codifying a program without an identified funding source raises false expectations,” the governor wrote in his veto message. “This grant program, like any new expenditure, is best left to budget discussions.”\u003c/p>\n\u003cp>The $90 million that Chiu and Assembly Democrats pushed for in this year’s budget was dropped in negotiations. Chiu is hopeful that the plan can be included in a larger legislative deal around housing that legislators are currently discussing with the governor’s office.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we make an investment in rental assistance and housing for these folks, in the long run that is far cheaper, more effective, and more humane for those individuals than what we are currently doing today,” Chiu said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Standing in his new apartment, on the top of a two-level building in Oakland, Daniel Yapo admits his journey from homelessness to housing took a lot of help.\u003c/p>\n\u003cp>Yapo spent years bouncing between temporary homes and jail, even spending time living on a roof in nearby Hayward. Service providers helped him find a place of his own, navigate treatment for mental illness and handle the tasks that come with independent living.\u003c/p>\n\u003cp>“Whatever problem I had, whether it be courts, or my license, or anything that I had a problem with, they assigned somebody to help me with that,” Yapo said. “They just keep on helping me!”\u003c/p>\n\u003caside class=\"pullquote alignright\">‘We really think that housing is health care.’\u003ccite>Maria X. Martinez, Whole Person Care\u003c/cite>\u003c/aside>\n\u003cp>A new program \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/12/23/california-hopes-3-billion-experiment-will-improve-health-of-neediest/\">launching\u003c/a> around the state this summer aims to help more Medi-Cal recipients like Yapo by using federal health dollars to pay for supportive housing services.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.dhcs.ca.gov/services/Pages/WholePersonCarePilots.aspx\">Whole Person Care\u003c/a> program represents a breakthrough in using health care money for housing services, which the federal government had long been wary of doing. The five-year pilot program allows local governments to pay for support services, but not actual rental costs, through a matching grant from Medicaid.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>State lawmakers are now hoping to take the program a step further, and fund rental assistance for vulnerable Medi-Cal recipients.\u003c/p>\n\u003cp>“We really think that housing is health care,” said Maria X. Martinez, who is running the Whole Person Care pilot in San Francisco. “There’s a small number of homeless folks who are not only very poor, they’re very sick, either from living on the streets for so long or maybe their illness precipitated their homelessness.”\u003cbr>\n\u003c/p>\u003cp>\u003c/p>\u003cp>\u003cbr>\nThe program could save taxpayers money by treating people early on, so they won’t end up requiring expensive emergency room care.\u003c/p>\n\u003cp>Counties and cities are planning to use the $1.5 billion of matching funds in a variety of ways — from creating a tool to evaluate the health of residents on the street and share that data among service providers, to boosting services to help the homeless find and stay in housing, In Alameda County, the grant will bring the total supportive housing slots in the county from 2,000 to 3,000.\u003c/p>\n\u003cp>It means that the newly housed homeless like Daniel Yapo can get help from local providers such as \u003ca href=\"http://www.abodeservices.org/\">Abode Services\u003c/a> that extend beyond traditional medical care.\u003c/p>\n\u003cp>“I feel like they enveloped me and took care of me,” Yapo says. “They took me to a lot of activities that I might of missed when I was a child. Simple things like movies, beach, plays, creative writing classes.”\u003c/p>\n\u003cp>The latter seems to have paid dividends for Yapo, who eagerly recited a poem he wrote entitled “Careful What You Wish For” about his journey out of homelessness.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Services around supportive housing aren’t new, but the idea of paying for them with health care dollars had traditionally been rejected by the federal government. That changed when the federal Centers for Medicare & Medicaid Services approved California’s waiver to create the program in 2015. Other states, including New York and Washington, are taking a similar approach with federal waivers.\u003c/p>\n\u003cp>“Homelessness is considered a social determinant. It’s not really health related,” said Sharon Rapport, associate director for California policy with the Corporation for Supportive Housing. “But it is health related in that when somebody is homeless, they are going to experience health conditions, even if they were healthy before.”\u003c/p>\n\u003cp>Rapport said that state health officials were unable to convince the Obama administration to use Medicaid dollars to actually pay the rent of homeless Medi-Cal recipients.\u003c/p>\n\u003cp>“The federal government was really nervous about doing that,” she said.\u003c/p>\n\u003cp>As a result, participants in Whole Person Care will have to rely on a variety of categorical funding sources to pay rent, from the federal Department of Housing and Urban Development, to state sources like the Mental Health Services Act.\u003c/p>\n\u003cp>“It’s a doughnut,” said Dr. Kathleen Clanon, who is leading the Whole Person Care pilot in Alameda County, adding there’s a need to fill the “hole in the middle of our doughnut.”\u003c/p>\n\u003cfigure id=\"attachment_11540913\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11540913 size-medium\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-1180x787.jpg 1180w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-960x640.jpg 960w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-240x160.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-375x250.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/10/2017/06/RS25439_20170515_StateCapitol_Assemblymember_DavidChiu_credit_BertJohnson-1-qut-1-1-520x347.jpg 520w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Asm. David Chiu (D-San Francisco) is hoping to fund rental assistance for homeless Californians on Medi-Cal. \u003ccite>(Guy Marzorati/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The effort to fill the funding doughnut has been adopted in the state Legislature by Assemblyman David Chiu (D-San Francisco). His \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB74\">Assembly Bill 74\u003c/a> would use general fund money to pay for rental assistance for Whole Person Care recipients.\u003c/p>\n\u003cp>An identical bill passed the Legislature last year, but was \u003ca href=\"https://www.gov.ca.gov/docs/AB_2821_Veto_Message.pdf\">vetoed\u003c/a> by Gov. Jerry Brown.\u003c/p>\n\u003cp>“While the goal of this bill is laudable and the policy could lead to savings in the health care system, codifying a program without an identified funding source raises false expectations,” the governor wrote in his veto message. “This grant program, like any new expenditure, is best left to budget discussions.”\u003c/p>\n\u003cp>The $90 million that Chiu and Assembly Democrats pushed for in this year’s budget was dropped in negotiations. Chiu is hopeful that the plan can be included in a larger legislative deal around housing that legislators are currently discussing with the governor’s office.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we make an investment in rental assistance and housing for these folks, in the long run that is far cheaper, more effective, and more humane for those individuals than what we are currently doing today,” Chiu said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>Political Analysis\u003c/strong>\u003c/p>\n\u003cp>KQED Newsroom goes on the road again to UC Hastings College of the Law to discuss the week’s big political and legal news. We discuss President Trump’s and California’s travel bans, the fate of national health care reform and statewide single-payer health care, and cases concerning religion and the environment.\u003c/p>\n\u003cp>Guests:\u003c/p>\n\u003cul>\n\u003cli>Professor Rory Little, UC Hastings College of the Law\u003c/li>\n\u003cli>Scott Shafer, KQED politics and government senior editor\u003c/li>\n\u003cli>Carla Marinucci, Politico senior writer\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Working Homeless\u003c/strong>\u003c/p>\n\u003cp>Many of the thousands of homeless people in the Bay Area work part- or full-time jobs even as they struggle to find a place to shower and sleep. We hear from three individuals about the challenges and misconceptions that many working homeless must overcome.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Guests:\u003c/p>\n\u003cul>\n\u003cli>Kevin McCracken, Social Imprints co-founder\u003c/li>\n\u003cli>Andrew Jackson, Civicorps member\u003c/li>\n\u003cli>Dominic Griffin, currently homeless\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>This segment is part of our ongoing coverage of homelessness in the Bay Area, and is also part of the SF Homeless Project, a collaboration of more than 80 media organizations from the Bay Area and beyond.\u003c/p>\n\n",
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"content": "\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mrVakER0R6f0AToNbkAK83dprja2VTaO\"]\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Obamacare Inspires Unlikely Political Action in Red California",
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"content": "\u003cp>Modoc County, in the northeast corner of California, is roughly the size of Connecticut. It's so sparsely populated, the entire county has just one stoplight. The nearest Wal-Mart is more than an hour's drive, across the Oregon border. Same with hospitals that deliver babies.\u003c/p>\n\u003cp>Greta Elliott runs a tiny health \u003ca href=\"http://canbyclinic.org/\" target=\"_blank\" rel=\"noopener noreferrer\">clinic\u003c/a> in Canby, on the edge of the national forest. \"Rural\" doesn’t begin to describe the area, she says. This is \"the frontier.\"\u003c/p>\n\u003cp>“There are more cows in Modoc than there are people,” Elliott says.\u003c/p>\n\u003cp>There's a frontier mentality, too. People take care of each other, and they take care of themselves. They don’t like being told what to do. Being forced to buy insurance made Obamacare a dirty word.\u003c/p>\n\u003cp>Even Elliott, the head of a health clinic, decided against buying coverage for herself.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It's too expensive,” she says. “I choose to put my money back into paying the bills of the whole family.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-28a-tcr.mp3\" Image=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/03/BloodPressure-768x512.jpg\" Title=\"Obamacare Inspires Unlikely Political Action in Red California\" program=\"The California Report\"]\u003c/p>\n\u003cp>Overall, the Affordable Care Act helped 25,000 people in far Northern California buy plans through the state marketplace, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>. But the law helped three times as many people, 75,000, enroll in Medi-Cal, the state’s Medicaid program that provides free health coverage for low-income residents.\u003c/p>\n\u003cp>“The data shows it's the rural communities that have greatly benefited from the Medicaid expansion. That’s the irony,” says Dean Germano, CEO of the \u003ca href=\"https://www.shastahealth.org\" target=\"_blank\" rel=\"noopener noreferrer\">Shasta Community Health Center\u003c/a>. “These are places that voted much more heavily for Donald Trump.”\u003c/p>\n\u003cp>In Modoc and Lassen counties, 70 percent of people voted for Trump in the November election. In neighboring Shasta County, Trump won 64 percent of the vote.\u003c/p>\n\u003cp>But now a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of clinics from across the Northeast corner of the state is lobbying local officials to take an unpopular position in this conservative land: defend Obamacare.\u003c/p>\n\u003cp>And the right-leaning Shasta County Board of Supervisors took them up on it.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Nl4j8x6j7iRmpWflZsVooGaqsbbbOLuA\"]\u003c/p>\n\u003cp>“We thought ‘Whoa! That is really bold,’” Germano says. “I was surprised.”\u003c/p>\n\u003cp>The board sent a letter to the local Republican congressman, \u003ca href=\"https://lamalfa.house.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Doug La Malfa\u003c/a>, asking him to vote against the initial GOP repeal and replace bill, because it would hurt local people.\u003c/p>\n\u003cp>“We have an obligation to say something,” says Supervisor David Kehoe. “And if it may be mildly offensive from a political standpoint for some, well, we’re not going to be intimidated by politics.”\u003c/p>\n\u003cp>But Congressman La Malfa still voted in favor of dismantling Obamacare.\u003c/p>\n\u003cp>La Malfa didn't return calls and emails for this story, but, in May, \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">he told KQED\u003c/a> that skyrocketing premiums were the main driver behind his vote.\u003c/p>\n\u003cp>\"Unfortunately, the reality is that too many young and healthy individuals are deciding they’d rather pay the penalty than sign up for care, citing financial barriers and lack of choice,\" he said in a statement. \"A 28 year old making $45,000 a year with no major health concerns is not going to pay upwards of $400 a month for a plan that does not even work for them.\"\u003c/p>\n\u003cp>When clinic representatives met with La Malfa's staffers, they were told the Congressman's office was flooded with calls like this.\u003c/p>\n\u003cp>But poor folks on Medi-Cal didn’t call to say how much they appreciate that program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.\u003c/p>\n\u003cp>“They feel like it's a handout and they're too proud, they don’t want to,” says Carol Morris, an enrollment counselor for the \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys\u003c/a> health clinics in Shasta county.\u003c/p>\n\u003cp>One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">\"Partnership Health Plan\" \u003c/a>and may not realize they’re actually covered by a government program.\u003c/p>\n\u003cp>“It feels like it's more of an insurance,” Morris says. “It’s like a laminated, wallet-sized card that's got your numbers on it. It just looks exactly like an insurance card.”\u003c/p>\n\u003cp>One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.\u003c/p>\n\u003cp>“It did me good,” she says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"swxoiuaBwIFNHC8PbxRB3kfDYxOKFLOH\"]\u003c/p>\n\u003cp>Now she has a subsidized commercial plan through Covered California, with modest premiums and co-pays, and she likes that, too.\u003c/p>\n\u003cp>“It’s okay. 'Cause I’m at the doctor’s at least once a month,” she says.\u003c/p>\n\u003cp>But when asked what she thinks of Obamacare overall, she says she doesn’t like it.\u003c/p>\n\u003cp>“Because of Obama himself,” she says with a laugh. “I rest my case.”\u003c/p>\n\u003cp>The confusion and the contradictions are common among patients, explains Morris, the enrollment counselor.\u003c/p>\n\u003cp>“People just don't understand the different names,” she says. “But, of course, it's the same thing.”\u003c/p>\n\u003cp>Morris has seen the difference Obamacare has made for people in the region. She’s seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn’t have gotten.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Those patients won’t fight for Obamacare, Morris says, so that’s why the clinics have to.\u003c/p>\n\n",
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"excerpt": "Under the ACA, 75,000 people enrolled in Medi-Cal in the state's northeast. 'The data shows it’s the rural communities that have greatly benefited from the Medicaid expansion.'",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Modoc County, in the northeast corner of California, is roughly the size of Connecticut. It's so sparsely populated, the entire county has just one stoplight. The nearest Wal-Mart is more than an hour's drive, across the Oregon border. Same with hospitals that deliver babies.\u003c/p>\n\u003cp>Greta Elliott runs a tiny health \u003ca href=\"http://canbyclinic.org/\" target=\"_blank\" rel=\"noopener noreferrer\">clinic\u003c/a> in Canby, on the edge of the national forest. \"Rural\" doesn’t begin to describe the area, she says. This is \"the frontier.\"\u003c/p>\n\u003cp>“There are more cows in Modoc than there are people,” Elliott says.\u003c/p>\n\u003cp>There's a frontier mentality, too. People take care of each other, and they take care of themselves. They don’t like being told what to do. Being forced to buy insurance made Obamacare a dirty word.\u003c/p>\n\u003cp>Even Elliott, the head of a health clinic, decided against buying coverage for herself.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It's too expensive,” she says. “I choose to put my money back into paying the bills of the whole family.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Overall, the Affordable Care Act helped 25,000 people in far Northern California buy plans through the state marketplace, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>. But the law helped three times as many people, 75,000, enroll in Medi-Cal, the state’s Medicaid program that provides free health coverage for low-income residents.\u003c/p>\n\u003cp>“The data shows it's the rural communities that have greatly benefited from the Medicaid expansion. That’s the irony,” says Dean Germano, CEO of the \u003ca href=\"https://www.shastahealth.org\" target=\"_blank\" rel=\"noopener noreferrer\">Shasta Community Health Center\u003c/a>. “These are places that voted much more heavily for Donald Trump.”\u003c/p>\n\u003cp>In Modoc and Lassen counties, 70 percent of people voted for Trump in the November election. In neighboring Shasta County, Trump won 64 percent of the vote.\u003c/p>\n\u003cp>But now a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of clinics from across the Northeast corner of the state is lobbying local officials to take an unpopular position in this conservative land: defend Obamacare.\u003c/p>\n\u003cp>And the right-leaning Shasta County Board of Supervisors took them up on it.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“We thought ‘Whoa! That is really bold,’” Germano says. “I was surprised.”\u003c/p>\n\u003cp>The board sent a letter to the local Republican congressman, \u003ca href=\"https://lamalfa.house.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Doug La Malfa\u003c/a>, asking him to vote against the initial GOP repeal and replace bill, because it would hurt local people.\u003c/p>\n\u003cp>“We have an obligation to say something,” says Supervisor David Kehoe. “And if it may be mildly offensive from a political standpoint for some, well, we’re not going to be intimidated by politics.”\u003c/p>\n\u003cp>But Congressman La Malfa still voted in favor of dismantling Obamacare.\u003c/p>\n\u003cp>La Malfa didn't return calls and emails for this story, but, in May, \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">he told KQED\u003c/a> that skyrocketing premiums were the main driver behind his vote.\u003c/p>\n\u003cp>\"Unfortunately, the reality is that too many young and healthy individuals are deciding they’d rather pay the penalty than sign up for care, citing financial barriers and lack of choice,\" he said in a statement. \"A 28 year old making $45,000 a year with no major health concerns is not going to pay upwards of $400 a month for a plan that does not even work for them.\"\u003c/p>\n\u003cp>When clinic representatives met with La Malfa's staffers, they were told the Congressman's office was flooded with calls like this.\u003c/p>\n\u003cp>But poor folks on Medi-Cal didn’t call to say how much they appreciate that program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.\u003c/p>\n\u003cp>“They feel like it's a handout and they're too proud, they don’t want to,” says Carol Morris, an enrollment counselor for the \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys\u003c/a> health clinics in Shasta county.\u003c/p>\n\u003cp>One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">\"Partnership Health Plan\" \u003c/a>and may not realize they’re actually covered by a government program.\u003c/p>\n\u003cp>“It feels like it's more of an insurance,” Morris says. “It’s like a laminated, wallet-sized card that's got your numbers on it. It just looks exactly like an insurance card.”\u003c/p>\n\u003cp>One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.\u003c/p>\n\u003cp>“It did me good,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Now she has a subsidized commercial plan through Covered California, with modest premiums and co-pays, and she likes that, too.\u003c/p>\n\u003cp>“It’s okay. 'Cause I’m at the doctor’s at least once a month,” she says.\u003c/p>\n\u003cp>But when asked what she thinks of Obamacare overall, she says she doesn’t like it.\u003c/p>\n\u003cp>“Because of Obama himself,” she says with a laugh. “I rest my case.”\u003c/p>\n\u003cp>The confusion and the contradictions are common among patients, explains Morris, the enrollment counselor.\u003c/p>\n\u003cp>“People just don't understand the different names,” she says. “But, of course, it's the same thing.”\u003c/p>\n\u003cp>Morris has seen the difference Obamacare has made for people in the region. She’s seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn’t have gotten.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Those patients won’t fight for Obamacare, Morris says, so that’s why the clinics have to.\u003c/p>\n\n\u003c/div>\u003c/p>",
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}
},
"baycurious": {
"id": "baycurious",
"title": "Bay Curious",
"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
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},
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},
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
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},
"link": "/radio/program/bbc-world-service",
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"tuneIn": "https://tunein.com/radio/BBC-World-Service-p455581/",
"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
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},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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}
},
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"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
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"order": 1
},
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
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"id": "fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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},
"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"hyphenacion": {
"id": "hyphenacion",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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"site": "news",
"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
"spotify": "https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"
}
},
"morning-edition": {
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