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"slug": "breast-cancer-rises-among-asian-american-and-pacific-islander-women",
"title": "'It's a Real Trend': Breast Cancer Cases Rise Among Asian Americans and Pacific Islanders",
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"content": "\u003cp>Christina Kashiwada was traveling for work during the summer of 2018 when she noticed a small, itchy lump in her left breast.\u003c/p>\n\u003cp>She thought little of it at first. She did routine self-checks and kept up with medical appointments. But a relative urged her to get a mammogram. She took the advice and learned she had stage 3 breast cancer, a revelation that stunned her.\u003c/p>\n\u003cp>“I’m 36 years old, right?” said Kashiwada, a civil engineer in Sacramento, California. “No one’s thinking about cancer.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>About 11,000 Asian American and Pacific Islander women were diagnosed with breast cancer in 2021 and about 1,500 died. The latest federal data shows the rate of new breast cancer diagnoses in Asian American and Pacific Islander women — a group that once had relatively low rates of diagnosis — is rising much faster than that of many other racial and ethnic groups. The trend is especially sharp among young women such as Kashiwada.\u003c/p>\n\u003cp>About 55 of every 100,000 Asian American and Pacific Islander women under 50 were diagnosed with breast cancer in 2021, surpassing the rate for Black and Hispanic women and on par with the rate for white women, according to \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=55&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=2#resultsRegion0\">age-adjusted data\u003c/a> from the National Institutes of Health. (Hispanic people can be of any race or combination of races but are grouped separately in this data.)\u003c/p>\n\u003cp>The rate of new breast cancer cases among Asian American and Pacific Islander women under 50 grew by about 52% from 2000 through 2021. Rates for AAPI women 50 to 64 rose 33% and rates for AAPI women 65 and older grew by 43% during that period. By comparison, the rate for women of all ages, races, and ethnicities grew by 3%.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/VwlRg/12/\" width=\"800\" height=\"600\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>Researchers have picked up on this trend and are racing to find out why it is occurring within this ethnically diverse group. They suspect the answer is complex, ranging from cultural shifts to pressure-filled lifestyles — yet they concede it remains a mystery and difficult for patients and their families to discuss because of cultural differences.\u003c/p>\n\u003cp>\u003ca href=\"https://health.ucdavis.edu/medical-center/team/646/helen-chew---cancer---hematology-oncology---internal-medicine-sacramento/\">Helen Chew\u003c/a>, director of the Clinical Breast Cancer Program at UC Davis Health, said the Asian American diaspora is so \u003ca href=\"https://data.census.gov/table/ACSDT1Y2022.B02015?q=B02015:%20Asian%20Alone%20by%20Selected%20Groups\">broad and diverse\u003c/a> that simple explanations for the increase in breast cancer aren’t obvious.\u003c/p>\n\u003cp>“It’s a real trend,” Chew said, adding that “it is just difficult to tease out exactly why it is. Is it because we’re seeing an influx of people who have less access to care? Is it because of many things culturally where they may not want to come in if they see something on their breast?”\u003c/p>\n\u003cp>There’s urgency to solve this mystery because it’s costing lives. While women in most ethnic and racial groups are experiencing sharp declines in breast cancer death rates, about \u003ca href=\"https://wonder.cdc.gov/controller/saved/D176/D401F928\">12 of every 100,000\u003c/a> Asian American and Pacific Islander women of any age died from breast cancer in 2023, essentially the same death rate as in 2000, according to age-adjusted, provisional data from the Centers for Disease Control and Prevention. The breast cancer death rate among all women during that period dropped 30%.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/vSr1U/13/\" width=\"800\" height=\"600\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>The CDC does not break out breast cancer death rates for many different groups of Asian American women, such as those of Chinese or Korean descent. It has, though, begun distinguishing between Asian American women and Pacific Islander women.\u003c/p>\n\u003cp>Nearly 9,000 Asian American women died from breast cancer from 2018 through 2023, compared with about 500 Native Hawaiian and Pacific Islander women. However, breast cancer death rates were \u003ca href=\"https://wonder.cdc.gov/controller/saved/D176/D403F335\">116% higher\u003c/a> among Native Hawaiian and Pacific Islander women than among Asian American women during that period.\u003c/p>\n\u003cp>Rates of \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=40&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=1#resultsRegion0\">pancreatic\u003c/a>, \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=80&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=1\">thyroid\u003c/a>, \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=21&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=1#resultsRegion0\">colon\u003c/a>, and \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=58&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&hdn_sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=1#resultsRegion0\">endometrial\u003c/a> cancer, along with \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=86&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=1#resultsRegion0\">non-Hodgkin lymphoma\u003c/a> rates, have also recently risen significantly among Asian American and Pacific Islander women under 50, NIH data show. Yet breast cancer is much more common among young AAPI women than any of those other types of cancer — especially concerning because young women are \u003ca href=\"https://www.bcrf.org/blog/breast-cancer-young-women/\">more likely to \u003c/a>\u003ca href=\"https://www.bcrf.org/blog/breast-cancer-young-women/\">face\u003c/a> more aggressive forms of the disease, with high mortality rates.\u003c/p>\n\u003cp>“We’re seeing somewhere almost around a 4% per-year increase,” said \u003ca href=\"https://cancer.ucsf.edu/people/gomez.scarlett\">Scarlett Gomez\u003c/a>, a professor and epidemiologist at the University of California-San Francisco’s Helen Diller Family Comprehensive Cancer Center. “We’re seeing even more than the 4% per-year increase in Asian/Pacific Islander women less than age 50.”\u003c/p>\n\u003cp>Gomez is a lead investigator on a \u003ca href=\"https://www.ucsf.edu/news/2024/05/427586/new-ucsf-study-find-out-what-drives-cancer-asian-americans\">large study\u003c/a> exploring the causes of cancer in Asian Americans. She said there is not yet enough research to know what is causing the recent spike in breast cancer. The answer may involve multiple risk factors over a long period of time.\u003c/p>\n\u003cp>“One of the hypotheses that we’re exploring there is the role of stress,” she said. “We’re asking all sorts of questions about different sources of stress, different coping styles throughout the lifetime.”\u003c/p>\n\u003cp>It’s likely not just that there’s more screening. “We looked at trends by stage at diagnosis, and we are seeing similar rates of increase across all stages of disease,” Gomez said.\u003c/p>\n\u003cp>\u003ca href=\"https://keck.usc.edu/faculty-search/veronica-w-setiawan/\">Veronica Setiawan\u003c/a>, a professor and epidemiologist at the Keck School of Medicine of the University of Southern California, said the trend may be related to Asian immigrants adopting some lifestyles that put them at higher risk. Setiawan is a breast cancer survivor who was diagnosed a few years ago at the age of 49.\u003c/p>\n\u003cp>“Asian women, American women, they become more westernized, so they have their puberty younger now — having earlier age at [the first menstrual cycle] is \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488186/\">associated with increased risk\u003c/a>,” said Setiawan, who is working with Gomez on the cancer study. “Maybe \u003ca href=\"https://www.komen.org/breast-cancer/risk-factor/age-at-first-childbirth/#:~:text=Women%20who%20give%20birth%20to%20their%20first%20child%20at%20later,never%20give%20birth%20%5B12%5D.\">giving birth later\u003c/a>, we delay childbearing, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9972148/\">we don’t breastfeed\u003c/a> — those are all associated with breast cancer risks.”\u003c/p>\n\u003cp>\u003ca href=\"https://health.ucdavis.edu/medical-center/team/1129/moon-chen--jr----population-health---cancer/\">Moon Chen\u003c/a>, a professor at the University of California-Davis and an \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9194616/\">expert on cancer health disparities\u003c/a>, added that only \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3980490/\">a tiny fraction\u003c/a> of NIH funding is devoted to researching cancer among Asian Americans.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/5RYAR/10/\" width=\"800\" height=\"700\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>Whatever its cause, the trend has created years of anguish for many patients.\u003c/p>\n\u003cp>Kashiwada underwent a mastectomy following her breast cancer diagnosis. During surgery, doctors at UC Davis Health discovered the cancer had spread to lymph nodes in her underarm. She underwent eight rounds of chemotherapy and 20 sessions of radiation treatment.\u003c/p>\n\u003cp>Throughout her treatments, Kashiwada kept her ordeal a secret from her grandmother, who had helped raise her. Her grandmother never knew about the diagnosis. “I didn’t want her to worry about me or add stress to her,” Kashiwada said. “She just would probably never sleep if she knew that was happening. It was very important to me to protect her.”\u003c/p>\n\u003cp>Kashiwada moved in with her parents. Her mom took a leave from work to help take care of her.\u003c/p>\n\u003cp>Kashiwada’s two young children, who were 3 and 6 at the time, stayed with their dad so she could focus on her recovery.\u003c/p>\n\u003cp>“The kids would come over after school,” she said. “My dad would pick them up and bring them over to see me almost every day while their dad was at work.”\u003c/p>\n\u003cfigure id=\"attachment_12003007\" class=\"wp-caption alignright\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12003007\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1707\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-2048x1365.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Kashiwada had to undergo eight rounds of chemotherapy and 20 sessions of radiation treatment to treat her breast cancer. \u003ccite>(Rich Pedroncelli for KFF Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kashiwada spent months regaining strength after the radiation treatments. She returned to work but with a doctor’s instruction to avoid lifting heavy objects.\u003c/p>\n\u003cp>Kashiwada had her final reconstructive surgery a few weeks before COVID-19 lockdowns began in 2020. But her treatment was not finished.\u003c/p>\n\u003cp>Her doctors had told her that estrogen fed her cancer, so they gave her medicine to put her through early menopause. The treatment was not as effective as they had hoped. Her doctor performed surgery in 2021 to remove her ovaries.\u003c/p>\n\u003cp>More recently, she was diagnosed with osteopenia and will start injections to stop bone loss.\u003c/p>\n\u003cp>Kashiwada said she has moved past many of the negative emotions she felt about her illness and wants other young women, including Asian American women like her, to be aware of their elevated risk.\u003c/p>\n\u003cp>“No matter how healthy you think you are, or you’re exercising, or whatever you’re doing, eating well, which is all the things I was doing — I would say it does not make you invincible or immune,” she said. “Not to say that you should be afraid of everything, but just be very in tune with your body and what your body’s telling you.”\u003c/p>\n\u003cp>\u003cem>Phillip Reese is a data reporting specialist and an associate professor of journalism at California State University-Sacramento.\u003c/em>\u003c/p>\n\u003cp>\u003cem>This article was produced by \u003c/em>\u003ca href=\"https://kffhealthnews.org/about-us\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>KFF Health News\u003c/em>\u003c/a>\u003cem>, which publishes \u003c/em>\u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>California Healthline\u003c/em>\u003c/a>\u003cem>, an editorially independent service of the \u003c/em>\u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>California Health Care Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em> \u003cem>Supplemental support comes from the \u003ca href=\"https://aaja-la.org/\" target=\"_blank\" rel=\"noreferrer noopener\">Asian American Journalists Association-Los Angeles\u003c/a> through \u003ca href=\"https://www.calendow.org/\" target=\"_blank\" rel=\"noreferrer noopener\">The California Endowment\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Christina Kashiwada was traveling for work during the summer of 2018 when she noticed a small, itchy lump in her left breast.\u003c/p>\n\u003cp>She thought little of it at first. She did routine self-checks and kept up with medical appointments. But a relative urged her to get a mammogram. She took the advice and learned she had stage 3 breast cancer, a revelation that stunned her.\u003c/p>\n\u003cp>“I’m 36 years old, right?” said Kashiwada, a civil engineer in Sacramento, California. “No one’s thinking about cancer.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>About 11,000 Asian American and Pacific Islander women were diagnosed with breast cancer in 2021 and about 1,500 died. The latest federal data shows the rate of new breast cancer diagnoses in Asian American and Pacific Islander women — a group that once had relatively low rates of diagnosis — is rising much faster than that of many other racial and ethnic groups. The trend is especially sharp among young women such as Kashiwada.\u003c/p>\n\u003cp>About 55 of every 100,000 Asian American and Pacific Islander women under 50 were diagnosed with breast cancer in 2021, surpassing the rate for Black and Hispanic women and on par with the rate for white women, according to \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=55&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=2#resultsRegion0\">age-adjusted data\u003c/a> from the National Institutes of Health. (Hispanic people can be of any race or combination of races but are grouped separately in this data.)\u003c/p>\n\u003cp>The rate of new breast cancer cases among Asian American and Pacific Islander women under 50 grew by about 52% from 2000 through 2021. Rates for AAPI women 50 to 64 rose 33% and rates for AAPI women 65 and older grew by 43% during that period. By comparison, the rate for women of all ages, races, and ethnicities grew by 3%.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/VwlRg/12/\" width=\"800\" height=\"600\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>Researchers have picked up on this trend and are racing to find out why it is occurring within this ethnically diverse group. They suspect the answer is complex, ranging from cultural shifts to pressure-filled lifestyles — yet they concede it remains a mystery and difficult for patients and their families to discuss because of cultural differences.\u003c/p>\n\u003cp>\u003ca href=\"https://health.ucdavis.edu/medical-center/team/646/helen-chew---cancer---hematology-oncology---internal-medicine-sacramento/\">Helen Chew\u003c/a>, director of the Clinical Breast Cancer Program at UC Davis Health, said the Asian American diaspora is so \u003ca href=\"https://data.census.gov/table/ACSDT1Y2022.B02015?q=B02015:%20Asian%20Alone%20by%20Selected%20Groups\">broad and diverse\u003c/a> that simple explanations for the increase in breast cancer aren’t obvious.\u003c/p>\n\u003cp>“It’s a real trend,” Chew said, adding that “it is just difficult to tease out exactly why it is. Is it because we’re seeing an influx of people who have less access to care? Is it because of many things culturally where they may not want to come in if they see something on their breast?”\u003c/p>\n\u003cp>There’s urgency to solve this mystery because it’s costing lives. While women in most ethnic and racial groups are experiencing sharp declines in breast cancer death rates, about \u003ca href=\"https://wonder.cdc.gov/controller/saved/D176/D401F928\">12 of every 100,000\u003c/a> Asian American and Pacific Islander women of any age died from breast cancer in 2023, essentially the same death rate as in 2000, according to age-adjusted, provisional data from the Centers for Disease Control and Prevention. The breast cancer death rate among all women during that period dropped 30%.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/vSr1U/13/\" width=\"800\" height=\"600\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>The CDC does not break out breast cancer death rates for many different groups of Asian American women, such as those of Chinese or Korean descent. It has, though, begun distinguishing between Asian American women and Pacific Islander women.\u003c/p>\n\u003cp>Nearly 9,000 Asian American women died from breast cancer from 2018 through 2023, compared with about 500 Native Hawaiian and Pacific Islander women. However, breast cancer death rates were \u003ca href=\"https://wonder.cdc.gov/controller/saved/D176/D403F335\">116% higher\u003c/a> among Native Hawaiian and Pacific Islander women than among Asian American women during that period.\u003c/p>\n\u003cp>Rates of \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=40&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=1#resultsRegion0\">pancreatic\u003c/a>, \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=80&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=1\">thyroid\u003c/a>, \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=21&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=1#resultsRegion0\">colon\u003c/a>, and \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=58&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&hdn_sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=1#resultsRegion0\">endometrial\u003c/a> cancer, along with \u003ca href=\"https://seer.cancer.gov/statistics-network/explorer/application.html?site=86&data_type=1&graph_type=2&compareBy=race&chk_race_4=4&rate_type=2&sex=3&age_range=9&stage=101&advopt_precision=1&advopt_show_ci=on&hdn_view=0&advopt_show_apc=on&advopt_display=1#resultsRegion0\">non-Hodgkin lymphoma\u003c/a> rates, have also recently risen significantly among Asian American and Pacific Islander women under 50, NIH data show. Yet breast cancer is much more common among young AAPI women than any of those other types of cancer — especially concerning because young women are \u003ca href=\"https://www.bcrf.org/blog/breast-cancer-young-women/\">more likely to \u003c/a>\u003ca href=\"https://www.bcrf.org/blog/breast-cancer-young-women/\">face\u003c/a> more aggressive forms of the disease, with high mortality rates.\u003c/p>\n\u003cp>“We’re seeing somewhere almost around a 4% per-year increase,” said \u003ca href=\"https://cancer.ucsf.edu/people/gomez.scarlett\">Scarlett Gomez\u003c/a>, a professor and epidemiologist at the University of California-San Francisco’s Helen Diller Family Comprehensive Cancer Center. “We’re seeing even more than the 4% per-year increase in Asian/Pacific Islander women less than age 50.”\u003c/p>\n\u003cp>Gomez is a lead investigator on a \u003ca href=\"https://www.ucsf.edu/news/2024/05/427586/new-ucsf-study-find-out-what-drives-cancer-asian-americans\">large study\u003c/a> exploring the causes of cancer in Asian Americans. She said there is not yet enough research to know what is causing the recent spike in breast cancer. The answer may involve multiple risk factors over a long period of time.\u003c/p>\n\u003cp>“One of the hypotheses that we’re exploring there is the role of stress,” she said. “We’re asking all sorts of questions about different sources of stress, different coping styles throughout the lifetime.”\u003c/p>\n\u003cp>It’s likely not just that there’s more screening. “We looked at trends by stage at diagnosis, and we are seeing similar rates of increase across all stages of disease,” Gomez said.\u003c/p>\n\u003cp>\u003ca href=\"https://keck.usc.edu/faculty-search/veronica-w-setiawan/\">Veronica Setiawan\u003c/a>, a professor and epidemiologist at the Keck School of Medicine of the University of Southern California, said the trend may be related to Asian immigrants adopting some lifestyles that put them at higher risk. Setiawan is a breast cancer survivor who was diagnosed a few years ago at the age of 49.\u003c/p>\n\u003cp>“Asian women, American women, they become more westernized, so they have their puberty younger now — having earlier age at [the first menstrual cycle] is \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488186/\">associated with increased risk\u003c/a>,” said Setiawan, who is working with Gomez on the cancer study. “Maybe \u003ca href=\"https://www.komen.org/breast-cancer/risk-factor/age-at-first-childbirth/#:~:text=Women%20who%20give%20birth%20to%20their%20first%20child%20at%20later,never%20give%20birth%20%5B12%5D.\">giving birth later\u003c/a>, we delay childbearing, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9972148/\">we don’t breastfeed\u003c/a> — those are all associated with breast cancer risks.”\u003c/p>\n\u003cp>\u003ca href=\"https://health.ucdavis.edu/medical-center/team/1129/moon-chen--jr----population-health---cancer/\">Moon Chen\u003c/a>, a professor at the University of California-Davis and an \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9194616/\">expert on cancer health disparities\u003c/a>, added that only \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3980490/\">a tiny fraction\u003c/a> of NIH funding is devoted to researching cancer among Asian Americans.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/5RYAR/10/\" width=\"800\" height=\"700\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>Whatever its cause, the trend has created years of anguish for many patients.\u003c/p>\n\u003cp>Kashiwada underwent a mastectomy following her breast cancer diagnosis. During surgery, doctors at UC Davis Health discovered the cancer had spread to lymph nodes in her underarm. She underwent eight rounds of chemotherapy and 20 sessions of radiation treatment.\u003c/p>\n\u003cp>Throughout her treatments, Kashiwada kept her ordeal a secret from her grandmother, who had helped raise her. Her grandmother never knew about the diagnosis. “I didn’t want her to worry about me or add stress to her,” Kashiwada said. “She just would probably never sleep if she knew that was happening. It was very important to me to protect her.”\u003c/p>\n\u003cp>Kashiwada moved in with her parents. Her mom took a leave from work to help take care of her.\u003c/p>\n\u003cp>Kashiwada’s two young children, who were 3 and 6 at the time, stayed with their dad so she could focus on her recovery.\u003c/p>\n\u003cp>“The kids would come over after school,” she said. “My dad would pick them up and bring them over to see me almost every day while their dad was at work.”\u003c/p>\n\u003cfigure id=\"attachment_12003007\" class=\"wp-caption alignright\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12003007\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1707\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-2048x1365.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Kashiwada_01-resized-copy-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Kashiwada had to undergo eight rounds of chemotherapy and 20 sessions of radiation treatment to treat her breast cancer. \u003ccite>(Rich Pedroncelli for KFF Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Kashiwada spent months regaining strength after the radiation treatments. She returned to work but with a doctor’s instruction to avoid lifting heavy objects.\u003c/p>\n\u003cp>Kashiwada had her final reconstructive surgery a few weeks before COVID-19 lockdowns began in 2020. But her treatment was not finished.\u003c/p>\n\u003cp>Her doctors had told her that estrogen fed her cancer, so they gave her medicine to put her through early menopause. The treatment was not as effective as they had hoped. Her doctor performed surgery in 2021 to remove her ovaries.\u003c/p>\n\u003cp>More recently, she was diagnosed with osteopenia and will start injections to stop bone loss.\u003c/p>\n\u003cp>Kashiwada said she has moved past many of the negative emotions she felt about her illness and wants other young women, including Asian American women like her, to be aware of their elevated risk.\u003c/p>\n\u003cp>“No matter how healthy you think you are, or you’re exercising, or whatever you’re doing, eating well, which is all the things I was doing — I would say it does not make you invincible or immune,” she said. “Not to say that you should be afraid of everything, but just be very in tune with your body and what your body’s telling you.”\u003c/p>\n\u003cp>\u003cem>Phillip Reese is a data reporting specialist and an associate professor of journalism at California State University-Sacramento.\u003c/em>\u003c/p>\n\u003cp>\u003cem>This article was produced by \u003c/em>\u003ca href=\"https://kffhealthnews.org/about-us\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>KFF Health News\u003c/em>\u003c/a>\u003cem>, which publishes \u003c/em>\u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>California Healthline\u003c/em>\u003c/a>\u003cem>, an editorially independent service of the \u003c/em>\u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noreferrer noopener\">\u003cem>California Health Care Foundation\u003c/em>\u003c/a>\u003cem>.\u003c/em> \u003cem>Supplemental support comes from the \u003ca href=\"https://aaja-la.org/\" target=\"_blank\" rel=\"noreferrer noopener\">Asian American Journalists Association-Los Angeles\u003c/a> through \u003ca href=\"https://www.calendow.org/\" target=\"_blank\" rel=\"noreferrer noopener\">The California Endowment\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "how-will-california-health-care-change-under-trump-or-harris-heres-what-their-records-show",
"title": "How Will California Health Care Change Under Trump or Harris? Here’s What Their Records Show",
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"content": "\u003cp>Donald Trump and \u003ca href=\"https://calmatters.org/tag/Kamala-Harris/\" target=\"_blank\" rel=\"noreferrer noopener\">Kamala Harris\u003c/a> stand far apart on most issues, and health care is no exception. The \u003ca href=\"https://calmatters.org/tag/election-2024/\" target=\"_blank\" rel=\"noreferrer noopener\">November election\u003c/a> carries major implications for Californians’ access to health care and the cost they pay for it.\u003c/p>\n\u003cp>While neither candidate has put forth a comprehensive \u003ca href=\"https://calmatters.org/tag/health-care/\" target=\"_blank\" rel=\"noreferrer noopener\">health care\u003c/a> agenda, both have track records from their respective time in the White House or previous posts that offer a glimpse on where they might stand on key health issues.\u003c/p>\n\u003cp>The cost of health care is a top concern for Californians and voters across the nation, millions of whom are saddled with medical debt or take less medication than prescribed because of the cost. While both candidates have acknowledged that health costs are a major burden to Americans, the difference will be in how they go about providing relief.\u003c/p>\n\u003cp>How the next president goes about strengthening — or chipping away — at the Affordable Care Act and abortion rights will also directly affect voters’ lives. Below are examples of both candidates’ records on key health issues and what they’ve promised to voters so far.\u003c/p>\n\u003ch3>The future of the Affordable Care Act\u003c/h3>\n\u003cp>\u003cstrong>TRUMP.\u003c/strong> Trump, as president, tried and failed to repeal the Affordable Care Act, the signature legislative achievement of his predecessor, Barack Obama. As recently as last year, Trump \u003ca href=\"https://www.nbcnews.com/politics/congress/trump-doubles-saying-obamacare-sucks-must-replaced-rcna126978\" target=\"_blank\" rel=\"noreferrer noopener\">vowed to try again if he’s reelected\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The idea of overhauling the health law would be a much harder sell today than in Trump’s presidency, some experts say, because the law is generally more popular. Some Republicans who opposed the law in the past have come to accept that it is here to stay or have moved on to other issues.\u003c/p>\n\u003cp>Nowadays, Trump says he \u003ca href=\"https://www.nytimes.com/2024/04/11/us/politics/trump-biden-affordable-care-act.html\" target=\"_blank\" rel=\"noreferrer noopener\">wants to “improve” the Affordable Care Act\u003c/a> and make it “less expensive.” He hasn’t offered any details as to what that would entail, but experts say any changes would likely come in the form of chipping away at certain provisions of the law.\u003c/p>\n\u003cp>Trump, as president, made one major change to the Affordable Care Act: He signed a tax cut law that also eliminated a penalty levied on people without health insurance. The idea behind this provision of the Affordable Care Act was that a penalty, charged when people filed their income taxes, would encourage people to sign up for health insurance. And getting more people insured, especially the young and healthy, drives down the cost of coverage for everyone. Today, uninsured \u003ca href=\"https://calmatters.org/health/2024/03/california-health-insurance-penalty/\">Californians still pay a penalty\u003c/a> of up to $850 per adult because Gov. Gavin Newsom enacted a state version of this mandate.\u003c/p>\n\u003cp>\u003cstrong>HARRIS.\u003c/strong> During \u003ca href=\"https://kamalaharris.medium.com/my-plan-for-medicare-for-all-7730370dd421\">her 2019 presidential campaign\u003c/a>, Harris promoted a version of Medicare for All, a government-run single-payer system. Today, health policy experts expect Harris to continue the current administration’s efforts to promote and build on the Affordable Care Act rather than move the country toward a new system.\u003c/p>\n\u003cp>Some California lawmakers are still interested in exploring a single-payer-like health care system. Last year, \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb770\">Newsom signed a law\u003c/a> directing the state to map out the next \u003ca href=\"https://calmatters.org/health/2023/07/single-payer-health-care/\">steps in creating a “unified financing” system\u003c/a> that would cover all Californians. Getting anywhere near this goal will require federal permission and resources, which are more likely to happen under a Harris administration, experts involved in these discussions say.\u003c/p>\n\u003cp>“A Harris presidency, I think, is going to view a waiver application from the state of California favorably,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research, who has served as a consultant to a state commission exploring this issue. “It’s not to say that it will sail through…getting a waiver to pool federal and state funding is still going to be a challenge, but I think her administration is going to find a way to work with California to make it happen.”\u003c/p>\n\u003cp>More people than ever, \u003ca href=\"https://www.kff.org/policy-watch/where-aca-marketplace-enrollment-is-growing-the-fastest-and-why/\">21 million\u003c/a>, signed up for health insurance under \u003ca href=\"https://calmatters.org/tag/affordable-care-act/\">Affordable Care Act \u003c/a>exchanges in 2024. Marketplace officials across the country say that’s in part because of the increased premium subsidies made available under the COVID-19 relief laws known as the American Rescue Plan and later the Inflation Reduction Act. That enhanced financial aid is currently set to expire at the end of 2025. About 90% of enrollees in Covered California receive financial assistance. The odds of continuing that enhanced aid are better under a Harris administration, experts say.\u003c/p>\n\u003ch3>The cost of health care\u003c/h3>\n\u003cp>\u003cstrong>HARRIS.\u003c/strong> As attorney general of California, Harris went after large health companies by moving to restrict mergers and investigate anti-competitive behaviors that research shows can drive up the cost of care.\u003c/p>\n\u003cp>She launched an investigation into several California health systems, examining their market power and their influence on prices. That investigation led her successor, Attorney General Xavier Becerra, to file a lawsuit against Sutter Health, a nonprofit hospital and clinic system in Northern California. In the lawsuit, Becerra accused Sutter of using its market power to drive up prices in Northern California. In 2019, \u003ca href=\"https://californiahealthline.org/news/california-ag-details-historic-settlement-agreement-in-sutter-health-antitrust-case/\" target=\"_blank\" rel=\"noreferrer noopener\">Sutter settled the case for $575 million\u003c/a>, although it did not admit wrongdoing.\u003c/p>\n\u003cp>Harris has also taken a leading role in the current administration’s efforts to address the medical debt that burdens millions of families. In June, she proposed rules to remove medical debt from credit reports. California lawmakers \u003ca href=\"https://calmatters.org/health/2024/08/medical-debt-credit-score/\" target=\"_blank\" rel=\"noreferrer noopener\">have a similar proposal\u003c/a> currently sitting on Newsom’s desk. About 4 in 10 Californians report having some type of medical debt, according to the California Health Care Foundation.\u003c/p>\n\u003cp>Among Harris’ campaign promises: “Work with states to cancel medical debt for millions of Americans.” While she hasn’t said how exactly she plans to do this, her work with North Carolina Gov. Roy Cooper may offer a preview: Starting next year, North Carolina will roll out a program that incentivizes hospitals to forgive patients’ medical debt in exchange for additional Medicaid dollars.\u003c/p>\n\u003cp>\u003cstrong>TRUMP.\u003c/strong> Perhaps some of Trump’s most significant contributions to reining in health care costs came in the form of price transparency rules. He signed an executive order that led to requirements for hospitals to disclose prices for common services on their websites. And in 2020, Trump signed the \u003ca href=\"https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills\">No Surprises Act\u003c/a>, a law designed to protect consumers against surprise medical bills when receiving care from out-of-network providers. This often happens when people receive emergency care and are not in a position to choose their providers. Surprise medical bills\u003ca href=\"https://www.kff.org/health-costs/press-release/a-polling-surprise-americans-rank-unexpected-medical-bills-at-top-of-family-budget-worries/\" target=\"_blank\" rel=\"noreferrer noopener\"> tend to rank among the public’s top concerns\u003c/a>.\u003c/p>\n\u003cp>The Trump administration greenlit some major health care mergers, but it did so with certain conditions signaling some caution in approving such deals. One example — CVS Health’s $69 billion acquisition of insurance giant Aetna, one of the biggest health mergers of all time. Aetna and CVS Health were competitors in the sale of Medicare drug plans. As a condition to approve the merger, Trump’s Department of Justice required that Aetna sell part of its Medicare drug business to another company as a way to preserve competition.\u003c/p>\n\u003cp>“That one was really contentious, and it took a long time, but we definitely didn’t see a rubber stamp,” said Rachel Nuzum, senior vice president of policy at The Commonwealth Fund. “There was an acknowledgment that the size and scope of these mergers could be problematic for consumers.”\u003c/p>\n\u003ch3>Abortion in the 2024 election\u003c/h3>\n\u003cfigure id=\"attachment_12003015\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12003015\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2.jpg\" alt=\"A crowd of people on the street march holding pink signs above their heads.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pro-abortion rights supporters marched in protest of a Supreme Court ruling that overturned Roe vs. Wade in Sacramento on June 25, 2022. \u003ccite>(Miguel Gutierrez Jr./CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>TRUMP.\u003c/strong> No other health issue has received as much attention this election cycle as \u003ca href=\"https://calmatters.org/tag/abortion\">abortion and reproductive health\u003c/a>. In California, Democrats have tried to cement abortion rights into state law, and this is often the first issue they use to go after Trump. That’s because the Supreme Court justices he appointed made the difference in overturning the 1973 ruling that had protected abortion rights, Roe v. Wade.\u003c/p>\n\u003cp>Trump has given inconsistent messages about abortion rights. Earlier this year, Trump made headlines for suggesting that if he were reelected, he’d support \u003ca href=\"https://apnews.com/article/trump-abortion-ban-15-weeks-91a9e0ce87d11dff0fa761f327bd0566\">a national ban on abortion\u003c/a> at 15 weeks of pregnancy. A few weeks later, he changed his tune, saying abortion \u003ca href=\"https://www.politico.com/news/2024/04/08/trump-says-abortion-is-up-to-the-states-declines-to-endorse-national-limit-00151022\">should be left up to the states\u003c/a>. He has indicated that he would not ban mail delivery of medication abortion pills and has said he wants insurance \u003ca href=\"https://www.latimes.com/politics/story/2024-08-29/trump-calls-for-universal-coverage-of-ivf-treatment-with-no-specifics-on-how-his-plan-would-work\">to cover the cost of in vitro fertilization treatment, or IVF\u003c/a>, “because we want more babies.”\u003c/p>\n\u003cp>\u003cstrong>HARRIS. \u003c/strong>Harris has leaned heavily into\u003ca href=\"https://calmatters.org/explainers/abortion-in-california-laws/\"> abortion and reproductive rights\u003c/a>, an issue she has remained consistent on throughout her career. She is often the voice and face for reproductive health in Biden’s administration and has expressed support for restoring abortion access through federal law.\u003c/p>\n\u003cp>As vice president, she launched a nationwide tour to promote reproductive rights with events across the country. It included a visit to a Planned Parenthood clinic, reportedly\u003ca href=\"https://www.plannedparenthoodaction.org/tipsheets/the-quickie-kamala-harris-makes-history-as-first-vice-president-to-tour-a-planned-parenthood-health-center\"> the first ever such visit\u003c/a> by a sitting VP or president.\u003c/p>\n\u003cp>As attorney general in California, Harris sponsored state law that aimed to regulate crisis pregnancy centers. These are often religiously affiliated and known for trying to prevent women from getting abortions. The law required these centers to display a notice letting people know that comprehensive family planning services, including contraception and abortion, were available through state programs. The U.S. Supreme Court eventually overturned that law.\u003c/p>\n\u003ch3>How they’d curb prescription drug prices\u003c/h3>\n\u003cfigure id=\"attachment_12003013\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12003013\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05.jpg\" alt=\"A view of various medications in a pharmacy with a person wearing a lab coat in the background.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Shelves full of prescription medication at La Clinic pharmacy in Oakland on Sept. 26, 2019. \u003ccite>(Anne Wernikoff/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>TRUMP. \u003c/strong>Trump often takes credit for lowering the price of insulin for millions of Americans — \u003ca href=\"https://www.politifact.com/factchecks/2024/jul/12/donald-trump/trump-wrong-in-claiming-full-credit-for-lowering-i/\">but that’s not totally accurate\u003c/a>. What his administration did was establish a temporary program known as the \u003ca href=\"https://www.cms.gov/priorities/innovation/innovation-models/part-d-savings-model\">Part D Senior Savings Model\u003c/a>. This program reduced copayments for insulin to $35 a month for about 800,000 seniors on certain Medicare plans. It lasted two years, expiring at the end of 2023. \u003ca href=\"https://www.kff.org/policy-watch/the-facts-about-the-35-insulin-copay-cap-in-medicare/\">The Biden administration went further\u003c/a> in the Inflation Reduction Act, which included a provision that capped insulin copay prices at $35 a month for about 3.3 million Medicare beneficiaries.[aside postID=\"news_12001799,news_11997351,news_12002132\" label=\"Related Stories\"]\u003c/p>\n\u003cp>Trump also took the first steps to allow states \u003ca href=\"https://www.nytimes.com/2019/12/18/health/drug-prices-imports-canada.html\">to import prescription drugs from Canada\u003c/a> as a way to increase competition and lower drug prices. The pharmaceutical industry and \u003ca href=\"https://www.reuters.com/business/healthcare-pharmaceuticals/canada-says-bulk-importation-not-an-effective-solution-high-drug-prices-us-2024-01-08/\">the Canadian government heavily opposed this move\u003c/a>. This idea came to fruition earlier this year when the FDA approved Florida’s plan to import prescription drugs to treat HIV/AIDS, mental illness and prostate cancer. Florida Gov. Ron DeSantis said that importing medications from Canada will \u003ca href=\"https://www.flgov.com/2024/01/05/florida-becomes-first-in-the-nation-to-have-canadian-drug-importation-program-approved-by-fda/\">save the state about $180 million\u003c/a> in year one.\u003c/p>\n\u003cp>\u003cstrong>HARRIS. \u003c/strong>In addition to expanding insulin copay caps to more seniors, Biden-Harris’ Inflation Reduction Act also directed the agency to negotiate drug prices with manufacturers for certain high-cost drugs covered under Medicare. The \u003ca href=\"https://www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf\">10 drugs in the first round of negotiations\u003c/a> included medications to treat diabetes, heart failure, blood clots and rheumatoid arthritis. The negotiations resulted in discounts between 38% to 79%. The new negotiated prices are set to go into effect in 2026.\u003c/p>\n\u003cp>The Inflation Reduction Act — for which Harris likes to remind voters she cast the tie-breaking vote — also caps the total annual out-of-pocket drug spending for people on Medicare. This means that starting in 2025, seniors will pay no more than $2,000 a year for all their medications. About 3.2 million Medicare beneficiaries are expected to reach this limit in 2025, \u003ca href=\"https://states.aarp.org/california/new-aarp-report-impact-of-historic-medicare-rx-out-of-pocket-spending-cap-on-california-seniors\">including 271,000 in California\u003c/a>, according to recent estimates from the AARP.\u003c/p>\n\u003cp>Harris has said she wants to expand these cost-saving efforts to everyone, not just seniors. \u003ca href=\"https://mailchi.mp/press.kamalaharris.com/vice-president-harris-lays-out-agenda-to-lower-costs-for-american-families\">She has also pledged\u003c/a> to go after drug companies and \u003ca href=\"https://calmatters.org/health/2024/08/pharmacy-benefit-manager/\">pharmaceutical middlemen\u003c/a> that thwart competition and drive up costs.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Kamala Harris investigated the market power of huge California health care companies. Donald Trump compelled hospitals to disclose prices. Here’s a look at their 2024 priorities on health.",
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"title": "How Will California Health Care Change Under Trump or Harris? Here’s What Their Records Show | KQED",
"description": "Kamala Harris investigated the market power of huge California health care companies. Donald Trump compelled hospitals to disclose prices. Here’s a look at their 2024 priorities on health.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Donald Trump and \u003ca href=\"https://calmatters.org/tag/Kamala-Harris/\" target=\"_blank\" rel=\"noreferrer noopener\">Kamala Harris\u003c/a> stand far apart on most issues, and health care is no exception. The \u003ca href=\"https://calmatters.org/tag/election-2024/\" target=\"_blank\" rel=\"noreferrer noopener\">November election\u003c/a> carries major implications for Californians’ access to health care and the cost they pay for it.\u003c/p>\n\u003cp>While neither candidate has put forth a comprehensive \u003ca href=\"https://calmatters.org/tag/health-care/\" target=\"_blank\" rel=\"noreferrer noopener\">health care\u003c/a> agenda, both have track records from their respective time in the White House or previous posts that offer a glimpse on where they might stand on key health issues.\u003c/p>\n\u003cp>The cost of health care is a top concern for Californians and voters across the nation, millions of whom are saddled with medical debt or take less medication than prescribed because of the cost. While both candidates have acknowledged that health costs are a major burden to Americans, the difference will be in how they go about providing relief.\u003c/p>\n\u003cp>How the next president goes about strengthening — or chipping away — at the Affordable Care Act and abortion rights will also directly affect voters’ lives. Below are examples of both candidates’ records on key health issues and what they’ve promised to voters so far.\u003c/p>\n\u003ch3>The future of the Affordable Care Act\u003c/h3>\n\u003cp>\u003cstrong>TRUMP.\u003c/strong> Trump, as president, tried and failed to repeal the Affordable Care Act, the signature legislative achievement of his predecessor, Barack Obama. As recently as last year, Trump \u003ca href=\"https://www.nbcnews.com/politics/congress/trump-doubles-saying-obamacare-sucks-must-replaced-rcna126978\" target=\"_blank\" rel=\"noreferrer noopener\">vowed to try again if he’s reelected\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The idea of overhauling the health law would be a much harder sell today than in Trump’s presidency, some experts say, because the law is generally more popular. Some Republicans who opposed the law in the past have come to accept that it is here to stay or have moved on to other issues.\u003c/p>\n\u003cp>Nowadays, Trump says he \u003ca href=\"https://www.nytimes.com/2024/04/11/us/politics/trump-biden-affordable-care-act.html\" target=\"_blank\" rel=\"noreferrer noopener\">wants to “improve” the Affordable Care Act\u003c/a> and make it “less expensive.” He hasn’t offered any details as to what that would entail, but experts say any changes would likely come in the form of chipping away at certain provisions of the law.\u003c/p>\n\u003cp>Trump, as president, made one major change to the Affordable Care Act: He signed a tax cut law that also eliminated a penalty levied on people without health insurance. The idea behind this provision of the Affordable Care Act was that a penalty, charged when people filed their income taxes, would encourage people to sign up for health insurance. And getting more people insured, especially the young and healthy, drives down the cost of coverage for everyone. Today, uninsured \u003ca href=\"https://calmatters.org/health/2024/03/california-health-insurance-penalty/\">Californians still pay a penalty\u003c/a> of up to $850 per adult because Gov. Gavin Newsom enacted a state version of this mandate.\u003c/p>\n\u003cp>\u003cstrong>HARRIS.\u003c/strong> During \u003ca href=\"https://kamalaharris.medium.com/my-plan-for-medicare-for-all-7730370dd421\">her 2019 presidential campaign\u003c/a>, Harris promoted a version of Medicare for All, a government-run single-payer system. Today, health policy experts expect Harris to continue the current administration’s efforts to promote and build on the Affordable Care Act rather than move the country toward a new system.\u003c/p>\n\u003cp>Some California lawmakers are still interested in exploring a single-payer-like health care system. Last year, \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb770\">Newsom signed a law\u003c/a> directing the state to map out the next \u003ca href=\"https://calmatters.org/health/2023/07/single-payer-health-care/\">steps in creating a “unified financing” system\u003c/a> that would cover all Californians. Getting anywhere near this goal will require federal permission and resources, which are more likely to happen under a Harris administration, experts involved in these discussions say.\u003c/p>\n\u003cp>“A Harris presidency, I think, is going to view a waiver application from the state of California favorably,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research, who has served as a consultant to a state commission exploring this issue. “It’s not to say that it will sail through…getting a waiver to pool federal and state funding is still going to be a challenge, but I think her administration is going to find a way to work with California to make it happen.”\u003c/p>\n\u003cp>More people than ever, \u003ca href=\"https://www.kff.org/policy-watch/where-aca-marketplace-enrollment-is-growing-the-fastest-and-why/\">21 million\u003c/a>, signed up for health insurance under \u003ca href=\"https://calmatters.org/tag/affordable-care-act/\">Affordable Care Act \u003c/a>exchanges in 2024. Marketplace officials across the country say that’s in part because of the increased premium subsidies made available under the COVID-19 relief laws known as the American Rescue Plan and later the Inflation Reduction Act. That enhanced financial aid is currently set to expire at the end of 2025. About 90% of enrollees in Covered California receive financial assistance. The odds of continuing that enhanced aid are better under a Harris administration, experts say.\u003c/p>\n\u003ch3>The cost of health care\u003c/h3>\n\u003cp>\u003cstrong>HARRIS.\u003c/strong> As attorney general of California, Harris went after large health companies by moving to restrict mergers and investigate anti-competitive behaviors that research shows can drive up the cost of care.\u003c/p>\n\u003cp>She launched an investigation into several California health systems, examining their market power and their influence on prices. That investigation led her successor, Attorney General Xavier Becerra, to file a lawsuit against Sutter Health, a nonprofit hospital and clinic system in Northern California. In the lawsuit, Becerra accused Sutter of using its market power to drive up prices in Northern California. In 2019, \u003ca href=\"https://californiahealthline.org/news/california-ag-details-historic-settlement-agreement-in-sutter-health-antitrust-case/\" target=\"_blank\" rel=\"noreferrer noopener\">Sutter settled the case for $575 million\u003c/a>, although it did not admit wrongdoing.\u003c/p>\n\u003cp>Harris has also taken a leading role in the current administration’s efforts to address the medical debt that burdens millions of families. In June, she proposed rules to remove medical debt from credit reports. California lawmakers \u003ca href=\"https://calmatters.org/health/2024/08/medical-debt-credit-score/\" target=\"_blank\" rel=\"noreferrer noopener\">have a similar proposal\u003c/a> currently sitting on Newsom’s desk. About 4 in 10 Californians report having some type of medical debt, according to the California Health Care Foundation.\u003c/p>\n\u003cp>Among Harris’ campaign promises: “Work with states to cancel medical debt for millions of Americans.” While she hasn’t said how exactly she plans to do this, her work with North Carolina Gov. Roy Cooper may offer a preview: Starting next year, North Carolina will roll out a program that incentivizes hospitals to forgive patients’ medical debt in exchange for additional Medicaid dollars.\u003c/p>\n\u003cp>\u003cstrong>TRUMP.\u003c/strong> Perhaps some of Trump’s most significant contributions to reining in health care costs came in the form of price transparency rules. He signed an executive order that led to requirements for hospitals to disclose prices for common services on their websites. And in 2020, Trump signed the \u003ca href=\"https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills\">No Surprises Act\u003c/a>, a law designed to protect consumers against surprise medical bills when receiving care from out-of-network providers. This often happens when people receive emergency care and are not in a position to choose their providers. Surprise medical bills\u003ca href=\"https://www.kff.org/health-costs/press-release/a-polling-surprise-americans-rank-unexpected-medical-bills-at-top-of-family-budget-worries/\" target=\"_blank\" rel=\"noreferrer noopener\"> tend to rank among the public’s top concerns\u003c/a>.\u003c/p>\n\u003cp>The Trump administration greenlit some major health care mergers, but it did so with certain conditions signaling some caution in approving such deals. One example — CVS Health’s $69 billion acquisition of insurance giant Aetna, one of the biggest health mergers of all time. Aetna and CVS Health were competitors in the sale of Medicare drug plans. As a condition to approve the merger, Trump’s Department of Justice required that Aetna sell part of its Medicare drug business to another company as a way to preserve competition.\u003c/p>\n\u003cp>“That one was really contentious, and it took a long time, but we definitely didn’t see a rubber stamp,” said Rachel Nuzum, senior vice president of policy at The Commonwealth Fund. “There was an acknowledgment that the size and scope of these mergers could be problematic for consumers.”\u003c/p>\n\u003ch3>Abortion in the 2024 election\u003c/h3>\n\u003cfigure id=\"attachment_12003015\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12003015\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2.jpg\" alt=\"A crowd of people on the street march holding pink signs above their heads.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/Roe-Wade-Abortion-Protest-MG-07-CM-2-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pro-abortion rights supporters marched in protest of a Supreme Court ruling that overturned Roe vs. Wade in Sacramento on June 25, 2022. \u003ccite>(Miguel Gutierrez Jr./CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>TRUMP.\u003c/strong> No other health issue has received as much attention this election cycle as \u003ca href=\"https://calmatters.org/tag/abortion\">abortion and reproductive health\u003c/a>. In California, Democrats have tried to cement abortion rights into state law, and this is often the first issue they use to go after Trump. That’s because the Supreme Court justices he appointed made the difference in overturning the 1973 ruling that had protected abortion rights, Roe v. Wade.\u003c/p>\n\u003cp>Trump has given inconsistent messages about abortion rights. Earlier this year, Trump made headlines for suggesting that if he were reelected, he’d support \u003ca href=\"https://apnews.com/article/trump-abortion-ban-15-weeks-91a9e0ce87d11dff0fa761f327bd0566\">a national ban on abortion\u003c/a> at 15 weeks of pregnancy. A few weeks later, he changed his tune, saying abortion \u003ca href=\"https://www.politico.com/news/2024/04/08/trump-says-abortion-is-up-to-the-states-declines-to-endorse-national-limit-00151022\">should be left up to the states\u003c/a>. He has indicated that he would not ban mail delivery of medication abortion pills and has said he wants insurance \u003ca href=\"https://www.latimes.com/politics/story/2024-08-29/trump-calls-for-universal-coverage-of-ivf-treatment-with-no-specifics-on-how-his-plan-would-work\">to cover the cost of in vitro fertilization treatment, or IVF\u003c/a>, “because we want more babies.”\u003c/p>\n\u003cp>\u003cstrong>HARRIS. \u003c/strong>Harris has leaned heavily into\u003ca href=\"https://calmatters.org/explainers/abortion-in-california-laws/\"> abortion and reproductive rights\u003c/a>, an issue she has remained consistent on throughout her career. She is often the voice and face for reproductive health in Biden’s administration and has expressed support for restoring abortion access through federal law.\u003c/p>\n\u003cp>As vice president, she launched a nationwide tour to promote reproductive rights with events across the country. It included a visit to a Planned Parenthood clinic, reportedly\u003ca href=\"https://www.plannedparenthoodaction.org/tipsheets/the-quickie-kamala-harris-makes-history-as-first-vice-president-to-tour-a-planned-parenthood-health-center\"> the first ever such visit\u003c/a> by a sitting VP or president.\u003c/p>\n\u003cp>As attorney general in California, Harris sponsored state law that aimed to regulate crisis pregnancy centers. These are often religiously affiliated and known for trying to prevent women from getting abortions. The law required these centers to display a notice letting people know that comprehensive family planning services, including contraception and abortion, were available through state programs. The U.S. Supreme Court eventually overturned that law.\u003c/p>\n\u003ch3>How they’d curb prescription drug prices\u003c/h3>\n\u003cfigure id=\"attachment_12003013\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12003013\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05.jpg\" alt=\"A view of various medications in a pharmacy with a person wearing a lab coat in the background.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/09/092619_laclinica_AW_CM_05-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Shelves full of prescription medication at La Clinic pharmacy in Oakland on Sept. 26, 2019. \u003ccite>(Anne Wernikoff/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>TRUMP. \u003c/strong>Trump often takes credit for lowering the price of insulin for millions of Americans — \u003ca href=\"https://www.politifact.com/factchecks/2024/jul/12/donald-trump/trump-wrong-in-claiming-full-credit-for-lowering-i/\">but that’s not totally accurate\u003c/a>. What his administration did was establish a temporary program known as the \u003ca href=\"https://www.cms.gov/priorities/innovation/innovation-models/part-d-savings-model\">Part D Senior Savings Model\u003c/a>. This program reduced copayments for insulin to $35 a month for about 800,000 seniors on certain Medicare plans. It lasted two years, expiring at the end of 2023. \u003ca href=\"https://www.kff.org/policy-watch/the-facts-about-the-35-insulin-copay-cap-in-medicare/\">The Biden administration went further\u003c/a> in the Inflation Reduction Act, which included a provision that capped insulin copay prices at $35 a month for about 3.3 million Medicare beneficiaries.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump also took the first steps to allow states \u003ca href=\"https://www.nytimes.com/2019/12/18/health/drug-prices-imports-canada.html\">to import prescription drugs from Canada\u003c/a> as a way to increase competition and lower drug prices. The pharmaceutical industry and \u003ca href=\"https://www.reuters.com/business/healthcare-pharmaceuticals/canada-says-bulk-importation-not-an-effective-solution-high-drug-prices-us-2024-01-08/\">the Canadian government heavily opposed this move\u003c/a>. This idea came to fruition earlier this year when the FDA approved Florida’s plan to import prescription drugs to treat HIV/AIDS, mental illness and prostate cancer. Florida Gov. Ron DeSantis said that importing medications from Canada will \u003ca href=\"https://www.flgov.com/2024/01/05/florida-becomes-first-in-the-nation-to-have-canadian-drug-importation-program-approved-by-fda/\">save the state about $180 million\u003c/a> in year one.\u003c/p>\n\u003cp>\u003cstrong>HARRIS. \u003c/strong>In addition to expanding insulin copay caps to more seniors, Biden-Harris’ Inflation Reduction Act also directed the agency to negotiate drug prices with manufacturers for certain high-cost drugs covered under Medicare. The \u003ca href=\"https://www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf\">10 drugs in the first round of negotiations\u003c/a> included medications to treat diabetes, heart failure, blood clots and rheumatoid arthritis. The negotiations resulted in discounts between 38% to 79%. The new negotiated prices are set to go into effect in 2026.\u003c/p>\n\u003cp>The Inflation Reduction Act — for which Harris likes to remind voters she cast the tie-breaking vote — also caps the total annual out-of-pocket drug spending for people on Medicare. This means that starting in 2025, seniors will pay no more than $2,000 a year for all their medications. About 3.2 million Medicare beneficiaries are expected to reach this limit in 2025, \u003ca href=\"https://states.aarp.org/california/new-aarp-report-impact-of-historic-medicare-rx-out-of-pocket-spending-cap-on-california-seniors\">including 271,000 in California\u003c/a>, according to recent estimates from the AARP.\u003c/p>\n\u003cp>Harris has said she wants to expand these cost-saving efforts to everyone, not just seniors. \u003ca href=\"https://mailchi.mp/press.kamalaharris.com/vice-president-harris-lays-out-agenda-to-lower-costs-for-american-families\">She has also pledged\u003c/a> to go after drug companies and \u003ca href=\"https://calmatters.org/health/2024/08/pharmacy-benefit-manager/\">pharmaceutical middlemen\u003c/a> that thwart competition and drive up costs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003ca href=\"https://www.kqed.org/news/tag/san-francisco\">San Francisco\u003c/a> is killing tobacco sellers’ buzz with a new lawsuit over the sale of flavored Zyns and other smokeless tobacco pouches that users tuck between their lips and gums for a nicotine fix.\u003c/p>\n\u003cp>The lawsuit targets several online vendors that the city attorney’s office accuses of flouting state and local laws aimed at preventing kids from getting hooked on tobacco products. Unflavored nicotine pouches, which are sold at corner stores and head shops throughout the city, are still available for online purchase.\u003c/p>\n\u003cp>“We will not allow decades of progress reducing youth tobacco to be unraveled. These products are not welcome here. We are taking decisive action against these retailers for selling these products to San Franciscans,” City Attorney David Chiu said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The suit, filed Tuesday in San Francisco County Superior Court, alleges that Northerner Scandinavia, Lucy Goods, Rogue Holdings and Swisher International sell flavored nicotine products online to San Franciscans despite the ban, which the city began enforcing in 2019. California followed suit \u003ca href=\"https://www.kqed.org/news/11972039/californias-ban-on-flavored-tobacco-upheld-by-u-s-supreme-court\">with a statewide ban\u003c/a> in 2022.\u003c/p>\n\u003cp>“Tobacco products are much more attractive to young people when they are flavored,” the complaint argues. “And teenagers believe that it is easy to access flavored tobacco products from the internet.”\u003c/p>\n\u003cp>Nicotine pouches are particularly appealing to youth given the low cost and attractive flavors, and recent studies have found that more children are trying and using them. The 2023 California Youth Tobacco Survey found nicotine pouches are the second most common form of tobacco use among California eighth-graders.\u003c/p>\n\u003cp>[aside postID=news_11983224 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/GettyImages-1486127435-1020x680.jpg']\u003c/p>\n\u003cp>“While the products evolve, the strategy is the same: targeting young people to be their next generation of consumers using bright colors and sweet flavors,” said Fahad Qurashi, chief program officer of the Bay Area-based Youth Leadership Institute.\u003c/p>\n\u003cp>The lawsuit also cites a\u003ca href=\"https://tobaccocontrol.bmj.com/content/early/2023/11/01/tc-2023-058269\"> November 2023 report\u003c/a> from researchers at UC San Diego that suggests action by California and local jurisdictions to prohibit the sale of flavored tobacco products at brick-and-mortar retailers has led to increased online sales of the products.\u003c/p>\n\u003cp>“This is why we want to make it very clear that we will enforce these laws against online retailers to stop their sales into San Francisco,” Chiu said. “We think that is key to protecting our next generation from these dangerous products.”\u003c/p>\n\u003cp>The companies cited in the lawsuit did not respond to requests for comment.\u003c/p>\n\u003cp>San Francisco has a history of being at the forefront of flavored tobacco prohibition. In 2019, the city became \u003ca href=\"https://www.kqed.org/futureofyou/441395/sf-voters-may-ban-vape-flavors-menthol-cigarettes\">the first in the nation\u003c/a> to ban all flavored tobacco products from store shelves, including the formerly popular Juul vape, as well as conventional menthol cigarettes.\u003c/p>\n\u003cp>In 2018, about 11% of high school students in San Francisco were regular users of vapes, according to the California Youth Tobacco Survey.\u003c/p>\n\u003cp>San Francisco Unified was among thousands of cities, counties and other school districts \u003ca href=\"https://www.kqed.org/news/11787277/california-sues-e-cigarette-maker-juul-alleges-it-deliberately-marketed-to-teens\">to sue tobacco companies over marketing\u003c/a> and advertising e-cigarettes to youth in 2019, with many of the cases merging into a class-action suit and leading to a $1.2 billion settlement nationwide.\u003c/p>\n\u003cp>Following the citywide ban and lawsuit, vaping among youth in the city declined. By 2022, less than 6% of high school students were vaping regularly, the survey found.\u003c/p>\n\u003cp>\u003cem>KQED’s \u003c/em>\u003ca href=\"https://www.kqed.org/author/ahall\">\u003cem>Alex Hall\u003c/em>\u003c/a>\u003cem> contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n",
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"excerpt": "The city attorney is suing four tobacco retailers accused of selling Zyns and other flavored nicotine pouches online to San Franciscans in violation of the city’s ban.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"https://www.kqed.org/news/tag/san-francisco\">San Francisco\u003c/a> is killing tobacco sellers’ buzz with a new lawsuit over the sale of flavored Zyns and other smokeless tobacco pouches that users tuck between their lips and gums for a nicotine fix.\u003c/p>\n\u003cp>The lawsuit targets several online vendors that the city attorney’s office accuses of flouting state and local laws aimed at preventing kids from getting hooked on tobacco products. Unflavored nicotine pouches, which are sold at corner stores and head shops throughout the city, are still available for online purchase.\u003c/p>\n\u003cp>“We will not allow decades of progress reducing youth tobacco to be unraveled. These products are not welcome here. We are taking decisive action against these retailers for selling these products to San Franciscans,” City Attorney David Chiu said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The suit, filed Tuesday in San Francisco County Superior Court, alleges that Northerner Scandinavia, Lucy Goods, Rogue Holdings and Swisher International sell flavored nicotine products online to San Franciscans despite the ban, which the city began enforcing in 2019. California followed suit \u003ca href=\"https://www.kqed.org/news/11972039/californias-ban-on-flavored-tobacco-upheld-by-u-s-supreme-court\">with a statewide ban\u003c/a> in 2022.\u003c/p>\n\u003cp>“Tobacco products are much more attractive to young people when they are flavored,” the complaint argues. “And teenagers believe that it is easy to access flavored tobacco products from the internet.”\u003c/p>\n\u003cp>Nicotine pouches are particularly appealing to youth given the low cost and attractive flavors, and recent studies have found that more children are trying and using them. The 2023 California Youth Tobacco Survey found nicotine pouches are the second most common form of tobacco use among California eighth-graders.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“While the products evolve, the strategy is the same: targeting young people to be their next generation of consumers using bright colors and sweet flavors,” said Fahad Qurashi, chief program officer of the Bay Area-based Youth Leadership Institute.\u003c/p>\n\u003cp>The lawsuit also cites a\u003ca href=\"https://tobaccocontrol.bmj.com/content/early/2023/11/01/tc-2023-058269\"> November 2023 report\u003c/a> from researchers at UC San Diego that suggests action by California and local jurisdictions to prohibit the sale of flavored tobacco products at brick-and-mortar retailers has led to increased online sales of the products.\u003c/p>\n\u003cp>“This is why we want to make it very clear that we will enforce these laws against online retailers to stop their sales into San Francisco,” Chiu said. “We think that is key to protecting our next generation from these dangerous products.”\u003c/p>\n\u003cp>The companies cited in the lawsuit did not respond to requests for comment.\u003c/p>\n\u003cp>San Francisco has a history of being at the forefront of flavored tobacco prohibition. In 2019, the city became \u003ca href=\"https://www.kqed.org/futureofyou/441395/sf-voters-may-ban-vape-flavors-menthol-cigarettes\">the first in the nation\u003c/a> to ban all flavored tobacco products from store shelves, including the formerly popular Juul vape, as well as conventional menthol cigarettes.\u003c/p>\n\u003cp>In 2018, about 11% of high school students in San Francisco were regular users of vapes, according to the California Youth Tobacco Survey.\u003c/p>\n\u003cp>San Francisco Unified was among thousands of cities, counties and other school districts \u003ca href=\"https://www.kqed.org/news/11787277/california-sues-e-cigarette-maker-juul-alleges-it-deliberately-marketed-to-teens\">to sue tobacco companies over marketing\u003c/a> and advertising e-cigarettes to youth in 2019, with many of the cases merging into a class-action suit and leading to a $1.2 billion settlement nationwide.\u003c/p>\n\u003cp>Following the citywide ban and lawsuit, vaping among youth in the city declined. By 2022, less than 6% of high school students were vaping regularly, the survey found.\u003c/p>\n\u003cp>\u003cem>KQED’s \u003c/em>\u003ca href=\"https://www.kqed.org/author/ahall\">\u003cem>Alex Hall\u003c/em>\u003c/a>\u003cem> contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>Updated 1:50 p.m. Wednesday\u003c/em>\u003c/p>\n\u003cp>After a handful of people initially reported getting \u003ca href=\"https://www.kqed.org/news/12001154/valley-fever-rises-after-california-music-festival-experts-warn-of-climate-change-link\">valley fever at a Kern County music festival\u003c/a> in May, California public health officials say the number of cases linked to the event nearly quadrupled in a month.\u003c/p>\n\u003cp>In late July, the California Department of Public Health announced that five attendees of Lightning in a Bottle tested positive, and three were hospitalized with symptoms. Last week, the department said that \u003ca href=\"https://www.cdph.ca.gov/Programs/OPA/Pages/NR24-22.aspx\">as of Aug. 21\u003c/a>, the number of confirmed cases linked to the festival is at least 19, including eight hospitalizations.\u003c/p>\n\u003cp>The actual number of people infected is likely higher since \u003ca href=\"https://www.kqed.org/news/12001920/valley-fever-in-california-symptoms-protecting-yourself-and-why-cases-are-way-up\">valley fever symptoms\u003c/a> — cough, fever, chest pain and fatigue — can be confused with other common respiratory infections and COVID-19.\u003c/p>\n\u003cp>Valley fever is not contagious from person to person but infects people and animals who breathe in dust or dirt that contains fungal spores of coccidioides, or “cocci.” When this dust is blown up into the air, people in the area can inhale the cocci spores, which can infect the lungs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>State officials have warned that \u003ca href=\"https://www.kqed.org/news/12001920/valley-fever-in-california-symptoms-protecting-yourself-and-why-cases-are-way-up\">valley fever is on the rise\u003c/a> this year and being reported outside the Central Valley and Central Coast areas where it is traditionally most common. A music festival is somewhat of a perfect storm for the infection — dancing kicks loose dust containing the soil-dwelling fungus, and singing festival-goers breathe in the spores.\u003c/p>\n\u003cp>More than 20,000 people traveled from across the state and beyond to attend Lightning in a Bottle between May 22 and 27. Health officials are continuing to investigate the cases linked to the festival.\u003c/p>\n\u003cp>Following news stories about the cases, multiple \u003ca href=\"https://www.reddit.com/r/LightningInABottle/comments/1efxmgw/festival_is_hit_with_deadly_fungus_outbreak_that/\">Reddit users\u003c/a> discussing the festival reported feeling sick, and some say that getting a test for the infection has been difficult.\u003c/p>\n\u003cp>Lightning in a Bottle organizers told KQED that health and safety are a primary concern and that the festival adheres to guidance from the Centers for Disease Control and Prevention, CDPH and local authorities.\u003c/p>\n\u003cp>“We, like other large scale gatherings in the region, will continue to seek out the most up to date health and safety guidance made available to us as we plan for future events,” organizers said in a statement.\u003c/p>\n\u003cp>“You really have to advocate to get tested,” one said. Another reported having symptoms since two weeks after the festival but said they were turned away from the doctor’s office without a test.\u003c/p>\n\u003cp>[aside postID=news_12001920 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/GettyImages-1386022781.jpg']\u003c/p>\n\u003cp>State medical officials are warning of an increased risk of valley fever infection this fall, the high season throughout Central California. The disease has spread more rapidly this year so far than in previous years, with \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CocciinCAProvisionalMonthlyReport.pdf\">6,280 suspected, probable or confirmed infections through the end of July\u003c/a> — about 2,500 more than in the same period in 2023.\u003c/p>\n\u003cp>The disease is prevalent only in a few areas, including the San Joaquin Valley and desert regions of Arizona, but experts say that California’s \u003ca href=\"https://www.kqed.org/news/12001154/valley-fever-rises-after-california-music-festival-experts-warn-of-climate-change-link\">changing weather patterns\u003c/a> could make the climate here even more conducive to the fungus.\u003c/p>\n\u003cp>A recent study by Alexandra Heaney, an assistant professor of public health at UC San Diego, hypothesizes that the state’s flip-flopping heavy rain and drought periods fuel the fungus.\u003c/p>\n\u003cp>She and her co-authors believe extensive fungus grows during wet, rainy periods, while dry spells allow the fungus to form and release infectious spores into the air. Cocci can also withstand extremely dry, harsh conditions allowing it to outlast much of its competition during droughts.\u003c/p>\n\u003cp>“If this is going to continue to become more common due to climate change, it’s something that might be contributing to the increases we’ve seen and may actually promote increases in the future as well,” Heaney told KQED in August.\u003c/p>\n\u003cp>CDPH Director Dr. Tomás Aragón warns that the state is preparing for “another possible increase,” and Californians should be aware of valley fever symptoms to catch it early.\u003c/p>\n\u003cp>“If you have a lingering cough and fatigue, please talk to a doctor about valley fever, especially if you’ve been outdoors in dusty air in the Central Valley or Central Coast regions,” Aragón said in a statement.\u003c/p>\n\u003cp>\u003c/p>\n",
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"excerpt": "The number of cases linked to Lightning in a Bottle has risen from five to 19 in a month as California public health officials warn of an increasing risk of infection.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated 1:50 p.m. Wednesday\u003c/em>\u003c/p>\n\u003cp>After a handful of people initially reported getting \u003ca href=\"https://www.kqed.org/news/12001154/valley-fever-rises-after-california-music-festival-experts-warn-of-climate-change-link\">valley fever at a Kern County music festival\u003c/a> in May, California public health officials say the number of cases linked to the event nearly quadrupled in a month.\u003c/p>\n\u003cp>In late July, the California Department of Public Health announced that five attendees of Lightning in a Bottle tested positive, and three were hospitalized with symptoms. Last week, the department said that \u003ca href=\"https://www.cdph.ca.gov/Programs/OPA/Pages/NR24-22.aspx\">as of Aug. 21\u003c/a>, the number of confirmed cases linked to the festival is at least 19, including eight hospitalizations.\u003c/p>\n\u003cp>The actual number of people infected is likely higher since \u003ca href=\"https://www.kqed.org/news/12001920/valley-fever-in-california-symptoms-protecting-yourself-and-why-cases-are-way-up\">valley fever symptoms\u003c/a> — cough, fever, chest pain and fatigue — can be confused with other common respiratory infections and COVID-19.\u003c/p>\n\u003cp>Valley fever is not contagious from person to person but infects people and animals who breathe in dust or dirt that contains fungal spores of coccidioides, or “cocci.” When this dust is blown up into the air, people in the area can inhale the cocci spores, which can infect the lungs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>State officials have warned that \u003ca href=\"https://www.kqed.org/news/12001920/valley-fever-in-california-symptoms-protecting-yourself-and-why-cases-are-way-up\">valley fever is on the rise\u003c/a> this year and being reported outside the Central Valley and Central Coast areas where it is traditionally most common. A music festival is somewhat of a perfect storm for the infection — dancing kicks loose dust containing the soil-dwelling fungus, and singing festival-goers breathe in the spores.\u003c/p>\n\u003cp>More than 20,000 people traveled from across the state and beyond to attend Lightning in a Bottle between May 22 and 27. Health officials are continuing to investigate the cases linked to the festival.\u003c/p>\n\u003cp>Following news stories about the cases, multiple \u003ca href=\"https://www.reddit.com/r/LightningInABottle/comments/1efxmgw/festival_is_hit_with_deadly_fungus_outbreak_that/\">Reddit users\u003c/a> discussing the festival reported feeling sick, and some say that getting a test for the infection has been difficult.\u003c/p>\n\u003cp>Lightning in a Bottle organizers told KQED that health and safety are a primary concern and that the festival adheres to guidance from the Centers for Disease Control and Prevention, CDPH and local authorities.\u003c/p>\n\u003cp>“We, like other large scale gatherings in the region, will continue to seek out the most up to date health and safety guidance made available to us as we plan for future events,” organizers said in a statement.\u003c/p>\n\u003cp>“You really have to advocate to get tested,” one said. Another reported having symptoms since two weeks after the festival but said they were turned away from the doctor’s office without a test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>State medical officials are warning of an increased risk of valley fever infection this fall, the high season throughout Central California. The disease has spread more rapidly this year so far than in previous years, with \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CocciinCAProvisionalMonthlyReport.pdf\">6,280 suspected, probable or confirmed infections through the end of July\u003c/a> — about 2,500 more than in the same period in 2023.\u003c/p>\n\u003cp>The disease is prevalent only in a few areas, including the San Joaquin Valley and desert regions of Arizona, but experts say that California’s \u003ca href=\"https://www.kqed.org/news/12001154/valley-fever-rises-after-california-music-festival-experts-warn-of-climate-change-link\">changing weather patterns\u003c/a> could make the climate here even more conducive to the fungus.\u003c/p>\n\u003cp>A recent study by Alexandra Heaney, an assistant professor of public health at UC San Diego, hypothesizes that the state’s flip-flopping heavy rain and drought periods fuel the fungus.\u003c/p>\n\u003cp>She and her co-authors believe extensive fungus grows during wet, rainy periods, while dry spells allow the fungus to form and release infectious spores into the air. Cocci can also withstand extremely dry, harsh conditions allowing it to outlast much of its competition during droughts.\u003c/p>\n\u003cp>“If this is going to continue to become more common due to climate change, it’s something that might be contributing to the increases we’ve seen and may actually promote increases in the future as well,” Heaney told KQED in August.\u003c/p>\n\u003cp>CDPH Director Dr. Tomás Aragón warns that the state is preparing for “another possible increase,” and Californians should be aware of valley fever symptoms to catch it early.\u003c/p>\n\u003cp>“If you have a lingering cough and fatigue, please talk to a doctor about valley fever, especially if you’ve been outdoors in dusty air in the Central Valley or Central Coast regions,” Aragón said in a statement.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>State \u003ca href=\"https://www.kqed.org/news/tag/health\">health\u003c/a> regulators have fined Blue Shield of California $250,000 for illegally charging hundreds of its members for contraceptive health care services.\u003c/p>\n\u003cp>The insurance company also paid $228,254 in reimbursements to the members who were incorrectly billed, the California Department of Managed Health Care announced on Thursday.\u003c/p>\n\u003cp>Under state law, health insurance companies must cover contraceptive drugs, devices and products such as birth control and intrauterine devices (IUDs) at no cost to the patient. The Department of Managed Health Care found that from 2016 through 2019, Blue Shield had charged more than 330 members for those services.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We always encourage health plan members who are having issues with their health plan — including billing issues like this, any kind of denials of healthcare services — file a complaint with your plan,” said Kevin Durawa, a spokesperson for the Department of Managed Health Care.\u003c/p>\n\u003cp>[aside postID=news_12001214 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/240524-REGIONALMEDICAL-JG-1-KQED-1020x680.jpg']\u003c/p>\n\u003cp>Blue Shield of California, based in Oakland, has over 4.8 million members across the state. The department started its investigation after receiving a complaint from a member who was charged for an IUD removal.\u003c/p>\n\u003cp>In October 2017, the member requested the device to be removed after experiencing complications with it. Doctors were unable to remove it during a routine office visit and had to perform an outpatient surgery to pull out the device.\u003c/p>\n\u003cp>The patient was billed $3,439 after the procedure. After Blue Shield denied a grievance filed by the patient, they turned to state regulators.\u003c/p>\n\u003cp>“The member did the right thing — they filed a complaint with the Department of Managed Health Care help center, which led to a broader investigation by the DMHC, which uncovered a much bigger issue,” Durawa said.\u003c/p>\n\u003cp>A Blue Shield spokesperson said the company has been “cooperative throughout the process of this investigation” and has taken steps to correct the issue but did not respond to a KQED inquiry into why the members were charged for contraceptive health care services in the first place.\u003c/p>\n\u003cp>\u003c/p>\n",
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"excerpt": "California law requires health insurance providers to fully cover contraceptives. Blue Shield of California charged hundreds of its patients anyway.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>State \u003ca href=\"https://www.kqed.org/news/tag/health\">health\u003c/a> regulators have fined Blue Shield of California $250,000 for illegally charging hundreds of its members for contraceptive health care services.\u003c/p>\n\u003cp>The insurance company also paid $228,254 in reimbursements to the members who were incorrectly billed, the California Department of Managed Health Care announced on Thursday.\u003c/p>\n\u003cp>Under state law, health insurance companies must cover contraceptive drugs, devices and products such as birth control and intrauterine devices (IUDs) at no cost to the patient. The Department of Managed Health Care found that from 2016 through 2019, Blue Shield had charged more than 330 members for those services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We always encourage health plan members who are having issues with their health plan — including billing issues like this, any kind of denials of healthcare services — file a complaint with your plan,” said Kevin Durawa, a spokesperson for the Department of Managed Health Care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Blue Shield of California, based in Oakland, has over 4.8 million members across the state. The department started its investigation after receiving a complaint from a member who was charged for an IUD removal.\u003c/p>\n\u003cp>In October 2017, the member requested the device to be removed after experiencing complications with it. Doctors were unable to remove it during a routine office visit and had to perform an outpatient surgery to pull out the device.\u003c/p>\n\u003cp>The patient was billed $3,439 after the procedure. After Blue Shield denied a grievance filed by the patient, they turned to state regulators.\u003c/p>\n\u003cp>“The member did the right thing — they filed a complaint with the Department of Managed Health Care help center, which led to a broader investigation by the DMHC, which uncovered a much bigger issue,” Durawa said.\u003c/p>\n\u003cp>A Blue Shield spokesperson said the company has been “cooperative throughout the process of this investigation” and has taken steps to correct the issue but did not respond to a KQED inquiry into why the members were charged for contraceptive health care services in the first place.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "health-insurers-hit-with-cas-largest-ever-penalty-over-gender-affirming-care-denials",
"title": "Health Insurers Hit With CA's Largest-Ever Penalty Over Gender-Affirming Care Denials",
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"headTitle": "Health Insurers Hit With CA’s Largest-Ever Penalty Over Gender-Affirming Care Denials | KQED",
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"content": "\u003cp>Two major California health insurers were hit with the state’s largest-ever fines for illegally denying coverage for gender-affirming care in a case that will compel them to revise how they treat patients diagnosed with gender dysphoria.\u003c/p>\n\u003cp>The $850,000 combined penalties against \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/4462/1723730164321.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Blue Cross of California Partnership Plan \u003c/a>and its \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/4492/1723732238309.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Anthem Blue Cross\u003c/a> also require the insurers to hire a dedicated case manager for people with gender dysphoria. Over 150 individuals who were denied coverage for such procedures will see their cases reviewed, and most have already seen reversals, according to the decision.\u003c/p>\n\u003cp>The insurers comply with the decision of the Department of Managed Health Care, a state office that regulates their industry.\u003c/p>\n\u003cp>“We take these matters seriously and have worked directly with the Department of Managed Health Care to identify and implement specific corrective actions to address and resolve the identified matters,” wrote Mike Bowman, a spokesperson for the insurance providers, in a statement to CalMatters.\u003c/p>\n\u003cp>From 2017 to 2020, two California plans by \u003ca href=\"https://providers.anthem.com/california-provider/our-network/plan-information\" target=\"_blank\" rel=\"noreferrer noopener\">Anthem Blue Cross and its state partnership \u003c/a>categorized over 20 surgeries, such as facial implants, hair removal, voice therapy and breast augmentation, as “not medically necessary.” But the procedures were covered if they corrected “abnormal” body structures to create a “normal appearance” for “the target gender.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The language the company employed “could create confusion for the reviewers regarding the medical necessity of the 22 procedures,” wrote Sonia R. Fernandes, deputy director and chief counsel office of enforcement at the Department of Managed Healthcare in an Aug. 15 ruling\u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/4462/1723730164321.pdf\"> against the Blue Cross of California Partnership Plan.\u003c/a>\u003c/p>\n\u003cp>In a parallel ruling against Anthem Blue Cross, she wrote that the company “did not provide alternate criteria” to help clinics and hospitals understand when the procedures would qualify for coverage. The plan in question called the procedures “cosmetic” when used to “improve the gender-specific appearance of an individual who has undergone, or is planning to undergo sex reassignment surgery.”[aside label=\"Related Stories\" tag=\"gender-affirming-care\"]\u003c/p>\n\u003cp>The contested plans were in place years after the state implemented the \u003ca href=\"https://www.insurance.ca.gov/01-consumers/110-health/60-resources/upload/CDI-Gender-Nondiscrimination-Regulations.pdf\">Insurance Gender Nondiscrimination Act in 2013\u003c/a>, which included many LGBTQ+ Californians into anti-discrimination protections for health coverage. Blue Cross officials acknowledged to regulators that the plans did not comply with state law, but the company and its affiliates have faced growing criticism in the past year over its handling of gender-affirming care.\u003c/p>\n\u003cp>It’s not the first time California’s insurance regulators have cracked down on such forms of discrimination. The department in 2017 issued a $200,000 fine against the insurer Health Net for \u003ca href=\"https://www.calhealthreport.org/2017/09/01/23219/\" target=\"_blank\" rel=\"noreferrer noopener\">gaps in coverage related to gender reassignment surgery\u003c/a> and other procedures.\u003c/p>\n\u003cp>Most recently, in December, the Department of Managed Health Care \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/4383/1702479511007.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">announced a $200,000 fine\u003c/a> against \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/actionListing.aspx?OrgType=0&Org=California+Physicians%27+Service\" target=\"_blank\" rel=\"noreferrer noopener\">California Physicians’ Service\u003c/a>, the doctor reimbursement side of BlueCross, also known as Blue Shield of California.\u003c/p>\n\u003cp>That \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/4383/1702479511007.pdf\">decision centered around\u003c/a> an individual who was diagnosed with gender dysphoria and received prior-approved services from an out-of-network provider but later saw their health care coverage suspended. The fine has since been paid, and the company has taken corrective action as requested by the state.\u003c/p>\n\u003cp>In this month’s case, regulators said the insurance companies must also provide written confirmation that they have modified their rules, ensured further denials comply with state law and provided training to the doctors and health care administrators.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two major California health insurers were hit with the state’s largest-ever fines for illegally denying coverage for gender-affirming care in a case that will compel them to revise how they treat patients diagnosed with gender dysphoria.\u003c/p>\n\u003cp>The $850,000 combined penalties against \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/4462/1723730164321.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Blue Cross of California Partnership Plan \u003c/a>and its \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/4492/1723732238309.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Anthem Blue Cross\u003c/a> also require the insurers to hire a dedicated case manager for people with gender dysphoria. Over 150 individuals who were denied coverage for such procedures will see their cases reviewed, and most have already seen reversals, according to the decision.\u003c/p>\n\u003cp>The insurers comply with the decision of the Department of Managed Health Care, a state office that regulates their industry.\u003c/p>\n\u003cp>“We take these matters seriously and have worked directly with the Department of Managed Health Care to identify and implement specific corrective actions to address and resolve the identified matters,” wrote Mike Bowman, a spokesperson for the insurance providers, in a statement to CalMatters.\u003c/p>\n\u003cp>From 2017 to 2020, two California plans by \u003ca href=\"https://providers.anthem.com/california-provider/our-network/plan-information\" target=\"_blank\" rel=\"noreferrer noopener\">Anthem Blue Cross and its state partnership \u003c/a>categorized over 20 surgeries, such as facial implants, hair removal, voice therapy and breast augmentation, as “not medically necessary.” But the procedures were covered if they corrected “abnormal” body structures to create a “normal appearance” for “the target gender.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The language the company employed “could create confusion for the reviewers regarding the medical necessity of the 22 procedures,” wrote Sonia R. Fernandes, deputy director and chief counsel office of enforcement at the Department of Managed Healthcare in an Aug. 15 ruling\u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/4462/1723730164321.pdf\"> against the Blue Cross of California Partnership Plan.\u003c/a>\u003c/p>\n\u003cp>In a parallel ruling against Anthem Blue Cross, she wrote that the company “did not provide alternate criteria” to help clinics and hospitals understand when the procedures would qualify for coverage. The plan in question called the procedures “cosmetic” when used to “improve the gender-specific appearance of an individual who has undergone, or is planning to undergo sex reassignment surgery.”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The contested plans were in place years after the state implemented the \u003ca href=\"https://www.insurance.ca.gov/01-consumers/110-health/60-resources/upload/CDI-Gender-Nondiscrimination-Regulations.pdf\">Insurance Gender Nondiscrimination Act in 2013\u003c/a>, which included many LGBTQ+ Californians into anti-discrimination protections for health coverage. Blue Cross officials acknowledged to regulators that the plans did not comply with state law, but the company and its affiliates have faced growing criticism in the past year over its handling of gender-affirming care.\u003c/p>\n\u003cp>It’s not the first time California’s insurance regulators have cracked down on such forms of discrimination. The department in 2017 issued a $200,000 fine against the insurer Health Net for \u003ca href=\"https://www.calhealthreport.org/2017/09/01/23219/\" target=\"_blank\" rel=\"noreferrer noopener\">gaps in coverage related to gender reassignment surgery\u003c/a> and other procedures.\u003c/p>\n\u003cp>Most recently, in December, the Department of Managed Health Care \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/4383/1702479511007.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">announced a $200,000 fine\u003c/a> against \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/actionListing.aspx?OrgType=0&Org=California+Physicians%27+Service\" target=\"_blank\" rel=\"noreferrer noopener\">California Physicians’ Service\u003c/a>, the doctor reimbursement side of BlueCross, also known as Blue Shield of California.\u003c/p>\n\u003cp>That \u003ca href=\"https://wpso.dmhc.ca.gov/enfactions/docs/4383/1702479511007.pdf\">decision centered around\u003c/a> an individual who was diagnosed with gender dysphoria and received prior-approved services from an out-of-network provider but later saw their health care coverage suspended. The fine has since been paid, and the company has taken corrective action as requested by the state.\u003c/p>\n\u003cp>In this month’s case, regulators said the insurance companies must also provide written confirmation that they have modified their rules, ensured further denials comply with state law and provided training to the doctors and health care administrators.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>At a contentious Oakland school board meeting where officials gave an update on \u003ca href=\"https://www.kqed.org/news/12002005/oakland-schools-vow-to-step-up-lead-testing-but-teachers-arent-convinced\">elevated lead levels\u003c/a> found in water at nearly two dozen campuses, district leaders called for state and federal help to address aging infrastructure and criticized communication lapses.\u003c/p>\n\u003cp>“This is a legacy problem that we’re facing,” board Vice President Mike Hutchinson said, addressing district officials and community members in attendance Wednesday night. “It’s something that’s been known, and it’s something that, as a community and a district, we need to be able to figure out how to address.”\u003c/p>\n\u003cp>Testing that found water sources on 22 campuses had lead levels above the Oakland Unified School District’s acceptable standard of 5 parts per billion was completed as early as April in some cases.\u003c/p>\n\u003cp>Emails to the affected school communities \u003ca href=\"https://www.kqed.org/news/12000525/water-at-22-oakland-schools-tested-high-for-lead-its-no-surprise-parents-and-teachers-say\">were only sent this month\u003c/a>, during the first week of class, prompting anger and fears about the students and staff drinking water in the months between.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At Wednesday night’s meeting, Superintendent Kyla Johnson-Trammell apologized for the lapse in communication, calling it “completely unacceptable.” She said a full personnel investigation was underway to determine the cause of the shortcomings.\u003c/p>\n\u003cp>“I sincerely apologize for the stress and concern this has caused our school sites, students and families,” Johnson-Trammell said. “We understand the gravity of this situation, and we are fully committed to taking immediate, transparent and corrective action.”\u003c/p>\n\u003cp>Still, board members and parents pressed that more should be done to replace the aging water fixtures and ensure that lead contamination isn’t just tested more regularly but absent in the schools.\u003c/p>\n\u003cp>[aside postID=news_12000525 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/016_KQEDScience_IntCommunitySchoolOakland_10202022_qed-1020x680.jpg']\u003c/p>\n\u003cp>Multiple district directors said they would work to access local funds allocated for lead abatement after Oakland and Alameda County were allotted a combined $24 million in a 2019 settlement “to clean up lead paint that poisons tens of thousands of children across California each year,” according to a \u003ca href=\"https://www.oaklandcityattorney.org/california-cities-and-counties-announce-groundbreaking-305-million-settlement-of-landmark-lead-paint-litigation/\">release from the city attorney’s office\u003c/a>.\u003c/p>\n\u003cp>Hutchinson also said the district needed “help to improve our infrastructure from both the state and federal government.”\u003c/p>\n\u003cp>“Our local facilities bonds cannot build our way out of this,” he said.\u003c/p>\n\u003cp>Preston Thomas, the district’s chief systems and services officer, said the cost of fixing aging water systems, brought in front of the board in 2017, was estimated at $38 million.\u003c/p>\n\u003cp>Currently, the district is watching Proposition 2, which could allot California schools funding for the renovation of aging facilities if it passes in November, as well as a state bill that would establish a pilot program to require lead testing and remediation at participating school sites built before 2010.\u003c/p>\n\u003cp>Other funding sources that have been discussed come from the lead paint settlement as well as revenue from Oakland’s tax on sugary drinks, which Thomas believed helped fund some of the district’s current FloWater bottle-filling systems.\u003c/p>\n\u003cp>During the meeting, Thomas \u003ca href=\"https://www.kqed.org/news/12002005/oakland-schools-vow-to-step-up-lead-testing-but-teachers-arent-convinced\">outlined the district’s plan\u003c/a> to restore water fixtures where lead was detected and create a more structured and transparent testing policy.\u003c/p>\n\u003cp>Thomas also said that the district had already ordered additional FloWater stations to be installed at the most affected schools this week and that a second round of testing, focusing on schools with the oldest buildings that were not tested this spring and summer, was completed. Results, which showed six fixtures identified for repair, according to the presentation, were communicated to the campus communities, he said.\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>At a contentious Oakland school board meeting where officials gave an update on \u003ca href=\"https://www.kqed.org/news/12002005/oakland-schools-vow-to-step-up-lead-testing-but-teachers-arent-convinced\">elevated lead levels\u003c/a> found in water at nearly two dozen campuses, district leaders called for state and federal help to address aging infrastructure and criticized communication lapses.\u003c/p>\n\u003cp>“This is a legacy problem that we’re facing,” board Vice President Mike Hutchinson said, addressing district officials and community members in attendance Wednesday night. “It’s something that’s been known, and it’s something that, as a community and a district, we need to be able to figure out how to address.”\u003c/p>\n\u003cp>Testing that found water sources on 22 campuses had lead levels above the Oakland Unified School District’s acceptable standard of 5 parts per billion was completed as early as April in some cases.\u003c/p>\n\u003cp>Emails to the affected school communities \u003ca href=\"https://www.kqed.org/news/12000525/water-at-22-oakland-schools-tested-high-for-lead-its-no-surprise-parents-and-teachers-say\">were only sent this month\u003c/a>, during the first week of class, prompting anger and fears about the students and staff drinking water in the months between.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Medical debt weighs heavily on the lives of millions of Californians. It can ding their credit scores and hurt their chances of landing a rental or securing a home mortgage.\u003c/p>\n\u003cp>Earlier this year, the Biden administration announced a proposal to stop medical debt from showing up on credit reports. That \u003ca href=\"https://www.federalregister.gov/documents/2024/06/18/2024-13208/prohibition-on-creditors-and-consumer-reporting-agencies-concerning-medical-information-regulation-v\" target=\"_blank\" rel=\"noreferrer noopener\">proposed rule is under consideration\u003c/a> with an uncertain timeline.\u003c/p>\n\u003cp>California lawmakers are moving faster with a similar measure that would take effect as soon as January if it becomes law.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/monique-limon-13069\" target=\"_blank\" rel=\"noreferrer noopener\">Sen. Monique Limón\u003c/a>, a Santa Barbara Democrat, is carrying \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb1061\" target=\"_blank\" rel=\"noreferrer noopener\">Senate Bill 1061\u003c/a>, which would remove medical debt from credit reports and prohibit debt collectors from reporting patients’ medical debt information to credit agencies. It would pertain specifically to debt owed to a medical provider, such as a hospital or a doctor’s office.\u003c/p>\n\u003cp>It passed the Assembly on Monday and is heading to the Senate for a final vote. Until recently, the bill would have also included debt charged to medical credit cards and specialty loans, but changes in the Assembly Appropriations Committee redefined “medical debt” to exclude these.\u003c/p>\n\u003cp>Limón was surprised by the changes. The amendments were a win for a\u003ca href=\"https://ct3.blob.core.windows.net/23blobs/e48c3e46-b46e-4876-a636-22a46392b276\" target=\"_blank\" rel=\"noreferrer noopener\"> coalition of bankers and lenders\u003c/a> that had been requesting that change for months. Following the amendments, the coalition removed its opposition to the proposal.\u003c/p>\n\u003cp>“This legislation passed through three Assembly policy committees without the most recent amendments by Assembly Appropriations, which substantially weaken the bill,” Limon told CalMatters in an emailed statement. “It is clear that … influential entities opposed to the measure prevailed.\u003c/p>\n\u003cp>“In spite of this disappointing setback, I plan to continue pushing for the passage of SB 1061 in the hope that we can provide partial relief to consumers.”\u003c/p>\n\u003cp>Representatives for Assembly Speaker Robert Rivas would not comment on the bill and Assembly Appropriations Committee Chairperson Buffy Wicks did not reply to messages and emails asking why the changes were made. Those lawmakers can change bills in the Appropriations Committee.\u003c/p>\n\u003cp>Supporters of Limon’s bill say even though the feds are moving in a similar direction, California’s bill still has merit.\u003c/p>\n\u003cp>“The (federal) rulemaking right now, it’s just a proposal. It could get watered down; they take a long time. And then, of course, depending on what happens with the election, there’s a big question mark of what happens to any of our federal rules,” said Jenn Engstrom, state director with the California Interest Research Group, a co-sponsor of the bill. “So rather than leaving it up to the uncertainty of the federal government, we think it’s really important that California has a strong role here.”\u003c/p>\n\u003cp>\u003ca href=\"https://oag.ca.gov/news/press-releases/attorney-general-bonta-continues-fight-against-medical-debt-reporting\">Attorney General Rob Bonta\u003c/a> and the California Nurses Association, among other health advocates, back the bill. Proponents argue that people acquire medical debt through no fault of their own. After all, going into debt because you need surgery is not the same as going into debt for a luxury vacation. Experts and advocates say medical debt is also more prone to inaccuracies because of mistakes in billing or disputes with insurers.\u003c/p>\n\u003cp>The bill “does not forgive debt, but it does ensure that when it’s not reported, we don’t negatively impact credit scores for a lifetime for people,” Limón said.\u003c/p>\n\u003cp>If the bill makes it to the governor’s desk and he signs it, California would join states such as Colorado and New York in prohibiting medical debt from damaging credit scores.\u003c/p>\n\u003ch2 id=\"h-the-burden-of-medical-debt\" class=\"wp-block-heading\">The burden of medical debt\u003c/h2>\n\u003cp>About \u003ca href=\"https://www.chcf.org/blog/top-takeaways-california-health-policy-poll/#:~:text=Meanwhile%2C%20close%20to%204%20in,racial%20equity%20in%20health%20care.\" target=\"_blank\" rel=\"noreferrer noopener\">4 in 10 Californians\u003c/a> report carrying some type of medical debt, according to the California Health Care Foundation. Nationally, \u003ca href=\"https://www.consumerfinance.gov/about-us/newsroom/cfpb-finds-15-million-americans-have-medical-bills-on-their-credit-reports/\" target=\"_blank\" rel=\"noreferrer noopener\">the average medical balance\u003c/a> on credit reports is around $3,100.\u003c/p>\n\u003cp>“The impact of this debt is so well-known that many people take it into consideration when deciding whether to seek care when they need it, and many opt not to, deciding to steer clear of the (medical) bill, which puts their health at risk,” said Katie Van Deynze, a policy and legislative advocate with the consumer advocacy group Health Access California.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=\"news_11996598,news_11984163,news_12000706\"]\u003c/p>\n\u003cp>In June, \u003ca href=\"https://www.whitehouse.gov/briefing-room/statements-releases/2024/06/11/fact-sheet-vice-president-harris-announces-proposal-to-prohibit-medical-bills-from-being-included-on-credit-reports-and-calls-on-states-and-localities-to-take-further-actions-to-reduce-medical-debt/\" target=\"_blank\" rel=\"noreferrer noopener\">the Biden administration announced\u003c/a> a proposal to bar medical debt from appearing on credit reports. It’s expected to help raise the credit scores of approximately 15 million Americans by an average of 20 points, according to the administration’s announcement. The administration estimates that would translate to the approval of about 22,000 additional mortgages every year.\u003c/p>\n\u003cp>The federal proposal also leaves out medical credit cards, a gap Limón hoped to close.\u003c/p>\n\u003cp>Medical providers may offer \u003ca href=\"https://www.forbes.com/advisor/credit-cards/medical-credit-cards-should-you-apply/\">medical credit cards\u003c/a> as an option to cover the cost of a procedure. They can be enticing, offering people the option of no payment upfront and a promotional period of deferred interest. However, if interest does kick in, it can be higher than that of a regular credit card.\u003c/p>\n\u003cp>Groups such as the California Bankers Association argued that the definition of “medical debt” in Limón’s bill was too broad. The only debt that should be included in this legislation, they said, is the kind that is directly owed to a medical facility or provider. In hearings and \u003ca href=\"https://ct3.blob.core.windows.net/23blobs/e48c3e46-b46e-4876-a636-22a46392b276\" target=\"_blank\" rel=\"noreferrer noopener\">letters to the Legislature\u003c/a>, lobbyists for these groups argued that medical credit cards could also be used for elective procedures, fitness programs and veterinary services, among other expenses. That type of debt, they argued, should not be hidden from creditors.\u003c/p>\n\u003ch2 id=\"h-medical-debt-forgiveness\" class=\"wp-block-heading\">Medical debt forgiveness\u003c/h2>\n\u003cp>The topic of medical debt resonates so much with the public that some local governments and states are going one step further and pushing for debt relief programs.\u003c/p>\n\u003cp>This summer, the Los Angeles County Board of Supervisors announced a \u003ca href=\"https://www.latimes.com/california/story/2024-06-25/medical-debt\">pilot program to buy off\u003c/a> millions worth of its residents’ medical debt through a partnership with the national nonprofit Undue Medical Debt. Hospitals and other providers can sell unpaid debt to companies that would profit from collecting that money. Undue Medical Debt leverages this arrangement and purchases debt for cents on the dollar, but instead of collecting the debt, it cancels it.\u003c/p>\n\u003cp>Through this model, county supervisors estimate \u003ca href=\"https://hahn.lacounty.gov/la-county-will-launch-pilot-program-to-eliminate-low-income-residents-medical-debt/\" target=\"_blank\" rel=\"noreferrer noopener\">they can spend $5 million\u003c/a> to cancel $500 million worth of debt for 150,000 lower-income residents. Medical debt in Los Angeles County \u003ca href=\"https://www.google.com/search?client=firefox-b-1-d&q=synoynm+for+system\" target=\"_blank\" rel=\"noreferrer noopener\">surpasses $2.9 billion\u003c/a>, according to an analysis by the county’s public health department.\u003c/p>\n\u003cp>New York City and \u003ca href=\"https://azgovernor.gov/office-arizona-governor/medical-debt-relief-faq\">Arizona\u003c/a> have done similar deals with the same nonprofit. And just last week, New Jersey Democratic Gov. Phil Murphy announced that the state would use leftover pandemic relief dollars to eliminate \u003ca href=\"https://www.nj.gov/governor/news/news/562024/approved/20240820a.shtml\" target=\"_blank\" rel=\"noreferrer noopener\">$100 million worth of medical debt\u003c/a> for 50,000 residents.\u003c/p>\n\u003cp>Democratic presidential nominee Kamala Harris has pledged to build on the current administration’s efforts to wipe medical debt from credit reports by incorporating debt forgiveness. Among her campaign promises: “Work with states to cancel medical debt for millions of Americans.”\u003c/p>\n\u003cp>Last month, \u003ca href=\"https://www.washingtonpost.com/health/2024/07/26/vice-president-kamala-harris-medical-debt/\" target=\"_blank\" rel=\"noreferrer noopener\">the \u003cem>Washington Post\u003c/em> reported\u003c/a> that Harris had been working with North Carolina to incentivize hospitals there to forgive patients’ medical debt in exchange for additional Medicaid dollars. In mid-August, North Carolina Democratic \u003ca href=\"https://governor.nc.gov/news/press-releases/2024/08/12/north-carolina-hospitals-sign-relieve-medical-debt\" target=\"_blank\" rel=\"noreferrer noopener\">Gov. Roy Cooper announced\u003c/a> that all of the state’s 99 hospitals agreed to participate in this program. About 2 million lower- and middle-income North Carolina residents will benefit starting next summer.\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "About 4 in 10 Californians are carrying medical debt. Lawmakers are advancing a bill to prevent that debt from affecting credit scores.",
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"title": "Millions of Californians Have Medical Debt. It Wouldn't Hurt Your Credit Under Proposed Rules | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Medical debt weighs heavily on the lives of millions of Californians. It can ding their credit scores and hurt their chances of landing a rental or securing a home mortgage.\u003c/p>\n\u003cp>Earlier this year, the Biden administration announced a proposal to stop medical debt from showing up on credit reports. That \u003ca href=\"https://www.federalregister.gov/documents/2024/06/18/2024-13208/prohibition-on-creditors-and-consumer-reporting-agencies-concerning-medical-information-regulation-v\" target=\"_blank\" rel=\"noreferrer noopener\">proposed rule is under consideration\u003c/a> with an uncertain timeline.\u003c/p>\n\u003cp>California lawmakers are moving faster with a similar measure that would take effect as soon as January if it becomes law.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/monique-limon-13069\" target=\"_blank\" rel=\"noreferrer noopener\">Sen. Monique Limón\u003c/a>, a Santa Barbara Democrat, is carrying \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb1061\" target=\"_blank\" rel=\"noreferrer noopener\">Senate Bill 1061\u003c/a>, which would remove medical debt from credit reports and prohibit debt collectors from reporting patients’ medical debt information to credit agencies. It would pertain specifically to debt owed to a medical provider, such as a hospital or a doctor’s office.\u003c/p>\n\u003cp>It passed the Assembly on Monday and is heading to the Senate for a final vote. Until recently, the bill would have also included debt charged to medical credit cards and specialty loans, but changes in the Assembly Appropriations Committee redefined “medical debt” to exclude these.\u003c/p>\n\u003cp>Limón was surprised by the changes. The amendments were a win for a\u003ca href=\"https://ct3.blob.core.windows.net/23blobs/e48c3e46-b46e-4876-a636-22a46392b276\" target=\"_blank\" rel=\"noreferrer noopener\"> coalition of bankers and lenders\u003c/a> that had been requesting that change for months. Following the amendments, the coalition removed its opposition to the proposal.\u003c/p>\n\u003cp>“This legislation passed through three Assembly policy committees without the most recent amendments by Assembly Appropriations, which substantially weaken the bill,” Limon told CalMatters in an emailed statement. “It is clear that … influential entities opposed to the measure prevailed.\u003c/p>\n\u003cp>“In spite of this disappointing setback, I plan to continue pushing for the passage of SB 1061 in the hope that we can provide partial relief to consumers.”\u003c/p>\n\u003cp>Representatives for Assembly Speaker Robert Rivas would not comment on the bill and Assembly Appropriations Committee Chairperson Buffy Wicks did not reply to messages and emails asking why the changes were made. Those lawmakers can change bills in the Appropriations Committee.\u003c/p>\n\u003cp>Supporters of Limon’s bill say even though the feds are moving in a similar direction, California’s bill still has merit.\u003c/p>\n\u003cp>“The (federal) rulemaking right now, it’s just a proposal. It could get watered down; they take a long time. And then, of course, depending on what happens with the election, there’s a big question mark of what happens to any of our federal rules,” said Jenn Engstrom, state director with the California Interest Research Group, a co-sponsor of the bill. “So rather than leaving it up to the uncertainty of the federal government, we think it’s really important that California has a strong role here.”\u003c/p>\n\u003cp>\u003ca href=\"https://oag.ca.gov/news/press-releases/attorney-general-bonta-continues-fight-against-medical-debt-reporting\">Attorney General Rob Bonta\u003c/a> and the California Nurses Association, among other health advocates, back the bill. Proponents argue that people acquire medical debt through no fault of their own. After all, going into debt because you need surgery is not the same as going into debt for a luxury vacation. Experts and advocates say medical debt is also more prone to inaccuracies because of mistakes in billing or disputes with insurers.\u003c/p>\n\u003cp>The bill “does not forgive debt, but it does ensure that when it’s not reported, we don’t negatively impact credit scores for a lifetime for people,” Limón said.\u003c/p>\n\u003cp>If the bill makes it to the governor’s desk and he signs it, California would join states such as Colorado and New York in prohibiting medical debt from damaging credit scores.\u003c/p>\n\u003ch2 id=\"h-the-burden-of-medical-debt\" class=\"wp-block-heading\">The burden of medical debt\u003c/h2>\n\u003cp>About \u003ca href=\"https://www.chcf.org/blog/top-takeaways-california-health-policy-poll/#:~:text=Meanwhile%2C%20close%20to%204%20in,racial%20equity%20in%20health%20care.\" target=\"_blank\" rel=\"noreferrer noopener\">4 in 10 Californians\u003c/a> report carrying some type of medical debt, according to the California Health Care Foundation. Nationally, \u003ca href=\"https://www.consumerfinance.gov/about-us/newsroom/cfpb-finds-15-million-americans-have-medical-bills-on-their-credit-reports/\" target=\"_blank\" rel=\"noreferrer noopener\">the average medical balance\u003c/a> on credit reports is around $3,100.\u003c/p>\n\u003cp>“The impact of this debt is so well-known that many people take it into consideration when deciding whether to seek care when they need it, and many opt not to, deciding to steer clear of the (medical) bill, which puts their health at risk,” said Katie Van Deynze, a policy and legislative advocate with the consumer advocacy group Health Access California.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In June, \u003ca href=\"https://www.whitehouse.gov/briefing-room/statements-releases/2024/06/11/fact-sheet-vice-president-harris-announces-proposal-to-prohibit-medical-bills-from-being-included-on-credit-reports-and-calls-on-states-and-localities-to-take-further-actions-to-reduce-medical-debt/\" target=\"_blank\" rel=\"noreferrer noopener\">the Biden administration announced\u003c/a> a proposal to bar medical debt from appearing on credit reports. It’s expected to help raise the credit scores of approximately 15 million Americans by an average of 20 points, according to the administration’s announcement. The administration estimates that would translate to the approval of about 22,000 additional mortgages every year.\u003c/p>\n\u003cp>The federal proposal also leaves out medical credit cards, a gap Limón hoped to close.\u003c/p>\n\u003cp>Medical providers may offer \u003ca href=\"https://www.forbes.com/advisor/credit-cards/medical-credit-cards-should-you-apply/\">medical credit cards\u003c/a> as an option to cover the cost of a procedure. They can be enticing, offering people the option of no payment upfront and a promotional period of deferred interest. However, if interest does kick in, it can be higher than that of a regular credit card.\u003c/p>\n\u003cp>Groups such as the California Bankers Association argued that the definition of “medical debt” in Limón’s bill was too broad. The only debt that should be included in this legislation, they said, is the kind that is directly owed to a medical facility or provider. In hearings and \u003ca href=\"https://ct3.blob.core.windows.net/23blobs/e48c3e46-b46e-4876-a636-22a46392b276\" target=\"_blank\" rel=\"noreferrer noopener\">letters to the Legislature\u003c/a>, lobbyists for these groups argued that medical credit cards could also be used for elective procedures, fitness programs and veterinary services, among other expenses. That type of debt, they argued, should not be hidden from creditors.\u003c/p>\n\u003ch2 id=\"h-medical-debt-forgiveness\" class=\"wp-block-heading\">Medical debt forgiveness\u003c/h2>\n\u003cp>The topic of medical debt resonates so much with the public that some local governments and states are going one step further and pushing for debt relief programs.\u003c/p>\n\u003cp>This summer, the Los Angeles County Board of Supervisors announced a \u003ca href=\"https://www.latimes.com/california/story/2024-06-25/medical-debt\">pilot program to buy off\u003c/a> millions worth of its residents’ medical debt through a partnership with the national nonprofit Undue Medical Debt. Hospitals and other providers can sell unpaid debt to companies that would profit from collecting that money. Undue Medical Debt leverages this arrangement and purchases debt for cents on the dollar, but instead of collecting the debt, it cancels it.\u003c/p>\n\u003cp>Through this model, county supervisors estimate \u003ca href=\"https://hahn.lacounty.gov/la-county-will-launch-pilot-program-to-eliminate-low-income-residents-medical-debt/\" target=\"_blank\" rel=\"noreferrer noopener\">they can spend $5 million\u003c/a> to cancel $500 million worth of debt for 150,000 lower-income residents. Medical debt in Los Angeles County \u003ca href=\"https://www.google.com/search?client=firefox-b-1-d&q=synoynm+for+system\" target=\"_blank\" rel=\"noreferrer noopener\">surpasses $2.9 billion\u003c/a>, according to an analysis by the county’s public health department.\u003c/p>\n\u003cp>New York City and \u003ca href=\"https://azgovernor.gov/office-arizona-governor/medical-debt-relief-faq\">Arizona\u003c/a> have done similar deals with the same nonprofit. And just last week, New Jersey Democratic Gov. Phil Murphy announced that the state would use leftover pandemic relief dollars to eliminate \u003ca href=\"https://www.nj.gov/governor/news/news/562024/approved/20240820a.shtml\" target=\"_blank\" rel=\"noreferrer noopener\">$100 million worth of medical debt\u003c/a> for 50,000 residents.\u003c/p>\n\u003cp>Democratic presidential nominee Kamala Harris has pledged to build on the current administration’s efforts to wipe medical debt from credit reports by incorporating debt forgiveness. Among her campaign promises: “Work with states to cancel medical debt for millions of Americans.”\u003c/p>\n\u003cp>Last month, \u003ca href=\"https://www.washingtonpost.com/health/2024/07/26/vice-president-kamala-harris-medical-debt/\" target=\"_blank\" rel=\"noreferrer noopener\">the \u003cem>Washington Post\u003c/em> reported\u003c/a> that Harris had been working with North Carolina to incentivize hospitals there to forgive patients’ medical debt in exchange for additional Medicaid dollars. In mid-August, North Carolina Democratic \u003ca href=\"https://governor.nc.gov/news/press-releases/2024/08/12/north-carolina-hospitals-sign-relieve-medical-debt\" target=\"_blank\" rel=\"noreferrer noopener\">Gov. Roy Cooper announced\u003c/a> that all of the state’s 99 hospitals agreed to participate in this program. About 2 million lower- and middle-income North Carolina residents will benefit starting next summer.\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "oakland-schools-vow-to-step-up-lead-testing-but-teachers-arent-convinced",
"title": "Oakland Schools Vow to Step Up Lead Testing, But Teachers Aren’t Convinced",
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"headTitle": "Oakland Schools Vow to Step Up Lead Testing, But Teachers Aren’t Convinced | KQED",
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"content": "\u003cp>After high lead levels were found in water sources \u003ca href=\"https://www.kqed.org/news/12000525/water-at-22-oakland-schools-tested-high-for-lead-its-no-surprise-parents-and-teachers-say\">at nearly two dozen Oakland public schools\u003c/a>, the district plans to roll out more robust testing on a routine schedule and share the data in a public dashboard.\u003c/p>\n\u003cp>The plans are set to be presented by Superintendent Kyla Johnson-Trammell at Wednesday’s school board meeting as the district seeks to quell concerns over the safety of drinking water at its campuses. Still, teachers say the situation has affected their classrooms and aren’t convinced that the district’s plans go far enough to ensure water on campus is safe in the future.\u003c/p>\n\u003cp>During the first week of school, OUSD sent emails notifying families of 22 schools that at least one water source on their campus had heightened lead levels in routine testing over the spring and summer. In one case, the concentration was as high as 900 parts per billion. The Oakland school board’s maximum allowable level is 5 parts per billion, while the state and federal standard is 15 parts per billion.\u003c/p>\n\u003cp>The testing took place at 49 sites and found a total of 186 needed repairs, according to Johnson-Trammell’s presentation.\u003c/p>\n\u003cp>As of Aug. 16, 66 have been addressed and are waiting for retesting. The district plans to complete the remediation process within three weeks.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some teachers and parents criticized what they called a lag in communication after tests were completed, as early as April at certain schools. Stuart Loebl, a sixth-grade teacher at Frick United Academy of Language, where the highest detected lead level was 51 parts per billion, said he doesn’t feel the district’s response has been adequate.\u003c/p>\n\u003cp>“They let students continue to drink from that fountain for months, both during the rest of the school year and [when] we had 80 students at our site during summer school. To call the problem an issue of communication is very damaging to the trust that I can put in the districts to solve this issue,” Loebl said. “I haven’t seen any kind of explanation as to why that failure happened, in which all these water fountains were not immediately shut down.”\u003c/p>\n\u003cp>OUSD officials did not respond to a request for comment on Tuesday, but spokesperson John Sasaki told KQED earlier this month that district officials were “aggressive about the testing but were not as efficient at communicating in the ways we should have been. That’s something we are working on as an organization.”\u003c/p>\n\u003cp>Frick staff found out on Aug. 12, the first day of school, that six fixtures on campus tested over the district limit in April.\u003c/p>\n\u003cp>Loebl said that made for a hectic start to the school year as everybody was directed to use only the campus’ single FloWater filtered water bottle filling station.\u003c/p>\n\u003cp>“When 400 people, 370 students plus staff, are trying to use that one FloWater station, it very quickly started to break down and go out of service because the way that these work is they need a certain amount of time for them to filter the water,” he said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[aside postID=news_12000525 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/016_KQEDScience_IntCommunitySchoolOakland_10202022_qed-1020x680.jpg']\u003c/span>\u003c/p>\n\u003cp>The administration added a second FloWater station last week and brought in Gatorade jugs to supplement the amount of water available. But Loebl teaches on the second floor of the two-story campus, while the FloWater stations are located on the first floor and in the cafeteria — “It’s, the way that students walk, a five to 10-minute round trip to get water,” he said.\u003c/p>\n\u003cp>Cassandra Lizardi Morales, who teaches sixth grade English at Frick, said it’s been “hit and miss” trying to meet the demand for water in her classroom, especially on hot days.\u003c/p>\n\u003cp>The district began expedited testing of all campuses more than 50 years old that were not tested earlier this year on Aug. 17. Reports from that testing showed that more than 95% of the fixtures were below OUSD’s permissible lead level and six fixtures were identified for repair, according to the superintendent’s presentation.\u003c/p>\n\u003cp>Throughout the fall, OUSD plans to conduct testing at its other sites, working from the oldest campuses to the newest and prioritizing early education centers that were not tested recently.\u003c/p>\n\u003cp>A comprehensive testing schedule will also be announced within 30 days, the presentation says, and OUSD will ask the facilities committee to install more water bottle filling stations on campuses. By January, the district plans to launch a testing dashboard on its website.\u003c/p>\n\u003cp>But teachers say that the efforts to test and repair fixtures where lead is found might just be “kicking the can down the road.”\u003c/p>\n\u003cp>“There’s soldering in the lead pipes, and you can do short-term filters, but if you’re not regularly maintaining the filters, the lead will come back into the water,” Loebl said. “There needs to be a long-term plan to replace the pipes so that there is no longer lead seeping into our water.”\u003c/p>\n\u003cp>Lizardi Morales added that she feels the district will need to rebuild trust in schools’ water sources after their retesting is complete. She said she wouldn’t feel comfortable drinking the water unless lead was not detectable at all.\u003c/p>\n\u003cp>“They are serving a community of children who are already exposed to lead in the paint of their old homes and soil; they shouldn’t be exasperating the lead poisoning of our children,” Lizardi Morales said. “I’m not even comfortable with the 5 parts per billion… no amount of lead is safe.”\u003c/p>\n\u003cp>\u003c/p>\n",
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"excerpt": "After high lead levels were found in water sources at 22 Oakland schools, the district plans to roll out more robust testing and share the data in a public dashboard.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After high lead levels were found in water sources \u003ca href=\"https://www.kqed.org/news/12000525/water-at-22-oakland-schools-tested-high-for-lead-its-no-surprise-parents-and-teachers-say\">at nearly two dozen Oakland public schools\u003c/a>, the district plans to roll out more robust testing on a routine schedule and share the data in a public dashboard.\u003c/p>\n\u003cp>The plans are set to be presented by Superintendent Kyla Johnson-Trammell at Wednesday’s school board meeting as the district seeks to quell concerns over the safety of drinking water at its campuses. Still, teachers say the situation has affected their classrooms and aren’t convinced that the district’s plans go far enough to ensure water on campus is safe in the future.\u003c/p>\n\u003cp>During the first week of school, OUSD sent emails notifying families of 22 schools that at least one water source on their campus had heightened lead levels in routine testing over the spring and summer. In one case, the concentration was as high as 900 parts per billion. The Oakland school board’s maximum allowable level is 5 parts per billion, while the state and federal standard is 15 parts per billion.\u003c/p>\n\u003cp>The testing took place at 49 sites and found a total of 186 needed repairs, according to Johnson-Trammell’s presentation.\u003c/p>\n\u003cp>As of Aug. 16, 66 have been addressed and are waiting for retesting. The district plans to complete the remediation process within three weeks.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some teachers and parents criticized what they called a lag in communication after tests were completed, as early as April at certain schools. Stuart Loebl, a sixth-grade teacher at Frick United Academy of Language, where the highest detected lead level was 51 parts per billion, said he doesn’t feel the district’s response has been adequate.\u003c/p>\n\u003cp>“They let students continue to drink from that fountain for months, both during the rest of the school year and [when] we had 80 students at our site during summer school. To call the problem an issue of communication is very damaging to the trust that I can put in the districts to solve this issue,” Loebl said. “I haven’t seen any kind of explanation as to why that failure happened, in which all these water fountains were not immediately shut down.”\u003c/p>\n\u003cp>OUSD officials did not respond to a request for comment on Tuesday, but spokesperson John Sasaki told KQED earlier this month that district officials were “aggressive about the testing but were not as efficient at communicating in the ways we should have been. That’s something we are working on as an organization.”\u003c/p>\n\u003cp>Frick staff found out on Aug. 12, the first day of school, that six fixtures on campus tested over the district limit in April.\u003c/p>\n\u003cp>Loebl said that made for a hectic start to the school year as everybody was directed to use only the campus’ single FloWater filtered water bottle filling station.\u003c/p>\n\u003cp>“When 400 people, 370 students plus staff, are trying to use that one FloWater station, it very quickly started to break down and go out of service because the way that these work is they need a certain amount of time for them to filter the water,” he said.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/span>\u003c/p>\n\u003cp>The administration added a second FloWater station last week and brought in Gatorade jugs to supplement the amount of water available. But Loebl teaches on the second floor of the two-story campus, while the FloWater stations are located on the first floor and in the cafeteria — “It’s, the way that students walk, a five to 10-minute round trip to get water,” he said.\u003c/p>\n\u003cp>Cassandra Lizardi Morales, who teaches sixth grade English at Frick, said it’s been “hit and miss” trying to meet the demand for water in her classroom, especially on hot days.\u003c/p>\n\u003cp>The district began expedited testing of all campuses more than 50 years old that were not tested earlier this year on Aug. 17. Reports from that testing showed that more than 95% of the fixtures were below OUSD’s permissible lead level and six fixtures were identified for repair, according to the superintendent’s presentation.\u003c/p>\n\u003cp>Throughout the fall, OUSD plans to conduct testing at its other sites, working from the oldest campuses to the newest and prioritizing early education centers that were not tested recently.\u003c/p>\n\u003cp>A comprehensive testing schedule will also be announced within 30 days, the presentation says, and OUSD will ask the facilities committee to install more water bottle filling stations on campuses. By January, the district plans to launch a testing dashboard on its website.\u003c/p>\n\u003cp>But teachers say that the efforts to test and repair fixtures where lead is found might just be “kicking the can down the road.”\u003c/p>\n\u003cp>“There’s soldering in the lead pipes, and you can do short-term filters, but if you’re not regularly maintaining the filters, the lead will come back into the water,” Loebl said. “There needs to be a long-term plan to replace the pipes so that there is no longer lead seeping into our water.”\u003c/p>\n\u003cp>Lizardi Morales added that she feels the district will need to rebuild trust in schools’ water sources after their retesting is complete. She said she wouldn’t feel comfortable drinking the water unless lead was not detectable at all.\u003c/p>\n\u003cp>“They are serving a community of children who are already exposed to lead in the paint of their old homes and soil; they shouldn’t be exasperating the lead poisoning of our children,” Lizardi Morales said. “I’m not even comfortable with the 5 parts per billion… no amount of lead is safe.”\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "lawmakers-say-newsom-staff-inflated-cost-of-failed-health-care-bills",
"title": "Lawmakers Say Newsom Staff ‘Inflated’ Cost of Failed Health Care Bills",
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"content": "\u003cp>Lawmakers and advocates say Gov. Gavin Newsom’s administration is making inflated estimates about the cost of legislation, with some suggesting his subordinates have been trying to kill the bills without making the governor politically accountable for the outcome.\u003c/p>\n\u003cp>“While people are dying on the streets from a lack of access to behavioral health care treatment, state agencies continue to fabricate exorbitant cost estimates,” Sen. \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/dave-cortese-164699\">Dave Cortese\u003c/a>, a Democrat from Campbell, told CalMatters after one of his mental health proposals died recently in the Assembly Appropriations Committee.\u003c/p>\n\u003cp>Sen. \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/scott-wiener-100936\">Scott Wiener\u003c/a>, a Democrat from San Francisco who authored another mental health bill that died recently, \u003ca href=\"https://digitaldemocracy.calmatters.org/hearings/258192?t=295&f=a2f15a64e9e6ef40221b60296d414495\">said in a public hearing last month\u003c/a> that the administration’s cost estimate of his bill was “extreme and outrageous.”\u003c/p>\n\u003cp>The pointed accusations from Democratic lawmakers and health care advocates who tend to be friendly with the Democratic governor are extraordinary because such criticism is rarely made in public. The examples also stand out because they challenge the administration’s response to one of the governor’s top priorities, \u003ca href=\"https://calmatters.org/tag/mental-health/\">mental health\u003c/a>.\u003c/p>\n\u003cp>The administration did not accept an interview request with CalMatters and would not provide more detail — to CalMatters or to lawmakers — to explain the cost estimates. By email, however, a spokesperson insisted the costs were accurate and rejected the idea that they were intentionally inflated.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s outrageous and inaccurate for anyone to suggest these numbers are fabricated or artificially inflated,” Rodger Butler, a spokesperson for Newsom’s Health and Human Services Agency, said in an email. “Legislative fiscal analyses from state government departments are informed by real-world, on-the-ground experience implementing legislative mandates.”\u003c/p>\n\u003cp>Whatever the motivations, four health care bills with controversial cost estimates died quietly earlier this month in the Senate and Assembly Appropriations committees even after each had advanced without a single “no” vote from a Democratic legislator.\u003c/p>\n\u003cfigure id=\"attachment_12002025\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12002025\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04.jpg\" alt=\"Three women dressed in orange, pink and green jackets and a man wearing a dark business suit sit in green chairs with the United States and California flags behind them.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Assembly lawmakers meet during a Suspense File hearing at the Capitol Annex Swing Space on O Street in Sacramento on Aug. 15, 2024. \u003ccite>(Fred Greaves / CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Appropriations Committees are focused on the cost of legislation, especially in a year when the state is struggling with a \u003ca href=\"https://calmatters.org/tag/california-budget/\">budget deficit\u003c/a>. The four bills were moved to the committees’ “suspense files,” \u003ca href=\"https://calmatters.org/politics/capitol/2024/08/california-laws-legislature-suspense-file/\">along with 263 other controversial or costly bills\u003c/a>. Each committee then killed the bills in their respective suspense file with a single vote.\u003c/p>\n\u003cp>Mike Gatto, a former Democratic lawmaker from Los Angeles who chaired the Assembly Appropriations Committee, said inflated cost estimates from a governor’s administration are nothing new.\u003c/p>\n\u003cp>When an executive branch agency provides “a significantly exaggerated cost” on a piece of legislation, “it’s generally a big flashing light that the administration dislikes the bill and that the governor would likely veto it,” he said.\u003c/p>\n\u003cp>It can be advantageous for the governor when legislators quietly kill those bills, he said.\u003c/p>\n\u003cp>“Having the appropriations committee there to kill it and to take the arrows (of criticism), that is a tremendous benefit politically for any governor,” Gatto said.\u003c/p>\n\u003cp>Gatto has a hand-written note framed on his wall that former Gov. Jerry Brown gave him expressing Brown’s appreciation for keeping bills from reaching the governor’s desk.\u003c/p>\n\u003cp>In a corner of the note are two words: “Keep holding.”\u003c/p>\n\u003cp>But Thad Kousser, a former legislative staffer who’s now a professor of political science at UC San Diego, said the integrity of the legislative process is jeopardized if cost estimates are not accurate.\u003c/p>\n\u003cp>“You’ve got to have reasonable and realistic estimates that are not part of a political strategy in order for everyone to make informed decisions,” he said.\u003c/p>\n\u003cp>This year alone, \u003ca href=\"https://digitaldemocracy.calmatters.org/\">according to the Digital Democracy database\u003c/a>, lawmakers considered 2,522 bills, many of them with large potential costs to taxpayers.\u003c/p>\n\u003ch2>Democrat calls costs ‘extreme and outrageous’\u003c/h2>\n\u003cp>Sen. Wiener’s legislation, \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb294?slug=CA_202320240SB294\">Senate Bill 294\u003c/a>, would have required an automatic review of cases in which commercial health plans denied children and young people mental health treatment.\u003c/p>\n\u003cp>Wiener, the chair of the Senate’s mental health caucus, said in the public hearing last month that the measure “does nothing more than require health plans to provide the coverage that they’re required to provide and stop denying covered behavioral health care treatment to children.”\u003c/p>\n\u003cp>So he said it was “outrageous” when the \u003ca href=\"https://s3.documentcloud.org/documents/25074843/sb-294-2024.pdf\">Department of Managed Health Care estimated\u003c/a> that the bill would cost $87.6 million per year by 2028 and would require 340 new employees. That’s a 55% increase over the\u003ca href=\"https://ebudget.ca.gov/reference/2024-PositionVacancyReport.pdf\"> 610 positions in the department’s budget for the 2022–23 fiscal year.\u003c/a> A separate state office, the Department of Insurance, also said the bill would require it to hire an additional five positions by 2026 for $1.2 million. There is no description in the cost estimate about how the departments arrived at the estimate or what jobs the new positions would perform.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/FM6KA/9/\" width=\"800\" height=\"500\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>The estimate also was a surprise to supporters of Wiener’s bill. In June, they sent a three-page memo to the chair of the Assembly Appropriations Committee, Democrat \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/buffy-wicks-165044\">Buffy Wicks\u003c/a> from Oakland, saying that a similar bill that failed last year had a significantly lower cost estimate. They also noted that the pending bill was more narrow in scope.\u003c/p>\n\u003cp>Lishaun Francis, director of behavioral health for the advocacy group Children Now, told CalMatters the Department of Managed Health Care, which is intended to protect consumers, inflated the cost of Wiener’s bill, presumably to try to kill it.\u003c/p>\n\u003cp>“This is not an analysis in good faith,” she said. “The unfortunate thing here is that DMHC has fallen into a trap where they are trying to be here for consumers while also inflating costs to make sure bills don’t get to the governor when there is a tight budget year.”\u003c/p>\n\u003cp>Before the bill died, it passed the Senate and an Assembly committee without any Democrats voting against it, according to the Digital Democracy database.\u003c/p>\n\u003ch2>Are there ‘multiple layers of fiscal review?’\u003c/h2>\n\u003cp>The Department of Managed Health Care, which issued the cost estimates, is part of the state’s \u003ca href=\"https://www.chhs.ca.gov/wp-content/uploads/2024/08/CalHHS-Organizational-Chart_AUG24.pdf\">Health and Human Services Agency\u003c/a>. Secretary Dr. Mark Ghaly, a Newsom appointee, oversees the agency.\u003c/p>\n\u003cp>CalMatters requested an interview with Ghaly or another top official to talk about the cost estimates, but the administration would not talk beyond providing the emailed statement from Butler at the Health and Human Services Agency.\u003c/p>\n\u003cp>“It’s important to note there are multiple layers of fiscal review throughout the process,” he said, citing the policy and appropriations committees in the Legislature and the governor’s Department of Finance.\u003c/p>\n\u003cp>However, Department of Finance spokesman H.D. Palmer told CalMatters, “We rely principally on (agencies and departments) to provide us with the personnel and fiscal estimates.”\u003c/p>\n\u003cfigure id=\"attachment_12002024\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12002024\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33.jpg\" alt=\"Two men wearing dark business suits stand behind two flags. The man on the left stands in front of a podium with a microphone and gestures with his right hand.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gov. Gavin Newsom, left, listens as Joe Stephenshaw, director of the Department of Finance, speaks during a press conference unveiling Newsom’s revised 2024–25 budget proposal at the Capitol Annex Swing Space in Sacramento on May 10, 2024. \u003ccite>(Fred Greaves / CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Policy committees, meanwhile, don’t evaluate the costs of bills.\u003c/p>\n\u003cp>“To say that policy committees vetted the finances of a bill is almost uniformly incorrect,” said Gatto, the former Assembly Appropriations chair. “Policy committees don’t do that.”\u003c/p>\n\u003cp>That independent fiscal review is supposed to happen at the Assembly and Senate Appropriations Committees, whose staffers are widely regarded as some of the smartest people in the Capitol. Their job is to independently vet the administration estimate and provide their own cost estimates for bills, Kousser and Gatto said.\u003c/p>\n\u003cp>“These people are professionals,” Kousser said. “They’re trying to get it right.”\u003c/p>\n\u003cp>Yet when it came to these four disputed bills, the analysis written by the staffs of the Appropriations Committees described the administration cost estimates and nothing more. Each of the four analysis included \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb999?slug=CA_202320240SB999\">language similar to SB 999\u003c/a>, which said only: “The Department of Managed Health Care (DMHC) reports the total costs of this bill as follows:”\u003c/p>\n\u003cp>Luis Quinonez, chief of staff for Sen. \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/anna-caballero-101330\">Anna Caballero\u003c/a> of Merced, who chairs the Senate’s Appropriations Committee, declined to discuss specific bills other than to say the committee’s consultants perform their own analyses.\u003c/p>\n\u003cp>Representatives for Assemblymember Wicks, who chairs the Assembly Appropriations Committee, did not return messages.\u003c/p>\n\u003ch2>Another Democrat calls costs ‘exorbitant’\u003c/h2>\n\u003cp>Regarding his mental health bill, Sen. Cortese said in an email he has “serious concerns about how the health care agencies are coming up with these cost projections.” \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb999?slug=CA_202320240SB999\">Senate Bill 999 \u003c/a>would have required health insurers to make sure they have mental health and addiction experts review claims for treatment, something advocates say is already required under state law.\u003c/p>\n\u003cp>This was the second time Cortese introduced the bill. A previous version made it through the Legislature in 2022 before Newsom \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2022/09/SB-999-VETO.pdf\">vetoed it\u003c/a>, saying the issue could be addressed by new regulations that would be issued soon.\u003c/p>\n\u003cp>After he felt draft regulations last year were inadequate, Cortese introduced a pared-down version of the 2022 bill. \u003cspan style=\"margin: 0px;padding: 0px\">However, advocates were surprised to see the \u003ca href=\"https://s3.documentcloud.org/documents/25074841/sb-999-2024-analysis.pdf\" target=\"_blank\" rel=\"noopener\">department’s cost estimate \u003c/a>increase significantly to $18 million over five years and about $4 million annually after 2028 to pay for 13 permanent positions.\u003c/span> The estimate does not explain how the department determined the number of positions needed or what jobs they would perform.\u003c/p>\n\u003cp>\u003cspan style=\"margin: 0px;padding: 0px\">Advocacy groups supporting the bill noted that, in recent years, budget allocations, the Department of Managed Health Care already received \u003ca href=\"https://bcp.dof.ca.gov/2122/FY2122_ORG4150_BCP4308.pdf\" target=\"_blank\" rel=\"noopener\">millions of\u003c/a> \u003ca href=\"https://bcp.dof.ca.gov/2223/FY2223_ORG4150_BCP5107.pdf\" target=\"_blank\" rel=\"noopener\">dollars \u003c/a>to cover some of the costs of implementing the proposed rules, so it didn’t make sense that the costs would be so high.\u003c/span>\u003c/p>\n\u003cp>“It’s sad to see some of these good faith efforts by advocates to try to bring accountability to the system kind of fall under the weight of a cost estimate that we don’t have a lot of insight into from the department,” said Lauren Finke, policy director for The Kennedy Forum, one of the bill’s sponsors.\u003c/p>\n\u003cfigure id=\"attachment_12002026\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12002026\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03.jpg\" alt=\"A white woman wearing a black jacket and grey shirt looks at a woman wearing a red jacket that has her back turned to the camera.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Assemblymember Gail Pellerin, a Santa Cruz Democrat, convenes with legislators during a session at the state Capitol in Sacramento on Jan. 19, 2023. \u003ccite>(Rahul Lal / CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Santa Cruz Democratic Assemblymember \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/gail-pellerin-149519\">Gail Pellerin\u003c/a> similarly couldn’t understand why there was such a high cost associated with her \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240ab3260?slug=CA_202320240AB3260\">Assembly Bill 3260\u003c/a>, which would have required health insurers to expedite reviews of mental health claims that doctors deem urgent.\u003c/p>\n\u003cp>The \u003ca href=\"https://s3.documentcloud.org/documents/25074842/ab-3260-analysis.pdf\">Department of Managed Health Care estimated\u003c/a> the bill would cost nearly $140 million in the first five years and $32 million annually after 2029 to pay 144 new positions — a 23% increase in staff size, Pellerin said in an interview. The estimate, which also includes an additional $238,000 annually for the Department of Insurance, does not provide any further description of the need for the positions.\u003c/p>\n\u003cp>Sal Rosselli, president emeritus of the National Union of Healthcare Workers, which supported the bill, said in an email that his organization reached out to agency officials to ask for an explanation of the cost analysis, “but they declined to engage with us.”\u003c/p>\n\u003cp>Eleven other states, plus Washington, D.C., have already adopted similar laws, he said, with no evidence that those laws resulted in a major increase in workload.\u003c/p>\n\u003cp>Pellerin said she and her staff also couldn’t get an answer from the department about how it came up with what she called “inflated” numbers.\u003c/p>\n\u003cp>“Is this taxpayer-funded state department doing the job it is required to do?” she asked.\u003c/p>\n\u003cp>For Pellerin, the issue is personal. She knows firsthand how an urgent mental health crisis can spiral out of control. Her husband died by suicide in 2018.\u003c/p>\n\u003cp>“My family, we’ve experienced this kind of situation,” she told CalMatters.\u003c/p>\n\u003ch2>Are agencies not showing their work?\u003c/h2>\n\u003cp>Advocates for Health Access California also were frustrated by the cost estimates associated with \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240ab236?_gl=1*ip5o3s*_gcl_au*MTQyNDUxODAyMS4xNzIzNTY4MzM1*_ga*OTk2OTcyMDkyLjE2OTk5MTE3MzA.*_ga_5TKXNLE5NK*MTcyNDM2MDMwNi43MjEuMS4xNzI0MzYwNDYwLjU3LjAuMA..*_ga_DX0K9PCWYH*MTcyNDM2MDMwNi4xNjUuMS4xNzI0MzYwNDU3LjAuMC4w*_ga_GNY4L81DZE*MTcyNDM2MDQ1Ny41OTguMC4xNzI0MzYwNDU3LjAuMC4w\">Assembly Bill 236\u003c/a> by Pasadena Democratic Assemblymember \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/chris-holden-78\">Chris Holden\u003c/a>. The bill \u003ca href=\"https://calmatters.org/health/2024/07/ghost-network-doctor-referrals/\">would have given state regulators\u003c/a> the authority to fine health insurers if their publicly available lists of in-network doctors and specialists aren’t accurate.\u003c/p>\n\u003cp>In testimony supporting the bill’s promises to crack down on so-called “ghost networks,” \u003ca href=\"https://digitaldemocracy.calmatters.org/hearings/258106?t=469&f=723bb83d8559a8dceb9316c055b8b3b2&_gl=1*6kjdh0*_gcl_au*MTQyNDUxODAyMS4xNzIzNTY4MzM1*_ga*OTk2OTcyMDkyLjE2OTk5MTE3MzA.*_ga_5TKXNLE5NK*MTcyNDM1NTkxNS43MjAuMS4xNzI0MzU2NDQ2LjU5LjAuMA..*_ga_DX0K9PCWYH*MTcyNDM1NTkxNS4xNjQuMS4xNzI0MzU2NDQ1LjAuMC4w*_ga_GNY4L81DZE*MTcyNDM1NjQ0NS41OTcuMC4xNzI0MzU2NDQ1LjAuMC4w\">a therapist described\u003c/a> having a patient end up in the emergency room from a suicide attempt after she called through a list of 50 mental health providers and couldn’t find one who’d see her.\u003c/p>\n\u003cp>The bill would have added teeth to a law that insurers and doctors are already supposed to follow and that state regulators are supposed to monitor.[aside postID=\"news_11981977,news_11999996,news_12000706\" label=\"Related Stories\"]\u003c/p>\n\u003cp>The Department of Managed Health Care \u003ca href=\"https://s3.documentcloud.org/documents/25074840/ab-236-2024.pdf\">estimated its cost\u003c/a> to be $3.5 million annually after 2029 for 14 new positions. In its one-sentence description, the Department of Health Care Services said its cost for the bill would be “approximately” $24 million. In an email, the department told CalMatters the bill would lead to “increased costs in the Medi-Cal managed care and behavioral health delivery systems and staffing requirements.”\u003c/p>\n\u003cp>“This $24 million is just mind-blowing,” said Rachel Linn Gish, a spokesperson for Health Access. “We do not understand how they came up with this number.”\u003c/p>\n\u003cp>Michael Genest spent four years as Gov. Arnold Schwarzenegger’s director of the Department of Finance. At CalMatters’ request, he reviewed the cost estimates of the four bills.\u003c/p>\n\u003cp>He said he could expect high costs for Wiener’s and Pellerin’s bills, but he said it wasn’t possible for him to independently evaluate the figures without more detail.\u003c/p>\n\u003cp>However, he said the other two estimates definitely seemed out of line based on the information the administration and the committees provided.\u003c/p>\n\u003cp>He said it wouldn’t surprise him if the agencies were inflating the projected costs of the bills to try to get more money to backfill their budgets — or if top officials in Newsom’s administration had told departments to oppose bills that weren’t the governor’s priorities.\u003c/p>\n\u003cp>Either way, he said the agencies should do a better job of explaining their cost projections.\u003c/p>\n\u003cp>“It’s poor practice,” he said. “It’s not a good thing that they’re not showing the detail.”\u003c/p>\n\u003cp>Genest worked in the Capitol when Willie Brown was Assembly speaker and when John Burton was president of the Senate. He said those leaders, known for their aggressive leadership styles, would never let the governor’s administration get away with blowing off lawmakers’ concerns. Back then, he said, lawmakers would have threatened to cut the departments’ budgets if they felt they were getting the runaround.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If a member was disrespected to that extent by a member of the bureaucracy,” he said, “there would be consequences.”\u003c/p>\n\n",
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"excerpt": "A trio of California Democratic lawmakers says they’re frustrated by high-cost estimates that helped kill their health care legislation. Did the Newsom administration inflate the numbers to quietly kill the bills?",
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"title": "Lawmakers Say Newsom Staff ‘Inflated’ Cost of Failed Health Care Bills | KQED",
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"nprByline": "\u003ca href=\"https://calmatters.org/author/ryan-sabalow\">Ryan Sabalow\u003c/a> and \u003ca href=\"https://calmatters.org/author/jocelyn-wiener\">Jocelyn Wiener, \u003c/a>CalMatters",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lawmakers and advocates say Gov. Gavin Newsom’s administration is making inflated estimates about the cost of legislation, with some suggesting his subordinates have been trying to kill the bills without making the governor politically accountable for the outcome.\u003c/p>\n\u003cp>“While people are dying on the streets from a lack of access to behavioral health care treatment, state agencies continue to fabricate exorbitant cost estimates,” Sen. \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/dave-cortese-164699\">Dave Cortese\u003c/a>, a Democrat from Campbell, told CalMatters after one of his mental health proposals died recently in the Assembly Appropriations Committee.\u003c/p>\n\u003cp>Sen. \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/scott-wiener-100936\">Scott Wiener\u003c/a>, a Democrat from San Francisco who authored another mental health bill that died recently, \u003ca href=\"https://digitaldemocracy.calmatters.org/hearings/258192?t=295&f=a2f15a64e9e6ef40221b60296d414495\">said in a public hearing last month\u003c/a> that the administration’s cost estimate of his bill was “extreme and outrageous.”\u003c/p>\n\u003cp>The pointed accusations from Democratic lawmakers and health care advocates who tend to be friendly with the Democratic governor are extraordinary because such criticism is rarely made in public. The examples also stand out because they challenge the administration’s response to one of the governor’s top priorities, \u003ca href=\"https://calmatters.org/tag/mental-health/\">mental health\u003c/a>.\u003c/p>\n\u003cp>The administration did not accept an interview request with CalMatters and would not provide more detail — to CalMatters or to lawmakers — to explain the cost estimates. By email, however, a spokesperson insisted the costs were accurate and rejected the idea that they were intentionally inflated.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s outrageous and inaccurate for anyone to suggest these numbers are fabricated or artificially inflated,” Rodger Butler, a spokesperson for Newsom’s Health and Human Services Agency, said in an email. “Legislative fiscal analyses from state government departments are informed by real-world, on-the-ground experience implementing legislative mandates.”\u003c/p>\n\u003cp>Whatever the motivations, four health care bills with controversial cost estimates died quietly earlier this month in the Senate and Assembly Appropriations committees even after each had advanced without a single “no” vote from a Democratic legislator.\u003c/p>\n\u003cfigure id=\"attachment_12002025\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12002025\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04.jpg\" alt=\"Three women dressed in orange, pink and green jackets and a man wearing a dark business suit sit in green chairs with the United States and California flags behind them.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/081524-Suspense-File-FG-CM-04-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Assembly lawmakers meet during a Suspense File hearing at the Capitol Annex Swing Space on O Street in Sacramento on Aug. 15, 2024. \u003ccite>(Fred Greaves / CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Appropriations Committees are focused on the cost of legislation, especially in a year when the state is struggling with a \u003ca href=\"https://calmatters.org/tag/california-budget/\">budget deficit\u003c/a>. The four bills were moved to the committees’ “suspense files,” \u003ca href=\"https://calmatters.org/politics/capitol/2024/08/california-laws-legislature-suspense-file/\">along with 263 other controversial or costly bills\u003c/a>. Each committee then killed the bills in their respective suspense file with a single vote.\u003c/p>\n\u003cp>Mike Gatto, a former Democratic lawmaker from Los Angeles who chaired the Assembly Appropriations Committee, said inflated cost estimates from a governor’s administration are nothing new.\u003c/p>\n\u003cp>When an executive branch agency provides “a significantly exaggerated cost” on a piece of legislation, “it’s generally a big flashing light that the administration dislikes the bill and that the governor would likely veto it,” he said.\u003c/p>\n\u003cp>It can be advantageous for the governor when legislators quietly kill those bills, he said.\u003c/p>\n\u003cp>“Having the appropriations committee there to kill it and to take the arrows (of criticism), that is a tremendous benefit politically for any governor,” Gatto said.\u003c/p>\n\u003cp>Gatto has a hand-written note framed on his wall that former Gov. Jerry Brown gave him expressing Brown’s appreciation for keeping bills from reaching the governor’s desk.\u003c/p>\n\u003cp>In a corner of the note are two words: “Keep holding.”\u003c/p>\n\u003cp>But Thad Kousser, a former legislative staffer who’s now a professor of political science at UC San Diego, said the integrity of the legislative process is jeopardized if cost estimates are not accurate.\u003c/p>\n\u003cp>“You’ve got to have reasonable and realistic estimates that are not part of a political strategy in order for everyone to make informed decisions,” he said.\u003c/p>\n\u003cp>This year alone, \u003ca href=\"https://digitaldemocracy.calmatters.org/\">according to the Digital Democracy database\u003c/a>, lawmakers considered 2,522 bills, many of them with large potential costs to taxpayers.\u003c/p>\n\u003ch2>Democrat calls costs ‘extreme and outrageous’\u003c/h2>\n\u003cp>Sen. Wiener’s legislation, \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb294?slug=CA_202320240SB294\">Senate Bill 294\u003c/a>, would have required an automatic review of cases in which commercial health plans denied children and young people mental health treatment.\u003c/p>\n\u003cp>Wiener, the chair of the Senate’s mental health caucus, said in the public hearing last month that the measure “does nothing more than require health plans to provide the coverage that they’re required to provide and stop denying covered behavioral health care treatment to children.”\u003c/p>\n\u003cp>So he said it was “outrageous” when the \u003ca href=\"https://s3.documentcloud.org/documents/25074843/sb-294-2024.pdf\">Department of Managed Health Care estimated\u003c/a> that the bill would cost $87.6 million per year by 2028 and would require 340 new employees. That’s a 55% increase over the\u003ca href=\"https://ebudget.ca.gov/reference/2024-PositionVacancyReport.pdf\"> 610 positions in the department’s budget for the 2022–23 fiscal year.\u003c/a> A separate state office, the Department of Insurance, also said the bill would require it to hire an additional five positions by 2026 for $1.2 million. There is no description in the cost estimate about how the departments arrived at the estimate or what jobs the new positions would perform.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://datawrapper.dwcdn.net/FM6KA/9/\" width=\"800\" height=\"500\" scrolling=\"yes\" class=\"iframe-class\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>The estimate also was a surprise to supporters of Wiener’s bill. In June, they sent a three-page memo to the chair of the Assembly Appropriations Committee, Democrat \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/buffy-wicks-165044\">Buffy Wicks\u003c/a> from Oakland, saying that a similar bill that failed last year had a significantly lower cost estimate. They also noted that the pending bill was more narrow in scope.\u003c/p>\n\u003cp>Lishaun Francis, director of behavioral health for the advocacy group Children Now, told CalMatters the Department of Managed Health Care, which is intended to protect consumers, inflated the cost of Wiener’s bill, presumably to try to kill it.\u003c/p>\n\u003cp>“This is not an analysis in good faith,” she said. “The unfortunate thing here is that DMHC has fallen into a trap where they are trying to be here for consumers while also inflating costs to make sure bills don’t get to the governor when there is a tight budget year.”\u003c/p>\n\u003cp>Before the bill died, it passed the Senate and an Assembly committee without any Democrats voting against it, according to the Digital Democracy database.\u003c/p>\n\u003ch2>Are there ‘multiple layers of fiscal review?’\u003c/h2>\n\u003cp>The Department of Managed Health Care, which issued the cost estimates, is part of the state’s \u003ca href=\"https://www.chhs.ca.gov/wp-content/uploads/2024/08/CalHHS-Organizational-Chart_AUG24.pdf\">Health and Human Services Agency\u003c/a>. Secretary Dr. Mark Ghaly, a Newsom appointee, oversees the agency.\u003c/p>\n\u003cp>CalMatters requested an interview with Ghaly or another top official to talk about the cost estimates, but the administration would not talk beyond providing the emailed statement from Butler at the Health and Human Services Agency.\u003c/p>\n\u003cp>“It’s important to note there are multiple layers of fiscal review throughout the process,” he said, citing the policy and appropriations committees in the Legislature and the governor’s Department of Finance.\u003c/p>\n\u003cp>However, Department of Finance spokesman H.D. Palmer told CalMatters, “We rely principally on (agencies and departments) to provide us with the personnel and fiscal estimates.”\u003c/p>\n\u003cfigure id=\"attachment_12002024\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12002024\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33.jpg\" alt=\"Two men wearing dark business suits stand behind two flags. The man on the left stands in front of a podium with a microphone and gestures with his right hand.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/051024_Newsom-Budget_FG_CM_33-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Gov. Gavin Newsom, left, listens as Joe Stephenshaw, director of the Department of Finance, speaks during a press conference unveiling Newsom’s revised 2024–25 budget proposal at the Capitol Annex Swing Space in Sacramento on May 10, 2024. \u003ccite>(Fred Greaves / CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Policy committees, meanwhile, don’t evaluate the costs of bills.\u003c/p>\n\u003cp>“To say that policy committees vetted the finances of a bill is almost uniformly incorrect,” said Gatto, the former Assembly Appropriations chair. “Policy committees don’t do that.”\u003c/p>\n\u003cp>That independent fiscal review is supposed to happen at the Assembly and Senate Appropriations Committees, whose staffers are widely regarded as some of the smartest people in the Capitol. Their job is to independently vet the administration estimate and provide their own cost estimates for bills, Kousser and Gatto said.\u003c/p>\n\u003cp>“These people are professionals,” Kousser said. “They’re trying to get it right.”\u003c/p>\n\u003cp>Yet when it came to these four disputed bills, the analysis written by the staffs of the Appropriations Committees described the administration cost estimates and nothing more. Each of the four analysis included \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb999?slug=CA_202320240SB999\">language similar to SB 999\u003c/a>, which said only: “The Department of Managed Health Care (DMHC) reports the total costs of this bill as follows:”\u003c/p>\n\u003cp>Luis Quinonez, chief of staff for Sen. \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/anna-caballero-101330\">Anna Caballero\u003c/a> of Merced, who chairs the Senate’s Appropriations Committee, declined to discuss specific bills other than to say the committee’s consultants perform their own analyses.\u003c/p>\n\u003cp>Representatives for Assemblymember Wicks, who chairs the Assembly Appropriations Committee, did not return messages.\u003c/p>\n\u003ch2>Another Democrat calls costs ‘exorbitant’\u003c/h2>\n\u003cp>Regarding his mental health bill, Sen. Cortese said in an email he has “serious concerns about how the health care agencies are coming up with these cost projections.” \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240sb999?slug=CA_202320240SB999\">Senate Bill 999 \u003c/a>would have required health insurers to make sure they have mental health and addiction experts review claims for treatment, something advocates say is already required under state law.\u003c/p>\n\u003cp>This was the second time Cortese introduced the bill. A previous version made it through the Legislature in 2022 before Newsom \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2022/09/SB-999-VETO.pdf\">vetoed it\u003c/a>, saying the issue could be addressed by new regulations that would be issued soon.\u003c/p>\n\u003cp>After he felt draft regulations last year were inadequate, Cortese introduced a pared-down version of the 2022 bill. \u003cspan style=\"margin: 0px;padding: 0px\">However, advocates were surprised to see the \u003ca href=\"https://s3.documentcloud.org/documents/25074841/sb-999-2024-analysis.pdf\" target=\"_blank\" rel=\"noopener\">department’s cost estimate \u003c/a>increase significantly to $18 million over five years and about $4 million annually after 2028 to pay for 13 permanent positions.\u003c/span> The estimate does not explain how the department determined the number of positions needed or what jobs they would perform.\u003c/p>\n\u003cp>\u003cspan style=\"margin: 0px;padding: 0px\">Advocacy groups supporting the bill noted that, in recent years, budget allocations, the Department of Managed Health Care already received \u003ca href=\"https://bcp.dof.ca.gov/2122/FY2122_ORG4150_BCP4308.pdf\" target=\"_blank\" rel=\"noopener\">millions of\u003c/a> \u003ca href=\"https://bcp.dof.ca.gov/2223/FY2223_ORG4150_BCP5107.pdf\" target=\"_blank\" rel=\"noopener\">dollars \u003c/a>to cover some of the costs of implementing the proposed rules, so it didn’t make sense that the costs would be so high.\u003c/span>\u003c/p>\n\u003cp>“It’s sad to see some of these good faith efforts by advocates to try to bring accountability to the system kind of fall under the weight of a cost estimate that we don’t have a lot of insight into from the department,” said Lauren Finke, policy director for The Kennedy Forum, one of the bill’s sponsors.\u003c/p>\n\u003cfigure id=\"attachment_12002026\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12002026\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03.jpg\" alt=\"A white woman wearing a black jacket and grey shirt looks at a woman wearing a red jacket that has her back turned to the camera.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/01192023_Assembly-Chamber_RL_CM_03-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Assemblymember Gail Pellerin, a Santa Cruz Democrat, convenes with legislators during a session at the state Capitol in Sacramento on Jan. 19, 2023. \u003ccite>(Rahul Lal / CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Santa Cruz Democratic Assemblymember \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/gail-pellerin-149519\">Gail Pellerin\u003c/a> similarly couldn’t understand why there was such a high cost associated with her \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240ab3260?slug=CA_202320240AB3260\">Assembly Bill 3260\u003c/a>, which would have required health insurers to expedite reviews of mental health claims that doctors deem urgent.\u003c/p>\n\u003cp>The \u003ca href=\"https://s3.documentcloud.org/documents/25074842/ab-3260-analysis.pdf\">Department of Managed Health Care estimated\u003c/a> the bill would cost nearly $140 million in the first five years and $32 million annually after 2029 to pay 144 new positions — a 23% increase in staff size, Pellerin said in an interview. The estimate, which also includes an additional $238,000 annually for the Department of Insurance, does not provide any further description of the need for the positions.\u003c/p>\n\u003cp>Sal Rosselli, president emeritus of the National Union of Healthcare Workers, which supported the bill, said in an email that his organization reached out to agency officials to ask for an explanation of the cost analysis, “but they declined to engage with us.”\u003c/p>\n\u003cp>Eleven other states, plus Washington, D.C., have already adopted similar laws, he said, with no evidence that those laws resulted in a major increase in workload.\u003c/p>\n\u003cp>Pellerin said she and her staff also couldn’t get an answer from the department about how it came up with what she called “inflated” numbers.\u003c/p>\n\u003cp>“Is this taxpayer-funded state department doing the job it is required to do?” she asked.\u003c/p>\n\u003cp>For Pellerin, the issue is personal. She knows firsthand how an urgent mental health crisis can spiral out of control. Her husband died by suicide in 2018.\u003c/p>\n\u003cp>“My family, we’ve experienced this kind of situation,” she told CalMatters.\u003c/p>\n\u003ch2>Are agencies not showing their work?\u003c/h2>\n\u003cp>Advocates for Health Access California also were frustrated by the cost estimates associated with \u003ca href=\"https://digitaldemocracy.calmatters.org/bills/ca_202320240ab236?_gl=1*ip5o3s*_gcl_au*MTQyNDUxODAyMS4xNzIzNTY4MzM1*_ga*OTk2OTcyMDkyLjE2OTk5MTE3MzA.*_ga_5TKXNLE5NK*MTcyNDM2MDMwNi43MjEuMS4xNzI0MzYwNDYwLjU3LjAuMA..*_ga_DX0K9PCWYH*MTcyNDM2MDMwNi4xNjUuMS4xNzI0MzYwNDU3LjAuMC4w*_ga_GNY4L81DZE*MTcyNDM2MDQ1Ny41OTguMC4xNzI0MzYwNDU3LjAuMC4w\">Assembly Bill 236\u003c/a> by Pasadena Democratic Assemblymember \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/chris-holden-78\">Chris Holden\u003c/a>. The bill \u003ca href=\"https://calmatters.org/health/2024/07/ghost-network-doctor-referrals/\">would have given state regulators\u003c/a> the authority to fine health insurers if their publicly available lists of in-network doctors and specialists aren’t accurate.\u003c/p>\n\u003cp>In testimony supporting the bill’s promises to crack down on so-called “ghost networks,” \u003ca href=\"https://digitaldemocracy.calmatters.org/hearings/258106?t=469&f=723bb83d8559a8dceb9316c055b8b3b2&_gl=1*6kjdh0*_gcl_au*MTQyNDUxODAyMS4xNzIzNTY4MzM1*_ga*OTk2OTcyMDkyLjE2OTk5MTE3MzA.*_ga_5TKXNLE5NK*MTcyNDM1NTkxNS43MjAuMS4xNzI0MzU2NDQ2LjU5LjAuMA..*_ga_DX0K9PCWYH*MTcyNDM1NTkxNS4xNjQuMS4xNzI0MzU2NDQ1LjAuMC4w*_ga_GNY4L81DZE*MTcyNDM1NjQ0NS41OTcuMC4xNzI0MzU2NDQ1LjAuMC4w\">a therapist described\u003c/a> having a patient end up in the emergency room from a suicide attempt after she called through a list of 50 mental health providers and couldn’t find one who’d see her.\u003c/p>\n\u003cp>The bill would have added teeth to a law that insurers and doctors are already supposed to follow and that state regulators are supposed to monitor.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The Department of Managed Health Care \u003ca href=\"https://s3.documentcloud.org/documents/25074840/ab-236-2024.pdf\">estimated its cost\u003c/a> to be $3.5 million annually after 2029 for 14 new positions. In its one-sentence description, the Department of Health Care Services said its cost for the bill would be “approximately” $24 million. In an email, the department told CalMatters the bill would lead to “increased costs in the Medi-Cal managed care and behavioral health delivery systems and staffing requirements.”\u003c/p>\n\u003cp>“This $24 million is just mind-blowing,” said Rachel Linn Gish, a spokesperson for Health Access. “We do not understand how they came up with this number.”\u003c/p>\n\u003cp>Michael Genest spent four years as Gov. Arnold Schwarzenegger’s director of the Department of Finance. At CalMatters’ request, he reviewed the cost estimates of the four bills.\u003c/p>\n\u003cp>He said he could expect high costs for Wiener’s and Pellerin’s bills, but he said it wasn’t possible for him to independently evaluate the figures without more detail.\u003c/p>\n\u003cp>However, he said the other two estimates definitely seemed out of line based on the information the administration and the committees provided.\u003c/p>\n\u003cp>He said it wouldn’t surprise him if the agencies were inflating the projected costs of the bills to try to get more money to backfill their budgets — or if top officials in Newsom’s administration had told departments to oppose bills that weren’t the governor’s priorities.\u003c/p>\n\u003cp>Either way, he said the agencies should do a better job of explaining their cost projections.\u003c/p>\n\u003cp>“It’s poor practice,” he said. “It’s not a good thing that they’re not showing the detail.”\u003c/p>\n\u003cp>Genest worked in the Capitol when Willie Brown was Assembly speaker and when John Burton was president of the Senate. He said those leaders, known for their aggressive leadership styles, would never let the governor’s administration get away with blowing off lawmakers’ concerns. Back then, he said, lawmakers would have threatened to cut the departments’ budgets if they felt they were getting the runaround.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If a member was disrespected to that extent by a member of the bureaucracy,” he said, “there would be consequences.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "they-delivered-5600-babies-they-blame-california-rules-for-putting-them-out-of-business",
"title": "They Delivered 5,600 Babies. They Blame California Rules for Putting Them Out of Business",
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"headTitle": "They Delivered 5,600 Babies. They Blame California Rules for Putting Them Out of Business | KQED",
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"content": "\u003cp>\u003cem>This story, produced by CalMatters, is published jointly with San Diego Magazine.\u003c/em>\u003c/p>\n\u003cp>Colorful collages line the hallways of Best Start Birth Center in San Diego, the squishy faces of hundreds of newborns carefully cut out and framed. A picture of executive director Karen Roslie’s son, born in 2003, hangs among the smiling, crying and squinting babies.\u003c/p>\n\u003cp>Thirty years ago, Roslie’s mother, Roberta Frank, opened Best Start after training to become a certified nurse midwife. Since that time, state agencies and national organizations have recognized the birth center as a model for alternative birth practices. The Canadian health ministry even visited in the 1990s as it developed plans to fund midwifery services, Roslie said.\u003c/p>\n\u003cp>But in March, Best Start closed its doors, unable to keep up with escalating costs. TRICARE, a major military insurer and Best Start’s biggest contractor, wouldn’t pay for licensed midwives — only nurses, who can make much more money in a hospital. In a community where the Navy is a major employer, it was a debilitating blow to the birth center. The photos Roslie meticulously framed over the years will most likely have to be destroyed to avoid any medical privacy violations — evidence of more than 5,600 births shredded.\u003c/p>\n\u003cp>“It feels like I’m mourning a death,” Roslie said, gazing at the pictures.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Best Start was the first licensed and accredited birth center in California, and even those credentials couldn’t save it. In fact, they may have hindered the birth center’s survival, requiring expensive renovations that many midwives say aren’t relevant to the care they provide or the safety of their practice. Its closure was one of at least 19 birth center shutdowns and service reductions in the past four years, according to the California chapter of the American Association of Birth Centers.\u003c/p>\n\u003cp>Those closures deepen a crisis of declining women’s health services across California. \u003ca href=\"https://calmatters.org/series/no-deliveries-maternity-care/\">More than 50 California hospital labor and delivery wards have closed\u003c/a> in the past decade, creating maternity care deserts in rural communities and overburdening the remaining labor wards in cities and suburbs.\u003c/p>\n\u003cp>Health experts have pointed to birth centers as a way to expand capacity in communities where hospitals no longer deliver babies. The midwife-run clinics handle low-risk births and direct higher-risk pregnancies to hospitals.\u003c/p>\n\u003cfigure id=\"attachment_12001858\" class=\"wp-caption alignright\" style=\"max-width: 280px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\" wp-image-12001858\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01-800x1000.jpg\" alt=\"Two women wearing. One sitting, one standing. \" width=\"280\" height=\"350\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01-800x1000.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01-1020x1275.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01-160x200.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01-1229x1536.jpg 1229w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01.jpg 1600w\" sizes=\"auto, (max-width: 280px) 100vw, 280px\">\u003cfigcaption class=\"wp-caption-text\">Left to right, Founder Roberta Frank and Executive Director Karen Rosalie at the Best Start Birthing Center in San Diego on March 20, 2024. \u003ccite>(Ariana Drehsler/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>However, California has some of the toughest licensing requirements in the country, according to the American Association of Birth Centers, and facilities such as Best Start have long argued that California’s onerous regulations and an uncooperative Public Health Department prevent them from succeeding.\u003c/p>\n\u003cp>Only six operating birth centers are licensed in California. Another 26 are unlicensed. Licensure isn’t required, but it helps enable a practice to work with insurance plans and serve lower-income families who can’t pay birthing costs out of pocket.\u003c/p>\n\u003cp>Increasingly, only wealthy families who pay cash can afford a midwife.\u003c/p>\n\u003cp>“The system is just a mess. It’s flawed. It’s set up to prevent providers that can provide really good care from even getting started,” Frank, the founder of Best Start, said.\u003c/p>\n\u003cp>While most California births happen in hospitals, birth centers serve a small but growing number of families. Planned out-of-hospital births attended by midwives have doubled over the past decade even as birth rates overall declined, according to \u003ca href=\"https://www.mbc.ca.gov/Resources/Publications/Licensed-Midwife-Annual-Report.aspx\">data from the Medical Board of California\u003c/a>. And a statewide survey conducted in 2018 by the California Health Care Foundation indicated that more than one-third of pregnant people would be\u003ca href=\"https://www.chcf.org/wp-content/uploads/2018/09/ListeningMothersCAFullSurveyReport2018.pdf\"> interested in having a midwife for a future birth (PDF)\u003c/a>.\u003c/p>\n\u003cp>Frequently, those who seek the services of midwives and birth centers cite the desire for more personalized care or poor experiences with previous hospital births. Studies show that for low-risk pregnancies, \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK555483/\">midwife-led deliveries at birth centers\u003c/a> are safe and lead to fewer interventions such as cesarean sections.\u003c/p>\n\u003cp>“Women deserve this,” Frank said. “Every human deserves to find their own strength, find their place, exercise their initiative, and I wanted to share it.”\u003c/p>\n\u003cp>But even as demand for out-of-hospital births increases, birth centers across the state are shutting their doors, unable to withstand the joint battering ram of financial and regulatory challenges.\u003c/p>\n\u003cp>Last year, the \u003ca href=\"https://www.pressdemocrat.com/article/news/if-you-dont-want-to-give-birth-in-a-hospital-your-options-are-few-in-sono/\">Santa Rosa Birth Center stopped delivering babies\u003c/a>, reducing options in a Wine Country community that recently lost a hospital maternity ward and another birth center.\u003c/p>\n\u003cp>A \u003ca href=\"https://calmatters.org/health/2024/02/midwife-medi-cal/\">Sacramento midwife closed her birth center\u003c/a> in February and left the country because she said California’s health system was too unfriendly to make ends meet. Another Sacramento birth center is also on the verge of closure because it cannot get a state license.\u003c/p>\n\u003cfigure id=\"attachment_12001860\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-12001860\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic-800x450.jpg\" alt=\"Collage of two images: On the left a pregnant belly being measured and on the right a woman with a face mask.\" width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic-1536x864.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Midwife Madeleine Wisner measures and checks Chloé Mick’s belly during a maternity care consultation at Mick’s home in Sacramento on Feb. 6, 2024. \u003ccite>(Miguel Gutierrez Jr./CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In September, Monterey Birth and Wellness Center will close, citing high costs and poor insurance reimbursement.\u003c/p>\n\u003cp>The California Public Health Department refused multiple requests for an interview about licensing, responding only to emailed questions. Licensing requires facilities to meet “minimum standards” for patient care, which include regulations about proper equipment and staff competency, the department said in an unsigned statement.\u003c/p>\n\u003cp>“We cannot speculate or comment on any reason why providers chose to close these facilities, aren’t seeking licensure for new (birth centers), or what could be done to improve the process,” the department statement said.\u003c/p>\n\u003ch3>Years-long wait for a health department license\u003c/h3>\n\u003cp>Nancy Myrick, a co-founder of the San Francisco Birth Center, said it took four-and-a-half years of back-and-forth with the state health department to obtain a license. In one instance, Myrick said, she asked for a list of items an inspector would check and the health department referred her to regulations that had not yet been written.\u003c/p>\n\u003cp>“In the process of opening, the state bureaucracy was like the Great Wall of China. It was such a horrible barrier,” Myrick said.\u003c/p>\n\u003cp>It wasn’t until Myrick called her state assemblymember’s office to complain about the inability to get licensed and see Medi-Cal patients that the application was approved, she said. The birth center was licensed in 2020.\u003c/p>\n\u003cp>“It literally took calling in the political dogs to get it done,” Myrick said.\u003c/p>\n\u003cp>Many providers noticed that getting a license became much more difficult after the state centralized the process under the public health department in 2018. Since then, nearly all birth center applications —11 out of 13 — have been rejected, according to department-provided data.\u003c/p>\n\u003cp>The department said in a statement the change was necessary to improve “standardization and consistency” in licensing multiple kinds of facilities. Previously, the department’s 14 regional offices processed applications and approved 11 out of 12 applications.\u003c/p>\n\u003cp>Yet midwives and advocates say obstacles continue to plague the process. It’s slow, often taking years; it’s expensive, costing tens of thousands of dollars to retrofit buildings and maintain a license; and the standards are frequently at odds with midwives’ scope of practice. What results is a “de facto ban” on birth center licensure in California, said Sandra Poole, a lobbyist with the Western Center on Law and Poverty.\u003c/p>\n\u003cp>Without licensing reform, more birth centers will close, said Bethany Sasaki, president of the state chapter of the American Association of Birth Centers.\u003c/p>\n\u003cfigure id=\"attachment_12001867\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12001867\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18.jpg\" alt=\"Pregnant woman sits in a room with a monitor, clock and greyish walls.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Sally K., right, 38-weeks pregnant, talks to midwife Andrea Bergleen, left, during a check-up at the Best Start Birthing Center in San Diego on March 20, 2024. \u003ccite>(Ariana Drehsler/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A key problem, Sasaki said, is that birth centers are expected to comply with \u003ca href=\"https://hcai.ca.gov/wp-content/uploads/2023/10/2022_1226.6-Primary-Care-Clinic_Checklist_102023.pdf\">building standards designed for hospitals (PDF)\u003c/a>. For example, the standards include negative pressure rooms for infection control and cast iron plumbing for water supply and drainage.\u003c/p>\n\u003cp>Many midwives argue the standards don’t make sense because their patients are legally required to be healthy with low-risk pregnancies. Any condition that would require the additional medical intervention the standards are meant to accommodate, such as surgery, would force the patient to be transferred to a doctor or hospital, Sasaki said.\u003c/p>\n\u003cp>“There’s no reason to hold a birth center to the same standards as a hospital because it’s not a hospital, and that’s the whole point, Sasaki said.\u003c/p>\n\u003cp>According to the state Department of Health Care Access and Information, which sets building codes for health facilities, it would take legislative changes to make exceptions for birth centers. Poole and a number of groups representing midwives and Black maternal health advocates tried to introduce a bill earlier this year that would ease licensing requirements but could not find a legislator to carry it.\u003c/p>\n\u003cp>The state denied Sasaki’s licensure application for Midtown Nurse Midwives in Sacramento in 2020. The holdup is the building’s ventilation system, which doesn’t meet hospital building code.\u003c/p>\n\u003cp>In March, Sasaki requested an appeal and emergency license after TRICARE, the same insurer that Best Start relied on, stopped contracting with unlicensed facilities. As of mid-July, she has not received a response from the state, though the department told CalMatters the appeal deadline for Sasaki’s application had passed.\u003c/p>\n\u003cp>Without the TRICARE contract, which made up about 30% of her clients, Sasaki said the birth center will close by November.\u003c/p>\n\u003cp>“We’ve had to turn away so many people that we stopped answering our phone because I don’t want to listen to another person cry,” Sasaki said.\u003c/p>\n\u003ch3>Birth centers must get licensed for Medi-Cal\u003c/h3>\n\u003cp>Why is licensure such a stumbling block for birth centers? Medi-Cal, the state’s public insurance program for low-income families, pays for half of all births in the state, requiring birth centers to be licensed.\u003c/p>\n\u003cp>“The single biggest thing that will help with sustainability is if birth centers can take Medi-Cal and if Medi-Cal can actually reimburse appropriately,” Sasaki said.\u003c/p>\n\u003cp>The majority of Medi-Cal births — more than 80% — are babies of color. A statewide survey also indicates that people of color, particularly Black women, \u003ca href=\"https://www.chcf.org/wp-content/uploads/2018/09/ListeningMothersCAFullSurveyReport2018.pdf\">want alternative birth support, such as midwives and doulas, more than any other demographic group (PDF)\u003c/a>. White women and those with private insurance were the highest users of midwives, the survey shows. While those who wanted a midwife but didn’t use one most commonly cited lack of insurance coverage as a barrier.\u003c/p>\n\u003cfigure id=\"attachment_12001870\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-12001870 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489.jpg\" alt=\"Image collage with two rooms, one with a small blue pool and one with a white bathtub.\" width=\"1920\" height=\"646\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489-800x269.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489-1020x343.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489-160x54.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489-1536x517.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Birthing rooms at the Best Start Birthing Center in San Diego on March 20, 2024. \u003ccite>(Ariana Drehsler/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Caroline Cusenza, a midwife and owner of the Monterey Birth and Wellness Center, said taking insurance allowed her to serve a more diverse population in the working-class Latino enclave where the birth center is located. She wanted to take Medi-Cal patients but couldn’t. Cusenza applied for licensure twice but was also rejected because the building didn’t meet ventilation standards.\u003c/p>\n\u003cp>The birth center will close in September after seven years.\u003c/p>\n\u003cp>“It was a hard decision to walk away, but we really just could see no path forward,” Cusenza said.\u003c/p>\n\u003cp>The Western Center for Law and Poverty has pointed to accreditation as a possible alternative to licensure. The Commission for the Accreditation of Birth Centers is the national organization that sets standards for birth center quality and safety. California regulators have used accreditation to help license \u003ca href=\"https://www.cdph.ca.gov/Programs/OSPHLD/LFS/CDPH%20Document%20Library/ACLL--16-01.pdf\">other kinds of health facilities (PDF)\u003c/a>, but health department officials see no need to provide birth centers with alternate options. They argue, in an email to CalMatters, that very few have tried to get a license in the first place. Only 23 birth centers have applied in the past decade.\u003c/p>\n\u003cp>Holly Smith, a certified nurse midwife and co-lead of Midwifery Access California, contends the low number of applicants reflects the difficulty of the process. Midwives know licensure is nearly impossible, so they don’t bother applying, Smith said.\u003c/p>\n\u003cp>“If (the Public Health Department) can be much more involved in figuring out solutions to help birth centers exist and be licensed should they want to be, then we would see a greater proliferation of it,” Smith said.\u003c/p>\n\u003cp>Midwifery Access California is working with another state agency to improve access for low-income patients, Smith said. The advocates hope to convince the Department of Health Care Services to increase Medi-Cal payments to midwives. Right now, a licensed birth center gets about $1,300 per birth, while the midwife gets $400.\u003c/p>\n\u003cp>At those rates, some birth centers say even Medi-Cal wouldn’t be enough to save them.\u003c/p>\n\u003cp>“If our birth center were to accept Medi-Cal, we would go bankrupt,” said Trisha Wimbs, owner of the California Birth Center in Rocklin.\u003c/p>\n\u003cp>Wimbs’ facility was one of only three birth centers to get licensed since the public health department took over and tightened building codes. It was licensed in 2023. Wimbs said it cost $1 million to build the “hospital grade facility” to code, including $80,000 to move a fire hydrant two feet closer to the building. The birth center does not take Medi-Cal because it pays too little to recoup expenses. Instead, the birth center caters to cash pay and commercially insured clients in the affluent suburb of Sacramento. Licensure was essential to securing commercial insurance contracts, Wimbs said.\u003c/p>\n\u003cp>To sustain birth centers, Medi-Cal needs to pay around $8,000 per birth, Smith said. At that price point, delivering at a birth center would cost \u003ca href=\"https://healthcostinstitute.org/hcci-originals-dropdown/all-hcci-reports/the-price-of-childbirth-in-the-u-s-tops-13-000-in-2020\">less than half as much as a hospital delivery\u003c/a>.\u003c/p>\n\u003ch3>Saying goodbye to Best Start\u003c/h3>\n\u003cp>Eighteen years ago, Ellary Alonso was born at Best Start Birth Center when her mom, a former labor and delivery nurse, sought a more personalized birth experience. Alonso, who was 21 weeks along in March, wanted to deliver her son in the same place, surrounded by midwives she knew, maybe even in a bath. She wanted the emotional support of the team, she said, because her husband is a Marine, and there’s no guarantee he’ll be able to make it to the birth.\u003c/p>\n\u003cp>But a week before her first prenatal appointment at Best Start, Alonso got a call that the center was closing permanently. No other birth centers in Southern California take her insurance.\u003c/p>\n\u003cp>“In this time when everything is about choice, you can choose not to have a baby, but you can’t choose how to have your baby,” Alonso said. “Hospitals are the only option.”\u003c/p>\n\u003cfigure id=\"attachment_12001873\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12001873\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26.jpg\" alt=\"Two women, one sitting and one standing pose for the camera.\" width=\"2000\" height=\"1334\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26-1536x1025.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26-1920x1281.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Ellary Alonso, right, 18 years old and 21-weeks pregnant, with her mom Hannah Fraley, left, at the Best Start Birthing Center in San Diego on March 20, 2024. Fraley had two of her kids at the center. \u003ccite>(Ariana Drehsler/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Compared to a hospital room, Best Start offers a homey atmosphere and promises that the midwife attending each birth will be familiar to the laboring client. The birthing rooms come with queen-sized beds, floral duvets, and white porcelain tubs for water births. A marble-topped “crash cart” sits in each room. With the doors closed, the cart looks just like an end table that matches the decor. Inside, it’s filled with medical supplies for emergency resuscitations or to stitch up lacerations. The rooms are homey but bear the hallmarks of a by-the-book clinic. Boxes of nitrile gloves are in each room; hazardous waste bins are mounted discreetly to the wall. Best Start was the only birth center in the state to have a licensed clinical laboratory to confirm water breakage. [aside tag=\"health\" label=\"More Related Stories\"]\u003c/p>\n\u003cp>It has never lost a mother or baby, Roslie said. Its transfer rate for cesarean sections was less than half the statewide target set for low-risk births. In the past five years, no episiotomies have been performed. And 96% of newborns are exclusively breastfed before leaving Best Start compared to the statewide hospital rate of 69%.\u003c/p>\n\u003cp>Despite the center’s recognized success, keeping it running has always been a labor of love, Roslie said.\u003c/p>\n\u003cp>“It’s never been a thriving business,” Roslie said. “Roberta’s gone without pay. I’ve gone with reduced pay. That’s what it takes to run a birth center.”\u003c/p>\n\u003cp>When Roberta Frank, Roslie’s mother, graduated from UC San Diego with her nursing midwifery degree in 1981, she was told, “San Diego will never accept midwives.”\u003c/p>\n\u003cp>Sometimes — in the face of Best Start’s closure — it still feels that way.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Birth centers are popular options for families who want to deliver a baby outside of a hospital. Nineteen of them closed in California in the past decade, deepening the state’s maternity care crisis.",
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"title": "They Delivered 5,600 Babies. They Blame California Rules for Putting Them Out of Business | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This story, produced by CalMatters, is published jointly with San Diego Magazine.\u003c/em>\u003c/p>\n\u003cp>Colorful collages line the hallways of Best Start Birth Center in San Diego, the squishy faces of hundreds of newborns carefully cut out and framed. A picture of executive director Karen Roslie’s son, born in 2003, hangs among the smiling, crying and squinting babies.\u003c/p>\n\u003cp>Thirty years ago, Roslie’s mother, Roberta Frank, opened Best Start after training to become a certified nurse midwife. Since that time, state agencies and national organizations have recognized the birth center as a model for alternative birth practices. The Canadian health ministry even visited in the 1990s as it developed plans to fund midwifery services, Roslie said.\u003c/p>\n\u003cp>But in March, Best Start closed its doors, unable to keep up with escalating costs. TRICARE, a major military insurer and Best Start’s biggest contractor, wouldn’t pay for licensed midwives — only nurses, who can make much more money in a hospital. In a community where the Navy is a major employer, it was a debilitating blow to the birth center. The photos Roslie meticulously framed over the years will most likely have to be destroyed to avoid any medical privacy violations — evidence of more than 5,600 births shredded.\u003c/p>\n\u003cp>“It feels like I’m mourning a death,” Roslie said, gazing at the pictures.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Best Start was the first licensed and accredited birth center in California, and even those credentials couldn’t save it. In fact, they may have hindered the birth center’s survival, requiring expensive renovations that many midwives say aren’t relevant to the care they provide or the safety of their practice. Its closure was one of at least 19 birth center shutdowns and service reductions in the past four years, according to the California chapter of the American Association of Birth Centers.\u003c/p>\n\u003cp>Those closures deepen a crisis of declining women’s health services across California. \u003ca href=\"https://calmatters.org/series/no-deliveries-maternity-care/\">More than 50 California hospital labor and delivery wards have closed\u003c/a> in the past decade, creating maternity care deserts in rural communities and overburdening the remaining labor wards in cities and suburbs.\u003c/p>\n\u003cp>Health experts have pointed to birth centers as a way to expand capacity in communities where hospitals no longer deliver babies. The midwife-run clinics handle low-risk births and direct higher-risk pregnancies to hospitals.\u003c/p>\n\u003cfigure id=\"attachment_12001858\" class=\"wp-caption alignright\" style=\"max-width: 280px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\" wp-image-12001858\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01-800x1000.jpg\" alt=\"Two women wearing. One sitting, one standing. \" width=\"280\" height=\"350\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01-800x1000.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01-1020x1275.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01-160x200.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01-1229x1536.jpg 1229w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/02_032024_Best-Start-Birthing_AD_CM_01.jpg 1600w\" sizes=\"auto, (max-width: 280px) 100vw, 280px\">\u003cfigcaption class=\"wp-caption-text\">Left to right, Founder Roberta Frank and Executive Director Karen Rosalie at the Best Start Birthing Center in San Diego on March 20, 2024. \u003ccite>(Ariana Drehsler/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>However, California has some of the toughest licensing requirements in the country, according to the American Association of Birth Centers, and facilities such as Best Start have long argued that California’s onerous regulations and an uncooperative Public Health Department prevent them from succeeding.\u003c/p>\n\u003cp>Only six operating birth centers are licensed in California. Another 26 are unlicensed. Licensure isn’t required, but it helps enable a practice to work with insurance plans and serve lower-income families who can’t pay birthing costs out of pocket.\u003c/p>\n\u003cp>Increasingly, only wealthy families who pay cash can afford a midwife.\u003c/p>\n\u003cp>“The system is just a mess. It’s flawed. It’s set up to prevent providers that can provide really good care from even getting started,” Frank, the founder of Best Start, said.\u003c/p>\n\u003cp>While most California births happen in hospitals, birth centers serve a small but growing number of families. Planned out-of-hospital births attended by midwives have doubled over the past decade even as birth rates overall declined, according to \u003ca href=\"https://www.mbc.ca.gov/Resources/Publications/Licensed-Midwife-Annual-Report.aspx\">data from the Medical Board of California\u003c/a>. And a statewide survey conducted in 2018 by the California Health Care Foundation indicated that more than one-third of pregnant people would be\u003ca href=\"https://www.chcf.org/wp-content/uploads/2018/09/ListeningMothersCAFullSurveyReport2018.pdf\"> interested in having a midwife for a future birth (PDF)\u003c/a>.\u003c/p>\n\u003cp>Frequently, those who seek the services of midwives and birth centers cite the desire for more personalized care or poor experiences with previous hospital births. Studies show that for low-risk pregnancies, \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK555483/\">midwife-led deliveries at birth centers\u003c/a> are safe and lead to fewer interventions such as cesarean sections.\u003c/p>\n\u003cp>“Women deserve this,” Frank said. “Every human deserves to find their own strength, find their place, exercise their initiative, and I wanted to share it.”\u003c/p>\n\u003cp>But even as demand for out-of-hospital births increases, birth centers across the state are shutting their doors, unable to withstand the joint battering ram of financial and regulatory challenges.\u003c/p>\n\u003cp>Last year, the \u003ca href=\"https://www.pressdemocrat.com/article/news/if-you-dont-want-to-give-birth-in-a-hospital-your-options-are-few-in-sono/\">Santa Rosa Birth Center stopped delivering babies\u003c/a>, reducing options in a Wine Country community that recently lost a hospital maternity ward and another birth center.\u003c/p>\n\u003cp>A \u003ca href=\"https://calmatters.org/health/2024/02/midwife-medi-cal/\">Sacramento midwife closed her birth center\u003c/a> in February and left the country because she said California’s health system was too unfriendly to make ends meet. Another Sacramento birth center is also on the verge of closure because it cannot get a state license.\u003c/p>\n\u003cfigure id=\"attachment_12001860\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-12001860\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic-800x450.jpg\" alt=\"Collage of two images: On the left a pregnant belly being measured and on the right a woman with a face mask.\" width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic-1536x864.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/sidebyside_graphic.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Midwife Madeleine Wisner measures and checks Chloé Mick’s belly during a maternity care consultation at Mick’s home in Sacramento on Feb. 6, 2024. \u003ccite>(Miguel Gutierrez Jr./CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In September, Monterey Birth and Wellness Center will close, citing high costs and poor insurance reimbursement.\u003c/p>\n\u003cp>The California Public Health Department refused multiple requests for an interview about licensing, responding only to emailed questions. Licensing requires facilities to meet “minimum standards” for patient care, which include regulations about proper equipment and staff competency, the department said in an unsigned statement.\u003c/p>\n\u003cp>“We cannot speculate or comment on any reason why providers chose to close these facilities, aren’t seeking licensure for new (birth centers), or what could be done to improve the process,” the department statement said.\u003c/p>\n\u003ch3>Years-long wait for a health department license\u003c/h3>\n\u003cp>Nancy Myrick, a co-founder of the San Francisco Birth Center, said it took four-and-a-half years of back-and-forth with the state health department to obtain a license. In one instance, Myrick said, she asked for a list of items an inspector would check and the health department referred her to regulations that had not yet been written.\u003c/p>\n\u003cp>“In the process of opening, the state bureaucracy was like the Great Wall of China. It was such a horrible barrier,” Myrick said.\u003c/p>\n\u003cp>It wasn’t until Myrick called her state assemblymember’s office to complain about the inability to get licensed and see Medi-Cal patients that the application was approved, she said. The birth center was licensed in 2020.\u003c/p>\n\u003cp>“It literally took calling in the political dogs to get it done,” Myrick said.\u003c/p>\n\u003cp>Many providers noticed that getting a license became much more difficult after the state centralized the process under the public health department in 2018. Since then, nearly all birth center applications —11 out of 13 — have been rejected, according to department-provided data.\u003c/p>\n\u003cp>The department said in a statement the change was necessary to improve “standardization and consistency” in licensing multiple kinds of facilities. Previously, the department’s 14 regional offices processed applications and approved 11 out of 12 applications.\u003c/p>\n\u003cp>Yet midwives and advocates say obstacles continue to plague the process. It’s slow, often taking years; it’s expensive, costing tens of thousands of dollars to retrofit buildings and maintain a license; and the standards are frequently at odds with midwives’ scope of practice. What results is a “de facto ban” on birth center licensure in California, said Sandra Poole, a lobbyist with the Western Center on Law and Poverty.\u003c/p>\n\u003cp>Without licensing reform, more birth centers will close, said Bethany Sasaki, president of the state chapter of the American Association of Birth Centers.\u003c/p>\n\u003cfigure id=\"attachment_12001867\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12001867\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18.jpg\" alt=\"Pregnant woman sits in a room with a monitor, clock and greyish walls.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/05_032024_Best-Start-Birthing_AD_CM_18-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Sally K., right, 38-weeks pregnant, talks to midwife Andrea Bergleen, left, during a check-up at the Best Start Birthing Center in San Diego on March 20, 2024. \u003ccite>(Ariana Drehsler/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>A key problem, Sasaki said, is that birth centers are expected to comply with \u003ca href=\"https://hcai.ca.gov/wp-content/uploads/2023/10/2022_1226.6-Primary-Care-Clinic_Checklist_102023.pdf\">building standards designed for hospitals (PDF)\u003c/a>. For example, the standards include negative pressure rooms for infection control and cast iron plumbing for water supply and drainage.\u003c/p>\n\u003cp>Many midwives argue the standards don’t make sense because their patients are legally required to be healthy with low-risk pregnancies. Any condition that would require the additional medical intervention the standards are meant to accommodate, such as surgery, would force the patient to be transferred to a doctor or hospital, Sasaki said.\u003c/p>\n\u003cp>“There’s no reason to hold a birth center to the same standards as a hospital because it’s not a hospital, and that’s the whole point, Sasaki said.\u003c/p>\n\u003cp>According to the state Department of Health Care Access and Information, which sets building codes for health facilities, it would take legislative changes to make exceptions for birth centers. Poole and a number of groups representing midwives and Black maternal health advocates tried to introduce a bill earlier this year that would ease licensing requirements but could not find a legislator to carry it.\u003c/p>\n\u003cp>The state denied Sasaki’s licensure application for Midtown Nurse Midwives in Sacramento in 2020. The holdup is the building’s ventilation system, which doesn’t meet hospital building code.\u003c/p>\n\u003cp>In March, Sasaki requested an appeal and emergency license after TRICARE, the same insurer that Best Start relied on, stopped contracting with unlicensed facilities. As of mid-July, she has not received a response from the state, though the department told CalMatters the appeal deadline for Sasaki’s application had passed.\u003c/p>\n\u003cp>Without the TRICARE contract, which made up about 30% of her clients, Sasaki said the birth center will close by November.\u003c/p>\n\u003cp>“We’ve had to turn away so many people that we stopped answering our phone because I don’t want to listen to another person cry,” Sasaki said.\u003c/p>\n\u003ch3>Birth centers must get licensed for Medi-Cal\u003c/h3>\n\u003cp>Why is licensure such a stumbling block for birth centers? Medi-Cal, the state’s public insurance program for low-income families, pays for half of all births in the state, requiring birth centers to be licensed.\u003c/p>\n\u003cp>“The single biggest thing that will help with sustainability is if birth centers can take Medi-Cal and if Medi-Cal can actually reimburse appropriately,” Sasaki said.\u003c/p>\n\u003cp>The majority of Medi-Cal births — more than 80% — are babies of color. A statewide survey also indicates that people of color, particularly Black women, \u003ca href=\"https://www.chcf.org/wp-content/uploads/2018/09/ListeningMothersCAFullSurveyReport2018.pdf\">want alternative birth support, such as midwives and doulas, more than any other demographic group (PDF)\u003c/a>. White women and those with private insurance were the highest users of midwives, the survey shows. While those who wanted a midwife but didn’t use one most commonly cited lack of insurance coverage as a barrier.\u003c/p>\n\u003cfigure id=\"attachment_12001870\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-12001870 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489.jpg\" alt=\"Image collage with two rooms, one with a small blue pool and one with a white bathtub.\" width=\"1920\" height=\"646\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489-800x269.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489-1020x343.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489-160x54.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/2-e1724696255489-1536x517.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Birthing rooms at the Best Start Birthing Center in San Diego on March 20, 2024. \u003ccite>(Ariana Drehsler/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Caroline Cusenza, a midwife and owner of the Monterey Birth and Wellness Center, said taking insurance allowed her to serve a more diverse population in the working-class Latino enclave where the birth center is located. She wanted to take Medi-Cal patients but couldn’t. Cusenza applied for licensure twice but was also rejected because the building didn’t meet ventilation standards.\u003c/p>\n\u003cp>The birth center will close in September after seven years.\u003c/p>\n\u003cp>“It was a hard decision to walk away, but we really just could see no path forward,” Cusenza said.\u003c/p>\n\u003cp>The Western Center for Law and Poverty has pointed to accreditation as a possible alternative to licensure. The Commission for the Accreditation of Birth Centers is the national organization that sets standards for birth center quality and safety. California regulators have used accreditation to help license \u003ca href=\"https://www.cdph.ca.gov/Programs/OSPHLD/LFS/CDPH%20Document%20Library/ACLL--16-01.pdf\">other kinds of health facilities (PDF)\u003c/a>, but health department officials see no need to provide birth centers with alternate options. They argue, in an email to CalMatters, that very few have tried to get a license in the first place. Only 23 birth centers have applied in the past decade.\u003c/p>\n\u003cp>Holly Smith, a certified nurse midwife and co-lead of Midwifery Access California, contends the low number of applicants reflects the difficulty of the process. Midwives know licensure is nearly impossible, so they don’t bother applying, Smith said.\u003c/p>\n\u003cp>“If (the Public Health Department) can be much more involved in figuring out solutions to help birth centers exist and be licensed should they want to be, then we would see a greater proliferation of it,” Smith said.\u003c/p>\n\u003cp>Midwifery Access California is working with another state agency to improve access for low-income patients, Smith said. The advocates hope to convince the Department of Health Care Services to increase Medi-Cal payments to midwives. Right now, a licensed birth center gets about $1,300 per birth, while the midwife gets $400.\u003c/p>\n\u003cp>At those rates, some birth centers say even Medi-Cal wouldn’t be enough to save them.\u003c/p>\n\u003cp>“If our birth center were to accept Medi-Cal, we would go bankrupt,” said Trisha Wimbs, owner of the California Birth Center in Rocklin.\u003c/p>\n\u003cp>Wimbs’ facility was one of only three birth centers to get licensed since the public health department took over and tightened building codes. It was licensed in 2023. Wimbs said it cost $1 million to build the “hospital grade facility” to code, including $80,000 to move a fire hydrant two feet closer to the building. The birth center does not take Medi-Cal because it pays too little to recoup expenses. Instead, the birth center caters to cash pay and commercially insured clients in the affluent suburb of Sacramento. Licensure was essential to securing commercial insurance contracts, Wimbs said.\u003c/p>\n\u003cp>To sustain birth centers, Medi-Cal needs to pay around $8,000 per birth, Smith said. At that price point, delivering at a birth center would cost \u003ca href=\"https://healthcostinstitute.org/hcci-originals-dropdown/all-hcci-reports/the-price-of-childbirth-in-the-u-s-tops-13-000-in-2020\">less than half as much as a hospital delivery\u003c/a>.\u003c/p>\n\u003ch3>Saying goodbye to Best Start\u003c/h3>\n\u003cp>Eighteen years ago, Ellary Alonso was born at Best Start Birth Center when her mom, a former labor and delivery nurse, sought a more personalized birth experience. Alonso, who was 21 weeks along in March, wanted to deliver her son in the same place, surrounded by midwives she knew, maybe even in a bath. She wanted the emotional support of the team, she said, because her husband is a Marine, and there’s no guarantee he’ll be able to make it to the birth.\u003c/p>\n\u003cp>But a week before her first prenatal appointment at Best Start, Alonso got a call that the center was closing permanently. No other birth centers in Southern California take her insurance.\u003c/p>\n\u003cp>“In this time when everything is about choice, you can choose not to have a baby, but you can’t choose how to have your baby,” Alonso said. “Hospitals are the only option.”\u003c/p>\n\u003cfigure id=\"attachment_12001873\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12001873\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26.jpg\" alt=\"Two women, one sitting and one standing pose for the camera.\" width=\"2000\" height=\"1334\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26-800x534.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26-1536x1025.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/032024_Best-Start-Birthing_AD_CM_26-1920x1281.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Ellary Alonso, right, 18 years old and 21-weeks pregnant, with her mom Hannah Fraley, left, at the Best Start Birthing Center in San Diego on March 20, 2024. Fraley had two of her kids at the center. \u003ccite>(Ariana Drehsler/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Compared to a hospital room, Best Start offers a homey atmosphere and promises that the midwife attending each birth will be familiar to the laboring client. The birthing rooms come with queen-sized beds, floral duvets, and white porcelain tubs for water births. A marble-topped “crash cart” sits in each room. With the doors closed, the cart looks just like an end table that matches the decor. Inside, it’s filled with medical supplies for emergency resuscitations or to stitch up lacerations. The rooms are homey but bear the hallmarks of a by-the-book clinic. Boxes of nitrile gloves are in each room; hazardous waste bins are mounted discreetly to the wall. Best Start was the only birth center in the state to have a licensed clinical laboratory to confirm water breakage. \u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It has never lost a mother or baby, Roslie said. Its transfer rate for cesarean sections was less than half the statewide target set for low-risk births. In the past five years, no episiotomies have been performed. And 96% of newborns are exclusively breastfed before leaving Best Start compared to the statewide hospital rate of 69%.\u003c/p>\n\u003cp>Despite the center’s recognized success, keeping it running has always been a labor of love, Roslie said.\u003c/p>\n\u003cp>“It’s never been a thriving business,” Roslie said. “Roberta’s gone without pay. I’ve gone with reduced pay. That’s what it takes to run a birth center.”\u003c/p>\n\u003cp>When Roberta Frank, Roslie’s mother, graduated from UC San Diego with her nursing midwifery degree in 1981, she was told, “San Diego will never accept midwives.”\u003c/p>\n\u003cp>Sometimes — in the face of Best Start’s closure — it still feels that way.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "valley-fever-rises-after-california-music-festival-experts-warn-of-climate-change-link",
"title": "Valley Fever Rises After California Music Festival, Experts Warn of Climate Change Link",
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"headTitle": "Valley Fever Rises After California Music Festival, Experts Warn of Climate Change Link | KQED",
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"content": "\u003cp>Attendees at this month’s foggy, mild Outside Lands might find it hard to believe that climate change could be affecting concerts, but an early summer music festival in Bakersfield resulted in a handful of cases of an illness that experts believe is spreading more due to the state’s changing weather patterns.\u003c/p>\n\u003cp>Valley fever is a respiratory disease caused by coccidioides or “cocci,” a soil-dwelling fungus found in California and the southwestern U.S. When contaminated soil is disturbed, infectious spores are released into the air and can be inhaled by people and animals. Once inhaled, cocci can infect the lungs, leading to symptoms such as cough, fever, chest pain and fatigue, according to the California Department of Public Health.\u003c/p>\n\u003cp>While valley fever has been present in the western United States for years, its incidence rate is increasing. The number of cases has tripled between 2014 and 2018 and again between 2018 and 2022, according to new research funded by the National Institutes of Health. In the past 20 years, the rate of infection has increased by 800%.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>By June 2024, more than 5,300 people in California have contracted the disease this year, including five who experienced symptoms after attending Bakersfield’s Lightning in a Bottle festival in May. The California Department of Public Health warned that these cases “occurred among people who traveled through Kern County, California, to attend the outdoor music festival.”\u003c/p>\n\u003cp>Climate and health experts believe that changing climate conditions contribute to the increase.\u003c/p>\n\u003cp>“We’ve had really the perfect conditions for the spread of coccidioides,” said Dr. George Thompson, a professor of medicine at UC Davis Medical Center in Sacramento. “The sort of cycle of precipitation and drought we’ve had really has favored the growth of coccidioides in the soil and then spread during and following periods of drought.”\u003c/p>\n\u003cfigure id=\"attachment_12001283\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12001283\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever.png\" alt=\"Two bar charts shoring valley fever rise in California and the Bay Area since 2022.\" width=\"1920\" height=\"1079\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever.png 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever-800x450.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever-1020x573.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever-160x90.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever-1536x863.png 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">State health officials say California is on track to have more valley fever cases this year than ever before – including a notable uptick in the Bay Area – likely resulting in part from climate change. Source: \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CocciinCAProvisionalMonthlyReport.pdf\">California Department of Public Health\u003c/a> \u003ccite>(Chart by Kara Newhouse/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The idea that drought could increase the number of valley fever cases is somewhat counterintuitive since it seems to dampen infection peaks in the short term.\u003c/p>\n\u003cp>However, Alexandra Heaney, an assistant professor of public health at UC San Diego and an author of the recent study, emphasized that her research indicated that drought increases the total number of cases in the long term.\u003c/p>\n\u003cp>“We think that there’s this sort of primary driver, which is wet conditions, followed by dry conditions, [that] leads to an increase in cases,” she said.\u003c/p>\n\u003cp>She and her co-authors hypothesize that wet, rainy periods promote extensive fungus growth, followed by dry spells that allow the fungus to form and release infectious spores into the air. Cocci can also withstand dryer, harsher conditions — allowing it to outlast much of its competition during droughts.\u003c/p>\n\u003cp>Another potential link between drought and valley fever is its impact on rodent populations, which serve as a nutrient source for the fungus. According to a release, Heaney and the team’s research suggests that during droughts, declining rodent populations lead to a “corresponding increase in rodent decomposition” and “may supply the necessary nutrients and moisture for the fungus to survive and spread in drought conditions.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">[aside postID=news_11998703 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/GettyImages-1771553132-1020x682.jpg']\u003c/span>\u003c/p>\n\u003cp>Drought also heightens the risk of wildfires, which can carry and spread infectious spores through smoke.\u003c/p>\n\u003cp>“Fire is going to follow droughts, just like valley fever follows droughts,” Thompson said. He explained that fires can create wind and updrafts that pull soil and particulate matter from the soil up into the air.\u003c/p>\n\u003cp>While the risk of infection remains low for most people, and valley fever is not transmitted from person to person, Heaney said that as climate change continues to alter California’s weather patterns, it could further accelerate the spread of the disease.\u003c/p>\n\u003cp>“Our evidence shows that these severe swings between really wet and really dry conditions tend to actually promote risk for the disease,” Heaney said. “And if this is going to continue to become more common due to climate change, it’s something that might be contributing to the increases we’ve seen and may actually promote increases in the future as well.”\u003c/p>\n\u003cp>\u003cem>KQED’s \u003c/em>\u003ca href=\"https://www.kqed.org/author/rcooke\">\u003cem>Riley Cooke\u003c/em>\u003c/a>\u003cem> contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Attendees at this month’s foggy, mild Outside Lands might find it hard to believe that climate change could be affecting concerts, but an early summer music festival in Bakersfield resulted in a handful of cases of an illness that experts believe is spreading more due to the state’s changing weather patterns.\u003c/p>\n\u003cp>Valley fever is a respiratory disease caused by coccidioides or “cocci,” a soil-dwelling fungus found in California and the southwestern U.S. When contaminated soil is disturbed, infectious spores are released into the air and can be inhaled by people and animals. Once inhaled, cocci can infect the lungs, leading to symptoms such as cough, fever, chest pain and fatigue, according to the California Department of Public Health.\u003c/p>\n\u003cp>While valley fever has been present in the western United States for years, its incidence rate is increasing. The number of cases has tripled between 2014 and 2018 and again between 2018 and 2022, according to new research funded by the National Institutes of Health. In the past 20 years, the rate of infection has increased by 800%.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>By June 2024, more than 5,300 people in California have contracted the disease this year, including five who experienced symptoms after attending Bakersfield’s Lightning in a Bottle festival in May. The California Department of Public Health warned that these cases “occurred among people who traveled through Kern County, California, to attend the outdoor music festival.”\u003c/p>\n\u003cp>Climate and health experts believe that changing climate conditions contribute to the increase.\u003c/p>\n\u003cp>“We’ve had really the perfect conditions for the spread of coccidioides,” said Dr. George Thompson, a professor of medicine at UC Davis Medical Center in Sacramento. “The sort of cycle of precipitation and drought we’ve had really has favored the growth of coccidioides in the soil and then spread during and following periods of drought.”\u003c/p>\n\u003cfigure id=\"attachment_12001283\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-12001283\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever.png\" alt=\"Two bar charts shoring valley fever rise in California and the Bay Area since 2022.\" width=\"1920\" height=\"1079\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever.png 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever-800x450.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever-1020x573.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever-160x90.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/08/Valley-fever-1536x863.png 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">State health officials say California is on track to have more valley fever cases this year than ever before – including a notable uptick in the Bay Area – likely resulting in part from climate change. Source: \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CocciinCAProvisionalMonthlyReport.pdf\">California Department of Public Health\u003c/a> \u003ccite>(Chart by Kara Newhouse/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The idea that drought could increase the number of valley fever cases is somewhat counterintuitive since it seems to dampen infection peaks in the short term.\u003c/p>\n\u003cp>However, Alexandra Heaney, an assistant professor of public health at UC San Diego and an author of the recent study, emphasized that her research indicated that drought increases the total number of cases in the long term.\u003c/p>\n\u003cp>“We think that there’s this sort of primary driver, which is wet conditions, followed by dry conditions, [that] leads to an increase in cases,” she said.\u003c/p>\n\u003cp>She and her co-authors hypothesize that wet, rainy periods promote extensive fungus growth, followed by dry spells that allow the fungus to form and release infectious spores into the air. Cocci can also withstand dryer, harsher conditions — allowing it to outlast much of its competition during droughts.\u003c/p>\n\u003cp>Another potential link between drought and valley fever is its impact on rodent populations, which serve as a nutrient source for the fungus. According to a release, Heaney and the team’s research suggests that during droughts, declining rodent populations lead to a “corresponding increase in rodent decomposition” and “may supply the necessary nutrients and moisture for the fungus to survive and spread in drought conditions.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400;\">\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/span>\u003c/p>\n\u003cp>Drought also heightens the risk of wildfires, which can carry and spread infectious spores through smoke.\u003c/p>\n\u003cp>“Fire is going to follow droughts, just like valley fever follows droughts,” Thompson said. He explained that fires can create wind and updrafts that pull soil and particulate matter from the soil up into the air.\u003c/p>\n\u003cp>While the risk of infection remains low for most people, and valley fever is not transmitted from person to person, Heaney said that as climate change continues to alter California’s weather patterns, it could further accelerate the spread of the disease.\u003c/p>\n\u003cp>“Our evidence shows that these severe swings between really wet and really dry conditions tend to actually promote risk for the disease,” Heaney said. “And if this is going to continue to become more common due to climate change, it’s something that might be contributing to the increases we’ve seen and may actually promote increases in the future as well.”\u003c/p>\n\u003cp>\u003cem>KQED’s \u003c/em>\u003ca href=\"https://www.kqed.org/author/rcooke\">\u003cem>Riley Cooke\u003c/em>\u003c/a>\u003cem> contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"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. ",
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"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. ",
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"marketplace": {
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"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",
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"masters-of-scale": {
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},
"mindshift": {
"id": "mindshift",
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"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>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
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"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"order": 11
},
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"on-the-media": {
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"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"link": "/radio/program/on-the-media",
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},
"pbs-newshour": {
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"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
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},
"perspectives": {
"id": "perspectives",
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"order": 14
},
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"planet-money": {
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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},
"link": "/radio/program/planet-money",
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"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
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},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
},
"link": "/podcasts/politicalbreakdown",
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"amazon": "https://music.amazon.com/podcasts/e0c2d153-ad36-4c8d-901d-f1da6a724824/political-breakdown",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
"meta": {
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"source": "Possible"
},
"link": "/radio/program/possible",
"subscribe": {
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
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