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"content": "\u003cp>PALM SPRINGS, Calif. — Rebecca Soltes walked into a gaily decorated hospital meeting room, pushing her kids in a double stroller and carrying a soft-sided cooler filled with bags of frozen breast milk — 100 ounces of the stuff.\u003c/p>\n\u003cp>She dropped it on a table, and the roomful of lactation consultants and maternal health advocates from California’s Inland Empire erupted in applause.\u003c/p>\n\u003cp>She was donating the milk because she didn’t need it anymore. Her son, a young toddler, had recently graduated to solid food, but her freezer at home was still packed with pumped milk.\u003c/p>\n\u003cp>“I didn’t know what to do with it,” a harried-looking Soltes told two young staffers from the \u003ca href=\"http://www.mothersmilk.org\">Mothers’ Milk Bank\u003c/a>, a nonprofit group in San Jose, Calif., that provides breast milk for fragile infants in neonatal intensive care units (NICUs).\u003c/p>\n\u003cp>Increasing numbers of women who produce more breast milk than they need are handing it over — or selling it — for others to use. It’s a boon to fragile infants and mothers who can’t produce enough milk, but it also poses challenging ethical and public health questions.\u003c/p>\n\u003cdiv class=\"side-by-side\">\n\u003cdiv class=\"alignleft wp-caption\">\n\t\t\t\t\t\t\t\t\t\u003cimg width=\"770\" height=\"513\" src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-9_770.jpg?w=770&h=513&crop=1\" class=\"attachment-khn-article-large size-khn-article-large\" alt=\"\">\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\u003cp class=\"wp-caption-text\">A breast milk fair, where the milk is collected for fragile infants in neonatal intensive care units, was held in Palm Springs, Calif., in August 2016. (Heidi de Marco/California KHN)\u003c/p>\n\u003c/div>\n\u003cdiv class=\"alignright wp-caption\">\n\t\t\t\t\t\t\t\t\t\u003cimg width=\"770\" height=\"513\" src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-8_770.jpg?w=770&h=513&crop=1\" class=\"attachment-khn-article-large size-khn-article-large\" alt=\"\">\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\u003cp class=\"wp-caption-text\">Christina Beltran, who recently had a baby, signs up to receive more information at the Palm Springs breast milk donation fair. (Heidi de Marco/KHN)\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Physicians, regulators and others ask: Should sickly, premature babies get access to this milk before healthy ones? Should women be paid for their milk — even if it might lead some to deprive their own infants? Should greater safeguards be required to ensure the safety of the supply?\u003c/p>\n\u003cp>The \u003ca href=\"https://www.fda.gov/scienceresearch/specialtopics/pediatrictherapeuticsresearch/ucm235203.htm\">Food and Drug Administration\u003c/a> does not require testing for donated human milk. A handful of states, including California and New York, regulate milk banks the way they do tissue banks, enforcing some safety standards, and many nonprofit milk banks screen donors.\u003c/p>\n\u003cp>But the FDA has expressed concern about milk-trading websites, \u003ca href=\"http://www.aappublications.org/content/32/2/6.1\">warning consumers\u003c/a> that the milk offered there carries an increased risk of contamination by drugs or disease, including HIV. The agency further urges mothers not to feed their infants donated milk acquired from other individuals or over the internet, also because of such safety risks.\u003c/p>\n\u003cp>Some companies and medical experts wonder if even established milk banks — whose voluntary screening practices the FDA praised in 2010 — should be doing more to ensure safety. Dr. Jae Hong Kim, a neonatologist at UC-San Diego, said milk banks’ safety efforts have worked well thus far but are not error-free. “The challenge is, if you expand the operations, you increase your risk exposure,” he said.\u003c/p>\n\u003cp>Scott Elster, CEO of Prolacta Bioscience, a company that uses human milk to make fortifier products in its pharmaceutical-grade manufacturing facility, said he advocates a more rigorous level of screening.\u003c/p>\n\u003cp>“We believe that all human milk, whether it is distributed commercially, by a nonprofit or peer-to-peer network, should be tested for drugs of abuse, nicotine and other adulterants,” he said.\u003c/p>\n\u003cp>Milk Magic\u003c/p>\n\u003cp>As recently as the early 1970s, barely a fifth of American babies were breast-fed. Today, \u003ca href=\"https://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf\">more than 80%\u003c/a> get at least a taste of their mother’s milk, according to the federal Centers for Disease Control and Prevention. The health advantages are well-established, especially for premature infants.\u003c/p>\n\u003cp>“The first class I had on human milk I was blown away,” said Maryanne Perrin, a nutrition scientist at the University of North Carolina-Greensboro. “It’s Harry Potter meets Willy Wonka. It’s a magical food.”\u003c/p>\n\u003cp> The Food and Drug Administration does not require testing for donated human milk. A handful of states, including California and New York, regulate milk banks as they do tissue banks. (Heidi de Marco/KHN)\u003c/p>\n\u003cp>Some breast-feeding enthusiasts refer to human milk as “liquid gold.” At times, it seems as though everyone wants the stuff — from nonprofits like Mothers’ Milk Bank, to high-tech pharmaceutical companies that concentrate it into premium medical products, to your neighbor who might just want a bit more to supplement her baby’s diet.\u003c/p>\n\u003cp>Each year, new human milk banks open and new milk-focused companies are launched.\u003c/p>\n\u003cp>No one knows exactly how much of this excess milk is donated or sold, but the volume is increasing. Pauline Sakamoto, executive director of the Mothers’ Milk Bank and former president of the \u003ca href=\"https://www.hmbana.org\">Human Milk Banking Association of North America\u003c/a>, an association of nonprofit milk banks in the U.S. and Canada, said her organization’s affiliated banks distributed about 4.4 million ounces of human milk to hospitals last year, up from less than half that amount as recently as five years ago. When Sakamoto became president of the organization in 2014, it had 18 milk banks. Now it has more than 30 open or planned.\u003c/p>\n\u003cp>To Profit Or Not To Profit?\u003c/p>\n\u003cp>The Mothers’ Milk Bank workers from San Jose traveled nearly 450 miles last year for donation drives in the southern part of the state, including the one at the Desert Regional Medical Center in Palm Springs where they applauded Soltes. The bank collects and pasteurizes donated human milk and provides it at cost to NICUs throughout California.\u003c/p>\n\u003cp>Over the week, workers planned to conduct risk screenings, including blood testing for HIV and other diseases, on mothers like Soltes. They also planned to ask the women’s doctors — and their babies’ doctors — to approve the donations. The team expected to collect 7,542 ounces of pumped breast milk — enough to provide more than 30,000 feedings for premature infants in NICUs.\u003c/p>\n\u003cp>“Right now, we have a consistent flow of milk coming in,” said Leah Carig, donor coordinator at the San Jose-based bank. “In the past, we’ve had to put out [e-mail] blasts” to increase supply.\u003c/p>\n\u003cfigure class=\"layout-lg carousel-article carousel slide carousel-article-1\">\n\u003col class=\"carousel-indicators\">\n\u003cli class=\"active\">\n\u003cli>\n\u003cli>\n\u003c/ol>\n\u003cdiv class=\"carousel-inner\">\n\u003cdiv class=\"item active\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-5_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Prolacta Bioscience purchases breast milk from women for $1 per ounce, tests it rigorously and uses it to make fortifiers that are added to a mother’s or donor’s milk to deliver extra calories, proteins and minerals to premature babies. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-4_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">“We believe that all human milk, whether it is distributed commercially, by a nonprofit or peer-to-peer network, should be tested for drugs of abuse, nicotine and other adulterants,” says Prolacta CEO Scott Elster. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-6_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Prolacta’s products win praise from NICU physicians because they can replace fortifiers made of cow’s milk, which are known to increase the risk of necrotizing enterocolitis and sepsis. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003c/div>\n\u003cp>\u003ca class=\"left carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-prev\">\u003c/span>\u003c/a>\u003ca class=\"right carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-next\">\u003c/span>\u003c/a>\u003c/p>\u003c/figure>\n\u003cp>For-profit breast milk operations are expanding, too. Elster’s company, \u003ca href=\"http://www.prolacta.com\">Prolacta Bioscience\u003c/a>, stocks warehouse-like freezers full of human milk.\u003c/p>\n\u003cp>Based in City of Industry, Calif., it purchases the milk from women for $1 per ounce. The company uses it to make fortifiers that are added to a mother’s or donor’s milk to deliver extra calories, proteins and minerals to premature babies.\u003c/p>\n\u003cp>The products are expensive, at $200 to $300 for a one-day supply. But they win praise from NICU physicians like Kim, because they can replace fortifiers made of cow’s milk, which are known to increase the risk of necrotizing enterocolitis and sepsis.\u003c/p>\n\u003cp>Beyond the NICU and the gates of industry, informal internet-based sites, with names like \u003ca href=\"http://www.onlythebreast.com\">Only the Breast\u003c/a> and \u003ca href=\"http://www.eatsonfeets.org\">Eats on Feets\u003c/a>, also \u003ca href=\"http://online.liebertpub.com/doi/abs/10.1089/bfm.2013.0114\">appear to be booming\u003c/a>. One \u003ca href=\"http://www.theverge.com/2015/4/28/8504443/mothers-buying-breast-milk-online-donors-risks\">report\u003c/a> estimated that the number of online milk transactions in the U.S. soared from 22,000 in 2012 to 55,000 in 2015.\u003c/p>\n\u003cp>Some milk-sharing networks are run by mothers who sell their milk, while others give it away.\u003c/p>\n\u003cp>Mandy Lindberg, a board member of the \u003ca href=\"http://www.iebreastfeeding.org/about3\">Inland Empire Breastfeeding Coalition\u003c/a>, has experience with both formal and informal donation networks. She said that women often opt to donate among themselves because they want to help friends or neighbors who don’t have enough milk for their babies.\u003c/p>\n\u003cp>“It’s nice to put a face with the name,” Lindberg said.\u003c/p>\n\u003cp>Research shows there’s some risk with milk that changes hands on informal sites, however. In 2015, a team of researchers who purchased breast milk on the open market \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/03/31/peds.2014-3554\">reported\u003c/a> in the journal Pediatrics that about 10 percent of samples contained cow’s milk, which could have been added by the sellers to increase volume and thus the size of the payment. The same team had reported in 2013 that milk purchased online was \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/10/16/peds.2013-1687.full.pdf+html\">frequently contaminated\u003c/a> by pathogenic bacteria.\u003c/p>\n\u003cp>Kim Updegrove, executive director of the nonprofit \u003ca href=\"https://www.milkbank.org\">Mothers’ Milk Bank at Austin\u003c/a>, in Texas, says the FDA should regulate informal milk-sharing, ideally requiring all milk to go through a milk bank focused on distributing it according to the greatest medical need. This, she believes, would help make the practice safer and ensure that the sickest babies were given priority.\u003c/p>\n\u003cp>Updegrove and others fear that if financial gain were to become the dominant factor in distribution of human milk, supplies could be siphoned away from the sickest NICU babies. Poor mothers might sell their milk instead of giving it to their own children, these critics said.\u003c/p>\n\u003cp>Women involved in sharing networks don’t always understand the mission and practices of nonprofit milk banks, Perrin reported with colleagues in a \u003ca href=\"http://jhl.sagepub.com/content/32/2/229.short\">2016 paper\u003c/a> that appeared in the Journal of Human Lactation. Better education might encourage more to donate for NICU use, she suggested.\u003c/p>\n\u003cp>She said that when she started her research, she thought of human milk as a “scarce resource.” “But I’ve talked to women who have shared 9,600 ounces of milk. Some have freezers full,” she said. “I think it’s a distribution problem, and not a supply problem.”\u003c/p>\n\u003cp>The entire concept of breast milk banking — of any type — was new to Soltes. The La Quinta, Calif., mother said that when other members of her breast-feeding group had more milk than they could use, they didn’t know what to do with it. She learned about the milk drive by doing a Google search online.\u003c/p>\n\u003cp>“I just happened to find this event,” she said. “I thought, wow — I’d rather do this than throw it all out.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>PALM SPRINGS, Calif. — Rebecca Soltes walked into a gaily decorated hospital meeting room, pushing her kids in a double stroller and carrying a soft-sided cooler filled with bags of frozen breast milk — 100 ounces of the stuff.\u003c/p>\n\u003cp>She dropped it on a table, and the roomful of lactation consultants and maternal health advocates from California’s Inland Empire erupted in applause.\u003c/p>\n\u003cp>She was donating the milk because she didn’t need it anymore. Her son, a young toddler, had recently graduated to solid food, but her freezer at home was still packed with pumped milk.\u003c/p>\n\u003cp>“I didn’t know what to do with it,” a harried-looking Soltes told two young staffers from the \u003ca href=\"http://www.mothersmilk.org\">Mothers’ Milk Bank\u003c/a>, a nonprofit group in San Jose, Calif., that provides breast milk for fragile infants in neonatal intensive care units (NICUs).\u003c/p>\n\u003cp>Increasing numbers of women who produce more breast milk than they need are handing it over — or selling it — for others to use. It’s a boon to fragile infants and mothers who can’t produce enough milk, but it also poses challenging ethical and public health questions.\u003c/p>\n\u003cdiv class=\"side-by-side\">\n\u003cdiv class=\"alignleft wp-caption\">\n\t\t\t\t\t\t\t\t\t\u003cimg width=\"770\" height=\"513\" src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-9_770.jpg?w=770&h=513&crop=1\" class=\"attachment-khn-article-large size-khn-article-large\" alt=\"\">\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\u003cp class=\"wp-caption-text\">A breast milk fair, where the milk is collected for fragile infants in neonatal intensive care units, was held in Palm Springs, Calif., in August 2016. (Heidi de Marco/California KHN)\u003c/p>\n\u003c/div>\n\u003cdiv class=\"alignright wp-caption\">\n\t\t\t\t\t\t\t\t\t\u003cimg width=\"770\" height=\"513\" src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-8_770.jpg?w=770&h=513&crop=1\" class=\"attachment-khn-article-large size-khn-article-large\" alt=\"\">\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\u003cp class=\"wp-caption-text\">Christina Beltran, who recently had a baby, signs up to receive more information at the Palm Springs breast milk donation fair. (Heidi de Marco/KHN)\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Physicians, regulators and others ask: Should sickly, premature babies get access to this milk before healthy ones? Should women be paid for their milk — even if it might lead some to deprive their own infants? Should greater safeguards be required to ensure the safety of the supply?\u003c/p>\n\u003cp>The \u003ca href=\"https://www.fda.gov/scienceresearch/specialtopics/pediatrictherapeuticsresearch/ucm235203.htm\">Food and Drug Administration\u003c/a> does not require testing for donated human milk. A handful of states, including California and New York, regulate milk banks the way they do tissue banks, enforcing some safety standards, and many nonprofit milk banks screen donors.\u003c/p>\n\u003cp>But the FDA has expressed concern about milk-trading websites, \u003ca href=\"http://www.aappublications.org/content/32/2/6.1\">warning consumers\u003c/a> that the milk offered there carries an increased risk of contamination by drugs or disease, including HIV. The agency further urges mothers not to feed their infants donated milk acquired from other individuals or over the internet, also because of such safety risks.\u003c/p>\n\u003cp>Some companies and medical experts wonder if even established milk banks — whose voluntary screening practices the FDA praised in 2010 — should be doing more to ensure safety. Dr. Jae Hong Kim, a neonatologist at UC-San Diego, said milk banks’ safety efforts have worked well thus far but are not error-free. “The challenge is, if you expand the operations, you increase your risk exposure,” he said.\u003c/p>\n\u003cp>Scott Elster, CEO of Prolacta Bioscience, a company that uses human milk to make fortifier products in its pharmaceutical-grade manufacturing facility, said he advocates a more rigorous level of screening.\u003c/p>\n\u003cp>“We believe that all human milk, whether it is distributed commercially, by a nonprofit or peer-to-peer network, should be tested for drugs of abuse, nicotine and other adulterants,” he said.\u003c/p>\n\u003cp>Milk Magic\u003c/p>\n\u003cp>As recently as the early 1970s, barely a fifth of American babies were breast-fed. Today, \u003ca href=\"https://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf\">more than 80%\u003c/a> get at least a taste of their mother’s milk, according to the federal Centers for Disease Control and Prevention. The health advantages are well-established, especially for premature infants.\u003c/p>\n\u003cp>“The first class I had on human milk I was blown away,” said Maryanne Perrin, a nutrition scientist at the University of North Carolina-Greensboro. “It’s Harry Potter meets Willy Wonka. It’s a magical food.”\u003c/p>\n\u003cp> The Food and Drug Administration does not require testing for donated human milk. A handful of states, including California and New York, regulate milk banks as they do tissue banks. (Heidi de Marco/KHN)\u003c/p>\n\u003cp>Some breast-feeding enthusiasts refer to human milk as “liquid gold.” At times, it seems as though everyone wants the stuff — from nonprofits like Mothers’ Milk Bank, to high-tech pharmaceutical companies that concentrate it into premium medical products, to your neighbor who might just want a bit more to supplement her baby’s diet.\u003c/p>\n\u003cp>Each year, new human milk banks open and new milk-focused companies are launched.\u003c/p>\n\u003cp>No one knows exactly how much of this excess milk is donated or sold, but the volume is increasing. Pauline Sakamoto, executive director of the Mothers’ Milk Bank and former president of the \u003ca href=\"https://www.hmbana.org\">Human Milk Banking Association of North America\u003c/a>, an association of nonprofit milk banks in the U.S. and Canada, said her organization’s affiliated banks distributed about 4.4 million ounces of human milk to hospitals last year, up from less than half that amount as recently as five years ago. When Sakamoto became president of the organization in 2014, it had 18 milk banks. Now it has more than 30 open or planned.\u003c/p>\n\u003cp>To Profit Or Not To Profit?\u003c/p>\n\u003cp>The Mothers’ Milk Bank workers from San Jose traveled nearly 450 miles last year for donation drives in the southern part of the state, including the one at the Desert Regional Medical Center in Palm Springs where they applauded Soltes. The bank collects and pasteurizes donated human milk and provides it at cost to NICUs throughout California.\u003c/p>\n\u003cp>Over the week, workers planned to conduct risk screenings, including blood testing for HIV and other diseases, on mothers like Soltes. They also planned to ask the women’s doctors — and their babies’ doctors — to approve the donations. The team expected to collect 7,542 ounces of pumped breast milk — enough to provide more than 30,000 feedings for premature infants in NICUs.\u003c/p>\n\u003cp>“Right now, we have a consistent flow of milk coming in,” said Leah Carig, donor coordinator at the San Jose-based bank. “In the past, we’ve had to put out [e-mail] blasts” to increase supply.\u003c/p>\n\u003cfigure class=\"layout-lg carousel-article carousel slide carousel-article-1\">\n\u003col class=\"carousel-indicators\">\n\u003cli class=\"active\">\n\u003cli>\n\u003cli>\n\u003c/ol>\n\u003cdiv class=\"carousel-inner\">\n\u003cdiv class=\"item active\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-5_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Prolacta Bioscience purchases breast milk from women for $1 per ounce, tests it rigorously and uses it to make fortifiers that are added to a mother’s or donor’s milk to deliver extra calories, proteins and minerals to premature babies. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-4_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">“We believe that all human milk, whether it is distributed commercially, by a nonprofit or peer-to-peer network, should be tested for drugs of abuse, nicotine and other adulterants,” says Prolacta CEO Scott Elster. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-6_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Prolacta’s products win praise from NICU physicians because they can replace fortifiers made of cow’s milk, which are known to increase the risk of necrotizing enterocolitis and sepsis. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003c/div>\n\u003cp>\u003ca class=\"left carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-prev\">\u003c/span>\u003c/a>\u003ca class=\"right carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-next\">\u003c/span>\u003c/a>\u003c/p>\u003c/figure>\n\u003cp>For-profit breast milk operations are expanding, too. Elster’s company, \u003ca href=\"http://www.prolacta.com\">Prolacta Bioscience\u003c/a>, stocks warehouse-like freezers full of human milk.\u003c/p>\n\u003cp>Based in City of Industry, Calif., it purchases the milk from women for $1 per ounce. The company uses it to make fortifiers that are added to a mother’s or donor’s milk to deliver extra calories, proteins and minerals to premature babies.\u003c/p>\n\u003cp>The products are expensive, at $200 to $300 for a one-day supply. But they win praise from NICU physicians like Kim, because they can replace fortifiers made of cow’s milk, which are known to increase the risk of necrotizing enterocolitis and sepsis.\u003c/p>\n\u003cp>Beyond the NICU and the gates of industry, informal internet-based sites, with names like \u003ca href=\"http://www.onlythebreast.com\">Only the Breast\u003c/a> and \u003ca href=\"http://www.eatsonfeets.org\">Eats on Feets\u003c/a>, also \u003ca href=\"http://online.liebertpub.com/doi/abs/10.1089/bfm.2013.0114\">appear to be booming\u003c/a>. One \u003ca href=\"http://www.theverge.com/2015/4/28/8504443/mothers-buying-breast-milk-online-donors-risks\">report\u003c/a> estimated that the number of online milk transactions in the U.S. soared from 22,000 in 2012 to 55,000 in 2015.\u003c/p>\n\u003cp>Some milk-sharing networks are run by mothers who sell their milk, while others give it away.\u003c/p>\n\u003cp>Mandy Lindberg, a board member of the \u003ca href=\"http://www.iebreastfeeding.org/about3\">Inland Empire Breastfeeding Coalition\u003c/a>, has experience with both formal and informal donation networks. She said that women often opt to donate among themselves because they want to help friends or neighbors who don’t have enough milk for their babies.\u003c/p>\n\u003cp>“It’s nice to put a face with the name,” Lindberg said.\u003c/p>\n\u003cp>Research shows there’s some risk with milk that changes hands on informal sites, however. In 2015, a team of researchers who purchased breast milk on the open market \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/03/31/peds.2014-3554\">reported\u003c/a> in the journal Pediatrics that about 10 percent of samples contained cow’s milk, which could have been added by the sellers to increase volume and thus the size of the payment. The same team had reported in 2013 that milk purchased online was \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/10/16/peds.2013-1687.full.pdf+html\">frequently contaminated\u003c/a> by pathogenic bacteria.\u003c/p>\n\u003cp>Kim Updegrove, executive director of the nonprofit \u003ca href=\"https://www.milkbank.org\">Mothers’ Milk Bank at Austin\u003c/a>, in Texas, says the FDA should regulate informal milk-sharing, ideally requiring all milk to go through a milk bank focused on distributing it according to the greatest medical need. This, she believes, would help make the practice safer and ensure that the sickest babies were given priority.\u003c/p>\n\u003cp>Updegrove and others fear that if financial gain were to become the dominant factor in distribution of human milk, supplies could be siphoned away from the sickest NICU babies. Poor mothers might sell their milk instead of giving it to their own children, these critics said.\u003c/p>\n\u003cp>Women involved in sharing networks don’t always understand the mission and practices of nonprofit milk banks, Perrin reported with colleagues in a \u003ca href=\"http://jhl.sagepub.com/content/32/2/229.short\">2016 paper\u003c/a> that appeared in the Journal of Human Lactation. Better education might encourage more to donate for NICU use, she suggested.\u003c/p>\n\u003cp>She said that when she started her research, she thought of human milk as a “scarce resource.” “But I’ve talked to women who have shared 9,600 ounces of milk. Some have freezers full,” she said. “I think it’s a distribution problem, and not a supply problem.”\u003c/p>\n\u003cp>The entire concept of breast milk banking — of any type — was new to Soltes. The La Quinta, Calif., mother said that when other members of her breast-feeding group had more milk than they could use, they didn’t know what to do with it. She learned about the milk drive by doing a Google search online.\u003c/p>\n\u003cp>“I just happened to find this event,” she said. “I thought, wow — I’d rather do this than throw it all out.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Safety-Net Medical Center Wrestles With Specter Of ‘Repeal’",
"title": "A Safety-Net Medical Center Wrestles With Specter Of ‘Repeal’",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>SAN MATEO — Little surprises Lynda Sutherland, who has been a licensed vocational nurse for 35 years at San Mateo Medical Center. But in the past few years, Sutherland said, she’s been surprised by what’s missing: the patients who used to return again and again to the public hospital for the same ailments.\u003c/p>\n\u003cp>“They’re just not coming back,” she said.\u003c/p>\n\u003cp>Spurred by the Affordable Care Act (ACA), medical centers like this one have overhauled the way they deliver care in an effort to keep patients healthier and out of hospital beds. They have connected newly insured patients with primary care doctors in outpatient clinics, helped them manage chronic diseases and tried to reduce their reliance on emergency rooms for routine care.\u003c/p>\n\u003cp>Now, with President Donald Trump and congressional Republicans pledging to repeal Obamacare, such hospitals fear the gains they have made could be lost or diminished. In particular, they worry that if patients lose health insurance, their revenue will fall — to the detriment of the patients, the hospital staff and the community.\u003c/p>\n\u003cp>“It would be felt on a daily basis,” said Erin O’Malley, director of policy for America’s Essential Hospitals, a nationwide association of nearly 300 hospitals that serve low-income patients. “Our mission will not be changing, but the challenges will be mounting … especially if we have a ‘repeal’ without a comparable ‘replace.’ ”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The California Hospital Association sent a letter Feb. 8 to California’s congressional delegation on behalf of hundreds of hospitals and health systems, saying that repealing the Affordable Care Act without replacing it “would upend the financial stability of hospitals and their patients.”\u003c/p>\n\u003cp>The association wrote that it was particularly concerned about proposals that would reduce federal dollars for Medicaid, which was significantly expanded under the 2010 health law to include low-income childless adults. The association also expressed concern about dismantling the changes hospitals have made to promote the quality of care over the quantity. For instance, as a result of new financial penalties under Medicare, many hospitals invested in changes to ensure they weren’t readmitting patients too soon after discharge.\u003c/p>\n\u003cp>Although all hospitals would be affected if the health law were repealed, public and safety-net facilities such as San Mateo Medical Center would suffer more, said Gerald Kominski, director of the UCLA Center for Health Policy Research.\u003c/p>\n\u003cp>“The Affordable Care Act has certainly stabilized the financial situation of safety-net providers,” he said. “If we roll back the ACA completely and don’t have a replacement plan that specifically improves funding for safety-net providers, then those hospitals are going to become more vulnerable again.”\u003c/p>\n\u003cp>Across the nation, hospitals that serve the poor have raised similar concerns. A recent analysis by America’s Essential Hospitals showed that hospitals could lose more than $40 billion in funding from 2018 to 2026 if the law is repealed.\u003c/p>\n\u003cp> Over the past several years, safety-net hospitals like San Mateo Medical Center have worked to help patients better manage their chronic diseases and reduce their reliance on emergency rooms for routine care. Administrators worry if the Affordable Care Act is repealed, they will lose revenue and be unable to focus as much on prevention. (Anna Gorman/KHN)\u003c/p>\n\u003cp>Republicans have put forward several proposals that worry hospital administrators. Among them are Medicaid block grants, which could result in less funding for beneficiaries, and withdrawal of federal support for insurance exchanges.\u003c/p>\n\u003cp>About 72,000 patients are seen annually at the county-run San Mateo Medical Center, which includes the hospital and nine outpatient clinics. Before the health law took effect, 48 percent of patients were uninsured and 31 percent were on Medi-Cal, the state’s version of Medicaid. Now, 17 percent are uninsured and 57 percent have Medi-Cal.\u003c/p>\n\u003cp>“If Medicaid rolls back … not only does the revenue disappear, but then people will delay care, get sicker and then costs will go up,” said Chester Kunnappilly, CEO of the medical center.\u003c/p>\n\u003cp>The hospital and clinics receive $166 million annually in Medi-Cal revenue — which makes up about 60 percent of the total budget. At least $50 million would be at risk with a repeal of the ACA, Kunnappilly said.\u003c/p>\n\u003cp>“People will lose their jobs, and it becomes this vicious cycle,” he said. “How many people we can take care of continues to shrink because the teams get smaller.”\u003c/p>\n\u003cp> Michael Asip enrolled in expanded Medi-Cal under the Affordable Care Act before switching to Medicare when he turned 65 last year. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the San Mateo Medical Center. “I’m the poster boy for the safety net,” he said. (Anna Gorman/KHN)\u003c/p>\n\u003cp>San Mateo Medical Center made numerous changes over the past few years to catch patients before they became seriously ill. For example, it created teams of outpatient providers — including pharmacists, medical assistants and social workers — to coordinate care. It began reminding patients when they needed to get mammograms and other preventive tests. They expanded substance abuse and mental health treatment, which was required to be covered under the law.\u003c/p>\n\u003cp>In addition, the medical center sent patients with urgent needs to “express care” so they wouldn’t have to go to the emergency room or wait to see their doctor. Hospital administrators changed the discharge process, sending some patients home with the medications they needed and even dispatching staff to visit others after release.\u003c/p>\n\u003cp>Dramatic changes were made by safety-net hospitals elsewhere in response to the ACA. In Los Angeles County, for example, a computer system was developed to the ensure less duplication of care and better monitoring of patients, and patients were assigned to clinics that served as their medical “homes.”\u003c/p>\n\u003cp>“The ACA provided the economic incentive to do what should have been done anyway,” said Mitch Katz, director of the Los Angeles County health department. “It won’t go back to the way it was done before.”\u003c/p>\n\u003cp>On a recent day at the San Mateo Medical Center, Marla Muniz, a 46-year-old waitress from San Mateo, came to a clinic at the medical center for a physical and treatment for worsening pain in her shoulders and arm. She has Medi-Cal now, because of the program’s expansion, after going years without health insurance.\u003c/p>\n\u003cp>“I am scared they are going to take away my Medi-Cal,” she said. “If I had a good job that paid well, it wouldn’t matter. But I don’t. And I have a lot of pain. I have more and more pain every day.”\u003c/p>\n\u003cp>Another patient, Michael Asip, was there to see one of his physicians. He’d enrolled in expanded Medi-Cal before turning 65, then switched to Medicare. Long uninsured, he had gone months without seeing a doctor even after a heart attack. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the medical center.\u003c/p>\n\u003cp>Sumita Kalra, a physician at a primary care clinic, said she has seen numerous patients like Muniz and Asip who put off health care for years. When they finally got coverage through the ACA, some were diagnosed with diabetes, cancer and other serious diseases.\u003c/p>\n\u003cp>Now “we can catch those ticking time bombs before something worse happens,” Kalra said.\u003c/p>\n\u003cp>Louise Rogers, chief of the San Mateo County Health System, said that kind of change, fostered by the ACA, should not be reversed.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We don’t want to see a turning back of the clock,” she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>SAN MATEO — Little surprises Lynda Sutherland, who has been a licensed vocational nurse for 35 years at San Mateo Medical Center. But in the past few years, Sutherland said, she’s been surprised by what’s missing: the patients who used to return again and again to the public hospital for the same ailments.\u003c/p>\n\u003cp>“They’re just not coming back,” she said.\u003c/p>\n\u003cp>Spurred by the Affordable Care Act (ACA), medical centers like this one have overhauled the way they deliver care in an effort to keep patients healthier and out of hospital beds. They have connected newly insured patients with primary care doctors in outpatient clinics, helped them manage chronic diseases and tried to reduce their reliance on emergency rooms for routine care.\u003c/p>\n\u003cp>Now, with President Donald Trump and congressional Republicans pledging to repeal Obamacare, such hospitals fear the gains they have made could be lost or diminished. In particular, they worry that if patients lose health insurance, their revenue will fall — to the detriment of the patients, the hospital staff and the community.\u003c/p>\n\u003cp>“It would be felt on a daily basis,” said Erin O’Malley, director of policy for America’s Essential Hospitals, a nationwide association of nearly 300 hospitals that serve low-income patients. “Our mission will not be changing, but the challenges will be mounting … especially if we have a ‘repeal’ without a comparable ‘replace.’ ”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The California Hospital Association sent a letter Feb. 8 to California’s congressional delegation on behalf of hundreds of hospitals and health systems, saying that repealing the Affordable Care Act without replacing it “would upend the financial stability of hospitals and their patients.”\u003c/p>\n\u003cp>The association wrote that it was particularly concerned about proposals that would reduce federal dollars for Medicaid, which was significantly expanded under the 2010 health law to include low-income childless adults. The association also expressed concern about dismantling the changes hospitals have made to promote the quality of care over the quantity. For instance, as a result of new financial penalties under Medicare, many hospitals invested in changes to ensure they weren’t readmitting patients too soon after discharge.\u003c/p>\n\u003cp>Although all hospitals would be affected if the health law were repealed, public and safety-net facilities such as San Mateo Medical Center would suffer more, said Gerald Kominski, director of the UCLA Center for Health Policy Research.\u003c/p>\n\u003cp>“The Affordable Care Act has certainly stabilized the financial situation of safety-net providers,” he said. “If we roll back the ACA completely and don’t have a replacement plan that specifically improves funding for safety-net providers, then those hospitals are going to become more vulnerable again.”\u003c/p>\n\u003cp>Across the nation, hospitals that serve the poor have raised similar concerns. A recent analysis by America’s Essential Hospitals showed that hospitals could lose more than $40 billion in funding from 2018 to 2026 if the law is repealed.\u003c/p>\n\u003cp> Over the past several years, safety-net hospitals like San Mateo Medical Center have worked to help patients better manage their chronic diseases and reduce their reliance on emergency rooms for routine care. Administrators worry if the Affordable Care Act is repealed, they will lose revenue and be unable to focus as much on prevention. (Anna Gorman/KHN)\u003c/p>\n\u003cp>Republicans have put forward several proposals that worry hospital administrators. Among them are Medicaid block grants, which could result in less funding for beneficiaries, and withdrawal of federal support for insurance exchanges.\u003c/p>\n\u003cp>About 72,000 patients are seen annually at the county-run San Mateo Medical Center, which includes the hospital and nine outpatient clinics. Before the health law took effect, 48 percent of patients were uninsured and 31 percent were on Medi-Cal, the state’s version of Medicaid. Now, 17 percent are uninsured and 57 percent have Medi-Cal.\u003c/p>\n\u003cp>“If Medicaid rolls back … not only does the revenue disappear, but then people will delay care, get sicker and then costs will go up,” said Chester Kunnappilly, CEO of the medical center.\u003c/p>\n\u003cp>The hospital and clinics receive $166 million annually in Medi-Cal revenue — which makes up about 60 percent of the total budget. At least $50 million would be at risk with a repeal of the ACA, Kunnappilly said.\u003c/p>\n\u003cp>“People will lose their jobs, and it becomes this vicious cycle,” he said. “How many people we can take care of continues to shrink because the teams get smaller.”\u003c/p>\n\u003cp> Michael Asip enrolled in expanded Medi-Cal under the Affordable Care Act before switching to Medicare when he turned 65 last year. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the San Mateo Medical Center. “I’m the poster boy for the safety net,” he said. (Anna Gorman/KHN)\u003c/p>\n\u003cp>San Mateo Medical Center made numerous changes over the past few years to catch patients before they became seriously ill. For example, it created teams of outpatient providers — including pharmacists, medical assistants and social workers — to coordinate care. It began reminding patients when they needed to get mammograms and other preventive tests. They expanded substance abuse and mental health treatment, which was required to be covered under the law.\u003c/p>\n\u003cp>In addition, the medical center sent patients with urgent needs to “express care” so they wouldn’t have to go to the emergency room or wait to see their doctor. Hospital administrators changed the discharge process, sending some patients home with the medications they needed and even dispatching staff to visit others after release.\u003c/p>\n\u003cp>Dramatic changes were made by safety-net hospitals elsewhere in response to the ACA. In Los Angeles County, for example, a computer system was developed to the ensure less duplication of care and better monitoring of patients, and patients were assigned to clinics that served as their medical “homes.”\u003c/p>\n\u003cp>“The ACA provided the economic incentive to do what should have been done anyway,” said Mitch Katz, director of the Los Angeles County health department. “It won’t go back to the way it was done before.”\u003c/p>\n\u003cp>On a recent day at the San Mateo Medical Center, Marla Muniz, a 46-year-old waitress from San Mateo, came to a clinic at the medical center for a physical and treatment for worsening pain in her shoulders and arm. She has Medi-Cal now, because of the program’s expansion, after going years without health insurance.\u003c/p>\n\u003cp>“I am scared they are going to take away my Medi-Cal,” she said. “If I had a good job that paid well, it wouldn’t matter. But I don’t. And I have a lot of pain. I have more and more pain every day.”\u003c/p>\n\u003cp>Another patient, Michael Asip, was there to see one of his physicians. He’d enrolled in expanded Medi-Cal before turning 65, then switched to Medicare. Long uninsured, he had gone months without seeing a doctor even after a heart attack. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the medical center.\u003c/p>\n\u003cp>Sumita Kalra, a physician at a primary care clinic, said she has seen numerous patients like Muniz and Asip who put off health care for years. When they finally got coverage through the ACA, some were diagnosed with diabetes, cancer and other serious diseases.\u003c/p>\n\u003cp>Now “we can catch those ticking time bombs before something worse happens,” Kalra said.\u003c/p>\n\u003cp>Louise Rogers, chief of the San Mateo County Health System, said that kind of change, fostered by the ACA, should not be reversed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We don’t want to see a turning back of the clock,” she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Single-Payer Health Care Bill Introduced In California Senate",
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"content": "\u003cp>Legislation introduced in the state Senate Friday would set California on a path toward the possible creation of a single-payer health care system ― a proposal that has failed to gain traction here in the past.\u003c/p>\n\u003cp>The bill, which is a preliminary step, says that it is the “intent of the Legislature” to enact a law that would establish a comprehensive, single-payer health care program for the benefit of everyone in the state. The legislation, introduced by state Sen. Ricardo Lara (D-Bell Gardens), does not offer specifics of what the plan would look like, nor does it mention a timetable.\u003c/p>\n\u003cp>A single-payer system would replace private insurance with a government plan that pays for coverage for everyone. Proponents argue that single-payer systems make health care more affordable and efficient, but opponents say they raise taxpayer costs and give government too much power.\u003c/p>\n\u003cp>Medicare, the federally-funded health coverage for the elderly, is often held up as a model of what a single-payer system might look like.\u003c/p>\n\u003cp>Lara said in an interview Thursday that the state needs to be prepared in case the Affordable Care Act is repealed, as President Donald Trump and Congressional Republicans have promised.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The health of Californians is really at stake here and is at risk with what is being threatened in Congress,” Lara said, as the debate continued in Washington about the future of President Barack Obama’s signature health law. “We don’t have the luxury to wait and see what they are going to do and what the plan is,”\u003c/p>\n\u003cp>Lara noted that while the Affordable Care Act expanded health coverage for many Californians, it left others uninsured or underinsured. He said the single-payer bill builds upon his “health for all kids” legislation, which resulted in coverage beginning last May for 170,000 immigrant children here illegally.\u003c/p>\n\u003cp>“I’ve met many children who have asked me point blank, ‘What about my mom? What about my dad?’” Lara said.\u003c/p>\n\u003cp>He recently \u003ca href=\"http://californiahealthline.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\" target=\"_blank\">withdrew a request\u003c/a> to the federal government, based on a bill he had introduced, that would have allowed adult immigrants here illegally to purchase unsubsidized health plans through Covered California, the state’s insurance exchange.\u003c/p>\n\u003cdiv id=\"attachment_188745\" style=\"width: 280px\" class=\"wp-caption alignright\">\u003cimg class=\"wp-image-188745 size-khn-article-vertical\" src=\"https://californiahealthline.files.wordpress.com/2016/02/lara_670.jpg?w=270&h=405&crop=1\" alt=\"Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara's office)\" width=\"270\" height=\"405\">\n\u003cp class=\"wp-caption-text\">Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara’s office)\u003c/p>\n\u003c/div>\n\u003cp>According to the text of the Lara’s bill, a single-payer system would help address rising out-of-pocket costs and shrinking networks of doctors.\u003c/p>\n\u003cp>No state has a single-payer health system. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after the state couldn’t figure out how to finance it. Last year, Colorado residents rejected a ballot measure that would have used payroll taxes to fund a near universal coverage system.\u003c/p>\n\u003cp>In California, voters rejected a ballot initiative in 1994 that would have established a government-run universal health program. Gov. Arnold Schwarzenegger later vetoed two bills that would have accomplished the same goal.\u003c/p>\n\u003cp>It’s difficult to create consensus on single-payer plans because they dramatically shift how health care is delivered and paid for, said Larry Levitt, a senior vice president at the Kaiser Family Foundation (California Healthline is produced by Kaiser Health News, an editorially-independent program of the foundation.)\u003c/p>\n\u003cp>“Single-payer plans have lots of appeal in their simplicity and ability to control costs,” Levitt said. “But what I think has always held back a move to single-payer is the disruption they create in financing and delivery of care.”\u003c/p>\n\u003cp>The problem, Levitt said, is that even if they end up costing less overall, single-payer plans look to the public like a “very big tax increase.”\u003c/p>\n\u003cp>The California Nurses Association, the primary sponsor of the new bill, is planning a rally in Sacramento next week in support of a single-payer system. Bonnie Castillo, the group’s associate executive director, said the goal is to create a system that doesn’t exclude anyone and helps relieve patients’ financial burdens.\u003c/p>\n\u003cp>“Patients and their families are suffering as a result of having very high co-pay and premium costs,” she said. “They are having to make gut-wrenching decisions whether they go to the doctor or they stick it out and see if they get better on their own.”\u003c/p>\n\u003cp>Castillo said that with so much uncertainty at the national level, California has the ability to create a better system. “We think we can get this right,” she said.\u003c/p>\n\u003cp>Charles Bacchi, president and CEO of the California Association of Health Plans, said he hadn’t yet seen the bill, but the trade group has opposed single-payer proposals in the past.\u003c/p>\n\u003cp>“It’s hard to tell until you know the details,” Bacchi said. “But past studies have shown [single-payer systems] are incredibly expensive and would be disruptive.”\u003c/p>\n\u003cp>He said health plans, doctors, hospitals and others are “laser-focused on protecting and enhancing the gains we have made in coverage” under the Affordable Care Act and ensuring that California continues to receive critical funding. “We think that’s where the focus should be,” he said.\u003c/p>\n\u003cp>One possible concept of a single-payer system in California would be to bring together funding from several sources under one state umbrella: Medi-Cal, which covers the poor; Medicare, the federal program that covers older adults, and private insurance.\u003c/p>\n\u003cp>Lara said he has not yet figured out the financing, saying that it is still early in the legislative process. But he said that even as California continues to defend the Affordable Care Act, it is time to put forward an alternative.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I think we’ve reached a tipping point now that we haven’t had before,” he said.\u003c/p>\n\n",
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"nprByline": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/anna-gorman/\" target=\"_blank\">Anna Gorman\u003c/a>\u003c/strong>\u003c/br>California Healthline",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Legislation introduced in the state Senate Friday would set California on a path toward the possible creation of a single-payer health care system ― a proposal that has failed to gain traction here in the past.\u003c/p>\n\u003cp>The bill, which is a preliminary step, says that it is the “intent of the Legislature” to enact a law that would establish a comprehensive, single-payer health care program for the benefit of everyone in the state. The legislation, introduced by state Sen. Ricardo Lara (D-Bell Gardens), does not offer specifics of what the plan would look like, nor does it mention a timetable.\u003c/p>\n\u003cp>A single-payer system would replace private insurance with a government plan that pays for coverage for everyone. Proponents argue that single-payer systems make health care more affordable and efficient, but opponents say they raise taxpayer costs and give government too much power.\u003c/p>\n\u003cp>Medicare, the federally-funded health coverage for the elderly, is often held up as a model of what a single-payer system might look like.\u003c/p>\n\u003cp>Lara said in an interview Thursday that the state needs to be prepared in case the Affordable Care Act is repealed, as President Donald Trump and Congressional Republicans have promised.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The health of Californians is really at stake here and is at risk with what is being threatened in Congress,” Lara said, as the debate continued in Washington about the future of President Barack Obama’s signature health law. “We don’t have the luxury to wait and see what they are going to do and what the plan is,”\u003c/p>\n\u003cp>Lara noted that while the Affordable Care Act expanded health coverage for many Californians, it left others uninsured or underinsured. He said the single-payer bill builds upon his “health for all kids” legislation, which resulted in coverage beginning last May for 170,000 immigrant children here illegally.\u003c/p>\n\u003cp>“I’ve met many children who have asked me point blank, ‘What about my mom? What about my dad?’” Lara said.\u003c/p>\n\u003cp>He recently \u003ca href=\"http://californiahealthline.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\" target=\"_blank\">withdrew a request\u003c/a> to the federal government, based on a bill he had introduced, that would have allowed adult immigrants here illegally to purchase unsubsidized health plans through Covered California, the state’s insurance exchange.\u003c/p>\n\u003cdiv id=\"attachment_188745\" style=\"width: 280px\" class=\"wp-caption alignright\">\u003cimg class=\"wp-image-188745 size-khn-article-vertical\" src=\"https://californiahealthline.files.wordpress.com/2016/02/lara_670.jpg?w=270&h=405&crop=1\" alt=\"Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara's office)\" width=\"270\" height=\"405\">\n\u003cp class=\"wp-caption-text\">Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara’s office)\u003c/p>\n\u003c/div>\n\u003cp>According to the text of the Lara’s bill, a single-payer system would help address rising out-of-pocket costs and shrinking networks of doctors.\u003c/p>\n\u003cp>No state has a single-payer health system. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after the state couldn’t figure out how to finance it. Last year, Colorado residents rejected a ballot measure that would have used payroll taxes to fund a near universal coverage system.\u003c/p>\n\u003cp>In California, voters rejected a ballot initiative in 1994 that would have established a government-run universal health program. Gov. Arnold Schwarzenegger later vetoed two bills that would have accomplished the same goal.\u003c/p>\n\u003cp>It’s difficult to create consensus on single-payer plans because they dramatically shift how health care is delivered and paid for, said Larry Levitt, a senior vice president at the Kaiser Family Foundation (California Healthline is produced by Kaiser Health News, an editorially-independent program of the foundation.)\u003c/p>\n\u003cp>“Single-payer plans have lots of appeal in their simplicity and ability to control costs,” Levitt said. “But what I think has always held back a move to single-payer is the disruption they create in financing and delivery of care.”\u003c/p>\n\u003cp>The problem, Levitt said, is that even if they end up costing less overall, single-payer plans look to the public like a “very big tax increase.”\u003c/p>\n\u003cp>The California Nurses Association, the primary sponsor of the new bill, is planning a rally in Sacramento next week in support of a single-payer system. Bonnie Castillo, the group’s associate executive director, said the goal is to create a system that doesn’t exclude anyone and helps relieve patients’ financial burdens.\u003c/p>\n\u003cp>“Patients and their families are suffering as a result of having very high co-pay and premium costs,” she said. “They are having to make gut-wrenching decisions whether they go to the doctor or they stick it out and see if they get better on their own.”\u003c/p>\n\u003cp>Castillo said that with so much uncertainty at the national level, California has the ability to create a better system. “We think we can get this right,” she said.\u003c/p>\n\u003cp>Charles Bacchi, president and CEO of the California Association of Health Plans, said he hadn’t yet seen the bill, but the trade group has opposed single-payer proposals in the past.\u003c/p>\n\u003cp>“It’s hard to tell until you know the details,” Bacchi said. “But past studies have shown [single-payer systems] are incredibly expensive and would be disruptive.”\u003c/p>\n\u003cp>He said health plans, doctors, hospitals and others are “laser-focused on protecting and enhancing the gains we have made in coverage” under the Affordable Care Act and ensuring that California continues to receive critical funding. “We think that’s where the focus should be,” he said.\u003c/p>\n\u003cp>One possible concept of a single-payer system in California would be to bring together funding from several sources under one state umbrella: Medi-Cal, which covers the poor; Medicare, the federal program that covers older adults, and private insurance.\u003c/p>\n\u003cp>Lara said he has not yet figured out the financing, saying that it is still early in the legislative process. But he said that even as California continues to defend the Affordable Care Act, it is time to put forward an alternative.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I think we’ve reached a tipping point now that we haven’t had before,” he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Threat of Losing Obamacare Brings out Some Formerly Apolitical Californians",
"title": "Threat of Losing Obamacare Brings out Some Formerly Apolitical Californians",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>ROSEVILLE, Calif. — Until recently, Paul Smith didn’t consider himself much of an activist. But he woke up hours before sunrise on Saturday to attend his first town hall meeting.\u003c/p>\n\u003cp>That meeting near Sacramento, organized by his district’s Congressman Tom McClintock (R-Roseville), sparked a peaceful — if large and raucous — protest over Obamacare, the travel ban and other issues. And it drew national headlines.\u003c/p>\n\u003cp>“I have noticed many of my friends who never speak [about] politics are getting political,” said Smith, a 46-year-old Rocklin, Calif., resident and registered Democrat who works in marketing. He said he did not vote for McClintock.\u003c/p>\n\u003cp>Once on the political sidelines, Smith now finds himself one of the leading members of a group called Indivisible California-04 — named for McClintock’s 4th Congressional district. It is one of hundreds of groups forming across the country to “resist” the Trump Administration’s agenda, which includes repealing and replacing the Affordable Care Act.\u003c/p>\n\u003cp>Alongside veteran protesters, recently galvanized Californians like Smith are demonstrating, calling lawmakers and taking other measures to make their voices heard. For many, the issues are not partisan. They are personal.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Placer County resident Veronica Blake said her mother went without health insurance for nearly 10 years before she died in 2012 from heart disease. She had been diagnosed with breast cancer in her early 30s, and although she beat it after a mastectomy, the preexisting condition made her a high-risk patient whom insurers didn’t want to take on, Blake said.\u003cbr>\nBlake wonders how much longer her mother would have lived if she’d had health insurance all those years. Could her heart problems have been detected and treated earlier?\u003c/p>\n\u003cdiv id=\"attachment_224629\" style=\"width: 780px\" class=\"wp-caption aligncenter\">\u003cimg class=\"wp-image-224629 size-full\" src=\"https://californiahealthline.files.wordpress.com/2017/02/mcclintock-aca-9_770.jpg?w=770&h=513\" alt=\"Veronica Blake (left), 48, of Placer County, said she was interested in learning what Rep. McClintock had to say about the ACA replacement plan, but wasn’t able to get into event. Her mother passed away in 2013. When her mother divorced, she lost her husband’s employer coverage. It was difficult for an insurance to her take her because she had been diagnosed with breast cancer in her 30s, and although it had been cleared through a mastectomy, it was considered a preexisting condition. If her mother would have had insurance and better preventive care, her heart conditions could have been detected earlier and she might have lived longer, Blake said. (Ana B. Ibarra/California Healthline)\" width=\"770\" height=\"513\">\n\u003cp class=\"wp-caption-text\">Veronica Blake, left, 48, of Placer County, said she was interested in learning what Rep. McClintock had to say about the ACA replacement plan, but wasn’t able to get into event. (Ana B. Ibarra/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>Blake joined hundreds of others at Saturday’s rally, she said, because she has other family members with illnesses that would be considered preexisting conditions and fears that their coverage could be taken away.\u003c/p>\n\u003cp>Laurel Ward, who is a nurse in Placer County, said she made her way to McClintock’s town hall event because of what she sees daily in her crowded emergency room.\u003c/p>\n\u003cp>She also has a younger sister who was able to obtain coverage as a result of the Medi-Cal expansion made possible by the Affordable Care Act. “It’s difficult for young people to afford health insurance,” Ward said. “I know, because I went without insurance when I was a student.”\u003c/p>\n\u003cp>“Without the ACA,” she said. “It’s only going to get worse.”\u003c/p>\n\u003cp>\u003cstrong>‘People Are Angry’\u003c/strong>\u003c/p>\n\u003cp>For Indivisible California-04, the goal is to look ahead to the 2018 election. “We want to change politics in our district,” Smith said.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.indivisibleguide.com/\">website for the Indivisible\u003c/a> movement offers groups a guide said to have been created by former congressional staffers and inspired by the rise of the Tea Party. It allows people to search and sign up for a local activist group, and as of Tuesday, there were 33 groups registered within 25 miles of Sacramento.\u003c/p>\n\u003cp>Jamie Beutler, chair of the rural caucus for the California Democratic Party and a founding member of another group, Indivisible Sierra Nevada, said she thinks these organizations are gaining popularity because people are desperate.\u003c/p>\n\u003cp>“People are angry, they are frustrated and want to do something. This gives them a place to go,” said the Placerville, Calif., resident.\u003c/p>\n\u003cp>Beutler, who is on Medicare and Social Security, worries that cuts to her benefits means she’ll have to sell her home.\u003c/p>\n\u003cp>“I hope this event was a wakeup call [for McClintock],” Beutler said. “His constituents are not happy.”\u003c/p>\n\u003cdiv id=\"attachment_224623\" style=\"width: 780px\" class=\"wp-caption aligncenter\">\u003cimg class=\"wp-image-224623 size-full\" src=\"https://californiahealthline.files.wordpress.com/2017/02/mcclintock-aca-3_770.jpg?w=770&h=513\" width=\"770\" height=\"513\">\n\u003cp class=\"wp-caption-text\">A protest organized near Sacramento sparked a peaceful — if large and raucous — protest over Obamacare. (Ana B. Ibarra/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>Although McClintock later characterized the gathering as having \u003ca href=\"http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-hundreds-of-people-show-up-for-town-1486246073-htmlstory.html\">“an anarchist element,”\u003c/a> other attendees and a reporter outside the packed auditorium saw an intense but peaceful demonstration, with many senior citizens among the crowd. McClintock was escorted from the town hall meeting by police, but no arrests or citations were made, according to Roseville police.\u003c/p>\n\u003cp>McClintock’s staff did not return a request for comment from California Healthline. But in an i\u003ca href=\"http://www.kcra.com/article/interview-rep-tom-mcclintock-r-roseville-talks-to-kcra-3/8677813\" target=\"_blank\">nterview with with Sacramento television station KCRA\u003c/a> 3 after the meeting, McClintock was critical of some demonstrators.\u003c/p>\n\u003cp>“It made a big impression on me that there is an intolerance in the political left that is running very deep, and the fact that police had to intervene is a serious indication of the growing violence streak within the left,” he said. “This is very disturbing, but I will also say that most of the people there were decent concerned citizens.”\u003c/p>\n\u003cp>Regarding the GOP’s plan to replace the ACA, McClintock told KCRA 3 he expects to see a plan “reported out within the next few weeks.”\u003c/p>\n\u003cp>“We’ll follow the plan that has been proposed by [Republican Congressman and Health and Human Services Secretary nominee] Tom Price over many years … which is restore to individuals the financial means and the wide range of choices to put their families back in charge of their own health care,” McClintock said.\u003c/p>\n\u003cp>Demonstrators also have been active in other largely Republican districts, in California and around the country. About 300 miles south of Roseville, hundreds gathered \u003ca href=\"http://www.fresnobee.com/news/local/article129305619.html\">on Jan. 27\u003c/a> in front of House Majority Leader Kevin McCarthy’s Bakersfield office to advocate for preserving the Affordable Care Act. McCarthy supports replacing it, but advocates point out that the area he represents is highly dependent on Medicaid and Medicare.\u003c/p>\n\u003cdiv id=\"attachment_224626\" style=\"width: 780px\" class=\"wp-caption aligncenter\">\u003cimg class=\"size-full wp-image-224626\" src=\"https://californiahealthline.files.wordpress.com/2017/02/mcclintock-aca-6_770.jpg?w=770&h=513\" alt=\"Helen Cheng, is an internist in El Dorado County. Some of her patients are worried about what might happen to their Covered California plans. “I’m here because of my patients. Getting insurance is a nightmare for some of these people.” (Ana B. Ibarra/California Healthline)\" width=\"770\" height=\"513\">\n\u003cp class=\"wp-caption-text\">Helen Cheng is an internist in El Dorado County. Some of her patients are worried about what might happen to their Covered California plans. “I’m here because of my patients. Getting insurance is a nightmare for some of these people.” (Ana B. Ibarra/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>\u003ca href=\"http://californiahealthline.org/news/with-a-high-deductible-even-a-doctor-can-short-change-his-health/\" target=\"_blank\">McCarthy represents most of Kern and Tulare counties\u003c/a>, where approximately 150,000 people are enrolled in expanded Medicaid as a result of the ACA, and about another 29,000 have enrolled in a Covered California plan.\u003c/p>\n\u003cp>In an \u003ca href=\"http://www.sacbee.com/opinion/op-ed/article127529659.html#storylink=cpy\" target=\"_blank\">op-ed published in the Sacramento Bee\u003c/a> last month, McCarthy wrote that the Medicaid program is in need of reform.\u003c/p>\n\u003cp>“It is true that millions of Californians receive health insurance coverage through Obamacare and in particular through the Medicaid expansion. But the number of insured matters little when the quality of the insurance is so dismal.”\u003c/p>\n\u003cp>Dennis Revell, chair of the Placer County Republican Party, said that the demonstration outside McClintock’s town hall meeting was one of the most organized he’s seen. But he said it was not a true organic, local movement. People were invited by organizers from across county and state lines, he said, although he offered no evidence of that.\u003c/p>\n\u003cp>The Democratic Party is not as active or organized in Placer County as it is in other counties, which is why Saturday’s event stood out, Revell said.\u003c/p>\n\u003cp>“I think it would be fair to say that the speed at which the Trump administration is moving to deliver on its promises has galvanized the progressive and left to organize to a point that they’ve never had to before,” Revell said.\u003c/p>\n\u003cp>Mark Rosen, a member of Indivisible Auburn, Calif., said organizers are now focused on spreading the word about citizen activism. In his last recruitment meeting, more than 80 local residents showed up wanting to learn more about how to become involved.\u003c/p>\n\u003cp>“It shows that there is an army of people who are profoundly upset,” Rosen said, “and particularly concerned about destroying the progress we’ve made with the ACA.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>CORRECTION: An earlier version of this story incorrectly reported that Veronica Blake's mother had obtained health insurance through Covered California in 2013, shortly before her death. Blake later told California Healthline that she had been mistaken. Her mother had not obtained this insurance before her death, which was in 2012. The story has been updated.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"title": "Threat of Losing Obamacare Brings out Some Formerly Apolitical Californians | KQED",
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"headline": "Threat of Losing Obamacare Brings out Some Formerly Apolitical Californians",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>ROSEVILLE, Calif. — Until recently, Paul Smith didn’t consider himself much of an activist. But he woke up hours before sunrise on Saturday to attend his first town hall meeting.\u003c/p>\n\u003cp>That meeting near Sacramento, organized by his district’s Congressman Tom McClintock (R-Roseville), sparked a peaceful — if large and raucous — protest over Obamacare, the travel ban and other issues. And it drew national headlines.\u003c/p>\n\u003cp>“I have noticed many of my friends who never speak [about] politics are getting political,” said Smith, a 46-year-old Rocklin, Calif., resident and registered Democrat who works in marketing. He said he did not vote for McClintock.\u003c/p>\n\u003cp>Once on the political sidelines, Smith now finds himself one of the leading members of a group called Indivisible California-04 — named for McClintock’s 4th Congressional district. It is one of hundreds of groups forming across the country to “resist” the Trump Administration’s agenda, which includes repealing and replacing the Affordable Care Act.\u003c/p>\n\u003cp>Alongside veteran protesters, recently galvanized Californians like Smith are demonstrating, calling lawmakers and taking other measures to make their voices heard. For many, the issues are not partisan. They are personal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Placer County resident Veronica Blake said her mother went without health insurance for nearly 10 years before she died in 2012 from heart disease. She had been diagnosed with breast cancer in her early 30s, and although she beat it after a mastectomy, the preexisting condition made her a high-risk patient whom insurers didn’t want to take on, Blake said.\u003cbr>\nBlake wonders how much longer her mother would have lived if she’d had health insurance all those years. Could her heart problems have been detected and treated earlier?\u003c/p>\n\u003cdiv id=\"attachment_224629\" style=\"width: 780px\" class=\"wp-caption aligncenter\">\u003cimg class=\"wp-image-224629 size-full\" src=\"https://californiahealthline.files.wordpress.com/2017/02/mcclintock-aca-9_770.jpg?w=770&h=513\" alt=\"Veronica Blake (left), 48, of Placer County, said she was interested in learning what Rep. McClintock had to say about the ACA replacement plan, but wasn’t able to get into event. Her mother passed away in 2013. When her mother divorced, she lost her husband’s employer coverage. It was difficult for an insurance to her take her because she had been diagnosed with breast cancer in her 30s, and although it had been cleared through a mastectomy, it was considered a preexisting condition. If her mother would have had insurance and better preventive care, her heart conditions could have been detected earlier and she might have lived longer, Blake said. (Ana B. Ibarra/California Healthline)\" width=\"770\" height=\"513\">\n\u003cp class=\"wp-caption-text\">Veronica Blake, left, 48, of Placer County, said she was interested in learning what Rep. McClintock had to say about the ACA replacement plan, but wasn’t able to get into event. (Ana B. Ibarra/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>Blake joined hundreds of others at Saturday’s rally, she said, because she has other family members with illnesses that would be considered preexisting conditions and fears that their coverage could be taken away.\u003c/p>\n\u003cp>Laurel Ward, who is a nurse in Placer County, said she made her way to McClintock’s town hall event because of what she sees daily in her crowded emergency room.\u003c/p>\n\u003cp>She also has a younger sister who was able to obtain coverage as a result of the Medi-Cal expansion made possible by the Affordable Care Act. “It’s difficult for young people to afford health insurance,” Ward said. “I know, because I went without insurance when I was a student.”\u003c/p>\n\u003cp>“Without the ACA,” she said. “It’s only going to get worse.”\u003c/p>\n\u003cp>\u003cstrong>‘People Are Angry’\u003c/strong>\u003c/p>\n\u003cp>For Indivisible California-04, the goal is to look ahead to the 2018 election. “We want to change politics in our district,” Smith said.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.indivisibleguide.com/\">website for the Indivisible\u003c/a> movement offers groups a guide said to have been created by former congressional staffers and inspired by the rise of the Tea Party. It allows people to search and sign up for a local activist group, and as of Tuesday, there were 33 groups registered within 25 miles of Sacramento.\u003c/p>\n\u003cp>Jamie Beutler, chair of the rural caucus for the California Democratic Party and a founding member of another group, Indivisible Sierra Nevada, said she thinks these organizations are gaining popularity because people are desperate.\u003c/p>\n\u003cp>“People are angry, they are frustrated and want to do something. This gives them a place to go,” said the Placerville, Calif., resident.\u003c/p>\n\u003cp>Beutler, who is on Medicare and Social Security, worries that cuts to her benefits means she’ll have to sell her home.\u003c/p>\n\u003cp>“I hope this event was a wakeup call [for McClintock],” Beutler said. “His constituents are not happy.”\u003c/p>\n\u003cdiv id=\"attachment_224623\" style=\"width: 780px\" class=\"wp-caption aligncenter\">\u003cimg class=\"wp-image-224623 size-full\" src=\"https://californiahealthline.files.wordpress.com/2017/02/mcclintock-aca-3_770.jpg?w=770&h=513\" width=\"770\" height=\"513\">\n\u003cp class=\"wp-caption-text\">A protest organized near Sacramento sparked a peaceful — if large and raucous — protest over Obamacare. (Ana B. Ibarra/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>Although McClintock later characterized the gathering as having \u003ca href=\"http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-hundreds-of-people-show-up-for-town-1486246073-htmlstory.html\">“an anarchist element,”\u003c/a> other attendees and a reporter outside the packed auditorium saw an intense but peaceful demonstration, with many senior citizens among the crowd. McClintock was escorted from the town hall meeting by police, but no arrests or citations were made, according to Roseville police.\u003c/p>\n\u003cp>McClintock’s staff did not return a request for comment from California Healthline. But in an i\u003ca href=\"http://www.kcra.com/article/interview-rep-tom-mcclintock-r-roseville-talks-to-kcra-3/8677813\" target=\"_blank\">nterview with with Sacramento television station KCRA\u003c/a> 3 after the meeting, McClintock was critical of some demonstrators.\u003c/p>\n\u003cp>“It made a big impression on me that there is an intolerance in the political left that is running very deep, and the fact that police had to intervene is a serious indication of the growing violence streak within the left,” he said. “This is very disturbing, but I will also say that most of the people there were decent concerned citizens.”\u003c/p>\n\u003cp>Regarding the GOP’s plan to replace the ACA, McClintock told KCRA 3 he expects to see a plan “reported out within the next few weeks.”\u003c/p>\n\u003cp>“We’ll follow the plan that has been proposed by [Republican Congressman and Health and Human Services Secretary nominee] Tom Price over many years … which is restore to individuals the financial means and the wide range of choices to put their families back in charge of their own health care,” McClintock said.\u003c/p>\n\u003cp>Demonstrators also have been active in other largely Republican districts, in California and around the country. About 300 miles south of Roseville, hundreds gathered \u003ca href=\"http://www.fresnobee.com/news/local/article129305619.html\">on Jan. 27\u003c/a> in front of House Majority Leader Kevin McCarthy’s Bakersfield office to advocate for preserving the Affordable Care Act. McCarthy supports replacing it, but advocates point out that the area he represents is highly dependent on Medicaid and Medicare.\u003c/p>\n\u003cdiv id=\"attachment_224626\" style=\"width: 780px\" class=\"wp-caption aligncenter\">\u003cimg class=\"size-full wp-image-224626\" src=\"https://californiahealthline.files.wordpress.com/2017/02/mcclintock-aca-6_770.jpg?w=770&h=513\" alt=\"Helen Cheng, is an internist in El Dorado County. Some of her patients are worried about what might happen to their Covered California plans. “I’m here because of my patients. Getting insurance is a nightmare for some of these people.” (Ana B. Ibarra/California Healthline)\" width=\"770\" height=\"513\">\n\u003cp class=\"wp-caption-text\">Helen Cheng is an internist in El Dorado County. Some of her patients are worried about what might happen to their Covered California plans. “I’m here because of my patients. Getting insurance is a nightmare for some of these people.” (Ana B. Ibarra/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>\u003ca href=\"http://californiahealthline.org/news/with-a-high-deductible-even-a-doctor-can-short-change-his-health/\" target=\"_blank\">McCarthy represents most of Kern and Tulare counties\u003c/a>, where approximately 150,000 people are enrolled in expanded Medicaid as a result of the ACA, and about another 29,000 have enrolled in a Covered California plan.\u003c/p>\n\u003cp>In an \u003ca href=\"http://www.sacbee.com/opinion/op-ed/article127529659.html#storylink=cpy\" target=\"_blank\">op-ed published in the Sacramento Bee\u003c/a> last month, McCarthy wrote that the Medicaid program is in need of reform.\u003c/p>\n\u003cp>“It is true that millions of Californians receive health insurance coverage through Obamacare and in particular through the Medicaid expansion. But the number of insured matters little when the quality of the insurance is so dismal.”\u003c/p>\n\u003cp>Dennis Revell, chair of the Placer County Republican Party, said that the demonstration outside McClintock’s town hall meeting was one of the most organized he’s seen. But he said it was not a true organic, local movement. People were invited by organizers from across county and state lines, he said, although he offered no evidence of that.\u003c/p>\n\u003cp>The Democratic Party is not as active or organized in Placer County as it is in other counties, which is why Saturday’s event stood out, Revell said.\u003c/p>\n\u003cp>“I think it would be fair to say that the speed at which the Trump administration is moving to deliver on its promises has galvanized the progressive and left to organize to a point that they’ve never had to before,” Revell said.\u003c/p>\n\u003cp>Mark Rosen, a member of Indivisible Auburn, Calif., said organizers are now focused on spreading the word about citizen activism. In his last recruitment meeting, more than 80 local residents showed up wanting to learn more about how to become involved.\u003c/p>\n\u003cp>“It shows that there is an army of people who are profoundly upset,” Rosen said, “and particularly concerned about destroying the progress we’ve made with the ACA.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>CORRECTION: An earlier version of this story incorrectly reported that Veronica Blake's mother had obtained health insurance through Covered California in 2013, shortly before her death. Blake later told California Healthline that she had been mistaken. Her mother had not obtained this insurance before her death, which was in 2012. The story has been updated.\u003cbr>\n\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California’s Community Clinics, Big Obamacare Beneficiaries, Worry About Their Future",
"title": "California’s Community Clinics, Big Obamacare Beneficiaries, Worry About Their Future",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>Paula Wilson has seen some tough times in her 23 years as the CEO of Valley Community Healthcare, a clinic that provides care for the poor in North Hollywood, Calif. But nothing was quite like November 9, the day after the U.S. elections, when walking around the office “was like coming into a funeral,” she said.\u003c/p>\n\u003cp>Her staff worried that a repeal of the Affordable Care Act, long promised by Republicans, would obliterate their jobs. Patients fretted it would jeopardize their care.\u003c/p>\n\u003cp>Nearly a third of the clinic’s 25,000 patients were newcomers, many of them recently covered through the expansion of Medi-Cal ushered in by the Affordable Care Act. Thanks to the expansion, Valley Community Healthcare had been growing rapidly, opening one new site, adding on to others, and offering patients new dental and mental health services.\u003c/p>\n\u003cp>What would happen if this new source of financial support were taken away?\u003c/p>\n\u003cp>Wilson didn’t have an answer that day, and she still doesn’t. But she’s hanging on to a cautious hope. “Pretty much that whole first week was getting a grip and assuring people: We’ve been here 46 years and we’re not going anywhere,” she said. “We’ve fought the fight before, and we’ll do it again.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In the absence of details about the impact and timing of a possible ACA repeal, Wilson’s brand of determination is all community clinics can count on for now.\u003c/p>\n\u003cp>Republicans, newly empowered by Donald Trump’s ascendance to the White House, have made clear they plan to repeal large parts of the landmark health care law in short order. The timing of any replacement is still uncertain, though political pressure has been growing recently for any void left by a repeal to be quickly filled with a new plan. For the time being, however, consumers are unlikely to see big changes in their health care.\u003c/p>\n\u003cp>Community clinics are key providers of primary care services for the poor. CaliforniaHealth+ Advocates, which represents the state’s clinics, estimates that they serve 6.2 million Californians — an increase of more than a million in less than five years. Today, more than 3.5 million community clinic patients are covered by Medi-Cal, California’s version of Medicaid, the federal health insurance program for people with low incomes.\u003c/p>\n\u003cp>More than half of patients who signed up for Medi-Cal after the advent of the ACA have gotten their primary care at community clinics, according to a December 2015 \u003ca href=\"http://www.chcf.org/publications/2015/12/medical-winwin-surging-enrollment\" target=\"_blank\">report\u003c/a> by the California Health Care Foundation. (California Healthline is an editorially independent service of the California Health Care Foundation.)\u003c/p>\n\u003cp>Historically supported by Democrats and Republicans alike, community clinics worked hard to implement Obamacare reforms, and they benefited as a result. Many, like Valley Community Healthcare, helped enroll patients and expanded their services, taking advantage of special ACA funding that enabled them to improve their facilities and systems of care.\u003c/p>\n\u003cp>The \u003ca href=\"http://khn.org/news/obamacare-boosted-community-health-centers-reach-now-what/\" target=\"_blank\">same scenario\u003c/a> has played out nationwide at many of 1,400 federally backed community health centers — a type of community clinic — according to two studies published recently in the journal \u003ca href=\"http://www.healthaffairs.org/\" target=\"_blank\">Health Affairs\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://content.healthaffairs.org/content/36/1/49.abstract\" target=\"_blank\">One of the studies\u003c/a>, which used data from 2012 to 2015 to track visits to community health centers, showed that in states that adopted the Medicaid expansion, the centers saw more patient visits, including those for mental health treatment, and lower rates of uninsured patients — a financial boon for clinics that typically operate on thin margins.\u003c/p>\n\u003cp>The second \u003ca href=\"http://content.healthaffairs.org/content/36/1/40.abstract\" target=\"_blank\">study\u003c/a> which examined data from 2011 to 2014, found that in the Medicaid expansion states, patients were more likely to receive asthma treatment when it was needed, have their body mass index assessed, get pap smears and keep their blood pressure relatively stable.\u003c/p>\n\u003cp>Proponents of the health reform law in California had hoped the expansion of community clinics would provide primary care for more patients, thus reducing expensive emergency room visits at safety-net hospitals.\u003c/p>\n\u003cp>“Health centers have been the poster child of positively embracing the ACA. They’ve gone along with everything,” said Blue Shield of California Foundation CEO Peter Long, whose organization supports the clinics. But without clarity about where funding will come from in the future, or how much of it there will be, it’s possible that clinics will “go into hunker-down mode,” he added. That could mean limiting hours, reinstating waiting lists for new patients and cutting promising new programs.\u003c/p>\n\u003cp>Implementing Obamacare “put a lot of stress on their systems,” Long said. “To unwind it would be equally hard.”\u003c/p>\n\u003cfigure class=\"layout-lg carousel-article carousel slide carousel-article-1\">\n\u003col class=\"carousel-indicators\">\n\u003cli class=\"active\">\n\u003cli>\n\u003cli>\n\u003c/ol>\n\u003cdiv class=\"carousel-inner\">\n\u003cdiv class=\"item active\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-1_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Paula Wilson, CEO of Valley Community Healthcare, says she has seen some tough times in her 23 years at the clinic which provides care for the poor in the area. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-2_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">The staff at Valley Community Healthcare worry that a promised Republican repeal of the Affordable Care Act would jeopardize the care offered to the 7,400 patients currently under the law. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-3_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Nearly a third of Valley Community Healthcare’s 25,000 customers are newcomers. Many had only recently secured health coverage through the Medicaid expansion provisions of the Affordable Care Act. After the election, Wilson spent the week assuring her customers: “We’ve been here 46 years and we’re not going anywhere,” said Wilson. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003c/div>\n\u003cp>\u003ca class=\"left carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-prev\">\u003c/span>\u003c/a>\u003ca class=\"right carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-next\">\u003c/span>\u003c/a>\u003c/p>\u003c/figure>\n\u003cp>Wilson and other clinic CEOs said they’re trying to anticipate worst-case scenarios and plan accordingly, but that’s hard when Congress hasn’t specified what changes it is planning, or when to expect them.\u003c/p>\n\u003cp>“Right now it’s all crystal ball gazing,” said Steven Wallace, associate director of the UCLA Center for Health Policy Research. “‘Repeal and replace’ is a great slogan, but ‘replace’ is really hard to figure out.”\u003c/p>\n\u003cp>Community clinic leaders say they’re focusing on several \u003ca href=\"http://khn.org/news/millions-could-lose-medicaid-coverage-under-trump-plan/\" target=\"_blank\">funding challenges\u003c/a>. First is a potential rollback of the ACA’s Medicaid expansion program, which extended new coverage to about 20 million people in the U.S., including more than 5 million in California, said Carmela Castellano-Garcia, CEO of CaliforniaHealth+ Advocates.\u003c/p>\n\u003cp>Some also worry that shifting Medicaid to a block grant system, an idea President-elect Trump has endorsed, would result in cuts to services; or that Congress could decline to reauthorize “330 funding” — an additional $5 billion community clinics receive each year from the federal government. That stream of federal dollars is set to expire in September of 2017.\u003c/p>\n\u003cp>That funding, in addition to payments from the Medi-Cal expansion, allowed the Los Angeles Christian Health Centers to add medical, mental health, dental and case management staff and open two new sites.\u003c/p>\n\u003cp>The clinic, headquartered on Skid Row in downtown Los Angeles, also launched a fundraising campaign to revamp and enlarge its flagship facility. But CEO Dr. Lisa Abdishoo now worries that some financial assumptions made in planning the expansion may no longer apply after Trump takes office on Friday. “We’re trying not to panic, but now we have to question the sustainability of some of the growth,” she said.\u003c/p>\n\u003cp>Health care advocates have advised community clinics that they may need to “look at 2009 levels” to plan for post-ACA operations, Abdishoo said. That year, Los Angeles Christian Health Centers served 6,600 patients a year, compared to 10,000 today.\u003c/p>\n\u003cp>Jane Garcia, CEO of La Clínica De La Raza, a 32-site clinic network in Alameda, Contra Costa and Solano Counties, said her organization could lose ground on hard-fought cost reductions if people’s insurance is taken away and they revert to their old behavior of seeking care only when they are very sick.\u003c/p>\n\u003cp>“Patients who don’t have coverage hesitate to come in and see the doctor, and they hesitate to seek preventive care,” Garcia said. “That’s the kind of thing that was starting to have an impact on bending the curve on cost reduction.”\u003c/p>\n\u003cp>ACA-related grants allowed La Clínica’s health centers to improve case management and collaborate more effectively with partners such as Sutter Health, which also saved money by reducing the number of patients seeking primary care in emergency rooms. La Clínica would probably have to cut such administrative efforts were the ACA repealed, Garcia said.\u003c/p>\n\u003cp>Pamela Richardson, a 60-year-old patient of Valley Community Healthcare who suffers from an iron absorption disorder called hereditary hemochromatosis, was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.\u003c/p>\n\u003cp>Once Richardson was covered, she got long-delayed primary care, which revealed that she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have pap smears,” she said. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”\u003c/p>\n\u003cdiv id=\"attachment_222383\" style=\"width: 780px\" class=\"wp-caption aligncenter\">\u003cimg class=\"wp-image-222383 size-khn-article-large\" src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-7_770.jpg?w=770&h=513&crop=1\" alt=\"Lisa Zeelander, a medical doctor at Valley Community Healthcare in North Hollywood, California, examines patient Pamela Richardson, 60, on Wednesday, December 21, 2016. (Heidi de Marco/KHN)\" width=\"770\" height=\"513\">\n\u003cp class=\"wp-caption-text\">Lisa Zeelander, a doctor at Valley Community Healthcare, examines Richardson in December 2016. (Heidi de Marco/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>Wilson, Castellano-Garcia and others said they plan to make precisely that case — that community clinics represent a good value — once state and federal officials begin mulling an ACA replacement in earnest.\u003c/p>\n\u003cp>A \u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303341\" target=\"_blank\">November 2016 study\u003c/a> in the American Journal of Public Health showed that Medicaid spending was 24 percent lower for patients who received a majority of their primary care from federally qualified health centers — a type of community clinic — than for patients who got care in other settings. The savings extended across all services, the study’s authors reported.\u003c/p>\n\u003cp>In rural Shasta County, where a majority voted for Trump, one in three people has Medi-Cal coverage. Dean Germano, CEO of Shasta Community Health in Redding, said he has already launched conversations with staffers of Republican U.S. Rep. Doug LaMalfa who he considers “a friend of the health centers.”\u003c/p>\n\u003cp>“Our mission is to make people like him realize what [repeal] will mean for people on the ground,” Germano said. “If the system goes through a major shock, what would happen to jobs? It would have a major impact on rural communities.”\u003c/p>\n\u003cp>Another clinic CEO, Kim Wyard of Northeast Valley Health Corporation in San Fernando, said she takes heart because Congress will have to do something to replace what it is taking away. Just blowing everything up isn’t an option, she said.\u003c/p>\n\u003cp>“We need a safety net, and if more patients are uninsured, we’ll need it more,” Wyard said. “We’re cost-effective,” she added. “Our new president wrote ‘The Art of the Deal.’ He likes a deal. I don’t think there’s a better deal than health centers.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Shefali Luthra contributed reporting.\u003c/em>\u003c/p>\n\n",
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"excerpt": "A flow of Medi-Cal expansion dollars — and patients — has fueled significant growth, making clinics in California one of the linchpins of primary care under the Affordable Care Act.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Paula Wilson has seen some tough times in her 23 years as the CEO of Valley Community Healthcare, a clinic that provides care for the poor in North Hollywood, Calif. But nothing was quite like November 9, the day after the U.S. elections, when walking around the office “was like coming into a funeral,” she said.\u003c/p>\n\u003cp>Her staff worried that a repeal of the Affordable Care Act, long promised by Republicans, would obliterate their jobs. Patients fretted it would jeopardize their care.\u003c/p>\n\u003cp>Nearly a third of the clinic’s 25,000 patients were newcomers, many of them recently covered through the expansion of Medi-Cal ushered in by the Affordable Care Act. Thanks to the expansion, Valley Community Healthcare had been growing rapidly, opening one new site, adding on to others, and offering patients new dental and mental health services.\u003c/p>\n\u003cp>What would happen if this new source of financial support were taken away?\u003c/p>\n\u003cp>Wilson didn’t have an answer that day, and she still doesn’t. But she’s hanging on to a cautious hope. “Pretty much that whole first week was getting a grip and assuring people: We’ve been here 46 years and we’re not going anywhere,” she said. “We’ve fought the fight before, and we’ll do it again.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In the absence of details about the impact and timing of a possible ACA repeal, Wilson’s brand of determination is all community clinics can count on for now.\u003c/p>\n\u003cp>Republicans, newly empowered by Donald Trump’s ascendance to the White House, have made clear they plan to repeal large parts of the landmark health care law in short order. The timing of any replacement is still uncertain, though political pressure has been growing recently for any void left by a repeal to be quickly filled with a new plan. For the time being, however, consumers are unlikely to see big changes in their health care.\u003c/p>\n\u003cp>Community clinics are key providers of primary care services for the poor. CaliforniaHealth+ Advocates, which represents the state’s clinics, estimates that they serve 6.2 million Californians — an increase of more than a million in less than five years. Today, more than 3.5 million community clinic patients are covered by Medi-Cal, California’s version of Medicaid, the federal health insurance program for people with low incomes.\u003c/p>\n\u003cp>More than half of patients who signed up for Medi-Cal after the advent of the ACA have gotten their primary care at community clinics, according to a December 2015 \u003ca href=\"http://www.chcf.org/publications/2015/12/medical-winwin-surging-enrollment\" target=\"_blank\">report\u003c/a> by the California Health Care Foundation. (California Healthline is an editorially independent service of the California Health Care Foundation.)\u003c/p>\n\u003cp>Historically supported by Democrats and Republicans alike, community clinics worked hard to implement Obamacare reforms, and they benefited as a result. Many, like Valley Community Healthcare, helped enroll patients and expanded their services, taking advantage of special ACA funding that enabled them to improve their facilities and systems of care.\u003c/p>\n\u003cp>The \u003ca href=\"http://khn.org/news/obamacare-boosted-community-health-centers-reach-now-what/\" target=\"_blank\">same scenario\u003c/a> has played out nationwide at many of 1,400 federally backed community health centers — a type of community clinic — according to two studies published recently in the journal \u003ca href=\"http://www.healthaffairs.org/\" target=\"_blank\">Health Affairs\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://content.healthaffairs.org/content/36/1/49.abstract\" target=\"_blank\">One of the studies\u003c/a>, which used data from 2012 to 2015 to track visits to community health centers, showed that in states that adopted the Medicaid expansion, the centers saw more patient visits, including those for mental health treatment, and lower rates of uninsured patients — a financial boon for clinics that typically operate on thin margins.\u003c/p>\n\u003cp>The second \u003ca href=\"http://content.healthaffairs.org/content/36/1/40.abstract\" target=\"_blank\">study\u003c/a> which examined data from 2011 to 2014, found that in the Medicaid expansion states, patients were more likely to receive asthma treatment when it was needed, have their body mass index assessed, get pap smears and keep their blood pressure relatively stable.\u003c/p>\n\u003cp>Proponents of the health reform law in California had hoped the expansion of community clinics would provide primary care for more patients, thus reducing expensive emergency room visits at safety-net hospitals.\u003c/p>\n\u003cp>“Health centers have been the poster child of positively embracing the ACA. They’ve gone along with everything,” said Blue Shield of California Foundation CEO Peter Long, whose organization supports the clinics. But without clarity about where funding will come from in the future, or how much of it there will be, it’s possible that clinics will “go into hunker-down mode,” he added. That could mean limiting hours, reinstating waiting lists for new patients and cutting promising new programs.\u003c/p>\n\u003cp>Implementing Obamacare “put a lot of stress on their systems,” Long said. “To unwind it would be equally hard.”\u003c/p>\n\u003cfigure class=\"layout-lg carousel-article carousel slide carousel-article-1\">\n\u003col class=\"carousel-indicators\">\n\u003cli class=\"active\">\n\u003cli>\n\u003cli>\n\u003c/ol>\n\u003cdiv class=\"carousel-inner\">\n\u003cdiv class=\"item active\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-1_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Paula Wilson, CEO of Valley Community Healthcare, says she has seen some tough times in her 23 years at the clinic which provides care for the poor in the area. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-2_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">The staff at Valley Community Healthcare worry that a promised Republican repeal of the Affordable Care Act would jeopardize the care offered to the 7,400 patients currently under the law. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-3_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Nearly a third of Valley Community Healthcare’s 25,000 customers are newcomers. Many had only recently secured health coverage through the Medicaid expansion provisions of the Affordable Care Act. After the election, Wilson spent the week assuring her customers: “We’ve been here 46 years and we’re not going anywhere,” said Wilson. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003c/div>\n\u003cp>\u003ca class=\"left carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-prev\">\u003c/span>\u003c/a>\u003ca class=\"right carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-next\">\u003c/span>\u003c/a>\u003c/p>\u003c/figure>\n\u003cp>Wilson and other clinic CEOs said they’re trying to anticipate worst-case scenarios and plan accordingly, but that’s hard when Congress hasn’t specified what changes it is planning, or when to expect them.\u003c/p>\n\u003cp>“Right now it’s all crystal ball gazing,” said Steven Wallace, associate director of the UCLA Center for Health Policy Research. “‘Repeal and replace’ is a great slogan, but ‘replace’ is really hard to figure out.”\u003c/p>\n\u003cp>Community clinic leaders say they’re focusing on several \u003ca href=\"http://khn.org/news/millions-could-lose-medicaid-coverage-under-trump-plan/\" target=\"_blank\">funding challenges\u003c/a>. First is a potential rollback of the ACA’s Medicaid expansion program, which extended new coverage to about 20 million people in the U.S., including more than 5 million in California, said Carmela Castellano-Garcia, CEO of CaliforniaHealth+ Advocates.\u003c/p>\n\u003cp>Some also worry that shifting Medicaid to a block grant system, an idea President-elect Trump has endorsed, would result in cuts to services; or that Congress could decline to reauthorize “330 funding” — an additional $5 billion community clinics receive each year from the federal government. That stream of federal dollars is set to expire in September of 2017.\u003c/p>\n\u003cp>That funding, in addition to payments from the Medi-Cal expansion, allowed the Los Angeles Christian Health Centers to add medical, mental health, dental and case management staff and open two new sites.\u003c/p>\n\u003cp>The clinic, headquartered on Skid Row in downtown Los Angeles, also launched a fundraising campaign to revamp and enlarge its flagship facility. But CEO Dr. Lisa Abdishoo now worries that some financial assumptions made in planning the expansion may no longer apply after Trump takes office on Friday. “We’re trying not to panic, but now we have to question the sustainability of some of the growth,” she said.\u003c/p>\n\u003cp>Health care advocates have advised community clinics that they may need to “look at 2009 levels” to plan for post-ACA operations, Abdishoo said. That year, Los Angeles Christian Health Centers served 6,600 patients a year, compared to 10,000 today.\u003c/p>\n\u003cp>Jane Garcia, CEO of La Clínica De La Raza, a 32-site clinic network in Alameda, Contra Costa and Solano Counties, said her organization could lose ground on hard-fought cost reductions if people’s insurance is taken away and they revert to their old behavior of seeking care only when they are very sick.\u003c/p>\n\u003cp>“Patients who don’t have coverage hesitate to come in and see the doctor, and they hesitate to seek preventive care,” Garcia said. “That’s the kind of thing that was starting to have an impact on bending the curve on cost reduction.”\u003c/p>\n\u003cp>ACA-related grants allowed La Clínica’s health centers to improve case management and collaborate more effectively with partners such as Sutter Health, which also saved money by reducing the number of patients seeking primary care in emergency rooms. La Clínica would probably have to cut such administrative efforts were the ACA repealed, Garcia said.\u003c/p>\n\u003cp>Pamela Richardson, a 60-year-old patient of Valley Community Healthcare who suffers from an iron absorption disorder called hereditary hemochromatosis, was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.\u003c/p>\n\u003cp>Once Richardson was covered, she got long-delayed primary care, which revealed that she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have pap smears,” she said. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”\u003c/p>\n\u003cdiv id=\"attachment_222383\" style=\"width: 780px\" class=\"wp-caption aligncenter\">\u003cimg class=\"wp-image-222383 size-khn-article-large\" src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-7_770.jpg?w=770&h=513&crop=1\" alt=\"Lisa Zeelander, a medical doctor at Valley Community Healthcare in North Hollywood, California, examines patient Pamela Richardson, 60, on Wednesday, December 21, 2016. (Heidi de Marco/KHN)\" width=\"770\" height=\"513\">\n\u003cp class=\"wp-caption-text\">Lisa Zeelander, a doctor at Valley Community Healthcare, examines Richardson in December 2016. (Heidi de Marco/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>Wilson, Castellano-Garcia and others said they plan to make precisely that case — that community clinics represent a good value — once state and federal officials begin mulling an ACA replacement in earnest.\u003c/p>\n\u003cp>A \u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303341\" target=\"_blank\">November 2016 study\u003c/a> in the American Journal of Public Health showed that Medicaid spending was 24 percent lower for patients who received a majority of their primary care from federally qualified health centers — a type of community clinic — than for patients who got care in other settings. The savings extended across all services, the study’s authors reported.\u003c/p>\n\u003cp>In rural Shasta County, where a majority voted for Trump, one in three people has Medi-Cal coverage. Dean Germano, CEO of Shasta Community Health in Redding, said he has already launched conversations with staffers of Republican U.S. Rep. Doug LaMalfa who he considers “a friend of the health centers.”\u003c/p>\n\u003cp>“Our mission is to make people like him realize what [repeal] will mean for people on the ground,” Germano said. “If the system goes through a major shock, what would happen to jobs? It would have a major impact on rural communities.”\u003c/p>\n\u003cp>Another clinic CEO, Kim Wyard of Northeast Valley Health Corporation in San Fernando, said she takes heart because Congress will have to do something to replace what it is taking away. Just blowing everything up isn’t an option, she said.\u003c/p>\n\u003cp>“We need a safety net, and if more patients are uninsured, we’ll need it more,” Wyard said. “We’re cost-effective,” she added. “Our new president wrote ‘The Art of the Deal.’ He likes a deal. I don’t think there’s a better deal than health centers.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Shefali Luthra contributed reporting.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"tagline": "The flip side of gentrification, told through one town",
"info": "Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?",
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},
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"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
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"order": 8
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},
"link": "https://www.cityarts.net",
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"order": 1
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
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"source": "Commonwealth Club of California"
},
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"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
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"source": "NPR"
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"hyphenacion": {
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"jerrybrown": {
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"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
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},
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"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
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},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
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