window.__IS_SSR__=true
window.__INITIAL_STATE__={
"attachmentsReducer": {
"audio_0": {
"type": "attachments",
"id": "audio_0",
"imgSizes": {
"kqedFullSize": {
"file": "https://ww2.kqed.org/news/wp-content/themes/KQED-unified/img/audio_bgs/background0.jpg"
}
}
},
"audio_1": {
"type": "attachments",
"id": "audio_1",
"imgSizes": {
"kqedFullSize": {
"file": "https://ww2.kqed.org/news/wp-content/themes/KQED-unified/img/audio_bgs/background1.jpg"
}
}
},
"audio_2": {
"type": "attachments",
"id": "audio_2",
"imgSizes": {
"kqedFullSize": {
"file": "https://ww2.kqed.org/news/wp-content/themes/KQED-unified/img/audio_bgs/background2.jpg"
}
}
},
"audio_3": {
"type": "attachments",
"id": "audio_3",
"imgSizes": {
"kqedFullSize": {
"file": "https://ww2.kqed.org/news/wp-content/themes/KQED-unified/img/audio_bgs/background3.jpg"
}
}
},
"audio_4": {
"type": "attachments",
"id": "audio_4",
"imgSizes": {
"kqedFullSize": {
"file": "https://ww2.kqed.org/news/wp-content/themes/KQED-unified/img/audio_bgs/background4.jpg"
}
}
},
"placeholder": {
"type": "attachments",
"id": "placeholder",
"imgSizes": {
"thumbnail": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-160x107.jpg",
"width": 160,
"height": 107,
"mimeType": "image/jpeg"
},
"medium": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-800x533.jpg",
"width": 800,
"height": 533,
"mimeType": "image/jpeg"
},
"medium_large": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-768x512.jpg",
"width": 768,
"height": 512,
"mimeType": "image/jpeg"
},
"large": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1020x680.jpg",
"width": 1020,
"height": 680,
"mimeType": "image/jpeg"
},
"1536x1536": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1536x1024.jpg",
"width": 1536,
"height": 1024,
"mimeType": "image/jpeg"
},
"fd-lrg": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1536x1024.jpg",
"width": 1536,
"height": 1024,
"mimeType": "image/jpeg"
},
"fd-med": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1020x680.jpg",
"width": 1020,
"height": 680,
"mimeType": "image/jpeg"
},
"fd-sm": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-800x533.jpg",
"width": 800,
"height": 533,
"mimeType": "image/jpeg"
},
"post-thumbnail": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-672x372.jpg",
"width": 672,
"height": 372,
"mimeType": "image/jpeg"
},
"twentyfourteen-full-width": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1038x576.jpg",
"width": 1038,
"height": 576,
"mimeType": "image/jpeg"
},
"xxsmall": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-160x107.jpg",
"width": 160,
"height": 107,
"mimeType": "image/jpeg"
},
"xsmall": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-672x372.jpg",
"width": 672,
"height": 372,
"mimeType": "image/jpeg"
},
"small": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-672x372.jpg",
"width": 672,
"height": 372,
"mimeType": "image/jpeg"
},
"xlarge": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1020x680.jpg",
"width": 1020,
"height": 680,
"mimeType": "image/jpeg"
},
"full-width": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1920x1280.jpg",
"width": 1920,
"height": 1280,
"mimeType": "image/jpeg"
},
"guest-author-32": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 32,
"height": 32,
"mimeType": "image/jpeg"
},
"guest-author-50": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 50,
"height": 50,
"mimeType": "image/jpeg"
},
"guest-author-64": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 64,
"height": 64,
"mimeType": "image/jpeg"
},
"guest-author-96": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 96,
"height": 96,
"mimeType": "image/jpeg"
},
"guest-author-128": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 128,
"height": 128,
"mimeType": "image/jpeg"
},
"detail": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 160,
"height": 160,
"mimeType": "image/jpeg"
},
"kqedFullSize": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1.jpg",
"width": 2000,
"height": 1333
}
}
},
"stateofhealth_354412": {
"type": "attachments",
"id": "stateofhealth_354412",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "354412",
"found": true
},
"parent": 354410,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-520x347.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 347
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-1024x576.jpg",
"width": 1024,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-160x107.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 107
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-960x640.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 640
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-375x250.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 250
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13.jpg",
"width": 1024,
"height": 683
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-1020x680.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 680
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-800x534.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 534
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-768x512.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 512
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/07/Mitch-McConnell-July-13-240x160.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 160
}
},
"publishDate": 1499983088,
"modified": 1499983149,
"caption": "Senate Majority Leader Mitch McConnell (R-KY) walks to a meeting of Republican senators where a new version of their healthcare bill was scheduled to be released at the U.S. Capitol July 13, 2017 in Washington, DC. ",
"description": null,
"title": "GOP Senators Continue Work On Revised Health Care Bill",
"credit": "Win McNamee/Getty Images",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_20482": {
"type": "attachments",
"id": "stateofhealth_20482",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "20482",
"found": true
},
"parent": 20449,
"imgSizes": {
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-400x266.jpg",
"width": 400,
"mimeType": "image/jpeg",
"height": 266
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-320x213.jpg",
"width": 320,
"mimeType": "image/jpeg",
"height": 213
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608.jpg",
"width": 4256,
"height": 2832
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-1440x958.jpg",
"width": 1440,
"mimeType": "image/jpeg",
"height": 958
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-800x532.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 532
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-1180x785.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 785
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-768x511.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 511
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-75x75.jpg",
"width": 75,
"mimeType": "image/jpeg",
"height": 75
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2014/08/110688608-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
}
},
"publishDate": 1406936718,
"modified": 1499377560,
"caption": null,
"description": null,
"title": "Woman with Alzheimer's",
"credit": "Sebastien Bozon/AFP/Getty Images",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_349026": {
"type": "attachments",
"id": "stateofhealth_349026",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "349026",
"found": true
},
"parent": 349025,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-520x390.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 390
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-160x120.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 120
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-960x720.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 720
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-375x281.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 281
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut.jpg",
"width": 1440,
"height": 1080
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-1020x765.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 765
},
"xlarge": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-1180x885.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 885
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-800x600.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 600
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-1180x885.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 885
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-768x576.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 576
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS13968_kaiser-1440-jpg-e1420908404158-qut-240x180.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 180
}
},
"publishDate": 1498863041,
"modified": 1498863091,
"caption": null,
"description": null,
"title": "RS13968_kaiser-1440-jpg-e1420908404158-qut",
"credit": "Lisa Aliferis/KQED",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_348980": {
"type": "attachments",
"id": "stateofhealth_348980",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "348980",
"found": true
},
"parent": 348976,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-520x346.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 346
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-160x107.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 107
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-375x250.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 250
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770.jpg",
"width": 770,
"height": 513
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-768x512.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 512
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/gettyimages-preexisting_condition_protest_770-240x160.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 160
}
},
"publishDate": 1498849094,
"modified": 1498849646,
"caption": "People protest Trump administration policies that threaten the Affordable Care Act, Medicare and Medicaid, near the Wilshire Federal Building on January 25, 2017 in Los Angeles, California. ",
"description": "People protest Trump administration policies that threaten the Affordable Care Act, Medicare and Medicaid, near the Wilshire Federal Building on January 25, 2017 in Los Angeles, California. ",
"title": "US-POLITICS-TRUMP-PROTEST",
"credit": "David McNew/AFP/Getty Images",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"news_11273798": {
"type": "attachments",
"id": "news_11273798",
"meta": {
"index": "attachments_1716263798",
"site": "news",
"id": "11273798",
"found": true
},
"parent": 11273732,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-520x281.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 281
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-160x87.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 87
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-375x203.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 203
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd.jpg",
"width": 926,
"height": 501
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-800x433.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 433
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"jmtc-small-thumb": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-280x150.jpg",
"width": 280,
"mimeType": "image/jpeg",
"height": 150
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/10/2017/01/dollar-hero_Editetd-240x130.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 130
}
},
"publishDate": 1484687601,
"modified": 1484687642,
"caption": null,
"description": null,
"title": "dollar-hero_Editetd",
"credit": "Francis Ying/KHN",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_283889": {
"type": "attachments",
"id": "stateofhealth_283889",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "283889",
"found": true
},
"parent": 283882,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-520x347.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 347
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-160x107.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 107
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-375x250.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 250
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills.jpg",
"width": 770,
"height": 514
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"jmtc-small-thumb": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-280x150.jpg",
"width": 280,
"mimeType": "image/jpeg",
"height": 150
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-768x513.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 513
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/HIV-pills-240x160.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 160
}
},
"publishDate": 1484354769,
"modified": 1484354803,
"caption": "Louis Arevalo holds his Truvada pills. The drug Truvada, used to halt HIV infection, has been shown to be over 90 percent effective when used correctly. ",
"description": null,
"title": "hiv-pills",
"credit": "Heidi de Marco/KHN",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_280736": {
"type": "attachments",
"id": "stateofhealth_280736",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "280736",
"found": true
},
"parent": 280735,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-520x347.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 347
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-160x107.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 107
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-960x641.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 641
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-375x250.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 250
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-e1483583358257.jpg",
"width": 1920,
"height": 1281
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-1020x681.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 681
},
"xlarge": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-1180x788.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 788
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-800x534.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 534
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"jmtc-small-thumb": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-280x150.jpg",
"width": 280,
"mimeType": "image/jpeg",
"height": 150
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-1920x1281.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1281
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-1180x788.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 788
},
"full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-1920x1281.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1281
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-768x513.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 513
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/01/alzheimer-gene-11-240x160.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 160
}
},
"publishDate": 1483583207,
"modified": 1483583287,
"caption": "Rosemary Navarro, 40, has a rare kind of early onset Alzheimer’s disease that researchers believe traces back to one individual family from Jalisco, Mexico. Navarro looks through old childhood photographs to find a picture of her mother, Rosa Maria Navarro, who also had the familial version of the disease.",
"description": null,
"title": "alzheimer-gene-11",
"credit": "Heidi de Marco/Kaiser Health News",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_274565": {
"type": "attachments",
"id": "stateofhealth_274565",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "274565",
"found": true
},
"parent": 274563,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-520x347.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 347
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-160x107.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 107
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-960x640.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 640
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-375x250.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 250
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-e1482365383838.jpg",
"width": 1920,
"height": 1281
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-1020x680.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 680
},
"xlarge": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-1180x787.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 787
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-800x534.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 534
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"jmtc-small-thumb": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-280x150.jpg",
"width": 280,
"mimeType": "image/jpeg",
"height": 150
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-1920x1281.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1281
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-1180x787.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 787
},
"full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-1920x1281.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1281
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-768x512.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 512
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/RS9434_450630099-240x160.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 160
}
},
"publishDate": 1482365277,
"modified": 1482365345,
"caption": null,
"description": "Obamacare\nAffordable Care Act",
"title": "Affordable Care Act (ACA) Enrollment Fair Held In Southern California",
"credit": "David McNew/Getty Images",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_272130": {
"type": "attachments",
"id": "stateofhealth_272130",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "272130",
"found": true
},
"parent": 272110,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-520x347.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 347
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-160x107.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 107
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-960x640.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 640
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-375x250.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 250
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-e1481846296429.jpg",
"width": 1920,
"height": 1280
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-1020x680.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 680
},
"xlarge": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-1180x787.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 787
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-800x533.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 533
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"jmtc-small-thumb": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-280x150.jpg",
"width": 280,
"mimeType": "image/jpeg",
"height": 150
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-1920x1280.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1280
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-1180x787.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 787
},
"full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-1920x1280.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1280
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-768x512.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 512
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/ACA-signup-240x160.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 160
}
},
"publishDate": 1481846170,
"modified": 1481846394,
"caption": " A specialist helps people select insurance plans during an enrollment fair in Pasadena on November 19, 2013 ",
"description": null,
"title": "Affordable Care Act (ACA) Enrollment Fair Held In Southern California",
"credit": "David McNew/Getty Images",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_271369": {
"type": "attachments",
"id": "stateofhealth_271369",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "271369",
"found": true
},
"parent": 271368,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-520x346.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 346
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-160x107.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 107
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-375x250.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 250
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax.jpg",
"width": 770,
"height": 513
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"jmtc-small-thumb": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-280x150.jpg",
"width": 280,
"mimeType": "image/jpeg",
"height": 150
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-768x512.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 512
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/12/KHN-soda-tax-240x160.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 160
}
},
"publishDate": 1481657806,
"modified": 1481676055,
"caption": "Yolanda Gutierrez and Elizabeth Bautista (L-R), health educators at La Clinica health centers in Oakland, Calif., called registered voters and went door-to-door in their neighborhoods in an effort to educate people about the city’s soda tax that was approved last month. ",
"description": "Yolanda Gutierrez and Elizabeth Bautista (L-R), health educators at La Clinica health centers in Oakland, Calif., called registered voters and went door-to-door in their neighborhoods in an effort to educate people about the city’s soda tax that was approved in November.",
"title": "khn-soda-tax",
"credit": "Ana B. Ibarra/California Healthline",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
}
},
"audioPlayerReducer": {
"postId": "stream_live",
"isPaused": true,
"isPlaying": false,
"pfsActive": false,
"pledgeModalIsOpen": true,
"playerDrawerIsOpen": false,
"liveAudioPlayStartedAt": 0,
"liveAudioPlayContext": ""
},
"authorsReducer": {
"byline_stateofhealth_354410": {
"type": "authors",
"id": "byline_stateofhealth_354410",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_354410",
"name": "\u003ca href=\"http://khn.org/news/author/julie-rovner/\">\u003cstrong>Julie Rovner\u003c/strong>\u003c/a>\u003c/span>",
"isLoading": false
},
"byline_stateofhealth_351133": {
"type": "authors",
"id": "byline_stateofhealth_351133",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_351133",
"name": "\u003ca href=\"http://khn.org/news/author/jordan-rau/\" target=\"_blank\">Jordan Rau\u003c/a>",
"isLoading": false
},
"byline_stateofhealth_349025": {
"type": "authors",
"id": "byline_stateofhealth_349025",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_349025",
"name": "\u003ca href=\"http://khn.org/news/author/jenny-gold/\" target=\"_blank\">Jenny Gold\u003c/a>",
"isLoading": false
},
"byline_stateofhealth_348976": {
"type": "authors",
"id": "byline_stateofhealth_348976",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_348976",
"name": "\u003ca href=\"http://khn.org/news/author/charlotte-huff/\" target=\"_blank\">Charlotte Huff\u003c/a>",
"isLoading": false
},
"byline_news_11273732": {
"type": "authors",
"id": "byline_news_11273732",
"meta": {
"override": true
},
"slug": "byline_news_11273732",
"name": "\u003ca href=\"http://khn.org/news/author/sarah-jane-tribble/\">\u003cstrong>Sarah Jane Tribble\u003c/strong>\u003c/a> and \u003ca href=\"http://khn.org/news/author/sydney-lupkin/\">\u003cstrong>Sydney Lupkin\u003c/strong>\u003c/a>\u003c/br>Kaiser Health News",
"isLoading": false
},
"byline_stateofhealth_283882": {
"type": "authors",
"id": "byline_stateofhealth_283882",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_283882",
"name": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/anna-gorman/\">Anna Gorman\u003c/a>\u003c/strong>\u003cbr/>Kaiser Health News",
"isLoading": false
},
"byline_stateofhealth_280735": {
"type": "authors",
"id": "byline_stateofhealth_280735",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_280735",
"name": "\u003ca href = \"http://khn.org/news/author/anna-gorman/\">Anna Gorman\u003c/a>\u003cbr/>Kaiser Health News",
"isLoading": false
},
"byline_stateofhealth_274563": {
"type": "authors",
"id": "byline_stateofhealth_274563",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_274563",
"name": "\u003ca href=\"http://khn.org/news/author/phil-galewitz/\">\u003cstrong>Phil Galewitz\u003c/strong>\u003c/a>",
"isLoading": false
},
"byline_stateofhealth_272110": {
"type": "authors",
"id": "byline_stateofhealth_272110",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_272110",
"name": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/pauline-bartolone\">Pauline Bartolone\u003c/a>\u003c/strong>",
"isLoading": false
},
"byline_stateofhealth_271368": {
"type": "authors",
"id": "byline_stateofhealth_271368",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_271368",
"name": "\u003cstrong>\u003ca href=\"http://khn.org/news/author/ana-b-ibarra/\">Ana Ibarra\u003c/a>\u003c/strong>",
"isLoading": false
}
},
"pagesReducer": {
"stateofhealth_affiliate_kaiser-health-news": {
"type": "terms",
"id": "stateofhealth_3007",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3007",
"score": 15.561474
},
"featImg": null,
"name": "Kaiser Health News",
"description": null,
"taxonomy": "affiliate",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Kaiser Health News Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3016,
"slug": "kaiser-health-news",
"isLoading": false,
"title": "Kaiser Health News",
"pageMeta": {
"site": "stateofhealth",
"WpPageTemplate": "page-topic-editorial",
"currentPage": 2
},
"blocks": [
{
"blockName": "kqed/post-list",
"attrs": {
"layout": "cardArticle2",
"query": "posts/stateofhealth?affiliate=kaiser-health-news",
"seeMore": false,
"paginated": true,
"page": 2
}
},
{
"blockName": "kqed/ad"
}
]
}
},
"pfsSessionReducer": {},
"postsReducer": {
"stream_live": {
"type": "live",
"id": "stream_live",
"audioUrl": "https://streams.kqed.org/kqedradio",
"title": "Live Stream",
"excerpt": "Live Stream information currently unavailable.",
"link": "/radio",
"featImg": "",
"label": {
"name": "KQED Live",
"link": "/"
}
},
"stream_kqedNewscast": {
"type": "posts",
"id": "stream_kqedNewscast",
"audioUrl": "https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1",
"title": "KQED Newscast",
"featImg": "",
"label": {
"name": "88.5 FM",
"link": "/"
}
},
"stateofhealth_354410": {
"type": "posts",
"id": "stateofhealth_354410",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "354410",
"score": null,
"sort": [
1499983375000
]
},
"guestAuthors": [],
"slug": "senate-health-bill-still-short-on-yays-but-leaders-vow-vote-next-week",
"title": "GOP Health Bill Still Short On ‘Yays’ But Leaders Vow Vote Next Week",
"publishDate": 1499983375,
"format": "standard",
"headTitle": "GOP Health Bill Still Short On ‘Yays’ But Leaders Vow Vote Next Week | KQED",
"labelTerm": {
"term": 3007,
"site": "stateofhealth"
},
"content": "\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
"blocks": [],
"excerpt": "Senate GOP leaders released their revised bill to 'repeal and replace' Obamacare, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary.",
"status": "publish",
"parent": 0,
"modified": 1721110677,
"stats": {
"hasAudio": false,
"hasVideo": false,
"hasChartOrMap": false,
"iframeSrcs": [],
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"hasPolis": false,
"paragraphCount": 26,
"wordCount": 1002
},
"headData": {
"title": "GOP Health Bill Still Short On ‘Yays’ But Leaders Vow Vote Next Week",
"description": "Senate GOP leaders released their revised bill to 'repeal and replace' Obamacare, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary.",
"ogTitle": "",
"ogDescription": "",
"ogImgId": "",
"twTitle": "",
"twDescription": "",
"twImgId": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "GOP Health Bill Still Short On ‘Yays’ But Leaders Vow Vote Next Week",
"datePublished": "2017-07-13T15:02:55-07:00",
"dateModified": "2024-07-15T23:17:57-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"sticky": false,
"nprByline": "\u003ca href=\"http://khn.org/news/author/julie-rovner/\">\u003cstrong>Julie Rovner\u003c/strong>\u003c/a>\u003c/span>",
"path": "/stateofhealth/354410/senate-health-bill-still-short-on-yays-but-leaders-vow-vote-next-week",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/354410/senate-health-bill-still-short-on-yays-but-leaders-vow-vote-next-week",
"authors": [
"byline_stateofhealth_354410"
],
"categories": [
"stateofhealth_15",
"stateofhealth_14"
],
"tags": [
"stateofhealth_3120",
"stateofhealth_2808",
"stateofhealth_2519",
"stateofhealth_365"
],
"affiliates": [
"stateofhealth_3007"
],
"featImg": "stateofhealth_354412",
"label": "stateofhealth_3007"
},
"stateofhealth_351133": {
"type": "posts",
"id": "stateofhealth_351133",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "351133",
"score": null,
"sort": [
1499378023000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth",
"term": 3007
},
"blocks": [],
"publishDate": 1499378023,
"format": "standard",
"disqusTitle": "Half of Nursing Homes Scrutinized on Safety Still Treacherous",
"title": "Half of Nursing Homes Scrutinized on Safety Still Treacherous",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>In 2012, Parkview Healthcare Center’s history of safety violations led California regulators to issue an ultimatum reserved for the most dangerous nursing homes.\u003c/p>\n\u003cp>The state’s public health department designated Parkview, a Bakersfield, Calif., nursing home, a “special focus facility,” requiring it to either fix lapses in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive. After 15 months of scrutiny, the regulators deemed Parkview improved and released it from extra oversight.\u003c/p>\n\u003cp>But a few months later, Elaine Fisher, a 74-year-old who had lost the use of her legs after a stroke, slid out of her wheelchair at Parkview. Afterward, the nursing home promised to place a nonskid pad on her chair but did not, inspectors later found. Twice more, Fisher slipped from her wheelchair, fracturing her hip the final time.\u003c/p>\n\u003cp>The violation drew a $10,000 penalty for Parkview, one of 10 fines totaling $126,300 incurred by the nursing home since the special focus status was lifted in 2014.\u003c/p>\n\u003cp>While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to a Kaiser Health News analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>These nursing homes are in 46 states. Some gave patients the wrong medications, failed to protect them from violent or bullying residents and staff members, or neglected to tell families or physicians about injuries, inspection records show. Years after regulators conferred clean bills of health, levels of registered nurses tend to remain lower than at other facilities.\u003c/p>\n\u003cp>Yet, despite recurrences of patient harm, nursing homes are rarely denied Medicare and Medicaid reimbursement. Consequences can be dire for patients like Fisher.\u003c/p>\n\u003cp>“She used to go to bingo every day and she was very involved in the nursing home,” said her son-in-law, Eric Powers. He said that although Fisher moved to a different nursing home for better care, “after this whole thing, she has to be on painkillers. She’s mainly in her room all the time. It’s the saddest thing in the world.”\u003c/p>\n\u003cp>Parkview’s owner at the time of the violations, LifeHouse Health Services, did not respond to requests for comment. Dr. David Silver, who purchased Parkview last fall, said he had replaced top management and staff members who resisted a new approach.\u003c/p>\n\u003cp>“We were not happy with the level of patient care,” he said.\u003c/p>\n\u003cp>Regulators rarely return homes to the watch list, instead issuing fines for subsequent lapses. Some homes continue operating despite multiple penalties.\u003c/p>\n\u003cp>“When you’re looking at these large corporations, that’s just the cost of doing business,” said Neil Gehlawat, who is representing Fisher in her pending lawsuit against Parkview. “It doesn’t have the effect of changing behavior.”\u003c/p>\n\u003cp>\u003cstrong>‘Worst Of The Worst’\u003c/strong>\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services, or CMS, sets the federal standards for nursing homes and determines whether they are in compliance, based on inspections performed primarily by state health departments. States license facilities and have the authority to revoke the licenses.\u003c/p>\n\u003cp>Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The federal government assigns each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.\u003c/p>\n\u003cp>More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts negotiated by President Barack Obama and Congress. This year, the $2.6 million budget allows only 88 nursing homes to \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-20.pdf\">receive the designation\u003c/a>, though regulators identified 435 as warranting scrutiny. California and Texas each has six slots, the most of any state. Twenty-nine states have just one.\u003c/p>\n\u003cp>Especially troubling is that more than a third of operating nursing facilities that graduated from the watch list before 2014 still hold the lowest possible Medicare rating for health and safety: one star of five, KHN’s analysis found.\u003c/p>\n\u003cp>“You have this recidivism of nursing homes that are special focus facilities,” said Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan. “These are the worst of the worst and they’re back?”\u003c/p>\n\u003cp>CMS defended the program, saying that nursing homes on the watch list showed more improvement than did comparably struggling facilities not selected for enhanced supervision. “CMS continues to work to improve oversight to prevent any facility from regressing in performance,” the statement said.\u003c/p>\n\u003cfigure id=\"attachment_351140\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-351140\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg\" alt=\"Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-520x346.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo.jpg 1540w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators. \u003ccite>(Doug Kapustin/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Short-Term Oversight\u003c/strong>\u003c/p>\n\u003cp>Special scrutiny was lifted for about one-fourth of the nursing homes in less than a year. Facilities need to pass only two consecutive inspections without major violations or substantiated complaints.\u003c/p>\n\u003cp>“The period of time is just not long enough for them to show that they can sustain improvement,” said Robyn Grant, director for public policy at the National Consumer Voice for Quality Long-Term Care in Washington. “There needs to be some significant changes in the program.”\u003c/p>\n\u003cp>In 2010, NMS Healthcare of Hagerstown, Md., left the watch list after 10 months.\u003c/p>\n\u003cp>Last year, Maryland’s attorney general \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\">sued the facility and its owner,\u003c/a> Neiswanger Management Services, \u003ca href=\"http://www.marylandattorneygeneral.gov/Press/2016/122116.pdf\">alleging that they evicted\u003c/a> frail, infirm and mentally disabled residents “with brutal indifference” when their health coverage ran out or the facility had the opportunity to get someone with better insurance.\u003c/p>\n\u003cp>Among those was Andrew Edwards, who was told by NMS that he was being discharged to an assisted-living center, according to the lawsuit. Instead, in January 2016, the staff sent him to a crowded, unlicensed Baltimore City row house where the owner confiscated his bank card and withdrew $966 over his objections, the lawsuit said. Although NMS said it had arranged for his outpatient kidney dialysis, “that was false,” Edwards said in an interview. He ended up in an emergency room after he missed his treatment.\u003c/p>\n\u003cp>NMS maintains it stopped referring patients to that owner when told of the conditions. This month, CMS expelled the Hagerstown nursing home from Medicare and Medicaid after citing it for more violations. The company is closing the facility. NMS, which still runs other homes in Maryland, has sued state regulators, claiming they are vindictively trying to drive the chain out of business.\u003c/p>\n\u003cp>\u003cstrong>Few Terminations\u003c/strong>\u003c/p>\n\u003cp>Some nursing homes on the watch list do maintain improvements. After Evergreen Nursing Home in southern Alabama was designated a special focus facility in 2005, the owners brought in new managers and added nursing supervisors, said Kimberly Bush, the facility’s administrator.\u003c/p>\n\u003cp>Medicare now rates Evergreen a five-star facility. “I’d like to say there’s some kind of magic recipe to this, but it’s just doing the job and holding people accountable,” Bush said.\u003c/p>\n\u003cp>But even prolonged supervision does not guarantee progress. Poplar Point Health and Rehabilitation in Memphis stayed on the watch list for 2½ years until 2009. A \u003ca href=\"https://www.justice.gov/opa/pr/united-states-files-false-claims-act-complaint-against-six-vanguard-nursing-facilities-and\">federal lawsuit brought last year\u003c/a> claims that Poplar and its owner, Vanguard Healthcare, regularly provided “nonexistent, grossly substandard, worthless care” as far back as 2010. Vanguard, now in bankruptcy court, declined to comment.\u003c/p>\n\u003cp>\u003cem>(Story continues below.)\u003c/em>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/Sfw8o/12/\" scrolling=\"yes\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"600\" height=\"600\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The ultimate enforcement threats are termination from Medicare and Medicaid or closure by state or federal authorities. But only 17 percent of former special focus facilities are no longer operating, and that can include ones that went out of business for unrelated reasons, KHN found.\u003c/p>\n\u003cp>State regulators are reluctant to close nursing homes because of the upheaval it causes patients and families. In some areas, there are no alternative facilities nearby, making termination even less appealing.\u003c/p>\n\u003cp>“At the end of the day, there are those centers that cannot be corrected, can’t fix themselves, and the best thing for the patients and the residents might be for them to move to another location,” said Lyn Bentley, an executive at the American Health Care Association, a nursing facility trade group. But, she said, “it’s always difficult to close someone’s home.”\u003c/p>\n\u003cp>\u003cstrong>Lack Of Nurses\u003c/strong>\u003c/p>\n\u003cp>Too few nurses, particularly registered nurses, provide care at some of the most troubled homes, KHN’s analysis shows. Registered nurse staffing was still 12 percent lower than at other facilities, even three years after the homes were released from the watch list.\u003c/p>\n\u003cp>In 2009, Pennsylvania health regulators released Golden LivingCenter-West Shore in Camp Hill after 17 months of supervision. The company said in a recent statement that when a home was put on that list, “we mobilize the resources necessary to help get that LivingCenter back into compliance.”\u003c/p>\n\u003cp>But data from Medicare’s Nursing Home Compare website show the facility has among the worst nurse-to-patient staffing ratios in the nation, with registered nurses devoting an average of 12 minutes for each patient daily. The state average is 58 minutes daily per patient.\u003c/p>\n\u003cp>Golden LivingCenter-West Shore was fined $59,150 in 2015 after being cited for, among other violations, allowing a resident’s feeding tube to become infested with maggots, records show. Also, Golden Living agreed to pay $750,000 to settle three cases involving patient injuries from falls that occurred after extra oversight ended, court records show.\u003c/p>\n\u003cp>Last year, Golden Living sold its Pennsylvania homes to Priority Healthcare Group.\u003c/p>\n\u003cp>Priority is following a common strategy for shedding an unwanted reputation: changing the facility’s name. In California, Parkview — where Fisher slipped out of her wheelchair — is being rebranded too, as Kingston Healthcare Center.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
"disqusIdentifier": "351133 https://ww2.kqed.org/stateofhealth/?p=351133",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/07/06/half-of-nursing-homes-scrutinized-on-safety-still-treacherous/",
"stats": {
"hasVideo": false,
"hasChartOrMap": true,
"hasAudio": false,
"hasPolis": false,
"wordCount": 1762,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [
"//datawrapper.dwcdn.net/Sfw8o/12/"
],
"paragraphCount": 45
},
"modified": 1499378023,
"excerpt": "Nursing homes that have graduated from an unsafe status by Medicare and are still operating have harmed patients.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "Nursing homes that have graduated from an unsafe status by Medicare and are still operating have harmed patients.",
"title": "Half of Nursing Homes Scrutinized on Safety Still Treacherous | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Half of Nursing Homes Scrutinized on Safety Still Treacherous",
"datePublished": "2017-07-06T14:53:43-07:00",
"dateModified": "2017-07-06T14:53:43-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "half-of-nursing-homes-scrutinized-on-safety-still-treacherous",
"status": "publish",
"nprByline": "\u003ca href=\"http://khn.org/news/author/jordan-rau/\" target=\"_blank\">Jordan Rau\u003c/a>",
"path": "/stateofhealth/351133/half-of-nursing-homes-scrutinized-on-safety-still-treacherous",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In 2012, Parkview Healthcare Center’s history of safety violations led California regulators to issue an ultimatum reserved for the most dangerous nursing homes.\u003c/p>\n\u003cp>The state’s public health department designated Parkview, a Bakersfield, Calif., nursing home, a “special focus facility,” requiring it to either fix lapses in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive. After 15 months of scrutiny, the regulators deemed Parkview improved and released it from extra oversight.\u003c/p>\n\u003cp>But a few months later, Elaine Fisher, a 74-year-old who had lost the use of her legs after a stroke, slid out of her wheelchair at Parkview. Afterward, the nursing home promised to place a nonskid pad on her chair but did not, inspectors later found. Twice more, Fisher slipped from her wheelchair, fracturing her hip the final time.\u003c/p>\n\u003cp>The violation drew a $10,000 penalty for Parkview, one of 10 fines totaling $126,300 incurred by the nursing home since the special focus status was lifted in 2014.\u003c/p>\n\u003cp>While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to a Kaiser Health News analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>These nursing homes are in 46 states. Some gave patients the wrong medications, failed to protect them from violent or bullying residents and staff members, or neglected to tell families or physicians about injuries, inspection records show. Years after regulators conferred clean bills of health, levels of registered nurses tend to remain lower than at other facilities.\u003c/p>\n\u003cp>Yet, despite recurrences of patient harm, nursing homes are rarely denied Medicare and Medicaid reimbursement. Consequences can be dire for patients like Fisher.\u003c/p>\n\u003cp>“She used to go to bingo every day and she was very involved in the nursing home,” said her son-in-law, Eric Powers. He said that although Fisher moved to a different nursing home for better care, “after this whole thing, she has to be on painkillers. She’s mainly in her room all the time. It’s the saddest thing in the world.”\u003c/p>\n\u003cp>Parkview’s owner at the time of the violations, LifeHouse Health Services, did not respond to requests for comment. Dr. David Silver, who purchased Parkview last fall, said he had replaced top management and staff members who resisted a new approach.\u003c/p>\n\u003cp>“We were not happy with the level of patient care,” he said.\u003c/p>\n\u003cp>Regulators rarely return homes to the watch list, instead issuing fines for subsequent lapses. Some homes continue operating despite multiple penalties.\u003c/p>\n\u003cp>“When you’re looking at these large corporations, that’s just the cost of doing business,” said Neil Gehlawat, who is representing Fisher in her pending lawsuit against Parkview. “It doesn’t have the effect of changing behavior.”\u003c/p>\n\u003cp>\u003cstrong>‘Worst Of The Worst’\u003c/strong>\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services, or CMS, sets the federal standards for nursing homes and determines whether they are in compliance, based on inspections performed primarily by state health departments. States license facilities and have the authority to revoke the licenses.\u003c/p>\n\u003cp>Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The federal government assigns each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.\u003c/p>\n\u003cp>More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts negotiated by President Barack Obama and Congress. This year, the $2.6 million budget allows only 88 nursing homes to \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-20.pdf\">receive the designation\u003c/a>, though regulators identified 435 as warranting scrutiny. California and Texas each has six slots, the most of any state. Twenty-nine states have just one.\u003c/p>\n\u003cp>Especially troubling is that more than a third of operating nursing facilities that graduated from the watch list before 2014 still hold the lowest possible Medicare rating for health and safety: one star of five, KHN’s analysis found.\u003c/p>\n\u003cp>“You have this recidivism of nursing homes that are special focus facilities,” said Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan. “These are the worst of the worst and they’re back?”\u003c/p>\n\u003cp>CMS defended the program, saying that nursing homes on the watch list showed more improvement than did comparably struggling facilities not selected for enhanced supervision. “CMS continues to work to improve oversight to prevent any facility from regressing in performance,” the statement said.\u003c/p>\n\u003cfigure id=\"attachment_351140\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-351140\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg\" alt=\"Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-520x346.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo.jpg 1540w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators. \u003ccite>(Doug Kapustin/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Short-Term Oversight\u003c/strong>\u003c/p>\n\u003cp>Special scrutiny was lifted for about one-fourth of the nursing homes in less than a year. Facilities need to pass only two consecutive inspections without major violations or substantiated complaints.\u003c/p>\n\u003cp>“The period of time is just not long enough for them to show that they can sustain improvement,” said Robyn Grant, director for public policy at the National Consumer Voice for Quality Long-Term Care in Washington. “There needs to be some significant changes in the program.”\u003c/p>\n\u003cp>In 2010, NMS Healthcare of Hagerstown, Md., left the watch list after 10 months.\u003c/p>\n\u003cp>Last year, Maryland’s attorney general \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\">sued the facility and its owner,\u003c/a> Neiswanger Management Services, \u003ca href=\"http://www.marylandattorneygeneral.gov/Press/2016/122116.pdf\">alleging that they evicted\u003c/a> frail, infirm and mentally disabled residents “with brutal indifference” when their health coverage ran out or the facility had the opportunity to get someone with better insurance.\u003c/p>\n\u003cp>Among those was Andrew Edwards, who was told by NMS that he was being discharged to an assisted-living center, according to the lawsuit. Instead, in January 2016, the staff sent him to a crowded, unlicensed Baltimore City row house where the owner confiscated his bank card and withdrew $966 over his objections, the lawsuit said. Although NMS said it had arranged for his outpatient kidney dialysis, “that was false,” Edwards said in an interview. He ended up in an emergency room after he missed his treatment.\u003c/p>\n\u003cp>NMS maintains it stopped referring patients to that owner when told of the conditions. This month, CMS expelled the Hagerstown nursing home from Medicare and Medicaid after citing it for more violations. The company is closing the facility. NMS, which still runs other homes in Maryland, has sued state regulators, claiming they are vindictively trying to drive the chain out of business.\u003c/p>\n\u003cp>\u003cstrong>Few Terminations\u003c/strong>\u003c/p>\n\u003cp>Some nursing homes on the watch list do maintain improvements. After Evergreen Nursing Home in southern Alabama was designated a special focus facility in 2005, the owners brought in new managers and added nursing supervisors, said Kimberly Bush, the facility’s administrator.\u003c/p>\n\u003cp>Medicare now rates Evergreen a five-star facility. “I’d like to say there’s some kind of magic recipe to this, but it’s just doing the job and holding people accountable,” Bush said.\u003c/p>\n\u003cp>But even prolonged supervision does not guarantee progress. Poplar Point Health and Rehabilitation in Memphis stayed on the watch list for 2½ years until 2009. A \u003ca href=\"https://www.justice.gov/opa/pr/united-states-files-false-claims-act-complaint-against-six-vanguard-nursing-facilities-and\">federal lawsuit brought last year\u003c/a> claims that Poplar and its owner, Vanguard Healthcare, regularly provided “nonexistent, grossly substandard, worthless care” as far back as 2010. Vanguard, now in bankruptcy court, declined to comment.\u003c/p>\n\u003cp>\u003cem>(Story continues below.)\u003c/em>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/Sfw8o/12/\" scrolling=\"yes\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"600\" height=\"600\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The ultimate enforcement threats are termination from Medicare and Medicaid or closure by state or federal authorities. But only 17 percent of former special focus facilities are no longer operating, and that can include ones that went out of business for unrelated reasons, KHN found.\u003c/p>\n\u003cp>State regulators are reluctant to close nursing homes because of the upheaval it causes patients and families. In some areas, there are no alternative facilities nearby, making termination even less appealing.\u003c/p>\n\u003cp>“At the end of the day, there are those centers that cannot be corrected, can’t fix themselves, and the best thing for the patients and the residents might be for them to move to another location,” said Lyn Bentley, an executive at the American Health Care Association, a nursing facility trade group. But, she said, “it’s always difficult to close someone’s home.”\u003c/p>\n\u003cp>\u003cstrong>Lack Of Nurses\u003c/strong>\u003c/p>\n\u003cp>Too few nurses, particularly registered nurses, provide care at some of the most troubled homes, KHN’s analysis shows. Registered nurse staffing was still 12 percent lower than at other facilities, even three years after the homes were released from the watch list.\u003c/p>\n\u003cp>In 2009, Pennsylvania health regulators released Golden LivingCenter-West Shore in Camp Hill after 17 months of supervision. The company said in a recent statement that when a home was put on that list, “we mobilize the resources necessary to help get that LivingCenter back into compliance.”\u003c/p>\n\u003cp>But data from Medicare’s Nursing Home Compare website show the facility has among the worst nurse-to-patient staffing ratios in the nation, with registered nurses devoting an average of 12 minutes for each patient daily. The state average is 58 minutes daily per patient.\u003c/p>\n\u003cp>Golden LivingCenter-West Shore was fined $59,150 in 2015 after being cited for, among other violations, allowing a resident’s feeding tube to become infested with maggots, records show. Also, Golden Living agreed to pay $750,000 to settle three cases involving patient injuries from falls that occurred after extra oversight ended, court records show.\u003c/p>\n\u003cp>Last year, Golden Living sold its Pennsylvania homes to Priority Healthcare Group.\u003c/p>\n\u003cp>Priority is following a common strategy for shedding an unwanted reputation: changing the facility’s name. In California, Parkview — where Fisher slipped out of her wheelchair — is being rebranded too, as Kingston Healthcare Center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "floatright"
},
"numeric": [
"floatright"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/351133/half-of-nursing-homes-scrutinized-on-safety-still-treacherous",
"authors": [
"byline_stateofhealth_351133"
],
"categories": [
"stateofhealth_11",
"stateofhealth_1"
],
"tags": [
"stateofhealth_2808",
"stateofhealth_2972",
"stateofhealth_2519",
"stateofhealth_2829"
],
"affiliates": [
"stateofhealth_3007"
],
"featImg": "stateofhealth_20482",
"label": "stateofhealth_3007"
},
"stateofhealth_349025": {
"type": "posts",
"id": "stateofhealth_349025",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "349025",
"score": null,
"sort": [
1498928455000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth",
"term": 3007
},
"blocks": [],
"publishDate": 1498928455,
"format": "standard",
"disqusTitle": "Kaiser Permanente Cited -- Again -- For Mental Health Access Problems",
"title": "Kaiser Permanente Cited -- Again -- For Mental Health Access Problems",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>Despite three warnings and a multimillion-dollar fine a few years ago, Kaiser Permanente still fails to provide members with appropriate access to mental health care, according to \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_full%20service-behavioral%20health_061217.pdf\">a recent survey\u003c/a> of the HMO by the state of California.\u003c/p>\n\u003cp>The routine survey, released by the state Department of Managed Health Care, found that Kaiser Foundation Health Plan did not provide enrollees \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\">with “timely access” to behavioral health treatment\u003c/a>, in violation of state law. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>The matter has now been referred back to the state Office of Enforcement for further action, which could include an additional fine.\u003c/p>\n\u003cp>California’s timely access laws require insurers to provide patients access to a medical appointment within 48 hours for an urgent problem, or within 10 business days for a non-urgent issue. Kaiser patients, however, often have to wait longer, according to the department.\u003c/p>\n\u003cp>The survey looked at Kaiser’s behavioral health files through Jan. 1, 2015. The department found that while the HMO had “undertaken extensive and meaningful efforts” to improve access to mental health care, the problems remain.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Headquartered in Oakland, \u003ca href=\"https://share.kaiserpermanente.org/article/fast-facts-about-kaiser-permanente/\">Kaiser Permanente\u003c/a> is one of the largest not-for-profit managed health care plans in the country, with an annual operating revenue of $64.6 billion and 8.5 million members in California.\u003c/p>\n\u003cp>In a formal response to the watchdog agency, Kaiser listed more than 10 changes it has made to improve members’ access to mental health care, including contracting with providers outside of the organization and aggressively recruiting and hiring clinicians. The plan cited internal audits finding that they complied with timely access laws more than 90 percent of the time and stated “a corrective action plan is not warranted.”\u003c/p>\n\u003cp>“We have made great progress over the nearly two years since this survey was begun to improve access by hiring over 1,030 new psychiatrists and therapists, expanding our network of community practitioners, and introducing more convenient ways to access treatment,” John Nelson, vice president of government relations for Kaiser, wrote in an email to Kaiser Health News.\u003c/p>\n\u003cp>The department, however, responded in its report that while Kaiser Permanente has been working with Office of Enforcement to correct the problems, “the access issues remain unresolved.”\u003c/p>\n\u003cp>In 2013, Kaiser agreed to pay a $4 million fine for several deficiencies in the plan’s delivery of mental health services — one of the largest ever paid by an insurer in the state. In 2015, the department found that \u003ca href=\"http://khn.org/news/kaiser-permanente-faulted-again-for-mental-health-care-in-california/\">some Kaiser patients still had to wait\u003c/a> weeks or even months to see a psychiatrist or a therapist.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_behavioral%20follow%20up_021315.pdf\">one case cited by the department\u003c/a> in a 2015 survey, a child was brought in by her father because of “aggressive behaviors, sexualized behaviors and significant behavioral problems in both the home and school environment.” The family told providers that they were “in crisis” and “pleaded for treatment.” The child, however, was not seen for therapy until seven weeks later.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
"disqusIdentifier": "349025 https://ww2.kqed.org/stateofhealth/?p=349025",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/07/01/kaiser-permanente-cited-again-for-mental-health-access-problems/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 543,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 14
},
"modified": 1498863699,
"excerpt": "California’s HMO watchdog agency says Kaiser Permanente is making mental health patients wait too long for treatment.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "California’s HMO watchdog agency says Kaiser Permanente is making mental health patients wait too long for treatment.",
"title": "Kaiser Permanente Cited -- Again -- For Mental Health Access Problems | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Kaiser Permanente Cited -- Again -- For Mental Health Access Problems",
"datePublished": "2017-07-01T10:00:55-07:00",
"dateModified": "2017-06-30T16:01:39-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "kaiser-permanente-cited-again-for-mental-health-access-problems",
"status": "publish",
"nprByline": "\u003ca href=\"http://khn.org/news/author/jenny-gold/\" target=\"_blank\">Jenny Gold\u003c/a>",
"path": "/stateofhealth/349025/kaiser-permanente-cited-again-for-mental-health-access-problems",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Despite three warnings and a multimillion-dollar fine a few years ago, Kaiser Permanente still fails to provide members with appropriate access to mental health care, according to \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_full%20service-behavioral%20health_061217.pdf\">a recent survey\u003c/a> of the HMO by the state of California.\u003c/p>\n\u003cp>The routine survey, released by the state Department of Managed Health Care, found that Kaiser Foundation Health Plan did not provide enrollees \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\">with “timely access” to behavioral health treatment\u003c/a>, in violation of state law. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>The matter has now been referred back to the state Office of Enforcement for further action, which could include an additional fine.\u003c/p>\n\u003cp>California’s timely access laws require insurers to provide patients access to a medical appointment within 48 hours for an urgent problem, or within 10 business days for a non-urgent issue. Kaiser patients, however, often have to wait longer, according to the department.\u003c/p>\n\u003cp>The survey looked at Kaiser’s behavioral health files through Jan. 1, 2015. The department found that while the HMO had “undertaken extensive and meaningful efforts” to improve access to mental health care, the problems remain.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Headquartered in Oakland, \u003ca href=\"https://share.kaiserpermanente.org/article/fast-facts-about-kaiser-permanente/\">Kaiser Permanente\u003c/a> is one of the largest not-for-profit managed health care plans in the country, with an annual operating revenue of $64.6 billion and 8.5 million members in California.\u003c/p>\n\u003cp>In a formal response to the watchdog agency, Kaiser listed more than 10 changes it has made to improve members’ access to mental health care, including contracting with providers outside of the organization and aggressively recruiting and hiring clinicians. The plan cited internal audits finding that they complied with timely access laws more than 90 percent of the time and stated “a corrective action plan is not warranted.”\u003c/p>\n\u003cp>“We have made great progress over the nearly two years since this survey was begun to improve access by hiring over 1,030 new psychiatrists and therapists, expanding our network of community practitioners, and introducing more convenient ways to access treatment,” John Nelson, vice president of government relations for Kaiser, wrote in an email to Kaiser Health News.\u003c/p>\n\u003cp>The department, however, responded in its report that while Kaiser Permanente has been working with Office of Enforcement to correct the problems, “the access issues remain unresolved.”\u003c/p>\n\u003cp>In 2013, Kaiser agreed to pay a $4 million fine for several deficiencies in the plan’s delivery of mental health services — one of the largest ever paid by an insurer in the state. In 2015, the department found that \u003ca href=\"http://khn.org/news/kaiser-permanente-faulted-again-for-mental-health-care-in-california/\">some Kaiser patients still had to wait\u003c/a> weeks or even months to see a psychiatrist or a therapist.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_behavioral%20follow%20up_021315.pdf\">one case cited by the department\u003c/a> in a 2015 survey, a child was brought in by her father because of “aggressive behaviors, sexualized behaviors and significant behavioral problems in both the home and school environment.” The family told providers that they were “in crisis” and “pleaded for treatment.” The child, however, was not seen for therapy until seven weeks later.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/349025/kaiser-permanente-cited-again-for-mental-health-access-problems",
"authors": [
"byline_stateofhealth_349025"
],
"categories": [
"stateofhealth_3012",
"stateofhealth_1"
],
"tags": [
"stateofhealth_2808",
"stateofhealth_2972",
"stateofhealth_2607",
"stateofhealth_68",
"stateofhealth_2519"
],
"affiliates": [
"stateofhealth_3007"
],
"featImg": "stateofhealth_349026",
"label": "stateofhealth_3007"
},
"stateofhealth_348976": {
"type": "posts",
"id": "stateofhealth_348976",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "348976",
"score": null,
"sort": [
1498850801000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth",
"term": 3007
},
"blocks": [],
"publishDate": 1498850801,
"format": "standard",
"disqusTitle": "Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals",
"title": "Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
"disqusIdentifier": "348976 https://ww2.kqed.org/stateofhealth/?p=348976",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/06/30/patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 1266,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 28
},
"modified": 1498850801,
"excerpt": "After testing to see if they're at risk of disease, people fear they'll be discriminated against under proposed legislation.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "After testing to see if they're at risk of disease, people fear they'll be discriminated against under proposed legislation.",
"title": "Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals",
"datePublished": "2017-06-30T12:26:41-07:00",
"dateModified": "2017-06-30T12:26:41-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals",
"status": "publish",
"nprByline": "\u003ca href=\"http://khn.org/news/author/charlotte-huff/\" target=\"_blank\">Charlotte Huff\u003c/a>",
"path": "/stateofhealth/348976/patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "floatright"
},
"numeric": [
"floatright"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/348976/patients-with-pre-existing-conditions-fear-bias-under-gop-health-proposals",
"authors": [
"byline_stateofhealth_348976"
],
"categories": [
"stateofhealth_2442",
"stateofhealth_15",
"stateofhealth_14"
],
"tags": [
"stateofhealth_294",
"stateofhealth_3104",
"stateofhealth_2808",
"stateofhealth_2972",
"stateofhealth_2519",
"stateofhealth_3088"
],
"affiliates": [
"stateofhealth_3007"
],
"featImg": "stateofhealth_348980",
"label": "stateofhealth_3007"
},
"news_11273732": {
"type": "posts",
"id": "news_11273732",
"meta": {
"index": "posts_1716263798",
"site": "news",
"id": "11273732",
"score": null,
"sort": [
1484687777000
]
},
"guestAuthors": [],
"slug": "drugmakers-manipulate-orphan-drug-rules-to-create-prized-monopolies",
"title": "Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies",
"publishDate": 1484687777,
"format": "standard",
"headTitle": "Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies | KQED",
"labelTerm": {
"term": 72,
"site": "news"
},
"content": "\u003cp>Lookup Tool: \u003ca href=\"http://khn.org/news/orphan-drugs-lookup-interactive/\">Orphan Drugs Database\u003c/a>\u003cbr>\nVideo: \u003ca href=\"http://khn.org/news/video-former-u-s-rep-henry-waxman-shares-deep-concerns-about-orphan-drugs/\">Interview With Henry Waxman\u003c/a>\u003cbr>\nTimeline: \u003ca href=\"http://khn.org/news/timeline-the-orphan-drug-act/\">The Orphan Drug Act\u003c/a>\u003c/p>\n\u003cp>More than 30 years ago, Congress overwhelmingly passed \u003ca href=\"https://history.nih.gov/research/downloads/PL97-414.pdf\">a landmark health bill\u003c/a> aimed at motivating pharmaceutical companies to develop new drugs for people whose rare diseases had been ignored.\u003c/p>\n\u003cp>By the drugmakers’ calculations, the markets for such diseases weren’t big enough to bother with.\u003c/p>\n\u003cp>But lucrative financial incentives created by the Orphan Drug Act signed into law by President Ronald Reagan in 1983 succeeded far beyond anyone’s expectations. More than 200 companies have brought almost 450 “orphan drugs” to market since the law took effect.\u003c/p>\n\u003cp>Yet a Kaiser Health News investigation shows that the system intended to help desperate patients is being manipulated by drugmakers to maximize profits and to protect niche markets for medicines already being taken by millions. The companies aren’t breaking the law but they are using the Orphan Drug Act to their advantage in ways that its architects say they didn’t foresee or intend. Today, many orphan medicines, originally developed to treat diseases affecting fewer than 200,000 people, come with astronomical price tags.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And many drugs that now have orphan status aren’t entirely new. More than 70 were drugs first approved by the Food and Drug Administration for mass market use. These medicines, some with familiar brand names, were later approved as orphans. In each case, their manufacturers received millions of dollars in government incentives plus seven years of exclusive rights to treat that rare disease, or a monopoly.\u003c/p>\n\u003cp>Drugmakers of popular mass market drugs later sought and received orphan status for the cholesterol blockbuster Crestor, Abilify for psychiatric conditions, cancer drug Herceptin, and rheumatoid arthritis drug Humira, the best-selling medicine in the world.\u003c/p>\n\u003cp>More than 80 other orphans won FDA approval for more than one rare disease, and in some cases, multiple rare diseases. For each additional approval, the drugmaker qualified for a fresh batch of incentives. Botox, stocked in most dermatologists’ offices, started out as a drug to treat painful muscle spasms of the eye and now has three orphan drug approvals. It’s also approved as a mass market drug to treat a variety of ailments, including chronic migraines and wrinkles.\u003c/p>\n\u003cp>Altogether, KHN’s investigation found that about a third of orphan approvals by the FDA since the program began have been either for repurposed mass market drugs or drugs that received multiple orphan approvals.\u003c/p>\n\u003cp>“What we are seeing is a system that was created with good intent being hijacked,” said Bernard Munos, a former corporate strategy advisor at drug giant Eli Lilly and Co. who reviewed the KHN analysis of several FDA drug databases. It’s “quite remarkable that it has gone on for so long.”\u003c/p>\n\u003cp>And the proportion of \u003ca href=\"http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DrugInnovation/ucm534863.htm\">new drugs\u003c/a> approved as orphans has ballooned. In 2015, 21 orphan drugs were approved, accounting for 47 percent of all new medicines, up from just 29 percent in 2010; in 2016, nine more orphans won approval, 40 percent of the total.\u003c/p>\n\u003cp>When a drugmaker wins approval of a medicine for an orphan disease, the company gets seven years of exclusive rights to the marketplace, which means the FDA won’t approve another version to treat that rare disease for seven years, even if the brand name company’s patent has run out. The exclusivity is compensation for developing a drug designed for a small number of patients whose total sales weren’t expected to be that profitable.\u003c/p>\n\u003cp>But the exclusivity is a potent pricing tool. Drugmakers can charge whatever they want by shielding their medicine from competition. The market exclusivity granted by the Orphan Drug Act can be a vital part of the protective shield that companies create. What’s more, manufacturers can return to the FDA with the same drug again and again, each time testing the drug against a new rare disease.\u003c/p>\n\u003cp>Critics have assailed drugmakers in the past for gaming the orphan drug approval process. But the extent to which companies have been winning approval for drugs that aren’t what advocates call “true orphans” hadn’t been documented until the Kaiser Health News investigation.\u003c/p>\n\u003cp>Munos said he was “shocked” by the sheer number of mass market drugs being repurposed as well as those approved multiple times.\u003c/p>\n\u003cp>Even agency officials said they weren’t aware of the scope of the issue. After reviewing KHN’s findings for two weeks, Dr. Gayatri Rao director of the FDA’s Office of Orphan Products Development said she “appreciated the work” and expressed interest in studying how often drug companies are “repurposing” a drug for a new rare disease, or taking “multiple bites of the apple.”\u003c/p>\n\u003cp>“We are going to look into this,” she said, adding that she could consider a regulatory change.\u003c/p>\n\u003cp>Rao pointed out that the “repurposing” of drugs does have scientific and patient benefits. For example, cancer drugs approved for one type of malignancy can be tested and approved for others. Gleevec, a drug that revolutionized the treatment of chronic myeloid leukemia, now has nine orphan approvals.\u003c/p>\n\u003cp>But in a \u003ca href=\"http://www.hopkinsmedicine.org/news/media/releases/orphan_drug_loophole_needs_closing_johns_hopkins_researchers_say\">2015 commentary\u003c/a> published in the American Journal of Clinical Oncology, Dr. Martin Makary at the Johns Hopkins University School of Medicine focused on cancer drugs including Gleevec, arguing that the drug was never meant to serve an orphan population. Instead, Makary and his team wrote, drugmakers purposely identify small patient populations to gain additional approvals — a process he described as “salami slicing.”\u003c/p>\n\u003cp>“By salami slicing the disease into subgroups, it allows them to get the orphan drug approval with all the government benefits and even some of the subsidies,” Makary said. The prices of such medications often rise because they have seven years without competition for a new set of patients, Makary added.\u003c/p>\n\u003cp>The FDA has taken a different view of repurposing.\u003c/p>\n\u003cp>“We always talked about how we permit the second bite of the apple, third bite of the apple, as one small way to incentivize repurposing,” Rao said, noting that industry and patient groups have been pressing the FDA for even stronger incentives. “Now, all of sudden, it seems like, wow, this practice may be driving up prices.”\u003c/p>\n\u003cp>Novartis, which owns Gleevec, said in an email statement that the company is advancing research and following the science to “bring the right treatments to the right patients based on unmet need, not the size of the patient population.”\u003c/p>\n\u003cp>Two KHN reporters spent six months analyzing data and talking to lawmakers, patients, advocates, doctors and companies to understand how the FDA’s orphan drug program has evolved amid a national uproar over soaring drug prices. President-elect Donald Trump vowed on the campaign trail to \u003ca href=\"http://www.reuters.com/article/us-usa-trump-pharmaceuticals-idUSKBN13W21I\">bring down\u003c/a> prescription drug prices and during a Jan. 11 press conference said the drug industry is \u003ca href=\"https://www.nytimes.com/2017/01/11/us/politics/trump-press-conference-transcript.html?_r=0\">“getting away with murder.”\u003c/a>\u003c/p>\n\u003cp>The investigation examined how drugmakers use the law to their advantage — often with the guidance of former FDA officials — and have made the development of medicines that were once thought to be business backwaters into one of the pharmaceutical industry’s hottest sectors.\u003c/p>\n\u003cp>Orphan drugs now account for seven of the 10 top-selling drugs of any kind, ranked by annual sales, according to EvaluatePharma.\u003c/p>\n\u003cp>“Orphans are wicked hot,” said Dr. Tim Coté, a former FDA official who now runs a consulting firm that advises drugmakers on orphan drugs.\u003c/p>\n\u003cp>No one disputes that orphan drugs have helped or saved hundreds of thousands of patients suffering from debilitating or even fatal rare diseases. Exactly how many is difficult to estimate because the FDA doesn’t track such information.\u003c/p>\n\u003cp>And drug industry officials say companies should be rewarded, not punished, for making those treatments possible and for pursuing new drugs that aren’t always an economic success.\u003c/p>\n\u003cp>Research and development is “long, costly, risky,” said Anne Pritchett, vice president, policy and research at industry lobbying group PhRMA. “When you look at cystic fibrosis it was 25 years to the development of an effective therapy … I think we would be concerned about anything that would undermine the current [orphan drug] incentives.”\u003c/p>\n\u003cp>Former U.S. Rep. Henry Waxman, D-Calif., a champion of the 1983 Orphan Drug Act takes a different view.\u003c/p>\n\u003cp>“The Orphan Drug Act has been a great success because many people with diseases that affect very few people now have drugs available to them,” Waxman said. “But it’s been in some ways turned on its head when it becomes the basis of manipulating the system for the drug company to make much more money than they would in an open, competitive market.”\u003c/p>\n\u003cp>Booming Business\u003c/p>\n\u003cp>On a late summer day, Tim Coté sat in a corner office of his Sandy Spring, Md., consulting firm, Coté Orphan. He leaned into his computer microphone to dispense insider knowledge about the orphan drug approval process on a webcast hosted by FDAnews, a trade news organization. Listeners paid about $300 a head, but Coté said he wasn’t paid for doing it.\u003c/p>\n\u003cp>The FDA is more flexible in evaluating drugs for rare diseases, he said, explaining that “about half of them get through with just one pivotal clinical trial. Not so for common diseases.” The FDA, citing \u003ca href=\"http://www.fda.gov/downloads/ForIndustry/DevelopingProductsforRareDiseasesConditions/OOPDNewsArchive/UCM294773.pdf\">a report\u003c/a> from the National Organization for Rare Disorders, said about two-thirds of orphan drugs were approved with one adequate and well-controlled trial with supportive evidence. It typically requires two or three such trials to approve a mass market drug.\u003c/p>\n\u003cp>Coté also told the webinar audience that clinical trials for orphan drugs are usually smaller and the approval is a “different scientific and regulatory experience.”\u003c/p>\n\u003cp>Coté knows his stuff. He was Rao’s immediate predecessor as chief of the FDA’s Office of Orphan Products Development. It’s not unusual for government officials to leave FDA and other regulatory agencies and \u003ca href=\"http://www.npr.org/sections/health-shots/2016/09/28/495694559/a-look-at-how-the-revolving-door-spins-from-fda-to-industry\">obtain jobs as consultants or industry executives\u003c/a>.\u003c/p>\n\u003cp>Coté’s website, headlined “The Inside Track,” notes that he oversaw applications that led to the approval of at least 150 orphan drugs when he was at the FDA and that his firm is now the largest submitter of orphan drug applications.\u003c/p>\n\u003cp>“We write the entire application,” the website for Coté’s company notes, adding that his staff of 25 includes regulatory scientists with deep knowledge and experience in FDA’s “unwritten rules” regarding orphan drugs.\u003c/p>\n\u003cp>Many of Coté’s more than 300 clients are small biotech companies begun by researchers or even passionate parents who found investment backing. Parents Ilan and Annie Ganot, for example, started Solid Biosciences to find treatments and potentially a cure for their son with Duchenne muscular dystrophy.\u003c/p>\n\u003cp>Coté guides them through the regulatory process since most don’t have the expertise. He can offer his expertise and develop an application that makes it easier for the FDA to designate and approve the drug.\u003c/p>\n\u003cp>“When you make the FDA smile, the value of your asset goes up. And that’s how the game is played,” he said in an interview, adding quickly, “It’s really not a game because people’s lives are what is in balance.”\u003c/p>\n\u003cp>Coté and other ex-FDA officials play a vital role in helping drugmakers choose rare disease targets and get through the FDA approval process.\u003c/p>\n\u003cp>A small cottage industry has grown around the Orphan Drug Act. Dr. Marlene Haffner, who preceded Coté in the FDA’s orphan office, started her own consulting firm, too, to advise small and large companies on orphan drug applications. A third company is Camargo Pharmaceutical Services, led by industry veterans and former FDA officials, which advises companies focused on repurposing drugs for orphan approval. The firm tries “to be in front of the FDA a lot — three to four times a month,” said Jennifer King, Camargo’s director of marketing. Fees for consulting on orphan drugs industry wide range from $5,000 to $100,000, depending upon what services are provided, Coté said.\u003c/p>\n\u003cp>Getting through the orphan approval process involves a series of steps.\u003c/p>\n\u003cp>First, drugs must be designated by the FDA as potential candidates for approval. A company has to demonstrate that its drug is a promising treatment for a disease that affects fewer than 200,000 patients. If the FDA agrees and makes the formal designation, financial incentives kick in, including a 50 percent tax break on research and development (R&D) and access to federal grants.\u003c/p>\n\u003cp>When drugs get orphan designation, companies often reap other financial rewards. Shares in publicly traded companies often rise on the news — sometimes soaring \u003ca href=\"http://www.bizjournals.com/triangle/news/2014/02/25/dara-stock-soars-on-orphan-drug.html\">as high as 30 percent\u003c/a>. That happens, in part, because orphans have a track record of being approved at much higher rates than drugs for common diseases.\u003c/p>\n\u003cp>The 50 percent R&D tax credit pays off, too. In 2012, one of the biggest orphan drug companies, BioMarin, received \u003ca href=\"http://files.shareholder.com/downloads/ABEA-3W276N/2866327224x0x664042/776E8656-30BA-4937-A2A0-3AB6450BCA00/2012_Annual_Report.pdf\">$32.6 million\u003c/a> from a combination of federal and state of California tax credits. BioMarin spokeswoman Debra Charlesworth confirmed that the orphan credit made up the “vast majority” of that deferred tax benefit. She also noted that credit “has successfully fueled an industry that didn’t previously exist” and led to more rare disease research.\u003c/p>\n\u003cp>Industry-wide, orphan drug tax credits cost the federal government $1.76 billion in fiscal 2016 — roughly what President Barack Obama asked Congress to spend to fight \u003ca href=\"https://www.washingtonpost.com/news/post-politics/wp/2016/02/08/obama-to-ask-congress-for-1-8-billion-to-combat-zika-virus/\">the Zika virus\u003c/a> before a $1.1 billion expenditure was approved. And, because so many orphan drugs are under development, the U.S. could grant nearly $50 billion in tax credits from 2016 to 2025, estimates \u003ca href=\"https://www.treasury.gov/resource-center/tax-policy/Documents/Tax-Expenditures-FY2017.pdf\">the Treasury Department\u003c/a>.\u003c/p>\n\u003cp>There’s a lot of creativity behind figuring out how to make a drug an orphan.\u003c/p>\n\u003cp>In Coté’s webinar and in multiple interviews, he described many ways companies can win orphan status. They can test their drugs on children with adult diseases, such as schizophrenia, or find drugs for ailments like malaria that are uncommon in America.\u003c/p>\n\u003cp>“African sleeping sickness: horrible problem in Africa but not here, not in the U.S.,” Coté told his webinar audience. “So a drug development effort that was aimed toward some of these tropical diseases can actually get all the benefits of the Orphan Drug Act.”\u003c/p>\n\u003cp>Another popular strategy is to create “follow-on drugs” that represent incremental steps forward.\u003c/p>\n\u003cp>About 30 percent of Coté’s clients are companies looking to improve upon some other orphan drug “which just made billions and billions,” he said in an interview.\u003c/p>\n\u003cp>Repurposing an already approved drug is another strategy his firm promotes. In a \u003ca href=\"https://www.linkedin.com/pulse/re-purposing-drugs-orphans-timothy-cote?published=t\">video\u003c/a> posted on his website in July, Coté explained the advantages for companies that can move directly into a clinical trial without much preparatory work because the drug’s safety has already been demonstrated.\u003c/p>\n\u003cp>“All you gotta do is establish that the product can work in this new orphan indication,” he said, adding tips on how to do it and still make money.\u003c/p>\n\u003cp>‘That Is Not A True Orphan Drug’\u003c/p>\n\u003cp>Turning mass market drugs into orphans has been a familiar path for some of the most popular drugs ever discovered.\u003c/p>\n\u003cp>AbbVie’s Humira is the best-selling drug in the world, and most of its sales are in the U.S. where revenue reached $7.6 billion through \u003ca href=\"https://news.abbvie.com/news/abbvie-reports-third-quarter-2016-financial-results.htm\">the third quarter\u003c/a> of 2016 and $11.8 billion worldwide, according to the company’s latest financial report.\u003c/p>\n\u003cp>Humira was approved by the FDA in late 2002 to treat millions of people who suffer from rheumatoid arthritis. Three years later, AbbVie asked the FDA to designate it as an orphan to treat juvenile rheumatoid arthritis, which they told the FDA affects between 30,000 and 50,000 Americans. That pediatric use was approved in 2008, and Humira subsequently was approved for four more rare diseases, including Crohn’s and uveitis, an inflammatory disease affecting the eyes.\u003c/p>\n\u003cp>The ophthalmologic approval would extend the market exclusivity for Humira for that disease until 2023. When asked why AbbVie sought multiple orphan designations and approvals for Humira, the company declined to comment.\u003c/p>\n\u003cp>Peter Saltonstall, executive director of the National Organization for Rare Disorders, said that Humira is “not a true orphan drug.” But, he said, the company has “the ability to go out and get orphan designation. That’s the way the law reads right now … they can do whatever they want to do.”\u003c/p>\n\u003cp>It is difficult to say exactly how or if orphan exclusivity affects the price of Humira, which is a complex biologic drug and also has been protected by \u003ca href=\"http://www.nytimes.com/2016/07/16/business/makers-of-humira-and-enbrel-using-new-drug-patents-to-delay-generic-versions.html?_r=3\">numerous patents\u003c/a>. The drug has long been AbbVie’s top seller, accounting for 63 percent of its revenues, according to its most recent financial filing.\u003c/p>\n\u003cp>EvaluatePharma notes \u003ca href=\"http://info.evaluategroup.com/rs/607-YGS-364/images/EPOD15.pdf\">in its recent report\u003c/a> that Humira, as well as a handful of other top drugs, receive less than 25 percent of their sales from orphan uses. Still, if Humira’s orphan uses accounted for just 10 percent of annual sales, the revenue would surpass $1 billion.\u003c/p>\n\u003cp>By stacking up a series of orphan disease approvals, one seven-year exclusivity period leads into another, maximizing the length of a company’s monopoly. Sigma-Tau Pharmaceuticals, for example, had some form of orphan exclusivity over its metabolic disorder drug for more than 20 years. The drug, Carnitor, received a second orphan approval four months before its first exclusivity was set to expire. And it won its third orphan approval, for an IV formulation of the drug, just one day before its second exclusivity period was set to expire in December of 1999.\u003c/p>\n\u003cp>“The sequence and timing of regulatory filings for Carnitor reflect the time required to conduct large controlled clinical trials, as well as evolving medical strategies and regulatory pathways pursued by different sponsors over many years,” said GianFranco Fornasini, senior vice president of scientific affairs at Sigma-Tau.\u003c/p>\n\u003cp>The FDA’s Rao said each new exclusivity period is disease-specific and once any seven-year period runs out, generics can come in. Gleevec, for example, won FDA approval to treat several kinds of rare cancer. All but one of its orphan exclusivity periods had expired by 2015, allowing two generics to enter the marketplace. But Gleevec still has exclusivity until 2020 to treat newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia in patients who are also on chemotherapy.\u003c/p>\n\u003cp>It’s also true, Rao explained, that some of the drugs that go through the orphan process may not specifically treat a rare disease. For example, a very toxic cancer drug might may not work well in earlier stages because its risks outweigh the benefits. But the company may propose that it will help a smaller group of later-stage cancer patients and win orphan approval just for that group.\u003c/p>\n\u003cp>Former FDA orphan drug director Haffner said her FDA office worked on rules defining how companies could legitimately pursue approval for a small group of patients with a specific unmet medical need.\u003c/p>\n\u003cp>“People have played games with the Orphan Drug Act since it was passed,” said Haffner, who first took a job with drugmaker Amgen after leaving the FDA and then became an independent consultant. “It’s the American way, I don’t mean that in a nasty way. But we take advantage of what’s in front of us.”\u003c/p>\n\u003cp>In 2013, the \u003ca href=\"https://www.federalregister.gov/documents/2013/06/12/2013-13930/orphan-drug-regulations\">FDA clarified the Orphan Drug Act’s regulations\u003c/a> and said it wanted to avoid the possibility that some companies could “potentially ‘game’ approvals by seeking successive narrow approvals of a drug.”\u003c/p>\n\u003cp>In reality, Rao said, the regulations did not really change “much of what our practice was.” The agency wanted to address what Rao said were “common misconceptions” and frequently asked questions so officials changed wording in the regulations to better define exactly what could be considered an orphan drug.\u003c/p>\n\u003cp>Breaking down larger, broader diseases into smaller groups is still allowed under certain conditions and companies can still win multiple orphan approvals for a single drug — even if the total population served rises above the 200,000 mark.\u003c/p>\n\u003cp>Amgen Inc.’s Repatha won marketing approval and exclusive rights in 2015 for the orphan disease homozygous familial hypercholesterolemia, which affects a population of \u003ca href=\"http://www.lipidjournal.com/article/S1933-2874(13)00309-7/abstract\">about 300 people\u003c/a> in the U.S. On the very same day, the drug was approved as a mass market drug to treat up to 11 million people with uncontrolled levels of LDL cholesterol, said Amgen spokeswoman Kristen Davis.\u003c/p>\n\u003cp>Dr. Steven Nissen of the Cleveland Clinic, who ran a broader trial on Repatha, said, “It’s certainly not considered by any of us to be an orphan drug.”\u003c/p>\n\u003cp>Safeguarding The ‘Prize’\u003c/p>\n\u003cp>Considering the long history of what’s happened, Tim Coté acknowledges that there are “some loopholes” in the Orphan Drug Act. Perhaps 3 percent or less of approved orphans were not in the “spirit” of the law, he said.\u003c/p>\n\u003cp>But Coté, rare disease advocates, patients and people in the drug industry expressed fear that changing the Orphan Drug Act or questioning its success would hurt the development of drugs for rare patients.\u003c/p>\n\u003cp>Former U.S. Rep. Jim Greenwood, R-Pa., now president of the Biotechnology Innovation Organization, an industry trade group, said that concerns about high prices for orphan drugs aren’t justified. The incentives, he said, should not be altered because rare diseases are “tragically killing and brutalizing mostly children.”\u003c/p>\n\u003cp>Greenwood seemed unaware that dozens of orphan approvals stemmed from the repurposing of mass market drugs, like Humira or Enbrel, another drug developed first for rheumatoid arthritis. Still, he said, “I would argue that the risk of losing incentives in the system far outweighs the benefit of trying to save a few pennies on the health care dollar.”\u003c/p>\n\u003cp>It’s a sentiment that Coté and other advocates share. While talking about the $311,000 annual price tag for cystic fibrosis drug Kalydeco, Coté said any parent whose child has the disease would be a big fan of the drug.\u003c/p>\n\u003cp>“The price point is justified because actually it has a dramatic effect on the children. Dead children … people are willing to pay a lot to prevent that,” Coté said. “And that’s a real good thing that we have this drug. OK?”\u003c/p>\n\u003cp>The first drug to specifically target the underlying biochemical defect of cystic fibrosis, Kalydeco is approved to treat a subset of patients who have specific mutations in their genes. Development of the drug was financed by the Cystic Fibrosis Foundation, which sold its rights to sales royalties from Kalydeco and other cystic fibrosis drugs for $3.3 billion in 2014.\u003c/p>\n\u003cp>Others, including Henry Waxman, are far more critical and have tried to do something about it over the years. Waxman proposed multiple bills to rein in corporate profits by amending the orphan drug law that he sponsored, but none succeeded.\u003c/p>\n\u003cp>The FDA has also tried but failed, to keep corporations in check.\u003c/p>\n\u003cp>In 2012, drugmaker Depomed Inc. filed suit against the FDA for refusing to give its drug Gralise seven years of market exclusivity as a treatment for pain related to shingles.\u003c/p>\n\u003cp>Rao said the agency wanted to see proof that Gralise was clinically superior to other drugs, noting there “were a bunch of other generics on the market” with different formulations and dosing requirements. Grasile’s active ingredient, gabapentin, is the same one as in Pfizer’s mass market blockbuster \u003ca href=\"http://www.pfizer.com/products/product-detail/neurontin\">Neurontin\u003c/a>, which is also approved for treatment of shingles pain.\u003c/p>\n\u003cp>The FDA approved Gralise but denied seven years of exclusivity.\u003c/p>\n\u003cp>In response, the drugmaker sued the agency and won its case, arguing that according to the law, they didn’t have to prove their drug was clinically superior to gain the monopoly.\u003c/p>\n\u003cp>Today, the drug is one of Depomed’s top products with sales of $81 million in 2015. And, in a \u003ca href=\"http://investor.depomedinc.com/phoenix.zhtml?c=97276&p=irol-SECText&TEXT=aHR0cDovL2FwaS50ZW5rd2l6YXJkLmNvbS9maWxpbmcueG1sP2lwYWdlPTEwODc0NDE5JkRTRVE9MCZTRVE9MCZTUURFU0M9U0VDVElPTl9FTlRJUkUmc3Vic2lkPTU3\">recent proxy statement\u003c/a>, Depomed listed “protecting Gralise exclusivity” as a corporate objective under the category of “enhance and protect future cash flow.” Its orphan exclusivity ends in 2018. Depomed spokesman Christopher Keenan said Gralise wanted patent exclusivity to block competition. But, Keenan said, “Had the patent effort failed on all fronts, the Orphan Drug Designation would have been very important.”\u003c/p>\n\u003cp>After reviewing KHN’s analysis, Rao said she wants to better understand why drugmakers are applying for multiple approvals and has asked for a case-by-case review of all orphan designations granted in 2010 and 2015. She said the agency lacks the resources to run an analysis of the entire orphan drug database.\u003c/p>\n\u003cp>“Our goal is to try to get it right,” she said. “There are over 7,000 rare diseases, likely more, the vast majority of which have nothing … I want to ensure that we continue to keep our eye on that prize.”\u003c/p>\n\u003cp>Contributors: John Hillkirk, Scott Hensley at NPR, Diane Webber, Marilyn Thompson (editors); Elizabeth Lucas (data editing); Joe Neel at NPR (radio editing)\u003c/p>\n\u003cp>Interactives, video and presentation: Lydia Zuraw, Emily Kopp, Meredith Rizzo at NPR (digital presentation); Francis Ying (videos, motion graphic); Heidi de Marco (videos, photos, audio); Alley Interactive (database lookup)\u003c/p>\n\u003cp>KHN’s coverage of prescription drug development, costs and pricing is supported in part by the \u003ca href=\"http://www.arnoldfoundation.org/\">Laura and John Arnold Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
"blocks": [],
"excerpt": "Orphan drugs were meant for patients with rare diseases, but drugmakers are increasingly using the special designation to land lucrative federal incentives and monopoly control for every drug that gets approved.",
"status": "publish",
"parent": 0,
"modified": 1726009413,
"stats": {
"hasAudio": false,
"hasVideo": false,
"hasChartOrMap": false,
"iframeSrcs": [],
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"hasPolis": false,
"paragraphCount": 98,
"wordCount": 4413
},
"headData": {
"title": "Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies | KQED",
"description": "Orphan drugs were meant for patients with rare diseases, but drugmakers are increasingly using the special designation to land lucrative federal incentives and monopoly control for every drug that gets approved.",
"ogTitle": "",
"ogDescription": "",
"ogImgId": "",
"twTitle": "",
"twDescription": "",
"twImgId": "",
"schema": {
"@context": "https://schema.org",
"@type": "NewsArticle",
"headline": "Drugmakers Manipulate Orphan Drug Rules To Create Prized Monopolies",
"datePublished": "2017-01-17T13:16:17-08:00",
"dateModified": "2024-09-10T16:03:33-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png",
"isAccessibleForFree": "True",
"publisher": {
"@type": "NewsMediaOrganization",
"@id": "https://www.kqed.org/#organization",
"name": "KQED",
"logo": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png",
"url": "https://www.kqed.org",
"sameAs": [
"https://www.facebook.com/KQED",
"https://twitter.com/KQED",
"https://www.instagram.com/kqed/",
"https://www.tiktok.com/@kqedofficial",
"https://www.linkedin.com/company/kqed",
"https://www.youtube.com/channel/UCeC0IOo7i1P_61zVUWbJ4nw"
]
}
}
},
"sticky": false,
"nprByline": "\u003ca href=\"http://khn.org/news/author/sarah-jane-tribble/\">\u003cstrong>Sarah Jane Tribble\u003c/strong>\u003c/a> and \u003ca href=\"http://khn.org/news/author/sydney-lupkin/\">\u003cstrong>Sydney Lupkin\u003c/strong>\u003c/a>\u003c/br>Kaiser Health News",
"path": "/news/11273732/drugmakers-manipulate-orphan-drug-rules-to-create-prized-monopolies",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lookup Tool: \u003ca href=\"http://khn.org/news/orphan-drugs-lookup-interactive/\">Orphan Drugs Database\u003c/a>\u003cbr>\nVideo: \u003ca href=\"http://khn.org/news/video-former-u-s-rep-henry-waxman-shares-deep-concerns-about-orphan-drugs/\">Interview With Henry Waxman\u003c/a>\u003cbr>\nTimeline: \u003ca href=\"http://khn.org/news/timeline-the-orphan-drug-act/\">The Orphan Drug Act\u003c/a>\u003c/p>\n\u003cp>More than 30 years ago, Congress overwhelmingly passed \u003ca href=\"https://history.nih.gov/research/downloads/PL97-414.pdf\">a landmark health bill\u003c/a> aimed at motivating pharmaceutical companies to develop new drugs for people whose rare diseases had been ignored.\u003c/p>\n\u003cp>By the drugmakers’ calculations, the markets for such diseases weren’t big enough to bother with.\u003c/p>\n\u003cp>But lucrative financial incentives created by the Orphan Drug Act signed into law by President Ronald Reagan in 1983 succeeded far beyond anyone’s expectations. More than 200 companies have brought almost 450 “orphan drugs” to market since the law took effect.\u003c/p>\n\u003cp>Yet a Kaiser Health News investigation shows that the system intended to help desperate patients is being manipulated by drugmakers to maximize profits and to protect niche markets for medicines already being taken by millions. The companies aren’t breaking the law but they are using the Orphan Drug Act to their advantage in ways that its architects say they didn’t foresee or intend. Today, many orphan medicines, originally developed to treat diseases affecting fewer than 200,000 people, come with astronomical price tags.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And many drugs that now have orphan status aren’t entirely new. More than 70 were drugs first approved by the Food and Drug Administration for mass market use. These medicines, some with familiar brand names, were later approved as orphans. In each case, their manufacturers received millions of dollars in government incentives plus seven years of exclusive rights to treat that rare disease, or a monopoly.\u003c/p>\n\u003cp>Drugmakers of popular mass market drugs later sought and received orphan status for the cholesterol blockbuster Crestor, Abilify for psychiatric conditions, cancer drug Herceptin, and rheumatoid arthritis drug Humira, the best-selling medicine in the world.\u003c/p>\n\u003cp>More than 80 other orphans won FDA approval for more than one rare disease, and in some cases, multiple rare diseases. For each additional approval, the drugmaker qualified for a fresh batch of incentives. Botox, stocked in most dermatologists’ offices, started out as a drug to treat painful muscle spasms of the eye and now has three orphan drug approvals. It’s also approved as a mass market drug to treat a variety of ailments, including chronic migraines and wrinkles.\u003c/p>\n\u003cp>Altogether, KHN’s investigation found that about a third of orphan approvals by the FDA since the program began have been either for repurposed mass market drugs or drugs that received multiple orphan approvals.\u003c/p>\n\u003cp>“What we are seeing is a system that was created with good intent being hijacked,” said Bernard Munos, a former corporate strategy advisor at drug giant Eli Lilly and Co. who reviewed the KHN analysis of several FDA drug databases. It’s “quite remarkable that it has gone on for so long.”\u003c/p>\n\u003cp>And the proportion of \u003ca href=\"http://www.fda.gov/Drugs/DevelopmentApprovalProcess/DrugInnovation/ucm534863.htm\">new drugs\u003c/a> approved as orphans has ballooned. In 2015, 21 orphan drugs were approved, accounting for 47 percent of all new medicines, up from just 29 percent in 2010; in 2016, nine more orphans won approval, 40 percent of the total.\u003c/p>\n\u003cp>When a drugmaker wins approval of a medicine for an orphan disease, the company gets seven years of exclusive rights to the marketplace, which means the FDA won’t approve another version to treat that rare disease for seven years, even if the brand name company’s patent has run out. The exclusivity is compensation for developing a drug designed for a small number of patients whose total sales weren’t expected to be that profitable.\u003c/p>\n\u003cp>But the exclusivity is a potent pricing tool. Drugmakers can charge whatever they want by shielding their medicine from competition. The market exclusivity granted by the Orphan Drug Act can be a vital part of the protective shield that companies create. What’s more, manufacturers can return to the FDA with the same drug again and again, each time testing the drug against a new rare disease.\u003c/p>\n\u003cp>Critics have assailed drugmakers in the past for gaming the orphan drug approval process. But the extent to which companies have been winning approval for drugs that aren’t what advocates call “true orphans” hadn’t been documented until the Kaiser Health News investigation.\u003c/p>\n\u003cp>Munos said he was “shocked” by the sheer number of mass market drugs being repurposed as well as those approved multiple times.\u003c/p>\n\u003cp>Even agency officials said they weren’t aware of the scope of the issue. After reviewing KHN’s findings for two weeks, Dr. Gayatri Rao director of the FDA’s Office of Orphan Products Development said she “appreciated the work” and expressed interest in studying how often drug companies are “repurposing” a drug for a new rare disease, or taking “multiple bites of the apple.”\u003c/p>\n\u003cp>“We are going to look into this,” she said, adding that she could consider a regulatory change.\u003c/p>\n\u003cp>Rao pointed out that the “repurposing” of drugs does have scientific and patient benefits. For example, cancer drugs approved for one type of malignancy can be tested and approved for others. Gleevec, a drug that revolutionized the treatment of chronic myeloid leukemia, now has nine orphan approvals.\u003c/p>\n\u003cp>But in a \u003ca href=\"http://www.hopkinsmedicine.org/news/media/releases/orphan_drug_loophole_needs_closing_johns_hopkins_researchers_say\">2015 commentary\u003c/a> published in the American Journal of Clinical Oncology, Dr. Martin Makary at the Johns Hopkins University School of Medicine focused on cancer drugs including Gleevec, arguing that the drug was never meant to serve an orphan population. Instead, Makary and his team wrote, drugmakers purposely identify small patient populations to gain additional approvals — a process he described as “salami slicing.”\u003c/p>\n\u003cp>“By salami slicing the disease into subgroups, it allows them to get the orphan drug approval with all the government benefits and even some of the subsidies,” Makary said. The prices of such medications often rise because they have seven years without competition for a new set of patients, Makary added.\u003c/p>\n\u003cp>The FDA has taken a different view of repurposing.\u003c/p>\n\u003cp>“We always talked about how we permit the second bite of the apple, third bite of the apple, as one small way to incentivize repurposing,” Rao said, noting that industry and patient groups have been pressing the FDA for even stronger incentives. “Now, all of sudden, it seems like, wow, this practice may be driving up prices.”\u003c/p>\n\u003cp>Novartis, which owns Gleevec, said in an email statement that the company is advancing research and following the science to “bring the right treatments to the right patients based on unmet need, not the size of the patient population.”\u003c/p>\n\u003cp>Two KHN reporters spent six months analyzing data and talking to lawmakers, patients, advocates, doctors and companies to understand how the FDA’s orphan drug program has evolved amid a national uproar over soaring drug prices. President-elect Donald Trump vowed on the campaign trail to \u003ca href=\"http://www.reuters.com/article/us-usa-trump-pharmaceuticals-idUSKBN13W21I\">bring down\u003c/a> prescription drug prices and during a Jan. 11 press conference said the drug industry is \u003ca href=\"https://www.nytimes.com/2017/01/11/us/politics/trump-press-conference-transcript.html?_r=0\">“getting away with murder.”\u003c/a>\u003c/p>\n\u003cp>The investigation examined how drugmakers use the law to their advantage — often with the guidance of former FDA officials — and have made the development of medicines that were once thought to be business backwaters into one of the pharmaceutical industry’s hottest sectors.\u003c/p>\n\u003cp>Orphan drugs now account for seven of the 10 top-selling drugs of any kind, ranked by annual sales, according to EvaluatePharma.\u003c/p>\n\u003cp>“Orphans are wicked hot,” said Dr. Tim Coté, a former FDA official who now runs a consulting firm that advises drugmakers on orphan drugs.\u003c/p>\n\u003cp>No one disputes that orphan drugs have helped or saved hundreds of thousands of patients suffering from debilitating or even fatal rare diseases. Exactly how many is difficult to estimate because the FDA doesn’t track such information.\u003c/p>\n\u003cp>And drug industry officials say companies should be rewarded, not punished, for making those treatments possible and for pursuing new drugs that aren’t always an economic success.\u003c/p>\n\u003cp>Research and development is “long, costly, risky,” said Anne Pritchett, vice president, policy and research at industry lobbying group PhRMA. “When you look at cystic fibrosis it was 25 years to the development of an effective therapy … I think we would be concerned about anything that would undermine the current [orphan drug] incentives.”\u003c/p>\n\u003cp>Former U.S. Rep. Henry Waxman, D-Calif., a champion of the 1983 Orphan Drug Act takes a different view.\u003c/p>\n\u003cp>“The Orphan Drug Act has been a great success because many people with diseases that affect very few people now have drugs available to them,” Waxman said. “But it’s been in some ways turned on its head when it becomes the basis of manipulating the system for the drug company to make much more money than they would in an open, competitive market.”\u003c/p>\n\u003cp>Booming Business\u003c/p>\n\u003cp>On a late summer day, Tim Coté sat in a corner office of his Sandy Spring, Md., consulting firm, Coté Orphan. He leaned into his computer microphone to dispense insider knowledge about the orphan drug approval process on a webcast hosted by FDAnews, a trade news organization. Listeners paid about $300 a head, but Coté said he wasn’t paid for doing it.\u003c/p>\n\u003cp>The FDA is more flexible in evaluating drugs for rare diseases, he said, explaining that “about half of them get through with just one pivotal clinical trial. Not so for common diseases.” The FDA, citing \u003ca href=\"http://www.fda.gov/downloads/ForIndustry/DevelopingProductsforRareDiseasesConditions/OOPDNewsArchive/UCM294773.pdf\">a report\u003c/a> from the National Organization for Rare Disorders, said about two-thirds of orphan drugs were approved with one adequate and well-controlled trial with supportive evidence. It typically requires two or three such trials to approve a mass market drug.\u003c/p>\n\u003cp>Coté also told the webinar audience that clinical trials for orphan drugs are usually smaller and the approval is a “different scientific and regulatory experience.”\u003c/p>\n\u003cp>Coté knows his stuff. He was Rao’s immediate predecessor as chief of the FDA’s Office of Orphan Products Development. It’s not unusual for government officials to leave FDA and other regulatory agencies and \u003ca href=\"http://www.npr.org/sections/health-shots/2016/09/28/495694559/a-look-at-how-the-revolving-door-spins-from-fda-to-industry\">obtain jobs as consultants or industry executives\u003c/a>.\u003c/p>\n\u003cp>Coté’s website, headlined “The Inside Track,” notes that he oversaw applications that led to the approval of at least 150 orphan drugs when he was at the FDA and that his firm is now the largest submitter of orphan drug applications.\u003c/p>\n\u003cp>“We write the entire application,” the website for Coté’s company notes, adding that his staff of 25 includes regulatory scientists with deep knowledge and experience in FDA’s “unwritten rules” regarding orphan drugs.\u003c/p>\n\u003cp>Many of Coté’s more than 300 clients are small biotech companies begun by researchers or even passionate parents who found investment backing. Parents Ilan and Annie Ganot, for example, started Solid Biosciences to find treatments and potentially a cure for their son with Duchenne muscular dystrophy.\u003c/p>\n\u003cp>Coté guides them through the regulatory process since most don’t have the expertise. He can offer his expertise and develop an application that makes it easier for the FDA to designate and approve the drug.\u003c/p>\n\u003cp>“When you make the FDA smile, the value of your asset goes up. And that’s how the game is played,” he said in an interview, adding quickly, “It’s really not a game because people’s lives are what is in balance.”\u003c/p>\n\u003cp>Coté and other ex-FDA officials play a vital role in helping drugmakers choose rare disease targets and get through the FDA approval process.\u003c/p>\n\u003cp>A small cottage industry has grown around the Orphan Drug Act. Dr. Marlene Haffner, who preceded Coté in the FDA’s orphan office, started her own consulting firm, too, to advise small and large companies on orphan drug applications. A third company is Camargo Pharmaceutical Services, led by industry veterans and former FDA officials, which advises companies focused on repurposing drugs for orphan approval. The firm tries “to be in front of the FDA a lot — three to four times a month,” said Jennifer King, Camargo’s director of marketing. Fees for consulting on orphan drugs industry wide range from $5,000 to $100,000, depending upon what services are provided, Coté said.\u003c/p>\n\u003cp>Getting through the orphan approval process involves a series of steps.\u003c/p>\n\u003cp>First, drugs must be designated by the FDA as potential candidates for approval. A company has to demonstrate that its drug is a promising treatment for a disease that affects fewer than 200,000 patients. If the FDA agrees and makes the formal designation, financial incentives kick in, including a 50 percent tax break on research and development (R&D) and access to federal grants.\u003c/p>\n\u003cp>When drugs get orphan designation, companies often reap other financial rewards. Shares in publicly traded companies often rise on the news — sometimes soaring \u003ca href=\"http://www.bizjournals.com/triangle/news/2014/02/25/dara-stock-soars-on-orphan-drug.html\">as high as 30 percent\u003c/a>. That happens, in part, because orphans have a track record of being approved at much higher rates than drugs for common diseases.\u003c/p>\n\u003cp>The 50 percent R&D tax credit pays off, too. In 2012, one of the biggest orphan drug companies, BioMarin, received \u003ca href=\"http://files.shareholder.com/downloads/ABEA-3W276N/2866327224x0x664042/776E8656-30BA-4937-A2A0-3AB6450BCA00/2012_Annual_Report.pdf\">$32.6 million\u003c/a> from a combination of federal and state of California tax credits. BioMarin spokeswoman Debra Charlesworth confirmed that the orphan credit made up the “vast majority” of that deferred tax benefit. She also noted that credit “has successfully fueled an industry that didn’t previously exist” and led to more rare disease research.\u003c/p>\n\u003cp>Industry-wide, orphan drug tax credits cost the federal government $1.76 billion in fiscal 2016 — roughly what President Barack Obama asked Congress to spend to fight \u003ca href=\"https://www.washingtonpost.com/news/post-politics/wp/2016/02/08/obama-to-ask-congress-for-1-8-billion-to-combat-zika-virus/\">the Zika virus\u003c/a> before a $1.1 billion expenditure was approved. And, because so many orphan drugs are under development, the U.S. could grant nearly $50 billion in tax credits from 2016 to 2025, estimates \u003ca href=\"https://www.treasury.gov/resource-center/tax-policy/Documents/Tax-Expenditures-FY2017.pdf\">the Treasury Department\u003c/a>.\u003c/p>\n\u003cp>There’s a lot of creativity behind figuring out how to make a drug an orphan.\u003c/p>\n\u003cp>In Coté’s webinar and in multiple interviews, he described many ways companies can win orphan status. They can test their drugs on children with adult diseases, such as schizophrenia, or find drugs for ailments like malaria that are uncommon in America.\u003c/p>\n\u003cp>“African sleeping sickness: horrible problem in Africa but not here, not in the U.S.,” Coté told his webinar audience. “So a drug development effort that was aimed toward some of these tropical diseases can actually get all the benefits of the Orphan Drug Act.”\u003c/p>\n\u003cp>Another popular strategy is to create “follow-on drugs” that represent incremental steps forward.\u003c/p>\n\u003cp>About 30 percent of Coté’s clients are companies looking to improve upon some other orphan drug “which just made billions and billions,” he said in an interview.\u003c/p>\n\u003cp>Repurposing an already approved drug is another strategy his firm promotes. In a \u003ca href=\"https://www.linkedin.com/pulse/re-purposing-drugs-orphans-timothy-cote?published=t\">video\u003c/a> posted on his website in July, Coté explained the advantages for companies that can move directly into a clinical trial without much preparatory work because the drug’s safety has already been demonstrated.\u003c/p>\n\u003cp>“All you gotta do is establish that the product can work in this new orphan indication,” he said, adding tips on how to do it and still make money.\u003c/p>\n\u003cp>‘That Is Not A True Orphan Drug’\u003c/p>\n\u003cp>Turning mass market drugs into orphans has been a familiar path for some of the most popular drugs ever discovered.\u003c/p>\n\u003cp>AbbVie’s Humira is the best-selling drug in the world, and most of its sales are in the U.S. where revenue reached $7.6 billion through \u003ca href=\"https://news.abbvie.com/news/abbvie-reports-third-quarter-2016-financial-results.htm\">the third quarter\u003c/a> of 2016 and $11.8 billion worldwide, according to the company’s latest financial report.\u003c/p>\n\u003cp>Humira was approved by the FDA in late 2002 to treat millions of people who suffer from rheumatoid arthritis. Three years later, AbbVie asked the FDA to designate it as an orphan to treat juvenile rheumatoid arthritis, which they told the FDA affects between 30,000 and 50,000 Americans. That pediatric use was approved in 2008, and Humira subsequently was approved for four more rare diseases, including Crohn’s and uveitis, an inflammatory disease affecting the eyes.\u003c/p>\n\u003cp>The ophthalmologic approval would extend the market exclusivity for Humira for that disease until 2023. When asked why AbbVie sought multiple orphan designations and approvals for Humira, the company declined to comment.\u003c/p>\n\u003cp>Peter Saltonstall, executive director of the National Organization for Rare Disorders, said that Humira is “not a true orphan drug.” But, he said, the company has “the ability to go out and get orphan designation. That’s the way the law reads right now … they can do whatever they want to do.”\u003c/p>\n\u003cp>It is difficult to say exactly how or if orphan exclusivity affects the price of Humira, which is a complex biologic drug and also has been protected by \u003ca href=\"http://www.nytimes.com/2016/07/16/business/makers-of-humira-and-enbrel-using-new-drug-patents-to-delay-generic-versions.html?_r=3\">numerous patents\u003c/a>. The drug has long been AbbVie’s top seller, accounting for 63 percent of its revenues, according to its most recent financial filing.\u003c/p>\n\u003cp>EvaluatePharma notes \u003ca href=\"http://info.evaluategroup.com/rs/607-YGS-364/images/EPOD15.pdf\">in its recent report\u003c/a> that Humira, as well as a handful of other top drugs, receive less than 25 percent of their sales from orphan uses. Still, if Humira’s orphan uses accounted for just 10 percent of annual sales, the revenue would surpass $1 billion.\u003c/p>\n\u003cp>By stacking up a series of orphan disease approvals, one seven-year exclusivity period leads into another, maximizing the length of a company’s monopoly. Sigma-Tau Pharmaceuticals, for example, had some form of orphan exclusivity over its metabolic disorder drug for more than 20 years. The drug, Carnitor, received a second orphan approval four months before its first exclusivity was set to expire. And it won its third orphan approval, for an IV formulation of the drug, just one day before its second exclusivity period was set to expire in December of 1999.\u003c/p>\n\u003cp>“The sequence and timing of regulatory filings for Carnitor reflect the time required to conduct large controlled clinical trials, as well as evolving medical strategies and regulatory pathways pursued by different sponsors over many years,” said GianFranco Fornasini, senior vice president of scientific affairs at Sigma-Tau.\u003c/p>\n\u003cp>The FDA’s Rao said each new exclusivity period is disease-specific and once any seven-year period runs out, generics can come in. Gleevec, for example, won FDA approval to treat several kinds of rare cancer. All but one of its orphan exclusivity periods had expired by 2015, allowing two generics to enter the marketplace. But Gleevec still has exclusivity until 2020 to treat newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia in patients who are also on chemotherapy.\u003c/p>\n\u003cp>It’s also true, Rao explained, that some of the drugs that go through the orphan process may not specifically treat a rare disease. For example, a very toxic cancer drug might may not work well in earlier stages because its risks outweigh the benefits. But the company may propose that it will help a smaller group of later-stage cancer patients and win orphan approval just for that group.\u003c/p>\n\u003cp>Former FDA orphan drug director Haffner said her FDA office worked on rules defining how companies could legitimately pursue approval for a small group of patients with a specific unmet medical need.\u003c/p>\n\u003cp>“People have played games with the Orphan Drug Act since it was passed,” said Haffner, who first took a job with drugmaker Amgen after leaving the FDA and then became an independent consultant. “It’s the American way, I don’t mean that in a nasty way. But we take advantage of what’s in front of us.”\u003c/p>\n\u003cp>In 2013, the \u003ca href=\"https://www.federalregister.gov/documents/2013/06/12/2013-13930/orphan-drug-regulations\">FDA clarified the Orphan Drug Act’s regulations\u003c/a> and said it wanted to avoid the possibility that some companies could “potentially ‘game’ approvals by seeking successive narrow approvals of a drug.”\u003c/p>\n\u003cp>In reality, Rao said, the regulations did not really change “much of what our practice was.” The agency wanted to address what Rao said were “common misconceptions” and frequently asked questions so officials changed wording in the regulations to better define exactly what could be considered an orphan drug.\u003c/p>\n\u003cp>Breaking down larger, broader diseases into smaller groups is still allowed under certain conditions and companies can still win multiple orphan approvals for a single drug — even if the total population served rises above the 200,000 mark.\u003c/p>\n\u003cp>Amgen Inc.’s Repatha won marketing approval and exclusive rights in 2015 for the orphan disease homozygous familial hypercholesterolemia, which affects a population of \u003ca href=\"http://www.lipidjournal.com/article/S1933-2874(13)00309-7/abstract\">about 300 people\u003c/a> in the U.S. On the very same day, the drug was approved as a mass market drug to treat up to 11 million people with uncontrolled levels of LDL cholesterol, said Amgen spokeswoman Kristen Davis.\u003c/p>\n\u003cp>Dr. Steven Nissen of the Cleveland Clinic, who ran a broader trial on Repatha, said, “It’s certainly not considered by any of us to be an orphan drug.”\u003c/p>\n\u003cp>Safeguarding The ‘Prize’\u003c/p>\n\u003cp>Considering the long history of what’s happened, Tim Coté acknowledges that there are “some loopholes” in the Orphan Drug Act. Perhaps 3 percent or less of approved orphans were not in the “spirit” of the law, he said.\u003c/p>\n\u003cp>But Coté, rare disease advocates, patients and people in the drug industry expressed fear that changing the Orphan Drug Act or questioning its success would hurt the development of drugs for rare patients.\u003c/p>\n\u003cp>Former U.S. Rep. Jim Greenwood, R-Pa., now president of the Biotechnology Innovation Organization, an industry trade group, said that concerns about high prices for orphan drugs aren’t justified. The incentives, he said, should not be altered because rare diseases are “tragically killing and brutalizing mostly children.”\u003c/p>\n\u003cp>Greenwood seemed unaware that dozens of orphan approvals stemmed from the repurposing of mass market drugs, like Humira or Enbrel, another drug developed first for rheumatoid arthritis. Still, he said, “I would argue that the risk of losing incentives in the system far outweighs the benefit of trying to save a few pennies on the health care dollar.”\u003c/p>\n\u003cp>It’s a sentiment that Coté and other advocates share. While talking about the $311,000 annual price tag for cystic fibrosis drug Kalydeco, Coté said any parent whose child has the disease would be a big fan of the drug.\u003c/p>\n\u003cp>“The price point is justified because actually it has a dramatic effect on the children. Dead children … people are willing to pay a lot to prevent that,” Coté said. “And that’s a real good thing that we have this drug. OK?”\u003c/p>\n\u003cp>The first drug to specifically target the underlying biochemical defect of cystic fibrosis, Kalydeco is approved to treat a subset of patients who have specific mutations in their genes. Development of the drug was financed by the Cystic Fibrosis Foundation, which sold its rights to sales royalties from Kalydeco and other cystic fibrosis drugs for $3.3 billion in 2014.\u003c/p>\n\u003cp>Others, including Henry Waxman, are far more critical and have tried to do something about it over the years. Waxman proposed multiple bills to rein in corporate profits by amending the orphan drug law that he sponsored, but none succeeded.\u003c/p>\n\u003cp>The FDA has also tried but failed, to keep corporations in check.\u003c/p>\n\u003cp>In 2012, drugmaker Depomed Inc. filed suit against the FDA for refusing to give its drug Gralise seven years of market exclusivity as a treatment for pain related to shingles.\u003c/p>\n\u003cp>Rao said the agency wanted to see proof that Gralise was clinically superior to other drugs, noting there “were a bunch of other generics on the market” with different formulations and dosing requirements. Grasile’s active ingredient, gabapentin, is the same one as in Pfizer’s mass market blockbuster \u003ca href=\"http://www.pfizer.com/products/product-detail/neurontin\">Neurontin\u003c/a>, which is also approved for treatment of shingles pain.\u003c/p>\n\u003cp>The FDA approved Gralise but denied seven years of exclusivity.\u003c/p>\n\u003cp>In response, the drugmaker sued the agency and won its case, arguing that according to the law, they didn’t have to prove their drug was clinically superior to gain the monopoly.\u003c/p>\n\u003cp>Today, the drug is one of Depomed’s top products with sales of $81 million in 2015. And, in a \u003ca href=\"http://investor.depomedinc.com/phoenix.zhtml?c=97276&p=irol-SECText&TEXT=aHR0cDovL2FwaS50ZW5rd2l6YXJkLmNvbS9maWxpbmcueG1sP2lwYWdlPTEwODc0NDE5JkRTRVE9MCZTRVE9MCZTUURFU0M9U0VDVElPTl9FTlRJUkUmc3Vic2lkPTU3\">recent proxy statement\u003c/a>, Depomed listed “protecting Gralise exclusivity” as a corporate objective under the category of “enhance and protect future cash flow.” Its orphan exclusivity ends in 2018. Depomed spokesman Christopher Keenan said Gralise wanted patent exclusivity to block competition. But, Keenan said, “Had the patent effort failed on all fronts, the Orphan Drug Designation would have been very important.”\u003c/p>\n\u003cp>After reviewing KHN’s analysis, Rao said she wants to better understand why drugmakers are applying for multiple approvals and has asked for a case-by-case review of all orphan designations granted in 2010 and 2015. She said the agency lacks the resources to run an analysis of the entire orphan drug database.\u003c/p>\n\u003cp>“Our goal is to try to get it right,” she said. “There are over 7,000 rare diseases, likely more, the vast majority of which have nothing … I want to ensure that we continue to keep our eye on that prize.”\u003c/p>\n\u003cp>Contributors: John Hillkirk, Scott Hensley at NPR, Diane Webber, Marilyn Thompson (editors); Elizabeth Lucas (data editing); Joe Neel at NPR (radio editing)\u003c/p>\n\u003cp>Interactives, video and presentation: Lydia Zuraw, Emily Kopp, Meredith Rizzo at NPR (digital presentation); Francis Ying (videos, motion graphic); Heidi de Marco (videos, photos, audio); Alley Interactive (database lookup)\u003c/p>\n\u003cp>KHN’s coverage of prescription drug development, costs and pricing is supported in part by the \u003ca href=\"http://www.arnoldfoundation.org/\">Laura and John Arnold Foundation\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "floatright"
},
"numeric": [
"floatright"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/news/11273732/drugmakers-manipulate-orphan-drug-rules-to-create-prized-monopolies",
"authors": [
"byline_news_11273732"
],
"programs": [
"news_6944",
"news_72"
],
"categories": [
"news_457",
"news_8"
],
"tags": [
"news_20402",
"news_18543"
],
"featImg": "news_11273798",
"label": "news_72"
},
"stateofhealth_283882": {
"type": "posts",
"id": "stateofhealth_283882",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "283882",
"score": null,
"sort": [
1484354886000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth",
"term": 3007
},
"blocks": [],
"publishDate": 1484354886,
"format": "standard",
"disqusTitle": "Crucial California HIV Program in Disarray After Contract Switch",
"title": "Crucial California HIV Program in Disarray After Contract Switch",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>A change in contractors for a state-run AIDS program has resulted in enrollment delays and left some patients unable to get necessary medications and timely medical care, according to legislators and nonprofit organizations across California.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdph.ca.gov/programs/aids/Pages/tOAADAPindiv.aspx\" target=\"_blank\">The AIDS Drug Assistance Program\u003c/a>, which helps more than 30,000 low-income HIV and AIDS patients pay for medications and insurance premiums, switched pharmacy and enrollment contractors in July. Since then, clients and service providers have reported numerous problems with the program, which is overseen by the \u003ca href=\"http://www.cdph.ca.gov/Pages/DEFAULT.aspx\" target=\"_blank\">California Department of Public Health\u003c/a>.\u003c/p>\n\u003cp>Patients have been turned away by pharmacies, been forced to postpone medical procedures and been dropped from the program altogether for no apparent reason, according to staffers at \u003ca href=\"https://aplahealth.org/\" target=\"_blank\">AIDS Project Los Angeles\u003c/a> and the \u003ca href=\"http://www.sfaf.org/?referrer=http://search.myway.com/search/GGmain.jhtml?p2=&ptb=&n=&ind=&tpr=hpsb&trs=wtt&cn=US&ln=en&si=&brwsid=&searchfor=san%20francisco%20aids%20foundation&st=tab\" target=\"_blank\">San Francisco AIDS Foundation\u003c/a>.\u003c/p>\n\u003cp>In addition, the online system to enroll applicants was shut down in November after security breaches and is still not working. Potential clients and enrollment workers have to send applications by fax and regularly have trouble getting documents through.\u003c/p>\n\u003cp>“It’s a mess,” said Courtney Mulhern-Pearson, director of state and local affairs with the San Francisco AIDS Foundation, a nonprofit service and advocacy organization. “This is the state’s safety net program and the cornerstone to the state’s response to the HIV epidemic. To have it all of a sudden not work and to have that system be thrown in disarray has been so destabilizing, not only for our clients but also for the enrollment workers.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One Los Angeles client, a 37-year-old Hollywood resident, said his insurance policy was cancelled after the AIDS Drug Assistance Program failed to send the premium to the correct address. As a result, the man, M.G., who only wanted his initials used because not everyone in his life knows he is HIV-positive, got turned away at the pharmacy.\u003c/p>\n\u003cp>“I was on my last pill for HIV medication,” he said. “It was very scary. I thought, ‘What am I going to do now?’”\u003c/p>\n\u003cp>The state’s contract with Oakland, Calif.-based Ramsell Corporation, which had handled both enrollment and pharmacy benefits, ended in July. To replace it, the state contracted with \u003ca href=\"http://www.ajboggs.com/\" target=\"_blank\">A.J. Boggs & Company\u003c/a> to do the enrollment and \u003ca href=\"https://www1.magellanrx.com/magellan-rx/solutions/pharmacy-benefit-management.aspx\" target=\"_blank\">Magellan Rx Management \u003c/a>to provide the pharmacy benefit services. The reason for the change was to reduce administrative fees and drug reimbursement rates, said public health department spokeswoman Ali Bay.\u003c/p>\n\u003cp>Since then, AIDS service organizations have written numerous complaint letters, contacted legislators and sent representatives to Sacramento to meet with public health department officials. State senators Ed Hernandez, Kevin De León and Scott D. Wiener also sent letters to the department insisting that the problems be fixed.\u003c/p>\n\u003cp>Wiener’s letter said he was “astounded that these systems issues have yet to be resolved and continue to arise six months into the transition” to the new vendors. The AIDS Drug Assistance Program, he wrote, is essential to keep HIV patients healthy and reduce their chances of infecting others.\u003c/p>\n\u003cp>“This is matter of life and death for some people,” Wiener said in an interview. “When I learned that the [AIDS Drug Assistance Program] enrollment was essentially in meltdown … I was horrified.”\u003c/p>\n\u003cp>The Department of Public Health’s director, Karen Smith, responded to Wiener in a letter last week saying her agency’s first concern was to ensure clients receive “life-saving medications without any disruption in treatment.” She said the state is “working diligently to address these concerns as quickly as possible.”\u003c/p>\n\u003cp>To help ensure uninterrupted access, the state has allowed its pharmacy benefit provider to authorize an emergency, 30-day supply of medications for enrolled patients who encounter obstacles at the pharmacy. Smith wrote that the state is also trying to resolve the online security issues and to get the enrollment site back up as soon as possible. But she noted that the problems may be “more serious” than the department initially thought.\u003c/p>\n\u003cp>In the meantime, Smith wrote, the department has shortened the application, streamlined the enrollment process and extended the reenrollment and recertification deadlines for clients.\u003c/p>\n\u003cp>Craig Pulsipher, state affairs specialist with AIDS Project Los Angeles, said he appreciated that the state has provided emergency medication access and responded to some of the concerns. But clients, enrollment workers, pharmacists and doctors are still facing hurdles, he said.\u003c/p>\n\u003cp>Pulsipher said he and others had warned the state it wasn’t allowing enough time to prepare for the changeover. The Los Angeles Department of Public Health, for example, had asked the state in June to postpone the transition for six months. About 10,000 L.A. County residents rely on the AIDS Drug Assistance Program.\u003c/p>\n\u003cp>In a letter to the public health department, Mario Perez, director of the L.A. County’s HIV and STD program division, wrote that patients need “unfettered access to antiretroviral therapy,” and any administrative changes to the AIDS Drug Assistance Program that can hamper that access “must be thoughtfully planned and adequately tested.”\u003c/p>\n\u003cp>Pulsipher said he tried to give the state the benefit of the doubt, knowing difficulties arise during every transition. But, he said, “clearly things haven’t been resolved.”\u003c/p>\n\u003cp>“We anticipated some of these issues and those concerns weren’t heeded,” he said. “And now we find ourselves here six months later with a system that is broken.”\u003c/p>\n\u003cp>Meanwhile, patients are struggling to get service they need. M.G, the patient who nearly ran out of drugs, said a surgical procedure to relieve pain in his neck was cancelled. He spent hours calling the AIDS assistance program and his insurance company, he said. He also had to pay about $500 to get his insurance reinstated.\u003c/p>\n\u003cp>A representative from the state AIDS program wrote to Pulsipher in an e-mail that the insurance payment had been sent to the wrong address. “We understand the severity of this issue and we will work … to ensure that this does not happen again,” the email said.\u003c/p>\n\u003cp>Finally, M.G. was able to get his medicine and have the surgery. Now, he plans to call the state and the insurer every month to make sure his drugs and services are covered.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The program was “supposed to be helping me,” he said. “And because of them, I was denied the medication that is keeping me alive.”\u003c/p>\n\n",
"disqusIdentifier": "283882 http://ww2.kqed.org/stateofhealth/?p=283882",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/01/13/crucial-california-hiv-program-in-disarray-after-contract-switch/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 1100,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 25
},
"modified": 1484357393,
"excerpt": "Patients who depend on the state-run AIDS Drug Assistance Program are having trouble getting medical appointments and life-saving medications.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "Patients who depend on the state-run AIDS Drug Assistance Program are having trouble getting medical appointments and life-saving medications.",
"title": "Crucial California HIV Program in Disarray After Contract Switch | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Crucial California HIV Program in Disarray After Contract Switch",
"datePublished": "2017-01-13T16:48:06-08:00",
"dateModified": "2017-01-13T17:29:53-08:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "crucial-california-hiv-program-in-disarray-after-contract-switch",
"status": "publish",
"nprByline": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/anna-gorman/\">Anna Gorman\u003c/a>\u003c/strong>\u003cbr/>Kaiser Health News",
"path": "/stateofhealth/283882/crucial-california-hiv-program-in-disarray-after-contract-switch",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A change in contractors for a state-run AIDS program has resulted in enrollment delays and left some patients unable to get necessary medications and timely medical care, according to legislators and nonprofit organizations across California.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdph.ca.gov/programs/aids/Pages/tOAADAPindiv.aspx\" target=\"_blank\">The AIDS Drug Assistance Program\u003c/a>, which helps more than 30,000 low-income HIV and AIDS patients pay for medications and insurance premiums, switched pharmacy and enrollment contractors in July. Since then, clients and service providers have reported numerous problems with the program, which is overseen by the \u003ca href=\"http://www.cdph.ca.gov/Pages/DEFAULT.aspx\" target=\"_blank\">California Department of Public Health\u003c/a>.\u003c/p>\n\u003cp>Patients have been turned away by pharmacies, been forced to postpone medical procedures and been dropped from the program altogether for no apparent reason, according to staffers at \u003ca href=\"https://aplahealth.org/\" target=\"_blank\">AIDS Project Los Angeles\u003c/a> and the \u003ca href=\"http://www.sfaf.org/?referrer=http://search.myway.com/search/GGmain.jhtml?p2=&ptb=&n=&ind=&tpr=hpsb&trs=wtt&cn=US&ln=en&si=&brwsid=&searchfor=san%20francisco%20aids%20foundation&st=tab\" target=\"_blank\">San Francisco AIDS Foundation\u003c/a>.\u003c/p>\n\u003cp>In addition, the online system to enroll applicants was shut down in November after security breaches and is still not working. Potential clients and enrollment workers have to send applications by fax and regularly have trouble getting documents through.\u003c/p>\n\u003cp>“It’s a mess,” said Courtney Mulhern-Pearson, director of state and local affairs with the San Francisco AIDS Foundation, a nonprofit service and advocacy organization. “This is the state’s safety net program and the cornerstone to the state’s response to the HIV epidemic. To have it all of a sudden not work and to have that system be thrown in disarray has been so destabilizing, not only for our clients but also for the enrollment workers.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One Los Angeles client, a 37-year-old Hollywood resident, said his insurance policy was cancelled after the AIDS Drug Assistance Program failed to send the premium to the correct address. As a result, the man, M.G., who only wanted his initials used because not everyone in his life knows he is HIV-positive, got turned away at the pharmacy.\u003c/p>\n\u003cp>“I was on my last pill for HIV medication,” he said. “It was very scary. I thought, ‘What am I going to do now?’”\u003c/p>\n\u003cp>The state’s contract with Oakland, Calif.-based Ramsell Corporation, which had handled both enrollment and pharmacy benefits, ended in July. To replace it, the state contracted with \u003ca href=\"http://www.ajboggs.com/\" target=\"_blank\">A.J. Boggs & Company\u003c/a> to do the enrollment and \u003ca href=\"https://www1.magellanrx.com/magellan-rx/solutions/pharmacy-benefit-management.aspx\" target=\"_blank\">Magellan Rx Management \u003c/a>to provide the pharmacy benefit services. The reason for the change was to reduce administrative fees and drug reimbursement rates, said public health department spokeswoman Ali Bay.\u003c/p>\n\u003cp>Since then, AIDS service organizations have written numerous complaint letters, contacted legislators and sent representatives to Sacramento to meet with public health department officials. State senators Ed Hernandez, Kevin De León and Scott D. Wiener also sent letters to the department insisting that the problems be fixed.\u003c/p>\n\u003cp>Wiener’s letter said he was “astounded that these systems issues have yet to be resolved and continue to arise six months into the transition” to the new vendors. The AIDS Drug Assistance Program, he wrote, is essential to keep HIV patients healthy and reduce their chances of infecting others.\u003c/p>\n\u003cp>“This is matter of life and death for some people,” Wiener said in an interview. “When I learned that the [AIDS Drug Assistance Program] enrollment was essentially in meltdown … I was horrified.”\u003c/p>\n\u003cp>The Department of Public Health’s director, Karen Smith, responded to Wiener in a letter last week saying her agency’s first concern was to ensure clients receive “life-saving medications without any disruption in treatment.” She said the state is “working diligently to address these concerns as quickly as possible.”\u003c/p>\n\u003cp>To help ensure uninterrupted access, the state has allowed its pharmacy benefit provider to authorize an emergency, 30-day supply of medications for enrolled patients who encounter obstacles at the pharmacy. Smith wrote that the state is also trying to resolve the online security issues and to get the enrollment site back up as soon as possible. But she noted that the problems may be “more serious” than the department initially thought.\u003c/p>\n\u003cp>In the meantime, Smith wrote, the department has shortened the application, streamlined the enrollment process and extended the reenrollment and recertification deadlines for clients.\u003c/p>\n\u003cp>Craig Pulsipher, state affairs specialist with AIDS Project Los Angeles, said he appreciated that the state has provided emergency medication access and responded to some of the concerns. But clients, enrollment workers, pharmacists and doctors are still facing hurdles, he said.\u003c/p>\n\u003cp>Pulsipher said he and others had warned the state it wasn’t allowing enough time to prepare for the changeover. The Los Angeles Department of Public Health, for example, had asked the state in June to postpone the transition for six months. About 10,000 L.A. County residents rely on the AIDS Drug Assistance Program.\u003c/p>\n\u003cp>In a letter to the public health department, Mario Perez, director of the L.A. County’s HIV and STD program division, wrote that patients need “unfettered access to antiretroviral therapy,” and any administrative changes to the AIDS Drug Assistance Program that can hamper that access “must be thoughtfully planned and adequately tested.”\u003c/p>\n\u003cp>Pulsipher said he tried to give the state the benefit of the doubt, knowing difficulties arise during every transition. But, he said, “clearly things haven’t been resolved.”\u003c/p>\n\u003cp>“We anticipated some of these issues and those concerns weren’t heeded,” he said. “And now we find ourselves here six months later with a system that is broken.”\u003c/p>\n\u003cp>Meanwhile, patients are struggling to get service they need. M.G, the patient who nearly ran out of drugs, said a surgical procedure to relieve pain in his neck was cancelled. He spent hours calling the AIDS assistance program and his insurance company, he said. He also had to pay about $500 to get his insurance reinstated.\u003c/p>\n\u003cp>A representative from the state AIDS program wrote to Pulsipher in an e-mail that the insurance payment had been sent to the wrong address. “We understand the severity of this issue and we will work … to ensure that this does not happen again,” the email said.\u003c/p>\n\u003cp>Finally, M.G. was able to get his medicine and have the surgery. Now, he plans to call the state and the insurer every month to make sure his drugs and services are covered.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "floatright"
},
"numeric": [
"floatright"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The program was “supposed to be helping me,” he said. “And because of them, I was denied the medication that is keeping me alive.”\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/283882/crucial-california-hiv-program-in-disarray-after-contract-switch",
"authors": [
"byline_stateofhealth_283882"
],
"categories": [
"stateofhealth_1"
],
"tags": [
"stateofhealth_2808",
"stateofhealth_313"
],
"affiliates": [
"stateofhealth_3007"
],
"featImg": "stateofhealth_283889",
"label": "stateofhealth_3007"
},
"stateofhealth_280735": {
"type": "posts",
"id": "stateofhealth_280735",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "280735",
"score": null,
"sort": [
1483619445000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth",
"term": 3007
},
"blocks": [],
"publishDate": 1483619445,
"format": "standard",
"disqusTitle": "Early Alzheimer’s Gene Spells Tragedy For Patients, Opportunity For Science",
"title": "Early Alzheimer’s Gene Spells Tragedy For Patients, Opportunity For Science",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>LA HABRA, California – Rosemary Navarro was living in Mexico when her brother called from California. Something wasn’t right with their mom, then in her early 40s. She was having trouble paying bills and keeping jobs as a food preparer in convalescent homes.\u003c/p>\n\u003cp>Navarro, then 22, moved back to the U.S. with her two young children. \u003c/p>\n\u003cp>Before long, Navarro was feeding her mom, then changing her diapers. Near the end, her mom, a quiet woman who had immigrated to the U.S. as a teenager and loved telenovelas, could communicate only by laughing or crying. She died at 53 in a nursing home. \u003c/p>\n\u003cp>It has happened again and again in her family — relatives struck by the same terrible disease, most without any clue what it was. An aunt, an uncle, a cousin, a grandfather, a great grandfather. “Too many have died,” Navarro said. All in their early 50s. \u003c/p>\n\u003cp>Now the family knows the reason for their curse: It’s a rare type of early-onset Alzheimer’s disease, caused by what’s come to be known as the “Jalisco” genetic mutation. Doctors today can tell someone they have it but can’t stop its destructive march.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For Navarro, watching her relatives succumb is like looking into a crystal ball, one she wants to hurl across the room. She, too, has the mutation. In April, she turned 40 — the same age her mother was when she started wandering off and forgetting simple things. \u003c/p>\n\u003cp>“I don’t look forward to birthdays,” she said. “I didn’t want to celebrate 40, much less 41.”\u003c/p>\n\u003cp>\u003cstrong>Sparing The Next Generation\u003c/strong>\u003c/p>\n\u003cp>Navarro, who lives in La Habra, Calif., belongs to an exclusive but unenviable club whose members are genetically programmed for early memory loss and death. \u003c/p>\n\u003cp>Of the more than 5 million people across the U.S. who have Alzheimer’s, about one percent have genetic mutations that are known to cause the disease. Navarro’s gene is known as the Jalisco mutation because it is believed to have surfaced first in that Mexican state. Roughly 50 families are known to have it. \u003c/p>\n\u003cp>Cases like Navarro’s are of great interest to Alzheimer’s researchers. Studying this unique population with genetic mutations, they say, could help unlock some of the biggest mysteries of the more common form of the disease: How does it develop? What can be done to stop it?\u003c/p>\n\u003cp>Ordinarily, it’s difficult — if not impossible — to predict Alzheimer’s. But with these families, researchers know the mutation carriers will get the disease. They also know approximately when symptoms will appear, so they can get a real-time look at how the disease develops and possibly design drugs for it before patients lose their memory. \u003c/p>\n\u003cp>“If you know from age 18 or even from birth whether someone is going to develop the disease or not, you have got a big window to intervene,” Navarro’s doctor, John Ringman, a neurology professor at the Keck School of Medicine of the University of Southern California. “We don’t have a way to repair or bring back lost brain cells.” \u003c/p>\n\u003cp>Hundreds of people whose families are afflicted with a variety of early-onset mutations are subjecting themselves to medical tests, hoping scientists can develop therapies to prevent and treat Alzheimer’s. But their participation often comes with the sad realization it may be too late to help them. \u003c/p>\n\u003cp>More than 450 people are part of an international network of research being led by Washington University School of Medicine in St. Louis. Each has a parent with an early-onset gene mutation.\u003c/p>\n\u003cp>“They are all desperately fearful that they themselves have inherited a mutation,” said John C. Morris, director of the school’s Alzheimer’s Disease Research Center. “But what they are really fearful about is that if they did, that they will pass it along to their children.”\u003c/p>\n\u003cp>Children have a 50 percent chance of inheriting the mutation from a parent who carries it.\u003c/p>\n\u003cp>Navarro, whose children are now young adults, is well aware of the statistics. She has joined the network’s research effort, of which Ringman is a part. Last year, a scan showed her brain had already started to shrink — a sign that the disease was taking hold.\u003c/p>\n\u003cp>\u003cstrong>‘At Least We Know Now’\u003cbr>\n\u003c/strong>\u003cbr>\nIn November 2015, Dr. Ringman drove to Colton, Calif. — 60 miles east of Los Angeles — to meet with the large and close-knit Kitchen family. Jay Kitchen and his younger brother John had been referred to him after each suffered a series of baffling symptoms. \u003c/p>\n\u003cp>It had started about four years earlier. Jay, then a 44-year-old sports writer, began having difficulty speaking. He felt off balance and was forgetting things. Soon afterward, his younger brother, John, a high school history teacher, started becoming easily confused. He would forget what day it was and how to get to the market.\u003c/p>\n\u003cp>Doctors were “scratching their heads trying to figure out what was wrong,” said the brothers’ aunt, Linda Ramos. \u003c/p>\n\u003cp>A neurologist referred the brothers to Ringman, who ordered a blood test. On this November morning, Ringman came to Ramos’ home, where the extended family was gathered, with grim news. Both men had the Jalisco mutation. The brothers sat in near silence, Ramos said. \u003c/p>\n\u003cp>Like many families Ringman encounters, the other relatives also absorbed the news with little emotion or surprise — as though the doctor were confirming nameless fears. \u003c/p>\n\u003cp>“My thought was, ‘At least we know now,” Ramos said. “Finally, we know. Thank God we have a name [for it] and maybe we can do something for their kids.” \u003c/p>\n\u003cp>\u003cstrong>One Family Leads To Another\u003cbr>\n\u003c/strong>\u003cbr>\nRingman was a young neurologist at the University of California, Irvine in 1999 when a 42-year-old woman, Rosa Maria Navarro, came to see him. Her daughter Rosemary brought her, distraught because her mother, like so many other relatives, had signs of early Alzheimer’s.\u003c/p>\n\u003cp>Ringman was aware of recently identified familial Alzheimer’s mutations and immediately suspected Rosa Maria had one. She tested positive for the mutation later named Jalisco. \u003c/p>\n\u003cp>Soon afterward, another patient of Ringman’s, also with forebears from Jalisco, tested positive for the same mutation. \u003c/p>\n\u003cp>Ringman started working with doctors in Mexico, and they identified many similar patients who were all at least distantly related. They concluded the disease likely started with one ancestor. \u003c/p>\n\u003cp>Ringman saw the tragedy but also the scientific opportunity in these discoveries. He later joined the Washington University research network in its quest for knowledge and treatment options. \u003c/p>\n\u003cp>Among the network’s early findings: The brain begins to change before any symptoms occur. The research essentially has presented a timeline of brain changes leading up to cognitive decline and has helped scientists decide when and where to aim drugs. \u003c/p>\n\u003cp>The Kitchen brothers are not participating in the research. Both are declining precipitously. Jay only occasionally recognizes family members. John can still hold a conversation but struggles for the right words.\u003c/p>\n\u003cp>“We get a glimmer of hope,” their aunt Ramos said, “but then we think we are foolish for even hoping.”\u003c/p>\n\u003cp>\u003cstrong>Fear And Faith\u003cbr>\n\u003c/strong>\u003cbr>\nNavarro’s 19-year-old daughter, Lizeth, and her 22-year-old son, Ricardo, live with her in a three-bedroom trailer in La Habra. Both say said their mom has started forgetting little things — the movie they saw last week or what they need from the grocery store. \u003c/p>\n\u003cp>Rosemary Navarro keeps working in customer service and tries to focus on her family, not the disease. “I can’t let it overcome me,” she said. \u003c/p>\n\u003cp>She’s joined a drug trial out of Washington University. Each month, a nurse visits and injects a medication, which she’s pretty sure is not a placebo.\u003c/p>\n\u003cp>“I have to have faith in the drug,” she said. “That’s my only solution for now.”\u003c/p>\n\u003cp>“Otherwise …” \u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>She didn’t finish her thought.\u003c/p>\n\n",
"disqusIdentifier": "280735 http://ww2.kqed.org/stateofhealth/?p=280735",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/01/05/early-alzheimers-gene-spells-tragedy-for-patients-opportunity-for-science/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 1385,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 40
},
"modified": 1483594399,
"excerpt": "Researchers are studying families from the U.S. and Mexico for clues to how Alzheimer’s develops in younger patients, with the hope of finding treatments for the more common form of the disease. ",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "Researchers are studying families from the U.S. and Mexico for clues to how Alzheimer’s develops in younger patients, with the hope of finding treatments for the more common form of the disease. ",
"title": "Early Alzheimer’s Gene Spells Tragedy For Patients, Opportunity For Science | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Early Alzheimer’s Gene Spells Tragedy For Patients, Opportunity For Science",
"datePublished": "2017-01-05T04:30:45-08:00",
"dateModified": "2017-01-04T21:33:19-08:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "early-alzheimers-gene-spells-tragedy-for-patients-opportunity-for-science",
"status": "publish",
"nprByline": "\u003ca href = \"http://khn.org/news/author/anna-gorman/\">Anna Gorman\u003c/a>\u003cbr/>Kaiser Health News",
"path": "/stateofhealth/280735/early-alzheimers-gene-spells-tragedy-for-patients-opportunity-for-science",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>LA HABRA, California – Rosemary Navarro was living in Mexico when her brother called from California. Something wasn’t right with their mom, then in her early 40s. She was having trouble paying bills and keeping jobs as a food preparer in convalescent homes.\u003c/p>\n\u003cp>Navarro, then 22, moved back to the U.S. with her two young children. \u003c/p>\n\u003cp>Before long, Navarro was feeding her mom, then changing her diapers. Near the end, her mom, a quiet woman who had immigrated to the U.S. as a teenager and loved telenovelas, could communicate only by laughing or crying. She died at 53 in a nursing home. \u003c/p>\n\u003cp>It has happened again and again in her family — relatives struck by the same terrible disease, most without any clue what it was. An aunt, an uncle, a cousin, a grandfather, a great grandfather. “Too many have died,” Navarro said. All in their early 50s. \u003c/p>\n\u003cp>Now the family knows the reason for their curse: It’s a rare type of early-onset Alzheimer’s disease, caused by what’s come to be known as the “Jalisco” genetic mutation. Doctors today can tell someone they have it but can’t stop its destructive march.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For Navarro, watching her relatives succumb is like looking into a crystal ball, one she wants to hurl across the room. She, too, has the mutation. In April, she turned 40 — the same age her mother was when she started wandering off and forgetting simple things. \u003c/p>\n\u003cp>“I don’t look forward to birthdays,” she said. “I didn’t want to celebrate 40, much less 41.”\u003c/p>\n\u003cp>\u003cstrong>Sparing The Next Generation\u003c/strong>\u003c/p>\n\u003cp>Navarro, who lives in La Habra, Calif., belongs to an exclusive but unenviable club whose members are genetically programmed for early memory loss and death. \u003c/p>\n\u003cp>Of the more than 5 million people across the U.S. who have Alzheimer’s, about one percent have genetic mutations that are known to cause the disease. Navarro’s gene is known as the Jalisco mutation because it is believed to have surfaced first in that Mexican state. Roughly 50 families are known to have it. \u003c/p>\n\u003cp>Cases like Navarro’s are of great interest to Alzheimer’s researchers. Studying this unique population with genetic mutations, they say, could help unlock some of the biggest mysteries of the more common form of the disease: How does it develop? What can be done to stop it?\u003c/p>\n\u003cp>Ordinarily, it’s difficult — if not impossible — to predict Alzheimer’s. But with these families, researchers know the mutation carriers will get the disease. They also know approximately when symptoms will appear, so they can get a real-time look at how the disease develops and possibly design drugs for it before patients lose their memory. \u003c/p>\n\u003cp>“If you know from age 18 or even from birth whether someone is going to develop the disease or not, you have got a big window to intervene,” Navarro’s doctor, John Ringman, a neurology professor at the Keck School of Medicine of the University of Southern California. “We don’t have a way to repair or bring back lost brain cells.” \u003c/p>\n\u003cp>Hundreds of people whose families are afflicted with a variety of early-onset mutations are subjecting themselves to medical tests, hoping scientists can develop therapies to prevent and treat Alzheimer’s. But their participation often comes with the sad realization it may be too late to help them. \u003c/p>\n\u003cp>More than 450 people are part of an international network of research being led by Washington University School of Medicine in St. Louis. Each has a parent with an early-onset gene mutation.\u003c/p>\n\u003cp>“They are all desperately fearful that they themselves have inherited a mutation,” said John C. Morris, director of the school’s Alzheimer’s Disease Research Center. “But what they are really fearful about is that if they did, that they will pass it along to their children.”\u003c/p>\n\u003cp>Children have a 50 percent chance of inheriting the mutation from a parent who carries it.\u003c/p>\n\u003cp>Navarro, whose children are now young adults, is well aware of the statistics. She has joined the network’s research effort, of which Ringman is a part. Last year, a scan showed her brain had already started to shrink — a sign that the disease was taking hold.\u003c/p>\n\u003cp>\u003cstrong>‘At Least We Know Now’\u003cbr>\n\u003c/strong>\u003cbr>\nIn November 2015, Dr. Ringman drove to Colton, Calif. — 60 miles east of Los Angeles — to meet with the large and close-knit Kitchen family. Jay Kitchen and his younger brother John had been referred to him after each suffered a series of baffling symptoms. \u003c/p>\n\u003cp>It had started about four years earlier. Jay, then a 44-year-old sports writer, began having difficulty speaking. He felt off balance and was forgetting things. Soon afterward, his younger brother, John, a high school history teacher, started becoming easily confused. He would forget what day it was and how to get to the market.\u003c/p>\n\u003cp>Doctors were “scratching their heads trying to figure out what was wrong,” said the brothers’ aunt, Linda Ramos. \u003c/p>\n\u003cp>A neurologist referred the brothers to Ringman, who ordered a blood test. On this November morning, Ringman came to Ramos’ home, where the extended family was gathered, with grim news. Both men had the Jalisco mutation. The brothers sat in near silence, Ramos said. \u003c/p>\n\u003cp>Like many families Ringman encounters, the other relatives also absorbed the news with little emotion or surprise — as though the doctor were confirming nameless fears. \u003c/p>\n\u003cp>“My thought was, ‘At least we know now,” Ramos said. “Finally, we know. Thank God we have a name [for it] and maybe we can do something for their kids.” \u003c/p>\n\u003cp>\u003cstrong>One Family Leads To Another\u003cbr>\n\u003c/strong>\u003cbr>\nRingman was a young neurologist at the University of California, Irvine in 1999 when a 42-year-old woman, Rosa Maria Navarro, came to see him. Her daughter Rosemary brought her, distraught because her mother, like so many other relatives, had signs of early Alzheimer’s.\u003c/p>\n\u003cp>Ringman was aware of recently identified familial Alzheimer’s mutations and immediately suspected Rosa Maria had one. She tested positive for the mutation later named Jalisco. \u003c/p>\n\u003cp>Soon afterward, another patient of Ringman’s, also with forebears from Jalisco, tested positive for the same mutation. \u003c/p>\n\u003cp>Ringman started working with doctors in Mexico, and they identified many similar patients who were all at least distantly related. They concluded the disease likely started with one ancestor. \u003c/p>\n\u003cp>Ringman saw the tragedy but also the scientific opportunity in these discoveries. He later joined the Washington University research network in its quest for knowledge and treatment options. \u003c/p>\n\u003cp>Among the network’s early findings: The brain begins to change before any symptoms occur. The research essentially has presented a timeline of brain changes leading up to cognitive decline and has helped scientists decide when and where to aim drugs. \u003c/p>\n\u003cp>The Kitchen brothers are not participating in the research. Both are declining precipitously. Jay only occasionally recognizes family members. John can still hold a conversation but struggles for the right words.\u003c/p>\n\u003cp>“We get a glimmer of hope,” their aunt Ramos said, “but then we think we are foolish for even hoping.”\u003c/p>\n\u003cp>\u003cstrong>Fear And Faith\u003cbr>\n\u003c/strong>\u003cbr>\nNavarro’s 19-year-old daughter, Lizeth, and her 22-year-old son, Ricardo, live with her in a three-bedroom trailer in La Habra. Both say said their mom has started forgetting little things — the movie they saw last week or what they need from the grocery store. \u003c/p>\n\u003cp>Rosemary Navarro keeps working in customer service and tries to focus on her family, not the disease. “I can’t let it overcome me,” she said. \u003c/p>\n\u003cp>She’s joined a drug trial out of Washington University. Each month, a nurse visits and injects a medication, which she’s pretty sure is not a placebo.\u003c/p>\n\u003cp>“I have to have faith in the drug,” she said. “That’s my only solution for now.”\u003c/p>\n\u003cp>“Otherwise …” \u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "floatright"
},
"numeric": [
"floatright"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She didn’t finish her thought.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/280735/early-alzheimers-gene-spells-tragedy-for-patients-opportunity-for-science",
"authors": [
"byline_stateofhealth_280735"
],
"categories": [
"stateofhealth_11",
"stateofhealth_13"
],
"tags": [
"stateofhealth_3020",
"stateofhealth_2808",
"stateofhealth_3021"
],
"affiliates": [
"stateofhealth_3007"
],
"featImg": "stateofhealth_280736",
"label": "stateofhealth_3007"
},
"stateofhealth_274563": {
"type": "posts",
"id": "stateofhealth_274563",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "274563",
"score": null,
"sort": [
1482365620000
]
},
"parent": 0,
"labelTerm": {},
"blocks": [],
"publishDate": 1482365620,
"format": "standard",
"disqusTitle": "Obamacare Enrollment is Beating Last Year’s Early Pace",
"title": "Obamacare Enrollment is Beating Last Year’s Early Pace",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>Despite the Affordable Care Act’s rising prices, decreased insurer participation and a vigorous political threat to its survival, consumer enrollment for 2017 is outpacing last year’s, according to new federal data and reports from state officials around the country.\u003c/p>\n\u003cp>Americans’ anxiety about how a new Republican-controlled Congress and President-elect Donald Trump will repeal and replace the health law is helping fuel early enrollment gains in the online marketplaces that sell individual coverage, state exchange officials and health consultants said.\u003c/p>\n\u003cp>Healthcare.gov, the federal marketplace which handles coverage for 39 states, enrolled 6.4 million people from Nov. 1 through Monday, about 400,000 more than at the same time a year ago, the Health and Human Services Department said Wednesday. Monday was the deadline in those states to sign up for coverage starting Jan. 1, but open enrollment will continue until Jan. 31 for 2017 coverage.\u003c/p>\n\u003cp>“The marketplace is strong … and now we know the doomsday predictions about the marketplace are not coming true,” HHS Secretary Sylvia Burwell said in a press briefing.\u003c/p>\n\u003cp>The surge in sign-ups on the federal marketplace mirrors activity on several state-run Obamacare exchanges, according to figures obtained from states independently by Kaiser Health News. Minnesota, with more than 54,000 enrollees as of Monday, doubled the number of sign-ups it had at the same time last year. Colorado, Massachusetts and Washington had enrollment growth of at least 13 percent compared to a year ago.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Because of the new administration and the high likelihood of changes coming to the ACA, it is creating a sense of urgency” for people to enroll, said Michael Marchand, director of communications for the Washington Health Benefit Exchange. Enrollment exceeded 170,000 customers on the Washington exchange as of this week, up 13 percent compared to same time a year ago.\u003c/p>\n\u003cp>Other state exchanges saw moderate increases: Connecticut, 3 percent; Idaho, 4 percent; Maryland, 1 percent. California’s enrollment is about same as a year ago. Rhode Island’s enrollment dropped to 27,555 from 31,900 for the same period last year. State exchange officials cited a drop in customers who were automatically renewed because UnitedHealthcare dropped out.\u003c/p>\n\u003cp>About 12.7 million people enrolled in the state and federal exchanges for 2016 coverage at the end of the previous enrollment season. HHS predicted in October that an additional 1.1 million people would sign up for 2017 coverage. Burwell said Wednesday that her department is sticking with that projection, even though “the headwinds have increased” since the election.\u003c/p>\n\u003cp>Obamacare, now in its fourth open enrollment season, took some heavy blows this year after several big insurers — including UnitedHealthcare, Humana and Aetna — withdrew from many marketplaces for 2017 because of heavy financial losses. At the same time, remaining insurers increased premiums by 25 percent on average.\u003c/p>\n\u003cp>All of that, plus a changed political climate in Washington, was expected to dampen enrollment. While the surprise presidential election outcome may have been the primary force for changing those expectations, other factors also have fueled enrollment growth this fall, state officials pointed out in interviews.\u003c/p>\n\u003cp>More people who don’t qualify for government subsidies are buying health plans on the exchanges because it’s an easier way to compare available plans in one place. Noting that trend, Premera Blue Cross in Washington recently stopped selling individual coverage off the exchange.\u003c/p>\n\u003cp>In Minnesota, higher government subsidies — which reduce premiums for people with lower incomes — is the main reason why more people have signed up, according to Allison O’Toole, CEO of MNsure, the state-run exchange. The subsidy amount is tied to the cost of the second-lowest silver plan on the exchange, so as premiums rise for that plan, the subsidy rises too. Premiums soared by an average 50 percent in Minnesota for second-lowest silver.\u003c/p>\n\u003cp>Another factor driving earlier enrollment in that state was caps set by several Minnesota insurers on the number of new enrollees they would accept. People signed up earlier to make sure they could get the plan they wanted, according to O’Toole.\u003c/p>\n\u003cp>Minnesota’s growth is surprising because one of its biggest carriers, Blue Cross and Blue Shield of Minnesota, stopped selling its most popular health plan on the exchange. That forced about 20,000 people to change insurers or switch from Blue Cross’ PPO, which has a broad provider network, to its HMO plan with a narrower network.\u003c/p>\n\u003cp>In Colorado, the 18 percent increase in enrollment so far has exceeded officials’ expectations, said Luke Clarke, the spokesman for Connect for Health Colorado, the state exchange. “We had an office pool and no one picked a number that high,” he said. “It was a healthy surprise,” particularly because premiums increased in the state by about 20 percent on average.\u003c/p>\n\u003cp>Conservatives warn it’s still too early for Obamacare supporters to celebrate.\u003c/p>\n\u003cp>“I suspect that some states saw big increases because local advocacy groups were able to tell their constituents that they should enroll before Trump is sworn in and Republicans take over Congress — thereby pretty much guaranteeing that they get a full year’s coverage regardless of what Republicans might do on repeal,” said Joe Antos, a health economist with the American Enterprise Institute, a conservative think tank.\u003c/p>\n\u003cp>Under that scenario, large enrollment increases this fall might be followed by a dropoff in January over the 2016 numbers and the final enrollment tally could end up similar this year’s, he said. Antos noted the true enrollment figures will be known once people pay for their coverage and stay enrolled for the full year.\u003c/p>\n\u003cp>“As with everything related to ACA,” Antos said, “it’s easy to find a happy story if you squint hard enough and don’t wait for the enrollment process to complete — or the plan year to end.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
"disqusIdentifier": "274563 http://ww2.kqed.org/stateofhealth/?p=274563",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2016/12/21/obamacare-enrollment-is-beating-last-years-early-pace/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 1040,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 22
},
"modified": 1482365620,
"excerpt": "Despite rising prices, decreased insurer participation and vigorous political opposition, patient enrollment for 2017 is exceeding pre-holiday numbers seen a year ago. ",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "Despite rising prices, decreased insurer participation and vigorous political opposition, patient enrollment for 2017 is exceeding pre-holiday numbers seen a year ago. ",
"title": "Obamacare Enrollment is Beating Last Year’s Early Pace | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Obamacare Enrollment is Beating Last Year’s Early Pace",
"datePublished": "2016-12-21T16:13:40-08:00",
"dateModified": "2016-12-21T16:13:40-08:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "obamacare-enrollment-is-beating-last-years-early-pace",
"status": "publish",
"sourceUrl": "http://khn.org/",
"nprByline": "\u003ca href=\"http://khn.org/news/author/phil-galewitz/\">\u003cstrong>Phil Galewitz\u003c/strong>\u003c/a>",
"source": "Kaiser Health News",
"path": "/stateofhealth/274563/obamacare-enrollment-is-beating-last-years-early-pace",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Despite the Affordable Care Act’s rising prices, decreased insurer participation and a vigorous political threat to its survival, consumer enrollment for 2017 is outpacing last year’s, according to new federal data and reports from state officials around the country.\u003c/p>\n\u003cp>Americans’ anxiety about how a new Republican-controlled Congress and President-elect Donald Trump will repeal and replace the health law is helping fuel early enrollment gains in the online marketplaces that sell individual coverage, state exchange officials and health consultants said.\u003c/p>\n\u003cp>Healthcare.gov, the federal marketplace which handles coverage for 39 states, enrolled 6.4 million people from Nov. 1 through Monday, about 400,000 more than at the same time a year ago, the Health and Human Services Department said Wednesday. Monday was the deadline in those states to sign up for coverage starting Jan. 1, but open enrollment will continue until Jan. 31 for 2017 coverage.\u003c/p>\n\u003cp>“The marketplace is strong … and now we know the doomsday predictions about the marketplace are not coming true,” HHS Secretary Sylvia Burwell said in a press briefing.\u003c/p>\n\u003cp>The surge in sign-ups on the federal marketplace mirrors activity on several state-run Obamacare exchanges, according to figures obtained from states independently by Kaiser Health News. Minnesota, with more than 54,000 enrollees as of Monday, doubled the number of sign-ups it had at the same time last year. Colorado, Massachusetts and Washington had enrollment growth of at least 13 percent compared to a year ago.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Because of the new administration and the high likelihood of changes coming to the ACA, it is creating a sense of urgency” for people to enroll, said Michael Marchand, director of communications for the Washington Health Benefit Exchange. Enrollment exceeded 170,000 customers on the Washington exchange as of this week, up 13 percent compared to same time a year ago.\u003c/p>\n\u003cp>Other state exchanges saw moderate increases: Connecticut, 3 percent; Idaho, 4 percent; Maryland, 1 percent. California’s enrollment is about same as a year ago. Rhode Island’s enrollment dropped to 27,555 from 31,900 for the same period last year. State exchange officials cited a drop in customers who were automatically renewed because UnitedHealthcare dropped out.\u003c/p>\n\u003cp>About 12.7 million people enrolled in the state and federal exchanges for 2016 coverage at the end of the previous enrollment season. HHS predicted in October that an additional 1.1 million people would sign up for 2017 coverage. Burwell said Wednesday that her department is sticking with that projection, even though “the headwinds have increased” since the election.\u003c/p>\n\u003cp>Obamacare, now in its fourth open enrollment season, took some heavy blows this year after several big insurers — including UnitedHealthcare, Humana and Aetna — withdrew from many marketplaces for 2017 because of heavy financial losses. At the same time, remaining insurers increased premiums by 25 percent on average.\u003c/p>\n\u003cp>All of that, plus a changed political climate in Washington, was expected to dampen enrollment. While the surprise presidential election outcome may have been the primary force for changing those expectations, other factors also have fueled enrollment growth this fall, state officials pointed out in interviews.\u003c/p>\n\u003cp>More people who don’t qualify for government subsidies are buying health plans on the exchanges because it’s an easier way to compare available plans in one place. Noting that trend, Premera Blue Cross in Washington recently stopped selling individual coverage off the exchange.\u003c/p>\n\u003cp>In Minnesota, higher government subsidies — which reduce premiums for people with lower incomes — is the main reason why more people have signed up, according to Allison O’Toole, CEO of MNsure, the state-run exchange. The subsidy amount is tied to the cost of the second-lowest silver plan on the exchange, so as premiums rise for that plan, the subsidy rises too. Premiums soared by an average 50 percent in Minnesota for second-lowest silver.\u003c/p>\n\u003cp>Another factor driving earlier enrollment in that state was caps set by several Minnesota insurers on the number of new enrollees they would accept. People signed up earlier to make sure they could get the plan they wanted, according to O’Toole.\u003c/p>\n\u003cp>Minnesota’s growth is surprising because one of its biggest carriers, Blue Cross and Blue Shield of Minnesota, stopped selling its most popular health plan on the exchange. That forced about 20,000 people to change insurers or switch from Blue Cross’ PPO, which has a broad provider network, to its HMO plan with a narrower network.\u003c/p>\n\u003cp>In Colorado, the 18 percent increase in enrollment so far has exceeded officials’ expectations, said Luke Clarke, the spokesman for Connect for Health Colorado, the state exchange. “We had an office pool and no one picked a number that high,” he said. “It was a healthy surprise,” particularly because premiums increased in the state by about 20 percent on average.\u003c/p>\n\u003cp>Conservatives warn it’s still too early for Obamacare supporters to celebrate.\u003c/p>\n\u003cp>“I suspect that some states saw big increases because local advocacy groups were able to tell their constituents that they should enroll before Trump is sworn in and Republicans take over Congress — thereby pretty much guaranteeing that they get a full year’s coverage regardless of what Republicans might do on repeal,” said Joe Antos, a health economist with the American Enterprise Institute, a conservative think tank.\u003c/p>\n\u003cp>Under that scenario, large enrollment increases this fall might be followed by a dropoff in January over the 2016 numbers and the final enrollment tally could end up similar this year’s, he said. Antos noted the true enrollment figures will be known once people pay for their coverage and stay enrolled for the full year.\u003c/p>\n\u003cp>“As with everything related to ACA,” Antos said, “it’s easy to find a happy story if you squint hard enough and don’t wait for the enrollment process to complete — or the plan year to end.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/274563/obamacare-enrollment-is-beating-last-years-early-pace",
"authors": [
"byline_stateofhealth_274563"
],
"categories": [
"stateofhealth_15"
],
"tags": [
"stateofhealth_2808",
"stateofhealth_365"
],
"affiliates": [
"stateofhealth_3007"
],
"featImg": "stateofhealth_274565",
"label": "source_stateofhealth_274563"
},
"stateofhealth_272110": {
"type": "posts",
"id": "stateofhealth_272110",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "272110",
"score": null,
"sort": [
1481846517000
]
},
"parent": 0,
"labelTerm": {},
"blocks": [],
"publishDate": 1481846517,
"format": "standard",
"disqusTitle": "Amid Sign-Up Surge, Covered California Extends Enrollment Deadline",
"title": "Amid Sign-Up Surge, Covered California Extends Enrollment Deadline",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>Californians are signing up in higher numbers than they did last year for health plans sold on the state’s health insurance exchange, despite great uncertainty over the future of Obamacare.\u003c/p>\n\u003cp>More than 25,000 new consumers chose new Covered California plans in just two days earlier this week, exchange officials said Wednesday.\u003c/p>\n\u003cp>Because of the last-minute rush, Covered California officials have extended the enrollment deadline for coverage that begins Jan. 1. Consumers now have until midnight on Dec. 17 to choose plans. Coverage purchased after this Saturday’s deadline will start either on Feb. 1 or March 1.\u003c/p>\n\u003cp>Since open enrollment began Nov. 1, more than 153,000 new people have signed up for 2017 coverage, compared with 144,000 at this time last year, Covered California officials said. In addition, more than 1.2 million people with existing Covered California plans have renewed their coverage for next year.\u003c/p>\n\u003cp>President-elect Donald Trump and Republican leaders in Congress have promised to repeal the Affordable Care Act, the health reform law under which Covered California was established. The exchange, like others around the U.S., sells health coverage that comes with federal tax subsidies to help people of modest means pay the premiums.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Republican lawmakers say they want a repeal bill ready by Inauguration Day on Jan. 20, but that timetable \u003ca href=\"http://khn.org/news/gops-timetable-for-getting-repeal-to-trump-may-be-ambitious/\" target=\"_blank\">may be too ambitious\u003c/a>. Still, Obamacare enrollment \u003ca href=\"http://www.usnews.com/news/health-care-news/articles/2016-12-14/obamacare-sees-strong-enrollment-despite-price-hikes-repeal-threats\" target=\"_blank\">has been surging\u003c/a> in California and nationwide.\u003c/p>\n\u003cp>Peter Lee, Covered California’s executive director, said he brought his staff together the day after Election Day and told them not to be deterred by the upcoming change in in the White House.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“One of the things I said [is] ‘now’s not the time to be looking for a job; now’s the time to be doing your job.’ And that’s exactly what people at Covered California have been doing,” Lee said at a health symposium in Sacramento on Tuesday.\u003c/p>\n\n",
"disqusIdentifier": "272110 http://ww2.kqed.org/stateofhealth/?p=272110",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2016/12/15/amid-sign-up-surge-covered-california-extends-enrollment-deadline/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 331,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 10
},
"modified": 1482171176,
"excerpt": "Despite health law uncertainty, more than 25,000 new consumers chose new plans in just two days this week.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "Despite health law uncertainty, more than 25,000 new consumers chose new plans in just two days this week.",
"title": "Amid Sign-Up Surge, Covered California Extends Enrollment Deadline | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Amid Sign-Up Surge, Covered California Extends Enrollment Deadline",
"datePublished": "2016-12-15T16:01:57-08:00",
"dateModified": "2016-12-19T10:12:56-08:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "amid-sign-up-surge-covered-california-extends-enrollment-deadline",
"status": "publish",
"sourceUrl": "http://californiahealthline.org/",
"nprByline": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/pauline-bartolone\">Pauline Bartolone\u003c/a>\u003c/strong>",
"source": "California Healthline",
"path": "/stateofhealth/272110/amid-sign-up-surge-covered-california-extends-enrollment-deadline",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Californians are signing up in higher numbers than they did last year for health plans sold on the state’s health insurance exchange, despite great uncertainty over the future of Obamacare.\u003c/p>\n\u003cp>More than 25,000 new consumers chose new Covered California plans in just two days earlier this week, exchange officials said Wednesday.\u003c/p>\n\u003cp>Because of the last-minute rush, Covered California officials have extended the enrollment deadline for coverage that begins Jan. 1. Consumers now have until midnight on Dec. 17 to choose plans. Coverage purchased after this Saturday’s deadline will start either on Feb. 1 or March 1.\u003c/p>\n\u003cp>Since open enrollment began Nov. 1, more than 153,000 new people have signed up for 2017 coverage, compared with 144,000 at this time last year, Covered California officials said. In addition, more than 1.2 million people with existing Covered California plans have renewed their coverage for next year.\u003c/p>\n\u003cp>President-elect Donald Trump and Republican leaders in Congress have promised to repeal the Affordable Care Act, the health reform law under which Covered California was established. The exchange, like others around the U.S., sells health coverage that comes with federal tax subsidies to help people of modest means pay the premiums.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Republican lawmakers say they want a repeal bill ready by Inauguration Day on Jan. 20, but that timetable \u003ca href=\"http://khn.org/news/gops-timetable-for-getting-repeal-to-trump-may-be-ambitious/\" target=\"_blank\">may be too ambitious\u003c/a>. Still, Obamacare enrollment \u003ca href=\"http://www.usnews.com/news/health-care-news/articles/2016-12-14/obamacare-sees-strong-enrollment-despite-price-hikes-repeal-threats\" target=\"_blank\">has been surging\u003c/a> in California and nationwide.\u003c/p>\n\u003cp>Peter Lee, Covered California’s executive director, said he brought his staff together the day after Election Day and told them not to be deterred by the upcoming change in in the White House.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“One of the things I said [is] ‘now’s not the time to be looking for a job; now’s the time to be doing your job.’ And that’s exactly what people at Covered California have been doing,” Lee said at a health symposium in Sacramento on Tuesday.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/272110/amid-sign-up-surge-covered-california-extends-enrollment-deadline",
"authors": [
"byline_stateofhealth_272110"
],
"categories": [
"stateofhealth_15"
],
"tags": [
"stateofhealth_368",
"stateofhealth_2808",
"stateofhealth_2846",
"stateofhealth_365"
],
"affiliates": [
"stateofhealth_3007"
],
"featImg": "stateofhealth_272130",
"label": "source_stateofhealth_272110"
},
"stateofhealth_271368": {
"type": "posts",
"id": "stateofhealth_271368",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "271368",
"score": null,
"sort": [
1481660194000
]
},
"parent": 0,
"labelTerm": {},
"blocks": [],
"publishDate": 1481660194,
"format": "standard",
"disqusTitle": "Leading the Way? Northern California Cities to Embark on Soda Tax Spending",
"title": "Leading the Way? Northern California Cities to Embark on Soda Tax Spending",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>Asian Health Services, a community health center in Oakland’s buzzing Chinatown, sees about 6,000 dental patients a year. Hundreds of others are on a waiting list.\u003c/p>\n\u003cp>“We simply cannot meet the demand,” said Dr. Huong Le, the center’s dental director.\u003c/p>\n\u003cp>But now that voters have passed soda taxes in Oakland, Albany and San Francisco, Le and other Bay Area health providers are eyeing millions of dollars in revenue that could help more patients prevent obesity and dental decay.\u003c/p>\n\u003cp>The San Francisco Bay Area is trying to lead the way in putting soda tax revenues to good use, and cities around the country are watching closely. Some are considering soda taxes of their own.\u003c/p>\n\u003cp>“Soda taxes are going to be spreading like wildfire,” said Harold Goldstein, executive director of the Davis-based nonprofit Public Health Advocates.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The city of Berkeley, also in Alameda County, passed the \u003ca href=\"http://californiahealthline.org/news/is-berkeleys-new-soda-tax-a-tipping-point-or-an-outlie/\" target=\"_blank\">nation’s first such tax \u003c/a>in 2014.\u003c/p>\n\u003cp>In San Francisco, the tax, which takes effect Jan. 1, 2018, is expected to raise up to $15 million annually. Meanwhile in the smaller city of Albany, the tax took effect immediately and is projected to garner $223,000 each year. In Oakland, the penny-per-ounce tax on the distribution of sugar-sweetened beverages is projected to bring in up to $8 million each year, some of which will be used for health education and prevention programs in schools and the community. It takes effect in July.\u003c/p>\n\u003cp>“We felt this was very important because of the dental needs we see within our patient population,” Le said. “We know there’s a strong link between tooth decay and sugary beverages.”\u003c/p>\n\u003cp>The link between sugary beverages and obesity, diabetes and tooth decay is well-established. People who drink one or two cans of sugary drinks per day have a 26 percent greater risk of developing type 2 diabetes, according to one \u003ca href=\"https://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/\" target=\"_blank\">study\u003c/a> by the Harvard School of Public Health.\u003c/p>\n\u003cp>A separate study found that for every 12-ounce soda consumed by a child each day, their odds of becoming obese increased by \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11229668\" target=\"_blank\">60 percent\u003c/a>. Soda also has been tied to dental erosion which can lead to cavities, according a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676420/\" target=\"_blank\">2009 study\u003c/a>. The most frequent sources of erosive acids are soft drinks like cola, the study found.\u003c/p>\n\u003cp>In a report earlier this this year, an oversight commission criticized the state’s dental program for the poor, finding that California is seeing an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches.” This is made worse when families struggle to get an appointment with a dentist, the report said.\u003c/p>\n\u003cp>In Oakland and the rest of Alameda County, \u003ca href=\"http://www.acgov.org/board/bos_calendar/documents/DocsAgendaReg_7_14_14/HEALTH%20CARE%20SERVICES/Regular%20Calendar/Alameda_County_Report_Exec_Summ_Obesity_Rpt.pdf\" target=\"_blank\">one third\u003c/a> of children consume one or more sugary drinks a day.\u003c/p>\n\u003cp>Oakland’s city council will establish a community advisory board to oversee the distribution of soda tax money, and local health advocates want to make sure they’re well-represented, Le said.\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/news/soda-taxes-gaining-steam-or-getting-steamrolled/\" target=\"_blank\">Goldstein\u003c/a> said the fact that measures recently passed in all three Bay Area cities by a notable margin — in Oakland the tax was approved with 61 percent of the vote — shows that Californians grasp the harmful effects of sugary drinks.\u003c/p>\n\u003cp>Soda taxes, he said, are significant because they raise money to be used in the fight against obesity and other chronic conditions, and they reduce the consumption of sugary drinks.\u003c/p>\n\u003cp>In Berkeley’s low-income neighborhoods, the consumption of soda and other sweetened beverages decreased by 21 percent in the months after the 2014 tax began, according to a \u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303362\" target=\"_blank\">UC Berkeley study\u003c/a>.\u003c/p>\n\u003cp>The study also showed a 63 percent increase in the consumption of bottled or tap water. It is not clear whether these results are due to the higher retail prices of sugary drinks or to the increased awareness on the health effects associated with the beverages, the study notes.\u003c/p>\n\u003cp>Goldstein said similar outcomes can be expected in Oakland, San Francisco and Albany, as well as in Boulder, Colo., where voters also passed a similar tax in November. This drives up the total number of cities with soda taxes to six — Philadelphia passed a 1.5 cents-per-ounce tax in June.\u003c/p>\n\u003cp>The American Beverage Association, which has lobbied heavily against soda taxes nationwide, doesn’t see a movement. Spokeswoman Lauren Kane said that \u003ca href=\"http://www.reuters.com/article/us-beverages-sodatax-bloomberg-idUSKCN0Z3275\" target=\"_blank\">43 soda tax proposals have been rejected \u003c/a>since 2008.\u003c/p>\n\u003cp>The association will continue to focus on reducing calories and sugar in beverages, Kane said. These taxes, Kane said, are only a Band-Aid solution to the larger national obesity problem.\u003c/p>\n\u003cp>But they are a start, said Elizabeth Bautista, a health educator at La Clinica, a health center in Oakland’s Fruitvale neighborhood, home to the city’ largest Latino population.\u003c/p>\n\u003cp>Bautista and 15 volunteer health educators known as promotoras engaged their community in the soda tax discussion by going door-to-door and making hundreds of calls to registered voters.\u003c/p>\n\u003cp>The challenge now, Bautista said, is to continue to motivate people to choose alternatives to sugary drinks.\u003c/p>\n\u003cp>The promotoras often share stories of what they see in the field: toddlers with soda in their bottles, and families walking out of dollar stores with grocery bags full of juices and sports drinks.\u003c/p>\n\u003cp>“It’s a serious problem in our community, and there is so much misinformation floating around,” Bautista said. She often hears from families that fruit-flavored sodas are not as harmful as dark sodas. “That of course is not true; that’s a myth we have to eliminate,” she said.\u003c/p>\n\u003cp>Maria Reyes, one of the promotoras, said the clinic is starting additional nutrition and physical activity classes — a healthy cooking class, for example, is expected to be of great interest. These are the type of activities that could be expanded by funds from the soda tax, Reyes said.\u003c/p>\n\u003cp>Reyes believes soda tax advocates in Oakland learned a lot from battles lost in other California cities, such as Richmond and El Monte, where voters rejected soda taxes in 2012.\u003c/p>\n\u003cp>“We learned that we needed a coalition and that we needed to focus the discussion on diabetes and obesity prevention,” Reyes said.\u003c/p>\n\u003cp>The promotoras say they are now hearing from community groups in Contra Costa cities interested in following in their footsteps.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“This is a big win,” Reyes said. “Once we start seeing results, I think more cities will join us.”\u003cbr>\n\u003cem>\u003cbr>\nThis story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
"disqusIdentifier": "271368 http://ww2.kqed.org/stateofhealth/?p=271368",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2016/12/13/leading-the-way-northern-california-cities-to-embark-on-soda-tax-spending/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 1122,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 32
},
"modified": 1481676233,
"excerpt": "The San Francisco Bay Area is trying to lead the way in putting soda tax revenues to good use, and cities around the country are watching closely.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "The San Francisco Bay Area is trying to lead the way in putting soda tax revenues to good use, and cities around the country are watching closely.",
"title": "Leading the Way? Northern California Cities to Embark on Soda Tax Spending | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Leading the Way? Northern California Cities to Embark on Soda Tax Spending",
"datePublished": "2016-12-13T12:16:34-08:00",
"dateModified": "2016-12-13T16:43:53-08:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "leading-the-way-northern-california-cities-to-embark-on-soda-tax-spending",
"status": "publish",
"sourceUrl": "http://khn.org/",
"nprByline": "\u003cstrong>\u003ca href=\"http://khn.org/news/author/ana-b-ibarra/\">Ana Ibarra\u003c/a>\u003c/strong>",
"source": "Kaiser Health News",
"path": "/stateofhealth/271368/leading-the-way-northern-california-cities-to-embark-on-soda-tax-spending",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Asian Health Services, a community health center in Oakland’s buzzing Chinatown, sees about 6,000 dental patients a year. Hundreds of others are on a waiting list.\u003c/p>\n\u003cp>“We simply cannot meet the demand,” said Dr. Huong Le, the center’s dental director.\u003c/p>\n\u003cp>But now that voters have passed soda taxes in Oakland, Albany and San Francisco, Le and other Bay Area health providers are eyeing millions of dollars in revenue that could help more patients prevent obesity and dental decay.\u003c/p>\n\u003cp>The San Francisco Bay Area is trying to lead the way in putting soda tax revenues to good use, and cities around the country are watching closely. Some are considering soda taxes of their own.\u003c/p>\n\u003cp>“Soda taxes are going to be spreading like wildfire,” said Harold Goldstein, executive director of the Davis-based nonprofit Public Health Advocates.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The city of Berkeley, also in Alameda County, passed the \u003ca href=\"http://californiahealthline.org/news/is-berkeleys-new-soda-tax-a-tipping-point-or-an-outlie/\" target=\"_blank\">nation’s first such tax \u003c/a>in 2014.\u003c/p>\n\u003cp>In San Francisco, the tax, which takes effect Jan. 1, 2018, is expected to raise up to $15 million annually. Meanwhile in the smaller city of Albany, the tax took effect immediately and is projected to garner $223,000 each year. In Oakland, the penny-per-ounce tax on the distribution of sugar-sweetened beverages is projected to bring in up to $8 million each year, some of which will be used for health education and prevention programs in schools and the community. It takes effect in July.\u003c/p>\n\u003cp>“We felt this was very important because of the dental needs we see within our patient population,” Le said. “We know there’s a strong link between tooth decay and sugary beverages.”\u003c/p>\n\u003cp>The link between sugary beverages and obesity, diabetes and tooth decay is well-established. People who drink one or two cans of sugary drinks per day have a 26 percent greater risk of developing type 2 diabetes, according to one \u003ca href=\"https://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/\" target=\"_blank\">study\u003c/a> by the Harvard School of Public Health.\u003c/p>\n\u003cp>A separate study found that for every 12-ounce soda consumed by a child each day, their odds of becoming obese increased by \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11229668\" target=\"_blank\">60 percent\u003c/a>. Soda also has been tied to dental erosion which can lead to cavities, according a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676420/\" target=\"_blank\">2009 study\u003c/a>. The most frequent sources of erosive acids are soft drinks like cola, the study found.\u003c/p>\n\u003cp>In a report earlier this this year, an oversight commission criticized the state’s dental program for the poor, finding that California is seeing an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches.” This is made worse when families struggle to get an appointment with a dentist, the report said.\u003c/p>\n\u003cp>In Oakland and the rest of Alameda County, \u003ca href=\"http://www.acgov.org/board/bos_calendar/documents/DocsAgendaReg_7_14_14/HEALTH%20CARE%20SERVICES/Regular%20Calendar/Alameda_County_Report_Exec_Summ_Obesity_Rpt.pdf\" target=\"_blank\">one third\u003c/a> of children consume one or more sugary drinks a day.\u003c/p>\n\u003cp>Oakland’s city council will establish a community advisory board to oversee the distribution of soda tax money, and local health advocates want to make sure they’re well-represented, Le said.\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/news/soda-taxes-gaining-steam-or-getting-steamrolled/\" target=\"_blank\">Goldstein\u003c/a> said the fact that measures recently passed in all three Bay Area cities by a notable margin — in Oakland the tax was approved with 61 percent of the vote — shows that Californians grasp the harmful effects of sugary drinks.\u003c/p>\n\u003cp>Soda taxes, he said, are significant because they raise money to be used in the fight against obesity and other chronic conditions, and they reduce the consumption of sugary drinks.\u003c/p>\n\u003cp>In Berkeley’s low-income neighborhoods, the consumption of soda and other sweetened beverages decreased by 21 percent in the months after the 2014 tax began, according to a \u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303362\" target=\"_blank\">UC Berkeley study\u003c/a>.\u003c/p>\n\u003cp>The study also showed a 63 percent increase in the consumption of bottled or tap water. It is not clear whether these results are due to the higher retail prices of sugary drinks or to the increased awareness on the health effects associated with the beverages, the study notes.\u003c/p>\n\u003cp>Goldstein said similar outcomes can be expected in Oakland, San Francisco and Albany, as well as in Boulder, Colo., where voters also passed a similar tax in November. This drives up the total number of cities with soda taxes to six — Philadelphia passed a 1.5 cents-per-ounce tax in June.\u003c/p>\n\u003cp>The American Beverage Association, which has lobbied heavily against soda taxes nationwide, doesn’t see a movement. Spokeswoman Lauren Kane said that \u003ca href=\"http://www.reuters.com/article/us-beverages-sodatax-bloomberg-idUSKCN0Z3275\" target=\"_blank\">43 soda tax proposals have been rejected \u003c/a>since 2008.\u003c/p>\n\u003cp>The association will continue to focus on reducing calories and sugar in beverages, Kane said. These taxes, Kane said, are only a Band-Aid solution to the larger national obesity problem.\u003c/p>\n\u003cp>But they are a start, said Elizabeth Bautista, a health educator at La Clinica, a health center in Oakland’s Fruitvale neighborhood, home to the city’ largest Latino population.\u003c/p>\n\u003cp>Bautista and 15 volunteer health educators known as promotoras engaged their community in the soda tax discussion by going door-to-door and making hundreds of calls to registered voters.\u003c/p>\n\u003cp>The challenge now, Bautista said, is to continue to motivate people to choose alternatives to sugary drinks.\u003c/p>\n\u003cp>The promotoras often share stories of what they see in the field: toddlers with soda in their bottles, and families walking out of dollar stores with grocery bags full of juices and sports drinks.\u003c/p>\n\u003cp>“It’s a serious problem in our community, and there is so much misinformation floating around,” Bautista said. She often hears from families that fruit-flavored sodas are not as harmful as dark sodas. “That of course is not true; that’s a myth we have to eliminate,” she said.\u003c/p>\n\u003cp>Maria Reyes, one of the promotoras, said the clinic is starting additional nutrition and physical activity classes — a healthy cooking class, for example, is expected to be of great interest. These are the type of activities that could be expanded by funds from the soda tax, Reyes said.\u003c/p>\n\u003cp>Reyes believes soda tax advocates in Oakland learned a lot from battles lost in other California cities, such as Richmond and El Monte, where voters rejected soda taxes in 2012.\u003c/p>\n\u003cp>“We learned that we needed a coalition and that we needed to focus the discussion on diabetes and obesity prevention,” Reyes said.\u003c/p>\n\u003cp>The promotoras say they are now hearing from community groups in Contra Costa cities interested in following in their footsteps.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "floatright"
},
"numeric": [
"floatright"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“This is a big win,” Reyes said. “Once we start seeing results, I think more cities will join us.”\u003cbr>\n\u003cem>\u003cbr>\nThis story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/271368/leading-the-way-northern-california-cities-to-embark-on-soda-tax-spending",
"authors": [
"byline_stateofhealth_271368"
],
"categories": [
"stateofhealth_11",
"stateofhealth_12",
"stateofhealth_14"
],
"tags": [
"stateofhealth_2808",
"stateofhealth_2519",
"stateofhealth_75",
"stateofhealth_728"
],
"affiliates": [
"stateofhealth_3007"
],
"featImg": "stateofhealth_271369",
"label": "source_stateofhealth_271368"
}
},
"podcastsReducer": {
"isFetching": false,
"fetchFailed": false,
"hasFetched": false,
"podcasts": {}
},
"radioProgramsReducer": {
"isFetching": false,
"fetchFailed": false,
"hasFetched": false,
"radioPrograms": {}
},
"radioSearchSegmentsReducer": {},
"programsReducer": {
"all-things-considered": {
"id": "all-things-considered",
"title": "All Things Considered",
"info": "Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.",
"airtime": "MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/all-things-considered/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/all-things-considered"
},
"american-suburb-podcast": {
"id": "american-suburb-podcast",
"title": "American Suburb: The Podcast",
"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?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg",
"officialWebsiteLink": "/news/series/american-suburb-podcast",
"meta": {
"site": "news",
"source": "kqed",
"order": 19
},
"link": "/news/series/american-suburb-podcast/",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/RBrW",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328",
"tuneIn": "https://tunein.com/radio/American-Suburb-p1086805/",
"rss": "https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"
}
},
"baycurious": {
"id": "baycurious",
"title": "Bay Curious",
"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Bay Curious",
"officialWebsiteLink": "/news/series/baycurious",
"meta": {
"site": "news",
"source": "kqed",
"order": 3
},
"link": "/podcasts/baycurious",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/bay-curious/id1172473406",
"npr": "https://www.npr.org/podcasts/500557090/bay-curious",
"rss": "https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast",
"amazon": "https://music.amazon.com/podcasts/9a90d476-aa04-455d-9a4c-0871ed6216d4/bay-curious",
"stitcher": "https://www.stitcher.com/podcast/kqed/bay-curious",
"spotify": "https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"
}
},
"bbc-world-service": {
"id": "bbc-world-service",
"title": "BBC World Service",
"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
"airtime": "MON-FRI 9pm-10pm, TUE-FRI 1am-2am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.bbc.co.uk/sounds/play/live:bbc_world_service",
"meta": {
"site": "news",
"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2",
"tuneIn": "https://tunein.com/radio/BBC-World-Service-p455581/",
"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The California Report",
"officialWebsiteLink": "/californiareport",
"meta": {
"site": "news",
"source": "kqed",
"order": 8
},
"link": "/californiareport",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/kqeds-the-california-report/id79681292",
"amazon": "https://music.amazon.com/podcasts/26099305-72af-4542-9dde-ac1807fe36d5/kqed-s-the-california-report",
"npr": "https://www.npr.org/podcasts/432285393/the-california-report",
"stitcher": "https://www.stitcher.com/podcast/kqedfm-kqeds-the-california-report-podcast-8838",
"rss": "https://ww2.kqed.org/news/tag/tcram/feed/podcast"
}
},
"californiareportmagazine": {
"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Magazine-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The California Report Magazine",
"officialWebsiteLink": "/californiareportmagazine",
"meta": {
"site": "news",
"source": "kqed",
"order": 10
},
"link": "/californiareportmagazine",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/the-california-report-magazine/id1314750545",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
"npr": "https://www.npr.org/podcasts/564733126/the-california-report-magazine",
"stitcher": "https://www.stitcher.com/podcast/kqed/the-california-report-magazine",
"rss": "https://ww2.kqed.org/news/tag/tcrmag/feed/podcast"
}
},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
"title": "Close All Tabs",
"tagline": "Your irreverent guide to the trends redefining our world",
"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/02/CAT_2_Tile-scaled.jpg",
"imageAlt": "KQED Close All Tabs",
"officialWebsiteLink": "/podcasts/closealltabs",
"meta": {
"site": "news",
"source": "kqed",
"order": 1
},
"link": "/podcasts/closealltabs",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/close-all-tabs/id214663465",
"rss": "https://feeds.megaphone.fm/KQINC6993880386",
"amazon": "https://music.amazon.com/podcasts/92d9d4ac-67a3-4eed-b10a-fb45d45b1ef2/close-all-tabs",
"spotify": "https://open.spotify.com/show/6LAJFHnGK1pYXYzv6SIol6?si=deb0cae19813417c"
}
},
"code-switch-life-kit": {
"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"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 />",
"airtime": "SUN 9pm-10pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg",
"meta": {
"site": "radio",
"source": "npr"
},
"link": "/radio/program/code-switch-life-kit",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
"spotify": "https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV",
"rss": "https://feeds.npr.org/510312/podcast.xml"
}
},
"commonwealth-club": {
"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",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.commonwealthclub.org/podcasts",
"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
"tuneIn": "https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"
}
},
"forum": {
"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
"officialWebsiteLink": "/forum",
"meta": {
"site": "news",
"source": "kqed",
"order": 9
},
"link": "/forum",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
"npr": "https://www.npr.org/podcasts/432307980/forum",
"stitcher": "https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast",
"rss": "https://feeds.megaphone.fm/KQINC9557381633"
}
},
"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/4s8b",
"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
}
},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
"airtime": "MON-FRI 7pm-8pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Fresh-Air-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/fresh-air/",
"meta": {
"site": "radio",
"source": "npr"
},
"link": "/radio/program/fresh-air",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/4s8b",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/Fresh-Air-p17/",
"rss": "https://feeds.npr.org/381444908/podcast.xml"
}
},
"here-and-now": {
"id": "here-and-now",
"title": "Here & Now",
"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
"airtime": "MON-THU 11am-12pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Here-And-Now-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "http://www.wbur.org/hereandnow",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/here-and-now",
"subsdcribe": {
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=426698661",
"tuneIn": "https://tunein.com/radio/Here--Now-p211/",
"rss": "https://feeds.npr.org/510051/podcast.xml"
}
},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/hiddenbrain.jpg",
"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
"site": "news",
"source": "NPR"
},
"link": "/radio/program/hidden-brain",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/hidden-brain/id1028908750?mt=2",
"tuneIn": "https://tunein.com/podcasts/Science-Podcasts/Hidden-Brain-p787503/",
"rss": "https://feeds.npr.org/510308/podcast.xml"
}
},
"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/how-i-built-this",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
"tuneIn": "https://tunein.com/podcasts/Arts--Culture-Podcasts/How-I-Built-This-p910896/",
"rss": "https://feeds.npr.org/510313/podcast.xml"
}
},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
"imageAlt": "KQED Hyphenación",
"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
"site": "news",
"source": "kqed",
"order": 15
},
"link": "/podcasts/hyphenacion",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/hyphenaci%C3%B3n/id1191591838",
"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
"youtube": "https://www.youtube.com/c/kqedarts",
"amazon": "https://music.amazon.com/podcasts/6c3dd23c-93fb-4aab-97ba-1725fa6315f1/hyphenaci%C3%B3n",
"rss": "https://feeds.megaphone.fm/KQINC2275451163"
}
},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Political Mind of Jerry Brown",
"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
"site": "news",
"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
"subscribe": {
"npr": "https://www.npr.org/podcasts/790253322/the-political-mind-of-jerry-brown",
"apple": "https://itunes.apple.com/us/podcast/id1492194549",
"rss": "https://ww2.kqed.org/news/series/jerrybrown/feed/podcast/",
"tuneIn": "http://tun.in/pjGcK",
"stitcher": "https://www.stitcher.com/podcast/kqed/the-political-mind-of-jerry-brown",
"spotify": "https://open.spotify.com/show/54C1dmuyFyKMFttY6X2j6r?si=K8SgRCoISNK6ZbjpXrX5-w",
"amazon": "https://music.amazon.com/podcasts/44420f75-3b0e-4301-ab3b-16da6b09e543/the-political-mind-of-jerry-brown"
}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/xtTd",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/Latino-USA-p621/",
"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
"subscribe": {
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=201853034&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/APM-Marketplace-p88/",
"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
"site": "news",
"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
"spotify": "https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"
}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
"npr": "https://rpb3r.app.goo.gl/onourwatch",
"spotify": "https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x",
"tuneIn": "https://tunein.com/radio/On-Our-Watch-p1436229/",
"stitcher": "https://www.stitcher.com/show/on-our-watch",
"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
"site": "news",
"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
"meta": {
"site": "news",
"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
"imageAlt": "KQED Perspectives",
"officialWebsiteLink": "/perspectives/",
"meta": {
"site": "radio",
"source": "kqed",
"order": 14
},
"link": "/perspectives",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/id73801135",
"npr": "https://www.npr.org/podcasts/432309616/perspectives",
"rss": "https://ww2.kqed.org/perspectives/category/perspectives/feed/",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"
}
},
"planet-money": {
"id": "planet-money",
"title": "Planet Money",
"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
"officialWebsiteLink": "https://www.npr.org/sections/money/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/planet-money",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/M4f5",
"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
"tuneIn": "https://tunein.com/podcasts/Business--Economics-Podcasts/Planet-Money-p164680/",
"rss": "https://feeds.npr.org/510289/podcast.xml"
}
},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Political Breakdown",
"officialWebsiteLink": "/podcasts/politicalbreakdown",
"meta": {
"site": "radio",
"source": "kqed",
"order": 5
},
"link": "/podcasts/politicalbreakdown",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/political-breakdown/id1327641087",
"amazon": "https://music.amazon.com/podcasts/e0c2d153-ad36-4c8d-901d-f1da6a724824/political-breakdown",
"npr": "https://www.npr.org/podcasts/572155894/political-breakdown",
"stitcher": "https://www.stitcher.com/podcast/kqed/political-breakdown",
"spotify": "https://open.spotify.com/show/07RVyIjIdk2WDuVehvBMoN",
"rss": "https://ww2.kqed.org/news/tag/political-breakdown/feed/podcast"
}
},
"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
"meta": {
"site": "news",
"source": "Possible"
},
"link": "/radio/program/possible",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/possible/id1677184070",
"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
}
},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pri.org/programs/the-world",
"meta": {
"site": "news",
"source": "PRI"
},
"link": "/radio/program/pri-the-world",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pris-the-world-latest-edition/id278196007?mt=2",
"tuneIn": "https://tunein.com/podcasts/News--Politics-Podcasts/PRIs-The-World-p24/",
"rss": "http://feeds.feedburner.com/pri/theworld"
}
},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
"airtime": "SUN 12am-1am, SAT 2pm-3pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/radiolab1400.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/radiolab/",
"meta": {
"site": "science",
"source": "WNYC"
},
"link": "/radio/program/radiolab",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/radiolab/id152249110?mt=2",
"tuneIn": "https://tunein.com/radio/RadioLab-p68032/",
"rss": "https://feeds.wnyc.org/radiolab"
}
},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
"airtime": "SAT 4pm-5pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/reveal300px.png",
"officialWebsiteLink": "https://www.revealnews.org/episodes/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/reveal",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/reveal/id886009669",
"tuneIn": "https://tunein.com/radio/Reveal-p679597/",
"rss": "http://feeds.revealradio.org/revealpodcast"
}
},
"rightnowish": {
"id": "rightnowish",
"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Rightnowish-Podcast-Tile-500x500-1.jpg",
"imageAlt": "KQED Rightnowish with Pendarvis Harshaw",
"officialWebsiteLink": "/podcasts/rightnowish",
"meta": {
"site": "arts",
"source": "kqed",
"order": 16
},
"link": "/podcasts/rightnowish",
"subscribe": {
"npr": "https://www.npr.org/podcasts/721590300/rightnowish",
"rss": "https://ww2.kqed.org/arts/programs/rightnowish/feed/podcast",
"apple": "https://podcasts.apple.com/us/podcast/rightnowish/id1482187648",
"stitcher": "https://www.stitcher.com/podcast/kqed/rightnowish",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMxMjU5MTY3NDc4",
"spotify": "https://open.spotify.com/show/7kEJuafTzTVan7B78ttz1I"
}
},
"science-friday": {
"id": "science-friday",
"title": "Science Friday",
"info": "Science Friday is a weekly science talk show, broadcast live over public radio stations nationwide. Each week, the show focuses on science topics that are in the news and tries to bring an educated, balanced discussion to bear on the scientific issues at hand. Panels of expert guests join host Ira Flatow, a veteran science journalist, to discuss science and to take questions from listeners during the call-in portion of the program.",
"airtime": "FRI 11am-1pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Science-Friday-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/science-friday",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/science-friday",
"subscribe": {
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=73329284&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/Science-Friday-p394/",
"rss": "http://feeds.wnyc.org/science-friday"
}
},
"snap-judgment": {
"id": "snap-judgment",
"title": "Snap Judgment",
"tagline": "Real stories with killer beats",
"info": "The Snap Judgment radio show and podcast mixes real stories with killer beats to produce cinematic, dramatic radio. Snap's musical brand of storytelling dares listeners to see the world through the eyes of another. This is storytelling... with a BEAT!! Snap first aired on public radio stations nationwide in July 2010. Today, Snap Judgment airs on over 450 public radio stations and is brought to the airwaves by KQED & PRX.",
"airtime": "SAT 1pm-2pm, 9pm-10pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/05/Snap-Judgment-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Snap Judgment",
"officialWebsiteLink": "https://snapjudgment.org",
"meta": {
"site": "arts",
"source": "kqed",
"order": 4
},
"link": "https://snapjudgment.org",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/snap-judgment/id283657561",
"npr": "https://www.npr.org/podcasts/449018144/snap-judgment",
"stitcher": "https://www.pandora.com/podcast/snap-judgment/PC:241?source=stitcher-sunset",
"spotify": "https://open.spotify.com/show/3Cct7ZWmxHNAtLgBTqjC5v",
"rss": "https://snap.feed.snapjudgment.org/"
}
},
"soldout": {
"id": "soldout",
"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
"info": "Sold Out: Rethinking Housing in America",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Sold-Out-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Sold Out: Rethinking Housing in America",
"officialWebsiteLink": "/podcasts/soldout",
"meta": {
"site": "news",
"source": "kqed",
"order": 13
},
"link": "/podcasts/soldout",
"subscribe": {
"npr": "https://www.npr.org/podcasts/911586047/s-o-l-d-o-u-t-a-new-future-for-housing",
"apple": "https://podcasts.apple.com/us/podcast/introducing-sold-out-rethinking-housing-in-america/id1531354937",
"rss": "https://feeds.megaphone.fm/soldout",
"spotify": "https://open.spotify.com/show/38dTBSk2ISFoPiyYNoKn1X",
"stitcher": "https://www.stitcher.com/podcast/kqed/sold-out-rethinking-housing-in-america",
"tunein": "https://tunein.com/radio/SOLD-OUT-Rethinking-Housing-in-America-p1365871/"
}
},
"spooked": {
"id": "spooked",
"title": "Spooked",
"tagline": "True-life supernatural stories",
"info": "",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/10/Spooked-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Spooked",
"officialWebsiteLink": "https://spookedpodcast.org/",
"meta": {
"site": "news",
"source": "kqed",
"order": 7
},
"link": "https://spookedpodcast.org/",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/spooked/id1279361017",
"npr": "https://www.npr.org/podcasts/549547848/snap-judgment-presents-spooked",
"spotify": "https://open.spotify.com/show/76571Rfl3m7PLJQZKQIGCT",
"rss": "https://feeds.simplecast.com/TBotaapn"
}
},
"tech-nation": {
"id": "tech-nation",
"title": "Tech Nation Radio Podcast",
"info": "Tech Nation is a weekly public radio program, hosted by Dr. Moira Gunn. Founded in 1993, it has grown from a simple interview show to a multi-faceted production, featuring conversations with noted technology and science leaders, and a weekly science and technology-related commentary.",
"airtime": "FRI 10pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Tech-Nation-Radio-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "http://technation.podomatic.com/",
"meta": {
"site": "science",
"source": "Tech Nation Media"
},
"link": "/radio/program/tech-nation",
"subscribe": {
"rss": "https://technation.podomatic.com/rss2.xml"
}
},
"ted-radio-hour": {
"id": "ted-radio-hour",
"title": "TED Radio Hour",
"info": "The TED Radio Hour is a journey through fascinating ideas, astonishing inventions, fresh approaches to old problems, and new ways to think and create.",
"airtime": "SUN 3pm-4pm, SAT 10pm-11pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/tedRadioHour.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/ted-radio-hour/?showDate=2018-06-22",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/ted-radio-hour",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/8vsS",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=523121474&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/TED-Radio-Hour-p418021/",
"rss": "https://feeds.npr.org/510298/podcast.xml"
}
},
"thebay": {
"id": "thebay",
"title": "The Bay",
"tagline": "Local news to keep you rooted",
"info": "Host Devin Katayama walks you through the biggest story of the day with reporters and newsmakers.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Bay-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Bay",
"officialWebsiteLink": "/podcasts/thebay",
"meta": {
"site": "radio",
"source": "kqed",
"order": 2
},
"link": "/podcasts/thebay",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/the-bay/id1350043452",
"amazon": "https://music.amazon.com/podcasts/d800ea4c-7a2c-42f2-b861-edaf78a5db0b/the-bay",
"npr": "https://www.npr.org/podcasts/586725995/the-bay",
"stitcher": "https://www.stitcher.com/podcast/kqed/the-bay",
"spotify": "https://open.spotify.com/show/4BIKBKIujizLHlIlBNaAqQ",
"rss": "https://feeds.megaphone.fm/KQINC8259786327"
}
},
"thelatest": {
"id": "thelatest",
"title": "The Latest",
"tagline": "Trusted local news in real time",
"info": "",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/05/The-Latest-2025-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Latest",
"officialWebsiteLink": "/thelatest",
"meta": {
"site": "news",
"source": "kqed",
"order": 6
},
"link": "/thelatest",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/the-latest-from-kqed/id1197721799",
"npr": "https://www.npr.org/podcasts/1257949365/the-latest-from-k-q-e-d",
"spotify": "https://open.spotify.com/show/5KIIXMgM9GTi5AepwOYvIZ?si=bd3053fec7244dba",
"rss": "https://feeds.megaphone.fm/KQINC9137121918"
}
},
"theleap": {
"id": "theleap",
"title": "The Leap",
"tagline": "What if you closed your eyes, and jumped?",
"info": "Stories about people making dramatic, risky changes, told by award-winning public radio reporter Judy Campbell.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Leap-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Leap",
"officialWebsiteLink": "/podcasts/theleap",
"meta": {
"site": "news",
"source": "kqed",
"order": 17
},
"link": "/podcasts/theleap",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/the-leap/id1046668171",
"npr": "https://www.npr.org/podcasts/447248267/the-leap",
"stitcher": "https://www.stitcher.com/podcast/kqed/the-leap",
"spotify": "https://open.spotify.com/show/3sSlVHHzU0ytLwuGs1SD1U",
"rss": "https://ww2.kqed.org/news/programs/the-leap/feed/podcast"
}
},
"the-moth-radio-hour": {
"id": "the-moth-radio-hour",
"title": "The Moth Radio Hour",
"info": "Since its launch in 1997, The Moth has presented thousands of true stories, told live and without notes, to standing-room-only crowds worldwide. Moth storytellers stand alone, under a spotlight, with only a microphone and a roomful of strangers. The storyteller and the audience embark on a high-wire act of shared experience which is both terrifying and exhilarating. Since 2008, The Moth podcast has featured many of our favorite stories told live on Moth stages around the country. For information on all of our programs and live events, visit themoth.org.",
"airtime": "SAT 8pm-9pm and SUN 11am-12pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/theMoth.jpg",
"officialWebsiteLink": "https://themoth.org/",
"meta": {
"site": "arts",
"source": "prx"
},
"link": "/radio/program/the-moth-radio-hour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/the-moth-podcast/id275699983?mt=2",
"tuneIn": "https://tunein.com/radio/The-Moth-p273888/",
"rss": "http://feeds.themoth.org/themothpodcast"
}
},
"the-new-yorker-radio-hour": {
"id": "the-new-yorker-radio-hour",
"title": "The New Yorker Radio Hour",
"info": "The New Yorker Radio Hour is a weekly program presented by the magazine's editor, David Remnick, and produced by WNYC Studios and The New Yorker. Each episode features a diverse mix of interviews, profiles, storytelling, and an occasional burst of humor inspired by the magazine, and shaped by its writers, artists, and editors. This isn't a radio version of a magazine, but something all its own, reflecting the rich possibilities of audio storytelling and conversation. Theme music for the show was composed and performed by Merrill Garbus of tUnE-YArDs.",
"airtime": "SAT 10am-11am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-New-Yorker-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/tnyradiohour",
"meta": {
"site": "arts",
"source": "WNYC"
},
"link": "/radio/program/the-new-yorker-radio-hour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/id1050430296",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/New-Yorker-Radio-Hour-p803804/",
"rss": "https://feeds.feedburner.com/newyorkerradiohour"
}
},
"the-sam-sanders-show": {
"id": "the-sam-sanders-show",
"title": "The Sam Sanders Show",
"info": "One of public radio's most dynamic voices, Sam Sanders helped launch The NPR Politics Podcast and hosted NPR's hit show It's Been A Minute. Now, the award-winning host returns with something brand new, The Sam Sanders Show. Every week, Sam Sanders and friends dig into the culture that shapes our lives: what's driving the biggest trends, how artists really think, and even the memes you can't stop scrolling past. Sam is beloved for his way of unpacking the world and bringing you up close to fresh currents and engaging conversations. The Sam Sanders Show is smart, funny and always a good time.",
"airtime": "FRI 12-1pm AND SAT 11am-12pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/11/The-Sam-Sanders-Show-Podcast-Tile-400x400-1.jpg",
"officialWebsiteLink": "https://www.kcrw.com/shows/the-sam-sanders-show/latest",
"meta": {
"site": "arts",
"source": "KCRW"
},
"link": "https://www.kcrw.com/shows/the-sam-sanders-show/latest",
"subscribe": {
"rss": "https://feed.cdnstream1.com/zjb/feed/download/ac/28/59/ac28594c-e1d0-4231-8728-61865cdc80e8.xml"
}
},
"the-splendid-table": {
"id": "the-splendid-table",
"title": "The Splendid Table",
"info": "\u003cem>The Splendid Table\u003c/em> hosts our nation's conversations about cooking, sustainability and food culture.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Splendid-Table-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.splendidtable.org/",
"airtime": "SUN 10-11 pm",
"meta": {
"site": "radio",
"source": "npr"
},
"link": "/radio/program/the-splendid-table"
},
"this-american-life": {
"id": "this-american-life",
"title": "This American Life",
"info": "This American Life is a weekly public radio show, heard by 2.2 million people on more than 500 stations. Another 2.5 million people download the weekly podcast. It is hosted by Ira Glass, produced in collaboration with Chicago Public Media, delivered to stations by PRX The Public Radio Exchange, and has won all of the major broadcasting awards.",
"airtime": "SAT 12pm-1pm, 7pm-8pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/thisAmericanLife.png",
"officialWebsiteLink": "https://www.thisamericanlife.org/",
"meta": {
"site": "news",
"source": "wbez"
},
"link": "/radio/program/this-american-life",
"subscribe": {
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=201671138&at=11l79Y&ct=nprdirectory",
"rss": "https://www.thisamericanlife.org/podcast/rss.xml"
}
},
"tinydeskradio": {
"id": "tinydeskradio",
"title": "Tiny Desk Radio",
"info": "We're bringing the best of Tiny Desk to the airwaves, only on public radio.",
"airtime": "SUN 8pm and SAT 9pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/04/300x300-For-Member-Station-Logo-Tiny-Desk-Radio-@2x.png",
"officialWebsiteLink": "https://www.npr.org/series/g-s1-52030/tiny-desk-radio",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/tinydeskradio",
"subscribe": {
"rss": "https://feeds.npr.org/g-s1-52030/rss.xml"
}
},
"wait-wait-dont-tell-me": {
"id": "wait-wait-dont-tell-me",
"title": "Wait Wait... Don't Tell Me!",
"info": "Peter Sagal and Bill Kurtis host the weekly NPR News quiz show alongside some of the best and brightest news and entertainment personalities.",
"airtime": "SUN 10am-11am, SAT 11am-12pm, SAT 6pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Wait-Wait-Podcast-Tile-300x300-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/wait-wait-dont-tell-me/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/wait-wait-dont-tell-me",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/Xogv",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=121493804&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/Wait-Wait-Dont-Tell-Me-p46/",
"rss": "https://feeds.npr.org/344098539/podcast.xml"
}
},
"weekend-edition-saturday": {
"id": "weekend-edition-saturday",
"title": "Weekend Edition Saturday",
"info": "Weekend Edition Saturday wraps up the week's news and offers a mix of analysis and features on a wide range of topics, including arts, sports, entertainment, and human interest stories. The two-hour program is hosted by NPR's Peabody Award-winning Scott Simon.",
"airtime": "SAT 5am-10am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Weekend-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/weekend-edition-saturday/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/weekend-edition-saturday"
},
"weekend-edition-sunday": {
"id": "weekend-edition-sunday",
"title": "Weekend Edition Sunday",
"info": "Weekend Edition Sunday features interviews with newsmakers, artists, scientists, politicians, musicians, writers, theologians and historians. The program has covered news events from Nelson Mandela's 1990 release from a South African prison to the capture of Saddam Hussein.",
"airtime": "SUN 5am-10am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Weekend-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/weekend-edition-sunday/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/weekend-edition-sunday"
}
},
"racesReducer": {},
"racesGenElectionReducer": {},
"racesGenElection2026Reducer": {},
"radioSchedulesReducer": {},
"listsReducer": {
"posts/stateofhealth?affiliate=kaiser-health-news": {
"isFetching": false,
"latestQuery": {
"from": 12,
"size": 12
},
"vitalsOnly": false,
"totalRequested": 10,
"isLoading": false,
"isLoadingMore": true,
"total": {
"value": 22,
"relation": "eq"
},
"items": [
"stateofhealth_354410",
"stateofhealth_351133",
"stateofhealth_349025",
"stateofhealth_348976",
"news_11273732",
"stateofhealth_283882",
"stateofhealth_280735",
"stateofhealth_274563",
"stateofhealth_272110",
"stateofhealth_271368"
],
"complete": true
}
},
"recallGuideReducer": {
"intros": {},
"policy": {},
"candidates": {}
},
"savedArticleReducer": {
"articles": [],
"status": {}
},
"newslettersReducer": {
"isFetching": false,
"fetchFailed": false,
"hasFetched": false,
"newsletters": {},
"isSubscribing": false,
"isUnsubscribing": false,
"subscribedNewsletters": {}
},
"termsReducer": {
"about": {
"name": "About",
"type": "terms",
"id": "about",
"slug": "about",
"link": "/about",
"taxonomy": "site"
},
"arts": {
"name": "Arts & Culture",
"grouping": [
"arts",
"pop",
"trulyca"
],
"description": "KQED Arts provides daily in-depth coverage of the Bay Area's music, art, film, performing arts, literature and arts news, as well as cultural commentary and criticism.",
"type": "terms",
"id": "arts",
"slug": "arts",
"link": "/arts",
"taxonomy": "site"
},
"artschool": {
"name": "Art School",
"parent": "arts",
"type": "terms",
"id": "artschool",
"slug": "artschool",
"link": "/artschool",
"taxonomy": "site"
},
"bayareabites": {
"name": "KQED food",
"grouping": [
"food",
"bayareabites",
"checkplease"
],
"parent": "food",
"type": "terms",
"id": "bayareabites",
"slug": "bayareabites",
"link": "/food",
"taxonomy": "site"
},
"bayareahiphop": {
"name": "Bay Area Hiphop",
"type": "terms",
"id": "bayareahiphop",
"slug": "bayareahiphop",
"link": "/bayareahiphop",
"taxonomy": "site"
},
"campaign21": {
"name": "Campaign 21",
"type": "terms",
"id": "campaign21",
"slug": "campaign21",
"link": "/campaign21",
"taxonomy": "site"
},
"careers": {
"name": "Careers",
"type": "terms",
"id": "careers",
"slug": "careers",
"link": "/careers",
"taxonomy": "site"
},
"checkplease": {
"name": "KQED food",
"grouping": [
"food",
"bayareabites",
"checkplease"
],
"parent": "food",
"type": "terms",
"id": "checkplease",
"slug": "checkplease",
"link": "/food",
"taxonomy": "site"
},
"education": {
"name": "Education",
"grouping": [
"education"
],
"type": "terms",
"id": "education",
"slug": "education",
"link": "/education",
"taxonomy": "site"
},
"elections": {
"name": "Elections",
"type": "terms",
"id": "elections",
"slug": "elections",
"link": "/elections",
"taxonomy": "site"
},
"events": {
"name": "Events",
"type": "terms",
"id": "events",
"slug": "events",
"link": "/events",
"taxonomy": "site"
},
"event": {
"name": "Event",
"alias": "events",
"type": "terms",
"id": "event",
"slug": "event",
"link": "/event",
"taxonomy": "site"
},
"filmschoolshorts": {
"name": "Film School Shorts",
"type": "terms",
"id": "filmschoolshorts",
"slug": "filmschoolshorts",
"link": "/filmschoolshorts",
"taxonomy": "site"
},
"food": {
"name": "KQED food",
"grouping": [
"food",
"bayareabites",
"checkplease"
],
"type": "terms",
"id": "food",
"slug": "food",
"link": "/food",
"taxonomy": "site"
},
"forum": {
"name": "Forum",
"relatedContentQuery": "posts/forum?",
"parent": "news",
"type": "terms",
"id": "forum",
"slug": "forum",
"link": "/forum",
"taxonomy": "site"
},
"futureofyou": {
"name": "Future of You",
"grouping": [
"science",
"futureofyou"
],
"parent": "science",
"type": "terms",
"id": "futureofyou",
"slug": "futureofyou",
"link": "/futureofyou",
"taxonomy": "site"
},
"jpepinheart": {
"name": "KQED food",
"relatedContentQuery": "posts/food,bayareabites,checkplease",
"parent": "food",
"type": "terms",
"id": "jpepinheart",
"slug": "jpepinheart",
"link": "/food",
"taxonomy": "site"
},
"liveblog": {
"name": "Live Blog",
"type": "terms",
"id": "liveblog",
"slug": "liveblog",
"link": "/liveblog",
"taxonomy": "site"
},
"livetv": {
"name": "Live TV",
"parent": "tv",
"type": "terms",
"id": "livetv",
"slug": "livetv",
"link": "/livetv",
"taxonomy": "site"
},
"lowdown": {
"name": "The Lowdown",
"relatedContentQuery": "posts/lowdown?",
"parent": "news",
"type": "terms",
"id": "lowdown",
"slug": "lowdown",
"link": "/lowdown",
"taxonomy": "site"
},
"mindshift": {
"name": "Mindshift",
"parent": "news",
"description": "MindShift explores the future of education by highlighting the innovative – and sometimes counterintuitive – ways educators and parents are helping all children succeed.",
"type": "terms",
"id": "mindshift",
"slug": "mindshift",
"link": "/mindshift",
"taxonomy": "site"
},
"news": {
"name": "News",
"grouping": [
"news",
"forum"
],
"type": "terms",
"id": "news",
"slug": "news",
"link": "/news",
"taxonomy": "site"
},
"newsletters": {
"name": "newsletters",
"type": "terms",
"id": "newsletters",
"slug": "newsletters",
"link": "/newsletters",
"taxonomy": "site"
},
"perspectives": {
"name": "Perspectives",
"parent": "radio",
"type": "terms",
"id": "perspectives",
"slug": "perspectives",
"link": "/perspectives",
"taxonomy": "site"
},
"podcasts": {
"name": "Podcasts",
"type": "terms",
"id": "podcasts",
"slug": "podcasts",
"link": "/podcasts",
"taxonomy": "site"
},
"pop": {
"name": "Pop",
"parent": "arts",
"type": "terms",
"id": "pop",
"slug": "pop",
"link": "/pop",
"taxonomy": "site"
},
"pressroom": {
"name": "Pressroom",
"type": "terms",
"id": "pressroom",
"slug": "pressroom",
"link": "/pressroom",
"taxonomy": "site"
},
"quest": {
"name": "Quest",
"parent": "science",
"type": "terms",
"id": "quest",
"slug": "quest",
"link": "/quest",
"taxonomy": "site"
},
"radio": {
"name": "Radio",
"grouping": [
"forum",
"perspectives"
],
"description": "Listen to KQED Public Radio – home of Forum and The California Report – on 88.5 FM in San Francisco, 89.3 FM in Sacramento, 88.3 FM in Santa Rosa and 88.1 FM in Martinez.",
"type": "terms",
"id": "radio",
"slug": "radio",
"link": "/radio",
"taxonomy": "site"
},
"root": {
"name": "KQED",
"image": "https://ww2.kqed.org/app/uploads/2020/02/KQED-OG-Image@1x.png",
"imageWidth": 1200,
"imageHeight": 630,
"headData": {
"title": "KQED | News, Radio, Podcasts, TV | Public Media for Northern California",
"description": "KQED provides public radio, television, and independent reporting on issues that matter to the Bay Area. We’re the NPR and PBS member station for Northern California."
},
"type": "terms",
"id": "root",
"slug": "root",
"link": "/root",
"taxonomy": "site"
},
"science": {
"name": "Science",
"grouping": [
"science",
"futureofyou"
],
"description": "KQED Science brings you award-winning science and environment coverage from the Bay Area and beyond.",
"type": "terms",
"id": "science",
"slug": "science",
"link": "/science",
"taxonomy": "site"
},
"stateofhealth": {
"name": "State of Health",
"parent": "science",
"type": "terms",
"id": "stateofhealth",
"slug": "stateofhealth",
"link": "/stateofhealth",
"taxonomy": "site"
},
"support": {
"name": "Support",
"type": "terms",
"id": "support",
"slug": "support",
"link": "/support",
"taxonomy": "site"
},
"thedolist": {
"name": "The Do List",
"parent": "arts",
"type": "terms",
"id": "thedolist",
"slug": "thedolist",
"link": "/thedolist",
"taxonomy": "site"
},
"trulyca": {
"name": "Truly CA",
"grouping": [
"arts",
"pop",
"trulyca"
],
"parent": "arts",
"type": "terms",
"id": "trulyca",
"slug": "trulyca",
"link": "/trulyca",
"taxonomy": "site"
},
"tv": {
"name": "TV",
"type": "terms",
"id": "tv",
"slug": "tv",
"link": "/tv",
"taxonomy": "site"
},
"voterguide": {
"name": "Voter Guide",
"parent": "elections",
"alias": "elections",
"type": "terms",
"id": "voterguide",
"slug": "voterguide",
"link": "/voterguide",
"taxonomy": "site"
},
"guiaelectoral": {
"name": "Guia Electoral",
"parent": "elections",
"alias": "elections",
"type": "terms",
"id": "guiaelectoral",
"slug": "guiaelectoral",
"link": "/guiaelectoral",
"taxonomy": "site"
},
"stateofhealth_affiliate_kaiser-health-news": {
"isLoading": true
},
"stateofhealth_3007": {
"type": "terms",
"id": "stateofhealth_3007",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3007",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Kaiser Health News",
"description": null,
"taxonomy": "affiliate",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Kaiser Health News Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3016,
"slug": "kaiser-health-news",
"isLoading": false,
"link": "/stateofhealth/affiliate/kaiser-health-news"
},
"source_stateofhealth_274563": {
"type": "terms",
"id": "source_stateofhealth_274563",
"meta": {
"override": true
},
"name": "Kaiser Health News",
"link": "http://khn.org/",
"isLoading": false
},
"source_stateofhealth_272110": {
"type": "terms",
"id": "source_stateofhealth_272110",
"meta": {
"override": true
},
"name": "California Healthline",
"link": "http://californiahealthline.org/",
"isLoading": false
},
"source_stateofhealth_271368": {
"type": "terms",
"id": "source_stateofhealth_271368",
"meta": {
"override": true
},
"name": "Kaiser Health News",
"link": "http://khn.org/",
"isLoading": false
},
"stateofhealth_15": {
"type": "terms",
"id": "stateofhealth_15",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "15",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Obamacare",
"description": "The Affordable Care Act celebrates its seventh birthday this year. California has embraced the law, but will it survive a new Congress and President? \r\n",
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": "The Affordable Care Act celebrates its seventh birthday this year. California has embraced the law, but will it survive a new Congress and President?",
"title": "Obamacare Archives | KQED Arts",
"ogDescription": null
},
"ttid": 15,
"slug": "reform",
"isLoading": false,
"link": "/stateofhealth/category/reform"
},
"stateofhealth_14": {
"type": "terms",
"id": "stateofhealth_14",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "14",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Policy",
"description": "Actions by people in power – lawmakers, regulators and the like – can make a difference to your health, for better or for worse. We keep you informed",
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": "Actions by people in power – lawmakers, regulators and the like – can make a difference to your health, for better or for worse. We keep you informed",
"title": "Policy Archives | KQED Arts",
"ogDescription": null
},
"ttid": 14,
"slug": "policy",
"isLoading": false,
"link": "/stateofhealth/category/policy"
},
"stateofhealth_3120": {
"type": "terms",
"id": "stateofhealth_3120",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3120",
"found": true
},
"relationships": {},
"featImg": null,
"name": "BCRA",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "BCRA Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3129,
"slug": "bcra",
"isLoading": false,
"link": "/stateofhealth/tag/bcra"
},
"stateofhealth_2808": {
"type": "terms",
"id": "stateofhealth_2808",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2808",
"found": true
},
"relationships": {},
"featImg": null,
"name": "featured",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "featured Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2817,
"slug": "featured",
"isLoading": false,
"link": "/stateofhealth/tag/featured"
},
"stateofhealth_2519": {
"type": "terms",
"id": "stateofhealth_2519",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2519",
"found": true
},
"relationships": {},
"featImg": null,
"name": "News",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "News Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2528,
"slug": "news",
"isLoading": false,
"link": "/stateofhealth/tag/news"
},
"stateofhealth_365": {
"type": "terms",
"id": "stateofhealth_365",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "365",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Obamacare",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Obamacare Archives | KQED Arts",
"ogDescription": null
},
"ttid": 366,
"slug": "obamacare",
"isLoading": false,
"link": "/stateofhealth/tag/obamacare"
},
"stateofhealth_11": {
"type": "terms",
"id": "stateofhealth_11",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "11",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Community Health",
"description": "\r\n\r\nFrom rural California to urban neighborhoods, where you live affects your health",
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": "From rural California to urban neighborhoods, where you live affects your health",
"title": "Community Health Archives | KQED Arts",
"ogDescription": null
},
"ttid": 11,
"slug": "place-matters",
"isLoading": false,
"link": "/stateofhealth/category/place-matters"
},
"stateofhealth_1": {
"type": "terms",
"id": "stateofhealth_1",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "1",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Uncategorized",
"description": null,
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Uncategorized Archives | KQED Arts",
"ogDescription": null
},
"ttid": 1,
"slug": "uncategorized",
"isLoading": false,
"link": "/stateofhealth/category/uncategorized"
},
"stateofhealth_2972": {
"type": "terms",
"id": "stateofhealth_2972",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2972",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Kaiser Health News",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Kaiser Health News Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2981,
"slug": "kaiser-health-news",
"isLoading": false,
"link": "/stateofhealth/tag/kaiser-health-news"
},
"stateofhealth_2829": {
"type": "terms",
"id": "stateofhealth_2829",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2829",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Nursing Homes",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Nursing Homes Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2838,
"slug": "nursing-homes",
"isLoading": false,
"link": "/stateofhealth/tag/nursing-homes"
},
"stateofhealth_3012": {
"type": "terms",
"id": "stateofhealth_3012",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3012",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Mental Health",
"description": null,
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Mental Health Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3021,
"slug": "mental-health",
"isLoading": false,
"link": "/stateofhealth/category/mental-health"
},
"stateofhealth_2607": {
"type": "terms",
"id": "stateofhealth_2607",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2607",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Kaiser Permanente",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Kaiser Permanente Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2616,
"slug": "kaiser-permanente",
"isLoading": false,
"link": "/stateofhealth/tag/kaiser-permanente"
},
"stateofhealth_68": {
"type": "terms",
"id": "stateofhealth_68",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "68",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Mental Health",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Mental Health Archives | KQED Arts",
"ogDescription": null
},
"ttid": 68,
"slug": "mental-health",
"isLoading": false,
"link": "/stateofhealth/tag/mental-health"
},
"stateofhealth_2442": {
"type": "terms",
"id": "stateofhealth_2442",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2442",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Health Insurance",
"description": null,
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Health Insurance Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2453,
"slug": "health-insurance",
"isLoading": false,
"link": "/stateofhealth/category/health-insurance"
},
"stateofhealth_294": {
"type": "terms",
"id": "stateofhealth_294",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "294",
"found": true
},
"relationships": {},
"featImg": null,
"name": "ACA",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "ACA Archives | KQED Arts",
"ogDescription": null
},
"ttid": 295,
"slug": "aca",
"isLoading": false,
"link": "/stateofhealth/tag/aca"
},
"stateofhealth_3104": {
"type": "terms",
"id": "stateofhealth_3104",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3104",
"found": true
},
"relationships": {},
"featImg": null,
"name": "AHCA",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "AHCA Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3113,
"slug": "ahca",
"isLoading": false,
"link": "/stateofhealth/tag/ahca"
},
"stateofhealth_3088": {
"type": "terms",
"id": "stateofhealth_3088",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3088",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Preexisting Conditions",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Preexisting Conditions Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3097,
"slug": "preexisting-conditions",
"isLoading": false,
"link": "/stateofhealth/tag/preexisting-conditions"
},
"news_6944": {
"type": "terms",
"id": "news_6944",
"meta": {
"index": "terms_1716263798",
"site": "news",
"id": "6944",
"found": true
},
"relationships": {},
"featImg": "https://ww2.kqed.org/app/uploads/sites/10/2014/10/News-Fix-Logo-Web-Banners-04.png",
"name": "News Fix",
"description": null,
"taxonomy": "program",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": "The News Fix is a daily news podcast from KQED that breaks down the latest headlines and provides in-depth analysis of the stories that matter to the Bay Area.",
"title": "News Fix - Daily Dose of Bay Area News | KQED",
"ogDescription": null
},
"ttid": 6968,
"slug": "news-fix",
"isLoading": false,
"link": "/news/program/news-fix"
},
"news_72": {
"type": "terms",
"id": "news_72",
"meta": {
"index": "terms_1716263798",
"site": "news",
"id": "72",
"found": true
},
"relationships": {},
"featImg": "https://ww2.kqed.org/app/uploads/sites/10/2014/10/TCR-2-Logo-Web-Banners-03.png",
"name": "The California Report",
"description": null,
"taxonomy": "program",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "The California Report Archives | KQED News",
"ogDescription": null
},
"ttid": 6969,
"slug": "the-california-report",
"isLoading": false,
"link": "/news/program/the-california-report"
},
"news_457": {
"type": "terms",
"id": "news_457",
"meta": {
"index": "terms_1716263798",
"site": "news",
"id": "457",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Health",
"description": null,
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Health Archives | KQED News",
"ogDescription": null
},
"ttid": 16998,
"slug": "health",
"isLoading": false,
"link": "/news/category/health"
},
"news_8": {
"type": "terms",
"id": "news_8",
"meta": {
"index": "terms_1716263798",
"site": "news",
"id": "8",
"found": true
},
"relationships": {},
"featImg": null,
"name": "News",
"description": null,
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "News Archives | KQED News",
"ogDescription": null
},
"ttid": 8,
"slug": "news",
"isLoading": false,
"link": "/news/category/news"
},
"news_20402": {
"type": "terms",
"id": "news_20402",
"meta": {
"index": "terms_1716263798",
"site": "news",
"id": "20402",
"found": true
},
"relationships": {},
"featImg": null,
"name": "FDA",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "FDA Archives | KQED News",
"ogDescription": null
},
"ttid": 20419,
"slug": "fda",
"isLoading": false,
"link": "/news/tag/fda"
},
"news_18543": {
"type": "terms",
"id": "news_18543",
"meta": {
"index": "terms_1716263798",
"site": "news",
"id": "18543",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Health",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Health Archives | KQED News",
"ogDescription": null
},
"ttid": 466,
"slug": "health",
"isLoading": false,
"link": "/news/tag/health"
},
"stateofhealth_313": {
"type": "terms",
"id": "stateofhealth_313",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "313",
"found": true
},
"relationships": {},
"featImg": null,
"name": "HIV/AIDS",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "HIV/AIDS Archives | KQED Arts",
"ogDescription": null
},
"ttid": 314,
"slug": "hivaids",
"isLoading": false,
"link": "/stateofhealth/tag/hivaids"
},
"stateofhealth_13": {
"type": "terms",
"id": "stateofhealth_13",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "13",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Tests & Treatments",
"description": "Information and new research about advances in discovering and treating diseases and conditions.",
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": "Information and new research about advances in discovering and treating diseases and conditions.",
"title": "Tests & Treatments Archives | KQED Arts",
"ogDescription": null
},
"ttid": 13,
"slug": "tests-treatments",
"isLoading": false,
"link": "/stateofhealth/category/tests-treatments"
},
"stateofhealth_3020": {
"type": "terms",
"id": "stateofhealth_3020",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3020",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Alzheimber's",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Alzheimber's Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3029,
"slug": "alzheimbers",
"isLoading": false,
"link": "/stateofhealth/tag/alzheimbers"
},
"stateofhealth_3021": {
"type": "terms",
"id": "stateofhealth_3021",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3021",
"found": true
},
"relationships": {},
"featImg": null,
"name": "genetic testing",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "genetic testing Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3030,
"slug": "genetic-testing",
"isLoading": false,
"link": "/stateofhealth/tag/genetic-testing"
},
"stateofhealth_368": {
"type": "terms",
"id": "stateofhealth_368",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "368",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Covered California",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Covered California Archives | KQED Arts",
"ogDescription": null
},
"ttid": 369,
"slug": "covered-california",
"isLoading": false,
"link": "/stateofhealth/tag/covered-california"
},
"stateofhealth_2846": {
"type": "terms",
"id": "stateofhealth_2846",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2846",
"found": true
},
"relationships": {},
"featImg": null,
"name": "News Featured",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "News Featured Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2855,
"slug": "news-featured",
"isLoading": false,
"link": "/stateofhealth/tag/news-featured"
},
"stateofhealth_12": {
"type": "terms",
"id": "stateofhealth_12",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "12",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Living Healthy",
"description": "Health is about much more than medicine. We show you what's new to help you attain and maintain a healthy life",
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": "Health is about much more than medicine. We show you what's new to help you attain and maintain a healthy life",
"title": "Living Healthy Archives | KQED Arts",
"ogDescription": null
},
"ttid": 12,
"slug": "living-healthy",
"isLoading": false,
"link": "/stateofhealth/category/living-healthy"
},
"stateofhealth_75": {
"type": "terms",
"id": "stateofhealth_75",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "75",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Soda Tax",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Soda Tax Archives | KQED Arts",
"ogDescription": null
},
"ttid": 75,
"slug": "soda-tax",
"isLoading": false,
"link": "/stateofhealth/tag/soda-tax"
},
"stateofhealth_728": {
"type": "terms",
"id": "stateofhealth_728",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "728",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Sugar-Sweetend Beverage",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Sugar-Sweetend Beverage Archives | KQED Arts",
"ogDescription": null
},
"ttid": 730,
"slug": "sugar-sweetend-beverage",
"isLoading": false,
"link": "/stateofhealth/tag/sugar-sweetend-beverage"
}
},
"userPermissionsReducer": {
"wpLoggedIn": false
},
"eventsReducer": {},
"fssReducer": {},
"tvDailyScheduleReducer": {},
"tvWeeklyScheduleReducer": {},
"tvPrimetimeScheduleReducer": {},
"tvMonthlyScheduleReducer": {},
"userAccountReducer": {
"user": {
"email": null,
"emailStatus": "EMAIL_UNVALIDATED",
"loggedStatus": "LOGGED_OUT",
"loggingChecked": false,
"articles": [],
"firstName": null,
"lastName": null,
"phoneNumber": null,
"fetchingMembership": false,
"membershipError": false,
"memberships": [
{
"id": null,
"startDate": null,
"firstName": null,
"lastName": null,
"familyNumber": null,
"memberNumber": null,
"memberSince": null,
"expirationDate": null,
"pfsEligible": false,
"isSustaining": false,
"membershipLevel": "Prospect",
"membershipStatus": "Non Member",
"lastGiftDate": null,
"renewalDate": null,
"lastDonationAmount": null
}
]
},
"authModal": {
"isOpen": false,
"view": "LANDING_VIEW"
},
"error": null
},
"youthMediaReducer": {},
"checkPleaseReducer": {
"filterData": {
"region": {
"key": "Restaurant Region",
"filters": [
"Any Region"
]
},
"cuisine": {
"key": "Restaurant Cuisine",
"filters": [
"Any Cuisine"
]
}
},
"restaurantDataById": {},
"restaurantIdsSorted": [],
"error": null
},
"userAgentReducer": {
"userAgent": "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)",
"isBot": true
}
}
