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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n",
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"excerpt": "'Less people will have coverage. Bottom line.' An interview with the CEO of Tiburcio Vasquez Health Center in Hayward.",
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"headline": "On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sighs of Relief From Health Safety-Net Providers in California After Senate Bill Collapses",
"title": "Sighs of Relief From Health Safety-Net Providers in California After Senate Bill Collapses",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Health care workers at California hospitals and clinics that serve low-income patients are relieved but still wary after the collapse of the Senate Republican health care bill earlier this week.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">The bill proposed deep funding cuts to Medicaid, which is called Medi-Cal in California and covers one out of three state residents. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.cbo.gov/publication/52941\" target=\"_blank\" rel=\"noopener noreferrer\">Congressional Budget Office (CBO) analysis\u003c/a> predicted the latest version of the Senate bill\u003c/span>\u003cspan style=\"font-weight: 400\"> would result in 15 million people losing insurance coverage next year and 22 million by 2026. But it would reduce the federal deficit by $420 billion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There has also been discussion of reviving a bill to repeal the Affordable Care Act (ACA) outright, without a plan to replace it. But that could be difficult because the \u003ca href=\"https://www.cbo.gov/publication/52939\" target=\"_blank\" rel=\"noopener noreferrer\">CBO estimated\u003c/a> that “repeal only” would lead to a whopping 32 million Americans without insurance by 2026.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal in California\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since the implementation of the ACA and the subsequent expansion of who qualifies for Medi-Cal, safety-net providers across the state have increased their capacity to treat more patients, and have hired more staff and improved outreach programs and infrastructure. This growth is possible because clinics are getting more reimbursements for their work treating people who were uninsured before the ACA.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When the ACA was implemented, states were given the choice to expand Medicaid eligibility to those making less than 138 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\" rel=\"noopener noreferrer\">federal poverty level\u003c/a>. California, along with 30 other states, adopted this expansion.\u003c/p>\n\u003cp>\u003cb>Here's How it Affects Real Californians:\u003c/b>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\u003cul>\n\u003cli>The number of people on Medi-Cal is \u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">13.5 million as of January 2017\u003c/a>. Of those, 3.8 million got this coverage through the ACA expansion.\u003c/li>\n\u003cli>\u003ca href=\"http://calbudgetcenter.org/resources/republican-plans-end-medicaid-know-threaten-medi-cal-coverage-benefits-millions-californians/\" target=\"_blank\" rel=\"noopener noreferrer\">Half\u003c/a> of \u003ca href=\"http://www.dof.ca.gov/Forecasting/Demographics/Projections/documents/P_PressRelease.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">California's kids\u003c/a> are on Medi-Cal.\u003c/li>\n\u003cli>\u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">One out of three California residents\u003c/a> is on Medi-Cal.\u003c/li>\n\u003cli>Medi-Cal covers \u003ca href=\"http://www.kff.org/infographic/medicaids-role-in-nursing-home-care/\" target=\"_blank\" rel=\"noopener noreferrer\">62 percent of seniors in nursing homes\u003c/a>.\u003c/li>\n\u003cli>The uninsured rate has dropped sharply. Before the ACA, \u003ca href=\"http://www.chcf.org/publications/2016/12/californias-uninsured\" target=\"_blank\" rel=\"noopener noreferrer\">16 percent\u003c/a> of Californians had no coverage. As of 2016, that number shrunk to \u003ca href=\"https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">7.4 percent\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What Was on the Chopping Block\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Both the House of Representatives' American Health Care Act (AHCA) and the Senate Republicans' Better Care Reconciliation Act (BCRA) proposed a hard annual limit on the amount of federal dollars Medi-Cal recipients would get, no matter how much treatment they would need.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Since Medi-Cal is funded by both the state and federal government, less federal money \u003c/span>\u003cspan style=\"font-weight: 400\">would compel states to either make up those dollars or make cuts to current programs. With the collapse of the BCRA, states won't need to think about those difficult decisions for the time being.\u003c/span>\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/RDnews/2017/07/ACHAcollapsereax.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26032_IMG_67441-qut.jpg\" Title=\"Breathing Sigh of Relief, Safety-Net Providers Hold onto Gains for Now\" program=\"State of Health\"]\u003c/p>\n\u003cp>\u003cb>'The threat is still there for our patients'\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Tiburcio Vasquez Health Center\u003c/a> (TVHC) in Hayward and Union City, and \u003ca href=\"http://zuckerbergsanfranciscogeneral.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Zuckerberg San Francisco General Hospital\u003c/a> have traditionally served low-income patients, regardless of their ability to pay. Before the ACA, the majority of their patients were uninsured, but now that’s reversed, and most patients arrive with Medi-Cal coverage or private insurance purchased with ACA subsidies on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California.\u003c/a>\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those additional insurance dollars have been the difference between scraping by and being able to make significant improvements.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Safety-net delivery systems are traditionally very poorly resourced,\" said Dr. Alice Chen, chief medical officer for the \u003ca href=\"http://www.sfhealthnetwork.org/\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Health Network\u003c/a>, an affiliate of Zuckerberg SF General. \"We've invested the new revenues that have come in for Medicaid patients into improving our systems of care.\" She says her network has brought in $150 million in new revenues from the Medicaid expansion.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">With those dollars, Chen says SF General, where she is based, has been implementing a new electronic health record system, and is working on initiatives to integrate mental and medical health and improve the patient's overall experience. Work like this, she says, wouldn't be possible without the additional resources from Medicaid dollars.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Medical students and residents at the University of California, San Francisco also said they were tentatively happy that it appears the ACA will remain in place. Dr. Emily Thomas is a UCSF resident who has been politically active since the 2016 election. She’s fighting to keep her patients insured through the ACA. She spoke to a crowd of doctors at SF General on Tuesday, explaining why she wanted the advocacy to continue. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Even though the BCRA has collapsed at the Senate, the threat is still there for our patients,” Thomas said. “Our patients are still relying on everyone in this room to continue to advocate for their expanded access to care.”\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Across the bay, at Tiburcio Vasquez Health Center, CEO David Vliet says his clinic has increased the number of patients it can serve due to the Medicaid expansion dollars. In addition to their existing clinics in Hayward, Union City and Fremont, health center administrators have built a $12 million facility with 22 exam rooms.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Regarding the additional Medicaid money, Vliet emphasized that \"those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs.\"\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Vliet said now that changes to the ACA are on hold, he's temporarily relieved. But he will still continue to monitor what's happening in Washington, D.C. If the increased funding continues to flow through Medi-Cal, Vliet says he would like to continue to expand services over the next few years to even more residents in the East Bay. Even after all the growth, TVHC staffers are working at capacity. There are still patients in the community waiting to be seen. \u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Adding to his concern, there is a chance Senate Republicans will revive the stalled health plan and push it through, which is what happened this spring in the House of Representatives.\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Health care workers at California hospitals and clinics that serve low-income patients are relieved but still wary after the collapse of the Senate Republican health care bill earlier this week.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">The bill proposed deep funding cuts to Medicaid, which is called Medi-Cal in California and covers one out of three state residents. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.cbo.gov/publication/52941\" target=\"_blank\" rel=\"noopener noreferrer\">Congressional Budget Office (CBO) analysis\u003c/a> predicted the latest version of the Senate bill\u003c/span>\u003cspan style=\"font-weight: 400\"> would result in 15 million people losing insurance coverage next year and 22 million by 2026. But it would reduce the federal deficit by $420 billion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There has also been discussion of reviving a bill to repeal the Affordable Care Act (ACA) outright, without a plan to replace it. But that could be difficult because the \u003ca href=\"https://www.cbo.gov/publication/52939\" target=\"_blank\" rel=\"noopener noreferrer\">CBO estimated\u003c/a> that “repeal only” would lead to a whopping 32 million Americans without insurance by 2026.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal in California\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since the implementation of the ACA and the subsequent expansion of who qualifies for Medi-Cal, safety-net providers across the state have increased their capacity to treat more patients, and have hired more staff and improved outreach programs and infrastructure. This growth is possible because clinics are getting more reimbursements for their work treating people who were uninsured before the ACA.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When the ACA was implemented, states were given the choice to expand Medicaid eligibility to those making less than 138 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\" rel=\"noopener noreferrer\">federal poverty level\u003c/a>. California, along with 30 other states, adopted this expansion.\u003c/p>\n\u003cp>\u003cb>Here's How it Affects Real Californians:\u003c/b>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\u003cul>\n\u003cli>The number of people on Medi-Cal is \u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">13.5 million as of January 2017\u003c/a>. Of those, 3.8 million got this coverage through the ACA expansion.\u003c/li>\n\u003cli>\u003ca href=\"http://calbudgetcenter.org/resources/republican-plans-end-medicaid-know-threaten-medi-cal-coverage-benefits-millions-californians/\" target=\"_blank\" rel=\"noopener noreferrer\">Half\u003c/a> of \u003ca href=\"http://www.dof.ca.gov/Forecasting/Demographics/Projections/documents/P_PressRelease.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">California's kids\u003c/a> are on Medi-Cal.\u003c/li>\n\u003cli>\u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">One out of three California residents\u003c/a> is on Medi-Cal.\u003c/li>\n\u003cli>Medi-Cal covers \u003ca href=\"http://www.kff.org/infographic/medicaids-role-in-nursing-home-care/\" target=\"_blank\" rel=\"noopener noreferrer\">62 percent of seniors in nursing homes\u003c/a>.\u003c/li>\n\u003cli>The uninsured rate has dropped sharply. Before the ACA, \u003ca href=\"http://www.chcf.org/publications/2016/12/californias-uninsured\" target=\"_blank\" rel=\"noopener noreferrer\">16 percent\u003c/a> of Californians had no coverage. As of 2016, that number shrunk to \u003ca href=\"https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">7.4 percent\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What Was on the Chopping Block\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Both the House of Representatives' American Health Care Act (AHCA) and the Senate Republicans' Better Care Reconciliation Act (BCRA) proposed a hard annual limit on the amount of federal dollars Medi-Cal recipients would get, no matter how much treatment they would need.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Since Medi-Cal is funded by both the state and federal government, less federal money \u003c/span>\u003cspan style=\"font-weight: 400\">would compel states to either make up those dollars or make cuts to current programs. With the collapse of the BCRA, states won't need to think about those difficult decisions for the time being.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cb>'The threat is still there for our patients'\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Tiburcio Vasquez Health Center\u003c/a> (TVHC) in Hayward and Union City, and \u003ca href=\"http://zuckerbergsanfranciscogeneral.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Zuckerberg San Francisco General Hospital\u003c/a> have traditionally served low-income patients, regardless of their ability to pay. Before the ACA, the majority of their patients were uninsured, but now that’s reversed, and most patients arrive with Medi-Cal coverage or private insurance purchased with ACA subsidies on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California.\u003c/a>\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those additional insurance dollars have been the difference between scraping by and being able to make significant improvements.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Safety-net delivery systems are traditionally very poorly resourced,\" said Dr. Alice Chen, chief medical officer for the \u003ca href=\"http://www.sfhealthnetwork.org/\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Health Network\u003c/a>, an affiliate of Zuckerberg SF General. \"We've invested the new revenues that have come in for Medicaid patients into improving our systems of care.\" She says her network has brought in $150 million in new revenues from the Medicaid expansion.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">With those dollars, Chen says SF General, where she is based, has been implementing a new electronic health record system, and is working on initiatives to integrate mental and medical health and improve the patient's overall experience. Work like this, she says, wouldn't be possible without the additional resources from Medicaid dollars.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Medical students and residents at the University of California, San Francisco also said they were tentatively happy that it appears the ACA will remain in place. Dr. Emily Thomas is a UCSF resident who has been politically active since the 2016 election. She’s fighting to keep her patients insured through the ACA. She spoke to a crowd of doctors at SF General on Tuesday, explaining why she wanted the advocacy to continue. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Even though the BCRA has collapsed at the Senate, the threat is still there for our patients,” Thomas said. “Our patients are still relying on everyone in this room to continue to advocate for their expanded access to care.”\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Across the bay, at Tiburcio Vasquez Health Center, CEO David Vliet says his clinic has increased the number of patients it can serve due to the Medicaid expansion dollars. In addition to their existing clinics in Hayward, Union City and Fremont, health center administrators have built a $12 million facility with 22 exam rooms.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Regarding the additional Medicaid money, Vliet emphasized that \"those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs.\"\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Vliet said now that changes to the ACA are on hold, he's temporarily relieved. But he will still continue to monitor what's happening in Washington, D.C. If the increased funding continues to flow through Medi-Cal, Vliet says he would like to continue to expand services over the next few years to even more residents in the East Bay. Even after all the growth, TVHC staffers are working at capacity. There are still patients in the community waiting to be seen. \u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Adding to his concern, there is a chance Senate Republicans will revive the stalled health plan and push it through, which is what happened this spring in the House of Representatives.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"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",
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"excerpt": "After testing to see if they're at risk of disease, people fear they'll be discriminated against under proposed legislation.",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/charlotte-huff/\" target=\"_blank\">Charlotte Huff\u003c/a>",
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"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>",
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"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>",
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"disqusTitle": "Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures",
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"content": "\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mrVakER0R6f0AToNbkAK83dprja2VTaO\"]\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "You Are Now Protected From Nasty Surprise Medical Bills",
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"content": "\u003cp>Before Kevin Powers underwent lung cancer surgery last October, his girlfriend, Agi Orsi, meticulously checked and double-checked to be sure his Santa Monica hospital and surgeon were in his health plan’s network. They were.\u003c/p>\n\u003cp>Even in the hospital, Orsi dutifully wrote “No out-of-network doctors” across the top of Powers’ admission paperwork.\u003c/p>\n\u003cp>Her diligence was for naught.\u003c/p>\n\u003cp>Powers, 57, suffered serious complications, resulting in a two-week hospital stay that included visits from several specialists. It also resulted in a barrage of surprise medical bills from some of those specialists charging out-of-network rates.\u003c/p>\n\u003cp>The bills total about $5,600 — so far.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s overwhelming,” says Orsi, 64, who lives with Powers in Topanga Canyon. “I feel like consumers are at a major disadvantage.”\u003c/p>\n\u003caside class=\"alignright\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/bazar_100.jpg\" alt=\"\" width=\"100\" height=\"133\" class=\"alignleft size-full wp-image-348286\">\u003cstrong>Ask Emily\u003c/strong>\n\u003cp>Answering consumers’ questions about California’s changing medical landscape.\u003cbr>\n\u003cbr>\nSend questions for Emily to \u003ca href=\"mailto:AskEmily@kff.org\">AskEmily@kff.org\u003c/a>\u003c/p>\u003c/aside>\n\u003cp>Starting next month, many Californians will be protected against such surprise medical bills from out-of-network providers, also known as “\u003ca href=\"http://www.kff.org/private-insurance/issue-brief/surprise-medical-bills/\" target=\"_blank\" rel=\"noopener noreferrer\">balance billing\u003c/a>.”\u003c/p>\n\u003cp>Under a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB72\" target=\"_blank\" rel=\"noopener noreferrer\">new state law\u003c/a>, if you visit an in-network facility — such as a hospital, lab or imaging center — you will be responsible only for your in-network share of the cost, even if you’re seen by an out-of-network provider.\u003c/p>\n\u003cp>The \u003ca href=\"http://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactSheets/fsab72.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">law\u003c/a> applies to non-emergency services received on or after July 1.\u003c/p>\n\u003cp>“This is a very big deal,” says Tam Ma, legal and policy director for the advocacy group \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access California\u003c/a>. “We’ve heard from hundreds of consumers who were getting these surprise bills.”\u003c/p>\n\u003cp>A 2015 Consumers Union \u003ca href=\"https://consumersunion.org/wp-content/uploads/2015/05/Surprise-Bills-Survey-CA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">survey\u003c/a> found that nearly 1 in 4 Californians who visited a hospital or had surgery in the previous two years were charged an out‐of‐network rate when they thought a provider was in‐network.\u003c/p>\n\u003cp>Here’s a common scenario: A patient takes pains to ensure her hospital and surgeon are in network, only to get billed by the out-of-network anesthesiologist who appears at her bedside to put her under.\u003c/p>\n\u003cdiv id=\"attachment_239562\" class=\"wp-caption alignleft\" style=\"width: 380px\">\n\u003cp>\u003cimg class=\"wp-image-239562 size-khn-article-small\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/agikevin-770.jpg?w=370&h=247&crop=1\" alt=\"\" width=\"370\" height=\"247\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers (right) is facing more than $5,000 in surprise medical bills from his October lung cancer surgery even though his girlfriend, Agi Orsi (left) took pains to ensure his hospital and surgeon were in his health plan’s network. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>“No one gets to pick their anesthesiologist,” Ma says. “It depends on who is on duty, who is available.”\u003c/p>\n\u003cp>Surprise bills also often come from pathologists, radiologists and assistant surgeons — other providers that patients typically can’t choose, she says.\u003c/p>\n\u003cp>The new law covers Californians with private health insurance plans that are regulated by the state Department of Managed Health Care (DMHC) and the state Department of Insurance, which includes roughly 70 percent of the state’s private insurance market, according to the California Health Care Foundation. (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>It does not cover some 5.7 million people whose employer-sponsored insurance plans are regulated by the U.S. Department of Labor.\u003c/p>\n\u003cp>Insurers, health care providers and regulators are working furiously behind the scenes to hash out some details about that law, including how much out-of-network providers should be compensated for their services.\u003c/p>\n\u003cp>But that shouldn’t affect you.\u003c/p>\n\u003cp>“Is it going to be pretty as plans and providers figure this out in the background? Maybe not,” says Charles Bacchi, president of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. “But what’s important is that it’s not readily apparent to the consumer.”\u003c/p>\n\u003cp>The key point to remember is that you shouldn’t pay more than your in-network copayment, coinsurance or deductible, as long as you visited an in-network facility for non-emergency services.\u003c/p>\n\u003cp>So, if you receive what looks like a bill from a provider showing an out-of-network rate, don’t panic, says Betsy Imholz, director of special projects for \u003ca href=\"https://consumersunion.org/experts/elizabeth-betsy-imholz/\" target=\"_blank\" rel=\"noopener noreferrer\">Consumers Union\u003c/a>.\u003c/p>\n\u003cdiv id=\"attachment_239563\" class=\"wp-caption alignleft\" style=\"width: 280px\">\n\u003cp>\u003cimg class=\"wp-image-239563 size-khn-article-vertical\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/kevin-in-hospital-770.jpg?w=270&h=405&crop=1\" alt=\"\" width=\"270\" height=\"405\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers suffered serious complications after his lung cancer surgery last October, resulting in a two-week hospital stay and surprise out-of-network bills. He is shown here in the hospital after surgery. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>First, read it carefully. It may not actually be a bill. Under the law, any communication to the patient from an out-of-network provider before that provider gets the consumer’s in-network cost information must say — in bold, 12-point type — that it is “not a bill.”\u003c/p>\n\u003cp>“If it’s an out-of-network doctor, they shouldn’t be claiming that you owe anything right away,” Imholz says.\u003c/p>\n\u003cp>And don’t pay anything until you receive an Explanation of Benefits from your insurer, experts advise.\u003c/p>\n\u003cp>When you do receive it, inspect it. If you think you’re still being billed incorrectly, call your health plan and file a grievance, says Mary Watanabe, DMHC’s deputy director of health policy. Your plan will have 30 days to resolve the problem.\u003c/p>\n\u003cp>If your plan doesn’t resolve the situation within that time frame, or you’re dissatisfied with the decision, it’s time to call your regulator. For most of you, that will be DMHC: \u003ca href=\"http://www.healthhelp.ca.gov/\">www.healthhelp.ca.gov\u003c/a> or 888-466-2219. To reach the Department of Insurance, visit \u003ca href=\"http://www.insurance.ca.gov/\">www.insurance.ca.gov\u003c/a> or call 800-927-HELP.\u003c/p>\n\u003cp>You can also call your regulator \u003cem>before\u003c/em> you hear back from your health plan, particularly if out-of-network providers are hassling you for payment.\u003c/p>\n\u003cp>If you inadvertently paid an out-of-network provider more than he or she is owed, all is not lost. The doctor has to refund the overpayment within 30 days, Ma says. Otherwise, interest starts to accrue.\u003c/p>\n\u003cp>One warning: The law allows out-of-network providers to bill you out-of-network rates, but only if you voluntarily sign a form at least 24 hours before you receive care, Imholz says. The form must include an estimate of your cost and explain that you can receive care from an in-network provider instead, she says.\u003c/p>\n\u003cp>“You don’t have to sign it. It’s completely voluntary.”\u003c/p>\n\u003cp>If you actually do want to be seen by an out-of-network provider and are willing to pay the out-of-network charges, you still have to sign the consent form.\u003c/p>\n\u003cp>Since this law kicks in July 1, the surprise medical bills Powers received after his lung surgery won’t be covered. Orsi says Powers can’t afford to pay them.\u003c/p>\n\u003cp>“I don’t think it’s fair,” she says. “I’m going to keep fighting it.”\u003c/p>\n\u003cp>There may be hope. If, like that Southern California couple, you’re currently fighting a surprise bill for a service you received before July 1, Watanabe urges you to call DMHC anyway.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We can often help,” she says.\u003c/p>\n\n",
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"excerpt": "A California law that takes effect July 1 prohibits out-of-network charges if you visit a medical facility that’s in your health plan’s network.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Before Kevin Powers underwent lung cancer surgery last October, his girlfriend, Agi Orsi, meticulously checked and double-checked to be sure his Santa Monica hospital and surgeon were in his health plan’s network. They were.\u003c/p>\n\u003cp>Even in the hospital, Orsi dutifully wrote “No out-of-network doctors” across the top of Powers’ admission paperwork.\u003c/p>\n\u003cp>Her diligence was for naught.\u003c/p>\n\u003cp>Powers, 57, suffered serious complications, resulting in a two-week hospital stay that included visits from several specialists. It also resulted in a barrage of surprise medical bills from some of those specialists charging out-of-network rates.\u003c/p>\n\u003cp>The bills total about $5,600 — so far.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s overwhelming,” says Orsi, 64, who lives with Powers in Topanga Canyon. “I feel like consumers are at a major disadvantage.”\u003c/p>\n\u003caside class=\"alignright\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/bazar_100.jpg\" alt=\"\" width=\"100\" height=\"133\" class=\"alignleft size-full wp-image-348286\">\u003cstrong>Ask Emily\u003c/strong>\n\u003cp>Answering consumers’ questions about California’s changing medical landscape.\u003cbr>\n\u003cbr>\nSend questions for Emily to \u003ca href=\"mailto:AskEmily@kff.org\">AskEmily@kff.org\u003c/a>\u003c/p>\u003c/aside>\n\u003cp>Starting next month, many Californians will be protected against such surprise medical bills from out-of-network providers, also known as “\u003ca href=\"http://www.kff.org/private-insurance/issue-brief/surprise-medical-bills/\" target=\"_blank\" rel=\"noopener noreferrer\">balance billing\u003c/a>.”\u003c/p>\n\u003cp>Under a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB72\" target=\"_blank\" rel=\"noopener noreferrer\">new state law\u003c/a>, if you visit an in-network facility — such as a hospital, lab or imaging center — you will be responsible only for your in-network share of the cost, even if you’re seen by an out-of-network provider.\u003c/p>\n\u003cp>The \u003ca href=\"http://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactSheets/fsab72.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">law\u003c/a> applies to non-emergency services received on or after July 1.\u003c/p>\n\u003cp>“This is a very big deal,” says Tam Ma, legal and policy director for the advocacy group \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access California\u003c/a>. “We’ve heard from hundreds of consumers who were getting these surprise bills.”\u003c/p>\n\u003cp>A 2015 Consumers Union \u003ca href=\"https://consumersunion.org/wp-content/uploads/2015/05/Surprise-Bills-Survey-CA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">survey\u003c/a> found that nearly 1 in 4 Californians who visited a hospital or had surgery in the previous two years were charged an out‐of‐network rate when they thought a provider was in‐network.\u003c/p>\n\u003cp>Here’s a common scenario: A patient takes pains to ensure her hospital and surgeon are in network, only to get billed by the out-of-network anesthesiologist who appears at her bedside to put her under.\u003c/p>\n\u003cdiv id=\"attachment_239562\" class=\"wp-caption alignleft\" style=\"width: 380px\">\n\u003cp>\u003cimg class=\"wp-image-239562 size-khn-article-small\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/agikevin-770.jpg?w=370&h=247&crop=1\" alt=\"\" width=\"370\" height=\"247\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers (right) is facing more than $5,000 in surprise medical bills from his October lung cancer surgery even though his girlfriend, Agi Orsi (left) took pains to ensure his hospital and surgeon were in his health plan’s network. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>“No one gets to pick their anesthesiologist,” Ma says. “It depends on who is on duty, who is available.”\u003c/p>\n\u003cp>Surprise bills also often come from pathologists, radiologists and assistant surgeons — other providers that patients typically can’t choose, she says.\u003c/p>\n\u003cp>The new law covers Californians with private health insurance plans that are regulated by the state Department of Managed Health Care (DMHC) and the state Department of Insurance, which includes roughly 70 percent of the state’s private insurance market, according to the California Health Care Foundation. (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>It does not cover some 5.7 million people whose employer-sponsored insurance plans are regulated by the U.S. Department of Labor.\u003c/p>\n\u003cp>Insurers, health care providers and regulators are working furiously behind the scenes to hash out some details about that law, including how much out-of-network providers should be compensated for their services.\u003c/p>\n\u003cp>But that shouldn’t affect you.\u003c/p>\n\u003cp>“Is it going to be pretty as plans and providers figure this out in the background? Maybe not,” says Charles Bacchi, president of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. “But what’s important is that it’s not readily apparent to the consumer.”\u003c/p>\n\u003cp>The key point to remember is that you shouldn’t pay more than your in-network copayment, coinsurance or deductible, as long as you visited an in-network facility for non-emergency services.\u003c/p>\n\u003cp>So, if you receive what looks like a bill from a provider showing an out-of-network rate, don’t panic, says Betsy Imholz, director of special projects for \u003ca href=\"https://consumersunion.org/experts/elizabeth-betsy-imholz/\" target=\"_blank\" rel=\"noopener noreferrer\">Consumers Union\u003c/a>.\u003c/p>\n\u003cdiv id=\"attachment_239563\" class=\"wp-caption alignleft\" style=\"width: 280px\">\n\u003cp>\u003cimg class=\"wp-image-239563 size-khn-article-vertical\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/kevin-in-hospital-770.jpg?w=270&h=405&crop=1\" alt=\"\" width=\"270\" height=\"405\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers suffered serious complications after his lung cancer surgery last October, resulting in a two-week hospital stay and surprise out-of-network bills. He is shown here in the hospital after surgery. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>First, read it carefully. It may not actually be a bill. Under the law, any communication to the patient from an out-of-network provider before that provider gets the consumer’s in-network cost information must say — in bold, 12-point type — that it is “not a bill.”\u003c/p>\n\u003cp>“If it’s an out-of-network doctor, they shouldn’t be claiming that you owe anything right away,” Imholz says.\u003c/p>\n\u003cp>And don’t pay anything until you receive an Explanation of Benefits from your insurer, experts advise.\u003c/p>\n\u003cp>When you do receive it, inspect it. If you think you’re still being billed incorrectly, call your health plan and file a grievance, says Mary Watanabe, DMHC’s deputy director of health policy. Your plan will have 30 days to resolve the problem.\u003c/p>\n\u003cp>If your plan doesn’t resolve the situation within that time frame, or you’re dissatisfied with the decision, it’s time to call your regulator. For most of you, that will be DMHC: \u003ca href=\"http://www.healthhelp.ca.gov/\">www.healthhelp.ca.gov\u003c/a> or 888-466-2219. To reach the Department of Insurance, visit \u003ca href=\"http://www.insurance.ca.gov/\">www.insurance.ca.gov\u003c/a> or call 800-927-HELP.\u003c/p>\n\u003cp>You can also call your regulator \u003cem>before\u003c/em> you hear back from your health plan, particularly if out-of-network providers are hassling you for payment.\u003c/p>\n\u003cp>If you inadvertently paid an out-of-network provider more than he or she is owed, all is not lost. The doctor has to refund the overpayment within 30 days, Ma says. Otherwise, interest starts to accrue.\u003c/p>\n\u003cp>One warning: The law allows out-of-network providers to bill you out-of-network rates, but only if you voluntarily sign a form at least 24 hours before you receive care, Imholz says. The form must include an estimate of your cost and explain that you can receive care from an in-network provider instead, she says.\u003c/p>\n\u003cp>“You don’t have to sign it. It’s completely voluntary.”\u003c/p>\n\u003cp>If you actually do want to be seen by an out-of-network provider and are willing to pay the out-of-network charges, you still have to sign the consent form.\u003c/p>\n\u003cp>Since this law kicks in July 1, the surprise medical bills Powers received after his lung surgery won’t be covered. Orsi says Powers can’t afford to pay them.\u003c/p>\n\u003cp>“I don’t think it’s fair,” she says. “I’m going to keep fighting it.”\u003c/p>\n\u003cp>There may be hope. If, like that Southern California couple, you’re currently fighting a surprise bill for a service you received before July 1, Watanabe urges you to call DMHC anyway.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We can often help,” she says.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Medi-Cal Patients Flocking to ERs More Than Before ACA",
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"content": "\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors?",
"title": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors?",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>A new outside analysis claims a \"single payer\" health system for California would cost $330 billion a year, not $400 billion, the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/\" target=\"_blank\" rel=\"noopener noreferrer\">initial price tag \u003c/a>announced last week in a legislative report.\u003c/p>\n\u003cp>The financial analysis also proposed two new taxes to pay for the system: an excise tax and a sales tax. That's in contrast to the 15 percent payroll tax proposed in last week's report.\u003c/p>\n\u003cp>The analysis was produced by a team of economists at the University of Massachusetts-Amherst, and paid for by the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">California Nurses Association\u003c/a>, a key leader in the movement to establish a universal health care system in California.\u003c/p>\n\u003cp>Supporters of a single-payer plan have promised these details for months, ever since two Democrats from southern California, state senators Ricardo Lara and Toni Atkins, introduced Senate Bill 562, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">\"The Healthy California Act.\" \u003c/a>The full Senate must vote on the bill by Friday for it to move forward in the legislative process.\u003c/p>\n\u003cp>Here's your takeaway:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>One Health Plan:\u003c/strong> Say goodbye to your employer-sponsored health plan, with its deductible, co-pays and co-insurance. Say goodbye to Medicare and its part B premium. Everyone would be moved into the still-unnamed, state-administered plan. The new plan would also completely absorb anyone now covered by Medi-Cal or Covered California. The seven percent of Californians who are still uninsured -- including undocumented residents -- would be brought into the fold as well.\u003c/p>\n\u003cp>The economists argue that a single payer plan, by eliminating private, for-profit insurers in California, and by pooling together public funds from Medicare and Medi-Cal, would create a stream-lined system with lots of bargaining power.\u003c/p>\n\u003cp>\"The good news is that California can get a lot more for our money,\" said State Senator Lara after unveiling the analysis on Wednesday at the state Capitol. \"When the legislature passes the Healthy California Act, we will actually spend less than we do now on health care.\"\u003c/p>\n\u003cp>\u003cstrong>Two New Taxes: \u003c/strong>The analysis assumes California would successfully obtain permission from the federal government -- not a given under a Trump administration -- to continue drawing down federal money for Medicare and Medi-Cal patients, but divert the funds into a single-payer system instead. That would take care of two-thirds of the annual cost.\u003c/p>\n\u003cp>Then, California could raise the remaining $106 billion by taxing consumers and business. Specifically, the analysis proposes:\u003c/p>\n\u003cul>\n\u003cli>A new 2.3 percent sales tax, except on basic living expenses such as housing, groceries, and utilities.\u003c/li>\n\u003cli>A new 2.3 percent excise tax on gross business receipts (the first $2 million in receipts are exempted).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Three Ways to Save:\u003c/strong> A single-payer plan would actually cost 10 percent less than the current system, the analysis claims. How would this savings of $38 billion be achieved?\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Overhead:\u003c/strong> Having only one insurer, California, eliminates the need to make a profit or spend money on marketing and sales. The health care \"providers\" (doctors, nurses, hospitals, nursing homes, etc.), would also save money because they wouldn't have to pay people to administer different insurance contracts and navigate multiple payment systems.\u003c/li>\n\u003cli>\u003cstrong>Medical Salaries and Drug Prices:\u003c/strong> As the only entity paying for healthcare, California could negotiate lower reimbursement rates for some services. The state plan could also pressure drug companies to lower prices as a condition of having their drugs included in the state-run \u003ca href=\"https://www.healthcare.gov/glossary/formulary/\" target=\"_blank\" rel=\"noopener noreferrer\">formulary.\u003c/a>\u003c/li>\n\u003cli>\u003cstrong>More Efficient Treatment from Cradle to Grave:\u003c/strong> In a single, streamlined system, doctors won't have to duplicate tests. A unified system of electronic health records could also help identify risk factors for illness, or prompt patients to get necessary vaccines and screenings.\u003c/li>\n\u003c/ul>\n\u003cp>The new report was received skeptically by Charles Bacchi, who leads the industry trade group for private insurers, the \u003ca href=\"http://California%20Association%20of%20Health%20Plans\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. Bacchi predicted the plan would be \"incredibly disruptive\" and \"unaffordable,\" and implied that doctors might leave the state.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They assume that every doctor is going to still be here in California providing coverage under this proposal,\" he said. \"And, you know, who knows? Something like this creates a lot of uncertainty.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A new outside analysis claims a \"single payer\" health system for California would cost $330 billion a year, not $400 billion, the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/\" target=\"_blank\" rel=\"noopener noreferrer\">initial price tag \u003c/a>announced last week in a legislative report.\u003c/p>\n\u003cp>The financial analysis also proposed two new taxes to pay for the system: an excise tax and a sales tax. That's in contrast to the 15 percent payroll tax proposed in last week's report.\u003c/p>\n\u003cp>The analysis was produced by a team of economists at the University of Massachusetts-Amherst, and paid for by the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">California Nurses Association\u003c/a>, a key leader in the movement to establish a universal health care system in California.\u003c/p>\n\u003cp>Supporters of a single-payer plan have promised these details for months, ever since two Democrats from southern California, state senators Ricardo Lara and Toni Atkins, introduced Senate Bill 562, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">\"The Healthy California Act.\" \u003c/a>The full Senate must vote on the bill by Friday for it to move forward in the legislative process.\u003c/p>\n\u003cp>Here's your takeaway:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>One Health Plan:\u003c/strong> Say goodbye to your employer-sponsored health plan, with its deductible, co-pays and co-insurance. Say goodbye to Medicare and its part B premium. Everyone would be moved into the still-unnamed, state-administered plan. The new plan would also completely absorb anyone now covered by Medi-Cal or Covered California. The seven percent of Californians who are still uninsured -- including undocumented residents -- would be brought into the fold as well.\u003c/p>\n\u003cp>The economists argue that a single payer plan, by eliminating private, for-profit insurers in California, and by pooling together public funds from Medicare and Medi-Cal, would create a stream-lined system with lots of bargaining power.\u003c/p>\n\u003cp>\"The good news is that California can get a lot more for our money,\" said State Senator Lara after unveiling the analysis on Wednesday at the state Capitol. \"When the legislature passes the Healthy California Act, we will actually spend less than we do now on health care.\"\u003c/p>\n\u003cp>\u003cstrong>Two New Taxes: \u003c/strong>The analysis assumes California would successfully obtain permission from the federal government -- not a given under a Trump administration -- to continue drawing down federal money for Medicare and Medi-Cal patients, but divert the funds into a single-payer system instead. That would take care of two-thirds of the annual cost.\u003c/p>\n\u003cp>Then, California could raise the remaining $106 billion by taxing consumers and business. Specifically, the analysis proposes:\u003c/p>\n\u003cul>\n\u003cli>A new 2.3 percent sales tax, except on basic living expenses such as housing, groceries, and utilities.\u003c/li>\n\u003cli>A new 2.3 percent excise tax on gross business receipts (the first $2 million in receipts are exempted).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Three Ways to Save:\u003c/strong> A single-payer plan would actually cost 10 percent less than the current system, the analysis claims. How would this savings of $38 billion be achieved?\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Overhead:\u003c/strong> Having only one insurer, California, eliminates the need to make a profit or spend money on marketing and sales. The health care \"providers\" (doctors, nurses, hospitals, nursing homes, etc.), would also save money because they wouldn't have to pay people to administer different insurance contracts and navigate multiple payment systems.\u003c/li>\n\u003cli>\u003cstrong>Medical Salaries and Drug Prices:\u003c/strong> As the only entity paying for healthcare, California could negotiate lower reimbursement rates for some services. The state plan could also pressure drug companies to lower prices as a condition of having their drugs included in the state-run \u003ca href=\"https://www.healthcare.gov/glossary/formulary/\" target=\"_blank\" rel=\"noopener noreferrer\">formulary.\u003c/a>\u003c/li>\n\u003cli>\u003cstrong>More Efficient Treatment from Cradle to Grave:\u003c/strong> In a single, streamlined system, doctors won't have to duplicate tests. A unified system of electronic health records could also help identify risk factors for illness, or prompt patients to get necessary vaccines and screenings.\u003c/li>\n\u003c/ul>\n\u003cp>The new report was received skeptically by Charles Bacchi, who leads the industry trade group for private insurers, the \u003ca href=\"http://California%20Association%20of%20Health%20Plans\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. Bacchi predicted the plan would be \"incredibly disruptive\" and \"unaffordable,\" and implied that doctors might leave the state.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They assume that every doctor is going to still be here in California providing coverage under this proposal,\" he said. \"And, you know, who knows? Something like this creates a lot of uncertainty.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The Senate is negotiating its own legislation to repeal and replace much of the Affordable Care Act in secret talks with senators hand-picked by party leaders and with no plans for committee hearings to publicly vet the bill.\u003c/p>\n\u003cp>\"I am encouraged by what we are seeing in the Senate. We're seeing senators leading,\" said Sen. Ted Cruz, R-Texas, one of the 13 Republicans involved in the private talks. \"We're seeing senators working together in good faith. We're not seeing senators throwing rocks at each other, either in private or in the press.\"\u003c/p>\n\u003cp>Senate Democrats have a different take. \"Your morning reminder that under the cloud cover of the FBI story, 13 GOP Senators are still secretly writing a bill to destroy the ACA,\" Sen. Chris Murphy, D-Conn., \u003ca href=\"https://twitter.com/ChrisMurphyCT/status/864089871270457345\">tweeted\u003c/a> Monday morning.\u003c/p>\n\u003cp>Senate Republicans have shrugged away criticism about their decision to avoid action in committees in favor of closely guarded meetings in the U.S. Capitol to craft legislation to repeal and replace key pillars of President Barack Obama's health care law and reshape Medicaid.\u003c/p>\n\u003cp>The working group has met four times, and it plans to continue to meet every Tuesday and Thursday. So far, its strategy appears to be selectively suggesting potential provisions of the legislation to the media.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For instance, Sen. John Thune, R-S.D., has \u003ca href=\"http://www.politico.com/story/2017/05/12/senate-obamacare-repeal-tax-credits-238290\">floated\u003c/a> pegging tax credits to help Americans buy health insurance to their income instead of their age like it does in the House version of the bill.\u003c/p>\n\u003cp>While the fallout over President Trump's decision to fire FBI Director James Comey consumes the news cycle, it has not had an impact on Republicans' health care talks. A GOP aide for a senator involved in the talks said it has even given the Senate some breathing room to negotiate with so much attention focused elsewhere.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell formed the negotiating team to take the lead on crafting health care legislation that can ultimately win the support of at least 50 of the chamber's 52 Republicans. No Democrats are expected to support any potential GOP health care bill. The legislation is moving under special budget rules known as reconciliation, which means it is not subject to usual filibuster rules and cannot be blocked by the minority party.\u003c/p>\n\u003cp>Republicans ditched the House-passed bill in pursuit of their own legislation, although the two chambers share the broad goals of repealing the ACA's individual mandates and taxes, restricting access to abortion services and overhauling the Medicaid system from an open-ended federal guarantee that covers costs to a system that gives states more flexibility to spend an allotted amount of money.\u003c/p>\n\u003cp>Conservatives like Cruz are also laying down what they say is a key marker for whether a bill can pass the Senate: \"Do premiums go up, or do they go down?\" Cruz said.\u003c/p>\n\u003cp>Sen. Ron Johnson, R-Wis., told reporters last week that Republicans are still in the early planning phase of crafting a bill. \"We still need to agree on those goals and find out what's achievable,\" he said. Like Cruz, Johnson said for him lowering premiums is a top goal and he wants to repeal as much of the ACA as possible under the Senate's more strict budget rules.\u003c/p>\n\u003cp>Early talks suggest Republicans are optimistic they can ultimately pass a bill by the August recess. \"We've got a group of 52 Republican senators, all of us want to get to 'yes,'\" Johnson said.\u003c/p>\n\u003cp>Sens. Susan Collins, R-Maine, and Bill Cassidy, R-La., have introduced their own health care plan, and they have been prominent voices in the debate, but they were excluded from the health care working group.\u003c/p>\n\u003cp>Republicans were roundly criticized for not including any women in their core group, but the Republican women in the Senate who were asked about the omission said they didn't mind. \"It doesn't bother me, the leaders have the right to choose whoever they wish,\" said Collins. \"It doesn't mean that I'm not going to work on health care.\"\u003c/p>\n\u003cp>Cassidy and Collins have been moderating voices in the health care debate, and their support or opposition could be critical to Republicans' success.\u003c/p>\n\u003cp>The Cassidy-Collins proposal would let states keep the ACA, also known as Obamacare, in place if they wanted to, and it leaves in place the ACA's taxes and fees to have revenue streams to pay for their health care overhaul. However, their plan doesn't enjoy support among conservatives who don't believe it goes far enough to repeal and replace Obamacare — the party's signature campaign pledge.\u003c/p>\n\u003cp>The duo has been reaching out to Democrats, but Cassidy said his efforts have been rejected. Democrats see no policy or political upside to working with Republicans to dismantle the ACA. \"Let me phrase this carefully. I've had seven or eight meetings with Democrats either in their office, maybe once my office or on the floor, and that was the consistent message I got,\" Cassidy said.\u003c/p>\n\u003cp>Most Republicans see no political advantage to attempting to craft bipartisan legislation that could aid vulnerable Red State Senate Democrats heading in to the midterm elections. In other words, there is mutual disinterest in bipartisanship when it comes to the fundamentals of Obamacare.\u003c/p>\n\u003cp>The GOP health care talks are expected to roll through the summer months in the Senate. The long-term strategy — according to senior GOP aides in both the House and Senate — is to pass a Senate bill and send it back to the House for an up-or-down vote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While House passage of their bill was hailed by the president in an unusual Rose Garden ceremony earlier this month, Republicans are still a long way away from fulfilling their campaign promises on health care. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Secret+Republican+Senate+Talks+Are+Shaping+Health+Care+Legislation&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is negotiating its own legislation to repeal and replace much of the Affordable Care Act in secret talks with senators hand-picked by party leaders and with no plans for committee hearings to publicly vet the bill.\u003c/p>\n\u003cp>\"I am encouraged by what we are seeing in the Senate. We're seeing senators leading,\" said Sen. Ted Cruz, R-Texas, one of the 13 Republicans involved in the private talks. \"We're seeing senators working together in good faith. We're not seeing senators throwing rocks at each other, either in private or in the press.\"\u003c/p>\n\u003cp>Senate Democrats have a different take. \"Your morning reminder that under the cloud cover of the FBI story, 13 GOP Senators are still secretly writing a bill to destroy the ACA,\" Sen. Chris Murphy, D-Conn., \u003ca href=\"https://twitter.com/ChrisMurphyCT/status/864089871270457345\">tweeted\u003c/a> Monday morning.\u003c/p>\n\u003cp>Senate Republicans have shrugged away criticism about their decision to avoid action in committees in favor of closely guarded meetings in the U.S. Capitol to craft legislation to repeal and replace key pillars of President Barack Obama's health care law and reshape Medicaid.\u003c/p>\n\u003cp>The working group has met four times, and it plans to continue to meet every Tuesday and Thursday. So far, its strategy appears to be selectively suggesting potential provisions of the legislation to the media.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For instance, Sen. John Thune, R-S.D., has \u003ca href=\"http://www.politico.com/story/2017/05/12/senate-obamacare-repeal-tax-credits-238290\">floated\u003c/a> pegging tax credits to help Americans buy health insurance to their income instead of their age like it does in the House version of the bill.\u003c/p>\n\u003cp>While the fallout over President Trump's decision to fire FBI Director James Comey consumes the news cycle, it has not had an impact on Republicans' health care talks. A GOP aide for a senator involved in the talks said it has even given the Senate some breathing room to negotiate with so much attention focused elsewhere.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell formed the negotiating team to take the lead on crafting health care legislation that can ultimately win the support of at least 50 of the chamber's 52 Republicans. No Democrats are expected to support any potential GOP health care bill. The legislation is moving under special budget rules known as reconciliation, which means it is not subject to usual filibuster rules and cannot be blocked by the minority party.\u003c/p>\n\u003cp>Republicans ditched the House-passed bill in pursuit of their own legislation, although the two chambers share the broad goals of repealing the ACA's individual mandates and taxes, restricting access to abortion services and overhauling the Medicaid system from an open-ended federal guarantee that covers costs to a system that gives states more flexibility to spend an allotted amount of money.\u003c/p>\n\u003cp>Conservatives like Cruz are also laying down what they say is a key marker for whether a bill can pass the Senate: \"Do premiums go up, or do they go down?\" Cruz said.\u003c/p>\n\u003cp>Sen. Ron Johnson, R-Wis., told reporters last week that Republicans are still in the early planning phase of crafting a bill. \"We still need to agree on those goals and find out what's achievable,\" he said. Like Cruz, Johnson said for him lowering premiums is a top goal and he wants to repeal as much of the ACA as possible under the Senate's more strict budget rules.\u003c/p>\n\u003cp>Early talks suggest Republicans are optimistic they can ultimately pass a bill by the August recess. \"We've got a group of 52 Republican senators, all of us want to get to 'yes,'\" Johnson said.\u003c/p>\n\u003cp>Sens. Susan Collins, R-Maine, and Bill Cassidy, R-La., have introduced their own health care plan, and they have been prominent voices in the debate, but they were excluded from the health care working group.\u003c/p>\n\u003cp>Republicans were roundly criticized for not including any women in their core group, but the Republican women in the Senate who were asked about the omission said they didn't mind. \"It doesn't bother me, the leaders have the right to choose whoever they wish,\" said Collins. \"It doesn't mean that I'm not going to work on health care.\"\u003c/p>\n\u003cp>Cassidy and Collins have been moderating voices in the health care debate, and their support or opposition could be critical to Republicans' success.\u003c/p>\n\u003cp>The Cassidy-Collins proposal would let states keep the ACA, also known as Obamacare, in place if they wanted to, and it leaves in place the ACA's taxes and fees to have revenue streams to pay for their health care overhaul. However, their plan doesn't enjoy support among conservatives who don't believe it goes far enough to repeal and replace Obamacare — the party's signature campaign pledge.\u003c/p>\n\u003cp>The duo has been reaching out to Democrats, but Cassidy said his efforts have been rejected. Democrats see no policy or political upside to working with Republicans to dismantle the ACA. \"Let me phrase this carefully. I've had seven or eight meetings with Democrats either in their office, maybe once my office or on the floor, and that was the consistent message I got,\" Cassidy said.\u003c/p>\n\u003cp>Most Republicans see no political advantage to attempting to craft bipartisan legislation that could aid vulnerable Red State Senate Democrats heading in to the midterm elections. In other words, there is mutual disinterest in bipartisanship when it comes to the fundamentals of Obamacare.\u003c/p>\n\u003cp>The GOP health care talks are expected to roll through the summer months in the Senate. 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"content": "\u003cp>Wearing white coats and surgical scrubs, a small group of political activists passed out pink fliers in downtown Oakland Wednesday. They wore toy stethoscopes and shiny, circular mirrors on their heads.\u003c/p>\n\u003cp>They're not really doctors, but they dressed the part to grab the attention of pedestrians and warn them about the political efforts to dismantle the Affordable Care Act. Since 2014, that law has provided five million previously uninsured Californians with coverage. The state's uninsured rate is now at a historical low of 7 percent.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/314153621\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>House Representatives, riven by political differences, have delayed a planned vote on the Republican health care bill until Friday. Their bill, the American Health Care Act (AHCA), has pushed these \u003ca href=\"https://bayresistance.org/\" target=\"_blank\">Bay Area activists\u003c/a> to get creative, and this \"Pop-Up Emergency Room\" on the sidewalk is one way of highlighting the fact that the bill would \u003cem>increase\u003c/em> the number of uninsured Americans by 24 million.\u003c/p>\n\u003cp>[gallery type=\"rectangular\" ids=\"307654,307652,307655,307649,307733\"]\u003c/p>\n\u003cp>Cindy Shamban of Berkeley wore her white coat draped over another, darker-colored coat.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"That’s part of the skit,\" she said. \"Dress up, have a little bit of fun with it, at the same time we know that we’re dealing with, you know, people’s lives.\"\u003c/p>\n\u003cp>Nearby, Monique Harris had propped a sign against her wheelchair. It read, “Losing Medi-Cal means being forced into an expensive nursing home. No more living at home.”\u003c/p>\n\u003cp>Harris has spastic cerebral palsy and is concerned about the bill's proposed funding cuts to Medi-Cal. Medi-Cal is taxpayer-funded insurance that covers low-income adults, people with disabilities, and nursing home residents.\u003c/p>\n\u003cp>\"Both me and my son receive it,\" she said. \"As well as many other people.\" Harris said Medi-Cal pays for essential equipment and treatments for her and her son. \"He has seizures and diabetes,\" she explained.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A forecast released this week by Sacramento officials estimates the adoption of the GOP-backed AHCA would blow a $6 billion hole in the California budget starting in 2020. As demand on the health system grows, the loss of federal funds to California would eventually reach $24 billion annually in 2027.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Wearing white coats and surgical scrubs, a small group of political activists passed out pink fliers in downtown Oakland Wednesday. They wore toy stethoscopes and shiny, circular mirrors on their heads.\u003c/p>\n\u003cp>They're not really doctors, but they dressed the part to grab the attention of pedestrians and warn them about the political efforts to dismantle the Affordable Care Act. Since 2014, that law has provided five million previously uninsured Californians with coverage. The state's uninsured rate is now at a historical low of 7 percent.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/314153621&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/314153621'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>House Representatives, riven by political differences, have delayed a planned vote on the Republican health care bill until Friday. Their bill, the American Health Care Act (AHCA), has pushed these \u003ca href=\"https://bayresistance.org/\" target=\"_blank\">Bay Area activists\u003c/a> to get creative, and this \"Pop-Up Emergency Room\" on the sidewalk is one way of highlighting the fact that the bill would \u003cem>increase\u003c/em> the number of uninsured Americans by 24 million.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"That’s part of the skit,\" she said. \"Dress up, have a little bit of fun with it, at the same time we know that we’re dealing with, you know, people’s lives.\"\u003c/p>\n\u003cp>Nearby, Monique Harris had propped a sign against her wheelchair. It read, “Losing Medi-Cal means being forced into an expensive nursing home. No more living at home.”\u003c/p>\n\u003cp>Harris has spastic cerebral palsy and is concerned about the bill's proposed funding cuts to Medi-Cal. Medi-Cal is taxpayer-funded insurance that covers low-income adults, people with disabilities, and nursing home residents.\u003c/p>\n\u003cp>\"Both me and my son receive it,\" she said. \"As well as many other people.\" Harris said Medi-Cal pays for essential equipment and treatments for her and her son. \"He has seizures and diabetes,\" she explained.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A forecast released this week by Sacramento officials estimates the adoption of the GOP-backed AHCA would blow a $6 billion hole in the California budget starting in 2020. As demand on the health system grows, the loss of federal funds to California would eventually reach $24 billion annually in 2027.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>After years of waiting, it's finally here.\u003c/p>\n\u003cp>The \u003ca href=\"https://waysandmeans.house.gov/event/markup-budget-reconciliation-recommendations-repeal-replace-obamacare/\">Republican plan\u003c/a> to \u003ca href=\"https://energycommerce.house.gov/news-center/press-releases/energy-and-commerce-republicans-release-legislation-repeal-and-replace\">reshape \u003c/a>the Affordable Care Act — what they call \"repeal and replace\" — kills the requirement that everyone buy health insurance by eliminating the tax penalty for those who don't have coverage. It also makes significant changes in the financial assistance people can receive to buy a health plan.\u003c/p>\n\u003cp>\"Our legislation transfers power from Washington back to the states,\" said House Ways and Means Committee Chairman Kevin Brady in a statement. \"We dismantle Obamacare's damaging taxes and mandates so states can deliver quality affordable options.\"\u003c/p>\n\u003cp>The bill would offer tax credits, refundable in advance, to people with incomes below $75,000. But those credits will be lower in many cases than the subsidies now offered in the ACA.\u003c/p>\n\u003cp>The bill, which will go through many revisions and challenges, was released late Monday by two House committees, Ways and Means and Energy and Commerce. Members are expected to start voting on parts of the bill Wednesday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rep. Frank Pallone, D-N.J., and Richard Neal, D-Mass., the ranking Democrats on the Energy and Commerce and Ways and Means committees, issued a joint statement saying the bill would \"rip healthcare away from millions of Americans, ration care for working families and put insurance companies back in charge.\"\u003c/p>\n\u003cp>The legislation will need approval by the full House and the Senate before it goes to President Trump for his signature. Until then, most of what is known as Obamacare will stay in place.\u003c/p>\n\u003cp>But it's far from clear that Republicans in the House are unified in their support of the bill. Members of the far-right Freedom Caucus have said they oppose giving tax credits to people who don't pay any federal income tax.\u003c/p>\n\u003cp>And with only a slim majority in the Senate, only a few Republican defections could defeat the bill there.\u003c/p>\n\u003cp>Four Republican senators wrote a letter to Majority Leader Mitch McConnell saying they were concerned an early draft of the House plan would not adequately protect people who have insurance through Obamacare's Medicaid expansion. And Sen. Rand Paul was among three conservative Republicans who criticized an earlier version of the bill as \"Obamacare lite.\"\u003c/p>\n\u003cp>Under the proposed bill, tax credits would start at $2,000 a year for individuals under age 30, rising to $4,000 for those of 60. The proposal, first seen in a Feb. 10 draft of the bill, has been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/24/517074764/gop-health-bill-draft-would-cut-medicaid-emphasize-tax-credits\">criticized \u003c/a>as too meager to cover the full cost of a health insurance plan that provides full benefits.\u003c/p>\n\u003cp>But the proposed tax credit could potentially pay for insurance that protects only against a catastrophic health event.\u003c/p>\n\u003cp>They would begin to be phased out at incomes of $75,000 for individuals and $150,000 for families.\u003c/p>\n\u003cp>To encourage people to buy coverage, the plan allows insurers to charge a 30 percent penalty to people who let their insurance lapse, and then try to buy a new policy.\u003c/p>\n\u003cp>In states that expanded Medicaid, people who are eligible can continue to enroll until January 1, 2020, and those states would continue to benefit from the federal government paying a greater share of the health costs of those beneficiaries.\u003c/p>\n\u003cp>Several taxes contained in the ACA would be repealed at the end of this year. These include taxes on health insurers, pharmaceutical and medical device manufacturers, and a tax on high-cost employer-sponsored group health plans (aka Cadillac plans).\u003c/p>\n\u003cp>An analysis by \u003ca href=\"http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-significantly-reduce-federal-spending\">Avalere Health\u003c/a> and \u003ca href=\"https://cdn2.vox-cdn.com/uploads/chorus_asset/file/8045899/Scanned_from_a_Xerox_Multifunction_Printer.0.pdf\">McKinsey\u003c/a> of an earlier draft of the bill, which contained many of the same provisions, concluded that it would lead to millions of people losing coverage.\u003c/p>\n\u003cp>The plan offered by the House Republicans falls short of the outright repeal that has been demanded by more conservative members, including those in the House Freedom Caucus.\u003c/p>\n\u003cp>That could be due to the shift in public attitudes toward the ACA in recent weeks.\u003c/p>\n\u003cp>Public opinion has grown more favorable as major changes appeared imminent. A Kaiser Family Foundation \u003ca href=\"http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/\">tracking poll\u003c/a> in late February found 48 percent having a favorable opinion versus 42 percent viewing the law unfavorably. Kaiser says the shift is due largely to a change in the view of political independents, among which 50 percent now view the law favorably.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We will have more on this story as it develops.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Bill+Would+Repeal+Obamacare+Taxes+And+Penalties%2C+Keep+Some+Subsidies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After years of waiting, it's finally here.\u003c/p>\n\u003cp>The \u003ca href=\"https://waysandmeans.house.gov/event/markup-budget-reconciliation-recommendations-repeal-replace-obamacare/\">Republican plan\u003c/a> to \u003ca href=\"https://energycommerce.house.gov/news-center/press-releases/energy-and-commerce-republicans-release-legislation-repeal-and-replace\">reshape \u003c/a>the Affordable Care Act — what they call \"repeal and replace\" — kills the requirement that everyone buy health insurance by eliminating the tax penalty for those who don't have coverage. It also makes significant changes in the financial assistance people can receive to buy a health plan.\u003c/p>\n\u003cp>\"Our legislation transfers power from Washington back to the states,\" said House Ways and Means Committee Chairman Kevin Brady in a statement. \"We dismantle Obamacare's damaging taxes and mandates so states can deliver quality affordable options.\"\u003c/p>\n\u003cp>The bill would offer tax credits, refundable in advance, to people with incomes below $75,000. But those credits will be lower in many cases than the subsidies now offered in the ACA.\u003c/p>\n\u003cp>The bill, which will go through many revisions and challenges, was released late Monday by two House committees, Ways and Means and Energy and Commerce. Members are expected to start voting on parts of the bill Wednesday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rep. Frank Pallone, D-N.J., and Richard Neal, D-Mass., the ranking Democrats on the Energy and Commerce and Ways and Means committees, issued a joint statement saying the bill would \"rip healthcare away from millions of Americans, ration care for working families and put insurance companies back in charge.\"\u003c/p>\n\u003cp>The legislation will need approval by the full House and the Senate before it goes to President Trump for his signature. Until then, most of what is known as Obamacare will stay in place.\u003c/p>\n\u003cp>But it's far from clear that Republicans in the House are unified in their support of the bill. Members of the far-right Freedom Caucus have said they oppose giving tax credits to people who don't pay any federal income tax.\u003c/p>\n\u003cp>And with only a slim majority in the Senate, only a few Republican defections could defeat the bill there.\u003c/p>\n\u003cp>Four Republican senators wrote a letter to Majority Leader Mitch McConnell saying they were concerned an early draft of the House plan would not adequately protect people who have insurance through Obamacare's Medicaid expansion. And Sen. Rand Paul was among three conservative Republicans who criticized an earlier version of the bill as \"Obamacare lite.\"\u003c/p>\n\u003cp>Under the proposed bill, tax credits would start at $2,000 a year for individuals under age 30, rising to $4,000 for those of 60. The proposal, first seen in a Feb. 10 draft of the bill, has been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/24/517074764/gop-health-bill-draft-would-cut-medicaid-emphasize-tax-credits\">criticized \u003c/a>as too meager to cover the full cost of a health insurance plan that provides full benefits.\u003c/p>\n\u003cp>But the proposed tax credit could potentially pay for insurance that protects only against a catastrophic health event.\u003c/p>\n\u003cp>They would begin to be phased out at incomes of $75,000 for individuals and $150,000 for families.\u003c/p>\n\u003cp>To encourage people to buy coverage, the plan allows insurers to charge a 30 percent penalty to people who let their insurance lapse, and then try to buy a new policy.\u003c/p>\n\u003cp>In states that expanded Medicaid, people who are eligible can continue to enroll until January 1, 2020, and those states would continue to benefit from the federal government paying a greater share of the health costs of those beneficiaries.\u003c/p>\n\u003cp>Several taxes contained in the ACA would be repealed at the end of this year. These include taxes on health insurers, pharmaceutical and medical device manufacturers, and a tax on high-cost employer-sponsored group health plans (aka Cadillac plans).\u003c/p>\n\u003cp>An analysis by \u003ca href=\"http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-significantly-reduce-federal-spending\">Avalere Health\u003c/a> and \u003ca href=\"https://cdn2.vox-cdn.com/uploads/chorus_asset/file/8045899/Scanned_from_a_Xerox_Multifunction_Printer.0.pdf\">McKinsey\u003c/a> of an earlier draft of the bill, which contained many of the same provisions, concluded that it would lead to millions of people losing coverage.\u003c/p>\n\u003cp>The plan offered by the House Republicans falls short of the outright repeal that has been demanded by more conservative members, including those in the House Freedom Caucus.\u003c/p>\n\u003cp>That could be due to the shift in public attitudes toward the ACA in recent weeks.\u003c/p>\n\u003cp>Public opinion has grown more favorable as major changes appeared imminent. A Kaiser Family Foundation \u003ca href=\"http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/\">tracking poll\u003c/a> in late February found 48 percent having a favorable opinion versus 42 percent viewing the law unfavorably. Kaiser says the shift is due largely to a change in the view of political independents, among which 50 percent now view the law favorably.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We will have more on this story as it develops.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Bill+Would+Repeal+Obamacare+Taxes+And+Penalties%2C+Keep+Some+Subsidies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Poll: Most Americans Say Don't Repeal Obamacare Without a Replacement",
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"content": "\u003cp>An overwhelming majority of people disapprove of Republican lawmakers' plan to repeal the Affordable Care Act without having a ready replacement for the health care law, according to a poll released Friday.\u003c/p>\n\u003cp>And judging by the letter-writing and lobbying in the first week of the new congressional session, many health care and business groups agree.\u003c/p>\n\u003cp>A \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-health-care-priorities-for-2017\">poll\u003c/a> released Friday by the \u003ca href=\"http://kff.org/about-us/\">Kaiser Family Foundation\u003c/a> finds that 75 percent of Americans say they either want lawmakers to leave Obamacare alone, or repeal it only when they can replace it with a new health care law. Twenty percent of those polled say they want to see the law killed immediately.\u003c/p>\n\u003cp>But Drew Altman, CEO of the Kaiser Family Foundation, says the poll shows lawmakers don't have a strong mandate to repeal Obamacare.\u003c/p>\n\u003cp>\"Most of the American people said they're either against repealing it or they're against repealing it unless Republicans put a replacement plan on the table,\" Altman says. \"They want to see what comes next before they seen the ACA repealed.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Americans are about equally divided over whether Congress should repeal Obamacare, the poll shows. But of the 48 percent who want the law rolled back, about 60 percent want lawmakers to wait until they have an alternative plan.\u003c/p>\n\u003cp>[kaiser_survey]\u003c/p>\n\u003cp>And Obamacare isn't even people's top health care concern. The vast majority -- 67 percent -- say their top priority is finding a way to lower their health care costs.\u003c/p>\n\u003cp>The poll findings come just days after Republicans in the Senate \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/03/508074966/republicans-take-the-first-step-to-repeal-obamacare\">took the first step\u003c/a> toward repealing President Obama's signature health care law. They voted on Wednesday to move ahead with a budget resolution that will allow them to take funding away from Obamacare, which will effectively gut the law because the subsidies to buy insurance, and the penalties for not doing so, will disappear.\u003c/p>\n\u003cp>Republicans say they intend to vote on repeal, but give the law \u003ca href=\"http://www.npr.org/sections/health-shots/2016/12/12/505285572/obamacares-demise-could-be-quicker-than-republicans-intend\">time to sunset\u003c/a> while they come up with a replacement that will give the millions of people covered under Obamacare access to insurance through some other vehicle.\u003c/p>\n\u003cp>On Thursday, House Speaker Paul Ryan, R-Wis., said the replacement legislation would pass by the end of the year.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.drsforamerica.org/blog/today-we-take-action\">doctors\u003c/a>, hospital groups, \u003ca href=\"https://www.scribd.com/document/333454038/AHIP-doc#from_embed\">insurers\u003c/a> and analysts are skeptical of that strategy. In letters, press releases and \u003ca href=\"https://www.youtube.com/watch?v=Z2qzZvWA-pM&feature=youtu.be\">advertising campaigns\u003c/a>, many organizations have made it clear that they want to see a replacement for the Affordable Care Act in place, or at least outlined, before Congress repeals the current law.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.aha.org/content/16/impact-repeal-aca-report.pdf\">report\u003c/a> released Dec. 6 by the American Hospital Association and Federation of American Hospitals warned that a repeal could cost hospitals hundreds of billions and said \"any reconsideration of the ACA should be accompanied at the same time by provisions that guarantee similar coverage to those who would lose it.\"\u003c/p>\n\u003cp>A \u003ca href=\"https://www.ama-assn.org/ama-letter-congressional-leaders-reform-health-care-system\">letter\u003c/a> sent Tuesday from the American Medical Association urged lawmakers to release details of their Obamacare replacement before repealing the current law.\u003c/p>\n\u003cp>\"Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform,\" the letter said.\u003c/p>\n\u003cp>Dr. Andrew Gurman, president of the American Medical Association, says people should be able to evaluate the proposed Obamacare replacement before the current law is thrown out.\u003c/p>\n\u003cp>\"People in this country need to understand what it is they're being asked to substitute for what's there now so they can have an informed opinion about whether it's better or not,\" \u003ca href=\"https://www.ama-assn.org/andrew-w-gurman-md\">Gurman\u003c/a> says.\u003c/p>\n\u003cp>And repeal and delay?\u003c/p>\n\u003cp>\"We have a concern that that creates uncertainty in insurance markets and uncertainty in people about whether they're going to have continuity of coverage,\" Gurman adds.\u003c/p>\n\u003cp>He says he and his members talk with lawmakers regularly.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.commonwealthfund.org/Publications/Issue-Briefs/2017/Jan/Repealing-Federal-Health-Reform.\">separate study\u003c/a> released Thursday projects that a straight repeal of the law could kill 3 million jobs across the country by 2021.\u003c/p>\n\u003cp>That study, by the \u003ca href=\"http://publichealth.gwu.edu/\">Milken Institute School of Public Health\u003c/a> at George Washington University, finds that about a third of those lost jobs would come from health care, and the rest would be in other industries such as retail, construction, finance and insurance. Total business output could be cut by as much as $2.6 billion over four years, the report says. California, Florida and Texas would be most affected.\u003c/p>\n\u003cp>Leighton Ku, the report's lead author, says the debate over ACA repeal has focused almost completely on insurance coverage and has ignored the broader economic impact.\u003c/p>\n\u003cp>\"The payments you make to health care then become income for workers and income for other businesses. And this spreads out,\" \u003ca href=\"http://publichealth.gwu.edu/departments/health-policy-and-management/leighton-ku\">Ku\u003c/a> says. \"Health care is almost a fifth of the US economy, so as you begin to change health care, there are repercussions that go across all sectors.\"\u003c/p>\n\u003cp>Ku says he can't estimate what economic impact Obamcare replacement would have because Republicans have yet to lay out their plans.\u003c/p>\n\u003cp>\"It's a mystery,\" he says.\u003c/p>\n\u003cp>\u003cstrong>Editor's note:\u003c/strong> \u003cem>The Kaiser Family Foundation supports Kaiser Health News, an editorially independent program that produces news reports heard on NPR and published on \u003c/em>\u003ca href=\"http://NPR.org\">NPR.org\u003c/a>. \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>An overwhelming majority of people disapprove of Republican lawmakers' plan to repeal the Affordable Care Act without having a ready replacement for the health care law, according to a poll released Friday.\u003c/p>\n\u003cp>And judging by the letter-writing and lobbying in the first week of the new congressional session, many health care and business groups agree.\u003c/p>\n\u003cp>A \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-health-care-priorities-for-2017\">poll\u003c/a> released Friday by the \u003ca href=\"http://kff.org/about-us/\">Kaiser Family Foundation\u003c/a> finds that 75 percent of Americans say they either want lawmakers to leave Obamacare alone, or repeal it only when they can replace it with a new health care law. Twenty percent of those polled say they want to see the law killed immediately.\u003c/p>\n\u003cp>But Drew Altman, CEO of the Kaiser Family Foundation, says the poll shows lawmakers don't have a strong mandate to repeal Obamacare.\u003c/p>\n\u003cp>\"Most of the American people said they're either against repealing it or they're against repealing it unless Republicans put a replacement plan on the table,\" Altman says. \"They want to see what comes next before they seen the ACA repealed.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Americans are about equally divided over whether Congress should repeal Obamacare, the poll shows. But of the 48 percent who want the law rolled back, about 60 percent want lawmakers to wait until they have an alternative plan.\u003c/p>\n\u003cp>[kaiser_survey]\u003c/p>\n\u003cp>And Obamacare isn't even people's top health care concern. The vast majority -- 67 percent -- say their top priority is finding a way to lower their health care costs.\u003c/p>\n\u003cp>The poll findings come just days after Republicans in the Senate \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/03/508074966/republicans-take-the-first-step-to-repeal-obamacare\">took the first step\u003c/a> toward repealing President Obama's signature health care law. They voted on Wednesday to move ahead with a budget resolution that will allow them to take funding away from Obamacare, which will effectively gut the law because the subsidies to buy insurance, and the penalties for not doing so, will disappear.\u003c/p>\n\u003cp>Republicans say they intend to vote on repeal, but give the law \u003ca href=\"http://www.npr.org/sections/health-shots/2016/12/12/505285572/obamacares-demise-could-be-quicker-than-republicans-intend\">time to sunset\u003c/a> while they come up with a replacement that will give the millions of people covered under Obamacare access to insurance through some other vehicle.\u003c/p>\n\u003cp>On Thursday, House Speaker Paul Ryan, R-Wis., said the replacement legislation would pass by the end of the year.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.drsforamerica.org/blog/today-we-take-action\">doctors\u003c/a>, hospital groups, \u003ca href=\"https://www.scribd.com/document/333454038/AHIP-doc#from_embed\">insurers\u003c/a> and analysts are skeptical of that strategy. In letters, press releases and \u003ca href=\"https://www.youtube.com/watch?v=Z2qzZvWA-pM&feature=youtu.be\">advertising campaigns\u003c/a>, many organizations have made it clear that they want to see a replacement for the Affordable Care Act in place, or at least outlined, before Congress repeals the current law.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.aha.org/content/16/impact-repeal-aca-report.pdf\">report\u003c/a> released Dec. 6 by the American Hospital Association and Federation of American Hospitals warned that a repeal could cost hospitals hundreds of billions and said \"any reconsideration of the ACA should be accompanied at the same time by provisions that guarantee similar coverage to those who would lose it.\"\u003c/p>\n\u003cp>A \u003ca href=\"https://www.ama-assn.org/ama-letter-congressional-leaders-reform-health-care-system\">letter\u003c/a> sent Tuesday from the American Medical Association urged lawmakers to release details of their Obamacare replacement before repealing the current law.\u003c/p>\n\u003cp>\"Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform,\" the letter said.\u003c/p>\n\u003cp>Dr. Andrew Gurman, president of the American Medical Association, says people should be able to evaluate the proposed Obamacare replacement before the current law is thrown out.\u003c/p>\n\u003cp>\"People in this country need to understand what it is they're being asked to substitute for what's there now so they can have an informed opinion about whether it's better or not,\" \u003ca href=\"https://www.ama-assn.org/andrew-w-gurman-md\">Gurman\u003c/a> says.\u003c/p>\n\u003cp>And repeal and delay?\u003c/p>\n\u003cp>\"We have a concern that that creates uncertainty in insurance markets and uncertainty in people about whether they're going to have continuity of coverage,\" Gurman adds.\u003c/p>\n\u003cp>He says he and his members talk with lawmakers regularly.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.commonwealthfund.org/Publications/Issue-Briefs/2017/Jan/Repealing-Federal-Health-Reform.\">separate study\u003c/a> released Thursday projects that a straight repeal of the law could kill 3 million jobs across the country by 2021.\u003c/p>\n\u003cp>That study, by the \u003ca href=\"http://publichealth.gwu.edu/\">Milken Institute School of Public Health\u003c/a> at George Washington University, finds that about a third of those lost jobs would come from health care, and the rest would be in other industries such as retail, construction, finance and insurance. Total business output could be cut by as much as $2.6 billion over four years, the report says. California, Florida and Texas would be most affected.\u003c/p>\n\u003cp>Leighton Ku, the report's lead author, says the debate over ACA repeal has focused almost completely on insurance coverage and has ignored the broader economic impact.\u003c/p>\n\u003cp>\"The payments you make to health care then become income for workers and income for other businesses. And this spreads out,\" \u003ca href=\"http://publichealth.gwu.edu/departments/health-policy-and-management/leighton-ku\">Ku\u003c/a> says. \"Health care is almost a fifth of the US economy, so as you begin to change health care, there are repercussions that go across all sectors.\"\u003c/p>\n\u003cp>Ku says he can't estimate what economic impact Obamcare replacement would have because Republicans have yet to lay out their plans.\u003c/p>\n\u003cp>\"It's a mystery,\" he says.\u003c/p>\n\u003cp>\u003cstrong>Editor's note:\u003c/strong> \u003cem>The Kaiser Family Foundation supports Kaiser Health News, an editorially independent program that produces news reports heard on NPR and published on \u003c/em>\u003ca href=\"http://NPR.org\">NPR.org\u003c/a>. \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"politicalbreakdown": {
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"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.",
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"possible": {
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"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.",
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"pri-the-world": {
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"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.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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"radiolab": {
"id": "radiolab",
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"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.",
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"reveal": {
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"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.",
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},
"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.",
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},
"science-friday": {
"id": "science-friday",
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"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.",
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"snap-judgment": {
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"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.",
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