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"bio": "Farida Jhabvala Romero is a Labor Correspondent for KQED. She previously covered immigration. Farida was \u003ca href=\"https://www.ccnma.org/2022-most-influential-latina-journalists\">named\u003c/a> one of the 10 Most Influential Latina Journalists in California in 2022 by the California Chicano News Media Association. Her work has won awards from the Society of Professional Journalists (Northern California), as well as a national and regional Edward M. Murrow Award for the collaborative reporting projects “Dangerous Air” and “Graying California.” Before joining KQED, Farida worked as a producer at Radio Bilingüe, a national public radio network. Farida earned her master’s degree in journalism from Stanford University.",
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"content": "\u003cp>Effective today, the legal age to buy tobacco products-- including e-cigarettes -- in California is now 21 years old.\u003c/p>\n\u003cp>For 144 years the legal age to buy tobacco in California was 18. But a package of anti-tobacco bills moved through the legislature and Gov. Jerry Brown\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/04/gov-brown-signs-major-tobacco-bills-raises-legal-age-to-21/\" target=\"_blank\"> signed five of them\u003c/a> last month.\u003c/p>\n\u003cp>The intent of the higher age is to get tobacco products out of the hands of teenagers. Many 18-year-olds are in high school and can share their lawfully-purchased cigarettes with those too young to buy.\u003c/p>\n\u003cp>Moving the tobacco age to 21 moves legal purchasers out of the orbit of teens. An Institute of Medicine \u003ca href=\"http://www.nationalacademies.org/hmd/Activities/PublicHealth/TobaccoMinimumAge.aspx\" target=\"_blank\">analysis \u003c/a>last year concluded that raising the tobacco age to 21 nationwide would result in a 12 percent drop in the number of teen and young adult smokers.\u003c/p>\n\u003cp>An estimated 240,000 18- to 20-year-olds use tobacco products.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In a press conference Thursday morning, the California Department of Public Health announced an education program targeted at vape shops and tobacco retailers.\u003c/p>\n\u003cp>[contextly_sidebar id=\"aaK9djuMZIqMps7F1Q0KzQpISKHWwGXB\"]\"Our goal is to help retailers comply with these important new laws governing the sale of tobacco products,\" said Dr. Karen Smith, director of the health department.\u003c/p>\n\u003cp>Smith also pointed out that 70 percent of tobacco retailers also sell alcohol, and now the age of sale for tobacco matches that of alcohol products.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.cdph.ca.gov/programs/Pages/FDB.aspx\" target=\"_blank\">food and drug branch\u003c/a> of the health department oversees enforcement of tobacco control. The Stop Tobacco Access to Kids Enforcement Act, commonly known as the Stake Act, has netted a significant drop in illegal sales of tobacco to minors.\u003c/p>\n\u003cp>Smith said that in 1995 one in three California stores illegally sold tobacco products to minors under age 18. \"In 2015, it was just one in 13 stores violating the law,\" Smith said.\u003c/p>\n\u003cp>Active members of the United States military are exempt from the new law and can still purchase tobacco at 18 with military-issued ID.\u003c/p>\n\u003cp>Also effective today -- e-cigarettes are subject to the same smoke-free laws traditional cigarettes are. So, wherever cigarettes can't be smoked, e-cigarettes can't be used either. This includes hookah products as well.\u003c/p>\n\u003cp>The only indoor places where smoking is allowed are \"tobacco-only retailers.\" These are businesses that sell only tobacco. Use of tobacco products would not be permitted, for example, in a business that sells tobacco along with food and drinks.\u003c/p>\n\u003cp>Smith said that success in the implementation of the new laws would mean fewer people under age 21 are smoking.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We really do want to save lives,\" she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Effective today, the legal age to buy tobacco products-- including e-cigarettes -- in California is now 21 years old.\u003c/p>\n\u003cp>For 144 years the legal age to buy tobacco in California was 18. But a package of anti-tobacco bills moved through the legislature and Gov. Jerry Brown\u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/04/gov-brown-signs-major-tobacco-bills-raises-legal-age-to-21/\" target=\"_blank\"> signed five of them\u003c/a> last month.\u003c/p>\n\u003cp>The intent of the higher age is to get tobacco products out of the hands of teenagers. Many 18-year-olds are in high school and can share their lawfully-purchased cigarettes with those too young to buy.\u003c/p>\n\u003cp>Moving the tobacco age to 21 moves legal purchasers out of the orbit of teens. An Institute of Medicine \u003ca href=\"http://www.nationalacademies.org/hmd/Activities/PublicHealth/TobaccoMinimumAge.aspx\" target=\"_blank\">analysis \u003c/a>last year concluded that raising the tobacco age to 21 nationwide would result in a 12 percent drop in the number of teen and young adult smokers.\u003c/p>\n\u003cp>An estimated 240,000 18- to 20-year-olds use tobacco products.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In a press conference Thursday morning, the California Department of Public Health announced an education program targeted at vape shops and tobacco retailers.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"Our goal is to help retailers comply with these important new laws governing the sale of tobacco products,\" said Dr. Karen Smith, director of the health department.\u003c/p>\n\u003cp>Smith also pointed out that 70 percent of tobacco retailers also sell alcohol, and now the age of sale for tobacco matches that of alcohol products.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.cdph.ca.gov/programs/Pages/FDB.aspx\" target=\"_blank\">food and drug branch\u003c/a> of the health department oversees enforcement of tobacco control. The Stop Tobacco Access to Kids Enforcement Act, commonly known as the Stake Act, has netted a significant drop in illegal sales of tobacco to minors.\u003c/p>\n\u003cp>Smith said that in 1995 one in three California stores illegally sold tobacco products to minors under age 18. \"In 2015, it was just one in 13 stores violating the law,\" Smith said.\u003c/p>\n\u003cp>Active members of the United States military are exempt from the new law and can still purchase tobacco at 18 with military-issued ID.\u003c/p>\n\u003cp>Also effective today -- e-cigarettes are subject to the same smoke-free laws traditional cigarettes are. So, wherever cigarettes can't be smoked, e-cigarettes can't be used either. This includes hookah products as well.\u003c/p>\n\u003cp>The only indoor places where smoking is allowed are \"tobacco-only retailers.\" These are businesses that sell only tobacco. Use of tobacco products would not be permitted, for example, in a business that sells tobacco along with food and drinks.\u003c/p>\n\u003cp>Smith said that success in the implementation of the new laws would mean fewer people under age 21 are smoking.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We really do want to save lives,\" she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California’s Aid-in-Dying Law Takes Effect Today -- Here's What You Need to Know",
"title": "California’s Aid-in-Dying Law Takes Effect Today -- Here's What You Need to Know",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Starting Thursday, June 9, terminally ill Californians with six months or less to live can request a doctor’s prescription for medications intended to end their lives peacefully.\u003c/p>\n\u003cp>If that sounds simple, it won’t be.\u003c/p>\n\u003caside class=\"pullquote alignright\">The patient has to jump through a lot of hoops -- that's to make sure the decision is made voluntarily.\u003c/aside>\n\u003cp>California’s \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/asm/ab_0001-0050/abx2_15_bill_20151005_chaptered.htm\" target=\"_blank\">End of Life Option Act\u003c/a> creates a long list of administrative hurdles that both patients and their doctors must clear.\u003c/p>\n\u003cp>For instance, you must make multiple requests for the drugs, orally and in writing, and provide a written attestation within 48 hours of taking the medication (you must be able to take the drugs yourself, without help, to qualify).\u003c/p>\n\u003cp>Two doctors must confirm your diagnosis, prognosis and ability to make medical decisions, and you must prove you’re a California resident.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And more.\u003c/p>\n\u003cp>“This will not be an on-demand service,” says Sarah Hooper, executive director of the \u003ca href=\"http://www.ucconsortium.org/\" target=\"_blank\">UCSF/UC Hastings Consortium on Law, Science and Health Policy\u003c/a>.\u003c/p>\n\u003cp>“The patient has to jump through a lot of hoops before accessing the prescription. Those hoops are designed to ensure that the patient has really thought about this and is making the decision voluntarily.\"\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/268313233\" 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>\u003ca href=\"http://ww2.kqed.org/lowdown/2015/10/06/california-becomes-fifth-state-to-legalize-physician-assisted-suicide-interactive-map/\" target=\"_blank\">California will be the fifth state \u003c/a>to implement an aid-in-dying law, and the Golden State’s version of it is considered the most stringent, says Sean Crowley, spokesman for the advocacy group \u003ca href=\"https://www.compassionandchoices.org/\" target=\"_blank\">Compassion & Choices\u003c/a>.\u003c/p>\n\u003cp>Rather than list every requirement, I’m going to describe a few potential challenges you might face if you or a loved one is considering asking for these medications — ranging from doctors who are unwilling to write prescriptions to the cost of the medications themselves.\u003c/p>\n\u003cp>This law is voluntary “every step of the way,” says state Sen. Bill Monning, D-Carmel, co-author of the law.\u003c/p>\n\u003cp>That means everyone — patients, physicians, health systems and pharmacies — gets to choose whether or not to participate.\u003c/p>\n\u003cp>Nothing requires patients to take the drugs once they have obtained a prescription.\u003c/p>\n\u003cp>[contextly_sidebar id=\"oappkhqYOxY2odvQWXkqxRUPDLXRQOaq\"]Since Oregon implemented its law in 1997, more than one-third of people who obtained prescriptions didn’t take the medications, according to \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf\" target=\"_blank\">data compiled by the Oregon Public Health Division\u003c/a>.\u003c/p>\n\u003cp>“You can still at any point decide, ‘I’m not going to need this. The hospice care is effective. The palliative care is effective,’ ” Monning says.\u003c/p>\n\u003cp>But before you can make that decision, you must first get a prescription — and that might take some doing. That’s because not all health care providers will be on board with the new law. It will be up to you to find the ones who are.\u003c/p>\n\u003cp>“Patients and families should expect that they will have to be a little proactive in asking questions and getting educated about their care,” Hooper says.\u003c/p>\n\u003cp>For instance, the Kaiser Permanente system will participate, and patients will be paired with a coordinator to guide them through the process, says spokeswoman Amy Thoma.\u003c/p>\n\u003cp>If your Kaiser Permanente doctor chooses not to participate, which is his or her right under the law, your coordinator will connect you with a physician who does, Thoma says.\u003c/p>\n\u003cp>But U.S. military veterans who receive health care from the U.S. Department of Veterans Affairs will have to look elsewhere for participating doctors, because federal law prohibits the use of federal money for such a purpose, Hooper says.\u003c/p>\n\u003cp>Nor will the 48 Catholic and Catholic-affiliated hospitals in California participate, including their doctors and staff, says Lori Dangberg, vice president of the \u003ca href=\"http://www.thealliance.net/\" target=\"_blank\">Alliance of Catholic Health Care\u003c/a>.\u003c/p>\n\u003cp>Dangberg insists that those providers will not abandon any patient who chooses to end his or her own life. “We will be with that patient and continue to care for that patient throughout their diagnosis and their dying process,” she says. “We just cannot participate in any action that would intentionally hasten a person’s death.”\u003c/p>\n\u003cp>If your doctor doesn’t participate, ask him or her to refer you to one who does. If your doctor won’t provide a reference, “call us and we can probably help,” says Crowley of Compassion & Choices. That number is 800-893-4548.\u003c/p>\n\u003cp>[contextly_sidebar id=\"eEwOCzZsqwP8UpYpMkLX1qXElE4Krqd6\"]Another potential obstacle is the cost of the drugs. Your insurance might not cover them. California’s law does not require health insurers to cover the medications, Monning says.\u003c/p>\n\u003cp>In Oregon, Washington and Montana — states where aid-in-dying is legal — some health plans cover the cost and some don’t, he says. He expects the same to occur here.\u003c/p>\n\u003cp>Insurers “are currently working on how they will implement this law,” says Nicole Kasabian Evans of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>.\u003c/p>\n\u003cp>If you have questions about coverage, she suggests you contact your insurer directly.\u003c/p>\n\u003cp>Medi-Cal, California’s version of the federal Medicaid program for low-income residents, will cover the cost of the drugs without relying on any federal money, says state Department of Health Care Services spokeswoman Katharine Weir.\u003c/p>\n\u003cp>If affordability becomes an issue, Compassion & Choices again urges you to call. “We try to work with people to find a way for them to access the law, through any challenges,” Crowley says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>If you need more step-by-step guidance about the law, tap into these resources:\u003c/p>\n\u003cul>\n\u003cli>Compassion & Choices has online guides for consumers and doctors at \u003ca href=\"http://www.endoflifeoption.org/\" target=\"_blank\">www.EndOfLifeOption.org\u003c/a>. You can also call the group’s help line at 800-893-4548.\u003c/li>\n\u003cli>The UCSF/UC Hastings Consortium on Law, Science and Health Policy has a \u003ca href=\"http://www.ucconsortium.org/wp-content/uploads/2015/12/FACT-SHEET-End-of-Life-Option-Act-Updated-01.15.16.pdf\" target=\"_blank\">helpful fact sheet\u003c/a> at \u003ca href=\"http://bit.ly/248Z2l6\" target=\"_blank\">http://bit.ly/248Z2l6\u003c/a>.\u003c/li>\n\u003cli>The California Medical Association, which represents doctors, has a detailed, \u003ca href=\"http://www.cmanet.org/resource-library/detail/?item=the-california-end-of-life-option-act&r_search=Document%203459&r_page=1&return_to=list\" target=\"_blank\">14-page document\u003c/a> at \u003ca href=\"http://www.cmanet.org/endoflife\" target=\"_blank\">www.cmanet.org/endoflife\u003c/a>. You’ll need to register on the site to read the document.\u003c/li>\n\u003cli>Once the law takes effect, or soon thereafter, you will be able to find the forms you and your physician need to sign at the Medical Board of California’s website: \u003ca href=\"http://www.mbc.ca.gov/\" target=\"_blank\">www.mbc.ca.gov\u003c/a>.\u003c/li>\n\u003c/ul>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Starting Thursday, June 9, terminally ill Californians with six months or less to live can request a doctor’s prescription for medications intended to end their lives peacefully.\u003c/p>\n\u003cp>If that sounds simple, it won’t be.\u003c/p>\n\u003caside class=\"pullquote alignright\">The patient has to jump through a lot of hoops -- that's to make sure the decision is made voluntarily.\u003c/aside>\n\u003cp>California’s \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/asm/ab_0001-0050/abx2_15_bill_20151005_chaptered.htm\" target=\"_blank\">End of Life Option Act\u003c/a> creates a long list of administrative hurdles that both patients and their doctors must clear.\u003c/p>\n\u003cp>For instance, you must make multiple requests for the drugs, orally and in writing, and provide a written attestation within 48 hours of taking the medication (you must be able to take the drugs yourself, without help, to qualify).\u003c/p>\n\u003cp>Two doctors must confirm your diagnosis, prognosis and ability to make medical decisions, and you must prove you’re a California resident.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And more.\u003c/p>\n\u003cp>“This will not be an on-demand service,” says Sarah Hooper, executive director of the \u003ca href=\"http://www.ucconsortium.org/\" target=\"_blank\">UCSF/UC Hastings Consortium on Law, Science and Health Policy\u003c/a>.\u003c/p>\n\u003cp>“The patient has to jump through a lot of hoops before accessing the prescription. Those hoops are designed to ensure that the patient has really thought about this and is making the decision voluntarily.\"\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/268313233&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/268313233'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/lowdown/2015/10/06/california-becomes-fifth-state-to-legalize-physician-assisted-suicide-interactive-map/\" target=\"_blank\">California will be the fifth state \u003c/a>to implement an aid-in-dying law, and the Golden State’s version of it is considered the most stringent, says Sean Crowley, spokesman for the advocacy group \u003ca href=\"https://www.compassionandchoices.org/\" target=\"_blank\">Compassion & Choices\u003c/a>.\u003c/p>\n\u003cp>Rather than list every requirement, I’m going to describe a few potential challenges you might face if you or a loved one is considering asking for these medications — ranging from doctors who are unwilling to write prescriptions to the cost of the medications themselves.\u003c/p>\n\u003cp>This law is voluntary “every step of the way,” says state Sen. Bill Monning, D-Carmel, co-author of the law.\u003c/p>\n\u003cp>That means everyone — patients, physicians, health systems and pharmacies — gets to choose whether or not to participate.\u003c/p>\n\u003cp>Nothing requires patients to take the drugs once they have obtained a prescription.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Since Oregon implemented its law in 1997, more than one-third of people who obtained prescriptions didn’t take the medications, according to \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf\" target=\"_blank\">data compiled by the Oregon Public Health Division\u003c/a>.\u003c/p>\n\u003cp>“You can still at any point decide, ‘I’m not going to need this. The hospice care is effective. The palliative care is effective,’ ” Monning says.\u003c/p>\n\u003cp>But before you can make that decision, you must first get a prescription — and that might take some doing. That’s because not all health care providers will be on board with the new law. It will be up to you to find the ones who are.\u003c/p>\n\u003cp>“Patients and families should expect that they will have to be a little proactive in asking questions and getting educated about their care,” Hooper says.\u003c/p>\n\u003cp>For instance, the Kaiser Permanente system will participate, and patients will be paired with a coordinator to guide them through the process, says spokeswoman Amy Thoma.\u003c/p>\n\u003cp>If your Kaiser Permanente doctor chooses not to participate, which is his or her right under the law, your coordinator will connect you with a physician who does, Thoma says.\u003c/p>\n\u003cp>But U.S. military veterans who receive health care from the U.S. Department of Veterans Affairs will have to look elsewhere for participating doctors, because federal law prohibits the use of federal money for such a purpose, Hooper says.\u003c/p>\n\u003cp>Nor will the 48 Catholic and Catholic-affiliated hospitals in California participate, including their doctors and staff, says Lori Dangberg, vice president of the \u003ca href=\"http://www.thealliance.net/\" target=\"_blank\">Alliance of Catholic Health Care\u003c/a>.\u003c/p>\n\u003cp>Dangberg insists that those providers will not abandon any patient who chooses to end his or her own life. “We will be with that patient and continue to care for that patient throughout their diagnosis and their dying process,” she says. “We just cannot participate in any action that would intentionally hasten a person’s death.”\u003c/p>\n\u003cp>If your doctor doesn’t participate, ask him or her to refer you to one who does. If your doctor won’t provide a reference, “call us and we can probably help,” says Crowley of Compassion & Choices. That number is 800-893-4548.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Another potential obstacle is the cost of the drugs. Your insurance might not cover them. California’s law does not require health insurers to cover the medications, Monning says.\u003c/p>\n\u003cp>In Oregon, Washington and Montana — states where aid-in-dying is legal — some health plans cover the cost and some don’t, he says. He expects the same to occur here.\u003c/p>\n\u003cp>Insurers “are currently working on how they will implement this law,” says Nicole Kasabian Evans of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>.\u003c/p>\n\u003cp>If you have questions about coverage, she suggests you contact your insurer directly.\u003c/p>\n\u003cp>Medi-Cal, California’s version of the federal Medicaid program for low-income residents, will cover the cost of the drugs without relying on any federal money, says state Department of Health Care Services spokeswoman Katharine Weir.\u003c/p>\n\u003cp>If affordability becomes an issue, Compassion & Choices again urges you to call. “We try to work with people to find a way for them to access the law, through any challenges,” Crowley says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If you need more step-by-step guidance about the law, tap into these resources:\u003c/p>\n\u003cul>\n\u003cli>Compassion & Choices has online guides for consumers and doctors at \u003ca href=\"http://www.endoflifeoption.org/\" target=\"_blank\">www.EndOfLifeOption.org\u003c/a>. You can also call the group’s help line at 800-893-4548.\u003c/li>\n\u003cli>The UCSF/UC Hastings Consortium on Law, Science and Health Policy has a \u003ca href=\"http://www.ucconsortium.org/wp-content/uploads/2015/12/FACT-SHEET-End-of-Life-Option-Act-Updated-01.15.16.pdf\" target=\"_blank\">helpful fact sheet\u003c/a> at \u003ca href=\"http://bit.ly/248Z2l6\" target=\"_blank\">http://bit.ly/248Z2l6\u003c/a>.\u003c/li>\n\u003cli>The California Medical Association, which represents doctors, has a detailed, \u003ca href=\"http://www.cmanet.org/resource-library/detail/?item=the-california-end-of-life-option-act&r_search=Document%203459&r_page=1&return_to=list\" target=\"_blank\">14-page document\u003c/a> at \u003ca href=\"http://www.cmanet.org/endoflife\" target=\"_blank\">www.cmanet.org/endoflife\u003c/a>. You’ll need to register on the site to read the document.\u003c/li>\n\u003cli>Once the law takes effect, or soon thereafter, you will be able to find the forms you and your physician need to sign at the Medical Board of California’s website: \u003ca href=\"http://www.mbc.ca.gov/\" target=\"_blank\">www.mbc.ca.gov\u003c/a>.\u003c/li>\n\u003c/ul>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Finding a therapist who takes your insurance can already be hard. If you’re black, or if you’re working class, it’s even harder.\u003c/p>\n\u003cp>\u003ca href=\"http://www.asanet.org/journals/JHSB/Jun16JHSBFeature.pdf\" target=\"_blank\">A new study \u003c/a>found 28 percent of white middle class people who called a psychotherapist asking for an appointment, were offered one, while 17 percent of middle class black callers were offered an appointment. Only 8 percent of working class callers – black or white – were offered a slot.\u003c/p>\n\u003cp>“Broadly, it shows how deeply embedded discrimination against black and working class individuals continues to be in American society, even in realms where people might not expect it,” said Heather Kugelmass, a Princeton University graduate student who conducted the study, published this month in the \u003cem>Journal of Health and Social Behavior\u003c/em>.\u003c/p>\n\u003cp>In the study, she had voice actors call 320 psychotherapists in New York City.\u003c/p>\n\u003cp>All the callers expressed symptoms of depression or anxiety, like having trouble sleeping, or not wanting to see friends. All said they had the exact same kind of insurance: Empire Blue Cross Blue Shield.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But some went by names like Amy Roberts and Bobby Carpenter. And others went by Latoya Johnson and Darnell Thomas.\u003c/p>\n\u003cp>“Race was signaled through name and accent,” Kugelmass explained. “And then class was cued through vocabulary, grammar, and accent.”\u003c/p>\n\u003cp>For example, a middle class white caller said things like, “I’m becoming concerned because I can’t get going in the morning, and it takes a lot of effort to deal with people at work.”\u003c/p>\n\u003cp>While a working class black caller said, “I just be feeling down and annoyed at work all the time. Now I can’t even sleep right and that ain’t no good.”\u003c/p>\n\u003cp>Kugelmass said the overall response rate was low, which is similar to findings of a recent \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey\u003c/a> of San Francisco psychologists.\u003c/p>\n\u003cp>But the disparities in who the therapists called back were “striking,” Kugelmass said. One out of two middle class white callers got a response, while one in three working class black callers did.\u003c/p>\n\u003cp>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22121963\" target=\"_blank\">Previous research\u003c/a> has shown that psychotherapists have a preference to treat clients they perceive to be verbal, intelligent, and “psychologically minded,” in other words, people who are like them. \u003ca href=\"http://psycnet.apa.org/psycinfo/1988-97772-005\" target=\"_blank\">Another study\u003c/a> found that psychiatrists perceive black patients as “less articulate, competent, [and] introspective” compared to white patients.\u003c/p>\n\u003cp>Kugelmass says her results suggest the therapists contacted for her study – all of whom held doctoral degrees and operated a solo practice – could be turning down potential patients based on unconscious biases or stereotypes.\u003c/p>\n\u003cp>“These white middle class, or upper middle class, therapists are probably reluctant to embark on what can be an intimate, potentially long-term relationship with someone that they feel they can't relate to,” Kugelmass said.\u003c/p>\n\u003cp>The biggest disparity found in the study appeared with weekday evening appointment times – the most coveted slots in therapy.\u003c/p>\n\u003cp>Of all the calls placed by middle class white women asking for that slot, 20 percent resulted in an appointment offer for a weekday evening. That compares to just one percent of calls placed by working class black men resulting in an evening appointment offer.\u003c/p>\n\u003cp>“If the magnitude of discrimination against working class men in the study translates to what is happening in the real world,” Kugelmass said, “then they’re facing a virtually insurmountable barrier to getting care from the types of therapists who were investigated here.”\u003c/p>\n\u003cp>She said she hopes psychotherapy training programs, professional associations, and insurers will take her findings seriously and find a way to address them in practice.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>To read more about barriers to mental health care in California, check out KQED's series, \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/state-of-mind/\">State of Mind\u003c/a>. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Finding a therapist who takes your insurance can already be hard. If you’re black, or if you’re working class, it’s even harder.\u003c/p>\n\u003cp>\u003ca href=\"http://www.asanet.org/journals/JHSB/Jun16JHSBFeature.pdf\" target=\"_blank\">A new study \u003c/a>found 28 percent of white middle class people who called a psychotherapist asking for an appointment, were offered one, while 17 percent of middle class black callers were offered an appointment. Only 8 percent of working class callers – black or white – were offered a slot.\u003c/p>\n\u003cp>“Broadly, it shows how deeply embedded discrimination against black and working class individuals continues to be in American society, even in realms where people might not expect it,” said Heather Kugelmass, a Princeton University graduate student who conducted the study, published this month in the \u003cem>Journal of Health and Social Behavior\u003c/em>.\u003c/p>\n\u003cp>In the study, she had voice actors call 320 psychotherapists in New York City.\u003c/p>\n\u003cp>All the callers expressed symptoms of depression or anxiety, like having trouble sleeping, or not wanting to see friends. All said they had the exact same kind of insurance: Empire Blue Cross Blue Shield.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But some went by names like Amy Roberts and Bobby Carpenter. And others went by Latoya Johnson and Darnell Thomas.\u003c/p>\n\u003cp>“Race was signaled through name and accent,” Kugelmass explained. “And then class was cued through vocabulary, grammar, and accent.”\u003c/p>\n\u003cp>For example, a middle class white caller said things like, “I’m becoming concerned because I can’t get going in the morning, and it takes a lot of effort to deal with people at work.”\u003c/p>\n\u003cp>While a working class black caller said, “I just be feeling down and annoyed at work all the time. Now I can’t even sleep right and that ain’t no good.”\u003c/p>\n\u003cp>Kugelmass said the overall response rate was low, which is similar to findings of a recent \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/23/single-moms-search-for-therapist-foiled-by-insurance-companies/\" target=\"_blank\">KQED survey\u003c/a> of San Francisco psychologists.\u003c/p>\n\u003cp>But the disparities in who the therapists called back were “striking,” Kugelmass said. One out of two middle class white callers got a response, while one in three working class black callers did.\u003c/p>\n\u003cp>\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22121963\" target=\"_blank\">Previous research\u003c/a> has shown that psychotherapists have a preference to treat clients they perceive to be verbal, intelligent, and “psychologically minded,” in other words, people who are like them. \u003ca href=\"http://psycnet.apa.org/psycinfo/1988-97772-005\" target=\"_blank\">Another study\u003c/a> found that psychiatrists perceive black patients as “less articulate, competent, [and] introspective” compared to white patients.\u003c/p>\n\u003cp>Kugelmass says her results suggest the therapists contacted for her study – all of whom held doctoral degrees and operated a solo practice – could be turning down potential patients based on unconscious biases or stereotypes.\u003c/p>\n\u003cp>“These white middle class, or upper middle class, therapists are probably reluctant to embark on what can be an intimate, potentially long-term relationship with someone that they feel they can't relate to,” Kugelmass said.\u003c/p>\n\u003cp>The biggest disparity found in the study appeared with weekday evening appointment times – the most coveted slots in therapy.\u003c/p>\n\u003cp>Of all the calls placed by middle class white women asking for that slot, 20 percent resulted in an appointment offer for a weekday evening. That compares to just one percent of calls placed by working class black men resulting in an evening appointment offer.\u003c/p>\n\u003cp>“If the magnitude of discrimination against working class men in the study translates to what is happening in the real world,” Kugelmass said, “then they’re facing a virtually insurmountable barrier to getting care from the types of therapists who were investigated here.”\u003c/p>\n\u003cp>She said she hopes psychotherapy training programs, professional associations, and insurers will take her findings seriously and find a way to address them in practice.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>To read more about barriers to mental health care in California, check out KQED's series, \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/state-of-mind/\">State of Mind\u003c/a>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Senate Kills Bill Requiring Doctors on Probation to Let You Know",
"title": "California Senate Kills Bill Requiring Doctors on Probation to Let You Know",
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"content": "\u003cp>The state Senate this week rejected legislation that would have required doctors and other medical to notify their patients if they were on probation for serious infractions.\u003c/p>\n\u003caside class=\"pullquote alignright\">The bill was aimed at a tiny fraction of doctors -- those disciplined for serious offenses including sexual misconduct\u003c/aside>\n\u003cp>The bill would have applied to a tiny pool of practitioners – those disciplined for serious offenses such as gross negligence, sexual misconduct, substance abuse or a felony conviction related to patient care. It would have required such physicians, chiropractors, podiatrists and acupuncturists to notify their patients in a one-page, “easy to read” notice that explained why they had been put on probation.\u003c/p>\n\u003cp>The bill’s supporters said consumers were ill-served by the Senate’s decision.\u003c/p>\n\u003cp>“Today’s vote means that most Californians will remain in the dark when their doctor is on probation for offenses that could jeopardize their health,” said Lisa McGiffert, manager of the Safe Patient Project at Consumers Union.\u003c/p>\n\u003cp>Opponents of the bill, including the California Medical Association, had argued that, as written, it would undermine physicians’ rights to due process and amount to a de facto suspension by severely restricting their ability to practice. They also noted that information about doctors’ offenses is already available on the internet.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"rb8PrSswaxF1kGnSGu3CLNCZF9vs5kpb\"]Some senators who opposed the measure said the language in the bill suggested that doctors and other providers could be forced to tell their patients about unproven allegations against them.\u003c/p>\n\u003cp>Sen. Richard Pan, D-Sacramento, a pediatrician, said he voted against it for that reason. “This is a significant concern, because I do believe that everyone has a right to due process in this country. It’s an issue of principle,” Pan said.\u003c/p>\n\u003cp>McGiffert said the due process argument was based on a misunderstanding. Before an accusation is made, there has to be clear and convincing evidence, and every case then gets full due process before doctors are put on probation, she said.\u003c/p>\n\u003cp>Under current law, clinicians are required to notify hospitals and malpractice insurers when they’re placed on probation. They don’t have to tell patients, but the information is available on the California Medical Board’s \u003ca href=\"https://www.breeze.ca.gov/datamart/loginCADCA.do;jsessionid=1AACA3B0BA91391B2472BEF33B8D086E.vo19\">BreEZe website\u003c/a>.\u003c/p>\n\u003cp>Some supporters of the bill have argued that the medical board website is too difficult for the average person to navigate and creates a barrier for those without internet access.\u003c/p>\n\u003cp>McGiffert said she hopes the bill's sponsor, \u003ca href=\"http://californiahealthline.org/news/is-your-doctor-hiding-something-from-you/\" target=\"_blank\">Sen. Jerry Hill, D – San Mateo,\u003c/a>, will present the bill again. If so, she and other advocates are prepared to speak with Senate members because, “we believe they have been misled in some ways,” she said. “I guarantee you that every single person who voted against [the bill] would want to know if their doctor was on probation.”\u003c/p>\n\u003cp>The Senate Wednesday voted 15-13 for the bill, short of the 21 votes needed to pass it. The Senate then unanimously approved a motion allowing the proposal to be amended and brought up for another vote this week. Hill had planned to seek a new vote on Thursday, but he later decided against it after realizing it still would not garner sufficient support.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Hill could reintroduce the measure in the next legislative session, which begins in early December. But a spokeswoman in his office said she didn’t know if he would.\u003c/p>\n\n",
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"excerpt": "Doctors who are disciplined for serious offenses including sexual misconduct or substance abuse are not required to tell you.",
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"title": "California Senate Kills Bill Requiring Doctors on Probation to Let You Know | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The state Senate this week rejected legislation that would have required doctors and other medical to notify their patients if they were on probation for serious infractions.\u003c/p>\n\u003caside class=\"pullquote alignright\">The bill was aimed at a tiny fraction of doctors -- those disciplined for serious offenses including sexual misconduct\u003c/aside>\n\u003cp>The bill would have applied to a tiny pool of practitioners – those disciplined for serious offenses such as gross negligence, sexual misconduct, substance abuse or a felony conviction related to patient care. It would have required such physicians, chiropractors, podiatrists and acupuncturists to notify their patients in a one-page, “easy to read” notice that explained why they had been put on probation.\u003c/p>\n\u003cp>The bill’s supporters said consumers were ill-served by the Senate’s decision.\u003c/p>\n\u003cp>“Today’s vote means that most Californians will remain in the dark when their doctor is on probation for offenses that could jeopardize their health,” said Lisa McGiffert, manager of the Safe Patient Project at Consumers Union.\u003c/p>\n\u003cp>Opponents of the bill, including the California Medical Association, had argued that, as written, it would undermine physicians’ rights to due process and amount to a de facto suspension by severely restricting their ability to practice. They also noted that information about doctors’ offenses is already available on the internet.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Some senators who opposed the measure said the language in the bill suggested that doctors and other providers could be forced to tell their patients about unproven allegations against them.\u003c/p>\n\u003cp>Sen. Richard Pan, D-Sacramento, a pediatrician, said he voted against it for that reason. “This is a significant concern, because I do believe that everyone has a right to due process in this country. It’s an issue of principle,” Pan said.\u003c/p>\n\u003cp>McGiffert said the due process argument was based on a misunderstanding. Before an accusation is made, there has to be clear and convincing evidence, and every case then gets full due process before doctors are put on probation, she said.\u003c/p>\n\u003cp>Under current law, clinicians are required to notify hospitals and malpractice insurers when they’re placed on probation. They don’t have to tell patients, but the information is available on the California Medical Board’s \u003ca href=\"https://www.breeze.ca.gov/datamart/loginCADCA.do;jsessionid=1AACA3B0BA91391B2472BEF33B8D086E.vo19\">BreEZe website\u003c/a>.\u003c/p>\n\u003cp>Some supporters of the bill have argued that the medical board website is too difficult for the average person to navigate and creates a barrier for those without internet access.\u003c/p>\n\u003cp>McGiffert said she hopes the bill's sponsor, \u003ca href=\"http://californiahealthline.org/news/is-your-doctor-hiding-something-from-you/\" target=\"_blank\">Sen. Jerry Hill, D – San Mateo,\u003c/a>, will present the bill again. If so, she and other advocates are prepared to speak with Senate members because, “we believe they have been misled in some ways,” she said. “I guarantee you that every single person who voted against [the bill] would want to know if their doctor was on probation.”\u003c/p>\n\u003cp>The Senate Wednesday voted 15-13 for the bill, short of the 21 votes needed to pass it. The Senate then unanimously approved a motion allowing the proposal to be amended and brought up for another vote this week. Hill had planned to seek a new vote on Thursday, but he later decided against it after realizing it still would not garner sufficient support.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Hill could reintroduce the measure in the next legislative session, which begins in early December. But a spokeswoman in his office said she didn’t know if he would.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Depressed Teen's Struggle to Find Mental Health Care in Rural California",
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"content": "\u003cp>There’s a hot pink suitcase on the floor of Shariah Vroman-Nagy’s bedroom. The 18-year-old is packing for a trip to Disneyland, one of several she takes with her family every year.\u003c/p>\n\u003cp>“Let’s see, I need a hairbrush,” she says, moving past the collection of Mickey Mouse ears on her dresser, glancing at the inspirational quotes from Marilyn Monroe on the wall.\u003c/p>\n\u003cp>The lyrics to a song called “\u003cem>Smile\u003c/em>” hang in a frame over her bed.\u003c/p>\n\u003cp>“My mom made me that when I was struggling,” says Vroman-Nagy, “because that’s the song that I would listen to. Michael Jackson did a version of it, which I love.”\u003c/p>\n\u003cp>When she feels her depression creeping in, she sings it to herself.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cem>Smile, though your heart is aching\u003c/em>\u003cbr>\n\u003cem>Smile, even though it’s breaking \u003c/em>\u003cbr>\n\u003cem>If you smile through your tears and sorrow\u003c/em>\u003cbr>\n\u003cem>Smile and maybe tomorrow \u003c/em>\u003cbr>\n\u003cem>You’ll see the sun come shining through, for you. \u003c/em>\u003c/p>\n\u003cp>Three years ago, it was in this room, lined with porcelain dolls and stuffed animals, where Vroman-Nagy tried to kill herself. She was 15, a freshman in high school.\u003c/p>\n\u003cp>“Everything piled up, piled up, piled up until I just couldn’t handle it anymore,” she says. “So I had my anti-depressants and I took a handful of those. But then I thought better of it, and I told my mom. She took me to the emergency room.”\u003c/p>\n\u003cfigure id=\"attachment_191785\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191785\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg\" alt=\"Shariah Vroman-Nagy in her bedroom in Redding, Calif. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy in her bedroom in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There’s no adolescent psychiatric hospital in Redding, the small city in far northern California where Vroman-Nagy lives. So she was taken from the local ER to a hospital in Sacramento, an hour and a half drive to the south. She was there for eight days.\u003c/p>\n\u003cp>The doctors diagnosed her with bipolar disorder. They wanted to keep her longer, but they told her the insurance company wouldn’t cover it.\u003c/p>\n\u003cp>“I didn’t feel like I was ready because I had just been put on new medications,” she says. “In the past I’ve had reactions to medications, and some have not worked. So I wanted to wait and stay for observation a little bit longer.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/266972349\" 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>Vroman-Nagy wasn’t alone with feeling that she was sent home too soon. Since 2010, the state received almost 900 appeals from patients saying their insurer unfairly denied inpatient mental health treatment, according to data from the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V04DLPkrKUl\">Department of Managed Health Care\u003c/a>, the main health insurance regulator in the state. The department overturned 47 percent of those decisions.\u003c/p>\n\u003cp>Insurers are allowed to deny coverage for certain treatments, if they determine that the care is not “medically necessary.” This determination is based on evidence-based clinical standards in both mental and medical care, but it has become a key battleground for mental health advocates.\u003c/p>\n\u003cp>They say insurers are able to \u003ca href=\"https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">deny mental health treatments\u003c/a> more often than other medical treatments, because it’s harder to prove when mental health care is medically necessary.\u003c/p>\n\u003cp>Determining the best treatment for depression, bipolar disorder, or anxiety disorders relies heavily on the subjective report of the patient, so it can be difficult to demonstrate how ill a person is.\u003c/p>\n\u003cp>“There aren’t blood tests in mental health, there aren’t X-rays in mental health,” says Keith Humphreys, Stanford psychiatrist and former White House advisor on mental health policy. “So, it’s easier to deny care for mental health than it is for things we've got physical evidence for.”\u003c/p>\n\u003cp>\u003cstrong>Outside the Hospital, Care Still Difficult to Find\u003c/strong>\u003c/p>\n\u003cp>After Vroman-Nagy went home, the hospital helped her find a therapist to continue the work she had begun on the inpatient unit. But the insurance company, Anthem Blue Cross, said no to that, too. They said the therapist wasn’t part of its network.\u003c/p>\n\u003cp>“We spent quite a long time with the insurance company battling them trying to get them to cover visits,” Vroman-Nagy says.\u003c/p>\n\u003cp>Anthem wanted her to see someone on its list of approved in-network providers, Vroman-Nagy says. At the time, that list was just six people, a common scarcity in \u003ca href=\"http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsacriteria.html\" target=\"_blank\">rural parts\u003c/a> of the country. When Vroman-Nagy started calling them, they either told her their schedules were full or they were retired. So Vroman-Nagy decided to stick with the out-of-network therapist.\u003c/p>\n\u003cfigure id=\"attachment_191782\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191782\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg\" alt=\"Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Her father, Tom Nagy, supported the decision. “Because at that point, I’m mean you’re talking possible life and death issues,” he says. “That was my approach, to pay for it. Run up the charge cards.”\u003c/p>\n\u003cp>He ended up paying thousands of dollars out of pocket. Nagy is a teacher, and his wife is a nurse. They couldn’t afford to keep doing that.\u003c/p>\n\u003cp>By law in California, insurers are required to make special arrangements for patients to see an outside therapist if there are none in the plan, and they have to provide the care at the same copay or coinsurance as an in-network clinician. They can’t charge extra.\u003c/p>\n\u003cp>It’s unclear why Tom Nagy didn’t get that help. He had to fight and fight with the insurance company until he was finally reimbursed.\u003c/p>\n\u003cp>He went through \"two or three denials,\" then filed an appeal with Anthem. That was denied. So he filed a second appeal.\u003c/p>\n\u003cp>“It was literally a year-long process,” he says. \"As a parent, it’s hard enough to deal with these situations and be supportive, but then you get the whole financial thing, it just adds a whole other layer. It’s frustrating.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"X2OS9UvvrWrgYd3y51AcrwAvhclm8opt\"]Psychiatrist Keith Humphreys says it’s rare to see someone keep up a fight with an insurance company as long as Nagy did.\u003c/p>\n\u003cp>“It's the easiest fight in the world to win for an insurer,” Humphreys says.\u003c/p>\n\u003cp>Most people would have given up long before, he says. Take someone with depression who has trouble concentrating or can’t get out of bed.\u003c/p>\n\u003cp>“Now you're demanding that I fill out eight pages of forms?” Humphreys says. “It's canted heavily against the people wanting the services, by the nature of the condition.”\u003c/p>\n\u003cp>In a statement, Anthem Blue Cross said it is “committed to providing access to high quality and affordable health care, including mental healthcare.” It has a variety of resources to help people find the best provider for them, the statement continues, including an online listing of available mental health providers, and customer service staff who can help with a search.\u003c/p>\n\u003cp>The company also launched a new online psychology service earlier this year, called LiveHealth Online Psychology, so patients who live in rural areas where it can sometimes be hard to find a clinician, can “talk face-to-face with a licensed therapist or psychologist through high-definition video on your smartphone, tablet or computer with a webcam.\"\u003c/p>\n\u003cp>\u003cstrong>Looking Toward the Future\u003c/strong>\u003c/p>\n\u003cp>It’s Shariah Vroman-Nagy’s spring break from college, and the preparations for the family trip to Disneyland continue. She says she really needs the vacation.\u003c/p>\n\u003cp>“They call it the happiest place on earth, and I really do feel that it makes me happy when I go,” Vroman-Nagy says. “I’m glad we get to go this week because I have been having a little depression going on.”\u003c/p>\n\u003cp>She and her parents run some errands before they leave town, including a stop at Walmart to stock up on snacks for the nine-hour drive.\u003c/p>\n\u003cp>“I have a question,” Vroman-Nagy says to the cashier. “You used to have Mickey Mouse shaped cheese. Do you not carry it anymore?”\u003c/p>\n\u003cp>Instead, she got \u003cem>Frozen\u003c/em>-themed cheese sticks, with characters from the hit Disney film on the package. The radio in her car is primed with a series of Disney soundtracks, from \u003cem>Tarzan\u003c/em> to \u003cem>Beauty and the Beast\u003c/em>, songs which Vroman-Nagy knows well from her days singing with a show choir in high school.\u003c/p>\n\u003cp>Overall, Vroman-Nagy is doing much better. She works part time at the local In-N-Out Burger, and she’s training to volunteer for a suicide hotline. She’s also studying psychology and music at the local junior college.\u003c/p>\n\u003cp>She plans to become an adolescent therapist one day. But first, she’d like to be a character singer at Disneyland.\u003c/p>\n\u003cp>“I would love to be in their entertainment,” she says, and imagines herself in a princess costume singing and dancing in the park’s stage shows or parades. “That would be my dream.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Have a story about mental health that you think KQED should cover? Email reporter \u003ca href=\"mailto:adembosky@kqed.org\" target=\"_blank\">April Dembosky\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There’s a hot pink suitcase on the floor of Shariah Vroman-Nagy’s bedroom. The 18-year-old is packing for a trip to Disneyland, one of several she takes with her family every year.\u003c/p>\n\u003cp>“Let’s see, I need a hairbrush,” she says, moving past the collection of Mickey Mouse ears on her dresser, glancing at the inspirational quotes from Marilyn Monroe on the wall.\u003c/p>\n\u003cp>The lyrics to a song called “\u003cem>Smile\u003c/em>” hang in a frame over her bed.\u003c/p>\n\u003cp>“My mom made me that when I was struggling,” says Vroman-Nagy, “because that’s the song that I would listen to. Michael Jackson did a version of it, which I love.”\u003c/p>\n\u003cp>When she feels her depression creeping in, she sings it to herself.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Smile, though your heart is aching\u003c/em>\u003cbr>\n\u003cem>Smile, even though it’s breaking \u003c/em>\u003cbr>\n\u003cem>If you smile through your tears and sorrow\u003c/em>\u003cbr>\n\u003cem>Smile and maybe tomorrow \u003c/em>\u003cbr>\n\u003cem>You’ll see the sun come shining through, for you. \u003c/em>\u003c/p>\n\u003cp>Three years ago, it was in this room, lined with porcelain dolls and stuffed animals, where Vroman-Nagy tried to kill herself. She was 15, a freshman in high school.\u003c/p>\n\u003cp>“Everything piled up, piled up, piled up until I just couldn’t handle it anymore,” she says. “So I had my anti-depressants and I took a handful of those. But then I thought better of it, and I told my mom. She took me to the emergency room.”\u003c/p>\n\u003cfigure id=\"attachment_191785\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191785\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg\" alt=\"Shariah Vroman-Nagy in her bedroom in Redding, Calif. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19653_0506_RCLO_Shariah310a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy in her bedroom in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>There’s no adolescent psychiatric hospital in Redding, the small city in far northern California where Vroman-Nagy lives. So she was taken from the local ER to a hospital in Sacramento, an hour and a half drive to the south. She was there for eight days.\u003c/p>\n\u003cp>The doctors diagnosed her with bipolar disorder. They wanted to keep her longer, but they told her the insurance company wouldn’t cover it.\u003c/p>\n\u003cp>“I didn’t feel like I was ready because I had just been put on new medications,” she says. “In the past I’ve had reactions to medications, and some have not worked. So I wanted to wait and stay for observation a little bit longer.”\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/266972349&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/266972349'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Vroman-Nagy wasn’t alone with feeling that she was sent home too soon. Since 2010, the state received almost 900 appeals from patients saying their insurer unfairly denied inpatient mental health treatment, according to data from the \u003ca href=\"http://www.dmhc.ca.gov/fileacomplaint.aspx#.V04DLPkrKUl\">Department of Managed Health Care\u003c/a>, the main health insurance regulator in the state. The department overturned 47 percent of those decisions.\u003c/p>\n\u003cp>Insurers are allowed to deny coverage for certain treatments, if they determine that the care is not “medically necessary.” This determination is based on evidence-based clinical standards in both mental and medical care, but it has become a key battleground for mental health advocates.\u003c/p>\n\u003cp>They say insurers are able to \u003ca href=\"https://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">deny mental health treatments\u003c/a> more often than other medical treatments, because it’s harder to prove when mental health care is medically necessary.\u003c/p>\n\u003cp>Determining the best treatment for depression, bipolar disorder, or anxiety disorders relies heavily on the subjective report of the patient, so it can be difficult to demonstrate how ill a person is.\u003c/p>\n\u003cp>“There aren’t blood tests in mental health, there aren’t X-rays in mental health,” says Keith Humphreys, Stanford psychiatrist and former White House advisor on mental health policy. “So, it’s easier to deny care for mental health than it is for things we've got physical evidence for.”\u003c/p>\n\u003cp>\u003cstrong>Outside the Hospital, Care Still Difficult to Find\u003c/strong>\u003c/p>\n\u003cp>After Vroman-Nagy went home, the hospital helped her find a therapist to continue the work she had begun on the inpatient unit. But the insurance company, Anthem Blue Cross, said no to that, too. They said the therapist wasn’t part of its network.\u003c/p>\n\u003cp>“We spent quite a long time with the insurance company battling them trying to get them to cover visits,” Vroman-Nagy says.\u003c/p>\n\u003cp>Anthem wanted her to see someone on its list of approved in-network providers, Vroman-Nagy says. At the time, that list was just six people, a common scarcity in \u003ca href=\"http://bhpr.hrsa.gov/shortage/hpsas/designationcriteria/mentalhealthhpsacriteria.html\" target=\"_blank\">rural parts\u003c/a> of the country. When Vroman-Nagy started calling them, they either told her their schedules were full or they were retired. So Vroman-Nagy decided to stick with the out-of-network therapist.\u003c/p>\n\u003cfigure id=\"attachment_191782\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-191782\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg\" alt=\"Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19650_0506_RCLO_Shariah141a-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Shariah Vroman-Nagy and her father, Tom Nagy, at their home in Redding, Calif. \u003ccite>(Andreas Fuhrmann/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Her father, Tom Nagy, supported the decision. “Because at that point, I’m mean you’re talking possible life and death issues,” he says. “That was my approach, to pay for it. Run up the charge cards.”\u003c/p>\n\u003cp>He ended up paying thousands of dollars out of pocket. Nagy is a teacher, and his wife is a nurse. They couldn’t afford to keep doing that.\u003c/p>\n\u003cp>By law in California, insurers are required to make special arrangements for patients to see an outside therapist if there are none in the plan, and they have to provide the care at the same copay or coinsurance as an in-network clinician. They can’t charge extra.\u003c/p>\n\u003cp>It’s unclear why Tom Nagy didn’t get that help. He had to fight and fight with the insurance company until he was finally reimbursed.\u003c/p>\n\u003cp>He went through \"two or three denials,\" then filed an appeal with Anthem. That was denied. So he filed a second appeal.\u003c/p>\n\u003cp>“It was literally a year-long process,” he says. \"As a parent, it’s hard enough to deal with these situations and be supportive, but then you get the whole financial thing, it just adds a whole other layer. It’s frustrating.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Psychiatrist Keith Humphreys says it’s rare to see someone keep up a fight with an insurance company as long as Nagy did.\u003c/p>\n\u003cp>“It's the easiest fight in the world to win for an insurer,” Humphreys says.\u003c/p>\n\u003cp>Most people would have given up long before, he says. Take someone with depression who has trouble concentrating or can’t get out of bed.\u003c/p>\n\u003cp>“Now you're demanding that I fill out eight pages of forms?” Humphreys says. “It's canted heavily against the people wanting the services, by the nature of the condition.”\u003c/p>\n\u003cp>In a statement, Anthem Blue Cross said it is “committed to providing access to high quality and affordable health care, including mental healthcare.” It has a variety of resources to help people find the best provider for them, the statement continues, including an online listing of available mental health providers, and customer service staff who can help with a search.\u003c/p>\n\u003cp>The company also launched a new online psychology service earlier this year, called LiveHealth Online Psychology, so patients who live in rural areas where it can sometimes be hard to find a clinician, can “talk face-to-face with a licensed therapist or psychologist through high-definition video on your smartphone, tablet or computer with a webcam.\"\u003c/p>\n\u003cp>\u003cstrong>Looking Toward the Future\u003c/strong>\u003c/p>\n\u003cp>It’s Shariah Vroman-Nagy’s spring break from college, and the preparations for the family trip to Disneyland continue. She says she really needs the vacation.\u003c/p>\n\u003cp>“They call it the happiest place on earth, and I really do feel that it makes me happy when I go,” Vroman-Nagy says. “I’m glad we get to go this week because I have been having a little depression going on.”\u003c/p>\n\u003cp>She and her parents run some errands before they leave town, including a stop at Walmart to stock up on snacks for the nine-hour drive.\u003c/p>\n\u003cp>“I have a question,” Vroman-Nagy says to the cashier. “You used to have Mickey Mouse shaped cheese. Do you not carry it anymore?”\u003c/p>\n\u003cp>Instead, she got \u003cem>Frozen\u003c/em>-themed cheese sticks, with characters from the hit Disney film on the package. The radio in her car is primed with a series of Disney soundtracks, from \u003cem>Tarzan\u003c/em> to \u003cem>Beauty and the Beast\u003c/em>, songs which Vroman-Nagy knows well from her days singing with a show choir in high school.\u003c/p>\n\u003cp>Overall, Vroman-Nagy is doing much better. She works part time at the local In-N-Out Burger, and she’s training to volunteer for a suicide hotline. She’s also studying psychology and music at the local junior college.\u003c/p>\n\u003cp>She plans to become an adolescent therapist one day. But first, she’d like to be a character singer at Disneyland.\u003c/p>\n\u003cp>“I would love to be in their entertainment,” she says, and imagines herself in a princess costume singing and dancing in the park’s stage shows or parades. “That would be my dream.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Have a story about mental health that you think KQED should cover? Email reporter \u003ca href=\"mailto:adembosky@kqed.org\" target=\"_blank\">April Dembosky\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Law Allows Women to Obtain Birth Control Without Prescription, But Few Pharmacies Offer Service",
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"content": "\u003cp>It's been more than 18 months since California's governor signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493\" target=\"_blank\">a law\u003c/a> allowing pharmacists to distribute birth control without a prescription.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They're being cautious. They don't know what demand is going to be, and they're a little hesitant to ramp up.'\u003ccite>Virginia Herold, California Board of Pharmacy. \u003c/cite>\u003c/aside>\n\u003cp>Now, legally, women can simply walk into their local pharmacy and pick up contraceptive pills, the patch or the ring -- much like getting a flu shot or buying over-the-counter medication.\u003c/p>\n\u003cp>But good luck finding a pharmacy that will actually do it.\u003c/p>\n\u003cp>Calls to eight pharmacies around the Bay Area, including both large corporate locations and smaller independent stores, yielded no pharmacies delivering these services. Most pharmacists said they still needed to undergo the state-mandated training and that their stores were in the process of figuring out what the service would look like.\u003c/p>\n\u003cp>There's confusion, too. One person told me that the law hadn’t yet passed; another told me prescription-free birth control was only an option in Oregon, where a similar bill went into effect on Jan. 1.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Pharmacy giants Walgreens and Rite Aid both confirmed that they are not yet providing birth control without a prescription.\u003c/p>\n\u003cp>Jim Graham, a spokesman for Walgreens, which operates 629 pharmacies in California, said the company is “currently assessing” the law’s requirements. \"We plan to test the service in a small number of pharmacies,\" he said.\u003c/p>\n\u003cp>CVS said it is testing the service at a few select locations in the Los Angeles area to determine customer demand.\u003c/p>\n\u003cp>It’s hard to pin down exactly how many -- or few -- pharmacies have implemented the new law, because there is no database of pharmacists trained to distribute birth control without a prescription.\u003c/p>\n\u003cp>\u003ca href=\"https://birthcontrolpharmacist.com/about/\" target=\"_blank\">Sally Rafie\u003c/a>, a professor at the UC San Diego School of Pharmacy, specializes in birth control training and access. She estimates that of the approximately 7,000 pharmacies in California, fewer than 100 are actually distributing non-prescription birth control to customers.\u003c/p>\n\u003cp>Rafie has been involved in training pharmacists to comply with the new law. Under protocol developed by the state Board of Pharmacy, pharmacists first have to be trained to do a short consultation with the customer and select the appropriate birth control option, as well as identify potential health red flags. Online courses are also available. Students in pharmacy programs in California since the law passed receive this training in their classes.\u003c/p>\n\u003cp>At the California Pharmacists Association's annual meeting two weeks ago, Rafie says, 150 people took the birth control training workshop. There are 29,000 registered pharmacists in the state.\u003c/p>\n\u003cp>Big players, like Rite Aid, Walgreens and CVS, have companywide processes that have to be standardized across all the stores, said Lisa Kroon, a professor at UC San Francisco’s school of pharmacy who has been involved in the implementation of the law.\u003c/p>\n\u003cp>\"There's just a lot of hoops that a large corporation has to implement,\" she said. She speaks from experience. The Walgreens where \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/04/california-women-can-soon-skip-the-doctor-to-get-their-birth-control/\" target=\"_blank\">Kroon oversees pharmacy students\u003c/a> on the UCSF campus has yet to implement the law.\u003c/p>\n\u003cp>Kroon says she is \"really pushing\" Walgreens to move the process along.\u003c/p>\n\u003cp>Stumbling blocks include: Who will answer incoming doctors' phone calls while the pharmacist provides the consultation, or where will the consultation happen? Rafie said that in the community pharmacy where she works in San Diego, a private consultation room has to be designed and remodeled.\u003c/p>\n\u003cp>All of this takes time, but there are other factors in play.\u003c/p>\n\u003cp class=\"p1\">Although the law finally went into effect on April 8, the state spent the previous 18 months developing regulations. Those were finalized earlier this year. Pharmacies had all that time to prepare to hit the ground running last month.\u003c/p>\n\u003cp>\"I think that they're being cautious,\" said Virginia Herold, head of the state Board of Pharmacy. \"They don't know what demand is going to be, and they're a little hesitant to ramp up.\"\u003c/p>\n\u003cp>Complying with the law is optional, not mandatory, and there’s no reason for pharmacies to opt in if there isn’t an incentive for them to do so. And right now, there’s actually a financial incentive for them \u003cem>not\u003c/em> to.\u003c/p>\n\u003cp>\"They have the authority to furnish birth control, but it didn't come with the requirement that they get paid for these services,\" said Kroon.\u003c/p>\n\u003cp>If you go to a gynecologist for a regular appointment or consultation, your insurance pays for the service (in addition to paying for the medication itself). But, right now, most insurance providers won't pay your pharmacist for the consultation. Customers would either have to pay out of their own pocket or the pharmacist has to work for free. In Oregon, the state's Medicaid pays $35 for the service. Kroon says there are efforts toward a similar law in California.\u003c/p>\n\u003cp>The bill to allow non-prescription birth control was put forward by Sen. Ed Hernandez, D-West Covina, and sponsored by \u003ca href=\"http://www.cpha.com/\" target=\"_blank\">the California Pharmacists Association\u003c/a> as part of a larger effort to put more primary care in the hands of pharmacists and other non-physician providers.\u003c/p>\n\u003cp>\"Pharmacists are accessible, and they're underutilized,\" said Herold.\u003c/p>\n\u003cp>Concerns have been raised, though, that by allowing women to bypass a visit to their doctor, they're less likely to get screened for cervical cancer or STDs.\u003c/p>\n\u003cp>Studies of women living near the border of Texas and Mexico found that women who obtained their birth control over the counter in Mexican pharmacies are\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22520645\" target=\"_blank\"> less likely to go to the doctor for other preventive care\u003c/a>, compared to women who got contraception at clinics. But women who had to go to the clinic were also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21343757\" target=\"_blank\">more likely to stop using birth control\u003c/a>, in part because of having to schedule a doctor’s visit to get it.\u003c/p>\n\u003cp>The potential for controversy may be part of what has slowed adoption at some pharmacies. And, certainly, said Rafie, it will require different marketing than flu vaccines or other services offered by pharmacists. Once it's clear that women want the service, though, she, Kroon and Herold all believe that pharmacies will eventually get on board.\u003c/p>\n\u003cp>\"By the end of the year, this will be very commonplace in California,\" said Herold.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This post has been updated.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's been more than 18 months since California's governor signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493\" target=\"_blank\">a law\u003c/a> allowing pharmacists to distribute birth control without a prescription.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They're being cautious. They don't know what demand is going to be, and they're a little hesitant to ramp up.'\u003ccite>Virginia Herold, California Board of Pharmacy. \u003c/cite>\u003c/aside>\n\u003cp>Now, legally, women can simply walk into their local pharmacy and pick up contraceptive pills, the patch or the ring -- much like getting a flu shot or buying over-the-counter medication.\u003c/p>\n\u003cp>But good luck finding a pharmacy that will actually do it.\u003c/p>\n\u003cp>Calls to eight pharmacies around the Bay Area, including both large corporate locations and smaller independent stores, yielded no pharmacies delivering these services. Most pharmacists said they still needed to undergo the state-mandated training and that their stores were in the process of figuring out what the service would look like.\u003c/p>\n\u003cp>There's confusion, too. One person told me that the law hadn’t yet passed; another told me prescription-free birth control was only an option in Oregon, where a similar bill went into effect on Jan. 1.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Pharmacy giants Walgreens and Rite Aid both confirmed that they are not yet providing birth control without a prescription.\u003c/p>\n\u003cp>Jim Graham, a spokesman for Walgreens, which operates 629 pharmacies in California, said the company is “currently assessing” the law’s requirements. \"We plan to test the service in a small number of pharmacies,\" he said.\u003c/p>\n\u003cp>CVS said it is testing the service at a few select locations in the Los Angeles area to determine customer demand.\u003c/p>\n\u003cp>It’s hard to pin down exactly how many -- or few -- pharmacies have implemented the new law, because there is no database of pharmacists trained to distribute birth control without a prescription.\u003c/p>\n\u003cp>\u003ca href=\"https://birthcontrolpharmacist.com/about/\" target=\"_blank\">Sally Rafie\u003c/a>, a professor at the UC San Diego School of Pharmacy, specializes in birth control training and access. She estimates that of the approximately 7,000 pharmacies in California, fewer than 100 are actually distributing non-prescription birth control to customers.\u003c/p>\n\u003cp>Rafie has been involved in training pharmacists to comply with the new law. Under protocol developed by the state Board of Pharmacy, pharmacists first have to be trained to do a short consultation with the customer and select the appropriate birth control option, as well as identify potential health red flags. Online courses are also available. Students in pharmacy programs in California since the law passed receive this training in their classes.\u003c/p>\n\u003cp>At the California Pharmacists Association's annual meeting two weeks ago, Rafie says, 150 people took the birth control training workshop. There are 29,000 registered pharmacists in the state.\u003c/p>\n\u003cp>Big players, like Rite Aid, Walgreens and CVS, have companywide processes that have to be standardized across all the stores, said Lisa Kroon, a professor at UC San Francisco’s school of pharmacy who has been involved in the implementation of the law.\u003c/p>\n\u003cp>\"There's just a lot of hoops that a large corporation has to implement,\" she said. She speaks from experience. The Walgreens where \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/04/california-women-can-soon-skip-the-doctor-to-get-their-birth-control/\" target=\"_blank\">Kroon oversees pharmacy students\u003c/a> on the UCSF campus has yet to implement the law.\u003c/p>\n\u003cp>Kroon says she is \"really pushing\" Walgreens to move the process along.\u003c/p>\n\u003cp>Stumbling blocks include: Who will answer incoming doctors' phone calls while the pharmacist provides the consultation, or where will the consultation happen? Rafie said that in the community pharmacy where she works in San Diego, a private consultation room has to be designed and remodeled.\u003c/p>\n\u003cp>All of this takes time, but there are other factors in play.\u003c/p>\n\u003cp class=\"p1\">Although the law finally went into effect on April 8, the state spent the previous 18 months developing regulations. Those were finalized earlier this year. Pharmacies had all that time to prepare to hit the ground running last month.\u003c/p>\n\u003cp>\"I think that they're being cautious,\" said Virginia Herold, head of the state Board of Pharmacy. \"They don't know what demand is going to be, and they're a little hesitant to ramp up.\"\u003c/p>\n\u003cp>Complying with the law is optional, not mandatory, and there’s no reason for pharmacies to opt in if there isn’t an incentive for them to do so. And right now, there’s actually a financial incentive for them \u003cem>not\u003c/em> to.\u003c/p>\n\u003cp>\"They have the authority to furnish birth control, but it didn't come with the requirement that they get paid for these services,\" said Kroon.\u003c/p>\n\u003cp>If you go to a gynecologist for a regular appointment or consultation, your insurance pays for the service (in addition to paying for the medication itself). But, right now, most insurance providers won't pay your pharmacist for the consultation. Customers would either have to pay out of their own pocket or the pharmacist has to work for free. In Oregon, the state's Medicaid pays $35 for the service. Kroon says there are efforts toward a similar law in California.\u003c/p>\n\u003cp>The bill to allow non-prescription birth control was put forward by Sen. Ed Hernandez, D-West Covina, and sponsored by \u003ca href=\"http://www.cpha.com/\" target=\"_blank\">the California Pharmacists Association\u003c/a> as part of a larger effort to put more primary care in the hands of pharmacists and other non-physician providers.\u003c/p>\n\u003cp>\"Pharmacists are accessible, and they're underutilized,\" said Herold.\u003c/p>\n\u003cp>Concerns have been raised, though, that by allowing women to bypass a visit to their doctor, they're less likely to get screened for cervical cancer or STDs.\u003c/p>\n\u003cp>Studies of women living near the border of Texas and Mexico found that women who obtained their birth control over the counter in Mexican pharmacies are\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22520645\" target=\"_blank\"> less likely to go to the doctor for other preventive care\u003c/a>, compared to women who got contraception at clinics. But women who had to go to the clinic were also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21343757\" target=\"_blank\">more likely to stop using birth control\u003c/a>, in part because of having to schedule a doctor’s visit to get it.\u003c/p>\n\u003cp>The potential for controversy may be part of what has slowed adoption at some pharmacies. And, certainly, said Rafie, it will require different marketing than flu vaccines or other services offered by pharmacists. Once it's clear that women want the service, though, she, Kroon and Herold all believe that pharmacies will eventually get on board.\u003c/p>\n\u003cp>\"By the end of the year, this will be very commonplace in California,\" said Herold.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Fresno Aims To Boost Health Through Biking, Walking",
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"content": "\u003cp>Volunteer bike mechanics fix faulty brakes and flat tires under colorful tents at a park in south Fresno. The free bike repair event, organized by the local nonprofit Cultiva la Salud, has attracted dozens of kids and their parents.\u003c/p>\n\u003cp>Joanna Ruiz, 13, awaits her turn while holding her bike, which has rusty chains. She says she would like to bike more, including riding her bike to school. But her parents won't allow it.\u003c/p>\n\u003cp>The 2-mile ride from her home to school is over busy roads with scary intersections and no bike lanes, Ruiz says.\u003c/p>\n\u003cp>\"It's basically too dangerous,\" she says. \"A lot of cars don't even stop when they see us, so it would be too dangerous for us to be just riding in the streets.\" Instead, Joanna's mom drives her and her three siblings to school and most destinations.\u003c/p>\n\u003cp>The family's fears are founded. They live in south Fresno, \u003ca href=\"http://www.fresno.gov/NR/rdonlyres/5DBFAA2D-5352-47D2-84BA-3A9BEDC99351/0/FresnoBMP.pdf\" target=\"_blank\">where the majority \u003c/a>of the city's car collisions with bicyclists and pedestrians take place.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Public health advocates say unsafe streets discourage people from being active, and lack of activity in turn can drive up rates of Type 2 diabetes and obesity. South Fresno is majority Latino and African-American -- people who suffer disproportionately from these conditions.\u003c/p>\n\u003cp>Joanna Ruiz's ZIP code in south Fresno has a higher incidence of diabetes among adults than Fresno as a whole, according to\u003ca href=\"http://www.fresno.gov/NR/rdonlyres/5DBFAA2D-5352-47D2-84BA-3A9BEDC99351/0/FresnoBMP.pdf\" target=\"_blank\"> data \u003c/a>from the UCLA Center for Health Policy Research. Fresno County's death rate from diabetes is one of the highest in California.\u003c/p>\n\u003cp>Officials in Fresno are now aiming to boost public health and safety for bicyclists and pedestrians by creating more transportation options that do not involve driving.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/264731777\" 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>\u003cstrong>Fresno Earns 'Bike-Friendly Community' Award \u003c/strong>\u003c/p>\n\u003cp>Fresno has already moved to become more bike-friendly, according to the League of American Bicyclists. The league cited Fresno's bike-friendly laws and public education outreach in awarding it a \"\u003ca href=\"http://www.bikeleague.org/sites/default/files/bfareportcards/BFC_Fall_2015_ReportCard_Fresno_CA.pdf\" target=\"_blank\">bronze designation\u003c/a>.\"\u003c/p>\n\u003cp>The city is pushing ahead with a transportation plan that includes more biking and pedestrian options. Fresno city officials are collecting public comment, with the\u003ca href=\"http://www.fresno.gov/NR/rdonlyres/4A9F5C32-4306-4BB4-9B55-12E10193FA45/34446/FresnoATPWorkshops05180519.pdf\" target=\"_blank\"> first two workshops open to the public\u003c/a> scheduled for tonight and Thursday. Residents can also suggest where the city should make streets safer for bicyclists and pedestrians through an online \u003ca href=\"http://gis.fehrandpeers.com/FresnoATPSurvey/\" target=\"_blank\">mapping\u003c/a> tool.\u003c/p>\n\u003cp>\u003cstrong>Infrastructure Lacking in Fresno's Older Neighborhoods\u003c/strong>\u003c/p>\n\u003cp>Since 2010, Fresno has dramatically extended its bike lane network by more than a third, to about 155 miles, say city officials.\u003c/p>\n\u003cp>Most of those improvements have been focused in the wealthier and newer neighborhoods in the city's north, says Genoveva Islas, who directs Cultiva la Salud. The health nonprofit organizes free bike repair events and group rides with Latin American cumbia music to promote exercise and prevent chronic illnesses among local Latino families.\u003c/p>\n\u003cp>\"Unfortunately, when you come south where there are census tracts of lower-income residents, that’s where you really begin to see a deficit in both bicycle and pedestrian infrastructure,\" says Islas, who was born in Fresno. \"So the protective factors that north Fresno has are clearly not available for residents who are living in south Fresno.\"\u003c/p>\n\u003cp>Islas says unsafe streets discourage residents from opting to be more physically active in their daily routines, while going to the store or work. That in turn hurts obesity and diabetes prevention efforts.\u003c/p>\n\u003cp>\"We understand that in order for our communities to bike more, they need the infrastructure that keeps them safe and doesn't put their lives or their children's lives at risk,\" says Islas.\u003c/p>\n\u003cfigure id=\"attachment_185736\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-185736 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19526_IMG_9891-qut.jpg\" alt=\"Genoveva Islas prepares to begin a group bike ride in Fresno. Islas directs Cultiva la Salud, a local non-profit pushing to create 'healthier environments' in Fresno and other parts of the San Joaquin Valley as a way to prevent chronic illnesses.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Genoveva Islas prepares to begin a group bike ride in Fresno. Islas directs Cultiva la Salud, a local nonprofit pushing to create 'healthier environments' as a way to prevent chronic illnesses in Fresno and other parts of the Central Valley. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>'New Idea' for City Planning\u003c/strong>\u003c/p>\n\u003cp>City officials say newer housing developments have paid fees toward building biking and pedestrian facilities in the north. By contrast, many of the city's older neighborhoods were built several decades ago when city planning prioritized car travel, says Randy Bell, who manages infrastructure projects for the city of Fresno.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Fifty years ago, city planning had a different idea of how to develop the city,\" says Bell, so the focus was on cars. \"\u003c/span>Today we have a new idea to get people more active, and to not use their cars as much.\"\u003c/p>\n\u003cp>Bell says the city wants public input to help prioritize projects.\u003c/p>\n\u003cp>\u003cstrong>Central Valley Cities Adding Bike Lanes, Sidewalks\u003c/strong>\u003c/p>\n\u003cp>Caltrans' \u003ca href=\"http://www.dot.ca.gov/hq/LocalPrograms/atp/\" target=\"_blank\">Active Transportation Program\u003c/a> is the biggest source of funding for localities statewide, with a pool of $120 million available annually, and is funding projects in Fresno, Bakersfield and Modesto.\u003c/p>\n\u003cp>Public health issues in particular are a rallying cry among community-based groups and city officials alike for Central Valley cities to become more bikable, says Jeanie Ward-Waller, policy director for the California Bicycle Coalition.\u003c/p>\n\u003cp>She says many in the Central Valley want to have more opportunities for physical activity built into their communities.\u003c/p>\n\u003cp>\"They definitely have high demand for more bikable and walkable places to live,\" she says.\u003c/p>\n\u003cp>North of Fresno on Highway 99, Modesto added 4 miles of additional bike lanes last December.\u003c/p>\n\u003cp>\"E\u003cspan style=\"font-weight: 400\">very time we do a road project now,\" says Michael Sacuskie, Modesto's \u003cspan style=\"font-weight: 400\">bicycle program coordinator, we \"\u003c/span>incorporate bike lanes when possible.\" Sacuskie is a life=long Modesto resident who regularly bikes 3 miles to work. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_185738\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-185738 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut.jpg\" alt=\"Bikers use new lanes opened last year in the Modesto Junior College area. The city paid $1.5 million in local funds to complete the project.\" width=\"1920\" height=\"1627\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-400x339.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-800x678.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-768x651.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-1440x1220.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-1180x1000.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-960x814.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Bikers use lanes opened last year in the Modesto Junior College area. The city paid $1.5 million in local funds to complete 4 miles of bike lane additions. \u003ccite>(Courtesy of Michael Sacuskie, city of Modesto)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Bakersfield is about to break ground on 20 miles of bike lanes, additional sidewalks close to schools in a disadvantaged neighborhood and more bicycle parking and wheelchair ramps, said Christopher Gerry, an analyst in the city manager's office.\u003c/p>\n\u003cp>Back at the Fresno bike repair event, Magdalena Barrios, Joanna Ruiz's mother, says she is planning to weigh in at one of the meetings with Fresno officials this week.\u003c/p>\n\u003cp>\"The city could help us with more bike lanes and street lights so that people can be out and about freely without being worried,\" says Barrios, 32. \"We also need parks.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Residents in south Fresno have complained for years about a lack of parks and other open space recreational areas in their neighborhoods. On parkland area, Fresno ranks close to the bottom when compared to 18 cities of similar size nationwide, according to a recent Trust for Public Lands \u003ca href=\"https://www.tpl.org/sites/default/files/files_upload/2015-City-Park-Facts-Report.pdf\">report\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Volunteer bike mechanics fix faulty brakes and flat tires under colorful tents at a park in south Fresno. The free bike repair event, organized by the local nonprofit Cultiva la Salud, has attracted dozens of kids and their parents.\u003c/p>\n\u003cp>Joanna Ruiz, 13, awaits her turn while holding her bike, which has rusty chains. She says she would like to bike more, including riding her bike to school. But her parents won't allow it.\u003c/p>\n\u003cp>The 2-mile ride from her home to school is over busy roads with scary intersections and no bike lanes, Ruiz says.\u003c/p>\n\u003cp>\"It's basically too dangerous,\" she says. \"A lot of cars don't even stop when they see us, so it would be too dangerous for us to be just riding in the streets.\" Instead, Joanna's mom drives her and her three siblings to school and most destinations.\u003c/p>\n\u003cp>The family's fears are founded. They live in south Fresno, \u003ca href=\"http://www.fresno.gov/NR/rdonlyres/5DBFAA2D-5352-47D2-84BA-3A9BEDC99351/0/FresnoBMP.pdf\" target=\"_blank\">where the majority \u003c/a>of the city's car collisions with bicyclists and pedestrians take place.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Public health advocates say unsafe streets discourage people from being active, and lack of activity in turn can drive up rates of Type 2 diabetes and obesity. South Fresno is majority Latino and African-American -- people who suffer disproportionately from these conditions.\u003c/p>\n\u003cp>Joanna Ruiz's ZIP code in south Fresno has a higher incidence of diabetes among adults than Fresno as a whole, according to\u003ca href=\"http://www.fresno.gov/NR/rdonlyres/5DBFAA2D-5352-47D2-84BA-3A9BEDC99351/0/FresnoBMP.pdf\" target=\"_blank\"> data \u003c/a>from the UCLA Center for Health Policy Research. Fresno County's death rate from diabetes is one of the highest in California.\u003c/p>\n\u003cp>Officials in Fresno are now aiming to boost public health and safety for bicyclists and pedestrians by creating more transportation options that do not involve driving.\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/264731777&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/264731777'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Fresno Earns 'Bike-Friendly Community' Award \u003c/strong>\u003c/p>\n\u003cp>Fresno has already moved to become more bike-friendly, according to the League of American Bicyclists. The league cited Fresno's bike-friendly laws and public education outreach in awarding it a \"\u003ca href=\"http://www.bikeleague.org/sites/default/files/bfareportcards/BFC_Fall_2015_ReportCard_Fresno_CA.pdf\" target=\"_blank\">bronze designation\u003c/a>.\"\u003c/p>\n\u003cp>The city is pushing ahead with a transportation plan that includes more biking and pedestrian options. Fresno city officials are collecting public comment, with the\u003ca href=\"http://www.fresno.gov/NR/rdonlyres/4A9F5C32-4306-4BB4-9B55-12E10193FA45/34446/FresnoATPWorkshops05180519.pdf\" target=\"_blank\"> first two workshops open to the public\u003c/a> scheduled for tonight and Thursday. Residents can also suggest where the city should make streets safer for bicyclists and pedestrians through an online \u003ca href=\"http://gis.fehrandpeers.com/FresnoATPSurvey/\" target=\"_blank\">mapping\u003c/a> tool.\u003c/p>\n\u003cp>\u003cstrong>Infrastructure Lacking in Fresno's Older Neighborhoods\u003c/strong>\u003c/p>\n\u003cp>Since 2010, Fresno has dramatically extended its bike lane network by more than a third, to about 155 miles, say city officials.\u003c/p>\n\u003cp>Most of those improvements have been focused in the wealthier and newer neighborhoods in the city's north, says Genoveva Islas, who directs Cultiva la Salud. The health nonprofit organizes free bike repair events and group rides with Latin American cumbia music to promote exercise and prevent chronic illnesses among local Latino families.\u003c/p>\n\u003cp>\"Unfortunately, when you come south where there are census tracts of lower-income residents, that’s where you really begin to see a deficit in both bicycle and pedestrian infrastructure,\" says Islas, who was born in Fresno. \"So the protective factors that north Fresno has are clearly not available for residents who are living in south Fresno.\"\u003c/p>\n\u003cp>Islas says unsafe streets discourage residents from opting to be more physically active in their daily routines, while going to the store or work. That in turn hurts obesity and diabetes prevention efforts.\u003c/p>\n\u003cp>\"We understand that in order for our communities to bike more, they need the infrastructure that keeps them safe and doesn't put their lives or their children's lives at risk,\" says Islas.\u003c/p>\n\u003cfigure id=\"attachment_185736\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-185736 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19526_IMG_9891-qut.jpg\" alt=\"Genoveva Islas prepares to begin a group bike ride in Fresno. Islas directs Cultiva la Salud, a local non-profit pushing to create 'healthier environments' in Fresno and other parts of the San Joaquin Valley as a way to prevent chronic illnesses.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19526_IMG_9891-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Genoveva Islas prepares to begin a group bike ride in Fresno. Islas directs Cultiva la Salud, a local nonprofit pushing to create 'healthier environments' as a way to prevent chronic illnesses in Fresno and other parts of the Central Valley. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>'New Idea' for City Planning\u003c/strong>\u003c/p>\n\u003cp>City officials say newer housing developments have paid fees toward building biking and pedestrian facilities in the north. By contrast, many of the city's older neighborhoods were built several decades ago when city planning prioritized car travel, says Randy Bell, who manages infrastructure projects for the city of Fresno.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Fifty years ago, city planning had a different idea of how to develop the city,\" says Bell, so the focus was on cars. \"\u003c/span>Today we have a new idea to get people more active, and to not use their cars as much.\"\u003c/p>\n\u003cp>Bell says the city wants public input to help prioritize projects.\u003c/p>\n\u003cp>\u003cstrong>Central Valley Cities Adding Bike Lanes, Sidewalks\u003c/strong>\u003c/p>\n\u003cp>Caltrans' \u003ca href=\"http://www.dot.ca.gov/hq/LocalPrograms/atp/\" target=\"_blank\">Active Transportation Program\u003c/a> is the biggest source of funding for localities statewide, with a pool of $120 million available annually, and is funding projects in Fresno, Bakersfield and Modesto.\u003c/p>\n\u003cp>Public health issues in particular are a rallying cry among community-based groups and city officials alike for Central Valley cities to become more bikable, says Jeanie Ward-Waller, policy director for the California Bicycle Coalition.\u003c/p>\n\u003cp>She says many in the Central Valley want to have more opportunities for physical activity built into their communities.\u003c/p>\n\u003cp>\"They definitely have high demand for more bikable and walkable places to live,\" she says.\u003c/p>\n\u003cp>North of Fresno on Highway 99, Modesto added 4 miles of additional bike lanes last December.\u003c/p>\n\u003cp>\"E\u003cspan style=\"font-weight: 400\">very time we do a road project now,\" says Michael Sacuskie, Modesto's \u003cspan style=\"font-weight: 400\">bicycle program coordinator, we \"\u003c/span>incorporate bike lanes when possible.\" Sacuskie is a life=long Modesto resident who regularly bikes 3 miles to work. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_185738\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-185738 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut.jpg\" alt=\"Bikers use new lanes opened last year in the Modesto Junior College area. The city paid $1.5 million in local funds to complete the project.\" width=\"1920\" height=\"1627\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-400x339.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-800x678.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-768x651.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-1440x1220.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-1180x1000.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/RS19528_Modesto-Junior-College-M.-Sacuskie-qut-960x814.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Bikers use lanes opened last year in the Modesto Junior College area. The city paid $1.5 million in local funds to complete 4 miles of bike lane additions. \u003ccite>(Courtesy of Michael Sacuskie, city of Modesto)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Bakersfield is about to break ground on 20 miles of bike lanes, additional sidewalks close to schools in a disadvantaged neighborhood and more bicycle parking and wheelchair ramps, said Christopher Gerry, an analyst in the city manager's office.\u003c/p>\n\u003cp>Back at the Fresno bike repair event, Magdalena Barrios, Joanna Ruiz's mother, says she is planning to weigh in at one of the meetings with Fresno officials this week.\u003c/p>\n\u003cp>\"The city could help us with more bike lanes and street lights so that people can be out and about freely without being worried,\" says Barrios, 32. \"We also need parks.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Residents in south Fresno have complained for years about a lack of parks and other open space recreational areas in their neighborhoods. On parkland area, Fresno ranks close to the bottom when compared to 18 cities of similar size nationwide, according to a recent Trust for Public Lands \u003ca href=\"https://www.tpl.org/sites/default/files/files_upload/2015-City-Park-Facts-Report.pdf\">report\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Genetically manipulated food remains generally safe for humans and the environment, a high-powered science advisory board declared in a report Tuesday.\u003c/p>\n\u003cp>The National Academies of Science, Engineering and Medicine concluded that tinkering with the genetics of what we eat doesn't produce the \"Frankenfood\" monster some opponents claim — but it isn't feeding the world with substantially increased yields, as proponents promised.\u003c/p>\n\u003cp>With the line between engineered and natural foods blurring thanks to newer techniques such as gene editing, the 408-page report said, regulators need to make their safety focus more on the end-product of the food that's made rather than the nuts and bolts of how it's made.\u003c/p>\n\u003cp>The report waltzed a bit around the hot political issue of whether genetically modified food should be labeled. The study's authors said labels aren't needed for food safety reasons but potentially could be justified because of transparency, social and cultural factors, somewhat similar to made-in-America stickers. That stance was praised by some environmental and consumer groups, but criticized by some scientists as unnecessary because the food poses no unique risks.\u003c/p>\n\u003cp>There's no evidence of environmental problems caused by genetically modified crops, but pesticide resistance is a problem, the report said. Farms that use genetically modified crops in general are helped, but it may be a different story for smaller farmers and in poorer areas of the world, it said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Most of the modified plants are soybean, cotton, corn and canola; in most cases, genetic tinkering has made them resistant to certain herbicides and insects. When farms switched from conventional crops to the engineered varieties, there was no substantial change in the yield compared to non-engineered food. Production in general is increasing in agriculture, but U.S. Department of Agriculture data don't show that genetically engineered crops are increasing at a higher rate, despite experimental results suggest that they should, the report said.\u003c/p>\n\u003cp>\"Farmers in general are gaining,\" with less pesticide use and a bit higher yield, academy committee chairman Fred Gould said at a Tuesday news conference.\u003c/p>\n\u003cp>The nuanced report first said it is important not to make sweeping statements on genetically engineered foods, which it called GE. Still, \"the committee concluded that no differences have been found that implicate a higher risk to human health safety from these GE foods than from their non-GE counterparts.\"\u003c/p>\n\u003cp>The National Academy, established by President Abraham Lincoln to provide scientific advice, has issued reports before saying it could find no safety problem with eating genetically modified food. But the academy committee chairman Fred Gould of North Carolina State University said this report is different because his study team started by listening to critics of such foods and examined anew more than 1,000 studies.\u003c/p>\n\u003cp>\"To some extent we know more about some genetically engineered food than we do about other food,\" committee member Dominique Brossard of the University of Wisconsin said. \"There are limits to what can be known about any food. That's something we're not used to hearing as consumers.\"\u003c/p>\n\u003cp>Many scientists who work on the issue but weren't part of the study team lauded the report as sensible, but not surprising.\u003c/p>\n\u003cp>Mark Sorrells at Cornell called it \"very well balanced, accurate, and reiterates much of what has already been published many times.\"\u003c/p>\n\u003cp>\"Science is science, facts are facts,\" emailed Bruce Chassy, an emeritus professor of biochemistry and food science at the University of Illinois. \"There's just no sound basis for their opposition just as there was never any scientific basis to believe GM plants should be viewed any differently than any other,\"\u003c/p>\n\u003cp>One dissenter was Charles Benbrook, who used to be at Washington State University but is now a private consultant. He said he feels the risks of genetically engineered food are more serious than more mainstream scientists do, and that the human health assessments aren't ample enough.\u003c/p>\n\u003cp>Some groups critical of genetically engineering foods criticized the report before it came out. Food & Water Watch criticized the National Academy as taking funding from biotechnology firms and using \"pro-GMO scientists\" to write its reports. The report was funded by the Burroughs Wellcome Fund, the Gordon and Betty Moore Foundation, the New Venture Fund, the U.S. Department of Agriculture and the academy itself — none of which have direct connections to the agricultural biotechnology industry. It was peer reviewed by outside experts and committee members are vetted for financial conflicts of interests, said academy spokesman William Kearney.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Unlike many scientists, Marion Nestle of New York University, who was a reviewer but not author of the report, said \"the report reveals how little is known about the effects of GE foods.\" She said if the people behind the report wanted to end the polarization over these foods, \"this won't do the trick.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Genetically manipulated food remains generally safe for humans and the environment, a high-powered science advisory board declared in a report Tuesday.\u003c/p>\n\u003cp>The National Academies of Science, Engineering and Medicine concluded that tinkering with the genetics of what we eat doesn't produce the \"Frankenfood\" monster some opponents claim — but it isn't feeding the world with substantially increased yields, as proponents promised.\u003c/p>\n\u003cp>With the line between engineered and natural foods blurring thanks to newer techniques such as gene editing, the 408-page report said, regulators need to make their safety focus more on the end-product of the food that's made rather than the nuts and bolts of how it's made.\u003c/p>\n\u003cp>The report waltzed a bit around the hot political issue of whether genetically modified food should be labeled. The study's authors said labels aren't needed for food safety reasons but potentially could be justified because of transparency, social and cultural factors, somewhat similar to made-in-America stickers. That stance was praised by some environmental and consumer groups, but criticized by some scientists as unnecessary because the food poses no unique risks.\u003c/p>\n\u003cp>There's no evidence of environmental problems caused by genetically modified crops, but pesticide resistance is a problem, the report said. Farms that use genetically modified crops in general are helped, but it may be a different story for smaller farmers and in poorer areas of the world, it said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Most of the modified plants are soybean, cotton, corn and canola; in most cases, genetic tinkering has made them resistant to certain herbicides and insects. When farms switched from conventional crops to the engineered varieties, there was no substantial change in the yield compared to non-engineered food. Production in general is increasing in agriculture, but U.S. Department of Agriculture data don't show that genetically engineered crops are increasing at a higher rate, despite experimental results suggest that they should, the report said.\u003c/p>\n\u003cp>\"Farmers in general are gaining,\" with less pesticide use and a bit higher yield, academy committee chairman Fred Gould said at a Tuesday news conference.\u003c/p>\n\u003cp>The nuanced report first said it is important not to make sweeping statements on genetically engineered foods, which it called GE. Still, \"the committee concluded that no differences have been found that implicate a higher risk to human health safety from these GE foods than from their non-GE counterparts.\"\u003c/p>\n\u003cp>The National Academy, established by President Abraham Lincoln to provide scientific advice, has issued reports before saying it could find no safety problem with eating genetically modified food. But the academy committee chairman Fred Gould of North Carolina State University said this report is different because his study team started by listening to critics of such foods and examined anew more than 1,000 studies.\u003c/p>\n\u003cp>\"To some extent we know more about some genetically engineered food than we do about other food,\" committee member Dominique Brossard of the University of Wisconsin said. \"There are limits to what can be known about any food. That's something we're not used to hearing as consumers.\"\u003c/p>\n\u003cp>Many scientists who work on the issue but weren't part of the study team lauded the report as sensible, but not surprising.\u003c/p>\n\u003cp>Mark Sorrells at Cornell called it \"very well balanced, accurate, and reiterates much of what has already been published many times.\"\u003c/p>\n\u003cp>\"Science is science, facts are facts,\" emailed Bruce Chassy, an emeritus professor of biochemistry and food science at the University of Illinois. \"There's just no sound basis for their opposition just as there was never any scientific basis to believe GM plants should be viewed any differently than any other,\"\u003c/p>\n\u003cp>One dissenter was Charles Benbrook, who used to be at Washington State University but is now a private consultant. He said he feels the risks of genetically engineered food are more serious than more mainstream scientists do, and that the human health assessments aren't ample enough.\u003c/p>\n\u003cp>Some groups critical of genetically engineering foods criticized the report before it came out. Food & Water Watch criticized the National Academy as taking funding from biotechnology firms and using \"pro-GMO scientists\" to write its reports. The report was funded by the Burroughs Wellcome Fund, the Gordon and Betty Moore Foundation, the New Venture Fund, the U.S. Department of Agriculture and the academy itself — none of which have direct connections to the agricultural biotechnology industry. It was peer reviewed by outside experts and committee members are vetted for financial conflicts of interests, said academy spokesman William Kearney.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Unlike many scientists, Marion Nestle of New York University, who was a reviewer but not author of the report, said \"the report reveals how little is known about the effects of GE foods.\" She said if the people behind the report wanted to end the polarization over these foods, \"this won't do the trick.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Supreme Court Sends Back Birth Control Case and Both Sides Claim Victory",
"title": "Supreme Court Sends Back Birth Control Case and Both Sides Claim Victory",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>When it comes to the issue of religious rights versus no-cost contraception, the only thing the Supreme Court could agree on was not to decide the case.\u003c/p>\n\u003cp>In an \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/14-1418_8758.pdf\" target=\"_blank\">unsigned opinion\u003c/a> issued Monday, the court sent a series of cases back to a raft of federal appeals courts, with instructions for those courts and the parties in the lawsuits to try harder to work things out. “The Court expresses no view on the merits of the cases,” the opinion said.\u003c/p>\n\u003cp>At issue is the extent to which religiously affiliated employers (such as universities or hospitals) need to participate in the requirement under the Affordable Care Act for most employer health plans to\u003ca href=\"http://khn.org/news/supreme-court-takes-up-birth-control-access-again/\" target=\"_blank\"> provide no-cost contraception for women.\u003c/a>\u003c/p>\n\u003cp>The government made \u003ca href=\"http://www.hhs.gov/about/news/2014/08/22/administration-takes-steps-to-ensure-womens-continued-access-to-contraception-coverage.html\" target=\"_blank\">several changes to the rules\u003c/a> over the past four years in an attempt to accommodate the religious employers’ objections while still ensuring that female employees would get contraceptive coverage. But \u003ca href=\"http://www.becketfund.org/hhsinformationcentral/\" target=\"_blank\">dozens of religious nonprofit employers sued anyway\u003c/a>, claiming that even the act of notifying the government of their objections (which would, in turn, trigger a requirement for the government to arrange coverage) made them “complicit” in providing a service they see as sinful.\u003c/p>\n\u003cp>The court’s opinion, and an \u003ca href=\"http://www.supremecourt.gov/orders/courtorders/051616zor1_g31h.pdf\" target=\"_blank\">accompanying order\u003c/a> on several similar cases that were awaiting a decision on whether the high court would take them up, erased all the lower appeals court rulings, all but one of which had sided with the government. That appeared at first glance to put at risk coverage for contraceptives for tens of thousands of employees of the organizations that filed suit.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>However, the court made clear in its opinion that because the employers who have sued have already in effect notified the government of their objections, the government can rely “on this notice, to the extent it considers it necessary, to facilitate the provision of full contraceptive coverage going forward.”\u003c/p>\n\u003cp>At the same time, however, the opinion said the government “may not impose taxes or penalties on petitioners for failure to provide the relevant notice.”\u003c/p>\n\u003cp>The goal, the justices wrote, is that both sides “should be afforded an opportunity to arrive at an approach going forward that accommodates petitions’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans ‘receive full and equal health coverage, including contraceptive coverage.’ ”\u003c/p>\n\u003cp>Both sides in the dispute claimed at least a partial victory.\u003c/p>\n\u003cp>“From our point of view this is a win for religious liberty,” said Mark Rienzi, a senior counsel for the Becket Fund for Religious Liberty, which is representing the Little Sisters of the Poor, one of the groups that sued the government. “The government can find ways to give out contraception without hassling nuns.”\u003c/p>\n\u003cp>But at the same time, said Louise Melling, deputy legal director of the Americans Civil Liberties Union, “the opinion states clearly the need for women to receive full and equal coverage.”\u003c/p>\n\u003cp>Contraceptive advocates also pointed to a concurring opinion from Justices Sonia Sotomayor and Ruth Bader Ginsburg that stressed that the decision should not be read as approving coverage strategies that make it harder for women to get the benefits.\u003c/p>\n\u003cp>For example, they wrote, “Requiring standalone contraceptive-only coverage would leave in limbo all of the women now guaranteed seamless preventive-care coverage under the Affordable Care Act. And requiring that women affirmatively opt into such coverage would ‘impose precisely the kind of barrier to the delivery of preventive services that Congress sought to eliminate.’ ”\u003c/p>\n\u003cp>It remains unclear exactly what the lower courts might do. In an effort to break what was clearly a 4-4 deadlock, the court in March asked each side for \u003ca href=\"http://khn.org/news/supreme-court-asks-for-more-information-in-birth-control-case/\" target=\"_blank\">supplemental material\u003c/a> outlining any potential compromises. The decision Monday referred to those new briefs as suggesting that providing contraceptive coverage without requiring notice from religious employers “is feasible.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But Sotomayor and Ginsburg, in their concurring opinion, noted that “the Courts of Appeals remain free to reach the same conclusion or a different one on each of the questions presented by these cases.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When it comes to the issue of religious rights versus no-cost contraception, the only thing the Supreme Court could agree on was not to decide the case.\u003c/p>\n\u003cp>In an \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/14-1418_8758.pdf\" target=\"_blank\">unsigned opinion\u003c/a> issued Monday, the court sent a series of cases back to a raft of federal appeals courts, with instructions for those courts and the parties in the lawsuits to try harder to work things out. “The Court expresses no view on the merits of the cases,” the opinion said.\u003c/p>\n\u003cp>At issue is the extent to which religiously affiliated employers (such as universities or hospitals) need to participate in the requirement under the Affordable Care Act for most employer health plans to\u003ca href=\"http://khn.org/news/supreme-court-takes-up-birth-control-access-again/\" target=\"_blank\"> provide no-cost contraception for women.\u003c/a>\u003c/p>\n\u003cp>The government made \u003ca href=\"http://www.hhs.gov/about/news/2014/08/22/administration-takes-steps-to-ensure-womens-continued-access-to-contraception-coverage.html\" target=\"_blank\">several changes to the rules\u003c/a> over the past four years in an attempt to accommodate the religious employers’ objections while still ensuring that female employees would get contraceptive coverage. But \u003ca href=\"http://www.becketfund.org/hhsinformationcentral/\" target=\"_blank\">dozens of religious nonprofit employers sued anyway\u003c/a>, claiming that even the act of notifying the government of their objections (which would, in turn, trigger a requirement for the government to arrange coverage) made them “complicit” in providing a service they see as sinful.\u003c/p>\n\u003cp>The court’s opinion, and an \u003ca href=\"http://www.supremecourt.gov/orders/courtorders/051616zor1_g31h.pdf\" target=\"_blank\">accompanying order\u003c/a> on several similar cases that were awaiting a decision on whether the high court would take them up, erased all the lower appeals court rulings, all but one of which had sided with the government. That appeared at first glance to put at risk coverage for contraceptives for tens of thousands of employees of the organizations that filed suit.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>However, the court made clear in its opinion that because the employers who have sued have already in effect notified the government of their objections, the government can rely “on this notice, to the extent it considers it necessary, to facilitate the provision of full contraceptive coverage going forward.”\u003c/p>\n\u003cp>At the same time, however, the opinion said the government “may not impose taxes or penalties on petitioners for failure to provide the relevant notice.”\u003c/p>\n\u003cp>The goal, the justices wrote, is that both sides “should be afforded an opportunity to arrive at an approach going forward that accommodates petitions’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans ‘receive full and equal health coverage, including contraceptive coverage.’ ”\u003c/p>\n\u003cp>Both sides in the dispute claimed at least a partial victory.\u003c/p>\n\u003cp>“From our point of view this is a win for religious liberty,” said Mark Rienzi, a senior counsel for the Becket Fund for Religious Liberty, which is representing the Little Sisters of the Poor, one of the groups that sued the government. “The government can find ways to give out contraception without hassling nuns.”\u003c/p>\n\u003cp>But at the same time, said Louise Melling, deputy legal director of the Americans Civil Liberties Union, “the opinion states clearly the need for women to receive full and equal coverage.”\u003c/p>\n\u003cp>Contraceptive advocates also pointed to a concurring opinion from Justices Sonia Sotomayor and Ruth Bader Ginsburg that stressed that the decision should not be read as approving coverage strategies that make it harder for women to get the benefits.\u003c/p>\n\u003cp>For example, they wrote, “Requiring standalone contraceptive-only coverage would leave in limbo all of the women now guaranteed seamless preventive-care coverage under the Affordable Care Act. And requiring that women affirmatively opt into such coverage would ‘impose precisely the kind of barrier to the delivery of preventive services that Congress sought to eliminate.’ ”\u003c/p>\n\u003cp>It remains unclear exactly what the lower courts might do. In an effort to break what was clearly a 4-4 deadlock, the court in March asked each side for \u003ca href=\"http://khn.org/news/supreme-court-asks-for-more-information-in-birth-control-case/\" target=\"_blank\">supplemental material\u003c/a> outlining any potential compromises. The decision Monday referred to those new briefs as suggesting that providing contraceptive coverage without requiring notice from religious employers “is feasible.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But Sotomayor and Ginsburg, in their concurring opinion, noted that “the Courts of Appeals remain free to reach the same conclusion or a different one on each of the questions presented by these cases.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Move to Triple California's Tobacco Tax Appears Headed to Ballot",
"title": "Move to Triple California's Tobacco Tax Appears Headed to Ballot",
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"content": "\u003cp>A well-financed campaign backed by billionaire environmentalist Tom Steyer, medical groups and organized labor said Monday that it collected more than 1 million signatures for a\u003ca href=\"https://www.oag.ca.gov/system/files/initiatives/pdfs/15-0081%20%28Tobacco%20Tax%20V3%29.pdf?\" target=\"_blank\"> ballot measure \u003c/a>to raise California's cigarette tax by $2 a pack.\u003c/p>\n\u003cp>Steyer and other leaders of the\u003ca href=\"http://www.savelivesca.com\" target=\"_blank\"> Save Lives California\u003c/a> coalition delivered boxes of petitions to the San Diego County of Registrar of Voters office and will do the same at county offices throughout the state in coming days in its bid to raise the tax to $2.87 a pack.\u003c/p>\n\u003cp>If 585,407 signatures are verified, the proposed state constitutional amendment would appear on an increasingly crowded Nov. 8 ballot alongside proposals to overturn a ban on single-use plastic bags at grocery stores and require actors to use condoms in adult films.\u003c/p>\n\u003cp>[contextly_sidebar id=\"CuC4lH6wKAyCJFkz7BkqwDDC4N5r71Ls\"]The announcement came less than a month after Democratic Gov. Jerry Brown \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/04/gov-brown-signs-major-tobacco-bills-raises-legal-age-to-21/\" target=\"_blank\">signed legislation\u003c/a> to make California the second state in the nation, following Hawaii, to raise the legal age to buy tobacco from 18 to 21. Beginning June 9, it will be a crime to sell or give tobacco to anyone under 21 — except military personnel.\u003c/p>\n\u003cp>The tax increase would apply to electronic cigarettes and other products with tobacco or nicotine. The measure calls for proceeds to be spent on Medi-Cal — the state's version of Medicaid — along with anti-smoking campaigns and medical research.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Steyer, a former hedge fund manager who has contributed $1 million, said at a news conference that the campaign is personal because his mother had a three-pack-a-day habit and died of lung cancer 14 years ago.\u003c/p>\n\u003cp>\"I think everybody in California has a family member, a close friend, whose lives have been tragically affected by tobacco ... This is going to make smokers pay their fair share,\" he said.\u003c/p>\n\u003cp>The increase would make California's cigarette tax the ninth-highest in the nation, according to the Campaign for Tobacco-Free Kids, an advocacy group. (Right now, \u003ca href=\"https://www.tobaccofreekids.org/research/factsheets/pdf/0097.pdf\" target=\"_blank\">California ranks 36th\u003c/a>.)New York has the nation's highest state tax at $4.35 a pack, and Virginia is lowest at 30 cents.\u003c/p>\n\u003cp>The weighted average cost for pack of cigarettes is $5.96 nationwide. The highest combined state-local tax rate is $6.16 in Chicago, with New York City second at $5.85 per pack.\u003c/p>\n\u003cp>The average per-pack cost in California, which prohibits local cigarette taxes, is about $5.50, said Debra Kelley, advocacy director of the American Lung Association. The $2-a-pack increase would raise that to about $7.50 if cigarette makers pass along the full amount to consumers.\u003c/p>\n\u003cp>David Sutton, a spokesman for tobacco company Altria Group Inc., said it opposes large targeted tobacco and e-vapor taxes. Altria is reviewing the California initiative and considering its options, he said.\u003c/p>\n\u003cp>The American Vaping Association said it would work to defeat the measure but was undecided how much it would spend.\u003c/p>\n\u003cp>\"Public health benefits every time a smoker switches to vaping,\" said George Conley, the group's president. \"By recklessly campaigning to equate the taxes on deadly cigarettes with smoke-free vapor products, it is clearer than ever that so called 'anti-smoking' activists have officially gone off the rails.\"\u003c/p>\n\u003cp>Backers of the tax increase contend that vaping lures young people to smoking tobacco.\u003c/p>\n\u003cp>The tobacco tax campaign reported this month that it spent $2.8 million during the first three months of the year and had more than $4 million in cash on hand. Major backers include the California Medical Association, California Association of Hospitals and Health Systems, and the Service Employees International Union.\u003c/p>\n\u003cp>Seven measures have collected enough signatures to qualify for the November ballot in the state, and an eighth — placed by the Legislature — would repeal prohibitions on multilingual instruction in public schools.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The tobacco tax joins four other measures, including a proposal to legalize recreational use of marijuana, that are pending signature verification.\u003c/p>\n\n",
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"excerpt": "Currently, the tobacco tax is 87 cents a pack. The proposed measure would add $2 more to the tax, making California the 9th highest in the U.S.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A well-financed campaign backed by billionaire environmentalist Tom Steyer, medical groups and organized labor said Monday that it collected more than 1 million signatures for a\u003ca href=\"https://www.oag.ca.gov/system/files/initiatives/pdfs/15-0081%20%28Tobacco%20Tax%20V3%29.pdf?\" target=\"_blank\"> ballot measure \u003c/a>to raise California's cigarette tax by $2 a pack.\u003c/p>\n\u003cp>Steyer and other leaders of the\u003ca href=\"http://www.savelivesca.com\" target=\"_blank\"> Save Lives California\u003c/a> coalition delivered boxes of petitions to the San Diego County of Registrar of Voters office and will do the same at county offices throughout the state in coming days in its bid to raise the tax to $2.87 a pack.\u003c/p>\n\u003cp>If 585,407 signatures are verified, the proposed state constitutional amendment would appear on an increasingly crowded Nov. 8 ballot alongside proposals to overturn a ban on single-use plastic bags at grocery stores and require actors to use condoms in adult films.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The announcement came less than a month after Democratic Gov. Jerry Brown \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/05/04/gov-brown-signs-major-tobacco-bills-raises-legal-age-to-21/\" target=\"_blank\">signed legislation\u003c/a> to make California the second state in the nation, following Hawaii, to raise the legal age to buy tobacco from 18 to 21. Beginning June 9, it will be a crime to sell or give tobacco to anyone under 21 — except military personnel.\u003c/p>\n\u003cp>The tax increase would apply to electronic cigarettes and other products with tobacco or nicotine. The measure calls for proceeds to be spent on Medi-Cal — the state's version of Medicaid — along with anti-smoking campaigns and medical research.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Steyer, a former hedge fund manager who has contributed $1 million, said at a news conference that the campaign is personal because his mother had a three-pack-a-day habit and died of lung cancer 14 years ago.\u003c/p>\n\u003cp>\"I think everybody in California has a family member, a close friend, whose lives have been tragically affected by tobacco ... This is going to make smokers pay their fair share,\" he said.\u003c/p>\n\u003cp>The increase would make California's cigarette tax the ninth-highest in the nation, according to the Campaign for Tobacco-Free Kids, an advocacy group. (Right now, \u003ca href=\"https://www.tobaccofreekids.org/research/factsheets/pdf/0097.pdf\" target=\"_blank\">California ranks 36th\u003c/a>.)New York has the nation's highest state tax at $4.35 a pack, and Virginia is lowest at 30 cents.\u003c/p>\n\u003cp>The weighted average cost for pack of cigarettes is $5.96 nationwide. The highest combined state-local tax rate is $6.16 in Chicago, with New York City second at $5.85 per pack.\u003c/p>\n\u003cp>The average per-pack cost in California, which prohibits local cigarette taxes, is about $5.50, said Debra Kelley, advocacy director of the American Lung Association. The $2-a-pack increase would raise that to about $7.50 if cigarette makers pass along the full amount to consumers.\u003c/p>\n\u003cp>David Sutton, a spokesman for tobacco company Altria Group Inc., said it opposes large targeted tobacco and e-vapor taxes. Altria is reviewing the California initiative and considering its options, he said.\u003c/p>\n\u003cp>The American Vaping Association said it would work to defeat the measure but was undecided how much it would spend.\u003c/p>\n\u003cp>\"Public health benefits every time a smoker switches to vaping,\" said George Conley, the group's president. \"By recklessly campaigning to equate the taxes on deadly cigarettes with smoke-free vapor products, it is clearer than ever that so called 'anti-smoking' activists have officially gone off the rails.\"\u003c/p>\n\u003cp>Backers of the tax increase contend that vaping lures young people to smoking tobacco.\u003c/p>\n\u003cp>The tobacco tax campaign reported this month that it spent $2.8 million during the first three months of the year and had more than $4 million in cash on hand. Major backers include the California Medical Association, California Association of Hospitals and Health Systems, and the Service Employees International Union.\u003c/p>\n\u003cp>Seven measures have collected enough signatures to qualify for the November ballot in the state, and an eighth — placed by the Legislature — would repeal prohibitions on multilingual instruction in public schools.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The tobacco tax joins four other measures, including a proposal to legalize recreational use of marijuana, that are pending signature verification.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Pilots And ACLU Sue Airline Over Breast Milk Pumping At Work",
"title": "Pilots And ACLU Sue Airline Over Breast Milk Pumping At Work",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Brandy Beck considers herself lucky. As a breast-feeding mom, the Frontier Airlines pilot has experienced severe breast pain, engorged breasts, clogged ducts, decreased milk supply, three interruptions while pumping at work, and pumping in airport and airplane bathrooms.\u003c/p>\n\u003cp>But unlike some of her colleagues, she escaped mastitis. Mastitis is a bacterial infection of the breast that can occur with clogged milk ducts if women cannot fully express their breast milk. And not receiving adequate, legally required accommodations for pumping breast milk at work is precisely why Beck and fellow Frontier pilots Randi Freyer, \u003ca href=\"https://www.aclu.org/blog/speak-freely/airline-pilots-should-not-have-choose-between-their-jobs-and-breastfeeding-their\">Shannon Kiedrowski\u003c/a> and Erin Zielinski are involved in a complaint against Frontier Airlines.\u003c/p>\n\u003cp>\"All four of us love our jobs, we love flying for Frontier and we love flying airplanes,\" Beck says. \"Most of us have wanted to do it all our lives, and we just want some equality in the workplace.\"\u003c/p>\n\u003cp>The American Civil Liberties Union, the ACLU of Colorado and the law firm Holwell Shuster & Goldberg LLP filed discrimination charges May 10 with the Equal Employment Opportunity Commission on the women's behalf. The charges claim that Frontier is discriminating against women by not providing sufficient accommodations for pregnant and breastfeeding employees.\u003c/p>\n\u003cp>\"This has been a long process of trying to struggle to get these accommodations with no success,\" says Galen Sherwin, a senior staff attorney with the ACLU in the women's right project. \"This lawsuit is the necessary last resort.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>According to Sherwin, the ACLU and the law firm sent Frontier management a letter describing the women's difficulties and several possible solutions, including temporary non-flying assignments that would allow easier accommodations, extension of maternity leave if the women wanted it and designated places where the women could pump in airports Frontier uses and on the plane when necessary.\u003c/p>\n\u003cp>For its part, the airline says that it already provides places that comply with federal and Colorado state requirements in all airports it uses, according to Cindi Ruff, vice president of human resources at Frontier. Women can contact the station manager of each airport to find the location, she says.\u003c/p>\n\u003cp>\"If they do [have those stations], they have not communicated that to the women I've spoken with, including women beyond these four pilots, despite repeated requests,\" Sherwin says. \"If it's up to the individual woman to contact each individual airport on her own, that would not be a sufficient accommodation. It's tantamount to providing no support to the women.\"\u003c/p>\n\u003cp>Beck says the stations she does know of are often a half mile from Frontier gates and are sometimes insufficient, such as the one at Denver airport that was being used for storage when she needed it. As directed by an assistant pilot, she used a vacated office — and movers attempted to enter while she was pumping.\u003c/p>\n\u003cp>Any temporary reassignments are governed by the \u003ca href=\"http://www.airlinepilotcentral.com/files/frontiercontract2007.pdf\">collective bargaining agreement\u003c/a> of the pilots' union, Ruff told Shots. That \u003ca href=\"http://www.airlinepilotcentral.com/files/frontiercontract2007.pdf\">contract\u003c/a> only addresses non-flying reassignments for on-the-job injuries and states that pilots who cannot return to work after four months may be entitled to receive an unpaid medical leave of absence. Maternity leave also is unpaid.\u003c/p>\n\u003cp>\"We assume that Frontier is in compliance with the Americans with Disabilities Act, which requires employers to provide reasonable accommodations, and temporary reassignment is one potential accommodation that Frontier that would be legally obligated to provide,\" Sherwin said. \"If they're offering that to people with disabilities, then they should be offering that to women.\"\u003c/p>\n\u003cp>Sherwin added that medical leave has only been granted for serious childbirth complications leading to physical injury or postpartum depression, and that breast-feeding women who requested it were denied.\u003c/p>\n\u003cp>Shannon Kiedrowski, one of the pilots involved in the suit, \u003ca href=\"https://www.aclu.org/blog/speak-freely/airline-pilots-should-not-have-choose-between-their-jobs-and-breastfeeding-their\">writes\u003c/a> that she \"battled for months to get Frontier's management to help future new moms.\" But, she says, \"my efforts went nowhere.\"\u003c/p>\n\u003cp>Frontier's Ruff says that the airline has worked with pilots who have raised concerns and adjusted their schedules to have less flying time.\u003c/p>\n\u003cp>But less flying time doesn't address the needs for accommodations during flying time, Sherwin says. Beck says she plans her flight days carefully to schedule in pumping time, but unexpected and sometimes long flight delays can interfere, necessitating pumping during a flight.\u003c/p>\n\u003cp>\"This situation is unique, but ultimately it's all about the safety of our passengers,\" Ruff says. \"Being on an aircraft and being a pilot is a very unique situation, unlike any other profession, and unfortunately there are sometimes limitations in what can be extended to an individual.\"\u003c/p>\n\u003cp>The challenges for pilots are similar to those for surgeons operating, where the patient's safety is paramount, says \u003ca href=\"http://sph.umn.edu/faculty1/name/katy-kozhimannil/\">Katy Kozhimannil\u003c/a>, an associate professor of health policy and management at the University of Minnesota School of Public Health.\u003c/p>\n\u003cp>\"It is a unique circumstance, but there are other circumstances where businesses face similar challenges in managing the trade-off between the safety of the patients or passengers and the urgent health needs of their employees,\" Kozhimannil says. \"If there are barriers, that's certainly understandable, and maybe there's a need for greater support for employers. But there have to be ways to try to address the needs of nursing mothers. It's extraordinarily important, and it's the law.\"\u003c/p>\n\u003cp>Pilots needing bathroom breaks leave the cockpit to do so, and the copilot must don an oxygen mask while the pilot is gone, Ruff says.\u003c/p>\n\u003cp>\"The request is that women be permitted to take breaks during flights as needed on the same terms that pilots are able to address their other bodily needs,\" Sherwin says. \"To say to a woman who's breast-feeding that you can't leave the cockpit to take care of her bodily needs but to allow everyone else to leave to use the bathroom is sex discrimination.\"\u003c/p>\n\u003cp>It can also have health consequences, Kozhimannil says. Her \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S1049386715001176\">research\u003c/a> has \u003ca href=\"http://www.forbes.com/sites/tarahaelle/2015/10/20/less-than-half-of-breastfeeding-mothers-have-legally-required-pumping-accommodations-at-work/#147d43073785\">found that only 40 percent\u003c/a> of full-time or part-time employed women surveyed in 2011 and 2012 have been provided both break time and private space to express breast milk, as required by the Affordable Care Act. Those women were also twice as likely to be exclusively breast-feeding at 6 months and more likely to breast-feed at all with each passing month.\u003c/p>\n\u003cp>\"That's unsurprising, given the physiology of breast-feeding, because women need to express breast milk during the day when they're away from their child for their bodies to keep producing breast milk,\" Kozhimannil says. \"When you stop expressing breast milk, your supply diminishes and you're no longer able to breast-feed.\" Clogged ducts and mastitis are other risks of not adequately expressing breast milk.\u003c/p>\n\u003cp>One possible solution more broadly would be state or federal laws requiring paid family leave, enabling the pilots to take a longer unpaid leave without losing as much income. Pilots are already required to start unpaid maternity leave 8 weeks before their due date and have the option of four more unpaid months after delivery.\u003c/p>\n\u003cp>\"I believe it's unrealistic to ask a working mom to come back after four months and be away from her child for four to five days,\" Beck says, adding that the problem is industry wide for pilots and flight attendants. \"Some people can afford that, and some people can't. The most ideal solution is to have choices, because every individual needs something different.\"\u003c/p>\n\u003cp>The U.S. is the only country in the world besides Papua New Guinea that does not require employers to provide any paid family leave, says Ellen Bravo, executive director of \u003ca href=\"http://familyvaluesatwork.org/\">Family Values @ Work\u003c/a>, a network of coalitions working for paid leave policies.\u003c/p>\n\u003cp>\"We tell women to be good mothers and then we punish them for doing so by making their family suffer financial insecurity or by shaming them for doing something like breast-feeding,\" Bravo says. \"That's got to change. It's a scandal that nearly one in four women go back to work within two weeks.\"\u003c/p>\n\u003cp>The only states currently requiring paid family leave are California, New Jersey, Rhode Island and, as of April 1, New York.\u003c/p>\n\u003cp>The lawsuit does not request money, Sherwin says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"They would like ideally to have Frontier adopt these solutions so no other women would have to go through what they went through,\" Sherwin says. \"It's 2016. It shouldn't be that women have to choose between their jobs and breast-feeding their babies, and that's why our clients are bringing the case.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Pilots+And+ACLU+Sue+Airline+Over+Breast+Milk+Pumping+At+Work&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Brandy Beck considers herself lucky. As a breast-feeding mom, the Frontier Airlines pilot has experienced severe breast pain, engorged breasts, clogged ducts, decreased milk supply, three interruptions while pumping at work, and pumping in airport and airplane bathrooms.\u003c/p>\n\u003cp>But unlike some of her colleagues, she escaped mastitis. Mastitis is a bacterial infection of the breast that can occur with clogged milk ducts if women cannot fully express their breast milk. And not receiving adequate, legally required accommodations for pumping breast milk at work is precisely why Beck and fellow Frontier pilots Randi Freyer, \u003ca href=\"https://www.aclu.org/blog/speak-freely/airline-pilots-should-not-have-choose-between-their-jobs-and-breastfeeding-their\">Shannon Kiedrowski\u003c/a> and Erin Zielinski are involved in a complaint against Frontier Airlines.\u003c/p>\n\u003cp>\"All four of us love our jobs, we love flying for Frontier and we love flying airplanes,\" Beck says. \"Most of us have wanted to do it all our lives, and we just want some equality in the workplace.\"\u003c/p>\n\u003cp>The American Civil Liberties Union, the ACLU of Colorado and the law firm Holwell Shuster & Goldberg LLP filed discrimination charges May 10 with the Equal Employment Opportunity Commission on the women's behalf. The charges claim that Frontier is discriminating against women by not providing sufficient accommodations for pregnant and breastfeeding employees.\u003c/p>\n\u003cp>\"This has been a long process of trying to struggle to get these accommodations with no success,\" says Galen Sherwin, a senior staff attorney with the ACLU in the women's right project. \"This lawsuit is the necessary last resort.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>According to Sherwin, the ACLU and the law firm sent Frontier management a letter describing the women's difficulties and several possible solutions, including temporary non-flying assignments that would allow easier accommodations, extension of maternity leave if the women wanted it and designated places where the women could pump in airports Frontier uses and on the plane when necessary.\u003c/p>\n\u003cp>For its part, the airline says that it already provides places that comply with federal and Colorado state requirements in all airports it uses, according to Cindi Ruff, vice president of human resources at Frontier. Women can contact the station manager of each airport to find the location, she says.\u003c/p>\n\u003cp>\"If they do [have those stations], they have not communicated that to the women I've spoken with, including women beyond these four pilots, despite repeated requests,\" Sherwin says. \"If it's up to the individual woman to contact each individual airport on her own, that would not be a sufficient accommodation. It's tantamount to providing no support to the women.\"\u003c/p>\n\u003cp>Beck says the stations she does know of are often a half mile from Frontier gates and are sometimes insufficient, such as the one at Denver airport that was being used for storage when she needed it. As directed by an assistant pilot, she used a vacated office — and movers attempted to enter while she was pumping.\u003c/p>\n\u003cp>Any temporary reassignments are governed by the \u003ca href=\"http://www.airlinepilotcentral.com/files/frontiercontract2007.pdf\">collective bargaining agreement\u003c/a> of the pilots' union, Ruff told Shots. That \u003ca href=\"http://www.airlinepilotcentral.com/files/frontiercontract2007.pdf\">contract\u003c/a> only addresses non-flying reassignments for on-the-job injuries and states that pilots who cannot return to work after four months may be entitled to receive an unpaid medical leave of absence. Maternity leave also is unpaid.\u003c/p>\n\u003cp>\"We assume that Frontier is in compliance with the Americans with Disabilities Act, which requires employers to provide reasonable accommodations, and temporary reassignment is one potential accommodation that Frontier that would be legally obligated to provide,\" Sherwin said. \"If they're offering that to people with disabilities, then they should be offering that to women.\"\u003c/p>\n\u003cp>Sherwin added that medical leave has only been granted for serious childbirth complications leading to physical injury or postpartum depression, and that breast-feeding women who requested it were denied.\u003c/p>\n\u003cp>Shannon Kiedrowski, one of the pilots involved in the suit, \u003ca href=\"https://www.aclu.org/blog/speak-freely/airline-pilots-should-not-have-choose-between-their-jobs-and-breastfeeding-their\">writes\u003c/a> that she \"battled for months to get Frontier's management to help future new moms.\" But, she says, \"my efforts went nowhere.\"\u003c/p>\n\u003cp>Frontier's Ruff says that the airline has worked with pilots who have raised concerns and adjusted their schedules to have less flying time.\u003c/p>\n\u003cp>But less flying time doesn't address the needs for accommodations during flying time, Sherwin says. Beck says she plans her flight days carefully to schedule in pumping time, but unexpected and sometimes long flight delays can interfere, necessitating pumping during a flight.\u003c/p>\n\u003cp>\"This situation is unique, but ultimately it's all about the safety of our passengers,\" Ruff says. \"Being on an aircraft and being a pilot is a very unique situation, unlike any other profession, and unfortunately there are sometimes limitations in what can be extended to an individual.\"\u003c/p>\n\u003cp>The challenges for pilots are similar to those for surgeons operating, where the patient's safety is paramount, says \u003ca href=\"http://sph.umn.edu/faculty1/name/katy-kozhimannil/\">Katy Kozhimannil\u003c/a>, an associate professor of health policy and management at the University of Minnesota School of Public Health.\u003c/p>\n\u003cp>\"It is a unique circumstance, but there are other circumstances where businesses face similar challenges in managing the trade-off between the safety of the patients or passengers and the urgent health needs of their employees,\" Kozhimannil says. \"If there are barriers, that's certainly understandable, and maybe there's a need for greater support for employers. But there have to be ways to try to address the needs of nursing mothers. It's extraordinarily important, and it's the law.\"\u003c/p>\n\u003cp>Pilots needing bathroom breaks leave the cockpit to do so, and the copilot must don an oxygen mask while the pilot is gone, Ruff says.\u003c/p>\n\u003cp>\"The request is that women be permitted to take breaks during flights as needed on the same terms that pilots are able to address their other bodily needs,\" Sherwin says. \"To say to a woman who's breast-feeding that you can't leave the cockpit to take care of her bodily needs but to allow everyone else to leave to use the bathroom is sex discrimination.\"\u003c/p>\n\u003cp>It can also have health consequences, Kozhimannil says. Her \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S1049386715001176\">research\u003c/a> has \u003ca href=\"http://www.forbes.com/sites/tarahaelle/2015/10/20/less-than-half-of-breastfeeding-mothers-have-legally-required-pumping-accommodations-at-work/#147d43073785\">found that only 40 percent\u003c/a> of full-time or part-time employed women surveyed in 2011 and 2012 have been provided both break time and private space to express breast milk, as required by the Affordable Care Act. Those women were also twice as likely to be exclusively breast-feeding at 6 months and more likely to breast-feed at all with each passing month.\u003c/p>\n\u003cp>\"That's unsurprising, given the physiology of breast-feeding, because women need to express breast milk during the day when they're away from their child for their bodies to keep producing breast milk,\" Kozhimannil says. \"When you stop expressing breast milk, your supply diminishes and you're no longer able to breast-feed.\" Clogged ducts and mastitis are other risks of not adequately expressing breast milk.\u003c/p>\n\u003cp>One possible solution more broadly would be state or federal laws requiring paid family leave, enabling the pilots to take a longer unpaid leave without losing as much income. Pilots are already required to start unpaid maternity leave 8 weeks before their due date and have the option of four more unpaid months after delivery.\u003c/p>\n\u003cp>\"I believe it's unrealistic to ask a working mom to come back after four months and be away from her child for four to five days,\" Beck says, adding that the problem is industry wide for pilots and flight attendants. \"Some people can afford that, and some people can't. The most ideal solution is to have choices, because every individual needs something different.\"\u003c/p>\n\u003cp>The U.S. is the only country in the world besides Papua New Guinea that does not require employers to provide any paid family leave, says Ellen Bravo, executive director of \u003ca href=\"http://familyvaluesatwork.org/\">Family Values @ Work\u003c/a>, a network of coalitions working for paid leave policies.\u003c/p>\n\u003cp>\"We tell women to be good mothers and then we punish them for doing so by making their family suffer financial insecurity or by shaming them for doing something like breast-feeding,\" Bravo says. \"That's got to change. It's a scandal that nearly one in four women go back to work within two weeks.\"\u003c/p>\n\u003cp>The only states currently requiring paid family leave are California, New Jersey, Rhode Island and, as of April 1, New York.\u003c/p>\n\u003cp>The lawsuit does not request money, Sherwin says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"They would like ideally to have Frontier adopt these solutions so no other women would have to go through what they went through,\" Sherwin says. \"It's 2016. It shouldn't be that women have to choose between their jobs and breast-feeding their babies, and that's why our clients are bringing the case.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Pilots+And+ACLU+Sue+Airline+Over+Breast+Milk+Pumping+At+Work&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Teresa Lopez is a single mother of three. Two of her kids are undocumented.\u003c/p>\n\u003cp>She says within her own family, there’s inequality when it comes to health care.\u003c/p>\n\u003cp>“It’s very difficult to find help for my kids who weren’t born here,” she says in Spanish. “I feel bad that one of them has good benefits and the others don’t.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"eZYFaTAYe3DNzEiruyuujW3GRB3mylY4\"]But that will change on Monday, when 170,000 undocumented children in California become eligible for comprehensive health care through the state’s Medi-Cal program for people who are low income.\u003c/p>\n\u003cp>Then, all of Lopez’ kids will have the same access to routine doctor visits, dental, and mental health care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some parents have been reluctant to sign up their kids, for fear of exposing other adult family members to risk of deportation, or of compromising future efforts to obtain legal status.\u003c/p>\n\u003cp>Lawmakers are touring the state through the weekend, stopping in Los Angeles, Fresno, and Orange County to dispel those fears. They’re reassuring families that no information used to enroll children in coverage will be shared with immigration officials. And they’re touting the benefits of coverage.\u003c/p>\n\u003cp>They say children who have health insurance \u003ca href=\"http://kff.org/report-section/the-impact-of-the-childrens-health-insurance-program-chip-issue-brief/\" target=\"_blank\">do better in school\u003c/a>, are more likely to get a high school diploma, and are less likely to become entwined in the criminal justice system.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/263963780\" 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>Sen. Ricardo Lara, D-Long Beach, the author of the bill that expanded full Medi-Cal coverage to undocumented children, said kids will no longer have to forgo care for a broken arm or hospitalization because their parents can’t pay for it.\u003c/p>\n\u003cp>“Children shouldn’t be worrying about how their parents are going to afford their health care,” he said Thursday at the Mission Neighborhood Health Center, a community clinic in San Francisco. “Children should be focused on their education.”\u003c/p>\n\u003cp>The expanded Medi-Cal program will cost the state $40 million this year and $132 million each year after that.\u003c/p>\n\u003cp>[contextly_sidebar id=\"CVDfpcHl6Kir3c9SbM58GhGyS9oG1LmJ\"]Critics say the program is too expensive and will allow families who are here illegally to set down deeper roots.\u003c/p>\n\u003cp>Sen. Lara said the program will be a test for that. He wants to demonstrate that offering health insurance to kids will have overall benefits for the economy, so that he can make a case for extending health insurance to undocumented adults, too.\u003c/p>\n\u003cp>He is sponsoring two bills this year. One of them, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">SB 10\u003c/a>, would allow undocumented adults to buy unsubsidized health plans through the state exchange, Covered California. Another,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1418\" target=\"_blank\"> SB 1418\u003c/a>, would extend Medi-Cal benefits to income-eligible adults, regardless of immigration status.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We’re going to be able to take care of our abuelitos and abuelitas, our aunts and uncles, who have sacrificed their entire lives in this country and in this state to make it a better place, ensuring they also have some sort of care,” Lara said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Teresa Lopez is a single mother of three. Two of her kids are undocumented.\u003c/p>\n\u003cp>She says within her own family, there’s inequality when it comes to health care.\u003c/p>\n\u003cp>“It’s very difficult to find help for my kids who weren’t born here,” she says in Spanish. “I feel bad that one of them has good benefits and the others don’t.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But that will change on Monday, when 170,000 undocumented children in California become eligible for comprehensive health care through the state’s Medi-Cal program for people who are low income.\u003c/p>\n\u003cp>Then, all of Lopez’ kids will have the same access to routine doctor visits, dental, and mental health care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some parents have been reluctant to sign up their kids, for fear of exposing other adult family members to risk of deportation, or of compromising future efforts to obtain legal status.\u003c/p>\n\u003cp>Lawmakers are touring the state through the weekend, stopping in Los Angeles, Fresno, and Orange County to dispel those fears. They’re reassuring families that no information used to enroll children in coverage will be shared with immigration officials. And they’re touting the benefits of coverage.\u003c/p>\n\u003cp>They say children who have health insurance \u003ca href=\"http://kff.org/report-section/the-impact-of-the-childrens-health-insurance-program-chip-issue-brief/\" target=\"_blank\">do better in school\u003c/a>, are more likely to get a high school diploma, and are less likely to become entwined in the criminal justice system.\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/263963780&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/263963780'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Sen. Ricardo Lara, D-Long Beach, the author of the bill that expanded full Medi-Cal coverage to undocumented children, said kids will no longer have to forgo care for a broken arm or hospitalization because their parents can’t pay for it.\u003c/p>\n\u003cp>“Children shouldn’t be worrying about how their parents are going to afford their health care,” he said Thursday at the Mission Neighborhood Health Center, a community clinic in San Francisco. “Children should be focused on their education.”\u003c/p>\n\u003cp>The expanded Medi-Cal program will cost the state $40 million this year and $132 million each year after that.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Critics say the program is too expensive and will allow families who are here illegally to set down deeper roots.\u003c/p>\n\u003cp>Sen. Lara said the program will be a test for that. He wants to demonstrate that offering health insurance to kids will have overall benefits for the economy, so that he can make a case for extending health insurance to undocumented adults, too.\u003c/p>\n\u003cp>He is sponsoring two bills this year. One of them, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">SB 10\u003c/a>, would allow undocumented adults to buy unsubsidized health plans through the state exchange, Covered California. Another,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160SB1418\" target=\"_blank\"> SB 1418\u003c/a>, would extend Medi-Cal benefits to income-eligible adults, regardless of immigration status.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We’re going to be able to take care of our abuelitos and abuelitas, our aunts and uncles, who have sacrificed their entire lives in this country and in this state to make it a better place, ensuring they also have some sort of care,” Lara said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"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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