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"content": "\u003cp>The Food and Drug Administration \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm478031.htm\" target=\"_blank\">announced Monday \u003c/a>that it is easing the ban on blood donations from men who have sex with men.\u003c/p>\n\u003cp>The ban had been in place for more than 30 years, since the early days of the AIDS epidemic when little was known about AIDS or how it spread. But advocates had long argued that the policy was antiquated.\u003c/p>\n\u003cp>The new policy has been \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/12/23/fda-proposes-lifting-lifetime-ban-on-gay-blood-donors/\" target=\"_blank\">under review \u003c/a>for the last year and was issued today as a \"\u003ca href=\"http://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/UCM446580.pdf\" target=\"_blank\">final guidance\u003c/a>\" by the FDA. Under the revision, men who have sex with men may donate blood -- but only if they have not had sex with another man for the last year or more.\u003c/p>\n\u003cp>The policy matches that of many other countries, including the United Kingdom, Australia and Japan.\u003c/p>\n\u003cp>In \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm478031.htm\" target=\"_blank\">a statement, \u003c/a>acting FDA Commissioner Dr. Stephen Ostroff said that the FDA's responsibility was to maintain a high level of safety in the nation's blood supply. “We have taken great care to ensure this policy revision is backed by sound science and continues to protect our blood supply.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But gay rights activists say the change doesn't go far enough.\u003c/p>\n\u003cp>\"It continues to stigmatize gay and bisexual men,\" David Stacy, of the Human Rights Campaign, \u003ca href=\"http://abcnews.go.com/Health/wireStory/fda-eases-restrictions-blood-donations-gay-men-35888660\" target=\"_blank\">told ABC News\u003c/a>. \"It simply cannot be justified in light of current scientific research and updated blood screening technology.\"\u003c/p>\n\u003cp>The National Gay Blood Drive said the change \"was a huge first step in the right direction,\" but also \u003ca href=\"http://www.gayblooddrive.com/#!updates/c1vwd\" target=\"_blank\">called on the FDA \u003c/a>to move toward a non-discriminatory policy and end discrimination based on sexual orientation.\u003c/p>\n\u003cp>Under the recommendations approved today, the FDA says the following donors should not be permitted to donate blood \"indefinitely\":\u003c/p>\n\u003cul>\n\u003cli>An individual who has ever had a positive test for HIV.\u003c/li>\n\u003cli>An individual who has ever exchanged sex for money or drugs.\u003c/li>\n\u003cli>An individual who has ever engaged in injection drug use that was not prescribed.\u003c/li>\n\u003c/ul>\n\u003cp>And these people should be deferred:\u003c/p>\n\u003cul>\n\u003cli>Defer for 12 months from the most recent contact any individual who has a history of sex with a person who: has ever had a positive test for HIV, ever exchanged sex for money or drugs, or ever engaged in non-prescription injection drug use.\u003c/li>\n\u003cli>Defer for 12 months from the most recent transfusion any individual who has a history of receiving a transfusion of Whole Blood or blood components donated by another person (allogeneic transfusion).\u003c/li>\n\u003cli>Defer for 12 months from the most recent exposure any individual who has a history of through-the-skin contact with the blood of another individual, such as a needle stick or blood contact with an open wound or mucous membrane.\u003c/li>\n\u003cli>Defer for 12 months from the most recent tattoo, ear or body piercing. However, individuals who have undergone tattooing within 12 months of donation are eligible to donate if the tattoo was applied by a state regulated entity with sterile needles and non-reused ink. Individuals who have undergone ear or body piercing within 12 months of donation are eligible to donate if the piercing was done using single-use equipment.\u003c/li>\n\u003cli>Defer for 12 months after completion of treatment any individual with a history of syphilis or gonorrhea or with a history of diagnosis or treatment for syphilis or gonorrhea in the past 12 months.\u003c/li>\n\u003cli>Defer for 12 months from the most recent contact a man who has had sex with another man during the past 12 months.\u003c/li>\n\u003cli>Defer for 12 months from the most recent contact a female who has had sex during the past 12 months with a man who has had sex with another man in the past 12 months.\u003c/li>\n\u003c/ul>\n\u003cp>The policy also addressed transgender donors, saying \"male or female gender should be self-identified and self-reported.\"\u003c/p>\n\u003cp>This does little to clarify \"a policy that some blood banks have interpreted as a ban on all transgender donors,\" \u003ca href=\"http://www.buzzfeed.com/dominicholden/new-fda-policy-relaxes-ban-on-gay-men-donating-blood#.djy8W0PPV\" target=\"_blank\">reports BuzzFeed News and continued\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>One national blood donation company — facing two discrimination lawsuits from transgender women who were allegedly turned away — has \u003ca href=\"http://www.buzzfeed.com/dominicholden/why-are-blood-banks-rejecting-transgender-women#.rf04yR9Z\">argued\u003c/a> in court records that previous FDA policy banned all transgender women. It is unclear that donors self-reporting their gender, as specified by the new guidance, clarifies that issue.\u003c/p>\n\u003cp>The FDA did not immediately reply to questions Monday from BuzzFeed News about whether all transgender people are banned from donating blood under the new guidelines.\u003c/p>\u003c/blockquote>\n\u003cp id=\"story-continues-4\" class=\"story-body-text story-content\">All U.S. blood donations are screened for HIV, the virus that causes AIDS. But there is a roughly 10-day window between initial infection and when the virus can be detected in the bloodstream. The American Red Cross estimates the risk of getting an HIV-positive blood donation is 1 in 1.5 million for U.S. patients. About 15.7 million blood donations are collected in the U.S. each year.\u003c/p>\n\u003cp class=\"story-body-text story-content\">In 2006 the Red Cross, the American Association of Blood Banks, and America's Blood Centers called the ban \"medically and scientifically unwarranted.\"\u003c/p>\n\u003cp class=\"story-body-text story-content\">The FDA concluded that moving to a one-year abstinence requirement would not change the safety of the U.S. blood supply, based on data from Australia and other sources.\u003c/p>\n\u003cp class=\"story-body-text story-content\">On the current blood donor questionnaire, men are asked if they have ever had sex with another man since 1977 -- the start of the AIDS epidemic in the U.S. Potential donors who answer positively are barred from donating blood. The new questionnaire, as outlined by the FDA, would ask men if they have had sex with another man in the last 12 months.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"story-body-text story-content\">\u003cem>This story includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm478031.htm\" target=\"_blank\">announced Monday \u003c/a>that it is easing the ban on blood donations from men who have sex with men.\u003c/p>\n\u003cp>The ban had been in place for more than 30 years, since the early days of the AIDS epidemic when little was known about AIDS or how it spread. But advocates had long argued that the policy was antiquated.\u003c/p>\n\u003cp>The new policy has been \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/12/23/fda-proposes-lifting-lifetime-ban-on-gay-blood-donors/\" target=\"_blank\">under review \u003c/a>for the last year and was issued today as a \"\u003ca href=\"http://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/UCM446580.pdf\" target=\"_blank\">final guidance\u003c/a>\" by the FDA. Under the revision, men who have sex with men may donate blood -- but only if they have not had sex with another man for the last year or more.\u003c/p>\n\u003cp>The policy matches that of many other countries, including the United Kingdom, Australia and Japan.\u003c/p>\n\u003cp>In \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm478031.htm\" target=\"_blank\">a statement, \u003c/a>acting FDA Commissioner Dr. Stephen Ostroff said that the FDA's responsibility was to maintain a high level of safety in the nation's blood supply. “We have taken great care to ensure this policy revision is backed by sound science and continues to protect our blood supply.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But gay rights activists say the change doesn't go far enough.\u003c/p>\n\u003cp>\"It continues to stigmatize gay and bisexual men,\" David Stacy, of the Human Rights Campaign, \u003ca href=\"http://abcnews.go.com/Health/wireStory/fda-eases-restrictions-blood-donations-gay-men-35888660\" target=\"_blank\">told ABC News\u003c/a>. \"It simply cannot be justified in light of current scientific research and updated blood screening technology.\"\u003c/p>\n\u003cp>The National Gay Blood Drive said the change \"was a huge first step in the right direction,\" but also \u003ca href=\"http://www.gayblooddrive.com/#!updates/c1vwd\" target=\"_blank\">called on the FDA \u003c/a>to move toward a non-discriminatory policy and end discrimination based on sexual orientation.\u003c/p>\n\u003cp>Under the recommendations approved today, the FDA says the following donors should not be permitted to donate blood \"indefinitely\":\u003c/p>\n\u003cul>\n\u003cli>An individual who has ever had a positive test for HIV.\u003c/li>\n\u003cli>An individual who has ever exchanged sex for money or drugs.\u003c/li>\n\u003cli>An individual who has ever engaged in injection drug use that was not prescribed.\u003c/li>\n\u003c/ul>\n\u003cp>And these people should be deferred:\u003c/p>\n\u003cul>\n\u003cli>Defer for 12 months from the most recent contact any individual who has a history of sex with a person who: has ever had a positive test for HIV, ever exchanged sex for money or drugs, or ever engaged in non-prescription injection drug use.\u003c/li>\n\u003cli>Defer for 12 months from the most recent transfusion any individual who has a history of receiving a transfusion of Whole Blood or blood components donated by another person (allogeneic transfusion).\u003c/li>\n\u003cli>Defer for 12 months from the most recent exposure any individual who has a history of through-the-skin contact with the blood of another individual, such as a needle stick or blood contact with an open wound or mucous membrane.\u003c/li>\n\u003cli>Defer for 12 months from the most recent tattoo, ear or body piercing. However, individuals who have undergone tattooing within 12 months of donation are eligible to donate if the tattoo was applied by a state regulated entity with sterile needles and non-reused ink. Individuals who have undergone ear or body piercing within 12 months of donation are eligible to donate if the piercing was done using single-use equipment.\u003c/li>\n\u003cli>Defer for 12 months after completion of treatment any individual with a history of syphilis or gonorrhea or with a history of diagnosis or treatment for syphilis or gonorrhea in the past 12 months.\u003c/li>\n\u003cli>Defer for 12 months from the most recent contact a man who has had sex with another man during the past 12 months.\u003c/li>\n\u003cli>Defer for 12 months from the most recent contact a female who has had sex during the past 12 months with a man who has had sex with another man in the past 12 months.\u003c/li>\n\u003c/ul>\n\u003cp>The policy also addressed transgender donors, saying \"male or female gender should be self-identified and self-reported.\"\u003c/p>\n\u003cp>This does little to clarify \"a policy that some blood banks have interpreted as a ban on all transgender donors,\" \u003ca href=\"http://www.buzzfeed.com/dominicholden/new-fda-policy-relaxes-ban-on-gay-men-donating-blood#.djy8W0PPV\" target=\"_blank\">reports BuzzFeed News and continued\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>One national blood donation company — facing two discrimination lawsuits from transgender women who were allegedly turned away — has \u003ca href=\"http://www.buzzfeed.com/dominicholden/why-are-blood-banks-rejecting-transgender-women#.rf04yR9Z\">argued\u003c/a> in court records that previous FDA policy banned all transgender women. It is unclear that donors self-reporting their gender, as specified by the new guidance, clarifies that issue.\u003c/p>\n\u003cp>The FDA did not immediately reply to questions Monday from BuzzFeed News about whether all transgender people are banned from donating blood under the new guidelines.\u003c/p>\u003c/blockquote>\n\u003cp id=\"story-continues-4\" class=\"story-body-text story-content\">All U.S. blood donations are screened for HIV, the virus that causes AIDS. But there is a roughly 10-day window between initial infection and when the virus can be detected in the bloodstream. The American Red Cross estimates the risk of getting an HIV-positive blood donation is 1 in 1.5 million for U.S. patients. About 15.7 million blood donations are collected in the U.S. each year.\u003c/p>\n\u003cp class=\"story-body-text story-content\">In 2006 the Red Cross, the American Association of Blood Banks, and America's Blood Centers called the ban \"medically and scientifically unwarranted.\"\u003c/p>\n\u003cp class=\"story-body-text story-content\">The FDA concluded that moving to a one-year abstinence requirement would not change the safety of the U.S. blood supply, based on data from Australia and other sources.\u003c/p>\n\u003cp class=\"story-body-text story-content\">On the current blood donor questionnaire, men are asked if they have ever had sex with another man since 1977 -- the start of the AIDS epidemic in the U.S. Potential donors who answer positively are barred from donating blood. The new questionnaire, as outlined by the FDA, would ask men if they have had sex with another man in the last 12 months.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"story-body-text story-content\">\u003cem>This story includes reporting from the Associated Press.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Kaiser Medical School Part of a Growing Trend",
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"content": "\u003cp>Thursday’s \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/17/kaiser-permanente-to-open-a-medical-school-in-southern-california/\" target=\"_blank\">announcement\u003c/a> by Kaiser Permanente that it plans to open its own medical school in Southern California has attracted a lot of attention in the health care community.\u003c/p>\n\u003cp>But Kaiser is actually at the trailing edge of a medical school expansion that has been unmatched since the 1960s and 1970s, say medical education experts. In the past decade alone, according to the \u003ca href=\"https://www.aamc.org/newsroom/newsreleases/436326/20150630_threenewlyaccreditedmedschools.html\" target=\"_blank\">Association of American Medical Colleges\u003c/a>, 20 new medical schools have opened or been approved.\u003c/p>\n\u003cp>That’s no coincidence. In 2006, the AAMC called for a \u003ca href=\"https://www.aamc.org/download/82874/data/helpwanted.pdf\" target=\"_blank\">30 percent increase\u003c/a> in medical school graduates by 2015 to meet a growing demand, both through expanded class sizes and newly created medical schools.\u003c/p>\n\u003cp>“We’re on track to meet that 30 percent increase in the next three or four years,” said Atul Grover, AAMC’s chief public policy officer. “Enrollment is already up 25 percent since 2002.”\u003c/p>\n\u003cp>Many of the new schools focus on producing more \u003ca href=\"http://www.npr.org/sections/health-shots/2013/04/02/175945921/new-medical-school-wants-to-build-ranks-of-primary-care-doctors\" target=\"_blank\">primary care doctors\u003c/a> — those specializing in pediatrics, family medicine or general internal medicine. In fact, Kaiser Permanente already has a partnership with the UC Davis on a \u003ca href=\"http://www.ucdmc.ucdavis.edu/publish/news/newsroom/9071\" target=\"_blank\">fast-track training program\u003c/a> for primary care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But Kaiser leaders say their new school (projected to enroll its first class in 2019) is about more than just primary care.\u003c/p>\n\u003cp>“We need to prepare physicians for the way health care is delivered in the future,” said Dr. Edward Ellison, executive medical director for the Southern California Permanente Medical Group. He said students need to learn not just medicine, but about integrated systems of care and how to work in a much different medical environment. “Our advantage is we can start from scratch,” he said.\u003c/p>\n\u003cp>Another advantage is the HMO’s deep pockets.\u003c/p>\n\u003cp>“They’ve got huge resources,” said George Thibault, president of the \u003ca href=\"http://macyfoundation.org/\" target=\"_blank\">Josiah Macy Jr. Foundation\u003c/a>, which focuses on medical education. “This is a grand experiment, but if anybody can do it, Kaiser can.”\u003c/p>\n\u003cp>Kaiser Permanente is far from the first health care provider to launch its own medical school — the \u003ca href=\"http://www.mayo.edu/mms/\" target=\"_blank\">Mayo Clinic\u003c/a> has had one since 1972 and is about to expand that school from its home base in Minnesota to its satellite campuses in Arizona and Florida.\u003c/p>\n\u003cp>Thibault said health-provider systems are already heavily involved in the new medical schools, often as partners with degree-granting universities, “which itself is a new trend.” For example, on Long Island, the North Shore-LIJ Health System \u003ca href=\"http://medicine.hofstra.edu/about/history/index.html\" target=\"_blank\">co-launched a medical school\u003c/a> with Hofstra University in 2011.\u003c/p>\n\u003cp>One big question is whether all these new schools will eventually produce more students than there are residency positions, which are necessary to complete the training. The federal government, which funds the majority of those residencies through the \u003ca href=\"http://economix.blogs.nytimes.com/2013/12/17/how-medicare-subsidizes-doctor-training/?_r=0\" target=\"_blank\">Medicare program\u003c/a>, capped the number of residencies it would fund in the \u003ca href=\"http://www.commonwealthfund.org/publications/fund-reports/1997/sep/an-examination-of-key-medicare-provisions-in-the-balanced-budget-act-of-1997\" target=\"_blank\">1997 Balanced Budget Act\u003c/a>.\u003c/p>\n\u003cp>Currently there are about 27,000 residency slots available each year, which are filled by students who have earned M.D. or D.O. degrees (doctors of osteopathy) in the U.S., as well as foreign medical school graduates and U.S. citizens who have graduated from medical schools overseas.\u003c/p>\n\u003cp>Between the new M.D.-granting schools and \u003ca href=\"http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Pages/growth-in-osteopathic-medical-students.aspx\" target=\"_blank\">a rapid expansion\u003c/a> of osteopathic medical schools, AAMC’s Grover said, demand will soon outstrip supply. Residency slots “are growing at about 1 percent per year,” he said (mostly funded by health systems themselves since Medicare will not), “while undergraduate medical education is growing about 3 percent per year.”\u003c/p>\n\u003cp>But Edward Salsberg of George Washington University, who has spent a career documenting health workforce trends, said any potential conflict is still a long way off.\u003c/p>\n\u003cp>“When you start with an excess of 7,000 slots” of residencies over graduating U.S. medical students, “it takes a very long time” to consume that excess, he said. By the year 2024, he and others concluded in a recent article in the \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1511707\" target=\"_blank\">New England Journal of Medicine\u003c/a>, there will still be 4,500 more slots than graduates.\u003c/p>\n\u003cp>“So yes, U.S. medical students will have a slightly more limited range of specialties to choose from,” said Salsberg, “but still plenty of room.”\u003c/p>\n\u003cp>There are also questions about whether there even is a \u003ca href=\"http://www.npr.org/sections/health-shots/2014/11/18/360145347/doctor-shortage-looming-maybe-not\" target=\"_blank\">doctor shortage\u003c/a> that all these new schools are aiming to alleviate.\u003c/p>\n\u003cp>Grover, whose organization has led the call for more doctors, said the anticipated shortage of primary care physicians might not be as acute as originally thought. That’s because the U.S. is producing dramatically more \u003ca href=\"http://healthaffairs.org/blog/2015/05/26/the-nurse-practitioner-physician-assistant-and-pharmacist-pipelines-continued-growth/\" target=\"_blank\">nurse practitioners and physician assistants\u003c/a>, who also provide primary care.\u003c/p>\n\u003cp>That’s probably a good thing, at least in supply terms, said Thibault of the Macy Foundation. Because it turns out that many students graduating from new primary care-focused school’s programs are in fact opting to become specialists instead.\u003c/p>\n\u003cp>“The career choices in the new schools look remarkably similar to career choices of more traditional schools,” he said. The graduating medical students “are responding to the same set of signals and stimuli” about prestige, income and lifestyle.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Julie Rovner is a reporter with \u003c/em>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003cem>\u003ca href=\"http://www.kff.org/\">Kaiser Family Foundation\u003c/a>\u003c/em>\u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003cem>and is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Thursday’s \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/17/kaiser-permanente-to-open-a-medical-school-in-southern-california/\" target=\"_blank\">announcement\u003c/a> by Kaiser Permanente that it plans to open its own medical school in Southern California has attracted a lot of attention in the health care community.\u003c/p>\n\u003cp>But Kaiser is actually at the trailing edge of a medical school expansion that has been unmatched since the 1960s and 1970s, say medical education experts. In the past decade alone, according to the \u003ca href=\"https://www.aamc.org/newsroom/newsreleases/436326/20150630_threenewlyaccreditedmedschools.html\" target=\"_blank\">Association of American Medical Colleges\u003c/a>, 20 new medical schools have opened or been approved.\u003c/p>\n\u003cp>That’s no coincidence. In 2006, the AAMC called for a \u003ca href=\"https://www.aamc.org/download/82874/data/helpwanted.pdf\" target=\"_blank\">30 percent increase\u003c/a> in medical school graduates by 2015 to meet a growing demand, both through expanded class sizes and newly created medical schools.\u003c/p>\n\u003cp>“We’re on track to meet that 30 percent increase in the next three or four years,” said Atul Grover, AAMC’s chief public policy officer. “Enrollment is already up 25 percent since 2002.”\u003c/p>\n\u003cp>Many of the new schools focus on producing more \u003ca href=\"http://www.npr.org/sections/health-shots/2013/04/02/175945921/new-medical-school-wants-to-build-ranks-of-primary-care-doctors\" target=\"_blank\">primary care doctors\u003c/a> — those specializing in pediatrics, family medicine or general internal medicine. In fact, Kaiser Permanente already has a partnership with the UC Davis on a \u003ca href=\"http://www.ucdmc.ucdavis.edu/publish/news/newsroom/9071\" target=\"_blank\">fast-track training program\u003c/a> for primary care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But Kaiser leaders say their new school (projected to enroll its first class in 2019) is about more than just primary care.\u003c/p>\n\u003cp>“We need to prepare physicians for the way health care is delivered in the future,” said Dr. Edward Ellison, executive medical director for the Southern California Permanente Medical Group. He said students need to learn not just medicine, but about integrated systems of care and how to work in a much different medical environment. “Our advantage is we can start from scratch,” he said.\u003c/p>\n\u003cp>Another advantage is the HMO’s deep pockets.\u003c/p>\n\u003cp>“They’ve got huge resources,” said George Thibault, president of the \u003ca href=\"http://macyfoundation.org/\" target=\"_blank\">Josiah Macy Jr. Foundation\u003c/a>, which focuses on medical education. “This is a grand experiment, but if anybody can do it, Kaiser can.”\u003c/p>\n\u003cp>Kaiser Permanente is far from the first health care provider to launch its own medical school — the \u003ca href=\"http://www.mayo.edu/mms/\" target=\"_blank\">Mayo Clinic\u003c/a> has had one since 1972 and is about to expand that school from its home base in Minnesota to its satellite campuses in Arizona and Florida.\u003c/p>\n\u003cp>Thibault said health-provider systems are already heavily involved in the new medical schools, often as partners with degree-granting universities, “which itself is a new trend.” For example, on Long Island, the North Shore-LIJ Health System \u003ca href=\"http://medicine.hofstra.edu/about/history/index.html\" target=\"_blank\">co-launched a medical school\u003c/a> with Hofstra University in 2011.\u003c/p>\n\u003cp>One big question is whether all these new schools will eventually produce more students than there are residency positions, which are necessary to complete the training. The federal government, which funds the majority of those residencies through the \u003ca href=\"http://economix.blogs.nytimes.com/2013/12/17/how-medicare-subsidizes-doctor-training/?_r=0\" target=\"_blank\">Medicare program\u003c/a>, capped the number of residencies it would fund in the \u003ca href=\"http://www.commonwealthfund.org/publications/fund-reports/1997/sep/an-examination-of-key-medicare-provisions-in-the-balanced-budget-act-of-1997\" target=\"_blank\">1997 Balanced Budget Act\u003c/a>.\u003c/p>\n\u003cp>Currently there are about 27,000 residency slots available each year, which are filled by students who have earned M.D. or D.O. degrees (doctors of osteopathy) in the U.S., as well as foreign medical school graduates and U.S. citizens who have graduated from medical schools overseas.\u003c/p>\n\u003cp>Between the new M.D.-granting schools and \u003ca href=\"http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Pages/growth-in-osteopathic-medical-students.aspx\" target=\"_blank\">a rapid expansion\u003c/a> of osteopathic medical schools, AAMC’s Grover said, demand will soon outstrip supply. Residency slots “are growing at about 1 percent per year,” he said (mostly funded by health systems themselves since Medicare will not), “while undergraduate medical education is growing about 3 percent per year.”\u003c/p>\n\u003cp>But Edward Salsberg of George Washington University, who has spent a career documenting health workforce trends, said any potential conflict is still a long way off.\u003c/p>\n\u003cp>“When you start with an excess of 7,000 slots” of residencies over graduating U.S. medical students, “it takes a very long time” to consume that excess, he said. By the year 2024, he and others concluded in a recent article in the \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1511707\" target=\"_blank\">New England Journal of Medicine\u003c/a>, there will still be 4,500 more slots than graduates.\u003c/p>\n\u003cp>“So yes, U.S. medical students will have a slightly more limited range of specialties to choose from,” said Salsberg, “but still plenty of room.”\u003c/p>\n\u003cp>There are also questions about whether there even is a \u003ca href=\"http://www.npr.org/sections/health-shots/2014/11/18/360145347/doctor-shortage-looming-maybe-not\" target=\"_blank\">doctor shortage\u003c/a> that all these new schools are aiming to alleviate.\u003c/p>\n\u003cp>Grover, whose organization has led the call for more doctors, said the anticipated shortage of primary care physicians might not be as acute as originally thought. That’s because the U.S. is producing dramatically more \u003ca href=\"http://healthaffairs.org/blog/2015/05/26/the-nurse-practitioner-physician-assistant-and-pharmacist-pipelines-continued-growth/\" target=\"_blank\">nurse practitioners and physician assistants\u003c/a>, who also provide primary care.\u003c/p>\n\u003cp>That’s probably a good thing, at least in supply terms, said Thibault of the Macy Foundation. Because it turns out that many students graduating from new primary care-focused school’s programs are in fact opting to become specialists instead.\u003c/p>\n\u003cp>“The career choices in the new schools look remarkably similar to career choices of more traditional schools,” he said. The graduating medical students “are responding to the same set of signals and stimuli” about prestige, income and lifestyle.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Julie Rovner is a reporter with \u003c/em>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003cem>\u003ca href=\"http://www.kff.org/\">Kaiser Family Foundation\u003c/a>\u003c/em>\u003cstrong>\u003cem> \u003c/em>\u003c/strong>\u003cem>and is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Kaiser Permanente, the managed health care giant that now offers patients an integrated system combining insurance, hospitals and outpatient physicians, is adding a medical school to its portfolio, the company announced Thursday.\u003c/p>\n\u003cp>The nonprofit HMO, based in Oakland, will open the Kaiser Permanente School of Medicine in Southern California in 2019. No specific site has yet been selected.\u003c/p>\n\u003cp>\"This is a natural evolution for us,\" Kaiser's CEO Bernard Tyson said in an interview. \"We are very motivated in being part of the transformation of the entire health care ecosystem.\"\u003c/p>\n\u003cp>Kaiser says it will base physician training on \"strategic pillars\" including providing care beyond traditional medical settings, emphasizing collaboration and teamwork, and addressing health disparities.\u003c/p>\n\u003cp>Kaiser has long been lauded by health care experts as delivering high quality care to its population of 10.2 million patients. Kaiser is known for providing coordinated care in a technology-driven environment. It was an early adopter of electronic health records and uses its system to reach patients about basic and complex medical needs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We now want to take all of our learnings and understanding of how to care for population and individuals and teach it more upstream for the future physicians of the 21st century,\" Tyson said.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/238062573\" 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>Kaiser says it is committed to attracting a diverse pool of students \"to better reflect the communities we serve,\" said Dr. Edward Ellison, executive director of the Southern California Permanente Medical Group. \"We've been able successfully to move, not completely, to closing the care gaps in health disequities for different populations, ... and we see that type of work in informing the medical students and how we educate them.\"\u003c/p>\n\u003cp>In a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/12/16/study-west-eliminates-race-gap-on-key-health-measures-disparities/\" target=\"_blank\">major analysis\u003c/a> last year, Kaiser was cited as closing the race gap in managing heart disease and diabetes, diseases which account for much of the reason African Americans have shorter life expectancies than caucasians.\u003c/p>\n\u003cp>The HMO has long been involved in medical education, but at the residency level, training more than 600 residents every year.\u003c/p>\n\u003cp>Kaiser's move is unusual. The nation's 145 medical schools are mostly affiliated with universities, although the Mayo Medical School campus operates within the Mayo Clinic in Rochester, Minnesota.\u003c/p>\n\u003cp>\"There are precedents, but this will be different,\" John Prescott, chief academic officer with the American Association of Medical Colleges, said of Kaiser's new school. \"It's an integrated health care system that's looking at developing a medical school. I think there will be some surprises as the school unfolds.\"\u003c/p>\n\u003cp>Prescott said the school will need to be accredited and that process could take several years. Twenty new medical schools have opened in the U.S. since 2002, he said, and many of them feature \"innovative models,\" he said.\u003c/p>\n\u003cp>Still, building a new medical school is \"fraught with risk,\" said John Deane, president of Advisory Board Consulting and Management. He said it could be a \"huge waste of money\" if Kaiser were to replicate the existing model of specialty-focused academic medical centers.\u003c/p>\n\u003cp>\"On the other hand,\" he said, \"they have an opportunity to do this in a new and different way that could be a form of disruptive innovation that could become a new standard for teaching doctors.\"\u003c/p>\n\u003cp>Tyson and Ellison both seemed focused on innovation as opposed to status quo.\u003c/p>\n\u003cp>\"We are excited to be on the frontier of creating a new medical school and thinking about how do we transform a medical education to meet the transformative needs of health care in this country, today, and into the future.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I'm as interested and motivated and part of the sponsorship of this 21st century new medical school if I were a physician myself,\" Tyson said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Kaiser Permanente, the managed health care giant that now offers patients an integrated system combining insurance, hospitals and outpatient physicians, is adding a medical school to its portfolio, the company announced Thursday.\u003c/p>\n\u003cp>The nonprofit HMO, based in Oakland, will open the Kaiser Permanente School of Medicine in Southern California in 2019. No specific site has yet been selected.\u003c/p>\n\u003cp>\"This is a natural evolution for us,\" Kaiser's CEO Bernard Tyson said in an interview. \"We are very motivated in being part of the transformation of the entire health care ecosystem.\"\u003c/p>\n\u003cp>Kaiser says it will base physician training on \"strategic pillars\" including providing care beyond traditional medical settings, emphasizing collaboration and teamwork, and addressing health disparities.\u003c/p>\n\u003cp>Kaiser has long been lauded by health care experts as delivering high quality care to its population of 10.2 million patients. Kaiser is known for providing coordinated care in a technology-driven environment. It was an early adopter of electronic health records and uses its system to reach patients about basic and complex medical needs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We now want to take all of our learnings and understanding of how to care for population and individuals and teach it more upstream for the future physicians of the 21st century,\" Tyson said.\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/238062573&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/238062573'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Kaiser says it is committed to attracting a diverse pool of students \"to better reflect the communities we serve,\" said Dr. Edward Ellison, executive director of the Southern California Permanente Medical Group. \"We've been able successfully to move, not completely, to closing the care gaps in health disequities for different populations, ... and we see that type of work in informing the medical students and how we educate them.\"\u003c/p>\n\u003cp>In a \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/12/16/study-west-eliminates-race-gap-on-key-health-measures-disparities/\" target=\"_blank\">major analysis\u003c/a> last year, Kaiser was cited as closing the race gap in managing heart disease and diabetes, diseases which account for much of the reason African Americans have shorter life expectancies than caucasians.\u003c/p>\n\u003cp>The HMO has long been involved in medical education, but at the residency level, training more than 600 residents every year.\u003c/p>\n\u003cp>Kaiser's move is unusual. The nation's 145 medical schools are mostly affiliated with universities, although the Mayo Medical School campus operates within the Mayo Clinic in Rochester, Minnesota.\u003c/p>\n\u003cp>\"There are precedents, but this will be different,\" John Prescott, chief academic officer with the American Association of Medical Colleges, said of Kaiser's new school. \"It's an integrated health care system that's looking at developing a medical school. I think there will be some surprises as the school unfolds.\"\u003c/p>\n\u003cp>Prescott said the school will need to be accredited and that process could take several years. Twenty new medical schools have opened in the U.S. since 2002, he said, and many of them feature \"innovative models,\" he said.\u003c/p>\n\u003cp>Still, building a new medical school is \"fraught with risk,\" said John Deane, president of Advisory Board Consulting and Management. He said it could be a \"huge waste of money\" if Kaiser were to replicate the existing model of specialty-focused academic medical centers.\u003c/p>\n\u003cp>\"On the other hand,\" he said, \"they have an opportunity to do this in a new and different way that could be a form of disruptive innovation that could become a new standard for teaching doctors.\"\u003c/p>\n\u003cp>Tyson and Ellison both seemed focused on innovation as opposed to status quo.\u003c/p>\n\u003cp>\"We are excited to be on the frontier of creating a new medical school and thinking about how do we transform a medical education to meet the transformative needs of health care in this country, today, and into the future.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I'm as interested and motivated and part of the sponsorship of this 21st century new medical school if I were a physician myself,\" Tyson said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In Federal Complaint, Advocates Allege Medi-Cal Violates Latinos' Civil Rights",
"title": "In Federal Complaint, Advocates Allege Medi-Cal Violates Latinos' Civil Rights",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Health advocates are accusing state officials of discriminating against Latino patients in Medi-Cal, the state’s health insurance program for people who are low income.\u003c/p>\n\u003cp>They filed \u003ca href=\"http://www.seiu-uhw.org/wp-content/blogs.dir/166/files/2015/12/CivilRightsComplaint_Text_12.15.15.pdf\" target=\"_blank\">a complaint \u003c/a>with the U.S. Department of Health and Human Services Office for Civil Rights, arguing reimbursement rates are so low that doctors refuse to see Medi-Cal patients -- nearly two-thirds of whom are Latino. Many patients face long waits for care or outright denial, the complaint says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'When I tell them I have Medi-Cal, they tell me they won't see me.'\u003ccite>Maria Barba, Medi-Cal patient \u003c/cite>\u003c/aside>\n\u003cp>One of them is Saul Jimenez, who has cerebral palsy and epilepsy. He gets terrible seizures that land him in the ER. His mother, Analilia Jimenez Perea, has been trying to get him to see a neurologist. But with Medi-Cal, she says the wait is a year and a half.\u003c/p>\n\u003cp>\"It’s very sad when I try to get an appointment for him at a special clinic,\" Jimenez Perea said in \u003ca href=\"https://www.youtube.com/watch?v=8GKAjo_W_p8&feature=youtu.be\" target=\"_blank\">videotaped remarks\u003c/a>. \"They so happy to answer me until they ask me what is insurance. And I say, 'Medi-Cal.' They say, 'We just don’t accepting Medi-Cal,' or, 'You have to be on the waiting list,' or, 'No thank you.'\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"Ufk3CCxjA2CAQFv3ZoqESkx0FSr4jgxy\"]Maria Barba has had similar difficulties getting treatment for kidney stones. She’s been to two different ER’s with incredible pain.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"They all tell me the same thing,\" Barba said in Spanish, through an interpreter, \"that I need a surgery and they won't do it. When I tell them I have Medi-Cal, they tell me they won't see me.\"\u003c/p>\n\u003cp>Lawyers from the Mexican American Legal Defense and Education Fund and the National Health Law Program say the state is abdicating its responsibility to provide equal access to health care. They allege that Medi-Cal reimbursement rates have fallen \"in tandem\" with the increasing proportion of Latinos in Medi-Cal.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/237879394\" 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>“By ensuring that reimbursement rates remain unduly low, the state of California has engaged in unlawful discrimination under both state and federal law,” said Thomas Saenz, president and general counsel for MALDEF.\u003c/p>\n\u003cp>Here's more from \u003ca href=\"http://www.seiu-uhw.org/wp-content/blogs.dir/166/files/2015/12/CivilRightsComplaint_Text_12.15.15.pdf\" target=\"_blank\">the complaint\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Today, no other type of health insurance in California covers a population that is so heavily Latino. The separate and unequal system of healthcare thus violates the protections of Title VI of the Civil Rights Act and the Department of Health and Human Services’ implementing regulations, as well as Section 1557 of the Affordable Care Act ...\u003c/p>\u003c/blockquote>\n\u003cp>State Medi-Cal officials said they would not comment on the specifics of the complaint, but insisted that they closely monitor access to all Medi-Cal programs.\u003c/p>\n\u003cp>“We work hard to serve all beneficiaries equally,” Jennifer Kent, director of the Department of Health Care Services, said in a statement. “We are committed to serving all vulnerable populations with vital health services.”\u003c/p>\n\u003cp>The statement cited a \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/publications/downloadable/BSCF%20Delivering%20Promise%20Full%20Report%20Web.pdf\" target=\"_blank\">January 2015 survey\u003c/a> by the Blue Shield of California Foundation that showed satisfaction gaps between whites and Latinos, identified in 2011, have been eliminated or dramatically narrowed. Overall satisfaction with Medi-Cal was 90 percent.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We are committed to serving all vulnerable populations with vital health services.'\u003ccite>Jennifer Kent, director, Dept. of Health Care Services \u003c/cite>\u003c/aside>\n\u003cp>Catha Worthman, an attorney with the Oakland law firm Feinberg, Jackson, Worthman and Wasow, says the Office of Civil Rights has a duty to investigate the claims, and, if they agree with the advocates that the law has been violated, they can negotiate a solution with California health officials. Advocates believe that solution should include raising reimbursement rates and better monitoring of access to doctors.\u003c/p>\n\u003cp>If no resolution is reached voluntarily, the Office of Civil Rights can ask the federal Department of Justice to bring a lawsuit or the complainants could file a class action lawsuit on behalf of all Latino Medi-Cal recipients.\u003c/p>\n\u003cp>H.D. Palmer, spokesman for the state Department of Finance, said Gov. Jerry Brown is currently working on a budget he will submit to the Legislature in January.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We have not said we’re opposed to rate increases, but if you’re going to have a rate increase, show us how that results in an expansion of care,” Palmer said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Health advocates are accusing state officials of discriminating against Latino patients in Medi-Cal, the state’s health insurance program for people who are low income.\u003c/p>\n\u003cp>They filed \u003ca href=\"http://www.seiu-uhw.org/wp-content/blogs.dir/166/files/2015/12/CivilRightsComplaint_Text_12.15.15.pdf\" target=\"_blank\">a complaint \u003c/a>with the U.S. Department of Health and Human Services Office for Civil Rights, arguing reimbursement rates are so low that doctors refuse to see Medi-Cal patients -- nearly two-thirds of whom are Latino. Many patients face long waits for care or outright denial, the complaint says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'When I tell them I have Medi-Cal, they tell me they won't see me.'\u003ccite>Maria Barba, Medi-Cal patient \u003c/cite>\u003c/aside>\n\u003cp>One of them is Saul Jimenez, who has cerebral palsy and epilepsy. He gets terrible seizures that land him in the ER. His mother, Analilia Jimenez Perea, has been trying to get him to see a neurologist. But with Medi-Cal, she says the wait is a year and a half.\u003c/p>\n\u003cp>\"It’s very sad when I try to get an appointment for him at a special clinic,\" Jimenez Perea said in \u003ca href=\"https://www.youtube.com/watch?v=8GKAjo_W_p8&feature=youtu.be\" target=\"_blank\">videotaped remarks\u003c/a>. \"They so happy to answer me until they ask me what is insurance. And I say, 'Medi-Cal.' They say, 'We just don’t accepting Medi-Cal,' or, 'You have to be on the waiting list,' or, 'No thank you.'\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Maria Barba has had similar difficulties getting treatment for kidney stones. She’s been to two different ER’s with incredible pain.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"They all tell me the same thing,\" Barba said in Spanish, through an interpreter, \"that I need a surgery and they won't do it. When I tell them I have Medi-Cal, they tell me they won't see me.\"\u003c/p>\n\u003cp>Lawyers from the Mexican American Legal Defense and Education Fund and the National Health Law Program say the state is abdicating its responsibility to provide equal access to health care. They allege that Medi-Cal reimbursement rates have fallen \"in tandem\" with the increasing proportion of Latinos in Medi-Cal.\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/237879394&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/237879394'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“By ensuring that reimbursement rates remain unduly low, the state of California has engaged in unlawful discrimination under both state and federal law,” said Thomas Saenz, president and general counsel for MALDEF.\u003c/p>\n\u003cp>Here's more from \u003ca href=\"http://www.seiu-uhw.org/wp-content/blogs.dir/166/files/2015/12/CivilRightsComplaint_Text_12.15.15.pdf\" target=\"_blank\">the complaint\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Today, no other type of health insurance in California covers a population that is so heavily Latino. The separate and unequal system of healthcare thus violates the protections of Title VI of the Civil Rights Act and the Department of Health and Human Services’ implementing regulations, as well as Section 1557 of the Affordable Care Act ...\u003c/p>\u003c/blockquote>\n\u003cp>State Medi-Cal officials said they would not comment on the specifics of the complaint, but insisted that they closely monitor access to all Medi-Cal programs.\u003c/p>\n\u003cp>“We work hard to serve all beneficiaries equally,” Jennifer Kent, director of the Department of Health Care Services, said in a statement. “We are committed to serving all vulnerable populations with vital health services.”\u003c/p>\n\u003cp>The statement cited a \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/publications/downloadable/BSCF%20Delivering%20Promise%20Full%20Report%20Web.pdf\" target=\"_blank\">January 2015 survey\u003c/a> by the Blue Shield of California Foundation that showed satisfaction gaps between whites and Latinos, identified in 2011, have been eliminated or dramatically narrowed. Overall satisfaction with Medi-Cal was 90 percent.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We are committed to serving all vulnerable populations with vital health services.'\u003ccite>Jennifer Kent, director, Dept. of Health Care Services \u003c/cite>\u003c/aside>\n\u003cp>Catha Worthman, an attorney with the Oakland law firm Feinberg, Jackson, Worthman and Wasow, says the Office of Civil Rights has a duty to investigate the claims, and, if they agree with the advocates that the law has been violated, they can negotiate a solution with California health officials. Advocates believe that solution should include raising reimbursement rates and better monitoring of access to doctors.\u003c/p>\n\u003cp>If no resolution is reached voluntarily, the Office of Civil Rights can ask the federal Department of Justice to bring a lawsuit or the complainants could file a class action lawsuit on behalf of all Latino Medi-Cal recipients.\u003c/p>\n\u003cp>H.D. Palmer, spokesman for the state Department of Finance, said Gov. Jerry Brown is currently working on a budget he will submit to the Legislature in January.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We have not said we’re opposed to rate increases, but if you’re going to have a rate increase, show us how that results in an expansion of care,” Palmer said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In Sacramento, Calls for Tougher Gun Laws Debated at Federal Hearing",
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"content": "\u003cp>Everyone from gun violence prevention advocates to law enforcement officers to gun dealers gathered in Sacramento Monday for a forum on reducing gun violence.\u003c/p>\n\u003caside class=\"pullquote alignright\">'As a gun owner I felt it was incumbent on all responsible gun owners to step up and to try and figure out how we can put an end to gun violence.'\u003cbr>\n\u003ccite>Rep. Mike Thompson, D-Napa\u003c/cite>\u003c/aside>\n\u003cp>U.S. Congressman Mike Thompson, D-Napa, called the meeting, held three years to the day when 20 school children and six teachers were fatally shot at Sandy Hook Elementary School in Connecticut, and less then two weeks after 14 people were killed in San Bernardino.\u003c/p>\n\u003cp>Thompson is a self-described \"gun guy,\" and remembers he was duck hunting when he got the call about the Sandy Hook shooting.\u003c/p>\n\u003cp>\"As a gun owner I felt it was incumbent on all responsible gun owners to step up and to try and figure out how we can put an end to gun violence, or at least put a dent in gun violence,\" said Thompson, now chair of the House Gun Violence Prevention Task Force.\u003c/p>\n\u003cp>California has some of the strongest gun control laws in the country, including strict background checks, even on second-hand sales, and, starting in January, the ability to remove guns from potentially dangerous people. But Thompson says those restrictions don't stop people from buying firearms in Nevada or Arizona and bringing them back across state lines. He says stronger federal laws are needed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/237698878\" 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>Thompson has proposed universal federal background checks on people who want to buy guns, including firearms sold at gun shows and online. He also wants to prohibit people on the \"no-fly\" list from buying guns.\u003c/p>\n\u003cp>Gun dealers were among those who spoke in favor of stronger rules.\u003c/p>\n\u003cp>\"With our constitutional right to bear arms comes a responsibility to protect our loved ones, our neighbors, and anybody else from the devastating effects of gun violence,\" said Joe Deaser, owner of Capital Gun Club, a gun shop and shooting range in Roseville, outside Sacramento.\u003c/p>\n\u003cp>He said he does a background check on everybody who comes to his shop, even in instances when he's not required to by law.\u003c/p>\n\u003cp>\"This really isn’t about gun control. It’s about keeping bad people from doing dumb things,\" Deaser said.\u003c/p>\n\u003cp>Most background checks take 90 seconds. But some take longer. And there's a loophole in the national law, that allows dealers to sell a gun if they don’t get a response in three days, said Chris Kitaeff, a gun show dealer from Phoenix, Arizona.\u003c/p>\n\u003cp>\"What we've done, and what we urge other gun dealers to do, is to adopt the common sense code of 'no completed background check, no sale,'\" he said. \"Walmart, one of our nation's largest retailers of firearms, has implemented this exact policy since 2002.\"\u003c/p>\n\u003cp>But several gun advocates at the forum said they opposed measures that would make it harder for law-abiding citizens to buy guns to protect themselves. One was Chase Buchanan from a group called the Pink Pistols.\u003c/p>\n\u003cp>\"It's a group for lesbian, gay, bisexual people who have made the decision to use firearms for self-defense against people who want to murder us. Against gay bashers, I suppose,\" Buchanan said.\u003c/p>\n\u003cp>He said discussions about gun control need to include the LGBT community.\u003c/p>\n\u003cp>\"We're here. We're queer. We're armed. Get used to it,\" he said.\u003c/p>\n\u003cp>Sam Paredes told a story about a home intruder who went into his daughter’s bedroom. Paredes got his gun and says that frightened the intruder away.\u003c/p>\n\u003cp>\"If I didn't have a gun, I could have lost a family member,\" he said.\u003c/p>\n\u003cp>A third gun rights advocate argued that California already has the strictest gun laws in the country, but they didn't stop the mass shooting in San Bernardino.\u003c/p>\n\u003cp>\"Criminals, terrorists don't care about the laws,\" said Craig DeLuz, legislative advocate for the California Association of Federal Firearms Licensees. \"Bad guys get guns no matter how strict the laws are. All these laws do is disarm law-abiding citizens.\"\u003c/p>\n\u003cp>But those who favor tougher gun laws say they're not aimed at eliminating gun violence. They're meant to reduce rates of violence, said Amanda Wilcox, legislative chair with the Brady Campaign to Prevent Gun Violence.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When someone runs a stop sign and causes a car crash, we don't say, 'See, stop signs don't work, let's get rid of all stop signs,'\" she said.\u003c/p>\n\n",
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"excerpt": "The forum was called by Rep. Mike Thompson, D-Napa, and was held on the third anniversary of the mass shooting at Sandy Hook Elementary School in Connecticut.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Everyone from gun violence prevention advocates to law enforcement officers to gun dealers gathered in Sacramento Monday for a forum on reducing gun violence.\u003c/p>\n\u003caside class=\"pullquote alignright\">'As a gun owner I felt it was incumbent on all responsible gun owners to step up and to try and figure out how we can put an end to gun violence.'\u003cbr>\n\u003ccite>Rep. Mike Thompson, D-Napa\u003c/cite>\u003c/aside>\n\u003cp>U.S. Congressman Mike Thompson, D-Napa, called the meeting, held three years to the day when 20 school children and six teachers were fatally shot at Sandy Hook Elementary School in Connecticut, and less then two weeks after 14 people were killed in San Bernardino.\u003c/p>\n\u003cp>Thompson is a self-described \"gun guy,\" and remembers he was duck hunting when he got the call about the Sandy Hook shooting.\u003c/p>\n\u003cp>\"As a gun owner I felt it was incumbent on all responsible gun owners to step up and to try and figure out how we can put an end to gun violence, or at least put a dent in gun violence,\" said Thompson, now chair of the House Gun Violence Prevention Task Force.\u003c/p>\n\u003cp>California has some of the strongest gun control laws in the country, including strict background checks, even on second-hand sales, and, starting in January, the ability to remove guns from potentially dangerous people. But Thompson says those restrictions don't stop people from buying firearms in Nevada or Arizona and bringing them back across state lines. He says stronger federal laws are needed.\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>\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/237698878&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/237698878'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Thompson has proposed universal federal background checks on people who want to buy guns, including firearms sold at gun shows and online. He also wants to prohibit people on the \"no-fly\" list from buying guns.\u003c/p>\n\u003cp>Gun dealers were among those who spoke in favor of stronger rules.\u003c/p>\n\u003cp>\"With our constitutional right to bear arms comes a responsibility to protect our loved ones, our neighbors, and anybody else from the devastating effects of gun violence,\" said Joe Deaser, owner of Capital Gun Club, a gun shop and shooting range in Roseville, outside Sacramento.\u003c/p>\n\u003cp>He said he does a background check on everybody who comes to his shop, even in instances when he's not required to by law.\u003c/p>\n\u003cp>\"This really isn’t about gun control. It’s about keeping bad people from doing dumb things,\" Deaser said.\u003c/p>\n\u003cp>Most background checks take 90 seconds. But some take longer. And there's a loophole in the national law, that allows dealers to sell a gun if they don’t get a response in three days, said Chris Kitaeff, a gun show dealer from Phoenix, Arizona.\u003c/p>\n\u003cp>\"What we've done, and what we urge other gun dealers to do, is to adopt the common sense code of 'no completed background check, no sale,'\" he said. \"Walmart, one of our nation's largest retailers of firearms, has implemented this exact policy since 2002.\"\u003c/p>\n\u003cp>But several gun advocates at the forum said they opposed measures that would make it harder for law-abiding citizens to buy guns to protect themselves. One was Chase Buchanan from a group called the Pink Pistols.\u003c/p>\n\u003cp>\"It's a group for lesbian, gay, bisexual people who have made the decision to use firearms for self-defense against people who want to murder us. Against gay bashers, I suppose,\" Buchanan said.\u003c/p>\n\u003cp>He said discussions about gun control need to include the LGBT community.\u003c/p>\n\u003cp>\"We're here. We're queer. We're armed. Get used to it,\" he said.\u003c/p>\n\u003cp>Sam Paredes told a story about a home intruder who went into his daughter’s bedroom. Paredes got his gun and says that frightened the intruder away.\u003c/p>\n\u003cp>\"If I didn't have a gun, I could have lost a family member,\" he said.\u003c/p>\n\u003cp>A third gun rights advocate argued that California already has the strictest gun laws in the country, but they didn't stop the mass shooting in San Bernardino.\u003c/p>\n\u003cp>\"Criminals, terrorists don't care about the laws,\" said Craig DeLuz, legislative advocate for the California Association of Federal Firearms Licensees. \"Bad guys get guns no matter how strict the laws are. All these laws do is disarm law-abiding citizens.\"\u003c/p>\n\u003cp>But those who favor tougher gun laws say they're not aimed at eliminating gun violence. They're meant to reduce rates of violence, said Amanda Wilcox, legislative chair with the Brady Campaign to Prevent Gun Violence.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When someone runs a stop sign and causes a car crash, we don't say, 'See, stop signs don't work, let's get rid of all stop signs,'\" she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California To Revamp Addiction Treatment For Medicaid Recipients",
"title": "California To Revamp Addiction Treatment For Medicaid Recipients",
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"content": "\u003cp>California is overhauling its substance abuse treatment system for low-income people, embarking on a massive experiment to create a smoother path for addicts from detox through recovery.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This was a long time coming. It’s a win/win for people with substance use issues and their families.'\u003cbr>\n\u003ccite>Keith Lewis, executive director of Horizon Services\u003c/cite>\u003c/aside>\n\u003cp>The state is the first to receive federal permission to revamp drug and alcohol treatment for beneficiaries of Medicaid, known as Medi-Cal in California. Through what’s known as a drug waiver, state officials will have new spending flexibility as they try to improve outcomes and reduce social and financial costs of people with substance abuse disorders.\u003c/p>\n\u003cp>Under the \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi-Cal-Organized-Delivery-System.aspx\" target=\"_blank\">waiver\u003c/a>, the state plans to expand treatment services, including inpatient care, case management, recovery services and added medication. Beginning next year, drug treatment centers will be able to get reimbursed for providing this much wider range of options to people on Medi-Cal.\u003c/p>\n\u003cp>Only a small fraction of low-income Californians with substance abuse disorders receive treatment, largely because of restrictions on what Medicaid will pay for.\u003c/p>\n\u003cp>“This was a long time coming,” said Keith Lewis, executive director of Horizon Services, which provides treatment in San Mateo, Santa Clara and Alameda counties. “It’s a win/win for people with substance use issues and their families … and for the people providing those services.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The changes will be phased in next year, beginning first in Bay Area counties before going to Los Angeles and Orange counties.\u003c/p>\n\u003cp>The changes stem in part from the Affordable Care Act, which required that substance abuse treatment be covered for people newly insured through Medicaid or insurance exchanges. The health law allowed states to expand Medicaid to cover millions more people.\u003c/p>\n\u003cp>Drug rehabilitation providers say the changes will give addicts a better chance at getting -- and staying -- clean. But they fear the state won’t raise traditionally low Medi-Cal reimbursement rates for treatment, making it harder to provide the new services and produce the outcomes California is hoping for.\u003c/p>\n\u003cp>Lewis, of Horizon Services, said that under the waiver, he expects drug treatment services to be higher quality and the workforce better trained. But he said that “Medi-Cal rates, which have always been too low, have to go up.\"\u003c/p>\n\u003cp>California’s Medi-Cal drug treatment program currently costs about $180 million annually, paid through a combination of state and federal funds. There aren’t any estimates for costs under the new approach, set to begin next year. But the idea is that the changes will lower overall health care expenses by enabling more people to get sober and healthier so they stop rotating through treatment centers, jails and hospitals.\u003c/p>\n\u003cp>\u003cstrong>New Access to Residential Treatment\u003c/strong>\u003c/p>\n\u003cp>Nearly 14 percent of Medicaid recipients are believed to have a substance abuse disorder, according to the National Survey on Drug Use and Health.\u003c/p>\n\u003cp>The five-year pilot project was approved by the federal Centers for Medicare & Medicaid Services in August. Under the waiver, California counties will approve treatment for Medi-Cal patients based on medical necessity and criteria established by the \u003ca href=\"http://www.asam.org/\" target=\"_blank\">American Society of Addiction Medicine\u003c/a>.\u003c/p>\n\u003cp>Currently, federal rules limit drug treatment centers' ability to get reimbursed under Medicaid for residential care. Clinics with more than 16 beds essentially cannot get paid, except for treating pregnant and post-partum women. That restriction will be dropped for California under the waiver.\u003c/p>\n\u003cp>Now, Medi-Cal beneficiaries will be able to access up to two 90-day residential stays each year (with a possibility of one 30-day extension) if providers determine that it is medically necessary. Certain populations, including those in the criminal justice system, can get approval for longer stays.\u003c/p>\n\u003cp>John Connolly, deputy director of substance abuse prevention and control for the Los Angeles County Department of Public Health, said the waiver is also designed to provide better coordination between physical, mental health and substance abuse services. That, along with more access, could result in fewer emergency room visits and hospitalizations, he said.\u003c/p>\n\u003cp>\u003cstrong>Treating Substance Abuse as Disease, Not Short-Term Illness\u003c/strong>\u003c/p>\n\u003cp>That’s potentially good news for patients like Caitlin Knoles, who says she gets turned down for treatment of her methamphetamine addiction every time she tells residential centers she’s on Medi-Cal. More than once, she has ended up in the hospital because of her addiction.\u003c/p>\n\u003cp>“It’s hard,” she said. “I can’t get help.”\u003c/p>\n\u003cp>The only way she can reliably get clean now is in jail, she says.\u003c/p>\n\u003cp>“It’d be nice to have a job and have my family back and just be normal,” said Knoles, 24, as she sat outside a liquor store in Laguna Hills.\u003c/p>\n\u003cp>For the first time, substance abuse disorders will be treated like a disease rather than a short-term illness, said Marlies Perez, chief of the substance use disorder compliance division for the state Department of Health Care Services.\u003c/p>\n\u003cp>“Even though we know it’s a chronic condition, we have treated it acutely,” she said. “If they relapse, they have come right through the front door again.”\u003c/p>\n\u003cp>“We are really paving the way in California with this waiver,” she added.\u003c/p>\n\u003cp>Much depends, however, on reimbursement rates, which are still being negotiated. Clinic officials say they need higher rates to expand services and handle the influx of clients, many of whom will be seeking rehab for the first time.\u003c/p>\n\u003cfigure id=\"attachment_120372\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-e1449601995985.jpg\">\u003cimg class=\"wp-image-120372 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-400x300.jpg\" alt=\"Tarzan Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Los Angeles County-based Tarzana Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“There is a cost to raising the bar on treatment,” said Albert Senella, president of the California Association of Alcohol and Drug Program Executives. “If the rates aren’t adequate … we are not going to be able to effectively meet the [new requirements] and the needs of the population.”\u003c/p>\n\u003cp>Senella, who is also CEO of Tarzana Treatment Centers, said many clinics across the state don’t have money upfront to prepare for the overhaul, which will require improving technology and adding and training staff. For now, no plans are in place to provide counties or clinics with startup funds.\u003c/p>\n\u003cp>Eli Veitzer, interim CEO of Prototypes, which provides treatment services in Los Angeles, Orange and Ventura counties, said the waiver provides an “incredible opportunity” to transform care.\u003c/p>\n\u003cp>But in addition to fears about rates, Veitzer said he is also worried that 90 days -- the limit for residential treatment -- won’t be long enough. Someone may be able to stem their addiction in three months but will still need more time in a treatment facility to prepare for life outside.\u003c/p>\n\u003cp>“If their ability to function independently in the community is not addressed, they are likely to relapse,” he said.\u003c/p>\n\u003cp>Danny Montgomery, a 33-year-old patient at Tarzana Treatment Centers, said he needed more than a few months to get clean after nearly a decade on heroin. The addiction, which he estimated cost him up to $100 a day, caused him to lose his job and nearly lose his family.\u003c/p>\n\u003cp>“The whole thing is a process,” said Montgomery, who lives in the San Fernando Valley. “You get the substance removed from your body but you have to retrain your mind.” Montgomery said he tried to get a bed in a residential treatment center but couldn’t find one that would take Medi-Cal.\u003c/p>\n\u003cp>He tried to get clean on his own but it never lasted. Months after beginning his search, Montgomery was finally able to get a spot at Tarzana. He said Los Angeles County is paying for his stay, which began in May.\u003c/p>\n\u003cp>As worried as they are about reimbursements, clinic operators said a big advantage of the new approach to drug treatment is that it could help stabilize their funding. Providers now depend largely on counties to pay for residential treatment for low-income residents.\u003c/p>\n\u003cp>“You always suffered the vagaries of the budget cycle,” said Vitka Eisen, CEO of HealthRIGHT 360, which provides drug treatment in the Bay Area.\u003c/p>\n\u003cp>The waiver means increased oversight of treatment centers. Last year, a state audit found widespread fraud and questionable billing among Medi-Cal drug treatment providers. The audit followed reports by the \u003ca href=\"http://cironline.org/rehabracket\" target=\"_blank\">Center for Investigative Reporting\u003c/a> that clinics were billing for fake clients.\u003c/p>\n\u003cp>Perez, of the state Department of Health Care Services, said the new system builds in more levels of accountability, including more stringent requirements for clinics and more local control over contracting.\u003c/p>\n\u003cp>Knoles, the methamphetamine addict from Orange County, said she hopes that more people like her will be able to get treatment.\u003c/p>\n\u003cp>“I’ve had a lot of friends die from addiction,” she said. “Imagine if they’d gotten the help they wanted and needed. Things would have been different.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Anna Gorman is a reporter with \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "The state is the first to overhaul substance abuse treatment as part of a federally approved experiment intended to improve outcomes and reduce costs.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California is overhauling its substance abuse treatment system for low-income people, embarking on a massive experiment to create a smoother path for addicts from detox through recovery.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This was a long time coming. It’s a win/win for people with substance use issues and their families.'\u003cbr>\n\u003ccite>Keith Lewis, executive director of Horizon Services\u003c/cite>\u003c/aside>\n\u003cp>The state is the first to receive federal permission to revamp drug and alcohol treatment for beneficiaries of Medicaid, known as Medi-Cal in California. Through what’s known as a drug waiver, state officials will have new spending flexibility as they try to improve outcomes and reduce social and financial costs of people with substance abuse disorders.\u003c/p>\n\u003cp>Under the \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi-Cal-Organized-Delivery-System.aspx\" target=\"_blank\">waiver\u003c/a>, the state plans to expand treatment services, including inpatient care, case management, recovery services and added medication. Beginning next year, drug treatment centers will be able to get reimbursed for providing this much wider range of options to people on Medi-Cal.\u003c/p>\n\u003cp>Only a small fraction of low-income Californians with substance abuse disorders receive treatment, largely because of restrictions on what Medicaid will pay for.\u003c/p>\n\u003cp>“This was a long time coming,” said Keith Lewis, executive director of Horizon Services, which provides treatment in San Mateo, Santa Clara and Alameda counties. “It’s a win/win for people with substance use issues and their families … and for the people providing those services.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The changes will be phased in next year, beginning first in Bay Area counties before going to Los Angeles and Orange counties.\u003c/p>\n\u003cp>The changes stem in part from the Affordable Care Act, which required that substance abuse treatment be covered for people newly insured through Medicaid or insurance exchanges. The health law allowed states to expand Medicaid to cover millions more people.\u003c/p>\n\u003cp>Drug rehabilitation providers say the changes will give addicts a better chance at getting -- and staying -- clean. But they fear the state won’t raise traditionally low Medi-Cal reimbursement rates for treatment, making it harder to provide the new services and produce the outcomes California is hoping for.\u003c/p>\n\u003cp>Lewis, of Horizon Services, said that under the waiver, he expects drug treatment services to be higher quality and the workforce better trained. But he said that “Medi-Cal rates, which have always been too low, have to go up.\"\u003c/p>\n\u003cp>California’s Medi-Cal drug treatment program currently costs about $180 million annually, paid through a combination of state and federal funds. There aren’t any estimates for costs under the new approach, set to begin next year. But the idea is that the changes will lower overall health care expenses by enabling more people to get sober and healthier so they stop rotating through treatment centers, jails and hospitals.\u003c/p>\n\u003cp>\u003cstrong>New Access to Residential Treatment\u003c/strong>\u003c/p>\n\u003cp>Nearly 14 percent of Medicaid recipients are believed to have a substance abuse disorder, according to the National Survey on Drug Use and Health.\u003c/p>\n\u003cp>The five-year pilot project was approved by the federal Centers for Medicare & Medicaid Services in August. Under the waiver, California counties will approve treatment for Medi-Cal patients based on medical necessity and criteria established by the \u003ca href=\"http://www.asam.org/\" target=\"_blank\">American Society of Addiction Medicine\u003c/a>.\u003c/p>\n\u003cp>Currently, federal rules limit drug treatment centers' ability to get reimbursed under Medicaid for residential care. Clinics with more than 16 beds essentially cannot get paid, except for treating pregnant and post-partum women. That restriction will be dropped for California under the waiver.\u003c/p>\n\u003cp>Now, Medi-Cal beneficiaries will be able to access up to two 90-day residential stays each year (with a possibility of one 30-day extension) if providers determine that it is medically necessary. Certain populations, including those in the criminal justice system, can get approval for longer stays.\u003c/p>\n\u003cp>John Connolly, deputy director of substance abuse prevention and control for the Los Angeles County Department of Public Health, said the waiver is also designed to provide better coordination between physical, mental health and substance abuse services. That, along with more access, could result in fewer emergency room visits and hospitalizations, he said.\u003c/p>\n\u003cp>\u003cstrong>Treating Substance Abuse as Disease, Not Short-Term Illness\u003c/strong>\u003c/p>\n\u003cp>That’s potentially good news for patients like Caitlin Knoles, who says she gets turned down for treatment of her methamphetamine addiction every time she tells residential centers she’s on Medi-Cal. More than once, she has ended up in the hospital because of her addiction.\u003c/p>\n\u003cp>“It’s hard,” she said. “I can’t get help.”\u003c/p>\n\u003cp>The only way she can reliably get clean now is in jail, she says.\u003c/p>\n\u003cp>“It’d be nice to have a job and have my family back and just be normal,” said Knoles, 24, as she sat outside a liquor store in Laguna Hills.\u003c/p>\n\u003cp>For the first time, substance abuse disorders will be treated like a disease rather than a short-term illness, said Marlies Perez, chief of the substance use disorder compliance division for the state Department of Health Care Services.\u003c/p>\n\u003cp>“Even though we know it’s a chronic condition, we have treated it acutely,” she said. “If they relapse, they have come right through the front door again.”\u003c/p>\n\u003cp>“We are really paving the way in California with this waiver,” she added.\u003c/p>\n\u003cp>Much depends, however, on reimbursement rates, which are still being negotiated. Clinic officials say they need higher rates to expand services and handle the influx of clients, many of whom will be seeking rehab for the first time.\u003c/p>\n\u003cfigure id=\"attachment_120372\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-e1449601995985.jpg\">\u003cimg class=\"wp-image-120372 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/DSCN1616-400x300.jpg\" alt=\"Tarzan Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Los Angeles County-based Tarzana Treatment Centers provides both outpatient and inpatient care for children and adults with substance use disorders and mental illnesses. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“There is a cost to raising the bar on treatment,” said Albert Senella, president of the California Association of Alcohol and Drug Program Executives. “If the rates aren’t adequate … we are not going to be able to effectively meet the [new requirements] and the needs of the population.”\u003c/p>\n\u003cp>Senella, who is also CEO of Tarzana Treatment Centers, said many clinics across the state don’t have money upfront to prepare for the overhaul, which will require improving technology and adding and training staff. For now, no plans are in place to provide counties or clinics with startup funds.\u003c/p>\n\u003cp>Eli Veitzer, interim CEO of Prototypes, which provides treatment services in Los Angeles, Orange and Ventura counties, said the waiver provides an “incredible opportunity” to transform care.\u003c/p>\n\u003cp>But in addition to fears about rates, Veitzer said he is also worried that 90 days -- the limit for residential treatment -- won’t be long enough. Someone may be able to stem their addiction in three months but will still need more time in a treatment facility to prepare for life outside.\u003c/p>\n\u003cp>“If their ability to function independently in the community is not addressed, they are likely to relapse,” he said.\u003c/p>\n\u003cp>Danny Montgomery, a 33-year-old patient at Tarzana Treatment Centers, said he needed more than a few months to get clean after nearly a decade on heroin. The addiction, which he estimated cost him up to $100 a day, caused him to lose his job and nearly lose his family.\u003c/p>\n\u003cp>“The whole thing is a process,” said Montgomery, who lives in the San Fernando Valley. “You get the substance removed from your body but you have to retrain your mind.” Montgomery said he tried to get a bed in a residential treatment center but couldn’t find one that would take Medi-Cal.\u003c/p>\n\u003cp>He tried to get clean on his own but it never lasted. Months after beginning his search, Montgomery was finally able to get a spot at Tarzana. He said Los Angeles County is paying for his stay, which began in May.\u003c/p>\n\u003cp>As worried as they are about reimbursements, clinic operators said a big advantage of the new approach to drug treatment is that it could help stabilize their funding. Providers now depend largely on counties to pay for residential treatment for low-income residents.\u003c/p>\n\u003cp>“You always suffered the vagaries of the budget cycle,” said Vitka Eisen, CEO of HealthRIGHT 360, which provides drug treatment in the Bay Area.\u003c/p>\n\u003cp>The waiver means increased oversight of treatment centers. Last year, a state audit found widespread fraud and questionable billing among Medi-Cal drug treatment providers. The audit followed reports by the \u003ca href=\"http://cironline.org/rehabracket\" target=\"_blank\">Center for Investigative Reporting\u003c/a> that clinics were billing for fake clients.\u003c/p>\n\u003cp>Perez, of the state Department of Health Care Services, said the new system builds in more levels of accountability, including more stringent requirements for clinics and more local control over contracting.\u003c/p>\n\u003cp>Knoles, the methamphetamine addict from Orange County, said she hopes that more people like her will be able to get treatment.\u003c/p>\n\u003cp>“I’ve had a lot of friends die from addiction,” she said. “Imagine if they’d gotten the help they wanted and needed. Things would have been different.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Anna Gorman is a reporter with \u003c/em>\u003ca href=\"http://khn.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Assisted-Death Laws Accentuate Need for Palliative Care, Doctors Say",
"title": "Assisted-Death Laws Accentuate Need for Palliative Care, Doctors Say",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>More times than she can count, Dr. Carin van Zyl has heard terminally ill patients beg to die. They tell her they can’t handle the pain, that the nausea is unbearable and the anxiety overwhelming.\u003c/p>\n\u003cp>If she were in the same situation, she too would want life-ending medication, even though she doubts she would ever take it. “I would want an escape hatch,” she said.\u003c/p>\n\u003cp>In October, California became the fifth — and largest — state to allow physicians to prescribe lethal medications to certain patients who ask for it. The law takes effect in 2016.\u003c/p>\n\u003cp>Yet van Zyl can’t see herself as one of those doctors.\u003c/p>\n\u003cp>“This is my life’s work, to relieve suffering,” said van Zyl, head of palliative care medicine at Los Angeles County-USC Medical Center. To her, that does not mean cutting short a life.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I can’t imagine pulling the trigger,” she said.\u003c/p>\n\u003cp>Weeks after California Gov. Jerry Brown signed the “\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">end-of-life option act\u003c/a>” into law, palliative care physicians like van Zyl are trying to come to terms with what it means for them and their terminally ill patients.\u003c/p>\n\u003cfigure id=\"attachment_118447\" class=\"wp-caption aligncenter\" style=\"max-width: 1919px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\">\u003cimg class=\"size-full wp-image-118447\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\" alt=\"Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer.\" width=\"1919\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not just a question of whether they support aid-in-dying or personally would ever help end a life. Palliative care doctors say the law underscores the need to raise awareness among doctors and patients about what they do and to expand access to high-quality programs.\u003c/p>\n\u003cp>Contrary to some patients’ fears, they say, palliative care doctors are not there to hasten death. Their job is to help seriously ill people get relief from symptoms and stress, and to improve quality of life for them and their families, regardless of how long the patients have to live.\u003c/p>\n\u003cp>The California law should be a “wake-up” call because it shows “how terrified patients are of what they will experience at the end of life,” said Dr. R. Sean Morrison, professor of geriatrics and palliative care medicine at Mt. Sinai’s Icahn School of Medicine in New York.\u003c/p>\n\u003cp>Morrison said that once patients who want to hasten their death get their symptoms controlled and their spiritual needs addressed, the overwhelming majority want to keep living.\u003c/p>\n\u003cp>“Their choice shouldn’t be an assisted death or living with intractable suffering,” Morrison said. “That’s what laws allowing assisted suicide, in the absence of palliative care, present as a choice to patients.”\u003c/p>\n\u003cp>Palliative care has become more widespread in recent years, and more doctors, nurses and social workers are being trained in how to provide it. In addition, \u003ca href=\"http://Dr.%20Carin%20van%20Zyl%20talks%20to%20patient%20Jose%20Garcia%20Flores%20about%20his%20treatment%20options%20for%20his%20advanced%20stage%20colon%20cancer.\" target=\"_blank\">recent legislation in California\u003c/a> requires that Medi-Cal managed care plans ensure access to programs.\u003c/p>\n\u003cfigure id=\"attachment_118446\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\">\u003cimg class=\"size-full wp-image-118446\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\" alt=\"Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But gaps remain. A \u003ca href=\"http://www.chcf.org/publications/2015/02/palliative-care-data\" target=\"_blank\">recent report by\u003c/a> the California HealthCare Foundation showed that residents in 22 of 58 California counties don’t have access to community-based palliative care, and those in 19 counties don’t have access to in-patient programs. Foundation researchers also found recently that specialists are in short supply and that there is no reliable way to pay for such care.\u003c/p>\n\u003cp>Dr. Ira Byock, a palliative care expert who opposed the California law, said its passage makes it more important than ever that all doctors receive more education on how to treat symptoms in seriously ill patients and talk with patients about what they want in their final months.\u003c/p>\n\u003cp>“As hard as illness and dying are … people still have the capacity to experience the sense of well-being,” said Byock, who heads the Providence Institute for Human Caring in Torrance, Calif.\u003c/p>\n\u003cp>Without palliative care programs, Byock and others say those conversations don’t always take place. Only about 17 percent of patients have had end-of-life discussions with their doctors, though nearly 90 percent believe doctors should be doing so, according to a \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-september-2015/\" target=\"_blank\">recent poll by the Kaiser Family Foundation\u003c/a>. In addition, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25488909\" target=\"_blank\">research out of the Mayo Clinic\u003c/a> found that only 12 percent of doctors had yearly end-of-life discussions with heart failure patients, and about 30 percent of the physicians had “little confidence” doing so.\u003c/p>\n\u003cp>Dr. Tony Back, who is co-director of the University of Washington’s Cambia Palliative Care Center of Excellence, said that after a similar aid-in-dying law passed in his state, more doctors realized that they “couldn’t just push it off on somebody else.”\u003c/p>\n\u003cp>As van Zyl struggles with her own reactions to the new law, she continues to have those tough conversations with one patient after another, every day.\u003c/p>\n\u003cfigure id=\"attachment_118445\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-e1449270397355.jpg\">\u003cimg class=\"size-thumbnail wp-image-118445\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-400x599.jpg\" alt=\"Jose Garcia Flores’ wife stands quietly at her husband’s bedside.\" width=\"400\" height=\"599\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores’ wife stands quietly at her husband’s bedside. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a recent day, more than two dozen names were listed on a white board in her hospital offices — all of them patients referred to her team for care. A 33-year-old woman with metastatic breast cancer. A 50-year-old with pancreatic cancer that had spread to her lungs. A 20-year-old man with a fast-growing brain tumor.\u003c/p>\n\u003cp>One patient van Zyl visited that day was Jose Garcia Flores, a gaunt, 60-year-old with advanced stage colon cancer. The former electrician had been diagnosed in the spring and was back in the hospital because of pain and nausea.\u003c/p>\n\u003cp>Van Zyl told him that there was a possibility that doctors would no longer be able to continue chemotherapy because of a complication. Van Zyl asked what he valued more — living longer, no matter what that looked like, or not living as long but being able to spend quality time with family at home.\u003c/p>\n\u003cp>“There is no right answer,” she said, promising to do everything she could to ease his pain and control his symptoms, regardless of whether he wanted to continue treatment for his cancer.\u003c/p>\n\u003cp>Garcia Flores paused and looked over at his wife standing next to the hospital bed. “I would prefer… to enjoy time with my family,” he said in Spanish.\u003c/p>\n\u003cp>“This isn’t fair — any of this,” she told him. “You are very brave.”\u003c/p>\n\u003cp>Van Zyl said that none of her patients have asked yet about the aid-in-dying law, which takes effect next year. She wonders if many of them even know about it.\u003c/p>\n\u003cp>A native of South Africa who used to work in emergency medicine, van Zyl said she recognizes that her views on the new law are hypocritical. “I don’t have a logical answer why I would want it for myself but not want to offer it to my patients,” she said. “I don’t know why I am still sitting on this fence that is increasingly pointy and uncomfortable.”\u003c/p>\n\u003cp>Part of it, she believes, is simple: “I’m deeply afraid of dying.”\u003c/p>\n\u003cfigure id=\"attachment_118448\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\">\u003cimg class=\"size-full wp-image-118448\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\" alt=\"Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center.\" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yet she knows, as a doctor, that death doesn’t have to be scary. Some problems, she says, have medical solutions — there are effective medications for pain and anxiety, for instance, so people can die peacefully. Van Zyl says her patients have always stopped asking to have their lives shortened once their symptoms were controlled.\u003c/p>\n\u003cp>Van Zyl believes medical providers, regardless of specialty, can be taught how to provide palliative care. That’s part of her job. And on this day, she stood before half a dozen medical residents, reviewing the best treatments for nausea, pain and shortness of breath. But suffering isn’t always physical, she said. Patients and families also need help coping with emotional suffering, she said.\u003c/p>\n\u003cp>“It is possible to screw up a family for life with a bad conversation,” she said. Van Zyl urged the residents not to run away from direct and honest — though hard — discussions. “Don’t do what so many doctors do, which is crumble.”\u003c/p>\n\u003cp>Then van Zyl brought up the aid-in-dying law. “What will you do when your patients says, ‘Can you kill me?’” she asked the group. “Somebody, at some point, is going to ask you to do that.”\u003c/p>\n\u003cp>One resident said that for her, prescribing lethal medication would be on a case-by-case basis. She would want to make sure the patient’s symptoms and pain were under control first. Another said she worried about how her own family would view her decision to help patients end their lives.\u003c/p>\n\u003cp>A third, Roshel Graham, said that no matter what, she hoped the law will help raise awareness about the benefits of palliative care. “I don’t think a lot of people even know palliative care exists,” she said.\u003c/p>\n\u003cp>As time goes on and doctors in California begin prescribing medicine to help people hasten their deaths, van Zyl said, perhaps her own views will become less conflicted.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Maybe my position will evolve,” she said. “I could imagine one bad death tipping me over.”\u003c/p>\n\n",
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"excerpt": "In wake of new law, palliative care physicians are trying to come to grips with what it means to them and their terminally ill patients. ",
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"title": "Assisted-Death Laws Accentuate Need for Palliative Care, Doctors Say | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More times than she can count, Dr. Carin van Zyl has heard terminally ill patients beg to die. They tell her they can’t handle the pain, that the nausea is unbearable and the anxiety overwhelming.\u003c/p>\n\u003cp>If she were in the same situation, she too would want life-ending medication, even though she doubts she would ever take it. “I would want an escape hatch,” she said.\u003c/p>\n\u003cp>In October, California became the fifth — and largest — state to allow physicians to prescribe lethal medications to certain patients who ask for it. The law takes effect in 2016.\u003c/p>\n\u003cp>Yet van Zyl can’t see herself as one of those doctors.\u003c/p>\n\u003cp>“This is my life’s work, to relieve suffering,” said van Zyl, head of palliative care medicine at Los Angeles County-USC Medical Center. To her, that does not mean cutting short a life.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I can’t imagine pulling the trigger,” she said.\u003c/p>\n\u003cp>Weeks after California Gov. Jerry Brown signed the “\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">end-of-life option act\u003c/a>” into law, palliative care physicians like van Zyl are trying to come to terms with what it means for them and their terminally ill patients.\u003c/p>\n\u003cfigure id=\"attachment_118447\" class=\"wp-caption aligncenter\" style=\"max-width: 1919px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\">\u003cimg class=\"size-full wp-image-118447\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-7-e1449270374470.jpg\" alt=\"Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer.\" width=\"1919\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores, 60, listens to Dr. Carin van Zyl as she explains that chemotherapy might not be an option to treat his colon cancer. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>It’s not just a question of whether they support aid-in-dying or personally would ever help end a life. Palliative care doctors say the law underscores the need to raise awareness among doctors and patients about what they do and to expand access to high-quality programs.\u003c/p>\n\u003cp>Contrary to some patients’ fears, they say, palliative care doctors are not there to hasten death. Their job is to help seriously ill people get relief from symptoms and stress, and to improve quality of life for them and their families, regardless of how long the patients have to live.\u003c/p>\n\u003cp>The California law should be a “wake-up” call because it shows “how terrified patients are of what they will experience at the end of life,” said Dr. R. Sean Morrison, professor of geriatrics and palliative care medicine at Mt. Sinai’s Icahn School of Medicine in New York.\u003c/p>\n\u003cp>Morrison said that once patients who want to hasten their death get their symptoms controlled and their spiritual needs addressed, the overwhelming majority want to keep living.\u003c/p>\n\u003cp>“Their choice shouldn’t be an assisted death or living with intractable suffering,” Morrison said. “That’s what laws allowing assisted suicide, in the absence of palliative care, present as a choice to patients.”\u003c/p>\n\u003cp>Palliative care has become more widespread in recent years, and more doctors, nurses and social workers are being trained in how to provide it. In addition, \u003ca href=\"http://Dr.%20Carin%20van%20Zyl%20talks%20to%20patient%20Jose%20Garcia%20Flores%20about%20his%20treatment%20options%20for%20his%20advanced%20stage%20colon%20cancer.\" target=\"_blank\">recent legislation in California\u003c/a> requires that Medi-Cal managed care plans ensure access to programs.\u003c/p>\n\u003cfigure id=\"attachment_118446\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\">\u003cimg class=\"size-full wp-image-118446\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-5-e1449270386245.jpg\" alt=\"Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl and patient Jose Garcia Flores hold hands as van Zyl promised to do everything she could to ease his pain and control his symptoms. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But gaps remain. A \u003ca href=\"http://www.chcf.org/publications/2015/02/palliative-care-data\" target=\"_blank\">recent report by\u003c/a> the California HealthCare Foundation showed that residents in 22 of 58 California counties don’t have access to community-based palliative care, and those in 19 counties don’t have access to in-patient programs. Foundation researchers also found recently that specialists are in short supply and that there is no reliable way to pay for such care.\u003c/p>\n\u003cp>Dr. Ira Byock, a palliative care expert who opposed the California law, said its passage makes it more important than ever that all doctors receive more education on how to treat symptoms in seriously ill patients and talk with patients about what they want in their final months.\u003c/p>\n\u003cp>“As hard as illness and dying are … people still have the capacity to experience the sense of well-being,” said Byock, who heads the Providence Institute for Human Caring in Torrance, Calif.\u003c/p>\n\u003cp>Without palliative care programs, Byock and others say those conversations don’t always take place. Only about 17 percent of patients have had end-of-life discussions with their doctors, though nearly 90 percent believe doctors should be doing so, according to a \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-september-2015/\" target=\"_blank\">recent poll by the Kaiser Family Foundation\u003c/a>. In addition, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25488909\" target=\"_blank\">research out of the Mayo Clinic\u003c/a> found that only 12 percent of doctors had yearly end-of-life discussions with heart failure patients, and about 30 percent of the physicians had “little confidence” doing so.\u003c/p>\n\u003cp>Dr. Tony Back, who is co-director of the University of Washington’s Cambia Palliative Care Center of Excellence, said that after a similar aid-in-dying law passed in his state, more doctors realized that they “couldn’t just push it off on somebody else.”\u003c/p>\n\u003cp>As van Zyl struggles with her own reactions to the new law, she continues to have those tough conversations with one patient after another, every day.\u003c/p>\n\u003cfigure id=\"attachment_118445\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-e1449270397355.jpg\">\u003cimg class=\"size-thumbnail wp-image-118445\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-3-400x599.jpg\" alt=\"Jose Garcia Flores’ wife stands quietly at her husband’s bedside.\" width=\"400\" height=\"599\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Garcia Flores’ wife stands quietly at her husband’s bedside. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>On a recent day, more than two dozen names were listed on a white board in her hospital offices — all of them patients referred to her team for care. A 33-year-old woman with metastatic breast cancer. A 50-year-old with pancreatic cancer that had spread to her lungs. A 20-year-old man with a fast-growing brain tumor.\u003c/p>\n\u003cp>One patient van Zyl visited that day was Jose Garcia Flores, a gaunt, 60-year-old with advanced stage colon cancer. The former electrician had been diagnosed in the spring and was back in the hospital because of pain and nausea.\u003c/p>\n\u003cp>Van Zyl told him that there was a possibility that doctors would no longer be able to continue chemotherapy because of a complication. Van Zyl asked what he valued more — living longer, no matter what that looked like, or not living as long but being able to spend quality time with family at home.\u003c/p>\n\u003cp>“There is no right answer,” she said, promising to do everything she could to ease his pain and control his symptoms, regardless of whether he wanted to continue treatment for his cancer.\u003c/p>\n\u003cp>Garcia Flores paused and looked over at his wife standing next to the hospital bed. “I would prefer… to enjoy time with my family,” he said in Spanish.\u003c/p>\n\u003cp>“This isn’t fair — any of this,” she told him. “You are very brave.”\u003c/p>\n\u003cp>Van Zyl said that none of her patients have asked yet about the aid-in-dying law, which takes effect next year. She wonders if many of them even know about it.\u003c/p>\n\u003cp>A native of South Africa who used to work in emergency medicine, van Zyl said she recognizes that her views on the new law are hypocritical. “I don’t have a logical answer why I would want it for myself but not want to offer it to my patients,” she said. “I don’t know why I am still sitting on this fence that is increasingly pointy and uncomfortable.”\u003c/p>\n\u003cp>Part of it, she believes, is simple: “I’m deeply afraid of dying.”\u003c/p>\n\u003cfigure id=\"attachment_118448\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\">\u003cimg class=\"size-full wp-image-118448\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/palliative-care-6-e1449270360767.jpg\" alt=\"Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center.\" width=\"1920\" height=\"1281\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Carin van Zyl, head of palliative care medicine, at Los Angeles County-USC Medical Center. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yet she knows, as a doctor, that death doesn’t have to be scary. Some problems, she says, have medical solutions — there are effective medications for pain and anxiety, for instance, so people can die peacefully. Van Zyl says her patients have always stopped asking to have their lives shortened once their symptoms were controlled.\u003c/p>\n\u003cp>Van Zyl believes medical providers, regardless of specialty, can be taught how to provide palliative care. That’s part of her job. And on this day, she stood before half a dozen medical residents, reviewing the best treatments for nausea, pain and shortness of breath. But suffering isn’t always physical, she said. Patients and families also need help coping with emotional suffering, she said.\u003c/p>\n\u003cp>“It is possible to screw up a family for life with a bad conversation,” she said. Van Zyl urged the residents not to run away from direct and honest — though hard — discussions. “Don’t do what so many doctors do, which is crumble.”\u003c/p>\n\u003cp>Then van Zyl brought up the aid-in-dying law. “What will you do when your patients says, ‘Can you kill me?’” she asked the group. “Somebody, at some point, is going to ask you to do that.”\u003c/p>\n\u003cp>One resident said that for her, prescribing lethal medication would be on a case-by-case basis. She would want to make sure the patient’s symptoms and pain were under control first. Another said she worried about how her own family would view her decision to help patients end their lives.\u003c/p>\n\u003cp>A third, Roshel Graham, said that no matter what, she hoped the law will help raise awareness about the benefits of palliative care. “I don’t think a lot of people even know palliative care exists,” she said.\u003c/p>\n\u003cp>As time goes on and doctors in California begin prescribing medicine to help people hasten their deaths, van Zyl said, perhaps her own views will become less conflicted.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Maybe my position will evolve,” she said. “I could imagine one bad death tipping me over.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "$1 Billion at Risk in California Fight Over Medi-Cal Managed Care Tax",
"title": "$1 Billion at Risk in California Fight Over Medi-Cal Managed Care Tax",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>California lawmakers are staring down a $1.1 billion hole in next year’s health budget after failing to come up with a way to replace the state’s “managed care organization tax” on health insurance plans that serve Medi-Cal managed care recipients.\u003c/p>\n\u003cp>It’s a hole big enough that state Gov. Jerry Brown recently used it as a reason to\u003ca href=\"http://ww2.kqed.org/news/2015/10/10/governors-vetoes-poke-lawmakers-on-special-session-failure\" target=\"_blank\"> veto 15 health care and other bills\u003c/a> sent to him by the state legislature. And unless it’s filled, Brown, a Democrat, is expected to issue a preliminary state budget in January with sizeable cuts to health and human services programs.\u003c/p>\n\u003cp>So far, the governor’s efforts to fill the void haven’t paid off. Brown in June had \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/06/legislators-take-on-health-spending-in-extraordinary-session/\" target=\"_blank\">called a special legislative session \u003c/a>to find other revenues to replace the tax, which the federal government says doesn’t meet regulations. That session is ongoing, and an informational hearing on the managed care organization tax is scheduled for Dec. 1 in Los Angeles, but getting everyone back to the negotiation table is proving difficult.\u003c/p>\n\u003cp>At the same time, state officials face other pressures on their Medi-Cal program, which has a total budget of $91.6 billion. After much delay, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/31/california-feds-reach-deal-on-medicaid-reform/\" target=\"_blank\">health officials only recently came to agreement in principle\u003c/a> with the federal government on how to fund reforms in Medi-Cal services. And federal officials approved less than half the $17 billion the state had originally sought.\u003c/p>\n\u003cp>Some observers say they don’t expect a deal on the managed care organization tax until the middle of next year, when federal officials have said the tax must end. While there may be closed-door discussions between insurers and state officials to find a solution, no one will talk publicly about them.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“In some ways, people are willing to walk away right now because they still have time,” said Shannon McConville, research associate at the Public Policy Institute of California.\u003c/p>\n\u003cp>The prospect of more than billion in budget cuts, however, could provide motivation for a deal.\u003c/p>\n\u003cp>“It’s unfortunate we got to this place, but when the governor’s budget comes out, there will be tremendous pressure” to fix the tax issue, said Maya Altman, CEO of Health Plan of San Mateo, which serves Medi-Cal managed care recipients.\u003c/p>\n\u003cp>She said budget cuts could make it difficult to raise already-low reimbursement rates for doctors, and almost certainly would reduce services for developmentally delayed children, the elderly and the disabled.\u003c/p>\n\u003cp>The problem is, the way California is taxing health care insurers and providers may be illegal under federal law. For years, the state has required managed care plans serving Medi-Cal recipients to pay a special health care tax. Because the federal government matches state funds spent on Medi-Cal, beefing up the state’s Medi-Cal budget has allowed the state to draw down more money from Washington.\u003c/p>\n\u003cp>The state then in effect reimburses the insurers for those tax payments through a complicated scheme involving payment of insurers’ administrative costs and the services they provide to Medi-Cal patients.\u003c/p>\n\u003cp>But Congress in 2005 changed tax law to try to end this practice, and last year the federal government warned California and other states still assessing these taxes that they have to tax all managed care plans, not just those serving Medicaid patients. The rationale: to lessen the financial burden on the federal Medicaid program and tax health insurance providers more equitably.\u003c/p>\n\u003cp>States with taxes that don’t meet federal guidelines must change or end them, or risk the loss of hundreds of millions of federal Medicaid dollars.\u003c/p>\n\u003cp>But managed care plans that don’t serve Medi-Cal patients – and thus would not benefit from reimbursements under the program – are resisting new state taxes. Those added costs would be passed on to consumers, the insurers have said.\u003c/p>\n\u003cp>A proposal from state health officials and backed by some Democratic state legislators to replace the tax in California with a new tax on all managed care insurers, based on their number of enrollees, \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2015/9/managed-care-tax-left-hanging\" target=\"_blank\">was roundly rejected by the state’s insurers \u003c/a>and the state’s Republican legislators. In opposing the proposal, the California Association of Health Plans cited excessive costs for its members.\u003c/p>\n\u003cp>The opposition drew a stinging statement from Diana Dooley, secretary of the California Health and Human Services Agency.\u003c/p>\n\u003cp>“It is now up to the plans which refused to endorse this proposal, and the Republicans who refused to consider it, to stop drawing lines and start putting solutions on the table,” she wrote.\u003c/p>\n\u003cp>California isn’t the only state in this mess. Pennsylvania was singled out by the U.S. Health and Human Services’ Inspector General for having a tax that didn’t comply with federal law. The Keystone state hasn’t been able to reach a deal with its insurers, either.\u003c/p>\n\u003cp>“Discussions are ongoing,”’ was the terse statement from Doug Furness, director of government affairs for the Insurance Federation of Pennsylvania. A spokeswoman for the Pennsylvania health agency overseeing Medicaid declined to comment.\u003c/p>\n\u003cp>Ohio officials were similarly tight-lipped about negotiations regarding the state’s tax, which, like California’s, can’t pass muster with federal officials. Michigan, as well, is wrestling with a similar health tax that may not be legal.\u003c/p>\n\u003cp>But other states have been able to change their health provider taxes to comply with the law, said Cindy Mann, a former top official with the Centers for Medicare & Medicaid Services who wrote the agency’s 2014 “guidance letter” warning states about the tax issue.\u003c/p>\n\u003cp>In California, Democratic lawmakers have proposed raising taxes on tobacco and cocktails in bars and restaurants to help pay for health services, but the proposals stalled in the legislature. Now, health advocates, lobbying groups and health worker unions including the American Lung Association, the California Medical Association and SEIU are pushing to place a $2-per-pack cigarette tax on the November 2016 ballot, which could raise an estimated $1.5 billion in its first year.\u003c/p>\n\u003cp>In the meantime, the backroom discussions will continue among insurers, legislators and state health officials on how to replace the managed care organization tax’s revenues.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“While it’s possible that this becomes a stalemate, it’s also possible that the health insurance industry acknowledges that a billion dollars in cuts is too much of an apocalypse to not grudgingly come to some kind of compromise,” said Anthony Wright of Health Access, a statewide health advocacy group. “Nobody wants to see what a billion dollars of cuts to our health care system looks like.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California lawmakers are staring down a $1.1 billion hole in next year’s health budget after failing to come up with a way to replace the state’s “managed care organization tax” on health insurance plans that serve Medi-Cal managed care recipients.\u003c/p>\n\u003cp>It’s a hole big enough that state Gov. Jerry Brown recently used it as a reason to\u003ca href=\"http://ww2.kqed.org/news/2015/10/10/governors-vetoes-poke-lawmakers-on-special-session-failure\" target=\"_blank\"> veto 15 health care and other bills\u003c/a> sent to him by the state legislature. And unless it’s filled, Brown, a Democrat, is expected to issue a preliminary state budget in January with sizeable cuts to health and human services programs.\u003c/p>\n\u003cp>So far, the governor’s efforts to fill the void haven’t paid off. Brown in June had \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/06/legislators-take-on-health-spending-in-extraordinary-session/\" target=\"_blank\">called a special legislative session \u003c/a>to find other revenues to replace the tax, which the federal government says doesn’t meet regulations. That session is ongoing, and an informational hearing on the managed care organization tax is scheduled for Dec. 1 in Los Angeles, but getting everyone back to the negotiation table is proving difficult.\u003c/p>\n\u003cp>At the same time, state officials face other pressures on their Medi-Cal program, which has a total budget of $91.6 billion. After much delay, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/31/california-feds-reach-deal-on-medicaid-reform/\" target=\"_blank\">health officials only recently came to agreement in principle\u003c/a> with the federal government on how to fund reforms in Medi-Cal services. And federal officials approved less than half the $17 billion the state had originally sought.\u003c/p>\n\u003cp>Some observers say they don’t expect a deal on the managed care organization tax until the middle of next year, when federal officials have said the tax must end. While there may be closed-door discussions between insurers and state officials to find a solution, no one will talk publicly about them.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“In some ways, people are willing to walk away right now because they still have time,” said Shannon McConville, research associate at the Public Policy Institute of California.\u003c/p>\n\u003cp>The prospect of more than billion in budget cuts, however, could provide motivation for a deal.\u003c/p>\n\u003cp>“It’s unfortunate we got to this place, but when the governor’s budget comes out, there will be tremendous pressure” to fix the tax issue, said Maya Altman, CEO of Health Plan of San Mateo, which serves Medi-Cal managed care recipients.\u003c/p>\n\u003cp>She said budget cuts could make it difficult to raise already-low reimbursement rates for doctors, and almost certainly would reduce services for developmentally delayed children, the elderly and the disabled.\u003c/p>\n\u003cp>The problem is, the way California is taxing health care insurers and providers may be illegal under federal law. For years, the state has required managed care plans serving Medi-Cal recipients to pay a special health care tax. Because the federal government matches state funds spent on Medi-Cal, beefing up the state’s Medi-Cal budget has allowed the state to draw down more money from Washington.\u003c/p>\n\u003cp>The state then in effect reimburses the insurers for those tax payments through a complicated scheme involving payment of insurers’ administrative costs and the services they provide to Medi-Cal patients.\u003c/p>\n\u003cp>But Congress in 2005 changed tax law to try to end this practice, and last year the federal government warned California and other states still assessing these taxes that they have to tax all managed care plans, not just those serving Medicaid patients. The rationale: to lessen the financial burden on the federal Medicaid program and tax health insurance providers more equitably.\u003c/p>\n\u003cp>States with taxes that don’t meet federal guidelines must change or end them, or risk the loss of hundreds of millions of federal Medicaid dollars.\u003c/p>\n\u003cp>But managed care plans that don’t serve Medi-Cal patients – and thus would not benefit from reimbursements under the program – are resisting new state taxes. Those added costs would be passed on to consumers, the insurers have said.\u003c/p>\n\u003cp>A proposal from state health officials and backed by some Democratic state legislators to replace the tax in California with a new tax on all managed care insurers, based on their number of enrollees, \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2015/9/managed-care-tax-left-hanging\" target=\"_blank\">was roundly rejected by the state’s insurers \u003c/a>and the state’s Republican legislators. In opposing the proposal, the California Association of Health Plans cited excessive costs for its members.\u003c/p>\n\u003cp>The opposition drew a stinging statement from Diana Dooley, secretary of the California Health and Human Services Agency.\u003c/p>\n\u003cp>“It is now up to the plans which refused to endorse this proposal, and the Republicans who refused to consider it, to stop drawing lines and start putting solutions on the table,” she wrote.\u003c/p>\n\u003cp>California isn’t the only state in this mess. Pennsylvania was singled out by the U.S. Health and Human Services’ Inspector General for having a tax that didn’t comply with federal law. The Keystone state hasn’t been able to reach a deal with its insurers, either.\u003c/p>\n\u003cp>“Discussions are ongoing,”’ was the terse statement from Doug Furness, director of government affairs for the Insurance Federation of Pennsylvania. A spokeswoman for the Pennsylvania health agency overseeing Medicaid declined to comment.\u003c/p>\n\u003cp>Ohio officials were similarly tight-lipped about negotiations regarding the state’s tax, which, like California’s, can’t pass muster with federal officials. Michigan, as well, is wrestling with a similar health tax that may not be legal.\u003c/p>\n\u003cp>But other states have been able to change their health provider taxes to comply with the law, said Cindy Mann, a former top official with the Centers for Medicare & Medicaid Services who wrote the agency’s 2014 “guidance letter” warning states about the tax issue.\u003c/p>\n\u003cp>In California, Democratic lawmakers have proposed raising taxes on tobacco and cocktails in bars and restaurants to help pay for health services, but the proposals stalled in the legislature. Now, health advocates, lobbying groups and health worker unions including the American Lung Association, the California Medical Association and SEIU are pushing to place a $2-per-pack cigarette tax on the November 2016 ballot, which could raise an estimated $1.5 billion in its first year.\u003c/p>\n\u003cp>In the meantime, the backroom discussions will continue among insurers, legislators and state health officials on how to replace the managed care organization tax’s revenues.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“While it’s possible that this becomes a stalemate, it’s also possible that the health insurance industry acknowledges that a billion dollars in cuts is too much of an apocalypse to not grudgingly come to some kind of compromise,” said Anthony Wright of Health Access, a statewide health advocacy group. “Nobody wants to see what a billion dollars of cuts to our health care system looks like.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Wishes for End-of-Life Care Are Common Across Ethnicities",
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"content": "\u003cp>What kind of care do you want at the end of your life?\u003c/p>\n\u003cp>Stanford University researchers put that question to members of three major ethnic groups in the Bay Area and, \u003ca href=\"http://online.liebertpub.com/doi/full/10.1089/jpm.2015.0403\" target=\"_blank\">in an analysis,\u003c/a> found little variation in their responses.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What this study tells us is that all of our patients want us to have these conversations.'\u003cbr>\n\u003ccite>Steven Pantilat, UCSF palliative care program\u003c/cite>\u003c/aside>\n\u003cp>“There is a common humanity –- people want to live as long as they have good quality of life. When it is their time, they want to be consulted so they die in a way that they are respected, and they don’t want their families burdened,” said the study’s lead author, Dr. V.J. Periyakoil, director of the Stanford Palliative Care Education and Training Program and associate director of palliative care services at the VA Palo Alto Health Care Center.\u003c/p>\n\u003cp>Regardless of ethnicity, however, the researchers found that access to high-quality end-of-life care is often hampered by lack of financial means, poor communication with health providers, cultural mores and family conflicts. The study, involving more than 300 white, Asian and African-American seniors, was published last week in the Journal of Palliative Medicine.\u003c/p>\n\u003cp>Periyakoil, whose earlier research focused on \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/22/ethnic-differences-thwart-end-of-life-conversations/\" target=\"_blank\">how doctors discuss end-of-life care\u003c/a> with patients from different cultures, said physicians often believe that talking about end-of-life care with patients of certain ethnic groups is taboo and that patients and their families are reluctant to have these sensitive conversations. The new study, though small and limited in geographic scope, suggests otherwise. The participants may have been more affluent and better educated than their counterparts nationwide, given the region’s demographics, Periyakoil noted.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers interviewed 315 people over 50 at senior centers in Fremont, Palo Alto, San Francisco, San Jose and Walnut Creek. The group included 38 African-Americans, 160 Asian-Americans and 117 Caucasians.\u003c/p>\n\u003cp>Interviews were conducted in multiple languages: English, Burmese, Hindi, Mandarin, Tagalog and Vietnamese. Researchers examined participants’ attitudes toward end-of-life care and whether they had experienced barriers to getting quality end-of-life care for relatives or others in their community.\u003c/p>\n\u003cp>\u003cstrong>Finances an Issue for Many\u003c/strong>\u003c/p>\n\u003cp>Researchers are still collecting data on Latino participants and plan to publish a separate study on their views, Periyakoil said.\u003c/p>\n\u003cp>While all of the participants in the study said they valued high-quality end-of-life care, about 60 percent said they had experienced barriers to getting it, most notably financial difficulties and a lack of adequate health insurance. Medicare typically covers only short-term nursing home care and offers hospice benefits to patients whose doctors certify they have six months or less to live and who are willing to forgo treatment intended to cure their terminal illness.\u003c/p>\n\u003cp>There were no statistically significant differences among ethnic groups in reporting barriers to care. But participants with less education were more likely to report that their biggest barrier to care was financial.\u003c/p>\n\u003cp>Patients with more education were more likely to cite doctor behaviors that hampered end-of-life communication. And women were more likely than men to cite barriers to care overall, perhaps because they were more likely to be direct caregivers and have more experience with end-of-life needs.\u003c/p>\n\u003cp>\u003cstrong>'Vague Responses' from Doctors\u003c/strong>\u003c/p>\n\u003cp>Regardless of ethnicity, patients felt that “doctors were just too busy to initiate [end-of-life] conversations, reluctant to listen to their concerns and questions about EOL decision making, and often gave vague responses, making it difficult for the patient to comprehend their choices and make informed decisions,” the researchers wrote.\u003c/p>\n\u003cp>An estimated 2.6 million Americans die every year, but how the American health care system handles their last days is problematic across ethnic groups, according to \u003ca href=\"http://iom.nationalacademies.org/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx\" target=\"_blank\">“Dying in America,”\u003c/a> a landmark report released in 2014 by the Institute of Medicine. Too many people end up having aggressive treatment that is ineffective and expensive and doesn’t contribute to the patient’s quality of life, the report found. Other research examining\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/25/a-racial-gap-in-attitudes-toward-hospice-care/\" target=\"_blank\"> racial gaps in attitudes toward hospice care\u003c/a> and other studies has found differences among ethnic and religious groups in how they approach end-of-life decisions.\u003c/p>\n\u003cp>[contextly_sidebar id=\"fDtiIK5xkI4TXA1JF0Lq6Kt8zKIAFZ4t\"]But people want to talk about it regardless of background, says Dr. Steven Pantilat, director of UC San Francisco's palliative care program. He was not involved in the study.\u003c/p>\n\u003cp>“What this study tells us is that \u003cem>all\u003c/em> of our patients want us to have these conversations,” Pantilat said. “They’re waiting for their doctors to bring it up, to not be rushed, to communicate sensitively.”\u003c/p>\n\u003cp>A new federal policy may make those conversations easier –- and more routine. Starting in January, \u003ca href=\"http://bigstory.ap.org/article/3c1463f23baa4b79b2f2462ee9fc29ff/medicare-cover-end-life-counseling\" target=\"_blank\">Medicare will reimburse physicians for discussing end-of-life care\u003c/a>. That policy infamously -- and incorrectly -- was derided as promoting “death panels” during the debate over the Affordable Care Act, and a version of it was dropped from the legislation. The counseling will cover what kind of medical care patients want to receive as they approach their last days.\u003c/p>\n\u003cp>Periyakoil urges patients of all backgrounds to prepare for these conversations, and new planning tools are available in different languages to help. Among them is the \u003ca href=\"http://med.stanford.edu/letter.html\" target=\"_blank\">Stanford Letter Project\u003c/a>, which helps patients write a letter to their doctors about the end-of-life care they do and don’t want in languages including English, Spanish, Mandarin, Vietnamese, Hindi, Urdu, Tagalog and Russian.\u003c/p>\n\u003cp>In one redacted letter provided by Periyakoil, a woman named Patricia writes: “I do not want my longevity to be more important than my comfort.”\u003c/p>\n\u003cp>Pantilat advises the doctors he trains that they don’t need deep knowledge of the beliefs of every religion and culture they might encounter, because every patient, of whatever ethnicity, has different goals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we come in with true curiosity, respect and openness, we can learn a lot about how to take care of someone in a sensitive way,” he said. We need to ask: “What do I need to know about your culture and your family to take good care of \u003cem>you\u003c/em>?”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>What kind of care do you want at the end of your life?\u003c/p>\n\u003cp>Stanford University researchers put that question to members of three major ethnic groups in the Bay Area and, \u003ca href=\"http://online.liebertpub.com/doi/full/10.1089/jpm.2015.0403\" target=\"_blank\">in an analysis,\u003c/a> found little variation in their responses.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What this study tells us is that all of our patients want us to have these conversations.'\u003cbr>\n\u003ccite>Steven Pantilat, UCSF palliative care program\u003c/cite>\u003c/aside>\n\u003cp>“There is a common humanity –- people want to live as long as they have good quality of life. When it is their time, they want to be consulted so they die in a way that they are respected, and they don’t want their families burdened,” said the study’s lead author, Dr. V.J. Periyakoil, director of the Stanford Palliative Care Education and Training Program and associate director of palliative care services at the VA Palo Alto Health Care Center.\u003c/p>\n\u003cp>Regardless of ethnicity, however, the researchers found that access to high-quality end-of-life care is often hampered by lack of financial means, poor communication with health providers, cultural mores and family conflicts. The study, involving more than 300 white, Asian and African-American seniors, was published last week in the Journal of Palliative Medicine.\u003c/p>\n\u003cp>Periyakoil, whose earlier research focused on \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/22/ethnic-differences-thwart-end-of-life-conversations/\" target=\"_blank\">how doctors discuss end-of-life care\u003c/a> with patients from different cultures, said physicians often believe that talking about end-of-life care with patients of certain ethnic groups is taboo and that patients and their families are reluctant to have these sensitive conversations. The new study, though small and limited in geographic scope, suggests otherwise. The participants may have been more affluent and better educated than their counterparts nationwide, given the region’s demographics, Periyakoil noted.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers interviewed 315 people over 50 at senior centers in Fremont, Palo Alto, San Francisco, San Jose and Walnut Creek. The group included 38 African-Americans, 160 Asian-Americans and 117 Caucasians.\u003c/p>\n\u003cp>Interviews were conducted in multiple languages: English, Burmese, Hindi, Mandarin, Tagalog and Vietnamese. Researchers examined participants’ attitudes toward end-of-life care and whether they had experienced barriers to getting quality end-of-life care for relatives or others in their community.\u003c/p>\n\u003cp>\u003cstrong>Finances an Issue for Many\u003c/strong>\u003c/p>\n\u003cp>Researchers are still collecting data on Latino participants and plan to publish a separate study on their views, Periyakoil said.\u003c/p>\n\u003cp>While all of the participants in the study said they valued high-quality end-of-life care, about 60 percent said they had experienced barriers to getting it, most notably financial difficulties and a lack of adequate health insurance. Medicare typically covers only short-term nursing home care and offers hospice benefits to patients whose doctors certify they have six months or less to live and who are willing to forgo treatment intended to cure their terminal illness.\u003c/p>\n\u003cp>There were no statistically significant differences among ethnic groups in reporting barriers to care. But participants with less education were more likely to report that their biggest barrier to care was financial.\u003c/p>\n\u003cp>Patients with more education were more likely to cite doctor behaviors that hampered end-of-life communication. And women were more likely than men to cite barriers to care overall, perhaps because they were more likely to be direct caregivers and have more experience with end-of-life needs.\u003c/p>\n\u003cp>\u003cstrong>'Vague Responses' from Doctors\u003c/strong>\u003c/p>\n\u003cp>Regardless of ethnicity, patients felt that “doctors were just too busy to initiate [end-of-life] conversations, reluctant to listen to their concerns and questions about EOL decision making, and often gave vague responses, making it difficult for the patient to comprehend their choices and make informed decisions,” the researchers wrote.\u003c/p>\n\u003cp>An estimated 2.6 million Americans die every year, but how the American health care system handles their last days is problematic across ethnic groups, according to \u003ca href=\"http://iom.nationalacademies.org/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx\" target=\"_blank\">“Dying in America,”\u003c/a> a landmark report released in 2014 by the Institute of Medicine. Too many people end up having aggressive treatment that is ineffective and expensive and doesn’t contribute to the patient’s quality of life, the report found. Other research examining\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/25/a-racial-gap-in-attitudes-toward-hospice-care/\" target=\"_blank\"> racial gaps in attitudes toward hospice care\u003c/a> and other studies has found differences among ethnic and religious groups in how they approach end-of-life decisions.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But people want to talk about it regardless of background, says Dr. Steven Pantilat, director of UC San Francisco's palliative care program. He was not involved in the study.\u003c/p>\n\u003cp>“What this study tells us is that \u003cem>all\u003c/em> of our patients want us to have these conversations,” Pantilat said. “They’re waiting for their doctors to bring it up, to not be rushed, to communicate sensitively.”\u003c/p>\n\u003cp>A new federal policy may make those conversations easier –- and more routine. Starting in January, \u003ca href=\"http://bigstory.ap.org/article/3c1463f23baa4b79b2f2462ee9fc29ff/medicare-cover-end-life-counseling\" target=\"_blank\">Medicare will reimburse physicians for discussing end-of-life care\u003c/a>. That policy infamously -- and incorrectly -- was derided as promoting “death panels” during the debate over the Affordable Care Act, and a version of it was dropped from the legislation. The counseling will cover what kind of medical care patients want to receive as they approach their last days.\u003c/p>\n\u003cp>Periyakoil urges patients of all backgrounds to prepare for these conversations, and new planning tools are available in different languages to help. Among them is the \u003ca href=\"http://med.stanford.edu/letter.html\" target=\"_blank\">Stanford Letter Project\u003c/a>, which helps patients write a letter to their doctors about the end-of-life care they do and don’t want in languages including English, Spanish, Mandarin, Vietnamese, Hindi, Urdu, Tagalog and Russian.\u003c/p>\n\u003cp>In one redacted letter provided by Periyakoil, a woman named Patricia writes: “I do not want my longevity to be more important than my comfort.”\u003c/p>\n\u003cp>Pantilat advises the doctors he trains that they don’t need deep knowledge of the beliefs of every religion and culture they might encounter, because every patient, of whatever ethnicity, has different goals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we come in with true curiosity, respect and openness, we can learn a lot about how to take care of someone in a sensitive way,” he said. We need to ask: “What do I need to know about your culture and your family to take good care of \u003cem>you\u003c/em>?”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>It's been more than 15 years since a team of researchers, led by a California physician, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/9635069?dopt=Abstract\" target=\"_blank\">identified \u003c/a>how traumatic events in childhood can be associated with risk factors for the leading causes of death later in life.\u003c/p>\n\u003cp>The team referred to the traumatic events they assessed -- including emotional, physical or sexual abuse, as well as household dysfunction -- as \"adverse childhood experiences\" or ACEs.\u003c/p>\n\u003cp>It's a straightforward \u003ca href=\"http://www.npr.org/blogs/health/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean\" target=\"_blank\">10-question quiz\u003c/a> of abuse and neglect. The more times you answer \"yes,\" the greater your risk of physical health as an adult.\u003c/p>\n\u003cp>It's taken awhile for the idea that ACEs can profoundly shape adult health to take hold. But over the last few years, the concept of ACEs have entered more mainstream conversations. Still, there's no recommended screening. A new Bay Area research collaboration wants to change that.\u003c/p>\n\u003cp>The San Francisco Center for Youth and Wellness, in partnership with researchers at UC San Francisco children's hospitals in both San Francisco and Oakland have teamed up to launch a multi-year study to evaluate screening for ACEs in primary care settings.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The goal is \"to develop and create a prospective pediatric screening tool which currently doesn't exist,\" said pediatrician Dayna Long who directs the health equity initiatives program at UCSF Children's Hospital Oakland.\u003c/p>\n\u003cp>Dr. Nadine Burke Harris is founder and CEO of the San Francisco-based Center for Youth Wellness. She says that the influential American Academy of Pediatrics told her that a \"rigorous study\" showing the impact of screening is needed, before it would recommend that its pediatrician members commence doing so.\u003c/p>\n\u003cp>The group's research is funded by a $4.8 million grant from the Tara Health Foundation. \"This is the type of research that the NIH isn't funding right now,\" Burke Harris said, in reference to the federal government's National Institutes of Health. \"So to be able to have organizations like Tara Health Foundation step up to advance the science is absolutely critical.\"\u003c/p>\n\u003cp>If the researchers can demonstrate the impact of screening, then the next step is treatment. \"Once we validate the screening tool,\" says Long, \"we're going to be able to pilot different intervention and mental health treatments to mitigate the harmful consequences of ACEs and prevent long term consequences.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.npr.org/sections/health-shots/2015/03/02/377569413/can-family-secrets-make-you-sick\" target=\"_blank\">Learn more about ACEs. \u003c/a>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's been more than 15 years since a team of researchers, led by a California physician, \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/9635069?dopt=Abstract\" target=\"_blank\">identified \u003c/a>how traumatic events in childhood can be associated with risk factors for the leading causes of death later in life.\u003c/p>\n\u003cp>The team referred to the traumatic events they assessed -- including emotional, physical or sexual abuse, as well as household dysfunction -- as \"adverse childhood experiences\" or ACEs.\u003c/p>\n\u003cp>It's a straightforward \u003ca href=\"http://www.npr.org/blogs/health/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean\" target=\"_blank\">10-question quiz\u003c/a> of abuse and neglect. The more times you answer \"yes,\" the greater your risk of physical health as an adult.\u003c/p>\n\u003cp>It's taken awhile for the idea that ACEs can profoundly shape adult health to take hold. But over the last few years, the concept of ACEs have entered more mainstream conversations. Still, there's no recommended screening. A new Bay Area research collaboration wants to change that.\u003c/p>\n\u003cp>The San Francisco Center for Youth and Wellness, in partnership with researchers at UC San Francisco children's hospitals in both San Francisco and Oakland have teamed up to launch a multi-year study to evaluate screening for ACEs in primary care settings.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The goal is \"to develop and create a prospective pediatric screening tool which currently doesn't exist,\" said pediatrician Dayna Long who directs the health equity initiatives program at UCSF Children's Hospital Oakland.\u003c/p>\n\u003cp>Dr. Nadine Burke Harris is founder and CEO of the San Francisco-based Center for Youth Wellness. She says that the influential American Academy of Pediatrics told her that a \"rigorous study\" showing the impact of screening is needed, before it would recommend that its pediatrician members commence doing so.\u003c/p>\n\u003cp>The group's research is funded by a $4.8 million grant from the Tara Health Foundation. \"This is the type of research that the NIH isn't funding right now,\" Burke Harris said, in reference to the federal government's National Institutes of Health. \"So to be able to have organizations like Tara Health Foundation step up to advance the science is absolutely critical.\"\u003c/p>\n\u003cp>If the researchers can demonstrate the impact of screening, then the next step is treatment. \"Once we validate the screening tool,\" says Long, \"we're going to be able to pilot different intervention and mental health treatments to mitigate the harmful consequences of ACEs and prevent long term consequences.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.npr.org/sections/health-shots/2015/03/02/377569413/can-family-secrets-make-you-sick\" target=\"_blank\">Learn more about ACEs. \u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Francisco Judge Rules For Husband in Frozen Embryo Fight",
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"content": "\u003cp>A woman must abide by an agreement with her ex-husband to destroy five frozen embryos if they got a divorce, despite her contention that they represent her last chance to have children, a San Francisco Superior Court judge ruled Wednesday.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/21/frozen-embryo-trial-highlights-gaps-in-law-ethics/\" target=\"_blank\">In the closely-watched case\u003c/a>, Judge Anne-Christine Massullo said in a tentative decision that the agreement trumps the woman's desire to now keep the embryos.\u003c/p>\n\u003cp>The couple's story began in 2010 as Mimi Lee and Stephen Findley were about to be married. Lee was diagnosed with breast cancer, and the couple decided to create embryos through in vitro fertilization in hopes of a future family.\u003c/p>\n\u003cp>Instead, the marriage fell apart, leaving the couple with five embryos. In 2013 the couple filed for divorce.\u003c/p>\n\u003cp>Findley wanted to discard the embryos in accordance with the agreement he and Lee signed while married. He worried in part that Lee would use any children to take financial advantage of him, according to the ruling.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lee's attorneys said no California court had previously ruled in such a case. A Pennsylvania court three years ago \u003ca href=\"http://articles.philly.com/2012-04-14/news/31342260_1_embryos-appeals-court-three-judge-superior-court-panel\" target=\"_blank\">awarded frozen embryos to a woman \u003c/a>who also said they may be her only way to have a child because of breast cancer treatment despite the objections of her ex-husband. An Illinois judge last year \u003ca href=\"http://www.chicagotribune.com/news/local/breaking/ct-embryos-court-ruling-met-20150612-story.html\" target=\"_blank\">also sided with a woman\u003c/a> who was infertile in her fight over embryos with an ex-boyfriend.\u003c/p>\n\u003cp>Massullo said California law is clear that couples must decide what to do with embryos they create in case of separation or divorce.\u003c/p>\n\u003cp>\"Decisions about family and children often are difficult, and can be wrenching when they become disputes,\" the judge wrote. \"The policy best suited to ensuring that these disputes are resolved in a clear-eyed manner ... is to give effect to the intentions of the parties at the time of the decision at issue.\"\u003c/p>\n\u003cp>An attorney for Lee, Peter Skinner, said in a statement his client was disappointed and was evaluating her legal options. Lee had argued that she had a right to change the agreement, and that she had a right to procreate.\u003c/p>\n\u003cp>While Lee might have a right to procreate in other circumstances, she doesn't have a right to procreate with Findley, the judge said.\u003c/p>\n\u003cp>The embryos were being held at UC San Francisco, which in accordance with state law gave Lee and Findley a consent agreement before the fertility treatments. In the agreement, they both said they would like the embryos \"thawed and discarded\" in case they divorced, according to court documents.\u003c/p>\n\u003cp>Lee argued that she thought the agreement was not legally binding. The judge ruled otherwise.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The tentative nature of the ruling gives the parties time to file objections, but such rulings generally become final.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A woman must abide by an agreement with her ex-husband to destroy five frozen embryos if they got a divorce, despite her contention that they represent her last chance to have children, a San Francisco Superior Court judge ruled Wednesday.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/21/frozen-embryo-trial-highlights-gaps-in-law-ethics/\" target=\"_blank\">In the closely-watched case\u003c/a>, Judge Anne-Christine Massullo said in a tentative decision that the agreement trumps the woman's desire to now keep the embryos.\u003c/p>\n\u003cp>The couple's story began in 2010 as Mimi Lee and Stephen Findley were about to be married. Lee was diagnosed with breast cancer, and the couple decided to create embryos through in vitro fertilization in hopes of a future family.\u003c/p>\n\u003cp>Instead, the marriage fell apart, leaving the couple with five embryos. In 2013 the couple filed for divorce.\u003c/p>\n\u003cp>Findley wanted to discard the embryos in accordance with the agreement he and Lee signed while married. He worried in part that Lee would use any children to take financial advantage of him, according to the ruling.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lee's attorneys said no California court had previously ruled in such a case. A Pennsylvania court three years ago \u003ca href=\"http://articles.philly.com/2012-04-14/news/31342260_1_embryos-appeals-court-three-judge-superior-court-panel\" target=\"_blank\">awarded frozen embryos to a woman \u003c/a>who also said they may be her only way to have a child because of breast cancer treatment despite the objections of her ex-husband. An Illinois judge last year \u003ca href=\"http://www.chicagotribune.com/news/local/breaking/ct-embryos-court-ruling-met-20150612-story.html\" target=\"_blank\">also sided with a woman\u003c/a> who was infertile in her fight over embryos with an ex-boyfriend.\u003c/p>\n\u003cp>Massullo said California law is clear that couples must decide what to do with embryos they create in case of separation or divorce.\u003c/p>\n\u003cp>\"Decisions about family and children often are difficult, and can be wrenching when they become disputes,\" the judge wrote. \"The policy best suited to ensuring that these disputes are resolved in a clear-eyed manner ... is to give effect to the intentions of the parties at the time of the decision at issue.\"\u003c/p>\n\u003cp>An attorney for Lee, Peter Skinner, said in a statement his client was disappointed and was evaluating her legal options. Lee had argued that she had a right to change the agreement, and that she had a right to procreate.\u003c/p>\n\u003cp>While Lee might have a right to procreate in other circumstances, she doesn't have a right to procreate with Findley, the judge said.\u003c/p>\n\u003cp>The embryos were being held at UC San Francisco, which in accordance with state law gave Lee and Findley a consent agreement before the fertility treatments. In the agreement, they both said they would like the embryos \"thawed and discarded\" in case they divorced, according to court documents.\u003c/p>\n\u003cp>Lee argued that she thought the agreement was not legally binding. The judge ruled otherwise.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The tentative nature of the ruling gives the parties time to file objections, but such rulings generally become final.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Contra Costa Co. Prepares to Offer Health Care to Undocumented Adults",
"title": "Contra Costa Co. Prepares to Offer Health Care to Undocumented Adults",
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"content": "\u003cp>Brookside Community Health Center in Richmond serves a lot of immigrants -- with legal papers and without -- and it's about to take on even more. Contra Costa County already provides insurance to undocumented children, and in September \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/22/contra-costa-restores-health-care-for-undocumented-adults/\" target=\"_blank\">county supervisors voted \u003c/a>to extend primary care services to 3,000 adults living here illegally.\u003c/p>\n\u003cp>The one-year pilot program, Contra Costa Cares, will offer coverage to 15 percent of those eligible.\u003c/p>\n\u003cp>Rosa Maria Arriaga, 72, has been living in Richmond as an undocumented immigrant for 24 years and was active in lobbying supervisors about the program. She says she needs treatment for asthma, depression and arthritis.\u003c/p>\n\u003cp>\"The coverage would help me a lot,\" she says in Spanish, \"because I could get my knee treated. The arthritis makes it so I can't walk. My asthma hits at night really hard, and when the depression comes on, I feel like it's better to die.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"5HTYXTB0erlz15N7R90X50ok3pbiChsI\"]Regular primary care might help Arriaga get her health issues under better control. But she says that level of care has been out of reach.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"When there's an emergency, I go to a clinic,\" she says. \"And each time it costs me $45. We need medical coverage, so we don't have to pay so much. That's why we're fighting for it.\"\u003c/p>\n\u003cp>Arriaga used to have health insurance through her work, but now that she's unemployed she says she relies more on over-the-counter remedies.\u003c/p>\n\u003cp>Gerald Kominski, director of the UCLA Center for Health Policy Research, says that's a typical solution for this population. \"When people are uninsured they just postpone care-seeking until it's absolutely necessary, and then it's much more costly.\"\u003c/p>\n\u003cp>Those working for the Contra Costa program are busy setting up systems to track these new patients.\u003c/p>\n\u003cp>\u003cstrong>Potential Savings ... or Costs?\u003c/strong>\u003c/p>\n\u003cp>Álvaro Fuentes is director of the county's Community Clinic Consortium, which will provide the medical homes for these new patients. He says they hope to show county officials a year from now that preventive care can save money.\u003c/p>\n\u003cp>\"If we can start with this small set of individuals and are able to start documenting and in some cases capture the cost savings to the health system, it may promote and motivate additional funding,\" Fuentes says.\u003c/p>\n\u003cp>But county Supervisor Candace Andersen is not convinced. She voted against the program, which is expected to cost $1 million and is being paid for by the county and by area hospitals.\u003c/p>\n\u003cp>\"This is a one-year pilot program,\" Andersen says, \"and there's no reliable funding source identified to make sure it's an ongoing program.\"\u003c/p>\n\u003cp>Contra Costa County used to provide health care coverage to undocumented adults, but cut its program during the 2009 recession. This move is a small step toward bringing it back.\u003c/p>\n\u003cp>Gabrielle Lessard, a health policy attorney with the National Immigration Law Center, says the task now is a bit less daunting, because so many more people are insured under the Affordable Care Act.\u003c/p>\n\u003cp>\"Now that the number has been whittled down to a more reasonable level, it's something the counties can see tackling,\" Lessard says. \"They understand when one person in a household doesn't have health insurance, the entire family is one illness or injury away from financial disaster.\"\u003c/p>\n\u003cp>\u003cstrong>Statewide Support for Coverage \u003c/strong>\u003c/p>\n\u003cp>And an increasing number of California voters seem to support tackling the issue. Fifty-eight percent of the state's voters, according to a \u003ca href=\"http://www.field.com/fieldpollonline/subscribers/Rls2510.pdf\" target=\"_blank\">recent Field Poll\u003c/a>, believe undocumented people should be eligible for Medi-Cal or a similar program.\u003c/p>\n\u003cp>Anthony Wright is executive director of Health Access, a statewide advocacy group. He believes there is momentum -- both policy and political -- to extend Medi-Cal to all the state's undocumented residents. He notes that 48 of California's 58 counties are now on board to provide some sort of limited low-cost or free health benefits to the undocumented.\u003c/p>\n\u003cp>\"We see the actions by Contra Costa, as well as other counties like Monterey and Sacramento, as county bridges to a statewide solution,\" he says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"8Cvj34dQy7DdilOQPhCdRrvrxS1D5Q2a\"]Wright and his allies recently won a big victory when the state agreed to expand Medi-Cal to\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\"> cover all undocumented children\u003c/a>, beginning next spring. That legislation had included insurance for all undocumented people regardless of age, but was pared down because of cost.\u003c/p>\n\u003cp>Expense isn't the only issue for Ira Mehlman, with the Federation for American Immigration Reform, which advocates for stricter immigration policies, including in California.\u003c/p>\n\u003cp>\"California for a long time has been moving in the direction of accommodating illegal immigration, bending over backwards to provide new services and benefits to people in the country illegally,\" he says.\u003c/p>\n\u003cp>Mehlman says other states are watching what's happening in California -- but, he says, it's a limited number of them.\u003c/p>\n\u003cp>\"If you look at the pattern over the past several years,\" he says, \"it is pretty much the same states that are doing things that are similar to what California is doing.\"\u003c/p>\n\u003cp>He's referring to other blue states -- like Washington, Illinois, Massachusetts and New York -- that already provide health coverage to undocumented children. The District of Columbia provides all its residents with public insurance, regardless of their immigration status.\u003c/p>\n\u003cp>Then there's California, with the largest undocumented population in the nation,\u003ca href=\"http://www.pewhispanic.org/2014/11/18/unauthorized-immigrant-totals-rise-in-7-states-fall-in-14/\" target=\"_blank\"> at 2.5 million\u003c/a>. Immigration law advocate Lessard says that makes the Golden State a kind of incubator.\u003c/p>\n\u003cp>\"Advocacy is going to continue,\" she says. \"It will probably be a multi-year effort, but I think eventually people will come to terms with the fact that everyone is just better off when we all have access to care.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That advocacy will be felt again in Sacramento next year. A two-year bill that was introduced last December would provide public health insurance to low-income people living here illegally. And the bill,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/12/01/senator-to-re-introduce-health-insurance-bill-for-undocumented-immigrants/\" target=\"_blank\"> SB10\u003c/a>, requests a federal waiver so those with more income can purchase private insurance through the state's health exchange.\u003c/p>\n\n\n\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Brookside Community Health Center in Richmond serves a lot of immigrants -- with legal papers and without -- and it's about to take on even more. Contra Costa County already provides insurance to undocumented children, and in September \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/22/contra-costa-restores-health-care-for-undocumented-adults/\" target=\"_blank\">county supervisors voted \u003c/a>to extend primary care services to 3,000 adults living here illegally.\u003c/p>\n\u003cp>The one-year pilot program, Contra Costa Cares, will offer coverage to 15 percent of those eligible.\u003c/p>\n\u003cp>Rosa Maria Arriaga, 72, has been living in Richmond as an undocumented immigrant for 24 years and was active in lobbying supervisors about the program. She says she needs treatment for asthma, depression and arthritis.\u003c/p>\n\u003cp>\"The coverage would help me a lot,\" she says in Spanish, \"because I could get my knee treated. The arthritis makes it so I can't walk. My asthma hits at night really hard, and when the depression comes on, I feel like it's better to die.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Regular primary care might help Arriaga get her health issues under better control. But she says that level of care has been out of reach.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"When there's an emergency, I go to a clinic,\" she says. \"And each time it costs me $45. We need medical coverage, so we don't have to pay so much. That's why we're fighting for it.\"\u003c/p>\n\u003cp>Arriaga used to have health insurance through her work, but now that she's unemployed she says she relies more on over-the-counter remedies.\u003c/p>\n\u003cp>Gerald Kominski, director of the UCLA Center for Health Policy Research, says that's a typical solution for this population. \"When people are uninsured they just postpone care-seeking until it's absolutely necessary, and then it's much more costly.\"\u003c/p>\n\u003cp>Those working for the Contra Costa program are busy setting up systems to track these new patients.\u003c/p>\n\u003cp>\u003cstrong>Potential Savings ... or Costs?\u003c/strong>\u003c/p>\n\u003cp>Álvaro Fuentes is director of the county's Community Clinic Consortium, which will provide the medical homes for these new patients. He says they hope to show county officials a year from now that preventive care can save money.\u003c/p>\n\u003cp>\"If we can start with this small set of individuals and are able to start documenting and in some cases capture the cost savings to the health system, it may promote and motivate additional funding,\" Fuentes says.\u003c/p>\n\u003cp>But county Supervisor Candace Andersen is not convinced. She voted against the program, which is expected to cost $1 million and is being paid for by the county and by area hospitals.\u003c/p>\n\u003cp>\"This is a one-year pilot program,\" Andersen says, \"and there's no reliable funding source identified to make sure it's an ongoing program.\"\u003c/p>\n\u003cp>Contra Costa County used to provide health care coverage to undocumented adults, but cut its program during the 2009 recession. This move is a small step toward bringing it back.\u003c/p>\n\u003cp>Gabrielle Lessard, a health policy attorney with the National Immigration Law Center, says the task now is a bit less daunting, because so many more people are insured under the Affordable Care Act.\u003c/p>\n\u003cp>\"Now that the number has been whittled down to a more reasonable level, it's something the counties can see tackling,\" Lessard says. \"They understand when one person in a household doesn't have health insurance, the entire family is one illness or injury away from financial disaster.\"\u003c/p>\n\u003cp>\u003cstrong>Statewide Support for Coverage \u003c/strong>\u003c/p>\n\u003cp>And an increasing number of California voters seem to support tackling the issue. Fifty-eight percent of the state's voters, according to a \u003ca href=\"http://www.field.com/fieldpollonline/subscribers/Rls2510.pdf\" target=\"_blank\">recent Field Poll\u003c/a>, believe undocumented people should be eligible for Medi-Cal or a similar program.\u003c/p>\n\u003cp>Anthony Wright is executive director of Health Access, a statewide advocacy group. He believes there is momentum -- both policy and political -- to extend Medi-Cal to all the state's undocumented residents. He notes that 48 of California's 58 counties are now on board to provide some sort of limited low-cost or free health benefits to the undocumented.\u003c/p>\n\u003cp>\"We see the actions by Contra Costa, as well as other counties like Monterey and Sacramento, as county bridges to a statewide solution,\" he says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Wright and his allies recently won a big victory when the state agreed to expand Medi-Cal to\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\"> cover all undocumented children\u003c/a>, beginning next spring. That legislation had included insurance for all undocumented people regardless of age, but was pared down because of cost.\u003c/p>\n\u003cp>Expense isn't the only issue for Ira Mehlman, with the Federation for American Immigration Reform, which advocates for stricter immigration policies, including in California.\u003c/p>\n\u003cp>\"California for a long time has been moving in the direction of accommodating illegal immigration, bending over backwards to provide new services and benefits to people in the country illegally,\" he says.\u003c/p>\n\u003cp>Mehlman says other states are watching what's happening in California -- but, he says, it's a limited number of them.\u003c/p>\n\u003cp>\"If you look at the pattern over the past several years,\" he says, \"it is pretty much the same states that are doing things that are similar to what California is doing.\"\u003c/p>\n\u003cp>He's referring to other blue states -- like Washington, Illinois, Massachusetts and New York -- that already provide health coverage to undocumented children. The District of Columbia provides all its residents with public insurance, regardless of their immigration status.\u003c/p>\n\u003cp>Then there's California, with the largest undocumented population in the nation,\u003ca href=\"http://www.pewhispanic.org/2014/11/18/unauthorized-immigrant-totals-rise-in-7-states-fall-in-14/\" target=\"_blank\"> at 2.5 million\u003c/a>. Immigration law advocate Lessard says that makes the Golden State a kind of incubator.\u003c/p>\n\u003cp>\"Advocacy is going to continue,\" she says. \"It will probably be a multi-year effort, but I think eventually people will come to terms with the fact that everyone is just better off when we all have access to care.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>That advocacy will be felt again in Sacramento next year. A two-year bill that was introduced last December would provide public health insurance to low-income people living here illegally. And the bill,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/12/01/senator-to-re-introduce-health-insurance-bill-for-undocumented-immigrants/\" target=\"_blank\"> SB10\u003c/a>, requests a federal waiver so those with more income can purchase private insurance through the state's health exchange.\u003c/p>\n\n\n\n\n\u003c/div>\u003c/p>",
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"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
"airtime": "SUN 9pm-10pm",
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"meta": {
"site": "radio",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.commonwealthclub.org/podcasts",
"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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}
},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
}
},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"id": "here-and-now",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/hiddenbrain.jpg",
"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
"site": "news",
"source": "NPR"
},
"link": "/radio/program/hidden-brain",
"subscribe": {
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"tuneIn": "https://tunein.com/podcasts/Science-Podcasts/Hidden-Brain-p787503/",
"rss": "https://feeds.npr.org/510308/podcast.xml"
}
},
"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"rss": "https://feeds.npr.org/510313/podcast.xml"
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
"imageAlt": "KQED Hyphenación",
"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
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"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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"amazon": "https://music.amazon.com/podcasts/6c3dd23c-93fb-4aab-97ba-1725fa6315f1/hyphenaci%C3%B3n",
"rss": "https://feeds.megaphone.fm/KQINC2275451163"
}
},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Political Mind of Jerry Brown",
"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/xtTd",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"stitcher": "https://www.stitcher.com/show/on-our-watch",
"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
"site": "news",
"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
"meta": {
"site": "news",
"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
"imageAlt": "KQED Perspectives",
"officialWebsiteLink": "/perspectives/",
"meta": {
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"source": "kqed",
"order": 14
},
"link": "/perspectives",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/id73801135",
"npr": "https://www.npr.org/podcasts/432309616/perspectives",
"rss": "https://ww2.kqed.org/perspectives/category/perspectives/feed/",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"
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},
"planet-money": {
"id": "planet-money",
"title": "Planet Money",
"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
"officialWebsiteLink": "https://www.npr.org/sections/money/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/planet-money",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/M4f5",
"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
"tuneIn": "https://tunein.com/podcasts/Business--Economics-Podcasts/Planet-Money-p164680/",
"rss": "https://feeds.npr.org/510289/podcast.xml"
}
},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Political Breakdown",
"officialWebsiteLink": "/podcasts/politicalbreakdown",
"meta": {
"site": "radio",
"source": "kqed",
"order": 5
},
"link": "/podcasts/politicalbreakdown",
"subscribe": {
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"amazon": "https://music.amazon.com/podcasts/e0c2d153-ad36-4c8d-901d-f1da6a724824/political-breakdown",
"npr": "https://www.npr.org/podcasts/572155894/political-breakdown",
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