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"content": "\u003cp>Just five months after the San Francisco Board of Supervisors approved a trio of regulations on sugar-sweetened beverages, a board committee will consider a proposal to repeal one of them.\u003c/p>\n\u003cp>On Monday the \u003ca href=\"https://sfgov.legistar.com/View.ashx?M=A&ID=444155&GUID=877CFFA5-29D1-42AE-A78F-071B6964A07D\" target=\"_blank\">Land Use Committee will debate\u003c/a> ending the city's prohibition on advertising of sugar-sweetened beverages on city property.\u003c/p>\n\u003cp>As it turns out,\u003ca href=\"https://sfgov.legistar.com/LegislationDetail.aspx?ID=2240423&GUID=5220A723-8443-476C-A36D-A986D9A4AAF3\" target=\"_blank\"> the advertising ban\u003c/a> has never been enforced. Just days after the supervisors passed the measure, the U.S. Supreme Court unanimously struck down an unrelated -- but similar -- effort to limit ads on public property, in the case \u003ca href=\"http://www.scotusblog.com/case-files/cases/reed-v-town-of-gilbert-arizona/\" target=\"_blank\">Reed vs. Town of Gilbert, Arizona.\u003c/a>\u003c/p>\n\u003cp>Shortly after that, the American Beverage Association, an industry group, slapped San Francisco with a lawsuit challenging both the ad ban and another measure requiring warning labels on sugary-beverage ads on First Amendment grounds.\u003c/p>\n\u003cp>Supervisor Malia Cohen introduced the original legislation -- and the proposed repeal to be considered Monday. \"I in no way see this as a setback,\" she said in an interview with State of Health. She said the City Attorney had reviewed the law after the Supreme Court's ruling in the Reed case and determined San Francisco's law was \"probably indefensible.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We need to be strategic about the battles we're fighting,\" said Cohen, who represents District 10, including the Bayview Hunters Point and Potrero Hill neighborhoods.\u003c/p>\n\u003cp>A spokeswoman for the American Beverage Association said the group would withhold comment until after the committee votes on the repeal on Monday.\u003c/p>\n\u003cp>Cohen said the city would not back down on the other two beverage regulations, including the\u003ca href=\"https://sfgov.legistar.com/LegislationDetail.aspx?ID=2240431&GUID=B8DF3155-7848-437C-BBDC-84DE56DEB16D\" target=\"_blank\"> warning requirement\u003c/a> for billboards and posters anywhere in San Francisco, not just public property that is also being challenged by the beverage association. The law is scheduled to take effect next June.\u003c/p>\n\u003cp>Deputy City Attorney Christine Aken is confident the law will survive the beverage association's lawsuit. \"We believe we have a strong legal basis for vigorously defending the warning requirement from First Amendment challenge,\" she said.\u003c/p>\n\u003cp>The third regulation \u003ca href=\"https://sfgov.legistar.com/LegislationDetail.aspx?ID=2240429&GUID=86A6B072-6A84-4F5E-88A1-0B133662EF12\" target=\"_blank\">bans the sale\u003c/a> of sugar-sweetened beverages by city departments as well as contractors and grantees. That law took effect in July and is not being challenged by the beverage association.\u003c/p>\n\u003cp>The committee meeting Monday comes just over a year after\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/11/04/will-berkeley-and-san-francisco-soda-tax-measures-set-precedent/\" target=\"_blank\"> San Francisco voters rejected\u003c/a> a proposed two-cents-per-ounce tax on sugar-sweetened beverages. The proposal needed a two-thirds majority, but received 55 percent of the vote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Last November\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/11/04/will-berkeley-and-san-francisco-soda-tax-measures-set-precedent/\" target=\"_blank\">, Berkeley voters overwhelmingly approved\u003c/a> a penny-per-ounce tax, making it the first city in the country to pass a so-called soda tax.\u003c/p>\n\n",
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"excerpt": "The law bans ads for sugar-sweetened beverages anywhere on city property. The city is being sued by the American Beverage Association.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Just five months after the San Francisco Board of Supervisors approved a trio of regulations on sugar-sweetened beverages, a board committee will consider a proposal to repeal one of them.\u003c/p>\n\u003cp>On Monday the \u003ca href=\"https://sfgov.legistar.com/View.ashx?M=A&ID=444155&GUID=877CFFA5-29D1-42AE-A78F-071B6964A07D\" target=\"_blank\">Land Use Committee will debate\u003c/a> ending the city's prohibition on advertising of sugar-sweetened beverages on city property.\u003c/p>\n\u003cp>As it turns out,\u003ca href=\"https://sfgov.legistar.com/LegislationDetail.aspx?ID=2240423&GUID=5220A723-8443-476C-A36D-A986D9A4AAF3\" target=\"_blank\"> the advertising ban\u003c/a> has never been enforced. Just days after the supervisors passed the measure, the U.S. Supreme Court unanimously struck down an unrelated -- but similar -- effort to limit ads on public property, in the case \u003ca href=\"http://www.scotusblog.com/case-files/cases/reed-v-town-of-gilbert-arizona/\" target=\"_blank\">Reed vs. Town of Gilbert, Arizona.\u003c/a>\u003c/p>\n\u003cp>Shortly after that, the American Beverage Association, an industry group, slapped San Francisco with a lawsuit challenging both the ad ban and another measure requiring warning labels on sugary-beverage ads on First Amendment grounds.\u003c/p>\n\u003cp>Supervisor Malia Cohen introduced the original legislation -- and the proposed repeal to be considered Monday. \"I in no way see this as a setback,\" she said in an interview with State of Health. She said the City Attorney had reviewed the law after the Supreme Court's ruling in the Reed case and determined San Francisco's law was \"probably indefensible.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We need to be strategic about the battles we're fighting,\" said Cohen, who represents District 10, including the Bayview Hunters Point and Potrero Hill neighborhoods.\u003c/p>\n\u003cp>A spokeswoman for the American Beverage Association said the group would withhold comment until after the committee votes on the repeal on Monday.\u003c/p>\n\u003cp>Cohen said the city would not back down on the other two beverage regulations, including the\u003ca href=\"https://sfgov.legistar.com/LegislationDetail.aspx?ID=2240431&GUID=B8DF3155-7848-437C-BBDC-84DE56DEB16D\" target=\"_blank\"> warning requirement\u003c/a> for billboards and posters anywhere in San Francisco, not just public property that is also being challenged by the beverage association. The law is scheduled to take effect next June.\u003c/p>\n\u003cp>Deputy City Attorney Christine Aken is confident the law will survive the beverage association's lawsuit. \"We believe we have a strong legal basis for vigorously defending the warning requirement from First Amendment challenge,\" she said.\u003c/p>\n\u003cp>The third regulation \u003ca href=\"https://sfgov.legistar.com/LegislationDetail.aspx?ID=2240429&GUID=86A6B072-6A84-4F5E-88A1-0B133662EF12\" target=\"_blank\">bans the sale\u003c/a> of sugar-sweetened beverages by city departments as well as contractors and grantees. That law took effect in July and is not being challenged by the beverage association.\u003c/p>\n\u003cp>The committee meeting Monday comes just over a year after\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/11/04/will-berkeley-and-san-francisco-soda-tax-measures-set-precedent/\" target=\"_blank\"> San Francisco voters rejected\u003c/a> a proposed two-cents-per-ounce tax on sugar-sweetened beverages. The proposal needed a two-thirds majority, but received 55 percent of the vote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Last November\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/11/04/will-berkeley-and-san-francisco-soda-tax-measures-set-precedent/\" target=\"_blank\">, Berkeley voters overwhelmingly approved\u003c/a> a penny-per-ounce tax, making it the first city in the country to pass a so-called soda tax.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Five years ago, Congress promised an overhaul of the nation's food safety system, passing the Food Safety Modernization Act.\u003c/p>\n\u003cp>It took much longer than expected, but the Food and Drug Administration has now released the centerpiece — or at least, the most contested — part of that overhaul. These are rules that cover farmers who grow \u003ca href=\"http://www.fda.gov/Food/GuidanceRegulation/FSMA/ucm334114.htm#dates\" target=\"_blank\">fresh produce\u003c/a>, as well as \u003ca href=\"http://www.fda.gov/Food/GuidanceRegulation/FSMA/ucm361902.htm\" target=\"_blank\">food importers\u003c/a>.\u003c/p>\n\u003cp>\"This is a giant step forward,\" said Michael Taylor, the FDA's deputy commissioner for foods.\u003c/p>\n\u003cp>Earlier drafts of the regulations on vegetable farming generated howls of protest. The rules are intended to prevent disease-causing bacteria from contaminating vegetables that people often eat raw.\u003c/p>\n\u003cp>But small farmers, in particular, complained that some requirements, such as those calling for regular testing of irrigation water, were onerous and costly. Organic farmers \u003ca href=\"http://www.npr.org/sections/thesalt/2013/11/21/246386290/organic-farmers-bash-fda-restrictions-on-manure-use\" target=\"_blank\">protested\u003c/a> against restrictions on the use of manure for fertilizer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The final regulations contain compromises on some of those requirements. The FDA is conducting more research on the risks of using fresh manure, but in the meantime, it \"does not object\" to farmers simply following rules that already govern the use of manure in organic farming.\u003c/p>\n\u003cp>New regulations on food importers, meanwhile, require them to have programs in place to verify that their foreign suppliers are taking just as many safety precautions as farmers in the U.S. And the FDA will check up, sending safety inspectors around the world to visit food suppliers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Both rules will start to go into effect in two years. Enforcing the new rules will require a boost in the FDA's budget, and Congress will have to approve it. \"It will not succeed without resources,\" said the FDA's Taylor.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=It%27s+Final%3A+FDA+Issues+Long-Awaited+Food+Safety+Rules&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Five years ago, Congress promised an overhaul of the nation's food safety system, passing the Food Safety Modernization Act.\u003c/p>\n\u003cp>It took much longer than expected, but the Food and Drug Administration has now released the centerpiece — or at least, the most contested — part of that overhaul. These are rules that cover farmers who grow \u003ca href=\"http://www.fda.gov/Food/GuidanceRegulation/FSMA/ucm334114.htm#dates\" target=\"_blank\">fresh produce\u003c/a>, as well as \u003ca href=\"http://www.fda.gov/Food/GuidanceRegulation/FSMA/ucm361902.htm\" target=\"_blank\">food importers\u003c/a>.\u003c/p>\n\u003cp>\"This is a giant step forward,\" said Michael Taylor, the FDA's deputy commissioner for foods.\u003c/p>\n\u003cp>Earlier drafts of the regulations on vegetable farming generated howls of protest. The rules are intended to prevent disease-causing bacteria from contaminating vegetables that people often eat raw.\u003c/p>\n\u003cp>But small farmers, in particular, complained that some requirements, such as those calling for regular testing of irrigation water, were onerous and costly. Organic farmers \u003ca href=\"http://www.npr.org/sections/thesalt/2013/11/21/246386290/organic-farmers-bash-fda-restrictions-on-manure-use\" target=\"_blank\">protested\u003c/a> against restrictions on the use of manure for fertilizer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The final regulations contain compromises on some of those requirements. The FDA is conducting more research on the risks of using fresh manure, but in the meantime, it \"does not object\" to farmers simply following rules that already govern the use of manure in organic farming.\u003c/p>\n\u003cp>New regulations on food importers, meanwhile, require them to have programs in place to verify that their foreign suppliers are taking just as many safety precautions as farmers in the U.S. And the FDA will check up, sending safety inspectors around the world to visit food suppliers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Both rules will start to go into effect in two years. Enforcing the new rules will require a boost in the FDA's budget, and Congress will have to approve it. \"It will not succeed without resources,\" said the FDA's Taylor.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=It%27s+Final%3A+FDA+Issues+Long-Awaited+Food+Safety+Rules&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "2 Million on Medi-Cal Face Different Appeals Process",
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"content": "\u003cp>Ben Fallstead, 28, was diagnosed several years ago with \u003ca href=\"http://www.cdc.gov/parasites/babesiosis/gen_info/faqs.html\" target=\"_blank\">babesiosis\u003c/a>, a tick-borne disease that left him exhausted, wracked with fevers and chronic joint pain and unable to hold a job.\u003c/p>\n\u003cp>After going through several antibiotics, his specialist prescribed one that brought him some relief.\u003c/p>\n\u003cp>“I was just getting to the point where I felt semi-normal,” he says.\u003c/p>\n\u003cp>But early last year, his managed care Medi-Cal plan told him it would not refill the medication, saying that it doesn’t support the long-term use of antibiotics, he says.\u003c/p>\n\u003cp>Since then, the Lake County man has been fighting his plan’s decision, waiting months for judges who aren’t medical experts to determine his medical fate.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Fallstead is among roughly 2 million Medi-Cal recipients who must use a different medical appeals process than most others on Medi-Cal. \u003ca href=\"http://www.dhcs.ca.gov/Services/medi-cal/pages/whatismedi-cal.aspx\" target=\"_blank\">Medi-Cal \u003c/a>is the state’s version of the federal Medicaid program that provides health insurance to low-income residents.\u003c/p>\n\u003cp>These Californians live in 22 counties, from Orange County to the Central Coast and rural Northern California. Unlike about 8 million other Medi-Cal enrollees in managed care, most of them can’t appeal their case to an independent physician.\u003c/p>\n\u003cp>Advocates, patients and some lawmakers say this has delayed critical treatments and is simply unfair.\u003c/p>\n\u003cp>“There should be uniformity in the protections of all Medi-Cal recipients,” says state Sen. Bill Monning, a Democrat whose district covers three affected counties: Monterey, Santa Cruz and San Luis Obispo.\u003c/p>\n\u003cp>Today, I’ll explain this inconsistency and offer advice to those people it affects.\u003c/p>\n\u003cp>\u003cb>Q: I live in Orange County and have Medi-Cal. I’m in the middle of cancer treatment but my health plan is making me get reapproved before I can continue. What are my options? \u003c/b>\u003c/p>\n\u003cp>A: If your medical plan makes a decision that you disagree with, such as not covering the medication or therapy your doctor has ordered, you usually start by appealing with the plan itself.\u003c/p>\n\u003cp>If the plan won’t budge, you move to the second level of appeals. This is where the difference lies.\u003c/p>\n\u003cp>The vast majority of managed care Medi-Cal recipients are in plans regulated by the state \u003ca href=\"https://www.dmhc.ca.gov/\" target=\"_blank\">Department of Managed Health Care\u003c/a>. They have access to something called an \u003ca href=\"https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReview(IMR).aspx#.VjpX0mSrTw4\" target=\"_blank\">Independent Medical Review \u003c/a>(IMR), which allows them to appeal their plan’s decision to an independent physician (or physicians) who are experts in the conditions being reviewed.\u003c/p>\n\u003cul>\n\u003cli>If your health issue is urgent, you can request an expedited IMR to be conducted within a week.\u003c/li>\n\u003cli>If it is not urgent, it is usually decided within 30 days.\u003c/li>\n\u003c/ul>\n\u003cp>But Orange County managed care Medi-Cal recipients receive coverage through a plan called a \u003ca href=\"http://www.healthconsumer.org/092914-ManagedCareinCaliforniaSeries-3-COHSMediCalPlans.pdf\" target=\"_blank\">County Organized Health System \u003c/a>(COHS).\u003c/p>\n\u003cp>There are six COHS plans, including \u003ca href=\"https://www.caloptima.org/\" target=\"_blank\">CalOptima\u003c/a> in Orange County and \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\">Partnership HealthPlan\u003c/a>, which covers 14 Northern California counties. If you’re in one of these counties, your local COHS plan is the only Medi-Cal plan available to you.\u003c/p>\n\u003cp>These publicly operated plans were exempted from certain requirements more than 30 years ago when they were much smaller entities.\u003c/p>\n\u003cp>That means you don’t have access to an IMR for your second layer of appeals. You must request a state fair hearing and plead your case before an administrative law judge who usually is not a medical expert.\u003c/p>\n\u003cul>\n\u003cli>The cases must be decided within 90 days after the Medi-Cal recipient requests a hearing, says Michael Weston, spokesman for the state \u003ca href=\"http://www.cdss.ca.gov/cdssweb/default.htm\" target=\"_blank\">Department of Social Services\u003c/a>, which conducts the hearings.\u003c/li>\n\u003cli>An enrollee whose health is in danger from delay may request an expedited hearing. If a judge agrees, a hearing will be scheduled within 10 days of the request and a decision rendered within five days after all evidence has been submitted, Weston says.\u003c/li>\n\u003c/ul>\n\u003cp>(There is an exception. \u003ca href=\"https://www.hpsm.org/\" target=\"_blank\">The Health Plan of San Mateo\u003c/a>, a COHS plan, has voluntarily agreed to be regulated by the Department of Managed Health Care, so its enrollees can request an IMR.)\u003c/p>\n\u003cp>Fallstead has requested two state fair hearings in the past two years. Both took longer than 90 days to resolve.\u003c/p>\n\u003cp>“I feel like they’re denying me medication,” he says. “It feels like I’m not a person to them.”\u003c/p>\n\u003cp>Liza Thantranon,\u003ca href=\"http://lsnc.info/\" target=\"_blank\"> Legal Services of Northern California\u003c/a>’s managing attorney for health, says she deals with this problem every day.\u003c/p>\n\u003cp>Her clients who have access to IMRs usually are able to resolve their cases within a month, she says. However, the majority of her COHS clients who request state fair hearings wait more than 90 days for a decision, some as long as six to eight months.\u003c/p>\n\u003cp>“In the middle, you have administrative law judges trying to evaluate which doctor is right,” Thantranon says. “They don’t know what the science is.”\u003c/p>\n\u003cp>Weston counters that the judges are trained to make “factual findings based on evidence, including the medical evidence provided by the plan and the doctor.”\u003c/p>\n\u003cp>The plans say they’re not against regulation, but over-regulation. They’re already regulated twice, by the federal and state governments, says Bob Freeman, CEO of \u003ca href=\"https://www.cencalhealth.org/\" target=\"_blank\">CenCal Health\u003c/a>, the COHS plan that covers about 165,000 Medi-Cal enrollees in San Luis Obispo and Santa Barbara Counties.\u003c/p>\n\u003cp>Adding this additional layer of regulation would require them to pay about $4 million collectively in fees each year to the Department of Managed Health Care, he says.\u003c/p>\n\u003cp>“Where’s the value to the taxpayer in that?” Freeman asks. “That money could go somewhere else.”\u003c/p>\n\u003cp>For those of you who are in a COHS plan, here are some tips on the appeal process:\u003c/p>\n\u003cul>\n\u003cli>If your plan denies the initial internal appeal, ask it to review its decision. At the same time, immediately request a state fair hearing. You can always withdraw from the hearing later if you’re able to resolve the problem directly with your health plan.\u003c/li>\n\u003cli>Request a state fair hearing by calling 855-795-0634 or email your request to \u003ca href=\"shdcsu@dss.ca.gov\" target=\"_blank\">shdcsu@dss.ca.gov\u003c/a>.\u003c/li>\n\u003cli>Before your hearing, gather medical evidence to bolster your case. “Ask your doctors to write letters of support,” Thantranon says. Your doctor can also participate in the hearing by phone, Weston says.\u003c/li>\n\u003cli>Get help from health care advocacy groups. The Health Consumer Alliance is a good place to start: \u003ca href=\"http://healthconsumer.org/\" target=\"_blank\">healthconsumer.org \u003c/a>and 888-804-3536.\u003c/li>\n\u003cli>If you’re unhappy with the state fair hearing decision, you may be able to request a rehearing or take your case to civil court, Weston says. You also can contact the \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx\" target=\"_blank\">Medi-Cal Managed Care Office of the Ombudsman\u003c/a> at 888-452-8609 or \u003ca href=\"MMCDOmbudsmanOffice@dhcs.ca.gov\" target=\"_blank\">MMCDOmbudsmanOffice@dhcs.ca.gov\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003ci>Questions for Emily: \u003c/i>\u003ci>\u003ca href=\"http://AskEmily@usc.edu\" target=\"_blank\">AskEmily@usc.edu\u003c/a>\u003c/i>\u003c/p>\n\u003cp>\u003cem>Read \u003ca href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\" target=\"_blank\">previous Ask Emily columns.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ci>The \u003ca href=\"http://www.centerforhealthreporting.org/\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a> partners with news organizations to cover California health policy. Located at the \u003ca href=\"http://annenberg.usc.edu/\" target=\"_blank\">USC Annenberg School for Communication and Journalism\u003c/a>, it is funded by the nonpartisan \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California HealthCare Foundation\u003c/a>\u003c/i>.\u003c/p>\n\n",
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"excerpt": "While most appeals for most people on Medi-Cal are reviewed by independent doctors, some are decided by a judge who may not have a medical background.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ben Fallstead, 28, was diagnosed several years ago with \u003ca href=\"http://www.cdc.gov/parasites/babesiosis/gen_info/faqs.html\" target=\"_blank\">babesiosis\u003c/a>, a tick-borne disease that left him exhausted, wracked with fevers and chronic joint pain and unable to hold a job.\u003c/p>\n\u003cp>After going through several antibiotics, his specialist prescribed one that brought him some relief.\u003c/p>\n\u003cp>“I was just getting to the point where I felt semi-normal,” he says.\u003c/p>\n\u003cp>But early last year, his managed care Medi-Cal plan told him it would not refill the medication, saying that it doesn’t support the long-term use of antibiotics, he says.\u003c/p>\n\u003cp>Since then, the Lake County man has been fighting his plan’s decision, waiting months for judges who aren’t medical experts to determine his medical fate.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Fallstead is among roughly 2 million Medi-Cal recipients who must use a different medical appeals process than most others on Medi-Cal. \u003ca href=\"http://www.dhcs.ca.gov/Services/medi-cal/pages/whatismedi-cal.aspx\" target=\"_blank\">Medi-Cal \u003c/a>is the state’s version of the federal Medicaid program that provides health insurance to low-income residents.\u003c/p>\n\u003cp>These Californians live in 22 counties, from Orange County to the Central Coast and rural Northern California. Unlike about 8 million other Medi-Cal enrollees in managed care, most of them can’t appeal their case to an independent physician.\u003c/p>\n\u003cp>Advocates, patients and some lawmakers say this has delayed critical treatments and is simply unfair.\u003c/p>\n\u003cp>“There should be uniformity in the protections of all Medi-Cal recipients,” says state Sen. Bill Monning, a Democrat whose district covers three affected counties: Monterey, Santa Cruz and San Luis Obispo.\u003c/p>\n\u003cp>Today, I’ll explain this inconsistency and offer advice to those people it affects.\u003c/p>\n\u003cp>\u003cb>Q: I live in Orange County and have Medi-Cal. I’m in the middle of cancer treatment but my health plan is making me get reapproved before I can continue. What are my options? \u003c/b>\u003c/p>\n\u003cp>A: If your medical plan makes a decision that you disagree with, such as not covering the medication or therapy your doctor has ordered, you usually start by appealing with the plan itself.\u003c/p>\n\u003cp>If the plan won’t budge, you move to the second level of appeals. This is where the difference lies.\u003c/p>\n\u003cp>The vast majority of managed care Medi-Cal recipients are in plans regulated by the state \u003ca href=\"https://www.dmhc.ca.gov/\" target=\"_blank\">Department of Managed Health Care\u003c/a>. They have access to something called an \u003ca href=\"https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReview(IMR).aspx#.VjpX0mSrTw4\" target=\"_blank\">Independent Medical Review \u003c/a>(IMR), which allows them to appeal their plan’s decision to an independent physician (or physicians) who are experts in the conditions being reviewed.\u003c/p>\n\u003cul>\n\u003cli>If your health issue is urgent, you can request an expedited IMR to be conducted within a week.\u003c/li>\n\u003cli>If it is not urgent, it is usually decided within 30 days.\u003c/li>\n\u003c/ul>\n\u003cp>But Orange County managed care Medi-Cal recipients receive coverage through a plan called a \u003ca href=\"http://www.healthconsumer.org/092914-ManagedCareinCaliforniaSeries-3-COHSMediCalPlans.pdf\" target=\"_blank\">County Organized Health System \u003c/a>(COHS).\u003c/p>\n\u003cp>There are six COHS plans, including \u003ca href=\"https://www.caloptima.org/\" target=\"_blank\">CalOptima\u003c/a> in Orange County and \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\">Partnership HealthPlan\u003c/a>, which covers 14 Northern California counties. If you’re in one of these counties, your local COHS plan is the only Medi-Cal plan available to you.\u003c/p>\n\u003cp>These publicly operated plans were exempted from certain requirements more than 30 years ago when they were much smaller entities.\u003c/p>\n\u003cp>That means you don’t have access to an IMR for your second layer of appeals. You must request a state fair hearing and plead your case before an administrative law judge who usually is not a medical expert.\u003c/p>\n\u003cul>\n\u003cli>The cases must be decided within 90 days after the Medi-Cal recipient requests a hearing, says Michael Weston, spokesman for the state \u003ca href=\"http://www.cdss.ca.gov/cdssweb/default.htm\" target=\"_blank\">Department of Social Services\u003c/a>, which conducts the hearings.\u003c/li>\n\u003cli>An enrollee whose health is in danger from delay may request an expedited hearing. If a judge agrees, a hearing will be scheduled within 10 days of the request and a decision rendered within five days after all evidence has been submitted, Weston says.\u003c/li>\n\u003c/ul>\n\u003cp>(There is an exception. \u003ca href=\"https://www.hpsm.org/\" target=\"_blank\">The Health Plan of San Mateo\u003c/a>, a COHS plan, has voluntarily agreed to be regulated by the Department of Managed Health Care, so its enrollees can request an IMR.)\u003c/p>\n\u003cp>Fallstead has requested two state fair hearings in the past two years. Both took longer than 90 days to resolve.\u003c/p>\n\u003cp>“I feel like they’re denying me medication,” he says. “It feels like I’m not a person to them.”\u003c/p>\n\u003cp>Liza Thantranon,\u003ca href=\"http://lsnc.info/\" target=\"_blank\"> Legal Services of Northern California\u003c/a>’s managing attorney for health, says she deals with this problem every day.\u003c/p>\n\u003cp>Her clients who have access to IMRs usually are able to resolve their cases within a month, she says. However, the majority of her COHS clients who request state fair hearings wait more than 90 days for a decision, some as long as six to eight months.\u003c/p>\n\u003cp>“In the middle, you have administrative law judges trying to evaluate which doctor is right,” Thantranon says. “They don’t know what the science is.”\u003c/p>\n\u003cp>Weston counters that the judges are trained to make “factual findings based on evidence, including the medical evidence provided by the plan and the doctor.”\u003c/p>\n\u003cp>The plans say they’re not against regulation, but over-regulation. They’re already regulated twice, by the federal and state governments, says Bob Freeman, CEO of \u003ca href=\"https://www.cencalhealth.org/\" target=\"_blank\">CenCal Health\u003c/a>, the COHS plan that covers about 165,000 Medi-Cal enrollees in San Luis Obispo and Santa Barbara Counties.\u003c/p>\n\u003cp>Adding this additional layer of regulation would require them to pay about $4 million collectively in fees each year to the Department of Managed Health Care, he says.\u003c/p>\n\u003cp>“Where’s the value to the taxpayer in that?” Freeman asks. “That money could go somewhere else.”\u003c/p>\n\u003cp>For those of you who are in a COHS plan, here are some tips on the appeal process:\u003c/p>\n\u003cul>\n\u003cli>If your plan denies the initial internal appeal, ask it to review its decision. At the same time, immediately request a state fair hearing. You can always withdraw from the hearing later if you’re able to resolve the problem directly with your health plan.\u003c/li>\n\u003cli>Request a state fair hearing by calling 855-795-0634 or email your request to \u003ca href=\"shdcsu@dss.ca.gov\" target=\"_blank\">shdcsu@dss.ca.gov\u003c/a>.\u003c/li>\n\u003cli>Before your hearing, gather medical evidence to bolster your case. “Ask your doctors to write letters of support,” Thantranon says. Your doctor can also participate in the hearing by phone, Weston says.\u003c/li>\n\u003cli>Get help from health care advocacy groups. The Health Consumer Alliance is a good place to start: \u003ca href=\"http://healthconsumer.org/\" target=\"_blank\">healthconsumer.org \u003c/a>and 888-804-3536.\u003c/li>\n\u003cli>If you’re unhappy with the state fair hearing decision, you may be able to request a rehearing or take your case to civil court, Weston says. You also can contact the \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx\" target=\"_blank\">Medi-Cal Managed Care Office of the Ombudsman\u003c/a> at 888-452-8609 or \u003ca href=\"MMCDOmbudsmanOffice@dhcs.ca.gov\" target=\"_blank\">MMCDOmbudsmanOffice@dhcs.ca.gov\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003ci>Questions for Emily: \u003c/i>\u003ci>\u003ca href=\"http://AskEmily@usc.edu\" target=\"_blank\">AskEmily@usc.edu\u003c/a>\u003c/i>\u003c/p>\n\u003cp>\u003cem>Read \u003ca href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\" target=\"_blank\">previous Ask Emily columns.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "California, Feds Reach Deal on Medicaid Reform",
"title": "California, Feds Reach Deal on Medicaid Reform",
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"content": "\u003cp>California and the federal government agreed in concept Saturday on a $6.2-billion deal to reform the Medicaid program and to help pay for care of the low-income population.\u003c/p>\n\u003cp>The largest share of the funds –- nearly $3.3 billion -– is aimed at helping public hospitals improve the safety and quality of patient care. The plan, known as the Medicaid waiver, also provides money to cover the uninsured and create pilot programs to keep high-need populations out of emergency rooms.\u003c/p>\n\u003cp>Erica Murray, CEO of the California Association of Public Hospitals and Health Systems, said that while the deal provides less than the state requested, it includes all the key policies needed to help public hospitals continue the work they started under the last waiver agreement.\u003c/p>\n\u003cp>“We are now excited to roll up our sleeves, negotiate the details and get to work,” Murray said.\u003c/p>\n\u003cp>State officials called the deal a “conceptual agreement” and said they would continue working with the federal government to work out specifics. In the meantime, the current waiver –- which would have expired Saturday -- will be extended until Dec. 31.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The funds come from both the federal and state governments and ease the rules on how to run the Medicaid program, known as Medi-Cal in California.\u003c/p>\n\u003cp>The state Department of Health Care Services submitted a proposal for the waiver, also known as \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx\" target=\"_blank\">“Medi-Cal 2020,”\u003c/a> in March and had been negotiating with the federal Centers for Medicare & Medicaid Services ever since. The original proposal was whittled down from $17 billion to $7.25 and finally to $6.2 billion during the negotiations.\u003c/p>\n\u003cp>Even so, Dr. Susan Ehrlich, CEO of San Mateo Medical Center, said Saturday that public hospitals can now keep improving access to primary care, integrating physical and mental health services and making other changes to help patients stay healthy and out of the hospital.\u003c/p>\n\u003cp>Ehrlich, who traveled to Washington earlier this week with several other hospital \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/28/billions-in-medicaid-funding-at-risk-as-california-feds-debate/\" target=\"_blank\">leaders to push for the new waiver\u003c/a>, said she and others will be watching closely to see how the details get worked out.\u003c/p>\n\u003cp>“But mostly, we are just really pleased that the overarching substance of the deal turned out the way it did,” she said.\u003c/p>\n\u003cp>Under the expiring five-year waiver, known as the “Bridge to Reform,” hospitals across the state began to overhaul the way they provided care. For example, they created programs to track chronically ill patients and expanded their primary care clinics. Other programs helped reduce deaths by sepsis infections and the number of patients with uncontrolled diabetes.\u003c/p>\n\u003cp>Hospital leaders said they expect the changes to save money for the state and federal government.\u003c/p>\n\u003cp>With the new waiver, health officials can take their efforts to the next level, Anthony Wright, executive director of Health Access California, said in a statement. Once the details are hammered out, Wright said, “we expect to see an explosion of exciting activity at the county level to improve health care.”\u003c/p>\n\u003cp>Wright added that the agreement has the potential to “spur innovation in counties across the state.”\u003c/p>\n\u003cp>The waiver also fundamentally changes the way government covers the uninsured. Instead of only covering hospital-based care, public hospitals and clinics will have more flexibility and be able to focus more on outpatient and primary care.\u003c/p>\n\u003cp>Instead of funding five years of care for the uninsured, however, the plan only specifies $236 million for the first year. Funding for the next four will depend on an outside assessment of how much hospitals need.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Affordable Care Act expanded coverage to millions of Californians. Still, more than 3 million are believed to be without insurance. Murray of the hospital association said she believes there will still be “significant need” for hospitals to receive additional funding for the uninsured population.\u003c/p>\n\n",
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"excerpt": "‘Conceptual agreement’ worth $6.2 billion a relief to California public hospitals, current Medicaid agreement was set to expire.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California and the federal government agreed in concept Saturday on a $6.2-billion deal to reform the Medicaid program and to help pay for care of the low-income population.\u003c/p>\n\u003cp>The largest share of the funds –- nearly $3.3 billion -– is aimed at helping public hospitals improve the safety and quality of patient care. The plan, known as the Medicaid waiver, also provides money to cover the uninsured and create pilot programs to keep high-need populations out of emergency rooms.\u003c/p>\n\u003cp>Erica Murray, CEO of the California Association of Public Hospitals and Health Systems, said that while the deal provides less than the state requested, it includes all the key policies needed to help public hospitals continue the work they started under the last waiver agreement.\u003c/p>\n\u003cp>“We are now excited to roll up our sleeves, negotiate the details and get to work,” Murray said.\u003c/p>\n\u003cp>State officials called the deal a “conceptual agreement” and said they would continue working with the federal government to work out specifics. In the meantime, the current waiver –- which would have expired Saturday -- will be extended until Dec. 31.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The funds come from both the federal and state governments and ease the rules on how to run the Medicaid program, known as Medi-Cal in California.\u003c/p>\n\u003cp>The state Department of Health Care Services submitted a proposal for the waiver, also known as \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx\" target=\"_blank\">“Medi-Cal 2020,”\u003c/a> in March and had been negotiating with the federal Centers for Medicare & Medicaid Services ever since. The original proposal was whittled down from $17 billion to $7.25 and finally to $6.2 billion during the negotiations.\u003c/p>\n\u003cp>Even so, Dr. Susan Ehrlich, CEO of San Mateo Medical Center, said Saturday that public hospitals can now keep improving access to primary care, integrating physical and mental health services and making other changes to help patients stay healthy and out of the hospital.\u003c/p>\n\u003cp>Ehrlich, who traveled to Washington earlier this week with several other hospital \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/28/billions-in-medicaid-funding-at-risk-as-california-feds-debate/\" target=\"_blank\">leaders to push for the new waiver\u003c/a>, said she and others will be watching closely to see how the details get worked out.\u003c/p>\n\u003cp>“But mostly, we are just really pleased that the overarching substance of the deal turned out the way it did,” she said.\u003c/p>\n\u003cp>Under the expiring five-year waiver, known as the “Bridge to Reform,” hospitals across the state began to overhaul the way they provided care. For example, they created programs to track chronically ill patients and expanded their primary care clinics. Other programs helped reduce deaths by sepsis infections and the number of patients with uncontrolled diabetes.\u003c/p>\n\u003cp>Hospital leaders said they expect the changes to save money for the state and federal government.\u003c/p>\n\u003cp>With the new waiver, health officials can take their efforts to the next level, Anthony Wright, executive director of Health Access California, said in a statement. Once the details are hammered out, Wright said, “we expect to see an explosion of exciting activity at the county level to improve health care.”\u003c/p>\n\u003cp>Wright added that the agreement has the potential to “spur innovation in counties across the state.”\u003c/p>\n\u003cp>The waiver also fundamentally changes the way government covers the uninsured. Instead of only covering hospital-based care, public hospitals and clinics will have more flexibility and be able to focus more on outpatient and primary care.\u003c/p>\n\u003cp>Instead of funding five years of care for the uninsured, however, the plan only specifies $236 million for the first year. Funding for the next four will depend on an outside assessment of how much hospitals need.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Affordable Care Act expanded coverage to millions of Californians. Still, more than 3 million are believed to be without insurance. Murray of the hospital association said she believes there will still be “significant need” for hospitals to receive additional funding for the uninsured population.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In California, Doctors on Probation Not Required to Tell You. Should They?",
"title": "In California, Doctors on Probation Not Required to Tell You. Should They?",
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"content": "\u003cp>When you call to set up your next check-up, you may be unknowingly arranging for care from a physician in trouble for drug abuse, sexual misconduct, patient negligence or harm.\u003c/p>\n\u003cp>In California, physicians on probation for such punishments are already required to report them to their malpractice insurers and hospitals where they work, yet there is no rule requiring similar pro-active notifications of patients.\u003c/p>\n\u003caside class=\"pullquote alignright\">“I was stunned to learn that the doctor I had been referred to had a long history of substance abuse and DUIs.\"\u003ccite>Marian Hollingsworth, Consumers Union\u003c/cite>\u003c/aside>\n\u003cp>The advocacy group Consumers Union wants that to change. They are calling for the Medical Board of California to make doctors on probation responsible for informing their patients. The board is \u003ca href=\"http://www.mbc.ca.gov/About_Us/Meetings/2015/Agendas/agenda_20151029_brd.pdf\" target=\"_blank\">scheduled to consider the idea\u003c/a> on Friday at its quarterly meeting in San Diego. But it is unlikely to win approval.\u003c/p>\n\u003cp>“Maybe if patients knew, they wouldn’t see the doctor,” said Lisa McGiffert, Director of the Safe Patient Project at Consumers Union. “Maybe they still would. But they are doing it with their eyes open.”\u003c/p>\n\u003cp>Under the proposed rule, doctors on probation would have to alert their patients when they call for an appointment as well as verbally and in writing during the visit. Consumers Union filed a \u003ca href=\"http://safepatientproject.org/wordpress/wp-content/uploads/2015/10/Administrative-petition-probation-disclosure-FINAL-CUSPP-as-sent-to-MBC-October-8-2015.pdf\" target=\"_blank\">9-page petition\u003c/a> with the board outlining its proposal. The petition was signed by more than 5,000 Californians.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Doctors' Group Resistant\u003c/strong>\u003c/p>\n\u003cp>Since the disciplinary actions against doctors \u003ca href=\"http://www.mbc.ca.gov/Breeze/License_Verification.aspx\" target=\"_blank\">are posted\u003c/a> on the board’s website, the state’s biggest physician group, the California Medical Association, says the proposed changes of the notification requirements would go too far.\u003c/p>\n\u003cp>In a statement Paul Hegyi, a spokesman for the association, said they worry this type of rule would “put a burden on the physician-patient relationship,\" especially when appointment time is already limited. “This information is already public and available online and can be accessed by anyone,\" he said. \"This is a duplicative burden that will interfere with patient care.”\u003c/p>\n\u003cp>The board rejected a similar measure when it was proposed by board staff in 2012. In fact, the board has just begun \u003ca href=\"http://www.mbc.ca.gov/About_Us/Media_Room/2015/news_releases_20151020_verify.pdf\" target=\"_blank\">a public relations effort\u003c/a> to encourage patients to take it upon themselves to research the disciplinary actions against their doctors.\u003c/p>\n\u003cp>Board officials even held a tutorial to show people how to use their website at a mall in Sacramento last week. Those who don’t have access to computers can call the board’s office for assistance, a statement from the board said.\u003c/p>\n\u003cp>Advocates see the board’s outreach as a response to their efforts but say it doesn’t go far enough. The burden to find the information shouldn’t be placed on patients, who may not think to look it up, know how to do so, or have access to the Internet, McGiffert said.\u003c/p>\n\u003cp>Other patients may not be able to research the information due to mental or physical impairments. They could be missing out on important information about the doctors they have trusted with their care, she said.\u003c/p>\n\u003cp>Of the approximately \u003ca href=\"http://www.oshpd.ca.gov/HWDD/HWC/FactSheets/MD-2014.pdf\" target=\"_blank\">137,000 licensed medical doctors\u003c/a> in California, nearly 500 are on probation for offenses including sexual misconduct, gross negligence, substance abuse, inappropriate prescribing, and conviction of a felony, Consumers Union said. The group \u003ca href=\"http://safepatientproject.org/wordpress/wp-content/uploads/2015/10/MBC-list-of-docs-on-probation-as-of-9-29-15-as-of-10-8-15.pdf\" target=\"_blank\">compiled a list of doctors on probation\u003c/a>.\u003c/p>\n\u003cp>Patient advocate Marian Hollingsworth, who works for Consumers Union, \u003ca href=\"http://www.sacbee.com/opinion/op-ed/soapbox/article27279535.html#storylink=cpy\" target=\"_blank\">described in a Sacramento Bee\u003c/a> opinion piece how she felt when she discovered her doctor’s probation.\u003c/p>\n\u003cp>“I was stunned to learn that the doctor I had been referred to for a routine colonoscopy was about to start a 30-day suspension and seven-year probation,” she wrote. “He had a long history of substance abuse and DUIs, but what finally got the board’s attention is that he went after a patient with a hatchet in an alcohol-fueled rage.”\u003c/p>\n\u003cp>The doctors who got into trouble are from all over the state -- in big cities like Los Angeles and rural areas like Humboldt County. In some areas with doctor shortages, if a doctor is on probation it may present an even bigger dilemma for patients. Those patients should be able to decide whether they still want to see the doctor even if it’s their only option for miles, McGiffert said\u003c/p>\n\u003cp>By agreeing to go on probation, doctors are not necessarily admitting they violated ethics rules. Some do it to avoid lengthy and costly legal battles, McGiffert said.\u003c/p>\n\u003cp>Physicians on probation may be barred from performing specific procedures, or prescribing certain medicines for a period of time. They might have to take classes or be supervised. In some cases it means a physician disciplined for sexual misconduct must be chaperoned in the exam room.\u003c/p>\n\u003cp>The issue of physician discipline has been difficult for the board. It has come under fire in recent years for failing to hold problem doctors accountable. Some legislators in 2013\u003ca href=\"http://articles.latimes.com/2013/apr/25/local/la-me-rx-medical-board-20130426\" target=\"_blank\"> called for stripping the board\u003c/a> of its investigative powers. This issue will draw renewed public attention to whether the board is aggressive enough in protecting the public from dangerous doctors.\u003c/p>\n\u003cp>McGiffert said there is concern in the medical field that requiring doctors to tell patients about their probationary status is too awkward.\u003c/p>\n\u003cp>“The objection is that, gee, this would be very uncomfortable for doctors,” McGiffert said. “What does that tell you? Sometimes you need that kind of pressure.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Update:\u003c/strong> In its meeting on Friday, the Medical Board of California voted to deny the petition that would have required doctors on probation to notify their patients. But it did agree to form a committee to review the petition more closely and potentially develop a plan to improve notification to patients of doctors on probation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When you call to set up your next check-up, you may be unknowingly arranging for care from a physician in trouble for drug abuse, sexual misconduct, patient negligence or harm.\u003c/p>\n\u003cp>In California, physicians on probation for such punishments are already required to report them to their malpractice insurers and hospitals where they work, yet there is no rule requiring similar pro-active notifications of patients.\u003c/p>\n\u003caside class=\"pullquote alignright\">“I was stunned to learn that the doctor I had been referred to had a long history of substance abuse and DUIs.\"\u003ccite>Marian Hollingsworth, Consumers Union\u003c/cite>\u003c/aside>\n\u003cp>The advocacy group Consumers Union wants that to change. They are calling for the Medical Board of California to make doctors on probation responsible for informing their patients. The board is \u003ca href=\"http://www.mbc.ca.gov/About_Us/Meetings/2015/Agendas/agenda_20151029_brd.pdf\" target=\"_blank\">scheduled to consider the idea\u003c/a> on Friday at its quarterly meeting in San Diego. But it is unlikely to win approval.\u003c/p>\n\u003cp>“Maybe if patients knew, they wouldn’t see the doctor,” said Lisa McGiffert, Director of the Safe Patient Project at Consumers Union. “Maybe they still would. But they are doing it with their eyes open.”\u003c/p>\n\u003cp>Under the proposed rule, doctors on probation would have to alert their patients when they call for an appointment as well as verbally and in writing during the visit. Consumers Union filed a \u003ca href=\"http://safepatientproject.org/wordpress/wp-content/uploads/2015/10/Administrative-petition-probation-disclosure-FINAL-CUSPP-as-sent-to-MBC-October-8-2015.pdf\" target=\"_blank\">9-page petition\u003c/a> with the board outlining its proposal. The petition was signed by more than 5,000 Californians.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Doctors' Group Resistant\u003c/strong>\u003c/p>\n\u003cp>Since the disciplinary actions against doctors \u003ca href=\"http://www.mbc.ca.gov/Breeze/License_Verification.aspx\" target=\"_blank\">are posted\u003c/a> on the board’s website, the state’s biggest physician group, the California Medical Association, says the proposed changes of the notification requirements would go too far.\u003c/p>\n\u003cp>In a statement Paul Hegyi, a spokesman for the association, said they worry this type of rule would “put a burden on the physician-patient relationship,\" especially when appointment time is already limited. “This information is already public and available online and can be accessed by anyone,\" he said. \"This is a duplicative burden that will interfere with patient care.”\u003c/p>\n\u003cp>The board rejected a similar measure when it was proposed by board staff in 2012. In fact, the board has just begun \u003ca href=\"http://www.mbc.ca.gov/About_Us/Media_Room/2015/news_releases_20151020_verify.pdf\" target=\"_blank\">a public relations effort\u003c/a> to encourage patients to take it upon themselves to research the disciplinary actions against their doctors.\u003c/p>\n\u003cp>Board officials even held a tutorial to show people how to use their website at a mall in Sacramento last week. Those who don’t have access to computers can call the board’s office for assistance, a statement from the board said.\u003c/p>\n\u003cp>Advocates see the board’s outreach as a response to their efforts but say it doesn’t go far enough. The burden to find the information shouldn’t be placed on patients, who may not think to look it up, know how to do so, or have access to the Internet, McGiffert said.\u003c/p>\n\u003cp>Other patients may not be able to research the information due to mental or physical impairments. They could be missing out on important information about the doctors they have trusted with their care, she said.\u003c/p>\n\u003cp>Of the approximately \u003ca href=\"http://www.oshpd.ca.gov/HWDD/HWC/FactSheets/MD-2014.pdf\" target=\"_blank\">137,000 licensed medical doctors\u003c/a> in California, nearly 500 are on probation for offenses including sexual misconduct, gross negligence, substance abuse, inappropriate prescribing, and conviction of a felony, Consumers Union said. The group \u003ca href=\"http://safepatientproject.org/wordpress/wp-content/uploads/2015/10/MBC-list-of-docs-on-probation-as-of-9-29-15-as-of-10-8-15.pdf\" target=\"_blank\">compiled a list of doctors on probation\u003c/a>.\u003c/p>\n\u003cp>Patient advocate Marian Hollingsworth, who works for Consumers Union, \u003ca href=\"http://www.sacbee.com/opinion/op-ed/soapbox/article27279535.html#storylink=cpy\" target=\"_blank\">described in a Sacramento Bee\u003c/a> opinion piece how she felt when she discovered her doctor’s probation.\u003c/p>\n\u003cp>“I was stunned to learn that the doctor I had been referred to for a routine colonoscopy was about to start a 30-day suspension and seven-year probation,” she wrote. “He had a long history of substance abuse and DUIs, but what finally got the board’s attention is that he went after a patient with a hatchet in an alcohol-fueled rage.”\u003c/p>\n\u003cp>The doctors who got into trouble are from all over the state -- in big cities like Los Angeles and rural areas like Humboldt County. In some areas with doctor shortages, if a doctor is on probation it may present an even bigger dilemma for patients. Those patients should be able to decide whether they still want to see the doctor even if it’s their only option for miles, McGiffert said\u003c/p>\n\u003cp>By agreeing to go on probation, doctors are not necessarily admitting they violated ethics rules. Some do it to avoid lengthy and costly legal battles, McGiffert said.\u003c/p>\n\u003cp>Physicians on probation may be barred from performing specific procedures, or prescribing certain medicines for a period of time. They might have to take classes or be supervised. In some cases it means a physician disciplined for sexual misconduct must be chaperoned in the exam room.\u003c/p>\n\u003cp>The issue of physician discipline has been difficult for the board. It has come under fire in recent years for failing to hold problem doctors accountable. Some legislators in 2013\u003ca href=\"http://articles.latimes.com/2013/apr/25/local/la-me-rx-medical-board-20130426\" target=\"_blank\"> called for stripping the board\u003c/a> of its investigative powers. This issue will draw renewed public attention to whether the board is aggressive enough in protecting the public from dangerous doctors.\u003c/p>\n\u003cp>McGiffert said there is concern in the medical field that requiring doctors to tell patients about their probationary status is too awkward.\u003c/p>\n\u003cp>“The objection is that, gee, this would be very uncomfortable for doctors,” McGiffert said. “What does that tell you? Sometimes you need that kind of pressure.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cstrong>Update:\u003c/strong> In its meeting on Friday, the Medical Board of California voted to deny the petition that would have required doctors on probation to notify their patients. But it did agree to form a committee to review the petition more closely and potentially develop a plan to improve notification to patients of doctors on probation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Billions in Medicaid Funding at Risk as California, Feds Debate",
"title": "Billions in Medicaid Funding at Risk as California, Feds Debate",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>California risks losing billions in health care dollars if the state and federal governments can’t agree this week on a plan to fund reforms of the Medicaid program, hospital officials and experts said.\u003c/p>\n\u003cp>Public hospitals throughout the state are counting on the $7.25 billion in state and federal funds to treat large numbers of low-income and uninsured patients. The plan, known as a Medicaid waiver, also would allow the state to continue improving the efficiency, safety and quality of its Medicaid program, called Medi-Cal.\u003c/p>\n\u003cp>About a third of all Californians are enrolled in Medi-Cal -- 12.5 million people. The current waiver, which took effect in 2010, expires on Oct. 31, though the federal government can grant an extension while negotiations over the plan continue.\u003c/p>\n\u003cp>[contextly_sidebar id=\"a5pZ22plFG1s4mvtWAOUCrTWG4OLpJXL\"]“It is critically important to us,” said Susan Ehrlich, CEO of San Mateo Medical Center, one of the state’s public hospital and clinic systems. “It is a very large percentage of the overall revenue that we rely on, and we don’t have other ways to make it up.”\u003c/p>\n\u003cp>Ehrlich is one of about a dozen public and University of California hospital leaders who traveled to Washington this week to make their case for the waiver to members of Congress and administration officials.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Erica Murray, CEO of the California Association of Public Hospitals, said one of the sticking points is how long an important provision of the waiver would last, with the state proposing five years and the federal government offering only three. The provision would pay for changes in how public hospitals deliver care, she said.\u003c/p>\n\u003cp>“Three years is not enough,” she said. “We need five years of support and incentive to achieve the goals of where the public systems need to be to stay competitive in their local marketplaces.”\u003c/p>\n\u003cp>Disagreements also exist over how hospitals should be paid to care for uninsured patients. The state wants to have the flexibility to use the money for more primary and preventive care rather than just to pay for emergency room visits and hospitalizations.\u003c/p>\n\u003cp>The state and the federal government have been negotiating since March, when California submitted a plan called “\u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx\" target=\"_blank\">Medi-Cal 2020\u003c/a>.” The plan also includes money to improve dental health programs, to expand the number of providers treating Medi-Cal patients and to start pilot projects addressing social problems of high-need patients.\u003c/p>\n\u003cp>State Department of Health Care Services Director Jennifer Kent said this week that the state needs the waiver to keep public hospitals financially stable so they can continue implementing reforms enacted under the Affordable Care Act. State officials are working toward a resolution and are trying to meet the deadline, Kent said.\u003c/p>\n\u003cp>“Everyone knows this is important,” Kent said. “It just boils down to getting the details worked out. I think we will get there.”\u003c/p>\n\u003cp>A spokesman for the Centers for Medicare & Medicaid Services declined to comment on the ongoing negotiations, but said extensions have been granted in other states.\u003c/p>\n\u003cp>Public hospitals have every right to be concerned about how the discussions are going, but there is always a lot of back and forth in Medicaid waiver negotiations, said Robin Rudowitz, associate director of the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured. “Given the amount of money, I can’t imagine that anyone is going to walk away from the table,” she said.\u003c/p>\n\u003cp>Waivers allow states to make exceptions to the usual Medicaid rules. Under the expiring Medicaid waiver, known as the “Bridge to Reform,” California enrolled about 650,000 uninsured residents in free county-based health coverage until they were able to enroll in Medi-Cal through the Affordable Care Act. The state also transitioned many of its Medi-Cal beneficiaries into managed care.\u003c/p>\n\u003cp>In addition, public hospitals revamped their programs — and created new ones — to improve the health and safety of their patients and to cut costs. For example, they began tracking patients with certain diseases, pairing patients with health coaches and making more weekend appointments for primary care.\u003c/p>\n\u003cp>Now public hospitals say they need money to continue implementing the reforms. The new waiver also would increase the number of hospitals that can access funds.\u003c/p>\n\u003cp>San Mateo Medical Center used the money to cut wait time for primary care appointments, screen diabetic patients for depression and reduce deaths by sepsis. Kern Medical Center reduced pressure ulcers among hospitalized patients and helped obese children lose weight.\u003c/p>\n\u003cp>[contextly_sidebar id=\"iB9CYD3FkXcoqHTBmSs0dLf7lgJv3VwT\"]UCLA Health System developed a program to help train physicians from Latin America so they could begin working in in high-need areas. The university’s health system also improved diabetic patients’ adherence to instructions on taking medication.\u003c/p>\n\u003cp>Santiago Muñoz, UCLA Health System’s chief strategy officer, said that his institution relies on it to help pay for expensive care to children with complex illnesses.\u003c/p>\n\u003cp>“We’re providing a lot of care to Medicaid kids,” said Munoz, who was among those who traveled to Washington this week to push for the waiver. “A lot of this highly specialized care is only available at academic or teaching hospitals.”\u003c/p>\n\u003cp>Without the new waiver, public hospitals will be in a “precarious situation,” said Christina Ghaly, deputy director for strategy and operations for the L.A. County Department of Health Services.\u003c/p>\n\u003cp>Through the waiver, the county’s public hospitals and clinics received about $2 billion in federal funding over the past five years, were able to assign more than 400,000 patients to primary care teams and better integrate physical and mental health services.\u003c/p>\n\u003cp>The goal of the Medicaid waiver, she said, is to shift more care from inpatient to outpatient settings and to get to the bottom of why some patients continue to seek high-cost treatment.\u003c/p>\n\u003cp>“When a person ends up in the emergency department 50 times because they are homeless, you can continue seeing them in the emergency department … or you can address the root cause of their homelessness,” she said.\u003c/p>\n\u003cp>The state’s low Medi-Cal reimbursement rate doesn’t fully cover care for the low-income population, providers said. And even though the Affordable Care Act expanded Medi-Cal, Ghaly said there are still millions of uninsured patients — and public hospitals are disproportionately responsible for their care.\u003c/p>\n\u003cp>“There has to be a deal,” Ghaly said. “If we aren’t able to close that gap … there would be some very difficult decisions.”\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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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California risks losing billions in health care dollars if the state and federal governments can’t agree this week on a plan to fund reforms of the Medicaid program, hospital officials and experts said.\u003c/p>\n\u003cp>Public hospitals throughout the state are counting on the $7.25 billion in state and federal funds to treat large numbers of low-income and uninsured patients. The plan, known as a Medicaid waiver, also would allow the state to continue improving the efficiency, safety and quality of its Medicaid program, called Medi-Cal.\u003c/p>\n\u003cp>About a third of all Californians are enrolled in Medi-Cal -- 12.5 million people. The current waiver, which took effect in 2010, expires on Oct. 31, though the federal government can grant an extension while negotiations over the plan continue.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“It is critically important to us,” said Susan Ehrlich, CEO of San Mateo Medical Center, one of the state’s public hospital and clinic systems. “It is a very large percentage of the overall revenue that we rely on, and we don’t have other ways to make it up.”\u003c/p>\n\u003cp>Ehrlich is one of about a dozen public and University of California hospital leaders who traveled to Washington this week to make their case for the waiver to members of Congress and administration officials.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Erica Murray, CEO of the California Association of Public Hospitals, said one of the sticking points is how long an important provision of the waiver would last, with the state proposing five years and the federal government offering only three. The provision would pay for changes in how public hospitals deliver care, she said.\u003c/p>\n\u003cp>“Three years is not enough,” she said. “We need five years of support and incentive to achieve the goals of where the public systems need to be to stay competitive in their local marketplaces.”\u003c/p>\n\u003cp>Disagreements also exist over how hospitals should be paid to care for uninsured patients. The state wants to have the flexibility to use the money for more primary and preventive care rather than just to pay for emergency room visits and hospitalizations.\u003c/p>\n\u003cp>The state and the federal government have been negotiating since March, when California submitted a plan called “\u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx\" target=\"_blank\">Medi-Cal 2020\u003c/a>.” The plan also includes money to improve dental health programs, to expand the number of providers treating Medi-Cal patients and to start pilot projects addressing social problems of high-need patients.\u003c/p>\n\u003cp>State Department of Health Care Services Director Jennifer Kent said this week that the state needs the waiver to keep public hospitals financially stable so they can continue implementing reforms enacted under the Affordable Care Act. State officials are working toward a resolution and are trying to meet the deadline, Kent said.\u003c/p>\n\u003cp>“Everyone knows this is important,” Kent said. “It just boils down to getting the details worked out. I think we will get there.”\u003c/p>\n\u003cp>A spokesman for the Centers for Medicare & Medicaid Services declined to comment on the ongoing negotiations, but said extensions have been granted in other states.\u003c/p>\n\u003cp>Public hospitals have every right to be concerned about how the discussions are going, but there is always a lot of back and forth in Medicaid waiver negotiations, said Robin Rudowitz, associate director of the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured. “Given the amount of money, I can’t imagine that anyone is going to walk away from the table,” she said.\u003c/p>\n\u003cp>Waivers allow states to make exceptions to the usual Medicaid rules. Under the expiring Medicaid waiver, known as the “Bridge to Reform,” California enrolled about 650,000 uninsured residents in free county-based health coverage until they were able to enroll in Medi-Cal through the Affordable Care Act. The state also transitioned many of its Medi-Cal beneficiaries into managed care.\u003c/p>\n\u003cp>In addition, public hospitals revamped their programs — and created new ones — to improve the health and safety of their patients and to cut costs. For example, they began tracking patients with certain diseases, pairing patients with health coaches and making more weekend appointments for primary care.\u003c/p>\n\u003cp>Now public hospitals say they need money to continue implementing the reforms. The new waiver also would increase the number of hospitals that can access funds.\u003c/p>\n\u003cp>San Mateo Medical Center used the money to cut wait time for primary care appointments, screen diabetic patients for depression and reduce deaths by sepsis. Kern Medical Center reduced pressure ulcers among hospitalized patients and helped obese children lose weight.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>UCLA Health System developed a program to help train physicians from Latin America so they could begin working in in high-need areas. The university’s health system also improved diabetic patients’ adherence to instructions on taking medication.\u003c/p>\n\u003cp>Santiago Muñoz, UCLA Health System’s chief strategy officer, said that his institution relies on it to help pay for expensive care to children with complex illnesses.\u003c/p>\n\u003cp>“We’re providing a lot of care to Medicaid kids,” said Munoz, who was among those who traveled to Washington this week to push for the waiver. “A lot of this highly specialized care is only available at academic or teaching hospitals.”\u003c/p>\n\u003cp>Without the new waiver, public hospitals will be in a “precarious situation,” said Christina Ghaly, deputy director for strategy and operations for the L.A. County Department of Health Services.\u003c/p>\n\u003cp>Through the waiver, the county’s public hospitals and clinics received about $2 billion in federal funding over the past five years, were able to assign more than 400,000 patients to primary care teams and better integrate physical and mental health services.\u003c/p>\n\u003cp>The goal of the Medicaid waiver, she said, is to shift more care from inpatient to outpatient settings and to get to the bottom of why some patients continue to seek high-cost treatment.\u003c/p>\n\u003cp>“When a person ends up in the emergency department 50 times because they are homeless, you can continue seeing them in the emergency department … or you can address the root cause of their homelessness,” she said.\u003c/p>\n\u003cp>The state’s low Medi-Cal reimbursement rate doesn’t fully cover care for the low-income population, providers said. And even though the Affordable Care Act expanded Medi-Cal, Ghaly said there are still millions of uninsured patients — and public hospitals are disproportionately responsible for their care.\u003c/p>\n\u003cp>“There has to be a deal,” Ghaly said. “If we aren’t able to close that gap … there would be some very difficult decisions.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "For Former Foster Kids, Moving Out of State Can Mean Losing Medicaid",
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"content": "\u003cp>Soon after moving to Utah this summer, Rainbow Sky Buck ended up at the hospital with a painful ear infection. There, Buck learned she no longer had access to the free health coverage she had in California as a former foster youth.\u003c/p>\n\u003cp>To pay for the care, Buck emptied out her bank account and borrowed money. “Luckily, I got my antibiotics and I am okay now,” she said. “But what is going to happen next time?”\u003c/p>\n\u003cp>Under the health law, young adults who age of out of the foster care system are eligible for free Medicaid coverage \u003ca href=\"http://khn.org/news/foster-children-california-adults-medicaid/\" target=\"_blank\">until they turn 26.\u003c/a> The provision was an attempt to give them the same opportunity as other young people who can stay on their parents’ insurance until their 26\u003csup>th\u003c/sup> birthday.\u003c/p>\n\u003cp>But these young adults are encountering a major barrier: They are only guaranteed coverage in the state where they were in foster care. States have the option of extending the benefit to all former foster youths, but only about a dozen have done so.\u003c/p>\n\u003cp>Now, advocates and policymakers are trying to change the law at the federal level, so former foster youths don’t lose access to Medicaid coverage no matter where they move.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"quDmgipf5B7js5fILKqbBJCNiiZBBixc\"]Reps. Karen Bass, D-Calif., and Jim McDermott, D-Wash., have proposed \u003ca href=\"http://bass.house.gov/press-release/reps-bass-mcdermott-introduce-legislation-ensure-former-foster-youth-can-keep-health\" target=\"_blank\">legislation\u003c/a> that would allow them to qualify for Medicaid, the government health program for low-income Americans, in any state. Sen. Bob Casey, D-Pa., has introduced a similar \u003ca href=\"http://www.casey.senate.gov/newsroom/releases/casey-introduces-bill-to-fix-glitch-that-could-kick-former-foster-youth-off-of-medicaid\" target=\"_blank\">bill\u003c/a> that he said would be a simple clarification of what Congress intended. Meanwhile, advocates are pushing the Centers for Medicare & Medicaid Services to change its interpretation of the original provision.\u003c/p>\n\u003cp>\u003ca href=\"http://firstfocus.org/\" target=\"_blank\">First Focus\u003c/a>, which advocates for foster youths, has been receiving calls from young people who had no idea that they would lose health insurance when they moved.\u003c/p>\n\u003cp>“We really do feel an urgency about this,” said Shadi Houshyar, vice president of child welfare policy at the organization. “So many people who have aged out have significant health needs and coverage is so important. There shouldn’t be an additional barrier.”\u003c/p>\n\u003cp>Former foster youths are more likely than their peers to have physical and mental health needs, experts say. Ongoing \u003ca href=\"http://www.chapinhall.org/research/report/midwest-evaluation-adult-functioning-former-foster-youth\" target=\"_blank\">research\u003c/a> in Illinois, Wisconsin and Iowa shows that 22 percent of former foster youths had been hospitalized at least once in the previous year and one-third had two or more emergency room visits.\u003c/p>\n\u003cp>Just like other young people, former foster youths move to different states for school, jobs or family, said Fatima Morales, policy and outreach associate for the advocacy group \u003ca href=\"http://www.childrennow.org/\" target=\"_blank\">Children Now\u003c/a>. Morales said they shouldn’t be penalized for doing so.\u003c/p>\n\u003cfigure id=\"attachment_94773\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/Screen-Shot-2015-10-19-at-9.27.56-AM.png\">\u003cimg class=\"size-thumbnail wp-image-94773\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/Screen-Shot-2015-10-19-at-9.27.56-AM-400x367.png\" alt=\"Lezlie Martinez, 19, holds her two-year-old son. She would like to move from California to Colorado where she says it would be cheaper to live, but she worries about losing her health coverage. \" width=\"400\" height=\"367\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/10/Screen-Shot-2015-10-19-at-9.27.56-AM-400x367.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/Screen-Shot-2015-10-19-at-9.27.56-AM.png 594w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lezlie Martinez, 19, holds her two-year-old son. She would like to move from California to Colorado where she says it would be cheaper to live, but she worries about losing her health coverage. \u003ccite>(Courtesy: Jordan Verdin )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Morales said her organization is trying to inform youths what they might face if they move. “They need to know how their health coverage might be impacted,” she said. “It’s just something that they need to weigh.”\u003c/p>\n\u003cp>Lezlie Martinez, 19, is weighing her options now. She is hoping to move from California to Colorado because she wants to live in a place with a lower cost of living. Her boyfriend is already there and she is looking for hospitality jobs to support herself and her 2-year-old son.\u003c/p>\n\u003cp>But she worries that she may be left uninsured and unable to pay for medical treatment for eczema, allergies and fibromyalgia. “It is causing foster youth to be stuck in the same state they were raised in,” said Martinez, who lives in Oceanside, Calif. “It is really stressing me out.”\u003c/p>\n\u003cp>Buck said she decided to move to Sandy City, Utah, because of the limited job prospects in the small northern California town of Crescent City. Before moving, she asked social workers about whether she would still qualify for free health coverage and was told that she would. Buck said she was shocked to learn otherwise.\u003c/p>\n\u003cp>She is no longer seeing a therapist for depression and said she is weaning herself off antidepressants because she can’t afford them. Buck said she also worries about getting another ear infection and not being able to afford treatment.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It is just scary to think I am completely on my own,” said Buck, who recently got a job at an automotive shop but doesn’t get insurance from her employer. “I don’t want to leave, but this is almost forcing me to move back to California.”\u003c/p>\n\n",
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"excerpt": "Advocates and some members of Congress want to fix the loophole.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Soon after moving to Utah this summer, Rainbow Sky Buck ended up at the hospital with a painful ear infection. There, Buck learned she no longer had access to the free health coverage she had in California as a former foster youth.\u003c/p>\n\u003cp>To pay for the care, Buck emptied out her bank account and borrowed money. “Luckily, I got my antibiotics and I am okay now,” she said. “But what is going to happen next time?”\u003c/p>\n\u003cp>Under the health law, young adults who age of out of the foster care system are eligible for free Medicaid coverage \u003ca href=\"http://khn.org/news/foster-children-california-adults-medicaid/\" target=\"_blank\">until they turn 26.\u003c/a> The provision was an attempt to give them the same opportunity as other young people who can stay on their parents’ insurance until their 26\u003csup>th\u003c/sup> birthday.\u003c/p>\n\u003cp>But these young adults are encountering a major barrier: They are only guaranteed coverage in the state where they were in foster care. States have the option of extending the benefit to all former foster youths, but only about a dozen have done so.\u003c/p>\n\u003cp>Now, advocates and policymakers are trying to change the law at the federal level, so former foster youths don’t lose access to Medicaid coverage no matter where they move.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Reps. Karen Bass, D-Calif., and Jim McDermott, D-Wash., have proposed \u003ca href=\"http://bass.house.gov/press-release/reps-bass-mcdermott-introduce-legislation-ensure-former-foster-youth-can-keep-health\" target=\"_blank\">legislation\u003c/a> that would allow them to qualify for Medicaid, the government health program for low-income Americans, in any state. Sen. Bob Casey, D-Pa., has introduced a similar \u003ca href=\"http://www.casey.senate.gov/newsroom/releases/casey-introduces-bill-to-fix-glitch-that-could-kick-former-foster-youth-off-of-medicaid\" target=\"_blank\">bill\u003c/a> that he said would be a simple clarification of what Congress intended. Meanwhile, advocates are pushing the Centers for Medicare & Medicaid Services to change its interpretation of the original provision.\u003c/p>\n\u003cp>\u003ca href=\"http://firstfocus.org/\" target=\"_blank\">First Focus\u003c/a>, which advocates for foster youths, has been receiving calls from young people who had no idea that they would lose health insurance when they moved.\u003c/p>\n\u003cp>“We really do feel an urgency about this,” said Shadi Houshyar, vice president of child welfare policy at the organization. “So many people who have aged out have significant health needs and coverage is so important. There shouldn’t be an additional barrier.”\u003c/p>\n\u003cp>Former foster youths are more likely than their peers to have physical and mental health needs, experts say. Ongoing \u003ca href=\"http://www.chapinhall.org/research/report/midwest-evaluation-adult-functioning-former-foster-youth\" target=\"_blank\">research\u003c/a> in Illinois, Wisconsin and Iowa shows that 22 percent of former foster youths had been hospitalized at least once in the previous year and one-third had two or more emergency room visits.\u003c/p>\n\u003cp>Just like other young people, former foster youths move to different states for school, jobs or family, said Fatima Morales, policy and outreach associate for the advocacy group \u003ca href=\"http://www.childrennow.org/\" target=\"_blank\">Children Now\u003c/a>. Morales said they shouldn’t be penalized for doing so.\u003c/p>\n\u003cfigure id=\"attachment_94773\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/Screen-Shot-2015-10-19-at-9.27.56-AM.png\">\u003cimg class=\"size-thumbnail wp-image-94773\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/10/Screen-Shot-2015-10-19-at-9.27.56-AM-400x367.png\" alt=\"Lezlie Martinez, 19, holds her two-year-old son. She would like to move from California to Colorado where she says it would be cheaper to live, but she worries about losing her health coverage. \" width=\"400\" height=\"367\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/10/Screen-Shot-2015-10-19-at-9.27.56-AM-400x367.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/10/Screen-Shot-2015-10-19-at-9.27.56-AM.png 594w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lezlie Martinez, 19, holds her two-year-old son. She would like to move from California to Colorado where she says it would be cheaper to live, but she worries about losing her health coverage. \u003ccite>(Courtesy: Jordan Verdin )\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Morales said her organization is trying to inform youths what they might face if they move. “They need to know how their health coverage might be impacted,” she said. “It’s just something that they need to weigh.”\u003c/p>\n\u003cp>Lezlie Martinez, 19, is weighing her options now. She is hoping to move from California to Colorado because she wants to live in a place with a lower cost of living. Her boyfriend is already there and she is looking for hospitality jobs to support herself and her 2-year-old son.\u003c/p>\n\u003cp>But she worries that she may be left uninsured and unable to pay for medical treatment for eczema, allergies and fibromyalgia. “It is causing foster youth to be stuck in the same state they were raised in,” said Martinez, who lives in Oceanside, Calif. “It is really stressing me out.”\u003c/p>\n\u003cp>Buck said she decided to move to Sandy City, Utah, because of the limited job prospects in the small northern California town of Crescent City. Before moving, she asked social workers about whether she would still qualify for free health coverage and was told that she would. Buck said she was shocked to learn otherwise.\u003c/p>\n\u003cp>She is no longer seeing a therapist for depression and said she is weaning herself off antidepressants because she can’t afford them. Buck said she also worries about getting another ear infection and not being able to afford treatment.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It is just scary to think I am completely on my own,” said Buck, who recently got a job at an automotive shop but doesn’t get insurance from her employer. “I don’t want to leave, but this is almost forcing me to move back to California.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California has adopted the toughest limits in the nation on the use of antibiotics in healthy livestock, barring their routine use to prevent illness or promote growth.\u003c/p>\n\u003cp>Calling the overuse of antibiotics “an urgent public health problem,” Gov. Jerry Brown announced Saturday that he signed the legislation. The bill, SB 27, will curb the overuse of antibiotics in livestock, which limits the effectiveness of the medicines in both animals and people and contributes to the spread of dangerous, drug-resistant superbugs.\u003c/p>\n\u003cp>“The science is clear that the overuse of antibiotics in livestock has contributed to the spread of antibiotic resistance and the undermining of decades of life-saving advances in medicine,” Brown said in a statement.\u003c/p>\n\u003cp>[contextly_sidebar id=”IPA7Z2cNGNEWXM3RNUpN7LFKzKK8f0Ui”]The U.S. Centers for Disease Control and Prevention calls antibiotic resistance one of the world’s most pressing health problems and estimates that 23,000 Americans die annually as a result of antibiotic-resistant infections.\u003c/p>\n\u003cp>The agency has recommended phasing out their use in cases solely to promote growth in livestock. In low doses, some antibiotics can generate greater muscle development by boosting the efficiency of food that animals eat.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Supporters of the legislation by Sen. Jerry Hill, D-San Mateo, say the antibiotics are fed to mostly healthy animals such as cows, pigs and chickens to make them grow faster and prevent disease in crowded industrial farms.\u003c/p>\n\u003cp>Widespread use of antibiotics by humans and animals reduce their effectiveness in treating illnesses because the diseases adapt by mutating, creating superbugs. Once-treatable illnesses can become dangerous infections when antibiotics are no longer effective.\u003c/p>\n\u003cp>“The lifesaving potential of antibiotics is quickly diminishing, and people are dying because the drugs are less effective,” Hill said in a statement.\u003c/p>\n\u003cp>Opponents argued that the California legislation does not go far enough to restrict preventive or routine use of antimicrobial drugs. Groups such as the California Cattlemen’s Association remained neutral on the bill.\u003c/p>\n\u003cp>Michael Hansen, a senior scientist at Consumers Union, the policy division of Consumer Reports, said many companies have voluntarily agreed to stop using antibiotics to promote growth after guidance from the Food and Drug Administration.\u003c/p>\n\u003cp>“No state yet has been able to pass a bill that is stronger than the one in California, and the fact that California is an important ag state, that makes this an important action,” Hansen said.\u003c/p>\n\u003cp>The antibiotics are different from the growth hormones used by many food producers that have drawn criticism and that some grocery stores and food chains have phased out. Companies including McDonald’s, Chipotle and Panera also have begun promoting their chicken as raised without antibiotics.\u003c/p>\n\u003cp>Brown, a Democrat, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/10/02/why-advocates-say-browns-veto-of-livestock-antibiotics-bill-is-a-good-thing/\" target=\"_blank\" rel=\"noopener\">vetoed a weaker version\u003c/a> of the bill last year, urging the state Department of Food and Agriculture to work with lawmakers on the issue. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/16/bill-making-california-toughest-in-u-s-on-livestock-antibiotics-now-up-to-governor/\" target=\"_blank\" rel=\"noopener\">His office helped make changes\u003c/a> to this year’s measure to strengthen protections against using antibiotics to prevent disease.\u003c/p>\n\u003cp>The bill allows exemptions when a licensed veterinarian determines antimicrobial drugs are needed to treat a disease or infection, to control the spread of a disease, or in relation to surgery or a medical procedure, according to an analysis prepared for the Legislature.\u003c/p>\n\u003cp>The California Veterinary Medical Association expressed concern that veterinarians might not be able to prescribe the drugs preventively to treat diseases for which there is no test available to determine which animals are carriers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The law, which takes effect in 2018, also eliminates the availability of livestock antibiotics for over-the-counter sales.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California has adopted the toughest limits in the nation on the use of antibiotics in healthy livestock, barring their routine use to prevent illness or promote growth.\u003c/p>\n\u003cp>Calling the overuse of antibiotics “an urgent public health problem,” Gov. Jerry Brown announced Saturday that he signed the legislation. The bill, SB 27, will curb the overuse of antibiotics in livestock, which limits the effectiveness of the medicines in both animals and people and contributes to the spread of dangerous, drug-resistant superbugs.\u003c/p>\n\u003cp>“The science is clear that the overuse of antibiotics in livestock has contributed to the spread of antibiotic resistance and the undermining of decades of life-saving advances in medicine,” Brown said in a statement.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The U.S. Centers for Disease Control and Prevention calls antibiotic resistance one of the world’s most pressing health problems and estimates that 23,000 Americans die annually as a result of antibiotic-resistant infections.\u003c/p>\n\u003cp>The agency has recommended phasing out their use in cases solely to promote growth in livestock. In low doses, some antibiotics can generate greater muscle development by boosting the efficiency of food that animals eat.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Supporters of the legislation by Sen. Jerry Hill, D-San Mateo, say the antibiotics are fed to mostly healthy animals such as cows, pigs and chickens to make them grow faster and prevent disease in crowded industrial farms.\u003c/p>\n\u003cp>Widespread use of antibiotics by humans and animals reduce their effectiveness in treating illnesses because the diseases adapt by mutating, creating superbugs. Once-treatable illnesses can become dangerous infections when antibiotics are no longer effective.\u003c/p>\n\u003cp>“The lifesaving potential of antibiotics is quickly diminishing, and people are dying because the drugs are less effective,” Hill said in a statement.\u003c/p>\n\u003cp>Opponents argued that the California legislation does not go far enough to restrict preventive or routine use of antimicrobial drugs. Groups such as the California Cattlemen’s Association remained neutral on the bill.\u003c/p>\n\u003cp>Michael Hansen, a senior scientist at Consumers Union, the policy division of Consumer Reports, said many companies have voluntarily agreed to stop using antibiotics to promote growth after guidance from the Food and Drug Administration.\u003c/p>\n\u003cp>“No state yet has been able to pass a bill that is stronger than the one in California, and the fact that California is an important ag state, that makes this an important action,” Hansen said.\u003c/p>\n\u003cp>The antibiotics are different from the growth hormones used by many food producers that have drawn criticism and that some grocery stores and food chains have phased out. Companies including McDonald’s, Chipotle and Panera also have begun promoting their chicken as raised without antibiotics.\u003c/p>\n\u003cp>Brown, a Democrat, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/10/02/why-advocates-say-browns-veto-of-livestock-antibiotics-bill-is-a-good-thing/\" target=\"_blank\" rel=\"noopener\">vetoed a weaker version\u003c/a> of the bill last year, urging the state Department of Food and Agriculture to work with lawmakers on the issue. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/16/bill-making-california-toughest-in-u-s-on-livestock-antibiotics-now-up-to-governor/\" target=\"_blank\" rel=\"noopener\">His office helped make changes\u003c/a> to this year’s measure to strengthen protections against using antibiotics to prevent disease.\u003c/p>\n\u003cp>The bill allows exemptions when a licensed veterinarian determines antimicrobial drugs are needed to treat a disease or infection, to control the spread of a disease, or in relation to surgery or a medical procedure, according to an analysis prepared for the Legislature.\u003c/p>\n\u003cp>The California Veterinary Medical Association expressed concern that veterinarians might not be able to prescribe the drugs preventively to treat diseases for which there is no test available to determine which animals are carriers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The law, which takes effect in 2018, also eliminates the availability of livestock antibiotics for over-the-counter sales.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Despite Sweeping 'Death-With-Dignity' Law, Few Will Have That Option",
"title": "Despite Sweeping 'Death-With-Dignity' Law, Few Will Have That Option",
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"content": "\u003cp>The death-with-dignity movement took a giant step forward this week, with 38 million people coming under its umbrella in a single swoop when California Gov. Jerry Brown signed the End of Life Option Act on Monday.\u003c/p>\n\u003cp>But the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\">law\u003c/a> still leaves out a wide range of people who might want to be covered: people with progressive debilitating diseases that don't have an obvious six-months-to-live prognosis and people with dementia, the fastest-growing health threat in the U.S. That's also true of similar laws in Oregon, Washington, Montana and Vermont.\u003c/p>\n\u003cp>And there might be no good way around this.\u003c/p>\n\u003cp>These restrictions might be necessary at this point in the history of aid in dying in this country, according to Judith Schwarz of the advocacy group \u003ca href=\"http://endoflifechoicesny.org/\" target=\"_blank\">End of Life Choices New York\u003c/a>. \"Opponents have many fears that such laws will be misapplied to the disenfranchised,\" she wrote in an email, and it's important to guarantee that for these groups — the poor, the elderly, the isolated — the \"right to die\" doesn't somehow morph into the duty to die \"for the sake of others.\"\u003c/p>\n\u003cp>Still, there's a problem with limiting the death-with-dignity option only to those with a prognosis of fewer than six months. For one thing, prognosis is difficult, and studies show that doctors are actually overoptimistic in their assessment of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/384011538/cancer-patients-and-doctors-struggle-to-predict-survival\" target=\"_blank\">how long their patients have to live\u003c/a>. \"Some doctors may wish to be more compassionate and not be as specific,\" Janis Landis, president of the Final Exit Network, wrote in an email, \"and ironically thus deny the patient the certification that is required.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And then there are the conditions that are completely unpredictable, not only in terms of life expectancy but in terms of how, when and in what order functions will be lost. This includes progressive neurological diseases like multiple sclerosis and ALS, where those who want to avoid the most debilitating final stages might end their lives prematurely, afraid that their ability to swallow a pill might disappear without warning.\u003c/p>\n\u003cp>\"Fear of this actually drives some individuals to act early, while they can still procure the equipment they need,\" Landis wrote. To her, it seems especially harsh \"to force such a cruel choice on an individual already suffering so greatly.\"\u003c/p>\n\u003cp>As fraught as it is, though, the requirement that a person be able to swallow lethal medication on his own is an important safeguard, according to Mickey MacIntyre, the chief strategic officer of Compassion & Choices. \"This self-administration requirement is a critical distinction between medical aid in dying and euthanasia,\" he wrote in an email.\u003c/p>\n\u003cp>\"Unlike medical aid in dying, euthanasia requires a healthcare professional or someone else, not the individual, to administer the medication,\" he added, \"So the individual loses control of the decision.\"\u003c/p>\n\u003cp>MacIntyre pointed out that people often change their minds at the last minute, and have every right to do so. In Oregon, he noted, about one-third of the people who obtained lethal drugs through the state's death-with-dignity program since 1998 ultimately \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf\" target=\"_blank\">decided not to take them\u003c/a>.\u003c/p>\n\u003cp>This seems to be a distinctly American quandary, though. In other countries, such as Belgium and the Netherlands, there are also safeguards written into their right-to-die laws, but they are broader and more inclusive.\u003c/p>\n\u003cp>\"The European safeguard is 'intolerable suffering,' \" said Margaret Pabst Battin, a bioethicist at the University of Utah. \"It's not defined in terms of the time until death, and it does include people with ALS or other conditions that wouldn't fall under our laws, which don't say anything about suffering.\"\u003c/p>\n\u003cp>Battin experienced the complexities of deciding when suffering becomes unbearable in caring for her husband, Brooke Hopkins, who was paralyzed from the shoulders down in a 2008 bicycle crash and lived for five more years, until he finally \u003ca href=\"http://6thfloor.blogs.nytimes.com/2013/08/21/choosing-to-die-after-a-struggle-with-life/\">decided\u003c/a> in 2013 to withdraw the machinery keeping him alive.\u003c/p>\n\u003cp>Earlier this year, the Supreme Court of Canada used European-style language \u003ca href=\"http://www.npr.org/sections/thetwo-way/2015/02/06/384292996/canadians-have-a-right-to-assisted-suicide-high-court-says\">upholding\u003c/a> the right to die for anyone with \"a grievous and irremediable medical condition ... that causes enduring suffering that is intolerable.\"\u003c/p>\n\u003cp>A death-with-dignity bill introduced in Battin's own state tried to broaden the safeguards to include people with a wider range of illnesses. On the phone with me, Battin read aloud from the \u003ca href=\"http://le.utah.gov/~2015/bills/static/HB0391.html\">Utah Death with Dignity Act\u003c/a>, introduced by Rep. Rebecca Chavez-Houk, which could apply to someone with an \"intractable and unbearable illness,\" defined as \"bodily disorder that cannot be cured or successfully palliated, and that causes such severe suffering that a patient prefers death.\" She said such broad language would no doubt be changed if the bill works its way through the state Legislature, as has happened elsewhere.\u003c/p>\n\u003cp>But people with Alzheimer's disease and other forms of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished\" target=\"_blank\">dementia\u003c/a> are beyond the scope of almost all these laws.\u003c/p>\n\u003cp>Schwarz said that maybe, very far in the future, there might be some way to cover dementia, but it's \"so complicated\" that she doesn't see it happening anytime soon. How, for instance, do you write legislation to deal with the question of personhood, which alters as the disease progresses? Is the demented individual — perhaps someone relatively content in her diminishment — \"the same as the individual who so FIRMLY REQUESTED/DEMANDED lethal meds at a certain point in their future demented state?\" Schwarz wondered. \"And who are you going to get to administer lethal meds under such circumstances?\"\u003c/p>\n\u003cp>Schwarz spends a lot of time these days with Alzheimer's patients who want to choose the timing of their deaths. She said all she can offer them is guidance about \u003ca href=\"http://journals.lww.com/ajnonline/Abstract/2009/09000/Stopping_Eating_and_Drinking.28.aspx\">stopping eating and drinking\u003c/a> as a way to hasten the end.\u003c/p>\n\u003cp>\"It's a very, very hard choice to make when life still has pleasure & purpose,\" she wrote. But \"the window can close\" on a person with dementia, affecting the ability to refuse food and water once that person can no longer feed herself and caregivers enter into the decision.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This means that \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished\" target=\"_blank\">a self-directed death for someone with dementia\u003c/a> might always have to mean saying farewell to life a bit sooner than she might have otherwise chosen.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Despite+Sweeping+Death-With-Dignity+Law%2C+Few+Will+Have+That+Option&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The death-with-dignity movement took a giant step forward this week, with 38 million people coming under its umbrella in a single swoop when California Gov. Jerry Brown signed the End of Life Option Act on Monday.\u003c/p>\n\u003cp>But the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\">law\u003c/a> still leaves out a wide range of people who might want to be covered: people with progressive debilitating diseases that don't have an obvious six-months-to-live prognosis and people with dementia, the fastest-growing health threat in the U.S. That's also true of similar laws in Oregon, Washington, Montana and Vermont.\u003c/p>\n\u003cp>And there might be no good way around this.\u003c/p>\n\u003cp>These restrictions might be necessary at this point in the history of aid in dying in this country, according to Judith Schwarz of the advocacy group \u003ca href=\"http://endoflifechoicesny.org/\" target=\"_blank\">End of Life Choices New York\u003c/a>. \"Opponents have many fears that such laws will be misapplied to the disenfranchised,\" she wrote in an email, and it's important to guarantee that for these groups — the poor, the elderly, the isolated — the \"right to die\" doesn't somehow morph into the duty to die \"for the sake of others.\"\u003c/p>\n\u003cp>Still, there's a problem with limiting the death-with-dignity option only to those with a prognosis of fewer than six months. For one thing, prognosis is difficult, and studies show that doctors are actually overoptimistic in their assessment of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/384011538/cancer-patients-and-doctors-struggle-to-predict-survival\" target=\"_blank\">how long their patients have to live\u003c/a>. \"Some doctors may wish to be more compassionate and not be as specific,\" Janis Landis, president of the Final Exit Network, wrote in an email, \"and ironically thus deny the patient the certification that is required.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And then there are the conditions that are completely unpredictable, not only in terms of life expectancy but in terms of how, when and in what order functions will be lost. This includes progressive neurological diseases like multiple sclerosis and ALS, where those who want to avoid the most debilitating final stages might end their lives prematurely, afraid that their ability to swallow a pill might disappear without warning.\u003c/p>\n\u003cp>\"Fear of this actually drives some individuals to act early, while they can still procure the equipment they need,\" Landis wrote. To her, it seems especially harsh \"to force such a cruel choice on an individual already suffering so greatly.\"\u003c/p>\n\u003cp>As fraught as it is, though, the requirement that a person be able to swallow lethal medication on his own is an important safeguard, according to Mickey MacIntyre, the chief strategic officer of Compassion & Choices. \"This self-administration requirement is a critical distinction between medical aid in dying and euthanasia,\" he wrote in an email.\u003c/p>\n\u003cp>\"Unlike medical aid in dying, euthanasia requires a healthcare professional or someone else, not the individual, to administer the medication,\" he added, \"So the individual loses control of the decision.\"\u003c/p>\n\u003cp>MacIntyre pointed out that people often change their minds at the last minute, and have every right to do so. In Oregon, he noted, about one-third of the people who obtained lethal drugs through the state's death-with-dignity program since 1998 ultimately \u003ca href=\"http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf\" target=\"_blank\">decided not to take them\u003c/a>.\u003c/p>\n\u003cp>This seems to be a distinctly American quandary, though. In other countries, such as Belgium and the Netherlands, there are also safeguards written into their right-to-die laws, but they are broader and more inclusive.\u003c/p>\n\u003cp>\"The European safeguard is 'intolerable suffering,' \" said Margaret Pabst Battin, a bioethicist at the University of Utah. \"It's not defined in terms of the time until death, and it does include people with ALS or other conditions that wouldn't fall under our laws, which don't say anything about suffering.\"\u003c/p>\n\u003cp>Battin experienced the complexities of deciding when suffering becomes unbearable in caring for her husband, Brooke Hopkins, who was paralyzed from the shoulders down in a 2008 bicycle crash and lived for five more years, until he finally \u003ca href=\"http://6thfloor.blogs.nytimes.com/2013/08/21/choosing-to-die-after-a-struggle-with-life/\">decided\u003c/a> in 2013 to withdraw the machinery keeping him alive.\u003c/p>\n\u003cp>Earlier this year, the Supreme Court of Canada used European-style language \u003ca href=\"http://www.npr.org/sections/thetwo-way/2015/02/06/384292996/canadians-have-a-right-to-assisted-suicide-high-court-says\">upholding\u003c/a> the right to die for anyone with \"a grievous and irremediable medical condition ... that causes enduring suffering that is intolerable.\"\u003c/p>\n\u003cp>A death-with-dignity bill introduced in Battin's own state tried to broaden the safeguards to include people with a wider range of illnesses. On the phone with me, Battin read aloud from the \u003ca href=\"http://le.utah.gov/~2015/bills/static/HB0391.html\">Utah Death with Dignity Act\u003c/a>, introduced by Rep. Rebecca Chavez-Houk, which could apply to someone with an \"intractable and unbearable illness,\" defined as \"bodily disorder that cannot be cured or successfully palliated, and that causes such severe suffering that a patient prefers death.\" She said such broad language would no doubt be changed if the bill works its way through the state Legislature, as has happened elsewhere.\u003c/p>\n\u003cp>But people with Alzheimer's disease and other forms of \u003ca href=\"http://www.npr.org/sections/health-shots/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished\" target=\"_blank\">dementia\u003c/a> are beyond the scope of almost all these laws.\u003c/p>\n\u003cp>Schwarz said that maybe, very far in the future, there might be some way to cover dementia, but it's \"so complicated\" that she doesn't see it happening anytime soon. How, for instance, do you write legislation to deal with the question of personhood, which alters as the disease progresses? Is the demented individual — perhaps someone relatively content in her diminishment — \"the same as the individual who so FIRMLY REQUESTED/DEMANDED lethal meds at a certain point in their future demented state?\" Schwarz wondered. \"And who are you going to get to administer lethal meds under such circumstances?\"\u003c/p>\n\u003cp>Schwarz spends a lot of time these days with Alzheimer's patients who want to choose the timing of their deaths. She said all she can offer them is guidance about \u003ca href=\"http://journals.lww.com/ajnonline/Abstract/2009/09000/Stopping_Eating_and_Drinking.28.aspx\">stopping eating and drinking\u003c/a> as a way to hasten the end.\u003c/p>\n\u003cp>\"It's a very, very hard choice to make when life still has pleasure & purpose,\" she wrote. But \"the window can close\" on a person with dementia, affecting the ability to refuse food and water once that person can no longer feed herself and caregivers enter into the decision.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>In order for Berkeley’s penny-an-ounce soda tax to work, advocates say, retailers have to pass it through to customers. That way, the shoppers will see the higher price on the shelf, and some will choose lower priced (i.e. non-sugary) drinks.\u003c/p>\n\u003cp>In an analysis, UC Berkeley researchers say many retailers are doing just that. They sampled prices in Berkeley, Oakland and San Francisco, just before last November’s election when \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/11/04/will-berkeley-and-san-francisco-soda-tax-measures-set-precedent/\" target=\"_blank\" rel=\"noopener\">Berkeley voters overwhelmingly passed\u003c/a> the first-in-the-country soda tax.\u003c/p>\n\u003cp>Then they sampled prices again last summer, after the tax had gone into effect March 1. They found that retailers were passing through 69 percent of the tax on sodas and 47 percent of the tax on average for all sugar-sweetened beverages.\u003c/p>\n\u003cp>For a 20-ounce soda that had cost $1.75 now would cost $1.89, a 14-cent increase.\u003c/p>\n\u003cp>Lead author Jennifer Falbe, a post-doctoral researcher in the UC Berkeley School of Public Health, said she was encouraged by these findings.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s promising that so early after implementation, we’re already seeing prices increase,” she said. “However, because it is so early, it’s worth it to continue to monitor how the prices change to see where prices ultimately end up.”\u003c/p>\n\u003cp>\u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302881\" target=\"_blank\" rel=\"noopener\">The analysis\u003c/a> is published in the American Journal of Public Health.\u003c/p>\n\u003cp>In August, \u003ca href=\"http://www.news.cornell.edu/stories/2015/08/study-berkeley-soda-tax-falls-flat\" target=\"_blank\" rel=\"noopener\">another study\u003c/a> found a similar result — less than half of the tax was passed through. Oddly, researchers found that the pass through for Coke and Pepsi was only 22 percent.\u003c/p>\n\u003cp>Falbe said some store owners had told the research team that they planned to raise prices. “Some store owners said they hadn’t had a chance to go through their invoices to find out how much they should be rising prices on all their beverages,” Falbe said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The study did not address if the higher price means people are buying fewer sugary drinks. Falbe said her team is in the process of looking at that data.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In order for Berkeley’s penny-an-ounce soda tax to work, advocates say, retailers have to pass it through to customers. That way, the shoppers will see the higher price on the shelf, and some will choose lower priced (i.e. non-sugary) drinks.\u003c/p>\n\u003cp>In an analysis, UC Berkeley researchers say many retailers are doing just that. They sampled prices in Berkeley, Oakland and San Francisco, just before last November’s election when \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/11/04/will-berkeley-and-san-francisco-soda-tax-measures-set-precedent/\" target=\"_blank\" rel=\"noopener\">Berkeley voters overwhelmingly passed\u003c/a> the first-in-the-country soda tax.\u003c/p>\n\u003cp>Then they sampled prices again last summer, after the tax had gone into effect March 1. They found that retailers were passing through 69 percent of the tax on sodas and 47 percent of the tax on average for all sugar-sweetened beverages.\u003c/p>\n\u003cp>For a 20-ounce soda that had cost $1.75 now would cost $1.89, a 14-cent increase.\u003c/p>\n\u003cp>Lead author Jennifer Falbe, a post-doctoral researcher in the UC Berkeley School of Public Health, said she was encouraged by these findings.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s promising that so early after implementation, we’re already seeing prices increase,” she said. “However, because it is so early, it’s worth it to continue to monitor how the prices change to see where prices ultimately end up.”\u003c/p>\n\u003cp>\u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302881\" target=\"_blank\" rel=\"noopener\">The analysis\u003c/a> is published in the American Journal of Public Health.\u003c/p>\n\u003cp>In August, \u003ca href=\"http://www.news.cornell.edu/stories/2015/08/study-berkeley-soda-tax-falls-flat\" target=\"_blank\" rel=\"noopener\">another study\u003c/a> found a similar result — less than half of the tax was passed through. Oddly, researchers found that the pass through for Coke and Pepsi was only 22 percent.\u003c/p>\n\u003cp>Falbe said some store owners had told the research team that they planned to raise prices. “Some store owners said they hadn’t had a chance to go through their invoices to find out how much they should be rising prices on all their beverages,” Falbe said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The study did not address if the higher price means people are buying fewer sugary drinks. Falbe said her team is in the process of looking at that data.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The U.S. Supreme Court will not hear a challenge to a requirement in New York state that all children be vaccinated, unless they have a religious exemption, before they can attend public school. The justices on Monday let stand lower court rulings that the policy does not violate the constitution.\u003c/p>\n\u003cp>While the particulars of the New York vaccine mandate is somewhat different than in California, this decision still matters here. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\"> new law\u003c/a> passed in June requires virtually all California schoolchildren to be vaccinated against a range of diseases in order to attend school.\u003c/p>\n\u003cp>The high court's move means that potential challenges to the California law are \"not likely to succeed,\" Prof. Dorit Reiss, a vaccine law expert at UC Hastings College of the Law in San Francisco, told KQED.\u003c/p>\n\u003cp>During the rancorous debate over the bill, SB277, one of the arguments I heard from those opposing it was that the Supreme Court's major cases on childhood vaccination were decades old -- or more -- and that the world had changed dramatically since the last major rulings.\u003c/p>\n\u003cp>Yes, this is the health blog, but bear with me while we take a look at two key cases.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>First, in 1905, the Supreme Court in \u003ca href=\"http://caselaw.findlaw.com/us-supreme-court/197/11.html\" target=\"_blank\">Jacobson v. Commonwealth of Massachusetts\u003c/a> essentially ruled that the states could enforce mandatory vaccination laws.\u003c/p>\n\u003cp>Reiss noted that Jacobson found \"states have extensive leeway to require vaccination.\"\u003c/p>\n\u003cp>California never had a religious exemption written into the law. Instead the state had only a \"personal belief exemption,\" now abolished by SB277. Only those children with a medical exemption may attend school without being vaccinated.\u003c/p>\n\u003cp>And that brings us to the second key case.\u003c/p>\n\u003cp>[contextly_sidebar id=\"XCNlz9GH0RZ29XkqsHVBKv8dlxU9i4f5\"]In 1944, the U.S. Supreme Court heard arguments in \u003ca href=\"https://www.law.cornell.edu/supremecourt/text/321/158\" target=\"_blank\">Prince v. Massachusetts\u003c/a>. The case was not explicitly about vaccines -- a Jehovah's Witness was charged with violating child labor law by having her child sell religious material. Rather, the case is seen as one that spells out limits on parental rights. Parents do not have absolute authority over their children, and that can include decisions about vaccination. From the decision:\u003c/p>\n\u003cblockquote>\u003cp> \"The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.\"\u003c/p>\u003c/blockquote>\n\u003cp>\"You don't get out of a general law because you have a religious exemption,\" Reiss told me. She used taxes as an example. You may have a religious objection, but you still must pay. Because SB277 is \"not aimed at a particular religion,\" one cannot apply a religious exemption.\u003c/p>\n\u003cp>Returning to the challenge to the New York law, Reiss said that by declining an opportunity to consider it, the Supreme Court is not reaffirming these older decisions. But it is also declining an opportunity to reconsider those rulings.\u003c/p>\n\u003cp>It may be that the petition was denied \"because there are not four justices on the Supreme Court who think Jacobson is such bad law that it should be overturned,\" Reiss wrote on\u003ca href=\"http://www.skepticalraptor.com/skepticalraptorblog.php/vaccines-and-religious-exemptions-recent-legal-decision/\" target=\"_blank\"> Skeptical Raptor\u003c/a>.\u003c/p>\n\u003cp>Here in California the new vaccine law appears to raise a different constitutional question -- all California children have a \u003ca href=\"https://oag.ca.gov/publications/CRhandbook/ch6\" target=\"_blank\">constitutional right to an education\u003c/a>. Under SB277, children who are not vaccinated cannot attend school.\u003c/p>\n\u003cp>Is the constitutional right to an education violated by SB277?\u003c/p>\n\u003cp>Reiss said she believes a constitutional challenge on these grounds would be \"incorrect.\" She pointed to a series of famous cases in California, \u003ca href=\"http://scocal.stanford.edu/opinion/serrano-v-priest-27628\" target=\"_blank\">Serrano v. Priest\u003c/a>, which found inequity in school financing. Schools were found to be \"discriminating on wealth,\" Reiss said.\u003c/p>\n\u003cp>But requiring schoolchildren to be vaccinated is not a violation under Serrano v. Priest, Reiss said, because choosing not to vaccinate is a behavior and not a fact of one's existence, such as wealth or race. \"It is perfectly legitimate for the state to regulate behavior, which is what SB277 does,\" Reiss said.\u003c/p>\n\u003cp>The new law goes into effect next July 1.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Oct. 8, 2015: this post has been updated to clarify that New York state permits a religious exemption from its vaccine mandate.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The U.S. Supreme Court will not hear a challenge to a requirement in New York state that all children be vaccinated, unless they have a religious exemption, before they can attend public school. The justices on Monday let stand lower court rulings that the policy does not violate the constitution.\u003c/p>\n\u003cp>While the particulars of the New York vaccine mandate is somewhat different than in California, this decision still matters here. A\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\"> new law\u003c/a> passed in June requires virtually all California schoolchildren to be vaccinated against a range of diseases in order to attend school.\u003c/p>\n\u003cp>The high court's move means that potential challenges to the California law are \"not likely to succeed,\" Prof. Dorit Reiss, a vaccine law expert at UC Hastings College of the Law in San Francisco, told KQED.\u003c/p>\n\u003cp>During the rancorous debate over the bill, SB277, one of the arguments I heard from those opposing it was that the Supreme Court's major cases on childhood vaccination were decades old -- or more -- and that the world had changed dramatically since the last major rulings.\u003c/p>\n\u003cp>Yes, this is the health blog, but bear with me while we take a look at two key cases.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>First, in 1905, the Supreme Court in \u003ca href=\"http://caselaw.findlaw.com/us-supreme-court/197/11.html\" target=\"_blank\">Jacobson v. Commonwealth of Massachusetts\u003c/a> essentially ruled that the states could enforce mandatory vaccination laws.\u003c/p>\n\u003cp>Reiss noted that Jacobson found \"states have extensive leeway to require vaccination.\"\u003c/p>\n\u003cp>California never had a religious exemption written into the law. Instead the state had only a \"personal belief exemption,\" now abolished by SB277. Only those children with a medical exemption may attend school without being vaccinated.\u003c/p>\n\u003cp>And that brings us to the second key case.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In 1944, the U.S. Supreme Court heard arguments in \u003ca href=\"https://www.law.cornell.edu/supremecourt/text/321/158\" target=\"_blank\">Prince v. Massachusetts\u003c/a>. The case was not explicitly about vaccines -- a Jehovah's Witness was charged with violating child labor law by having her child sell religious material. Rather, the case is seen as one that spells out limits on parental rights. Parents do not have absolute authority over their children, and that can include decisions about vaccination. From the decision:\u003c/p>\n\u003cblockquote>\u003cp> \"The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.\"\u003c/p>\u003c/blockquote>\n\u003cp>\"You don't get out of a general law because you have a religious exemption,\" Reiss told me. She used taxes as an example. You may have a religious objection, but you still must pay. Because SB277 is \"not aimed at a particular religion,\" one cannot apply a religious exemption.\u003c/p>\n\u003cp>Returning to the challenge to the New York law, Reiss said that by declining an opportunity to consider it, the Supreme Court is not reaffirming these older decisions. But it is also declining an opportunity to reconsider those rulings.\u003c/p>\n\u003cp>It may be that the petition was denied \"because there are not four justices on the Supreme Court who think Jacobson is such bad law that it should be overturned,\" Reiss wrote on\u003ca href=\"http://www.skepticalraptor.com/skepticalraptorblog.php/vaccines-and-religious-exemptions-recent-legal-decision/\" target=\"_blank\"> Skeptical Raptor\u003c/a>.\u003c/p>\n\u003cp>Here in California the new vaccine law appears to raise a different constitutional question -- all California children have a \u003ca href=\"https://oag.ca.gov/publications/CRhandbook/ch6\" target=\"_blank\">constitutional right to an education\u003c/a>. Under SB277, children who are not vaccinated cannot attend school.\u003c/p>\n\u003cp>Is the constitutional right to an education violated by SB277?\u003c/p>\n\u003cp>Reiss said she believes a constitutional challenge on these grounds would be \"incorrect.\" She pointed to a series of famous cases in California, \u003ca href=\"http://scocal.stanford.edu/opinion/serrano-v-priest-27628\" target=\"_blank\">Serrano v. Priest\u003c/a>, which found inequity in school financing. Schools were found to be \"discriminating on wealth,\" Reiss said.\u003c/p>\n\u003cp>But requiring schoolchildren to be vaccinated is not a violation under Serrano v. Priest, Reiss said, because choosing not to vaccinate is a behavior and not a fact of one's existence, such as wealth or race. \"It is perfectly legitimate for the state to regulate behavior, which is what SB277 does,\" Reiss said.\u003c/p>\n\u003cp>The new law goes into effect next July 1.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Oct. 8, 2015: this post has been updated to clarify that New York state permits a religious exemption from its vaccine mandate.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Governor Signs Physician-Assisted Suicide Bill Into Law",
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"content": "\u003cp>California Gov. Jerry Brown signed \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">landmark legislation\u003c/a> today allowing terminally ill patients to obtain lethal medication to end their lives when and where they choose.\u003c/p>\n\u003cp>In a deeply personal note, Brown said he read opposition materials carefully, but in the end was left to reflect on what he would want in the face of his own death.\u003c/p>\n\u003cp>\"I do not know what I would do if I were dying in prolonged and excruciating pain,\" he wrote. \"I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others.\"\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>Listen to a special presentation from The California Report:\u003c/h3>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/227092538\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>One of the key co-authors of the legislation, Sen. Bill Monning, D-Carmel, said the signing “marks a historic day in California” and called the governor’s thoughts “a powerful statement.”\u003c/p>\n\u003cp>Brown’s signature concludes a hotly contested, 10-month debate that elicited impassioned testimony from lawmakers, cancer patients who fear deaths marked by uncontrollable pain and suffering, and religious and disability advocates who fear coercion and abuse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Marg Hall, an advocate with the Bay Area disability rights group Communities United in Defense of Olmstead, said she was \"disappointed\" and \"worried.\"\u003c/p>\n\u003cp>\"Given the level of dysfunction and injustice that exists currently in our health care system, with many people without insurance still, with the very underfunded ability of people to have choices for treatment and care, adding this very potentially dangerous tool to the mix is of great concern to people with disabilities,\" Hall said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"iTOdYPi32BS7nDkgWWeO1fNHFQH9Ia8E\"]\u003c/p>\n\u003cp>Marilyn Golden, senior policy analyst with the Disability Rights Education and Defense Fund strongly opposed the new law and said it lacked safeguards and that abusive heirs or caregivers could “steer” patients toward assisted suicide.\u003c/p>\n\u003cp>The new law requires two doctors to determine that a patient has six months or less to live before prescribing the drugs. Patients must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions.\u003c/p>\n\u003cp>One of the meetings must be private, with only the patient and the physician present, a requirement aimed at ensuring the patient is acting independently, Monning said. Patients must also reaffirm in writing that they intend to take the medication within 48 hours of doing so.\u003c/p>\n\u003cp>Golden called these safeguards “hollow.” She said none of the states that have legalized this option require a witness at the death. When asked if opponents would be monitoring implementation of the law to ensure there is no abuse, she said her group “is not taking any options off the table right now.”\u003c/p>\n\u003cp>Perhaps the most visible face of passage of this law is Brittany Maynard, the 29-year-old California woman who suffered from terminal brain cancer and moved to Oregon explicitly because it permits aid-in-dying. Maynard used the law to end her life last November.\u003c/p>\n\u003cp>In an interview with KQED on Monday, her widower, Dan Diaz, said he felt “an enormous sense of gratitude” upon passage of the law in California. He said his wife would have felt “relief … for all terminally ill Californians that they have that bit of control.”\u003c/p>\n\u003cp>Elizabeth Wallner, 51, a stage 4 colon cancer patient in Sacramento, said she felt a “a great sense of relief. … I don’t want to die,” she said, but “having the option is really powerful.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>KQED's April Dembosky breaks down the bill:\u003c/h3>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/227091620\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>The law started out as \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128\" target=\"_blank\">SB128\u003c/a>, a bill introduced in January. That bill cleared the senate floor, but ultimately stalled in the Assembly in July. The authors introduced a similar bill in August during the special legislative session called by Brown this summer.\u003c/p>\n\u003cp>The law will take effect sometime in 2016, 91 days after the special legislative session concludes. At present, the special session is ongoing and does not have an end date scheduled.\u003c/p>\n\u003cp>When the law goes into effect, California will become the fifth state to allow physician-assisted suicide, along with Oregon, Washington, Montana and Vermont. The practice was permitted in New Mexico until August, when an appeals court reversed a lower court ruling establishing physician-assisted suicide as a fundamental right.\u003c/p>\n\u003cp>Advocates have appealed the case to the state Supreme Court, and a hearing is set for later this month.\u003c/p>\n\u003cp>The California law is set to expire in 10 years, unless the Legislature passes another law to extend it.\u003c/p>\n\u003cp>\u003cem>Read the governor's full statement:\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe class=\"scribd_iframe_embed\" src=\"https://www.scribd.com/embeds/283748544/content?start_page=1&view_mode=scroll&show_recommendations=true\" data-auto-height=\"false\" data-aspect-ratio=\"undefined\" scrolling=\"no\" id=\"doc_19793\" width=\"100%\" height=\"600\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Marg Hall, an advocate with the Bay Area disability rights group Communities United in Defense of Olmstead, said she was \"disappointed\" and \"worried.\"\u003c/p>\n\u003cp>\"Given the level of dysfunction and injustice that exists currently in our health care system, with many people without insurance still, with the very underfunded ability of people to have choices for treatment and care, adding this very potentially dangerous tool to the mix is of great concern to people with disabilities,\" Hall said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Marilyn Golden, senior policy analyst with the Disability Rights Education and Defense Fund strongly opposed the new law and said it lacked safeguards and that abusive heirs or caregivers could “steer” patients toward assisted suicide.\u003c/p>\n\u003cp>The new law requires two doctors to determine that a patient has six months or less to live before prescribing the drugs. Patients must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions.\u003c/p>\n\u003cp>One of the meetings must be private, with only the patient and the physician present, a requirement aimed at ensuring the patient is acting independently, Monning said. Patients must also reaffirm in writing that they intend to take the medication within 48 hours of doing so.\u003c/p>\n\u003cp>Golden called these safeguards “hollow.” She said none of the states that have legalized this option require a witness at the death. When asked if opponents would be monitoring implementation of the law to ensure there is no abuse, she said her group “is not taking any options off the table right now.”\u003c/p>\n\u003cp>Perhaps the most visible face of passage of this law is Brittany Maynard, the 29-year-old California woman who suffered from terminal brain cancer and moved to Oregon explicitly because it permits aid-in-dying. Maynard used the law to end her life last November.\u003c/p>\n\u003cp>In an interview with KQED on Monday, her widower, Dan Diaz, said he felt “an enormous sense of gratitude” upon passage of the law in California. He said his wife would have felt “relief … for all terminally ill Californians that they have that bit of control.”\u003c/p>\n\u003cp>Elizabeth Wallner, 51, a stage 4 colon cancer patient in Sacramento, said she felt a “a great sense of relief. … I don’t want to die,” she said, but “having the option is really powerful.”\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>KQED's April Dembosky breaks down the bill:\u003c/h3>\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/227091620&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/227091620'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003cbr>\n\u003c/p>\u003c/aside>\n\u003cp>The law started out as \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128\" target=\"_blank\">SB128\u003c/a>, a bill introduced in January. That bill cleared the senate floor, but ultimately stalled in the Assembly in July. The authors introduced a similar bill in August during the special legislative session called by Brown this summer.\u003c/p>\n\u003cp>The law will take effect sometime in 2016, 91 days after the special legislative session concludes. At present, the special session is ongoing and does not have an end date scheduled.\u003c/p>\n\u003cp>When the law goes into effect, California will become the fifth state to allow physician-assisted suicide, along with Oregon, Washington, Montana and Vermont. The practice was permitted in New Mexico until August, when an appeals court reversed a lower court ruling establishing physician-assisted suicide as a fundamental right.\u003c/p>\n\u003cp>Advocates have appealed the case to the state Supreme Court, and a hearing is set for later this month.\u003c/p>\n\u003cp>The California law is set to expire in 10 years, unless the Legislature passes another law to extend it.\u003c/p>\n\u003cp>\u003cem>Read the governor's full statement:\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe class=\"scribd_iframe_embed\" src=\"https://www.scribd.com/embeds/283748544/content?start_page=1&view_mode=scroll&show_recommendations=true\" data-auto-height=\"false\" data-aspect-ratio=\"undefined\" scrolling=\"no\" id=\"doc_19793\" width=\"100%\" height=\"600\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\n\u003c/div>\u003c/p>",
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},
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"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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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.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"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",
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"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
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"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/",
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},
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"id": "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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"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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},
"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
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"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",
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"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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"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",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"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",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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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/",
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},
"link": "/radio/program/latino-usa",
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"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": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
"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)",
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"meta": {
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"source": "WaitWhat"
},
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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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",
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"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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},
"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": {
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"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/",
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"source": "pbs"
},
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