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"content": "\u003cp>The Trump administration — reversing guidelines put in place under President Barack Obama — is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.\u003c/p>\n\u003cp>The shift in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association, the industry’s main trade group, has complained that under Obama, federal inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.\u003c/p>\n\u003cp>“It is critical that we have relief,” Mark Parkinson, the group’s president, wrote in a letter to then-President-elect Donald Trump in December 2016.\u003c/p>\n\u003cp>Since 2013, nearly 6,500 nursing homes — 4 of every 10 — have been cited at least once for a serious violation, federal records show. Medicare has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.\u003c/p>\n\u003cp>The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.\u003c/p>\n\u003cp>Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), said in a statement that unnecessary regulation was the main concern that health care providers raised with officials.\u003c/p>\n\u003cp>“Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.\u003c/p>\n\u003cp>But advocates for nursing-home residents say the revised penalties are weakening a valuable patient-safety tool.\u003c/p>\n\u003cp>“They’ve pretty much emasculated enforcement, which was already weak,” said Toby Edelman, a senior attorney at the Center for Medicare Advocacy.\u003c/p>\n\u003cp>Medicare has different ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. Or it can deny payments for new admissions.\u003c/p>\n\u003cp>The average fine in recent years has been $33,453, but 531 nursing homes amassed combined federal fines above $100,000, records show. In 2016, Congress \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Civil-Monetary-Penalties-Annual-Adjustments.html\" target=\"_blank\" rel=\"noopener\">increased the fines\u003c/a> to factor in several years of inflation that had not been accounted for previously.\u003c/p>\n\u003cp>The new rules have been instituted gradually throughout the year.\u003c/p>\n\u003cp>In October, \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-01.pdf\" target=\"_blank\" rel=\"noopener\">CMS discouraged\u003c/a> its regional offices from levying fines, even in the most serious health violations, if the error was a “one-time mistake.” The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-37.pdf\" target=\"_blank\" rel=\"noopener\">July memo\u003c/a> from CMS discouraged the directors of state agencies that survey nursing homes from issuing daily fines for violations that began before an inspection, favoring one-time fines instead. Daily fines remain the recommended approach for major violations discovered during an inspection.\u003c/p>\n\u003cp>Dr. David Gifford, the American Health Care Association’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.\u003c/p>\n\u003cp>“What was happening is you were seeing massive fines accumulating because they were applying them on a per-day basis retrospectively,” Gifford said.\u003c/p>\n\u003cp>But the change means that some nursing homes could be sheltered from fines above the maximum per-instance fine of $20,965, even for egregious mistakes.\u003c/p>\n\u003cp>In September 2016, for instance, health inspectors \u003ca href=\"https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.aspx?ID=146064&SURVEYDATE=09/21/2016&INSPTYPE=CMPL&Inspn=HEALTH&profTab=1&loc=DECATUR%2C%20IL&lat=39.8403147&lng=-88.9548001&name=LINCOLN%20MANOR&Distn=2.7\" target=\"_blank\" rel=\"noopener\">faulted Lincoln Manor\u003c/a>, a nursing home in Decatur, Ill., for failing to monitor and treat the wound of a patient whose implanted pain-medication pump gradually slipped over eight days through a ruptured suture and protruded from her abdomen. The patient died.\u003c/p>\n\u003cp>CMS fined Lincoln Manor $282,954, including $10,091 a day for 28 days, from the time the nursing home noticed the problem with the wound until supervisors had retrained nurses to avoid similar errors. An administrative law judge called the penalties “quite modest” given the “appalling” care.\u003c/p>\n\u003cp>The fines were issued before the new guidelines took effect; if the agency had issued a one-time fine, the maximum would have been less than $21,000.\u003c/p>\n\u003cp>Lincoln Manor closed in September. Its owner could not be reached for comment, and his lawyer did not respond to an interview request.\u003c/p>\n\u003cp>Advocates for nursing home residents say that relaxing penalties threatens to undo progress at deterring wrongdoing. Janet Wells, a consultant for California Advocates for Nursing Home Reform, said the changes come as “some egregious violations and injuries to residents are being penalized — finally — at a level that gets the industry’s attention and isn’t just the cost of doing business.”\u003c/p>\n\u003cp>In November, the Trump administration exempted nursing homes that violate \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-04.pdf\" target=\"_blank\" rel=\"noopener\">eight new safety rules\u003c/a> from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.\u003c/p>\n\u003cp>Rodney Whitlock, a health policy consultant and former Republican Senate staffer, said health inspectors “are out there looking for opportunities to show that the nursing homes are not living up to some extremely tight standards.” He said while the motivation for tough regulation was understandable, “the fines don’t make it easier to hire people and doesn’t make it easier to stay in business.”\u003c/p>\n\u003cp>In June, CMS rescinded another Obama administration action that banned nursing homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than going to court.\u003c/p>\n\u003cp>“We publish nearly 11,000 pages of regulation every year,” the agency’s administrator, Seema Verma, said in \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-30.html\" target=\"_blank\" rel=\"noopener\">a speech in October\u003c/a>. That paperwork is “taking doctors away from what matters most: patients.”\u003c/p>\n\u003cp>Janine Finck-Boyle, director of health regulations and policy at LeadingAge, a group of nonprofit nursing homes and other entities that care for older people, said the group’s members had been struggling to cope with regulations.\u003c/p>\n\u003cp>“If you’re a 50-bed rural facility out West or in the Dakotas,” she said, “you don’t have the resources to get everything done from A to Z.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.\u003c/p>\n\u003cp>Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), said in a statement that unnecessary regulation was the main concern that health care providers raised with officials.\u003c/p>\n\u003cp>“Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.\u003c/p>\n\u003cp>But advocates for nursing-home residents say the revised penalties are weakening a valuable patient-safety tool.\u003c/p>\n\u003cp>“They’ve pretty much emasculated enforcement, which was already weak,” said Toby Edelman, a senior attorney at the Center for Medicare Advocacy.\u003c/p>\n\u003cp>Medicare has different ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. Or it can deny payments for new admissions.\u003c/p>\n\u003cp>The average fine in recent years has been $33,453, but 531 nursing homes amassed combined federal fines above $100,000, records show. In 2016, Congress \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Civil-Monetary-Penalties-Annual-Adjustments.html\" target=\"_blank\" rel=\"noopener\">increased the fines\u003c/a> to factor in several years of inflation that had not been accounted for previously.\u003c/p>\n\u003cp>The new rules have been instituted gradually throughout the year.\u003c/p>\n\u003cp>In October, \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-01.pdf\" target=\"_blank\" rel=\"noopener\">CMS discouraged\u003c/a> its regional offices from levying fines, even in the most serious health violations, if the error was a “one-time mistake.” The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-37.pdf\" target=\"_blank\" rel=\"noopener\">July memo\u003c/a> from CMS discouraged the directors of state agencies that survey nursing homes from issuing daily fines for violations that began before an inspection, favoring one-time fines instead. Daily fines remain the recommended approach for major violations discovered during an inspection.\u003c/p>\n\u003cp>Dr. David Gifford, the American Health Care Association’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.\u003c/p>\n\u003cp>“What was happening is you were seeing massive fines accumulating because they were applying them on a per-day basis retrospectively,” Gifford said.\u003c/p>\n\u003cp>But the change means that some nursing homes could be sheltered from fines above the maximum per-instance fine of $20,965, even for egregious mistakes.\u003c/p>\n\u003cp>In September 2016, for instance, health inspectors \u003ca href=\"https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.aspx?ID=146064&SURVEYDATE=09/21/2016&INSPTYPE=CMPL&Inspn=HEALTH&profTab=1&loc=DECATUR%2C%20IL&lat=39.8403147&lng=-88.9548001&name=LINCOLN%20MANOR&Distn=2.7\" target=\"_blank\" rel=\"noopener\">faulted Lincoln Manor\u003c/a>, a nursing home in Decatur, Ill., for failing to monitor and treat the wound of a patient whose implanted pain-medication pump gradually slipped over eight days through a ruptured suture and protruded from her abdomen. The patient died.\u003c/p>\n\u003cp>CMS fined Lincoln Manor $282,954, including $10,091 a day for 28 days, from the time the nursing home noticed the problem with the wound until supervisors had retrained nurses to avoid similar errors. An administrative law judge called the penalties “quite modest” given the “appalling” care.\u003c/p>\n\u003cp>The fines were issued before the new guidelines took effect; if the agency had issued a one-time fine, the maximum would have been less than $21,000.\u003c/p>\n\u003cp>Lincoln Manor closed in September. Its owner could not be reached for comment, and his lawyer did not respond to an interview request.\u003c/p>\n\u003cp>Advocates for nursing home residents say that relaxing penalties threatens to undo progress at deterring wrongdoing. Janet Wells, a consultant for California Advocates for Nursing Home Reform, said the changes come as “some egregious violations and injuries to residents are being penalized — finally — at a level that gets the industry’s attention and isn’t just the cost of doing business.”\u003c/p>\n\u003cp>In November, the Trump administration exempted nursing homes that violate \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-04.pdf\" target=\"_blank\" rel=\"noopener\">eight new safety rules\u003c/a> from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.\u003c/p>\n\u003cp>Rodney Whitlock, a health policy consultant and former Republican Senate staffer, said health inspectors “are out there looking for opportunities to show that the nursing homes are not living up to some extremely tight standards.” He said while the motivation for tough regulation was understandable, “the fines don’t make it easier to hire people and doesn’t make it easier to stay in business.”\u003c/p>\n\u003cp>In June, CMS rescinded another Obama administration action that banned nursing homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than going to court.\u003c/p>\n\u003cp>“We publish nearly 11,000 pages of regulation every year,” the agency’s administrator, Seema Verma, said in \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-30.html\" target=\"_blank\" rel=\"noopener\">a speech in October\u003c/a>. That paperwork is “taking doctors away from what matters most: patients.”\u003c/p>\n\u003cp>Janine Finck-Boyle, director of health regulations and policy at LeadingAge, a group of nonprofit nursing homes and other entities that care for older people, said the group’s members had been struggling to cope with regulations.\u003c/p>\n\u003cp>“If you’re a 50-bed rural facility out West or in the Dakotas,” she said, “you don’t have the resources to get everything done from A to Z.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Complaints Rise in California as Nursing Homes Evict Poor Patients",
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"content": "\u003cp>Anita Willis says the social worker offered her a painful choice: She could either leave the San Jose, Calif., nursing home where she’d spent a month recovering from a stroke — or come up with $336 a day to stay on.\u003c/p>\n\u003cp>She had until midnight to decide.\u003c/p>\n\u003cp>Willis’ Medicaid managed-care plan had told the home that it was cutting off payment because she no longer qualified for such a high level of care. If Willis, 58, stayed and paid the daily rate, her Social Security disability money would run out in three days. But if she left, she had nowhere to go. She’d recently become homeless after a breakup and said she couldn’t even afford a room-and-board setting.\u003c/p>\n\u003cp>In tears, she said, she agreed to leave. Thus began a months-long odyssey from budget motels to acquaintances’ couches to hospital ERs — at least five emergency visits in all, she said. Sometimes, her 25-year-old daughter drove down from Sacramento, and Willis slept in her daughter’s car.\u003c/p>\n\u003cp>“They kicked me out in the cold,” said Willis, a former Head Start teacher.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates.\u003c/p>\n\u003cp>In California alone, such complaints have jumped 70 percent in five years, reaching 1,504 last year, said Joseph Rodrigues, the state-employed Long-Term Care Ombudsman, who for 15 years has overseen local ombudsman programs, which are responsible for resolving consumer complaints.\u003c/p>\n\u003cp>Around the country, ombudsmen say many patients like Willis end up with no permanent housing or regular medical care after being discharged. Even when the discharges are deemed legal, these ombudsmen say, they often are unethical.\u003c/p>\n\u003cp>“It’s a growing problem,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association. Coleman says the practice stems from skilled nursing facilities’ desire for better compensation for their services and from the shortage of other affordable long-term care options that might absorb less severe cases.\u003c/p>\n\u003cp>In Willis’ case, she ultimately lost her appeal to return to the nursing home, Courtyard Care Center. A state hearing judge determined that she had left the home voluntarily because she refused the opportunity to pay to remain there.\u003c/p>\n\u003cp>Top administrators at Sava Senior Care, which owns Courtyard, did not return repeated calls for comment.\u003c/p>\n\u003cp>Among other recent cases of allegedly improper discharges:\u003c/p>\n\u003cul>\n\u003cli>In October, California’s attorney general moved to prevent a Bakersfield nursing home administrator from working with elderly and disabled people, while he awaits trial on charges of elder abuse and wrongful discharge. State prosecutors said one patient was falsely informed that she owed the home money, then sent to an independent living center even though she could not “walk or toilet on her own.” The administrator did not return messages left at the nursing home.\u003c/li>\n\u003cli>A \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\" target=\"_blank\" rel=\"noopener\">pending lawsuit\u003c/a> by Maryland’s attorney general alleges a nursing home chain, Neiswanger Management Services (NMS), illegally evicted residents, sending them to homeless shelters or other inadequate facilities to free up bed space for higher-paying patients. NMS countersued state regulators, alleging they are trying to drive the chain out of business.\u003c/li>\n\u003cli>Last month, a 73-year-old woman with diabetes and heart failure \u003ca href=\"http://canhr.org/newsroom/newdev_archive/2017/PDFs/Complaint-JohnsonMoore-Dumping.pdf\" target=\"_blank\" rel=\"noopener\">sued a Fresno, Calif., nursing home\u003c/a> for allegedly \u003ca href=\"http://www.fresnobee.com/news/local/article182618836.html\" target=\"_blank\" rel=\"noopener\">leaving her with an open wound on a sidewalk\u003c/a> in front of a relative’s home. The suit said conditions in the residence were unsafe and a family member refused to allow her inside. The state cited the home in July and issued a $20,000 fine.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, not all complaints or lawsuits are well-founded. Federal law allows a nursing home to discharge or evict a patient when it cannot meet the resident’s needs or the person no longer requires services; if the resident endangers the health and safety of other individuals; or if the patient has failed, after reasonable and appropriate notice, to pay.\u003c/p>\n\u003cp>The law also generally requires a home to provide 30 days’ notice before discharging a patient involuntarily and requires all discharges be safe and orderly.\u003c/p>\n\u003cp>Deborah Pacyna, spokeswoman for the California Association of Health Facilities, a trade organization that represents nursing homes, questions why nursing homes should be responsible for providing a safety net for the indigent and homeless.\u003c/p>\n\u003cp>“Nursing home residents reflect society,” she said in a written statement. “Some nursing home residents live in homeless shelters or hotels. They may request that they go back ‘home,’ or to their local shelter or hotel upon discharge. We must honor their choices as long as their needs are met.”\u003c/p>\n\u003cp>Pacyna also noted that eviction and discharge complaints represent a tiny fraction of the hundreds of thousands of residents released from the state’s nursing homes each year.\u003c/p>\n\u003cp>Nationally, discharge and eviction complaints have remained more or less steady in recent years after rising significantly between 2000 and 2007, according to data collected by the federal government. Still, these complaints remain the top grievance reported to nursing home ombudsmen as the number of overall complaints about everything from abuse to access to information has dropped in the past decade.\u003c/p>\n\u003cp>The rate of complaints can vary considerably by state. Jamie Freschi, the Illinois state ombudsman, says discharge and eviction complaints have more than doubled in her state since 2011.\u003c/p>\n\u003cp>She recalled one wheelchair-bound nursing resident who was in severe pain from osteoarthritis, scoliosis and fibromyalgia when she was discharged from a nursing home and sent to a homeless shelter. After the shelter rejected her because it could not accommodate her wheelchair, the resident went to a motel, which kicked her out when she ran out of money. She has since cycled between the emergency room and the streets, Freschi said.\u003c/p>\n\u003cp>“It’s an example of a really, really broken system, all the way around,” Freschi said.\u003c/p>\n\u003cp>Advocates say such decisions are often money-driven: Medicare covers patients for just a short time after they are released from hospitals. After that, these critics say, many nursing homes don’t want to accept the lower rates paid by Medicaid, the public insurance program for low-income residents.\u003c/p>\n\u003cp>Even when they appeal and win, advocates say, it doesn’t always help the patient. The Centers for Medicare & Medicaid Services has advised California on two occasions — including this past summer — that it must enforce decisions from appeals hearings. (The state contends that it uses a variety of strategies to enforce the law.)\u003c/p>\n\u003cp>Last month, the California Long-Term Care Ombudsman Association joined with the legal wing of the AARP Foundation to \u003ca href=\"https://www.documentcloud.org/documents/4199718-2017-10-02-Complaint.html\" target=\"_blank\" rel=\"noopener\">sue a Sacramento nursing home\u003c/a>, alleging it had improperly discharged an 83-year-old woman with Alzheimer’s — requiring the nursing home to readmit her.\u003c/p>\n\u003cp>“The facilities are getting the message that they don’t have to follow the rules here, so they’re emboldened,” said Matt Borden, a San Francisco attorney helping with the lawsuit.\u003c/p>\n\u003cp>Willis and her advocates were convinced that Courtyard Care Center broke the rules in her case.\u003c/p>\n\u003cp>Willis “did not leave Courtyard ‘voluntarily’ in just about any sense of the word,” said Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform.\u003c/p>\n\u003cp>At a hearing in April, held at the nursing home and attended by a reporter, Chicotel and an ombudsman argued that Willis’ discharge violated legal requirements, including lack of written notice. They asked that she be immediately readmitted.\u003c/p>\n\u003cp>According to hearing documents, Willis’ documented medical problems were many: an aneurysm, an ulcer, difficulty walking, muscle weakness, gastritis, anemia and heart and kidney disease. During her stay at the nursing home, she said, she’d fallen and hit her head while visiting the doctor, resulting in a severe concussion.\u003c/p>\n\u003cp>For their part, Courtyard staffers explained that Medicaid wouldn’t cover Willis anymore based on their assessment of her condition. They said she had “almost returned to her prior level of functioning.”\u003c/p>\n\u003cp>During the hearing, Willis repeatedly told those in attendance that she felt dizzy and nauseated. Her head pounded. “I’m not good,” she said. Afterward, she begged for a ride to the emergency room, where she was admitted with a torn aorta and bleeding ulcer.\u003c/p>\n\u003cp>She was still in the hospital when the hearing officer issued her decision a few days later. Eventually, she was released to another nursing home, which also discharged her after a month, she said. Then she resumed sleeping on friends’ couches. She chose not to file another appeal.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“This time in my life,” Willis said, “it’s very discouraging.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Anita Willis says the social worker offered her a painful choice: She could either leave the San Jose, Calif., nursing home where she’d spent a month recovering from a stroke — or come up with $336 a day to stay on.\u003c/p>\n\u003cp>She had until midnight to decide.\u003c/p>\n\u003cp>Willis’ Medicaid managed-care plan had told the home that it was cutting off payment because she no longer qualified for such a high level of care. If Willis, 58, stayed and paid the daily rate, her Social Security disability money would run out in three days. But if she left, she had nowhere to go. She’d recently become homeless after a breakup and said she couldn’t even afford a room-and-board setting.\u003c/p>\n\u003cp>In tears, she said, she agreed to leave. Thus began a months-long odyssey from budget motels to acquaintances’ couches to hospital ERs — at least five emergency visits in all, she said. Sometimes, her 25-year-old daughter drove down from Sacramento, and Willis slept in her daughter’s car.\u003c/p>\n\u003cp>“They kicked me out in the cold,” said Willis, a former Head Start teacher.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates.\u003c/p>\n\u003cp>In California alone, such complaints have jumped 70 percent in five years, reaching 1,504 last year, said Joseph Rodrigues, the state-employed Long-Term Care Ombudsman, who for 15 years has overseen local ombudsman programs, which are responsible for resolving consumer complaints.\u003c/p>\n\u003cp>Around the country, ombudsmen say many patients like Willis end up with no permanent housing or regular medical care after being discharged. Even when the discharges are deemed legal, these ombudsmen say, they often are unethical.\u003c/p>\n\u003cp>“It’s a growing problem,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association. Coleman says the practice stems from skilled nursing facilities’ desire for better compensation for their services and from the shortage of other affordable long-term care options that might absorb less severe cases.\u003c/p>\n\u003cp>In Willis’ case, she ultimately lost her appeal to return to the nursing home, Courtyard Care Center. A state hearing judge determined that she had left the home voluntarily because she refused the opportunity to pay to remain there.\u003c/p>\n\u003cp>Top administrators at Sava Senior Care, which owns Courtyard, did not return repeated calls for comment.\u003c/p>\n\u003cp>Among other recent cases of allegedly improper discharges:\u003c/p>\n\u003cul>\n\u003cli>In October, California’s attorney general moved to prevent a Bakersfield nursing home administrator from working with elderly and disabled people, while he awaits trial on charges of elder abuse and wrongful discharge. State prosecutors said one patient was falsely informed that she owed the home money, then sent to an independent living center even though she could not “walk or toilet on her own.” The administrator did not return messages left at the nursing home.\u003c/li>\n\u003cli>A \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\" target=\"_blank\" rel=\"noopener\">pending lawsuit\u003c/a> by Maryland’s attorney general alleges a nursing home chain, Neiswanger Management Services (NMS), illegally evicted residents, sending them to homeless shelters or other inadequate facilities to free up bed space for higher-paying patients. NMS countersued state regulators, alleging they are trying to drive the chain out of business.\u003c/li>\n\u003cli>Last month, a 73-year-old woman with diabetes and heart failure \u003ca href=\"http://canhr.org/newsroom/newdev_archive/2017/PDFs/Complaint-JohnsonMoore-Dumping.pdf\" target=\"_blank\" rel=\"noopener\">sued a Fresno, Calif., nursing home\u003c/a> for allegedly \u003ca href=\"http://www.fresnobee.com/news/local/article182618836.html\" target=\"_blank\" rel=\"noopener\">leaving her with an open wound on a sidewalk\u003c/a> in front of a relative’s home. The suit said conditions in the residence were unsafe and a family member refused to allow her inside. The state cited the home in July and issued a $20,000 fine.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, not all complaints or lawsuits are well-founded. Federal law allows a nursing home to discharge or evict a patient when it cannot meet the resident’s needs or the person no longer requires services; if the resident endangers the health and safety of other individuals; or if the patient has failed, after reasonable and appropriate notice, to pay.\u003c/p>\n\u003cp>The law also generally requires a home to provide 30 days’ notice before discharging a patient involuntarily and requires all discharges be safe and orderly.\u003c/p>\n\u003cp>Deborah Pacyna, spokeswoman for the California Association of Health Facilities, a trade organization that represents nursing homes, questions why nursing homes should be responsible for providing a safety net for the indigent and homeless.\u003c/p>\n\u003cp>“Nursing home residents reflect society,” she said in a written statement. “Some nursing home residents live in homeless shelters or hotels. They may request that they go back ‘home,’ or to their local shelter or hotel upon discharge. We must honor their choices as long as their needs are met.”\u003c/p>\n\u003cp>Pacyna also noted that eviction and discharge complaints represent a tiny fraction of the hundreds of thousands of residents released from the state’s nursing homes each year.\u003c/p>\n\u003cp>Nationally, discharge and eviction complaints have remained more or less steady in recent years after rising significantly between 2000 and 2007, according to data collected by the federal government. Still, these complaints remain the top grievance reported to nursing home ombudsmen as the number of overall complaints about everything from abuse to access to information has dropped in the past decade.\u003c/p>\n\u003cp>The rate of complaints can vary considerably by state. Jamie Freschi, the Illinois state ombudsman, says discharge and eviction complaints have more than doubled in her state since 2011.\u003c/p>\n\u003cp>She recalled one wheelchair-bound nursing resident who was in severe pain from osteoarthritis, scoliosis and fibromyalgia when she was discharged from a nursing home and sent to a homeless shelter. After the shelter rejected her because it could not accommodate her wheelchair, the resident went to a motel, which kicked her out when she ran out of money. She has since cycled between the emergency room and the streets, Freschi said.\u003c/p>\n\u003cp>“It’s an example of a really, really broken system, all the way around,” Freschi said.\u003c/p>\n\u003cp>Advocates say such decisions are often money-driven: Medicare covers patients for just a short time after they are released from hospitals. After that, these critics say, many nursing homes don’t want to accept the lower rates paid by Medicaid, the public insurance program for low-income residents.\u003c/p>\n\u003cp>Even when they appeal and win, advocates say, it doesn’t always help the patient. The Centers for Medicare & Medicaid Services has advised California on two occasions — including this past summer — that it must enforce decisions from appeals hearings. (The state contends that it uses a variety of strategies to enforce the law.)\u003c/p>\n\u003cp>Last month, the California Long-Term Care Ombudsman Association joined with the legal wing of the AARP Foundation to \u003ca href=\"https://www.documentcloud.org/documents/4199718-2017-10-02-Complaint.html\" target=\"_blank\" rel=\"noopener\">sue a Sacramento nursing home\u003c/a>, alleging it had improperly discharged an 83-year-old woman with Alzheimer’s — requiring the nursing home to readmit her.\u003c/p>\n\u003cp>“The facilities are getting the message that they don’t have to follow the rules here, so they’re emboldened,” said Matt Borden, a San Francisco attorney helping with the lawsuit.\u003c/p>\n\u003cp>Willis and her advocates were convinced that Courtyard Care Center broke the rules in her case.\u003c/p>\n\u003cp>Willis “did not leave Courtyard ‘voluntarily’ in just about any sense of the word,” said Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform.\u003c/p>\n\u003cp>At a hearing in April, held at the nursing home and attended by a reporter, Chicotel and an ombudsman argued that Willis’ discharge violated legal requirements, including lack of written notice. They asked that she be immediately readmitted.\u003c/p>\n\u003cp>According to hearing documents, Willis’ documented medical problems were many: an aneurysm, an ulcer, difficulty walking, muscle weakness, gastritis, anemia and heart and kidney disease. During her stay at the nursing home, she said, she’d fallen and hit her head while visiting the doctor, resulting in a severe concussion.\u003c/p>\n\u003cp>For their part, Courtyard staffers explained that Medicaid wouldn’t cover Willis anymore based on their assessment of her condition. They said she had “almost returned to her prior level of functioning.”\u003c/p>\n\u003cp>During the hearing, Willis repeatedly told those in attendance that she felt dizzy and nauseated. Her head pounded. “I’m not good,” she said. Afterward, she begged for a ride to the emergency room, where she was admitted with a torn aorta and bleeding ulcer.\u003c/p>\n\u003cp>She was still in the hospital when the hearing officer issued her decision a few days later. Eventually, she was released to another nursing home, which also discharged her after a month, she said. Then she resumed sleeping on friends’ couches. She chose not to file another appeal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.\u003c/p>\n\u003cp>In a \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">ruling this week\u003c/a>, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”\u003c/p>\n\u003cp>Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling.\u003c/p>\n\u003cp>Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable mistake.\u003c/p>\n\u003cp>Employers and policymakers across the country are closely watching this legal fight amid growing concern about the financial implications of industry consolidation. Large health systems are gaining market clout and the ability to raise prices by acquiring more hospitals, outpatient surgery centers and physician offices.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s stunning what Sutter did to cover up incriminating documents in this case,” said Richard Grossman, the lead plaintiffs’ lawyer representing a class of more than 1,500 employer-funded health plans.\u003c/p>\n\u003cp>In April 2014, a grocery workers’ health plan sued Sutter and alleged it was violating antitrust and unfair competition laws. The plaintiffs began requesting documents related to contracting practices, such as “gag clauses” that prevent patients from seeing negotiated rates and choosing a cheaper provider and “all-or-nothing” terms that require every facility in a health system to be included in insurance networks \u003c/p>\n\u003cp>Sutter disputes the broader allegations in the lawsuit over its market conduct and said its charges are in line with its competitors’.\u003c/p>\n\u003cp>The judge said that in 2015 \u003ca href=\"https://www.youtube.com/watch?v=hLtEtJgW7no\">Melissa Brendt\u003c/a>, Sutter’s chief contracting officer in the managed-care department, and an assistant general counsel, Daniela Almeida, authorized Brendt’s executive assistant to destroy 10 years’ worth of managed-care documents going back to 1995. The company earlier had scheduled the documents to be destroyed in 2035 — 20 years later.\u003c/p>\n\u003cp>The executive assistant, Sina Santagata, testified in a deposition she wasn’t aware of any other time in her 17 years at Sutter when the managed-care department destroyed records held in storage.\u003c/p>\n\u003cp>In his \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">Nov. 13 ruling\u003c/a> against Sutter, the judge singled out an email by Santagata as “particularly noteworthy.”\u003c/p>\n\u003cp>The executive assistant emailed Brendt, the chief contracting officer, on July 30, 2015, after sending the order to destroy the records. She wrote, “I’ve pushed the button … if someone is in need of a box between 3/15/95 & 11/23/05 … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.”\u003c/p>\n\u003cp>The Federal Trade Commission (FTC) enforces antitrust laws in health care to prevent hospitals, drugmakers and other industry players from engaging in anti-competitive behavior that could harm consumers.\u003c/p>\n\u003cp>Santagata testified that she was being “sarcastic” in her email, and Sutter told the judge that the FTC reference was just a “joke.”\u003c/p>\n\u003cp>Karnow saw no humor in it. “There are infinite topics for jokes, and the choice of this one is strong evidence” in the plaintiffs’ favor, he wrote in his order Monday.\u003c/p>\n\u003cp>As part of his sanctions against Sutter, the judge ordered the health system to examine \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/plaintiffs-motion-for-sutter-sanctions.pdf\">email\u003c/a> backup tapes covering 2002 through 2005 to search for documents on some of the same topics as the destroyed records. Also, Karnow said he will consider a plaintiffs’ motion for issuing jury instructions that are adverse to Sutter in light of the document destruction. The trial is scheduled for June 2019.\u003c/p>\n\u003cp>“The record shows that Sutter’s conduct was more than just an inadvertent error,” Karnow wrote.\u003c/p>\n\u003cp>Sutter spokeswoman Karen Garner said the incident was a “mistake made as part of a routine destruction of old paper records” and the Sacramento-based health system disclosed the error as soon as it was discovered.\u003c/p>\n\u003cp>“We regret that as part of a routine archiving process we failed to preserve some boxes of decades-old hard-copy documents,” Garner said.\u003c/p>\n\u003cp>The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014. The joint employer-union health plan represents more than 60,000 employees, dependents and retirees. The court certified the case as a class action in August, allowing hundreds of other employers and self-funded health plans to potentially benefit from the litigation.\u003c/p>\n\u003cp>In addition to its 24 hospitals, Sutter’s nonprofit health system has 35 surgery centers and more than 5,000 physicians in its network. It reported $11.9 billion in revenue last year and income of $554 million.\u003c/p>\n\u003cp>Grossman, the plaintiffs’ counsel, said he welcomed the judge’s ruling. But he said much of the evidence is irreplaceable, particularly handwritten notes from negotiating sessions and meetings involving key Sutter executives.\u003c/p>\n\u003cp>He said those records covered a critical period in the early 2000s when there was a “sea change in Sutter’s contracting strategy” and it implemented provisions that insulated the health system from price competition.\u003c/p>\n\u003cp>“This was groundbreaking in the industry,” Grossman said. “Until we address the anti-competitive behavior of entities like Sutter, we will not solve the problem of high costs in health care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The plaintiffs are seeking to recover hundreds of millions of dollars from Sutter from what it claims are illegally inflated prices. The lawsuit alleges that an overnight hospital stay at Sutter hospitals in San Francisco or Sacramento costs at least 38 percent more than a comparable stay in the more competitive Los Angeles market.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.\u003c/p>\n\u003cp>In a \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">ruling this week\u003c/a>, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”\u003c/p>\n\u003cp>Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling.\u003c/p>\n\u003cp>Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable mistake.\u003c/p>\n\u003cp>Employers and policymakers across the country are closely watching this legal fight amid growing concern about the financial implications of industry consolidation. Large health systems are gaining market clout and the ability to raise prices by acquiring more hospitals, outpatient surgery centers and physician offices.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s stunning what Sutter did to cover up incriminating documents in this case,” said Richard Grossman, the lead plaintiffs’ lawyer representing a class of more than 1,500 employer-funded health plans.\u003c/p>\n\u003cp>In April 2014, a grocery workers’ health plan sued Sutter and alleged it was violating antitrust and unfair competition laws. The plaintiffs began requesting documents related to contracting practices, such as “gag clauses” that prevent patients from seeing negotiated rates and choosing a cheaper provider and “all-or-nothing” terms that require every facility in a health system to be included in insurance networks \u003c/p>\n\u003cp>Sutter disputes the broader allegations in the lawsuit over its market conduct and said its charges are in line with its competitors’.\u003c/p>\n\u003cp>The judge said that in 2015 \u003ca href=\"https://www.youtube.com/watch?v=hLtEtJgW7no\">Melissa Brendt\u003c/a>, Sutter’s chief contracting officer in the managed-care department, and an assistant general counsel, Daniela Almeida, authorized Brendt’s executive assistant to destroy 10 years’ worth of managed-care documents going back to 1995. The company earlier had scheduled the documents to be destroyed in 2035 — 20 years later.\u003c/p>\n\u003cp>The executive assistant, Sina Santagata, testified in a deposition she wasn’t aware of any other time in her 17 years at Sutter when the managed-care department destroyed records held in storage.\u003c/p>\n\u003cp>In his \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">Nov. 13 ruling\u003c/a> against Sutter, the judge singled out an email by Santagata as “particularly noteworthy.”\u003c/p>\n\u003cp>The executive assistant emailed Brendt, the chief contracting officer, on July 30, 2015, after sending the order to destroy the records. She wrote, “I’ve pushed the button … if someone is in need of a box between 3/15/95 & 11/23/05 … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.”\u003c/p>\n\u003cp>The Federal Trade Commission (FTC) enforces antitrust laws in health care to prevent hospitals, drugmakers and other industry players from engaging in anti-competitive behavior that could harm consumers.\u003c/p>\n\u003cp>Santagata testified that she was being “sarcastic” in her email, and Sutter told the judge that the FTC reference was just a “joke.”\u003c/p>\n\u003cp>Karnow saw no humor in it. “There are infinite topics for jokes, and the choice of this one is strong evidence” in the plaintiffs’ favor, he wrote in his order Monday.\u003c/p>\n\u003cp>As part of his sanctions against Sutter, the judge ordered the health system to examine \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/plaintiffs-motion-for-sutter-sanctions.pdf\">email\u003c/a> backup tapes covering 2002 through 2005 to search for documents on some of the same topics as the destroyed records. Also, Karnow said he will consider a plaintiffs’ motion for issuing jury instructions that are adverse to Sutter in light of the document destruction. The trial is scheduled for June 2019.\u003c/p>\n\u003cp>“The record shows that Sutter’s conduct was more than just an inadvertent error,” Karnow wrote.\u003c/p>\n\u003cp>Sutter spokeswoman Karen Garner said the incident was a “mistake made as part of a routine destruction of old paper records” and the Sacramento-based health system disclosed the error as soon as it was discovered.\u003c/p>\n\u003cp>“We regret that as part of a routine archiving process we failed to preserve some boxes of decades-old hard-copy documents,” Garner said.\u003c/p>\n\u003cp>The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014. The joint employer-union health plan represents more than 60,000 employees, dependents and retirees. The court certified the case as a class action in August, allowing hundreds of other employers and self-funded health plans to potentially benefit from the litigation.\u003c/p>\n\u003cp>In addition to its 24 hospitals, Sutter’s nonprofit health system has 35 surgery centers and more than 5,000 physicians in its network. It reported $11.9 billion in revenue last year and income of $554 million.\u003c/p>\n\u003cp>Grossman, the plaintiffs’ counsel, said he welcomed the judge’s ruling. But he said much of the evidence is irreplaceable, particularly handwritten notes from negotiating sessions and meetings involving key Sutter executives.\u003c/p>\n\u003cp>He said those records covered a critical period in the early 2000s when there was a “sea change in Sutter’s contracting strategy” and it implemented provisions that insulated the health system from price competition.\u003c/p>\n\u003cp>“This was groundbreaking in the industry,” Grossman said. “Until we address the anti-competitive behavior of entities like Sutter, we will not solve the problem of high costs in health care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The plaintiffs are seeking to recover hundreds of millions of dollars from Sutter from what it claims are illegally inflated prices. The lawsuit alleges that an overnight hospital stay at Sutter hospitals in San Francisco or Sacramento costs at least 38 percent more than a comparable stay in the more competitive Los Angeles market.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Human Psychology Makes Health Insurance a Hard Sell – Especially for Latino Consumers",
"title": "Human Psychology Makes Health Insurance a Hard Sell – Especially for Latino Consumers",
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"content": "\u003cp>The way human brains are wired, it just doesn’t make sense to us to buy something now that we may not need for years in the future.\u003c/p>\n\u003cp>“Health insurance has to be the toughest thing on earth to sell,” said \u003ca href=\"http://www.ogilvy.com/ogilvy-mather-board/christopher-graves/\" target=\"_blank\" rel=\"noopener\">Christopher Graves\u003c/a>, president and founder of Ogilvy’s Behavioral Science Center. “Especially if you're trying to sell it to somebody who's young, healthy and has not had some catastrophe health-wise.\u003c/p>\n\u003cp>That would be most Latinos in California, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/\" target=\"_blank\" rel=\"noopener\">a primary target\u003c/a> of the marketing and outreach strategy for \u003ca href=\"https://www.coveredca.com/\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s insurance marketplace. The more healthy Latinos sign up for insurance, the more their premiums help balance the costs of caring for older, sicker Californians.\u003c/p>\n\u003cp>Latinos represent 38 percent of the marketplace’s potential customer base but about 30 percent of people who actually enroll, so Covered California sees marketing to the demographic as a good return on investment for the whole exchange.\u003c/p>\n\u003cp>But the Trump administration has made the already difficult task, of selling a product people don’t want to think about, even harder. Federal health officials slashed the national budget for marketing around the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s over for Obamacare,” President Trump has been saying since his campaign. “Let Obamacare implode.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=FAJfWfzKSxs\u003c/p>\n\u003cp>But California controls its own marketing budget and plans to invest $111 million to counteract the negative press from the feds. It will also spend 30 percent of its media buy on Spanish-language ads. But in terms of the creative message, California is on the defensive.\u003c/p>\n\u003cp>“Even if they're hearing you know the Affordable Care Act is going away, we're saying ‘No, no, not yet, not yet,' ” said Lizelda Lopez, who helps direct Latino outreach for Covered California as the agency’s deputy director of communications. “We're still here.”\u003c/p>\n\u003cp>That’s the mantra for this year, she said: “We are open for business. We are here. Financial assistance is still available. Open enrollment is Nov. 1 to Jan. 31. We are here.”\u003c/p>\n\u003cp>Such simple messages may work for people who already bought coverage in previous years and just need to renew their plan, said Carlos Santiago, chief strategist at \u003ca href=\"http://santiagosolutionsgroup.com/\" target=\"_blank\" rel=\"noopener\">Santiago Solutions Group\u003c/a>, a research consulting firm. But they could be too simple for new customers.\u003c/p>\n\u003cp>“To convince someone that was uninsured to get it for the first time? Obviously that message is not going to work,” Santiago said. “Especially not this year.”\u003c/p>\n\u003cp>Plus, the belief that illness won’t happen to you -- Santiago said this is especially entrenched in Latino culture.\u003c/p>\n\u003cp>“Latinos are extremely, extremely positive and overly optimistic,” he said, one reason Latinos have higher rates of going uninsured.\u003c/p>\n\u003cp>“We don't need to worry so much about today. Things will be OK,” he said. “And obviously when it comes to insurance, that's not exactly what it's all about.\"\u003c/p>\n\u003cp>On that front, Covered California has some more dramatic ads featuring ambulances and overturned bicycles, or a scene of a \u003ca href=\"https://vimeopro.com/coveredcanews/instant-tv/video/239171245\" target=\"_blank\" rel=\"noopener\">ladder falling backward\u003c/a>. It also plans to push a series of videos on social media. Its market research shows Latina women are very active video sharers, Lopez said.\u003c/p>\n\u003cp>“Mi nombre es Guadalupe,” says a young woman in\u003ca href=\"https://player.vimeo.com/video/215252751/?autoplay=1\" target=\"_blank\" rel=\"noopener\"> one video\u003c/a>, as she shows pictures from her wedding day and talks about suddenly finding out she needed a heart transplant.\u003c/p>\n\u003cp>Without her health plan from Covered California, she said she never would have been able to afford the cost of surgery: $1.5 million.\u003c/p>\n\u003cp>This kind of personal story, which other Latinas can relate to, is good, Santiago said. But Latinos don’t respond to fear, he added, so if the message is too scary, it could backfire.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It’s a tug of war,” said Christopher Graves. “That trade-off is, people stop taking action. They basically become paralyzed by how overwhelming it is. There needs to be a balance.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The way human brains are wired, it just doesn’t make sense to us to buy something now that we may not need for years in the future.\u003c/p>\n\u003cp>“Health insurance has to be the toughest thing on earth to sell,” said \u003ca href=\"http://www.ogilvy.com/ogilvy-mather-board/christopher-graves/\" target=\"_blank\" rel=\"noopener\">Christopher Graves\u003c/a>, president and founder of Ogilvy’s Behavioral Science Center. “Especially if you're trying to sell it to somebody who's young, healthy and has not had some catastrophe health-wise.\u003c/p>\n\u003cp>That would be most Latinos in California, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/\" target=\"_blank\" rel=\"noopener\">a primary target\u003c/a> of the marketing and outreach strategy for \u003ca href=\"https://www.coveredca.com/\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s insurance marketplace. The more healthy Latinos sign up for insurance, the more their premiums help balance the costs of caring for older, sicker Californians.\u003c/p>\n\u003cp>Latinos represent 38 percent of the marketplace’s potential customer base but about 30 percent of people who actually enroll, so Covered California sees marketing to the demographic as a good return on investment for the whole exchange.\u003c/p>\n\u003cp>But the Trump administration has made the already difficult task, of selling a product people don’t want to think about, even harder. Federal health officials slashed the national budget for marketing around the Affordable Care Act.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s over for Obamacare,” President Trump has been saying since his campaign. “Let Obamacare implode.”\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/FAJfWfzKSxs'\n title='//www.youtube.com/embed/FAJfWfzKSxs'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>But California controls its own marketing budget and plans to invest $111 million to counteract the negative press from the feds. It will also spend 30 percent of its media buy on Spanish-language ads. But in terms of the creative message, California is on the defensive.\u003c/p>\n\u003cp>“Even if they're hearing you know the Affordable Care Act is going away, we're saying ‘No, no, not yet, not yet,' ” said Lizelda Lopez, who helps direct Latino outreach for Covered California as the agency’s deputy director of communications. “We're still here.”\u003c/p>\n\u003cp>That’s the mantra for this year, she said: “We are open for business. We are here. Financial assistance is still available. Open enrollment is Nov. 1 to Jan. 31. We are here.”\u003c/p>\n\u003cp>Such simple messages may work for people who already bought coverage in previous years and just need to renew their plan, said Carlos Santiago, chief strategist at \u003ca href=\"http://santiagosolutionsgroup.com/\" target=\"_blank\" rel=\"noopener\">Santiago Solutions Group\u003c/a>, a research consulting firm. But they could be too simple for new customers.\u003c/p>\n\u003cp>“To convince someone that was uninsured to get it for the first time? Obviously that message is not going to work,” Santiago said. “Especially not this year.”\u003c/p>\n\u003cp>Plus, the belief that illness won’t happen to you -- Santiago said this is especially entrenched in Latino culture.\u003c/p>\n\u003cp>“Latinos are extremely, extremely positive and overly optimistic,” he said, one reason Latinos have higher rates of going uninsured.\u003c/p>\n\u003cp>“We don't need to worry so much about today. Things will be OK,” he said. “And obviously when it comes to insurance, that's not exactly what it's all about.\"\u003c/p>\n\u003cp>On that front, Covered California has some more dramatic ads featuring ambulances and overturned bicycles, or a scene of a \u003ca href=\"https://vimeopro.com/coveredcanews/instant-tv/video/239171245\" target=\"_blank\" rel=\"noopener\">ladder falling backward\u003c/a>. It also plans to push a series of videos on social media. Its market research shows Latina women are very active video sharers, Lopez said.\u003c/p>\n\u003cp>“Mi nombre es Guadalupe,” says a young woman in\u003ca href=\"https://player.vimeo.com/video/215252751/?autoplay=1\" target=\"_blank\" rel=\"noopener\"> one video\u003c/a>, as she shows pictures from her wedding day and talks about suddenly finding out she needed a heart transplant.\u003c/p>\n\u003cp>Without her health plan from Covered California, she said she never would have been able to afford the cost of surgery: $1.5 million.\u003c/p>\n\u003cp>This kind of personal story, which other Latinas can relate to, is good, Santiago said. But Latinos don’t respond to fear, he added, so if the message is too scary, it could backfire.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It’s a tug of war,” said Christopher Graves. “That trade-off is, people stop taking action. They basically become paralyzed by how overwhelming it is. There needs to be a balance.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Beyond The Shattered Lives And Bodies, Money Worries Weigh On Las Vegas Victims",
"title": "Beyond The Shattered Lives And Bodies, Money Worries Weigh On Las Vegas Victims",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp class=\"p1\">LAS VEGAS — Kurt Fowler and his wife, Trina, were celebrating their 18th wedding anniversary at a country music festival when the shooting started. Fowler, 41, knew he’d been hit in the ankle and couldn’t run. He hid under the stage until the gunfire ended.\u003c/p>\n\u003cp class=\"p1\">“I knew my foot was completely useless,” said Fowler, a firefighter from Lake Havasu City, Ariz., and a father of three. He underwent surgery, spent nearly two weeks in the hospital and still may need another operation. He also will need rehabilitation and follow-up visits with a specialist.\u003c/p>\n\u003cp class=\"p1\">Fowler has a Blue Cross Blue Shield PPO through his job, but he said he doesn’t know how much he will have to pay out of his own pocket for the care he is receiving. In an era of higher deductibles and limited choice of in-network doctors, however, he knows he could face significant medical bills.\u003c/p>\n\u003cp class=\"p1\">His insurance card says his individual deductible is $5,000 and his coinsurance 20 percent. He said he didn’t know how much his health plan would cover for out-of-state care.\u003c/p>\n\u003cp class=\"p1\">“Medical expenses are astronomical these days,” Fowler said from his bed at Sunrise Hospital & Medical Center here. “It’s a mountain that just doesn’t seem like it’s gonna be climbable, but we are gonna do our best.”\u003c/p>\n\u003cfigure id=\"attachment_361805\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361805\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kurt Fowler looks at an X-ray of his ankle as he sits in a hospital bed at Sunrise Hospital & Medical Center. Fowler, a firefighter from Arizona, got shot in the ankle and said he expects to be out of work for months as he recovers. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">As hundreds of survivors struggle to recover emotionally and physically from the Oct. 1 attack, they are beginning to come to terms with the financial toll of the violence perpetrated against them. Even those who are insured could face untold costs in a city they were only visiting.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp class=\"p1\">The total costs of medical care alone could reach into the tens of millions of dollars, said Garen Wintemute, who researches gun violence at the University of California-Davis. And that is just the beginning. Many survivors will be out of work for months, if they are able to return at all.\u003c/p>\n\u003cp class=\"p1\">“We really don’t have a good handle on the intangible costs of something like this … the ripple effects on family and friends and neighborhoods when a large number of people have been shot,” Wintemute said.\u003c/p>\n\u003cp class=\"p1\">More than 100,000 people are shot every year in the U.S., according to the Centers for Disease Control and Prevention. That generates about $2.8 billion per year in emergency room and inpatient charges alone, according to a recent study in \u003cspan class=\"s1\">Health Affairs\u003c/span>. The average emergency room bill for an individual gunshot victim is $5,254 and the average inpatient charge is $95,887, according to the study.\u003c/p>\n\u003cp class=\"p1\">The U.S. senators representing Nevada, Dean Heller and Catherine Cortez Masto, wrote a \u003cspan class=\"s1\">letter \u003c/span>to America’s Health Insurance Plans, an industry trade group, and CEO Scott Serota of Blue Cross Blue Shield requesting help with out-of-network bills, copayments and deductibles for the Las Vegas shooting victims. Many of the people who were shot had traveled from other states, including California, Iowa and Tennessee.\u003c/p>\n\u003cp class=\"p1\">California and some states protect consumers from such bills, but Nevada is not one of them, said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. But Corlette said most insurers allow patients to request exceptions based on the circumstances. “In this situation, I imagine most insurers are going to want to be compassionate and work something out,” she said.\u003c/p>\n\u003cp class=\"p1\">The victims and their families aren’t the only ones who will be affected financially by the mass shooting. Taxpayers, too, pick up much of the tab for the health care costs associated with gun violence because many patients are covered by Medicaid and Medicare, two government insurance programs.\u003c/p>\n\u003cp class=\"p1\">And hospitals will also be on the hook for some of the care for patients who don’t have insurance. Hospitals in Las Vegas quickly mobilized to treat the hundreds of victims who were streaming in that night, and they don’t know yet how much of the care will be reimbursed.\u003c/p>\n\u003cp class=\"p1\">At Sunrise Hospital & Medical Center, staff treated more than 200 patients. Sunrise plans to file insurance claims and will “be extremely sensitive to the financial status” of patients when considering their out-of-pocket portions, a spokeswoman said.\u003c/p>\n\u003cp class=\"p1\">Valley Hospital Medical Center is encouraging patients to complete paperwork for a state program called Nevada Victims of Violent Crime, which would pay their balances. And Dignity Health’s St. Rose Dominican said it will bill insurers and accept donations but will not require payment from victims.\u003c/p>\n\u003cp class=\"p1\">California victims can also get help with medical expenses and income loss from the \u003cspan class=\"s1\">California \u003c/span>Victim Compensation Board.\u003c/p>\n\u003cp class=\"p1\">In addition, a GoFundMe account started by a Clark County commissioner has raised $11 million thus far. And many survivors have individual GoFundMe accounts.\u003c/p>\n\u003cp class=\"p1\">Kurt Fowler’s GoFundMe page has raised about $39,000. Fowler said he doesn’t have disability insurance so he will rely on the funds to help cover his expenses while he is recovering and missing work.\u003c/p>\n\u003cp class=\"p1\">Michael Caster, 41, who lives in Indio, Calif., has a GoFundMe account that has raised about $26,000 so far. He’s paralyzed from the waist down after a bullet lodged in his spine.\u003c/p>\n\u003cp class=\"p1\">He works in human resources at a California hospital and has a job-sponsored policy with Anthem Blue Cross. “I’ve never really dealt with injury,” he said. “I don’t want to be stuck with a bunch of bills.”\u003c/p>\n\u003cp class=\"p1\">His bills could rise further: That day, he was scheduled to be flown to a rehabilitation center in Colorado for people with spinal cord injuries.\u003c/p>\n\u003cfigure id=\"attachment_361804\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361804\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Frost-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">Mary Moreland gets an update on her daughter from neurosurgeon Keith Blum at Sunrise Hospital & Medical Center. Moreland’s daughter, Tina Frost, was shot in the eye and was in a medically induced coma for two weeks. Frost has insurance through her job as an accountant in San Diego, but her mother said she knows it won’t cover everything. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Mary Moreland, whose daughter Tina Frost was shot during the country music festival, said that at first she didn’t understand why so many families were setting up fundraisers. Then, the severe financial strain the shooting would take started to dawn on her.\u003c/p>\n\u003cp class=\"p1\">Now, Moreland said she’s grateful for the nearly $580,000 raised through GoFundMe. Frost, a resident of San Diego, had emergency brain surgery the night of the shooting. A bullet had pierced her eye and exploded in her brain. As she lay in ICU earlier this month, her mother said small improvements were major milestones. “Today she squeezed my hands,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">The next night, Frost came out of a medically induced coma and was later flown to Johns Hopkins Hospital in Baltimore, near her mother’s home. Over the next weeks and months, she will need multiple operations and a slew of specialists, including neurosurgeons, plastic surgeons, occupational therapists and mental health counselors.\u003c/p>\n\u003cfigure id=\"attachment_361803\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361803\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot from a GoFundMe page set up for Tina Frost, who was shot at the country music festival in Las Vegas. Frost was at Sunrise Hospital & Medical Center for two weeks and was recently flown to a hospital near her mother’s home in Maryland. \u003ccite>(Courtesy of GoFundMe)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Moreland said she cannot even begin to imagine what her daughter’s care will cost. Frost has Blue Cross insurance through her job at Ernst & Young in San Diego, but Moreland said she doesn’t know what the deductible and copayments are.\u003c/p>\n\u003cp class=\"p1\">“Being realistic, knowing what I know about costs of health care, it’s scary,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">“But she’s alive. She’s not one of the 58 other people.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp class=\"p3\">\u003cem>\u003ca href=\"https://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">Kaiser Health News\u003c/span>\u003c/a>, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the \u003ca href=\"https://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"nprByline": "\u003ca href=\"https://khn.org/news/author/anna-gorman/\" rel=\"noopener\" target=\"_blank\">\u003cstrong>Anna Gorman\u003c/strong>\u003c/a>\u003cbr>Kaiser Health News",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"p1\">LAS VEGAS — Kurt Fowler and his wife, Trina, were celebrating their 18th wedding anniversary at a country music festival when the shooting started. Fowler, 41, knew he’d been hit in the ankle and couldn’t run. He hid under the stage until the gunfire ended.\u003c/p>\n\u003cp class=\"p1\">“I knew my foot was completely useless,” said Fowler, a firefighter from Lake Havasu City, Ariz., and a father of three. He underwent surgery, spent nearly two weeks in the hospital and still may need another operation. He also will need rehabilitation and follow-up visits with a specialist.\u003c/p>\n\u003cp class=\"p1\">Fowler has a Blue Cross Blue Shield PPO through his job, but he said he doesn’t know how much he will have to pay out of his own pocket for the care he is receiving. In an era of higher deductibles and limited choice of in-network doctors, however, he knows he could face significant medical bills.\u003c/p>\n\u003cp class=\"p1\">His insurance card says his individual deductible is $5,000 and his coinsurance 20 percent. He said he didn’t know how much his health plan would cover for out-of-state care.\u003c/p>\n\u003cp class=\"p1\">“Medical expenses are astronomical these days,” Fowler said from his bed at Sunrise Hospital & Medical Center here. “It’s a mountain that just doesn’t seem like it’s gonna be climbable, but we are gonna do our best.”\u003c/p>\n\u003cfigure id=\"attachment_361805\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361805\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kurt Fowler looks at an X-ray of his ankle as he sits in a hospital bed at Sunrise Hospital & Medical Center. Fowler, a firefighter from Arizona, got shot in the ankle and said he expects to be out of work for months as he recovers. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">As hundreds of survivors struggle to recover emotionally and physically from the Oct. 1 attack, they are beginning to come to terms with the financial toll of the violence perpetrated against them. Even those who are insured could face untold costs in a city they were only visiting.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">The total costs of medical care alone could reach into the tens of millions of dollars, said Garen Wintemute, who researches gun violence at the University of California-Davis. And that is just the beginning. Many survivors will be out of work for months, if they are able to return at all.\u003c/p>\n\u003cp class=\"p1\">“We really don’t have a good handle on the intangible costs of something like this … the ripple effects on family and friends and neighborhoods when a large number of people have been shot,” Wintemute said.\u003c/p>\n\u003cp class=\"p1\">More than 100,000 people are shot every year in the U.S., according to the Centers for Disease Control and Prevention. That generates about $2.8 billion per year in emergency room and inpatient charges alone, according to a recent study in \u003cspan class=\"s1\">Health Affairs\u003c/span>. The average emergency room bill for an individual gunshot victim is $5,254 and the average inpatient charge is $95,887, according to the study.\u003c/p>\n\u003cp class=\"p1\">The U.S. senators representing Nevada, Dean Heller and Catherine Cortez Masto, wrote a \u003cspan class=\"s1\">letter \u003c/span>to America’s Health Insurance Plans, an industry trade group, and CEO Scott Serota of Blue Cross Blue Shield requesting help with out-of-network bills, copayments and deductibles for the Las Vegas shooting victims. Many of the people who were shot had traveled from other states, including California, Iowa and Tennessee.\u003c/p>\n\u003cp class=\"p1\">California and some states protect consumers from such bills, but Nevada is not one of them, said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. But Corlette said most insurers allow patients to request exceptions based on the circumstances. “In this situation, I imagine most insurers are going to want to be compassionate and work something out,” she said.\u003c/p>\n\u003cp class=\"p1\">The victims and their families aren’t the only ones who will be affected financially by the mass shooting. Taxpayers, too, pick up much of the tab for the health care costs associated with gun violence because many patients are covered by Medicaid and Medicare, two government insurance programs.\u003c/p>\n\u003cp class=\"p1\">And hospitals will also be on the hook for some of the care for patients who don’t have insurance. Hospitals in Las Vegas quickly mobilized to treat the hundreds of victims who were streaming in that night, and they don’t know yet how much of the care will be reimbursed.\u003c/p>\n\u003cp class=\"p1\">At Sunrise Hospital & Medical Center, staff treated more than 200 patients. Sunrise plans to file insurance claims and will “be extremely sensitive to the financial status” of patients when considering their out-of-pocket portions, a spokeswoman said.\u003c/p>\n\u003cp class=\"p1\">Valley Hospital Medical Center is encouraging patients to complete paperwork for a state program called Nevada Victims of Violent Crime, which would pay their balances. And Dignity Health’s St. Rose Dominican said it will bill insurers and accept donations but will not require payment from victims.\u003c/p>\n\u003cp class=\"p1\">California victims can also get help with medical expenses and income loss from the \u003cspan class=\"s1\">California \u003c/span>Victim Compensation Board.\u003c/p>\n\u003cp class=\"p1\">In addition, a GoFundMe account started by a Clark County commissioner has raised $11 million thus far. And many survivors have individual GoFundMe accounts.\u003c/p>\n\u003cp class=\"p1\">Kurt Fowler’s GoFundMe page has raised about $39,000. Fowler said he doesn’t have disability insurance so he will rely on the funds to help cover his expenses while he is recovering and missing work.\u003c/p>\n\u003cp class=\"p1\">Michael Caster, 41, who lives in Indio, Calif., has a GoFundMe account that has raised about $26,000 so far. He’s paralyzed from the waist down after a bullet lodged in his spine.\u003c/p>\n\u003cp class=\"p1\">He works in human resources at a California hospital and has a job-sponsored policy with Anthem Blue Cross. “I’ve never really dealt with injury,” he said. “I don’t want to be stuck with a bunch of bills.”\u003c/p>\n\u003cp class=\"p1\">His bills could rise further: That day, he was scheduled to be flown to a rehabilitation center in Colorado for people with spinal cord injuries.\u003c/p>\n\u003cfigure id=\"attachment_361804\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361804\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Frost-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">Mary Moreland gets an update on her daughter from neurosurgeon Keith Blum at Sunrise Hospital & Medical Center. Moreland’s daughter, Tina Frost, was shot in the eye and was in a medically induced coma for two weeks. Frost has insurance through her job as an accountant in San Diego, but her mother said she knows it won’t cover everything. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Mary Moreland, whose daughter Tina Frost was shot during the country music festival, said that at first she didn’t understand why so many families were setting up fundraisers. Then, the severe financial strain the shooting would take started to dawn on her.\u003c/p>\n\u003cp class=\"p1\">Now, Moreland said she’s grateful for the nearly $580,000 raised through GoFundMe. Frost, a resident of San Diego, had emergency brain surgery the night of the shooting. A bullet had pierced her eye and exploded in her brain. As she lay in ICU earlier this month, her mother said small improvements were major milestones. “Today she squeezed my hands,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">The next night, Frost came out of a medically induced coma and was later flown to Johns Hopkins Hospital in Baltimore, near her mother’s home. Over the next weeks and months, she will need multiple operations and a slew of specialists, including neurosurgeons, plastic surgeons, occupational therapists and mental health counselors.\u003c/p>\n\u003cfigure id=\"attachment_361803\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361803\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot from a GoFundMe page set up for Tina Frost, who was shot at the country music festival in Las Vegas. Frost was at Sunrise Hospital & Medical Center for two weeks and was recently flown to a hospital near her mother’s home in Maryland. \u003ccite>(Courtesy of GoFundMe)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Moreland said she cannot even begin to imagine what her daughter’s care will cost. Frost has Blue Cross insurance through her job at Ernst & Young in San Diego, but Moreland said she doesn’t know what the deductible and copayments are.\u003c/p>\n\u003cp class=\"p1\">“Being realistic, knowing what I know about costs of health care, it’s scary,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">“But she’s alive. She’s not one of the 58 other people.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Gov. Brown Signs Into Law Key Health Bills, But Nixes Others",
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"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>Wielding his pen, Gov. Jerry Brown has reinforced the Affordable Care Act, stood up to pharmaceutical companies and boosted testing for childhood lead poisoning.\u003c/p>\n\u003cp>Brown had until Sunday, Oct. 15, to approve or reject \u003ca href=\"https://californiahealthline.org/news/state-lawmakers-tackle-public-smoking-and-lead-poisoning-but-punt-on-single-payer/\">measures passed by the legislature \u003c/a>this year, Brown weighed in on some key health care bills, including measures to protect Californians who buy insurance for themselves.\u003c/p>\n\u003cp>One law will ensure that consumers have \u003ca href=\"https://californiahealthline.org/news/california-other-states-to-extend-obamacare-sign-up-beyond-federal-limit/\">three months to shop\u003c/a> for health plans in future years, rebuffing a move by the Trump administration that cuts that time in half. Another law will help people \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">keep their health care providers \u003c/a>if insurers cancel their policy.\u003c/p>\n\u003cp>Health consumer advocates said Brown’s signatures on those and other bills will help maintain California’s role as a leader in protecting health care coverage in the face of federal threats. Last week, for instance, \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">President Donald Trump ended\u003c/a> an important Obamacare health insurance subsidy for consumers — a move that could destabilize insurance markets across the country.\u003c/p>\n\u003cp>Californians will stay “ahead of the curve, and ahead of the federal threats” because of lawmakers’ actions this year, said Betsy Imholz, director of special projects at Consumers Union in San Francisco.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The governor’s health care actions and rhetoric have been particularly impassioned lately, especially in response to federal moves on health care policy, Imholz said.\u003c/p>\n\u003cp>“There’s a lot to be fiery about these days, and he’s using his bully pulpit well,” she said.\u003c/p>\n\u003cp>But Brown didn’t sign off on everything the legislature sent to his desk. He used his veto pen to kill some health care legislation, including a proposed statewide \u003ca href=\"https://californiahealthline.org/news/will-california-kick-butts-off-state-beaches-not-this-year/\">ban on smoking\u003c/a> at state beaches and parks.\u003c/p>\n\u003cp>\u003cstrong>SIGNED BY THE GOVERNOR \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Open Enrollment\u003c/strong>🖋\u003c/p>\n\u003cp>By codifying \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180AB156\">AB 156,\u003c/a> by Assemblyman Jim Wood (D-Healdsburg), Brown agreed that Californians who buy insurance for themselves should continue to have a \u003ca href=\"https://californiahealthline.org/news/california-other-states-to-extend-obamacare-sign-up-beyond-federal-limit/\">three-month open enrollment period\u003c/a>, during which they can choose or switch health plans. The law exempts the Golden State from a Trump administration rule that shortens the sign-up period to 45 days, and applies to people who purchase individual market plans for 2019 and beyond. Californians already are assured a three-month open-enrollment period — Nov. 1 to Jan. 31 — for 2018 coverage.\u003c/p>\n\u003cp>\u003cstrong>Keeping Your Doctors\u003c/strong>🖋\u003c/p>\n\u003cp>Brown signed off on \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">a measure\u003c/a> to allow some seriously ill patients to continue seeing their current providers for a limited time if their insurer discontinues their plan. The bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB133\">SB 133\u003c/a>, was introduced by Sen. Ed Hernandez (D-West Covina) in response to the impending departures of Anthem Blue Cross and Cigna from portions of California’s individual insurance market next year. The law will continue an eligible patient’s coverage even if her doctors don’t contract with the new health plan, so long as the doctors are willing to accept the plan’s reimbursement rates.\u003c/p>\n\u003cp>\u003cstrong>Prescription Drug Costs\u003c/strong>🖋\u003c/p>\n\u003cp>The governor signed a \u003ca href=\"https://californiahealthline.org/news/california-drug-price-bill-sweeping-in-scope-lacking-in-muscle/\">hotly contested bill\u003c/a> by Hernandez that will require drugmakers to report and explain big price hikes. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB17\">SB 17\u003c/a> directs pharmaceutical companies to notify state agencies and insurers 60 days in advance if they plan to raise prices more than 16 percent over two years on drugs with a wholesale cost of at least $40.\u003c/p>\n\u003cp>The governor also approved \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB265\">AB 265\u003c/a> by Wood, which will ban pharmaceutical companies from giving consumers coupons for brand-name drugs when a generic equivalent is available, with some exceptions.\u003c/p>\n\u003cp>\u003cstrong>Childhood Lead Poisoning\u003c/strong>🖋\u003c/p>\n\u003cp>Brown signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1316\">AB 1316\u003c/a> by Assemblyman Bill Quirk (D-Hayward), which calls for all California kids to be evaluated by their doctor for lead poisoning, starting next year. Currently, children who receive government assistance such as Medi-Cal must be screened for lead, but that requirement doesn’t extend to other children. Doctors will also have to consider new factors when evaluating children, such as proximity to potential sources of lead contamination. A report published last month by the Environmental Working Group showed that \u003ca href=\"http://www.ewg.org/research/one-third-california-s-high-risk-kids-not-tested-lead-poisoning#.Wd6u82hSyUk\">one-third of infants\u003c/a> who were at risk for lead poisoning had not been tested. “The current screening process is outdated and leaves many children vulnerable to lead poisoning,” Quirk said in a statement.\u003c/p>\n\u003cp>\u003cstrong>Unapproved Stem Cell Treatments\u003c/strong>🖋\u003c/p>\n\u003cp>Brown approved \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB512\">a bill\u003c/a> that requires doctors to warn their patients before they undergo \u003ca href=\"https://ipscell.com/2017/10/groundbreaking-california-stem-cell-law-gives-consumer-protections-on-clinics/\">unapproved stem cell therapies\u003c/a>. SB 512, also by Hernandez, says health care providers who offer such treatments must disclose to patients that the treatments have not been approved by the Food and Drug Administration, and urge them “to consult with your primary care physician prior to undergoing a stem cell therapy.” Health care providers may face fines for noncompliance.\u003c/p>\n\u003cp>\u003cstrong>VETOED BY THE GOVERNOR \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Valley Fever\u003c/strong>🚫\u003c/p>\n\u003cp>Brown nixed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180AB1279\">AB 1279\u003c/a>, which would have required the state Department of Public Health to develop additional outreach programs to educate people about Valley Fever, an infection caused by inhaling fungal spores often found in soil. The measure, by Assemblyman Rudy Salas (D-Bakersfield), had been watered down from its original form by the time it hit the governor’s desk. The original language called for a $2 million investment in research on the disease, which is common in dry regions, like Salas’ district. In his \u003ca href=\"https://www.gov.ca.gov/docs/AB_1279_Veto_Message_2017.pdf\">veto message\u003c/a>, Brown said the department already provides fact sheets, brochures and other materials to educate the public about Valley Fever.\u003c/p>\n\u003cp>\u003cstrong>Smoking At State Parks\u003c/strong>🚫\u003c/p>\n\u003cp>Once again, Brown \u003ca href=\"https://californiahealthline.org/news/will-california-kick-butts-off-state-beaches-not-this-year/\">vetoed legislation\u003c/a> that would have banned smoking at state beaches and parks. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB725\">AB 725\u003c/a>, by Assemblyman Marc Levine (D-San Rafael), would have established smoking areas at some parks and beaches. People caught smoking outside those designated spaces would have faced a $50 fine. A stricter bill by Sen. Steve Glazer (D-Orinda), \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB386\">SB 386\u003c/a>, proposed a fine of up to $100. Lawmakers had previously sent similar legislation to Brown, but so far they have not won him over. In his \u003ca href=\"https://www.gov.ca.gov/docs/AB_725_Veto_Message_2017.pdf\">veto message\u003c/a>, Brown said a ban would be an overreach of government power. “If people can’t smoke even on a deserted beach, where can they?” he asked.\u003c/p>\n\u003cp>\u003cstrong>Reproductive Bias\u003c/strong>🚫\u003c/p>\n\u003cp>A bill that would have prohibited institutions with religious affiliations from firing employees because of their reproductive choices, such as having abortions, failed to make it past the governor’s desk. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB569\">AB 569\u003c/a>, by Assemblywoman Lorena Gonzalez Fletcher (D-San Diego), would have barred religion-based employers such as a Christian school, from requiring workers to sign a code of conduct that waived their reproductive health rights. \u003ca href=\"https://www.gov.ca.gov/docs/AB_569_Veto_Message_2017.pdf\">In his veto message\u003c/a>, Brown said that “these types of claims should remain within the jurisdiction of the Department of Fair Employment and Housing.”\u003c/p>\n\u003cp>\u003cstrong>SEE YOU NEXT YEAR?\u003c/strong>\u003c/p>\n\u003cp>(Some significant health bills that stalled in the legislature, but may be resurrected for another attempt in 2018)\u003c/p>\n\u003cp>\u003cstrong>Regulating Dialysis Clinics\u003c/strong>🤔\u003c/p>\n\u003cp>A proposal by Sen. Ricardo Lara (D-Bell Gardens) would have required minimum staff-to-patient ratios at dialysis centers, such as one nurse for every eight patients or one technician for every three. The stalled bill, SB 349, also would have mandated more time for staff to prepare between patient appointments. A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB251\">bill\u003c/a> by Assemblyman Rob Bonta (D-Oakland) would have required dialysis centers to spend at least 85 percent of their revenue primarily on direct patient care.\u003c/p>\n\u003cp>Both measures were backed by a large labor union, Service Employees International Union-United Healthcare Workers West (\u003ca href=\"http://www.seiu-uhw.org/\">SEIU-UHW\u003c/a>), which has threatened to take the issue directly to voters if the Legislature does not act.\u003c/p>\n\u003cp>\u003cstrong>Single-Payer Health Care\u003c/strong>🤔\u003c/p>\n\u003cp>The ambitious attempt to create one government-administered or “single-payer” health care system in California has been tabled until next year. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">SB 562\u003c/a> by Lara and Assemblywoman Toni Atkins (D-San Diego) would provide comprehensive health coverage to all Californians, regardless of immigration status. Private insurance companies would be barred from the system, and enrollees would not be charged copayments or premiums. A legislative committee estimated that the program would require $200 billion annually in additional tax revenue.\u003c/p>\n\u003cp>Supporters of universal health care hope to \u003ca href=\"https://oag.ca.gov/system/files/initiatives/pdfs/17-0019%20%28Healthcare%20Roadblock%20Removal%29.pdf\">put a measure\u003c/a> on the statewide ballot that would make it easier to fund a single-payer system.\u003c/p>\n\u003cp>\u003cstrong>Pediatric Dental Anesthesia \u003c/strong>🤔\u003c/p>\n\u003cp>A bill that would have required oral surgeons to have a specially trained staff member with them to monitor a child under anesthesia stalled in committee. Current law allows an oral surgeon to perform surgery and monitor the unconscious child at the same time. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB224\">AB 224\u003c/a>, by Assemblyman Tony Thurmond (D-Richmond), would have built on last year’s “\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB2235\">Caleb’s Law\u003c/a>,” named after Caleb Sears, a 6-year-old boy who died in 2015 after oral surgery under anesthesia.\u003c/p>\n\u003cp>\u003cstrong>Containing Drug Costs\u003c/strong>🤔\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/news/negotiating-drug-prices-should-state-agencies-band-together/\">A measure\u003c/a> by Assemblyman David Chiu (D-San Francisco) would have brought together administrators from 17 state agencies to devise ways to reduce state drug costs. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB587\">AB 587\u003c/a> would have expanded an existing state purchasing collaborative that buys drugs for a handful of public health programs, and directed the new group to develop cost controls, such as creating a uniform drug formulary for state agencies.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB790\">SB 790\u003c/a> by Sen. Mike McGuire (D-North Coast/North Bay) sought to \u003ca href=\"https://californiahealthline.org/news/bill-aims-to-loosen-drugmaker-doctor-ties-by-limiting-perks-for-promoting-meds/\">restrict the pharmaceutical industry’s\u003c/a> marketing to doctors, limiting their spending to mostly educational or scientific purposes, which McGuire said could reduce unnecessary prescriptions of pricey drugs.\u003c/p>\n\n",
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"excerpt": "Gov. Jerry Brown signed many critical health care bills sent to him by the state Legislature, cementing California’s role as a health care champion.",
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"nprByline": "\u003ca href=\"https://californiahealthline.org/news/author/pauline-bartolone/\">\u003cstrong>Pauline Bartolone\u003c/strong>\u003c/a> and \u003ca href=\"https://californiahealthline.org/news/author/ana-b-ibarra/\">\u003cstrong>Ana B. Ibarra\u003c/strong>\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Wielding his pen, Gov. Jerry Brown has reinforced the Affordable Care Act, stood up to pharmaceutical companies and boosted testing for childhood lead poisoning.\u003c/p>\n\u003cp>Brown had until Sunday, Oct. 15, to approve or reject \u003ca href=\"https://californiahealthline.org/news/state-lawmakers-tackle-public-smoking-and-lead-poisoning-but-punt-on-single-payer/\">measures passed by the legislature \u003c/a>this year, Brown weighed in on some key health care bills, including measures to protect Californians who buy insurance for themselves.\u003c/p>\n\u003cp>One law will ensure that consumers have \u003ca href=\"https://californiahealthline.org/news/california-other-states-to-extend-obamacare-sign-up-beyond-federal-limit/\">three months to shop\u003c/a> for health plans in future years, rebuffing a move by the Trump administration that cuts that time in half. Another law will help people \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">keep their health care providers \u003c/a>if insurers cancel their policy.\u003c/p>\n\u003cp>Health consumer advocates said Brown’s signatures on those and other bills will help maintain California’s role as a leader in protecting health care coverage in the face of federal threats. Last week, for instance, \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">President Donald Trump ended\u003c/a> an important Obamacare health insurance subsidy for consumers — a move that could destabilize insurance markets across the country.\u003c/p>\n\u003cp>Californians will stay “ahead of the curve, and ahead of the federal threats” because of lawmakers’ actions this year, said Betsy Imholz, director of special projects at Consumers Union in San Francisco.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The governor’s health care actions and rhetoric have been particularly impassioned lately, especially in response to federal moves on health care policy, Imholz said.\u003c/p>\n\u003cp>“There’s a lot to be fiery about these days, and he’s using his bully pulpit well,” she said.\u003c/p>\n\u003cp>But Brown didn’t sign off on everything the legislature sent to his desk. He used his veto pen to kill some health care legislation, including a proposed statewide \u003ca href=\"https://californiahealthline.org/news/will-california-kick-butts-off-state-beaches-not-this-year/\">ban on smoking\u003c/a> at state beaches and parks.\u003c/p>\n\u003cp>\u003cstrong>SIGNED BY THE GOVERNOR \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Open Enrollment\u003c/strong>🖋\u003c/p>\n\u003cp>By codifying \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180AB156\">AB 156,\u003c/a> by Assemblyman Jim Wood (D-Healdsburg), Brown agreed that Californians who buy insurance for themselves should continue to have a \u003ca href=\"https://californiahealthline.org/news/california-other-states-to-extend-obamacare-sign-up-beyond-federal-limit/\">three-month open enrollment period\u003c/a>, during which they can choose or switch health plans. The law exempts the Golden State from a Trump administration rule that shortens the sign-up period to 45 days, and applies to people who purchase individual market plans for 2019 and beyond. Californians already are assured a three-month open-enrollment period — Nov. 1 to Jan. 31 — for 2018 coverage.\u003c/p>\n\u003cp>\u003cstrong>Keeping Your Doctors\u003c/strong>🖋\u003c/p>\n\u003cp>Brown signed off on \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">a measure\u003c/a> to allow some seriously ill patients to continue seeing their current providers for a limited time if their insurer discontinues their plan. The bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB133\">SB 133\u003c/a>, was introduced by Sen. Ed Hernandez (D-West Covina) in response to the impending departures of Anthem Blue Cross and Cigna from portions of California’s individual insurance market next year. The law will continue an eligible patient’s coverage even if her doctors don’t contract with the new health plan, so long as the doctors are willing to accept the plan’s reimbursement rates.\u003c/p>\n\u003cp>\u003cstrong>Prescription Drug Costs\u003c/strong>🖋\u003c/p>\n\u003cp>The governor signed a \u003ca href=\"https://californiahealthline.org/news/california-drug-price-bill-sweeping-in-scope-lacking-in-muscle/\">hotly contested bill\u003c/a> by Hernandez that will require drugmakers to report and explain big price hikes. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB17\">SB 17\u003c/a> directs pharmaceutical companies to notify state agencies and insurers 60 days in advance if they plan to raise prices more than 16 percent over two years on drugs with a wholesale cost of at least $40.\u003c/p>\n\u003cp>The governor also approved \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB265\">AB 265\u003c/a> by Wood, which will ban pharmaceutical companies from giving consumers coupons for brand-name drugs when a generic equivalent is available, with some exceptions.\u003c/p>\n\u003cp>\u003cstrong>Childhood Lead Poisoning\u003c/strong>🖋\u003c/p>\n\u003cp>Brown signed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1316\">AB 1316\u003c/a> by Assemblyman Bill Quirk (D-Hayward), which calls for all California kids to be evaluated by their doctor for lead poisoning, starting next year. Currently, children who receive government assistance such as Medi-Cal must be screened for lead, but that requirement doesn’t extend to other children. Doctors will also have to consider new factors when evaluating children, such as proximity to potential sources of lead contamination. A report published last month by the Environmental Working Group showed that \u003ca href=\"http://www.ewg.org/research/one-third-california-s-high-risk-kids-not-tested-lead-poisoning#.Wd6u82hSyUk\">one-third of infants\u003c/a> who were at risk for lead poisoning had not been tested. “The current screening process is outdated and leaves many children vulnerable to lead poisoning,” Quirk said in a statement.\u003c/p>\n\u003cp>\u003cstrong>Unapproved Stem Cell Treatments\u003c/strong>🖋\u003c/p>\n\u003cp>Brown approved \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB512\">a bill\u003c/a> that requires doctors to warn their patients before they undergo \u003ca href=\"https://ipscell.com/2017/10/groundbreaking-california-stem-cell-law-gives-consumer-protections-on-clinics/\">unapproved stem cell therapies\u003c/a>. SB 512, also by Hernandez, says health care providers who offer such treatments must disclose to patients that the treatments have not been approved by the Food and Drug Administration, and urge them “to consult with your primary care physician prior to undergoing a stem cell therapy.” Health care providers may face fines for noncompliance.\u003c/p>\n\u003cp>\u003cstrong>VETOED BY THE GOVERNOR \u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Valley Fever\u003c/strong>🚫\u003c/p>\n\u003cp>Brown nixed \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180AB1279\">AB 1279\u003c/a>, which would have required the state Department of Public Health to develop additional outreach programs to educate people about Valley Fever, an infection caused by inhaling fungal spores often found in soil. The measure, by Assemblyman Rudy Salas (D-Bakersfield), had been watered down from its original form by the time it hit the governor’s desk. The original language called for a $2 million investment in research on the disease, which is common in dry regions, like Salas’ district. In his \u003ca href=\"https://www.gov.ca.gov/docs/AB_1279_Veto_Message_2017.pdf\">veto message\u003c/a>, Brown said the department already provides fact sheets, brochures and other materials to educate the public about Valley Fever.\u003c/p>\n\u003cp>\u003cstrong>Smoking At State Parks\u003c/strong>🚫\u003c/p>\n\u003cp>Once again, Brown \u003ca href=\"https://californiahealthline.org/news/will-california-kick-butts-off-state-beaches-not-this-year/\">vetoed legislation\u003c/a> that would have banned smoking at state beaches and parks. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB725\">AB 725\u003c/a>, by Assemblyman Marc Levine (D-San Rafael), would have established smoking areas at some parks and beaches. People caught smoking outside those designated spaces would have faced a $50 fine. A stricter bill by Sen. Steve Glazer (D-Orinda), \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB386\">SB 386\u003c/a>, proposed a fine of up to $100. Lawmakers had previously sent similar legislation to Brown, but so far they have not won him over. In his \u003ca href=\"https://www.gov.ca.gov/docs/AB_725_Veto_Message_2017.pdf\">veto message\u003c/a>, Brown said a ban would be an overreach of government power. “If people can’t smoke even on a deserted beach, where can they?” he asked.\u003c/p>\n\u003cp>\u003cstrong>Reproductive Bias\u003c/strong>🚫\u003c/p>\n\u003cp>A bill that would have prohibited institutions with religious affiliations from firing employees because of their reproductive choices, such as having abortions, failed to make it past the governor’s desk. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB569\">AB 569\u003c/a>, by Assemblywoman Lorena Gonzalez Fletcher (D-San Diego), would have barred religion-based employers such as a Christian school, from requiring workers to sign a code of conduct that waived their reproductive health rights. \u003ca href=\"https://www.gov.ca.gov/docs/AB_569_Veto_Message_2017.pdf\">In his veto message\u003c/a>, Brown said that “these types of claims should remain within the jurisdiction of the Department of Fair Employment and Housing.”\u003c/p>\n\u003cp>\u003cstrong>SEE YOU NEXT YEAR?\u003c/strong>\u003c/p>\n\u003cp>(Some significant health bills that stalled in the legislature, but may be resurrected for another attempt in 2018)\u003c/p>\n\u003cp>\u003cstrong>Regulating Dialysis Clinics\u003c/strong>🤔\u003c/p>\n\u003cp>A proposal by Sen. Ricardo Lara (D-Bell Gardens) would have required minimum staff-to-patient ratios at dialysis centers, such as one nurse for every eight patients or one technician for every three. The stalled bill, SB 349, also would have mandated more time for staff to prepare between patient appointments. A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB251\">bill\u003c/a> by Assemblyman Rob Bonta (D-Oakland) would have required dialysis centers to spend at least 85 percent of their revenue primarily on direct patient care.\u003c/p>\n\u003cp>Both measures were backed by a large labor union, Service Employees International Union-United Healthcare Workers West (\u003ca href=\"http://www.seiu-uhw.org/\">SEIU-UHW\u003c/a>), which has threatened to take the issue directly to voters if the Legislature does not act.\u003c/p>\n\u003cp>\u003cstrong>Single-Payer Health Care\u003c/strong>🤔\u003c/p>\n\u003cp>The ambitious attempt to create one government-administered or “single-payer” health care system in California has been tabled until next year. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">SB 562\u003c/a> by Lara and Assemblywoman Toni Atkins (D-San Diego) would provide comprehensive health coverage to all Californians, regardless of immigration status. Private insurance companies would be barred from the system, and enrollees would not be charged copayments or premiums. A legislative committee estimated that the program would require $200 billion annually in additional tax revenue.\u003c/p>\n\u003cp>Supporters of universal health care hope to \u003ca href=\"https://oag.ca.gov/system/files/initiatives/pdfs/17-0019%20%28Healthcare%20Roadblock%20Removal%29.pdf\">put a measure\u003c/a> on the statewide ballot that would make it easier to fund a single-payer system.\u003c/p>\n\u003cp>\u003cstrong>Pediatric Dental Anesthesia \u003c/strong>🤔\u003c/p>\n\u003cp>A bill that would have required oral surgeons to have a specially trained staff member with them to monitor a child under anesthesia stalled in committee. Current law allows an oral surgeon to perform surgery and monitor the unconscious child at the same time. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB224\">AB 224\u003c/a>, by Assemblyman Tony Thurmond (D-Richmond), would have built on last year’s “\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB2235\">Caleb’s Law\u003c/a>,” named after Caleb Sears, a 6-year-old boy who died in 2015 after oral surgery under anesthesia.\u003c/p>\n\u003cp>\u003cstrong>Containing Drug Costs\u003c/strong>🤔\u003c/p>\n\u003cp>\u003ca href=\"https://californiahealthline.org/news/negotiating-drug-prices-should-state-agencies-band-together/\">A measure\u003c/a> by Assemblyman David Chiu (D-San Francisco) would have brought together administrators from 17 state agencies to devise ways to reduce state drug costs. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB587\">AB 587\u003c/a> would have expanded an existing state purchasing collaborative that buys drugs for a handful of public health programs, and directed the new group to develop cost controls, such as creating a uniform drug formulary for state agencies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB790\">SB 790\u003c/a> by Sen. Mike McGuire (D-North Coast/North Bay) sought to \u003ca href=\"https://californiahealthline.org/news/bill-aims-to-loosen-drugmaker-doctor-ties-by-limiting-perks-for-promoting-meds/\">restrict the pharmaceutical industry’s\u003c/a> marketing to doctors, limiting their spending to mostly educational or scientific purposes, which McGuire said could reduce unnecessary prescriptions of pricey drugs.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California Gov. Jerry Brown defied the drug industry Monday, signing the most comprehensive drug price transparency bill in the nation, one which will force drug makers to publicly justify big price hikes.\u003c/p>\n\u003cp>“Californians have a right to know why their medical costs are out of control, especially when pharmaceutical profits are soaring,” Brown said. “This measure is a step at bringing transparency, truth, exposure to a very important part of our lives, that is the cost of prescription drugs.”\u003c/p>\n\u003cp style=\"background: white;margin: 0in 0in .25in 0in\">\u003cspan style=\"color: #222222\">Brown said the bill was part of a broader push toward correcting growing economic inequities in the U.S., and called on the pharmaceutical leaders “at the top” to consider doing business in a way that helps those with a lot less. \u003c/span>\u003c/p>\n\u003cp style=\"background: white;margin: 0in 0in .25in 0in\">\u003cspan style=\"color: #222222\">“The rich are getting richer. \u003c/span>The powerful are getting more powerful,” Brown said. “So this is just another example where the powerful get more power and take more… We've got to point to the evils, and there's a real evil when so many people are suffering so much from rising drug profits.”\u003c/p>\n\u003cp>The drug lobby fiercely opposed the bill, SB 17, hiring 45 firms to try to defeat it and spending $16.8 million on lobbying against the full range of drug legislation.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new law will shine light into the mystery of how drugs are priced, requiring pharmaceutical companies to notify the state and health insurers anytime they plan to raise the price of a medication by 16 percent or more over two years. And, companies will have to provide justification for the increase.\u003c/p>\n\u003cp>The legislation was supported by a diverse coalition, including labor and consumer groups, hospital groups and even health insurers, who agreed to share some of their own data under the bill. They will have to report what percentage of premium increases are due to drug prices.\u003c/p>\n\u003cp>“Health coverage premiums directly reflect the cost of providing medical care, and prescription drug prices have become one of the main factors driving up these costs,” said Charles Bacchi, CEO of the California Association of Health Plans. “SB 17 will help us understand why, so we can prepare for and address the unrelenting price increases.”\u003c/p>\n\u003cp>Drug companies criticized the governors move, saying the new law focuses too narrowly on just one part of the drug distribution chain and won't help consumers afford their medicine.\u003c/p>\n\u003cp>“It is disappointing that Gov. Brown has decided to sign a bill that is based on misleading rhetoric instead of what’s in the best interest of patients,” said Priscilla VanderVeer, spokesperson for the Pharmaceutical Research and Manufacturers of America. “There is no evidence that SB 17 will lower drug costs for patients because it does not shed light on the large rebates and discounts insurance companies and pharmacy benefit managers are receiving that are not always being passed on to patients.”\u003c/p>\n\u003cp>Policy experts are clear that this law is part of a long game toward developing a stronger web of drug laws across the country. In that respect, it makes sense to start with the source of the drug prices: the drug makers themselves, said Gerard Anderson, a health policy professor at Johns Hopkins Bloomberg School of Public Health who tracks drug legislation in the states.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The manufacturers get most of the money – probably about three quarters or more of the money that you pay for a drug, and they're the ones that set the price initially,” he said. “So they are not the only piece of the drug supply chain, but they are the key piece to this.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Gov. Jerry Brown defied the drug industry Monday, signing the most comprehensive drug price transparency bill in the nation, one which will force drug makers to publicly justify big price hikes.\u003c/p>\n\u003cp>“Californians have a right to know why their medical costs are out of control, especially when pharmaceutical profits are soaring,” Brown said. “This measure is a step at bringing transparency, truth, exposure to a very important part of our lives, that is the cost of prescription drugs.”\u003c/p>\n\u003cp style=\"background: white;margin: 0in 0in .25in 0in\">\u003cspan style=\"color: #222222\">Brown said the bill was part of a broader push toward correcting growing economic inequities in the U.S., and called on the pharmaceutical leaders “at the top” to consider doing business in a way that helps those with a lot less. \u003c/span>\u003c/p>\n\u003cp style=\"background: white;margin: 0in 0in .25in 0in\">\u003cspan style=\"color: #222222\">“The rich are getting richer. \u003c/span>The powerful are getting more powerful,” Brown said. “So this is just another example where the powerful get more power and take more… We've got to point to the evils, and there's a real evil when so many people are suffering so much from rising drug profits.”\u003c/p>\n\u003cp>The drug lobby fiercely opposed the bill, SB 17, hiring 45 firms to try to defeat it and spending $16.8 million on lobbying against the full range of drug legislation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new law will shine light into the mystery of how drugs are priced, requiring pharmaceutical companies to notify the state and health insurers anytime they plan to raise the price of a medication by 16 percent or more over two years. And, companies will have to provide justification for the increase.\u003c/p>\n\u003cp>The legislation was supported by a diverse coalition, including labor and consumer groups, hospital groups and even health insurers, who agreed to share some of their own data under the bill. They will have to report what percentage of premium increases are due to drug prices.\u003c/p>\n\u003cp>“Health coverage premiums directly reflect the cost of providing medical care, and prescription drug prices have become one of the main factors driving up these costs,” said Charles Bacchi, CEO of the California Association of Health Plans. “SB 17 will help us understand why, so we can prepare for and address the unrelenting price increases.”\u003c/p>\n\u003cp>Drug companies criticized the governors move, saying the new law focuses too narrowly on just one part of the drug distribution chain and won't help consumers afford their medicine.\u003c/p>\n\u003cp>“It is disappointing that Gov. Brown has decided to sign a bill that is based on misleading rhetoric instead of what’s in the best interest of patients,” said Priscilla VanderVeer, spokesperson for the Pharmaceutical Research and Manufacturers of America. “There is no evidence that SB 17 will lower drug costs for patients because it does not shed light on the large rebates and discounts insurance companies and pharmacy benefit managers are receiving that are not always being passed on to patients.”\u003c/p>\n\u003cp>Policy experts are clear that this law is part of a long game toward developing a stronger web of drug laws across the country. In that respect, it makes sense to start with the source of the drug prices: the drug makers themselves, said Gerard Anderson, a health policy professor at Johns Hopkins Bloomberg School of Public Health who tracks drug legislation in the states.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“The manufacturers get most of the money – probably about three quarters or more of the money that you pay for a drug, and they're the ones that set the price initially,” he said. “So they are not the only piece of the drug supply chain, but they are the key piece to this.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Will California Kick Butts Off State Beaches? Not This Year",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp class=\"p1\">For years, state lawmakers have been trying to eliminate second-hand smoke and cigarette butts from California’s 280 illustrious beaches and natural parks.\u003c/p>\n\u003cp class=\"p1\">Once again, they have come up short.\u003c/p>\n\u003cp class=\"p1\">Late Friday, Gov. Jerry Brown vetoed two bills that would have banned or drastically curtailed smoking and vaping in parks and beaches run by the state.\u003c/p>\n\u003cp class=\"p1\">“If people can’t even smoke on a deserted beach, where can they?” Brown pondered in his \u003ca href=\"https://www.gov.ca.gov/docs/AB_725_Veto_Message_2017.pdf\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">veto \u003c/span>\u003c/a>\u003cspan class=\"s1\">message\u003c/span>. “There must be some limit to the coercive power of government.”\u003c/p>\n\u003cp class=\"p1\">Lawmakers who supported the legislation said banning smoking at state parks would protect people from health hazards associated with second-hand smoke and prevent the risks that cigarette butts pose to marine life.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cimg class=\"alignnone size-medium wp-image-361399\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Butt-on-beach-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s2\">The author of one of the bills, \u003c/span>Assemblyman Marc Levine (D-San Rafael), said \u003cspan class=\"s2\">he was \u003c/span>disappointed by Brown’s decision. Trying to protect people and wildlife from “poisonous” cigarette butts is hardly coercive, he said in an emailed statement.\u003c/p>\n\u003cp class=\"p1\">“The common person knows these dangers too well, and flippantly dismissing them isn't cool. Even for a governor who is featured in Rolling Stone magazine,” Levine said, referring to an \u003cspan class=\"s1\">\u003ca href=\"http://www.rollingstone.com/politics/features/jerry-browns-california-dream-the-rolling-stone-interview-w507082\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> with Brown \u003c/span>that ran last week in the popular culture biweekly.\u003c/p>\n\u003cp class=\"p2\">Levine’s \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB725\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">bill \u003c/span>\u003c/a>would have established designated smoking areas at some parks and beaches and imposed a fine of $50 on anyone caught lighting up outside of them.\u003c/p>\n\u003cp class=\"p2\">Another\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB386\" target=\"_blank\" rel=\"noopener\"> bill\u003c/a>, by Senator Steve Glazer (D-Orinda), would have banned smoking altogether on state beaches, and established designated smoking zones at state parks. The fine for any violation would have been $100.\u003c/p>\n\u003cp class=\"p2\">Brown and former Gov. Arnold Schwarzenegger both have vetoed similar measures in the past.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s3\">Last year, Brown \u003c/span>said a smoking ban passed by the Legislature in 2016 was \u003cspan class=\"s1\">too “broad” and “punitive\u003c/span>.”\u003c/p>\n\u003cp class=\"p1\">Beachgoers in southern California, speaking to a reporter before Brown issued Friday’s vetoes, gave mixed reviews to the idea.\u003c/p>\n\u003cp class=\"p1\">“I’m all for banning smoking on the beach. I think it's repulsive,” said MaryAnn Morton, a resident of Orange County’s Huntington Beach who regularly visits the shoreline, including a stretch of state-owned beach where smoking is permitted.\u003c/p>\n\u003cp class=\"p1\">Smoking is already prohibited on the city-controlled portion of the beach, as well as many other locally-managed beaches in California.\u003c/p>\n\u003cp class=\"p1\">Others at Huntington Beach said they didn’t think they would be harmed by second-hand smoke there.\u003c/p>\n\u003cp>\"I don't see how you can get second hand smoke from such a big public place,\" said Letty Herrera. \"I mean look at our neighbors, how they're not that close to us. If I was out here smoking a joint, I don't think they'd smell it.\"\u003c/p>\n\u003cfigure id=\"attachment_361396\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361396\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/IMG_7926-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Letty Herrera, right, enjoys the fresh air at Huntington State Beach with her friends George and Jennifer Cortez. An adjoining beach controlled by the city prohibits smoking. \u003ccite>(Pauline Bartolone/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">“Sometimes they ban things without a sole reason,\" said Jesse Miller, 24, who was drinking with friends on the city-managed stretch of beach. \"It feels more for votes.”\u003c/p>\n\u003cp class=\"p1\">Miller admitted he and his friends had just smoked on the city beach, where it is prohibited.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He said the government should focus instead on more significant contributors to poor air quality, such as a nearby industrial plant, and the offshore oil rigs that are visible from Huntington Beach.\u003c/span>\u003c/p>\n\u003cp>\"There's pollution being created,\" Miller said.\u003c/p>\n\u003cp class=\"p1\">Glen Stainer, a cigar-smoking tourist from Pennsylvania, said he could get on board with a smoking ban that allowed for designated areas. But in general, people should not smoke when others are nearby, he said.\u003c/p>\n\u003cp class=\"p1\">Stainer said can understand both sides of the issue: “It’s not fair to have smoke being blown on little children that aren’t asking for that. And yet, a beach should be a public place where I can do what I want.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Gov. Jerry Brown last week vetoed two bills that would have limited or completely banned smoking at state parks and beaches.",
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"description": "Gov. Jerry Brown last week vetoed two bills that would have limited or completely banned smoking at state parks and beaches.",
"title": "Will California Kick Butts Off State Beaches? Not This Year | KQED",
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"nprByline": "\u003cstrong>\u003ca href=\"https://khn.org/news/author/pauline-bartolone/\" rel=\"noopener\" target=\"_blank\">Pauline Bartolone\u003c/a>\u003c/strong>, California Healthline",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"p1\">For years, state lawmakers have been trying to eliminate second-hand smoke and cigarette butts from California’s 280 illustrious beaches and natural parks.\u003c/p>\n\u003cp class=\"p1\">Once again, they have come up short.\u003c/p>\n\u003cp class=\"p1\">Late Friday, Gov. Jerry Brown vetoed two bills that would have banned or drastically curtailed smoking and vaping in parks and beaches run by the state.\u003c/p>\n\u003cp class=\"p1\">“If people can’t even smoke on a deserted beach, where can they?” Brown pondered in his \u003ca href=\"https://www.gov.ca.gov/docs/AB_725_Veto_Message_2017.pdf\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">veto \u003c/span>\u003c/a>\u003cspan class=\"s1\">message\u003c/span>. “There must be some limit to the coercive power of government.”\u003c/p>\n\u003cp class=\"p1\">Lawmakers who supported the legislation said banning smoking at state parks would protect people from health hazards associated with second-hand smoke and prevent the risks that cigarette butts pose to marine life.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cimg class=\"alignnone size-medium wp-image-361399\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Butt-on-beach-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Butt-on-beach-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp class=\"p2\">\u003cspan class=\"s2\">The author of one of the bills, \u003c/span>Assemblyman Marc Levine (D-San Rafael), said \u003cspan class=\"s2\">he was \u003c/span>disappointed by Brown’s decision. Trying to protect people and wildlife from “poisonous” cigarette butts is hardly coercive, he said in an emailed statement.\u003c/p>\n\u003cp class=\"p1\">“The common person knows these dangers too well, and flippantly dismissing them isn't cool. Even for a governor who is featured in Rolling Stone magazine,” Levine said, referring to an \u003cspan class=\"s1\">\u003ca href=\"http://www.rollingstone.com/politics/features/jerry-browns-california-dream-the-rolling-stone-interview-w507082\" target=\"_blank\" rel=\"noopener\">interview\u003c/a> with Brown \u003c/span>that ran last week in the popular culture biweekly.\u003c/p>\n\u003cp class=\"p2\">Levine’s \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB725\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">bill \u003c/span>\u003c/a>would have established designated smoking areas at some parks and beaches and imposed a fine of $50 on anyone caught lighting up outside of them.\u003c/p>\n\u003cp class=\"p2\">Another\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB386\" target=\"_blank\" rel=\"noopener\"> bill\u003c/a>, by Senator Steve Glazer (D-Orinda), would have banned smoking altogether on state beaches, and established designated smoking zones at state parks. The fine for any violation would have been $100.\u003c/p>\n\u003cp class=\"p2\">Brown and former Gov. Arnold Schwarzenegger both have vetoed similar measures in the past.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s3\">Last year, Brown \u003c/span>said a smoking ban passed by the Legislature in 2016 was \u003cspan class=\"s1\">too “broad” and “punitive\u003c/span>.”\u003c/p>\n\u003cp class=\"p1\">Beachgoers in southern California, speaking to a reporter before Brown issued Friday’s vetoes, gave mixed reviews to the idea.\u003c/p>\n\u003cp class=\"p1\">“I’m all for banning smoking on the beach. I think it's repulsive,” said MaryAnn Morton, a resident of Orange County’s Huntington Beach who regularly visits the shoreline, including a stretch of state-owned beach where smoking is permitted.\u003c/p>\n\u003cp class=\"p1\">Smoking is already prohibited on the city-controlled portion of the beach, as well as many other locally-managed beaches in California.\u003c/p>\n\u003cp class=\"p1\">Others at Huntington Beach said they didn’t think they would be harmed by second-hand smoke there.\u003c/p>\n\u003cp>\"I don't see how you can get second hand smoke from such a big public place,\" said Letty Herrera. \"I mean look at our neighbors, how they're not that close to us. If I was out here smoking a joint, I don't think they'd smell it.\"\u003c/p>\n\u003cfigure id=\"attachment_361396\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361396\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/IMG_7926-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/IMG_7926-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Letty Herrera, right, enjoys the fresh air at Huntington State Beach with her friends George and Jennifer Cortez. An adjoining beach controlled by the city prohibits smoking. \u003ccite>(Pauline Bartolone/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">“Sometimes they ban things without a sole reason,\" said Jesse Miller, 24, who was drinking with friends on the city-managed stretch of beach. \"It feels more for votes.”\u003c/p>\n\u003cp class=\"p1\">Miller admitted he and his friends had just smoked on the city beach, where it is prohibited.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He said the government should focus instead on more significant contributors to poor air quality, such as a nearby industrial plant, and the offshore oil rigs that are visible from Huntington Beach.\u003c/span>\u003c/p>\n\u003cp>\"There's pollution being created,\" Miller said.\u003c/p>\n\u003cp class=\"p1\">Glen Stainer, a cigar-smoking tourist from Pennsylvania, said he could get on board with a smoking ban that allowed for designated areas. But in general, people should not smoke when others are nearby, he said.\u003c/p>\n\u003cp class=\"p1\">Stainer said can understand both sides of the issue: “It’s not fair to have smoke being blown on little children that aren’t asking for that. And yet, a beach should be a public place where I can do what I want.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Frets Over Funding After Congress Misses Health Care Deadlines",
"title": "California Frets Over Funding After Congress Misses Health Care Deadlines",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>More than a million California children get their health insurance from the Children's Health Insurance Program, also know as \"CHIP.\" Like they do with Medicaid, states split the costs for CHIP with the federal government. But Congress missed an Oct. 1 deadline to renew CHIP funding -- a lapse that many blame on the drawn-out effort to repeal the Affordable Care Act. That fight put other health care priorities on the back burner, and anxiety is growing about when -- or if -- Congress will reauthorize the money to pay for them.\u003c/p>\n\u003cp>\u003cem>What exactly is CHIP?\u003c/em>\u003c/p>\n\u003cp>CHIP is a little-known program but very important. Everyone knows about Medi-Cal, which covers lots of low-income children (and many adults as well), but CHIP is for children whose parents make too much money to qualify them for Medi-Cal, but don't have insurance through their jobs.\u003c/p>\n\u003cp>\"It saddens me because, I mean, they're children. Children should not be politicized,\" said Dr. Porshia Mack, chief medical officer at the \u003ca href=\"http://www.tvhc.org/Home.aspx\" target=\"_blank\" rel=\"noopener\">Tiburcio Vasquez Health Center\u003c/a> in Hayward.\u003c/p>\n\u003cp>A lot of people agree with Mack. CHIP has never been a controversial program, unlike the Affordable Care Act. It's always had bipartisan support since its start in 1997. Everyone professes a desire to insure children, and kids are relatively cheap to insure, compared to adults and seniors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cem>So what happened?\u003c/em>\u003c/p>\n\u003cp>Congress simply missed the deadline to renew the funding. In September, the Senate decided to try yet again to repeal and replace the Affordable Care Act, and it was so busy that CHIP was one of many programs that just didn't get voted on in time.\u003c/p>\n\u003cp>This week, Congress is starting to discuss reauthorizing the money for CHIP, but some of the ideas include ratcheting down the funding amounts. In recent years, CHIP funding had gotten a financial boost from the Affordable Care Act. Right now, California's share of CHIP's costs amount to $364 million a year, but some of the new funding proposals being floated in Congress would increase California's CHIP contribution to $1.5 billion a year.\u003c/p>\n\u003cp>California's CHIP program does have enough money to keep going through the end of 2017, according to the state's Medicaid director, Mari Cantwell. If the federal funding does not come back by January, the state could face some difficult decisions. Cantwell said most children won't actually be kicked off of their insurance, but California would have to pay much more to move them into Medi-Cal plans to keep them insured.\u003c/p>\n\u003cp>\u003cem>What else has been put on the back burner while Congress debated the Affordable Care Act?\u003c/em>\u003c/p>\n\u003cp>There were a number of health programs that also had funding deadlines of Sept. 30. One \u003ca href=\"https://khn.org/news/congress-cold-shoulder-sends-shivers-through-community-health-centers/\" target=\"_blank\" rel=\"noopener\">program\u003c/a> provides federal funding for community health clinics like Tiburcio Vasquez in Hayward. These are safety-net clinics that typically treat low-income people on Medi-Cal, and also provide a last resort for uninsured or undocumented people who have no other options. In California, the federal funding for these clinics came to $1.6 billion over the past five years. Clinic directors in California have been \u003ca href=\"https://www.sfccc.org/blog/2017/9/19/time-to-fight-back-against-graham-cassidy-repeal-bill-and-health-center-funding-cliff\" target=\"_blank\" rel=\"noopener\">vocal\u003c/a> about the importance of this money over the past few weeks, and are especially anxious now that the deadline has been missed. They're saying Congress really has to act soon.\u003c/p>\n\u003cp>\u003cem>What about the future of Obamacare itself? It seems to be very unclear about which direction it's heading.\u003c/em>\u003c/p>\n\u003cp>The repeal efforts seem to have stopped for now, or at least for 2017. But there was also a separate bill to fix one of the chief problems plaguing Obamacare, and that has also been delayed. The bill would have stabilized the individual insurance markets in the states by locking in funding that the Trump administration has threatened to cut. As a result of the ongoing uncertainty, some insurance companies have dropped out of the markets, and some have raised premiums for 2018.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Some states are waiting to see if that bill gets passed, and there is \u003ca href=\"http://thehill.com/policy/healthcare/353671-gop-willing-to-give-ground-on-obamacare-subsidies\" target=\"_blank\" rel=\"noopener\">movement\u003c/a> this week to revive it. But others have already announced that the premiums are going to increase. In Georgia, for example, premiums are set to go up by 50 percent for 2018 -- all because Congress hasn't yet fixed this funding gap. California still hasn't released the rates for Covered California plans for 2018, but they will have to do that soon, because open enrollment for 2018 starts on Nov. 1.\u003c/p>\n\n",
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"excerpt": "A program that covers more than a million children is in funding limbo. Community clinics and Covered California are also waiting on Congress to take action. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than a million California children get their health insurance from the Children's Health Insurance Program, also know as \"CHIP.\" Like they do with Medicaid, states split the costs for CHIP with the federal government. But Congress missed an Oct. 1 deadline to renew CHIP funding -- a lapse that many blame on the drawn-out effort to repeal the Affordable Care Act. That fight put other health care priorities on the back burner, and anxiety is growing about when -- or if -- Congress will reauthorize the money to pay for them.\u003c/p>\n\u003cp>\u003cem>What exactly is CHIP?\u003c/em>\u003c/p>\n\u003cp>CHIP is a little-known program but very important. Everyone knows about Medi-Cal, which covers lots of low-income children (and many adults as well), but CHIP is for children whose parents make too much money to qualify them for Medi-Cal, but don't have insurance through their jobs.\u003c/p>\n\u003cp>\"It saddens me because, I mean, they're children. Children should not be politicized,\" said Dr. Porshia Mack, chief medical officer at the \u003ca href=\"http://www.tvhc.org/Home.aspx\" target=\"_blank\" rel=\"noopener\">Tiburcio Vasquez Health Center\u003c/a> in Hayward.\u003c/p>\n\u003cp>A lot of people agree with Mack. CHIP has never been a controversial program, unlike the Affordable Care Act. It's always had bipartisan support since its start in 1997. Everyone professes a desire to insure children, and kids are relatively cheap to insure, compared to adults and seniors.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>So what happened?\u003c/em>\u003c/p>\n\u003cp>Congress simply missed the deadline to renew the funding. In September, the Senate decided to try yet again to repeal and replace the Affordable Care Act, and it was so busy that CHIP was one of many programs that just didn't get voted on in time.\u003c/p>\n\u003cp>This week, Congress is starting to discuss reauthorizing the money for CHIP, but some of the ideas include ratcheting down the funding amounts. In recent years, CHIP funding had gotten a financial boost from the Affordable Care Act. Right now, California's share of CHIP's costs amount to $364 million a year, but some of the new funding proposals being floated in Congress would increase California's CHIP contribution to $1.5 billion a year.\u003c/p>\n\u003cp>California's CHIP program does have enough money to keep going through the end of 2017, according to the state's Medicaid director, Mari Cantwell. If the federal funding does not come back by January, the state could face some difficult decisions. Cantwell said most children won't actually be kicked off of their insurance, but California would have to pay much more to move them into Medi-Cal plans to keep them insured.\u003c/p>\n\u003cp>\u003cem>What else has been put on the back burner while Congress debated the Affordable Care Act?\u003c/em>\u003c/p>\n\u003cp>There were a number of health programs that also had funding deadlines of Sept. 30. One \u003ca href=\"https://khn.org/news/congress-cold-shoulder-sends-shivers-through-community-health-centers/\" target=\"_blank\" rel=\"noopener\">program\u003c/a> provides federal funding for community health clinics like Tiburcio Vasquez in Hayward. These are safety-net clinics that typically treat low-income people on Medi-Cal, and also provide a last resort for uninsured or undocumented people who have no other options. In California, the federal funding for these clinics came to $1.6 billion over the past five years. Clinic directors in California have been \u003ca href=\"https://www.sfccc.org/blog/2017/9/19/time-to-fight-back-against-graham-cassidy-repeal-bill-and-health-center-funding-cliff\" target=\"_blank\" rel=\"noopener\">vocal\u003c/a> about the importance of this money over the past few weeks, and are especially anxious now that the deadline has been missed. They're saying Congress really has to act soon.\u003c/p>\n\u003cp>\u003cem>What about the future of Obamacare itself? It seems to be very unclear about which direction it's heading.\u003c/em>\u003c/p>\n\u003cp>The repeal efforts seem to have stopped for now, or at least for 2017. But there was also a separate bill to fix one of the chief problems plaguing Obamacare, and that has also been delayed. The bill would have stabilized the individual insurance markets in the states by locking in funding that the Trump administration has threatened to cut. As a result of the ongoing uncertainty, some insurance companies have dropped out of the markets, and some have raised premiums for 2018.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Some states are waiting to see if that bill gets passed, and there is \u003ca href=\"http://thehill.com/policy/healthcare/353671-gop-willing-to-give-ground-on-obamacare-subsidies\" target=\"_blank\" rel=\"noopener\">movement\u003c/a> this week to revive it. But others have already announced that the premiums are going to increase. In Georgia, for example, premiums are set to go up by 50 percent for 2018 -- all because Congress hasn't yet fixed this funding gap. California still hasn't released the rates for Covered California plans for 2018, but they will have to do that soon, because open enrollment for 2018 starts on Nov. 1.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Other States Closely Watching Fate of California’s Drug Price Transparency Bill",
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"content": "\u003cp>Insurers, hospitals and health advocates are waiting for Gov. Jerry Brown to deal the drug lobby a rare defeat, by signing legislation that would force pharmaceutical companies to justify big price hikes on drugs in California.\u003c/p>\n\u003cp>Drugmakers have spent $16.8 million on lobbying since January 2015 to kill an array of drug legislation in California, according to data from the Secretary of State's Office. For the pricing bill alone, the industry hired 45 lobbyists or firms to fight it. Against the backdrop of this opposition campaign, Brown must decide by Oct.15 whether to sign or veto the bill.\u003c/p>\n\u003cp>“If it gets signed by this governor, it's going to send shock waves throughout the country,” said state \u003ca href=\"http://sd22.senate.ca.gov/\" target=\"_blank\" rel=\"noopener\">Sen. Ed Hernandez\u003c/a> (D-West Covina), the bill's author and an optometrist. “A lot of other states have the same concerns we have, and you're going to see other states try to emulate what we did.”\u003c/p>\n\u003cp>The bill, SB 17, would require drug companies to give California 60 days notice anytime they plan to raise the price of a drug by 16 percent or more over two years. They’d also have to explain why the increases are necessary. In addition, health insurers would have to report what percentage of premium increases are caused by drug spending.\u003c/p>\n\u003cp>This is the second go-round for this drug price bill. Last summer, the same legislation crashed and burned. Its intended regulations were gutted so extensively that Hernandez decided to pull it. But two key things happened after that, he said, which set the stage for a successful second attempt.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>First, in August 2016, less than a week after Hernandez pulled the bill, a firestorm of controversy erupted nationally over the price of EpiPens spiking nearly 500 percent. The increase inspired a chorus of outrage from parents who carry the auto-injectors to save their children from life-threatening allergic reactions.\u003c/p>\n\u003cp>Momentum grew among federal lawmakers last September to do something. They called for hearings. Several proposed bills aimed to reign in drug prices across the country.\u003c/p>\n\u003cp>But then, the election of November 2016 disrupted all order of health care business in Washington. After Donald Trump was elected and Republicans took control of Congress, the number one health policy priority became repealing and replacing the Affordable Care Act.\u003c/p>\n\u003cp>As federal lawmakers focused on taking away health coverage from millions of Americans, Hernandez said he saw another opportunity for state lawmakers to act on drug prices. He reintroduced his bill in early 2017, and this time political support grew quickly, beyond the usual suspects.\u003c/p>\n\u003cp>“It wasn’t just labor,” he recalled. “It was consumer groups, it was health plans. It was the Chambers of Commerce, it was the Hospital Association.”\u003c/p>\n\u003cp>Hernandez is optimistic the governor will sign SB 17 into law. But he knows nothing’s certain. That's because of what happened on Sept. 11, the day the bill came up for a key vote in the state Assembly -- the same place it went down the year before. Hernandez thought he’d secured all the votes he needed, but at the last minute the votes started slipping away.\u003c/p>\n\u003cp>The bill needed 41 votes to pass the Assembly. During the roll call, the tally stalled around 35. Hernandez said he had plenty of colleagues willing to cast the 42nd vote, but with drug lobbyists swarming the Capitol, no legislators wanted to be the one to cast the \u003cem>deciding\u003c/em> vote.\u003c/p>\n\u003cp>“If the bill fails and you’re stuck out there, then you’re the person that’s attacking the industry,” Hernandez said.\u003c/p>\n\u003cp>On the second round of voting, the bill crossed the 41-vote threshold quickly, and the remaining lawmakers glommed on. In the end, the bill passed with 66 votes. All the Democrats and half the Republicans in the state Assembly voted for it.\u003c/p>\n\u003cp>This was much to the dismay of drug companies, which lobbied hard and issued a blitz of advertising in the last weeks before the vote.\u003c/p>\n\u003cp>The Pharmaceutical Research and Manufacturers of America, or \u003ca href=\"http://www.phrma.org/\" target=\"_blank\" rel=\"noopener\">PhRMA\u003c/a>, the industry’s trade group, argued that SB 17 was full of “false promises” that wouldn’t help consumers pay for their medicines, and would instead stifle innovation with cumbersome regulatory compliance.\u003c/p>\n\u003cp>“That takes up a lot of resources and will take up a lot of time,” said Priscilla VanderVeer, deputy vice president of public affairs for PhRMA. “And that could mean pulling resources from research and development and having to put it into the reporting structure.”\u003c/p>\n\u003cp>Experts say the drug industry doesn’t want a large influential state like California forcing them to share their data.\u003c/p>\n\u003cp>“When they have to justify in California, de facto, they have to justify it to the other 49 states,” said \u003ca href=\"https://www.jhsph.edu/faculty/directory/profile/11/gerard-anderson\" target=\"_blank\" rel=\"noopener\">Gerard Anderson\u003c/a>, a public health professor at Johns Hopkins University. “So other states essentially get to piggyback on the good efforts of California, and hopefully, because they might have difficulty justifying the price increases, everybody’s prices around the country will be lower.”\u003c/p>\n\u003cp>Other states, like Maryland, Vermont, Nevada and New York, have passed similar laws aimed at bringing more transparency to prices and curbing price gouging. But the pharmaceutical industry has fought the hardest in California. If drug companies don’t like the disclosure laws in smaller states, they could decide not to sell their drugs there, Anderson said, but the market in California is just too big to ignore.\u003c/p>\n\u003cp>“States like Maryland are just not as powerful,” he said. “It just doesn’t have the clout that a state like California has.”\u003c/p>\n\u003cp>But drugmakers are likely already devising ways to work around the California bill, Anderson warned. They’ve filed lawsuits to try to slow or stop laws from being implemented in other states, or to weaken the rules if and when they go into effect. Policy experts are watching to see what kinds of legal challenges the California law might be vulnerable to, and if it can withstand them.\u003c/p>\n\u003cp>“We learn from the mistakes of other states,” Anderson said. “Legislation is an iterative process. We have 50 states and hopefully, by some time, we'll get it right. We’re looking for California to take the lead on this.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[documentcloud url=\"http://www.documentcloud.org/documents/4065249-CA-Rx-Lobbying-Expenditures-Jan-15-June-17.html\" width=800 height=900]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Insurers, hospitals and health advocates are waiting for Gov. Jerry Brown to deal the drug lobby a rare defeat, by signing legislation that would force pharmaceutical companies to justify big price hikes on drugs in California.\u003c/p>\n\u003cp>Drugmakers have spent $16.8 million on lobbying since January 2015 to kill an array of drug legislation in California, according to data from the Secretary of State's Office. For the pricing bill alone, the industry hired 45 lobbyists or firms to fight it. Against the backdrop of this opposition campaign, Brown must decide by Oct.15 whether to sign or veto the bill.\u003c/p>\n\u003cp>“If it gets signed by this governor, it's going to send shock waves throughout the country,” said state \u003ca href=\"http://sd22.senate.ca.gov/\" target=\"_blank\" rel=\"noopener\">Sen. Ed Hernandez\u003c/a> (D-West Covina), the bill's author and an optometrist. “A lot of other states have the same concerns we have, and you're going to see other states try to emulate what we did.”\u003c/p>\n\u003cp>The bill, SB 17, would require drug companies to give California 60 days notice anytime they plan to raise the price of a drug by 16 percent or more over two years. They’d also have to explain why the increases are necessary. In addition, health insurers would have to report what percentage of premium increases are caused by drug spending.\u003c/p>\n\u003cp>This is the second go-round for this drug price bill. Last summer, the same legislation crashed and burned. Its intended regulations were gutted so extensively that Hernandez decided to pull it. But two key things happened after that, he said, which set the stage for a successful second attempt.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>First, in August 2016, less than a week after Hernandez pulled the bill, a firestorm of controversy erupted nationally over the price of EpiPens spiking nearly 500 percent. The increase inspired a chorus of outrage from parents who carry the auto-injectors to save their children from life-threatening allergic reactions.\u003c/p>\n\u003cp>Momentum grew among federal lawmakers last September to do something. They called for hearings. Several proposed bills aimed to reign in drug prices across the country.\u003c/p>\n\u003cp>But then, the election of November 2016 disrupted all order of health care business in Washington. After Donald Trump was elected and Republicans took control of Congress, the number one health policy priority became repealing and replacing the Affordable Care Act.\u003c/p>\n\u003cp>As federal lawmakers focused on taking away health coverage from millions of Americans, Hernandez said he saw another opportunity for state lawmakers to act on drug prices. He reintroduced his bill in early 2017, and this time political support grew quickly, beyond the usual suspects.\u003c/p>\n\u003cp>“It wasn’t just labor,” he recalled. “It was consumer groups, it was health plans. It was the Chambers of Commerce, it was the Hospital Association.”\u003c/p>\n\u003cp>Hernandez is optimistic the governor will sign SB 17 into law. But he knows nothing’s certain. That's because of what happened on Sept. 11, the day the bill came up for a key vote in the state Assembly -- the same place it went down the year before. Hernandez thought he’d secured all the votes he needed, but at the last minute the votes started slipping away.\u003c/p>\n\u003cp>The bill needed 41 votes to pass the Assembly. During the roll call, the tally stalled around 35. Hernandez said he had plenty of colleagues willing to cast the 42nd vote, but with drug lobbyists swarming the Capitol, no legislators wanted to be the one to cast the \u003cem>deciding\u003c/em> vote.\u003c/p>\n\u003cp>“If the bill fails and you’re stuck out there, then you’re the person that’s attacking the industry,” Hernandez said.\u003c/p>\n\u003cp>On the second round of voting, the bill crossed the 41-vote threshold quickly, and the remaining lawmakers glommed on. In the end, the bill passed with 66 votes. All the Democrats and half the Republicans in the state Assembly voted for it.\u003c/p>\n\u003cp>This was much to the dismay of drug companies, which lobbied hard and issued a blitz of advertising in the last weeks before the vote.\u003c/p>\n\u003cp>The Pharmaceutical Research and Manufacturers of America, or \u003ca href=\"http://www.phrma.org/\" target=\"_blank\" rel=\"noopener\">PhRMA\u003c/a>, the industry’s trade group, argued that SB 17 was full of “false promises” that wouldn’t help consumers pay for their medicines, and would instead stifle innovation with cumbersome regulatory compliance.\u003c/p>\n\u003cp>“That takes up a lot of resources and will take up a lot of time,” said Priscilla VanderVeer, deputy vice president of public affairs for PhRMA. “And that could mean pulling resources from research and development and having to put it into the reporting structure.”\u003c/p>\n\u003cp>Experts say the drug industry doesn’t want a large influential state like California forcing them to share their data.\u003c/p>\n\u003cp>“When they have to justify in California, de facto, they have to justify it to the other 49 states,” said \u003ca href=\"https://www.jhsph.edu/faculty/directory/profile/11/gerard-anderson\" target=\"_blank\" rel=\"noopener\">Gerard Anderson\u003c/a>, a public health professor at Johns Hopkins University. “So other states essentially get to piggyback on the good efforts of California, and hopefully, because they might have difficulty justifying the price increases, everybody’s prices around the country will be lower.”\u003c/p>\n\u003cp>Other states, like Maryland, Vermont, Nevada and New York, have passed similar laws aimed at bringing more transparency to prices and curbing price gouging. But the pharmaceutical industry has fought the hardest in California. If drug companies don’t like the disclosure laws in smaller states, they could decide not to sell their drugs there, Anderson said, but the market in California is just too big to ignore.\u003c/p>\n\u003cp>“States like Maryland are just not as powerful,” he said. “It just doesn’t have the clout that a state like California has.”\u003c/p>\n\u003cp>But drugmakers are likely already devising ways to work around the California bill, Anderson warned. They’ve filed lawsuits to try to slow or stop laws from being implemented in other states, or to weaken the rules if and when they go into effect. Policy experts are watching to see what kinds of legal challenges the California law might be vulnerable to, and if it can withstand them.\u003c/p>\n\u003cp>“We learn from the mistakes of other states,” Anderson said. “Legislation is an iterative process. We have 50 states and hopefully, by some time, we'll get it right. 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"disqusTitle": "Congress’ Cold Shoulder Sends Shivers Through Community Health Centers",
"title": "Congress’ Cold Shoulder Sends Shivers Through Community Health Centers",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>One community health center in New York has frozen hiring. Another in Missouri can’t get a bank loan to expand.\u003c/p>\n\u003cp>The nation’s 1,400 community health centers are carefully watching expenses in case the financial rescue they hope Congress delivers this week doesn’t arrive. With four days left in the government’s fiscal year, Congress has not voted on reauthorizing billions of dollars now going to community health centers and other health programs for the 2018 budget year that starts Sunday.\u003c/p>\n\u003cp>“The anxiety level is increasing on almost a daily basis,” said Dan Hawkins, senior vice president of the National Association of Community Health Centers (NACHC) in Washington, D.C. “There is broad support and agreement in Congress that it should get done, but we are working against a ticking clock and a crowded legislative calendar.”\u003c/p>\n\u003cp>For the past two weeks, the GOP’s scramble to repeal the Affordable Care Act before the month ends pushed other health care matters off the congressional agenda. That effort ended Tuesday when Senate Republicans said they would not seek a vote this week because they lacked enough support to pass the bill.\u003c/p>\n\u003cp>It’s not clear if lawmakers’ lighter agenda will now leave room for funding health centers or deciding other issues, such as renewing the Children’s Health Insurance Program (CHIP), which also expires Saturday. At a hearing Monday, Senate Finance Committee Chairman Orrin Hatch (R-Utah) urged his colleagues to work with the Senate’s health committee to settle the matter. NACHC officials privately express optimism that a deal might come later in October if not by Sunday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Community health centers operate in more than 9,500 locations, serving 27 million people, according to the NACHC. They are the main source of health care for many low-income Americans — and the only source of primary care in many underserved areas.\u003c/p>\n\u003cp>Health centers provide preventive care, counseling, dentistry and primary care to everyone, whether or not they can pay. A sliding fee scale based on income and family size is available to patients without insurance.\u003c/p>\n\u003cp>In 2015, nearly 1 in 6 Medicaid beneficiaries received health center services, the Kaiser Family Foundation \u003ca href=\"http://www.kff.org/medicaid/issue-brief/community-health-centers-recent-growth-and-the-role-of-the-aca/\">reported\u003c/a> this year. (Kaiser Health News is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>“The end result is these are people who will be locked out of health care” without new funding, Hawkins said.\u003c/p>\n\u003cp>Community health centers gained billions of dollars in federal revenue under the ACA, which created a special trust fund to support them from 2011 through 2015. The Community Health Center Fund was extended in 2015 for two years with an additional $3.6 billion annually.\u003c/p>\n\u003cp>That money represents 70 percent of all federal grants to health centers and about a fifth of their annual revenue. Medicaid reimbursements account for the largest share, about 40 percent.\u003c/p>\n\u003cp>One beneficiary is Pamela Richardson, a 60-year-old patient of Valley Community Healthcare in North Hollywood, California, who suffers from an iron absorption disorder called hereditary hemochromatosis. She was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.\u003c/p>\n\u003cp>Once Richardson was covered, she received long-delayed primary care, which revealed she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have Pap smears,” she \u003ca href=\"http://khn.org/news/californias-community-clinics-big-aca-beneficiaries-worry-about-their-future/\">told\u003c/a> a KHN reporter earlier this year. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”\u003c/p>\n\u003cp>California has by far the most federally funded health centers and they serve 6.2 million Californians, according to CaliforniaHealth+ Advocates, which represents state clinics. They have received over $1.6 billion from 2011 through 2016 from the Community Health Center Fund, more than any other state, the Congressional Research Service \u003ca href=\"https://www.everycrsreport.com/files/20170113_R43911_852eca9ca6e96b41176e6609d8cb068ba7e770ed.pdf\">reported\u003c/a> in January.\u003c/p>\n\u003cp>If health centers receive no new funds for 2018, the ensuing financial crunch would cost 51,000 jobs, force the centers to close 2,800 locations and cause 9 million people to lose health care services, according to a budget document that the Health and Human Services Department gave Congress in July.\u003c/p>\n\u003cp>Uncertainty about what Congress will do now is already causing problems. Hawkins said his members call him and his staff every day, fretting about employment contracts, lease agreements and equipment rentals that run past Oct. 1.\u003c/p>\n\u003cp>Neighborhood Health in Nashville, Tennessee, has federal grant money that will carry it through Jan. 31, but CEO Mary Bufwack said some of her 180 staff members live paycheck to paycheck and are getting nervous about Neighborhood’s stability.\u003c/p>\n\u003cp>Bufwack is worried the health center won’t receive money it needs to replace a clinic, a project now being planned.\u003c/p>\n\u003cp>She fears that a new doctor she recruited to join Neighborhood next June will take another job before she can get his signature on an employment contract. And she doesn’t want to do that until she’s sure about her budget.\u003c/p>\n\u003cp>Mostly, she worries that whatever Congress gives her will be only for one year.\u003c/p>\n\u003cp>“We’re already worried about next Sept. 30,” Bufwack said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"excerpt": "The clinics, which serve many poor people, are tightening spending in case Congress doesn’t approve new funding for them before the government’s 2018 fiscal year starts Sunday. California has the most at stake.",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/rachel-bluth/\" rel=\"noopener\" target=\"_blank\">\u003cstrong>Rachel Bluth\u003c/strong>\u003c/a>, Kaiser Health News",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>One community health center in New York has frozen hiring. Another in Missouri can’t get a bank loan to expand.\u003c/p>\n\u003cp>The nation’s 1,400 community health centers are carefully watching expenses in case the financial rescue they hope Congress delivers this week doesn’t arrive. With four days left in the government’s fiscal year, Congress has not voted on reauthorizing billions of dollars now going to community health centers and other health programs for the 2018 budget year that starts Sunday.\u003c/p>\n\u003cp>“The anxiety level is increasing on almost a daily basis,” said Dan Hawkins, senior vice president of the National Association of Community Health Centers (NACHC) in Washington, D.C. “There is broad support and agreement in Congress that it should get done, but we are working against a ticking clock and a crowded legislative calendar.”\u003c/p>\n\u003cp>For the past two weeks, the GOP’s scramble to repeal the Affordable Care Act before the month ends pushed other health care matters off the congressional agenda. That effort ended Tuesday when Senate Republicans said they would not seek a vote this week because they lacked enough support to pass the bill.\u003c/p>\n\u003cp>It’s not clear if lawmakers’ lighter agenda will now leave room for funding health centers or deciding other issues, such as renewing the Children’s Health Insurance Program (CHIP), which also expires Saturday. At a hearing Monday, Senate Finance Committee Chairman Orrin Hatch (R-Utah) urged his colleagues to work with the Senate’s health committee to settle the matter. NACHC officials privately express optimism that a deal might come later in October if not by Sunday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Community health centers operate in more than 9,500 locations, serving 27 million people, according to the NACHC. They are the main source of health care for many low-income Americans — and the only source of primary care in many underserved areas.\u003c/p>\n\u003cp>Health centers provide preventive care, counseling, dentistry and primary care to everyone, whether or not they can pay. A sliding fee scale based on income and family size is available to patients without insurance.\u003c/p>\n\u003cp>In 2015, nearly 1 in 6 Medicaid beneficiaries received health center services, the Kaiser Family Foundation \u003ca href=\"http://www.kff.org/medicaid/issue-brief/community-health-centers-recent-growth-and-the-role-of-the-aca/\">reported\u003c/a> this year. (Kaiser Health News is an editorially independent program of the foundation.)\u003c/p>\n\u003cp>“The end result is these are people who will be locked out of health care” without new funding, Hawkins said.\u003c/p>\n\u003cp>Community health centers gained billions of dollars in federal revenue under the ACA, which created a special trust fund to support them from 2011 through 2015. The Community Health Center Fund was extended in 2015 for two years with an additional $3.6 billion annually.\u003c/p>\n\u003cp>That money represents 70 percent of all federal grants to health centers and about a fifth of their annual revenue. Medicaid reimbursements account for the largest share, about 40 percent.\u003c/p>\n\u003cp>One beneficiary is Pamela Richardson, a 60-year-old patient of Valley Community Healthcare in North Hollywood, California, who suffers from an iron absorption disorder called hereditary hemochromatosis. She was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.\u003c/p>\n\u003cp>Once Richardson was covered, she received long-delayed primary care, which revealed she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have Pap smears,” she \u003ca href=\"http://khn.org/news/californias-community-clinics-big-aca-beneficiaries-worry-about-their-future/\">told\u003c/a> a KHN reporter earlier this year. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”\u003c/p>\n\u003cp>California has by far the most federally funded health centers and they serve 6.2 million Californians, according to CaliforniaHealth+ Advocates, which represents state clinics. They have received over $1.6 billion from 2011 through 2016 from the Community Health Center Fund, more than any other state, the Congressional Research Service \u003ca href=\"https://www.everycrsreport.com/files/20170113_R43911_852eca9ca6e96b41176e6609d8cb068ba7e770ed.pdf\">reported\u003c/a> in January.\u003c/p>\n\u003cp>If health centers receive no new funds for 2018, the ensuing financial crunch would cost 51,000 jobs, force the centers to close 2,800 locations and cause 9 million people to lose health care services, according to a budget document that the Health and Human Services Department gave Congress in July.\u003c/p>\n\u003cp>Uncertainty about what Congress will do now is already causing problems. Hawkins said his members call him and his staff every day, fretting about employment contracts, lease agreements and equipment rentals that run past Oct. 1.\u003c/p>\n\u003cp>Neighborhood Health in Nashville, Tennessee, has federal grant money that will carry it through Jan. 31, but CEO Mary Bufwack said some of her 180 staff members live paycheck to paycheck and are getting nervous about Neighborhood’s stability.\u003c/p>\n\u003cp>Bufwack is worried the health center won’t receive money it needs to replace a clinic, a project now being planned.\u003c/p>\n\u003cp>She fears that a new doctor she recruited to join Neighborhood next June will take another job before she can get his signature on an employment contract. And she doesn’t want to do that until she’s sure about her budget.\u003c/p>\n\u003cp>Mostly, she worries that whatever Congress gives her will be only for one year.\u003c/p>\n\u003cp>“We’re already worried about next Sept. 30,” Bufwack said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "'Devastating' Cuts to Come: How California Would Suffer Under GOP Health Plan",
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"content": "\u003cp>State officials are sounding the alarm over a last-minute push by Republican Senators to \"replace and replace\" the Affordable Care Act. Health officials warn it's the worst proposal yet, with California set to \u003ca href=\"http://www.dhcs.ca.gov/Documents/Graham_Cassidy_Impact_Memo_DHCS_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lose billions of dollars\u003c/a>.\u003c/p>\n\u003cp>\"Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,\" said Jennifer Kent, Director of the Department of Health Care Services.\u003c/p>\n\u003cp>The two previous plans debated in Congress only partially dismantled the structures that undergird the Affordable Care Act.\u003c/p>\n\u003cp>But the new Graham-Cassidy proposal would blow up those ACA structures, and retract the money that currently pays for them, starting in 2020. After lopping off more than $200 billion from the retracted money, the federal government would use a new formula to scatter the remaining funds across the 50 states and District of Columbia.\u003c/p>\n\u003cp>Prominent losers in this scenario include states like California that eagerly embraced the Affordable Care Act. Health consulting firm Avalere \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">predicts\u003c/a> 34 states and DC would experience funding cuts, and 16 states would see an increase.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>What Graham-Cassidy does, starting in 2020:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends payments\u003c/span> for Medicaid expansion, which allowed 3.8 million Californians to join Medi-Cal.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends federal subsidies\u003c/span> for private insurance coverage sold through \"Covered California,\" which cover more than one million Californians.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Removes guarantees\u003c/span> that insurance plans cannot charge higher prices to patients with pre-existing conditions to pay more for coverage, or must offer plans that include a basic suite of services, such as prescriptions, maternity care, and mental health treatment. States could opt out of many of these protections, although most experts agree that California would try to maintain them.\u003c/p>\n\u003cp>But that could be an empty promise, warns Peter Lee, executive director of Covered California. Even if California continued the protections for sick people, the insurance market could collapse as healthy people stop buying coverage when federal subsidies end.\u003c/p>\n\u003cp>\u003cstrong>California's \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\" target=\"_blank\" rel=\"noopener noreferrer\">projected losses\u003c/a>:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Number of uninsured:\u003c/span> More than 10 million Californians will lose health coverage by 2027, according to an \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_Potential_Impacts_Graham-Cassidy-9-25-17.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">new analysis \u003c/a>by Covered California. (UC Berkeley has a \u003ca href=\"http://laborcenter.berkeley.edu/projected-health-insurance-coverage-loss-by-county-2027-under-graham-cassidy/\" target=\"_blank\" rel=\"noopener noreferrer\">breakdown\u003c/a> by Congressional district and county).\u003c/p>\n\u003cp>\u003cem>That's nearly 1 in 4 Californians under age 65, worse than pre-Obamacare levels. \u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Federal funds loss:\u003c/span> Total losses for health care in California ratchet up to $28 billion/year by 2026, then increase dramatically to $57.5 billion a year later, in 2027. That's equivalent to more than a third of all General Fund spending in California's budget.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Medi-Cal changes:\u003c/span> In addition to changes to the Affordable Care Act, the Graham-Cassidy proposal radically changes how traditional Medicaid, dating back to 1965, is funded. 14 million Californians depend on Medi-Cal coverage, and it's particularly critical for people with disabilities and residents of nursing homes.\u003c/p>\n\u003cp>California stands to lose the most money of all the states.\u003c/p>\n\u003cp>Supporters of the new plan's redistribution formulas explain that it's a matter of fairness to all states.\u003c/p>\n\u003cp>“Four states get 40 percent of the money under Obamacare: New York, California, Massachusetts, and Maryland,\" said Senator Lindsey Graham. \"Our goal is by 2026 to make sure every patient in every state gets the same contribution, roughly, from the federal government.”\u003c/p>\n\u003cp>Opponents of the repeal efforts point out that California gets more money under the law because it has the largest population in the country, and because it embraced the Affordable Care Act's funding opportunities.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Other states such as Texas didn't get as much money under the ACA not because the distribution wasn't fair, but because officials in those states refused to expand Medicaid to more residents, so they didn’t pull down the federal money to pay for that. Under the new plan, Texas will get $35 billion more in federal funds by 2026.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>State officials are sounding the alarm over a last-minute push by Republican Senators to \"replace and replace\" the Affordable Care Act. Health officials warn it's the worst proposal yet, with California set to \u003ca href=\"http://www.dhcs.ca.gov/Documents/Graham_Cassidy_Impact_Memo_DHCS_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lose billions of dollars\u003c/a>.\u003c/p>\n\u003cp>\"Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,\" said Jennifer Kent, Director of the Department of Health Care Services.\u003c/p>\n\u003cp>The two previous plans debated in Congress only partially dismantled the structures that undergird the Affordable Care Act.\u003c/p>\n\u003cp>But the new Graham-Cassidy proposal would blow up those ACA structures, and retract the money that currently pays for them, starting in 2020. After lopping off more than $200 billion from the retracted money, the federal government would use a new formula to scatter the remaining funds across the 50 states and District of Columbia.\u003c/p>\n\u003cp>Prominent losers in this scenario include states like California that eagerly embraced the Affordable Care Act. Health consulting firm Avalere \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">predicts\u003c/a> 34 states and DC would experience funding cuts, and 16 states would see an increase.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What Graham-Cassidy does, starting in 2020:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends payments\u003c/span> for Medicaid expansion, which allowed 3.8 million Californians to join Medi-Cal.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends federal subsidies\u003c/span> for private insurance coverage sold through \"Covered California,\" which cover more than one million Californians.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Removes guarantees\u003c/span> that insurance plans cannot charge higher prices to patients with pre-existing conditions to pay more for coverage, or must offer plans that include a basic suite of services, such as prescriptions, maternity care, and mental health treatment. States could opt out of many of these protections, although most experts agree that California would try to maintain them.\u003c/p>\n\u003cp>But that could be an empty promise, warns Peter Lee, executive director of Covered California. Even if California continued the protections for sick people, the insurance market could collapse as healthy people stop buying coverage when federal subsidies end.\u003c/p>\n\u003cp>\u003cstrong>California's \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\" target=\"_blank\" rel=\"noopener noreferrer\">projected losses\u003c/a>:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Number of uninsured:\u003c/span> More than 10 million Californians will lose health coverage by 2027, according to an \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_Potential_Impacts_Graham-Cassidy-9-25-17.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">new analysis \u003c/a>by Covered California. (UC Berkeley has a \u003ca href=\"http://laborcenter.berkeley.edu/projected-health-insurance-coverage-loss-by-county-2027-under-graham-cassidy/\" target=\"_blank\" rel=\"noopener noreferrer\">breakdown\u003c/a> by Congressional district and county).\u003c/p>\n\u003cp>\u003cem>That's nearly 1 in 4 Californians under age 65, worse than pre-Obamacare levels. \u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Federal funds loss:\u003c/span> Total losses for health care in California ratchet up to $28 billion/year by 2026, then increase dramatically to $57.5 billion a year later, in 2027. That's equivalent to more than a third of all General Fund spending in California's budget.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Medi-Cal changes:\u003c/span> In addition to changes to the Affordable Care Act, the Graham-Cassidy proposal radically changes how traditional Medicaid, dating back to 1965, is funded. 14 million Californians depend on Medi-Cal coverage, and it's particularly critical for people with disabilities and residents of nursing homes.\u003c/p>\n\u003cp>California stands to lose the most money of all the states.\u003c/p>\n\u003cp>Supporters of the new plan's redistribution formulas explain that it's a matter of fairness to all states.\u003c/p>\n\u003cp>“Four states get 40 percent of the money under Obamacare: New York, California, Massachusetts, and Maryland,\" said Senator Lindsey Graham. \"Our goal is by 2026 to make sure every patient in every state gets the same contribution, roughly, from the federal government.”\u003c/p>\n\u003cp>Opponents of the repeal efforts point out that California gets more money under the law because it has the largest population in the country, and because it embraced the Affordable Care Act's funding opportunities.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Other states such as Texas didn't get as much money under the ACA not because the distribution wasn't fair, but because officials in those states refused to expand Medicaid to more residents, so they didn’t pull down the federal money to pay for that. Under the new plan, Texas will get $35 billion more in federal funds by 2026.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"soldout": {
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