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"title": "Sen. John McCain (R-AZ) leaves a meeting where a new version of a GOP healthcare bill was unveiled to Republican senators at the U.S. Capitol July 13, 2017 in Washington, DC. The latest version of the proposed bill aims to repeal and replace the Affordable Care Act, also knows as Obamacare.",
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"content": "\u003cp>California stands to lose billions in health care funding under the GOP’s latest plan to repeal and replace the Affordable Care Act, resulting in millions of Californians losing coverage.\u003c/p>\n\u003cp>The Graham-Cassidy legislation under discussion in the Senate would redistribute the funds now used to pay for the Affordable Care Act, effectively taking money from states that embraced all aspects of the law, like California, and redistributing it to other states, that didn't, like Texas.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“For a state like California or a Massachusetts or a New York, exactly the states that might be most motivated to at least try to preserve the ACA coverage gains - those are the states that would face the deepest cuts to their federal resources,” said Aviva Aron-Dine, senior fellow at the \u003ca href=\"https://www.cbpp.org/\">Center on Budget and Policy Priorities\u003c/a>.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">The bill's Republican authors say redistributing the health funds is about fairness, and will give states more \"flexibility\" to redesign their own health systems.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">But health officials in California predict dire consequences if the measure were to pass.\u003c/p>\n\u003cp>[ad fullwidth]\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,” top officials from the state Department of Health Care Services wrote in \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/09/graham_cassidy_impact_memo_dhcs_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">an analysis\u003c/a> released Friday. “If this amendment is adopted and becomes law, California will be faced with tens of billions of dollars in new costs [and] will require difficult decisions regarding the populations and benefits we choose to cover and how much we pay providers and plans for the services they provide.”\u003c/p>\n\u003cp> \u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">By 2026, California would lose $85.7 billion in federal funds, and by 2027 it would lose $138.8 billion, according to the analysis. That could cause 6.7 million Californians to lose insurance coverage, according to \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\">estimates\u003c/a> from the The UC Berkeley Labor Center.\u003c/p>\n\u003cp>A lot of those people are entrepreneurs or their employees. Under the Affordable Care Act in California, half a million self-employed entrepreneurs -- and a million employees who work for small businesses -- got health coverage because of the ACA, either through the expansion of Medi-Cal, or through a subsidized personal insurance plan on the state exchange, Covered California.\u003c/p>\n\u003cp>\"It would be very difficult for entrepreneurs and self employed folks to access some level of coverage,\" said Mark Herbert, California director for the \u003ca href=\"http://www.smallbusinessmajority.org/states/california\" target=\"_blank\" rel=\"noopener noreferrer\">Small Business Majority\u003c/a>. \"So it would be massively destabilizing to the ability of small employers to attract talent.\"\u003c/p>\n\u003cp>Beyond that, there would be damaging ripple effects, Herbert added: \"There's no way that you can remove those sorts of dollars out of our local communities and not see some sort of economic impact on small businesses.\"\u003c/p>\n\u003cp>Under the Graham-Cassidy bill’s redistribution formula, several states that shunned the Affordable Care Act would get more money, according to a \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\">study\u003c/a> by health consulting firm Avalare.\u003c/p>\n\u003cp>Texas will get a windfall of $35 billion in health funding over the next ten years, more than any other state. State officials would get to decide how they want to spend that money. But advocates and analysts say more money for Texas doesn't necessarily guarantee an improved health care system.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“Regardless of the size of the block grant, there's just no assurance that it would translate into good coverage, or coverage that's as affordable as what we have today,” said Stacey Pogue with the \u003ca href=\"http://bettertexasblog.org/2017/09/harmful-medicaid-cutaca-repeal-bill-resurfaces-senate/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Public Policy Priorities \u003c/a>in Austin.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">Texas already has the highest number of uninsured folks, and Pogue says the state just doesn't have the infrastructure in place to expand coverage to more people. It didn't expand Medicaid in 2014, which was optional under the ACA, and the state didn't set up its own exchange, like California did with \"Covered California.\" Texans who wanted subsidized insurance plans had to use the federal exchange, healthcare.gov, which meant Texas had less flexibility when it came to regulating insurers.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“There's no planning and no thought put into, 'How would we create affordable coverage for low-income Texans?\" Pogue said, \"Unlike the 31 states that have expanded Medicaid, have done some central planning. And Texas would be starting from scratch.”\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">It would also take a lot of political will to make sure the state is actually expanding health care, Pogue added, and that motivation has been lacking among state lawmakers for years. In order to get the block grant, states would need to create a workable health infrastructure by 2020. For comparison, it took Massachusetts four years to set up its pre-Obamacare statewide insurance market.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We are very concerned,” said Stacy Wilson, president of the Children's Hospital Association of Texas.\u003c/p>\n\u003cp>Wilson said this pot of money from Cassidy-Graham wouldn't solve chronic problems with Medicaid, 70 percent of which covers children. Wilson explained that's because the federal government would pay a fixed amount per person, under a per capita cap. That formula locks in how much the state gets per Medicaid enrollee, no matter how much treatment those enrollees need.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We have very low per-capita costs already, and we get locked into that forever,” Wilson said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">A conservative policy group in Texas, \u003ca href=\"https://www.texaspolicy.com/press_release/detail/tppf-statement-on-graham-cassidy-health-care-bill\" target=\"_blank\" rel=\"noopener noreferrer\">The Texas Public Policy Foundation\u003c/a>, is also not happy about the bill, but their concern is that it doesn't go far enough to repeal Obamacare.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California stands to lose billions in health care funding under the GOP’s latest plan to repeal and replace the Affordable Care Act, resulting in millions of Californians losing coverage.\u003c/p>\n\u003cp>The Graham-Cassidy legislation under discussion in the Senate would redistribute the funds now used to pay for the Affordable Care Act, effectively taking money from states that embraced all aspects of the law, like California, and redistributing it to other states, that didn't, like Texas.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“For a state like California or a Massachusetts or a New York, exactly the states that might be most motivated to at least try to preserve the ACA coverage gains - those are the states that would face the deepest cuts to their federal resources,” said Aviva Aron-Dine, senior fellow at the \u003ca href=\"https://www.cbpp.org/\">Center on Budget and Policy Priorities\u003c/a>.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">The bill's Republican authors say redistributing the health funds is about fairness, and will give states more \"flexibility\" to redesign their own health systems.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">But health officials in California predict dire consequences if the measure were to pass.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\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,” top officials from the state Department of Health Care Services wrote in \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/09/graham_cassidy_impact_memo_dhcs_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">an analysis\u003c/a> released Friday. “If this amendment is adopted and becomes law, California will be faced with tens of billions of dollars in new costs [and] will require difficult decisions regarding the populations and benefits we choose to cover and how much we pay providers and plans for the services they provide.”\u003c/p>\n\u003cp> \u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">By 2026, California would lose $85.7 billion in federal funds, and by 2027 it would lose $138.8 billion, according to the analysis. That could cause 6.7 million Californians to lose insurance coverage, according to \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\">estimates\u003c/a> from the The UC Berkeley Labor Center.\u003c/p>\n\u003cp>A lot of those people are entrepreneurs or their employees. Under the Affordable Care Act in California, half a million self-employed entrepreneurs -- and a million employees who work for small businesses -- got health coverage because of the ACA, either through the expansion of Medi-Cal, or through a subsidized personal insurance plan on the state exchange, Covered California.\u003c/p>\n\u003cp>\"It would be very difficult for entrepreneurs and self employed folks to access some level of coverage,\" said Mark Herbert, California director for the \u003ca href=\"http://www.smallbusinessmajority.org/states/california\" target=\"_blank\" rel=\"noopener noreferrer\">Small Business Majority\u003c/a>. \"So it would be massively destabilizing to the ability of small employers to attract talent.\"\u003c/p>\n\u003cp>Beyond that, there would be damaging ripple effects, Herbert added: \"There's no way that you can remove those sorts of dollars out of our local communities and not see some sort of economic impact on small businesses.\"\u003c/p>\n\u003cp>Under the Graham-Cassidy bill’s redistribution formula, several states that shunned the Affordable Care Act would get more money, according to a \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\">study\u003c/a> by health consulting firm Avalare.\u003c/p>\n\u003cp>Texas will get a windfall of $35 billion in health funding over the next ten years, more than any other state. State officials would get to decide how they want to spend that money. But advocates and analysts say more money for Texas doesn't necessarily guarantee an improved health care system.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“Regardless of the size of the block grant, there's just no assurance that it would translate into good coverage, or coverage that's as affordable as what we have today,” said Stacey Pogue with the \u003ca href=\"http://bettertexasblog.org/2017/09/harmful-medicaid-cutaca-repeal-bill-resurfaces-senate/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Public Policy Priorities \u003c/a>in Austin.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">Texas already has the highest number of uninsured folks, and Pogue says the state just doesn't have the infrastructure in place to expand coverage to more people. It didn't expand Medicaid in 2014, which was optional under the ACA, and the state didn't set up its own exchange, like California did with \"Covered California.\" Texans who wanted subsidized insurance plans had to use the federal exchange, healthcare.gov, which meant Texas had less flexibility when it came to regulating insurers.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“There's no planning and no thought put into, 'How would we create affordable coverage for low-income Texans?\" Pogue said, \"Unlike the 31 states that have expanded Medicaid, have done some central planning. And Texas would be starting from scratch.”\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">It would also take a lot of political will to make sure the state is actually expanding health care, Pogue added, and that motivation has been lacking among state lawmakers for years. In order to get the block grant, states would need to create a workable health infrastructure by 2020. For comparison, it took Massachusetts four years to set up its pre-Obamacare statewide insurance market.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We are very concerned,” said Stacy Wilson, president of the Children's Hospital Association of Texas.\u003c/p>\n\u003cp>Wilson said this pot of money from Cassidy-Graham wouldn't solve chronic problems with Medicaid, 70 percent of which covers children. Wilson explained that's because the federal government would pay a fixed amount per person, under a per capita cap. That formula locks in how much the state gets per Medicaid enrollee, no matter how much treatment those enrollees need.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We have very low per-capita costs already, and we get locked into that forever,” Wilson said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">A conservative policy group in Texas, \u003ca href=\"https://www.texaspolicy.com/press_release/detail/tppf-statement-on-graham-cassidy-health-care-bill\" target=\"_blank\" rel=\"noopener noreferrer\">The Texas Public Policy Foundation\u003c/a>, is also not happy about the bill, but their concern is that it doesn't go far enough to repeal Obamacare.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>With ongoing uncertainty around the Affordable Care Act (ACA), the board that oversees California's health care marketplace took action to stabilize the exchange on Thursday. Their goal was to convince insurance companies to continue offering health plans through \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee praised California's overall success as a health care marketplace, but cautioned that the exchange faces significant challenges.\u003c/p>\n\u003cp>\"We think this open enrollment’s going to be the most challenging since year one,\" Lee said. \"We’re dealing with the most federal uncertainty we’ve ever had.\"\u003c/p>\n\u003cp>Lee is referring to Congress's attempts to repeal the ACA, and the Trump administration's threats not to pay subsidies to insurance companies, as required under the health care law.\u003c/p>\n\u003cp>In the meeting, the board unanimously adopted two new resolutions they believe will maintain market stability. \u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/2017-2019%20QHP%20Issuer%20Contract%20Amendment%20Resolution%20(2017-36).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The first\u003c/a> updates contracts between Covered California and insurance companies, allowing insurers who lose money in 2018 to increase profit margins in the following three years in order to recoup losses. Alternatively, if companies make unforeseen profits because of national uncertainty, those profits would go to reducing premiums in the future.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In an email, a spokesperson for Blue Shield of California, one of the exchange's providers, said the company \"supports Covered California’s program to address the pricing uncertainty and will participate to add stability in the market.\"\u003c/p>\n\u003cp>\u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/Fiscal%20Year%202017-18%20Budget%20Revision%20(Resolution%202017-37).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The second resolution\u003c/a> increases Covered California's marketing and outreach budget by over $5 million. Marketing helps convince consumers, especially healthy ones, to sign up for plans. A mix of healthy and sick participants allows health care marketplaces to maintain lower premiums.\u003c/p>\n\u003cp>Finally, the board announced it would delay a decision about whether to further increase 2018 premiums until Sept. 30.\u003c/p>\n\u003cp>[contextly_sidebar id=\"QtimBtKZJz3HyH4ttMNqWM3dVsZyKIDx\"]\u003c/p>\n\u003cp>Those increases could be necessary to make up for the insurance companies' financial losses, if the federal government withholds subsidies designed to decrease costs for low-income consumers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The board hopes that by the end of September it will better understand what will happen to the Affordable Care Act and how that will impact California.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>With ongoing uncertainty around the Affordable Care Act (ACA), the board that oversees California's health care marketplace took action to stabilize the exchange on Thursday. Their goal was to convince insurance companies to continue offering health plans through \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee praised California's overall success as a health care marketplace, but cautioned that the exchange faces significant challenges.\u003c/p>\n\u003cp>\"We think this open enrollment’s going to be the most challenging since year one,\" Lee said. \"We’re dealing with the most federal uncertainty we’ve ever had.\"\u003c/p>\n\u003cp>Lee is referring to Congress's attempts to repeal the ACA, and the Trump administration's threats not to pay subsidies to insurance companies, as required under the health care law.\u003c/p>\n\u003cp>In the meeting, the board unanimously adopted two new resolutions they believe will maintain market stability. \u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/2017-2019%20QHP%20Issuer%20Contract%20Amendment%20Resolution%20(2017-36).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The first\u003c/a> updates contracts between Covered California and insurance companies, allowing insurers who lose money in 2018 to increase profit margins in the following three years in order to recoup losses. Alternatively, if companies make unforeseen profits because of national uncertainty, those profits would go to reducing premiums in the future.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In an email, a spokesperson for Blue Shield of California, one of the exchange's providers, said the company \"supports Covered California’s program to address the pricing uncertainty and will participate to add stability in the market.\"\u003c/p>\n\u003cp>\u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/Fiscal%20Year%202017-18%20Budget%20Revision%20(Resolution%202017-37).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The second resolution\u003c/a> increases Covered California's marketing and outreach budget by over $5 million. Marketing helps convince consumers, especially healthy ones, to sign up for plans. A mix of healthy and sick participants allows health care marketplaces to maintain lower premiums.\u003c/p>\n\u003cp>Finally, the board announced it would delay a decision about whether to further increase 2018 premiums until Sept. 30.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Those increases could be necessary to make up for the insurance companies' financial losses, if the federal government withholds subsidies designed to decrease costs for low-income consumers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The board hopes that by the end of September it will better understand what will happen to the Affordable Care Act and how that will impact California.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Fate Of San Francisco’s Ban On Flavored Tobacco Products Is Now Up To Voters",
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"content": "\u003cp>A coalition of local business owners financed by the tobacco industry has blocked San Francisco’s new ban on menthol cigarettes and flavored tobacco products until voters decide whether to uphold or overturn it.\u003c/p>\n\u003cp>The ban, adopted unanimously by the Board of Supervisors in June, would have kicked in next year. But the city’s \u003ca href=\"http://sfgov.org/elections/measures\" target=\"_blank\" rel=\"noopener noreferrer\">Office of Elections\u003c/a> determined earlier this month that the opposition group \u003ca href=\"http://www.letsberealsf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Let’s Be Real, San Francisco\u003c/a> has gathered enough signatures for a ballot referendum, putting the ban on hold until voters decide next year.\u003c/p>\n\u003cp>“This is a freedom-of-choice issue for responsible adults,” said Jaime Rojas, a spokesman for the coalition.\u003c/p>\n\u003cp>“We believe that local government officials have overreached and the referendum will allow the voters of San Francisco to make the final decision,” he said.\u003c/p>\n\u003cp>The San Francisco Board of Supervisors will vote next month whether to overturn the ordinance themselves — which is unlikely — or put it before voters, probably in June.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The \u003ca href=\"https://sfgov.legistar.com/View.ashx?M=F&ID=5274235&GUID=86C18253-BA63-4C0F-A6A0-E881211D2CB7\" target=\"_blank\" rel=\"noopener noreferrer\">tobacco ordinance \u003c/a>would prohibit the sale of menthol cigarettes and other flavored tobacco, including hookah tobacco and small cigars, as well as most vaping products and e-cigarettes.\u003c/p>\n\u003cp>“San Francisco made history when it passed this ordinance, the strongest restrictions on flavored tobacco products in the nation,” said Stanton Glantz, professor of medicine and director of the \u003ca href=\"http://www.tobacco.ucsf.edu/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Tobacco Control Research and Education\u003c/a> at the University of California-San Francisco (UCSF).\u003c/p>\n\u003cp>According \u003ca href=\"http://sfcontroller.org/sites/default/files/Documents/Economic%20Analysis/170441_economic_impact_final.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">to a report\u003c/a> from the City Controller’s Office of Economic Analysis, 35 percent of the cigarettes sold in San Francisco are menthol and would be subject to the ban.\u003c/p>\n\u003cp>Rojas said he believes retailers would lose about $50 million in local tobacco sales annually under the ordinance.\u003c/p>\n\u003cp>Vivian New, co-owner of SF Smoke N’ Vape Shop on Fisherman’s Wharf, estimated that the ban would drive down her profits by 30 to 40 percent.\u003c/p>\n\u003cp>New, 22, said she has “never laid my lips on a cigarette.” Nonetheless, she opposes restrictions on the kinds of tobacco products her customers can buy because “it’s part of [their] rights.”\u003c/p>\n\u003cp>Let’s Be Real, San Francisco describes itself as a coalition of “concerned citizens supporting freedom of choice, adult consumers, community leaders and neighborhood small businesses.”\u003c/p>\n\u003cp>But campaign filing statements for the last half of July \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/08/document6.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">show only one donor\u003c/a>: R.J. Reynolds Tobacco Co. of Winston-Salem, N.C., which gave more than $685,000 to the effort.\u003c/p>\n\u003cp>David Howard, a spokesman for R.J. Reynolds, said the company is proud to be a part of the coalition and sees the referendum campaign “as an opportunity to educate the citizens of San Francisco on the negative impacts that this [ordinance] can have.”\u003c/p>\n\u003cp>The industry giant manufactures Newport, the nation’s leading menthol brand, which would be banned under the ordinance.\u003c/p>\n\u003cp>“It’s just a complete hoax,” Glantz said. “This organization that’s putting itself out as a bunch of free-thinking concerned local citizens is actually just a front for the tobacco companies.”\u003c/p>\n\u003cp>Supervisor Malia Cohen, who sponsored the tobacco measure, called the opposition referendum “a ridiculous attempt to put profit over people’s health.” She said R.J. Reynolds is attacking the legislation “because they know it is strong and that people will stop smoking.”\u003c/p>\n\u003cp>Flavored tobacco and menthol cigarettes, including Newport, the No. 2 cigarette brand in the nation, are popular with young people and minorities, \u003ca href=\"http://californiahealthline.org/news/sf-seeks-to-ban-sale-of-menthol-cigarettes-and-flavored-tobacco-products/\" target=\"_blank\" rel=\"noopener noreferrer\">especially African-Americans\u003c/a>.\u003c/p>\n\u003cp>“Menthol is an especially pernicious additive,” Glantz said, since it interacts with nicotine to make cigarettes easier to smoke and all tobacco products more addictive.\u003c/p>\n\u003cp>Miriam Zouzounis, a board member with the Arab American Grocers Association and member of the coalition, insisted that the campaign against the tobacco ordinance started as a grass-roots effort by working-class shop owners and their customers. She said the tobacco industry stepped in only after the ban was approved unanimously by the Board of Supervisors.\u003c/p>\n\u003cp>Zouzounis believes the ordinance is a burden for small merchants like her family of immigrants who own Ted’s Market, a corner grocery and sandwich shop south of Market Street.\u003c/p>\n\u003cp>“Basically it is a redundant policy. There’s laws already on the books to keep tobacco out of the hands of kids,” she said.\u003c/p>\n\u003cp>She pointed to a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162SB7\">law\u003c/a> signed last year by Gov. Jerry Brown that raised the legal smoking age in California from 18 to 21. Under the new rules, anyone caught giving or selling tobacco products to people under 21 could face misdemeanor charges.\u003c/p>\n\u003cp>“It’s kind of nonsense,” said Jiries Totah, an auto mechanic who buys Grizzly wintergreen-flavored chewing tobacco from Ted’s Market. “I’m 27. I pay my taxes and I do what I’m supposed to do as a citizen. How can someone tell me I can’t purchase a legal product?”\u003c/p>\n\u003cp>Zouzounis and other business owners say city officials failed to consult with them or consider amendments that addressed their concerns. The ordinance also gives out-of-state businesses that sell online an advantage over brick-and-mortar shops in the city, she said.\u003c/p>\n\u003cp>“You can buy these products they’re trying to ban online and get them delivered straight to your address in SF, and we know that an online check of an ID is not fail-proof,” she said.\u003c/p>\n\u003cp>But advocates of the ban say these arguments are diversions from the real point, which is to reduce tobacco consumption and improve health.\u003c/p>\n\u003cp>They vow to fight to keep the ordinance in place.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We’ve seen this group pop up out of nowhere,” said Valerie Yerger, an associate professor of health policy at UCSF. “Obviously it’s a concerted effort that’s getting a lot of support from R.J. Reynolds to confuse the issues.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A coalition of local business owners financed by the tobacco industry has blocked San Francisco’s new ban on menthol cigarettes and flavored tobacco products until voters decide whether to uphold or overturn it.\u003c/p>\n\u003cp>The ban, adopted unanimously by the Board of Supervisors in June, would have kicked in next year. But the city’s \u003ca href=\"http://sfgov.org/elections/measures\" target=\"_blank\" rel=\"noopener noreferrer\">Office of Elections\u003c/a> determined earlier this month that the opposition group \u003ca href=\"http://www.letsberealsf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Let’s Be Real, San Francisco\u003c/a> has gathered enough signatures for a ballot referendum, putting the ban on hold until voters decide next year.\u003c/p>\n\u003cp>“This is a freedom-of-choice issue for responsible adults,” said Jaime Rojas, a spokesman for the coalition.\u003c/p>\n\u003cp>“We believe that local government officials have overreached and the referendum will allow the voters of San Francisco to make the final decision,” he said.\u003c/p>\n\u003cp>The San Francisco Board of Supervisors will vote next month whether to overturn the ordinance themselves — which is unlikely — or put it before voters, probably in June.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The \u003ca href=\"https://sfgov.legistar.com/View.ashx?M=F&ID=5274235&GUID=86C18253-BA63-4C0F-A6A0-E881211D2CB7\" target=\"_blank\" rel=\"noopener noreferrer\">tobacco ordinance \u003c/a>would prohibit the sale of menthol cigarettes and other flavored tobacco, including hookah tobacco and small cigars, as well as most vaping products and e-cigarettes.\u003c/p>\n\u003cp>“San Francisco made history when it passed this ordinance, the strongest restrictions on flavored tobacco products in the nation,” said Stanton Glantz, professor of medicine and director of the \u003ca href=\"http://www.tobacco.ucsf.edu/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Tobacco Control Research and Education\u003c/a> at the University of California-San Francisco (UCSF).\u003c/p>\n\u003cp>According \u003ca href=\"http://sfcontroller.org/sites/default/files/Documents/Economic%20Analysis/170441_economic_impact_final.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">to a report\u003c/a> from the City Controller’s Office of Economic Analysis, 35 percent of the cigarettes sold in San Francisco are menthol and would be subject to the ban.\u003c/p>\n\u003cp>Rojas said he believes retailers would lose about $50 million in local tobacco sales annually under the ordinance.\u003c/p>\n\u003cp>Vivian New, co-owner of SF Smoke N’ Vape Shop on Fisherman’s Wharf, estimated that the ban would drive down her profits by 30 to 40 percent.\u003c/p>\n\u003cp>New, 22, said she has “never laid my lips on a cigarette.” Nonetheless, she opposes restrictions on the kinds of tobacco products her customers can buy because “it’s part of [their] rights.”\u003c/p>\n\u003cp>Let’s Be Real, San Francisco describes itself as a coalition of “concerned citizens supporting freedom of choice, adult consumers, community leaders and neighborhood small businesses.”\u003c/p>\n\u003cp>But campaign filing statements for the last half of July \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/08/document6.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">show only one donor\u003c/a>: R.J. Reynolds Tobacco Co. of Winston-Salem, N.C., which gave more than $685,000 to the effort.\u003c/p>\n\u003cp>David Howard, a spokesman for R.J. Reynolds, said the company is proud to be a part of the coalition and sees the referendum campaign “as an opportunity to educate the citizens of San Francisco on the negative impacts that this [ordinance] can have.”\u003c/p>\n\u003cp>The industry giant manufactures Newport, the nation’s leading menthol brand, which would be banned under the ordinance.\u003c/p>\n\u003cp>“It’s just a complete hoax,” Glantz said. “This organization that’s putting itself out as a bunch of free-thinking concerned local citizens is actually just a front for the tobacco companies.”\u003c/p>\n\u003cp>Supervisor Malia Cohen, who sponsored the tobacco measure, called the opposition referendum “a ridiculous attempt to put profit over people’s health.” She said R.J. Reynolds is attacking the legislation “because they know it is strong and that people will stop smoking.”\u003c/p>\n\u003cp>Flavored tobacco and menthol cigarettes, including Newport, the No. 2 cigarette brand in the nation, are popular with young people and minorities, \u003ca href=\"http://californiahealthline.org/news/sf-seeks-to-ban-sale-of-menthol-cigarettes-and-flavored-tobacco-products/\" target=\"_blank\" rel=\"noopener noreferrer\">especially African-Americans\u003c/a>.\u003c/p>\n\u003cp>“Menthol is an especially pernicious additive,” Glantz said, since it interacts with nicotine to make cigarettes easier to smoke and all tobacco products more addictive.\u003c/p>\n\u003cp>Miriam Zouzounis, a board member with the Arab American Grocers Association and member of the coalition, insisted that the campaign against the tobacco ordinance started as a grass-roots effort by working-class shop owners and their customers. She said the tobacco industry stepped in only after the ban was approved unanimously by the Board of Supervisors.\u003c/p>\n\u003cp>Zouzounis believes the ordinance is a burden for small merchants like her family of immigrants who own Ted’s Market, a corner grocery and sandwich shop south of Market Street.\u003c/p>\n\u003cp>“Basically it is a redundant policy. There’s laws already on the books to keep tobacco out of the hands of kids,” she said.\u003c/p>\n\u003cp>She pointed to a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162SB7\">law\u003c/a> signed last year by Gov. Jerry Brown that raised the legal smoking age in California from 18 to 21. Under the new rules, anyone caught giving or selling tobacco products to people under 21 could face misdemeanor charges.\u003c/p>\n\u003cp>“It’s kind of nonsense,” said Jiries Totah, an auto mechanic who buys Grizzly wintergreen-flavored chewing tobacco from Ted’s Market. “I’m 27. I pay my taxes and I do what I’m supposed to do as a citizen. How can someone tell me I can’t purchase a legal product?”\u003c/p>\n\u003cp>Zouzounis and other business owners say city officials failed to consult with them or consider amendments that addressed their concerns. The ordinance also gives out-of-state businesses that sell online an advantage over brick-and-mortar shops in the city, she said.\u003c/p>\n\u003cp>“You can buy these products they’re trying to ban online and get them delivered straight to your address in SF, and we know that an online check of an ID is not fail-proof,” she said.\u003c/p>\n\u003cp>But advocates of the ban say these arguments are diversions from the real point, which is to reduce tobacco consumption and improve health.\u003c/p>\n\u003cp>They vow to fight to keep the ordinance in place.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We’ve seen this group pop up out of nowhere,” said Valerie Yerger, an associate professor of health policy at UCSF. “Obviously it’s a concerted effort that’s getting a lot of support from R.J. Reynolds to confuse the issues.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine",
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"content": "\u003cp>It was 1 am at San Francisco General Hospital. Saturday. The ambulances were rolling in one after another. Resident doctor Josie Valenzuela was near the end of her shift, trying to stay awake.\u003c/p>\n\u003cp>“I was really tired. And my back hurt a lot,” she remembers. “My mind was wandering all over the place.”\u003c/p>\n\u003cp>She was caring for a heroin addict, cutting an abscess open on her leg to drain infection. Then her pager went off. Another ambulance was coming in and this would have to wait for later.\u003c/p>\n\u003cp>“So I went to put the scalpel in some sterile towels for when I could come back,” Valenzuela says, “and I cut my left index finger.”\u003c/p>\n\u003cp>The patient had HIV and hepatitis C.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I knew this was a bad exposure, and that all of the blood and pus that was on that scalpel was now touching my bloodstream,” she says.\u003c/p>\n\u003cp>[audio src=\"http:www.kqed.org/.stream/anon/radio//2017/08/28hourworkdayDembosky.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-ultrasound-768x432.jpg\" Title=\"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine\" program=\"The California Report\"]\u003c/p>\n\u003cp>Valenzuela would have to take anti-viral medications that would make her nauseated for weeks. And she’d have to explain to her husband that she may have contracted a life-long disease.\u003c/p>\n\u003cp>“We were going to start trying to have kids soon,” she says, choking up, “and so that would make it complicated for us.”\u003c/p>\n\u003cp>That’s what she was thinking about when she finally left the hospital at 4 in the morning.\u003c/p>\n\u003cp>“I found my car and I was backing out,” she says. “And I mixed up the gas and the brake. I've never done that before, but I backed right into a concrete pole.”\u003c/p>\n\u003cp>Mistakes like these led medical experts at the Institute of Medicine to issue a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23616719\" target=\"_blank\" rel=\"noopener noreferrer\">recommendation \u003c/a>in 2009 that residents' work shifts be capped at 16 hours. Until then, they were allowed to work up to 28 hours. After a year-long review of the scientific literature, the Institute concluded that human performance begins to decline after 16 hours, and the risk of medical errors and car accidents goes up.\u003c/p>\n\u003cp>So, in 2011, the \u003ca href=\"http://www.acgme.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Accreditation Council for Graduate Medical Education\u003c/a> made a rule, saying first-year doctors could only work a maximum of 16 hours per shift.\u003c/p>\n\u003cp>But this year, the council reversed itself, and starting this summer, new doctors can again work up to 28 hours in a row.\u003c/p>\n\u003cp>“I think the majority of patients in the United States expect that their physician will be available to them whether it's daytime, nighttime, Saturday or Sunday,” says Dr. Rowen Zetterman, co-chair of the task force that reviewed and changed the rule.\u003c/p>\n\u003cfigure id=\"attachment_360682\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360682\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-microscope-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Josie Valenzuela looks through a slit lamp at work. The microscope is for examining the eye. \u003ccite>(Georgie Baumann/University of Arizona)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Patient and resident groups wanted to keep the 16-hour rule, Zetterman says. But senior doctors argued that long hours come with the profession. They complained that the shift limits cut into the time they had for teaching in the hospital, compromising the educational integrity of the residency.\u003c/p>\n\u003cp>“You ask residents a question and they'll say, ‘’I'm just covering, I don't know those things.’ That drives the more senior physicians batty,” says Adams Dudley, a pulmonologist and professor at UCSF School of Medicine. “The perception is they don't know what they're doing as well because they spend less time at the hospital.”\u003c/p>\n\u003cp>Physicians grouse that residents don’t seem as invested in the work when shift limits are in effect, he says, because they’re more focused on handing off their patients to others, rather then seeing them through the cycle of illness.\u003c/p>\n\u003cp>“Because they leave, they don't see the evolution of things, and they don't know the patients as well,” Dudley says. “If you're told you must pay attention to leaving, you have to detach yourself from the patient.”\u003c/p>\n\u003cp>Surgical residents complained about this, too.\u003c/p>\n\u003cp>“They would be in the middle of an operation that they felt like they were learning from, and they would hit the end of their 16 hours and be told that they had to leave the operation and go home,” Zetterman says.\u003c/p>\n\u003cp>This hurt morale on the health care team, he says, as other doctors watched first-year residents clock out when they had to stay, and raised patient-safety concerns.\u003c/p>\n\u003cp>“Let's say your copilot kept coming and going throughout the flight and, then was gone. Didn't come back for the remainder that flight,” Zetterman says. “It seems to me that would be disruptive.”\u003c/p>\n\u003cp>It’s unclear what’s riskier for patients: more frequent hand-offs between doctors, or doctors that are just exhausted. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26054323\" target=\"_blank\" rel=\"noopener noreferrer\">Most studies \u003c/a>show little or no change in patient outcomes after shift limits were put in place, suggesting mistakes and miscommunications that resulted from transitions in care offset any gains made from reducing doctor fatigue.\u003c/p>\n\u003cp>If that's the case, Dr. Josie Valenzuela believes there should be more focus on residents’ well-being, in addition to patients. And while the shift limit was extended to 28 hours in the regulatory, other rules require residency programs to provide more support for residents who feel burned out, stressed, or depressed, including \u003ca href=\"https://ww2.kqed.org/news/2017/07/05/physicians-are-human-beings-new-rules-aim-to-battle-burnout-in-medical-residencies/\" target=\"_blank\" rel=\"noopener noreferrer\">24/7 access\u003c/a> to a mental health professional.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Valenzuela is in her last year of residency now. She says she was lucky after that accidental cut. After nearly a year of periodic checks, she's been officially declared negative for HIV and hepatitis C. Next year, she and her husband plan to have a baby.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was 1 am at San Francisco General Hospital. Saturday. The ambulances were rolling in one after another. Resident doctor Josie Valenzuela was near the end of her shift, trying to stay awake.\u003c/p>\n\u003cp>“I was really tired. And my back hurt a lot,” she remembers. “My mind was wandering all over the place.”\u003c/p>\n\u003cp>She was caring for a heroin addict, cutting an abscess open on her leg to drain infection. Then her pager went off. Another ambulance was coming in and this would have to wait for later.\u003c/p>\n\u003cp>“So I went to put the scalpel in some sterile towels for when I could come back,” Valenzuela says, “and I cut my left index finger.”\u003c/p>\n\u003cp>The patient had HIV and hepatitis C.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Valenzuela would have to take anti-viral medications that would make her nauseated for weeks. And she’d have to explain to her husband that she may have contracted a life-long disease.\u003c/p>\n\u003cp>“We were going to start trying to have kids soon,” she says, choking up, “and so that would make it complicated for us.”\u003c/p>\n\u003cp>That’s what she was thinking about when she finally left the hospital at 4 in the morning.\u003c/p>\n\u003cp>“I found my car and I was backing out,” she says. “And I mixed up the gas and the brake. I've never done that before, but I backed right into a concrete pole.”\u003c/p>\n\u003cp>Mistakes like these led medical experts at the Institute of Medicine to issue a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23616719\" target=\"_blank\" rel=\"noopener noreferrer\">recommendation \u003c/a>in 2009 that residents' work shifts be capped at 16 hours. Until then, they were allowed to work up to 28 hours. After a year-long review of the scientific literature, the Institute concluded that human performance begins to decline after 16 hours, and the risk of medical errors and car accidents goes up.\u003c/p>\n\u003cp>So, in 2011, the \u003ca href=\"http://www.acgme.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Accreditation Council for Graduate Medical Education\u003c/a> made a rule, saying first-year doctors could only work a maximum of 16 hours per shift.\u003c/p>\n\u003cp>But this year, the council reversed itself, and starting this summer, new doctors can again work up to 28 hours in a row.\u003c/p>\n\u003cp>“I think the majority of patients in the United States expect that their physician will be available to them whether it's daytime, nighttime, Saturday or Sunday,” says Dr. Rowen Zetterman, co-chair of the task force that reviewed and changed the rule.\u003c/p>\n\u003cfigure id=\"attachment_360682\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360682\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-microscope-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Josie Valenzuela looks through a slit lamp at work. The microscope is for examining the eye. \u003ccite>(Georgie Baumann/University of Arizona)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Patient and resident groups wanted to keep the 16-hour rule, Zetterman says. But senior doctors argued that long hours come with the profession. They complained that the shift limits cut into the time they had for teaching in the hospital, compromising the educational integrity of the residency.\u003c/p>\n\u003cp>“You ask residents a question and they'll say, ‘’I'm just covering, I don't know those things.’ That drives the more senior physicians batty,” says Adams Dudley, a pulmonologist and professor at UCSF School of Medicine. “The perception is they don't know what they're doing as well because they spend less time at the hospital.”\u003c/p>\n\u003cp>Physicians grouse that residents don’t seem as invested in the work when shift limits are in effect, he says, because they’re more focused on handing off their patients to others, rather then seeing them through the cycle of illness.\u003c/p>\n\u003cp>“Because they leave, they don't see the evolution of things, and they don't know the patients as well,” Dudley says. “If you're told you must pay attention to leaving, you have to detach yourself from the patient.”\u003c/p>\n\u003cp>Surgical residents complained about this, too.\u003c/p>\n\u003cp>“They would be in the middle of an operation that they felt like they were learning from, and they would hit the end of their 16 hours and be told that they had to leave the operation and go home,” Zetterman says.\u003c/p>\n\u003cp>This hurt morale on the health care team, he says, as other doctors watched first-year residents clock out when they had to stay, and raised patient-safety concerns.\u003c/p>\n\u003cp>“Let's say your copilot kept coming and going throughout the flight and, then was gone. Didn't come back for the remainder that flight,” Zetterman says. “It seems to me that would be disruptive.”\u003c/p>\n\u003cp>It’s unclear what’s riskier for patients: more frequent hand-offs between doctors, or doctors that are just exhausted. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26054323\" target=\"_blank\" rel=\"noopener noreferrer\">Most studies \u003c/a>show little or no change in patient outcomes after shift limits were put in place, suggesting mistakes and miscommunications that resulted from transitions in care offset any gains made from reducing doctor fatigue.\u003c/p>\n\u003cp>If that's the case, Dr. Josie Valenzuela believes there should be more focus on residents’ well-being, in addition to patients. And while the shift limit was extended to 28 hours in the regulatory, other rules require residency programs to provide more support for residents who feel burned out, stressed, or depressed, including \u003ca href=\"https://ww2.kqed.org/news/2017/07/05/physicians-are-human-beings-new-rules-aim-to-battle-burnout-in-medical-residencies/\" target=\"_blank\" rel=\"noopener noreferrer\">24/7 access\u003c/a> to a mental health professional.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Valenzuela is in her last year of residency now. She says she was lucky after that accidental cut. After nearly a year of periodic checks, she's been officially declared negative for HIV and hepatitis C. Next year, she and her husband plan to have a baby.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California",
"title": "Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California",
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"content": "\u003cp>More than half of the Californians who have an individual health insurance policy from Anthem Blue Cross will have to shop for a new plan next year.\u003c/p>\n\u003cp>The company is pulling out of the individual market in all but three regions of the state, abandoning 153,000 of its customers. Of those, 30,000 will be left with just one plan on offer through Covered California.\u003c/p>\n\u003cp>But the former Anthem customers who do have a choice of plans will be able to find reasonable alternatives.\u003c/p>\n\u003cp>“In a number of areas where consumers in Anthem will now be forced to shop, they will find much more cost-competitive options,” said Peter Lee, executive director of Covered California.\u003c/p>\n\u003cp>Statewide, premium rates will go up an average 12.5 percent in 2018 in the state’s Affordable Care Act marketplace. But in San Francisco, the average premium increase will be just 6.6 percent. In Fresno, Kings, and Madera counties, the average increase will be 4.7 percent.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Anthem customers can keep their plan if they live in the far rural northern part of the state, parts of the Central Valley, and Santa Clara County. But in areas where Anthem is one of only two plans offered for sale – like Modoc, Lassen, and Siskiyou counties in the far north – customers will pay as much as 54 percent more for their Anthem plan. The alternative, Blue Shield, will charge up to 24 percent more next year.\u003c/p>\n\u003cp>In a statement, Anthem said its price increases and partial departure from the market are due largely to federal changes and uncertainty around the future of the Affordable Care Act.\u003c/p>\n\u003cp>“Planning and pricing for ACA-compliant health plans has become increasingly difficult,” it said, because of “continual changes in federal operations, rules and guidance.”\u003c/p>\n\u003cp>The overall lack of predictability “simply does not provide a sustainable path forward to providing affordable plan choices for all California consumers,” the company said.\u003c/p>\n\u003cp>Uncertainty also affected the prices the remaining marketplace insurers plan to charge next year. Of the overall 12.5 percent average increase, 3 percent is due to uncertainty alone, Lee said.\u003c/p>\n\u003cp>Lee warned that some plans will see an additional 12 percent surcharge, on top of the 12.5 percent average increase, if President Trump makes good on his threat to stop so-called \"Cost-Sharing Reduction\" payments to insurers. These CSR payments help insurers provide discounts on co-pays and deductibles for low-income consumers, as they are required to do by the Affordable Care Act.\u003c/p>\n\u003cp>But even if the Trump administration withdraws the money, and insurers add the surcharge to premiums, Lee says most Californians won’t feel it, because the federal subsidy will also go up in kind, covering most of the premium increase.\u003c/p>\n\u003cp>“We do not want to implement this workaround,” Lee said. “It will cause unnecessary confusion, and ultimately cost the federal government billions of dollars more than they would have spent by [just] making the CSR payments directly to health plans.”\u003c/p>\n\u003cp>Covered California submitted \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_CL_2018_Rates-HHSLetter.pdf\">a letter\u003c/a> to federal health officials, saying there's an urgent need to get clarity on the future of the cost-sharing reduction payments. California will have to decide by the end of August whether to add the surcharge to monthly premiums or not. After that, it cannot make changes to \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\">2018 rates\u003c/a>.\u003c/p>\n\u003cp>\"I'm expecting to be dealing with a lot of angry and frustrated consumers as we head into 2018 open enrollment,\" said Jonathan Greer, a health insurance broker with Rockridge Health Benefits in Oakland. \"Unfortunately, many consumers will experience sticker shock this year, especially if the Trump Administration stops making the cost-sharing payments.\"\u003c/p>\n\u003cp>Insurers are also worried that the federal government will make changes to the Affordable Care Act in the middle of next year, after rates are locked in. In addition to the CSR payments, they are concerned the IRS will stop enforcing the individual mandate, the ACA's requirement that almost all Americans buy insurance. The mandate helps balance insurance \"risk pools\" by ensuring young, healthy people also buy policies, to help cover the costs of care for the sick.\u003c/p>\n\u003cp>Covered California had to fend off requests for premium increases well beyond the 12.5 percent average because of these fears.\u003c/p>\n\u003cp>“One of the things that many of the health plans said to us is ‘What if policies change mid-year? Our actuaries are saying, ‘Be really conservative and bump rates a boatload,’” Peter Lee said, recalling the tensions underlying the negotiations. “We said, ‘Take a deep breath. Before you bump up rates a boatload, instead, what can we do to help you plan over the long term?’”\u003c/p>\n\u003cp>The agency convinced insurers to keep the increases in check by drafting a plan that would allow them to make up for any 2018 losses in subsequent years. This backup plan, which still has to be approved by state regulators, wouldn’t cost the state money, Lee said. But it would allow insurers to shift costs internally so they could replenish the coffers in later years.\u003c/p>\n\u003cp>But Lee predicts the state probably won’t have to implement the backup plan. By keeping increases relatively low this year, more people will sign up for health plans, which will give insurers the stability they need to keep prices low in 2019 and beyond.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "Uncertainty around the Affordable Care Act is pushing rates higher in California and has Anthem scaling back coverage.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than half of the Californians who have an individual health insurance policy from Anthem Blue Cross will have to shop for a new plan next year.\u003c/p>\n\u003cp>The company is pulling out of the individual market in all but three regions of the state, abandoning 153,000 of its customers. Of those, 30,000 will be left with just one plan on offer through Covered California.\u003c/p>\n\u003cp>But the former Anthem customers who do have a choice of plans will be able to find reasonable alternatives.\u003c/p>\n\u003cp>“In a number of areas where consumers in Anthem will now be forced to shop, they will find much more cost-competitive options,” said Peter Lee, executive director of Covered California.\u003c/p>\n\u003cp>Statewide, premium rates will go up an average 12.5 percent in 2018 in the state’s Affordable Care Act marketplace. But in San Francisco, the average premium increase will be just 6.6 percent. In Fresno, Kings, and Madera counties, the average increase will be 4.7 percent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Anthem customers can keep their plan if they live in the far rural northern part of the state, parts of the Central Valley, and Santa Clara County. But in areas where Anthem is one of only two plans offered for sale – like Modoc, Lassen, and Siskiyou counties in the far north – customers will pay as much as 54 percent more for their Anthem plan. The alternative, Blue Shield, will charge up to 24 percent more next year.\u003c/p>\n\u003cp>In a statement, Anthem said its price increases and partial departure from the market are due largely to federal changes and uncertainty around the future of the Affordable Care Act.\u003c/p>\n\u003cp>“Planning and pricing for ACA-compliant health plans has become increasingly difficult,” it said, because of “continual changes in federal operations, rules and guidance.”\u003c/p>\n\u003cp>The overall lack of predictability “simply does not provide a sustainable path forward to providing affordable plan choices for all California consumers,” the company said.\u003c/p>\n\u003cp>Uncertainty also affected the prices the remaining marketplace insurers plan to charge next year. Of the overall 12.5 percent average increase, 3 percent is due to uncertainty alone, Lee said.\u003c/p>\n\u003cp>Lee warned that some plans will see an additional 12 percent surcharge, on top of the 12.5 percent average increase, if President Trump makes good on his threat to stop so-called \"Cost-Sharing Reduction\" payments to insurers. These CSR payments help insurers provide discounts on co-pays and deductibles for low-income consumers, as they are required to do by the Affordable Care Act.\u003c/p>\n\u003cp>But even if the Trump administration withdraws the money, and insurers add the surcharge to premiums, Lee says most Californians won’t feel it, because the federal subsidy will also go up in kind, covering most of the premium increase.\u003c/p>\n\u003cp>“We do not want to implement this workaround,” Lee said. “It will cause unnecessary confusion, and ultimately cost the federal government billions of dollars more than they would have spent by [just] making the CSR payments directly to health plans.”\u003c/p>\n\u003cp>Covered California submitted \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_CL_2018_Rates-HHSLetter.pdf\">a letter\u003c/a> to federal health officials, saying there's an urgent need to get clarity on the future of the cost-sharing reduction payments. California will have to decide by the end of August whether to add the surcharge to monthly premiums or not. After that, it cannot make changes to \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\">2018 rates\u003c/a>.\u003c/p>\n\u003cp>\"I'm expecting to be dealing with a lot of angry and frustrated consumers as we head into 2018 open enrollment,\" said Jonathan Greer, a health insurance broker with Rockridge Health Benefits in Oakland. \"Unfortunately, many consumers will experience sticker shock this year, especially if the Trump Administration stops making the cost-sharing payments.\"\u003c/p>\n\u003cp>Insurers are also worried that the federal government will make changes to the Affordable Care Act in the middle of next year, after rates are locked in. In addition to the CSR payments, they are concerned the IRS will stop enforcing the individual mandate, the ACA's requirement that almost all Americans buy insurance. The mandate helps balance insurance \"risk pools\" by ensuring young, healthy people also buy policies, to help cover the costs of care for the sick.\u003c/p>\n\u003cp>Covered California had to fend off requests for premium increases well beyond the 12.5 percent average because of these fears.\u003c/p>\n\u003cp>“One of the things that many of the health plans said to us is ‘What if policies change mid-year? Our actuaries are saying, ‘Be really conservative and bump rates a boatload,’” Peter Lee said, recalling the tensions underlying the negotiations. “We said, ‘Take a deep breath. Before you bump up rates a boatload, instead, what can we do to help you plan over the long term?’”\u003c/p>\n\u003cp>The agency convinced insurers to keep the increases in check by drafting a plan that would allow them to make up for any 2018 losses in subsequent years. This backup plan, which still has to be approved by state regulators, wouldn’t cost the state money, Lee said. But it would allow insurers to shift costs internally so they could replenish the coffers in later years.\u003c/p>\n\u003cp>But Lee predicts the state probably won’t have to implement the backup plan. By keeping increases relatively low this year, more people will sign up for health plans, which will give insurers the stability they need to keep prices low in 2019 and beyond.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Covered California Announces 2018 Rate Hikes, and an Anthem Exit",
"title": "Covered California Announces 2018 Rate Hikes, and an Anthem Exit",
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"content": "\u003cp>Covered California said Tuesday that premiums on its health insurance plans would rise by an average of 12.5 percent statewide next year, amid continuing uncertainty over the future of the Affordable Care Act.\u003c/p>\n\u003cp>The state’s Obamacare exchange also said one of its largest insurers, Anthem Blue Cross, would pull out of the exchange and the overall individual market in 16 of the 19 regions it currently serves, forcing 153,000 consumers to find new health plans.\u003c/p>\n\u003cp>The rate increases apply to people who purchase their own coverage in the individual market, not the majority of Americans who get their health insurance through work or government programs such as Medicare and Medicaid.\u003c/p>\n\u003cp>The expected 2018 rate increase is down from 2017’s average rise of 13.2 percent, and it includes a one-time increase averaging 2.8 percentage points because of the end of a “holiday” that gave health plans a break from the tax they are required to pay under the Affordable Care Act.\u003c/p>\n\u003cp>Without that one-time hit, Covered California said, the average 2018 premium increase would be lower than 10 percent. And the exchange said consumers could face increases as low as 3.3 percent if they shop for the best-priced plan at the same level of coverage they already have.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The expected California premium increases are dwarfed by some of the rates proposed in other states. In Iowa, for example, the sole carrier remaining on the exchange — Medica — has proposed a \u003ca href=\"http://www.desmoinesregister.com/story/news/health/2017/07/31/iowa-insurance-premiums-could-spike-moref-obamacare-funding-cut/526363001/\">43 percent increase \u003c/a>for next year, and it has said it would propose another increase of 12 to 20 percent on top of that if President Donald Trump decides to eliminate an important subsidy that helps some consumers reduce the cost of doctor visits, hospital stays and other medical services.\u003c/p>\n\u003cp>Blue Cross-Blue Shield of Georgia, the only insurer covering all counties in that state, is proposing a \u003ca href=\"http://www.myajc.com/news/state--regional-govt--politics/citing-uncertainty-blue-cross-seeks-big-rate-increases-georgia/hEVvZdpt6ODVmbtNokL12H/\">40.6 percent increase\u003c/a>, in large part because of the uncertainty surrounding these so-called \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/ask-emily/article2581624.html\">cost-sharing subsidies\u003c/a>.\u003c/p>\n\u003cp>Some states, however, will see more moderate rate hikes next year than in California. In \u003ca href=\"http://www.bnd.com/news/article164506387.html\">Minnesota\u003c/a>, which has been hit in the past with large increases, some consumers could see their premiums shrink by as much as 15 percent, while others could pay 11 percent more. In Pennsylvania, premiums on exchange-based plans are expected to rise by a relatively tame \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/19/538099050/uncertainty-over-obamacare-leaves-next-years-rates-in-limbo\">9 percent on average \u003c/a>if the cost-sharing subsidies continue, and by 20 percent if they don’t.\u003c/p>\n\u003cp>Covered California’s calculation of the average statewide premium increase assumes the federal government will continue to fund the subsidies — which may not be a safe assumption.\u003c/p>\n\u003cp>The exchange said there could be an additional charge averaging 12.4 percent on silver plans — the second-least-expensive type of policy among the exchange’s \u003ca href=\"http://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">four tiers\u003c/a> — if the administration under Trump decides not to continue funding them. The subsidies, paid directly to insurers, help reduce what some consumers pay out of their own pockets for medical expenses, such as physician visits, prescription drugs and hospital stays.\u003c/p>\n\u003cp>An announcement on whether the Trump administration will continue paying for them, at least for another month, was expected as early as this week. So far, Trump has let the subsidies continue on a month-to-month basis. But after Senate efforts to pass a repeal of the Affordable Care Act failed last week, he suggested in a tweet that he might pull the plug on them.\u003c/p>\n\u003cp>“We’ve prepared these rates in the midst of great uncertainty,” said Peter Lee, Covered California’s executive director. “We are doing our best to protect consumers. We hope to get clarity from the federal government before we make a decision by the end of August” on whether to tack on the silver plan surcharge to offset the loss of the federal subsidies, he said.\u003c/p>\n\u003cp>Lee said the exchange hoped not to do that, because “it will cause unnecessary confusion and ultimately cost the fed government billions of dollars more.”\u003c/p>\n\u003cp>Many Covered California consumers would not pay more out-of-pocket even if the cost of their health plans were to rise sharply, because the extra expense would be covered by federal tax credits intended to keep premiums affordable for consumers. Those subsidies, not directly threatened by Trump, are separate from the ones that help consumers with their out-of-pocket costs.\u003c/p>\n\u003cp>About 650,000 Covered California enrollees, or nearly half the exchange’s total enrollment, benefit from the cost-sharing reductions.\u003c/p>\n\u003cp>Those reduced rates are available only to Covered California enrollees who choose silver-level plans and whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four.\u003c/p>\n\u003cp>The exchange can’t wait too long before determining which rates consumers will face in 2018. State regulators need at least 60 days to review the rates, and Covered California and health plans also need to time to prepare for open enrollment, which begins Nov. 1.\u003c/p>\n\u003cp>Current enrollees will have the option to start renewing their plans sometime in October, said Covered California spokeswoman Lizelda Lopez.\u003c/p>\n\u003cp>Covered California also plans to create a new silver plan to be sold on the exchange for individuals and families who make too much money to qualify for tax credits and cost-sharing reductions. The surcharge will not be applied to that plan.\u003c/p>\n\u003cp>Covered California started offering plans in 2014. In the following two years, the agency successfully negotiated 4 percent average premium increases, far below the double-digit rate hikes that were the norm before the federal health law. That streak ended this year when rates shot up.\u003c/p>\n\u003cp>All of the rates are subject to state regulatory review and public comment. But neither of the state’s insurance regulators, the Department of Managed Health Care and Insurance Commissioner Dave Jones, has the authority to block the hikes.\u003c/p>\n\u003cp>The expansion of coverage under the Affordable Care Act has driven the percentage of uninsured Californians to a record low. The proportion of Californians lacking health insurance was 7.1 percent last year, down from 17 percent in 2013, before the coverage-expanding provisions of Obamacare began, federal data show.\u003c/p>\n\u003cp>The expansion of Medi-Cal, the state’s Medicaid program for lower-income residents, accounts for a significant part of that reduction. About 3.8 million Californians became eligible for Medi-Cal coverage under the Affordable Care Act. Total enrollment is 13.5 million, or about a third of the state’s population.\u003c/p>\n\u003cp>\u003cem>Chad Terhune contributed to this report.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "The figure could be higher if President Trump ends an important consumer subsidy, which he has threatened to do. Anthem Blue Cross also says it won't offer individual coverage in large parts of the state next year. ",
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"description": "The figure could be higher if President Trump ends an important consumer subsidy, which he has threatened to do. Anthem Blue Cross also says it won't offer individual coverage in large parts of the state next year. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Covered California said Tuesday that premiums on its health insurance plans would rise by an average of 12.5 percent statewide next year, amid continuing uncertainty over the future of the Affordable Care Act.\u003c/p>\n\u003cp>The state’s Obamacare exchange also said one of its largest insurers, Anthem Blue Cross, would pull out of the exchange and the overall individual market in 16 of the 19 regions it currently serves, forcing 153,000 consumers to find new health plans.\u003c/p>\n\u003cp>The rate increases apply to people who purchase their own coverage in the individual market, not the majority of Americans who get their health insurance through work or government programs such as Medicare and Medicaid.\u003c/p>\n\u003cp>The expected 2018 rate increase is down from 2017’s average rise of 13.2 percent, and it includes a one-time increase averaging 2.8 percentage points because of the end of a “holiday” that gave health plans a break from the tax they are required to pay under the Affordable Care Act.\u003c/p>\n\u003cp>Without that one-time hit, Covered California said, the average 2018 premium increase would be lower than 10 percent. And the exchange said consumers could face increases as low as 3.3 percent if they shop for the best-priced plan at the same level of coverage they already have.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The expected California premium increases are dwarfed by some of the rates proposed in other states. In Iowa, for example, the sole carrier remaining on the exchange — Medica — has proposed a \u003ca href=\"http://www.desmoinesregister.com/story/news/health/2017/07/31/iowa-insurance-premiums-could-spike-moref-obamacare-funding-cut/526363001/\">43 percent increase \u003c/a>for next year, and it has said it would propose another increase of 12 to 20 percent on top of that if President Donald Trump decides to eliminate an important subsidy that helps some consumers reduce the cost of doctor visits, hospital stays and other medical services.\u003c/p>\n\u003cp>Blue Cross-Blue Shield of Georgia, the only insurer covering all counties in that state, is proposing a \u003ca href=\"http://www.myajc.com/news/state--regional-govt--politics/citing-uncertainty-blue-cross-seeks-big-rate-increases-georgia/hEVvZdpt6ODVmbtNokL12H/\">40.6 percent increase\u003c/a>, in large part because of the uncertainty surrounding these so-called \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/ask-emily/article2581624.html\">cost-sharing subsidies\u003c/a>.\u003c/p>\n\u003cp>Some states, however, will see more moderate rate hikes next year than in California. In \u003ca href=\"http://www.bnd.com/news/article164506387.html\">Minnesota\u003c/a>, which has been hit in the past with large increases, some consumers could see their premiums shrink by as much as 15 percent, while others could pay 11 percent more. In Pennsylvania, premiums on exchange-based plans are expected to rise by a relatively tame \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/19/538099050/uncertainty-over-obamacare-leaves-next-years-rates-in-limbo\">9 percent on average \u003c/a>if the cost-sharing subsidies continue, and by 20 percent if they don’t.\u003c/p>\n\u003cp>Covered California’s calculation of the average statewide premium increase assumes the federal government will continue to fund the subsidies — which may not be a safe assumption.\u003c/p>\n\u003cp>The exchange said there could be an additional charge averaging 12.4 percent on silver plans — the second-least-expensive type of policy among the exchange’s \u003ca href=\"http://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">four tiers\u003c/a> — if the administration under Trump decides not to continue funding them. The subsidies, paid directly to insurers, help reduce what some consumers pay out of their own pockets for medical expenses, such as physician visits, prescription drugs and hospital stays.\u003c/p>\n\u003cp>An announcement on whether the Trump administration will continue paying for them, at least for another month, was expected as early as this week. So far, Trump has let the subsidies continue on a month-to-month basis. But after Senate efforts to pass a repeal of the Affordable Care Act failed last week, he suggested in a tweet that he might pull the plug on them.\u003c/p>\n\u003cp>“We’ve prepared these rates in the midst of great uncertainty,” said Peter Lee, Covered California’s executive director. “We are doing our best to protect consumers. We hope to get clarity from the federal government before we make a decision by the end of August” on whether to tack on the silver plan surcharge to offset the loss of the federal subsidies, he said.\u003c/p>\n\u003cp>Lee said the exchange hoped not to do that, because “it will cause unnecessary confusion and ultimately cost the fed government billions of dollars more.”\u003c/p>\n\u003cp>Many Covered California consumers would not pay more out-of-pocket even if the cost of their health plans were to rise sharply, because the extra expense would be covered by federal tax credits intended to keep premiums affordable for consumers. Those subsidies, not directly threatened by Trump, are separate from the ones that help consumers with their out-of-pocket costs.\u003c/p>\n\u003cp>About 650,000 Covered California enrollees, or nearly half the exchange’s total enrollment, benefit from the cost-sharing reductions.\u003c/p>\n\u003cp>Those reduced rates are available only to Covered California enrollees who choose silver-level plans and whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four.\u003c/p>\n\u003cp>The exchange can’t wait too long before determining which rates consumers will face in 2018. State regulators need at least 60 days to review the rates, and Covered California and health plans also need to time to prepare for open enrollment, which begins Nov. 1.\u003c/p>\n\u003cp>Current enrollees will have the option to start renewing their plans sometime in October, said Covered California spokeswoman Lizelda Lopez.\u003c/p>\n\u003cp>Covered California also plans to create a new silver plan to be sold on the exchange for individuals and families who make too much money to qualify for tax credits and cost-sharing reductions. The surcharge will not be applied to that plan.\u003c/p>\n\u003cp>Covered California started offering plans in 2014. In the following two years, the agency successfully negotiated 4 percent average premium increases, far below the double-digit rate hikes that were the norm before the federal health law. That streak ended this year when rates shot up.\u003c/p>\n\u003cp>All of the rates are subject to state regulatory review and public comment. But neither of the state’s insurance regulators, the Department of Managed Health Care and Insurance Commissioner Dave Jones, has the authority to block the hikes.\u003c/p>\n\u003cp>The expansion of coverage under the Affordable Care Act has driven the percentage of uninsured Californians to a record low. The proportion of Californians lacking health insurance was 7.1 percent last year, down from 17 percent in 2013, before the coverage-expanding provisions of Obamacare began, federal data show.\u003c/p>\n\u003cp>The expansion of Medi-Cal, the state’s Medicaid program for lower-income residents, accounts for a significant part of that reduction. About 3.8 million Californians became eligible for Medi-Cal coverage under the Affordable Care Act. Total enrollment is 13.5 million, or about a third of the state’s population.\u003c/p>\n\u003cp>\u003cem>Chad Terhune contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "States Have Already Tried Versions of 'Skinny Repeal.' It Didn't Go Well",
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"content": "\u003cp>Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a \"skinny repeal\" that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.\u003c/p>\n\u003cp>Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act's \"individual mandate,\" which assesses a tax on Americans who don't have insurance. The bill would also eliminate the ACA's penalties for some businesses -- those that have 50 or more workers and fail to offer their employees health coverage.\u003c/p>\n\u003cp>Details aren't clear, but it appears that — at least initially — much of the rest of the 2010 health law would remain, under this strategy, including the rule that says insurers must cover people who have pre-existing medical problems.\u003c/p>\n\u003cp>[contextly_sidebar id=\"3xCHRB83RCegO5eCE9I9b7XUGYrDBx2J\"]\u003c/p>\n\u003cp>In remarks on the Senate floor Wednesday, Sen. Minority Leader Charles Schumer, D-N.Y., said that \"we just heard from the nonpartisan Congressional Budget Office that under such a plan ... 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.\" The CBO \u003ca href=\"https://www.cbo.gov/publication/52977\" target=\"_blank\" rel=\"noopener noreferrer\">posted its evaluation\u003c/a> of the GOP's proposed plan Wednesday evening.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Earlier in the day, some Republicans seemed determined to find some way to keep the health care debate alive.\u003c/p>\n\u003cp>\"We need an outcome, and if a so-called skinny repeal is the first step, that's a good first step,\" said Sen. Thom Tillis, R-N.C.\u003c/p>\n\u003cp>Several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach, according to \u003ca href=\"http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982\" target=\"_blank\" rel=\"noopener noreferrer\">published reports\u003c/a>. It is, at least for now, being viewed as a step along the way to Republican health reform.\u003c/p>\n\u003cp>\"I think that most people would understand that what you're really voting on is trying to keep the conversation alive,\" said Sen. Bob Corker, R-Tenn. \"It's not the policy itself ... it's about trying to create a bigger discussion about repeal between the House and Senate.\"\u003c/p>\n\u003cp>But what if, during these strange legislative times, the skinny repeal were to be passed by the Senate and then go on to become law? States' experiences with insurance market reforms and rollbacks highlight the possible trouble spots.\u003c/p>\n\u003ch3>Considering the Parallels\u003c/h3>\n\u003cp>By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash when some of the coverage requirement rules they'd previously put on the individual market were lifted. \"Things went badly,\" said \u003ca href=\"http://law.wfu.edu/faculty/profile/hallma/\" target=\"_blank\" rel=\"noopener noreferrer\">Mark Hall\u003c/a>, director of the health law and policy program at Wake Forest University.\u003c/p>\n\u003cp>Premiums rose and insurers fled these states, leaving consumers who buy their own coverage (usually because they don't get it through their jobs) with fewer choices and higher prices.\u003c/p>\n\u003cp>That's because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with pre-existing conditions. At the same time, they didn't include mandates that consumers carry coverage.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uvPSgszQseNfQlpVIo48aD8k0r8xaCVy\"]\u003c/p>\n\u003cp>That goes to a basic concept about any kind of insurance: People who don't file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, and that leaves insurance companies with only the more costly policyholders.\u003c/p>\n\u003cp>Bottom line: Insurers end up \"less willing to participate in the market,\" said Hall.\u003c/p>\n\u003cp>It's not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage. Those subsidies could blunt the effect of not having a mandate.\u003c/p>\n\u003cp>During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be \"strong incentives for people to obtain health insurance and keep it year-round.\"\u003c/p>\n\u003ch3>Individual Mandate Is Still Unpopular in Voter Polls\u003c/h3>\n\u003cp>About 6.5 million Americans \u003ca href=\"http://www.cnbc.com/2017/01/11/fewer-people-paid-obamacare-tax-penalties-as-more-got-obamacare-aid.html\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> owing penalties for not having coverage in 2015.\u003c/p>\n\u003cp>Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult \u003ca href=\"http://www.cnbc.com/2017/02/22/obamacare-getting-more-popular-with-voters-in-trumps-presidency-poll.html\">poll\u003c/a> said they want the Senate to keep eight, rejecting only the individual mandate.\u003c/p>\n\u003cp>Even though the mandate's penalty is often criticized as not strong enough, removing it would still affect the individual market.\u003c/p>\n\u003cp>\"Insurers would react conservatively and increase rates substantially to cover their risk,\" said insurance industry consultant \u003ca href=\"http://www.healthpol.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Robert Laszewski\u003c/a>.\u003c/p>\n\u003cp>That's what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state's insurance commissioner. By 1998, the state's largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, \"precipitating a sense of crisis,\" according to a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/10804476\" target=\"_blank\" rel=\"noopener noreferrer\">published\u003c/a> in 2000 in the \u003cem>Journal of Health Politics, Policy and Law\u003c/em>.\u003c/p>\n\u003cp>\"When one pulled out, the others followed,\" said current Washington Insurance Commissioner \u003ca href=\"https://www.insurance.wa.gov/about-mike-kreidler\" target=\"_blank\" rel=\"noopener noreferrer\">Mike Kreidler\u003c/a>, who was then a regional director in the federal department of Health and Human Services.\u003c/p>\n\u003cp>The state's individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, reclaimed that authority.\u003c/p>\n\u003cp>Predicting the effect of removing the individual mandate is difficult, although Kreidler said he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.\u003c/p>\n\u003cp>\"Few markets can go bad on you as fast as a health insurance market,\" said Kreidler.\u003c/p>\n\u003cp>As for employers, dropping the requirement that those with 50 or more workers must offer health insurance or face a financial penalty could mean some workers would lose coverage. But their jobs might be more secure, said \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\" target=\"_blank\" rel=\"noopener noreferrer\">Joseph Antos\u003c/a>, a health care economist and resident scholar at the American Enterprise Institute.\u003c/p>\n\u003cp>That's because the requirement under the ACA meant that some smaller firms didn't hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.\u003c/p>\n\u003cp>The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think, because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.\u003c/p>\n\u003cp>However, the individual market could be roiled by other factors, Antos said.\u003c/p>\n\u003cp>\"The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges the state and federal markets through which insurance is offered] work more poorly.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit health newsroom, an editorially independent part of the Kaiser Family Foundation. You can follow KHN senior correspondent Julie Appleby on Twitter \u003c/em>\u003ca href=\"http://twitter.com/Julie_Appleby\">\u003cem>\u003cstrong>@Julie_Appleby\u003c/strong>\u003c/em>\u003c/a>\u003cem> Congressional reporter \u003c/em>\u003ca href=\"https://twitter.com/RachelHBluth\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Rachel Bluth\u003c/em>\u003c/a>\u003cem> also contributed to this report. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=States+Have+Already+Tried+Versions+Of+%27Skinny+Repeal.%27+It+Didn%27t+Go+Well&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a \"skinny repeal\" that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.\u003c/p>\n\u003cp>Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act's \"individual mandate,\" which assesses a tax on Americans who don't have insurance. The bill would also eliminate the ACA's penalties for some businesses -- those that have 50 or more workers and fail to offer their employees health coverage.\u003c/p>\n\u003cp>Details aren't clear, but it appears that — at least initially — much of the rest of the 2010 health law would remain, under this strategy, including the rule that says insurers must cover people who have pre-existing medical problems.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In remarks on the Senate floor Wednesday, Sen. Minority Leader Charles Schumer, D-N.Y., said that \"we just heard from the nonpartisan Congressional Budget Office that under such a plan ... 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.\" The CBO \u003ca href=\"https://www.cbo.gov/publication/52977\" target=\"_blank\" rel=\"noopener noreferrer\">posted its evaluation\u003c/a> of the GOP's proposed plan Wednesday evening.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Earlier in the day, some Republicans seemed determined to find some way to keep the health care debate alive.\u003c/p>\n\u003cp>\"We need an outcome, and if a so-called skinny repeal is the first step, that's a good first step,\" said Sen. Thom Tillis, R-N.C.\u003c/p>\n\u003cp>Several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach, according to \u003ca href=\"http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982\" target=\"_blank\" rel=\"noopener noreferrer\">published reports\u003c/a>. It is, at least for now, being viewed as a step along the way to Republican health reform.\u003c/p>\n\u003cp>\"I think that most people would understand that what you're really voting on is trying to keep the conversation alive,\" said Sen. Bob Corker, R-Tenn. \"It's not the policy itself ... it's about trying to create a bigger discussion about repeal between the House and Senate.\"\u003c/p>\n\u003cp>But what if, during these strange legislative times, the skinny repeal were to be passed by the Senate and then go on to become law? States' experiences with insurance market reforms and rollbacks highlight the possible trouble spots.\u003c/p>\n\u003ch3>Considering the Parallels\u003c/h3>\n\u003cp>By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash when some of the coverage requirement rules they'd previously put on the individual market were lifted. \"Things went badly,\" said \u003ca href=\"http://law.wfu.edu/faculty/profile/hallma/\" target=\"_blank\" rel=\"noopener noreferrer\">Mark Hall\u003c/a>, director of the health law and policy program at Wake Forest University.\u003c/p>\n\u003cp>Premiums rose and insurers fled these states, leaving consumers who buy their own coverage (usually because they don't get it through their jobs) with fewer choices and higher prices.\u003c/p>\n\u003cp>That's because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with pre-existing conditions. At the same time, they didn't include mandates that consumers carry coverage.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That goes to a basic concept about any kind of insurance: People who don't file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, and that leaves insurance companies with only the more costly policyholders.\u003c/p>\n\u003cp>Bottom line: Insurers end up \"less willing to participate in the market,\" said Hall.\u003c/p>\n\u003cp>It's not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage. Those subsidies could blunt the effect of not having a mandate.\u003c/p>\n\u003cp>During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be \"strong incentives for people to obtain health insurance and keep it year-round.\"\u003c/p>\n\u003ch3>Individual Mandate Is Still Unpopular in Voter Polls\u003c/h3>\n\u003cp>About 6.5 million Americans \u003ca href=\"http://www.cnbc.com/2017/01/11/fewer-people-paid-obamacare-tax-penalties-as-more-got-obamacare-aid.html\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> owing penalties for not having coverage in 2015.\u003c/p>\n\u003cp>Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult \u003ca href=\"http://www.cnbc.com/2017/02/22/obamacare-getting-more-popular-with-voters-in-trumps-presidency-poll.html\">poll\u003c/a> said they want the Senate to keep eight, rejecting only the individual mandate.\u003c/p>\n\u003cp>Even though the mandate's penalty is often criticized as not strong enough, removing it would still affect the individual market.\u003c/p>\n\u003cp>\"Insurers would react conservatively and increase rates substantially to cover their risk,\" said insurance industry consultant \u003ca href=\"http://www.healthpol.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Robert Laszewski\u003c/a>.\u003c/p>\n\u003cp>That's what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state's insurance commissioner. By 1998, the state's largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, \"precipitating a sense of crisis,\" according to a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/10804476\" target=\"_blank\" rel=\"noopener noreferrer\">published\u003c/a> in 2000 in the \u003cem>Journal of Health Politics, Policy and Law\u003c/em>.\u003c/p>\n\u003cp>\"When one pulled out, the others followed,\" said current Washington Insurance Commissioner \u003ca href=\"https://www.insurance.wa.gov/about-mike-kreidler\" target=\"_blank\" rel=\"noopener noreferrer\">Mike Kreidler\u003c/a>, who was then a regional director in the federal department of Health and Human Services.\u003c/p>\n\u003cp>The state's individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, reclaimed that authority.\u003c/p>\n\u003cp>Predicting the effect of removing the individual mandate is difficult, although Kreidler said he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.\u003c/p>\n\u003cp>\"Few markets can go bad on you as fast as a health insurance market,\" said Kreidler.\u003c/p>\n\u003cp>As for employers, dropping the requirement that those with 50 or more workers must offer health insurance or face a financial penalty could mean some workers would lose coverage. But their jobs might be more secure, said \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\" target=\"_blank\" rel=\"noopener noreferrer\">Joseph Antos\u003c/a>, a health care economist and resident scholar at the American Enterprise Institute.\u003c/p>\n\u003cp>That's because the requirement under the ACA meant that some smaller firms didn't hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.\u003c/p>\n\u003cp>The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think, because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.\u003c/p>\n\u003cp>However, the individual market could be roiled by other factors, Antos said.\u003c/p>\n\u003cp>\"The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges the state and federal markets through which insurance is offered] work more poorly.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit health newsroom, an editorially independent part of the Kaiser Family Foundation. You can follow KHN senior correspondent Julie Appleby on Twitter \u003c/em>\u003ca href=\"http://twitter.com/Julie_Appleby\">\u003cem>\u003cstrong>@Julie_Appleby\u003c/strong>\u003c/em>\u003c/a>\u003cem> Congressional reporter \u003c/em>\u003ca href=\"https://twitter.com/RachelHBluth\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Rachel Bluth\u003c/em>\u003c/a>\u003cem> also contributed to this report. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=States+Have+Already+Tried+Versions+Of+%27Skinny+Repeal.%27+It+Didn%27t+Go+Well&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients",
"title": "On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The Senate is expected to vote Tuesday on whether to advance health care legislation to the Senate floor. That would open up debate on an Obamacare repeal and/or replacement plan.\u003c/p>\n\u003cp>The importance of the vote was highlighted by \u003ca href=\"https://twitter.com/SenJohnMcCain/status/889652943791824897\" target=\"_blank\" rel=\"noopener noreferrer\">Sen. John McCain’s decision\u003c/a> to return to Washington to take part. He announced last week that he had been diagnosed with brain cancer.\u003c/p>\n\u003cp>At a White House event Monday, President Trump highlighted what he called the “failures” of the Affordable Care Act, also known as Obamacare, and called on senators to pass a bill that both repeals and replaces the ACA. Last week, Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\" target=\"_blank\" rel=\"noopener noreferrer\">urged an approach\u003c/a> that would repeal the law over two years, giving lawmakers more time to craft new health care legislation. Several days later \u003ca href=\"http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care\" target=\"_blank\" rel=\"noopener noreferrer\">at a lunch\u003c/a> with lawmakers, he advocated repeal and replace.\u003c/p>\n\u003cp>But it’s still not clear what the Senate will be voting on. There are \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">multiple bills\u003c/a> in play.\u003c/p>\n\u003cp>The Senate hopes it can muster the 51 votes needed to pass a bill, but some Republicans are wavering, both in the center and on the right.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>NPR’s health and politics teams have been doing our best to shed some light on what’s a very confusing situation, even by health policy standards.\u003c/p>\n\u003cp>\u003cstrong>What are they voting on?\u003c/strong>\u003c/p>\n\u003cp>There are at least four bills that could advance to the Senate floor. \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">Here’s our summary\u003c/a>, with a chart comparing House and Senate bills to the Affordable Care Act, and links to stories that dive into the implications of the legislation.\u003c/p>\n\u003cp>\u003cstrong>Who wins? Who loses?\u003c/strong>\u003c/p>\n\u003cp>We worked with NPR member station reporters and editors to create an interactive \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you\" target=\"_blank\" rel=\"noopener noreferrer\">Q&A\u003c/a> on how key elements of the bills would affect people in different states.\u003c/p>\n\u003cp>\u003cstrong>What if the Senate parliamentarian says “nope”?\u003c/strong>\u003c/p>\n\u003cp>Another \u003ca href=\"http://khn.org/news/ruling-by-senate-parliamentarian-upends-gop-hopes-for-health-care-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">potential wrinkle\u003c/a> came up late Friday. Julie Rovner with Kaiser Health News reports that the Senate rule-keeper has advised that some key parts of some of the bills could need 60 votes to proceed. They include defunding Planned Parenthood and incentives to have people keep health insurance. Getting 60 votes would require Democratic support, which they won’t get.\u003c/p>\n\u003cp>\u003cstrong>And if Obamacare remains the law of the land?\u003c/strong>\u003c/p>\n\u003cp>For now, the Affordable Care Act is still the law, and insurers are trying to plan for next year. That’s \u003ca href=\"http://www.npr.org/2017/07/21/538399298/even-talking-about-weakening-obamacare-provisions-weakens-the-exchanges\" target=\"_blank\" rel=\"noopener noreferrer\">proving to be difficult\u003c/a> and might \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=538099050\" target=\"_blank\" rel=\"noopener noreferrer\">drive up costs\u003c/a> for \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/22/538396570/rural-californians-want-price-relief-from-gop-health-bill-but-most-won-t-get-it\" target=\"_blank\" rel=\"noopener noreferrer\">consumers\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Congressional action could have an enormous impact on people’s health insurance. But the U.S. Department of Health and Human Services has some wide berth in interpreting the law and could make a lot of changes without congressional action. Here are some \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/29/521713002/even-without-congress-the-trump-administration-can-still-redo-obamacare\" target=\"_blank\" rel=\"noopener noreferrer\">key actions\u003c/a> and regulations that could affect the exchanges and Medicaid (and more).\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Senate+Health+Care+Vote%2C+Simplified&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is expected to vote Tuesday on whether to advance health care legislation to the Senate floor. That would open up debate on an Obamacare repeal and/or replacement plan.\u003c/p>\n\u003cp>The importance of the vote was highlighted by \u003ca href=\"https://twitter.com/SenJohnMcCain/status/889652943791824897\" target=\"_blank\" rel=\"noopener noreferrer\">Sen. John McCain’s decision\u003c/a> to return to Washington to take part. He announced last week that he had been diagnosed with brain cancer.\u003c/p>\n\u003cp>At a White House event Monday, President Trump highlighted what he called the “failures” of the Affordable Care Act, also known as Obamacare, and called on senators to pass a bill that both repeals and replaces the ACA. Last week, Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\" target=\"_blank\" rel=\"noopener noreferrer\">urged an approach\u003c/a> that would repeal the law over two years, giving lawmakers more time to craft new health care legislation. Several days later \u003ca href=\"http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care\" target=\"_blank\" rel=\"noopener noreferrer\">at a lunch\u003c/a> with lawmakers, he advocated repeal and replace.\u003c/p>\n\u003cp>But it’s still not clear what the Senate will be voting on. There are \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">multiple bills\u003c/a> in play.\u003c/p>\n\u003cp>The Senate hopes it can muster the 51 votes needed to pass a bill, but some Republicans are wavering, both in the center and on the right.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>NPR’s health and politics teams have been doing our best to shed some light on what’s a very confusing situation, even by health policy standards.\u003c/p>\n\u003cp>\u003cstrong>What are they voting on?\u003c/strong>\u003c/p>\n\u003cp>There are at least four bills that could advance to the Senate floor. \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">Here’s our summary\u003c/a>, with a chart comparing House and Senate bills to the Affordable Care Act, and links to stories that dive into the implications of the legislation.\u003c/p>\n\u003cp>\u003cstrong>Who wins? Who loses?\u003c/strong>\u003c/p>\n\u003cp>We worked with NPR member station reporters and editors to create an interactive \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you\" target=\"_blank\" rel=\"noopener noreferrer\">Q&A\u003c/a> on how key elements of the bills would affect people in different states.\u003c/p>\n\u003cp>\u003cstrong>What if the Senate parliamentarian says “nope”?\u003c/strong>\u003c/p>\n\u003cp>Another \u003ca href=\"http://khn.org/news/ruling-by-senate-parliamentarian-upends-gop-hopes-for-health-care-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">potential wrinkle\u003c/a> came up late Friday. Julie Rovner with Kaiser Health News reports that the Senate rule-keeper has advised that some key parts of some of the bills could need 60 votes to proceed. They include defunding Planned Parenthood and incentives to have people keep health insurance. Getting 60 votes would require Democratic support, which they won’t get.\u003c/p>\n\u003cp>\u003cstrong>And if Obamacare remains the law of the land?\u003c/strong>\u003c/p>\n\u003cp>For now, the Affordable Care Act is still the law, and insurers are trying to plan for next year. That’s \u003ca href=\"http://www.npr.org/2017/07/21/538399298/even-talking-about-weakening-obamacare-provisions-weakens-the-exchanges\" target=\"_blank\" rel=\"noopener noreferrer\">proving to be difficult\u003c/a> and might \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=538099050\" target=\"_blank\" rel=\"noopener noreferrer\">drive up costs\u003c/a> for \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/22/538396570/rural-californians-want-price-relief-from-gop-health-bill-but-most-won-t-get-it\" target=\"_blank\" rel=\"noopener noreferrer\">consumers\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Congressional action could have an enormous impact on people’s health insurance. But the U.S. Department of Health and Human Services has some wide berth in interpreting the law and could make a lot of changes without congressional action. Here are some \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/29/521713002/even-without-congress-the-trump-administration-can-still-redo-obamacare\" target=\"_blank\" rel=\"noopener noreferrer\">key actions\u003c/a> and regulations that could affect the exchanges and Medicaid (and more).\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Senate+Health+Care+Vote%2C+Simplified&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sighs of Relief From Health Safety-Net Providers in California After Senate Bill Collapses",
"title": "Sighs of Relief From Health Safety-Net Providers in California After Senate Bill Collapses",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Health care workers at California hospitals and clinics that serve low-income patients are relieved but still wary after the collapse of the Senate Republican health care bill earlier this week.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">The bill proposed deep funding cuts to Medicaid, which is called Medi-Cal in California and covers one out of three state residents. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.cbo.gov/publication/52941\" target=\"_blank\" rel=\"noopener noreferrer\">Congressional Budget Office (CBO) analysis\u003c/a> predicted the latest version of the Senate bill\u003c/span>\u003cspan style=\"font-weight: 400\"> would result in 15 million people losing insurance coverage next year and 22 million by 2026. But it would reduce the federal deficit by $420 billion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There has also been discussion of reviving a bill to repeal the Affordable Care Act (ACA) outright, without a plan to replace it. But that could be difficult because the \u003ca href=\"https://www.cbo.gov/publication/52939\" target=\"_blank\" rel=\"noopener noreferrer\">CBO estimated\u003c/a> that “repeal only” would lead to a whopping 32 million Americans without insurance by 2026.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal in California\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since the implementation of the ACA and the subsequent expansion of who qualifies for Medi-Cal, safety-net providers across the state have increased their capacity to treat more patients, and have hired more staff and improved outreach programs and infrastructure. This growth is possible because clinics are getting more reimbursements for their work treating people who were uninsured before the ACA.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When the ACA was implemented, states were given the choice to expand Medicaid eligibility to those making less than 138 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\" rel=\"noopener noreferrer\">federal poverty level\u003c/a>. California, along with 30 other states, adopted this expansion.\u003c/p>\n\u003cp>\u003cb>Here's How it Affects Real Californians:\u003c/b>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\u003cul>\n\u003cli>The number of people on Medi-Cal is \u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">13.5 million as of January 2017\u003c/a>. Of those, 3.8 million got this coverage through the ACA expansion.\u003c/li>\n\u003cli>\u003ca href=\"http://calbudgetcenter.org/resources/republican-plans-end-medicaid-know-threaten-medi-cal-coverage-benefits-millions-californians/\" target=\"_blank\" rel=\"noopener noreferrer\">Half\u003c/a> of \u003ca href=\"http://www.dof.ca.gov/Forecasting/Demographics/Projections/documents/P_PressRelease.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">California's kids\u003c/a> are on Medi-Cal.\u003c/li>\n\u003cli>\u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">One out of three California residents\u003c/a> is on Medi-Cal.\u003c/li>\n\u003cli>Medi-Cal covers \u003ca href=\"http://www.kff.org/infographic/medicaids-role-in-nursing-home-care/\" target=\"_blank\" rel=\"noopener noreferrer\">62 percent of seniors in nursing homes\u003c/a>.\u003c/li>\n\u003cli>The uninsured rate has dropped sharply. Before the ACA, \u003ca href=\"http://www.chcf.org/publications/2016/12/californias-uninsured\" target=\"_blank\" rel=\"noopener noreferrer\">16 percent\u003c/a> of Californians had no coverage. As of 2016, that number shrunk to \u003ca href=\"https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">7.4 percent\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What Was on the Chopping Block\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Both the House of Representatives' American Health Care Act (AHCA) and the Senate Republicans' Better Care Reconciliation Act (BCRA) proposed a hard annual limit on the amount of federal dollars Medi-Cal recipients would get, no matter how much treatment they would need.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Since Medi-Cal is funded by both the state and federal government, less federal money \u003c/span>\u003cspan style=\"font-weight: 400\">would compel states to either make up those dollars or make cuts to current programs. With the collapse of the BCRA, states won't need to think about those difficult decisions for the time being.\u003c/span>\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/RDnews/2017/07/ACHAcollapsereax.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26032_IMG_67441-qut.jpg\" Title=\"Breathing Sigh of Relief, Safety-Net Providers Hold onto Gains for Now\" program=\"State of Health\"]\u003c/p>\n\u003cp>\u003cb>'The threat is still there for our patients'\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Tiburcio Vasquez Health Center\u003c/a> (TVHC) in Hayward and Union City, and \u003ca href=\"http://zuckerbergsanfranciscogeneral.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Zuckerberg San Francisco General Hospital\u003c/a> have traditionally served low-income patients, regardless of their ability to pay. Before the ACA, the majority of their patients were uninsured, but now that’s reversed, and most patients arrive with Medi-Cal coverage or private insurance purchased with ACA subsidies on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California.\u003c/a>\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those additional insurance dollars have been the difference between scraping by and being able to make significant improvements.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Safety-net delivery systems are traditionally very poorly resourced,\" said Dr. Alice Chen, chief medical officer for the \u003ca href=\"http://www.sfhealthnetwork.org/\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Health Network\u003c/a>, an affiliate of Zuckerberg SF General. \"We've invested the new revenues that have come in for Medicaid patients into improving our systems of care.\" She says her network has brought in $150 million in new revenues from the Medicaid expansion.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">With those dollars, Chen says SF General, where she is based, has been implementing a new electronic health record system, and is working on initiatives to integrate mental and medical health and improve the patient's overall experience. Work like this, she says, wouldn't be possible without the additional resources from Medicaid dollars.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Medical students and residents at the University of California, San Francisco also said they were tentatively happy that it appears the ACA will remain in place. Dr. Emily Thomas is a UCSF resident who has been politically active since the 2016 election. She’s fighting to keep her patients insured through the ACA. She spoke to a crowd of doctors at SF General on Tuesday, explaining why she wanted the advocacy to continue. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Even though the BCRA has collapsed at the Senate, the threat is still there for our patients,” Thomas said. “Our patients are still relying on everyone in this room to continue to advocate for their expanded access to care.”\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Across the bay, at Tiburcio Vasquez Health Center, CEO David Vliet says his clinic has increased the number of patients it can serve due to the Medicaid expansion dollars. In addition to their existing clinics in Hayward, Union City and Fremont, health center administrators have built a $12 million facility with 22 exam rooms.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Regarding the additional Medicaid money, Vliet emphasized that \"those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs.\"\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Vliet said now that changes to the ACA are on hold, he's temporarily relieved. But he will still continue to monitor what's happening in Washington, D.C. If the increased funding continues to flow through Medi-Cal, Vliet says he would like to continue to expand services over the next few years to even more residents in the East Bay. Even after all the growth, TVHC staffers are working at capacity. There are still patients in the community waiting to be seen. \u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Adding to his concern, there is a chance Senate Republicans will revive the stalled health plan and push it through, which is what happened this spring in the House of Representatives.\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Health care workers at California hospitals and clinics that serve low-income patients are relieved but still wary after the collapse of the Senate Republican health care bill earlier this week.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">The bill proposed deep funding cuts to Medicaid, which is called Medi-Cal in California and covers one out of three state residents. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.cbo.gov/publication/52941\" target=\"_blank\" rel=\"noopener noreferrer\">Congressional Budget Office (CBO) analysis\u003c/a> predicted the latest version of the Senate bill\u003c/span>\u003cspan style=\"font-weight: 400\"> would result in 15 million people losing insurance coverage next year and 22 million by 2026. But it would reduce the federal deficit by $420 billion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There has also been discussion of reviving a bill to repeal the Affordable Care Act (ACA) outright, without a plan to replace it. But that could be difficult because the \u003ca href=\"https://www.cbo.gov/publication/52939\" target=\"_blank\" rel=\"noopener noreferrer\">CBO estimated\u003c/a> that “repeal only” would lead to a whopping 32 million Americans without insurance by 2026.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal in California\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since the implementation of the ACA and the subsequent expansion of who qualifies for Medi-Cal, safety-net providers across the state have increased their capacity to treat more patients, and have hired more staff and improved outreach programs and infrastructure. This growth is possible because clinics are getting more reimbursements for their work treating people who were uninsured before the ACA.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When the ACA was implemented, states were given the choice to expand Medicaid eligibility to those making less than 138 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\" rel=\"noopener noreferrer\">federal poverty level\u003c/a>. California, along with 30 other states, adopted this expansion.\u003c/p>\n\u003cp>\u003cb>Here's How it Affects Real Californians:\u003c/b>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\u003cul>\n\u003cli>The number of people on Medi-Cal is \u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">13.5 million as of January 2017\u003c/a>. Of those, 3.8 million got this coverage through the ACA expansion.\u003c/li>\n\u003cli>\u003ca href=\"http://calbudgetcenter.org/resources/republican-plans-end-medicaid-know-threaten-medi-cal-coverage-benefits-millions-californians/\" target=\"_blank\" rel=\"noopener noreferrer\">Half\u003c/a> of \u003ca href=\"http://www.dof.ca.gov/Forecasting/Demographics/Projections/documents/P_PressRelease.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">California's kids\u003c/a> are on Medi-Cal.\u003c/li>\n\u003cli>\u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">One out of three California residents\u003c/a> is on Medi-Cal.\u003c/li>\n\u003cli>Medi-Cal covers \u003ca href=\"http://www.kff.org/infographic/medicaids-role-in-nursing-home-care/\" target=\"_blank\" rel=\"noopener noreferrer\">62 percent of seniors in nursing homes\u003c/a>.\u003c/li>\n\u003cli>The uninsured rate has dropped sharply. Before the ACA, \u003ca href=\"http://www.chcf.org/publications/2016/12/californias-uninsured\" target=\"_blank\" rel=\"noopener noreferrer\">16 percent\u003c/a> of Californians had no coverage. As of 2016, that number shrunk to \u003ca href=\"https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">7.4 percent\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What Was on the Chopping Block\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Both the House of Representatives' American Health Care Act (AHCA) and the Senate Republicans' Better Care Reconciliation Act (BCRA) proposed a hard annual limit on the amount of federal dollars Medi-Cal recipients would get, no matter how much treatment they would need.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Since Medi-Cal is funded by both the state and federal government, less federal money \u003c/span>\u003cspan style=\"font-weight: 400\">would compel states to either make up those dollars or make cuts to current programs. With the collapse of the BCRA, states won't need to think about those difficult decisions for the time being.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cb>'The threat is still there for our patients'\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Tiburcio Vasquez Health Center\u003c/a> (TVHC) in Hayward and Union City, and \u003ca href=\"http://zuckerbergsanfranciscogeneral.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Zuckerberg San Francisco General Hospital\u003c/a> have traditionally served low-income patients, regardless of their ability to pay. Before the ACA, the majority of their patients were uninsured, but now that’s reversed, and most patients arrive with Medi-Cal coverage or private insurance purchased with ACA subsidies on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California.\u003c/a>\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those additional insurance dollars have been the difference between scraping by and being able to make significant improvements.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Safety-net delivery systems are traditionally very poorly resourced,\" said Dr. Alice Chen, chief medical officer for the \u003ca href=\"http://www.sfhealthnetwork.org/\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Health Network\u003c/a>, an affiliate of Zuckerberg SF General. \"We've invested the new revenues that have come in for Medicaid patients into improving our systems of care.\" She says her network has brought in $150 million in new revenues from the Medicaid expansion.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">With those dollars, Chen says SF General, where she is based, has been implementing a new electronic health record system, and is working on initiatives to integrate mental and medical health and improve the patient's overall experience. Work like this, she says, wouldn't be possible without the additional resources from Medicaid dollars.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Medical students and residents at the University of California, San Francisco also said they were tentatively happy that it appears the ACA will remain in place. Dr. Emily Thomas is a UCSF resident who has been politically active since the 2016 election. She’s fighting to keep her patients insured through the ACA. She spoke to a crowd of doctors at SF General on Tuesday, explaining why she wanted the advocacy to continue. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Even though the BCRA has collapsed at the Senate, the threat is still there for our patients,” Thomas said. “Our patients are still relying on everyone in this room to continue to advocate for their expanded access to care.”\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Across the bay, at Tiburcio Vasquez Health Center, CEO David Vliet says his clinic has increased the number of patients it can serve due to the Medicaid expansion dollars. In addition to their existing clinics in Hayward, Union City and Fremont, health center administrators have built a $12 million facility with 22 exam rooms.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Regarding the additional Medicaid money, Vliet emphasized that \"those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs.\"\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Vliet said now that changes to the ACA are on hold, he's temporarily relieved. But he will still continue to monitor what's happening in Washington, D.C. If the increased funding continues to flow through Medi-Cal, Vliet says he would like to continue to expand services over the next few years to even more residents in the East Bay. Even after all the growth, TVHC staffers are working at capacity. There are still patients in the community waiting to be seen. \u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Adding to his concern, there is a chance Senate Republicans will revive the stalled health plan and push it through, which is what happened this spring in the House of Representatives.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "trumps-big-repealing-deal-8-takeaways-on-the-senates-health-care-meltdown-moment",
"title": "Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown",
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"headTitle": "Why ‘Repeal and Replace’ Collapsed: 8 Takeaways on the Senate’s Health Care Meltdown | KQED",
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"content": "\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain’s absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama’s health care law.\u003c/p>\n\u003cp>McCain’s office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain’s office says he’ll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a “crusty voice in Washington.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump added, “Plus, we need his vote.”\u003c/p>\n\u003cp>Trump brought up McCain while calling for the repeal of the national health care law during a trade event at the White House.\u003c/p>\n\u003cp>McCain’s absence has led Senate leaders to postpone action on the health care measure. It needs almost every Republican vote to pass.\u003c/p>\n\u003cp>But the postponement also gives McConnell and the White House more time to cut the deals they need to rescue the imperiled measure.\u003c/p>\n\u003cp>McConnell signaled Monday that days of bargaining and persuasion with reluctant colleagues lie ahead. He says the only way to prevail “is with continued hard work, and that’s just what we intend to do. ”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AARP is aiming TV and radio ads at undecided, moderate Republican senators in five states. From the right, Americans for Prosperity is rallying its members to urge senators to make the bill even more conservative.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain’s absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama’s health care law.\u003c/p>\n\u003cp>McCain’s office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain’s office says he’ll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a “crusty voice in Washington.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"tagline": "Art is where you find it",
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"soldout": {
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"tagline": "A new future for housing",
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"info": "",
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"tech-nation": {
"id": "tech-nation",
"title": "Tech Nation Radio Podcast",
"info": "Tech Nation is a weekly public radio program, hosted by Dr. Moira Gunn. Founded in 1993, it has grown from a simple interview show to a multi-faceted production, featuring conversations with noted technology and science leaders, and a weekly science and technology-related commentary.",
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"ted-radio-hour": {
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"title": "TED Radio Hour",
"info": "The TED Radio Hour is a journey through fascinating ideas, astonishing inventions, fresh approaches to old problems, and new ways to think and create.",
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