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"disqusTitle": "Is It Time to Reform California's Sex Offender Registry?",
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"content": "\u003cfigure id=\"attachment_20044\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/eeskaatt/6465253809/in/photolist-aRj7Hg-6ojdf2-98yyuS-7jsKMe-hWxnEH-cjk3rA-4Jz9hR-hefNZU-6TdxC2-ZhJz8-6YpeWb-cGUK5b-fy6K1E-ddSc9B-6Yt9Xq-dy1Gtb-4sfi4R-jhPnas-58z6Qg-sV5Lz-bkkuEB-3i7w5p-nySkCf-7TDkqc-6PwPTK-hr4LFq-kaDit-fs3yS5-nLGUVG-78btf4-8nHj2D-4zDfum-bUEmjC-5qTEgG-ds1yZ4-nn9hjo-CxZ7o-4gtYTE-4LNuUV-6mjCfy-4uBnwF-66WSsm-sGqLo-b9wwH-hFbB48-adYpqi-7Ct8XX-tpLBt-9AKQgd-m695fS\">\u003cimg class=\"wp-image-20044 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/6465253809_10ecedace3_o-640x480.jpg\" alt=\"(Scott Pacaldo/Flickr)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">California is one of just four states that requires sex offenders to register for the rest of their lives. (Scott Pacaldo/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Tara Siler\u003c/strong>\u003c/p>\n\u003cp>Back in 1947 California became the first state to require sex offenders to register with law enforcement after being released from prison. Now there are just under 100,000 sex offenders on the state's lifetime registry -- most of whom can be found on the state's public website. But here's what a lot of people don't know: California is one of just four states requiring all sex offenders to register for the rest of their lives.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'The reality is that for most of them the offense happened years ago.' \u003c/aside>\n\u003cp>The state board that oversees the registry believes it's time to overhaul the registry to make it smaller and easier to spot those at high risk of reoffending.\u003c/p>\n\u003cp>\"K\" -- as he wants to be identified -- is a case in point. He was added to the registry last year when he was released from prison. In 2009, he was convicted of multiple felony charges, including lewd and lascivious conduct.\u003c/p>\n\u003cp>While K claims the touching was consensual, the woman said it wasn’t. In any case, the woman was developmentally disabled and K was her caregiver.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The bottom line,\" K told me, \"is I believe in law, and if I made a mistake I’ll pay for it, which I did.\"\u003c/p>\n\u003cp>K spent more than three years in prison. He says he had no prior criminal record, and that the state considers him a very low risk to reoffend. He's not, he says, a hard-core sexual predator.\u003c/p>\n\u003cp>\"You know, not all of us are the same way,\" he says.\u003c/p>\n\u003cp>The state’s Sex Offender Management Board agrees with that statement. The board wants to prioritize sex offenders on the registry, based on the type of crime committed and their risk of re-offending. Under a \u003ca href=\"http://www.cce.csus.edu/portal/admin/handouts/Tiering%20Background%20Paper%20FINAL%20FINAL%204-2-14.pdf\" target=\"_blank\">recent proposal\u003c/a>, some would have to register for 10 years, some for 20 and some for life. K, for example, would probably be dropped from the registry after 20 years -- when he would be in his 80s -- if he doesn't reoffend. This \"tiered system\" is already in use by many other states, including \u003ca href=\"http://www.nvsexoffenders.gov/definitions.aspx\" target=\"_blank\">Nevada\u003c/a>, for example.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157685134&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>Tom Tobin is a clinical psychologist who works with sex offenders and is vice chair of the California Sex Offender Management Board, which oversees the registry. He supports the proposed overhaul, saying that the term \"sex offenders\" suggests that the likelihood of reoffending is always high.\u003c/p>\n\u003cp>\"While the reality is that, for most of them, the offense happened years ago,\" Tobin says, \"sometimes many years ago, and they have not reoffended. So to call them 'sex offenders' is not a very accurate use of language, and one I think makes us distort reality.\"\u003c/p>\n\u003cp>In fact, Tobin says, 95 percent of solved sex crimes are not committed by people on the registry, and most sex offenses are perpetrated by someone the victim knows -- not a stranger.\u003c/p>\n\u003cp>Even some law enforcement officials are questioning the value of the lifetime registry. Bradley McCartt is a Los Angeles County deputy district attorney with the sex crimes division. He says the current registry isn't helping keep the public safe.\u003c/p>\n\u003cp>\"Let’s say you have a kidnapped child,\" McCartt says. \"Going to that registry has all but become meaningless because when people look at it, you basically have 98,000 people to look at, as opposed to better focus on who your suspect might be, to quickly act to try and save that child.\"\u003c/p>\n\u003cp>McCartt says that by creating a tiered registry, more attention and resources could be trained on monitoring high-risk offenders, and a lot less time could be taken up with less risky offenders, including young men who had consensual sex with their minor girlfriends or men who merely urinated in public.\u003c/p>\n\u003cp>\u003cstrong>'Gambling with Lives'\u003c/strong>\u003c/p>\n\u003cp>Marc Klaas argues that the tiered approach is risky. Klaas is the founder of KlaasKids Foundation, named after his daughter, Polly, who was kidnapped and murdered in 1993. He says he'll fight any major changes to the registry. \"This is a small subset that can be dealt with without a sweeping overhaul of the entire system,\" he says.\u003c/p>\n\u003cp>Klass has a strong ally in Nina Salerno with California Crime Victims United. \"I think a tiered system is gambling with lives,\" she says.\u003c/p>\n\u003cp>Both Salerno and Klaas don't trust how the state says it would decide who is likely to reoffend. \"The risk assessment tools deserve a lot of scrutiny themselves,\" Klaas says.\u003c/p>\n\u003cp>He cites the case of John Gardner, a registered sex offender who, while on parole, was considered a low-to-moderate risk. Then in 2010 he was convicted of raping and murdering two teenage girls near San Diego.\u003c/p>\n\u003cp>But Tom Tobin of the California Sex Offender Management Board defends the state’s risk assessment tool. He says it's similar to that used by the insurance industry.\u003c/p>\n\u003cp>\"They are the first to admit,\" Tobin says, \"they cannot predict with perfect accuracy whether or not someone will have a future automobile accident or someone is going to die at a certain age. On the other hand, they can come very, very close.\"\u003c/p>\n\u003cp>The main assessment tool used by the state spots those likely to reoffend about 75 percent of the time. That number increases when combined with other risk factors. But the margin of error has scared many lawmakers away from backing a bill to change the registry.\u003c/p>\n\u003cp>Democratic Assemblymember Tom Ammiano has twice tried and failed to \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB702\" target=\"_blank\">pass legislation\u003c/a> creating a tiered sex offender registry, but he hasn't had a lot of success. \"This isn’t a demographic that people feel warm and fuzzy about,\" he notes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Ammiano is termed out of office this year and says he doesn’t have time to try again to pass the reform. Supporters are hoping another lawmaker will step forward, but it's likely to be tough -- especially in an election year when no one wants to be seen as going easy on sex offenders.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20044\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/eeskaatt/6465253809/in/photolist-aRj7Hg-6ojdf2-98yyuS-7jsKMe-hWxnEH-cjk3rA-4Jz9hR-hefNZU-6TdxC2-ZhJz8-6YpeWb-cGUK5b-fy6K1E-ddSc9B-6Yt9Xq-dy1Gtb-4sfi4R-jhPnas-58z6Qg-sV5Lz-bkkuEB-3i7w5p-nySkCf-7TDkqc-6PwPTK-hr4LFq-kaDit-fs3yS5-nLGUVG-78btf4-8nHj2D-4zDfum-bUEmjC-5qTEgG-ds1yZ4-nn9hjo-CxZ7o-4gtYTE-4LNuUV-6mjCfy-4uBnwF-66WSsm-sGqLo-b9wwH-hFbB48-adYpqi-7Ct8XX-tpLBt-9AKQgd-m695fS\">\u003cimg class=\"wp-image-20044 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/6465253809_10ecedace3_o-640x480.jpg\" alt=\"(Scott Pacaldo/Flickr)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">California is one of just four states that requires sex offenders to register for the rest of their lives. (Scott Pacaldo/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Tara Siler\u003c/strong>\u003c/p>\n\u003cp>Back in 1947 California became the first state to require sex offenders to register with law enforcement after being released from prison. Now there are just under 100,000 sex offenders on the state's lifetime registry -- most of whom can be found on the state's public website. But here's what a lot of people don't know: California is one of just four states requiring all sex offenders to register for the rest of their lives.\u003c/p>\n\u003caside class=\"pullquote alignleft\">'The reality is that for most of them the offense happened years ago.' \u003c/aside>\n\u003cp>The state board that oversees the registry believes it's time to overhaul the registry to make it smaller and easier to spot those at high risk of reoffending.\u003c/p>\n\u003cp>\"K\" -- as he wants to be identified -- is a case in point. He was added to the registry last year when he was released from prison. In 2009, he was convicted of multiple felony charges, including lewd and lascivious conduct.\u003c/p>\n\u003cp>While K claims the touching was consensual, the woman said it wasn’t. In any case, the woman was developmentally disabled and K was her caregiver.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The bottom line,\" K told me, \"is I believe in law, and if I made a mistake I’ll pay for it, which I did.\"\u003c/p>\n\u003cp>K spent more than three years in prison. He says he had no prior criminal record, and that the state considers him a very low risk to reoffend. He's not, he says, a hard-core sexual predator.\u003c/p>\n\u003cp>\"You know, not all of us are the same way,\" he says.\u003c/p>\n\u003cp>The state’s Sex Offender Management Board agrees with that statement. The board wants to prioritize sex offenders on the registry, based on the type of crime committed and their risk of re-offending. Under a \u003ca href=\"http://www.cce.csus.edu/portal/admin/handouts/Tiering%20Background%20Paper%20FINAL%20FINAL%204-2-14.pdf\" target=\"_blank\">recent proposal\u003c/a>, some would have to register for 10 years, some for 20 and some for life. K, for example, would probably be dropped from the registry after 20 years -- when he would be in his 80s -- if he doesn't reoffend. This \"tiered system\" is already in use by many other states, including \u003ca href=\"http://www.nvsexoffenders.gov/definitions.aspx\" target=\"_blank\">Nevada\u003c/a>, for example.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157685134&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>Tom Tobin is a clinical psychologist who works with sex offenders and is vice chair of the California Sex Offender Management Board, which oversees the registry. He supports the proposed overhaul, saying that the term \"sex offenders\" suggests that the likelihood of reoffending is always high.\u003c/p>\n\u003cp>\"While the reality is that, for most of them, the offense happened years ago,\" Tobin says, \"sometimes many years ago, and they have not reoffended. So to call them 'sex offenders' is not a very accurate use of language, and one I think makes us distort reality.\"\u003c/p>\n\u003cp>In fact, Tobin says, 95 percent of solved sex crimes are not committed by people on the registry, and most sex offenses are perpetrated by someone the victim knows -- not a stranger.\u003c/p>\n\u003cp>Even some law enforcement officials are questioning the value of the lifetime registry. Bradley McCartt is a Los Angeles County deputy district attorney with the sex crimes division. He says the current registry isn't helping keep the public safe.\u003c/p>\n\u003cp>\"Let’s say you have a kidnapped child,\" McCartt says. \"Going to that registry has all but become meaningless because when people look at it, you basically have 98,000 people to look at, as opposed to better focus on who your suspect might be, to quickly act to try and save that child.\"\u003c/p>\n\u003cp>McCartt says that by creating a tiered registry, more attention and resources could be trained on monitoring high-risk offenders, and a lot less time could be taken up with less risky offenders, including young men who had consensual sex with their minor girlfriends or men who merely urinated in public.\u003c/p>\n\u003cp>\u003cstrong>'Gambling with Lives'\u003c/strong>\u003c/p>\n\u003cp>Marc Klaas argues that the tiered approach is risky. Klaas is the founder of KlaasKids Foundation, named after his daughter, Polly, who was kidnapped and murdered in 1993. He says he'll fight any major changes to the registry. \"This is a small subset that can be dealt with without a sweeping overhaul of the entire system,\" he says.\u003c/p>\n\u003cp>Klass has a strong ally in Nina Salerno with California Crime Victims United. \"I think a tiered system is gambling with lives,\" she says.\u003c/p>\n\u003cp>Both Salerno and Klaas don't trust how the state says it would decide who is likely to reoffend. \"The risk assessment tools deserve a lot of scrutiny themselves,\" Klaas says.\u003c/p>\n\u003cp>He cites the case of John Gardner, a registered sex offender who, while on parole, was considered a low-to-moderate risk. Then in 2010 he was convicted of raping and murdering two teenage girls near San Diego.\u003c/p>\n\u003cp>But Tom Tobin of the California Sex Offender Management Board defends the state’s risk assessment tool. He says it's similar to that used by the insurance industry.\u003c/p>\n\u003cp>\"They are the first to admit,\" Tobin says, \"they cannot predict with perfect accuracy whether or not someone will have a future automobile accident or someone is going to die at a certain age. On the other hand, they can come very, very close.\"\u003c/p>\n\u003cp>The main assessment tool used by the state spots those likely to reoffend about 75 percent of the time. That number increases when combined with other risk factors. But the margin of error has scared many lawmakers away from backing a bill to change the registry.\u003c/p>\n\u003cp>Democratic Assemblymember Tom Ammiano has twice tried and failed to \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB702\" target=\"_blank\">pass legislation\u003c/a> creating a tiered sex offender registry, but he hasn't had a lot of success. \"This isn’t a demographic that people feel warm and fuzzy about,\" he notes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Ammiano is termed out of office this year and says he doesn’t have time to try again to pass the reform. Supporters are hoping another lawmaker will step forward, but it's likely to be tough -- especially in an election year when no one wants to be seen as going easy on sex offenders.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Code Black: Young Doctors Still in Love with Medicine",
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"content": "\u003cfigure id=\"attachment_20002\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/4-Jamie-Eng-M.D.-with-patient-in-CODE-BLACK-a-Long-Shot-release-2014.jpg\">\u003cimg class=\"size-large wp-image-20002\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/4-Jamie-Eng-M.D.-with-patient-in-CODE-BLACK-a-Long-Shot-release-2014-640x360.jpg\" alt='Dr. Jamie Eng with patient in the documentary \"Code Black.\"' width=\"640\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jamie Eng with patient in the documentary \"Code Black.\"\u003c/figcaption>\u003c/figure>\n\u003cp>Don't eat a sandwich before you sit down to watch the documentary \"\u003ca href=\"http://codeblackmovie.com\" target=\"_blank\">Code Black\u003c/a>.\" In one of the first scenes, we watch a team of doctors and nurses cut into a patient. It's a bloody business, and the camera doesn't turn away. That's because this film is about the brilliant chaos of emergency care, and the people drawn to this work.\u003c/p>\n\u003cp>For all the debate over health care in America, it's relatively rare to hear from doctors on the front lines, and even more rare to hear from young doctors about a field they've recently chosen to devote their lives to. “Code Black,” a documentary by a doctor when he was a resident at LA County's USC Medical Center, delivers that perspective with punch and passion. It promises a look into \"America's busiest ER.\"\u003c!--more-->\u003c/p>\n\u003cp>Ryan McGarry is now an assistant professor and physician at The Weill Medical College of Cornell University. Possibly, his penchant for storytelling has something to do with his bachelor's degree in English at Pennsylvania State University. His decision to become a doctor was inspired in part by his experience as a Stage IV cancer patient while an undergraduate. Even though he switched gears professionally, he finds poetry in his new field.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157165060&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>His training ground for emergency medicine is “C-Booth”, a now-closed but legendary trauma bay, where “more people have died and more people have been saved than in any other square footage in the United States,” McGarry tells us in his voice over.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The film is a first-person reflection of McGarry's personal choices: of his respect for the students and teachers around him, of how jazzed he is to be doing emergency medicine, of how anxious he is about the primacy of money and politics over human values in medicine today.\u003c/p>\n\u003cp>We also hear from McGarry's fellow interns, like Jamie Eng, speaking with an almost dreamy calm about what motivates her to charge into a scene that would send most people running. \"When I rotated here as a medical student, I saw how the seniors just commanded the place. And I thought, 'I want to be that person. I want to be that calm. That cool. That collected. That knowledgeable. That confident.'”\u003c/p>\n\u003cfigure id=\"attachment_20004\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/3-Danny-Cheng-M.D.-Dave-Pomeranz-M.D.-Ryan-McGarry-M.D.-Billy-Mallon-M.D.-at-bedside-in-CODE-BLACK-a-Long-Shot-Factory-release-2014.jpg\">\u003cimg class=\"size-medium wp-image-20004\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/3-Danny-Cheng-M.D.-Dave-Pomeranz-M.D.-Ryan-McGarry-M.D.-Billy-Mallon-M.D.-at-bedside-in-CODE-BLACK-a-Long-Shot-Factory-release-2014-300x169.jpg\" alt='From L to R: Danny Cheng, M.D., Dave Pomeranz, M.D., Ryan McGarry, M.D., Billy Mallon, M.D. at bedside in C-Booth in the documentary \"Code Black.\"' width=\"300\" height=\"169\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">From L to R: Danny Cheng, M.D., Dave Pomeranz, M.D., Ryan McGarry, M.D., Billy Mallon, M.D. at bedside in C-Booth in the documentary \"Code Black.\"\u003c/figcaption>\u003c/figure>\n\u003cp>That's everything you want to believe about doctors: that smart, soulful, driven people will be doing their darndest to keep you or your loved one alive in that critical moment of need. Whether you can pay or not.\u003c/p>\n\u003cp>LA County/USC is a public hospital, and it's cheering to see how much the interns care for their patients, no matter how poor. But time marches on. A new hospital was built. It’s clean. It’s quiet. It meets modern codes for earthquake safety. Still, whatever rules the old hospital could be exempted from because it was so old and so small, the doctors have to follow modern rules in the new hospital. Perhaps predictably, they hate them, particularly the bureaucratic documentation required for every last, little thing that happens in the ER.\u003c/p>\n\u003cp>Eng laments, \"I just had a patient with the simplest of complaints. It took me about two minutes to see her. I saw her standing right here in the hallway. I don’t even need a room for her. Basically, it took me four times as long to document as it took me to talk to her and do the exam at the same time.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I've worked on both coasts now,\" McGarry says, \"and whether it be a primary care office or a busy emergency department, the thing that physicians and other providers are talking the most right now is the disconnection from us and patients.\" How did it come to be, he wonders, \"that insurance companies and administrators and everybody else who isn't as invested, arguably, is sort of running that experience?\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20002\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/4-Jamie-Eng-M.D.-with-patient-in-CODE-BLACK-a-Long-Shot-release-2014.jpg\">\u003cimg class=\"size-large wp-image-20002\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/4-Jamie-Eng-M.D.-with-patient-in-CODE-BLACK-a-Long-Shot-release-2014-640x360.jpg\" alt='Dr. Jamie Eng with patient in the documentary \"Code Black.\"' width=\"640\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jamie Eng with patient in the documentary \"Code Black.\"\u003c/figcaption>\u003c/figure>\n\u003cp>Don't eat a sandwich before you sit down to watch the documentary \"\u003ca href=\"http://codeblackmovie.com\" target=\"_blank\">Code Black\u003c/a>.\" In one of the first scenes, we watch a team of doctors and nurses cut into a patient. It's a bloody business, and the camera doesn't turn away. That's because this film is about the brilliant chaos of emergency care, and the people drawn to this work.\u003c/p>\n\u003cp>For all the debate over health care in America, it's relatively rare to hear from doctors on the front lines, and even more rare to hear from young doctors about a field they've recently chosen to devote their lives to. “Code Black,” a documentary by a doctor when he was a resident at LA County's USC Medical Center, delivers that perspective with punch and passion. It promises a look into \"America's busiest ER.\"\u003c!--more-->\u003c/p>\n\u003cp>Ryan McGarry is now an assistant professor and physician at The Weill Medical College of Cornell University. Possibly, his penchant for storytelling has something to do with his bachelor's degree in English at Pennsylvania State University. His decision to become a doctor was inspired in part by his experience as a Stage IV cancer patient while an undergraduate. Even though he switched gears professionally, he finds poetry in his new field.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157165060&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>His training ground for emergency medicine is “C-Booth”, a now-closed but legendary trauma bay, where “more people have died and more people have been saved than in any other square footage in the United States,” McGarry tells us in his voice over.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The film is a first-person reflection of McGarry's personal choices: of his respect for the students and teachers around him, of how jazzed he is to be doing emergency medicine, of how anxious he is about the primacy of money and politics over human values in medicine today.\u003c/p>\n\u003cp>We also hear from McGarry's fellow interns, like Jamie Eng, speaking with an almost dreamy calm about what motivates her to charge into a scene that would send most people running. \"When I rotated here as a medical student, I saw how the seniors just commanded the place. And I thought, 'I want to be that person. I want to be that calm. That cool. That collected. That knowledgeable. That confident.'”\u003c/p>\n\u003cfigure id=\"attachment_20004\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/3-Danny-Cheng-M.D.-Dave-Pomeranz-M.D.-Ryan-McGarry-M.D.-Billy-Mallon-M.D.-at-bedside-in-CODE-BLACK-a-Long-Shot-Factory-release-2014.jpg\">\u003cimg class=\"size-medium wp-image-20004\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/3-Danny-Cheng-M.D.-Dave-Pomeranz-M.D.-Ryan-McGarry-M.D.-Billy-Mallon-M.D.-at-bedside-in-CODE-BLACK-a-Long-Shot-Factory-release-2014-300x169.jpg\" alt='From L to R: Danny Cheng, M.D., Dave Pomeranz, M.D., Ryan McGarry, M.D., Billy Mallon, M.D. at bedside in C-Booth in the documentary \"Code Black.\"' width=\"300\" height=\"169\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">From L to R: Danny Cheng, M.D., Dave Pomeranz, M.D., Ryan McGarry, M.D., Billy Mallon, M.D. at bedside in C-Booth in the documentary \"Code Black.\"\u003c/figcaption>\u003c/figure>\n\u003cp>That's everything you want to believe about doctors: that smart, soulful, driven people will be doing their darndest to keep you or your loved one alive in that critical moment of need. Whether you can pay or not.\u003c/p>\n\u003cp>LA County/USC is a public hospital, and it's cheering to see how much the interns care for their patients, no matter how poor. But time marches on. A new hospital was built. It’s clean. It’s quiet. It meets modern codes for earthquake safety. Still, whatever rules the old hospital could be exempted from because it was so old and so small, the doctors have to follow modern rules in the new hospital. Perhaps predictably, they hate them, particularly the bureaucratic documentation required for every last, little thing that happens in the ER.\u003c/p>\n\u003cp>Eng laments, \"I just had a patient with the simplest of complaints. It took me about two minutes to see her. I saw her standing right here in the hallway. I don’t even need a room for her. Basically, it took me four times as long to document as it took me to talk to her and do the exam at the same time.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I've worked on both coasts now,\" McGarry says, \"and whether it be a primary care office or a busy emergency department, the thing that physicians and other providers are talking the most right now is the disconnection from us and patients.\" How did it come to be, he wonders, \"that insurance companies and administrators and everybody else who isn't as invested, arguably, is sort of running that experience?\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Nearly a Million People Backlogged in Medi-Cal Expansion",
"title": "Nearly a Million People Backlogged in Medi-Cal Expansion",
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"content": "\u003cfigure id=\"attachment_20007\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/83121913crop.jpg\">\u003cimg class=\"size-large wp-image-20007\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/83121913crop-640x429.jpg\" alt=\"It's not clear when the backlog will be cleared. (Getty Images)\" width=\"640\" height=\"429\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">It's not clear when the backlog will be cleared. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Helen Shen,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/02/Mountainous-Backlog-Stalls-MediCal-Expansion-in-California.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>A massive backlog of Medi-Cal applications is well into its third month, and California officials have provided little information about how and when the largest such bottleneck in the nation might be cleared.\u003c/p>\n\u003cp>The California Department of Health Care Services in Sacramento first reported 800,000 pending applications in April. By May, that number had grown by 100,000 and has not budged much since. As the state works through older applications, new ones continue each day to enter the system, which has been plagued by computer glitches and inefficient procedures for verifying applicants' personal information.\u003c/p>\n\u003cp>There are no estimates of processing times or how long delays will persist, though a state official said last month that new applications in May appeared to have slowed.\u003c!--more-->\u003c/p>\n\u003cp>\"All the resources are just devoted to getting people moving forward,\" said Norman Williams, a department spokesman.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Not only has application processing been delayed, the state has fallen behind in sending final notifications to enrollees, officials confirmed. Meanwhile, many people are showing up at community clinics and costly emergency rooms as they have in the past. Others are putting off care.\u003c/p>\n\u003cp>Although Medi-Cal coverage is retroactive from the time eligible patients apply, some don't trust they will be covered until they have a card in hand.\u003c/p>\n\u003cp>\"I'm afraid to go to the hospital,\" said Adolfo Rodriguez, 35, of East Palo Alto. \"I can't afford it.\"\u003c/p>\n\u003cp>Rodriguez’s Medi-Cal application has been pending since March. In the meantime, he said, he can't do his job as a truck driver – he needs to see a specialist about severe muscle and joint pain.\u003c/p>\n\u003cp>Part of the problem is high demand. In California, as in many of the 26 states that opted to expand Medicaid eligibility under the Affordable Care Act, people turned out in much higher numbers than projected. The state health department said it now expects 2.2 million people to enroll in Medi-Cal this month —300,000 more than estimated last fall.\u003c/p>\n\u003cp>Since last fall, 40 percent more people have signed up for Medi-Cal than the number who enrolled in private insurance through Covered California, the state’s health insurance exchange. Roughly 1.4 million of those applicants were newly eligible for Medi-Cal, which was expanded to serve people up to 138 percent of the federal poverty level. About 600,000 more were previously eligible for coverage but had not enrolled. Experts say the massive outreach campaigns across the country helped alert many of these people to their eligibility.\u003c/p>\n\u003cp>\u003cstrong>Unanswered Questions\u003c/strong>\u003c/p>\n\u003cp>State health officials said about half of the 900,000 pending applications have been filed within the past 45 days—the maximum processing period typically allowed by law. Little is known about the other half, and why they have exceeded this time window.\u003c/p>\n\u003cp>\"It's difficult to determine exactly who is in that 900,000 and for what reason,\" said Williams, the health department spokesman.\u003c/p>\n\u003cp>Although California experienced an initial swell of applications in December 2013, a second, enormous wave landed in March, as people scrambled to meet the deadline for obtaining insurance coverage.\u003c/p>\n\u003cp>\"We did not anticipate the surge in applications to this extent,\" said Anastasia Dodson, associate director of policy at the California Department of Health Care Services.\u003c/p>\n\u003cp>The state has refused to release the number of applications that were backlogged before April. \"The numbers for previous months probably wouldn't be accurate for readers,\" said Dodson. Among other reasons, she said that the health department did not realize how many duplicated applications were stuck in the mix, as frustrated users tried repeatedly to sign up for Medi-Cal. \"We had people who applied 30 times,\" Dodson said.\u003c/p>\n\u003cp>The department has since identified and removed duplicate applications to arrive at the figures that have been reported since April.\u003c/p>\n\u003cp>Though details remain sketchy, one problem was delayed development of an interface that would connect the state's new system with old county-based social services computer systems for verifying Medi-Cal eligibility. Some people were able to sign up smoothly by applying in-person at county health departments. But many applications submitted through the state website stalled.\u003c/p>\n\u003cp>Some applications have been delayed by missing or inaccurate information. Others have been slowed by outdated procedures for verifying residency—only recently replaced by an automated verification system.\u003c/p>\n\u003cp>Critics say that launching the Covered California insurance exchange was made a higher priority than improving the online enrollment process for Medi-Cal patients, despite their great numbers.\u003c/p>\n\u003cp>\"In a very short period of time, there was a lot of work to do, and I think the folks that make the priorities decided that the particular piece for Medi-Cal recipients could wait,\" said Frank Mecca, executive director of the County Welfare Directors Association of California.\u003c/p>\n\u003cp>\u003cstrong>Uncertainty For Providers And Patients\u003c/strong>\u003c/p>\n\u003cp>Although open enrollment for private insurance plans closed in April, Medi-Cal enrollment remains open year-round, leaving little breathing room for health officials.\u003c/p>\n\u003cp>The holdup in Medi-Cal approvals has led to financial uncertainty for many of California's community health clinics, which depend on Medi-Cal payments to supplement the reduced fees or fee waivers they accept from low-income, uninsured patients. A number of centers have recently expanded facilities, staff and services in anticipation of a wave of Medi-Cal patients and the extra cash they would bring.\u003c/p>\n\u003cp>\"We basically don't know if we're going to be receiving payment for the services we're providing,\" said Carmela Castellano-Garcia, chief executive of the California Primary Care Association, which represents more than 1,000 community clinics and health centers. Private providers are even more wary.\u003c/p>\n\u003cp>\"A typical private practice might say, 'You're uninsured,' and be unwilling to participate in that bureaucracy of claims that need to be paid retroactively,\" said Dylan Roby, a health policy professor at the University of California, Los Angeles. Patients, too, have been left in limbo.\u003c/p>\n\u003cp>“They're afraid they may not be approved and that they'll be stuck with this huge bill,\" said Irais Bazan, an enrollment and eligibility manager at Ravenswood Family Health Center in East Palo Alto.\u003c/p>\n\u003cp>Rodriguez said he that he did not know about his retroactive payment options when he visited a county hospital in San Mateo two months ago for his muscle and joint pains. He borrowed money from his brother to pay off the $1,400 bill—much larger than he had expected.\u003c/p>\n\u003cp>He could not afford the pain medications that the doctor prescribed. He still does not have a diagnosis and said he will not try again until his Medi-Cal card arrives.\u003c/p>\n\u003cp>Thomas Kurthy of Los Angeles is waiting for his Medi-Cal card so that he can get a physical and a colonoscopy. His father was recently treated for cancer, and Kurthy said he wants to stay on top of his health.\u003c/p>\n\u003cp>His last doctor's visit was in 2012. Since January, the 51-year-old garden designer has amassed a large folder of notes as he has tried to follow up with local health advocates, navigators, county health workers, and others who at various times have handled his Medi-Cal application.\u003c/p>\n\u003cp>\"I've been bounced around from office to office, person to person,\" said Kurthy. \"I think if I didn't stay on top of this, I would never hear from anybody.\"\u003c/p>\n\u003cp>Last month, a county health worker told Kurthy that his application had a good chance of being decided within the next 30 to 45 days.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org\" target=\"_blank\">Kaiser Health News\u003c/a> (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20007\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/83121913crop.jpg\">\u003cimg class=\"size-large wp-image-20007\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/83121913crop-640x429.jpg\" alt=\"It's not clear when the backlog will be cleared. (Getty Images)\" width=\"640\" height=\"429\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">It's not clear when the backlog will be cleared. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Helen Shen,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/July/02/Mountainous-Backlog-Stalls-MediCal-Expansion-in-California.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>A massive backlog of Medi-Cal applications is well into its third month, and California officials have provided little information about how and when the largest such bottleneck in the nation might be cleared.\u003c/p>\n\u003cp>The California Department of Health Care Services in Sacramento first reported 800,000 pending applications in April. By May, that number had grown by 100,000 and has not budged much since. As the state works through older applications, new ones continue each day to enter the system, which has been plagued by computer glitches and inefficient procedures for verifying applicants' personal information.\u003c/p>\n\u003cp>There are no estimates of processing times or how long delays will persist, though a state official said last month that new applications in May appeared to have slowed.\u003c!--more-->\u003c/p>\n\u003cp>\"All the resources are just devoted to getting people moving forward,\" said Norman Williams, a department spokesman.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Not only has application processing been delayed, the state has fallen behind in sending final notifications to enrollees, officials confirmed. Meanwhile, many people are showing up at community clinics and costly emergency rooms as they have in the past. Others are putting off care.\u003c/p>\n\u003cp>Although Medi-Cal coverage is retroactive from the time eligible patients apply, some don't trust they will be covered until they have a card in hand.\u003c/p>\n\u003cp>\"I'm afraid to go to the hospital,\" said Adolfo Rodriguez, 35, of East Palo Alto. \"I can't afford it.\"\u003c/p>\n\u003cp>Rodriguez’s Medi-Cal application has been pending since March. In the meantime, he said, he can't do his job as a truck driver – he needs to see a specialist about severe muscle and joint pain.\u003c/p>\n\u003cp>Part of the problem is high demand. In California, as in many of the 26 states that opted to expand Medicaid eligibility under the Affordable Care Act, people turned out in much higher numbers than projected. The state health department said it now expects 2.2 million people to enroll in Medi-Cal this month —300,000 more than estimated last fall.\u003c/p>\n\u003cp>Since last fall, 40 percent more people have signed up for Medi-Cal than the number who enrolled in private insurance through Covered California, the state’s health insurance exchange. Roughly 1.4 million of those applicants were newly eligible for Medi-Cal, which was expanded to serve people up to 138 percent of the federal poverty level. About 600,000 more were previously eligible for coverage but had not enrolled. Experts say the massive outreach campaigns across the country helped alert many of these people to their eligibility.\u003c/p>\n\u003cp>\u003cstrong>Unanswered Questions\u003c/strong>\u003c/p>\n\u003cp>State health officials said about half of the 900,000 pending applications have been filed within the past 45 days—the maximum processing period typically allowed by law. Little is known about the other half, and why they have exceeded this time window.\u003c/p>\n\u003cp>\"It's difficult to determine exactly who is in that 900,000 and for what reason,\" said Williams, the health department spokesman.\u003c/p>\n\u003cp>Although California experienced an initial swell of applications in December 2013, a second, enormous wave landed in March, as people scrambled to meet the deadline for obtaining insurance coverage.\u003c/p>\n\u003cp>\"We did not anticipate the surge in applications to this extent,\" said Anastasia Dodson, associate director of policy at the California Department of Health Care Services.\u003c/p>\n\u003cp>The state has refused to release the number of applications that were backlogged before April. \"The numbers for previous months probably wouldn't be accurate for readers,\" said Dodson. Among other reasons, she said that the health department did not realize how many duplicated applications were stuck in the mix, as frustrated users tried repeatedly to sign up for Medi-Cal. \"We had people who applied 30 times,\" Dodson said.\u003c/p>\n\u003cp>The department has since identified and removed duplicate applications to arrive at the figures that have been reported since April.\u003c/p>\n\u003cp>Though details remain sketchy, one problem was delayed development of an interface that would connect the state's new system with old county-based social services computer systems for verifying Medi-Cal eligibility. Some people were able to sign up smoothly by applying in-person at county health departments. But many applications submitted through the state website stalled.\u003c/p>\n\u003cp>Some applications have been delayed by missing or inaccurate information. Others have been slowed by outdated procedures for verifying residency—only recently replaced by an automated verification system.\u003c/p>\n\u003cp>Critics say that launching the Covered California insurance exchange was made a higher priority than improving the online enrollment process for Medi-Cal patients, despite their great numbers.\u003c/p>\n\u003cp>\"In a very short period of time, there was a lot of work to do, and I think the folks that make the priorities decided that the particular piece for Medi-Cal recipients could wait,\" said Frank Mecca, executive director of the County Welfare Directors Association of California.\u003c/p>\n\u003cp>\u003cstrong>Uncertainty For Providers And Patients\u003c/strong>\u003c/p>\n\u003cp>Although open enrollment for private insurance plans closed in April, Medi-Cal enrollment remains open year-round, leaving little breathing room for health officials.\u003c/p>\n\u003cp>The holdup in Medi-Cal approvals has led to financial uncertainty for many of California's community health clinics, which depend on Medi-Cal payments to supplement the reduced fees or fee waivers they accept from low-income, uninsured patients. A number of centers have recently expanded facilities, staff and services in anticipation of a wave of Medi-Cal patients and the extra cash they would bring.\u003c/p>\n\u003cp>\"We basically don't know if we're going to be receiving payment for the services we're providing,\" said Carmela Castellano-Garcia, chief executive of the California Primary Care Association, which represents more than 1,000 community clinics and health centers. Private providers are even more wary.\u003c/p>\n\u003cp>\"A typical private practice might say, 'You're uninsured,' and be unwilling to participate in that bureaucracy of claims that need to be paid retroactively,\" said Dylan Roby, a health policy professor at the University of California, Los Angeles. Patients, too, have been left in limbo.\u003c/p>\n\u003cp>“They're afraid they may not be approved and that they'll be stuck with this huge bill,\" said Irais Bazan, an enrollment and eligibility manager at Ravenswood Family Health Center in East Palo Alto.\u003c/p>\n\u003cp>Rodriguez said he that he did not know about his retroactive payment options when he visited a county hospital in San Mateo two months ago for his muscle and joint pains. He borrowed money from his brother to pay off the $1,400 bill—much larger than he had expected.\u003c/p>\n\u003cp>He could not afford the pain medications that the doctor prescribed. He still does not have a diagnosis and said he will not try again until his Medi-Cal card arrives.\u003c/p>\n\u003cp>Thomas Kurthy of Los Angeles is waiting for his Medi-Cal card so that he can get a physical and a colonoscopy. His father was recently treated for cancer, and Kurthy said he wants to stay on top of his health.\u003c/p>\n\u003cp>His last doctor's visit was in 2012. Since January, the 51-year-old garden designer has amassed a large folder of notes as he has tried to follow up with local health advocates, navigators, county health workers, and others who at various times have handled his Medi-Cal application.\u003c/p>\n\u003cp>\"I've been bounced around from office to office, person to person,\" said Kurthy. \"I think if I didn't stay on top of this, I would never hear from anybody.\"\u003c/p>\n\u003cp>Last month, a county health worker told Kurthy that his application had a good chance of being decided within the next 30 to 45 days.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org\" target=\"_blank\">Kaiser Health News\u003c/a> (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Advocates Urge Repeal of 'Maximum Family Grant'",
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"content": "\u003cfigure id=\"attachment_14796\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/RS1369_IMG_1902-scr-e1378443813373.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-14796\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/RS1369_IMG_1902-scr-640x480.jpg\" alt=\"(Craig Miller/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Craig Miller/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>If you looked at that headline and thought, “What is the \u003ca href=\"http://www.cdss.ca.gov/cdssweb/entres/forms/English/CW2102.PDF\" target=\"_blank\" rel=\"noopener\">maximum family grant\u003c/a>?” you’re probably not alone.\u003c/p>\n\u003caside class=\"pullquote alignleft\">‘We’re choosing to have a policy which penalizes the poor child and the woman who is poor.’\u003c/aside>\n\u003cp>Twenty years ago this week, in the midst of the Clinton-era welfare reforms, California became one of 16 states to pass a limit on assistance to new children born into families that had been receiving welfare benefits in the 10 months before the child was born. In California, the welfare program is called CalWORKs.\u003c/p>\n\u003cp>The idea was to prevent people receiving aid from having more children.\u003c!--more-->\u003c/p>\n\u003cp>That law is still on the books and today, according to \u003ca href=\"http://media.wix.com/ugd/dd1ec6_4bfec98b43584002b054d41ccfdaa26d.pdf\" target=\"_blank\" rel=\"noopener\">a brief \u003c/a>from the Western Center on Law and Poverty (WCLP), 13.4 percent of children in CalWORKs households — that’s 143,300 children — are “currently impacted by the (maximum family grant) rule.”\u003c/p>\n\u003cp>CalWORKs provides needy families with basic-needs cash grants, and it’s not much. According to WCLP, the average grant is $464 per month. That puts a family of three at roughly 29 percent of the federal poverty level. The maximum grant would push families up to 41 percent of the poverty level.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>If the maximum family grant (MFG) rule were repealed, most households would receive an additional $122 per month.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml\" target=\"_blank\" rel=\"noopener\">SB899\u003c/a> would do just that, but the bill is currently on hold in the California Senate.\u003c/p>\n\u003cp>In the meantime, senators will vote Thursday on \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SR54\" target=\"_blank\" rel=\"noopener\">a resolution\u003c/a> to repeal the rule “as soon as legislatively possible.”\u003c/p>\n\u003cp>The movement to repeal the law has drawn together groups that are not normally on the same side of an issue. In addition to the Western Center on Law and Poverty, the ACLU, Planned Parenthood and the Catholic Conference all support its overturn.\u003c/p>\n\u003cp>Ned Dolejsi, executive director of the California Catholic Conference, pointed to research showing that people on public assistance don’t have more children than the general population. “We’re choosing to have a policy which penalizes the poor child and the woman who is poor,” he said, “and we’re penalizing them for no particular good public policy reason.”\u003c/p>\n\u003cp>In addition, he said, “essentially the state is incentivizing poor women to choose an abortion, since the state says we’re not going to give you any assistance to raise a child.”\u003c/p>\n\u003cp>A withering piece \u003ca href=\"http://www.slate.com/articles/news_and_politics/politics/2014/06/the_maximum_family_grant_and_family_caps_a_racist_law_that_punishes_the.single.html\" target=\"_blank\" rel=\"noopener\">on Slate\u003c/a> calls the rule “the most discriminatory law in the land” and notes:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"color: #281b21\">And, for all the ways these laws disadvantage poor families, they also fail in their purported mission of reducing family size. Several studies—including a \u003c/span>\u003ca style=\"color: #660033\" href=\"http://www.gao.gov/new.items/d01924.pdf\" target=\"_blank\" rel=\"noopener\">2001 analysis\u003c/a> \u003cspan style=\"color: #281b21\">from the Government Accounting Office—have found no substantial relationship between welfare caps and a reduction in births. “Despite the political attractiveness of caps,“ writes researcher Michael Wiseman in a \u003c/span>\u003ca style=\"color: #660033\" href=\"https://www.evernote.com/shard/s4/sh/db646634-a7fc-4ccd-a16f-890b2ce5b442/12071c59f74d88397382b00a24e8726c\" target=\"_blank\" rel=\"noopener\">2000 study\u003c/a>\u003cspan style=\"color: #281b21\"> on welfare policy and children, “there is little empirical support for expecting them to do much beyond reducing costs. …”\u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>While repealing the rule would cost California about $220 million annually, the Urban Institute estimates that it could \u003ca href=\"http://www.urban.org/uploadedpdf/411334_welfare_policies.pdf\" target=\"_blank\" rel=\"noopener\">reduce childhood poverty rates by 7 to 13 percent\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14796\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/RS1369_IMG_1902-scr-e1378443813373.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-14796\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/RS1369_IMG_1902-scr-640x480.jpg\" alt=\"(Craig Miller/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Craig Miller/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>If you looked at that headline and thought, “What is the \u003ca href=\"http://www.cdss.ca.gov/cdssweb/entres/forms/English/CW2102.PDF\" target=\"_blank\" rel=\"noopener\">maximum family grant\u003c/a>?” you’re probably not alone.\u003c/p>\n\u003caside class=\"pullquote alignleft\">‘We’re choosing to have a policy which penalizes the poor child and the woman who is poor.’\u003c/aside>\n\u003cp>Twenty years ago this week, in the midst of the Clinton-era welfare reforms, California became one of 16 states to pass a limit on assistance to new children born into families that had been receiving welfare benefits in the 10 months before the child was born. In California, the welfare program is called CalWORKs.\u003c/p>\n\u003cp>The idea was to prevent people receiving aid from having more children.\u003c!--more-->\u003c/p>\n\u003cp>That law is still on the books and today, according to \u003ca href=\"http://media.wix.com/ugd/dd1ec6_4bfec98b43584002b054d41ccfdaa26d.pdf\" target=\"_blank\" rel=\"noopener\">a brief \u003c/a>from the Western Center on Law and Poverty (WCLP), 13.4 percent of children in CalWORKs households — that’s 143,300 children — are “currently impacted by the (maximum family grant) rule.”\u003c/p>\n\u003cp>CalWORKs provides needy families with basic-needs cash grants, and it’s not much. According to WCLP, the average grant is $464 per month. That puts a family of three at roughly 29 percent of the federal poverty level. The maximum grant would push families up to 41 percent of the poverty level.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If the maximum family grant (MFG) rule were repealed, most households would receive an additional $122 per month.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml\" target=\"_blank\" rel=\"noopener\">SB899\u003c/a> would do just that, but the bill is currently on hold in the California Senate.\u003c/p>\n\u003cp>In the meantime, senators will vote Thursday on \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SR54\" target=\"_blank\" rel=\"noopener\">a resolution\u003c/a> to repeal the rule “as soon as legislatively possible.”\u003c/p>\n\u003cp>The movement to repeal the law has drawn together groups that are not normally on the same side of an issue. In addition to the Western Center on Law and Poverty, the ACLU, Planned Parenthood and the Catholic Conference all support its overturn.\u003c/p>\n\u003cp>Ned Dolejsi, executive director of the California Catholic Conference, pointed to research showing that people on public assistance don’t have more children than the general population. “We’re choosing to have a policy which penalizes the poor child and the woman who is poor,” he said, “and we’re penalizing them for no particular good public policy reason.”\u003c/p>\n\u003cp>In addition, he said, “essentially the state is incentivizing poor women to choose an abortion, since the state says we’re not going to give you any assistance to raise a child.”\u003c/p>\n\u003cp>A withering piece \u003ca href=\"http://www.slate.com/articles/news_and_politics/politics/2014/06/the_maximum_family_grant_and_family_caps_a_racist_law_that_punishes_the.single.html\" target=\"_blank\" rel=\"noopener\">on Slate\u003c/a> calls the rule “the most discriminatory law in the land” and notes:\u003c/p>\n\u003cblockquote>\u003cp>\u003cspan style=\"color: #281b21\">And, for all the ways these laws disadvantage poor families, they also fail in their purported mission of reducing family size. Several studies—including a \u003c/span>\u003ca style=\"color: #660033\" href=\"http://www.gao.gov/new.items/d01924.pdf\" target=\"_blank\" rel=\"noopener\">2001 analysis\u003c/a> \u003cspan style=\"color: #281b21\">from the Government Accounting Office—have found no substantial relationship between welfare caps and a reduction in births. “Despite the political attractiveness of caps,“ writes researcher Michael Wiseman in a \u003c/span>\u003ca style=\"color: #660033\" href=\"https://www.evernote.com/shard/s4/sh/db646634-a7fc-4ccd-a16f-890b2ce5b442/12071c59f74d88397382b00a24e8726c\" target=\"_blank\" rel=\"noopener\">2000 study\u003c/a>\u003cspan style=\"color: #281b21\"> on welfare policy and children, “there is little empirical support for expecting them to do much beyond reducing costs. …”\u003c/span>\u003c/p>\u003c/blockquote>\n\u003cp>While repealing the rule would cost California about $220 million annually, the Urban Institute estimates that it could \u003ca href=\"http://www.urban.org/uploadedpdf/411334_welfare_policies.pdf\" target=\"_blank\" rel=\"noopener\">reduce childhood poverty rates by 7 to 13 percent\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Opposing Sides Testify Before State Committee over Insurance Proposition",
"title": "Opposing Sides Testify Before State Committee over Insurance Proposition",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_16359\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/PEterLeeCROP-e1386913666627.jpg\">\u003cimg class=\"size-large wp-image-16359\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/PEterLeeCROP-640x464.jpg\" alt=\"Peter Lee, seen here in a 2012 photo, is the executive director of Covered California and testified Thursday before the joint legislative committee on health.\" width=\"640\" height=\"464\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Peter Lee, seen here in a 2012 photo, is the executive director of Covered California and testified Thursday before the joint legislative committee on health.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan>State insurance commissioner Dave Jones is flatly rejecting accusations that a proposition on November's ballot would undermine the implementation of the Affordable Care Act in California.\u003c/span>\u003c/p>\n\u003cp>If passed by voters, Proposition 45 would give the commissioner the power to reject excessive rate hikes for health insurance –- and, he argues, keep health premiums affordable for consumers. Last month, Covered California, the state’s health insurance exchange, said the measure could compromise its operations, possibly causing delays in approving health plans before they are federally mandated to go on sale to consumers, or curtailing its own authority to negotiate the details of plans with insurers.\u003c/p>\n\u003cp>“These conclusions are fundamentally flawed,” Jones said on Wednesday, speaking before the state’s joint legislative committee on health.\u003c!--more-->\u003c/p>\n\u003cp>Jones issued a letter to the members of the committee detailing responses to the concerns and questions raised by Covered California. He said delays were unlikely given the small number of health insurers (40) and plans (100 per year) the commissioner would be tasked with overseeing under the initiative. This is compared to property insurers (500) and rate filings (7,000 year) currently overseen by his department.\u003c/p>\n\u003cp>He also emphasized that the scope of review under the measure would be limited to rates only. Covered California officials called the wording of the proposition “broad,” and said it could be interpreted to grant the commissioner power to review not only rates, but also specific benefits of health plans and the network of providers included in a plan.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It doesn’t. It doesn’t,” Jones said at the hearing. He argued that if voters do not pass the proposition, California would see less competition in the health insurance market, leaving consumers with less choice and ever-increasing health insurance premiums. He said Covered California failed to negotiate better rates for consumers last year, noting premiums on individual plans for 2013 had increased between 21 and 88 percent the following year.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said there is more to plans than just the premiums. Testifying at Wednesday’s hearing, he conceded on the point of timing, expressing new confidence that his and Jones’ agencies could work together to meet federally set deadlines for approving health plans before the start of open enrollment in mid-November. However, he said there could still be negative implications.\u003c/p>\n\u003cp>His main concern is that health insurers will simply withdraw their plans from the marketplace if the rates are rejected by the commissioner. This would leave consumers with less plans to choose from, and complicate how federal subsidies are calculated for all the consumers in that region. Subsidies, the financial assistance provided by the federal government to pay for plans, are calculated based, in part, on the number of plans available for sale in a particular market and prices. If one plan withdraws, or offers the previous year’s plan at the previous year’s rate, that complicates the calculation.\u003c/p>\n\u003cp>“The only thing we can be sure of is the uncertainty of the products that would be available,” Lee said.\u003c/p>\n\u003cp>Lee also responded to questions from committee members who worried that the measure would cause health insurers to become singularly focused on keeping rates down at the expense of the benefits included in health plans.\u003c/p>\n\u003cp>“People can get something cheap, but it may not have a good value,” said Assemblymember Richard Pan (D-Sacramento). “I hear from physicians who take care of minority populations. It is important that they are part of networks…and it is important for Covered California to make sure we have plans that pay attention to those things.”\u003c/p>\n\u003cp>Lee said the measure might compromise Covered California’s power to negotiate these plan designs, as well as efforts to promote innovation among plans. He said his agency wants to encourage plans to try new care delivery models or payment models that emphasize preventive care and could ultimately result in better health for patients in the long term.\u003c/p>\n\u003cp>“It may be that contracting with them costs more on the front end, but has better back end results in terms of outcomes,” he said, adding that the opportunity to experiment with these models could be lost of insurers focus only on providing the cheapest plan now. “This ripple effect is one of the big uncertainties.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Members of the joint committee called on both sides to conduct further analysis.\u003c/p>\n\n",
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"excerpt": "Prop. 45 would give the CA insurance commissioner power to reject excessive health insurance premiums.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16359\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/PEterLeeCROP-e1386913666627.jpg\">\u003cimg class=\"size-large wp-image-16359\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/11/PEterLeeCROP-640x464.jpg\" alt=\"Peter Lee, seen here in a 2012 photo, is the executive director of Covered California and testified Thursday before the joint legislative committee on health.\" width=\"640\" height=\"464\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Peter Lee, seen here in a 2012 photo, is the executive director of Covered California and testified Thursday before the joint legislative committee on health.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan>State insurance commissioner Dave Jones is flatly rejecting accusations that a proposition on November's ballot would undermine the implementation of the Affordable Care Act in California.\u003c/span>\u003c/p>\n\u003cp>If passed by voters, Proposition 45 would give the commissioner the power to reject excessive rate hikes for health insurance –- and, he argues, keep health premiums affordable for consumers. Last month, Covered California, the state’s health insurance exchange, said the measure could compromise its operations, possibly causing delays in approving health plans before they are federally mandated to go on sale to consumers, or curtailing its own authority to negotiate the details of plans with insurers.\u003c/p>\n\u003cp>“These conclusions are fundamentally flawed,” Jones said on Wednesday, speaking before the state’s joint legislative committee on health.\u003c!--more-->\u003c/p>\n\u003cp>Jones issued a letter to the members of the committee detailing responses to the concerns and questions raised by Covered California. He said delays were unlikely given the small number of health insurers (40) and plans (100 per year) the commissioner would be tasked with overseeing under the initiative. This is compared to property insurers (500) and rate filings (7,000 year) currently overseen by his department.\u003c/p>\n\u003cp>He also emphasized that the scope of review under the measure would be limited to rates only. Covered California officials called the wording of the proposition “broad,” and said it could be interpreted to grant the commissioner power to review not only rates, but also specific benefits of health plans and the network of providers included in a plan.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It doesn’t. It doesn’t,” Jones said at the hearing. He argued that if voters do not pass the proposition, California would see less competition in the health insurance market, leaving consumers with less choice and ever-increasing health insurance premiums. He said Covered California failed to negotiate better rates for consumers last year, noting premiums on individual plans for 2013 had increased between 21 and 88 percent the following year.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said there is more to plans than just the premiums. Testifying at Wednesday’s hearing, he conceded on the point of timing, expressing new confidence that his and Jones’ agencies could work together to meet federally set deadlines for approving health plans before the start of open enrollment in mid-November. However, he said there could still be negative implications.\u003c/p>\n\u003cp>His main concern is that health insurers will simply withdraw their plans from the marketplace if the rates are rejected by the commissioner. This would leave consumers with less plans to choose from, and complicate how federal subsidies are calculated for all the consumers in that region. Subsidies, the financial assistance provided by the federal government to pay for plans, are calculated based, in part, on the number of plans available for sale in a particular market and prices. If one plan withdraws, or offers the previous year’s plan at the previous year’s rate, that complicates the calculation.\u003c/p>\n\u003cp>“The only thing we can be sure of is the uncertainty of the products that would be available,” Lee said.\u003c/p>\n\u003cp>Lee also responded to questions from committee members who worried that the measure would cause health insurers to become singularly focused on keeping rates down at the expense of the benefits included in health plans.\u003c/p>\n\u003cp>“People can get something cheap, but it may not have a good value,” said Assemblymember Richard Pan (D-Sacramento). “I hear from physicians who take care of minority populations. It is important that they are part of networks…and it is important for Covered California to make sure we have plans that pay attention to those things.”\u003c/p>\n\u003cp>Lee said the measure might compromise Covered California’s power to negotiate these plan designs, as well as efforts to promote innovation among plans. He said his agency wants to encourage plans to try new care delivery models or payment models that emphasize preventive care and could ultimately result in better health for patients in the long term.\u003c/p>\n\u003cp>“It may be that contracting with them costs more on the front end, but has better back end results in terms of outcomes,” he said, adding that the opportunity to experiment with these models could be lost of insurers focus only on providing the cheapest plan now. “This ripple effect is one of the big uncertainties.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Members of the joint committee called on both sides to conduct further analysis.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hobby Lobby Decision Has Limited Impact in California",
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"content": "\u003cfigure id=\"attachment_19909\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/451505174.jpg\">\u003cimg class=\"size-large wp-image-19909\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/451505174-640x420.jpg\" alt=\" Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores was announced Monday. (Chip Somodevilla/Getty Images)\" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores was announced Monday. (Chip Somodevilla/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Most women in California won't be affected by Monday's U.S. Supreme Court \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/Supreme-Court-Limits-Contraceptive-Mandate-For-Certain-Employers.aspx\" target=\"_blank\">landmark decision \u003c/a>in Sebelius v. Hobby Lobby. The Christian owners of the craft store chain challenged the Affordable Care Act's requirement that companies provide contraception coverage to their employees. The Court ruled that closely-held, for-profit companies can opt out if they object on religious grounds.\u003c/p>\n\u003cp>But it's not so easy in California. That’s because the ruling doesn’t apply to state laws. California has had the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB39&search_keywords=\" target=\"_blank\">Women's Contraceptive Equity Act\u003c/a> on the books since 1999. It requires health insurance companies that cover prescription drugs to also cover birth control.\u003c/p>\n\u003cp>“For most workers in California, nothing will change,” says Maggie Crosby, attorney with the ACLU of Northern California. “Women should feel secure that if they have birth control coverage today, they will have it tomorrow.”\u003c/p>\n\u003cp>She says the state law is still in full effect after Monday's Supreme Court ruling.\u003c!--more-->\u003c/p>\n\u003cp>“If there is anything that is not the boss’ business, it is whether an employee uses contraception,” she says. “That is the rule in California.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>More than two dozen\u003ca href=\"http://www.guttmacher.org/statecenter/spibs/spib_ICC.pdf\" target=\"_blank\"> other states have similar laws\u003c/a>, including Texas, Massachusetts, and New Jersey. Those state laws stick because of the legal reasoning on which the Court based its ruling. Lawyers for Hobby Lobby argued the company could claim religious rights under a federal law, the Religious Freedom Restoration Act, and the First Amendment of the Constitution.\u003c/p>\n\u003cp>“The Court decided not to rely on the First Amendment claim, but instead to rely on the statutory claim,” says Joel Paul, law professor at U.C. Hastings College of the Law. “That means the decision only applies to federal laws. If a state, like California, requires employers to provide contraceptive coverage, that law survives this decision.”\u003c/p>\n\u003cp>But there is an exception to the exception. Hobby Lobby is self-insured, meaning the company hires an insurer to manage care, but Hobby Lobby puts up the money to cover its employees’ claims and accepts all liability if the claims end up exceeding the money it initially sets aside.\u003c/p>\n\u003cp>Companies that self-insure are governed by a federal law known as ERISA, the Employee Retirement Income Security Act. They are not required to comply with state laws, like California’s contraceptive equity act. So Hobby Lobby, which has 26 locations in California, is not required to provide birth control coverage to those employees.\u003c/p>\n\u003cp>The company did not comment on the details of the state law, but issued a statement saying it was “overjoyed” by the court's decision.\u003c/p>\n\u003cp>“The nation’s highest court has re-affirmed the vital importance of religious liberty as one of our country's founding principles,\" said Barbara Green, co-founder of Hobby Lobby.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/156863156&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>Most companies in California that choose to self-insure are large, public companies that do not fall into the category of companies the Court’s decision is limited to – \"closely held\" companies, where half the company is owned by five individuals or fewer.\u003c/p>\n\u003cp>Janice Rocco, a spokesperson for the California Department of Insurance, said the exact number of companies that fall into both categories - closely held and self insured - is unknown, but expected to be small.\u003c/p>\n\u003cp>“I’m not sure there would be a huge number of employers availing themselves of this decision,” she said. “At least in California, the applicability of the decision on employers is going to be minimal in terms of there being changes.”\u003c/p>\n\u003cp>But the California law has gaps and health care advocates plan to use political momentum against the court's ruling to push for further changes in the state law. The contraceptive equity act does not require companies to provide contraceptives at no charge to the patient, the way the Affordable Care Act does. A bill currently working its way through the state legislature would eliminate co-pays and other cost sharing for birth control. It would also prevent insurers from requiring women to “fail” cheaper birth control methods before paying for more expensive ones.\u003c/p>\n\u003cp>“There's one insurer in California that makes women take oral contraceptive pills for three months before she can get access to the ring, when the ring might be the best method for her,” said Susan Berke Fogel of the National Health Law Program. “Or, others are imposing cost sharing on IUDs [intra-uterine devices], which makes it absolutely unaffordable.”\u003c/p>\n\u003cp>She believes the Supreme Court decision in Hobby Lobby will embolden California lawmakers to pass the bill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And there's at least one more twist in the complicated interpretation of the court's decision. Julie Rovner reports for Kaiser Health News that large companies are subject to a year 2000 \u003ca href=\"http://www.eeoc.gov/policy/docs/decision-contraception.html\" target=\"_blank\">ruling from the Equal Employment Opportunity Commission\u003c/a>. \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/contraception-mandate-state-laws-EEOC-pregnancy-discrimination-act.aspx\" target=\"_blank\">From KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>[The ruling stated] that employers that fail to cover contraception as part of their health insurance benefit package are \u003ca href=\"http://www.npr.org/blogs/health/2012/02/10/146662285/rules-requiring-contraceptive-coverage-have-been-in-force-for-years\" target=\"_blank\">discriminating against women\u003c/a> in violation of the 1978 Pregnancy Discrimination Act. That law was itself an amendment to the 1964 Civil Rights Act.\u003c/p>\n\u003cp>So what happens now? “It depends,” said Brigitte Amiri, senior staff attorney at the ACLU.\u003c/p>\n\u003cp>Employers that don’t want to offer some or full contraceptive coverage could sue to block the state contraceptive laws, “but that would be harder given how long some of those laws have been in effect,” she said.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://www.newrepublic.com/article/118303/hobby-lobby-case-what-if-court-strikes-down-contraception-mandate\" target=\"_blank\">others have suggested \u003c/a>that female employees of Hobby Lobby or other companies that stop offering contraceptive coverage could turn back to the courts for relief themselves, charging gender discrimination.\u003c/p>\n\u003cp>“There will be no shortage of exciting moments in the coming months,” said Amiri.\u003c/p>\u003c/blockquote>\n\n",
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"excerpt": "While a Calif. law on contraceptive equity supersedes the court's decision, that law has limits, too.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19909\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/451505174.jpg\">\u003cimg class=\"size-large wp-image-19909\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/451505174-640x420.jpg\" alt=\" Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores was announced Monday. (Chip Somodevilla/Getty Images)\" width=\"640\" height=\"420\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Anti-abortion advocates rally in front of the Supreme Court awaiting the decision in Burwell v. Hobby Lobby Stores was announced Monday. (Chip Somodevilla/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Most women in California won't be affected by Monday's U.S. Supreme Court \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/Supreme-Court-Limits-Contraceptive-Mandate-For-Certain-Employers.aspx\" target=\"_blank\">landmark decision \u003c/a>in Sebelius v. Hobby Lobby. The Christian owners of the craft store chain challenged the Affordable Care Act's requirement that companies provide contraception coverage to their employees. The Court ruled that closely-held, for-profit companies can opt out if they object on religious grounds.\u003c/p>\n\u003cp>But it's not so easy in California. That’s because the ruling doesn’t apply to state laws. California has had the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=199920000AB39&search_keywords=\" target=\"_blank\">Women's Contraceptive Equity Act\u003c/a> on the books since 1999. It requires health insurance companies that cover prescription drugs to also cover birth control.\u003c/p>\n\u003cp>“For most workers in California, nothing will change,” says Maggie Crosby, attorney with the ACLU of Northern California. “Women should feel secure that if they have birth control coverage today, they will have it tomorrow.”\u003c/p>\n\u003cp>She says the state law is still in full effect after Monday's Supreme Court ruling.\u003c!--more-->\u003c/p>\n\u003cp>“If there is anything that is not the boss’ business, it is whether an employee uses contraception,” she says. “That is the rule in California.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>More than two dozen\u003ca href=\"http://www.guttmacher.org/statecenter/spibs/spib_ICC.pdf\" target=\"_blank\"> other states have similar laws\u003c/a>, including Texas, Massachusetts, and New Jersey. Those state laws stick because of the legal reasoning on which the Court based its ruling. Lawyers for Hobby Lobby argued the company could claim religious rights under a federal law, the Religious Freedom Restoration Act, and the First Amendment of the Constitution.\u003c/p>\n\u003cp>“The Court decided not to rely on the First Amendment claim, but instead to rely on the statutory claim,” says Joel Paul, law professor at U.C. Hastings College of the Law. “That means the decision only applies to federal laws. If a state, like California, requires employers to provide contraceptive coverage, that law survives this decision.”\u003c/p>\n\u003cp>But there is an exception to the exception. Hobby Lobby is self-insured, meaning the company hires an insurer to manage care, but Hobby Lobby puts up the money to cover its employees’ claims and accepts all liability if the claims end up exceeding the money it initially sets aside.\u003c/p>\n\u003cp>Companies that self-insure are governed by a federal law known as ERISA, the Employee Retirement Income Security Act. They are not required to comply with state laws, like California’s contraceptive equity act. So Hobby Lobby, which has 26 locations in California, is not required to provide birth control coverage to those employees.\u003c/p>\n\u003cp>The company did not comment on the details of the state law, but issued a statement saying it was “overjoyed” by the court's decision.\u003c/p>\n\u003cp>“The nation’s highest court has re-affirmed the vital importance of religious liberty as one of our country's founding principles,\" said Barbara Green, co-founder of Hobby Lobby.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/156863156&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>Most companies in California that choose to self-insure are large, public companies that do not fall into the category of companies the Court’s decision is limited to – \"closely held\" companies, where half the company is owned by five individuals or fewer.\u003c/p>\n\u003cp>Janice Rocco, a spokesperson for the California Department of Insurance, said the exact number of companies that fall into both categories - closely held and self insured - is unknown, but expected to be small.\u003c/p>\n\u003cp>“I’m not sure there would be a huge number of employers availing themselves of this decision,” she said. “At least in California, the applicability of the decision on employers is going to be minimal in terms of there being changes.”\u003c/p>\n\u003cp>But the California law has gaps and health care advocates plan to use political momentum against the court's ruling to push for further changes in the state law. The contraceptive equity act does not require companies to provide contraceptives at no charge to the patient, the way the Affordable Care Act does. A bill currently working its way through the state legislature would eliminate co-pays and other cost sharing for birth control. It would also prevent insurers from requiring women to “fail” cheaper birth control methods before paying for more expensive ones.\u003c/p>\n\u003cp>“There's one insurer in California that makes women take oral contraceptive pills for three months before she can get access to the ring, when the ring might be the best method for her,” said Susan Berke Fogel of the National Health Law Program. “Or, others are imposing cost sharing on IUDs [intra-uterine devices], which makes it absolutely unaffordable.”\u003c/p>\n\u003cp>She believes the Supreme Court decision in Hobby Lobby will embolden California lawmakers to pass the bill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And there's at least one more twist in the complicated interpretation of the court's decision. Julie Rovner reports for Kaiser Health News that large companies are subject to a year 2000 \u003ca href=\"http://www.eeoc.gov/policy/docs/decision-contraception.html\" target=\"_blank\">ruling from the Equal Employment Opportunity Commission\u003c/a>. \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/contraception-mandate-state-laws-EEOC-pregnancy-discrimination-act.aspx\" target=\"_blank\">From KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>[The ruling stated] that employers that fail to cover contraception as part of their health insurance benefit package are \u003ca href=\"http://www.npr.org/blogs/health/2012/02/10/146662285/rules-requiring-contraceptive-coverage-have-been-in-force-for-years\" target=\"_blank\">discriminating against women\u003c/a> in violation of the 1978 Pregnancy Discrimination Act. That law was itself an amendment to the 1964 Civil Rights Act.\u003c/p>\n\u003cp>So what happens now? “It depends,” said Brigitte Amiri, senior staff attorney at the ACLU.\u003c/p>\n\u003cp>Employers that don’t want to offer some or full contraceptive coverage could sue to block the state contraceptive laws, “but that would be harder given how long some of those laws have been in effect,” she said.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://www.newrepublic.com/article/118303/hobby-lobby-case-what-if-court-strikes-down-contraception-mandate\" target=\"_blank\">others have suggested \u003c/a>that female employees of Hobby Lobby or other companies that stop offering contraceptive coverage could turn back to the courts for relief themselves, charging gender discrimination.\u003c/p>\n\u003cp>“There will be no shortage of exciting moments in the coming months,” said Amiri.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cspan>Most women in California won't be affected by Monday's U.S. Supreme Court landmark decision in \u003c/span>\u003cem style=\"font-size: 14px\">Sebelius v. Hobby Lobby\u003c/em>\u003cspan>. The Christian owners of the craft store chain challenged the Affordable Care Act's requirement that companies provide contraception coverage to their employees. The Court ruled that closely-held, for-profit companies can opt out if they object on religious grounds.\u003c/span>\u003c/p>\n\u003cp>But it's not so easy in California. That’s because the ruling doesn’t apply to state laws. And California has had the Women's Contraceptive Equity Act on the books since 1999. It requires health insurance companies that cover prescription drugs to also cover birth control.\u003c/p>\n\u003cp>“For most workers in California, nothing will change,” says Maggie Crosby, attorney with the ACLU of Northern California. “Women should feel secure that if they have birth control coverage today, they will have it tomorrow.”\u003c!--more-->\u003c/p>\n\u003cp>She says the state law is still in full effect after Monday's Supreme Court ruling.\u003c/p>\n\u003cp>“If there is anything that is not the boss’ business, it is whether an employee uses contraception,” she says. “That is the rule in California.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>More than two dozen other states have similar laws, including Texas, Massachusetts, and New Jersey. The laws stick because of the legal reasoning on which the Court based its ruling. Lawyers for Hobby Lobby argued the company could claim religious rights under a federal law, the Religious Freedom Restoration Act, and the First Amendment of the Constitution.\u003c/p>\n\u003cp>“The Court decided not to rely on the First Amendment claim, but instead to rely on the statutory claim,” says Joel Paul, law professor at UC Hastings College of the Law. “That means the decision only applies to federal laws. If a state, like California, requires employers to provide contraceptive coverage, that law survives this decision.”\u003c/p>\n\u003cp>But there is an exception to the exception. Hobby Lobby is self-insured, meaning the company hires an insurer to manage care, but Hobby Lobby puts up the money to cover its employees’ claims and accepts all liability if the claims end up exceeding the money it initially sets aside.\u003c/p>\n\u003cp>Companies that self-insure are governed by a federal law, the Employee Retirement Income Security Act, or ERISA . They are not required to comply with state laws, like California’s contraceptive equity act. So Hobby Lobby, which has 26 locations in California, is not required to provide birth control coverage to those employees.\u003c/p>\n\u003cp>The company did not comment on the details of the state law, but issued a statement saying it was “overjoyed” by the overall decision.\u003c/p>\n\u003cp>“The nation’s highest court has re-affirmed the vital importance of religious liberty as one of our country's founding principles,\" said Barbara Green, co-founder of Hobby Lobby.\u003c/p>\n\u003cp>Most companies in California that choose to self-insure are large, public companies that do not fall into the category of companies the Court’s decision is limited to – \"closely held\" companies, where half the company is owned by five individuals or fewer.\u003c/p>\n\u003cp>Janice Rocco, a spokesperson for the California Department of Insurance, said the exact number of companies that fall into both categories - closely held and self insured - is unknown, but expected to be small.\u003c/p>\n\u003cp>“I’m not sure there would be a huge number of employers availing themselves of this decision,” she said. “At least in California, the applicability of the decision on employers is going to be minimal in terms of there being changes.”\u003c/p>\n\u003cp>Health care advocates do plan to use political momentum against the ruling to push for further changes in California law. The contraceptive equity act does not require companies\u003cbr>\nto provide contraceptives at no charge to the patient, the way the Affordable Care Act does. A bill currently working its way through the state legislature would eliminate co-pays and other cost sharing for birth control. It would also prevent insurers from requiring women to “fail” cheaper birth control methods before paying for more expensive ones.\u003c/p>\n\u003cp>“There's one insurer in California that makes women take oral contraceptive pills for three months before she can get access to the ring, when the ring might be the best method for her,” said Susan Berke Fogel of the National Health Law Program. “Or, others are imposing cost sharing on IUDs [intra-uterine devices], which makes it absolutely unaffordable.”\u003c/p>\n\u003cp>She believes the Supreme Court decision in Hobby Lobby will embolden California lawmakers to pass the bill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And there's at least one more twist in the complicated interpretation of the court's decision. Julie Rovner reports for Kaiser Health News that large companies are subject to a year 2000 \u003ca href=\"http://www.eeoc.gov/policy/docs/decision-contraception.html\" target=\"_blank\">ruling from the Equal Employment Opportunity Commission\u003c/a>. \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/contraception-mandate-state-laws-EEOC-pregnancy-discrimination-act.aspx\" target=\"_blank\">From KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>[The ruling stated] that employers that fail to cover contraception as part of their health insurance benefit package are \u003ca href=\"http://www.npr.org/blogs/health/2012/02/10/146662285/rules-requiring-contraceptive-coverage-have-been-in-force-for-years\" target=\"_blank\">discriminating against women\u003c/a> in violation of the 1978 Pregnancy Discrimination Act. That law was itself an amendment to the 1964 Civil Rights Act.\u003c/p>\n\u003cp>So what happens now? “It depends,” said Brigitte Amiri, senior staff attorney at the ACLU.\u003c/p>\n\u003cp>Employers that don’t want to offer some or full contraceptive coverage could sue to block the state contraceptive laws, “but that would be harder given how long some of those laws have been in effect,” she said.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://www.newrepublic.com/article/118303/hobby-lobby-case-what-if-court-strikes-down-contraception-mandate\" target=\"_blank\">others have suggested \u003c/a>that female employees of Hobby Lobby or other companies that stop offering contraceptive coverage could turn back to the courts for relief themselves, charging gender discrimination.\u003c/p>\n\u003cp>“There will be no shortage of exciting moments in the coming months,” said Amiri.\u003c/p>\u003c/blockquote>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan>Most women in California won't be affected by Monday's U.S. Supreme Court landmark decision in \u003c/span>\u003cem style=\"font-size: 14px\">Sebelius v. Hobby Lobby\u003c/em>\u003cspan>. The Christian owners of the craft store chain challenged the Affordable Care Act's requirement that companies provide contraception coverage to their employees. The Court ruled that closely-held, for-profit companies can opt out if they object on religious grounds.\u003c/span>\u003c/p>\n\u003cp>But it's not so easy in California. That’s because the ruling doesn’t apply to state laws. And California has had the Women's Contraceptive Equity Act on the books since 1999. It requires health insurance companies that cover prescription drugs to also cover birth control.\u003c/p>\n\u003cp>“For most workers in California, nothing will change,” says Maggie Crosby, attorney with the ACLU of Northern California. “Women should feel secure that if they have birth control coverage today, they will have it tomorrow.”\u003c!--more-->\u003c/p>\n\u003cp>She says the state law is still in full effect after Monday's Supreme Court ruling.\u003c/p>\n\u003cp>“If there is anything that is not the boss’ business, it is whether an employee uses contraception,” she says. “That is the rule in California.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>More than two dozen other states have similar laws, including Texas, Massachusetts, and New Jersey. The laws stick because of the legal reasoning on which the Court based its ruling. Lawyers for Hobby Lobby argued the company could claim religious rights under a federal law, the Religious Freedom Restoration Act, and the First Amendment of the Constitution.\u003c/p>\n\u003cp>“The Court decided not to rely on the First Amendment claim, but instead to rely on the statutory claim,” says Joel Paul, law professor at UC Hastings College of the Law. “That means the decision only applies to federal laws. If a state, like California, requires employers to provide contraceptive coverage, that law survives this decision.”\u003c/p>\n\u003cp>But there is an exception to the exception. Hobby Lobby is self-insured, meaning the company hires an insurer to manage care, but Hobby Lobby puts up the money to cover its employees’ claims and accepts all liability if the claims end up exceeding the money it initially sets aside.\u003c/p>\n\u003cp>Companies that self-insure are governed by a federal law, the Employee Retirement Income Security Act, or ERISA . They are not required to comply with state laws, like California’s contraceptive equity act. So Hobby Lobby, which has 26 locations in California, is not required to provide birth control coverage to those employees.\u003c/p>\n\u003cp>The company did not comment on the details of the state law, but issued a statement saying it was “overjoyed” by the overall decision.\u003c/p>\n\u003cp>“The nation’s highest court has re-affirmed the vital importance of religious liberty as one of our country's founding principles,\" said Barbara Green, co-founder of Hobby Lobby.\u003c/p>\n\u003cp>Most companies in California that choose to self-insure are large, public companies that do not fall into the category of companies the Court’s decision is limited to – \"closely held\" companies, where half the company is owned by five individuals or fewer.\u003c/p>\n\u003cp>Janice Rocco, a spokesperson for the California Department of Insurance, said the exact number of companies that fall into both categories - closely held and self insured - is unknown, but expected to be small.\u003c/p>\n\u003cp>“I’m not sure there would be a huge number of employers availing themselves of this decision,” she said. “At least in California, the applicability of the decision on employers is going to be minimal in terms of there being changes.”\u003c/p>\n\u003cp>Health care advocates do plan to use political momentum against the ruling to push for further changes in California law. The contraceptive equity act does not require companies\u003cbr>\nto provide contraceptives at no charge to the patient, the way the Affordable Care Act does. A bill currently working its way through the state legislature would eliminate co-pays and other cost sharing for birth control. It would also prevent insurers from requiring women to “fail” cheaper birth control methods before paying for more expensive ones.\u003c/p>\n\u003cp>“There's one insurer in California that makes women take oral contraceptive pills for three months before she can get access to the ring, when the ring might be the best method for her,” said Susan Berke Fogel of the National Health Law Program. “Or, others are imposing cost sharing on IUDs [intra-uterine devices], which makes it absolutely unaffordable.”\u003c/p>\n\u003cp>She believes the Supreme Court decision in Hobby Lobby will embolden California lawmakers to pass the bill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And there's at least one more twist in the complicated interpretation of the court's decision. Julie Rovner reports for Kaiser Health News that large companies are subject to a year 2000 \u003ca href=\"http://www.eeoc.gov/policy/docs/decision-contraception.html\" target=\"_blank\">ruling from the Equal Employment Opportunity Commission\u003c/a>. \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/June/30/contraception-mandate-state-laws-EEOC-pregnancy-discrimination-act.aspx\" target=\"_blank\">From KHN\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>[The ruling stated] that employers that fail to cover contraception as part of their health insurance benefit package are \u003ca href=\"http://www.npr.org/blogs/health/2012/02/10/146662285/rules-requiring-contraceptive-coverage-have-been-in-force-for-years\" target=\"_blank\">discriminating against women\u003c/a> in violation of the 1978 Pregnancy Discrimination Act. That law was itself an amendment to the 1964 Civil Rights Act.\u003c/p>\n\u003cp>So what happens now? “It depends,” said Brigitte Amiri, senior staff attorney at the ACLU.\u003c/p>\n\u003cp>Employers that don’t want to offer some or full contraceptive coverage could sue to block the state contraceptive laws, “but that would be harder given how long some of those laws have been in effect,” she said.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://www.newrepublic.com/article/118303/hobby-lobby-case-what-if-court-strikes-down-contraception-mandate\" target=\"_blank\">others have suggested \u003c/a>that female employees of Hobby Lobby or other companies that stop offering contraceptive coverage could turn back to the courts for relief themselves, charging gender discrimination.\u003c/p>\n\u003cp>“There will be no shortage of exciting moments in the coming months,” said Amiri.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Initial Mammogram Cost Comparisons in KQED's PriceCheck Project",
"title": "Initial Mammogram Cost Comparisons in KQED's PriceCheck Project",
"headTitle": "Price Check | State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_19667\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg\">\u003cimg class=\"size-full wp-image-19667\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg\" alt=\"(Illustration: Andy Warner)\" width=\"640\" height=\"206\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf-400x129.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf-320x103.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Illustration: Andy Warner)\u003c/figcaption>\u003c/figure>\n\u003cp>Last Monday, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">KQED\u003c/a>, \u003ca href=\"http://www.scpr.org/blogs/health/2014/06/23/16873/join-pricecheck-help-make-health-care-costs-more-t/\" target=\"_blank\">KPCC\u003c/a> and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a> launched our community-created guide to health costs.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Share what you paid for a mammogram. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Visit KQED's PriceCheck\u003c/a>. \u003c/aside>\n\u003cp>As\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\"> I outlined last week\u003c/a>, health care costs lack transparency, and it's virtually impossible for consumers to shop around. We're asking you, members of our KQED community, to share what you've paid for common health care procedures. Your responses feed directly into a database so others can look up how much mammograms cost in their area.\u003c/p>\n\u003cp>So far, we've received a handful of submitted prices. Our partner, ClearHealthCosts, had previously collected a range of \"self-pay\" prices -- that's the price people are charged if they do not have insurance or have decided to go out of their insurance network and are paying out of their own pocket.\u003c!--more-->\u003c/p>\n\u003cp>Those self-pay prices for a screening mammogram in the Bay Area range from $125 at the low end -- from NorCal Imaging in Walnut Creek -- to $801 at the other end at UCSF.\u003c/p>\n\u003cp>Here's a screen shot of some places in the middle:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.33.24-PM.png\">\u003cimg class=\"aligncenter wp-image-19813 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.33.24-PM.png\" alt=\"Screen Shot 2014-06-29 at 2.33.24 PM\" width=\"462\" height=\"614\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.33.24-PM.png 462w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.33.24-PM-400x532.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.33.24-PM-320x425.png 320w\" sizes=\"(max-width: 462px) 100vw, 462px\">\u003c/a>\u003c/p>\n\u003cp>Then there are the submitted prices. Here's a screenshot of two prices shared by women in the Bay Area (and thank you to them!). Remember, this is all anonymous:\u003c/p>\n\u003cfigure id=\"attachment_19814\" class=\"wp-caption aligncenter\" style=\"max-width: 465px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\">\u003cimg class=\"size-full wp-image-19814\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.40.20-PM.png\" alt=\"(screenshot of mammogram prices submitted by KQED audience members from our PriceCheck project)\" width=\"465\" height=\"441\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.40.20-PM.png 465w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.40.20-PM-400x379.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.40.20-PM-320x303.png 320w\" sizes=\"(max-width: 465px) 100vw, 465px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot of mammogram prices submitted by KQED audience members from our \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck project\u003c/a>.\u003c/figcaption>\u003c/figure>\n\u003cp>(As an aside, please bear with us as we refine this tool. We've just discovered that even though the two people above both are insured, the tool lists their insurer as \"Self-pay.\" We are fixing this!)\u003c/p>\n\u003cp>Screening mammograms are supposed to be covered at no co-pay or other costs to patients. This patient appeared to pay $300, but her comments detail that she also got an ultrasound.\u003c/p>\n\u003cfigure id=\"attachment_19815\" class=\"wp-caption aligncenter\" style=\"max-width: 459px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\">\u003cimg class=\"size-full wp-image-19815\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.04.43-PM.png\" alt=\"Screenshot from PRice Check.\" width=\"459\" height=\"240\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.04.43-PM.png 459w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.04.43-PM-400x209.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.04.43-PM-320x167.png 320w\" sizes=\"(max-width: 459px) 100vw, 459px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot from PRice Check.\u003c/figcaption>\u003c/figure>\n\u003cp>So what do these early data tell us? Starting with the final submission above, the apparent $300 co-pay, it's clear that consumers need to be careful about what procedures they're getting. While screening mammograms are supposed to be a zero-cost item for patients, diagnostic procedures are different. They are possibly subject to co-pays, depending on your insurance.\u003c/p>\n\u003caside class=\"pullquote alignright\">Learn more: \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">read all our PriceCheck coverage\u003c/a>. \u003c/aside>\n\u003cp>These early data demonstrate that there's tremendous cost variation -- especially on self-pay prices -- on screening mammograms in the Bay Area. While cost variation is well known in American medicine, there aren't a lot of places consumers can go to see prices laid out in front of them. If you're not insured or if you want to go out-of-network for a screening mammogram, these data, though not comprehensive, at least give you a starting point on price.\u003c/p>\n\u003cp>Finally, in addition to the handful of prices people have submitted to us, we've also been gratified that doctors have reached out to talk to us, too.\u003c/p>\n\u003cp>This week, Dr. Eli Chen in Morgan Hill emailed us that he'd had a patient come in with a flier of self-pay prices. Chen had a second price list as well. Here's one of them, from Valley Radiology Imaging. which lists several locations in the South Bay. Its cash price for a screening mammogram is $125, and it appears to offer an additional discount if a patient is uninsured and pays in full at time of service:\u003c/p>\n\u003cfigure id=\"attachment_19817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.22.34-PM.png\">\u003cimg class=\"size-large wp-image-19817\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.22.34-PM-640x503.png\" alt=\"Excerpt of flyer of self-pay prices from Valley Radiology Imaging. \" width=\"640\" height=\"503\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Excerpt of flyer of self-pay prices from Valley Radiology Imaging.\u003c/figcaption>\u003c/figure>\n\u003cp>If you have a price to share, please do so. If you see an advertised list of cash or self-pay prices, please send us those, too! Our centralized email address is info@clearhealthcosts.com.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated to clarify the lowest cost self-pay mammogram in our PriceCheck database for the Bay Area.\u003c/em>\u003c/p>\n\n",
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"headline": "Initial Mammogram Cost Comparisons in KQED's PriceCheck Project",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19667\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg\">\u003cimg class=\"size-full wp-image-19667\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg\" alt=\"(Illustration: Andy Warner)\" width=\"640\" height=\"206\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf-400x129.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10943_Facebook_Final-hpf-320x103.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Illustration: Andy Warner)\u003c/figcaption>\u003c/figure>\n\u003cp>Last Monday, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">KQED\u003c/a>, \u003ca href=\"http://www.scpr.org/blogs/health/2014/06/23/16873/join-pricecheck-help-make-health-care-costs-more-t/\" target=\"_blank\">KPCC\u003c/a> and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a> launched our community-created guide to health costs.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Share what you paid for a mammogram. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Visit KQED's PriceCheck\u003c/a>. \u003c/aside>\n\u003cp>As\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\"> I outlined last week\u003c/a>, health care costs lack transparency, and it's virtually impossible for consumers to shop around. We're asking you, members of our KQED community, to share what you've paid for common health care procedures. Your responses feed directly into a database so others can look up how much mammograms cost in their area.\u003c/p>\n\u003cp>So far, we've received a handful of submitted prices. Our partner, ClearHealthCosts, had previously collected a range of \"self-pay\" prices -- that's the price people are charged if they do not have insurance or have decided to go out of their insurance network and are paying out of their own pocket.\u003c!--more-->\u003c/p>\n\u003cp>Those self-pay prices for a screening mammogram in the Bay Area range from $125 at the low end -- from NorCal Imaging in Walnut Creek -- to $801 at the other end at UCSF.\u003c/p>\n\u003cp>Here's a screen shot of some places in the middle:\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://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.33.24-PM.png\">\u003cimg class=\"aligncenter wp-image-19813 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.33.24-PM.png\" alt=\"Screen Shot 2014-06-29 at 2.33.24 PM\" width=\"462\" height=\"614\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.33.24-PM.png 462w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.33.24-PM-400x532.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.33.24-PM-320x425.png 320w\" sizes=\"(max-width: 462px) 100vw, 462px\">\u003c/a>\u003c/p>\n\u003cp>Then there are the submitted prices. Here's a screenshot of two prices shared by women in the Bay Area (and thank you to them!). Remember, this is all anonymous:\u003c/p>\n\u003cfigure id=\"attachment_19814\" class=\"wp-caption aligncenter\" style=\"max-width: 465px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\">\u003cimg class=\"size-full wp-image-19814\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.40.20-PM.png\" alt=\"(screenshot of mammogram prices submitted by KQED audience members from our PriceCheck project)\" width=\"465\" height=\"441\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.40.20-PM.png 465w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.40.20-PM-400x379.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-2.40.20-PM-320x303.png 320w\" sizes=\"(max-width: 465px) 100vw, 465px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot of mammogram prices submitted by KQED audience members from our \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">PriceCheck project\u003c/a>.\u003c/figcaption>\u003c/figure>\n\u003cp>(As an aside, please bear with us as we refine this tool. We've just discovered that even though the two people above both are insured, the tool lists their insurer as \"Self-pay.\" We are fixing this!)\u003c/p>\n\u003cp>Screening mammograms are supposed to be covered at no co-pay or other costs to patients. This patient appeared to pay $300, but her comments detail that she also got an ultrasound.\u003c/p>\n\u003cfigure id=\"attachment_19815\" class=\"wp-caption aligncenter\" style=\"max-width: 459px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\">\u003cimg class=\"size-full wp-image-19815\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.04.43-PM.png\" alt=\"Screenshot from PRice Check.\" width=\"459\" height=\"240\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.04.43-PM.png 459w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.04.43-PM-400x209.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.04.43-PM-320x167.png 320w\" sizes=\"(max-width: 459px) 100vw, 459px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot from PRice Check.\u003c/figcaption>\u003c/figure>\n\u003cp>So what do these early data tell us? Starting with the final submission above, the apparent $300 co-pay, it's clear that consumers need to be careful about what procedures they're getting. While screening mammograms are supposed to be a zero-cost item for patients, diagnostic procedures are different. They are possibly subject to co-pays, depending on your insurance.\u003c/p>\n\u003caside class=\"pullquote alignright\">Learn more: \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">read all our PriceCheck coverage\u003c/a>. \u003c/aside>\n\u003cp>These early data demonstrate that there's tremendous cost variation -- especially on self-pay prices -- on screening mammograms in the Bay Area. While cost variation is well known in American medicine, there aren't a lot of places consumers can go to see prices laid out in front of them. If you're not insured or if you want to go out-of-network for a screening mammogram, these data, though not comprehensive, at least give you a starting point on price.\u003c/p>\n\u003cp>Finally, in addition to the handful of prices people have submitted to us, we've also been gratified that doctors have reached out to talk to us, too.\u003c/p>\n\u003cp>This week, Dr. Eli Chen in Morgan Hill emailed us that he'd had a patient come in with a flier of self-pay prices. Chen had a second price list as well. Here's one of them, from Valley Radiology Imaging. which lists several locations in the South Bay. Its cash price for a screening mammogram is $125, and it appears to offer an additional discount if a patient is uninsured and pays in full at time of service:\u003c/p>\n\u003cfigure id=\"attachment_19817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.22.34-PM.png\">\u003cimg class=\"size-large wp-image-19817\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Screen-Shot-2014-06-29-at-3.22.34-PM-640x503.png\" alt=\"Excerpt of flyer of self-pay prices from Valley Radiology Imaging. \" width=\"640\" height=\"503\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Excerpt of flyer of self-pay prices from Valley Radiology Imaging.\u003c/figcaption>\u003c/figure>\n\u003cp>If you have a price to share, please do so. If you see an advertised list of cash or self-pay prices, please send us those, too! Our centralized email address is info@clearhealthcosts.com.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated to clarify the lowest cost self-pay mammogram in our PriceCheck database for the Bay Area.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Coordinated Care for Those Nearing Life's End — But Does It Save Money?",
"title": "Coordinated Care for Those Nearing Life's End — But Does It Save Money?",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_19725\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Bob_april-e1403652651481.jpg\">\u003cimg class=\"wp-image-19725 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Bob_april-e1403652651481-640x480.jpg\" alt=\"Sutter nurse Aileen Capuyan listens to Bob Martinez’s lungs. (April Dembosky/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sutter nurse Aileen Capuyan listens to Bob Martinez’s lungs. (April Dembosky/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Bob Martinez has been in the hospital so many times, the surgical staff treats him like a regular at a coffee shop.\u003c/p>\n\u003cp>“They all know me!” he says. “If I go in there today, they’d say, ‘How’re ya doing Mr. Martinez?' ”\u003c/p>\n\u003caside class=\"pullquote alignleft\">'I’m so sick and tired of being in hospitals. I don’t want to go back no more. I said, God, no more.'\u003c/aside>\n\u003cp>Martinez is 81, a long-retired life insurance salesman. In the last few years, he's had more than a dozen surgeries on his right leg, including a foot amputation, a casualty of severe diabetes. His heart disease has warranted almost half a dozen heart procedures. After one of his recent operations, he said he'd had enough.\u003c/p>\n\u003cp>“I’m so sick and tired of being in hospitals,” he says shaking his head. “I don’t want to go back no more. I said, God, no more. No more.”\u003c/p>\n\u003cp>That’s when hospital staff told him about a program through Sutter Health that would send people to take care of him at home. It’s called the Advanced Illness Management program, or AIM. It’s designed for people like Martinez who have multiple chronic illnesses.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It’s not hospice. That’s for people who doctors say have six months or less to live. This program is for the pre-hospice population, people estimated to be in the last 18 months of life. The AIM program assigns a team of doctors, nurses and social workers to help patients transition home after hospital stays, manage medication, and carefully coordinate care, at home and over the phone, to help keep patients out of the hospital.\u003c/p>\n\u003cp>Martinez’ nurse, Aileen Capuyan, and social worker, Ally Chu, come to his home in Oakland once a week.\u003c/p>\n\u003cp>“Are you coughing? Do you have any shortness of breath?” Capuyan asks as she listens to Martinez’s lungs.\u003c/p>\n\u003cp>He sits in the brown leather armchair in his living room while she takes his temperature and checks his blood pressure. Meanwhile, Chu is in the kitchen talking with Martinez's son, Jimmy, who takes care of him. Jimmy is making tamales. Then Capuyan and Chu switch.\u003c/p>\n\u003cp>Most of the visit is spent talking: about the pain in Martinez’s leg, how his dominoes game is going at the senior center, and about more sensitive things, like what happens when his health gets worse — what kind of care he wants at the end of life and what care he doesn’t want.\u003c/p>\n\u003cp>“I don’t want to be resuscitated,” Martinez says. “When my time comes — let it go.”\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/155994604&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>The founders of the AIM program hope that these ongoing visits build the kind of trust where patients can fully explore these questions. Chief program executive Betsy Gornet says this avoids rushed decisions that don’t capture a person’s real values.\u003c/p>\n\u003cp>“Spending fifteen minutes in a doctor's office or in an ICU in a crisis isn’t necessarily the way to do advanced care planning,” she says. “We do know that a dialogue over time does help foster the right kind of information.”\u003c/p>\n\u003cp>She says that means patients get the kind of care they want, and get help before their conditions reach a crisis level.\u003c/p>\n\u003cp>“We’ve been able to track very consistently a 30 percent reduction in emergency room visits by these patients, 70 to 80 percent reduction in ICU days, 50 percent reduction in hospitalizations,” she says.\u003c/p>\n\u003cp>That in turn has saved money.\u003c/p>\n\u003cp>“We’ve seen the total cost of care go down anywhere from $3,600 to $5,000 dollar per patient over the course of 90 days,” she says.\u003c/p>\n\u003cp>This is the kind of talk that has sparked fiery debates in Washington. Back in 2009, the idea of doctors even talking to their patients about their end-of-life wishes spurred fears of “\u003ca href=\"http://www.washingtonpost.com/wp-dyn/content/article/2009/07/31/AR2009073103148.html\" target=\"_blank\">death panels\u003c/a>” rationing care.\u003c/p>\n\u003cp>But today, the tone is shifting, according to health policy lobbyist Andrew MacPherson.\u003c/p>\n\u003cp>“We’re seeing a death of the death panels,” he says. “We’re in a totally new place today.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"392e700af225e5a57a941f70d559db24\"]\u003c/p>\n\u003cp>He says lawmakers are having real bipartisan discussions about overhauling the American way of death, especially now that more and more politicians are shepherding their own parents through the end of life.\u003c/p>\n\u003cp>“It’s personal stories,” MacPherson says. “People's personal stories about their mother, about their father are really what bring folks to table to say, 'Look, we need to have a health care system that is responsive to patients’ values and preferences and wishes when they’re really seriously ill.' ”\u003c/p>\n\u003cp>He says officials in Washington are keeping an eye on the Sutter program as a model that might be replicated across the country. The Medicare program, which pays for health care for people over 65, gave the AIM program a $13 million grant from a fund created under the Affordable Care Act. In return, they want to see the program generate savings for Medicare of at least $29 million.\u003c/p>\n\u003cp>“The big question is whether or not it will pan out,” says Suzanne Delbanco, executive director of the nonprofit group Catalyst for Payment Reform.\u003c/p>\n\u003cp>The Medicare grants are one way the government is trying to move away from paying for health care on a fee-for-service basis, which Delbanco says incentivizes doctors to order more tests and procedures to drive up their revenues. Instead, interest is growing to develop more holistic payment models — things like “care management fees,” “bundled payments” and “shared savings” — that reward doctors based on the overall care they provide and outcomes where their patients ultimately get better.\u003c/p>\n\u003cp>“It’s almost as if we’re going from an a la carte menu to a pre-fixe meal where you pay a set amount for all your courses,” Delbanco says.\u003c/p>\n\u003cp>But there are two big unknowns.\u003c/p>\n\u003cp>First, it's not clear if these new models of care really will cost less in the long run. “We don’t know for sure whether or not financially it will end up being beneficial in an effort to curtail our health care costs,” Delbanco says.\u003c/p>\n\u003cp>Second, Sutter has to find a way to operate the AIM program that works for its own bottom line. When Sutter saves money for Medicare, by reducing hospitalizations and ER visits, it takes a financial hit on its own revenues. Many of the new services it provides to achieve those savings — the telephone coordination, some home care and some social work services — are not reimbursed under Medicare’s current payment system.\u003c/p>\n\u003cp>Sutter declined to reveal operation costs or budget figures for the AIM program, although the federal Agency for Healthcare Research and Quality reports it costs about $900 monthly, for each patient, on average.\u003c/p>\n\u003cp>AIM chief executive Betsy Gornet says the program does operate at a loss in some regions and has stayed afloat so far through foundation grants and investments from Sutter. But its goal this year, as part of the government grant, is to become self-sustaining, and to propose a new payment model for Medicare that balances savings for the government and still keeps its own program in business.\u003c/p>\n\u003cp>“We want to get the right care to the right patient at the right time,” Gornet says. “That will help save everybody’s resources.”\u003c/p>\n\u003cp>Gornet says the ultimate goal is to keep patients like Bob Martinez as comfortable and vibrant as possible until he reaches the end of his life.\u003c/p>\n\u003cp>Martinez says he's been thinking about death a lot lately, especially since his wife, Josie, died two years ago — at home, with her husband at her side.\u003c/p>\n\u003cp>“God’s got a plan for everybody, different plans,\" Martinez says. \"Some die at home. Some die in a hospital. I want to be home like she was. If it comes to that. But anyway, I’ll take it any way. I just want to be with her now.\"\u003c/p>\n\u003cp>Martinez died in May. He was at home, in his living room, surrounded by family.\u003c/p>\n\u003cp>\u003cem>This report was produced with support from \u003c/em>\u003cem>the MetLife Foundation Journalists in Aging Fellowships, a program of New America Media and the Gerontological Society of America.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19725\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Bob_april-e1403652651481.jpg\">\u003cimg class=\"wp-image-19725 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Bob_april-e1403652651481-640x480.jpg\" alt=\"Sutter nurse Aileen Capuyan listens to Bob Martinez’s lungs. (April Dembosky/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sutter nurse Aileen Capuyan listens to Bob Martinez’s lungs. (April Dembosky/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Bob Martinez has been in the hospital so many times, the surgical staff treats him like a regular at a coffee shop.\u003c/p>\n\u003cp>“They all know me!” he says. “If I go in there today, they’d say, ‘How’re ya doing Mr. Martinez?' ”\u003c/p>\n\u003caside class=\"pullquote alignleft\">'I’m so sick and tired of being in hospitals. I don’t want to go back no more. I said, God, no more.'\u003c/aside>\n\u003cp>Martinez is 81, a long-retired life insurance salesman. In the last few years, he's had more than a dozen surgeries on his right leg, including a foot amputation, a casualty of severe diabetes. His heart disease has warranted almost half a dozen heart procedures. After one of his recent operations, he said he'd had enough.\u003c/p>\n\u003cp>“I’m so sick and tired of being in hospitals,” he says shaking his head. “I don’t want to go back no more. I said, God, no more. No more.”\u003c/p>\n\u003cp>That’s when hospital staff told him about a program through Sutter Health that would send people to take care of him at home. It’s called the Advanced Illness Management program, or AIM. It’s designed for people like Martinez who have multiple chronic illnesses.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It’s not hospice. That’s for people who doctors say have six months or less to live. This program is for the pre-hospice population, people estimated to be in the last 18 months of life. The AIM program assigns a team of doctors, nurses and social workers to help patients transition home after hospital stays, manage medication, and carefully coordinate care, at home and over the phone, to help keep patients out of the hospital.\u003c/p>\n\u003cp>Martinez’ nurse, Aileen Capuyan, and social worker, Ally Chu, come to his home in Oakland once a week.\u003c/p>\n\u003cp>“Are you coughing? Do you have any shortness of breath?” Capuyan asks as she listens to Martinez’s lungs.\u003c/p>\n\u003cp>He sits in the brown leather armchair in his living room while she takes his temperature and checks his blood pressure. Meanwhile, Chu is in the kitchen talking with Martinez's son, Jimmy, who takes care of him. Jimmy is making tamales. Then Capuyan and Chu switch.\u003c/p>\n\u003cp>Most of the visit is spent talking: about the pain in Martinez’s leg, how his dominoes game is going at the senior center, and about more sensitive things, like what happens when his health gets worse — what kind of care he wants at the end of life and what care he doesn’t want.\u003c/p>\n\u003cp>“I don’t want to be resuscitated,” Martinez says. “When my time comes — let it go.”\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/155994604&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>The founders of the AIM program hope that these ongoing visits build the kind of trust where patients can fully explore these questions. Chief program executive Betsy Gornet says this avoids rushed decisions that don’t capture a person’s real values.\u003c/p>\n\u003cp>“Spending fifteen minutes in a doctor's office or in an ICU in a crisis isn’t necessarily the way to do advanced care planning,” she says. “We do know that a dialogue over time does help foster the right kind of information.”\u003c/p>\n\u003cp>She says that means patients get the kind of care they want, and get help before their conditions reach a crisis level.\u003c/p>\n\u003cp>“We’ve been able to track very consistently a 30 percent reduction in emergency room visits by these patients, 70 to 80 percent reduction in ICU days, 50 percent reduction in hospitalizations,” she says.\u003c/p>\n\u003cp>That in turn has saved money.\u003c/p>\n\u003cp>“We’ve seen the total cost of care go down anywhere from $3,600 to $5,000 dollar per patient over the course of 90 days,” she says.\u003c/p>\n\u003cp>This is the kind of talk that has sparked fiery debates in Washington. Back in 2009, the idea of doctors even talking to their patients about their end-of-life wishes spurred fears of “\u003ca href=\"http://www.washingtonpost.com/wp-dyn/content/article/2009/07/31/AR2009073103148.html\" target=\"_blank\">death panels\u003c/a>” rationing care.\u003c/p>\n\u003cp>But today, the tone is shifting, according to health policy lobbyist Andrew MacPherson.\u003c/p>\n\u003cp>“We’re seeing a death of the death panels,” he says. “We’re in a totally new place today.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>He says lawmakers are having real bipartisan discussions about overhauling the American way of death, especially now that more and more politicians are shepherding their own parents through the end of life.\u003c/p>\n\u003cp>“It’s personal stories,” MacPherson says. “People's personal stories about their mother, about their father are really what bring folks to table to say, 'Look, we need to have a health care system that is responsive to patients’ values and preferences and wishes when they’re really seriously ill.' ”\u003c/p>\n\u003cp>He says officials in Washington are keeping an eye on the Sutter program as a model that might be replicated across the country. The Medicare program, which pays for health care for people over 65, gave the AIM program a $13 million grant from a fund created under the Affordable Care Act. In return, they want to see the program generate savings for Medicare of at least $29 million.\u003c/p>\n\u003cp>“The big question is whether or not it will pan out,” says Suzanne Delbanco, executive director of the nonprofit group Catalyst for Payment Reform.\u003c/p>\n\u003cp>The Medicare grants are one way the government is trying to move away from paying for health care on a fee-for-service basis, which Delbanco says incentivizes doctors to order more tests and procedures to drive up their revenues. Instead, interest is growing to develop more holistic payment models — things like “care management fees,” “bundled payments” and “shared savings” — that reward doctors based on the overall care they provide and outcomes where their patients ultimately get better.\u003c/p>\n\u003cp>“It’s almost as if we’re going from an a la carte menu to a pre-fixe meal where you pay a set amount for all your courses,” Delbanco says.\u003c/p>\n\u003cp>But there are two big unknowns.\u003c/p>\n\u003cp>First, it's not clear if these new models of care really will cost less in the long run. “We don’t know for sure whether or not financially it will end up being beneficial in an effort to curtail our health care costs,” Delbanco says.\u003c/p>\n\u003cp>Second, Sutter has to find a way to operate the AIM program that works for its own bottom line. When Sutter saves money for Medicare, by reducing hospitalizations and ER visits, it takes a financial hit on its own revenues. Many of the new services it provides to achieve those savings — the telephone coordination, some home care and some social work services — are not reimbursed under Medicare’s current payment system.\u003c/p>\n\u003cp>Sutter declined to reveal operation costs or budget figures for the AIM program, although the federal Agency for Healthcare Research and Quality reports it costs about $900 monthly, for each patient, on average.\u003c/p>\n\u003cp>AIM chief executive Betsy Gornet says the program does operate at a loss in some regions and has stayed afloat so far through foundation grants and investments from Sutter. But its goal this year, as part of the government grant, is to become self-sustaining, and to propose a new payment model for Medicare that balances savings for the government and still keeps its own program in business.\u003c/p>\n\u003cp>“We want to get the right care to the right patient at the right time,” Gornet says. “That will help save everybody’s resources.”\u003c/p>\n\u003cp>Gornet says the ultimate goal is to keep patients like Bob Martinez as comfortable and vibrant as possible until he reaches the end of his life.\u003c/p>\n\u003cp>Martinez says he's been thinking about death a lot lately, especially since his wife, Josie, died two years ago — at home, with her husband at her side.\u003c/p>\n\u003cp>“God’s got a plan for everybody, different plans,\" Martinez says. \"Some die at home. Some die in a hospital. I want to be home like she was. If it comes to that. But anyway, I’ll take it any way. I just want to be with her now.\"\u003c/p>\n\u003cp>Martinez died in May. He was at home, in his living room, surrounded by family.\u003c/p>\n\u003cp>\u003cem>This report was produced with support from \u003c/em>\u003cem>the MetLife Foundation Journalists in Aging Fellowships, a program of New America Media and the Gerontological Society of America.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp> \u003cscript>var chc_widget_hash = \"TRHMKJCB\";\u003c/script>\u003cbr>\n \u003cscript src=\"http://widgets.clearhealthcosts.com/assets/widgets/widget.js\">\u003c/script>\u003c!--more-->\u003cbr>\nRight now, buying health care is like going to the grocery store and finding all the price tags removed. Even worse, bananas might cost you $4 and another shopper $400, and you wouldn’t know which until you handed over your debit card. By collecting information from you and others like you, we can help change that.\u003c/p>\n\u003cp>Check out the form below and share what you paid. If you have insurance, you’ll need your \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/18/explaining-the-health-insurance-explanation-of-benefits/\" target=\"_blank\">explanation of benefits\u003c/a>.\u003c/p>\n\u003cp>We’re focusing now on \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/27/pricecheck-how-much-does-a-colonoscopy-cost/\" target=\"_blank\">colonoscopies\u003c/a>, a screening test for colon cancer. \u003cem>When\u003c/em>\u003cem> you share your price, please indicate in comments if you had anesthesia as part of the procedure and if any polyps were removed.\u003c/em>\u003c/p>\n\u003cp>Our form is designed to accept many kinds of medical tests and procedures. Please check out \u003ca title=\"PriceCheck\" href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">all of our PriceCheck coverage\u003c/a>.\u003c/p>\n\u003cdiv id=\"chc_widget\">\u003c/div>\n\u003cp> \u003cscript>var chc_widget_hash = \"TRHMKJCB\"\u003c/script>\u003cbr>\n \u003cscript src=\"https://widgets.clearhealthcosts.com/assets/widgets/widget.js\">\u003c/script>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cfigure id=\"attachment_19661\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\">\u003cimg class=\"wp-image-19661 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/pricecheck-wname-2.jpg\" alt=\"(Photo: Getty Images)\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/pricecheck-wname-2.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/pricecheck-wname-2-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/pricecheck-wname-2-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update June 30:\u003c/strong> Early PriceCheck data show\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/30/initial-mammogram-cost-comparisons-in-kqeds-pricecheck-project/\" target=\"_blank\"> Bay Area mammogram prices range from $125 to $801\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>Say you're shopping for a new computer or a new car, and you want to get the best price. Within a matter of minutes on Google, you would have a pretty good idea of the price range for the product you want.\u003c/p>\n\u003cp>But in health care? Forget it.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Shining light on a system where the costs of the same procedure might range from $0 to $1,100. That's just one example.\u003c/aside>\n\u003cp>It's well known to health policy types, but less so to consumers, that health care prices are utterly lacking in transparency and wildly variable.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>If you've ever looked at a bill for a health care procedure -- and been astounded by the numbers you see -- or thought that you would like to find the best price on an elective procedure -- and been astounded that there's no easy way to compare prices -- KQED is launching a new project for you.\u003c/p>\n\u003cp>Today we bring you \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Price Check\u003c/a>,\" a community-created guide to health costs. Since no database yet exists where consumers can easily look up costs, we're commencing the work of creating one. But we need your help.\u003c/p>\n\u003cp>This summer and into the fall, we're turning to you, our community, to share -- anonymously -- what you have paid for some common procedures. We're starting with mammograms. (More on \"why mammograms?\" in a moment.)\u003c!--more-->\u003c/p>\n\u003cp>We've created a tool to make it easy to share what you paid. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Visit the tool and take a look\u003c/a>. If you don't have insurance and pay out of pocket -- called self-pay -- you can enter that price. If you have insurance, you can submit both what your health insurance paid and your own co-pay charge, if any.\u003c/p>\n\u003cp>Once you've shared your costs, the tool will feed your information into a database so you can see how much mammograms cost elsewhere in the Bay Area and across California. Again, your submitted data are anonymous and confidential.\u003c/p>\n\u003cp>We want this project to have as much impact as possible, so we have teamed up with \u003ca href=\"http://www.scpr.org/blogs/health/2014/06/23/16873/join-pricecheck-help-make-health-care-costs-more-t/\" target=\"_blank\">KPCC\u003c/a>, our public radio friends in Southern California, and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, a New York City startup working to bring transparency to the health care marketplace.\u003c/p>\n\u003cp>We chose to start with mammograms, because it is a screening test that many women have at least every other year. Because it is a test that can be scheduled, women could, in theory, shop around for the best price. Yes, mammograms are covered as a preventive benefit under the Affordable Care Act, and patients are supposed to access them at no co-pay, but that doesn't always happen.\u003c/p>\n\u003caside class=\"pullquote alignright\">Learn more: \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">read all our PriceCheck coverage\u003c/a>. \u003c/aside>\n\u003cp>ClearHealthCosts did a \u003ca href=\"http://clearhealthcosts.com/wnyc/how-much-do-birth-control-mammograms-cost/\" target=\"_blank\">pilot version of this project\u003c/a> with WNYC public radio in New York in 2012. They found that 25-30 percent of the 400 respondents were paying for their mammograms. That's because some of the women chose out-of-network providers, or they weren't insured, or the mammogram simply wasn't covered.\u003c/p>\n\u003cp>We'll be able to compare California data with what ClearHealthCosts learned with WNYC -- where \u003ca href=\"http://clearhealthcosts.com/blog/2013/07/how-much-does-a-mammogram-cost-the-takeaway-on-billing-from-our-wnyc-partnership/\" target=\"_blank\">women paid between $0 and $1,100 or more\u003c/a>.\u003c/p>\n\u003cp>In other sectors of the economy, people often equate higher cost with higher quality, but in health care there's not a correlation between price and quality. We think people want quality care at a fair price. But just as there is little transparency in health costs, there are few good measures of quality. We believe that shining a bright light on health costs helps to drive discussion about quality metrics.\u003c/p>\n\u003cp>We're just at the start of this project. Over the next four months, we'll sample other common procedures. We're grateful to the Knight Foundation for funding this project through a \u003ca href=\"http://www.knightfoundation.org/blogs/knightblog/2014/4/22/17-projects-receive-funding-through-knight-prototype-fund/\" target=\"_blank\">Prototype Fund grant\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Please join us! We'll report what you share with us as soon as we have stories to tell.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19661\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\">\u003cimg class=\"wp-image-19661 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/pricecheck-wname-2.jpg\" alt=\"(Photo: Getty Images)\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/pricecheck-wname-2.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/pricecheck-wname-2-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/pricecheck-wname-2-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update June 30:\u003c/strong> Early PriceCheck data show\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/30/initial-mammogram-cost-comparisons-in-kqeds-pricecheck-project/\" target=\"_blank\"> Bay Area mammogram prices range from $125 to $801\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>Say you're shopping for a new computer or a new car, and you want to get the best price. Within a matter of minutes on Google, you would have a pretty good idea of the price range for the product you want.\u003c/p>\n\u003cp>But in health care? Forget it.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Shining light on a system where the costs of the same procedure might range from $0 to $1,100. That's just one example.\u003c/aside>\n\u003cp>It's well known to health policy types, but less so to consumers, that health care prices are utterly lacking in transparency and wildly variable.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>If you've ever looked at a bill for a health care procedure -- and been astounded by the numbers you see -- or thought that you would like to find the best price on an elective procedure -- and been astounded that there's no easy way to compare prices -- KQED is launching a new project for you.\u003c/p>\n\u003cp>Today we bring you \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Price Check\u003c/a>,\" a community-created guide to health costs. Since no database yet exists where consumers can easily look up costs, we're commencing the work of creating one. But we need your help.\u003c/p>\n\u003cp>This summer and into the fall, we're turning to you, our community, to share -- anonymously -- what you have paid for some common procedures. We're starting with mammograms. (More on \"why mammograms?\" in a moment.)\u003c!--more-->\u003c/p>\n\u003cp>We've created a tool to make it easy to share what you paid. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">Visit the tool and take a look\u003c/a>. If you don't have insurance and pay out of pocket -- called self-pay -- you can enter that price. If you have insurance, you can submit both what your health insurance paid and your own co-pay charge, if any.\u003c/p>\n\u003cp>Once you've shared your costs, the tool will feed your information into a database so you can see how much mammograms cost elsewhere in the Bay Area and across California. Again, your submitted data are anonymous and confidential.\u003c/p>\n\u003cp>We want this project to have as much impact as possible, so we have teamed up with \u003ca href=\"http://www.scpr.org/blogs/health/2014/06/23/16873/join-pricecheck-help-make-health-care-costs-more-t/\" target=\"_blank\">KPCC\u003c/a>, our public radio friends in Southern California, and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a>, a New York City startup working to bring transparency to the health care marketplace.\u003c/p>\n\u003cp>We chose to start with mammograms, because it is a screening test that many women have at least every other year. Because it is a test that can be scheduled, women could, in theory, shop around for the best price. Yes, mammograms are covered as a preventive benefit under the Affordable Care Act, and patients are supposed to access them at no co-pay, but that doesn't always happen.\u003c/p>\n\u003caside class=\"pullquote alignright\">Learn more: \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/price-check/\" target=\"_blank\">read all our PriceCheck coverage\u003c/a>. \u003c/aside>\n\u003cp>ClearHealthCosts did a \u003ca href=\"http://clearhealthcosts.com/wnyc/how-much-do-birth-control-mammograms-cost/\" target=\"_blank\">pilot version of this project\u003c/a> with WNYC public radio in New York in 2012. They found that 25-30 percent of the 400 respondents were paying for their mammograms. That's because some of the women chose out-of-network providers, or they weren't insured, or the mammogram simply wasn't covered.\u003c/p>\n\u003cp>We'll be able to compare California data with what ClearHealthCosts learned with WNYC -- where \u003ca href=\"http://clearhealthcosts.com/blog/2013/07/how-much-does-a-mammogram-cost-the-takeaway-on-billing-from-our-wnyc-partnership/\" target=\"_blank\">women paid between $0 and $1,100 or more\u003c/a>.\u003c/p>\n\u003cp>In other sectors of the economy, people often equate higher cost with higher quality, but in health care there's not a correlation between price and quality. We think people want quality care at a fair price. But just as there is little transparency in health costs, there are few good measures of quality. We believe that shining a bright light on health costs helps to drive discussion about quality metrics.\u003c/p>\n\u003cp>We're just at the start of this project. Over the next four months, we'll sample other common procedures. We're grateful to the Knight Foundation for funding this project through a \u003ca href=\"http://www.knightfoundation.org/blogs/knightblog/2014/4/22/17-projects-receive-funding-through-knight-prototype-fund/\" target=\"_blank\">Prototype Fund grant\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Please join us! We'll report what you share with us as soon as we have stories to tell.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Another Step Closer to Autism Therapy as Medi-Cal Benefit?",
"title": "Another Step Closer to Autism Therapy as Medi-Cal Benefit?",
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"content": "\u003cfigure id=\"attachment_18394\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/183682661-e1395966642552.jpg\">\u003cimg class=\"size-large wp-image-18394\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/183682661-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By David Gorn,\u003c/strong> \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2014/6/california-may-be-pushed-to-offer-autism-treatment-as-medical-benefit#.U6NDpLXgICg.twitter\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>CMS officials last week approved a state plan amendment for the state of Washington that includes autism therapy as a Medicaid benefit.\u003c/p>\n\u003cp>It's the second state in a month to receive that go-ahead from the federal government, and it means autism coverage should be a Medi-Cal benefit in California, as well, according to Kristin Jacobson, president of Autism Deserves Equal Coverage, a not-for-profit autism advocacy group.\u003c/p>\n\u003cp>The budget passed this week by the California Legislature omitted autism therapy as a Medi-Cal benefit.\u003c/p>\n\u003cp>Autism advocates hope one day soon CMS will make it clear that applied behavior analysis treatment -- known as ABA therapy -- should be a required benefit for all states receiving Medicaid, including California.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It looks as if that day is already here, Jacobson said.\u003c/p>\n\u003cp>The ruling by CMS in Washington state, and earlier in Louisiana, combine to \"clearly establish\" that ABA therapy is a Medicaid benefit, Jacobson said.\u003c/p>\n\u003cp>\"It shouldn't vary from state to state because it's a federal benefit. The feds have spoken by approving [the benefit coverage] in both Louisiana and Washington. It shows that the Louisiana approval is not somehow a unique situation,\" Jacobson said.\u003c/p>\n\u003cp>California health officials have said they're watching the cases in other states closely, particularly in Washington, since that state's rules around autism treatment are similar to California's.\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"AjurOcz0t2FwjHtorRejPFS96LEZfSuj\"]\u003c/p>\n\u003cp>When CMS gave approval of coverage to Louisiana, state officials here issued a statement about it:\u003c/p>\n\u003cp>\"California and other states are currently awaiting guidance on ABA services from CMS, which we expect to receive soon,\" said Norman Williams, deputy director of public affairs for DHCS. \"This guidance is what will be used to set policy direction for the inclusion of ABA therapy as a covered Medicaid benefit.\"\u003c/p>\n\u003cp>When asked if the Washington state approval was actually federal guidance, Williams said only that they \"continue to await forthcoming guidance from CMS as it relates specifically to California.\"\u003c/p>\n\u003cp>Over two days of inquiry, CMS officials declined to comment for this story.\u003c/p>\n\u003cp>All of that doesn't sit well with Jacobson.\u003c/p>\n\u003cp>\"I don't think any further guidance is necessary. It's a bit of excuse for them to say they need more guidance,\" Jacobson said.\u003c/p>\n\u003cp>\"If it's an approvable benefit, then it's a required benefit. … Washington asked for guidance and CMS told them. Louisiana asked for guidance and CMS told them. It's disappointing that the administration has still been so resistant and keeps wanting more guidance. At this point, they shouldn't need more,\" Jacobson said.\u003c/p>\n\u003cp>\"I don't think the families can keep waiting. That's not acceptable, and it's not legally compliant, either,\" she said. \"Given the state's position [acknowledging] the benefits of ABA therapy, it's unconscionable that they're not providing it to this population.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Louisiana and Washington approvals were prompted by lawsuits. \"I hope we don't have to do that, but we're not going to rule it out till we see them moving forward for this benefit,\" Jacobson said.\u003c/p>\n\n",
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"excerpt": "Advocates say federal approval of an autism therapy in two states means California must also offer it.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18394\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/183682661-e1395966642552.jpg\">\u003cimg class=\"size-large wp-image-18394\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/183682661-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By David Gorn,\u003c/strong> \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2014/6/california-may-be-pushed-to-offer-autism-treatment-as-medical-benefit#.U6NDpLXgICg.twitter\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>CMS officials last week approved a state plan amendment for the state of Washington that includes autism therapy as a Medicaid benefit.\u003c/p>\n\u003cp>It's the second state in a month to receive that go-ahead from the federal government, and it means autism coverage should be a Medi-Cal benefit in California, as well, according to Kristin Jacobson, president of Autism Deserves Equal Coverage, a not-for-profit autism advocacy group.\u003c/p>\n\u003cp>The budget passed this week by the California Legislature omitted autism therapy as a Medi-Cal benefit.\u003c/p>\n\u003cp>Autism advocates hope one day soon CMS will make it clear that applied behavior analysis treatment -- known as ABA therapy -- should be a required benefit for all states receiving Medicaid, including California.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It looks as if that day is already here, Jacobson said.\u003c/p>\n\u003cp>The ruling by CMS in Washington state, and earlier in Louisiana, combine to \"clearly establish\" that ABA therapy is a Medicaid benefit, Jacobson said.\u003c/p>\n\u003cp>\"It shouldn't vary from state to state because it's a federal benefit. The feds have spoken by approving [the benefit coverage] in both Louisiana and Washington. It shows that the Louisiana approval is not somehow a unique situation,\" Jacobson said.\u003c/p>\n\u003cp>California health officials have said they're watching the cases in other states closely, particularly in Washington, since that state's rules around autism treatment are similar to California's.\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"AjurOcz0t2FwjHtorRejPFS96LEZfSuj\"]\u003c/p>\n\u003cp>When CMS gave approval of coverage to Louisiana, state officials here issued a statement about it:\u003c/p>\n\u003cp>\"California and other states are currently awaiting guidance on ABA services from CMS, which we expect to receive soon,\" said Norman Williams, deputy director of public affairs for DHCS. \"This guidance is what will be used to set policy direction for the inclusion of ABA therapy as a covered Medicaid benefit.\"\u003c/p>\n\u003cp>When asked if the Washington state approval was actually federal guidance, Williams said only that they \"continue to await forthcoming guidance from CMS as it relates specifically to California.\"\u003c/p>\n\u003cp>Over two days of inquiry, CMS officials declined to comment for this story.\u003c/p>\n\u003cp>All of that doesn't sit well with Jacobson.\u003c/p>\n\u003cp>\"I don't think any further guidance is necessary. It's a bit of excuse for them to say they need more guidance,\" Jacobson said.\u003c/p>\n\u003cp>\"If it's an approvable benefit, then it's a required benefit. … Washington asked for guidance and CMS told them. Louisiana asked for guidance and CMS told them. It's disappointing that the administration has still been so resistant and keeps wanting more guidance. At this point, they shouldn't need more,\" Jacobson said.\u003c/p>\n\u003cp>\"I don't think the families can keep waiting. That's not acceptable, and it's not legally compliant, either,\" she said. \"Given the state's position [acknowledging] the benefits of ABA therapy, it's unconscionable that they're not providing it to this population.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Louisiana and Washington approvals were prompted by lawsuits. \"I hope we don't have to do that, but we're not going to rule it out till we see them moving forward for this benefit,\" Jacobson said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"meta": {
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"source": "Commonwealth Club of California"
},
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"title": "Forum",
"tagline": "The conversation starts here",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
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"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"officialWebsiteLink": "http://freakonomics.com/",
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"meta": {
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"source": "WNYC"
},
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
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"id": "fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
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"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
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"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
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"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
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"officialWebsiteLink": "/perspectives/",
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"source": "kqed",
"order": 14
},
"link": "/perspectives",
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