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"content": "\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "Will it change my job-based coverage? What about my pre-existing condition? Will it cover mental illness? Does it cover abortion? This searchable FAQ has answers.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Aaron Albaugh peers out from under the brim of his cowboy hat, surveying the acres of hay fields in front of him. The fourth-generation \u003ca href=\"http://www.frostyacres.net/index.html\">rancher\u003c/a> is raising about 450 cattle this year, in this remote corner of Lassen County.\u003c/p>\n\u003cp>His closest neighbor lives a half mile away. “And that’s my brother,” Albaugh says.\u003c/p>\n\u003cp>“If I want to go see a movie, it’s 70 miles round trip,” he adds. “If I want to go bowling, that’s 100 miles round trip.”\u003c/p>\n\u003cp>Living a half day’s drive from civilization, you learn to do without, he explains. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.\u003c/p>\n\u003cp>“Put a Band Aid on it,” Albaugh says. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So, when people are already used to doing without health coverage, it’s particularly annoying to have the government say you have to buy it, according to Albaugh and many of his neighbors in Lassen, Modoc and Shasta Counties.\u003c/p>\n\u003cp>While Obamacare is largely viewed as a success in California – the state marketplace, \u003ca href=\"http://www.coveredca.com/\">Covered California\u003c/a>, is one of the most financially stable in the country – it hasn’t worked as well for folks in this rural northeast corner of the state.\u003c/p>\n\u003cp>There are two insurers selling plans in each county here, but residents say that hasn’t created enough competition to bring down prices. Plus, a lot of the doctors they’re used to seeing don’t take the marketplace plans.\u003c/p>\n\u003cp>“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” says Modoc County resident Althia Cline, who decided to forego coverage – and a surgery she needed for her asthma.\u003c/p>\n\u003cp>Just like the movie theater and bowling alley, most medical specialists are miles away. In Modoc County, there’s nowhere to have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half away from home.\u003c/p>\n\u003cp>Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.\u003c/p>\n\u003cfigure id=\"attachment_353608\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-353608 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Tessa-front-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tessa Anklin says Covered California health plans are too expensive for her family. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Two years ago, they bought a plan through Covered California. With a subsidy, they paid just $2 a month for their premium, but their deductible was $10,000.\u003c/p>\n\u003cp>“We paid for all of our medical services and our prescriptions,” she says. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”\u003c/p>\n\u003cp>Then, last year, their monthly premium jumped to $600. The plan was the same, Anklin says, and their household income was the same. But they still faced the same hour and a half drive to see doctors they almost never needed.*\u003c/p>\n\u003cp>Anklin thought of all the other ways she could spend that money.\u003c/p>\n\u003cp>“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she says. “That’s a big difference, when you think about how little you actually use the health coverage.”\u003c/p>\n\u003cp>That’s the reason she decided to cancel her health plan this year and go without. But she’ll still have to pay a penalty when the next tax season comes around.\u003c/p>\n\u003cp>“It basically penalizes us one way or the other because we can’t afford the coverage,” she says. “So that’s kind of difficult, to be that middle-class person.”\u003c/p>\n\u003cp>Anklin says she’d be happy to see Republicans get rid of Obamacare.\u003c/p>\n\u003cp>“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck when they’re already trying to survive with what they have,” she says. “It should be an option.”\u003c/p>\n\u003cp>But the Republican repeal and replace plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the GOP plan, according to a recent \u003ca href=\"http://www.kff.org/health-reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/\">analysis\u003c/a> from the Kaiser Family Foundation. Anklin could end up paying more than $2,000 a month for coverage, according to Kaiser’s \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\">county-by-county projections\u003c/a>.\u003c/p>\n\u003cp>That’s not what she had in mind for a fix.\u003c/p>\n\u003cp>“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin says.\u003c/p>\n\u003cp>With the Republican bill now in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.\u003c/p>\n\u003cp>Democrats have also said if the Republican bill fails, they’d be willing to \u003ca href=\"https://www.statnews.com/2017/07/05/health-care-compromise/\">work together on solutions\u003c/a>, but it’s not clear the parties could agree on one that would help people like Anklin.\u003c/p>\n\u003cp>If they can’t, she says she has no choice but to continue to go without coverage. Financially it makes sense in the short term, but it still worries her.\u003c/p>\n\u003cp>“If I ever have a problem,” she says, “I know I will be paying for the rest of my life.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/07/2017-07-11b-tcr.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Aaron-car-768x576.jpg\" Title=\"Rural Californians Want Price Relief From GOP Health Bill – But Most Won’t Get It\" program=\"The California Report\"]\u003c/p>\n\u003cp>\u003cem>*Premiums in this region of the state went up an average of 10.6 percent in 2016, according to Covered California’s \u003ca href=\"http://www.coveredca.com/news/\" target=\"_blank\" rel=\"noopener noreferrer\">rate booklet\u003c/a>, and most premium increases are matched with an increase in subsidy, so the most likely explanation for why Anklin’s premium jumped this much is that she lost her subsidy. This can happen if customers, intentionally or unintentionally, do not check a box on their application form that allows the federal government to verify their income, or, if customers do not file tax returns.\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>\u003cp>Aaron Albaugh peers out from under the brim of his cowboy hat, surveying the acres of hay fields in front of him. The fourth-generation \u003ca href=\"http://www.frostyacres.net/index.html\">rancher\u003c/a> is raising about 450 cattle this year, in this remote corner of Lassen County.\u003c/p>\n\u003cp>His closest neighbor lives a half mile away. “And that’s my brother,” Albaugh says.\u003c/p>\n\u003cp>“If I want to go see a movie, it’s 70 miles round trip,” he adds. “If I want to go bowling, that’s 100 miles round trip.”\u003c/p>\n\u003cp>Living a half day’s drive from civilization, you learn to do without, he explains. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.\u003c/p>\n\u003cp>“Put a Band Aid on it,” Albaugh says. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So, when people are already used to doing without health coverage, it’s particularly annoying to have the government say you have to buy it, according to Albaugh and many of his neighbors in Lassen, Modoc and Shasta Counties.\u003c/p>\n\u003cp>While Obamacare is largely viewed as a success in California – the state marketplace, \u003ca href=\"http://www.coveredca.com/\">Covered California\u003c/a>, is one of the most financially stable in the country – it hasn’t worked as well for folks in this rural northeast corner of the state.\u003c/p>\n\u003cp>There are two insurers selling plans in each county here, but residents say that hasn’t created enough competition to bring down prices. Plus, a lot of the doctors they’re used to seeing don’t take the marketplace plans.\u003c/p>\n\u003cp>“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” says Modoc County resident Althia Cline, who decided to forego coverage – and a surgery she needed for her asthma.\u003c/p>\n\u003cp>Just like the movie theater and bowling alley, most medical specialists are miles away. In Modoc County, there’s nowhere to have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half away from home.\u003c/p>\n\u003cp>Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.\u003c/p>\n\u003cfigure id=\"attachment_353608\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-353608 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Tessa-front-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tessa Anklin says Covered California health plans are too expensive for her family. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Two years ago, they bought a plan through Covered California. With a subsidy, they paid just $2 a month for their premium, but their deductible was $10,000.\u003c/p>\n\u003cp>“We paid for all of our medical services and our prescriptions,” she says. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”\u003c/p>\n\u003cp>Then, last year, their monthly premium jumped to $600. The plan was the same, Anklin says, and their household income was the same. But they still faced the same hour and a half drive to see doctors they almost never needed.*\u003c/p>\n\u003cp>Anklin thought of all the other ways she could spend that money.\u003c/p>\n\u003cp>“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she says. “That’s a big difference, when you think about how little you actually use the health coverage.”\u003c/p>\n\u003cp>That’s the reason she decided to cancel her health plan this year and go without. But she’ll still have to pay a penalty when the next tax season comes around.\u003c/p>\n\u003cp>“It basically penalizes us one way or the other because we can’t afford the coverage,” she says. “So that’s kind of difficult, to be that middle-class person.”\u003c/p>\n\u003cp>Anklin says she’d be happy to see Republicans get rid of Obamacare.\u003c/p>\n\u003cp>“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck when they’re already trying to survive with what they have,” she says. “It should be an option.”\u003c/p>\n\u003cp>But the Republican repeal and replace plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the GOP plan, according to a recent \u003ca href=\"http://www.kff.org/health-reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/\">analysis\u003c/a> from the Kaiser Family Foundation. Anklin could end up paying more than $2,000 a month for coverage, according to Kaiser’s \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\">county-by-county projections\u003c/a>.\u003c/p>\n\u003cp>That’s not what she had in mind for a fix.\u003c/p>\n\u003cp>“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin says.\u003c/p>\n\u003cp>With the Republican bill now in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.\u003c/p>\n\u003cp>Democrats have also said if the Republican bill fails, they’d be willing to \u003ca href=\"https://www.statnews.com/2017/07/05/health-care-compromise/\">work together on solutions\u003c/a>, but it’s not clear the parties could agree on one that would help people like Anklin.\u003c/p>\n\u003cp>If they can’t, she says she has no choice but to continue to go without coverage. Financially it makes sense in the short term, but it still worries her.\u003c/p>\n\u003cp>“If I ever have a problem,” she says, “I know I will be paying for the rest of my life.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Latino Patients Sue State Over 'Separate and Unequal' Health Care",
"title": "Latino Patients Sue State Over 'Separate and Unequal' Health Care",
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"content": "\u003cp>Latino Medi-Cal patients are suing the state, alleging the health program for low-income Californians is a separate and unequal system of health care.\u003c/p>\n\u003cp>Because the majority of Medi-Cal patients are Latino – 7.2 million out of 13 million total enrollees – the \u003ca href=\"http://www.seiu-uhw.org/wp-content/blogs.dir/166/files/2016/07/Medi-Cal-Complaint-2017-07-12.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lawsuit\u003c/a> alleges that delays in access to care, and denials of care, amount to civil rights violations.\u003c/p>\n\u003cp>“Medi-Cal participants suffer from greater pain, illness, and undiagnosed and untreated serious medical conditions—with significant impact to their overall health—than do their fellow Californians with other insurance,” the complaint says.\u003c/p>\n\u003cp>That’s been true for Gloria de Jesus, 16, who waited months to see a neurologist after being diagnosed with epilepsy. Her brother, Andrew, often lands in the emergency room because he can’t get his asthma prescription filled on time. Their mother, Rebecca Binsfeld, says she can’t find a pediatrician in Sacramento who takes their Medi-Cal coverage.\u003c/p>\n\u003cp>“They gave me a booklet, and in the booklet it has hundreds of doctors’ names and numbers, but you call and they’re not accepting new patients,” she says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Binsfeld, who suffers from lupus, waited 10 months to see a rheumatologist (she’s supposed to see one every four months), and a year to see an ophthalmologist (she’s supposed to go every six months, to check for blindness associated with her medications). The delays in care led to several lupus flares, episodes during which Binsfeld experiences extreme fatigue, pain in her joints, and headaches. Repeated flares can cause organ damage or kidney disease.\u003c/p>\n\u003cp>“I just want better health care. I want to be able to call the doctor if I’m not feeling well and to be able to be seen,” Binsfeld says. “I want everybody else on Medi-Cal to be treated the same as those that have private insurance.”\u003c/p>\n\u003cp>The lawsuit alleges several shortcomings in the Medi-Cal program that lead to these delays, namely “extremely low” reimbursement rates and burdensome paperwork that forces doctors to limit the number of low-income patients they see.\u003c/p>\n\u003cp>“As the number of Latinos has grown in the program, the state has cut funding,” says Darin Ranahan, an attorney from the Oakland law firm \u003ca href=\"http://feinbergjackson.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Feinberg, Jackson, Worthman and Wasow\u003c/a>, representing the plaintiffs. “Simply put, if you disinvest from a program as it’s coming to serve more and more people of color, that’s a form of race discrimination.”\u003c/p>\n\u003cp>The state is also failing to adequately monitor the program and ensure that patients are being seen in a timely manner, Ranahan says. For example, state regulations require patients to get urgent care within 48 hours, primary care within 10 days, and specialty appointments within 15 days.\u003c/p>\n\u003cp>“What we’ve seen, repeatedly, is people on Medi-Cal are not able to get appointments within these times,” Ranahan says.\u003c/p>\n\u003cp>The state Department of Health Care Services countered, saying it routinely monitors patient access to care in the Medi-Cal program, and that neither the state, nor federal health officials, had identified any systemic problems.\u003c/p>\n\u003cp>Beyond that, the state said it's position on the allegations was outlined in \u003ca href=\"///Users/aprildembosky/Downloads/AG%20Response%20Letter%205.10.16.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">a letter\u003c/a> the state attorney general wrote last year, after health advocates and union representatives from SEIU filed \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/15/advocates-allege-medi-cal-violates-latinos-civil-rights/\" target=\"_blank\" rel=\"noopener noreferrer\">a similar complaint\u003c/a> with the U.S. Department of Health and Human Services Office for Civil Rights in December 2015.\u003c/p>\n\u003cp>The letter says the state's reimbursement rates have been thoroughly reviewed and approved by federal officials, and that rates are uniform for all providers and patients. It says Latino beneficiaries are treated the same as all Medi-Cal beneficiaries.\u003c/p>\n\u003cp>“We work hard to serve all beneficiaries equally,” Jennifer Kent, director of the Department of Health Care Services, said in a 2015 statement responding to the original complaint. “We are committed to serving all vulnerable populations with vital health services.”\u003c/p>\n\u003cp>The department also cited a \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/publications/downloadable/BSCF%20Delivering%20Promise%20Full%20Report%20Web.pdf\">January 2015 survey\u003c/a> by the Blue Shield of California Foundation that showed satisfaction gaps between whites and Latinos, which were identified in 2011, have been eliminated or dramatically narrowed. Overall satisfaction with Medi-Cal was 90 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Federal officials did not act on the original complaint, and advocates say that’s why they are now filing the lawsuit directly against the state.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Latino Medi-Cal patients are suing the state, alleging the health program for low-income Californians is a separate and unequal system of health care.\u003c/p>\n\u003cp>Because the majority of Medi-Cal patients are Latino – 7.2 million out of 13 million total enrollees – the \u003ca href=\"http://www.seiu-uhw.org/wp-content/blogs.dir/166/files/2016/07/Medi-Cal-Complaint-2017-07-12.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lawsuit\u003c/a> alleges that delays in access to care, and denials of care, amount to civil rights violations.\u003c/p>\n\u003cp>“Medi-Cal participants suffer from greater pain, illness, and undiagnosed and untreated serious medical conditions—with significant impact to their overall health—than do their fellow Californians with other insurance,” the complaint says.\u003c/p>\n\u003cp>That’s been true for Gloria de Jesus, 16, who waited months to see a neurologist after being diagnosed with epilepsy. Her brother, Andrew, often lands in the emergency room because he can’t get his asthma prescription filled on time. Their mother, Rebecca Binsfeld, says she can’t find a pediatrician in Sacramento who takes their Medi-Cal coverage.\u003c/p>\n\u003cp>“They gave me a booklet, and in the booklet it has hundreds of doctors’ names and numbers, but you call and they’re not accepting new patients,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Binsfeld, who suffers from lupus, waited 10 months to see a rheumatologist (she’s supposed to see one every four months), and a year to see an ophthalmologist (she’s supposed to go every six months, to check for blindness associated with her medications). The delays in care led to several lupus flares, episodes during which Binsfeld experiences extreme fatigue, pain in her joints, and headaches. Repeated flares can cause organ damage or kidney disease.\u003c/p>\n\u003cp>“I just want better health care. I want to be able to call the doctor if I’m not feeling well and to be able to be seen,” Binsfeld says. “I want everybody else on Medi-Cal to be treated the same as those that have private insurance.”\u003c/p>\n\u003cp>The lawsuit alleges several shortcomings in the Medi-Cal program that lead to these delays, namely “extremely low” reimbursement rates and burdensome paperwork that forces doctors to limit the number of low-income patients they see.\u003c/p>\n\u003cp>“As the number of Latinos has grown in the program, the state has cut funding,” says Darin Ranahan, an attorney from the Oakland law firm \u003ca href=\"http://feinbergjackson.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Feinberg, Jackson, Worthman and Wasow\u003c/a>, representing the plaintiffs. “Simply put, if you disinvest from a program as it’s coming to serve more and more people of color, that’s a form of race discrimination.”\u003c/p>\n\u003cp>The state is also failing to adequately monitor the program and ensure that patients are being seen in a timely manner, Ranahan says. For example, state regulations require patients to get urgent care within 48 hours, primary care within 10 days, and specialty appointments within 15 days.\u003c/p>\n\u003cp>“What we’ve seen, repeatedly, is people on Medi-Cal are not able to get appointments within these times,” Ranahan says.\u003c/p>\n\u003cp>The state Department of Health Care Services countered, saying it routinely monitors patient access to care in the Medi-Cal program, and that neither the state, nor federal health officials, had identified any systemic problems.\u003c/p>\n\u003cp>Beyond that, the state said it's position on the allegations was outlined in \u003ca href=\"///Users/aprildembosky/Downloads/AG%20Response%20Letter%205.10.16.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">a letter\u003c/a> the state attorney general wrote last year, after health advocates and union representatives from SEIU filed \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/15/advocates-allege-medi-cal-violates-latinos-civil-rights/\" target=\"_blank\" rel=\"noopener noreferrer\">a similar complaint\u003c/a> with the U.S. Department of Health and Human Services Office for Civil Rights in December 2015.\u003c/p>\n\u003cp>The letter says the state's reimbursement rates have been thoroughly reviewed and approved by federal officials, and that rates are uniform for all providers and patients. It says Latino beneficiaries are treated the same as all Medi-Cal beneficiaries.\u003c/p>\n\u003cp>“We work hard to serve all beneficiaries equally,” Jennifer Kent, director of the Department of Health Care Services, said in a 2015 statement responding to the original complaint. “We are committed to serving all vulnerable populations with vital health services.”\u003c/p>\n\u003cp>The department also cited a \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/publications/downloadable/BSCF%20Delivering%20Promise%20Full%20Report%20Web.pdf\">January 2015 survey\u003c/a> by the Blue Shield of California Foundation that showed satisfaction gaps between whites and Latinos, which were identified in 2011, have been eliminated or dramatically narrowed. Overall satisfaction with Medi-Cal was 90 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Federal officials did not act on the original complaint, and advocates say that’s why they are now filing the lawsuit directly against the state.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Last fall, California voters approved the biggest increase in cigarette taxes since the state first began levying tobacco in the 1950s. Advocates for Proposition 56, which passed with a fairly overwhelming 64 percent of the vote, argued that a $2-per-pack tax hike would hurt pocketbooks enough to nudge millions of California smokers to quit, or at least to light up less frequently.\u003c/p>\n\u003cp>When the tax went into effect in April, smokers saw the average cost of a pack of cigarettes soar from under $6 to up to $9, making California one of the most expensive states in which to buy cigarettes. But the question then: Was that enough to force smokers to kick an increasingly expensive habit?\u003c/p>\n\u003cp>The early data suggest that yes, California cigarette sales have declined significantly since prices went up. In fact, the drop is even sharper than the state anticipated -- which could spell trouble for state coffers.\u003c/p>\n\u003cp>[cigtax]\u003c/p>\n\u003cp>Cigarette pack \"distributions\" -- tax lingo for a pack of cigarettes typically sold from a distributor to a retailer, and a good proxy for consumption -- dropped 56 percent year-over-year in the two months following the tax increase, according to data obtained from the California Department of Tax and Fee Administration and analyzed by CALmatters. That’s a decline of nearly 82 million packs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“This is a big effect,” said Dr. Stanton Glantz, a researcher at UCSF's Center for Tobacco Control Research and Education. “I have felt for a long time where we’re getting to the point in California where smoking is so low that a couple of good shoves like this one, and we might be rid of it.”\u003c/p>\n\u003cp>Glantz and other tobacco experts cautioned that it is still far too early to make definitive conclusions: It’s difficult to draw inferences from two months of data, as both suppliers and consumers are still figuring out what they can and can’t afford.\u003c/p>\n\u003cp>Knowing that prices were about to rise, tobacco distributors and smokers also rushed to stockpile as many cigarettes as possible the month preceding the tax hike, deflating the April and May figures. California cigarette distributors sold nearly 104 million cigarette packs in March, by far the most of any month in the last two years.\u003c/p>\n\u003cp>[contextly_sidebar id=\"7wYFkDkJqpG5LX8BPIbgWZ6c23FJqkpm\"]\u003c/p>\n\u003cp>But even after adjusting for stockpiling, the tax hike appears to be having a major impact: Cigarette sales still dropped 23 percent year-over-year for the three-month period, including the pretax run-up.\u003c/p>\n\u003cp>Experts say cigarette consumption will likely rise slightly in the months ahead, before stabilizing in the next four to five months. Lower-income and younger smokers are typically the first to cut back in response to a tax hike.\u003c/p>\n\u003cp>But what’s beneficial for public health isn’t necessarily good for the state budget, at least in the near term.\u003c/p>\n\u003cp>Proposition 56 was supposed to generate an additional $1.3 billion in revenue for the state to shore up Medi-Cal, the state health insurance program for low-income Californians. In the two months since the tax has been in place, the state has raised a total of $182 million -- below what the Brown administration was expecting.\u003c/p>\n\u003cp>\"Sales are still more sluggish than had been originally anticipated,\" H.D. Palmer, spokesman for the Department of Finance, said via email. \"Given that we only have two months of data, it is too early to predict a trend. If the current trend holds, we would likely make a revision to our expected decline in consumption.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"B6j14NxRMaFQ9SqSivOZuj8kr97QZdE1\"]\u003c/p>\n\u003cp>How the new cigarette tax revenue would be spent became a \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener noreferrer\">hot-button issue\u003c/a> in state budget negotiations last month. Ultimately, legislators and Gov. Jerry Brown agreed to divide the new revenue between increased payments to physicians and general Medi-Cal expenses.\u003c/p>\n\u003cp>Palmer said that if cigarette tax revenues continue to come in lower than anticipated, the administration would need to identify an alternative revenue source or propose cutbacks to Medi-Cal.\u003c/p>\n\u003cp>Of course, tax revenue is just one side of the equation when it comes to the fiscal effects of the new cigarette tax. Savings from lower health care costs as more low-income smokers quit are not factored into the revenue side of the state budget.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://calmatters.org/\" target=\"_blank\" rel=\"noopener noreferrer\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politic\u003c/em>s.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last fall, California voters approved the biggest increase in cigarette taxes since the state first began levying tobacco in the 1950s. Advocates for Proposition 56, which passed with a fairly overwhelming 64 percent of the vote, argued that a $2-per-pack tax hike would hurt pocketbooks enough to nudge millions of California smokers to quit, or at least to light up less frequently.\u003c/p>\n\u003cp>When the tax went into effect in April, smokers saw the average cost of a pack of cigarettes soar from under $6 to up to $9, making California one of the most expensive states in which to buy cigarettes. But the question then: Was that enough to force smokers to kick an increasingly expensive habit?\u003c/p>\n\u003cp>The early data suggest that yes, California cigarette sales have declined significantly since prices went up. In fact, the drop is even sharper than the state anticipated -- which could spell trouble for state coffers.\u003c/p>\n\u003cp>[cigtax]\u003c/p>\n\u003cp>Cigarette pack \"distributions\" -- tax lingo for a pack of cigarettes typically sold from a distributor to a retailer, and a good proxy for consumption -- dropped 56 percent year-over-year in the two months following the tax increase, according to data obtained from the California Department of Tax and Fee Administration and analyzed by CALmatters. That’s a decline of nearly 82 million packs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“This is a big effect,” said Dr. Stanton Glantz, a researcher at UCSF's Center for Tobacco Control Research and Education. “I have felt for a long time where we’re getting to the point in California where smoking is so low that a couple of good shoves like this one, and we might be rid of it.”\u003c/p>\n\u003cp>Glantz and other tobacco experts cautioned that it is still far too early to make definitive conclusions: It’s difficult to draw inferences from two months of data, as both suppliers and consumers are still figuring out what they can and can’t afford.\u003c/p>\n\u003cp>Knowing that prices were about to rise, tobacco distributors and smokers also rushed to stockpile as many cigarettes as possible the month preceding the tax hike, deflating the April and May figures. California cigarette distributors sold nearly 104 million cigarette packs in March, by far the most of any month in the last two years.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But even after adjusting for stockpiling, the tax hike appears to be having a major impact: Cigarette sales still dropped 23 percent year-over-year for the three-month period, including the pretax run-up.\u003c/p>\n\u003cp>Experts say cigarette consumption will likely rise slightly in the months ahead, before stabilizing in the next four to five months. Lower-income and younger smokers are typically the first to cut back in response to a tax hike.\u003c/p>\n\u003cp>But what’s beneficial for public health isn’t necessarily good for the state budget, at least in the near term.\u003c/p>\n\u003cp>Proposition 56 was supposed to generate an additional $1.3 billion in revenue for the state to shore up Medi-Cal, the state health insurance program for low-income Californians. In the two months since the tax has been in place, the state has raised a total of $182 million -- below what the Brown administration was expecting.\u003c/p>\n\u003cp>\"Sales are still more sluggish than had been originally anticipated,\" H.D. Palmer, spokesman for the Department of Finance, said via email. \"Given that we only have two months of data, it is too early to predict a trend. If the current trend holds, we would likely make a revision to our expected decline in consumption.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>How the new cigarette tax revenue would be spent became a \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener noreferrer\">hot-button issue\u003c/a> in state budget negotiations last month. Ultimately, legislators and Gov. Jerry Brown agreed to divide the new revenue between increased payments to physicians and general Medi-Cal expenses.\u003c/p>\n\u003cp>Palmer said that if cigarette tax revenues continue to come in lower than anticipated, the administration would need to identify an alternative revenue source or propose cutbacks to Medi-Cal.\u003c/p>\n\u003cp>Of course, tax revenue is just one side of the equation when it comes to the fiscal effects of the new cigarette tax. Savings from lower health care costs as more low-income smokers quit are not factored into the revenue side of the state budget.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"https://calmatters.org/\" target=\"_blank\" rel=\"noopener noreferrer\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politic\u003c/em>s.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/charlotte-huff/\" target=\"_blank\">Charlotte Huff\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures",
"title": "Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures",
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"content": "\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mrVakER0R6f0AToNbkAK83dprja2VTaO\"]\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal",
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"content": "\u003cp>Three years ago, Carol Morris was put in charge of a massive remodel of the new Mountain Valleys health clinic in Burney, a small town in mountains in eastern Shasta County.\u003c/p>\n\u003cp>She painted the new exam rooms in muted greens and browns, to reflect the pine forest and cattle ranches outside, and she made a series of equipment upgrades: new sonogram and retina scanning machines, a designer vaccine refrigerator, and a fleet of cushy new exam tables.\u003c/p>\n\u003cp>“Some of the staff will come in and nap on one at lunchtime,” Morris says, stroking the leather table.\u003c/p>\n\u003cp>The new Burney clinic is three times as big as the old one, Morris says. They’ve doubled the number of patients they see, and they’ve doubled their staff.\u003c/p>\n\u003cp>All thanks to money from the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I guess it's true, build it and they will come,” Morris says.\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-29a-tcr.mp3\" Image=\"https://u.s.kqed.net/2017/06/29/Stethoscope.jpg\" Title=\"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal\" program=\"The California Report\"]\u003c/p>\n\u003cp>President Obama’s signature health law provided grants for capital construction at rural clinics, and increased payments for treating patients on Medi-Cal, the state’s health program for low-income people. The law also expanded who qualified for Medi-Cal, adding close to 4 million Californians to the rolls, many of them from \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">rural, Republican counties\u003c/a> in the state, like Shasta, Lassen, and Siskiyou, where Mountain Valleys clinics operate.\u003c/p>\n\u003cp>With many of their previously uninsured patients now covered by Medi-Cal, the clinic is making money instead of losing it.\u003c/p>\n\u003cp>“That was a real boon to us,” says Dave Jones, CEO of \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys clinics\u003c/a>. “We went from struggling payday to payday, to actually having a reserve at this point.”\u003c/p>\n\u003cp>In addition to moving into the new medical clinic in Burney, Jones was able to buy a dental building next door, expand mental health and drug counseling services, and hire a range of new administrative staff.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uO0r77wi0xkfHFV79VI4jRtVOZYGMW8u\"]\u003c/p>\n\u003cp>Across Shasta County, the Obamacare Medi-Cal expansion helped create more than 900 jobs in the health care sector and beyond, according to an economic impact report commissioned by \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Partnership Health Plan\u003c/a>, the insurer that manages Medi-Cal in far northern California.\u003c/p>\n\u003cp>One of the Burney clinic’s newest hires is Laura Hodge. The clinic had noticed a lot of patients who got health coverage for the first time were going to the Emergency Room more -- for simple things, like a headache or Band-Aid.\u003c/p>\n\u003cp>They brought Hodge on to start a program aimed at reducing overuse of the ER. She sat in her office on a recent afternoon calling patients, asking them if they wanted to participate in the new program.\u003c/p>\n\u003cp>“I would be your liaison with the doctors,” she explains over the phone. “If you feel like you're not being listened to, or if you have any questions and you don't feel like you're being answered, you could come to me.”\u003c/p>\n\u003cp>The new job is a huge economic help for Hodge. Her husband is a trucker and they have three kids. Hodge’s salary is critical to keeping the household going.\u003c/p>\n\u003cp>And that’s critical to Burney. After the logging company, the clinic is one of the largest employers in town. A lot of the money Hodge and her coworkers make goes straight back into the community.\u003c/p>\n\u003cp>“The grocery store, the tire shop, the gas station,” Hodge lists the places she spends her paycheck. “Our little theater, the bowling alley, Kristi’s Unique Boutique.”\u003c/p>\n\u003cfigure id=\"attachment_348515\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-348515\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Laura-Hodge-sips-red-bull-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Laura Hodge sips a blended Red Bull at her favorite coffee shop in Burney. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hodge takes me to one of her favorite haunts, the drive-thru window of the Mt. Burney Coffee Co.\u003c/p>\n\u003cp>“I will take a blended Red Bull,” she says, mulling over the list of flavors, deciding on the Fruit Loop – club soda with passion fruit, peach, and red raspberry syrup mixed in the blender with ice and a can of Red Bull.\u003c/p>\n\u003cp>“The first time I drank one, oh my gosh,” Hodge laughs, “I went home and I cleaned everything in my house.”\u003c/p>\n\u003cp>Staff from the health clinic are regulars at the coffee shop, says barista Abby Fristine.\u003c/p>\n\u003cp>“Most of them come through everyday, before or after work,” she says.\u003c/p>\n\u003cp>The money earned and spent by the health clinic staff ripples through the local economy. And all the people they’ve hired in recent years makes a difference in a small town like this, says Jones, the clinic CEO.\u003c/p>\n\u003cp>“I'm sure over the last two or three years it's been worth a couple million dollars to the community,” he says.\u003c/p>\n\u003cp>That’s why Jones is sounding the alarm on attempts to repeal the Affordable Care Act.\u003c/p>\n\u003cp>He and other clinic directors have managed to convince conservative officials, like the Shasta County Board of Supervisors, to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">formally oppose the Republican health bill\u003c/a>, in part because of the potential economic impacts. The Siskiyou board is considering a similar move.\u003c/p>\n\u003cp>Together, both counties stand to lose close to $200 million in business revenue from a rollback to Medicaid funding, hitting not just clinics, but local shops and restaurants, too.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we have to revert back to where we were,” Jones says, “it could be disastrous.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three years ago, Carol Morris was put in charge of a massive remodel of the new Mountain Valleys health clinic in Burney, a small town in mountains in eastern Shasta County.\u003c/p>\n\u003cp>She painted the new exam rooms in muted greens and browns, to reflect the pine forest and cattle ranches outside, and she made a series of equipment upgrades: new sonogram and retina scanning machines, a designer vaccine refrigerator, and a fleet of cushy new exam tables.\u003c/p>\n\u003cp>“Some of the staff will come in and nap on one at lunchtime,” Morris says, stroking the leather table.\u003c/p>\n\u003cp>The new Burney clinic is three times as big as the old one, Morris says. They’ve doubled the number of patients they see, and they’ve doubled their staff.\u003c/p>\n\u003cp>All thanks to money from the Affordable Care Act.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>President Obama’s signature health law provided grants for capital construction at rural clinics, and increased payments for treating patients on Medi-Cal, the state’s health program for low-income people. The law also expanded who qualified for Medi-Cal, adding close to 4 million Californians to the rolls, many of them from \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">rural, Republican counties\u003c/a> in the state, like Shasta, Lassen, and Siskiyou, where Mountain Valleys clinics operate.\u003c/p>\n\u003cp>With many of their previously uninsured patients now covered by Medi-Cal, the clinic is making money instead of losing it.\u003c/p>\n\u003cp>“That was a real boon to us,” says Dave Jones, CEO of \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys clinics\u003c/a>. “We went from struggling payday to payday, to actually having a reserve at this point.”\u003c/p>\n\u003cp>In addition to moving into the new medical clinic in Burney, Jones was able to buy a dental building next door, expand mental health and drug counseling services, and hire a range of new administrative staff.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Across Shasta County, the Obamacare Medi-Cal expansion helped create more than 900 jobs in the health care sector and beyond, according to an economic impact report commissioned by \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Partnership Health Plan\u003c/a>, the insurer that manages Medi-Cal in far northern California.\u003c/p>\n\u003cp>One of the Burney clinic’s newest hires is Laura Hodge. The clinic had noticed a lot of patients who got health coverage for the first time were going to the Emergency Room more -- for simple things, like a headache or Band-Aid.\u003c/p>\n\u003cp>They brought Hodge on to start a program aimed at reducing overuse of the ER. She sat in her office on a recent afternoon calling patients, asking them if they wanted to participate in the new program.\u003c/p>\n\u003cp>“I would be your liaison with the doctors,” she explains over the phone. “If you feel like you're not being listened to, or if you have any questions and you don't feel like you're being answered, you could come to me.”\u003c/p>\n\u003cp>The new job is a huge economic help for Hodge. Her husband is a trucker and they have three kids. Hodge’s salary is critical to keeping the household going.\u003c/p>\n\u003cp>And that’s critical to Burney. After the logging company, the clinic is one of the largest employers in town. A lot of the money Hodge and her coworkers make goes straight back into the community.\u003c/p>\n\u003cp>“The grocery store, the tire shop, the gas station,” Hodge lists the places she spends her paycheck. “Our little theater, the bowling alley, Kristi’s Unique Boutique.”\u003c/p>\n\u003cfigure id=\"attachment_348515\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-348515\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Laura-Hodge-sips-red-bull-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Laura Hodge sips a blended Red Bull at her favorite coffee shop in Burney. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hodge takes me to one of her favorite haunts, the drive-thru window of the Mt. Burney Coffee Co.\u003c/p>\n\u003cp>“I will take a blended Red Bull,” she says, mulling over the list of flavors, deciding on the Fruit Loop – club soda with passion fruit, peach, and red raspberry syrup mixed in the blender with ice and a can of Red Bull.\u003c/p>\n\u003cp>“The first time I drank one, oh my gosh,” Hodge laughs, “I went home and I cleaned everything in my house.”\u003c/p>\n\u003cp>Staff from the health clinic are regulars at the coffee shop, says barista Abby Fristine.\u003c/p>\n\u003cp>“Most of them come through everyday, before or after work,” she says.\u003c/p>\n\u003cp>The money earned and spent by the health clinic staff ripples through the local economy. And all the people they’ve hired in recent years makes a difference in a small town like this, says Jones, the clinic CEO.\u003c/p>\n\u003cp>“I'm sure over the last two or three years it's been worth a couple million dollars to the community,” he says.\u003c/p>\n\u003cp>That’s why Jones is sounding the alarm on attempts to repeal the Affordable Care Act.\u003c/p>\n\u003cp>He and other clinic directors have managed to convince conservative officials, like the Shasta County Board of Supervisors, to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">formally oppose the Republican health bill\u003c/a>, in part because of the potential economic impacts. The Siskiyou board is considering a similar move.\u003c/p>\n\u003cp>Together, both counties stand to lose close to $200 million in business revenue from a rollback to Medicaid funding, hitting not just clinics, but local shops and restaurants, too.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we have to revert back to where we were,” Jones says, “it could be disastrous.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Obamacare Inspires Unlikely Political Action in Red California",
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"content": "\u003cp>Modoc County, in the northeast corner of California, is roughly the size of Connecticut. It's so sparsely populated, the entire county has just one stoplight. The nearest Wal-Mart is more than an hour's drive, across the Oregon border. Same with hospitals that deliver babies.\u003c/p>\n\u003cp>Greta Elliott runs a tiny health \u003ca href=\"http://canbyclinic.org/\" target=\"_blank\" rel=\"noopener noreferrer\">clinic\u003c/a> in Canby, on the edge of the national forest. \"Rural\" doesn’t begin to describe the area, she says. This is \"the frontier.\"\u003c/p>\n\u003cp>“There are more cows in Modoc than there are people,” Elliott says.\u003c/p>\n\u003cp>There's a frontier mentality, too. People take care of each other, and they take care of themselves. They don’t like being told what to do. Being forced to buy insurance made Obamacare a dirty word.\u003c/p>\n\u003cp>Even Elliott, the head of a health clinic, decided against buying coverage for herself.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It's too expensive,” she says. “I choose to put my money back into paying the bills of the whole family.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-28a-tcr.mp3\" Image=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/03/BloodPressure-768x512.jpg\" Title=\"Obamacare Inspires Unlikely Political Action in Red California\" program=\"The California Report\"]\u003c/p>\n\u003cp>Overall, the Affordable Care Act helped 25,000 people in far Northern California buy plans through the state marketplace, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>. But the law helped three times as many people, 75,000, enroll in Medi-Cal, the state’s Medicaid program that provides free health coverage for low-income residents.\u003c/p>\n\u003cp>“The data shows it's the rural communities that have greatly benefited from the Medicaid expansion. That’s the irony,” says Dean Germano, CEO of the \u003ca href=\"https://www.shastahealth.org\" target=\"_blank\" rel=\"noopener noreferrer\">Shasta Community Health Center\u003c/a>. “These are places that voted much more heavily for Donald Trump.”\u003c/p>\n\u003cp>In Modoc and Lassen counties, 70 percent of people voted for Trump in the November election. In neighboring Shasta County, Trump won 64 percent of the vote.\u003c/p>\n\u003cp>But now a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of clinics from across the Northeast corner of the state is lobbying local officials to take an unpopular position in this conservative land: defend Obamacare.\u003c/p>\n\u003cp>And the right-leaning Shasta County Board of Supervisors took them up on it.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Nl4j8x6j7iRmpWflZsVooGaqsbbbOLuA\"]\u003c/p>\n\u003cp>“We thought ‘Whoa! That is really bold,’” Germano says. “I was surprised.”\u003c/p>\n\u003cp>The board sent a letter to the local Republican congressman, \u003ca href=\"https://lamalfa.house.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Doug La Malfa\u003c/a>, asking him to vote against the initial GOP repeal and replace bill, because it would hurt local people.\u003c/p>\n\u003cp>“We have an obligation to say something,” says Supervisor David Kehoe. “And if it may be mildly offensive from a political standpoint for some, well, we’re not going to be intimidated by politics.”\u003c/p>\n\u003cp>But Congressman La Malfa still voted in favor of dismantling Obamacare.\u003c/p>\n\u003cp>La Malfa didn't return calls and emails for this story, but, in May, \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">he told KQED\u003c/a> that skyrocketing premiums were the main driver behind his vote.\u003c/p>\n\u003cp>\"Unfortunately, the reality is that too many young and healthy individuals are deciding they’d rather pay the penalty than sign up for care, citing financial barriers and lack of choice,\" he said in a statement. \"A 28 year old making $45,000 a year with no major health concerns is not going to pay upwards of $400 a month for a plan that does not even work for them.\"\u003c/p>\n\u003cp>When clinic representatives met with La Malfa's staffers, they were told the Congressman's office was flooded with calls like this.\u003c/p>\n\u003cp>But poor folks on Medi-Cal didn’t call to say how much they appreciate that program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.\u003c/p>\n\u003cp>“They feel like it's a handout and they're too proud, they don’t want to,” says Carol Morris, an enrollment counselor for the \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys\u003c/a> health clinics in Shasta county.\u003c/p>\n\u003cp>One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">\"Partnership Health Plan\" \u003c/a>and may not realize they’re actually covered by a government program.\u003c/p>\n\u003cp>“It feels like it's more of an insurance,” Morris says. “It’s like a laminated, wallet-sized card that's got your numbers on it. It just looks exactly like an insurance card.”\u003c/p>\n\u003cp>One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.\u003c/p>\n\u003cp>“It did me good,” she says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"swxoiuaBwIFNHC8PbxRB3kfDYxOKFLOH\"]\u003c/p>\n\u003cp>Now she has a subsidized commercial plan through Covered California, with modest premiums and co-pays, and she likes that, too.\u003c/p>\n\u003cp>“It’s okay. 'Cause I’m at the doctor’s at least once a month,” she says.\u003c/p>\n\u003cp>But when asked what she thinks of Obamacare overall, she says she doesn’t like it.\u003c/p>\n\u003cp>“Because of Obama himself,” she says with a laugh. “I rest my case.”\u003c/p>\n\u003cp>The confusion and the contradictions are common among patients, explains Morris, the enrollment counselor.\u003c/p>\n\u003cp>“People just don't understand the different names,” she says. “But, of course, it's the same thing.”\u003c/p>\n\u003cp>Morris has seen the difference Obamacare has made for people in the region. She’s seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn’t have gotten.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Those patients won’t fight for Obamacare, Morris says, so that’s why the clinics have to.\u003c/p>\n\n",
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"excerpt": "Under the ACA, 75,000 people enrolled in Medi-Cal in the state's northeast. 'The data shows it’s the rural communities that have greatly benefited from the Medicaid expansion.'",
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"description": "Under the ACA, 75,000 people enrolled in Medi-Cal in the state's northeast. 'The data shows it’s the rural communities that have greatly benefited from the Medicaid expansion.'",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Modoc County, in the northeast corner of California, is roughly the size of Connecticut. It's so sparsely populated, the entire county has just one stoplight. The nearest Wal-Mart is more than an hour's drive, across the Oregon border. Same with hospitals that deliver babies.\u003c/p>\n\u003cp>Greta Elliott runs a tiny health \u003ca href=\"http://canbyclinic.org/\" target=\"_blank\" rel=\"noopener noreferrer\">clinic\u003c/a> in Canby, on the edge of the national forest. \"Rural\" doesn’t begin to describe the area, she says. This is \"the frontier.\"\u003c/p>\n\u003cp>“There are more cows in Modoc than there are people,” Elliott says.\u003c/p>\n\u003cp>There's a frontier mentality, too. People take care of each other, and they take care of themselves. They don’t like being told what to do. Being forced to buy insurance made Obamacare a dirty word.\u003c/p>\n\u003cp>Even Elliott, the head of a health clinic, decided against buying coverage for herself.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It's too expensive,” she says. “I choose to put my money back into paying the bills of the whole family.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Overall, the Affordable Care Act helped 25,000 people in far Northern California buy plans through the state marketplace, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>. But the law helped three times as many people, 75,000, enroll in Medi-Cal, the state’s Medicaid program that provides free health coverage for low-income residents.\u003c/p>\n\u003cp>“The data shows it's the rural communities that have greatly benefited from the Medicaid expansion. That’s the irony,” says Dean Germano, CEO of the \u003ca href=\"https://www.shastahealth.org\" target=\"_blank\" rel=\"noopener noreferrer\">Shasta Community Health Center\u003c/a>. “These are places that voted much more heavily for Donald Trump.”\u003c/p>\n\u003cp>In Modoc and Lassen counties, 70 percent of people voted for Trump in the November election. In neighboring Shasta County, Trump won 64 percent of the vote.\u003c/p>\n\u003cp>But now a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of clinics from across the Northeast corner of the state is lobbying local officials to take an unpopular position in this conservative land: defend Obamacare.\u003c/p>\n\u003cp>And the right-leaning Shasta County Board of Supervisors took them up on it.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“We thought ‘Whoa! That is really bold,’” Germano says. “I was surprised.”\u003c/p>\n\u003cp>The board sent a letter to the local Republican congressman, \u003ca href=\"https://lamalfa.house.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Doug La Malfa\u003c/a>, asking him to vote against the initial GOP repeal and replace bill, because it would hurt local people.\u003c/p>\n\u003cp>“We have an obligation to say something,” says Supervisor David Kehoe. “And if it may be mildly offensive from a political standpoint for some, well, we’re not going to be intimidated by politics.”\u003c/p>\n\u003cp>But Congressman La Malfa still voted in favor of dismantling Obamacare.\u003c/p>\n\u003cp>La Malfa didn't return calls and emails for this story, but, in May, \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">he told KQED\u003c/a> that skyrocketing premiums were the main driver behind his vote.\u003c/p>\n\u003cp>\"Unfortunately, the reality is that too many young and healthy individuals are deciding they’d rather pay the penalty than sign up for care, citing financial barriers and lack of choice,\" he said in a statement. \"A 28 year old making $45,000 a year with no major health concerns is not going to pay upwards of $400 a month for a plan that does not even work for them.\"\u003c/p>\n\u003cp>When clinic representatives met with La Malfa's staffers, they were told the Congressman's office was flooded with calls like this.\u003c/p>\n\u003cp>But poor folks on Medi-Cal didn’t call to say how much they appreciate that program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.\u003c/p>\n\u003cp>“They feel like it's a handout and they're too proud, they don’t want to,” says Carol Morris, an enrollment counselor for the \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys\u003c/a> health clinics in Shasta county.\u003c/p>\n\u003cp>One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">\"Partnership Health Plan\" \u003c/a>and may not realize they’re actually covered by a government program.\u003c/p>\n\u003cp>“It feels like it's more of an insurance,” Morris says. “It’s like a laminated, wallet-sized card that's got your numbers on it. It just looks exactly like an insurance card.”\u003c/p>\n\u003cp>One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.\u003c/p>\n\u003cp>“It did me good,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Now she has a subsidized commercial plan through Covered California, with modest premiums and co-pays, and she likes that, too.\u003c/p>\n\u003cp>“It’s okay. 'Cause I’m at the doctor’s at least once a month,” she says.\u003c/p>\n\u003cp>But when asked what she thinks of Obamacare overall, she says she doesn’t like it.\u003c/p>\n\u003cp>“Because of Obama himself,” she says with a laugh. “I rest my case.”\u003c/p>\n\u003cp>The confusion and the contradictions are common among patients, explains Morris, the enrollment counselor.\u003c/p>\n\u003cp>“People just don't understand the different names,” she says. “But, of course, it's the same thing.”\u003c/p>\n\u003cp>Morris has seen the difference Obamacare has made for people in the region. She’s seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn’t have gotten.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Those patients won’t fight for Obamacare, Morris says, so that’s why the clinics have to.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "You Are Now Protected From Nasty Surprise Medical Bills",
"title": "You Are Now Protected From Nasty Surprise Medical Bills",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>Before Kevin Powers underwent lung cancer surgery last October, his girlfriend, Agi Orsi, meticulously checked and double-checked to be sure his Santa Monica hospital and surgeon were in his health plan’s network. They were.\u003c/p>\n\u003cp>Even in the hospital, Orsi dutifully wrote “No out-of-network doctors” across the top of Powers’ admission paperwork.\u003c/p>\n\u003cp>Her diligence was for naught.\u003c/p>\n\u003cp>Powers, 57, suffered serious complications, resulting in a two-week hospital stay that included visits from several specialists. It also resulted in a barrage of surprise medical bills from some of those specialists charging out-of-network rates.\u003c/p>\n\u003cp>The bills total about $5,600 — so far.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s overwhelming,” says Orsi, 64, who lives with Powers in Topanga Canyon. “I feel like consumers are at a major disadvantage.”\u003c/p>\n\u003caside class=\"alignright\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/bazar_100.jpg\" alt=\"\" width=\"100\" height=\"133\" class=\"alignleft size-full wp-image-348286\">\u003cstrong>Ask Emily\u003c/strong>\n\u003cp>Answering consumers’ questions about California’s changing medical landscape.\u003cbr>\n\u003cbr>\nSend questions for Emily to \u003ca href=\"mailto:AskEmily@kff.org\">AskEmily@kff.org\u003c/a>\u003c/p>\u003c/aside>\n\u003cp>Starting next month, many Californians will be protected against such surprise medical bills from out-of-network providers, also known as “\u003ca href=\"http://www.kff.org/private-insurance/issue-brief/surprise-medical-bills/\" target=\"_blank\" rel=\"noopener noreferrer\">balance billing\u003c/a>.”\u003c/p>\n\u003cp>Under a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB72\" target=\"_blank\" rel=\"noopener noreferrer\">new state law\u003c/a>, if you visit an in-network facility — such as a hospital, lab or imaging center — you will be responsible only for your in-network share of the cost, even if you’re seen by an out-of-network provider.\u003c/p>\n\u003cp>The \u003ca href=\"http://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactSheets/fsab72.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">law\u003c/a> applies to non-emergency services received on or after July 1.\u003c/p>\n\u003cp>“This is a very big deal,” says Tam Ma, legal and policy director for the advocacy group \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access California\u003c/a>. “We’ve heard from hundreds of consumers who were getting these surprise bills.”\u003c/p>\n\u003cp>A 2015 Consumers Union \u003ca href=\"https://consumersunion.org/wp-content/uploads/2015/05/Surprise-Bills-Survey-CA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">survey\u003c/a> found that nearly 1 in 4 Californians who visited a hospital or had surgery in the previous two years were charged an out‐of‐network rate when they thought a provider was in‐network.\u003c/p>\n\u003cp>Here’s a common scenario: A patient takes pains to ensure her hospital and surgeon are in network, only to get billed by the out-of-network anesthesiologist who appears at her bedside to put her under.\u003c/p>\n\u003cdiv id=\"attachment_239562\" class=\"wp-caption alignleft\" style=\"width: 380px\">\n\u003cp>\u003cimg class=\"wp-image-239562 size-khn-article-small\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/agikevin-770.jpg?w=370&h=247&crop=1\" alt=\"\" width=\"370\" height=\"247\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers (right) is facing more than $5,000 in surprise medical bills from his October lung cancer surgery even though his girlfriend, Agi Orsi (left) took pains to ensure his hospital and surgeon were in his health plan’s network. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>“No one gets to pick their anesthesiologist,” Ma says. “It depends on who is on duty, who is available.”\u003c/p>\n\u003cp>Surprise bills also often come from pathologists, radiologists and assistant surgeons — other providers that patients typically can’t choose, she says.\u003c/p>\n\u003cp>The new law covers Californians with private health insurance plans that are regulated by the state Department of Managed Health Care (DMHC) and the state Department of Insurance, which includes roughly 70 percent of the state’s private insurance market, according to the California Health Care Foundation. (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>It does not cover some 5.7 million people whose employer-sponsored insurance plans are regulated by the U.S. Department of Labor.\u003c/p>\n\u003cp>Insurers, health care providers and regulators are working furiously behind the scenes to hash out some details about that law, including how much out-of-network providers should be compensated for their services.\u003c/p>\n\u003cp>But that shouldn’t affect you.\u003c/p>\n\u003cp>“Is it going to be pretty as plans and providers figure this out in the background? Maybe not,” says Charles Bacchi, president of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. “But what’s important is that it’s not readily apparent to the consumer.”\u003c/p>\n\u003cp>The key point to remember is that you shouldn’t pay more than your in-network copayment, coinsurance or deductible, as long as you visited an in-network facility for non-emergency services.\u003c/p>\n\u003cp>So, if you receive what looks like a bill from a provider showing an out-of-network rate, don’t panic, says Betsy Imholz, director of special projects for \u003ca href=\"https://consumersunion.org/experts/elizabeth-betsy-imholz/\" target=\"_blank\" rel=\"noopener noreferrer\">Consumers Union\u003c/a>.\u003c/p>\n\u003cdiv id=\"attachment_239563\" class=\"wp-caption alignleft\" style=\"width: 280px\">\n\u003cp>\u003cimg class=\"wp-image-239563 size-khn-article-vertical\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/kevin-in-hospital-770.jpg?w=270&h=405&crop=1\" alt=\"\" width=\"270\" height=\"405\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers suffered serious complications after his lung cancer surgery last October, resulting in a two-week hospital stay and surprise out-of-network bills. He is shown here in the hospital after surgery. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>First, read it carefully. It may not actually be a bill. Under the law, any communication to the patient from an out-of-network provider before that provider gets the consumer’s in-network cost information must say — in bold, 12-point type — that it is “not a bill.”\u003c/p>\n\u003cp>“If it’s an out-of-network doctor, they shouldn’t be claiming that you owe anything right away,” Imholz says.\u003c/p>\n\u003cp>And don’t pay anything until you receive an Explanation of Benefits from your insurer, experts advise.\u003c/p>\n\u003cp>When you do receive it, inspect it. If you think you’re still being billed incorrectly, call your health plan and file a grievance, says Mary Watanabe, DMHC’s deputy director of health policy. Your plan will have 30 days to resolve the problem.\u003c/p>\n\u003cp>If your plan doesn’t resolve the situation within that time frame, or you’re dissatisfied with the decision, it’s time to call your regulator. For most of you, that will be DMHC: \u003ca href=\"http://www.healthhelp.ca.gov/\">www.healthhelp.ca.gov\u003c/a> or 888-466-2219. To reach the Department of Insurance, visit \u003ca href=\"http://www.insurance.ca.gov/\">www.insurance.ca.gov\u003c/a> or call 800-927-HELP.\u003c/p>\n\u003cp>You can also call your regulator \u003cem>before\u003c/em> you hear back from your health plan, particularly if out-of-network providers are hassling you for payment.\u003c/p>\n\u003cp>If you inadvertently paid an out-of-network provider more than he or she is owed, all is not lost. The doctor has to refund the overpayment within 30 days, Ma says. Otherwise, interest starts to accrue.\u003c/p>\n\u003cp>One warning: The law allows out-of-network providers to bill you out-of-network rates, but only if you voluntarily sign a form at least 24 hours before you receive care, Imholz says. The form must include an estimate of your cost and explain that you can receive care from an in-network provider instead, she says.\u003c/p>\n\u003cp>“You don’t have to sign it. It’s completely voluntary.”\u003c/p>\n\u003cp>If you actually do want to be seen by an out-of-network provider and are willing to pay the out-of-network charges, you still have to sign the consent form.\u003c/p>\n\u003cp>Since this law kicks in July 1, the surprise medical bills Powers received after his lung surgery won’t be covered. Orsi says Powers can’t afford to pay them.\u003c/p>\n\u003cp>“I don’t think it’s fair,” she says. “I’m going to keep fighting it.”\u003c/p>\n\u003cp>There may be hope. If, like that Southern California couple, you’re currently fighting a surprise bill for a service you received before July 1, Watanabe urges you to call DMHC anyway.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We can often help,” she says.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Before Kevin Powers underwent lung cancer surgery last October, his girlfriend, Agi Orsi, meticulously checked and double-checked to be sure his Santa Monica hospital and surgeon were in his health plan’s network. They were.\u003c/p>\n\u003cp>Even in the hospital, Orsi dutifully wrote “No out-of-network doctors” across the top of Powers’ admission paperwork.\u003c/p>\n\u003cp>Her diligence was for naught.\u003c/p>\n\u003cp>Powers, 57, suffered serious complications, resulting in a two-week hospital stay that included visits from several specialists. It also resulted in a barrage of surprise medical bills from some of those specialists charging out-of-network rates.\u003c/p>\n\u003cp>The bills total about $5,600 — so far.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s overwhelming,” says Orsi, 64, who lives with Powers in Topanga Canyon. “I feel like consumers are at a major disadvantage.”\u003c/p>\n\u003caside class=\"alignright\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/bazar_100.jpg\" alt=\"\" width=\"100\" height=\"133\" class=\"alignleft size-full wp-image-348286\">\u003cstrong>Ask Emily\u003c/strong>\n\u003cp>Answering consumers’ questions about California’s changing medical landscape.\u003cbr>\n\u003cbr>\nSend questions for Emily to \u003ca href=\"mailto:AskEmily@kff.org\">AskEmily@kff.org\u003c/a>\u003c/p>\u003c/aside>\n\u003cp>Starting next month, many Californians will be protected against such surprise medical bills from out-of-network providers, also known as “\u003ca href=\"http://www.kff.org/private-insurance/issue-brief/surprise-medical-bills/\" target=\"_blank\" rel=\"noopener noreferrer\">balance billing\u003c/a>.”\u003c/p>\n\u003cp>Under a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB72\" target=\"_blank\" rel=\"noopener noreferrer\">new state law\u003c/a>, if you visit an in-network facility — such as a hospital, lab or imaging center — you will be responsible only for your in-network share of the cost, even if you’re seen by an out-of-network provider.\u003c/p>\n\u003cp>The \u003ca href=\"http://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactSheets/fsab72.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">law\u003c/a> applies to non-emergency services received on or after July 1.\u003c/p>\n\u003cp>“This is a very big deal,” says Tam Ma, legal and policy director for the advocacy group \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access California\u003c/a>. “We’ve heard from hundreds of consumers who were getting these surprise bills.”\u003c/p>\n\u003cp>A 2015 Consumers Union \u003ca href=\"https://consumersunion.org/wp-content/uploads/2015/05/Surprise-Bills-Survey-CA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">survey\u003c/a> found that nearly 1 in 4 Californians who visited a hospital or had surgery in the previous two years were charged an out‐of‐network rate when they thought a provider was in‐network.\u003c/p>\n\u003cp>Here’s a common scenario: A patient takes pains to ensure her hospital and surgeon are in network, only to get billed by the out-of-network anesthesiologist who appears at her bedside to put her under.\u003c/p>\n\u003cdiv id=\"attachment_239562\" class=\"wp-caption alignleft\" style=\"width: 380px\">\n\u003cp>\u003cimg class=\"wp-image-239562 size-khn-article-small\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/agikevin-770.jpg?w=370&h=247&crop=1\" alt=\"\" width=\"370\" height=\"247\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers (right) is facing more than $5,000 in surprise medical bills from his October lung cancer surgery even though his girlfriend, Agi Orsi (left) took pains to ensure his hospital and surgeon were in his health plan’s network. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>“No one gets to pick their anesthesiologist,” Ma says. “It depends on who is on duty, who is available.”\u003c/p>\n\u003cp>Surprise bills also often come from pathologists, radiologists and assistant surgeons — other providers that patients typically can’t choose, she says.\u003c/p>\n\u003cp>The new law covers Californians with private health insurance plans that are regulated by the state Department of Managed Health Care (DMHC) and the state Department of Insurance, which includes roughly 70 percent of the state’s private insurance market, according to the California Health Care Foundation. (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>It does not cover some 5.7 million people whose employer-sponsored insurance plans are regulated by the U.S. Department of Labor.\u003c/p>\n\u003cp>Insurers, health care providers and regulators are working furiously behind the scenes to hash out some details about that law, including how much out-of-network providers should be compensated for their services.\u003c/p>\n\u003cp>But that shouldn’t affect you.\u003c/p>\n\u003cp>“Is it going to be pretty as plans and providers figure this out in the background? Maybe not,” says Charles Bacchi, president of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. “But what’s important is that it’s not readily apparent to the consumer.”\u003c/p>\n\u003cp>The key point to remember is that you shouldn’t pay more than your in-network copayment, coinsurance or deductible, as long as you visited an in-network facility for non-emergency services.\u003c/p>\n\u003cp>So, if you receive what looks like a bill from a provider showing an out-of-network rate, don’t panic, says Betsy Imholz, director of special projects for \u003ca href=\"https://consumersunion.org/experts/elizabeth-betsy-imholz/\" target=\"_blank\" rel=\"noopener noreferrer\">Consumers Union\u003c/a>.\u003c/p>\n\u003cdiv id=\"attachment_239563\" class=\"wp-caption alignleft\" style=\"width: 280px\">\n\u003cp>\u003cimg class=\"wp-image-239563 size-khn-article-vertical\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/kevin-in-hospital-770.jpg?w=270&h=405&crop=1\" alt=\"\" width=\"270\" height=\"405\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers suffered serious complications after his lung cancer surgery last October, resulting in a two-week hospital stay and surprise out-of-network bills. He is shown here in the hospital after surgery. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>First, read it carefully. It may not actually be a bill. Under the law, any communication to the patient from an out-of-network provider before that provider gets the consumer’s in-network cost information must say — in bold, 12-point type — that it is “not a bill.”\u003c/p>\n\u003cp>“If it’s an out-of-network doctor, they shouldn’t be claiming that you owe anything right away,” Imholz says.\u003c/p>\n\u003cp>And don’t pay anything until you receive an Explanation of Benefits from your insurer, experts advise.\u003c/p>\n\u003cp>When you do receive it, inspect it. If you think you’re still being billed incorrectly, call your health plan and file a grievance, says Mary Watanabe, DMHC’s deputy director of health policy. Your plan will have 30 days to resolve the problem.\u003c/p>\n\u003cp>If your plan doesn’t resolve the situation within that time frame, or you’re dissatisfied with the decision, it’s time to call your regulator. For most of you, that will be DMHC: \u003ca href=\"http://www.healthhelp.ca.gov/\">www.healthhelp.ca.gov\u003c/a> or 888-466-2219. To reach the Department of Insurance, visit \u003ca href=\"http://www.insurance.ca.gov/\">www.insurance.ca.gov\u003c/a> or call 800-927-HELP.\u003c/p>\n\u003cp>You can also call your regulator \u003cem>before\u003c/em> you hear back from your health plan, particularly if out-of-network providers are hassling you for payment.\u003c/p>\n\u003cp>If you inadvertently paid an out-of-network provider more than he or she is owed, all is not lost. The doctor has to refund the overpayment within 30 days, Ma says. Otherwise, interest starts to accrue.\u003c/p>\n\u003cp>One warning: The law allows out-of-network providers to bill you out-of-network rates, but only if you voluntarily sign a form at least 24 hours before you receive care, Imholz says. The form must include an estimate of your cost and explain that you can receive care from an in-network provider instead, she says.\u003c/p>\n\u003cp>“You don’t have to sign it. It’s completely voluntary.”\u003c/p>\n\u003cp>If you actually do want to be seen by an out-of-network provider and are willing to pay the out-of-network charges, you still have to sign the consent form.\u003c/p>\n\u003cp>Since this law kicks in July 1, the surprise medical bills Powers received after his lung surgery won’t be covered. Orsi says Powers can’t afford to pay them.\u003c/p>\n\u003cp>“I don’t think it’s fair,” she says. “I’m going to keep fighting it.”\u003c/p>\n\u003cp>There may be hope. If, like that Southern California couple, you’re currently fighting a surprise bill for a service you received before July 1, Watanabe urges you to call DMHC anyway.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Though Senate Republicans decided Tuesday to delay a vote on their controversial health plan until after the July 4 recess, Democrats in California are calling on residents to keep up their resistance to the plan.\u003c/p>\n\u003cp>Gov. Jerry Brown joined Sens. Dianne Feinstein and Kamala Harris for a call with reporters early Tuesday. Brown said the GOP bill's proposed Medicaid cuts, and its rollback of Obamacare's insurance regulations, would be disastrous for millions of Californians.\u003c/p>\n\u003cp>Feinstein said one in three Californians are covered by Medi-Cal. The loss of funding could put up to 14 million Californians at risk of losing health coverage or critical medical services, she said.\u003c/p>\n\u003cp>\"One of the things we all try not to do is never turn the haves or the have-nots against each other ... and this bill does that,\" she said.\u003c/p>\n\u003cp>\"This is a bad plan through and through and through, she added. \"There aren’t one or two amendments that can fix it. So it’s got to be defeated.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Though Senate Republicans decided Tuesday to delay a vote on their controversial health plan until after the July 4 recess, Democrats in California are calling on residents to keep up their resistance to the plan.\u003c/p>\n\u003cp>Gov. Jerry Brown joined Sens. Dianne Feinstein and Kamala Harris for a call with reporters early Tuesday. Brown said the GOP bill's proposed Medicaid cuts, and its rollback of Obamacare's insurance regulations, would be disastrous for millions of Californians.\u003c/p>\n\u003cp>Feinstein said one in three Californians are covered by Medi-Cal. The loss of funding could put up to 14 million Californians at risk of losing health coverage or critical medical services, she said.\u003c/p>\n\u003cp>\"One of the things we all try not to do is never turn the haves or the have-nots against each other ... and this bill does that,\" she said.\u003c/p>\n\u003cp>\"This is a bad plan through and through and through, she added. \"There aren’t one or two amendments that can fix it. So it’s got to be defeated.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n",
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"excerpt": "Five takeaways from the new draft bill, and why it's not really 'repeal and replace.'",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"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. ",
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"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. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"masters-of-scale": {
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},
"mindshift": {
"id": "mindshift",
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"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>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"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.",
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"onourwatch": {
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"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?",
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"order": 11
},
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"on-the-media": {
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"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",
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"link": "/radio/program/on-the-media",
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},
"pbs-newshour": {
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"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
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},
"perspectives": {
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"order": 14
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"planet-money": {
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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"link": "/radio/program/planet-money",
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"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
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},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
},
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"amazon": "https://music.amazon.com/podcasts/e0c2d153-ad36-4c8d-901d-f1da6a724824/political-breakdown",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
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