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"disqusTitle": "Teens Turned Away from Tanning Salons, That's the Good News …",
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"content": "\u003cfigure id=\"attachment_15708\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/evilerin/3096163337/in/set-72157608357937086\">\u003cimg class=\"size-large wp-image-15708\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/TANNING-1-640x425.jpg\" alt=\"Exposure to ultraviolet tanning devices before age 30 increases the risk of skin cancer by 75 percent. (Evil Erin/Flickr)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Exposure to ultraviolet tanning devices before age 30 increases the risk of skin cancer by 75 percent. (Evil Erin/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>California was the first state to \u003ca href=\"http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0701-0750/sb_746_bill_20111009_chaptered.pdf\">ban people under 18-years-old\u003c/a> from using tanning salons, and now new research takes a look at how well the law is working.\u003c/p>\n\u003cp>In \u003ca href=\"http://www.jaad.org/article/S0190-9622(13)00967-5/abstract\">the study\u003c/a> researchers, including a team at UC San Francisco, surveyed hundreds of tanning salons and found roughly three-quarters of them were adhering with key aspects of the law, although many also misrepresented health benefits of indoor tanning.\u003c/p>\n\u003cp>\"The good news was that the majority of salons were complying with the law,\" said Jack Resneck, the study's senior author and an associate professor of dermatology at UCSF. \"The bad news was that we got rampant misinformation — a lot of which is prohibited by law.\"\u003c/p>\n\u003cp>Resneck said tanning beds can have significant health consequences for young people. Exposure to ultraviolet tanning devices before age 30 increases the risk of skin cancer by 75 percent, and nationally, the tanning industry aggressively targets minors in advertising.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers said that despite what they called clear evidence of cancer risk, \"indoor tanning remains popular in the United States.\"\u003c/p>\n\u003cp>Nationwide, more than 3.5 million cases of skin cancer are diagnosed each year, according to the study.\u003c!--more-->\u003c/p>\n\u003cp>The survey was conducted in May, 2013. A female medical student who identified herself as a 17-year-old called a random sample of salons in California that advertised on Yellowpages.com, the majority of which were clustered in metropolitan areas. She told respondents that she wanted a base tan before summer, asked how frequently she could tan, whether there were any dangers, and if tanning was good for her.\u003c/p>\n\u003cp>Of the tanning salons she called, 77 percent — 260 out of 338 — told the female caller that she could not use their tanning beds.\u003c/p>\n\u003cp>But some said she could use their tanning beds with a doctor's note, and some told her she could use their facilities with parental consent. In addition, researchers said out of the 338 salons, 61 percent \"made unlawful claims of specific health benefits,\" including vitamin D production, skin disease treatment, prevention of future sunburns, and remedies for depression.\u003c/p>\n\u003cp>\"That was extremely troubling, because we have overwhelming evidence that tanning, especially at an early age, causes cancer, and it's killing people,\" Resneck said. \"When you're young and invincible and there's people telling you tanning is safe, that information is going to be much more believable, even if it's not backed up by facts.\"\u003c/p>\n\u003cp>\"There's a common misconception that tanning helps your health, and is better or the same as the sun,\" Resneck added. \"So we thought this was critical to look at, knowing that the tanning industry is marketing to teenagers, and knowing that early tanning exposure causes cancer.\"\u003c/p>\n\u003cp>Researchers attributed the misinformation to salons workers not being familiar with the law -- or with lack of law enforcement.\u003c/p>\n\u003cp>Resneck said despite lack of education and enforcement, that the study's results were a big leap forward in an industry that doesn't have a lot of good data and that hasn't accurately tracked enforcement of laws that prevent or restrict tanning among minors.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California lawmakers were the first to pass an outright ban on minors using indoor ultraviolet tanning salons in 2011. Since, California passed its ban on minors using indoor tanning beds, eight other states have passed similar laws. Statewide, salons that violate the law are required to pay a civil violation fine of $2,500 a day.\u003c/p>\n\n",
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"excerpt": "California was the first state to ban people under 18-years-old from using tanning salons, and now new research takes a look at how well the law is working. \r\n\r\nIn the study researchers, including a team at UC San Francisco, surveyed hundreds of tanning salons and found roughly three-quarters of them were adhering with key aspects of the law, although many also misrepresented health benefits of indoor tanning.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15708\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/evilerin/3096163337/in/set-72157608357937086\">\u003cimg class=\"size-large wp-image-15708\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/TANNING-1-640x425.jpg\" alt=\"Exposure to ultraviolet tanning devices before age 30 increases the risk of skin cancer by 75 percent. (Evil Erin/Flickr)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Exposure to ultraviolet tanning devices before age 30 increases the risk of skin cancer by 75 percent. (Evil Erin/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>California was the first state to \u003ca href=\"http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0701-0750/sb_746_bill_20111009_chaptered.pdf\">ban people under 18-years-old\u003c/a> from using tanning salons, and now new research takes a look at how well the law is working.\u003c/p>\n\u003cp>In \u003ca href=\"http://www.jaad.org/article/S0190-9622(13)00967-5/abstract\">the study\u003c/a> researchers, including a team at UC San Francisco, surveyed hundreds of tanning salons and found roughly three-quarters of them were adhering with key aspects of the law, although many also misrepresented health benefits of indoor tanning.\u003c/p>\n\u003cp>\"The good news was that the majority of salons were complying with the law,\" said Jack Resneck, the study's senior author and an associate professor of dermatology at UCSF. \"The bad news was that we got rampant misinformation — a lot of which is prohibited by law.\"\u003c/p>\n\u003cp>Resneck said tanning beds can have significant health consequences for young people. Exposure to ultraviolet tanning devices before age 30 increases the risk of skin cancer by 75 percent, and nationally, the tanning industry aggressively targets minors in advertising.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers said that despite what they called clear evidence of cancer risk, \"indoor tanning remains popular in the United States.\"\u003c/p>\n\u003cp>Nationwide, more than 3.5 million cases of skin cancer are diagnosed each year, according to the study.\u003c!--more-->\u003c/p>\n\u003cp>The survey was conducted in May, 2013. A female medical student who identified herself as a 17-year-old called a random sample of salons in California that advertised on Yellowpages.com, the majority of which were clustered in metropolitan areas. She told respondents that she wanted a base tan before summer, asked how frequently she could tan, whether there were any dangers, and if tanning was good for her.\u003c/p>\n\u003cp>Of the tanning salons she called, 77 percent — 260 out of 338 — told the female caller that she could not use their tanning beds.\u003c/p>\n\u003cp>But some said she could use their tanning beds with a doctor's note, and some told her she could use their facilities with parental consent. In addition, researchers said out of the 338 salons, 61 percent \"made unlawful claims of specific health benefits,\" including vitamin D production, skin disease treatment, prevention of future sunburns, and remedies for depression.\u003c/p>\n\u003cp>\"That was extremely troubling, because we have overwhelming evidence that tanning, especially at an early age, causes cancer, and it's killing people,\" Resneck said. \"When you're young and invincible and there's people telling you tanning is safe, that information is going to be much more believable, even if it's not backed up by facts.\"\u003c/p>\n\u003cp>\"There's a common misconception that tanning helps your health, and is better or the same as the sun,\" Resneck added. \"So we thought this was critical to look at, knowing that the tanning industry is marketing to teenagers, and knowing that early tanning exposure causes cancer.\"\u003c/p>\n\u003cp>Researchers attributed the misinformation to salons workers not being familiar with the law -- or with lack of law enforcement.\u003c/p>\n\u003cp>Resneck said despite lack of education and enforcement, that the study's results were a big leap forward in an industry that doesn't have a lot of good data and that hasn't accurately tracked enforcement of laws that prevent or restrict tanning among minors.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California lawmakers were the first to pass an outright ban on minors using indoor ultraviolet tanning salons in 2011. Since, California passed its ban on minors using indoor tanning beds, eight other states have passed similar laws. Statewide, salons that violate the law are required to pay a civil violation fine of $2,500 a day.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Future of Healthy San Francisco Unclear in Face of Obamacare",
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"content": "\u003cfigure id=\"attachment_15684\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/SCALAS-2.jpg\">\u003cimg class=\"size-large wp-image-15684\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/SCALAS-2-640x387.jpg\" alt=\"Many San Francisco restaurants pass along at least part of their cost of Healthy San Francisco to patrons. (Angela Hart/KQED)\" width=\"640\" height=\"387\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Many San Francisco restaurants pass along at least part of their cost of Healthy San Francisco to patrons. (Angela Hart/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>San Francisco is scrambling to figure out how the Affordable Care Act will impact the city's own landmark universal health legislation, less than three months before the full rollout of Obamacare.\u003c/p>\n\u003cp>Barbara Garcia, who runs the Department of Public Health, is leading a task force of health experts, business groups and labor leaders who have until the end of November to decipher what health experts are calling confusing and complex details in both the local and national health laws.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"How do you make these two laws correspond?\" \u003c/aside>\n\u003cp>\"The question for the task force is how do you make these two laws correspond,\" said Ken Jacobs, chair of the Labor Center at UC Berkeley who specializes in health policy, and who is also on the task force. \"In my view, they correspond quite well, though there's some work to do around the edges.\"\u003c/p>\n\u003cp>Healthy San Francisco rolled out in 2006 to provide universal health access to the city's 85,000 uninsured. Today, it covers about 60,000 people.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Now, health experts and city leaders are floating the idea of using Healthy San Francisco monies to help uninsured residents pay their Covered California premiums. Even with federal subsidies available under Obamacare, the cost of insurance may be out of reach for many, they say.\u003c/p>\n\u003cp>And, experts familiar with Healthy San Francisco say additional financial incentives for consumers will increase the number of young healthy people who sign up for insurance under Covered California, the state's new health insurance marketplace.\u003c!--more-->\u003c/p>\n\u003cp>Businesses fund Healthy San Francisco through an “employer spending requirement,” which was bitterly fought by some groups when the law passed. Any business employing 20 or more workers must pay between $1.55 and $2.33 per hour, per employee, as long as the worker puts in at least eight hours a week.\u003c/p>\n\u003cp>Some businesses can pass off part of that cost. People who eat in San Francisco restaurants, for example, might see this as a line item on their restaurant bill.\u003c/p>\n\u003cp>\"There are some who feel the employer spending requirement should go away,\" said San Francisco Supervisor David Campos. \"We believe eliminating the employer spending requirement would be a major disaster.\"\u003c/p>\n\u003cp>But prominent business groups such as the San Francisco Chamber of Commerce say they're worried that using Healthy San Francisco funds could create a different problem —making workers ineligible for Covered California.\u003c/p>\n\u003cp>\"We all want to ensure people get the benefits they're entitled to under the Affordable Care Act,\" said Jim Lazarus, with the San Francisco Chamber of Commerce \"But we're concerned about how the employer spending requirement interacts with the Affordable Care Act.\"\u003c/p>\n\u003cp>Lazarus said the Chamber and other business groups worry that money employers set aside for workers to spend on their health care costs could count as minimum essential coverage, which they say could fulfill the individual mandate under Obamacare guidelines. City leaders are \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/10/07/how-healthy-san-francisco-matters-and-doesnt-in-obamacare/\" target=\"_blank\">already on the record\u003c/a> as saying Healthy San Francisco will not fulfill the Obamacare individual mandate. But there are more questions than answers at this point around meshing Healthy San Francisco with the Affordable Care Act.\u003c/p>\n\u003cp>\"All we've been asking for is the city to give us guidance on what employers can do,\" Lazarus said. He's especially concerned about the businesses which do not offer health insurance, but want to comply with the ACA.\u003c/p>\n\u003cp>Jacobs, the UC Berkeley health policy analyst, says the national health law allows for states and cities to offer additional subsidy programs – exactly what the task force is considering for Healthy San Francisco.\u003c/p>\n\u003cp>He pointed to similar programs underway in Vermont, Massachusetts and New York that offer financial help for workers who find paying their insurance premium too expensive, even with the federal subsidies.\u003c/p>\n\u003cp>\"Healthy San Francisco could go far in filling in the gaps in the Affordable Care Act,\" Jacobs said. He's especially concerned about low- and middle-income people who can't afford the premium in the face of the high cost of living in San Francisco. Additional premium subsidies from Healthy San Francisco \"could help lower their cost and increase the uptake for Covered California insurance required under ACA.\"\u003c/p>\n\u003cp>Campos has argued since the task force started meeting in July that \"what we're doing in San Francisco is complementary to the Affordable Care Act.\"\u003c/p>\n\u003cp>Yet another key issue is what to do in place of health reimbursement accounts, which are no longer allowed under federal guidelines.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The task force plans to evaluate Healthy San Francisco funding over the next two months. The next meeting is Thursday, Oct. 24. The City says it should have guidance for San Francisco businesses by the end of November.\u003c/p>\n\n",
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"description": "By Angela Hart San Francisco is scrambling to figure out how the Affordable Care Act will impact the city's own landmark universal health legislation, less than three months before the full rollout of Obamacare. Barbara Garcia, who runs the Department of Public Health, is leading a task force of health experts, business groups and labor",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15684\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/SCALAS-2.jpg\">\u003cimg class=\"size-large wp-image-15684\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/SCALAS-2-640x387.jpg\" alt=\"Many San Francisco restaurants pass along at least part of their cost of Healthy San Francisco to patrons. (Angela Hart/KQED)\" width=\"640\" height=\"387\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Many San Francisco restaurants pass along at least part of their cost of Healthy San Francisco to patrons. (Angela Hart/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>San Francisco is scrambling to figure out how the Affordable Care Act will impact the city's own landmark universal health legislation, less than three months before the full rollout of Obamacare.\u003c/p>\n\u003cp>Barbara Garcia, who runs the Department of Public Health, is leading a task force of health experts, business groups and labor leaders who have until the end of November to decipher what health experts are calling confusing and complex details in both the local and national health laws.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"How do you make these two laws correspond?\" \u003c/aside>\n\u003cp>\"The question for the task force is how do you make these two laws correspond,\" said Ken Jacobs, chair of the Labor Center at UC Berkeley who specializes in health policy, and who is also on the task force. \"In my view, they correspond quite well, though there's some work to do around the edges.\"\u003c/p>\n\u003cp>Healthy San Francisco rolled out in 2006 to provide universal health access to the city's 85,000 uninsured. Today, it covers about 60,000 people.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Now, health experts and city leaders are floating the idea of using Healthy San Francisco monies to help uninsured residents pay their Covered California premiums. Even with federal subsidies available under Obamacare, the cost of insurance may be out of reach for many, they say.\u003c/p>\n\u003cp>And, experts familiar with Healthy San Francisco say additional financial incentives for consumers will increase the number of young healthy people who sign up for insurance under Covered California, the state's new health insurance marketplace.\u003c!--more-->\u003c/p>\n\u003cp>Businesses fund Healthy San Francisco through an “employer spending requirement,” which was bitterly fought by some groups when the law passed. Any business employing 20 or more workers must pay between $1.55 and $2.33 per hour, per employee, as long as the worker puts in at least eight hours a week.\u003c/p>\n\u003cp>Some businesses can pass off part of that cost. People who eat in San Francisco restaurants, for example, might see this as a line item on their restaurant bill.\u003c/p>\n\u003cp>\"There are some who feel the employer spending requirement should go away,\" said San Francisco Supervisor David Campos. \"We believe eliminating the employer spending requirement would be a major disaster.\"\u003c/p>\n\u003cp>But prominent business groups such as the San Francisco Chamber of Commerce say they're worried that using Healthy San Francisco funds could create a different problem —making workers ineligible for Covered California.\u003c/p>\n\u003cp>\"We all want to ensure people get the benefits they're entitled to under the Affordable Care Act,\" said Jim Lazarus, with the San Francisco Chamber of Commerce \"But we're concerned about how the employer spending requirement interacts with the Affordable Care Act.\"\u003c/p>\n\u003cp>Lazarus said the Chamber and other business groups worry that money employers set aside for workers to spend on their health care costs could count as minimum essential coverage, which they say could fulfill the individual mandate under Obamacare guidelines. City leaders are \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/10/07/how-healthy-san-francisco-matters-and-doesnt-in-obamacare/\" target=\"_blank\">already on the record\u003c/a> as saying Healthy San Francisco will not fulfill the Obamacare individual mandate. But there are more questions than answers at this point around meshing Healthy San Francisco with the Affordable Care Act.\u003c/p>\n\u003cp>\"All we've been asking for is the city to give us guidance on what employers can do,\" Lazarus said. He's especially concerned about the businesses which do not offer health insurance, but want to comply with the ACA.\u003c/p>\n\u003cp>Jacobs, the UC Berkeley health policy analyst, says the national health law allows for states and cities to offer additional subsidy programs – exactly what the task force is considering for Healthy San Francisco.\u003c/p>\n\u003cp>He pointed to similar programs underway in Vermont, Massachusetts and New York that offer financial help for workers who find paying their insurance premium too expensive, even with the federal subsidies.\u003c/p>\n\u003cp>\"Healthy San Francisco could go far in filling in the gaps in the Affordable Care Act,\" Jacobs said. He's especially concerned about low- and middle-income people who can't afford the premium in the face of the high cost of living in San Francisco. Additional premium subsidies from Healthy San Francisco \"could help lower their cost and increase the uptake for Covered California insurance required under ACA.\"\u003c/p>\n\u003cp>Campos has argued since the task force started meeting in July that \"what we're doing in San Francisco is complementary to the Affordable Care Act.\"\u003c/p>\n\u003cp>Yet another key issue is what to do in place of health reimbursement accounts, which are no longer allowed under federal guidelines.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The task force plans to evaluate Healthy San Francisco funding over the next two months. The next meeting is Thursday, Oct. 24. The City says it should have guidance for San Francisco businesses by the end of November.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "5 Lessons from Massachusetts About the Obamacare Rollout",
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"content": "\u003cfigure id=\"attachment_15297\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/57327920-e1380638950841.jpg\">\u003cimg class=\"size-large wp-image-15297\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/57327920-640x500.jpg\" alt=\"Mitt Romney, as governor of Massachusetts, signs the state's health care reform bill into law in April, 2006. Sen. Ted Kennedy (2nd from right) and others look on. (Joe Raedle/Getty Images)\" width=\"640\" height=\"500\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mitt Romney, as governor of Massachusetts, signs the state's health care reform bill into law in April, 2006. Sen. Ted Kennedy (2nd from right) and others look on. (Joe Raedle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Martha Bebinger, WBUR and\u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/October/10/massachusetts-lessons-for-obamacare.aspx\" target=\"_blank\"> Kaiser Health News\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>A lot of the Affordable Care Act supporters point to Massachusetts as proof that signing up the uninsured is a big, but doable task. Here, in 2013, that’s a reasonable conclusion.\u003c/p>\n\u003cdiv>\n\u003cp>But back in 2007 and 2008 things were a lot messier, and some advocates for universal coverage were worried.\u003c/p>\n\u003cp>Here’s why:\u003c/p>\n\u003cp>\u003cstrong>1)\u003c/strong> \u003cstrong>Underestimates of people eligible for subsidies:\u003c/strong> It looked like the state had, by a lot, underestimated the number of people who would be eligible for free and subsidized coverage. In 2006, the estimate was 140,000. By April 2008, the estimate rose to 225,000, based on early sign-ups. Enrollment plateaued at 177,000 in 2009.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>2) New enrollees strained system:\u003c/strong> A dramatic increase in first enrollment put a strain on doctors and health care services at every level. When the \"Connector\" opened for business in late 2006, people signed up\u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=19266657\" target=\"_blank\"> much faster than projected\u003c/a>. Within a year there were 367,000 newly insured citizens.\u003c/p>\n\u003cp>\u003cstrong>3) New enrollees needed more care:\u003c/strong> Patients, many of whom had not had insurance for years, had a lot of problems they hadn’t taken care of and were seeking more tests, surgery and other treatment that drove up costs.\u003c/p>\n\u003cp>\u003cstrong>4) State budget watchers started to panic: \u003c/strong>The governor’s office kept going back to the Legislature to ask for more money and a few top lawmakers began to question whether the state could afford to fund the coverage law.\u003c/p>\n\u003cp>\u003cstrong>5) Employer costs went up:\u003c/strong> Employers saw an increase in workers who, to avoid the individual mandate penalty, signed up for their employer’s coverage, which increased employers’ outlays for health insurance.\u003c/p>\n\u003cp>Of course we don’t know if people who’ve gone without insurance in California and around the country will behave like the newly insured in Massachusetts. There are lots of reasons why Massachusetts residents are different. They see a doctor more often, for example, than do residents of most other states.\u003c/p>\n\u003cp>Today, despite rising costs, the state’s effort to cover the uninsured is pretty stable - 97 percent of the state's 6.6 million people have it. It's the highest coverage rate anywhere in America.\u003c/p>\n\u003cp>If there’s a lesson from Massachusetts as the rest of the country starts enrolling the uninsured, it’s this: Be prepared for a rush of sick, or at least not completely healthy, people. Healthy folks will sign up later, when the individual mandate kicks in, and hopefully balance out the costs. But any estimates about how many people are eligible and how much care they have been waiting to get may not hold true.\u003c/p>\n\u003cp>\u003cem>NPR correspondent Richard Knox \u003ca href=\"http://www.npr.org/blogs/health/2013/10/01/227887992/lessons-for-the-obamacare-rollout-courtesy-of-massachusetts\" target=\"_blank\">contributed\u003c/a> to this story, which is part of a collaboration that includes NPR, Kaiser Health News and \u003ca href=\"http://commonhealth.wbur.org/\" target=\"_blank\">WBUR\u003c/a>.\u003c/em>\u003c/p>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "A lot of the Affordable Care Act supporters point to Massachusetts as proof that signing up the uninsured is a big, but doable task. Here, in 2013, that’s a reasonable conclusion. \r\n\r\nBut back in 2007 and 2008 things were a lot messier, and some advocates for universal coverage were worried. \r\n\r\nHere’s why: ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15297\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/57327920-e1380638950841.jpg\">\u003cimg class=\"size-large wp-image-15297\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/57327920-640x500.jpg\" alt=\"Mitt Romney, as governor of Massachusetts, signs the state's health care reform bill into law in April, 2006. Sen. Ted Kennedy (2nd from right) and others look on. (Joe Raedle/Getty Images)\" width=\"640\" height=\"500\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mitt Romney, as governor of Massachusetts, signs the state's health care reform bill into law in April, 2006. Sen. Ted Kennedy (2nd from right) and others look on. (Joe Raedle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Martha Bebinger, WBUR and\u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/October/10/massachusetts-lessons-for-obamacare.aspx\" target=\"_blank\"> Kaiser Health News\u003c/a>\u003c/strong>\u003c/p>\n\u003cp>A lot of the Affordable Care Act supporters point to Massachusetts as proof that signing up the uninsured is a big, but doable task. Here, in 2013, that’s a reasonable conclusion.\u003c/p>\n\u003cdiv>\n\u003cp>But back in 2007 and 2008 things were a lot messier, and some advocates for universal coverage were worried.\u003c/p>\n\u003cp>Here’s why:\u003c/p>\n\u003cp>\u003cstrong>1)\u003c/strong> \u003cstrong>Underestimates of people eligible for subsidies:\u003c/strong> It looked like the state had, by a lot, underestimated the number of people who would be eligible for free and subsidized coverage. In 2006, the estimate was 140,000. By April 2008, the estimate rose to 225,000, based on early sign-ups. Enrollment plateaued at 177,000 in 2009.\u003c!--more-->\u003c/p>\n\u003cp>\u003cstrong>2) New enrollees strained system:\u003c/strong> A dramatic increase in first enrollment put a strain on doctors and health care services at every level. When the \"Connector\" opened for business in late 2006, people signed up\u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=19266657\" target=\"_blank\"> much faster than projected\u003c/a>. Within a year there were 367,000 newly insured citizens.\u003c/p>\n\u003cp>\u003cstrong>3) New enrollees needed more care:\u003c/strong> Patients, many of whom had not had insurance for years, had a lot of problems they hadn’t taken care of and were seeking more tests, surgery and other treatment that drove up costs.\u003c/p>\n\u003cp>\u003cstrong>4) State budget watchers started to panic: \u003c/strong>The governor’s office kept going back to the Legislature to ask for more money and a few top lawmakers began to question whether the state could afford to fund the coverage law.\u003c/p>\n\u003cp>\u003cstrong>5) Employer costs went up:\u003c/strong> Employers saw an increase in workers who, to avoid the individual mandate penalty, signed up for their employer’s coverage, which increased employers’ outlays for health insurance.\u003c/p>\n\u003cp>Of course we don’t know if people who’ve gone without insurance in California and around the country will behave like the newly insured in Massachusetts. There are lots of reasons why Massachusetts residents are different. They see a doctor more often, for example, than do residents of most other states.\u003c/p>\n\u003cp>Today, despite rising costs, the state’s effort to cover the uninsured is pretty stable - 97 percent of the state's 6.6 million people have it. It's the highest coverage rate anywhere in America.\u003c/p>\n\u003cp>If there’s a lesson from Massachusetts as the rest of the country starts enrolling the uninsured, it’s this: Be prepared for a rush of sick, or at least not completely healthy, people. Healthy folks will sign up later, when the individual mandate kicks in, and hopefully balance out the costs. But any estimates about how many people are eligible and how much care they have been waiting to get may not hold true.\u003c/p>\n\u003cp>\u003cem>NPR correspondent Richard Knox \u003ca href=\"http://www.npr.org/blogs/health/2013/10/01/227887992/lessons-for-the-obamacare-rollout-courtesy-of-massachusetts\" target=\"_blank\">contributed\u003c/a> to this story, which is part of a collaboration that includes NPR, Kaiser Health News and \u003ca href=\"http://commonhealth.wbur.org/\" target=\"_blank\">WBUR\u003c/a>.\u003c/em>\u003c/p>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "School Meals Face Rules on Fat, Meat, Veggies – But No Limits on Sugar",
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"content": "\u003cfigure id=\"attachment_15440\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/41284017@N08/7995796099/in/photolist-dbyxBr-dbyAAG-dbyBzy-dbyzdA-dbyC9q-dbyAij-dbyCMQ-dbyDqA-dbyBGE-dbyCE5-dbyzrZ-dbyBZQ-dbyyNU-dbyA6U-dbyBVS-dbyzpL-dbyyKc-dbyBfz-dbyyEx-dbyzx3-dbyzP6-dbyAYu-dbyz2U-dbyzKG-dbyCv3-dbyzg7-dbyBfY-dbyBpQ-dbyxPx-dbywSH-dbyChm-dbyAq4-dbyDmm-dbyASH-dbyARN-dbyB7d-dbyzYC-dbyAud-dbyB8H-dbyz8o-dbyxsB-dbyCYw-8KiC9Y-ayDy68-azaFpD-d6WUpm-cZDSds-e9WPJv-e9WPJe-fh9dsC-abwWoB\">\u003cimg class=\"size-large wp-image-15440 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/7995796099_c60447daba_c-640x424.jpg\" alt=\"(Photo: USDAgov via Flickr)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: USDAgov via Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Eleanor Yang Su\u003c/strong>, \u003ca href=\"http://cironline.org\" target=\"_blank\">The Center for Investigative Reporting\u003c/a>\u003c/p>\n\u003cp>Almost everything about a school cafeteria meal has a regulation. The federal government caps the amount of fat and salt in breakfasts and lunches. It sets minimum standards for servings of fruit, vegetables, grains, milk and meat.\u003c/p>\n\u003cp>But one widely used and often-overused product has no official limits: sugar.\u003c/p>\n\u003cp>As Congress faces increased scrutiny over subsidies to the sugar industry, nutritionists and anti-obesity crusaders are focusing on the amount of sugar in school meals – and asking whether regulations governing school lunches deliberately exclude limits on sugar to favor a powerful industry.\u003c/p>\n\u003cp>Recent research shows that sugar levels in school meals are more than double what is recommended for the general public. Elementary school lunch menus contain 115 percent of the recommended daily calories from added sugars and fats, according to a \u003ca href=\"http://www.mathematica-mpr.com/publications/PDFs/nutrition/snda-iv_vol1.pdf\">November study\u003c/a> by the USDA’s Food and Nutrition Service. Middle school and high school lunch menus also are sugar- and fat-heavy, averaging between 59 and 74 percent of the recommended amounts.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>About 1 in 5 school lunch menus includes dessert, the federal study said. The most common are cookies, cakes and brownies, some of which are counted as grain requirements. Other popular options are fruit with gelatin, ice cream and pudding.\u003c!--more-->\u003c/p>\n\u003cp>The data from the School Nutrition Dietary Assessment is based on a 2010 survey of about 900 schools across the country and is considered the most comprehensive federal research on school meals.\u003c/p>\n\u003cp>For years, schools added sweets, such as graham crackers or cookies, to bump up calorie counts and meet minimum thresholds. Researchers say that practice is less common now that the USDA has implemented calorie limits. But some say sugary treats still are appealing to school administrators.\u003c/p>\n\u003cp>“Sugar-related products are the least expensive source of calories in the school meal program,” said Matthew Sharp, senior advocate for California Food Policy Advocates. He said many school officials oppose reducing sugar in meals because it would force them to buy more expensive products.\u003c/p>\n\u003cp>The USDA, which administers the national school lunch and breakfast programs, says newly created total calorie limits are designed to discourage extra-sugary and fatty foods. A USDA spokesman noted that as of June 30, about 70 percent\u003cstrong> \u003c/strong>of all schools have shown they’re in compliance with the new plan, which means students are eating healthier meals.\u003c/p>\n\u003cp>Industry representatives at the Sugar Association, a Washington lobbying group, said the USDA based its final rules on “many important and practical considerations.” For one, it said in a statement, “sugar makes many healthful foods palatable so children will eat them, which the science confirms helps\u003cstrong> \u003c/strong>increase intakes of many essential vitamins and minerals.”\u003c/p>\n\u003cp>“We continue to emphasize that the most important consideration of a healthful diet is the nutritional value of the foods and beverages consumed, not the sugar content,” the association said. “Portion control, monitoring caloric intake and being physically active are among the most important tools children can learn for long-term health.\"\u003c/p>\n\u003cp>But researchers say students’ sugar consumption places them at greater risk for obesity, Type 2 diabetes and heart disease. Boys consume an average of about 360 calories – more than 22 teaspoons – of added sugars a day, according to a 2012 \u003ca href=\"http://www.cdc.gov/nchs/data/databriefs/db87.pdf\">report\u003c/a> by the Centers for Disease Control and Prevention. Girls average about 280 calories – more than 17 teaspoons – daily.\u003c/p>\n\u003cp>Even if regulators eventually agree to restrict sugar in meals, schools would face the challenge of finding more healthful processed foods and the money to buy them. The federal government reimburses schools between 27 cents and $2.86 for each lunch served, depending on how much students can pay. Many school districts struggle to run their cafeterias with the current funding.\u003c/p>\n\u003cp>Schools have come to rely on revenue from vending machines, which Sharp says are one of the worst sources of sugary snacks and drinks on campus. He’s optimistic about the new standards released by the USDA that require items sold at school vending machines and snack bars to meet minimal nutrient requirements and limit sodium, sugar and fat.\u003c/p>\n\u003cp>But even as regulators tighten rules, other challenges arise.\u003c/p>\n\u003cp>“In L.A., there’s some neighborhoods where street vendors come around the school at the start of school and during breaks,” said Michael Goran, director of the Childhood Obesity Research Center at the University of Southern California. “The students can easily buy a boatload of sugary products.”\u003c/p>\n\u003cp>For years, researchers have debated how much sugar can be consumed in a healthy diet. USDA \u003ca href=\"http://www.cnpp.usda.gov/dietaryguidelines.htm\">guidelines\u003c/a> say calories from added sugars and solid fats should be limited to 5 to 15 percent of daily calories but provides no specific rule for sugars.\u003c/p>\n\u003cp>According to the CDC, American children \u003ca href=\"http://www.cdc.gov/nchs/data/databriefs/db87.pdf\">consume\u003c/a> about 16 percent of their daily calories from added sugars, which include white sugar, high-fructose corn syrup, honey and other sweeteners.\u003c/p>\n\u003cp>Some academics who believe that Americans are eating too much sugar blame the lack of regulations on the political clout of the food and beverage industry.\u003c/p>\n\u003cp>“Sugar is the only nutrient with no dietary reference intake, and it’s because the food industry doesn’t want it,” said Dr. Robert Lustig, a pediatric endocrinologist at UC San Francisco.\u003c/p>\n\u003cp>Lustig is the author of “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease” and has been on a crusade against sugar. He argues that it’s addictive and toxic and that in the amounts consumed by Americans, sugar changes metabolism, raises blood pressure and damages the liver.\u003c/p>\n\u003cp>The Sugar Association argues that Lustig's research lacks scientific basis and that sugar consumption is correlated with, but not the proven cause of, health problems like Type 2 diabetes.\u003c/p>\n\u003cp>“We are not consuming enough of it (sugar) for it to have negative health impacts,” said Megan Mitchell, a spokeswoman for the lobbying group. “If the science supported setting an upper limit intake on sugar, they (federal regulators) would do it. There has been no major body of science to come out in support of it. That's why it hasn't happened yet.”\u003c/p>\n\u003cp>USDA officials say school meal regulations are based on independent scientific recommendations and input from all stakeholders. In its statement, the Sugar Association said it “did not lobby or meet with anyone at the U.S. Department of Agriculture with respect to the school lunch rule, nor was the Association involved in the crafting of that rule.”\u003c/p>\n\u003cp>Some say political pushback from food and beverage companies is part of the problem, but regulating sugar is complicated. It can be difficult to differentiate and enforce rules for naturally occurring sugars and added sweeteners, said Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest.\u003c/p>\n\u003cp>“These are extra calories that many children can’t afford,” Wootan said. “One-third of children are either overweight or obese. And it contributes to heart disease and diabetes. And in addition to that, oftentimes, the sugary food crowds out more healthy foods that kids need. So kids are overfed and undernourished.”\u003c/p>\n\u003cp>\u003cem>This story was edited by Robert Salladay and copy edited by Pam Hogle and Nikki Frick.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>The independent, nonprofit Center for Investigative Reporting is the country’s largest investigative reporting team. For more, visit \u003c/strong>\u003ca href=\"http://www.californiawatch.org\">\u003cstrong>www.cironline.org\u003c/strong>\u003c/a>\u003cstrong>.\u003c/strong>\u003c/p>\n\n",
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"excerpt": "Almost everything about a school cafeteria meal has a regulation. The federal government caps the amount of fat and salt in breakfasts and lunches. It sets minimum standards for servings of fruit, vegetables, grains, milk and meat.\r\n\r\nBut one widely used and often-overused product has no official limits: sugar.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15440\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/41284017@N08/7995796099/in/photolist-dbyxBr-dbyAAG-dbyBzy-dbyzdA-dbyC9q-dbyAij-dbyCMQ-dbyDqA-dbyBGE-dbyCE5-dbyzrZ-dbyBZQ-dbyyNU-dbyA6U-dbyBVS-dbyzpL-dbyyKc-dbyBfz-dbyyEx-dbyzx3-dbyzP6-dbyAYu-dbyz2U-dbyzKG-dbyCv3-dbyzg7-dbyBfY-dbyBpQ-dbyxPx-dbywSH-dbyChm-dbyAq4-dbyDmm-dbyASH-dbyARN-dbyB7d-dbyzYC-dbyAud-dbyB8H-dbyz8o-dbyxsB-dbyCYw-8KiC9Y-ayDy68-azaFpD-d6WUpm-cZDSds-e9WPJv-e9WPJe-fh9dsC-abwWoB\">\u003cimg class=\"size-large wp-image-15440 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/7995796099_c60447daba_c-640x424.jpg\" alt=\"(Photo: USDAgov via Flickr)\" width=\"640\" height=\"424\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Photo: USDAgov via Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Eleanor Yang Su\u003c/strong>, \u003ca href=\"http://cironline.org\" target=\"_blank\">The Center for Investigative Reporting\u003c/a>\u003c/p>\n\u003cp>Almost everything about a school cafeteria meal has a regulation. The federal government caps the amount of fat and salt in breakfasts and lunches. It sets minimum standards for servings of fruit, vegetables, grains, milk and meat.\u003c/p>\n\u003cp>But one widely used and often-overused product has no official limits: sugar.\u003c/p>\n\u003cp>As Congress faces increased scrutiny over subsidies to the sugar industry, nutritionists and anti-obesity crusaders are focusing on the amount of sugar in school meals – and asking whether regulations governing school lunches deliberately exclude limits on sugar to favor a powerful industry.\u003c/p>\n\u003cp>Recent research shows that sugar levels in school meals are more than double what is recommended for the general public. Elementary school lunch menus contain 115 percent of the recommended daily calories from added sugars and fats, according to a \u003ca href=\"http://www.mathematica-mpr.com/publications/PDFs/nutrition/snda-iv_vol1.pdf\">November study\u003c/a> by the USDA’s Food and Nutrition Service. Middle school and high school lunch menus also are sugar- and fat-heavy, averaging between 59 and 74 percent of the recommended amounts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>About 1 in 5 school lunch menus includes dessert, the federal study said. The most common are cookies, cakes and brownies, some of which are counted as grain requirements. Other popular options are fruit with gelatin, ice cream and pudding.\u003c!--more-->\u003c/p>\n\u003cp>The data from the School Nutrition Dietary Assessment is based on a 2010 survey of about 900 schools across the country and is considered the most comprehensive federal research on school meals.\u003c/p>\n\u003cp>For years, schools added sweets, such as graham crackers or cookies, to bump up calorie counts and meet minimum thresholds. Researchers say that practice is less common now that the USDA has implemented calorie limits. But some say sugary treats still are appealing to school administrators.\u003c/p>\n\u003cp>“Sugar-related products are the least expensive source of calories in the school meal program,” said Matthew Sharp, senior advocate for California Food Policy Advocates. He said many school officials oppose reducing sugar in meals because it would force them to buy more expensive products.\u003c/p>\n\u003cp>The USDA, which administers the national school lunch and breakfast programs, says newly created total calorie limits are designed to discourage extra-sugary and fatty foods. A USDA spokesman noted that as of June 30, about 70 percent\u003cstrong> \u003c/strong>of all schools have shown they’re in compliance with the new plan, which means students are eating healthier meals.\u003c/p>\n\u003cp>Industry representatives at the Sugar Association, a Washington lobbying group, said the USDA based its final rules on “many important and practical considerations.” For one, it said in a statement, “sugar makes many healthful foods palatable so children will eat them, which the science confirms helps\u003cstrong> \u003c/strong>increase intakes of many essential vitamins and minerals.”\u003c/p>\n\u003cp>“We continue to emphasize that the most important consideration of a healthful diet is the nutritional value of the foods and beverages consumed, not the sugar content,” the association said. “Portion control, monitoring caloric intake and being physically active are among the most important tools children can learn for long-term health.\"\u003c/p>\n\u003cp>But researchers say students’ sugar consumption places them at greater risk for obesity, Type 2 diabetes and heart disease. Boys consume an average of about 360 calories – more than 22 teaspoons – of added sugars a day, according to a 2012 \u003ca href=\"http://www.cdc.gov/nchs/data/databriefs/db87.pdf\">report\u003c/a> by the Centers for Disease Control and Prevention. Girls average about 280 calories – more than 17 teaspoons – daily.\u003c/p>\n\u003cp>Even if regulators eventually agree to restrict sugar in meals, schools would face the challenge of finding more healthful processed foods and the money to buy them. The federal government reimburses schools between 27 cents and $2.86 for each lunch served, depending on how much students can pay. Many school districts struggle to run their cafeterias with the current funding.\u003c/p>\n\u003cp>Schools have come to rely on revenue from vending machines, which Sharp says are one of the worst sources of sugary snacks and drinks on campus. He’s optimistic about the new standards released by the USDA that require items sold at school vending machines and snack bars to meet minimal nutrient requirements and limit sodium, sugar and fat.\u003c/p>\n\u003cp>But even as regulators tighten rules, other challenges arise.\u003c/p>\n\u003cp>“In L.A., there’s some neighborhoods where street vendors come around the school at the start of school and during breaks,” said Michael Goran, director of the Childhood Obesity Research Center at the University of Southern California. “The students can easily buy a boatload of sugary products.”\u003c/p>\n\u003cp>For years, researchers have debated how much sugar can be consumed in a healthy diet. USDA \u003ca href=\"http://www.cnpp.usda.gov/dietaryguidelines.htm\">guidelines\u003c/a> say calories from added sugars and solid fats should be limited to 5 to 15 percent of daily calories but provides no specific rule for sugars.\u003c/p>\n\u003cp>According to the CDC, American children \u003ca href=\"http://www.cdc.gov/nchs/data/databriefs/db87.pdf\">consume\u003c/a> about 16 percent of their daily calories from added sugars, which include white sugar, high-fructose corn syrup, honey and other sweeteners.\u003c/p>\n\u003cp>Some academics who believe that Americans are eating too much sugar blame the lack of regulations on the political clout of the food and beverage industry.\u003c/p>\n\u003cp>“Sugar is the only nutrient with no dietary reference intake, and it’s because the food industry doesn’t want it,” said Dr. Robert Lustig, a pediatric endocrinologist at UC San Francisco.\u003c/p>\n\u003cp>Lustig is the author of “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease” and has been on a crusade against sugar. He argues that it’s addictive and toxic and that in the amounts consumed by Americans, sugar changes metabolism, raises blood pressure and damages the liver.\u003c/p>\n\u003cp>The Sugar Association argues that Lustig's research lacks scientific basis and that sugar consumption is correlated with, but not the proven cause of, health problems like Type 2 diabetes.\u003c/p>\n\u003cp>“We are not consuming enough of it (sugar) for it to have negative health impacts,” said Megan Mitchell, a spokeswoman for the lobbying group. “If the science supported setting an upper limit intake on sugar, they (federal regulators) would do it. There has been no major body of science to come out in support of it. That's why it hasn't happened yet.”\u003c/p>\n\u003cp>USDA officials say school meal regulations are based on independent scientific recommendations and input from all stakeholders. In its statement, the Sugar Association said it “did not lobby or meet with anyone at the U.S. Department of Agriculture with respect to the school lunch rule, nor was the Association involved in the crafting of that rule.”\u003c/p>\n\u003cp>Some say political pushback from food and beverage companies is part of the problem, but regulating sugar is complicated. It can be difficult to differentiate and enforce rules for naturally occurring sugars and added sweeteners, said Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest.\u003c/p>\n\u003cp>“These are extra calories that many children can’t afford,” Wootan said. “One-third of children are either overweight or obese. And it contributes to heart disease and diabetes. And in addition to that, oftentimes, the sugary food crowds out more healthy foods that kids need. So kids are overfed and undernourished.”\u003c/p>\n\u003cp>\u003cem>This story was edited by Robert Salladay and copy edited by Pam Hogle and Nikki Frick.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>The independent, nonprofit Center for Investigative Reporting is the country’s largest investigative reporting team. For more, visit \u003c/strong>\u003ca href=\"http://www.californiawatch.org\">\u003cstrong>www.cironline.org\u003c/strong>\u003c/a>\u003cstrong>.\u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Thousands of Californians could lose food stamp benefits under a plan approved by congressional Republicans last week cutting the federal program by approximately $40 billion over ten years. California already has the lowest food stamp participation rate in the nation. Advocates for the poor are alarmed, and they say the GOP plan would hurt veterans and former foster youth, among others.\u003c/p>\n\u003cp style=\"text-align: justify\">An estimated four million Californians receive food assistance through a state-administered program called CalFresh. \u003ca href=\"http://www.govtrack.us/congress/votes/113-2013/h476\" target=\"_blank\">The bill\u003c/a>, which passed by a 217-210 margin, would protect benefits for the poorest households with children (who comprise about 80 percent of food stamp recipients in California), but restrict benefits for unemployed childless adults after three months.\u003c/p>\n\u003cp style=\"text-align: justify\">GOP Rep. Tom McClintock, who represents a district stretching from Truckee to the Sequoia National Forest, says he voted on behalf of every California household that pays $720 a year in taxes to support CalFresh. “I think they’ve got a right to ask in return that those who are on the program make a good faith effort to get off it, and that’s what this bill does,” he said.\u003c/p>\n\u003cp>More than 360,000 out-of-work Californians could lose CalFresh benefits, unless they enroll in vocational courses or a county jobs program. “The bill restores a requirement that able-bodied adults work, or look for work, or at least be training for work in order to receive this assistance,” said McClintock.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But there’s just one catch, according to Jessica Bartholow, a legislative advocate at the nonprofit Western Center on Law and Poverty. “Our counties and our state administrators all say that they don't have the capacity to absorb those individuals into a job search and a job training program,” she said.\u003c/p>\n\u003cp>The House GOP cuts could also hurt one vulnerable group state lawmakers have been actively trying to help: jobless veterans. Bartholow says the House plan reverses a newly passed state law giving special benefits to returning vets. “The bill passed by the House of Representatives would put that policy in jeopardy,” said Bartholow.\u003c/p>\n\u003cp>The federal government pays for food stamps, formally called the Supplemental Nutrition Assistance Program or SNAP. Bartholow believes that instead of eliminating people from the food stamp rolls, California should be working to enroll more of the estimated 4 million residents who are eligible for but do not receive food assistance. Because of that low participation rate, California leaves about $4.7 billion in federal money earmarked for SNAP on the table each year.\u003c/p>\n\u003cp>According to Bartholow, past Republican governors oversaw tough requirements that helped keep the state’s SNAP participation rate low. “We were one of the first states to have a finger image requirement for the program,” said Bartholow. “We were one of the last states to allow for phone interviews when people couldn't come into the office, and we were the last state to change reporting requirements for income and assets from quarterly to semiannually.”\u003c/p>\n\u003cp>Some of those barriers to enrollment have been lifted through legislation signed by Gov. Brown, but according to a U.S. Dept. of Agriculture survey earlier this year, approximately one-half of Californians entitled to federal nutrition assistance do not receive it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>All California’s Democratic representatives voted against the bill. Republican representatives Gary Miller and David Valadao also voted no.\u003c/p>\n\n",
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"excerpt": "Thousands of Californians could lose food stamp benefits under a plan approved by congressional Republicans last week cutting the federal program by approximately $40 billion over ten years. Advocates for the poor are alarmed; California already has the lowest food stamp participation rate in the nation, and they say the GOP plan would hurt veterans and former foster youth, among others.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Thousands of Californians could lose food stamp benefits under a plan approved by congressional Republicans last week cutting the federal program by approximately $40 billion over ten years. California already has the lowest food stamp participation rate in the nation. Advocates for the poor are alarmed, and they say the GOP plan would hurt veterans and former foster youth, among others.\u003c/p>\n\u003cp style=\"text-align: justify\">An estimated four million Californians receive food assistance through a state-administered program called CalFresh. \u003ca href=\"http://www.govtrack.us/congress/votes/113-2013/h476\" target=\"_blank\">The bill\u003c/a>, which passed by a 217-210 margin, would protect benefits for the poorest households with children (who comprise about 80 percent of food stamp recipients in California), but restrict benefits for unemployed childless adults after three months.\u003c/p>\n\u003cp style=\"text-align: justify\">GOP Rep. Tom McClintock, who represents a district stretching from Truckee to the Sequoia National Forest, says he voted on behalf of every California household that pays $720 a year in taxes to support CalFresh. “I think they’ve got a right to ask in return that those who are on the program make a good faith effort to get off it, and that’s what this bill does,” he said.\u003c/p>\n\u003cp>More than 360,000 out-of-work Californians could lose CalFresh benefits, unless they enroll in vocational courses or a county jobs program. “The bill restores a requirement that able-bodied adults work, or look for work, or at least be training for work in order to receive this assistance,” said McClintock.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But there’s just one catch, according to Jessica Bartholow, a legislative advocate at the nonprofit Western Center on Law and Poverty. “Our counties and our state administrators all say that they don't have the capacity to absorb those individuals into a job search and a job training program,” she said.\u003c/p>\n\u003cp>The House GOP cuts could also hurt one vulnerable group state lawmakers have been actively trying to help: jobless veterans. Bartholow says the House plan reverses a newly passed state law giving special benefits to returning vets. “The bill passed by the House of Representatives would put that policy in jeopardy,” said Bartholow.\u003c/p>\n\u003cp>The federal government pays for food stamps, formally called the Supplemental Nutrition Assistance Program or SNAP. Bartholow believes that instead of eliminating people from the food stamp rolls, California should be working to enroll more of the estimated 4 million residents who are eligible for but do not receive food assistance. Because of that low participation rate, California leaves about $4.7 billion in federal money earmarked for SNAP on the table each year.\u003c/p>\n\u003cp>According to Bartholow, past Republican governors oversaw tough requirements that helped keep the state’s SNAP participation rate low. “We were one of the first states to have a finger image requirement for the program,” said Bartholow. “We were one of the last states to allow for phone interviews when people couldn't come into the office, and we were the last state to change reporting requirements for income and assets from quarterly to semiannually.”\u003c/p>\n\u003cp>Some of those barriers to enrollment have been lifted through legislation signed by Gov. Brown, but according to a U.S. Dept. of Agriculture survey earlier this year, approximately one-half of Californians entitled to federal nutrition assistance do not receive it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>All California’s Democratic representatives voted against the bill. Republican representatives Gary Miller and David Valadao also voted no.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Hospital Tells Police Where Fights Happen, and Crime Drops",
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"content": "\u003cfigure id=\"attachment_15114\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-15114\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/103077312-640x432.jpg\" alt=\"An ambulance makes its way through revelers in Cardiff city center in Wales in 2010. New measures in the city have reduced injuries caused by violence.\" width=\"640\" height=\"432\">\u003cfigcaption class=\"wp-caption-text\">An ambulance makes its way through revelers in Cardiff city center in Wales in 2010. New measures in the city have reduced injuries caused by violence. (Matt Cardy/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nancy Shute\u003c/strong>,\u003ca href=\"http://www.npr.org/blogs/health/2013/09/19/224052451/a-hospital-tells-police-where-fights-happen-and-crime-drops\" target=\"_blank\"> NPR\u003c/a>\u003c/p>\n\u003cp>On Saturday night, the emergency room staff knows all too well what's coming — people showing up with a broken jaw, a knife wound or a bashed-in face, often after too many hours in a pub. Doctors at the emergency department in Cardiff, Wales, realized that many of the people who were injured in fights never reported it to the police. That realization led to a simple program that has radically reduced the toll of violence.\u003c/p>\n\u003cp>The hospital already had information on where and how people in the emergency room had been injured — \"which bar, which club, which street, which park, which school,\" says \u003ca href=\"http://www.cardiff.ac.uk/dentl/contactsandpeople/academicstaff/p-t/shepherd-jonathan-prof-overview_new.html\">Dr. Jonathan Shepherd\u003c/a>, a professor of oral and maxillofacial surgery at Cardiff University and an author of the study.\u003c/p>\n\u003cp>Many people who are injured in a fight never reported it to police, it turned out. That was particularly true with fights happening inside pubs and clubs. \"They don't know who the perpetrator was, so what's the point of going to the police?\" Shepherd tells Shots. \"And they're afraid of having their own conduct scrutinized. If it's a fist fight or gang related or drug related, nobody's going to want to go to the police.\"\u003c!--more-->\u003c/p>\n\u003cp>So the hospital started sharing its information with the police, after removing names and other identifying information. With that anonymous information, authorities found they could do a much better job of targeting violence hot spots.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That and other measures reduced the social and economic costs of violence in Cardiff by about $11 million in 2007, according to the\u003ca href=\"http://injuryprevention.bmj.com/content/early/2013/08/22/injuryprev-2012-040622.abstract\"> study\u003c/a>, which was published in the journal \u003cem>Injury Prevention\u003c/em>.\u003c/p>\n\u003cp>That includes lower costs of health care and criminal justice. The program itself costs the city about $338,000 a year, including data-management costs and prevention efforts.\u003c/p>\n\u003cp>Some of those prevention efforts were novel indeed. After it became clear that a lot of people were getting injured in fights inside pubs and bars, the establishments were required to switch from glass to plastic cups. The number of people injured with a broken bottle or glass dropped by 70 percent.\u003c/p>\n\u003cp>A section of the Cardiff city center rich with nightlife was blocked off to cars on weekend nights, making it less likely that revelers would run afoul of a motor vehicle. And some bars that proved to be big trouble spots were closed.\u003c/p>\n\u003cp>An earlier \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21680632\">study \u003c/a>of the Cardiff experiment found hospital admissions reduced by 42 percent, compared to cities without the reporting plan and preventive efforts, and a 32 percent reduction in wounding recorded by police.\u003c/p>\n\u003cp>Word on the success of the reporting system spread. By mid-2012, one-third of emergency departments in England had implemented it in full, and almost all were well on their way to doing so, Shepherd says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the U.K. gun violence is very, very rare,\" Shepherd says. \"There are some years when the local police force here doesn't have one firearms offense to deal with. That means the focus shifts from gun violence to knife violence and fistfights.\" But he says that this same approach could be useful in addressing gun violence as well.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15114\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-15114\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/103077312-640x432.jpg\" alt=\"An ambulance makes its way through revelers in Cardiff city center in Wales in 2010. New measures in the city have reduced injuries caused by violence.\" width=\"640\" height=\"432\">\u003cfigcaption class=\"wp-caption-text\">An ambulance makes its way through revelers in Cardiff city center in Wales in 2010. New measures in the city have reduced injuries caused by violence. (Matt Cardy/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nancy Shute\u003c/strong>,\u003ca href=\"http://www.npr.org/blogs/health/2013/09/19/224052451/a-hospital-tells-police-where-fights-happen-and-crime-drops\" target=\"_blank\"> NPR\u003c/a>\u003c/p>\n\u003cp>On Saturday night, the emergency room staff knows all too well what's coming — people showing up with a broken jaw, a knife wound or a bashed-in face, often after too many hours in a pub. Doctors at the emergency department in Cardiff, Wales, realized that many of the people who were injured in fights never reported it to the police. That realization led to a simple program that has radically reduced the toll of violence.\u003c/p>\n\u003cp>The hospital already had information on where and how people in the emergency room had been injured — \"which bar, which club, which street, which park, which school,\" says \u003ca href=\"http://www.cardiff.ac.uk/dentl/contactsandpeople/academicstaff/p-t/shepherd-jonathan-prof-overview_new.html\">Dr. Jonathan Shepherd\u003c/a>, a professor of oral and maxillofacial surgery at Cardiff University and an author of the study.\u003c/p>\n\u003cp>Many people who are injured in a fight never reported it to police, it turned out. That was particularly true with fights happening inside pubs and clubs. \"They don't know who the perpetrator was, so what's the point of going to the police?\" Shepherd tells Shots. \"And they're afraid of having their own conduct scrutinized. If it's a fist fight or gang related or drug related, nobody's going to want to go to the police.\"\u003c!--more-->\u003c/p>\n\u003cp>So the hospital started sharing its information with the police, after removing names and other identifying information. With that anonymous information, authorities found they could do a much better job of targeting violence hot spots.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That and other measures reduced the social and economic costs of violence in Cardiff by about $11 million in 2007, according to the\u003ca href=\"http://injuryprevention.bmj.com/content/early/2013/08/22/injuryprev-2012-040622.abstract\"> study\u003c/a>, which was published in the journal \u003cem>Injury Prevention\u003c/em>.\u003c/p>\n\u003cp>That includes lower costs of health care and criminal justice. The program itself costs the city about $338,000 a year, including data-management costs and prevention efforts.\u003c/p>\n\u003cp>Some of those prevention efforts were novel indeed. After it became clear that a lot of people were getting injured in fights inside pubs and bars, the establishments were required to switch from glass to plastic cups. The number of people injured with a broken bottle or glass dropped by 70 percent.\u003c/p>\n\u003cp>A section of the Cardiff city center rich with nightlife was blocked off to cars on weekend nights, making it less likely that revelers would run afoul of a motor vehicle. And some bars that proved to be big trouble spots were closed.\u003c/p>\n\u003cp>An earlier \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21680632\">study \u003c/a>of the Cardiff experiment found hospital admissions reduced by 42 percent, compared to cities without the reporting plan and preventive efforts, and a 32 percent reduction in wounding recorded by police.\u003c/p>\n\u003cp>Word on the success of the reporting system spread. By mid-2012, one-third of emergency departments in England had implemented it in full, and almost all were well on their way to doing so, Shepherd says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the U.K. gun violence is very, very rare,\" Shepherd says. \"There are some years when the local police force here doesn't have one firearms offense to deal with. That means the focus shifts from gun violence to knife violence and fistfights.\" But he says that this same approach could be useful in addressing gun violence as well.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why School Lunch Matters in State's New Education Funding Formula",
"title": "Why School Lunch Matters in State's New Education Funding Formula",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_15063\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/137164122-e1379438099505.jpg\">\u003cimg class=\"size-large wp-image-15063\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/137164122-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Jane Meredith Adams,\u003c/strong> \u003ca href=\"http://www.edsource.org/today/2013/school-finance-reform-prompts-dispute-over-counting-low-income-students/38908#.UjiGcBZRYRk\" target=\"_blank\">EdSource\u003c/a>\u003c/p>\n\u003cp>Never has school lunch meant so much for California education.\u003c/p>\n\u003cp>Delivering significantly more money to schools based on the number of low-income children they serve is at the heart of the sweeping\u003ca href=\"http://www.edsource.org/today/2013/a-new-k-12-funding-system-demands-new-thinking-in-building-local-budgets/36182#.UjXukryxM7A\" target=\"_blank\"> new K-12 finance system\u003c/a> approved by the state Legislature in June. The new system defines “low income” as those students eligible for the school’s free and reduced-price meals program.\u003c/p>\n\u003caside class=\"pullquote alignleft\">If the demand for new paperwork jeopardizes funding for needy children in any way, after years of work to pass Proposition 30, “People will become unglued.\"\u003c/aside>\n\u003cp>But two months into the rollout of the reforms, which Gov. Jerry Brown praised as a victory for the neediest students, two of the largest districts –- Los Angeles Unified and Fresno Unified –- are in a dispute with the state over a last-minute change in how children who receive free meals are counted. Instead of moving into the school year confident of how much new funding they’ll receive for low-income students, the two districts, as well as scores of other districts in the state, are now being asked to submit new data from hundreds of thousands of low-income families before the funding will be released.\u003c/p>\n\u003cp>“We didn’t bargain for this and we were not told this,” said John Deasy, superintendent of Los Angeles Unified School District, the state’s largest district with more than 650,000 students, more than half of whom –- 384,000 students –- attend 466 district schools that are being asked to certify low-income students again. If the demand for new paperwork jeopardizes funding for needy children in any way, after years of work to pass Proposition 30 to fund education and to pass the new education finance system, Deasy said, there will be an outcry from educators, advocates, students, parents and legislators. “People will become unglued,” he said.\u003c!--more-->\u003c/p>\n\u003ch4>Two different methods of counting heads\u003c/h4>\n\u003cp>The dispute originated in a California Department of Education \u003ca href=\"http://www.cde.ca.gov/ds/sp/cl/documents/calpadsupdflash78.pdf\" target=\"_blank\">statement\u003c/a> in August that it would no longer accept meal eligibility data used for decades by the federal government at a subset of schools that serve high percentages of low-income families. The state’s rejection of the data is being “hotly contested” in conversations between the district, the California Department of Education and the governor’s office, Deasy said. “We have been documenting poverty for years,” he said, and the federal data requirements are “an absolutely legitimate way to document poverty.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The August announcement sent districts into a panic because they believed they would need to file the new low-income student certification data by Oct. 2. That's the annual “census day” when schools must provide a comprehensive count of their student body to the state. But the state has clarified its information and has said that schools can correct the documentation of low-income students through Feb. 6, 2014.\u003c/p>\n\u003cp>At issue are two different methods used by the federal government to track low-income students eligible for free and reduced-price meals. The first method, used by the vast majority of schools, reports eligible students by their individual student identification numbers every year. The second method, used by 1,529 schools in high-poverty neighborhoods in the state, reports students individually once every four years and then uses that “base year” data to create a percentage of eligible students.\u003c/p>\n\u003cp>But with hundreds of millions of dollars of funding for low-income students on the line, the California Department of Education says it needs current data on low-income students.\u003c/p>\n\u003cp>“It’s one thing to do a rough estimate (based on numbers collected every four years), and it’s a much different thing when you have to calculate how much money to give to schools,” said Keric Ashley, director of the Analysis, Measurement and Accountability Reporting Division in the California Department of Education.\u003c/p>\n\u003ch4>Millions at stake\u003c/h4>\n\u003cp>Under the new formula approved by the Legislature, districts are supposed to receive additional funds for every high-needs student enrolled – as much as $3,000 per student once the formula is fully funded over the next eight years. With more than half of California’s 6 million students from low-income families, the monetary impact is huge for both the districts and the state budget.\u003c/p>\n\u003cp>And that demands reliable data, said Ashley, noting that some high-poverty-level schools collect data even less frequently than every four years. This is because income levels at their schools have remained consistently low and the federal government has granted extensions. There are schools, he said, “that haven’t collected that data for over a decade.”\u003c/p>\n\u003cp>Also at issue is whether low-income students must be identified individually, by their student identification numbers – which is data the group of high-poverty schools don’t have. But this level of detail is necessary, Ashley said, to ensure that low-income students aren’t also counted as foster youth or English learners. Each of these classifications – low income, foster youth and English learner – triggers additional funding for a student, but students are not allowed to collect additional funding for more than one classification. For instance, for the purposes of the new state funding formula, a low-income foster youth must be categorized as either low income or foster youth, but not both.\u003c/p>\n\u003cp>Still, Ruth F. Quinto, chief financial officer of Fresno Unified, questioned whether a new round of data collection was necessary in this first year of implementation of the new funding system, known as the Local Control Funding Formula.\u003c/p>\n\u003cp>“The requirements from the California Department of Education to document all of this sensitive information right now, we believe, are unnecessary, given the type of documentation that already exists,” she said.\u003c/p>\n\u003cp>The Fresno district has 35,000 students in 79 schools – representing three-quarters of the 106 schools in the district – that serve high-poverty neighborhoods and use the four-year data collection cycle.\u003c/p>\n\u003ch4>‘Students are going to get left out’\u003c/h4>\n\u003cp>While still hoping that the California Department of Education will adjust its demand for new documents, Quinto said Fresno is gearing up for a massive outreach to families. “The biggest barrier is logistically reaching families and having forms completed, returned, entered and accepted by the state,” she said. “We are putting together teams of people in a variety of languages, a game plan, and different communication strategies if we are left with no choice but to get moving on it.”\u003c/p>\n\u003cp>She added, “Students are going to get left out. We believe that would be in contrast to the governor’s desire to provide resources to our most at-risk population statewide.”\u003c/p>\n\u003cp>Even smaller districts are concerned.\u003c/p>\n\u003cp>“I don’t make the (federal) rules on how my kids qualify for free and reduced-price lunch,” said Frank Betry, superintendent of the Terra Bella Union School District in Tulare County. State lawmakers decided to use federal eligibility for the meal program as the qualification for extra funding for low-income students, he said, but now the California Department of Education has decided it won’t accept that count at the high-poverty schools. “If you are going to attach a qualifier to an existing program,” he said, “you can’t carve out the rules you don’t like.”\u003c/p>\n\u003cp>Deasy and others are still hoping to find a solution that addresses both district and state needs.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>The new funding formula is “supposed to be less bureaucratic, more flexible and serve kids of greatest need,” Deasy said. “We believe in it completely and we hope the governor continues to be the unwavering governor he has been on this issue.”\u003c/p>\n\n",
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"excerpt": "Never has school lunch meant so much for California education.\r\n\r\nDelivering significantly more money to schools based on the number of low-income children they serve is at the heart of the sweeping new K-12 finance system approved by the state Legislature in June. The new system defines “low income” as those students eligible for the school’s free and reduced-price meals program.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15063\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/137164122-e1379438099505.jpg\">\u003cimg class=\"size-large wp-image-15063\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/137164122-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Jane Meredith Adams,\u003c/strong> \u003ca href=\"http://www.edsource.org/today/2013/school-finance-reform-prompts-dispute-over-counting-low-income-students/38908#.UjiGcBZRYRk\" target=\"_blank\">EdSource\u003c/a>\u003c/p>\n\u003cp>Never has school lunch meant so much for California education.\u003c/p>\n\u003cp>Delivering significantly more money to schools based on the number of low-income children they serve is at the heart of the sweeping\u003ca href=\"http://www.edsource.org/today/2013/a-new-k-12-funding-system-demands-new-thinking-in-building-local-budgets/36182#.UjXukryxM7A\" target=\"_blank\"> new K-12 finance system\u003c/a> approved by the state Legislature in June. The new system defines “low income” as those students eligible for the school’s free and reduced-price meals program.\u003c/p>\n\u003caside class=\"pullquote alignleft\">If the demand for new paperwork jeopardizes funding for needy children in any way, after years of work to pass Proposition 30, “People will become unglued.\"\u003c/aside>\n\u003cp>But two months into the rollout of the reforms, which Gov. Jerry Brown praised as a victory for the neediest students, two of the largest districts –- Los Angeles Unified and Fresno Unified –- are in a dispute with the state over a last-minute change in how children who receive free meals are counted. Instead of moving into the school year confident of how much new funding they’ll receive for low-income students, the two districts, as well as scores of other districts in the state, are now being asked to submit new data from hundreds of thousands of low-income families before the funding will be released.\u003c/p>\n\u003cp>“We didn’t bargain for this and we were not told this,” said John Deasy, superintendent of Los Angeles Unified School District, the state’s largest district with more than 650,000 students, more than half of whom –- 384,000 students –- attend 466 district schools that are being asked to certify low-income students again. If the demand for new paperwork jeopardizes funding for needy children in any way, after years of work to pass Proposition 30 to fund education and to pass the new education finance system, Deasy said, there will be an outcry from educators, advocates, students, parents and legislators. “People will become unglued,” he said.\u003c!--more-->\u003c/p>\n\u003ch4>Two different methods of counting heads\u003c/h4>\n\u003cp>The dispute originated in a California Department of Education \u003ca href=\"http://www.cde.ca.gov/ds/sp/cl/documents/calpadsupdflash78.pdf\" target=\"_blank\">statement\u003c/a> in August that it would no longer accept meal eligibility data used for decades by the federal government at a subset of schools that serve high percentages of low-income families. The state’s rejection of the data is being “hotly contested” in conversations between the district, the California Department of Education and the governor’s office, Deasy said. “We have been documenting poverty for years,” he said, and the federal data requirements are “an absolutely legitimate way to document poverty.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The August announcement sent districts into a panic because they believed they would need to file the new low-income student certification data by Oct. 2. That's the annual “census day” when schools must provide a comprehensive count of their student body to the state. But the state has clarified its information and has said that schools can correct the documentation of low-income students through Feb. 6, 2014.\u003c/p>\n\u003cp>At issue are two different methods used by the federal government to track low-income students eligible for free and reduced-price meals. The first method, used by the vast majority of schools, reports eligible students by their individual student identification numbers every year. The second method, used by 1,529 schools in high-poverty neighborhoods in the state, reports students individually once every four years and then uses that “base year” data to create a percentage of eligible students.\u003c/p>\n\u003cp>But with hundreds of millions of dollars of funding for low-income students on the line, the California Department of Education says it needs current data on low-income students.\u003c/p>\n\u003cp>“It’s one thing to do a rough estimate (based on numbers collected every four years), and it’s a much different thing when you have to calculate how much money to give to schools,” said Keric Ashley, director of the Analysis, Measurement and Accountability Reporting Division in the California Department of Education.\u003c/p>\n\u003ch4>Millions at stake\u003c/h4>\n\u003cp>Under the new formula approved by the Legislature, districts are supposed to receive additional funds for every high-needs student enrolled – as much as $3,000 per student once the formula is fully funded over the next eight years. With more than half of California’s 6 million students from low-income families, the monetary impact is huge for both the districts and the state budget.\u003c/p>\n\u003cp>And that demands reliable data, said Ashley, noting that some high-poverty-level schools collect data even less frequently than every four years. This is because income levels at their schools have remained consistently low and the federal government has granted extensions. There are schools, he said, “that haven’t collected that data for over a decade.”\u003c/p>\n\u003cp>Also at issue is whether low-income students must be identified individually, by their student identification numbers – which is data the group of high-poverty schools don’t have. But this level of detail is necessary, Ashley said, to ensure that low-income students aren’t also counted as foster youth or English learners. Each of these classifications – low income, foster youth and English learner – triggers additional funding for a student, but students are not allowed to collect additional funding for more than one classification. For instance, for the purposes of the new state funding formula, a low-income foster youth must be categorized as either low income or foster youth, but not both.\u003c/p>\n\u003cp>Still, Ruth F. Quinto, chief financial officer of Fresno Unified, questioned whether a new round of data collection was necessary in this first year of implementation of the new funding system, known as the Local Control Funding Formula.\u003c/p>\n\u003cp>“The requirements from the California Department of Education to document all of this sensitive information right now, we believe, are unnecessary, given the type of documentation that already exists,” she said.\u003c/p>\n\u003cp>The Fresno district has 35,000 students in 79 schools – representing three-quarters of the 106 schools in the district – that serve high-poverty neighborhoods and use the four-year data collection cycle.\u003c/p>\n\u003ch4>‘Students are going to get left out’\u003c/h4>\n\u003cp>While still hoping that the California Department of Education will adjust its demand for new documents, Quinto said Fresno is gearing up for a massive outreach to families. “The biggest barrier is logistically reaching families and having forms completed, returned, entered and accepted by the state,” she said. “We are putting together teams of people in a variety of languages, a game plan, and different communication strategies if we are left with no choice but to get moving on it.”\u003c/p>\n\u003cp>She added, “Students are going to get left out. We believe that would be in contrast to the governor’s desire to provide resources to our most at-risk population statewide.”\u003c/p>\n\u003cp>Even smaller districts are concerned.\u003c/p>\n\u003cp>“I don’t make the (federal) rules on how my kids qualify for free and reduced-price lunch,” said Frank Betry, superintendent of the Terra Bella Union School District in Tulare County. State lawmakers decided to use federal eligibility for the meal program as the qualification for extra funding for low-income students, he said, but now the California Department of Education has decided it won’t accept that count at the high-poverty schools. “If you are going to attach a qualifier to an existing program,” he said, “you can’t carve out the rules you don’t like.”\u003c/p>\n\u003cp>Deasy and others are still hoping to find a solution that addresses both district and state needs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new funding formula is “supposed to be less bureaucratic, more flexible and serve kids of greatest need,” Deasy said. “We believe in it completely and we hope the governor continues to be the unwavering governor he has been on this issue.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk",
"title": "Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_15016\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-e1379100622408.jpg\">\u003cimg class=\"size-large wp-image-15016\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/12/the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient/\" target=\"_blank\">expand access to primary care\u003c/a>. These \"scope-of-practice\" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.\u003c/p>\n\u003cp>Here's a recap of some of the bills and where they stand now:\u003c/p>\n\u003cp>\u003cstrong>Midwifery Bill (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml\" target=\"_blank\">AB 1308\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>The \u003ca href=\"http://centerforhealthreporting.org/blog/update-midwifery-bill-moves-governor%E2%80%99s-desk1175\" target=\"_blank\">Center for Health Reporting writes\u003c/a> that the bill passed unanimously Thursday night and is now on the governor's desk. From the Center:\u003c/p>\n\u003cblockquote>\n\u003cp dir=\"ltr\">(L)icensed midwives were legally obligated to be supervised by physicians. If a doctor supervised a licensed midwife, however, the doctor ran the risk of losing liability insurance. So, collaboration was unattainable and advocates said this put women and babies at risk.\u003c/p>\n\u003cp dir=\"ltr\">The bill removes the requirement for licensed midwives to be supervised by a physician.\u003c/p>\n\u003cp dir=\"ltr\">“Because physician supervision was required but not available, the midwives often had to operate in the shadows,” said Shannon Smith-Crowley, a lobbyist for the American Congress of Obstetricians and Gynecologists (ACOG), a group representing OB/GYNs and the bill’s sponsor. “Midwives can be out in the open, helping them develop better relationships, warmer reception and protocols for transfer, ideally leading to earlier transfers in less dire circumstances.”\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003cstrong>Physical Therapy (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/asm/ab_0951-1000/ab_1000_bill_20130906_amended_sen_v91.pdf\" target=\"_blank\">AB 1000\u003c/a>) -- headed to governor's desk\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This bill would eliminate the need for patients to have a physician's diagnosis to receive physical therapy. Under the bill, patients could access physical therapy directly. But as \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/9/physical-therapist-bill-headed-to-governor\" target=\"_blank\">California Healthline \u003c/a>reports, the bill is both supported and opposed by physical therapists, some of whom want the governor to veto the bill:\u003c/p>\n\u003cblockquote>\u003cp>Paul Gaspar, president of the Independent Physical Therapists of California, said the bill wasn't really about direct patient access to therapy as much as it was about changing the financial relationship between physicians and physical therapists.\u003c/p>\n\u003cp>\"People who own [physical therapy] businesses are very concerned about this,\" Gaspar said. \"We feel threatened that people are going to take advantage of us.\"\u003c/p>\n\u003cp>Physician groups now will be able to directly hire physical therapists, and Gaspar said that means they'll be able to make money on the work of other providers. That bucks a national trend, he said, that goes against referral-for-profit plans.\u003c/p>\n\u003cp>Gaspar said his group will talk to the governor's office about the possibility of a veto, based in part on national legislation (\u003ca href=\"http://thomas.loc.gov/cgi-bin/bdquery/z?d113:hr.2914:\" target=\"_blank\">HR 2914\u003c/a>) by Rep. Jackie Speier (D-San Mateo) that may conflict with the state law.\u003c/p>\n\u003cp>Wieckowski said direct access to physical therapists can only be good for consumers.\u003c/p>\n\u003cp>\"This bill helps streamline health care delivery in California and will help patients get the access they need,\" he said, \"rather than losing valuable time with unnecessary and costly delays.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong> Pharmacists (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml\" target=\"_blank\">SB 493\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>This bill allows pharmacists to order some lab tests and prescribe smoking cessation drugs. From \u003ca href=\"http://www.sacbee.com/2013/09/11/5728426/bill-would-expand-role-of-pharmacists.html#storylink=cpy\" target=\"_blank\">The Sacramento Bee\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The legislation is part of what had been a package from Democratic Sen. Ed Hernandez of \u003ca href=\"http://topics.sacbee.com/West+Covina/\" rel=\"nofollow\">West Covina\u003c/a> intended to help address the state's expected shortage of primary care physicians. ...\u003c/p>\n\u003cp>Supporters, which include pharmacy schools and \u003ca href=\"http://topics.sacbee.com/Blue+Shield/\" rel=\"nofollow\">Blue Shield\u003c/a> of California, say the legislation would allow pharmacists to better use their training and could help control \u003ca href=\"http://topics.sacbee.com/health+care+costs/\" rel=\"nofollow\">health care costs.\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cdiv>\u003cstrong>Nurse Practitioners (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB491\" target=\"_blank\">SB 491\u003c/a>) -- stuck in committee\u003c/strong>\u003c/div>\n\u003cdiv>This bill was \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/09/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities/\" target=\"_blank\">one of the most hotly contested\u003c/a> of all the scope-of-practice bills. On August 30, it failed to move out of committee. The Los Angeles Times\u003ca href=\"http://www.latimes.com/local/la-me-healthcare-20130902,0,3526045.story\" target=\"_blank\"> captured the mood\u003c/a>:\u003c/div>\n\u003cdiv>\n\u003cblockquote>\u003cp>The proposal failed in a committee Friday, under fire from the California Medical Assn., the powerful lobbying arm for the state's physicians. The organization teamed with some specialists and labor unions to mobilize lobbyists, engage doctors across the state and even dedicate Twitter accounts as it waged its campaign against the bill. ...\u003c/p>\n\u003cp>Jockeying over the scope of medical professionals' practice has intensified this year as California prepares for full implementation of the new national healthcare law, which will bring an influx of newly insured patients.\u003c/p>\n\u003cp>But \"the sticking point for the nurse practitioner bill [was] the word 'independent,'\" said Hernandez, who chairs the Senate health committee. \"For organized medicine, that's the … line in the sand.\"\u003c/p>\u003c/blockquote>\n\u003c/div>\n\u003cp>\u003cstrong> Optometrists (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0451-0500/sb_492_bill_20130508_amended_sen_v95.html\" target=\"_blank\">SB 492\u003c/a>) -- pulled from consideration by bill's author\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill would have allowed optometrists to prescribe more drugs and treat certain diseases. But Sen. Ed Hernandez (D-West Covina) opted to hold the bill to the next session, as the\u003ca href=\"http://blogs.sacbee.com/capitolalertlatest/2013/08/bill-expanding-optometrists-authority-on-hold-til-next-year.html\" target=\"_blank\"> Sacramento Bee\u003c/a> reported:\u003c/p>\n\u003cblockquote>\u003cp>\"We turned that into a two-year bill just to make sure we can continue working on it in committee, continue to work with the opposition,\" Hernandez told The Bee.\u003c/p>\n\u003cp>\"What we wanted to achieve we felt needed a little more conversation, and we felt it would just be better to work over the break on it.\" ...\u003c/p>\n\u003cp>Molly Weedn, a spokeswoman for the California Medical Association, said doctors hoped to reach compromise with Hernandez on the optometry bill the way they had on the bill regarding pharmacists.\u003c/p>\n\u003cp>\"We're glad there is extra time to work out what some of those difference are,\" she said. \"Our biggest concern has been and remains that patients are being treated by qualified health care professionals.\"\u003c/p>\n\u003cp>Hernandez said it's too soon to say what kind of compromise is in order:\u003c/p>\n\u003cp>\"We're not willing to give up on anything because we haven't had that conversation yet with the opposition.\"\u003c/p>\u003c/blockquote>\n\u003cdiv>And, as has been\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/06/bill-to-increase-abortion-providers-on-governors-desk/\" target=\"_blank\"> widely reported\u003c/a>,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB154\" target=\"_blank\"> AB 154\u003c/a>, which would permit specially trained clinicians to conduct aspiration abortions, went to the governor's desk earlier this month.\u003c/div>\n\n",
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"excerpt": "California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to expand access to primary care. These \"scope-of-practice\" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.",
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"description": "California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to expand access to primary care. These "scope-of-practice" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.",
"title": "Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk | KQED",
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"headline": "Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15016\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-e1379100622408.jpg\">\u003cimg class=\"size-large wp-image-15016\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/12/the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient/\" target=\"_blank\">expand access to primary care\u003c/a>. These \"scope-of-practice\" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.\u003c/p>\n\u003cp>Here's a recap of some of the bills and where they stand now:\u003c/p>\n\u003cp>\u003cstrong>Midwifery Bill (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml\" target=\"_blank\">AB 1308\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>The \u003ca href=\"http://centerforhealthreporting.org/blog/update-midwifery-bill-moves-governor%E2%80%99s-desk1175\" target=\"_blank\">Center for Health Reporting writes\u003c/a> that the bill passed unanimously Thursday night and is now on the governor's desk. From the Center:\u003c/p>\n\u003cblockquote>\n\u003cp dir=\"ltr\">(L)icensed midwives were legally obligated to be supervised by physicians. If a doctor supervised a licensed midwife, however, the doctor ran the risk of losing liability insurance. So, collaboration was unattainable and advocates said this put women and babies at risk.\u003c/p>\n\u003cp dir=\"ltr\">The bill removes the requirement for licensed midwives to be supervised by a physician.\u003c/p>\n\u003cp dir=\"ltr\">“Because physician supervision was required but not available, the midwives often had to operate in the shadows,” said Shannon Smith-Crowley, a lobbyist for the American Congress of Obstetricians and Gynecologists (ACOG), a group representing OB/GYNs and the bill’s sponsor. “Midwives can be out in the open, helping them develop better relationships, warmer reception and protocols for transfer, ideally leading to earlier transfers in less dire circumstances.”\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003cstrong>Physical Therapy (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/asm/ab_0951-1000/ab_1000_bill_20130906_amended_sen_v91.pdf\" target=\"_blank\">AB 1000\u003c/a>) -- headed to governor's desk\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This bill would eliminate the need for patients to have a physician's diagnosis to receive physical therapy. Under the bill, patients could access physical therapy directly. But as \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/9/physical-therapist-bill-headed-to-governor\" target=\"_blank\">California Healthline \u003c/a>reports, the bill is both supported and opposed by physical therapists, some of whom want the governor to veto the bill:\u003c/p>\n\u003cblockquote>\u003cp>Paul Gaspar, president of the Independent Physical Therapists of California, said the bill wasn't really about direct patient access to therapy as much as it was about changing the financial relationship between physicians and physical therapists.\u003c/p>\n\u003cp>\"People who own [physical therapy] businesses are very concerned about this,\" Gaspar said. \"We feel threatened that people are going to take advantage of us.\"\u003c/p>\n\u003cp>Physician groups now will be able to directly hire physical therapists, and Gaspar said that means they'll be able to make money on the work of other providers. That bucks a national trend, he said, that goes against referral-for-profit plans.\u003c/p>\n\u003cp>Gaspar said his group will talk to the governor's office about the possibility of a veto, based in part on national legislation (\u003ca href=\"http://thomas.loc.gov/cgi-bin/bdquery/z?d113:hr.2914:\" target=\"_blank\">HR 2914\u003c/a>) by Rep. Jackie Speier (D-San Mateo) that may conflict with the state law.\u003c/p>\n\u003cp>Wieckowski said direct access to physical therapists can only be good for consumers.\u003c/p>\n\u003cp>\"This bill helps streamline health care delivery in California and will help patients get the access they need,\" he said, \"rather than losing valuable time with unnecessary and costly delays.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong> Pharmacists (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml\" target=\"_blank\">SB 493\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>This bill allows pharmacists to order some lab tests and prescribe smoking cessation drugs. From \u003ca href=\"http://www.sacbee.com/2013/09/11/5728426/bill-would-expand-role-of-pharmacists.html#storylink=cpy\" target=\"_blank\">The Sacramento Bee\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The legislation is part of what had been a package from Democratic Sen. Ed Hernandez of \u003ca href=\"http://topics.sacbee.com/West+Covina/\" rel=\"nofollow\">West Covina\u003c/a> intended to help address the state's expected shortage of primary care physicians. ...\u003c/p>\n\u003cp>Supporters, which include pharmacy schools and \u003ca href=\"http://topics.sacbee.com/Blue+Shield/\" rel=\"nofollow\">Blue Shield\u003c/a> of California, say the legislation would allow pharmacists to better use their training and could help control \u003ca href=\"http://topics.sacbee.com/health+care+costs/\" rel=\"nofollow\">health care costs.\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cdiv>\u003cstrong>Nurse Practitioners (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB491\" target=\"_blank\">SB 491\u003c/a>) -- stuck in committee\u003c/strong>\u003c/div>\n\u003cdiv>This bill was \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/09/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities/\" target=\"_blank\">one of the most hotly contested\u003c/a> of all the scope-of-practice bills. On August 30, it failed to move out of committee. The Los Angeles Times\u003ca href=\"http://www.latimes.com/local/la-me-healthcare-20130902,0,3526045.story\" target=\"_blank\"> captured the mood\u003c/a>:\u003c/div>\n\u003cdiv>\n\u003cblockquote>\u003cp>The proposal failed in a committee Friday, under fire from the California Medical Assn., the powerful lobbying arm for the state's physicians. The organization teamed with some specialists and labor unions to mobilize lobbyists, engage doctors across the state and even dedicate Twitter accounts as it waged its campaign against the bill. ...\u003c/p>\n\u003cp>Jockeying over the scope of medical professionals' practice has intensified this year as California prepares for full implementation of the new national healthcare law, which will bring an influx of newly insured patients.\u003c/p>\n\u003cp>But \"the sticking point for the nurse practitioner bill [was] the word 'independent,'\" said Hernandez, who chairs the Senate health committee. \"For organized medicine, that's the … line in the sand.\"\u003c/p>\u003c/blockquote>\n\u003c/div>\n\u003cp>\u003cstrong> Optometrists (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0451-0500/sb_492_bill_20130508_amended_sen_v95.html\" target=\"_blank\">SB 492\u003c/a>) -- pulled from consideration by bill's author\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill would have allowed optometrists to prescribe more drugs and treat certain diseases. But Sen. Ed Hernandez (D-West Covina) opted to hold the bill to the next session, as the\u003ca href=\"http://blogs.sacbee.com/capitolalertlatest/2013/08/bill-expanding-optometrists-authority-on-hold-til-next-year.html\" target=\"_blank\"> Sacramento Bee\u003c/a> reported:\u003c/p>\n\u003cblockquote>\u003cp>\"We turned that into a two-year bill just to make sure we can continue working on it in committee, continue to work with the opposition,\" Hernandez told The Bee.\u003c/p>\n\u003cp>\"What we wanted to achieve we felt needed a little more conversation, and we felt it would just be better to work over the break on it.\" ...\u003c/p>\n\u003cp>Molly Weedn, a spokeswoman for the California Medical Association, said doctors hoped to reach compromise with Hernandez on the optometry bill the way they had on the bill regarding pharmacists.\u003c/p>\n\u003cp>\"We're glad there is extra time to work out what some of those difference are,\" she said. \"Our biggest concern has been and remains that patients are being treated by qualified health care professionals.\"\u003c/p>\n\u003cp>Hernandez said it's too soon to say what kind of compromise is in order:\u003c/p>\n\u003cp>\"We're not willing to give up on anything because we haven't had that conversation yet with the opposition.\"\u003c/p>\u003c/blockquote>\n\u003cdiv>And, as has been\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/06/bill-to-increase-abortion-providers-on-governors-desk/\" target=\"_blank\"> widely reported\u003c/a>,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB154\" target=\"_blank\"> AB 154\u003c/a>, which would permit specially trained clinicians to conduct aspiration abortions, went to the governor's desk earlier this month.\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The Primary Care Crunch: Not Enough Doctors and More Patients Coming",
"title": "The Primary Care Crunch: Not Enough Doctors and More Patients Coming",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_14991\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126488183-e1379026016774.jpg\">\u003cimg class=\"size-full wp-image-14991\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126488183-e1379026016774.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"564\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774-400x353.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774-320x282.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The full implementation of Obamacare and (potentially) millions more insured is now just over 100 days away, on Jan. 1. Questions abound: W\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/24/young-adults-key-to-obamacare-in-california/\" target=\"_blank\">ill young, healthy people really sign up?\u003c/a> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/23/californias-health-insurance-exchange-sets-plans-premiums-no-apparent-rate-shock/\" target=\"_blank\">How much will my premium be? \u003c/a>\u003ca href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" target=\"_blank\">How does the Affordable Care Act work anyway? \u003c/a>\u003c/p>\n\u003cp>Floating around in all those Obamacare discussions is another question: Who is going to treat all the newly insured? After all, we already have\u003ca href=\"http://www.chcf.org/publications/2009/06/fewer-and-more-specialized--a-new-assessment-of-physician-supply-in-california\" target=\"_blank\"> a shortage \u003c/a>of primary care doctors. Out of 7 million uninsured in the state, Covered California estimates 1.4 million people could sign up for insurance next year. Plus another 1.4 million people will be newly eligible for Medi-Cal.\u003c/p>\n\u003cp>To address this question, San Francisco's Commonwealth Club invited me to \u003ca href=\"http://www.commonwealthclub.org/events/archive/podcast/primary-care-crunch-anticipating-doctor-shortage-after-obamacare-82813\" target=\"_blank\">moderate a discussion\u003c/a> about the shortage of primary care providers. Kevin Grumbach, a family physician and co-director at UC San Francisco's Center for Excellence in Primary Care, started off by defining the subject at hand.\u003c!--more-->\u003c/p>\n\u003cp>Primary care \"is about having someone who cares for you as a whole person,\" he said. \"What a shocking concept, right.\"\u003c/p>\n\u003cp>Judging from the laughter in the room, audience members hadn't had a lot of experience with being dealt with as a whole person in their medical encounters. Much has been written about \u003ca href=\"https://www.google.com/#q=lack+of+coordinated+health+care+\" target=\"_blank\">the lack of coordination in health care\u003c/a>. One example: when the surgeon confirms the incision is healing nicely, but is seemingly unaware that the patient has moved to ICU due to pulmonary failure. (Examples are not hard to come by; this one happened to the father of a dear friend of mine.)\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Bob Wiebe, chief medical officer of Dignity Health, pointed to two chief drivers of the primary care shortage: money and work environment. Taking money first, Wiebe noted that medical students often graduate with $200,000 to $300,000 of debt. While primary care doctors might earn $200,000 to $220,000 a year, he said, specialists can make double or triple that amount. In addition, primary care physicians work in a \"hectic, even chaotic environment\" defined by 15-minute appointments with patients.\u003c/p>\n\u003cp>\u003cstrong>Transformation needed\u003c/strong>\u003c/p>\n\u003cp>While \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/14/in-midst-of-physician-shortage-inland-empire-gets-new-medical-school/\" target=\"_blank\">educating more primary care doctors\u003c/a> would help, a bigger change is needed, all three panelists argued. Panelist Patricia Knight had a special perspective. She's a former nurse who became an attorney and now works as a \u003ca href=\"http://pacificcoasthealthadvocacy.com/about.html\" target=\"_blank\">patient advocate\u003c/a>. She talked about nurse practitioners, nurses with advanced training who, along with physician assistants, \"can handle many of the problems that come in and take care of them without ever having to involve the physicians.\" But she also urged caution before rushing ahead. She worries that if we try to \"churn out more nurse practitioners\" they might be lacking in the clinical experience necessary to do an effective job. Amending laws to allow these midlevel health providers to practice more independently has been a\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/09/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities/\" target=\"_blank\"> hot topic in Sacramento\u003c/a>.\u003c/p>\n\u003cp>Grumbach argued for a new approach to primary care, a team-based approach. \"We need to deploy nurses, physicians, pharmacists, mental health personnel in the team. There's so much work to be done.\" He said that people in the U.S. who have diabetes are twice as likely to have an amputation as someone in Europe. That's because we haven't invested in \"nursing care, the head coaching, the health coaching, the support in how to control your diet, the fundamental primary care to keep that foot healthy so you don't wind up in the hospital.\"\u003c/p>\n\u003cp>Knight called for an innovation in the way people are seen. Instead of having an appointment, going home and then heading off to a specialist appointment at another location, the patient stays in the room and various health professionals come to the patient, all in one visit. She described how this could work for someone with diabetes or heart disease. \"Instead of seeing one (health care provider) in a silo, you have a group, and with the specialties together, (providers) are able to offer a broader scope of care in a concentrated time.\"\u003c/p>\n\u003cp>\u003cstrong>People don't want health care, they want health\u003c/strong>\u003c/p>\n\u003cp>Wiebe pointed to changes already coming, some related to new incentives under the Affordable Care Act. Already there are changes coming in payment systems. Instead of a fee-for-service model where doctors get paid for specific things they do to patients -- tests, treatments -- new approaches, such as a bundled payments, are coming into play. Physicians might receive a lump sum of money, an incentive to keep patients healthy.\u003c/p>\n\u003cp>Knight said that patients have a responsibility to oversee their own health and be more engaged. Patients should \"be prepared to the extent you can be for your appointment ... getting an overview of a condition. That enables you to go in and ask more questions, be prepared, be ready to interact with your team.\"\u003c/p>\n\u003cp>Grumbach believes the Affordable Care Act is a step ahead for the country, making sure that people have health insurance, but beyond that \"we need to fundamentally rethink how we deliver health care,\" he said. \"It does not makes sense to just cover more people with the same shoddy product.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.commonwealthclub.org/events/archive/podcast/primary-care-crunch-anticipating-doctor-shortage-after-obamacare-82813\" target=\"_blank\">Listen to the podcast of the one-hour discussion\u003c/a>.\u003c/p>\n\n",
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"excerpt": "The full implementation of Obamacare and (potentially) millions more insured is now just over 100 days away, on Jan. 1. Questions abound: Will young, healthy people really sign up? How much will my premium be? How does the Affordable Care Act work anyway?\r\n\r\nFloating around in all that Obamacare discussion is another question: Who is going to treat all the newly insured? After all, we already have a shortage of primary care doctors. Out of 7 million uninsured in the state, Covered California estimates 1.4 million people could sign up for insurance next year. Plus another 1.4 million people will be newly eligible for Medi-Cal.",
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"description": "The full implementation of Obamacare and (potentially) millions more insured is now just over 100 days away, on Jan. 1. Questions abound: Will young, healthy people really sign up? How much will my premium be? How does the Affordable Care Act work anyway?\r\n\r\nFloating around in all that Obamacare discussion is another question: Who is going to treat all the newly insured? After all, we already have a shortage of primary care doctors. Out of 7 million uninsured in the state, Covered California estimates 1.4 million people could sign up for insurance next year. Plus another 1.4 million people will be newly eligible for Medi-Cal.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14991\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126488183-e1379026016774.jpg\">\u003cimg class=\"size-full wp-image-14991\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126488183-e1379026016774.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"564\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774-400x353.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/09/126488183-e1379026016774-320x282.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>The full implementation of Obamacare and (potentially) millions more insured is now just over 100 days away, on Jan. 1. Questions abound: W\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/24/young-adults-key-to-obamacare-in-california/\" target=\"_blank\">ill young, healthy people really sign up?\u003c/a> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/23/californias-health-insurance-exchange-sets-plans-premiums-no-apparent-rate-shock/\" target=\"_blank\">How much will my premium be? \u003c/a>\u003ca href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" target=\"_blank\">How does the Affordable Care Act work anyway? \u003c/a>\u003c/p>\n\u003cp>Floating around in all those Obamacare discussions is another question: Who is going to treat all the newly insured? After all, we already have\u003ca href=\"http://www.chcf.org/publications/2009/06/fewer-and-more-specialized--a-new-assessment-of-physician-supply-in-california\" target=\"_blank\"> a shortage \u003c/a>of primary care doctors. Out of 7 million uninsured in the state, Covered California estimates 1.4 million people could sign up for insurance next year. Plus another 1.4 million people will be newly eligible for Medi-Cal.\u003c/p>\n\u003cp>To address this question, San Francisco's Commonwealth Club invited me to \u003ca href=\"http://www.commonwealthclub.org/events/archive/podcast/primary-care-crunch-anticipating-doctor-shortage-after-obamacare-82813\" target=\"_blank\">moderate a discussion\u003c/a> about the shortage of primary care providers. Kevin Grumbach, a family physician and co-director at UC San Francisco's Center for Excellence in Primary Care, started off by defining the subject at hand.\u003c!--more-->\u003c/p>\n\u003cp>Primary care \"is about having someone who cares for you as a whole person,\" he said. \"What a shocking concept, right.\"\u003c/p>\n\u003cp>Judging from the laughter in the room, audience members hadn't had a lot of experience with being dealt with as a whole person in their medical encounters. Much has been written about \u003ca href=\"https://www.google.com/#q=lack+of+coordinated+health+care+\" target=\"_blank\">the lack of coordination in health care\u003c/a>. One example: when the surgeon confirms the incision is healing nicely, but is seemingly unaware that the patient has moved to ICU due to pulmonary failure. (Examples are not hard to come by; this one happened to the father of a dear friend of mine.)\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Bob Wiebe, chief medical officer of Dignity Health, pointed to two chief drivers of the primary care shortage: money and work environment. Taking money first, Wiebe noted that medical students often graduate with $200,000 to $300,000 of debt. While primary care doctors might earn $200,000 to $220,000 a year, he said, specialists can make double or triple that amount. In addition, primary care physicians work in a \"hectic, even chaotic environment\" defined by 15-minute appointments with patients.\u003c/p>\n\u003cp>\u003cstrong>Transformation needed\u003c/strong>\u003c/p>\n\u003cp>While \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/14/in-midst-of-physician-shortage-inland-empire-gets-new-medical-school/\" target=\"_blank\">educating more primary care doctors\u003c/a> would help, a bigger change is needed, all three panelists argued. Panelist Patricia Knight had a special perspective. She's a former nurse who became an attorney and now works as a \u003ca href=\"http://pacificcoasthealthadvocacy.com/about.html\" target=\"_blank\">patient advocate\u003c/a>. She talked about nurse practitioners, nurses with advanced training who, along with physician assistants, \"can handle many of the problems that come in and take care of them without ever having to involve the physicians.\" But she also urged caution before rushing ahead. She worries that if we try to \"churn out more nurse practitioners\" they might be lacking in the clinical experience necessary to do an effective job. Amending laws to allow these midlevel health providers to practice more independently has been a\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/09/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities/\" target=\"_blank\"> hot topic in Sacramento\u003c/a>.\u003c/p>\n\u003cp>Grumbach argued for a new approach to primary care, a team-based approach. \"We need to deploy nurses, physicians, pharmacists, mental health personnel in the team. There's so much work to be done.\" He said that people in the U.S. who have diabetes are twice as likely to have an amputation as someone in Europe. That's because we haven't invested in \"nursing care, the head coaching, the health coaching, the support in how to control your diet, the fundamental primary care to keep that foot healthy so you don't wind up in the hospital.\"\u003c/p>\n\u003cp>Knight called for an innovation in the way people are seen. Instead of having an appointment, going home and then heading off to a specialist appointment at another location, the patient stays in the room and various health professionals come to the patient, all in one visit. She described how this could work for someone with diabetes or heart disease. \"Instead of seeing one (health care provider) in a silo, you have a group, and with the specialties together, (providers) are able to offer a broader scope of care in a concentrated time.\"\u003c/p>\n\u003cp>\u003cstrong>People don't want health care, they want health\u003c/strong>\u003c/p>\n\u003cp>Wiebe pointed to changes already coming, some related to new incentives under the Affordable Care Act. Already there are changes coming in payment systems. Instead of a fee-for-service model where doctors get paid for specific things they do to patients -- tests, treatments -- new approaches, such as a bundled payments, are coming into play. Physicians might receive a lump sum of money, an incentive to keep patients healthy.\u003c/p>\n\u003cp>Knight said that patients have a responsibility to oversee their own health and be more engaged. Patients should \"be prepared to the extent you can be for your appointment ... getting an overview of a condition. That enables you to go in and ask more questions, be prepared, be ready to interact with your team.\"\u003c/p>\n\u003cp>Grumbach believes the Affordable Care Act is a step ahead for the country, making sure that people have health insurance, but beyond that \"we need to fundamentally rethink how we deliver health care,\" he said. \"It does not makes sense to just cover more people with the same shoddy product.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.commonwealthclub.org/events/archive/podcast/primary-care-crunch-anticipating-doctor-shortage-after-obamacare-82813\" target=\"_blank\">Listen to the podcast of the one-hour discussion\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Foster Kids, Children in Orphanages at Higher Risk for Fetal Alcohol Syndrome",
"title": "Foster Kids, Children in Orphanages at Higher Risk for Fetal Alcohol Syndrome",
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"content": "\u003cfigure id=\"attachment_14863\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126221153-e1378752078714.jpg\">\u003cimg class=\"size-large wp-image-14863\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126221153-640x480.jpg\" alt=\"Experts say no amount of alcohol is known to be safe during pregnancy. (Getty Images)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Experts say no amount of alcohol is known to be safe during pregnancy. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>Children who grow up in foster care or are adopted from orphanages are more at risk for fetal alcohol syndrome because there is a higher probability that their mothers consumed alcohol during pregnancy. An \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/09/04/peds.2013-0066.abstract\" target=\"_blank\">international study\u003c/a> published Monday strongly recommends that infants and adolescents in these child welfare settings be tested for the disorder.\u003c/p>\n\u003cp>\"It is imperative that screening be implemented in these at-risk populations,\" reported the authors of the study, \"Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Setting.\" The researchers conducted a meta-analysis, where they pooled data from past studies.\u003c/p>\n\u003cp>Fetal alcohol syndrome can cause a \u003ca href=\"http://www.mayoclinic.com/health/fetal-alcohol-syndrome/DS00184\" target=\"_blank\">cascade of problems\u003c/a>, including physical deformities, developmental delay, learning disorders and behavior problems.\u003c/p>\n\u003cp>Svetlana Popova of the University of Toronto said she and three other researchers collected international data from peer-reviewed journals, government reports and books. They found that 6 percent of children who live in foster homes or similar care settings have fetal alcohol syndrome. This rate is approximately nine to 60 times higher than that in the general population internationally and up to 30 times higher than the prevalence of the disorder in the general population in the U.S., which is between 0.2 and 0.7 percent, Popova said in an interview.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Our research team has been studying the disorder for years,\" Popova said. \"We hope the results of this study will attract attention to the needs of children in care affected by prenatal alcohol exposure.\"\u003c/p>\n\u003cp>Though fetal alcohol syndrome is preventable, it is difficult to diagnose because health care providers must understand how often and how much alcohol the mother drank during pregnancy, and at which stages, according to experts who study the disorder. Even more challenging is that alcohol affects children differently — problems range from facial deformities to brain damage that can manifest itself in cognitive impairments, difficulty learning, and inability to cope in social settings.\u003c/p>\n\u003cp>Tom Donaldson, president of the National Organization on Fetal Alcohol Syndrome, said screening for the disorder would have huge benefits both to the person who has it and to society.\u003c/p>\n\u003cp>\"Screening would be very important in many systems of care because when you screen, you can then diagnose, and then you can develop a care plan and get somebody on a path of reaching their full potential,\" Donaldson said.\u003c/p>\n\u003cp>But he cautioned that information needed to identify the disorder is often hard to come by.\u003c/p>\n\u003cp>\"You need the alcohol usage history from the mother,\" he said. And when so many affected children \"are in foster care or adoptive care — they're not with their biological parents — that can sometimes can be hard to obtain,\" he said.\u003c/p>\n\u003cp>Monday was also International Fetal Alcohol Syndrome Awareness Day, established in 1999 in an attempt to draw international attention to the importance of abstaining from drinking alcohol during pregnancy, said experts in the field.\u003c/p>\n\u003cp>The awareness day \"is an important reminder that prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disorders in the United States,\" said the National Institutes of Health in \u003ca href=\"http://www.nih.gov/news/health/sep2013/niaaa-06.htm\" target=\"_blank\">a release\u003c/a>. \"Almost 40 years have passed since we recognized that drinking during pregnancy can result in a wide range of disabilities for children, of which Fetal Alcohol Syndrome is the most severe.\"\u003c/p>\n\u003cp>Sarah Mattson, an expert in fetal alcohol syndrome at San Diego State University, said the disorder has remained a severe public health problem since its initial identification in 1973.\u003c/p>\n\u003cp>\"Mixed messages in the media and a general lack of information about the disorder in the general population are at least part of the reason that it is so prevalent,\" Mattson said.\u003c/p>\n\u003cp>Advocates say the leading recommendation of the study in the journal \"Pediatrics\" — early detection, especially in foster care settings -- can lead to wider public awareness and improved health for those affected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Screening can lead to better coordination between agencies, for example, between schools, between health care agencies and in the actual foster homes,\" said Mike Odeh, of Children Now, an advocacy group. \"We know by definition, children in the welfare system are by definition more vulnerable, so it's no surprise that there is higher prevalence of the disorder in those areas. We need to focus on early identification, but also look at how our systems are set up to coordinate their care.\"\u003c/p>\n\n",
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"excerpt": "Children who grow up in foster care or are adopted from orphanages are more at risk for fetal alcohol syndrome because there is a higher probability that their mothers consumed alcohol during pregnancy. An international study published Monday strongly recommends that infants and adolescents in these child welfare settings be tested for the disorder.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14863\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126221153-e1378752078714.jpg\">\u003cimg class=\"size-large wp-image-14863\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/126221153-640x480.jpg\" alt=\"Experts say no amount of alcohol is known to be safe during pregnancy. (Getty Images)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Experts say no amount of alcohol is known to be safe during pregnancy. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>Children who grow up in foster care or are adopted from orphanages are more at risk for fetal alcohol syndrome because there is a higher probability that their mothers consumed alcohol during pregnancy. An \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/09/04/peds.2013-0066.abstract\" target=\"_blank\">international study\u003c/a> published Monday strongly recommends that infants and adolescents in these child welfare settings be tested for the disorder.\u003c/p>\n\u003cp>\"It is imperative that screening be implemented in these at-risk populations,\" reported the authors of the study, \"Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Setting.\" The researchers conducted a meta-analysis, where they pooled data from past studies.\u003c/p>\n\u003cp>Fetal alcohol syndrome can cause a \u003ca href=\"http://www.mayoclinic.com/health/fetal-alcohol-syndrome/DS00184\" target=\"_blank\">cascade of problems\u003c/a>, including physical deformities, developmental delay, learning disorders and behavior problems.\u003c/p>\n\u003cp>Svetlana Popova of the University of Toronto said she and three other researchers collected international data from peer-reviewed journals, government reports and books. They found that 6 percent of children who live in foster homes or similar care settings have fetal alcohol syndrome. This rate is approximately nine to 60 times higher than that in the general population internationally and up to 30 times higher than the prevalence of the disorder in the general population in the U.S., which is between 0.2 and 0.7 percent, Popova said in an interview.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Our research team has been studying the disorder for years,\" Popova said. \"We hope the results of this study will attract attention to the needs of children in care affected by prenatal alcohol exposure.\"\u003c/p>\n\u003cp>Though fetal alcohol syndrome is preventable, it is difficult to diagnose because health care providers must understand how often and how much alcohol the mother drank during pregnancy, and at which stages, according to experts who study the disorder. Even more challenging is that alcohol affects children differently — problems range from facial deformities to brain damage that can manifest itself in cognitive impairments, difficulty learning, and inability to cope in social settings.\u003c/p>\n\u003cp>Tom Donaldson, president of the National Organization on Fetal Alcohol Syndrome, said screening for the disorder would have huge benefits both to the person who has it and to society.\u003c/p>\n\u003cp>\"Screening would be very important in many systems of care because when you screen, you can then diagnose, and then you can develop a care plan and get somebody on a path of reaching their full potential,\" Donaldson said.\u003c/p>\n\u003cp>But he cautioned that information needed to identify the disorder is often hard to come by.\u003c/p>\n\u003cp>\"You need the alcohol usage history from the mother,\" he said. And when so many affected children \"are in foster care or adoptive care — they're not with their biological parents — that can sometimes can be hard to obtain,\" he said.\u003c/p>\n\u003cp>Monday was also International Fetal Alcohol Syndrome Awareness Day, established in 1999 in an attempt to draw international attention to the importance of abstaining from drinking alcohol during pregnancy, said experts in the field.\u003c/p>\n\u003cp>The awareness day \"is an important reminder that prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disorders in the United States,\" said the National Institutes of Health in \u003ca href=\"http://www.nih.gov/news/health/sep2013/niaaa-06.htm\" target=\"_blank\">a release\u003c/a>. \"Almost 40 years have passed since we recognized that drinking during pregnancy can result in a wide range of disabilities for children, of which Fetal Alcohol Syndrome is the most severe.\"\u003c/p>\n\u003cp>Sarah Mattson, an expert in fetal alcohol syndrome at San Diego State University, said the disorder has remained a severe public health problem since its initial identification in 1973.\u003c/p>\n\u003cp>\"Mixed messages in the media and a general lack of information about the disorder in the general population are at least part of the reason that it is so prevalent,\" Mattson said.\u003c/p>\n\u003cp>Advocates say the leading recommendation of the study in the journal \"Pediatrics\" — early detection, especially in foster care settings -- can lead to wider public awareness and improved health for those affected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Screening can lead to better coordination between agencies, for example, between schools, between health care agencies and in the actual foster homes,\" said Mike Odeh, of Children Now, an advocacy group. \"We know by definition, children in the welfare system are by definition more vulnerable, so it's no surprise that there is higher prevalence of the disorder in those areas. We need to focus on early identification, but also look at how our systems are set up to coordinate their care.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Prison Hunger Strike Ends, Inmates' Health Still at Risk",
"title": "Prison Hunger Strike Ends, Inmates' Health Still at Risk",
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"content": "\u003cfigure id=\"attachment_14760\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/RS1076_PelicanBaySHU-lpr.jpg\">\u003cimg class=\"size-large wp-image-14760 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/RS1076_PelicanBaySHU-lpr-640x480.jpg\" alt=\"Pelican Bay prison Secure Housing Unit. (Michael Montgomery/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Inside Pelican Bay State Prison's security housing unit. (Michael Montgomery/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>After 59 days, California inmates have \u003ca href=\"http://ww2.kqed.org/news/2013/09/05/110028/california-prison-hunger-strike-ends\" target=\"_blank\">ended their hunger strike\u003c/a>. The prisoners had been protesting what they called aggressive use of solitary confinement, which kept some prisoners in isolation for decades.\u003c/p>\n\u003cp>Some 30,000 inmates began the strike on July 8, but that number dropped over time. This week there were about 100 remaining, including 40 who have been on continuous hunger strike during the two-month period. Those on hunger strike were \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/30/prison-hunger-strikers-getting-by-on-gatorade-vitamins/\" target=\"_blank\">getting by on Gatorade\u003c/a>, totaling 600-625 calories a day, and vitamins.\u003c/p>\n\u003cp>In addition, advocates say the men had put on extra pounds in anticipation of the hunger strike. Some may have weighed 225 to 250 pounds at the start of the strike; others likely weighed less.\u003c/p>\n\u003cp>While it does not appear that any of the inmates have suffered severe health problems that can result from starvation, the process of commencing eating again must be done slowly and carefully. Anyone who has refused food over a long period of time is at risk of \"\u003ca href=\"http://www.californiareport.org/archive/R201307290850/a\" target=\"_blank\">refeeding syndrome\u003c/a>,\" which can cause \"\u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440847/\" target=\"_blank\">potentially fatal shifts\u003c/a>\" in fluids and electrolytes possibly leading to cardiac arrest and even death.\u003c!--more-->\u003c/p>\n\u003cp>Joyce Hayhoe, spokeswoman for the court-appointed federal receiver overseeing prison health care, says the Gatorade seems to have helped the inmates avoid significant health problems and hopes that the men will avoid other health problems during the refeeding phase.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But Andrea Garber, an expert on starvation with UC San Francisco Benioff Children’s Hospital, urged caution. \"Nobody really knows. You have to assume that they are at just as high risk as they would have been without Gatorade.\"\u003c/p>\n\u003cp>The California Correctional Health Care System has \u003ca href=\"http://www.cphcs.ca.gov/docs/careguides/MassHungerStrikeCareGuide2012-10-4.pdf\" target=\"_blank\">established guidelines\u003c/a> about safely beginning to eat again.\u003c/p>\n\u003cp>Specifically, on day 1 of refeeding, which would be Thursday, men could receive 5-10 calories per day per kilogram of body weight. So, a 158-pound man (or 72 kg) could receive up to 720 calories. The guidelines specify meals: breakfast would be 4 ounces nonfat milk, 2 ounces hot cereal, 1 ounce breakfast meat or eggs, 2 ounces juice.\u003c/p>\n\u003cp>Hayhoe stressed that each inmate would be treated individually and their individual diets will depend on their health status. Some of the men will do refeeding in their cells, while others will be medically monitored 24 hours a day.\u003c/p>\n\u003cp>In the first several days of refeeding, calories are increased slowly, as long as the patient tolerates the food. Hayhoe estimated the refeeding process for this group of hunger strikers will take between four days to just over a week.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Garber said she found the guidelines \"very cautious\" and added, \"It does sound like they are taking it seriously and proceeding with every caution.\"\u003c/p>\n\n",
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"excerpt": "After 59 days, California inmates have ended their hunger strike and are slowly starting to eat again.\r\n\r\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14760\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/RS1076_PelicanBaySHU-lpr.jpg\">\u003cimg class=\"size-large wp-image-14760 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/RS1076_PelicanBaySHU-lpr-640x480.jpg\" alt=\"Pelican Bay prison Secure Housing Unit. (Michael Montgomery/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Inside Pelican Bay State Prison's security housing unit. (Michael Montgomery/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>After 59 days, California inmates have \u003ca href=\"http://ww2.kqed.org/news/2013/09/05/110028/california-prison-hunger-strike-ends\" target=\"_blank\">ended their hunger strike\u003c/a>. The prisoners had been protesting what they called aggressive use of solitary confinement, which kept some prisoners in isolation for decades.\u003c/p>\n\u003cp>Some 30,000 inmates began the strike on July 8, but that number dropped over time. This week there were about 100 remaining, including 40 who have been on continuous hunger strike during the two-month period. Those on hunger strike were \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/30/prison-hunger-strikers-getting-by-on-gatorade-vitamins/\" target=\"_blank\">getting by on Gatorade\u003c/a>, totaling 600-625 calories a day, and vitamins.\u003c/p>\n\u003cp>In addition, advocates say the men had put on extra pounds in anticipation of the hunger strike. Some may have weighed 225 to 250 pounds at the start of the strike; others likely weighed less.\u003c/p>\n\u003cp>While it does not appear that any of the inmates have suffered severe health problems that can result from starvation, the process of commencing eating again must be done slowly and carefully. Anyone who has refused food over a long period of time is at risk of \"\u003ca href=\"http://www.californiareport.org/archive/R201307290850/a\" target=\"_blank\">refeeding syndrome\u003c/a>,\" which can cause \"\u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440847/\" target=\"_blank\">potentially fatal shifts\u003c/a>\" in fluids and electrolytes possibly leading to cardiac arrest and even death.\u003c!--more-->\u003c/p>\n\u003cp>Joyce Hayhoe, spokeswoman for the court-appointed federal receiver overseeing prison health care, says the Gatorade seems to have helped the inmates avoid significant health problems and hopes that the men will avoid other health problems during the refeeding phase.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But Andrea Garber, an expert on starvation with UC San Francisco Benioff Children’s Hospital, urged caution. \"Nobody really knows. You have to assume that they are at just as high risk as they would have been without Gatorade.\"\u003c/p>\n\u003cp>The California Correctional Health Care System has \u003ca href=\"http://www.cphcs.ca.gov/docs/careguides/MassHungerStrikeCareGuide2012-10-4.pdf\" target=\"_blank\">established guidelines\u003c/a> about safely beginning to eat again.\u003c/p>\n\u003cp>Specifically, on day 1 of refeeding, which would be Thursday, men could receive 5-10 calories per day per kilogram of body weight. So, a 158-pound man (or 72 kg) could receive up to 720 calories. The guidelines specify meals: breakfast would be 4 ounces nonfat milk, 2 ounces hot cereal, 1 ounce breakfast meat or eggs, 2 ounces juice.\u003c/p>\n\u003cp>Hayhoe stressed that each inmate would be treated individually and their individual diets will depend on their health status. Some of the men will do refeeding in their cells, while others will be medically monitored 24 hours a day.\u003c/p>\n\u003cp>In the first several days of refeeding, calories are increased slowly, as long as the patient tolerates the food. Hayhoe estimated the refeeding process for this group of hunger strikers will take between four days to just over a week.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Garber said she found the guidelines \"very cautious\" and added, \"It does sound like they are taking it seriously and proceeding with every caution.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Prison Hunger Strikers Getting by on Gatorade, Vitamins",
"title": "Prison Hunger Strikers Getting by on Gatorade, Vitamins",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_11720\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-e1377893062521.jpg\">\u003cimg class=\"size-full wp-image-11720\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-e1377893062521.jpg\" alt=\"Pelican Bay State Prison, Crescent City, CA. (Michael Montgomery/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-e1377893062521.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-e1377893062521-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-e1377893062521-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pelican Bay State Prison, Crescent City, CA. (Michael Montgomery/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Michael Montgomery and Lisa Aliferis\u003c/strong>\u003c/p>\n\u003cp>With an inmate hunger strike over conditions at California’s highest security lockups now at day 54, it seems remarkable that none of the 41 prisoners refusing food since July 8 has experienced serious or life-threatening medical problems.\u003c/p>\n\u003cp>Officials monitoring the protest report that, as of Wednesday, the men had \u003ca href=\"http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm\" target=\"_blank\">body mass indexes\u003c/a> in the 20s, well above a danger zone established by the court-appointed receiver overseeing prison medical care. Only two of the prisoners had lost more than 15 percent of their body weight, another critical measure.\u003c/p>\n\u003cp>While the inmates are clearly suffering as a result of the extended fast, and report bouts of extreme nausea and dizziness, there are “no imminent health emergencies and no prisoners in critical condition,” said Joyce Hayhoe, a spokesperson for receiver Clark Kelso.\u003c/p>\n\u003cp>So what’s keeping the hunger strikers from more severe starvation? The answer, it turns out, could be mass quantities of Gatorade, the ubiquitous sports drink.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Under state rules, inmates are considered on hunger strike if they refuse all state meals for more than three days and have no other food items in their cells, such as snacks from the prison commissary.\u003c!--more-->\u003c/p>\n\u003cp>However, Hayhoe said each day the hunger strikers are receiving five powder packets of Gatorade that deliver a total of 600-625 calories. That’s in addition to supplies of vitamins.\u003c/p>\n\u003cp>Hayhoe said the electrolytes in Gatorade are not considered “nutrition,” which would otherwise cancel inmates’ participation in a hunger strike.\u003c/p>\n\u003cp>“The amount of calories and the type of calories (from Gatorade) will not keep them from getting malnourished and could lead to heart, liver and muscle damage,” she said. “But it helps sustain them longer.”\u003c/p>\n\u003cp>The aim of providing electrolytes is to prevent severe dehydration, Hayhoe said.\u003c/p>\n\u003cp>Still, 650 calories from Gatorade constitutes “a severe starvation diet,\" notes Andrea Garber, an expert on starvation with UC San Francisco Benioff Children's Hospital. The Gatorade is merely \"prolonging the starvation, not preventing it.\"\u003c/p>\n\u003cp>Garber further notes that body mass index is a blunt measure and must be looked at individually. “We see patients starved and at high risk and they still have normal BMIs,” Garber noted. So hunger striking prisoners with BMIs in the 20s may not indicate much about their medical condition.\u003c/p>\n\u003cp>The fact that two of the prisoners have lost 15 percent of their body weight is a more accurate measure, she says, because it takes into account their starting point. Garber said a loss of 15 percent of body weight is a criteria for hospital admission in adolescents she treats.\u003c/p>\n\u003cp>As of Thursday, none of the strikers had been moved to an outside hospital, according to Hayhoe.\u003c/p>\n\u003cp>On August 19, U.S. District Judge Thelton Henderson issued an order allowing force-feeding (or involuntary re-feeding) of any inmate near death. While the order prompted angry responses from prisoner advocacy groups, officials said such measures are not needed, at least for now.\u003c/p>\n\u003cp>In fact, visitors who spoke with strike leaders this week reported the men were chipper and energetic, thanks in part to the daily supply of Gatorade.\u003c/p>\n\u003cp>Anne Weills, an Oakland attorney representing several of the strikers in a federal lawsuit over conditions at Pelican Bay State Prison in Crescent City, said the prisoners were “vibrant and intellectually sharp” when she met with them on Wednesday.\u003c/p>\n\u003cp>“They are fiercely committed to this struggle,” she said. “They still want to negotiate with the state.”\u003c/p>\n\u003cp>However, corrections officials have refused to negotiate with the hunger strikers and this week \u003ca href=\"http://cdcrtoday.blogspot.com/2013/08/cdcrs-responses-to-hunger-strikers.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+CDCRToday+%28CDCR+Today%29\" target=\"_blank\">released a document \u003c/a>claiming to have addressed (thought not agreed to) all their key demands.\u003c/p>\n\u003cp>Officials maintain the current protest is the work of violent gang leaders seeking to reassert control over criminal networks in prison system and on the streets.\u003c/p>\n\u003cp>Hayhoe said that while several inmates are under medical observation, the biggest concern right now is a sudden heart attack.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Update: The \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/05/while-prison-hunger-strike-ends-inmates-still-at-risk-refeeding/\" target=\"_blank\">prison hunger strike ended\u003c/a> on Sep. 5, 2013.\u003c/strong>\u003c/p>\n\n",
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"excerpt": "While the inmates are clearing suffering as a result of the extended fast, and report bouts of extreme nausea and dizziness, there are “no imminent health emergencies and no prisoners in critical condition,” said Joyce Hayhoe, a spokesperson for receiver Clark Kelso.\r\n\r\nSo what’s keeping the hunger strikers from more severe starvation? The answer, it turns out, could be mass quantities of Gatorade, the ubiquitous sports drink.",
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"description": "While the inmates are clearing suffering as a result of the extended fast, and report bouts of extreme nausea and dizziness, there are “no imminent health emergencies and no prisoners in critical condition,” said Joyce Hayhoe, a spokesperson for receiver Clark Kelso.\r\n\r\nSo what’s keeping the hunger strikers from more severe starvation? The answer, it turns out, could be mass quantities of Gatorade, the ubiquitous sports drink.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_11720\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-e1377893062521.jpg\">\u003cimg class=\"size-full wp-image-11720\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-e1377893062521.jpg\" alt=\"Pelican Bay State Prison, Crescent City, CA. (Michael Montgomery/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-e1377893062521.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-e1377893062521-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/03/RS2383_PelicanBayExterior-e1377893062521-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Pelican Bay State Prison, Crescent City, CA. (Michael Montgomery/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Michael Montgomery and Lisa Aliferis\u003c/strong>\u003c/p>\n\u003cp>With an inmate hunger strike over conditions at California’s highest security lockups now at day 54, it seems remarkable that none of the 41 prisoners refusing food since July 8 has experienced serious or life-threatening medical problems.\u003c/p>\n\u003cp>Officials monitoring the protest report that, as of Wednesday, the men had \u003ca href=\"http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm\" target=\"_blank\">body mass indexes\u003c/a> in the 20s, well above a danger zone established by the court-appointed receiver overseeing prison medical care. Only two of the prisoners had lost more than 15 percent of their body weight, another critical measure.\u003c/p>\n\u003cp>While the inmates are clearly suffering as a result of the extended fast, and report bouts of extreme nausea and dizziness, there are “no imminent health emergencies and no prisoners in critical condition,” said Joyce Hayhoe, a spokesperson for receiver Clark Kelso.\u003c/p>\n\u003cp>So what’s keeping the hunger strikers from more severe starvation? The answer, it turns out, could be mass quantities of Gatorade, the ubiquitous sports drink.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Under state rules, inmates are considered on hunger strike if they refuse all state meals for more than three days and have no other food items in their cells, such as snacks from the prison commissary.\u003c!--more-->\u003c/p>\n\u003cp>However, Hayhoe said each day the hunger strikers are receiving five powder packets of Gatorade that deliver a total of 600-625 calories. That’s in addition to supplies of vitamins.\u003c/p>\n\u003cp>Hayhoe said the electrolytes in Gatorade are not considered “nutrition,” which would otherwise cancel inmates’ participation in a hunger strike.\u003c/p>\n\u003cp>“The amount of calories and the type of calories (from Gatorade) will not keep them from getting malnourished and could lead to heart, liver and muscle damage,” she said. “But it helps sustain them longer.”\u003c/p>\n\u003cp>The aim of providing electrolytes is to prevent severe dehydration, Hayhoe said.\u003c/p>\n\u003cp>Still, 650 calories from Gatorade constitutes “a severe starvation diet,\" notes Andrea Garber, an expert on starvation with UC San Francisco Benioff Children's Hospital. The Gatorade is merely \"prolonging the starvation, not preventing it.\"\u003c/p>\n\u003cp>Garber further notes that body mass index is a blunt measure and must be looked at individually. “We see patients starved and at high risk and they still have normal BMIs,” Garber noted. So hunger striking prisoners with BMIs in the 20s may not indicate much about their medical condition.\u003c/p>\n\u003cp>The fact that two of the prisoners have lost 15 percent of their body weight is a more accurate measure, she says, because it takes into account their starting point. Garber said a loss of 15 percent of body weight is a criteria for hospital admission in adolescents she treats.\u003c/p>\n\u003cp>As of Thursday, none of the strikers had been moved to an outside hospital, according to Hayhoe.\u003c/p>\n\u003cp>On August 19, U.S. District Judge Thelton Henderson issued an order allowing force-feeding (or involuntary re-feeding) of any inmate near death. While the order prompted angry responses from prisoner advocacy groups, officials said such measures are not needed, at least for now.\u003c/p>\n\u003cp>In fact, visitors who spoke with strike leaders this week reported the men were chipper and energetic, thanks in part to the daily supply of Gatorade.\u003c/p>\n\u003cp>Anne Weills, an Oakland attorney representing several of the strikers in a federal lawsuit over conditions at Pelican Bay State Prison in Crescent City, said the prisoners were “vibrant and intellectually sharp” when she met with them on Wednesday.\u003c/p>\n\u003cp>“They are fiercely committed to this struggle,” she said. “They still want to negotiate with the state.”\u003c/p>\n\u003cp>However, corrections officials have refused to negotiate with the hunger strikers and this week \u003ca href=\"http://cdcrtoday.blogspot.com/2013/08/cdcrs-responses-to-hunger-strikers.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+CDCRToday+%28CDCR+Today%29\" target=\"_blank\">released a document \u003c/a>claiming to have addressed (thought not agreed to) all their key demands.\u003c/p>\n\u003cp>Officials maintain the current protest is the work of violent gang leaders seeking to reassert control over criminal networks in prison system and on the streets.\u003c/p>\n\u003cp>Hayhoe said that while several inmates are under medical observation, the biggest concern right now is a sudden heart attack.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Update: The \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/05/while-prison-hunger-strike-ends-inmates-still-at-risk-refeeding/\" target=\"_blank\">prison hunger strike ended\u003c/a> on Sep. 5, 2013.\u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>",
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