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"content": "\u003cfigure id=\"attachment_4834\" class=\"wp-caption alignleft\" style=\"max-width: 342px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/04/06/insurance-commissioner-calls-aetna-rate-hike-unreasonable/aetnarate_images-money_apr62012/\" rel=\"attachment wp-att-4834\">\u003cimg class=\"size-medium wp-image-4834 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/AetnaRate_Images-Money_Apr62012-300x225.jpg\" alt=\"AetnaRate_Images Money_Apr62012\" width=\"342\" height=\"256\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(flickr: Images Money)\u003c/figcaption>\u003c/figure>\n\u003cp>The largest public employees retirement system in the country - CalPERS - has plenty to gain from a drop in health care costs. After all, they cover 1.6 million employees, retirees and their families in California.\u003c/p>\n\u003cp>Now they're saying, \u003ca href=\"http://www.nytimes.com/2013/06/24/health/employers-test-plan-to-cap-medical-spending.html?pagewanted=all\" target=\"_blank\">they found a way to decrease the amount they've spent on knee and hip replacements\u003c/a> by 19 percent in a year, which could have implications for other employer health plans.\u003c/p>\n\u003cp>Lisa Aliferis blogged about the CalPERS experiment in controlling costs right \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/04/27/steps-toward-lower-cost-higher-quality-health-care/\" target=\"_blank\">here on State of Health\u003c/a> about a year ago. Aliferis wrote that they decided to tackle costs around these two surgeries, which cost them $55 million dollars a year in 2008.\u003c/p>\n\u003cblockquote>\u003cp>Now, you might not think there would be much difference in the price for getting a knee or hip replacement across the state. But think again. CalPERS asked Anthem Blue Cross — which manages its PPO plans — to examine the range of prices for these operations in California.\u003c/p>\n\u003cp>Anthem came back with the startling information that CalPERS was paying $15,000 on the low end to $110,000 on the high end, a more than seven-fold difference from lowest to highest.\u003c/p>\n\u003cp>“So we started asking ourselves,” Kathy Donneson, Chief of the CalPERS Heatlhy Plan Administration Division told me, “what are we getting from the $110,000 surgery that we couldn’t get from the $15,000 surgery?”\u003c/p>\n\u003cp>That’s when CalPERS turned to what’s called a “value based purchasing” approach for elective hip and knee replacements, starting with its non-Medicare population. CalPERS set a threshold price of $30,000 for the hospitalization and device charges for these operations. That $30,000 is slightly higher than the average price CalPERS had been paying for a hip or knee replacement. Anthem identified 46 hospitals across the state which would do these operations at the threshold price.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c!--more-->Those PPO members who chose a hospital above the threshold price had to pay the additional costs out of pocket.\u003c/p>\n\u003cp>CalPERS's Donneson said that quality was an important consideration. Only institutions that scored a certain rank on a quality scorecard were included.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This week CalPERS and \u003ca href=\"https://www.anthem.com/ca/health-insurance/about-us/pressreleasedetails/CA/2013/1356\" target=\"_blank\">Anthem released the analysis\u003c/a> showing that their expenses dropped from $35,408 to $28,695 for each knee or hip replacement surgery they covered. And they say that patients' out of pocket expenses didn't go up during this time period.\u003c/p>\n\u003cp>So if being aware of the costs of treatment and chosing the lower cost options without sacrificing quality worked for CalPERS, can it work for the general population as they strike out on their own to find a doctor for a given procedure?\u003c/p>\n\u003cp>There has been a tremendous surge in interest in this issue with new initiatives to get medical cost data online.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services \u003ca href=\"http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html\" target=\"_blank\">released their charges to hospitals\u003c/a> for common procedures in May. This followed an \u003ca href=\"http://healthland.time.com/why-medical-bills-are-killing-us/\" target=\"_blank\">in-depth article about dramatic differences in medical bills\u003c/a> that was published in Time magazine this March. And both for-profit websites like \u003ca href=\"https://www.healthcarebluebook.com/\" target=\"_blank\">Healthcare Blue Book\u003c/a> and not-for-proft ones like \u003ca href=\"http://www.fairhealthconsumer.org/\" target=\"_blank\">FAIR health\u003c/a> are giving people a benchmark for reasonable procedure rates.\u003c/p>\n\u003cp>In\u003ca href=\"http://www.ihealthbeat.org/special-reports/2013/federal-govt-private-groups-step-up-efforts-to-boost-online-health-care-cost-transparency.aspx\" target=\"_blank\"> a story for iHealthBeat,\u003c/a>I spoke with Victoria Bogatyrenko, the vice president of product and innovation at insurer United HealthCare. That company has been putting both cost and quality data for their providers online so that consumers can browse the options. Bogatyrenko says they'll be analyzing the data from the online tool at the end of the year and have a few questions in mind.\u003c/p>\n\u003cp>\"Of those people who used the tool, did they go to the physician for the service that they were looking for, that they estimated cost for in the tool?\" she asks. \"Did they switch from their longstanding doctor to a new provider who might have been more cost effective or who might be of higher quality?\"\u003c/p>\n\u003cp>Bogatyrenko says 84 percent of users in recent focus groups say they're very likely to access the data again. More striking, a third of those said using the tool changed their decision about their provider or treatment.\u003c/p>\n\u003cp>Still, recent testimony to \u003ca href=\"http://www.finance.senate.gov/hearings/hearing/?id=12b343eb-5056-a032-525a-bfdd0e908a37\" target=\"_blank\">a US Senate Committee on Finance hearing about medical bills\u003c/a> suggested cost transparency alone won't be enough to rein in the price of health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Steven Brill whose article in Time Magazine helped prompt the hearing told senators, \"While transparency starts the conversation about prices ... it's only a start.\"\u003c/p>\n\u003cdiv>UCLA's Health Policy Center director Jerry Kominski told me earlier this month that he is skeptical that cost data alone will drive health care costs down. But he says the more transparency there is, the less medical billing will feel like a \"mysterious and black box process.\"\u003c/div>\n\u003cdiv>\u003c/div>\n\u003cdiv>And Kominski says it is sure to achieve another important goal: Increasing consumers' confidence in how their health care dollars are being spent.\u003c/div>\n\n",
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"excerpt": "The largest public employees retirement system in the country - CalPERS - has plenty to gain from a drop in health care costs. After all, they cover 1.6 million employees, retirees and their families in California.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_4834\" class=\"wp-caption alignleft\" style=\"max-width: 342px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/04/06/insurance-commissioner-calls-aetna-rate-hike-unreasonable/aetnarate_images-money_apr62012/\" rel=\"attachment wp-att-4834\">\u003cimg class=\"size-medium wp-image-4834 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/04/AetnaRate_Images-Money_Apr62012-300x225.jpg\" alt=\"AetnaRate_Images Money_Apr62012\" width=\"342\" height=\"256\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(flickr: Images Money)\u003c/figcaption>\u003c/figure>\n\u003cp>The largest public employees retirement system in the country - CalPERS - has plenty to gain from a drop in health care costs. After all, they cover 1.6 million employees, retirees and their families in California.\u003c/p>\n\u003cp>Now they're saying, \u003ca href=\"http://www.nytimes.com/2013/06/24/health/employers-test-plan-to-cap-medical-spending.html?pagewanted=all\" target=\"_blank\">they found a way to decrease the amount they've spent on knee and hip replacements\u003c/a> by 19 percent in a year, which could have implications for other employer health plans.\u003c/p>\n\u003cp>Lisa Aliferis blogged about the CalPERS experiment in controlling costs right \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/04/27/steps-toward-lower-cost-higher-quality-health-care/\" target=\"_blank\">here on State of Health\u003c/a> about a year ago. Aliferis wrote that they decided to tackle costs around these two surgeries, which cost them $55 million dollars a year in 2008.\u003c/p>\n\u003cblockquote>\u003cp>Now, you might not think there would be much difference in the price for getting a knee or hip replacement across the state. But think again. CalPERS asked Anthem Blue Cross — which manages its PPO plans — to examine the range of prices for these operations in California.\u003c/p>\n\u003cp>Anthem came back with the startling information that CalPERS was paying $15,000 on the low end to $110,000 on the high end, a more than seven-fold difference from lowest to highest.\u003c/p>\n\u003cp>“So we started asking ourselves,” Kathy Donneson, Chief of the CalPERS Heatlhy Plan Administration Division told me, “what are we getting from the $110,000 surgery that we couldn’t get from the $15,000 surgery?”\u003c/p>\n\u003cp>That’s when CalPERS turned to what’s called a “value based purchasing” approach for elective hip and knee replacements, starting with its non-Medicare population. CalPERS set a threshold price of $30,000 for the hospitalization and device charges for these operations. That $30,000 is slightly higher than the average price CalPERS had been paying for a hip or knee replacement. Anthem identified 46 hospitals across the state which would do these operations at the threshold price.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c!--more-->Those PPO members who chose a hospital above the threshold price had to pay the additional costs out of pocket.\u003c/p>\n\u003cp>CalPERS's Donneson said that quality was an important consideration. Only institutions that scored a certain rank on a quality scorecard were included.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This week CalPERS and \u003ca href=\"https://www.anthem.com/ca/health-insurance/about-us/pressreleasedetails/CA/2013/1356\" target=\"_blank\">Anthem released the analysis\u003c/a> showing that their expenses dropped from $35,408 to $28,695 for each knee or hip replacement surgery they covered. And they say that patients' out of pocket expenses didn't go up during this time period.\u003c/p>\n\u003cp>So if being aware of the costs of treatment and chosing the lower cost options without sacrificing quality worked for CalPERS, can it work for the general population as they strike out on their own to find a doctor for a given procedure?\u003c/p>\n\u003cp>There has been a tremendous surge in interest in this issue with new initiatives to get medical cost data online.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services \u003ca href=\"http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html\" target=\"_blank\">released their charges to hospitals\u003c/a> for common procedures in May. This followed an \u003ca href=\"http://healthland.time.com/why-medical-bills-are-killing-us/\" target=\"_blank\">in-depth article about dramatic differences in medical bills\u003c/a> that was published in Time magazine this March. And both for-profit websites like \u003ca href=\"https://www.healthcarebluebook.com/\" target=\"_blank\">Healthcare Blue Book\u003c/a> and not-for-proft ones like \u003ca href=\"http://www.fairhealthconsumer.org/\" target=\"_blank\">FAIR health\u003c/a> are giving people a benchmark for reasonable procedure rates.\u003c/p>\n\u003cp>In\u003ca href=\"http://www.ihealthbeat.org/special-reports/2013/federal-govt-private-groups-step-up-efforts-to-boost-online-health-care-cost-transparency.aspx\" target=\"_blank\"> a story for iHealthBeat,\u003c/a>I spoke with Victoria Bogatyrenko, the vice president of product and innovation at insurer United HealthCare. That company has been putting both cost and quality data for their providers online so that consumers can browse the options. Bogatyrenko says they'll be analyzing the data from the online tool at the end of the year and have a few questions in mind.\u003c/p>\n\u003cp>\"Of those people who used the tool, did they go to the physician for the service that they were looking for, that they estimated cost for in the tool?\" she asks. \"Did they switch from their longstanding doctor to a new provider who might have been more cost effective or who might be of higher quality?\"\u003c/p>\n\u003cp>Bogatyrenko says 84 percent of users in recent focus groups say they're very likely to access the data again. More striking, a third of those said using the tool changed their decision about their provider or treatment.\u003c/p>\n\u003cp>Still, recent testimony to \u003ca href=\"http://www.finance.senate.gov/hearings/hearing/?id=12b343eb-5056-a032-525a-bfdd0e908a37\" target=\"_blank\">a US Senate Committee on Finance hearing about medical bills\u003c/a> suggested cost transparency alone won't be enough to rein in the price of health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Steven Brill whose article in Time Magazine helped prompt the hearing told senators, \"While transparency starts the conversation about prices ... it's only a start.\"\u003c/p>\n\u003cdiv>UCLA's Health Policy Center director Jerry Kominski told me earlier this month that he is skeptical that cost data alone will drive health care costs down. But he says the more transparency there is, the less medical billing will feel like a \"mysterious and black box process.\"\u003c/div>\n\u003cdiv>\u003c/div>\n\u003cdiv>And Kominski says it is sure to achieve another important goal: Increasing consumers' confidence in how their health care dollars are being spent.\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "LGBT Couples Face Ongoing Hurdles in Health Care Parity",
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"content": "\u003cfigure id=\"attachment_13391\" class=\"wp-caption alignleft\" style=\"max-width: 349px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/06/26/lgbt-couples-face-ongoing-hurdles-in-health-care-parity/marriage-ring-2/\" rel=\"attachment wp-att-13391\">\u003cimg class=\"size-medium wp-image-13391 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/marriage-ring-2-300x262.jpg\" alt=\"(Rachel Dornhelm/KQED)\" width=\"349\" height=\"304\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Rachel Dornhelm/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>The Supreme Court ruled today to repeal the Defense of Marriage Act (DOMA) and expand the legal definition of marriage. Married people enjoy a slew of federal benefits and in California, gay couples already enjoy many of those same rights. One problem, however, is that some LGBT couples have faced hurdles accessing a number of those privileges.\u003c/p>\n\u003cp>In January 2011, the Department of Health and Human Services adopted a \u003ca href=\"http://www.gpo.gov/fdsys/pkg/FR-2010-11-19/html/2010-29194.htm\" target=\"_blank\">policy\u003c/a> to address one important benefit that married couples already enjoyed: hospital visitation rights. Under that policy, people can choose practically any individual they would like to be at their hospital bedside, from a spouse to a partner to a friend. The policy is not specifically tailored to gays and lesbians; it applies to everyone.\u003c/p>\n\u003cp>Within the LGBT community in California, advocates say the visitation policy seems to be working well. There are far fewer people being denied the right to be with their loved ones in their time of need.\u003c/p>\n\u003cp>“I haven’t heard of anything in awhile in California,” said John Davidson of Lambda Legal, a civil rights advocacy group for lesbians and gay men. “A lot of hospitals have become more aware.”\u003c/p>\n\u003cp>But that's not the case everywhere – and that can make a difference when people are visiting other states.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Stories of discrimination in \u003ca href=\"http://articles.washingtonpost.com/2012-01-19/national/35439569_1_visitation-rights-visitation-policies-accreditation\" target=\"_blank\">Washington\u003c/a>, \u003ca href=\"http://thinkprogress.org/lgbt/2012/08/20/713251/nevada-same-sex-couple-denied-hospital-visitation-despite-domestic-partnership/?mobile=nc\" target=\"_blank\">Nevada\u003c/a>, and \u003ca href=\"http://www.rawstory.com/rs/2013/04/11/missouri-man-arrested-at-hospital-for-refusing-to-leave-gay-partner/\" target=\"_blank\">Missouri\u003c/a> have raised questions about how well hospitals are following these regulations, especially for the LGBT community. People have been barred from hospital rooms where their partners were dealing with serious medical issues. This despite the fact that they often had documents showing their legal partnerships.\u003c/p>\n\u003cp>“We do advise our members and people who come to us for advice to have legal documents that protect them, but [there are] these cases of hospitals ignoring it,” said Cindy Butler, executive director of Unmarried Equality, a Seattle-based advocacy organization for unmarried people.\u003c/p>\n\u003cp>Under the new visitation policy, hospitals that fail to respect a patient’s visitation wishes can get their Medicaid and Medicare funding pulled.\u003c/p>\n\u003cp>But the visitation policy doesn’t explicitly mention nursing homes or hospice facilities. While other long-standing rule give partners the right to visit, many have been turned away, according to Maya Rupert, with the National Center for Lesbian Rights.\u003c/p>\n\u003cp>“When we tell [the facilities] that is the rule we’ve gotten push back very often saying that the hospital visitation rule doesn’t apply,” said Rupert.\u003c/p>\n\u003cp>NCLR hopes to get the Department of Health and Human Services to reaffirm that policy.\u003c/p>\n\u003cp>“We’re talking about people in life and death situations, so we really can’t have someone call a lawyer to get in and see someone,” said Rupert. “We don’t have time for that.”\u003c/p>\n\u003cp>The 2011 rules also do not cover one key area: medical decision making for patients that are unconscious and unable to speak for themselves.\u003c/p>\n\u003cp>In California, hospitals are required by law to treat domestic partners the same as married people. But again, decision making becomes an issue when LGBT couples travel to states where their marriage or partnership isn’t recognized.\u003c/p>\n\u003cp>“What we keep seeing is that the partner claims they are the correct decision maker,\" says Rupert. But \"they’re not legally married in the state, and an estranged family member also claims they are the decision maker. In most states, the estranged family member is going to trump the partner.”\u003c/p>\n\u003cp>If an unconscious patient had not previously named someone to make medical decisions for them in a legal document, then each state will follow its own rules -- usually defaulting to the blood relatives.\u003c/p>\n\u003cp>One way around this confusion is for people to complete and carry what's called an \u003ca href=\"http://ag.ca.gov/consumers/pdf/ProbateCodeAdvancedHealthCareDirectiveForm-fillable.pdf\" target=\"_blank\">advance health care directive\u003c/a> form. You designate a specific person who can make decisions for you.\u003c/p>\n\u003cp>Today’s Supreme Court ruling does nothing to change the situation because each state determines who gets to make medical decisions. Advocates want a similar rule for medical decision making as was passed for visitation; a federal rule that would protect the rights of married, partnered, and single people alike whatever local law may be.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Update, July 2:\u003c/strong> The Centers for Medicare & Medicaid Services (CMS) have formally clarified their position on visitation rules at long-term care facilities, such as nursing homes and hospice centers. According to CMS, these facilities must give equal visitation rights to same-sex couples. As noted in our post, this has been a major point of confusion as some of these facilities believed they were exempt from the 2011 Hospital Visitation Rule. The new CMS memo makes the rule clear:\u003c/p>\n\u003cblockquote>\u003cp>“Residents must be notified of their rights to have visitors on a 24-hour basis, who could include, but are not limited to, spouses (including same-sex spouses), domestic partners (including same-sex domestic partners), other family members, or friends.”\u003c/p>\u003c/blockquote>\n\u003cdiv>\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_13391\" class=\"wp-caption alignleft\" style=\"max-width: 349px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/06/26/lgbt-couples-face-ongoing-hurdles-in-health-care-parity/marriage-ring-2/\" rel=\"attachment wp-att-13391\">\u003cimg class=\"size-medium wp-image-13391 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/marriage-ring-2-300x262.jpg\" alt=\"(Rachel Dornhelm/KQED)\" width=\"349\" height=\"304\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Rachel Dornhelm/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>The Supreme Court ruled today to repeal the Defense of Marriage Act (DOMA) and expand the legal definition of marriage. Married people enjoy a slew of federal benefits and in California, gay couples already enjoy many of those same rights. One problem, however, is that some LGBT couples have faced hurdles accessing a number of those privileges.\u003c/p>\n\u003cp>In January 2011, the Department of Health and Human Services adopted a \u003ca href=\"http://www.gpo.gov/fdsys/pkg/FR-2010-11-19/html/2010-29194.htm\" target=\"_blank\">policy\u003c/a> to address one important benefit that married couples already enjoyed: hospital visitation rights. Under that policy, people can choose practically any individual they would like to be at their hospital bedside, from a spouse to a partner to a friend. The policy is not specifically tailored to gays and lesbians; it applies to everyone.\u003c/p>\n\u003cp>Within the LGBT community in California, advocates say the visitation policy seems to be working well. There are far fewer people being denied the right to be with their loved ones in their time of need.\u003c/p>\n\u003cp>“I haven’t heard of anything in awhile in California,” said John Davidson of Lambda Legal, a civil rights advocacy group for lesbians and gay men. “A lot of hospitals have become more aware.”\u003c/p>\n\u003cp>But that's not the case everywhere – and that can make a difference when people are visiting other states.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Stories of discrimination in \u003ca href=\"http://articles.washingtonpost.com/2012-01-19/national/35439569_1_visitation-rights-visitation-policies-accreditation\" target=\"_blank\">Washington\u003c/a>, \u003ca href=\"http://thinkprogress.org/lgbt/2012/08/20/713251/nevada-same-sex-couple-denied-hospital-visitation-despite-domestic-partnership/?mobile=nc\" target=\"_blank\">Nevada\u003c/a>, and \u003ca href=\"http://www.rawstory.com/rs/2013/04/11/missouri-man-arrested-at-hospital-for-refusing-to-leave-gay-partner/\" target=\"_blank\">Missouri\u003c/a> have raised questions about how well hospitals are following these regulations, especially for the LGBT community. People have been barred from hospital rooms where their partners were dealing with serious medical issues. This despite the fact that they often had documents showing their legal partnerships.\u003c/p>\n\u003cp>“We do advise our members and people who come to us for advice to have legal documents that protect them, but [there are] these cases of hospitals ignoring it,” said Cindy Butler, executive director of Unmarried Equality, a Seattle-based advocacy organization for unmarried people.\u003c/p>\n\u003cp>Under the new visitation policy, hospitals that fail to respect a patient’s visitation wishes can get their Medicaid and Medicare funding pulled.\u003c/p>\n\u003cp>But the visitation policy doesn’t explicitly mention nursing homes or hospice facilities. While other long-standing rule give partners the right to visit, many have been turned away, according to Maya Rupert, with the National Center for Lesbian Rights.\u003c/p>\n\u003cp>“When we tell [the facilities] that is the rule we’ve gotten push back very often saying that the hospital visitation rule doesn’t apply,” said Rupert.\u003c/p>\n\u003cp>NCLR hopes to get the Department of Health and Human Services to reaffirm that policy.\u003c/p>\n\u003cp>“We’re talking about people in life and death situations, so we really can’t have someone call a lawyer to get in and see someone,” said Rupert. “We don’t have time for that.”\u003c/p>\n\u003cp>The 2011 rules also do not cover one key area: medical decision making for patients that are unconscious and unable to speak for themselves.\u003c/p>\n\u003cp>In California, hospitals are required by law to treat domestic partners the same as married people. But again, decision making becomes an issue when LGBT couples travel to states where their marriage or partnership isn’t recognized.\u003c/p>\n\u003cp>“What we keep seeing is that the partner claims they are the correct decision maker,\" says Rupert. But \"they’re not legally married in the state, and an estranged family member also claims they are the decision maker. In most states, the estranged family member is going to trump the partner.”\u003c/p>\n\u003cp>If an unconscious patient had not previously named someone to make medical decisions for them in a legal document, then each state will follow its own rules -- usually defaulting to the blood relatives.\u003c/p>\n\u003cp>One way around this confusion is for people to complete and carry what's called an \u003ca href=\"http://ag.ca.gov/consumers/pdf/ProbateCodeAdvancedHealthCareDirectiveForm-fillable.pdf\" target=\"_blank\">advance health care directive\u003c/a> form. You designate a specific person who can make decisions for you.\u003c/p>\n\u003cp>Today’s Supreme Court ruling does nothing to change the situation because each state determines who gets to make medical decisions. Advocates want a similar rule for medical decision making as was passed for visitation; a federal rule that would protect the rights of married, partnered, and single people alike whatever local law may be.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Update, July 2:\u003c/strong> The Centers for Medicare & Medicaid Services (CMS) have formally clarified their position on visitation rules at long-term care facilities, such as nursing homes and hospice centers. According to CMS, these facilities must give equal visitation rights to same-sex couples. As noted in our post, this has been a major point of confusion as some of these facilities believed they were exempt from the 2011 Hospital Visitation Rule. The new CMS memo makes the rule clear:\u003c/p>\n\u003cblockquote>\u003cp>“Residents must be notified of their rights to have visitors on a 24-hour basis, who could include, but are not limited to, spouses (including same-sex spouses), domestic partners (including same-sex domestic partners), other family members, or friends.”\u003c/p>\u003c/blockquote>\n\u003cdiv>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Low-income California Children Among Least Likely to Get Dental Care",
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"content": "\u003cfigure id=\"attachment_13396\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/06/25/low-income-california-children-among-least-likely-to-get-dental-care/kids-dentist/\" rel=\"attachment wp-att-13396\">\u003cimg class=\"size-medium wp-image-13396\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/Kids-dentist-300x275.jpg\" alt=\"Almost 60% of California children on Medi-Cal did not receive any dental care in 2011 (nmoira/flickr)\" width=\"300\" height=\"275\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Almost 60 percent of California children on Medi-Cal did not receive any dental care in 2011. (nmoira/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Young people who don't get the routine dental care they need find themselves at a disadvantage, studies have shown: not just in overall health but also in school performance.\u003c/p>\n\u003cp>Now a study from the Pew Charitable Trusts finds that California is among the 10 states where low-income children are least likely to receive dental care.\u003c/p>\n\u003cp>Almost 60 percent of children with Medi-Cal did not receive any dental care in 2011, said co-author Jane Koppelman.\u003c/p>\n\u003cp>\"What it means is that kids can have insurance, they can have (Medi-Cal), but it’s more like a hunting license than an entitlement,\" says Koppelman, research director for the Pew Children's Dental Campaign. \"It’s a license to try to find a dentist who can give you care. And in a lot of areas that is quite a trial.”\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Koppelman said there are a number of reasons why pediatric dentists who take Medi-Cal are few and far between. For one, some dentists don't want to deal with the hassle factor that comes with being involved in a paperwork-intensive public program. But Koppelman also points to low reimbursement rates.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Kids can have insurance, they can have (Medi-Cal), but it’s more like a hunting license than an entitlement. It’s a license to try to find a dentist who can give you care.\"\u003c/aside>\n\u003cp>Ellen Espejo, director of media and health policy at Children Now, agrees.\u003c/p>\n\u003cp>\"Given that California has one of the lowest reimbursement rates in its Medicaid program, it's unfortunately not surprising,\" said Espejo.\u003c/p>\n\u003cp>In fact, the portion of kids on Medi-Cal who weren't seen by a dentist in California increased between 2010 and 2011, from 57.7 percent to 58.6 percent.\u003c/p>\n\u003cp>\"This is definitely an ongoing problem with the threat to escalate,\" Espejo said. \"The budget before the governor now has a 10 percent reimbursement rate cut that would affect dentists.\"\u003c/p>\n\u003cp>The reimbursement cuts to Medi-Cal have been the subject of \u003ca href=\"http://blogs.sacbee.com/capitolalertlatest/2013/06/healthcare-coalition-rallies-against-medi-cal-cuts.html\" target=\"_blank\">protests in Sacramento by health professionals this month\u003c/a> as the budget inches closer to being signed by the governor.\u003c/p>\n\u003cp>There has been some good news for \u003cem>adults\u003c/em> using Denti-Cal, the dental arm of Medi-Cal. Non\u003ca href=\"http://www.californiahealthline.org/features/2013/medical-dental-coverage-partially-restored.aspx\" target=\"_blank\">emergency dentist benefits were partially reinstated\u003c/a> for the coming year after being cut out in 2009. But Espejo said for kids the issue is more than just coverage and having providers signed up. It's about having providers that are also able and willing to work with kids.\u003c/p>\n\u003cp>\"There are general dentists that accept Medi-Cal,\" Espejo said. \"But the issue from the children’s perspective is that these general dentists may not be well trained or staffed to see children.\"\u003c/p>\n\u003cp>Getting children in the door early is key to the long-term benefits of dental care, said Nadereh Pourat, a professor at the UCLA School of Public Health.\u003c/p>\n\u003cp>\"You want the kids to get early care to prevent cavities. They don’t get that and then they are set up for problems later on,” Pourat said.\u003c/p>\n\u003cp>Pourat said the fact that children are not being seen is all the more frustrating because it requires a relatively small outlay of money. ”When you talk about preventive care for children you’re talking about really inexpensive care ... sealants and fluoride, and about teaching them how to clean their teeth,” she says.\u003c/p>\n\u003cp>Pourat said there is also an element to the story that raises questions about the factors that are necessary to make sure people actually receive health care.\u003c/p>\n\u003cp>“Coverage is supposed to be the No. 1 facilitator to access and here are all these kids not getting access,” said Pourat.\u003c/p>\n\u003cp>The intersection between coverage and access is at the heart of the Affordable Care Act. Pew study author Koppelman said the lack of dental access for low-income California children is important to keep in mind as the state faces a time when expanded private insurance coverage could mean even more competition for pediatric dentistry resources.\u003c/p>\n\u003cp>\"The provider shortage is not a new story,\" Koppelman said. \"What’s new is that it’s not getting better, and it’s not getting better at a time when we’re going to see an influx of millions more children into the dental delivery care system.\"\u003c/p>\n\u003cp>The state's health exchange, Covered California, is scheduled to release information about pediatric dental plans today.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_13396\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/06/25/low-income-california-children-among-least-likely-to-get-dental-care/kids-dentist/\" rel=\"attachment wp-att-13396\">\u003cimg class=\"size-medium wp-image-13396\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/Kids-dentist-300x275.jpg\" alt=\"Almost 60% of California children on Medi-Cal did not receive any dental care in 2011 (nmoira/flickr)\" width=\"300\" height=\"275\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Almost 60 percent of California children on Medi-Cal did not receive any dental care in 2011. (nmoira/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Young people who don't get the routine dental care they need find themselves at a disadvantage, studies have shown: not just in overall health but also in school performance.\u003c/p>\n\u003cp>Now a study from the Pew Charitable Trusts finds that California is among the 10 states where low-income children are least likely to receive dental care.\u003c/p>\n\u003cp>Almost 60 percent of children with Medi-Cal did not receive any dental care in 2011, said co-author Jane Koppelman.\u003c/p>\n\u003cp>\"What it means is that kids can have insurance, they can have (Medi-Cal), but it’s more like a hunting license than an entitlement,\" says Koppelman, research director for the Pew Children's Dental Campaign. \"It’s a license to try to find a dentist who can give you care. And in a lot of areas that is quite a trial.”\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Koppelman said there are a number of reasons why pediatric dentists who take Medi-Cal are few and far between. For one, some dentists don't want to deal with the hassle factor that comes with being involved in a paperwork-intensive public program. But Koppelman also points to low reimbursement rates.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Kids can have insurance, they can have (Medi-Cal), but it’s more like a hunting license than an entitlement. It’s a license to try to find a dentist who can give you care.\"\u003c/aside>\n\u003cp>Ellen Espejo, director of media and health policy at Children Now, agrees.\u003c/p>\n\u003cp>\"Given that California has one of the lowest reimbursement rates in its Medicaid program, it's unfortunately not surprising,\" said Espejo.\u003c/p>\n\u003cp>In fact, the portion of kids on Medi-Cal who weren't seen by a dentist in California increased between 2010 and 2011, from 57.7 percent to 58.6 percent.\u003c/p>\n\u003cp>\"This is definitely an ongoing problem with the threat to escalate,\" Espejo said. \"The budget before the governor now has a 10 percent reimbursement rate cut that would affect dentists.\"\u003c/p>\n\u003cp>The reimbursement cuts to Medi-Cal have been the subject of \u003ca href=\"http://blogs.sacbee.com/capitolalertlatest/2013/06/healthcare-coalition-rallies-against-medi-cal-cuts.html\" target=\"_blank\">protests in Sacramento by health professionals this month\u003c/a> as the budget inches closer to being signed by the governor.\u003c/p>\n\u003cp>There has been some good news for \u003cem>adults\u003c/em> using Denti-Cal, the dental arm of Medi-Cal. Non\u003ca href=\"http://www.californiahealthline.org/features/2013/medical-dental-coverage-partially-restored.aspx\" target=\"_blank\">emergency dentist benefits were partially reinstated\u003c/a> for the coming year after being cut out in 2009. But Espejo said for kids the issue is more than just coverage and having providers signed up. It's about having providers that are also able and willing to work with kids.\u003c/p>\n\u003cp>\"There are general dentists that accept Medi-Cal,\" Espejo said. \"But the issue from the children’s perspective is that these general dentists may not be well trained or staffed to see children.\"\u003c/p>\n\u003cp>Getting children in the door early is key to the long-term benefits of dental care, said Nadereh Pourat, a professor at the UCLA School of Public Health.\u003c/p>\n\u003cp>\"You want the kids to get early care to prevent cavities. They don’t get that and then they are set up for problems later on,” Pourat said.\u003c/p>\n\u003cp>Pourat said the fact that children are not being seen is all the more frustrating because it requires a relatively small outlay of money. ”When you talk about preventive care for children you’re talking about really inexpensive care ... sealants and fluoride, and about teaching them how to clean their teeth,” she says.\u003c/p>\n\u003cp>Pourat said there is also an element to the story that raises questions about the factors that are necessary to make sure people actually receive health care.\u003c/p>\n\u003cp>“Coverage is supposed to be the No. 1 facilitator to access and here are all these kids not getting access,” said Pourat.\u003c/p>\n\u003cp>The intersection between coverage and access is at the heart of the Affordable Care Act. Pew study author Koppelman said the lack of dental access for low-income California children is important to keep in mind as the state faces a time when expanded private insurance coverage could mean even more competition for pediatric dentistry resources.\u003c/p>\n\u003cp>\"The provider shortage is not a new story,\" Koppelman said. \"What’s new is that it’s not getting better, and it’s not getting better at a time when we’re going to see an influx of millions more children into the dental delivery care system.\"\u003c/p>\n\u003cp>The state's health exchange, Covered California, is scheduled to release information about pediatric dental plans today.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Despite Promises, Key Autism Therapy Cut from Medi-Cal",
"title": "Despite Promises, Key Autism Therapy Cut from Medi-Cal",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>By Ryder Diaz, KQED\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_13282\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"size-medium wp-image-13282\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/166731138-300x225.jpg\" alt=\"(Getty Images)\" width=\"300\" height=\"225\">\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>If you don't have a child with autism, you might not know about Applied Behavioral Analysis. ABA is widely regarded as a necessary and effective treatment.\u003c/p>\n\u003cp>Now many poor children will lose access to this therapy under deals reached in Sacramento last week. Meanwhile, other kids -- including those who become insured under the state's new Obamacare marketplace -- may well continue to have access to this therapy.\u003c/p>\n\u003cp>Here's the background: under the Affordable Care Act, states can expand Medicaid, called Medi-Cal in California. People with incomes up to 138 percent of poverty will be eligible. Last week, as the legislature and the administration were wrapping up the state's budget, the legislature was simultaneously moving forward on final bills to implement the Medi-Cal expansion.\u003c/p>\n\u003cp>Last Friday, after months of debate, legislators sent two final bills to the governor's desk to approve the expansion. But for supporters of the expansion, this victory came at the cost -- ABA therapy for kids on Medi-Cal was axed. Children's advocates are frustrated.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“With ABA services not covered in Medi-Cal, it essentially means that low-income children are not provided the same comprehensive level of mental health benefits that we’ve mandated private plans cover,” said Mike Odeh, senior health policy associate at Children Now, an advocacy group based in Oakland.\u003c/p>\n\u003cp>Private insurers are currently required to cover ABA therapy under a law signed in 2011. But that law is scheduled to sunset in 2014. In an odd turn of fate, as legislators nixed ABA coverage for Medi-Cal last week they simultaneously \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/6/good-policy-news-for-autistic-kids.aspx\" target=\"_blank\">moved a bill forward\u003c/a> that would extend the mandate for private plans to continue to cover ABA therapy.\u003c/p>\n\u003cp>In short, if your children are on Medi-Cal, they will lose access to ABA while children receiving private insurance will apparently retain it -- until 2019, if the \u003ca href=\"http://www.legtrack.com/bill.html?bill=201320140SB126\" target=\"_blank\">proposed bill\u003c/a> passes.\u003c/p>\n\u003cp>Families who had been receiving insurance through Healthy Families, California's low-cost insurance specifically for children and pregnant women, have been fighting hard to keep access to ABA. Last fall, the state passed an emergency measure to provide ABA to children enrolled in the insurance program. When the state began moving Healthy Families children to Medi-Cal earlier this year, families were promised that benefits would be the same. Yet, some 500 children have lost or will soon lose their ABA benefits.\u003c/p>\n\u003cp>The emergency legislation “specifically documented that these children would likely face irreparable harm if they did not receive this treatment,” said Kristin Jacobson, President and Co-Founder of Autism Deserves Equal Coverage.\u003c/p>\n\u003cp>Families and advocates have been pushing the state to continue to cover this intensive therapy, which they say is necessary for many autistic children to build important developmental and social skills.\u003c/p>\n\u003cp>Without ABA “not only are you condemning [children] to a life where they are unable to function in society, you’re also burdening society with their care for their lifetime,” said Jacobson. She said the legislators' move to take ABA coverage out of last week’s bills was “completely perplexing” and “inexplicable.”\u003c/p>\n\u003cp>Parents like Rachel Harris feel betrayed. Harris was told that her son’s treatments would continue despite the switch from Healthy Families to Medi-Cal. Harris’s 4-year-old son, Daniel, had just started receiving ABA for autism that he was diagnosed with at age 3.\u003c/p>\n\u003cp>In the short time Daniel had been receiving the therapy, he was already making big gains: making eye contact with people, asking questions, and he ran off less.\u003c/p>\n\u003cp>But when Daniel was moved to Medi-Cal on April 1, his ABA treatments ended. Harris said Daniel has begun to go backwards, biting his brother, climbing on top of the refrigerator and running off into a parking lot.\u003c/p>\n\u003cp>“I am trying to tend to my son and help him cope day to day,” Harris said in a press release. “It is nearly impossible without the ABA therapy on which we depended. We are devastated that the State has broken its promises to our son and our family.”\u003c/p>\n\u003cp>Half of the children enrolled in Healthy Families have already been switched over to Medi-Cal with the rest moving over in the coming months. With larger numbers of families expected to sign up for Medi-Cal later this year, more children with autism will not be able to access the care that they need.\u003c/p>\n\u003cp>Advocates are hoping to work with the legislature to get the therapy covered.\u003c/p>\n\u003cp>“There’s some urgency to it,” said Mike Odeh. “Some children that have already transitioned to Medi-Cal have lost those services but there’s still more transitions to come.”\u003c/p>\n\u003cp>At the state capital, Sen. Darrell Steinberg, (D-Sacramento), who has been pushing for autism coverage in both private insurance and Medi-Cal, said he will keep trying.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Unfortunately, this year, there simply wasn't enough room in the budget to fund ABA therapy in Medi-Cal for kids with autism spectrum disorder. I will not give up the fight, however,” Steinberg told \u003ca href=\"http://www.californiahealthline.org/features/2013/california-budget-puts-some-health-care-issues-on-hold.aspx#ixzz2WUpCVTex\" target=\"_blank\">California Healthline\u003c/a>. “It's at the top of my list to get done next year.\"\u003c/p>\n\n",
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"excerpt": "If you don't have a child with autism, you might not know about Applied Behavioral Analysis. ABA is widely regarded as a necessary and effective treatment.\r\n\r\nNow many poor children will lose access to this therapy under deals reached in Sacramento last week. Meanwhile, other kids -- including those who become insured under the state's new Obamacare marketplace -- may well continue to have access to this therapy. \r\n\r\nHere's the background: under the Affordable Care Act, states can expand Medicaid, called Medi-Cal in California. People will incomes up to 138 percent of poverty will be eligible. Last week, as the legislature and the administration were wrapping up the state's budget, the legislature was simultaneously moving forward on final bills to implement the Medi-Cal expansion.",
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"description": "If you don't have a child with autism, you might not know about Applied Behavioral Analysis. ABA is widely regarded as a necessary and effective treatment.\r\n\r\nNow many poor children will lose access to this therapy under deals reached in Sacramento last week. Meanwhile, other kids -- including those who become insured under the state's new Obamacare marketplace -- may well continue to have access to this therapy. \r\n\r\nHere's the background: under the Affordable Care Act, states can expand Medicaid, called Medi-Cal in California. People will incomes up to 138 percent of poverty will be eligible. Last week, as the legislature and the administration were wrapping up the state's budget, the legislature was simultaneously moving forward on final bills to implement the Medi-Cal expansion.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Ryder Diaz, KQED\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_13282\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"size-medium wp-image-13282\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/166731138-300x225.jpg\" alt=\"(Getty Images)\" width=\"300\" height=\"225\">\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>If you don't have a child with autism, you might not know about Applied Behavioral Analysis. ABA is widely regarded as a necessary and effective treatment.\u003c/p>\n\u003cp>Now many poor children will lose access to this therapy under deals reached in Sacramento last week. Meanwhile, other kids -- including those who become insured under the state's new Obamacare marketplace -- may well continue to have access to this therapy.\u003c/p>\n\u003cp>Here's the background: under the Affordable Care Act, states can expand Medicaid, called Medi-Cal in California. People with incomes up to 138 percent of poverty will be eligible. Last week, as the legislature and the administration were wrapping up the state's budget, the legislature was simultaneously moving forward on final bills to implement the Medi-Cal expansion.\u003c/p>\n\u003cp>Last Friday, after months of debate, legislators sent two final bills to the governor's desk to approve the expansion. But for supporters of the expansion, this victory came at the cost -- ABA therapy for kids on Medi-Cal was axed. Children's advocates are frustrated.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“With ABA services not covered in Medi-Cal, it essentially means that low-income children are not provided the same comprehensive level of mental health benefits that we’ve mandated private plans cover,” said Mike Odeh, senior health policy associate at Children Now, an advocacy group based in Oakland.\u003c/p>\n\u003cp>Private insurers are currently required to cover ABA therapy under a law signed in 2011. But that law is scheduled to sunset in 2014. In an odd turn of fate, as legislators nixed ABA coverage for Medi-Cal last week they simultaneously \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/6/good-policy-news-for-autistic-kids.aspx\" target=\"_blank\">moved a bill forward\u003c/a> that would extend the mandate for private plans to continue to cover ABA therapy.\u003c/p>\n\u003cp>In short, if your children are on Medi-Cal, they will lose access to ABA while children receiving private insurance will apparently retain it -- until 2019, if the \u003ca href=\"http://www.legtrack.com/bill.html?bill=201320140SB126\" target=\"_blank\">proposed bill\u003c/a> passes.\u003c/p>\n\u003cp>Families who had been receiving insurance through Healthy Families, California's low-cost insurance specifically for children and pregnant women, have been fighting hard to keep access to ABA. Last fall, the state passed an emergency measure to provide ABA to children enrolled in the insurance program. When the state began moving Healthy Families children to Medi-Cal earlier this year, families were promised that benefits would be the same. Yet, some 500 children have lost or will soon lose their ABA benefits.\u003c/p>\n\u003cp>The emergency legislation “specifically documented that these children would likely face irreparable harm if they did not receive this treatment,” said Kristin Jacobson, President and Co-Founder of Autism Deserves Equal Coverage.\u003c/p>\n\u003cp>Families and advocates have been pushing the state to continue to cover this intensive therapy, which they say is necessary for many autistic children to build important developmental and social skills.\u003c/p>\n\u003cp>Without ABA “not only are you condemning [children] to a life where they are unable to function in society, you’re also burdening society with their care for their lifetime,” said Jacobson. She said the legislators' move to take ABA coverage out of last week’s bills was “completely perplexing” and “inexplicable.”\u003c/p>\n\u003cp>Parents like Rachel Harris feel betrayed. Harris was told that her son’s treatments would continue despite the switch from Healthy Families to Medi-Cal. Harris’s 4-year-old son, Daniel, had just started receiving ABA for autism that he was diagnosed with at age 3.\u003c/p>\n\u003cp>In the short time Daniel had been receiving the therapy, he was already making big gains: making eye contact with people, asking questions, and he ran off less.\u003c/p>\n\u003cp>But when Daniel was moved to Medi-Cal on April 1, his ABA treatments ended. Harris said Daniel has begun to go backwards, biting his brother, climbing on top of the refrigerator and running off into a parking lot.\u003c/p>\n\u003cp>“I am trying to tend to my son and help him cope day to day,” Harris said in a press release. “It is nearly impossible without the ABA therapy on which we depended. We are devastated that the State has broken its promises to our son and our family.”\u003c/p>\n\u003cp>Half of the children enrolled in Healthy Families have already been switched over to Medi-Cal with the rest moving over in the coming months. With larger numbers of families expected to sign up for Medi-Cal later this year, more children with autism will not be able to access the care that they need.\u003c/p>\n\u003cp>Advocates are hoping to work with the legislature to get the therapy covered.\u003c/p>\n\u003cp>“There’s some urgency to it,” said Mike Odeh. “Some children that have already transitioned to Medi-Cal have lost those services but there’s still more transitions to come.”\u003c/p>\n\u003cp>At the state capital, Sen. Darrell Steinberg, (D-Sacramento), who has been pushing for autism coverage in both private insurance and Medi-Cal, said he will keep trying.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Unfortunately, this year, there simply wasn't enough room in the budget to fund ABA therapy in Medi-Cal for kids with autism spectrum disorder. I will not give up the fight, however,” Steinberg told \u003ca href=\"http://www.californiahealthline.org/features/2013/california-budget-puts-some-health-care-issues-on-hold.aspx#ixzz2WUpCVTex\" target=\"_blank\">California Healthline\u003c/a>. “It's at the top of my list to get done next year.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Francisco Breast Cancer Advocates Jubilant Over Supreme Court Human Genes Ruling",
"title": "San Francisco Breast Cancer Advocates Jubilant Over Supreme Court Human Genes Ruling",
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"content": "\u003cfigure id=\"attachment_13262\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-13262\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/RS5070_81147632-scr-620x377.jpg\" alt=\"(William West/AFP/Getty Images)\" width=\"620\" height=\"377\">\u003cfigcaption class=\"wp-caption-text\">(William West/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>In a unanimous decision, the U.S. Supreme Court ruled Thursday morning that \u003ca href=\"http://ww2.kqed.org/news/2013/06/13/supreme-court-rules-human-genes-cannot-be-patented/\" target=\"_blank\">human genes are not patentable\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://science.kqed.org/quest/audio/bay-area-biotech-industry-braces-for-gene-patenting-court-case/\" target=\"_blank\">The case \u003c/a>centered around Myriad Genetics, the holder of patents on two genes, BRCA1 and BRCA2. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/12/breast-cancer-gene-mutations-at-heart-of-supreme-court-case/\" target=\"_blank\">Some mutations of these genes\u003c/a> are associated with an increased risk of breast and ovarian cancer. For women with a strong family history of these cancers, the only place they could be tested was Myriad Genetics, which sometimes charged more than $3,000 for the test.\u003c/p>\n\u003cp>Breast Cancer Action, an advocacy group based in San Francisco, was a plaintiff in the case, and executive director Karuna Jaggar sounded jubilant in a phone call Thursday morning.\u003c/p>\n\u003cp>\"From our perspective, these patents never should have been granted in the first place,\" Jaggar said. \"There's no question that DNA is a product of nature, and so it's very affirming to see the court rule in our favor.\"\u003c/p>\n\u003cp>BRCA1 and 2 mutations became international news when actress \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/14/why-angelina-jolies-medical-choice-is-likely-not-yours/\" target=\"_blank\">Angelina Jolie\u003c/a> revealed that she'd had a preventive double mastectomy after testing showed that she had a specific mutation that put her at very high risk of developing breast cancer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Breast Cancer Action has long argued against the high cost of the test, and said that the patent gave an unfair monopoly to Myriad Genetics, which is located in Salt Lake City. With the court's ruling, Jaggar believes that more companies will be able to offer a test to women.\u003c/p>\n\u003cp>\"They'll have access to new tests at lower costs and will have access to second opinions,\" Jaggar said. \"Currently Myriad offers the one and only test. It has not been peer reviewed; it has not been scientifically validated. New labs will now be able to offer new tests using new methodologies.\"\u003c/p>\n\u003cp>In a statement Myriad Genetics played down the magnitude of the decision, pointing to its 500 other valid patent claims as well as the BRCA test. The court upheld patent claims on what's known as synthetic DNA or \"cDNA.\" Synthetic DNA is man-made, not a \"product of nature,\" and is still patentable.\u003c/p>\n\u003cp>\"We believe the Court appropriately upheld our claims on cDNA,\" Myriad's CEO Peter Meldrum said in a release, \"ensuring strong intellectual property protection for our BRACAnalysis test moving forward.\"\u003c/p>\n\u003cp>But Breast Cancer Action insists the Supreme Court's decision opens the door to new options for women who worry about inherited risk of breast cancer. “Laboratories can conduct genetic testing without using cDNA and this means that Myriad no longer holds a monopoly on the BRCA genes,\" Jaggar said in a release this morning.\u003c/p>\n\u003cp>Roughly 5 to 10 percent of women carry a BRCA1 or 2 mutation, according to the National Cancer Institute. Not all mutations are harmful, but some can be devastating. Angelina Jolie said that she had a mutation that put her at an 87 percent risk of breast cancer.\u003c/p>\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://www.supremecourt.gov/opinions/12pdf/12-398_8njq.pdf\" target=\"_blank\">Read the decision: Association for Molecular Pathology v. Myriad Genetics, Inc.\u003c/a>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "In a unanimous decision, the Supreme Court ruled Thursday morning that human genes are not patentable.\r\n\r\nThe case centered around Myriad Genetics, the holder of patents on two genes, BRCA 1 and BRCA 2. Some mutations of these genes are associated with an increased risk of breast and ovarian cancer. For women with a strong family history of these cancers, the only place they could be tested was Myriad Genetics, which sometimes charged more than $3,000 for the test.\r\n\r\nBreast Cancer Action, an advocacy group based in San Francisco, was a plaintiff in the case and executive director Karuna Jagger sounded jubilant in a phone call Thursday morning.",
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"description": "In a unanimous decision, the Supreme Court ruled Thursday morning that human genes are not patentable.\r\n\r\nThe case centered around Myriad Genetics, the holder of patents on two genes, BRCA 1 and BRCA 2. Some mutations of these genes are associated with an increased risk of breast and ovarian cancer. For women with a strong family history of these cancers, the only place they could be tested was Myriad Genetics, which sometimes charged more than $3,000 for the test.\r\n\r\nBreast Cancer Action, an advocacy group based in San Francisco, was a plaintiff in the case and executive director Karuna Jagger sounded jubilant in a phone call Thursday morning.",
"title": "San Francisco Breast Cancer Advocates Jubilant Over Supreme Court Human Genes Ruling | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_13262\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-13262\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/RS5070_81147632-scr-620x377.jpg\" alt=\"(William West/AFP/Getty Images)\" width=\"620\" height=\"377\">\u003cfigcaption class=\"wp-caption-text\">(William West/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>In a unanimous decision, the U.S. Supreme Court ruled Thursday morning that \u003ca href=\"http://ww2.kqed.org/news/2013/06/13/supreme-court-rules-human-genes-cannot-be-patented/\" target=\"_blank\">human genes are not patentable\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://science.kqed.org/quest/audio/bay-area-biotech-industry-braces-for-gene-patenting-court-case/\" target=\"_blank\">The case \u003c/a>centered around Myriad Genetics, the holder of patents on two genes, BRCA1 and BRCA2. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/12/breast-cancer-gene-mutations-at-heart-of-supreme-court-case/\" target=\"_blank\">Some mutations of these genes\u003c/a> are associated with an increased risk of breast and ovarian cancer. For women with a strong family history of these cancers, the only place they could be tested was Myriad Genetics, which sometimes charged more than $3,000 for the test.\u003c/p>\n\u003cp>Breast Cancer Action, an advocacy group based in San Francisco, was a plaintiff in the case, and executive director Karuna Jaggar sounded jubilant in a phone call Thursday morning.\u003c/p>\n\u003cp>\"From our perspective, these patents never should have been granted in the first place,\" Jaggar said. \"There's no question that DNA is a product of nature, and so it's very affirming to see the court rule in our favor.\"\u003c/p>\n\u003cp>BRCA1 and 2 mutations became international news when actress \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/14/why-angelina-jolies-medical-choice-is-likely-not-yours/\" target=\"_blank\">Angelina Jolie\u003c/a> revealed that she'd had a preventive double mastectomy after testing showed that she had a specific mutation that put her at very high risk of developing breast cancer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>Breast Cancer Action has long argued against the high cost of the test, and said that the patent gave an unfair monopoly to Myriad Genetics, which is located in Salt Lake City. With the court's ruling, Jaggar believes that more companies will be able to offer a test to women.\u003c/p>\n\u003cp>\"They'll have access to new tests at lower costs and will have access to second opinions,\" Jaggar said. \"Currently Myriad offers the one and only test. It has not been peer reviewed; it has not been scientifically validated. New labs will now be able to offer new tests using new methodologies.\"\u003c/p>\n\u003cp>In a statement Myriad Genetics played down the magnitude of the decision, pointing to its 500 other valid patent claims as well as the BRCA test. The court upheld patent claims on what's known as synthetic DNA or \"cDNA.\" Synthetic DNA is man-made, not a \"product of nature,\" and is still patentable.\u003c/p>\n\u003cp>\"We believe the Court appropriately upheld our claims on cDNA,\" Myriad's CEO Peter Meldrum said in a release, \"ensuring strong intellectual property protection for our BRACAnalysis test moving forward.\"\u003c/p>\n\u003cp>But Breast Cancer Action insists the Supreme Court's decision opens the door to new options for women who worry about inherited risk of breast cancer. “Laboratories can conduct genetic testing without using cDNA and this means that Myriad no longer holds a monopoly on the BRCA genes,\" Jaggar said in a release this morning.\u003c/p>\n\u003cp>Roughly 5 to 10 percent of women carry a BRCA1 or 2 mutation, according to the National Cancer Institute. Not all mutations are harmful, but some can be devastating. Angelina Jolie said that she had a mutation that put her at an 87 percent risk of breast cancer.\u003c/p>\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://www.supremecourt.gov/opinions/12pdf/12-398_8njq.pdf\" target=\"_blank\">Read the decision: Association for Molecular Pathology v. Myriad Genetics, Inc.\u003c/a>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_9250\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"size-medium wp-image-9250\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>After years of devastating cuts to the health and human services budget, this year's \u003ca href=\"http://ww2.kqed.org/news/2013/06/11/California_budget\" target=\"_blank\">small surplus \u003c/a>brought restoration of some programs.\u003c/p>\n\u003cp>Mental health programs will get a one-time boost of $140 million. The adult dental program, Denti-Cal, cut back in 2009 and leaving tooth extraction as just about the only service being covered, has been restored, albeit partially. Benefits won't start until next May.\u003c/p>\n\u003cp>But lost in the deal was a proposal to provide some therapies to 500 children with autism. Those children had lost some services when the state moved them from Healthy Families and to Medi-Cal.\u003c/p>\n\u003cp>Then there's the issue of funding to county health programs. Counties bear the cost for providing health care to the uninsured. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/11/state-vs-county-showdown-over-funding-the-medi-cal-expansion/\" target=\"_blank\">Gov. Brown has been arguing\u003c/a> since he introduced his budget in January that counties will gain federal money in January under the full implementation of the Affordable Care Act and so the state could reduce its own health funding to counties. But counties have fought that idea, saying that there would still be plenty of uninsured people after Jan. 1 -- and that now is not the time to cut the safety net.\u003c!--more-->\u003c/p>\n\u003cp>While we're still waiting for final language, the legislature seems to have agreed with the governor's numbers, and it appears $300 million in \u003ca href=\"http://www.icontact-archive.com/C0nDqAgSsbNcyiNcayrpmhiipuXa1F1o?w=3\" target=\"_blank\">county health funding cuts \u003c/a>are coming.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Alex Briscoe, Director of Alameda County’s Health Care Services Agency, called it a \"money grab\" that will \"threaten the stability of local safety nets.\"\u003c/p>\n\u003cp>Briscoe says the cuts presume that safety net providers are adequately funded right now, a presumption he called \"offensive.\"\u003c/p>\n\u003cp>\"The state has overestimated savings it will achieve, underestimated the burden of the residually uninsured and put forward a proposal that is divorced form the reality of local safety nets,\" he said.\u003c/p>\n\u003cp>The budget deal also leaves in place a 10 percent cut in Medi-Cal provider rates -- cuts that were approved by the legislature in 2011 and then held up in a long court challenge.\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/25/appeal-denied-medi-cal-rate-cuts-poised-to-move-forward/\" target=\"_blank\"> The appeals process\u003c/a> was exhausted last month, and the cuts will likely move forward this summer.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California has some of the lowest Medicaid reimbursement rates in the nation, advocates say.\u003c/p>\n\n",
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"excerpt": "After years of devastating cuts to the health and human services budget, this year's small surplus brought restoration of some programs.\r\n\r\nMental health programs will get a one-time boost of $140 million. The adult dental program, Denti-Cal, cut back in 2009 and leaving tooth extraction as just about the only service being covered, has been restored, albeit partially. Benefits won't start until next May.",
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"description": "After years of devastating cuts to the health and human services budget, this year's small surplus brought restoration of some programs.\r\n\r\nMental health programs will get a one-time boost of $140 million. The adult dental program, Denti-Cal, cut back in 2009 and leaving tooth extraction as just about the only service being covered, has been restored, albeit partially. Benefits won't start until next May.",
"title": "Budget Deal Restores Some Health Programs -- While Slashing Others | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_9250\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"size-medium wp-image-9250\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003cfigcaption class=\"wp-caption-text\">(seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>After years of devastating cuts to the health and human services budget, this year's \u003ca href=\"http://ww2.kqed.org/news/2013/06/11/California_budget\" target=\"_blank\">small surplus \u003c/a>brought restoration of some programs.\u003c/p>\n\u003cp>Mental health programs will get a one-time boost of $140 million. The adult dental program, Denti-Cal, cut back in 2009 and leaving tooth extraction as just about the only service being covered, has been restored, albeit partially. Benefits won't start until next May.\u003c/p>\n\u003cp>But lost in the deal was a proposal to provide some therapies to 500 children with autism. Those children had lost some services when the state moved them from Healthy Families and to Medi-Cal.\u003c/p>\n\u003cp>Then there's the issue of funding to county health programs. Counties bear the cost for providing health care to the uninsured. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/01/11/state-vs-county-showdown-over-funding-the-medi-cal-expansion/\" target=\"_blank\">Gov. Brown has been arguing\u003c/a> since he introduced his budget in January that counties will gain federal money in January under the full implementation of the Affordable Care Act and so the state could reduce its own health funding to counties. But counties have fought that idea, saying that there would still be plenty of uninsured people after Jan. 1 -- and that now is not the time to cut the safety net.\u003c!--more-->\u003c/p>\n\u003cp>While we're still waiting for final language, the legislature seems to have agreed with the governor's numbers, and it appears $300 million in \u003ca href=\"http://www.icontact-archive.com/C0nDqAgSsbNcyiNcayrpmhiipuXa1F1o?w=3\" target=\"_blank\">county health funding cuts \u003c/a>are coming.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Alex Briscoe, Director of Alameda County’s Health Care Services Agency, called it a \"money grab\" that will \"threaten the stability of local safety nets.\"\u003c/p>\n\u003cp>Briscoe says the cuts presume that safety net providers are adequately funded right now, a presumption he called \"offensive.\"\u003c/p>\n\u003cp>\"The state has overestimated savings it will achieve, underestimated the burden of the residually uninsured and put forward a proposal that is divorced form the reality of local safety nets,\" he said.\u003c/p>\n\u003cp>The budget deal also leaves in place a 10 percent cut in Medi-Cal provider rates -- cuts that were approved by the legislature in 2011 and then held up in a long court challenge.\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/25/appeal-denied-medi-cal-rate-cuts-poised-to-move-forward/\" target=\"_blank\"> The appeals process\u003c/a> was exhausted last month, and the cuts will likely move forward this summer.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California has some of the lowest Medicaid reimbursement rates in the nation, advocates say.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Thousands Expected for Rally to Block Medi-Cal Rate Cuts ",
"title": "Thousands Expected for Rally to Block Medi-Cal Rate Cuts ",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>By David Gorn,\u003c/strong> \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/6/massive-rally-set-to-protest-provider-cuts.aspx#ixzz2VGabz8tK\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_9250\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"size-medium wp-image-9250 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003cfigcaption class=\"wp-caption-text\">Protesters are calling on the governor to restore $1 billion in health care funding. (seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Thousands of doctors, dentists, patients, health care professionals and other protesters are expected to \u003ca href=\"http://www.cmanet.org/we-care-for-california\" target=\"_blank\">gather Tuesday\u003c/a> outside the Capitol Building to support the idea of reversing a 10 percent Medi-Cal provider rate cut. Organizers say it will be the largest health care protest in Sacramento history.\u003c/p>\n\u003cp>\"We have people hopping on buses in Oceanside at 4 in the morning to get here,\" said Molly Weedn, director of media relations for the California Medical Association. \"People are coming from all over the state, and we've seen support from both sides in the Legislature. All of this [support] shows that the public doesn't want Medi-Cal to be cut, so that's why we're doing this.\"\u003c/p>\n\u003cp>It has been a tough couple of weeks for proponents of reversing the rate cut made in 2011 and not yet implemented because of court battles.\u003c/p>\n\u003cp>On May 24, the Ninth Circuit federal appeals court\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/25/appeal-denied-medi-cal-rate-cuts-poised-to-move-forward/\" target=\"_blank\"> ruled the Medi-Cal cut to be legal\u003c/a>, and lifted the injunctions on its implementation. That means the lawsuits to reverse the reduction now have only legal recourse, and that's an appeal to the U.S. Supreme Court.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Two bills moving through the legislature are seeking to stop the cuts.\u003c/p>\n\u003cp>The day before the court ruled, a bill to reverse the Medi-Cal reduction, \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0601-0650/sb_640_bill_20130501_amended_sen_v96.pdf\">SB 640\u003c/a> was put on suspense file in the Senate Committee on Appropriations. Until that day, the bill had bipartisan, unanimous support in committee voting.\u003c/p>\n\u003cp>The companion piece of legislation to SB 640 was \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/asm/ab_0851-0900/ab_900_bill_20130419_amended_asm_v98.pdf\" target=\"_blank\">AB 900\u003c/a>. It passed committee and the Assembly floor, but only after the scope was narrowed to reverse cuts exclusively for certain skilled nursing facilities.\u003c/p>\n\u003cp>\"The legislation is certainly an important piece,\" Weedn said, \"but this is something that can ultimately be fixed in the budget. We think it's unique, this coalition coming together, because we've all independently fought against these Medi-Cal cuts for years, and now we're together. That coalition and the bipartisan support [in the Legislature] is pretty remarkable.\"\u003c/p>\n\u003cp>Weedn said she expects 5,000 to 7,000 people to show up on the Capitol lawns, and that's a conservative estimate, she said. \"We've never had a group that size rallying around a health care issue in Sacramento,\" she said. The event will run most of the day.\u003c/p>\n\u003cp>According to Jan Emerson-Shea, vice president of external affairs for the California Hospital Association, legislation may have stalled but there is a real possibility that the Medi-Cal reduction could be reversed in budget negotiations over the next few weeks.\u003c/p>\n\u003cp>\"The situation is still very fluid,\" Emerson-Shea said. \"There is still a lot of negotiations and discussion that will play out over the next few weeks.\"\u003c/p>\n\u003cp>Legislators are keenly aware of the problem with the provider cuts, she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The event just cements the issue in legislators' minds as a high priority,\" Emerson-Shea said.\u003c/p>\n\n",
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"excerpt": "Thousands of doctors, dentists, patients, health care professionals and other protesters are expected to gather Tuesday outside the Capitol Building to support the idea of reversing a 10 percent Medi-Cal provider rate cut. Organizers say it will be the largest health care protest in Sacramento history.\r\n\r\n\"We have people hopping on buses in Oceanside at 4 in the morning to get here,\" said Molly Weedn, director of media relations for the California Medical Association. \"People are coming from all over the state, and we've seen support from both sides in the Legislature. All of this [support] shows that the public doesn't want Medi-Cal to be cut, so that's why we're doing this.\"",
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"description": "Thousands of doctors, dentists, patients, health care professionals and other protesters are expected to gather Tuesday outside the Capitol Building to support the idea of reversing a 10 percent Medi-Cal provider rate cut. Organizers say it will be the largest health care protest in Sacramento history.\r\n\r\n"We have people hopping on buses in Oceanside at 4 in the morning to get here," said Molly Weedn, director of media relations for the California Medical Association. "People are coming from all over the state, and we've seen support from both sides in the Legislature. All of this shows that the public doesn't want Medi-Cal to be cut, so that's why we're doing this."",
"title": "Thousands Expected for Rally to Block Medi-Cal Rate Cuts | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By David Gorn,\u003c/strong> \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/6/massive-rally-set-to-protest-provider-cuts.aspx#ixzz2VGabz8tK\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_9250\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"size-medium wp-image-9250 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/Sacramento_Capital_seliaymiwell_flickr-300x200.jpg\" alt=\"(seliaymiwell/flickr)\" width=\"300\" height=\"200\">\u003cfigcaption class=\"wp-caption-text\">Protesters are calling on the governor to restore $1 billion in health care funding. (seliaymiwell/flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Thousands of doctors, dentists, patients, health care professionals and other protesters are expected to \u003ca href=\"http://www.cmanet.org/we-care-for-california\" target=\"_blank\">gather Tuesday\u003c/a> outside the Capitol Building to support the idea of reversing a 10 percent Medi-Cal provider rate cut. Organizers say it will be the largest health care protest in Sacramento history.\u003c/p>\n\u003cp>\"We have people hopping on buses in Oceanside at 4 in the morning to get here,\" said Molly Weedn, director of media relations for the California Medical Association. \"People are coming from all over the state, and we've seen support from both sides in the Legislature. All of this [support] shows that the public doesn't want Medi-Cal to be cut, so that's why we're doing this.\"\u003c/p>\n\u003cp>It has been a tough couple of weeks for proponents of reversing the rate cut made in 2011 and not yet implemented because of court battles.\u003c/p>\n\u003cp>On May 24, the Ninth Circuit federal appeals court\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/25/appeal-denied-medi-cal-rate-cuts-poised-to-move-forward/\" target=\"_blank\"> ruled the Medi-Cal cut to be legal\u003c/a>, and lifted the injunctions on its implementation. That means the lawsuits to reverse the reduction now have only legal recourse, and that's an appeal to the U.S. Supreme Court.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Two bills moving through the legislature are seeking to stop the cuts.\u003c/p>\n\u003cp>The day before the court ruled, a bill to reverse the Medi-Cal reduction, \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0601-0650/sb_640_bill_20130501_amended_sen_v96.pdf\">SB 640\u003c/a> was put on suspense file in the Senate Committee on Appropriations. Until that day, the bill had bipartisan, unanimous support in committee voting.\u003c/p>\n\u003cp>The companion piece of legislation to SB 640 was \u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/asm/ab_0851-0900/ab_900_bill_20130419_amended_asm_v98.pdf\" target=\"_blank\">AB 900\u003c/a>. It passed committee and the Assembly floor, but only after the scope was narrowed to reverse cuts exclusively for certain skilled nursing facilities.\u003c/p>\n\u003cp>\"The legislation is certainly an important piece,\" Weedn said, \"but this is something that can ultimately be fixed in the budget. We think it's unique, this coalition coming together, because we've all independently fought against these Medi-Cal cuts for years, and now we're together. That coalition and the bipartisan support [in the Legislature] is pretty remarkable.\"\u003c/p>\n\u003cp>Weedn said she expects 5,000 to 7,000 people to show up on the Capitol lawns, and that's a conservative estimate, she said. \"We've never had a group that size rallying around a health care issue in Sacramento,\" she said. The event will run most of the day.\u003c/p>\n\u003cp>According to Jan Emerson-Shea, vice president of external affairs for the California Hospital Association, legislation may have stalled but there is a real possibility that the Medi-Cal reduction could be reversed in budget negotiations over the next few weeks.\u003c/p>\n\u003cp>\"The situation is still very fluid,\" Emerson-Shea said. \"There is still a lot of negotiations and discussion that will play out over the next few weeks.\"\u003c/p>\n\u003cp>Legislators are keenly aware of the problem with the provider cuts, she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The event just cements the issue in legislators' minds as a high priority,\" Emerson-Shea said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Want To Get People to Eat More Fresh Produce? Give Them A Little Money",
"title": "Want To Get People to Eat More Fresh Produce? Give Them A Little Money",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>By\u003ca href=\"http://www.marnettefederis.com\" target=\"_blank\"> Marnette Federis\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_13049\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-13049\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/FreshFund_MarnetteFederisKQED-620x420.jpg\" alt=\"(Marnette Federis/KQED)\" width=\"620\" height=\"420\">\u003cfigcaption class=\"wp-caption-text\">(Marnette Federis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Collene Kraut says she never misses a chance to tell her 3-year-old daughter to eat vegetables and fruits. So when a farmers’ market launched in March, a block away from her home near San Diego, Kraut was eager to go.\u003c/p>\n\u003cp>“I don’t like it when people give my kid bad things to eat,\" said Kraut. \"I just want her to be healthy.\"\u003c/p>\n\u003cp>Kraut receives funds from SNAP (formerly called food stamps), and she learned that she could use those funds at this new market. But Kraut learned about another new program while she was there, one that would help her stretch her dollars further. It's called\u003ca href=\"http://www.healthyworks.org/healthy-foods/fresh-fund\" target=\"_blank\"> Fresh Fund,\u003c/a> a grant-funded program which provides matching dollars specifically to purchase produce.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The program's goal is to help low-income families buy accessible, affordable, nutritious produce.\u003c/aside>\n\u003cp>That extra money is having an impact. Because of Fresh Fund, Kraut says she and other family members are now trying different varieties of fruits and vegetables. Kraut says she especially likes the different varieties of greens she finds, adding that they taste better than what she can buy at the supermarket.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I brought some [greens] back for my dad, and he was eating it plain without salad dressing, he said it was good,” she recounts.\u003c/p>\n\u003cp>The Fresh Fund program helps families such as Kraut’s to stretch their food budgets so they have more room to shop for healthier food. The program's goal is to help low-income families buy accessible, affordable, nutritious produce. Offering matching dollars for produce appears to influence people's diets.\u003c!--more-->\u003c/p>\n\u003cp>“People come out and try things they may not be used to, and they understand this produce tastes so much better than what they can get at the corner store,” said Troy McKinney, coordinator of Fresh Fund.\u003c/p>\n\u003cp>At the El Cajon Farmers’ Market, eligible families may collect up to $30 over a two months. At another market, in San Diego’s City Heights neighborhood, people get up to $90 over three months.\u003c/p>\n\u003cp>Organizers acknowledge that there are some limitations to the program because participants only have a two or three-month period to be part of it. The goal is that once families try out the farmers’ market they will keep coming back.\u003c/p>\n\u003cp>“We’re hoping that in that short period of time, they’ll come out here … they’ll try the produce, and they’ll choose to budget farmers’ market produce\" into their regular shopping McKinney explained.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.rescue.org/us-program/us-san-diego-ca/fresh-fund\" target=\"_blank\">International Rescue Committee\u003c/a>, which provides services to refugees resettling in the United States, launched both the farmers’ markets and Fresh Fund as a way to expand access to healthier food for low-income families.\u003c/p>\n\u003cp>In 2008, IRC opened the market in City Heights, a low-income neighborhood and home to a large population of refugees from Southeast Asia, Africa and other parts of the world.\u003c/p>\n\u003cp>IRC staffers said the farmers’ market was a way to address challenges often faced by low to moderate-income families when it comes to eating healthy.\u003c/p>\n\u003cp>“Families don’t have to fall into the trap of buying calorie-rich but nutrient-deficient, cheap food,” said Ralph Achenbach, IRC’s Food and Farming Marketing Coordinator.\u003c/p>\n\u003cp>Refugees also find it difficult to cook native dishes without access to fruits and vegetables they traditionally use, said Achenbach. At the City Heights Farmers’ Market, some of the vendors include refugees who are trained by IRC to grow and sell produce found in their home countries.\u003c/p>\n\u003cp>“Some of the African farmers are growing African amaranth or cassava, or things you don't necessarily find in other farmer's market,” said Achenbach.\u003c/p>\n\u003cp>McKinney said El Cajon was chosen as the site for the newest farmers’ market because many of IRC’s clients, including Iraqi refugees, have resettled in the area.\u003c/p>\n\u003cp>“We want to make sure that our clients and the community, have access to this quality produce, which we think is really the highest quality produce you can buy in San Diego or in any other neighborhood,” said McKinney.\u003c/p>\n\u003cp>Mayce Kadhum is from Iraq and recently moved to El Cajon in the beginning of 2013. She said she appreciates the produce available at the farmers’ market because she is unable to plant her own vegetables.\u003c/p>\n\u003cp>“Someone told me to plant something,” Kadhum said. “The problem is, I don't have enough space in my flat. This is the problem.”\u003c/p>\n\u003cp>Fresh Fund organizers said they have seen the program improve the lives of participants.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Of participants surveyed, more than 95 percent said they have increased or greatly increased both the amount and variety of fruits and vegetables they eat.\u003c/p>\n\n",
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"excerpt": "Collene Kraut says she never misses a chance to tell her 3-year-old daughter to eat vegetables and fruits. So when a farmers’ market launched in March, a block away from her home near San Diego, Kraut was eager to go.\r\n\r\n“I don’t like it when people give my kid bad things to eat,\" said Kraut. \"I just want her to be healthy.\"\r\n\r\nAt the market, Kraut learned not only would she be able to use money she gets through SNAP (formerly food stamps), but that she also qualifies for Fresh Fund, a grant-funded program, which provides matching dollars to purchase produce.",
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"title": "Want To Get People to Eat More Fresh Produce? Give Them A Little Money | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By\u003ca href=\"http://www.marnettefederis.com\" target=\"_blank\"> Marnette Federis\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_13049\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-13049\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/FreshFund_MarnetteFederisKQED-620x420.jpg\" alt=\"(Marnette Federis/KQED)\" width=\"620\" height=\"420\">\u003cfigcaption class=\"wp-caption-text\">(Marnette Federis/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Collene Kraut says she never misses a chance to tell her 3-year-old daughter to eat vegetables and fruits. So when a farmers’ market launched in March, a block away from her home near San Diego, Kraut was eager to go.\u003c/p>\n\u003cp>“I don’t like it when people give my kid bad things to eat,\" said Kraut. \"I just want her to be healthy.\"\u003c/p>\n\u003cp>Kraut receives funds from SNAP (formerly called food stamps), and she learned that she could use those funds at this new market. But Kraut learned about another new program while she was there, one that would help her stretch her dollars further. It's called\u003ca href=\"http://www.healthyworks.org/healthy-foods/fresh-fund\" target=\"_blank\"> Fresh Fund,\u003c/a> a grant-funded program which provides matching dollars specifically to purchase produce.\u003c/p>\n\u003caside class=\"pullquote alignleft\">The program's goal is to help low-income families buy accessible, affordable, nutritious produce.\u003c/aside>\n\u003cp>That extra money is having an impact. Because of Fresh Fund, Kraut says she and other family members are now trying different varieties of fruits and vegetables. Kraut says she especially likes the different varieties of greens she finds, adding that they taste better than what she can buy at the supermarket.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I brought some [greens] back for my dad, and he was eating it plain without salad dressing, he said it was good,” she recounts.\u003c/p>\n\u003cp>The Fresh Fund program helps families such as Kraut’s to stretch their food budgets so they have more room to shop for healthier food. The program's goal is to help low-income families buy accessible, affordable, nutritious produce. Offering matching dollars for produce appears to influence people's diets.\u003c!--more-->\u003c/p>\n\u003cp>“People come out and try things they may not be used to, and they understand this produce tastes so much better than what they can get at the corner store,” said Troy McKinney, coordinator of Fresh Fund.\u003c/p>\n\u003cp>At the El Cajon Farmers’ Market, eligible families may collect up to $30 over a two months. At another market, in San Diego’s City Heights neighborhood, people get up to $90 over three months.\u003c/p>\n\u003cp>Organizers acknowledge that there are some limitations to the program because participants only have a two or three-month period to be part of it. The goal is that once families try out the farmers’ market they will keep coming back.\u003c/p>\n\u003cp>“We’re hoping that in that short period of time, they’ll come out here … they’ll try the produce, and they’ll choose to budget farmers’ market produce\" into their regular shopping McKinney explained.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.rescue.org/us-program/us-san-diego-ca/fresh-fund\" target=\"_blank\">International Rescue Committee\u003c/a>, which provides services to refugees resettling in the United States, launched both the farmers’ markets and Fresh Fund as a way to expand access to healthier food for low-income families.\u003c/p>\n\u003cp>In 2008, IRC opened the market in City Heights, a low-income neighborhood and home to a large population of refugees from Southeast Asia, Africa and other parts of the world.\u003c/p>\n\u003cp>IRC staffers said the farmers’ market was a way to address challenges often faced by low to moderate-income families when it comes to eating healthy.\u003c/p>\n\u003cp>“Families don’t have to fall into the trap of buying calorie-rich but nutrient-deficient, cheap food,” said Ralph Achenbach, IRC’s Food and Farming Marketing Coordinator.\u003c/p>\n\u003cp>Refugees also find it difficult to cook native dishes without access to fruits and vegetables they traditionally use, said Achenbach. At the City Heights Farmers’ Market, some of the vendors include refugees who are trained by IRC to grow and sell produce found in their home countries.\u003c/p>\n\u003cp>“Some of the African farmers are growing African amaranth or cassava, or things you don't necessarily find in other farmer's market,” said Achenbach.\u003c/p>\n\u003cp>McKinney said El Cajon was chosen as the site for the newest farmers’ market because many of IRC’s clients, including Iraqi refugees, have resettled in the area.\u003c/p>\n\u003cp>“We want to make sure that our clients and the community, have access to this quality produce, which we think is really the highest quality produce you can buy in San Diego or in any other neighborhood,” said McKinney.\u003c/p>\n\u003cp>Mayce Kadhum is from Iraq and recently moved to El Cajon in the beginning of 2013. She said she appreciates the produce available at the farmers’ market because she is unable to plant her own vegetables.\u003c/p>\n\u003cp>“Someone told me to plant something,” Kadhum said. “The problem is, I don't have enough space in my flat. This is the problem.”\u003c/p>\n\u003cp>Fresh Fund organizers said they have seen the program improve the lives of participants.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Of participants surveyed, more than 95 percent said they have increased or greatly increased both the amount and variety of fruits and vegetables they eat.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Insurers Balk at Some Rare Genetic Tests for Breast Cancer",
"title": "Insurers Balk at Some Rare Genetic Tests for Breast Cancer",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>By Michelle Andrews for \u003ca href=\"http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/052813-Michelle-Andrews-on-breast-cancer-care.aspx\" target=\"_blank\">Kaiser Health News\u003c/a> and \u003ca href=\"http://www.npr.org/blogs/health/2013/05/28/186885334/insurers-balk-on-rarer-genetic-tests-for-breast-cancer\" target=\"_blank\">NPR\u003c/a>\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_12992\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://www.flickr.com/photos/gageskidmore/4840431698/\">\u003cimg class=\"size-large wp-image-12992 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/AngelinaJolie_GageSkidmore_Flickr-620x413.jpg\" alt=\"Angelina Jolie's decision to have a double mastectomy after genetic testing has prompted a discussion about which other tests should be covered. (Gage Skidmore/Flickr)\" width=\"620\" height=\"413\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Angelina Jolie's decision to have a double mastectomy after genetic testing has prompted a discussion about which other tests should be covered. (Gage Skidmore/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>When it comes to inherited genetic mutations that increase the risk of breast cancer,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/15/whats-a-brca-gene-anyway-angelina-jolie/\" target=\"_blank\"> BRCA1 and BRCA2 \u003c/a>get nearly all the attention.\u003c/p>\n\u003cp>Inherited mutations in these genes \u003ca href=\"http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA\" target=\"_blank\">cause from 5 to 10 percent\u003c/a> of breast cancers as well as up to 15 percent of ovarian cancers, according to the National Cancer Institute.\u003c/p>\n\u003cp>There are other, rarer genetic mutations that also predispose women to breast cancer.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Other genes besides BRCA1 and BRCA2 may have mutations that predispose a woman to breast cancer.\u003c/aside>\n\u003cp>Health insurers that cover BRCA-related testing and treatment without a hitch sometimes balk at providing coverage in these other instances. The predictive value of some of those variations isn't always as strong or clear-cut.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When Angelie Jolie \u003ca href=\"http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html\" target=\"_blank\">said earlier this month\u003c/a> that she'd tested positive for a particularly harmful BRCA1 mutation and had a double mastectomy to substantially reduce her risk of getting breast cancer, she didn't mention her insurance coverage.\u003c!--more-->\u003c/p>\n\u003cp>But many health insurance plans \u003ca href=\"http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/052813-Michelle-Andrews-on-breast-cancer-care.aspx\" target=\"_blank\">routinely cover\u003c/a> genetic counseling and testing if a woman has a family history of breast or ovarian cancer. This is particularly true when there's a pattern of early breast cancer, with diagnoses of family members in their 40s, long before the mid-60s when most women develop the disease.\u003c/p>\n\u003cp>Under President Obama's Affordable Care Act, health plans that weren't grandfathered \u003ca href=\"http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.html\" target=\"_blank\">must cover genetic counseling and testing\u003c/a> in such women without requiring them to pay anything out of pocket for it.\u003c/p>\n\u003cp>Counseling can cost several hundred dollars, and the genetic test costs roughly $3,000. (The high cost is in part because one company, Myriad Genetics, holds the patent on the BRCA1 and BRCA2 genes. That patent has been challenged and is\u003ca href=\"http://science.kqed.org/quest/audio/bay-area-biotech-industry-braces-for-gene-patenting-court-case/\" target=\"_blank\"> currently under review \u003c/a>by the U.S. Supreme Court.)\u003c/p>\n\u003cp>But other genes besides BRCA1 and BRCA2 might have mutations that predispose a woman to breast cancer. Even though women may test negative for BRCA1 and BRCA2 mutations, some women's history clearly indicates a familial link.\u003c/p>\n\u003cp>\"These women come from families where breast cancer has been marching through the family in young women, with women in their 40s being diagnosed with breast cancer,\" said Stephen Edge, the medical director of the breast center at Roswell Park Cancer Institute in Buffalo, N.Y.\u003c/p>\n\u003cp>These women may well have inherited other genetic mutations, probably related to complex interactions with other genes, that haven't yet been identified, said Edge.\u003c/p>\n\u003cp>In such cases, even without a positive genetic test, insurers generally don't quibble about covering treatment such as a prophylactic double mastectomy if that's what the woman decides she wants to do, he said.\u003c/p>\n\u003cp>But sometimes a woman's family history will indicate the possibility that she has a different, rarer inherited mutation that increases the likelihood of developing breast and other cancers.\u003c/p>\n\u003cp>For example, \u003ca href=\"http://ghr.nlm.nih.gov/condition/li-fraumeni-syndrome\">Li-Fraumeni syndrome\u003c/a>, caused by a mutation on the TP53 gene, is often associated with an increased risk of breast cancer and sarcomas, cancers of the bones or connective tissues, said Mary Daly, chair of the department of clinical genetics at Fox Chase Cancer Center in Philadelphia. Likewise, Cowden syndrome, associated with a mutation on the PTEN gene, increases the risk of breast and thyroid tumors.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Even though genetic tests are available for these rarer breast cancer syndromes, \"they often aren't covered by insurance,\" she said.\u003c/p>\n\n",
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"excerpt": "When it comes to inherited genetic mutations that increase the risk of breast cancer, BRCA1 and BRCA2 get nearly all the attention.\r\n\r\nInherited mutations in these genes cause from 5 to 10 percent of breast cancers as well as up to 15 percent of ovarian cancers, according to the National Cancer Institute.\r\n\r\nThere are other, rarer genetic mutations that also predispose women to breast cancer.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Michelle Andrews for \u003ca href=\"http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/052813-Michelle-Andrews-on-breast-cancer-care.aspx\" target=\"_blank\">Kaiser Health News\u003c/a> and \u003ca href=\"http://www.npr.org/blogs/health/2013/05/28/186885334/insurers-balk-on-rarer-genetic-tests-for-breast-cancer\" target=\"_blank\">NPR\u003c/a>\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_12992\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://www.flickr.com/photos/gageskidmore/4840431698/\">\u003cimg class=\"size-large wp-image-12992 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/AngelinaJolie_GageSkidmore_Flickr-620x413.jpg\" alt=\"Angelina Jolie's decision to have a double mastectomy after genetic testing has prompted a discussion about which other tests should be covered. (Gage Skidmore/Flickr)\" width=\"620\" height=\"413\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Angelina Jolie's decision to have a double mastectomy after genetic testing has prompted a discussion about which other tests should be covered. (Gage Skidmore/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>When it comes to inherited genetic mutations that increase the risk of breast cancer,\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/15/whats-a-brca-gene-anyway-angelina-jolie/\" target=\"_blank\"> BRCA1 and BRCA2 \u003c/a>get nearly all the attention.\u003c/p>\n\u003cp>Inherited mutations in these genes \u003ca href=\"http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA\" target=\"_blank\">cause from 5 to 10 percent\u003c/a> of breast cancers as well as up to 15 percent of ovarian cancers, according to the National Cancer Institute.\u003c/p>\n\u003cp>There are other, rarer genetic mutations that also predispose women to breast cancer.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Other genes besides BRCA1 and BRCA2 may have mutations that predispose a woman to breast cancer.\u003c/aside>\n\u003cp>Health insurers that cover BRCA-related testing and treatment without a hitch sometimes balk at providing coverage in these other instances. The predictive value of some of those variations isn't always as strong or clear-cut.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When Angelie Jolie \u003ca href=\"http://www.nytimes.com/2013/05/14/opinion/my-medical-choice.html\" target=\"_blank\">said earlier this month\u003c/a> that she'd tested positive for a particularly harmful BRCA1 mutation and had a double mastectomy to substantially reduce her risk of getting breast cancer, she didn't mention her insurance coverage.\u003c!--more-->\u003c/p>\n\u003cp>But many health insurance plans \u003ca href=\"http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/052813-Michelle-Andrews-on-breast-cancer-care.aspx\" target=\"_blank\">routinely cover\u003c/a> genetic counseling and testing if a woman has a family history of breast or ovarian cancer. This is particularly true when there's a pattern of early breast cancer, with diagnoses of family members in their 40s, long before the mid-60s when most women develop the disease.\u003c/p>\n\u003cp>Under President Obama's Affordable Care Act, health plans that weren't grandfathered \u003ca href=\"http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs12.html\" target=\"_blank\">must cover genetic counseling and testing\u003c/a> in such women without requiring them to pay anything out of pocket for it.\u003c/p>\n\u003cp>Counseling can cost several hundred dollars, and the genetic test costs roughly $3,000. (The high cost is in part because one company, Myriad Genetics, holds the patent on the BRCA1 and BRCA2 genes. That patent has been challenged and is\u003ca href=\"http://science.kqed.org/quest/audio/bay-area-biotech-industry-braces-for-gene-patenting-court-case/\" target=\"_blank\"> currently under review \u003c/a>by the U.S. Supreme Court.)\u003c/p>\n\u003cp>But other genes besides BRCA1 and BRCA2 might have mutations that predispose a woman to breast cancer. Even though women may test negative for BRCA1 and BRCA2 mutations, some women's history clearly indicates a familial link.\u003c/p>\n\u003cp>\"These women come from families where breast cancer has been marching through the family in young women, with women in their 40s being diagnosed with breast cancer,\" said Stephen Edge, the medical director of the breast center at Roswell Park Cancer Institute in Buffalo, N.Y.\u003c/p>\n\u003cp>These women may well have inherited other genetic mutations, probably related to complex interactions with other genes, that haven't yet been identified, said Edge.\u003c/p>\n\u003cp>In such cases, even without a positive genetic test, insurers generally don't quibble about covering treatment such as a prophylactic double mastectomy if that's what the woman decides she wants to do, he said.\u003c/p>\n\u003cp>But sometimes a woman's family history will indicate the possibility that she has a different, rarer inherited mutation that increases the likelihood of developing breast and other cancers.\u003c/p>\n\u003cp>For example, \u003ca href=\"http://ghr.nlm.nih.gov/condition/li-fraumeni-syndrome\">Li-Fraumeni syndrome\u003c/a>, caused by a mutation on the TP53 gene, is often associated with an increased risk of breast cancer and sarcomas, cancers of the bones or connective tissues, said Mary Daly, chair of the department of clinical genetics at Fox Chase Cancer Center in Philadelphia. Likewise, Cowden syndrome, associated with a mutation on the PTEN gene, increases the risk of breast and thyroid tumors.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Even though genetic tests are available for these rarer breast cancer syndromes, \"they often aren't covered by insurance,\" she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Appeal Denied: Medi-Cal Rate Cuts Poised to Move Forward",
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"content": "\u003cp>\u003cstrong>By Judy Lin, Associated Press\u003c/strong>\u003c/p>\n\u003cp>A federal appeals court on Friday denied a second request by California doctors, pharmacists and hospitals seeking to undo the state's 10 percent provider rate cut for treating the poor.\u003c/p>\n\u003cp>The 9th U.S. Circuit Court of Appeals denied an appeal from medical providers to rehear their case, which allows Gov. Jerry Brown to begin implementing the cuts retroactively. A three-judge panel had \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/14/federal-appeals-court-approves-cuts-to-medi-cal-providers/\" target=\"_blank\">ruled against them in December\u003c/a> on the grounds that trial courts cannot block the state from making cuts that were approved by the U.S. Department of Health and Human Services.\u003c/p>\n\u003cp>Health providers vowed they will continue to press lawmakers to restore the 10 percent reimbursement rate cut to the state's Medicaid program, kn\u003cspan style=\"color: #000000\">own as Medi-Cal.\u003c!--more-->\u003c/span>\u003c/p>\n\u003cp>\"While we are not surprised by the 9th Circuit Court ruling, we are certainly disappointed, as the 10 percent cut \u003cspan style=\"color: #000000\">to Medi-Cal will have devastating effects on California's poorest and most vulnerable patients,\" said Paul Phinney, president of the California Medical Association, in a statement.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Phinney said the state needs competitive Medi-Cal payments\u003c/span> as the state prepares to get millions of Californians health coverage under the Affordable Care Act. The association, which represents 35,000 doctors, says ongoing cuts have left doctors with little option but to stop taking qualified patients because the reimbursements do not meet the cost of overhead and supplies to treat them.\u003c/p>\n\u003cp>\"Reversal of these cuts is a California priority,\" said Duane Dauner, president of the California Hospital Association, in a statement.\u003c/p>\n\u003cp>Friday's decision cements a budget victory for Brown, who has vowed to hold the line on spending. The administration had estimated the two-year savings from the cut would be $508.9 million but will revise the figure because the state assumed the decision would not be made until August, said H.D. Palmer, the governor's finance spokesman.\u003c/p>\n\u003cp>At the time lawmakers passed the cut, the reduction was projected to save the state some $330 million a year.\u003c/p>\n\u003cp>It's unclear if health providers will find success in reversing the cut this legislative cycle. Doctors and hospitals sponsored SB640 by Sen. Ricardo Lara, D-Bell Gardens, a bill that would restore the 10 percent rate cut, but the bill stalled in committee Thursday as the deadline nears for passing bills out of their houses of origin.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Another bill, AB900, by Assemblyman Luis Alejo, D-Watsonville, advanced in the Assembly this week only \u003cspan style=\"color: #000000\">after Medi-Cal re\u003c/span>storation was limited to skilled nursing facilities.\u003c/p>\n\n",
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"excerpt": "A federal appeals court on Friday denied a second request by California doctors, pharmacists and hospitals seeking to undo the state's 10 percent provider rate cut for treating the poor.\r\n\r\nThe 9th U.S. Circuit Court of Appeals denied an appeal from medical providers to rehear their case, which allows Gov. Jerry Brown to begin implementing the cuts retroactively. A three-judge panel had ruled against them in December on the grounds that trial courts cannot block the state from making cuts that were approved by the U.S. Department of Health and Human Services.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Judy Lin, Associated Press\u003c/strong>\u003c/p>\n\u003cp>A federal appeals court on Friday denied a second request by California doctors, pharmacists and hospitals seeking to undo the state's 10 percent provider rate cut for treating the poor.\u003c/p>\n\u003cp>The 9th U.S. Circuit Court of Appeals denied an appeal from medical providers to rehear their case, which allows Gov. Jerry Brown to begin implementing the cuts retroactively. A three-judge panel had \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/14/federal-appeals-court-approves-cuts-to-medi-cal-providers/\" target=\"_blank\">ruled against them in December\u003c/a> on the grounds that trial courts cannot block the state from making cuts that were approved by the U.S. Department of Health and Human Services.\u003c/p>\n\u003cp>Health providers vowed they will continue to press lawmakers to restore the 10 percent reimbursement rate cut to the state's Medicaid program, kn\u003cspan style=\"color: #000000\">own as Medi-Cal.\u003c!--more-->\u003c/span>\u003c/p>\n\u003cp>\"While we are not surprised by the 9th Circuit Court ruling, we are certainly disappointed, as the 10 percent cut \u003cspan style=\"color: #000000\">to Medi-Cal will have devastating effects on California's poorest and most vulnerable patients,\" said Paul Phinney, president of the California Medical Association, in a statement.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"color: #000000\">Phinney said the state needs competitive Medi-Cal payments\u003c/span> as the state prepares to get millions of Californians health coverage under the Affordable Care Act. The association, which represents 35,000 doctors, says ongoing cuts have left doctors with little option but to stop taking qualified patients because the reimbursements do not meet the cost of overhead and supplies to treat them.\u003c/p>\n\u003cp>\"Reversal of these cuts is a California priority,\" said Duane Dauner, president of the California Hospital Association, in a statement.\u003c/p>\n\u003cp>Friday's decision cements a budget victory for Brown, who has vowed to hold the line on spending. The administration had estimated the two-year savings from the cut would be $508.9 million but will revise the figure because the state assumed the decision would not be made until August, said H.D. Palmer, the governor's finance spokesman.\u003c/p>\n\u003cp>At the time lawmakers passed the cut, the reduction was projected to save the state some $330 million a year.\u003c/p>\n\u003cp>It's unclear if health providers will find success in reversing the cut this legislative cycle. Doctors and hospitals sponsored SB640 by Sen. Ricardo Lara, D-Bell Gardens, a bill that would restore the 10 percent rate cut, but the bill stalled in committee Thursday as the deadline nears for passing bills out of their houses of origin.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Another bill, AB900, by Assemblyman Luis Alejo, D-Watsonville, advanced in the Assembly this week only \u003cspan style=\"color: #000000\">after Medi-Cal re\u003c/span>storation was limited to skilled nursing facilities.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Calif's Health Insurance Exchange Sets Plans, Premiums; No Apparent 'Rate Shock'",
"title": "Calif's Health Insurance Exchange Sets Plans, Premiums; No Apparent 'Rate Shock'",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_14199\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\" wp-image-14199\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/RS170_108160554-scr-640x426.jpg\" alt=\"RS170_108160554-scr\" width=\"640\" height=\"426\">\u003cfigcaption class=\"wp-caption-text\">(Joe Raedle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update: Aug. 7, 2013: \u003c/strong>Covered California announced Wednesday that 12 insurance companies have formally signed contracts with the agency to offer plans on the new marketplace. Since the initial announcement (below), one company, Ventura County Health Plan, has withdrawn from offering coverage on the marketplace. The following companies will offer plans on the marketplace, although not all companies will offer plans in every region of California:\u003c/p>\n\u003caside class=\"pullquote alignright\">\u003ca href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" target=\"_blank\">Learn more about Obamacare; check out KQED's guide, specifically for Californians\u003c/a>\u003c/aside>\n\u003cp>· Alameda Alliance for Health\u003c/p>\n\u003cp>· Anthem Blue Cross of California\u003c/p>\n\u003cp>· Blue Shield of California\u003c/p>\n\u003cp>· Chinese Community Health Plan\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>· Contra Costa Health Plan\u003c/p>\n\u003cp>· Health Net\u003c/p>\n\u003cp>· Kaiser Permanente\u003c/p>\n\u003cp>· L.A. Care Health Plan\u003c/p>\n\u003cp>· Molina Healthcare\u003c/p>\n\u003cp>· Sharp Health Plan\u003c/p>\n\u003cp>· Valley Health Plan\u003c/p>\n\u003cp>· Western Health Advantage\u003c/p>\n\u003cp>Last week, Covered California \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/01/covered-california-sets-small-business-marketplace-plans-premiums/\" target=\"_blank\">announced\u003c/a> tentative plans and premiums for its small business marketplace, also called SHOP.\u003c/p>\n\u003cp>\u003cstrong>ORIGINAL POST:\u003c/strong>\u003c/p>\n\u003cp>The state's health insurance exchange, Covered California, announced Thursday morning the plans and premiums that will be available to millions of Californians.\u003c/p>\n\u003cp>And what everyone wants to know is: how much will it cost. Experts had warned of \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/27/health-care-overhaul-actuaries-say-costs-could-go-up-32-percent/\">rate shock\u003c/a>,\" that premiums might skyrocket for all kinds of reasons. That has not happened.\u003c/p>\n\u003cp>Covered California says that individuals will pay an average premium of $321 per month for a \"silver\" plan. (More on silver plans below.) Many people will be eligible for subsidies to reduce that cost further.\u003c/p>\n\u003cp>Across the state, people who had been working toward this day seemed to heave a collective sigh of relief.\u003c/p>\n\u003cp>\"This is a home run for consumers in every region of California,\" said Peter Lee, executive director of Covered California, in a release to reporters. \"Californians should be proud of how not only health plans in this state, but doctors, medical groups and hospitals have stepped up -- creating a market that will allow millions of consumers to enroll in affordably priced products.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\u003ca href=\"http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf\">Look up a sample of plans, premiums offered in your area.\u003c/a> \u003c/aside>\n\u003cp>Charles Bacchi, executive vice president with the California Association of Health Plans called it an \"important day\" and commended both insurance companies and providers for working together \"to deliver quality, affordable health care. We couldn't have done this without providers willing to join us to make the Affordable Care Act a success,\" he said in a reference to provider groups working to keep rates low.\u003c/p>\n\u003cp>The plans on the exchange are required to offer a standard set of comprehensive benefits. It's hard to compare premiums next year to what's in place this year, since there is no standard set of benefits at present. Covered California chose as the best comparison the average premium for a small business plan. The rates in Covered California range from 2 percent above to 29 percent below that benchmark.\u003c!--more-->\u003c/p>\n\u003cp>\"It's nice to have a good news day in California,\" said Daniel Zingale, senior vice president of The California Endowment. \"It turns out there's power in numbers when it comes to … health plans.\"\u003c/p>\n\u003cp>\u003cstrong>13 Plans Selected for the Insurance Exchange\u003c/strong>\u003c/p>\n\u003cp>The selected plans and premiums are still subject to review by state regulators. Covered California has picked 13 plans, including Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser as well as many regional plans and some country-sponsored health plans. Those include Alameda Alliance for Health, Chinese Community Health Plan, Contra Costa Health Services, L.A. Care Health Plan, Molina Helathcare, Sharp Health Paln, Valley Health Plan, Ventura County Health Care Plan and Western Health Advantage. \u003ca href=\"http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf\">You can look up your own region\u003c/a> and see what plans and premiums you can choose from.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Everything will be quite standardized and literally charted out. So you can look across lines and compare plans.\" -- \u003cem>Betsy Imholz, Consumers Union\u003c/em>\u003c/aside>\n\u003cp>Plans will be offered in tiers of coverage: platinum, gold, silver, bronze. The platinum plans have the highest premiums but you will pay less when you see the doctor; the bronze plans have the lowest premium, meaning you will pay more when you see the doctor.\u003c/p>\n\u003cp>The \"silver\" plan mentioned above is in the middle. It has the same standard set of benefits as the other plans, and has a $2,000 annual deductible. Still, preventive care and some other services are outside the deductible -- people would pay only a co-pay when they see the doctor.\u003c/p>\n\u003cp>When setting an individual's premium, insurance plans in the exchange may look at only three factors: age, where you live and family size. Insurance companies may no longer use your health condition or your health history to set premiums. People may no longer be turned down for pre-existing conditions.\u003c/p>\n\u003cp>Subsidies are available for people making from 138 to 400 percent of the federal poverty level – or about $15,500 to $45,000 for an individual or about $31,000 to $92,000 for a family of four.\u003c/p>\n\u003cp>\u003cstrong>Breakdown on Premiums, Before and After Subsidy\u003c/strong>\u003c/p>\n\u003cp>Covered California provided tables of average rates for a 21-year-old and a 40-year-old single person. For the 21-year-old buying the most affordable silver plan, the premium is $216 per month. But depending on income, the 21-year-old may get a subsidy, making the price that person would pay range from $44 per month to $216 per month.\u003c/p>\n\u003cp>The premium for a 40-year-old buying the most affordable silver plan will be $276. But depending on the subsidy, that 40-year-old will pay from $40 to the full $276.\u003c/p>\n\u003cp>Starting this fall, people will be able to go online and look up plans and rates across the board for themselves or their families.\u003c/p>\n\u003cp>\"Everything will be quite standardized and literally charted out,\" said Betsy Imholz, special projects director for Consumers Union. \"So you can look across lines and compare plans.\"\u003c/p>\n\u003cp>On average, people in the larger metropolitan areas in California will be able to choose from among five different plans. Covered California says that even in rural areas where options have typically been sparse, people will have two or three health plans to choose from.\u003c/p>\n\u003cp>\"We were particularly concerned about Californians in rural parts of the state,\" Zingale said. \"So it's a relief to see that they will have doctors, hospitals and health benefits available in those areas.\"\u003c/p>\n\u003cp>But not everyone was delighted. Jay Nelson is a 33-year-old attorney who lives with his wife and three children in Oakland. Nelson does not have employer-based insurance, although his firm is looking into options. He has been unable to afford insurance for his family. Nelson said he was disappointed the premiums were not cheaper.\u003c/p>\n\u003cp>\"We're exactly in that income level that is essentially uninsurable,\" he said. \"We make too much money to qualify for any help, but we don't make enough money to pay for this … comfortably.\"\u003c/p>\n\u003cp>Bacchi acknowledged that while the Covered California premiums are generally \"positive news,\" that's not the case for everyone. \"The reality is that there are some people who will pay more than they currently pay. That's because the Affordable Care Act requires increased benefits and it also imposes less cost sharing on the enrollee through deductibles and co-pays.\"\u003c/p>\n\u003cp>Plans and premiums for Covered California's small business exchange are expected to be announced in June, and a major \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/14/californias-health-insurance-exchange-builds-critical-outreach-network/\">education and outreach campaign\u003c/a> will launch this summer.\u003c/p>\n\u003cp>\u003cstrong>Learn More:\u003c/strong>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Listen to a discussion of the new plans and premiums on KQED's Forum:\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201305240900.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201305240900.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "The state's health insurance exchange, Covered California, announced Thursday morning the plans and premiums that will be available to people statewide to millions of Californians.\r\n\r\nAnd what everyone wants to know is: how much will it cost. Experts had warned of \"rate shock,\" that premiums might skyrocket for all kinds of reasons.\r\n\r\nThat does not appear to be the case. Covered California says that individuals will pay an average premium of $321 per month for a \"silver\" plan.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14199\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\" wp-image-14199\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/RS170_108160554-scr-640x426.jpg\" alt=\"RS170_108160554-scr\" width=\"640\" height=\"426\">\u003cfigcaption class=\"wp-caption-text\">(Joe Raedle/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Update: Aug. 7, 2013: \u003c/strong>Covered California announced Wednesday that 12 insurance companies have formally signed contracts with the agency to offer plans on the new marketplace. Since the initial announcement (below), one company, Ventura County Health Plan, has withdrawn from offering coverage on the marketplace. The following companies will offer plans on the marketplace, although not all companies will offer plans in every region of California:\u003c/p>\n\u003caside class=\"pullquote alignright\">\u003ca href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" target=\"_blank\">Learn more about Obamacare; check out KQED's guide, specifically for Californians\u003c/a>\u003c/aside>\n\u003cp>· Alameda Alliance for Health\u003c/p>\n\u003cp>· Anthem Blue Cross of California\u003c/p>\n\u003cp>· Blue Shield of California\u003c/p>\n\u003cp>· Chinese Community Health Plan\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>· Contra Costa Health Plan\u003c/p>\n\u003cp>· Health Net\u003c/p>\n\u003cp>· Kaiser Permanente\u003c/p>\n\u003cp>· L.A. Care Health Plan\u003c/p>\n\u003cp>· Molina Healthcare\u003c/p>\n\u003cp>· Sharp Health Plan\u003c/p>\n\u003cp>· Valley Health Plan\u003c/p>\n\u003cp>· Western Health Advantage\u003c/p>\n\u003cp>Last week, Covered California \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/01/covered-california-sets-small-business-marketplace-plans-premiums/\" target=\"_blank\">announced\u003c/a> tentative plans and premiums for its small business marketplace, also called SHOP.\u003c/p>\n\u003cp>\u003cstrong>ORIGINAL POST:\u003c/strong>\u003c/p>\n\u003cp>The state's health insurance exchange, Covered California, announced Thursday morning the plans and premiums that will be available to millions of Californians.\u003c/p>\n\u003cp>And what everyone wants to know is: how much will it cost. Experts had warned of \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/03/27/health-care-overhaul-actuaries-say-costs-could-go-up-32-percent/\">rate shock\u003c/a>,\" that premiums might skyrocket for all kinds of reasons. That has not happened.\u003c/p>\n\u003cp>Covered California says that individuals will pay an average premium of $321 per month for a \"silver\" plan. (More on silver plans below.) Many people will be eligible for subsidies to reduce that cost further.\u003c/p>\n\u003cp>Across the state, people who had been working toward this day seemed to heave a collective sigh of relief.\u003c/p>\n\u003cp>\"This is a home run for consumers in every region of California,\" said Peter Lee, executive director of Covered California, in a release to reporters. \"Californians should be proud of how not only health plans in this state, but doctors, medical groups and hospitals have stepped up -- creating a market that will allow millions of consumers to enroll in affordably priced products.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\u003ca href=\"http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf\">Look up a sample of plans, premiums offered in your area.\u003c/a> \u003c/aside>\n\u003cp>Charles Bacchi, executive vice president with the California Association of Health Plans called it an \"important day\" and commended both insurance companies and providers for working together \"to deliver quality, affordable health care. We couldn't have done this without providers willing to join us to make the Affordable Care Act a success,\" he said in a reference to provider groups working to keep rates low.\u003c/p>\n\u003cp>The plans on the exchange are required to offer a standard set of comprehensive benefits. It's hard to compare premiums next year to what's in place this year, since there is no standard set of benefits at present. Covered California chose as the best comparison the average premium for a small business plan. The rates in Covered California range from 2 percent above to 29 percent below that benchmark.\u003c!--more-->\u003c/p>\n\u003cp>\"It's nice to have a good news day in California,\" said Daniel Zingale, senior vice president of The California Endowment. \"It turns out there's power in numbers when it comes to … health plans.\"\u003c/p>\n\u003cp>\u003cstrong>13 Plans Selected for the Insurance Exchange\u003c/strong>\u003c/p>\n\u003cp>The selected plans and premiums are still subject to review by state regulators. Covered California has picked 13 plans, including Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser as well as many regional plans and some country-sponsored health plans. Those include Alameda Alliance for Health, Chinese Community Health Plan, Contra Costa Health Services, L.A. Care Health Plan, Molina Helathcare, Sharp Health Paln, Valley Health Plan, Ventura County Health Care Plan and Western Health Advantage. \u003ca href=\"http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf\">You can look up your own region\u003c/a> and see what plans and premiums you can choose from.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"Everything will be quite standardized and literally charted out. So you can look across lines and compare plans.\" -- \u003cem>Betsy Imholz, Consumers Union\u003c/em>\u003c/aside>\n\u003cp>Plans will be offered in tiers of coverage: platinum, gold, silver, bronze. The platinum plans have the highest premiums but you will pay less when you see the doctor; the bronze plans have the lowest premium, meaning you will pay more when you see the doctor.\u003c/p>\n\u003cp>The \"silver\" plan mentioned above is in the middle. It has the same standard set of benefits as the other plans, and has a $2,000 annual deductible. Still, preventive care and some other services are outside the deductible -- people would pay only a co-pay when they see the doctor.\u003c/p>\n\u003cp>When setting an individual's premium, insurance plans in the exchange may look at only three factors: age, where you live and family size. Insurance companies may no longer use your health condition or your health history to set premiums. People may no longer be turned down for pre-existing conditions.\u003c/p>\n\u003cp>Subsidies are available for people making from 138 to 400 percent of the federal poverty level – or about $15,500 to $45,000 for an individual or about $31,000 to $92,000 for a family of four.\u003c/p>\n\u003cp>\u003cstrong>Breakdown on Premiums, Before and After Subsidy\u003c/strong>\u003c/p>\n\u003cp>Covered California provided tables of average rates for a 21-year-old and a 40-year-old single person. For the 21-year-old buying the most affordable silver plan, the premium is $216 per month. But depending on income, the 21-year-old may get a subsidy, making the price that person would pay range from $44 per month to $216 per month.\u003c/p>\n\u003cp>The premium for a 40-year-old buying the most affordable silver plan will be $276. But depending on the subsidy, that 40-year-old will pay from $40 to the full $276.\u003c/p>\n\u003cp>Starting this fall, people will be able to go online and look up plans and rates across the board for themselves or their families.\u003c/p>\n\u003cp>\"Everything will be quite standardized and literally charted out,\" said Betsy Imholz, special projects director for Consumers Union. \"So you can look across lines and compare plans.\"\u003c/p>\n\u003cp>On average, people in the larger metropolitan areas in California will be able to choose from among five different plans. Covered California says that even in rural areas where options have typically been sparse, people will have two or three health plans to choose from.\u003c/p>\n\u003cp>\"We were particularly concerned about Californians in rural parts of the state,\" Zingale said. \"So it's a relief to see that they will have doctors, hospitals and health benefits available in those areas.\"\u003c/p>\n\u003cp>But not everyone was delighted. Jay Nelson is a 33-year-old attorney who lives with his wife and three children in Oakland. Nelson does not have employer-based insurance, although his firm is looking into options. He has been unable to afford insurance for his family. Nelson said he was disappointed the premiums were not cheaper.\u003c/p>\n\u003cp>\"We're exactly in that income level that is essentially uninsurable,\" he said. \"We make too much money to qualify for any help, but we don't make enough money to pay for this … comfortably.\"\u003c/p>\n\u003cp>Bacchi acknowledged that while the Covered California premiums are generally \"positive news,\" that's not the case for everyone. \"The reality is that there are some people who will pay more than they currently pay. That's because the Affordable Care Act requires increased benefits and it also imposes less cost sharing on the enrollee through deductibles and co-pays.\"\u003c/p>\n\u003cp>Plans and premiums for Covered California's small business exchange are expected to be announced in June, and a major \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/05/14/californias-health-insurance-exchange-builds-critical-outreach-network/\">education and outreach campaign\u003c/a> will launch this summer.\u003c/p>\n\u003cp>\u003cstrong>Learn 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>Listen to a discussion of the new plans and premiums on KQED's Forum:\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201305240900.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201305240900.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Where You Live Affects What Kind of Surgery You'll Have: Look It Up",
"title": "Where You Live Affects What Kind of Surgery You'll Have: Look It Up",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_12878\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-12878\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/surgeon-hands-620x413.jpg\" alt=\"(Getty Images)\" width=\"620\" height=\"413\">\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Where you live matters. And in health care, it matters in all sorts of ways you might not think of immediately. If you're having elective surgery, one of the major factors determining what kind of treatment you will receive depends on where you live, according to new research released Tuesday.\u003c/p>\n\u003cp>In health policy, \"elective\" does not necessarily mean cosmetic surgery. Treatments for early stage cancers are considered \"elective\" because there are a range of options. The California Healthcare Foundation (CHCF) has been following this issue in its \"\u003ca href=\"http://www.chcf.org/publications/2011/09/medical-variation-rates-california#region=hsa&c=6/37.41928/-123.39017&procedure=epci\" target=\"_blank\">All Over the Map\u003c/a>\" project. Previously, the foundation has examined variation in heart procedures, joint replacement and c-sections. Tuesday the foundation added a detailed look at geographic variation in treatments for three more conditions: breast cancer, prostate cancer, and back and neck pain.\u003c/p>\n\u003cp>PIcking out eyebrow-raising numbers was no problem:\u003c/p>\n\u003cul>\n\u003cli>Men in Indio (Riverside County) receive brachytherapy, known commonly as radiation seeds, to treat prostate cancer at almost five times the statewide average.\u003c/li>\n\u003cli>Women in Healdsburg (Sonoma County) receive lumpectomy without radiation for early stage breast cancer at 270 percent of the statewide average.\u003c/li>\n\u003cli>People in Brawley (Imperial County) are nearly three times as likely to receive cervical fusion, where two vertebrae in the neck are fused together, for neck problems compared to statewide.\u003c/li>\n\u003c/ul>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2013/05/medical-variation-map#6/36.985/-119.443&procedure=lura_123®ion=hsa\" target=\"_blank\">\u003cimg class=\"alignright size-full wp-image-12855\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/CHCF_AllOverTheMap_Banner2_200513_R1Single.jpg\" alt=\"CHCF_AllOverTheMap_Banner2_200513_R1Single\" width=\"289\" height=\"399\">\u003c/a>Low rates are easy to find, too. To name just one: women in Lancaster, northeast of Los Angeles, with early stage breast cancer receive lumpectomy with radiation at just 26 percent of the statewide average.\u003c/p>\n\u003cp>The question is why. Maribeth Shannon with the foundation says the variation is \"just puzzling to us.\" She stressed that the statewide average is not necessarily the \"right\" rate, but the state average is an estimate that's easy to use as a benchmark.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In its analysis, the foundation accounted and adjusted for a host of patient characteristics that might skew the numbers. Still, the broad variation is there. Shannon pointed out that it would be \"unusual\" that patients would differ so significantly in what treatments they wanted, simply according to where they lived.\u003c/p>\n\u003cp>\"It's much more likely,\" Shannon said, \"that physicians practicing in that area tend to rely on that course of treatment over others. ... It does seem to be more the physician preference than the patient preference.\"\u003c!--more-->\u003c/p>\n\u003cp>Professor Renee Hsia at UC San Francisco was not involved in the study. She agreed that physician preference matters, counter to what patients might think.\u003c/p>\n\u003cp>\"A lot of patients out there think you go to one doctor and they will prescribe the same treatment,\" no matter where you live, Hsia said, \"because you go to medical school and there's one answer.\" Tuesday's release shows there's \"a lot of variability.\"\u003c/p>\n\u003cp>\"The way your peers practice ... in your group or in your hospital affects the way you practice also,\" Hsia said. \"I wouldn't say it's peer pressure, but it's adapting to your current environment.\"\u003c/p>\n\u003cp>\u003cstrong>Patients should be \"good consumers\"\u003c/strong>\u003c/p>\n\u003cp>Jeff Belkora, a UCSF professor of health policy says that physician preference for certain treatments needs to be \"trumped\" by what individual patients need. He called for patients to be good consumers and challenge their physicians. \"We want to work with our physicians,\" Belkora said. \"We want to trust them. At the same time ... any given doctor is different than any given patient, so we need to make them understand what we want and what we need.\"\u003c/p>\n\u003cp>If you're thinking that's a tall order in the face of a challenging diagnosis, patients should remember that they likely have more time to weigh options than they might think. Belkora says patients need to make their diagnosis and treatment decisions into a \"project.\"\u003c/p>\n\u003cp>Elizabeth Becker of Piedmont did exactly that. She was diagnosed with DCIS, a very early stage non-invasive breast cancer, a year ago. She spent weeks researching her treatment options. The more she found out about the specific biology of her specific type of cancer, the closer she came to a decision. While DCIS is unlikely to recur as invasive cancer, in Becker's case, if the cancer recurred, it was likely to be aggressive. Becker ultimately chose a mastectomy.\u003c/p>\n\u003cp>\"I felt powerful,\" she said, referring to the process of deciding as well as the options and choices she had. She also credited her doctor who held open-ended conversations with her. Becker said another doctor she had seen seemed to want to \"teach me about breast cancer and then tell me my (treatment) option.\" She was unimpressed.\u003c/p>\n\u003cp>Belkora says there are resources available for people facing treatment decisions. The first stop is research at reputable sites such as the American Cancer Society or the National Cancer Institute for those with a cancer diagnosis, he says.\u003c/p>\n\u003cp>The Informed Medical Decisions Foundation has \u003ca href=\"http://informedmedicaldecisions.org/shared-decision-making-in-practice/decision-aids/\" target=\"_blank\">decision aids\u003c/a> for a wide variety of conditions, from cancers to back pain to heart disease. Health libraries at medical centers can also be a good resource.\u003c/p>\n\u003cp>But it's easy to imagine that handling this \"project\" and doing all this research is a tall order for anyone staring down a diagnosis, let alone the most vulnerable among us, people who are low income, with little education, people who have limited English skills.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While Shannon said the foundation's goal is in part to encourage patients to be more proactive, she also said the greater transparency could be an effective way to let \"physicians know that they seem to be outliers,\" she said. \"that they seem to be prescribing a particular course of treatment much more often or less often than their peers across the state do.\"\u003c/p>\n\n",
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"excerpt": "Where you live matters. And in health care, it matters in all sorts of ways you might not think of immediately. If you're having elective surgery, one of the major factors determining what kind of treatment you will receive depends on where you live, according to new research released Tuesday.\r\n\r\nIn health policy, \"elective\" does not necessarily mean cosmetic surgery. Treatments for early stage cancers are considered \"elective\" because there are a range of options. The California Healthcare Foundation (CHCF) has been following this issue in its \"All Over the Map\" project. Previously, the foundation has examined variation in heart procedures, joint replacement and c-sections. Tuesday the foundation added a detailed look at geographic variation in treatments for three more conditions: breast cancer, prostate cancer, and back and neck pain.",
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"description": "Where you live matters. And in health care, it matters in all sorts of ways you might not think of immediately. If you're having elective surgery, one of the major factors determining what kind of treatment you will receive depends on where you live, according to new research released Tuesday.\r\n\r\nIn health policy, "elective" does not necessarily mean cosmetic surgery. Treatments for early stage cancers are considered "elective" because there are a range of options. The California Healthcare Foundation (CHCF) has been following this issue in its "All Over the Map" project. Previously, the foundation has examined variation in heart procedures, joint replacement and c-sections. Tuesday the foundation added a detailed look at geographic variation in treatments for three more conditions: breast cancer, prostate cancer, and back and neck pain.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_12878\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-12878\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/surgeon-hands-620x413.jpg\" alt=\"(Getty Images)\" width=\"620\" height=\"413\">\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Where you live matters. And in health care, it matters in all sorts of ways you might not think of immediately. If you're having elective surgery, one of the major factors determining what kind of treatment you will receive depends on where you live, according to new research released Tuesday.\u003c/p>\n\u003cp>In health policy, \"elective\" does not necessarily mean cosmetic surgery. Treatments for early stage cancers are considered \"elective\" because there are a range of options. The California Healthcare Foundation (CHCF) has been following this issue in its \"\u003ca href=\"http://www.chcf.org/publications/2011/09/medical-variation-rates-california#region=hsa&c=6/37.41928/-123.39017&procedure=epci\" target=\"_blank\">All Over the Map\u003c/a>\" project. Previously, the foundation has examined variation in heart procedures, joint replacement and c-sections. Tuesday the foundation added a detailed look at geographic variation in treatments for three more conditions: breast cancer, prostate cancer, and back and neck pain.\u003c/p>\n\u003cp>PIcking out eyebrow-raising numbers was no problem:\u003c/p>\n\u003cul>\n\u003cli>Men in Indio (Riverside County) receive brachytherapy, known commonly as radiation seeds, to treat prostate cancer at almost five times the statewide average.\u003c/li>\n\u003cli>Women in Healdsburg (Sonoma County) receive lumpectomy without radiation for early stage breast cancer at 270 percent of the statewide average.\u003c/li>\n\u003cli>People in Brawley (Imperial County) are nearly three times as likely to receive cervical fusion, where two vertebrae in the neck are fused together, for neck problems compared to statewide.\u003c/li>\n\u003c/ul>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2013/05/medical-variation-map#6/36.985/-119.443&procedure=lura_123®ion=hsa\" target=\"_blank\">\u003cimg class=\"alignright size-full wp-image-12855\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/CHCF_AllOverTheMap_Banner2_200513_R1Single.jpg\" alt=\"CHCF_AllOverTheMap_Banner2_200513_R1Single\" width=\"289\" height=\"399\">\u003c/a>Low rates are easy to find, too. To name just one: women in Lancaster, northeast of Los Angeles, with early stage breast cancer receive lumpectomy with radiation at just 26 percent of the statewide average.\u003c/p>\n\u003cp>The question is why. Maribeth Shannon with the foundation says the variation is \"just puzzling to us.\" She stressed that the statewide average is not necessarily the \"right\" rate, but the state average is an estimate that's easy to use as a benchmark.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In its analysis, the foundation accounted and adjusted for a host of patient characteristics that might skew the numbers. Still, the broad variation is there. Shannon pointed out that it would be \"unusual\" that patients would differ so significantly in what treatments they wanted, simply according to where they lived.\u003c/p>\n\u003cp>\"It's much more likely,\" Shannon said, \"that physicians practicing in that area tend to rely on that course of treatment over others. ... It does seem to be more the physician preference than the patient preference.\"\u003c!--more-->\u003c/p>\n\u003cp>Professor Renee Hsia at UC San Francisco was not involved in the study. She agreed that physician preference matters, counter to what patients might think.\u003c/p>\n\u003cp>\"A lot of patients out there think you go to one doctor and they will prescribe the same treatment,\" no matter where you live, Hsia said, \"because you go to medical school and there's one answer.\" Tuesday's release shows there's \"a lot of variability.\"\u003c/p>\n\u003cp>\"The way your peers practice ... in your group or in your hospital affects the way you practice also,\" Hsia said. \"I wouldn't say it's peer pressure, but it's adapting to your current environment.\"\u003c/p>\n\u003cp>\u003cstrong>Patients should be \"good consumers\"\u003c/strong>\u003c/p>\n\u003cp>Jeff Belkora, a UCSF professor of health policy says that physician preference for certain treatments needs to be \"trumped\" by what individual patients need. He called for patients to be good consumers and challenge their physicians. \"We want to work with our physicians,\" Belkora said. \"We want to trust them. At the same time ... any given doctor is different than any given patient, so we need to make them understand what we want and what we need.\"\u003c/p>\n\u003cp>If you're thinking that's a tall order in the face of a challenging diagnosis, patients should remember that they likely have more time to weigh options than they might think. Belkora says patients need to make their diagnosis and treatment decisions into a \"project.\"\u003c/p>\n\u003cp>Elizabeth Becker of Piedmont did exactly that. She was diagnosed with DCIS, a very early stage non-invasive breast cancer, a year ago. She spent weeks researching her treatment options. The more she found out about the specific biology of her specific type of cancer, the closer she came to a decision. While DCIS is unlikely to recur as invasive cancer, in Becker's case, if the cancer recurred, it was likely to be aggressive. Becker ultimately chose a mastectomy.\u003c/p>\n\u003cp>\"I felt powerful,\" she said, referring to the process of deciding as well as the options and choices she had. She also credited her doctor who held open-ended conversations with her. Becker said another doctor she had seen seemed to want to \"teach me about breast cancer and then tell me my (treatment) option.\" She was unimpressed.\u003c/p>\n\u003cp>Belkora says there are resources available for people facing treatment decisions. The first stop is research at reputable sites such as the American Cancer Society or the National Cancer Institute for those with a cancer diagnosis, he says.\u003c/p>\n\u003cp>The Informed Medical Decisions Foundation has \u003ca href=\"http://informedmedicaldecisions.org/shared-decision-making-in-practice/decision-aids/\" target=\"_blank\">decision aids\u003c/a> for a wide variety of conditions, from cancers to back pain to heart disease. Health libraries at medical centers can also be a good resource.\u003c/p>\n\u003cp>But it's easy to imagine that handling this \"project\" and doing all this research is a tall order for anyone staring down a diagnosis, let alone the most vulnerable among us, people who are low income, with little education, people who have limited English skills.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>While Shannon said the foundation's goal is in part to encourage patients to be more proactive, she also said the greater transparency could be an effective way to let \"physicians know that they seem to be outliers,\" she said. \"that they seem to be prescribing a particular course of treatment much more often or less often than their peers across the state do.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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