window.__IS_SSR__=true
window.__INITIAL_STATE__={
"attachmentsReducer": {
"audio_0": {
"type": "attachments",
"id": "audio_0",
"imgSizes": {
"kqedFullSize": {
"file": "https://ww2.kqed.org/news/wp-content/themes/KQED-unified/img/audio_bgs/background0.jpg"
}
}
},
"audio_1": {
"type": "attachments",
"id": "audio_1",
"imgSizes": {
"kqedFullSize": {
"file": "https://ww2.kqed.org/news/wp-content/themes/KQED-unified/img/audio_bgs/background1.jpg"
}
}
},
"audio_2": {
"type": "attachments",
"id": "audio_2",
"imgSizes": {
"kqedFullSize": {
"file": "https://ww2.kqed.org/news/wp-content/themes/KQED-unified/img/audio_bgs/background2.jpg"
}
}
},
"audio_3": {
"type": "attachments",
"id": "audio_3",
"imgSizes": {
"kqedFullSize": {
"file": "https://ww2.kqed.org/news/wp-content/themes/KQED-unified/img/audio_bgs/background3.jpg"
}
}
},
"audio_4": {
"type": "attachments",
"id": "audio_4",
"imgSizes": {
"kqedFullSize": {
"file": "https://ww2.kqed.org/news/wp-content/themes/KQED-unified/img/audio_bgs/background4.jpg"
}
}
},
"placeholder": {
"type": "attachments",
"id": "placeholder",
"imgSizes": {
"thumbnail": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-160x107.jpg",
"width": 160,
"height": 107,
"mimeType": "image/jpeg"
},
"medium": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-800x533.jpg",
"width": 800,
"height": 533,
"mimeType": "image/jpeg"
},
"medium_large": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-768x512.jpg",
"width": 768,
"height": 512,
"mimeType": "image/jpeg"
},
"large": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1020x680.jpg",
"width": 1020,
"height": 680,
"mimeType": "image/jpeg"
},
"1536x1536": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1536x1024.jpg",
"width": 1536,
"height": 1024,
"mimeType": "image/jpeg"
},
"fd-lrg": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1536x1024.jpg",
"width": 1536,
"height": 1024,
"mimeType": "image/jpeg"
},
"fd-med": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1020x680.jpg",
"width": 1020,
"height": 680,
"mimeType": "image/jpeg"
},
"fd-sm": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-800x533.jpg",
"width": 800,
"height": 533,
"mimeType": "image/jpeg"
},
"post-thumbnail": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-672x372.jpg",
"width": 672,
"height": 372,
"mimeType": "image/jpeg"
},
"twentyfourteen-full-width": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1038x576.jpg",
"width": 1038,
"height": 576,
"mimeType": "image/jpeg"
},
"xxsmall": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-160x107.jpg",
"width": 160,
"height": 107,
"mimeType": "image/jpeg"
},
"xsmall": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-672x372.jpg",
"width": 672,
"height": 372,
"mimeType": "image/jpeg"
},
"small": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-672x372.jpg",
"width": 672,
"height": 372,
"mimeType": "image/jpeg"
},
"xlarge": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1020x680.jpg",
"width": 1020,
"height": 680,
"mimeType": "image/jpeg"
},
"full-width": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1-1920x1280.jpg",
"width": 1920,
"height": 1280,
"mimeType": "image/jpeg"
},
"guest-author-32": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 32,
"height": 32,
"mimeType": "image/jpeg"
},
"guest-author-50": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 50,
"height": 50,
"mimeType": "image/jpeg"
},
"guest-author-64": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 64,
"height": 64,
"mimeType": "image/jpeg"
},
"guest-author-96": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 96,
"height": 96,
"mimeType": "image/jpeg"
},
"guest-author-128": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 128,
"height": 128,
"mimeType": "image/jpeg"
},
"detail": {
"file": "https://cdn.kqed.org/wp-content/uploads/2025/01/KQED-Default-Image-816638274-1333x1333-1-160x160.jpg",
"width": 160,
"height": 160,
"mimeType": "image/jpeg"
},
"kqedFullSize": {
"file": "https://cdn.kqed.org/wp-content/uploads/2024/12/KQED-Default-Image-816638274-2000x1333-1.jpg",
"width": 2000,
"height": 1333
}
}
},
"stateofhealth_342585": {
"type": "attachments",
"id": "stateofhealth_342585",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "342585",
"found": true
},
"parent": 342500,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-520x390.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 390
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-160x120.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 120
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-960x720.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 720
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-375x281.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 281
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038.jpg",
"width": 2816,
"height": 2112
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-1020x765.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 765
},
"xlarge": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-1180x885.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 885
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-800x600.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 600
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-1920x1440.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1440
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-1180x885.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 885
},
"full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-1920x1440.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1440
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-768x576.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 576
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/FreeStanding-ERs-038-240x180.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 180
}
},
"publishDate": 1497313263,
"modified": 1497313263,
"caption": null,
"description": null,
"title": "FreeStanding ERs 038",
"credit": null,
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_99973": {
"type": "attachments",
"id": "stateofhealth_99973",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "99973",
"found": true
},
"parent": 99946,
"imgSizes": {
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-400x267.jpg",
"width": 400,
"mimeType": "image/jpeg",
"height": 267
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-960x640.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 640
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-e1446142378301.jpg",
"width": 1921,
"height": 1280
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-1440x960.jpg",
"width": 1440,
"mimeType": "image/jpeg",
"height": 960
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-800x533.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 533
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"jmtc-small-thumb": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-280x150.jpg",
"width": 280,
"mimeType": "image/jpeg",
"height": 150
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-1920x1280.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1280
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-1180x786.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 786
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-75x75.jpg",
"width": 75,
"mimeType": "image/jpeg",
"height": 75
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2015/10/iStock_000071399601_Large-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
}
},
"publishDate": 1446142369,
"modified": 1467846841,
"caption": null,
"description": "Hands of practitioner with stethoscope; doctor",
"title": null,
"credit": "iStockphoto",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_338275": {
"type": "attachments",
"id": "stateofhealth_338275",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "338275",
"found": true
},
"parent": 337900,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-520x343.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 343
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-160x106.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 106
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-960x634.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 634
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-375x248.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 248
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-e1496454824569.jpg",
"width": 1920,
"height": 1267
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-1020x673.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 673
},
"xlarge": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-1180x779.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 779
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-800x528.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 528
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-1920x1267.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1267
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-1180x779.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 779
},
"full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-1920x1267.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1267
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-768x507.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 507
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-91024772-240x158.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 158
}
},
"publishDate": 1496454777,
"modified": 1496454932,
"caption": "Supporters of single payer health care hold signs as they protest outside of the Anthem Blue Cross offices September 22, 2009 in San Francisco, California. (Photo by Justin Sullivan/Getty Images)",
"description": null,
"title": "Activists Rally For Health Care Insurance Reform",
"credit": null,
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_337507": {
"type": "attachments",
"id": "stateofhealth_337507",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "337507",
"found": true
},
"parent": 337364,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-520x319.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 319
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-160x98.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 98
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-960x588.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 588
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-375x230.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 230
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network.jpg",
"width": 1213,
"height": 743
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-1020x625.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 625
},
"xlarge": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-1180x723.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 723
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-800x490.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 490
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-1180x723.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 723
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-768x470.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 470
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Health-abstract-network-240x147.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 147
}
},
"publishDate": 1496297550,
"modified": 1496297578,
"caption": null,
"description": null,
"title": "Health abstract network",
"credit": "iStock/Getty",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_337325": {
"type": "attachments",
"id": "stateofhealth_337325",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "337325",
"found": true
},
"parent": 337321,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-520x520.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 520
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-1024x576.jpg",
"width": 1024,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-160x160.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 160
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-960x960.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 960
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-375x375.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 375
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign.jpg",
"width": 1024,
"height": 1024
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-1020x1020.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 1020
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-800x800.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 800
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-768x768.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 768
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/Treating-a-Dollar-Sign-240x240.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 240
}
},
"publishDate": 1496264451,
"modified": 1496264491,
"caption": null,
"description": null,
"title": "Sick Dollar",
"credit": "iStock/Getty Images",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_316319": {
"type": "attachments",
"id": "stateofhealth_316319",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "316319",
"found": true
},
"parent": 314323,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-520x348.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 348
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-1024x576.jpg",
"width": 1024,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-160x107.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 107
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-960x642.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 642
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-375x251.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 251
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now.jpg",
"width": 1024,
"height": 685
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-1020x682.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 682
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-800x535.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 535
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-768x514.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 514
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/Single-Payer-Now-240x161.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 161
}
},
"publishDate": 1491958259,
"modified": 1491958294,
"caption": null,
"description": null,
"title": "Health Care Activists Demonstrate In Favor Of Single Payer Care Legislation",
"credit": "Justin Sullivan/Getty Images",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_148704": {
"type": "attachments",
"id": "stateofhealth_148704",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "148704",
"found": true
},
"parent": 148703,
"imgSizes": {
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-400x266.jpg",
"width": 400,
"mimeType": "image/jpeg",
"height": 266
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-960x639.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 639
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-e1455649306948.jpg",
"width": 1920,
"height": 1279
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-1440x959.jpg",
"width": 1440,
"mimeType": "image/jpeg",
"height": 959
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-800x533.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 533
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"jmtc-small-thumb": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-280x150.jpg",
"width": 280,
"mimeType": "image/jpeg",
"height": 150
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-1920x1279.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1279
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-1180x786.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 786
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-75x75.jpg",
"width": 75,
"mimeType": "image/jpeg",
"height": 75
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-768x511.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 511
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2016/02/autismscreening_enl-ca4439befe73f6a7967c47d638168053a3f1bec4-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
}
},
"publishDate": 1455649040,
"modified": 1494886899,
"caption": null,
"description": "The American Academy of Pediatrics recommends that all children be screened for autism and other developmental disorders.",
"title": "The American Academy of Pediatrics recommends that all children be screened for autism and other developmental disorders.",
"credit": "B Busco/Getty Images",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_3456": {
"type": "attachments",
"id": "stateofhealth_3456",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "3456",
"found": true
},
"parent": 3448,
"imgSizes": {
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-400x435.jpg",
"width": 400,
"mimeType": "image/jpeg",
"height": 435
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-320x348.jpg",
"width": 320,
"mimeType": "image/jpeg",
"height": 348
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty.jpg",
"width": 1477,
"height": 1608
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-1440x1568.jpg",
"width": 1440,
"mimeType": "image/jpeg",
"height": 1568
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-800x871.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 871
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-1180x1285.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 1285
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-768x836.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 836
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-75x75.jpg",
"width": 75,
"mimeType": "image/jpeg",
"height": 75
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
}
},
"publishDate": 1330714446,
"modified": 1330714446,
"caption": "(Jupiter Images: Getty)",
"description": "(Jupiter Images: Getty)",
"title": "(Jupiter Images: Getty)",
"credit": null,
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_325773": {
"type": "attachments",
"id": "stateofhealth_325773",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "325773",
"found": true
},
"parent": 325769,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-520x346.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 346
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-160x107.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 107
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-375x250.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 250
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770.jpg",
"width": 770,
"height": 513
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-768x512.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 512
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/05/breast-milk-2_770-240x160.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 160
}
},
"publishDate": 1493767431,
"modified": 1493767460,
"caption": "Prolacta Bioscience, a company based in City of Industry, Calif., stocks warehouse-like freezers full of human milk. ",
"description": null,
"title": "breast-milk-2_770",
"credit": "Heidi de Marco/KHN",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_323599": {
"type": "attachments",
"id": "stateofhealth_323599",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "323599",
"found": true
},
"parent": 323597,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-520x355.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 355
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-160x109.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 109
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-960x655.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 655
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-375x256.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 256
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-e1493399189888.jpg",
"width": 1920,
"height": 1310
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-1020x696.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 696
},
"xlarge": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-1180x805.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 805
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-800x546.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 546
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-1920x1310.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1310
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-1180x805.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 805
},
"full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-1920x1310.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1310
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-768x524.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 524
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-513491906-240x164.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 164
}
},
"publishDate": 1493399145,
"modified": 1493399232,
"caption": null,
"description": null,
"title": null,
"credit": "Getty images",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_322684": {
"type": "attachments",
"id": "stateofhealth_322684",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "322684",
"found": true
},
"parent": 322664,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-520x347.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 347
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-160x107.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 107
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-960x641.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 641
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-375x250.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 250
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-e1493241719809.jpg",
"width": 1920,
"height": 1282
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-1020x681.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 681
},
"xlarge": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-1180x788.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 788
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-800x534.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 534
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-1920x1282.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1282
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-1180x788.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 788
},
"full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-1920x1282.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1282
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-768x513.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 513
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-622208456-240x160.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 160
}
},
"publishDate": 1493241658,
"modified": 1493241685,
"caption": null,
"description": null,
"title": "iStock-622208456",
"credit": "Getty images",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
},
"stateofhealth_322155": {
"type": "attachments",
"id": "stateofhealth_322155",
"meta": {
"index": "attachments_1716263798",
"site": "stateofhealth",
"id": "322155",
"found": true
},
"parent": 322154,
"imgSizes": {
"small": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-520x347.jpg",
"width": 520,
"mimeType": "image/jpeg",
"height": 347
},
"twentyfourteen-full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-1038x576.jpg",
"width": 1038,
"mimeType": "image/jpeg",
"height": 576
},
"thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-160x107.jpg",
"width": 160,
"mimeType": "image/jpeg",
"height": 107
},
"fd-sm": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-960x641.jpg",
"width": 960,
"mimeType": "image/jpeg",
"height": 641
},
"post-thumbnail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-672x372.jpg",
"width": 672,
"mimeType": "image/jpeg",
"height": 372
},
"xsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-375x250.jpg",
"width": 375,
"mimeType": "image/jpeg",
"height": 250
},
"kqedFullSize": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-e1493135024521.jpg",
"width": 1920,
"height": 1282
},
"large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-1020x681.jpg",
"width": 1020,
"mimeType": "image/jpeg",
"height": 681
},
"xlarge": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-1180x788.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 788
},
"guest-author-50": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-50x50.jpg",
"width": 50,
"mimeType": "image/jpeg",
"height": 50
},
"guest-author-96": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-96x96.jpg",
"width": 96,
"mimeType": "image/jpeg",
"height": 96
},
"medium": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-800x534.jpg",
"width": 800,
"mimeType": "image/jpeg",
"height": 534
},
"guest-author-64": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-64x64.jpg",
"width": 64,
"mimeType": "image/jpeg",
"height": 64
},
"guest-author-32": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-32x32.jpg",
"width": 32,
"mimeType": "image/jpeg",
"height": 32
},
"fd-lrg": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-1920x1282.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1282
},
"fd-med": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-1180x788.jpg",
"width": 1180,
"mimeType": "image/jpeg",
"height": 788
},
"full-width": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-1920x1282.jpg",
"width": 1920,
"mimeType": "image/jpeg",
"height": 1282
},
"detail": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-150x150.jpg",
"width": 150,
"mimeType": "image/jpeg",
"height": 150
},
"medium_large": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-768x513.jpg",
"width": 768,
"mimeType": "image/jpeg",
"height": 513
},
"guest-author-128": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-128x128.jpg",
"width": 128,
"mimeType": "image/jpeg",
"height": 128
},
"xxsmall": {
"file": "https://ww2.kqed.org/app/uploads/sites/27/2017/04/iStock-511944320-240x160.jpg",
"width": 240,
"mimeType": "image/jpeg",
"height": 160
}
},
"publishDate": 1493134948,
"modified": 1493134996,
"caption": null,
"description": null,
"title": "iStock-511944320",
"credit": "Getty images",
"status": "inherit",
"isLoading": false,
"fetchFailed": false
}
},
"audioPlayerReducer": {
"postId": "stream_live",
"isPaused": true,
"isPlaying": false,
"pfsActive": false,
"pledgeModalIsOpen": true,
"playerDrawerIsOpen": false,
"liveAudioPlayStartedAt": 0,
"liveAudioPlayContext": ""
},
"authorsReducer": {
"byline_stateofhealth_342500": {
"type": "authors",
"id": "byline_stateofhealth_342500",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_342500",
"name": " Kellen Browning",
"isLoading": false
},
"byline_stateofhealth_337321": {
"type": "authors",
"id": "byline_stateofhealth_337321",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_337321",
"name": "\u003cstrong>\u003ca href=\"http://khn.org/news/author/chad-terhune/\">Chad Terhune\u003c/a>\u003c/strong>",
"isLoading": false
},
"byline_stateofhealth_330339": {
"type": "authors",
"id": "byline_stateofhealth_330339",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_330339",
"name": " \u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/ana-b-ibarra/\" target=\"_blank\">Ana Ibarra\u003c/a>\u003c/strong>",
"isLoading": false
},
"byline_stateofhealth_328856": {
"type": "authors",
"id": "byline_stateofhealth_328856",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_328856",
"name": "\u003cstrong> \u003ca href=\"http://californiahealthline.org/news/author/pauline-bartolone/\" target=\"_blank\">Pauline Bartolone\u003c/a>\u003c/strong>",
"isLoading": false
},
"byline_stateofhealth_325769": {
"type": "authors",
"id": "byline_stateofhealth_325769",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_325769",
"name": "\u003ca href=\"http://khn.org/news/author/eryn-brown/\">\u003cstrong>Eryn Brown\u003c/strong>\u003c/a>",
"isLoading": false
},
"byline_stateofhealth_323597": {
"type": "authors",
"id": "byline_stateofhealth_323597",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_323597",
"name": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/stephanie-oneill/\"_blank\">Stephanie O'Neill \u003c/strong>\u003c/a>\u003c/br>California Healthline",
"isLoading": false
},
"byline_stateofhealth_322664": {
"type": "authors",
"id": "byline_stateofhealth_322664",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_322664",
"name": "Associated Press",
"isLoading": false
},
"byline_stateofhealth_322154": {
"type": "authors",
"id": "byline_stateofhealth_322154",
"meta": {
"override": true
},
"slug": "byline_stateofhealth_322154",
"name": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/pauline-bartolone/\">Pauline Bartolone\u003c/strong>\u003c/a>\u003c/br>California HealthLine",
"isLoading": false
},
"adembosky": {
"type": "authors",
"id": "3205",
"meta": {
"index": "authors_1716337520",
"id": "3205",
"found": true
},
"name": "April Dembosky",
"firstName": "April",
"lastName": "Dembosky",
"slug": "adembosky",
"email": "adembosky@kqed.org",
"display_author_email": false,
"staff_mastheads": [
"news",
"science"
],
"title": "KQED Health Correspondent",
"bio": "April Dembosky is the health correspondent for KQED News and a regular contributor to NPR. She specializes in covering altered states of mind, from postpartum depression to methamphetamine-induced psychosis to the insanity defense. Her investigative series on insurance companies sidestepping mental health laws won multiple awards, including first place in beat reporting from the national Association of Health Care Journalists. She is the recipient of numerous other prizes and fellowships, including a national Edward R. Murrow award for investigative reporting, a Society of Professional Journalists award for long-form storytelling, and a Carter Center Fellowship for Mental Health Journalism.\r\n\r\nDembosky reported and produced \u003cem>Soundtrack of Silence\u003c/em>, an audio documentary about music and memory that is currently being made into a feature film by Paramount Pictures.\r\n\r\nBefore joining KQED in 2013, Dembosky covered technology and Silicon Valley for \u003cem>The Financial Times of London,\u003c/em> and contributed business and arts stories to \u003cem>Marketplace \u003c/em>and \u003cem>The New York Times.\u003c/em> She got her undergraduate degree in philosophy from Smith College and her master's in journalism from the University of California, Berkeley. She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.",
"avatar": "https://secure.gravatar.com/avatar/d6593cd737b732102fe0b6250b5351c2d3bc9b2987566514aa3c9a106494d684?s=600&d=blank&r=g",
"twitter": "adembosky",
"bluesky": null,
"facebook": null,
"instagram": null,
"linkedin": null,
"sites": [
{
"site": "arts",
"roles": [
"author"
]
},
{
"site": "news",
"roles": [
"editor"
]
},
{
"site": "futureofyou",
"roles": [
"author"
]
},
{
"site": "stateofhealth",
"roles": [
"editor"
]
},
{
"site": "science",
"roles": [
"editor"
]
},
{
"site": "forum",
"roles": [
"editor"
]
}
],
"headData": {
"title": "April Dembosky | KQED",
"description": "KQED Health Correspondent",
"ogImgSrc": "https://secure.gravatar.com/avatar/d6593cd737b732102fe0b6250b5351c2d3bc9b2987566514aa3c9a106494d684?s=600&d=blank&r=g",
"twImgSrc": "https://secure.gravatar.com/avatar/d6593cd737b732102fe0b6250b5351c2d3bc9b2987566514aa3c9a106494d684?s=600&d=blank&r=g"
},
"isLoading": false,
"link": "/author/adembosky"
},
"cfeibel": {
"type": "authors",
"id": "11314",
"meta": {
"index": "authors_1716337520",
"id": "11314",
"found": true
},
"name": "Carrie Feibel",
"firstName": "Carrie",
"lastName": "Feibel",
"slug": "cfeibel",
"email": "cfeibel@KQED.org",
"display_author_email": false,
"staff_mastheads": [],
"title": "KQED Contributor",
"bio": "Carrie Feibel is a former health editor at KQED, where she has also reported for radio and online. Her stories have appeared on the national NPR shows \u003cem>Morning Edition\u003c/em>, \u003cem>All Things Considered\u003c/em>, and \u003cem>Here & Now\u003c/em>, and on the national website, Kaiser Health News. Her print career included stints at the \u003cem>Houston Chronicle\u003c/em>, \u003cem>The (Bergen) Record,\u003c/em> and the Associated Press in New York City. A native of St. Louis, Feibel attended Cornell University, and earned a master's in journalism from Columbia University.",
"avatar": "https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g",
"twitter": "KQEDHealth",
"facebook": null,
"instagram": null,
"linkedin": null,
"sites": [
{
"site": "news",
"roles": [
"subscriber"
]
},
{
"site": "stateofhealth",
"roles": [
"administrator"
]
}
],
"headData": {
"title": "Carrie Feibel | KQED",
"description": "KQED Contributor",
"ogImgSrc": "https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g",
"twImgSrc": "https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g"
},
"isLoading": false,
"link": "/author/cfeibel"
}
},
"pagesReducer": {
"stateofhealth_category_policy": {
"type": "terms",
"id": "stateofhealth_14",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "14",
"score": 12.672578
},
"featImg": null,
"name": "Policy",
"description": "Actions by people in power – lawmakers, regulators and the like – can make a difference to your health, for better or for worse. We keep you informed",
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": "Actions by people in power – lawmakers, regulators and the like – can make a difference to your health, for better or for worse. We keep you informed",
"title": "Policy Archives | KQED Arts",
"ogDescription": null
},
"ttid": 14,
"slug": "policy",
"isLoading": false,
"title": "Policy",
"pageMeta": {
"site": "stateofhealth",
"WpPageTemplate": "page-topic-editorial",
"currentPage": 5
},
"blocks": [
{
"blockName": "kqed/company-paragraph",
"content": "Actions by people in power – lawmakers, regulators and the like – can make a difference to your health, for better or for worse. We keep you informed"
},
{
"blockName": "kqed/post-list",
"attrs": {
"layout": "cardArticle2",
"query": "posts/stateofhealth?category=policy",
"seeMore": false,
"paginated": true,
"page": 5
}
},
{
"blockName": "kqed/ad"
}
]
}
},
"pfsSessionReducer": {},
"postsReducer": {
"stream_live": {
"type": "live",
"id": "stream_live",
"audioUrl": "https://hls.kqed.org/hls/kqed_app/playlist.m3u8",
"title": "Live Stream",
"excerpt": "Live Stream information currently unavailable.",
"link": "/radio",
"featImg": "",
"label": {
"name": "KQED Live",
"link": "/"
}
},
"stream_kqedNewscast": {
"type": "posts",
"id": "stream_kqedNewscast",
"audioUrl": "https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1",
"title": "KQED Newscast",
"featImg": "",
"label": {
"name": "88.5 FM",
"link": "/"
}
},
"stateofhealth_342500": {
"type": "posts",
"id": "stateofhealth_342500",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "342500",
"score": null,
"sort": [
1497468710000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth",
"term": 3036
},
"blocks": [],
"publishDate": 1497468710,
"format": "standard",
"disqusTitle": "Medi-Cal Patients Flocking to ERs More Than Before ACA",
"title": "Medi-Cal Patients Flocking to ERs More Than Before ACA",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n",
"disqusIdentifier": "342500 https://ww2.kqed.org/stateofhealth/?p=342500",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/06/14/medi-cal-patients-flocking-to-ers-more-than-before-aca/",
"stats": {
"hasVideo": false,
"hasChartOrMap": true,
"hasAudio": false,
"hasPolis": false,
"wordCount": 740,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [
"//datawrapper.dwcdn.net/5D3d9/1/"
],
"paragraphCount": 19
},
"modified": 1497472683,
"excerpt": "Experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "Experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.",
"title": "Medi-Cal Patients Flocking to ERs More Than Before ACA | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Medi-Cal Patients Flocking to ERs More Than Before ACA",
"datePublished": "2017-06-14T12:31:50-07:00",
"dateModified": "2017-06-14T13:38:03-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "medi-cal-patients-flocking-to-ers-more-than-before-aca",
"status": "publish",
"nprByline": " Kellen Browning",
"path": "/stateofhealth/342500/medi-cal-patients-flocking-to-ers-more-than-before-aca",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Medi-Cal patients are swamping California emergency rooms in greater numbers than they did before the Affordable Care Act took effect, despite predictions that the health law would ease the burden on ERs.\u003c/p>\n\u003cp>Emergency room visits by people on Medi-Cal rose 75 percent over five years, from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, \u003ca href=\"http://www.oshpd.ca.gov/documents/PressReleases/2017/ED-Encounters-by-Expected-Payer-2012-2016.pdf\" target=\"_blank\" rel=\"noopener\">according to data\u003c/a> recently released by the state’s Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>The most dramatic increase began roughly around the time the ACA expanded health care benefits in January 2014. More than \u003ca href=\"http://www.chcf.org/publications/2016/11/facts-figures-aca-ca\" target=\"_blank\" rel=\"noopener\">5 million\u003c/a> Californians have gained coverage under the ACA, either through the expansion of Medi-Cal, California’s version of the Medicaid program for low-income people, or by purchasing health plans from Covered California, the state’s Obamacare insurance exchange.\u003c/p>\n\u003cp>The architects and proponents of Obamacare had argued that once people got health coverage they would stop going to the ER so much, because they could visit primary care doctors instead. But in reality, people who were uninsured before the ACA were actually reluctant to go to the ER unless they were “about to die,” because they would be saddled with big bills, said state Sen. Richard Pan (D-Sacramento), a pediatrician. Under Medi-Cal, though, patients aren’t worried about those expenses.\u003c/p>\n\u003cp>And old habits die hard: A newly-insured patient accustomed to visiting the ER for treatment might not immediately switch to a primary care doctor who is, “just a name — not somebody you know,” Pan added.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Still, experts believe fewer Medi-Cal patients would be visiting the ER if there were more doctors willing to treat them.\u003c/p>\n\u003cp>Though “we have seen a very strong increase in the number of Medi-Cal patients … the number of doctors willing to see Medi-Cal patients has not increased accordingly,” said Jan Emerson-Shea, vice president of external affairs for the \u003ca href=\"http://www.calhospital.org/\" target=\"_blank\" rel=\"noopener\">California Hospital Association\u003c/a>.\u003c/p>\n\u003cp>Dr. Marc Futernick, the immediate past president of the California American College of Emergency Physicians, agreed that “there aren’t adequate providers for the demands.” He said he believes Medi-Cal’s low payment rates for physicians play a role.\u003c/p>\n\u003cp>Historically, doctors across the country have been reimbursed less for treating Medicaid patients than those on private insurance or Medicare — especially in California, which \u003ca href=\"http://www.kff.org/medicaid/state-indicator/medicaid-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22All%20Services%22,%22sort%22:%22desc%22%7D\" target=\"_blank\" rel=\"noopener\">ranks 47th\u003c/a> in the country in fee-for-service reimbursement rates.\u003c/p>\n\u003cp>This means the state’s doctors are less likely to accept Medi-Cal patients, who will then seek treatment wherever they can get it, Futernick said. The ER is always open and cannot legally turn people away, even though many of the Medi-Cal patients’ ills could be treated by primary care providers, Emerson-Shea said.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe width=\"600\" height=\"338\" src=\"//datawrapper.dwcdn.net/5D3d9/1/\" frameborder=\"0\" scrolling=\"no\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>California doctors have long lobbied to increase Medi-Cal reimbursements. They are pushing hard to use some revenue from California’s recently passed tobacco tax to increase Medi-Cal rates. But Gov. Jerry Brown wants to use it more broadly for \u003ca href=\"http://www.latimes.com/politics/la-pol-sac-tobacco-tax-budget-20170316-story.html\" target=\"_blank\" rel=\"noopener\">overall Medi-Cal spending\u003c/a>.\u003c/p>\n\u003cp>Pan, the state senator, noted other factors that could explain the surge in ER use.\u003c/p>\n\u003cp>Health clinics, which see many Medi-Cal patients, generally cannot provide specialty care on site, he said. “What’s the quickest way to see a specialist? Send them to the emergency room.”\u003c/p>\n\u003cp>Moreover, many Medi-Cal patients work jobs without flexible hours or sick leave, which means they are not able to make appointments or visit health care providers during regular hours, Pan said.\u003c/p>\n\u003cp>“When I worked in the emergency room,” he recalled, “people would show up early in the morning with their kids who had an ear infection or cold or something and the parents would tell me, ‘Well, I have to go to work today or I’ll get fired.’”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>California is not the only state where the ACA has failed to produce a drop in ER use. A study \u003ca href=\"https://www.nytimes.com/2014/01/03/health/access-to-health-care-may-increase-er-visits-study-suggests.html\" target=\"_blank\" rel=\"noopener\">published in 2014\u003c/a> found that Oregon residents who won Medicaid coverage in a 2008 lottery made 40 percent more trips to the ER in the first 18 months they were covered than those who entered the lottery but were not selected.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/342500/medi-cal-patients-flocking-to-ers-more-than-before-aca",
"authors": [
"byline_stateofhealth_342500"
],
"categories": [
"stateofhealth_2442",
"stateofhealth_14",
"stateofhealth_2746"
],
"tags": [
"stateofhealth_294",
"stateofhealth_3116",
"stateofhealth_2808",
"stateofhealth_99",
"stateofhealth_2519",
"stateofhealth_365"
],
"affiliates": [
"stateofhealth_3036"
],
"featImg": "stateofhealth_342585",
"label": "stateofhealth_3036"
},
"stateofhealth_339838": {
"type": "posts",
"id": "stateofhealth_339838",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "339838",
"score": null,
"sort": [
1496833243000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth"
},
"blocks": [],
"publishDate": 1496833243,
"format": "standard",
"disqusTitle": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors?",
"title": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors?",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
"disqusIdentifier": "339838 https://ww2.kqed.org/stateofhealth/?p=339838",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/06/07/is-the-fight-over-tobacco-tax-money-about-helping-patients-or-enriching-doctors/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 1431,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 32
},
"modified": 1539629169,
"excerpt": "Doctors groups want at least half of the tax money, $610 million a year, to increase payments to doctors who treat Medi-Cal patients.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "Doctors groups want at least half of the tax money, $610 million a year, to increase payments to doctors who treat Medi-Cal patients.",
"title": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors? | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Is the Fight Over Tobacco Tax Money About Helping Patients or Helping Doctors?",
"datePublished": "2017-06-07T04:00:43-07:00",
"dateModified": "2018-10-15T11:46:09-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "is-the-fight-over-tobacco-tax-money-about-helping-patients-or-enriching-doctors",
"status": "publish",
"path": "/stateofhealth/339838/is-the-fight-over-tobacco-tax-money-about-helping-patients-or-enriching-doctors",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>One of the biggest budget fights unfolding behind closed doors in Sacramento this week is over how to spend the $1.2 billion raised by the state’s new tobacco tax, with dentists, doctors, gynecologists, and podiatrists all vying for a cut.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The biggest ask comes from the California Medical Association, which wants at least half of the money, $610 million a year, to increase payments to doctors who treat low-income patients on Medi-Cal. The group has long argued that low reimbursement rates force doctors to limit the number of Medi-Cal patients they can see, making it harder for some patients to find care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We’ve let this program atrophy for so long, you have to put a substantial amount toward it to make a difference in access to care,” says Dustin Corcoran, CEO of the \u003ca href=\"https://www.cmanet.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Medical Association\u003c/a>. “It’s been a systemic problem for years, and Prop 56 was an important investment in that.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The 2016 \u003ca href=\"http://vig.cdn.sos.ca.gov/2016/general/en/pdf/text-proposed-laws.pdf#prop56\" target=\"_blank\" rel=\"noopener noreferrer\">ballot initiative\u003c/a> that raised the tobacco tax earmarked the revenue to \"augment spending on health care for low–income Californians,” in part, by \"providing improved payments for all healthcare.\" That fuels the medical association's argument that increasing Medi-Cal payments to doctors should be the first priority. Other health advocates say California should also bring back services Medi-Cal used to cover before the recession (hearing tests, vision care, podiatry exams); and, allow undocumented immigrant young adults to receive Medi-Cal coverage until age 26. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the loudest fight over the money has revolved around the payments for doctors. The California Medical Association has been highly critical of Gov. Jerry Brown, who has routinely refused to increase doctors’ payments in years past, and whose draft budget again snubbed doctors, allocating the entirety of the tobacco tax proceeds to cover the general costs of the Medi-Cal program in the next fiscal year, namely, new patients coming on to the Medi-Cal rolls. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The thinking behind this is simple, says H.D. Palmer, the governor’s spokesman on finance and the budget. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Eighty percent of Medi-Cal patients are covered by managed care plans, Palmer explains. These insurance companies, contracted by the state to run the Medi-Cal program, are the ones who negotiate payment rates with doctors, not the governor. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Four out of every five participants in the Medi-Cal program are in managed care,” Palmer says repeatedly. “Rates are specifically negotiated between the plans and their network of providers. That’s not a negotiation that the state is in the middle of.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state can only raise reimbursement rates for doctors with whom it contracts directly in “fee-for-service” arrangements. Those doctors serve just one out of five Medi-Cal patients. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Managed care plans may look to the state rates when setting payment rates for doctors in their own networks. But insurance experts say that only happens to a minor extent. Plans rely more on a range of actuarial risk data to set rates, and increasingly, plans are paying doctors a fixed, “capitated” payment to manage each patient’s overall health for the year, rather than paying for individual appointments or medical procedures.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Fight with Governor\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nonetheless, both the state Senate and Assembly have rejected the governor’s spending plan for the tobacco tax. Instead, each house has proposed setting aside hundreds of millions of dollars to fund provider rate increases that would directly benefit doctors who serve the 20 percent of Medi-Cal patients not covered by managed-care.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“That’s still three million people,” says Anthony Wright, executive director of \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access\u003c/a>, a patient advocacy group. “There is a rationale to do this.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wright points to dental care and family planning services as two specialties that mainly operate outside managed care plans, and have a “demonstrated need” for improved access.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.auditor.ca.gov/pdfs/reports/2013-125.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">state audit\u003c/a> found 16 counties in California had no dentists accepting new Medi-Cal patients, while Planned Parenthood recently announced it will close three of its reproductive health clinics in Northern California, and Women’s Health Specialists \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/19/womens-health-clinics-in-california-struggle-in-a-shifting-healthcare-landscape/\" target=\"_blank\" rel=\"noopener noreferrer\">closed another two\u003c/a>. Both clinic operators cited low Medi-Cal reimbursement rates for family planning services as the main reason for the closures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than half of Planned Parenthood’s patients are covered by fee-for-service contracts with the state, and the Medi-Cal managed care contracts it does have, covering 31 percent of patients, specifically set fees to match the state rate, says Beth Parker, chief legal counsel for Planned Parenthood. A fee bump could help prevent more clinic closures. Also, making it easy for women to get contraception saves the state more money in the long run.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“California pays for \u003ca href=\"https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-california\" target=\"_blank\" rel=\"noopener noreferrer\">64 percent of unplanned births\u003c/a> in the state through the Medi-Cal program,\" she says. \"So every time an unplanned pregnancy is averted, it saves the state a tremendous amount of money, not just in the maternity costs, but also all the social services costs that come after.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The state Senate and Assembly are both proposing giving a small portion of the tobacco tax money specifically to family planning providers ($50 million) and dentists (up to $247 million). Up to $700 million would go to other doctors to increase payments.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But the bigger question is whether or not raising rates for doctors actually prods them to accept more Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“There’s always a question of whether or not physicians respond to economic stimuli that simply,” said Suzanne Delbanco, executive director for \u003ca href=\"https://www.catalyze.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Catalyst for Payment Reform\u003c/a>. “If an increase in fee schedules will make them take more patients, it’s hard to say what the right level of increase would be to lead to that scenario.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For example, after Tennessee’s Medicaid program increased reimbursement rates for dentists, the number of dentists participating in the program more than doubled. But the number of children who got dental care only went up by 38 percent, according to\u003c/span>\u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=DgRDGvMxpSQbiM7sxd2OnXy3MuxXAq4cOeo1xBbuoleVreZvnazUCA..&URL=http%3a%2f%2fwww.nashp.org%2fsites%2fdefault%2ffiles%2fCHCF_dental_rates.pdf\">\u003cspan style=\"font-weight: 400\"> a study\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> by the National Academy for State Health Policy.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal government tried it, too: The Affordable Care Act mandated an increase in Medicaid payments to primary care doctors for two years. In California, doctors got paid 136 percent more, but state health officials say they don't know if the increase affected the rate of patients accessing primary care in the state at all.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>California proposals\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s why the California Medical Association developed a plan, taken up by the state Assembly, to give supplemental payments to doctors based on the percentage of Medi-Cal patients they see in their practice. Doctors would get extra money if 5 percent of their patients were on Medi-Cal; they'd get more if the proportion were 10 percent, and more at 15 percent, and so on up to 30 percent.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">All doctors would be eligible for these lump sums, whether they’re contracted by the state or by managed care plans.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Many physicians have to severely limit their patient population on Medi-Cal because they lose money on each patient,” says Dustin Corcoran, the California Medical Association’s CEO. “If we can improve that and incentivize physicians to enter the space, we think that would do a lot to improve access.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But patient advocate Anthony Wright says this plan amounts to giving doctors a “bonus” for work they’ve already done, and in some cases, arguably, would have done anyway.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Instead, Wright’s group has convinced the Senate to advocate for rate increases based on data, carefully evaluating geographic regions and medical specialties for shortages, then directing money where the need is most acute. Again, these rate increases would apply to doctors seeing 20 percent of Medi-Cal patients.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“We think that would be a more targeted and data-driven way to make an impact on access to care,” Wright said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Legislature must pass a final budget by June 15, and whether lawmakers unite behind the Assembly plan, the Senate plan, or a compromise plan, they still have to convince the governor. With the number of people enrolling in Medi-Cal increasing every year, and federal funding for the program uncertain because of political infighting in D.C., Jerry Brown seems more skeptical than ever of spending new money.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "floatright"
},
"numeric": [
"floatright"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/339838/is-the-fight-over-tobacco-tax-money-about-helping-patients-or-enriching-doctors",
"authors": [
"3205"
],
"categories": [
"stateofhealth_2442",
"stateofhealth_15",
"stateofhealth_14"
],
"tags": [
"stateofhealth_2808",
"stateofhealth_2519"
],
"featImg": "stateofhealth_99973",
"label": "stateofhealth"
},
"stateofhealth_337900": {
"type": "posts",
"id": "stateofhealth_337900",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "337900",
"score": null,
"sort": [
1496454967000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth"
},
"blocks": [],
"publishDate": 1496454967,
"format": "standard",
"disqusTitle": "California Senate Passes Single-Payer Health Care Bill, Despite Missing Financial Details",
"title": "California Senate Passes Single-Payer Health Care Bill, Despite Missing Financial Details",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>State senators voted mostly along party lines, 23-14, to pass a bill that would create a state-managed health care system for all 39 million Californians – even though the bill was missing key details, namely, how to pay for it.\u003c/p>\n\u003cp>Opponents of the “Healthy California Act” repeatedly drew comparisons to the rushed Republican House bill to repeal and replace the Affordable Care Act in Washington, DC. They said state Democrats were guilty of the same tactics, pushing their bill on a single payer health system without a funding mechanism.\u003c/p>\n\u003cp>“It’s not cooked,” Sen. Jeff Stone, R-Temecula, said of the bill. “It’s raw meat.”\u003c/p>\n\u003cp>Senate Bill 596 would upend the state’s employer-based health insurance system and replace it with a “Medicare-for-all” single payer system run by the state.\u003c/p>\n\u003cp>Supporters admitted that the bill is a work in progress, but urged passage as a way to continue the debate, especially in light of uncertainty around billions of dollars in federal funding tied to the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The message to those people who say we’re irresponsible, I tell you, do not don’t judge us based upon a vote in a day,” said Sen. Bob Hertzberg, D-Los Angeles. “Judge us based upon our work at the end of the day.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz.\"\u003cbr>\n\u003ccite>Sen. John Moorlach, R-Costa Mesa\u003c/cite>\u003c/aside>\n\u003cp>How to pay for the new system – estimated to cost $400 billion a year – was the main point of contention, with several lawmakers arguing the state’s finances were already strapped.\u003c/p>\n\u003cp>\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz,\" said Sen. John Moorlach, R-Costa Mesa.\u003c/p>\n\u003cp>No specific funding plan was included in the bill, but an economic analysis by the University of Massachusetts-Amherst, commissioned by the bill’s sponsors, assumed two-thirds of the funding would come from existing federal and state funds that currently pay for Medicare and Medi-Cal, and the rest would come from either a payroll tax, or a combination of a 2.3 percent gross receipts tax on business revenue above $2 million and a 2.3 percent sales tax.\u003c/p>\n\u003cp>The health insurance industry criticized the financial assumptions in the report as “overly optimistic.\" Business groups called the taxes a “job killer” and lawmakers raised concerns on the Senate floor that the Trump administration would not allow the state, which has identified itself as a part of the Trump resistance, to re-apply those funds to a single payer system.\u003c/p>\n\u003cp>“We’re going to kick the crap out of Trump day in and day out on this floor, then we’re going to go beg him for a couple hundred billion dollars?” said Sen. Tom Berryhill, R-Twain Harte. “Should be an interesting ask.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“They are fighting to limit care and we’re fighting to expand it.”\u003cbr>\n\u003ccite>Sen. Ricardo Lara, D-Bell Gardens \u003c/cite>\u003c/aside>\n\u003cp>The bill’s primary author, Sen. Ricardo Lara, D-Bell Gardens, thanked his colleagues for a robust debate. He took copious notes, and even accepted critics’ comparison to him pushing his unfinished bill with the Republicans’ hasty passage of the repeal and replace Obamacare bill.\u003c/p>\n\u003cp>“But there is one fundamental difference,” Lara said. “They are fighting to limit care and we’re fighting to expand it.”\u003c/p>\n\u003cp>Because the bill is on a two-year legislative cycle, Lara has another year and half to work out the details of the funding plan. Getting it passed through the Senate gives him extra momentum to bring other stakeholders in on the debate, including, perhaps, Gov. Jerry Brown, who has indicated he would veto a single payer bill.\u003c/p>\n\u003cp>Lara vowed to work with lawmakers on both sides of the aisle going forward, and committed to having a transparent debate.\u003c/p>\n\u003cp>“For the countless people that still do not have access to care, and are still making the decision about putting food on their table or buying prescription drugs because they cannot afford them, we are going to put our minds together to ensure that we bring back a product that is fiscally prudent and sustainable.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
"disqusIdentifier": "337900 https://ww2.kqed.org/stateofhealth/?p=337900",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/06/02/california-senate-passes-single-payer-health-care-bill-despite-missing-financial-details/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 753,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 18
},
"modified": 1496455647,
"excerpt": "Legislative approval means more time to work out details for funding government-sponsored health plan",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "Legislative approval means more time to work out details for funding government-sponsored health plan",
"title": "California Senate Passes Single-Payer Health Care Bill, Despite Missing Financial Details | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "California Senate Passes Single-Payer Health Care Bill, Despite Missing Financial Details",
"datePublished": "2017-06-02T18:56:07-07:00",
"dateModified": "2017-06-02T19:07:27-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "california-senate-passes-single-payer-health-care-bill-despite-missing-financial-details",
"status": "publish",
"path": "/stateofhealth/337900/california-senate-passes-single-payer-health-care-bill-despite-missing-financial-details",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>State senators voted mostly along party lines, 23-14, to pass a bill that would create a state-managed health care system for all 39 million Californians – even though the bill was missing key details, namely, how to pay for it.\u003c/p>\n\u003cp>Opponents of the “Healthy California Act” repeatedly drew comparisons to the rushed Republican House bill to repeal and replace the Affordable Care Act in Washington, DC. They said state Democrats were guilty of the same tactics, pushing their bill on a single payer health system without a funding mechanism.\u003c/p>\n\u003cp>“It’s not cooked,” Sen. Jeff Stone, R-Temecula, said of the bill. “It’s raw meat.”\u003c/p>\n\u003cp>Senate Bill 596 would upend the state’s employer-based health insurance system and replace it with a “Medicare-for-all” single payer system run by the state.\u003c/p>\n\u003cp>Supporters admitted that the bill is a work in progress, but urged passage as a way to continue the debate, especially in light of uncertainty around billions of dollars in federal funding tied to the Affordable Care Act.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The message to those people who say we’re irresponsible, I tell you, do not don’t judge us based upon a vote in a day,” said Sen. Bob Hertzberg, D-Los Angeles. “Judge us based upon our work at the end of the day.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz.\"\u003cbr>\n\u003ccite>Sen. John Moorlach, R-Costa Mesa\u003c/cite>\u003c/aside>\n\u003cp>How to pay for the new system – estimated to cost $400 billion a year – was the main point of contention, with several lawmakers arguing the state’s finances were already strapped.\u003c/p>\n\u003cp>\"We should not be maxed out on our credit cards and then try and buy a Mercedes Benz,\" said Sen. John Moorlach, R-Costa Mesa.\u003c/p>\n\u003cp>No specific funding plan was included in the bill, but an economic analysis by the University of Massachusetts-Amherst, commissioned by the bill’s sponsors, assumed two-thirds of the funding would come from existing federal and state funds that currently pay for Medicare and Medi-Cal, and the rest would come from either a payroll tax, or a combination of a 2.3 percent gross receipts tax on business revenue above $2 million and a 2.3 percent sales tax.\u003c/p>\n\u003cp>The health insurance industry criticized the financial assumptions in the report as “overly optimistic.\" Business groups called the taxes a “job killer” and lawmakers raised concerns on the Senate floor that the Trump administration would not allow the state, which has identified itself as a part of the Trump resistance, to re-apply those funds to a single payer system.\u003c/p>\n\u003cp>“We’re going to kick the crap out of Trump day in and day out on this floor, then we’re going to go beg him for a couple hundred billion dollars?” said Sen. Tom Berryhill, R-Twain Harte. “Should be an interesting ask.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“They are fighting to limit care and we’re fighting to expand it.”\u003cbr>\n\u003ccite>Sen. Ricardo Lara, D-Bell Gardens \u003c/cite>\u003c/aside>\n\u003cp>The bill’s primary author, Sen. Ricardo Lara, D-Bell Gardens, thanked his colleagues for a robust debate. He took copious notes, and even accepted critics’ comparison to him pushing his unfinished bill with the Republicans’ hasty passage of the repeal and replace Obamacare bill.\u003c/p>\n\u003cp>“But there is one fundamental difference,” Lara said. “They are fighting to limit care and we’re fighting to expand it.”\u003c/p>\n\u003cp>Because the bill is on a two-year legislative cycle, Lara has another year and half to work out the details of the funding plan. Getting it passed through the Senate gives him extra momentum to bring other stakeholders in on the debate, including, perhaps, Gov. Jerry Brown, who has indicated he would veto a single payer bill.\u003c/p>\n\u003cp>Lara vowed to work with lawmakers on both sides of the aisle going forward, and committed to having a transparent debate.\u003c/p>\n\u003cp>“For the countless people that still do not have access to care, and are still making the decision about putting food on their table or buying prescription drugs because they cannot afford them, we are going to put our minds together to ensure that we bring back a product that is fiscally prudent and sustainable.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/337900/california-senate-passes-single-payer-health-care-bill-despite-missing-financial-details",
"authors": [
"3205"
],
"categories": [
"stateofhealth_15",
"stateofhealth_14"
],
"tags": [
"stateofhealth_3112",
"stateofhealth_2808",
"stateofhealth_3110",
"stateofhealth_2874",
"stateofhealth_2845",
"stateofhealth_2519",
"stateofhealth_365",
"stateofhealth_3048",
"stateofhealth_3111"
],
"featImg": "stateofhealth_338275",
"label": "stateofhealth"
},
"stateofhealth_337364": {
"type": "posts",
"id": "stateofhealth_337364",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "337364",
"score": null,
"sort": [
1496318421000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth"
},
"blocks": [],
"publishDate": 1496318421,
"format": "standard",
"disqusTitle": "Single Payer Economics: One Health Plan, Two New Taxes, Three Ways to Save",
"title": "Single Payer Economics: One Health Plan, Two New Taxes, Three Ways to Save",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>A new outside analysis claims a \"single payer\" health system for California would cost $330 billion a year, not $400 billion, the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/\" target=\"_blank\" rel=\"noopener noreferrer\">initial price tag \u003c/a>announced last week in a legislative report.\u003c/p>\n\u003cp>The financial analysis also proposed two new taxes to pay for the system: an excise tax and a sales tax. That's in contrast to the 15 percent payroll tax proposed in last week's report.\u003c/p>\n\u003cp>The analysis was produced by a team of economists at the University of Massachusetts-Amherst, and paid for by the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">California Nurses Association\u003c/a>, a key leader in the movement to establish a universal health care system in California.\u003c/p>\n\u003cp>Supporters of a single-payer plan have promised these details for months, ever since two Democrats from southern California, state senators Ricardo Lara and Toni Atkins, introduced Senate Bill 562, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">\"The Healthy California Act.\" \u003c/a>The full Senate must vote on the bill by Friday for it to move forward in the legislative process.\u003c/p>\n\u003cp>Here's your takeaway:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>One Health Plan:\u003c/strong> Say goodbye to your employer-sponsored health plan, with its deductible, co-pays and co-insurance. Say goodbye to Medicare and its part B premium. Everyone would be moved into the still-unnamed, state-administered plan. The new plan would also completely absorb anyone now covered by Medi-Cal or Covered California. The seven percent of Californians who are still uninsured -- including undocumented residents -- would be brought into the fold as well.\u003c/p>\n\u003cp>The economists argue that a single payer plan, by eliminating private, for-profit insurers in California, and by pooling together public funds from Medicare and Medi-Cal, would create a stream-lined system with lots of bargaining power.\u003c/p>\n\u003cp>\"The good news is that California can get a lot more for our money,\" said State Senator Lara after unveiling the analysis on Wednesday at the state Capitol. \"When the legislature passes the Healthy California Act, we will actually spend less than we do now on health care.\"\u003c/p>\n\u003cp>\u003cstrong>Two New Taxes: \u003c/strong>The analysis assumes California would successfully obtain permission from the federal government -- not a given under a Trump administration -- to continue drawing down federal money for Medicare and Medi-Cal patients, but divert the funds into a single-payer system instead. That would take care of two-thirds of the annual cost.\u003c/p>\n\u003cp>Then, California could raise the remaining $106 billion by taxing consumers and business. Specifically, the analysis proposes:\u003c/p>\n\u003cul>\n\u003cli>A new 2.3 percent sales tax, except on basic living expenses such as housing, groceries, and utilities.\u003c/li>\n\u003cli>A new 2.3 percent excise tax on gross business receipts (the first $2 million in receipts are exempted).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Three Ways to Save:\u003c/strong> A single-payer plan would actually cost 10 percent less than the current system, the analysis claims. How would this savings of $38 billion be achieved?\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Overhead:\u003c/strong> Having only one insurer, California, eliminates the need to make a profit or spend money on marketing and sales. The health care \"providers\" (doctors, nurses, hospitals, nursing homes, etc.), would also save money because they wouldn't have to pay people to administer different insurance contracts and navigate multiple payment systems.\u003c/li>\n\u003cli>\u003cstrong>Medical Salaries and Drug Prices:\u003c/strong> As the only entity paying for healthcare, California could negotiate lower reimbursement rates for some services. The state plan could also pressure drug companies to lower prices as a condition of having their drugs included in the state-run \u003ca href=\"https://www.healthcare.gov/glossary/formulary/\" target=\"_blank\" rel=\"noopener noreferrer\">formulary.\u003c/a>\u003c/li>\n\u003cli>\u003cstrong>More Efficient Treatment from Cradle to Grave:\u003c/strong> In a single, streamlined system, doctors won't have to duplicate tests. A unified system of electronic health records could also help identify risk factors for illness, or prompt patients to get necessary vaccines and screenings.\u003c/li>\n\u003c/ul>\n\u003cp>The new report was received skeptically by Charles Bacchi, who leads the industry trade group for private insurers, the \u003ca href=\"http://California%20Association%20of%20Health%20Plans\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. Bacchi predicted the plan would be \"incredibly disruptive\" and \"unaffordable,\" and implied that doctors might leave the state.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They assume that every doctor is going to still be here in California providing coverage under this proposal,\" he said. \"And, you know, who knows? Something like this creates a lot of uncertainty.\"\u003c/p>\n\n",
"disqusIdentifier": "337364 https://ww2.kqed.org/stateofhealth/?p=337364",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/06/01/single-payer-economics-one-health-plan-two-new-taxes-three-ways-to-save/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 693,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 15
},
"modified": 1496298197,
"excerpt": "New economic analysis lowers final price tag to $330 billion a year. ",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "New economic analysis lowers final price tag to $330 billion a year. ",
"title": "Single Payer Economics: One Health Plan, Two New Taxes, Three Ways to Save | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Single Payer Economics: One Health Plan, Two New Taxes, Three Ways to Save",
"datePublished": "2017-06-01T05:00:21-07:00",
"dateModified": "2017-05-31T23:23:17-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "single-payer-economics-one-health-plan-two-new-taxes-three-ways-to-save",
"status": "publish",
"path": "/stateofhealth/337364/single-payer-economics-one-health-plan-two-new-taxes-three-ways-to-save",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A new outside analysis claims a \"single payer\" health system for California would cost $330 billion a year, not $400 billion, the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/\" target=\"_blank\" rel=\"noopener noreferrer\">initial price tag \u003c/a>announced last week in a legislative report.\u003c/p>\n\u003cp>The financial analysis also proposed two new taxes to pay for the system: an excise tax and a sales tax. That's in contrast to the 15 percent payroll tax proposed in last week's report.\u003c/p>\n\u003cp>The analysis was produced by a team of economists at the University of Massachusetts-Amherst, and paid for by the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\" rel=\"noopener noreferrer\">California Nurses Association\u003c/a>, a key leader in the movement to establish a universal health care system in California.\u003c/p>\n\u003cp>Supporters of a single-payer plan have promised these details for months, ever since two Democrats from southern California, state senators Ricardo Lara and Toni Atkins, introduced Senate Bill 562, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml?bill_id=201720180SB562\" target=\"_blank\" rel=\"noopener noreferrer\">\"The Healthy California Act.\" \u003c/a>The full Senate must vote on the bill by Friday for it to move forward in the legislative process.\u003c/p>\n\u003cp>Here's your takeaway:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>One Health Plan:\u003c/strong> Say goodbye to your employer-sponsored health plan, with its deductible, co-pays and co-insurance. Say goodbye to Medicare and its part B premium. Everyone would be moved into the still-unnamed, state-administered plan. The new plan would also completely absorb anyone now covered by Medi-Cal or Covered California. The seven percent of Californians who are still uninsured -- including undocumented residents -- would be brought into the fold as well.\u003c/p>\n\u003cp>The economists argue that a single payer plan, by eliminating private, for-profit insurers in California, and by pooling together public funds from Medicare and Medi-Cal, would create a stream-lined system with lots of bargaining power.\u003c/p>\n\u003cp>\"The good news is that California can get a lot more for our money,\" said State Senator Lara after unveiling the analysis on Wednesday at the state Capitol. \"When the legislature passes the Healthy California Act, we will actually spend less than we do now on health care.\"\u003c/p>\n\u003cp>\u003cstrong>Two New Taxes: \u003c/strong>The analysis assumes California would successfully obtain permission from the federal government -- not a given under a Trump administration -- to continue drawing down federal money for Medicare and Medi-Cal patients, but divert the funds into a single-payer system instead. That would take care of two-thirds of the annual cost.\u003c/p>\n\u003cp>Then, California could raise the remaining $106 billion by taxing consumers and business. Specifically, the analysis proposes:\u003c/p>\n\u003cul>\n\u003cli>A new 2.3 percent sales tax, except on basic living expenses such as housing, groceries, and utilities.\u003c/li>\n\u003cli>A new 2.3 percent excise tax on gross business receipts (the first $2 million in receipts are exempted).\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Three Ways to Save:\u003c/strong> A single-payer plan would actually cost 10 percent less than the current system, the analysis claims. How would this savings of $38 billion be achieved?\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Overhead:\u003c/strong> Having only one insurer, California, eliminates the need to make a profit or spend money on marketing and sales. The health care \"providers\" (doctors, nurses, hospitals, nursing homes, etc.), would also save money because they wouldn't have to pay people to administer different insurance contracts and navigate multiple payment systems.\u003c/li>\n\u003cli>\u003cstrong>Medical Salaries and Drug Prices:\u003c/strong> As the only entity paying for healthcare, California could negotiate lower reimbursement rates for some services. The state plan could also pressure drug companies to lower prices as a condition of having their drugs included in the state-run \u003ca href=\"https://www.healthcare.gov/glossary/formulary/\" target=\"_blank\" rel=\"noopener noreferrer\">formulary.\u003c/a>\u003c/li>\n\u003cli>\u003cstrong>More Efficient Treatment from Cradle to Grave:\u003c/strong> In a single, streamlined system, doctors won't have to duplicate tests. A unified system of electronic health records could also help identify risk factors for illness, or prompt patients to get necessary vaccines and screenings.\u003c/li>\n\u003c/ul>\n\u003cp>The new report was received skeptically by Charles Bacchi, who leads the industry trade group for private insurers, the \u003ca href=\"http://California%20Association%20of%20Health%20Plans\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. Bacchi predicted the plan would be \"incredibly disruptive\" and \"unaffordable,\" and implied that doctors might leave the state.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"They assume that every doctor is going to still be here in California providing coverage under this proposal,\" he said. \"And, you know, who knows? Something like this creates a lot of uncertainty.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/337364/single-payer-economics-one-health-plan-two-new-taxes-three-ways-to-save",
"authors": [
"11314"
],
"categories": [
"stateofhealth_2442",
"stateofhealth_15",
"stateofhealth_14",
"stateofhealth_2746",
"stateofhealth_1"
],
"tags": [
"stateofhealth_294",
"stateofhealth_2808",
"stateofhealth_2845",
"stateofhealth_2519",
"stateofhealth_3048"
],
"featImg": "stateofhealth_337507",
"label": "stateofhealth"
},
"stateofhealth_337321": {
"type": "posts",
"id": "stateofhealth_337321",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "337321",
"score": null,
"sort": [
1496264630000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth",
"term": 3036
},
"blocks": [],
"publishDate": 1496264630,
"format": "standard",
"disqusTitle": "California’s New Single-Payer Proposal Based On Costly Old Ways",
"title": "California’s New Single-Payer Proposal Based On Costly Old Ways",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>Three of the dirtiest words in health care are “fee for service.”\u003c/p>\n\u003cp>For years, U.S. officials have sought to move Medicare away from paying doctors and hospitals for each task they perform, a costly approach that rewards the quantity of care over quality. State Medicaid programs and private insurers are pursuing similar changes.\u003c/p>\n\u003cp>Yet the \u003ca href=\"http://californiahealthline.org/news/tab-for-single-payer-proposal-in-california-could-run-400-billion/\">$400 billion single-payer proposal\u003c/a> that’s advancing in the California legislature would restore fee-for-service to its once-dominant perch in California.\u003c/p>\n\u003cp>A \u003ca href=\"https://assets.documentcloud.org/documents/3728610/SB-0562.pdf\">state Senate analysis\u003c/a> released last week warned that fee-for-service and other provisions in the legislation would “strongly limit the state’s ability to control costs.” Cost containment will be key in persuading lawmakers and the public to support the increased taxes that would be necessary to finance this ambitious, universal health care system for 39 million Californians.\u003c/p>\n\u003cp>Several health experts expressed skepticism about the bill’s prospects in its current form.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Single-payer has its pros and cons, but if it’s built on the foundation of fee-for-service it will be a disaster,” said Stephen Shortell, dean emeritus of the School of Public Health at the University of California-Berkeley. “It would be a huge step backwards in delivering health care.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"TJaQ7ImJONsaQhBNKC359DYzk8X4H5t4\"]\u003c/p>\n\u003cp>Paul Ginsburg, a health economist and professor at the University of Southern California, agreed and said the legislation reads like something out of the 1960s in terms of how it wants to reimburse providers.\u003c/p>\n\u003cp>“There’s broad consensus we ought to go from volume to value. This bill ignores all the signs pointing to progress and advocates a system that failed,” he said.\u003c/p>\n\u003cp>Backers of the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Healthy California proposal\u003c/a> are pushing for a vote in the Senate by Friday so the legislation can go to the state Assembly and remain in play for this year’s session.\u003c/p>\n\u003cp>The authors say that their single-payer proposal won’t rely entirely on old-fashioned fee-for-service and that there’s plenty of time for the bill to be amended. According to the authors, some of the criticism in the legislative analysis reflects a misreading of the bill: It would, they say, include some use of managed care.\u003c/p>\n\u003cp>In managed care organizations such as HMOs, providers receive a lump sum every month based on how many people they have enrolled. The idea is to encourage providers to offer preventive care and to scrutinize every test or treatment, since they bear the losses if they go over budget.\u003c/p>\n\u003cp>More than other states, California embraced this approach. In its Medicaid program, about 80 percent of enrollees are in managed care.\u003c/p>\n\u003cp>Michael Lighty, director of public policy for the California Nurses Association/National Nurses United, the lead sponsor of the California bill said “it will be a mixed-payment approach. Per capita payments are envisioned in this system.”\u003c/p>\n\u003cp>“We want to address how different payment methodologies work before mandating specifics in the bill,” he added.\u003c/p>\n\u003cp>Lighty said more provisions to curtail costs will be added shortly.\u003c/p>\n\u003cp>As opposition builds over congressional efforts to dismantle the Affordable Care Act, progressives in California and New York have responded to the ACA repeal threat by \u003ca href=\"http://nymag.com/daily/intelligencer/2017/05/new-york-and-california-consider-single-payer-health-care.html?mid=twitter-share-di\">crafting proposals\u003c/a> for universal coverage. (Such efforts failed earlier in Vermont and Colorado.)\u003c/p>\n\u003cp>Single-payer supporters are tapping into Americans’ deep dissatisfaction with the high costs and red tape embedded in the current hodgepodge of private insurance and public programs. But some defenders of the existing national health law say single-payer proposals are a costly distraction from the immediate fight in Washington over the health care safety net that millions of Americans rely on.\u003c/p>\n\u003cp>The California legislation, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Senate Bill 562\u003c/a>, requires that payments to providers be made on a “fee-for-service basis unless and until another payment methodology is established by the [Healthy California] board,” according to the bill.\u003c/p>\n\u003cp>It says health care delivery systems can choose to be paid on a capitated basis. But the analysis by the state Senate Appropriations Committee said it may be difficult for the single-payer program to establish such a payment system because of other features in the law, such as patients’ ability to see any provider with no referral necessary. A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201720180SB562\">report in April\u003c/a> from the state Senate Health Committee made a similar determination, saying multiple provisions in this bill “would make cost control unlikely to occur.”\u003c/p>\n\u003cp>The bill doesn’t address other innovative approaches being rolled out across California and the country. For instance, Medicare and private insurers are shifting to “bundled payments” for knee and hip surgeries, in which providers are paid a set fee for all treatment. More physician groups and hospitals are forming accountable care organizations (ACOs), which try to coordinate care within a budget.\u003c/p>\n\u003cp>While fee-for-service medicine can lead to excessive spending, Lighty said, ACOs and other “pay-for-performance” initiatives haven’t been entirely effective at reining in costs either.\u003c/p>\n\u003cp>The California bill faces another daunting challenge: coming up with the estimated $400 billion annually required to pay for universal coverage. Existing government money used for health care could cover half of that amount, but the other half may need to come from payroll taxes on workers and employers — not a politically palatable prospect. (The taxes could be offset in some measure by reduced health spending by employers and workers.)\u003c/p>\n\u003cp>Every Californian, regardless of age, employment or immigration status, would be eligible for coverage and there would be no premiums, copayments or deductibles. In addition, patients could see any willing provider without a referral and receive any service deemed medically appropriate.\u003c/p>\n\u003cp>Those factors would make it difficult for the program to use “drug formularies, prior authorization requirements or other utilization management tools,” the Senate analysts wrote. As a result, they estimated that health care utilization may increase by 10 percent compared to fee-for-service in Medi-Cal, the state’s Medicaid program.\u003c/p>\n\u003cp>At a hearing May 22, state Sen. Jim Nielsen (R-Tehama) said the single-payer proposal appears to invite patients to “come in for what’s almost like a blank check.”\u003c/p>\n\u003cp>State Sen. Ricardo Lara (D-Bell Gardens), a chief sponsor of the bill, acknowledged the concern and said he’s looking at what single-payer systems outside the U.S. do to contain costs.\u003c/p>\n\u003cp>The bill’s sponsors are opposed to the proliferation of narrow insurance networks that exclude providers to keep costs down. But the Senate analysis said that approach means the state couldn’t use potential exclusion from the single-payer system as a means of negotiating favorable prices, as health insurers often do.\u003c/p>\n\u003cp>Lighty said significant costs can be pared from the current system in other ways. For instance, consumers will no longer subsidize lavish salaries for hospital CEOs and excessive profits because reimbursements will be tied to “efficiently providing health care services.”\u003c/p>\n\u003cp>Lara said eliminating the middleman role of health insurers and consolidating the state’s purchasing power would lead to huge savings. “By pooling health care funds in a publicly run fund, we get the bargaining power of the seventh-largest economy in the world,” he said.\u003c/p>\n\u003cp>Insurers and brokers in California and nationwide oppose single-payer proposals because they could literally put them out of business. And legislative analysts and health policy experts question whether California would be able to exert sufficient bargaining power. They noted the political constraints that Medicare has faced in flexing its market power on prices.\u003c/p>\n\u003cp>“Our system of government may mean single-payer is much less successful than in other countries,” Ginsburg said. “We are so open to lobbying it means we can’t count on some of the very strong actions other countries have taken to keep costs down.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
"disqusIdentifier": "337321 https://ww2.kqed.org/stateofhealth/?p=337321",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/05/31/californias-new-single-payer-proposal-based-on-costly-old-ways/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 1386,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 36
},
"modified": 1496275443,
"excerpt": "Health experts say California shouldn't roll out universal health care unless there are limits on doctor and hospital fees.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "Health experts say California shouldn't roll out universal health care unless there are limits on doctor and hospital fees.",
"title": "California’s New Single-Payer Proposal Based On Costly Old Ways | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "California’s New Single-Payer Proposal Based On Costly Old Ways",
"datePublished": "2017-05-31T14:03:50-07:00",
"dateModified": "2017-05-31T17:04:03-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "californias-new-single-payer-proposal-based-on-costly-old-ways",
"status": "publish",
"nprByline": "\u003cstrong>\u003ca href=\"http://khn.org/news/author/chad-terhune/\">Chad Terhune\u003c/a>\u003c/strong>",
"path": "/stateofhealth/337321/californias-new-single-payer-proposal-based-on-costly-old-ways",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three of the dirtiest words in health care are “fee for service.”\u003c/p>\n\u003cp>For years, U.S. officials have sought to move Medicare away from paying doctors and hospitals for each task they perform, a costly approach that rewards the quantity of care over quality. State Medicaid programs and private insurers are pursuing similar changes.\u003c/p>\n\u003cp>Yet the \u003ca href=\"http://californiahealthline.org/news/tab-for-single-payer-proposal-in-california-could-run-400-billion/\">$400 billion single-payer proposal\u003c/a> that’s advancing in the California legislature would restore fee-for-service to its once-dominant perch in California.\u003c/p>\n\u003cp>A \u003ca href=\"https://assets.documentcloud.org/documents/3728610/SB-0562.pdf\">state Senate analysis\u003c/a> released last week warned that fee-for-service and other provisions in the legislation would “strongly limit the state’s ability to control costs.” Cost containment will be key in persuading lawmakers and the public to support the increased taxes that would be necessary to finance this ambitious, universal health care system for 39 million Californians.\u003c/p>\n\u003cp>Several health experts expressed skepticism about the bill’s prospects in its current form.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Single-payer has its pros and cons, but if it’s built on the foundation of fee-for-service it will be a disaster,” said Stephen Shortell, dean emeritus of the School of Public Health at the University of California-Berkeley. “It would be a huge step backwards in delivering health care.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Paul Ginsburg, a health economist and professor at the University of Southern California, agreed and said the legislation reads like something out of the 1960s in terms of how it wants to reimburse providers.\u003c/p>\n\u003cp>“There’s broad consensus we ought to go from volume to value. This bill ignores all the signs pointing to progress and advocates a system that failed,” he said.\u003c/p>\n\u003cp>Backers of the \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Healthy California proposal\u003c/a> are pushing for a vote in the Senate by Friday so the legislation can go to the state Assembly and remain in play for this year’s session.\u003c/p>\n\u003cp>The authors say that their single-payer proposal won’t rely entirely on old-fashioned fee-for-service and that there’s plenty of time for the bill to be amended. According to the authors, some of the criticism in the legislative analysis reflects a misreading of the bill: It would, they say, include some use of managed care.\u003c/p>\n\u003cp>In managed care organizations such as HMOs, providers receive a lump sum every month based on how many people they have enrolled. The idea is to encourage providers to offer preventive care and to scrutinize every test or treatment, since they bear the losses if they go over budget.\u003c/p>\n\u003cp>More than other states, California embraced this approach. In its Medicaid program, about 80 percent of enrollees are in managed care.\u003c/p>\n\u003cp>Michael Lighty, director of public policy for the California Nurses Association/National Nurses United, the lead sponsor of the California bill said “it will be a mixed-payment approach. Per capita payments are envisioned in this system.”\u003c/p>\n\u003cp>“We want to address how different payment methodologies work before mandating specifics in the bill,” he added.\u003c/p>\n\u003cp>Lighty said more provisions to curtail costs will be added shortly.\u003c/p>\n\u003cp>As opposition builds over congressional efforts to dismantle the Affordable Care Act, progressives in California and New York have responded to the ACA repeal threat by \u003ca href=\"http://nymag.com/daily/intelligencer/2017/05/new-york-and-california-consider-single-payer-health-care.html?mid=twitter-share-di\">crafting proposals\u003c/a> for universal coverage. (Such efforts failed earlier in Vermont and Colorado.)\u003c/p>\n\u003cp>Single-payer supporters are tapping into Americans’ deep dissatisfaction with the high costs and red tape embedded in the current hodgepodge of private insurance and public programs. But some defenders of the existing national health law say single-payer proposals are a costly distraction from the immediate fight in Washington over the health care safety net that millions of Americans rely on.\u003c/p>\n\u003cp>The California legislation, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\">Senate Bill 562\u003c/a>, requires that payments to providers be made on a “fee-for-service basis unless and until another payment methodology is established by the [Healthy California] board,” according to the bill.\u003c/p>\n\u003cp>It says health care delivery systems can choose to be paid on a capitated basis. But the analysis by the state Senate Appropriations Committee said it may be difficult for the single-payer program to establish such a payment system because of other features in the law, such as patients’ ability to see any provider with no referral necessary. A \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=201720180SB562\">report in April\u003c/a> from the state Senate Health Committee made a similar determination, saying multiple provisions in this bill “would make cost control unlikely to occur.”\u003c/p>\n\u003cp>The bill doesn’t address other innovative approaches being rolled out across California and the country. For instance, Medicare and private insurers are shifting to “bundled payments” for knee and hip surgeries, in which providers are paid a set fee for all treatment. More physician groups and hospitals are forming accountable care organizations (ACOs), which try to coordinate care within a budget.\u003c/p>\n\u003cp>While fee-for-service medicine can lead to excessive spending, Lighty said, ACOs and other “pay-for-performance” initiatives haven’t been entirely effective at reining in costs either.\u003c/p>\n\u003cp>The California bill faces another daunting challenge: coming up with the estimated $400 billion annually required to pay for universal coverage. Existing government money used for health care could cover half of that amount, but the other half may need to come from payroll taxes on workers and employers — not a politically palatable prospect. (The taxes could be offset in some measure by reduced health spending by employers and workers.)\u003c/p>\n\u003cp>Every Californian, regardless of age, employment or immigration status, would be eligible for coverage and there would be no premiums, copayments or deductibles. In addition, patients could see any willing provider without a referral and receive any service deemed medically appropriate.\u003c/p>\n\u003cp>Those factors would make it difficult for the program to use “drug formularies, prior authorization requirements or other utilization management tools,” the Senate analysts wrote. As a result, they estimated that health care utilization may increase by 10 percent compared to fee-for-service in Medi-Cal, the state’s Medicaid program.\u003c/p>\n\u003cp>At a hearing May 22, state Sen. Jim Nielsen (R-Tehama) said the single-payer proposal appears to invite patients to “come in for what’s almost like a blank check.”\u003c/p>\n\u003cp>State Sen. Ricardo Lara (D-Bell Gardens), a chief sponsor of the bill, acknowledged the concern and said he’s looking at what single-payer systems outside the U.S. do to contain costs.\u003c/p>\n\u003cp>The bill’s sponsors are opposed to the proliferation of narrow insurance networks that exclude providers to keep costs down. But the Senate analysis said that approach means the state couldn’t use potential exclusion from the single-payer system as a means of negotiating favorable prices, as health insurers often do.\u003c/p>\n\u003cp>Lighty said significant costs can be pared from the current system in other ways. For instance, consumers will no longer subsidize lavish salaries for hospital CEOs and excessive profits because reimbursements will be tied to “efficiently providing health care services.”\u003c/p>\n\u003cp>Lara said eliminating the middleman role of health insurers and consolidating the state’s purchasing power would lead to huge savings. “By pooling health care funds in a publicly run fund, we get the bargaining power of the seventh-largest economy in the world,” he said.\u003c/p>\n\u003cp>Insurers and brokers in California and nationwide oppose single-payer proposals because they could literally put them out of business. And legislative analysts and health policy experts question whether California would be able to exert sufficient bargaining power. They noted the political constraints that Medicare has faced in flexing its market power on prices.\u003c/p>\n\u003cp>“Our system of government may mean single-payer is much less successful than in other countries,” Ginsburg said. “We are so open to lobbying it means we can’t count on some of the very strong actions other countries have taken to keep costs down.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "floatright"
},
"numeric": [
"floatright"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/337321/californias-new-single-payer-proposal-based-on-costly-old-ways",
"authors": [
"byline_stateofhealth_337321"
],
"categories": [
"stateofhealth_14"
],
"tags": [
"stateofhealth_2808",
"stateofhealth_28",
"stateofhealth_2519",
"stateofhealth_3048"
],
"affiliates": [
"stateofhealth_3036"
],
"featImg": "stateofhealth_337325",
"label": "stateofhealth_3036"
},
"stateofhealth_333573": {
"type": "posts",
"id": "stateofhealth_333573",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "333573",
"score": null,
"sort": [
1495483865000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth"
},
"blocks": [],
"publishDate": 1495483865,
"format": "standard",
"disqusTitle": "Single-Payer Plan's Price Tag in California: $400 Billion Per Year",
"title": "Single-Payer Plan's Price Tag in California: $400 Billion Per Year",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>It would cost the state of California an estimated $400 billion per year to cover all of its 39 million residents, according to a staff analysis by the state's Senate Appropriation Committee. That's more than twice the state's total annual budget of $180 billion.\u003c/p>\n\u003cp>But the main legislative advocate for single-payer, \u003ca href=\"http://sd33.senate.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Senator Ricardo Lara\u003c/a> (D-Bell Gardens), explained the state could get access to half of that amount, $200 billion, by shifting over what it already spends on Medicare, Medi-Cal and other state-run health services. That assumes the federal government would agree to let California re-route federal funds in that way.\u003c/p>\n\u003cp>\"The fiscal estimates are subject to enormous uncertainty,\" said Nick Louizos, vice president of legislative affairs for the \u003ca href=\"http://www.calhealthplans.org/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. \"If a combination of assumptions don't come through, this could be even more expensive than we even think.\"\u003c/p>\n\u003cp>To raise the other $200 billion, the state could implement a 15 percent payroll tax, according to the analysis, which was released Monday during a Senate Appropriations Committee in Sacramento. It's unclear how that tax might be split between the employer and the employee.\u003c/p>\n\u003cp>\"Given this picture of increasing costs, health care inefficiency, and the uncertainty created by Republicans in Congress, it is critical that California chart our own path,\" said Lara at the committee hearing.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It will eliminate the need for insurance companies and their administrative costs and profits,\" he added. \"Doctors and hospitals will no longer need to negotiate rates and deals with insurance companies to seek reimbursement.\"\u003c/p>\n\u003cp>At the hearing, Kyle Thayer, a paramedic who works in San Diego, urged the legislators to move forward with the plan.\u003c/p>\n\u003cp>“I see every single day the people that don’t have health coverage and the things that happen. Often they choose between one medicine and another, and end up in the back of my ambulance for something as simple as high-blood pressure medication,\" said Thayer, a resident of Carlsbad.\u003c/p>\n\u003cp>His concerns were personal as well as professional, he said.\u003c/p>\n\u003cp>“My fiancee’s mother was trying to manage her blood pressure, and for a time wasn’t taking her medication, and she ended up with a stroke in the emergency room,\" said Thayer. \"It cost them all kinds of money.”\u003c/p>\n\u003cp>Opponents of the plan also spoke, including Karen Sarkissian from the California Chamber of Commerce, who called the 15 percent payroll tax a \"job killer,\" and a line of representatives from private health insurance companies. These companies would see their business model collapse in California in the face of a single-payer plan, which would be state-administered and not-for-profit.\u003c/p>\n\u003cp>“We don’t need to go backwards and start from scratch. This bill could have catastrophic implications for the health care system in our state,” said Teresa Stark, the chief lobbyist for Kaiser Permanente in California, which covers 8.5 million Californians.\u003c/p>\n\u003cp>\"We share the goal of health care for all,\" she explained, but added that a single-payer system would \"dismantle Kaiser Permanente as we know it.\"\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>[docCloudTestLPW]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>April Dembosky contributed reporting.\u003c/em>\u003c/p>\n\n",
"disqusIdentifier": "333573 https://ww2.kqed.org/stateofhealth/?p=333573",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/05/22/single-payers-price-tag-in-california-400-billion-a-year/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 538,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 17
},
"modified": 1495675006,
"excerpt": "It would cost the state of California more than twice the state's total annual budget.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "It would cost the state of California more than twice the state's total annual budget.",
"title": "Single-Payer Plan's Price Tag in California: $400 Billion Per Year | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Single-Payer Plan's Price Tag in California: $400 Billion Per Year",
"datePublished": "2017-05-22T13:11:05-07:00",
"dateModified": "2017-05-24T18:16:46-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "single-payers-price-tag-in-california-400-billion-a-year",
"status": "publish",
"path": "/stateofhealth/333573/single-payers-price-tag-in-california-400-billion-a-year",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It would cost the state of California an estimated $400 billion per year to cover all of its 39 million residents, according to a staff analysis by the state's Senate Appropriation Committee. That's more than twice the state's total annual budget of $180 billion.\u003c/p>\n\u003cp>But the main legislative advocate for single-payer, \u003ca href=\"http://sd33.senate.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Senator Ricardo Lara\u003c/a> (D-Bell Gardens), explained the state could get access to half of that amount, $200 billion, by shifting over what it already spends on Medicare, Medi-Cal and other state-run health services. That assumes the federal government would agree to let California re-route federal funds in that way.\u003c/p>\n\u003cp>\"The fiscal estimates are subject to enormous uncertainty,\" said Nick Louizos, vice president of legislative affairs for the \u003ca href=\"http://www.calhealthplans.org/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. \"If a combination of assumptions don't come through, this could be even more expensive than we even think.\"\u003c/p>\n\u003cp>To raise the other $200 billion, the state could implement a 15 percent payroll tax, according to the analysis, which was released Monday during a Senate Appropriations Committee in Sacramento. It's unclear how that tax might be split between the employer and the employee.\u003c/p>\n\u003cp>\"Given this picture of increasing costs, health care inefficiency, and the uncertainty created by Republicans in Congress, it is critical that California chart our own path,\" said Lara at the committee hearing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It will eliminate the need for insurance companies and their administrative costs and profits,\" he added. \"Doctors and hospitals will no longer need to negotiate rates and deals with insurance companies to seek reimbursement.\"\u003c/p>\n\u003cp>At the hearing, Kyle Thayer, a paramedic who works in San Diego, urged the legislators to move forward with the plan.\u003c/p>\n\u003cp>“I see every single day the people that don’t have health coverage and the things that happen. Often they choose between one medicine and another, and end up in the back of my ambulance for something as simple as high-blood pressure medication,\" said Thayer, a resident of Carlsbad.\u003c/p>\n\u003cp>His concerns were personal as well as professional, he said.\u003c/p>\n\u003cp>“My fiancee’s mother was trying to manage her blood pressure, and for a time wasn’t taking her medication, and she ended up with a stroke in the emergency room,\" said Thayer. \"It cost them all kinds of money.”\u003c/p>\n\u003cp>Opponents of the plan also spoke, including Karen Sarkissian from the California Chamber of Commerce, who called the 15 percent payroll tax a \"job killer,\" and a line of representatives from private health insurance companies. These companies would see their business model collapse in California in the face of a single-payer plan, which would be state-administered and not-for-profit.\u003c/p>\n\u003cp>“We don’t need to go backwards and start from scratch. This bill could have catastrophic implications for the health care system in our state,” said Teresa Stark, the chief lobbyist for Kaiser Permanente in California, which covers 8.5 million Californians.\u003c/p>\n\u003cp>\"We share the goal of health care for all,\" she explained, but added that a single-payer system would \"dismantle Kaiser Permanente as we know it.\"\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>[docCloudTestLPW]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>April Dembosky contributed reporting.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/333573/single-payers-price-tag-in-california-400-billion-a-year",
"authors": [
"11314"
],
"categories": [
"stateofhealth_15",
"stateofhealth_14"
],
"tags": [
"stateofhealth_2808",
"stateofhealth_28",
"stateofhealth_2519",
"stateofhealth_3048"
],
"featImg": "stateofhealth_316319",
"label": "stateofhealth"
},
"stateofhealth_330339": {
"type": "posts",
"id": "stateofhealth_330339",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "330339",
"score": null,
"sort": [
1494932431000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth",
"term": 3036
},
"blocks": [],
"publishDate": 1494932431,
"format": "standard",
"disqusTitle": "Fearing Deportation, Parents Worry About Enrolling Undocumented Kids In Medi-Cal",
"title": "Fearing Deportation, Parents Worry About Enrolling Undocumented Kids In Medi-Cal",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>Luz felt relieved and grateful when she learned that her 16-year-old son qualified for full coverage under Medi-Cal. Now, she worries that the information she provided to the government health program could put her family at risk of deportation.\u003c/p>\n\u003cp>Luz’s son is one of nearly 190,000 children who have enrolled in Medi-Cal since California opened it to undocumented children last year. Luz, her husband and her son came to Merced, California, from Mexico without papers about 10 years ago. Luz asked that the family’s last name not be used, for fear of being identified by federal immigration authorities.\u003c/p>\n\u003cp>In the current political climate, immigration and health advocates worry that children, like Luz’s son, will drop out of Medi-Cal and that new kids won’t enroll out of concern that personal information may be used to deport families.\u003c/p>\n\u003cp>Luz would need to renew her son’s coverage in October, but she remains undecided even though the program paid for his hospital visit when he injured a foot. “I’m still thinking about it,” she said.\u003c/p>\n\u003cp>Last May, the state Department of Health Care Services (DHCS) implemented the new “Health For All Kids” law allowing California children under 19 to receive full Medi-Cal benefits, including dental care and mental health, regardless of their immigration status. Previously, undocumented children could receive only emergency care through Medi-Cal.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California followed Illinois, Massachusetts, New York, Washington and the District of Columbia in offering state-supported health coverage to children in the country illegally.\u003c/p>\n\u003cp>Medi-Cal is California’s version of the federal Medicaid program for people with low incomes. The federal government pays for a significant portion of the California program, as it does for all states. But coverage for undocumented kids is entirely funded by the state.\u003c/p>\n\u003cp>From last May to through April 6, 189,434 undocumented children signed up for the program, according to the most recent state data. The health care services department estimates that another 61,000 children are eligible but not enrolled. Advocates say now is the time for a push to sign up these “harder-to-reach” children and to encourage those already in the program to stay.\u003c/p>\n\u003cp>Immigrant families have become more reluctant to share personal information with government programs because of the Trump administration’s planned changes in health care and immigration policies, according to a \u003ca href=\"https://www.childrennow.org/files/6714/9374/6391/H4AK-SurveyUPDATE_4_25_17FINAL.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">recent survey\u003c/a> of 62 individuals working for pediatric practices, community clinics, local public health departments and hospitals serving immigrant communities throughout the state.\u003c/p>\n\u003cp>Immigrants are also increasingly skipping doctor appointments because of similar concerns, according to the survey, conducted in March by the advocacy group Children Now.\u003c/p>\n\u003cp>Kelly Hardy, Children Now’s managing director of health policy, said some families even have \u003ca href=\"http://californiahealthline.org/news/some-immigrants-fearful-of-political-climate-shy-away-from-medi-cal/\" target=\"_blank\" rel=\"noopener noreferrer\">sought to withdraw\u003c/a> their children from the Medi-Cal program because they fear that their immigration status might be shared with immigration officials.\u003c/p>\n\u003cp>“Holding on to the kids who have recently enrolled is going to become critically important,” Hardy said. She said she hopes families will see that the coverage is a boon to their health and will not be scared away.\u003c/p>\n\u003cp>In an email last week, the DHCS reiterated to California Healthline that an applicant’s immigration status is “only used for the purposes of determining Medi-Cal eligibility.”\u003c/p>\n\u003cp>But that doesn’t eliminate the worry for some parents.\u003c/p>\n\u003cp>“This fear is horrible. We don’t know who to trust,” Luz said.\u003c/p>\n\u003cp>Before the coverage-for-all law took effect last year, undocumented children could get coverage through the Healthy Kids insurance program in some California counties. However, many of those children have been transferred to Medi-Cal, and the Healthy Kids programs are closing down.\u003c/p>\n\u003cp>Carlos Jimenez, a health policy advocate at the Mixteco Community Organizing Project in Oxnard, Calif., said the nonprofit doubled its enrollment assistance efforts after the law was implemented.\u003c/p>\n\u003cp>Community health educators known as \u003cem>promotoras\u003c/em>, spread word about the new law in farm fields, in front of supermarkets and outside churches. Last year, enrollment counselors saw up to 400 people a month who had questions about Medi-Cal, the majority looking to enroll their children, Jimenez said.\u003c/p>\n\u003cp>But after the November presidential election, enrollment counselors at Mixteco saw the number of people seeking help drop by nearly half, Jimenez said. Staffers had expected more inquiries about renewals by now, he said.\u003c/p>\n\u003cp>Most people ask whether enrolling an undocumented child would bring any problems with the U.S. Immigration and Customs Enforcement agency, Jimenez said. “We tell them their information is safe. But even then, they’re afraid.”\u003c/p>\n\u003cp>The Children Now survey showed that participants had questions about the future of Medi-Cal for undocumented children — in particular, whether it would continue if the Affordable Care Act were replaced.\u003c/p>\n\u003cp>In an \u003ca href=\"http://californiahealthline.org/news/qa-efforts-to-extend-health-coverage-to-undocumented-immigrants/\" target=\"_blank\" rel=\"noopener noreferrer\">interview\u003c/a> with California Healthline in February, Sen. Ricardo Lara (D-Bell Gardens), who authored the Health for All Kids law, said there was no reason for people to be concerned about the program’s durability.\u003c/p>\n\u003cp>Democratic Gov. Jerry Brown continues to make this program a priority, Lara said, noting that California is spending \u003ca href=\"http://www.ebudget.ca.gov/2017-18/pdf/GovernorsBudget/4000/4260.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$279.5 million\u003c/a> to continue benefits for undocumented kids this year. That’s up from the $188 million it provided for the program last year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Health advocates in California are hoping to extend the program to young adults. Earlier this month, the California Immigrant Policy Center and Health Access California, launched an online \u003ca href=\"https://act.myngp.com/Forms/7315664987463485440\" target=\"_blank\" rel=\"noopener noreferrer\">petition\u003c/a> requesting that full Medi-Cal benefits be made available to people ages 19 to 26.\u003c/p>\n\n",
"disqusIdentifier": "330339 https://ww2.kqed.org/stateofhealth/?p=330339",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/05/16/fearing-deportation-parents-worry-about-enrolling-undocumented-kids-in-medi-cal/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 951,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 26
},
"modified": 1494956541,
"excerpt": "A 2016 California law allowed children without papers to sign up for full Medi-Cal benefits. More than 189,000 children have been covered, but some families now fear renewing coverage or signing up their kids for the first time.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "A 2016 California law allowed children without papers to sign up for full Medi-Cal benefits. More than 189,000 children have been covered, but some families now fear renewing coverage or signing up their kids for the first time.",
"title": "Fearing Deportation, Parents Worry About Enrolling Undocumented Kids In Medi-Cal | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Fearing Deportation, Parents Worry About Enrolling Undocumented Kids In Medi-Cal",
"datePublished": "2017-05-16T04:00:31-07:00",
"dateModified": "2017-05-16T10:42:21-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "fearing-deportation-parents-worry-about-enrolling-undocumented-kids-in-medi-cal",
"status": "publish",
"nprByline": " \u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/ana-b-ibarra/\" target=\"_blank\">Ana Ibarra\u003c/a>\u003c/strong>",
"path": "/stateofhealth/330339/fearing-deportation-parents-worry-about-enrolling-undocumented-kids-in-medi-cal",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Luz felt relieved and grateful when she learned that her 16-year-old son qualified for full coverage under Medi-Cal. Now, she worries that the information she provided to the government health program could put her family at risk of deportation.\u003c/p>\n\u003cp>Luz’s son is one of nearly 190,000 children who have enrolled in Medi-Cal since California opened it to undocumented children last year. Luz, her husband and her son came to Merced, California, from Mexico without papers about 10 years ago. Luz asked that the family’s last name not be used, for fear of being identified by federal immigration authorities.\u003c/p>\n\u003cp>In the current political climate, immigration and health advocates worry that children, like Luz’s son, will drop out of Medi-Cal and that new kids won’t enroll out of concern that personal information may be used to deport families.\u003c/p>\n\u003cp>Luz would need to renew her son’s coverage in October, but she remains undecided even though the program paid for his hospital visit when he injured a foot. “I’m still thinking about it,” she said.\u003c/p>\n\u003cp>Last May, the state Department of Health Care Services (DHCS) implemented the new “Health For All Kids” law allowing California children under 19 to receive full Medi-Cal benefits, including dental care and mental health, regardless of their immigration status. Previously, undocumented children could receive only emergency care through Medi-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California followed Illinois, Massachusetts, New York, Washington and the District of Columbia in offering state-supported health coverage to children in the country illegally.\u003c/p>\n\u003cp>Medi-Cal is California’s version of the federal Medicaid program for people with low incomes. The federal government pays for a significant portion of the California program, as it does for all states. But coverage for undocumented kids is entirely funded by the state.\u003c/p>\n\u003cp>From last May to through April 6, 189,434 undocumented children signed up for the program, according to the most recent state data. The health care services department estimates that another 61,000 children are eligible but not enrolled. Advocates say now is the time for a push to sign up these “harder-to-reach” children and to encourage those already in the program to stay.\u003c/p>\n\u003cp>Immigrant families have become more reluctant to share personal information with government programs because of the Trump administration’s planned changes in health care and immigration policies, according to a \u003ca href=\"https://www.childrennow.org/files/6714/9374/6391/H4AK-SurveyUPDATE_4_25_17FINAL.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">recent survey\u003c/a> of 62 individuals working for pediatric practices, community clinics, local public health departments and hospitals serving immigrant communities throughout the state.\u003c/p>\n\u003cp>Immigrants are also increasingly skipping doctor appointments because of similar concerns, according to the survey, conducted in March by the advocacy group Children Now.\u003c/p>\n\u003cp>Kelly Hardy, Children Now’s managing director of health policy, said some families even have \u003ca href=\"http://californiahealthline.org/news/some-immigrants-fearful-of-political-climate-shy-away-from-medi-cal/\" target=\"_blank\" rel=\"noopener noreferrer\">sought to withdraw\u003c/a> their children from the Medi-Cal program because they fear that their immigration status might be shared with immigration officials.\u003c/p>\n\u003cp>“Holding on to the kids who have recently enrolled is going to become critically important,” Hardy said. She said she hopes families will see that the coverage is a boon to their health and will not be scared away.\u003c/p>\n\u003cp>In an email last week, the DHCS reiterated to California Healthline that an applicant’s immigration status is “only used for the purposes of determining Medi-Cal eligibility.”\u003c/p>\n\u003cp>But that doesn’t eliminate the worry for some parents.\u003c/p>\n\u003cp>“This fear is horrible. We don’t know who to trust,” Luz said.\u003c/p>\n\u003cp>Before the coverage-for-all law took effect last year, undocumented children could get coverage through the Healthy Kids insurance program in some California counties. However, many of those children have been transferred to Medi-Cal, and the Healthy Kids programs are closing down.\u003c/p>\n\u003cp>Carlos Jimenez, a health policy advocate at the Mixteco Community Organizing Project in Oxnard, Calif., said the nonprofit doubled its enrollment assistance efforts after the law was implemented.\u003c/p>\n\u003cp>Community health educators known as \u003cem>promotoras\u003c/em>, spread word about the new law in farm fields, in front of supermarkets and outside churches. Last year, enrollment counselors saw up to 400 people a month who had questions about Medi-Cal, the majority looking to enroll their children, Jimenez said.\u003c/p>\n\u003cp>But after the November presidential election, enrollment counselors at Mixteco saw the number of people seeking help drop by nearly half, Jimenez said. Staffers had expected more inquiries about renewals by now, he said.\u003c/p>\n\u003cp>Most people ask whether enrolling an undocumented child would bring any problems with the U.S. Immigration and Customs Enforcement agency, Jimenez said. “We tell them their information is safe. But even then, they’re afraid.”\u003c/p>\n\u003cp>The Children Now survey showed that participants had questions about the future of Medi-Cal for undocumented children — in particular, whether it would continue if the Affordable Care Act were replaced.\u003c/p>\n\u003cp>In an \u003ca href=\"http://californiahealthline.org/news/qa-efforts-to-extend-health-coverage-to-undocumented-immigrants/\" target=\"_blank\" rel=\"noopener noreferrer\">interview\u003c/a> with California Healthline in February, Sen. Ricardo Lara (D-Bell Gardens), who authored the Health for All Kids law, said there was no reason for people to be concerned about the program’s durability.\u003c/p>\n\u003cp>Democratic Gov. Jerry Brown continues to make this program a priority, Lara said, noting that California is spending \u003ca href=\"http://www.ebudget.ca.gov/2017-18/pdf/GovernorsBudget/4000/4260.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$279.5 million\u003c/a> to continue benefits for undocumented kids this year. That’s up from the $188 million it provided for the program last year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Health advocates in California are hoping to extend the program to young adults. Earlier this month, the California Immigrant Policy Center and Health Access California, launched an online \u003ca href=\"https://act.myngp.com/Forms/7315664987463485440\" target=\"_blank\" rel=\"noopener noreferrer\">petition\u003c/a> requesting that full Medi-Cal benefits be made available to people ages 19 to 26.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/330339/fearing-deportation-parents-worry-about-enrolling-undocumented-kids-in-medi-cal",
"authors": [
"byline_stateofhealth_330339"
],
"categories": [
"stateofhealth_11",
"stateofhealth_15",
"stateofhealth_14"
],
"tags": [
"stateofhealth_2808",
"stateofhealth_99",
"stateofhealth_2519",
"stateofhealth_2914"
],
"affiliates": [
"stateofhealth_3036"
],
"featImg": "stateofhealth_148704",
"label": "stateofhealth_3036"
},
"stateofhealth_328856": {
"type": "posts",
"id": "stateofhealth_328856",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "328856",
"score": null,
"sort": [
1494536408000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth",
"term": 3036
},
"blocks": [],
"publishDate": 1494536408,
"format": "standard",
"disqusTitle": "California Measure Aims To Limit Drugmakers’ Influence On Doctors",
"title": "California Measure Aims To Limit Drugmakers’ Influence On Doctors",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>A new California bill aims to reduce the pharmaceutical industry’s influence in medical decision-making by restricting payments and gifts from drug companies to doctors and other medical providers.\u003c/p>\n\u003cp>State Sen. Mike McGuire (D-Healdsburg), who \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB790\" target=\"_blank\" rel=\"noopener noreferrer\">authored the bill\u003c/a>, said that when drugmakers woo physicians with meals and other enticements they generate brand loyalty, which can raise health care costs and even compromise patient safety.\u003c/p>\n\u003cp>McGuire’s bill would limit drug company payments to health care providers — including cash and gifts of food, travel or entertainment — mostly to educational and scientific purposes, such as seminars.\u003c/p>\n\u003cp>“Financial incentives change minds,” said McGuire, who cited a \u003ca href=\"https://www.propublica.org/article/doctors-who-take-company-cash-tend-to-prescribe-more-brand-name-drugs\" target=\"_blank\" rel=\"noopener noreferrer\">news media report\u003c/a> showing that doctors who accepted money or meals from the pharmaceutical industry were two to three times more likely to prescribe high-priced brand-name drugs than those who did not accept such benefits.\u003c/p>\n\u003cfigure class=\"related\">\u003cfigcaption>Use Our Content\u003c/figcaption>\u003cdiv class=\"related-content\">This story can be republished for free (\u003ca href=\"/syndication/\" target=\"_blank\" rel=\"noopener noreferrer\">details\u003c/a>).\u003c/div>\n\u003c/figure>\n\u003cp>Brand-name drugs \u003ca href=\"https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/understandinggenericdrugs/ucm167991.htm\" target=\"_blank\" rel=\"noopener noreferrer\">tend to be pricier\u003c/a> than generic drugs, even though research shows they are not necessarily more effective.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The proposed measure would allow pharmaceutical companies to continue paying health care professionals for their work on clinical trials and other scientific research. And the industry could continue to sponsor educational events, as long as they were not for the purpose of promoting specific products.\u003c/p>\n\u003cp>Doctors would still be allowed to accept free drug samples and take up to $250-a-year’s worth of food paid for by companies. But drugmakers could be slapped with a $10,000 state fine if they pay a physician, or cover the cost of a flight, hotel room or entertainment for purely promotional purpose.\u003c/p>\n\u003cp>Doctors can receive hundreds of thousands of dollars from drug companies, according to a \u003ca href=\"https://www.propublica.org/article/a-pharma-payment-a-day-keeps-docs-finances-ok\" target=\"_blank\" rel=\"noopener noreferrer\">ProPublica investigation\u003c/a>. One New Hampshire nephrologist received more than a half-million dollars in speaking and consulting fees, and a Brooklyn-based psychiatrist prescribed much higher rates of brand-name drugs while receiving $53,400 from drug companies, according to ProPublica.\u003c/p>\n\u003cp>The Pharmaceutical Research and Manufacturers of America (PhRMA), the drug industry’s primary trade association, opposes McGuire’s measure, arguing that the legislation could compromise communication with companies that helps doctors stay up to date on medication safety and effectiveness.\u003c/p>\n\u003cp>Information provided by drugmakers “may inform a physician’s prescribing decisions as they weigh the best options for their patients,” said Holly Campbell, a PhRMA senior director for public affairs, in an emailed statement. “Collaboration between biopharmaceutical companies and physicians not only helps advance patient care, but is essential in the development of new treatments and diagnostics.”\u003c/p>\n\u003cp>Advocacy groups, including Consumers Union and Health Access, support the bill, saying it could lower drug costs by reducing incentives for doctors to prescribe higher-cost brand-name drugs when cheaper generic drugs are available.\u003c/p>\n\u003cp>A \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2520679\" target=\"_blank\" rel=\"noopener noreferrer\">2016 survey\u003c/a> of more than 107,000 health care consumers showed that about $73 billion from 2010 to 2012 was spent unnecessarily on brand-name drugs in cases where generic medications were available.\u003c/p>\n\u003cp>The advocates also say cutting pharmaceutical industry ties with doctors will make patients safer because providers will be more likely to prescribe based on medical evidence.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.nimh.nih.gov/news/science-news/2017/prescribing-patterns-change-following-direct-marketing-restrictions.shtml\" target=\"_blank\" rel=\"noopener noreferrer\">new study\u003c/a> published in JAMA found that doctors at academic medical centers that have restricted financial ties to the pharmaceutical industry prescribed fewer medications promoted by drug companies.\u003c/p>\n\u003cp>Several states and the District of Columbia already restrict pharmaceutical gifts to health care providers, according to Sen. McGuire and \u003ca href=\"http://www.policymed.com/2014/04/physician-payments-sunshine-act-review-of-individual-state-reporting-requirements.html\" target=\"_blank\" rel=\"noopener noreferrer\">medical education researchers.\u003c/a>\u003c/p>\n\u003cp>California health care providers received more money from pharmaceutical companies in 2014-15 — about $1.4 billion — than their counterparts in any other state, according to \u003ca href=\"https://projects.propublica.org/docdollars/\" target=\"_blank\" rel=\"noopener noreferrer\">ProPublica\u003c/a>. But some health providers in California already ban company payments and gifts to their staff.\u003c/p>\n\u003cp>\u003ca href=\"http://www.providers.kaiserpermanente.org/info_assets/cpp_cod/cod_principlesofresponsibility.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Permanente\u003c/a>, which covers more than 8 million Californians, does not allow employees involved in drug-buying decisions to accept gifts from the industry, and some physicians are restricted from accepting anything of value from the industry. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>The hospitals and clinics of the University of California-San Francisco does not allow faculty, staff or students to receive gifts from the industry.\u003c/p>\n\u003cp>“UCSF wishes to minimize such conflicts and to ensure to the best of its ability that all decisions regarding clinical care, research activities and educational content are unbiased and independent of outside influence,” according to its \u003ca href=\"https://policies.ucsf.edu/policy/150-30\" target=\"_blank\" rel=\"noopener noreferrer\">written policy\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill will next be heard in the Senate Appropriations Committee on Monday.\u003c/p>\n\n",
"disqusIdentifier": "328856 https://ww2.kqed.org/stateofhealth/?p=328856",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/05/11/california-measure-aims-to-limit-drugmakers-influence-on-doctors/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 759,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 22
},
"modified": 1494529148,
"excerpt": "The bill would limit drug company payments to health care providers — including cash and gifts of food, travel or entertainment — mostly to educational and scientific purposes, such as seminars.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "The bill would limit drug company payments to health care providers — including cash and gifts of food, travel or entertainment — mostly to educational and scientific purposes, such as seminars.",
"title": "California Measure Aims To Limit Drugmakers’ Influence On Doctors | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "California Measure Aims To Limit Drugmakers’ Influence On Doctors",
"datePublished": "2017-05-11T14:00:08-07:00",
"dateModified": "2017-05-11T11:59:08-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "california-measure-aims-to-limit-drugmakers-influence-on-doctors",
"status": "publish",
"nprByline": "\u003cstrong> \u003ca href=\"http://californiahealthline.org/news/author/pauline-bartolone/\" target=\"_blank\">Pauline Bartolone\u003c/a>\u003c/strong>",
"path": "/stateofhealth/328856/california-measure-aims-to-limit-drugmakers-influence-on-doctors",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A new California bill aims to reduce the pharmaceutical industry’s influence in medical decision-making by restricting payments and gifts from drug companies to doctors and other medical providers.\u003c/p>\n\u003cp>State Sen. Mike McGuire (D-Healdsburg), who \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB790\" target=\"_blank\" rel=\"noopener noreferrer\">authored the bill\u003c/a>, said that when drugmakers woo physicians with meals and other enticements they generate brand loyalty, which can raise health care costs and even compromise patient safety.\u003c/p>\n\u003cp>McGuire’s bill would limit drug company payments to health care providers — including cash and gifts of food, travel or entertainment — mostly to educational and scientific purposes, such as seminars.\u003c/p>\n\u003cp>“Financial incentives change minds,” said McGuire, who cited a \u003ca href=\"https://www.propublica.org/article/doctors-who-take-company-cash-tend-to-prescribe-more-brand-name-drugs\" target=\"_blank\" rel=\"noopener noreferrer\">news media report\u003c/a> showing that doctors who accepted money or meals from the pharmaceutical industry were two to three times more likely to prescribe high-priced brand-name drugs than those who did not accept such benefits.\u003c/p>\n\u003cfigure class=\"related\">\u003cfigcaption>Use Our Content\u003c/figcaption>\u003cdiv class=\"related-content\">This story can be republished for free (\u003ca href=\"/syndication/\" target=\"_blank\" rel=\"noopener noreferrer\">details\u003c/a>).\u003c/div>\n\u003c/figure>\n\u003cp>Brand-name drugs \u003ca href=\"https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/understandinggenericdrugs/ucm167991.htm\" target=\"_blank\" rel=\"noopener noreferrer\">tend to be pricier\u003c/a> than generic drugs, even though research shows they are not necessarily more effective.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The proposed measure would allow pharmaceutical companies to continue paying health care professionals for their work on clinical trials and other scientific research. And the industry could continue to sponsor educational events, as long as they were not for the purpose of promoting specific products.\u003c/p>\n\u003cp>Doctors would still be allowed to accept free drug samples and take up to $250-a-year’s worth of food paid for by companies. But drugmakers could be slapped with a $10,000 state fine if they pay a physician, or cover the cost of a flight, hotel room or entertainment for purely promotional purpose.\u003c/p>\n\u003cp>Doctors can receive hundreds of thousands of dollars from drug companies, according to a \u003ca href=\"https://www.propublica.org/article/a-pharma-payment-a-day-keeps-docs-finances-ok\" target=\"_blank\" rel=\"noopener noreferrer\">ProPublica investigation\u003c/a>. One New Hampshire nephrologist received more than a half-million dollars in speaking and consulting fees, and a Brooklyn-based psychiatrist prescribed much higher rates of brand-name drugs while receiving $53,400 from drug companies, according to ProPublica.\u003c/p>\n\u003cp>The Pharmaceutical Research and Manufacturers of America (PhRMA), the drug industry’s primary trade association, opposes McGuire’s measure, arguing that the legislation could compromise communication with companies that helps doctors stay up to date on medication safety and effectiveness.\u003c/p>\n\u003cp>Information provided by drugmakers “may inform a physician’s prescribing decisions as they weigh the best options for their patients,” said Holly Campbell, a PhRMA senior director for public affairs, in an emailed statement. “Collaboration between biopharmaceutical companies and physicians not only helps advance patient care, but is essential in the development of new treatments and diagnostics.”\u003c/p>\n\u003cp>Advocacy groups, including Consumers Union and Health Access, support the bill, saying it could lower drug costs by reducing incentives for doctors to prescribe higher-cost brand-name drugs when cheaper generic drugs are available.\u003c/p>\n\u003cp>A \u003ca href=\"http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2520679\" target=\"_blank\" rel=\"noopener noreferrer\">2016 survey\u003c/a> of more than 107,000 health care consumers showed that about $73 billion from 2010 to 2012 was spent unnecessarily on brand-name drugs in cases where generic medications were available.\u003c/p>\n\u003cp>The advocates also say cutting pharmaceutical industry ties with doctors will make patients safer because providers will be more likely to prescribe based on medical evidence.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.nimh.nih.gov/news/science-news/2017/prescribing-patterns-change-following-direct-marketing-restrictions.shtml\" target=\"_blank\" rel=\"noopener noreferrer\">new study\u003c/a> published in JAMA found that doctors at academic medical centers that have restricted financial ties to the pharmaceutical industry prescribed fewer medications promoted by drug companies.\u003c/p>\n\u003cp>Several states and the District of Columbia already restrict pharmaceutical gifts to health care providers, according to Sen. McGuire and \u003ca href=\"http://www.policymed.com/2014/04/physician-payments-sunshine-act-review-of-individual-state-reporting-requirements.html\" target=\"_blank\" rel=\"noopener noreferrer\">medical education researchers.\u003c/a>\u003c/p>\n\u003cp>California health care providers received more money from pharmaceutical companies in 2014-15 — about $1.4 billion — than their counterparts in any other state, according to \u003ca href=\"https://projects.propublica.org/docdollars/\" target=\"_blank\" rel=\"noopener noreferrer\">ProPublica\u003c/a>. But some health providers in California already ban company payments and gifts to their staff.\u003c/p>\n\u003cp>\u003ca href=\"http://www.providers.kaiserpermanente.org/info_assets/cpp_cod/cod_principlesofresponsibility.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Permanente\u003c/a>, which covers more than 8 million Californians, does not allow employees involved in drug-buying decisions to accept gifts from the industry, and some physicians are restricted from accepting anything of value from the industry. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>The hospitals and clinics of the University of California-San Francisco does not allow faculty, staff or students to receive gifts from the industry.\u003c/p>\n\u003cp>“UCSF wishes to minimize such conflicts and to ensure to the best of its ability that all decisions regarding clinical care, research activities and educational content are unbiased and independent of outside influence,” according to its \u003ca href=\"https://policies.ucsf.edu/policy/150-30\" target=\"_blank\" rel=\"noopener noreferrer\">written policy\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill will next be heard in the Senate Appropriations Committee on Monday.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/328856/california-measure-aims-to-limit-drugmakers-influence-on-doctors",
"authors": [
"byline_stateofhealth_328856"
],
"categories": [
"stateofhealth_14"
],
"tags": [
"stateofhealth_2892",
"stateofhealth_2808",
"stateofhealth_3103"
],
"affiliates": [
"stateofhealth_3036"
],
"featImg": "stateofhealth_3456",
"label": "stateofhealth_3036"
},
"stateofhealth_325769": {
"type": "posts",
"id": "stateofhealth_325769",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "325769",
"score": null,
"sort": [
1493767618000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth",
"term": 3036
},
"blocks": [],
"publishDate": 1493767618,
"format": "standard",
"disqusTitle": "Going For $1 An Ounce: The Burgeoning Trade In Mothers’ Milk",
"title": "Going For $1 An Ounce: The Burgeoning Trade In Mothers’ Milk",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>PALM SPRINGS, Calif. — Rebecca Soltes walked into a gaily decorated hospital meeting room, pushing her kids in a double stroller and carrying a soft-sided cooler filled with bags of frozen breast milk — 100 ounces of the stuff.\u003c/p>\n\u003cp>She dropped it on a table, and the roomful of lactation consultants and maternal health advocates from California’s Inland Empire erupted in applause.\u003c/p>\n\u003cp>She was donating the milk because she didn’t need it anymore. Her son, a young toddler, had recently graduated to solid food, but her freezer at home was still packed with pumped milk.\u003c/p>\n\u003cp>“I didn’t know what to do with it,” a harried-looking Soltes told two young staffers from the \u003ca href=\"http://www.mothersmilk.org\">Mothers’ Milk Bank\u003c/a>, a nonprofit group in San Jose, Calif., that provides breast milk for fragile infants in neonatal intensive care units (NICUs).\u003c/p>\n\u003cp>Increasing numbers of women who produce more breast milk than they need are handing it over — or selling it — for others to use. It’s a boon to fragile infants and mothers who can’t produce enough milk, but it also poses challenging ethical and public health questions.\u003c/p>\n\u003cdiv class=\"side-by-side\">\n\u003cdiv class=\"alignleft wp-caption\">\n\t\t\t\t\t\t\t\t\t\u003cimg width=\"770\" height=\"513\" src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-9_770.jpg?w=770&h=513&crop=1\" class=\"attachment-khn-article-large size-khn-article-large\" alt=\"\">\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\u003cp class=\"wp-caption-text\">A breast milk fair, where the milk is collected for fragile infants in neonatal intensive care units, was held in Palm Springs, Calif., in August 2016. (Heidi de Marco/California KHN)\u003c/p>\n\u003c/div>\n\u003cdiv class=\"alignright wp-caption\">\n\t\t\t\t\t\t\t\t\t\u003cimg width=\"770\" height=\"513\" src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-8_770.jpg?w=770&h=513&crop=1\" class=\"attachment-khn-article-large size-khn-article-large\" alt=\"\">\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\u003cp class=\"wp-caption-text\">Christina Beltran, who recently had a baby, signs up to receive more information at the Palm Springs breast milk donation fair. (Heidi de Marco/KHN)\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Physicians, regulators and others ask: Should sickly, premature babies get access to this milk before healthy ones? Should women be paid for their milk — even if it might lead some to deprive their own infants? Should greater safeguards be required to ensure the safety of the supply?\u003c/p>\n\u003cp>The \u003ca href=\"https://www.fda.gov/scienceresearch/specialtopics/pediatrictherapeuticsresearch/ucm235203.htm\">Food and Drug Administration\u003c/a> does not require testing for donated human milk. A handful of states, including California and New York, regulate milk banks the way they do tissue banks, enforcing some safety standards, and many nonprofit milk banks screen donors.\u003c/p>\n\u003cp>But the FDA has expressed concern about milk-trading websites, \u003ca href=\"http://www.aappublications.org/content/32/2/6.1\">warning consumers\u003c/a> that the milk offered there carries an increased risk of contamination by drugs or disease, including HIV. The agency further urges mothers not to feed their infants donated milk acquired from other individuals or over the internet, also because of such safety risks.\u003c/p>\n\u003cp>Some companies and medical experts wonder if even established milk banks — whose voluntary screening practices the FDA praised in 2010 — should be doing more to ensure safety. Dr. Jae Hong Kim, a neonatologist at UC-San Diego, said milk banks’ safety efforts have worked well thus far but are not error-free. “The challenge is, if you expand the operations, you increase your risk exposure,” he said.\u003c/p>\n\u003cp>Scott Elster, CEO of Prolacta Bioscience, a company that uses human milk to make fortifier products in its pharmaceutical-grade manufacturing facility, said he advocates a more rigorous level of screening.\u003c/p>\n\u003cp>“We believe that all human milk, whether it is distributed commercially, by a nonprofit or peer-to-peer network, should be tested for drugs of abuse, nicotine and other adulterants,” he said.\u003c/p>\n\u003cp>Milk Magic\u003c/p>\n\u003cp>As recently as the early 1970s, barely a fifth of American babies were breast-fed. Today, \u003ca href=\"https://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf\">more than 80%\u003c/a> get at least a taste of their mother’s milk, according to the federal Centers for Disease Control and Prevention. The health advantages are well-established, especially for premature infants.\u003c/p>\n\u003cp>“The first class I had on human milk I was blown away,” said Maryanne Perrin, a nutrition scientist at the University of North Carolina-Greensboro. “It’s Harry Potter meets Willy Wonka. It’s a magical food.”\u003c/p>\n\u003cp> The Food and Drug Administration does not require testing for donated human milk. A handful of states, including California and New York, regulate milk banks as they do tissue banks. (Heidi de Marco/KHN)\u003c/p>\n\u003cp>Some breast-feeding enthusiasts refer to human milk as “liquid gold.” At times, it seems as though everyone wants the stuff — from nonprofits like Mothers’ Milk Bank, to high-tech pharmaceutical companies that concentrate it into premium medical products, to your neighbor who might just want a bit more to supplement her baby’s diet.\u003c/p>\n\u003cp>Each year, new human milk banks open and new milk-focused companies are launched.\u003c/p>\n\u003cp>No one knows exactly how much of this excess milk is donated or sold, but the volume is increasing. Pauline Sakamoto, executive director of the Mothers’ Milk Bank and former president of the \u003ca href=\"https://www.hmbana.org\">Human Milk Banking Association of North America\u003c/a>, an association of nonprofit milk banks in the U.S. and Canada, said her organization’s affiliated banks distributed about 4.4 million ounces of human milk to hospitals last year, up from less than half that amount as recently as five years ago. When Sakamoto became president of the organization in 2014, it had 18 milk banks. Now it has more than 30 open or planned.\u003c/p>\n\u003cp>To Profit Or Not To Profit?\u003c/p>\n\u003cp>The Mothers’ Milk Bank workers from San Jose traveled nearly 450 miles last year for donation drives in the southern part of the state, including the one at the Desert Regional Medical Center in Palm Springs where they applauded Soltes. The bank collects and pasteurizes donated human milk and provides it at cost to NICUs throughout California.\u003c/p>\n\u003cp>Over the week, workers planned to conduct risk screenings, including blood testing for HIV and other diseases, on mothers like Soltes. They also planned to ask the women’s doctors — and their babies’ doctors — to approve the donations. The team expected to collect 7,542 ounces of pumped breast milk — enough to provide more than 30,000 feedings for premature infants in NICUs.\u003c/p>\n\u003cp>“Right now, we have a consistent flow of milk coming in,” said Leah Carig, donor coordinator at the San Jose-based bank. “In the past, we’ve had to put out [e-mail] blasts” to increase supply.\u003c/p>\n\u003cfigure class=\"layout-lg carousel-article carousel slide carousel-article-1\">\n\u003col class=\"carousel-indicators\">\n\u003cli class=\"active\">\n\u003cli>\n\u003cli>\n\u003c/ol>\n\u003cdiv class=\"carousel-inner\">\n\u003cdiv class=\"item active\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-5_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Prolacta Bioscience purchases breast milk from women for $1 per ounce, tests it rigorously and uses it to make fortifiers that are added to a mother’s or donor’s milk to deliver extra calories, proteins and minerals to premature babies. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-4_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">“We believe that all human milk, whether it is distributed commercially, by a nonprofit or peer-to-peer network, should be tested for drugs of abuse, nicotine and other adulterants,” says Prolacta CEO Scott Elster. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-6_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Prolacta’s products win praise from NICU physicians because they can replace fortifiers made of cow’s milk, which are known to increase the risk of necrotizing enterocolitis and sepsis. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003c/div>\n\u003cp>\u003ca class=\"left carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-prev\">\u003c/span>\u003c/a>\u003ca class=\"right carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-next\">\u003c/span>\u003c/a>\u003c/p>\u003c/figure>\n\u003cp>For-profit breast milk operations are expanding, too. Elster’s company, \u003ca href=\"http://www.prolacta.com\">Prolacta Bioscience\u003c/a>, stocks warehouse-like freezers full of human milk.\u003c/p>\n\u003cp>Based in City of Industry, Calif., it purchases the milk from women for $1 per ounce. The company uses it to make fortifiers that are added to a mother’s or donor’s milk to deliver extra calories, proteins and minerals to premature babies.\u003c/p>\n\u003cp>The products are expensive, at $200 to $300 for a one-day supply. But they win praise from NICU physicians like Kim, because they can replace fortifiers made of cow’s milk, which are known to increase the risk of necrotizing enterocolitis and sepsis.\u003c/p>\n\u003cp>Beyond the NICU and the gates of industry, informal internet-based sites, with names like \u003ca href=\"http://www.onlythebreast.com\">Only the Breast\u003c/a> and \u003ca href=\"http://www.eatsonfeets.org\">Eats on Feets\u003c/a>, also \u003ca href=\"http://online.liebertpub.com/doi/abs/10.1089/bfm.2013.0114\">appear to be booming\u003c/a>. One \u003ca href=\"http://www.theverge.com/2015/4/28/8504443/mothers-buying-breast-milk-online-donors-risks\">report\u003c/a> estimated that the number of online milk transactions in the U.S. soared from 22,000 in 2012 to 55,000 in 2015.\u003c/p>\n\u003cp>Some milk-sharing networks are run by mothers who sell their milk, while others give it away.\u003c/p>\n\u003cp>Mandy Lindberg, a board member of the \u003ca href=\"http://www.iebreastfeeding.org/about3\">Inland Empire Breastfeeding Coalition\u003c/a>, has experience with both formal and informal donation networks. She said that women often opt to donate among themselves because they want to help friends or neighbors who don’t have enough milk for their babies.\u003c/p>\n\u003cp>“It’s nice to put a face with the name,” Lindberg said.\u003c/p>\n\u003cp>Research shows there’s some risk with milk that changes hands on informal sites, however. In 2015, a team of researchers who purchased breast milk on the open market \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/03/31/peds.2014-3554\">reported\u003c/a> in the journal Pediatrics that about 10 percent of samples contained cow’s milk, which could have been added by the sellers to increase volume and thus the size of the payment. The same team had reported in 2013 that milk purchased online was \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/10/16/peds.2013-1687.full.pdf+html\">frequently contaminated\u003c/a> by pathogenic bacteria.\u003c/p>\n\u003cp>Kim Updegrove, executive director of the nonprofit \u003ca href=\"https://www.milkbank.org\">Mothers’ Milk Bank at Austin\u003c/a>, in Texas, says the FDA should regulate informal milk-sharing, ideally requiring all milk to go through a milk bank focused on distributing it according to the greatest medical need. This, she believes, would help make the practice safer and ensure that the sickest babies were given priority.\u003c/p>\n\u003cp>Updegrove and others fear that if financial gain were to become the dominant factor in distribution of human milk, supplies could be siphoned away from the sickest NICU babies. Poor mothers might sell their milk instead of giving it to their own children, these critics said.\u003c/p>\n\u003cp>Women involved in sharing networks don’t always understand the mission and practices of nonprofit milk banks, Perrin reported with colleagues in a \u003ca href=\"http://jhl.sagepub.com/content/32/2/229.short\">2016 paper\u003c/a> that appeared in the Journal of Human Lactation. Better education might encourage more to donate for NICU use, she suggested.\u003c/p>\n\u003cp>She said that when she started her research, she thought of human milk as a “scarce resource.” “But I’ve talked to women who have shared 9,600 ounces of milk. Some have freezers full,” she said. “I think it’s a distribution problem, and not a supply problem.”\u003c/p>\n\u003cp>The entire concept of breast milk banking — of any type — was new to Soltes. The La Quinta, Calif., mother said that when other members of her breast-feeding group had more milk than they could use, they didn’t know what to do with it. She learned about the milk drive by doing a Google search online.\u003c/p>\n\u003cp>“I just happened to find this event,” she said. “I thought, wow — I’d rather do this than throw it all out.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n",
"disqusIdentifier": "325769 https://ww2.kqed.org/stateofhealth/?p=325769",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/05/02/going-for-1-an-ounce-the-burgeoning-trade-in-mothers-milk/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 1806,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 41
},
"modified": 1493767753,
"excerpt": "As a fountain of nonprofit milk banks emerge, one woman’s abundant supply can fill another’s yawning demand. But critics fear that poor women will sell start selling their milk for survival, depriving their own babies of vital nutrients.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "As a fountain of nonprofit milk banks emerge, one woman’s abundant supply can fill another’s yawning demand. But critics fear that poor women will sell start selling their milk for survival, depriving their own babies of vital nutrients.",
"title": "Going For $1 An Ounce: The Burgeoning Trade In Mothers’ Milk | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Going For $1 An Ounce: The Burgeoning Trade In Mothers’ Milk",
"datePublished": "2017-05-02T16:26:58-07:00",
"dateModified": "2017-05-02T16:29:13-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "going-for-1-an-ounce-the-burgeoning-trade-in-mothers-milk",
"status": "publish",
"nprByline": "\u003ca href=\"http://khn.org/news/author/eryn-brown/\">\u003cstrong>Eryn Brown\u003c/strong>\u003c/a>",
"path": "/stateofhealth/325769/going-for-1-an-ounce-the-burgeoning-trade-in-mothers-milk",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>PALM SPRINGS, Calif. — Rebecca Soltes walked into a gaily decorated hospital meeting room, pushing her kids in a double stroller and carrying a soft-sided cooler filled with bags of frozen breast milk — 100 ounces of the stuff.\u003c/p>\n\u003cp>She dropped it on a table, and the roomful of lactation consultants and maternal health advocates from California’s Inland Empire erupted in applause.\u003c/p>\n\u003cp>She was donating the milk because she didn’t need it anymore. Her son, a young toddler, had recently graduated to solid food, but her freezer at home was still packed with pumped milk.\u003c/p>\n\u003cp>“I didn’t know what to do with it,” a harried-looking Soltes told two young staffers from the \u003ca href=\"http://www.mothersmilk.org\">Mothers’ Milk Bank\u003c/a>, a nonprofit group in San Jose, Calif., that provides breast milk for fragile infants in neonatal intensive care units (NICUs).\u003c/p>\n\u003cp>Increasing numbers of women who produce more breast milk than they need are handing it over — or selling it — for others to use. It’s a boon to fragile infants and mothers who can’t produce enough milk, but it also poses challenging ethical and public health questions.\u003c/p>\n\u003cdiv class=\"side-by-side\">\n\u003cdiv class=\"alignleft wp-caption\">\n\t\t\t\t\t\t\t\t\t\u003cimg width=\"770\" height=\"513\" src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-9_770.jpg?w=770&h=513&crop=1\" class=\"attachment-khn-article-large size-khn-article-large\" alt=\"\">\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\u003cp class=\"wp-caption-text\">A breast milk fair, where the milk is collected for fragile infants in neonatal intensive care units, was held in Palm Springs, Calif., in August 2016. (Heidi de Marco/California KHN)\u003c/p>\n\u003c/div>\n\u003cdiv class=\"alignright wp-caption\">\n\t\t\t\t\t\t\t\t\t\u003cimg width=\"770\" height=\"513\" src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-8_770.jpg?w=770&h=513&crop=1\" class=\"attachment-khn-article-large size-khn-article-large\" alt=\"\">\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\u003cp class=\"wp-caption-text\">Christina Beltran, who recently had a baby, signs up to receive more information at the Palm Springs breast milk donation fair. (Heidi de Marco/KHN)\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Physicians, regulators and others ask: Should sickly, premature babies get access to this milk before healthy ones? Should women be paid for their milk — even if it might lead some to deprive their own infants? Should greater safeguards be required to ensure the safety of the supply?\u003c/p>\n\u003cp>The \u003ca href=\"https://www.fda.gov/scienceresearch/specialtopics/pediatrictherapeuticsresearch/ucm235203.htm\">Food and Drug Administration\u003c/a> does not require testing for donated human milk. A handful of states, including California and New York, regulate milk banks the way they do tissue banks, enforcing some safety standards, and many nonprofit milk banks screen donors.\u003c/p>\n\u003cp>But the FDA has expressed concern about milk-trading websites, \u003ca href=\"http://www.aappublications.org/content/32/2/6.1\">warning consumers\u003c/a> that the milk offered there carries an increased risk of contamination by drugs or disease, including HIV. The agency further urges mothers not to feed their infants donated milk acquired from other individuals or over the internet, also because of such safety risks.\u003c/p>\n\u003cp>Some companies and medical experts wonder if even established milk banks — whose voluntary screening practices the FDA praised in 2010 — should be doing more to ensure safety. Dr. Jae Hong Kim, a neonatologist at UC-San Diego, said milk banks’ safety efforts have worked well thus far but are not error-free. “The challenge is, if you expand the operations, you increase your risk exposure,” he said.\u003c/p>\n\u003cp>Scott Elster, CEO of Prolacta Bioscience, a company that uses human milk to make fortifier products in its pharmaceutical-grade manufacturing facility, said he advocates a more rigorous level of screening.\u003c/p>\n\u003cp>“We believe that all human milk, whether it is distributed commercially, by a nonprofit or peer-to-peer network, should be tested for drugs of abuse, nicotine and other adulterants,” he said.\u003c/p>\n\u003cp>Milk Magic\u003c/p>\n\u003cp>As recently as the early 1970s, barely a fifth of American babies were breast-fed. Today, \u003ca href=\"https://www.cdc.gov/breastfeeding/pdf/2016breastfeedingreportcard.pdf\">more than 80%\u003c/a> get at least a taste of their mother’s milk, according to the federal Centers for Disease Control and Prevention. The health advantages are well-established, especially for premature infants.\u003c/p>\n\u003cp>“The first class I had on human milk I was blown away,” said Maryanne Perrin, a nutrition scientist at the University of North Carolina-Greensboro. “It’s Harry Potter meets Willy Wonka. It’s a magical food.”\u003c/p>\n\u003cp> The Food and Drug Administration does not require testing for donated human milk. A handful of states, including California and New York, regulate milk banks as they do tissue banks. (Heidi de Marco/KHN)\u003c/p>\n\u003cp>Some breast-feeding enthusiasts refer to human milk as “liquid gold.” At times, it seems as though everyone wants the stuff — from nonprofits like Mothers’ Milk Bank, to high-tech pharmaceutical companies that concentrate it into premium medical products, to your neighbor who might just want a bit more to supplement her baby’s diet.\u003c/p>\n\u003cp>Each year, new human milk banks open and new milk-focused companies are launched.\u003c/p>\n\u003cp>No one knows exactly how much of this excess milk is donated or sold, but the volume is increasing. Pauline Sakamoto, executive director of the Mothers’ Milk Bank and former president of the \u003ca href=\"https://www.hmbana.org\">Human Milk Banking Association of North America\u003c/a>, an association of nonprofit milk banks in the U.S. and Canada, said her organization’s affiliated banks distributed about 4.4 million ounces of human milk to hospitals last year, up from less than half that amount as recently as five years ago. When Sakamoto became president of the organization in 2014, it had 18 milk banks. Now it has more than 30 open or planned.\u003c/p>\n\u003cp>To Profit Or Not To Profit?\u003c/p>\n\u003cp>The Mothers’ Milk Bank workers from San Jose traveled nearly 450 miles last year for donation drives in the southern part of the state, including the one at the Desert Regional Medical Center in Palm Springs where they applauded Soltes. The bank collects and pasteurizes donated human milk and provides it at cost to NICUs throughout California.\u003c/p>\n\u003cp>Over the week, workers planned to conduct risk screenings, including blood testing for HIV and other diseases, on mothers like Soltes. They also planned to ask the women’s doctors — and their babies’ doctors — to approve the donations. The team expected to collect 7,542 ounces of pumped breast milk — enough to provide more than 30,000 feedings for premature infants in NICUs.\u003c/p>\n\u003cp>“Right now, we have a consistent flow of milk coming in,” said Leah Carig, donor coordinator at the San Jose-based bank. “In the past, we’ve had to put out [e-mail] blasts” to increase supply.\u003c/p>\n\u003cfigure class=\"layout-lg carousel-article carousel slide carousel-article-1\">\n\u003col class=\"carousel-indicators\">\n\u003cli class=\"active\">\n\u003cli>\n\u003cli>\n\u003c/ol>\n\u003cdiv class=\"carousel-inner\">\n\u003cdiv class=\"item active\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-5_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Prolacta Bioscience purchases breast milk from women for $1 per ounce, tests it rigorously and uses it to make fortifiers that are added to a mother’s or donor’s milk to deliver extra calories, proteins and minerals to premature babies. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-4_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">“We believe that all human milk, whether it is distributed commercially, by a nonprofit or peer-to-peer network, should be tested for drugs of abuse, nicotine and other adulterants,” says Prolacta CEO Scott Elster. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://kaiserhealthnews.files.wordpress.com/2017/04/breast-milk-6_770.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Prolacta’s products win praise from NICU physicians because they can replace fortifiers made of cow’s milk, which are known to increase the risk of necrotizing enterocolitis and sepsis. (Heidi de Marco/KHN)\u003c/figcaption>\u003c/div>\n\u003c/div>\n\u003cp>\u003ca class=\"left carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-prev\">\u003c/span>\u003c/a>\u003ca class=\"right carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-next\">\u003c/span>\u003c/a>\u003c/p>\u003c/figure>\n\u003cp>For-profit breast milk operations are expanding, too. Elster’s company, \u003ca href=\"http://www.prolacta.com\">Prolacta Bioscience\u003c/a>, stocks warehouse-like freezers full of human milk.\u003c/p>\n\u003cp>Based in City of Industry, Calif., it purchases the milk from women for $1 per ounce. The company uses it to make fortifiers that are added to a mother’s or donor’s milk to deliver extra calories, proteins and minerals to premature babies.\u003c/p>\n\u003cp>The products are expensive, at $200 to $300 for a one-day supply. But they win praise from NICU physicians like Kim, because they can replace fortifiers made of cow’s milk, which are known to increase the risk of necrotizing enterocolitis and sepsis.\u003c/p>\n\u003cp>Beyond the NICU and the gates of industry, informal internet-based sites, with names like \u003ca href=\"http://www.onlythebreast.com\">Only the Breast\u003c/a> and \u003ca href=\"http://www.eatsonfeets.org\">Eats on Feets\u003c/a>, also \u003ca href=\"http://online.liebertpub.com/doi/abs/10.1089/bfm.2013.0114\">appear to be booming\u003c/a>. One \u003ca href=\"http://www.theverge.com/2015/4/28/8504443/mothers-buying-breast-milk-online-donors-risks\">report\u003c/a> estimated that the number of online milk transactions in the U.S. soared from 22,000 in 2012 to 55,000 in 2015.\u003c/p>\n\u003cp>Some milk-sharing networks are run by mothers who sell their milk, while others give it away.\u003c/p>\n\u003cp>Mandy Lindberg, a board member of the \u003ca href=\"http://www.iebreastfeeding.org/about3\">Inland Empire Breastfeeding Coalition\u003c/a>, has experience with both formal and informal donation networks. She said that women often opt to donate among themselves because they want to help friends or neighbors who don’t have enough milk for their babies.\u003c/p>\n\u003cp>“It’s nice to put a face with the name,” Lindberg said.\u003c/p>\n\u003cp>Research shows there’s some risk with milk that changes hands on informal sites, however. In 2015, a team of researchers who purchased breast milk on the open market \u003ca href=\"http://pediatrics.aappublications.org/content/early/2015/03/31/peds.2014-3554\">reported\u003c/a> in the journal Pediatrics that about 10 percent of samples contained cow’s milk, which could have been added by the sellers to increase volume and thus the size of the payment. The same team had reported in 2013 that milk purchased online was \u003ca href=\"http://pediatrics.aappublications.org/content/early/2013/10/16/peds.2013-1687.full.pdf+html\">frequently contaminated\u003c/a> by pathogenic bacteria.\u003c/p>\n\u003cp>Kim Updegrove, executive director of the nonprofit \u003ca href=\"https://www.milkbank.org\">Mothers’ Milk Bank at Austin\u003c/a>, in Texas, says the FDA should regulate informal milk-sharing, ideally requiring all milk to go through a milk bank focused on distributing it according to the greatest medical need. This, she believes, would help make the practice safer and ensure that the sickest babies were given priority.\u003c/p>\n\u003cp>Updegrove and others fear that if financial gain were to become the dominant factor in distribution of human milk, supplies could be siphoned away from the sickest NICU babies. Poor mothers might sell their milk instead of giving it to their own children, these critics said.\u003c/p>\n\u003cp>Women involved in sharing networks don’t always understand the mission and practices of nonprofit milk banks, Perrin reported with colleagues in a \u003ca href=\"http://jhl.sagepub.com/content/32/2/229.short\">2016 paper\u003c/a> that appeared in the Journal of Human Lactation. Better education might encourage more to donate for NICU use, she suggested.\u003c/p>\n\u003cp>She said that when she started her research, she thought of human milk as a “scarce resource.” “But I’ve talked to women who have shared 9,600 ounces of milk. Some have freezers full,” she said. “I think it’s a distribution problem, and not a supply problem.”\u003c/p>\n\u003cp>The entire concept of breast milk banking — of any type — was new to Soltes. The La Quinta, Calif., mother said that when other members of her breast-feeding group had more milk than they could use, they didn’t know what to do with it. She learned about the milk drive by doing a Google search online.\u003c/p>\n\u003cp>“I just happened to find this event,” she said. “I thought, wow — I’d rather do this than throw it all out.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "floatright"
},
"numeric": [
"floatright"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/325769/going-for-1-an-ounce-the-burgeoning-trade-in-mothers-milk",
"authors": [
"byline_stateofhealth_325769"
],
"categories": [
"stateofhealth_12",
"stateofhealth_14",
"stateofhealth_2746",
"stateofhealth_1"
],
"tags": [
"stateofhealth_3086",
"stateofhealth_2808",
"stateofhealth_2519",
"stateofhealth_2578"
],
"affiliates": [
"stateofhealth_3036"
],
"featImg": "stateofhealth_325773",
"label": "stateofhealth_3036"
},
"stateofhealth_323597": {
"type": "posts",
"id": "stateofhealth_323597",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "323597",
"score": null,
"sort": [
1493399964000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth"
},
"blocks": [],
"publishDate": 1493399964,
"format": "standard",
"disqusTitle": "California Proposes Strict Limit on Toxic Chemical in Drinking Water",
"title": "California Proposes Strict Limit on Toxic Chemical in Drinking Water",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>California regulators are proposing a strict limit on a toxic man-made chemical that has contaminated water supplies throughout the state, particularly in its vast agricultural heartland.\u003c/p>\n\u003cp>California would be the second state, after Hawaii, to establish a threshold for the former pesticide ingredient and industrial solvent known as TCP (1,2,3-trichloropropane) in drinking water. The chemical compound, identified in California as a human carcinogen, is no longer in wide use but has leached over the years into many wells and reservoirs in California and other states.\u003c/p>\n\u003cp>The California State Water Resources Control Board’s proposal would set the maximum allowable amount of TCP in public tap water at five parts per trillion — the lowest level that existing filtration systems can reliably detect and far lower than Hawaii’s.\u003c/p>\n\u003cp>It “is a top priority for the state water board,” said board spokesman Andrew DiLuccia.\u003c/p>\n\u003cp>TCP taints water systems serving nearly a million people from Sacramento to San Diego, according to the state water board. The compound is present at levels above the proposed limit in 562 wells, reservoirs and other sources belonging to 94 public water systems, according to 2016 data. Those numbers do not include private wells.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Citing federal data, the Environmental Working Group, a Washington, D.C.-based advocacy organization, says the chemical also has been detected in water supplies of a dozen other states, including New York, Pennsylvania and New Jersey, as well as Puerto Rico. The group, or EWG, said the extent of contamination is likely underestimated because federal tests used a contamination threshold much higher than California’s. (The federal government does not set restrictions on TCP in drinking water.)\u003c/p>\n\u003cp>Once TCP gets into the groundwater, it “persists for centuries,” according to the EWG’s April report.\u003c/p>\n\u003cp>In California, the contamination exists in many urban areas, including in Los Angeles, San Bernardino and San Mateo counties. Though the source in those more populated regions is not known, the pollution is believed to come from industrial and hazardous waste sites.\u003c/p>\n\u003cp>“Los Angeles has quite a bit of contamination,” said Andria Ventura, toxics program manager for the environmental advocacy group Clean Water Action. “It’s hard for water providers to pinpoint where it came from.”\u003c/p>\n\u003cp>But California’s most serious and widespread TCP contamination is in the agricultural counties of the Central Valley, where the chemical was an ingredient in soil fumigants sold by the Shell Oil and Dow Chemical companies from at least the 1950s into the 1980s.\u003c/p>\n\u003cp>During that period, farmers who grew potatoes, sugar beets and other vegetables used the fumigants to kill tiny, soil-dwelling worms called nematodes. Dozens of municipalities and public water suppliers across the state have filed lawsuits against Shell and Dow, alleging that the companies knew — or should have known — that the TCP in their soil-fumigating pesticides would migrate into groundwater and pose a serious health hazard.\u003c/p>\n\u003cp>Shell and Dow have denied wrongdoing. Shell quit selling its product, known as D-D, in the mid-1980s. About the same time, Dow opted to reformulate its fumigant, known as Telone, after which TCP declined to “generally undetectable” levels, according to company spokesman Jarrod Erpelding. He declined to comment further, citing pending litigation.\u003c/p>\n\u003cp>Shell sent an email response: “The former Shell agricultural product, last manufactured more than 30 years ago, contained trace amounts of 1,2,3 trichloropropane (TCP). It was used to control microscopic worms that attacked crops causing millions of dollars a year of crop loss for farmers, and was approved for use by the U.S. government and the State of California.”\u003c/p>\n\u003cp>Environmental advocates say the adoption of a regulatory limit for TCP is a crucial step to help cash-strapped, rural water districts pay for the cleanup of their drinking water.\u003c/p>\n\u003cp>“It allows the districts when they go into court to be very specific and say to the judge, ‘We’re going to need exactly this amount of money to purchase this kind of system to meet the state standards,’” said Bill Walker, managing editor at the Environmental Working Group and co-author of its report on the role of Shell and Dow in California’s TCP drinking water problem.\u003c/p>\n\u003cp>“It doesn’t guarantee they’ll win,” he said, “but it increases their leverage.”\u003c/p>\n\u003cp>At a public hearing on April 19, water board members heard testimony and received written comments on the proposed limit. Now the board is reviewing the input it received and will likely vote on the plan by summer, DiLuccia said.\u003c/p>\n\u003cp>The regulation would require water utilities to test their supplies for TCP and remove it from any public drinking water source that exceeded the threshold, starting in 2018.\u003c/p>\n\u003cp>The proposed limit is more stringent than Hawaii’s because it is as close as California could get to meeting its stated “public health goal” for TCP set in 2009, officials say.\u003c/p>\n\u003cp>Though it is difficult to know how long the California cleanup might take, the cost of TCP testing and subsequent cleanup could reach nearly $500 million over 20 years, according to one water board estimate.\u003c/p>\n\u003cp>TCP contamination “disproportionately impacts poor communities and communities of color,” said Jenny Rempel, of Community Water Center, a Visalia, Calif.-based advocacy group. “This is a problem where the cost should not be borne by taxpayers.”\u003c/p>\n\u003cp>Todd E. Robins, a San Francisco attorney who is representing more than two dozen of the water suppliers that are suing Shell and Dow, argues that the companies included TCP in their worm-killing pesticides to get rid of the compound without having to pay for proper disposal. It was a byproduct of unrelated manufacturing processes and, according to the suits, played no role in killing the plant-damaging worms.\u003c/p>\n\u003cp>“The TCP that we find today in groundwater is the result of past use of soil fumigants that contained TCP as an unnecessary ingredient,” Robins said. “Instead of paying for disposal costs, they started getting farmers to pay for them.”\u003c/p>\n\u003cp>“The saddest part of the story,” Robins added, “is that the … actual active ingredient breaks down in the soil after a matter of days and has rarely been detected in anyone’s groundwater.”\u003c/p>\n\u003cp>One of the lawsuits filed by Robins, on behalf of the Del Rey Community Service District in Fresno County, says the companies knew they could remove or reduce the amount of TCP in their pesticides without compromising its effectiveness but failed to do so.\u003c/p>\n\u003cp>The complaint calls TCP a “hazardous waste” — a byproduct created in the manufacturing of a different chemical, allyl chloride, that Shell and Dow used to make plastics and other commercial products.\u003c/p>\n\u003cp>An internal Shell memo uncovered in Robins’ litigation cites $3.2 million in savings from “cost avoidance for disposal” related to the allyl chloride operations. The memo is dated Jan. 20, 1983 — a year before the company stopped producing the TCP-laced pesticide.\u003c/p>\n\u003cp>In addition to the pending cases, which also name distributors and marketers as defendants, Robins said he has settled eight cases against both Shell and Dow since 2010. He said he cannot disclose the amounts because of confidentiality agreements.\u003c/p>\n\u003cp>Last December, in a case tried by a different lawyer, a Fresno Superior Court jury awarded the city of Clovis $22 million against Shell to clean up its TCP-tainted drinking water.\u003c/p>\n\u003cp>In 2010, in a case brought by the city of Redlands, Shell won. The company argued that a nearby aerospace plant was the source of the toxin. Moreover, the wells in question were used for irrigation, and the jury didn’t believe they’d ever be used for drinking water.\u003c/p>\n\u003cp>As the lawsuits proceed, some California residents do what they can to protest the toxic chemicals in their water supply. Bartolo Chavez, 57, took time off his job in a juice packing house to testify at the recent hearing in Sacramento.\u003c/p>\n\u003cp>“We talk about the contaminants and the danger,” said Chavez, who has lived for 21 years in the Central Valley town of Arvin, Calif. “And [that] we’re exposed.”\u003c/p>\n\u003cp>He said he gets tokens from the water district to get free filtered water — not just because of TCP but because of other contaminants as well, such as arsenic and chromium-6.\u003c/p>\n\u003cp>“But the tokens aren’t enough,” Chavez said, speaking through a Spanish-language interpreter. “So in addition, we buy bottled water at Costco.”\u003c/p>\n\u003cp>Chavez and his wife, a hotel worker, pay about $50 a month for that water — a price they say they can ill afford. But leaving Arvin isn’t an option either, Chavez said.\u003c/p>\n\u003cp>“I have thought about moving, but it’s not so easy to find work in other places, especially when you’re older,” he said. “Our house is almost paid off, and to move would be to start over again, so it’s almost impossible.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>California Healthline Managing Editor Bernard Wolfson contributed to this report.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
"disqusIdentifier": "323597 https://ww2.kqed.org/stateofhealth/?p=323597",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/04/28/california-proposes-strict-limit-on-toxic-chemical-in-drinking-water/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 1558,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 39
},
"modified": 1493407583,
"excerpt": "TCP contamination is found in water supplies in the agricultural Central Valley and in some urban areas of the state, including Los Angeles, San Bernardino and San Mateo counties.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "TCP contamination is found in water supplies in the agricultural Central Valley and in some urban areas of the state, including Los Angeles, San Bernardino and San Mateo counties.",
"title": "California Proposes Strict Limit on Toxic Chemical in Drinking Water | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "California Proposes Strict Limit on Toxic Chemical in Drinking Water",
"datePublished": "2017-04-28T10:19:24-07:00",
"dateModified": "2017-04-28T12:26:23-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "california-proposes-strict-limit-on-toxic-chemical-in-drinking-water",
"status": "publish",
"nprByline": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/stephanie-oneill/\"_blank\">Stephanie O'Neill \u003c/strong>\u003c/a>\u003c/br>California Healthline",
"path": "/stateofhealth/323597/california-proposes-strict-limit-on-toxic-chemical-in-drinking-water",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California regulators are proposing a strict limit on a toxic man-made chemical that has contaminated water supplies throughout the state, particularly in its vast agricultural heartland.\u003c/p>\n\u003cp>California would be the second state, after Hawaii, to establish a threshold for the former pesticide ingredient and industrial solvent known as TCP (1,2,3-trichloropropane) in drinking water. The chemical compound, identified in California as a human carcinogen, is no longer in wide use but has leached over the years into many wells and reservoirs in California and other states.\u003c/p>\n\u003cp>The California State Water Resources Control Board’s proposal would set the maximum allowable amount of TCP in public tap water at five parts per trillion — the lowest level that existing filtration systems can reliably detect and far lower than Hawaii’s.\u003c/p>\n\u003cp>It “is a top priority for the state water board,” said board spokesman Andrew DiLuccia.\u003c/p>\n\u003cp>TCP taints water systems serving nearly a million people from Sacramento to San Diego, according to the state water board. The compound is present at levels above the proposed limit in 562 wells, reservoirs and other sources belonging to 94 public water systems, according to 2016 data. Those numbers do not include private wells.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Citing federal data, the Environmental Working Group, a Washington, D.C.-based advocacy organization, says the chemical also has been detected in water supplies of a dozen other states, including New York, Pennsylvania and New Jersey, as well as Puerto Rico. The group, or EWG, said the extent of contamination is likely underestimated because federal tests used a contamination threshold much higher than California’s. (The federal government does not set restrictions on TCP in drinking water.)\u003c/p>\n\u003cp>Once TCP gets into the groundwater, it “persists for centuries,” according to the EWG’s April report.\u003c/p>\n\u003cp>In California, the contamination exists in many urban areas, including in Los Angeles, San Bernardino and San Mateo counties. Though the source in those more populated regions is not known, the pollution is believed to come from industrial and hazardous waste sites.\u003c/p>\n\u003cp>“Los Angeles has quite a bit of contamination,” said Andria Ventura, toxics program manager for the environmental advocacy group Clean Water Action. “It’s hard for water providers to pinpoint where it came from.”\u003c/p>\n\u003cp>But California’s most serious and widespread TCP contamination is in the agricultural counties of the Central Valley, where the chemical was an ingredient in soil fumigants sold by the Shell Oil and Dow Chemical companies from at least the 1950s into the 1980s.\u003c/p>\n\u003cp>During that period, farmers who grew potatoes, sugar beets and other vegetables used the fumigants to kill tiny, soil-dwelling worms called nematodes. Dozens of municipalities and public water suppliers across the state have filed lawsuits against Shell and Dow, alleging that the companies knew — or should have known — that the TCP in their soil-fumigating pesticides would migrate into groundwater and pose a serious health hazard.\u003c/p>\n\u003cp>Shell and Dow have denied wrongdoing. Shell quit selling its product, known as D-D, in the mid-1980s. About the same time, Dow opted to reformulate its fumigant, known as Telone, after which TCP declined to “generally undetectable” levels, according to company spokesman Jarrod Erpelding. He declined to comment further, citing pending litigation.\u003c/p>\n\u003cp>Shell sent an email response: “The former Shell agricultural product, last manufactured more than 30 years ago, contained trace amounts of 1,2,3 trichloropropane (TCP). It was used to control microscopic worms that attacked crops causing millions of dollars a year of crop loss for farmers, and was approved for use by the U.S. government and the State of California.”\u003c/p>\n\u003cp>Environmental advocates say the adoption of a regulatory limit for TCP is a crucial step to help cash-strapped, rural water districts pay for the cleanup of their drinking water.\u003c/p>\n\u003cp>“It allows the districts when they go into court to be very specific and say to the judge, ‘We’re going to need exactly this amount of money to purchase this kind of system to meet the state standards,’” said Bill Walker, managing editor at the Environmental Working Group and co-author of its report on the role of Shell and Dow in California’s TCP drinking water problem.\u003c/p>\n\u003cp>“It doesn’t guarantee they’ll win,” he said, “but it increases their leverage.”\u003c/p>\n\u003cp>At a public hearing on April 19, water board members heard testimony and received written comments on the proposed limit. Now the board is reviewing the input it received and will likely vote on the plan by summer, DiLuccia said.\u003c/p>\n\u003cp>The regulation would require water utilities to test their supplies for TCP and remove it from any public drinking water source that exceeded the threshold, starting in 2018.\u003c/p>\n\u003cp>The proposed limit is more stringent than Hawaii’s because it is as close as California could get to meeting its stated “public health goal” for TCP set in 2009, officials say.\u003c/p>\n\u003cp>Though it is difficult to know how long the California cleanup might take, the cost of TCP testing and subsequent cleanup could reach nearly $500 million over 20 years, according to one water board estimate.\u003c/p>\n\u003cp>TCP contamination “disproportionately impacts poor communities and communities of color,” said Jenny Rempel, of Community Water Center, a Visalia, Calif.-based advocacy group. “This is a problem where the cost should not be borne by taxpayers.”\u003c/p>\n\u003cp>Todd E. Robins, a San Francisco attorney who is representing more than two dozen of the water suppliers that are suing Shell and Dow, argues that the companies included TCP in their worm-killing pesticides to get rid of the compound without having to pay for proper disposal. It was a byproduct of unrelated manufacturing processes and, according to the suits, played no role in killing the plant-damaging worms.\u003c/p>\n\u003cp>“The TCP that we find today in groundwater is the result of past use of soil fumigants that contained TCP as an unnecessary ingredient,” Robins said. “Instead of paying for disposal costs, they started getting farmers to pay for them.”\u003c/p>\n\u003cp>“The saddest part of the story,” Robins added, “is that the … actual active ingredient breaks down in the soil after a matter of days and has rarely been detected in anyone’s groundwater.”\u003c/p>\n\u003cp>One of the lawsuits filed by Robins, on behalf of the Del Rey Community Service District in Fresno County, says the companies knew they could remove or reduce the amount of TCP in their pesticides without compromising its effectiveness but failed to do so.\u003c/p>\n\u003cp>The complaint calls TCP a “hazardous waste” — a byproduct created in the manufacturing of a different chemical, allyl chloride, that Shell and Dow used to make plastics and other commercial products.\u003c/p>\n\u003cp>An internal Shell memo uncovered in Robins’ litigation cites $3.2 million in savings from “cost avoidance for disposal” related to the allyl chloride operations. The memo is dated Jan. 20, 1983 — a year before the company stopped producing the TCP-laced pesticide.\u003c/p>\n\u003cp>In addition to the pending cases, which also name distributors and marketers as defendants, Robins said he has settled eight cases against both Shell and Dow since 2010. He said he cannot disclose the amounts because of confidentiality agreements.\u003c/p>\n\u003cp>Last December, in a case tried by a different lawyer, a Fresno Superior Court jury awarded the city of Clovis $22 million against Shell to clean up its TCP-tainted drinking water.\u003c/p>\n\u003cp>In 2010, in a case brought by the city of Redlands, Shell won. The company argued that a nearby aerospace plant was the source of the toxin. Moreover, the wells in question were used for irrigation, and the jury didn’t believe they’d ever be used for drinking water.\u003c/p>\n\u003cp>As the lawsuits proceed, some California residents do what they can to protest the toxic chemicals in their water supply. Bartolo Chavez, 57, took time off his job in a juice packing house to testify at the recent hearing in Sacramento.\u003c/p>\n\u003cp>“We talk about the contaminants and the danger,” said Chavez, who has lived for 21 years in the Central Valley town of Arvin, Calif. “And [that] we’re exposed.”\u003c/p>\n\u003cp>He said he gets tokens from the water district to get free filtered water — not just because of TCP but because of other contaminants as well, such as arsenic and chromium-6.\u003c/p>\n\u003cp>“But the tokens aren’t enough,” Chavez said, speaking through a Spanish-language interpreter. “So in addition, we buy bottled water at Costco.”\u003c/p>\n\u003cp>Chavez and his wife, a hotel worker, pay about $50 a month for that water — a price they say they can ill afford. But leaving Arvin isn’t an option either, Chavez said.\u003c/p>\n\u003cp>“I have thought about moving, but it’s not so easy to find work in other places, especially when you’re older,” he said. “Our house is almost paid off, and to move would be to start over again, so it’s almost impossible.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "floatright"
},
"numeric": [
"floatright"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>California Healthline Managing Editor Bernard Wolfson contributed to this report.\u003cbr>\n\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/323597/california-proposes-strict-limit-on-toxic-chemical-in-drinking-water",
"authors": [
"byline_stateofhealth_323597"
],
"categories": [
"stateofhealth_14",
"stateofhealth_1"
],
"tags": [
"stateofhealth_2808",
"stateofhealth_2519",
"stateofhealth_3100",
"stateofhealth_3099",
"stateofhealth_2610"
],
"featImg": "stateofhealth_323599",
"label": "stateofhealth"
},
"stateofhealth_322664": {
"type": "posts",
"id": "stateofhealth_322664",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "322664",
"score": null,
"sort": [
1493242189000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth"
},
"blocks": [],
"publishDate": 1493242189,
"format": "standard",
"disqusTitle": "California Lawmakers Advance Single-Payer Health Bill",
"title": "California Lawmakers Advance Single-Payer Health Bill",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>Update\u003c/strong> 8:00 a.m\u003c/p>\n\u003cp>A proposal to substantially remake California's health care system by eliminating insurance companies and guaranteeing coverage for everyone has cleared the first legislative hurdle.\u003c/p>\n\u003cp>The state Senate Health Committee voted to advance the measure on Wednesday as hundreds of nurses and advocates converged on the state Capitol to show their support. \u003c/p>\n\u003cp>The plan, known as single-payer health care, is getting a new look in California as President Donald Trump struggles to repeal and replace former President Barack Obama's health care law.\u003c/p>\n\u003cp>The proposal, promoted by the state's powerful nursing union and two Democratic senators, is still a longshot. But supporters hope the time is right to persuade lawmakers in California, where Democrats are eager to stand up to the Republican president.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We have the chance to make universal health care a reality now,\" Democratic state Sen. Ricardo Lara of the Los Angeles-area city of Bell Gardens said last month. \"It's time to talk about how we get to health care for all that covers more and costs less.\"\u003c/p>\n\u003cp>The measure would guarantee health coverage with no out-of-pocket costs for all California residents, including people living in the country illegally.\u003c/p>\n\u003cp>Private insurers would be barred from covering the same services, essentially eliminating them from the marketplace. Instead, a new state agency would contract with health care providers such as doctors and hospitals and pay the bills for everyone.\u003c/p>\n\u003cp>However, an essential question is still unanswered: Where will the money come from? California health care expenditures last year totaled more than $367 billion, according to the Center for Health Policy Research at University of California, Los Angeles.\u003c/p>\n\u003cp>The measure envisions using all public money now spent on health care — from Medicare, Medicaid, federal public health funds and \"Obamacare\" subsidies. But it would also require tax increases on businesses, individuals or both.\u003c/p>\n\u003cp>Lara, who wrote the legislation with Democratic Sen. Toni Atkins of San Diego, says they are working on the details.\u003c/p>\n\u003cp>Employers, business groups and health plans have mobilized in opposition, warning that the measure would require massive tax increases and force patients into lengthy waits to see a doctor.\u003c/p>\n\u003cp>They say the state should stay focused on implementing Obama's health care law, which is credited with significantly reducing the ranks of the uninsured in California.\u003c/p>\n\u003cp>\"California can't afford a single-payer health care system,\" said Charles Bacchi, president and CEO of the California Association of Health Plans. \"It's going to reduce the quality of care. We think it will restrict access to care, and it will be incredibly disruptive to all the Californians who currently get health care coverage through their employer.\"\u003c/p>\n\u003cp>The idea faces significant hurdles.\u003c/p>\n\u003cp>The legislation, SB562, would affect everyone — not just the roughly 8 percent of Californians without insurance — including people on Medicare and private, employer-sponsored insurance, plans that are generally well-liked.\u003c/p>\n\u003cp>Replacing billions of dollars in health care spending by employers and individuals would require significant tax increases, which must have support from two-thirds of the Assembly and Senate.\u003c/p>\n\u003cp>Even if it were to clear the Legislature and be signed by Democratic Gov. Jerry Brown, it would require cooperation from Trump's administration to waive rules about federal Medicare and Medicaid dollars.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The idea to substantially increase the government's role in health care comes as Trump and Republicans in Congress look to reduce it. The conservative House Freedom Caucus on Wednesday announced its support for a newly revised GOP health care bill, a month after the group's opposition forced Republican leaders to pull the legislation.\u003c/p>\n\n",
"disqusIdentifier": "322664 https://ww2.kqed.org/stateofhealth/?p=322664",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/04/26/california-lawmakers-consider-plan-to-create-single-payer-health-system/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 605,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 21
},
"modified": 1493309410,
"excerpt": "The proposal, which would guarantee health coverage for all California residents and eliminate insurers, faces significant hurdles.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "The proposal, which would guarantee health coverage for all California residents and eliminate insurers, faces significant hurdles.",
"title": "California Lawmakers Advance Single-Payer Health Bill | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "California Lawmakers Advance Single-Payer Health Bill",
"datePublished": "2017-04-26T14:29:49-07:00",
"dateModified": "2017-04-27T09:10:10-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "california-lawmakers-consider-plan-to-create-single-payer-health-system",
"status": "publish",
"nprByline": "Associated Press",
"path": "/stateofhealth/322664/california-lawmakers-consider-plan-to-create-single-payer-health-system",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update\u003c/strong> 8:00 a.m\u003c/p>\n\u003cp>A proposal to substantially remake California's health care system by eliminating insurance companies and guaranteeing coverage for everyone has cleared the first legislative hurdle.\u003c/p>\n\u003cp>The state Senate Health Committee voted to advance the measure on Wednesday as hundreds of nurses and advocates converged on the state Capitol to show their support. \u003c/p>\n\u003cp>The plan, known as single-payer health care, is getting a new look in California as President Donald Trump struggles to repeal and replace former President Barack Obama's health care law.\u003c/p>\n\u003cp>The proposal, promoted by the state's powerful nursing union and two Democratic senators, is still a longshot. But supporters hope the time is right to persuade lawmakers in California, where Democrats are eager to stand up to the Republican president.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We have the chance to make universal health care a reality now,\" Democratic state Sen. Ricardo Lara of the Los Angeles-area city of Bell Gardens said last month. \"It's time to talk about how we get to health care for all that covers more and costs less.\"\u003c/p>\n\u003cp>The measure would guarantee health coverage with no out-of-pocket costs for all California residents, including people living in the country illegally.\u003c/p>\n\u003cp>Private insurers would be barred from covering the same services, essentially eliminating them from the marketplace. Instead, a new state agency would contract with health care providers such as doctors and hospitals and pay the bills for everyone.\u003c/p>\n\u003cp>However, an essential question is still unanswered: Where will the money come from? California health care expenditures last year totaled more than $367 billion, according to the Center for Health Policy Research at University of California, Los Angeles.\u003c/p>\n\u003cp>The measure envisions using all public money now spent on health care — from Medicare, Medicaid, federal public health funds and \"Obamacare\" subsidies. But it would also require tax increases on businesses, individuals or both.\u003c/p>\n\u003cp>Lara, who wrote the legislation with Democratic Sen. Toni Atkins of San Diego, says they are working on the details.\u003c/p>\n\u003cp>Employers, business groups and health plans have mobilized in opposition, warning that the measure would require massive tax increases and force patients into lengthy waits to see a doctor.\u003c/p>\n\u003cp>They say the state should stay focused on implementing Obama's health care law, which is credited with significantly reducing the ranks of the uninsured in California.\u003c/p>\n\u003cp>\"California can't afford a single-payer health care system,\" said Charles Bacchi, president and CEO of the California Association of Health Plans. \"It's going to reduce the quality of care. We think it will restrict access to care, and it will be incredibly disruptive to all the Californians who currently get health care coverage through their employer.\"\u003c/p>\n\u003cp>The idea faces significant hurdles.\u003c/p>\n\u003cp>The legislation, SB562, would affect everyone — not just the roughly 8 percent of Californians without insurance — including people on Medicare and private, employer-sponsored insurance, plans that are generally well-liked.\u003c/p>\n\u003cp>Replacing billions of dollars in health care spending by employers and individuals would require significant tax increases, which must have support from two-thirds of the Assembly and Senate.\u003c/p>\n\u003cp>Even if it were to clear the Legislature and be signed by Democratic Gov. Jerry Brown, it would require cooperation from Trump's administration to waive rules about federal Medicare and Medicaid dollars.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The idea to substantially increase the government's role in health care comes as Trump and Republicans in Congress look to reduce it. The conservative House Freedom Caucus on Wednesday announced its support for a newly revised GOP health care bill, a month after the group's opposition forced Republican leaders to pull the legislation.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/322664/california-lawmakers-consider-plan-to-create-single-payer-health-system",
"authors": [
"byline_stateofhealth_322664"
],
"categories": [
"stateofhealth_14"
],
"tags": [
"stateofhealth_2808",
"stateofhealth_2519",
"stateofhealth_365",
"stateofhealth_3048",
"stateofhealth_3092"
],
"featImg": "stateofhealth_322684",
"label": "stateofhealth"
},
"stateofhealth_322154": {
"type": "posts",
"id": "stateofhealth_322154",
"meta": {
"index": "posts_1716263798",
"site": "stateofhealth",
"id": "322154",
"score": null,
"sort": [
1493136123000
]
},
"parent": 0,
"labelTerm": {
"site": "stateofhealth"
},
"blocks": [],
"publishDate": 1493136123,
"format": "standard",
"disqusTitle": "Should California Agencies Work Together to Negotiate Better Drug Prices?",
"title": "Should California Agencies Work Together to Negotiate Better Drug Prices?",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Citing budget-busting drug costs, a California lawmaker wants state health programs to band together to negotiate better prices with drug companies.\u003c/p>\n\u003cp>Assemblymember David Chiu (D-San Francisco) has introduced a bill that would strengthen intra-agency collaboration on drug cost-saving strategies. Lawmakers will consider the bill at an Assembly Health Committee hearing on Tuesday.\u003c/p>\n\u003cp>“Californians and Americans are frustrated with the lack of progress around drug prices,” Chiu said, citing the uproar over EpiPen and hepatitis C medications.\u003c/p>\n\u003cp>He said state agencies should pool their efforts “so that we can leverage that consumer power and get the best deal for our money.”\u003c/p>\n\u003cp>While the proposed California Drug Costs Reduction Act does not mandate that various California health programs such as Medi-Cal or Covered California purchase drugs together, it would require administrators of those programs and 17 other state agencies to convene twice a year to strategize about ways to keep costs down.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Through the California Pharmaceutical Collaborative (CPC), state officials would consider a uniform state drug formulary and look at paying for drugs based on the value they bring to the health system.\u003c/p>\n\u003cp>A pharmaceutical collaborative by that name already exists within the California Department of General Services and purchases drugs for state prisons, hospitals and universities. This bill would significantly expand on those efforts.\u003c/p>\n\u003cp>Chiu says it’s unclear what the current program is doing, and if it has been successful in bringing down drug costs. The 2002 legislation that created the collaborative required only a few agencies to participate, and only one report back to the legislature in 2005.\u003c/p>\n\u003cp>A 2005 report from the California State Auditor suggested the Department of General Services could do more to bring down pharmaceutical costs for California.\u003c/p>\n\u003cp>A more recent analysis from the nonpartisan Legislative Analyst’s Office showed spending by the Department of General Services has increased at a relatively high rate — about 20 percent annually between 2012 and 2016, although that trend may have been skewed by the release of high-cost hepatitis C drugs during that time.\u003c/p>\n\u003cp>“I haven’t had transparency about the work that’s happened,” Chiu said. During a February 2017 California legislative hearing about drug prices, the lawmaker expressed frustration about not being able to get information about the workings of the CPC.\u003c/p>\n\u003cp>Chiu’s bill would require annual reports from the pharmaceutical collaborative, which the lawmaker says would ensure more accountability.\u003c/p>\n\u003cp>A spokesman with the Department of General Services, Brian Ferguson, wrote in a statement that it has been meeting “regularly” to create a “roadmap” to cut drug costs.\u003c/p>\n\u003cp>The proposal so far has no registered opposition. Priscilla VanderVeer, a spokeswoman with the drug company trade association Pharmaceutical Research and Manufacturers of America (PhRMA) had no comment on the proposal.\u003c/p>\n\u003cp>Other states such as Massachusetts have bulk purchasing programs for drugs, according to the National Academy for State Health Policy. And Oregon and Washington have joined together to create a bulk purchasing program. It is one of five multi-state pharmaceutical programs in the country, according to the National Conference of State Legislatures.\u003c/p>\n\u003cp>About a third of Californians have health care coverage through Medi-Cal alone. Together with Covered California, and the California Public Employees’ Retirement System (CalPERS), these agencies insure more than 16 million people.\u003c/p>\n\u003cp>Experts say the diverse ways state programs pay for drugs would make it hard to implement an across-the-board prescription drug purchasing system in California.\u003c/p>\n\u003cp>Ben Johnson, fiscal and policy analyst with the Legislative Analyst’s Office said that the Medi-Cal program has different rules for payment and coverage than the state’s prison system. Medi-Cal is also entitled to deep drug discounts that other state agencies don’t receive.\u003c/p>\n\u003cp>“A lot of work would have to be done to be able to actually harmonize and create a uniform system of drug procurement in the state,” Johnson said. His agency does not take positions on legislation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Advocates for AIDS patients and retired people support the bill. The California Public Interest Research Group (CALPIRG), which sponsored the initial legislation to create the collaborative in 2002, supports the current proposal as well. In a letter to the bill’s author, the group said the measure would provide “additional tools and direction” and increase accountability on the state government’s actions to reduce drug prices.\u003c/p>\n\n",
"disqusIdentifier": "322154 https://ww2.kqed.org/stateofhealth/?p=322154",
"disqusUrl": "https://ww2.kqed.org/stateofhealth/2017/04/25/should-california-agencies-work-together-to-negotiate-better-drug-prices/",
"stats": {
"hasVideo": false,
"hasChartOrMap": false,
"hasAudio": false,
"hasPolis": false,
"wordCount": 748,
"hasGoogleForm": false,
"hasGallery": false,
"hasHearkenModule": false,
"iframeSrcs": [],
"paragraphCount": 22
},
"modified": 1493136123,
"excerpt": "Lawmakers will consider a plan to require administrators from about 20 state agencies to meet twice a year to strategize ways to keep costs down.",
"headData": {
"twImgId": "",
"twTitle": "",
"ogTitle": "",
"ogImgId": "",
"twDescription": "",
"description": "Lawmakers will consider a plan to require administrators from about 20 state agencies to meet twice a year to strategize ways to keep costs down.",
"title": "Should California Agencies Work Together to Negotiate Better Drug Prices? | KQED",
"ogDescription": "",
"schema": {
"@context": "https://schema.org",
"@type": "Article",
"headline": "Should California Agencies Work Together to Negotiate Better Drug Prices?",
"datePublished": "2017-04-25T09:02:03-07:00",
"dateModified": "2017-04-25T09:02:03-07:00",
"image": "https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"
}
},
"guestAuthors": [],
"slug": "should-california-agencies-work-together-to-negotiate-better-drug-prices",
"status": "publish",
"nprByline": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/pauline-bartolone/\">Pauline Bartolone\u003c/strong>\u003c/a>\u003c/br>California HealthLine",
"path": "/stateofhealth/322154/should-california-agencies-work-together-to-negotiate-better-drug-prices",
"audioTrackLength": null,
"parsedContent": [
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Citing budget-busting drug costs, a California lawmaker wants state health programs to band together to negotiate better prices with drug companies.\u003c/p>\n\u003cp>Assemblymember David Chiu (D-San Francisco) has introduced a bill that would strengthen intra-agency collaboration on drug cost-saving strategies. Lawmakers will consider the bill at an Assembly Health Committee hearing on Tuesday.\u003c/p>\n\u003cp>“Californians and Americans are frustrated with the lack of progress around drug prices,” Chiu said, citing the uproar over EpiPen and hepatitis C medications.\u003c/p>\n\u003cp>He said state agencies should pool their efforts “so that we can leverage that consumer power and get the best deal for our money.”\u003c/p>\n\u003cp>While the proposed California Drug Costs Reduction Act does not mandate that various California health programs such as Medi-Cal or Covered California purchase drugs together, it would require administrators of those programs and 17 other state agencies to convene twice a year to strategize about ways to keep costs down.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
"attributes": {
"named": {},
"numeric": []
}
},
{
"type": "component",
"content": "",
"name": "ad",
"attributes": {
"named": {
"label": "fullwidth"
},
"numeric": [
"fullwidth"
]
}
},
{
"type": "contentString",
"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Through the California Pharmaceutical Collaborative (CPC), state officials would consider a uniform state drug formulary and look at paying for drugs based on the value they bring to the health system.\u003c/p>\n\u003cp>A pharmaceutical collaborative by that name already exists within the California Department of General Services and purchases drugs for state prisons, hospitals and universities. This bill would significantly expand on those efforts.\u003c/p>\n\u003cp>Chiu says it’s unclear what the current program is doing, and if it has been successful in bringing down drug costs. The 2002 legislation that created the collaborative required only a few agencies to participate, and only one report back to the legislature in 2005.\u003c/p>\n\u003cp>A 2005 report from the California State Auditor suggested the Department of General Services could do more to bring down pharmaceutical costs for California.\u003c/p>\n\u003cp>A more recent analysis from the nonpartisan Legislative Analyst’s Office showed spending by the Department of General Services has increased at a relatively high rate — about 20 percent annually between 2012 and 2016, although that trend may have been skewed by the release of high-cost hepatitis C drugs during that time.\u003c/p>\n\u003cp>“I haven’t had transparency about the work that’s happened,” Chiu said. During a February 2017 California legislative hearing about drug prices, the lawmaker expressed frustration about not being able to get information about the workings of the CPC.\u003c/p>\n\u003cp>Chiu’s bill would require annual reports from the pharmaceutical collaborative, which the lawmaker says would ensure more accountability.\u003c/p>\n\u003cp>A spokesman with the Department of General Services, Brian Ferguson, wrote in a statement that it has been meeting “regularly” to create a “roadmap” to cut drug costs.\u003c/p>\n\u003cp>The proposal so far has no registered opposition. Priscilla VanderVeer, a spokeswoman with the drug company trade association Pharmaceutical Research and Manufacturers of America (PhRMA) had no comment on the proposal.\u003c/p>\n\u003cp>Other states such as Massachusetts have bulk purchasing programs for drugs, according to the National Academy for State Health Policy. And Oregon and Washington have joined together to create a bulk purchasing program. It is one of five multi-state pharmaceutical programs in the country, according to the National Conference of State Legislatures.\u003c/p>\n\u003cp>About a third of Californians have health care coverage through Medi-Cal alone. Together with Covered California, and the California Public Employees’ Retirement System (CalPERS), these agencies insure more than 16 million people.\u003c/p>\n\u003cp>Experts say the diverse ways state programs pay for drugs would make it hard to implement an across-the-board prescription drug purchasing system in California.\u003c/p>\n\u003cp>Ben Johnson, fiscal and policy analyst with the Legislative Analyst’s Office said that the Medi-Cal program has different rules for payment and coverage than the state’s prison system. Medi-Cal is also entitled to deep drug discounts that other state agencies don’t receive.\u003c/p>\n\u003cp>“A lot of work would have to be done to be able to actually harmonize and create a uniform system of drug procurement in the state,” Johnson said. His agency does not take positions on legislation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Advocates for AIDS patients and retired people support the bill. The California Public Interest Research Group (CALPIRG), which sponsored the initial legislation to create the collaborative in 2002, supports the current proposal as well. In a letter to the bill’s author, the group said the measure would provide “additional tools and direction” and increase accountability on the state government’s actions to reduce drug prices.\u003c/p>\n\n\u003c/div>\u003c/p>",
"attributes": {
"named": {},
"numeric": []
}
}
],
"link": "/stateofhealth/322154/should-california-agencies-work-together-to-negotiate-better-drug-prices",
"authors": [
"byline_stateofhealth_322154"
],
"categories": [
"stateofhealth_14"
],
"tags": [
"stateofhealth_2722",
"stateofhealth_2650",
"stateofhealth_2808",
"stateofhealth_2519"
],
"featImg": "stateofhealth_322155",
"label": "stateofhealth"
}
},
"podcastsReducer": {
"isFetching": false,
"fetchFailed": false,
"hasFetched": false,
"podcasts": {}
},
"radioProgramsReducer": {
"isFetching": false,
"fetchFailed": false,
"hasFetched": false,
"radioPrograms": {}
},
"radioSearchSegmentsReducer": {},
"programsReducer": {
"all-things-considered": {
"id": "all-things-considered",
"title": "All Things Considered",
"info": "Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.",
"airtime": "MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/all-things-considered/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/all-things-considered"
},
"american-suburb-podcast": {
"id": "american-suburb-podcast",
"title": "American Suburb: The Podcast",
"tagline": "The flip side of gentrification, told through one town",
"info": "Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg",
"officialWebsiteLink": "/news/series/american-suburb-podcast",
"meta": {
"site": "news",
"source": "kqed",
"order": 19
},
"link": "/news/series/american-suburb-podcast/",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/RBrW",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328",
"tuneIn": "https://tunein.com/radio/American-Suburb-p1086805/",
"rss": "https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"
}
},
"baycurious": {
"id": "baycurious",
"title": "Bay Curious",
"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Bay Curious",
"officialWebsiteLink": "/news/series/baycurious",
"meta": {
"site": "news",
"source": "kqed",
"order": 3
},
"link": "/podcasts/baycurious",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/bay-curious/id1172473406",
"npr": "https://www.npr.org/podcasts/500557090/bay-curious",
"rss": "https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast",
"amazon": "https://music.amazon.com/podcasts/9a90d476-aa04-455d-9a4c-0871ed6216d4/bay-curious",
"stitcher": "https://www.stitcher.com/podcast/kqed/bay-curious",
"spotify": "https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"
}
},
"bbc-world-service": {
"id": "bbc-world-service",
"title": "BBC World Service",
"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
"airtime": "MON-FRI 9pm-10pm, TUE-FRI 1am-2am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.bbc.co.uk/sounds/play/live:bbc_world_service",
"meta": {
"site": "news",
"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2",
"tuneIn": "https://tunein.com/radio/BBC-World-Service-p455581/",
"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The California Report",
"officialWebsiteLink": "/californiareport",
"meta": {
"site": "news",
"source": "kqed",
"order": 8
},
"link": "/californiareport",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/kqeds-the-california-report/id79681292",
"amazon": "https://music.amazon.com/podcasts/26099305-72af-4542-9dde-ac1807fe36d5/kqed-s-the-california-report",
"npr": "https://www.npr.org/podcasts/432285393/the-california-report",
"stitcher": "https://www.stitcher.com/podcast/kqedfm-kqeds-the-california-report-podcast-8838",
"rss": "https://ww2.kqed.org/news/tag/tcram/feed/podcast"
}
},
"californiareportmagazine": {
"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Magazine-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The California Report Magazine",
"officialWebsiteLink": "/californiareportmagazine",
"meta": {
"site": "news",
"source": "kqed",
"order": 10
},
"link": "/californiareportmagazine",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/the-california-report-magazine/id1314750545",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
"npr": "https://www.npr.org/podcasts/564733126/the-california-report-magazine",
"stitcher": "https://www.stitcher.com/podcast/kqed/the-california-report-magazine",
"rss": "https://ww2.kqed.org/news/tag/tcrmag/feed/podcast"
}
},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
"title": "Close All Tabs",
"tagline": "Your irreverent guide to the trends redefining our world",
"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/02/CAT_2_Tile-scaled.jpg",
"imageAlt": "KQED Close All Tabs",
"officialWebsiteLink": "/podcasts/closealltabs",
"meta": {
"site": "news",
"source": "kqed",
"order": 1
},
"link": "/podcasts/closealltabs",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/close-all-tabs/id214663465",
"rss": "https://feeds.megaphone.fm/KQINC6993880386",
"amazon": "https://music.amazon.com/podcasts/92d9d4ac-67a3-4eed-b10a-fb45d45b1ef2/close-all-tabs",
"spotify": "https://open.spotify.com/show/6LAJFHnGK1pYXYzv6SIol6?si=deb0cae19813417c"
}
},
"code-switch-life-kit": {
"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
"airtime": "SUN 9pm-10pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg",
"meta": {
"site": "radio",
"source": "npr"
},
"link": "/radio/program/code-switch-life-kit",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
"spotify": "https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV",
"rss": "https://feeds.npr.org/510312/podcast.xml"
}
},
"commonwealth-club": {
"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.commonwealthclub.org/podcasts",
"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
"tuneIn": "https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"
}
},
"forum": {
"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
"officialWebsiteLink": "/forum",
"meta": {
"site": "news",
"source": "kqed",
"order": 9
},
"link": "/forum",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
"npr": "https://www.npr.org/podcasts/432307980/forum",
"stitcher": "https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast",
"rss": "https://feeds.megaphone.fm/KQINC9557381633"
}
},
"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/4s8b",
"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
}
},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
"airtime": "MON-FRI 7pm-8pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Fresh-Air-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/fresh-air/",
"meta": {
"site": "radio",
"source": "npr"
},
"link": "/radio/program/fresh-air",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/4s8b",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/Fresh-Air-p17/",
"rss": "https://feeds.npr.org/381444908/podcast.xml"
}
},
"here-and-now": {
"id": "here-and-now",
"title": "Here & Now",
"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
"airtime": "MON-THU 11am-12pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Here-And-Now-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "http://www.wbur.org/hereandnow",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/here-and-now",
"subsdcribe": {
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=426698661",
"tuneIn": "https://tunein.com/radio/Here--Now-p211/",
"rss": "https://feeds.npr.org/510051/podcast.xml"
}
},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/hiddenbrain.jpg",
"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
"site": "news",
"source": "NPR"
},
"link": "/radio/program/hidden-brain",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/hidden-brain/id1028908750?mt=2",
"tuneIn": "https://tunein.com/podcasts/Science-Podcasts/Hidden-Brain-p787503/",
"rss": "https://feeds.npr.org/510308/podcast.xml"
}
},
"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/how-i-built-this",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
"tuneIn": "https://tunein.com/podcasts/Arts--Culture-Podcasts/How-I-Built-This-p910896/",
"rss": "https://feeds.npr.org/510313/podcast.xml"
}
},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
"imageAlt": "KQED Hyphenación",
"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
"site": "news",
"source": "kqed",
"order": 15
},
"link": "/podcasts/hyphenacion",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/hyphenaci%C3%B3n/id1191591838",
"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
"youtube": "https://www.youtube.com/c/kqedarts",
"amazon": "https://music.amazon.com/podcasts/6c3dd23c-93fb-4aab-97ba-1725fa6315f1/hyphenaci%C3%B3n",
"rss": "https://feeds.megaphone.fm/KQINC2275451163"
}
},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Political Mind of Jerry Brown",
"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
"site": "news",
"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
"subscribe": {
"npr": "https://www.npr.org/podcasts/790253322/the-political-mind-of-jerry-brown",
"apple": "https://itunes.apple.com/us/podcast/id1492194549",
"rss": "https://ww2.kqed.org/news/series/jerrybrown/feed/podcast/",
"tuneIn": "http://tun.in/pjGcK",
"stitcher": "https://www.stitcher.com/podcast/kqed/the-political-mind-of-jerry-brown",
"spotify": "https://open.spotify.com/show/54C1dmuyFyKMFttY6X2j6r?si=K8SgRCoISNK6ZbjpXrX5-w",
"amazon": "https://music.amazon.com/podcasts/44420f75-3b0e-4301-ab3b-16da6b09e543/the-political-mind-of-jerry-brown"
}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/xtTd",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/Latino-USA-p621/",
"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
"subscribe": {
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=201853034&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/APM-Marketplace-p88/",
"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
"site": "news",
"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
"spotify": "https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"
}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
"npr": "https://rpb3r.app.goo.gl/onourwatch",
"spotify": "https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x",
"tuneIn": "https://tunein.com/radio/On-Our-Watch-p1436229/",
"stitcher": "https://www.stitcher.com/show/on-our-watch",
"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
"site": "news",
"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
"meta": {
"site": "news",
"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
"imageAlt": "KQED Perspectives",
"officialWebsiteLink": "/perspectives/",
"meta": {
"site": "radio",
"source": "kqed",
"order": 14
},
"link": "/perspectives",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/id73801135",
"npr": "https://www.npr.org/podcasts/432309616/perspectives",
"rss": "https://ww2.kqed.org/perspectives/category/perspectives/feed/",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"
}
},
"planet-money": {
"id": "planet-money",
"title": "Planet Money",
"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
"officialWebsiteLink": "https://www.npr.org/sections/money/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/planet-money",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/M4f5",
"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
"tuneIn": "https://tunein.com/podcasts/Business--Economics-Podcasts/Planet-Money-p164680/",
"rss": "https://feeds.npr.org/510289/podcast.xml"
}
},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Political Breakdown",
"officialWebsiteLink": "/podcasts/politicalbreakdown",
"meta": {
"site": "radio",
"source": "kqed",
"order": 5
},
"link": "/podcasts/politicalbreakdown",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/political-breakdown/id1327641087",
"amazon": "https://music.amazon.com/podcasts/e0c2d153-ad36-4c8d-901d-f1da6a724824/political-breakdown",
"npr": "https://www.npr.org/podcasts/572155894/political-breakdown",
"stitcher": "https://www.stitcher.com/podcast/kqed/political-breakdown",
"spotify": "https://open.spotify.com/show/07RVyIjIdk2WDuVehvBMoN",
"rss": "https://ww2.kqed.org/news/tag/political-breakdown/feed/podcast"
}
},
"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
"meta": {
"site": "news",
"source": "Possible"
},
"link": "/radio/program/possible",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/possible/id1677184070",
"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
}
},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pri.org/programs/the-world",
"meta": {
"site": "news",
"source": "PRI"
},
"link": "/radio/program/pri-the-world",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pris-the-world-latest-edition/id278196007?mt=2",
"tuneIn": "https://tunein.com/podcasts/News--Politics-Podcasts/PRIs-The-World-p24/",
"rss": "http://feeds.feedburner.com/pri/theworld"
}
},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
"airtime": "SUN 12am-1am, SAT 2pm-3pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/radiolab1400.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/radiolab/",
"meta": {
"site": "science",
"source": "WNYC"
},
"link": "/radio/program/radiolab",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/radiolab/id152249110?mt=2",
"tuneIn": "https://tunein.com/radio/RadioLab-p68032/",
"rss": "https://feeds.wnyc.org/radiolab"
}
},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
"airtime": "SAT 4pm-5pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/reveal300px.png",
"officialWebsiteLink": "https://www.revealnews.org/episodes/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/reveal",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/reveal/id886009669",
"tuneIn": "https://tunein.com/radio/Reveal-p679597/",
"rss": "http://feeds.revealradio.org/revealpodcast"
}
},
"rightnowish": {
"id": "rightnowish",
"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Rightnowish-Podcast-Tile-500x500-1.jpg",
"imageAlt": "KQED Rightnowish with Pendarvis Harshaw",
"officialWebsiteLink": "/podcasts/rightnowish",
"meta": {
"site": "arts",
"source": "kqed",
"order": 16
},
"link": "/podcasts/rightnowish",
"subscribe": {
"npr": "https://www.npr.org/podcasts/721590300/rightnowish",
"rss": "https://ww2.kqed.org/arts/programs/rightnowish/feed/podcast",
"apple": "https://podcasts.apple.com/us/podcast/rightnowish/id1482187648",
"stitcher": "https://www.stitcher.com/podcast/kqed/rightnowish",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMxMjU5MTY3NDc4",
"spotify": "https://open.spotify.com/show/7kEJuafTzTVan7B78ttz1I"
}
},
"science-friday": {
"id": "science-friday",
"title": "Science Friday",
"info": "Science Friday is a weekly science talk show, broadcast live over public radio stations nationwide. Each week, the show focuses on science topics that are in the news and tries to bring an educated, balanced discussion to bear on the scientific issues at hand. Panels of expert guests join host Ira Flatow, a veteran science journalist, to discuss science and to take questions from listeners during the call-in portion of the program.",
"airtime": "FRI 11am-1pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Science-Friday-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/science-friday",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/science-friday",
"subscribe": {
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=73329284&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/Science-Friday-p394/",
"rss": "http://feeds.wnyc.org/science-friday"
}
},
"snap-judgment": {
"id": "snap-judgment",
"title": "Snap Judgment",
"tagline": "Real stories with killer beats",
"info": "The Snap Judgment radio show and podcast mixes real stories with killer beats to produce cinematic, dramatic radio. Snap's musical brand of storytelling dares listeners to see the world through the eyes of another. This is storytelling... with a BEAT!! Snap first aired on public radio stations nationwide in July 2010. Today, Snap Judgment airs on over 450 public radio stations and is brought to the airwaves by KQED & PRX.",
"airtime": "SAT 1pm-2pm, 9pm-10pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/05/Snap-Judgment-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Snap Judgment",
"officialWebsiteLink": "https://snapjudgment.org",
"meta": {
"site": "arts",
"source": "kqed",
"order": 4
},
"link": "https://snapjudgment.org",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/snap-judgment/id283657561",
"npr": "https://www.npr.org/podcasts/449018144/snap-judgment",
"stitcher": "https://www.pandora.com/podcast/snap-judgment/PC:241?source=stitcher-sunset",
"spotify": "https://open.spotify.com/show/3Cct7ZWmxHNAtLgBTqjC5v",
"rss": "https://snap.feed.snapjudgment.org/"
}
},
"soldout": {
"id": "soldout",
"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
"info": "Sold Out: Rethinking Housing in America",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Sold-Out-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Sold Out: Rethinking Housing in America",
"officialWebsiteLink": "/podcasts/soldout",
"meta": {
"site": "news",
"source": "kqed",
"order": 13
},
"link": "/podcasts/soldout",
"subscribe": {
"npr": "https://www.npr.org/podcasts/911586047/s-o-l-d-o-u-t-a-new-future-for-housing",
"apple": "https://podcasts.apple.com/us/podcast/introducing-sold-out-rethinking-housing-in-america/id1531354937",
"rss": "https://feeds.megaphone.fm/soldout",
"spotify": "https://open.spotify.com/show/38dTBSk2ISFoPiyYNoKn1X",
"stitcher": "https://www.stitcher.com/podcast/kqed/sold-out-rethinking-housing-in-america",
"tunein": "https://tunein.com/radio/SOLD-OUT-Rethinking-Housing-in-America-p1365871/"
}
},
"spooked": {
"id": "spooked",
"title": "Spooked",
"tagline": "True-life supernatural stories",
"info": "",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/10/Spooked-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Spooked",
"officialWebsiteLink": "https://spookedpodcast.org/",
"meta": {
"site": "news",
"source": "kqed",
"order": 7
},
"link": "https://spookedpodcast.org/",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/spooked/id1279361017",
"npr": "https://www.npr.org/podcasts/549547848/snap-judgment-presents-spooked",
"spotify": "https://open.spotify.com/show/76571Rfl3m7PLJQZKQIGCT",
"rss": "https://feeds.simplecast.com/TBotaapn"
}
},
"tech-nation": {
"id": "tech-nation",
"title": "Tech Nation Radio Podcast",
"info": "Tech Nation is a weekly public radio program, hosted by Dr. Moira Gunn. Founded in 1993, it has grown from a simple interview show to a multi-faceted production, featuring conversations with noted technology and science leaders, and a weekly science and technology-related commentary.",
"airtime": "FRI 10pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Tech-Nation-Radio-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "http://technation.podomatic.com/",
"meta": {
"site": "science",
"source": "Tech Nation Media"
},
"link": "/radio/program/tech-nation",
"subscribe": {
"rss": "https://technation.podomatic.com/rss2.xml"
}
},
"ted-radio-hour": {
"id": "ted-radio-hour",
"title": "TED Radio Hour",
"info": "The TED Radio Hour is a journey through fascinating ideas, astonishing inventions, fresh approaches to old problems, and new ways to think and create.",
"airtime": "SUN 3pm-4pm, SAT 10pm-11pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/tedRadioHour.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/ted-radio-hour/?showDate=2018-06-22",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/ted-radio-hour",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/8vsS",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=523121474&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/TED-Radio-Hour-p418021/",
"rss": "https://feeds.npr.org/510298/podcast.xml"
}
},
"thebay": {
"id": "thebay",
"title": "The Bay",
"tagline": "Local news to keep you rooted",
"info": "Host Devin Katayama walks you through the biggest story of the day with reporters and newsmakers.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Bay-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Bay",
"officialWebsiteLink": "/podcasts/thebay",
"meta": {
"site": "radio",
"source": "kqed",
"order": 2
},
"link": "/podcasts/thebay",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/the-bay/id1350043452",
"amazon": "https://music.amazon.com/podcasts/d800ea4c-7a2c-42f2-b861-edaf78a5db0b/the-bay",
"npr": "https://www.npr.org/podcasts/586725995/the-bay",
"stitcher": "https://www.stitcher.com/podcast/kqed/the-bay",
"spotify": "https://open.spotify.com/show/4BIKBKIujizLHlIlBNaAqQ",
"rss": "https://feeds.megaphone.fm/KQINC8259786327"
}
},
"thelatest": {
"id": "thelatest",
"title": "The Latest",
"tagline": "Trusted local news in real time",
"info": "",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/05/The-Latest-2025-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Latest",
"officialWebsiteLink": "/thelatest",
"meta": {
"site": "news",
"source": "kqed",
"order": 6
},
"link": "/thelatest",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/the-latest-from-kqed/id1197721799",
"npr": "https://www.npr.org/podcasts/1257949365/the-latest-from-k-q-e-d",
"spotify": "https://open.spotify.com/show/5KIIXMgM9GTi5AepwOYvIZ?si=bd3053fec7244dba",
"rss": "https://feeds.megaphone.fm/KQINC9137121918"
}
},
"theleap": {
"id": "theleap",
"title": "The Leap",
"tagline": "What if you closed your eyes, and jumped?",
"info": "Stories about people making dramatic, risky changes, told by award-winning public radio reporter Judy Campbell.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Leap-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The Leap",
"officialWebsiteLink": "/podcasts/theleap",
"meta": {
"site": "news",
"source": "kqed",
"order": 17
},
"link": "/podcasts/theleap",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/the-leap/id1046668171",
"npr": "https://www.npr.org/podcasts/447248267/the-leap",
"stitcher": "https://www.stitcher.com/podcast/kqed/the-leap",
"spotify": "https://open.spotify.com/show/3sSlVHHzU0ytLwuGs1SD1U",
"rss": "https://ww2.kqed.org/news/programs/the-leap/feed/podcast"
}
},
"the-moth-radio-hour": {
"id": "the-moth-radio-hour",
"title": "The Moth Radio Hour",
"info": "Since its launch in 1997, The Moth has presented thousands of true stories, told live and without notes, to standing-room-only crowds worldwide. Moth storytellers stand alone, under a spotlight, with only a microphone and a roomful of strangers. The storyteller and the audience embark on a high-wire act of shared experience which is both terrifying and exhilarating. Since 2008, The Moth podcast has featured many of our favorite stories told live on Moth stages around the country. For information on all of our programs and live events, visit themoth.org.",
"airtime": "SAT 8pm-9pm and SUN 11am-12pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/theMoth.jpg",
"officialWebsiteLink": "https://themoth.org/",
"meta": {
"site": "arts",
"source": "prx"
},
"link": "/radio/program/the-moth-radio-hour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/the-moth-podcast/id275699983?mt=2",
"tuneIn": "https://tunein.com/radio/The-Moth-p273888/",
"rss": "http://feeds.themoth.org/themothpodcast"
}
},
"the-new-yorker-radio-hour": {
"id": "the-new-yorker-radio-hour",
"title": "The New Yorker Radio Hour",
"info": "The New Yorker Radio Hour is a weekly program presented by the magazine's editor, David Remnick, and produced by WNYC Studios and The New Yorker. Each episode features a diverse mix of interviews, profiles, storytelling, and an occasional burst of humor inspired by the magazine, and shaped by its writers, artists, and editors. This isn't a radio version of a magazine, but something all its own, reflecting the rich possibilities of audio storytelling and conversation. Theme music for the show was composed and performed by Merrill Garbus of tUnE-YArDs.",
"airtime": "SAT 10am-11am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-New-Yorker-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/tnyradiohour",
"meta": {
"site": "arts",
"source": "WNYC"
},
"link": "/radio/program/the-new-yorker-radio-hour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/id1050430296",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/New-Yorker-Radio-Hour-p803804/",
"rss": "https://feeds.feedburner.com/newyorkerradiohour"
}
},
"the-sam-sanders-show": {
"id": "the-sam-sanders-show",
"title": "The Sam Sanders Show",
"info": "One of public radio's most dynamic voices, Sam Sanders helped launch The NPR Politics Podcast and hosted NPR's hit show It's Been A Minute. Now, the award-winning host returns with something brand new, The Sam Sanders Show. Every week, Sam Sanders and friends dig into the culture that shapes our lives: what's driving the biggest trends, how artists really think, and even the memes you can't stop scrolling past. Sam is beloved for his way of unpacking the world and bringing you up close to fresh currents and engaging conversations. The Sam Sanders Show is smart, funny and always a good time.",
"airtime": "FRI 12-1pm AND SAT 11am-12pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/11/The-Sam-Sanders-Show-Podcast-Tile-400x400-1.jpg",
"officialWebsiteLink": "https://www.kcrw.com/shows/the-sam-sanders-show/latest",
"meta": {
"site": "arts",
"source": "KCRW"
},
"link": "https://www.kcrw.com/shows/the-sam-sanders-show/latest",
"subscribe": {
"rss": "https://feed.cdnstream1.com/zjb/feed/download/ac/28/59/ac28594c-e1d0-4231-8728-61865cdc80e8.xml"
}
},
"the-splendid-table": {
"id": "the-splendid-table",
"title": "The Splendid Table",
"info": "\u003cem>The Splendid Table\u003c/em> hosts our nation's conversations about cooking, sustainability and food culture.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Splendid-Table-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.splendidtable.org/",
"airtime": "SUN 10-11 pm",
"meta": {
"site": "radio",
"source": "npr"
},
"link": "/radio/program/the-splendid-table"
},
"this-american-life": {
"id": "this-american-life",
"title": "This American Life",
"info": "This American Life is a weekly public radio show, heard by 2.2 million people on more than 500 stations. Another 2.5 million people download the weekly podcast. It is hosted by Ira Glass, produced in collaboration with Chicago Public Media, delivered to stations by PRX The Public Radio Exchange, and has won all of the major broadcasting awards.",
"airtime": "SAT 12pm-1pm, 7pm-8pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/thisAmericanLife.png",
"officialWebsiteLink": "https://www.thisamericanlife.org/",
"meta": {
"site": "news",
"source": "wbez"
},
"link": "/radio/program/this-american-life",
"subscribe": {
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=201671138&at=11l79Y&ct=nprdirectory",
"rss": "https://www.thisamericanlife.org/podcast/rss.xml"
}
},
"tinydeskradio": {
"id": "tinydeskradio",
"title": "Tiny Desk Radio",
"info": "We're bringing the best of Tiny Desk to the airwaves, only on public radio.",
"airtime": "SUN 8pm and SAT 9pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/04/300x300-For-Member-Station-Logo-Tiny-Desk-Radio-@2x.png",
"officialWebsiteLink": "https://www.npr.org/series/g-s1-52030/tiny-desk-radio",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/tinydeskradio",
"subscribe": {
"rss": "https://feeds.npr.org/g-s1-52030/rss.xml"
}
},
"wait-wait-dont-tell-me": {
"id": "wait-wait-dont-tell-me",
"title": "Wait Wait... Don't Tell Me!",
"info": "Peter Sagal and Bill Kurtis host the weekly NPR News quiz show alongside some of the best and brightest news and entertainment personalities.",
"airtime": "SUN 10am-11am, SAT 11am-12pm, SAT 6pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Wait-Wait-Podcast-Tile-300x300-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/wait-wait-dont-tell-me/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/wait-wait-dont-tell-me",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/Xogv",
"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=121493804&at=11l79Y&ct=nprdirectory",
"tuneIn": "https://tunein.com/radio/Wait-Wait-Dont-Tell-Me-p46/",
"rss": "https://feeds.npr.org/344098539/podcast.xml"
}
},
"weekend-edition-saturday": {
"id": "weekend-edition-saturday",
"title": "Weekend Edition Saturday",
"info": "Weekend Edition Saturday wraps up the week's news and offers a mix of analysis and features on a wide range of topics, including arts, sports, entertainment, and human interest stories. The two-hour program is hosted by NPR's Peabody Award-winning Scott Simon.",
"airtime": "SAT 5am-10am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Weekend-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/weekend-edition-saturday/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/weekend-edition-saturday"
},
"weekend-edition-sunday": {
"id": "weekend-edition-sunday",
"title": "Weekend Edition Sunday",
"info": "Weekend Edition Sunday features interviews with newsmakers, artists, scientists, politicians, musicians, writers, theologians and historians. The program has covered news events from Nelson Mandela's 1990 release from a South African prison to the capture of Saddam Hussein.",
"airtime": "SUN 5am-10am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Weekend-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/weekend-edition-sunday/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/weekend-edition-sunday"
}
},
"racesReducer": {},
"racesGenElectionReducer": {},
"racesGenElection2026Reducer": {},
"racesGenElection2026PresidentialReducer": {},
"radioSchedulesReducer": {},
"listsReducer": {
"posts/stateofhealth?category=policy": {
"isFetching": false,
"latestQuery": {
"from": 48,
"size": 12
},
"vitalsOnly": false,
"totalRequested": 12,
"isLoading": false,
"isLoadingMore": true,
"total": {
"value": 824,
"relation": "eq"
},
"items": [
"stateofhealth_342500",
"stateofhealth_339838",
"stateofhealth_337900",
"stateofhealth_337364",
"stateofhealth_337321",
"stateofhealth_333573",
"stateofhealth_330339",
"stateofhealth_328856",
"stateofhealth_325769",
"stateofhealth_323597",
"stateofhealth_322664",
"stateofhealth_322154"
],
"complete": true
}
},
"recallGuideReducer": {
"intros": {},
"policy": {},
"candidates": {}
},
"savedArticleReducer": {
"articles": [],
"status": {}
},
"newslettersReducer": {
"isFetching": false,
"fetchFailed": false,
"hasFetched": false,
"newsletters": {},
"isSubscribing": false,
"isUnsubscribing": false,
"subscribedNewsletters": {}
},
"termsReducer": {
"about": {
"name": "About",
"type": "terms",
"id": "about",
"slug": "about",
"link": "/about",
"taxonomy": "site"
},
"arts": {
"name": "Arts & Culture",
"grouping": [
"arts",
"pop",
"trulyca"
],
"description": "KQED Arts provides daily in-depth coverage of the Bay Area's music, art, film, performing arts, literature and arts news, as well as cultural commentary and criticism.",
"type": "terms",
"id": "arts",
"slug": "arts",
"link": "/arts",
"taxonomy": "site"
},
"artschool": {
"name": "Art School",
"parent": "arts",
"type": "terms",
"id": "artschool",
"slug": "artschool",
"link": "/artschool",
"taxonomy": "site"
},
"bayareabites": {
"name": "KQED food",
"grouping": [
"food",
"bayareabites",
"checkplease"
],
"parent": "food",
"type": "terms",
"id": "bayareabites",
"slug": "bayareabites",
"link": "/food",
"taxonomy": "site"
},
"bayareahiphop": {
"name": "Bay Area Hiphop",
"type": "terms",
"id": "bayareahiphop",
"slug": "bayareahiphop",
"link": "/bayareahiphop",
"taxonomy": "site"
},
"campaign21": {
"name": "Campaign 21",
"type": "terms",
"id": "campaign21",
"slug": "campaign21",
"link": "/campaign21",
"taxonomy": "site"
},
"careers": {
"name": "Careers",
"type": "terms",
"id": "careers",
"slug": "careers",
"link": "/careers",
"taxonomy": "site"
},
"checkplease": {
"name": "KQED food",
"grouping": [
"food",
"bayareabites",
"checkplease"
],
"parent": "food",
"type": "terms",
"id": "checkplease",
"slug": "checkplease",
"link": "/food",
"taxonomy": "site"
},
"education": {
"name": "Education",
"grouping": [
"education"
],
"type": "terms",
"id": "education",
"slug": "education",
"link": "/education",
"taxonomy": "site"
},
"elections": {
"name": "Elections",
"type": "terms",
"id": "elections",
"slug": "elections",
"link": "/elections",
"taxonomy": "site"
},
"events": {
"name": "Events",
"type": "terms",
"id": "events",
"slug": "events",
"link": "/events",
"taxonomy": "site"
},
"event": {
"name": "Event",
"alias": "events",
"type": "terms",
"id": "event",
"slug": "event",
"link": "/event",
"taxonomy": "site"
},
"filmschoolshorts": {
"name": "Film School Shorts",
"type": "terms",
"id": "filmschoolshorts",
"slug": "filmschoolshorts",
"link": "/filmschoolshorts",
"taxonomy": "site"
},
"food": {
"name": "KQED food",
"grouping": [
"food",
"bayareabites",
"checkplease"
],
"type": "terms",
"id": "food",
"slug": "food",
"link": "/food",
"taxonomy": "site"
},
"forum": {
"name": "Forum",
"relatedContentQuery": "posts/forum?",
"parent": "news",
"type": "terms",
"id": "forum",
"slug": "forum",
"link": "/forum",
"taxonomy": "site"
},
"futureofyou": {
"name": "Future of You",
"grouping": [
"science",
"futureofyou"
],
"parent": "science",
"type": "terms",
"id": "futureofyou",
"slug": "futureofyou",
"link": "/futureofyou",
"taxonomy": "site"
},
"jpepinheart": {
"name": "KQED food",
"relatedContentQuery": "posts/food,bayareabites,checkplease",
"parent": "food",
"type": "terms",
"id": "jpepinheart",
"slug": "jpepinheart",
"link": "/food",
"taxonomy": "site"
},
"liveblog": {
"name": "Live Blog",
"type": "terms",
"id": "liveblog",
"slug": "liveblog",
"link": "/liveblog",
"taxonomy": "site"
},
"livetv": {
"name": "Live TV",
"parent": "tv",
"type": "terms",
"id": "livetv",
"slug": "livetv",
"link": "/livetv",
"taxonomy": "site"
},
"lowdown": {
"name": "The Lowdown",
"relatedContentQuery": "posts/lowdown?",
"parent": "news",
"type": "terms",
"id": "lowdown",
"slug": "lowdown",
"link": "/lowdown",
"taxonomy": "site"
},
"mindshift": {
"name": "Mindshift",
"parent": "news",
"description": "MindShift explores the future of education by highlighting the innovative – and sometimes counterintuitive – ways educators and parents are helping all children succeed.",
"type": "terms",
"id": "mindshift",
"slug": "mindshift",
"link": "/mindshift",
"taxonomy": "site"
},
"news": {
"name": "News",
"grouping": [
"news",
"forum"
],
"type": "terms",
"id": "news",
"slug": "news",
"link": "/news",
"taxonomy": "site"
},
"newsletters": {
"name": "newsletters",
"type": "terms",
"id": "newsletters",
"slug": "newsletters",
"link": "/newsletters",
"taxonomy": "site"
},
"perspectives": {
"name": "Perspectives",
"parent": "radio",
"type": "terms",
"id": "perspectives",
"slug": "perspectives",
"link": "/perspectives",
"taxonomy": "site"
},
"podcasts": {
"name": "Podcasts",
"type": "terms",
"id": "podcasts",
"slug": "podcasts",
"link": "/podcasts",
"taxonomy": "site"
},
"pop": {
"name": "Pop",
"parent": "arts",
"type": "terms",
"id": "pop",
"slug": "pop",
"link": "/pop",
"taxonomy": "site"
},
"pressroom": {
"name": "Pressroom",
"type": "terms",
"id": "pressroom",
"slug": "pressroom",
"link": "/pressroom",
"taxonomy": "site"
},
"quest": {
"name": "Quest",
"parent": "science",
"type": "terms",
"id": "quest",
"slug": "quest",
"link": "/quest",
"taxonomy": "site"
},
"radio": {
"name": "Radio",
"grouping": [
"forum",
"perspectives"
],
"description": "Listen to KQED Public Radio – home of Forum and The California Report – on 88.5 FM in San Francisco, 89.3 FM in Sacramento, 88.3 FM in Santa Rosa and 88.1 FM in Martinez.",
"type": "terms",
"id": "radio",
"slug": "radio",
"link": "/radio",
"taxonomy": "site"
},
"root": {
"name": "KQED",
"image": "https://ww2.kqed.org/app/uploads/2020/02/KQED-OG-Image@1x.png",
"imageWidth": 1200,
"imageHeight": 630,
"headData": {
"title": "KQED | News, Radio, Podcasts, TV | Public Media for Northern California",
"description": "KQED provides public radio, television, and independent reporting on issues that matter to the Bay Area. We’re the NPR and PBS member station for Northern California."
},
"type": "terms",
"id": "root",
"slug": "root",
"link": "/root",
"taxonomy": "site"
},
"science": {
"name": "Science",
"grouping": [
"science",
"futureofyou"
],
"description": "KQED Science brings you award-winning science and environment coverage from the Bay Area and beyond.",
"type": "terms",
"id": "science",
"slug": "science",
"link": "/science",
"taxonomy": "site"
},
"stateofhealth": {
"name": "State of Health",
"parent": "science",
"type": "terms",
"id": "stateofhealth",
"slug": "stateofhealth",
"link": "/stateofhealth",
"taxonomy": "site"
},
"support": {
"name": "Support",
"type": "terms",
"id": "support",
"slug": "support",
"link": "/support",
"taxonomy": "site"
},
"thedolist": {
"name": "The Do List",
"parent": "arts",
"type": "terms",
"id": "thedolist",
"slug": "thedolist",
"link": "/thedolist",
"taxonomy": "site"
},
"trulyca": {
"name": "Truly CA",
"grouping": [
"arts",
"pop",
"trulyca"
],
"parent": "arts",
"type": "terms",
"id": "trulyca",
"slug": "trulyca",
"link": "/trulyca",
"taxonomy": "site"
},
"tv": {
"name": "TV",
"type": "terms",
"id": "tv",
"slug": "tv",
"link": "/tv",
"taxonomy": "site"
},
"voterguide": {
"name": "Voter Guide",
"parent": "elections",
"alias": "elections",
"type": "terms",
"id": "voterguide",
"slug": "voterguide",
"link": "/voterguide",
"taxonomy": "site"
},
"guiaelectoral": {
"name": "Guia Electoral",
"parent": "elections",
"alias": "elections",
"type": "terms",
"id": "guiaelectoral",
"slug": "guiaelectoral",
"link": "/guiaelectoral",
"taxonomy": "site"
},
"stateofhealth_category_policy": {
"isLoading": true
},
"stateofhealth_14": {
"type": "terms",
"id": "stateofhealth_14",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "14",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Policy",
"description": "Actions by people in power – lawmakers, regulators and the like – can make a difference to your health, for better or for worse. We keep you informed",
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": "Actions by people in power – lawmakers, regulators and the like – can make a difference to your health, for better or for worse. We keep you informed",
"title": "Policy Archives | KQED Arts",
"ogDescription": null
},
"ttid": 14,
"slug": "policy",
"isLoading": false,
"link": "/stateofhealth/category/policy"
},
"stateofhealth_2442": {
"type": "terms",
"id": "stateofhealth_2442",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2442",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Health Insurance",
"description": null,
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Health Insurance Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2453,
"slug": "health-insurance",
"isLoading": false,
"link": "/stateofhealth/category/health-insurance"
},
"stateofhealth_2746": {
"type": "terms",
"id": "stateofhealth_2746",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2746",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Public Health",
"description": null,
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Public Health Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2755,
"slug": "public-health",
"isLoading": false,
"link": "/stateofhealth/category/public-health"
},
"stateofhealth_294": {
"type": "terms",
"id": "stateofhealth_294",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "294",
"found": true
},
"relationships": {},
"featImg": null,
"name": "ACA",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "ACA Archives | KQED Arts",
"ogDescription": null
},
"ttid": 295,
"slug": "aca",
"isLoading": false,
"link": "/stateofhealth/tag/aca"
},
"stateofhealth_3116": {
"type": "terms",
"id": "stateofhealth_3116",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3116",
"found": true
},
"relationships": {},
"featImg": null,
"name": "emergency room",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "emergency room Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3125,
"slug": "emergency-room",
"isLoading": false,
"link": "/stateofhealth/tag/emergency-room"
},
"stateofhealth_2808": {
"type": "terms",
"id": "stateofhealth_2808",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2808",
"found": true
},
"relationships": {},
"featImg": null,
"name": "featured",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "featured Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2817,
"slug": "featured",
"isLoading": false,
"link": "/stateofhealth/tag/featured"
},
"stateofhealth_99": {
"type": "terms",
"id": "stateofhealth_99",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "99",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Medi-Cal",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Medi-Cal Archives | KQED Arts",
"ogDescription": null
},
"ttid": 99,
"slug": "medi-cal",
"isLoading": false,
"link": "/stateofhealth/tag/medi-cal"
},
"stateofhealth_2519": {
"type": "terms",
"id": "stateofhealth_2519",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2519",
"found": true
},
"relationships": {},
"featImg": null,
"name": "News",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "News Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2528,
"slug": "news",
"isLoading": false,
"link": "/stateofhealth/tag/news"
},
"stateofhealth_365": {
"type": "terms",
"id": "stateofhealth_365",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "365",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Obamacare",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Obamacare Archives | KQED Arts",
"ogDescription": null
},
"ttid": 366,
"slug": "obamacare",
"isLoading": false,
"link": "/stateofhealth/tag/obamacare"
},
"stateofhealth_3036": {
"type": "terms",
"id": "stateofhealth_3036",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3036",
"found": true
},
"relationships": {},
"featImg": null,
"name": "California Healthline",
"description": null,
"taxonomy": "affiliate",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "California Healthline Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3045,
"slug": "california-healthline",
"isLoading": false,
"link": "/stateofhealth/affiliate/california-healthline"
},
"stateofhealth_15": {
"type": "terms",
"id": "stateofhealth_15",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "15",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Obamacare",
"description": "The Affordable Care Act celebrates its seventh birthday this year. California has embraced the law, but will it survive a new Congress and President? \r\n",
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": "The Affordable Care Act celebrates its seventh birthday this year. California has embraced the law, but will it survive a new Congress and President?",
"title": "Obamacare Archives | KQED Arts",
"ogDescription": null
},
"ttid": 15,
"slug": "reform",
"isLoading": false,
"link": "/stateofhealth/category/reform"
},
"stateofhealth_3112": {
"type": "terms",
"id": "stateofhealth_3112",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3112",
"found": true
},
"relationships": {},
"featImg": null,
"name": "California Legislature",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "California Legislature Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3121,
"slug": "california-legislature",
"isLoading": false,
"link": "/stateofhealth/tag/california-legislature"
},
"stateofhealth_3110": {
"type": "terms",
"id": "stateofhealth_3110",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3110",
"found": true
},
"relationships": {},
"featImg": null,
"name": "health policy",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "health policy Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3119,
"slug": "health-policy",
"isLoading": false,
"link": "/stateofhealth/tag/health-policy"
},
"stateofhealth_2874": {
"type": "terms",
"id": "stateofhealth_2874",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2874",
"found": true
},
"relationships": {},
"featImg": null,
"name": "healthcare",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "healthcare Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2883,
"slug": "healthcare",
"isLoading": false,
"link": "/stateofhealth/tag/healthcare"
},
"stateofhealth_2845": {
"type": "terms",
"id": "stateofhealth_2845",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2845",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Insurance",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Insurance Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2854,
"slug": "insurance",
"isLoading": false,
"link": "/stateofhealth/tag/insurance"
},
"stateofhealth_3048": {
"type": "terms",
"id": "stateofhealth_3048",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3048",
"found": true
},
"relationships": {},
"featImg": null,
"name": "single payer",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "single payer Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3057,
"slug": "single-payer",
"isLoading": false,
"link": "/stateofhealth/tag/single-payer"
},
"stateofhealth_3111": {
"type": "terms",
"id": "stateofhealth_3111",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3111",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Trump administration",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Trump administration Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3120,
"slug": "trump-administration",
"isLoading": false,
"link": "/stateofhealth/tag/trump-administration"
},
"stateofhealth_1": {
"type": "terms",
"id": "stateofhealth_1",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "1",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Uncategorized",
"description": null,
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Uncategorized Archives | KQED Arts",
"ogDescription": null
},
"ttid": 1,
"slug": "uncategorized",
"isLoading": false,
"link": "/stateofhealth/category/uncategorized"
},
"stateofhealth_28": {
"type": "terms",
"id": "stateofhealth_28",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "28",
"found": true
},
"relationships": {},
"featImg": null,
"name": "health insurance",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "health insurance Archives | KQED Arts",
"ogDescription": null
},
"ttid": 28,
"slug": "health-insurance",
"isLoading": false,
"link": "/stateofhealth/tag/health-insurance"
},
"stateofhealth_11": {
"type": "terms",
"id": "stateofhealth_11",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "11",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Community Health",
"description": "\r\n\r\nFrom rural California to urban neighborhoods, where you live affects your health",
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": "From rural California to urban neighborhoods, where you live affects your health",
"title": "Community Health Archives | KQED Arts",
"ogDescription": null
},
"ttid": 11,
"slug": "place-matters",
"isLoading": false,
"link": "/stateofhealth/category/place-matters"
},
"stateofhealth_2914": {
"type": "terms",
"id": "stateofhealth_2914",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2914",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Undocumented",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Undocumented Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2923,
"slug": "undocumented",
"isLoading": false,
"link": "/stateofhealth/tag/undocumented"
},
"stateofhealth_2892": {
"type": "terms",
"id": "stateofhealth_2892",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2892",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Drugs",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Drugs Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2901,
"slug": "drugs",
"isLoading": false,
"link": "/stateofhealth/tag/drugs"
},
"stateofhealth_3103": {
"type": "terms",
"id": "stateofhealth_3103",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3103",
"found": true
},
"relationships": {},
"featImg": null,
"name": "pharmaceutical",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "pharmaceutical Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3112,
"slug": "pharmaceutical",
"isLoading": false,
"link": "/stateofhealth/tag/pharmaceutical"
},
"stateofhealth_12": {
"type": "terms",
"id": "stateofhealth_12",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "12",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Living Healthy",
"description": "Health is about much more than medicine. We show you what's new to help you attain and maintain a healthy life",
"taxonomy": "category",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": "Health is about much more than medicine. We show you what's new to help you attain and maintain a healthy life",
"title": "Living Healthy Archives | KQED Arts",
"ogDescription": null
},
"ttid": 12,
"slug": "living-healthy",
"isLoading": false,
"link": "/stateofhealth/category/living-healthy"
},
"stateofhealth_3086": {
"type": "terms",
"id": "stateofhealth_3086",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3086",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Breast Milk",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Breast Milk Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3095,
"slug": "breast-milk",
"isLoading": false,
"link": "/stateofhealth/tag/breast-milk"
},
"stateofhealth_2578": {
"type": "terms",
"id": "stateofhealth_2578",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2578",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Nursing",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Nursing Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2587,
"slug": "nursing",
"isLoading": false,
"link": "/stateofhealth/tag/nursing"
},
"stateofhealth_3100": {
"type": "terms",
"id": "stateofhealth_3100",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3100",
"found": true
},
"relationships": {},
"featImg": null,
"name": "TCP",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "TCP Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3109,
"slug": "tcp",
"isLoading": false,
"link": "/stateofhealth/tag/tcp"
},
"stateofhealth_3099": {
"type": "terms",
"id": "stateofhealth_3099",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3099",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Toxic",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Toxic Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3108,
"slug": "toxic",
"isLoading": false,
"link": "/stateofhealth/tag/toxic"
},
"stateofhealth_2610": {
"type": "terms",
"id": "stateofhealth_2610",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2610",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Water",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Water Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2619,
"slug": "water",
"isLoading": false,
"link": "/stateofhealth/tag/water"
},
"stateofhealth_3092": {
"type": "terms",
"id": "stateofhealth_3092",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "3092",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Universal Health Care",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Universal Health Care Archives | KQED Arts",
"ogDescription": null
},
"ttid": 3101,
"slug": "universal-health-care",
"isLoading": false,
"link": "/stateofhealth/tag/universal-health-care"
},
"stateofhealth_2722": {
"type": "terms",
"id": "stateofhealth_2722",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2722",
"found": true
},
"relationships": {},
"featImg": null,
"name": "California",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "California Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2731,
"slug": "california",
"isLoading": false,
"link": "/stateofhealth/tag/california"
},
"stateofhealth_2650": {
"type": "terms",
"id": "stateofhealth_2650",
"meta": {
"index": "terms_1716263798",
"site": "stateofhealth",
"id": "2650",
"found": true
},
"relationships": {},
"featImg": null,
"name": "Drug Costs",
"description": null,
"taxonomy": "tag",
"headData": {
"twImgId": null,
"twTitle": null,
"ogTitle": null,
"ogImgId": null,
"twDescription": null,
"description": null,
"title": "Drug Costs Archives | KQED Arts",
"ogDescription": null
},
"ttid": 2659,
"slug": "drug-costs",
"isLoading": false,
"link": "/stateofhealth/tag/drug-costs"
}
},
"userPermissionsReducer": {
"wpLoggedIn": false
},
"eventsReducer": {},
"fssReducer": {},
"tvDailyScheduleReducer": {},
"tvWeeklyScheduleReducer": {},
"tvPrimetimeScheduleReducer": {},
"tvMonthlyScheduleReducer": {},
"userAccountReducer": {
"user": {
"email": null,
"emailStatus": "EMAIL_UNVALIDATED",
"loggedStatus": "LOGGED_OUT",
"loggingChecked": false,
"articles": [],
"firstName": null,
"lastName": null,
"phoneNumber": null,
"fetchingMembership": false,
"membershipError": false,
"memberships": [
{
"id": null,
"startDate": null,
"firstName": null,
"lastName": null,
"familyNumber": null,
"memberNumber": null,
"memberSince": null,
"expirationDate": null,
"pfsEligible": false,
"isSustaining": false,
"membershipLevel": "Prospect",
"membershipStatus": "Non Member",
"lastGiftDate": null,
"renewalDate": null,
"lastDonationAmount": null
}
]
},
"authModal": {
"isOpen": false,
"view": "LANDING_VIEW"
},
"error": null
},
"youthMediaReducer": {},
"checkPleaseReducer": {
"filterData": {
"region": {
"key": "Restaurant Region",
"filters": [
"Any Region"
]
},
"cuisine": {
"key": "Restaurant Cuisine",
"filters": [
"Any Cuisine"
]
}
},
"restaurantDataById": {},
"restaurantIdsSorted": [],
"error": null
},
"userAgentReducer": {
"userAgent": "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)",
"isBot": true
},
"requestOutcomesReducer": {
"notFound": []
},
"navPromosReducer": {
"isFetching": false,
"fetchFailed": false,
"hasFetched": true,
"promos": {
"news": {
"name": "2026 Voter Guide",
"link": "/voterguide",
"imageURL": "https://cdn.kqed.org/wp-content/uploads/2026/10/Nav-News-Nov2026ElectionCoverage@2x-7bd4aad4.png",
"description": "Get informed in minutes with our Voter Guide for California’s November 3 election."
},
"podcasts-radio": {},
"video-tv": {},
"events": {},
"support": {}
}
}
}