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"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",
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"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>",
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"disqusTitle": "Before Obamacare, People with Pre-Existing Conditions Got Little Help From States",
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"content": "\u003cp>For most of his life, Carl Goulden had near-perfect health. He and his wife, Wanda, say that changed 10 years ago. Carl remembered feeling “a lot of pain in the back, tired, fatigue, yellow eyes — a lot of jaundice.”\u003c/p>\n\u003cp>“Gray-like skin,” Wanda added. His liver wasn’t working, she explained. “It wasn’t filtering.”\u003c/p>\n\u003cp>Carl was diagnosed with hepatitis B. He is now 65 and on Medicare, but back then he had a flower shop in Littlestown, Pennsylvania, so he had been buying health insurance for his family on the market for small businesses and the self-employed.\u003c/p>\n\u003cp>The medications to manage Carl’s hepatitis cost more than $10,000 a year — and if he ever needed a liver transplant, as some people with hepatitis eventually do, the costs could be formidable. Thank goodness they had health insurance, the couple thought.\u003c/p>\n\u003cp>But then, Carl said, “the insurance renewals went way up.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>After a few years, he could no longer afford to buy the coverage — more than $1,000 a month — and maintain his business. So he dropped the insurance.\u003c/p>\n\u003cp>“I was devastated,” he said, “because I didn’t know when my liver might fail.”\u003c/p>\n\u003cp>Teresa Miller, Pennsylvania’s insurance commissioner, said that steep increase in insurance rates was legal. And before the Affordable Care Act became law, a patient like Goulden might have had a hard time buying another policy. He likely would have been turned down by private insurers because he had a “pre-existing” medical condition.\u003c/p>\n\u003cp>A family like the Gouldens would “just have been out of luck,” Miller said.\u003c/p>\n\u003cp>\u003cstrong>Pennsylvania: The Wild, Wild West\u003cbr>\n\u003c/strong>\u003cbr>\nBefore the ACA, states had differing approaches to handling pre-existing conditions.\u003c/p>\n\u003cp>Pennsylvania was typical. Until the ACA mandated that insurers treat sick and healthy people equally, buying insurance seemed as lawless as the Wild West.\u003c/p>\n\u003cp>Insurers couldn’t overtly kick people off a plan if they got sick, but they could find ways to charge them much more, even those whose chronic condition wasn’t that serious — such as acne. For individuals looking to sign up in the first place, “an insurance company could simply decline to offer you insurance at all because of your pre-existing condition,” Miller said.\u003c/p>\n\u003cp>Insurers who did offer a policy to someone with a pre-existing condition might have done so with a catch — the plan could require a waiting period or might exclude treatment for that condition.\u003c/p>\n\u003cp>“So, let’s say you had diabetes, for example,” Miller said. “You might have been able to get coverage for an unexpected health care need that arose, but you’d still be on your own for any treatment and management of your diabetes.”\u003c/p>\n\u003cp>From the perspective of an insurance company, these practices were intended to prevent the sick from signing up for a health plan only when they needed costly care.\u003c/p>\n\u003cp>Pennsylvania tried to partially solve this problem by creating a scaled-back health plan, called adultBasic, for those with incomes too high to qualify for Medicaid who didn’t have any coverage. Household incomes had to be less than 200 percent of the federal poverty level, which at that time would have been $21,660 for an individual. More than 40,000 people were signed up in 2011, and nearly half a million were on the waiting list, but the plans didn’t include coverage for mental health care, prescription drugs or more than two nights in a hospital. Even so, Miller said, the strategy proved too expensive for the state.\u003c/p>\n\u003cp>“That program was spending $13 million to $14 million a month when it was shut down,” she said.\u003c/p>\n\u003cp>\u003cstrong>California: High-Risk Pool at High Cost\u003cbr>\n\u003c/strong>\u003cbr>\nMore than 30 other states dealt with pre-existing conditions by setting up what are called high-risk pools, a separate insurance plan for individuals who couldn’t get health coverage in the private market.\u003c/p>\n\u003cp>These plans could be lifesavers for some people with conditions like cancer — which can cost tens if not hundreds of thousands of dollars to treat.\u003c/p>\n\u003cp>The experiences with high-risk pools varied, but states faced challenges, said John Bertko, an insurance actuary with the state of California. And the main problem was the high cost.\u003c/p>\n\u003cp>“The one in California, which I was associated with, limited annual services to no more than $75,000, and they had a waiting list. There was not enough money,” Bertko said. “The 20,000 people who got into it were the lucky ones. At one point in time, there were another 10,000 people on a waiting list.”\u003c/p>\n\u003cp>The pools also had catches: Premiums were expensive, as were out-of-pocket costs. And plans often excluded the coverage of pre-existing conditions for six months to a year after the patient bought the policy.\u003c/p>\n\u003cp>\u003cstrong>New Jersey: Pre-existing Conditions Covered, With A Catch\u003cbr>\n\u003c/strong>\u003cbr>\nAround that same time, across the Delaware River, the state of New Jersey was trying something different.\u003c/p>\n\u003cp>“Insurers could not take health status into account,” said Joel Cantor, director of Rutgers’ Center for State Health Policy who has been analyzing the New Jersey experience.\u003c/p>\n\u003cp>Before the ACA, New Jersey was one of just a handful of states that prohibited insurers from denying coverage to people with pre-existing conditions. Insurers also weren’t allowed to charge people significantly more for having a health issue, and the plans had to offer robust coverage of services.\u003c/p>\n\u003cp>There was a one-year waiting period for coverage of a pre-existing condition, but a larger issue became cost. The entire individual market in New Jersey became expensive for everyone, regardless of their health status, Cantor said. Because there was no mandate to have health insurance coverage, those who signed up tended to need it, and healthy people did not enroll.\u003c/p>\n\u003cp>And so, “the prices went up and up,” he said. And the premiums and enrollment “went down and down.”\u003c/p>\n\u003cp>The state tried to address this in the early 2000s by introducing a “skinny” health plan, Cantor said.\u003c/p>\n\u003cp>“By that I mean very few benefits,” he explains. “It covered very, very limited services.”\u003c/p>\n\u003cp>The plan was affordable and really popular, especially among the young and healthy people, and about 100,000 people signed up. But if a person had a health need, many costs shifted to the individual.\u003c/p>\n\u003cp>“It left people with huge financial exposure,” he said.\u003c/p>\n\u003cp>That’s, in part, why the ACA included a rule that insurance plans now must offer good benefits and be available to everybody. In exchange, insurers have the mandate and subsidies — so that everybody will buy in.\u003c/p>\n\u003cp>Cantor said these experiences point to an ongoing quandary: A small portion of people consume a big chunk of health care costs. It’s hard to predict who will cost a lot — or when.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes The Pulse, NPR and Kaiser Health News.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For most of his life, Carl Goulden had near-perfect health. He and his wife, Wanda, say that changed 10 years ago. Carl remembered feeling “a lot of pain in the back, tired, fatigue, yellow eyes — a lot of jaundice.”\u003c/p>\n\u003cp>“Gray-like skin,” Wanda added. His liver wasn’t working, she explained. “It wasn’t filtering.”\u003c/p>\n\u003cp>Carl was diagnosed with hepatitis B. He is now 65 and on Medicare, but back then he had a flower shop in Littlestown, Pennsylvania, so he had been buying health insurance for his family on the market for small businesses and the self-employed.\u003c/p>\n\u003cp>The medications to manage Carl’s hepatitis cost more than $10,000 a year — and if he ever needed a liver transplant, as some people with hepatitis eventually do, the costs could be formidable. Thank goodness they had health insurance, the couple thought.\u003c/p>\n\u003cp>But then, Carl said, “the insurance renewals went way up.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After a few years, he could no longer afford to buy the coverage — more than $1,000 a month — and maintain his business. So he dropped the insurance.\u003c/p>\n\u003cp>“I was devastated,” he said, “because I didn’t know when my liver might fail.”\u003c/p>\n\u003cp>Teresa Miller, Pennsylvania’s insurance commissioner, said that steep increase in insurance rates was legal. And before the Affordable Care Act became law, a patient like Goulden might have had a hard time buying another policy. He likely would have been turned down by private insurers because he had a “pre-existing” medical condition.\u003c/p>\n\u003cp>A family like the Gouldens would “just have been out of luck,” Miller said.\u003c/p>\n\u003cp>\u003cstrong>Pennsylvania: The Wild, Wild West\u003cbr>\n\u003c/strong>\u003cbr>\nBefore the ACA, states had differing approaches to handling pre-existing conditions.\u003c/p>\n\u003cp>Pennsylvania was typical. Until the ACA mandated that insurers treat sick and healthy people equally, buying insurance seemed as lawless as the Wild West.\u003c/p>\n\u003cp>Insurers couldn’t overtly kick people off a plan if they got sick, but they could find ways to charge them much more, even those whose chronic condition wasn’t that serious — such as acne. For individuals looking to sign up in the first place, “an insurance company could simply decline to offer you insurance at all because of your pre-existing condition,” Miller said.\u003c/p>\n\u003cp>Insurers who did offer a policy to someone with a pre-existing condition might have done so with a catch — the plan could require a waiting period or might exclude treatment for that condition.\u003c/p>\n\u003cp>“So, let’s say you had diabetes, for example,” Miller said. “You might have been able to get coverage for an unexpected health care need that arose, but you’d still be on your own for any treatment and management of your diabetes.”\u003c/p>\n\u003cp>From the perspective of an insurance company, these practices were intended to prevent the sick from signing up for a health plan only when they needed costly care.\u003c/p>\n\u003cp>Pennsylvania tried to partially solve this problem by creating a scaled-back health plan, called adultBasic, for those with incomes too high to qualify for Medicaid who didn’t have any coverage. Household incomes had to be less than 200 percent of the federal poverty level, which at that time would have been $21,660 for an individual. More than 40,000 people were signed up in 2011, and nearly half a million were on the waiting list, but the plans didn’t include coverage for mental health care, prescription drugs or more than two nights in a hospital. Even so, Miller said, the strategy proved too expensive for the state.\u003c/p>\n\u003cp>“That program was spending $13 million to $14 million a month when it was shut down,” she said.\u003c/p>\n\u003cp>\u003cstrong>California: High-Risk Pool at High Cost\u003cbr>\n\u003c/strong>\u003cbr>\nMore than 30 other states dealt with pre-existing conditions by setting up what are called high-risk pools, a separate insurance plan for individuals who couldn’t get health coverage in the private market.\u003c/p>\n\u003cp>These plans could be lifesavers for some people with conditions like cancer — which can cost tens if not hundreds of thousands of dollars to treat.\u003c/p>\n\u003cp>The experiences with high-risk pools varied, but states faced challenges, said John Bertko, an insurance actuary with the state of California. And the main problem was the high cost.\u003c/p>\n\u003cp>“The one in California, which I was associated with, limited annual services to no more than $75,000, and they had a waiting list. There was not enough money,” Bertko said. “The 20,000 people who got into it were the lucky ones. At one point in time, there were another 10,000 people on a waiting list.”\u003c/p>\n\u003cp>The pools also had catches: Premiums were expensive, as were out-of-pocket costs. And plans often excluded the coverage of pre-existing conditions for six months to a year after the patient bought the policy.\u003c/p>\n\u003cp>\u003cstrong>New Jersey: Pre-existing Conditions Covered, With A Catch\u003cbr>\n\u003c/strong>\u003cbr>\nAround that same time, across the Delaware River, the state of New Jersey was trying something different.\u003c/p>\n\u003cp>“Insurers could not take health status into account,” said Joel Cantor, director of Rutgers’ Center for State Health Policy who has been analyzing the New Jersey experience.\u003c/p>\n\u003cp>Before the ACA, New Jersey was one of just a handful of states that prohibited insurers from denying coverage to people with pre-existing conditions. Insurers also weren’t allowed to charge people significantly more for having a health issue, and the plans had to offer robust coverage of services.\u003c/p>\n\u003cp>There was a one-year waiting period for coverage of a pre-existing condition, but a larger issue became cost. The entire individual market in New Jersey became expensive for everyone, regardless of their health status, Cantor said. Because there was no mandate to have health insurance coverage, those who signed up tended to need it, and healthy people did not enroll.\u003c/p>\n\u003cp>And so, “the prices went up and up,” he said. And the premiums and enrollment “went down and down.”\u003c/p>\n\u003cp>The state tried to address this in the early 2000s by introducing a “skinny” health plan, Cantor said.\u003c/p>\n\u003cp>“By that I mean very few benefits,” he explains. “It covered very, very limited services.”\u003c/p>\n\u003cp>The plan was affordable and really popular, especially among the young and healthy people, and about 100,000 people signed up. 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"content": "\u003cp>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 Mothers’ Milk Bank, 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\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 Food and Drug Administration 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, warning consumers 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>\u003cstrong>Milk Magic\u003c/strong>\u003c/p>\n\u003cp>As recently as the early 1970s, barely a fifth of American babies were breast-fed. Today, more than 80% 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>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 Human Milk Banking Association of North America, 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>\u003cstrong>To Profit Or Not To Profit?\u003c/strong>\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\u003cp>For-profit breast milk operations are expanding, too. Elster’s company, Prolacta Bioscience, 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 Only the Breast and Eats on Feets, also appear to be booming. One report 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 Inland Empire Breastfeeding Coalition, 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 reported 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 frequently contaminated by pathogenic bacteria.\u003c/p>\n\u003cp>Kim Updegrove, executive director of the nonprofit Mothers’ Milk Bank at Austin, 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 2016 paper 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>[ad floatright]\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\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>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 Mothers’ Milk Bank, 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\u003cp>\u003c/p>\u003c/div>",
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"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 Food and Drug Administration 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, warning consumers 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>\u003cstrong>Milk Magic\u003c/strong>\u003c/p>\n\u003cp>As recently as the early 1970s, barely a fifth of American babies were breast-fed. Today, more than 80% 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>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 Human Milk Banking Association of North America, 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>\u003cstrong>To Profit Or Not To Profit?\u003c/strong>\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\u003cp>For-profit breast milk operations are expanding, too. Elster’s company, Prolacta Bioscience, 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 Only the Breast and Eats on Feets, also appear to be booming. One report 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 Inland Empire Breastfeeding Coalition, 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 reported 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 frequently contaminated by pathogenic bacteria.\u003c/p>\n\u003cp>Kim Updegrove, executive director of the nonprofit Mothers’ Milk Bank at Austin, 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 2016 paper 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>\u003c/p>\u003c/div>",
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"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",
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"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>",
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"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>",
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"disqusTitle": "Why Slashing Federal Health Spending Could Be a Job Killer",
"title": "Why Slashing Federal Health Spending Could Be a Job Killer",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>In many ways, the health care industry has been a great friend to the U.S. economy. Its plentiful jobs helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs 1 in 9 Americans — up from 1 in 12 in 2000.\u003c/p>\n\u003cp>As President Donald Trump seeks to fulfill his campaign pledge to create millions more jobs, the industry would seem a promising place to turn. But the business mogul also campaigned to repeal Obamacare and lower health care costs — a potentially serious job killer. It’s a dilemma: One promise could run headlong into the other.\u003c/p>\n\u003cp>“The goal of increasing jobs in health care is incompatible with the goal of keeping health care affordable,” said Harvard University economist Katherine Baicker, who sees advantages in trimming the industry’s growth. “There’s a lot of evidence we can get more bang for our buck in health care. We should be aiming for a health care system that operates more efficiently and effectively. That might mean better outcomes for patients and fewer jobs.”\u003c/p>\n\u003cp>But the country has grown increasingly dependent on the health sector to power the economy — and it will be a tough habit to break. Thirty-five percent of the nation’s job growth has come from health care since the recession hit in late 2007, the single-biggest sector for job creation.\u003c/p>\n\u003cp>Hiring rose even more as coverage expanded in 2014 under the health law and new federal dollars flowed in. It gave hospitals, universities and companies even more reason to invest in new facilities and staff. Training programs sprang up to fill the growing job pool. Cities welcomed the development — and the revenue. Simply put, rising health spending has been good for some economically distressed parts of the country, many of which voted for Trump last year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In Morgantown, W.Va., the West Virginia University health system just opened a 10-story medical tower and hired 2,000 employees last year. In Danville, Pa., the Geisinger Health System has added more than 2,200 workers since July and is trying to fill 2,000 more jobs across its 12 hospital campuses and a health plan. Out West, the UCHealth system in Colorado expanded its Fort Collins hospital and is building three hospitals in the state.\u003c/p>\n\u003cp>In cities such as Pittsburgh, Cleveland and St. Louis, health care has replaced dying industries like coal and heavy manufacturing as a primary source of new jobs. “The industry accounts for a lot of good middle-class jobs and, in many communities, it’s the single-largest employer,” said Sam Glick, a partner at the Oliver Wyman consulting firm in San Francisco. “One of the hardest decisions for the new Trump administration is how far do they push on health care costs at the expense of jobs in health care.”\u003c/p>\n\u003cp>House Republicans, with backing from Trump, took the first swipe. Their American Health Care Act sought to roll back the current health law’s Medicaid expansion and cut federal subsidies for private health insurance. The GOP plan faltered in the House, but Republican lawmakers and the Trump administration are still trying to craft a replacement for Obamacare.\u003c/p>\n\u003cp>Neither the ACA nor the latest Republican attempt at an overhaul tackle what some industry experts and economists see as a serious underlying reason for high health care costs: a system bloated by redundancy, inefficiency and a growing number of jobs far removed from patient care.\u003c/p>\n\u003cp>Labor accounts for more than half of the $3.4 trillion spent on U.S. health care, and medical professionals from health aides to nurse practitioners are in high demand. But the sheer complexity of the system also has spawned jobs for legions of data-entry clerks, revenue-cycle analysts and medical billing coders who must decipher arcane rules to mine money from human ills.\u003c/p>\n\u003cp>For every physician, there are 16 other workers in U.S. health care. And half of those 16 are in administrative and other nonclinical roles, said Bob Kocher, a former Obama administration official who worked on the Affordable Care Act. He’s now a partner at the venture capital firm Venrock in Palo Alto, Calif.\u003c/p>\n\u003cp>“I find super-expensive drugs annoying and hospital market power is a big problem,” Kocher said. “But what’s driving our health insurance premiums is that we are paying the wages of a whole bunch of people who aren’t involved in the delivery of care. Hospitals keep raising their rates to pay for all of this labor.”\u003c/p>\n\u003cp>Take medical coders. Membership in the American Academy of Professional Coders has swelled to more than 165,000, up 10,000 in the past year alone. The average salary has risen to nearly $50,000, offering a path to the American Dream.\u003c/p>\n\u003cp>“The coding profession is a great opportunity for individuals seeking their first job, and it’s attractive to a lot of medical professionals burned out on patient care,” said Raemarie Jimenez, a vice president at the medical coding group. “There is a lot of opportunity once you’ve got a foot in the door.”\u003c/p>\n\u003cp>Some of these back-office workers wage battle every day in clinics and hospitals against an army of claims administrators filling up cubicles inside insurance companies. Overseeing it all are hundreds of corporate vice presidents drawing six-figure salaries.\u003c/p>\n\u003cp>Administrative costs in U.S. health care are the highest in the developed world, according to a January report from the Organization for Economic Cooperation and Development. More than 8 percent of U.S. health spending is tied up in administration while the average globally is 3 percent. America spent $631 for every man, woman and child on health insurance administration for 2012 compared with $54 in Japan.\u003c/p>\n\u003cp>America’s huge investment in health care and related jobs hasn’t always led to better results for patients, data show. But it has provided good-paying jobs, which is why the talk of deep cuts in federal health spending has many people concerned.\u003c/p>\n\u003cp>Linda Gonzalez, a 31-year-old mother of two, was among the thousands of enrollment counselors hired to help sign up Americans for health insurance as Obamacare rolled out in 2014. The college graduate makes more than $40,000 a year working at an AltaMed enrollment center, tucked between a Verizon Wireless store and a nail salon on a busy street in Los Angeles.\u003c/p>\n\u003cp>In her cramped cubicle, families pull up chairs and sort through pay stubs and tax returns, often relying on her to sort out enrollment glitches with Medicaid. As the sole breadwinner for her two children, ages 9 and 10, she counts on this job but isn’t sure how long it will last.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“A lot of people depend on this,” she said one recent weekday. “It’s something I do worry about.”\u003c/p>\n\n",
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"nprByline": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/Chad-Terhune/\">Chad Terhune\u003c/strong>\u003c/a>\u003c/br>California HealthLine",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In many ways, the health care industry has been a great friend to the U.S. economy. Its plentiful jobs helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs 1 in 9 Americans — up from 1 in 12 in 2000.\u003c/p>\n\u003cp>As President Donald Trump seeks to fulfill his campaign pledge to create millions more jobs, the industry would seem a promising place to turn. But the business mogul also campaigned to repeal Obamacare and lower health care costs — a potentially serious job killer. It’s a dilemma: One promise could run headlong into the other.\u003c/p>\n\u003cp>“The goal of increasing jobs in health care is incompatible with the goal of keeping health care affordable,” said Harvard University economist Katherine Baicker, who sees advantages in trimming the industry’s growth. “There’s a lot of evidence we can get more bang for our buck in health care. We should be aiming for a health care system that operates more efficiently and effectively. That might mean better outcomes for patients and fewer jobs.”\u003c/p>\n\u003cp>But the country has grown increasingly dependent on the health sector to power the economy — and it will be a tough habit to break. Thirty-five percent of the nation’s job growth has come from health care since the recession hit in late 2007, the single-biggest sector for job creation.\u003c/p>\n\u003cp>Hiring rose even more as coverage expanded in 2014 under the health law and new federal dollars flowed in. It gave hospitals, universities and companies even more reason to invest in new facilities and staff. Training programs sprang up to fill the growing job pool. Cities welcomed the development — and the revenue. Simply put, rising health spending has been good for some economically distressed parts of the country, many of which voted for Trump last year.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In Morgantown, W.Va., the West Virginia University health system just opened a 10-story medical tower and hired 2,000 employees last year. In Danville, Pa., the Geisinger Health System has added more than 2,200 workers since July and is trying to fill 2,000 more jobs across its 12 hospital campuses and a health plan. Out West, the UCHealth system in Colorado expanded its Fort Collins hospital and is building three hospitals in the state.\u003c/p>\n\u003cp>In cities such as Pittsburgh, Cleveland and St. Louis, health care has replaced dying industries like coal and heavy manufacturing as a primary source of new jobs. “The industry accounts for a lot of good middle-class jobs and, in many communities, it’s the single-largest employer,” said Sam Glick, a partner at the Oliver Wyman consulting firm in San Francisco. “One of the hardest decisions for the new Trump administration is how far do they push on health care costs at the expense of jobs in health care.”\u003c/p>\n\u003cp>House Republicans, with backing from Trump, took the first swipe. Their American Health Care Act sought to roll back the current health law’s Medicaid expansion and cut federal subsidies for private health insurance. The GOP plan faltered in the House, but Republican lawmakers and the Trump administration are still trying to craft a replacement for Obamacare.\u003c/p>\n\u003cp>Neither the ACA nor the latest Republican attempt at an overhaul tackle what some industry experts and economists see as a serious underlying reason for high health care costs: a system bloated by redundancy, inefficiency and a growing number of jobs far removed from patient care.\u003c/p>\n\u003cp>Labor accounts for more than half of the $3.4 trillion spent on U.S. health care, and medical professionals from health aides to nurse practitioners are in high demand. But the sheer complexity of the system also has spawned jobs for legions of data-entry clerks, revenue-cycle analysts and medical billing coders who must decipher arcane rules to mine money from human ills.\u003c/p>\n\u003cp>For every physician, there are 16 other workers in U.S. health care. And half of those 16 are in administrative and other nonclinical roles, said Bob Kocher, a former Obama administration official who worked on the Affordable Care Act. He’s now a partner at the venture capital firm Venrock in Palo Alto, Calif.\u003c/p>\n\u003cp>“I find super-expensive drugs annoying and hospital market power is a big problem,” Kocher said. “But what’s driving our health insurance premiums is that we are paying the wages of a whole bunch of people who aren’t involved in the delivery of care. Hospitals keep raising their rates to pay for all of this labor.”\u003c/p>\n\u003cp>Take medical coders. Membership in the American Academy of Professional Coders has swelled to more than 165,000, up 10,000 in the past year alone. The average salary has risen to nearly $50,000, offering a path to the American Dream.\u003c/p>\n\u003cp>“The coding profession is a great opportunity for individuals seeking their first job, and it’s attractive to a lot of medical professionals burned out on patient care,” said Raemarie Jimenez, a vice president at the medical coding group. “There is a lot of opportunity once you’ve got a foot in the door.”\u003c/p>\n\u003cp>Some of these back-office workers wage battle every day in clinics and hospitals against an army of claims administrators filling up cubicles inside insurance companies. Overseeing it all are hundreds of corporate vice presidents drawing six-figure salaries.\u003c/p>\n\u003cp>Administrative costs in U.S. health care are the highest in the developed world, according to a January report from the Organization for Economic Cooperation and Development. More than 8 percent of U.S. health spending is tied up in administration while the average globally is 3 percent. America spent $631 for every man, woman and child on health insurance administration for 2012 compared with $54 in Japan.\u003c/p>\n\u003cp>America’s huge investment in health care and related jobs hasn’t always led to better results for patients, data show. But it has provided good-paying jobs, which is why the talk of deep cuts in federal health spending has many people concerned.\u003c/p>\n\u003cp>Linda Gonzalez, a 31-year-old mother of two, was among the thousands of enrollment counselors hired to help sign up Americans for health insurance as Obamacare rolled out in 2014. The college graduate makes more than $40,000 a year working at an AltaMed enrollment center, tucked between a Verizon Wireless store and a nail salon on a busy street in Los Angeles.\u003c/p>\n\u003cp>In her cramped cubicle, families pull up chairs and sort through pay stubs and tax returns, often relying on her to sort out enrollment glitches with Medicaid. As the sole breadwinner for her two children, ages 9 and 10, she counts on this job but isn’t sure how long it will last.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“A lot of people depend on this,” she said one recent weekday. “It’s something I do worry about.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Consumer Advocates Push for Over the Counter Sale of Hearing Aids",
"title": "Consumer Advocates Push for Over the Counter Sale of Hearing Aids",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Four out of five older Americans with hearing loss just ignore it, in part because a hearing aid is an unwelcome sign of aging. But what if hearing aids looked like stylish fashion accessories and could be bought at your local pharmacy like reading glasses?\u003c/p>\n\u003cp>That's the vision of Kristen \"KR\" Liu, who's the director of accessibility and advocacy for Doppler Labs, a company marketing one of these devices. She thinks a hearing aid could be \"something that's hip and cool and people have multiple pairs and it's fashionable.\"\u003c/p>\n\u003cp>Liu, who has severe hearing loss herself, helped design a device designed to let people with hearing loss blend in. One person may be using the technology to stream music or take a phone call, she says. Another may be wearing it to amplify speech and hear the conversation. \"And no one is going to know the difference,\" Liu says. \"So you're wearing technology in your ear, proudly.\"\u003c/p>\n\u003cp>The device is a small circular instrument that fits snugly in the ear. It can be adjusted to individual hearing using a smartphone app to control volume, cut out background noise or turn up the sound in a theater. \"It's pretty much a hearing aid,\" says Liu, except the company isn't allowed to call it that.\u003c/p>\n\u003cp>That's because the Food and Drug Administration, which regulates medical devices, doesn't allow hearing aids to be sold over the counter. So devices sold directly to consumers are marketed as \"personal sound amplification products,\" or PSAPs. They range in price from about $250 to $350 and are considerably cheaper than hearing aids, which can cost up to $6,000 and are typically not covered by Medicare or most private insurance companies. Hearing aids are customized by a hearing specialist such as an audiologist, following a hearing test.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>PSAPs can only be marketed as sound amplifiers for people with normal hearing who want to make things louder, like music or the sounds of birds chirping. Hearing loss advocates believe this means people with mild to moderate hearing loss who could benefit from the devices don't know about them. There are dozens of the devices on the market, but their quality varies wildly, as an analysis of 11 of them last year for hearing care professionals shows. And there's no easy way for potential purchasers to figure out which work best.\u003c/p>\n\u003cp>The Hearing Loss Association of America, a consumer group, wants Congress to create a new category of aids for people with mild to moderate hearing loss by passing the Over-the-Counter Hearing Aid Act of2017. (People with severe hearing loss would still need to be seen by a medical professional.) The bill would direct the FDA to come up with safety and effectiveness standards for these new hearing aids.\u003c/p>\n\u003cp>The FDA is already moving in that direction, and in December said it would no longer require adults to be medically evaluated before buying a hearing aid. Proponents of direct-to-consumer sales hope Congressional action would get the FDA moving faster. A 2016 report from the National Academies of Sciences also endorsed allowing over-the-counter sales.\u003c/p>\n\u003cp>This could be life changing for people with hearing loss, says Richard Einhorn, a composer of modern classical music who is on the board of the Hearing Loss Association of America.\u003c/p>\n\u003cp>Early one morning in 2010, he woke up with his ears ringing — a loud, piercing hiss. \"I hit the panic button,\" Einhorn says. \"I jumped out of bed and immediately fell over onto the floor.\"\u003c/p>\n\u003cp>An inner ear infection, likely a virus, had caused him to lose his balance. He went deaf in his right ear. He already had some hearing loss in his left ear. His hearing aids cost $5,000 and were not covered by insurance.\u003c/p>\n\u003cp>\"I'm a composer, for goodness sake,\" Einhorn says. \"This is not an easy purchase to scrounge up the money for.\"\u003c/p>\n\u003cp>Opening up the hearing aid market would foster competition and drive prices down, says Einhorn.\u003c/p>\n\u003cp>It would also encourage companies to come up with new and better products, says Liu. She envisions a future that solves one of the biggest problems for many people – hearing in a noisy environment, like a party or a busy restaurant. She wants a hearing aid that would automatically adjust to different sound environments, so she could hear the person talking to her and not the background distraction.\u003c/p>\n\u003cp>\"Nothing like that exists today,\" Liu says. \"But I very much see something like that down the road.\"\u003c/p>\n\u003cp>Some audio specialists support rolling back regulations, while others are skeptical.\u003c/p>\n\u003cp>Hearing loss is complex, says Neil DiSarno, chief staff officer for audiology at the American Speech-Language-Hearing Association. This makes it difficult for consumers to \"self-evaluate, self-treat and self-monitor,\" he says. If people buy their hearing aids directly over the counter, they'll miss out on all the skills audiologists can teach them, like how to lip read and how to distinguish high frequency sounds, he says.\u003c/p>\n\u003cp>The market for over-the-counter hearing aids could be huge. More than 35 million Americans have some degree of hearing loss. And for older Americans, not dealing with the problem can have a big impact on age-related cognitive decline, says Dr. Frank Lin, associate professor of otolaryngology at Johns Hopkins University School of Medicine. Lin has done studies looking at the link between hearing loss and cognitive decline.\u003c/p>\n\u003cp>\"The greater the hearing loss, the greater the risk of loss of thinking and memory abilities over time,\" he says, which can lead to feelings of insecurity and social isolation – a known risk factor for dementia.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lin says his findings should serve as a \"wake-up call\" for policy makers. If people have easier access to more affordable hearing aids, he says, that could lead to benefits that go far beyond hearing.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Four out of five older Americans with hearing loss just ignore it, in part because a hearing aid is an unwelcome sign of aging. But what if hearing aids looked like stylish fashion accessories and could be bought at your local pharmacy like reading glasses?\u003c/p>\n\u003cp>That's the vision of Kristen \"KR\" Liu, who's the director of accessibility and advocacy for Doppler Labs, a company marketing one of these devices. She thinks a hearing aid could be \"something that's hip and cool and people have multiple pairs and it's fashionable.\"\u003c/p>\n\u003cp>Liu, who has severe hearing loss herself, helped design a device designed to let people with hearing loss blend in. One person may be using the technology to stream music or take a phone call, she says. Another may be wearing it to amplify speech and hear the conversation. \"And no one is going to know the difference,\" Liu says. \"So you're wearing technology in your ear, proudly.\"\u003c/p>\n\u003cp>The device is a small circular instrument that fits snugly in the ear. It can be adjusted to individual hearing using a smartphone app to control volume, cut out background noise or turn up the sound in a theater. \"It's pretty much a hearing aid,\" says Liu, except the company isn't allowed to call it that.\u003c/p>\n\u003cp>That's because the Food and Drug Administration, which regulates medical devices, doesn't allow hearing aids to be sold over the counter. So devices sold directly to consumers are marketed as \"personal sound amplification products,\" or PSAPs. They range in price from about $250 to $350 and are considerably cheaper than hearing aids, which can cost up to $6,000 and are typically not covered by Medicare or most private insurance companies. Hearing aids are customized by a hearing specialist such as an audiologist, following a hearing test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>PSAPs can only be marketed as sound amplifiers for people with normal hearing who want to make things louder, like music or the sounds of birds chirping. Hearing loss advocates believe this means people with mild to moderate hearing loss who could benefit from the devices don't know about them. There are dozens of the devices on the market, but their quality varies wildly, as an analysis of 11 of them last year for hearing care professionals shows. And there's no easy way for potential purchasers to figure out which work best.\u003c/p>\n\u003cp>The Hearing Loss Association of America, a consumer group, wants Congress to create a new category of aids for people with mild to moderate hearing loss by passing the Over-the-Counter Hearing Aid Act of2017. (People with severe hearing loss would still need to be seen by a medical professional.) The bill would direct the FDA to come up with safety and effectiveness standards for these new hearing aids.\u003c/p>\n\u003cp>The FDA is already moving in that direction, and in December said it would no longer require adults to be medically evaluated before buying a hearing aid. Proponents of direct-to-consumer sales hope Congressional action would get the FDA moving faster. A 2016 report from the National Academies of Sciences also endorsed allowing over-the-counter sales.\u003c/p>\n\u003cp>This could be life changing for people with hearing loss, says Richard Einhorn, a composer of modern classical music who is on the board of the Hearing Loss Association of America.\u003c/p>\n\u003cp>Early one morning in 2010, he woke up with his ears ringing — a loud, piercing hiss. \"I hit the panic button,\" Einhorn says. \"I jumped out of bed and immediately fell over onto the floor.\"\u003c/p>\n\u003cp>An inner ear infection, likely a virus, had caused him to lose his balance. He went deaf in his right ear. He already had some hearing loss in his left ear. His hearing aids cost $5,000 and were not covered by insurance.\u003c/p>\n\u003cp>\"I'm a composer, for goodness sake,\" Einhorn says. \"This is not an easy purchase to scrounge up the money for.\"\u003c/p>\n\u003cp>Opening up the hearing aid market would foster competition and drive prices down, says Einhorn.\u003c/p>\n\u003cp>It would also encourage companies to come up with new and better products, says Liu. She envisions a future that solves one of the biggest problems for many people – hearing in a noisy environment, like a party or a busy restaurant. She wants a hearing aid that would automatically adjust to different sound environments, so she could hear the person talking to her and not the background distraction.\u003c/p>\n\u003cp>\"Nothing like that exists today,\" Liu says. \"But I very much see something like that down the road.\"\u003c/p>\n\u003cp>Some audio specialists support rolling back regulations, while others are skeptical.\u003c/p>\n\u003cp>Hearing loss is complex, says Neil DiSarno, chief staff officer for audiology at the American Speech-Language-Hearing Association. This makes it difficult for consumers to \"self-evaluate, self-treat and self-monitor,\" he says. If people buy their hearing aids directly over the counter, they'll miss out on all the skills audiologists can teach them, like how to lip read and how to distinguish high frequency sounds, he says.\u003c/p>\n\u003cp>The market for over-the-counter hearing aids could be huge. More than 35 million Americans have some degree of hearing loss. And for older Americans, not dealing with the problem can have a big impact on age-related cognitive decline, says Dr. Frank Lin, associate professor of otolaryngology at Johns Hopkins University School of Medicine. Lin has done studies looking at the link between hearing loss and cognitive decline.\u003c/p>\n\u003cp>\"The greater the hearing loss, the greater the risk of loss of thinking and memory abilities over time,\" he says, which can lead to feelings of insecurity and social isolation – a known risk factor for dementia.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lin says his findings should serve as a \"wake-up call\" for policy makers. If people have easier access to more affordable hearing aids, he says, that could lead to benefits that go far beyond hearing.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Kids Should Not Take Drugs Containing Codeine or Tramadol, FDA Says",
"title": "Kids Should Not Take Drugs Containing Codeine or Tramadol, FDA Says",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>The Food and Drug Administration says children under 12 should not be given prescription medicines that contain codeine or another narcotic, tramadol, and that such drugs can also be dangerous to youth between 12 and 18.\u003c/p>\n\u003cp>On Thursday, the FDA said it will require that prescription drugs containing codeine or tramadol carry a warning on the label against using them in children under 12 or in women who are breast-feeding. The agency cited evidence that the drugs could cause dangerously slowed breathing in some children, which could lead to death.\u003c/p>\n\u003cp>Multiple prescription drugs contain codeine or tramadol. For example, the painkiller Tylenol 3 contains acetaminophen and codeine. Drugs containing codeine already carry a black-box warning against using it to treat pain in children who have their tonsils removed.\u003c/p>\n\u003cp>\"This is something we've been watching for several years,\" says Douglas Throckmorton, the deputy director for regulatory programs at the FDA's Center for Drug Evaluation and Research. \"They are powerful, effective medicines when used right [but] they can cause a lot of harm when they're not.\"\u003c/p>\n\u003cp>The agency also warned against using the drugs in young people between 12 and 18 who are obese or have breathing problems such as sleep apnea or lung disease.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new warnings did not further restrict over-the-counter medicines that contain codeine, such as popular types of cough syrup and medication marketed for cold and flu symptoms. The FDA recommends that parents talk to a doctor before giving their children such drugs and notes that colds and coughs in kids \"are generally mild and go away in a few days, so they may not need to take any medicine.\"\u003c/p>\n\u003cp>Thursday's announcement was a partial acceptance of 2015 recommendations by an independent advisory committee that recommended the agency restrict prescription of codeine-containing drugs for children and also voted overwhelmingly against over-the-counter sale of codeine-containing cough syrup for children.\u003c/p>\n\u003cp>At the time, pharmacist Maria Pruchnicki, an associate professor at the Ohio State University College of Pharmacy, told NPR's Rob Stein, \"My concern, were I to be prescribing codeine in children, would be that I would, frankly, kill them.\"\u003c/p>\n\u003cp>As Stein reported, the FDA is not required to follow the committee's 2015 advice, although the agency generally acts in line with advisory committee recommendations.\u003c/p>\n\u003cp>In this case, the agency did act on prescription drugs but did not act on the over-the-counter recommendation.\u003c/p>\n\u003cp>It was unclear why more than a year passed between the committee recommendations and their partial adoption by the agency. In a press briefing, Throckmorton said the agency had received \"additional information.\"\u003c/p>\n\u003cp>Diana Zuckerman, president of the consumer group National Center for Health Research, called the move a \"long-overdue step to protect our children\":\u003c/p>\n\u003cp>\"The science is clear, so why did it take almost 18 months since the FDA's public meeting on the exact same issue? FDA needs to do more to warn patients about the known risks of medical products as soon as data are available. A change in the label is important, but unfortunately many doctors and patients don't read these labels. We need a public education campaign to warn parents and nursing women about these risks.\"\u003c/p>\n\u003cp>In 2015, the FDA acknowledged that although tramadol is not approved for use in children, it is used off-label to treat pain in kids. In that warning, the agency noted that some people are what's known as ultra-rapid metabolizers of tramadol and codeine. Those people have a variant of a liver enzyme that breaks down the drugs more quickly, leading to a rapid and potentially dangerous spike in the level of active opioids in the bloodstream.\u003c/p>\n\u003cp>The drugs can make their way into breast milk in nursing mothers and potentially harm infants, the FDA warns. The proportion of people with the enzyme variant, which is genetic, is thought to be between 1 and 10 percent.\u003c/p>\n\u003cp>\"Because we can't easily determine which children or nursing mothers specifically are at greater risk of ultra-rapid metabolism of codeine or tramadol, we are requiring manufacturers ... to make important labeling changes to protect those children who are at the greatest risk,\" explains Throckmorton.\u003c/p>\n\u003cp>As for future action on over-the-counter medicines that contain codeine, the American Academy of Pediatrics has made its position clear.\u003c/p>\n\u003cp>In a report published last year in the journal Pediatrics, members of the academy's committee on drugs wrote that although over-the-counter cough and cold medicines containing codeine were available in 28 states and Washington, D.C., \"neither the value of suppressing cough nor the effectiveness of codeine in children with acute illnesses has been shown.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Regulators in Europe, Canada and Australia have all restricted the use of medicines containing codeine for children. According to the FDA's public label database, more than 100 medications containing codeine are approved for sale without a prescription in the U.S.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration says children under 12 should not be given prescription medicines that contain codeine or another narcotic, tramadol, and that such drugs can also be dangerous to youth between 12 and 18.\u003c/p>\n\u003cp>On Thursday, the FDA said it will require that prescription drugs containing codeine or tramadol carry a warning on the label against using them in children under 12 or in women who are breast-feeding. The agency cited evidence that the drugs could cause dangerously slowed breathing in some children, which could lead to death.\u003c/p>\n\u003cp>Multiple prescription drugs contain codeine or tramadol. For example, the painkiller Tylenol 3 contains acetaminophen and codeine. Drugs containing codeine already carry a black-box warning against using it to treat pain in children who have their tonsils removed.\u003c/p>\n\u003cp>\"This is something we've been watching for several years,\" says Douglas Throckmorton, the deputy director for regulatory programs at the FDA's Center for Drug Evaluation and Research. \"They are powerful, effective medicines when used right [but] they can cause a lot of harm when they're not.\"\u003c/p>\n\u003cp>The agency also warned against using the drugs in young people between 12 and 18 who are obese or have breathing problems such as sleep apnea or lung disease.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new warnings did not further restrict over-the-counter medicines that contain codeine, such as popular types of cough syrup and medication marketed for cold and flu symptoms. The FDA recommends that parents talk to a doctor before giving their children such drugs and notes that colds and coughs in kids \"are generally mild and go away in a few days, so they may not need to take any medicine.\"\u003c/p>\n\u003cp>Thursday's announcement was a partial acceptance of 2015 recommendations by an independent advisory committee that recommended the agency restrict prescription of codeine-containing drugs for children and also voted overwhelmingly against over-the-counter sale of codeine-containing cough syrup for children.\u003c/p>\n\u003cp>At the time, pharmacist Maria Pruchnicki, an associate professor at the Ohio State University College of Pharmacy, told NPR's Rob Stein, \"My concern, were I to be prescribing codeine in children, would be that I would, frankly, kill them.\"\u003c/p>\n\u003cp>As Stein reported, the FDA is not required to follow the committee's 2015 advice, although the agency generally acts in line with advisory committee recommendations.\u003c/p>\n\u003cp>In this case, the agency did act on prescription drugs but did not act on the over-the-counter recommendation.\u003c/p>\n\u003cp>It was unclear why more than a year passed between the committee recommendations and their partial adoption by the agency. In a press briefing, Throckmorton said the agency had received \"additional information.\"\u003c/p>\n\u003cp>Diana Zuckerman, president of the consumer group National Center for Health Research, called the move a \"long-overdue step to protect our children\":\u003c/p>\n\u003cp>\"The science is clear, so why did it take almost 18 months since the FDA's public meeting on the exact same issue? FDA needs to do more to warn patients about the known risks of medical products as soon as data are available. A change in the label is important, but unfortunately many doctors and patients don't read these labels. We need a public education campaign to warn parents and nursing women about these risks.\"\u003c/p>\n\u003cp>In 2015, the FDA acknowledged that although tramadol is not approved for use in children, it is used off-label to treat pain in kids. In that warning, the agency noted that some people are what's known as ultra-rapid metabolizers of tramadol and codeine. Those people have a variant of a liver enzyme that breaks down the drugs more quickly, leading to a rapid and potentially dangerous spike in the level of active opioids in the bloodstream.\u003c/p>\n\u003cp>The drugs can make their way into breast milk in nursing mothers and potentially harm infants, the FDA warns. The proportion of people with the enzyme variant, which is genetic, is thought to be between 1 and 10 percent.\u003c/p>\n\u003cp>\"Because we can't easily determine which children or nursing mothers specifically are at greater risk of ultra-rapid metabolism of codeine or tramadol, we are requiring manufacturers ... to make important labeling changes to protect those children who are at the greatest risk,\" explains Throckmorton.\u003c/p>\n\u003cp>As for future action on over-the-counter medicines that contain codeine, the American Academy of Pediatrics has made its position clear.\u003c/p>\n\u003cp>In a report published last year in the journal Pediatrics, members of the academy's committee on drugs wrote that although over-the-counter cough and cold medicines containing codeine were available in 28 states and Washington, D.C., \"neither the value of suppressing cough nor the effectiveness of codeine in children with acute illnesses has been shown.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Regulators in Europe, Canada and Australia have all restricted the use of medicines containing codeine for children. According to the FDA's public label database, more than 100 medications containing codeine are approved for sale without a prescription in the U.S.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>House Republicans are mulling new changes to their health care proposal, hoping to wrangle enough votes to pass a bill that would allow them to keep their campaign pledge to repeal and replace the Affordable Care Act.\u003c/p>\n\u003cp>The latest proposal allows states to make changes to the Affordable Care Act's rules governing health insurance policies and markets, in an effort to allow some states to offer stripped down policies with lower premiums.\u003c/p>\n\u003cp>The proposal represents a deal between Rep. Tom MacArthur, R., N.J., who is the head of the moderate Tuesday Group and Rep. Mark Meadows, R., N.C., who leads the far-right Freedom Caucus. The two groups could not agree on details of an earlier health care plan championed by House Speaker Paul Ryan, known as the American Health Care Act.\u003c/p>\n\u003cp>The new proposal, which was reported by Politico and The Huffington Post, is an amendment to that bill. It consists of a summary and bullet points rather than legislative language.\u003c/p>\n\u003cp>Without the full language it's unclear whether the plan could bring in enough votes to pass, says a senior House Republican aide.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The proposal retains many of the popular consumer protections of the Affordable Care Act, including ensuring that people with pre-existing medical conditions cannot be refused coverage or charged more.\u003c/p>\n\u003cp>MacArthur, on his Facebook page, said the plan \"will make coverage of pre-existing conditions sacrosanct for all Americans.\"\u003c/p>\n\u003cp>But the plan also allows states to waive those protections.\u003c/p>\n\u003cp>If states requested waivers, people with pre-existing conditions would likely be covered through state-run high-risk pools, which can be expensive for patients and for taxpayers. Many states used high-risk pools before Obamacare with limited success because they weren't adequately funded, according to a study by the Kaiser Family Foundation.\u003c/p>\n\u003cp>The plan \"would make coverage unaffordable for many older consumers and would segregate high cost consumers in coverage that would likely be inadequate,\" says Timothy Jost, an emeritus professor at Washington and Lee Law School who writes a health policy blog for Health Affairs.\u003c/p>\n\u003cp>The proposal could also cause premiums to spike for people with medical issues, according comments posted on Twitter by Topher Spiro, vice president for health policy at the left-leaning Center for American Progress. A person with diabetes could see premiums rise by about $5,600 while someone with metastatic breast cancer could be charged an additional $142,650, he says.\u003c/p>\n\u003cp>There are some protections against such premium spikes in the proposal, says Rodney Whitlock, vice president of health policy at ML Strategies who was a Republican Senate staffer when the Affordable Care Act was passed.\u003c/p>\n\u003cp>He says language that forces states to promise their changes would still protect people with pre-existing conditions, and result in lower premiums, invites people hurt by the changes to sue the state.\u003c/p>\n\u003cp>The proposal doesn't mention Medicaid at all, so it may do little to bring in support for the Republican bill. That's because the American Health Care Act was killed in part because it rolled back Medicaid coverage for millions of low-income people, something moderate Republicans opposed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I have a hard time believing that this will be acceptable to moderates in the House, much less the Senate, and will certainly be opposed by all Democrats,\" Jost says.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>House Republicans are mulling new changes to their health care proposal, hoping to wrangle enough votes to pass a bill that would allow them to keep their campaign pledge to repeal and replace the Affordable Care Act.\u003c/p>\n\u003cp>The latest proposal allows states to make changes to the Affordable Care Act's rules governing health insurance policies and markets, in an effort to allow some states to offer stripped down policies with lower premiums.\u003c/p>\n\u003cp>The proposal represents a deal between Rep. Tom MacArthur, R., N.J., who is the head of the moderate Tuesday Group and Rep. Mark Meadows, R., N.C., who leads the far-right Freedom Caucus. The two groups could not agree on details of an earlier health care plan championed by House Speaker Paul Ryan, known as the American Health Care Act.\u003c/p>\n\u003cp>The new proposal, which was reported by Politico and The Huffington Post, is an amendment to that bill. It consists of a summary and bullet points rather than legislative language.\u003c/p>\n\u003cp>Without the full language it's unclear whether the plan could bring in enough votes to pass, says a senior House Republican aide.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The proposal retains many of the popular consumer protections of the Affordable Care Act, including ensuring that people with pre-existing medical conditions cannot be refused coverage or charged more.\u003c/p>\n\u003cp>MacArthur, on his Facebook page, said the plan \"will make coverage of pre-existing conditions sacrosanct for all Americans.\"\u003c/p>\n\u003cp>But the plan also allows states to waive those protections.\u003c/p>\n\u003cp>If states requested waivers, people with pre-existing conditions would likely be covered through state-run high-risk pools, which can be expensive for patients and for taxpayers. Many states used high-risk pools before Obamacare with limited success because they weren't adequately funded, according to a study by the Kaiser Family Foundation.\u003c/p>\n\u003cp>The plan \"would make coverage unaffordable for many older consumers and would segregate high cost consumers in coverage that would likely be inadequate,\" says Timothy Jost, an emeritus professor at Washington and Lee Law School who writes a health policy blog for Health Affairs.\u003c/p>\n\u003cp>The proposal could also cause premiums to spike for people with medical issues, according comments posted on Twitter by Topher Spiro, vice president for health policy at the left-leaning Center for American Progress. A person with diabetes could see premiums rise by about $5,600 while someone with metastatic breast cancer could be charged an additional $142,650, he says.\u003c/p>\n\u003cp>There are some protections against such premium spikes in the proposal, says Rodney Whitlock, vice president of health policy at ML Strategies who was a Republican Senate staffer when the Affordable Care Act was passed.\u003c/p>\n\u003cp>He says language that forces states to promise their changes would still protect people with pre-existing conditions, and result in lower premiums, invites people hurt by the changes to sue the state.\u003c/p>\n\u003cp>The proposal doesn't mention Medicaid at all, so it may do little to bring in support for the Republican bill. That's because the American Health Care Act was killed in part because it rolled back Medicaid coverage for millions of low-income people, something moderate Republicans opposed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I have a hard time believing that this will be acceptable to moderates in the House, much less the Senate, and will certainly be opposed by all Democrats,\" Jost says.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Beauty salon workers who paint the nails and treat the hair of millions of Californians are regularly exposed to toxic chemicals — and they may not know it, advocates say.\u003c/p>\n\u003cp>The advocates are asking California lawmakers to approve legislation requiring cosmetic companies to list the ingredients of beauty products used in professional salons. The bill, which passed the Assembly health committee Tuesday, will next be heard by the environmental safety committee.\u003c/p>\n\u003cp>Ingredient labels are now required on retail beauty products like makeup or shampoo, but federal law on labeling doesn’t apply to cosmetic products such as hair-straightening treatments or nail polishes used in salons.\u003c/p>\n\u003cp>In addition to requiring a list of ingredients on the salon product, the Assembly bill would require the label to flag any hazardous chemicals. The manufacturer would also be required to print its website address on the product and list its ingredients on the site.\u003c/p>\n\u003cp>“Nobody’s minding the store” when it comes to protecting the health of the workers who handle these products every day, said Nourbese Flint, policy director for Los Angeles-based Black Women for Wellness, an advocacy organization that is co-sponsoring the bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Hair stylists in black beauty salons are some of the backbones of the black community in terms of economic entrepreneurship,” said Flint. More transparency about salon product ingredients would help the cosmetologists “make better, healthier choices for their bodies and their clients.”\u003c/p>\n\u003cp>A cosmetics industry trade group, the Personal Care Products Council, opposes the bill. During the hearing in the Assembly health committee, Tom Myers, general counsel for the group, said the bill is unnecessary because the industry already sends out safety information to salons.\u003c/p>\n\u003cp>The council also opposes the measure because it would impose “unworkable, state-specific labeling requirements on global brands,” according to a legislative analysis.\u003c/p>\n\u003cp>Nail care products such as artificial nails and polishes contain chemicals like formaldehyde, which is a probable carcinogen, and toluene, which has been shown to cause birth defects when inhaled by pregnant women.\u003c/p>\n\u003cp>A 2015 study looking at birth outcomes among California cosmetologists and manicurists found that, overall, these workers had a higher rate of gestational diabetes, and babies born to Vietnamese manicurists were smaller than those born in the general population.\u003c/p>\n\u003cp>Hair-straightening treatments such as the Brazilian Blowout have been known to contain formaldehyde. The U.S. Department of Labor found that workers using such products in one beauty salon were exposed to as much as five times the accepted limits of exposure to formaldehyde.\u003c/p>\n\u003cp>Dr. Thu Quach, a researcher at the Cancer Prevention Institute of California, says informing workers of potential risks is especially important given their level of exposure to salon products. Beauty salon workers may absorb chemicals both through their skin and the air they breathe, Quach said. A cosmetologist could apply a chemical-laden treatment to customers 10 times a day, or work in a space where chemicals are recirculating in the air all day, she added.\u003c/p>\n\u003cp>“Workers are exposed at much higher levels, so why would they not have the same right as consumers to know what they’re being exposed to?” said Quach, who is also a Steering Committee member of the California Health Nail Salon Collaborative, a co-sponsor of the bill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Supporters hope new labeling requirements on salon products would pressure manufacturers to change the chemical formulations in their products.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Beauty salon workers who paint the nails and treat the hair of millions of Californians are regularly exposed to toxic chemicals — and they may not know it, advocates say.\u003c/p>\n\u003cp>The advocates are asking California lawmakers to approve legislation requiring cosmetic companies to list the ingredients of beauty products used in professional salons. The bill, which passed the Assembly health committee Tuesday, will next be heard by the environmental safety committee.\u003c/p>\n\u003cp>Ingredient labels are now required on retail beauty products like makeup or shampoo, but federal law on labeling doesn’t apply to cosmetic products such as hair-straightening treatments or nail polishes used in salons.\u003c/p>\n\u003cp>In addition to requiring a list of ingredients on the salon product, the Assembly bill would require the label to flag any hazardous chemicals. The manufacturer would also be required to print its website address on the product and list its ingredients on the site.\u003c/p>\n\u003cp>“Nobody’s minding the store” when it comes to protecting the health of the workers who handle these products every day, said Nourbese Flint, policy director for Los Angeles-based Black Women for Wellness, an advocacy organization that is co-sponsoring the bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Hair stylists in black beauty salons are some of the backbones of the black community in terms of economic entrepreneurship,” said Flint. More transparency about salon product ingredients would help the cosmetologists “make better, healthier choices for their bodies and their clients.”\u003c/p>\n\u003cp>A cosmetics industry trade group, the Personal Care Products Council, opposes the bill. During the hearing in the Assembly health committee, Tom Myers, general counsel for the group, said the bill is unnecessary because the industry already sends out safety information to salons.\u003c/p>\n\u003cp>The council also opposes the measure because it would impose “unworkable, state-specific labeling requirements on global brands,” according to a legislative analysis.\u003c/p>\n\u003cp>Nail care products such as artificial nails and polishes contain chemicals like formaldehyde, which is a probable carcinogen, and toluene, which has been shown to cause birth defects when inhaled by pregnant women.\u003c/p>\n\u003cp>A 2015 study looking at birth outcomes among California cosmetologists and manicurists found that, overall, these workers had a higher rate of gestational diabetes, and babies born to Vietnamese manicurists were smaller than those born in the general population.\u003c/p>\n\u003cp>Hair-straightening treatments such as the Brazilian Blowout have been known to contain formaldehyde. The U.S. Department of Labor found that workers using such products in one beauty salon were exposed to as much as five times the accepted limits of exposure to formaldehyde.\u003c/p>\n\u003cp>Dr. Thu Quach, a researcher at the Cancer Prevention Institute of California, says informing workers of potential risks is especially important given their level of exposure to salon products. Beauty salon workers may absorb chemicals both through their skin and the air they breathe, Quach said. A cosmetologist could apply a chemical-laden treatment to customers 10 times a day, or work in a space where chemicals are recirculating in the air all day, she added.\u003c/p>\n\u003cp>“Workers are exposed at much higher levels, so why would they not have the same right as consumers to know what they’re being exposed to?” said Quach, who is also a Steering Committee member of the California Health Nail Salon Collaborative, a co-sponsor of the bill.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Supporters hope new labeling requirements on salon products would pressure manufacturers to change the chemical formulations in their products.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>San Francisco has unveiled a tough anti-tobacco proposal that would ban the retail sale of menthol cigarettes and other flavored tobacco or tobacco-related products that are often the first choice of minority group members and teenagers who smoke.\u003c/p>\n\u003cp>Supervisor Malia Cohen, sponsor of the proposed ordinance, joined Tuesday with public health experts and community advocates to announce the measure, which she said goes beyond more narrow laws on flavored tobacco in cities such as Chicago, Berkeley and New York.\u003c/p>\n\u003cp>“The legislation I’ve authored is a full restriction on the sale of all flavored tobacco products, and that does include menthol. There are no exemptions,” Cohen said. This includes cigarettes, cigars, smokeless tobacco and e-cigarettes.\u003c/p>\n\u003cp>The proposed ordinance is designed to address two major groups, youth and minorities, who have been targeted in successful, well-financed advertising campaigns that promote menthol cigarettes and flavored non-cigarette tobacco products. The products often attract African-Americans, Asian-Americans and Latinos, as well as teenagers.\u003c/p>\n\u003cp>San Francisco Mayor Ed Lee endorsed the proposal. “We know from research and studies that tobacco-related diseases continue to be the No. 1 cause of preventable deaths, especially among low-income and minority communities,” he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A similar measure is being considered in Oakland.\u003c/p>\n\u003cp>Cohen, who represents the predominantly African-American Bayview-Hunters Point district of San Francisco, said the ordinance grew out of her personal experience with family members who smoked menthol cigarettes and died of cancer, and her desire to spare San Franciscans a similar fate. “This is an evidence-based tobacco prevention strategy that will save lives and cut costs for taxpayers who are collectively shouldering the health care costs of tobacco-related illnesses,” she said.\u003c/p>\n\u003cp>Nearly 9 out of 10 African-Americans who smoke prefer menthol cigarettes, according to the federal Centers for Disease Control and Prevention. Menthol is believed to make the harmful chemicals contained in cigarettes more easily absorbed by the body, and some research shows that menthol cigarettes are more addictive than regular ones, according to the CDC.\u003c/p>\n\u003cp>“African-Americans don’t have a genetic disposition that makes them smoke menthol cigarettes,” said Dr. Valerie Yerger, an associate professor of health policy at the University of California, San Francisco. “It’s the result of a very conscious advertising campaign by the tobacco industry.” Menthol cigarettes are also preferred by a majority of Latinos and Asian-Americans who smoke, according to Randy Uang, director of tobacco prevention and control services at Breathe California, a Golden Gate Public Health Partnership.\u003c/p>\n\u003cp>Public health experts say restricting menthol and other flavored tobacco would improve health outcomes not only for the minority populations but also for teens. “Because flavors play such a key role in youth starting to smoke, restricting access to these products means that fewer youth will start smoking,” said Uang.\u003c/p>\n\u003cp>Flavors are popular with inexperienced smokers, he said, because they mask the taste of tobacco and decrease the irritating effects of nicotine.\u003c/p>\n\u003cp>E-cigarettes are now the tobacco-related product most commonly used by young people in the U.S., according to the CDC. It found that more than 8 out of 10 youths ages 12-17 who vape said they use flavored e-cigarettes that taste like mint, candy or other sweets.\u003c/p>\n\u003cp>The San Francisco ordinance, if approved, would fill a gap in federal legislation that authorized the U.S. Food and Drug Administration to regulate tobacco. In 2009, the FDA banned “characterizing flavors,” such as candy, fruit and chocolate in cigarettes. But, faced with tobacco industry lobbying, it stopped short of prohibiting menthol in cigarettes or flavorings in other tobacco-related products such as e-cigarettes, little cigars and smokeless tobacco.\u003c/p>\n\u003cp>Tobacco control advocates, such as Yerger, have been pushing the FDA to ban menthol and other flavorings for years. “This ordinance didn’t happen overnight,” she said. “It’s been a very long process and part of that has been gathering evidence about the role of menthol in hooking kids at a very early age and the tobacco industry knowing that it has the ability to do that by manipulating the levels of menthol in their products.”\u003c/p>\n\u003cp>Cohen noted the tobacco lobby is strong in Sacramento and she’s expecting pushback from the industry. “I would imagine they will be fighting this legislation every step of the way,” she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If enacted, the tobacco ordinance would become effective Jan. 1, 2018. Enforcement would be the job of the Department of Public Health, which also would be responsible for educating retailers about the new restrictions.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>San Francisco has unveiled a tough anti-tobacco proposal that would ban the retail sale of menthol cigarettes and other flavored tobacco or tobacco-related products that are often the first choice of minority group members and teenagers who smoke.\u003c/p>\n\u003cp>Supervisor Malia Cohen, sponsor of the proposed ordinance, joined Tuesday with public health experts and community advocates to announce the measure, which she said goes beyond more narrow laws on flavored tobacco in cities such as Chicago, Berkeley and New York.\u003c/p>\n\u003cp>“The legislation I’ve authored is a full restriction on the sale of all flavored tobacco products, and that does include menthol. There are no exemptions,” Cohen said. This includes cigarettes, cigars, smokeless tobacco and e-cigarettes.\u003c/p>\n\u003cp>The proposed ordinance is designed to address two major groups, youth and minorities, who have been targeted in successful, well-financed advertising campaigns that promote menthol cigarettes and flavored non-cigarette tobacco products. The products often attract African-Americans, Asian-Americans and Latinos, as well as teenagers.\u003c/p>\n\u003cp>San Francisco Mayor Ed Lee endorsed the proposal. “We know from research and studies that tobacco-related diseases continue to be the No. 1 cause of preventable deaths, especially among low-income and minority communities,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A similar measure is being considered in Oakland.\u003c/p>\n\u003cp>Cohen, who represents the predominantly African-American Bayview-Hunters Point district of San Francisco, said the ordinance grew out of her personal experience with family members who smoked menthol cigarettes and died of cancer, and her desire to spare San Franciscans a similar fate. “This is an evidence-based tobacco prevention strategy that will save lives and cut costs for taxpayers who are collectively shouldering the health care costs of tobacco-related illnesses,” she said.\u003c/p>\n\u003cp>Nearly 9 out of 10 African-Americans who smoke prefer menthol cigarettes, according to the federal Centers for Disease Control and Prevention. Menthol is believed to make the harmful chemicals contained in cigarettes more easily absorbed by the body, and some research shows that menthol cigarettes are more addictive than regular ones, according to the CDC.\u003c/p>\n\u003cp>“African-Americans don’t have a genetic disposition that makes them smoke menthol cigarettes,” said Dr. Valerie Yerger, an associate professor of health policy at the University of California, San Francisco. “It’s the result of a very conscious advertising campaign by the tobacco industry.” Menthol cigarettes are also preferred by a majority of Latinos and Asian-Americans who smoke, according to Randy Uang, director of tobacco prevention and control services at Breathe California, a Golden Gate Public Health Partnership.\u003c/p>\n\u003cp>Public health experts say restricting menthol and other flavored tobacco would improve health outcomes not only for the minority populations but also for teens. “Because flavors play such a key role in youth starting to smoke, restricting access to these products means that fewer youth will start smoking,” said Uang.\u003c/p>\n\u003cp>Flavors are popular with inexperienced smokers, he said, because they mask the taste of tobacco and decrease the irritating effects of nicotine.\u003c/p>\n\u003cp>E-cigarettes are now the tobacco-related product most commonly used by young people in the U.S., according to the CDC. It found that more than 8 out of 10 youths ages 12-17 who vape said they use flavored e-cigarettes that taste like mint, candy or other sweets.\u003c/p>\n\u003cp>The San Francisco ordinance, if approved, would fill a gap in federal legislation that authorized the U.S. Food and Drug Administration to regulate tobacco. In 2009, the FDA banned “characterizing flavors,” such as candy, fruit and chocolate in cigarettes. But, faced with tobacco industry lobbying, it stopped short of prohibiting menthol in cigarettes or flavorings in other tobacco-related products such as e-cigarettes, little cigars and smokeless tobacco.\u003c/p>\n\u003cp>Tobacco control advocates, such as Yerger, have been pushing the FDA to ban menthol and other flavorings for years. “This ordinance didn’t happen overnight,” she said. “It’s been a very long process and part of that has been gathering evidence about the role of menthol in hooking kids at a very early age and the tobacco industry knowing that it has the ability to do that by manipulating the levels of menthol in their products.”\u003c/p>\n\u003cp>Cohen noted the tobacco lobby is strong in Sacramento and she’s expecting pushback from the industry. “I would imagine they will be fighting this legislation every step of the way,” she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If enacted, the tobacco ordinance would become effective Jan. 1, 2018. Enforcement would be the job of the Department of Public Health, which also would be responsible for educating retailers about the new restrictions.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Post-Election, Doctors See Kids Suffering Trump-Related Anxiety",
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"content": "\u003cp>Sixth grade started out fine for Mohammed, an 11-year-old Muslim boy who lives in East Oakland, until Donald Trump won the presidency.\u003c/p>\n\u003cp>\"After Trump got elected, everybody started treating me differently,\" he said. His classmates started criticizing Muslims, and calling him a “terrorist,” he said.\u003c/p>\n\u003cp>The boy, whose family wanted him to be identified only as “Mohammed” rather than his real name to protect his privacy, said he started getting depressed after the harassment and name-calling started. He said he began having physical symptoms of anxiety like chest pain and headaches. He even talked about killing himself.\u003c/p>\n\u003cp>\"After he got elected I felt different than I used to be feeling,” he said, hugging his knees to his chest as he sat on the edge of the couch at his family’s studio apartment in the Oakland hills. “I changed in a bad way.\"\u003c/p>\n\u003cp>The type of chest pain he felt, along with shortness of breath and other physical symptoms of anxiety, are complaints some Bay Area pediatricians said they're seeing more of in immigrant and Muslim populations, based on rhetoric set in motion by President Trump's administration.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It felt like somebody was pushing something on me,\" Mohammed said in a quiet voice. \"It was like the bones in my chest were like going backward. It hurt a lot.\"\u003c/p>\n\u003cp>Dr. Gabriela Bronson-Castain, a pediatric psychologist in Oakland, said most of the kids she sees who are experiencing this fear have families who immigrated to the U.S. from Central America or families who are Muslim.\u003c/p>\n\u003cp>\"It is not uncommon within our assessments to hear somehow an inherent fear of the Trump administration,\" Bronson-Castain said. \"Very unsolicited -- you know and you're talking about sometimes 8, 9 and 10-year-old kids.\"\u003c/p>\n\u003cp>She said the first child she saw, the day after the election, was a boy who claimed to have a BB gun at his school because he was afraid of being deported. Really the kid was bluffing; he didn’t have a BB gun.\u003c/p>\n\u003cp>\"But he wanted everybody to know that he did in the event that somebody would try to take him away,\" Bronson-Castain said, referring to the child's fear of deportation or separation from his family.\u003c/p>\n\u003cp>Bronson-Castain said kids try to cope in one of two ways: \"They’ll act inward, which I think we see as maybe some kind of self-injury or more depressive symptoms; potential suicidality. Or we see them act outward, which is, 'I become aggressive. I bring that BB gun to school. I carry a knife in my bag just in case.' \"\u003c/p>\n\u003cp>Another pediatrician, Dr. Nooshin Razani, said she’s never seen symptoms so severe in response to politics. Discrimination is always painful, she said, but it’s worse when it comes from an authority figure.\u003c/p>\n\u003cp>\"It's one thing if you're 1 percent of the population. And everyone else is targeting you,\" the doctor said. \"It's another thing when the government of the most powerful country in the whole world is also on the side of everyone that's targeting you.\"\u003c/p>\n\u003cp>Razani herself said she feels nervous as an Iranian American. Iran is one of the countries targeted in both versions of Trump’s travel ban. She said having Iran called out like that by the administration actually helps her empathize.\u003c/p>\n\u003cp>\"There's a lot of moments where I am able to bond with my patients in a way that I've never been able to do before because we may all be on the list of seven,\" she said, referring to the list of seven countries included in Trump’s first travel ban.\u003c/p>\n\u003cp>\u003cstrong>Doctors Mobilize to Help Patients Deal With Trump-Era Anxiety\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>In response, pediatricians like Razani and Bronson-Castain are organizing. They're both part of a group of health professionals informally called #EveryoneBelongsHere. They recently gathered at a home in the Oakland hills.\u003c/p>\n\u003cfigure id=\"attachment_317718\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-317718\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-800x450.jpg\" alt=\"(From left to right) Doctors Jyothi Marbin, Abimbola Dairo, Emma Anselin, and Preeya Desai are getting politically active in response to President Trump's proposed health and immigration policies. They met with staff from U.S. Congresswoman Barbara Lee's office to discuss their concerns about how immigration is affecting the health of Bay Area children.\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">(From left to right) Doctors Jyothi Marbin, Abimbola Dairo, Emma Anselin, and Preeya Desai are getting politically active in response to President Trump's proposed health and immigration policies. They met with staff from U.S. congresswoman Barbara Lee's office to discuss their concerns about how immigration is affecting the health of Bay Area children. \u003ccite>(Courtesy Jyothi Marbin)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Some were there to get politically active. Others came to talk about how best to help their immigrant patients. Dr. Noemi Spinazzi said she’s worried about Immigration and Customs Enforcement (ICE).\u003c/p>\n\u003cp>\"I was wondering if ICE would have any latitude to run any searches of our database using key words like 'immigrant' to kind of isolate those people who would be vulnerable,\" she asked.\u003c/p>\n\u003cp>A lawyer in the crowd explained it would be tough for ICE to force access to medical records.\u003c/p>\n\u003cp>Another doctor wondered whether putting cards with legal advice for immigrants in her waiting room would draw attention to her practice or endanger the people she sees?\u003c/p>\n\u003cp>Many in the group have been moved to action after seeing young patients -- patients like Mohammed -- who are suffering as they hear talk about potential changes to immigration and travel policies. Even if their parents try to shield them from the news, they still pick up on that tension, doctors said.\u003c/p>\n\u003cp>\u003cstrong>Parents Struggle to Help Their Kids Cope\u003cbr>\n\u003c/strong>\u003cbr>\nBack in East Oakland, Mohammed's mother said that their family left their home country of Yemen after she was attacked for working on women's rights. The family of four then fled to the U.S. and eventually got asylum.\u003c/p>\n\u003cp>\"I don't know what to do,\" she said. \"So should we leave here and go back to our country? My country is in war. So we’re rejected here and we can't go back to our country and I don't know about what the future is going to bring for us.\"\u003c/p>\n\u003cp>Mohammed said he doesn’t want to tell his teachers of his challenges with his classmates because he thinks that will make things worse, and he doesn’t want his parents to get involved because he said he wants to fix the problem by himself.\u003c/p>\n\u003cp>\"Not every Muslim is a terrorist,\" Mohammed said about being called one by classmates. \"Some are terrorists. But I’m not. … I didn’t do anything to you, so you shouldn’t call me a terrorist.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Mohammed said his chest pain has been getting better with medical treatment, and his first therapy session is scheduled this month.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sixth grade started out fine for Mohammed, an 11-year-old Muslim boy who lives in East Oakland, until Donald Trump won the presidency.\u003c/p>\n\u003cp>\"After Trump got elected, everybody started treating me differently,\" he said. His classmates started criticizing Muslims, and calling him a “terrorist,” he said.\u003c/p>\n\u003cp>The boy, whose family wanted him to be identified only as “Mohammed” rather than his real name to protect his privacy, said he started getting depressed after the harassment and name-calling started. He said he began having physical symptoms of anxiety like chest pain and headaches. He even talked about killing himself.\u003c/p>\n\u003cp>\"After he got elected I felt different than I used to be feeling,” he said, hugging his knees to his chest as he sat on the edge of the couch at his family’s studio apartment in the Oakland hills. “I changed in a bad way.\"\u003c/p>\n\u003cp>The type of chest pain he felt, along with shortness of breath and other physical symptoms of anxiety, are complaints some Bay Area pediatricians said they're seeing more of in immigrant and Muslim populations, based on rhetoric set in motion by President Trump's administration.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It felt like somebody was pushing something on me,\" Mohammed said in a quiet voice. \"It was like the bones in my chest were like going backward. It hurt a lot.\"\u003c/p>\n\u003cp>Dr. Gabriela Bronson-Castain, a pediatric psychologist in Oakland, said most of the kids she sees who are experiencing this fear have families who immigrated to the U.S. from Central America or families who are Muslim.\u003c/p>\n\u003cp>\"It is not uncommon within our assessments to hear somehow an inherent fear of the Trump administration,\" Bronson-Castain said. \"Very unsolicited -- you know and you're talking about sometimes 8, 9 and 10-year-old kids.\"\u003c/p>\n\u003cp>She said the first child she saw, the day after the election, was a boy who claimed to have a BB gun at his school because he was afraid of being deported. Really the kid was bluffing; he didn’t have a BB gun.\u003c/p>\n\u003cp>\"But he wanted everybody to know that he did in the event that somebody would try to take him away,\" Bronson-Castain said, referring to the child's fear of deportation or separation from his family.\u003c/p>\n\u003cp>Bronson-Castain said kids try to cope in one of two ways: \"They’ll act inward, which I think we see as maybe some kind of self-injury or more depressive symptoms; potential suicidality. Or we see them act outward, which is, 'I become aggressive. I bring that BB gun to school. I carry a knife in my bag just in case.' \"\u003c/p>\n\u003cp>Another pediatrician, Dr. Nooshin Razani, said she’s never seen symptoms so severe in response to politics. Discrimination is always painful, she said, but it’s worse when it comes from an authority figure.\u003c/p>\n\u003cp>\"It's one thing if you're 1 percent of the population. And everyone else is targeting you,\" the doctor said. \"It's another thing when the government of the most powerful country in the whole world is also on the side of everyone that's targeting you.\"\u003c/p>\n\u003cp>Razani herself said she feels nervous as an Iranian American. Iran is one of the countries targeted in both versions of Trump’s travel ban. She said having Iran called out like that by the administration actually helps her empathize.\u003c/p>\n\u003cp>\"There's a lot of moments where I am able to bond with my patients in a way that I've never been able to do before because we may all be on the list of seven,\" she said, referring to the list of seven countries included in Trump’s first travel ban.\u003c/p>\n\u003cp>\u003cstrong>Doctors Mobilize to Help Patients Deal With Trump-Era Anxiety\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>In response, pediatricians like Razani and Bronson-Castain are organizing. They're both part of a group of health professionals informally called #EveryoneBelongsHere. They recently gathered at a home in the Oakland hills.\u003c/p>\n\u003cfigure id=\"attachment_317718\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-317718\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-800x450.jpg\" alt=\"(From left to right) Doctors Jyothi Marbin, Abimbola Dairo, Emma Anselin, and Preeya Desai are getting politically active in response to President Trump's proposed health and immigration policies. They met with staff from U.S. Congresswoman Barbara Lee's office to discuss their concerns about how immigration is affecting the health of Bay Area children.\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-160x90.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-1020x574.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-1180x664.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-960x540.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-240x135.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-375x211.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/04/RS24954_Doctors-Lobbying-qut-520x293.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">(From left to right) Doctors Jyothi Marbin, Abimbola Dairo, Emma Anselin, and Preeya Desai are getting politically active in response to President Trump's proposed health and immigration policies. They met with staff from U.S. congresswoman Barbara Lee's office to discuss their concerns about how immigration is affecting the health of Bay Area children. \u003ccite>(Courtesy Jyothi Marbin)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Some were there to get politically active. Others came to talk about how best to help their immigrant patients. Dr. Noemi Spinazzi said she’s worried about Immigration and Customs Enforcement (ICE).\u003c/p>\n\u003cp>\"I was wondering if ICE would have any latitude to run any searches of our database using key words like 'immigrant' to kind of isolate those people who would be vulnerable,\" she asked.\u003c/p>\n\u003cp>A lawyer in the crowd explained it would be tough for ICE to force access to medical records.\u003c/p>\n\u003cp>Another doctor wondered whether putting cards with legal advice for immigrants in her waiting room would draw attention to her practice or endanger the people she sees?\u003c/p>\n\u003cp>Many in the group have been moved to action after seeing young patients -- patients like Mohammed -- who are suffering as they hear talk about potential changes to immigration and travel policies. Even if their parents try to shield them from the news, they still pick up on that tension, doctors said.\u003c/p>\n\u003cp>\u003cstrong>Parents Struggle to Help Their Kids Cope\u003cbr>\n\u003c/strong>\u003cbr>\nBack in East Oakland, Mohammed's mother said that their family left their home country of Yemen after she was attacked for working on women's rights. The family of four then fled to the U.S. and eventually got asylum.\u003c/p>\n\u003cp>\"I don't know what to do,\" she said. \"So should we leave here and go back to our country? My country is in war. So we’re rejected here and we can't go back to our country and I don't know about what the future is going to bring for us.\"\u003c/p>\n\u003cp>Mohammed said he doesn’t want to tell his teachers of his challenges with his classmates because he thinks that will make things worse, and he doesn’t want his parents to get involved because he said he wants to fix the problem by himself.\u003c/p>\n\u003cp>\"Not every Muslim is a terrorist,\" Mohammed said about being called one by classmates. \"Some are terrorists. But I’m not. … I didn’t do anything to you, so you shouldn’t call me a terrorist.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The public could soon get a look at confidential reports about errors, mishaps and mix-ups in the nation's hospitals that put patients' health and safety at risk, under a groundbreaking proposal from federal health officials.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services wants to require that private health care accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. Nearly nine in 10 hospitals are directly overseen by those accreditors, not the government.\u003c/p>\n\u003cp>There's increasing concern among regulators that private accreditors aren't picking up on serious problems at health facilities. Every year, CMS takes a sample of hospitals and other health care facilities accredited by private organizations and does its own inspections to validate the work of the groups. In a 2016 report, CMS noted that its review found that accrediting organizations often missed serious deficiencies found soon after by state inspectors.\u003c/p>\n\u003cp>In 2014, for instance, state officials examined 103 acute-care hospitals that had been reviewed by an accreditor in the past 60 days. The state officials found 41 serious deficiencies. Of those, 39 were missed by the accrediting organizations. This disparity \"raises serious concerns regarding the [accrediting organizations'] ability to appropriately identify and cite health and safety deficiencies\" during inspections, CMS officials wrote when they released draft regulations including the proposed change on Friday.\u003c/p>\n\u003cp>The move follows steps CMS took several years ago to post government inspection reports online for nursing homes and some hospitals. ProPublica has created a tool, Nursing Home Inspect, to allow people to more easily search through the nursing home deficiency reports; the Association of Health Care Journalists has done the same for hospital violations.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Those government inspection reports do not identify patients or medical staff, but they do offer a description—often detailed—of what went wrong. This includes medication errors, operations on the wrong patient or the wrong body part, and patient abuse.\u003c/p>\n\u003cp>But private accrediting organizations, the largest of which is The Joint Commission, have not followed suit, creating a patchwork of disclosure in which some inspections are public and others are not. CMS' proposed rules are designed to fix this.\u003c/p>\n\u003cp>\"We believe it is important to continue to lead the effort to make information regarding a health care facility's compliance with health and safety requirements\" publicly available, CMS officials wrote.\u003c/p>\n\u003cp>\"It's huge, absolutely,\" says Rosemary Gibson, a patient safety expert who wrote a book, Wall of Silence, about medical errors. \"Right now the public has very little information about the places where they're putting their life on the line, and that's just not acceptable. If you're a good place, what are they afraid of?\"\u003c/p>\n\u003cp>Medical errors are a leading cause of death and injuries in U.S. hospitals. A 1999 report by the Institute of Medicine estimated that up to 98,000 people a year die because of mistakes in hospitals; subsequent reports have said the number is much higher.\u003c/p>\n\u003cp>To qualify for federal funding, health facilities have to meet minimum requirements, known as Medicare conditions of participation. If a health facility has problems and doesn't fix them, it stands to lose its Medicare funding. Though this rarely happens, it can be crippling for an institution and could force it to close.\u003c/p>\n\u003cp>State health departments get funding from CMS to inspect facilities to ensure they comply with these requirements. But the law also allows hospitals, ambulatory surgery centers, home health agencies and hospices to pay private, national accrediting organizations for such oversight. The Joint Commission conducts unannounced inspections at hospitals at least once every 39 months, and more often if complaints arise.\u003c/p>\n\u003cp>Though accreditors have to be approved by the secretary of Health and Human Services, they rarely take punitive action against the organizations they oversee. Of the 4,018 hospitals listed on the The Joint Commission's website, more than 99 percent have full accreditation and only seven are on track to lose their \"gold seal of approval.\"\u003c/p>\n\u003cp>The Joint Commission said it is reviewing the CMS proposal and couldn't comment further. A smaller competitor, the Healthcare Facilities Accreditation Program, said it supports the goal of transparency but is studying what the change would mean in practice, both in terms of staffing and costs. \"We haven't talked to our hospital partners,\" says Gary Ley, its executive director. \"It would be a major change for them also. It's hard not to support the goals but we have to look at the execution.\"\u003c/p>\n\u003cp>For its part, the American Hospital Association said it supports providing the public \"useful information\" about hospital quality, but has doubts that detailed inspection reports fit that description.\u003c/p>\n\u003cp>\"It's important that the information shared with consumers has a clear purpose, is transparent and is readily understood by folks from all walks of life, not just those with deep expertise in health care,\" says Nancy Foster, AHA's vice president of quality and patient safety, in a statement. \"We are concerned that sharing a detailed report may not be the most useful or effective strategy for informing the public.\"\u003c/p>\n\u003cp>Foster says it might be more useful to provide a one- or two-page \"accurate summary\" of inspection findings, with \"key takeaways\" and why they are important. \"This summary could also draw from the plan of correction the hospital creates and summarize how the hospital plans to address the findings,\" Foster says.\u003c/p>\n\u003cp>For years, accreditors have been accused of putting the interests of the facilities that pay them ahead of patient safety. In 2002, the Chicago Tribune reported how The Joint Commission gave its seal of approval to \"medical centers riddled by life-threatening problems and underreporting of patient deaths due to infections and hospital errors.\"\u003c/p>\n\u003cp>Last week, BuzzFeed News reported how an Oklahoma psychiatric hospital was named a \"Top Performer in Key Quality Measures\" by The Joint Commission even though police records, state inspection reports and lawsuit records showed that it \"is a profoundly troubled facility where frequent violence endangers patients and staff alike, where children as young as 5 are separated from their parents and held in dangerous situations, and where wards lack adequate staffing and staff lack adequate training.\"\u003c/p>\n\u003cp>In a response to BuzzFeed, the company that runs the hospital, Universal Health Services, said it \"is proud of the care it provides patients at Shadow Mountain Behavioral Health.\"\u003c/p>\n\u003cp>On its website, The Joint Commission allows users to check the accreditation status of hospitals but provides scant information of what went wrong, even when hospitals are described as receiving a \"preliminary denial of accreditation.\" For one hospital, the explanation is: \"Existence at time of survey of a condition, which in The Joint Commission's view, poses a threat to patients or other individuals served.\" The threat itself is not disclosed.\u003c/p>\n\u003cp>Consumers Union's Safe Patient Project and other patient safety organizations have been pushing for years for more information about hospital inspections. Lisa McGiffert, who directs the Safe Patient Project, hopes this may be the opportunity for change. \"The information that's available now is so minimal and would not really inform anyone about real quality of a hospital,\" she says.\u003c/p>\n\u003cp>Comments on the proposal may be submitted from April 28 to June 13 through the CMS website.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Disclosure: Ornstein was previously president of the Association of Health Care Journalists. While he served in that position, AHCJ called for The Joint Commission to make its inspection reports public. The Joint Commission declined to do so. Have you complained about a hospital to The Joint Commission or another accrediting body? We'd like to hear from you. Email Charles.ornstein@propublica.org. ProPublica is an independent nonprofit newsroom based in New York.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The public could soon get a look at confidential reports about errors, mishaps and mix-ups in the nation's hospitals that put patients' health and safety at risk, under a groundbreaking proposal from federal health officials.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services wants to require that private health care accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. Nearly nine in 10 hospitals are directly overseen by those accreditors, not the government.\u003c/p>\n\u003cp>There's increasing concern among regulators that private accreditors aren't picking up on serious problems at health facilities. Every year, CMS takes a sample of hospitals and other health care facilities accredited by private organizations and does its own inspections to validate the work of the groups. In a 2016 report, CMS noted that its review found that accrediting organizations often missed serious deficiencies found soon after by state inspectors.\u003c/p>\n\u003cp>In 2014, for instance, state officials examined 103 acute-care hospitals that had been reviewed by an accreditor in the past 60 days. The state officials found 41 serious deficiencies. Of those, 39 were missed by the accrediting organizations. This disparity \"raises serious concerns regarding the [accrediting organizations'] ability to appropriately identify and cite health and safety deficiencies\" during inspections, CMS officials wrote when they released draft regulations including the proposed change on Friday.\u003c/p>\n\u003cp>The move follows steps CMS took several years ago to post government inspection reports online for nursing homes and some hospitals. ProPublica has created a tool, Nursing Home Inspect, to allow people to more easily search through the nursing home deficiency reports; the Association of Health Care Journalists has done the same for hospital violations.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Those government inspection reports do not identify patients or medical staff, but they do offer a description—often detailed—of what went wrong. This includes medication errors, operations on the wrong patient or the wrong body part, and patient abuse.\u003c/p>\n\u003cp>But private accrediting organizations, the largest of which is The Joint Commission, have not followed suit, creating a patchwork of disclosure in which some inspections are public and others are not. CMS' proposed rules are designed to fix this.\u003c/p>\n\u003cp>\"We believe it is important to continue to lead the effort to make information regarding a health care facility's compliance with health and safety requirements\" publicly available, CMS officials wrote.\u003c/p>\n\u003cp>\"It's huge, absolutely,\" says Rosemary Gibson, a patient safety expert who wrote a book, Wall of Silence, about medical errors. \"Right now the public has very little information about the places where they're putting their life on the line, and that's just not acceptable. If you're a good place, what are they afraid of?\"\u003c/p>\n\u003cp>Medical errors are a leading cause of death and injuries in U.S. hospitals. A 1999 report by the Institute of Medicine estimated that up to 98,000 people a year die because of mistakes in hospitals; subsequent reports have said the number is much higher.\u003c/p>\n\u003cp>To qualify for federal funding, health facilities have to meet minimum requirements, known as Medicare conditions of participation. If a health facility has problems and doesn't fix them, it stands to lose its Medicare funding. Though this rarely happens, it can be crippling for an institution and could force it to close.\u003c/p>\n\u003cp>State health departments get funding from CMS to inspect facilities to ensure they comply with these requirements. But the law also allows hospitals, ambulatory surgery centers, home health agencies and hospices to pay private, national accrediting organizations for such oversight. The Joint Commission conducts unannounced inspections at hospitals at least once every 39 months, and more often if complaints arise.\u003c/p>\n\u003cp>Though accreditors have to be approved by the secretary of Health and Human Services, they rarely take punitive action against the organizations they oversee. Of the 4,018 hospitals listed on the The Joint Commission's website, more than 99 percent have full accreditation and only seven are on track to lose their \"gold seal of approval.\"\u003c/p>\n\u003cp>The Joint Commission said it is reviewing the CMS proposal and couldn't comment further. A smaller competitor, the Healthcare Facilities Accreditation Program, said it supports the goal of transparency but is studying what the change would mean in practice, both in terms of staffing and costs. \"We haven't talked to our hospital partners,\" says Gary Ley, its executive director. \"It would be a major change for them also. It's hard not to support the goals but we have to look at the execution.\"\u003c/p>\n\u003cp>For its part, the American Hospital Association said it supports providing the public \"useful information\" about hospital quality, but has doubts that detailed inspection reports fit that description.\u003c/p>\n\u003cp>\"It's important that the information shared with consumers has a clear purpose, is transparent and is readily understood by folks from all walks of life, not just those with deep expertise in health care,\" says Nancy Foster, AHA's vice president of quality and patient safety, in a statement. \"We are concerned that sharing a detailed report may not be the most useful or effective strategy for informing the public.\"\u003c/p>\n\u003cp>Foster says it might be more useful to provide a one- or two-page \"accurate summary\" of inspection findings, with \"key takeaways\" and why they are important. \"This summary could also draw from the plan of correction the hospital creates and summarize how the hospital plans to address the findings,\" Foster says.\u003c/p>\n\u003cp>For years, accreditors have been accused of putting the interests of the facilities that pay them ahead of patient safety. In 2002, the Chicago Tribune reported how The Joint Commission gave its seal of approval to \"medical centers riddled by life-threatening problems and underreporting of patient deaths due to infections and hospital errors.\"\u003c/p>\n\u003cp>Last week, BuzzFeed News reported how an Oklahoma psychiatric hospital was named a \"Top Performer in Key Quality Measures\" by The Joint Commission even though police records, state inspection reports and lawsuit records showed that it \"is a profoundly troubled facility where frequent violence endangers patients and staff alike, where children as young as 5 are separated from their parents and held in dangerous situations, and where wards lack adequate staffing and staff lack adequate training.\"\u003c/p>\n\u003cp>In a response to BuzzFeed, the company that runs the hospital, Universal Health Services, said it \"is proud of the care it provides patients at Shadow Mountain Behavioral Health.\"\u003c/p>\n\u003cp>On its website, The Joint Commission allows users to check the accreditation status of hospitals but provides scant information of what went wrong, even when hospitals are described as receiving a \"preliminary denial of accreditation.\" For one hospital, the explanation is: \"Existence at time of survey of a condition, which in The Joint Commission's view, poses a threat to patients or other individuals served.\" The threat itself is not disclosed.\u003c/p>\n\u003cp>Consumers Union's Safe Patient Project and other patient safety organizations have been pushing for years for more information about hospital inspections. Lisa McGiffert, who directs the Safe Patient Project, hopes this may be the opportunity for change. \"The information that's available now is so minimal and would not really inform anyone about real quality of a hospital,\" she says.\u003c/p>\n\u003cp>Comments on the proposal may be submitted from April 28 to June 13 through the CMS website.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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}
},
"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",
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"officialWebsiteLink": "/news/series/baycurious",
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"source": "kqed",
"order": 3
},
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"npr": "https://www.npr.org/podcasts/500557090/bay-curious",
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}
},
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"id": "bbc-world-service",
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"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": {
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"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
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"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",
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"officialWebsiteLink": "/californiareport",
"meta": {
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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"amazon": "https://music.amazon.com/podcasts/26099305-72af-4542-9dde-ac1807fe36d5/kqed-s-the-california-report",
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}
},
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"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",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"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": {
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"officialWebsiteLink": "/podcasts/closealltabs",
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"source": "kqed",
"order": 1
},
"link": "/podcasts/closealltabs",
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
"site": "radio",
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},
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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}
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"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",
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"meta": {
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"source": "kqed",
"order": 9
},
"link": "/forum",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"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",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"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.",
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"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"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": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"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": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
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"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.",
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