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"content": "\u003cp>Michael Miller, 44, does what most smokers do to protect his sons and daughter from the fumes of his Marlboro Ultra Lights. He takes it outside.\u003c/p>\n\u003cp>After his 7 a.m. coffee, he walks out of his home in Cincinnati to smoke his first cigarette of the day. Then, as a branch manager of a road safety construction company, he smokes dozens more on street curbs.\u003c/p>\n\u003cp>The tobacco never appears when Miller is coaching on the baseball or football field, or when he’s in the car with his children. But when he’s alone on the road, he sometimes rolls the windows down and lights up.\u003c/p>\n\u003cp>Michael Miller, right, and wife Jill spend time supporting their kids’ athletic pursuits. He says his children, from left, Max, Brody and Brynn, often remind him that his smoking habit is dangerous to his health. 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This thin film can be picked up by touch or released back into the air when disturbed.\u003c/p>\n\u003cp>The researchers examined 25 children who arrived at an emergency room with breathing problems associated with secondhand smoke exposure.\u003c/p>\n\u003cp>They discovered the average level of nicotine on the children’s hands was more than three times higher than the level of nicotine found on the hands of non-smoking adults who live with smokers. They said nicotine on the skin of a nonsmoker is a good proxy to measure exposure to thirdhand smoke.\u003c/p>\n\u003cp>“Because nicotine is specific to tobacco, its presence on children’s hands may serve as a proxy of tobacco smoke pollution in their immediate environment,” the researchers wrote.\u003c/p>\n\u003cp>They also found that all but one of the children had detectable levels in their saliva of cotinine, a biomarker for exposure to nicotine. All of the children in the study had parents who smoked but did not smoke themselves.\u003c/p>\n\u003cp>The high nicotine readings on the kids’ hands, coupled with the “light smoking” habits of the majority of their parents, signaled to lead author E. Melinda Mahabee-Gittens that these toxins could have arrived from a source other than direct access to cigarette smoke.\u003c/p>\n\u003cp>“Clearly they’re getting it from somewhere, and perhaps it may be this thirdhand smoke connection,” said Mahabee-Gittens, an emergency room physician at Cincinnati Children’s Hospital Medical Center.\u003c/p>\n\u003cp>Children face a higher risk of developing health complications from thirdhand smoke than adults. Infants tend to spend more time indoors and can be surrounded by contaminated objects like rugs and blankets, according to a 2004 study written by Georg Matt, a professor of psychology at San Diego State University who co-authored the study and has researched thirdhand smoke. An infant’s propensity to place their hands in their mouth increases the likelihood of the young ingesting the toxic residue.\u003c/p>\n\u003cp>Thirdhand smoke can linger in an area long after a cigarette or cigar is snuffed out — for up to five years, Matt said.\u003c/p>\n\u003cp>“Tobacco smoke doesn’t go up in the air and it disappears and it’s gone,” Matt said. “That’s the illusion.”\u003c/p>\n\u003cp>The negative health consequences of secondhand smoke are well-established.\u003c/p>\n\u003cp>Researchers at the U.S. Centers for Disease Control and Prevention estimate that since 1964 at least 2.5 million nonsmokers have died of diseases linked to their exposure to cigarette smoke.\u003c/p>\n\u003cp>In contrast, research on thirdhand smoke gained popularity only a decade ago, but multiple studies suggest the mix of toxins can lead to adverse health outcomes. An animal model simulating thirdhand-smoke-contaminated homes found the chemicals harmed mice’s livers, lungs and healing abilities. A separate 2010 study showed thirdhand smoke mixed with nitrous acid — a gas sometimes emitted from leaky gas stoves — can form cancer-causing chemical compounds. These toxins have also been shown to damage human DNA.\u003c/p>\n\u003cp>“All in all, I think the evidence that we’ve gathered is basically pointing to potentially high levels of risk to young children and toddlers, and also expectant mothers,” Anwer Mujeeb, program officer for the Tobacco-Related Disease Research Program.\u003c/p>\n\u003cp>Unfortunately, removing thirdhand smoke from a child’s environment is no easy task. The variety of compounds that make up cigarette residue react to cleaning products differently, Matt said, making it difficult to purge a space of pollutants.\u003c/p>\n\u003cp>Governments and agencies across the nation have attempted to curb the threat of smoke exposure by implementing tobacco bans. Forty-one states and the District of Columbia have implemented local smoke-free laws, according to the lobbying group Americans for Nonsmokers’ Rights.\u003c/p>\n\u003cp>Although the majority of these laws are meant to address secondhand smoke exposure, an unintended benefit of the ordinances is a reduction in thirdhand smoke, said Stanton Glantz, professor of medicine and director of the Center for Tobacco Control Research and Education at University of California-San Francisco.\u003c/p>\n\u003cp>Reynolds American Inc., the second-largest tobacco company in the United States, declined to comment on the study. The Altria Group, the leading U.S. cigarette manufacturer, did not respond to requests for comment.\u003c/p>\n\u003cp>Mujeeb said more work must be done to better understand the risks of thirdhand smoke. Researchers still do not know the threshold of exposure that leads to harm. Other potential pollutants in the environment need to be identified as well to “properly characterize the risk of thirdhand smoke,” he said.\u003c/p>\n\u003cp>Miller is skeptical of the threat thirdhand smoke poses to his family, but he is determined to quit smoking this year on his 45th birthday in July. With the help of medicine, he hopes to break the habit his kids remind him is proven to kill.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“I think there’s far worse things that are going on than any tar on my hands,” he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>New findings highlight the scientific community’s efforts to identify potential dangers of another byproduct of cigarettes that may slip past Miller’s precautions and affect his kids: “thirdhand smoke.”\u003c/p>\n\u003cp>A recent study in the journal Tobacco Control found high levels of nicotine on the hands of children of smokers, raising concerns about thirdhand smoke, a name given to the nicotine and chemical residue left behind from cigarette and cigar smoke that can cling to skin, hair, clothes, rugs and walls. This thin film can be picked up by touch or released back into the air when disturbed.\u003c/p>\n\u003cp>The researchers examined 25 children who arrived at an emergency room with breathing problems associated with secondhand smoke exposure.\u003c/p>\n\u003cp>They discovered the average level of nicotine on the children’s hands was more than three times higher than the level of nicotine found on the hands of non-smoking adults who live with smokers. They said nicotine on the skin of a nonsmoker is a good proxy to measure exposure to thirdhand smoke.\u003c/p>\n\u003cp>“Because nicotine is specific to tobacco, its presence on children’s hands may serve as a proxy of tobacco smoke pollution in their immediate environment,” the researchers wrote.\u003c/p>\n\u003cp>They also found that all but one of the children had detectable levels in their saliva of cotinine, a biomarker for exposure to nicotine. All of the children in the study had parents who smoked but did not smoke themselves.\u003c/p>\n\u003cp>The high nicotine readings on the kids’ hands, coupled with the “light smoking” habits of the majority of their parents, signaled to lead author E. Melinda Mahabee-Gittens that these toxins could have arrived from a source other than direct access to cigarette smoke.\u003c/p>\n\u003cp>“Clearly they’re getting it from somewhere, and perhaps it may be this thirdhand smoke connection,” said Mahabee-Gittens, an emergency room physician at Cincinnati Children’s Hospital Medical Center.\u003c/p>\n\u003cp>Children face a higher risk of developing health complications from thirdhand smoke than adults. Infants tend to spend more time indoors and can be surrounded by contaminated objects like rugs and blankets, according to a 2004 study written by Georg Matt, a professor of psychology at San Diego State University who co-authored the study and has researched thirdhand smoke. An infant’s propensity to place their hands in their mouth increases the likelihood of the young ingesting the toxic residue.\u003c/p>\n\u003cp>Thirdhand smoke can linger in an area long after a cigarette or cigar is snuffed out — for up to five years, Matt said.\u003c/p>\n\u003cp>“Tobacco smoke doesn’t go up in the air and it disappears and it’s gone,” Matt said. “That’s the illusion.”\u003c/p>\n\u003cp>The negative health consequences of secondhand smoke are well-established.\u003c/p>\n\u003cp>Researchers at the U.S. Centers for Disease Control and Prevention estimate that since 1964 at least 2.5 million nonsmokers have died of diseases linked to their exposure to cigarette smoke.\u003c/p>\n\u003cp>In contrast, research on thirdhand smoke gained popularity only a decade ago, but multiple studies suggest the mix of toxins can lead to adverse health outcomes. An animal model simulating thirdhand-smoke-contaminated homes found the chemicals harmed mice’s livers, lungs and healing abilities. A separate 2010 study showed thirdhand smoke mixed with nitrous acid — a gas sometimes emitted from leaky gas stoves — can form cancer-causing chemical compounds. These toxins have also been shown to damage human DNA.\u003c/p>\n\u003cp>“All in all, I think the evidence that we’ve gathered is basically pointing to potentially high levels of risk to young children and toddlers, and also expectant mothers,” Anwer Mujeeb, program officer for the Tobacco-Related Disease Research Program.\u003c/p>\n\u003cp>Unfortunately, removing thirdhand smoke from a child’s environment is no easy task. The variety of compounds that make up cigarette residue react to cleaning products differently, Matt said, making it difficult to purge a space of pollutants.\u003c/p>\n\u003cp>Governments and agencies across the nation have attempted to curb the threat of smoke exposure by implementing tobacco bans. Forty-one states and the District of Columbia have implemented local smoke-free laws, according to the lobbying group Americans for Nonsmokers’ Rights.\u003c/p>\n\u003cp>Although the majority of these laws are meant to address secondhand smoke exposure, an unintended benefit of the ordinances is a reduction in thirdhand smoke, said Stanton Glantz, professor of medicine and director of the Center for Tobacco Control Research and Education at University of California-San Francisco.\u003c/p>\n\u003cp>Reynolds American Inc., the second-largest tobacco company in the United States, declined to comment on the study. The Altria Group, the leading U.S. cigarette manufacturer, did not respond to requests for comment.\u003c/p>\n\u003cp>Mujeeb said more work must be done to better understand the risks of thirdhand smoke. Researchers still do not know the threshold of exposure that leads to harm. Other potential pollutants in the environment need to be identified as well to “properly characterize the risk of thirdhand smoke,” he said.\u003c/p>\n\u003cp>Miller is skeptical of the threat thirdhand smoke poses to his family, but he is determined to quit smoking this year on his 45th birthday in July. With the help of medicine, he hopes to break the habit his kids remind him is proven to kill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I think there’s far worse things that are going on than any tar on my hands,” he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Lawmakers Weigh Measures to Improve Dental Care for the Poor",
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"content": "\u003cp>California lawmakers are considering several bills to improve and expand access to Denti-Cal, the state’s troubled dental program for low-income people — including ones that would draw from the state’s new tobacco tax to boost dentists’ pay.\u003c/p>\n\u003cp>Assembly Bill 753, introduced by Assemblywoman Anna Caballero (D-Salinas), would direct money from the state’s new tobacco tax to broaden access to Denti-Cal, which for years has been faulted in state and federal reports. The bill will be heard in the Assembly Committee on Health on Tuesday.\u003c/p>\n\u003cp>A 2014 California state auditor’s report showed that fewer than half of the children eligible for Denti-Cal benefits actually saw a dentist in the previous year.\u003c/p>\n\u003cp>Critics say access to care suffers because Denti-Cal payments to dentists are so low that many can’t afford to participate in the program. The auditor’s report also found that Denti-Cal payments for the most common procedures averaged $21.60, about 35 percent of the national average.\u003c/p>\n\u003cp>In the next fiscal year, Caballero’s bill would earmark $300 million of the almost $1.2 billion expected in new Medi-Cal funding from the state’s tobacco tax revenues. In future years, the bill would require at least 15 percent of those revenues to be spent on Denti-Cal services.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Most of the money would go toward boosting payments to dentists who provide preventive services to adults, such as regular teeth cleanings. A program known as the Dental Transformation Initiative, funded by both state and federal dollars, offers extra money to dentists for children’s preventive services.\u003c/p>\n\u003cp>Caballero said she believes California voters who approved the tobacco tax last year wanted the money to be used to improve underfunded programs like Denti-Cal. “We want to make sure that this intent is kept alive,” Caballero said.\u003c/p>\n\u003cp>Caballero represents a largely rural district that includes the Salinas Valley, San Benito County and Watsonville. She said there are not enough dentists overall in the region, let alone ones who can afford to see Denti-Cal patients.\u003c/p>\n\u003cp>Dr. John Blake runs the Children’s Dental Health Clinic in Long Beach, where 85 percent of the patients are on Denti-Cal. Blake said Caballero’s legislation is a good start, although it probably is not enough to draw more dentists into the program, he said.\u003c/p>\n\u003cp>The initiative would help fill gaps in preventive care, he said, but adults may have serious dental disease and dentists would find themselves in a difficult position if they detected it during basic cleaning and screening.\u003c/p>\n\u003cp>“The adult population is a different beast from a treatment standpoint,” Blake said. “We’ve done all this cleaning, but now we need root canals and extractions…how do we cover this?”\u003c/p>\n\u003cp>Caballero’s bill would also require that some of the tobacco tax money be used to increase payments to dentists for the 20 most common dental procedures for children, such as X-rays and fillings. This would supplement and expand efforts by the Dental Transformation Initiative.\u003c/p>\n\u003cp>Another bill, AB 15, introduced by Republicans late last year, would require that Denti-Cal rates be doubled for the 15 most common prevention and treatment services.\u003c/p>\n\u003cp>Blake said most dentists ask only that Denti-Cal payments match the national median rate, and that’s not taking into account that California tends to have higher living and business costs.\u003c/p>\n\u003cp>Using tobacco tax money to improve Denti-Cal makes sense, Blake said. That was the intent of the proposition to better Medi-Cal, including its dental program.\u003c/p>\n\u003cp>“We’d certainly like to see that honored,” Blake said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>AB 15 cleared the Assembly Health Committee last month and next will be heard by the Assembly’s Committee on Appropriations. A hearing date has not yet been set.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California lawmakers are considering several bills to improve and expand access to Denti-Cal, the state’s troubled dental program for low-income people — including ones that would draw from the state’s new tobacco tax to boost dentists’ pay.\u003c/p>\n\u003cp>Assembly Bill 753, introduced by Assemblywoman Anna Caballero (D-Salinas), would direct money from the state’s new tobacco tax to broaden access to Denti-Cal, which for years has been faulted in state and federal reports. The bill will be heard in the Assembly Committee on Health on Tuesday.\u003c/p>\n\u003cp>A 2014 California state auditor’s report showed that fewer than half of the children eligible for Denti-Cal benefits actually saw a dentist in the previous year.\u003c/p>\n\u003cp>Critics say access to care suffers because Denti-Cal payments to dentists are so low that many can’t afford to participate in the program. The auditor’s report also found that Denti-Cal payments for the most common procedures averaged $21.60, about 35 percent of the national average.\u003c/p>\n\u003cp>In the next fiscal year, Caballero’s bill would earmark $300 million of the almost $1.2 billion expected in new Medi-Cal funding from the state’s tobacco tax revenues. In future years, the bill would require at least 15 percent of those revenues to be spent on Denti-Cal services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Most of the money would go toward boosting payments to dentists who provide preventive services to adults, such as regular teeth cleanings. A program known as the Dental Transformation Initiative, funded by both state and federal dollars, offers extra money to dentists for children’s preventive services.\u003c/p>\n\u003cp>Caballero said she believes California voters who approved the tobacco tax last year wanted the money to be used to improve underfunded programs like Denti-Cal. “We want to make sure that this intent is kept alive,” Caballero said.\u003c/p>\n\u003cp>Caballero represents a largely rural district that includes the Salinas Valley, San Benito County and Watsonville. She said there are not enough dentists overall in the region, let alone ones who can afford to see Denti-Cal patients.\u003c/p>\n\u003cp>Dr. John Blake runs the Children’s Dental Health Clinic in Long Beach, where 85 percent of the patients are on Denti-Cal. Blake said Caballero’s legislation is a good start, although it probably is not enough to draw more dentists into the program, he said.\u003c/p>\n\u003cp>The initiative would help fill gaps in preventive care, he said, but adults may have serious dental disease and dentists would find themselves in a difficult position if they detected it during basic cleaning and screening.\u003c/p>\n\u003cp>“The adult population is a different beast from a treatment standpoint,” Blake said. “We’ve done all this cleaning, but now we need root canals and extractions…how do we cover this?”\u003c/p>\n\u003cp>Caballero’s bill would also require that some of the tobacco tax money be used to increase payments to dentists for the 20 most common dental procedures for children, such as X-rays and fillings. This would supplement and expand efforts by the Dental Transformation Initiative.\u003c/p>\n\u003cp>Another bill, AB 15, introduced by Republicans late last year, would require that Denti-Cal rates be doubled for the 15 most common prevention and treatment services.\u003c/p>\n\u003cp>Blake said most dentists ask only that Denti-Cal payments match the national median rate, and that’s not taking into account that California tends to have higher living and business costs.\u003c/p>\n\u003cp>Using tobacco tax money to improve Denti-Cal makes sense, Blake said. That was the intent of the proposition to better Medi-Cal, including its dental program.\u003c/p>\n\u003cp>“We’d certainly like to see that honored,” Blake said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>AB 15 cleared the Assembly Health Committee last month and next will be heard by the Assembly’s Committee on Appropriations. A hearing date has not yet been set.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Vaccination Rates for California Kindergarteners Are Higher Than Ever After New Law",
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"content": "\u003cp>Vaccination rates hit an all-time high for California kindergartners, the California Department of Public Health said Wednesday as it announced its first findings since a new law ended the era of the “personal belief exemption” that allowed thousands of parents to choose not to vaccinate their children who attend public and private schools.\u003c/p>\n\u003cp>The percentage of kindergartners who received all required vaccines rose to 95.6 percent in 2016-17, up from the 92.8 percent rate in 2015-16. This is the highest reported rate for the current set of immunization requirements, which began in the 2001-02 school year, the state said.\u003c/p>\n\u003cp>“It’s a great thing for California kids,” said Catherine Flores Martin, director of the California Immunization Coalition. “It’s a big win for schools and communities.”\u003c/p>\n\u003cp>To be clear, California parents do not have to immunize their children. But under the new law, Senate Bill 277, passed in 2015, children must be immunized against 10 serious communicable diseases if they want to attend public or private schools and child care centers. If unvaccinated, children must be home schooled or enrolled in independent study with no classroom instruction or receiving special education services, the California Department of Public Health said.\u003c/p>\n\u003cp>Children may be granted a medical exemption to vaccinations with a note from a doctor attesting that the child’s health condition prohibits vaccinations. Rates of medical exemptions rose to 0.5 percent in 2016-17 from 0.2 percent in 2015-16. The California Department of Health also released a new category of information – 0.5 percent of kindergartners were reported as lacking full immunization because they attended private home schools or independent study programs or received special education services.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Tulare County had the highest rate – 98.5 percent – of vaccinated kindergartners followed by San Benito County with 98.1 percent, the state said.\u003c/p>\n\u003cp>But even with the increase in vaccination rates, nine counties have vaccination rates below 90 percent for kindergartners, the state said. A 90 percent to 95 percent vaccination rate is considered “herd immunity,” the rate necessary to protect a community – particularly those who are too sick or too young to be vaccinated – from an outbreak of many types of contagious diseases. Measles, which is highly contagious, requires a 95 percent vaccination rate to protect the community, health officials say.\u003c/p>\n\u003cp>While personal belief exemptions are no longer granted, 0.6 percent of kindergartners were not vaccinated because of a personal belief exemption they had obtained a year earlier in transitional kindergarten. The law stated that their exemption would continue to be valid in kindergarten. All told, 1.5 percent of kindergartners lacked required immunizations in 2016-17, a decline from the 2.5 percent rate in 2015-16, because of medical exemptions, previously awarded personal belief exemptions or enrollment in home schooling, independent study or special education, the state said.\u003c/p>\n\u003cp>At hearings at the state Capitol, hundreds of parents vociferously pleaded with legislators not to repeal the personal belief exemption. But public health advocates prevailed.\u003c/p>\n\u003cp>In California and elsewhere, nonmedical exemptions have created pockets of unvaccinated children that have facilitated the spread of potentially life-threatening diseases, particularly measles and pertussis, according to a 2016 research review published in the Journal of the American Medical Association in 2016.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The most at-risk groups for the diseases are infants who are too young to be vaccinated and individuals with compromised immune systems.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Vaccination rates hit an all-time high for California kindergartners, the California Department of Public Health said Wednesday as it announced its first findings since a new law ended the era of the “personal belief exemption” that allowed thousands of parents to choose not to vaccinate their children who attend public and private schools.\u003c/p>\n\u003cp>The percentage of kindergartners who received all required vaccines rose to 95.6 percent in 2016-17, up from the 92.8 percent rate in 2015-16. This is the highest reported rate for the current set of immunization requirements, which began in the 2001-02 school year, the state said.\u003c/p>\n\u003cp>“It’s a great thing for California kids,” said Catherine Flores Martin, director of the California Immunization Coalition. “It’s a big win for schools and communities.”\u003c/p>\n\u003cp>To be clear, California parents do not have to immunize their children. But under the new law, Senate Bill 277, passed in 2015, children must be immunized against 10 serious communicable diseases if they want to attend public or private schools and child care centers. If unvaccinated, children must be home schooled or enrolled in independent study with no classroom instruction or receiving special education services, the California Department of Public Health said.\u003c/p>\n\u003cp>Children may be granted a medical exemption to vaccinations with a note from a doctor attesting that the child’s health condition prohibits vaccinations. Rates of medical exemptions rose to 0.5 percent in 2016-17 from 0.2 percent in 2015-16. The California Department of Health also released a new category of information – 0.5 percent of kindergartners were reported as lacking full immunization because they attended private home schools or independent study programs or received special education services.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Tulare County had the highest rate – 98.5 percent – of vaccinated kindergartners followed by San Benito County with 98.1 percent, the state said.\u003c/p>\n\u003cp>But even with the increase in vaccination rates, nine counties have vaccination rates below 90 percent for kindergartners, the state said. A 90 percent to 95 percent vaccination rate is considered “herd immunity,” the rate necessary to protect a community – particularly those who are too sick or too young to be vaccinated – from an outbreak of many types of contagious diseases. Measles, which is highly contagious, requires a 95 percent vaccination rate to protect the community, health officials say.\u003c/p>\n\u003cp>While personal belief exemptions are no longer granted, 0.6 percent of kindergartners were not vaccinated because of a personal belief exemption they had obtained a year earlier in transitional kindergarten. The law stated that their exemption would continue to be valid in kindergarten. All told, 1.5 percent of kindergartners lacked required immunizations in 2016-17, a decline from the 2.5 percent rate in 2015-16, because of medical exemptions, previously awarded personal belief exemptions or enrollment in home schooling, independent study or special education, the state said.\u003c/p>\n\u003cp>At hearings at the state Capitol, hundreds of parents vociferously pleaded with legislators not to repeal the personal belief exemption. But public health advocates prevailed.\u003c/p>\n\u003cp>In California and elsewhere, nonmedical exemptions have created pockets of unvaccinated children that have facilitated the spread of potentially life-threatening diseases, particularly measles and pertussis, according to a 2016 research review published in the Journal of the American Medical Association in 2016.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The most at-risk groups for the diseases are infants who are too young to be vaccinated and individuals with compromised immune systems.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>As the nation’s Republican leaders huddle to reconsider their plans to “repeal and replace” the nation’s health law, advocates for universal health coverage press on in California, armed with renewed political will and a new set of proposals.\u003c/p>\n\u003cp>Organized labor and two lawmakers are leading the charge for a single, government-financed program for everyone in the state. Another legislator wants to create a commission that would weigh the best options for a system to cover everyone. And Democratic Lt. Gov. Gavin Newsom, who hopes to become the next governor, has suggested building on employer-based health care to plug holes in existing coverage.\u003c/p>\n\u003cp>The proposals are fueled both by a fear of losing gains under the Affordable Care Act and a sense that the law doesn’t go far enough toward covering everyone and cutting costs.\u003c/p>\n\u003cp>But heath policy experts say that creating any type of universal health plan would face enormous political and fiscal challenges — and that if it happens at all, it could take years.\u003c/p>\n\u003cp>“There are different ways to get there,” says Jonathan Oberlander, professor of social medicine and health policy at the University of North Carolina. “None of them is easy.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The most specific California proposal comes from state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), co-authors of legislation that would take steps toward creating one publicly financed “single-payer” program.\u003c/p>\n\u003cp>The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180SB562\" target=\"_blank\">bill\u003c/a>, co-sponsored by the California Nurses Association, would aim for something like a system of “Medicare for all” in which the government, not insurers, provides payments and sets coverage rules.\u003c/p>\n\u003cp>\"It's the right moral thing to do,\" Lara says. \"We live in the United States of America. We live in the most powerful state in the union. It is the right thing for us to make sure that we fight to ensure that everyone has coverage.”\u003c/p>\n\u003cp>Lara’s bill contains a long \u003ca href=\"http://sd33.senate.ca.gov/news/2017-02-17-californians-healthy-california-act-seeks-one-plan-more-choice-residents\" target=\"_blank\">list of benefits \u003c/a>the statewide program would cover. Not just doctors and hospitals, but also prescriptions, vision and dental care, hospice and rehabilitative therapies, and more.\u003c/p>\n\u003cp>California Health and Human Services Secretary, \u003ca href=\"http://www.chhs.ca.gov/Pages/Secretary-Diana-S.-Dooley.aspx\" target=\"_blank\">Diana Dooley\u003c/a>, understands the appeal.\u003c/p>\n\u003cp>“I think in California there continues to be a great deal of interest and enthusiasm around single payer,\" she says. \"It is very easy to talk about and it certainly takes advantage of the anxiety people have about health insurance companies.”\u003c/p>\n\u003cp>Lara’s plan does away with premiums, deductibles, co-pays — all those pesky out-of-pocket expenses. So where would the state get the money? Past proposals – here and in states like Vermont and Colorado – have suggested new payroll taxes.\u003c/p>\n\u003cp>\"We know that single payer will be expensive,\" says Assemblyman Jim Wood, chairman of the Health Committee. \"Some estimates from a few years ago, the analysis showed $200 billion plus.\"\u003c/p>\n\u003cp>\"I believe in universal coverage and I’d love to see that happen in the future, but the devils in the details,” he added.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/317282377\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003ca href=\"http://kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\" target=\"_blank\">Roughly half of coverage\u003c/a> in California is sponsored by employers.\u003c/p>\n\u003cp>If “you’re going to take health insurance largely out of the market, you’re going to disconnect it from employers,” Oberlander says.\u003c/p>\n\u003cp>Currently, premiums paid by both employer and employee fund private health insurance plans. Single-payer would change that: instead of paycheck deductions for premiums, workers would see new taxes on their wages to pay for the state plan. It would be controversial and disruptive, Oberlander says. \"A lot of people are satisfied with what they have.\"\u003c/p>\n\u003cp>But Lara thinks it can be done, slowly and methodically. He is traveling this week in Canada, along with Bay-Area state senators Nancy Skinner and Scott Wiener. They’ll be learning about Canadian medical care and how it’s financed.\u003c/p>\n\u003cp>Lara takes heart from the fact that Canada’s system began in just one province, and then spread to others. It did so despite resistance, over many years.\u003c/p>\n\u003cp>\"We envision California being the first state to implement a universal healthcare program, and then having that then be the model for the rest of the other states.”\u003c/p>\n\u003cp>Lara says everyone should withhold judgment until he can provide more detailed funding plans in a month or two. His goal is to get the bill at least through the Senate this year, and then push it farther forward in 2018.\u003c/p>\n\u003cp>The trade group for insurers in California does not support the single-payer idea.\u003c/p>\n\u003cp>“A single-payer system would make the quality of our health care worse, not better,” says Charles Bacchi, president and CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>. “We’ve made substantial progress in expanding and increasing access to and quality of care — this step backwards would be particularly devastating for Californians.”\u003c/p>\n\u003cp>Many conservatives oppose the single-payer approach. “We have come to value and expect a health care system that has private-sector market elements,” said \u003ca href=\"http://www.hoover.org/profiles/lanhee-j-chen\" target=\"_blank\">Lanhee Chen,\u003c/a> a fellow at the Hoover Institution and former chief policy adviser to former Massachusetts governor Mitt Romney.\u003c/p>\n\u003cp>A single-payer system would need federal approval, essentially giving California permission to take the money meant for Medicare and Medicaid, and distribute those funds in a totally new way.\u003c/p>\n\u003cp>\"I’m not sure under what construct that could even occur,\" says \u003ca href=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" target=\"_blank\">Jennifer Kent\u003c/a>, director of the Department of Health Care Services, which operates the state’s Medicaid program, known as Medi-Cal.\u003c/p>\n\u003cp>\"The federal government would have to essentially turn those funds over to a state,\" she says.\u003c/p>\n\u003cp>As it stands, \u003ca href=\"http://californiahealthline.org/news/single-payer-health-care-bill-to-be-introduced-in-california-senate/\">no state has a single-payer system\u003c/a>. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after officials there couldn’t figure out how to finance it.\u003c/p>\n\u003cp>Single-payer proposals have been put forth many times in the California Legislature since 2003, and all have hit roadblocks.\u003c/p>\n\u003cp>One bill, carried by former state senator Sheila Kuehl several years ago and passed by the state Legislature, would have created a payroll tax to help fund a program \u003ca href=\"http://www.lao.ca.gov/2008/hlth/sb840/SB840_analysis.pdf\" target=\"_blank\">costing \u003c/a> $200 billion a year or more. That measure and a similar bill were vetoed by then-governor Arnold Schwarzenegger, who cited financial concerns.\u003c/p>\n\u003cp>Kuehl, now a Los Angeles County supervisor, said the time is as good as ever to reintroduce a proposal like single-payer because many people fear losing coverage under Republican proposals being discussed in Washington, D.C.\u003c/p>\n\u003cp>“The ACA created more familiarity with being insured,” said Kuehl. “They’ve recognized the value.”\u003c/p>\n\u003cp>Other observers say attempts to expand access should not undermine efforts to preserve insurance gains under Obamacare. The threat to Medicaid or private insurance access is still real, they say.\u003c/p>\n\u003cp>“California should explore all options, [but] we should not do that if it means withdrawing support for protecting the ACA,” said Jerry Kominski, director of the UCLA Center for Health Policy Research. “It would take decades to get back to where we are now,” he said.\u003c/p>\n\u003cp>In an interview with California Healthline, California Gov. Jerry Brown emphasized that financing a single-payer system would be a major challenge. Although he said he would entertain a conversation about a single-payer system, he did not say whether he would endorse creating one.\u003c/p>\n\u003cp>For one thing, it would require a new tax, which would have to be approved either by a two-thirds majority vote in the state Legislature or a simple-majority popular vote, he said. Even with the current Democratic supermajority, Brown said, there are always a few “outliers” who wouldn’t support raising new revenues.\u003c/p>\n\u003cp>Brown leaves office in 2018, however, and Newsom, who hopes to succeed him, is looking into a creating a plan for universal coverage that would be an alternative to a single-payer system.\u003c/p>\n\u003cp>One option, according to Newsom’s office, would be to use as a model the Healthy San Francisco program he introduced in 2007 as mayor. The city has used a combination of public money and contributions from employers and enrollees to plug holes in coverage and make primary care accessible to nearly everyone.\u003c/p>\n\u003cp>Newsom has acknowledged, however, that the San Francisco approach \u003ca href=\"https://www.thenation.com/article/can-california-achieve-universal-health-care-in-the-age-of-trump/\">would not necessarily work in every county\u003c/a>, and said he is open to other possibilities.\u003c/p>\n\u003cp>Using that model to expand health care statewide has some political advantages, Oberlander said, because it builds on the “status quo rather than radically restructuring” the current system.\u003c/p>\n\u003cp>Another California lawmaker proposes to keep the conversation going about universal health care, at least, by creating a commission that would make various recommendations to policymakers.\u003c/p>\n\u003cp>“We have to be able to move on multiple tracks at once,” said Assemblyman Rob Bonta (D-Oakland), who is carrying the bill to create the Health Care for All commission, which would convene in 2018.\u003c/p>\n\u003cp>The debate in Washington could actually produce some surprising opportunities for California and other states. The feds might, for instance, approve waivers to allow other types of experimentation within states. \u003ca href=\"http://healthaffairs.org/blog/2017/01/24/aca-replacement-bill-from-cassidy-and-colleagues-offers-state-options-roth-hsas/\">Some Republicans\u003c/a> favor an approach in which each state decides on its own coverage system, within certain limits.\u003c/p>\n\u003cp>That could mean a retraction of coverage in some states, but in California it might open the door to a new model.\u003c/p>\n\u003cp>“It is possible that some liberal-leaning states are going to do things that we didn’t think possible before,” Oberlander said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/pauline-bartolone/\">\u003cstrong>Pauline Bartolone,\u003c/strong>\u003c/a> California Healthline, and \u003cstrong>Carrie Feibel,\u003c/strong> KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As the nation’s Republican leaders huddle to reconsider their plans to “repeal and replace” the nation’s health law, advocates for universal health coverage press on in California, armed with renewed political will and a new set of proposals.\u003c/p>\n\u003cp>Organized labor and two lawmakers are leading the charge for a single, government-financed program for everyone in the state. Another legislator wants to create a commission that would weigh the best options for a system to cover everyone. And Democratic Lt. Gov. Gavin Newsom, who hopes to become the next governor, has suggested building on employer-based health care to plug holes in existing coverage.\u003c/p>\n\u003cp>The proposals are fueled both by a fear of losing gains under the Affordable Care Act and a sense that the law doesn’t go far enough toward covering everyone and cutting costs.\u003c/p>\n\u003cp>But heath policy experts say that creating any type of universal health plan would face enormous political and fiscal challenges — and that if it happens at all, it could take years.\u003c/p>\n\u003cp>“There are different ways to get there,” says Jonathan Oberlander, professor of social medicine and health policy at the University of North Carolina. “None of them is easy.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The most specific California proposal comes from state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), co-authors of legislation that would take steps toward creating one publicly financed “single-payer” program.\u003c/p>\n\u003cp>The \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180SB562\" target=\"_blank\">bill\u003c/a>, co-sponsored by the California Nurses Association, would aim for something like a system of “Medicare for all” in which the government, not insurers, provides payments and sets coverage rules.\u003c/p>\n\u003cp>\"It's the right moral thing to do,\" Lara says. \"We live in the United States of America. We live in the most powerful state in the union. It is the right thing for us to make sure that we fight to ensure that everyone has coverage.”\u003c/p>\n\u003cp>Lara’s bill contains a long \u003ca href=\"http://sd33.senate.ca.gov/news/2017-02-17-californians-healthy-california-act-seeks-one-plan-more-choice-residents\" target=\"_blank\">list of benefits \u003c/a>the statewide program would cover. Not just doctors and hospitals, but also prescriptions, vision and dental care, hospice and rehabilitative therapies, and more.\u003c/p>\n\u003cp>California Health and Human Services Secretary, \u003ca href=\"http://www.chhs.ca.gov/Pages/Secretary-Diana-S.-Dooley.aspx\" target=\"_blank\">Diana Dooley\u003c/a>, understands the appeal.\u003c/p>\n\u003cp>“I think in California there continues to be a great deal of interest and enthusiasm around single payer,\" she says. \"It is very easy to talk about and it certainly takes advantage of the anxiety people have about health insurance companies.”\u003c/p>\n\u003cp>Lara’s plan does away with premiums, deductibles, co-pays — all those pesky out-of-pocket expenses. So where would the state get the money? Past proposals – here and in states like Vermont and Colorado – have suggested new payroll taxes.\u003c/p>\n\u003cp>\"We know that single payer will be expensive,\" says Assemblyman Jim Wood, chairman of the Health Committee. \"Some estimates from a few years ago, the analysis showed $200 billion plus.\"\u003c/p>\n\u003cp>\"I believe in universal coverage and I’d love to see that happen in the future, but the devils in the details,” he added.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/317282377&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/317282377'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\" target=\"_blank\">Roughly half of coverage\u003c/a> in California is sponsored by employers.\u003c/p>\n\u003cp>If “you’re going to take health insurance largely out of the market, you’re going to disconnect it from employers,” Oberlander says.\u003c/p>\n\u003cp>Currently, premiums paid by both employer and employee fund private health insurance plans. Single-payer would change that: instead of paycheck deductions for premiums, workers would see new taxes on their wages to pay for the state plan. It would be controversial and disruptive, Oberlander says. \"A lot of people are satisfied with what they have.\"\u003c/p>\n\u003cp>But Lara thinks it can be done, slowly and methodically. He is traveling this week in Canada, along with Bay-Area state senators Nancy Skinner and Scott Wiener. They’ll be learning about Canadian medical care and how it’s financed.\u003c/p>\n\u003cp>Lara takes heart from the fact that Canada’s system began in just one province, and then spread to others. It did so despite resistance, over many years.\u003c/p>\n\u003cp>\"We envision California being the first state to implement a universal healthcare program, and then having that then be the model for the rest of the other states.”\u003c/p>\n\u003cp>Lara says everyone should withhold judgment until he can provide more detailed funding plans in a month or two. His goal is to get the bill at least through the Senate this year, and then push it farther forward in 2018.\u003c/p>\n\u003cp>The trade group for insurers in California does not support the single-payer idea.\u003c/p>\n\u003cp>“A single-payer system would make the quality of our health care worse, not better,” says Charles Bacchi, president and CEO of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\">California Association of Health Plans\u003c/a>. “We’ve made substantial progress in expanding and increasing access to and quality of care — this step backwards would be particularly devastating for Californians.”\u003c/p>\n\u003cp>Many conservatives oppose the single-payer approach. “We have come to value and expect a health care system that has private-sector market elements,” said \u003ca href=\"http://www.hoover.org/profiles/lanhee-j-chen\" target=\"_blank\">Lanhee Chen,\u003c/a> a fellow at the Hoover Institution and former chief policy adviser to former Massachusetts governor Mitt Romney.\u003c/p>\n\u003cp>A single-payer system would need federal approval, essentially giving California permission to take the money meant for Medicare and Medicaid, and distribute those funds in a totally new way.\u003c/p>\n\u003cp>\"I’m not sure under what construct that could even occur,\" says \u003ca href=\"http://www.dhcs.ca.gov/Pages/DirectorsBiography.aspx\" target=\"_blank\">Jennifer Kent\u003c/a>, director of the Department of Health Care Services, which operates the state’s Medicaid program, known as Medi-Cal.\u003c/p>\n\u003cp>\"The federal government would have to essentially turn those funds over to a state,\" she says.\u003c/p>\n\u003cp>As it stands, \u003ca href=\"http://californiahealthline.org/news/single-payer-health-care-bill-to-be-introduced-in-california-senate/\">no state has a single-payer system\u003c/a>. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after officials there couldn’t figure out how to finance it.\u003c/p>\n\u003cp>Single-payer proposals have been put forth many times in the California Legislature since 2003, and all have hit roadblocks.\u003c/p>\n\u003cp>One bill, carried by former state senator Sheila Kuehl several years ago and passed by the state Legislature, would have created a payroll tax to help fund a program \u003ca href=\"http://www.lao.ca.gov/2008/hlth/sb840/SB840_analysis.pdf\" target=\"_blank\">costing \u003c/a> $200 billion a year or more. That measure and a similar bill were vetoed by then-governor Arnold Schwarzenegger, who cited financial concerns.\u003c/p>\n\u003cp>Kuehl, now a Los Angeles County supervisor, said the time is as good as ever to reintroduce a proposal like single-payer because many people fear losing coverage under Republican proposals being discussed in Washington, D.C.\u003c/p>\n\u003cp>“The ACA created more familiarity with being insured,” said Kuehl. “They’ve recognized the value.”\u003c/p>\n\u003cp>Other observers say attempts to expand access should not undermine efforts to preserve insurance gains under Obamacare. The threat to Medicaid or private insurance access is still real, they say.\u003c/p>\n\u003cp>“California should explore all options, [but] we should not do that if it means withdrawing support for protecting the ACA,” said Jerry Kominski, director of the UCLA Center for Health Policy Research. “It would take decades to get back to where we are now,” he said.\u003c/p>\n\u003cp>In an interview with California Healthline, California Gov. Jerry Brown emphasized that financing a single-payer system would be a major challenge. Although he said he would entertain a conversation about a single-payer system, he did not say whether he would endorse creating one.\u003c/p>\n\u003cp>For one thing, it would require a new tax, which would have to be approved either by a two-thirds majority vote in the state Legislature or a simple-majority popular vote, he said. Even with the current Democratic supermajority, Brown said, there are always a few “outliers” who wouldn’t support raising new revenues.\u003c/p>\n\u003cp>Brown leaves office in 2018, however, and Newsom, who hopes to succeed him, is looking into a creating a plan for universal coverage that would be an alternative to a single-payer system.\u003c/p>\n\u003cp>One option, according to Newsom’s office, would be to use as a model the Healthy San Francisco program he introduced in 2007 as mayor. The city has used a combination of public money and contributions from employers and enrollees to plug holes in coverage and make primary care accessible to nearly everyone.\u003c/p>\n\u003cp>Newsom has acknowledged, however, that the San Francisco approach \u003ca href=\"https://www.thenation.com/article/can-california-achieve-universal-health-care-in-the-age-of-trump/\">would not necessarily work in every county\u003c/a>, and said he is open to other possibilities.\u003c/p>\n\u003cp>Using that model to expand health care statewide has some political advantages, Oberlander said, because it builds on the “status quo rather than radically restructuring” the current system.\u003c/p>\n\u003cp>Another California lawmaker proposes to keep the conversation going about universal health care, at least, by creating a commission that would make various recommendations to policymakers.\u003c/p>\n\u003cp>“We have to be able to move on multiple tracks at once,” said Assemblyman Rob Bonta (D-Oakland), who is carrying the bill to create the Health Care for All commission, which would convene in 2018.\u003c/p>\n\u003cp>The debate in Washington could actually produce some surprising opportunities for California and other states. The feds might, for instance, approve waivers to allow other types of experimentation within states. \u003ca href=\"http://healthaffairs.org/blog/2017/01/24/aca-replacement-bill-from-cassidy-and-colleagues-offers-state-options-roth-hsas/\">Some Republicans\u003c/a> favor an approach in which each state decides on its own coverage system, within certain limits.\u003c/p>\n\u003cp>That could mean a retraction of coverage in some states, but in California it might open the door to a new model.\u003c/p>\n\u003cp>“It is possible that some liberal-leaning states are going to do things that we didn’t think possible before,” Oberlander said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Last November, California voters defeated a \u003ca href=\"http://voterguide.sos.ca.gov/en/propositions/61/analysis.htm\" target=\"_blank\" rel=\"noopener\">ballot proposal\u003c/a> that would have given state government more control over drug prices. It was a \u003ca href=\"https://ww2.kqed.org/news/2016/11/09/voters-approve-2-tobacco-tax-but-remain-mixed-on-other-health-measures/\" target=\"_blank\" rel=\"noopener\">victory\u003c/a> for pharmaceutical companies, who spent more than $100 million campaigning against the measure. Now the industry is fighting new efforts by state lawmakers to control the industry.\u003c/p>\n\u003cp>Drug makers are watching \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB17\" target=\"_blank\" rel=\"noopener\">Senate Bill 17 \u003c/a>in particular. Instead of direct price controls, it takes a different tack: price transparency. Drug companies would have to announce large price hikes and give detailed justifications to explain why the prices are going up.\u003c/p>\n\u003cp>Democratic Assemblyman \u003ca href=\"https://a02.asmdc.org/\" target=\"_blank\" rel=\"noopener\">Jim Wood\u003c/a> supported a similar \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml?bill_id=201520160SB1010\" target=\"_blank\" rel=\"noopener\">bill\u003c/a> that failed to move forward a year ago.\u003c/p>\n\u003cp>“It’s basically an effort to provide some transparency around how drug companies price their products,” Wood said. “How do you arrive at these? And what are your practices?”\u003c/p>\n\u003cp>SB 17 is scheduled for a hearing in the \u003ca href=\"http://shea.senate.ca.gov/\" target=\"_blank\" rel=\"noopener\">Senate Committee on Health\u003c/a> on April 19.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Wood chairs the \u003ca href=\"http://ahea.assembly.ca.gov/\" target=\"_blank\" rel=\"noopener\">Committee on Health\u003c/a> in the Assembly. “If you can’t understand what’s going on, how could you possibly make efforts to change that?” he said.\u003c/p>\n\u003cp>Pharmaceutical manufactures frequently argue that drug prices are high because it’s expensive to conduct the scientific research and development that is necessary to bring a drug to market. But Wood says we can’t simply take their word on that.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/316603543″ params=”auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&visual=true” width=”100%” height=”300″ iframe=”true” /]\u003c/p>\n\u003cp>“I would personally love to know how much they spend on advertising and marketing, versus how much they spend on R&D,” he said.\u003c/p>\n\u003cp>Drug industry representatives and researchers visited the Capitol Wednesday to meet with lawmakers and promote their contributions to the California economy. The pharmaceutical industry employs more people in California than any other state (145,880 jobs), according to Priscilla VanderVeer, a spokeswoman with \u003ca href=\"http://www.phrma.org/\" target=\"_blank\" rel=\"noopener\">Pharmaceutical Research and Manufacturers of American. \u003c/a>\u003c/p>\n\u003cp>VanderVeer said SB 17 won’t do anything to help consumers. “If the problem is that patients are having a hard time affording their medicines, which we know they are, then let’s come to the table and talk about solutions that can actually help them,” she said.\u003c/p>\n\u003cp>VanderVeer said one problem is that consumers often must pay the full list price of a drug, even if they are insured.\u003c/p>\n\u003cp>“Oftentimes when a patient goes to the pharmacy counter and they haven’t reached their deductible, or they have a co-insurance on their drugs, they’re paying that off the list price, not the negotiated rate their insurance has,” she said. VanderVeer says that doesn’t happen to insured patients in other parts of the health care system.\u003c/p>\n\u003cp>“I give the example of the hospital. You know the $350 x-ray that your insurance brings down to $50, and then you pay your cost-sharing off the $50. That’s not happening with your drugs, that’s not happening at the pharmacy counter,” she said.\u003c/p>\n\u003cp>VanderVeer also criticized the bill for ignoring other parts of the pharmaceutical supply chain that also affect prices.\u003c/p>\n\u003cp>“You’ve also got pharmacy benefit managers and insurers who negotiate the price significantly down, I might say, and then you also got wholesalers who purchase drugs directly and keep them in their warehouses and disseminate them to pharmacies. And then you’ve got pharmacies,” VanderVeer explained. She said those links in the supply chain account for one-third of the final price.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Assemblyman Wood agrees that California should pay more attention to \u003ca href=\"http://www.investopedia.com/articles/markets/070215/what-pharmacy-benefit-management-industry.asp\" target=\"_blank\" rel=\"noopener\">pharmacy benefit managers\u003c/a>, companies that act as middlemen, negotiating purchase contracts with drug manufacturers on behalf of health plans. Wood has introduced a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB315\" target=\"_blank\" rel=\"noopener\">different bill\u003c/a> in the Assembly that would require pharmacy benefit managers to be licensed in California. It would also require them to disclose information about their business practices, including rebates and hidden \u003ca href=\"https://www.bloomberg.com/news/articles/2017-02-24/sworn-to-secrecy-drugstores-stay-silent-as-customers-overpay\" target=\"_blank\" rel=\"noopener\">“clawback” \u003c/a>arrangements that force patients to unwittingly pay more for drugs.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last November, California voters defeated a \u003ca href=\"http://voterguide.sos.ca.gov/en/propositions/61/analysis.htm\" target=\"_blank\" rel=\"noopener\">ballot proposal\u003c/a> that would have given state government more control over drug prices. It was a \u003ca href=\"https://ww2.kqed.org/news/2016/11/09/voters-approve-2-tobacco-tax-but-remain-mixed-on-other-health-measures/\" target=\"_blank\" rel=\"noopener\">victory\u003c/a> for pharmaceutical companies, who spent more than $100 million campaigning against the measure. Now the industry is fighting new efforts by state lawmakers to control the industry.\u003c/p>\n\u003cp>Drug makers are watching \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB17\" target=\"_blank\" rel=\"noopener\">Senate Bill 17 \u003c/a>in particular. Instead of direct price controls, it takes a different tack: price transparency. Drug companies would have to announce large price hikes and give detailed justifications to explain why the prices are going up.\u003c/p>\n\u003cp>Democratic Assemblyman \u003ca href=\"https://a02.asmdc.org/\" target=\"_blank\" rel=\"noopener\">Jim Wood\u003c/a> supported a similar \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml?bill_id=201520160SB1010\" target=\"_blank\" rel=\"noopener\">bill\u003c/a> that failed to move forward a year ago.\u003c/p>\n\u003cp>“It’s basically an effort to provide some transparency around how drug companies price their products,” Wood said. “How do you arrive at these? And what are your practices?”\u003c/p>\n\u003cp>SB 17 is scheduled for a hearing in the \u003ca href=\"http://shea.senate.ca.gov/\" target=\"_blank\" rel=\"noopener\">Senate Committee on Health\u003c/a> on April 19.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Wood chairs the \u003ca href=\"http://ahea.assembly.ca.gov/\" target=\"_blank\" rel=\"noopener\">Committee on Health\u003c/a> in the Assembly. “If you can’t understand what’s going on, how could you possibly make efforts to change that?” he said.\u003c/p>\n\u003cp>Pharmaceutical manufactures frequently argue that drug prices are high because it’s expensive to conduct the scientific research and development that is necessary to bring a drug to market. But Wood says we can’t simply take their word on that.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”300″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/316603543″&visual=true&”auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&visual=true”'\n title='”https://api.soundcloud.com/tracks/316603543″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“I would personally love to know how much they spend on advertising and marketing, versus how much they spend on R&D,” he said.\u003c/p>\n\u003cp>Drug industry representatives and researchers visited the Capitol Wednesday to meet with lawmakers and promote their contributions to the California economy. The pharmaceutical industry employs more people in California than any other state (145,880 jobs), according to Priscilla VanderVeer, a spokeswoman with \u003ca href=\"http://www.phrma.org/\" target=\"_blank\" rel=\"noopener\">Pharmaceutical Research and Manufacturers of American. \u003c/a>\u003c/p>\n\u003cp>VanderVeer said SB 17 won’t do anything to help consumers. “If the problem is that patients are having a hard time affording their medicines, which we know they are, then let’s come to the table and talk about solutions that can actually help them,” she said.\u003c/p>\n\u003cp>VanderVeer said one problem is that consumers often must pay the full list price of a drug, even if they are insured.\u003c/p>\n\u003cp>“Oftentimes when a patient goes to the pharmacy counter and they haven’t reached their deductible, or they have a co-insurance on their drugs, they’re paying that off the list price, not the negotiated rate their insurance has,” she said. VanderVeer says that doesn’t happen to insured patients in other parts of the health care system.\u003c/p>\n\u003cp>“I give the example of the hospital. You know the $350 x-ray that your insurance brings down to $50, and then you pay your cost-sharing off the $50. That’s not happening with your drugs, that’s not happening at the pharmacy counter,” she said.\u003c/p>\n\u003cp>VanderVeer also criticized the bill for ignoring other parts of the pharmaceutical supply chain that also affect prices.\u003c/p>\n\u003cp>“You’ve also got pharmacy benefit managers and insurers who negotiate the price significantly down, I might say, and then you also got wholesalers who purchase drugs directly and keep them in their warehouses and disseminate them to pharmacies. And then you’ve got pharmacies,” VanderVeer explained. She said those links in the supply chain account for one-third of the final price.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Assemblyman Wood agrees that California should pay more attention to \u003ca href=\"http://www.investopedia.com/articles/markets/070215/what-pharmacy-benefit-management-industry.asp\" target=\"_blank\" rel=\"noopener\">pharmacy benefit managers\u003c/a>, companies that act as middlemen, negotiating purchase contracts with drug manufacturers on behalf of health plans. Wood has introduced a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB315\" target=\"_blank\" rel=\"noopener\">different bill\u003c/a> in the Assembly that would require pharmacy benefit managers to be licensed in California. It would also require them to disclose information about their business practices, including rebates and hidden \u003ca href=\"https://www.bloomberg.com/news/articles/2017-02-24/sworn-to-secrecy-drugstores-stay-silent-as-customers-overpay\" target=\"_blank\" rel=\"noopener\">“clawback” \u003c/a>arrangements that force patients to unwittingly pay more for drugs.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Brings 15 Felony Charges Against Activists Who Secretly Recorded Planned Parenthood",
"title": "California Brings 15 Felony Charges Against Activists Who Secretly Recorded Planned Parenthood",
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"content": "\u003cp>Two anti-abortion rights activists who covertly recorded themselves discussing fetal tissue with Planned Parenthood staff are facing felony charges in California, for allegedly violating state law by filming people without their permission.\u003c/p>\n\u003cp>California Attorney General Xavier Becerra announced the charges against David Daleiden and Sandra Merritt on Tuesday, saying the state \"will not tolerate the criminal recording of confidential conversations.\"\u003c/p>\n\u003cp>In a statement, Daleiden called the charges \"bogus\" and reiterated claims that Planned Parenthood has violated the law by selling fetal tissue — an allegation that has been investigated by more than a dozen states, none of which found evidence supporting Daleiden's claim.\u003c/p>\n\u003cp>Planned Parenthood, meanwhile, says it has \"has done nothing wrong, and the only people who broke the law are those behind the fraudulent tapes.\"\u003c/p>\n\u003cp>You may remember that in 2015, Daleiden's organization released a video of a Planned Parenthood official discussing how the organization provides fetal tissue to researchers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Daleiden claimed the video showed evidence that Planned Parenthood was selling that tissue, which would be illegal. Planned Parenthood said the footage was misleadingly edited and that the organization donates tissue following legal guidelines and with permitted reimbursements for expenses, which investigations have corroborated.\u003c/p>\n\u003cp>Last year, a grand jury in Texas was examining Daleiden's allegations. The grand jury determined there was no sign of criminal wrongdoing by Planned Parenthood.\u003c/p>\n\u003cp>Instead, in a surprise twist, it indicted Daleiden and Merritt on felony charges of using fake drivers licenses to gain access to a Planned Parenthood meeting. They also indicted Daleiden on misdemeanor charges of trying to buy human tissue — the kind of misconduct he was trying to pin on Planned Parenthood.\u003c/p>\n\u003cp>Those charges were dismissed: the misdemeanor on technical grounds, and the felonies after lawyers argued the grand jury didn't have the authority to bring charges so different from their original mandate.\u003c/p>\n\u003cp>The new charges filed in California are different felony charges, tied to the act of recording. The state says it reviewed thousands of video files to try to identify the people Merritt and Daleiden are accused of recording without consent. They found 14 such people recorded in California in 2014 and 2015.\u003c/p>\n\u003cp>(The state of California has not named the people it identified. In 2015 Daleiden told NPR that he spent three years planning his sting video operation, recording hours of conversation with \"top-level Planned Parenthood executives, and doctors,\" among other people. )\u003c/p>\n\u003cp>The two activists each face 15 charges — one for each person they are accused of recording without permission, and one for conspiracy.\u003c/p>\n\u003cp>In California, you generally need the consent of everyone involved in order to legally record a private conversation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Here's more context from The Associated Press:\u003c/p>\n\u003cblockquote>\u003cp>\n\"In April of last year, Daleiden said in a Facebook post that California Department of Justice agents raided his home, seizing all of his video footage along with personal information.\u003c/p>\n\u003cp>\"Since then the case had gone largely quiet, with virtually no revelations about the investigation and no indication that the charges were coming before they were filed Tuesday in San Francisco Superior Court.\u003c/p>\n\u003cp>\"The case is one of the first of high-profile prosecutions for Becerra, who left the U.S. House to take over for Kamala Harris after she became a U.S. Senator.\"\u003c/p>\u003c/blockquote>\n\n",
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"excerpt": "The anti-abortion group ignited a controversy over fetal tissue research, but may have violated a state law prohibiting filming people without permission. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Two anti-abortion rights activists who covertly recorded themselves discussing fetal tissue with Planned Parenthood staff are facing felony charges in California, for allegedly violating state law by filming people without their permission.\u003c/p>\n\u003cp>California Attorney General Xavier Becerra announced the charges against David Daleiden and Sandra Merritt on Tuesday, saying the state \"will not tolerate the criminal recording of confidential conversations.\"\u003c/p>\n\u003cp>In a statement, Daleiden called the charges \"bogus\" and reiterated claims that Planned Parenthood has violated the law by selling fetal tissue — an allegation that has been investigated by more than a dozen states, none of which found evidence supporting Daleiden's claim.\u003c/p>\n\u003cp>Planned Parenthood, meanwhile, says it has \"has done nothing wrong, and the only people who broke the law are those behind the fraudulent tapes.\"\u003c/p>\n\u003cp>You may remember that in 2015, Daleiden's organization released a video of a Planned Parenthood official discussing how the organization provides fetal tissue to researchers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Daleiden claimed the video showed evidence that Planned Parenthood was selling that tissue, which would be illegal. Planned Parenthood said the footage was misleadingly edited and that the organization donates tissue following legal guidelines and with permitted reimbursements for expenses, which investigations have corroborated.\u003c/p>\n\u003cp>Last year, a grand jury in Texas was examining Daleiden's allegations. The grand jury determined there was no sign of criminal wrongdoing by Planned Parenthood.\u003c/p>\n\u003cp>Instead, in a surprise twist, it indicted Daleiden and Merritt on felony charges of using fake drivers licenses to gain access to a Planned Parenthood meeting. They also indicted Daleiden on misdemeanor charges of trying to buy human tissue — the kind of misconduct he was trying to pin on Planned Parenthood.\u003c/p>\n\u003cp>Those charges were dismissed: the misdemeanor on technical grounds, and the felonies after lawyers argued the grand jury didn't have the authority to bring charges so different from their original mandate.\u003c/p>\n\u003cp>The new charges filed in California are different felony charges, tied to the act of recording. The state says it reviewed thousands of video files to try to identify the people Merritt and Daleiden are accused of recording without consent. They found 14 such people recorded in California in 2014 and 2015.\u003c/p>\n\u003cp>(The state of California has not named the people it identified. In 2015 Daleiden told NPR that he spent three years planning his sting video operation, recording hours of conversation with \"top-level Planned Parenthood executives, and doctors,\" among other people. )\u003c/p>\n\u003cp>The two activists each face 15 charges — one for each person they are accused of recording without permission, and one for conspiracy.\u003c/p>\n\u003cp>In California, you generally need the consent of everyone involved in order to legally record a private conversation.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Here's more context from The Associated Press:\u003c/p>\n\u003cblockquote>\u003cp>\n\"In April of last year, Daleiden said in a Facebook post that California Department of Justice agents raided his home, seizing all of his video footage along with personal information.\u003c/p>\n\u003cp>\"Since then the case had gone largely quiet, with virtually no revelations about the investigation and no indication that the charges were coming before they were filed Tuesday in San Francisco Superior Court.\u003c/p>\n\u003cp>\"The case is one of the first of high-profile prosecutions for Becerra, who left the U.S. House to take over for Kamala Harris after she became a U.S. Senator.\"\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Reality Check: Trump's Claim That a Health Care Deal with Dems is 'Easy'",
"title": "Reality Check: Trump's Claim That a Health Care Deal with Dems is 'Easy'",
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"content": "\u003cp>The fallout from Friday's Republican health care bill collapse is still trying to be understood.\u003c/p>\n\u003cp>Right after the bill was pulled, President Trump teased that he wanted to work with Democrats and believed a bipartisan bill would be possible.\u003c/p>\n\u003cp>But it wasn't clear if that was just talk. On Tuesday night, he may have taken the first step to trying to reach across the aisle.\u003c/p>\n\u003cp>\"I know that we're all going to make a deal on health care, that's such an easy one,\" Trump told a bipartisan group of senators gathered at the White House. \"I have no doubt that's going to happen very quickly.\"\u003c/p>\n\u003cp>Speed is relative. The Trump-Paul Ryan health care bill was fast-tracked and collapsed in 17 days. It took President Obama more than a year to pass the Affordable Care Act, with more members of his own party in the Senate than Republicans have now.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We have all been promising it -- Democrat, Republican -- to the public,\" Trump said Tuesday night.\u003c/p>\n\u003cp>That's the rub for Republicans. Health care has been one of the most hotly partisan issues of the past decade. It has been \u003cem>the\u003c/em> issue that has animated Republican opposition to Obama. The prospect of repealing and replacing Obamacare has been so critical to Republican success, it is arguably responsible for hollowing out the Democratic Party.\u003c/p>\n\u003cp>Obama's focus on instituting the law gave the Tea Party a clear focus.\u003c/p>\n\u003cp>\"What brought everything together was the Obamacare idea, which contains every odiferous objection,\" Mark Williams of Tea Party Express told \u003ca href=\"http://www.cnn.com/2009/POLITICS/09/12/tea.party.rally/index.html?iref=nextin\">CNN\u003c/a> in August of 2009.\u003c/p>\n\u003cp>It was a staple of every Tea Party rally through that election cycle, so it is unlikely the GOP base shrugs its collective shoulders and moves on the way Trump promised to do Thursday and Friday -- and wait for Obamacare to \"explode.\"\u003c/p>\n\u003cp>Waiting for the law to fall apart puts Republicans in a terrible bind. Trump could get it left, right and center. If the Trump administration doesn't work as hard as it can to implement and administer the law, and you start seeing reporting from unnamed career officials verifying that, it very well could mean the Trump administration is blamed for harming real people's lives.\u003c/p>\n\u003cp>That would enrage not just Democrats, but independents and some Republicans.\u003c/p>\n\u003cp>If the Trump administration does administer the law the way the Obama administration did, the GOP base would likely be enraged, especially without a repeal-and-replace option. Is this what they voted for all these years?\u003c/p>\n\u003cp>\"We are going to be doing a great job,\" Trump added in his remarks to senators Tuesday night. \"Hopefully it will start being bipartisan, because everybody really wants the same thing. We want greatness for this country that we love.\"\u003c/p>\n\u003cp>But there is little muscle memory for anything bipartisan with this Congress. And there are challenges.\u003c/p>\n\u003cp>Democrats may be open to it, but Senate Minority Leader Chuck Schumer said only if repeal is off the table. Would Republicans in Congress be OK with that? Maybe some, but it's unlikely — and could cost Ryan his job as speaker if he doesn't have the majority of his conference and winds up working with Democrats.\u003c/p>\n\u003cp>Plus, congressional Republicans viewed Trump's election as their chance, finally, to enact sweeping changes with traditional Republican agenda items. They won't give that up easily.\u003c/p>\n\u003cp>\u003ca href=\"http://www.npr.org/2017/03/28/521800963/house-gop-says-health-care-fight-not-over-but-offers-no-path-forward\">NPR's Susan Davis noted\u003c/a> Tuesday that congressional Republicans are insisting they are closer now to passing health care than they were Friday and aren't giving up, reversing course on the tone Ryan took Friday that Obamacare is now \"the law of the land.\" But, as Davis put it:\u003c/p>\n\u003cblockquote>\n\u003cp>\"House Republicans' optimism that they could find a GOP-based solution to health care is undercut by comments this week by the White House and Senate Republicans who say any future health care legislation will likely require Democratic support — a tacit acknowledgement that repealing Obamacare is off the table.\"\u003c/p>\n\u003c/blockquote>\n\u003cp>Will Trump really force their hand on \"repair\"? So far, there's no real evidence of that. His whole presidency to this point has been bold appeals to his base, not reaching across the aisle.\u003c/p>\n\u003cp>What's more, would rank-and-file Republican voters be OK with it? They'd be skeptical, and it'd be up to Trump to make the sale — something he didn't do the first go-round with health care.\u003c/p>\n\u003cp>\"Bipartisanship\" is just an idea at this point. There is no discernible White House strategy for getting a bill through right now, and no evidence to suggest his team could shepherd it through.\u003c/p>\n\u003cp>Trump took a first step Tuesday night. He acknowledged Schumer, whom he \u003ca href=\"http://www.politico.com/story/2017/03/donald-trump-chuck-schumer-236603\">hasn't spoken with since\u003c/a> shortly after the inauguration.\u003c/p>\n\u003cp>\"I think we are going to have some very good relationships — right, Chuck?\" Trump said. \"I see Chuck. Hello, Chuck.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But, as the health care failure showed, legislating is a lot harder than talking. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Reality+Check+On+Trump+Calling+For+Bipartisanship+On+Health+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "The president told a bipartisan group of senators that there will be a deal on health care, saying it will \"happen very quickly.\" But it's hardly that easy.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The fallout from Friday's Republican health care bill collapse is still trying to be understood.\u003c/p>\n\u003cp>Right after the bill was pulled, President Trump teased that he wanted to work with Democrats and believed a bipartisan bill would be possible.\u003c/p>\n\u003cp>But it wasn't clear if that was just talk. On Tuesday night, he may have taken the first step to trying to reach across the aisle.\u003c/p>\n\u003cp>\"I know that we're all going to make a deal on health care, that's such an easy one,\" Trump told a bipartisan group of senators gathered at the White House. \"I have no doubt that's going to happen very quickly.\"\u003c/p>\n\u003cp>Speed is relative. The Trump-Paul Ryan health care bill was fast-tracked and collapsed in 17 days. It took President Obama more than a year to pass the Affordable Care Act, with more members of his own party in the Senate than Republicans have now.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We have all been promising it -- Democrat, Republican -- to the public,\" Trump said Tuesday night.\u003c/p>\n\u003cp>That's the rub for Republicans. Health care has been one of the most hotly partisan issues of the past decade. It has been \u003cem>the\u003c/em> issue that has animated Republican opposition to Obama. The prospect of repealing and replacing Obamacare has been so critical to Republican success, it is arguably responsible for hollowing out the Democratic Party.\u003c/p>\n\u003cp>Obama's focus on instituting the law gave the Tea Party a clear focus.\u003c/p>\n\u003cp>\"What brought everything together was the Obamacare idea, which contains every odiferous objection,\" Mark Williams of Tea Party Express told \u003ca href=\"http://www.cnn.com/2009/POLITICS/09/12/tea.party.rally/index.html?iref=nextin\">CNN\u003c/a> in August of 2009.\u003c/p>\n\u003cp>It was a staple of every Tea Party rally through that election cycle, so it is unlikely the GOP base shrugs its collective shoulders and moves on the way Trump promised to do Thursday and Friday -- and wait for Obamacare to \"explode.\"\u003c/p>\n\u003cp>Waiting for the law to fall apart puts Republicans in a terrible bind. Trump could get it left, right and center. If the Trump administration doesn't work as hard as it can to implement and administer the law, and you start seeing reporting from unnamed career officials verifying that, it very well could mean the Trump administration is blamed for harming real people's lives.\u003c/p>\n\u003cp>That would enrage not just Democrats, but independents and some Republicans.\u003c/p>\n\u003cp>If the Trump administration does administer the law the way the Obama administration did, the GOP base would likely be enraged, especially without a repeal-and-replace option. Is this what they voted for all these years?\u003c/p>\n\u003cp>\"We are going to be doing a great job,\" Trump added in his remarks to senators Tuesday night. \"Hopefully it will start being bipartisan, because everybody really wants the same thing. We want greatness for this country that we love.\"\u003c/p>\n\u003cp>But there is little muscle memory for anything bipartisan with this Congress. And there are challenges.\u003c/p>\n\u003cp>Democrats may be open to it, but Senate Minority Leader Chuck Schumer said only if repeal is off the table. Would Republicans in Congress be OK with that? Maybe some, but it's unlikely — and could cost Ryan his job as speaker if he doesn't have the majority of his conference and winds up working with Democrats.\u003c/p>\n\u003cp>Plus, congressional Republicans viewed Trump's election as their chance, finally, to enact sweeping changes with traditional Republican agenda items. They won't give that up easily.\u003c/p>\n\u003cp>\u003ca href=\"http://www.npr.org/2017/03/28/521800963/house-gop-says-health-care-fight-not-over-but-offers-no-path-forward\">NPR's Susan Davis noted\u003c/a> Tuesday that congressional Republicans are insisting they are closer now to passing health care than they were Friday and aren't giving up, reversing course on the tone Ryan took Friday that Obamacare is now \"the law of the land.\" But, as Davis put it:\u003c/p>\n\u003cblockquote>\n\u003cp>\"House Republicans' optimism that they could find a GOP-based solution to health care is undercut by comments this week by the White House and Senate Republicans who say any future health care legislation will likely require Democratic support — a tacit acknowledgement that repealing Obamacare is off the table.\"\u003c/p>\n\u003c/blockquote>\n\u003cp>Will Trump really force their hand on \"repair\"? So far, there's no real evidence of that. His whole presidency to this point has been bold appeals to his base, not reaching across the aisle.\u003c/p>\n\u003cp>What's more, would rank-and-file Republican voters be OK with it? They'd be skeptical, and it'd be up to Trump to make the sale — something he didn't do the first go-round with health care.\u003c/p>\n\u003cp>\"Bipartisanship\" is just an idea at this point. There is no discernible White House strategy for getting a bill through right now, and no evidence to suggest his team could shepherd it through.\u003c/p>\n\u003cp>Trump took a first step Tuesday night. He acknowledged Schumer, whom he \u003ca href=\"http://www.politico.com/story/2017/03/donald-trump-chuck-schumer-236603\">hasn't spoken with since\u003c/a> shortly after the inauguration.\u003c/p>\n\u003cp>\"I think we are going to have some very good relationships — right, Chuck?\" Trump said. \"I see Chuck. Hello, Chuck.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But, as the health care failure showed, legislating is a lot harder than talking. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Reality+Check+On+Trump+Calling+For+Bipartisanship+On+Health+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Fighting Children's Cavities in Chinatown: It Takes a Coalition",
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"content": "\u003cp>Sixteen years ago, city and school officials in San Francisco came together with dentists to figure out how to improve oral health in students. The program screens all San Francisco public school kindergartners for tooth decay.\u003c/p>\n\u003cp>A new report shows it’s working. Overall, children’s oral health in San Francisco is \u003ca href=\"http://assets.thehcn.net/content/sites/sanfrancisco/Final_document_Nov_2014_20141126111021.pdf\" target=\"_blank\">improving\u003c/a>: the citywide cavity rate has dropped almost ten percent since 2008. Among children of color, however, the improvements have been slower.\u003c/p>\n\u003cp>\"All children should be declining,” said Margaret Fisher, a dental hygienist with \u003ca href=\"https://www.sfdph.org/dph/comupg/oservices/medSvs/dentalSvcs/dentalSvcs.asp\" target=\"_blank\">San Francisco’s Department of Public Health\u003c/a>. “There should not be 25-20 percent of kids of a particular ethnicity having decay, whereas five percent of another group have decay,\" she says, referring to the disparity between kids of color and white kids.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/315095828\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Data from last year shows that Asians have the highest rate of tooth decay in the city, and the neighborhood with the highest rate is Chinatown.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That’s why the program has ramped up its efforts in and around Chinatown. In addition to screening kindergartners, most of these schools screen second and fifth graders too. The Department of Public Health also offers expanded access to free fluoride treatments and sealants. Volunteer dentists from the \u003ca href=\"https://www.sfds.org/\" target=\"_blank\">San Francisco Dental Society\u003c/a> lead the exams.\u003c/p>\n\u003cp>At Spring Valley Science Elementary School near Chinatown, it was screening day, and students waited for their turn to say “aaah!” The line snaked down the hallway. Students joked and fidgeted outside the multipurpose classroom where dentist Richard Choi perched on a tiny classroom chair, peering into mouth after mouth with a flashlight and tongue depressor. Sherry, a second-grader with straight black hair, stepped forward.\u003c/p>\n\u003cp>\"Open wide,\" Dr. Choi says, \"let me take a look up on top.\" He counted out loud how many fillings, cavities, and missing teeth Sherry had. A public health official sat across the table from Dr. Choi, logging the results.\u003c/p>\n\u003cp>Among other things, public health officials are concerned about children's teeth because poor oral health can affect a child’s diet, ability to concentrate and do well in school, and self-esteem.\u003c/p>\n\u003cp>Kent Woo runs the nonprofit \u003ca href=\"http://www.nicoschc.org/\" target=\"_blank\">NICOS Chinese Health Coalition\u003c/a>. It focuses on the health of San Francisco’s Chinese community.\u003c/p>\n\u003cp>He said Asian-Americans “are oftentimes thought of as a model minority, that we have no problems. We do well, regardless. And yet here is just a very glaring health disparity.\"\u003c/p>\n\u003cp>Woo and his colleagues are trying to understand the causes of that disparity in oral health. Recently, he met with other community health organizations that focus on San Francisco's Chinese residents, to hear results from a focus group that health worker Christina Nip ran.\u003c/p>\n\u003cp>Nip found that the participants, who all live in Chinatown, understood the importance of brushing, flossing, going to the dentist, and avoiding sugar. But she also discovered that they mostly waited to call a dentist after they had already developed a dental problem.\u003c/p>\n\u003cp>“Back in the home country there’s a lack of emphasis on oral health,” Nip said, referring to China.\u003c/p>\n\u003cp>The focus group members told her that even in a country that does emphasize preventative visits, it’s not easy to go to the dentist. It’s hard to find one within a specific insurance plan, especially one that may speak their language. For some, it can be prohibitively expensive. Some focus group participants expressed concern that a visit to the dentist for a very young child would be too scary for them.\u003c/p>\n\u003cp>Tap water was also a concern. \"Many of them actually are not comfortable drinking tap water,\" Nip said. That’s an issue because tap water contains fluoride, which has been shown to help prevent cavities.\u003c/p>\n\u003cp>Some said they have heard it's fine to drink tap water in San Francisco, but when they turn the water on, the water that emerges for a few moments is discolored.\u003c/p>\n\u003cp>Nip, Woo and their colleagues will use all this information to develop new messages and strategies. Some proposals include having doctors bring up oral health with new moms during post-partum check-ups, and and doing outreach at churches.\u003c/p>\n\u003cp>After the screening at Spring Valley, the children get a sticker reminding them to “brush, floss, smile.” Dr. Choi has screened 145 kids in less than four hours. Later in the week, a dental hygienist will come back to the school and apply free sealants to the teeth of children who need them.\u003c/p>\n\u003cp>Spring Valley’s principal, Marlene Callejas, praised the program. She recalled one student, newly arrived from Yemen, who was suffering from an infected cavity.\u003c/p>\n\u003cp>\"He wanted to spend time out of the class,\" Callejas said. \"He was crying, he couldn’t focus on paper that was in front of him, he was just in a lot of pain.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>After the student went to the dentist, Callejas said, things turned around. He could concentrate, and he started learning English faster.\u003c/p>\n\n",
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"excerpt": "Children's oral health is improving across San Francisco. But it's not improving as quickly for kids of color.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sixteen years ago, city and school officials in San Francisco came together with dentists to figure out how to improve oral health in students. The program screens all San Francisco public school kindergartners for tooth decay.\u003c/p>\n\u003cp>A new report shows it’s working. Overall, children’s oral health in San Francisco is \u003ca href=\"http://assets.thehcn.net/content/sites/sanfrancisco/Final_document_Nov_2014_20141126111021.pdf\" target=\"_blank\">improving\u003c/a>: the citywide cavity rate has dropped almost ten percent since 2008. Among children of color, however, the improvements have been slower.\u003c/p>\n\u003cp>\"All children should be declining,” said Margaret Fisher, a dental hygienist with \u003ca href=\"https://www.sfdph.org/dph/comupg/oservices/medSvs/dentalSvcs/dentalSvcs.asp\" target=\"_blank\">San Francisco’s Department of Public Health\u003c/a>. “There should not be 25-20 percent of kids of a particular ethnicity having decay, whereas five percent of another group have decay,\" she says, referring to the disparity between kids of color and white kids.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/315095828&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/315095828'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Data from last year shows that Asians have the highest rate of tooth decay in the city, and the neighborhood with the highest rate is Chinatown.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That’s why the program has ramped up its efforts in and around Chinatown. In addition to screening kindergartners, most of these schools screen second and fifth graders too. The Department of Public Health also offers expanded access to free fluoride treatments and sealants. Volunteer dentists from the \u003ca href=\"https://www.sfds.org/\" target=\"_blank\">San Francisco Dental Society\u003c/a> lead the exams.\u003c/p>\n\u003cp>At Spring Valley Science Elementary School near Chinatown, it was screening day, and students waited for their turn to say “aaah!” The line snaked down the hallway. Students joked and fidgeted outside the multipurpose classroom where dentist Richard Choi perched on a tiny classroom chair, peering into mouth after mouth with a flashlight and tongue depressor. Sherry, a second-grader with straight black hair, stepped forward.\u003c/p>\n\u003cp>\"Open wide,\" Dr. Choi says, \"let me take a look up on top.\" He counted out loud how many fillings, cavities, and missing teeth Sherry had. A public health official sat across the table from Dr. Choi, logging the results.\u003c/p>\n\u003cp>Among other things, public health officials are concerned about children's teeth because poor oral health can affect a child’s diet, ability to concentrate and do well in school, and self-esteem.\u003c/p>\n\u003cp>Kent Woo runs the nonprofit \u003ca href=\"http://www.nicoschc.org/\" target=\"_blank\">NICOS Chinese Health Coalition\u003c/a>. It focuses on the health of San Francisco’s Chinese community.\u003c/p>\n\u003cp>He said Asian-Americans “are oftentimes thought of as a model minority, that we have no problems. We do well, regardless. And yet here is just a very glaring health disparity.\"\u003c/p>\n\u003cp>Woo and his colleagues are trying to understand the causes of that disparity in oral health. Recently, he met with other community health organizations that focus on San Francisco's Chinese residents, to hear results from a focus group that health worker Christina Nip ran.\u003c/p>\n\u003cp>Nip found that the participants, who all live in Chinatown, understood the importance of brushing, flossing, going to the dentist, and avoiding sugar. But she also discovered that they mostly waited to call a dentist after they had already developed a dental problem.\u003c/p>\n\u003cp>“Back in the home country there’s a lack of emphasis on oral health,” Nip said, referring to China.\u003c/p>\n\u003cp>The focus group members told her that even in a country that does emphasize preventative visits, it’s not easy to go to the dentist. It’s hard to find one within a specific insurance plan, especially one that may speak their language. For some, it can be prohibitively expensive. Some focus group participants expressed concern that a visit to the dentist for a very young child would be too scary for them.\u003c/p>\n\u003cp>Tap water was also a concern. \"Many of them actually are not comfortable drinking tap water,\" Nip said. That’s an issue because tap water contains fluoride, which has been shown to help prevent cavities.\u003c/p>\n\u003cp>Some said they have heard it's fine to drink tap water in San Francisco, but when they turn the water on, the water that emerges for a few moments is discolored.\u003c/p>\n\u003cp>Nip, Woo and their colleagues will use all this information to develop new messages and strategies. Some proposals include having doctors bring up oral health with new moms during post-partum check-ups, and and doing outreach at churches.\u003c/p>\n\u003cp>After the screening at Spring Valley, the children get a sticker reminding them to “brush, floss, smile.” Dr. Choi has screened 145 kids in less than four hours. Later in the week, a dental hygienist will come back to the school and apply free sealants to the teeth of children who need them.\u003c/p>\n\u003cp>Spring Valley’s principal, Marlene Callejas, praised the program. She recalled one student, newly arrived from Yemen, who was suffering from an infected cavity.\u003c/p>\n\u003cp>\"He wanted to spend time out of the class,\" Callejas said. \"He was crying, he couldn’t focus on paper that was in front of him, he was just in a lot of pain.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>After the student went to the dentist, Callejas said, things turned around. He could concentrate, and he started learning English faster.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Wearing white coats and surgical scrubs, a small group of political activists passed out pink fliers in downtown Oakland Wednesday. They wore toy stethoscopes and shiny, circular mirrors on their heads.\u003c/p>\n\u003cp>They're not really doctors, but they dressed the part to grab the attention of pedestrians and warn them about the political efforts to dismantle the Affordable Care Act. Since 2014, that law has provided five million previously uninsured Californians with coverage. The state's uninsured rate is now at a historical low of 7 percent.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/314153621\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>House Representatives, riven by political differences, have delayed a planned vote on the Republican health care bill until Friday. Their bill, the American Health Care Act (AHCA), has pushed these \u003ca href=\"https://bayresistance.org/\" target=\"_blank\">Bay Area activists\u003c/a> to get creative, and this \"Pop-Up Emergency Room\" on the sidewalk is one way of highlighting the fact that the bill would \u003cem>increase\u003c/em> the number of uninsured Americans by 24 million.\u003c/p>\n\u003cp>[gallery type=\"rectangular\" ids=\"307654,307652,307655,307649,307733\"]\u003c/p>\n\u003cp>Cindy Shamban of Berkeley wore her white coat draped over another, darker-colored coat.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"That’s part of the skit,\" she said. \"Dress up, have a little bit of fun with it, at the same time we know that we’re dealing with, you know, people’s lives.\"\u003c/p>\n\u003cp>Nearby, Monique Harris had propped a sign against her wheelchair. It read, “Losing Medi-Cal means being forced into an expensive nursing home. No more living at home.”\u003c/p>\n\u003cp>Harris has spastic cerebral palsy and is concerned about the bill's proposed funding cuts to Medi-Cal. Medi-Cal is taxpayer-funded insurance that covers low-income adults, people with disabilities, and nursing home residents.\u003c/p>\n\u003cp>\"Both me and my son receive it,\" she said. \"As well as many other people.\" Harris said Medi-Cal pays for essential equipment and treatments for her and her son. \"He has seizures and diabetes,\" she explained.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A forecast released this week by Sacramento officials estimates the adoption of the GOP-backed AHCA would blow a $6 billion hole in the California budget starting in 2020. As demand on the health system grows, the loss of federal funds to California would eventually reach $24 billion annually in 2027.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Wearing white coats and surgical scrubs, a small group of political activists passed out pink fliers in downtown Oakland Wednesday. They wore toy stethoscopes and shiny, circular mirrors on their heads.\u003c/p>\n\u003cp>They're not really doctors, but they dressed the part to grab the attention of pedestrians and warn them about the political efforts to dismantle the Affordable Care Act. Since 2014, that law has provided five million previously uninsured Californians with coverage. The state's uninsured rate is now at a historical low of 7 percent.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/314153621&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/314153621'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>House Representatives, riven by political differences, have delayed a planned vote on the Republican health care bill until Friday. Their bill, the American Health Care Act (AHCA), has pushed these \u003ca href=\"https://bayresistance.org/\" target=\"_blank\">Bay Area activists\u003c/a> to get creative, and this \"Pop-Up Emergency Room\" on the sidewalk is one way of highlighting the fact that the bill would \u003cem>increase\u003c/em> the number of uninsured Americans by 24 million.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"That’s part of the skit,\" she said. \"Dress up, have a little bit of fun with it, at the same time we know that we’re dealing with, you know, people’s lives.\"\u003c/p>\n\u003cp>Nearby, Monique Harris had propped a sign against her wheelchair. It read, “Losing Medi-Cal means being forced into an expensive nursing home. No more living at home.”\u003c/p>\n\u003cp>Harris has spastic cerebral palsy and is concerned about the bill's proposed funding cuts to Medi-Cal. Medi-Cal is taxpayer-funded insurance that covers low-income adults, people with disabilities, and nursing home residents.\u003c/p>\n\u003cp>\"Both me and my son receive it,\" she said. \"As well as many other people.\" Harris said Medi-Cal pays for essential equipment and treatments for her and her son. \"He has seizures and diabetes,\" she explained.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A forecast released this week by Sacramento officials estimates the adoption of the GOP-backed AHCA would blow a $6 billion hole in the California budget starting in 2020. As demand on the health system grows, the loss of federal funds to California would eventually reach $24 billion annually in 2027.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California would lose $24.3 billion in federal funding by 2027 for low-income health coverage under the current Republican plan to replace the Affordable Care Act, according to \u003ca href=\"https://www.gov.ca.gov/docs/3.21.17_AHCA_Fiscal_Analysis.pdf\" target=\"_blank\">a new state analysis\u003c/a> released Wednesday.\u003c/p>\n\u003cp>The bill, up for a vote in the House on Thursday, represents a “massive and significant fiscal shift” from the federal to state governments by setting caps on spending, reducing the amount of money available for new enrollees and eliminating other funding for hospitals and Planned Parenthood, the analysis said. The analysis, based on internal cost, utilization and enrollment data, was sent Tuesday to the state’s secretary of Health and Human Services.\u003c/p>\n\u003cp>“It’s really devastating,” said Mari Cantwell, state Medicaid director with the California Department of Health Care Services, who co-wrote the analysis. “It raises some serious questions about whether we can continue to operate the program the way we do today.”\u003c/p>\n\u003cp>Although the analysis didn’t explain how the state would deal with the federal cuts, Cantwell said it would have to look at changes to eligibility, benefits or provider rates — or all three.\u003c/p>\n\u003cp>The Republican bill, called the American Health Care Act, would dramatically change funding for the Medicaid program, known as Medi-Cal in California. Since its inception, Medicaid funding has been open-ended, based on need. Under the new bill, federal money would be capped either through block grants or fixed per-capita amounts.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Medi-Cal provides coverage to 13.5 million low-income residents, about half of California’s children and a third of the adults. About 3.7 million people of those became newly eligible for the publicly funded health coverage through the Affordable Care Act, helping to reduce the state’s uninsurance rate from 17 percent in 2013 to about 7 percent in 2016, according to the \u003ca href=\"http://laborcenter.berkeley.edu/medi-cal-expansion-under-ahca/\" target=\"_blank\">UC Berkeley Labor Center for Education and Research\u003c/a>.\u003c/p>\n\u003cp>The public insurance program is funded jointly by California and the federal government and provides health, dental, mental health, long-term care and other services. The Affordable Care Act allowed states to expand their Medicaid programs in 2014 to low-income childless adults, and the federal government is paying nearly all the costs for those new beneficiaries.\u003c/p>\n\u003cp>The bill could put hospitals, clinics and other providers in a tenuous financial position by forcing them to live within the cost limits while at the same time seeing more uninsured patients, the analysis said.\u003c/p>\n\u003cp>California health officials said they estimated that Medi-Cal costs would exceed per-capita caps by nearly $680 million in 2020, with the gap growing to $5.28 billion by 2027. That spending limit could have a “devastating and chilling effect” on any increases in provider payments or plan rates, according to the analysis.\u003c/p>\n\u003cp>The state also expects an additional $3.3 billion in costs in 2020, growing to $13 billion by 2027, because of a change that reduces federal funds for new enrollees and for people who have a break in coverage. The bill would require certain beneficiaries to renew coverage every six months rather than once a year, which state officials say will cause many to lose their coverage.\u003c/p>\n\u003cp>According to the analysis, the state would face additional costs from other federal cuts, including to a program that pays for in-home care for elderly and disabled residents. In addition, the proposed freeze on federal funding to organizations that provide abortions would make the state responsible for $400 million in payments to Planned Parenthood, which serves more than 600,000 people in Medi-Cal and a state family planning program.\u003c/p>\n\u003cp>A new study by UC Berkeley’s Labor Center released Wednesday also warned of dramatic cuts in federal Medi-Cal funding that would threaten coverage for low-income adults. The center estimated that the state would have to increase spending by $10 billion each year to maintain coverage for those who became eligible for coverage under the Affordable Care Act. Without that funding, the researchers wrote, 3.7 million people could lose coverage by 2027.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California would lose $24.3 billion in federal funding by 2027 for low-income health coverage under the current Republican plan to replace the Affordable Care Act, according to \u003ca href=\"https://www.gov.ca.gov/docs/3.21.17_AHCA_Fiscal_Analysis.pdf\" target=\"_blank\">a new state analysis\u003c/a> released Wednesday.\u003c/p>\n\u003cp>The bill, up for a vote in the House on Thursday, represents a “massive and significant fiscal shift” from the federal to state governments by setting caps on spending, reducing the amount of money available for new enrollees and eliminating other funding for hospitals and Planned Parenthood, the analysis said. The analysis, based on internal cost, utilization and enrollment data, was sent Tuesday to the state’s secretary of Health and Human Services.\u003c/p>\n\u003cp>“It’s really devastating,” said Mari Cantwell, state Medicaid director with the California Department of Health Care Services, who co-wrote the analysis. “It raises some serious questions about whether we can continue to operate the program the way we do today.”\u003c/p>\n\u003cp>Although the analysis didn’t explain how the state would deal with the federal cuts, Cantwell said it would have to look at changes to eligibility, benefits or provider rates — or all three.\u003c/p>\n\u003cp>The Republican bill, called the American Health Care Act, would dramatically change funding for the Medicaid program, known as Medi-Cal in California. Since its inception, Medicaid funding has been open-ended, based on need. Under the new bill, federal money would be capped either through block grants or fixed per-capita amounts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Medi-Cal provides coverage to 13.5 million low-income residents, about half of California’s children and a third of the adults. About 3.7 million people of those became newly eligible for the publicly funded health coverage through the Affordable Care Act, helping to reduce the state’s uninsurance rate from 17 percent in 2013 to about 7 percent in 2016, according to the \u003ca href=\"http://laborcenter.berkeley.edu/medi-cal-expansion-under-ahca/\" target=\"_blank\">UC Berkeley Labor Center for Education and Research\u003c/a>.\u003c/p>\n\u003cp>The public insurance program is funded jointly by California and the federal government and provides health, dental, mental health, long-term care and other services. The Affordable Care Act allowed states to expand their Medicaid programs in 2014 to low-income childless adults, and the federal government is paying nearly all the costs for those new beneficiaries.\u003c/p>\n\u003cp>The bill could put hospitals, clinics and other providers in a tenuous financial position by forcing them to live within the cost limits while at the same time seeing more uninsured patients, the analysis said.\u003c/p>\n\u003cp>California health officials said they estimated that Medi-Cal costs would exceed per-capita caps by nearly $680 million in 2020, with the gap growing to $5.28 billion by 2027. That spending limit could have a “devastating and chilling effect” on any increases in provider payments or plan rates, according to the analysis.\u003c/p>\n\u003cp>The state also expects an additional $3.3 billion in costs in 2020, growing to $13 billion by 2027, because of a change that reduces federal funds for new enrollees and for people who have a break in coverage. The bill would require certain beneficiaries to renew coverage every six months rather than once a year, which state officials say will cause many to lose their coverage.\u003c/p>\n\u003cp>According to the analysis, the state would face additional costs from other federal cuts, including to a program that pays for in-home care for elderly and disabled residents. In addition, the proposed freeze on federal funding to organizations that provide abortions would make the state responsible for $400 million in payments to Planned Parenthood, which serves more than 600,000 people in Medi-Cal and a state family planning program.\u003c/p>\n\u003cp>A new study by UC Berkeley’s Labor Center released Wednesday also warned of dramatic cuts in federal Medi-Cal funding that would threaten coverage for low-income adults. The center estimated that the state would have to increase spending by $10 billion each year to maintain coverage for those who became eligible for coverage under the Affordable Care Act. Without that funding, the researchers wrote, 3.7 million people could lose coverage by 2027.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The Affordable Care Act's tax penalty for people who opt out of health insurance is one of the most loathed parts of the law, so it is no surprise that Republicans are keen to abolish it. But the penalty, also called \u003ca href=\"https://www.healthcare.gov/fees/fee-for-not-being-covered/\">the individual mandate\u003c/a>, plays a vital function: nudging healthy people into the insurance markets, where their premiums help pay for the cost of care for the sick. Republican lawmakers think they have a better alternative.\u003c/p>\n\u003cp>The GOP approach is called a \"continuous coverage\" penalty. It increases the cost of the premiums for anyone buying an individual insurance policy if they have gone 63 or more consecutive days without health insurance in the previous 12 months. Their monthly premiums would rise by 30 percent, and that surcharge would last for a year. While Obamacare assesses a fine for each year people don't buy insurance, the GOP plan would punish those who decide to purchase health insurance for the first time ever, or after a lapse.\u003c/p>\n\u003cp>Much is at stake. If the GOP approach fails to prod enough healthy people into buying insurance, rates for everyone else in the insurance pool will rise — destabilizing promises by President Donald Trump and GOP leaders to make their Obamacare replacement more affordable.\u003c/p>\n\u003cp>The nonpartisan Congressional Budget Office \u003ca href=\"https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf\">projects\u003c/a> that millions fewer people will buy insurance if the individual mandate is repealed and replaced with a continuous coverage surcharge.\u003c/p>\n\u003cp>\u003cstrong>Why do people allow their insurance to lapse?\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some consumers, like Sheila Swartz, who lives outside Nashville, Tenn., and works as a house cleaner, simply can't afford the premiums. She and her husband, Don, who has a heart condition, dropped their policy in December after learning monthly premiums were going to increase by about $140 to $530.\u003c/p>\n\u003cp>\"You can't get blood out of a turnip,\" Swartz said. \"If you can't afford that premium, you can't afford that premium.\"\u003c/p>\n\u003cp>Others stop paying premiums when they lose a job or are hit with unexpected costs in other areas, such as major repairs to a car or home.\u003c/p>\n\u003cp>If you find yourself having to choose between paying rent versus health insurance, \"you are probably not going to choose health insurance,\" said \u003ca href=\"https://twitter.com/benefitscafe\">Bruce Jugan\u003c/a>, a health insurance broker in Montebello, Calif.\u003c/p>\n\u003cp>Some people try to game the system, taking the calculated risk of going without insurance until they get sick or know they need expensive medical care — such as to cover the costs pregnancy and childbirth, or an elective surgery.\u003c/p>\n\u003cp>Both the Affordable Care Act and the GOP proposal include a deterrent by restricting people from enrolling anytime they want. Instead, applicants must wait for annual enrollment periods, usually in the final weeks of the year, meaning that some people might have to wait months before getting coverage. (Applicants still can get insurance during \u003ca href=\"https://www.healthcare.gov/blog/special-enrollment-period/\">special enrollment periods\u003c/a> if they lose a job, get divorced or have another specified major life change.)\u003c/p>\n\u003cp>\u003cstrong>How tough is the GOP penalty compared with the individual mandate?\u003c/strong>\u003c/p>\n\u003cp>Under the ACA, the average individual mandate penalty in 2015 \u003ca href=\"http://taxpayeradvocate.irs.gov/Media/Default/Documents/2017-JRC/2016_filing_season_review.pdf\" target=\"_blank\">was $442\u003c/a>, according to the Internal Revenue Service. The GOP penalty would vary, based on cost of premiums, but generally would be more expensive than paying the mandate's penalty. A 40-year-old with annual premiums of $4,328 would pay an extra $1,298 because of the GOP surcharge.\u003c/p>\n\u003cp>\"It's got teeth,\" said \u003ca href=\"http://www.rand.org/about/people/d/damberg_cheryl_l.html\">Cheryl Damberg\u003c/a>, a RAND Corp. economist. \"In some ways, it's a more punishing penalty, and it's going to hit people who are least capable of financially affording it.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.law.uh.edu/faculty/main.asp?PID=6\">Seth Chandler\u003c/a>, a law professor at the University of Houston Law Center, who has been critical of the Affordable Care Act's insurance markets, said he is skeptical the GOP surcharge is high enough to make people enroll.\u003c/p>\n\u003cp>\"I am concerned that the Republicans are succumbing to the same softness of heart as the Democrats succumbed too when they set the individual mandate [penalty],\" he said. \"If you start to see insurance companies object or drop out of the markets, that's a sign this thing is miscalculated.\"\u003c/p>\n\u003cp>Two conservative economists at the American Enterprise Institute, \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\">Joseph Antos\u003c/a> and\u003ca href=\"http://www.aei.org/scholar/james-c-capretta/\"> James Capretta\u003c/a>, see the penalty as \"far too small\" to be effective. \"Healthy consumers are likely to take their chances,\" \u003ca href=\"http://healthaffairs.org/blog/2017/03/10/republicans-should-take-the-time-necessary-to-improve-the-american-health-care-act/\">they wrote\u003c/a> in this month's issue of Health Affairs Blog. \"With the repeal of the individual mandate, and the retention of the ACA's insurance rules, the overall effect would be significant market turbulence, starting immediately in 2017.\"\u003c/p>\n\u003cp>The \u003ca href=\"https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf\">CBO has predicted\u003c/a> there would be a brief increase in the number of people holding insurance in 2018, under the GOP plan, as roughly 1 million people buy coverage to avoid the surcharge. In most years afterward, however, about 2 million fewer people would be expected to buy policies, either because of the surcharge or because of the requirement that they provide documentation proving they've been insured. The CBO predicted that healthy people in particular would be more likely to avoid buying policies.\u003c/p>\n\u003cp>The plan has some parallels to Medicare's late-enrollment penalty, which is applied to premiums for people who don't sign up when they turn 65. But \u003ca href=\"https://www.milbank.org/?staff-member=christopher-f-koller\">Christopher Koller\u003c/a>, a former Rhode Island health insurance commissioner, doubts the GOP penalty would be as effective.\u003c/p>\n\u003cp>\"Medicare is an entitlement with the force of government behind it,\" said Koller, now president of the \u003ca href=\"https://www.milbank.org/about/\">Milbank Memorial Fund\u003c/a>, a foundation in New York that does health policy analysis. \"You get lots of notices about what your obligations are as you approach that age.\"\u003c/p>\n\u003cp>\u003cstrong>What about people who can't afford premiums?\u003c/strong>\u003c/p>\n\u003cp>The GOP surcharge would contain no hardship exemptions, \u003ca href=\"https://www.healthcare.gov/health-coverage-exemptions/hardship-exemptions/\">unlike the individual mandate\u003c/a>, which allows people to escape paying a penalty if premiums would eat up too much of their income (8.16 percent in 2017).\u003c/p>\n\u003cp>In 2015, 5.6 million people paid the individual mandate penalty, but another 11 million claimed a hardship exemption, according to the IRS.\u003c/p>\n\u003cp>Lower-income people are going to have even more trouble buying — and keeping — coverage under the GOP plan, health care analysts said. The ACA's subsidies to help pay monthly premiums are based on income, and millions of people on the poorer end of the spectrum do not have to pay anything toward their premiums if they choose the cheapest plan. The GOP plan, on the other hand, would offer a flat tax credit that adjusts only for age. The penalties would make some people even more reluctant to buy insurance — especially if they are relatively healthy.\u003c/p>\n\u003cp>\"I think we would just end up with a lot more uninsured people, and they would clearly be the type of people who are less able to navigate [the insurance system] and less able to afford insurance,\" said \u003ca href=\"http://healthpolicy.usc.edu/ListItem.aspx?ID=6\">Geoffrey Joyce\u003c/a>, director of health policy for the University of Southern California Schaeffer Center for Health Policy & Economics.\u003c/p>\n\u003cp>Republican lawmakers have said their plan rightly places the responsibility on individuals. That's a view shared by some health insurance brokers, including \u003ca href=\"http://ruffinsolutions.com/about/helena-ruffin-company-president/\">Helena Ruffin\u003c/a>, president of the Ruffin Group Insurance Services in Playa Vista, Calif. A continuous coverage requirement would \"limit those people who are not playing by the rules,\" she said.\u003c/p>\n\u003cp>\"I am favor of the penalties,\" said Ruffin. \"Whether or not people are going to pay attention is another story.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation. \u003c/em>\u003c/em>\u003cem>\u003ca href=\"http://khn.org/news/author/jordan-rau/\">Jordan Rau\u003c/a> \u003c/em>\u003cem>and\u003c/em>\u003cem> \u003ca href=\"http://khn.org/news/author/anna-gorman/\">Anna Gorman\u003c/a>\u003c/em>\u003cem> are senior correspondent for KHN.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Health+Plan+Has+Its+Own+Financial+Stick+To+Prod+People+To+Buy+Insurance&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "The GOP plan would fine insurance buyers who had a lapse in coverage of more than 63 days a year. The penalty? A 30 percent surcharge every month for 12 months.",
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"description": "The GOP plan would fine insurance buyers who had a lapse in coverage of more than 63 days a year. The penalty? A 30 percent surcharge every month for 12 months.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Affordable Care Act's tax penalty for people who opt out of health insurance is one of the most loathed parts of the law, so it is no surprise that Republicans are keen to abolish it. But the penalty, also called \u003ca href=\"https://www.healthcare.gov/fees/fee-for-not-being-covered/\">the individual mandate\u003c/a>, plays a vital function: nudging healthy people into the insurance markets, where their premiums help pay for the cost of care for the sick. Republican lawmakers think they have a better alternative.\u003c/p>\n\u003cp>The GOP approach is called a \"continuous coverage\" penalty. It increases the cost of the premiums for anyone buying an individual insurance policy if they have gone 63 or more consecutive days without health insurance in the previous 12 months. Their monthly premiums would rise by 30 percent, and that surcharge would last for a year. While Obamacare assesses a fine for each year people don't buy insurance, the GOP plan would punish those who decide to purchase health insurance for the first time ever, or after a lapse.\u003c/p>\n\u003cp>Much is at stake. If the GOP approach fails to prod enough healthy people into buying insurance, rates for everyone else in the insurance pool will rise — destabilizing promises by President Donald Trump and GOP leaders to make their Obamacare replacement more affordable.\u003c/p>\n\u003cp>The nonpartisan Congressional Budget Office \u003ca href=\"https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf\">projects\u003c/a> that millions fewer people will buy insurance if the individual mandate is repealed and replaced with a continuous coverage surcharge.\u003c/p>\n\u003cp>\u003cstrong>Why do people allow their insurance to lapse?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some consumers, like Sheila Swartz, who lives outside Nashville, Tenn., and works as a house cleaner, simply can't afford the premiums. She and her husband, Don, who has a heart condition, dropped their policy in December after learning monthly premiums were going to increase by about $140 to $530.\u003c/p>\n\u003cp>\"You can't get blood out of a turnip,\" Swartz said. \"If you can't afford that premium, you can't afford that premium.\"\u003c/p>\n\u003cp>Others stop paying premiums when they lose a job or are hit with unexpected costs in other areas, such as major repairs to a car or home.\u003c/p>\n\u003cp>If you find yourself having to choose between paying rent versus health insurance, \"you are probably not going to choose health insurance,\" said \u003ca href=\"https://twitter.com/benefitscafe\">Bruce Jugan\u003c/a>, a health insurance broker in Montebello, Calif.\u003c/p>\n\u003cp>Some people try to game the system, taking the calculated risk of going without insurance until they get sick or know they need expensive medical care — such as to cover the costs pregnancy and childbirth, or an elective surgery.\u003c/p>\n\u003cp>Both the Affordable Care Act and the GOP proposal include a deterrent by restricting people from enrolling anytime they want. Instead, applicants must wait for annual enrollment periods, usually in the final weeks of the year, meaning that some people might have to wait months before getting coverage. (Applicants still can get insurance during \u003ca href=\"https://www.healthcare.gov/blog/special-enrollment-period/\">special enrollment periods\u003c/a> if they lose a job, get divorced or have another specified major life change.)\u003c/p>\n\u003cp>\u003cstrong>How tough is the GOP penalty compared with the individual mandate?\u003c/strong>\u003c/p>\n\u003cp>Under the ACA, the average individual mandate penalty in 2015 \u003ca href=\"http://taxpayeradvocate.irs.gov/Media/Default/Documents/2017-JRC/2016_filing_season_review.pdf\" target=\"_blank\">was $442\u003c/a>, according to the Internal Revenue Service. The GOP penalty would vary, based on cost of premiums, but generally would be more expensive than paying the mandate's penalty. A 40-year-old with annual premiums of $4,328 would pay an extra $1,298 because of the GOP surcharge.\u003c/p>\n\u003cp>\"It's got teeth,\" said \u003ca href=\"http://www.rand.org/about/people/d/damberg_cheryl_l.html\">Cheryl Damberg\u003c/a>, a RAND Corp. economist. \"In some ways, it's a more punishing penalty, and it's going to hit people who are least capable of financially affording it.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.law.uh.edu/faculty/main.asp?PID=6\">Seth Chandler\u003c/a>, a law professor at the University of Houston Law Center, who has been critical of the Affordable Care Act's insurance markets, said he is skeptical the GOP surcharge is high enough to make people enroll.\u003c/p>\n\u003cp>\"I am concerned that the Republicans are succumbing to the same softness of heart as the Democrats succumbed too when they set the individual mandate [penalty],\" he said. \"If you start to see insurance companies object or drop out of the markets, that's a sign this thing is miscalculated.\"\u003c/p>\n\u003cp>Two conservative economists at the American Enterprise Institute, \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\">Joseph Antos\u003c/a> and\u003ca href=\"http://www.aei.org/scholar/james-c-capretta/\"> James Capretta\u003c/a>, see the penalty as \"far too small\" to be effective. \"Healthy consumers are likely to take their chances,\" \u003ca href=\"http://healthaffairs.org/blog/2017/03/10/republicans-should-take-the-time-necessary-to-improve-the-american-health-care-act/\">they wrote\u003c/a> in this month's issue of Health Affairs Blog. \"With the repeal of the individual mandate, and the retention of the ACA's insurance rules, the overall effect would be significant market turbulence, starting immediately in 2017.\"\u003c/p>\n\u003cp>The \u003ca href=\"https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf\">CBO has predicted\u003c/a> there would be a brief increase in the number of people holding insurance in 2018, under the GOP plan, as roughly 1 million people buy coverage to avoid the surcharge. In most years afterward, however, about 2 million fewer people would be expected to buy policies, either because of the surcharge or because of the requirement that they provide documentation proving they've been insured. The CBO predicted that healthy people in particular would be more likely to avoid buying policies.\u003c/p>\n\u003cp>The plan has some parallels to Medicare's late-enrollment penalty, which is applied to premiums for people who don't sign up when they turn 65. But \u003ca href=\"https://www.milbank.org/?staff-member=christopher-f-koller\">Christopher Koller\u003c/a>, a former Rhode Island health insurance commissioner, doubts the GOP penalty would be as effective.\u003c/p>\n\u003cp>\"Medicare is an entitlement with the force of government behind it,\" said Koller, now president of the \u003ca href=\"https://www.milbank.org/about/\">Milbank Memorial Fund\u003c/a>, a foundation in New York that does health policy analysis. \"You get lots of notices about what your obligations are as you approach that age.\"\u003c/p>\n\u003cp>\u003cstrong>What about people who can't afford premiums?\u003c/strong>\u003c/p>\n\u003cp>The GOP surcharge would contain no hardship exemptions, \u003ca href=\"https://www.healthcare.gov/health-coverage-exemptions/hardship-exemptions/\">unlike the individual mandate\u003c/a>, which allows people to escape paying a penalty if premiums would eat up too much of their income (8.16 percent in 2017).\u003c/p>\n\u003cp>In 2015, 5.6 million people paid the individual mandate penalty, but another 11 million claimed a hardship exemption, according to the IRS.\u003c/p>\n\u003cp>Lower-income people are going to have even more trouble buying — and keeping — coverage under the GOP plan, health care analysts said. The ACA's subsidies to help pay monthly premiums are based on income, and millions of people on the poorer end of the spectrum do not have to pay anything toward their premiums if they choose the cheapest plan. The GOP plan, on the other hand, would offer a flat tax credit that adjusts only for age. The penalties would make some people even more reluctant to buy insurance — especially if they are relatively healthy.\u003c/p>\n\u003cp>\"I think we would just end up with a lot more uninsured people, and they would clearly be the type of people who are less able to navigate [the insurance system] and less able to afford insurance,\" said \u003ca href=\"http://healthpolicy.usc.edu/ListItem.aspx?ID=6\">Geoffrey Joyce\u003c/a>, director of health policy for the University of Southern California Schaeffer Center for Health Policy & Economics.\u003c/p>\n\u003cp>Republican lawmakers have said their plan rightly places the responsibility on individuals. That's a view shared by some health insurance brokers, including \u003ca href=\"http://ruffinsolutions.com/about/helena-ruffin-company-president/\">Helena Ruffin\u003c/a>, president of the Ruffin Group Insurance Services in Playa Vista, Calif. A continuous coverage requirement would \"limit those people who are not playing by the rules,\" she said.\u003c/p>\n\u003cp>\"I am favor of the penalties,\" said Ruffin. \"Whether or not people are going to pay attention is another story.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://khn.org/\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation. \u003c/em>\u003c/em>\u003cem>\u003ca href=\"http://khn.org/news/author/jordan-rau/\">Jordan Rau\u003c/a> \u003c/em>\u003cem>and\u003c/em>\u003cem> \u003ca href=\"http://khn.org/news/author/anna-gorman/\">Anna Gorman\u003c/a>\u003c/em>\u003cem> are senior correspondent for KHN.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Health+Plan+Has+Its+Own+Financial+Stick+To+Prod+People+To+Buy+Insurance&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Ignored by Obamacare, Vasectomies Find a Champion in 'March Madness' Marketing",
"title": "Ignored by Obamacare, Vasectomies Find a Champion in 'March Madness' Marketing",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Doctors say it all started eight years ago, when a urology clinic in Oregon ran \u003ca href=\"https://www.youtube.com/watch?v=_fpfMtRIdKM\" target=\"_blank\">an ad\u003c/a> promoting the benefits of scheduling a vasectomy in March.\u003c/p>\n\u003cp>“You go in for a little snip, snip and come out with doctor's orders to sit back and watch nonstop basketball,” the voice-over promises. “If you miss out on this, you’ll end up recovering during a weekend marathon of \u003cem>Desperate Housewives\u003c/em>!”\u003c/p>\n\u003cp>Copycat ads followed. Now a \u003ca href=\"http://washington.cbslocal.com/station/106-7-the-fan/\" target=\"_blank\">sports radio show\u003c/a> in Washington, D.C., has an annual Vasectomy Madness contest, where the prize is a free vasectomy.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/313607132\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Here's how it works: Three guys come on the air to make their cases for getting snipped. The announcers ruthlessly roast them, then listeners vote on their favorite.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“All right, let's bring in our next contestant,\" a host says. \"I believe it’s Abe from Warrenton, Virginia. So tell us your story, why are you here?”\u003c/p>\n\u003cp>Abe has three kids now, ages 9, 6 and 3.\u003c/p>\n\u003cp>“Another one, surprise! Due in July,” Abe says. “I was shopping after the third for a vasectomy, and like a dope, drug my feet.”\u003c/p>\n\u003cp>There’s Mike, also expecting his fourth child -- \u003cem>also\u003c/em> a surprise.\u003c/p>\n\u003cp>“My wife and I have had enough,” he pleads. “We need help to stop the flow.”\u003c/p>\n\u003cp>And then there’s Charles.\u003c/p>\n\u003cp>“Four kids, three different women,” Charles says, inspiring a roar of jeers from the hosts.\u003c/p>\n\u003cp>Procrastination can be so common with the “Big V” that it takes a panel of sports jocks offering a free procedure for some guys to finally let a doctor take a scalpel to their nether regions.\u003c/p>\n\u003cp>That may be one reason vasectomy rates are low: \u003ca href=\"https://www.cdc.gov/nchs/nsfg/key_statistics/v.htm\" target=\"_blank\">Five percent\u003c/a> of women rely on their partner’s vasectomy for contraception, unchanged from a decade ago. The CDC's National Survey of Family Growth compares that to \u003ca href=\"https://www.cdc.gov/nchs/nsfg/key_statistics/s.htm#sterilizationfemale\">20 percent \u003c/a>of women who have had a sterilization procedure, even though women’s surgery is more invasive and more expensive.\u003c/p>\n\u003cp>“Men are culturally the providers. It’s hard for them to seek care,” said Dr. Paul Turek, a urologist. “They don’t know how to be a patient.”\u003c/p>\n\u003cp>Turek has \u003ca href=\"http://www.theturekclinic.com/\" target=\"_blank\">clinics\u003c/a> in San Francisco and Beverly Hills. He sees an uptick in vasectomy visits during March Madness, and he’s also noticed more guys coming in together.\u003c/p>\n\u003cp>“One group came in from a tech company in a limousine,” he remembered.\u003c/p>\n\u003cp>Last year, five college buddies scheduled a group vasectomy in March. They live all over the U.S. now, and one of them had an idea to reunite in San Francisco and undergo the outpatient procedure together.\u003c/p>\n\u003cp>“I gave 'em a deal. I closed the doors,” Turek said. “We had sports TV on. They were having fun.”\u003c/p>\n\u003cp>As each guy returned to the waiting room, he was greeted with fist bumps and high-fives. Then they hobbled back to their hotel to bet on the games and yell at the television.\u003c/p>\n\u003cp>Turek made an interesting observation during that bro basketball weekend: The guys seemed to recover faster than his typical patients.\u003c/p>\n\u003cp>“They had no complaints. They were back at work sooner. They took fewer pain pills,” he said. “It was the best anesthesia, having their buddies with them.”\u003c/p>\n\u003cp>Turek gives all his vasectomy patients a certificate of honor for “uncommon bravery and meritorious performance.”\u003c/p>\n\u003cp>There is another theory about why vasectomies aren’t more popular: the cost. The Affordable Care Act requires insurers to \u003ca href=\"https://www.healthcare.gov/coverage/birth-control-benefits/\" target=\"_blank\">cover contraceptives \u003c/a>without charging out-of-pocket costs. But vasectomy wasn’t included in the rule. The procedure costs about $500, but some doctors charge up to $1,000.\u003c/p>\n\u003cp>That’s why Charles subjected himself to the free vasectomy contest at the D.C. radio station. His insurance covers a portion of the procedure, “but I'd still have to pay my deductible, which is, like, a thousand bucks.”\u003c/p>\n\u003cp>Vasectomy was overlooked in Obamacare because, under the law, birth control was considered a women’s health service.\u003c/p>\n\u003cp>“Right now the policy says to a couple: Your insurance will cover birth control without any out-of-pocket costs on your end, as long as it’s the woman who’s using it,” said \u003ca href=\"https://www.guttmacher.org/about/staff/adam-sonfield\" target=\"_blank\">Adam Sonfield\u003c/a>, senior policy manager at the \u003ca href=\"https://www.guttmacher.org/\" target=\"_blank\">Guttmacher Institute.\u003c/a>\u003c/p>\n\u003cp>Last year, 12,000 people signed a \u003ca href=\"https://www.change.org/p/health-and-human-services-cover-vasectomies-under-the-affordable-care-act\" target=\"_blank\">petition\u003c/a> asking regulators to cover vasectomy without cost sharing. Doctors’ groups even drafted language to this effect to add to the regulations, but when the Trump administration took over, it told the groups to stop trying, according to Aaron Hamlin, executive director of the \u003ca href=\"https://www.malecontraceptive.org/\" target=\"_blank\">Male Contraception Initiative.\u003c/a>\u003c/p>\n\u003cp>“The birth control benefit has been under pretty much continual political attack since the ACA was enacted,” said Sonfield.\u003c/p>\n\u003cp>The vasectomy battle is now moot, he added, because President Trump’s health officials want to get rid of the contraceptive mandate altogether, even for women.\u003c/p>\n\u003cp>“They are very much in danger at the moment,” Sonfield said.\u003c/p>\n\u003cp>So for now that leaves guys like Charles, Mike and Abe vying for a free March Madness vasectomy. The winner in the end?\u003c/p>\n\u003cp>Abe.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>His prize comes with a catch, though. He has to let one of the sportscasters come to his appointment, to broadcast a \"play-by-play.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“All right, let's bring in our next contestant,\" a host says. \"I believe it’s Abe from Warrenton, Virginia. So tell us your story, why are you here?”\u003c/p>\n\u003cp>Abe has three kids now, ages 9, 6 and 3.\u003c/p>\n\u003cp>“Another one, surprise! 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The CDC's National Survey of Family Growth compares that to \u003ca href=\"https://www.cdc.gov/nchs/nsfg/key_statistics/s.htm#sterilizationfemale\">20 percent \u003c/a>of women who have had a sterilization procedure, even though women’s surgery is more invasive and more expensive.\u003c/p>\n\u003cp>“Men are culturally the providers. It’s hard for them to seek care,” said Dr. Paul Turek, a urologist. “They don’t know how to be a patient.”\u003c/p>\n\u003cp>Turek has \u003ca href=\"http://www.theturekclinic.com/\" target=\"_blank\">clinics\u003c/a> in San Francisco and Beverly Hills. He sees an uptick in vasectomy visits during March Madness, and he’s also noticed more guys coming in together.\u003c/p>\n\u003cp>“One group came in from a tech company in a limousine,” he remembered.\u003c/p>\n\u003cp>Last year, five college buddies scheduled a group vasectomy in March. 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The Affordable Care Act requires insurers to \u003ca href=\"https://www.healthcare.gov/coverage/birth-control-benefits/\" target=\"_blank\">cover contraceptives \u003c/a>without charging out-of-pocket costs. But vasectomy wasn’t included in the rule. The procedure costs about $500, but some doctors charge up to $1,000.\u003c/p>\n\u003cp>That’s why Charles subjected himself to the free vasectomy contest at the D.C. radio station. 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"order": 1
},
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"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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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.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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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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"order": 9
},
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"id": "freakonomics-radio",
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"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",
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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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"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": {
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"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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"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",
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"airtime": "SUN 7:30pm-8pm",
"meta": {
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"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
},
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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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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"order": 18
},
"link": "/podcasts/jerrybrown",
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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/",
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"link": "/radio/program/latino-usa",
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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": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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},
"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)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"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",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"rss": "https://feeds.npr.org/510360/podcast.xml"
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},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
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"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
"title": "Perspectives",
"tagline": "KQED's series of daily listener commentaries since 1991",
"info": "KQED's series of daily listener commentaries since 1991.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/01/Perspectives_Tile_Final.jpg",
"imageAlt": "KQED Perspectives",
"officialWebsiteLink": "/perspectives/",
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"source": "kqed",
"order": 14
},
"link": "/perspectives",
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"npr": "https://www.npr.org/podcasts/432309616/perspectives",
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},
"planet-money": {
"id": "planet-money",
"title": "Planet Money",
"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
"officialWebsiteLink": "https://www.npr.org/sections/money/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/planet-money",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
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"rss": "https://feeds.npr.org/510289/podcast.xml"
}
},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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