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"content": "\u003cp>Wally Pfingsten has always been a news junkie. But since President Donald Trump was elected, he’s been so anxious about the political tumult that even just having the TV news on in the background at home is unbearable.\u003c/p>\n\u003cp>“It’s been crippling,” said the 35-year-old San Mateo resident and political moderate who has supported both Democratic and Republican candidates in the past. “I feel angry, really, really angry, far more angry than I expected to be.”\u003c/p>\n\u003cp>He’s tried hard to quell his anxiety. First, he shut down his Facebook page to limit his exposure to the daily soaking of news from Washington. But not knowing the goings-on made him anxious, too. He found himself sneaking onto the Facebook account he made for his dog. “I felt like I was cheating,” he said.\u003c/p>\n\u003cp>Pfingsten is not alone in his politics-induced anxiety — it’s so common it’s been given an unofficial name: Post-Election Stress Disorder. Mental health professionals around the country, especially those working in Democratic strongholds, report a stream of patients coming in with anxiety and depression related to — or worsened by — the blast of daily news on the new administration.\u003c/p>\n\u003cp>In the past, therapists say it’s been fairly uncommon for patients to bring up politics on the couch. “It is big money to talk about politics with me ― that is not what we do!” said Maria Lymberis, a psychiatrist in Santa Monica.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But that was before “fake news,” “alternative facts,” “repeal and replace,” contested confirmations, travel bans, protests and suits over travel bans, suspicions about Russian influence and the departures of the acting attorney general and the new national security adviser. Among other things.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/312550437\" 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>Requests for therapy appointments to Talkspace, an online therapy portal based in New York City, tripled immediately following the election and have remained high through January, according to the company. In particular, Talkspace has seen a steady increase in requests from minorities, including Muslim-Americans, African-Americans, Jews, gays and lesbians.\u003c/p>\n\u003cp>“In my 28 years in practice, I’ve never seen anything like this level of stress,” said Nancy Molitor, a psychologist in the Chicago suburbs. She says the vast majority of her patients — from millennials to those in their 80s — are bringing up politics in their therapy sessions. “What we’re seeing now after the inauguration is a huge uptick in anxiety.”\u003c/p>\n\u003cp>Many of her patients say they are having trouble sleeping and focusing at work or are fighting more with family members, she said.\u003c/p>\n\u003cp>“I have people who’ve told me they’re in mourning, that they’ve lost their libido,” Molitor said. “I have people saying the anxiety is causing them to be so distracted that they’re blowing through stop signs or getting into fender benders.”\u003c/p>\n\u003cp>The anxiety appears to be widespread. Fifty-seven percent of Americans report that the current political climate is a very or somewhat significant source of stress, and 40 percent say the same about the outcome of the election, according to an online survey of 1,019 adults conducted by the American Psychological Association after the inauguration. Between August 2016 and January 2017, the overall average stress level increased significantly for the first time since the Stress in America survey began 10 years ago.\u003c/p>\n\u003cp>And it’s not Democrats: a quarter of Republicans report that the outcome of election is a significant source of stress for them.\u003c/p>\n\u003cp>“I’m seeing lot of anxiety and anger on both sides,” says Elaine DuCharme, a psychologist in Glastonbury, Conn. “People who are Republicans are afraid to tell anyone. They’re afraid that everybody thinks that every Republican thinks exactly as Trump does, and support every single thing he does.”\u003c/p>\n\u003cp>She says some of her patients are particularly concerned about maintaining civil relationships with friends and loved ones who have different political opinions. “People are walking on eggshells,” DuCharme said.\u003c/p>\n\u003cp>Karri King, 56, who lives in Buckeye, Ariz., and voted for Trump, says her experiences on social media have left her feeling sad and hopeless. “There’s so much negative from all these stupid Facebook posts acting like the world is going to end. And it’s false. And I can’t do a thing about it.”\u003c/p>\n\u003cp>King said she’s tried to engage civilly with people online who disagree with her, but “every time [Republicans] turn around, we’re bashed.”\u003c/p>\n\u003cp>When you say “a bunch of idiots” voted Trump in, “you’re talking about half of all Americans! We were hopeful at first, and now we’re angry and tired of being blamed,” said King. “Nobody wants to listen anymore, and that’s where my sadness comes from.”\u003c/p>\n\u003cp>Of course, in some parts of the country, especially those that are overwhelmingly Republican and outside big cities, people seem relieved if not uplifted by the new president’s flurry of executive orders and appointments.\u003c/p>\n\u003cp>Kristin Addison-Brown, a psychologist in rural Jonesboro, Ark., says before the election, some of her patients were voicing concerns about a possible Clinton victory. But since then, “it’s pretty much been crickets for my patients. They got their guy, so they’re not stressed anymore.”\u003c/p>\n\u003cp>Nancy Cottle, a Trump supporter in Mesa, Ariz., has been riding high since the election. “We got to go to the inauguration, and, oh, it was a wonderful experience! We got to go to the Trump hotel and have breakfast and then lunch there, and it was just great. The inauguration itself was very inspiring.”\u003c/p>\n\u003cp>Cottle, 64, has been struggling to understand the public outcry about Trump. “It’s like the sky is falling ― but a lot of that is just drama,” she said. “I feel encouraged, I feel hopeful. I can’t wait to wake up and see what the day’s going to bring and what else is going to happen.”\u003c/p>\n\u003cp>That same daily dose of news ― and the uncertainty of what will happen next ― rattles many Trump opponents. But, like Pfingsten, they can’t seem to quit their news consumption cold turkey.\u003c/p>\n\u003cp>“Part of the brain wants to know what’s going on, and you’re drawn to watching CNN or reading the news. And then the other part of you is saying no, no, this isn’t good for me!” says Molitor, the Chicago psychologist. “It’s unfortunately like driving by a car accident ― they know it’s not good for them [to gawk], but it’s hard to stop.”\u003c/p>\n\u003cp>Molitor recommends patients stay engaged but limit the time they spend on Facebook or watching the news. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Wally Pfingsten has always been a news junkie. But since President Donald Trump was elected, he’s been so anxious about the political tumult that even just having the TV news on in the background at home is unbearable.\u003c/p>\n\u003cp>“It’s been crippling,” said the 35-year-old San Mateo resident and political moderate who has supported both Democratic and Republican candidates in the past. “I feel angry, really, really angry, far more angry than I expected to be.”\u003c/p>\n\u003cp>He’s tried hard to quell his anxiety. First, he shut down his Facebook page to limit his exposure to the daily soaking of news from Washington. But not knowing the goings-on made him anxious, too. He found himself sneaking onto the Facebook account he made for his dog. “I felt like I was cheating,” he said.\u003c/p>\n\u003cp>Pfingsten is not alone in his politics-induced anxiety — it’s so common it’s been given an unofficial name: Post-Election Stress Disorder. Mental health professionals around the country, especially those working in Democratic strongholds, report a stream of patients coming in with anxiety and depression related to — or worsened by — the blast of daily news on the new administration.\u003c/p>\n\u003cp>In the past, therapists say it’s been fairly uncommon for patients to bring up politics on the couch. “It is big money to talk about politics with me ― that is not what we do!” said Maria Lymberis, a psychiatrist in Santa Monica.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But that was before “fake news,” “alternative facts,” “repeal and replace,” contested confirmations, travel bans, protests and suits over travel bans, suspicions about Russian influence and the departures of the acting attorney general and the new national security adviser. Among other things.\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/312550437&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/312550437'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Requests for therapy appointments to Talkspace, an online therapy portal based in New York City, tripled immediately following the election and have remained high through January, according to the company. In particular, Talkspace has seen a steady increase in requests from minorities, including Muslim-Americans, African-Americans, Jews, gays and lesbians.\u003c/p>\n\u003cp>“In my 28 years in practice, I’ve never seen anything like this level of stress,” said Nancy Molitor, a psychologist in the Chicago suburbs. She says the vast majority of her patients — from millennials to those in their 80s — are bringing up politics in their therapy sessions. “What we’re seeing now after the inauguration is a huge uptick in anxiety.”\u003c/p>\n\u003cp>Many of her patients say they are having trouble sleeping and focusing at work or are fighting more with family members, she said.\u003c/p>\n\u003cp>“I have people who’ve told me they’re in mourning, that they’ve lost their libido,” Molitor said. “I have people saying the anxiety is causing them to be so distracted that they’re blowing through stop signs or getting into fender benders.”\u003c/p>\n\u003cp>The anxiety appears to be widespread. Fifty-seven percent of Americans report that the current political climate is a very or somewhat significant source of stress, and 40 percent say the same about the outcome of the election, according to an online survey of 1,019 adults conducted by the American Psychological Association after the inauguration. Between August 2016 and January 2017, the overall average stress level increased significantly for the first time since the Stress in America survey began 10 years ago.\u003c/p>\n\u003cp>And it’s not Democrats: a quarter of Republicans report that the outcome of election is a significant source of stress for them.\u003c/p>\n\u003cp>“I’m seeing lot of anxiety and anger on both sides,” says Elaine DuCharme, a psychologist in Glastonbury, Conn. “People who are Republicans are afraid to tell anyone. They’re afraid that everybody thinks that every Republican thinks exactly as Trump does, and support every single thing he does.”\u003c/p>\n\u003cp>She says some of her patients are particularly concerned about maintaining civil relationships with friends and loved ones who have different political opinions. “People are walking on eggshells,” DuCharme said.\u003c/p>\n\u003cp>Karri King, 56, who lives in Buckeye, Ariz., and voted for Trump, says her experiences on social media have left her feeling sad and hopeless. “There’s so much negative from all these stupid Facebook posts acting like the world is going to end. And it’s false. And I can’t do a thing about it.”\u003c/p>\n\u003cp>King said she’s tried to engage civilly with people online who disagree with her, but “every time [Republicans] turn around, we’re bashed.”\u003c/p>\n\u003cp>When you say “a bunch of idiots” voted Trump in, “you’re talking about half of all Americans! We were hopeful at first, and now we’re angry and tired of being blamed,” said King. “Nobody wants to listen anymore, and that’s where my sadness comes from.”\u003c/p>\n\u003cp>Of course, in some parts of the country, especially those that are overwhelmingly Republican and outside big cities, people seem relieved if not uplifted by the new president’s flurry of executive orders and appointments.\u003c/p>\n\u003cp>Kristin Addison-Brown, a psychologist in rural Jonesboro, Ark., says before the election, some of her patients were voicing concerns about a possible Clinton victory. But since then, “it’s pretty much been crickets for my patients. They got their guy, so they’re not stressed anymore.”\u003c/p>\n\u003cp>Nancy Cottle, a Trump supporter in Mesa, Ariz., has been riding high since the election. “We got to go to the inauguration, and, oh, it was a wonderful experience! We got to go to the Trump hotel and have breakfast and then lunch there, and it was just great. The inauguration itself was very inspiring.”\u003c/p>\n\u003cp>Cottle, 64, has been struggling to understand the public outcry about Trump. “It’s like the sky is falling ― but a lot of that is just drama,” she said. “I feel encouraged, I feel hopeful. I can’t wait to wake up and see what the day’s going to bring and what else is going to happen.”\u003c/p>\n\u003cp>That same daily dose of news ― and the uncertainty of what will happen next ― rattles many Trump opponents. But, like Pfingsten, they can’t seem to quit their news consumption cold turkey.\u003c/p>\n\u003cp>“Part of the brain wants to know what’s going on, and you’re drawn to watching CNN or reading the news. 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"content": "\u003cp>In her office in Zuckerberg San Francisco General Hospital, Dr. Alice Chen pulled down a blue box she keeps on top of a file cabinet. She set it on her lap and leafed through a stack of thank-you notes, until she found one from a former patient that she wanted to read aloud.\u003c/p>\n\u003cp>\"I feel enormously fortunate to have been granted such a willing and able team to support me during such a tough period,\" she read.\u003c/p>\n\u003cp>The grateful patient who wrote those words was uninsured, but was still able to get some treatment at Zuckerberg at the time. That's because Zuckerberg — and other taxpayer-funded hospitals across California —formed the medical safety net of last resort for 17 million uninsured Californians before 2014. That was the year the Affordable Care Act kicked into gear, which helped California lower that uninsured rate down to 7 percent.\u003c/p>\n\u003cp>Like many Californians in the health industry, Chen is struggling to understand the implications of the Republican health care bill, introduced last week in Congress and followed this week by sobering analyses of its effects: one from the national \u003ca href=\"https://www.cbo.gov/publication/52486\" target=\"_blank\">Congressional Budget Office\u003c/a> (CBO) and another from \u003ca href=\"http://hbex.coveredca.com/pdfs/Preliminary_Analysis_of_AHCA.pdf\" target=\"_blank\">Covered California\u003c/a>, the state's health care marketplace.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee expressed immediate concern.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We are deeply troubled by the CBO's finding that the amount of support provided for consumers to buy health insurance in 2020, under proposed legislation would be only 60 percent of what is provided under current law,\" Lee said in a press release.\u003c/p>\n\u003cp>Before the Affordable Care Act, 40 percent of patients at Zuckerberg San Francisco General were uninsured. Now it's down to 3 percent, according to hospital CEO Susan Ehrlich.\u003c/p>\n\u003cp>Many of the people who now have coverage are similar to the young woman who wrote the letter to Chen: They got insurance through the Affordable Care Act's expansion of Medi-Cal to 3.7 million additional Californians. The Republican bill jeopardizes that funding.\u003c/p>\n\u003cp>\"There’s a whole invisible group of people out there who really want insurance, want to pay their dues, but can’t afford it unless we structure the system right,\" Chen said.\u003c/p>\n\u003cp>Federico Reyes is a good example. He's a regular patient at Chen's clinic at the hospital. Among other things, he goes there to manage health issues related to having a leg amputated years ago.\u003c/p>\n\u003cp>When he lost his leg, Reyes was uninsured. He had necrotizing fasciitis, a bacterial infection that spreads quickly and kills the body's soft tissue. He said he went to another hospital but didn't receive adequate treatment because he lacked insurance. He later ended up in the emergency room at Zuckerberg S.F. General, where they amputated the leg. To this day, Reyes believes that if he had been covered at the time, the outcome of his infection would have been different.\u003c/p>\n\u003cp>Reyes is concerned about the Republican health bill, called the American Health Care Act (AHCA). He fears it will leave members of his community without proper health insurance.\u003c/p>\n\u003cp>\"All the people that got health care —and I'm speaking mostly for us poor people — it's like taking the carpet right from under our feet,\" he said. \"You hand us a piece of meat, and then you take it away from us.\"\u003c/p>\n\u003cp>Beyond concerns for patients, hospital staff members are worried about funding. Provisions of the Affordable Care Act \u003ca href=\"http://caph.org/wp-content/uploads/2017/02/sfhn-aca-final-profile.pdf\" target=\"_blank\">added\u003c/a> $125 million in revenue to the annual budget of the hospital and an affiliated network of neighborhood clinics.\u003c/p>\n\u003cp>\"If Medi-Cal expansion is capped, then some of our patients will not be insured,\" said nurse Philippa Doyle. Medi-Cal expansion provided coverage for more Californians than those traditionally included in the Medi-Cal pool. \"Because we treat everybody, then our reimbursement will go down significantly, and we won’t be able to provide resources that we are currently.\"\u003c/p>\n\u003cp>For Doyle, \"resources\" are not an abstraction. That money pays for more nurses, medical assistants and clerks to help with work flow.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Under the AHCA, public hospitals like San Francisco General are expected to lose tens of millions of dollars in government support every year.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In her office in Zuckerberg San Francisco General Hospital, Dr. Alice Chen pulled down a blue box she keeps on top of a file cabinet. She set it on her lap and leafed through a stack of thank-you notes, until she found one from a former patient that she wanted to read aloud.\u003c/p>\n\u003cp>\"I feel enormously fortunate to have been granted such a willing and able team to support me during such a tough period,\" she read.\u003c/p>\n\u003cp>The grateful patient who wrote those words was uninsured, but was still able to get some treatment at Zuckerberg at the time. That's because Zuckerberg — and other taxpayer-funded hospitals across California —formed the medical safety net of last resort for 17 million uninsured Californians before 2014. That was the year the Affordable Care Act kicked into gear, which helped California lower that uninsured rate down to 7 percent.\u003c/p>\n\u003cp>Like many Californians in the health industry, Chen is struggling to understand the implications of the Republican health care bill, introduced last week in Congress and followed this week by sobering analyses of its effects: one from the national \u003ca href=\"https://www.cbo.gov/publication/52486\" target=\"_blank\">Congressional Budget Office\u003c/a> (CBO) and another from \u003ca href=\"http://hbex.coveredca.com/pdfs/Preliminary_Analysis_of_AHCA.pdf\" target=\"_blank\">Covered California\u003c/a>, the state's health care marketplace.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee expressed immediate concern.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We are deeply troubled by the CBO's finding that the amount of support provided for consumers to buy health insurance in 2020, under proposed legislation would be only 60 percent of what is provided under current law,\" Lee said in a press release.\u003c/p>\n\u003cp>Before the Affordable Care Act, 40 percent of patients at Zuckerberg San Francisco General were uninsured. Now it's down to 3 percent, according to hospital CEO Susan Ehrlich.\u003c/p>\n\u003cp>Many of the people who now have coverage are similar to the young woman who wrote the letter to Chen: They got insurance through the Affordable Care Act's expansion of Medi-Cal to 3.7 million additional Californians. The Republican bill jeopardizes that funding.\u003c/p>\n\u003cp>\"There’s a whole invisible group of people out there who really want insurance, want to pay their dues, but can’t afford it unless we structure the system right,\" Chen said.\u003c/p>\n\u003cp>Federico Reyes is a good example. He's a regular patient at Chen's clinic at the hospital. Among other things, he goes there to manage health issues related to having a leg amputated years ago.\u003c/p>\n\u003cp>When he lost his leg, Reyes was uninsured. He had necrotizing fasciitis, a bacterial infection that spreads quickly and kills the body's soft tissue. He said he went to another hospital but didn't receive adequate treatment because he lacked insurance. He later ended up in the emergency room at Zuckerberg S.F. General, where they amputated the leg. To this day, Reyes believes that if he had been covered at the time, the outcome of his infection would have been different.\u003c/p>\n\u003cp>Reyes is concerned about the Republican health bill, called the American Health Care Act (AHCA). He fears it will leave members of his community without proper health insurance.\u003c/p>\n\u003cp>\"All the people that got health care —and I'm speaking mostly for us poor people — it's like taking the carpet right from under our feet,\" he said. \"You hand us a piece of meat, and then you take it away from us.\"\u003c/p>\n\u003cp>Beyond concerns for patients, hospital staff members are worried about funding. Provisions of the Affordable Care Act \u003ca href=\"http://caph.org/wp-content/uploads/2017/02/sfhn-aca-final-profile.pdf\" target=\"_blank\">added\u003c/a> $125 million in revenue to the annual budget of the hospital and an affiliated network of neighborhood clinics.\u003c/p>\n\u003cp>\"If Medi-Cal expansion is capped, then some of our patients will not be insured,\" said nurse Philippa Doyle. Medi-Cal expansion provided coverage for more Californians than those traditionally included in the Medi-Cal pool. \"Because we treat everybody, then our reimbursement will go down significantly, and we won’t be able to provide resources that we are currently.\"\u003c/p>\n\u003cp>For Doyle, \"resources\" are not an abstraction. That money pays for more nurses, medical assistants and clerks to help with work flow.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Under the AHCA, public hospitals like San Francisco General are expected to lose tens of millions of dollars in government support every year.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "GOP Health Proposal Would Upend Consumers’ Cost Calculations In California",
"title": "GOP Health Proposal Would Upend Consumers’ Cost Calculations In California",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>For better or worse, Californians who aren’t insured through their employers could see major changes in their health insurance costs under a Republican replacement for the Affordable Care Act.\u003c/p>\n\u003cp>A \u003ca href=\"https://housegop.leadpages.co/healthcare/\" target=\"_blank\">House GOP proposal\u003c/a> introduced Monday would provide substantially less financial help to many consumers in higher-cost areas of California, from San Francisco to Monterey. But people in lower-cost markets like Los Angeles could fare better.\u003c/p>\n\u003cp>That’s because the Republican proposal takes a simpler, across-the-board approach to tax credits than the current law. The ACA offers a wide range of subsidies that take into account household income and the local cost of coverage. The nationwide Republican tax credits are tied just to age, starting at $2,000 per year for people under 30 and increasing to $4,000 for those over 60.\u003c/p>\n\u003cp>That doesn’t bode well for a 60-year-old in Santa Cruz. If he makes $40,000 a year, he would receive $12,836 in ACA premium subsidies to buy insurance on the state exchange for 2017, \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=R-U2DS6x8EeQhAPCLWbcVuq82ZoP3htjXhB8MWddPCaR3P3bEmXUCA..&URL=http%3a%2f%2fkff.org%2finteractive%2ftax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map%2f\" target=\"_blank\">according to an analysis\u003c/a> by the Kaiser Family Foundation. The subsidy takes into account the person’s income and the cost of insurance in the coastal town. (California Healthline is an editorially independent service of the foundation.)\u003c/p>\n\u003cp>The House’s American Health Care Act would cut that person’s assistance to $4,000, based purely on his age. A 60-year-old making $20,000 a year in the same town would be even worse off, because his low income wouldn’t be part of the calculation. He would get nearly $12,000 less under the House plan than under the current law.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the GOP’s plan could benefit younger consumers in general and particularly those in lower-priced markets of Southern California. Under current law, a 27-year-old in Los Angeles making $40,000 doesn’t get any ACA subsidy because the cost of coverage is low for someone of her income. She has to pay her entire premium.\u003c/p>\n\u003cp>But under the House plan, she would qualify for a flat $2,000 tax credit based entirely on her age.\u003c/p>\n\u003cp>The GOP plan would begin to phase out age-based tax credits when an individual’s annual income reached $75,000. The upper limit under the ACA is 400 percent of the federal poverty level or about $47,000 for an individual and more than $97,000 for a family of four.\u003c/p>\n\u003cp>Cynthia Cox, associate director of health reform and private insurance at the Kaiser Family Foundation, said any replacement plan for the ACA will create “winners and losers.”\u003c/p>\n\u003cp>She said “the people likely to gain under the ACA replacement are those who are younger, higher income and live in lower-cost areas. That might be millennials living in Los Angeles.”\u003c/p>\n\u003cp>But she said the added costs imposed on consumers in other markets could be enormous. “For a person living in Santa Cruz or another high-cost area, that is a big chunk of their income to come up with,” she said.\u003c/p>\n\u003cp>California has long had a north-south divide on medical costs. Health policy experts say the lack of competition in Northern California helps explain why health insurance premiums are, on average, about 25 percent higher compared to the southern part of the state.\u003c/p>\n\u003cp>For 2017, rates in the Covered California exchange rose by 13.2 percent, on average, statewide. But premiums in the Santa Cruz-Monterey area jumped by \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=8J6HRVhYXiQ8q6jd0etguGxJ5Cy0ftd1750eCWSgfyaR3P3bEmXUCA..&URL=http%3a%2f%2fcaliforniahealthline.org%2fnews%2fcovered-california-2017-rate-hikes-will-hit-states-central-coast-hardest%2f\" target=\"_blank\">nearly 29 percent\u003c/a>.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said ignoring income and location in issuing tax credits may force thousands of people to drop coverage.\u003c/p>\n\u003cp>“The wide variations in the health-care system across California could result in consumers in some areas being priced out of coverage,” Lee said. “The analysis of some early proposals also underscores the importance of providing financial help that is directly tied to a consumer’s income.”\u003c/p>\n\u003cp>Cox said some Republicans are purposely ignoring those geographic differences because they don’t want to reward higher-priced areas with more generous taxpayer subsidies. The hope is that lower tax credits could put pressure on insurers or medical providers to charge less.\u003c/p>\n\u003cp>Lanhee Chen, a \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=MuEfZ28KfW9Lu6GWvfsLP1pSb7IF3Zcgzj1EMKOPC-mR3P3bEmXUCA..&URL=http%3a%2f%2fkhn.org%2fnews%2ffor-conservatives-its-a-new-day-in-health-care%2f\" target=\"_blank\">conservative health-policy expert\u003c/a> and a fellow at Stanford University’s Hoover Institution, said the House Republicans’ tax-credit proposal would simplify the process and have a “positive impact on bringing down health costs over the long run.”\u003c/p>\n\u003cp>But even some critics of Obamacare think Republicans will have to alter their approach and account for differences in health costs within states and across the country.\u003c/p>\n\u003cp>“The impact will not be uniform and many parts of the country will be big losers — and not just the high-cost big cities that are traditionally Democratic areas,” said Robert Laszewski, a Virginia-based health care consultant and frequent critic of the ACA. “Many of the highest cost places are Republican strongholds. Geographic rating is as basic to health insurance 101 as anything.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "Decently paid millennials in LA might be better off than under Obamacare — but older people in pricier areas much worse.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For better or worse, Californians who aren’t insured through their employers could see major changes in their health insurance costs under a Republican replacement for the Affordable Care Act.\u003c/p>\n\u003cp>A \u003ca href=\"https://housegop.leadpages.co/healthcare/\" target=\"_blank\">House GOP proposal\u003c/a> introduced Monday would provide substantially less financial help to many consumers in higher-cost areas of California, from San Francisco to Monterey. But people in lower-cost markets like Los Angeles could fare better.\u003c/p>\n\u003cp>That’s because the Republican proposal takes a simpler, across-the-board approach to tax credits than the current law. The ACA offers a wide range of subsidies that take into account household income and the local cost of coverage. The nationwide Republican tax credits are tied just to age, starting at $2,000 per year for people under 30 and increasing to $4,000 for those over 60.\u003c/p>\n\u003cp>That doesn’t bode well for a 60-year-old in Santa Cruz. If he makes $40,000 a year, he would receive $12,836 in ACA premium subsidies to buy insurance on the state exchange for 2017, \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=R-U2DS6x8EeQhAPCLWbcVuq82ZoP3htjXhB8MWddPCaR3P3bEmXUCA..&URL=http%3a%2f%2fkff.org%2finteractive%2ftax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map%2f\" target=\"_blank\">according to an analysis\u003c/a> by the Kaiser Family Foundation. The subsidy takes into account the person’s income and the cost of insurance in the coastal town. (California Healthline is an editorially independent service of the foundation.)\u003c/p>\n\u003cp>The House’s American Health Care Act would cut that person’s assistance to $4,000, based purely on his age. A 60-year-old making $20,000 a year in the same town would be even worse off, because his low income wouldn’t be part of the calculation. He would get nearly $12,000 less under the House plan than under the current law.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the GOP’s plan could benefit younger consumers in general and particularly those in lower-priced markets of Southern California. Under current law, a 27-year-old in Los Angeles making $40,000 doesn’t get any ACA subsidy because the cost of coverage is low for someone of her income. She has to pay her entire premium.\u003c/p>\n\u003cp>But under the House plan, she would qualify for a flat $2,000 tax credit based entirely on her age.\u003c/p>\n\u003cp>The GOP plan would begin to phase out age-based tax credits when an individual’s annual income reached $75,000. The upper limit under the ACA is 400 percent of the federal poverty level or about $47,000 for an individual and more than $97,000 for a family of four.\u003c/p>\n\u003cp>Cynthia Cox, associate director of health reform and private insurance at the Kaiser Family Foundation, said any replacement plan for the ACA will create “winners and losers.”\u003c/p>\n\u003cp>She said “the people likely to gain under the ACA replacement are those who are younger, higher income and live in lower-cost areas. That might be millennials living in Los Angeles.”\u003c/p>\n\u003cp>But she said the added costs imposed on consumers in other markets could be enormous. “For a person living in Santa Cruz or another high-cost area, that is a big chunk of their income to come up with,” she said.\u003c/p>\n\u003cp>California has long had a north-south divide on medical costs. Health policy experts say the lack of competition in Northern California helps explain why health insurance premiums are, on average, about 25 percent higher compared to the southern part of the state.\u003c/p>\n\u003cp>For 2017, rates in the Covered California exchange rose by 13.2 percent, on average, statewide. But premiums in the Santa Cruz-Monterey area jumped by \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=8J6HRVhYXiQ8q6jd0etguGxJ5Cy0ftd1750eCWSgfyaR3P3bEmXUCA..&URL=http%3a%2f%2fcaliforniahealthline.org%2fnews%2fcovered-california-2017-rate-hikes-will-hit-states-central-coast-hardest%2f\" target=\"_blank\">nearly 29 percent\u003c/a>.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said ignoring income and location in issuing tax credits may force thousands of people to drop coverage.\u003c/p>\n\u003cp>“The wide variations in the health-care system across California could result in consumers in some areas being priced out of coverage,” Lee said. “The analysis of some early proposals also underscores the importance of providing financial help that is directly tied to a consumer’s income.”\u003c/p>\n\u003cp>Cox said some Republicans are purposely ignoring those geographic differences because they don’t want to reward higher-priced areas with more generous taxpayer subsidies. The hope is that lower tax credits could put pressure on insurers or medical providers to charge less.\u003c/p>\n\u003cp>Lanhee Chen, a \u003ca href=\"https://owa.mp.kff.org/owa/redir.aspx?C=MuEfZ28KfW9Lu6GWvfsLP1pSb7IF3Zcgzj1EMKOPC-mR3P3bEmXUCA..&URL=http%3a%2f%2fkhn.org%2fnews%2ffor-conservatives-its-a-new-day-in-health-care%2f\" target=\"_blank\">conservative health-policy expert\u003c/a> and a fellow at Stanford University’s Hoover Institution, said the House Republicans’ tax-credit proposal would simplify the process and have a “positive impact on bringing down health costs over the long run.”\u003c/p>\n\u003cp>But even some critics of Obamacare think Republicans will have to alter their approach and account for differences in health costs within states and across the country.\u003c/p>\n\u003cp>“The impact will not be uniform and many parts of the country will be big losers — and not just the high-cost big cities that are traditionally Democratic areas,” said Robert Laszewski, a Virginia-based health care consultant and frequent critic of the ACA. “Many of the highest cost places are Republican strongholds. Geographic rating is as basic to health insurance 101 as anything.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "GOP Bill Would Repeal Obamacare Taxes and Penalties, Keep Some Subsidies",
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"content": "\u003cp>After years of waiting, it's finally here.\u003c/p>\n\u003cp>The \u003ca href=\"https://waysandmeans.house.gov/event/markup-budget-reconciliation-recommendations-repeal-replace-obamacare/\">Republican plan\u003c/a> to \u003ca href=\"https://energycommerce.house.gov/news-center/press-releases/energy-and-commerce-republicans-release-legislation-repeal-and-replace\">reshape \u003c/a>the Affordable Care Act — what they call \"repeal and replace\" — kills the requirement that everyone buy health insurance by eliminating the tax penalty for those who don't have coverage. It also makes significant changes in the financial assistance people can receive to buy a health plan.\u003c/p>\n\u003cp>\"Our legislation transfers power from Washington back to the states,\" said House Ways and Means Committee Chairman Kevin Brady in a statement. \"We dismantle Obamacare's damaging taxes and mandates so states can deliver quality affordable options.\"\u003c/p>\n\u003cp>The bill would offer tax credits, refundable in advance, to people with incomes below $75,000. But those credits will be lower in many cases than the subsidies now offered in the ACA.\u003c/p>\n\u003cp>The bill, which will go through many revisions and challenges, was released late Monday by two House committees, Ways and Means and Energy and Commerce. Members are expected to start voting on parts of the bill Wednesday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rep. Frank Pallone, D-N.J., and Richard Neal, D-Mass., the ranking Democrats on the Energy and Commerce and Ways and Means committees, issued a joint statement saying the bill would \"rip healthcare away from millions of Americans, ration care for working families and put insurance companies back in charge.\"\u003c/p>\n\u003cp>The legislation will need approval by the full House and the Senate before it goes to President Trump for his signature. Until then, most of what is known as Obamacare will stay in place.\u003c/p>\n\u003cp>But it's far from clear that Republicans in the House are unified in their support of the bill. Members of the far-right Freedom Caucus have said they oppose giving tax credits to people who don't pay any federal income tax.\u003c/p>\n\u003cp>And with only a slim majority in the Senate, only a few Republican defections could defeat the bill there.\u003c/p>\n\u003cp>Four Republican senators wrote a letter to Majority Leader Mitch McConnell saying they were concerned an early draft of the House plan would not adequately protect people who have insurance through Obamacare's Medicaid expansion. And Sen. Rand Paul was among three conservative Republicans who criticized an earlier version of the bill as \"Obamacare lite.\"\u003c/p>\n\u003cp>Under the proposed bill, tax credits would start at $2,000 a year for individuals under age 30, rising to $4,000 for those of 60. The proposal, first seen in a Feb. 10 draft of the bill, has been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/24/517074764/gop-health-bill-draft-would-cut-medicaid-emphasize-tax-credits\">criticized \u003c/a>as too meager to cover the full cost of a health insurance plan that provides full benefits.\u003c/p>\n\u003cp>But the proposed tax credit could potentially pay for insurance that protects only against a catastrophic health event.\u003c/p>\n\u003cp>They would begin to be phased out at incomes of $75,000 for individuals and $150,000 for families.\u003c/p>\n\u003cp>To encourage people to buy coverage, the plan allows insurers to charge a 30 percent penalty to people who let their insurance lapse, and then try to buy a new policy.\u003c/p>\n\u003cp>In states that expanded Medicaid, people who are eligible can continue to enroll until January 1, 2020, and those states would continue to benefit from the federal government paying a greater share of the health costs of those beneficiaries.\u003c/p>\n\u003cp>Several taxes contained in the ACA would be repealed at the end of this year. These include taxes on health insurers, pharmaceutical and medical device manufacturers, and a tax on high-cost employer-sponsored group health plans (aka Cadillac plans).\u003c/p>\n\u003cp>An analysis by \u003ca href=\"http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-significantly-reduce-federal-spending\">Avalere Health\u003c/a> and \u003ca href=\"https://cdn2.vox-cdn.com/uploads/chorus_asset/file/8045899/Scanned_from_a_Xerox_Multifunction_Printer.0.pdf\">McKinsey\u003c/a> of an earlier draft of the bill, which contained many of the same provisions, concluded that it would lead to millions of people losing coverage.\u003c/p>\n\u003cp>The plan offered by the House Republicans falls short of the outright repeal that has been demanded by more conservative members, including those in the House Freedom Caucus.\u003c/p>\n\u003cp>That could be due to the shift in public attitudes toward the ACA in recent weeks.\u003c/p>\n\u003cp>Public opinion has grown more favorable as major changes appeared imminent. A Kaiser Family Foundation \u003ca href=\"http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/\">tracking poll\u003c/a> in late February found 48 percent having a favorable opinion versus 42 percent viewing the law unfavorably. Kaiser says the shift is due largely to a change in the view of political independents, among which 50 percent now view the law favorably.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We will have more on this story as it develops.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Bill+Would+Repeal+Obamacare+Taxes+And+Penalties%2C+Keep+Some+Subsidies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After years of waiting, it's finally here.\u003c/p>\n\u003cp>The \u003ca href=\"https://waysandmeans.house.gov/event/markup-budget-reconciliation-recommendations-repeal-replace-obamacare/\">Republican plan\u003c/a> to \u003ca href=\"https://energycommerce.house.gov/news-center/press-releases/energy-and-commerce-republicans-release-legislation-repeal-and-replace\">reshape \u003c/a>the Affordable Care Act — what they call \"repeal and replace\" — kills the requirement that everyone buy health insurance by eliminating the tax penalty for those who don't have coverage. It also makes significant changes in the financial assistance people can receive to buy a health plan.\u003c/p>\n\u003cp>\"Our legislation transfers power from Washington back to the states,\" said House Ways and Means Committee Chairman Kevin Brady in a statement. \"We dismantle Obamacare's damaging taxes and mandates so states can deliver quality affordable options.\"\u003c/p>\n\u003cp>The bill would offer tax credits, refundable in advance, to people with incomes below $75,000. But those credits will be lower in many cases than the subsidies now offered in the ACA.\u003c/p>\n\u003cp>The bill, which will go through many revisions and challenges, was released late Monday by two House committees, Ways and Means and Energy and Commerce. Members are expected to start voting on parts of the bill Wednesday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rep. Frank Pallone, D-N.J., and Richard Neal, D-Mass., the ranking Democrats on the Energy and Commerce and Ways and Means committees, issued a joint statement saying the bill would \"rip healthcare away from millions of Americans, ration care for working families and put insurance companies back in charge.\"\u003c/p>\n\u003cp>The legislation will need approval by the full House and the Senate before it goes to President Trump for his signature. Until then, most of what is known as Obamacare will stay in place.\u003c/p>\n\u003cp>But it's far from clear that Republicans in the House are unified in their support of the bill. Members of the far-right Freedom Caucus have said they oppose giving tax credits to people who don't pay any federal income tax.\u003c/p>\n\u003cp>And with only a slim majority in the Senate, only a few Republican defections could defeat the bill there.\u003c/p>\n\u003cp>Four Republican senators wrote a letter to Majority Leader Mitch McConnell saying they were concerned an early draft of the House plan would not adequately protect people who have insurance through Obamacare's Medicaid expansion. And Sen. Rand Paul was among three conservative Republicans who criticized an earlier version of the bill as \"Obamacare lite.\"\u003c/p>\n\u003cp>Under the proposed bill, tax credits would start at $2,000 a year for individuals under age 30, rising to $4,000 for those of 60. The proposal, first seen in a Feb. 10 draft of the bill, has been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/24/517074764/gop-health-bill-draft-would-cut-medicaid-emphasize-tax-credits\">criticized \u003c/a>as too meager to cover the full cost of a health insurance plan that provides full benefits.\u003c/p>\n\u003cp>But the proposed tax credit could potentially pay for insurance that protects only against a catastrophic health event.\u003c/p>\n\u003cp>They would begin to be phased out at incomes of $75,000 for individuals and $150,000 for families.\u003c/p>\n\u003cp>To encourage people to buy coverage, the plan allows insurers to charge a 30 percent penalty to people who let their insurance lapse, and then try to buy a new policy.\u003c/p>\n\u003cp>In states that expanded Medicaid, people who are eligible can continue to enroll until January 1, 2020, and those states would continue to benefit from the federal government paying a greater share of the health costs of those beneficiaries.\u003c/p>\n\u003cp>Several taxes contained in the ACA would be repealed at the end of this year. These include taxes on health insurers, pharmaceutical and medical device manufacturers, and a tax on high-cost employer-sponsored group health plans (aka Cadillac plans).\u003c/p>\n\u003cp>An analysis by \u003ca href=\"http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-significantly-reduce-federal-spending\">Avalere Health\u003c/a> and \u003ca href=\"https://cdn2.vox-cdn.com/uploads/chorus_asset/file/8045899/Scanned_from_a_Xerox_Multifunction_Printer.0.pdf\">McKinsey\u003c/a> of an earlier draft of the bill, which contained many of the same provisions, concluded that it would lead to millions of people losing coverage.\u003c/p>\n\u003cp>The plan offered by the House Republicans falls short of the outright repeal that has been demanded by more conservative members, including those in the House Freedom Caucus.\u003c/p>\n\u003cp>That could be due to the shift in public attitudes toward the ACA in recent weeks.\u003c/p>\n\u003cp>Public opinion has grown more favorable as major changes appeared imminent. A Kaiser Family Foundation \u003ca href=\"http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/\">tracking poll\u003c/a> in late February found 48 percent having a favorable opinion versus 42 percent viewing the law unfavorably. Kaiser says the shift is due largely to a change in the view of political independents, among which 50 percent now view the law favorably.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We will have more on this story as it develops.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Bill+Would+Repeal+Obamacare+Taxes+And+Penalties%2C+Keep+Some+Subsidies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Medical Board President Faces Questions Over Vote In Sexual Misconduct Case",
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"content": "\u003cp>The president of the Medical Board of California is facing questions from critics about a business deal he struck after the board decided to reinstate the license of a doctor who engaged in sexual misconduct with patients.\u003c/p>\n\u003cp>In 2012, Dr. Dev GnanaDev, new to the board and not yet president, was part of a disciplinary panel that voted to \u003ca href=\"http://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5cDIDOCS%5c20160824%5cDMRAAAFC5%5c&did=AAAFC160824220345223.DID&licenseType=A&licenseNumber=56371#page=1\">reinstate Dr. Hari Reddy\u003c/a>. The Victorville family physician had lost his license in 2003 after the board found he had engaged in sexual misconduct with four female patients, including a minor.\u003c/p>\n\u003cp>About a year after the 2012 vote, GnanaDev sought a donation from one of Reddy’s relatives to start a new medical school in California’s Inland Empire, GnanaDev confirmed. Dr. Prem Reddy, Reddy’s brother-in-law, agreed to \u003ca href=\"http://www.premreddyfamilyfoundation.org/Press-Center/Recent-News/2014/Dr-Reddy-Puts-40-Million-Into-Nonprofit-Medical-.aspx\">put $40 million into the nonprofit venture\u003c/a>.\u003c/p>\n\u003cp>Prem Reddy is founder and CEO of Prime Healthcare, which operates \u003ca href=\"http://www.primehealthcare.com/\">44 hospitals in 14 states\u003c/a>, including the medical center where Hari Reddy now works.\u003c/p>\n\u003cp>The new medical school, \u003ca href=\"http://www.calmedu.org/\">California University of Science and Medicine\u003c/a>, is scheduled to open in 2018. GnanaDev is the president; Prem Reddy, chairman of the board.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>GnanaDev declined to say how he voted in Hari Reddy’s case, citing board policy. The medical board said the vote tally and how each board member voted is not public information.\u003c/p>\n\u003cp>The sequence of events has led a pair of vocal board critics, Marian Hollingsworth and Eric Andrist, to question whether there was a relationship between GnanaDev’s vote and the subsequent medical school donation.\u003c/p>\n\u003cp>Hollingsworth and Andrist called for an investigation Monday at legislative oversight hearing to review the performance of the medical board. \u003ca href=\"https://docs.google.com/document/d/1evuYpLqWGnWFKmTy3nk4DjP8CF9H1w9IOneyW88bpok/edit\">In a report\u003c/a> they submitted to legislators, which was broadly critical of the board, they detailed the Hari Reddy case and demanded the board be transparent about the vote.\u003c/p>\n\u003cp>“This smacks of conflict of interest,“ Hollingsworth told the Joint Sunset Review Oversight Hearing, which is held every four years. “Please help reorganize this agency so that exceptions and conflicts do not get in the way of protecting California consumers from truly dangerous doctors.”\u003c/p>\n\u003cp>State Sen. Jerry Hill (D-San Mateo) called the events, as described to him by a reporter, “alarming.” Hill, who is chairman of the Senate committee that took part in the oversight hearing, was contacted before the hearing and had been previously unaware of the circumstances.\u003c/p>\n\u003cp>“It certainly is worth looking at to see if there is a conflict that presented itself,” Hill said, adding that the board’s voting information should be public and “readily accessible.”\u003c/p>\n\u003cp> Dr. Prem Reddy (center) is pictured with Dr. Dev GnanaDev (right) in 2014. (James Quigg/Daily Press)\u003c/p>\n\u003cp>GnanaDev and Prem Reddy both deny any connection between Hari Reddy’s case and the medical school.\u003c/p>\n\u003cp>“I don’t know why someone thinks there was a conflict here. It’s just mind-boggling,” GnanaDev said in an interview.\u003c/p>\n\u003cp>At the time of the 2012 vote on Hari Reddy’s license, GnanaDev said he wasn’t even considering starting a medical school yet and knew Prem Reddy only in passing. He did know Hari Reddy, because Reddy had been a resident at Arrowhead Regional Medical Center in San Bernardino County, where GnanaDev was chief of surgery. But he said he followed protocol and disclosed that to the board before the vote.\u003c/p>\n\u003cp>GnanaDev said that when he later decided to start the school, it was out of a desire to contribute to an underserved community. He filed paperwork to incorporate the school in August 2012. He asked several wealthy donors for funding but came up short. “Then someone mentioned that Prem Reddy was thinking of starting a medical school, and why don’t you guys get together?”\u003c/p>\n\u003cp>GnanaDev said he approached Reddy for a donation in the spring of 2013. During his meetings with Prem Reddy, GnanaDev said the subject of Hari Reddy’s medical license never came up.\u003c/p>\n\u003cp>Elizabeth Nikels, a spokeswoman for Prime Healthcare and Prem Reddy, said any implication that the medical school had anything to do with Hari Reddy’s medical license was “outrageous.” She added that Prem Reddy was not aware of GnanaDev’s role on the medical board until discussions for the medical school were well underway.\u003c/p>\n\u003cp>“Dr. Reddy’s selfless commitment to education and health care is the only reason for his sizable endowment to establish the medical school in San Bernardino County,” she said. “Any suggestions to the contrary are completely untrue and unfounded.”\u003c/p>\n\u003cp>Hari Reddy did not respond to multiple requests for comment by telephone and email.\u003c/p>\n\u003cp>Hari Reddy has long worked for facilities run by his brother-in law’s company. At the time the sexual misconduct took place, he was working at the Desert Valley Medical Group, a Prime Healthcare facility. After his license was revoked, he worked for Desert Valley Medical Group as a clerk and in other jobs that did not involve patient care, according to the medical board. And he is currently a hospitalist, a doctor who cares for hospitalized patients, at Desert Valley Hospital. (Hari Reddy is married to Prem Reddy’s sister; the couple happens to have same surname.)\u003c/p>\n\u003cp>The case against Hari Reddy is detailed in board documents. According to \u003ca href=\"http://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5cDIDOCS%5c20030425%5cDMRA2%5c&did=A1HUA093.DID&licenseType=A&licenseNumber=56371#page=1\">the findings of administrative law judge\u003c/a> in 2003, Hari Reddy repeatedly called an 18-year-old patient at home and made sexually explicit comments; he attempted to kiss a 16-year-old patient; he “cupped each of [a third patient’s] breasts with his hand”; and in the case of a fourth patient, he placed a stethoscope on her nipple, leaned against her and asked seductively, “Is there anything else I can do for you?”\u003c/p>\n\u003cp>The incidents led to Hari Reddy’s arrest and conviction on one count of misdemeanor battery — a conviction \u003ca href=\"http://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5cDIDOCS%5c20160824%5cDMRAAAFC5%5c&did=AAAFC160824220345223.DID&licenseType=A&licenseNumber=56371#page=1\">he successfully sought to have dismissed in 2005.\u003c/a>\u003c/p>\n\u003cp>Hari Reddy’s license was revoked by the medical board in 2003. After seeking unsuccessfully to have it reinstated in 2008, Reddy asked again three years later. This time, \u003ca href=\"http://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5cDIDOCS%5c20160824%5cDMRAAAFC5%5c&did=AAAFC160824220345223.DID&licenseType=A&licenseNumber=56371#page=1\">an administrative law judge concluded\u003c/a> that it was safe for him to practice, provided he be closely supervised for three years.\u003c/p>\n\u003cp>In February 2012, the case came before the medical board’s five-member disciplinary panel, which makes final decisions on behalf of the board. It was GnanaDev’s first time on the panel, as he had just been appointed to the board by Gov. Jerry Brown. The panel voted to reinstate Hari Reddy’s license, and increased the time of his administrative probation to seven years.\u003c/p>\n\u003cp>Although the board would not say how GnanaDev voted, he did not recuse himself. The panel required a quorum of four doctors, and with the absence of the panel’s usual fifth member, everyone had to participate for a vote to occur.\u003c/p>\n\u003cp>Andrist, the board critic, said he was bothered not just by the lack of transparency in the vote and the potential conflict of interest but the substance of the decision itself. “That doctor was dangerous…What mother would want to take her daughter to see him?”\u003c/p>\n\u003cp>Referring to everything that troubled him about the case, he said: “If this is happening with one doctor, who’s to say it isn’t happening with other doctors?”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Chad Terhune contributed to this report.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The president of the Medical Board of California is facing questions from critics about a business deal he struck after the board decided to reinstate the license of a doctor who engaged in sexual misconduct with patients.\u003c/p>\n\u003cp>In 2012, Dr. Dev GnanaDev, new to the board and not yet president, was part of a disciplinary panel that voted to \u003ca href=\"http://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5cDIDOCS%5c20160824%5cDMRAAAFC5%5c&did=AAAFC160824220345223.DID&licenseType=A&licenseNumber=56371#page=1\">reinstate Dr. Hari Reddy\u003c/a>. The Victorville family physician had lost his license in 2003 after the board found he had engaged in sexual misconduct with four female patients, including a minor.\u003c/p>\n\u003cp>About a year after the 2012 vote, GnanaDev sought a donation from one of Reddy’s relatives to start a new medical school in California’s Inland Empire, GnanaDev confirmed. Dr. Prem Reddy, Reddy’s brother-in-law, agreed to \u003ca href=\"http://www.premreddyfamilyfoundation.org/Press-Center/Recent-News/2014/Dr-Reddy-Puts-40-Million-Into-Nonprofit-Medical-.aspx\">put $40 million into the nonprofit venture\u003c/a>.\u003c/p>\n\u003cp>Prem Reddy is founder and CEO of Prime Healthcare, which operates \u003ca href=\"http://www.primehealthcare.com/\">44 hospitals in 14 states\u003c/a>, including the medical center where Hari Reddy now works.\u003c/p>\n\u003cp>The new medical school, \u003ca href=\"http://www.calmedu.org/\">California University of Science and Medicine\u003c/a>, is scheduled to open in 2018. GnanaDev is the president; Prem Reddy, chairman of the board.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>GnanaDev declined to say how he voted in Hari Reddy’s case, citing board policy. The medical board said the vote tally and how each board member voted is not public information.\u003c/p>\n\u003cp>The sequence of events has led a pair of vocal board critics, Marian Hollingsworth and Eric Andrist, to question whether there was a relationship between GnanaDev’s vote and the subsequent medical school donation.\u003c/p>\n\u003cp>Hollingsworth and Andrist called for an investigation Monday at legislative oversight hearing to review the performance of the medical board. \u003ca href=\"https://docs.google.com/document/d/1evuYpLqWGnWFKmTy3nk4DjP8CF9H1w9IOneyW88bpok/edit\">In a report\u003c/a> they submitted to legislators, which was broadly critical of the board, they detailed the Hari Reddy case and demanded the board be transparent about the vote.\u003c/p>\n\u003cp>“This smacks of conflict of interest,“ Hollingsworth told the Joint Sunset Review Oversight Hearing, which is held every four years. “Please help reorganize this agency so that exceptions and conflicts do not get in the way of protecting California consumers from truly dangerous doctors.”\u003c/p>\n\u003cp>State Sen. Jerry Hill (D-San Mateo) called the events, as described to him by a reporter, “alarming.” Hill, who is chairman of the Senate committee that took part in the oversight hearing, was contacted before the hearing and had been previously unaware of the circumstances.\u003c/p>\n\u003cp>“It certainly is worth looking at to see if there is a conflict that presented itself,” Hill said, adding that the board’s voting information should be public and “readily accessible.”\u003c/p>\n\u003cp> Dr. Prem Reddy (center) is pictured with Dr. Dev GnanaDev (right) in 2014. (James Quigg/Daily Press)\u003c/p>\n\u003cp>GnanaDev and Prem Reddy both deny any connection between Hari Reddy’s case and the medical school.\u003c/p>\n\u003cp>“I don’t know why someone thinks there was a conflict here. It’s just mind-boggling,” GnanaDev said in an interview.\u003c/p>\n\u003cp>At the time of the 2012 vote on Hari Reddy’s license, GnanaDev said he wasn’t even considering starting a medical school yet and knew Prem Reddy only in passing. He did know Hari Reddy, because Reddy had been a resident at Arrowhead Regional Medical Center in San Bernardino County, where GnanaDev was chief of surgery. But he said he followed protocol and disclosed that to the board before the vote.\u003c/p>\n\u003cp>GnanaDev said that when he later decided to start the school, it was out of a desire to contribute to an underserved community. He filed paperwork to incorporate the school in August 2012. He asked several wealthy donors for funding but came up short. “Then someone mentioned that Prem Reddy was thinking of starting a medical school, and why don’t you guys get together?”\u003c/p>\n\u003cp>GnanaDev said he approached Reddy for a donation in the spring of 2013. During his meetings with Prem Reddy, GnanaDev said the subject of Hari Reddy’s medical license never came up.\u003c/p>\n\u003cp>Elizabeth Nikels, a spokeswoman for Prime Healthcare and Prem Reddy, said any implication that the medical school had anything to do with Hari Reddy’s medical license was “outrageous.” She added that Prem Reddy was not aware of GnanaDev’s role on the medical board until discussions for the medical school were well underway.\u003c/p>\n\u003cp>“Dr. Reddy’s selfless commitment to education and health care is the only reason for his sizable endowment to establish the medical school in San Bernardino County,” she said. “Any suggestions to the contrary are completely untrue and unfounded.”\u003c/p>\n\u003cp>Hari Reddy did not respond to multiple requests for comment by telephone and email.\u003c/p>\n\u003cp>Hari Reddy has long worked for facilities run by his brother-in law’s company. At the time the sexual misconduct took place, he was working at the Desert Valley Medical Group, a Prime Healthcare facility. After his license was revoked, he worked for Desert Valley Medical Group as a clerk and in other jobs that did not involve patient care, according to the medical board. And he is currently a hospitalist, a doctor who cares for hospitalized patients, at Desert Valley Hospital. (Hari Reddy is married to Prem Reddy’s sister; the couple happens to have same surname.)\u003c/p>\n\u003cp>The case against Hari Reddy is detailed in board documents. According to \u003ca href=\"http://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5cDIDOCS%5c20030425%5cDMRA2%5c&did=A1HUA093.DID&licenseType=A&licenseNumber=56371#page=1\">the findings of administrative law judge\u003c/a> in 2003, Hari Reddy repeatedly called an 18-year-old patient at home and made sexually explicit comments; he attempted to kiss a 16-year-old patient; he “cupped each of [a third patient’s] breasts with his hand”; and in the case of a fourth patient, he placed a stethoscope on her nipple, leaned against her and asked seductively, “Is there anything else I can do for you?”\u003c/p>\n\u003cp>The incidents led to Hari Reddy’s arrest and conviction on one count of misdemeanor battery — a conviction \u003ca href=\"http://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5cDIDOCS%5c20160824%5cDMRAAAFC5%5c&did=AAAFC160824220345223.DID&licenseType=A&licenseNumber=56371#page=1\">he successfully sought to have dismissed in 2005.\u003c/a>\u003c/p>\n\u003cp>Hari Reddy’s license was revoked by the medical board in 2003. After seeking unsuccessfully to have it reinstated in 2008, Reddy asked again three years later. This time, \u003ca href=\"http://www2.mbc.ca.gov/BreezePDL/document.aspx?path=%5cDIDOCS%5c20160824%5cDMRAAAFC5%5c&did=AAAFC160824220345223.DID&licenseType=A&licenseNumber=56371#page=1\">an administrative law judge concluded\u003c/a> that it was safe for him to practice, provided he be closely supervised for three years.\u003c/p>\n\u003cp>In February 2012, the case came before the medical board’s five-member disciplinary panel, which makes final decisions on behalf of the board. It was GnanaDev’s first time on the panel, as he had just been appointed to the board by Gov. Jerry Brown. The panel voted to reinstate Hari Reddy’s license, and increased the time of his administrative probation to seven years.\u003c/p>\n\u003cp>Although the board would not say how GnanaDev voted, he did not recuse himself. The panel required a quorum of four doctors, and with the absence of the panel’s usual fifth member, everyone had to participate for a vote to occur.\u003c/p>\n\u003cp>Andrist, the board critic, said he was bothered not just by the lack of transparency in the vote and the potential conflict of interest but the substance of the decision itself. “That doctor was dangerous…What mother would want to take her daughter to see him?”\u003c/p>\n\u003cp>Referring to everything that troubled him about the case, he said: “If this is happening with one doctor, who’s to say it isn’t happening with other doctors?”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Chad Terhune contributed to this report.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "State Fires Contractor After Problems Put California HIV Patients At Risk",
"title": "State Fires Contractor After Problems Put California HIV Patients At Risk",
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"content": "\u003cp>California’s public health department Wednesday fired the contractor responsible for enrolling patients in a state-run AIDS program, saying its poor performance threatened enrollees’ access to life-saving medications.\u003c/p>\n\u003cp>The state announced it had terminated the contract with A.J. Boggs & Company because of several “material breaches,” including the failure to keep an online enrollment portal working properly. The department said in a written statement that the company also neglected to provide notice before hiring a subcontractor to provide services.\u003c/p>\n\u003cp>The state’s contract with Michigan-based A.J. Boggs began last July, when the California public health department decided not to renew the previous contractor, Ramsell Corp. Another company, Magellan Rx Management, of Arizona, got a contract to take over the pharmacy benefit services. It will continue to provide those services.\u003c/p>\n\u003cp>The department said it switched contracts to reduce administrative fees and drug reimbursement rates.\u003c/p>\n\u003cp>A.J. Boggs’ CEO Clarke Anderson declined to comment for this story.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The termination of the company’s enrollment contract followed a report in January by \u003ca href=\"http://aliforniahealthline.org/news/crucial-california-hiv-program-in-disarray-after-contract-switch/\" target=\"_blank\">California Healthline \u003c/a>and \u003ca href=\"http://khn.org/news/crucial-california-hiv-program-in-disarray-after-contract-switch/\" target=\"_blank\">Kaiser Health News\u003c/a> that patients were unable to get necessary drugs and timely care.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.cdph.ca.gov/programs/aids/Pages/tOAADAPindiv.aspx\" target=\"_blank\">AIDS Drug Assistance Program\u003c/a>, overseen by the public health department, helps nearly 30,000 low-income HIV and AIDS patients in California pay for medications, insurance premiums and medical care.\u003c/p>\n\u003cp>Public health department officials said Wednesday they planned to determine eligibility and enroll patients directly rather than contract with a new company to do so. It wasn’t clear how long the state would manage these services in-house, but the department’s statement said it was “exploring all long-term options.”\u003c/p>\n\u003cp>The departure of A.J. Boggs was welcomed by advocates across the state, who for months had been lobbying state officials to fix problems with enrollment and access, said Courtney Mulhern-Pearson, director of state and local affairs for the San Francisco AIDS Foundation.\u003c/p>\n\u003cp>“We are pleased that the state was able to make such a decisive move. This was necessary and what we have been asking them to do for a while,” she said. “We are cautiously optimistic this is going to be a good fix for the program.”\u003c/p>\n\u003cp>Mulhern-Pearson said advocacy groups were notified during a Wednesday morning conference call about the decision to end the contract with A.J. Boggs. She said she believes it will be more efficient for the state to determine eligibility and enroll patients in-house. “I am hoping this will mean less communication breakdown,” she said.\u003c/p>\n\u003cp>AIDS service providers began reporting problems soon after A.J. Boggs took over enrollment. Patients were turned away by pharmacies and had to postpone medical procedures, they said. Some were dropped from the program for no apparent reason, according to the San Francisco AIDS Foundation and APLA Health.\u003c/p>\n\u003cp>In November, the state shut down the online enrollment system because of security breaches. Enrollment workers from HIV and AIDS service organizations had to send in applications by fax.\u003c/p>\n\u003cp>The public health department said Wednesday it hired an independent consulting firm to help create a new system and plans to begin training enrollment workers the week of March 13.\u003c/p>\n\u003cp>State Sen. Scott D. Wiener (D-San Francisco), one of several legislators who wrote a letter late last year to the public health department insisting the problems be fixed, said in an email Wednesday that the contract termination is an “important first step.”\u003c/p>\n\u003cp>“Now, the Department needs to make system changes to ensure that HIV patients get the medication they need to survive and be healthy,” Wiener wrote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Consistent medical care and access to medication are critical for keeping HIV and AIDS patients healthy and reducing the spread of the disease.\u003c/p>\n\n",
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"excerpt": "The company tasked with enrolling eligible patients in an HIV assistance program failed to keep an online enrollment portal working effectively and violated other contract terms, the public health agency said.",
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"description": "The company tasked with enrolling eligible patients in an HIV assistance program failed to keep an online enrollment portal working effectively and violated other contract terms, the public health agency said.",
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"nprByline": "\u003ca href=\"http://californiahealthline.org/news/author/anna-gorman/\" target=\"_blank\">\u003cstrong>Anna Gorman\u003c/strong>\u003c/a>\u003c/br>\u003ca href=\"http://californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California’s public health department Wednesday fired the contractor responsible for enrolling patients in a state-run AIDS program, saying its poor performance threatened enrollees’ access to life-saving medications.\u003c/p>\n\u003cp>The state announced it had terminated the contract with A.J. Boggs & Company because of several “material breaches,” including the failure to keep an online enrollment portal working properly. The department said in a written statement that the company also neglected to provide notice before hiring a subcontractor to provide services.\u003c/p>\n\u003cp>The state’s contract with Michigan-based A.J. Boggs began last July, when the California public health department decided not to renew the previous contractor, Ramsell Corp. Another company, Magellan Rx Management, of Arizona, got a contract to take over the pharmacy benefit services. It will continue to provide those services.\u003c/p>\n\u003cp>The department said it switched contracts to reduce administrative fees and drug reimbursement rates.\u003c/p>\n\u003cp>A.J. Boggs’ CEO Clarke Anderson declined to comment for this story.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The termination of the company’s enrollment contract followed a report in January by \u003ca href=\"http://aliforniahealthline.org/news/crucial-california-hiv-program-in-disarray-after-contract-switch/\" target=\"_blank\">California Healthline \u003c/a>and \u003ca href=\"http://khn.org/news/crucial-california-hiv-program-in-disarray-after-contract-switch/\" target=\"_blank\">Kaiser Health News\u003c/a> that patients were unable to get necessary drugs and timely care.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.cdph.ca.gov/programs/aids/Pages/tOAADAPindiv.aspx\" target=\"_blank\">AIDS Drug Assistance Program\u003c/a>, overseen by the public health department, helps nearly 30,000 low-income HIV and AIDS patients in California pay for medications, insurance premiums and medical care.\u003c/p>\n\u003cp>Public health department officials said Wednesday they planned to determine eligibility and enroll patients directly rather than contract with a new company to do so. It wasn’t clear how long the state would manage these services in-house, but the department’s statement said it was “exploring all long-term options.”\u003c/p>\n\u003cp>The departure of A.J. Boggs was welcomed by advocates across the state, who for months had been lobbying state officials to fix problems with enrollment and access, said Courtney Mulhern-Pearson, director of state and local affairs for the San Francisco AIDS Foundation.\u003c/p>\n\u003cp>“We are pleased that the state was able to make such a decisive move. This was necessary and what we have been asking them to do for a while,” she said. “We are cautiously optimistic this is going to be a good fix for the program.”\u003c/p>\n\u003cp>Mulhern-Pearson said advocacy groups were notified during a Wednesday morning conference call about the decision to end the contract with A.J. Boggs. She said she believes it will be more efficient for the state to determine eligibility and enroll patients in-house. “I am hoping this will mean less communication breakdown,” she said.\u003c/p>\n\u003cp>AIDS service providers began reporting problems soon after A.J. Boggs took over enrollment. Patients were turned away by pharmacies and had to postpone medical procedures, they said. Some were dropped from the program for no apparent reason, according to the San Francisco AIDS Foundation and APLA Health.\u003c/p>\n\u003cp>In November, the state shut down the online enrollment system because of security breaches. Enrollment workers from HIV and AIDS service organizations had to send in applications by fax.\u003c/p>\n\u003cp>The public health department said Wednesday it hired an independent consulting firm to help create a new system and plans to begin training enrollment workers the week of March 13.\u003c/p>\n\u003cp>State Sen. Scott D. Wiener (D-San Francisco), one of several legislators who wrote a letter late last year to the public health department insisting the problems be fixed, said in an email Wednesday that the contract termination is an “important first step.”\u003c/p>\n\u003cp>“Now, the Department needs to make system changes to ensure that HIV patients get the medication they need to survive and be healthy,” Wiener wrote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Consistent medical care and access to medication are critical for keeping HIV and AIDS patients healthy and reducing the spread of the disease.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Safety-Net Medical Center Wrestles With Specter Of ‘Repeal’",
"title": "A Safety-Net Medical Center Wrestles With Specter Of ‘Repeal’",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>SAN MATEO — Little surprises Lynda Sutherland, who has been a licensed vocational nurse for 35 years at San Mateo Medical Center. But in the past few years, Sutherland said, she’s been surprised by what’s missing: the patients who used to return again and again to the public hospital for the same ailments.\u003c/p>\n\u003cp>“They’re just not coming back,” she said.\u003c/p>\n\u003cp>Spurred by the Affordable Care Act (ACA), medical centers like this one have overhauled the way they deliver care in an effort to keep patients healthier and out of hospital beds. They have connected newly insured patients with primary care doctors in outpatient clinics, helped them manage chronic diseases and tried to reduce their reliance on emergency rooms for routine care.\u003c/p>\n\u003cp>Now, with President Donald Trump and congressional Republicans pledging to repeal Obamacare, such hospitals fear the gains they have made could be lost or diminished. In particular, they worry that if patients lose health insurance, their revenue will fall — to the detriment of the patients, the hospital staff and the community.\u003c/p>\n\u003cp>“It would be felt on a daily basis,” said Erin O’Malley, director of policy for America’s Essential Hospitals, a nationwide association of nearly 300 hospitals that serve low-income patients. “Our mission will not be changing, but the challenges will be mounting … especially if we have a ‘repeal’ without a comparable ‘replace.’ ”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The California Hospital Association sent a letter Feb. 8 to California’s congressional delegation on behalf of hundreds of hospitals and health systems, saying that repealing the Affordable Care Act without replacing it “would upend the financial stability of hospitals and their patients.”\u003c/p>\n\u003cp>The association wrote that it was particularly concerned about proposals that would reduce federal dollars for Medicaid, which was significantly expanded under the 2010 health law to include low-income childless adults. The association also expressed concern about dismantling the changes hospitals have made to promote the quality of care over the quantity. For instance, as a result of new financial penalties under Medicare, many hospitals invested in changes to ensure they weren’t readmitting patients too soon after discharge.\u003c/p>\n\u003cp>Although all hospitals would be affected if the health law were repealed, public and safety-net facilities such as San Mateo Medical Center would suffer more, said Gerald Kominski, director of the UCLA Center for Health Policy Research.\u003c/p>\n\u003cp>“The Affordable Care Act has certainly stabilized the financial situation of safety-net providers,” he said. “If we roll back the ACA completely and don’t have a replacement plan that specifically improves funding for safety-net providers, then those hospitals are going to become more vulnerable again.”\u003c/p>\n\u003cp>Across the nation, hospitals that serve the poor have raised similar concerns. A recent analysis by America’s Essential Hospitals showed that hospitals could lose more than $40 billion in funding from 2018 to 2026 if the law is repealed.\u003c/p>\n\u003cp> Over the past several years, safety-net hospitals like San Mateo Medical Center have worked to help patients better manage their chronic diseases and reduce their reliance on emergency rooms for routine care. Administrators worry if the Affordable Care Act is repealed, they will lose revenue and be unable to focus as much on prevention. (Anna Gorman/KHN)\u003c/p>\n\u003cp>Republicans have put forward several proposals that worry hospital administrators. Among them are Medicaid block grants, which could result in less funding for beneficiaries, and withdrawal of federal support for insurance exchanges.\u003c/p>\n\u003cp>About 72,000 patients are seen annually at the county-run San Mateo Medical Center, which includes the hospital and nine outpatient clinics. Before the health law took effect, 48 percent of patients were uninsured and 31 percent were on Medi-Cal, the state’s version of Medicaid. Now, 17 percent are uninsured and 57 percent have Medi-Cal.\u003c/p>\n\u003cp>“If Medicaid rolls back … not only does the revenue disappear, but then people will delay care, get sicker and then costs will go up,” said Chester Kunnappilly, CEO of the medical center.\u003c/p>\n\u003cp>The hospital and clinics receive $166 million annually in Medi-Cal revenue — which makes up about 60 percent of the total budget. At least $50 million would be at risk with a repeal of the ACA, Kunnappilly said.\u003c/p>\n\u003cp>“People will lose their jobs, and it becomes this vicious cycle,” he said. “How many people we can take care of continues to shrink because the teams get smaller.”\u003c/p>\n\u003cp> Michael Asip enrolled in expanded Medi-Cal under the Affordable Care Act before switching to Medicare when he turned 65 last year. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the San Mateo Medical Center. “I’m the poster boy for the safety net,” he said. (Anna Gorman/KHN)\u003c/p>\n\u003cp>San Mateo Medical Center made numerous changes over the past few years to catch patients before they became seriously ill. For example, it created teams of outpatient providers — including pharmacists, medical assistants and social workers — to coordinate care. It began reminding patients when they needed to get mammograms and other preventive tests. They expanded substance abuse and mental health treatment, which was required to be covered under the law.\u003c/p>\n\u003cp>In addition, the medical center sent patients with urgent needs to “express care” so they wouldn’t have to go to the emergency room or wait to see their doctor. Hospital administrators changed the discharge process, sending some patients home with the medications they needed and even dispatching staff to visit others after release.\u003c/p>\n\u003cp>Dramatic changes were made by safety-net hospitals elsewhere in response to the ACA. In Los Angeles County, for example, a computer system was developed to the ensure less duplication of care and better monitoring of patients, and patients were assigned to clinics that served as their medical “homes.”\u003c/p>\n\u003cp>“The ACA provided the economic incentive to do what should have been done anyway,” said Mitch Katz, director of the Los Angeles County health department. “It won’t go back to the way it was done before.”\u003c/p>\n\u003cp>On a recent day at the San Mateo Medical Center, Marla Muniz, a 46-year-old waitress from San Mateo, came to a clinic at the medical center for a physical and treatment for worsening pain in her shoulders and arm. She has Medi-Cal now, because of the program’s expansion, after going years without health insurance.\u003c/p>\n\u003cp>“I am scared they are going to take away my Medi-Cal,” she said. “If I had a good job that paid well, it wouldn’t matter. But I don’t. And I have a lot of pain. I have more and more pain every day.”\u003c/p>\n\u003cp>Another patient, Michael Asip, was there to see one of his physicians. He’d enrolled in expanded Medi-Cal before turning 65, then switched to Medicare. Long uninsured, he had gone months without seeing a doctor even after a heart attack. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the medical center.\u003c/p>\n\u003cp>Sumita Kalra, a physician at a primary care clinic, said she has seen numerous patients like Muniz and Asip who put off health care for years. When they finally got coverage through the ACA, some were diagnosed with diabetes, cancer and other serious diseases.\u003c/p>\n\u003cp>Now “we can catch those ticking time bombs before something worse happens,” Kalra said.\u003c/p>\n\u003cp>Louise Rogers, chief of the San Mateo County Health System, said that kind of change, fostered by the ACA, should not be reversed.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We don’t want to see a turning back of the clock,” she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>SAN MATEO — Little surprises Lynda Sutherland, who has been a licensed vocational nurse for 35 years at San Mateo Medical Center. But in the past few years, Sutherland said, she’s been surprised by what’s missing: the patients who used to return again and again to the public hospital for the same ailments.\u003c/p>\n\u003cp>“They’re just not coming back,” she said.\u003c/p>\n\u003cp>Spurred by the Affordable Care Act (ACA), medical centers like this one have overhauled the way they deliver care in an effort to keep patients healthier and out of hospital beds. They have connected newly insured patients with primary care doctors in outpatient clinics, helped them manage chronic diseases and tried to reduce their reliance on emergency rooms for routine care.\u003c/p>\n\u003cp>Now, with President Donald Trump and congressional Republicans pledging to repeal Obamacare, such hospitals fear the gains they have made could be lost or diminished. In particular, they worry that if patients lose health insurance, their revenue will fall — to the detriment of the patients, the hospital staff and the community.\u003c/p>\n\u003cp>“It would be felt on a daily basis,” said Erin O’Malley, director of policy for America’s Essential Hospitals, a nationwide association of nearly 300 hospitals that serve low-income patients. “Our mission will not be changing, but the challenges will be mounting … especially if we have a ‘repeal’ without a comparable ‘replace.’ ”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The California Hospital Association sent a letter Feb. 8 to California’s congressional delegation on behalf of hundreds of hospitals and health systems, saying that repealing the Affordable Care Act without replacing it “would upend the financial stability of hospitals and their patients.”\u003c/p>\n\u003cp>The association wrote that it was particularly concerned about proposals that would reduce federal dollars for Medicaid, which was significantly expanded under the 2010 health law to include low-income childless adults. The association also expressed concern about dismantling the changes hospitals have made to promote the quality of care over the quantity. For instance, as a result of new financial penalties under Medicare, many hospitals invested in changes to ensure they weren’t readmitting patients too soon after discharge.\u003c/p>\n\u003cp>Although all hospitals would be affected if the health law were repealed, public and safety-net facilities such as San Mateo Medical Center would suffer more, said Gerald Kominski, director of the UCLA Center for Health Policy Research.\u003c/p>\n\u003cp>“The Affordable Care Act has certainly stabilized the financial situation of safety-net providers,” he said. “If we roll back the ACA completely and don’t have a replacement plan that specifically improves funding for safety-net providers, then those hospitals are going to become more vulnerable again.”\u003c/p>\n\u003cp>Across the nation, hospitals that serve the poor have raised similar concerns. A recent analysis by America’s Essential Hospitals showed that hospitals could lose more than $40 billion in funding from 2018 to 2026 if the law is repealed.\u003c/p>\n\u003cp> Over the past several years, safety-net hospitals like San Mateo Medical Center have worked to help patients better manage their chronic diseases and reduce their reliance on emergency rooms for routine care. Administrators worry if the Affordable Care Act is repealed, they will lose revenue and be unable to focus as much on prevention. (Anna Gorman/KHN)\u003c/p>\n\u003cp>Republicans have put forward several proposals that worry hospital administrators. Among them are Medicaid block grants, which could result in less funding for beneficiaries, and withdrawal of federal support for insurance exchanges.\u003c/p>\n\u003cp>About 72,000 patients are seen annually at the county-run San Mateo Medical Center, which includes the hospital and nine outpatient clinics. Before the health law took effect, 48 percent of patients were uninsured and 31 percent were on Medi-Cal, the state’s version of Medicaid. Now, 17 percent are uninsured and 57 percent have Medi-Cal.\u003c/p>\n\u003cp>“If Medicaid rolls back … not only does the revenue disappear, but then people will delay care, get sicker and then costs will go up,” said Chester Kunnappilly, CEO of the medical center.\u003c/p>\n\u003cp>The hospital and clinics receive $166 million annually in Medi-Cal revenue — which makes up about 60 percent of the total budget. At least $50 million would be at risk with a repeal of the ACA, Kunnappilly said.\u003c/p>\n\u003cp>“People will lose their jobs, and it becomes this vicious cycle,” he said. “How many people we can take care of continues to shrink because the teams get smaller.”\u003c/p>\n\u003cp> Michael Asip enrolled in expanded Medi-Cal under the Affordable Care Act before switching to Medicare when he turned 65 last year. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the San Mateo Medical Center. “I’m the poster boy for the safety net,” he said. (Anna Gorman/KHN)\u003c/p>\n\u003cp>San Mateo Medical Center made numerous changes over the past few years to catch patients before they became seriously ill. For example, it created teams of outpatient providers — including pharmacists, medical assistants and social workers — to coordinate care. It began reminding patients when they needed to get mammograms and other preventive tests. They expanded substance abuse and mental health treatment, which was required to be covered under the law.\u003c/p>\n\u003cp>In addition, the medical center sent patients with urgent needs to “express care” so they wouldn’t have to go to the emergency room or wait to see their doctor. Hospital administrators changed the discharge process, sending some patients home with the medications they needed and even dispatching staff to visit others after release.\u003c/p>\n\u003cp>Dramatic changes were made by safety-net hospitals elsewhere in response to the ACA. In Los Angeles County, for example, a computer system was developed to the ensure less duplication of care and better monitoring of patients, and patients were assigned to clinics that served as their medical “homes.”\u003c/p>\n\u003cp>“The ACA provided the economic incentive to do what should have been done anyway,” said Mitch Katz, director of the Los Angeles County health department. “It won’t go back to the way it was done before.”\u003c/p>\n\u003cp>On a recent day at the San Mateo Medical Center, Marla Muniz, a 46-year-old waitress from San Mateo, came to a clinic at the medical center for a physical and treatment for worsening pain in her shoulders and arm. She has Medi-Cal now, because of the program’s expansion, after going years without health insurance.\u003c/p>\n\u003cp>“I am scared they are going to take away my Medi-Cal,” she said. “If I had a good job that paid well, it wouldn’t matter. But I don’t. And I have a lot of pain. I have more and more pain every day.”\u003c/p>\n\u003cp>Another patient, Michael Asip, was there to see one of his physicians. He’d enrolled in expanded Medi-Cal before turning 65, then switched to Medicare. Long uninsured, he had gone months without seeing a doctor even after a heart attack. Now, the San Mateo resident sees a cardiologist, a primary care doctor, a psychologist and an endocrinologist through the medical center.\u003c/p>\n\u003cp>Sumita Kalra, a physician at a primary care clinic, said she has seen numerous patients like Muniz and Asip who put off health care for years. When they finally got coverage through the ACA, some were diagnosed with diabetes, cancer and other serious diseases.\u003c/p>\n\u003cp>Now “we can catch those ticking time bombs before something worse happens,” Kalra said.\u003c/p>\n\u003cp>Louise Rogers, chief of the San Mateo County Health System, said that kind of change, fostered by the ACA, should not be reversed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Chanting \"Medicare for all is our fight, health care is a human right,\" nurses and health care activists rallied in Sacramento Wednesday to support a new bill that would create universal health coverage for Californians.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/309210872\" 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>State Senators Ricardo Lara (D-Bell Gardens) and Toni G. Atkins (D-San Diego) introduced \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\" target=\"_blank\">Senate Bill 562 \u003c/a>last week. The bill would cover all residents of the state, even those who are undocumented. The bill does not include a timeline or specifics, but it does mention the intent to \"enact legislation that would establish a comprehensive universal single-payer health care coverage program.\" This would mean that the state government, not insurance companies, would pay for care. Such systems are also known as \"single payer,\" with Medicare being the best-known example.\u003c/p>\n\u003cp>Lara spoke at the rally, greeting the crowd of roughly 400, many of them nurses mobilized by their union, the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\">California Nurses Association\u003c/a>. \"We’re going to finally put doctors, nurses, and clinicians actually in charge of the care, and not insurance companies,\" he said.\u003c/p>\n\u003cp>California legislators have twice submitted bills for universal health care that went all the way to the desk of then-governor Arnold Schwarzennegger. He vetoed both.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The head of the California Nurses Association, RoseAnn DeMoro, thinks this time things will be different. She acknowledged the Affordable Care Act has expanded coverage, but said the plans it offers are still too expensive for some, and asking low-income people to step up and politically defend the ACA doesn't make sense.\u003c/p>\n\u003cp>\"The average person who we’re asking to take a stand for the ACA, we’re basically asking them to do something they can’t afford,\" she said.\u003c/p>\n\u003cp>She and other nurses, who showed up wearing the red colors of the nurse's union, want something broader than the ACA, which offers few options for undocumented people. They want a system that covers all their patients, no exceptions. They also argue that single-payer health care systems are more cost-efficient, because they eliminate burdensome paperwork and administrative overhead.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Critics of universal coverage say it would give government too much control over medicine, and require a drastic increase in taxes to fund it.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Chanting \"Medicare for all is our fight, health care is a human right,\" nurses and health care activists rallied in Sacramento Wednesday to support a new bill that would create universal health coverage for Californians.\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/309210872&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/309210872'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>State Senators Ricardo Lara (D-Bell Gardens) and Toni G. Atkins (D-San Diego) introduced \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562\" target=\"_blank\">Senate Bill 562 \u003c/a>last week. The bill would cover all residents of the state, even those who are undocumented. The bill does not include a timeline or specifics, but it does mention the intent to \"enact legislation that would establish a comprehensive universal single-payer health care coverage program.\" This would mean that the state government, not insurance companies, would pay for care. Such systems are also known as \"single payer,\" with Medicare being the best-known example.\u003c/p>\n\u003cp>Lara spoke at the rally, greeting the crowd of roughly 400, many of them nurses mobilized by their union, the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\">California Nurses Association\u003c/a>. \"We’re going to finally put doctors, nurses, and clinicians actually in charge of the care, and not insurance companies,\" he said.\u003c/p>\n\u003cp>California legislators have twice submitted bills for universal health care that went all the way to the desk of then-governor Arnold Schwarzennegger. He vetoed both.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The head of the California Nurses Association, RoseAnn DeMoro, thinks this time things will be different. She acknowledged the Affordable Care Act has expanded coverage, but said the plans it offers are still too expensive for some, and asking low-income people to step up and politically defend the ACA doesn't make sense.\u003c/p>\n\u003cp>\"The average person who we’re asking to take a stand for the ACA, we’re basically asking them to do something they can’t afford,\" she said.\u003c/p>\n\u003cp>She and other nurses, who showed up wearing the red colors of the nurse's union, want something broader than the ACA, which offers few options for undocumented people. They want a system that covers all their patients, no exceptions. They also argue that single-payer health care systems are more cost-efficient, because they eliminate burdensome paperwork and administrative overhead.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Critics of universal coverage say it would give government too much control over medicine, and require a drastic increase in taxes to fund it.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Legislation introduced in the state Senate Friday would set California on a path toward the possible creation of a single-payer health care system ― a proposal that has failed to gain traction here in the past.\u003c/p>\n\u003cp>The bill, which is a preliminary step, says that it is the “intent of the Legislature” to enact a law that would establish a comprehensive, single-payer health care program for the benefit of everyone in the state. The legislation, introduced by state Sen. Ricardo Lara (D-Bell Gardens), does not offer specifics of what the plan would look like, nor does it mention a timetable.\u003c/p>\n\u003cp>A single-payer system would replace private insurance with a government plan that pays for coverage for everyone. Proponents argue that single-payer systems make health care more affordable and efficient, but opponents say they raise taxpayer costs and give government too much power.\u003c/p>\n\u003cp>Medicare, the federally-funded health coverage for the elderly, is often held up as a model of what a single-payer system might look like.\u003c/p>\n\u003cp>Lara said in an interview Thursday that the state needs to be prepared in case the Affordable Care Act is repealed, as President Donald Trump and Congressional Republicans have promised.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The health of Californians is really at stake here and is at risk with what is being threatened in Congress,” Lara said, as the debate continued in Washington about the future of President Barack Obama’s signature health law. “We don’t have the luxury to wait and see what they are going to do and what the plan is,”\u003c/p>\n\u003cp>Lara noted that while the Affordable Care Act expanded health coverage for many Californians, it left others uninsured or underinsured. He said the single-payer bill builds upon his “health for all kids” legislation, which resulted in coverage beginning last May for 170,000 immigrant children here illegally.\u003c/p>\n\u003cp>“I’ve met many children who have asked me point blank, ‘What about my mom? What about my dad?’” Lara said.\u003c/p>\n\u003cp>He recently \u003ca href=\"http://californiahealthline.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\" target=\"_blank\">withdrew a request\u003c/a> to the federal government, based on a bill he had introduced, that would have allowed adult immigrants here illegally to purchase unsubsidized health plans through Covered California, the state’s insurance exchange.\u003c/p>\n\u003cdiv id=\"attachment_188745\" style=\"width: 280px\" class=\"wp-caption alignright\">\u003cimg class=\"wp-image-188745 size-khn-article-vertical\" src=\"https://californiahealthline.files.wordpress.com/2016/02/lara_670.jpg?w=270&h=405&crop=1\" alt=\"Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara's office)\" width=\"270\" height=\"405\">\n\u003cp class=\"wp-caption-text\">Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara’s office)\u003c/p>\n\u003c/div>\n\u003cp>According to the text of the Lara’s bill, a single-payer system would help address rising out-of-pocket costs and shrinking networks of doctors.\u003c/p>\n\u003cp>No state has a single-payer health system. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after the state couldn’t figure out how to finance it. Last year, Colorado residents rejected a ballot measure that would have used payroll taxes to fund a near universal coverage system.\u003c/p>\n\u003cp>In California, voters rejected a ballot initiative in 1994 that would have established a government-run universal health program. Gov. Arnold Schwarzenegger later vetoed two bills that would have accomplished the same goal.\u003c/p>\n\u003cp>It’s difficult to create consensus on single-payer plans because they dramatically shift how health care is delivered and paid for, said Larry Levitt, a senior vice president at the Kaiser Family Foundation (California Healthline is produced by Kaiser Health News, an editorially-independent program of the foundation.)\u003c/p>\n\u003cp>“Single-payer plans have lots of appeal in their simplicity and ability to control costs,” Levitt said. “But what I think has always held back a move to single-payer is the disruption they create in financing and delivery of care.”\u003c/p>\n\u003cp>The problem, Levitt said, is that even if they end up costing less overall, single-payer plans look to the public like a “very big tax increase.”\u003c/p>\n\u003cp>The California Nurses Association, the primary sponsor of the new bill, is planning a rally in Sacramento next week in support of a single-payer system. Bonnie Castillo, the group’s associate executive director, said the goal is to create a system that doesn’t exclude anyone and helps relieve patients’ financial burdens.\u003c/p>\n\u003cp>“Patients and their families are suffering as a result of having very high co-pay and premium costs,” she said. “They are having to make gut-wrenching decisions whether they go to the doctor or they stick it out and see if they get better on their own.”\u003c/p>\n\u003cp>Castillo said that with so much uncertainty at the national level, California has the ability to create a better system. “We think we can get this right,” she said.\u003c/p>\n\u003cp>Charles Bacchi, president and CEO of the California Association of Health Plans, said he hadn’t yet seen the bill, but the trade group has opposed single-payer proposals in the past.\u003c/p>\n\u003cp>“It’s hard to tell until you know the details,” Bacchi said. “But past studies have shown [single-payer systems] are incredibly expensive and would be disruptive.”\u003c/p>\n\u003cp>He said health plans, doctors, hospitals and others are “laser-focused on protecting and enhancing the gains we have made in coverage” under the Affordable Care Act and ensuring that California continues to receive critical funding. “We think that’s where the focus should be,” he said.\u003c/p>\n\u003cp>One possible concept of a single-payer system in California would be to bring together funding from several sources under one state umbrella: Medi-Cal, which covers the poor; Medicare, the federal program that covers older adults, and private insurance.\u003c/p>\n\u003cp>Lara said he has not yet figured out the financing, saying that it is still early in the legislative process. But he said that even as California continues to defend the Affordable Care Act, it is time to put forward an alternative.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I think we’ve reached a tipping point now that we haven’t had before,” he said.\u003c/p>\n\n",
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"nprByline": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/anna-gorman/\" target=\"_blank\">Anna Gorman\u003c/a>\u003c/strong>\u003c/br>California Healthline",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Legislation introduced in the state Senate Friday would set California on a path toward the possible creation of a single-payer health care system ― a proposal that has failed to gain traction here in the past.\u003c/p>\n\u003cp>The bill, which is a preliminary step, says that it is the “intent of the Legislature” to enact a law that would establish a comprehensive, single-payer health care program for the benefit of everyone in the state. The legislation, introduced by state Sen. Ricardo Lara (D-Bell Gardens), does not offer specifics of what the plan would look like, nor does it mention a timetable.\u003c/p>\n\u003cp>A single-payer system would replace private insurance with a government plan that pays for coverage for everyone. Proponents argue that single-payer systems make health care more affordable and efficient, but opponents say they raise taxpayer costs and give government too much power.\u003c/p>\n\u003cp>Medicare, the federally-funded health coverage for the elderly, is often held up as a model of what a single-payer system might look like.\u003c/p>\n\u003cp>Lara said in an interview Thursday that the state needs to be prepared in case the Affordable Care Act is repealed, as President Donald Trump and Congressional Republicans have promised.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The health of Californians is really at stake here and is at risk with what is being threatened in Congress,” Lara said, as the debate continued in Washington about the future of President Barack Obama’s signature health law. “We don’t have the luxury to wait and see what they are going to do and what the plan is,”\u003c/p>\n\u003cp>Lara noted that while the Affordable Care Act expanded health coverage for many Californians, it left others uninsured or underinsured. He said the single-payer bill builds upon his “health for all kids” legislation, which resulted in coverage beginning last May for 170,000 immigrant children here illegally.\u003c/p>\n\u003cp>“I’ve met many children who have asked me point blank, ‘What about my mom? What about my dad?’” Lara said.\u003c/p>\n\u003cp>He recently \u003ca href=\"http://californiahealthline.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\" target=\"_blank\">withdrew a request\u003c/a> to the federal government, based on a bill he had introduced, that would have allowed adult immigrants here illegally to purchase unsubsidized health plans through Covered California, the state’s insurance exchange.\u003c/p>\n\u003cdiv id=\"attachment_188745\" style=\"width: 280px\" class=\"wp-caption alignright\">\u003cimg class=\"wp-image-188745 size-khn-article-vertical\" src=\"https://californiahealthline.files.wordpress.com/2016/02/lara_670.jpg?w=270&h=405&crop=1\" alt=\"Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara's office)\" width=\"270\" height=\"405\">\n\u003cp class=\"wp-caption-text\">Sen. Ricardo Lara, D-Bell Gardens (Courtesy Sen. Lara’s office)\u003c/p>\n\u003c/div>\n\u003cp>According to the text of the Lara’s bill, a single-payer system would help address rising out-of-pocket costs and shrinking networks of doctors.\u003c/p>\n\u003cp>No state has a single-payer health system. Perhaps the best-known effort to create one was in Vermont, but it failed in 2014 after the state couldn’t figure out how to finance it. Last year, Colorado residents rejected a ballot measure that would have used payroll taxes to fund a near universal coverage system.\u003c/p>\n\u003cp>In California, voters rejected a ballot initiative in 1994 that would have established a government-run universal health program. Gov. Arnold Schwarzenegger later vetoed two bills that would have accomplished the same goal.\u003c/p>\n\u003cp>It’s difficult to create consensus on single-payer plans because they dramatically shift how health care is delivered and paid for, said Larry Levitt, a senior vice president at the Kaiser Family Foundation (California Healthline is produced by Kaiser Health News, an editorially-independent program of the foundation.)\u003c/p>\n\u003cp>“Single-payer plans have lots of appeal in their simplicity and ability to control costs,” Levitt said. “But what I think has always held back a move to single-payer is the disruption they create in financing and delivery of care.”\u003c/p>\n\u003cp>The problem, Levitt said, is that even if they end up costing less overall, single-payer plans look to the public like a “very big tax increase.”\u003c/p>\n\u003cp>The California Nurses Association, the primary sponsor of the new bill, is planning a rally in Sacramento next week in support of a single-payer system. Bonnie Castillo, the group’s associate executive director, said the goal is to create a system that doesn’t exclude anyone and helps relieve patients’ financial burdens.\u003c/p>\n\u003cp>“Patients and their families are suffering as a result of having very high co-pay and premium costs,” she said. “They are having to make gut-wrenching decisions whether they go to the doctor or they stick it out and see if they get better on their own.”\u003c/p>\n\u003cp>Castillo said that with so much uncertainty at the national level, California has the ability to create a better system. “We think we can get this right,” she said.\u003c/p>\n\u003cp>Charles Bacchi, president and CEO of the California Association of Health Plans, said he hadn’t yet seen the bill, but the trade group has opposed single-payer proposals in the past.\u003c/p>\n\u003cp>“It’s hard to tell until you know the details,” Bacchi said. “But past studies have shown [single-payer systems] are incredibly expensive and would be disruptive.”\u003c/p>\n\u003cp>He said health plans, doctors, hospitals and others are “laser-focused on protecting and enhancing the gains we have made in coverage” under the Affordable Care Act and ensuring that California continues to receive critical funding. “We think that’s where the focus should be,” he said.\u003c/p>\n\u003cp>One possible concept of a single-payer system in California would be to bring together funding from several sources under one state umbrella: Medi-Cal, which covers the poor; Medicare, the federal program that covers older adults, and private insurance.\u003c/p>\n\u003cp>Lara said he has not yet figured out the financing, saying that it is still early in the legislative process. But he said that even as California continues to defend the Affordable Care Act, it is time to put forward an alternative.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I think we’ve reached a tipping point now that we haven’t had before,” he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "CEO of California-Based Health Insurer Says Obamacare Just Needs a Tune-Up",
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"content": "\u003cp>Some large health insurance companies have suffered losses under the Affordable Care Act, leading to a couple high-profile exits from the health exchanges – Humana was the latest. But one smaller, Long Beach-based insurer has done OK: Molina Healthcare.\u003c/p>\n\u003cp>“We understood the demographics of the people that we’re serving a little better, ” said J. Mario Molina, CEO of Molina Healthcare, \"because we’ve been doing it for so long,\"\u003c/p>\n\u003cp>Molina’s father, David, founded Molina Healthcare in 1980, after a career as a doctor. Sometimes his patients couldn’t pay, so they would barter, or they gave him items from their homes instead: a glass decanter, a pipe organ, even the family dog.\u003c/p>\n\u003cp>“My father was old-fashioned,” recalled the younger Molina. “He believed doctors had an obligation to take care of patients, and that the primary issue was not how they were going to get paid.”\u003c/p>\n\u003cfigure id=\"attachment_294594\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-294594\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/015-800x623.jpg\" alt=\"C. David Molina reviewing medical records\" width=\"800\" height=\"623\">\u003cfigcaption class=\"wp-caption-text\">C. David Molina reviewing medical records \u003ccite>(Courtesy of Molina Healthcare)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The elder Molina opened a network of medical clinics serving low-income patients, and then later, started a health insurance company focused on customers with Medicaid, government coverage for the poor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That is what positioned the company to move into the Obamacare marketplaces so smoothly, Mario Molina explained, because most people who signed up for Obamacare plans are low-income.\u003c/p>\n\u003cp>“It’s a different population most insurance companies haven’t been interested in,” he said.\u003c/p>\n\u003cp>For example, transportation is an issue for their customers, Molina said. They often take the bus to medical appointments, so they’d much rather see a doctor close to home, not someone at a fancy academic hospital 30 miles away.\u003c/p>\n\u003cp>“We don’t contract with every hospital and every doctor,” he said. “It’s not everyone, but it’s enough so that you can find a doctor and the hospital and the services you need.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/308218361\" 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>Having fewer doctors in their network means lower costs for Molina. And that means the company was able to earn some modest profits -- roughly 1 percent in the first couple years of Obamacare.\u003c/p>\n\u003cp>But some big name commercial insurers are used to creating health plans for employers, who often want more doctors and more benefits to attract better employees. Plans like that cost more.\u003c/p>\n\u003cp>“They’re looking at things sort of from the top down, and we’re looking at things from the bottom up,” Molina said.\u003c/p>\n\u003cp>He’s used to running a low-cost, low-margin business. Those big guys aren’t. Industry analysts say that’s why some of them lost money with Obamacare.\u003c/p>\n\u003cp>“It’s easier to work up from a low-cost position than it is to work down from a higher-cost position,” said Josh Weisbrod, a health care consultant with Bain and Company. “For an insurer that is used to selling employer plans with rich benefit designs and broad networks, it is difficult for them to transition that to a narrow network of lower cost providers.”\u003c/p>\n\u003cp>But Molina says there’s been a serious downside to his company’s success: a provision of the Affordable Care Act known as “risk transfer.” The program was designed to help insurance companies cover losses, if they ended up with a lot of really sick, expensive patients. The way it works: companies with fewer sick patients pay some of their revenues to the companies that have more.\u003c/p>\n\u003cp>It was a fine idea, Molina said, but the formula lawmakers came up with to calculate risk was all wrong.\u003c/p>\n\u003cfigure id=\"attachment_294593\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-294593\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/MARIO-MOLINA_FINAL1-800x532.jpg\" alt=\"Mario Molina, CEO of Molina Healthcare\" width=\"800\" height=\"532\">\u003cfigcaption class=\"wp-caption-text\">Mario Molina, CEO of Molina Healthcare \u003ccite>(Courtesy of Molina Healthcare)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Let’s put it this way: currently Molina Healthcare is returning 25 percent of our premiums to the government, which are then distributed to our competitors,” he said. “So we are really subsidizing our competitors and helping them, rather than forcing them to compete.”\u003c/p>\n\u003cp>And that hit Molina’s bottom line in 2016, resulting in much lower profits than originally projected. Molina said the risk formula factors in the average cost of premiums in the state, which seems to punish efficiency rather than help those who had some bad luck.\u003c/p>\n\u003cp>“I think it was done by well-meaning people who had a theoretical knowledge, but not a practical knowledge of insurance,” he said.\u003c/p>\n\u003cp>Still, Molina remains a fan of the Affordable Care Act overall. His company operates in 12 states and Puerto Rico, and he hopes Congress will consult with him and other insurers as it debates the future of the health law.\u003c/p>\n\u003cp>“It doesn’t need to be scrapped and replaced,” he said. “It needs a tune-up.”\u003c/p>\n\u003cp>He added that if lawmakers need guidance on how to fix Obamacare, they should look at one state that really got it right: California.\u003c/p>\n\u003cp>California insurance regulators \"forced everyone to really compete. and that made everyone kind of sharpen their pencils and do a better job,” he said. “It’s kept everyone on their toes, and, as a result, I think there’s been more stability in the marketplace.”\u003c/p>\n\u003cp>There’s also more predictability. California may have more business regulations than other states, but Molina believes that’s created a level playing field.\u003c/p>\n\u003cp>“The state doesn’t make arbitrary decisions. We can plan from year to year. We understand the rules,” he said. “Imagine if you’re trying to play a game and the rules change in every quarter.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Molina is hoping the newly-elected rule makers at the federal level take this to heart.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Some large health insurance companies have suffered losses under the Affordable Care Act, leading to a couple high-profile exits from the health exchanges – Humana was the latest. But one smaller, Long Beach-based insurer has done OK: Molina Healthcare.\u003c/p>\n\u003cp>“We understood the demographics of the people that we’re serving a little better, ” said J. Mario Molina, CEO of Molina Healthcare, \"because we’ve been doing it for so long,\"\u003c/p>\n\u003cp>Molina’s father, David, founded Molina Healthcare in 1980, after a career as a doctor. Sometimes his patients couldn’t pay, so they would barter, or they gave him items from their homes instead: a glass decanter, a pipe organ, even the family dog.\u003c/p>\n\u003cp>“My father was old-fashioned,” recalled the younger Molina. “He believed doctors had an obligation to take care of patients, and that the primary issue was not how they were going to get paid.”\u003c/p>\n\u003cfigure id=\"attachment_294594\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-294594\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/015-800x623.jpg\" alt=\"C. David Molina reviewing medical records\" width=\"800\" height=\"623\">\u003cfigcaption class=\"wp-caption-text\">C. David Molina reviewing medical records \u003ccite>(Courtesy of Molina Healthcare)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The elder Molina opened a network of medical clinics serving low-income patients, and then later, started a health insurance company focused on customers with Medicaid, government coverage for the poor.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That is what positioned the company to move into the Obamacare marketplaces so smoothly, Mario Molina explained, because most people who signed up for Obamacare plans are low-income.\u003c/p>\n\u003cp>“It’s a different population most insurance companies haven’t been interested in,” he said.\u003c/p>\n\u003cp>For example, transportation is an issue for their customers, Molina said. They often take the bus to medical appointments, so they’d much rather see a doctor close to home, not someone at a fancy academic hospital 30 miles away.\u003c/p>\n\u003cp>“We don’t contract with every hospital and every doctor,” he said. “It’s not everyone, but it’s enough so that you can find a doctor and the hospital and the services you need.”\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/308218361&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/308218361'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Having fewer doctors in their network means lower costs for Molina. And that means the company was able to earn some modest profits -- roughly 1 percent in the first couple years of Obamacare.\u003c/p>\n\u003cp>But some big name commercial insurers are used to creating health plans for employers, who often want more doctors and more benefits to attract better employees. Plans like that cost more.\u003c/p>\n\u003cp>“They’re looking at things sort of from the top down, and we’re looking at things from the bottom up,” Molina said.\u003c/p>\n\u003cp>He’s used to running a low-cost, low-margin business. Those big guys aren’t. Industry analysts say that’s why some of them lost money with Obamacare.\u003c/p>\n\u003cp>“It’s easier to work up from a low-cost position than it is to work down from a higher-cost position,” said Josh Weisbrod, a health care consultant with Bain and Company. “For an insurer that is used to selling employer plans with rich benefit designs and broad networks, it is difficult for them to transition that to a narrow network of lower cost providers.”\u003c/p>\n\u003cp>But Molina says there’s been a serious downside to his company’s success: a provision of the Affordable Care Act known as “risk transfer.” The program was designed to help insurance companies cover losses, if they ended up with a lot of really sick, expensive patients. The way it works: companies with fewer sick patients pay some of their revenues to the companies that have more.\u003c/p>\n\u003cp>It was a fine idea, Molina said, but the formula lawmakers came up with to calculate risk was all wrong.\u003c/p>\n\u003cfigure id=\"attachment_294593\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-294593\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/MARIO-MOLINA_FINAL1-800x532.jpg\" alt=\"Mario Molina, CEO of Molina Healthcare\" width=\"800\" height=\"532\">\u003cfigcaption class=\"wp-caption-text\">Mario Molina, CEO of Molina Healthcare \u003ccite>(Courtesy of Molina Healthcare)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Let’s put it this way: currently Molina Healthcare is returning 25 percent of our premiums to the government, which are then distributed to our competitors,” he said. “So we are really subsidizing our competitors and helping them, rather than forcing them to compete.”\u003c/p>\n\u003cp>And that hit Molina’s bottom line in 2016, resulting in much lower profits than originally projected. Molina said the risk formula factors in the average cost of premiums in the state, which seems to punish efficiency rather than help those who had some bad luck.\u003c/p>\n\u003cp>“I think it was done by well-meaning people who had a theoretical knowledge, but not a practical knowledge of insurance,” he said.\u003c/p>\n\u003cp>Still, Molina remains a fan of the Affordable Care Act overall. His company operates in 12 states and Puerto Rico, and he hopes Congress will consult with him and other insurers as it debates the future of the health law.\u003c/p>\n\u003cp>“It doesn’t need to be scrapped and replaced,” he said. “It needs a tune-up.”\u003c/p>\n\u003cp>He added that if lawmakers need guidance on how to fix Obamacare, they should look at one state that really got it right: California.\u003c/p>\n\u003cp>California insurance regulators \"forced everyone to really compete. and that made everyone kind of sharpen their pencils and do a better job,” he said. “It’s kept everyone on their toes, and, as a result, I think there’s been more stability in the marketplace.”\u003c/p>\n\u003cp>There’s also more predictability. California may have more business regulations than other states, but Molina believes that’s created a level playing field.\u003c/p>\n\u003cp>“The state doesn’t make arbitrary decisions. We can plan from year to year. We understand the rules,” he said. “Imagine if you’re trying to play a game and the rules change in every quarter.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Molina is hoping the newly-elected rule makers at the federal level take this to heart.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Prisons Fight to Reduce Dangerous 'Valley Fever' Infections Among Inmates",
"title": "California Prisons Fight to Reduce Dangerous 'Valley Fever' Infections Among Inmates",
"headTitle": "Valley Public Radio | State of Health | KQED News",
"content": "\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/307877957\" 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\u003caside class=\"alignright\">\n\u003ch2>\u003cstrong>\"Just One Breath\"\u003c/strong>: Read More \u003ca href=\"http://www.centerforhealthjournalism.org/valleyfever\" target=\"_blank\">Investigations\u003c/a> About Valley Fever\u003c/h2>\n\u003cp>The \u003ca href=\"http://www.centerforhealthjournalism.org/valleyfever\" target=\"_blank\">“Just One Breath”\u003c/a> project results from an innovative reporting venture, the Center for Health Journalism Collaborative, which currently involves the Bakersfield Californian, Radio Bilingüe in Fresno, Valley Public Radio in Fresno and Bakersfield, Vida en el Valle in Fresno, Hanford Sentinel, the Voice of OC in Santa Ana, the Arizona Daily Star in Tucson and La Estrella de Tucsón. The collaborative is an initiative of the \u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">Center for Health Journalism\u003c/a> at the University of Southern California’s Annenberg School for Communication and Journalism.\u003c/p>\n\u003c/aside>\n\u003cp>When the wind kicks up in the town of Coalinga, dust devils whirl over almond orchards and pumpjacks. You can even see the narrow brown funnels from the grounds of Pleasant Valley State Prison, on the outskirts of town.\u003c/p>\n\u003cp>But at the prison itself, there’s hardly any dust. That's evidence of years of work by the California Department of Corrections and Rehabilitation to reduce and control the San Joaquin Valley's ubiquitous wind-borne dust. The dust carries the spores of the debilitating fungal disease known as \u003ca href=\"https://www.cdc.gov/fungal/diseases/coccidioidomycosis/\" target=\"_blank\">coccidioidomycosis\u003c/a>, or \"valley fever.\"\u003c/p>\n\u003cp>“As you can see, it’s a slight breeze but there’s nothing blowing around,” says prison spokesman Matt Martin, gesturing toward dirt-packed exercise yards and the unpaved shoulders of nearby roads. \"It’s a dirt spray, it’ll keep the dust down.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Inhaling the dust can be deadly. Spores of the dangerous fungus lurk inside the dust, and if prisoners inhale those spores, they can get sick.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">By 2011, hundreds of state prisoners were falling ill with the disease every year. Annual prisoner deaths from the disease ranged between six to nine. Pleasant Valley had the most cases; in 2011, the prison's diagnosis rate was more than 600 times the general California rate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Prisoners are especially vulnerable to valley fever. They can’t install new air filters or double-paned windows. And they obviously can’t leave.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_291432\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-291432\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/PleasantValley3-800x533.jpg\" alt=\"Pleasant Valley State Prison in western Fresno County has reported the most cases of valley fever of any California state prison.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Pleasant Valley State Prison in western Fresno County has reported the most cases of valley fever of any California state prison. \u003ccite>(Kerry Klein/Valley Public Radio)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Preventing this disease is challenging because we all breathe, and many of us live in areas where this fungus is found,” says Dr. Tom Chiller, chief of the \u003ca href=\"https://www.cdc.gov/ncezid/dfwed/mycotics/\" target=\"_blank\">mycotic diseases branch \u003c/a>of the Centers for Disease Control and Prevention.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But in the last few years, California’s state prisons have made progress. They’ve worked to screen out the prisoners most vulnerable to the disease and have taken measures to lower the risk to inmates incarcerated there. Between 2011 and 2015, while background valley fever rates in the southwest dropped by 30 to 50 percent, rates in state prisons fell close to 90 percent overall. Those improvements did not happen quickly or easily, and some required intervention by outsiders.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Some prisoners more vulnerable than others\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Richard Nuwintore was barely three weeks into his sentence at Taft Correctional Institution when he began to cough and experience chest pain. Within a few days, it was obvious something was wrong.\u003c/span>\u003c/p>\n\u003cp>\u003cb>“\u003c/b>\u003cspan style=\"font-weight: 400\">I could touch my skin and I was really hot,” Nuwintore recalls. “I had the coughing, the night sweats. My appetite was gone. I couldn't eat. I couldn't swallow, and I was losing weight really, really fast.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Valley fever is endemic to dusty areas of the southwestern United States. Most who inhale the spores overcome the disease without ever knowing it. Some develop symptoms resembling pneumonia or bronchitis. In a small minority, the disease causes severe lung infection or disseminates throughout the body, requiring lifelong treatment. In the worst cases, the infection leads to fatal meningitis. \u003c/span>\u003c/p>\n\u003cp>The disease draws its name from the San Joaquin Valley, the agricultural belt in the center of the state where the disease is concentrated. Kern County — where Nuwintore was incarcerated at Taft — has the highest valley fever incidence of any California county.\u003c/p>\n\u003cp>Originally a refugee from the east African country of Burundi, Nuwintore had never heard of the disease before arriving at Taft.\u003c/p>\n\u003cp>“Other inmates were telling me about valley fever, and I was like, ‘What is it? What is it?’ ” he says. “It was something scary, you know?”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nuwintore was a victim of confinement in an endemic area, but weather and genetics also played a role. In 2011, when he was diagnosed, valley fever rates in Arizona and California were skyrocketing — a peak experts largely attribute to\u003c/span>\u003ca href=\"http://www.bakersfield.com/special/just-one-breath/valley-fever-cases-spike-is-it-the-weather/article_7ce6b232-d0a0-5674-bdf6-e512a3d46d42.html\"> \u003cspan style=\"font-weight: 400\">weather cycles of rain and drought\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. And research shows that individuals of African-American or African descent, like Nuwintore, are especially prone to the disease.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Taft is a federal prison and its health data have not been made available. But in state prisons all around Taft, the disease simmered. Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever — many of whom, like Nuwintore, still struggle to manage the disease.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Prisons take steps to reduce risk\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The California Department of Corrections and Rehabilitation began taking steps to prevent valley fever long before the alarming 2011 spike in cases.\u003c/span>\u003c/p>\n\u003cp>Beginning in 2006, prison officials began excluding inmates with weakened immune systems — due to factors such as HIV or chemotherapy — from all eight prisons in the Central Valley. But valley fever rates still rose among prisoners.\u003c/p>\n\u003cfigure id=\"attachment_291430\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-291430\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/PleasantValley1-800x533.jpg\" alt=\"Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever. \u003ccite>(Kerry Klein/Valley Public Radio)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">More sweeping interventions arrived in 2013, at the behest of federal officials who by that time had taken over the administration of prison health care in California. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal oversight officials added a new rule specifically for prisoners who are African-American or Filipino, another group that is especially susceptible to the disease. The rule held that inmates from those two ethnic groups could \u003cem>not\u003c/em> be sent to the two most affected prisons, Pleasant Valley and nearby Avenal State Prison.\u003c/span>\u003c/p>\n\u003cp>At those two prisons, officials have distributed dust masks that inmates can wear outside. Prisoners also have the option to stay indoors when wind speeds are high.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I think [valley fever] is one of the biggest issues that we've had in this system,” says Janet Mohle-Boetani, a health administrator with the California Department of Corrections and Rehabilitation. “We're taking precautions for every prison in the Central Valley, and we're taking extra special precautions for the two prisons that have the very high rates of valley fever.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The most significant change, perhaps, arrived in 2015 on the recommendation of the Centers for Disease Control and Prevention. It’s\u003c/span>\u003ca href=\"http://kvpr.org/post/new-valley-fever-skin-test-shows-promise-obstacles-remain\"> \u003cspan style=\"font-weight: 400\">a skin test called Spherusol\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that can detect valley fever immunity, and it’s offered to every inmate entering the state prison system. An individual who tests positive has already been exposed to the fungus and fought it off successfully, and is henceforth immune. Inmates who test negative are still at risk. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If they inhale the dust with the fungus in it and they've tested negative, they're much more likely to get the disease than someone who has a positive test,” says Mohle-Boetani. “So if someone comes into the reception center and then they test negative, we put a medical restriction on those patients so they are not sent to live in Avenal or Pleasant Valley State Prison.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">People gain immunity after successfully fighting off the disease. In a mass screening in early 2015, around 35,000 inmates in the California prison system took the test and roughly 9 percent were shown to be immune.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The CDC recommended Spherusol to the state prison system shortly after the test became commercially available in 2014. The FDA has not actually approved Spherusol for this purpose, but like other medical products, it is being used off-label to sort the prisoners by risk.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Given the fact that they were having such high rates of cocci, we knew that we needed to do whatever we could to try to help them lower the risk,” says the CDC’s Tom Chiller, referring to valley fever by its scientific nickname, cocci. “We immediately thought 'Maybe this could be used to understand which prisoners could exist in an area with the fungal spores but not get infected, or at least have an extremely low risk of getting infected.'”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">John Galgiani, director of the University of Arizona’s Valley Fever Center for Excellence, is optimistic about the decline in valley fever reported in California’s prisons, but he says it’s too early to determine the exact reasons.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I think they should be given credit for the drop to some extent,” Galgiani says, “but it'll take time to see if it stays low, to see if it's because of the policies that are now put in place.”\u003c/span>\u003c/p>\n\u003cp>\u003cb>Health impacts linger after prison sentence\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Today, Richard Nuwintore lives on a suburban cul-de-sac outside Sacramento with his mother and girlfriend.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He may be free from prison, but he’s not free of the disease. He’s too sick to work, and he’ll probably be on antifungal medications for the rest of his life. The fat pink and blue pills keep him alive, but their side effects are almost as bad as the disease itself.\u003c/span>\u003c/p>\n\u003cp>“You wake up, you have a little bit of energy, but as the day goes by you start to just feel pain in the joints,” he says. “Of course, your stomach is still on fire because the medicine is kind of powerful. And [there's] fatigue, and sometimes you get dizzy.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Last year, Nuwintore and another inmate won a landmark case that established the right of prisoners to sue the federal government for damages related to the disease, even though Taft is managed by a private contractor. They’ve now filed a second lawsuit to recoup their medical costs and lost earnings — a sum that could reach millions.\u003c/p>\n\n",
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"nprByline": "\u003cstrong> \u003ca href=\"http://kvpr.org/people/kerry-klein\" target=\"_blank\">Kerry Klein\u003c/a>\u003c/strong>\u003c/br>\u003ca href=\"http://kvpr.org/\" target=\"_blank\">Valley Public Radio\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\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/307877957&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/307877957'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch2>\u003cstrong>\"Just One Breath\"\u003c/strong>: Read More \u003ca href=\"http://www.centerforhealthjournalism.org/valleyfever\" target=\"_blank\">Investigations\u003c/a> About Valley Fever\u003c/h2>\n\u003cp>The \u003ca href=\"http://www.centerforhealthjournalism.org/valleyfever\" target=\"_blank\">“Just One Breath”\u003c/a> project results from an innovative reporting venture, the Center for Health Journalism Collaborative, which currently involves the Bakersfield Californian, Radio Bilingüe in Fresno, Valley Public Radio in Fresno and Bakersfield, Vida en el Valle in Fresno, Hanford Sentinel, the Voice of OC in Santa Ana, the Arizona Daily Star in Tucson and La Estrella de Tucsón. The collaborative is an initiative of the \u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">Center for Health Journalism\u003c/a> at the University of Southern California’s Annenberg School for Communication and Journalism.\u003c/p>\n\u003c/aside>\n\u003cp>When the wind kicks up in the town of Coalinga, dust devils whirl over almond orchards and pumpjacks. You can even see the narrow brown funnels from the grounds of Pleasant Valley State Prison, on the outskirts of town.\u003c/p>\n\u003cp>But at the prison itself, there’s hardly any dust. That's evidence of years of work by the California Department of Corrections and Rehabilitation to reduce and control the San Joaquin Valley's ubiquitous wind-borne dust. The dust carries the spores of the debilitating fungal disease known as \u003ca href=\"https://www.cdc.gov/fungal/diseases/coccidioidomycosis/\" target=\"_blank\">coccidioidomycosis\u003c/a>, or \"valley fever.\"\u003c/p>\n\u003cp>“As you can see, it’s a slight breeze but there’s nothing blowing around,” says prison spokesman Matt Martin, gesturing toward dirt-packed exercise yards and the unpaved shoulders of nearby roads. \"It’s a dirt spray, it’ll keep the dust down.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Inhaling the dust can be deadly. Spores of the dangerous fungus lurk inside the dust, and if prisoners inhale those spores, they can get sick.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">By 2011, hundreds of state prisoners were falling ill with the disease every year. Annual prisoner deaths from the disease ranged between six to nine. Pleasant Valley had the most cases; in 2011, the prison's diagnosis rate was more than 600 times the general California rate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Prisoners are especially vulnerable to valley fever. They can’t install new air filters or double-paned windows. And they obviously can’t leave.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_291432\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-291432\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/PleasantValley3-800x533.jpg\" alt=\"Pleasant Valley State Prison in western Fresno County has reported the most cases of valley fever of any California state prison.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley3-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Pleasant Valley State Prison in western Fresno County has reported the most cases of valley fever of any California state prison. \u003ccite>(Kerry Klein/Valley Public Radio)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Preventing this disease is challenging because we all breathe, and many of us live in areas where this fungus is found,” says Dr. Tom Chiller, chief of the \u003ca href=\"https://www.cdc.gov/ncezid/dfwed/mycotics/\" target=\"_blank\">mycotic diseases branch \u003c/a>of the Centers for Disease Control and Prevention.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But in the last few years, California’s state prisons have made progress. They’ve worked to screen out the prisoners most vulnerable to the disease and have taken measures to lower the risk to inmates incarcerated there. Between 2011 and 2015, while background valley fever rates in the southwest dropped by 30 to 50 percent, rates in state prisons fell close to 90 percent overall. Those improvements did not happen quickly or easily, and some required intervention by outsiders.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Some prisoners more vulnerable than others\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Richard Nuwintore was barely three weeks into his sentence at Taft Correctional Institution when he began to cough and experience chest pain. Within a few days, it was obvious something was wrong.\u003c/span>\u003c/p>\n\u003cp>\u003cb>“\u003c/b>\u003cspan style=\"font-weight: 400\">I could touch my skin and I was really hot,” Nuwintore recalls. “I had the coughing, the night sweats. My appetite was gone. I couldn't eat. I couldn't swallow, and I was losing weight really, really fast.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Valley fever is endemic to dusty areas of the southwestern United States. Most who inhale the spores overcome the disease without ever knowing it. Some develop symptoms resembling pneumonia or bronchitis. In a small minority, the disease causes severe lung infection or disseminates throughout the body, requiring lifelong treatment. In the worst cases, the infection leads to fatal meningitis. \u003c/span>\u003c/p>\n\u003cp>The disease draws its name from the San Joaquin Valley, the agricultural belt in the center of the state where the disease is concentrated. Kern County — where Nuwintore was incarcerated at Taft — has the highest valley fever incidence of any California county.\u003c/p>\n\u003cp>Originally a refugee from the east African country of Burundi, Nuwintore had never heard of the disease before arriving at Taft.\u003c/p>\n\u003cp>“Other inmates were telling me about valley fever, and I was like, ‘What is it? What is it?’ ” he says. “It was something scary, you know?”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Nuwintore was a victim of confinement in an endemic area, but weather and genetics also played a role. In 2011, when he was diagnosed, valley fever rates in Arizona and California were skyrocketing — a peak experts largely attribute to\u003c/span>\u003ca href=\"http://www.bakersfield.com/special/just-one-breath/valley-fever-cases-spike-is-it-the-weather/article_7ce6b232-d0a0-5674-bdf6-e512a3d46d42.html\"> \u003cspan style=\"font-weight: 400\">weather cycles of rain and drought\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. And research shows that individuals of African-American or African descent, like Nuwintore, are especially prone to the disease.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Taft is a federal prison and its health data have not been made available. But in state prisons all around Taft, the disease simmered. Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever — many of whom, like Nuwintore, still struggle to manage the disease.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Prisons take steps to reduce risk\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The California Department of Corrections and Rehabilitation began taking steps to prevent valley fever long before the alarming 2011 spike in cases.\u003c/span>\u003c/p>\n\u003cp>Beginning in 2006, prison officials began excluding inmates with weakened immune systems — due to factors such as HIV or chemotherapy — from all eight prisons in the Central Valley. But valley fever rates still rose among prisoners.\u003c/p>\n\u003cfigure id=\"attachment_291430\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-291430\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/02/PleasantValley1-800x533.jpg\" alt=\"Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/02/PleasantValley1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Between 2007 and 2015, almost 3,500 state prisoners in California were diagnosed with valley fever. \u003ccite>(Kerry Klein/Valley Public Radio)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">More sweeping interventions arrived in 2013, at the behest of federal officials who by that time had taken over the administration of prison health care in California. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The federal oversight officials added a new rule specifically for prisoners who are African-American or Filipino, another group that is especially susceptible to the disease. The rule held that inmates from those two ethnic groups could \u003cem>not\u003c/em> be sent to the two most affected prisons, Pleasant Valley and nearby Avenal State Prison.\u003c/span>\u003c/p>\n\u003cp>At those two prisons, officials have distributed dust masks that inmates can wear outside. Prisoners also have the option to stay indoors when wind speeds are high.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I think [valley fever] is one of the biggest issues that we've had in this system,” says Janet Mohle-Boetani, a health administrator with the California Department of Corrections and Rehabilitation. “We're taking precautions for every prison in the Central Valley, and we're taking extra special precautions for the two prisons that have the very high rates of valley fever.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The most significant change, perhaps, arrived in 2015 on the recommendation of the Centers for Disease Control and Prevention. It’s\u003c/span>\u003ca href=\"http://kvpr.org/post/new-valley-fever-skin-test-shows-promise-obstacles-remain\"> \u003cspan style=\"font-weight: 400\">a skin test called Spherusol\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> that can detect valley fever immunity, and it’s offered to every inmate entering the state prison system. An individual who tests positive has already been exposed to the fungus and fought it off successfully, and is henceforth immune. Inmates who test negative are still at risk. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If they inhale the dust with the fungus in it and they've tested negative, they're much more likely to get the disease than someone who has a positive test,” says Mohle-Boetani. “So if someone comes into the reception center and then they test negative, we put a medical restriction on those patients so they are not sent to live in Avenal or Pleasant Valley State Prison.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">People gain immunity after successfully fighting off the disease. In a mass screening in early 2015, around 35,000 inmates in the California prison system took the test and roughly 9 percent were shown to be immune.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The CDC recommended Spherusol to the state prison system shortly after the test became commercially available in 2014. The FDA has not actually approved Spherusol for this purpose, but like other medical products, it is being used off-label to sort the prisoners by risk.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Given the fact that they were having such high rates of cocci, we knew that we needed to do whatever we could to try to help them lower the risk,” says the CDC’s Tom Chiller, referring to valley fever by its scientific nickname, cocci. “We immediately thought 'Maybe this could be used to understand which prisoners could exist in an area with the fungal spores but not get infected, or at least have an extremely low risk of getting infected.'”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">John Galgiani, director of the University of Arizona’s Valley Fever Center for Excellence, is optimistic about the decline in valley fever reported in California’s prisons, but he says it’s too early to determine the exact reasons.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“I think they should be given credit for the drop to some extent,” Galgiani says, “but it'll take time to see if it stays low, to see if it's because of the policies that are now put in place.”\u003c/span>\u003c/p>\n\u003cp>\u003cb>Health impacts linger after prison sentence\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Today, Richard Nuwintore lives on a suburban cul-de-sac outside Sacramento with his mother and girlfriend.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He may be free from prison, but he’s not free of the disease. He’s too sick to work, and he’ll probably be on antifungal medications for the rest of his life. The fat pink and blue pills keep him alive, but their side effects are almost as bad as the disease itself.\u003c/span>\u003c/p>\n\u003cp>“You wake up, you have a little bit of energy, but as the day goes by you start to just feel pain in the joints,” he says. “Of course, your stomach is still on fire because the medicine is kind of powerful. And [there's] fatigue, and sometimes you get dizzy.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Last year, Nuwintore and another inmate won a landmark case that established the right of prisoners to sue the federal government for damages related to the disease, even though Taft is managed by a private contractor. They’ve now filed a second lawsuit to recoup their medical costs and lost earnings — a sum that could reach millions.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Tom Price Confirmed as Secretary of Health and Human Services",
"title": "Tom Price Confirmed as Secretary of Health and Human Services",
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"content": "\u003cp>The Senate confirmed Rep. \u003ca href=\"http://www.npr.org/sections/health-shots/2016/11/28/502566553/trump-chooses-rep-tom-price-an-obamacare-foe-to-run-hhs\">Tom Price\u003c/a> (R-Georgia) early Friday as the new secretary of Health and Human Services.\u003c/p>\n\u003cp>He was approved by a party-line vote of 52-47. Democrats were concerned that the conservative congressman wants to pare down government health programs. They were also troubled by lingering ethics questions over Price's investments.\u003c/p>\n\u003cp>In his new role, Price, a retired orthopedic surgeon from suburban Atlanta who served as chairman of the House Budget Committee, is expected to \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/03/508074966/republicans-take-the-first-step-to-repeal-obamacare\" target=\"_blank\">implement the repeal\u003c/a> and replacement of the Affordable Care Act, which his colleagues in Congress have been working on this year.\u003c/p>\n\u003cp>Price will oversee a $1 trillion agency, the largest budget of any Cabinet secretary. In addition to Obamacare, HHS administers the Medicare and Medicaid programs and oversees the \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/01/512687027/hhs-nominee-tom-price-targeted-panel-that-urged-fewer-cancer-screenings\" target=\"_blank\">National Institutes of Health\u003c/a>, among other programs and agencies.\u003c/p>\n\u003cp>With Price's confirmation, HHS now has as its leader a budget hawk who \u003ca href=\"http://tomprice.house.gov/sites/tomprice.house.gov/files/HR%202300%20Empowering%20Patients%20First%20Act%202015.pdf\" target=\"_blank\">has proposed\u003c/a> replacing the Affordable Care Act subsidies that are tied to income, with tax credits to purchase insurance. Tax credits are not determined by an individual's income level.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Price also supports \u003ca href=\"http://www.npr.org/sections/health-shots/2016/11/26/503158039/paul-ryans-plan-to-change-medicare-looks-a-lot-like-obamacare\" target=\"_blank\">the proposal\u003c/a> by House Speaker Paul Ryan to turn Medicare into what some call a \"voucher\" program. Under the plan, beneficiaries would receive \"premium support\" from the government to buy a Medicare health plan through an exchange. The private plans would compete against the traditional government-run program.\u003c/p>\n\u003cp>During his \u003ca href=\"http://www.npr.org/2017/01/18/510472472/senate-health-committee-questions-rep-tom-price-in-hhs-confirmation-hearing\" target=\"_blank\">confirmation hearing\u003c/a>, Price said his goal was that everyone have access to health insurance.\u003c/p>\n\u003cp>\"What I commit to the American people is to keep patients at the center of health care. And what that means to me is making certain every single American has access to affordable health coverage,\" he said.\u003c/p>\n\u003cp>Democrats spent hours on Thursday reading stories from their constituents about how the Affordable Care Act helped them, and tried to make the case that Price is a threat to Medicare, Medicaid and health care for people who have ongoing medical conditions.\u003c/p>\n\u003cp>\"Congressman Price's budget in the House cuts nearly $500 million from Medicare and turns it into a voucher program,\" said \u003ca href=\"https://www.billnelson.senate.gov/\" target=\"_blank\">Sen. Bill Nelson\u003c/a> (D-Florida) during the 30-hour debate.\u003c/p>\n\u003cp>The Obamacare replacement \u003ca href=\"http://tomprice.house.gov/sites/tomprice.house.gov/files/HR%202300%20Empowering%20Patients%20First%20Act%202015.pdf\" target=\"_blank\">Price proposed\u003c/a> included offering tax credits starting at $1,200 a year to allow people to buy health insurance, boosting the use of tax-advantaged health savings accounts and limiting the tax deduction companies take for providing health insurance to workers.\u003c/p>\n\u003cp>Those ideas are the core of what Republicans say they want to do to replace the ACA, but the details of how big the tax credits would be and exactly how the HSAs would be structured are unknown.\u003c/p>\n\u003cp>During his confirmation, Price was dogged by \u003ca href=\"http://www.npr.org/2017/01/18/510459094/tom-price-hhs-nominee-faces-tough-questions-on-stocks-deals-and-obamacare\" target=\"_blank\">questions\u003c/a> about investments he made in health care-related companies.\u003c/p>\n\u003cp>Price says he followed all congressional ethics rules, but his \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/19/510593180/a-roundup-of-the-controversies-over-rep-tom-prices-investments\" target=\"_blank\">well-timed trades\u003c/a> made it appear that he could have used his position to influence the price of stocks he owned, or that he received special treatment from companies in which he invested.\u003c/p>\n\u003cp>Republicans in the Senate were satisfied with his explanations, however, and the former congressman will be headed to his new office today.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate confirmed Rep. \u003ca href=\"http://www.npr.org/sections/health-shots/2016/11/28/502566553/trump-chooses-rep-tom-price-an-obamacare-foe-to-run-hhs\">Tom Price\u003c/a> (R-Georgia) early Friday as the new secretary of Health and Human Services.\u003c/p>\n\u003cp>He was approved by a party-line vote of 52-47. Democrats were concerned that the conservative congressman wants to pare down government health programs. They were also troubled by lingering ethics questions over Price's investments.\u003c/p>\n\u003cp>In his new role, Price, a retired orthopedic surgeon from suburban Atlanta who served as chairman of the House Budget Committee, is expected to \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/03/508074966/republicans-take-the-first-step-to-repeal-obamacare\" target=\"_blank\">implement the repeal\u003c/a> and replacement of the Affordable Care Act, which his colleagues in Congress have been working on this year.\u003c/p>\n\u003cp>Price will oversee a $1 trillion agency, the largest budget of any Cabinet secretary. In addition to Obamacare, HHS administers the Medicare and Medicaid programs and oversees the \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/01/512687027/hhs-nominee-tom-price-targeted-panel-that-urged-fewer-cancer-screenings\" target=\"_blank\">National Institutes of Health\u003c/a>, among other programs and agencies.\u003c/p>\n\u003cp>With Price's confirmation, HHS now has as its leader a budget hawk who \u003ca href=\"http://tomprice.house.gov/sites/tomprice.house.gov/files/HR%202300%20Empowering%20Patients%20First%20Act%202015.pdf\" target=\"_blank\">has proposed\u003c/a> replacing the Affordable Care Act subsidies that are tied to income, with tax credits to purchase insurance. Tax credits are not determined by an individual's income level.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Price also supports \u003ca href=\"http://www.npr.org/sections/health-shots/2016/11/26/503158039/paul-ryans-plan-to-change-medicare-looks-a-lot-like-obamacare\" target=\"_blank\">the proposal\u003c/a> by House Speaker Paul Ryan to turn Medicare into what some call a \"voucher\" program. Under the plan, beneficiaries would receive \"premium support\" from the government to buy a Medicare health plan through an exchange. The private plans would compete against the traditional government-run program.\u003c/p>\n\u003cp>During his \u003ca href=\"http://www.npr.org/2017/01/18/510472472/senate-health-committee-questions-rep-tom-price-in-hhs-confirmation-hearing\" target=\"_blank\">confirmation hearing\u003c/a>, Price said his goal was that everyone have access to health insurance.\u003c/p>\n\u003cp>\"What I commit to the American people is to keep patients at the center of health care. And what that means to me is making certain every single American has access to affordable health coverage,\" he said.\u003c/p>\n\u003cp>Democrats spent hours on Thursday reading stories from their constituents about how the Affordable Care Act helped them, and tried to make the case that Price is a threat to Medicare, Medicaid and health care for people who have ongoing medical conditions.\u003c/p>\n\u003cp>\"Congressman Price's budget in the House cuts nearly $500 million from Medicare and turns it into a voucher program,\" said \u003ca href=\"https://www.billnelson.senate.gov/\" target=\"_blank\">Sen. Bill Nelson\u003c/a> (D-Florida) during the 30-hour debate.\u003c/p>\n\u003cp>The Obamacare replacement \u003ca href=\"http://tomprice.house.gov/sites/tomprice.house.gov/files/HR%202300%20Empowering%20Patients%20First%20Act%202015.pdf\" target=\"_blank\">Price proposed\u003c/a> included offering tax credits starting at $1,200 a year to allow people to buy health insurance, boosting the use of tax-advantaged health savings accounts and limiting the tax deduction companies take for providing health insurance to workers.\u003c/p>\n\u003cp>Those ideas are the core of what Republicans say they want to do to replace the ACA, but the details of how big the tax credits would be and exactly how the HSAs would be structured are unknown.\u003c/p>\n\u003cp>During his confirmation, Price was dogged by \u003ca href=\"http://www.npr.org/2017/01/18/510459094/tom-price-hhs-nominee-faces-tough-questions-on-stocks-deals-and-obamacare\" target=\"_blank\">questions\u003c/a> about investments he made in health care-related companies.\u003c/p>\n\u003cp>Price says he followed all congressional ethics rules, but his \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/19/510593180/a-roundup-of-the-controversies-over-rep-tom-prices-investments\" target=\"_blank\">well-timed trades\u003c/a> made it appear that he could have used his position to influence the price of stocks he owned, or that he received special treatment from companies in which he invested.\u003c/p>\n\u003cp>Republicans in the Senate were satisfied with his explanations, however, and the former congressman will be headed to his new office today.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n\u003c/div>\u003c/p>",
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