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"content": "\u003cp>On a recent rainy morning in Los Angeles, Maria Bernal’s stove clicks to life with a bright blue flame to toast bread on a griddle for her 9-year-old son Edwin to smear with peanut butter. As she scoops papaya chunks into the blender for a smoothie, she recalls her worry during all the years when she couldn’t afford health care and he suffered painful ear infections.\u003c/p>\n\u003cp>The waiting six months to get an appointment for Edwin at a county facility. The nights trying to calm him as he cried in constant pain. The months-long wait for each of three surgeries to insert tubes into his ears. The fear when the medical bills arrived.\u003c/p>\n\u003cp>At the time, she couldn’t afford health care, and he wasn't eligible for regular government-funded Medi-Cal coverage because she had brought Edwin to the United States illegally from Mexico when he was 1. He qualified for a local program and emergency Medi-Cal, but that didn’t provide all the care he needed. Then last year, she heard on TV that California was \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_EE_Plan_032116_Final.PDF\" target=\"_blank\">creating a new program\u003c/a> under Medi-Cal to fully cover poor undocumented children. Relieved, she rushed to sign Edwin up. As a result, she says, “I can take him in whenever he needs to go.”\u003c/p>\n\u003cp>Now, however, the ability of Edwin and some 164,000 poor undocumented California children to see a doctor for regular medical care hangs in the balance—with several experts predicting they could be among the first to lose health coverage if the Trump administration carries out its promise to end much of Obamacare, leaving California to try to make up the difference.\u003c/p>\n\u003cp>To be clear, the federal government does pay \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014b.aspx\" target=\"_blank\">limited medical costs\u003c/a> for kids in the country illegally under the restricted-scope Medi-Cal program, which is available to anyone regardless of immigration status for emergency and prenatal services only. Last May, however, California became one of a handful of states to provide \u003ca href=\"http://www.scpr.org/programs/take-two/2016/04/21/48148/medi-cal-for-immigrant-kids-in-us-illegally-starts/\" target=\"_blank\">state-funded full-scope Medi-Cal\u003c/a>, California’s Medicaid program. About 71 percent of the program is funded by the state, according to the state \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SB-75.aspx\" target=\"_blank\">Department of Health Care Services\u003c/a>, with 29 percent paid for out of \u003ca href=\"https://www.medicaid.gov/medicaid/outreach-and-enrollment/downloads/overview-of-eligibility-for-non-citizens-in-medicaid-and-chip.pdf\" target=\"_blank\">federal funds\u003c/a> for emergency coverage. Also of note: Because the federal government funds emergency services, the state shares enrollee information with federal health officials.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In his most recent \u003ca href=\"http://www.ebudget.ca.gov/2017-18/pdf/BudgetSummary/FullBudgetSummary.pdf\" target=\"_blank\">budget proposal\u003c/a>, Gov. Jerry Brown allocated $279.5 million to cover approximately 185,000 kids in the coming year in what the state has dubbed its Health for All Kids program—double what the program was estimated to cost when it was approved.\u003c/p>\n\u003cp>With the election of Donald Trump, who took office last week, some health policy experts and advocates say the fledgling program is in danger. Assuming the new administration carries out plans to change how Medicaid is funded, California could stand to lose $17 billion the federal government currently provides for the Medi-Cal expansion that California adopted under the Affordable Care Act.\u003c/p>\n\u003cp>Such a cut would leave state leaders unable to fully make up the funding difference—and could force them to revisit a decades-old debate over whether the state has an obligation to care for sick children regardless of their immigration status, or should focus limited resources on citizens and legal residents.\u003c/p>\n\u003cp>It’s impossible to precisely predict the ripple effects. But, said Nancy Gomez, organizing director of the health advocacy organization \u003ca href=\"http://Health%20Access%20California\" target=\"_blank\">Health Access California\u003c/a>: “The first things that are going to go are these optional programs. They are not optional to us. But Health for All Kids are discretionary funds and they may be the first to go.”\u003c/p>\n\u003cp>Trying to make up the gap will be nearly impossible, experts say.\u003c/p>\n\u003cp>“These federal cuts to the broader Medi-Cal program would force California policymakers to make some difficult decisions—raise revenue by unprecedented amounts to maintain the current program, cut benefits, reduce eligibility, or make other cuts to the program,” said Laurel Lucia, manager of the Health Care Program at the UC Berkeley \u003ca href=\"http://laborcenter.berkeley.edu/\" target=\"_blank\">Center for Labor Research and Education\u003c/a>. But, she acknowledged, “if the Legislature decides to take a 'last in, first out' approach to making eligibility cuts in response to federal cuts, state-funded Medi-Cal for undocumented kids would especially be at risk because the expansion started less than one year ago.”\u003c/p>\n\u003cp>That’s as is should be, according to those who insist that anyone in the country illegally should not receive state resources—especially if funding is cut short.\u003c/p>\n\u003cp>“Sacramento should be focused on helping American citizens,” said Robin Hvidston, executive director of \u003ca href=\"https://wethepeoplerising.wordpress.com/\" target=\"_blank\">We The People Rising\u003c/a>, a Claremont-based organization that fights against legislation that it says promotes illegal immigration. The group opposed the expansion, which she contends is merely an open invitation for illegal immigration.\u003c/p>\n\u003cp>“It’s a program our state cannot afford,” she said. “We have a burgeoning homeless crisis in this state, we have disabled people in this state that need help. This energy and our tax dollars should be going to help our suffering American citizens in this state and not those here illegally.”\u003c/p>\n\u003cp>Nonetheless, the lawmaker who \u003ca href=\"https://calmatters.org/articles/californias-undocumented-kidswhy-they-could-be-first-to-lose-medical-care-under-trump/\" target=\"_blank\">authored\u003c/a> the expansion to cover undocumented children, Democratic Sen. Ricardo Lara of Los Angeles, has vowed to protect them.\u003c/p>\n\u003cp>“I will fight to ensure that they remain a priority population in terms of receiving adequate healthcare and meeting their health needs,” Lara said. “It makes economic sense, it’s the moral thing to do.”\u003c/p>\n\u003cp>But in an unmistakable sign that the Democratic-controlled state is changing tactics in response to a less receptive White House, California recently \u003ca href=\"http://khn.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\" target=\"_blank\">retracted\u003c/a> its request for a federal waiver that it had hoped would allow undocumented immigrants of all ages to buy unsubsidized health care via California’s Affordable Care Act exchange. Lara labeled it the “first California casualty of the Trump presidency.”\u003c/p>\n\u003cp>He said the state could always renew its quest for such a waiver, but won’t until it first ensures that the state can protect the data immigrants would be sharing with the federal government by using the health exchange.\u003c/p>\n\u003cp>“It’s very clear and apparent that we are dealing with a hostile administration toward our immigration community,” Lara said. “Given the fact that we are working currently on legislation to protect the privacy of the immigrant communities, we felt that it was appropriate to pull the waiver and focus on the fights ahead with the incoming administration.”\u003c/p>\n\u003cp>President Trump and the Republican-controlled Congress favor establishing caps on Medicaid and changing funding to a block grant formula that sets limits on total spending per state regardless of how many people are in the program. Currently it is funded as an entitlement for all enrollees who qualify.\u003c/p>\n\u003cp>Medicaid is the largest insurer in the country, with 73 million people enrolled, mostly low-income or disabled. In California, 13.5 million people are on Medi-Cal, or roughly one in three Californians. The program grew by 3.6 million people when it was expanded under the Affordable Care Act.\u003c/p>\n\u003cp>A study by the Center on Budget and Policy Priorities found that the proposals to reorganize Medicaid funding would decrease funding by one-third to one-half within a decade.\u003c/p>\n\u003cp>Such federal cuts would trigger a cascade of effects, said Senate President Pro Tem Kevin de Leon (D-Los Angeles).\u003c/p>\n\u003cp>“If the Trump administration decides to remove and take away access to quality healthcare that could possibly drive a budget deficit—and if you drive a budget deficit that means cuts would have to be made,” he said at a health care rally in Los Angeles after the November election. “If cuts have to be made that means other people could be hurt.”\u003c/p>\n\u003cp>But others aren’t ready to concede that outcome, and say there are likely alternatives the state can employ to keep as many people covered as possible.\u003c/p>\n\u003cp>“The reality is if Congress has enough votes to change the Medicaid program into a block grant program, California will struggle to maintain its commitment to the 13.5 million people currently covered,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “I suspect the governor and Legislature will give higher priority to cutting covered services rather than cutting the number of beneficiaries.”\u003c/p>\n\u003cp>Sen. Lara said he hopes the state resists choosing one group over another—adding that he plans to suggest cutting coverage, as the state has done during lean times, or increasing eligibility thresholds in his fight to keep health care for the neediest across all groups, including undocumented children.\u003c/p>\n\u003cp>As for 9-year-old Edwin Bernal, he says going to the doctor more often is good for him because of his hearing challenges and ear tubes.\u003c/p>\n\u003cfigure id=\"attachment_287952\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg\" alt=\"Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger.\" width=\"800\" height=\"533\" class=\"size-medium wp-image-287952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger. \u003ccite>(Maria J. Avila/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“My friends talk to me and I’m like ‘what, what,’ because I can’t hear them that good,” he said. “Same with my mom, she tells me something and I don’t really hear her and I don’t do the stuff she tells me because I can’t hear. So it’s better, I can hear her and I’m not getting in more trouble.”\u003c/p>\n\u003cp>If kids like Edwin lose Medi-Cal overage, their health care will depend largely on where they live. \u003c/p>\n\u003cp>In Los Angeles, the county offers a basic low-cost program to everyone regardless of immigration status and emergency Medi-Cal is expected to still be available. Private insurer Kaiser Permanente also offers a community benefit program for kids without legal status who live near their facilities.\u003c/p>\n\u003cp>“It’s going to be a challenge for us and the patients,” said Chona de Leon, senior vice president and chief operating officer at Eisner Pediatric & Family Center, in downtown Los Angeles, where Edwin has received care since he was a baby. \u003c/p>\n\u003cp>Clinics like Eisner would lose the increased funding that has come from previously uninsured patients getting access through the Affordable Care Act. de Leon says they would continue to serve uninsured patients as they always have, although they would have to work hard to find outside funding and donations.\u003c/p>\n\u003cp>But in 11 California counties, including Orange and San Diego, there are no programs for undocumented families to find care for their children outside of charitable clinics and hospital emergency rooms.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://CALmatters.org\" target=\"_blank\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California’s policies and politics.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On a recent rainy morning in Los Angeles, Maria Bernal’s stove clicks to life with a bright blue flame to toast bread on a griddle for her 9-year-old son Edwin to smear with peanut butter. As she scoops papaya chunks into the blender for a smoothie, she recalls her worry during all the years when she couldn’t afford health care and he suffered painful ear infections.\u003c/p>\n\u003cp>The waiting six months to get an appointment for Edwin at a county facility. The nights trying to calm him as he cried in constant pain. The months-long wait for each of three surgeries to insert tubes into his ears. The fear when the medical bills arrived.\u003c/p>\n\u003cp>At the time, she couldn’t afford health care, and he wasn't eligible for regular government-funded Medi-Cal coverage because she had brought Edwin to the United States illegally from Mexico when he was 1. He qualified for a local program and emergency Medi-Cal, but that didn’t provide all the care he needed. Then last year, she heard on TV that California was \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_EE_Plan_032116_Final.PDF\" target=\"_blank\">creating a new program\u003c/a> under Medi-Cal to fully cover poor undocumented children. Relieved, she rushed to sign Edwin up. As a result, she says, “I can take him in whenever he needs to go.”\u003c/p>\n\u003cp>Now, however, the ability of Edwin and some 164,000 poor undocumented California children to see a doctor for regular medical care hangs in the balance—with several experts predicting they could be among the first to lose health coverage if the Trump administration carries out its promise to end much of Obamacare, leaving California to try to make up the difference.\u003c/p>\n\u003cp>To be clear, the federal government does pay \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014b.aspx\" target=\"_blank\">limited medical costs\u003c/a> for kids in the country illegally under the restricted-scope Medi-Cal program, which is available to anyone regardless of immigration status for emergency and prenatal services only. Last May, however, California became one of a handful of states to provide \u003ca href=\"http://www.scpr.org/programs/take-two/2016/04/21/48148/medi-cal-for-immigrant-kids-in-us-illegally-starts/\" target=\"_blank\">state-funded full-scope Medi-Cal\u003c/a>, California’s Medicaid program. About 71 percent of the program is funded by the state, according to the state \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SB-75.aspx\" target=\"_blank\">Department of Health Care Services\u003c/a>, with 29 percent paid for out of \u003ca href=\"https://www.medicaid.gov/medicaid/outreach-and-enrollment/downloads/overview-of-eligibility-for-non-citizens-in-medicaid-and-chip.pdf\" target=\"_blank\">federal funds\u003c/a> for emergency coverage. Also of note: Because the federal government funds emergency services, the state shares enrollee information with federal health officials.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In his most recent \u003ca href=\"http://www.ebudget.ca.gov/2017-18/pdf/BudgetSummary/FullBudgetSummary.pdf\" target=\"_blank\">budget proposal\u003c/a>, Gov. Jerry Brown allocated $279.5 million to cover approximately 185,000 kids in the coming year in what the state has dubbed its Health for All Kids program—double what the program was estimated to cost when it was approved.\u003c/p>\n\u003cp>With the election of Donald Trump, who took office last week, some health policy experts and advocates say the fledgling program is in danger. Assuming the new administration carries out plans to change how Medicaid is funded, California could stand to lose $17 billion the federal government currently provides for the Medi-Cal expansion that California adopted under the Affordable Care Act.\u003c/p>\n\u003cp>Such a cut would leave state leaders unable to fully make up the funding difference—and could force them to revisit a decades-old debate over whether the state has an obligation to care for sick children regardless of their immigration status, or should focus limited resources on citizens and legal residents.\u003c/p>\n\u003cp>It’s impossible to precisely predict the ripple effects. But, said Nancy Gomez, organizing director of the health advocacy organization \u003ca href=\"http://Health%20Access%20California\" target=\"_blank\">Health Access California\u003c/a>: “The first things that are going to go are these optional programs. They are not optional to us. But Health for All Kids are discretionary funds and they may be the first to go.”\u003c/p>\n\u003cp>Trying to make up the gap will be nearly impossible, experts say.\u003c/p>\n\u003cp>“These federal cuts to the broader Medi-Cal program would force California policymakers to make some difficult decisions—raise revenue by unprecedented amounts to maintain the current program, cut benefits, reduce eligibility, or make other cuts to the program,” said Laurel Lucia, manager of the Health Care Program at the UC Berkeley \u003ca href=\"http://laborcenter.berkeley.edu/\" target=\"_blank\">Center for Labor Research and Education\u003c/a>. But, she acknowledged, “if the Legislature decides to take a 'last in, first out' approach to making eligibility cuts in response to federal cuts, state-funded Medi-Cal for undocumented kids would especially be at risk because the expansion started less than one year ago.”\u003c/p>\n\u003cp>That’s as is should be, according to those who insist that anyone in the country illegally should not receive state resources—especially if funding is cut short.\u003c/p>\n\u003cp>“Sacramento should be focused on helping American citizens,” said Robin Hvidston, executive director of \u003ca href=\"https://wethepeoplerising.wordpress.com/\" target=\"_blank\">We The People Rising\u003c/a>, a Claremont-based organization that fights against legislation that it says promotes illegal immigration. The group opposed the expansion, which she contends is merely an open invitation for illegal immigration.\u003c/p>\n\u003cp>“It’s a program our state cannot afford,” she said. “We have a burgeoning homeless crisis in this state, we have disabled people in this state that need help. This energy and our tax dollars should be going to help our suffering American citizens in this state and not those here illegally.”\u003c/p>\n\u003cp>Nonetheless, the lawmaker who \u003ca href=\"https://calmatters.org/articles/californias-undocumented-kidswhy-they-could-be-first-to-lose-medical-care-under-trump/\" target=\"_blank\">authored\u003c/a> the expansion to cover undocumented children, Democratic Sen. Ricardo Lara of Los Angeles, has vowed to protect them.\u003c/p>\n\u003cp>“I will fight to ensure that they remain a priority population in terms of receiving adequate healthcare and meeting their health needs,” Lara said. “It makes economic sense, it’s the moral thing to do.”\u003c/p>\n\u003cp>But in an unmistakable sign that the Democratic-controlled state is changing tactics in response to a less receptive White House, California recently \u003ca href=\"http://khn.org/news/california-withdraws-bid-to-allow-undocumented-immigrants-to-buy-unsubsidized-obamacare-plans/\" target=\"_blank\">retracted\u003c/a> its request for a federal waiver that it had hoped would allow undocumented immigrants of all ages to buy unsubsidized health care via California’s Affordable Care Act exchange. Lara labeled it the “first California casualty of the Trump presidency.”\u003c/p>\n\u003cp>He said the state could always renew its quest for such a waiver, but won’t until it first ensures that the state can protect the data immigrants would be sharing with the federal government by using the health exchange.\u003c/p>\n\u003cp>“It’s very clear and apparent that we are dealing with a hostile administration toward our immigration community,” Lara said. “Given the fact that we are working currently on legislation to protect the privacy of the immigrant communities, we felt that it was appropriate to pull the waiver and focus on the fights ahead with the incoming administration.”\u003c/p>\n\u003cp>President Trump and the Republican-controlled Congress favor establishing caps on Medicaid and changing funding to a block grant formula that sets limits on total spending per state regardless of how many people are in the program. Currently it is funded as an entitlement for all enrollees who qualify.\u003c/p>\n\u003cp>Medicaid is the largest insurer in the country, with 73 million people enrolled, mostly low-income or disabled. In California, 13.5 million people are on Medi-Cal, or roughly one in three Californians. The program grew by 3.6 million people when it was expanded under the Affordable Care Act.\u003c/p>\n\u003cp>A study by the Center on Budget and Policy Priorities found that the proposals to reorganize Medicaid funding would decrease funding by one-third to one-half within a decade.\u003c/p>\n\u003cp>Such federal cuts would trigger a cascade of effects, said Senate President Pro Tem Kevin de Leon (D-Los Angeles).\u003c/p>\n\u003cp>“If the Trump administration decides to remove and take away access to quality healthcare that could possibly drive a budget deficit—and if you drive a budget deficit that means cuts would have to be made,” he said at a health care rally in Los Angeles after the November election. “If cuts have to be made that means other people could be hurt.”\u003c/p>\n\u003cp>But others aren’t ready to concede that outcome, and say there are likely alternatives the state can employ to keep as many people covered as possible.\u003c/p>\n\u003cp>“The reality is if Congress has enough votes to change the Medicaid program into a block grant program, California will struggle to maintain its commitment to the 13.5 million people currently covered,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “I suspect the governor and Legislature will give higher priority to cutting covered services rather than cutting the number of beneficiaries.”\u003c/p>\n\u003cp>Sen. Lara said he hopes the state resists choosing one group over another—adding that he plans to suggest cutting coverage, as the state has done during lean times, or increasing eligibility thresholds in his fight to keep health care for the neediest across all groups, including undocumented children.\u003c/p>\n\u003cp>As for 9-year-old Edwin Bernal, he says going to the doctor more often is good for him because of his hearing challenges and ear tubes.\u003c/p>\n\u003cfigure id=\"attachment_287952\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg\" alt=\"Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger.\" width=\"800\" height=\"533\" class=\"size-medium wp-image-287952\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/UNDOCUMENTED-KIDS-Photo-2-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Maria Bernal, 30, cooks breakfast for her son Edwin Bernal, 9, before school at their home in Los Angeles. His mother fears that under the Trump administration the program will be in danger. \u003ccite>(Maria J. Avila/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“My friends talk to me and I’m like ‘what, what,’ because I can’t hear them that good,” he said. “Same with my mom, she tells me something and I don’t really hear her and I don’t do the stuff she tells me because I can’t hear. So it’s better, I can hear her and I’m not getting in more trouble.”\u003c/p>\n\u003cp>If kids like Edwin lose Medi-Cal overage, their health care will depend largely on where they live. \u003c/p>\n\u003cp>In Los Angeles, the county offers a basic low-cost program to everyone regardless of immigration status and emergency Medi-Cal is expected to still be available. Private insurer Kaiser Permanente also offers a community benefit program for kids without legal status who live near their facilities.\u003c/p>\n\u003cp>“It’s going to be a challenge for us and the patients,” said Chona de Leon, senior vice president and chief operating officer at Eisner Pediatric & Family Center, in downtown Los Angeles, where Edwin has received care since he was a baby. \u003c/p>\n\u003cp>Clinics like Eisner would lose the increased funding that has come from previously uninsured patients getting access through the Affordable Care Act. de Leon says they would continue to serve uninsured patients as they always have, although they would have to work hard to find outside funding and donations.\u003c/p>\n\u003cp>But in 11 California counties, including Orange and San Diego, there are no programs for undocumented families to find care for their children outside of charitable clinics and hospital emergency rooms.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://CALmatters.org\" target=\"_blank\">CALmatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California’s policies and politics.\u003cbr>\n\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California’s Community Clinics, Big Obamacare Beneficiaries, Worry About Their Future",
"title": "California’s Community Clinics, Big Obamacare Beneficiaries, Worry About Their Future",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>Paula Wilson has seen some tough times in her 23 years as the CEO of Valley Community Healthcare, a clinic that provides care for the poor in North Hollywood, Calif. But nothing was quite like November 9, the day after the U.S. elections, when walking around the office “was like coming into a funeral,” she said.\u003c/p>\n\u003cp>Her staff worried that a repeal of the Affordable Care Act, long promised by Republicans, would obliterate their jobs. Patients fretted it would jeopardize their care.\u003c/p>\n\u003cp>Nearly a third of the clinic’s 25,000 patients were newcomers, many of them recently covered through the expansion of Medi-Cal ushered in by the Affordable Care Act. Thanks to the expansion, Valley Community Healthcare had been growing rapidly, opening one new site, adding on to others, and offering patients new dental and mental health services.\u003c/p>\n\u003cp>What would happen if this new source of financial support were taken away?\u003c/p>\n\u003cp>Wilson didn’t have an answer that day, and she still doesn’t. But she’s hanging on to a cautious hope. “Pretty much that whole first week was getting a grip and assuring people: We’ve been here 46 years and we’re not going anywhere,” she said. “We’ve fought the fight before, and we’ll do it again.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In the absence of details about the impact and timing of a possible ACA repeal, Wilson’s brand of determination is all community clinics can count on for now.\u003c/p>\n\u003cp>Republicans, newly empowered by Donald Trump’s ascendance to the White House, have made clear they plan to repeal large parts of the landmark health care law in short order. The timing of any replacement is still uncertain, though political pressure has been growing recently for any void left by a repeal to be quickly filled with a new plan. For the time being, however, consumers are unlikely to see big changes in their health care.\u003c/p>\n\u003cp>Community clinics are key providers of primary care services for the poor. CaliforniaHealth+ Advocates, which represents the state’s clinics, estimates that they serve 6.2 million Californians — an increase of more than a million in less than five years. Today, more than 3.5 million community clinic patients are covered by Medi-Cal, California’s version of Medicaid, the federal health insurance program for people with low incomes.\u003c/p>\n\u003cp>More than half of patients who signed up for Medi-Cal after the advent of the ACA have gotten their primary care at community clinics, according to a December 2015 \u003ca href=\"http://www.chcf.org/publications/2015/12/medical-winwin-surging-enrollment\" target=\"_blank\">report\u003c/a> by the California Health Care Foundation. (California Healthline is an editorially independent service of the California Health Care Foundation.)\u003c/p>\n\u003cp>Historically supported by Democrats and Republicans alike, community clinics worked hard to implement Obamacare reforms, and they benefited as a result. Many, like Valley Community Healthcare, helped enroll patients and expanded their services, taking advantage of special ACA funding that enabled them to improve their facilities and systems of care.\u003c/p>\n\u003cp>The \u003ca href=\"http://khn.org/news/obamacare-boosted-community-health-centers-reach-now-what/\" target=\"_blank\">same scenario\u003c/a> has played out nationwide at many of 1,400 federally backed community health centers — a type of community clinic — according to two studies published recently in the journal \u003ca href=\"http://www.healthaffairs.org/\" target=\"_blank\">Health Affairs\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://content.healthaffairs.org/content/36/1/49.abstract\" target=\"_blank\">One of the studies\u003c/a>, which used data from 2012 to 2015 to track visits to community health centers, showed that in states that adopted the Medicaid expansion, the centers saw more patient visits, including those for mental health treatment, and lower rates of uninsured patients — a financial boon for clinics that typically operate on thin margins.\u003c/p>\n\u003cp>The second \u003ca href=\"http://content.healthaffairs.org/content/36/1/40.abstract\" target=\"_blank\">study\u003c/a> which examined data from 2011 to 2014, found that in the Medicaid expansion states, patients were more likely to receive asthma treatment when it was needed, have their body mass index assessed, get pap smears and keep their blood pressure relatively stable.\u003c/p>\n\u003cp>Proponents of the health reform law in California had hoped the expansion of community clinics would provide primary care for more patients, thus reducing expensive emergency room visits at safety-net hospitals.\u003c/p>\n\u003cp>“Health centers have been the poster child of positively embracing the ACA. They’ve gone along with everything,” said Blue Shield of California Foundation CEO Peter Long, whose organization supports the clinics. But without clarity about where funding will come from in the future, or how much of it there will be, it’s possible that clinics will “go into hunker-down mode,” he added. That could mean limiting hours, reinstating waiting lists for new patients and cutting promising new programs.\u003c/p>\n\u003cp>Implementing Obamacare “put a lot of stress on their systems,” Long said. “To unwind it would be equally hard.”\u003c/p>\n\u003cfigure class=\"layout-lg carousel-article carousel slide carousel-article-1\">\n\u003col class=\"carousel-indicators\">\n\u003cli class=\"active\">\n\u003cli>\n\u003cli>\n\u003c/ol>\n\u003cdiv class=\"carousel-inner\">\n\u003cdiv class=\"item active\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-1_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Paula Wilson, CEO of Valley Community Healthcare, says she has seen some tough times in her 23 years at the clinic which provides care for the poor in the area. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-2_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">The staff at Valley Community Healthcare worry that a promised Republican repeal of the Affordable Care Act would jeopardize the care offered to the 7,400 patients currently under the law. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-3_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Nearly a third of Valley Community Healthcare’s 25,000 customers are newcomers. Many had only recently secured health coverage through the Medicaid expansion provisions of the Affordable Care Act. After the election, Wilson spent the week assuring her customers: “We’ve been here 46 years and we’re not going anywhere,” said Wilson. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003c/div>\n\u003cp>\u003ca class=\"left carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-prev\">\u003c/span>\u003c/a>\u003ca class=\"right carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-next\">\u003c/span>\u003c/a>\u003c/p>\u003c/figure>\n\u003cp>Wilson and other clinic CEOs said they’re trying to anticipate worst-case scenarios and plan accordingly, but that’s hard when Congress hasn’t specified what changes it is planning, or when to expect them.\u003c/p>\n\u003cp>“Right now it’s all crystal ball gazing,” said Steven Wallace, associate director of the UCLA Center for Health Policy Research. “‘Repeal and replace’ is a great slogan, but ‘replace’ is really hard to figure out.”\u003c/p>\n\u003cp>Community clinic leaders say they’re focusing on several \u003ca href=\"http://khn.org/news/millions-could-lose-medicaid-coverage-under-trump-plan/\" target=\"_blank\">funding challenges\u003c/a>. First is a potential rollback of the ACA’s Medicaid expansion program, which extended new coverage to about 20 million people in the U.S., including more than 5 million in California, said Carmela Castellano-Garcia, CEO of CaliforniaHealth+ Advocates.\u003c/p>\n\u003cp>Some also worry that shifting Medicaid to a block grant system, an idea President-elect Trump has endorsed, would result in cuts to services; or that Congress could decline to reauthorize “330 funding” — an additional $5 billion community clinics receive each year from the federal government. That stream of federal dollars is set to expire in September of 2017.\u003c/p>\n\u003cp>That funding, in addition to payments from the Medi-Cal expansion, allowed the Los Angeles Christian Health Centers to add medical, mental health, dental and case management staff and open two new sites.\u003c/p>\n\u003cp>The clinic, headquartered on Skid Row in downtown Los Angeles, also launched a fundraising campaign to revamp and enlarge its flagship facility. But CEO Dr. Lisa Abdishoo now worries that some financial assumptions made in planning the expansion may no longer apply after Trump takes office on Friday. “We’re trying not to panic, but now we have to question the sustainability of some of the growth,” she said.\u003c/p>\n\u003cp>Health care advocates have advised community clinics that they may need to “look at 2009 levels” to plan for post-ACA operations, Abdishoo said. That year, Los Angeles Christian Health Centers served 6,600 patients a year, compared to 10,000 today.\u003c/p>\n\u003cp>Jane Garcia, CEO of La Clínica De La Raza, a 32-site clinic network in Alameda, Contra Costa and Solano Counties, said her organization could lose ground on hard-fought cost reductions if people’s insurance is taken away and they revert to their old behavior of seeking care only when they are very sick.\u003c/p>\n\u003cp>“Patients who don’t have coverage hesitate to come in and see the doctor, and they hesitate to seek preventive care,” Garcia said. “That’s the kind of thing that was starting to have an impact on bending the curve on cost reduction.”\u003c/p>\n\u003cp>ACA-related grants allowed La Clínica’s health centers to improve case management and collaborate more effectively with partners such as Sutter Health, which also saved money by reducing the number of patients seeking primary care in emergency rooms. La Clínica would probably have to cut such administrative efforts were the ACA repealed, Garcia said.\u003c/p>\n\u003cp>Pamela Richardson, a 60-year-old patient of Valley Community Healthcare who suffers from an iron absorption disorder called hereditary hemochromatosis, was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.\u003c/p>\n\u003cp>Once Richardson was covered, she got long-delayed primary care, which revealed that she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have pap smears,” she said. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”\u003c/p>\n\u003cdiv id=\"attachment_222383\" style=\"width: 780px\" class=\"wp-caption aligncenter\">\u003cimg class=\"wp-image-222383 size-khn-article-large\" src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-7_770.jpg?w=770&h=513&crop=1\" alt=\"Lisa Zeelander, a medical doctor at Valley Community Healthcare in North Hollywood, California, examines patient Pamela Richardson, 60, on Wednesday, December 21, 2016. (Heidi de Marco/KHN)\" width=\"770\" height=\"513\">\n\u003cp class=\"wp-caption-text\">Lisa Zeelander, a doctor at Valley Community Healthcare, examines Richardson in December 2016. (Heidi de Marco/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>Wilson, Castellano-Garcia and others said they plan to make precisely that case — that community clinics represent a good value — once state and federal officials begin mulling an ACA replacement in earnest.\u003c/p>\n\u003cp>A \u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303341\" target=\"_blank\">November 2016 study\u003c/a> in the American Journal of Public Health showed that Medicaid spending was 24 percent lower for patients who received a majority of their primary care from federally qualified health centers — a type of community clinic — than for patients who got care in other settings. The savings extended across all services, the study’s authors reported.\u003c/p>\n\u003cp>In rural Shasta County, where a majority voted for Trump, one in three people has Medi-Cal coverage. Dean Germano, CEO of Shasta Community Health in Redding, said he has already launched conversations with staffers of Republican U.S. Rep. Doug LaMalfa who he considers “a friend of the health centers.”\u003c/p>\n\u003cp>“Our mission is to make people like him realize what [repeal] will mean for people on the ground,” Germano said. “If the system goes through a major shock, what would happen to jobs? It would have a major impact on rural communities.”\u003c/p>\n\u003cp>Another clinic CEO, Kim Wyard of Northeast Valley Health Corporation in San Fernando, said she takes heart because Congress will have to do something to replace what it is taking away. Just blowing everything up isn’t an option, she said.\u003c/p>\n\u003cp>“We need a safety net, and if more patients are uninsured, we’ll need it more,” Wyard said. “We’re cost-effective,” she added. “Our new president wrote ‘The Art of the Deal.’ He likes a deal. I don’t think there’s a better deal than health centers.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Shefali Luthra contributed reporting.\u003c/em>\u003c/p>\n\n",
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"excerpt": "A flow of Medi-Cal expansion dollars — and patients — has fueled significant growth, making clinics in California one of the linchpins of primary care under the Affordable Care Act.",
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"description": "A flow of Medi-Cal expansion dollars — and patients — has fueled significant growth, making clinics in California one of the linchpins of primary care under the Affordable Care Act.",
"title": "California’s Community Clinics, Big Obamacare Beneficiaries, Worry About Their Future | KQED",
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"headline": "California’s Community Clinics, Big Obamacare Beneficiaries, Worry About Their Future",
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"nprByline": "\u003cstrong>\u003ca href=\"http://californiahealthline.org/news/author/eryn-brown/\">Eryn Brown\u003c/a>\u003c/strong>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Paula Wilson has seen some tough times in her 23 years as the CEO of Valley Community Healthcare, a clinic that provides care for the poor in North Hollywood, Calif. But nothing was quite like November 9, the day after the U.S. elections, when walking around the office “was like coming into a funeral,” she said.\u003c/p>\n\u003cp>Her staff worried that a repeal of the Affordable Care Act, long promised by Republicans, would obliterate their jobs. Patients fretted it would jeopardize their care.\u003c/p>\n\u003cp>Nearly a third of the clinic’s 25,000 patients were newcomers, many of them recently covered through the expansion of Medi-Cal ushered in by the Affordable Care Act. Thanks to the expansion, Valley Community Healthcare had been growing rapidly, opening one new site, adding on to others, and offering patients new dental and mental health services.\u003c/p>\n\u003cp>What would happen if this new source of financial support were taken away?\u003c/p>\n\u003cp>Wilson didn’t have an answer that day, and she still doesn’t. But she’s hanging on to a cautious hope. “Pretty much that whole first week was getting a grip and assuring people: We’ve been here 46 years and we’re not going anywhere,” she said. “We’ve fought the fight before, and we’ll do it again.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In the absence of details about the impact and timing of a possible ACA repeal, Wilson’s brand of determination is all community clinics can count on for now.\u003c/p>\n\u003cp>Republicans, newly empowered by Donald Trump’s ascendance to the White House, have made clear they plan to repeal large parts of the landmark health care law in short order. The timing of any replacement is still uncertain, though political pressure has been growing recently for any void left by a repeal to be quickly filled with a new plan. For the time being, however, consumers are unlikely to see big changes in their health care.\u003c/p>\n\u003cp>Community clinics are key providers of primary care services for the poor. CaliforniaHealth+ Advocates, which represents the state’s clinics, estimates that they serve 6.2 million Californians — an increase of more than a million in less than five years. Today, more than 3.5 million community clinic patients are covered by Medi-Cal, California’s version of Medicaid, the federal health insurance program for people with low incomes.\u003c/p>\n\u003cp>More than half of patients who signed up for Medi-Cal after the advent of the ACA have gotten their primary care at community clinics, according to a December 2015 \u003ca href=\"http://www.chcf.org/publications/2015/12/medical-winwin-surging-enrollment\" target=\"_blank\">report\u003c/a> by the California Health Care Foundation. (California Healthline is an editorially independent service of the California Health Care Foundation.)\u003c/p>\n\u003cp>Historically supported by Democrats and Republicans alike, community clinics worked hard to implement Obamacare reforms, and they benefited as a result. Many, like Valley Community Healthcare, helped enroll patients and expanded their services, taking advantage of special ACA funding that enabled them to improve their facilities and systems of care.\u003c/p>\n\u003cp>The \u003ca href=\"http://khn.org/news/obamacare-boosted-community-health-centers-reach-now-what/\" target=\"_blank\">same scenario\u003c/a> has played out nationwide at many of 1,400 federally backed community health centers — a type of community clinic — according to two studies published recently in the journal \u003ca href=\"http://www.healthaffairs.org/\" target=\"_blank\">Health Affairs\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"http://content.healthaffairs.org/content/36/1/49.abstract\" target=\"_blank\">One of the studies\u003c/a>, which used data from 2012 to 2015 to track visits to community health centers, showed that in states that adopted the Medicaid expansion, the centers saw more patient visits, including those for mental health treatment, and lower rates of uninsured patients — a financial boon for clinics that typically operate on thin margins.\u003c/p>\n\u003cp>The second \u003ca href=\"http://content.healthaffairs.org/content/36/1/40.abstract\" target=\"_blank\">study\u003c/a> which examined data from 2011 to 2014, found that in the Medicaid expansion states, patients were more likely to receive asthma treatment when it was needed, have their body mass index assessed, get pap smears and keep their blood pressure relatively stable.\u003c/p>\n\u003cp>Proponents of the health reform law in California had hoped the expansion of community clinics would provide primary care for more patients, thus reducing expensive emergency room visits at safety-net hospitals.\u003c/p>\n\u003cp>“Health centers have been the poster child of positively embracing the ACA. They’ve gone along with everything,” said Blue Shield of California Foundation CEO Peter Long, whose organization supports the clinics. But without clarity about where funding will come from in the future, or how much of it there will be, it’s possible that clinics will “go into hunker-down mode,” he added. That could mean limiting hours, reinstating waiting lists for new patients and cutting promising new programs.\u003c/p>\n\u003cp>Implementing Obamacare “put a lot of stress on their systems,” Long said. “To unwind it would be equally hard.”\u003c/p>\n\u003cfigure class=\"layout-lg carousel-article carousel slide carousel-article-1\">\n\u003col class=\"carousel-indicators\">\n\u003cli class=\"active\">\n\u003cli>\n\u003cli>\n\u003c/ol>\n\u003cdiv class=\"carousel-inner\">\n\u003cdiv class=\"item active\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-1_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Paula Wilson, CEO of Valley Community Healthcare, says she has seen some tough times in her 23 years at the clinic which provides care for the poor in the area. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-2_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">The staff at Valley Community Healthcare worry that a promised Republican repeal of the Affordable Care Act would jeopardize the care offered to the 7,400 patients currently under the law. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003cdiv class=\"item\">\u003cimg src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-3_cropped.jpg\" class=\"img-responsive\">\u003cfigcaption class=\"caption carousel-caption\">Nearly a third of Valley Community Healthcare’s 25,000 customers are newcomers. Many had only recently secured health coverage through the Medicaid expansion provisions of the Affordable Care Act. After the election, Wilson spent the week assuring her customers: “We’ve been here 46 years and we’re not going anywhere,” said Wilson. (Heidi de Marco/California Healthline)\u003c/figcaption>\u003c/div>\n\u003c/div>\n\u003cp>\u003ca class=\"left carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-prev\">\u003c/span>\u003c/a>\u003ca class=\"right carousel-control\" href=\".carousel-article.carousel-article-1\">\u003cspan class=\"btn-next\">\u003c/span>\u003c/a>\u003c/p>\u003c/figure>\n\u003cp>Wilson and other clinic CEOs said they’re trying to anticipate worst-case scenarios and plan accordingly, but that’s hard when Congress hasn’t specified what changes it is planning, or when to expect them.\u003c/p>\n\u003cp>“Right now it’s all crystal ball gazing,” said Steven Wallace, associate director of the UCLA Center for Health Policy Research. “‘Repeal and replace’ is a great slogan, but ‘replace’ is really hard to figure out.”\u003c/p>\n\u003cp>Community clinic leaders say they’re focusing on several \u003ca href=\"http://khn.org/news/millions-could-lose-medicaid-coverage-under-trump-plan/\" target=\"_blank\">funding challenges\u003c/a>. First is a potential rollback of the ACA’s Medicaid expansion program, which extended new coverage to about 20 million people in the U.S., including more than 5 million in California, said Carmela Castellano-Garcia, CEO of CaliforniaHealth+ Advocates.\u003c/p>\n\u003cp>Some also worry that shifting Medicaid to a block grant system, an idea President-elect Trump has endorsed, would result in cuts to services; or that Congress could decline to reauthorize “330 funding” — an additional $5 billion community clinics receive each year from the federal government. That stream of federal dollars is set to expire in September of 2017.\u003c/p>\n\u003cp>That funding, in addition to payments from the Medi-Cal expansion, allowed the Los Angeles Christian Health Centers to add medical, mental health, dental and case management staff and open two new sites.\u003c/p>\n\u003cp>The clinic, headquartered on Skid Row in downtown Los Angeles, also launched a fundraising campaign to revamp and enlarge its flagship facility. But CEO Dr. Lisa Abdishoo now worries that some financial assumptions made in planning the expansion may no longer apply after Trump takes office on Friday. “We’re trying not to panic, but now we have to question the sustainability of some of the growth,” she said.\u003c/p>\n\u003cp>Health care advocates have advised community clinics that they may need to “look at 2009 levels” to plan for post-ACA operations, Abdishoo said. That year, Los Angeles Christian Health Centers served 6,600 patients a year, compared to 10,000 today.\u003c/p>\n\u003cp>Jane Garcia, CEO of La Clínica De La Raza, a 32-site clinic network in Alameda, Contra Costa and Solano Counties, said her organization could lose ground on hard-fought cost reductions if people’s insurance is taken away and they revert to their old behavior of seeking care only when they are very sick.\u003c/p>\n\u003cp>“Patients who don’t have coverage hesitate to come in and see the doctor, and they hesitate to seek preventive care,” Garcia said. “That’s the kind of thing that was starting to have an impact on bending the curve on cost reduction.”\u003c/p>\n\u003cp>ACA-related grants allowed La Clínica’s health centers to improve case management and collaborate more effectively with partners such as Sutter Health, which also saved money by reducing the number of patients seeking primary care in emergency rooms. La Clínica would probably have to cut such administrative efforts were the ACA repealed, Garcia said.\u003c/p>\n\u003cp>Pamela Richardson, a 60-year-old patient of Valley Community Healthcare who suffers from an iron absorption disorder called hereditary hemochromatosis, was unable to get health insurance before Obamacare prohibited insurers from excluding people with preexisting medical conditions. The clinic helped her sign up for coverage through the Medi-Cal expansion.\u003c/p>\n\u003cp>Once Richardson was covered, she got long-delayed primary care, which revealed that she had “scary high” blood pressure and a lump in one breast (which proved benign). “When you don’t have insurance you don’t get breast exams. You don’t have pap smears,” she said. “I wish people had a little more patience with Obamacare. Once you get what’s wrong with you under control, the cost would come down.”\u003c/p>\n\u003cdiv id=\"attachment_222383\" style=\"width: 780px\" class=\"wp-caption aligncenter\">\u003cimg class=\"wp-image-222383 size-khn-article-large\" src=\"https://californiahealthline.files.wordpress.com/2016/12/community-clinics-7_770.jpg?w=770&h=513&crop=1\" alt=\"Lisa Zeelander, a medical doctor at Valley Community Healthcare in North Hollywood, California, examines patient Pamela Richardson, 60, on Wednesday, December 21, 2016. (Heidi de Marco/KHN)\" width=\"770\" height=\"513\">\n\u003cp class=\"wp-caption-text\">Lisa Zeelander, a doctor at Valley Community Healthcare, examines Richardson in December 2016. (Heidi de Marco/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>Wilson, Castellano-Garcia and others said they plan to make precisely that case — that community clinics represent a good value — once state and federal officials begin mulling an ACA replacement in earnest.\u003c/p>\n\u003cp>A \u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303341\" target=\"_blank\">November 2016 study\u003c/a> in the American Journal of Public Health showed that Medicaid spending was 24 percent lower for patients who received a majority of their primary care from federally qualified health centers — a type of community clinic — than for patients who got care in other settings. The savings extended across all services, the study’s authors reported.\u003c/p>\n\u003cp>In rural Shasta County, where a majority voted for Trump, one in three people has Medi-Cal coverage. Dean Germano, CEO of Shasta Community Health in Redding, said he has already launched conversations with staffers of Republican U.S. Rep. Doug LaMalfa who he considers “a friend of the health centers.”\u003c/p>\n\u003cp>“Our mission is to make people like him realize what [repeal] will mean for people on the ground,” Germano said. “If the system goes through a major shock, what would happen to jobs? It would have a major impact on rural communities.”\u003c/p>\n\u003cp>Another clinic CEO, Kim Wyard of Northeast Valley Health Corporation in San Fernando, said she takes heart because Congress will have to do something to replace what it is taking away. Just blowing everything up isn’t an option, she said.\u003c/p>\n\u003cp>“We need a safety net, and if more patients are uninsured, we’ll need it more,” Wyard said. “We’re cost-effective,” she added. “Our new president wrote ‘The Art of the Deal.’ He likes a deal. I don’t think there’s a better deal than health centers.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Shefali Luthra contributed reporting.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Nail Salons Start To Invest In Worker Safety",
"title": "California Nail Salons Start To Invest In Worker Safety",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>What stands out upon entering Mai Dang's nail salon, located on a busy street in Berkeley, Calif., is what's missing — the stinging smell of polish, remover and other nail products. That wasn't always the case. For a decade, Dang suffered from the effects of the chemicals she used at work every day.\u003c/p>\n\u003cp>\"When you do nails, workers get itchy skin and watery eyes,\" says Dang, 40. She also used to have frequent headaches, and one of her workers developed asthma. So when she heard about an opportunity to improve the safety at her salon, she signed up.\u003c/p>\n\u003cp>\"I work every day. I need the air to be pure, to be better for me. I have to take care of my health this way,\" she says, speaking in Vietnamese through an interpreter.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/509315426/509444361\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>\u003ca href=\"http://www.asianhealthservices.org/\">Asian Health Services\u003c/a>, a community clinic in Oakland, started \u003ca href=\"http://www.cahealthynailsalons.org/\">The California Healthy Nail Salon Collaborative\u003c/a> after the clinic identified a pattern of illness among nail salon workers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Practically every worker was experiencing some kind of health issue. And we realized that this was an epidemic,\" says Julia Liou, planning and development director at the clinic and the co-founder of the collaborative.\u003c/p>\n\u003cp>Nail salons are big business in the United States — \u003ca href=\"http://files.nailsmag.com/Feature-Articles-in-PDF/NABB2015-16stats.pdf\">approximately $8.5 billion \u003c/a> in revenue in 2015. Some of the chemicals used in salons \u003ca href=\"https://www.osha.gov/SLTC/nailsalons/chemicalhazards.html\">are known to cause\u003c/a> skin disorders and respiratory problems, and possibly even cancer, miscarriages and birth defects. Formaldehyde and toluene are just two of the risky ingredients in the nail polishes, solvents, glues and hardeners in constant use in salons; the Environmental Protection Agency \u003ca href=\"https://www.epa.gov/sites/production/files/2015-05/documents/nailsalonguide.pdf\">lists\u003c/a> at least 20 such worrisome chemicals.\u003c/p>\n\u003cp>But, so far, there's been little government regulation to protect workers. Liou is trying to get salon owners to make changes voluntarily to improve worker safety.\u003c/p>\n\u003cp>\"We don't want to create a fear where it's like, 'Oh nail salons are so scary that people can't go to them,' \" explains Liou. \"But we want to create a space where both the owner and the customer can feel comfortable, and actually create a model where the return on investment ends up being worker health.\"\u003c/p>\n\u003cp>Salons that participate in the collaborative must make significant changes to their business, including buying less toxic nail polishes, thinners and removers. All workers are required to wear specific types of gloves and masks when using certain products. Owners are also required to purchase a portable mechanical ventilation unit.\u003c/p>\n\u003cp>\"It sucks in the air when I do artificial nails so the workers don't have to breathe in the toxic chemicals anymore,\" explains Dang, as she turns on the machine with a remote control. More than 80 percent of salon workers in California are Vietnamese American, and more than half are of reproductive age, according to the collaborative.\u003c/p>\n\u003cfigure id=\"attachment_283568\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-800x533.jpg\" alt=\"Mai Dang's Fashion Nails has been certified as a healthy salon since 2013. Salons with that designation provide proper ventilation, train employees on best practices, and avoid products containing formaldehyde, toluene and other particularly toxic solvents and glues.\" width=\"800\" height=\"533\" class=\"size-medium wp-image-283568\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-768x511.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-1020x679.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-960x639.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-520x346.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Mai Dang's Fashion Nails has been certified as a healthy salon since 2013. Salons with that designation provide proper ventilation, train employees on best practices, and avoid products containing formaldehyde, toluene and other particularly toxic solvents and glues. \u003ccite>(Jenny Gold/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Alameda County certified Dang's salon, Fashion Nails, as a healthy salon in 2013, based on her changes. In return, Dang got a certificate that she hangs in her window to let customers know she is part of the collaborative. Fashion Nails is also listed as \u003ca href=\"http://www.co.alameda.ca.us/aceh/healthynail/documents/RECOGNIZED-SALONS.pdf\">a healthier nail salon \u003c/a>on a county website.\u003c/p>\n\u003cp>The process, however, was not cheap. Dang says the products she now uses, while safer, cost about 30 percent more. Overall, she estimates that she spent about $3,000 on the upgrades. To pay for it, she raised her prices by $2 per service.\u003c/p>\n\u003cp>One of Dang's customers, Genell Johnson, says she's more than willing to pay extra for the service.\u003c/p>\n\u003cp>\"You get what you pay for,\" Johnson says. \"That's what they always say, and it's very true.\"\u003c/p>\n\u003cp>A survey of customers by the collaborative found that 90 percent were willing to pay at least a dollar more for services they knew were healthier. Johnson says she's a regular at Fashion Nails but had no idea it was a healthy salon.\u003c/p>\n\u003cp>\"Now I'm going to spread the word,\" says Johnson. \"This will be the perfect place, knowing they're so health conscious.\"\u003c/p>\n\u003cp>For Dang, the investment in a healthier salon seems to be paying off. Visits to her salon have increased, and her business has become more profitable, she says.\u003c/p>\n\u003cp>But getting businesses to make changes voluntarily is a slow process. Out of more than 8,000 nail salons in California, only 120 have joined the collaborative so far.\u003c/p>\n\u003cp>\"I think the ultimate root of the issue is that the chemicals are still in the products,\" says collaborative co-founder Liou. \"If we want to look at really how do we improve worker health, we also need the manufacturers to consider how they can they make safer products as well.\"\u003c/p>\n\u003cp>Still, the Healthy Nail Salon Collaborative is making progress. The EPA recently \u003ca href=\"https://www.epa.gov/newsreleases/us-epa-awards-120000-protect-health-bay-area-nail-salons\">gave the collaborative a grant\u003c/a> to help them offer microloans to salons wanting to upgrade.\u003c/p>\n\u003cp>In September, California \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB2125\">passed legislation\u003c/a> to help expand the program across the state, by training cities and counties on how to certify healthy nail salons in their regions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. You can follow Jenny Gold on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/JennyAGold\">@JennyAGold\u003c/a>. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=California+Nail+Salons+Start+To+Invest+In+Worker+Safety&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>What stands out upon entering Mai Dang's nail salon, located on a busy street in Berkeley, Calif., is what's missing — the stinging smell of polish, remover and other nail products. That wasn't always the case. For a decade, Dang suffered from the effects of the chemicals she used at work every day.\u003c/p>\n\u003cp>\"When you do nails, workers get itchy skin and watery eyes,\" says Dang, 40. She also used to have frequent headaches, and one of her workers developed asthma. So when she heard about an opportunity to improve the safety at her salon, she signed up.\u003c/p>\n\u003cp>\"I work every day. I need the air to be pure, to be better for me. I have to take care of my health this way,\" she says, speaking in Vietnamese through an interpreter.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/509315426/509444361\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>\u003ca href=\"http://www.asianhealthservices.org/\">Asian Health Services\u003c/a>, a community clinic in Oakland, started \u003ca href=\"http://www.cahealthynailsalons.org/\">The California Healthy Nail Salon Collaborative\u003c/a> after the clinic identified a pattern of illness among nail salon workers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Practically every worker was experiencing some kind of health issue. And we realized that this was an epidemic,\" says Julia Liou, planning and development director at the clinic and the co-founder of the collaborative.\u003c/p>\n\u003cp>Nail salons are big business in the United States — \u003ca href=\"http://files.nailsmag.com/Feature-Articles-in-PDF/NABB2015-16stats.pdf\">approximately $8.5 billion \u003c/a> in revenue in 2015. Some of the chemicals used in salons \u003ca href=\"https://www.osha.gov/SLTC/nailsalons/chemicalhazards.html\">are known to cause\u003c/a> skin disorders and respiratory problems, and possibly even cancer, miscarriages and birth defects. Formaldehyde and toluene are just two of the risky ingredients in the nail polishes, solvents, glues and hardeners in constant use in salons; the Environmental Protection Agency \u003ca href=\"https://www.epa.gov/sites/production/files/2015-05/documents/nailsalonguide.pdf\">lists\u003c/a> at least 20 such worrisome chemicals.\u003c/p>\n\u003cp>But, so far, there's been little government regulation to protect workers. Liou is trying to get salon owners to make changes voluntarily to improve worker safety.\u003c/p>\n\u003cp>\"We don't want to create a fear where it's like, 'Oh nail salons are so scary that people can't go to them,' \" explains Liou. \"But we want to create a space where both the owner and the customer can feel comfortable, and actually create a model where the return on investment ends up being worker health.\"\u003c/p>\n\u003cp>Salons that participate in the collaborative must make significant changes to their business, including buying less toxic nail polishes, thinners and removers. All workers are required to wear specific types of gloves and masks when using certain products. Owners are also required to purchase a portable mechanical ventilation unit.\u003c/p>\n\u003cp>\"It sucks in the air when I do artificial nails so the workers don't have to breathe in the toxic chemicals anymore,\" explains Dang, as she turns on the machine with a remote control. More than 80 percent of salon workers in California are Vietnamese American, and more than half are of reproductive age, according to the collaborative.\u003c/p>\n\u003cfigure id=\"attachment_283568\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-800x533.jpg\" alt=\"Mai Dang's Fashion Nails has been certified as a healthy salon since 2013. Salons with that designation provide proper ventilation, train employees on best practices, and avoid products containing formaldehyde, toluene and other particularly toxic solvents and glues.\" width=\"800\" height=\"533\" class=\"size-medium wp-image-283568\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-768x511.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-1020x679.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-960x639.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/01/salon-2_enl-216a76948fef4044ad8fe46c41f7a076bc2f2fcf-520x346.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Mai Dang's Fashion Nails has been certified as a healthy salon since 2013. Salons with that designation provide proper ventilation, train employees on best practices, and avoid products containing formaldehyde, toluene and other particularly toxic solvents and glues. \u003ccite>(Jenny Gold/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Alameda County certified Dang's salon, Fashion Nails, as a healthy salon in 2013, based on her changes. In return, Dang got a certificate that she hangs in her window to let customers know she is part of the collaborative. Fashion Nails is also listed as \u003ca href=\"http://www.co.alameda.ca.us/aceh/healthynail/documents/RECOGNIZED-SALONS.pdf\">a healthier nail salon \u003c/a>on a county website.\u003c/p>\n\u003cp>The process, however, was not cheap. Dang says the products she now uses, while safer, cost about 30 percent more. Overall, she estimates that she spent about $3,000 on the upgrades. To pay for it, she raised her prices by $2 per service.\u003c/p>\n\u003cp>One of Dang's customers, Genell Johnson, says she's more than willing to pay extra for the service.\u003c/p>\n\u003cp>\"You get what you pay for,\" Johnson says. \"That's what they always say, and it's very true.\"\u003c/p>\n\u003cp>A survey of customers by the collaborative found that 90 percent were willing to pay at least a dollar more for services they knew were healthier. Johnson says she's a regular at Fashion Nails but had no idea it was a healthy salon.\u003c/p>\n\u003cp>\"Now I'm going to spread the word,\" says Johnson. \"This will be the perfect place, knowing they're so health conscious.\"\u003c/p>\n\u003cp>For Dang, the investment in a healthier salon seems to be paying off. Visits to her salon have increased, and her business has become more profitable, she says.\u003c/p>\n\u003cp>But getting businesses to make changes voluntarily is a slow process. Out of more than 8,000 nail salons in California, only 120 have joined the collaborative so far.\u003c/p>\n\u003cp>\"I think the ultimate root of the issue is that the chemicals are still in the products,\" says collaborative co-founder Liou. \"If we want to look at really how do we improve worker health, we also need the manufacturers to consider how they can they make safer products as well.\"\u003c/p>\n\u003cp>Still, the Healthy Nail Salon Collaborative is making progress. The EPA recently \u003ca href=\"https://www.epa.gov/newsreleases/us-epa-awards-120000-protect-health-bay-area-nail-salons\">gave the collaborative a grant\u003c/a> to help them offer microloans to salons wanting to upgrade.\u003c/p>\n\u003cp>In September, California \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB2125\">passed legislation\u003c/a> to help expand the program across the state, by training cities and counties on how to certify healthy nail salons in their regions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. You can follow Jenny Gold on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/JennyAGold\">@JennyAGold\u003c/a>. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=California+Nail+Salons+Start+To+Invest+In+Worker+Safety&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"slug": "bay-area-man-confronts-and-embraces-his-right-to-die",
"title": "Bay Area Cancer Patient Confronts and Embraces His Right to Die",
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"headTitle": "Bay Area Cancer Patient Confronts and Embraces His Right to Die | KQED",
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"content": "\u003cp>\u003cem>Last year, California became the fifth state to allow terminally ill patients to take lethal medication to end their lives. The new law — the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/03/10/californias-physician-assisted-suicide-law-to-take-effect-in-june/\" target=\"_blank\" rel=\"noopener\">End of Life Option Act\u003c/a> — took effect in June, 2016.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Piedmont resident \u003cstrong>Ray Perman\u003c/strong> always knew this is the way he wanted to go. He’s 64, a retired pilot, like his father, and an entrepreneur. He’s dying of cancer. I interviewed him about his decision. The following words, culled from that interview, are his.\u003c/em>\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/301315866″ 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>My pelvis is fully populated by prostate cancer. I have a one-inch tumor in my tailbone. I have seven tumors in my ribs, like little Christmas tree lights. So about two months ago, my physician called me in and said, ‘Well Ray, we’ve done everything we can.’ I said, ‘Well then I want to be on hospice. And I’d like to have you start with End of Life Options.’ He looked at me and said ‘I’ll write the prescription.’\u003c/p>\n\u003cp>So now I have my medical aid-in-dying drugs up in my bedroom, ready to go. You’re not allowed to go to the pharmacy and go pick them up. They won’t have you inadvertently leave them on the seat of the 57 bus. It has to be delivered like a loaded weapon. So the end-of-life options team came here with three people, the pharmacist with the drugs, my case manager and also another witness. They arrived here with these drugs and they went through the instructions on how to use them, and had me sign all the appropriate documents under witness, which is what they should absolutely do.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Remember that I have to take these prescriptions on my own. No one can assist me. No one can cajole or put the straw in my mouth or squeeze the drugs into my mouth. I have to take them, which means I have to have the ability to swallow. So what the hospice team is learning, they give you about a five-day window when you can do this drug and do the deed. And they’re learning, because they’ve missed a couple of times with other patients. They didn’t call it early enough, and the person could no longer do the drug and they feel very badly.\u003c/p>\n\u003cfigure id=\"attachment_281642\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281642\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-800x1002.jpg\" alt=\"Ray Perman is a percussionist, avid traveler and self-described “manic volunteer.” Here he plays the Cuban bell during a trip to Havana last March, where he played with six bands.\" width=\"800\" height=\"1002\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-160x200.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-768x962.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-240x301.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-375x470.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-520x651.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman is a percussionist, avid traveler and self-described “manic volunteer.” Here he plays the Cuban bell during a trip to Havana last March, where he played with six bands. \u003ccite>(Courtesy Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>They’ve giving me markers, clues as you get closer to the end. You look for changes in perception of food taste, general weakness, or the need to take a mid-morning nap, which I’m starting to do now. My stairway is a measuring device. People say, ‘Ray, should you get a hospital bed down here?’ I say, no I don’t want to die in my living room. I have a beautiful bedroom with windows on three sides, I want to look at my view. So if I can’t get up the stairway anymore, it means we’re darn close. And we are kind of close.\u003c/p>\n\u003cp>It will be a hard decision. People who go for the aid-in-dying option, I understand only 65 percent actually do it. Of the people who don’t, some basically die of symptoms prior to using the option, some simply change their mind. You know, I’m not a hero. I may chicken out.\u003c/p>\n\u003cp>I attended my daughter’s wedding in September and afterwards my oncologist said, the whole department, we figured you had 50/50 odds of attending. And I had a 70 percent chance of dying last month in December. I mean, who knows how it’ll go. Some days I wake up and I can feel cancer coming. It feels like I’m not going to make it to January 15. I have meetings on January 15 — I’ve got to make those meetings. And my wonderful in-home care provider, she’s pregnant and she’s going to give birth around February 15.\u003c/p>\n\u003cp>Our goal is for me to hold the baby. It’ll be great. Maybe I’ll get there.\u003c/p>\n\u003cfigure id=\"attachment_281644\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281644\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/RayFlying-800x778.jpg\" alt=\"Ray Perman’s first career was as a pilot, similar to his father. He poses here with his daughter, Andrea, before a recreational flight. Andrea is now 24. His son, Eric, is 27.\" width=\"800\" height=\"778\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-160x156.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-768x747.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-240x233.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-375x365.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-520x506.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-32x32.jpg 32w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-50x50.jpg 50w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman’s first career was as a pilot, similar to his father. He poses here with his daughter, Andrea, before a recreational flight. Andrea is now 24. His son, Eric, is 27. \u003ccite>(Courtesy Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I made sure that the newspapers don’t say ‘Ray lost his battle with cancer.’ There’s no battle. If I were to be battling or struggling I would be preempting my ability to soak in all the wonderful things that are happening to me emotionally.\u003c/p>\n\u003cp>For me the epiphany in all of this is that I shifted from wanting to die quickly to wanting to enjoy this last phase. I think it’s the explorer in me. I want to carry the torch into that last phase and say ‘My gosh, look what I’m discovering. It’s beautiful.’ You shouldn’t miss it. Don’t fear death. It’s wrong.\u003c/p>\n\u003cfigure id=\"attachment_281521\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281521\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/KP-Racing-Team-2016-05-1-800x450.jpg\" alt=\"Ray Perman says he's maintained his "rollicking" sense of humor after being diagnosed with two types of cancer.\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman says he’s maintained his “rollicking” sense of humor after being diagnosed with two types of cancer. \u003ccite>(Courtesy of Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When the hospice team gives me the five day window, I will announce to my relatives: It’s time. I’m going to make it this day, come.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>I will have my closest loved ones around me when I do that. I’ll have an open house in the morning for my friends to give me a hug goodbye and then we’ll probably do the deed in the afternoon. Then my family can have time with my body in the evening, as long as they’d like. And I have a complete description on where to dispose of my ashes. It’ll be in the departure path of a Boeing aircraft that took off with my father, on an outgoing tide.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Last year, California became the fifth state to allow terminally ill patients to take lethal medication to end their lives. The new law — the \u003ca href=\"https://ww2.kqed.org/stateofhealth/2016/03/10/californias-physician-assisted-suicide-law-to-take-effect-in-june/\" target=\"_blank\" rel=\"noopener\">End of Life Option Act\u003c/a> — took effect in June, 2016.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Piedmont resident \u003cstrong>Ray Perman\u003c/strong> always knew this is the way he wanted to go. He’s 64, a retired pilot, like his father, and an entrepreneur. He’s dying of cancer. I interviewed him about his decision. The following words, culled from that interview, are his.\u003c/em>\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/301315866″&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/301315866″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>My pelvis is fully populated by prostate cancer. I have a one-inch tumor in my tailbone. I have seven tumors in my ribs, like little Christmas tree lights. So about two months ago, my physician called me in and said, ‘Well Ray, we’ve done everything we can.’ I said, ‘Well then I want to be on hospice. And I’d like to have you start with End of Life Options.’ He looked at me and said ‘I’ll write the prescription.’\u003c/p>\n\u003cp>So now I have my medical aid-in-dying drugs up in my bedroom, ready to go. You’re not allowed to go to the pharmacy and go pick them up. They won’t have you inadvertently leave them on the seat of the 57 bus. It has to be delivered like a loaded weapon. So the end-of-life options team came here with three people, the pharmacist with the drugs, my case manager and also another witness. They arrived here with these drugs and they went through the instructions on how to use them, and had me sign all the appropriate documents under witness, which is what they should absolutely do.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Remember that I have to take these prescriptions on my own. No one can assist me. No one can cajole or put the straw in my mouth or squeeze the drugs into my mouth. I have to take them, which means I have to have the ability to swallow. So what the hospice team is learning, they give you about a five-day window when you can do this drug and do the deed. And they’re learning, because they’ve missed a couple of times with other patients. They didn’t call it early enough, and the person could no longer do the drug and they feel very badly.\u003c/p>\n\u003cfigure id=\"attachment_281642\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281642\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-800x1002.jpg\" alt=\"Ray Perman is a percussionist, avid traveler and self-described “manic volunteer.” Here he plays the Cuban bell during a trip to Havana last March, where he played with six bands.\" width=\"800\" height=\"1002\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-160x200.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-768x962.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-240x301.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-375x470.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayPermanPercussion-520x651.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman is a percussionist, avid traveler and self-described “manic volunteer.” Here he plays the Cuban bell during a trip to Havana last March, where he played with six bands. \u003ccite>(Courtesy Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>They’ve giving me markers, clues as you get closer to the end. You look for changes in perception of food taste, general weakness, or the need to take a mid-morning nap, which I’m starting to do now. My stairway is a measuring device. People say, ‘Ray, should you get a hospital bed down here?’ I say, no I don’t want to die in my living room. I have a beautiful bedroom with windows on three sides, I want to look at my view. So if I can’t get up the stairway anymore, it means we’re darn close. And we are kind of close.\u003c/p>\n\u003cp>It will be a hard decision. People who go for the aid-in-dying option, I understand only 65 percent actually do it. Of the people who don’t, some basically die of symptoms prior to using the option, some simply change their mind. You know, I’m not a hero. I may chicken out.\u003c/p>\n\u003cp>I attended my daughter’s wedding in September and afterwards my oncologist said, the whole department, we figured you had 50/50 odds of attending. And I had a 70 percent chance of dying last month in December. I mean, who knows how it’ll go. Some days I wake up and I can feel cancer coming. It feels like I’m not going to make it to January 15. I have meetings on January 15 — I’ve got to make those meetings. And my wonderful in-home care provider, she’s pregnant and she’s going to give birth around February 15.\u003c/p>\n\u003cp>Our goal is for me to hold the baby. It’ll be great. Maybe I’ll get there.\u003c/p>\n\u003cfigure id=\"attachment_281644\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281644\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/RayFlying-800x778.jpg\" alt=\"Ray Perman’s first career was as a pilot, similar to his father. He poses here with his daughter, Andrea, before a recreational flight. Andrea is now 24. His son, Eric, is 27.\" width=\"800\" height=\"778\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-160x156.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-768x747.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-240x233.jpg 240w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-375x365.jpg 375w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-520x506.jpg 520w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-32x32.jpg 32w, https://cdn.kqed.org/wp-content/uploads/sites/27/2017/01/RayFlying-50x50.jpg 50w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman’s first career was as a pilot, similar to his father. He poses here with his daughter, Andrea, before a recreational flight. Andrea is now 24. His son, Eric, is 27. \u003ccite>(Courtesy Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I made sure that the newspapers don’t say ‘Ray lost his battle with cancer.’ There’s no battle. If I were to be battling or struggling I would be preempting my ability to soak in all the wonderful things that are happening to me emotionally.\u003c/p>\n\u003cp>For me the epiphany in all of this is that I shifted from wanting to die quickly to wanting to enjoy this last phase. I think it’s the explorer in me. I want to carry the torch into that last phase and say ‘My gosh, look what I’m discovering. It’s beautiful.’ You shouldn’t miss it. Don’t fear death. It’s wrong.\u003c/p>\n\u003cfigure id=\"attachment_281521\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-281521\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/01/KP-Racing-Team-2016-05-1-800x450.jpg\" alt=\"Ray Perman says he's maintained his "rollicking" sense of humor after being diagnosed with two types of cancer.\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Ray Perman says he’s maintained his “rollicking” sense of humor after being diagnosed with two types of cancer. \u003ccite>(Courtesy of Ray Perman)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When the hospice team gives me the five day window, I will announce to my relatives: It’s time. I’m going to make it this day, come.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>I will have my closest loved ones around me when I do that. I’ll have an open house in the morning for my friends to give me a hug goodbye and then we’ll probably do the deed in the afternoon. Then my family can have time with my body in the evening, as long as they’d like. And I have a complete description on where to dispose of my ashes. It’ll be in the departure path of a Boeing aircraft that took off with my father, on an outgoing tide.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Poll: Most Americans Say Don't Repeal Obamacare Without a Replacement",
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"content": "\u003cp>An overwhelming majority of people disapprove of Republican lawmakers' plan to repeal the Affordable Care Act without having a ready replacement for the health care law, according to a poll released Friday.\u003c/p>\n\u003cp>And judging by the letter-writing and lobbying in the first week of the new congressional session, many health care and business groups agree.\u003c/p>\n\u003cp>A \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-health-care-priorities-for-2017\">poll\u003c/a> released Friday by the \u003ca href=\"http://kff.org/about-us/\">Kaiser Family Foundation\u003c/a> finds that 75 percent of Americans say they either want lawmakers to leave Obamacare alone, or repeal it only when they can replace it with a new health care law. Twenty percent of those polled say they want to see the law killed immediately.\u003c/p>\n\u003cp>But Drew Altman, CEO of the Kaiser Family Foundation, says the poll shows lawmakers don't have a strong mandate to repeal Obamacare.\u003c/p>\n\u003cp>\"Most of the American people said they're either against repealing it or they're against repealing it unless Republicans put a replacement plan on the table,\" Altman says. \"They want to see what comes next before they seen the ACA repealed.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Americans are about equally divided over whether Congress should repeal Obamacare, the poll shows. But of the 48 percent who want the law rolled back, about 60 percent want lawmakers to wait until they have an alternative plan.\u003c/p>\n\u003cp>[kaiser_survey]\u003c/p>\n\u003cp>And Obamacare isn't even people's top health care concern. The vast majority -- 67 percent -- say their top priority is finding a way to lower their health care costs.\u003c/p>\n\u003cp>The poll findings come just days after Republicans in the Senate \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/03/508074966/republicans-take-the-first-step-to-repeal-obamacare\">took the first step\u003c/a> toward repealing President Obama's signature health care law. They voted on Wednesday to move ahead with a budget resolution that will allow them to take funding away from Obamacare, which will effectively gut the law because the subsidies to buy insurance, and the penalties for not doing so, will disappear.\u003c/p>\n\u003cp>Republicans say they intend to vote on repeal, but give the law \u003ca href=\"http://www.npr.org/sections/health-shots/2016/12/12/505285572/obamacares-demise-could-be-quicker-than-republicans-intend\">time to sunset\u003c/a> while they come up with a replacement that will give the millions of people covered under Obamacare access to insurance through some other vehicle.\u003c/p>\n\u003cp>On Thursday, House Speaker Paul Ryan, R-Wis., said the replacement legislation would pass by the end of the year.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.drsforamerica.org/blog/today-we-take-action\">doctors\u003c/a>, hospital groups, \u003ca href=\"https://www.scribd.com/document/333454038/AHIP-doc#from_embed\">insurers\u003c/a> and analysts are skeptical of that strategy. In letters, press releases and \u003ca href=\"https://www.youtube.com/watch?v=Z2qzZvWA-pM&feature=youtu.be\">advertising campaigns\u003c/a>, many organizations have made it clear that they want to see a replacement for the Affordable Care Act in place, or at least outlined, before Congress repeals the current law.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.aha.org/content/16/impact-repeal-aca-report.pdf\">report\u003c/a> released Dec. 6 by the American Hospital Association and Federation of American Hospitals warned that a repeal could cost hospitals hundreds of billions and said \"any reconsideration of the ACA should be accompanied at the same time by provisions that guarantee similar coverage to those who would lose it.\"\u003c/p>\n\u003cp>A \u003ca href=\"https://www.ama-assn.org/ama-letter-congressional-leaders-reform-health-care-system\">letter\u003c/a> sent Tuesday from the American Medical Association urged lawmakers to release details of their Obamacare replacement before repealing the current law.\u003c/p>\n\u003cp>\"Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform,\" the letter said.\u003c/p>\n\u003cp>Dr. Andrew Gurman, president of the American Medical Association, says people should be able to evaluate the proposed Obamacare replacement before the current law is thrown out.\u003c/p>\n\u003cp>\"People in this country need to understand what it is they're being asked to substitute for what's there now so they can have an informed opinion about whether it's better or not,\" \u003ca href=\"https://www.ama-assn.org/andrew-w-gurman-md\">Gurman\u003c/a> says.\u003c/p>\n\u003cp>And repeal and delay?\u003c/p>\n\u003cp>\"We have a concern that that creates uncertainty in insurance markets and uncertainty in people about whether they're going to have continuity of coverage,\" Gurman adds.\u003c/p>\n\u003cp>He says he and his members talk with lawmakers regularly.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.commonwealthfund.org/Publications/Issue-Briefs/2017/Jan/Repealing-Federal-Health-Reform.\">separate study\u003c/a> released Thursday projects that a straight repeal of the law could kill 3 million jobs across the country by 2021.\u003c/p>\n\u003cp>That study, by the \u003ca href=\"http://publichealth.gwu.edu/\">Milken Institute School of Public Health\u003c/a> at George Washington University, finds that about a third of those lost jobs would come from health care, and the rest would be in other industries such as retail, construction, finance and insurance. Total business output could be cut by as much as $2.6 billion over four years, the report says. California, Florida and Texas would be most affected.\u003c/p>\n\u003cp>Leighton Ku, the report's lead author, says the debate over ACA repeal has focused almost completely on insurance coverage and has ignored the broader economic impact.\u003c/p>\n\u003cp>\"The payments you make to health care then become income for workers and income for other businesses. And this spreads out,\" \u003ca href=\"http://publichealth.gwu.edu/departments/health-policy-and-management/leighton-ku\">Ku\u003c/a> says. \"Health care is almost a fifth of the US economy, so as you begin to change health care, there are repercussions that go across all sectors.\"\u003c/p>\n\u003cp>Ku says he can't estimate what economic impact Obamcare replacement would have because Republicans have yet to lay out their plans.\u003c/p>\n\u003cp>\"It's a mystery,\" he says.\u003c/p>\n\u003cp>\u003cstrong>Editor's note:\u003c/strong> \u003cem>The Kaiser Family Foundation supports Kaiser Health News, an editorially independent program that produces news reports heard on NPR and published on \u003c/em>\u003ca href=\"http://NPR.org\">NPR.org\u003c/a>. \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>An overwhelming majority of people disapprove of Republican lawmakers' plan to repeal the Affordable Care Act without having a ready replacement for the health care law, according to a poll released Friday.\u003c/p>\n\u003cp>And judging by the letter-writing and lobbying in the first week of the new congressional session, many health care and business groups agree.\u003c/p>\n\u003cp>A \u003ca href=\"http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-health-care-priorities-for-2017\">poll\u003c/a> released Friday by the \u003ca href=\"http://kff.org/about-us/\">Kaiser Family Foundation\u003c/a> finds that 75 percent of Americans say they either want lawmakers to leave Obamacare alone, or repeal it only when they can replace it with a new health care law. Twenty percent of those polled say they want to see the law killed immediately.\u003c/p>\n\u003cp>But Drew Altman, CEO of the Kaiser Family Foundation, says the poll shows lawmakers don't have a strong mandate to repeal Obamacare.\u003c/p>\n\u003cp>\"Most of the American people said they're either against repealing it or they're against repealing it unless Republicans put a replacement plan on the table,\" Altman says. \"They want to see what comes next before they seen the ACA repealed.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Americans are about equally divided over whether Congress should repeal Obamacare, the poll shows. But of the 48 percent who want the law rolled back, about 60 percent want lawmakers to wait until they have an alternative plan.\u003c/p>\n\u003cp>[kaiser_survey]\u003c/p>\n\u003cp>And Obamacare isn't even people's top health care concern. The vast majority -- 67 percent -- say their top priority is finding a way to lower their health care costs.\u003c/p>\n\u003cp>The poll findings come just days after Republicans in the Senate \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/03/508074966/republicans-take-the-first-step-to-repeal-obamacare\">took the first step\u003c/a> toward repealing President Obama's signature health care law. They voted on Wednesday to move ahead with a budget resolution that will allow them to take funding away from Obamacare, which will effectively gut the law because the subsidies to buy insurance, and the penalties for not doing so, will disappear.\u003c/p>\n\u003cp>Republicans say they intend to vote on repeal, but give the law \u003ca href=\"http://www.npr.org/sections/health-shots/2016/12/12/505285572/obamacares-demise-could-be-quicker-than-republicans-intend\">time to sunset\u003c/a> while they come up with a replacement that will give the millions of people covered under Obamacare access to insurance through some other vehicle.\u003c/p>\n\u003cp>On Thursday, House Speaker Paul Ryan, R-Wis., said the replacement legislation would pass by the end of the year.\u003c/p>\n\u003cp>But \u003ca href=\"http://www.drsforamerica.org/blog/today-we-take-action\">doctors\u003c/a>, hospital groups, \u003ca href=\"https://www.scribd.com/document/333454038/AHIP-doc#from_embed\">insurers\u003c/a> and analysts are skeptical of that strategy. In letters, press releases and \u003ca href=\"https://www.youtube.com/watch?v=Z2qzZvWA-pM&feature=youtu.be\">advertising campaigns\u003c/a>, many organizations have made it clear that they want to see a replacement for the Affordable Care Act in place, or at least outlined, before Congress repeals the current law.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.aha.org/content/16/impact-repeal-aca-report.pdf\">report\u003c/a> released Dec. 6 by the American Hospital Association and Federation of American Hospitals warned that a repeal could cost hospitals hundreds of billions and said \"any reconsideration of the ACA should be accompanied at the same time by provisions that guarantee similar coverage to those who would lose it.\"\u003c/p>\n\u003cp>A \u003ca href=\"https://www.ama-assn.org/ama-letter-congressional-leaders-reform-health-care-system\">letter\u003c/a> sent Tuesday from the American Medical Association urged lawmakers to release details of their Obamacare replacement before repealing the current law.\u003c/p>\n\u003cp>\"Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform,\" the letter said.\u003c/p>\n\u003cp>Dr. Andrew Gurman, president of the American Medical Association, says people should be able to evaluate the proposed Obamacare replacement before the current law is thrown out.\u003c/p>\n\u003cp>\"People in this country need to understand what it is they're being asked to substitute for what's there now so they can have an informed opinion about whether it's better or not,\" \u003ca href=\"https://www.ama-assn.org/andrew-w-gurman-md\">Gurman\u003c/a> says.\u003c/p>\n\u003cp>And repeal and delay?\u003c/p>\n\u003cp>\"We have a concern that that creates uncertainty in insurance markets and uncertainty in people about whether they're going to have continuity of coverage,\" Gurman adds.\u003c/p>\n\u003cp>He says he and his members talk with lawmakers regularly.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.commonwealthfund.org/Publications/Issue-Briefs/2017/Jan/Repealing-Federal-Health-Reform.\">separate study\u003c/a> released Thursday projects that a straight repeal of the law could kill 3 million jobs across the country by 2021.\u003c/p>\n\u003cp>That study, by the \u003ca href=\"http://publichealth.gwu.edu/\">Milken Institute School of Public Health\u003c/a> at George Washington University, finds that about a third of those lost jobs would come from health care, and the rest would be in other industries such as retail, construction, finance and insurance. Total business output could be cut by as much as $2.6 billion over four years, the report says. California, Florida and Texas would be most affected.\u003c/p>\n\u003cp>Leighton Ku, the report's lead author, says the debate over ACA repeal has focused almost completely on insurance coverage and has ignored the broader economic impact.\u003c/p>\n\u003cp>\"The payments you make to health care then become income for workers and income for other businesses. And this spreads out,\" \u003ca href=\"http://publichealth.gwu.edu/departments/health-policy-and-management/leighton-ku\">Ku\u003c/a> says. \"Health care is almost a fifth of the US economy, so as you begin to change health care, there are repercussions that go across all sectors.\"\u003c/p>\n\u003cp>Ku says he can't estimate what economic impact Obamcare replacement would have because Republicans have yet to lay out their plans.\u003c/p>\n\u003cp>\"It's a mystery,\" he says.\u003c/p>\n\u003cp>\u003cstrong>Editor's note:\u003c/strong> \u003cem>The Kaiser Family Foundation supports Kaiser Health News, an editorially independent program that produces news reports heard on NPR and published on \u003c/em>\u003ca href=\"http://NPR.org\">NPR.org\u003c/a>. \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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"disqusTitle": "Will California’s New 'Right to Try' Law Empower or Exploit Patients?",
"title": "Will California’s New 'Right to Try' Law Empower or Exploit Patients?",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>With the enactment of a new “Right to Try” law, California joins 31 other states that have already passed legislation to support patients’ efforts to access experimental drugs.\u003c/p>\n\u003cp>As of Jan. 1, state agencies and licensing boards will not penalize California doctors or hospitals that want to help patients directly petition pharmaceutical companies for the investigational drugs.\u003c/p>\n\u003cp>Proponents of the “Right to Try” movement had contended that doctors could be hesitant to help such patients because of the risk of using drugs or devices that haven’t passed FDA tests for safety and effectiveness.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/300768363\" 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>The new law makes it clear that California doctors can proceed without fear of censure from the state’s medical board. It also eliminates other possible regulatory obstacles on the state level and creates processes for patient consent and data collection.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"The idea is to kind of get government out of the way in this situation and allow people to just go at it with a doctor to try to get access to these potentially life-saving medications,” said the law’s sponsor \u003ca href=\"http://asmdc.org/members/a57/\" target=\"_blank\">Ian Calderon\u003c/a>, the Democratic majority leader in the California Assembly.\u003c/p>\n\u003cp>Supporters of “Right to Try” laws sometimes frame them as the logical counterpart to “Right to Die” laws, which allow physician-assisted suicide for terminally ill patients. California enacted such a law in 2016.\u003c/p>\n\u003cp>\"The patient community is saying, ‘We are smart, we’re informed, we feel it is our right to try some of these therapies, because we’re going to die anyway,’” said Lina Clark, a patients’ rights \u003ca href=\"http://www.hopenowforals.org\" target=\"_blank\">activist\u003c/a> in San Diego.\u003c/p>\n\u003cp>Clark’s husband, \u003ca href=\"http://sci.sdsu.edu/geology/remembering-dr-david-huntley/\" target=\"_blank\">David Huntley\u003c/a>, had wanted to try an experimental drug before his death in 2015 from \u003ca href=\"https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Amyotrophic-Lateral-Sclerosis-ALS-Fact-Sheet\" target=\"_blank\">amyotrophic lateral sclerosis\u003c/a> (ALS).\u003c/p>\n\u003cfigure id=\"attachment_278363\" class=\"wp-caption alignnone\" style=\"max-width: 720px\">\u003cimg class=\"size-full wp-image-278363\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento.jpg\" alt=\"David Huntley testified in favor of California's "Right to Try" bill in April, 2015. He died three months later. \" width=\"720\" height=\"960\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento.jpg 720w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento-520x693.jpg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003cfigcaption class=\"wp-caption-text\">David Huntley testified in favor of California's \"Right to Try\" bill in April 2015. He died three months later. \u003ccite>(Courtesy of Lina Clark)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The FDA already offers a \u003ca href=\"http://www.fda.gov/NewsEvents/PublicHealthFocus/ExpandedAccessCompassionateUse/default.htm\" target=\"_blank\">process\u003c/a>, called “expanded access” or “compassionate use,” for some patients to obtain experimental drugs. But critics say it’s too slow and cumbersome, even though the FDA approves more than 99 percent of requests that come through that pipeline.\u003c/p>\n\u003cp>“It just takes so long, it’s inefficient, it’s ridiculous,” Calderon said of the FDA process. “I don’t understand.”\u003c/p>\n\u003cp>As the state laws proliferate, clinicians and medical ethicists are growing increasingly concerned about the potential safety and financial risks to patients.\u003c/p>\n\u003cp>“If we take the FDA out of it, how do we protect people from physicians or drug companies that will want to sell them things and will want to prey on their desperation?” asked \u003ca href=\"http://healthpolicy.ucsf.edu/people/r-adams-dudley-md-mba\" target=\"_blank\">Dr. R. Adams Dudley\u003c/a>, director of UCSF’s \u003ca href=\"http://healthvalue.ucsf.edu/\" target=\"_blank\">Center for Healthcare Value\u003c/a>.\u003c/p>\n\u003cp>Dudley says the FDA and the clinical trial process were put in place for a reason.\u003c/p>\n\u003cp>\"Have we somehow gotten better at managing snake oil salesmen now, than we were back when we decided we needed an FDA in the first place?\" Dudley said.\u003c/p>\n\u003cp>Under the new law, all that patients and doctors can really do is \u003cem>ask\u003c/em> for an experimental drug. Drug companies don’t have to give it to them, and insurance companies don’t have to pay for it.\u003c/p>\n\u003cp>Dudley fears that family members of a patient might exhaust their life savings trying a drug that hasn’t been proven to work -- and could even speed up death or increase end-of-life suffering.\u003c/p>\n\u003cp>That’s one reason the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\">California Nurses Association\u003c/a>, among other groups, strongly opposed the bill.\u003c/p>\n\u003cp>“It basically turns patients -- terminally-ill patients -- into guinea pigs,” said Don Nielsen, the CNA's director of government relations.\u003c/p>\n\u003cp>“There’s really no demonstrated need for this,” Nielsen said. “This so-called \"Right to Try\" movement is nothing more than boilerplate legislation promoted by the far-right Goldwater Institute.”\u003c/p>\n\u003cp>(While the Arizona-based Goldwater Institute has taken an active role in \u003ca href=\"http://goldwaterinstitute.org/en/work/topics/healthcare/right-to-try/right-try/\" target=\"_blank\">promoting\u003c/a> the laws, in California and other states, Calderon insists he came upon the issue independently, while researching physician-assisted suicide for California.)\u003c/p>\n\u003cp>It’s unclear how effective the state laws have been. There’s no data yet on how many patients have used the state laws, compared to the FDA’s expanded access process.\u003c/p>\n\u003cp>Dudley predicts the state-based Right to Try laws may eventually face a court challenge and be declared unconstitutional. That’s because federal law gives the power to regulate pharmaceuticals to the FDA, not the states.\u003c/p>\n\u003cp>But Clark thinks Congress might be open to amending that authority.\u003c/p>\n\u003cp>“It’s kind of parallel with what’s going on with medical marijuana,” Clark said. “It’s legal at the state level, but we still have a federal Drug Enforcement Agency to whom it is illegal. It’s not an ideal situation. It’s kind of similar to that. We ultimately need a federal law.”\u003c/p>\n\u003cp>A federal version of Right to Try was introduced in the Senate last year. In the meantime, a recently passed federal law addressing medical research, the \u003ca href=\"http://docs.house.gov/billsthisweek/20161128/CPRT-114-HPRT-RU00-SAHR34.pdf\" target=\"_blank\">21st Century Cures Act\u003c/a>, contains a \u003ca href=\"https://www.statnews.com/pharmalot/2016/11/28/21st-century-experimental-drugs/\" target=\"_blank\">provision\u003c/a> that requires drug companies to be more transparent about how they decide who gets access to experimental drugs and how long it will take.\u003c/p>\n\u003cfigure id=\"attachment_278364\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-278364\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-800x800.jpg\" alt='Lina Clark and her husband David Huntley on vacation in Croatia in 2014, before he succumbed to ALS. The disease made both of them activists for the \"right to try\" in California. ' width=\"800\" height=\"800\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-800x800.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-160x160.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-240x240.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-375x375.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-520x520.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-150x150.jpg 150w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Lina Clark and her husband David Huntley on vacation in Croatia in 2014, before he succumbed to ALS. The disease made both of them activists for the \"Right to Try\" in California. \u003ccite>(Courtesy of Lina Clark)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's note: The original version of this article incorrectly stated the California \"Right To Try\" law allowed access to an experimental drug at any stage. The law actually only allows a patient to request a drug that has passed through Phase I of the FDA clinical process, when a candidate drug is tested for toxicity on otherwise healthy subjects.\u003cbr>\n\u003c/em>\u003c/p>\n\n",
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"excerpt": "California is the 32nd state to pass a law supporting patients’ efforts to access experimental drugs. But critics say the movement poses potential safety and financial risks to vulnerable patients. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>With the enactment of a new “Right to Try” law, California joins 31 other states that have already passed legislation to support patients’ efforts to access experimental drugs.\u003c/p>\n\u003cp>As of Jan. 1, state agencies and licensing boards will not penalize California doctors or hospitals that want to help patients directly petition pharmaceutical companies for the investigational drugs.\u003c/p>\n\u003cp>Proponents of the “Right to Try” movement had contended that doctors could be hesitant to help such patients because of the risk of using drugs or devices that haven’t passed FDA tests for safety and effectiveness.\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/300768363&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/300768363'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The new law makes it clear that California doctors can proceed without fear of censure from the state’s medical board. It also eliminates other possible regulatory obstacles on the state level and creates processes for patient consent and data collection.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"The idea is to kind of get government out of the way in this situation and allow people to just go at it with a doctor to try to get access to these potentially life-saving medications,” said the law’s sponsor \u003ca href=\"http://asmdc.org/members/a57/\" target=\"_blank\">Ian Calderon\u003c/a>, the Democratic majority leader in the California Assembly.\u003c/p>\n\u003cp>Supporters of “Right to Try” laws sometimes frame them as the logical counterpart to “Right to Die” laws, which allow physician-assisted suicide for terminally ill patients. California enacted such a law in 2016.\u003c/p>\n\u003cp>\"The patient community is saying, ‘We are smart, we’re informed, we feel it is our right to try some of these therapies, because we’re going to die anyway,’” said Lina Clark, a patients’ rights \u003ca href=\"http://www.hopenowforals.org\" target=\"_blank\">activist\u003c/a> in San Diego.\u003c/p>\n\u003cp>Clark’s husband, \u003ca href=\"http://sci.sdsu.edu/geology/remembering-dr-david-huntley/\" target=\"_blank\">David Huntley\u003c/a>, had wanted to try an experimental drug before his death in 2015 from \u003ca href=\"https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Amyotrophic-Lateral-Sclerosis-ALS-Fact-Sheet\" target=\"_blank\">amyotrophic lateral sclerosis\u003c/a> (ALS).\u003c/p>\n\u003cfigure id=\"attachment_278363\" class=\"wp-caption alignnone\" style=\"max-width: 720px\">\u003cimg class=\"size-full wp-image-278363\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento.jpg\" alt=\"David Huntley testified in favor of California's "Right to Try" bill in April, 2015. He died three months later. \" width=\"720\" height=\"960\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento.jpg 720w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento-240x320.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento-375x500.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Sacramento-520x693.jpg 520w\" sizes=\"(max-width: 720px) 100vw, 720px\">\u003cfigcaption class=\"wp-caption-text\">David Huntley testified in favor of California's \"Right to Try\" bill in April 2015. He died three months later. \u003ccite>(Courtesy of Lina Clark)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The FDA already offers a \u003ca href=\"http://www.fda.gov/NewsEvents/PublicHealthFocus/ExpandedAccessCompassionateUse/default.htm\" target=\"_blank\">process\u003c/a>, called “expanded access” or “compassionate use,” for some patients to obtain experimental drugs. But critics say it’s too slow and cumbersome, even though the FDA approves more than 99 percent of requests that come through that pipeline.\u003c/p>\n\u003cp>“It just takes so long, it’s inefficient, it’s ridiculous,” Calderon said of the FDA process. “I don’t understand.”\u003c/p>\n\u003cp>As the state laws proliferate, clinicians and medical ethicists are growing increasingly concerned about the potential safety and financial risks to patients.\u003c/p>\n\u003cp>“If we take the FDA out of it, how do we protect people from physicians or drug companies that will want to sell them things and will want to prey on their desperation?” asked \u003ca href=\"http://healthpolicy.ucsf.edu/people/r-adams-dudley-md-mba\" target=\"_blank\">Dr. R. Adams Dudley\u003c/a>, director of UCSF’s \u003ca href=\"http://healthvalue.ucsf.edu/\" target=\"_blank\">Center for Healthcare Value\u003c/a>.\u003c/p>\n\u003cp>Dudley says the FDA and the clinical trial process were put in place for a reason.\u003c/p>\n\u003cp>\"Have we somehow gotten better at managing snake oil salesmen now, than we were back when we decided we needed an FDA in the first place?\" Dudley said.\u003c/p>\n\u003cp>Under the new law, all that patients and doctors can really do is \u003cem>ask\u003c/em> for an experimental drug. Drug companies don’t have to give it to them, and insurance companies don’t have to pay for it.\u003c/p>\n\u003cp>Dudley fears that family members of a patient might exhaust their life savings trying a drug that hasn’t been proven to work -- and could even speed up death or increase end-of-life suffering.\u003c/p>\n\u003cp>That’s one reason the \u003ca href=\"http://www.nationalnursesunited.org/site/entry/california-nurses-association\" target=\"_blank\">California Nurses Association\u003c/a>, among other groups, strongly opposed the bill.\u003c/p>\n\u003cp>“It basically turns patients -- terminally-ill patients -- into guinea pigs,” said Don Nielsen, the CNA's director of government relations.\u003c/p>\n\u003cp>“There’s really no demonstrated need for this,” Nielsen said. “This so-called \"Right to Try\" movement is nothing more than boilerplate legislation promoted by the far-right Goldwater Institute.”\u003c/p>\n\u003cp>(While the Arizona-based Goldwater Institute has taken an active role in \u003ca href=\"http://goldwaterinstitute.org/en/work/topics/healthcare/right-to-try/right-try/\" target=\"_blank\">promoting\u003c/a> the laws, in California and other states, Calderon insists he came upon the issue independently, while researching physician-assisted suicide for California.)\u003c/p>\n\u003cp>It’s unclear how effective the state laws have been. There’s no data yet on how many patients have used the state laws, compared to the FDA’s expanded access process.\u003c/p>\n\u003cp>Dudley predicts the state-based Right to Try laws may eventually face a court challenge and be declared unconstitutional. That’s because federal law gives the power to regulate pharmaceuticals to the FDA, not the states.\u003c/p>\n\u003cp>But Clark thinks Congress might be open to amending that authority.\u003c/p>\n\u003cp>“It’s kind of parallel with what’s going on with medical marijuana,” Clark said. “It’s legal at the state level, but we still have a federal Drug Enforcement Agency to whom it is illegal. It’s not an ideal situation. It’s kind of similar to that. We ultimately need a federal law.”\u003c/p>\n\u003cp>A federal version of Right to Try was introduced in the Senate last year. In the meantime, a recently passed federal law addressing medical research, the \u003ca href=\"http://docs.house.gov/billsthisweek/20161128/CPRT-114-HPRT-RU00-SAHR34.pdf\" target=\"_blank\">21st Century Cures Act\u003c/a>, contains a \u003ca href=\"https://www.statnews.com/pharmalot/2016/11/28/21st-century-experimental-drugs/\" target=\"_blank\">provision\u003c/a> that requires drug companies to be more transparent about how they decide who gets access to experimental drugs and how long it will take.\u003c/p>\n\u003cfigure id=\"attachment_278364\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-278364\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-800x800.jpg\" alt='Lina Clark and her husband David Huntley on vacation in Croatia in 2014, before he succumbed to ALS. The disease made both of them activists for the \"right to try\" in California. ' width=\"800\" height=\"800\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-800x800.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-160x160.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-240x240.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-375x375.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-520x520.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Right-to-Try-Huntley-Clark-Sailing-150x150.jpg 150w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Lina Clark and her husband David Huntley on vacation in Croatia in 2014, before he succumbed to ALS. The disease made both of them activists for the \"Right to Try\" in California. \u003ccite>(Courtesy of Lina Clark)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor's note: The original version of this article incorrectly stated the California \"Right To Try\" law allowed access to an experimental drug at any stage. The law actually only allows a patient to request a drug that has passed through Phase I of the FDA clinical process, when a candidate drug is tested for toxicity on otherwise healthy subjects.\u003cbr>\n\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A New Generation Competes in Traditional Games to Preserve Washoe Culture",
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"content": "\u003cp>\u003cem>This story was originally published on Aug. 9, 2016. \u003c/em>\u003c/p>\n\u003cp>--\u003cbr>\n\u003cem>This week, the mountains of Lake Tahoe are teeming with skiers and snowboarders. But long before Tahoe got its first chair lift, different sports were popular with locals. Games like Baloyap, Sugayuk, or Hinoyowgi. \u003c/em>\u003c/p>\n\u003cp>These are the games of the Washoe people, a group native to the mountains and valleys straddling the California-Nevada border. And they’re critical for sustaining Washoe culture and language.\u003cbr>\n--\u003c/p>\n\u003cp>Lisa Enos looked out over an athletic field at the Dresslerville Reservation in Gardnerville, Nevada. On a lawn yellowed by the sun with a backdrop of the Sierra Nevada mountains, a group of young men played a game. It looked like soccer, except the ball was made of buckskin, and the goals were marked with Aspen trees jutting from the ground. The game was “Baloyap,” a traditional game of the Washoe Tribe of Nevada and California, and it hadn’t been played there in over 50 years.\u003c/p>\n\u003cp>That recent day marked the first ever “Traditional Washoe Pastimes,” a series of games and events organized by Washoe language teacher Enos and her colleagues.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The purpose of the August 4 event was not just to have fun. It was about preserving a culture, a language, and as some studies indicate, emotional wellbeing.\u003c/p>\n\u003cfigure id=\"attachment_222206\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-222206\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS20604_Buckberries-qut-800x584.jpg\" alt=\"Melanie Smokey brought buck berries to the Traditional Washoe Pastimes to educate youth about the natural foods Washoe eat. Smokey dries the berries and later makes pudding or jelly.\" width=\"800\" height=\"584\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-800x584.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-400x292.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-768x560.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-1440x1051.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-1180x861.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-960x701.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Melanie Smokey brought buck berries to the Traditional Washoe Pastimes to educate youth about the natural foods Washoe eat. Smokey dries the berries and later makes pudding or jelly. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Turning to the Baloyap game, Enos explained the rules. \"The boys can only kick the ball with their feet and they’re trying to get the ball through the post here.\" Later in the day, girls joined in.\u003c/p>\n\u003cp>\"Girls are the only ones that can use their hands. They can pick up the ball and run with it through the goalposts,\" Enos said. \"But a boy can pick up a girl and run her through a goalie if she’s holding a ball.\"\u003c/p>\n\u003cp>Then Enos got emotional. \"Our grandfathers had played it and that generation previous. But this is the first time this generation of kids has played this game,\" Enos said.\u003c/p>\n\u003cp>\u003cstrong>Piecing together the rules\u003c/strong>\u003c/p>\n\u003cp>Since Enos had never seen the game played in real life, she and other game organizers pieced together the Baloyap rules by asking Washoe elders and people from other tribes in California who the Washoe used to compete with.\u003c/p>\n\u003cp>Then there was Sagayuk, a women’s only game. Two teams went head-to-head on a field. Each player carried a nearly eight foot long aspen stick. They whacked at what looks like a piece of rope, trying to get it into a goal. In Washoe the rope is called a rabbit or a snake.\u003c/p>\n\u003cp>There are about 1,500 Washoe these days. The Washoe have been based around Lake Tahoe and the Sierra for thousands of years. The land where they once lived was vast, stretching hundreds of miles around the pristine lake. The name Tahoe was derived from Washoe: “Da ow aga,” meaning “the edge of the lake.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/277035940\" 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>Like most indigenous people, the Washoe were gravely mistreated when settlers came West. Even within the last century, members were sent to boarding schools that did not allow them to practice their own customs, and forced them to only speak English.\u003c/p>\n\u003cp>Enos estimates that fewer than 20 people are fluent in Washoe now. So it’s events like this that are essential to continuing Washoe traditions.\u003c/p>\n\u003cp>\u003cstrong>Keeping tradition alive to save lives\u003c/strong>\u003c/p>\n\u003cp>Beyond this, \u003ca href=\"http://web.uvic.ca/~lalonde/manuscripts/2007CogDevt.pdf\">studies show\u003c/a> the mental health of indigenous people is impacted by their tribe’s ability to retain language and culture.\u003c/p>\n\u003cp>\"These studies show that youth suicide is much lower in communities that are making strong attempts to keep their language going,\" said Leanne Hinton, professor emerita of linguistics at University of California, Berkeley.\u003c/p>\n\u003cp>For the Washoe, these efforts are headed by people like Enos and language teacher Herman Fillmore, who, back at the Traditional Washoe Pastimes, instructed kids how to play Hinoyowgi. It's a hand game that mixes in both rhythm and song. While the kids have played this before, Fillmore added in a twist for the big day.\u003c/p>\n\u003cfigure id=\"attachment_222339\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-222339\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-800x758.jpg\" alt=\"Herman Fillmore (upper right) teaches young Washoe kids how to play the game Hinoyowgi in Gardnerville, Nevada. This game incorporates rhythm and song.\" width=\"800\" height=\"758\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-800x758.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-400x379.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-768x727.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-1440x1364.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-1180x1117.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-960x909.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Herman Fillmore (upper right) teaches young Washoe kids how to play the game Hinoyowgi in Gardnerville, Nevada. This game incorporates rhythm and song. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"The reason why we have all these sticks and everything playing on the ground is that this is how we would play a long time ago,\" he said.\u003c/p>\n\u003cp>Fillmore incorporated Washoe words into the game whenever possible. Before even starting, he reminded the young people what to call the sticks, bones and other tools they play with.\u003c/p>\n\u003cp>This technique was an intentional one that follows the theory that it's easier to learn language when it's associated with an action. It's called total physical response.\u003c/p>\n\u003cp>As the Hinoyowgi game continued, the group began to sing songs specific to the game as they tapped smaller sticks onto a log, creating a beautiful rhythm.\u003c/p>\n\u003cp>\u003cstrong>Speaking the language of Washoe \u003c/strong>\u003c/p>\n\u003cp>Benny Fillmore watched his son Herman teach. The elder Fillmore moved his lips slightly as he sang along.\u003c/p>\n\u003cp>He didn't grow up speaking Washoe regularly. \"To know that you have this whole internal way of belief, way of thought, way of prayer that you’re not able to vocalize, you’re not able to use,\" Fillmore said, \"It’s like missing a body part. You’re not complete.\"\u003c/p>\n\u003cp>According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), half of the world’s 6000 languages will go extinct by the end of the century. This tribe doesn’t want their language, Washoe, to be one of them.\u003c/p>\n\u003cp>They’re implementing many strategies to combat language loss. In the 1990s they had an immersion school. More recently they put together a language-focused head start program. The Traditional Washoe Pastimes was their latest effort.\u003c/p>\n\u003cp>Over 100 people came for the Traditional Washoe Pastimes. At the closing awards ceremony, Lisa Enos got teary.\u003c/p>\n\u003cp>\"These games you guys have been playing today have been played for thousands and thousands of years on this very ground,\" she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Kids glowed as their names were called and they were handed flags and ribbons as prizes. But Enos reminded them that really the event wasn’t about the awards. It was about the Washoe coming together.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This story was originally published on Aug. 9, 2016. \u003c/em>\u003c/p>\n\u003cp>--\u003cbr>\n\u003cem>This week, the mountains of Lake Tahoe are teeming with skiers and snowboarders. But long before Tahoe got its first chair lift, different sports were popular with locals. Games like Baloyap, Sugayuk, or Hinoyowgi. \u003c/em>\u003c/p>\n\u003cp>These are the games of the Washoe people, a group native to the mountains and valleys straddling the California-Nevada border. And they’re critical for sustaining Washoe culture and language.\u003cbr>\n--\u003c/p>\n\u003cp>Lisa Enos looked out over an athletic field at the Dresslerville Reservation in Gardnerville, Nevada. On a lawn yellowed by the sun with a backdrop of the Sierra Nevada mountains, a group of young men played a game. It looked like soccer, except the ball was made of buckskin, and the goals were marked with Aspen trees jutting from the ground. The game was “Baloyap,” a traditional game of the Washoe Tribe of Nevada and California, and it hadn’t been played there in over 50 years.\u003c/p>\n\u003cp>That recent day marked the first ever “Traditional Washoe Pastimes,” a series of games and events organized by Washoe language teacher Enos and her colleagues.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The purpose of the August 4 event was not just to have fun. It was about preserving a culture, a language, and as some studies indicate, emotional wellbeing.\u003c/p>\n\u003cfigure id=\"attachment_222206\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-222206\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS20604_Buckberries-qut-800x584.jpg\" alt=\"Melanie Smokey brought buck berries to the Traditional Washoe Pastimes to educate youth about the natural foods Washoe eat. Smokey dries the berries and later makes pudding or jelly.\" width=\"800\" height=\"584\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-800x584.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-400x292.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-768x560.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-1440x1051.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-1180x861.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20604_Buckberries-qut-960x701.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Melanie Smokey brought buck berries to the Traditional Washoe Pastimes to educate youth about the natural foods Washoe eat. Smokey dries the berries and later makes pudding or jelly. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Turning to the Baloyap game, Enos explained the rules. \"The boys can only kick the ball with their feet and they’re trying to get the ball through the post here.\" Later in the day, girls joined in.\u003c/p>\n\u003cp>\"Girls are the only ones that can use their hands. They can pick up the ball and run with it through the goalposts,\" Enos said. \"But a boy can pick up a girl and run her through a goalie if she’s holding a ball.\"\u003c/p>\n\u003cp>Then Enos got emotional. \"Our grandfathers had played it and that generation previous. But this is the first time this generation of kids has played this game,\" Enos said.\u003c/p>\n\u003cp>\u003cstrong>Piecing together the rules\u003c/strong>\u003c/p>\n\u003cp>Since Enos had never seen the game played in real life, she and other game organizers pieced together the Baloyap rules by asking Washoe elders and people from other tribes in California who the Washoe used to compete with.\u003c/p>\n\u003cp>Then there was Sagayuk, a women’s only game. Two teams went head-to-head on a field. Each player carried a nearly eight foot long aspen stick. They whacked at what looks like a piece of rope, trying to get it into a goal. In Washoe the rope is called a rabbit or a snake.\u003c/p>\n\u003cp>There are about 1,500 Washoe these days. The Washoe have been based around Lake Tahoe and the Sierra for thousands of years. The land where they once lived was vast, stretching hundreds of miles around the pristine lake. The name Tahoe was derived from Washoe: “Da ow aga,” meaning “the edge of the lake.”\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/277035940&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/277035940'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Like most indigenous people, the Washoe were gravely mistreated when settlers came West. Even within the last century, members were sent to boarding schools that did not allow them to practice their own customs, and forced them to only speak English.\u003c/p>\n\u003cp>Enos estimates that fewer than 20 people are fluent in Washoe now. So it’s events like this that are essential to continuing Washoe traditions.\u003c/p>\n\u003cp>\u003cstrong>Keeping tradition alive to save lives\u003c/strong>\u003c/p>\n\u003cp>Beyond this, \u003ca href=\"http://web.uvic.ca/~lalonde/manuscripts/2007CogDevt.pdf\">studies show\u003c/a> the mental health of indigenous people is impacted by their tribe’s ability to retain language and culture.\u003c/p>\n\u003cp>\"These studies show that youth suicide is much lower in communities that are making strong attempts to keep their language going,\" said Leanne Hinton, professor emerita of linguistics at University of California, Berkeley.\u003c/p>\n\u003cp>For the Washoe, these efforts are headed by people like Enos and language teacher Herman Fillmore, who, back at the Traditional Washoe Pastimes, instructed kids how to play Hinoyowgi. It's a hand game that mixes in both rhythm and song. While the kids have played this before, Fillmore added in a twist for the big day.\u003c/p>\n\u003cfigure id=\"attachment_222339\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-222339\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-800x758.jpg\" alt=\"Herman Fillmore (upper right) teaches young Washoe kids how to play the game Hinoyowgi in Gardnerville, Nevada. This game incorporates rhythm and song.\" width=\"800\" height=\"758\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-800x758.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-400x379.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-768x727.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-1440x1364.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-1180x1117.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS20606_Hinowyowgi-qut-960x909.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Herman Fillmore (upper right) teaches young Washoe kids how to play the game Hinoyowgi in Gardnerville, Nevada. This game incorporates rhythm and song. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"The reason why we have all these sticks and everything playing on the ground is that this is how we would play a long time ago,\" he said.\u003c/p>\n\u003cp>Fillmore incorporated Washoe words into the game whenever possible. Before even starting, he reminded the young people what to call the sticks, bones and other tools they play with.\u003c/p>\n\u003cp>This technique was an intentional one that follows the theory that it's easier to learn language when it's associated with an action. It's called total physical response.\u003c/p>\n\u003cp>As the Hinoyowgi game continued, the group began to sing songs specific to the game as they tapped smaller sticks onto a log, creating a beautiful rhythm.\u003c/p>\n\u003cp>\u003cstrong>Speaking the language of Washoe \u003c/strong>\u003c/p>\n\u003cp>Benny Fillmore watched his son Herman teach. The elder Fillmore moved his lips slightly as he sang along.\u003c/p>\n\u003cp>He didn't grow up speaking Washoe regularly. \"To know that you have this whole internal way of belief, way of thought, way of prayer that you’re not able to vocalize, you’re not able to use,\" Fillmore said, \"It’s like missing a body part. You’re not complete.\"\u003c/p>\n\u003cp>According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), half of the world’s 6000 languages will go extinct by the end of the century. This tribe doesn’t want their language, Washoe, to be one of them.\u003c/p>\n\u003cp>They’re implementing many strategies to combat language loss. In the 1990s they had an immersion school. More recently they put together a language-focused head start program. The Traditional Washoe Pastimes was their latest effort.\u003c/p>\n\u003cp>Over 100 people came for the Traditional Washoe Pastimes. At the closing awards ceremony, Lisa Enos got teary.\u003c/p>\n\u003cp>\"These games you guys have been playing today have been played for thousands and thousands of years on this very ground,\" she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Kids glowed as their names were called and they were handed flags and ribbons as prizes. But Enos reminded them that really the event wasn’t about the awards. It was about the Washoe coming together.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Stopping Suicide, With Help From the Local Gun Shop",
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"content": "\u003cp>Ralph Demicco was standing behind the counter at Riley’s Sport Shop in New Hampshire one Saturday morning when a woman walked in and came right up to the counter.\u003c/p>\n\u003cp>“Almost immediately she pointed to a firearm at the counter and said, ‘I’d like to buy that gun,’ ” Demicco remembers. “And that just sets off alarm bells.\"\u003c/p>\n\u003cp>Most customers would browse, ask to see a few different models, ask questions.\u003c/p>\n\u003cp>“I said to her, ‘Ma’am, should you really be buying this gun?’ ” Demicco recalls now.\u003c/p>\n\u003cp>The woman started crying. Demicco took her into the back office to talk.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“She had been released from a mental health facility that morning,” he said. “Didn’t feel like she was ready to go.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/299777934\" 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>Demicco has lots of stories like this from his 40 years owning the gun shop. At one point, he got a call from a public health researcher who studies suicides. She told him that three people, over the course of a week, had bought firearms from his store and killed themselves.\u003c/p>\n\u003cp>“To say I was speechless is an understatement,” he says.\u003c/p>\n\u003cp>Demicco is skeptical of public health types, and worries they have hidden agendas. But after hearing about those suicides, he decided to join forces with the researchers to form the \u003ca href=\"http://www.theconnectprogram.org/firearms-safety-coalitions-role-nh-suicide-prevention\" target=\"_blank\">New Hampshire Firearms Safety Coalition\u003c/a>. They developed a prevention campaign, but one that was rooted in gun culture.\u003c/p>\n\u003cp>Demicco traveled across New Hampshire and asked gun dealers to put up a poster in their stores. It shows two people, one of them clearly in distress, and the other lending a comforting hand. The message, Demicco says, was “Friends don’t let friends hurt themselves.”\u003c/p>\n\u003cp>It's similar to the “Friends don’t let friends drive drunk” campaigns of the '80s. The idea was to raise awareness of suicide risk factors among gun enthusiasts, so they could look out for one another.\u003c/p>\n\u003cp>“If Uncle Harry is getting a divorce and is distraught over it and he has firearms, you need to step up to the plate, you need to be the one,” Demicco says. “It’s OK to intervene.”\u003c/p>\n\u003cp>In the last several years since then, firearm clubs have partnered with health experts in 20 states to adopt the New Hampshire Firearms Safety Coalition’s campaign.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Shasta County Gun Shop Owners\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Public health officials in \u003ca href=\"http://www.co.shasta.ca.us/index.aspx\" target=\"_blank\">Shasta County\u003c/a>, in the far northern reaches of California, were among the first to approach gun shop owners for help. They say there are similarities in Shasta County with New Hampshire, when it comes to suicide trends and a pro-gun culture.\u003c/p>\n\u003cp>\"We have a high number of firearm suicides,” says Katie Cassidy, who spearheaded the project for the county Health and Human Services Department in 2008. “We’re a very rural community, we have a lot of hunters. So taking a traditional approach, like ‘Wear your seatbelt,’ didn’t go over very well.”\u003c/p>\n\u003cp>Instead, the department took the New Hampshire approach and partnered with firearm dealers and law enforcement, asking them what kind of messaging would work, and asking them to review brochure drafts.\u003c/p>\n\u003cp>“As soon as we took the approach of curiosity, rather than coming into the discussion with an opinion,” Cassidy says, “that opened a lot of dialogue that hadn’t been at the table before.”\u003c/p>\n\u003cfigure id=\"attachment_275389\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-275389 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/IMG_1723-800x800.jpg\" alt=\"The Olde West Gun & Loan in Redding, Calif.\" width=\"800\" height=\"800\">\u003cfigcaption class=\"wp-caption-text\">The Olde West Gun & Loan in Redding, California \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the Olde West Gun & Loan in Redding, some impressive stuffed deer heads and wild pigs line the walls. General manager Richard Howell demonstrates some of the merchandise responsible for these trophies.\u003c/p>\n\u003cp>“Bolt-action rifles, lever-action rifles, .22s,” he says, pointing to the rows of weapons in the case. He opens the port of a pump-action shotgun.\u003c/p>\n\u003cp>“Load it,” he says, closing the chamber, “take it out in the field, hunt.”\u003c/p>\n\u003cp>The local sheriff and health department are now asking shop owners like Howell to put some new versions of the brochures on their sales counters. Howell looks over a draft.\u003c/p>\n\u003cp>“These are the 10 commandments of gun safety,” Howell observes, chewing a piece of frost-blue gum while he scans the pamphlet. “Now 11. OK, they’ve added 11.”\u003c/p>\n\u003cfigure id=\"attachment_275390\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-275390\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/IMG_2237-800x600.jpg\" alt=\"Shasta County health officials, in collaboration with gun shop owners, developed a brochure to raise awareness around suicide prevention.\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Shasta County health officials, in collaboration with gun shop owners, developed a brochure to raise awareness around suicide prevention. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Virtually all kids and new shooters learn about the 10 commandments of gun safety. The brochure boldly adds an 11th: knowing the signs of suicidal behavior and helping friends store their guns outside the home during an emotional crisis.\u003c/p>\n\u003cp>“Well ...,” Howell says uneasily. “Now we’re going to be the gun safety psychologists? I’m not trained for that.”\u003c/p>\n\u003cp>He’s not sure the “friends don’t let friends drive drunk” philosophy really works with guns. He says the difference is that driving is a privilege, while owning a gun is a right.\u003c/p>\n\u003cp>But Howell says he can understand why Shasta County is trying this. If the sheriff just wants him to leave a pile of brochures on the counter, it's no problem. And if someone were to ask him to store a firearm at the shop, he would be OK with that.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We wouldn’t be against that,” he says. “If someone takes a pamphlet home and it saves one life, then it’s done its job.”\u003c/p>\n\n",
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"excerpt": "When health experts talk suicide prevention, gun fans often feel like their Second Amendment rights are under attack. But now, some gun shop owners want to be part of the solution. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ralph Demicco was standing behind the counter at Riley’s Sport Shop in New Hampshire one Saturday morning when a woman walked in and came right up to the counter.\u003c/p>\n\u003cp>“Almost immediately she pointed to a firearm at the counter and said, ‘I’d like to buy that gun,’ ” Demicco remembers. “And that just sets off alarm bells.\"\u003c/p>\n\u003cp>Most customers would browse, ask to see a few different models, ask questions.\u003c/p>\n\u003cp>“I said to her, ‘Ma’am, should you really be buying this gun?’ ” Demicco recalls now.\u003c/p>\n\u003cp>The woman started crying. Demicco took her into the back office to talk.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“She had been released from a mental health facility that morning,” he said. “Didn’t feel like she was ready to go.”\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/299777934&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/299777934'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Demicco has lots of stories like this from his 40 years owning the gun shop. At one point, he got a call from a public health researcher who studies suicides. She told him that three people, over the course of a week, had bought firearms from his store and killed themselves.\u003c/p>\n\u003cp>“To say I was speechless is an understatement,” he says.\u003c/p>\n\u003cp>Demicco is skeptical of public health types, and worries they have hidden agendas. But after hearing about those suicides, he decided to join forces with the researchers to form the \u003ca href=\"http://www.theconnectprogram.org/firearms-safety-coalitions-role-nh-suicide-prevention\" target=\"_blank\">New Hampshire Firearms Safety Coalition\u003c/a>. They developed a prevention campaign, but one that was rooted in gun culture.\u003c/p>\n\u003cp>Demicco traveled across New Hampshire and asked gun dealers to put up a poster in their stores. It shows two people, one of them clearly in distress, and the other lending a comforting hand. The message, Demicco says, was “Friends don’t let friends hurt themselves.”\u003c/p>\n\u003cp>It's similar to the “Friends don’t let friends drive drunk” campaigns of the '80s. The idea was to raise awareness of suicide risk factors among gun enthusiasts, so they could look out for one another.\u003c/p>\n\u003cp>“If Uncle Harry is getting a divorce and is distraught over it and he has firearms, you need to step up to the plate, you need to be the one,” Demicco says. “It’s OK to intervene.”\u003c/p>\n\u003cp>In the last several years since then, firearm clubs have partnered with health experts in 20 states to adopt the New Hampshire Firearms Safety Coalition’s campaign.\u003c/p>\n\u003cp>\u003cstrong>\u003cem>Shasta County Gun Shop Owners\u003c/em>\u003c/strong>\u003c/p>\n\u003cp>Public health officials in \u003ca href=\"http://www.co.shasta.ca.us/index.aspx\" target=\"_blank\">Shasta County\u003c/a>, in the far northern reaches of California, were among the first to approach gun shop owners for help. They say there are similarities in Shasta County with New Hampshire, when it comes to suicide trends and a pro-gun culture.\u003c/p>\n\u003cp>\"We have a high number of firearm suicides,” says Katie Cassidy, who spearheaded the project for the county Health and Human Services Department in 2008. “We’re a very rural community, we have a lot of hunters. So taking a traditional approach, like ‘Wear your seatbelt,’ didn’t go over very well.”\u003c/p>\n\u003cp>Instead, the department took the New Hampshire approach and partnered with firearm dealers and law enforcement, asking them what kind of messaging would work, and asking them to review brochure drafts.\u003c/p>\n\u003cp>“As soon as we took the approach of curiosity, rather than coming into the discussion with an opinion,” Cassidy says, “that opened a lot of dialogue that hadn’t been at the table before.”\u003c/p>\n\u003cfigure id=\"attachment_275389\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-275389 size-medium\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/IMG_1723-800x800.jpg\" alt=\"The Olde West Gun & Loan in Redding, Calif.\" width=\"800\" height=\"800\">\u003cfigcaption class=\"wp-caption-text\">The Olde West Gun & Loan in Redding, California \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the Olde West Gun & Loan in Redding, some impressive stuffed deer heads and wild pigs line the walls. General manager Richard Howell demonstrates some of the merchandise responsible for these trophies.\u003c/p>\n\u003cp>“Bolt-action rifles, lever-action rifles, .22s,” he says, pointing to the rows of weapons in the case. He opens the port of a pump-action shotgun.\u003c/p>\n\u003cp>“Load it,” he says, closing the chamber, “take it out in the field, hunt.”\u003c/p>\n\u003cp>The local sheriff and health department are now asking shop owners like Howell to put some new versions of the brochures on their sales counters. Howell looks over a draft.\u003c/p>\n\u003cp>“These are the 10 commandments of gun safety,” Howell observes, chewing a piece of frost-blue gum while he scans the pamphlet. “Now 11. OK, they’ve added 11.”\u003c/p>\n\u003cfigure id=\"attachment_275390\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-275390\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/IMG_2237-800x600.jpg\" alt=\"Shasta County health officials, in collaboration with gun shop owners, developed a brochure to raise awareness around suicide prevention.\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Shasta County health officials, in collaboration with gun shop owners, developed a brochure to raise awareness around suicide prevention. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Virtually all kids and new shooters learn about the 10 commandments of gun safety. The brochure boldly adds an 11th: knowing the signs of suicidal behavior and helping friends store their guns outside the home during an emotional crisis.\u003c/p>\n\u003cp>“Well ...,” Howell says uneasily. “Now we’re going to be the gun safety psychologists? I’m not trained for that.”\u003c/p>\n\u003cp>He’s not sure the “friends don’t let friends drive drunk” philosophy really works with guns. He says the difference is that driving is a privilege, while owning a gun is a right.\u003c/p>\n\u003cp>But Howell says he can understand why Shasta County is trying this. If the sheriff just wants him to leave a pile of brochures on the counter, it's no problem. And if someone were to ask him to store a firearm at the shop, he would be OK with that.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We wouldn’t be against that,” he says. “If someone takes a pamphlet home and it saves one life, then it’s done its job.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Hopes $3 Billion Experiment Will Improve Health of Neediest",
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"content": "\u003cp>Riverside County plans to connect former inmates with health clinics and social services. Orange County hopes to get homeless residents into housing — and help them stay there. Placer County is opening a respite center where homeless patients can go after they leave the hospital.\u003c/p>\n\u003cp>Those are just some of the pilot projects in a $3 billion experimental effort officials hope will improve the health of California’s most vulnerable populations. The effort is a recognition that improving people’s health will take more than just getting them insured.\u003c/p>\n\u003cp>The state has approved plans in 18 counties intended to reduce unnecessary emergency room visits and hospital stays among these groups. In addition to ex-prisoners and the homeless, they include people who have multiple chronic illnesses, substance abuse problems and mental health disorders. The state is accepting a second round of applications for such projects next year.\u003c/p>\n\u003cp>The effort, known as “whole person care,” is part of an agreement between California and the federal government. It gives the state flexibility to try to improve the efficiency and quality of care in the state’s Medicaid program — known as Medi-Cal — which provides health coverage to low-income people.\u003c/p>\n\u003cp>The projects are designed to blend physical care, mental health care and social services for the participants, who are among the neediest and costliest in the state.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We have people coming out of jail and they are homeless, they don’t have food and they are diabetic and they are bipolar and they drink too much alcohol and they use heroin,” said Judi Nightingale, director of population health for Riverside University Health System. “They need services from different county departments in 20 different locations … and we don’t talk to each other.”\u003c/p>\n\u003cp>Half the funding for the program comes from the federal government, and the other half will be provided by local entities, including counties and hospital systems.\u003c/p>\n\u003cp>Some county leaders fear President-elect Donald Trump’s plan to dismantle the Affordable Care Act could derail their plans, but they hope nothing will change right away. State officials are urging counties to continue laying the groundwork for their projects, which are expected to start next spring or summer.\u003c/p>\n\u003cp>“We are just moving forward in terms of implementation and not speculating on any changes that might happen,” said Sarah Brooks, a deputy director at the state Department of Health Care Services. “We will see what comes in the next year.”\u003c/p>\n\u003cp>Mark Ghaly, a program director with Los Angeles County’s Department of Health Services, said he believes the program is going to stand for at least a while. “The question is will we have enough time to show what works,” he said.\u003c/p>\n\u003cp>The key to success will be getting various agencies to work together to identify participants and serve them no matter where they are, Brooks said.\u003c/p>\n\u003cp>Part of that depends on being able to share data, which remains a challenge for many counties, Brooks said. Most counties have multiple electronic health records systems that may not interact with other government computer systems. There are also patient privacy concerns.\u003c/p>\n\u003cp>Riverside County’s project aims not only to reduce ER use but also to keep former inmates out of jail. They will be screened upon their release and offered help with housing, health insurance, drug treatment and mental health services.\u003c/p>\n\u003cp>Los Angeles County’s project, which will cost $900 million over five years, is an ambitious effort to improve the health of high-risk populations, including the homeless and recent inmates. The county plans to target about 1,000 soon-to-be released inmates each month and will use community health workers to help them get the care and social services they need. The county also is working to get inmates released with a 30-day supply of medications.\u003c/p>\n\u003cp>Ghaly said he believes the project will “stabilize people upon release so they don’t hit the emergency departments in the volume they are now.”\u003c/p>\n\u003cp>Nadereh Pourat, director of research at the UCLA Center for Health Policy Research, said she expects the projects to improve care and outcomes as well as save money. “There is going to be some reduction in [emergency department] use if you are wrapping these additional services around these populations who are complex and high-need,” she said.\u003c/p>\n\u003cp>More than 14 million Californians are covered by Medi-Cal, including about 5 million who have signed up since the Affordable Care Act took effect in 2014. The health reform law allowed states to expand the number of people who were eligible. Many new Medi-Cal beneficiaries went years without coverage and had untreated chronic conditions and mental health and substance use disorders.\u003c/p>\n\u003cp>Insurance coverage is the first step because it gets them in the door, Pourat said. But that must be followed by getting them the right services to keep them out of the hospital. The pilot programs will allow the state to see what works and doesn’t work, Pourat said. They will be evaluated based their impact on ER visits, inpatient stays and other measures of health and housing.\u003c/p>\n\u003cp>“It’s a great laboratory,” she said. “There is not going to be a cookie cutter approach throughout the state.”\u003c/p>\n\u003cp>The planned projects vary in size, method and goals. Many include housing services, care management and data sharing. For the counties that focus on homeless people, federal money cannot be used to pay rent. But it can be used for other housing services such as move-in costs, financial education and outreach to landlords.\u003c/p>\n\u003cp>In Orange County, officials are linking homeless residents to primary care providers and helping them find places to live.\u003c/p>\n\u003cp>“If we are able to get them stabilized and into stable housing … we can improve their overall health,” said Melissa Tober, manager of strategic projects for the Orange County Health Care Agency.\u003c/p>\n\u003cp>In Placer County, which also will target homeless residents, Health and Human Services Director Jeff Brown said each participant will have an intensive care plan, which may include substance abuse treatment, mental health care or peer support. Brown said the pilot project provides the money and flexibility.\u003c/p>\n\u003cp>But, he said, “There really is no road map for the perfect way to implement this, and without that road map or blueprint, it can be a bit difficult.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Riverside County plans to connect former inmates with health clinics and social services. Orange County hopes to get homeless residents into housing — and help them stay there. Placer County is opening a respite center where homeless patients can go after they leave the hospital.\u003c/p>\n\u003cp>Those are just some of the pilot projects in a $3 billion experimental effort officials hope will improve the health of California’s most vulnerable populations. The effort is a recognition that improving people’s health will take more than just getting them insured.\u003c/p>\n\u003cp>The state has approved plans in 18 counties intended to reduce unnecessary emergency room visits and hospital stays among these groups. In addition to ex-prisoners and the homeless, they include people who have multiple chronic illnesses, substance abuse problems and mental health disorders. The state is accepting a second round of applications for such projects next year.\u003c/p>\n\u003cp>The effort, known as “whole person care,” is part of an agreement between California and the federal government. It gives the state flexibility to try to improve the efficiency and quality of care in the state’s Medicaid program — known as Medi-Cal — which provides health coverage to low-income people.\u003c/p>\n\u003cp>The projects are designed to blend physical care, mental health care and social services for the participants, who are among the neediest and costliest in the state.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We have people coming out of jail and they are homeless, they don’t have food and they are diabetic and they are bipolar and they drink too much alcohol and they use heroin,” said Judi Nightingale, director of population health for Riverside University Health System. “They need services from different county departments in 20 different locations … and we don’t talk to each other.”\u003c/p>\n\u003cp>Half the funding for the program comes from the federal government, and the other half will be provided by local entities, including counties and hospital systems.\u003c/p>\n\u003cp>Some county leaders fear President-elect Donald Trump’s plan to dismantle the Affordable Care Act could derail their plans, but they hope nothing will change right away. State officials are urging counties to continue laying the groundwork for their projects, which are expected to start next spring or summer.\u003c/p>\n\u003cp>“We are just moving forward in terms of implementation and not speculating on any changes that might happen,” said Sarah Brooks, a deputy director at the state Department of Health Care Services. “We will see what comes in the next year.”\u003c/p>\n\u003cp>Mark Ghaly, a program director with Los Angeles County’s Department of Health Services, said he believes the program is going to stand for at least a while. “The question is will we have enough time to show what works,” he said.\u003c/p>\n\u003cp>The key to success will be getting various agencies to work together to identify participants and serve them no matter where they are, Brooks said.\u003c/p>\n\u003cp>Part of that depends on being able to share data, which remains a challenge for many counties, Brooks said. Most counties have multiple electronic health records systems that may not interact with other government computer systems. There are also patient privacy concerns.\u003c/p>\n\u003cp>Riverside County’s project aims not only to reduce ER use but also to keep former inmates out of jail. They will be screened upon their release and offered help with housing, health insurance, drug treatment and mental health services.\u003c/p>\n\u003cp>Los Angeles County’s project, which will cost $900 million over five years, is an ambitious effort to improve the health of high-risk populations, including the homeless and recent inmates. The county plans to target about 1,000 soon-to-be released inmates each month and will use community health workers to help them get the care and social services they need. The county also is working to get inmates released with a 30-day supply of medications.\u003c/p>\n\u003cp>Ghaly said he believes the project will “stabilize people upon release so they don’t hit the emergency departments in the volume they are now.”\u003c/p>\n\u003cp>Nadereh Pourat, director of research at the UCLA Center for Health Policy Research, said she expects the projects to improve care and outcomes as well as save money. “There is going to be some reduction in [emergency department] use if you are wrapping these additional services around these populations who are complex and high-need,” she said.\u003c/p>\n\u003cp>More than 14 million Californians are covered by Medi-Cal, including about 5 million who have signed up since the Affordable Care Act took effect in 2014. The health reform law allowed states to expand the number of people who were eligible. Many new Medi-Cal beneficiaries went years without coverage and had untreated chronic conditions and mental health and substance use disorders.\u003c/p>\n\u003cp>Insurance coverage is the first step because it gets them in the door, Pourat said. But that must be followed by getting them the right services to keep them out of the hospital. The pilot programs will allow the state to see what works and doesn’t work, Pourat said. They will be evaluated based their impact on ER visits, inpatient stays and other measures of health and housing.\u003c/p>\n\u003cp>“It’s a great laboratory,” she said. “There is not going to be a cookie cutter approach throughout the state.”\u003c/p>\n\u003cp>The planned projects vary in size, method and goals. Many include housing services, care management and data sharing. For the counties that focus on homeless people, federal money cannot be used to pay rent. But it can be used for other housing services such as move-in costs, financial education and outreach to landlords.\u003c/p>\n\u003cp>In Orange County, officials are linking homeless residents to primary care providers and helping them find places to live.\u003c/p>\n\u003cp>“If we are able to get them stabilized and into stable housing … we can improve their overall health,” said Melissa Tober, manager of strategic projects for the Orange County Health Care Agency.\u003c/p>\n\u003cp>In Placer County, which also will target homeless residents, Health and Human Services Director Jeff Brown said each participant will have an intensive care plan, which may include substance abuse treatment, mental health care or peer support. Brown said the pilot project provides the money and flexibility.\u003c/p>\n\u003cp>But, he said, “There really is no road map for the perfect way to implement this, and without that road map or blueprint, it can be a bit difficult.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Why are California Republicans Prioritizing Dental Care for the Poor?",
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"content": "\u003cp>Democrats have traditionally been the ones to champion health care programs for low-income Californians. But this month, Republicans proposed a bill that would put $200 million dollars toward improving Denti-Cal, the state’s free dental care program for the poor.\u003c/p>\n\u003cp>“If you have a program that already exists that isn’t properly funded, and isn’t working properly, you should fix that first before spending money on new programs,” said Chad Mayes, an Assembly Republican leader who represents Yucca Valley.\u003c/p>\n\u003cp>About 13 million Californians are eligible for Denti-Cal, including 5 million children. But the program is widely viewed as “broken,” “bureaucratically rigid,” and “a disaster,” according to \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\">a 2016 report\u003c/a> from the \u003ca href=\"http://www.lhc.ca.gov/index.html\" target=\"_blank\" rel=\"noopener\">Little Hoover Commission\u003c/a>, an independent state oversight agency.\u003c/p>\n\u003cp>Most people who have Denti-Cal never actually see the dentist, because they can’t find one who accepts their coverage. Eleven counties in California have no dentists who accept Denti-Cal or who are accepting new Denti-Cal patients, according to a 2014 \u003ca href=\"https://www.auditor.ca.gov/reports/summary/2013-125\">California State Auditor report\u003c/a>.\u003c/p>\n\u003cp>“And we just think that that’s wrong,” Mayes said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Many dentists limit the number of Denti-Cal patients they see, or stop seeing them altogether because the pay is too low: California’s reimbursement rates are 35 percent of the national average.\u003c/p>\n\u003cp>The Republican bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB15\">AB 15\u003c/a>, would put all $200 million into paying dentists a better rate, in the hopes of attracting more dentists to participate in the program.\u003c/p>\n\u003cp>“We need to make it as efficient and effective as possible, so that millions of adults and kids in California that aren’t able to receive dental services are able to get them,” Mayes said.\u003c/p>\n\u003cp>But it’s not clear that giving dentists more money actually results in more patients getting care.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the Little Hoover Commission – a report Mayes and other Republicans cite frequently in defending their bill – includes 11 recommendations on how to fix Denti-Cal.\u003c/p>\n\u003cp>Not one of the recommendations involves increasing payments to dentists. In fact, the report calls across-the-board rate hikes a “costly” move that would result in attracting only “a few more Denti-Cal providers.”\u003c/p>\n\u003cp>Instead, the report recommends improving the Denti-Cal program by simplifying paperwork, focusing on less expensive prevention strategies (like having pediatricians teach patients about good oral hygiene), and establishing dental clinics inside schools or community centers in remote areas, so that patients can go to a centrally located place for care, rather than traveling 60 miles to a dentist’s office.\u003c/p>\n\u003cp>Senate Republican Leader Jean Fuller, who represents Kern County, acknowledged that the bill doesn’t address those recommendations.\u003c/p>\n\u003cp>“Yes, there are a lot of things that I would like to fix about the program. But I am not the majority party, unfortunately. I am not likely to get to adjust those,” she said. “There are 120,000 children in my district who are not getting the service. So my job is to fight for my children to get what I can.”\u003c/p>\n\u003cp>Paying dentists more money is really about making dentists happy, says Jessica Levinson, a professor at Loyola Law School in Los Angeles.\u003c/p>\n\u003cp>“It’s certainly a Republican goal to be business friendly,” she said. “This proposal is actually a business-friendly, a professional-friendly proposal to try and say to a dentist, ‘You will get higher reimbursement rates and you will be able to serve poor clients.’”\u003c/p>\n\u003cp>Levinson says there could also be something else at play here: campaign money. The \u003ca href=\"http://www.cda.org/\" target=\"_blank\" rel=\"noopener\">California Dental Association\u003c/a> gives more to Democrats in the state, but compared to other similar interest groups, like the California Medical Association, the dental group gives more generously to Republicans.\u003c/p>\n\u003cp>When it comes to Californian candidates running for federal office, in the most recent election cycle, the Dental Association gave exclusively to the Republican party, according to \u003ca href=\"https://www.opensecrets.org/pacs/lookup2.php?strID=C00005751&cycle=2016\">campaign contribution data\u003c/a> from Open Secrets. That’s a complete turnaround from 25 years ago, when the Association gave only to Democrats running at that level.\u003c/p>\n\u003cp>“It’s obvious to me that state office holders in California would be well aware of the fact that the California Dental Association is spending a lot of money for Republican candidates on the federal level,” Levinson said, “So they may be hoping that that money will soon come their way.”\u003c/p>\n\u003cp>Republicans and Democrats both are always on the lookout for new sources of campaign money. Asked if the Dental Association’s shift in giving influenced the Republican bill, Assemblyman Chad Mayes said he wasn’t aware of the shift.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Actually, I’m a bit offended by even asking the question, because we really, genuinely care about the people of California,” he said. “This is about fixing a broken governmental program.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Democrats have traditionally been the ones to champion health care programs for low-income Californians. But this month, Republicans proposed a bill that would put $200 million dollars toward improving Denti-Cal, the state’s free dental care program for the poor.\u003c/p>\n\u003cp>“If you have a program that already exists that isn’t properly funded, and isn’t working properly, you should fix that first before spending money on new programs,” said Chad Mayes, an Assembly Republican leader who represents Yucca Valley.\u003c/p>\n\u003cp>About 13 million Californians are eligible for Denti-Cal, including 5 million children. But the program is widely viewed as “broken,” “bureaucratically rigid,” and “a disaster,” according to \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\">a 2016 report\u003c/a> from the \u003ca href=\"http://www.lhc.ca.gov/index.html\" target=\"_blank\" rel=\"noopener\">Little Hoover Commission\u003c/a>, an independent state oversight agency.\u003c/p>\n\u003cp>Most people who have Denti-Cal never actually see the dentist, because they can’t find one who accepts their coverage. Eleven counties in California have no dentists who accept Denti-Cal or who are accepting new Denti-Cal patients, according to a 2014 \u003ca href=\"https://www.auditor.ca.gov/reports/summary/2013-125\">California State Auditor report\u003c/a>.\u003c/p>\n\u003cp>“And we just think that that’s wrong,” Mayes said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Many dentists limit the number of Denti-Cal patients they see, or stop seeing them altogether because the pay is too low: California’s reimbursement rates are 35 percent of the national average.\u003c/p>\n\u003cp>The Republican bill, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180AB15\">AB 15\u003c/a>, would put all $200 million into paying dentists a better rate, in the hopes of attracting more dentists to participate in the program.\u003c/p>\n\u003cp>“We need to make it as efficient and effective as possible, so that millions of adults and kids in California that aren’t able to receive dental services are able to get them,” Mayes said.\u003c/p>\n\u003cp>But it’s not clear that giving dentists more money actually results in more patients getting care.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the Little Hoover Commission – a report Mayes and other Republicans cite frequently in defending their bill – includes 11 recommendations on how to fix Denti-Cal.\u003c/p>\n\u003cp>Not one of the recommendations involves increasing payments to dentists. In fact, the report calls across-the-board rate hikes a “costly” move that would result in attracting only “a few more Denti-Cal providers.”\u003c/p>\n\u003cp>Instead, the report recommends improving the Denti-Cal program by simplifying paperwork, focusing on less expensive prevention strategies (like having pediatricians teach patients about good oral hygiene), and establishing dental clinics inside schools or community centers in remote areas, so that patients can go to a centrally located place for care, rather than traveling 60 miles to a dentist’s office.\u003c/p>\n\u003cp>Senate Republican Leader Jean Fuller, who represents Kern County, acknowledged that the bill doesn’t address those recommendations.\u003c/p>\n\u003cp>“Yes, there are a lot of things that I would like to fix about the program. But I am not the majority party, unfortunately. I am not likely to get to adjust those,” she said. “There are 120,000 children in my district who are not getting the service. So my job is to fight for my children to get what I can.”\u003c/p>\n\u003cp>Paying dentists more money is really about making dentists happy, says Jessica Levinson, a professor at Loyola Law School in Los Angeles.\u003c/p>\n\u003cp>“It’s certainly a Republican goal to be business friendly,” she said. “This proposal is actually a business-friendly, a professional-friendly proposal to try and say to a dentist, ‘You will get higher reimbursement rates and you will be able to serve poor clients.’”\u003c/p>\n\u003cp>Levinson says there could also be something else at play here: campaign money. The \u003ca href=\"http://www.cda.org/\" target=\"_blank\" rel=\"noopener\">California Dental Association\u003c/a> gives more to Democrats in the state, but compared to other similar interest groups, like the California Medical Association, the dental group gives more generously to Republicans.\u003c/p>\n\u003cp>When it comes to Californian candidates running for federal office, in the most recent election cycle, the Dental Association gave exclusively to the Republican party, according to \u003ca href=\"https://www.opensecrets.org/pacs/lookup2.php?strID=C00005751&cycle=2016\">campaign contribution data\u003c/a> from Open Secrets. That’s a complete turnaround from 25 years ago, when the Association gave only to Democrats running at that level.\u003c/p>\n\u003cp>“It’s obvious to me that state office holders in California would be well aware of the fact that the California Dental Association is spending a lot of money for Republican candidates on the federal level,” Levinson said, “So they may be hoping that that money will soon come their way.”\u003c/p>\n\u003cp>Republicans and Democrats both are always on the lookout for new sources of campaign money. Asked if the Dental Association’s shift in giving influenced the Republican bill, Assemblyman Chad Mayes said he wasn’t aware of the shift.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Actually, I’m a bit offended by even asking the question, because we really, genuinely care about the people of California,” he said. “This is about fixing a broken governmental program.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "On a 'Eugenics Registry,' a Record Of California's Thousands Of Sterilizations",
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"content": "\u003cp>There's a grim chapter in American history that involves forced sterilization. And for much of this past century, California had one of the most active sterilization programs in the country.\u003c/p>\n\u003cp>A state law from 1909 authorized the surgery for people judged to have \"mental disease, which may have been inherited.\" That law remained on the books until 1979.\u003c/p>\n\u003cp>University of Michigan professor Alexandra Minna Stern has been working to identify people who were forcibly sterilized under California's program. NPR's Ailsa Chang spoke with Stern, who said this idea of eugenics was intended to \"eradicate certain genes from the population.\"\u003c/p>\n\u003cp>The professor describes the program as a historic injustice and called for the state of California to compensate surviving victims of sterilization of relatives of those who are now deceased.\u003c/p>\n\u003cp>\u003cem>The interview highlights contain some extra content that did not air in the broadcast version.\u003c/em>\u003c/p>\n\u003chr>\n\u003ch3>Interview highlights\u003c/h3>\n\u003cp>\u003cstrong>On how she found the names of all the victims \u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The names are located in 19 microfilm reels that I happened upon while doing research in Sacramento about seven years ago.\u003c/p>\n\u003cp>\u003cstrong>On what made her look at the microfilms\u003c/strong>\u003c/p>\n\u003cp>I've written a book on the history of eugenics in California. But at that point, I still knew very little about the sterilizations themselves; who was sterilized, where did all of the sterilizations take place, how is the policy enacted?\u003c/p>\n\u003cp>So I did a bit of sleuthing and went to the actual departments themselves — the department of mental health in this case, in Sacramento — and was fortunate that someone there directed me to some file cabinets that contained microfilm reels with materials that had been microfilmed over the course of the '60s and '70s.\u003c/p>\n\u003cp>And lo and behold, there they were! I was able to begin using them as historical documents and that's how the project started.\u003c/p>\n\u003cp>\u003cstrong>On whether she found any patterns among the 20,000 names she discovered\u003c/strong>\u003c/p>\n\u003cp>Our team (and I should say this is the effort of a research team that includes epidemiologists, historians, digital humanists), we have a found a variety of patterns and we keep discovering more.\u003c/p>\n\u003cp>For example, we have determined that patients with Spanish surnames were much more likely to be sterilized than other patients, demonstrating that there was a racial bias in the sterilization program. We were also able to show the kinds of diagnoses that were given to patients, how that affected times of sterilization. We're able to look at age of sterilization and also patterns related to gender.\u003c/p>\n\u003cp>So there's a whole range of patterns that will help us to understand this pattern of history in California and also how it relates to national dynamics more broadly.\u003c/p>\n\u003cfigure id=\"attachment_273662\" class=\"wp-caption alignnone\" style=\"max-width: 427px\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich.jpg\" alt=\"University of Michigan professor Alex Stern has completed a database of thousands recommended for sterilization when California had eugenics laws on the book and she says those alive should be compensated.\" width=\"427\" height=\"320\" class=\"size-full wp-image-273662\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich.jpg 427w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-375x281.jpg 375w\" sizes=\"(max-width: 427px) 100vw, 427px\">\u003cfigcaption class=\"wp-caption-text\">University of Michigan professor Alex Stern has completed a database of thousands recommended for sterilization when California had eugenics laws on the book and she says those alive should be compensated. \u003ccite>(Michigan Photography)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>On what Stern and her team found with regard to age and gender patterns\u003c/strong>\u003c/p>\n\u003cp>Well, we found that people were sterilized at very young ages, that really often the focus was on minors, people as young as 7. The average age of sterilization was the low 20s, so many of these people were 15, 16, 17 and 18. We also found that, as I mentioned before, that the Spanish surname individuals were more likely to be sterilized at younger ages, indicating that there was interest on behalf of the state at targeting them at lower reproductive ages. In terms of gender, that pattern that I just mentioned, pertains to women as well.\u003c/p>\n\u003cp>One of the interesting things that we discovered is that initially, more men were sterilized. It started off as sterilization in general and across the country and in California, focused more on men in the teens and 20s and into the 30s. But by the 1930s, that pattern started to change. So by the '40s and '50s, more women were being sterilized.\u003c/p>\n\u003cp>\u003cstrong>On what kinds of \"mental diseases\" were focused on \u003c/strong>\u003c/p>\n\u003cp>It's very important to take that terminology with many historic grains of salt. If we go back in time and look at what the terms meant, it often meant people who were not conforming to societal norms, people who were poor, people who lacked education, perhaps didn't speak sufficient English to make it through school, and so on.\u003c/p>\n\u003cp>But what it meant for those who were enacting the law were people who were determined to have poor IQs, people with certain psychiatric disorders. But generally, often the way it was used was much more as a catch-all category — so people who just didn't fit, kind of like the misfits of society, so to speak. That's the way they looked at them.\u003c/p>\n\u003cp>Looking back on it, I would say that those who were institutionalized — because many more people where institutionalized than actually sterilized — was because maybe they had a psychiatric condition and they were sent to an institution as was the policy at the time in the mid-20th century. ...\u003c/p>\n\u003cp>But for the most part, this program of eugenics ... the idea of sterilization was to eradicate certain genes from the population.\u003c/p>\n\u003cp>\u003cstrong>On whether anyone among those who were sterilized are still alive\u003c/strong>\u003c/p>\n\u003cp>I haven't found anyone who's still alive. I have been contacted by relatives ... people who contacted me whose aunts or uncles were sterilized at some of these institutions. In the recent paper that my team published, we determined through statistical analysis that it is likely that slightly over 800 people, about 500 women and 300 men, are alive today.\u003c/p>\n\u003cp>Those numbers don't map on to exact people, they don't correspond to a precise person. But what we've done, we've generated the most reliable estimates, and based on that estimate and also looking at the timing, we estimate that the majority of these people were sterilized between 1945 and 1949 and their average age is about 88, so fairly old.\u003c/p>\n\u003cp>So what we could do is we could go and look at the records. And that's where I'd like to work with the state of California, because we've essentially created a eugenics registry. We can look at the records and identify likely individuals and then reach out and contact them.\u003c/p>\n\u003cp>I, however, would like to mention that two states that have enacted policies for monetary reparations for sterilization victims — North Carolina and Virginia — the states have to lead in kind of creating a committee and a registry. And because it was the state seeking to provide some type of redress and acknowledge this history, the state was able to actively set up a program and seek out and try to identify individuals. So they would come to the state and they would confirm through documentation that they had been sterilized and then receive recognition and monetary compensation.\u003c/p>\n\u003cp>\u003cstrong>On if there are indications that California is interested in compensating victims of sterilization\u003c/strong>\u003c/p>\n\u003cp>There's indication that the state is interested in this history and is aware of possibility of sterilization abuse. Just three years ago, news broke that about 150 women in two California women's prisons \u003ca href=\"http://www.npr.org/2013/09/20/219366146/calif-seeks-answers-on-questionable-prison-sterilizations\">had been sterilized\u003c/a> without proper consent and proper procedure. That resulted in a state audit in the interest of the state legislators and eventually, a law that was unanimously passed, banning sterilizations except under extreme medical circumstances in California state prisons. So this issue is on the radar screen.\u003c/p>\n\u003cp>It's easy to forget about these patients who were in these remote institutions in the 1940s and '50s in California. However, I think it behooves the state to not forget this history, and all of us to not forget this history. So hopefully, having this fairly solid number that we've generated of an estimate of likely living survivors could help facilitate that process. ...\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>It would also be a good idea to think about other forms of recognition of this historical injustice. For example, putting up a historical plaque in Sacramento somewhere to recognize those who were sterilized, or at one of the institutions such as the Sonoma State Home or the Patton State Home, making sure this history is included in K-12 curriculum. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. \u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=On+A+%27Eugenics+Registry%2C%27+A+Record+Of+California%27s+Thousands+Of+Sterilizations&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There's a grim chapter in American history that involves forced sterilization. And for much of this past century, California had one of the most active sterilization programs in the country.\u003c/p>\n\u003cp>A state law from 1909 authorized the surgery for people judged to have \"mental disease, which may have been inherited.\" That law remained on the books until 1979.\u003c/p>\n\u003cp>University of Michigan professor Alexandra Minna Stern has been working to identify people who were forcibly sterilized under California's program. NPR's Ailsa Chang spoke with Stern, who said this idea of eugenics was intended to \"eradicate certain genes from the population.\"\u003c/p>\n\u003cp>The professor describes the program as a historic injustice and called for the state of California to compensate surviving victims of sterilization of relatives of those who are now deceased.\u003c/p>\n\u003cp>\u003cem>The interview highlights contain some extra content that did not air in the broadcast version.\u003c/em>\u003c/p>\n\u003chr>\n\u003ch3>Interview highlights\u003c/h3>\n\u003cp>\u003cstrong>On how she found the names of all the victims \u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The names are located in 19 microfilm reels that I happened upon while doing research in Sacramento about seven years ago.\u003c/p>\n\u003cp>\u003cstrong>On what made her look at the microfilms\u003c/strong>\u003c/p>\n\u003cp>I've written a book on the history of eugenics in California. But at that point, I still knew very little about the sterilizations themselves; who was sterilized, where did all of the sterilizations take place, how is the policy enacted?\u003c/p>\n\u003cp>So I did a bit of sleuthing and went to the actual departments themselves — the department of mental health in this case, in Sacramento — and was fortunate that someone there directed me to some file cabinets that contained microfilm reels with materials that had been microfilmed over the course of the '60s and '70s.\u003c/p>\n\u003cp>And lo and behold, there they were! I was able to begin using them as historical documents and that's how the project started.\u003c/p>\n\u003cp>\u003cstrong>On whether she found any patterns among the 20,000 names she discovered\u003c/strong>\u003c/p>\n\u003cp>Our team (and I should say this is the effort of a research team that includes epidemiologists, historians, digital humanists), we have a found a variety of patterns and we keep discovering more.\u003c/p>\n\u003cp>For example, we have determined that patients with Spanish surnames were much more likely to be sterilized than other patients, demonstrating that there was a racial bias in the sterilization program. We were also able to show the kinds of diagnoses that were given to patients, how that affected times of sterilization. We're able to look at age of sterilization and also patterns related to gender.\u003c/p>\n\u003cp>So there's a whole range of patterns that will help us to understand this pattern of history in California and also how it relates to national dynamics more broadly.\u003c/p>\n\u003cfigure id=\"attachment_273662\" class=\"wp-caption alignnone\" style=\"max-width: 427px\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich.jpg\" alt=\"University of Michigan professor Alex Stern has completed a database of thousands recommended for sterilization when California had eugenics laws on the book and she says those alive should be compensated.\" width=\"427\" height=\"320\" class=\"size-full wp-image-273662\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich.jpg 427w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2016/12/Alex-Stern-U.-of-Mich-375x281.jpg 375w\" sizes=\"(max-width: 427px) 100vw, 427px\">\u003cfigcaption class=\"wp-caption-text\">University of Michigan professor Alex Stern has completed a database of thousands recommended for sterilization when California had eugenics laws on the book and she says those alive should be compensated. \u003ccite>(Michigan Photography)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>On what Stern and her team found with regard to age and gender patterns\u003c/strong>\u003c/p>\n\u003cp>Well, we found that people were sterilized at very young ages, that really often the focus was on minors, people as young as 7. The average age of sterilization was the low 20s, so many of these people were 15, 16, 17 and 18. We also found that, as I mentioned before, that the Spanish surname individuals were more likely to be sterilized at younger ages, indicating that there was interest on behalf of the state at targeting them at lower reproductive ages. In terms of gender, that pattern that I just mentioned, pertains to women as well.\u003c/p>\n\u003cp>One of the interesting things that we discovered is that initially, more men were sterilized. It started off as sterilization in general and across the country and in California, focused more on men in the teens and 20s and into the 30s. But by the 1930s, that pattern started to change. So by the '40s and '50s, more women were being sterilized.\u003c/p>\n\u003cp>\u003cstrong>On what kinds of \"mental diseases\" were focused on \u003c/strong>\u003c/p>\n\u003cp>It's very important to take that terminology with many historic grains of salt. If we go back in time and look at what the terms meant, it often meant people who were not conforming to societal norms, people who were poor, people who lacked education, perhaps didn't speak sufficient English to make it through school, and so on.\u003c/p>\n\u003cp>But what it meant for those who were enacting the law were people who were determined to have poor IQs, people with certain psychiatric disorders. But generally, often the way it was used was much more as a catch-all category — so people who just didn't fit, kind of like the misfits of society, so to speak. That's the way they looked at them.\u003c/p>\n\u003cp>Looking back on it, I would say that those who were institutionalized — because many more people where institutionalized than actually sterilized — was because maybe they had a psychiatric condition and they were sent to an institution as was the policy at the time in the mid-20th century. ...\u003c/p>\n\u003cp>But for the most part, this program of eugenics ... the idea of sterilization was to eradicate certain genes from the population.\u003c/p>\n\u003cp>\u003cstrong>On whether anyone among those who were sterilized are still alive\u003c/strong>\u003c/p>\n\u003cp>I haven't found anyone who's still alive. I have been contacted by relatives ... people who contacted me whose aunts or uncles were sterilized at some of these institutions. In the recent paper that my team published, we determined through statistical analysis that it is likely that slightly over 800 people, about 500 women and 300 men, are alive today.\u003c/p>\n\u003cp>Those numbers don't map on to exact people, they don't correspond to a precise person. But what we've done, we've generated the most reliable estimates, and based on that estimate and also looking at the timing, we estimate that the majority of these people were sterilized between 1945 and 1949 and their average age is about 88, so fairly old.\u003c/p>\n\u003cp>So what we could do is we could go and look at the records. And that's where I'd like to work with the state of California, because we've essentially created a eugenics registry. We can look at the records and identify likely individuals and then reach out and contact them.\u003c/p>\n\u003cp>I, however, would like to mention that two states that have enacted policies for monetary reparations for sterilization victims — North Carolina and Virginia — the states have to lead in kind of creating a committee and a registry. And because it was the state seeking to provide some type of redress and acknowledge this history, the state was able to actively set up a program and seek out and try to identify individuals. So they would come to the state and they would confirm through documentation that they had been sterilized and then receive recognition and monetary compensation.\u003c/p>\n\u003cp>\u003cstrong>On if there are indications that California is interested in compensating victims of sterilization\u003c/strong>\u003c/p>\n\u003cp>There's indication that the state is interested in this history and is aware of possibility of sterilization abuse. Just three years ago, news broke that about 150 women in two California women's prisons \u003ca href=\"http://www.npr.org/2013/09/20/219366146/calif-seeks-answers-on-questionable-prison-sterilizations\">had been sterilized\u003c/a> without proper consent and proper procedure. That resulted in a state audit in the interest of the state legislators and eventually, a law that was unanimously passed, banning sterilizations except under extreme medical circumstances in California state prisons. So this issue is on the radar screen.\u003c/p>\n\u003cp>It's easy to forget about these patients who were in these remote institutions in the 1940s and '50s in California. However, I think it behooves the state to not forget this history, and all of us to not forget this history. So hopefully, having this fairly solid number that we've generated of an estimate of likely living survivors could help facilitate that process. ...\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It would also be a good idea to think about other forms of recognition of this historical injustice. For example, putting up a historical plaque in Sacramento somewhere to recognize those who were sterilized, or at one of the institutions such as the Sonoma State Home or the Patton State Home, making sure this history is included in K-12 curriculum. \u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. \u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=On+A+%27Eugenics+Registry%2C%27+A+Record+Of+California%27s+Thousands+Of+Sterilizations&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Leading the Way? Northern California Cities to Embark on Soda Tax Spending",
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"content": "\u003cp>Asian Health Services, a community health center in Oakland’s buzzing Chinatown, sees about 6,000 dental patients a year. Hundreds of others are on a waiting list.\u003c/p>\n\u003cp>“We simply cannot meet the demand,” said Dr. Huong Le, the center’s dental director.\u003c/p>\n\u003cp>But now that voters have passed soda taxes in Oakland, Albany and San Francisco, Le and other Bay Area health providers are eyeing millions of dollars in revenue that could help more patients prevent obesity and dental decay.\u003c/p>\n\u003cp>The San Francisco Bay Area is trying to lead the way in putting soda tax revenues to good use, and cities around the country are watching closely. Some are considering soda taxes of their own.\u003c/p>\n\u003cp>“Soda taxes are going to be spreading like wildfire,” said Harold Goldstein, executive director of the Davis-based nonprofit Public Health Advocates.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The city of Berkeley, also in Alameda County, passed the \u003ca href=\"http://californiahealthline.org/news/is-berkeleys-new-soda-tax-a-tipping-point-or-an-outlie/\" target=\"_blank\">nation’s first such tax \u003c/a>in 2014.\u003c/p>\n\u003cp>In San Francisco, the tax, which takes effect Jan. 1, 2018, is expected to raise up to $15 million annually. Meanwhile in the smaller city of Albany, the tax took effect immediately and is projected to garner $223,000 each year. In Oakland, the penny-per-ounce tax on the distribution of sugar-sweetened beverages is projected to bring in up to $8 million each year, some of which will be used for health education and prevention programs in schools and the community. It takes effect in July.\u003c/p>\n\u003cp>“We felt this was very important because of the dental needs we see within our patient population,” Le said. “We know there’s a strong link between tooth decay and sugary beverages.”\u003c/p>\n\u003cp>The link between sugary beverages and obesity, diabetes and tooth decay is well-established. People who drink one or two cans of sugary drinks per day have a 26 percent greater risk of developing type 2 diabetes, according to one \u003ca href=\"https://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/\" target=\"_blank\">study\u003c/a> by the Harvard School of Public Health.\u003c/p>\n\u003cp>A separate study found that for every 12-ounce soda consumed by a child each day, their odds of becoming obese increased by \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11229668\" target=\"_blank\">60 percent\u003c/a>. Soda also has been tied to dental erosion which can lead to cavities, according a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676420/\" target=\"_blank\">2009 study\u003c/a>. The most frequent sources of erosive acids are soft drinks like cola, the study found.\u003c/p>\n\u003cp>In a report earlier this this year, an oversight commission criticized the state’s dental program for the poor, finding that California is seeing an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches.” This is made worse when families struggle to get an appointment with a dentist, the report said.\u003c/p>\n\u003cp>In Oakland and the rest of Alameda County, \u003ca href=\"http://www.acgov.org/board/bos_calendar/documents/DocsAgendaReg_7_14_14/HEALTH%20CARE%20SERVICES/Regular%20Calendar/Alameda_County_Report_Exec_Summ_Obesity_Rpt.pdf\" target=\"_blank\">one third\u003c/a> of children consume one or more sugary drinks a day.\u003c/p>\n\u003cp>Oakland’s city council will establish a community advisory board to oversee the distribution of soda tax money, and local health advocates want to make sure they’re well-represented, Le said.\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/news/soda-taxes-gaining-steam-or-getting-steamrolled/\" target=\"_blank\">Goldstein\u003c/a> said the fact that measures recently passed in all three Bay Area cities by a notable margin — in Oakland the tax was approved with 61 percent of the vote — shows that Californians grasp the harmful effects of sugary drinks.\u003c/p>\n\u003cp>Soda taxes, he said, are significant because they raise money to be used in the fight against obesity and other chronic conditions, and they reduce the consumption of sugary drinks.\u003c/p>\n\u003cp>In Berkeley’s low-income neighborhoods, the consumption of soda and other sweetened beverages decreased by 21 percent in the months after the 2014 tax began, according to a \u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303362\" target=\"_blank\">UC Berkeley study\u003c/a>.\u003c/p>\n\u003cp>The study also showed a 63 percent increase in the consumption of bottled or tap water. It is not clear whether these results are due to the higher retail prices of sugary drinks or to the increased awareness on the health effects associated with the beverages, the study notes.\u003c/p>\n\u003cp>Goldstein said similar outcomes can be expected in Oakland, San Francisco and Albany, as well as in Boulder, Colo., where voters also passed a similar tax in November. This drives up the total number of cities with soda taxes to six — Philadelphia passed a 1.5 cents-per-ounce tax in June.\u003c/p>\n\u003cp>The American Beverage Association, which has lobbied heavily against soda taxes nationwide, doesn’t see a movement. Spokeswoman Lauren Kane said that \u003ca href=\"http://www.reuters.com/article/us-beverages-sodatax-bloomberg-idUSKCN0Z3275\" target=\"_blank\">43 soda tax proposals have been rejected \u003c/a>since 2008.\u003c/p>\n\u003cp>The association will continue to focus on reducing calories and sugar in beverages, Kane said. These taxes, Kane said, are only a Band-Aid solution to the larger national obesity problem.\u003c/p>\n\u003cp>But they are a start, said Elizabeth Bautista, a health educator at La Clinica, a health center in Oakland’s Fruitvale neighborhood, home to the city’ largest Latino population.\u003c/p>\n\u003cp>Bautista and 15 volunteer health educators known as promotoras engaged their community in the soda tax discussion by going door-to-door and making hundreds of calls to registered voters.\u003c/p>\n\u003cp>The challenge now, Bautista said, is to continue to motivate people to choose alternatives to sugary drinks.\u003c/p>\n\u003cp>The promotoras often share stories of what they see in the field: toddlers with soda in their bottles, and families walking out of dollar stores with grocery bags full of juices and sports drinks.\u003c/p>\n\u003cp>“It’s a serious problem in our community, and there is so much misinformation floating around,” Bautista said. She often hears from families that fruit-flavored sodas are not as harmful as dark sodas. “That of course is not true; that’s a myth we have to eliminate,” she said.\u003c/p>\n\u003cp>Maria Reyes, one of the promotoras, said the clinic is starting additional nutrition and physical activity classes — a healthy cooking class, for example, is expected to be of great interest. These are the type of activities that could be expanded by funds from the soda tax, Reyes said.\u003c/p>\n\u003cp>Reyes believes soda tax advocates in Oakland learned a lot from battles lost in other California cities, such as Richmond and El Monte, where voters rejected soda taxes in 2012.\u003c/p>\n\u003cp>“We learned that we needed a coalition and that we needed to focus the discussion on diabetes and obesity prevention,” Reyes said.\u003c/p>\n\u003cp>The promotoras say they are now hearing from community groups in Contra Costa cities interested in following in their footsteps.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“This is a big win,” Reyes said. “Once we start seeing results, I think more cities will join us.”\u003cbr>\n\u003cem>\u003cbr>\nThis story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Asian Health Services, a community health center in Oakland’s buzzing Chinatown, sees about 6,000 dental patients a year. Hundreds of others are on a waiting list.\u003c/p>\n\u003cp>“We simply cannot meet the demand,” said Dr. Huong Le, the center’s dental director.\u003c/p>\n\u003cp>But now that voters have passed soda taxes in Oakland, Albany and San Francisco, Le and other Bay Area health providers are eyeing millions of dollars in revenue that could help more patients prevent obesity and dental decay.\u003c/p>\n\u003cp>The San Francisco Bay Area is trying to lead the way in putting soda tax revenues to good use, and cities around the country are watching closely. Some are considering soda taxes of their own.\u003c/p>\n\u003cp>“Soda taxes are going to be spreading like wildfire,” said Harold Goldstein, executive director of the Davis-based nonprofit Public Health Advocates.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The city of Berkeley, also in Alameda County, passed the \u003ca href=\"http://californiahealthline.org/news/is-berkeleys-new-soda-tax-a-tipping-point-or-an-outlie/\" target=\"_blank\">nation’s first such tax \u003c/a>in 2014.\u003c/p>\n\u003cp>In San Francisco, the tax, which takes effect Jan. 1, 2018, is expected to raise up to $15 million annually. Meanwhile in the smaller city of Albany, the tax took effect immediately and is projected to garner $223,000 each year. In Oakland, the penny-per-ounce tax on the distribution of sugar-sweetened beverages is projected to bring in up to $8 million each year, some of which will be used for health education and prevention programs in schools and the community. It takes effect in July.\u003c/p>\n\u003cp>“We felt this was very important because of the dental needs we see within our patient population,” Le said. “We know there’s a strong link between tooth decay and sugary beverages.”\u003c/p>\n\u003cp>The link between sugary beverages and obesity, diabetes and tooth decay is well-established. People who drink one or two cans of sugary drinks per day have a 26 percent greater risk of developing type 2 diabetes, according to one \u003ca href=\"https://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/\" target=\"_blank\">study\u003c/a> by the Harvard School of Public Health.\u003c/p>\n\u003cp>A separate study found that for every 12-ounce soda consumed by a child each day, their odds of becoming obese increased by \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11229668\" target=\"_blank\">60 percent\u003c/a>. Soda also has been tied to dental erosion which can lead to cavities, according a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676420/\" target=\"_blank\">2009 study\u003c/a>. The most frequent sources of erosive acids are soft drinks like cola, the study found.\u003c/p>\n\u003cp>In a report earlier this this year, an oversight commission criticized the state’s dental program for the poor, finding that California is seeing an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches.” This is made worse when families struggle to get an appointment with a dentist, the report said.\u003c/p>\n\u003cp>In Oakland and the rest of Alameda County, \u003ca href=\"http://www.acgov.org/board/bos_calendar/documents/DocsAgendaReg_7_14_14/HEALTH%20CARE%20SERVICES/Regular%20Calendar/Alameda_County_Report_Exec_Summ_Obesity_Rpt.pdf\" target=\"_blank\">one third\u003c/a> of children consume one or more sugary drinks a day.\u003c/p>\n\u003cp>Oakland’s city council will establish a community advisory board to oversee the distribution of soda tax money, and local health advocates want to make sure they’re well-represented, Le said.\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/news/soda-taxes-gaining-steam-or-getting-steamrolled/\" target=\"_blank\">Goldstein\u003c/a> said the fact that measures recently passed in all three Bay Area cities by a notable margin — in Oakland the tax was approved with 61 percent of the vote — shows that Californians grasp the harmful effects of sugary drinks.\u003c/p>\n\u003cp>Soda taxes, he said, are significant because they raise money to be used in the fight against obesity and other chronic conditions, and they reduce the consumption of sugary drinks.\u003c/p>\n\u003cp>In Berkeley’s low-income neighborhoods, the consumption of soda and other sweetened beverages decreased by 21 percent in the months after the 2014 tax began, according to a \u003ca href=\"http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303362\" target=\"_blank\">UC Berkeley study\u003c/a>.\u003c/p>\n\u003cp>The study also showed a 63 percent increase in the consumption of bottled or tap water. It is not clear whether these results are due to the higher retail prices of sugary drinks or to the increased awareness on the health effects associated with the beverages, the study notes.\u003c/p>\n\u003cp>Goldstein said similar outcomes can be expected in Oakland, San Francisco and Albany, as well as in Boulder, Colo., where voters also passed a similar tax in November. This drives up the total number of cities with soda taxes to six — Philadelphia passed a 1.5 cents-per-ounce tax in June.\u003c/p>\n\u003cp>The American Beverage Association, which has lobbied heavily against soda taxes nationwide, doesn’t see a movement. Spokeswoman Lauren Kane said that \u003ca href=\"http://www.reuters.com/article/us-beverages-sodatax-bloomberg-idUSKCN0Z3275\" target=\"_blank\">43 soda tax proposals have been rejected \u003c/a>since 2008.\u003c/p>\n\u003cp>The association will continue to focus on reducing calories and sugar in beverages, Kane said. These taxes, Kane said, are only a Band-Aid solution to the larger national obesity problem.\u003c/p>\n\u003cp>But they are a start, said Elizabeth Bautista, a health educator at La Clinica, a health center in Oakland’s Fruitvale neighborhood, home to the city’ largest Latino population.\u003c/p>\n\u003cp>Bautista and 15 volunteer health educators known as promotoras engaged their community in the soda tax discussion by going door-to-door and making hundreds of calls to registered voters.\u003c/p>\n\u003cp>The challenge now, Bautista said, is to continue to motivate people to choose alternatives to sugary drinks.\u003c/p>\n\u003cp>The promotoras often share stories of what they see in the field: toddlers with soda in their bottles, and families walking out of dollar stores with grocery bags full of juices and sports drinks.\u003c/p>\n\u003cp>“It’s a serious problem in our community, and there is so much misinformation floating around,” Bautista said. She often hears from families that fruit-flavored sodas are not as harmful as dark sodas. “That of course is not true; that’s a myth we have to eliminate,” she said.\u003c/p>\n\u003cp>Maria Reyes, one of the promotoras, said the clinic is starting additional nutrition and physical activity classes — a healthy cooking class, for example, is expected to be of great interest. These are the type of activities that could be expanded by funds from the soda tax, Reyes said.\u003c/p>\n\u003cp>Reyes believes soda tax advocates in Oakland learned a lot from battles lost in other California cities, such as Richmond and El Monte, where voters rejected soda taxes in 2012.\u003c/p>\n\u003cp>“We learned that we needed a coalition and that we needed to focus the discussion on diabetes and obesity prevention,” Reyes said.\u003c/p>\n\u003cp>The promotoras say they are now hearing from community groups in Contra Costa cities interested in following in their footsteps.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“This is a big win,” Reyes said. “Once we start seeing results, I think more cities will join us.”\u003cbr>\n\u003cem>\u003cbr>\nThis story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
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"order": 8
},
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"order": 1
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
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"order": 9
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"hidden-brain": {
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
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"source": "NPR"
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"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"airtime": "SUN 7:30pm-8pm",
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"hyphenacion": {
"id": "hyphenacion",
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"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"order": 15
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"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"order": 18
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},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
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},
"masters-of-scale": {
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"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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