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"disqusTitle": "California Firms Take On Health Giant Sutter Over Contract Demand",
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"content": "\u003cp>Sutter Health, a large network of doctors and hospitals in Northern California that has long been accused of abusing its market power, is now squaring off against major U.S. corporations in a closely watched legal fight.\u003c/p>\n\u003cp>The battle is over Sutter's demand that companies sign an arbitration agreement to resolve any legal disputes with the health system. If firms don't sign the agreement, Sutter says, the companies will have to pay sharply higher rates for medical treatment of their employees at Sutter's hospitals, surgery centers and clinics – 95 percent of Sutter's full charge.\u003c/p>\n\u003cp>Sutter's nonprofit system, based in Sacramento, includes 24 hospitals, 34 surgery centers and more than 5,000 physicians. It reported $11 billion in revenue last year and an operating profit of $287 million.\u003c/p>\n\u003cp>Some companies and labor unions say Sutter's ultimatum is aimed at preventing them from joining an ongoing class-action lawsuit that accuses the giant health system of imposing anticompetitive terms and \"illegally inflated prices\" for health care. Sutter disputes the allegations, and says its charges are in line with those of its peers.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Y2d5hBl1KuDN1DpSTprRzxb3vXMiE6Wd\"]In a March 16 \u003ca href=\"https://californiahealthline.files.wordpress.com/2016/04/pbgh-sutter-filing.pdf\" target=\"_blank\">court filing\u003c/a>, \u003ca href=\"http://staging.pbgh.org/about/pbgh-staff\">David Lansky\u003c/a>, chief executive of the Pacific Business Group on Health, said it isn't feasible for large companies employing people in Northern California to exclude Sutter from their workers' insurance networks, given the network's size and reach. Lansky's organization represents big companies like Wells Fargo Bank, Intel and Chevron, as well as government agencies like the California Public Employees' Retirement System.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Their choice is between two unacceptable alternatives,\" Lansky said in his filing. \"Pay 95 percent out-of-network pricing for enrollees that access Sutter services, or agree to give up their claims in this litigation.\"\u003c/p>\n\u003cp>Major insurers are split in their reaction to Sutter's move. Industry giants Anthem and Aetna are urging customers to accept arbitration in order to remain in the network, while rival Blue Shield of California says it opposes Sutter's request. Blue Shield has clashed publicly with Sutter before over contract terms and prices.\u003c/p>\n\u003cp>All this comes amid growing concern nationwide about the financial toll from industry consolidation, as big health systems amass market clout by acquiring more hospitals, outpatient facilities and physician offices.\u003c/p>\n\u003cp>\"This is an important legal case because it could have national repercussions,\" said \u003ca href=\"https://priceschool.usc.edu/glenn-melnick/\">Glenn Melnick\u003c/a>, a health-care economist at the University of Southern California. \"Sutter is the model for the rest of the country, and there are so many other health systems doing similar things so they can raise prices.\"\u003c/p>\n\u003cp>The current fight centers on large employers that tend to self-insure because they have the financial resources to pay their own medical claims. These firms often hire an insurer to negotiate with hospitals and other health care providers to get discounted rates for employees.\u003c/p>\n\u003cp>Sutter insists it won't use the arbitration agreements to prevent employers from participating in the class-action lawsuit brought by a grocery workers' health plan in San Francisco County Superior Court.\u003c/p>\n\u003cp>[contextly_sidebar id=\"kkWEu5RBmPnXoSZHYWYjolhcRwWQy64j\"]The health system says it only sought the new arbitration requirement after a state appellate court ruling last year. The court ruled that the plaintiff suing Sutter — the \u003ca href=\"http://www.ufcw.org/\" target=\"_blank\">United Food and Commercial Workers\u003c/a> and its \u003ca href=\"https://www.ufcwtrust.com/memberservicesinformation.aspx\" target=\"_blank\">Employers Benefit Trust\u003c/a> — wasn't bound by the arbitration provisions in the contract that Blue Shield signed with Sutter as the health plan administrator.\u003c/p>\n\u003cp>Sutter says it is asking employers and labor groups to review and agree to its contract terms so there's consistency among all parties involved. Arbitration is widely used by companies of all types to avoid costly litigation in resolving disputes.\u003c/p>\n\u003cp>\"If self-funded payers wish to access the discounted rates that Sutter Health makes available under these contracts, it is reasonable to ask that they abide by the package of terms that make those rates financially feasible,\" Sutter spokesman \u003ca href=\"https://www.linkedin.com/in/bill-gleeson-5b8b908\">Bill Gleeson\u003c/a> says. \"They should not be able to cherry pick which provisions apply to them and which do not.\"\u003c/p>\n\u003cp>But attorneys for the grocery workers' health plan are asking the court to stop Sutter from seeking arbitration agreements, alleging that the health giant's move is an attempt to hinder the litigation. A hearing on the matter is slated for Thursday.\u003c/p>\n\u003cp>\"We do not want potential class members precluded from this lawsuit at the point of a gun,\" said \u003ca href=\"http://www.pillsburycoleman.com/Attorneys/Richard-L-Grossman.shtml\">Richard Grossman\u003c/a>, lead counsel for the joint employer-union health plan, which represents more than 60,000 employees, dependents and retirees. \"The fact they are even willing to make this threat to obtain the arbitration clause has shocked the payer community.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.pbgh.org/about/pbgh-staff/52-bill-kramer-mba\">Bill Kramer\u003c/a>, executive director for national health policy at the Pacific Business Group on Health, agreed that Sutter's threat to pull all of its facilities from an insurance network took employers by surprise.\u003c/p>\n\u003cp>\"This can appear to be an arcane legal battle between corporations, but it has real-world consequences for the affordability of health care for employees and their families,\" Kramer says. \"The in-network rates at Sutter are already too high, and out-of-network prices are even higher.\"\u003c/p>\n\u003cp>The lawsuit over antitrust violations and unfair competition alleges that Sutter's hospital prices in San Francisco have exceeded those of competitors by as much as 56 percent. It also says an overnight hospital stay at Sutter hospitals in San Francisco or Sacramento costs at least 38 percent more than a comparable stay in the more competitive Los Angeles market.\u003c/p>\n\u003cp>Employers began expressing concerns about Sutter's move in recent weeks after insurers raised the issue.\u003c/p>\n\u003cp>In a \u003ca href=\"https://californiahealthline.files.wordpress.com/2016/04/anthem-sutter-documents.pdf\" target=\"_blank\">Feb. 22 memo\u003c/a> to customers, Anthem said it \"must now obtain a signed attestation from all California-based self-funded customers and all Anthem national accounts with 50-plus members in Sutter's Northern California service area.\" Many customers face a May 16 deadline to sign, according to Anthem.\u003c/p>\n\u003cp>The insurer noted that state and federal investigations of Sutter's conduct haven't yielded any results so far.\u003c/p>\n\u003cp>California Attorney General \u003ca href=\"https://oag.ca.gov/about\">Kamala Harris\u003c/a> has been investigating Sutter and other big medical providers for several years over potential harm to consumers. A spokeswoman for her office says the attorney general can't comment on any ongoing investigations.\u003c/p>\n\u003cp>Meanwhile, Sutter accounts for 28 percent of Anthem's medical spending in a 21-county area of Northern California, according to the insurer.\u003c/p>\n\u003cp>\"Sutter's market share is over 35 percent in eight counties and over 45 percent in six counties,\" Perry Pogany, Anthem's vice president for account management, wrote to customers in February. \"Sutter is able to secure significant and unique concessions in its carrier contracts due to its position in northern California.\"\u003c/p>\n\u003cp>Anthem and Blue Shield both declined to comment further on the Sutter matter. The grocery workers' self-funded plan that is suing Sutter is a customer of Blue Shield.\u003c/p>\n\u003cp>Melnick and other economists say the lack of competition among health care providers in Northern California helps explain why the premiums there for health insurance are about 25 percent higher, on average, than premiums in the southern part of the state.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> has reported a similar pattern, with an average rate increase of 7 percent for policyholders in Northern California this year, compared to 1.8 percent for plans in southern California.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 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=Big+California+Firms+Take+On+Health+Care+Giant+Over+Cost+of+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sutter Health, a large network of doctors and hospitals in Northern California that has long been accused of abusing its market power, is now squaring off against major U.S. corporations in a closely watched legal fight.\u003c/p>\n\u003cp>The battle is over Sutter's demand that companies sign an arbitration agreement to resolve any legal disputes with the health system. If firms don't sign the agreement, Sutter says, the companies will have to pay sharply higher rates for medical treatment of their employees at Sutter's hospitals, surgery centers and clinics – 95 percent of Sutter's full charge.\u003c/p>\n\u003cp>Sutter's nonprofit system, based in Sacramento, includes 24 hospitals, 34 surgery centers and more than 5,000 physicians. It reported $11 billion in revenue last year and an operating profit of $287 million.\u003c/p>\n\u003cp>Some companies and labor unions say Sutter's ultimatum is aimed at preventing them from joining an ongoing class-action lawsuit that accuses the giant health system of imposing anticompetitive terms and \"illegally inflated prices\" for health care. Sutter disputes the allegations, and says its charges are in line with those of its peers.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>In a March 16 \u003ca href=\"https://californiahealthline.files.wordpress.com/2016/04/pbgh-sutter-filing.pdf\" target=\"_blank\">court filing\u003c/a>, \u003ca href=\"http://staging.pbgh.org/about/pbgh-staff\">David Lansky\u003c/a>, chief executive of the Pacific Business Group on Health, said it isn't feasible for large companies employing people in Northern California to exclude Sutter from their workers' insurance networks, given the network's size and reach. Lansky's organization represents big companies like Wells Fargo Bank, Intel and Chevron, as well as government agencies like the California Public Employees' Retirement System.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Their choice is between two unacceptable alternatives,\" Lansky said in his filing. \"Pay 95 percent out-of-network pricing for enrollees that access Sutter services, or agree to give up their claims in this litigation.\"\u003c/p>\n\u003cp>Major insurers are split in their reaction to Sutter's move. Industry giants Anthem and Aetna are urging customers to accept arbitration in order to remain in the network, while rival Blue Shield of California says it opposes Sutter's request. Blue Shield has clashed publicly with Sutter before over contract terms and prices.\u003c/p>\n\u003cp>All this comes amid growing concern nationwide about the financial toll from industry consolidation, as big health systems amass market clout by acquiring more hospitals, outpatient facilities and physician offices.\u003c/p>\n\u003cp>\"This is an important legal case because it could have national repercussions,\" said \u003ca href=\"https://priceschool.usc.edu/glenn-melnick/\">Glenn Melnick\u003c/a>, a health-care economist at the University of Southern California. \"Sutter is the model for the rest of the country, and there are so many other health systems doing similar things so they can raise prices.\"\u003c/p>\n\u003cp>The current fight centers on large employers that tend to self-insure because they have the financial resources to pay their own medical claims. These firms often hire an insurer to negotiate with hospitals and other health care providers to get discounted rates for employees.\u003c/p>\n\u003cp>Sutter insists it won't use the arbitration agreements to prevent employers from participating in the class-action lawsuit brought by a grocery workers' health plan in San Francisco County Superior Court.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The health system says it only sought the new arbitration requirement after a state appellate court ruling last year. The court ruled that the plaintiff suing Sutter — the \u003ca href=\"http://www.ufcw.org/\" target=\"_blank\">United Food and Commercial Workers\u003c/a> and its \u003ca href=\"https://www.ufcwtrust.com/memberservicesinformation.aspx\" target=\"_blank\">Employers Benefit Trust\u003c/a> — wasn't bound by the arbitration provisions in the contract that Blue Shield signed with Sutter as the health plan administrator.\u003c/p>\n\u003cp>Sutter says it is asking employers and labor groups to review and agree to its contract terms so there's consistency among all parties involved. Arbitration is widely used by companies of all types to avoid costly litigation in resolving disputes.\u003c/p>\n\u003cp>\"If self-funded payers wish to access the discounted rates that Sutter Health makes available under these contracts, it is reasonable to ask that they abide by the package of terms that make those rates financially feasible,\" Sutter spokesman \u003ca href=\"https://www.linkedin.com/in/bill-gleeson-5b8b908\">Bill Gleeson\u003c/a> says. \"They should not be able to cherry pick which provisions apply to them and which do not.\"\u003c/p>\n\u003cp>But attorneys for the grocery workers' health plan are asking the court to stop Sutter from seeking arbitration agreements, alleging that the health giant's move is an attempt to hinder the litigation. A hearing on the matter is slated for Thursday.\u003c/p>\n\u003cp>\"We do not want potential class members precluded from this lawsuit at the point of a gun,\" said \u003ca href=\"http://www.pillsburycoleman.com/Attorneys/Richard-L-Grossman.shtml\">Richard Grossman\u003c/a>, lead counsel for the joint employer-union health plan, which represents more than 60,000 employees, dependents and retirees. \"The fact they are even willing to make this threat to obtain the arbitration clause has shocked the payer community.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.pbgh.org/about/pbgh-staff/52-bill-kramer-mba\">Bill Kramer\u003c/a>, executive director for national health policy at the Pacific Business Group on Health, agreed that Sutter's threat to pull all of its facilities from an insurance network took employers by surprise.\u003c/p>\n\u003cp>\"This can appear to be an arcane legal battle between corporations, but it has real-world consequences for the affordability of health care for employees and their families,\" Kramer says. \"The in-network rates at Sutter are already too high, and out-of-network prices are even higher.\"\u003c/p>\n\u003cp>The lawsuit over antitrust violations and unfair competition alleges that Sutter's hospital prices in San Francisco have exceeded those of competitors by as much as 56 percent. It also says an overnight hospital stay at Sutter hospitals in San Francisco or Sacramento costs at least 38 percent more than a comparable stay in the more competitive Los Angeles market.\u003c/p>\n\u003cp>Employers began expressing concerns about Sutter's move in recent weeks after insurers raised the issue.\u003c/p>\n\u003cp>In a \u003ca href=\"https://californiahealthline.files.wordpress.com/2016/04/anthem-sutter-documents.pdf\" target=\"_blank\">Feb. 22 memo\u003c/a> to customers, Anthem said it \"must now obtain a signed attestation from all California-based self-funded customers and all Anthem national accounts with 50-plus members in Sutter's Northern California service area.\" Many customers face a May 16 deadline to sign, according to Anthem.\u003c/p>\n\u003cp>The insurer noted that state and federal investigations of Sutter's conduct haven't yielded any results so far.\u003c/p>\n\u003cp>California Attorney General \u003ca href=\"https://oag.ca.gov/about\">Kamala Harris\u003c/a> has been investigating Sutter and other big medical providers for several years over potential harm to consumers. A spokeswoman for her office says the attorney general can't comment on any ongoing investigations.\u003c/p>\n\u003cp>Meanwhile, Sutter accounts for 28 percent of Anthem's medical spending in a 21-county area of Northern California, according to the insurer.\u003c/p>\n\u003cp>\"Sutter's market share is over 35 percent in eight counties and over 45 percent in six counties,\" Perry Pogany, Anthem's vice president for account management, wrote to customers in February. \"Sutter is able to secure significant and unique concessions in its carrier contracts due to its position in northern California.\"\u003c/p>\n\u003cp>Anthem and Blue Shield both declined to comment further on the Sutter matter. The grocery workers' self-funded plan that is suing Sutter is a customer of Blue Shield.\u003c/p>\n\u003cp>Melnick and other economists say the lack of competition among health care providers in Northern California helps explain why the premiums there for health insurance are about 25 percent higher, on average, than premiums in the southern part of the state.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a> has reported a similar pattern, with an average rate increase of 7 percent for policyholders in Northern California this year, compared to 1.8 percent for plans in southern California.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 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=Big+California+Firms+Take+On+Health+Care+Giant+Over+Cost+of+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Denti-Cal Program 'Dysfunctional' Says Scathing Bipartisan Report",
"title": "Denti-Cal Program 'Dysfunctional' Says Scathing Bipartisan Report",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>The State of California’s dental health system for the poor is “dysfunctional” according to a \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\" target=\"_blank\">scathing report\u003c/a> issued Friday by a bipartisan oversight commission.\u003c/p>\n\u003cp>The program, Denti-Cal, “ranks among state government’s greatest deficiencies,” said the report by the \u003ca href=\"http://www.lhc.ca.gov/about/about.html\" target=\"_blank\">Little Hoover Commission\u003c/a>, a statutorily independent oversight agency.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In California we have kids’ teeth rotting out of their heads.'\u003ccite> Pedro Nava, Chairman, Little Hoover Commission \u003c/cite>\u003c/aside>\n\u003cp>The state bureaucracy that runs Denti-Cal draws only part of the blame. The legislature, the governor’s office, and the political culture of California share culpability for decades of neglect and strategic misdirection, the commission says.\u003c/p>\n\u003cp>The program falls “disastrously short in providing dental care to a third of California’s population and more than half of its children.”\u003c/p>\n\u003cp>A more vivid description comes from Pedro Nava, the commission’s chairman:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“In California we have kids’ teeth rotting out of their heads,” he says. “That’s utterly inexcusable.”\u003c/p>\n\u003cp>\u003cb>Dental Profession 'Thoroughly Alienated'\u003c/b>\u003c/p>\n\u003cp>The report makes grim reading. California faces an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches, whole counties have no Denti-Cal providers and families don’t understand basic preventative dental care,” it said.\u003c/p>\n\u003cp>Meanwhile, Denti-Cal has “thoroughly alienated the dental profession” with tangles of red tape and “reimbursement rates among the nation’s lowest,” the report said.\u003c/p>\n\u003cp>In sum, the commission said it’s time to “reboot” Denti-Cal.\u003c/p>\n\u003cp>[contextly_sidebar id=\"MvOmIplCazK7Ew4ddY2etXumhgCTSgzr\"]The program is run by the state Department of Health Care Services, which oversees Medi-Care, California’s version of Medicaid.\u003c/p>\n\u003cp>The department released a \u003ca href=\"https://californiahealthline.files.wordpress.com/2016/04/californiahealthline-denti-cal-040116.pdf\" target=\"_blank\">lengthy prepared response to questions\u003c/a> from CHL, which includes this statement:\u003c/p>\n\u003cp>“DHCS is strongly committed to providing access to quality dental care for our millions of Medi-Cal members, and Director Jennifer Kent has publicly stated that improving the Denti-Cal program is one of her top priorities.”\u003c/p>\n\u003cp>Nava has heard it before. “I have been completely underwhelmed by the response of the department,” he said. “Their efforts have been far too little and far too late.”\u003c/p>\n\u003cp>It’s not just the department though. Acccording to the report, “Blame goes so much deeper.”\u003c/p>\n\u003cp>“Successive legislatures and administrations,” the commission said, “have underfunded the Denti-Cal program and slashed reimbursement rates for dental providers to national lows. The state has historically lacked any strategy to prevent dental disease among its neediest populations.”\u003c/p>\n\u003cp>Evidence is widespread that bad dental health can seriously affect general health, making more people sick and driving health costs even higher.\u003c/p>\n\u003cp>But in California, there is a Denti-Cal dentist shortage.\u003c/p>\n\u003cp>Many dentists say they lose money on state-funded patients, so caring for them becomes a form of charity work.\u003c/p>\n\u003cp>John Blake is a dentist who gave up a private practice in Long Beach to run the Children’s Dental Health Clinic in Long Beach, where about 85 percent of patients are on Denti-Cal.\u003c/p>\n\u003cp>Blake said he just wants to break even — the business is a non-profit — 25 percent of his overhead is paid for through donations and fund-raising events. It’s impossible to cover costs with the low payments from the state, he said.\u003c/p>\n\u003cp>“A lot of my colleagues used to take Denti-Cal, but it’s not just the low rates, it’s that the hassle of the system is so much worse than reimbursement. The hassle factor just got to be too much,” Blake said. “They just gave up.”\u003c/p>\n\u003cp>Little Hoover more formally addressed the hassle factor, noting that copious pre-authorizations for basic procedures are a major hassle, never mind a a clunky billing system, much of it still paper-based, and a 22-page application form just to participate in the program.\u003c/p>\n\u003cp>Camille Nishikawa is a dentist in Los Angeles who doesn’t have those problems. She runs the QueensCare mobile dental clinic in partnership with USC Medical Center, which travels to the poorest parts of LA to take care of kids’ teeth. The mobile dental van is funded by grants; it doesn’t accept any money from patients or from Denti-Cal.\u003c/p>\n\u003cp>\u003cstrong>Children 'Suffer in Pain'\u003c/strong>\u003c/p>\n\u003cp>Organizational dysfunction is only part of the problem with Denti-Cal, Nishikawa said. Many poor people who are eligible for the program’s benefits don’t even know about them.\u003c/p>\n\u003cp>“A lot of the community isn’t aware of what they’re entitled to,” she said. “And if they do, they don’t know where to go to find a dentist.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"YqwmVIo7HQrzTrqAnpvYUxl7c1QcyMYV\"]Ruth Sandoval is one of those low-income people, a mostly Spanish-speaking mother of two in Los Angeles. She said she had no idea she and her two children could even get dental care as part of their Medi-Cal program. “It has been hard to find a dentist; it’s very hard to find one,” Sandoval said.\u003c/p>\n\u003cp>She went to a clinic in LA for a different health problem and discovered a dentist on staff. She’s grateful for that, she said, because she wouldn’t have a dentist otherwise. “It’s so important to us, we were so happy to find her there,” Sandoval said.\u003c/p>\n\u003cp>Most low-income Californians aren’t that lucky. Only about half of the children eligible for dental coverage actually see a dentist, said Jenny Kattlove of the Santa Monica-based Children’s Partnership advocacy group.\u003c/p>\n\u003cp>She said the severity of the dental problem was accurately outlined in the Little Hoover report, saying it lays out “an ambitious but necessary path” toward revamping the entire low-income dental system.\u003c/p>\n\u003cp>People think of dental care as just getting a teeth-cleaning, and that it’s not seen as a health issue.\u003c/p>\n\u003cp>“Look, when children don’t get the oral health care they need, they suffer in pain,” she said. “Untreated dental problems actually can lead to death, I don’t know what’s more health-related than that.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Nava said access problems may only get worse as more Californians are added to the Medi-Cal rolls. In mid-May, an estimated 170,000 undocumented children will become eligible for full Medi-Cal benefits, including dental care, and Nava worries that they won’t get it.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The State of California’s dental health system for the poor is “dysfunctional” according to a \u003ca href=\"http://www.lhc.ca.gov/studies/230/Report230.pdf\" target=\"_blank\">scathing report\u003c/a> issued Friday by a bipartisan oversight commission.\u003c/p>\n\u003cp>The program, Denti-Cal, “ranks among state government’s greatest deficiencies,” said the report by the \u003ca href=\"http://www.lhc.ca.gov/about/about.html\" target=\"_blank\">Little Hoover Commission\u003c/a>, a statutorily independent oversight agency.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In California we have kids’ teeth rotting out of their heads.'\u003ccite> Pedro Nava, Chairman, Little Hoover Commission \u003c/cite>\u003c/aside>\n\u003cp>The state bureaucracy that runs Denti-Cal draws only part of the blame. The legislature, the governor’s office, and the political culture of California share culpability for decades of neglect and strategic misdirection, the commission says.\u003c/p>\n\u003cp>The program falls “disastrously short in providing dental care to a third of California’s population and more than half of its children.”\u003c/p>\n\u003cp>A more vivid description comes from Pedro Nava, the commission’s chairman:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“In California we have kids’ teeth rotting out of their heads,” he says. “That’s utterly inexcusable.”\u003c/p>\n\u003cp>\u003cb>Dental Profession 'Thoroughly Alienated'\u003c/b>\u003c/p>\n\u003cp>The report makes grim reading. California faces an “epidemic of tooth disease in which toddlers by the thousands have mouthfuls of cavities, children and adults are plagued with toothaches, whole counties have no Denti-Cal providers and families don’t understand basic preventative dental care,” it said.\u003c/p>\n\u003cp>Meanwhile, Denti-Cal has “thoroughly alienated the dental profession” with tangles of red tape and “reimbursement rates among the nation’s lowest,” the report said.\u003c/p>\n\u003cp>In sum, the commission said it’s time to “reboot” Denti-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The program is run by the state Department of Health Care Services, which oversees Medi-Care, California’s version of Medicaid.\u003c/p>\n\u003cp>The department released a \u003ca href=\"https://californiahealthline.files.wordpress.com/2016/04/californiahealthline-denti-cal-040116.pdf\" target=\"_blank\">lengthy prepared response to questions\u003c/a> from CHL, which includes this statement:\u003c/p>\n\u003cp>“DHCS is strongly committed to providing access to quality dental care for our millions of Medi-Cal members, and Director Jennifer Kent has publicly stated that improving the Denti-Cal program is one of her top priorities.”\u003c/p>\n\u003cp>Nava has heard it before. “I have been completely underwhelmed by the response of the department,” he said. “Their efforts have been far too little and far too late.”\u003c/p>\n\u003cp>It’s not just the department though. Acccording to the report, “Blame goes so much deeper.”\u003c/p>\n\u003cp>“Successive legislatures and administrations,” the commission said, “have underfunded the Denti-Cal program and slashed reimbursement rates for dental providers to national lows. The state has historically lacked any strategy to prevent dental disease among its neediest populations.”\u003c/p>\n\u003cp>Evidence is widespread that bad dental health can seriously affect general health, making more people sick and driving health costs even higher.\u003c/p>\n\u003cp>But in California, there is a Denti-Cal dentist shortage.\u003c/p>\n\u003cp>Many dentists say they lose money on state-funded patients, so caring for them becomes a form of charity work.\u003c/p>\n\u003cp>John Blake is a dentist who gave up a private practice in Long Beach to run the Children’s Dental Health Clinic in Long Beach, where about 85 percent of patients are on Denti-Cal.\u003c/p>\n\u003cp>Blake said he just wants to break even — the business is a non-profit — 25 percent of his overhead is paid for through donations and fund-raising events. It’s impossible to cover costs with the low payments from the state, he said.\u003c/p>\n\u003cp>“A lot of my colleagues used to take Denti-Cal, but it’s not just the low rates, it’s that the hassle of the system is so much worse than reimbursement. The hassle factor just got to be too much,” Blake said. “They just gave up.”\u003c/p>\n\u003cp>Little Hoover more formally addressed the hassle factor, noting that copious pre-authorizations for basic procedures are a major hassle, never mind a a clunky billing system, much of it still paper-based, and a 22-page application form just to participate in the program.\u003c/p>\n\u003cp>Camille Nishikawa is a dentist in Los Angeles who doesn’t have those problems. She runs the QueensCare mobile dental clinic in partnership with USC Medical Center, which travels to the poorest parts of LA to take care of kids’ teeth. The mobile dental van is funded by grants; it doesn’t accept any money from patients or from Denti-Cal.\u003c/p>\n\u003cp>\u003cstrong>Children 'Suffer in Pain'\u003c/strong>\u003c/p>\n\u003cp>Organizational dysfunction is only part of the problem with Denti-Cal, Nishikawa said. Many poor people who are eligible for the program’s benefits don’t even know about them.\u003c/p>\n\u003cp>“A lot of the community isn’t aware of what they’re entitled to,” she said. “And if they do, they don’t know where to go to find a dentist.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Ruth Sandoval is one of those low-income people, a mostly Spanish-speaking mother of two in Los Angeles. She said she had no idea she and her two children could even get dental care as part of their Medi-Cal program. “It has been hard to find a dentist; it’s very hard to find one,” Sandoval said.\u003c/p>\n\u003cp>She went to a clinic in LA for a different health problem and discovered a dentist on staff. She’s grateful for that, she said, because she wouldn’t have a dentist otherwise. “It’s so important to us, we were so happy to find her there,” Sandoval said.\u003c/p>\n\u003cp>Most low-income Californians aren’t that lucky. Only about half of the children eligible for dental coverage actually see a dentist, said Jenny Kattlove of the Santa Monica-based Children’s Partnership advocacy group.\u003c/p>\n\u003cp>She said the severity of the dental problem was accurately outlined in the Little Hoover report, saying it lays out “an ambitious but necessary path” toward revamping the entire low-income dental system.\u003c/p>\n\u003cp>People think of dental care as just getting a teeth-cleaning, and that it’s not seen as a health issue.\u003c/p>\n\u003cp>“Look, when children don’t get the oral health care they need, they suffer in pain,” she said. “Untreated dental problems actually can lead to death, I don’t know what’s more health-related than that.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nava said access problems may only get worse as more Californians are added to the Medi-Cal rolls. In mid-May, an estimated 170,000 undocumented children will become eligible for full Medi-Cal benefits, including dental care, and Nava worries that they won’t get it.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "San Francisco, Oakland Working to Put Soda Tax Before Voters",
"title": "San Francisco, Oakland Working to Put Soda Tax Before Voters",
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"content": "\u003cp>Berkeley was the trend setter in 2014 when voters there approved the first a soda tax in the U.S. with a resounding 75 percent of the vote.\u003c/p>\n\u003cp>That same year San Francisco voters rejected a soda tax. But supporters were not deterred. Now, new efforts have resumed in San Francisco and in Oakland to move through a tax with a goal of fighting the obesity and diabetes epidemic. Both cities seem to be applying lessons from the Berkeley playbook to see the taxes through.\u003c/p>\n\u003cp>First, a bit of review: in 2014 San Franciscans considered a dedicated tax, one that would be earmarked to fund specific health programs. That kind of earmarked tax needs a two-thirds supermajority approval to become law. With 55 percent of the vote, it fell short of the threshhold.\u003c/p>\n\u003cp>Berkeley, meanwhile, had pursued a different path, one where the proceeds of a tax would go toward the city's general fund. But the law called for the creation of a health panel to advise the Berkeley City Council on appropriate programs to fund. This approach requires only a simple majority -- 50 percent plus one vote -- to pass.\u003c/p>\n\u003cp>Backers of the Berkeley soda tax also cultivated a \u003ca href=\"http://www.berkeleyvsbigsoda.com/supporters\" target=\"_blank\">long list of supporters,\u003c/a> including health organizations and grassroots groups.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That's where Oakland and San Francisco are today -- both proposals are remarkably similar to the Berkeley approach:\u003c/p>\n\u003cul>\n\u003cli>a penny per ounce fee on sugar-sweetened beverages\u003c/li>\n\u003cli>a dedicated health panel to advise city or county officials on spending\u003c/li>\n\u003cli>plenty of grassroots support\u003c/li>\n\u003cli>levied on distributors (in Berkeley much of the tax is passed through to consumers)\u003c/li>\n\u003c/ul>\n\u003cp>“We’re building a much stronger community coalition,\" says San Francisco Supervisor Malia Cohen, one of the sponsors of the 2014 effort and a backer of the current move. \"We’re taking a much more thoughtful and grassroots focused effort this time around. We have learned from errors.\"\u003c/p>\n\u003cp>Cohen says 10,000 signatures are needed by a July deadline to place the item on the San Francisco ballot. Nine-thousand people have already signed and she expects the remainder by late May, well in advance of the deadline.\u003c/p>\n\u003cp>The Oakland City Council, meanwhile, is weighing whether to directly place a soda tax on the ballot. The proposed measure will be heard in committee this Thursday. If it passes there, it goes before the full board. Adam Simons, chief of staff for City Council Member Annie Campbell Washington, one of the proponents of the ordinance, said he expects it will be approved for the November ballot.\u003c/p>\n\u003cp>\"We're feeling very confident it will move through,\" he says.\u003c/p>\n\u003cp>\u003cstrong>Mexico Was First\u003c/strong>\u003c/p>\n\u003cp>Globally, the first soda tax was in Mexico. Its tax took effect in January, 2014 -- 11 months before the Berkeley and San Francisco votes. Consumption of sugary drinks dropped 6-12 percent in the year after it was implemented and raised millions for the Mexican government.\u003c/p>\n\u003cp>More recently, the British Parliament \u003ca href=\"http://www.vox.com/2016/3/17/11256594/jamie-oliver-soda-tax\" target=\"_blank\">passed a soda tax\u003c/a> just last month. \u003ca href=\"http://www.nbcphiladelphia.com/news/politics/Mayor-Jim-Kenney-Philadelphia-Soda-Tax-371956832.html\" target=\"_blank\">Philadelphia's mayor \u003c/a>has pitched a three-cents-per-ounce tax. The \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/03/09/soda-tax-is-again-before-california-legislators/\" target=\"_blank\">California legislature\u003c/a> is considering a two-cents-per-ounce tax. But multiple attempts at a tax or even a warning label have failed at the state level in recent years.\u003c/p>\n\u003cp>The taxes achieve multiple goals, advocates say, not just the obvious one to reduce consumption of sugar-sweetened beverages. The effect of a tax to \u003ca href=\"http://soda%20tax%20what%20a%20penny%20can%20do%20kqed\" target=\"_blank\">get people to switch to healthier beverages is, at best, modest\u003c/a>.\u003c/p>\n\u003cp>But the taxes also raise money and awareness. In just over a year, Berkeley's tax has already \u003ca href=\"http://www.berkeleyvsbigsoda.com/faq\" target=\"_blank\">generated more than $1.5 million \u003c/a>for nutrition and health programs.\u003c/p>\n\u003cp>[contextly_sidebar id=\"yZpoYrRYKbFsAhYAGSb8bRQ4dqMRfrax\"]Harold Goldstein, executive director of the California Center for Public Health Advocacy, has long worked on educating the public about the harms of sugar-sweetened beverages. He says \"soda tax's time has come.\"\u003c/p>\n\u003cp>\"We're at the point of no return where soda taxes are going to be sweeping the country and sweeping the world,\" he says.\u003c/p>\n\u003cp>Sugary drinks -- sodas, energy drinks and fruit-flavored beverages -- are the number one source of added sugar in the American diet. A 12-ounce can of Coke, for example, has more than nine teaspoons of added sugar. Health advocates argue that these beverages and their so-called empty calories put people at higher risk of type 2 diabetes and obesity.\u003c/p>\n\u003cp>\"So taxing soda to raise a lot of money to solve this problem is it,\" says Goldstein. \"They are a product that should be taxed so you have the revenue to solve the problem that they are causing.\"\u003c/p>\n\u003cp>The beverage industry fires back that obesity and diabetes are far more complicated problems than can be solved by taxing a single product. And the tax is regressive, they say, hitting poor people hardest. The American Beverage Association spent $9.1 million defeating the San Francisco tax and another $2.4 million fighting the Berkeley measure in 2014.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/10/15/election-2014-san-francisco-berkeley-consider-soda-taxes/\" target=\"_blank\">Some voters in Berkeley voted against the tax\u003c/a> because they did not trust city government to spend the money on health programs. Since the tax is not earmarked, governments can allocate the money however they like.\u003c/p>\n\u003cp>In Berkeley, diet drinks with very low calories, 100 percent fruit juice and most milk products are exempt from the tax. Infant formulas are exempt.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Sports drinks like Gatorade, energy drinks, sweetened teas, fruit-flavored drinks and sodas sold both in bottles and cans as well as fountain drinks are taxed.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Berkeley was the trend setter in 2014 when voters there approved the first a soda tax in the U.S. with a resounding 75 percent of the vote.\u003c/p>\n\u003cp>That same year San Francisco voters rejected a soda tax. But supporters were not deterred. Now, new efforts have resumed in San Francisco and in Oakland to move through a tax with a goal of fighting the obesity and diabetes epidemic. Both cities seem to be applying lessons from the Berkeley playbook to see the taxes through.\u003c/p>\n\u003cp>First, a bit of review: in 2014 San Franciscans considered a dedicated tax, one that would be earmarked to fund specific health programs. That kind of earmarked tax needs a two-thirds supermajority approval to become law. With 55 percent of the vote, it fell short of the threshhold.\u003c/p>\n\u003cp>Berkeley, meanwhile, had pursued a different path, one where the proceeds of a tax would go toward the city's general fund. But the law called for the creation of a health panel to advise the Berkeley City Council on appropriate programs to fund. This approach requires only a simple majority -- 50 percent plus one vote -- to pass.\u003c/p>\n\u003cp>Backers of the Berkeley soda tax also cultivated a \u003ca href=\"http://www.berkeleyvsbigsoda.com/supporters\" target=\"_blank\">long list of supporters,\u003c/a> including health organizations and grassroots groups.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That's where Oakland and San Francisco are today -- both proposals are remarkably similar to the Berkeley approach:\u003c/p>\n\u003cul>\n\u003cli>a penny per ounce fee on sugar-sweetened beverages\u003c/li>\n\u003cli>a dedicated health panel to advise city or county officials on spending\u003c/li>\n\u003cli>plenty of grassroots support\u003c/li>\n\u003cli>levied on distributors (in Berkeley much of the tax is passed through to consumers)\u003c/li>\n\u003c/ul>\n\u003cp>“We’re building a much stronger community coalition,\" says San Francisco Supervisor Malia Cohen, one of the sponsors of the 2014 effort and a backer of the current move. \"We’re taking a much more thoughtful and grassroots focused effort this time around. We have learned from errors.\"\u003c/p>\n\u003cp>Cohen says 10,000 signatures are needed by a July deadline to place the item on the San Francisco ballot. Nine-thousand people have already signed and she expects the remainder by late May, well in advance of the deadline.\u003c/p>\n\u003cp>The Oakland City Council, meanwhile, is weighing whether to directly place a soda tax on the ballot. The proposed measure will be heard in committee this Thursday. If it passes there, it goes before the full board. Adam Simons, chief of staff for City Council Member Annie Campbell Washington, one of the proponents of the ordinance, said he expects it will be approved for the November ballot.\u003c/p>\n\u003cp>\"We're feeling very confident it will move through,\" he says.\u003c/p>\n\u003cp>\u003cstrong>Mexico Was First\u003c/strong>\u003c/p>\n\u003cp>Globally, the first soda tax was in Mexico. Its tax took effect in January, 2014 -- 11 months before the Berkeley and San Francisco votes. Consumption of sugary drinks dropped 6-12 percent in the year after it was implemented and raised millions for the Mexican government.\u003c/p>\n\u003cp>More recently, the British Parliament \u003ca href=\"http://www.vox.com/2016/3/17/11256594/jamie-oliver-soda-tax\" target=\"_blank\">passed a soda tax\u003c/a> just last month. \u003ca href=\"http://www.nbcphiladelphia.com/news/politics/Mayor-Jim-Kenney-Philadelphia-Soda-Tax-371956832.html\" target=\"_blank\">Philadelphia's mayor \u003c/a>has pitched a three-cents-per-ounce tax. The \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/03/09/soda-tax-is-again-before-california-legislators/\" target=\"_blank\">California legislature\u003c/a> is considering a two-cents-per-ounce tax. But multiple attempts at a tax or even a warning label have failed at the state level in recent years.\u003c/p>\n\u003cp>The taxes achieve multiple goals, advocates say, not just the obvious one to reduce consumption of sugar-sweetened beverages. The effect of a tax to \u003ca href=\"http://soda%20tax%20what%20a%20penny%20can%20do%20kqed\" target=\"_blank\">get people to switch to healthier beverages is, at best, modest\u003c/a>.\u003c/p>\n\u003cp>But the taxes also raise money and awareness. In just over a year, Berkeley's tax has already \u003ca href=\"http://www.berkeleyvsbigsoda.com/faq\" target=\"_blank\">generated more than $1.5 million \u003c/a>for nutrition and health programs.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Harold Goldstein, executive director of the California Center for Public Health Advocacy, has long worked on educating the public about the harms of sugar-sweetened beverages. He says \"soda tax's time has come.\"\u003c/p>\n\u003cp>\"We're at the point of no return where soda taxes are going to be sweeping the country and sweeping the world,\" he says.\u003c/p>\n\u003cp>Sugary drinks -- sodas, energy drinks and fruit-flavored beverages -- are the number one source of added sugar in the American diet. A 12-ounce can of Coke, for example, has more than nine teaspoons of added sugar. Health advocates argue that these beverages and their so-called empty calories put people at higher risk of type 2 diabetes and obesity.\u003c/p>\n\u003cp>\"So taxing soda to raise a lot of money to solve this problem is it,\" says Goldstein. \"They are a product that should be taxed so you have the revenue to solve the problem that they are causing.\"\u003c/p>\n\u003cp>The beverage industry fires back that obesity and diabetes are far more complicated problems than can be solved by taxing a single product. And the tax is regressive, they say, hitting poor people hardest. The American Beverage Association spent $9.1 million defeating the San Francisco tax and another $2.4 million fighting the Berkeley measure in 2014.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/10/15/election-2014-san-francisco-berkeley-consider-soda-taxes/\" target=\"_blank\">Some voters in Berkeley voted against the tax\u003c/a> because they did not trust city government to spend the money on health programs. Since the tax is not earmarked, governments can allocate the money however they like.\u003c/p>\n\u003cp>In Berkeley, diet drinks with very low calories, 100 percent fruit juice and most milk products are exempt from the tax. Infant formulas are exempt.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Sports drinks like Gatorade, energy drinks, sweetened teas, fruit-flavored drinks and sodas sold both in bottles and cans as well as fountain drinks are taxed.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How Theater Helps This HIV-Positive Grandmother Transform Lives",
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"content": "\u003cp>For decades, Cassandra Steptoe felt like she couldn’t talk about her HIV diagnosis with anyone.\u003c/p>\n\u003cp>\"I couldn't forgive myself for getting HIV,\" says Steptoe, who spent much of her early adult life in and out of jail for shoplifting and burglaries linked to her IV drug use. \"But someone told me a long time ago, if you are looking for a reason to feel shame, you can always find it. I learned to look for something else: forgiveness.\"\u003c/p>\n\u003cp>For Steptoe, now 59 and a grandmother, it wasn't until her 40s -- after decades of struggling with addiction -- that she finally completed a rehab program and committed to ongoing HIV treatment.\u003c/p>\n\u003cp>Today she talks openly about that experience onstage, as part of a theater project aimed at inspiring others. The quote about learning to forgive herself is part of an autobiographical monologue Steptoe wrote and performs in a San Francisco theater production of \u003ca href=\"https://www.facebook.com/MedeaProject/\" target=\"_blank\">The Medea Project: Theater for Incarcerated Women/HIV Circle\u003c/a>.\u003c/p>\n\u003cp>It was Steptoe's physician, \u003ca href=\"http://whp.ucsf.edu/about/team-members/edward-machtinger-m-d\">Dr. Edward Machtinger\u003c/a>, who first told her about the project. Established by playwright and director \u003ca href=\"http://www.culturalodyssey.org/v2/aboutus/rhodessa_bio.html\" target=\"_blank\">Rhodessa Jones\u003c/a> in 2008 as an extension of an improvisational production that draws on and explores the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=15146105\" target=\"_blank\">experiences of jailed women\u003c/a>, the \"HIV Circle\" focuses on the experiences of women living with the AIDS virus.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The therapeutic aspect of the performance workshop is called \u003ca href=\"http://rtc.umn.edu/docs/pep_facguide.pdf\" target=\"_blank\">peer empowerment\u003c/a>, explains Machtinger, an internist and director of the Women's HIV Program at the University of California, San Francisco. The strength and healing Steptoe and others have gained from processing and sharing their stories this way is profound, he says — and can serve as a model for helping other patients deal with psychological trauma.\u003c/p>\n\u003cfigure id=\"attachment_164615\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164615\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg\" alt=\"Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Medications 'Not Enough'\u003c/strong>\u003c/p>\n\u003cp>With the theater group, Steptoe began writing about her experiences and sharing them with a small group of women, some of whom had gone through similar struggles of addiction and histories of incarceration. The process of uncovering her past and making sense of her experiences in a cathartic, supportive environment helped Steptoe end her feelings of isolation.\u003c/p>\n\u003cp>\"Having these women that really love you and support you ... it feels good to have some real friends, 'cause I never had that before,\" Steptoe says. \"We're all sharing something together 'cause we all get something out of everybody's story.\"\u003c/p>\n\u003cp>The potential of peer empowerment is not just anecdotal. Machtinger has \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S1055329014000971\" target=\"_blank\">studied\u003c/a> the Medea Project's life-saving impact on his patients.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/256844757\" 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>Machtinger says the patients in the Medea Project followed by his research team went through an extraordinary transformation. Many who had barely disclosed their HIV status to anyone when they began, became activists and leaders in their communities, helping to destigmatize HIV while pursuing personal goals and leading productive lives.\u003c/p>\n\u003cp>\"For them to develop what they described as \"sisterhood\" was the most important and most profound type of healing that I ever witnessed,\" Machtinger says.\u003c/p>\n\u003cp>He began seeking alternative methods to help his patients after increasingly noticing that a large proportion were successfully receiving antiretroviral treatment, but still dying from reasons that had \"nothing to do with HIV,\" such as murder, suicide or drug overdose.\u003c/p>\n\u003cp>\"They could have their HIV under control, (but) their lives were not getting better,\" Machtinger says. \"That was because their core issue -- a life of trauma and the impacts of depression, isolation and shame -- wasn’t being effectively addressed. And to us, that's not acceptable.\"\u003c/p>\n\u003cp>Machtinger's experience is reverberating beyond the Medea Project. He says witnessing and studying the impact of peer empowerment has helped inform a broader role. He is part of an advisory group helping to develop new guidelines for trauma-informed primary care for the federal Substance Abuse and Mental Health Services Administration.\u003c/p>\n\u003cp>The new guidelines will likely include a substantial focus on interventions with peer empowerment as one ingredient to help people with severe trauma heal, says Machtinger.\u003c/p>\n\u003cp>\"The core elements of the Medea Project are really lessons for other interventions to help people overcome trauma and other stigmatizing situations and conditions,\" says Machtinger, adding that childhood and adult trauma have been linked to a variety of illnesses, such as hepatitis C, heart disease and diabetes.\u003c/p>\n\u003cp>He expects the new guidelines for primary care clinics and other health providers to be finalized and published later this year.\u003c/p>\n\u003cp>\u003cstrong>Trauma at the Root of HIV Diagnosis\u003c/strong>\u003c/p>\n\u003cp>Steptoe now realizes she was infected with HIV through unprotected sex and sharing needles. She used to be addicted to heroin and cocaine. During a decades-long period of her life, she was in and out of the criminal justice system. She worked as a prostitute and survived abusive relationships -- getting beat up so badly one time that she spent three months recovering at a hospital, she said.\u003c/p>\n\u003cp>Steptoe says experiencing sexual abuse repeatedly as a child and teen led her on the path that eventually resulted in HIV infection.\u003c/p>\n\u003cp>\"Sexual abuse came from family,\" she says. \"And I guess I was kind of covering all that up by choosing the drugs. It kind of took me out there into the street, looking for love in the wrong places because I didn't have it at home. I started shooting drugs and that led into prostitution and to prison.\"\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/\">Recent studies\u003c/a> show that HIV-positive women suffer disproportionately from high rates of trauma and post-traumatic stress disorder. The high rates of trauma also lead to increased risk of further spreading HIV, according to researchers.\u003c/p>\n\u003cp>\u003cstrong>Transforming Her Life\u003c/strong>\u003c/p>\n\u003cp>Now Steptoe is busy and full of energy. She takes antiretroviral medication religiously every morning, eats a healthy diet and works out by taking Zumba fitness classes at her gym.\u003c/p>\n\u003cp>Steptoe, a mother of three and grandmother of nine has also taken full custody of her 8-year-old granddaughter, who frequently accompanies her to rehearsals.\u003c/p>\n\u003cp>\"She teaches me how to love, and she gives me patience,\" says Steptoe, who also cares for other kids in her Mission apartment building.\u003c/p>\n\u003cp>Rhodessa Jones, the Medea Project's dynamic and energetic director, says Steptoe has flourished since she joined the organization, becoming a leader and inspiration to other women.\u003c/p>\n\u003cp>\"She’s so powerful, positive and forceful. She gets it,\" says Jones, who founded Medea more than 23 years ago. \"Theater has really been expressive therapy for her. It gives her a space to speak her truth.\"\u003c/p>\n\u003cfigure id=\"attachment_164614\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164614\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg\" alt='Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\"' width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\" \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Medea Project uses Greek, Roman and African mythology to introduce \"the universality of all of our stories,\" says Jones, who asked Steptoe to imagine going back in time to age 14 and write the lessons she would give herself. The result was Steptoe's piece \"Younger Self.\"\u003c/p>\n\u003cp>Steptoe wrote the piece, performed in January in San Francisco, about the moment in 1987 when she first found out she was HIV-positive. She was serving time in jail and received a health checkup.\u003c/p>\n\u003cp>\"My world crashed. I didn't have no education of what I had, I didn't have no support,\" says Steptoe, adding that she considered her condition \"a death sentence\" at the time. \"I had to relive that again by writing this because I needed to heal.\"\u003c/p>\n\u003cp>\u003cstrong>'HIV is a Health Condition, Not a Crime'\u003c/strong>\u003c/p>\n\u003cp>After receiving the diagnosis, she remembers crying at night with a pillow over her head so others wouldn't hear.\u003c/p>\n\u003cp>Steptoe then kept her HIV status a secret for many years.\u003c/p>\n\u003cp>But, years later, the key for her to find and use her voice was becoming a part of The Medea Project, she says. The main motivation for telling her story? She wants to give hope to others, and help them feel they are not alone.\u003c/p>\n\u003cp>\"Now I can tell the world that HIV is just a health condition, not a crime,\" says Steptoe, who doesn't hesitate to share her story as a lead actress for Medea in front of audiences of hundreds of people.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"I don't have shame around it no more,” Steptoe says. “I let my grandkids know that even if you go the wrong way, you can still turn your life around.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For decades, Cassandra Steptoe felt like she couldn’t talk about her HIV diagnosis with anyone.\u003c/p>\n\u003cp>\"I couldn't forgive myself for getting HIV,\" says Steptoe, who spent much of her early adult life in and out of jail for shoplifting and burglaries linked to her IV drug use. \"But someone told me a long time ago, if you are looking for a reason to feel shame, you can always find it. I learned to look for something else: forgiveness.\"\u003c/p>\n\u003cp>For Steptoe, now 59 and a grandmother, it wasn't until her 40s -- after decades of struggling with addiction -- that she finally completed a rehab program and committed to ongoing HIV treatment.\u003c/p>\n\u003cp>Today she talks openly about that experience onstage, as part of a theater project aimed at inspiring others. The quote about learning to forgive herself is part of an autobiographical monologue Steptoe wrote and performs in a San Francisco theater production of \u003ca href=\"https://www.facebook.com/MedeaProject/\" target=\"_blank\">The Medea Project: Theater for Incarcerated Women/HIV Circle\u003c/a>.\u003c/p>\n\u003cp>It was Steptoe's physician, \u003ca href=\"http://whp.ucsf.edu/about/team-members/edward-machtinger-m-d\">Dr. Edward Machtinger\u003c/a>, who first told her about the project. Established by playwright and director \u003ca href=\"http://www.culturalodyssey.org/v2/aboutus/rhodessa_bio.html\" target=\"_blank\">Rhodessa Jones\u003c/a> in 2008 as an extension of an improvisational production that draws on and explores the \u003ca href=\"http://www.npr.org/templates/story/story.php?storyId=15146105\" target=\"_blank\">experiences of jailed women\u003c/a>, the \"HIV Circle\" focuses on the experiences of women living with the AIDS virus.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The therapeutic aspect of the performance workshop is called \u003ca href=\"http://rtc.umn.edu/docs/pep_facguide.pdf\" target=\"_blank\">peer empowerment\u003c/a>, explains Machtinger, an internist and director of the Women's HIV Program at the University of California, San Francisco. The strength and healing Steptoe and others have gained from processing and sharing their stories this way is profound, he says — and can serve as a model for helping other patients deal with psychological trauma.\u003c/p>\n\u003cfigure id=\"attachment_164615\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164615\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg\" alt=\"Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18863_IMG_9455-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Cassandra Steptoe at the apartment she shares with her 8-year-old granddaughter in San Francisco. She credits The Medea Project with helping her improve her overall well-being. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Medications 'Not Enough'\u003c/strong>\u003c/p>\n\u003cp>With the theater group, Steptoe began writing about her experiences and sharing them with a small group of women, some of whom had gone through similar struggles of addiction and histories of incarceration. The process of uncovering her past and making sense of her experiences in a cathartic, supportive environment helped Steptoe end her feelings of isolation.\u003c/p>\n\u003cp>\"Having these women that really love you and support you ... it feels good to have some real friends, 'cause I never had that before,\" Steptoe says. \"We're all sharing something together 'cause we all get something out of everybody's story.\"\u003c/p>\n\u003cp>The potential of peer empowerment is not just anecdotal. Machtinger has \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S1055329014000971\" target=\"_blank\">studied\u003c/a> the Medea Project's life-saving impact on his patients.\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/256844757&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/256844757'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Machtinger says the patients in the Medea Project followed by his research team went through an extraordinary transformation. Many who had barely disclosed their HIV status to anyone when they began, became activists and leaders in their communities, helping to destigmatize HIV while pursuing personal goals and leading productive lives.\u003c/p>\n\u003cp>\"For them to develop what they described as \"sisterhood\" was the most important and most profound type of healing that I ever witnessed,\" Machtinger says.\u003c/p>\n\u003cp>He began seeking alternative methods to help his patients after increasingly noticing that a large proportion were successfully receiving antiretroviral treatment, but still dying from reasons that had \"nothing to do with HIV,\" such as murder, suicide or drug overdose.\u003c/p>\n\u003cp>\"They could have their HIV under control, (but) their lives were not getting better,\" Machtinger says. \"That was because their core issue -- a life of trauma and the impacts of depression, isolation and shame -- wasn’t being effectively addressed. And to us, that's not acceptable.\"\u003c/p>\n\u003cp>Machtinger's experience is reverberating beyond the Medea Project. He says witnessing and studying the impact of peer empowerment has helped inform a broader role. He is part of an advisory group helping to develop new guidelines for trauma-informed primary care for the federal Substance Abuse and Mental Health Services Administration.\u003c/p>\n\u003cp>The new guidelines will likely include a substantial focus on interventions with peer empowerment as one ingredient to help people with severe trauma heal, says Machtinger.\u003c/p>\n\u003cp>\"The core elements of the Medea Project are really lessons for other interventions to help people overcome trauma and other stigmatizing situations and conditions,\" says Machtinger, adding that childhood and adult trauma have been linked to a variety of illnesses, such as hepatitis C, heart disease and diabetes.\u003c/p>\n\u003cp>He expects the new guidelines for primary care clinics and other health providers to be finalized and published later this year.\u003c/p>\n\u003cp>\u003cstrong>Trauma at the Root of HIV Diagnosis\u003c/strong>\u003c/p>\n\u003cp>Steptoe now realizes she was infected with HIV through unprotected sex and sharing needles. She used to be addicted to heroin and cocaine. During a decades-long period of her life, she was in and out of the criminal justice system. She worked as a prostitute and survived abusive relationships -- getting beat up so badly one time that she spent three months recovering at a hospital, she said.\u003c/p>\n\u003cp>Steptoe says experiencing sexual abuse repeatedly as a child and teen led her on the path that eventually resulted in HIV infection.\u003c/p>\n\u003cp>\"Sexual abuse came from family,\" she says. \"And I guess I was kind of covering all that up by choosing the drugs. It kind of took me out there into the street, looking for love in the wrong places because I didn't have it at home. I started shooting drugs and that led into prostitution and to prison.\"\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/http://ww2.kqed.org/stateofhealth/2012/03/20/trauma-fuels-hiv-epidemic-among-women/\">Recent studies\u003c/a> show that HIV-positive women suffer disproportionately from high rates of trauma and post-traumatic stress disorder. The high rates of trauma also lead to increased risk of further spreading HIV, according to researchers.\u003c/p>\n\u003cp>\u003cstrong>Transforming Her Life\u003c/strong>\u003c/p>\n\u003cp>Now Steptoe is busy and full of energy. She takes antiretroviral medication religiously every morning, eats a healthy diet and works out by taking Zumba fitness classes at her gym.\u003c/p>\n\u003cp>Steptoe, a mother of three and grandmother of nine has also taken full custody of her 8-year-old granddaughter, who frequently accompanies her to rehearsals.\u003c/p>\n\u003cp>\"She teaches me how to love, and she gives me patience,\" says Steptoe, who also cares for other kids in her Mission apartment building.\u003c/p>\n\u003cp>Rhodessa Jones, the Medea Project's dynamic and energetic director, says Steptoe has flourished since she joined the organization, becoming a leader and inspiration to other women.\u003c/p>\n\u003cp>\"She’s so powerful, positive and forceful. She gets it,\" says Jones, who founded Medea more than 23 years ago. \"Theater has really been expressive therapy for her. It gives her a space to speak her truth.\"\u003c/p>\n\u003cfigure id=\"attachment_164614\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"size-full wp-image-164614\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg\" alt='Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\"' width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/03/RS18862_IMG_9445-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Performers at The Medea Project rehearse in San Francisco. Founder and director Rhodessa Jones, uses Greek, Roman and African mythology to introduce \"the universality of all of our stories.\" \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Medea Project uses Greek, Roman and African mythology to introduce \"the universality of all of our stories,\" says Jones, who asked Steptoe to imagine going back in time to age 14 and write the lessons she would give herself. The result was Steptoe's piece \"Younger Self.\"\u003c/p>\n\u003cp>Steptoe wrote the piece, performed in January in San Francisco, about the moment in 1987 when she first found out she was HIV-positive. She was serving time in jail and received a health checkup.\u003c/p>\n\u003cp>\"My world crashed. I didn't have no education of what I had, I didn't have no support,\" says Steptoe, adding that she considered her condition \"a death sentence\" at the time. \"I had to relive that again by writing this because I needed to heal.\"\u003c/p>\n\u003cp>\u003cstrong>'HIV is a Health Condition, Not a Crime'\u003c/strong>\u003c/p>\n\u003cp>After receiving the diagnosis, she remembers crying at night with a pillow over her head so others wouldn't hear.\u003c/p>\n\u003cp>Steptoe then kept her HIV status a secret for many years.\u003c/p>\n\u003cp>But, years later, the key for her to find and use her voice was becoming a part of The Medea Project, she says. The main motivation for telling her story? She wants to give hope to others, and help them feel they are not alone.\u003c/p>\n\u003cp>\"Now I can tell the world that HIV is just a health condition, not a crime,\" says Steptoe, who doesn't hesitate to share her story as a lead actress for Medea in front of audiences of hundreds of people.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I don't have shame around it no more,” Steptoe says. “I let my grandkids know that even if you go the wrong way, you can still turn your life around.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Decade Later, Obama Advances 'Mental Health Parity'",
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"content": "\u003cp>Tucked in \u003ca href=\"http://www.11alive.com/news/full-transcript-president-obama-at-atlanta-heroin-summit/108944462\" target=\"_blank\">remarks\u003c/a> the president made Tuesday on the opioid epidemic was his announcement of a new \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/03/29/presidential-memorandum-mental-health-and-substance-use-disorder-parity\" target=\"_blank\">task force on mental health parity\u003c/a> — aimed at ensuring that people with mental illnesses and substance abuse problems don’t face discrimination in the health care system.\u003c/p>\n\u003caside class=\"pullquote alignright\">Advocates say parity has long been an 'empty phrase' and it has taken the administration far too long to address the problem.\u003c/aside>\n\u003cp>Despite a landmark \u003ca href=\"https://www.cms.gov/Regulations-and-Guidance/Health-Insurance-Reform/HealthInsReformforConsume/downloads/MHPAEA.pdf\" target=\"_blank\">2008 law\u003c/a> intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.\u003c/p>\n\u003cp>“The goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it’s actually enforced, that the concept is not just a phrase — an empty phrase,” President Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. “We’ve got to let the insurance carriers know that we’re serious about this.”\u003c/p>\n\u003cp>Advocates say parity has long been an “empty phrase” and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them.\u003c/p>\n\u003cp>“It’s better late than never, and you can’t not be grateful for the fact that we’re finally implementing a law that was passed nearly a decade ago,” said former congressman Patrick Kennedy, one of the authors of the parity law. “But it’s troubling that it’s occurring in the last year of the presidency, and that it took the administration this long to address a problem that’s been with us for many years.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In \u003ca href=\"http://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">a 2015 survey\u003c/a> by the National Alliance on Mental Illness, an advocacy group for people with mental illness and their families, many patients said they were denied payment because treatment was deemed “not medically necessary” twice as often for mental health as for other medical conditions. Only \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\" target=\"_blank\">a handful of states, including California\u003c/a> and New York, have been investigating whether insurers are complying with the parity law. Meanwhile, the federal government has taken few if any public enforcement actions, as \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\" target=\"_blank\">Kaiser Health News reported\u003c/a> last year.\u003c/p>\n\u003cp>For years, Kennedy has been traveling the country speaking about the lack of enforcement of the federal mental health parity law he helped create. One problem, he has said repeatedly, is that the administration has been hesitant to enforce a law against insurers, who were a key partner in implementing the Affordable Care Act.\u003c/p>\n\u003cp>“Even this administration, which is pro-consumer and liberal, has a tough time doing anything but dancing around issues of enforcing the law because they’re afraid to step on the insurers’ toes,” Kennedy said.\u003c/p>\n\u003cp>Tuesday’s announcement, he said, was also meager. “If the administration really wanted to be front and center on this they could have done it at the White House at a summit that would have gotten all kind of attention.”\u003c/p>\n\u003cp>Instead, he said, it was buried in an announcement of new programs and funding for opioid addiction. Also announced Tuesday were \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-03-29.html\" target=\"_blank\">the final parity rules\u003c/a> for patients with coverage under Medicaid and the Children’s Health Insurance Program (CHIP).\u003c/p>\n\u003cp>Despite the complaints of advocates and patients, insurers argue they have long been complying with parity.\u003c/p>\n\u003cp>“Our industry has long supported mental health parity and implementation of those requirements so that consumers have access to care when they need it,” Clare Krusing, a spokesperson for America’s Health Insurance Plans, the industry’s main trade group, said in a written statement. “Suggesting that coverage decisions drive the mental health challenges we face does a disservice to the ongoing efforts to improve the country’s health system for those who need behavioral health care.”\u003c/p>\n\u003cp>The interagency task force, which will be chaired by the White House’s \u003ca href=\"https://www.whitehouse.gov/administration/eop/dpc\" target=\"_blank\">Domestic Policy Council\u003c/a>, will aim to identify and promote best practices for state and federal agencies to ensure that insurers are complying with the parity law. It will consist of heads of the departments of Treasury, Justice, Labor and Health and Human Services, among others, and will be responsible for delivering a report to the President by October 31, 2016.\u003c/p>\n\u003cp>“I think anything the White House does to acknowledge the obstacles to treatment of mental illness is a step in the right direction. But frankly, another task force is a far cry from much-needed enforcement,” said Meiram Bendat, a Los Angeles-based lawyer who has filed several lawsuits against insurers alleging violations of the parity law.\u003c/p>\n\u003cp>People with mental illness and their advocates have long been aware of exactly what the problems are, he said. But rooting them out will require the task force to be “keenly attuned to social and institutional bias against patients with behavioral health problems. And that bias frequently takes the form of insurance companies effectively limiting care only to crisis and refusing to acknowledge the pervasive and long-term nature of these disorders.”\u003c/p>\n\u003cp>Provider groups widely applauded the creation of the task force.\u003c/p>\n\u003cp>“What we’re hoping is that the task force will increase the visibility of the issue and highlight its significance,” said Dr. Renée Binder, president of the American Psychiatric Association, which has identified wide variation in how well insurers are complying with the law.\u003c/p>\n\u003cp>“We would welcome the opportunity to meet with the task force as part of its outreach charge,” she said.\u003c/p>\n\u003cp>But even if parity is successfully implemented, Benjamin Miller, director of the health policy center at the University of Colorado School of Medicine, said it may be “too little, too late.”\u003c/p>\n\u003cp>“It’s simply not enough to have mental health parity – even with this change in law, there will still be access issues for patients.”\u003c/p>\n\u003cp>That’s because mental health providers often don’t have appointments readily available or won’t accept these patients’ insurance coverage, he said.\u003c/p>\n\u003cp>“While mental health parity rights a wrong, it does not change the fundamental delivery of care, which is sorely needed for increasing access to mental health,” Miller said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>, an editorially independent project of the Kaiser Family Foundation.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Tucked in \u003ca href=\"http://www.11alive.com/news/full-transcript-president-obama-at-atlanta-heroin-summit/108944462\" target=\"_blank\">remarks\u003c/a> the president made Tuesday on the opioid epidemic was his announcement of a new \u003ca href=\"https://www.whitehouse.gov/the-press-office/2016/03/29/presidential-memorandum-mental-health-and-substance-use-disorder-parity\" target=\"_blank\">task force on mental health parity\u003c/a> — aimed at ensuring that people with mental illnesses and substance abuse problems don’t face discrimination in the health care system.\u003c/p>\n\u003caside class=\"pullquote alignright\">Advocates say parity has long been an 'empty phrase' and it has taken the administration far too long to address the problem.\u003c/aside>\n\u003cp>Despite a landmark \u003ca href=\"https://www.cms.gov/Regulations-and-Guidance/Health-Insurance-Reform/HealthInsReformforConsume/downloads/MHPAEA.pdf\" target=\"_blank\">2008 law\u003c/a> intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.\u003c/p>\n\u003cp>“The goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it’s actually enforced, that the concept is not just a phrase — an empty phrase,” President Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. “We’ve got to let the insurance carriers know that we’re serious about this.”\u003c/p>\n\u003cp>Advocates say parity has long been an “empty phrase” and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them.\u003c/p>\n\u003cp>“It’s better late than never, and you can’t not be grateful for the fact that we’re finally implementing a law that was passed nearly a decade ago,” said former congressman Patrick Kennedy, one of the authors of the parity law. “But it’s troubling that it’s occurring in the last year of the presidency, and that it took the administration this long to address a problem that’s been with us for many years.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In \u003ca href=\"http://www.nami.org/About-NAMI/Publications-Reports/Public-Policy-Reports/A-Long-Road-Ahead/2015-ALongRoadAhead.pdf\" target=\"_blank\">a 2015 survey\u003c/a> by the National Alliance on Mental Illness, an advocacy group for people with mental illness and their families, many patients said they were denied payment because treatment was deemed “not medically necessary” twice as often for mental health as for other medical conditions. Only \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\" target=\"_blank\">a handful of states, including California\u003c/a> and New York, have been investigating whether insurers are complying with the parity law. Meanwhile, the federal government has taken few if any public enforcement actions, as \u003ca href=\"http://khn.org/news/advocates-say-mental-health-parity-law-is-not-fulfilling-its-promise/\" target=\"_blank\">Kaiser Health News reported\u003c/a> last year.\u003c/p>\n\u003cp>For years, Kennedy has been traveling the country speaking about the lack of enforcement of the federal mental health parity law he helped create. One problem, he has said repeatedly, is that the administration has been hesitant to enforce a law against insurers, who were a key partner in implementing the Affordable Care Act.\u003c/p>\n\u003cp>“Even this administration, which is pro-consumer and liberal, has a tough time doing anything but dancing around issues of enforcing the law because they’re afraid to step on the insurers’ toes,” Kennedy said.\u003c/p>\n\u003cp>Tuesday’s announcement, he said, was also meager. “If the administration really wanted to be front and center on this they could have done it at the White House at a summit that would have gotten all kind of attention.”\u003c/p>\n\u003cp>Instead, he said, it was buried in an announcement of new programs and funding for opioid addiction. Also announced Tuesday were \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-03-29.html\" target=\"_blank\">the final parity rules\u003c/a> for patients with coverage under Medicaid and the Children’s Health Insurance Program (CHIP).\u003c/p>\n\u003cp>Despite the complaints of advocates and patients, insurers argue they have long been complying with parity.\u003c/p>\n\u003cp>“Our industry has long supported mental health parity and implementation of those requirements so that consumers have access to care when they need it,” Clare Krusing, a spokesperson for America’s Health Insurance Plans, the industry’s main trade group, said in a written statement. “Suggesting that coverage decisions drive the mental health challenges we face does a disservice to the ongoing efforts to improve the country’s health system for those who need behavioral health care.”\u003c/p>\n\u003cp>The interagency task force, which will be chaired by the White House’s \u003ca href=\"https://www.whitehouse.gov/administration/eop/dpc\" target=\"_blank\">Domestic Policy Council\u003c/a>, will aim to identify and promote best practices for state and federal agencies to ensure that insurers are complying with the parity law. It will consist of heads of the departments of Treasury, Justice, Labor and Health and Human Services, among others, and will be responsible for delivering a report to the President by October 31, 2016.\u003c/p>\n\u003cp>“I think anything the White House does to acknowledge the obstacles to treatment of mental illness is a step in the right direction. But frankly, another task force is a far cry from much-needed enforcement,” said Meiram Bendat, a Los Angeles-based lawyer who has filed several lawsuits against insurers alleging violations of the parity law.\u003c/p>\n\u003cp>People with mental illness and their advocates have long been aware of exactly what the problems are, he said. But rooting them out will require the task force to be “keenly attuned to social and institutional bias against patients with behavioral health problems. And that bias frequently takes the form of insurance companies effectively limiting care only to crisis and refusing to acknowledge the pervasive and long-term nature of these disorders.”\u003c/p>\n\u003cp>Provider groups widely applauded the creation of the task force.\u003c/p>\n\u003cp>“What we’re hoping is that the task force will increase the visibility of the issue and highlight its significance,” said Dr. Renée Binder, president of the American Psychiatric Association, which has identified wide variation in how well insurers are complying with the law.\u003c/p>\n\u003cp>“We would welcome the opportunity to meet with the task force as part of its outreach charge,” she said.\u003c/p>\n\u003cp>But even if parity is successfully implemented, Benjamin Miller, director of the health policy center at the University of Colorado School of Medicine, said it may be “too little, too late.”\u003c/p>\n\u003cp>“It’s simply not enough to have mental health parity – even with this change in law, there will still be access issues for patients.”\u003c/p>\n\u003cp>That’s because mental health providers often don’t have appointments readily available or won’t accept these patients’ insurance coverage, he said.\u003c/p>\n\u003cp>“While mental health parity rights a wrong, it does not change the fundamental delivery of care, which is sorely needed for increasing access to mental health,” Miller said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Mandatory Waiting Period Dissuaded Few Women from Abortions, Study Finds",
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"content": "\u003cp>Most women seeking an abortion were not deterred by a Utah law requiring a 72-hour waiting period before having the procedure, according to a recent study by the University of California, San Francisco.\u003c/p>\n\u003cp>The 2012 law requires a 72-hour waiting period and at least two medical visits before an abortion. It was the first such law in the nation, and researchers found that it added financial costs and increased logistical hassles and anxiety for the women.\u003c/p>\n\u003cp>Most women were certain in their decision to have an abortion, so the law was “unnecessary,” researchers said. It would be more appropriate to offer individual counseling for the women who were conflicted about the decision, they said.\u003c/p>\n\u003cp>“The policy just created hardship for the women, most of whom had already made decision to have an abortion,” said lead author Sarah Roberts, assistant professor at UCSF and the Advancing New Standards in Reproductive Health. “I’m a researcher, and I believe policy should be based available evidence. I hope policymakers considering waiting periods in their states will pay attention to these findings.”\u003c/p>\n\u003cp>Four other states, Missouri, Oklahoma, South Dakota, and North Carolina, enacted 72-hour requirements. Twenty-seven states have shorter waiting periods and 13 states require two visits before having an abortion, the study noted.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At four family planning facilities in Utah in 2013-2014, the researchers recruited 500 women who, as required, attended the information visit before seeking an abortion. The women completed initial surveys on an iPad.\u003c/p>\n\u003cp>Of the 309 women who also completed a follow-up survey by phone three weeks later, 86 percent went through with having an abortion, 8 percent were no longer seeking an abortion, 3 percent miscarried or discovered they had not been pregnant, and 2 percent were still seeking an abortion. One woman was undecided, and the waiting period pushed another woman beyond her abortion provider’s gestational limit so the pregnancy continued, according to the study published in the March 24 issue of \u003cem>\u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1363/48e8216/abstract\" target=\"_blank\">Perspectives on Sexual and Reproductive Health\u003c/a>\u003c/em>.\u003c/p>\n\u003cp>Utah state Rep. Steve Eliason, who sponsored the 72-hour waiting period bill, said the study’s findings did not make him question the need for the law.\u003c/p>\n\u003cp>“Nobody ever thought that everybody would change their mind,” Eliason said. “What about the some women who did? Even if it’s effective for a handful of people, what’s the rush?”\u003c/p>\n\u003cp>He questioned the validity of the study for reasons including the unidentified source of funding. Roberts said funding came from an anonymous foundation that complied with UCSF’s grant policies and that the organization was not involved at all in conducting, reviewing, writing or publishing the study.\u003c/p>\n\u003cp>Eliason said he disagreed with the study’s conclusion.\u003c/p>\n\u003cp>“The study’s ultimate conclusion is that it is unnecessary,” Eliason said. “They can have that opinion. The objective was why don’t we give women in a difficult position, sufficient time they can use to consider the facts. We will have multiple extra kindergarten classes as a result.”\u003c/p>\n\u003cp>Most of the women who changed their minds about having an abortion reported being conflicted at the initial information visit. Only 2 percent of those women said they were not conflicted at the information visit but later decided against having an abortion, the study said.\u003c/p>\n\u003cp>Even though the waiting period was 72 hours, the women had to wait much longer to have the procedure -- about eight days after their initial information visit, the study said. The delay was caused mostly by appointment availability and personal logistics.\u003c/p>\n\u003cp>The increased wait time also cost women privacy. Six percent of the women said they had to disclose that they were seeking an abortion to additional people in their lives because of the extra time and logistics involved in getting the procedure, the study said.\u003c/p>\n\u003cp>Women had to pay 10 percent more for an abortion because of the additional wait and having to make two visits, the study said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Financially, it was just hard,” a 30-year-old Idaho woman who went to Utah for the procedure wrote in the survey. “I have three children, so I couldn’t stay there during the waiting period,\" she said. “I had to make the trip, come back home and do the regular stuff, and then plan another trip.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Most women seeking an abortion were not deterred by a Utah law requiring a 72-hour waiting period before having the procedure, according to a recent study by the University of California, San Francisco.\u003c/p>\n\u003cp>The 2012 law requires a 72-hour waiting period and at least two medical visits before an abortion. It was the first such law in the nation, and researchers found that it added financial costs and increased logistical hassles and anxiety for the women.\u003c/p>\n\u003cp>Most women were certain in their decision to have an abortion, so the law was “unnecessary,” researchers said. It would be more appropriate to offer individual counseling for the women who were conflicted about the decision, they said.\u003c/p>\n\u003cp>“The policy just created hardship for the women, most of whom had already made decision to have an abortion,” said lead author Sarah Roberts, assistant professor at UCSF and the Advancing New Standards in Reproductive Health. “I’m a researcher, and I believe policy should be based available evidence. I hope policymakers considering waiting periods in their states will pay attention to these findings.”\u003c/p>\n\u003cp>Four other states, Missouri, Oklahoma, South Dakota, and North Carolina, enacted 72-hour requirements. Twenty-seven states have shorter waiting periods and 13 states require two visits before having an abortion, the study noted.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At four family planning facilities in Utah in 2013-2014, the researchers recruited 500 women who, as required, attended the information visit before seeking an abortion. The women completed initial surveys on an iPad.\u003c/p>\n\u003cp>Of the 309 women who also completed a follow-up survey by phone three weeks later, 86 percent went through with having an abortion, 8 percent were no longer seeking an abortion, 3 percent miscarried or discovered they had not been pregnant, and 2 percent were still seeking an abortion. One woman was undecided, and the waiting period pushed another woman beyond her abortion provider’s gestational limit so the pregnancy continued, according to the study published in the March 24 issue of \u003cem>\u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1363/48e8216/abstract\" target=\"_blank\">Perspectives on Sexual and Reproductive Health\u003c/a>\u003c/em>.\u003c/p>\n\u003cp>Utah state Rep. Steve Eliason, who sponsored the 72-hour waiting period bill, said the study’s findings did not make him question the need for the law.\u003c/p>\n\u003cp>“Nobody ever thought that everybody would change their mind,” Eliason said. “What about the some women who did? Even if it’s effective for a handful of people, what’s the rush?”\u003c/p>\n\u003cp>He questioned the validity of the study for reasons including the unidentified source of funding. Roberts said funding came from an anonymous foundation that complied with UCSF’s grant policies and that the organization was not involved at all in conducting, reviewing, writing or publishing the study.\u003c/p>\n\u003cp>Eliason said he disagreed with the study’s conclusion.\u003c/p>\n\u003cp>“The study’s ultimate conclusion is that it is unnecessary,” Eliason said. “They can have that opinion. The objective was why don’t we give women in a difficult position, sufficient time they can use to consider the facts. We will have multiple extra kindergarten classes as a result.”\u003c/p>\n\u003cp>Most of the women who changed their minds about having an abortion reported being conflicted at the initial information visit. Only 2 percent of those women said they were not conflicted at the information visit but later decided against having an abortion, the study said.\u003c/p>\n\u003cp>Even though the waiting period was 72 hours, the women had to wait much longer to have the procedure -- about eight days after their initial information visit, the study said. The delay was caused mostly by appointment availability and personal logistics.\u003c/p>\n\u003cp>The increased wait time also cost women privacy. Six percent of the women said they had to disclose that they were seeking an abortion to additional people in their lives because of the extra time and logistics involved in getting the procedure, the study said.\u003c/p>\n\u003cp>Women had to pay 10 percent more for an abortion because of the additional wait and having to make two visits, the study said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Financially, it was just hard,” a 30-year-old Idaho woman who went to Utah for the procedure wrote in the survey. “I have three children, so I couldn’t stay there during the waiting period,\" she said. “I had to make the trip, come back home and do the regular stuff, and then plan another trip.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Insurance Commissioner Expresses Skepticism Over Anthem-Cigna Merger",
"title": "California Insurance Commissioner Expresses Skepticism Over Anthem-Cigna Merger",
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"content": "\u003cp>State Insurance Commissioner Dave Jones continued to make his skepticism clear regarding Anthem Inc.’s proposed $54.2 billion acquisition of Cigna Corp. during a hearing in San Francisco on Tuesday.\u003c/p>\n\u003cp>Company executives faced Jones and a panel of physicians and consumer advocates who questioned the benefits the companies say the acquisition will bring.\u003c/p>\n\u003cp>The California Department of Insurance hearing took a more pressing tone than a related hearing held by the California Department of Managed Health Care earlier this month.\u003c/p>\n\u003cp>According to Anthem and Cigna, the merger will result in easier access to medical providers for patients and lead to more affordable health insurance policies.\u003c/p>\n\u003cp>Jay Wagner, Anthem’s vice president and counsel, and Tom Richards, Cigna’s global leader for strategy and business development, said the purchase would cut costs by $2 billion annually.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>They told Jones they were “quite confident” in that estimate. But Wagner and Richards said they could not commit to guaranteeing savings for consumers because of factors out of their control, such as the rising prices of specialty drugs.\u003c/p>\n\u003cp>Brent Fulton, a professor of health economics and policy at UC Berkeley, presented an analysis on the Anthem and Cigna merger at the request of the Department of Insurance.\u003c/p>\n\u003cp>Theoretically, Fulton said, consolidation could lead to stronger negotiating leverage with hospitals, physician organizations and other providers of health care services that now hold market power, resulting in lower costs for health insurance customers.\u003c/p>\n\u003cp>“However, we are not aware of any peer-reviewed studies that have found that higher insurer market concentration has led to lower health insurance premiums,” Fulton said.\u003c/p>\n\u003cp>Consumer advocates said the acquisition would make existing problems with health insurance worse. Anthem, they claimed, has already struggled with inaccuracies in provider directories, low quality ratings and poor management of grievances.\u003c/p>\n\u003cp>“We don’t have any proof from Anthem on concrete benefits to consumers,” said Carmen Balber, executive director of Consumer Watchdog.\u003c/p>\n\u003cp>“Consumers are already hurting in cost,” she said, stating that about 20 percent of consumers can’t afford the prices even with insurance.\u003c/p>\n\u003cp>Anthem is part of the four insurance titans that dominate the health insurance market in California, along with Kaiser Permanente, Blue Shield and Health Net. If approved, the Anthem and Cigna merger would result in the largest insurer by enrollment in the state, with an approximate 8.2 million policyholders, surpassing current leader Kaiser. (Cigna now is in fifth place.)\u003c/p>\n\u003cp>Even without the merger, the top four insurance companies control more than 80 percent of the market. The Anthem-Cigna union is one of two pending mergers still under review by state regulators.\u003c/p>\n\u003cp>Last week, Centene’s $7 billion purchase of Health Net was approved. Regulators are also examining the planned $37 billion combination of Aetna Inc. and Humana Inc.\u003c/p>\n\u003cp>The Anthem-Cigna merger also needs the green light from 23 other states. Nationally, the combination would cover some 53 million policyholders, overtaking UnitedHealth Group Inc., which has close to 46 million members, according to 2013 estimates.\u003c/p>\n\u003cp>The California Department of Managed Health Care, which held a hearing on this same merger earlier this month, is expected to impose certain conditions on the Anthem-Cigna deal to address consumer worries about the potential impact of large-scale consolidation. Those conditions are not yet clear.\u003c/p>\n\u003cp>Jones said he’s asked the two companies for more information, and he expects to make a recommendation in the coming week.\u003c/p>\n\u003cp>“I am considering what is best for consumers and the overall marketplace,” Jones said in a prepared statement. “Anthem and Cigna bear the burden of demonstrating this proposed merger is in the best interest of the California consumers and health care marketplace.”\u003c/p>\n\u003cp>Jones said he plans to make a recommendation to the Federal Trade Commission and Department of Justice, who ultimately have the final say on the merger nationwide.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>State Insurance Commissioner Dave Jones continued to make his skepticism clear regarding Anthem Inc.’s proposed $54.2 billion acquisition of Cigna Corp. during a hearing in San Francisco on Tuesday.\u003c/p>\n\u003cp>Company executives faced Jones and a panel of physicians and consumer advocates who questioned the benefits the companies say the acquisition will bring.\u003c/p>\n\u003cp>The California Department of Insurance hearing took a more pressing tone than a related hearing held by the California Department of Managed Health Care earlier this month.\u003c/p>\n\u003cp>According to Anthem and Cigna, the merger will result in easier access to medical providers for patients and lead to more affordable health insurance policies.\u003c/p>\n\u003cp>Jay Wagner, Anthem’s vice president and counsel, and Tom Richards, Cigna’s global leader for strategy and business development, said the purchase would cut costs by $2 billion annually.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>They told Jones they were “quite confident” in that estimate. But Wagner and Richards said they could not commit to guaranteeing savings for consumers because of factors out of their control, such as the rising prices of specialty drugs.\u003c/p>\n\u003cp>Brent Fulton, a professor of health economics and policy at UC Berkeley, presented an analysis on the Anthem and Cigna merger at the request of the Department of Insurance.\u003c/p>\n\u003cp>Theoretically, Fulton said, consolidation could lead to stronger negotiating leverage with hospitals, physician organizations and other providers of health care services that now hold market power, resulting in lower costs for health insurance customers.\u003c/p>\n\u003cp>“However, we are not aware of any peer-reviewed studies that have found that higher insurer market concentration has led to lower health insurance premiums,” Fulton said.\u003c/p>\n\u003cp>Consumer advocates said the acquisition would make existing problems with health insurance worse. Anthem, they claimed, has already struggled with inaccuracies in provider directories, low quality ratings and poor management of grievances.\u003c/p>\n\u003cp>“We don’t have any proof from Anthem on concrete benefits to consumers,” said Carmen Balber, executive director of Consumer Watchdog.\u003c/p>\n\u003cp>“Consumers are already hurting in cost,” she said, stating that about 20 percent of consumers can’t afford the prices even with insurance.\u003c/p>\n\u003cp>Anthem is part of the four insurance titans that dominate the health insurance market in California, along with Kaiser Permanente, Blue Shield and Health Net. If approved, the Anthem and Cigna merger would result in the largest insurer by enrollment in the state, with an approximate 8.2 million policyholders, surpassing current leader Kaiser. (Cigna now is in fifth place.)\u003c/p>\n\u003cp>Even without the merger, the top four insurance companies control more than 80 percent of the market. The Anthem-Cigna union is one of two pending mergers still under review by state regulators.\u003c/p>\n\u003cp>Last week, Centene’s $7 billion purchase of Health Net was approved. Regulators are also examining the planned $37 billion combination of Aetna Inc. and Humana Inc.\u003c/p>\n\u003cp>The Anthem-Cigna merger also needs the green light from 23 other states. Nationally, the combination would cover some 53 million policyholders, overtaking UnitedHealth Group Inc., which has close to 46 million members, according to 2013 estimates.\u003c/p>\n\u003cp>The California Department of Managed Health Care, which held a hearing on this same merger earlier this month, is expected to impose certain conditions on the Anthem-Cigna deal to address consumer worries about the potential impact of large-scale consolidation. Those conditions are not yet clear.\u003c/p>\n\u003cp>Jones said he’s asked the two companies for more information, and he expects to make a recommendation in the coming week.\u003c/p>\n\u003cp>“I am considering what is best for consumers and the overall marketplace,” Jones said in a prepared statement. “Anthem and Cigna bear the burden of demonstrating this proposed merger is in the best interest of the California consumers and health care marketplace.”\u003c/p>\n\u003cp>Jones said he plans to make a recommendation to the Federal Trade Commission and Department of Justice, who ultimately have the final say on the merger nationwide.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Representatives of the fast-growing vaping industry are promoting themselves as partners in the effort to reduce tobacco use, not as a public health scourge.\u003c/p>\n\u003cp>Industry officials held a Capitol news conference Tuesday urging California Gov. Jerry Brown to veto a bill that would subject vaping products to the same restrictions as cigarettes.\u003c/p>\n\u003cp>The bill is one of six anti-smoking bills awaiting action by the Democratic governor. Brown has not said whether he'll sign them.\u003c/p>\n\u003cp>Josh Krane, owner of Craft Vapery in Torrance, says e-cigarettes were the only way for him and many of his customers to quit smoking.\u003c/p>\n\u003cp>Proponents of the bill say vapor products are enticing to teenagers and threaten to get more young people addicted to nicotine.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"disqusTitle": "Can't Afford Your Life-Saving Prescription Drugs? Get a Mortgage, Some Experts Propose",
"title": "Can't Afford Your Life-Saving Prescription Drugs? Get a Mortgage, Some Experts Propose",
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"content": "\u003cp>Californians are used to big mortgages. Now, how about prescription drug loans?\u003c/p>\n\u003cp>That’s one idea for coping with prohibitively expensive drug prices. The unusual proposal is being pitched by academics at the Massachusetts Institute of Technology and Harvard University.\u003c/p>\n\u003cp>Writing last month in the journal Science Translational Medicine, the authors liken drug loans to mortgages, noting that both can enable consumers to buy big-ticket items requiring a hefty up-front payment that they could not otherwise afford.\u003c/p>\n\u003cp>Some consumer advocates and health insurance experts see it differently.\u003c/p>\n\u003cp>“Isn’t this why we have health insurance?” asked Mark Rukavina, a Boston-based health care consultant whose work has focused on affordability and medical debt. “Insurance used to protect people from financial ruin for these unpredictable, costly occurrences. Now, with large deductibles, we’ve got coverage for preventive care but not for treatment.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Andrew Lo, a financial economist at MIT’s Sloan School of Management, and Dr. David Weinstock, an oncologist at the Harvard-affiliated Dana-Farber Cancer Institute, agree that insurance would be a better option. But for many consumers that isn’t enough protection these days.\u003c/p>\n\u003cp>“This is a private sector stopgap way to deal with something right now,” said Lo.\u003c/p>\n\u003cp>Their proposal calls for the loans to be financed by a pool of investors who would buy bonds and equities issued by an organization that makes the loans to consumers.\u003c/p>\n\u003cp>While it’s “distasteful” to talk about patients mortgaging their lives for treatment, Lo said, they hope the proposal will spur change.\u003c/p>\n\u003cp>The health care installment loans that Lo, Weinstock and their co-author Vahid Montazerhodjat, a former MIT doctoral student who was working with Lo, propose would be aimed at helping people afford “transformative” therapies that cure potentially lethal conditions such as cancer or hepatitis C. They’re not designed to pay for maintenance drugs that help people deal with chronic illness. It’s easier for insurers to cover maintenance drugs because they’re purchased over an extended period of time, they said.\u003c/p>\n\u003cp>In contrast, breakthrough hepatitis C drugs Sovaldi and Harvoni, for example, can cure people of the liver-destroying disease in a few months, but the price tag of $84,000 or more has led many insurers to limit coverage to people whose disease has significantly progressed to show signs of liver damage.\u003c/p>\n\u003cp>“There are miraculous treatments like Harvoni, but they’re out of reach” for many people, said Lo.\u003c/p>\n\u003cp>Someone who wanted that Harvoni treatment might take out a health care loan with a nine-year term at an annual interest rate of about 9 percent, the authors suggest. In a twist on conventional loans, if a therapy doesn’t work or the patient relapses or dies, the patient isn’t obligated to repay the loan.\u003c/p>\n\u003cp>Are sick patients good loan prospects? Lenders might want to assess not only loan applicants’ creditworthiness but also their health to determine whether the applicant is likely to live long enough to pay it off.\u003c/p>\n\u003cp>The study authors say that requiring repayment only if the treatment works will protect patients and provide an incentive for the development of more effective drugs.\u003c/p>\n\u003cp>That’s a wrongheaded approach, said A. Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design.\u003c/p>\n\u003cp>Medical treatment isn’t always straightforward. Even highly “transformative” drugs such as Sovaldi aren’t guaranteed to work, Fendrick said, and other factors come into play. For example, about 10 percent of people who were prescribed Sovaldi for hepatitis C didn’t finish their course of treatment, Fendrick said, referring to an analysis by the CVS Health Research Institute.\u003c/p>\n\u003cp>“In this situation, the person who does the right thing and gets the good outcome is penalized and has to pay the money back,” he said. Instead, he argued, patients who follow their doctor’s recommendations and “do what you’re supposed to do” should not be held liable for the loans.\u003c/p>\n\u003cp>The proposal doesn’t address drug prices, except to say that the potential for increase due to higher demand for previously unaffordable therapies needs to be addressed.\u003c/p>\n\u003cp>Price increases are a real concern, said Paul Ginsburg, director of public policy at the University of Southern California’s Schaeffer Center for Health Policy and Economics. The health law has made it easier for people to afford expensive drugs. It expanded Medicaid coverage to millions of lower income adults and capped at roughly $7,000 the amount consumers generally spend annually out-of-pocket for care.\u003c/p>\n\u003cp>“It’s helped people, but it’s also driven prices higher,” he said. From a drug company’s perspective, “It just means that more people can afford this drug, so we can charge more for it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lo said the MIT Laboratory for Financial Engineering and the Dana-Farber Cancer Institute will host a conference this winter to bring together drug manufacturers, insurers, patient advocates, financial engineers and others to discuss strategies to make expensive drug therapies more affordable. Health care loans will be on the agenda, he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Californians are used to big mortgages. Now, how about prescription drug loans?\u003c/p>\n\u003cp>That’s one idea for coping with prohibitively expensive drug prices. The unusual proposal is being pitched by academics at the Massachusetts Institute of Technology and Harvard University.\u003c/p>\n\u003cp>Writing last month in the journal Science Translational Medicine, the authors liken drug loans to mortgages, noting that both can enable consumers to buy big-ticket items requiring a hefty up-front payment that they could not otherwise afford.\u003c/p>\n\u003cp>Some consumer advocates and health insurance experts see it differently.\u003c/p>\n\u003cp>“Isn’t this why we have health insurance?” asked Mark Rukavina, a Boston-based health care consultant whose work has focused on affordability and medical debt. “Insurance used to protect people from financial ruin for these unpredictable, costly occurrences. Now, with large deductibles, we’ve got coverage for preventive care but not for treatment.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Andrew Lo, a financial economist at MIT’s Sloan School of Management, and Dr. David Weinstock, an oncologist at the Harvard-affiliated Dana-Farber Cancer Institute, agree that insurance would be a better option. But for many consumers that isn’t enough protection these days.\u003c/p>\n\u003cp>“This is a private sector stopgap way to deal with something right now,” said Lo.\u003c/p>\n\u003cp>Their proposal calls for the loans to be financed by a pool of investors who would buy bonds and equities issued by an organization that makes the loans to consumers.\u003c/p>\n\u003cp>While it’s “distasteful” to talk about patients mortgaging their lives for treatment, Lo said, they hope the proposal will spur change.\u003c/p>\n\u003cp>The health care installment loans that Lo, Weinstock and their co-author Vahid Montazerhodjat, a former MIT doctoral student who was working with Lo, propose would be aimed at helping people afford “transformative” therapies that cure potentially lethal conditions such as cancer or hepatitis C. They’re not designed to pay for maintenance drugs that help people deal with chronic illness. It’s easier for insurers to cover maintenance drugs because they’re purchased over an extended period of time, they said.\u003c/p>\n\u003cp>In contrast, breakthrough hepatitis C drugs Sovaldi and Harvoni, for example, can cure people of the liver-destroying disease in a few months, but the price tag of $84,000 or more has led many insurers to limit coverage to people whose disease has significantly progressed to show signs of liver damage.\u003c/p>\n\u003cp>“There are miraculous treatments like Harvoni, but they’re out of reach” for many people, said Lo.\u003c/p>\n\u003cp>Someone who wanted that Harvoni treatment might take out a health care loan with a nine-year term at an annual interest rate of about 9 percent, the authors suggest. In a twist on conventional loans, if a therapy doesn’t work or the patient relapses or dies, the patient isn’t obligated to repay the loan.\u003c/p>\n\u003cp>Are sick patients good loan prospects? Lenders might want to assess not only loan applicants’ creditworthiness but also their health to determine whether the applicant is likely to live long enough to pay it off.\u003c/p>\n\u003cp>The study authors say that requiring repayment only if the treatment works will protect patients and provide an incentive for the development of more effective drugs.\u003c/p>\n\u003cp>That’s a wrongheaded approach, said A. Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design.\u003c/p>\n\u003cp>Medical treatment isn’t always straightforward. Even highly “transformative” drugs such as Sovaldi aren’t guaranteed to work, Fendrick said, and other factors come into play. For example, about 10 percent of people who were prescribed Sovaldi for hepatitis C didn’t finish their course of treatment, Fendrick said, referring to an analysis by the CVS Health Research Institute.\u003c/p>\n\u003cp>“In this situation, the person who does the right thing and gets the good outcome is penalized and has to pay the money back,” he said. Instead, he argued, patients who follow their doctor’s recommendations and “do what you’re supposed to do” should not be held liable for the loans.\u003c/p>\n\u003cp>The proposal doesn’t address drug prices, except to say that the potential for increase due to higher demand for previously unaffordable therapies needs to be addressed.\u003c/p>\n\u003cp>Price increases are a real concern, said Paul Ginsburg, director of public policy at the University of Southern California’s Schaeffer Center for Health Policy and Economics. The health law has made it easier for people to afford expensive drugs. It expanded Medicaid coverage to millions of lower income adults and capped at roughly $7,000 the amount consumers generally spend annually out-of-pocket for care.\u003c/p>\n\u003cp>“It’s helped people, but it’s also driven prices higher,” he said. From a drug company’s perspective, “It just means that more people can afford this drug, so we can charge more for it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lo said the MIT Laboratory for Financial Engineering and the Dana-Farber Cancer Institute will host a conference this winter to bring together drug manufacturers, insurers, patient advocates, financial engineers and others to discuss strategies to make expensive drug therapies more affordable. Health care loans will be on the agenda, he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Proposed Anthem-Cigna Merger Under Scrutiny in California",
"title": "Proposed Anthem-Cigna Merger Under Scrutiny in California",
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"content": "\u003cp>Last week, state regulators signed off on Centene’s $7 billion purchase of fellow health insurer Health Net.\u003c/p>\n\u003cp>But that’s a dinky deal compared to Anthem’s proposed $54 billion acquisition of Cigna, which Tuesday undergoes public review by the California Department of Insurance and its politically ambitious commissioner, Dave Jones.\u003c/p>\n\u003cp>The stakes are high. A rejection by California — given the state’s huge market — could jeopardize the acquisition altogether.\u003c/p>\n\u003cp>Eyes are now on Jones, who plans to run for state attorney general in 2018. Last week he said the Centene-Health Net deal could enhance competition in California. Centene currently has almost no market share in California but does have financial stability from its out-of-state business, so it would bring an infusion of “new capital and new resources” to take over Health Net and take on market share leaders.\u003c/p>\n\u003cp>More than three-quarters of the private insurance market in California now belongs to Kaiser Permanente (42 percent), Anthem Blue Cross (20 percent) and Blue Shield of California (15 percent). Centene’s acquisition of Health Net, the fourth-largest insurer in the state (6 percent), could help it compete with the Big Three, Jones said. In the case of Anthem, though, that logic would work against it, because merger approval would mean one of the Big Three would just get more powerful, according to Shana Charles, health policy professor at California State University Fullerton.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“For the regulators, the big question is whether or not a merger would make the market more competitive,” she said. “Because Anthem is so big in California, that’s going to be a big concern.”\u003c/p>\n\u003cp>Jones has fashioned himself as a consumer advocate challenging the power of big insurers. “He has consistently played that role,” Charles said. “So really, this is a perfect opportunity for him.”\u003c/p>\n\u003cp>Several factors weigh against the Anthem/Cigna and Aetna/Humana deals, consumer advocates said.\u003c/p>\n\u003cp>“For the Anthem/Cigna deal, there is overlap in market share, and that wasn’t the case with Centene,” said Tam Ma, attorney for the Sacramento-based advocacy nonprofit Health Access California. Since Cigna and Anthem compete for subscribers, Ma said the Anthem deal would reduce health insurance competition in 31 counties in California.\u003c/p>\n\u003cp>And, Ma said, Anthem has a history of dramatically hiking premium rates, even after state regulators have deemed them unreasonable. Add in a high number of consumer complaints, a question about whether they contract with enough doctors, low quality ratings and Anthem’s major data breach last year, and you get a volatile mixture that defies merger approval, she said. “The big concern is, if they get bigger, are these problems going to get bigger?”\u003c/p>\n\u003cp>In a prepared statement, Anthem spokesman Darrel Ng said Anthem and Cigna have limited overlap and combined will be in a better position to improve consumer choice and quality as well as preserve affordability.\u003c/p>\n\u003cp>“Expanding access to affordable health coverage is the foundation of our combination with Cigna and will remain Anthem’s top priority,” Ng said.\u003c/p>\n\u003cp>“We are continuing to work with the Department of Justice and appropriate state regulators, and are confident that our proposed merger is being reviewed based on these facts.”\u003c/p>\n\u003cp>An outright rejection could sink the deal. That could send shockwaves through the stock market and raise questions about California’s attitude toward business. Health care systems around the country are combining, claiming financial necessity. Insurers say they need to combine, too, to maintain negotiating clout.\u003c/p>\n\u003cp>Instead of blocking the deal, regulators could approve it with conditions.\u003c/p>\n\u003cp>One of Jones’ predecessors, John Garamendi, did both. In 2004, he rejected Anthem’s proposed merger with competitor Wellpoint. Anthem sued him. Garamendi later approved the deal, but got the company to pay $265 million toward various health projects in California, double those in the original agreement.\u003c/p>\n\u003cp>Approval in California isn’t Anthem’s only worry. Federal antitrust officials have yet to weigh in. It’s unclear who will render judgment on the deal first, them or Jones.\u003c/p>\n\u003cp>The hearing Tuesday is in San Francisco. The insurance department said it will soon hold hearings on another huge health industry deal, Aetna’s proposed $37 million acquisition of Humana. The Department of Managed Health Care has already held its hearings on both mergers, but has not issued a timeframe for any decision.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Last week, state regulators signed off on Centene’s $7 billion purchase of fellow health insurer Health Net.\u003c/p>\n\u003cp>But that’s a dinky deal compared to Anthem’s proposed $54 billion acquisition of Cigna, which Tuesday undergoes public review by the California Department of Insurance and its politically ambitious commissioner, Dave Jones.\u003c/p>\n\u003cp>The stakes are high. A rejection by California — given the state’s huge market — could jeopardize the acquisition altogether.\u003c/p>\n\u003cp>Eyes are now on Jones, who plans to run for state attorney general in 2018. Last week he said the Centene-Health Net deal could enhance competition in California. Centene currently has almost no market share in California but does have financial stability from its out-of-state business, so it would bring an infusion of “new capital and new resources” to take over Health Net and take on market share leaders.\u003c/p>\n\u003cp>More than three-quarters of the private insurance market in California now belongs to Kaiser Permanente (42 percent), Anthem Blue Cross (20 percent) and Blue Shield of California (15 percent). Centene’s acquisition of Health Net, the fourth-largest insurer in the state (6 percent), could help it compete with the Big Three, Jones said. In the case of Anthem, though, that logic would work against it, because merger approval would mean one of the Big Three would just get more powerful, according to Shana Charles, health policy professor at California State University Fullerton.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“For the regulators, the big question is whether or not a merger would make the market more competitive,” she said. “Because Anthem is so big in California, that’s going to be a big concern.”\u003c/p>\n\u003cp>Jones has fashioned himself as a consumer advocate challenging the power of big insurers. “He has consistently played that role,” Charles said. “So really, this is a perfect opportunity for him.”\u003c/p>\n\u003cp>Several factors weigh against the Anthem/Cigna and Aetna/Humana deals, consumer advocates said.\u003c/p>\n\u003cp>“For the Anthem/Cigna deal, there is overlap in market share, and that wasn’t the case with Centene,” said Tam Ma, attorney for the Sacramento-based advocacy nonprofit Health Access California. Since Cigna and Anthem compete for subscribers, Ma said the Anthem deal would reduce health insurance competition in 31 counties in California.\u003c/p>\n\u003cp>And, Ma said, Anthem has a history of dramatically hiking premium rates, even after state regulators have deemed them unreasonable. Add in a high number of consumer complaints, a question about whether they contract with enough doctors, low quality ratings and Anthem’s major data breach last year, and you get a volatile mixture that defies merger approval, she said. “The big concern is, if they get bigger, are these problems going to get bigger?”\u003c/p>\n\u003cp>In a prepared statement, Anthem spokesman Darrel Ng said Anthem and Cigna have limited overlap and combined will be in a better position to improve consumer choice and quality as well as preserve affordability.\u003c/p>\n\u003cp>“Expanding access to affordable health coverage is the foundation of our combination with Cigna and will remain Anthem’s top priority,” Ng said.\u003c/p>\n\u003cp>“We are continuing to work with the Department of Justice and appropriate state regulators, and are confident that our proposed merger is being reviewed based on these facts.”\u003c/p>\n\u003cp>An outright rejection could sink the deal. That could send shockwaves through the stock market and raise questions about California’s attitude toward business. Health care systems around the country are combining, claiming financial necessity. Insurers say they need to combine, too, to maintain negotiating clout.\u003c/p>\n\u003cp>Instead of blocking the deal, regulators could approve it with conditions.\u003c/p>\n\u003cp>One of Jones’ predecessors, John Garamendi, did both. In 2004, he rejected Anthem’s proposed merger with competitor Wellpoint. Anthem sued him. Garamendi later approved the deal, but got the company to pay $265 million toward various health projects in California, double those in the original agreement.\u003c/p>\n\u003cp>Approval in California isn’t Anthem’s only worry. Federal antitrust officials have yet to weigh in. It’s unclear who will render judgment on the deal first, them or Jones.\u003c/p>\n\u003cp>The hearing Tuesday is in San Francisco. The insurance department said it will soon hold hearings on another huge health industry deal, Aetna’s proposed $37 million acquisition of Humana. The Department of Managed Health Care has already held its hearings on both mergers, but has not issued a timeframe for any decision.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The first case of Zika virus acquired in California was confirmed by health department officials on Friday.\u003c/p>\n\u003cp>A San Diego woman contracted the virus in February after sexual contact with a male partner who had been infected with Zika on a trip to Colombia, a country where the virus is prevalent, San Diego County officials \u003ca href=\"http://www.countynewscenter.com/news/first-sexually-transmitted-zika-virus-case-san-diego-county-reported\" target=\"_blank\">report\u003c/a>.\u003c/p>\n\u003cp>The woman was not pregnant and she and her partner have fully recovered, the California Department of Public Health said.\u003c/p>\n\u003cp>“This is the first confirmed case in California where Zika virus was transmitted sexually,” California Department of Public Health Director and State Public Health Officer Karen Smith \u003ca href=\"https://www.cdph.ca.gov/Pages/NR16-016.aspx\" target=\"_blank\">said\u003c/a>. “If your partner has traveled to an area where Zika is present, protecting yourself by abstaining from sex or using condoms during sex is the best way to prevent sexual transmission of the Zika virus.”\u003c/p>\n\u003cp>In California, there have been 22 travel-associated Zika cases in 2015 and 2016. There have been no cases of the virus being acquired from mosquito bites here.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The spread of Zika virus has caused alarm worldwide because it can spread from a woman to her baby during pregnancy and lead to birth defects including microcephaly, a condition, where a baby is born with a smaller head due to abnormal brain development.\u003c/p>\n\u003cp>State and local health officials offered recommendations to help prevent the spread of Zika virus.\u003c/p>\n\u003cp>Men who have traveled to an area where Zika virus is present should abstain from sex or use condoms with a partner who is pregnant or trying to become pregnant for the duration of the pregnancy, state health officials said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Women who want to get pregnant with a partner who has had exposure to Zika virus should talk to their doctor about the risks of Zika virus during pregnancy, state officials said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The first case of Zika virus acquired in California was confirmed by health department officials on Friday.\u003c/p>\n\u003cp>A San Diego woman contracted the virus in February after sexual contact with a male partner who had been infected with Zika on a trip to Colombia, a country where the virus is prevalent, San Diego County officials \u003ca href=\"http://www.countynewscenter.com/news/first-sexually-transmitted-zika-virus-case-san-diego-county-reported\" target=\"_blank\">report\u003c/a>.\u003c/p>\n\u003cp>The woman was not pregnant and she and her partner have fully recovered, the California Department of Public Health said.\u003c/p>\n\u003cp>“This is the first confirmed case in California where Zika virus was transmitted sexually,” California Department of Public Health Director and State Public Health Officer Karen Smith \u003ca href=\"https://www.cdph.ca.gov/Pages/NR16-016.aspx\" target=\"_blank\">said\u003c/a>. “If your partner has traveled to an area where Zika is present, protecting yourself by abstaining from sex or using condoms during sex is the best way to prevent sexual transmission of the Zika virus.”\u003c/p>\n\u003cp>In California, there have been 22 travel-associated Zika cases in 2015 and 2016. There have been no cases of the virus being acquired from mosquito bites here.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The spread of Zika virus has caused alarm worldwide because it can spread from a woman to her baby during pregnancy and lead to birth defects including microcephaly, a condition, where a baby is born with a smaller head due to abnormal brain development.\u003c/p>\n\u003cp>State and local health officials offered recommendations to help prevent the spread of Zika virus.\u003c/p>\n\u003cp>Men who have traveled to an area where Zika virus is present should abstain from sex or use condoms with a partner who is pregnant or trying to become pregnant for the duration of the pregnancy, state health officials said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Women who want to get pregnant with a partner who has had exposure to Zika virus should talk to their doctor about the risks of Zika virus during pregnancy, state officials said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Delays BPA Warning So Low-Income People Won't Be Scared of Canned Food",
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"content": "\u003cp>California plans to delay state-required warnings on metal cans lined with the chemical BPA, arguing too-specific warnings could scare stores and shoppers in poor neighborhoods away from some of the only fruits and vegetables available — canned ones, officials said Thursday.\u003c/p>\n\u003cp>The decision and rationale of the California Environmental Protection Agency are angering some community and public-health groups.\u003c/p>\n\u003cp>It's \"ridiculous. It's paternalistic,\" said Martha Dina Arguello, executive director of Physicians for Social Responsibility-Los Angeles. \"I just can't imagine that it's a better idea not to let us know what's in our food.\"\u003c/p>\n\u003cp>The warnings are coming on line in California under the state's Proposition 65, a measure approved by voters in 1986 that requires businesses to notify the public about high levels of chemicals in products or places.\u003c/p>\n\u003cp>California officials decided last year to add BPA, or bisphenol A, to the list of about 800 other chemicals requiring Proposition 65 notices. Manufacturers use BPA in epoxy liners of some cans, bottles and jars.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The state based its action on a 2008 finding by the National Toxicology Program, which determined the chemical was an estrogen-like substance that could harm the female reproductive system at high levels.\u003c/p>\n\u003cp>That 2015 decision by California is controversial. The U.S. Food and Drug Administration banned BPA from baby bottles and sippy cups in 2012, but it says the level of BPA that leeches into food is safe otherwise. The federal agency also is awaiting the results of more studies.\u003c/p>\n\u003cp>Ordinarily, the state would either require manufacturers to put those warnings on the cans, or make grocers post signs on canned-goods shelves specifically warning that \"Brand X tomato sauce, Brand Y green beans\" have the targeted chemical in the can, said Allan Hirsch, chief deputy director of the state EPA's Office of Environmental Health Hazard Assessment.\u003c/p>\n\u003cp>For BPA, though, \"we think that would be kind of chaotic,\" the state official said. \"Retailers might react ... by just pulling canned and bottled foods off their shelves entirely,\" which would be bad news in neighborhoods without good grocery stores.\u003c/p>\n\u003cp>\"We would want to make sure that people, especially in low-income communities, still have access to canned fruits and vegetables. That's certainly better than not having access to them,\" the state official said.\u003c/p>\n\u003cp>Hirsch also acknowledged hearing \"some concern from retailers\" about how the warning is going to work.\u003c/p>\n\u003cp>Kathleen Roberts, executive director of the can industry's North American Metal Packaging Alliance, said Thursday that confusion \"from these warning signs could further limit healthy choices, particularly for low-income families in inner-city neighborhoods and rural communities.\"\u003c/p>\n\u003cp>Rather than require warnings for specific cans and other goods when the warning-requirement kicks in in May, the state plans to make merchants place general notices saying some cans for sale in the store have BPA.\u003c/p>\n\u003cp>State officials foresee requiring more specific notices after perhaps a year. That would give can manufacturers more time to label their cans and to see what ongoing medical studies find regarding safe and unsafe levels of the chemicals, Hirsch said.\u003c/p>\n\u003cp>It's the state's arguments about BPA and canned vegetables in so-called food deserts — neighborhoods too poor to attract top grocery chains — that offend the community groups.\u003c/p>\n\u003cp>\"California is willingly putting out the language ... excluding a whole sub-population of people from protection,\" said Jose T. Bravo, executive director of Just Transition Alliance, an environmental health and labor coalition in San Diego.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The community representatives say they plan to file protests before a final decision by another state agency that approves such regulatory changes.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California plans to delay state-required warnings on metal cans lined with the chemical BPA, arguing too-specific warnings could scare stores and shoppers in poor neighborhoods away from some of the only fruits and vegetables available — canned ones, officials said Thursday.\u003c/p>\n\u003cp>The decision and rationale of the California Environmental Protection Agency are angering some community and public-health groups.\u003c/p>\n\u003cp>It's \"ridiculous. It's paternalistic,\" said Martha Dina Arguello, executive director of Physicians for Social Responsibility-Los Angeles. \"I just can't imagine that it's a better idea not to let us know what's in our food.\"\u003c/p>\n\u003cp>The warnings are coming on line in California under the state's Proposition 65, a measure approved by voters in 1986 that requires businesses to notify the public about high levels of chemicals in products or places.\u003c/p>\n\u003cp>California officials decided last year to add BPA, or bisphenol A, to the list of about 800 other chemicals requiring Proposition 65 notices. Manufacturers use BPA in epoxy liners of some cans, bottles and jars.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The state based its action on a 2008 finding by the National Toxicology Program, which determined the chemical was an estrogen-like substance that could harm the female reproductive system at high levels.\u003c/p>\n\u003cp>That 2015 decision by California is controversial. The U.S. Food and Drug Administration banned BPA from baby bottles and sippy cups in 2012, but it says the level of BPA that leeches into food is safe otherwise. The federal agency also is awaiting the results of more studies.\u003c/p>\n\u003cp>Ordinarily, the state would either require manufacturers to put those warnings on the cans, or make grocers post signs on canned-goods shelves specifically warning that \"Brand X tomato sauce, Brand Y green beans\" have the targeted chemical in the can, said Allan Hirsch, chief deputy director of the state EPA's Office of Environmental Health Hazard Assessment.\u003c/p>\n\u003cp>For BPA, though, \"we think that would be kind of chaotic,\" the state official said. \"Retailers might react ... by just pulling canned and bottled foods off their shelves entirely,\" which would be bad news in neighborhoods without good grocery stores.\u003c/p>\n\u003cp>\"We would want to make sure that people, especially in low-income communities, still have access to canned fruits and vegetables. That's certainly better than not having access to them,\" the state official said.\u003c/p>\n\u003cp>Hirsch also acknowledged hearing \"some concern from retailers\" about how the warning is going to work.\u003c/p>\n\u003cp>Kathleen Roberts, executive director of the can industry's North American Metal Packaging Alliance, said Thursday that confusion \"from these warning signs could further limit healthy choices, particularly for low-income families in inner-city neighborhoods and rural communities.\"\u003c/p>\n\u003cp>Rather than require warnings for specific cans and other goods when the warning-requirement kicks in in May, the state plans to make merchants place general notices saying some cans for sale in the store have BPA.\u003c/p>\n\u003cp>State officials foresee requiring more specific notices after perhaps a year. That would give can manufacturers more time to label their cans and to see what ongoing medical studies find regarding safe and unsafe levels of the chemicals, Hirsch said.\u003c/p>\n\u003cp>It's the state's arguments about BPA and canned vegetables in so-called food deserts — neighborhoods too poor to attract top grocery chains — that offend the community groups.\u003c/p>\n\u003cp>\"California is willingly putting out the language ... excluding a whole sub-population of people from protection,\" said Jose T. Bravo, executive director of Just Transition Alliance, an environmental health and labor coalition in San Diego.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The community representatives say they plan to file protests before a final decision by another state agency that approves such regulatory changes.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"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.",
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"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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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"tagline": "Politics from a personal perspective",
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"radiolab": {
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"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
"info": "Sold Out: Rethinking Housing in America",
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"info": "",
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"tech-nation": {
"id": "tech-nation",
"title": "Tech Nation Radio Podcast",
"info": "Tech Nation is a weekly public radio program, hosted by Dr. Moira Gunn. Founded in 1993, it has grown from a simple interview show to a multi-faceted production, featuring conversations with noted technology and science leaders, and a weekly science and technology-related commentary.",
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"ted-radio-hour": {
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"title": "TED Radio Hour",
"info": "The TED Radio Hour is a journey through fascinating ideas, astonishing inventions, fresh approaches to old problems, and new ways to think and create.",
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