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"content": "\u003cp>The Trump administration — reversing guidelines put in place under President Barack Obama — is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.\u003c/p>\n\u003cp>The shift in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association, the industry’s main trade group, has complained that under Obama, federal inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.\u003c/p>\n\u003cp>“It is critical that we have relief,” Mark Parkinson, the group’s president, wrote in a letter to then-President-elect Donald Trump in December 2016.\u003c/p>\n\u003cp>Since 2013, nearly 6,500 nursing homes — 4 of every 10 — have been cited at least once for a serious violation, federal records show. Medicare has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.\u003c/p>\n\u003cp>The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.\u003c/p>\n\u003cp>Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), said in a statement that unnecessary regulation was the main concern that health care providers raised with officials.\u003c/p>\n\u003cp>“Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.\u003c/p>\n\u003cp>But advocates for nursing-home residents say the revised penalties are weakening a valuable patient-safety tool.\u003c/p>\n\u003cp>“They’ve pretty much emasculated enforcement, which was already weak,” said Toby Edelman, a senior attorney at the Center for Medicare Advocacy.\u003c/p>\n\u003cp>Medicare has different ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. Or it can deny payments for new admissions.\u003c/p>\n\u003cp>The average fine in recent years has been $33,453, but 531 nursing homes amassed combined federal fines above $100,000, records show. In 2016, Congress \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Civil-Monetary-Penalties-Annual-Adjustments.html\" target=\"_blank\" rel=\"noopener\">increased the fines\u003c/a> to factor in several years of inflation that had not been accounted for previously.\u003c/p>\n\u003cp>The new rules have been instituted gradually throughout the year.\u003c/p>\n\u003cp>In October, \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-01.pdf\" target=\"_blank\" rel=\"noopener\">CMS discouraged\u003c/a> its regional offices from levying fines, even in the most serious health violations, if the error was a “one-time mistake.” The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-37.pdf\" target=\"_blank\" rel=\"noopener\">July memo\u003c/a> from CMS discouraged the directors of state agencies that survey nursing homes from issuing daily fines for violations that began before an inspection, favoring one-time fines instead. Daily fines remain the recommended approach for major violations discovered during an inspection.\u003c/p>\n\u003cp>Dr. David Gifford, the American Health Care Association’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.\u003c/p>\n\u003cp>“What was happening is you were seeing massive fines accumulating because they were applying them on a per-day basis retrospectively,” Gifford said.\u003c/p>\n\u003cp>But the change means that some nursing homes could be sheltered from fines above the maximum per-instance fine of $20,965, even for egregious mistakes.\u003c/p>\n\u003cp>In September 2016, for instance, health inspectors \u003ca href=\"https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.aspx?ID=146064&SURVEYDATE=09/21/2016&INSPTYPE=CMPL&Inspn=HEALTH&profTab=1&loc=DECATUR%2C%20IL&lat=39.8403147&lng=-88.9548001&name=LINCOLN%20MANOR&Distn=2.7\" target=\"_blank\" rel=\"noopener\">faulted Lincoln Manor\u003c/a>, a nursing home in Decatur, Ill., for failing to monitor and treat the wound of a patient whose implanted pain-medication pump gradually slipped over eight days through a ruptured suture and protruded from her abdomen. The patient died.\u003c/p>\n\u003cp>CMS fined Lincoln Manor $282,954, including $10,091 a day for 28 days, from the time the nursing home noticed the problem with the wound until supervisors had retrained nurses to avoid similar errors. An administrative law judge called the penalties “quite modest” given the “appalling” care.\u003c/p>\n\u003cp>The fines were issued before the new guidelines took effect; if the agency had issued a one-time fine, the maximum would have been less than $21,000.\u003c/p>\n\u003cp>Lincoln Manor closed in September. Its owner could not be reached for comment, and his lawyer did not respond to an interview request.\u003c/p>\n\u003cp>Advocates for nursing home residents say that relaxing penalties threatens to undo progress at deterring wrongdoing. Janet Wells, a consultant for California Advocates for Nursing Home Reform, said the changes come as “some egregious violations and injuries to residents are being penalized — finally — at a level that gets the industry’s attention and isn’t just the cost of doing business.”\u003c/p>\n\u003cp>In November, the Trump administration exempted nursing homes that violate \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-04.pdf\" target=\"_blank\" rel=\"noopener\">eight new safety rules\u003c/a> from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.\u003c/p>\n\u003cp>Rodney Whitlock, a health policy consultant and former Republican Senate staffer, said health inspectors “are out there looking for opportunities to show that the nursing homes are not living up to some extremely tight standards.” He said while the motivation for tough regulation was understandable, “the fines don’t make it easier to hire people and doesn’t make it easier to stay in business.”\u003c/p>\n\u003cp>In June, CMS rescinded another Obama administration action that banned nursing homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than going to court.\u003c/p>\n\u003cp>“We publish nearly 11,000 pages of regulation every year,” the agency’s administrator, Seema Verma, said in \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-30.html\" target=\"_blank\" rel=\"noopener\">a speech in October\u003c/a>. That paperwork is “taking doctors away from what matters most: patients.”\u003c/p>\n\u003cp>Janine Finck-Boyle, director of health regulations and policy at LeadingAge, a group of nonprofit nursing homes and other entities that care for older people, said the group’s members had been struggling to cope with regulations.\u003c/p>\n\u003cp>“If you’re a 50-bed rural facility out West or in the Dakotas,” she said, “you don’t have the resources to get everything done from A to Z.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a> which is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Trump administration — reversing guidelines put in place under President Barack Obama — is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.\u003c/p>\n\u003cp>The shift in the Medicare program’s penalty protocols was requested by the nursing home industry. The American Health Care Association, the industry’s main trade group, has complained that under Obama, federal inspectors focused excessively on catching wrongdoing rather than helping nursing homes improve.\u003c/p>\n\u003cp>“It is critical that we have relief,” Mark Parkinson, the group’s president, wrote in a letter to then-President-elect Donald Trump in December 2016.\u003c/p>\n\u003cp>Since 2013, nearly 6,500 nursing homes — 4 of every 10 — have been cited at least once for a serious violation, federal records show. Medicare has fined two-thirds of those homes. Common citations include failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores.\u003c/p>\n\u003cp>The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The change in policy aligns with Trump’s promise to reduce bureaucracy, regulation and government intervention in business.\u003c/p>\n\u003cp>Dr. Kate Goodrich, director of clinical standards and quality at the Centers for Medicare & Medicaid Services (CMS), said in a statement that unnecessary regulation was the main concern that health care providers raised with officials.\u003c/p>\n\u003cp>“Rather than spending quality time with their patients, the providers are spending time complying with regulations that get in the way of caring for their patients and doesn’t increase the quality of care they provide,” Goodrich said.\u003c/p>\n\u003cp>But advocates for nursing-home residents say the revised penalties are weakening a valuable patient-safety tool.\u003c/p>\n\u003cp>“They’ve pretty much emasculated enforcement, which was already weak,” said Toby Edelman, a senior attorney at the Center for Medicare Advocacy.\u003c/p>\n\u003cp>Medicare has different ways of applying penalties. It can impose a specific fine for a particular violation. It can assess a fine for each day that a nursing home was in violation. Or it can deny payments for new admissions.\u003c/p>\n\u003cp>The average fine in recent years has been $33,453, but 531 nursing homes amassed combined federal fines above $100,000, records show. In 2016, Congress \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Civil-Monetary-Penalties-Annual-Adjustments.html\" target=\"_blank\" rel=\"noopener\">increased the fines\u003c/a> to factor in several years of inflation that had not been accounted for previously.\u003c/p>\n\u003cp>The new rules have been instituted gradually throughout the year.\u003c/p>\n\u003cp>In October, \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-01.pdf\" target=\"_blank\" rel=\"noopener\">CMS discouraged\u003c/a> its regional offices from levying fines, even in the most serious health violations, if the error was a “one-time mistake.” The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-37.pdf\" target=\"_blank\" rel=\"noopener\">July memo\u003c/a> from CMS discouraged the directors of state agencies that survey nursing homes from issuing daily fines for violations that began before an inspection, favoring one-time fines instead. Daily fines remain the recommended approach for major violations discovered during an inspection.\u003c/p>\n\u003cp>Dr. David Gifford, the American Health Care Association’s senior vice president for quality, said daily fines were intended to prompt quick remedies but were pointless when applied to past errors that had already been fixed by the time inspectors discovered them.\u003c/p>\n\u003cp>“What was happening is you were seeing massive fines accumulating because they were applying them on a per-day basis retrospectively,” Gifford said.\u003c/p>\n\u003cp>But the change means that some nursing homes could be sheltered from fines above the maximum per-instance fine of $20,965, even for egregious mistakes.\u003c/p>\n\u003cp>In September 2016, for instance, health inspectors \u003ca href=\"https://www.medicare.gov/nursinghomecompare/InspectionReportDetail.aspx?ID=146064&SURVEYDATE=09/21/2016&INSPTYPE=CMPL&Inspn=HEALTH&profTab=1&loc=DECATUR%2C%20IL&lat=39.8403147&lng=-88.9548001&name=LINCOLN%20MANOR&Distn=2.7\" target=\"_blank\" rel=\"noopener\">faulted Lincoln Manor\u003c/a>, a nursing home in Decatur, Ill., for failing to monitor and treat the wound of a patient whose implanted pain-medication pump gradually slipped over eight days through a ruptured suture and protruded from her abdomen. The patient died.\u003c/p>\n\u003cp>CMS fined Lincoln Manor $282,954, including $10,091 a day for 28 days, from the time the nursing home noticed the problem with the wound until supervisors had retrained nurses to avoid similar errors. An administrative law judge called the penalties “quite modest” given the “appalling” care.\u003c/p>\n\u003cp>The fines were issued before the new guidelines took effect; if the agency had issued a one-time fine, the maximum would have been less than $21,000.\u003c/p>\n\u003cp>Lincoln Manor closed in September. Its owner could not be reached for comment, and his lawyer did not respond to an interview request.\u003c/p>\n\u003cp>Advocates for nursing home residents say that relaxing penalties threatens to undo progress at deterring wrongdoing. Janet Wells, a consultant for California Advocates for Nursing Home Reform, said the changes come as “some egregious violations and injuries to residents are being penalized — finally — at a level that gets the industry’s attention and isn’t just the cost of doing business.”\u003c/p>\n\u003cp>In November, the Trump administration exempted nursing homes that violate \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-18-04.pdf\" target=\"_blank\" rel=\"noopener\">eight new safety rules\u003c/a> from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.\u003c/p>\n\u003cp>Rodney Whitlock, a health policy consultant and former Republican Senate staffer, said health inspectors “are out there looking for opportunities to show that the nursing homes are not living up to some extremely tight standards.” He said while the motivation for tough regulation was understandable, “the fines don’t make it easier to hire people and doesn’t make it easier to stay in business.”\u003c/p>\n\u003cp>In June, CMS rescinded another Obama administration action that banned nursing homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than going to court.\u003c/p>\n\u003cp>“We publish nearly 11,000 pages of regulation every year,” the agency’s administrator, Seema Verma, said in \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-10-30.html\" target=\"_blank\" rel=\"noopener\">a speech in October\u003c/a>. That paperwork is “taking doctors away from what matters most: patients.”\u003c/p>\n\u003cp>Janine Finck-Boyle, director of health regulations and policy at LeadingAge, a group of nonprofit nursing homes and other entities that care for older people, said the group’s members had been struggling to cope with regulations.\u003c/p>\n\u003cp>“If you’re a 50-bed rural facility out West or in the Dakotas,” she said, “you don’t have the resources to get everything done from A to Z.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Anita Willis says the social worker offered her a painful choice: She could either leave the San Jose, Calif., nursing home where she’d spent a month recovering from a stroke — or come up with $336 a day to stay on.\u003c/p>\n\u003cp>She had until midnight to decide.\u003c/p>\n\u003cp>Willis’ Medicaid managed-care plan had told the home that it was cutting off payment because she no longer qualified for such a high level of care. If Willis, 58, stayed and paid the daily rate, her Social Security disability money would run out in three days. But if she left, she had nowhere to go. She’d recently become homeless after a breakup and said she couldn’t even afford a room-and-board setting.\u003c/p>\n\u003cp>In tears, she said, she agreed to leave. Thus began a months-long odyssey from budget motels to acquaintances’ couches to hospital ERs — at least five emergency visits in all, she said. Sometimes, her 25-year-old daughter drove down from Sacramento, and Willis slept in her daughter’s car.\u003c/p>\n\u003cp>“They kicked me out in the cold,” said Willis, a former Head Start teacher.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates.\u003c/p>\n\u003cp>In California alone, such complaints have jumped 70 percent in five years, reaching 1,504 last year, said Joseph Rodrigues, the state-employed Long-Term Care Ombudsman, who for 15 years has overseen local ombudsman programs, which are responsible for resolving consumer complaints.\u003c/p>\n\u003cp>Around the country, ombudsmen say many patients like Willis end up with no permanent housing or regular medical care after being discharged. Even when the discharges are deemed legal, these ombudsmen say, they often are unethical.\u003c/p>\n\u003cp>“It’s a growing problem,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association. Coleman says the practice stems from skilled nursing facilities’ desire for better compensation for their services and from the shortage of other affordable long-term care options that might absorb less severe cases.\u003c/p>\n\u003cp>In Willis’ case, she ultimately lost her appeal to return to the nursing home, Courtyard Care Center. A state hearing judge determined that she had left the home voluntarily because she refused the opportunity to pay to remain there.\u003c/p>\n\u003cp>Top administrators at Sava Senior Care, which owns Courtyard, did not return repeated calls for comment.\u003c/p>\n\u003cp>Among other recent cases of allegedly improper discharges:\u003c/p>\n\u003cul>\n\u003cli>In October, California’s attorney general moved to prevent a Bakersfield nursing home administrator from working with elderly and disabled people, while he awaits trial on charges of elder abuse and wrongful discharge. State prosecutors said one patient was falsely informed that she owed the home money, then sent to an independent living center even though she could not “walk or toilet on her own.” The administrator did not return messages left at the nursing home.\u003c/li>\n\u003cli>A \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\" target=\"_blank\" rel=\"noopener\">pending lawsuit\u003c/a> by Maryland’s attorney general alleges a nursing home chain, Neiswanger Management Services (NMS), illegally evicted residents, sending them to homeless shelters or other inadequate facilities to free up bed space for higher-paying patients. NMS countersued state regulators, alleging they are trying to drive the chain out of business.\u003c/li>\n\u003cli>Last month, a 73-year-old woman with diabetes and heart failure \u003ca href=\"http://canhr.org/newsroom/newdev_archive/2017/PDFs/Complaint-JohnsonMoore-Dumping.pdf\" target=\"_blank\" rel=\"noopener\">sued a Fresno, Calif., nursing home\u003c/a> for allegedly \u003ca href=\"http://www.fresnobee.com/news/local/article182618836.html\" target=\"_blank\" rel=\"noopener\">leaving her with an open wound on a sidewalk\u003c/a> in front of a relative’s home. The suit said conditions in the residence were unsafe and a family member refused to allow her inside. The state cited the home in July and issued a $20,000 fine.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, not all complaints or lawsuits are well-founded. Federal law allows a nursing home to discharge or evict a patient when it cannot meet the resident’s needs or the person no longer requires services; if the resident endangers the health and safety of other individuals; or if the patient has failed, after reasonable and appropriate notice, to pay.\u003c/p>\n\u003cp>The law also generally requires a home to provide 30 days’ notice before discharging a patient involuntarily and requires all discharges be safe and orderly.\u003c/p>\n\u003cp>Deborah Pacyna, spokeswoman for the California Association of Health Facilities, a trade organization that represents nursing homes, questions why nursing homes should be responsible for providing a safety net for the indigent and homeless.\u003c/p>\n\u003cp>“Nursing home residents reflect society,” she said in a written statement. “Some nursing home residents live in homeless shelters or hotels. They may request that they go back ‘home,’ or to their local shelter or hotel upon discharge. We must honor their choices as long as their needs are met.”\u003c/p>\n\u003cp>Pacyna also noted that eviction and discharge complaints represent a tiny fraction of the hundreds of thousands of residents released from the state’s nursing homes each year.\u003c/p>\n\u003cp>Nationally, discharge and eviction complaints have remained more or less steady in recent years after rising significantly between 2000 and 2007, according to data collected by the federal government. Still, these complaints remain the top grievance reported to nursing home ombudsmen as the number of overall complaints about everything from abuse to access to information has dropped in the past decade.\u003c/p>\n\u003cp>The rate of complaints can vary considerably by state. Jamie Freschi, the Illinois state ombudsman, says discharge and eviction complaints have more than doubled in her state since 2011.\u003c/p>\n\u003cp>She recalled one wheelchair-bound nursing resident who was in severe pain from osteoarthritis, scoliosis and fibromyalgia when she was discharged from a nursing home and sent to a homeless shelter. After the shelter rejected her because it could not accommodate her wheelchair, the resident went to a motel, which kicked her out when she ran out of money. She has since cycled between the emergency room and the streets, Freschi said.\u003c/p>\n\u003cp>“It’s an example of a really, really broken system, all the way around,” Freschi said.\u003c/p>\n\u003cp>Advocates say such decisions are often money-driven: Medicare covers patients for just a short time after they are released from hospitals. After that, these critics say, many nursing homes don’t want to accept the lower rates paid by Medicaid, the public insurance program for low-income residents.\u003c/p>\n\u003cp>Even when they appeal and win, advocates say, it doesn’t always help the patient. The Centers for Medicare & Medicaid Services has advised California on two occasions — including this past summer — that it must enforce decisions from appeals hearings. (The state contends that it uses a variety of strategies to enforce the law.)\u003c/p>\n\u003cp>Last month, the California Long-Term Care Ombudsman Association joined with the legal wing of the AARP Foundation to \u003ca href=\"https://www.documentcloud.org/documents/4199718-2017-10-02-Complaint.html\" target=\"_blank\" rel=\"noopener\">sue a Sacramento nursing home\u003c/a>, alleging it had improperly discharged an 83-year-old woman with Alzheimer’s — requiring the nursing home to readmit her.\u003c/p>\n\u003cp>“The facilities are getting the message that they don’t have to follow the rules here, so they’re emboldened,” said Matt Borden, a San Francisco attorney helping with the lawsuit.\u003c/p>\n\u003cp>Willis and her advocates were convinced that Courtyard Care Center broke the rules in her case.\u003c/p>\n\u003cp>Willis “did not leave Courtyard ‘voluntarily’ in just about any sense of the word,” said Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform.\u003c/p>\n\u003cp>At a hearing in April, held at the nursing home and attended by a reporter, Chicotel and an ombudsman argued that Willis’ discharge violated legal requirements, including lack of written notice. They asked that she be immediately readmitted.\u003c/p>\n\u003cp>According to hearing documents, Willis’ documented medical problems were many: an aneurysm, an ulcer, difficulty walking, muscle weakness, gastritis, anemia and heart and kidney disease. During her stay at the nursing home, she said, she’d fallen and hit her head while visiting the doctor, resulting in a severe concussion.\u003c/p>\n\u003cp>For their part, Courtyard staffers explained that Medicaid wouldn’t cover Willis anymore based on their assessment of her condition. They said she had “almost returned to her prior level of functioning.”\u003c/p>\n\u003cp>During the hearing, Willis repeatedly told those in attendance that she felt dizzy and nauseated. Her head pounded. “I’m not good,” she said. Afterward, she begged for a ride to the emergency room, where she was admitted with a torn aorta and bleeding ulcer.\u003c/p>\n\u003cp>She was still in the hospital when the hearing officer issued her decision a few days later. Eventually, she was released to another nursing home, which also discharged her after a month, she said. Then she resumed sleeping on friends’ couches. She chose not to file another appeal.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“This time in my life,” Willis said, “it’s very discouraging.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Anita Willis says the social worker offered her a painful choice: She could either leave the San Jose, Calif., nursing home where she’d spent a month recovering from a stroke — or come up with $336 a day to stay on.\u003c/p>\n\u003cp>She had until midnight to decide.\u003c/p>\n\u003cp>Willis’ Medicaid managed-care plan had told the home that it was cutting off payment because she no longer qualified for such a high level of care. If Willis, 58, stayed and paid the daily rate, her Social Security disability money would run out in three days. But if she left, she had nowhere to go. She’d recently become homeless after a breakup and said she couldn’t even afford a room-and-board setting.\u003c/p>\n\u003cp>In tears, she said, she agreed to leave. Thus began a months-long odyssey from budget motels to acquaintances’ couches to hospital ERs — at least five emergency visits in all, she said. Sometimes, her 25-year-old daughter drove down from Sacramento, and Willis slept in her daughter’s car.\u003c/p>\n\u003cp>“They kicked me out in the cold,” said Willis, a former Head Start teacher.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Complaints about allegedly improper evictions and discharges from nursing homes are on the rise in California, Illinois and other states, according to government data. These concerns are echoed in lawsuits and by ombudsmen and consumer advocates.\u003c/p>\n\u003cp>In California alone, such complaints have jumped 70 percent in five years, reaching 1,504 last year, said Joseph Rodrigues, the state-employed Long-Term Care Ombudsman, who for 15 years has overseen local ombudsman programs, which are responsible for resolving consumer complaints.\u003c/p>\n\u003cp>Around the country, ombudsmen say many patients like Willis end up with no permanent housing or regular medical care after being discharged. Even when the discharges are deemed legal, these ombudsmen say, they often are unethical.\u003c/p>\n\u003cp>“It’s a growing problem,” said Leza Coleman, executive director of the California Long-Term Care Ombudsman Association. Coleman says the practice stems from skilled nursing facilities’ desire for better compensation for their services and from the shortage of other affordable long-term care options that might absorb less severe cases.\u003c/p>\n\u003cp>In Willis’ case, she ultimately lost her appeal to return to the nursing home, Courtyard Care Center. A state hearing judge determined that she had left the home voluntarily because she refused the opportunity to pay to remain there.\u003c/p>\n\u003cp>Top administrators at Sava Senior Care, which owns Courtyard, did not return repeated calls for comment.\u003c/p>\n\u003cp>Among other recent cases of allegedly improper discharges:\u003c/p>\n\u003cul>\n\u003cli>In October, California’s attorney general moved to prevent a Bakersfield nursing home administrator from working with elderly and disabled people, while he awaits trial on charges of elder abuse and wrongful discharge. State prosecutors said one patient was falsely informed that she owed the home money, then sent to an independent living center even though she could not “walk or toilet on her own.” The administrator did not return messages left at the nursing home.\u003c/li>\n\u003cli>A \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\" target=\"_blank\" rel=\"noopener\">pending lawsuit\u003c/a> by Maryland’s attorney general alleges a nursing home chain, Neiswanger Management Services (NMS), illegally evicted residents, sending them to homeless shelters or other inadequate facilities to free up bed space for higher-paying patients. NMS countersued state regulators, alleging they are trying to drive the chain out of business.\u003c/li>\n\u003cli>Last month, a 73-year-old woman with diabetes and heart failure \u003ca href=\"http://canhr.org/newsroom/newdev_archive/2017/PDFs/Complaint-JohnsonMoore-Dumping.pdf\" target=\"_blank\" rel=\"noopener\">sued a Fresno, Calif., nursing home\u003c/a> for allegedly \u003ca href=\"http://www.fresnobee.com/news/local/article182618836.html\" target=\"_blank\" rel=\"noopener\">leaving her with an open wound on a sidewalk\u003c/a> in front of a relative’s home. The suit said conditions in the residence were unsafe and a family member refused to allow her inside. The state cited the home in July and issued a $20,000 fine.\u003c/li>\n\u003c/ul>\n\u003cp>Of course, not all complaints or lawsuits are well-founded. Federal law allows a nursing home to discharge or evict a patient when it cannot meet the resident’s needs or the person no longer requires services; if the resident endangers the health and safety of other individuals; or if the patient has failed, after reasonable and appropriate notice, to pay.\u003c/p>\n\u003cp>The law also generally requires a home to provide 30 days’ notice before discharging a patient involuntarily and requires all discharges be safe and orderly.\u003c/p>\n\u003cp>Deborah Pacyna, spokeswoman for the California Association of Health Facilities, a trade organization that represents nursing homes, questions why nursing homes should be responsible for providing a safety net for the indigent and homeless.\u003c/p>\n\u003cp>“Nursing home residents reflect society,” she said in a written statement. “Some nursing home residents live in homeless shelters or hotels. They may request that they go back ‘home,’ or to their local shelter or hotel upon discharge. We must honor their choices as long as their needs are met.”\u003c/p>\n\u003cp>Pacyna also noted that eviction and discharge complaints represent a tiny fraction of the hundreds of thousands of residents released from the state’s nursing homes each year.\u003c/p>\n\u003cp>Nationally, discharge and eviction complaints have remained more or less steady in recent years after rising significantly between 2000 and 2007, according to data collected by the federal government. Still, these complaints remain the top grievance reported to nursing home ombudsmen as the number of overall complaints about everything from abuse to access to information has dropped in the past decade.\u003c/p>\n\u003cp>The rate of complaints can vary considerably by state. Jamie Freschi, the Illinois state ombudsman, says discharge and eviction complaints have more than doubled in her state since 2011.\u003c/p>\n\u003cp>She recalled one wheelchair-bound nursing resident who was in severe pain from osteoarthritis, scoliosis and fibromyalgia when she was discharged from a nursing home and sent to a homeless shelter. After the shelter rejected her because it could not accommodate her wheelchair, the resident went to a motel, which kicked her out when she ran out of money. She has since cycled between the emergency room and the streets, Freschi said.\u003c/p>\n\u003cp>“It’s an example of a really, really broken system, all the way around,” Freschi said.\u003c/p>\n\u003cp>Advocates say such decisions are often money-driven: Medicare covers patients for just a short time after they are released from hospitals. After that, these critics say, many nursing homes don’t want to accept the lower rates paid by Medicaid, the public insurance program for low-income residents.\u003c/p>\n\u003cp>Even when they appeal and win, advocates say, it doesn’t always help the patient. The Centers for Medicare & Medicaid Services has advised California on two occasions — including this past summer — that it must enforce decisions from appeals hearings. (The state contends that it uses a variety of strategies to enforce the law.)\u003c/p>\n\u003cp>Last month, the California Long-Term Care Ombudsman Association joined with the legal wing of the AARP Foundation to \u003ca href=\"https://www.documentcloud.org/documents/4199718-2017-10-02-Complaint.html\" target=\"_blank\" rel=\"noopener\">sue a Sacramento nursing home\u003c/a>, alleging it had improperly discharged an 83-year-old woman with Alzheimer’s — requiring the nursing home to readmit her.\u003c/p>\n\u003cp>“The facilities are getting the message that they don’t have to follow the rules here, so they’re emboldened,” said Matt Borden, a San Francisco attorney helping with the lawsuit.\u003c/p>\n\u003cp>Willis and her advocates were convinced that Courtyard Care Center broke the rules in her case.\u003c/p>\n\u003cp>Willis “did not leave Courtyard ‘voluntarily’ in just about any sense of the word,” said Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform.\u003c/p>\n\u003cp>At a hearing in April, held at the nursing home and attended by a reporter, Chicotel and an ombudsman argued that Willis’ discharge violated legal requirements, including lack of written notice. They asked that she be immediately readmitted.\u003c/p>\n\u003cp>According to hearing documents, Willis’ documented medical problems were many: an aneurysm, an ulcer, difficulty walking, muscle weakness, gastritis, anemia and heart and kidney disease. During her stay at the nursing home, she said, she’d fallen and hit her head while visiting the doctor, resulting in a severe concussion.\u003c/p>\n\u003cp>For their part, Courtyard staffers explained that Medicaid wouldn’t cover Willis anymore based on their assessment of her condition. They said she had “almost returned to her prior level of functioning.”\u003c/p>\n\u003cp>During the hearing, Willis repeatedly told those in attendance that she felt dizzy and nauseated. Her head pounded. “I’m not good,” she said. Afterward, she begged for a ride to the emergency room, where she was admitted with a torn aorta and bleeding ulcer.\u003c/p>\n\u003cp>She was still in the hospital when the hearing officer issued her decision a few days later. Eventually, she was released to another nursing home, which also discharged her after a month, she said. Then she resumed sleeping on friends’ couches. She chose not to file another appeal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?",
"title": "There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cspan style=\"font-weight: 400\">A small purple-and-white sign hangs on the waiting room wall in Highland Hospital’s emergency department in Oakland.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In English and Spanish it reads: \"Our ER’s policy for patients 18 to 75 years old: HIV and Hepatitis C tests are done once a year if you are having other blood tests.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s a policy that emergency room physician Doug White and his colleagues instituted four years ago. Since up to half of people with hepatitis C do not know they are infected, testing is the first step toward eradicating the deadly, blood-borne virus, he said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C is the leading cause of liver failure in the U.S.,\" White said. \"It's the number one cause of liver cancer. Number one cause of liver transplants. It’s a phenomenon of epic proportion.\"\u003c/span>\u003c/p>\n\u003cp>[audio src=\"https://www.kqed.org/.stream/anon/radio/tcr/2017/11/KlivansHepCCure.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28161_IMG_7054-qut-1180x885.jpg\" Title=\"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?\" program=\"The California Report\"]\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/hepatitis/hcv/cfaq.htm\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">B\u003c/span>\u003cspan style=\"font-weight: 400\">etween 2.7 million and 3.9 million Americans have hepatitis C\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, according to the Centers for Disease Control and Prevention (CDC). The virus can remain dormant for years, and by the time symptoms arise, the organs may already be damaged. Except for flu, \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/hcv-mortality.html\" target=\"_blank\" rel=\"noopener\">hepatitis C \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">takes more lives than all other CDC-tracked infectious diseases \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">combined -- and that includes HIV, tuberculosis and other more prominent diseases.\u003c/span>\u003c/i> \u003cspan style=\"font-weight: 400\">In 2015,\u003c/span>\u003ca href=\"https://www.cdc.gov/hepatitis/statistics/2015surveillance/commentary.htm\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">19,629 Americans died\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> from hepatitis C, mostly from liver disease caused by the virus. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For years the few treatments for hepatitis C had severe side effects and were not very effective at eliminating the virus from the body. But a new generation of powerful drugs came out in late 2013. These drugs have minimal side effects and usually require taking just one pill a day for two to three months. The cure rate is more than 90 percent. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Given this powerful new option, it’s possible to\u003c/span>\u003ca href=\"http://nationalacademies.org/hmd/Reports/2016/Eliminating-the-Public-Health-Problem-of-Hepatitis-B-and-C-in-the-US.aspx\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">eliminate hepatitis C as a public health threat in the U.S. by 2030\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, researchers say. But social and financial barriers remain, so it would take a concerted effort by government, health plans, doctors and hospitals.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dr. White hopes Highland Hospital can be a leader in the fight, and a model for other hospitals tackling the hepatitis C epidemic. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C has gone from a disease that I had no incentive to look for to diagnose, because I couldn't do anything about it, to essentially a curable disease with treatment that's well tolerated,\" White said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Highland staffers test nearly everyone who comes to the ER and gets blood drawn. They've built a robust electronic medical system that reminds medical staff to test for hepatitis C when doing other blood tests, as long as the patient hasn't had this test in the past year. Highland was one of the first ERs to test for hepatitis C like this nationwide. That helps flag infections among low-income or undocumented patients who use the ER for primary care. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_362079\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362079\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg\" alt=\"Dr. Doug White points to tubes used for Hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Doug White points to tubes used for hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">And the work doesn't end in the ER. If patients test positive, they get a call or visit from Mae Petti.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Petti has a desk a few floors above the emergency room. She spends hours making phone call after phone call. In her friendly, polite but insistent manner, she persists until she speaks with every patient on her list. As Highland's hepatitis C linkage coordinator, Petti will contact patients again and again until they come in to get follow-up care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Few hospitals have someone like Petti -- her position at Highland is grant-funded. And her work is paying off: Highland has doubled the number of people who return for follow-up appointments. Now, patients can start getting treated for hepatitis C in as soon as two weeks. Previously, it took six months after a positive test before a patient began treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>San Francisco's Mission to Stamp out the Virus\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Across the bay, San Francisco has its own approach to the problem. A group there has been addressing hepatitis C since former Mayor Gavin Newsom assigned a specific \u003c/span>\u003ca href=\"http://sfhepc.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">task force\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to the issue in 2009. The group’s mission was first to recommend how the city should address hepatitis C. These days, they believe the threat of hepatitis C can be stamped out, and they think San Francisco is the place to do it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At a recent task force gathering at San Francisco’s Department of Public Health, doctors, public health workers and many former hepatitis C patients -- now cured -- took their seats around a table.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After a dinner of pizza and salad, San Francisco’s viral hepatitis coordinator, Katie Burk, launched into a presentation. She listed reasons why she thinks San Francisco is a great candidate for elimination. First, she said, the city of San Francisco is small.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That matters when you’re trying to grab folks from all parts of the city, and make sure they’re getting the care they need,\" Burk said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And there’s a historical commitment to fighting disease here.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"We have this really incredible HIV program infrastructure in San Francisco,\" she said. \"We've built a lot of what we've done with hepatitis C sort of on the back of that program, and learned from a lot of our successes and challenges.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Hepatitis C is transmitted by blood -- and these days most of that happens through shared needles. Stopping the spread of the virus is therefore inextricably connected with efforts to end addiction to injectable drugs. San Francisco has places to exchange dirty syringes for clean ones, and plenty of programs and clinics offer “medication-assisted treatment” -- usually using buprenorphine, which helps people addicted to heroin and other opioids kick the habit. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco has another weapon too: a coalition specifically devoted to hepatitis C elimination, called \u003c/span>\u003ca href=\"http://www.endhepcsf.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">End Hep C SF\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It launched in 2016. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The End Hep C SF coalition has created something that experts consider crucial for the elimination of hepatitis C: an accurate estimate of how many residents harbor the virus, whether they are aware of it or not. In San Francisco, the current estimate is 12,000 people. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s unusual for a city to have a number like that to work with, because typically public health departments know only the number of people who have recently tested positive for hepatitis C. But San Francisco officials have gone farther: subtracting estimates of people who have been cured, died or moved away. They have calculated how many people probably have the virus, but have yet to be diagnosed.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Having that estimate is exciting, according to public health consultant Shelley Facente, who was also at the meeting, because it will allow the city to set goals of how many people to treat each year, and can offer an idea of when hepatitis C can largely be wiped out. The data have also helped identify target groups that have disproportionately high rates of hepatitis C in San Francisco, like transgender women. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Facente said roughly 4,500 San Franciscans already have been cured, using the new class of treatments for hepatitis C. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That means this is doable,\" Facente said, referring to elimination. \"We can really make this happen. It's very exciting that we've already made such progress. And now that we have even more information about what we need to do and where we need to go, it's even going to get better from here.\"\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Remaining Barriers to Elimination\u003c/strong>\u003c/p>\n\u003cp>Back at Highland Hospital, patient June Bullock had an appointment to pick up a refill of pills for his hepatitis C treatment. He met with physician assistant Amy Smith, who guides Highland patients through the treatment. Smith handed Bullock his last pack of pills and asked if he had any questions. His wife, Alfreda, was the one who spoke up.\u003c/p>\n\u003cfigure id=\"attachment_362085\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362085\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg\" alt=\"June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"My daughter says nobody can drink behind him out of a straw,\" Alfreda Bullock said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"No,\" Smith replied. \"That’s not true.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There’s a whole bunch of stuff going on, you know what I’m saying?\" Bullock said, explaining she’d heard a lot of misinformation about the virus.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Smith took the blame. \"Yeah. Well, I’m sorry we haven’t covered that.\" Smith then reviewed for them how hepatitis C is spread.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Research shows that to really curb hepatitis C, it takes a program like Highland’s: test widely, and then treat aggressively.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But, new hepatitis C infections still increased in California by 5.5 percent between 2011 and 2015, according to the state Department of Public Health.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s frustrating for people like Smith, who has seen many people get cured.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There are a lot of good people out there doing good work,\" she said. \"I just don’t think all the pieces are in place just yet.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Unaffordable drugs, for instance, are still one of the biggest barriers to treatment, Smith said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The cheapest available drug retails at about $26,000 for a course that ranges from two to four months. Others can cost as much as $133,400. While insurance companies often negotiate lower prices, some have still tried to control costs by instituting limits on who qualifies for treatment. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Another problem is the nationwide opioid epidemic, which includes heroin abuse, often via needle. Many experts say that’s why hepatitis C infections are rising among people under 30 -- although hepatitis C has traditionally been considered a disease of the baby boomers. This older generation grew up before the virus was identified, let alone subject to screening in the blood supply. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some advocates say the fight against hepatitis C is especially difficult because society places little value on the lives of the people who tend to get the virus -- current or former drug users, jail inmates and former prisoners.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Despite the challenges, efforts in the Bay Area show progress is still possible. The hope is that if a city like San Francisco can eliminate hepatitis C, others will follow suit. \u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">A small purple-and-white sign hangs on the waiting room wall in Highland Hospital’s emergency department in Oakland.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In English and Spanish it reads: \"Our ER’s policy for patients 18 to 75 years old: HIV and Hepatitis C tests are done once a year if you are having other blood tests.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s a policy that emergency room physician Doug White and his colleagues instituted four years ago. Since up to half of people with hepatitis C do not know they are infected, testing is the first step toward eradicating the deadly, blood-borne virus, he said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C is the leading cause of liver failure in the U.S.,\" White said. \"It's the number one cause of liver cancer. Number one cause of liver transplants. It’s a phenomenon of epic proportion.\"\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/hepatitis/hcv/cfaq.htm\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">B\u003c/span>\u003cspan style=\"font-weight: 400\">etween 2.7 million and 3.9 million Americans have hepatitis C\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, according to the Centers for Disease Control and Prevention (CDC). The virus can remain dormant for years, and by the time symptoms arise, the organs may already be damaged. Except for flu, \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/hcv-mortality.html\" target=\"_blank\" rel=\"noopener\">hepatitis C \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">takes more lives than all other CDC-tracked infectious diseases \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">combined -- and that includes HIV, tuberculosis and other more prominent diseases.\u003c/span>\u003c/i> \u003cspan style=\"font-weight: 400\">In 2015,\u003c/span>\u003ca href=\"https://www.cdc.gov/hepatitis/statistics/2015surveillance/commentary.htm\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">19,629 Americans died\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> from hepatitis C, mostly from liver disease caused by the virus. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For years the few treatments for hepatitis C had severe side effects and were not very effective at eliminating the virus from the body. But a new generation of powerful drugs came out in late 2013. These drugs have minimal side effects and usually require taking just one pill a day for two to three months. The cure rate is more than 90 percent. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Given this powerful new option, it’s possible to\u003c/span>\u003ca href=\"http://nationalacademies.org/hmd/Reports/2016/Eliminating-the-Public-Health-Problem-of-Hepatitis-B-and-C-in-the-US.aspx\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">eliminate hepatitis C as a public health threat in the U.S. by 2030\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, researchers say. But social and financial barriers remain, so it would take a concerted effort by government, health plans, doctors and hospitals.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dr. White hopes Highland Hospital can be a leader in the fight, and a model for other hospitals tackling the hepatitis C epidemic. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C has gone from a disease that I had no incentive to look for to diagnose, because I couldn't do anything about it, to essentially a curable disease with treatment that's well tolerated,\" White said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Highland staffers test nearly everyone who comes to the ER and gets blood drawn. They've built a robust electronic medical system that reminds medical staff to test for hepatitis C when doing other blood tests, as long as the patient hasn't had this test in the past year. Highland was one of the first ERs to test for hepatitis C like this nationwide. That helps flag infections among low-income or undocumented patients who use the ER for primary care. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_362079\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362079\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg\" alt=\"Dr. Doug White points to tubes used for Hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Doug White points to tubes used for hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">And the work doesn't end in the ER. If patients test positive, they get a call or visit from Mae Petti.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Petti has a desk a few floors above the emergency room. She spends hours making phone call after phone call. In her friendly, polite but insistent manner, she persists until she speaks with every patient on her list. As Highland's hepatitis C linkage coordinator, Petti will contact patients again and again until they come in to get follow-up care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Few hospitals have someone like Petti -- her position at Highland is grant-funded. And her work is paying off: Highland has doubled the number of people who return for follow-up appointments. Now, patients can start getting treated for hepatitis C in as soon as two weeks. Previously, it took six months after a positive test before a patient began treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>San Francisco's Mission to Stamp out the Virus\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Across the bay, San Francisco has its own approach to the problem. A group there has been addressing hepatitis C since former Mayor Gavin Newsom assigned a specific \u003c/span>\u003ca href=\"http://sfhepc.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">task force\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to the issue in 2009. The group’s mission was first to recommend how the city should address hepatitis C. These days, they believe the threat of hepatitis C can be stamped out, and they think San Francisco is the place to do it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At a recent task force gathering at San Francisco’s Department of Public Health, doctors, public health workers and many former hepatitis C patients -- now cured -- took their seats around a table.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After a dinner of pizza and salad, San Francisco’s viral hepatitis coordinator, Katie Burk, launched into a presentation. She listed reasons why she thinks San Francisco is a great candidate for elimination. First, she said, the city of San Francisco is small.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That matters when you’re trying to grab folks from all parts of the city, and make sure they’re getting the care they need,\" Burk said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And there’s a historical commitment to fighting disease here.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"We have this really incredible HIV program infrastructure in San Francisco,\" she said. \"We've built a lot of what we've done with hepatitis C sort of on the back of that program, and learned from a lot of our successes and challenges.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Hepatitis C is transmitted by blood -- and these days most of that happens through shared needles. Stopping the spread of the virus is therefore inextricably connected with efforts to end addiction to injectable drugs. San Francisco has places to exchange dirty syringes for clean ones, and plenty of programs and clinics offer “medication-assisted treatment” -- usually using buprenorphine, which helps people addicted to heroin and other opioids kick the habit. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco has another weapon too: a coalition specifically devoted to hepatitis C elimination, called \u003c/span>\u003ca href=\"http://www.endhepcsf.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">End Hep C SF\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It launched in 2016. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The End Hep C SF coalition has created something that experts consider crucial for the elimination of hepatitis C: an accurate estimate of how many residents harbor the virus, whether they are aware of it or not. In San Francisco, the current estimate is 12,000 people. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s unusual for a city to have a number like that to work with, because typically public health departments know only the number of people who have recently tested positive for hepatitis C. But San Francisco officials have gone farther: subtracting estimates of people who have been cured, died or moved away. They have calculated how many people probably have the virus, but have yet to be diagnosed.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Having that estimate is exciting, according to public health consultant Shelley Facente, who was also at the meeting, because it will allow the city to set goals of how many people to treat each year, and can offer an idea of when hepatitis C can largely be wiped out. The data have also helped identify target groups that have disproportionately high rates of hepatitis C in San Francisco, like transgender women. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Facente said roughly 4,500 San Franciscans already have been cured, using the new class of treatments for hepatitis C. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That means this is doable,\" Facente said, referring to elimination. \"We can really make this happen. It's very exciting that we've already made such progress. And now that we have even more information about what we need to do and where we need to go, it's even going to get better from here.\"\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Remaining Barriers to Elimination\u003c/strong>\u003c/p>\n\u003cp>Back at Highland Hospital, patient June Bullock had an appointment to pick up a refill of pills for his hepatitis C treatment. He met with physician assistant Amy Smith, who guides Highland patients through the treatment. Smith handed Bullock his last pack of pills and asked if he had any questions. His wife, Alfreda, was the one who spoke up.\u003c/p>\n\u003cfigure id=\"attachment_362085\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362085\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg\" alt=\"June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"My daughter says nobody can drink behind him out of a straw,\" Alfreda Bullock said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"No,\" Smith replied. \"That’s not true.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There’s a whole bunch of stuff going on, you know what I’m saying?\" Bullock said, explaining she’d heard a lot of misinformation about the virus.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Smith took the blame. \"Yeah. Well, I’m sorry we haven’t covered that.\" Smith then reviewed for them how hepatitis C is spread.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Research shows that to really curb hepatitis C, it takes a program like Highland’s: test widely, and then treat aggressively.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But, new hepatitis C infections still increased in California by 5.5 percent between 2011 and 2015, according to the state Department of Public Health.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s frustrating for people like Smith, who has seen many people get cured.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There are a lot of good people out there doing good work,\" she said. \"I just don’t think all the pieces are in place just yet.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Unaffordable drugs, for instance, are still one of the biggest barriers to treatment, Smith said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The cheapest available drug retails at about $26,000 for a course that ranges from two to four months. Others can cost as much as $133,400. While insurance companies often negotiate lower prices, some have still tried to control costs by instituting limits on who qualifies for treatment. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Another problem is the nationwide opioid epidemic, which includes heroin abuse, often via needle. Many experts say that’s why hepatitis C infections are rising among people under 30 -- although hepatitis C has traditionally been considered a disease of the baby boomers. This older generation grew up before the virus was identified, let alone subject to screening in the blood supply. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some advocates say the fight against hepatitis C is especially difficult because society places little value on the lives of the people who tend to get the virus -- current or former drug users, jail inmates and former prisoners.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Despite the challenges, efforts in the Bay Area show progress is still possible. The hope is that if a city like San Francisco can eliminate hepatitis C, others will follow suit. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Wrecked And Retching: Obscure Vomiting Illness Linked To Long-Term Pot Use",
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"content": "\u003cp>For 17 years, Chalfonte LeNee Queen suffered periodic episodes of violent retching and abdominal pain that would knock her off her feet for days, sometimes leaving her writhing on the floor in pain.\u003c/p>\n\u003cp>“I’ve screamed out for death,” said Queen, 48, who lives in San Diego. “I’ve cried out for my mom who’s been dead for 20 years, mentally not realizing she can’t come to me.”\u003c/p>\n\u003cp>Queen lost a modeling job after being mistaken for an alcoholic. She racked up tens of thousands of dollars in medical bills, and her nausea interrupted her sex life. Toward the end of her illness, Queen, who stands 5-foot-9, weighed in at a frail 109 pounds.\u003c/p>\n\u003cp>Throughout the nearly two decades of pain, vomiting and mental fog, she visited the hospital about three times a year, but doctors never got to the bottom of what was ailing her. By 2016, she thought she was dying, that she “must have some sort of cancer or something they can’t detect,” Queen said.\u003c/p>\n\u003cp>But she didn’t have cancer. She had an obscure syndrome called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/\">cannabinoid hyperemesis syndrome\u003c/a>, a condition only recently acknowledged by the medical community. It affects a small population — namely, a subset of marijuana users who smoke multiple times a day for months, years or even decades.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There’s no hard data on the prevalence of the illness. But in California and Colorado, which have loosened marijuana laws in recent years, emergency physicians say they’re seeing it more often. One \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469074/\">study\u003c/a> in Colorado suggests there may be a link.\u003c/p>\n\u003cp>Dr. Aimee Moulin, an emergency room physician at UC-Davis Medical Center in Sacramento, said she has seen a rise in the number of cases since California voters legalized recreational marijuana last November. She expects to see another increase after commercial sales are permitted starting in January.\u003c/p>\n\u003cp>Doctors say it’s difficult to treat the condition. There is no cure other than to quit using marijuana, and many patients are skeptical that cannabis is making them sick, so they keep using it and their vomiting episodes continue.\u003c/p>\n\u003cp>Doctors can do little to relieve the symptoms, since traditional anti-nausea medications often don’t work and there are no pills to prevent the onset of an episode. Patients may need intravenous hydration and hospital stays until the symptoms subside.\u003c/p>\n\u003cp>“That’s really frustrating as an emergency physician,” said Moulin. “I really like to make people feel better.”\u003c/p>\n\u003cp>Diagnosing the syndrome can also be frustrating — and expensive. There is no blood test to link the stomach ailment with marijuana use, so physicians often order pricey CT scans and lab tests to rule out other medical problems.\u003c/p>\n\u003cp>Cannabinoid hyperemesis syndrome was \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774264/\">first documented in Australia\u003c/a> in 2004. Physicians have historically misdiagnosed it as the more generic \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/cyclic-vomiting-syndrome/symptoms-causes/syc-20352161\">cyclic vomiting syndrome\u003c/a>, which has no identifiable cause or, as in Queen’s case, \u003ca href=\"http://www.porphyriafoundation.com/about-porphyria/types-of-porphyria/AIP\">acute intermittent porphyria (AIP)\u003c/a>.\u003c/p>\n\u003cp>“Five years ago, this wasn’t something that [doctors] had on their radar,” said Dr. Kennon Heard, an emergency physician at the University of Colorado in Aurora, who co-authored the Colorado study showing a possible tie between the liberalization of marijuana and a surge of the vomiting illness. “We’re at least making the diagnosis more now.”\u003c/p>\n\u003cp>One surefire sign of the illness is when patients find relief in hot showers and baths. Queen said she would vomit repeatedly unless she was in a hot shower — so she’d stay in there for hours. Toxicologists say the heat may distract the brain from pain receptors in the abdomen but, like the syndrome itself, that phenomenon is \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751385/\">not well understood\u003c/a>.\u003c/p>\n\u003cp>The exact cause of the condition is still a mystery. Toxicologists say the chemical compounds in marijuana may throw off the normal function of the body’s \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/18426493\">cannabinoid receptors\u003c/a>, which help regulate the nervous system.\u003c/p>\n\u003cp>Some people may be genetically predisposed to the syndrome, or marijuana’s potency or chemical makeup may have changed over time, said Dr. Craig Smollin, medical director of the San Francisco division of the California Poison Control System, who also works as an emergency physician at Zuckerberg San Francisco General Hospital.\u003c/p>\n\u003cp>The vomiting link to cannabis is counterintuitive to many, because of its widely known reputation as an anti-nausea remedy for cancer patients.\u003c/p>\n\u003cp>“A lot of times, people just don’t believe you,” said Dr. John Coburn, an emergency physician at Kaiser Permanente in south Sacramento. Even after being told that quitting may help, some patients will visit the hospital multiple times before they stop smoking marijuana, Coburn said. “I can’t really tell you why. I mean, why do people ride motorcycles without helmets on?”\u003c/p>\n\u003cp>Cameron Nicole Beard, 19, of East Moline, Ill., said she struggled to believe her doctors about the link between pot and severe vomiting.\u003c/p>\n\u003cp>“Who wants to be told you can’t smoke marijuana, when you think marijuana can help?” said Beard, while recovering from a marijuana-related vomiting episode at a University of Iowa hospital in Iowa City, Iowa, last month. She said she had lost 20 pounds in 10 days.\u003c/p>\n\u003cp>Although there’s still no magic cure for a patient’s marijuana-related hyperemesis, Moulin and other doctors say \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28370228\">they’re getting better at treating\u003c/a> the symptoms, using old anti-psychotic medications and cream for muscle aches.\u003c/p>\n\u003cp>Dr. Heard said the cases in Colorado seem to have leveled off. But without hard data, and because the overall numbers are small, it’s hard to say for sure. Heard said he doesn’t believe cases of the pot syndrome increased after recreational use was legalized in 2012, because chronic users probably already had medical marijuana cards.\u003c/p>\n\u003cp>Chalfonte LeNee Queen is still struggling to completely quit marijuana, but her symptoms are down to a dull stomachache. She now smokes a couple of times a day, compared with her near-constant use in the past. She said it’s the only thing that works for her depression and anxiety.\u003c/p>\n\u003cp>Queen is back to a healthy weight and hasn’t been to the hospital in a year. She said she wouldn’t want to discourage anybody from smoking weed; she just wants people to know heavy use can bring them some serious misery.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Now, if I get sick, as sad as I’ll be and as upset and disappointed with myself as I would be, at least it’s a freaking choice,” she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For 17 years, Chalfonte LeNee Queen suffered periodic episodes of violent retching and abdominal pain that would knock her off her feet for days, sometimes leaving her writhing on the floor in pain.\u003c/p>\n\u003cp>“I’ve screamed out for death,” said Queen, 48, who lives in San Diego. “I’ve cried out for my mom who’s been dead for 20 years, mentally not realizing she can’t come to me.”\u003c/p>\n\u003cp>Queen lost a modeling job after being mistaken for an alcoholic. She racked up tens of thousands of dollars in medical bills, and her nausea interrupted her sex life. Toward the end of her illness, Queen, who stands 5-foot-9, weighed in at a frail 109 pounds.\u003c/p>\n\u003cp>Throughout the nearly two decades of pain, vomiting and mental fog, she visited the hospital about three times a year, but doctors never got to the bottom of what was ailing her. By 2016, she thought she was dying, that she “must have some sort of cancer or something they can’t detect,” Queen said.\u003c/p>\n\u003cp>But she didn’t have cancer. She had an obscure syndrome called \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/\">cannabinoid hyperemesis syndrome\u003c/a>, a condition only recently acknowledged by the medical community. It affects a small population — namely, a subset of marijuana users who smoke multiple times a day for months, years or even decades.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There’s no hard data on the prevalence of the illness. But in California and Colorado, which have loosened marijuana laws in recent years, emergency physicians say they’re seeing it more often. One \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4469074/\">study\u003c/a> in Colorado suggests there may be a link.\u003c/p>\n\u003cp>Dr. Aimee Moulin, an emergency room physician at UC-Davis Medical Center in Sacramento, said she has seen a rise in the number of cases since California voters legalized recreational marijuana last November. She expects to see another increase after commercial sales are permitted starting in January.\u003c/p>\n\u003cp>Doctors say it’s difficult to treat the condition. There is no cure other than to quit using marijuana, and many patients are skeptical that cannabis is making them sick, so they keep using it and their vomiting episodes continue.\u003c/p>\n\u003cp>Doctors can do little to relieve the symptoms, since traditional anti-nausea medications often don’t work and there are no pills to prevent the onset of an episode. Patients may need intravenous hydration and hospital stays until the symptoms subside.\u003c/p>\n\u003cp>“That’s really frustrating as an emergency physician,” said Moulin. “I really like to make people feel better.”\u003c/p>\n\u003cp>Diagnosing the syndrome can also be frustrating — and expensive. There is no blood test to link the stomach ailment with marijuana use, so physicians often order pricey CT scans and lab tests to rule out other medical problems.\u003c/p>\n\u003cp>Cannabinoid hyperemesis syndrome was \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774264/\">first documented in Australia\u003c/a> in 2004. Physicians have historically misdiagnosed it as the more generic \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/cyclic-vomiting-syndrome/symptoms-causes/syc-20352161\">cyclic vomiting syndrome\u003c/a>, which has no identifiable cause or, as in Queen’s case, \u003ca href=\"http://www.porphyriafoundation.com/about-porphyria/types-of-porphyria/AIP\">acute intermittent porphyria (AIP)\u003c/a>.\u003c/p>\n\u003cp>“Five years ago, this wasn’t something that [doctors] had on their radar,” said Dr. Kennon Heard, an emergency physician at the University of Colorado in Aurora, who co-authored the Colorado study showing a possible tie between the liberalization of marijuana and a surge of the vomiting illness. “We’re at least making the diagnosis more now.”\u003c/p>\n\u003cp>One surefire sign of the illness is when patients find relief in hot showers and baths. Queen said she would vomit repeatedly unless she was in a hot shower — so she’d stay in there for hours. Toxicologists say the heat may distract the brain from pain receptors in the abdomen but, like the syndrome itself, that phenomenon is \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751385/\">not well understood\u003c/a>.\u003c/p>\n\u003cp>The exact cause of the condition is still a mystery. Toxicologists say the chemical compounds in marijuana may throw off the normal function of the body’s \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/18426493\">cannabinoid receptors\u003c/a>, which help regulate the nervous system.\u003c/p>\n\u003cp>Some people may be genetically predisposed to the syndrome, or marijuana’s potency or chemical makeup may have changed over time, said Dr. Craig Smollin, medical director of the San Francisco division of the California Poison Control System, who also works as an emergency physician at Zuckerberg San Francisco General Hospital.\u003c/p>\n\u003cp>The vomiting link to cannabis is counterintuitive to many, because of its widely known reputation as an anti-nausea remedy for cancer patients.\u003c/p>\n\u003cp>“A lot of times, people just don’t believe you,” said Dr. John Coburn, an emergency physician at Kaiser Permanente in south Sacramento. Even after being told that quitting may help, some patients will visit the hospital multiple times before they stop smoking marijuana, Coburn said. “I can’t really tell you why. I mean, why do people ride motorcycles without helmets on?”\u003c/p>\n\u003cp>Cameron Nicole Beard, 19, of East Moline, Ill., said she struggled to believe her doctors about the link between pot and severe vomiting.\u003c/p>\n\u003cp>“Who wants to be told you can’t smoke marijuana, when you think marijuana can help?” said Beard, while recovering from a marijuana-related vomiting episode at a University of Iowa hospital in Iowa City, Iowa, last month. She said she had lost 20 pounds in 10 days.\u003c/p>\n\u003cp>Although there’s still no magic cure for a patient’s marijuana-related hyperemesis, Moulin and other doctors say \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/28370228\">they’re getting better at treating\u003c/a> the symptoms, using old anti-psychotic medications and cream for muscle aches.\u003c/p>\n\u003cp>Dr. Heard said the cases in Colorado seem to have leveled off. But without hard data, and because the overall numbers are small, it’s hard to say for sure. Heard said he doesn’t believe cases of the pot syndrome increased after recreational use was legalized in 2012, because chronic users probably already had medical marijuana cards.\u003c/p>\n\u003cp>Chalfonte LeNee Queen is still struggling to completely quit marijuana, but her symptoms are down to a dull stomachache. She now smokes a couple of times a day, compared with her near-constant use in the past. She said it’s the only thing that works for her depression and anxiety.\u003c/p>\n\u003cp>Queen is back to a healthy weight and hasn’t been to the hospital in a year. She said she wouldn’t want to discourage anybody from smoking weed; she just wants people to know heavy use can bring them some serious misery.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Health Giant Sutter Destroys Evidence In Crucial Antitrust Case Over High Prices",
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"content": "\u003cp>Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.\u003c/p>\n\u003cp>In a \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">ruling this week\u003c/a>, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”\u003c/p>\n\u003cp>Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling.\u003c/p>\n\u003cp>Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable mistake.\u003c/p>\n\u003cp>Employers and policymakers across the country are closely watching this legal fight amid growing concern about the financial implications of industry consolidation. Large health systems are gaining market clout and the ability to raise prices by acquiring more hospitals, outpatient surgery centers and physician offices.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s stunning what Sutter did to cover up incriminating documents in this case,” said Richard Grossman, the lead plaintiffs’ lawyer representing a class of more than 1,500 employer-funded health plans.\u003c/p>\n\u003cp>In April 2014, a grocery workers’ health plan sued Sutter and alleged it was violating antitrust and unfair competition laws. The plaintiffs began requesting documents related to contracting practices, such as “gag clauses” that prevent patients from seeing negotiated rates and choosing a cheaper provider and “all-or-nothing” terms that require every facility in a health system to be included in insurance networks \u003c/p>\n\u003cp>Sutter disputes the broader allegations in the lawsuit over its market conduct and said its charges are in line with its competitors’.\u003c/p>\n\u003cp>The judge said that in 2015 \u003ca href=\"https://www.youtube.com/watch?v=hLtEtJgW7no\">Melissa Brendt\u003c/a>, Sutter’s chief contracting officer in the managed-care department, and an assistant general counsel, Daniela Almeida, authorized Brendt’s executive assistant to destroy 10 years’ worth of managed-care documents going back to 1995. The company earlier had scheduled the documents to be destroyed in 2035 — 20 years later.\u003c/p>\n\u003cp>The executive assistant, Sina Santagata, testified in a deposition she wasn’t aware of any other time in her 17 years at Sutter when the managed-care department destroyed records held in storage.\u003c/p>\n\u003cp>In his \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">Nov. 13 ruling\u003c/a> against Sutter, the judge singled out an email by Santagata as “particularly noteworthy.”\u003c/p>\n\u003cp>The executive assistant emailed Brendt, the chief contracting officer, on July 30, 2015, after sending the order to destroy the records. She wrote, “I’ve pushed the button … if someone is in need of a box between 3/15/95 & 11/23/05 … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.”\u003c/p>\n\u003cp>The Federal Trade Commission (FTC) enforces antitrust laws in health care to prevent hospitals, drugmakers and other industry players from engaging in anti-competitive behavior that could harm consumers.\u003c/p>\n\u003cp>Santagata testified that she was being “sarcastic” in her email, and Sutter told the judge that the FTC reference was just a “joke.”\u003c/p>\n\u003cp>Karnow saw no humor in it. “There are infinite topics for jokes, and the choice of this one is strong evidence” in the plaintiffs’ favor, he wrote in his order Monday.\u003c/p>\n\u003cp>As part of his sanctions against Sutter, the judge ordered the health system to examine \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/plaintiffs-motion-for-sutter-sanctions.pdf\">email\u003c/a> backup tapes covering 2002 through 2005 to search for documents on some of the same topics as the destroyed records. Also, Karnow said he will consider a plaintiffs’ motion for issuing jury instructions that are adverse to Sutter in light of the document destruction. The trial is scheduled for June 2019.\u003c/p>\n\u003cp>“The record shows that Sutter’s conduct was more than just an inadvertent error,” Karnow wrote.\u003c/p>\n\u003cp>Sutter spokeswoman Karen Garner said the incident was a “mistake made as part of a routine destruction of old paper records” and the Sacramento-based health system disclosed the error as soon as it was discovered.\u003c/p>\n\u003cp>“We regret that as part of a routine archiving process we failed to preserve some boxes of decades-old hard-copy documents,” Garner said.\u003c/p>\n\u003cp>The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014. The joint employer-union health plan represents more than 60,000 employees, dependents and retirees. The court certified the case as a class action in August, allowing hundreds of other employers and self-funded health plans to potentially benefit from the litigation.\u003c/p>\n\u003cp>In addition to its 24 hospitals, Sutter’s nonprofit health system has 35 surgery centers and more than 5,000 physicians in its network. It reported $11.9 billion in revenue last year and income of $554 million.\u003c/p>\n\u003cp>Grossman, the plaintiffs’ counsel, said he welcomed the judge’s ruling. But he said much of the evidence is irreplaceable, particularly handwritten notes from negotiating sessions and meetings involving key Sutter executives.\u003c/p>\n\u003cp>He said those records covered a critical period in the early 2000s when there was a “sea change in Sutter’s contracting strategy” and it implemented provisions that insulated the health system from price competition.\u003c/p>\n\u003cp>“This was groundbreaking in the industry,” Grossman said. “Until we address the anti-competitive behavior of entities like Sutter, we will not solve the problem of high costs in health care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The plaintiffs are seeking to recover hundreds of millions of dollars from Sutter from what it claims are illegally inflated prices. The lawsuit alleges that 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\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge.\u003c/p>\n\u003cp>In a \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">ruling this week\u003c/a>, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.”\u003c/p>\n\u003cp>Karnow cited an internal email by a Sutter employee who said she was “running and hiding” after ordering the records destroyed in 2015. “The most generous interpretation to Sutter is that it was grossly reckless,” the judge wrote in his 12-page ruling.\u003c/p>\n\u003cp>Sutter, which has 24 hospitals and nearly $12 billion in annual revenue, said the destruction was a regrettable mistake.\u003c/p>\n\u003cp>Employers and policymakers across the country are closely watching this legal fight amid growing concern about the financial implications of industry consolidation. Large health systems are gaining market clout and the ability to raise prices by acquiring more hospitals, outpatient surgery centers and physician offices.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s stunning what Sutter did to cover up incriminating documents in this case,” said Richard Grossman, the lead plaintiffs’ lawyer representing a class of more than 1,500 employer-funded health plans.\u003c/p>\n\u003cp>In April 2014, a grocery workers’ health plan sued Sutter and alleged it was violating antitrust and unfair competition laws. The plaintiffs began requesting documents related to contracting practices, such as “gag clauses” that prevent patients from seeing negotiated rates and choosing a cheaper provider and “all-or-nothing” terms that require every facility in a health system to be included in insurance networks \u003c/p>\n\u003cp>Sutter disputes the broader allegations in the lawsuit over its market conduct and said its charges are in line with its competitors’.\u003c/p>\n\u003cp>The judge said that in 2015 \u003ca href=\"https://www.youtube.com/watch?v=hLtEtJgW7no\">Melissa Brendt\u003c/a>, Sutter’s chief contracting officer in the managed-care department, and an assistant general counsel, Daniela Almeida, authorized Brendt’s executive assistant to destroy 10 years’ worth of managed-care documents going back to 1995. The company earlier had scheduled the documents to be destroyed in 2035 — 20 years later.\u003c/p>\n\u003cp>The executive assistant, Sina Santagata, testified in a deposition she wasn’t aware of any other time in her 17 years at Sutter when the managed-care department destroyed records held in storage.\u003c/p>\n\u003cp>In his \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/sutter-nov-13-order.pdf\">Nov. 13 ruling\u003c/a> against Sutter, the judge singled out an email by Santagata as “particularly noteworthy.”\u003c/p>\n\u003cp>The executive assistant emailed Brendt, the chief contracting officer, on July 30, 2015, after sending the order to destroy the records. She wrote, “I’ve pushed the button … if someone is in need of a box between 3/15/95 & 11/23/05 … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.”\u003c/p>\n\u003cp>The Federal Trade Commission (FTC) enforces antitrust laws in health care to prevent hospitals, drugmakers and other industry players from engaging in anti-competitive behavior that could harm consumers.\u003c/p>\n\u003cp>Santagata testified that she was being “sarcastic” in her email, and Sutter told the judge that the FTC reference was just a “joke.”\u003c/p>\n\u003cp>Karnow saw no humor in it. “There are infinite topics for jokes, and the choice of this one is strong evidence” in the plaintiffs’ favor, he wrote in his order Monday.\u003c/p>\n\u003cp>As part of his sanctions against Sutter, the judge ordered the health system to examine \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/11/plaintiffs-motion-for-sutter-sanctions.pdf\">email\u003c/a> backup tapes covering 2002 through 2005 to search for documents on some of the same topics as the destroyed records. Also, Karnow said he will consider a plaintiffs’ motion for issuing jury instructions that are adverse to Sutter in light of the document destruction. The trial is scheduled for June 2019.\u003c/p>\n\u003cp>“The record shows that Sutter’s conduct was more than just an inadvertent error,” Karnow wrote.\u003c/p>\n\u003cp>Sutter spokeswoman Karen Garner said the incident was a “mistake made as part of a routine destruction of old paper records” and the Sacramento-based health system disclosed the error as soon as it was discovered.\u003c/p>\n\u003cp>“We regret that as part of a routine archiving process we failed to preserve some boxes of decades-old hard-copy documents,” Garner said.\u003c/p>\n\u003cp>The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014. The joint employer-union health plan represents more than 60,000 employees, dependents and retirees. The court certified the case as a class action in August, allowing hundreds of other employers and self-funded health plans to potentially benefit from the litigation.\u003c/p>\n\u003cp>In addition to its 24 hospitals, Sutter’s nonprofit health system has 35 surgery centers and more than 5,000 physicians in its network. It reported $11.9 billion in revenue last year and income of $554 million.\u003c/p>\n\u003cp>Grossman, the plaintiffs’ counsel, said he welcomed the judge’s ruling. But he said much of the evidence is irreplaceable, particularly handwritten notes from negotiating sessions and meetings involving key Sutter executives.\u003c/p>\n\u003cp>He said those records covered a critical period in the early 2000s when there was a “sea change in Sutter’s contracting strategy” and it implemented provisions that insulated the health system from price competition.\u003c/p>\n\u003cp>“This was groundbreaking in the industry,” Grossman said. “Until we address the anti-competitive behavior of entities like Sutter, we will not solve the problem of high costs in health care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The plaintiffs are seeking to recover hundreds of millions of dollars from Sutter from what it claims are illegally inflated prices. The lawsuit alleges that 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\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Fines Anthem $5 Million For Failing to Address Consumer Grievances",
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"content": "\u003cp>California’s managed-care regulator announced Wednesday it has fined insurance giant Anthem Blue Cross $5 million for repeatedly failing to resolve consumer grievances in a timely manner.\u003c/p>\n\u003cp>The state Department of Managed Health Care criticized Anthem, the nation’s second-largest health insurer, for systemic violations and a long history of flouting the law in regard to consumer complaints.\u003c/p>\n\u003cp>“Anthem Blue Cross’ failures to comply with the law surrounding grievance and appeals rights are long-standing, ongoing and unacceptable,” said Shelley Rouillard, director of the Department of Managed Health Care. “Anthem knows this is a huge problem, but they haven’t addressed it.”\u003c/p>\n\u003cp>Before this latest action, California had already fined Anthem more than $6 million collectively for grievance-system violations since 2002.\u003c/p>\n\u003cp>The state said it identified 245 grievance-system violations during this latest investigation of consumer complaints at Anthem from 2013 to 2016.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rouillard cited one example in which Anthem denied a submitted claim for an extensive surgical procedure, even though it had issued prior approval for the operation. Twenty-two calls contesting the denial — placed by the patient, the patient’s spouse, the couple’s insurance broker and the medical provider — failed to resolve the complaint. It was not until the patient sought help from the managed-care agency, more than six months after the treatment, that Anthem paid the claim.\u003c/p>\n\u003cp>In a statement, Anthem acknowledged there are some legitimate findings in the audit, but it strongly disagreed with the state’s assertion that the problems are “systemic and ongoing.” The company said it will contest the fine.\u003c/p>\n\u003cp>“Anthem has taken responsibility for errors in the past and has made significant changes in our grievance and appeals process, as well as investments in system improvements,” the company said. “We remain committed to putting the needs of our members first.”\u003c/p>\n\u003cp>Anthem Inc., based in Indianapolis, sells Blue Cross policies in California and 13 other states.\u003c/p>\n\u003cp>California is known for having tough consumer protection laws on health coverage and for assisting policyholders when they exhaust their appeals with insurers. In other actions, the state has fined insurers for overstating the extent of their doctor networks and for denying patients timely access to mental health treatment.\u003c/p>\n\u003cp>Jamie Court, president of Consumer Watchdog, an advocacy group in Santa Monica, Calif., said the regulatory response to these problems varies greatly by state. He singled out New York, Washington and Kansas as some of the states with good track records of holding health insurers accountable.\u003c/p>\n\u003cp>“The real problem is when states don’t act there is not a great avenue for the consumer. It’s very hard to bring legal action,” Court said. “Anthem definitely needed a wake-up call. But this will also send a message to other insurers.”\u003c/p>\n\u003cp>Nationally, consumers continue to express their displeasure with health insurers over a wide range of issues, including denials for treatment, billing disputes and the lack of in-network doctors.\u003c/p>\n\u003cp>Verified complaints related to health insurance and accident coverage rose 12 percent in 2016 compared to the previous year, totaling 53,680, according to data compiled by the National Association of Insurance Commissioners. The data only includes incidents in which state regulators confirmed there was a violation or error by the insurer involved.\u003c/p>\n\u003cp>Court and other advocates welcomed the significant fine in California and said this is just the latest example of Anthem’s failure to uphold basic consumer protections.\u003c/p>\n\u003cp>Overall, state officials said that calls to Anthem’s customer service department often led to repeated transfers and that the company failed to follow up with enrollees.\u003c/p>\n\u003cp>“If you look at the history of Anthem and the penalties assessed over the years, they are definitely an outlier compared to other health plans,” Rouillard said.\u003c/p>\n\u003cp>“All the plans have some issues with grievances, but nothing to the degree we are seeing with Anthem.”\u003c/p>\n\u003cp>The managed-care department said a health plan’s grievance program is critical, so that consumers know they have the right to pursue an \u003ca href=\"https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReview(IMR).aspx#.Wgxw3mhSyUk\" target=\"_blank\" rel=\"noopener\">independent medical \u003c/a>review or file a complaint with regulators if they are dissatisfied with the insurer’s decision. The grievance system can also help insurers identify systemic problems and improve customer service, state officials said.\u003c/p>\n\u003cp>The state’s independent medical review program allows consumers to have their case heard by doctors who are not tied to their health plan. The cases often arise when an insurer denies a patient’s request for treatment or a prescription drug.\u003c/p>\n\u003cp>In 2016, insurance company denials were overturned in nearly 70 percent of medical review cases and patients received the requested treatment, according to state officials.\u003c/p>\n\u003cp>\u003cem>This post has been updated.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California’s managed-care regulator announced Wednesday it has fined insurance giant Anthem Blue Cross $5 million for repeatedly failing to resolve consumer grievances in a timely manner.\u003c/p>\n\u003cp>The state Department of Managed Health Care criticized Anthem, the nation’s second-largest health insurer, for systemic violations and a long history of flouting the law in regard to consumer complaints.\u003c/p>\n\u003cp>“Anthem Blue Cross’ failures to comply with the law surrounding grievance and appeals rights are long-standing, ongoing and unacceptable,” said Shelley Rouillard, director of the Department of Managed Health Care. “Anthem knows this is a huge problem, but they haven’t addressed it.”\u003c/p>\n\u003cp>Before this latest action, California had already fined Anthem more than $6 million collectively for grievance-system violations since 2002.\u003c/p>\n\u003cp>The state said it identified 245 grievance-system violations during this latest investigation of consumer complaints at Anthem from 2013 to 2016.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rouillard cited one example in which Anthem denied a submitted claim for an extensive surgical procedure, even though it had issued prior approval for the operation. Twenty-two calls contesting the denial — placed by the patient, the patient’s spouse, the couple’s insurance broker and the medical provider — failed to resolve the complaint. It was not until the patient sought help from the managed-care agency, more than six months after the treatment, that Anthem paid the claim.\u003c/p>\n\u003cp>In a statement, Anthem acknowledged there are some legitimate findings in the audit, but it strongly disagreed with the state’s assertion that the problems are “systemic and ongoing.” The company said it will contest the fine.\u003c/p>\n\u003cp>“Anthem has taken responsibility for errors in the past and has made significant changes in our grievance and appeals process, as well as investments in system improvements,” the company said. “We remain committed to putting the needs of our members first.”\u003c/p>\n\u003cp>Anthem Inc., based in Indianapolis, sells Blue Cross policies in California and 13 other states.\u003c/p>\n\u003cp>California is known for having tough consumer protection laws on health coverage and for assisting policyholders when they exhaust their appeals with insurers. In other actions, the state has fined insurers for overstating the extent of their doctor networks and for denying patients timely access to mental health treatment.\u003c/p>\n\u003cp>Jamie Court, president of Consumer Watchdog, an advocacy group in Santa Monica, Calif., said the regulatory response to these problems varies greatly by state. He singled out New York, Washington and Kansas as some of the states with good track records of holding health insurers accountable.\u003c/p>\n\u003cp>“The real problem is when states don’t act there is not a great avenue for the consumer. It’s very hard to bring legal action,” Court said. “Anthem definitely needed a wake-up call. But this will also send a message to other insurers.”\u003c/p>\n\u003cp>Nationally, consumers continue to express their displeasure with health insurers over a wide range of issues, including denials for treatment, billing disputes and the lack of in-network doctors.\u003c/p>\n\u003cp>Verified complaints related to health insurance and accident coverage rose 12 percent in 2016 compared to the previous year, totaling 53,680, according to data compiled by the National Association of Insurance Commissioners. The data only includes incidents in which state regulators confirmed there was a violation or error by the insurer involved.\u003c/p>\n\u003cp>Court and other advocates welcomed the significant fine in California and said this is just the latest example of Anthem’s failure to uphold basic consumer protections.\u003c/p>\n\u003cp>Overall, state officials said that calls to Anthem’s customer service department often led to repeated transfers and that the company failed to follow up with enrollees.\u003c/p>\n\u003cp>“If you look at the history of Anthem and the penalties assessed over the years, they are definitely an outlier compared to other health plans,” Rouillard said.\u003c/p>\n\u003cp>“All the plans have some issues with grievances, but nothing to the degree we are seeing with Anthem.”\u003c/p>\n\u003cp>The managed-care department said a health plan’s grievance program is critical, so that consumers know they have the right to pursue an \u003ca href=\"https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReview(IMR).aspx#.Wgxw3mhSyUk\" target=\"_blank\" rel=\"noopener\">independent medical \u003c/a>review or file a complaint with regulators if they are dissatisfied with the insurer’s decision. The grievance system can also help insurers identify systemic problems and improve customer service, state officials said.\u003c/p>\n\u003cp>The state’s independent medical review program allows consumers to have their case heard by doctors who are not tied to their health plan. The cases often arise when an insurer denies a patient’s request for treatment or a prescription drug.\u003c/p>\n\u003cp>In 2016, insurance company denials were overturned in nearly 70 percent of medical review cases and patients received the requested treatment, according to state officials.\u003c/p>\n\u003cp>\u003cem>This post has been updated.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Valley Fever is shaping up to be worse this year than in 2016, when the number of cases hit a record high.\u003c/p>\n\u003cp>Suspected cases of the fungal disease in the first 10 months of 2017 surged by more than one-third from the same period last year to 5,121, officials at the California Department of Public Health (CDPH) said Monday.\u003c/p>\n\u003cp>That puts this year on track to surpass the number of cases recorded in 2016.\u003c/p>\n\u003cp>“It is important that people living, working and travelling in California are aware of its symptoms, especially in the southern San Joaquin Valley and the Central Coast, where it is most common,” Dr. Karen Smith, CDPH director and state public health officer, said in a written statement.\u003c/p>\n\u003cp>\u003c!--/.slab-container -->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The illness, also known by the scientific name coccidioidomycosis, typically causes flu-like symptoms such as fever, chest pain and coughing — but it can be dangerous. It is most prevalent in the late summer and fall.\u003c/p>\n\u003cp>The department said it doesn’t know why there has been an apparent increase in cases again this year. But climatologists and other researchers have theorized that intensified \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/2017GL073524/full\" target=\"_blank\" rel=\"noopener\">dust storms\u003c/a> or \u003ca href=\"https://www.scientificamerican.com/article/valley-fever-on-the-rise-in-us-southwest/\" target=\"_blank\" rel=\"noopener\">heat waves\u003c/a> linked to global warming can fuel Valley Fever.\u003c/p>\n\u003cp>Many people infected by the fungus don’t show symptoms. But Valley Fever can also be confused with other respiratory infections such as influenza and pneumonia. Elderly people and those with weakened immune symptoms can develop more severe symptoms, including infections of the bone, brain or other organs.\u003c/p>\n\u003cp>State Assemblyman Rudy Salas (D-Bakersfield), who represents areas of the San Joaquin Valley where the fungus is endemic, said the increase was alarming.\u003c/p>\n\u003cp>“[This] underscores the need for a statewide approach to help the thousands of families affected across the state,” Salas said in a written statement.\u003c/p>\n\u003cp>He \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1279\" target=\"_blank\" rel=\"noopener\">authored a measure\u003c/a> earlier this year that would have required the state public health department to develop outreach programs to educate people about the illness. \u003ca href=\"https://www.gov.ca.gov/docs/AB_1279_Veto_Message_2017.pdf\" target=\"_blank\" rel=\"noopener\">Governor Brown vetoed\u003c/a> the bill, arguing that the state already provides fact sheets and posters to raise awareness, and that delegating more resources should be decided through state budget negotiations.\u003c/p>\n\u003cp>Agricultural communities are particularly hard hit by the fungal infection, which is contracted by breathing in spores when dust rises into the air because of weather conditions or activities such as farm work or construction.\u003c/p>\n\u003cp>Fresno and Kern County reported a notable increase in the number of cases compared with the same period last year. Los Angeles, Tulare and San Luis Obispo counties also had a large share of the cases.\u003c/p>\n\u003cp>Salas also wanted to establish an enhanced monitoring system for Valley Fever, including a working group of health officers from the five counties with the highest number of cases. Those proposals didn’t make it into the bill that Brown vetoed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Valley Fever is shaping up to be worse this year than in 2016, when the number of cases hit a record high.\u003c/p>\n\u003cp>Suspected cases of the fungal disease in the first 10 months of 2017 surged by more than one-third from the same period last year to 5,121, officials at the California Department of Public Health (CDPH) said Monday.\u003c/p>\n\u003cp>That puts this year on track to surpass the number of cases recorded in 2016.\u003c/p>\n\u003cp>“It is important that people living, working and travelling in California are aware of its symptoms, especially in the southern San Joaquin Valley and the Central Coast, where it is most common,” Dr. Karen Smith, CDPH director and state public health officer, said in a written statement.\u003c/p>\n\u003cp>\u003c!--/.slab-container -->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The illness, also known by the scientific name coccidioidomycosis, typically causes flu-like symptoms such as fever, chest pain and coughing — but it can be dangerous. It is most prevalent in the late summer and fall.\u003c/p>\n\u003cp>The department said it doesn’t know why there has been an apparent increase in cases again this year. But climatologists and other researchers have theorized that intensified \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/2017GL073524/full\" target=\"_blank\" rel=\"noopener\">dust storms\u003c/a> or \u003ca href=\"https://www.scientificamerican.com/article/valley-fever-on-the-rise-in-us-southwest/\" target=\"_blank\" rel=\"noopener\">heat waves\u003c/a> linked to global warming can fuel Valley Fever.\u003c/p>\n\u003cp>Many people infected by the fungus don’t show symptoms. But Valley Fever can also be confused with other respiratory infections such as influenza and pneumonia. Elderly people and those with weakened immune symptoms can develop more severe symptoms, including infections of the bone, brain or other organs.\u003c/p>\n\u003cp>State Assemblyman Rudy Salas (D-Bakersfield), who represents areas of the San Joaquin Valley where the fungus is endemic, said the increase was alarming.\u003c/p>\n\u003cp>“[This] underscores the need for a statewide approach to help the thousands of families affected across the state,” Salas said in a written statement.\u003c/p>\n\u003cp>He \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180AB1279\" target=\"_blank\" rel=\"noopener\">authored a measure\u003c/a> earlier this year that would have required the state public health department to develop outreach programs to educate people about the illness. \u003ca href=\"https://www.gov.ca.gov/docs/AB_1279_Veto_Message_2017.pdf\" target=\"_blank\" rel=\"noopener\">Governor Brown vetoed\u003c/a> the bill, arguing that the state already provides fact sheets and posters to raise awareness, and that delegating more resources should be decided through state budget negotiations.\u003c/p>\n\u003cp>Agricultural communities are particularly hard hit by the fungal infection, which is contracted by breathing in spores when dust rises into the air because of weather conditions or activities such as farm work or construction.\u003c/p>\n\u003cp>Fresno and Kern County reported a notable increase in the number of cases compared with the same period last year. Los Angeles, Tulare and San Luis Obispo counties also had a large share of the cases.\u003c/p>\n\u003cp>Salas also wanted to establish an enhanced monitoring system for Valley Fever, including a working group of health officers from the five counties with the highest number of cases. Those proposals didn’t make it into the bill that Brown vetoed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A lot of Ron Fleming’s fellow soldiers spent the last five decades trying to forget what they saw and did in Vietnam. Now 74, Fleming has spent most of that time trying to hold on to it. He has never been as proud as he was when he was 21.\u003c/p>\n\u003cp>“I take issue with those who say we lost. We didn’t lose that war,” he said, sitting on the edge of his hospital bed at the \u003ca href=\"https://www.sanfrancisco.va.gov/\" target=\"_blank\" rel=\"noopener\">San Francisco VA medical center\u003c/a>. “Everywhere I went, we literally kicked the crap out of them.”\u003c/p>\n\u003cp>Fleming was a door gunner in the war, hanging out of a helicopter on a strap with a machine gun in his hands. He fought in the Tet Offensive, sometimes 40 hours straight, firing 6,000 rounds a minute. But he never gave much thought to catching one himself.\u003c/p>\n\u003cp>“You see, at 21, you’re bulletproof,” he said. “Dying wasn’t on the agenda.”\u003c/p>\n\u003cp>But now, it is. Fleming has congestive heart failure, arthritis and breathing problems. He often lands in the VA hospital with asthma attacks, and the palliative care team visits him regularly. He thinks about death.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I wish it’d get off its ass and come on me. I’m sick of this crap,” he said, as his heart rate monitor ticked up. “You see, dying’s the easy part. Living is what’s hard.”\u003c/p>\n\u003cp>Fleming has had trouble holding down a job since he got back from the war. He had a girl he lived with for 10 years, but they never married, never had kids. He lives alone in Oakland now. He says he angers easily and is always hypervigilant. About 10 years ago, he was diagnosed with PTSD. More than anything, he says, he suffers from a \"rotten outlook\" on life.\u003c/p>\n\u003cp>“Sometimes I think that now I’m being paid back for all the men I killed,” he said. “I killed a lot of them. More than I can count.”\u003c/p>\n\u003cp>Unlike Fleming, some Vietnam vets don’t find out they have PTSD until they have just months or weeks left to live. Symptoms of terminal illnesses, like pain or breathlessness, can trigger flashbacks, making vets feel as threatened as they did on the battlefield.\u003c/p>\n\u003cp>“The war memories start coming back, they start having nightmares,” said \u003ca href=\"https://profiles.stanford.edu/vj-periyakoil\" target=\"_blank\" rel=\"noopener\">VJ Periyakoil\u003c/a>, a palliative care physician at the VA in Palo Alto. She says opioid medications, like morphine and oxycodone, that are often used for treating pain and breathlessness can make PTSD symptoms worse.\u003c/p>\n\u003cp>“The side effect of those medications, they make you fuzzyheaded,” she said. “Your defenses that you use to cope with the PTSD, which might help repress a lot of the difficult memories, that coping strategy starts to come apart.”\u003c/p>\n\u003cp>She has had patients tell her: “I would much rather tolerate the physical pain, the cancer pain, than take opioids and my defenses crumble.”\u003c/p>\n\u003cp>Some vets see their pain or PTSD as retribution for their work in the line of duty.\u003c/p>\n\u003cp>“Sometimes I’ve had patients refuse medications that might ease their experiences because they feel that they deserve to suffer,” Periyakoil said. “This is redemptive.”\u003c/p>\n\u003cp>The best thing to do in these situations can be to stand down, she said. With weeks left to live, there isn’t enough time to resolve the mental anguish, and staff have to let patients set the pace and tone for their care.\u003c/p>\n\u003cp>But doctors and nurses, just like soldiers, hate doing nothing.\u003c/p>\n\u003cp>“We talk about the moral distress that \u003cem>we \u003c/em>have sometimes about really knowing that we’re doing the right thing for this individual, so that we can be present for \u003cem>their \u003c/em>suffering, the way \u003cem>they\u003c/em> need to do it,” said Patrice Villars, a hospice nurse at the San Francisco VA.\u003c/p>\n\u003cp>For Ron Fleming, death is still likely a couple of years out. His doctors have been begging him, gently, to consider mental health counseling or antidepressants. But he has refused.\u003c/p>\n\u003cp>“I don’t want to take psychiatric drugs. The vets call them the happy pills,” he said. “I don’t want any of those, because they change you. I don’t want to change.”\u003c/p>\n\u003cp>He’s not sure if he deserves to be happy.\u003c/p>\n\u003cp>“That I don’t know,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>His pain is what connects him to the past. Fleming was awarded 18 air medals for acts of meritorious achievement and heroism. The loss and grief he experienced in Vietnam are woven into the same memories of victory and glory. He doesn’t want treatment that might make that go away.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A lot of Ron Fleming’s fellow soldiers spent the last five decades trying to forget what they saw and did in Vietnam. Now 74, Fleming has spent most of that time trying to hold on to it. He has never been as proud as he was when he was 21.\u003c/p>\n\u003cp>“I take issue with those who say we lost. We didn’t lose that war,” he said, sitting on the edge of his hospital bed at the \u003ca href=\"https://www.sanfrancisco.va.gov/\" target=\"_blank\" rel=\"noopener\">San Francisco VA medical center\u003c/a>. “Everywhere I went, we literally kicked the crap out of them.”\u003c/p>\n\u003cp>Fleming was a door gunner in the war, hanging out of a helicopter on a strap with a machine gun in his hands. He fought in the Tet Offensive, sometimes 40 hours straight, firing 6,000 rounds a minute. But he never gave much thought to catching one himself.\u003c/p>\n\u003cp>“You see, at 21, you’re bulletproof,” he said. “Dying wasn’t on the agenda.”\u003c/p>\n\u003cp>But now, it is. Fleming has congestive heart failure, arthritis and breathing problems. He often lands in the VA hospital with asthma attacks, and the palliative care team visits him regularly. He thinks about death.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I wish it’d get off its ass and come on me. I’m sick of this crap,” he said, as his heart rate monitor ticked up. “You see, dying’s the easy part. Living is what’s hard.”\u003c/p>\n\u003cp>Fleming has had trouble holding down a job since he got back from the war. He had a girl he lived with for 10 years, but they never married, never had kids. He lives alone in Oakland now. He says he angers easily and is always hypervigilant. About 10 years ago, he was diagnosed with PTSD. More than anything, he says, he suffers from a \"rotten outlook\" on life.\u003c/p>\n\u003cp>“Sometimes I think that now I’m being paid back for all the men I killed,” he said. “I killed a lot of them. More than I can count.”\u003c/p>\n\u003cp>Unlike Fleming, some Vietnam vets don’t find out they have PTSD until they have just months or weeks left to live. Symptoms of terminal illnesses, like pain or breathlessness, can trigger flashbacks, making vets feel as threatened as they did on the battlefield.\u003c/p>\n\u003cp>“The war memories start coming back, they start having nightmares,” said \u003ca href=\"https://profiles.stanford.edu/vj-periyakoil\" target=\"_blank\" rel=\"noopener\">VJ Periyakoil\u003c/a>, a palliative care physician at the VA in Palo Alto. She says opioid medications, like morphine and oxycodone, that are often used for treating pain and breathlessness can make PTSD symptoms worse.\u003c/p>\n\u003cp>“The side effect of those medications, they make you fuzzyheaded,” she said. “Your defenses that you use to cope with the PTSD, which might help repress a lot of the difficult memories, that coping strategy starts to come apart.”\u003c/p>\n\u003cp>She has had patients tell her: “I would much rather tolerate the physical pain, the cancer pain, than take opioids and my defenses crumble.”\u003c/p>\n\u003cp>Some vets see their pain or PTSD as retribution for their work in the line of duty.\u003c/p>\n\u003cp>“Sometimes I’ve had patients refuse medications that might ease their experiences because they feel that they deserve to suffer,” Periyakoil said. “This is redemptive.”\u003c/p>\n\u003cp>The best thing to do in these situations can be to stand down, she said. With weeks left to live, there isn’t enough time to resolve the mental anguish, and staff have to let patients set the pace and tone for their care.\u003c/p>\n\u003cp>But doctors and nurses, just like soldiers, hate doing nothing.\u003c/p>\n\u003cp>“We talk about the moral distress that \u003cem>we \u003c/em>have sometimes about really knowing that we’re doing the right thing for this individual, so that we can be present for \u003cem>their \u003c/em>suffering, the way \u003cem>they\u003c/em> need to do it,” said Patrice Villars, a hospice nurse at the San Francisco VA.\u003c/p>\n\u003cp>For Ron Fleming, death is still likely a couple of years out. His doctors have been begging him, gently, to consider mental health counseling or antidepressants. But he has refused.\u003c/p>\n\u003cp>“I don’t want to take psychiatric drugs. The vets call them the happy pills,” he said. “I don’t want any of those, because they change you. I don’t want to change.”\u003c/p>\n\u003cp>He’s not sure if he deserves to be happy.\u003c/p>\n\u003cp>“That I don’t know,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>His pain is what connects him to the past. Fleming was awarded 18 air medals for acts of meritorious achievement and heroism. The loss and grief he experienced in Vietnam are woven into the same memories of victory and glory. He doesn’t want treatment that might make that go away.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Cracks Down On Weed Killer As Lawsuits Abound",
"title": "California Cracks Down On Weed Killer As Lawsuits Abound",
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"content": "\u003cp>Jack McCall was a fixture at the local farmers market, where he sold avocados and other fruits he grew on his 20-acre ranch in Cambria, on California’s Central Coast.\u003c/p>\n\u003cp>The U.S. postal worker and Little League coach was “very environmentally friendly,” said Teri McCall, his wife of 41 years. He avoided chemicals, using only his tractor-mower to root out the thistle and other weeds that continually sprouted on the flat areas of the ranch.\u003c/p>\n\u003cp>But he did make one exception to that rule — a fateful one, his wife now believes. For more than three decades, on the hilly parts of the ranch where he grew the avocados, and around newly planted fruit trees, Jack donned a backpack sprayer and doused weeds with the widely sold herbicide Roundup.\u003c/p>\n\u003cp>“He believed Roundup was safe,” Teri McCall said, noting that St. Louis-based Monsanto Co. has regularly touted its flagship product as \u003ca href=\"https://www.youtube.com/watch?v=vJboNdWoFws\" target=\"_blank\" rel=\"noopener\">harmless to people and pets\u003c/a>.\u003c/p>\n\u003cp>In 2012, the McCalls’ 6-year-old dog, Duke, who regularly accompanied Jack around the farm, fell ill with swollen lymph nodes in his neck and died shortly afterward of lymphoma — a type of blood cancer. Three years later, Jack discovered swollen lymph nodes in his own neck, Teri said. The diagnosis: a rare form of non-Hodgkin lymphoma, which killed him on Dec. 26, 2015.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I thought, ‘That’s kind of a coincidence that they both got lumps in their neck,’” Teri recalled. “Then I thought about all the time Duke spent sticking his nose in grass that had been sprayed with Roundup.”\u003c/p>\n\u003cp>In March 2016, McCall filed a \u003ca href=\"http://baumhedlundlaw.com/pdf/monsanto-documents/Teri-McCall-Monsanto-Roundup-Lawsuit-Complaint.pdf\" target=\"_blank\" rel=\"noopener\">wrongful death lawsuit\u003c/a> against Monsanto, alleging that the company concealed the cancer risk posed by a chemical called “glyphosate,” the active ingredient in Roundup, which she now blames for the deaths of her husband and their dog.\u003c/p>\n\u003cp>Hundreds of similar lawsuits are pending in federal and state courthouses around the United States.\u003c/p>\n\u003cp>Monsanto vigorously contests them.\u003c/p>\n\u003cp>“To be clear: The underlying science behind glyphosate is not at question,” said Scott Partridge, the company’s vice president of global strategy. “Monsanto’s glyphosate-based herbicides have a long history of safe use and have been studied in real-world application, including the largest study ever of the actual use of pesticides by farmers.”\u003c/p>\n\u003cp>Monsanto’s Partridge contended that “cherry-picking isolated documents out of context is an attempt by the plaintiffs’ attorneys in pending litigation to distract from the science, which is not on their side.”\u003c/p>\n\u003cp>The use of glyphosate has grown exponentially in the past two decades. The chemical has found its way into the food chain — and into people’s bodies. A \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2658306\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published this week in the medical journal JAMA showed that the number of Southern California adults who tested positive for glyphosate in their urine rose dramatically from 1993 to 2016, as did the amount of the chemical in those who excreted it.\u003c/p>\n\u003cp>In July, California added glyphosate to its list of cancer-causing chemicals under the \u003ca href=\"https://oehha.ca.gov/proposition-65\" target=\"_blank\" rel=\"noopener\">Safe Drinking Water and Toxic Enforcement Act of 1986.\u003c/a> The act, also known as Proposition 65, requires businesses to warn consumers if their products or facilities contain potentially unsafe amounts of any toxic substances known to cause cancer, birth defects or other reproductive harm.\u003c/p>\n\u003cp>California is the first state in the U.S. to “take regulatory action to protect our residents from this chemical,” said Olga Naidenko, senior science adviser for the Environmental Working Group, a nonprofit research and advocacy organization. The move is “a huge step and has global implications.”\u003c/p>\n\u003cp>The state’s Office of Environmental Health Hazard Assessment, which is responsible for listing chemicals under Proposition 65, has proposed a \u003ca href=\"https://oehha.ca.gov/media/downloads/crnr/glyphosate032917isor.pdf\" target=\"_blank\" rel=\"noopener\">threshold\u003c/a> of 1.1 milligrams of glyphosate a day for an adult weighing 70 kilograms, or 154 pounds. That’s about 122 times more stringent than the federal Environmental Protection Agency’s safety guideline.\u003c/p>\n\u003cp>The state agency is studying more than 1,300 written public comments, along with oral testimony from a \u003ca href=\"https://oehha.ca.gov/media/downloads/crnr/060717glyphosatetranscript.pdf\" target=\"_blank\" rel=\"noopener\">June hearing\u003c/a>, to decide whether it should implement or revise its proposed limit.\u003c/p>\n\u003cp>The Prop. 65 listing requires warning labels beginning next July.\u003c/p>\n\u003cp>Other companies, including Dow AgroSciences and DuPont, also sell products containing glyphosate, since Monsanto’s patent expired in 2000.\u003c/p>\n\u003cp>California’s decision to list the chemical was triggered by a 2015 \u003ca href=\"https://www.iarc.fr/en/media-centre/iarcnews/pdf/MonographVolume112.pdf\">study\u003c/a> from the World Health Organization that described the chemical as “probably carcinogenic to humans” and cited “convincing evidence that glyphosate also can cause cancer in laboratory animals.”\u003c/p>\n\u003cp>The organization’s International Agency for Research on Cancer found a “positive association” between exposure to glyphosate and malignancy in humans, though it added that other explanations could not be excluded. In particular, the international agency found a possible link to non-Hodgkin lymphoma, the type of cancer that killed Jack McCall.\u003c/p>\n\u003cp>Monsanto sued in state Superior Court to overrule the California listing but \u003ca href=\"http://www.latimes.com/business/la-fi-roundup-california-20170314-story.html\">lost in March\u003c/a>, and it has appealed that decision. Its bid to temporarily halt the cancer listing pending trial was rejected by a state appellate court and the California Supreme Court. The company says that labeling glyphosate a cancer risk is unjustified.\u003c/p>\n\u003cp>It argues that the International Agency for Research on Cancer erred by neglecting to consider data suggesting no link between glyphosate and non-Hodgkin lymphoma. That research was in an unpublished part of the multiyear and multifaceted \u003ca href=\"https://aghealth.nih.gov/\" target=\"_blank\" rel=\"noopener\">Agricultural Health Study\u003c/a>, which assesses the effects of pesticide exposure on farmers. The international cancer agency, an independent panel of scientists, said it weighs only published, peer-reviewed studies.\u003c/p>\n\u003cp>Other studies also have failed to establish a convincing link between glyphosate and cancer. Earlier this year, the European Union’s chemical safety regulator determined there was \u003ca href=\"https://echa.europa.eu/-/glyphosate-not-classified-as-a-carcinogen-by-echa\" target=\"_blank\" rel=\"noopener\">not sufficient evidence\u003c/a> to classify glyphosate as a carcinogen, though it did say the compound could cause eye damage and long-term harm to aquatic life.\u003c/p>\n\u003cp>But the international cancer agency, which said it examined about 1,000 studies, determined there was enough information to support its finding of a link between glyphosate and cancer.\u003c/p>\n\u003cp>Advocates for farmers say California’s plan to require warning labels for glyphosate-based products is wrong-headed. At a June hearing, Cynthia Cory, environmental affairs director for the nonprofit California Farm Bureau Federation, told the board of the health hazard assessment agency that the herbicide is an important tool for farmers. It ultimately benefits the environment, she said, because “it allows us to reduce our tractor passes, which means you have cleaner air.”\u003c/p>\n\u003cp>Dr. Michelle Perro, a pediatrician who treats children for glyphosate exposure, offered the board a different viewpoint. “What I am seeing is sicker kids,” she said.\u003c/p>\n\u003cp>Research suggests that Roundup and other glyphosate-based herbicides may be linked not only to cancer but to a variety of \u003ca href=\"http://www.mdpi.com/1099-4300/15/4/1416\" target=\"_blank\" rel=\"noopener\">other health problems\u003c/a>. Recent studies link the compound to DNA and chromosomal damage in human cells, kidney failure, chronic kidney disease, intestinal disorders, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945755/\" target=\"_blank\" rel=\"noopener\">Celiac disease\u003c/a> and autism.\u003c/p>\n\u003cp>About 250 million pounds of glyphosate were sprayed on U.S. crops in 2014, a ninefold increase in just under two decades, according to \u003ca href=\"https://enveurope.springeropen.com/articles/10.1186/s12302-016-0070-0\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> in the journal Environmental Sciences Europe. Two-thirds of all the glyphosate used in the U.S. during the 40 years from 1974 to 2014 was sprayed in the last decade.\u003c/p>\n\u003cp>And you don’t need to live next to farm fields to be exposed to it, said Dr. Paul Winchester, a clinical professor of neonatology at Indiana University School of Medicine and medical director of the neonatal unit at Franciscan St. Francis Health in Indianapolis. “It turns out it’s in almost every [non-organic] food.”\u003c/p>\n\u003cp>That concerns him in light of a \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0066318\" target=\"_blank\" rel=\"noopener\">study\u003c/a> that suggests chromosomal damage caused by pesticides has the potential to embed in DNA and get passed down to future generations.\u003c/p>\n\u003cp>Teri McCall said she applauds California’s decision to list glyphosate as a carcinogen and hopes it will help protect others from the kind of loss she’s suffered.\u003c/p>\n\u003cp>Since her husband’s death, “it’s kind of like my life of living color has gone to black-and-white,” she said. “My life with Jack was just so full of joy and laughter and fun, and this has just left a huge void. … Every day is just a series of efforts to escape the loss and there’s just no escaping it.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "California has listed the active ingredient in Monsanto’s Roundup as cancer-causing.",
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"nprByline": "\u003ca href=\"https://khn.org/news/author/stephanie-oneill/\" target=\"_blank\" rel=\"noopener\">Stephanie O'Neill\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Jack McCall was a fixture at the local farmers market, where he sold avocados and other fruits he grew on his 20-acre ranch in Cambria, on California’s Central Coast.\u003c/p>\n\u003cp>The U.S. postal worker and Little League coach was “very environmentally friendly,” said Teri McCall, his wife of 41 years. He avoided chemicals, using only his tractor-mower to root out the thistle and other weeds that continually sprouted on the flat areas of the ranch.\u003c/p>\n\u003cp>But he did make one exception to that rule — a fateful one, his wife now believes. For more than three decades, on the hilly parts of the ranch where he grew the avocados, and around newly planted fruit trees, Jack donned a backpack sprayer and doused weeds with the widely sold herbicide Roundup.\u003c/p>\n\u003cp>“He believed Roundup was safe,” Teri McCall said, noting that St. Louis-based Monsanto Co. has regularly touted its flagship product as \u003ca href=\"https://www.youtube.com/watch?v=vJboNdWoFws\" target=\"_blank\" rel=\"noopener\">harmless to people and pets\u003c/a>.\u003c/p>\n\u003cp>In 2012, the McCalls’ 6-year-old dog, Duke, who regularly accompanied Jack around the farm, fell ill with swollen lymph nodes in his neck and died shortly afterward of lymphoma — a type of blood cancer. Three years later, Jack discovered swollen lymph nodes in his own neck, Teri said. The diagnosis: a rare form of non-Hodgkin lymphoma, which killed him on Dec. 26, 2015.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I thought, ‘That’s kind of a coincidence that they both got lumps in their neck,’” Teri recalled. “Then I thought about all the time Duke spent sticking his nose in grass that had been sprayed with Roundup.”\u003c/p>\n\u003cp>In March 2016, McCall filed a \u003ca href=\"http://baumhedlundlaw.com/pdf/monsanto-documents/Teri-McCall-Monsanto-Roundup-Lawsuit-Complaint.pdf\" target=\"_blank\" rel=\"noopener\">wrongful death lawsuit\u003c/a> against Monsanto, alleging that the company concealed the cancer risk posed by a chemical called “glyphosate,” the active ingredient in Roundup, which she now blames for the deaths of her husband and their dog.\u003c/p>\n\u003cp>Hundreds of similar lawsuits are pending in federal and state courthouses around the United States.\u003c/p>\n\u003cp>Monsanto vigorously contests them.\u003c/p>\n\u003cp>“To be clear: The underlying science behind glyphosate is not at question,” said Scott Partridge, the company’s vice president of global strategy. “Monsanto’s glyphosate-based herbicides have a long history of safe use and have been studied in real-world application, including the largest study ever of the actual use of pesticides by farmers.”\u003c/p>\n\u003cp>Monsanto’s Partridge contended that “cherry-picking isolated documents out of context is an attempt by the plaintiffs’ attorneys in pending litigation to distract from the science, which is not on their side.”\u003c/p>\n\u003cp>The use of glyphosate has grown exponentially in the past two decades. The chemical has found its way into the food chain — and into people’s bodies. A \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2658306\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published this week in the medical journal JAMA showed that the number of Southern California adults who tested positive for glyphosate in their urine rose dramatically from 1993 to 2016, as did the amount of the chemical in those who excreted it.\u003c/p>\n\u003cp>In July, California added glyphosate to its list of cancer-causing chemicals under the \u003ca href=\"https://oehha.ca.gov/proposition-65\" target=\"_blank\" rel=\"noopener\">Safe Drinking Water and Toxic Enforcement Act of 1986.\u003c/a> The act, also known as Proposition 65, requires businesses to warn consumers if their products or facilities contain potentially unsafe amounts of any toxic substances known to cause cancer, birth defects or other reproductive harm.\u003c/p>\n\u003cp>California is the first state in the U.S. to “take regulatory action to protect our residents from this chemical,” said Olga Naidenko, senior science adviser for the Environmental Working Group, a nonprofit research and advocacy organization. The move is “a huge step and has global implications.”\u003c/p>\n\u003cp>The state’s Office of Environmental Health Hazard Assessment, which is responsible for listing chemicals under Proposition 65, has proposed a \u003ca href=\"https://oehha.ca.gov/media/downloads/crnr/glyphosate032917isor.pdf\" target=\"_blank\" rel=\"noopener\">threshold\u003c/a> of 1.1 milligrams of glyphosate a day for an adult weighing 70 kilograms, or 154 pounds. That’s about 122 times more stringent than the federal Environmental Protection Agency’s safety guideline.\u003c/p>\n\u003cp>The state agency is studying more than 1,300 written public comments, along with oral testimony from a \u003ca href=\"https://oehha.ca.gov/media/downloads/crnr/060717glyphosatetranscript.pdf\" target=\"_blank\" rel=\"noopener\">June hearing\u003c/a>, to decide whether it should implement or revise its proposed limit.\u003c/p>\n\u003cp>The Prop. 65 listing requires warning labels beginning next July.\u003c/p>\n\u003cp>Other companies, including Dow AgroSciences and DuPont, also sell products containing glyphosate, since Monsanto’s patent expired in 2000.\u003c/p>\n\u003cp>California’s decision to list the chemical was triggered by a 2015 \u003ca href=\"https://www.iarc.fr/en/media-centre/iarcnews/pdf/MonographVolume112.pdf\">study\u003c/a> from the World Health Organization that described the chemical as “probably carcinogenic to humans” and cited “convincing evidence that glyphosate also can cause cancer in laboratory animals.”\u003c/p>\n\u003cp>The organization’s International Agency for Research on Cancer found a “positive association” between exposure to glyphosate and malignancy in humans, though it added that other explanations could not be excluded. In particular, the international agency found a possible link to non-Hodgkin lymphoma, the type of cancer that killed Jack McCall.\u003c/p>\n\u003cp>Monsanto sued in state Superior Court to overrule the California listing but \u003ca href=\"http://www.latimes.com/business/la-fi-roundup-california-20170314-story.html\">lost in March\u003c/a>, and it has appealed that decision. Its bid to temporarily halt the cancer listing pending trial was rejected by a state appellate court and the California Supreme Court. The company says that labeling glyphosate a cancer risk is unjustified.\u003c/p>\n\u003cp>It argues that the International Agency for Research on Cancer erred by neglecting to consider data suggesting no link between glyphosate and non-Hodgkin lymphoma. That research was in an unpublished part of the multiyear and multifaceted \u003ca href=\"https://aghealth.nih.gov/\" target=\"_blank\" rel=\"noopener\">Agricultural Health Study\u003c/a>, which assesses the effects of pesticide exposure on farmers. The international cancer agency, an independent panel of scientists, said it weighs only published, peer-reviewed studies.\u003c/p>\n\u003cp>Other studies also have failed to establish a convincing link between glyphosate and cancer. Earlier this year, the European Union’s chemical safety regulator determined there was \u003ca href=\"https://echa.europa.eu/-/glyphosate-not-classified-as-a-carcinogen-by-echa\" target=\"_blank\" rel=\"noopener\">not sufficient evidence\u003c/a> to classify glyphosate as a carcinogen, though it did say the compound could cause eye damage and long-term harm to aquatic life.\u003c/p>\n\u003cp>But the international cancer agency, which said it examined about 1,000 studies, determined there was enough information to support its finding of a link between glyphosate and cancer.\u003c/p>\n\u003cp>Advocates for farmers say California’s plan to require warning labels for glyphosate-based products is wrong-headed. At a June hearing, Cynthia Cory, environmental affairs director for the nonprofit California Farm Bureau Federation, told the board of the health hazard assessment agency that the herbicide is an important tool for farmers. It ultimately benefits the environment, she said, because “it allows us to reduce our tractor passes, which means you have cleaner air.”\u003c/p>\n\u003cp>Dr. Michelle Perro, a pediatrician who treats children for glyphosate exposure, offered the board a different viewpoint. “What I am seeing is sicker kids,” she said.\u003c/p>\n\u003cp>Research suggests that Roundup and other glyphosate-based herbicides may be linked not only to cancer but to a variety of \u003ca href=\"http://www.mdpi.com/1099-4300/15/4/1416\" target=\"_blank\" rel=\"noopener\">other health problems\u003c/a>. Recent studies link the compound to DNA and chromosomal damage in human cells, kidney failure, chronic kidney disease, intestinal disorders, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945755/\" target=\"_blank\" rel=\"noopener\">Celiac disease\u003c/a> and autism.\u003c/p>\n\u003cp>About 250 million pounds of glyphosate were sprayed on U.S. crops in 2014, a ninefold increase in just under two decades, according to \u003ca href=\"https://enveurope.springeropen.com/articles/10.1186/s12302-016-0070-0\" target=\"_blank\" rel=\"noopener\">a study\u003c/a> in the journal Environmental Sciences Europe. Two-thirds of all the glyphosate used in the U.S. during the 40 years from 1974 to 2014 was sprayed in the last decade.\u003c/p>\n\u003cp>And you don’t need to live next to farm fields to be exposed to it, said Dr. Paul Winchester, a clinical professor of neonatology at Indiana University School of Medicine and medical director of the neonatal unit at Franciscan St. Francis Health in Indianapolis. “It turns out it’s in almost every [non-organic] food.”\u003c/p>\n\u003cp>That concerns him in light of a \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0066318\" target=\"_blank\" rel=\"noopener\">study\u003c/a> that suggests chromosomal damage caused by pesticides has the potential to embed in DNA and get passed down to future generations.\u003c/p>\n\u003cp>Teri McCall said she applauds California’s decision to list glyphosate as a carcinogen and hopes it will help protect others from the kind of loss she’s suffered.\u003c/p>\n\u003cp>Since her husband’s death, “it’s kind of like my life of living color has gone to black-and-white,” she said. “My life with Jack was just so full of joy and laughter and fun, and this has just left a huge void. … Every day is just a series of efforts to escape the loss and there’s just no escaping it.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener\">California Healthline\u003c/a>, a service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Human Psychology Makes Health Insurance a Hard Sell – Especially for Latino Consumers",
"title": "Human Psychology Makes Health Insurance a Hard Sell – Especially for Latino Consumers",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>The way human brains are wired, it just doesn’t make sense to us to buy something now that we may not need for years in the future.\u003c/p>\n\u003cp>“Health insurance has to be the toughest thing on earth to sell,” said \u003ca href=\"http://www.ogilvy.com/ogilvy-mather-board/christopher-graves/\" target=\"_blank\" rel=\"noopener\">Christopher Graves\u003c/a>, president and founder of Ogilvy’s Behavioral Science Center. “Especially if you're trying to sell it to somebody who's young, healthy and has not had some catastrophe health-wise.\u003c/p>\n\u003cp>That would be most Latinos in California, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/\" target=\"_blank\" rel=\"noopener\">a primary target\u003c/a> of the marketing and outreach strategy for \u003ca href=\"https://www.coveredca.com/\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s insurance marketplace. The more healthy Latinos sign up for insurance, the more their premiums help balance the costs of caring for older, sicker Californians.\u003c/p>\n\u003cp>Latinos represent 38 percent of the marketplace’s potential customer base but about 30 percent of people who actually enroll, so Covered California sees marketing to the demographic as a good return on investment for the whole exchange.\u003c/p>\n\u003cp>But the Trump administration has made the already difficult task, of selling a product people don’t want to think about, even harder. Federal health officials slashed the national budget for marketing around the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s over for Obamacare,” President Trump has been saying since his campaign. “Let Obamacare implode.”\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=FAJfWfzKSxs\u003c/p>\n\u003cp>But California controls its own marketing budget and plans to invest $111 million to counteract the negative press from the feds. It will also spend 30 percent of its media buy on Spanish-language ads. But in terms of the creative message, California is on the defensive.\u003c/p>\n\u003cp>“Even if they're hearing you know the Affordable Care Act is going away, we're saying ‘No, no, not yet, not yet,' ” said Lizelda Lopez, who helps direct Latino outreach for Covered California as the agency’s deputy director of communications. “We're still here.”\u003c/p>\n\u003cp>That’s the mantra for this year, she said: “We are open for business. We are here. Financial assistance is still available. Open enrollment is Nov. 1 to Jan. 31. We are here.”\u003c/p>\n\u003cp>Such simple messages may work for people who already bought coverage in previous years and just need to renew their plan, said Carlos Santiago, chief strategist at \u003ca href=\"http://santiagosolutionsgroup.com/\" target=\"_blank\" rel=\"noopener\">Santiago Solutions Group\u003c/a>, a research consulting firm. But they could be too simple for new customers.\u003c/p>\n\u003cp>“To convince someone that was uninsured to get it for the first time? Obviously that message is not going to work,” Santiago said. “Especially not this year.”\u003c/p>\n\u003cp>Plus, the belief that illness won’t happen to you -- Santiago said this is especially entrenched in Latino culture.\u003c/p>\n\u003cp>“Latinos are extremely, extremely positive and overly optimistic,” he said, one reason Latinos have higher rates of going uninsured.\u003c/p>\n\u003cp>“We don't need to worry so much about today. Things will be OK,” he said. “And obviously when it comes to insurance, that's not exactly what it's all about.\"\u003c/p>\n\u003cp>On that front, Covered California has some more dramatic ads featuring ambulances and overturned bicycles, or a scene of a \u003ca href=\"https://vimeopro.com/coveredcanews/instant-tv/video/239171245\" target=\"_blank\" rel=\"noopener\">ladder falling backward\u003c/a>. It also plans to push a series of videos on social media. Its market research shows Latina women are very active video sharers, Lopez said.\u003c/p>\n\u003cp>“Mi nombre es Guadalupe,” says a young woman in\u003ca href=\"https://player.vimeo.com/video/215252751/?autoplay=1\" target=\"_blank\" rel=\"noopener\"> one video\u003c/a>, as she shows pictures from her wedding day and talks about suddenly finding out she needed a heart transplant.\u003c/p>\n\u003cp>Without her health plan from Covered California, she said she never would have been able to afford the cost of surgery: $1.5 million.\u003c/p>\n\u003cp>This kind of personal story, which other Latinas can relate to, is good, Santiago said. But Latinos don’t respond to fear, he added, so if the message is too scary, it could backfire.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It’s a tug of war,” said Christopher Graves. “That trade-off is, people stop taking action. They basically become paralyzed by how overwhelming it is. There needs to be a balance.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The way human brains are wired, it just doesn’t make sense to us to buy something now that we may not need for years in the future.\u003c/p>\n\u003cp>“Health insurance has to be the toughest thing on earth to sell,” said \u003ca href=\"http://www.ogilvy.com/ogilvy-mather-board/christopher-graves/\" target=\"_blank\" rel=\"noopener\">Christopher Graves\u003c/a>, president and founder of Ogilvy’s Behavioral Science Center. “Especially if you're trying to sell it to somebody who's young, healthy and has not had some catastrophe health-wise.\u003c/p>\n\u003cp>That would be most Latinos in California, \u003ca href=\"https://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/\" target=\"_blank\" rel=\"noopener\">a primary target\u003c/a> of the marketing and outreach strategy for \u003ca href=\"https://www.coveredca.com/\" target=\"_blank\" rel=\"noopener\">Covered California\u003c/a>, the state’s insurance marketplace. The more healthy Latinos sign up for insurance, the more their premiums help balance the costs of caring for older, sicker Californians.\u003c/p>\n\u003cp>Latinos represent 38 percent of the marketplace’s potential customer base but about 30 percent of people who actually enroll, so Covered California sees marketing to the demographic as a good return on investment for the whole exchange.\u003c/p>\n\u003cp>But the Trump administration has made the already difficult task, of selling a product people don’t want to think about, even harder. Federal health officials slashed the national budget for marketing around the Affordable Care Act.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s over for Obamacare,” President Trump has been saying since his campaign. “Let Obamacare implode.”\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/FAJfWfzKSxs'\n title='//www.youtube.com/embed/FAJfWfzKSxs'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>But California controls its own marketing budget and plans to invest $111 million to counteract the negative press from the feds. It will also spend 30 percent of its media buy on Spanish-language ads. But in terms of the creative message, California is on the defensive.\u003c/p>\n\u003cp>“Even if they're hearing you know the Affordable Care Act is going away, we're saying ‘No, no, not yet, not yet,' ” said Lizelda Lopez, who helps direct Latino outreach for Covered California as the agency’s deputy director of communications. “We're still here.”\u003c/p>\n\u003cp>That’s the mantra for this year, she said: “We are open for business. We are here. Financial assistance is still available. Open enrollment is Nov. 1 to Jan. 31. We are here.”\u003c/p>\n\u003cp>Such simple messages may work for people who already bought coverage in previous years and just need to renew their plan, said Carlos Santiago, chief strategist at \u003ca href=\"http://santiagosolutionsgroup.com/\" target=\"_blank\" rel=\"noopener\">Santiago Solutions Group\u003c/a>, a research consulting firm. But they could be too simple for new customers.\u003c/p>\n\u003cp>“To convince someone that was uninsured to get it for the first time? Obviously that message is not going to work,” Santiago said. “Especially not this year.”\u003c/p>\n\u003cp>Plus, the belief that illness won’t happen to you -- Santiago said this is especially entrenched in Latino culture.\u003c/p>\n\u003cp>“Latinos are extremely, extremely positive and overly optimistic,” he said, one reason Latinos have higher rates of going uninsured.\u003c/p>\n\u003cp>“We don't need to worry so much about today. Things will be OK,” he said. “And obviously when it comes to insurance, that's not exactly what it's all about.\"\u003c/p>\n\u003cp>On that front, Covered California has some more dramatic ads featuring ambulances and overturned bicycles, or a scene of a \u003ca href=\"https://vimeopro.com/coveredcanews/instant-tv/video/239171245\" target=\"_blank\" rel=\"noopener\">ladder falling backward\u003c/a>. It also plans to push a series of videos on social media. Its market research shows Latina women are very active video sharers, Lopez said.\u003c/p>\n\u003cp>“Mi nombre es Guadalupe,” says a young woman in\u003ca href=\"https://player.vimeo.com/video/215252751/?autoplay=1\" target=\"_blank\" rel=\"noopener\"> one video\u003c/a>, as she shows pictures from her wedding day and talks about suddenly finding out she needed a heart transplant.\u003c/p>\n\u003cp>Without her health plan from Covered California, she said she never would have been able to afford the cost of surgery: $1.5 million.\u003c/p>\n\u003cp>This kind of personal story, which other Latinas can relate to, is good, Santiago said. But Latinos don’t respond to fear, he added, so if the message is too scary, it could backfire.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It’s a tug of war,” said Christopher Graves. “That trade-off is, people stop taking action. They basically become paralyzed by how overwhelming it is. There needs to be a balance.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Beyond The Shattered Lives And Bodies, Money Worries Weigh On Las Vegas Victims",
"title": "Beyond The Shattered Lives And Bodies, Money Worries Weigh On Las Vegas Victims",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp class=\"p1\">LAS VEGAS — Kurt Fowler and his wife, Trina, were celebrating their 18th wedding anniversary at a country music festival when the shooting started. Fowler, 41, knew he’d been hit in the ankle and couldn’t run. He hid under the stage until the gunfire ended.\u003c/p>\n\u003cp class=\"p1\">“I knew my foot was completely useless,” said Fowler, a firefighter from Lake Havasu City, Ariz., and a father of three. He underwent surgery, spent nearly two weeks in the hospital and still may need another operation. He also will need rehabilitation and follow-up visits with a specialist.\u003c/p>\n\u003cp class=\"p1\">Fowler has a Blue Cross Blue Shield PPO through his job, but he said he doesn’t know how much he will have to pay out of his own pocket for the care he is receiving. In an era of higher deductibles and limited choice of in-network doctors, however, he knows he could face significant medical bills.\u003c/p>\n\u003cp class=\"p1\">His insurance card says his individual deductible is $5,000 and his coinsurance 20 percent. He said he didn’t know how much his health plan would cover for out-of-state care.\u003c/p>\n\u003cp class=\"p1\">“Medical expenses are astronomical these days,” Fowler said from his bed at Sunrise Hospital & Medical Center here. “It’s a mountain that just doesn’t seem like it’s gonna be climbable, but we are gonna do our best.”\u003c/p>\n\u003cfigure id=\"attachment_361805\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361805\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kurt Fowler looks at an X-ray of his ankle as he sits in a hospital bed at Sunrise Hospital & Medical Center. Fowler, a firefighter from Arizona, got shot in the ankle and said he expects to be out of work for months as he recovers. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">As hundreds of survivors struggle to recover emotionally and physically from the Oct. 1 attack, they are beginning to come to terms with the financial toll of the violence perpetrated against them. Even those who are insured could face untold costs in a city they were only visiting.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp class=\"p1\">The total costs of medical care alone could reach into the tens of millions of dollars, said Garen Wintemute, who researches gun violence at the University of California-Davis. And that is just the beginning. Many survivors will be out of work for months, if they are able to return at all.\u003c/p>\n\u003cp class=\"p1\">“We really don’t have a good handle on the intangible costs of something like this … the ripple effects on family and friends and neighborhoods when a large number of people have been shot,” Wintemute said.\u003c/p>\n\u003cp class=\"p1\">More than 100,000 people are shot every year in the U.S., according to the Centers for Disease Control and Prevention. That generates about $2.8 billion per year in emergency room and inpatient charges alone, according to a recent study in \u003cspan class=\"s1\">Health Affairs\u003c/span>. The average emergency room bill for an individual gunshot victim is $5,254 and the average inpatient charge is $95,887, according to the study.\u003c/p>\n\u003cp class=\"p1\">The U.S. senators representing Nevada, Dean Heller and Catherine Cortez Masto, wrote a \u003cspan class=\"s1\">letter \u003c/span>to America’s Health Insurance Plans, an industry trade group, and CEO Scott Serota of Blue Cross Blue Shield requesting help with out-of-network bills, copayments and deductibles for the Las Vegas shooting victims. Many of the people who were shot had traveled from other states, including California, Iowa and Tennessee.\u003c/p>\n\u003cp class=\"p1\">California and some states protect consumers from such bills, but Nevada is not one of them, said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. But Corlette said most insurers allow patients to request exceptions based on the circumstances. “In this situation, I imagine most insurers are going to want to be compassionate and work something out,” she said.\u003c/p>\n\u003cp class=\"p1\">The victims and their families aren’t the only ones who will be affected financially by the mass shooting. Taxpayers, too, pick up much of the tab for the health care costs associated with gun violence because many patients are covered by Medicaid and Medicare, two government insurance programs.\u003c/p>\n\u003cp class=\"p1\">And hospitals will also be on the hook for some of the care for patients who don’t have insurance. Hospitals in Las Vegas quickly mobilized to treat the hundreds of victims who were streaming in that night, and they don’t know yet how much of the care will be reimbursed.\u003c/p>\n\u003cp class=\"p1\">At Sunrise Hospital & Medical Center, staff treated more than 200 patients. Sunrise plans to file insurance claims and will “be extremely sensitive to the financial status” of patients when considering their out-of-pocket portions, a spokeswoman said.\u003c/p>\n\u003cp class=\"p1\">Valley Hospital Medical Center is encouraging patients to complete paperwork for a state program called Nevada Victims of Violent Crime, which would pay their balances. And Dignity Health’s St. Rose Dominican said it will bill insurers and accept donations but will not require payment from victims.\u003c/p>\n\u003cp class=\"p1\">California victims can also get help with medical expenses and income loss from the \u003cspan class=\"s1\">California \u003c/span>Victim Compensation Board.\u003c/p>\n\u003cp class=\"p1\">In addition, a GoFundMe account started by a Clark County commissioner has raised $11 million thus far. And many survivors have individual GoFundMe accounts.\u003c/p>\n\u003cp class=\"p1\">Kurt Fowler’s GoFundMe page has raised about $39,000. Fowler said he doesn’t have disability insurance so he will rely on the funds to help cover his expenses while he is recovering and missing work.\u003c/p>\n\u003cp class=\"p1\">Michael Caster, 41, who lives in Indio, Calif., has a GoFundMe account that has raised about $26,000 so far. He’s paralyzed from the waist down after a bullet lodged in his spine.\u003c/p>\n\u003cp class=\"p1\">He works in human resources at a California hospital and has a job-sponsored policy with Anthem Blue Cross. “I’ve never really dealt with injury,” he said. “I don’t want to be stuck with a bunch of bills.”\u003c/p>\n\u003cp class=\"p1\">His bills could rise further: That day, he was scheduled to be flown to a rehabilitation center in Colorado for people with spinal cord injuries.\u003c/p>\n\u003cfigure id=\"attachment_361804\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361804\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Frost-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">Mary Moreland gets an update on her daughter from neurosurgeon Keith Blum at Sunrise Hospital & Medical Center. Moreland’s daughter, Tina Frost, was shot in the eye and was in a medically induced coma for two weeks. Frost has insurance through her job as an accountant in San Diego, but her mother said she knows it won’t cover everything. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Mary Moreland, whose daughter Tina Frost was shot during the country music festival, said that at first she didn’t understand why so many families were setting up fundraisers. Then, the severe financial strain the shooting would take started to dawn on her.\u003c/p>\n\u003cp class=\"p1\">Now, Moreland said she’s grateful for the nearly $580,000 raised through GoFundMe. Frost, a resident of San Diego, had emergency brain surgery the night of the shooting. A bullet had pierced her eye and exploded in her brain. As she lay in ICU earlier this month, her mother said small improvements were major milestones. “Today she squeezed my hands,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">The next night, Frost came out of a medically induced coma and was later flown to Johns Hopkins Hospital in Baltimore, near her mother’s home. Over the next weeks and months, she will need multiple operations and a slew of specialists, including neurosurgeons, plastic surgeons, occupational therapists and mental health counselors.\u003c/p>\n\u003cfigure id=\"attachment_361803\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361803\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot from a GoFundMe page set up for Tina Frost, who was shot at the country music festival in Las Vegas. Frost was at Sunrise Hospital & Medical Center for two weeks and was recently flown to a hospital near her mother’s home in Maryland. \u003ccite>(Courtesy of GoFundMe)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Moreland said she cannot even begin to imagine what her daughter’s care will cost. Frost has Blue Cross insurance through her job at Ernst & Young in San Diego, but Moreland said she doesn’t know what the deductible and copayments are.\u003c/p>\n\u003cp class=\"p1\">“Being realistic, knowing what I know about costs of health care, it’s scary,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">“But she’s alive. She’s not one of the 58 other people.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp class=\"p3\">\u003cem>\u003ca href=\"https://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan class=\"s1\">Kaiser Health News\u003c/span>\u003c/a>, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the \u003ca href=\"https://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "Many of the gunshot survivors who suffered serious injuries face not only high deductibles and out-of-network charges but also lost wages.",
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"description": "Many of the gunshot survivors who suffered serious injuries face not only high deductibles and out-of-network charges but also lost wages.",
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"nprByline": "\u003ca href=\"https://khn.org/news/author/anna-gorman/\" rel=\"noopener\" target=\"_blank\">\u003cstrong>Anna Gorman\u003c/strong>\u003c/a>\u003cbr>Kaiser Health News",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"p1\">LAS VEGAS — Kurt Fowler and his wife, Trina, were celebrating their 18th wedding anniversary at a country music festival when the shooting started. Fowler, 41, knew he’d been hit in the ankle and couldn’t run. He hid under the stage until the gunfire ended.\u003c/p>\n\u003cp class=\"p1\">“I knew my foot was completely useless,” said Fowler, a firefighter from Lake Havasu City, Ariz., and a father of three. He underwent surgery, spent nearly two weeks in the hospital and still may need another operation. He also will need rehabilitation and follow-up visits with a specialist.\u003c/p>\n\u003cp class=\"p1\">Fowler has a Blue Cross Blue Shield PPO through his job, but he said he doesn’t know how much he will have to pay out of his own pocket for the care he is receiving. In an era of higher deductibles and limited choice of in-network doctors, however, he knows he could face significant medical bills.\u003c/p>\n\u003cp class=\"p1\">His insurance card says his individual deductible is $5,000 and his coinsurance 20 percent. He said he didn’t know how much his health plan would cover for out-of-state care.\u003c/p>\n\u003cp class=\"p1\">“Medical expenses are astronomical these days,” Fowler said from his bed at Sunrise Hospital & Medical Center here. “It’s a mountain that just doesn’t seem like it’s gonna be climbable, but we are gonna do our best.”\u003c/p>\n\u003cfigure id=\"attachment_361805\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361805\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Kurt-Fowler-photo-KHN.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Kurt Fowler looks at an X-ray of his ankle as he sits in a hospital bed at Sunrise Hospital & Medical Center. Fowler, a firefighter from Arizona, got shot in the ankle and said he expects to be out of work for months as he recovers. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">As hundreds of survivors struggle to recover emotionally and physically from the Oct. 1 attack, they are beginning to come to terms with the financial toll of the violence perpetrated against them. Even those who are insured could face untold costs in a city they were only visiting.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">The total costs of medical care alone could reach into the tens of millions of dollars, said Garen Wintemute, who researches gun violence at the University of California-Davis. And that is just the beginning. Many survivors will be out of work for months, if they are able to return at all.\u003c/p>\n\u003cp class=\"p1\">“We really don’t have a good handle on the intangible costs of something like this … the ripple effects on family and friends and neighborhoods when a large number of people have been shot,” Wintemute said.\u003c/p>\n\u003cp class=\"p1\">More than 100,000 people are shot every year in the U.S., according to the Centers for Disease Control and Prevention. That generates about $2.8 billion per year in emergency room and inpatient charges alone, according to a recent study in \u003cspan class=\"s1\">Health Affairs\u003c/span>. The average emergency room bill for an individual gunshot victim is $5,254 and the average inpatient charge is $95,887, according to the study.\u003c/p>\n\u003cp class=\"p1\">The U.S. senators representing Nevada, Dean Heller and Catherine Cortez Masto, wrote a \u003cspan class=\"s1\">letter \u003c/span>to America’s Health Insurance Plans, an industry trade group, and CEO Scott Serota of Blue Cross Blue Shield requesting help with out-of-network bills, copayments and deductibles for the Las Vegas shooting victims. Many of the people who were shot had traveled from other states, including California, Iowa and Tennessee.\u003c/p>\n\u003cp class=\"p1\">California and some states protect consumers from such bills, but Nevada is not one of them, said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. But Corlette said most insurers allow patients to request exceptions based on the circumstances. “In this situation, I imagine most insurers are going to want to be compassionate and work something out,” she said.\u003c/p>\n\u003cp class=\"p1\">The victims and their families aren’t the only ones who will be affected financially by the mass shooting. Taxpayers, too, pick up much of the tab for the health care costs associated with gun violence because many patients are covered by Medicaid and Medicare, two government insurance programs.\u003c/p>\n\u003cp class=\"p1\">And hospitals will also be on the hook for some of the care for patients who don’t have insurance. Hospitals in Las Vegas quickly mobilized to treat the hundreds of victims who were streaming in that night, and they don’t know yet how much of the care will be reimbursed.\u003c/p>\n\u003cp class=\"p1\">At Sunrise Hospital & Medical Center, staff treated more than 200 patients. Sunrise plans to file insurance claims and will “be extremely sensitive to the financial status” of patients when considering their out-of-pocket portions, a spokeswoman said.\u003c/p>\n\u003cp class=\"p1\">Valley Hospital Medical Center is encouraging patients to complete paperwork for a state program called Nevada Victims of Violent Crime, which would pay their balances. And Dignity Health’s St. Rose Dominican said it will bill insurers and accept donations but will not require payment from victims.\u003c/p>\n\u003cp class=\"p1\">California victims can also get help with medical expenses and income loss from the \u003cspan class=\"s1\">California \u003c/span>Victim Compensation Board.\u003c/p>\n\u003cp class=\"p1\">In addition, a GoFundMe account started by a Clark County commissioner has raised $11 million thus far. And many survivors have individual GoFundMe accounts.\u003c/p>\n\u003cp class=\"p1\">Kurt Fowler’s GoFundMe page has raised about $39,000. Fowler said he doesn’t have disability insurance so he will rely on the funds to help cover his expenses while he is recovering and missing work.\u003c/p>\n\u003cp class=\"p1\">Michael Caster, 41, who lives in Indio, Calif., has a GoFundMe account that has raised about $26,000 so far. He’s paralyzed from the waist down after a bullet lodged in his spine.\u003c/p>\n\u003cp class=\"p1\">He works in human resources at a California hospital and has a job-sponsored policy with Anthem Blue Cross. “I’ve never really dealt with injury,” he said. “I don’t want to be stuck with a bunch of bills.”\u003c/p>\n\u003cp class=\"p1\">His bills could rise further: That day, he was scheduled to be flown to a rehabilitation center in Colorado for people with spinal cord injuries.\u003c/p>\n\u003cfigure id=\"attachment_361804\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361804\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/Frost-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/Frost-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">Mary Moreland gets an update on her daughter from neurosurgeon Keith Blum at Sunrise Hospital & Medical Center. Moreland’s daughter, Tina Frost, was shot in the eye and was in a medically induced coma for two weeks. Frost has insurance through her job as an accountant in San Diego, but her mother said she knows it won’t cover everything. \u003ccite>(Anna Gorman/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Mary Moreland, whose daughter Tina Frost was shot during the country music festival, said that at first she didn’t understand why so many families were setting up fundraisers. Then, the severe financial strain the shooting would take started to dawn on her.\u003c/p>\n\u003cp class=\"p1\">Now, Moreland said she’s grateful for the nearly $580,000 raised through GoFundMe. Frost, a resident of San Diego, had emergency brain surgery the night of the shooting. A bullet had pierced her eye and exploded in her brain. As she lay in ICU earlier this month, her mother said small improvements were major milestones. “Today she squeezed my hands,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">The next night, Frost came out of a medically induced coma and was later flown to Johns Hopkins Hospital in Baltimore, near her mother’s home. Over the next weeks and months, she will need multiple operations and a slew of specialists, including neurosurgeons, plastic surgeons, occupational therapists and mental health counselors.\u003c/p>\n\u003cfigure id=\"attachment_361803\" class=\"wp-caption alignnone\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-361803\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg\" alt=\"\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/10/gofundme_screenshot-photo-KHN-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">A screenshot from a GoFundMe page set up for Tina Frost, who was shot at the country music festival in Las Vegas. Frost was at Sunrise Hospital & Medical Center for two weeks and was recently flown to a hospital near her mother’s home in Maryland. \u003ccite>(Courtesy of GoFundMe)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Moreland said she cannot even begin to imagine what her daughter’s care will cost. Frost has Blue Cross insurance through her job at Ernst & Young in San Diego, but Moreland said she doesn’t know what the deductible and copayments are.\u003c/p>\n\u003cp class=\"p1\">“Being realistic, knowing what I know about costs of health care, it’s scary,” Moreland said.\u003c/p>\n\u003cp class=\"p1\">“But she’s alive. She’s not one of the 58 other people.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Acute Confusion As Enrollment for Affordable Care Act Nears",
"title": "Acute Confusion As Enrollment for Affordable Care Act Nears",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>If the comments on Covered California’s \u003ca href=\"https://www.facebook.com/CoveredCA/\">Facebook page\u003c/a> are any indication, you’re all suffering from acute health insurance confusion:\u003c/p>\n\u003cp>\u003cem>“I wanted to sign up again this year. … I’m hesitant now because of what Trump has done. Should I still consider?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“Does the removal of subsidies mean we might lose our premium tax credits during the year?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“So you’re telling me that [Trump’s] executive order didn’t do anything? I am so confused.”\u003c/em>\u003c/p>\n\u003cp>I don’t blame you. Choosing a health plan will be doubly hard this year given \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">President Donald Trump’s recent move\u003c/a> to cut off federal payments for a key consumer subsidy, his administration’s decision to shorten exchange open-enrollment periods in most states to 45 days, Congress’ failed attempts to repeal Obamacare and the departure of some insurers from certain markets.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Let me ease your mind straightaway on three critical points:\u003c/p>\n\u003cp>1. In California, open enrollment for individuals and families who buy their 2018 plans through Covered California and in the open market lasts three months, from Nov. 1 to Jan. 31.\u003c/p>\n\u003cp>2. You won’t lose the tax credits that help you — and the vast majority of Covered California enrollees — afford your premiums, assuming you still qualify.\u003c/p>\n\u003cp>3. The same goes for the cost-sharing subsidies that reduce out-of-pocket costs for some Covered California members, despite Trump’s decision to stop funding them.\u003c/p>\n\u003cp>But shopping will be challenging. Anthem Blue Cross is pulling out of a large swath of California’s individual market, on and off the exchange, forcing hundreds of thousands of consumers to find new plans. And in addition to regular, annual rate hikes — averaging 12.3 percent statewide — silver-level plans will bear an additional \u003ca href=\"https://californiahealthline.org/news/california-slaps-surcharge-on-aca-plans-as-trump-remains-coy-on-subsidies/\">12.4 percent average surcharge\u003c/a> to make up for the loss of federal funding for the cost-sharing subsidies.\u003c/p>\n\u003cp>Remember, those are averages. Your actual premium will depend on several factors, including where you live, your income, what level of coverage you choose and which insurer you pick.\u003c/p>\n\u003cp>In an unexpected twist, some people may actually benefit from the surcharge because it could bring plans with more robust coverage within financial reach.\u003c/p>\n\u003cp>Before we get into all that, my most important piece of advice remains the same this year as before:\u003c/p>\n\u003cp>Don’t do this alone. Help from certified insurance agents and enrollment “navigators” is free. You can find local options by clicking on the “Find Help” tab on Covered California’s website, \u003ca href=\"http://www.coveredca.com/\">www.CoveredCA.com\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Silver-Plan Surcharge\u003c/strong>\u003c/p>\n\u003cp>Nearly half of Covered California enrollees qualify for cost-sharing subsidies, which lower their copays, deductibles and coinsurance. The subsidies are paid directly to insurers, and are separate from the tax credits that reduce monthly premiums.\u003c/p>\n\u003cp>These discounts are available only to silver-plan enrollees whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four. That’s why Covered California added the 12.4 percent average surcharge only to silver plans amid Trump’s threats — \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">and ultimate decision\u003c/a> — to stop funding the subsidies.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com/news/\">Covered California estimates\u003c/a> that 78 percent of subsidized consumers will pay the same as — or less than — this year, despite the surcharge, because their tax credits will rise with their premiums. About half of the remaining 22 percent will see increases of less than $25 per month.\u003c/p>\n\u003cp>“This is potentially good news for both insurers and consumers,” says \u003ca href=\"http://axenehp.com/consultants/greg-fann-fsa-fca-maaa/\">Greg Fann\u003c/a>, a senior consulting actuary based in Murrieta. “And bad news for taxpayers,” who are footing the bill for the increased tax credits.\u003c/p>\n\u003cp>Fann offers advice to consumers based on their income.\u003c/p>\n\u003cp>Covered California enrollees with incomes up to roughly 200 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\">federal poverty level\u003c/a> — or about $49,200 for a family of four — should probably remain in silver plans, he advises, because they qualify for significant cost-sharing reduction subsidies.\u003c/p>\n\u003cp>Policyholders who make between 200 and 400 percent of the federal poverty level (400 percent is about $98,400 for a family of four) should consider ditching silver plans and applying their higher tax credits to gold or platinum plans, he says. \u003ca href=\"https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/\">Tax credits\u003c/a> are pegged to the cost of silver plans, which means that all subsidized enrollees will benefit from higher tax credits as silver premiums rise, regardless of which plan they ultimately purchase.\u003c/p>\n\u003cp>\u003ca href=\"https://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">Gold and platinum plans\u003c/a> are more expensive than silver plans, but they offer higher levels of coverage and lower out-of-pocket costs.\u003c/p>\n\u003cp>In some cases, “the gold may be cheaper than the silver,” Fann says.\u003c/p>\n\u003cp>You could also apply your increased tax credits to bronze plans, which have lower premiums and higher out-of-pocket costs. According to Covered California, three-quarters of enrollees can sign up for bronze coverage for less than $10 a month.\u003c/p>\n\u003cp>“I suspect a lot of people are going to downgrade their plans to high-deductible plans,” says \u003ca href=\"http://ruffinsolutions.com/about/helena-ruffin-company-president/\">Helena Ruffin\u003c/a>, an insurance agent in Playa Vista.\u003c/p>\n\u003cp>Finally, there are about 65,000 Covered California enrollees with silver plans who don’t receive premium tax credits, says exchange spokeswoman Amy Palmer.\u003c/p>\n\u003cp>People in this group must pay the entire cost of their premiums.\u003c/p>\n\u003cp>“These are the ones in the middle class that are … getting hammered,” Ruffin says.\u003c/p>\n\u003cp>If you’re in this category, avoid the surcharge by buying a bronze, gold or platinum plan. Or, opt for a newly created silver plan sold off the exchange that won’t be subject to the surcharge — if you’re confident your income will remain above the threshold to qualify for premium tax credits.\u003c/p>\n\u003cp>“There may be better options off the exchange,” Palmer says. But if your income fluctuates, “it may be better to stay on the exchange so that you can receive tax credits if you become eligible,” she adds.\u003c/p>\n\u003cp>\u003cstrong>Health Plan Departures\u003c/strong>\u003c/p>\n\u003cp>Anthem will pull out of 16 of California’s 19 pricing regions, affecting about \u003ca href=\"https://californiahealthline.org/news/anthems-retreat-leaves-californians-with-fewer-choices-more-worries/\">300,000 policyholders\u003c/a> who purchase from the individual market, both on and off the exchange.\u003c/p>\n\u003cp>Its departure will leave about 60,000 Covered California consumers \u003ca href=\"https://californiahealthline.org/news/anthems-exit-leaves-thousands-with-no-choice-of-health-plans/\">with one option\u003c/a> — Blue Shield of California. If you do not select a new plan by mid-November, Covered California will \u003ca href=\"https://www.coveredca.com/members/renewal/\">automatically enroll you\u003c/a> in one. If you’re not satisfied with its decision, you can change it before the end of open enrollment, assuming you have a choice.\u003c/p>\n\u003cp>For those of you losing your insurer, you’ll want to know whether your existing providers are in any other Covered California plan networks.\u003c/p>\n\u003cp>Unfortunately, “the doctors networks are smaller and smaller all the time,” says \u003ca href=\"http://crazyhealthinsurance.com/\">Tom Freker\u003c/a>, an insurance broker in Fountain Valley.\u003c/p>\n\u003cp>Covered California this year has debuted a revamped online directory that will allow you to search five doctors, hospitals or pediatric dentists at once.\u003c/p>\n\u003cp>It’s part of the agency’s “\u003ca href=\"https://apply.coveredca.com/apspahbx/ahbxanonym.portal?_nfpb=true&_st=&_nfls=false&_pageLabel=previewPlanPage\">Shop and Compare\u003c/a>” tool that allows you to enter your personal details to retrieve your plan choices and costs.\u003c/p>\n\u003cp>Because the directory is new, I urge you to cross-check with your plan and/or your provider.\u003c/p>\n\u003cp>Also, if you’re in the middle of treatment for a complex medical condition and lose your insurer, you may have options. \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">A new state law\u003c/a> will allow some seriously ill patients to continue seeing their current providers for a limited time.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Your new insurer may also be able to work with your existing provider to finish your treatment. Covered California advises you to call your new health plan to explain your situation.\u003c/p>\n\n",
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"excerpt": "Choosing a health plan will be doubly hard this year, after Trump made big changes to the online insurance exchanges. But Covered California responded by adding extra consumer protections for shoppers. ",
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"nprByline": "\u003ca href=\"https://californiahealthline.org/news/author/emily-bazar/\">\u003cstrong>Emily Bazar\u003c/strong>\u003c/a>\u003cbr>Kaiser Health News",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If the comments on Covered California’s \u003ca href=\"https://www.facebook.com/CoveredCA/\">Facebook page\u003c/a> are any indication, you’re all suffering from acute health insurance confusion:\u003c/p>\n\u003cp>\u003cem>“I wanted to sign up again this year. … I’m hesitant now because of what Trump has done. Should I still consider?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“Does the removal of subsidies mean we might lose our premium tax credits during the year?”\u003c/em>\u003c/p>\n\u003cp>\u003cem>“So you’re telling me that [Trump’s] executive order didn’t do anything? I am so confused.”\u003c/em>\u003c/p>\n\u003cp>I don’t blame you. Choosing a health plan will be doubly hard this year given \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">President Donald Trump’s recent move\u003c/a> to cut off federal payments for a key consumer subsidy, his administration’s decision to shorten exchange open-enrollment periods in most states to 45 days, Congress’ failed attempts to repeal Obamacare and the departure of some insurers from certain markets.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Let me ease your mind straightaway on three critical points:\u003c/p>\n\u003cp>1. In California, open enrollment for individuals and families who buy their 2018 plans through Covered California and in the open market lasts three months, from Nov. 1 to Jan. 31.\u003c/p>\n\u003cp>2. You won’t lose the tax credits that help you — and the vast majority of Covered California enrollees — afford your premiums, assuming you still qualify.\u003c/p>\n\u003cp>3. The same goes for the cost-sharing subsidies that reduce out-of-pocket costs for some Covered California members, despite Trump’s decision to stop funding them.\u003c/p>\n\u003cp>But shopping will be challenging. Anthem Blue Cross is pulling out of a large swath of California’s individual market, on and off the exchange, forcing hundreds of thousands of consumers to find new plans. And in addition to regular, annual rate hikes — averaging 12.3 percent statewide — silver-level plans will bear an additional \u003ca href=\"https://californiahealthline.org/news/california-slaps-surcharge-on-aca-plans-as-trump-remains-coy-on-subsidies/\">12.4 percent average surcharge\u003c/a> to make up for the loss of federal funding for the cost-sharing subsidies.\u003c/p>\n\u003cp>Remember, those are averages. Your actual premium will depend on several factors, including where you live, your income, what level of coverage you choose and which insurer you pick.\u003c/p>\n\u003cp>In an unexpected twist, some people may actually benefit from the surcharge because it could bring plans with more robust coverage within financial reach.\u003c/p>\n\u003cp>Before we get into all that, my most important piece of advice remains the same this year as before:\u003c/p>\n\u003cp>Don’t do this alone. Help from certified insurance agents and enrollment “navigators” is free. You can find local options by clicking on the “Find Help” tab on Covered California’s website, \u003ca href=\"http://www.coveredca.com/\">www.CoveredCA.com\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Silver-Plan Surcharge\u003c/strong>\u003c/p>\n\u003cp>Nearly half of Covered California enrollees qualify for cost-sharing subsidies, which lower their copays, deductibles and coinsurance. The subsidies are paid directly to insurers, and are separate from the tax credits that reduce monthly premiums.\u003c/p>\n\u003cp>These discounts are available only to silver-plan enrollees whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four. That’s why Covered California added the 12.4 percent average surcharge only to silver plans amid Trump’s threats — \u003ca href=\"https://californiahealthline.org/news/impact-of-trump-subsidy-decision-blunted-in-california-for-now/\">and ultimate decision\u003c/a> — to stop funding the subsidies.\u003c/p>\n\u003cp>\u003ca href=\"http://www.coveredca.com/news/\">Covered California estimates\u003c/a> that 78 percent of subsidized consumers will pay the same as — or less than — this year, despite the surcharge, because their tax credits will rise with their premiums. About half of the remaining 22 percent will see increases of less than $25 per month.\u003c/p>\n\u003cp>“This is potentially good news for both insurers and consumers,” says \u003ca href=\"http://axenehp.com/consultants/greg-fann-fsa-fca-maaa/\">Greg Fann\u003c/a>, a senior consulting actuary based in Murrieta. “And bad news for taxpayers,” who are footing the bill for the increased tax credits.\u003c/p>\n\u003cp>Fann offers advice to consumers based on their income.\u003c/p>\n\u003cp>Covered California enrollees with incomes up to roughly 200 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\">federal poverty level\u003c/a> — or about $49,200 for a family of four — should probably remain in silver plans, he advises, because they qualify for significant cost-sharing reduction subsidies.\u003c/p>\n\u003cp>Policyholders who make between 200 and 400 percent of the federal poverty level (400 percent is about $98,400 for a family of four) should consider ditching silver plans and applying their higher tax credits to gold or platinum plans, he says. \u003ca href=\"https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/\">Tax credits\u003c/a> are pegged to the cost of silver plans, which means that all subsidized enrollees will benefit from higher tax credits as silver premiums rise, regardless of which plan they ultimately purchase.\u003c/p>\n\u003cp>\u003ca href=\"https://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">Gold and platinum plans\u003c/a> are more expensive than silver plans, but they offer higher levels of coverage and lower out-of-pocket costs.\u003c/p>\n\u003cp>In some cases, “the gold may be cheaper than the silver,” Fann says.\u003c/p>\n\u003cp>You could also apply your increased tax credits to bronze plans, which have lower premiums and higher out-of-pocket costs. According to Covered California, three-quarters of enrollees can sign up for bronze coverage for less than $10 a month.\u003c/p>\n\u003cp>“I suspect a lot of people are going to downgrade their plans to high-deductible plans,” says \u003ca href=\"http://ruffinsolutions.com/about/helena-ruffin-company-president/\">Helena Ruffin\u003c/a>, an insurance agent in Playa Vista.\u003c/p>\n\u003cp>Finally, there are about 65,000 Covered California enrollees with silver plans who don’t receive premium tax credits, says exchange spokeswoman Amy Palmer.\u003c/p>\n\u003cp>People in this group must pay the entire cost of their premiums.\u003c/p>\n\u003cp>“These are the ones in the middle class that are … getting hammered,” Ruffin says.\u003c/p>\n\u003cp>If you’re in this category, avoid the surcharge by buying a bronze, gold or platinum plan. Or, opt for a newly created silver plan sold off the exchange that won’t be subject to the surcharge — if you’re confident your income will remain above the threshold to qualify for premium tax credits.\u003c/p>\n\u003cp>“There may be better options off the exchange,” Palmer says. But if your income fluctuates, “it may be better to stay on the exchange so that you can receive tax credits if you become eligible,” she adds.\u003c/p>\n\u003cp>\u003cstrong>Health Plan Departures\u003c/strong>\u003c/p>\n\u003cp>Anthem will pull out of 16 of California’s 19 pricing regions, affecting about \u003ca href=\"https://californiahealthline.org/news/anthems-retreat-leaves-californians-with-fewer-choices-more-worries/\">300,000 policyholders\u003c/a> who purchase from the individual market, both on and off the exchange.\u003c/p>\n\u003cp>Its departure will leave about 60,000 Covered California consumers \u003ca href=\"https://californiahealthline.org/news/anthems-exit-leaves-thousands-with-no-choice-of-health-plans/\">with one option\u003c/a> — Blue Shield of California. If you do not select a new plan by mid-November, Covered California will \u003ca href=\"https://www.coveredca.com/members/renewal/\">automatically enroll you\u003c/a> in one. If you’re not satisfied with its decision, you can change it before the end of open enrollment, assuming you have a choice.\u003c/p>\n\u003cp>For those of you losing your insurer, you’ll want to know whether your existing providers are in any other Covered California plan networks.\u003c/p>\n\u003cp>Unfortunately, “the doctors networks are smaller and smaller all the time,” says \u003ca href=\"http://crazyhealthinsurance.com/\">Tom Freker\u003c/a>, an insurance broker in Fountain Valley.\u003c/p>\n\u003cp>Covered California this year has debuted a revamped online directory that will allow you to search five doctors, hospitals or pediatric dentists at once.\u003c/p>\n\u003cp>It’s part of the agency’s “\u003ca href=\"https://apply.coveredca.com/apspahbx/ahbxanonym.portal?_nfpb=true&_st=&_nfls=false&_pageLabel=previewPlanPage\">Shop and Compare\u003c/a>” tool that allows you to enter your personal details to retrieve your plan choices and costs.\u003c/p>\n\u003cp>Because the directory is new, I urge you to cross-check with your plan and/or your provider.\u003c/p>\n\u003cp>Also, if you’re in the middle of treatment for a complex medical condition and lose your insurer, you may have options. \u003ca href=\"https://californiahealthline.org/news/what-happens-if-you-have-to-switch-health-plans-when-youre-sick/\">A new state law\u003c/a> will allow some seriously ill patients to continue seeing their current providers for a limited time.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Your new insurer may also be able to work with your existing provider to finish your treatment. Covered California advises you to call your new health plan to explain your situation.\u003c/p>\n\n\u003c/div>\u003c/p>",
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},
"link": "/radio/program/bbc-world-service",
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"apple": "https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2",
"tuneIn": "https://tunein.com/radio/BBC-World-Service-p455581/",
"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
"meta": {
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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"amazon": "https://music.amazon.com/podcasts/26099305-72af-4542-9dde-ac1807fe36d5/kqed-s-the-california-report",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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},
"freakonomics-radio": {
"id": "freakonomics-radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"here-and-now": {
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
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"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
"site": "news",
"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
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"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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"info": "One of public radio's most dynamic voices, Sam Sanders helped launch The NPR Politics Podcast and hosted NPR's hit show It's Been A Minute. Now, the award-winning host returns with something brand new, The Sam Sanders Show. Every week, Sam Sanders and friends dig into the culture that shapes our lives: what's driving the biggest trends, how artists really think, and even the memes you can't stop scrolling past. Sam is beloved for his way of unpacking the world and bringing you up close to fresh currents and engaging conversations. The Sam Sanders Show is smart, funny and always a good time.",
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