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"disqusTitle": "Congress Lifts Ban, Needle Exchanges Now Eligible for Federal Funds",
"title": "Congress Lifts Ban, Needle Exchanges Now Eligible for Federal Funds",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>LOS ANGELES — At precisely 8:30 a.m. on a Tuesday morning, the doors to the needle exchange on Skid Row open and the daily procession of injection drug users begins.\u003c/p>\n\u003cp>Michael Poor, 47, is one of the first customers. He has used his last clean syringe. Poor, who is homeless and addicted to methamphetamines, says coming to the downtown exchange puts his mind at ease: clean needles lower his risk for HIV.\u003c/p>\n\u003cp>“It is a very needed service, not just in downtown but anywhere drugs are an issue,” says Poor, a lanky, friendly man who is missing all of his teeth. “Thanks to needle exchange … I have stayed pretty healthy, which is a hard thing to do when you are injecting drugs.”\u003c/p>\n\u003cp>Needle exchanges like the one Poor visits could receive a financial boost this year \u003ca href=\"http://www.npr.org/2016/01/08/462412631/congress-ends-ban-on-federal-funding-for-needle-exchange-programs\" target=\"_blank\">following a decision by Congress \u003c/a>in January to lift a ban on federal funding. As abuse of prescription drugs and opiates continues to spread across the nation, more states are considering exchanges as a way to save lives.\u003c/p>\n\u003cp>Indiana, for instance, opened its first exchange after an HIV outbreak last year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The change in federal policy, part of a spending bill approved earlier this month, allows funding only in areas where drug-related cases of hepatitis and HIV are rising or are likely to. State and city health departments will make that determination along with the federal Centers for Disease Control and Prevention, according to the legislation.\u003c/p>\n\u003cp>The money can be used to pay for staff and programs, but not for syringes.\u003c/p>\n\u003cp>“It is really an important and historic moment for us at syringe exchanges,” said Mark Casanova, executive director of Homeless Health Care Los Angeles, which runs the syringe exchange on Skid Row, known as the Center for Harm Reduction. “But it doesn’t go far enough.”\u003c/p>\n\u003cp>Casanova said about a third of his $350,000 budget for the exchange program is spent on the 1.2 million syringes he hands out each year, and he will have to continue relying heavily on private donations to pay for them.\u003c/p>\n\u003cp>Despite the restrictions, lifting the ban underscores a growing recognition that needle exchange programs can help reduce the the spread of infectious diseases, said Daniel Raymond, policy director for Harm Reduction Coalition.\u003c/p>\n\u003cp>“This is a huge victory,” said Raymond, whose national organization advocates and provides training for exchange programs. “It is in some way the last chapter of an era where syringe exchange was considered too volatile and too partisan [for policy makers] to come to a consensus.”\u003c/p>\n\u003cfigure id=\"attachment_149292\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-149292 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-1-400x267.jpg\" alt=\"The Center for Harm Reduction in Skid Row has a syringe exchange program, which provides treatment, prevention and disease management for injection drug users. \" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">The Center for Harm Reduction on LA's Skid Row has a syringe exchange program, which provides treatment, prevention and disease management for injection drug users. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Critics of needle programs counter that opening the door to federal funding could leave less money for treatment of people who want to get sober. The new law does not allot additional funds for the exchanges, but rather allows them to compete for existing drug program money.\u003c/p>\n\u003cp>“The dollars are precious these days,” said Calvina Fay, executive director of Drug Free America Foundation, a drug policy and prevention organization. “When we have people wanting to get clean and standing in line waiting for a treatment bed … the money could certainly be better spent.”\u003c/p>\n\u003cp>Needle exchanges began at the height of the AIDS epidemic and today number roughly 200 around the United States, including about 40 in California.\u003c/p>\n\u003cp>Using clean syringes continues to be the safest way to prevent transmission among injection drug users, according to a 2012 CDC report, which said the percentage of injection drug users infected with HIV dropped by half from the mid-1990s to 2009.\u003c/p>\n\u003cp>“Syringe programs have really been concentrated in large cities and have done an excellent job of preventing HIV infection where they have been implemented, but we now really need to move to address the new injectors that we see in small towns and in rural areas, particularly in Appalachia,” said Don Des Jarlais of the Icahn School of Medicine at Mount Sinai, who has spent 25 years studying the exchanges.\u003c/p>\n\u003cfigure id=\"attachment_149293\" class=\"wp-caption aligncenter\" style=\"max-width: 1919px\">\u003cimg class=\"size-full wp-image-149293\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-6-e1455750248794.jpg\" alt=\"James Nolen, 65, gets his kit with needles, cotton balls and alcohol swabs at the Harm Reduction Center in Los Angeles.\" width=\"1919\" height=\"1281\">\u003cfigcaption class=\"wp-caption-text\">James Nolen, 65, gets his kit with needles, cotton balls and alcohol swabs at the Harm Reduction Center in Los Angeles. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Des Jarlais said federal funding should enable existing centers to expand and new ones to open.. “With the exception of a few states, there really has not been adequate funding of needle exchange programs in the US,” he said.\u003c/p>\n\u003cp>Libby Harrison, who manages the Cincinnati Exchange Project in Ohio, said it was “about damn time” for the change in federal policy.\u003c/p>\n\u003cp>“We’ve had the science on syringe exchange for almost 30 years. People and their politics getting in the way of science drives me crazy,” said Harrison, whose exchange has two staff members and is open three days a week in a region that has been hit hard by drug abuse.\u003c/p>\n\u003cp>Inside the lobby of the Harm Reduction Center in Los Angeles, customers wait in a line marked with red tape on the floor. A poster on the wall reads in big letters, “Needle exchange saves lives.”\u003c/p>\n\u003cp>At the front of the room, plastic bins are filled with syringes, sterile water ampoules, rubber bands, antibacterial ointment and alcohol swabs. An oversized, locked red bin sits nearby, and clients deposit dirty needles into it.\u003c/p>\n\u003cfigure id=\"attachment_149291\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-149291 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-9-400x599.jpg\" alt=\"Michael Poor, 47, visits the needle exchange at the Center for Harm Reduction, which is part of Homeless Healthcare Los Angeles, on a daily basis. He lives in a tent on Skid Row and is addicted to methamphetamine.\" width=\"400\" height=\"599\">\u003cfigcaption class=\"wp-caption-text\">Michael Poor, 47, visits the needle exchange at the Center for Harm Reduction, which is part of Homeless Healthcare Los Angeles, on a daily basis. He lives in a tent on Skid Row and is addicted to methamphetamine. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>They don’t need appointments, insurance or even identification. They simply answer a few questions, including whether they are homeless. When 26-year-old Eli Guerra walks up to the front counter, he tells the clerk he is out of needles. The clerk asks him what he uses now.\u003c/p>\n\u003cp>“Whatever I get my hands on,” he replies.\u003c/p>\n\u003cp>Guerra, who uses heroin, has been coming to the needle exchange for about a year but says he hopes this will be one of his last visits.\u003c/p>\n\u003cp>“This ain’t me, really,” he says. “I am really trying to stop.”\u003c/p>\n\u003cp>Chloe Blalock, program coordinator of the center, said she hopes federal funding will enable her to hire more people and expand services such as therapy, medical care, overdose prevention training and medication-assisted treatment. For now, she can afford to stay open only seven hours on weekdays and six on weekends.\u003c/p>\n\u003cp>“We should be open 24 hours,” she said. “From a public health standpoint, you want to make sure people have what they need — or more than what they need — no matter what.”\u003c/p>\n\u003cp>On a recent Tuesday, Dr. Rolando Tringale was at the center, teaching medical students about the health effects of drug use.\u003c/p>\n\u003cp>Tringale, who treats abscesses and wounds, explained why staffers hand out alcohol swabs. “This is an important part of harm reduction education, preventing skin-based infections,” he said.\u003c/p>\n\u003cp>Diamond Mendoza, a self-described homeless man who is addicted to heroin, said that since coming to the exchange he has learned a lot about injecting drugs more safely. He wipes his skin with alcohol before puncturing it. He goes to see the doctor whenever he gets a wound or an abscess. And he always uses clean needles, he said.\u003c/p>\n\u003cfigure id=\"attachment_149290\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-149290\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-5-400x607.jpg\" alt=\"Heroin addict Diamond Mendoza, 49, dropped off a pile of syringes. “I usually bring about 40 needles at a time. I exchange my dirties for my cleans. And it’s really good here,” he said. \" width=\"400\" height=\"607\">\u003cfigcaption class=\"wp-caption-text\">Heroin addict Diamond Mendoza, 49, dropped off a pile of syringes. “I usually bring about 40 needles at a time. I exchange my dirties for my cleans. And it’s really good here,” he said. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I don’t have HIV because I am really careful,” said Mendoza, who exchanged 40 needles on a recent morning.\u003c/p>\n\u003cp>Michael Poor said he has been using drugs since getting hooked on Vicodin, when he was a registered nurse. At first, Poor said, he couldn’t get clean syringes and often reused and shared them.\u003c/p>\n\u003cp>“You had to use one that had been used 15 or 20 times,” he said.\u003c/p>\n\u003cp>He said he believes that’s how he became infected with hepatitis C.\u003c/p>\n\u003cp>Poor said he has been coming to the center for about five years and stocks up so he can give clean needles to others. Staff members know him by name.\u003c/p>\n\u003cp>During his recent visit, he dumped about 35 used syringes into the red bin.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Minutes later, he was back out on the street, holding a small brown lunch bag filled with supplies.\u003c/p>\n\n",
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"excerpt": "Congress lifted a ban on federal funding for needle exchange programs. As abuse of prescription drugs and opiates spreads, more states are considering exchanges to save lives.\r\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>LOS ANGELES — At precisely 8:30 a.m. on a Tuesday morning, the doors to the needle exchange on Skid Row open and the daily procession of injection drug users begins.\u003c/p>\n\u003cp>Michael Poor, 47, is one of the first customers. He has used his last clean syringe. Poor, who is homeless and addicted to methamphetamines, says coming to the downtown exchange puts his mind at ease: clean needles lower his risk for HIV.\u003c/p>\n\u003cp>“It is a very needed service, not just in downtown but anywhere drugs are an issue,” says Poor, a lanky, friendly man who is missing all of his teeth. “Thanks to needle exchange … I have stayed pretty healthy, which is a hard thing to do when you are injecting drugs.”\u003c/p>\n\u003cp>Needle exchanges like the one Poor visits could receive a financial boost this year \u003ca href=\"http://www.npr.org/2016/01/08/462412631/congress-ends-ban-on-federal-funding-for-needle-exchange-programs\" target=\"_blank\">following a decision by Congress \u003c/a>in January to lift a ban on federal funding. As abuse of prescription drugs and opiates continues to spread across the nation, more states are considering exchanges as a way to save lives.\u003c/p>\n\u003cp>Indiana, for instance, opened its first exchange after an HIV outbreak last year.\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 federal policy, part of a spending bill approved earlier this month, allows funding only in areas where drug-related cases of hepatitis and HIV are rising or are likely to. State and city health departments will make that determination along with the federal Centers for Disease Control and Prevention, according to the legislation.\u003c/p>\n\u003cp>The money can be used to pay for staff and programs, but not for syringes.\u003c/p>\n\u003cp>“It is really an important and historic moment for us at syringe exchanges,” said Mark Casanova, executive director of Homeless Health Care Los Angeles, which runs the syringe exchange on Skid Row, known as the Center for Harm Reduction. “But it doesn’t go far enough.”\u003c/p>\n\u003cp>Casanova said about a third of his $350,000 budget for the exchange program is spent on the 1.2 million syringes he hands out each year, and he will have to continue relying heavily on private donations to pay for them.\u003c/p>\n\u003cp>Despite the restrictions, lifting the ban underscores a growing recognition that needle exchange programs can help reduce the the spread of infectious diseases, said Daniel Raymond, policy director for Harm Reduction Coalition.\u003c/p>\n\u003cp>“This is a huge victory,” said Raymond, whose national organization advocates and provides training for exchange programs. “It is in some way the last chapter of an era where syringe exchange was considered too volatile and too partisan [for policy makers] to come to a consensus.”\u003c/p>\n\u003cfigure id=\"attachment_149292\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-149292 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-1-400x267.jpg\" alt=\"The Center for Harm Reduction in Skid Row has a syringe exchange program, which provides treatment, prevention and disease management for injection drug users. \" width=\"400\" height=\"267\">\u003cfigcaption class=\"wp-caption-text\">The Center for Harm Reduction on LA's Skid Row has a syringe exchange program, which provides treatment, prevention and disease management for injection drug users. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Critics of needle programs counter that opening the door to federal funding could leave less money for treatment of people who want to get sober. The new law does not allot additional funds for the exchanges, but rather allows them to compete for existing drug program money.\u003c/p>\n\u003cp>“The dollars are precious these days,” said Calvina Fay, executive director of Drug Free America Foundation, a drug policy and prevention organization. “When we have people wanting to get clean and standing in line waiting for a treatment bed … the money could certainly be better spent.”\u003c/p>\n\u003cp>Needle exchanges began at the height of the AIDS epidemic and today number roughly 200 around the United States, including about 40 in California.\u003c/p>\n\u003cp>Using clean syringes continues to be the safest way to prevent transmission among injection drug users, according to a 2012 CDC report, which said the percentage of injection drug users infected with HIV dropped by half from the mid-1990s to 2009.\u003c/p>\n\u003cp>“Syringe programs have really been concentrated in large cities and have done an excellent job of preventing HIV infection where they have been implemented, but we now really need to move to address the new injectors that we see in small towns and in rural areas, particularly in Appalachia,” said Don Des Jarlais of the Icahn School of Medicine at Mount Sinai, who has spent 25 years studying the exchanges.\u003c/p>\n\u003cfigure id=\"attachment_149293\" class=\"wp-caption aligncenter\" style=\"max-width: 1919px\">\u003cimg class=\"size-full wp-image-149293\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-6-e1455750248794.jpg\" alt=\"James Nolen, 65, gets his kit with needles, cotton balls and alcohol swabs at the Harm Reduction Center in Los Angeles.\" width=\"1919\" height=\"1281\">\u003cfigcaption class=\"wp-caption-text\">James Nolen, 65, gets his kit with needles, cotton balls and alcohol swabs at the Harm Reduction Center in Los Angeles. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Des Jarlais said federal funding should enable existing centers to expand and new ones to open.. “With the exception of a few states, there really has not been adequate funding of needle exchange programs in the US,” he said.\u003c/p>\n\u003cp>Libby Harrison, who manages the Cincinnati Exchange Project in Ohio, said it was “about damn time” for the change in federal policy.\u003c/p>\n\u003cp>“We’ve had the science on syringe exchange for almost 30 years. People and their politics getting in the way of science drives me crazy,” said Harrison, whose exchange has two staff members and is open three days a week in a region that has been hit hard by drug abuse.\u003c/p>\n\u003cp>Inside the lobby of the Harm Reduction Center in Los Angeles, customers wait in a line marked with red tape on the floor. A poster on the wall reads in big letters, “Needle exchange saves lives.”\u003c/p>\n\u003cp>At the front of the room, plastic bins are filled with syringes, sterile water ampoules, rubber bands, antibacterial ointment and alcohol swabs. An oversized, locked red bin sits nearby, and clients deposit dirty needles into it.\u003c/p>\n\u003cfigure id=\"attachment_149291\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"wp-image-149291 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-9-400x599.jpg\" alt=\"Michael Poor, 47, visits the needle exchange at the Center for Harm Reduction, which is part of Homeless Healthcare Los Angeles, on a daily basis. He lives in a tent on Skid Row and is addicted to methamphetamine.\" width=\"400\" height=\"599\">\u003cfigcaption class=\"wp-caption-text\">Michael Poor, 47, visits the needle exchange at the Center for Harm Reduction, which is part of Homeless Healthcare Los Angeles, on a daily basis. He lives in a tent on Skid Row and is addicted to methamphetamine. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>They don’t need appointments, insurance or even identification. They simply answer a few questions, including whether they are homeless. When 26-year-old Eli Guerra walks up to the front counter, he tells the clerk he is out of needles. The clerk asks him what he uses now.\u003c/p>\n\u003cp>“Whatever I get my hands on,” he replies.\u003c/p>\n\u003cp>Guerra, who uses heroin, has been coming to the needle exchange for about a year but says he hopes this will be one of his last visits.\u003c/p>\n\u003cp>“This ain’t me, really,” he says. “I am really trying to stop.”\u003c/p>\n\u003cp>Chloe Blalock, program coordinator of the center, said she hopes federal funding will enable her to hire more people and expand services such as therapy, medical care, overdose prevention training and medication-assisted treatment. For now, she can afford to stay open only seven hours on weekdays and six on weekends.\u003c/p>\n\u003cp>“We should be open 24 hours,” she said. “From a public health standpoint, you want to make sure people have what they need — or more than what they need — no matter what.”\u003c/p>\n\u003cp>On a recent Tuesday, Dr. Rolando Tringale was at the center, teaching medical students about the health effects of drug use.\u003c/p>\n\u003cp>Tringale, who treats abscesses and wounds, explained why staffers hand out alcohol swabs. “This is an important part of harm reduction education, preventing skin-based infections,” he said.\u003c/p>\n\u003cp>Diamond Mendoza, a self-described homeless man who is addicted to heroin, said that since coming to the exchange he has learned a lot about injecting drugs more safely. He wipes his skin with alcohol before puncturing it. He goes to see the doctor whenever he gets a wound or an abscess. And he always uses clean needles, he said.\u003c/p>\n\u003cfigure id=\"attachment_149290\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-149290\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/needle-exchange-5-400x607.jpg\" alt=\"Heroin addict Diamond Mendoza, 49, dropped off a pile of syringes. “I usually bring about 40 needles at a time. I exchange my dirties for my cleans. And it’s really good here,” he said. \" width=\"400\" height=\"607\">\u003cfigcaption class=\"wp-caption-text\">Heroin addict Diamond Mendoza, 49, dropped off a pile of syringes. “I usually bring about 40 needles at a time. I exchange my dirties for my cleans. And it’s really good here,” he said. \u003ccite>(Heidi de Marco/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I don’t have HIV because I am really careful,” said Mendoza, who exchanged 40 needles on a recent morning.\u003c/p>\n\u003cp>Michael Poor said he has been using drugs since getting hooked on Vicodin, when he was a registered nurse. At first, Poor said, he couldn’t get clean syringes and often reused and shared them.\u003c/p>\n\u003cp>“You had to use one that had been used 15 or 20 times,” he said.\u003c/p>\n\u003cp>He said he believes that’s how he became infected with hepatitis C.\u003c/p>\n\u003cp>Poor said he has been coming to the center for about five years and stocks up so he can give clean needles to others. Staff members know him by name.\u003c/p>\n\u003cp>During his recent visit, he dumped about 35 used syringes into the red bin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Minutes later, he was back out on the street, holding a small brown lunch bag filled with supplies.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Cal/OSHA Rejects Condom Requirement in Porn Films",
"title": "Cal/OSHA Rejects Condom Requirement in Porn Films",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>Update: Feb. 18, 4:30 p.m.\u003c/strong>\u003c/p>\n\u003cp>California's Divison of Occupational Safety and Health -- Cal/OSHA -- rejected proposed regulations Thursday that would have required actors in all porn films statewide to use condoms.\u003c/p>\n\u003cp>Cal/OSHA's Standards Board voted 3-2 to accept the new regulations, but needed four \"yes\" votes to pass. The board voted to ask Cal/OSHA staff to work on new regulations for the porn industry.\u003c/p>\n\u003cp>The board heard five hours of testimony from scores of actors, writers, directors and producers at the hearing in Oakland.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/247790917\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Several said doing so would force the industry underground, prompting it to film in secret, which would essentially make all those involved criminals. They added it might also put an end to the industry's own requirement that actors be tested for sexually transmitted disease every 14 days.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"I ask you not to approve this policy that will endanger me and my colleagues,\" porn actress Maxine Holloway said during the hearing that continued.\u003c/p>\n\u003cp>The problem, several speakers said, is that a large segment of their audience loses interest in a film when they see actors with condoms. \"Like it or not, there a very real market demand for condomless sex,\" said one woman who identified herself as a sex worker.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>Adult film executives are complaining that proposed state health and safety regulations threaten to drive the industry out of the state.\u003c/p>\n\u003cp>California regulators with the Division of Occupational Safety and Health (Cal/OSHA) will vote on new rules Thursday that would require performers to use condoms, dental dams, and even eye gear on set.\u003c/p>\n\u003cp>Performers say the rules go too far.\u003c/p>\n\u003cp>“If you think about how porn is looking today, and how it’ll look after February 18\u003csup>th\u003c/sup>, we’re talking about gloves, full body cover, and goggles,” said Eric Leue, executive director of the Free Speech Coalition, a porn industry trade group. “It’s going to turn into surgical porn.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/247726098\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>The majority of adult films globally are produced in California. In 2012, \u003ca href=\"http://www.kqed.org/news/story/2013/01/15/114539/porn_industry_turned_off_by_la_mandate_for_condoms_on_set\" target=\"_blank\">Los Angeles County passed a local law\u003c/a> mandating condom use on adult film sets. But statewide, the rules are more vague.\u003c/p>\n\u003cp>The adult film industry is regulated by the same health and safety codes that govern hospitals. Film producers are required to protect actors against certain infections that can be sexually transmitted. But the regulations don't specify that performers must use condoms.\u003c/p>\n\u003cp>The new proposed regulations clarify this. If passed, they will take effect this spring.\u003c/p>\n\u003cp>“The industry had been complaining that the reason they were violating the regulations was because they didn't apply to them,” said Adam Cohen, a public health consultant with the AIDS Healthcare Foundation, a nonprofit that has been pushing for the new rules since 2009. “This will put on the books, officially, that the state of California sees adult film employees as deserving of worker health and safety protections.”\u003c/p>\n\u003cp>The industry fears the requirements could hit their bottom line.\u003c/p>\n\u003cp>“For the consumer, there’s not going to be the fantasy, there’s not going to be the artistic vision and the expression of sexual freedom,” Leue says. “It’s going to be hazmat suits.”\u003c/p>\n\u003cp>Supporters of the rules reject that.\u003c/p>\n\u003cp>“That’s 100 percent hyperbole,” says Cohen. “There are many studios that film exclusively with condoms and have stated publicly that their sales are fantastic.”\u003c/p>\n\u003cp>Twenty-eight percent of adult film workers tested positive for chlamydia and/or gonorrhea, according to a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23191956\">2012 study\u003c/a> published in the journal Sexually Transmitted Diseases.\u003c/p>\n\u003cp>The proposed Cal/OSHA rules would also require producers to pay for medical visits for performers and offer vaccines for hepatitis A, hepatitis B and HPV. They also require testing performers for sexually transmitted infections every three months.\u003c/p>\n\u003cp>Leue says performers feel that the Cal/OSHA board did not adequately consider their input on how the regulations would affect them, or their suggestions for alternate prevention strategies, such as PrEP, a daily pill that has been shown to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/02/no-new-infections-in-hundreds-taking-pill-to-prevent-hiv/\">prevent new HIV infections\u003c/a>, but is also associated with less condom use and higher rates of other sexually transmitted infections. (The proposed regulations were updated to recommend performers discuss PrEP with a doctor).\u003c/p>\n\u003cp>Leue also says studios already test more frequently than the proposed rules: every two weeks vs. every three months.\u003c/p>\n\u003cp>“Testing is not prevention,” says Cohen. “Taking an STD test to prevent an STD is like taking a pregnancy test to prevent pregnancy. Testing, and condoms, is the best form of prevention.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press. \u003c/em>\u003c/p>\n\n",
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"excerpt": "Los Angeles County has a local law requiring condoms for adult film performers. This would have been a statewide regulation.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Update: Feb. 18, 4:30 p.m.\u003c/strong>\u003c/p>\n\u003cp>California's Divison of Occupational Safety and Health -- Cal/OSHA -- rejected proposed regulations Thursday that would have required actors in all porn films statewide to use condoms.\u003c/p>\n\u003cp>Cal/OSHA's Standards Board voted 3-2 to accept the new regulations, but needed four \"yes\" votes to pass. The board voted to ask Cal/OSHA staff to work on new regulations for the porn industry.\u003c/p>\n\u003cp>The board heard five hours of testimony from scores of actors, writers, directors and producers at the hearing in Oakland.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/247790917&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/247790917'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Several said doing so would force the industry underground, prompting it to film in secret, which would essentially make all those involved criminals. They added it might also put an end to the industry's own requirement that actors be tested for sexually transmitted disease every 14 days.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"I ask you not to approve this policy that will endanger me and my colleagues,\" porn actress Maxine Holloway said during the hearing that continued.\u003c/p>\n\u003cp>The problem, several speakers said, is that a large segment of their audience loses interest in a film when they see actors with condoms. \"Like it or not, there a very real market demand for condomless sex,\" said one woman who identified herself as a sex worker.\u003c/p>\n\u003cp>\u003cstrong>Original post:\u003c/strong>\u003c/p>\n\u003cp>Adult film executives are complaining that proposed state health and safety regulations threaten to drive the industry out of the state.\u003c/p>\n\u003cp>California regulators with the Division of Occupational Safety and Health (Cal/OSHA) will vote on new rules Thursday that would require performers to use condoms, dental dams, and even eye gear on set.\u003c/p>\n\u003cp>Performers say the rules go too far.\u003c/p>\n\u003cp>“If you think about how porn is looking today, and how it’ll look after February 18\u003csup>th\u003c/sup>, we’re talking about gloves, full body cover, and goggles,” said Eric Leue, executive director of the Free Speech Coalition, a porn industry trade group. “It’s going to turn into surgical porn.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/247726098&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/247726098'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The majority of adult films globally are produced in California. In 2012, \u003ca href=\"http://www.kqed.org/news/story/2013/01/15/114539/porn_industry_turned_off_by_la_mandate_for_condoms_on_set\" target=\"_blank\">Los Angeles County passed a local law\u003c/a> mandating condom use on adult film sets. But statewide, the rules are more vague.\u003c/p>\n\u003cp>The adult film industry is regulated by the same health and safety codes that govern hospitals. Film producers are required to protect actors against certain infections that can be sexually transmitted. But the regulations don't specify that performers must use condoms.\u003c/p>\n\u003cp>The new proposed regulations clarify this. If passed, they will take effect this spring.\u003c/p>\n\u003cp>“The industry had been complaining that the reason they were violating the regulations was because they didn't apply to them,” said Adam Cohen, a public health consultant with the AIDS Healthcare Foundation, a nonprofit that has been pushing for the new rules since 2009. “This will put on the books, officially, that the state of California sees adult film employees as deserving of worker health and safety protections.”\u003c/p>\n\u003cp>The industry fears the requirements could hit their bottom line.\u003c/p>\n\u003cp>“For the consumer, there’s not going to be the fantasy, there’s not going to be the artistic vision and the expression of sexual freedom,” Leue says. “It’s going to be hazmat suits.”\u003c/p>\n\u003cp>Supporters of the rules reject that.\u003c/p>\n\u003cp>“That’s 100 percent hyperbole,” says Cohen. “There are many studios that film exclusively with condoms and have stated publicly that their sales are fantastic.”\u003c/p>\n\u003cp>Twenty-eight percent of adult film workers tested positive for chlamydia and/or gonorrhea, according to a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23191956\">2012 study\u003c/a> published in the journal Sexually Transmitted Diseases.\u003c/p>\n\u003cp>The proposed Cal/OSHA rules would also require producers to pay for medical visits for performers and offer vaccines for hepatitis A, hepatitis B and HPV. They also require testing performers for sexually transmitted infections every three months.\u003c/p>\n\u003cp>Leue says performers feel that the Cal/OSHA board did not adequately consider their input on how the regulations would affect them, or their suggestions for alternate prevention strategies, such as PrEP, a daily pill that has been shown to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/02/no-new-infections-in-hundreds-taking-pill-to-prevent-hiv/\">prevent new HIV infections\u003c/a>, but is also associated with less condom use and higher rates of other sexually transmitted infections. (The proposed regulations were updated to recommend performers discuss PrEP with a doctor).\u003c/p>\n\u003cp>Leue also says studios already test more frequently than the proposed rules: every two weeks vs. every three months.\u003c/p>\n\u003cp>“Testing is not prevention,” says Cohen. “Taking an STD test to prevent an STD is like taking a pregnancy test to prevent pregnancy. Testing, and condoms, is the best form of prevention.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post includes reporting from the Associated Press. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mobile Clinics Serve California's Growing Homeless Youth Population",
"title": "Mobile Clinics Serve California's Growing Homeless Youth Population",
"headTitle": "Vital Signs | State of Health | KQED News",
"content": "\u003cp>Dr. Seth Ammerman listens intently to his new patient. Ernesto, who does not want his last name disclosed, is homeless. Ernesto is earning a high school degree and working part time, but at night, he and his brother share a tent that they set up on San Jose streets. The daily stress of being homeless is wearing Ernesto out and making him light up too many cigarettes.\u003c/p>\n\u003caside class=\"pullquote alignright\">'These kids, because of all these access barriers — lack of insurance, lack of transportation — they’re not going to get this kind of care unless we go to them.'\u003ccite>Dr. Seth Ammerman, medical director, Stanford Teen Health Van \u003c/cite>\u003c/aside>\n\u003cp>“I just want to cut down on my smoking,” says Ernesto, 21, with a tentative, soft voice. “I’ve been on the streets all the time, you know? I just want to make sure I’m OK.”\u003c/p>\n\u003cp>That's why Ernesto walked into this mobile clinic parked just a few steps away from his classroom at the San Jose Conservation Corps & Charter School. He's sitting in a fully equipped exam room inside a shiny blue tour bus with Wi-Fi and the ability to get HIV test results in 20 minutes.\u003c/p>\n\u003cp>During the consultation with Ernesto, Ammerman nods sympathetically. In his 20 years working in this teen health van, Ammerman has treated thousands of uninsured and homeless adolescents ages 24 and under.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/247566086\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>Twice a week, Ammerman and two nurses park the clinic at continuation high schools and other places frequented by at-risk adolescents in Santa Clara, San Mateo and San Francisco counties. The van is a community project of the Lucile Packard Children's Hospital Stanford and Children's Health Fund, with support from Samsung.\u003c/p>\n\u003cfigure id=\"attachment_146678\" class=\"wp-caption alignright\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146678 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">The teen health van parks at continuation high schools and other places frequented by adolescents in Santa Clara, San Mateo and San Francisco counties. Inside, patients are seen in two exam rooms and a nursing station. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The team provides free medical, nutrition and mental health services, including reproductive health care and treatment for chronic illnesses, substance abuse and depression. All medications are free and provided at the time of consultation. A social worker is available for counseling and connects adolescents to additional resources; a registered dietitian works with patients who are malnourished, a frequent health issue for this population.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Some of the 400 patients who visit the teen health van each year have never seen a doctor, says Ammerman.\u003c/p>\n\u003cp>“Going to the patients makes all the difference, and it's not just a matter of convenience,” says Ammerman, a clinical professor of adolescent medicine at Stanford University. “It really is that these kids, because of all these access barriers -- lack of insurance, lack of transportation -- they're not going to get this kind of care unless we go to them.”\u003c/p>\n\u003cp>For many patients here, the teen health van can become a trustworthy and reliable place in an otherwise unstable world.\u003c/p>\n\u003cp>Grace Kim first set foot in the van 10 years ago when she was 17. She admits she was skeptical.\u003c/p>\n\u003cp>\"Because it was a van, and I wasn't really sure what they could really provide for me,\" says Kim, 27. \"Off the bat I don't trust people very easily and that probably comes from the territory that I grew up in.\"\u003c/p>\n\u003cp>Kim, a second-generation Korean-American, says she grew up with abusive relatives in a house \"full of conflict.\" By the time she was 14, she had already attempted suicide. With the help of a high school counselor, Kim moved out of her parents' home into a transitional living program, which required her to get medical checkups at the van initially. For the next four years, Kim was a regular patient.\u003c/p>\n\u003cfigure id=\"attachment_147012\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-147012 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg\" alt=\"Grace Kim, 27, credits the teen health van with helping her overcome depression, malnutrition and other health issues when she 17. Kim was photographed near Santa Clara University, where she is a masters student.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Grace Kim credits the teen health van with helping her overcome depression and other health issues when she was 17. Kim was photographed near Santa Clara University, where she is a master's student in counseling psychology.\u003c/figcaption>\u003c/figure>\n\u003cp>Ammerman and other staff at the van treated Kim's malnutrition, substance abuse and other health issues. They connected her with free visits to see a psychiatrist at Stanford Medical Center who treated her depression, and she thrived.\u003c/p>\n\u003cp>\"If I didn't get that help, I would probably be in a very bad place,\" says Kim, now a master's student in counseling psychology at Santa Clara University. \"The whole mental health aspect of it was probably the most beneficial, probably the most powerful.\"\u003c/p>\n\u003cp>Today, Kim facilitates a support group for suicide survivors at Santa Clara Valley Medical Center and says her passion for her work comes from those dark days in her past. She still keeps in touch with Ammerman, calling him once in a while with health-related questions.\u003c/p>\n\u003cp>\"I trust him absolutely with everything because he's seen me at my worst, and he still to this day has the most faith in me,\" says Kim, adding that Ammerman motivated her to take care of herself and do better. \"To have someone care for you and tell you that you can get better and do anything that you put you heart into. ... I mean, there are no words for that.\"\u003c/p>\n\u003cp>Kim recognizes she was lucky to have access to housing, medical and mental health resources, but that may not be true for others.\u003c/p>\n\u003cp>\u003cstrong>Health Van Patients Often Face Precarious Housing\u003c/strong>\u003c/p>\n\u003cp>Over 40 percent of Stanford's teen health van patients are homeless, says Ammerman. These are adolescents up to age 25 living on the streets, in cars and, most commonly, overcrowded apartments. While doubling up with relatives or friends may sound like housing, it's not stable because people can be asked to leave at any time.\u003c/p>\n\u003cp>Ammerman says he's seen a significant increase in this population of teens and young adults -- those living in overcrowded conditions -- since 2008. Working families unable to make rent are more likely to end up in these challenging conditions.\u003c/p>\n\u003cp>\"We are seeing, unfortunately, more homeless kids. And that's really due to the housing crisis that we are all aware of here in the Bay Area,\" says Ammerman.\u003c/p>\n\u003cp>\u003cstrong>Homeless Youth Population Growing in California\u003c/strong>\u003c/p>\n\u003cp>Most Bay Area counties and the state as a whole are seeing a greater number of homeless kids in recent years, according to figures collected by the California Department of Education and crunched by \u003ca href=\"http://www.kidsdata.org/topic/230/homeless-students/table#fmt=355&loc=2,265,59,4,127,171,341,338,339,217&tf=79,73,67,64&sortType=asc\" target=\"_blank\">Kidsdata.org\u003c/a>. The education department designates students as \"homeless\" if their primary residence at any point in the school year was a:\u003c/p>\n\u003cul>\n\u003cli>Shelter\u003c/li>\n\u003cli>Hotel or motel\u003c/li>\n\u003cli>Shared housing with others due to loss of housing or economic hardship\u003c/li>\n\u003cli>No shelter at all.\u003c/li>\n\u003c/ul>\n\u003cp>Statewide, the rate of homeless public school students in grades K-12 jumped by one-third in just three years -- from 3.6 percent in 2011 to 4.8 percent in 2014. \u003ca href=\"http://www.kidsdata.org/topic/793/homeless-students-residence/table#fmt=1211&loc=2&tf=79,73,67,64&ch=1132,1133,1134,1135&sortColumnId=0&sortType=asc\" target=\"_blank\">More than 86 percent\u003c/a> of the nearly 300,000 homeless public school students statewide are living doubled up with friends or relatives.\u003c/p>\n\u003cp>\"So it's a very unstable housing situation, and that is always problematic for your health,\" says Ammerman.\u003c/p>\n\u003cp>Children and youth facing homelessness or housing insecurity are more likely than their peers to face \u003ca href=\"http://pediatrics.aappublications.org/content/131/6/1206\" target=\"_blank\">chronic illness\u003c/a> and mental health problems, as well as\u003ca href=\"http://www.homelesschildrenamerica.org/\"> traumas\u003c/a> and safety risks, studies show.\u003c/p>\n\u003cp>\u003cstrong>Resources for Homeless Youth are Not Keeping Up\u003c/strong>\u003c/p>\n\u003cp>Shahera Hyatt directs the California Homeless Youth Project at the \u003ca href=\"https://www.library.ca.gov/crb/\" target=\"_blank\">California Research Bureau\u003c/a> in Sacramento. She supports Ammerman's experience as to why the state is seeing a lot more child, youth and family homelessness.\u003c/p>\n\u003cp>\"We know that housing affordability is in crisis proportions,\" says Hyatt. \"In many communities across the state there's rapid gentrification happening and a very low housing stock.\"\u003c/p>\n\u003cp>Homeless youth -- particularly those constantly on the streets or without any access to shelters -- risk sexual abuse, police harassment and substance addiction. Yet the state is woefully lacking in services and resources for this population, says Hyatt.\u003c/p>\n\u003cp>Sacramento has a single six-bed transitional housing center for young adults -- and a nine-month waiting list of about 100 people, says Hyatt. She added that two-thirds of the state's counties lack shelters and other basic services for homeless youth.\u003c/p>\n\u003cp>\"There’s a lot of mythology about why young people become homeless ... that they are unruly or want to live outside. But that's not true,\" says Hyatt. \"A lot of these people are really disenfranchised by the lack of services out there and become homeless.\"\u003c/p>\n\u003cp>Since 1988, California has spent $1.1 million annually on programs that serve homeless youth: the Homeless Youth and Exploitation Program and the California Youth Crisis Line, according to the California Coalition for Youth.\u003c/p>\n\u003cp>A bill introduced last month by Assemblywoman Young Kim, \u003ca href=\"https://ad65.asmrc.org/press-release/14533\" target=\"_blank\">AB1699\u003c/a>, would provide $25 million in funding for homeless youth emergency service projects. The bill's first hearing should be in the next two months, according to Bryan Shroyer in Kim's office.\u003c/p>\n\u003cp>\u003cstrong>Popularity of Mobile Clinics Increases\u003c/strong>\u003c/p>\n\u003cp>Meanwhile, mobile health clinics like Ammerman's in San Jose continue to fill a gap in access to care for uninsured youth. That model of delivering care directly to underserved populations has been gaining popularity nationwide.\u003c/p>\n\u003cp>In the last two decades, the number of mobile clinics has grown to about 2,000 throughout the country, according to the Mobile Health Clinics Association.\u003c/p>\n\u003cp>\"What we are seeing is greater acceptance that mobile care can be really high-quality care,\" says Dr. Delaney Gracy, chief medical officer with the Children's Health Fund. \"More people are realizing that mobile health is an important part of safety net care.\"\u003c/p>\n\u003cfigure id=\"attachment_146679\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146679 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg\" alt=\"Ammerman fill a prescription for a patient. The teen health van provides medications for free.\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-960x720.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Ammerman fills a prescription for a patient. The teen health van provides medications for free. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the teen health van's exam room, Ammerman is ending his consultation with Ernesto by handing him packages of nicotine gum, the medication Ernesto chose from several options to help him quit smoking. Before Ernesto leaves, Ammerman has one last question for first-time patients like him.\u003c/p>\n\u003cp>\"We literally ask each kid, 'What are you good at, what are your strengths?' And they're shocked at this question because no one's ever asked that before,\" says Ammerman.\u003c/p>\n\u003cp>When Ernesto's turn comes to answer, he thinks for a while before responding.\u003c/p>\n\u003cp>\"Um ... I like to work and stay busy,\" says Ernesto. \"And I motivate my brothers a lot, as much as I can.\"\u003c/p>\n\u003cp>\"Cool! That's a really cool thing,\" responds Ammerman.\u003c/p>\n\u003cp>As his patients successfully take steps to care for their health, says Ammerman, they also gain the confidence to tackle other goals, like getting steady housing.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"These kids have strengths, and by focusing on their strengths it can really make a difference. Because strength builds strength. And success builds success,\" says Ammerman.\u003c/p>\n\n",
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"excerpt": "Statewide, the rate of homeless public school students in grades K-12 jumped by one-third in just three years.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Seth Ammerman listens intently to his new patient. Ernesto, who does not want his last name disclosed, is homeless. Ernesto is earning a high school degree and working part time, but at night, he and his brother share a tent that they set up on San Jose streets. The daily stress of being homeless is wearing Ernesto out and making him light up too many cigarettes.\u003c/p>\n\u003caside class=\"pullquote alignright\">'These kids, because of all these access barriers — lack of insurance, lack of transportation — they’re not going to get this kind of care unless we go to them.'\u003ccite>Dr. Seth Ammerman, medical director, Stanford Teen Health Van \u003c/cite>\u003c/aside>\n\u003cp>“I just want to cut down on my smoking,” says Ernesto, 21, with a tentative, soft voice. “I’ve been on the streets all the time, you know? I just want to make sure I’m OK.”\u003c/p>\n\u003cp>That's why Ernesto walked into this mobile clinic parked just a few steps away from his classroom at the San Jose Conservation Corps & Charter School. He's sitting in a fully equipped exam room inside a shiny blue tour bus with Wi-Fi and the ability to get HIV test results in 20 minutes.\u003c/p>\n\u003cp>During the consultation with Ernesto, Ammerman nods sympathetically. In his 20 years working in this teen health van, Ammerman has treated thousands of uninsured and homeless adolescents ages 24 and under.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/247566086&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/247566086'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Twice a week, Ammerman and two nurses park the clinic at continuation high schools and other places frequented by at-risk adolescents in Santa Clara, San Mateo and San Francisco counties. The van is a community project of the Lucile Packard Children's Hospital Stanford and Children's Health Fund, with support from Samsung.\u003c/p>\n\u003cfigure id=\"attachment_146678\" class=\"wp-caption alignright\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146678 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18410_IMG_9380.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">The teen health van parks at continuation high schools and other places frequented by adolescents in Santa Clara, San Mateo and San Francisco counties. Inside, patients are seen in two exam rooms and a nursing station. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The team provides free medical, nutrition and mental health services, including reproductive health care and treatment for chronic illnesses, substance abuse and depression. All medications are free and provided at the time of consultation. A social worker is available for counseling and connects adolescents to additional resources; a registered dietitian works with patients who are malnourished, a frequent health issue for this population.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Some of the 400 patients who visit the teen health van each year have never seen a doctor, says Ammerman.\u003c/p>\n\u003cp>“Going to the patients makes all the difference, and it's not just a matter of convenience,” says Ammerman, a clinical professor of adolescent medicine at Stanford University. “It really is that these kids, because of all these access barriers -- lack of insurance, lack of transportation -- they're not going to get this kind of care unless we go to them.”\u003c/p>\n\u003cp>For many patients here, the teen health van can become a trustworthy and reliable place in an otherwise unstable world.\u003c/p>\n\u003cp>Grace Kim first set foot in the van 10 years ago when she was 17. She admits she was skeptical.\u003c/p>\n\u003cp>\"Because it was a van, and I wasn't really sure what they could really provide for me,\" says Kim, 27. \"Off the bat I don't trust people very easily and that probably comes from the territory that I grew up in.\"\u003c/p>\n\u003cp>Kim, a second-generation Korean-American, says she grew up with abusive relatives in a house \"full of conflict.\" By the time she was 14, she had already attempted suicide. With the help of a high school counselor, Kim moved out of her parents' home into a transitional living program, which required her to get medical checkups at the van initially. For the next four years, Kim was a regular patient.\u003c/p>\n\u003cfigure id=\"attachment_147012\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-147012 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg\" alt=\"Grace Kim, 27, credits the teen health van with helping her overcome depression, malnutrition and other health issues when she 17. Kim was photographed near Santa Clara University, where she is a masters student.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18425_IMG_9465.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Grace Kim credits the teen health van with helping her overcome depression and other health issues when she was 17. Kim was photographed near Santa Clara University, where she is a master's student in counseling psychology.\u003c/figcaption>\u003c/figure>\n\u003cp>Ammerman and other staff at the van treated Kim's malnutrition, substance abuse and other health issues. They connected her with free visits to see a psychiatrist at Stanford Medical Center who treated her depression, and she thrived.\u003c/p>\n\u003cp>\"If I didn't get that help, I would probably be in a very bad place,\" says Kim, now a master's student in counseling psychology at Santa Clara University. \"The whole mental health aspect of it was probably the most beneficial, probably the most powerful.\"\u003c/p>\n\u003cp>Today, Kim facilitates a support group for suicide survivors at Santa Clara Valley Medical Center and says her passion for her work comes from those dark days in her past. She still keeps in touch with Ammerman, calling him once in a while with health-related questions.\u003c/p>\n\u003cp>\"I trust him absolutely with everything because he's seen me at my worst, and he still to this day has the most faith in me,\" says Kim, adding that Ammerman motivated her to take care of herself and do better. \"To have someone care for you and tell you that you can get better and do anything that you put you heart into. ... I mean, there are no words for that.\"\u003c/p>\n\u003cp>Kim recognizes she was lucky to have access to housing, medical and mental health resources, but that may not be true for others.\u003c/p>\n\u003cp>\u003cstrong>Health Van Patients Often Face Precarious Housing\u003c/strong>\u003c/p>\n\u003cp>Over 40 percent of Stanford's teen health van patients are homeless, says Ammerman. These are adolescents up to age 25 living on the streets, in cars and, most commonly, overcrowded apartments. While doubling up with relatives or friends may sound like housing, it's not stable because people can be asked to leave at any time.\u003c/p>\n\u003cp>Ammerman says he's seen a significant increase in this population of teens and young adults -- those living in overcrowded conditions -- since 2008. Working families unable to make rent are more likely to end up in these challenging conditions.\u003c/p>\n\u003cp>\"We are seeing, unfortunately, more homeless kids. And that's really due to the housing crisis that we are all aware of here in the Bay Area,\" says Ammerman.\u003c/p>\n\u003cp>\u003cstrong>Homeless Youth Population Growing in California\u003c/strong>\u003c/p>\n\u003cp>Most Bay Area counties and the state as a whole are seeing a greater number of homeless kids in recent years, according to figures collected by the California Department of Education and crunched by \u003ca href=\"http://www.kidsdata.org/topic/230/homeless-students/table#fmt=355&loc=2,265,59,4,127,171,341,338,339,217&tf=79,73,67,64&sortType=asc\" target=\"_blank\">Kidsdata.org\u003c/a>. The education department designates students as \"homeless\" if their primary residence at any point in the school year was a:\u003c/p>\n\u003cul>\n\u003cli>Shelter\u003c/li>\n\u003cli>Hotel or motel\u003c/li>\n\u003cli>Shared housing with others due to loss of housing or economic hardship\u003c/li>\n\u003cli>No shelter at all.\u003c/li>\n\u003c/ul>\n\u003cp>Statewide, the rate of homeless public school students in grades K-12 jumped by one-third in just three years -- from 3.6 percent in 2011 to 4.8 percent in 2014. \u003ca href=\"http://www.kidsdata.org/topic/793/homeless-students-residence/table#fmt=1211&loc=2&tf=79,73,67,64&ch=1132,1133,1134,1135&sortColumnId=0&sortType=asc\" target=\"_blank\">More than 86 percent\u003c/a> of the nearly 300,000 homeless public school students statewide are living doubled up with friends or relatives.\u003c/p>\n\u003cp>\"So it's a very unstable housing situation, and that is always problematic for your health,\" says Ammerman.\u003c/p>\n\u003cp>Children and youth facing homelessness or housing insecurity are more likely than their peers to face \u003ca href=\"http://pediatrics.aappublications.org/content/131/6/1206\" target=\"_blank\">chronic illness\u003c/a> and mental health problems, as well as\u003ca href=\"http://www.homelesschildrenamerica.org/\"> traumas\u003c/a> and safety risks, studies show.\u003c/p>\n\u003cp>\u003cstrong>Resources for Homeless Youth are Not Keeping Up\u003c/strong>\u003c/p>\n\u003cp>Shahera Hyatt directs the California Homeless Youth Project at the \u003ca href=\"https://www.library.ca.gov/crb/\" target=\"_blank\">California Research Bureau\u003c/a> in Sacramento. She supports Ammerman's experience as to why the state is seeing a lot more child, youth and family homelessness.\u003c/p>\n\u003cp>\"We know that housing affordability is in crisis proportions,\" says Hyatt. \"In many communities across the state there's rapid gentrification happening and a very low housing stock.\"\u003c/p>\n\u003cp>Homeless youth -- particularly those constantly on the streets or without any access to shelters -- risk sexual abuse, police harassment and substance addiction. Yet the state is woefully lacking in services and resources for this population, says Hyatt.\u003c/p>\n\u003cp>Sacramento has a single six-bed transitional housing center for young adults -- and a nine-month waiting list of about 100 people, says Hyatt. She added that two-thirds of the state's counties lack shelters and other basic services for homeless youth.\u003c/p>\n\u003cp>\"There’s a lot of mythology about why young people become homeless ... that they are unruly or want to live outside. But that's not true,\" says Hyatt. \"A lot of these people are really disenfranchised by the lack of services out there and become homeless.\"\u003c/p>\n\u003cp>Since 1988, California has spent $1.1 million annually on programs that serve homeless youth: the Homeless Youth and Exploitation Program and the California Youth Crisis Line, according to the California Coalition for Youth.\u003c/p>\n\u003cp>A bill introduced last month by Assemblywoman Young Kim, \u003ca href=\"https://ad65.asmrc.org/press-release/14533\" target=\"_blank\">AB1699\u003c/a>, would provide $25 million in funding for homeless youth emergency service projects. The bill's first hearing should be in the next two months, according to Bryan Shroyer in Kim's office.\u003c/p>\n\u003cp>\u003cstrong>Popularity of Mobile Clinics Increases\u003c/strong>\u003c/p>\n\u003cp>Meanwhile, mobile health clinics like Ammerman's in San Jose continue to fill a gap in access to care for uninsured youth. That model of delivering care directly to underserved populations has been gaining popularity nationwide.\u003c/p>\n\u003cp>In the last two decades, the number of mobile clinics has grown to about 2,000 throughout the country, according to the Mobile Health Clinics Association.\u003c/p>\n\u003cp>\"What we are seeing is greater acceptance that mobile care can be really high-quality care,\" says Dr. Delaney Gracy, chief medical officer with the Children's Health Fund. \"More people are realizing that mobile health is an important part of safety net care.\"\u003c/p>\n\u003cfigure id=\"attachment_146679\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-146679 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg\" alt=\"Ammerman fill a prescription for a patient. The teen health van provides medications for free.\" width=\"1920\" height=\"1440\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1440x1080.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/RS18411_IMG_4503.JPG-qut-960x720.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Ammerman fills a prescription for a patient. The teen health van provides medications for free. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the teen health van's exam room, Ammerman is ending his consultation with Ernesto by handing him packages of nicotine gum, the medication Ernesto chose from several options to help him quit smoking. Before Ernesto leaves, Ammerman has one last question for first-time patients like him.\u003c/p>\n\u003cp>\"We literally ask each kid, 'What are you good at, what are your strengths?' And they're shocked at this question because no one's ever asked that before,\" says Ammerman.\u003c/p>\n\u003cp>When Ernesto's turn comes to answer, he thinks for a while before responding.\u003c/p>\n\u003cp>\"Um ... I like to work and stay busy,\" says Ernesto. \"And I motivate my brothers a lot, as much as I can.\"\u003c/p>\n\u003cp>\"Cool! That's a really cool thing,\" responds Ammerman.\u003c/p>\n\u003cp>As his patients successfully take steps to care for their health, says Ammerman, they also gain the confidence to tackle other goals, like getting steady housing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"These kids have strengths, and by focusing on their strengths it can really make a difference. Because strength builds strength. And success builds success,\" says Ammerman.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>For the first time in three years, Blue Shield of California leads enrollment in the state’s insurance exchange while Oscar, a closely watched newcomer, experienced a slow start.\u003c/p>\n\u003cp>The Covered California exchange said it won’t release enrollment figures by company until later this month, and insurers declined to share specifics until then. But interviews with industry officials indicate some insurers, such as Blue Shield and Molina Healthcare Inc., picked up more business while others lost ground during the Affordable Care Act’s third open enrollment.\u003c/p>\n\u003cp>Until now, Anthem Inc. had led Obamacare enrollment in California with 30 percent share of the market. But now rival Blue Shield has jumped ahead.\u003c/p>\n\u003cp>“Our competitive position did improve,” said Ken Wood, senior vice president of consumer markets at San Francisco-based Blue Shield. “A better price position meant better retention and more new enrollment.”\u003c/p>\n\u003cp>A spokesman for Anthem declined to discuss the company’s California results ahead of the exchange’s announcement. But last month, the company said its Obamacare enrollment in California and 13 other states was 30 percent lower than expected and rivals’ lower rates were one reason. Anthem Blue Cross is California’s largest for-profit insurer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We aren’t experiencing the overall market growth on the public exchanges that we projected when we laid out our five-year plan and unsustainable pricing in some markets is hurting our historic market share,” Anthem Chief Executive Joseph Swedish said during a Jan. 27 conference call with analysts and investors.\u003c/p>\n\u003cp>Last week, Covered California said about 425,000 new enrollees had picked out coverage but more last-minute applicants were being counted. Nearly 1.2 million consumers had renewed their policies, bringing enrollment to about 1.6 million.\u003c/p>\n\u003cp>Enrollment totals will increase some as many people rushed to beat the Jan. 31 sign-up deadline. But the final tally will likely drop because some people don’t pay their initial premium or they find coverage elsewhere.\u003c/p>\n\u003cp>The California exchange added two new insurers for this year — Oscar and UnitedHealth Group Inc. — but neither garnered much enrollment, according to sources who spoke on the condition of anonymity.\u003c/p>\n\u003cp>Both Oscar and UnitedHealth are only selling policies in a limited number of regions and each insurer had less than 1,000 enrollees by early January.\u003c/p>\n\u003cp>Covered California had denied UnitedHealth’s bid to sell statewide during 2016 and instead limited the insurer to five of the state’s 19 rating regions, primarily rural counties in Northern California. Then in November, the company announced heavy losses on individual policies across the country, and it cut back on marketing of exchange coverage companywide.\u003c/p>\n\u003cp>Oscar, on the other hand, blanketed Southern California with ads touting its high-tech, customer friendly approach to healthcare. But its initial sales in Los Angeles and Orange counties were modest, according to sources who saw preliminary enrollment totals.\u003c/p>\n\u003cp>The New York company was a relative unknown in California and going up against established insurers with strong name recognition and existing networks of doctors and hospitals. The company hasn’t commented on its California enrollment, but overall it covers more than 125,000 people in New York, New Jersey, Texas and California.\u003c/p>\n\u003cp>“We are thrilled by the reaction we have received entering the California marketplace this year,” Oscar Chief Executive Mario Schlosser said in a statement. “Our priority is to provide simple, intuitive healthcare for our new members and we look forward to continued expansion and growth throughout the state.”\u003c/p>\n\u003cp>HMO giant Kaiser Permanente appears on track to remain in third place in Covered California, behind Blue Shield and Anthem. Molina, based in Long Beach, also made substantial gains during open enrollment after a smaller presence the first two years, according to people familiar with the market.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said the exchange plans to release detailed data on enrollment by health plans and ethnicity later this month. The state spent $29 million on marketing during the recent open enrollment to attract the uninsured and persuade existing enrollees to renew.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Most of us are healthy. But you need to remind people just because you didn’t use your insurance it’s still something you need,” Lee said. “Health insurance marketplaces need to be constant sales and renewal machines.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For the first time in three years, Blue Shield of California leads enrollment in the state’s insurance exchange while Oscar, a closely watched newcomer, experienced a slow start.\u003c/p>\n\u003cp>The Covered California exchange said it won’t release enrollment figures by company until later this month, and insurers declined to share specifics until then. But interviews with industry officials indicate some insurers, such as Blue Shield and Molina Healthcare Inc., picked up more business while others lost ground during the Affordable Care Act’s third open enrollment.\u003c/p>\n\u003cp>Until now, Anthem Inc. had led Obamacare enrollment in California with 30 percent share of the market. But now rival Blue Shield has jumped ahead.\u003c/p>\n\u003cp>“Our competitive position did improve,” said Ken Wood, senior vice president of consumer markets at San Francisco-based Blue Shield. “A better price position meant better retention and more new enrollment.”\u003c/p>\n\u003cp>A spokesman for Anthem declined to discuss the company’s California results ahead of the exchange’s announcement. But last month, the company said its Obamacare enrollment in California and 13 other states was 30 percent lower than expected and rivals’ lower rates were one reason. Anthem Blue Cross is California’s largest for-profit insurer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We aren’t experiencing the overall market growth on the public exchanges that we projected when we laid out our five-year plan and unsustainable pricing in some markets is hurting our historic market share,” Anthem Chief Executive Joseph Swedish said during a Jan. 27 conference call with analysts and investors.\u003c/p>\n\u003cp>Last week, Covered California said about 425,000 new enrollees had picked out coverage but more last-minute applicants were being counted. Nearly 1.2 million consumers had renewed their policies, bringing enrollment to about 1.6 million.\u003c/p>\n\u003cp>Enrollment totals will increase some as many people rushed to beat the Jan. 31 sign-up deadline. But the final tally will likely drop because some people don’t pay their initial premium or they find coverage elsewhere.\u003c/p>\n\u003cp>The California exchange added two new insurers for this year — Oscar and UnitedHealth Group Inc. — but neither garnered much enrollment, according to sources who spoke on the condition of anonymity.\u003c/p>\n\u003cp>Both Oscar and UnitedHealth are only selling policies in a limited number of regions and each insurer had less than 1,000 enrollees by early January.\u003c/p>\n\u003cp>Covered California had denied UnitedHealth’s bid to sell statewide during 2016 and instead limited the insurer to five of the state’s 19 rating regions, primarily rural counties in Northern California. Then in November, the company announced heavy losses on individual policies across the country, and it cut back on marketing of exchange coverage companywide.\u003c/p>\n\u003cp>Oscar, on the other hand, blanketed Southern California with ads touting its high-tech, customer friendly approach to healthcare. But its initial sales in Los Angeles and Orange counties were modest, according to sources who saw preliminary enrollment totals.\u003c/p>\n\u003cp>The New York company was a relative unknown in California and going up against established insurers with strong name recognition and existing networks of doctors and hospitals. The company hasn’t commented on its California enrollment, but overall it covers more than 125,000 people in New York, New Jersey, Texas and California.\u003c/p>\n\u003cp>“We are thrilled by the reaction we have received entering the California marketplace this year,” Oscar Chief Executive Mario Schlosser said in a statement. “Our priority is to provide simple, intuitive healthcare for our new members and we look forward to continued expansion and growth throughout the state.”\u003c/p>\n\u003cp>HMO giant Kaiser Permanente appears on track to remain in third place in Covered California, behind Blue Shield and Anthem. Molina, based in Long Beach, also made substantial gains during open enrollment after a smaller presence the first two years, according to people familiar with the market.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said the exchange plans to release detailed data on enrollment by health plans and ethnicity later this month. The state spent $29 million on marketing during the recent open enrollment to attract the uninsured and persuade existing enrollees to renew.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Most of us are healthy. But you need to remind people just because you didn’t use your insurance it’s still something you need,” Lee said. “Health insurance marketplaces need to be constant sales and renewal machines.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Santa Clara Student Got Meningitis Despite New Vaccine",
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"content": "\u003cp>Sometimes the story comes to you.\u003c/p>\n\u003cp>One of the three students sickened in last week's meningococcal disease outbreak at Santa Clara University is the son of Penny Nelson, who works with me at KQED News. What's especially interesting about his case is that he had received a new vaccine against the illness, yet still got sick.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We don’t know if it impacts herd immunity. We don’t know how long immunity lasts. Is it a few years? Five years? Ten years?'\u003cbr>\n\u003ccite>Dr. Cody Meissner, Tufts Univ. School of Medicine\u003c/cite>\u003c/aside>\n\u003cp>Backing up a bit, the outbreak was caused by Neisseria meningitidis serogroup B, an especially serious infection. All three students now have been discharged from the hospital in good condition. Two of them, including Nelson's son, Misha Hindery, were treated for meningitis, an infection of the lining of the brain and spinal cord. A third student had septicemia, a bloodstream infection.\u003c/p>\n\u003cp>The disease is fatal in 10-15 percent of cases, and many others lose a limb or suffer brain damage.\u003c/p>\n\u003cp>Nelson knew how serious a disease it could be. A few years ago, a friend's daughter contracted a serogroup B infection at college and died within days, despite aggressive medical treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When Nelson found out her son was in the hospital, she says she got there as fast as she could. \"I was so frightened. I just couldn't believe it. ... I sat there and read about it, and that frightened me even more.\"\u003c/p>\n\u003cp>The \u003ca href=\"http://www.cdc.gov/meningococcal/\" target=\"_blank\">chief symptoms \u003c/a>are sudden onset of fever, headache and stiff neck.\u003c/p>\n\u003cp>After Misha was released, Nelson contacted his primary care doctor, who confirmed that Misha had received both doses of Bexsero. The vaccine was \u003ca href=\"http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm431446.htm\" target=\"_blank\">approved by the Food and Drug Administration\u003c/a> (FDA) a year ago, under an accelerated process, says Dr. Cody Meissner, a pediatrics professor at Tufts University School of Medicine and consultant to the Advisory Committee on Immunization Practice, which recommends vaccine guidelines to the Centers for Disease Control and Prevention (CDC). It is intended for people ages 10 to 25.\u003c/p>\n\u003cp>The vaccine was developed in a new way, a \"terrific accomplishment\" technologically, Meissner said. But because of the shortened approval process, much is not known about it. \"We don't know if it impacts herd immunity,\" he says, in reference to vaccinating enough of a population to keep a disease that crops up from spreading. \"We don't know how long immunity lasts. Is it a few years? Five years? Ten years?\"\u003c/p>\n\u003cp>Bexsero and a second vaccine, Trumenba, cover most -- but not all -- strains of bacteria within the serogroup B. It's possible Misha was infected with a strain that is not included in the vaccine. Meissner said there is no scientific evidence to support the idea that the vaccine makes the course of the disease less severe, if someone does become infected.\u003c/p>\n\u003cp>And while meningococcal group B infections are rare -- just \u003ca href=\"http://www.cdc.gov/media/releases/2013/t1125-serogroup-b-meningitis.html\" target=\"_blank\">160 cases in 2012\u003c/a> -- they can be devastating, often striking young, healthy people. Nelson's son rows crew and was a member of an eight-man boat that won a national title last year.\u003c/p>\n\u003cp>Public health officials are now watching to see how the vaccine performs, says Dr. James Watt with the California Department of Public Health.\u003c/p>\n\u003cp>\"These vaccines have been used in outbreaks,\" he said. \"They have appeared to have an impact, so that's good news.\" Together with the Santa Clara County Public Health Department, Santa Clara University ran four vaccine clinics, ending Monday. Nearly 5,000 of the university's 8,000 undergraduate and graduate students received the first dose.\u003c/p>\n\u003cfigure id=\"attachment_146287\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-146287\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/Penny-400x533.jpg\" alt=\"Penny Nelson with her son, Misha. He is recovering from bacterial meningitis. \" width=\"400\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny.jpg 1224w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Penny Nelson with her son, Misha. He is recovering from bacterial meningitis. \u003ccite>(Courtesy: Penny Nelson)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The California Department of Public Health will provide 5,000 doses next month, when students will need the final shot in the two-dose series.\u003c/p>\n\u003cp>The vaccine is not part of the routine immunization schedule for adolescents. Instead, it received a \"permissive\" recommendation, meaning that doctors can administer it if they feel it is in the best interest of the adolescent. Some people at high risk\u003ca href=\"http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mening-serogroup.html\" target=\"_blank\"> should be immunized\u003c/a>, according to the Centers for Disease Control and Prevention, including anyone with a damaged or removed spleen, sickle cell anemia or who has a rare immune system condition known as \"complement deficiency.\"\u003c/p>\n\u003cp>California follows CDC guidelines, so does not require the vaccine for school-age children. Watt says California colleges and universities set their own vaccine guidelines.\u003c/p>\n\u003cp>Meanwhile, cases are dropping. In the late 1990s, there were 1-2 cases per 100,000 people. Now it's 0.1 per 100,000. \"Meningococcal disease is disappearing in the U.S.,\" Meissner says. \"No one knows why.\"\u003c/p>\n\u003cp>On top of everything else, this vaccine is expensive, more than $300 for the series. Meissner published \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2491460\" target=\"_blank\">an analysis\u003c/a> in Monday's JAMA spotlighting the challenges of providing such an expensive vaccine for such a rare disease. As many as 350,000 adolescents would need to be vaccinated to prevent one case of disease, he wrote.\u003c/p>\n\u003cp>\"This vaccine is 25 times higher [in cost] than any other vaccine,\" he told me.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Is this the way we want to be spending scarce funds for public health?\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sometimes the story comes to you.\u003c/p>\n\u003cp>One of the three students sickened in last week's meningococcal disease outbreak at Santa Clara University is the son of Penny Nelson, who works with me at KQED News. What's especially interesting about his case is that he had received a new vaccine against the illness, yet still got sick.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We don’t know if it impacts herd immunity. We don’t know how long immunity lasts. Is it a few years? Five years? Ten years?'\u003cbr>\n\u003ccite>Dr. Cody Meissner, Tufts Univ. School of Medicine\u003c/cite>\u003c/aside>\n\u003cp>Backing up a bit, the outbreak was caused by Neisseria meningitidis serogroup B, an especially serious infection. All three students now have been discharged from the hospital in good condition. Two of them, including Nelson's son, Misha Hindery, were treated for meningitis, an infection of the lining of the brain and spinal cord. A third student had septicemia, a bloodstream infection.\u003c/p>\n\u003cp>The disease is fatal in 10-15 percent of cases, and many others lose a limb or suffer brain damage.\u003c/p>\n\u003cp>Nelson knew how serious a disease it could be. A few years ago, a friend's daughter contracted a serogroup B infection at college and died within days, despite aggressive medical treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When Nelson found out her son was in the hospital, she says she got there as fast as she could. \"I was so frightened. I just couldn't believe it. ... I sat there and read about it, and that frightened me even more.\"\u003c/p>\n\u003cp>The \u003ca href=\"http://www.cdc.gov/meningococcal/\" target=\"_blank\">chief symptoms \u003c/a>are sudden onset of fever, headache and stiff neck.\u003c/p>\n\u003cp>After Misha was released, Nelson contacted his primary care doctor, who confirmed that Misha had received both doses of Bexsero. The vaccine was \u003ca href=\"http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm431446.htm\" target=\"_blank\">approved by the Food and Drug Administration\u003c/a> (FDA) a year ago, under an accelerated process, says Dr. Cody Meissner, a pediatrics professor at Tufts University School of Medicine and consultant to the Advisory Committee on Immunization Practice, which recommends vaccine guidelines to the Centers for Disease Control and Prevention (CDC). It is intended for people ages 10 to 25.\u003c/p>\n\u003cp>The vaccine was developed in a new way, a \"terrific accomplishment\" technologically, Meissner said. But because of the shortened approval process, much is not known about it. \"We don't know if it impacts herd immunity,\" he says, in reference to vaccinating enough of a population to keep a disease that crops up from spreading. \"We don't know how long immunity lasts. Is it a few years? Five years? Ten years?\"\u003c/p>\n\u003cp>Bexsero and a second vaccine, Trumenba, cover most -- but not all -- strains of bacteria within the serogroup B. It's possible Misha was infected with a strain that is not included in the vaccine. Meissner said there is no scientific evidence to support the idea that the vaccine makes the course of the disease less severe, if someone does become infected.\u003c/p>\n\u003cp>And while meningococcal group B infections are rare -- just \u003ca href=\"http://www.cdc.gov/media/releases/2013/t1125-serogroup-b-meningitis.html\" target=\"_blank\">160 cases in 2012\u003c/a> -- they can be devastating, often striking young, healthy people. Nelson's son rows crew and was a member of an eight-man boat that won a national title last year.\u003c/p>\n\u003cp>Public health officials are now watching to see how the vaccine performs, says Dr. James Watt with the California Department of Public Health.\u003c/p>\n\u003cp>\"These vaccines have been used in outbreaks,\" he said. \"They have appeared to have an impact, so that's good news.\" Together with the Santa Clara County Public Health Department, Santa Clara University ran four vaccine clinics, ending Monday. Nearly 5,000 of the university's 8,000 undergraduate and graduate students received the first dose.\u003c/p>\n\u003cfigure id=\"attachment_146287\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-146287\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/02/Penny-400x533.jpg\" alt=\"Penny Nelson with her son, Misha. He is recovering from bacterial meningitis. \" width=\"400\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny-400x533.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny-800x1067.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny-768x1024.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny-1180x1573.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny-960x1280.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/02/Penny.jpg 1224w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Penny Nelson with her son, Misha. He is recovering from bacterial meningitis. \u003ccite>(Courtesy: Penny Nelson)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The California Department of Public Health will provide 5,000 doses next month, when students will need the final shot in the two-dose series.\u003c/p>\n\u003cp>The vaccine is not part of the routine immunization schedule for adolescents. Instead, it received a \"permissive\" recommendation, meaning that doctors can administer it if they feel it is in the best interest of the adolescent. Some people at high risk\u003ca href=\"http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mening-serogroup.html\" target=\"_blank\"> should be immunized\u003c/a>, according to the Centers for Disease Control and Prevention, including anyone with a damaged or removed spleen, sickle cell anemia or who has a rare immune system condition known as \"complement deficiency.\"\u003c/p>\n\u003cp>California follows CDC guidelines, so does not require the vaccine for school-age children. Watt says California colleges and universities set their own vaccine guidelines.\u003c/p>\n\u003cp>Meanwhile, cases are dropping. In the late 1990s, there were 1-2 cases per 100,000 people. Now it's 0.1 per 100,000. \"Meningococcal disease is disappearing in the U.S.,\" Meissner says. \"No one knows why.\"\u003c/p>\n\u003cp>On top of everything else, this vaccine is expensive, more than $300 for the series. Meissner published \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2491460\" target=\"_blank\">an analysis\u003c/a> in Monday's JAMA spotlighting the challenges of providing such an expensive vaccine for such a rare disease. As many as 350,000 adolescents would need to be vaccinated to prevent one case of disease, he wrote.\u003c/p>\n\u003cp>\"This vaccine is 25 times higher [in cost] than any other vaccine,\" he told me.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Is this the way we want to be spending scarce funds for public health?\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "State's Medi-Cal Bill for Undocumented Children Could Go Up",
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"content": "\u003cp>The cost of providing full Medi-Cal benefits to undocumented immigrant children in California could be significantly more than the state’s health care agency has projected, according to experts and advocates.\u003c/p>\n\u003cp>That’s because state officials may have underestimated the number of kids in the United States illegally who will be eligible for the program -– though it’s hard to know precisely by how much.\u003c/p>\n\u003cp>The Department of Health Care Services has said about \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\">170,000 such children\u003c/a> will be eligible for full Medi-Cal beginning in May, when the expansion takes effect, and that covering them will cost the state $142.8 million in fiscal year 2016-2017.\u003c/p>\n\u003cp>But some advocates believe the number of eligible kids – and thus the price of covering them – will be much higher.\u003c/p>\n\u003cp>“Oh, no, it’s going to be a lot more than that,” said Mark Diel, executive director of California Coverage and Health Initiatives, a children’s health advocacy group based in Sacramento. “We think the overall number will be more like 260,000 kids who will be eligible.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And that, Diel believes, could add roughly $40 million to the health care department’s projection.\u003c/p>\n\u003cp>Unlike the regular Medi-Cal program, which is a partnership with the federal government, the state of California must foot the full bill for coverage of kids who are not in the country legally, except when they seek emergency services.\u003c/p>\n\u003cp>What’s missing from the state’s estimate of that bill, Diehl said, are at least 70,000 undocumented children currently receiving benefits through Kaiser Permanente and about 20,000 more who get varying levels of care through county programs.\u003c/p>\n\u003cp>However, those additional 90,000 children will not be as expensive to cover as the ones counted by state health officials, because they already are receiving care.\u003c/p>\n\u003cp>Most of the 170,000 eligible children included in the state’s estimate “don’t have any care at all right now, outside of some of them getting care in the ER,” Diel explained. “It will be their first year of coverage, and that’s a lot more expensive.”\u003c/p>\n\u003cp>The 90,000 additional children who are already getting care would cost about half as much as the first-timers, on average, because “it’s easier to care for them,” he said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"8LfJdr5rt0Uz6n9ZjpXzSqG4uMKL0DYQ\"]But the state’s eligibility numbers could be off by even more than 90,000, said Richard Figueroa, program director at the California Endowment, a health care philanthropy.\u003c/p>\n\u003cp>He said as many as 300,000 children in the country illegally might be eligible for full Medi-Cal benefits, though no one really knows exactly how many children in California are without legal papers.\u003c/p>\n\u003cp>Diel said his estimate of $40 million in extra state spending is a conservative number. “It’s speculation, but it’s speculation based on past experience,” he said.\u003c/p>\n\u003cp>Ronald Coleman, government affairs manager in the Sacramento office of the Los Angeles-based California Immigrant Policy Center, a think tank and advocacy group, said it is premature to pin down the cost of covering the children living in the U.S. and California illegally who are not yet counted by the health care department.\u003c/p>\n\u003cp>However, “it’s safe to say the state will have to put additional funds into this,” Coleman said.\u003c/p>\n\u003cp>Figures on those living in the U.S. and California without legal permission are unclear, and the cost of caring for children who already have some kind of coverage is also uncertain, he said.\u003c/p>\n\u003cp>He noted that not all of the 70,000 or more kids currently getting care through Kaiser Permanente will necessarily go into Medi-Cal. Talks are underway to decide how best to care for them.\u003c/p>\n\u003cp>In addition, the equation could change if a federal court injunction is lifted on President Barack Obama’s executive order offering citizenship to some of these people, Coleman noted. The Supreme Court in January agreed to hear the case.\u003c/p>\n\u003cp>If the injunction is lifted, some of the kids in California could be eligible for citizenship under Obama’s order.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Assuming they qualified, they would be covered under regular Medi-Cal, which gets significant funding from the federal government, thus reducing the state’s bill for their care.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The cost of providing full Medi-Cal benefits to undocumented immigrant children in California could be significantly more than the state’s health care agency has projected, according to experts and advocates.\u003c/p>\n\u003cp>That’s because state officials may have underestimated the number of kids in the United States illegally who will be eligible for the program -– though it’s hard to know precisely by how much.\u003c/p>\n\u003cp>The Department of Health Care Services has said about \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\">170,000 such children\u003c/a> will be eligible for full Medi-Cal beginning in May, when the expansion takes effect, and that covering them will cost the state $142.8 million in fiscal year 2016-2017.\u003c/p>\n\u003cp>But some advocates believe the number of eligible kids – and thus the price of covering them – will be much higher.\u003c/p>\n\u003cp>“Oh, no, it’s going to be a lot more than that,” said Mark Diel, executive director of California Coverage and Health Initiatives, a children’s health advocacy group based in Sacramento. “We think the overall number will be more like 260,000 kids who will be eligible.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And that, Diel believes, could add roughly $40 million to the health care department’s projection.\u003c/p>\n\u003cp>Unlike the regular Medi-Cal program, which is a partnership with the federal government, the state of California must foot the full bill for coverage of kids who are not in the country legally, except when they seek emergency services.\u003c/p>\n\u003cp>What’s missing from the state’s estimate of that bill, Diehl said, are at least 70,000 undocumented children currently receiving benefits through Kaiser Permanente and about 20,000 more who get varying levels of care through county programs.\u003c/p>\n\u003cp>However, those additional 90,000 children will not be as expensive to cover as the ones counted by state health officials, because they already are receiving care.\u003c/p>\n\u003cp>Most of the 170,000 eligible children included in the state’s estimate “don’t have any care at all right now, outside of some of them getting care in the ER,” Diel explained. “It will be their first year of coverage, and that’s a lot more expensive.”\u003c/p>\n\u003cp>The 90,000 additional children who are already getting care would cost about half as much as the first-timers, on average, because “it’s easier to care for them,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But the state’s eligibility numbers could be off by even more than 90,000, said Richard Figueroa, program director at the California Endowment, a health care philanthropy.\u003c/p>\n\u003cp>He said as many as 300,000 children in the country illegally might be eligible for full Medi-Cal benefits, though no one really knows exactly how many children in California are without legal papers.\u003c/p>\n\u003cp>Diel said his estimate of $40 million in extra state spending is a conservative number. “It’s speculation, but it’s speculation based on past experience,” he said.\u003c/p>\n\u003cp>Ronald Coleman, government affairs manager in the Sacramento office of the Los Angeles-based California Immigrant Policy Center, a think tank and advocacy group, said it is premature to pin down the cost of covering the children living in the U.S. and California illegally who are not yet counted by the health care department.\u003c/p>\n\u003cp>However, “it’s safe to say the state will have to put additional funds into this,” Coleman said.\u003c/p>\n\u003cp>Figures on those living in the U.S. and California without legal permission are unclear, and the cost of caring for children who already have some kind of coverage is also uncertain, he said.\u003c/p>\n\u003cp>He noted that not all of the 70,000 or more kids currently getting care through Kaiser Permanente will necessarily go into Medi-Cal. Talks are underway to decide how best to care for them.\u003c/p>\n\u003cp>In addition, the equation could change if a federal court injunction is lifted on President Barack Obama’s executive order offering citizenship to some of these people, Coleman noted. The Supreme Court in January agreed to hear the case.\u003c/p>\n\u003cp>If the injunction is lifted, some of the kids in California could be eligible for citizenship under Obama’s order.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Assuming they qualified, they would be covered under regular Medi-Cal, which gets significant funding from the federal government, thus reducing the state’s bill for their care.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "L.A. Doctor Gets 30 Years to Life for Patients' Prescription Drug Deaths",
"title": "L.A. Doctor Gets 30 Years to Life for Patients' Prescription Drug Deaths",
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"content": "\u003cp>LOS ANGELES (AP) — A Los Angeles-area doctor convicted of murder for prescribing exorbitant amounts of painkillers that left a dozen patients dead was sentenced Friday to 30 years to life in prison.\u003c/p>\n\u003cp>The conviction of Dr. Hsiu-Ying \"Lisa\" Tseng and her long prison sentence are rare for a doctor.\u003c/p>\n\u003cp>Minutes before she was sentenced, Tseng apologized in court to the families of her dead patients and others who became addicted to prescription drugs under her care.\u003c/p>\n\u003cp>\"I suffer every day from the impact and I will do everything I can to take responsibility,\" she said. \"I have learned a very hard lesson on this that will stay with me forever.\"\u003c/p>\n\u003cp>In handing down the harsh sentence, Los Angeles County Superior Court Judge George Lomeli said he found it egregious that Tseng continued to write reckless prescriptions even after learning her patients were dying.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"(She's) a person who seemingly did not care about the lives of her patients in this case but rather appeared more concerned about distributing dangerous controlled substances in an assembly line fashion so as to collect payments which amounted to her amassing several million dollars,\" Lomeli said.\u003c/p>\n\u003cp>The mother of two children will be over 70 before she has a chance at release.\u003c/p>\n\u003cp>Tseng had asked Lomeli for a 15-year prison term.\u003c/p>\n\u003cp>Tseng prescribed \"crazy, outrageous amounts of medication\" to patients who didn't need the pills, Deputy District Attorney John Niedermann told jurors during her trial.\u003c/p>\n\u003cp>\"Something is wrong with what you're doing if your patients are dying,\" Niedermann said.\u003c/p>\n\u003cp>Twelve of Tseng's patients died but she was charged with just three murders because other factors were involved in the other deaths, including drugs prescribed by other doctors and a possible suicide.\u003c/p>\n\u003cp>Tseng's lawyer, Tracy Green, has said the 46-year-old doctor had been naive to prescribe so many medications and didn't think her patients would abuse them. Tseng's patients often hid addictions to painkillers and Tseng she thought she was helping ease their pain, she said.\u003c/p>\n\u003cp>The powerful painkillers Tseng prescribed included oxycodone, sold as Percocet and other brand names, and hydrocodone, popularly known under the brand name Vicodin.\u003c/p>\n\u003cp>The first of her patients to die had received prescriptions from Tseng two days earlier for oxycodone, the anti-anxiety drug Xanax and the muscle-relaxer Soma, prosecutors said.\u003c/p>\n\u003cp>Tseng was convicted of three counts of second-degree murder and all but one of 21 drug-related counts. She was also charged with illegally writing prescriptions for two of the deceased patients and 16 other people, three of them undercover agents.\u003c/p>\n\u003cp>Vu Nguyen, 29, of Lake Forest, Steven Ogle, 25, of Palm Desert, and Joseph Rovero, 21, an Arizona State University student from San Ramon, died of overdoses between March and December 2009.\u003c/p>\n\u003cp>Ogle's mother, Desiree Ogle, said after the sentencing that her son died in April 2009 eight hours after getting a methadone prescription from Tseng.\u003c/p>\n\u003cp>\"She actually stopped his heart,\" Ogle said, adding that she thought Tseng's lengthy prison term was appropriate. \"She froze time for us that day.\"\u003c/p>\n\u003cp>Tseng barely kept any records on the three men until she was contacted by the Medical Board of California, prosecutors said, then fabricated documents to make it look like she had kept thorough records.\u003c/p>\n\u003cp>Tseng also ignored pleas from family members of patients who demanded she stop prescribing them drugs, prosecutors said.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.latimes.com/local/lanow/la-me-ln-doctor-murder-overdose-drugs-sentencing-20160205-story.html\" target=\"_blank\">Los Angeles Times reports\u003c/a> that many experts worry Tseng's conviction will have a chilling effect -- that doctors will be so worried about prosecution that they won't prescribe painkillers to suffering patients who need them.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>From \u003ca href=\"http://www.latimes.com/local/lanow/la-me-ln-doctor-murder-overdose-drugs-sentencing-20160205-story.html\" target=\"_blank\">the Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Attorney Peter Osinoff, who represented Tseng before the state medical board, told the judge during Friday's hearing that the doctor no longer represents a danger to society since she surrendered her medical license in 2012.\u003c/p>\n\u003cp>The trial had already had a \"deterrent effect\" on other doctors and has captured the medical community's attention.\u003c/p>\n\u003cp>\"More primary care physicians no longer accept or treat chronic pain patients in their practice,\" he told the judge.\u003c/p>\n\u003cp>Outside the courtroom, Osinoff said Tseng's prosecution has had a negative impact on physicians and patients.\u003c/p>\n\u003cp>\"The doctors are scared out of their minds,\" he said. \"The pendulum has swung so far. The people who need [pain medication] can't get it now.\"\u003c/p>\u003c/blockquote>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>LOS ANGELES (AP) — A Los Angeles-area doctor convicted of murder for prescribing exorbitant amounts of painkillers that left a dozen patients dead was sentenced Friday to 30 years to life in prison.\u003c/p>\n\u003cp>The conviction of Dr. Hsiu-Ying \"Lisa\" Tseng and her long prison sentence are rare for a doctor.\u003c/p>\n\u003cp>Minutes before she was sentenced, Tseng apologized in court to the families of her dead patients and others who became addicted to prescription drugs under her care.\u003c/p>\n\u003cp>\"I suffer every day from the impact and I will do everything I can to take responsibility,\" she said. \"I have learned a very hard lesson on this that will stay with me forever.\"\u003c/p>\n\u003cp>In handing down the harsh sentence, Los Angeles County Superior Court Judge George Lomeli said he found it egregious that Tseng continued to write reckless prescriptions even after learning her patients were dying.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"(She's) a person who seemingly did not care about the lives of her patients in this case but rather appeared more concerned about distributing dangerous controlled substances in an assembly line fashion so as to collect payments which amounted to her amassing several million dollars,\" Lomeli said.\u003c/p>\n\u003cp>The mother of two children will be over 70 before she has a chance at release.\u003c/p>\n\u003cp>Tseng had asked Lomeli for a 15-year prison term.\u003c/p>\n\u003cp>Tseng prescribed \"crazy, outrageous amounts of medication\" to patients who didn't need the pills, Deputy District Attorney John Niedermann told jurors during her trial.\u003c/p>\n\u003cp>\"Something is wrong with what you're doing if your patients are dying,\" Niedermann said.\u003c/p>\n\u003cp>Twelve of Tseng's patients died but she was charged with just three murders because other factors were involved in the other deaths, including drugs prescribed by other doctors and a possible suicide.\u003c/p>\n\u003cp>Tseng's lawyer, Tracy Green, has said the 46-year-old doctor had been naive to prescribe so many medications and didn't think her patients would abuse them. Tseng's patients often hid addictions to painkillers and Tseng she thought she was helping ease their pain, she said.\u003c/p>\n\u003cp>The powerful painkillers Tseng prescribed included oxycodone, sold as Percocet and other brand names, and hydrocodone, popularly known under the brand name Vicodin.\u003c/p>\n\u003cp>The first of her patients to die had received prescriptions from Tseng two days earlier for oxycodone, the anti-anxiety drug Xanax and the muscle-relaxer Soma, prosecutors said.\u003c/p>\n\u003cp>Tseng was convicted of three counts of second-degree murder and all but one of 21 drug-related counts. She was also charged with illegally writing prescriptions for two of the deceased patients and 16 other people, three of them undercover agents.\u003c/p>\n\u003cp>Vu Nguyen, 29, of Lake Forest, Steven Ogle, 25, of Palm Desert, and Joseph Rovero, 21, an Arizona State University student from San Ramon, died of overdoses between March and December 2009.\u003c/p>\n\u003cp>Ogle's mother, Desiree Ogle, said after the sentencing that her son died in April 2009 eight hours after getting a methadone prescription from Tseng.\u003c/p>\n\u003cp>\"She actually stopped his heart,\" Ogle said, adding that she thought Tseng's lengthy prison term was appropriate. \"She froze time for us that day.\"\u003c/p>\n\u003cp>Tseng barely kept any records on the three men until she was contacted by the Medical Board of California, prosecutors said, then fabricated documents to make it look like she had kept thorough records.\u003c/p>\n\u003cp>Tseng also ignored pleas from family members of patients who demanded she stop prescribing them drugs, prosecutors said.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.latimes.com/local/lanow/la-me-ln-doctor-murder-overdose-drugs-sentencing-20160205-story.html\" target=\"_blank\">Los Angeles Times reports\u003c/a> that many experts worry Tseng's conviction will have a chilling effect -- that doctors will be so worried about prosecution that they won't prescribe painkillers to suffering patients who need them.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>From \u003ca href=\"http://www.latimes.com/local/lanow/la-me-ln-doctor-murder-overdose-drugs-sentencing-20160205-story.html\" target=\"_blank\">the Times\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Attorney Peter Osinoff, who represented Tseng before the state medical board, told the judge during Friday's hearing that the doctor no longer represents a danger to society since she surrendered her medical license in 2012.\u003c/p>\n\u003cp>The trial had already had a \"deterrent effect\" on other doctors and has captured the medical community's attention.\u003c/p>\n\u003cp>\"More primary care physicians no longer accept or treat chronic pain patients in their practice,\" he told the judge.\u003c/p>\n\u003cp>Outside the courtroom, Osinoff said Tseng's prosecution has had a negative impact on physicians and patients.\u003c/p>\n\u003cp>\"The doctors are scared out of their minds,\" he said. \"The pendulum has swung so far. The people who need [pain medication] can't get it now.\"\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "425,000 More People Sign Up for Covered California",
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"content": "\u003cp>More than 425,000 Californians have signed up on the state’s health insurance exchange — with nearly 100,000 rushing to enroll in the last four days before the 2016 open enrollment period ended Jan. 31, officials said Thursday.\u003c/p>\n\u003cp>The exchange, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a>, had estimated it would attract between 295,000 and 450,000 new enrollees during its third open enrollment season since the Affordable Care Act took effect. In addition to the new enrollees, about 1.15 million existing consumers re-upped this year, officials said, for a total of about 1.57 million.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said about 37 percent of the new enrollees are young adults aged 18-34, up from 34 percent from last year. That’s good news for exchange officials, because younger, healthier adults help subsidize coverage for older Californians.\u003c/p>\n\u003cp>“We continue to have a broad and healthy mix of those signing up for coverage … which means better rates and a more stable system, both for all of our enrollees, and for the entire individual health insurance marketplace in California,” Lee said.\u003c/p>\n\u003cp>Lee declined to provide additional information on the ethnic and demographic breakdown of enrollees or the plans they chose, saying the numbers were still being analyzed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The number of enrollees could still grow a bit this year, because the state last week extended the enrollment deadline for people who had officially begun the process by Jan. 31. Lee said “tens of thousands” of Californians are in that group.\u003c/p>\n\u003cp>With the end of open enrollment for 2016, consumers in California and nationwide can sign up for Affordable Care Act insurance only if they encounter a life-altering event such as having a baby, getting married or losing employer-based insurance. The next open enrollment period, for coverage in 2017, will start in November.\u003c/p>\n\u003cp>Most people who fail to sign up by the deadline face tax penalties of $695 per adult, plus $347.50 per child, or 2.5 percent of family income in excess of 2015 income tax filing thresholds. Since Covered California launched, the exchange has served more than 2 million people, Lee said. Of the consumers who have left the exchange, about 85 percent found other insurance options, including through their jobs, he said.\u003c/p>\n\u003cp>Still, California’s health insurance exchange \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/11/02/covered-california-targets-african-americans-latinos-in-obamacare-open-enrollment/\" target=\"_blank\">has struggled\u003c/a> to reach the state’s remaining uninsured, particularly Latinos and African-Americans.\u003c/p>\n\u003cp>About 2.4 percent of the exchange’s approximately 1.3 million enrollees are African-American. That’s only about half of the blacks considered eligible for subsidies because of their income. Another 30 percent are Latino, although 37 percent are considered eligible for subsidies, according to \u003ca href=\"http://hbex.coveredca.com/data-research/library/Active-Membership-Slides.pdf\" target=\"_blank\">Covered California data\u003c/a>.\u003c/p>\n\u003cp>When the 2016 open enrollment period started in November, the exchange \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/11/02/covered-california-targets-african-americans-latinos-in-obamacare-open-enrollment/\" target=\"_blank\">promised deeper outreach\u003c/a> in those communities, including more targeted advertising, events and storefront enrollment centers.\u003c/p>\n\u003cp>Concerns also remain about Covered California’s ability to rein in insurance costs, especially for consumers who make too much money to qualify for subsidies or Medi-Cal but not enough to afford full-fare premiums. Lee said that Covered California consumers saw an average 4 percent rate increase in 2016, slightly lower than in 2015. Nationally, however, the increase was higher: Obamacare premiums for “benchmark” insurance plans were expected to rise by \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-26-2.html\" target=\"_blank\">an average of 7.5 percent\u003c/a>, according to federal data.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But because consumers can change plans during open enrollment, those who switched to the lowest-cost plan in their area could lower their premiums by an average of 4.5 percent this year, Lee said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than 425,000 Californians have signed up on the state’s health insurance exchange — with nearly 100,000 rushing to enroll in the last four days before the 2016 open enrollment period ended Jan. 31, officials said Thursday.\u003c/p>\n\u003cp>The exchange, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\">Covered California\u003c/a>, had estimated it would attract between 295,000 and 450,000 new enrollees during its third open enrollment season since the Affordable Care Act took effect. In addition to the new enrollees, about 1.15 million existing consumers re-upped this year, officials said, for a total of about 1.57 million.\u003c/p>\n\u003cp>Peter Lee, executive director of Covered California, said about 37 percent of the new enrollees are young adults aged 18-34, up from 34 percent from last year. That’s good news for exchange officials, because younger, healthier adults help subsidize coverage for older Californians.\u003c/p>\n\u003cp>“We continue to have a broad and healthy mix of those signing up for coverage … which means better rates and a more stable system, both for all of our enrollees, and for the entire individual health insurance marketplace in California,” Lee said.\u003c/p>\n\u003cp>Lee declined to provide additional information on the ethnic and demographic breakdown of enrollees or the plans they chose, saying the numbers were still being analyzed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The number of enrollees could still grow a bit this year, because the state last week extended the enrollment deadline for people who had officially begun the process by Jan. 31. Lee said “tens of thousands” of Californians are in that group.\u003c/p>\n\u003cp>With the end of open enrollment for 2016, consumers in California and nationwide can sign up for Affordable Care Act insurance only if they encounter a life-altering event such as having a baby, getting married or losing employer-based insurance. The next open enrollment period, for coverage in 2017, will start in November.\u003c/p>\n\u003cp>Most people who fail to sign up by the deadline face tax penalties of $695 per adult, plus $347.50 per child, or 2.5 percent of family income in excess of 2015 income tax filing thresholds. Since Covered California launched, the exchange has served more than 2 million people, Lee said. Of the consumers who have left the exchange, about 85 percent found other insurance options, including through their jobs, he said.\u003c/p>\n\u003cp>Still, California’s health insurance exchange \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/11/02/covered-california-targets-african-americans-latinos-in-obamacare-open-enrollment/\" target=\"_blank\">has struggled\u003c/a> to reach the state’s remaining uninsured, particularly Latinos and African-Americans.\u003c/p>\n\u003cp>About 2.4 percent of the exchange’s approximately 1.3 million enrollees are African-American. That’s only about half of the blacks considered eligible for subsidies because of their income. Another 30 percent are Latino, although 37 percent are considered eligible for subsidies, according to \u003ca href=\"http://hbex.coveredca.com/data-research/library/Active-Membership-Slides.pdf\" target=\"_blank\">Covered California data\u003c/a>.\u003c/p>\n\u003cp>When the 2016 open enrollment period started in November, the exchange \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/11/02/covered-california-targets-african-americans-latinos-in-obamacare-open-enrollment/\" target=\"_blank\">promised deeper outreach\u003c/a> in those communities, including more targeted advertising, events and storefront enrollment centers.\u003c/p>\n\u003cp>Concerns also remain about Covered California’s ability to rein in insurance costs, especially for consumers who make too much money to qualify for subsidies or Medi-Cal but not enough to afford full-fare premiums. Lee said that Covered California consumers saw an average 4 percent rate increase in 2016, slightly lower than in 2015. Nationally, however, the increase was higher: Obamacare premiums for “benchmark” insurance plans were expected to rise by \u003ca href=\"https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-26-2.html\" target=\"_blank\">an average of 7.5 percent\u003c/a>, according to federal data.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But because consumers can change plans during open enrollment, those who switched to the lowest-cost plan in their area could lower their premiums by an average of 4.5 percent this year, Lee said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Whooping Cough 'Booster' Vaccine Protection Fades Quickly, Kaiser Study Shows",
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"content": "\u003cp>In the late 1990s, a new version of the whooping cough vaccine was introduced. The big benefit was that it had fewer side effects. But in the years since, evidence has been mounting that this newer vaccine loses its effectiveness -- and fast.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Routine vaccination of 11- and 12-year-olds does not appear to be preventing outbreaks.'\u003cbr>\n\u003ccite>Dr. Nicola Klein, Kaiser Vaccine Study Center\u003c/cite>\u003c/aside>\n\u003cp>Now, another study sheds light on how well the \"booster\" dose works. California requires this booster -- called Tdap -- for all incoming 7th graders.\u003c/p>\n\u003cp>Researchers at the Kaiser Permanente Vaccine Study Center looked at the protection level of 175,000 adolescents in the Kaiser Northern California system vaccinated with Tdap. And just as with earlier studies, they saw that protection faded.\u003c/p>\n\u003cp>\"What we found was the the Tdap vaccine offers moderate protection in the first year,\" said Dr. Nicola Klein, co-director of Kaiser's vaccine center, \"but then that rapidly decreased over the next four years, so by the time we were at four years after vaccination, it was down to nine percent.\"\u003c/p>\n\u003cp>There have been two statewide whooping cough -- also called pertussis -- epidemics in recent years. The first was in 2010, the second in 2014, which was the first where all adolescents had received only the newer pertussis vaccine, the \"acellular pertussis\" vaccine: five doses by age 6, plus the booster before 7th grade. The 2014 epidemic was even more severe than the one in 2010.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Unfortunately,\" said Klein, \"routine vaccination of 11- and 12-year-olds does not appear to be preventing outbreaks.\"\u003c/p>\n\u003cp>The question becomes what to do about it -- especially since the authors predict the situation will only get worse. \"Future pertussis epidemics,\" they write in the study, will \"be larger as the cohort that has only received acellular pertussis vaccines ages.\"\u003c/p>\n\u003cp>At the very end of the study, published in the journal Pediatrics, the authors raise the question of a different strategy, one where the vaccine was \"administered to adolescents in anticipation of a local pertussis outbreak, rather than on a routine basis.\"\u003c/p>\n\u003cp>It seems like a good idea, but it's one that would be a significant departure for the U.S., according to Dr. Arthur Reingold, head of epidemiology at the UC Berkeley School of Public Health.\u003c/p>\n\u003cp>\"The United State doesn't have a lot of experience in doing mass campaigns in response to or in preparation of an outbreak,\" he said.\u003c/p>\n\u003cp>It might also seem reasonable to give doses more frequently. But Reingold, who also chairs the pertussis group for the nation's Advisory Committee on Immunization Practices, says first you need a lot of evidence that extra doses are both safe and effective.\u003c/p>\n\u003cp>\"Give a dose at 12 [years], another one at 15 and another one at 18,\" Reingold questioned. \"It's expense and it's complicated, and it's not clear what the effects would be. There's not a clear solution at this point.\"\u003c/p>\n\u003cp>A clear solution would be a new vaccine that is, again, safe and effective. Reingold says that's at least five years off.\u003c/p>\n\u003cp>In the meantime, no adolescents died or were hospitalized in the 2014 epidemic. Klein referred to pertussis as a \"mild to moderate disease.\" Yet, the illness is often referred to as \"the 100-day cough.\"\u003c/p>\n\u003cp>\"It's not a deadly disease,\" Klein said, \"but it is an impact on kids' lives.\" And parents, too, who may have to take time off work to care for their sick children.\u003c/p>\n\u003cp>It becomes a question of priorities in a limited-resources world. \"At the public health level, the emphasis is on preventing deaths and hospitalizations,\" Reingold said. \"How much money do we want to spend ... to prevent the 100-day cough?\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a perfectly legitimate question, and I don't know the answer.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the late 1990s, a new version of the whooping cough vaccine was introduced. The big benefit was that it had fewer side effects. But in the years since, evidence has been mounting that this newer vaccine loses its effectiveness -- and fast.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Routine vaccination of 11- and 12-year-olds does not appear to be preventing outbreaks.'\u003cbr>\n\u003ccite>Dr. Nicola Klein, Kaiser Vaccine Study Center\u003c/cite>\u003c/aside>\n\u003cp>Now, another study sheds light on how well the \"booster\" dose works. California requires this booster -- called Tdap -- for all incoming 7th graders.\u003c/p>\n\u003cp>Researchers at the Kaiser Permanente Vaccine Study Center looked at the protection level of 175,000 adolescents in the Kaiser Northern California system vaccinated with Tdap. And just as with earlier studies, they saw that protection faded.\u003c/p>\n\u003cp>\"What we found was the the Tdap vaccine offers moderate protection in the first year,\" said Dr. Nicola Klein, co-director of Kaiser's vaccine center, \"but then that rapidly decreased over the next four years, so by the time we were at four years after vaccination, it was down to nine percent.\"\u003c/p>\n\u003cp>There have been two statewide whooping cough -- also called pertussis -- epidemics in recent years. The first was in 2010, the second in 2014, which was the first where all adolescents had received only the newer pertussis vaccine, the \"acellular pertussis\" vaccine: five doses by age 6, plus the booster before 7th grade. The 2014 epidemic was even more severe than the one in 2010.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Unfortunately,\" said Klein, \"routine vaccination of 11- and 12-year-olds does not appear to be preventing outbreaks.\"\u003c/p>\n\u003cp>The question becomes what to do about it -- especially since the authors predict the situation will only get worse. \"Future pertussis epidemics,\" they write in the study, will \"be larger as the cohort that has only received acellular pertussis vaccines ages.\"\u003c/p>\n\u003cp>At the very end of the study, published in the journal Pediatrics, the authors raise the question of a different strategy, one where the vaccine was \"administered to adolescents in anticipation of a local pertussis outbreak, rather than on a routine basis.\"\u003c/p>\n\u003cp>It seems like a good idea, but it's one that would be a significant departure for the U.S., according to Dr. Arthur Reingold, head of epidemiology at the UC Berkeley School of Public Health.\u003c/p>\n\u003cp>\"The United State doesn't have a lot of experience in doing mass campaigns in response to or in preparation of an outbreak,\" he said.\u003c/p>\n\u003cp>It might also seem reasonable to give doses more frequently. But Reingold, who also chairs the pertussis group for the nation's Advisory Committee on Immunization Practices, says first you need a lot of evidence that extra doses are both safe and effective.\u003c/p>\n\u003cp>\"Give a dose at 12 [years], another one at 15 and another one at 18,\" Reingold questioned. \"It's expense and it's complicated, and it's not clear what the effects would be. There's not a clear solution at this point.\"\u003c/p>\n\u003cp>A clear solution would be a new vaccine that is, again, safe and effective. Reingold says that's at least five years off.\u003c/p>\n\u003cp>In the meantime, no adolescents died or were hospitalized in the 2014 epidemic. Klein referred to pertussis as a \"mild to moderate disease.\" Yet, the illness is often referred to as \"the 100-day cough.\"\u003c/p>\n\u003cp>\"It's not a deadly disease,\" Klein said, \"but it is an impact on kids' lives.\" And parents, too, who may have to take time off work to care for their sick children.\u003c/p>\n\u003cp>It becomes a question of priorities in a limited-resources world. \"At the public health level, the emphasis is on preventing deaths and hospitalizations,\" Reingold said. \"How much money do we want to spend ... to prevent the 100-day cough?\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a perfectly legitimate question, and I don't know the answer.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How High-Cost Specialty Drugs Impact California",
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"content": "\u003cp id=\"3531\" class=\"graf--p graf-after--figure\">What’s behind the jaw-dropping cost of new “specialty drugs” like Orkambi, which has a sticker price of $259,000 per year for cystic fibrosis patients?\u003c/p>\n\u003cp id=\"4e0b\" class=\"graf--p graf-after--p\">Orkambi, which was approved by the U.S. Food and Drug Administration last July, is expected to take almost $36 million from the state’s general fund this fiscal year and next. Seventy-four Californians with health coverage under the Department of Health Care Services are estimated to receive the drug this year, and next year, 220 people will benefit, some of whom may be the same patients as this year. That does not include any discounts the state may receive from drug manufacturers.\u003c/p>\n\u003cp id=\"5b0e\" class=\"graf--p graf-after--p\">Orkambi is listed as a “specialty tier” drug in some private health plans. That category is reserved for high-cost drugs, or, in the \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/SpecialtyTierMethodology.pdf\" rel=\"nofollow\">federal government’s\u003c/a>view, for drugs that cost more than $600 a month and are used by a small proportion of patients.\u003c/p>\n\u003cp id=\"3924\" class=\"graf--p graf-after--p\">Specialty drugs are already proving to be a financial burden on one California agency, the California Public Employees’ Retirement System, which purchases health benefits for active and retired state workers. The state public pension system says that specialty drugs made up less than 1 percent of all prescriptions for its members but 30 percent of the total drugs costs in 2014.\u003c/p>\n\u003cp class=\"graf--p graf-after--p\">The health benefits from specialty drugs justify the cost, according to the pharmaceutical industry.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp id=\"ee28\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Patients are gaining access to medicines that are better treating their diseases or frankly even curing them,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA). “Patients are now healthier. They’re more productive. They’re functioning.”\u003c/p>\n\u003cp id=\"e169\" class=\"graf--p graf-after--p\">VanderVeer said companies price drugs not just on the cost of production, but on the value the industry believes the drug brings to the health care system, such as:\u003c/p>\n\u003cul class=\"postList\">\n\u003cli id=\"7b31\" class=\"graf--li graf-after--p\">Efficacy of the treatment\u003c/li>\n\u003cli id=\"b80b\" class=\"graf--li graf-after--li\">How it increases the quality or length of life\u003c/li>\n\u003cli id=\"5c88\" class=\"graf--li graf-after--li\">The “unmet need” in the drug market\u003c/li>\n\u003c/ul>\n\u003cp id=\"cc5b\" class=\"graf--p graf-after--li\">The price of the drug also accounts for the cost of developing other drugs and the high risk that a particular drug won’t make it to market, VanderVeer said. Only 12 percent of drugs that go through clinical trials get approved, according to PhRMA.\u003c/p>\n\u003cp id=\"ef58\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Because of that high rate of failures there would be no innovative incentive for companies to continue to try to invest” if they could not recoup costs and make a profit, VanderVeer said.\u003c/p>\n\u003cp id=\"93ab\" class=\"graf--p graf-after--p\">Finally, she added, the sticker price doesn’t reflect the final price paid for the drug, which can be heavily discounted through negotiations or because of mandated rebates for Medicaid programs.\u003c/p>\n\u003cp id=\"b00f\" class=\"graf--p graf-after--p\">[contextly_sidebar id=\"zzW5l7DTsYNjFFcWE84QTNvLSahLvtDx\"]Drugmakers are following the money, said Joel Hay, professor of pharmaceutical economics and policy at USC. Companies invest in specialty drugs that target a small population because their high price tags can be spread over a large insurance pool, he said.\u003c/p>\n\u003cp id=\"02e0\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">Even though specialty drugs are \"ridiculously expensive per treatment episode,\" Hay said, the cost for each member in a health plan is \"just a few cents.” Raising 10 cents on a diabetes drug, for example, would have a bigger budget impact, he said, because more people have diabetes than cystic fibrosis.\u003c/p>\n\u003cp id=\"14f9\" class=\"graf--p graf-after--p\">Hay says manufacturers are now less inclined to invest in drugs that treat millions of people, because there is more pushback on price.\u003c/p>\n\u003cp id=\"de1b\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Drug companies are for-profit companies obligated to make money for their stockholders,” Hay said. “They’re not virtuous charitable organizations.”\u003c/p>\n\u003cp id=\"708f\" class=\"graf--p graf-after--p\">Drugmakers are also investing more in treating uncommon illnesses because there is less competition and therefore more opportunity for profit, said Dr. Helene Lipton, professor of health policy at the School of Pharmacy and Institute for Health Policy Studies at UC San Francisco.\u003c/p>\n\u003cp id=\"f652\" class=\"graf--p graf-after--p\">The high price of the drugs affects patients, she noted, because health plans put controls on the drugs so that they’re used as a last resort.\u003c/p>\n\u003cp id=\"ed3c\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“That may mean going through two or more rounds of care with other medications before being able to use the specialty drug,” Lipton said.\u003c/p>\n\u003cp id=\"063c\" class=\"graf--p graf-after--p\">It’s not just specialty drugs that are straining health plans’ budgets, said Steve Miller, chief medical officer at Express Scripts, a pharmaceutical benefits manager that negotiates drug prices for 7.5 million Californians.\u003c/p>\n\u003cp id=\"0f47\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“The price of drugs is just continuing to go up,” said Miller, explaining that the trend is due to both new high-cost drugs coming on the market, and mark-ups of old drugs.\u003c/p>\n\u003cp class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">There’s been an explosion of drugs costing $100,000 a year over the last decade, for things like cystic fibrosis and cancer, Miller said. And there was a 127 percent price increase of branded drugs that had been on the market between 2008 and 2014, he says.\u003c/p>\n\u003cp id=\"0c65\" class=\"graf--p graf-after--p\">Limiting the cost of pharmaceuticals is the basis of a California ballot initiative scheduled to go before voters this November that would limit the amount the state pays for a drug to no more than the lowest price paid for the same drug by the U.S. Department of Veterans Affairs.\u003c/p>\n\u003cp id=\"9370\" class=\"graf--p graf-after--p\">We’ll be exploring how a specialty drug’s cost affects patient access. If you are a chronic disease patient who is having difficulty getting specialty drugs, we’d like to hear from you. \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"mailto:Pauline@Calmatters.org\">email\u003c/a> us.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp id=\"f877\" class=\"graf--p graf-after--p graf--last\">\u003cem class=\"markup--em markup--p-em\">CALmatters is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">California Data\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">Fellowship,\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> a program of the \u003c/em>\u003cem class=\"markup--em markup--p-em\">\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/\" rel=\"nofollow\">Center for Health Journalism\u003c/a> \u003c/em>\u003cem class=\"markup--em markup--p-em\">at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n",
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"excerpt": "For starters, CalPERS says specialty drugs made up less than 1 percent of prescriptions for its members but 30 percent of total drugs costs in 2014.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp id=\"3531\" class=\"graf--p graf-after--figure\">What’s behind the jaw-dropping cost of new “specialty drugs” like Orkambi, which has a sticker price of $259,000 per year for cystic fibrosis patients?\u003c/p>\n\u003cp id=\"4e0b\" class=\"graf--p graf-after--p\">Orkambi, which was approved by the U.S. Food and Drug Administration last July, is expected to take almost $36 million from the state’s general fund this fiscal year and next. Seventy-four Californians with health coverage under the Department of Health Care Services are estimated to receive the drug this year, and next year, 220 people will benefit, some of whom may be the same patients as this year. That does not include any discounts the state may receive from drug manufacturers.\u003c/p>\n\u003cp id=\"5b0e\" class=\"graf--p graf-after--p\">Orkambi is listed as a “specialty tier” drug in some private health plans. That category is reserved for high-cost drugs, or, in the \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/SpecialtyTierMethodology.pdf\" rel=\"nofollow\">federal government’s\u003c/a>view, for drugs that cost more than $600 a month and are used by a small proportion of patients.\u003c/p>\n\u003cp id=\"3924\" class=\"graf--p graf-after--p\">Specialty drugs are already proving to be a financial burden on one California agency, the California Public Employees’ Retirement System, which purchases health benefits for active and retired state workers. The state public pension system says that specialty drugs made up less than 1 percent of all prescriptions for its members but 30 percent of the total drugs costs in 2014.\u003c/p>\n\u003cp class=\"graf--p graf-after--p\">The health benefits from specialty drugs justify the cost, according to the pharmaceutical industry.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp id=\"ee28\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Patients are gaining access to medicines that are better treating their diseases or frankly even curing them,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA). “Patients are now healthier. They’re more productive. They’re functioning.”\u003c/p>\n\u003cp id=\"e169\" class=\"graf--p graf-after--p\">VanderVeer said companies price drugs not just on the cost of production, but on the value the industry believes the drug brings to the health care system, such as:\u003c/p>\n\u003cul class=\"postList\">\n\u003cli id=\"7b31\" class=\"graf--li graf-after--p\">Efficacy of the treatment\u003c/li>\n\u003cli id=\"b80b\" class=\"graf--li graf-after--li\">How it increases the quality or length of life\u003c/li>\n\u003cli id=\"5c88\" class=\"graf--li graf-after--li\">The “unmet need” in the drug market\u003c/li>\n\u003c/ul>\n\u003cp id=\"cc5b\" class=\"graf--p graf-after--li\">The price of the drug also accounts for the cost of developing other drugs and the high risk that a particular drug won’t make it to market, VanderVeer said. Only 12 percent of drugs that go through clinical trials get approved, according to PhRMA.\u003c/p>\n\u003cp id=\"ef58\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Because of that high rate of failures there would be no innovative incentive for companies to continue to try to invest” if they could not recoup costs and make a profit, VanderVeer said.\u003c/p>\n\u003cp id=\"93ab\" class=\"graf--p graf-after--p\">Finally, she added, the sticker price doesn’t reflect the final price paid for the drug, which can be heavily discounted through negotiations or because of mandated rebates for Medicaid programs.\u003c/p>\n\u003cp id=\"b00f\" class=\"graf--p graf-after--p\">\u003c/p>\u003cp>\u003c/p>\u003cp>Drugmakers are following the money, said Joel Hay, professor of pharmaceutical economics and policy at USC. Companies invest in specialty drugs that target a small population because their high price tags can be spread over a large insurance pool, he said.\u003c/p>\n\u003cp id=\"02e0\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">Even though specialty drugs are \"ridiculously expensive per treatment episode,\" Hay said, the cost for each member in a health plan is \"just a few cents.” Raising 10 cents on a diabetes drug, for example, would have a bigger budget impact, he said, because more people have diabetes than cystic fibrosis.\u003c/p>\n\u003cp id=\"14f9\" class=\"graf--p graf-after--p\">Hay says manufacturers are now less inclined to invest in drugs that treat millions of people, because there is more pushback on price.\u003c/p>\n\u003cp id=\"de1b\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“Drug companies are for-profit companies obligated to make money for their stockholders,” Hay said. “They’re not virtuous charitable organizations.”\u003c/p>\n\u003cp id=\"708f\" class=\"graf--p graf-after--p\">Drugmakers are also investing more in treating uncommon illnesses because there is less competition and therefore more opportunity for profit, said Dr. Helene Lipton, professor of health policy at the School of Pharmacy and Institute for Health Policy Studies at UC San Francisco.\u003c/p>\n\u003cp id=\"f652\" class=\"graf--p graf-after--p\">The high price of the drugs affects patients, she noted, because health plans put controls on the drugs so that they’re used as a last resort.\u003c/p>\n\u003cp id=\"ed3c\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“That may mean going through two or more rounds of care with other medications before being able to use the specialty drug,” Lipton said.\u003c/p>\n\u003cp id=\"063c\" class=\"graf--p graf-after--p\">It’s not just specialty drugs that are straining health plans’ budgets, said Steve Miller, chief medical officer at Express Scripts, a pharmaceutical benefits manager that negotiates drug prices for 7.5 million Californians.\u003c/p>\n\u003cp id=\"0f47\" class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">“The price of drugs is just continuing to go up,” said Miller, explaining that the trend is due to both new high-cost drugs coming on the market, and mark-ups of old drugs.\u003c/p>\n\u003cp class=\"graf--p graf--startsWithDoubleQuote graf-after--p\">There’s been an explosion of drugs costing $100,000 a year over the last decade, for things like cystic fibrosis and cancer, Miller said. And there was a 127 percent price increase of branded drugs that had been on the market between 2008 and 2014, he says.\u003c/p>\n\u003cp id=\"0c65\" class=\"graf--p graf-after--p\">Limiting the cost of pharmaceuticals is the basis of a California ballot initiative scheduled to go before voters this November that would limit the amount the state pays for a drug to no more than the lowest price paid for the same drug by the U.S. Department of Veterans Affairs.\u003c/p>\n\u003cp id=\"9370\" class=\"graf--p graf-after--p\">We’ll be exploring how a specialty drug’s cost affects patient access. If you are a chronic disease patient who is having difficulty getting specialty drugs, we’d like to hear from you. \u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"mailto:Pauline@Calmatters.org\">email\u003c/a> us.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp id=\"f877\" class=\"graf--p graf-after--p graf--last\">\u003cem class=\"markup--em markup--p-em\">CALmatters is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">California Data\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> \u003c/em>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" rel=\"nofollow\">\u003cem class=\"markup--em markup--p-em\">Fellowship,\u003c/em>\u003c/a>\u003cem class=\"markup--em markup--p-em\"> a program of the \u003c/em>\u003cem class=\"markup--em markup--p-em\">\u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.centerforhealthjournalism.org/\" rel=\"nofollow\">Center for Health Journalism\u003c/a> \u003c/em>\u003cem class=\"markup--em markup--p-em\">at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Covered California Chief Rips UnitedHealth for Blaming Woes on Obamacare",
"title": "Covered California Chief Rips UnitedHealth for Blaming Woes on Obamacare",
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"content": "\u003cp>Amid growing questions over the future of insurance exchanges, the head of California’s marketplace said the nation’s largest health insurer should take responsibility for nearly $1 billion in losses and stop blaming the federal health law.\u003c/p>\n\u003cp>In a blistering critique, Covered California’s executive director, Peter Lee, said UnitedHealth Group Inc. made a series of blunders on rates and networks that led to a $475 million loss last year on individual policies across the country. The company estimates a similar exchange-related loss of $500 million for this year.\u003c/p>\n\u003cp>“Instead of saying we screwed up, they said Obamacare is the problem and we may not play any more,” Lee said in an interview with California Healthline. “It was giving an excuse to Wall Street and throwing the Affordable Care Act under the bus.”\u003c/p>\n\u003cp>Lee, a staunch defender of the health law and a former official in the Obama administration, has tangled with UnitedHealth in the past. He knocked the company for sitting out the launch of Obamacare in 2014, then welcomed UnitedHealth into Covered California for 2016.\u003c/p>\n\u003cp>But now, he said, the company is “driving me bonkers” because it has “fed this political frenzy that Obamacare doesn’t work. It’s total spin and unanchored in reality.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A company spokesman declined to comment on Lee’s criticism, and referred to UnitedHealth’s previous statements on the exchange business.\u003c/p>\n\u003cp>During a Nov. 19 conference call with analysts, UnitedHealth’s CEO Stephen Hemsley said: “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself… I think that basically is an industry-wide proposition.”\u003c/p>\n\u003cp>An Urban Institute report issued last week, however, found that some of UnitedHealth’s troubles may have been self-inflicted. The company’s premiums were substantially higher than its competitors in many of the largest U.S. markets. The insurer also offered broader provider networks that tend to attract sicker customers who incur big medical bills.\u003c/p>\n\u003cp>In November, UnitedHealth surprised analysts and health-policy experts with its steep losses and said it might leave the exchanges altogether, just after expanding into new states. The sudden reversal prompted questions about the sustainability of the government-run marketplaces, the linchpin of President Obama’s signature law.\u003c/p>\n\u003cp>UnitedHealth reiterated its dour outlook for the exchange market when it announced quarterly results Jan. 19. The company said it has seen an influx of sicker patients during special enrollment, fewer healthy people signing up and costs rising as a result.\u003c/p>\n\u003cp>UnitedHealth ended last year with about 500,000 customers in the public exchanges, and it expects membership to grow to about 800,000 during the recent open enrollment. It has said it will decide by mid-year whether to continue selling in Obamacare marketplaces.\u003c/p>\n\u003cp>Other major insurers have expressed similar concerns about doing business in the public exchanges, albeit with less red ink than UnitedHealth.\u003c/p>\n\u003cp>Anthem Inc., the nation’s second-largest health insurer, said last week that its exchange enrollment in California and 13 other states was running about 30 percent below expectations, but the business was still slightly profitable. Anthem ended last year with 791,000 exchange members.\u003c/p>\n\u003cp>Monday, insurance giant Aetna Inc. said it lost up to $140 million, or a negative margin of 3 to 4 percent, on individual coverage last year. It has 1 million members with individual policies, about 75 percent of them on public exchanges. It said it expects to break even this year, however.\u003c/p>\n\u003cp>“Our individual commercial business ended the year with improved results,” Aetna’s chief executive, Mark Bertolini, said Monday during an earnings conference call. “Despite our improved finish, this business remained unprofitable in 2015 and we continue to have serious concerns about the sustainability of the public exchanges.”\u003c/p>\n\u003cp>Ana Gupte, a healthcare analyst at Leerink Partners, said UnitedHealth and other insurers have valid complaints about the exchange market. But she acknowledged that UnitedHealth’s decision to sit out the exchanges during the first year in 2014 may have hurt the company, too.\u003c/p>\n\u003cp>“United was newer to the marketplaces than other companies, and the other guys incorporated lessons learned,” she said. “But there are broader issues. There are some changes needed from a policy perspective so all of these players can remain in the market for 2017.”\u003c/p>\n\u003cp>Gupte cited the need for federal officials to tighten the rules for special enrollment and revisit a risk adjustment program that compensates insurers for taking on costlier patients.\u003c/p>\n\u003cp>In response to industry criticism, the Obama administration is taking steps to prevent the misuse of special enrollment so people can’t wait to sign up until they need care. Special enrollment is designed for people who lose coverage or need to make a change because of an event in their life, such as moving, getting married or having a child.\u003c/p>\n\u003cp>Insurance markets can’t function properly without enough healthy customers paying premiums, which are used to cover expenses incurred by sicker policyholders. The three-month open enrollment period for the federal and state exchanges just ended Jan. 31. California extended its deadline to Feb. 6 for people who already had begun the sign-up process by Sunday.\u003c/p>\n\u003cp>John Holahan, a health-policy researcher at the Urban Institute, said the Obama administration does need to impose stricter rules for special enrollment. He also said concerns over affordability have hampered enrollment since some middle-class consumers and young, healthy people are put off by high premiums and large deductibles.\u003c/p>\n\u003cp>“But I haven’t seen anything that shows the exchanges are really in trouble,” Holahan said. “That doesn’t mean every insurer is going to make it. Some companies don’t make it, and that isn’t a sign markets are unsustainable.”\u003c/p>\n\u003cp>The U.S. Department of Health and Human Services expects about 10 million people to be enrolled in federal and state exchanges at the end of 2016. That’s far below previous government forecasts.\u003c/p>\n\u003cp>UnitedHealth sat out Covered California for the first two years before joining in several rural areas. Lee said both sides will be analyzing whether the company returns for 2017. As an active purchaser, Covered California can decide whether or not to contract with certain health plans and allow them on the state exchange.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“United will be looking at what their prospects are in California,” Lee said. “We will be looking at United as a plan to see if they offer good value for Californians. It’s to be determined on both ends.”\u003c/p>\n\n",
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"excerpt": "Covered California’s executive director, Peter Lee, said UnitedHealth made its own series of blunders that led to a $475 million loss last year.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Amid growing questions over the future of insurance exchanges, the head of California’s marketplace said the nation’s largest health insurer should take responsibility for nearly $1 billion in losses and stop blaming the federal health law.\u003c/p>\n\u003cp>In a blistering critique, Covered California’s executive director, Peter Lee, said UnitedHealth Group Inc. made a series of blunders on rates and networks that led to a $475 million loss last year on individual policies across the country. The company estimates a similar exchange-related loss of $500 million for this year.\u003c/p>\n\u003cp>“Instead of saying we screwed up, they said Obamacare is the problem and we may not play any more,” Lee said in an interview with California Healthline. “It was giving an excuse to Wall Street and throwing the Affordable Care Act under the bus.”\u003c/p>\n\u003cp>Lee, a staunch defender of the health law and a former official in the Obama administration, has tangled with UnitedHealth in the past. He knocked the company for sitting out the launch of Obamacare in 2014, then welcomed UnitedHealth into Covered California for 2016.\u003c/p>\n\u003cp>But now, he said, the company is “driving me bonkers” because it has “fed this political frenzy that Obamacare doesn’t work. It’s total spin and unanchored in reality.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A company spokesman declined to comment on Lee’s criticism, and referred to UnitedHealth’s previous statements on the exchange business.\u003c/p>\n\u003cp>During a Nov. 19 conference call with analysts, UnitedHealth’s CEO Stephen Hemsley said: “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself… I think that basically is an industry-wide proposition.”\u003c/p>\n\u003cp>An Urban Institute report issued last week, however, found that some of UnitedHealth’s troubles may have been self-inflicted. The company’s premiums were substantially higher than its competitors in many of the largest U.S. markets. The insurer also offered broader provider networks that tend to attract sicker customers who incur big medical bills.\u003c/p>\n\u003cp>In November, UnitedHealth surprised analysts and health-policy experts with its steep losses and said it might leave the exchanges altogether, just after expanding into new states. The sudden reversal prompted questions about the sustainability of the government-run marketplaces, the linchpin of President Obama’s signature law.\u003c/p>\n\u003cp>UnitedHealth reiterated its dour outlook for the exchange market when it announced quarterly results Jan. 19. The company said it has seen an influx of sicker patients during special enrollment, fewer healthy people signing up and costs rising as a result.\u003c/p>\n\u003cp>UnitedHealth ended last year with about 500,000 customers in the public exchanges, and it expects membership to grow to about 800,000 during the recent open enrollment. It has said it will decide by mid-year whether to continue selling in Obamacare marketplaces.\u003c/p>\n\u003cp>Other major insurers have expressed similar concerns about doing business in the public exchanges, albeit with less red ink than UnitedHealth.\u003c/p>\n\u003cp>Anthem Inc., the nation’s second-largest health insurer, said last week that its exchange enrollment in California and 13 other states was running about 30 percent below expectations, but the business was still slightly profitable. Anthem ended last year with 791,000 exchange members.\u003c/p>\n\u003cp>Monday, insurance giant Aetna Inc. said it lost up to $140 million, or a negative margin of 3 to 4 percent, on individual coverage last year. It has 1 million members with individual policies, about 75 percent of them on public exchanges. It said it expects to break even this year, however.\u003c/p>\n\u003cp>“Our individual commercial business ended the year with improved results,” Aetna’s chief executive, Mark Bertolini, said Monday during an earnings conference call. “Despite our improved finish, this business remained unprofitable in 2015 and we continue to have serious concerns about the sustainability of the public exchanges.”\u003c/p>\n\u003cp>Ana Gupte, a healthcare analyst at Leerink Partners, said UnitedHealth and other insurers have valid complaints about the exchange market. But she acknowledged that UnitedHealth’s decision to sit out the exchanges during the first year in 2014 may have hurt the company, too.\u003c/p>\n\u003cp>“United was newer to the marketplaces than other companies, and the other guys incorporated lessons learned,” she said. “But there are broader issues. There are some changes needed from a policy perspective so all of these players can remain in the market for 2017.”\u003c/p>\n\u003cp>Gupte cited the need for federal officials to tighten the rules for special enrollment and revisit a risk adjustment program that compensates insurers for taking on costlier patients.\u003c/p>\n\u003cp>In response to industry criticism, the Obama administration is taking steps to prevent the misuse of special enrollment so people can’t wait to sign up until they need care. Special enrollment is designed for people who lose coverage or need to make a change because of an event in their life, such as moving, getting married or having a child.\u003c/p>\n\u003cp>Insurance markets can’t function properly without enough healthy customers paying premiums, which are used to cover expenses incurred by sicker policyholders. The three-month open enrollment period for the federal and state exchanges just ended Jan. 31. California extended its deadline to Feb. 6 for people who already had begun the sign-up process by Sunday.\u003c/p>\n\u003cp>John Holahan, a health-policy researcher at the Urban Institute, said the Obama administration does need to impose stricter rules for special enrollment. He also said concerns over affordability have hampered enrollment since some middle-class consumers and young, healthy people are put off by high premiums and large deductibles.\u003c/p>\n\u003cp>“But I haven’t seen anything that shows the exchanges are really in trouble,” Holahan said. “That doesn’t mean every insurer is going to make it. Some companies don’t make it, and that isn’t a sign markets are unsustainable.”\u003c/p>\n\u003cp>The U.S. Department of Health and Human Services expects about 10 million people to be enrolled in federal and state exchanges at the end of 2016. That’s far below previous government forecasts.\u003c/p>\n\u003cp>UnitedHealth sat out Covered California for the first two years before joining in several rural areas. Lee said both sides will be analyzing whether the company returns for 2017. As an active purchaser, Covered California can decide whether or not to contract with certain health plans and allow them on the state exchange.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“United will be looking at what their prospects are in California,” Lee said. “We will be looking at United as a plan to see if they offer good value for Californians. It’s to be determined on both ends.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The call to a Glendora emergency dispatcher one night last October had the grim details that, officials say, have become all too familiar: a woman had found her brother unconscious on his bathroom floor. She feared he’d overdosed on drugs.\u003c/p>\n\u003cp>When Glendora Police Corporal Bill Lee and his partner, Jon Drake, responded to the call, they found a scrap of aluminum foil beside the man, holding a little bead of heroin. They noted the man’s sluggish heartbeat, faltering respiration and pinpoint pupils associated with opiate poisoning.\u003c/p>\n\u003cp>But unlike similar experiences in the past, this time Lee and Drake had a tool authorities credit with saving the man’s life: they administered a nasal spray containing the potent opioid blocker naloxone.\u003c/p>\n\u003cp>In less than 90 seconds, the man’s breathing returned to normal. He was taken to the hospital, and when Drake checked on him shortly afterwards, he was conscious, Lee said.\u003c/p>\n\u003cp>Like other communities across California, Lee’s small town in the foothills of the San Gabriel Mountains east of Los Angeles has seen a surge in heroin abuse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When there’s an overdose call, it's often a police officer -- like Lee -- who is the first to arrive on the scene.\u003c/p>\n\u003cp>In the past, he said, he would do whatever he could. “Then you wait for fire to get there, and unfortunately, sometimes things don’t work out,” he said. Now he's hoping the naloxone spray \"will provide us with a means of changing that pattern.”\u003c/p>\n\u003cp>Some advocates call it the \"overdose antidote.\"\u003c/p>\n\u003cp>Last year, \u003ca href=\"http://sd27.senate.ca.gov/news/2014-09-19-california-governor-signs-bill-prevent-drug-overdose-fatalities\" target=\"_blank\">California lawmakers authorized\u003c/a> police officers to carry naloxone, also commonly known by a brand name, Narcan. Now, a handful of law enforcement agencies are issuing the emergency medication to officers.\u003c/p>\n\u003cp>Glendora’s tiny police department – which also was a pioneer two decades ago in equipping officers with defibrillators to help heart attack victims – issues naloxone to its emergency medical technicians.\u003c/p>\n\u003cp>The San Diego County Sheriff’s Department recently moved beyond a test program to equip all deputies. San Francisco also has a \u003ca href=\"http://www.sf-police.org/index.aspx?page=3763&recordid=1129\" target=\"_blank\">pilot project underway.\u003c/a> The Orange County Sheriff’s Department expects to expand its initial program to include all deputies in the first quarter of this year, said Lt. Jeff Hallock, a department spokesman.\u003c/p>\n\u003cp>San Diego sheriff’s Capt. James Bovet, who oversaw his department’s pilot program, said the naloxone spray clearly met a need. From 2000 to 2014, the county saw the death rate from opioid overdose increase by 50 percent, “and the trend was just increasing upward,” he said.\u003c/p>\n\u003cp>During the pilot program to test whether naloxone could help, sheriff’s deputies frequently arrived at the scene of an overdose before paramedics, Bovet said. He said the San Diego Sheriff’s Department has successfully revived 28 people with naloxone since the pilot program began. Orange County Sheriff’s and Glendora officers have each recorded one save as well.\u003c/p>\n\u003cfigure id=\"attachment_143815\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-143815\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-400x288.jpg\" alt=\"Some California law enforcement agencies are equipping their patrol officers with nasal inhalers that dispense naloxone, a potent antidote to opiate drug overdoses.\" width=\"400\" height=\"288\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-400x288.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-800x576.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-768x553.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-1440x1037.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-1180x850.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-960x692.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1.jpg 1502w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Some California law enforcement agencies are equipping their patrol officers with nasal inhalers that dispense naloxone, a potent antidote to opiate drug overdoses. \u003ccite>(Courtesy Orange County Sheriff’s Department)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Opioids depress brain functions that regulate breathing, and during an overdose, respiration slows, then stops. Naloxone kicks the opioids off those crucial brain receptors so an overdose victim can breathe again. While naloxone is non-addictive and generally considered safe, it pushes addicts into immediate withdrawal, sometimes triggering side effects such as a rapid increase in in blood pressure or seizures.\u003c/p>\n\u003cp>At the \u003ca href=\"http://www.nchrc.org\" target=\"_blank\">North Carolina Harm Reduction Coalition\u003c/a> –- a leading advocate of broadening naloxone availability –- advocacy and communications coordinator Tessie Castillo calls such adverse reactions “extremely rare.”\u003c/p>\n\u003cp>Still, some law enforcement agencies have balked at the $52-per-dose cost of the remedy, Castillo said.\u003c/p>\n\u003cp>“Sometimes there’s a reluctance to institute yet one more program and have officers train on yet one more thing,” she said. “They’ll argue that the ambulance crews already get there soon enough.”\u003c/p>\n\u003cp>Meanwhile, California has broadened access to the antidote further with a \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1535\" target=\"_blank\">new law permitting pharmacies to sell naloxone \u003c/a>without a prescription.\u003c/p>\n\u003cp>“The evidence shows very clearly that the most effective way to make sure that naloxone is at the scene of an overdose is to get it into the hands of people who use drugs and their friends and family members,” said Laura Thomas, California deputy director of the Drug Policy Alliance.\u003c/p>\n\u003cp>Bertha Madras, who served as deputy director of the White House Office on National Drug Control Policy in the George W. Bush administration, said she’s gained confidence in naloxone’s usefulness since it first came to her attention.\u003c/p>\n\u003cp>Madras said that while serving as a deputy drug czar, she questioned whether widespread access to the antidote might lead addicts to “a sense of confidence that they could push the envelope with higher doses.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>She said she now strongly supports public safety personnel having ready access to naloxone. But the uninformed may be misled by the antidote’s seeming ability to provide a miracle cure, she said. The body stores some opiates in fat for long periods, and an overdose could recur after the naloxone wears off, Madras said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The call to a Glendora emergency dispatcher one night last October had the grim details that, officials say, have become all too familiar: a woman had found her brother unconscious on his bathroom floor. She feared he’d overdosed on drugs.\u003c/p>\n\u003cp>When Glendora Police Corporal Bill Lee and his partner, Jon Drake, responded to the call, they found a scrap of aluminum foil beside the man, holding a little bead of heroin. They noted the man’s sluggish heartbeat, faltering respiration and pinpoint pupils associated with opiate poisoning.\u003c/p>\n\u003cp>But unlike similar experiences in the past, this time Lee and Drake had a tool authorities credit with saving the man’s life: they administered a nasal spray containing the potent opioid blocker naloxone.\u003c/p>\n\u003cp>In less than 90 seconds, the man’s breathing returned to normal. He was taken to the hospital, and when Drake checked on him shortly afterwards, he was conscious, Lee said.\u003c/p>\n\u003cp>Like other communities across California, Lee’s small town in the foothills of the San Gabriel Mountains east of Los Angeles has seen a surge in heroin abuse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When there’s an overdose call, it's often a police officer -- like Lee -- who is the first to arrive on the scene.\u003c/p>\n\u003cp>In the past, he said, he would do whatever he could. “Then you wait for fire to get there, and unfortunately, sometimes things don’t work out,” he said. Now he's hoping the naloxone spray \"will provide us with a means of changing that pattern.”\u003c/p>\n\u003cp>Some advocates call it the \"overdose antidote.\"\u003c/p>\n\u003cp>Last year, \u003ca href=\"http://sd27.senate.ca.gov/news/2014-09-19-california-governor-signs-bill-prevent-drug-overdose-fatalities\" target=\"_blank\">California lawmakers authorized\u003c/a> police officers to carry naloxone, also commonly known by a brand name, Narcan. Now, a handful of law enforcement agencies are issuing the emergency medication to officers.\u003c/p>\n\u003cp>Glendora’s tiny police department – which also was a pioneer two decades ago in equipping officers with defibrillators to help heart attack victims – issues naloxone to its emergency medical technicians.\u003c/p>\n\u003cp>The San Diego County Sheriff’s Department recently moved beyond a test program to equip all deputies. San Francisco also has a \u003ca href=\"http://www.sf-police.org/index.aspx?page=3763&recordid=1129\" target=\"_blank\">pilot project underway.\u003c/a> The Orange County Sheriff’s Department expects to expand its initial program to include all deputies in the first quarter of this year, said Lt. Jeff Hallock, a department spokesman.\u003c/p>\n\u003cp>San Diego sheriff’s Capt. James Bovet, who oversaw his department’s pilot program, said the naloxone spray clearly met a need. From 2000 to 2014, the county saw the death rate from opioid overdose increase by 50 percent, “and the trend was just increasing upward,” he said.\u003c/p>\n\u003cp>During the pilot program to test whether naloxone could help, sheriff’s deputies frequently arrived at the scene of an overdose before paramedics, Bovet said. He said the San Diego Sheriff’s Department has successfully revived 28 people with naloxone since the pilot program began. Orange County Sheriff’s and Glendora officers have each recorded one save as well.\u003c/p>\n\u003cfigure id=\"attachment_143815\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-143815\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-400x288.jpg\" alt=\"Some California law enforcement agencies are equipping their patrol officers with nasal inhalers that dispense naloxone, a potent antidote to opiate drug overdoses.\" width=\"400\" height=\"288\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-400x288.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-800x576.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-768x553.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-1440x1037.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-1180x850.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1-960x692.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/NaloxoneAndLawEnforcement_1.jpg 1502w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Some California law enforcement agencies are equipping their patrol officers with nasal inhalers that dispense naloxone, a potent antidote to opiate drug overdoses. \u003ccite>(Courtesy Orange County Sheriff’s Department)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Opioids depress brain functions that regulate breathing, and during an overdose, respiration slows, then stops. Naloxone kicks the opioids off those crucial brain receptors so an overdose victim can breathe again. While naloxone is non-addictive and generally considered safe, it pushes addicts into immediate withdrawal, sometimes triggering side effects such as a rapid increase in in blood pressure or seizures.\u003c/p>\n\u003cp>At the \u003ca href=\"http://www.nchrc.org\" target=\"_blank\">North Carolina Harm Reduction Coalition\u003c/a> –- a leading advocate of broadening naloxone availability –- advocacy and communications coordinator Tessie Castillo calls such adverse reactions “extremely rare.”\u003c/p>\n\u003cp>Still, some law enforcement agencies have balked at the $52-per-dose cost of the remedy, Castillo said.\u003c/p>\n\u003cp>“Sometimes there’s a reluctance to institute yet one more program and have officers train on yet one more thing,” she said. “They’ll argue that the ambulance crews already get there soon enough.”\u003c/p>\n\u003cp>Meanwhile, California has broadened access to the antidote further with a \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1535\" target=\"_blank\">new law permitting pharmacies to sell naloxone \u003c/a>without a prescription.\u003c/p>\n\u003cp>“The evidence shows very clearly that the most effective way to make sure that naloxone is at the scene of an overdose is to get it into the hands of people who use drugs and their friends and family members,” said Laura Thomas, California deputy director of the Drug Policy Alliance.\u003c/p>\n\u003cp>Bertha Madras, who served as deputy director of the White House Office on National Drug Control Policy in the George W. Bush administration, said she’s gained confidence in naloxone’s usefulness since it first came to her attention.\u003c/p>\n\u003cp>Madras said that while serving as a deputy drug czar, she questioned whether widespread access to the antidote might lead addicts to “a sense of confidence that they could push the envelope with higher doses.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>She said she now strongly supports public safety personnel having ready access to naloxone. But the uninformed may be misled by the antidote’s seeming ability to provide a miracle cure, she said. The body stores some opiates in fat for long periods, and an overdose could recur after the naloxone wears off, Madras said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"soldout": {
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