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"disqusTitle": "Legislation Targets Childhood Trauma with School, Mental Health Support",
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"content": "\u003cp>As a college student, Rob Bonta had a summer job working as a counselor for troubled kids.\u003c/p>\n\u003cp>Now, two decades later, he is bringing legislation to address some of the needs he saw then.\u003c/p>\n\u003cp>\"I worked with some of these kids as a counselor out of college, and I'd walk them home and hear some of these stories,\" said Assemblyman Bonta, D-Oakland. \"Shootings they heard. Or shootings they witnessed the night before.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'We see childhood trauma as a public health crisis that is critical for the state to address.'\u003ccite>Ben Rubin, Children Now \u003c/cite>\u003c/aside>\n\u003cp>It was the summer of his junior year at Yale, when he worked in the Leadership Education and Athletics Partnership program in Connecticut. That took him to a side of New Haven many people don't see -- the economically depressed inner city. He said kids there endured trauma, sometimes on a daily basis.\u003c/p>\n\u003cp>Those traumatic events add up in children's lives, Bonta said, and \u003ca href=\"https://app.box.com/s/dw2tev06fny3tczomb68/1/2622361035/22579574285/1\" target=\"_blank\">have been shown\u003c/a> to result in higher risk of chronic health conditions and risky health behaviors later in life.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The medical community uses a scale of ACE indicators -- for adverse childhood experiences -- to measure that higher-risk category. People with four or more childhood traumas, such as physical abuse or having a family member with a drinking problem, have a much higher prevalence later in life for a host of health issues -- chronic obstructive pulmonary disease, asthma, kidney disease, stroke, depression, dementia and other maladies.\u003c/p>\n\u003cp>\"We see childhood trauma and ACEs as a public health crisis that is critical for the state to address,\" said Ben Rubin with Children Now, an advocacy group based in Oakland.\u003c/p>\n\u003cp>\"More and more ACE indicators have been gaining traction,\" Rubin said, not just in the medical community but in criminal justice and legislative circles as well. \"We think [addressing] this has been a big deficit in the state. This bill is a good step toward providing services.\"\u003c/p>\n\u003cp>\u003cstrong>Childhood Trauma Bill\u003c/strong>\u003c/p>\n\u003cp>Bonta's legislation, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1644\" target=\"_blank\">AB1644\u003c/a>, would establish a four-year pilot program to help some schools and communities provide mental health services, with the state chipping in funds, training and technical assistance. It also would commit state money for the Early Mental Health Initiative, which was cut by the governor in 2012.\u003c/p>\n\u003cp>The benefits for the state are many, he said:\u003c/p>\n\u003cul>\n\u003cli>School classrooms would be more effective if teachers are better able to screen and help children who exhibit symptoms of adverse childhood experiences.\u003c/li>\n\u003cli>Dealing with children's trauma now could mean big savings in health care spending in the future, as ACE indicators are one of the telling signs of those who are the heaviest users of the health care system.\u003c/li>\n\u003cli>The ability of children to become adults who contribute to society goes down among those with a number of ACE indicators, so there are strong economic and workforce reasons to address those problems earlier.\u003c/li>\n\u003c/ul>\n\u003cp>\"It's true, it's our moral imperative to do something about it, to protect our children,\" Bonta said. \"But there's also a financial imperative, because early prevention saves dollars down the road.\"\u003c/p>\n\u003cp>The pilot program would target younger students, up to third grade. It would provide teachers with a better screening tool to identify withdrawal problems, anxiety or bullying, among other behaviors, Rubin said.\u003c/p>\n\u003cp>\"Schools across the state are doing it to some degree, but not with any kind of state support,\" Rubin said. \"We need to invest in providing those services, so we wanted to fund a modest but important state role.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"hZQ2WEmKe7JNBp4VwKA0k77KegZzOncz\"]Through the pilot program, the state's Department of Public Health could help provide regional training and outreach to schools that provide those types of services, and also expand the number of school sites providing services.\u003c/p>\n\u003cp>\"Every year more and more folks become more aware of what this is,\" Bonta said. \"More and more people are seeing the adverse impact of this and the multiplier effect of it. There are just so many social and health consequences of childhood trauma. It's something we have to address.\"\u003c/p>\n\u003cp>What Bonta saw 20 years ago on the streets echoes the pervasive and persistent quandary now, he said. \"This is not a new problem,\" Bonta said, \"but we want to come at it with new focus and new momentum.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill is expected to be heard in committee in April.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As a college student, Rob Bonta had a summer job working as a counselor for troubled kids.\u003c/p>\n\u003cp>Now, two decades later, he is bringing legislation to address some of the needs he saw then.\u003c/p>\n\u003cp>\"I worked with some of these kids as a counselor out of college, and I'd walk them home and hear some of these stories,\" said Assemblyman Bonta, D-Oakland. \"Shootings they heard. Or shootings they witnessed the night before.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'We see childhood trauma as a public health crisis that is critical for the state to address.'\u003ccite>Ben Rubin, Children Now \u003c/cite>\u003c/aside>\n\u003cp>It was the summer of his junior year at Yale, when he worked in the Leadership Education and Athletics Partnership program in Connecticut. That took him to a side of New Haven many people don't see -- the economically depressed inner city. He said kids there endured trauma, sometimes on a daily basis.\u003c/p>\n\u003cp>Those traumatic events add up in children's lives, Bonta said, and \u003ca href=\"https://app.box.com/s/dw2tev06fny3tczomb68/1/2622361035/22579574285/1\" target=\"_blank\">have been shown\u003c/a> to result in higher risk of chronic health conditions and risky health behaviors later in life.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The medical community uses a scale of ACE indicators -- for adverse childhood experiences -- to measure that higher-risk category. People with four or more childhood traumas, such as physical abuse or having a family member with a drinking problem, have a much higher prevalence later in life for a host of health issues -- chronic obstructive pulmonary disease, asthma, kidney disease, stroke, depression, dementia and other maladies.\u003c/p>\n\u003cp>\"We see childhood trauma and ACEs as a public health crisis that is critical for the state to address,\" said Ben Rubin with Children Now, an advocacy group based in Oakland.\u003c/p>\n\u003cp>\"More and more ACE indicators have been gaining traction,\" Rubin said, not just in the medical community but in criminal justice and legislative circles as well. \"We think [addressing] this has been a big deficit in the state. This bill is a good step toward providing services.\"\u003c/p>\n\u003cp>\u003cstrong>Childhood Trauma Bill\u003c/strong>\u003c/p>\n\u003cp>Bonta's legislation, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1644\" target=\"_blank\">AB1644\u003c/a>, would establish a four-year pilot program to help some schools and communities provide mental health services, with the state chipping in funds, training and technical assistance. It also would commit state money for the Early Mental Health Initiative, which was cut by the governor in 2012.\u003c/p>\n\u003cp>The benefits for the state are many, he said:\u003c/p>\n\u003cul>\n\u003cli>School classrooms would be more effective if teachers are better able to screen and help children who exhibit symptoms of adverse childhood experiences.\u003c/li>\n\u003cli>Dealing with children's trauma now could mean big savings in health care spending in the future, as ACE indicators are one of the telling signs of those who are the heaviest users of the health care system.\u003c/li>\n\u003cli>The ability of children to become adults who contribute to society goes down among those with a number of ACE indicators, so there are strong economic and workforce reasons to address those problems earlier.\u003c/li>\n\u003c/ul>\n\u003cp>\"It's true, it's our moral imperative to do something about it, to protect our children,\" Bonta said. \"But there's also a financial imperative, because early prevention saves dollars down the road.\"\u003c/p>\n\u003cp>The pilot program would target younger students, up to third grade. It would provide teachers with a better screening tool to identify withdrawal problems, anxiety or bullying, among other behaviors, Rubin said.\u003c/p>\n\u003cp>\"Schools across the state are doing it to some degree, but not with any kind of state support,\" Rubin said. \"We need to invest in providing those services, so we wanted to fund a modest but important state role.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Through the pilot program, the state's Department of Public Health could help provide regional training and outreach to schools that provide those types of services, and also expand the number of school sites providing services.\u003c/p>\n\u003cp>\"Every year more and more folks become more aware of what this is,\" Bonta said. \"More and more people are seeing the adverse impact of this and the multiplier effect of it. There are just so many social and health consequences of childhood trauma. It's something we have to address.\"\u003c/p>\n\u003cp>What Bonta saw 20 years ago on the streets echoes the pervasive and persistent quandary now, he said. \"This is not a new problem,\" Bonta said, \"but we want to come at it with new focus and new momentum.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill is expected to be heard in committee in April.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Doles Out Millions to Insurers for Hepatitis C Drugs",
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"content": "\u003cp>In an unusual funding arrangement, California is paying private health plans hundreds of millions of dollars in supplemental payments to cover the high price of hepatitis C drugs for patients in Medi-Cal managed care plans.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Dollars that were intended for a wide array of medical services started being gobbled up by just one drug.'\u003ccite>Charles Bacchi, California Association of Health Plans\u003c/cite>\u003c/aside>\n\u003cp>While Medi-Cal is California's program of health insurance for people who are low income, nearly 80 percent of beneficiaries are in managed care plans run by private health insurance companies. The companies are paid a flat rate per member each month to cover all health care needs.\u003c/p>\n\u003cp>The funding agreement was reached after health plans raised \"alarm\" over the high cost of new hepatitis C drugs and plans had to dig into reserves because of the drugs' cost, says Charles Bacchi, president of the California Association of Health Plans, an industry trade group.\u003c/p>\n\u003cp>“Dollars that were intended for a wide array of medical services started being gobbled up by just one drug,” Bacchi said.\u003c/p>\n\u003cp>A spokesperson for the state's Department of Health Care Services says it's the first time the state has paid health plans a supplemental money just to cover the high cost of a drug. Specifically, Sovaldi, a hepatitis C drug retailing at $1,000 per pill, has sent \u003ca href=\"http://www.wsj.com/articles/gileads-1-000-hep-c-pill-is-hard-for-states-to-swallow-1428525426\" target=\"_blank\">treatment prices soaring.\u003c/a> The drug is made by Gilead Sciences in Foster City.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Although the members of Bacchi’s trade group directly benefit from the supplemental payments, he says the additional money is not a “sustainable” solution to the underlying problem of high-priced drugs.\u003c/p>\n\u003cp>Here are some of the details about the supplemental government funding stream to Medi-Cal plans:\u003c/p>\n\u003cul>\n\u003cli>Health plans invoiced California for $387.5 million for hepatitis C drugs between July 2014 and November 2015, according to the California Department of Health Care Services. The payments come from a mix of federal and state dollars.\u003c/li>\n\u003cli>During that time period, 3,624 Medi-Cal managed care members with hepatitis C were treated.\u003c/li>\n\u003cli>By CALmatters' calculations, the payments amount to $106,926 per patient. The number reflects other drugs used to treat hepatitis C, and isn’t solely the price of Sovaldi and Harvoni, another new, pricey drug to treat hepatis C.\u003c/li>\n\u003cli>Payments to plans are expected to continue in the next fiscal year. The California Department of Health Care Services has budgeted $303.4 million for health plans for 2016–17.\u003c/li>\n\u003c/ul>\n\u003cp>While California will receive some money back from drugmakers in the form of rebates, the ultimate price the state pays for the drugs is confidential, according to the Department of Health Care Services.\u003c/p>\n\u003cp>Limiting the cost of pharmaceuticals is the basis of a \u003ca href=\"http://www.sos.ca.gov/administration/news-releases-and-advisories/2015-news-releases-and-advisories/new-measure-eligible-californias-november-2016-ballot3/\" target=\"_blank\">ballot initiative\u003c/a> expected to be before California voters this November. The proposal 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>The state health care agency says its payments to insurers of Medi-Cal patients for hepatitis C drugs are a “very unique” solution, one that they may use for other high-cost drugs in the future. The state says the current hepatitis C payments may be reassessed in a year or two as it expects the price of the drugs to go down.\u003c/p>\n\u003cp>“As the prescribing of the drugs levels off, as the population and the overall nature of who’s getting it settles down, we may get to a point where we look at carving that responsibility back into the plans’ … rate,” said Jennifer Kent, director of the California Department of Health Care Services.\u003c/p>\n\u003cp>But California’s spending on hepatitis C drugs doesn’t end there.\u003c/p>\n\u003cp>For the rest of the Medi-Cal population — the 2.7 million people who are not in a private managed care plan and whose health care services are directly reimbursed by the state — a \u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.finance.senate.gov/ranking-members-news/wyden-grassley-sovaldi-investigation-finds-revenue-driven-pricing-strategy-behind-84-000-hepatitis-drug\" target=\"_blank\" rel=\"nofollow\">U.S. Senate Finance Committee\u003c/a> reports the following for the year 2014:\u003c/p>\n\u003cul>\n\u003cli>California paid almost $22 million to treat 280 hepatitis C patients with Sovaldi.\u003c/li>\n\u003cli>California paid more than $2.8 million for 57 Harvoni prescriptions.\u003c/li>\n\u003c/ul>\n\u003cp>According to the U.S. Senate report, 237,000 people in Medi-Cal are infected with hepatitis C. So, doing the math between the 3,624 managed care patients and the 337 covered directly by the state, means less than 2 percent of those infected have been treated with the new drugs -- at a cost of hundreds of millions of dollars already.\u003c/p>\n\u003cp>“In order for taxpayers of the state of California to afford to provide people the necessary treatments,” says Bacchi, “we have to have drug pricing society can afford to pay.”\u003c/p>\n\u003cp>At CALmatters, \u003ca href=\"https://medium.com/california-s-legal-drug-dilemma/the-obscurity-of-drug-spending-in-medi-cal-4ccf1df97392#.ii6y9pxr6\" target=\"_blank\">we’re exploring how a drug’s cost affects patient access.\u003c/a> If you are a hepatitis C patient, or other chronic disease patient who is having difficulty getting drugs, we’d like to hear from you.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" target=\"_blank\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://pauline@calmatters.org/\" rel=\"nofollow\">email us\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In an unusual funding arrangement, California is paying private health plans hundreds of millions of dollars in supplemental payments to cover the high price of hepatitis C drugs for patients in Medi-Cal managed care plans.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Dollars that were intended for a wide array of medical services started being gobbled up by just one drug.'\u003ccite>Charles Bacchi, California Association of Health Plans\u003c/cite>\u003c/aside>\n\u003cp>While Medi-Cal is California's program of health insurance for people who are low income, nearly 80 percent of beneficiaries are in managed care plans run by private health insurance companies. The companies are paid a flat rate per member each month to cover all health care needs.\u003c/p>\n\u003cp>The funding agreement was reached after health plans raised \"alarm\" over the high cost of new hepatitis C drugs and plans had to dig into reserves because of the drugs' cost, says Charles Bacchi, president of the California Association of Health Plans, an industry trade group.\u003c/p>\n\u003cp>“Dollars that were intended for a wide array of medical services started being gobbled up by just one drug,” Bacchi said.\u003c/p>\n\u003cp>A spokesperson for the state's Department of Health Care Services says it's the first time the state has paid health plans a supplemental money just to cover the high cost of a drug. Specifically, Sovaldi, a hepatitis C drug retailing at $1,000 per pill, has sent \u003ca href=\"http://www.wsj.com/articles/gileads-1-000-hep-c-pill-is-hard-for-states-to-swallow-1428525426\" target=\"_blank\">treatment prices soaring.\u003c/a> The drug is made by Gilead Sciences in Foster City.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Although the members of Bacchi’s trade group directly benefit from the supplemental payments, he says the additional money is not a “sustainable” solution to the underlying problem of high-priced drugs.\u003c/p>\n\u003cp>Here are some of the details about the supplemental government funding stream to Medi-Cal plans:\u003c/p>\n\u003cul>\n\u003cli>Health plans invoiced California for $387.5 million for hepatitis C drugs between July 2014 and November 2015, according to the California Department of Health Care Services. The payments come from a mix of federal and state dollars.\u003c/li>\n\u003cli>During that time period, 3,624 Medi-Cal managed care members with hepatitis C were treated.\u003c/li>\n\u003cli>By CALmatters' calculations, the payments amount to $106,926 per patient. The number reflects other drugs used to treat hepatitis C, and isn’t solely the price of Sovaldi and Harvoni, another new, pricey drug to treat hepatis C.\u003c/li>\n\u003cli>Payments to plans are expected to continue in the next fiscal year. The California Department of Health Care Services has budgeted $303.4 million for health plans for 2016–17.\u003c/li>\n\u003c/ul>\n\u003cp>While California will receive some money back from drugmakers in the form of rebates, the ultimate price the state pays for the drugs is confidential, according to the Department of Health Care Services.\u003c/p>\n\u003cp>Limiting the cost of pharmaceuticals is the basis of a \u003ca href=\"http://www.sos.ca.gov/administration/news-releases-and-advisories/2015-news-releases-and-advisories/new-measure-eligible-californias-november-2016-ballot3/\" target=\"_blank\">ballot initiative\u003c/a> expected to be before California voters this November. The proposal 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>The state health care agency says its payments to insurers of Medi-Cal patients for hepatitis C drugs are a “very unique” solution, one that they may use for other high-cost drugs in the future. The state says the current hepatitis C payments may be reassessed in a year or two as it expects the price of the drugs to go down.\u003c/p>\n\u003cp>“As the prescribing of the drugs levels off, as the population and the overall nature of who’s getting it settles down, we may get to a point where we look at carving that responsibility back into the plans’ … rate,” said Jennifer Kent, director of the California Department of Health Care Services.\u003c/p>\n\u003cp>But California’s spending on hepatitis C drugs doesn’t end there.\u003c/p>\n\u003cp>For the rest of the Medi-Cal population — the 2.7 million people who are not in a private managed care plan and whose health care services are directly reimbursed by the state — a \u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://www.finance.senate.gov/ranking-members-news/wyden-grassley-sovaldi-investigation-finds-revenue-driven-pricing-strategy-behind-84-000-hepatitis-drug\" target=\"_blank\" rel=\"nofollow\">U.S. Senate Finance Committee\u003c/a> reports the following for the year 2014:\u003c/p>\n\u003cul>\n\u003cli>California paid almost $22 million to treat 280 hepatitis C patients with Sovaldi.\u003c/li>\n\u003cli>California paid more than $2.8 million for 57 Harvoni prescriptions.\u003c/li>\n\u003c/ul>\n\u003cp>According to the U.S. Senate report, 237,000 people in Medi-Cal are infected with hepatitis C. So, doing the math between the 3,624 managed care patients and the 337 covered directly by the state, means less than 2 percent of those infected have been treated with the new drugs -- at a cost of hundreds of millions of dollars already.\u003c/p>\n\u003cp>“In order for taxpayers of the state of California to afford to provide people the necessary treatments,” says Bacchi, “we have to have drug pricing society can afford to pay.”\u003c/p>\n\u003cp>At CALmatters, \u003ca href=\"https://medium.com/california-s-legal-drug-dilemma/the-obscurity-of-drug-spending-in-medi-cal-4ccf1df97392#.ii6y9pxr6\" target=\"_blank\">we’re exploring how a drug’s cost affects patient access.\u003c/a> If you are a hepatitis C patient, or other chronic disease patient who is having difficulty getting drugs, we’d like to hear from you.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca class=\"markup--anchor markup--p-anchor\" href=\"https://twitter.com/pbartolone\" target=\"_blank\" rel=\"nofollow\">Tweet\u003c/a> or \u003ca class=\"markup--anchor markup--p-anchor\" href=\"http://pauline@calmatters.org/\" rel=\"nofollow\">email us\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Just 1 percent of doctors are linked to nearly one-third of all paid malpractice claims, an analysis by researchers at Stanford finds, and those physicians have a set of distinctive characteristics.\u003c/p>\n\u003cp>\"This problem of physicians who accumulate multiple claims and continue to practice ... is a significant policy problem,\" said lead author David Studdert, a professor of medicine and law at Stanford, \"and one that we need to address.\"\u003c/p>\n\u003cp>In the study, published in the \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1506137\" target=\"_blank\">New England Journal of Medicine\u003c/a>, researchers looked at more than 66,000 malpractice claims paid against 54,000 physicians nationwide between 2005 and 2014.\u003c/p>\n\u003cp>Researchers focused on paid, rather than unpaid, claims, because that is a marker for substandard care. About one in three malpractice claims is ultimately paid. In the claims the researchers reviewed, one-third resulted in patient death and another 54 percent in serious injury.\u003c/p>\n\u003cp>The study noted that only 6 percent of doctors had any paid claims over the 10-year period studied.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers said that the \"claim-prone\" physicians were disproportionately male (82 percent) and were older, rather than younger. More than half the claims were by doctors in one of four areas: internal medicine, obstetrics and gynecology, general surgery and general practice or family medicine.\u003c/p>\n\u003cp>But the biggest predictor of all in the claim-prone doctors was whether they'd had a prior claim.\u003c/p>\n\u003cp>\"Compared to physicians with only one previous claim,\" Studdert said, \"a physician who has had three previous claims is three times as likely to have another one. A physician who has had four is four times more likely and so on.\"\u003c/p>\n\u003cp>In the study the researchers are clear that they have identified risk factors but that it is up to health care systems, hospital and malpractice insurers to identify and work with these doctors. But they noted that few of these organizations do.\u003c/p>\n\u003cp>\"With notable exception,\" the researchers write, \"fewer still systematically identify and intervene with practitioners who are at high risk for future claims.\" They call for further investigation into predicting which doctors are at risk and then implementing interventions such as training and supervision to improve their quality of care.\u003c/p>\n\u003cp>In California, \u003ca href=\"https://www.breeze.ca.gov/datamart/loginCADCA.do;jsessionid=B624544A8FEC9896B9DD303B85994EC2.vo1\" target=\"_blank\">patients can look up their doctor \u003c/a>on the state's medical board website. Depending on the type of malpractice settlement, it will be part of the public record if the doctor has had either three or four settlements within a five-year period. \u003ca href=\"http://www.mbc.ca.gov/Consumers/public_disclosure.pdf\" target=\"_blank\">Other information is also available\u003c/a>, including whether your doctor has had a felony conviction or is on probation. Patients can use the website simply to determine that a doctor's license is valid.\u003c/p>\n\u003cp>But advocates like Lisa McGiffert, with Consumers Union's Safe Patient Project, say that's not enough and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/29/in-california-doctors-on-probation-not-required-to-tell-you-should-they/\" target=\"_blank\">have been pushing\u003c/a> the Medical Board of California to require that doctors placed on probation notify their patients. The board has resisted taking this step.\u003c/p>\n\u003cp>While probation and multiple malpractice claims are not necessarily linked, McGiffert says she hopes doctors will pay attention to this study. \"Because I have this sense that doctors as a group protect other doctors who are on probation or get in trouble because they think it might happen to them,\" she said, but since this study demonstrates that a small percentage of doctors are responsible for a disproportionate number of claims, it should be reassuring to physicians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This study is one more piece of information that regulators can use in determining their strategy in addressing the small percentage of doctors who have problems in their treatment of patients,\" she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Just 1 percent of doctors are linked to nearly one-third of all paid malpractice claims, an analysis by researchers at Stanford finds, and those physicians have a set of distinctive characteristics.\u003c/p>\n\u003cp>\"This problem of physicians who accumulate multiple claims and continue to practice ... is a significant policy problem,\" said lead author David Studdert, a professor of medicine and law at Stanford, \"and one that we need to address.\"\u003c/p>\n\u003cp>In the study, published in the \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMsa1506137\" target=\"_blank\">New England Journal of Medicine\u003c/a>, researchers looked at more than 66,000 malpractice claims paid against 54,000 physicians nationwide between 2005 and 2014.\u003c/p>\n\u003cp>Researchers focused on paid, rather than unpaid, claims, because that is a marker for substandard care. About one in three malpractice claims is ultimately paid. In the claims the researchers reviewed, one-third resulted in patient death and another 54 percent in serious injury.\u003c/p>\n\u003cp>The study noted that only 6 percent of doctors had any paid claims over the 10-year period studied.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers said that the \"claim-prone\" physicians were disproportionately male (82 percent) and were older, rather than younger. More than half the claims were by doctors in one of four areas: internal medicine, obstetrics and gynecology, general surgery and general practice or family medicine.\u003c/p>\n\u003cp>But the biggest predictor of all in the claim-prone doctors was whether they'd had a prior claim.\u003c/p>\n\u003cp>\"Compared to physicians with only one previous claim,\" Studdert said, \"a physician who has had three previous claims is three times as likely to have another one. A physician who has had four is four times more likely and so on.\"\u003c/p>\n\u003cp>In the study the researchers are clear that they have identified risk factors but that it is up to health care systems, hospital and malpractice insurers to identify and work with these doctors. But they noted that few of these organizations do.\u003c/p>\n\u003cp>\"With notable exception,\" the researchers write, \"fewer still systematically identify and intervene with practitioners who are at high risk for future claims.\" They call for further investigation into predicting which doctors are at risk and then implementing interventions such as training and supervision to improve their quality of care.\u003c/p>\n\u003cp>In California, \u003ca href=\"https://www.breeze.ca.gov/datamart/loginCADCA.do;jsessionid=B624544A8FEC9896B9DD303B85994EC2.vo1\" target=\"_blank\">patients can look up their doctor \u003c/a>on the state's medical board website. Depending on the type of malpractice settlement, it will be part of the public record if the doctor has had either three or four settlements within a five-year period. \u003ca href=\"http://www.mbc.ca.gov/Consumers/public_disclosure.pdf\" target=\"_blank\">Other information is also available\u003c/a>, including whether your doctor has had a felony conviction or is on probation. Patients can use the website simply to determine that a doctor's license is valid.\u003c/p>\n\u003cp>But advocates like Lisa McGiffert, with Consumers Union's Safe Patient Project, say that's not enough and \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/29/in-california-doctors-on-probation-not-required-to-tell-you-should-they/\" target=\"_blank\">have been pushing\u003c/a> the Medical Board of California to require that doctors placed on probation notify their patients. The board has resisted taking this step.\u003c/p>\n\u003cp>While probation and multiple malpractice claims are not necessarily linked, McGiffert says she hopes doctors will pay attention to this study. \"Because I have this sense that doctors as a group protect other doctors who are on probation or get in trouble because they think it might happen to them,\" she said, but since this study demonstrates that a small percentage of doctors are responsible for a disproportionate number of claims, it should be reassuring to physicians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"This study is one more piece of information that regulators can use in determining their strategy in addressing the small percentage of doctors who have problems in their treatment of patients,\" she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Obamacare is throwing the agricultural industry into a tailspin. Farm labor contractors who must now offer their workers health insurance are complaining loudly about the cost in their already low-margin business.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No, no, no. My margin is 10 percent. And I have to increase expenses 10 percent? Well, that doesn’t work.'\u003ccite>Jesse Sandoval, farm labor contractor\u003c/cite>\u003c/aside>\n\u003cp>Some are also concerned that the forms they must file with the federal government under the Affordable Care Act will bring immigration problems to the fore: about \u003ca href=\"http://www.ers.usda.gov/topics/farm-economy/farm-labor/background.aspx\" target=\"_blank\">half of the farm labor workforce\u003c/a> in the U.S. is undocumented.\u003c/p>\n\u003cp>“There’s definitely going to be some repercussions to it,” says Jesse Sandoval, a farm labor contractor based in Stockton. \"I think there’s going to be some things that cannot be ignored.\"\u003c/p>\n\u003cp>Sandoval came to an educational conference for farm labor contractors -- essentially staffing agencies for field workers -- held at the San Joaquin County Agricultural Center in Stockton last fall. Men with broad shoulders, wearing denim jackets and cowboy hats, sat in the audience, listening to lectures on a litany of laws and rules regulating their industry, including Obamacare's employer mandate.\u003c/p>\n\u003cp>Last year, employers with 100 or more full-time employees had to offer health insurance to their workers or pay a stiff penalty. This year, employers with 50 to 99 full-time employees must comply.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/243903827\" 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>Sandoval has about 100 workers on his payroll. When farmers need a crew to pick cherries or pumpkins or asparagus, they call him to send the workers. He needs to offer insurance this year, and he's smarting at the price tag. At $300 a month per employee, he's looking at a $30,000 monthly bill.\u003c/p>\n\u003cp>“Yeah, no. No, no, no,” Sandoval says about absorbing that into his budget. “The numbers aren't there. My margin is 10 percent. And I have to increase expenses 10 percent? Well, that doesn't work.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"pxRkcuCqePJ1SkL5fHgzAqVTxkQMmNhi\"]So, like a lot of contractors, he’s passing the bill onto the farmers, who in turn are passing the bill onto the farmworkers. Under the Affordable Care Act, employees can be asked to contribute 9.5 percent of their income toward health premiums.\u003c/p>\n\u003cp>But for farmworkers who pick oranges or peaches for $10 an hour, that’s still too much.\u003c/p>\n\u003cp>Agostin Garcia says the two contractors he works for near Fresno offered him insurance directly. But when he saw the price tag, he turned them both down.\u003c/p>\n\u003cp>“For me, I’m the only one in my house who works. There’s five of us in the family,” he says in Spanish. “It just wouldn’t work. Either I pay for health insurance, or I pay the rent and utilities.”\u003c/p>\n\u003cp>Garcia says only a fraction of his co-workers have signed up for coverage. He says when farm labor contractors hand out packets explaining the coverage, the page where workers reject it is right on top.\u003c/p>\n\u003cp>“I think they do it intentionally,” Garcia says. “They comply with the laws, by saying, ‘I offered.’ But they know that nobody’s going to accept it, they know that nobody’s going to pay those amounts.”\u003c/p>\n\u003cp>The cost isn’t the only thing about Obamacare stressing people out in the ag industry. Some are worried about immigration problems. Employers have to file new health care forms with the IRS for all their workers, whether they accept the insurance or not.\u003c/p>\n\u003cp>Kaya Bromley, an attorney who advises employers in the farming industry about the Affordable Care Act, says the health law will make it harder for contractors to turn a blind eye when workers give them fraudulent documents.\u003c/p>\n\u003cp>“Now that there’s more transparency because of all of the reporting, I think we're going to have a lot more data on how many illegal or undocumented workers we have,” she says.\u003c/p>\n\u003cp>Among the contractors she consults for, Bromley has seen a range of quasi-legal and even illegal strategies to sidestep the health law.\u003c/p>\n\u003cp>“I have heard of employees who are choosing to opt out because they want to fly under the radar. I have also heard of employers who are urging the opt-out or at least encouraging it,” she says. “And I warn all of them that they are going to be in big trouble.”\u003c/p>\n\u003cp>But it’s still early. There’s been no enforcement yet. The feds haven’t made an example of anyone, Bromley says, and so employers are ignoring the fact that they could face penalties that run several thousand dollars per employee.\u003c/p>\n\u003cp>“It’s huge. And no one’s talking about the enormity of it,” she says. “When it plays out, and the penalties start getting assessed, that's when people will start having religion about it.”\u003c/p>\n\u003cp>Farm labor contractors say they’re stuck in a Catch-22. The Affordable Care Act doesn’t cover undocumented immigrants, but contractors will get fined if they don’t offer them coverage. Contractors aren’t supposed to hire undocumented workers, but the president and Congress can't agree on what to do about the massive number of immigrants living and working here illegally.\u003c/p>\n\u003cp>How are contractors supposed to comply with the new health care law when the feds are deadlocked over how to update the immigration system?\u003c/p>\n\u003cp>“Our government, all they do is talk about it. They don’t fix anything, they make everything worse,” says Golinda Vela Chavez, who helps run a labor contracting company in Salinas.\u003c/p>\n\u003cp>Her company started offering their employees insurance last year, at no cost to the workers, and she says, still, more than half of them turned down the coverage.\u003c/p>\n\u003cp>This year, the company has to start filing the paperwork with the IRS and she says it's been a nightmare.\u003c/p>\n\u003cp>“They don’t try to help you, they want to get you,” she says. “They implement all these things, because they want to get you!”\u003c/p>\n\u003cp>Ofelia Reyes just wants peace of mind. She’s has been harvesting nectarines and tying grapevines in fields near Fresno for 20 years. She recently had a breast cancer scare. None of the contractors she works for have offered her insurance.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“No, never. No one’s ever offered me anything,” she says in Spanish. \"All they say is, ‘Hurry up! Your ladder is waiting for you. Your co-workers are already over there.’ That’s how we live.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Obamacare is throwing the agricultural industry into a tailspin. Farm labor contractors who must now offer their workers health insurance are complaining loudly about the cost in their already low-margin business.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No, no, no. My margin is 10 percent. And I have to increase expenses 10 percent? Well, that doesn’t work.'\u003ccite>Jesse Sandoval, farm labor contractor\u003c/cite>\u003c/aside>\n\u003cp>Some are also concerned that the forms they must file with the federal government under the Affordable Care Act will bring immigration problems to the fore: about \u003ca href=\"http://www.ers.usda.gov/topics/farm-economy/farm-labor/background.aspx\" target=\"_blank\">half of the farm labor workforce\u003c/a> in the U.S. is undocumented.\u003c/p>\n\u003cp>“There’s definitely going to be some repercussions to it,” says Jesse Sandoval, a farm labor contractor based in Stockton. \"I think there’s going to be some things that cannot be ignored.\"\u003c/p>\n\u003cp>Sandoval came to an educational conference for farm labor contractors -- essentially staffing agencies for field workers -- held at the San Joaquin County Agricultural Center in Stockton last fall. Men with broad shoulders, wearing denim jackets and cowboy hats, sat in the audience, listening to lectures on a litany of laws and rules regulating their industry, including Obamacare's employer mandate.\u003c/p>\n\u003cp>Last year, employers with 100 or more full-time employees had to offer health insurance to their workers or pay a stiff penalty. This year, employers with 50 to 99 full-time employees must comply.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\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/243903827&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/243903827'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Sandoval has about 100 workers on his payroll. When farmers need a crew to pick cherries or pumpkins or asparagus, they call him to send the workers. He needs to offer insurance this year, and he's smarting at the price tag. At $300 a month per employee, he's looking at a $30,000 monthly bill.\u003c/p>\n\u003cp>“Yeah, no. No, no, no,” Sandoval says about absorbing that into his budget. “The numbers aren't there. My margin is 10 percent. And I have to increase expenses 10 percent? Well, that doesn't work.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>So, like a lot of contractors, he’s passing the bill onto the farmers, who in turn are passing the bill onto the farmworkers. Under the Affordable Care Act, employees can be asked to contribute 9.5 percent of their income toward health premiums.\u003c/p>\n\u003cp>But for farmworkers who pick oranges or peaches for $10 an hour, that’s still too much.\u003c/p>\n\u003cp>Agostin Garcia says the two contractors he works for near Fresno offered him insurance directly. But when he saw the price tag, he turned them both down.\u003c/p>\n\u003cp>“For me, I’m the only one in my house who works. There’s five of us in the family,” he says in Spanish. “It just wouldn’t work. Either I pay for health insurance, or I pay the rent and utilities.”\u003c/p>\n\u003cp>Garcia says only a fraction of his co-workers have signed up for coverage. He says when farm labor contractors hand out packets explaining the coverage, the page where workers reject it is right on top.\u003c/p>\n\u003cp>“I think they do it intentionally,” Garcia says. “They comply with the laws, by saying, ‘I offered.’ But they know that nobody’s going to accept it, they know that nobody’s going to pay those amounts.”\u003c/p>\n\u003cp>The cost isn’t the only thing about Obamacare stressing people out in the ag industry. Some are worried about immigration problems. Employers have to file new health care forms with the IRS for all their workers, whether they accept the insurance or not.\u003c/p>\n\u003cp>Kaya Bromley, an attorney who advises employers in the farming industry about the Affordable Care Act, says the health law will make it harder for contractors to turn a blind eye when workers give them fraudulent documents.\u003c/p>\n\u003cp>“Now that there’s more transparency because of all of the reporting, I think we're going to have a lot more data on how many illegal or undocumented workers we have,” she says.\u003c/p>\n\u003cp>Among the contractors she consults for, Bromley has seen a range of quasi-legal and even illegal strategies to sidestep the health law.\u003c/p>\n\u003cp>“I have heard of employees who are choosing to opt out because they want to fly under the radar. I have also heard of employers who are urging the opt-out or at least encouraging it,” she says. “And I warn all of them that they are going to be in big trouble.”\u003c/p>\n\u003cp>But it’s still early. There’s been no enforcement yet. The feds haven’t made an example of anyone, Bromley says, and so employers are ignoring the fact that they could face penalties that run several thousand dollars per employee.\u003c/p>\n\u003cp>“It’s huge. And no one’s talking about the enormity of it,” she says. “When it plays out, and the penalties start getting assessed, that's when people will start having religion about it.”\u003c/p>\n\u003cp>Farm labor contractors say they’re stuck in a Catch-22. The Affordable Care Act doesn’t cover undocumented immigrants, but contractors will get fined if they don’t offer them coverage. Contractors aren’t supposed to hire undocumented workers, but the president and Congress can't agree on what to do about the massive number of immigrants living and working here illegally.\u003c/p>\n\u003cp>How are contractors supposed to comply with the new health care law when the feds are deadlocked over how to update the immigration system?\u003c/p>\n\u003cp>“Our government, all they do is talk about it. They don’t fix anything, they make everything worse,” says Golinda Vela Chavez, who helps run a labor contracting company in Salinas.\u003c/p>\n\u003cp>Her company started offering their employees insurance last year, at no cost to the workers, and she says, still, more than half of them turned down the coverage.\u003c/p>\n\u003cp>This year, the company has to start filing the paperwork with the IRS and she says it's been a nightmare.\u003c/p>\n\u003cp>“They don’t try to help you, they want to get you,” she says. “They implement all these things, because they want to get you!”\u003c/p>\n\u003cp>Ofelia Reyes just wants peace of mind. She’s has been harvesting nectarines and tying grapevines in fields near Fresno for 20 years. She recently had a breast cancer scare. None of the contractors she works for have offered her insurance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“No, never. No one’s ever offered me anything,” she says in Spanish. \"All they say is, ‘Hurry up! Your ladder is waiting for you. Your co-workers are already over there.’ That’s how we live.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "To Avoid Obamacare, Some Fast Food Restaurants Cut Staff Hours. Did It Work?",
"title": "To Avoid Obamacare, Some Fast Food Restaurants Cut Staff Hours. Did It Work?",
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"content": "\u003cp>At a Burger King off Highway 99 in the Central Valley, half a dozen workers in black uniforms scurry around, grabbing packets of ketchup, stuffing paper bags with French fries.\u003c/p>\n\u003cp>“Number 22! Two barbecue, two ketchup,” one worker says, handing an order to a customer through the drive-thru window.\u003c/p>\n\u003cp>Tiana Mua has worked here almost a year. She’s part time, but she’d like to be full time.\u003c/p>\n\u003cp>“Cause I want to become independent,” she says.\u003c/p>\n\u003cp>But at this Burger King, only the managers are full time. Mua says it’s like that at fast food joints all over town. It’s hard to get full time work.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“They’re cutting back on all the jobs, and a lot of people have been let go,” she says.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/243706979\" 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>One reason is the local economy is bad. People aren’t eating out as much, and sales are down. So restaurants can’t afford a robust staff.\u003c/p>\n\u003cp>But there’s another reason that might explain why fast food employees aren’t getting more hours: Obamacare.\u003c/p>\n\u003cp>Starting January 1, businesses with 50 or more full time employees must offer health insurance to all full time staff or pay a hefty fine. Employers with 100 or more workers had to start offering coverage last year. But smaller businesses that operate on lower margins, especially restaurants, complained loudly about the cost. And some fast food franchise owners, figured out a way to avoid paying for coverage: just make everyone part time.\u003c/p>\n\u003cp>Nearly 60 percent of small franchise business owners said they would make personnel changes like this to avoid hitting the 50 employee threshhold, according to a \u003ca href=\"https://www.uschamber.com/report/presentation-findings-national-research-conducted-among-business-decision-makers\">2013 U.S. Chamber of Commerce survey\u003c/a>.\u003c/p>\n\u003cp>[contextly_sidebar id=\"IXLLCVOZiAev3kR4Ny3nEMwYmTK7EQb4\"]But, some of those restaurant owners who cut hours to sidestep the health law –- now regret it, says Kaya Bromley, an attorney who consults with employers on how to comply with the Affordable Care Act, and author of The Employers’ Guide to Obamacare.\u003c/p>\n\u003cp>“A lot of the fast food franchisees that did this are now coming back and saying, it was a great idea for reducing the number of people that I have to offer benefits, but now I can't run my restaurants,” she says.\u003c/p>\n\u003cp>They tell her it’s been a nightmare trying to manage a part time staff.\u003c/p>\n\u003cp>“Because you’ve got people who are less loyal, you’ve got people who are less skilled who don’t understand the business, and there’s more turnover,” she says.\u003c/p>\n\u003cp>So, Bromley has seen a lot of those restaurants reverse course.\u003c/p>\n\u003cp>“So they’re backtracking, saying, ‘It’s worth it to me to have a full of time staff of people in every restaurant and offer them benefits,’”she says. “Employers think that there’s a shortcut here or there, and then they realize, yeah, that shortcut really hurt me more than it helped me.”\u003c/p>\n\u003cp>The people hurt most by all the workforce management gymnastics are the people at the bottom of the restaurant pecking order who want to advance, but can’t, says Angelo Amador, vice president of labor and workforce policy for the National Restaurant Association.\u003c/p>\n\u003cp>“Someone who’s working part time, but wants more hours so they can move up the ladder, they can’t get the hours,” he says. “It ends up taking out that middle rung of employees.”\u003c/p>\n\u003cp>Obamacare has made restaurants less flexible, he says, mainly because it defines full time work as 30 hours a week or more. Amador says most other laws restaurants have to comply with, like overtime pay, define full time as 40 hours. He thinks the Affordable Care Act should be changed for consistency.\u003c/p>\n\u003cp>“It would be much easier if we could have one definition of full time,” he says.\u003c/p>\n\u003cp>Silvia Campos is relieved that she’s allowed to keep as many workers full time as she can at the Carl’s Junior she manages in Chowchilla.\u003c/p>\n\u003cp>“It’s a small town. For me, it’s hard to find a really good employee,” she says. “We have employees, and for some reason, they don’t like it and go. So it’s really hard to keep good people.”\u003c/p>\n\u003cp>But Campos says some workers don’t want more hours. They get subsidized health care through Covered California, the state’s health insurance marketplace, or free coverage through Medi-Cal. If their income gets too high, they lose eligibility for public benefits.\u003c/p>\n\u003cp>“We try but some people, they don’t want the full time,” she says. “They say no, keep me on part time and that’s good with me.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The company does offer insurance, at a cost of about $300 a month, according to the workers. But some of them say they’re better off making less money and getting their coverage free from the state.\u003c/p>\n\n",
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"excerpt": "Fast food restaurants are where the latest drama of the Affordable Care Act is playing out. It's called the \"employer mandate.\"",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>At a Burger King off Highway 99 in the Central Valley, half a dozen workers in black uniforms scurry around, grabbing packets of ketchup, stuffing paper bags with French fries.\u003c/p>\n\u003cp>“Number 22! Two barbecue, two ketchup,” one worker says, handing an order to a customer through the drive-thru window.\u003c/p>\n\u003cp>Tiana Mua has worked here almost a year. She’s part time, but she’d like to be full time.\u003c/p>\n\u003cp>“Cause I want to become independent,” she says.\u003c/p>\n\u003cp>But at this Burger King, only the managers are full time. Mua says it’s like that at fast food joints all over town. It’s hard to get full time work.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“They’re cutting back on all the jobs, and a lot of people have been let go,” she says.\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/243706979&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/243706979'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>One reason is the local economy is bad. People aren’t eating out as much, and sales are down. So restaurants can’t afford a robust staff.\u003c/p>\n\u003cp>But there’s another reason that might explain why fast food employees aren’t getting more hours: Obamacare.\u003c/p>\n\u003cp>Starting January 1, businesses with 50 or more full time employees must offer health insurance to all full time staff or pay a hefty fine. Employers with 100 or more workers had to start offering coverage last year. But smaller businesses that operate on lower margins, especially restaurants, complained loudly about the cost. And some fast food franchise owners, figured out a way to avoid paying for coverage: just make everyone part time.\u003c/p>\n\u003cp>Nearly 60 percent of small franchise business owners said they would make personnel changes like this to avoid hitting the 50 employee threshhold, according to a \u003ca href=\"https://www.uschamber.com/report/presentation-findings-national-research-conducted-among-business-decision-makers\">2013 U.S. Chamber of Commerce survey\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But, some of those restaurant owners who cut hours to sidestep the health law –- now regret it, says Kaya Bromley, an attorney who consults with employers on how to comply with the Affordable Care Act, and author of The Employers’ Guide to Obamacare.\u003c/p>\n\u003cp>“A lot of the fast food franchisees that did this are now coming back and saying, it was a great idea for reducing the number of people that I have to offer benefits, but now I can't run my restaurants,” she says.\u003c/p>\n\u003cp>They tell her it’s been a nightmare trying to manage a part time staff.\u003c/p>\n\u003cp>“Because you’ve got people who are less loyal, you’ve got people who are less skilled who don’t understand the business, and there’s more turnover,” she says.\u003c/p>\n\u003cp>So, Bromley has seen a lot of those restaurants reverse course.\u003c/p>\n\u003cp>“So they’re backtracking, saying, ‘It’s worth it to me to have a full of time staff of people in every restaurant and offer them benefits,’”she says. “Employers think that there’s a shortcut here or there, and then they realize, yeah, that shortcut really hurt me more than it helped me.”\u003c/p>\n\u003cp>The people hurt most by all the workforce management gymnastics are the people at the bottom of the restaurant pecking order who want to advance, but can’t, says Angelo Amador, vice president of labor and workforce policy for the National Restaurant Association.\u003c/p>\n\u003cp>“Someone who’s working part time, but wants more hours so they can move up the ladder, they can’t get the hours,” he says. “It ends up taking out that middle rung of employees.”\u003c/p>\n\u003cp>Obamacare has made restaurants less flexible, he says, mainly because it defines full time work as 30 hours a week or more. Amador says most other laws restaurants have to comply with, like overtime pay, define full time as 40 hours. He thinks the Affordable Care Act should be changed for consistency.\u003c/p>\n\u003cp>“It would be much easier if we could have one definition of full time,” he says.\u003c/p>\n\u003cp>Silvia Campos is relieved that she’s allowed to keep as many workers full time as she can at the Carl’s Junior she manages in Chowchilla.\u003c/p>\n\u003cp>“It’s a small town. For me, it’s hard to find a really good employee,” she says. “We have employees, and for some reason, they don’t like it and go. So it’s really hard to keep good people.”\u003c/p>\n\u003cp>But Campos says some workers don’t want more hours. They get subsidized health care through Covered California, the state’s health insurance marketplace, or free coverage through Medi-Cal. If their income gets too high, they lose eligibility for public benefits.\u003c/p>\n\u003cp>“We try but some people, they don’t want the full time,” she says. “They say no, keep me on part time and that’s good with me.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The company does offer insurance, at a cost of about $300 a month, according to the workers. But some of them say they’re better off making less money and getting their coverage free from the state.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Teens in San Francisco's Bayview Find Haven in Garden",
"title": "Teens in San Francisco's Bayview Find Haven in Garden",
"headTitle": "Vital Signs | State of Health | KQED News",
"content": "\u003cp>On a sunny day in San Francisco's southeast corner, a group of teenagers are getting ready to plant strawberries and build raised garden beds in a small plot of land blocks away from the former Hunters Point Naval Shipyard.\u003c/p>\n\u003cp>Over the last few years, these teens have transformed the weedy yard at the Oakdale Community Center into a small orchard and farm with roaming chickens and beehives.\u003c/p>\n\u003cp>They've nurtured what once was rocky soil and have grown collard greens, chives and peppers. They've cooked and tasted fresh vegetables or distributed them free to their neighbors. Some have used power tools to build a large chicken coop for the 14 or so resident chickens that lay a dozen eggs per day in the summer.\u003c/p>\n\u003cfigure id=\"attachment_138586\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-138586 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut.jpg\" alt=\"Dominique Brooks, 12, cuts open a bag of soil for a garden bed as Mutee [[LAST NAME]], 10, and residents of the Hunters Point West public housing development look on.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dominique Brooks, 12, (R) and Mutee Algaaffar, 10, cut open a bag of soil while working at the City of Dreams gardening after-school program. 'Junior gardeners' such as Brooks and Algaaffar have built more than 30 garden beds throughout the Hunters Point West public housing development, across the street from the Oakdale Community Center. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The gardeners -- some as young as 10 -- are all part of an after-school program run by the nonprofit City of Dreams in the Bayview-Hunters Point neighborhood. The organization employs 32 kids from the area as junior gardeners, paying them $35 for completing eight gardening sessions. It's a modest stipend for anyone, but earning the cash gives an air of formality to kids like Zavion Gilbert, 15, who shows up regularly to work.\u003c/p>\n\u003cp>“It’s kind of like a job but it’s teaching us a lot of stuff, too,” says Zavion, who aspires to become a chef. “I keep doing it because it got me more interested in life and healthy things. I want to work with vegetables and stuff.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>On the day I visited, a handful of volunteers -- U.S. Army veterans -- were teaching Zavion and Dominique Brooks, 12, to drill wooden planks and assemble garden beds. The adult volunteers supervised Brooks and other teens as they cut a plastic sheet and inserted it into the bottom of a garden bed to prevent weeds from growing inside.\u003c/p>\n\u003cfigure id=\"attachment_138589\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-138589 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut.jpg\" alt=\"Peppers growing in the Oakdale Community Center garden. The garden also has chives, sunflowers, radishes, pomegranates, as well as lemon and orange trees.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Different varieties of peppers grow at the Oakdale Community Center garden. Local teenagers also tend to chives, collar greens, sunflowers and fruit trees. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dominique has participated in the garden since its inception over four years ago, and points proudly to the lemon, pomegranate and orange trees that she planted along the edges. A few of the trees are now about as tall as she is.\u003c/p>\n\u003cp>\"The garden is joyful,\" says Dominique, a middle schooler with long braided hair. \"It helps me do more stuff, and it helps me learn. If I go to college and want to know more stuff about plants, I'll already know something because I started gardening at a young age.\"\u003c/p>\n\u003cfigure id=\"attachment_138614\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-138614 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut.jpg\" alt=\"Dominique Brooks and Mutee Algaaffar put the finishing touches on a new garden bed for residents of the Hunters Point West housing development. The garden sits right across the street.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dominique Brooks and Mutee Algaaffar put the finishing touches on a new garden bed for people who live across the street at the Hunters Point West housing development. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>She says she likes being in the garden, in part because she considers it safer than hanging out in the streets nearby. She says she has witnessed shootings firsthand.\u003c/p>\n\u003cp>“One day somebody got shot in front of the garden right there,\" recalls Dominique, pointing to the street. \"We didn't know what to do. We didn't know it was coming.\"\u003c/p>\n\u003cp>The Bayview-Hunters Point area struggles with gang violence and poverty. The proportion of residents living at or below 200 percent poverty is \u003ca href=\"https://www.sfdph.org/dph/files/HCSMP/HCSMP_DataHandout_ENG_03222012.pdf\" target=\"_blank\">50 percent higher \u003c/a>than for San Francisco as a whole.\u003c/p>\n\u003cp>\"When you hang out in the neighborhood, you see the pressure that the families are under to just make it,\" says Cody Reynolds, 52, lead gardener in the project. \"These kids come to us frustrated, upset. They are kids dealing with this violence that, as an adult, I have a hard time dealing with.\"\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/243109730\" 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>Reynolds is an artist who has lived in Bayview-Hunters Point for 20 years. He says most of those years he kept to himself and wasn't deeply engaged with the community. He dreaded the summers, when he says teens would break windows at his warehouse studio.\u003c/p>\n\u003cp>\"I realized they didn't have any activities. They weren't being engaged to do better,\" says Reynolds.\u003c/p>\n\u003cp>So he tried a small experiment. An avid gardener for a long time, he would keep his \"hands grounded\" by tending to plants in pots and tires. One day, a group of teens stopped by to try to sell him a bike. Instead, Reynolds offered them a job: to plant avocado and other trees in the neighborhood. He paid them a small amount out of his own pocket. It was a success.\u003c/p>\n\u003cfigure id=\"attachment_138588\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-138588 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut.jpg\" alt=\"Murals by participants of the gardening after school program cover the walls of the old daycare center where the garden is now set. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Murals by participants of the gardening after-school program decorate the walls of the Oakdale Community Center. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The experience brewed a dream for him: to turn open spaces in Bayview-Hunters Point into orchards with fresh foods for residents, involving youth. This garden with the teens, at the Oakdale Community Center, is a first big step.\u003c/p>\n\u003cp>\"We are turning a food desert into a food forest. In the Bayview we have lots of sunshine and the right weather to grow everything from apples and pears to watermelon, squash and cucumbers,\" says Reynolds, while helping Mutee Algaaffar, 10, plant a large patch of strawberries.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"For the kids, this is their nature and you see how they resonate here,\" he says. \"Everyone is a little calmer. It's just a natural place to be.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On a sunny day in San Francisco's southeast corner, a group of teenagers are getting ready to plant strawberries and build raised garden beds in a small plot of land blocks away from the former Hunters Point Naval Shipyard.\u003c/p>\n\u003cp>Over the last few years, these teens have transformed the weedy yard at the Oakdale Community Center into a small orchard and farm with roaming chickens and beehives.\u003c/p>\n\u003cp>They've nurtured what once was rocky soil and have grown collard greens, chives and peppers. They've cooked and tasted fresh vegetables or distributed them free to their neighbors. Some have used power tools to build a large chicken coop for the 14 or so resident chickens that lay a dozen eggs per day in the summer.\u003c/p>\n\u003cfigure id=\"attachment_138586\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-138586 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut.jpg\" alt=\"Dominique Brooks, 12, cuts open a bag of soil for a garden bed as Mutee [[LAST NAME]], 10, and residents of the Hunters Point West public housing development look on.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18016_IMG_9245.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dominique Brooks, 12, (R) and Mutee Algaaffar, 10, cut open a bag of soil while working at the City of Dreams gardening after-school program. 'Junior gardeners' such as Brooks and Algaaffar have built more than 30 garden beds throughout the Hunters Point West public housing development, across the street from the Oakdale Community Center. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The gardeners -- some as young as 10 -- are all part of an after-school program run by the nonprofit City of Dreams in the Bayview-Hunters Point neighborhood. The organization employs 32 kids from the area as junior gardeners, paying them $35 for completing eight gardening sessions. It's a modest stipend for anyone, but earning the cash gives an air of formality to kids like Zavion Gilbert, 15, who shows up regularly to work.\u003c/p>\n\u003cp>“It’s kind of like a job but it’s teaching us a lot of stuff, too,” says Zavion, who aspires to become a chef. “I keep doing it because it got me more interested in life and healthy things. I want to work with vegetables and stuff.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On the day I visited, a handful of volunteers -- U.S. Army veterans -- were teaching Zavion and Dominique Brooks, 12, to drill wooden planks and assemble garden beds. The adult volunteers supervised Brooks and other teens as they cut a plastic sheet and inserted it into the bottom of a garden bed to prevent weeds from growing inside.\u003c/p>\n\u003cfigure id=\"attachment_138589\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-138589 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut.jpg\" alt=\"Peppers growing in the Oakdale Community Center garden. The garden also has chives, sunflowers, radishes, pomegranates, as well as lemon and orange trees.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18021_IMG_9273.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Different varieties of peppers grow at the Oakdale Community Center garden. Local teenagers also tend to chives, collar greens, sunflowers and fruit trees. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dominique has participated in the garden since its inception over four years ago, and points proudly to the lemon, pomegranate and orange trees that she planted along the edges. A few of the trees are now about as tall as she is.\u003c/p>\n\u003cp>\"The garden is joyful,\" says Dominique, a middle schooler with long braided hair. \"It helps me do more stuff, and it helps me learn. If I go to college and want to know more stuff about plants, I'll already know something because I started gardening at a young age.\"\u003c/p>\n\u003cfigure id=\"attachment_138614\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-138614 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut.jpg\" alt=\"Dominique Brooks and Mutee Algaaffar put the finishing touches on a new garden bed for residents of the Hunters Point West housing development. The garden sits right across the street.\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18017_IMG_9248.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Dominique Brooks and Mutee Algaaffar put the finishing touches on a new garden bed for people who live across the street at the Hunters Point West housing development. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>She says she likes being in the garden, in part because she considers it safer than hanging out in the streets nearby. She says she has witnessed shootings firsthand.\u003c/p>\n\u003cp>“One day somebody got shot in front of the garden right there,\" recalls Dominique, pointing to the street. \"We didn't know what to do. We didn't know it was coming.\"\u003c/p>\n\u003cp>The Bayview-Hunters Point area struggles with gang violence and poverty. The proportion of residents living at or below 200 percent poverty is \u003ca href=\"https://www.sfdph.org/dph/files/HCSMP/HCSMP_DataHandout_ENG_03222012.pdf\" target=\"_blank\">50 percent higher \u003c/a>than for San Francisco as a whole.\u003c/p>\n\u003cp>\"When you hang out in the neighborhood, you see the pressure that the families are under to just make it,\" says Cody Reynolds, 52, lead gardener in the project. \"These kids come to us frustrated, upset. They are kids dealing with this violence that, as an adult, I have a hard time dealing with.\"\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/243109730&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/243109730'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Reynolds is an artist who has lived in Bayview-Hunters Point for 20 years. He says most of those years he kept to himself and wasn't deeply engaged with the community. He dreaded the summers, when he says teens would break windows at his warehouse studio.\u003c/p>\n\u003cp>\"I realized they didn't have any activities. They weren't being engaged to do better,\" says Reynolds.\u003c/p>\n\u003cp>So he tried a small experiment. An avid gardener for a long time, he would keep his \"hands grounded\" by tending to plants in pots and tires. One day, a group of teens stopped by to try to sell him a bike. Instead, Reynolds offered them a job: to plant avocado and other trees in the neighborhood. He paid them a small amount out of his own pocket. It was a success.\u003c/p>\n\u003cfigure id=\"attachment_138588\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-138588 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut.jpg\" alt=\"Murals by participants of the gardening after school program cover the walls of the old daycare center where the garden is now set. \" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/01/RS18025_IMG_9292.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Murals by participants of the gardening after-school program decorate the walls of the Oakdale Community Center. \u003ccite>(Farida Jhabvala Romero / KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The experience brewed a dream for him: to turn open spaces in Bayview-Hunters Point into orchards with fresh foods for residents, involving youth. This garden with the teens, at the Oakdale Community Center, is a first big step.\u003c/p>\n\u003cp>\"We are turning a food desert into a food forest. In the Bayview we have lots of sunshine and the right weather to grow everything from apples and pears to watermelon, squash and cucumbers,\" says Reynolds, while helping Mutee Algaaffar, 10, plant a large patch of strawberries.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"For the kids, this is their nature and you see how they resonate here,\" he says. \"Everyone is a little calmer. It's just a natural place to be.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Why Vaccination Rates Are Up Across California",
"title": "Why Vaccination Rates Are Up Across California",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Vaccination rates are up in 49 out of 58 counties in California, according to \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx\" target=\"_blank\">data released Tuesday \u003c/a>by state health officials.\u003c/p>\n\u003cp>The California Department of Public Health annually reports vaccination data for kindergartners at virtually all public and private schools statewide. For the 2015-2016 school year, 92.9 percent of kindergartners were up-to-date on their vaccines, an increase of 2.5 percentage points from last year.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/242982475\" 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>In California, 2015 was the year of heated debate around vaccines. It started last January with the first reports of a measles outbreak tied to Disneyland. Then, in early February, lawmakers introduced a bill to eliminate the \"personal belief exemption\" (PBE) which allows parents to refuse vaccines on behalf of their children.\u003c/p>\n\u003cp>The law takes effect in July, but this school year the PBE rate declined slightly -- it's now 2.38 percent, down from 2.54 percent last year. It's the second straight year of declines.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>While no one can say for sure exactly what's driving the increasing vaccination rates, it seems reasonable that all the focus on vaccinations -- and those who choose not to vaccinate -- last year had an impact.\u003c/p>\n\u003cp>But James Watt, chief of the division of communicable diseases with the state's department of public health, says another big factor is \"conditional admissions.\" These are children who arrive at school with some vaccines, but are not up to date.\u003c/p>\n\u003cp>This school year, 4.4 percent -- about 24,000 -- of the state's 550,000 kindergartners were admitted conditionally.\u003c/p>\n\u003cp>[contextly_sidebar id=\"S07THKkVXvpUeGb2IhP48ymUxbk2OH1q\"]The problem, Watt explained to me in an interview, is that the\u003ca href=\"http://www.shotsforschool.org/laws/conditional-admission/\" target=\"_blank\"> rules around conditional entry are actually quite strict\u003c/a>. It's not simply that a child has some vaccines and will get the rest at a later date. In other words, \"conditional entry\" is not for children whose parents haven't gotten them to the doctor's office or clinic for a shot.\u003c/p>\n\u003cp>\"If those children could get a dose 'today,' they're not supposed to be admitted to school,\" Watt says.\u003c/p>\n\u003cp>To say it in reverse -- conditional entry is for children who cannot be vaccinated \"today.\"\u003c/p>\n\u003cp>Why couldn't you be vaccinated \"today\"? Here's one example: Children are supposed to receive two doses of the measles, mumps, rubella (MMR) vaccine. But the second dose can only be given starting one month after the first dose. If school starts less than one month after the child has had the first MMR dose, then the child is eligible for \"conditional entry\" to school, until the month has passed and the second dose can be given.\u003c/p>\n\u003cp>Department of public health estimates show that more than 90 percent of those 24,000 children with conditional entry do not meet the \u003ca href=\"http://eziz.org/assets/docs/IMM-1080_Conditional.pdf\" target=\"_blank\">requirements\u003c/a> of the policy and should not have been admitted to school.\u003c/p>\n\u003cp>Watt says the criteria have been misunderstood and \"can be confusing,\" so the state's health department has been working with local health departments to inform them about correct use of conditional entry. In addition, schools financial and compliance audits for the current school year \"will scrutinize reimbursements for attendance at schools with higher rates of conditional entrance.\"\u003c/p>\n\u003cp>The department said it turned to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/19/alameda-county-vaccinations-surge-in-wake-of-enforcement/\" target=\"_blank\">approaches used successfully \u003c/a>by the Alameda County Public Health Department. The state says Alameda had the biggest decrease -- 7.2 percent -- of any California county in its conditional entry rate. Statewide, the rate declined 2.5 percent.\u003c/p>\n\u003cp>Watt acknowledged \"there is a tension\" between health requirements and school attendance, but even if children need vaccinations, there's \"no need to be out of school for more than a day,\" Watt said. \"There should not be prolonged absences from school because of the immunization requirement.\"\u003c/p>\n\u003cp>Despite the increases in the rate of kindergartners now fully vaccinated \"a number of schools and communities remain at risk of contagion,\" the state says. For the current school year, 20 of California's 58 counties have rates of fully-vaccinated kindergartners below 90 percent.\u003c/p>\n\u003cp>Here are the counties with the lowest rates of fully vaccinated kindergartners this year:\u003c/p>\n\u003cul>\n\u003cli>Trinity 77.0 percent\u003c/li>\n\u003cli>Nevada 77.1 percent\u003c/li>\n\u003cli>Tuolumne 77.7 percent\u003c/li>\n\u003cli>Mariposa 81.5 percent\u003c/li>\n\u003cli>Humboldt 82.0 percent\u003c/li>\n\u003cli>Siskiyou 83.8 percent\u003c/li>\n\u003c/ul>\n\u003cp>Many of those counties also have high rates of personal belief exemptions. But individual schools even within counties with high fully vaccinated rates may have high personal belief exemption rates.\u003c/p>\n\u003cp>You can look up the personal belief exemption rate at your own school below.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"http://projects1.kqed.org/vaccines/pbe2015.html\" width=\"100%\" height=\"700px\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>You can also see the \u003ca href=\"http://projects1.kqed.org/vaccines/pbe2015.html\" target=\"_blank\">school search tool on its own page\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Vaccination rates are up in 49 out of 58 counties in California, according to \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx\" target=\"_blank\">data released Tuesday \u003c/a>by state health officials.\u003c/p>\n\u003cp>The California Department of Public Health annually reports vaccination data for kindergartners at virtually all public and private schools statewide. For the 2015-2016 school year, 92.9 percent of kindergartners were up-to-date on their vaccines, an increase of 2.5 percentage points from last year.\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/242982475&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/242982475'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In California, 2015 was the year of heated debate around vaccines. It started last January with the first reports of a measles outbreak tied to Disneyland. Then, in early February, lawmakers introduced a bill to eliminate the \"personal belief exemption\" (PBE) which allows parents to refuse vaccines on behalf of their children.\u003c/p>\n\u003cp>The law takes effect in July, but this school year the PBE rate declined slightly -- it's now 2.38 percent, down from 2.54 percent last year. It's the second straight year of declines.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While no one can say for sure exactly what's driving the increasing vaccination rates, it seems reasonable that all the focus on vaccinations -- and those who choose not to vaccinate -- last year had an impact.\u003c/p>\n\u003cp>But James Watt, chief of the division of communicable diseases with the state's department of public health, says another big factor is \"conditional admissions.\" These are children who arrive at school with some vaccines, but are not up to date.\u003c/p>\n\u003cp>This school year, 4.4 percent -- about 24,000 -- of the state's 550,000 kindergartners were admitted conditionally.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The problem, Watt explained to me in an interview, is that the\u003ca href=\"http://www.shotsforschool.org/laws/conditional-admission/\" target=\"_blank\"> rules around conditional entry are actually quite strict\u003c/a>. It's not simply that a child has some vaccines and will get the rest at a later date. In other words, \"conditional entry\" is not for children whose parents haven't gotten them to the doctor's office or clinic for a shot.\u003c/p>\n\u003cp>\"If those children could get a dose 'today,' they're not supposed to be admitted to school,\" Watt says.\u003c/p>\n\u003cp>To say it in reverse -- conditional entry is for children who cannot be vaccinated \"today.\"\u003c/p>\n\u003cp>Why couldn't you be vaccinated \"today\"? Here's one example: Children are supposed to receive two doses of the measles, mumps, rubella (MMR) vaccine. But the second dose can only be given starting one month after the first dose. If school starts less than one month after the child has had the first MMR dose, then the child is eligible for \"conditional entry\" to school, until the month has passed and the second dose can be given.\u003c/p>\n\u003cp>Department of public health estimates show that more than 90 percent of those 24,000 children with conditional entry do not meet the \u003ca href=\"http://eziz.org/assets/docs/IMM-1080_Conditional.pdf\" target=\"_blank\">requirements\u003c/a> of the policy and should not have been admitted to school.\u003c/p>\n\u003cp>Watt says the criteria have been misunderstood and \"can be confusing,\" so the state's health department has been working with local health departments to inform them about correct use of conditional entry. In addition, schools financial and compliance audits for the current school year \"will scrutinize reimbursements for attendance at schools with higher rates of conditional entrance.\"\u003c/p>\n\u003cp>The department said it turned to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/19/alameda-county-vaccinations-surge-in-wake-of-enforcement/\" target=\"_blank\">approaches used successfully \u003c/a>by the Alameda County Public Health Department. The state says Alameda had the biggest decrease -- 7.2 percent -- of any California county in its conditional entry rate. Statewide, the rate declined 2.5 percent.\u003c/p>\n\u003cp>Watt acknowledged \"there is a tension\" between health requirements and school attendance, but even if children need vaccinations, there's \"no need to be out of school for more than a day,\" Watt said. \"There should not be prolonged absences from school because of the immunization requirement.\"\u003c/p>\n\u003cp>Despite the increases in the rate of kindergartners now fully vaccinated \"a number of schools and communities remain at risk of contagion,\" the state says. For the current school year, 20 of California's 58 counties have rates of fully-vaccinated kindergartners below 90 percent.\u003c/p>\n\u003cp>Here are the counties with the lowest rates of fully vaccinated kindergartners this year:\u003c/p>\n\u003cul>\n\u003cli>Trinity 77.0 percent\u003c/li>\n\u003cli>Nevada 77.1 percent\u003c/li>\n\u003cli>Tuolumne 77.7 percent\u003c/li>\n\u003cli>Mariposa 81.5 percent\u003c/li>\n\u003cli>Humboldt 82.0 percent\u003c/li>\n\u003cli>Siskiyou 83.8 percent\u003c/li>\n\u003c/ul>\n\u003cp>Many of those counties also have high rates of personal belief exemptions. But individual schools even within counties with high fully vaccinated rates may have high personal belief exemption rates.\u003c/p>\n\u003cp>You can look up the personal belief exemption rate at your own school below.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"http://projects1.kqed.org/vaccines/pbe2015.html\" width=\"100%\" height=\"700px\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>You can also see the \u003ca href=\"http://projects1.kqed.org/vaccines/pbe2015.html\" target=\"_blank\">school search tool on its own page\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Alameda County Vaccinations Surge In Wake of Enforcement",
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"content": "\u003cp>When it comes to vaccination rates, Alameda County made the comeback of the year in California.\u003c/p>\n\u003cp>The county was named by state officials as the “most improved” for raising the rate of kindergartners with “up-to-date” immunizations, said Amy Pine, immunization director of the Alameda County Public Health Department.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"We made it our mission to say, 'No shots, no records, no school,'” \u003ccite>Amy Pine, Alameda County Public Health Department \u003c/cite>\u003c/aside>\n\u003cp>About 97 percent of kindergartners in Alameda had up-to-date vaccinations this school year, compared to 89 percent a year ago, according to the county’s records.\u003c/p>\n\u003cp>“We made it our mission to say, 'No shots, no records, no school,' ” Pine said. “The school personnel ... worked so hard. They are the heroes.\"\u003c/p>\n\u003cp>The countywide turnaround is due in large part to improvement in vaccination rates recorded in the Oakland Unified School District. The district lifted its rates of kindergartners with up-to-date vaccinations from only 75 percent in 2014-15 to 97 percent this year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Individual schools had major improvement, like Thornhill Elementary School in Oakland's Montclair district, which saw its up-to-date vaccination rate skyrocket from 14 percent last year to 96 percent this year.\u003c/p>\n\u003cp>“We doubled down on this issue, and we're glad to see our efforts are paying off, because what it's really about is the health of all of our children,” said Oakland Unified School District spokesman Isaac Kos-Read.\u003c/p>\n\u003cp>[contextly_sidebar id=\"HqMgQuu17xblX9gtajhD70E32Vqa4p4X\"]Even though it’s an issue that gets a lot of attention in the media, the number of parents choosing not to vaccinate their children due to personal beliefs was actually not a major phenomenon in Alameda. Only 1.5 percent of kindergartners in the county had such exemptions in 2014-2015 and it fell to 1 percent this year.\u003c/p>\n\u003cp>All children are required to be vaccinated against a range of diseases in order to attend school -- unless they have filed a \"personal belief exemption\" or a medical exemption with their school.\u003c/p>\n\u003cp>Last summer, California Gov. Jerry Brown \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">signed a law \u003c/a>abolishing the personal belief exemption. The law takes effect in July, and in the next school year all students must be vaccinated unless they have a medical exemption.\u003c/p>\n\u003cp>Alameda County's major challenge was students with incomplete vaccination records who were allowed “conditional entry” to school. The rate of such admissions was 9.7 percent last year, and this year it has plummeted to 2 percent.\u003c/p>\n\u003cp>In Oakland, conditional entrants represented 25 percent of kindergartners last year, and that dropped to about 2 percent, Pine said.\u003c/p>\n\u003cp>The high rate of conditional entrants at some schools was in part because those exemptions were used inappropriately, she said. Some school personnel interpreted “conditional entry” to mean that students were allowed to enter school as long as their parents promised to get them the shots in the future.\u003c/p>\n\u003cp>But conditional entry is meant for kids who were recently vaccinated and aren’t due for the next shot in the series yet or those who have a temporary medical exemption.\u003c/p>\n\u003cp>\u003cstrong>Fixing the problem\u003c/strong>\u003c/p>\n\u003cp>Schools with low vaccination rates aren’t necessarily filled with unvaccinated children, Pine said. It’s often due to poor record keeping and administrative challenges.\u003c/p>\n\u003cp>School support staffers struggle to enter complete vaccination records because of turnover, lack of training and inadequate time to enter the data or follow up with parents, she said.\u003c/p>\n\u003cp>Also, schools have been reluctant to turn away kids just because they don’t have complete vaccinations. There was a financial disincentive to exclude children as schools get funding based on attendance, but the state has taken steps to change that, Pine said.\u003c/p>\n\u003cp>Schools with problematic vaccination rates in 2014-2015 received a letter saying they would be audited if their Fall 2015 rates didn’t improve, she said.\u003c/p>\n\u003cp>To help boost vaccination rates, Pine said, the county department ranked schools on a “community immunity” honor society based on their vaccination rates and sent \u003ca href=\"http://www.acphd.org/media/398838/community-immunity-honor-society.pdf\" target=\"_blank\">the listing\u003c/a> to school personnel. She said seeing the information displayed like that encouraged officials from schools that were ranked low to ask the county health department how they could turn that around.\u003c/p>\n\u003cp>The county health department worked with schools to train staff, she said. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">A measles outbreak tied to Disneyland\u003c/a>, which was first reported last January, helped to boost public awareness about the importance of vaccines, encouraging parents and schools to put a priority on immunizations, Pine said.\u003c/p>\n\u003cp>“Schools really have to give protected and focused time to staff to do it, where they won’t be interrupted,” Pine said.\u003c/p>\n\u003cp>It’s challenging for front desk staff to enter data when students and parents are constantly coming up to them and signing in and out of school.\u003c/p>\n\u003cp>“Much of what we needed was in the records,” said Thornhill Elementary School’s secretary, Sheila Smith. “It wasn't a matter of obtaining it. It was a matter of finding the time.”\u003c/p>\n\u003cp>She said entering immunization data is complicated for school staff because not all medical records look alike and the office environment is constantly distracting.\u003c/p>\n\u003cp>She said she asked for some dedicated time to work on the project and used personal hours as well, she said.\u003c/p>\n\u003cp>The principal, Steven Daubenspeck, said when he learned the school’s rate was so low last year, he began holding weekly meetings to check in with staff to increase accountability on vaccination record keeping. A lot of the information hadn’t been entered on time, he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I was shocked,” he said. “I got the staff to really rally around, and focus on it. I do have immune-compromised kids here, and it's a life-and-death issue.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When it comes to vaccination rates, Alameda County made the comeback of the year in California.\u003c/p>\n\u003cp>The county was named by state officials as the “most improved” for raising the rate of kindergartners with “up-to-date” immunizations, said Amy Pine, immunization director of the Alameda County Public Health Department.\u003c/p>\n\u003caside class=\"pullquote alignright\">\"We made it our mission to say, 'No shots, no records, no school,'” \u003ccite>Amy Pine, Alameda County Public Health Department \u003c/cite>\u003c/aside>\n\u003cp>About 97 percent of kindergartners in Alameda had up-to-date vaccinations this school year, compared to 89 percent a year ago, according to the county’s records.\u003c/p>\n\u003cp>“We made it our mission to say, 'No shots, no records, no school,' ” Pine said. “The school personnel ... worked so hard. They are the heroes.\"\u003c/p>\n\u003cp>The countywide turnaround is due in large part to improvement in vaccination rates recorded in the Oakland Unified School District. The district lifted its rates of kindergartners with up-to-date vaccinations from only 75 percent in 2014-15 to 97 percent this year.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Individual schools had major improvement, like Thornhill Elementary School in Oakland's Montclair district, which saw its up-to-date vaccination rate skyrocket from 14 percent last year to 96 percent this year.\u003c/p>\n\u003cp>“We doubled down on this issue, and we're glad to see our efforts are paying off, because what it's really about is the health of all of our children,” said Oakland Unified School District spokesman Isaac Kos-Read.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Even though it’s an issue that gets a lot of attention in the media, the number of parents choosing not to vaccinate their children due to personal beliefs was actually not a major phenomenon in Alameda. Only 1.5 percent of kindergartners in the county had such exemptions in 2014-2015 and it fell to 1 percent this year.\u003c/p>\n\u003cp>All children are required to be vaccinated against a range of diseases in order to attend school -- unless they have filed a \"personal belief exemption\" or a medical exemption with their school.\u003c/p>\n\u003cp>Last summer, California Gov. Jerry Brown \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/29/bill-ending-vaccine-exemptions-passes-california-senate-moves-to-governors-desk/\" target=\"_blank\">signed a law \u003c/a>abolishing the personal belief exemption. The law takes effect in July, and in the next school year all students must be vaccinated unless they have a medical exemption.\u003c/p>\n\u003cp>Alameda County's major challenge was students with incomplete vaccination records who were allowed “conditional entry” to school. The rate of such admissions was 9.7 percent last year, and this year it has plummeted to 2 percent.\u003c/p>\n\u003cp>In Oakland, conditional entrants represented 25 percent of kindergartners last year, and that dropped to about 2 percent, Pine said.\u003c/p>\n\u003cp>The high rate of conditional entrants at some schools was in part because those exemptions were used inappropriately, she said. Some school personnel interpreted “conditional entry” to mean that students were allowed to enter school as long as their parents promised to get them the shots in the future.\u003c/p>\n\u003cp>But conditional entry is meant for kids who were recently vaccinated and aren’t due for the next shot in the series yet or those who have a temporary medical exemption.\u003c/p>\n\u003cp>\u003cstrong>Fixing the problem\u003c/strong>\u003c/p>\n\u003cp>Schools with low vaccination rates aren’t necessarily filled with unvaccinated children, Pine said. It’s often due to poor record keeping and administrative challenges.\u003c/p>\n\u003cp>School support staffers struggle to enter complete vaccination records because of turnover, lack of training and inadequate time to enter the data or follow up with parents, she said.\u003c/p>\n\u003cp>Also, schools have been reluctant to turn away kids just because they don’t have complete vaccinations. There was a financial disincentive to exclude children as schools get funding based on attendance, but the state has taken steps to change that, Pine said.\u003c/p>\n\u003cp>Schools with problematic vaccination rates in 2014-2015 received a letter saying they would be audited if their Fall 2015 rates didn’t improve, she said.\u003c/p>\n\u003cp>To help boost vaccination rates, Pine said, the county department ranked schools on a “community immunity” honor society based on their vaccination rates and sent \u003ca href=\"http://www.acphd.org/media/398838/community-immunity-honor-society.pdf\" target=\"_blank\">the listing\u003c/a> to school personnel. She said seeing the information displayed like that encouraged officials from schools that were ranked low to ask the county health department how they could turn that around.\u003c/p>\n\u003cp>The county health department worked with schools to train staff, she said. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/16/disneyland-measles-outbreak-to-be-declared-over/\" target=\"_blank\">A measles outbreak tied to Disneyland\u003c/a>, which was first reported last January, helped to boost public awareness about the importance of vaccines, encouraging parents and schools to put a priority on immunizations, Pine said.\u003c/p>\n\u003cp>“Schools really have to give protected and focused time to staff to do it, where they won’t be interrupted,” Pine said.\u003c/p>\n\u003cp>It’s challenging for front desk staff to enter data when students and parents are constantly coming up to them and signing in and out of school.\u003c/p>\n\u003cp>“Much of what we needed was in the records,” said Thornhill Elementary School’s secretary, Sheila Smith. “It wasn't a matter of obtaining it. It was a matter of finding the time.”\u003c/p>\n\u003cp>She said entering immunization data is complicated for school staff because not all medical records look alike and the office environment is constantly distracting.\u003c/p>\n\u003cp>She said she asked for some dedicated time to work on the project and used personal hours as well, she said.\u003c/p>\n\u003cp>The principal, Steven Daubenspeck, said when he learned the school’s rate was so low last year, he began holding weekly meetings to check in with staff to increase accountability on vaccination record keeping. A lot of the information hadn’t been entered on time, he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I was shocked,” he said. “I got the staff to really rally around, and focus on it. I do have immune-compromised kids here, and it's a life-and-death issue.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Frequent medical visits had become a way of life earlier this year for John and Audrey Stanton.\u003c/p>\n\u003cp>John, 86, suffered from serious eye problems, a painful skin infection called cellulitis and, more recently, repeated shortness of breath — all of which kept landing him in the hospital.\u003c/p>\n\u003cp>\"It was one thing after another. Like the doctor said, 'Somebody is after you!' \" Stanton laughs.\u003c/p>\n\u003cp>And for his 81-year-old wife, Audrey, the nearly two-hour drive each way to Kaiser in Riverside from their home in Hemet was a tough haul.\u003c/p>\n\u003cp>\"I’m not a long-distance driver so I had to be real careful,\" she says. \"It was stressful.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/242752789\" 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>But that stress dissipated last summer when John was admitted to the hospital -- without leaving home.\u003c/p>\n\u003cp>\"I thought, 'Wow! This is amazing. I love this!' \" John Stanton says. \"This is what people need!\"\u003c/p>\n\u003cp>\u003cstrong>Pneumonia, Cellulitis or Congestive Heart Failure\u003c/strong>\u003c/p>\n\u003cp>Stanton is one of about 125 patients who have been enrolled in an experimental \"hospital at home\" program run out of Kaiser’s Permanente’s Riverside Medical Center.\u003c/p>\n\u003cp>Launched two years ago, the program is designed for people who need treatment -- typically only given in the hospital -- for one of three conditions: pneumonia, cellulitis or congestive heart failure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.scpr.org/news/2015/11/25/55860/kaiser-program-brings-hospital-care-to-the-patient/\" target=\"_blank\">Read the rest of the story at KPCC.org.\u003c/a>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Frequent medical visits had become a way of life earlier this year for John and Audrey Stanton.\u003c/p>\n\u003cp>John, 86, suffered from serious eye problems, a painful skin infection called cellulitis and, more recently, repeated shortness of breath — all of which kept landing him in the hospital.\u003c/p>\n\u003cp>\"It was one thing after another. Like the doctor said, 'Somebody is after you!' \" Stanton laughs.\u003c/p>\n\u003cp>And for his 81-year-old wife, Audrey, the nearly two-hour drive each way to Kaiser in Riverside from their home in Hemet was a tough haul.\u003c/p>\n\u003cp>\"I’m not a long-distance driver so I had to be real careful,\" she says. \"It was stressful.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cstrong>Update, 4 p.m. Thursday:\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong> \u003c/strong>A San Francisco judge has denied a woman's request that he require a Catholic hospital to perform a tubal ligation to prevent pregnancy.\u003c/p>\n\u003cp>Superior Court Judge Ernest Goldsmith on Thursday upheld his previous tentative ruling that Mercy Medical Center in Redding was not engaging in sex discrimination by denying Rebecca Chamorro the procedure.\u003c/p>\n\u003cp>The judge said the hospital's policy against sterilization also applies to men and that Chamorro could get the procedure at another hospital.\u003c/p>\n\u003cp>Mercy Medical Center said the procedure conflicts with the hospital's religious beliefs against sterilization.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Attorneys for Chamorro appeared before Goldsmith on Thursday seeking a preliminary injunction.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical, also says the tubal ligation Chamorro seeks is not medically necessary.\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>A Northern California Catholic hospital is not engaging in sex discrimination by denying a woman's request for the sterilization procedure known as tubal ligation, a San Francisco judge said in a tentative ruling.\u003c/p>\n\u003cp>Superior Court Judge Ernest Goldsmith said in his decision Wednesday that Rebecca Chamorro could get the procedure at another hospital, and that Mercy Medical Center's policy against sterilization on religious ground also applies to men.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical and 38 other hospitals in California, Nevada and Arizona, says the tubal ligation sought by Chamorro is not medically necessary and would violate the hospital's right to freedom of religion.\u003c/p>\n\u003cp>\"The jurisprudence is unequivocal: A Catholic hospital may prohibit sterilization procedures that violate the core principles of the hospital's faith,\" attorneys for Dignity Health wrote in a court filing.\u003c/p>\n\u003cp>The judge issued the ruling in advance of a hearing on the matter. Attorneys representing Chamorro in her lawsuit were set to appear before Goldsmith on Thursday to try to change his mind and issue a preliminary injunction.\u003c/p>\n\u003cp>Chamorro is currently on bedrest at her home and scheduled to deliver by cesarean section later this month. The ideal time, medically, for a woman to have a tubal ligation, commonly known as having one's \"tubes tied,\" is at the point of delivery. The next nearest hospital where Chamorro could have the procedure done is in Chico, 70 miles from her home.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/242148103\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003cbr>\nChamorro's suit is part of a growing clash over birth control and abortion health care coverage. Dozens of U.S. Roman Catholic dioceses, charities and colleges have sued in federal court over the contraceptive coverage required under the federal Affordable Care Act.\u003c/p>\n\u003cp>Several evangelical nonprofits have also sued, arguing some of the birth control methods covered under the law are tantamount to abortion.\u003c/p>\n\u003cp>Last June, the U.S. Supreme Court ruled that the Hobby Lobby chain and other closely held private businesses with religious objections could opt out of the birth control mandate.\u003c/p>\n\u003cp>The ACLU has filed a complaint against a Michigan Catholic hospital that also refused to perform tubal ligation, according to Brigitte Amiri, a senior staff attorney with the ACLU. She said the woman in that case was able to go to another hospital.\u003c/p>\n\u003cp>Chamorro sued to get the procedure done immediately following her scheduled cesarean section on Jan. 28 because she and her husband do not want more children.\u003c/p>\n\u003cp>Chamorro's attorneys, including the American Civil Liberties Union, say the procedure is safest when performed immediately after birth, and Chamorro has no choice but to use Mercy Medical Center because Redding is about 200 miles north of San Francisco and the next closest hospital she could go to is more than 70 miles away.\u003c/p>\n\u003cp>The lawsuit accuses Dignity Health of violating California laws against sex discrimination and the practice of medicine by corporations, pointing out that Chamorro's obstetrician had sought permission from Mercy Medical to perform the procedure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The ACLU says the hospital allowed another woman to undergo a tubal ligation after the ACLU threatened a lawsuit.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Attorneys for Chamorro appeared before Goldsmith on Thursday seeking a preliminary injunction.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical, also says the tubal ligation Chamorro seeks is not medically necessary.\u003c/p>\n\u003cp>\u003cstrong>Original Post:\u003c/strong>\u003c/p>\n\u003cp>A Northern California Catholic hospital is not engaging in sex discrimination by denying a woman's request for the sterilization procedure known as tubal ligation, a San Francisco judge said in a tentative ruling.\u003c/p>\n\u003cp>Superior Court Judge Ernest Goldsmith said in his decision Wednesday that Rebecca Chamorro could get the procedure at another hospital, and that Mercy Medical Center's policy against sterilization on religious ground also applies to men.\u003c/p>\n\u003cp>Health care provider Dignity Health, which operates Mercy Medical and 38 other hospitals in California, Nevada and Arizona, says the tubal ligation sought by Chamorro is not medically necessary and would violate the hospital's right to freedom of religion.\u003c/p>\n\u003cp>\"The jurisprudence is unequivocal: A Catholic hospital may prohibit sterilization procedures that violate the core principles of the hospital's faith,\" attorneys for Dignity Health wrote in a court filing.\u003c/p>\n\u003cp>The judge issued the ruling in advance of a hearing on the matter. Attorneys representing Chamorro in her lawsuit were set to appear before Goldsmith on Thursday to try to change his mind and issue a preliminary injunction.\u003c/p>\n\u003cp>Chamorro is currently on bedrest at her home and scheduled to deliver by cesarean section later this month. The ideal time, medically, for a woman to have a tubal ligation, commonly known as having one's \"tubes tied,\" is at the point of delivery. The next nearest hospital where Chamorro could have the procedure done is in Chico, 70 miles from her home.\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/242148103&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/242148103'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003cbr>\nChamorro's suit is part of a growing clash over birth control and abortion health care coverage. Dozens of U.S. Roman Catholic dioceses, charities and colleges have sued in federal court over the contraceptive coverage required under the federal Affordable Care Act.\u003c/p>\n\u003cp>Several evangelical nonprofits have also sued, arguing some of the birth control methods covered under the law are tantamount to abortion.\u003c/p>\n\u003cp>Last June, the U.S. Supreme Court ruled that the Hobby Lobby chain and other closely held private businesses with religious objections could opt out of the birth control mandate.\u003c/p>\n\u003cp>The ACLU has filed a complaint against a Michigan Catholic hospital that also refused to perform tubal ligation, according to Brigitte Amiri, a senior staff attorney with the ACLU. She said the woman in that case was able to go to another hospital.\u003c/p>\n\u003cp>Chamorro sued to get the procedure done immediately following her scheduled cesarean section on Jan. 28 because she and her husband do not want more children.\u003c/p>\n\u003cp>Chamorro's attorneys, including the American Civil Liberties Union, say the procedure is safest when performed immediately after birth, and Chamorro has no choice but to use Mercy Medical Center because Redding is about 200 miles north of San Francisco and the next closest hospital she could go to is more than 70 miles away.\u003c/p>\n\u003cp>The lawsuit accuses Dignity Health of violating California laws against sex discrimination and the practice of medicine by corporations, pointing out that Chamorro's obstetrician had sought permission from Mercy Medical to perform the procedure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The ACLU says the hospital allowed another woman to undergo a tubal ligation after the ACLU threatened a lawsuit.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The Bay Area's health care systems -- think Stanford, Sutter, John Muir and more -- are continuing to align and consolidate in different ways to expand across the region, \u003ca href=\"http://stage.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\">a new analysis shows\u003c/a>, and it's unclear if this will lead to lower or higher health care costs.\u003c/p>\n\u003cp>The report, from the Oakland-based California HealthCare Foundation (CHCF), serves as a summary of the transformation in the Bay Area's health care market over the last few years since the foundation's last report on the subject in 2012.\u003c/p>\n\u003cp>Maribeth Shannon, director at CHCF, referred to \"an arms race.\"\u003c/p>\n\u003cp>\"Providers see health plans consolidating and they want to have a similar level of leverage when they negotiate\" with health insurers, she said. \"The idea [is] that you have to be strong to get a good price in this market.\"\u003c/p>\n\u003cp>The analysis, conducted for the foundation by Mathematica Policy Research, called out three specific health system regionalization efforts and the different ways they were achieving their goals:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Stanford Health Care\u003c/strong> reached across San Francisco Bay to acquire ValleyCare, based in Pleasanton. The goal of such an expansion, the report says, is for Stanford \"to support an expansion of its health plan.\"\u003c/li>\n\u003cli>\u003cstrong>UCSF and John Muir Health\u003c/strong> -- also on opposite sides of San Francisco Bay -- formed a partnership aimed at building a \"network large enough to compete with systems like Kaiser and Sutter\" throughout the Bay Area.\u003c/li>\n\u003cli>\u003cstrong>Sutter Health,\u003c/strong> meanwhile, is consolidating its own operations. The foundation's report cites multiple rounds of reorganization over the past few years, and says Sutter now is attempting to merge its three Bay Area foundations with the goal of extending the successful Palo Alto Medical Foundation model to other sites. But the analysts predict that will be a tall order, given the foundations' different \"histories and physician cultures.\"\u003c/li>\n\u003c/ul>\n\u003cp>And what of patients? Ha Tu, senior health researcher of Mathematica Policy Research and lead author of the study, predicts the increasing consolidation, \"at least in the short term, will result in more provider competition and more choices for consumers, but over the longer term, it remains to be seen whether it's a sustainable thing.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Glenn Melnick, a health economist at USC, flatly rejects that the consolidation will ever benefit consumers.\u003c/p>\n\u003cp>\"What's happening,\" he said, \"is they're getting together to negotiate contracts, and that's it. I'm very cynical.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\" rel=\"attachment wp-att-138796\">\u003cimg class=\"alignright wp-image-138796 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/EmpireBuildingByBayTeaser.jpg\" alt=\"\" width=\"291\" height=\"400\">\u003c/a>Northern California as a whole has \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">long had higher health care prices\u003c/a> than Southern California. Melnick described \"monstrous health care enterprises who are just building on existing market power to expand and protect it in the future.\"\u003c/p>\n\u003cp>Both the foundation's Shannon and lead author Tu stressed that future cost savings are unknown. While more consolidation can lead to higher prices, efficiencies can improve, Shannon said, but she added it's not clear now if those efficiencies would be robust enough to offset price hikes.\u003c/p>\n\u003cp>Tu pointed to a desire by many health systems to be more competitive against health giant Kaiser.\u003c/p>\n\u003cp>At both Sutter and UCSF/John Muir \"they are very well aware they need to lower their cost structures significantly and do population health effectively,\" Tu said in reference to the push to move away from fee-for-service medicine, which can lead to unnecessary care and waste. \"Whether they can do that is a big challenge and an open question.\"\u003c/p>\n\u003cp>In the report, analysts also looked at safety net providers and the challenge posed by increased demand as millions more Californians have coverage, in the wake of the full implementation of the Affordable Care Act. Just over \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/07/browns-budget-plan-new-managed-care-tax-increase-ssi-benefits-more-medi-cal-enrollment/\" target=\"_blank\">one-third of Californians are now covered by Medi-Cal\u003c/a>, and primary care providers are in short supply, the report said.\u003c/p>\n\u003cp>\"The primary care physicians that are needed to serve that population just don't exist,\" Shannon said. \"What we need are innovative ways of meeting the health care needs of that population.\"\u003c/p>\n\u003cp>Providing behavioral health care to patients in the face of expanded health insurance access and regulations requiring coverage \"\u003ca href=\"http://www.dol.gov/ebsa/mentalhealthparity/\" target=\"_blank\">parity\u003c/a>\" -- that health insurers \u003ca href=\"https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Understanding-Health-Insurance/What-is-Mental-Health-Parity\" target=\"_blank\">must provide equal coverage\u003c/a> for mental health conditions -- is an \"enormous problem,\" Shannon said, and many patients are facing long wait times to access care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a significant problem,\" she said, \"and it's long been simmering, it's been below the surface for a long time, and now parity has brought it up to the top.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Bay Area's health care systems -- think Stanford, Sutter, John Muir and more -- are continuing to align and consolidate in different ways to expand across the region, \u003ca href=\"http://stage.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\">a new analysis shows\u003c/a>, and it's unclear if this will lead to lower or higher health care costs.\u003c/p>\n\u003cp>The report, from the Oakland-based California HealthCare Foundation (CHCF), serves as a summary of the transformation in the Bay Area's health care market over the last few years since the foundation's last report on the subject in 2012.\u003c/p>\n\u003cp>Maribeth Shannon, director at CHCF, referred to \"an arms race.\"\u003c/p>\n\u003cp>\"Providers see health plans consolidating and they want to have a similar level of leverage when they negotiate\" with health insurers, she said. \"The idea [is] that you have to be strong to get a good price in this market.\"\u003c/p>\n\u003cp>The analysis, conducted for the foundation by Mathematica Policy Research, called out three specific health system regionalization efforts and the different ways they were achieving their goals:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Stanford Health Care\u003c/strong> reached across San Francisco Bay to acquire ValleyCare, based in Pleasanton. The goal of such an expansion, the report says, is for Stanford \"to support an expansion of its health plan.\"\u003c/li>\n\u003cli>\u003cstrong>UCSF and John Muir Health\u003c/strong> -- also on opposite sides of San Francisco Bay -- formed a partnership aimed at building a \"network large enough to compete with systems like Kaiser and Sutter\" throughout the Bay Area.\u003c/li>\n\u003cli>\u003cstrong>Sutter Health,\u003c/strong> meanwhile, is consolidating its own operations. The foundation's report cites multiple rounds of reorganization over the past few years, and says Sutter now is attempting to merge its three Bay Area foundations with the goal of extending the successful Palo Alto Medical Foundation model to other sites. But the analysts predict that will be a tall order, given the foundations' different \"histories and physician cultures.\"\u003c/li>\n\u003c/ul>\n\u003cp>And what of patients? Ha Tu, senior health researcher of Mathematica Policy Research and lead author of the study, predicts the increasing consolidation, \"at least in the short term, will result in more provider competition and more choices for consumers, but over the longer term, it remains to be seen whether it's a sustainable thing.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Glenn Melnick, a health economist at USC, flatly rejects that the consolidation will ever benefit consumers.\u003c/p>\n\u003cp>\"What's happening,\" he said, \"is they're getting together to negotiate contracts, and that's it. I'm very cynical.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.chcf.org/publications/2016/01/regional-market-san-francisco\" target=\"_blank\" rel=\"attachment wp-att-138796\">\u003cimg class=\"alignright wp-image-138796 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/01/EmpireBuildingByBayTeaser.jpg\" alt=\"\" width=\"291\" height=\"400\">\u003c/a>Northern California as a whole has \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/03/why-health-insurance-in-the-bay-area-costs-more-than-in-southern-california-hospital-prices/\" target=\"_blank\">long had higher health care prices\u003c/a> than Southern California. Melnick described \"monstrous health care enterprises who are just building on existing market power to expand and protect it in the future.\"\u003c/p>\n\u003cp>Both the foundation's Shannon and lead author Tu stressed that future cost savings are unknown. While more consolidation can lead to higher prices, efficiencies can improve, Shannon said, but she added it's not clear now if those efficiencies would be robust enough to offset price hikes.\u003c/p>\n\u003cp>Tu pointed to a desire by many health systems to be more competitive against health giant Kaiser.\u003c/p>\n\u003cp>At both Sutter and UCSF/John Muir \"they are very well aware they need to lower their cost structures significantly and do population health effectively,\" Tu said in reference to the push to move away from fee-for-service medicine, which can lead to unnecessary care and waste. \"Whether they can do that is a big challenge and an open question.\"\u003c/p>\n\u003cp>In the report, analysts also looked at safety net providers and the challenge posed by increased demand as millions more Californians have coverage, in the wake of the full implementation of the Affordable Care Act. Just over \u003ca href=\"http://ww2.kqed.org/stateofhealth/2016/01/07/browns-budget-plan-new-managed-care-tax-increase-ssi-benefits-more-medi-cal-enrollment/\" target=\"_blank\">one-third of Californians are now covered by Medi-Cal\u003c/a>, and primary care providers are in short supply, the report said.\u003c/p>\n\u003cp>\"The primary care physicians that are needed to serve that population just don't exist,\" Shannon said. \"What we need are innovative ways of meeting the health care needs of that population.\"\u003c/p>\n\u003cp>Providing behavioral health care to patients in the face of expanded health insurance access and regulations requiring coverage \"\u003ca href=\"http://www.dol.gov/ebsa/mentalhealthparity/\" target=\"_blank\">parity\u003c/a>\" -- that health insurers \u003ca href=\"https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Understanding-Health-Insurance/What-is-Mental-Health-Parity\" target=\"_blank\">must provide equal coverage\u003c/a> for mental health conditions -- is an \"enormous problem,\" Shannon said, and many patients are facing long wait times to access care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a significant problem,\" she said, \"and it's long been simmering, it's been below the surface for a long time, and now parity has brought it up to the top.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Nearly four out of five registered voters — 78 percent — support a warning label on sugary beverages, according to a statewide Field Poll released Wednesday. More than half of those surveyed — 54 percent — “strongly” favor a label.\u003c/p>\n\u003cp>Overall support crossed party lines. “You see bipartisan support, although different levels of support,” said Mark DiCamillo, Field Poll director. Eighty-six percent of Democrats supported a label with 12 percent opposed; among Republicans, 60 percent supported and 37 percent opposed.\u003c/p>\n\u003cp>This is the second Field Poll in two years on the question, with a slight increase over the \u003ca href=\"http://www.field.com/fieldpollonline/subscribers/Rls2461.pdf\" target=\"_blank\" rel=\"noopener\">2014 results\u003c/a> showing 74 percent support.\u003c/p>\n\u003cp>Registered voters across the state were asked about their support for a warning stating: “Studies show that daily consumption of soda and other sugary drinks contributes to diabetes, obesity and tooth decay.”\u003c/p>\n\u003cp>The poll was commissioned by The California Endowment and the California Center for Public Health Advocacy. CCPHA executive director Harold Goldstein said he was “heartened” that even more voters support a warning label now than two years ago.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“What it means to us is voters in California want to know the scientific truth about the harmful effects of these sugary drinks,” Goldstein said, “and they want that information right there on the front of cans and bottles.”\u003c/p>\n\u003cp>Support was especially strong among Latino voters with 85 percent in favor and 13 percent opposed. Even among Latino Republican voters, support ran to 74 percent.\u003c/p>\n\u003cp>“There is not a single subgroup within Latino voting populations that opposes warning labels, at least that we could identify,” said DiCamillo. Latinos make up 23 percent of the state’s registered voters overall, he said, and “are a growing subgroup.”\u003c/p>\n\u003cp>Last year, the California Legislature considered \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB203\" target=\"_blank\" rel=\"noopener\">a bill\u003c/a> that would require a warning label on beverages with added sweeteners that exceeded 75 calories in 12 ounces. The bill stalled in the Senate Health committee when\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/30/health-advocates-frustrated-as-soda-warning-bill-dies/\" target=\"_blank\" rel=\"noopener\"> four members who were present at the hearing abstained from voting\u003c/a>.\u003c/p>\n\u003cp>In a statement Bob Achermann, executive director of CalBev, an industry group, said labels about calories and ingredients are already available and that a warning suggesting sugary beverages are a unique driver of obesity and diabetes would mislead people.\u003c/p>\n\u003cp>“The best way to promote balanced lifestyles is through fact-based information,” Achermann said, “rather than simplistic approaches that target just one product but don’t ultimately address complex health challenges.”\u003c/p>\n\u003cp>Numerous business groups have also voiced their opposition to warning labels.\u003c/p>\n\u003cp>The poll included two questions that asked respondents to select which of three beverages (a 12-ounce can) had the most sugar:\u003c/p>\n\u003cul>\n\u003cli>Coke (39 grams)\u003c/li>\n\u003cli>Minute Maid Lemonade (40 grams)\u003c/li>\n\u003cli>Hawaiian Punch (21 grams)\u003c/li>\n\u003c/ul>\n\u003cp>Only 7 percent of respondents correctly said the can of Minute Maid had the most sugar. In addition, 34 percent said Hawaiian Punch had the most sugar, even though it has about half the sugar content of Coke or Minute Maid Lemonade.\u003c/p>\n\u003cp>In the second question, people picked from:\u003c/p>\n\u003cul>\n\u003cli>O.N.E. Mango Coconut Water (30 grams)\u003c/li>\n\u003cli>Glaceau Orange Mango FruitWater (0 grams)\u003c/li>\n\u003cli>Honest Lemon Tea (21 grams)\u003c/li>\n\u003c/ul>\n\u003cp>Only 14 percent of people correctly picked the coconut water. Fully one-third of respondents — 33 percent — said the Glaceau FruitWater had the most sugar, even though it is a sugar-free drink; 32 percent picked the Honest Lemon Tea.\u003c/p>\n\u003cp>Goldstein, the public health advocate, said that marketers are “purposely confusing consumers” by using words like “honest” in the names of their products.\u003c/p>\n\u003cp>“One of the great benefits of a warning label is consumers will no longer be confused,” he said. When they’re grocery shopping, they don’t have to “wonder which (beverages) are harmful and which ones are not.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>When asked why they supported warning labels, 28.6 percent of respondents said that they would promote “greater personal responsibility” in helping people cut their sugar consumption, while 28 percent said consumers have a “right to know the truth” about harmful products. Another 21 percent said parents would be able to make more informed beverage choices for their children.\u003c/p>\n\u003cdiv class=\"page\" title=\"Page 2\">\n\u003cdiv class=\"layoutArea\">\n\u003cdiv class=\"column\">\n\u003cp>The telephone survey was conducted in English and Spanish Dec. 10-Jan. 3, 2016. A total of 1,253 interviews were completed, with an additional 250 interviews among the Latino registered voters statewide.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nearly four out of five registered voters — 78 percent — support a warning label on sugary beverages, according to a statewide Field Poll released Wednesday. More than half of those surveyed — 54 percent — “strongly” favor a label.\u003c/p>\n\u003cp>Overall support crossed party lines. “You see bipartisan support, although different levels of support,” said Mark DiCamillo, Field Poll director. Eighty-six percent of Democrats supported a label with 12 percent opposed; among Republicans, 60 percent supported and 37 percent opposed.\u003c/p>\n\u003cp>This is the second Field Poll in two years on the question, with a slight increase over the \u003ca href=\"http://www.field.com/fieldpollonline/subscribers/Rls2461.pdf\" target=\"_blank\" rel=\"noopener\">2014 results\u003c/a> showing 74 percent support.\u003c/p>\n\u003cp>Registered voters across the state were asked about their support for a warning stating: “Studies show that daily consumption of soda and other sugary drinks contributes to diabetes, obesity and tooth decay.”\u003c/p>\n\u003cp>The poll was commissioned by The California Endowment and the California Center for Public Health Advocacy. CCPHA executive director Harold Goldstein said he was “heartened” that even more voters support a warning label now than two years ago.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“What it means to us is voters in California want to know the scientific truth about the harmful effects of these sugary drinks,” Goldstein said, “and they want that information right there on the front of cans and bottles.”\u003c/p>\n\u003cp>Support was especially strong among Latino voters with 85 percent in favor and 13 percent opposed. Even among Latino Republican voters, support ran to 74 percent.\u003c/p>\n\u003cp>“There is not a single subgroup within Latino voting populations that opposes warning labels, at least that we could identify,” said DiCamillo. Latinos make up 23 percent of the state’s registered voters overall, he said, and “are a growing subgroup.”\u003c/p>\n\u003cp>Last year, the California Legislature considered \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB203\" target=\"_blank\" rel=\"noopener\">a bill\u003c/a> that would require a warning label on beverages with added sweeteners that exceeded 75 calories in 12 ounces. The bill stalled in the Senate Health committee when\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/30/health-advocates-frustrated-as-soda-warning-bill-dies/\" target=\"_blank\" rel=\"noopener\"> four members who were present at the hearing abstained from voting\u003c/a>.\u003c/p>\n\u003cp>In a statement Bob Achermann, executive director of CalBev, an industry group, said labels about calories and ingredients are already available and that a warning suggesting sugary beverages are a unique driver of obesity and diabetes would mislead people.\u003c/p>\n\u003cp>“The best way to promote balanced lifestyles is through fact-based information,” Achermann said, “rather than simplistic approaches that target just one product but don’t ultimately address complex health challenges.”\u003c/p>\n\u003cp>Numerous business groups have also voiced their opposition to warning labels.\u003c/p>\n\u003cp>The poll included two questions that asked respondents to select which of three beverages (a 12-ounce can) had the most sugar:\u003c/p>\n\u003cul>\n\u003cli>Coke (39 grams)\u003c/li>\n\u003cli>Minute Maid Lemonade (40 grams)\u003c/li>\n\u003cli>Hawaiian Punch (21 grams)\u003c/li>\n\u003c/ul>\n\u003cp>Only 7 percent of respondents correctly said the can of Minute Maid had the most sugar. In addition, 34 percent said Hawaiian Punch had the most sugar, even though it has about half the sugar content of Coke or Minute Maid Lemonade.\u003c/p>\n\u003cp>In the second question, people picked from:\u003c/p>\n\u003cul>\n\u003cli>O.N.E. Mango Coconut Water (30 grams)\u003c/li>\n\u003cli>Glaceau Orange Mango FruitWater (0 grams)\u003c/li>\n\u003cli>Honest Lemon Tea (21 grams)\u003c/li>\n\u003c/ul>\n\u003cp>Only 14 percent of people correctly picked the coconut water. Fully one-third of respondents — 33 percent — said the Glaceau FruitWater had the most sugar, even though it is a sugar-free drink; 32 percent picked the Honest Lemon Tea.\u003c/p>\n\u003cp>Goldstein, the public health advocate, said that marketers are “purposely confusing consumers” by using words like “honest” in the names of their products.\u003c/p>\n\u003cp>“One of the great benefits of a warning label is consumers will no longer be confused,” he said. When they’re grocery shopping, they don’t have to “wonder which (beverages) are harmful and which ones are not.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>When asked why they supported warning labels, 28.6 percent of respondents said that they would promote “greater personal responsibility” in helping people cut their sugar consumption, while 28 percent said consumers have a “right to know the truth” about harmful products. Another 21 percent said parents would be able to make more informed beverage choices for their children.\u003c/p>\n\u003cdiv class=\"page\" title=\"Page 2\">\n\u003cdiv class=\"layoutArea\">\n\u003cdiv class=\"column\">\n\u003cp>The telephone survey was conducted in English and Spanish Dec. 10-Jan. 3, 2016. A total of 1,253 interviews were completed, with an additional 250 interviews among the Latino registered voters statewide.\u003c/p>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\n\u003c/div>\u003c/p>",
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