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"content": "\u003cp>Five years ago, Congress promised an overhaul of the nation's food safety system, passing the Food Safety Modernization Act.\u003c/p>\n\u003cp>It took much longer than expected, but the Food and Drug Administration has now released the centerpiece — or at least, the most contested — part of that overhaul. These are rules that cover farmers who grow \u003ca href=\"http://www.fda.gov/Food/GuidanceRegulation/FSMA/ucm334114.htm#dates\" target=\"_blank\">fresh produce\u003c/a>, as well as \u003ca href=\"http://www.fda.gov/Food/GuidanceRegulation/FSMA/ucm361902.htm\" target=\"_blank\">food importers\u003c/a>.\u003c/p>\n\u003cp>\"This is a giant step forward,\" said Michael Taylor, the FDA's deputy commissioner for foods.\u003c/p>\n\u003cp>Earlier drafts of the regulations on vegetable farming generated howls of protest. The rules are intended to prevent disease-causing bacteria from contaminating vegetables that people often eat raw.\u003c/p>\n\u003cp>But small farmers, in particular, complained that some requirements, such as those calling for regular testing of irrigation water, were onerous and costly. Organic farmers \u003ca href=\"http://www.npr.org/sections/thesalt/2013/11/21/246386290/organic-farmers-bash-fda-restrictions-on-manure-use\" target=\"_blank\">protested\u003c/a> against restrictions on the use of manure for fertilizer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The final regulations contain compromises on some of those requirements. The FDA is conducting more research on the risks of using fresh manure, but in the meantime, it \"does not object\" to farmers simply following rules that already govern the use of manure in organic farming.\u003c/p>\n\u003cp>New regulations on food importers, meanwhile, require them to have programs in place to verify that their foreign suppliers are taking just as many safety precautions as farmers in the U.S. And the FDA will check up, sending safety inspectors around the world to visit food suppliers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Both rules will start to go into effect in two years. Enforcing the new rules will require a boost in the FDA's budget, and Congress will have to approve it. \"It will not succeed without resources,\" said the FDA's Taylor.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=It%27s+Final%3A+FDA+Issues+Long-Awaited+Food+Safety+Rules&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n",
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"content": "\u003cp>There are major differences in health care status among different types of Asians and Latinos in California -- and yet the state so far has resisted treating those subgroups differently, according to UCLA researchers who released an \u003ca href=\"http://healthpolicy.ucla.edu/newsroom/press-releases/pages/details.aspx?NewsID=231\" target=\"_blank\">updated version of health survey data \u003c/a>last month.\u003c/p>\n\u003cp>\"Data clearly show the need to disaggregate the Asian community and to some degree the Latino community,\" said David Grant, director of the \u003ca href=\"http://healthpolicy.ucla.edu/chis/about/Pages/about.aspx\" target=\"_blank\">California Health Interview Survey.\u003c/a>\u003c/p>\n\u003cp>For instance, he said, the state categorizes \"Asian\" as an ethnic group, but there are major differences between various Asian subgroups, and a similar trend has developed among various Latino cultures, as well.\u003c/p>\n\u003cp>\"Looking at different groups in the survey information busts a lot of myths,\" Grant said. \"Most people think about Asians as having health insurance and doing well, but if you break out the subgroups, you see that Koreans have a high uninsured rate of about 47 percent. Also, obesity levels among Asians in general are lower than the state averages, but Filipinos have a higher rate [of obesity] and double the diabetes rate.\"\u003c/p>\n\u003cp>Similar disparities in care and health crop up in the Latino population, too. Different subgroups experience the health care system differently, he said, depending on country of origin.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Their health needs are far from homogeneous,\" Grant said. \"And in terms of policy-making it's clear that different needs apply to different groups.\"\u003c/p>\n\u003cp>One bill dealing with the issue of ethnic subgroups was passed by the Legislature this year, but Gov. Jerry Brown vetoed it.\u003c/p>\n\u003cp>Brown called the bill \"unnecessary\" in his \u003ca href=\"https://www.gov.ca.gov/docs/AB_176_Veto_Message.pdf\" target=\"_blank\">veto message\u003c/a> for \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB176\" target=\"_blank\">AB 176\u003c/a> by Assembly member Rob Bonta, D-Oakland.\u003c/p>\n\u003cp>\"I am wary of the ever growing desire to stratify,\" Brown wrote. \"Dividing people into ethnic or other subcategories may yield more information, but not necessarily greater wisdom about what actions should follow.\"\u003c/p>\n\u003cp>To researchers who believe more information better informs policy, them's fighting words.\u003c/p>\n\u003cp>\"As long as the state puts its head in the sand and fails to acknowledge these differences,\" Grant said, \"they won't be able to address the disparities in health care within those groups.\"\u003c/p>\n\u003cp>Grant said the October release of updated survey data could help inform the discussion, for example, about insuring the undocumented population in California or addressing health disparities of specific ethnic population subsets.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The idea behind the profiles is to highlight information for groups that don't have a lot of data associated with them,\" Grant said. \"What's really unique here is the detailed breakdown of the variety of Latino and other ethnic groups. The power of these data is that we can show ... how the communities are different.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There are major differences in health care status among different types of Asians and Latinos in California -- and yet the state so far has resisted treating those subgroups differently, according to UCLA researchers who released an \u003ca href=\"http://healthpolicy.ucla.edu/newsroom/press-releases/pages/details.aspx?NewsID=231\" target=\"_blank\">updated version of health survey data \u003c/a>last month.\u003c/p>\n\u003cp>\"Data clearly show the need to disaggregate the Asian community and to some degree the Latino community,\" said David Grant, director of the \u003ca href=\"http://healthpolicy.ucla.edu/chis/about/Pages/about.aspx\" target=\"_blank\">California Health Interview Survey.\u003c/a>\u003c/p>\n\u003cp>For instance, he said, the state categorizes \"Asian\" as an ethnic group, but there are major differences between various Asian subgroups, and a similar trend has developed among various Latino cultures, as well.\u003c/p>\n\u003cp>\"Looking at different groups in the survey information busts a lot of myths,\" Grant said. \"Most people think about Asians as having health insurance and doing well, but if you break out the subgroups, you see that Koreans have a high uninsured rate of about 47 percent. Also, obesity levels among Asians in general are lower than the state averages, but Filipinos have a higher rate [of obesity] and double the diabetes rate.\"\u003c/p>\n\u003cp>Similar disparities in care and health crop up in the Latino population, too. Different subgroups experience the health care system differently, he said, depending on country of origin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Their health needs are far from homogeneous,\" Grant said. \"And in terms of policy-making it's clear that different needs apply to different groups.\"\u003c/p>\n\u003cp>One bill dealing with the issue of ethnic subgroups was passed by the Legislature this year, but Gov. Jerry Brown vetoed it.\u003c/p>\n\u003cp>Brown called the bill \"unnecessary\" in his \u003ca href=\"https://www.gov.ca.gov/docs/AB_176_Veto_Message.pdf\" target=\"_blank\">veto message\u003c/a> for \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB176\" target=\"_blank\">AB 176\u003c/a> by Assembly member Rob Bonta, D-Oakland.\u003c/p>\n\u003cp>\"I am wary of the ever growing desire to stratify,\" Brown wrote. \"Dividing people into ethnic or other subcategories may yield more information, but not necessarily greater wisdom about what actions should follow.\"\u003c/p>\n\u003cp>To researchers who believe more information better informs policy, them's fighting words.\u003c/p>\n\u003cp>\"As long as the state puts its head in the sand and fails to acknowledge these differences,\" Grant said, \"they won't be able to address the disparities in health care within those groups.\"\u003c/p>\n\u003cp>Grant said the October release of updated survey data could help inform the discussion, for example, about insuring the undocumented population in California or addressing health disparities of specific ethnic population subsets.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The idea behind the profiles is to highlight information for groups that don't have a lot of data associated with them,\" Grant said. \"What's really unique here is the detailed breakdown of the variety of Latino and other ethnic groups. The power of these data is that we can show ... how the communities are different.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Some days, Celia Díaz doesn’t want to get out of bed. But since she’s the major wage earner in her household, she doesn’t have much choice. Six days a week, she drags herself to the Santa Cruz restaurant where she works 10- and 12-hour days as head prep cook. She rarely gets a break and often goes the entire shift without sitting down. She’s developed arthritis in her fingers.\u003c/p>\n\u003caside class=\"pullquote alignright\">“Here in California, in America, people still aren’t making enough money to survive.\"\u003cbr>\n\u003ccite>Lizeth Vizcaya, UCSC student interviewer\u003c/cite>\u003c/aside>\n\u003cp>“There are times I want to quit,” she says in Spanish, while eating a breakfast of tortillas and frijoles in the dim light of her tiny kitchen. “But I can’t, because many jobs pay less for more work.”\u003c/p>\n\u003cp>Díaz, whose name has been changed to protect her privacy, has to work more than 60 hours a week in order to make ends meet on her $11.50 per hour wage. Still, her paycheck — which never includes overtime pay (she’s paid in cash for anything above 40 hours) —doesn’t come close to covering the cost of living in this coastal California town. She, her husband, their two small children and four other adults share a cramped two-bedroom apartment. A metal-framed bunk bed dominates the living room. The other adults in the house earn less money per hour than Díaz.\u003c/p>\n\u003cp>They are all members of Santa Cruz County’s working poor. This population of low-wage earners was the focus of a recent UC Santa Cruz study, “\u003ca href=\"http://workingfordignity.sites.ucsc.edu/wp-content/uploads/sites/192/2015/09/Final-Report-Working-for-Dignity-9-21-15.pdf\" target=\"_blank\">Working for Dignity\u003c/a>.\" Based on interviews with more than 1,300 people, researchers looked at working conditions of the county’s lowest-paid workers, and put a human face on the unseen labor force that supports the base of the Central Coast’s economy.\u003c/p>\n\u003cp>“This was a ‘census of the invisible,’ ” says lead author Steve McKay, an associate professor of sociology who also directs the UC Santa Cruz Center for Labor Studies. “Our goal was to look at the numbers, but also tell the stories of low-wage workers in Santa Cruz County.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The report’s release is timely. The Santa Cruz City Council is debating raising the minimum wage and recently commissioned a study looking at the impact of an increase. Other California cities have already begun raising their local minimum wage with San Francisco planning to reach $15 an hour by 2018 and Los Angeles planning to do the same by 2020.\u003c/p>\n\u003cp>\u003cstrong>Bridging the Town-Gown Gap\u003c/strong>\u003c/p>\n\u003cp>McKay conceived of the \"Working for Dignity\" study after he was contacted by the Watsonville office of California Rural Legal Assistance. The agency was looking for data on the low-wage earners of Santa Cruz County.\u003c/p>\n\u003cp>No such data existed.\u003c/p>\n\u003cp>So McKay launched the project, with an idea to use students to survey low-wage workers. He connected with the Chicano Latino Research Center on campus to train students how to conduct surveys and collect data. He also redesigned his “Work and Society” class into a research-based course. Students learned research methods, and then McKay sent them off on interviews.\u003c/p>\n\u003cfigure id=\"attachment_106567\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Veteran2-e1447269509837.jpg\">\u003cimg class=\"wp-image-106567 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Veteran2-400x500.jpg\" alt=\"Mario, a day laborer, looks for work at the Day Worker Center in Santa Cruz. \" width=\"400\" height=\"500\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mario, photographed while looking for work at the Day Worker Center in Santa Cruz. \u003ccite>(Edward Ramirez)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“There is often a town-gown split in university towns,” says McKay, referring to the divide that can exist between a campus that generally has money and people in the surrounding community who may not. “This project epitomizes the role that the university should play in the state, building new knowledge and training people to identify and respond to the needs of the local community.”\u003c/p>\n\u003cp>Students met with interviewees at bus stops, parks, laundromats and the farmer’s market in Watsonville’s central plaza. In addition to interviewing workers, students handed out information about workers' rights and where they could go for help if they suspect their rights are being violated.\u003c/p>\n\u003cp>More than 100 students were involved in different aspects of the two-year project.\u003c/p>\n\u003cp>“It was an eye-opening experience,” says Lizeth Vizcaya, a community studies major. She described interviewing a strawberry picker who was paid $9 for each box he filled with smaller cartons of fruit. After sorting through berries and discarding unripe or rotten fruit, labor he didn’t get paid for, Vizcaya says his average wage amounted to $4 an hour. “Here in California — in America — people still aren’t making enough money to survive,\" Vizcaya said.\u003c/p>\n\u003cp>To define low-wage worker, the study used the \u003ca href=\"http://web.stanford.edu/group/scspi/cpm_overview.html\" target=\"_blank\">California Poverty Measure\u003c/a> (CPM), an index designed by the Stanford Center on Poverty and Inequality to factor cost of living into the measure of poverty. By that measure, the poverty line for a family of four living in Santa Cruz County is $32,884, or an hourly wage of $15.81. Twenty-two percent of county residents live below the CPM.\u003c/p>\n\u003cp>“That’s not a living wage – it’s subsistence level,” says McKay. “People will be in real trouble if they fall below that.”\u003c/p>\n\u003cp>The median wage of those surveyed fell short of that poverty measure -- $10 an hour. And, like Díaz, nearly two-thirds of the surveyed group (62 percent) said they were the major earner for their household.\u003c/p>\n\u003cp>“Just try to imagine living in Santa Cruz on $10 an hour,” says McKay. “It would be really, really tough.”\u003c/p>\n\u003cp>The result is a vulnerable workforce, living paycheck to paycheck, dependent upon the whim of employers. Interviewees reported a high rate of labor violations, including wage theft, health and safety violations, sexual harassment and racial discrimination. Forty-one percent said they worked overtime hours and, of those, 38 percent did not receive overtime wages. More than seven in 10 (71 percent) said they either did not get breaks or did not get paid for breaks.\u003c/p>\n\u003cp>There was also racial disparity between the experiences of low-wage white workers versus low-wage Latino workers, the two main racial groups in Santa Cruz County. Of those who worked overtime, 28 percent of whites reported not receiving overtime pay, and 58 percent of Latinos reported not receiving overtime pay.\u003c/p>\n\u003cp>\u003cstrong>Putting a human face on labor\u003c/strong>\u003c/p>\n\u003cp>A primary goal of the “Working for Dignity” project was to document the human experience behind low-wage labor -- and to put a face on the often-invisible working poor. McKay partnered with the university’s Everett Program, which helps students develop skills to generate social change, \u003ca href=\"https://workingfordignity.ucsc.edu/about/\" target=\"_blank\">to create a website\u003c/a> that would feature digital stories and photographs of low-wage workers.\u003c/p>\n\u003cfigure id=\"attachment_106566\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Stirringg2-e1447269431836.jpg\">\u003cimg class=\"size-thumbnail wp-image-106566\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Stirringg2-400x322.jpg\" alt=\"James stirs a vat of kettle corn at the Watsonville Farmer's Market.\" width=\"400\" height=\"322\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">James stirs a vat of kettle corn at the Watsonville Farmer's Market. \u003ccite>(Edward Ramirez)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Student Edward Ramirez led the project’s documentary team during his senior year at UC Santa Cruz. Ramirez, a Los Angeles native, was attracted to the project because his parents, who immigrated to the U.S. from El Salvador during its Civil War, had scraped by as low-wage workers throughout his entire life. “I always wanted to give them honor, because society didn’t honor them,” he says.\u003c/p>\n\u003cp>Working with the local \u003ca href=\"http://dayworkercentersc.org\" target=\"_blank\">day labor center\u003c/a>, Ramirez set out to photograph people who sought day work in various jobs in the area.\u003c/p>\n\u003cp>One of the biggest rewards for Ramirez was giving the workers their portraits, mounted in wooden frames that he made by hand. “It was great seeing their faces looking at images of themselves,” he says. “They were filled with pride.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>A version of this story first appeared in the \u003ca href=\"http://www.healthycal.org\" target=\"_blank\">California Health Report.\u003c/a> \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Some days, Celia Díaz doesn’t want to get out of bed. But since she’s the major wage earner in her household, she doesn’t have much choice. Six days a week, she drags herself to the Santa Cruz restaurant where she works 10- and 12-hour days as head prep cook. She rarely gets a break and often goes the entire shift without sitting down. She’s developed arthritis in her fingers.\u003c/p>\n\u003caside class=\"pullquote alignright\">“Here in California, in America, people still aren’t making enough money to survive.\"\u003cbr>\n\u003ccite>Lizeth Vizcaya, UCSC student interviewer\u003c/cite>\u003c/aside>\n\u003cp>“There are times I want to quit,” she says in Spanish, while eating a breakfast of tortillas and frijoles in the dim light of her tiny kitchen. “But I can’t, because many jobs pay less for more work.”\u003c/p>\n\u003cp>Díaz, whose name has been changed to protect her privacy, has to work more than 60 hours a week in order to make ends meet on her $11.50 per hour wage. Still, her paycheck — which never includes overtime pay (she’s paid in cash for anything above 40 hours) —doesn’t come close to covering the cost of living in this coastal California town. She, her husband, their two small children and four other adults share a cramped two-bedroom apartment. A metal-framed bunk bed dominates the living room. The other adults in the house earn less money per hour than Díaz.\u003c/p>\n\u003cp>They are all members of Santa Cruz County’s working poor. This population of low-wage earners was the focus of a recent UC Santa Cruz study, “\u003ca href=\"http://workingfordignity.sites.ucsc.edu/wp-content/uploads/sites/192/2015/09/Final-Report-Working-for-Dignity-9-21-15.pdf\" target=\"_blank\">Working for Dignity\u003c/a>.\" Based on interviews with more than 1,300 people, researchers looked at working conditions of the county’s lowest-paid workers, and put a human face on the unseen labor force that supports the base of the Central Coast’s economy.\u003c/p>\n\u003cp>“This was a ‘census of the invisible,’ ” says lead author Steve McKay, an associate professor of sociology who also directs the UC Santa Cruz Center for Labor Studies. “Our goal was to look at the numbers, but also tell the stories of low-wage workers in Santa Cruz County.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The report’s release is timely. The Santa Cruz City Council is debating raising the minimum wage and recently commissioned a study looking at the impact of an increase. Other California cities have already begun raising their local minimum wage with San Francisco planning to reach $15 an hour by 2018 and Los Angeles planning to do the same by 2020.\u003c/p>\n\u003cp>\u003cstrong>Bridging the Town-Gown Gap\u003c/strong>\u003c/p>\n\u003cp>McKay conceived of the \"Working for Dignity\" study after he was contacted by the Watsonville office of California Rural Legal Assistance. The agency was looking for data on the low-wage earners of Santa Cruz County.\u003c/p>\n\u003cp>No such data existed.\u003c/p>\n\u003cp>So McKay launched the project, with an idea to use students to survey low-wage workers. He connected with the Chicano Latino Research Center on campus to train students how to conduct surveys and collect data. He also redesigned his “Work and Society” class into a research-based course. Students learned research methods, and then McKay sent them off on interviews.\u003c/p>\n\u003cfigure id=\"attachment_106567\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Veteran2-e1447269509837.jpg\">\u003cimg class=\"wp-image-106567 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Veteran2-400x500.jpg\" alt=\"Mario, a day laborer, looks for work at the Day Worker Center in Santa Cruz. \" width=\"400\" height=\"500\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mario, photographed while looking for work at the Day Worker Center in Santa Cruz. \u003ccite>(Edward Ramirez)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“There is often a town-gown split in university towns,” says McKay, referring to the divide that can exist between a campus that generally has money and people in the surrounding community who may not. “This project epitomizes the role that the university should play in the state, building new knowledge and training people to identify and respond to the needs of the local community.”\u003c/p>\n\u003cp>Students met with interviewees at bus stops, parks, laundromats and the farmer’s market in Watsonville’s central plaza. In addition to interviewing workers, students handed out information about workers' rights and where they could go for help if they suspect their rights are being violated.\u003c/p>\n\u003cp>More than 100 students were involved in different aspects of the two-year project.\u003c/p>\n\u003cp>“It was an eye-opening experience,” says Lizeth Vizcaya, a community studies major. She described interviewing a strawberry picker who was paid $9 for each box he filled with smaller cartons of fruit. After sorting through berries and discarding unripe or rotten fruit, labor he didn’t get paid for, Vizcaya says his average wage amounted to $4 an hour. “Here in California — in America — people still aren’t making enough money to survive,\" Vizcaya said.\u003c/p>\n\u003cp>To define low-wage worker, the study used the \u003ca href=\"http://web.stanford.edu/group/scspi/cpm_overview.html\" target=\"_blank\">California Poverty Measure\u003c/a> (CPM), an index designed by the Stanford Center on Poverty and Inequality to factor cost of living into the measure of poverty. By that measure, the poverty line for a family of four living in Santa Cruz County is $32,884, or an hourly wage of $15.81. Twenty-two percent of county residents live below the CPM.\u003c/p>\n\u003cp>“That’s not a living wage – it’s subsistence level,” says McKay. “People will be in real trouble if they fall below that.”\u003c/p>\n\u003cp>The median wage of those surveyed fell short of that poverty measure -- $10 an hour. And, like Díaz, nearly two-thirds of the surveyed group (62 percent) said they were the major earner for their household.\u003c/p>\n\u003cp>“Just try to imagine living in Santa Cruz on $10 an hour,” says McKay. “It would be really, really tough.”\u003c/p>\n\u003cp>The result is a vulnerable workforce, living paycheck to paycheck, dependent upon the whim of employers. Interviewees reported a high rate of labor violations, including wage theft, health and safety violations, sexual harassment and racial discrimination. Forty-one percent said they worked overtime hours and, of those, 38 percent did not receive overtime wages. More than seven in 10 (71 percent) said they either did not get breaks or did not get paid for breaks.\u003c/p>\n\u003cp>There was also racial disparity between the experiences of low-wage white workers versus low-wage Latino workers, the two main racial groups in Santa Cruz County. Of those who worked overtime, 28 percent of whites reported not receiving overtime pay, and 58 percent of Latinos reported not receiving overtime pay.\u003c/p>\n\u003cp>\u003cstrong>Putting a human face on labor\u003c/strong>\u003c/p>\n\u003cp>A primary goal of the “Working for Dignity” project was to document the human experience behind low-wage labor -- and to put a face on the often-invisible working poor. McKay partnered with the university’s Everett Program, which helps students develop skills to generate social change, \u003ca href=\"https://workingfordignity.ucsc.edu/about/\" target=\"_blank\">to create a website\u003c/a> that would feature digital stories and photographs of low-wage workers.\u003c/p>\n\u003cfigure id=\"attachment_106566\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Stirringg2-e1447269431836.jpg\">\u003cimg class=\"size-thumbnail wp-image-106566\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Stirringg2-400x322.jpg\" alt=\"James stirs a vat of kettle corn at the Watsonville Farmer's Market.\" width=\"400\" height=\"322\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">James stirs a vat of kettle corn at the Watsonville Farmer's Market. \u003ccite>(Edward Ramirez)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Student Edward Ramirez led the project’s documentary team during his senior year at UC Santa Cruz. Ramirez, a Los Angeles native, was attracted to the project because his parents, who immigrated to the U.S. from El Salvador during its Civil War, had scraped by as low-wage workers throughout his entire life. “I always wanted to give them honor, because society didn’t honor them,” he says.\u003c/p>\n\u003cp>Working with the local \u003ca href=\"http://dayworkercentersc.org\" target=\"_blank\">day labor center\u003c/a>, Ramirez set out to photograph people who sought day work in various jobs in the area.\u003c/p>\n\u003cp>One of the biggest rewards for Ramirez was giving the workers their portraits, mounted in wooden frames that he made by hand. “It was great seeing their faces looking at images of themselves,” he says. “They were filled with pride.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>A version of this story first appeared in the \u003ca href=\"http://www.healthycal.org\" target=\"_blank\">California Health Report.\u003c/a> \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "2 Million on Medi-Cal Face Different Appeals Process",
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"content": "\u003cp>Ben Fallstead, 28, was diagnosed several years ago with \u003ca href=\"http://www.cdc.gov/parasites/babesiosis/gen_info/faqs.html\" target=\"_blank\">babesiosis\u003c/a>, a tick-borne disease that left him exhausted, wracked with fevers and chronic joint pain and unable to hold a job.\u003c/p>\n\u003cp>After going through several antibiotics, his specialist prescribed one that brought him some relief.\u003c/p>\n\u003cp>“I was just getting to the point where I felt semi-normal,” he says.\u003c/p>\n\u003cp>But early last year, his managed care Medi-Cal plan told him it would not refill the medication, saying that it doesn’t support the long-term use of antibiotics, he says.\u003c/p>\n\u003cp>Since then, the Lake County man has been fighting his plan’s decision, waiting months for judges who aren’t medical experts to determine his medical fate.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Fallstead is among roughly 2 million Medi-Cal recipients who must use a different medical appeals process than most others on Medi-Cal. \u003ca href=\"http://www.dhcs.ca.gov/Services/medi-cal/pages/whatismedi-cal.aspx\" target=\"_blank\">Medi-Cal \u003c/a>is the state’s version of the federal Medicaid program that provides health insurance to low-income residents.\u003c/p>\n\u003cp>These Californians live in 22 counties, from Orange County to the Central Coast and rural Northern California. Unlike about 8 million other Medi-Cal enrollees in managed care, most of them can’t appeal their case to an independent physician.\u003c/p>\n\u003cp>Advocates, patients and some lawmakers say this has delayed critical treatments and is simply unfair.\u003c/p>\n\u003cp>“There should be uniformity in the protections of all Medi-Cal recipients,” says state Sen. Bill Monning, a Democrat whose district covers three affected counties: Monterey, Santa Cruz and San Luis Obispo.\u003c/p>\n\u003cp>Today, I’ll explain this inconsistency and offer advice to those people it affects.\u003c/p>\n\u003cp>\u003cb>Q: I live in Orange County and have Medi-Cal. I’m in the middle of cancer treatment but my health plan is making me get reapproved before I can continue. What are my options? \u003c/b>\u003c/p>\n\u003cp>A: If your medical plan makes a decision that you disagree with, such as not covering the medication or therapy your doctor has ordered, you usually start by appealing with the plan itself.\u003c/p>\n\u003cp>If the plan won’t budge, you move to the second level of appeals. This is where the difference lies.\u003c/p>\n\u003cp>The vast majority of managed care Medi-Cal recipients are in plans regulated by the state \u003ca href=\"https://www.dmhc.ca.gov/\" target=\"_blank\">Department of Managed Health Care\u003c/a>. They have access to something called an \u003ca href=\"https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReview(IMR).aspx#.VjpX0mSrTw4\" target=\"_blank\">Independent Medical Review \u003c/a>(IMR), which allows them to appeal their plan’s decision to an independent physician (or physicians) who are experts in the conditions being reviewed.\u003c/p>\n\u003cul>\n\u003cli>If your health issue is urgent, you can request an expedited IMR to be conducted within a week.\u003c/li>\n\u003cli>If it is not urgent, it is usually decided within 30 days.\u003c/li>\n\u003c/ul>\n\u003cp>But Orange County managed care Medi-Cal recipients receive coverage through a plan called a \u003ca href=\"http://www.healthconsumer.org/092914-ManagedCareinCaliforniaSeries-3-COHSMediCalPlans.pdf\" target=\"_blank\">County Organized Health System \u003c/a>(COHS).\u003c/p>\n\u003cp>There are six COHS plans, including \u003ca href=\"https://www.caloptima.org/\" target=\"_blank\">CalOptima\u003c/a> in Orange County and \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\">Partnership HealthPlan\u003c/a>, which covers 14 Northern California counties. If you’re in one of these counties, your local COHS plan is the only Medi-Cal plan available to you.\u003c/p>\n\u003cp>These publicly operated plans were exempted from certain requirements more than 30 years ago when they were much smaller entities.\u003c/p>\n\u003cp>That means you don’t have access to an IMR for your second layer of appeals. You must request a state fair hearing and plead your case before an administrative law judge who usually is not a medical expert.\u003c/p>\n\u003cul>\n\u003cli>The cases must be decided within 90 days after the Medi-Cal recipient requests a hearing, says Michael Weston, spokesman for the state \u003ca href=\"http://www.cdss.ca.gov/cdssweb/default.htm\" target=\"_blank\">Department of Social Services\u003c/a>, which conducts the hearings.\u003c/li>\n\u003cli>An enrollee whose health is in danger from delay may request an expedited hearing. If a judge agrees, a hearing will be scheduled within 10 days of the request and a decision rendered within five days after all evidence has been submitted, Weston says.\u003c/li>\n\u003c/ul>\n\u003cp>(There is an exception. \u003ca href=\"https://www.hpsm.org/\" target=\"_blank\">The Health Plan of San Mateo\u003c/a>, a COHS plan, has voluntarily agreed to be regulated by the Department of Managed Health Care, so its enrollees can request an IMR.)\u003c/p>\n\u003cp>Fallstead has requested two state fair hearings in the past two years. Both took longer than 90 days to resolve.\u003c/p>\n\u003cp>“I feel like they’re denying me medication,” he says. “It feels like I’m not a person to them.”\u003c/p>\n\u003cp>Liza Thantranon,\u003ca href=\"http://lsnc.info/\" target=\"_blank\"> Legal Services of Northern California\u003c/a>’s managing attorney for health, says she deals with this problem every day.\u003c/p>\n\u003cp>Her clients who have access to IMRs usually are able to resolve their cases within a month, she says. However, the majority of her COHS clients who request state fair hearings wait more than 90 days for a decision, some as long as six to eight months.\u003c/p>\n\u003cp>“In the middle, you have administrative law judges trying to evaluate which doctor is right,” Thantranon says. “They don’t know what the science is.”\u003c/p>\n\u003cp>Weston counters that the judges are trained to make “factual findings based on evidence, including the medical evidence provided by the plan and the doctor.”\u003c/p>\n\u003cp>The plans say they’re not against regulation, but over-regulation. They’re already regulated twice, by the federal and state governments, says Bob Freeman, CEO of \u003ca href=\"https://www.cencalhealth.org/\" target=\"_blank\">CenCal Health\u003c/a>, the COHS plan that covers about 165,000 Medi-Cal enrollees in San Luis Obispo and Santa Barbara Counties.\u003c/p>\n\u003cp>Adding this additional layer of regulation would require them to pay about $4 million collectively in fees each year to the Department of Managed Health Care, he says.\u003c/p>\n\u003cp>“Where’s the value to the taxpayer in that?” Freeman asks. “That money could go somewhere else.”\u003c/p>\n\u003cp>For those of you who are in a COHS plan, here are some tips on the appeal process:\u003c/p>\n\u003cul>\n\u003cli>If your plan denies the initial internal appeal, ask it to review its decision. At the same time, immediately request a state fair hearing. You can always withdraw from the hearing later if you’re able to resolve the problem directly with your health plan.\u003c/li>\n\u003cli>Request a state fair hearing by calling 855-795-0634 or email your request to \u003ca href=\"shdcsu@dss.ca.gov\" target=\"_blank\">shdcsu@dss.ca.gov\u003c/a>.\u003c/li>\n\u003cli>Before your hearing, gather medical evidence to bolster your case. “Ask your doctors to write letters of support,” Thantranon says. Your doctor can also participate in the hearing by phone, Weston says.\u003c/li>\n\u003cli>Get help from health care advocacy groups. The Health Consumer Alliance is a good place to start: \u003ca href=\"http://healthconsumer.org/\" target=\"_blank\">healthconsumer.org \u003c/a>and 888-804-3536.\u003c/li>\n\u003cli>If you’re unhappy with the state fair hearing decision, you may be able to request a rehearing or take your case to civil court, Weston says. You also can contact the \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx\" target=\"_blank\">Medi-Cal Managed Care Office of the Ombudsman\u003c/a> at 888-452-8609 or \u003ca href=\"MMCDOmbudsmanOffice@dhcs.ca.gov\" target=\"_blank\">MMCDOmbudsmanOffice@dhcs.ca.gov\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003ci>Questions for Emily: \u003c/i>\u003ci>\u003ca href=\"http://AskEmily@usc.edu\" target=\"_blank\">AskEmily@usc.edu\u003c/a>\u003c/i>\u003c/p>\n\u003cp>\u003cem>Read \u003ca href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\" target=\"_blank\">previous Ask Emily columns.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ci>The \u003ca href=\"http://www.centerforhealthreporting.org/\" target=\"_blank\">CHCF Center for Health Reporting\u003c/a> partners with news organizations to cover California health policy. Located at the \u003ca href=\"http://annenberg.usc.edu/\" target=\"_blank\">USC Annenberg School for Communication and Journalism\u003c/a>, it is funded by the nonpartisan \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California HealthCare Foundation\u003c/a>\u003c/i>.\u003c/p>\n\n",
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"excerpt": "While most appeals for most people on Medi-Cal are reviewed by independent doctors, some are decided by a judge who may not have a medical background.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Ben Fallstead, 28, was diagnosed several years ago with \u003ca href=\"http://www.cdc.gov/parasites/babesiosis/gen_info/faqs.html\" target=\"_blank\">babesiosis\u003c/a>, a tick-borne disease that left him exhausted, wracked with fevers and chronic joint pain and unable to hold a job.\u003c/p>\n\u003cp>After going through several antibiotics, his specialist prescribed one that brought him some relief.\u003c/p>\n\u003cp>“I was just getting to the point where I felt semi-normal,” he says.\u003c/p>\n\u003cp>But early last year, his managed care Medi-Cal plan told him it would not refill the medication, saying that it doesn’t support the long-term use of antibiotics, he says.\u003c/p>\n\u003cp>Since then, the Lake County man has been fighting his plan’s decision, waiting months for judges who aren’t medical experts to determine his medical fate.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Fallstead is among roughly 2 million Medi-Cal recipients who must use a different medical appeals process than most others on Medi-Cal. \u003ca href=\"http://www.dhcs.ca.gov/Services/medi-cal/pages/whatismedi-cal.aspx\" target=\"_blank\">Medi-Cal \u003c/a>is the state’s version of the federal Medicaid program that provides health insurance to low-income residents.\u003c/p>\n\u003cp>These Californians live in 22 counties, from Orange County to the Central Coast and rural Northern California. Unlike about 8 million other Medi-Cal enrollees in managed care, most of them can’t appeal their case to an independent physician.\u003c/p>\n\u003cp>Advocates, patients and some lawmakers say this has delayed critical treatments and is simply unfair.\u003c/p>\n\u003cp>“There should be uniformity in the protections of all Medi-Cal recipients,” says state Sen. Bill Monning, a Democrat whose district covers three affected counties: Monterey, Santa Cruz and San Luis Obispo.\u003c/p>\n\u003cp>Today, I’ll explain this inconsistency and offer advice to those people it affects.\u003c/p>\n\u003cp>\u003cb>Q: I live in Orange County and have Medi-Cal. I’m in the middle of cancer treatment but my health plan is making me get reapproved before I can continue. What are my options? \u003c/b>\u003c/p>\n\u003cp>A: If your medical plan makes a decision that you disagree with, such as not covering the medication or therapy your doctor has ordered, you usually start by appealing with the plan itself.\u003c/p>\n\u003cp>If the plan won’t budge, you move to the second level of appeals. This is where the difference lies.\u003c/p>\n\u003cp>The vast majority of managed care Medi-Cal recipients are in plans regulated by the state \u003ca href=\"https://www.dmhc.ca.gov/\" target=\"_blank\">Department of Managed Health Care\u003c/a>. They have access to something called an \u003ca href=\"https://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReview(IMR).aspx#.VjpX0mSrTw4\" target=\"_blank\">Independent Medical Review \u003c/a>(IMR), which allows them to appeal their plan’s decision to an independent physician (or physicians) who are experts in the conditions being reviewed.\u003c/p>\n\u003cul>\n\u003cli>If your health issue is urgent, you can request an expedited IMR to be conducted within a week.\u003c/li>\n\u003cli>If it is not urgent, it is usually decided within 30 days.\u003c/li>\n\u003c/ul>\n\u003cp>But Orange County managed care Medi-Cal recipients receive coverage through a plan called a \u003ca href=\"http://www.healthconsumer.org/092914-ManagedCareinCaliforniaSeries-3-COHSMediCalPlans.pdf\" target=\"_blank\">County Organized Health System \u003c/a>(COHS).\u003c/p>\n\u003cp>There are six COHS plans, including \u003ca href=\"https://www.caloptima.org/\" target=\"_blank\">CalOptima\u003c/a> in Orange County and \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\">Partnership HealthPlan\u003c/a>, which covers 14 Northern California counties. If you’re in one of these counties, your local COHS plan is the only Medi-Cal plan available to you.\u003c/p>\n\u003cp>These publicly operated plans were exempted from certain requirements more than 30 years ago when they were much smaller entities.\u003c/p>\n\u003cp>That means you don’t have access to an IMR for your second layer of appeals. You must request a state fair hearing and plead your case before an administrative law judge who usually is not a medical expert.\u003c/p>\n\u003cul>\n\u003cli>The cases must be decided within 90 days after the Medi-Cal recipient requests a hearing, says Michael Weston, spokesman for the state \u003ca href=\"http://www.cdss.ca.gov/cdssweb/default.htm\" target=\"_blank\">Department of Social Services\u003c/a>, which conducts the hearings.\u003c/li>\n\u003cli>An enrollee whose health is in danger from delay may request an expedited hearing. If a judge agrees, a hearing will be scheduled within 10 days of the request and a decision rendered within five days after all evidence has been submitted, Weston says.\u003c/li>\n\u003c/ul>\n\u003cp>(There is an exception. \u003ca href=\"https://www.hpsm.org/\" target=\"_blank\">The Health Plan of San Mateo\u003c/a>, a COHS plan, has voluntarily agreed to be regulated by the Department of Managed Health Care, so its enrollees can request an IMR.)\u003c/p>\n\u003cp>Fallstead has requested two state fair hearings in the past two years. Both took longer than 90 days to resolve.\u003c/p>\n\u003cp>“I feel like they’re denying me medication,” he says. “It feels like I’m not a person to them.”\u003c/p>\n\u003cp>Liza Thantranon,\u003ca href=\"http://lsnc.info/\" target=\"_blank\"> Legal Services of Northern California\u003c/a>’s managing attorney for health, says she deals with this problem every day.\u003c/p>\n\u003cp>Her clients who have access to IMRs usually are able to resolve their cases within a month, she says. However, the majority of her COHS clients who request state fair hearings wait more than 90 days for a decision, some as long as six to eight months.\u003c/p>\n\u003cp>“In the middle, you have administrative law judges trying to evaluate which doctor is right,” Thantranon says. “They don’t know what the science is.”\u003c/p>\n\u003cp>Weston counters that the judges are trained to make “factual findings based on evidence, including the medical evidence provided by the plan and the doctor.”\u003c/p>\n\u003cp>The plans say they’re not against regulation, but over-regulation. They’re already regulated twice, by the federal and state governments, says Bob Freeman, CEO of \u003ca href=\"https://www.cencalhealth.org/\" target=\"_blank\">CenCal Health\u003c/a>, the COHS plan that covers about 165,000 Medi-Cal enrollees in San Luis Obispo and Santa Barbara Counties.\u003c/p>\n\u003cp>Adding this additional layer of regulation would require them to pay about $4 million collectively in fees each year to the Department of Managed Health Care, he says.\u003c/p>\n\u003cp>“Where’s the value to the taxpayer in that?” Freeman asks. “That money could go somewhere else.”\u003c/p>\n\u003cp>For those of you who are in a COHS plan, here are some tips on the appeal process:\u003c/p>\n\u003cul>\n\u003cli>If your plan denies the initial internal appeal, ask it to review its decision. At the same time, immediately request a state fair hearing. You can always withdraw from the hearing later if you’re able to resolve the problem directly with your health plan.\u003c/li>\n\u003cli>Request a state fair hearing by calling 855-795-0634 or email your request to \u003ca href=\"shdcsu@dss.ca.gov\" target=\"_blank\">shdcsu@dss.ca.gov\u003c/a>.\u003c/li>\n\u003cli>Before your hearing, gather medical evidence to bolster your case. “Ask your doctors to write letters of support,” Thantranon says. Your doctor can also participate in the hearing by phone, Weston says.\u003c/li>\n\u003cli>Get help from health care advocacy groups. The Health Consumer Alliance is a good place to start: \u003ca href=\"http://healthconsumer.org/\" target=\"_blank\">healthconsumer.org \u003c/a>and 888-804-3536.\u003c/li>\n\u003cli>If you’re unhappy with the state fair hearing decision, you may be able to request a rehearing or take your case to civil court, Weston says. You also can contact the \u003ca href=\"http://www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx\" target=\"_blank\">Medi-Cal Managed Care Office of the Ombudsman\u003c/a> at 888-452-8609 or \u003ca href=\"MMCDOmbudsmanOffice@dhcs.ca.gov\" target=\"_blank\">MMCDOmbudsmanOffice@dhcs.ca.gov\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003ci>Questions for Emily: \u003c/i>\u003ci>\u003ca href=\"http://AskEmily@usc.edu\" target=\"_blank\">AskEmily@usc.edu\u003c/a>\u003c/i>\u003c/p>\n\u003cp>\u003cem>Read \u003ca href=\"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare\" target=\"_blank\">previous Ask Emily columns.\u003c/a>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "The Mendocino Coast Fears Losing Its Only Hospital",
"title": "The Mendocino Coast Fears Losing Its Only Hospital",
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"content": "\u003cp>Board meetings for the Mendocino Coast District Hospital are usually pretty dismal affairs. The facility in Fort Bragg, California, has been running at a deficit for a decade, and barely survived a recent bankruptcy. But finally, this September, the report from the finance committee wasn’t terrible.\u003c/p>\n\u003cp>“This is probably the first good news that I’ve experienced since I’ve been here,” said Bill Rohr, a doctor at the hospital for 11 years. “This is the first black ink that I’ve seen at the end of the month in quite some time.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'Nobody can live here without that hospital. The nearest hospital is an hour and a half away on treacherous mountain roads.'\u003cbr>\n\u003ccite>Sue Gibson, Mendocino resident\u003c/cite>\u003c/aside>\n\u003cp>The committee erupted into applause, even a few cheers. But the joy was short-lived. By the next month, the hospital was back in the red.\u003c/p>\n\u003cp>Things first started going badly for the hospital in 2002, when the lumber mill in Fort Bragg closed down. People lost their jobs -- and their health insurance, which paid good rates to the hospital. Today, about 7,000 people are left in the blue-collar town, and the economy is propped up by tourists who come to the rugged Mendocino coastline to hike or fish. Visiting the hospital does not usually make it onto their itinerary.\u003c/p>\n\u003cp>By 2012, the hospital declared bankruptcy. Now it’s barely hanging on. And some locals are worried that the only hospital in the area might close for good.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Nobody can live here without that hospital,” says Sue Gibson, 78, a Mendocino resident. “I mean the nearest hospital is an hour and a half away on treacherous mountain roads.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/231924129\" 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>It’s not only her family’s and the community’s health that Gibson is concerned about. She’s afraid the local economy would be wrecked. The hospital is the largest employer.\u003c/p>\n\u003cp>“It has probably the best-paying jobs, and if they close that, all of that income would go away,” she says.\u003c/p>\n\u003cp>That means less money spread around to the local bait shops and seafood restaurants.\u003c/p>\n\u003cp>Also, Gibson says, people's property values would plummet.\u003c/p>\n\u003cp>Across the country, rural communities share similar fears. Small rural hospitals everywhere have been struggling to survive. Many people who live in these areas are older or low income -- not a great customer base for a hospital to make good money.\u003c/p>\n\u003cfigure id=\"attachment_104334\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM.png\">\u003cimg class=\"size-thumbnail wp-image-104334\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-400x207.png\" alt=\"Mendocino Coast District Hospital in Fort Bragg. The hospital is struggling to find money to stay open.\" width=\"400\" height=\"207\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-400x207.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-800x415.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM.png 858w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mendocino Coast District Hospital in Fort Bragg. The hospital is struggling to find money to stay open. \u003ccite>(Google Street View)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The government used to pay these small \u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/CritAccessHospfctsht.pdf\" target=\"_blank\">critical access hospitals\u003c/a> extra to account for that. Medicare reimbursed them 101 percent of their reasonable costs. But after the recession, the government trimmed payments down to 99 percent of costs. Medicaid pays much less, sometimes just half the cost of providing the care.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>At the Mendocino Coast Hospital, more than 80 percent of patients are covered by Medicare or Medicaid.\u003c/p>\n\u003cp>“The general health care reimbursement environment is to do more with less,” says Bob Edwards, the hospital’s CEO. “And I would even go as far to say, it’s a starvation model.”\u003c/p>\n\u003cp>Plus, the government excludes a lot of expenses from its cost calculation, says Wade Sturgeon, CFO, like doctors’ fees or janitorial services. Medicare basically tells the hospital what it will pay.\u003c/p>\n\u003cp>“So it’d be like going in to Safeway and saying, ‘Hey, there’s a jug of milk. I really want that jug of milk, I’ll give you $2,’ ” Sturgeon explains. “But the price says $3.50. 'You’re only going to get $2.' Often times, that’s what happens to us.”\u003c/p>\n\u003cp>So, many hospitals that never had to worry about controlling costs -- now they do. They have to learn to compete in an open market, just like other hospitals, just like many other profit-driven businesses.\u003c/p>\n\u003cp>Some hospitals have planned ahead and adapted. Down the long winding road from Fort Bragg, the Frank R. Howard Memorial Hospital in Willits just finished a $64 million renovation, complete with modern technology and a full organic garden that supplies the hospital cafeteria.\u003c/p>\n\u003cp>But some hospitals haven’t adapted. In the last five years, 57 rural hospitals in the United States have closed, according to data from the \u003ca href=\"https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">Rural Health Research Program \u003c/a>at the University of North Carolina. Others have declared bankruptcy, like the Mendocino Coast District Hospital.\u003c/p>\n\u003cp>\u003cstrong>Battles Over How to Keep Hospital Afloat\u003c/strong>\u003c/p>\n\u003cp>The financial failure led to a lot of finger-pointing in this small town. Administrators blame the policy changes and payment reforms. Some doctors blame the administrators.\u003c/p>\n\u003cp>“It was economic mismanagement, to put a single label over all these things,” says Dr. Peter Glusker, a neurologist based in Fort Bragg for 37 years. “Because of people who just didn’t know any better.”\u003c/p>\n\u003cfigure id=\"attachment_104332\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/MCDH-e1446845198328.jpg\">\u003cimg class=\"wp-image-104332 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/MCDH-400x300.jpg\" alt=\"Mendocino Coast District Hospital CFO Wade Sturgeon (L) and board member Bill Rohr at a recent hospital board meeting.\" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mendocino Coast District Hospital CFO Wade Sturgeon (L) and board member Bill Rohr at a recent hospital board meeting. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The public hospital is governed by a five-member board of directors, elected from and by the community. Glusker says some past directors knew nothing about finance or nothing about health care. Some just stopped caring.\u003c/p>\n\u003cp>So he and another doctor ran their own campaign, promising to shake things up on the board and change things. They were elected last year.\u003c/p>\n\u003cp>“There’s a segment of the population that says, ‘Oh good, it’s about bloody time,’ ” Glusker says. “But there’s another segment of the population, in the institution, that says, ‘Hey, you’re rocking the boat and this is bad.’ ”\u003c/p>\n\u003cp>Glusker’s running mate and ally on the board is Dr. Bill Rohr, a steely orthopedist with long gray hair tied back in a tight ponytail. He spent many years in the corporate world and vowed to bring the kind of financial discipline he learned there to the tiny public hospital in Fort Bragg. A lot of people are afraid of him.\u003c/p>\n\u003cp>“Look, this is not about being ruthless,” he says. “It’s about keeping this business alive, and it’s only alive if it makes money, OK.”\u003c/p>\n\u003cp>A lot of his sentences are punctuated like this, with a sometimes impatient “OK,” which seems aimed at making sure you don’t miss his point. Like when he’s giving a presentation at a finance committee meeting, staring daggers down at the CEO.\u003c/p>\n\u003cp>“We keep saying $870,000 loss. Not acceptable, OK.”\u003c/p>\n\u003cp>The current CEO, Bob Edwards, has been on the job six months. He’s the hospital’s fourth chief executive in a year. His right-hand man is Wade Sturgeon, the brand-new CFO, who started in September.\u003c/p>\n\u003cp>On days the financial committee meets, Sturgeon wears a mint-green shirt and a tie with a $100 bill on it. He says things like, “Do the math.”\u003c/p>\n\u003cp>Right now, the hospital administrators and the doctors on the board are pitted against each other in a battle over how to keep the hospital doors open -– a battle that is echoed at small hospitals across the nation.\u003c/p>\n\u003caside class=\"pullquote alignright\">Cut costs or raise prices? Board members disagree on best approach\u003c/aside>\n\u003cp>CFO Sturgeon and CEO Edwards say the hospital should focus on increasing revenues. It should find more patients to come to the hospital, maybe develop new services to attract then.\u003c/p>\n\u003cp>“If you’re not growing, you’re dying,” Sturgeon says.\u003c/p>\n\u003cp>He says the hospital should also charge more money for services provided to patients who have private insurance -- currently about 15 percent of the hospital’s patients.\u003c/p>\n\u003cp>“Anytime we don’t raise prices, we’re leaving money on the table,” he says.\u003c/p>\n\u003cp>But Rohr says that would put an unfair burden on the small business owners in town, the ones who typically buy their own private insurance.\u003c/p>\n\u003cp>He and Glusker say the hospital should be focused on controlling costs.\u003c/p>\n\u003cp>“It’s obviously an expense problem,” Rohr says. \"And you can come to that conclusion very quickly, just by looking at the data.\"\u003c/p>\n\u003cp>He says the hospital is going to have to make some very difficult decisions to balance its budget. He offers this analogy:\u003c/p>\n\u003cp>“There’s 20 people in the water about to drown. And there’s a rowboat there, but the rowboat can only hold 10,” he says. “If 11 people get in that rowboat, it sinks and all die, OK.”\u003c/p>\n\u003cp>At the hospital, this means choosing between a cardiologist and an ophthalmologist, a cafeteria and a new X-ray machine.\u003c/p>\n\u003cp>“It’s horrible to make the decision that 10 are going to drown,” he says. “But I’ve got to pick the 10. OK.”\u003c/p>\n\u003cp>One area Rohr thinks could be ripe for trimming? Administrative positions.\u003c/p>\n\u003cp>“I walk into the hospital to do rounds in the morning, and there’s more people standing around with clipboards than with stethoscopes, and that doesn't feel like the right formula to me,” he says.\u003c/p>\n\u003cp>But CFO Sturgeon says there’s not enough management.\u003c/p>\n\u003cp>“Physicians always think there’s too much management,” he says. “You have some people with 50 direct reports. Does that make sense?”\u003c/p>\n\u003cp>There are some cuts both sides agree on. All say there needs to be some serious culling of the health benefits for hospital staff. Years ago, the nurses union negotiated to have the hospital pay full health benefits for any full-time or part-time nurse and their entire families. Nurses pay nothing toward their monthly premiums.\u003c/p>\n\u003cp>“Do the math. How many people are we paying for to have full family coverage?” Sturgeon says. “I’ve never worked in a hospital that provided the type of health insurance benefits that we have at this facility.”\u003c/p>\n\u003cp>\u003cstrong>Meanwhile, Need for New Hospital\u003c/strong>\u003c/p>\n\u003cp>To understand exactly how dire the financial situation is, one need only walk into the lobby of the hospital itself. It’s like stepping back into 1971. The main patient floor is lined with drab brown carpets. The smell of Salisbury steak spills out of patient rooms.\u003c/p>\n\u003cp>“I’ve been in Third World countries. This is pretty basic, OK,” Rohr says, walking by the operating suite.\u003c/p>\n\u003cp>Through the maternity ward and the emergency room, Rohr says the flooring is layered with asbestos. The concrete isn’t strong enough to hold the weight of modern-day CAT scanners and MRI machines. On top of all that, in 2030 new state requirements kick in for earthquake readiness. It all points to one conclusion.\u003c/p>\n\u003cp>“We’re going to have to build a new hospital,” Rohr says.\u003c/p>\n\u003cp>So, not only is the hospital struggling to maintain a balanced budget through normal hospital operations, it also has to come up with tens of millions of dollars to replace itself in 15 years.\u003c/p>\n\u003cp>It's an especially tall order for a hospital that just posted its first monthly profit in a decade, then slipped into the red again right away.\u003c/p>\n\u003cp>If you ask the Washington policymakers in charge of payment reform, some will say it’s just a harsh reality that some hospitals will have to close. Some previous local administrators have predicted that the Fort Bragg hospital will one day be replaced by a helicopter landing pad. People will be airlifted out for heart attacks and other emergencies. For other planned surgeries, like hip replacements, people will have to drive “over the hill” to another hospital.\u003c/p>\n\u003cp>But the people who live in Fort Bragg and Mendocino don’t like that scenario. Sue Gibson has been hosting community meetings in her living room, where people spread out on the pink Victorian sofas to talk about how to save the hospital.\u003c/p>\n\u003cp>She’s rallying support for a possible solution to the hospital’s financial woes, and it’s one the administrators and doctors are united around: a new tax on homeowners. Local residents will likely vote on it in November 2016.\u003c/p>\n\u003cp>“The only way we're going to be able to save this place, really, is with a parcel tax,” she says. “But they can't even think about that until they clean up their act.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>After the Wall Street meltdown, banks were too big to fail. The feeling here is that the local hospital is too important to fail. And the residents will be tapped to fund the bailout.\u003c/p>\n\n",
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"excerpt": "Saving the Fort Bragg hospital from bankruptcy has sparked a small town drama, pitting hospital administrators and doctors against each other. \r\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Board meetings for the Mendocino Coast District Hospital are usually pretty dismal affairs. The facility in Fort Bragg, California, has been running at a deficit for a decade, and barely survived a recent bankruptcy. But finally, this September, the report from the finance committee wasn’t terrible.\u003c/p>\n\u003cp>“This is probably the first good news that I’ve experienced since I’ve been here,” said Bill Rohr, a doctor at the hospital for 11 years. “This is the first black ink that I’ve seen at the end of the month in quite some time.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'Nobody can live here without that hospital. The nearest hospital is an hour and a half away on treacherous mountain roads.'\u003cbr>\n\u003ccite>Sue Gibson, Mendocino resident\u003c/cite>\u003c/aside>\n\u003cp>The committee erupted into applause, even a few cheers. But the joy was short-lived. By the next month, the hospital was back in the red.\u003c/p>\n\u003cp>Things first started going badly for the hospital in 2002, when the lumber mill in Fort Bragg closed down. People lost their jobs -- and their health insurance, which paid good rates to the hospital. Today, about 7,000 people are left in the blue-collar town, and the economy is propped up by tourists who come to the rugged Mendocino coastline to hike or fish. Visiting the hospital does not usually make it onto their itinerary.\u003c/p>\n\u003cp>By 2012, the hospital declared bankruptcy. Now it’s barely hanging on. And some locals are worried that the only hospital in the area might close for good.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Nobody can live here without that hospital,” says Sue Gibson, 78, a Mendocino resident. “I mean the nearest hospital is an hour and a half away on treacherous mountain roads.”\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/231924129&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/231924129'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>It’s not only her family’s and the community’s health that Gibson is concerned about. She’s afraid the local economy would be wrecked. The hospital is the largest employer.\u003c/p>\n\u003cp>“It has probably the best-paying jobs, and if they close that, all of that income would go away,” she says.\u003c/p>\n\u003cp>That means less money spread around to the local bait shops and seafood restaurants.\u003c/p>\n\u003cp>Also, Gibson says, people's property values would plummet.\u003c/p>\n\u003cp>Across the country, rural communities share similar fears. Small rural hospitals everywhere have been struggling to survive. Many people who live in these areas are older or low income -- not a great customer base for a hospital to make good money.\u003c/p>\n\u003cfigure id=\"attachment_104334\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM.png\">\u003cimg class=\"size-thumbnail wp-image-104334\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-400x207.png\" alt=\"Mendocino Coast District Hospital in Fort Bragg. The hospital is struggling to find money to stay open.\" width=\"400\" height=\"207\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-400x207.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM-800x415.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/Screen-Shot-2015-11-06-at-1.34.07-PM.png 858w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mendocino Coast District Hospital in Fort Bragg. The hospital is struggling to find money to stay open. \u003ccite>(Google Street View)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The government used to pay these small \u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/CritAccessHospfctsht.pdf\" target=\"_blank\">critical access hospitals\u003c/a> extra to account for that. Medicare reimbursed them 101 percent of their reasonable costs. But after the recession, the government trimmed payments down to 99 percent of costs. Medicaid pays much less, sometimes just half the cost of providing the care.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>At the Mendocino Coast Hospital, more than 80 percent of patients are covered by Medicare or Medicaid.\u003c/p>\n\u003cp>“The general health care reimbursement environment is to do more with less,” says Bob Edwards, the hospital’s CEO. “And I would even go as far to say, it’s a starvation model.”\u003c/p>\n\u003cp>Plus, the government excludes a lot of expenses from its cost calculation, says Wade Sturgeon, CFO, like doctors’ fees or janitorial services. Medicare basically tells the hospital what it will pay.\u003c/p>\n\u003cp>“So it’d be like going in to Safeway and saying, ‘Hey, there’s a jug of milk. I really want that jug of milk, I’ll give you $2,’ ” Sturgeon explains. “But the price says $3.50. 'You’re only going to get $2.' Often times, that’s what happens to us.”\u003c/p>\n\u003cp>So, many hospitals that never had to worry about controlling costs -- now they do. They have to learn to compete in an open market, just like other hospitals, just like many other profit-driven businesses.\u003c/p>\n\u003cp>Some hospitals have planned ahead and adapted. Down the long winding road from Fort Bragg, the Frank R. Howard Memorial Hospital in Willits just finished a $64 million renovation, complete with modern technology and a full organic garden that supplies the hospital cafeteria.\u003c/p>\n\u003cp>But some hospitals haven’t adapted. In the last five years, 57 rural hospitals in the United States have closed, according to data from the \u003ca href=\"https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/\">Rural Health Research Program \u003c/a>at the University of North Carolina. Others have declared bankruptcy, like the Mendocino Coast District Hospital.\u003c/p>\n\u003cp>\u003cstrong>Battles Over How to Keep Hospital Afloat\u003c/strong>\u003c/p>\n\u003cp>The financial failure led to a lot of finger-pointing in this small town. Administrators blame the policy changes and payment reforms. Some doctors blame the administrators.\u003c/p>\n\u003cp>“It was economic mismanagement, to put a single label over all these things,” says Dr. Peter Glusker, a neurologist based in Fort Bragg for 37 years. “Because of people who just didn’t know any better.”\u003c/p>\n\u003cfigure id=\"attachment_104332\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/MCDH-e1446845198328.jpg\">\u003cimg class=\"wp-image-104332 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/MCDH-400x300.jpg\" alt=\"Mendocino Coast District Hospital CFO Wade Sturgeon (L) and board member Bill Rohr at a recent hospital board meeting.\" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mendocino Coast District Hospital CFO Wade Sturgeon (L) and board member Bill Rohr at a recent hospital board meeting. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The public hospital is governed by a five-member board of directors, elected from and by the community. Glusker says some past directors knew nothing about finance or nothing about health care. Some just stopped caring.\u003c/p>\n\u003cp>So he and another doctor ran their own campaign, promising to shake things up on the board and change things. They were elected last year.\u003c/p>\n\u003cp>“There’s a segment of the population that says, ‘Oh good, it’s about bloody time,’ ” Glusker says. “But there’s another segment of the population, in the institution, that says, ‘Hey, you’re rocking the boat and this is bad.’ ”\u003c/p>\n\u003cp>Glusker’s running mate and ally on the board is Dr. Bill Rohr, a steely orthopedist with long gray hair tied back in a tight ponytail. He spent many years in the corporate world and vowed to bring the kind of financial discipline he learned there to the tiny public hospital in Fort Bragg. A lot of people are afraid of him.\u003c/p>\n\u003cp>“Look, this is not about being ruthless,” he says. “It’s about keeping this business alive, and it’s only alive if it makes money, OK.”\u003c/p>\n\u003cp>A lot of his sentences are punctuated like this, with a sometimes impatient “OK,” which seems aimed at making sure you don’t miss his point. Like when he’s giving a presentation at a finance committee meeting, staring daggers down at the CEO.\u003c/p>\n\u003cp>“We keep saying $870,000 loss. Not acceptable, OK.”\u003c/p>\n\u003cp>The current CEO, Bob Edwards, has been on the job six months. He’s the hospital’s fourth chief executive in a year. His right-hand man is Wade Sturgeon, the brand-new CFO, who started in September.\u003c/p>\n\u003cp>On days the financial committee meets, Sturgeon wears a mint-green shirt and a tie with a $100 bill on it. He says things like, “Do the math.”\u003c/p>\n\u003cp>Right now, the hospital administrators and the doctors on the board are pitted against each other in a battle over how to keep the hospital doors open -– a battle that is echoed at small hospitals across the nation.\u003c/p>\n\u003caside class=\"pullquote alignright\">Cut costs or raise prices? Board members disagree on best approach\u003c/aside>\n\u003cp>CFO Sturgeon and CEO Edwards say the hospital should focus on increasing revenues. It should find more patients to come to the hospital, maybe develop new services to attract then.\u003c/p>\n\u003cp>“If you’re not growing, you’re dying,” Sturgeon says.\u003c/p>\n\u003cp>He says the hospital should also charge more money for services provided to patients who have private insurance -- currently about 15 percent of the hospital’s patients.\u003c/p>\n\u003cp>“Anytime we don’t raise prices, we’re leaving money on the table,” he says.\u003c/p>\n\u003cp>But Rohr says that would put an unfair burden on the small business owners in town, the ones who typically buy their own private insurance.\u003c/p>\n\u003cp>He and Glusker say the hospital should be focused on controlling costs.\u003c/p>\n\u003cp>“It’s obviously an expense problem,” Rohr says. \"And you can come to that conclusion very quickly, just by looking at the data.\"\u003c/p>\n\u003cp>He says the hospital is going to have to make some very difficult decisions to balance its budget. He offers this analogy:\u003c/p>\n\u003cp>“There’s 20 people in the water about to drown. And there’s a rowboat there, but the rowboat can only hold 10,” he says. “If 11 people get in that rowboat, it sinks and all die, OK.”\u003c/p>\n\u003cp>At the hospital, this means choosing between a cardiologist and an ophthalmologist, a cafeteria and a new X-ray machine.\u003c/p>\n\u003cp>“It’s horrible to make the decision that 10 are going to drown,” he says. “But I’ve got to pick the 10. OK.”\u003c/p>\n\u003cp>One area Rohr thinks could be ripe for trimming? Administrative positions.\u003c/p>\n\u003cp>“I walk into the hospital to do rounds in the morning, and there’s more people standing around with clipboards than with stethoscopes, and that doesn't feel like the right formula to me,” he says.\u003c/p>\n\u003cp>But CFO Sturgeon says there’s not enough management.\u003c/p>\n\u003cp>“Physicians always think there’s too much management,” he says. “You have some people with 50 direct reports. Does that make sense?”\u003c/p>\n\u003cp>There are some cuts both sides agree on. All say there needs to be some serious culling of the health benefits for hospital staff. Years ago, the nurses union negotiated to have the hospital pay full health benefits for any full-time or part-time nurse and their entire families. Nurses pay nothing toward their monthly premiums.\u003c/p>\n\u003cp>“Do the math. How many people are we paying for to have full family coverage?” Sturgeon says. “I’ve never worked in a hospital that provided the type of health insurance benefits that we have at this facility.”\u003c/p>\n\u003cp>\u003cstrong>Meanwhile, Need for New Hospital\u003c/strong>\u003c/p>\n\u003cp>To understand exactly how dire the financial situation is, one need only walk into the lobby of the hospital itself. It’s like stepping back into 1971. The main patient floor is lined with drab brown carpets. The smell of Salisbury steak spills out of patient rooms.\u003c/p>\n\u003cp>“I’ve been in Third World countries. This is pretty basic, OK,” Rohr says, walking by the operating suite.\u003c/p>\n\u003cp>Through the maternity ward and the emergency room, Rohr says the flooring is layered with asbestos. The concrete isn’t strong enough to hold the weight of modern-day CAT scanners and MRI machines. On top of all that, in 2030 new state requirements kick in for earthquake readiness. It all points to one conclusion.\u003c/p>\n\u003cp>“We’re going to have to build a new hospital,” Rohr says.\u003c/p>\n\u003cp>So, not only is the hospital struggling to maintain a balanced budget through normal hospital operations, it also has to come up with tens of millions of dollars to replace itself in 15 years.\u003c/p>\n\u003cp>It's an especially tall order for a hospital that just posted its first monthly profit in a decade, then slipped into the red again right away.\u003c/p>\n\u003cp>If you ask the Washington policymakers in charge of payment reform, some will say it’s just a harsh reality that some hospitals will have to close. Some previous local administrators have predicted that the Fort Bragg hospital will one day be replaced by a helicopter landing pad. People will be airlifted out for heart attacks and other emergencies. For other planned surgeries, like hip replacements, people will have to drive “over the hill” to another hospital.\u003c/p>\n\u003cp>But the people who live in Fort Bragg and Mendocino don’t like that scenario. Sue Gibson has been hosting community meetings in her living room, where people spread out on the pink Victorian sofas to talk about how to save the hospital.\u003c/p>\n\u003cp>She’s rallying support for a possible solution to the hospital’s financial woes, and it’s one the administrators and doctors are united around: a new tax on homeowners. Local residents will likely vote on it in November 2016.\u003c/p>\n\u003cp>“The only way we're going to be able to save this place, really, is with a parcel tax,” she says. “But they can't even think about that until they clean up their act.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After the Wall Street meltdown, banks were too big to fail. The feeling here is that the local hospital is too important to fail. And the residents will be tapped to fund the bailout.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Cancer Patients on Medi-Cal Do Worse Than Those with Other Insurance",
"title": "Cancer Patients on Medi-Cal Do Worse Than Those with Other Insurance",
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"content": "\u003cp>Cancer patients with Medi-Cal are less likely to get recommended treatment and also have lower survival rates than patients with other types of insurance, according to a \u003ca href=\"https://www.ucdmc.ucdavis.edu/iphi/resources/1117737_CancerHI_100615.pdf\" target=\"_blank\">study\u003c/a> by UC Davis researchers. Medi-Cal is California's version of Medicaid, health insurance for people who are low income.\u003c/p>\n\u003caside class=\"pullquote alignright\">“What’s particularly poignant is that we’re seeing these big disparate outcomes among groups in cancers where we have strong playbooks.\"\u003cbr>\n\u003ccite>Christina Clarke, Cancer Prevention Institute of California\u003c/cite>\u003c/aside>\n\u003cp>While other \u003ca href=\"http://consumer.healthday.com/cancer-information-5/breast-cancer-news-94/medicaid-patients-get-worse-cancer-care-studies-contend-688451.html\" target=\"_blank\">studies\u003c/a> have linked Medicaid insurance status to worse cancer outcomes, the UC Davis study appears to be the first to examine the impact of various kinds of health insurance across more than one kind of cancer.\u003c/p>\n\u003cp>Understanding how well Medi-Cal serves cancer patients is crucial, experts say, because as much as 10 percent of Medi-Cal expenditures go to cancer care. And under the Affordable Care Act, the program has grown to cover more than 12 million Californians – nearly a third of the state’s population.\u003c/p>\n\u003cp>“What’s striking is how similar the findings were for Medi-Cal members and the uninsured,” said Dr. Kenneth Kizer, director of the UC Davis’ Institute for Population Health Improvement, which conducted the study. “If we weren’t spending billions of Medi-Cal dollars on cancer care perhaps that would not be surprising, but you’d think that the outcomes might be better when you’re spending that much money.”\u003c/p>\n\u003cp>The UC Davis researchers used \u003ca href=\"http://www.ccrcal.org/\" target=\"_blank\">California Cancer Registry\u003c/a> data to study the experiences of approximately 700,000 Californians diagnosed with breast, colon, rectal, lung, and prostate cancer between 2004 and 2012. They tracked how early these patients were diagnosed, their quality of treatment and their five-year relative survival rates according to their type of insurance. The types were Medi-Cal, Medicare, dual Medi-Cal/Medicare (for lowest-income seniors), private insurance, Department of Defense (DOD) insurance and Department of Veterans Affairs (VA) insurance.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Among the findings:\u003c/p>\n\u003cul>\n\u003cli>Medi-Cal patients were diagnosed with advanced (stage IV) prostate cancer more than three times as often as patients with private insurance or DOD coverage.\u003c/li>\n\u003cli>Medi-Cal patients with breast, colon or rectal cancer were more likely to be diagnosed at an advanced stage and to have worse five-year survival rates than people with other types of insurance.\u003c/li>\n\u003cli>Low-income seniors covered by Medicare and Medi-Cal, known as “dual-eligible patients,” were the least likely to receive recommended treatment for breast and colon cancer.\u003c/li>\n\u003cli>VA patients waited the longest to be treated for breast, colon, rectal, lung and prostate cancers, but their outcomes compared favorably to patients with other types of health insurance and they were generally more likely to receive recommended treatment.\u003c/li>\n\u003c/ul>\n\u003cp>What researchers still don’t know, Kizer said, is the reason for these disparities. It’s possible that Medi-Cal patients drop on and off the rolls, missing preventive screenings that could help detect cancers earlier. \u003ca href=\"http://khn.org/news/state-auditor-slams-californias-oversight-of-medi-cal-plans-used-by-9-million/\" target=\"_blank\">Audits\u003c/a> and studies also have shown that some of the state’s Medi-Cal patients have difficulty getting access to doctors and specialists.\u003c/p>\n\u003cp>Researchers also can’t explain why Medi-Cal patients are less likely than patients with other kinds of insurance to receive recommended treatment after they are diagnosed. And they also don’t know whether cancer patients fare better or worse in Medi-Cal managed care programs, which now cover most of the Medi-Cal population.\u003c/p>\n\u003cp>“It’s not acceptable to have these variations” based on insurance coverage, particularly regarding breast and colon cancers for which preventive screenings are well-established and effective, said Christina Clarke, a research scientist at the Cancer Prevention Institute of California and a consulting associate professor at the Stanford University School of Medicine. She was not involved in the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“What’s particularly poignant is that we’re seeing these big disparate outcomes among groups in cancers where we have strong playbooks. That’s the tragic thing here,” Clarke said. “There’s a body count and we’d like to figure out a better way to insure that all Californians are getting the recommended screening for these deadly cancers and treatment according to guidelines. We have a lot of work to do.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cancer patients with Medi-Cal are less likely to get recommended treatment and also have lower survival rates than patients with other types of insurance, according to a \u003ca href=\"https://www.ucdmc.ucdavis.edu/iphi/resources/1117737_CancerHI_100615.pdf\" target=\"_blank\">study\u003c/a> by UC Davis researchers. Medi-Cal is California's version of Medicaid, health insurance for people who are low income.\u003c/p>\n\u003caside class=\"pullquote alignright\">“What’s particularly poignant is that we’re seeing these big disparate outcomes among groups in cancers where we have strong playbooks.\"\u003cbr>\n\u003ccite>Christina Clarke, Cancer Prevention Institute of California\u003c/cite>\u003c/aside>\n\u003cp>While other \u003ca href=\"http://consumer.healthday.com/cancer-information-5/breast-cancer-news-94/medicaid-patients-get-worse-cancer-care-studies-contend-688451.html\" target=\"_blank\">studies\u003c/a> have linked Medicaid insurance status to worse cancer outcomes, the UC Davis study appears to be the first to examine the impact of various kinds of health insurance across more than one kind of cancer.\u003c/p>\n\u003cp>Understanding how well Medi-Cal serves cancer patients is crucial, experts say, because as much as 10 percent of Medi-Cal expenditures go to cancer care. And under the Affordable Care Act, the program has grown to cover more than 12 million Californians – nearly a third of the state’s population.\u003c/p>\n\u003cp>“What’s striking is how similar the findings were for Medi-Cal members and the uninsured,” said Dr. Kenneth Kizer, director of the UC Davis’ Institute for Population Health Improvement, which conducted the study. “If we weren’t spending billions of Medi-Cal dollars on cancer care perhaps that would not be surprising, but you’d think that the outcomes might be better when you’re spending that much money.”\u003c/p>\n\u003cp>The UC Davis researchers used \u003ca href=\"http://www.ccrcal.org/\" target=\"_blank\">California Cancer Registry\u003c/a> data to study the experiences of approximately 700,000 Californians diagnosed with breast, colon, rectal, lung, and prostate cancer between 2004 and 2012. They tracked how early these patients were diagnosed, their quality of treatment and their five-year relative survival rates according to their type of insurance. The types were Medi-Cal, Medicare, dual Medi-Cal/Medicare (for lowest-income seniors), private insurance, Department of Defense (DOD) insurance and Department of Veterans Affairs (VA) insurance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Among the findings:\u003c/p>\n\u003cul>\n\u003cli>Medi-Cal patients were diagnosed with advanced (stage IV) prostate cancer more than three times as often as patients with private insurance or DOD coverage.\u003c/li>\n\u003cli>Medi-Cal patients with breast, colon or rectal cancer were more likely to be diagnosed at an advanced stage and to have worse five-year survival rates than people with other types of insurance.\u003c/li>\n\u003cli>Low-income seniors covered by Medicare and Medi-Cal, known as “dual-eligible patients,” were the least likely to receive recommended treatment for breast and colon cancer.\u003c/li>\n\u003cli>VA patients waited the longest to be treated for breast, colon, rectal, lung and prostate cancers, but their outcomes compared favorably to patients with other types of health insurance and they were generally more likely to receive recommended treatment.\u003c/li>\n\u003c/ul>\n\u003cp>What researchers still don’t know, Kizer said, is the reason for these disparities. It’s possible that Medi-Cal patients drop on and off the rolls, missing preventive screenings that could help detect cancers earlier. \u003ca href=\"http://khn.org/news/state-auditor-slams-californias-oversight-of-medi-cal-plans-used-by-9-million/\" target=\"_blank\">Audits\u003c/a> and studies also have shown that some of the state’s Medi-Cal patients have difficulty getting access to doctors and specialists.\u003c/p>\n\u003cp>Researchers also can’t explain why Medi-Cal patients are less likely than patients with other kinds of insurance to receive recommended treatment after they are diagnosed. And they also don’t know whether cancer patients fare better or worse in Medi-Cal managed care programs, which now cover most of the Medi-Cal population.\u003c/p>\n\u003cp>“It’s not acceptable to have these variations” based on insurance coverage, particularly regarding breast and colon cancers for which preventive screenings are well-established and effective, said Christina Clarke, a research scientist at the Cancer Prevention Institute of California and a consulting associate professor at the Stanford University School of Medicine. She was not involved in the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“What’s particularly poignant is that we’re seeing these big disparate outcomes among groups in cancers where we have strong playbooks. That’s the tragic thing here,” Clarke said. “There’s a body count and we’d like to figure out a better way to insure that all Californians are getting the recommended screening for these deadly cancers and treatment according to guidelines. We have a lot of work to do.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California’s Pressing Need for Latino and Black Nurses",
"title": "California’s Pressing Need for Latino and Black Nurses",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>East Oakland's Allen Temple Baptist Church is buzzing with chatter and upbeat music. On this warm Saturday morning, the church is hosting its annual holistic health fair.\u003c/p>\n\u003cp>Students from Oakland's Samuel Merritt University, clad in blue scrubs, hustle to give eye exams and check blood pressure.\u003c/p>\n\u003cp>A couple tables down, Samuel Merritt's chief diversity officer, Shirley Strong, hopes to address prospective students. The Oakland-based university is one of the three biggest programs for registered nursing students in California and is committed to reducing health disparities by recruiting more students of color .\u003c/p>\n\u003cp>\"The work of diversity at Samuel Merritt involves recruiting faculty, staff and students of color particularly,\" Strong says, especially \"African-American/black, Latino/Hispanic students because they’re the ones underrepresented in our community.\"\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/231710622\" 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>Last May, Samuel Merritt University's nursing program graduated its second-largest class of African-American and Latino students, including 10 African-Americans and 28 Latinos.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“What we’d like to do is train more (registered nurses) and more case managers and more nurse practitioners, people who are really in decision-making roles in hospitals,” says Strong.\u003c/p>\n\u003cp>\u003cstrong>Black and Latino Registered Nurses Needed\u003c/strong>\u003c/p>\n\u003cp>The \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CaliforniaNursesFactsFigures2010.pdf\" target=\"_blank\">majority of the state's registered nurses\u003c/a> are white or Asian. While 39 percent of California's population is Latino, just\u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CaliforniaNursesFactsFigures2010.pdf\"> \u003c/a>8 percent of nurses are; 6 percent of the state's population is black, but just 4 percent of nurses are.\u003c/p>\n\u003cp>David Hayes-Bautista is director of the Center for the Study of Latino Health and Culture at UCLA's medical school.\u003c/p>\n\u003cp>\"Clearly we are lacking African-American and Latina nurses,\" he says, adding that the health of everyone suffers because of it. \"Having them in the workforce will ... make for better patient care [and] better language communication.\"\u003c/p>\n\u003cp>But that can be hard when you have a population as diverse as California, where \u003ca href=\"http://articles.latimes.com/2010/nov/14/opinion/la-ed-longevity-20101114\">Latinos \u003c/a>lack access to preventive care and \u003ca href=\"http://www.naacp.org/pages/health-care-fact-sheet\">African-Americans\u003c/a> experience higher rates of heart disease and shorter life expectancy than whites.\u003c/p>\n\u003cp>These disparities are what motivated Samuel Merritt grad Shanda Williams, who recently passed her registered nurses' licensing exam.\u003c/p>\n\u003cfigure id=\"attachment_10745329\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2015/11/RS17385_IMG_4274.JPG-sfi.jpg\">\u003cimg class=\"wp-image-10745329 size-thumbnail\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2015/11/RS17385_IMG_4274.JPG-sfi-400x300.jpg\" alt=\"Shanda Williams \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Shanda Williams grew up in Oakland, where there's great need for providers who understand the community. She was inspired to become a nurse after accompanying her grandmother to the doctor. (Adizah Eghan/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>She grew up in Oakland, where there's a great need for providers who understand the community. Williams says she's experienced this firsthand.\u003c/p>\n\u003cp>\"I would go to the doctor’s office with my grandmother,\" Williams says, \"and she would basically lie to all of her doctors about everything that she was doing.\"\u003c/p>\n\u003cp>Williams says her grandmother told her doctor she was eating her fruits and vegetables and cutting out fried foods. Williams knew this was not true.\u003c/p>\n\u003cp>\"It sparked a conversation,\" she says, but her grandmother \"basically said, 'They don't understand the way we eat, this is part of my identity.' \"\u003c/p>\n\u003cp>Williams says this moment stuck with her because the doctor never asked some key questions.\u003c/p>\n\u003cp>“There was never really a time when her doctor would ask her a question, 'Well, why do you eat that way?' or, 'Can we find a compromise?' or anything like that. Those questions never came up.”\u003c/p>\n\u003cp>\u003cstrong>Helping Others Achieve\u003c/strong>\u003c/p>\n\u003cp>Now Williams wants to extend what she's learned to others. She tutors in Samuel Merritt’s academic success program, specifically geared toward Latino and African-American students. Today she's working with junior Leslie Hernandez. The two are sitting in one of Samuel Merritt's basement classrooms going over neuropharmacology.\u003c/p>\n\u003cp>Hernandez says she sees a lot of Latino students in nursing school with her, but it’s not the same when she accompanies family members to the hospital or when she's at her clinical placements.\u003c/p>\n\u003cp>She remembers the moment when she realized the need for more Latinos -- and Spanish-speaking -- health care professionals. As one of her student placements, she was working in the psychiatric unit of a hospital. A patient had been deemed noncompliant by her doctors and nurses because she did not talk.\u003c/p>\n\u003cp>But Hernandez was able to communicate with the patient — in Spanish.\u003c/p>\n\u003cp>\"She was speaking in Spanish and she felt like nobody could understand her,\" Hernandez recounts.\u003c/p>\n\u003cp>The patient told Hernandez that she had suicidal thoughts, and Hernandez could pass that on to the doctor.\u003c/p>\n\u003cp>\u003cb>Addressing Barriers Faced by Low-Income Students\u003c/b>\u003c/p>\n\u003cp>Financial support is a major barrier for students of color. While lower-income students can take advantage of financial aid to cover tuition at either a public or private school, they can be derailed by smaller unexpected problems.\u003c/p>\n\u003cp>A sudden need for hundreds of dollars for a car repair or an emergency dental problem can force students to drop out, diversity officer Strong says, adding that these students come from families that often don't have the resources to help in an emergency.\u003c/p>\n\u003cp>To help these students, Strong says Samuel Merritt is working to create a special fund, \"so that when a student has a problem we just write the check from the emergency fund, [so students can] stay attentive and on course to graduate.\"\u003c/p>\n\u003cp class=\"\">But emergency finances and need for tutoring are the issues that black and Latino students face only after they get into nursing school. For so many others, nursing school isn’t even an option.\u003c/p>\n\u003cp class=\"\">Strong says preparation for health care careers starts in high school -- or sooner. “The key really is that they have to take science courses and the math courses early on, so when they get to college ... they are prepared to step into these various programs.\"\u003c/p>\n\u003cp class=\"\">She says if students don’t have these courses, they spend a lot of time playing catch-up. Sometimes it's just too overwhelming to tackle.\u003c/p>\n\u003cp class=\"\">Samuel Merritt is partnering with pathway programs such as the Health Academy at Oakland Technical High School, and Berkeley High's B-Tech Academy. The goal of these schools is to give students who are interested in the health care field specialized instruction.\u003c/p>\n\u003cp>The Board of Registered Nursing \u003ca href=\"http://www.rn.ca.gov/pdfs/forms/diversityupdate.pdf\" target=\"_blank\">forecasts \u003c/a>that Latino population growth will continue to outpace the number of registered nurses and doctors unless more efforts are implemented to encourage enrollment and graduation of Latinos from RN programs.\u003c/p>\n\u003cp>While African-Americans will be equally represented by 2030, they could be equally represented sooner if more African-American students are recruited to and graduate from RN programs.\u003c/p>\n\u003cp>As for Shanda Williams, she wants to open a clinic with some of her classmates.\u003c/p>\n\u003cp>\"Working in my community is what also helped keep me motivated in school,\" she says, adding that she thinks other students of color feel the same way. \"We want to make changes in our communities that we have grown up (in) and that we have seen.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>She wants patients like her grandmother to seek care from people who they trust, people who can say, \"I'm from the same neighborhood you come from.\"\u003c/p>\n\n",
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"excerpt": "Thirty-nine percent of Californians are Hispanic, versus only 9 percent of nurses. An Oakland university strives to address the need.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>East Oakland's Allen Temple Baptist Church is buzzing with chatter and upbeat music. On this warm Saturday morning, the church is hosting its annual holistic health fair.\u003c/p>\n\u003cp>Students from Oakland's Samuel Merritt University, clad in blue scrubs, hustle to give eye exams and check blood pressure.\u003c/p>\n\u003cp>A couple tables down, Samuel Merritt's chief diversity officer, Shirley Strong, hopes to address prospective students. The Oakland-based university is one of the three biggest programs for registered nursing students in California and is committed to reducing health disparities by recruiting more students of color .\u003c/p>\n\u003cp>\"The work of diversity at Samuel Merritt involves recruiting faculty, staff and students of color particularly,\" Strong says, especially \"African-American/black, Latino/Hispanic students because they’re the ones underrepresented in our community.\"\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/231710622&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/231710622'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Last May, Samuel Merritt University's nursing program graduated its second-largest class of African-American and Latino students, including 10 African-Americans and 28 Latinos.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“What we’d like to do is train more (registered nurses) and more case managers and more nurse practitioners, people who are really in decision-making roles in hospitals,” says Strong.\u003c/p>\n\u003cp>\u003cstrong>Black and Latino Registered Nurses Needed\u003c/strong>\u003c/p>\n\u003cp>The \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CaliforniaNursesFactsFigures2010.pdf\" target=\"_blank\">majority of the state's registered nurses\u003c/a> are white or Asian. While 39 percent of California's population is Latino, just\u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20C/PDF%20CaliforniaNursesFactsFigures2010.pdf\"> \u003c/a>8 percent of nurses are; 6 percent of the state's population is black, but just 4 percent of nurses are.\u003c/p>\n\u003cp>David Hayes-Bautista is director of the Center for the Study of Latino Health and Culture at UCLA's medical school.\u003c/p>\n\u003cp>\"Clearly we are lacking African-American and Latina nurses,\" he says, adding that the health of everyone suffers because of it. \"Having them in the workforce will ... make for better patient care [and] better language communication.\"\u003c/p>\n\u003cp>But that can be hard when you have a population as diverse as California, where \u003ca href=\"http://articles.latimes.com/2010/nov/14/opinion/la-ed-longevity-20101114\">Latinos \u003c/a>lack access to preventive care and \u003ca href=\"http://www.naacp.org/pages/health-care-fact-sheet\">African-Americans\u003c/a> experience higher rates of heart disease and shorter life expectancy than whites.\u003c/p>\n\u003cp>These disparities are what motivated Samuel Merritt grad Shanda Williams, who recently passed her registered nurses' licensing exam.\u003c/p>\n\u003cfigure id=\"attachment_10745329\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2015/11/RS17385_IMG_4274.JPG-sfi.jpg\">\u003cimg class=\"wp-image-10745329 size-thumbnail\" src=\"http://ww2.kqed.org/news/wp-content/uploads/sites/10/2015/11/RS17385_IMG_4274.JPG-sfi-400x300.jpg\" alt=\"Shanda Williams \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Shanda Williams grew up in Oakland, where there's great need for providers who understand the community. She was inspired to become a nurse after accompanying her grandmother to the doctor. (Adizah Eghan/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>She grew up in Oakland, where there's a great need for providers who understand the community. Williams says she's experienced this firsthand.\u003c/p>\n\u003cp>\"I would go to the doctor’s office with my grandmother,\" Williams says, \"and she would basically lie to all of her doctors about everything that she was doing.\"\u003c/p>\n\u003cp>Williams says her grandmother told her doctor she was eating her fruits and vegetables and cutting out fried foods. Williams knew this was not true.\u003c/p>\n\u003cp>\"It sparked a conversation,\" she says, but her grandmother \"basically said, 'They don't understand the way we eat, this is part of my identity.' \"\u003c/p>\n\u003cp>Williams says this moment stuck with her because the doctor never asked some key questions.\u003c/p>\n\u003cp>“There was never really a time when her doctor would ask her a question, 'Well, why do you eat that way?' or, 'Can we find a compromise?' or anything like that. Those questions never came up.”\u003c/p>\n\u003cp>\u003cstrong>Helping Others Achieve\u003c/strong>\u003c/p>\n\u003cp>Now Williams wants to extend what she's learned to others. She tutors in Samuel Merritt’s academic success program, specifically geared toward Latino and African-American students. Today she's working with junior Leslie Hernandez. The two are sitting in one of Samuel Merritt's basement classrooms going over neuropharmacology.\u003c/p>\n\u003cp>Hernandez says she sees a lot of Latino students in nursing school with her, but it’s not the same when she accompanies family members to the hospital or when she's at her clinical placements.\u003c/p>\n\u003cp>She remembers the moment when she realized the need for more Latinos -- and Spanish-speaking -- health care professionals. As one of her student placements, she was working in the psychiatric unit of a hospital. A patient had been deemed noncompliant by her doctors and nurses because she did not talk.\u003c/p>\n\u003cp>But Hernandez was able to communicate with the patient — in Spanish.\u003c/p>\n\u003cp>\"She was speaking in Spanish and she felt like nobody could understand her,\" Hernandez recounts.\u003c/p>\n\u003cp>The patient told Hernandez that she had suicidal thoughts, and Hernandez could pass that on to the doctor.\u003c/p>\n\u003cp>\u003cb>Addressing Barriers Faced by Low-Income Students\u003c/b>\u003c/p>\n\u003cp>Financial support is a major barrier for students of color. While lower-income students can take advantage of financial aid to cover tuition at either a public or private school, they can be derailed by smaller unexpected problems.\u003c/p>\n\u003cp>A sudden need for hundreds of dollars for a car repair or an emergency dental problem can force students to drop out, diversity officer Strong says, adding that these students come from families that often don't have the resources to help in an emergency.\u003c/p>\n\u003cp>To help these students, Strong says Samuel Merritt is working to create a special fund, \"so that when a student has a problem we just write the check from the emergency fund, [so students can] stay attentive and on course to graduate.\"\u003c/p>\n\u003cp class=\"\">But emergency finances and need for tutoring are the issues that black and Latino students face only after they get into nursing school. For so many others, nursing school isn’t even an option.\u003c/p>\n\u003cp class=\"\">Strong says preparation for health care careers starts in high school -- or sooner. “The key really is that they have to take science courses and the math courses early on, so when they get to college ... they are prepared to step into these various programs.\"\u003c/p>\n\u003cp class=\"\">She says if students don’t have these courses, they spend a lot of time playing catch-up. Sometimes it's just too overwhelming to tackle.\u003c/p>\n\u003cp class=\"\">Samuel Merritt is partnering with pathway programs such as the Health Academy at Oakland Technical High School, and Berkeley High's B-Tech Academy. The goal of these schools is to give students who are interested in the health care field specialized instruction.\u003c/p>\n\u003cp>The Board of Registered Nursing \u003ca href=\"http://www.rn.ca.gov/pdfs/forms/diversityupdate.pdf\" target=\"_blank\">forecasts \u003c/a>that Latino population growth will continue to outpace the number of registered nurses and doctors unless more efforts are implemented to encourage enrollment and graduation of Latinos from RN programs.\u003c/p>\n\u003cp>While African-Americans will be equally represented by 2030, they could be equally represented sooner if more African-American students are recruited to and graduate from RN programs.\u003c/p>\n\u003cp>As for Shanda Williams, she wants to open a clinic with some of her classmates.\u003c/p>\n\u003cp>\"Working in my community is what also helped keep me motivated in school,\" she says, adding that she thinks other students of color feel the same way. \"We want to make changes in our communities that we have grown up (in) and that we have seen.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Doctors Find Tapeworm Larva in Napa Man's Brain",
"title": "Doctors Find Tapeworm Larva in Napa Man's Brain",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>If you've made it past the headline, you deserve to know more.\u003c/p>\n\u003cp>That's right, a 26-year-old Napa man went to the Queen of the Valley Medical Center ER with an awful headache and nausea, went into a coma and when he woke up was told there was a\u003cem> tapeworm larva \u003c/em>living in his brain. (I tend not to use italics, but it seemed like emphasis was needed in this case.)\u003c/p>\n\u003cp>The Associated Press picks up the story:\u003c/p>\n\u003cblockquote>\u003cp>College student Luis Ortiz, 26, of Napa said doctors told him he needed immediate surgery to remove it.\u003c/p>\n\u003cp>\"I was shocked,\" Ortiz said. \"I just couldn't believe something like that would happen to me. I didn't know there was a parasite in my head trying to ruin my life.\"\u003c/p>\n\u003cp>The surgery and the aftermath have greatly impacted his life, Ortiz said. He had to drop out of school, move back home and find a temporary place for his dog. He can't drive or work.\u003c/p>\n\u003cp>\"My memory is like a work in progress,\" he said. \"It gets better from therapy,\" but he has to remind himself to do his memory exercises and other daily tasks.\u003c/p>\n\u003cp>Ortiz's neurosurgeon, Dr. Soren Singel, said Ortiz was lucky he arrived at the hospital when he did.\u003c/p>\n\u003cp>The worm was forming in a cyst that was blocking the flow of water to chambers in his brain, \"like a cork in a bottle,\" Singel told the \u003ca href=\"http://bit.ly/1RQzfHc\" target=\"_blank\">Napa Valley Register\u003c/a>.\u003c/p>\n\u003cp>Another 30 minutes of that blockage, and \"he would have been dead,\" Singel said. \"It was a close call.\"\u003c/p>\n\u003cp>Ortiz said his headaches began in late August and he didn't think much of it at first.\u003c/p>\n\u003cp>\"I just ignored it,\" said Ortiz, who was attending California State University, Sacramento.\u003c/p>\n\u003cp>During the first days of September, Ortiz had been skateboarding on a warm day when the pain increased. When he arrived at his mother's house, he appeared disoriented and began to vomit. She rushed him to the hospital.\u003c/p>\u003c/blockquote>\n\u003cp>By now I'm sure you're wondering how a tapeworm larva got to Ortiz's brain in the first place.\u003c/p>\n\u003cp>Here's how he did not get it: \u003ca href=\"http://www.cdc.gov/parasites/cysticercosis/\" target=\"_blank\">He did not get it from eating undercooked pork\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Eating undercooked pork can only give you an intestinal tapeworm, the \u003ca href=\"http://www.cdc.gov/parasites/cysticercosis/\" target=\"_blank\">Centers for Disease Control \u003c/a>says, and then only if it is also infected with tapeworm larva. The larva mature in the intestine and give you a tapeworm. The tapeworm spews eggs but they do not travel through the body. They end up in the toilet.\u003c/p>\n\u003cp>Professor Ray Kuhn at Wake Forest University is an expert on parasites. \"The only way you can get the [tapeworm] larva is for the person to actually eat the eggs of the tapeworm, and that is only found in human fecal material.\" That's how pigs get infected as well.\u003c/p>\n\u003cp>How do we get it? \"It's possible that people preparing foods will have the tapeworm and don't use good bathroom sanitation and go back to preparing food,\" Kuhn says.\u003c/p>\n\u003cp>Yet another reason why good hand-washing is so important.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated with more information about how the larvae are spread.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you've made it past the headline, you deserve to know more.\u003c/p>\n\u003cp>That's right, a 26-year-old Napa man went to the Queen of the Valley Medical Center ER with an awful headache and nausea, went into a coma and when he woke up was told there was a\u003cem> tapeworm larva \u003c/em>living in his brain. (I tend not to use italics, but it seemed like emphasis was needed in this case.)\u003c/p>\n\u003cp>The Associated Press picks up the story:\u003c/p>\n\u003cblockquote>\u003cp>College student Luis Ortiz, 26, of Napa said doctors told him he needed immediate surgery to remove it.\u003c/p>\n\u003cp>\"I was shocked,\" Ortiz said. \"I just couldn't believe something like that would happen to me. I didn't know there was a parasite in my head trying to ruin my life.\"\u003c/p>\n\u003cp>The surgery and the aftermath have greatly impacted his life, Ortiz said. He had to drop out of school, move back home and find a temporary place for his dog. He can't drive or work.\u003c/p>\n\u003cp>\"My memory is like a work in progress,\" he said. \"It gets better from therapy,\" but he has to remind himself to do his memory exercises and other daily tasks.\u003c/p>\n\u003cp>Ortiz's neurosurgeon, Dr. Soren Singel, said Ortiz was lucky he arrived at the hospital when he did.\u003c/p>\n\u003cp>The worm was forming in a cyst that was blocking the flow of water to chambers in his brain, \"like a cork in a bottle,\" Singel told the \u003ca href=\"http://bit.ly/1RQzfHc\" target=\"_blank\">Napa Valley Register\u003c/a>.\u003c/p>\n\u003cp>Another 30 minutes of that blockage, and \"he would have been dead,\" Singel said. \"It was a close call.\"\u003c/p>\n\u003cp>Ortiz said his headaches began in late August and he didn't think much of it at first.\u003c/p>\n\u003cp>\"I just ignored it,\" said Ortiz, who was attending California State University, Sacramento.\u003c/p>\n\u003cp>During the first days of September, Ortiz had been skateboarding on a warm day when the pain increased. When he arrived at his mother's house, he appeared disoriented and began to vomit. She rushed him to the hospital.\u003c/p>\u003c/blockquote>\n\u003cp>By now I'm sure you're wondering how a tapeworm larva got to Ortiz's brain in the first place.\u003c/p>\n\u003cp>Here's how he did not get it: \u003ca href=\"http://www.cdc.gov/parasites/cysticercosis/\" target=\"_blank\">He did not get it from eating undercooked pork\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Eating undercooked pork can only give you an intestinal tapeworm, the \u003ca href=\"http://www.cdc.gov/parasites/cysticercosis/\" target=\"_blank\">Centers for Disease Control \u003c/a>says, and then only if it is also infected with tapeworm larva. The larva mature in the intestine and give you a tapeworm. The tapeworm spews eggs but they do not travel through the body. They end up in the toilet.\u003c/p>\n\u003cp>Professor Ray Kuhn at Wake Forest University is an expert on parasites. \"The only way you can get the [tapeworm] larva is for the person to actually eat the eggs of the tapeworm, and that is only found in human fecal material.\" That's how pigs get infected as well.\u003c/p>\n\u003cp>How do we get it? \"It's possible that people preparing foods will have the tapeworm and don't use good bathroom sanitation and go back to preparing food,\" Kuhn says.\u003c/p>\n\u003cp>Yet another reason why good hand-washing is so important.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This post has been updated with more information about how the larvae are spread.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Lake County Native Americans Learn Power of Exercise to Fight Diabetes",
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"content": "\u003cp>Johnny Gonzales kneels next to his client, Jorje Mendez, who is struggling through the last set of pushups at the gym.\u003c/p>\n\u003cp>“Give me eight of them!” says Gonzales, 59. “Be strict. This is where all the gains are made right here. If you can do this, you can do anything!”\u003c/p>\n\u003cp>It's a pretty typical gym in an atypical setting. Gonzales works with patients of the Lake County Tribal Health Clinic, and the gym is within the clinic itself.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/231367075\" 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>Patients diagnosed with prediabetes who enroll in a program to lose weight are eligible for work with Gonzales -- free of charge.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The clinic, which targets members of the six local Pomo tribes in the county, also offers classes on healthy eating and other lifestyle changes that can reduce the risk of diabetes.\u003c/p>\n\u003cfigure id=\"attachment_102193\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut.jpg\">\u003cimg class=\"wp-image-102193 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-400x267.jpg\" alt=\"Trainer Johny Gonzales coaches Jorje Mendez through a set of exercises at Lake County Tribal Health Consortium. Increasing physical activity is a key goal of the clinic's diabetes prevention program.\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Trainer Johnny Gonzales coaches Jorje Mendez through a set of exercises at Lake County Tribal Health Consortium. Increasing physical activity is a key goal of the clinic's diabetes prevention program. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Mendez, 33, an accountant and father of five, was a cross-country champion at Clear Lake High during his younger days, but settled into a more sedentary lifestyle that involved “eating a lot -- and [drinking] a lot of alcohol.” His weight ballooned to 300 pounds.\u003c/p>\n\u003cp>He decided to join the clinic's program after he was diagnosed as prediabetic. Grueling sessions with Gonzales three times a week have helped him lose over 45 pounds, he says.\u003c/p>\n\u003cp>“I feel better now,” says Mendez. “Other places you got to pay a fortune; I don’t have that. So I’m blessed to come here.”\u003c/p>\n\u003cp>Access to this gym and Gonzales' training sessions are a game changer for patients like Mendez, who wouldn't be able to afford it otherwise. In Lake County, a quarter of the population lives below the federal poverty level, and the median household income of $36,548 is much lower than the statewide average.\u003c/p>\n\u003cp>The clinic’s local efforts target a rapidly growing disease among Native Americans, who are twice as likely to be diagnosed with diabetes compared with non-Hispanic whites, according to the U.S. Department of Health and Human Services’ \u003ca href=\"http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Resources/FactSheets/2012/Fact_sheet_AIAN_508c.pdf\" target=\"_blank\">Indian Health Service\u003c/a>. Particularly alarming is the impact of the disease among Native young people ages 10 to 19. That population is nine times more likely to be diagnosed with Type 2 diabetes than non-Hispanic white children.\u003c/p>\n\u003cp>Gonzales, who has worked with the Lake County Tribal Health Consortium since 2002, says that reality requires immediate attention.\u003c/p>\n\u003cp>“We are seeing it. We have kids that are 12 years old that weigh 240, 250. So they are candidates for diabetes,” says Gonzales. “When you see a 12-year-old kid that is prediabetic, that is pretty sad. A lot of it is lack of education to that kid, or their parents just don’t know.”\u003c/p>\n\u003cp>Gonzales, a former Marine, says Native American communities in Lake County face challenges that make them susceptible to diabetes. He has witnessed how lack of physical activity and healthy foods can take a toll in people's bodies.\u003c/p>\n\u003cp>“A lot of aching and pains weren’t due to injuries. It’s because they were inactive,” says Gonzales of clients living at Big Valley Rancheria, one of the local Pomo reservations. “Their challenge is trying to eat healthy. On this reservation and some of the other reservations, it’s not the healthiest food.”\u003c/p>\n\u003cfigure id=\"attachment_102194\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1.jpg\">\u003cimg class=\"wp-image-102194 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-400x267.jpg\" alt='Johny Gonzales shows off a food guide for patients in the Lake County Tribal Health clinic diabetes prevention program. He recommends clients to stay away from processed foods and to \"get off the couch.\" ' width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Johnny Gonzales shows off a food guide for patients in the Lake County Tribal Health clinic diabetes prevention program. He recommends that clients stay away from processed foods and 'get off the couch.' \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Even with those challenges, Gonzales remains evangelical about the healing powers of physical activity. It’s a deep-seated belief stemming from his personal experience after he hurt his back while working as a welder. Doctors told him he couldn’t do construction work anymore and recommended surgery. At the time, Gonzales balked at the procedure and chose instead to swim and exercise to strengthen his back.\u003c/p>\n\u003cp>“I noticed that when I was active I didn’t hurt nearly as bad, but when I wasn’t active I hurt all the time,” says Gonzales. “I didn’t want to depend on meds all the time, so I had to be active. That’s when I started pursuing becoming a trainer.”\u003c/p>\n\u003cp>Gonzales tells his clients that physical activity and perseverance are great medicines to combat diabetes and other ills. That helps him stay optimistic while on his job, which includes leading exercise workshops at nearby reservations. Participants often crowd the training, he says, though at other times nobody shows up. That doesn't dampen his passion for the job.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Things tend to move a little slow in native country. Sometimes we just have to take baby steps,” he says. “And as a provider, you can’t give up or they give up themselves.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Johnny Gonzales kneels next to his client, Jorje Mendez, who is struggling through the last set of pushups at the gym.\u003c/p>\n\u003cp>“Give me eight of them!” says Gonzales, 59. “Be strict. This is where all the gains are made right here. If you can do this, you can do anything!”\u003c/p>\n\u003cp>It's a pretty typical gym in an atypical setting. Gonzales works with patients of the Lake County Tribal Health Clinic, and the gym is within the clinic itself.\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/231367075&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/231367075'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Patients diagnosed with prediabetes who enroll in a program to lose weight are eligible for work with Gonzales -- free of charge.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The clinic, which targets members of the six local Pomo tribes in the county, also offers classes on healthy eating and other lifestyle changes that can reduce the risk of diabetes.\u003c/p>\n\u003cfigure id=\"attachment_102193\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut.jpg\">\u003cimg class=\"wp-image-102193 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-400x267.jpg\" alt=\"Trainer Johny Gonzales coaches Jorje Mendez through a set of exercises at Lake County Tribal Health Consortium. Increasing physical activity is a key goal of the clinic's diabetes prevention program.\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17291_IMG_9342.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Trainer Johnny Gonzales coaches Jorje Mendez through a set of exercises at Lake County Tribal Health Consortium. Increasing physical activity is a key goal of the clinic's diabetes prevention program. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Mendez, 33, an accountant and father of five, was a cross-country champion at Clear Lake High during his younger days, but settled into a more sedentary lifestyle that involved “eating a lot -- and [drinking] a lot of alcohol.” His weight ballooned to 300 pounds.\u003c/p>\n\u003cp>He decided to join the clinic's program after he was diagnosed as prediabetic. Grueling sessions with Gonzales three times a week have helped him lose over 45 pounds, he says.\u003c/p>\n\u003cp>“I feel better now,” says Mendez. “Other places you got to pay a fortune; I don’t have that. So I’m blessed to come here.”\u003c/p>\n\u003cp>Access to this gym and Gonzales' training sessions are a game changer for patients like Mendez, who wouldn't be able to afford it otherwise. In Lake County, a quarter of the population lives below the federal poverty level, and the median household income of $36,548 is much lower than the statewide average.\u003c/p>\n\u003cp>The clinic’s local efforts target a rapidly growing disease among Native Americans, who are twice as likely to be diagnosed with diabetes compared with non-Hispanic whites, according to the U.S. Department of Health and Human Services’ \u003ca href=\"http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Resources/FactSheets/2012/Fact_sheet_AIAN_508c.pdf\" target=\"_blank\">Indian Health Service\u003c/a>. Particularly alarming is the impact of the disease among Native young people ages 10 to 19. That population is nine times more likely to be diagnosed with Type 2 diabetes than non-Hispanic white children.\u003c/p>\n\u003cp>Gonzales, who has worked with the Lake County Tribal Health Consortium since 2002, says that reality requires immediate attention.\u003c/p>\n\u003cp>“We are seeing it. We have kids that are 12 years old that weigh 240, 250. So they are candidates for diabetes,” says Gonzales. “When you see a 12-year-old kid that is prediabetic, that is pretty sad. A lot of it is lack of education to that kid, or their parents just don’t know.”\u003c/p>\n\u003cp>Gonzales, a former Marine, says Native American communities in Lake County face challenges that make them susceptible to diabetes. He has witnessed how lack of physical activity and healthy foods can take a toll in people's bodies.\u003c/p>\n\u003cp>“A lot of aching and pains weren’t due to injuries. It’s because they were inactive,” says Gonzales of clients living at Big Valley Rancheria, one of the local Pomo reservations. “Their challenge is trying to eat healthy. On this reservation and some of the other reservations, it’s not the healthiest food.”\u003c/p>\n\u003cfigure id=\"attachment_102194\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1.jpg\">\u003cimg class=\"wp-image-102194 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-400x267.jpg\" alt='Johny Gonzales shows off a food guide for patients in the Lake County Tribal Health clinic diabetes prevention program. He recommends clients to stay away from processed foods and to \"get off the couch.\" ' width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/11/RS17292_IMG_9344.JPG-qut-1-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Johnny Gonzales shows off a food guide for patients in the Lake County Tribal Health clinic diabetes prevention program. He recommends that clients stay away from processed foods and 'get off the couch.' \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Even with those challenges, Gonzales remains evangelical about the healing powers of physical activity. It’s a deep-seated belief stemming from his personal experience after he hurt his back while working as a welder. Doctors told him he couldn’t do construction work anymore and recommended surgery. At the time, Gonzales balked at the procedure and chose instead to swim and exercise to strengthen his back.\u003c/p>\n\u003cp>“I noticed that when I was active I didn’t hurt nearly as bad, but when I wasn’t active I hurt all the time,” says Gonzales. “I didn’t want to depend on meds all the time, so I had to be active. That’s when I started pursuing becoming a trainer.”\u003c/p>\n\u003cp>Gonzales tells his clients that physical activity and perseverance are great medicines to combat diabetes and other ills. That helps him stay optimistic while on his job, which includes leading exercise workshops at nearby reservations. Participants often crowd the training, he says, though at other times nobody shows up. That doesn't dampen his passion for the job.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“Things tend to move a little slow in native country. Sometimes we just have to take baby steps,” he says. “And as a provider, you can’t give up or they give up themselves.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Covered California Targets African Americans, Latinos In Obamacare Open Enrollment",
"title": "Covered California Targets African Americans, Latinos In Obamacare Open Enrollment",
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"content": "\u003cp>Covered California still faces major challenges in enrolling African-Americans and Latinos as the state’s health insurance exchange launched its third open enrollment period Sunday.\u003c/p>\n\u003cp>“We know we’ve come up short in who’s enrolled today,” Covered California Executive Director Peter Lee said at a recent media briefing on the exchange’s marketing and outreach plans. “Of those who are still uninsured, we want to make sure we reach them.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“We know we’ve come up short in who’s enrolled today.\"\u003cbr>\n\u003ccite>Peter Lee, Covered California Executive Director \u003c/cite>\u003c/aside>\n\u003cp>About 2.4 percent of the exchange’s approximately 1.3 million enrollees are African-American, only about half of the blacks considered eligible for subsidies because of their income. Another 30 percent are Latino; 37 percent are considered eligible for subsidies, according to \u003ca href=\"http://hbex.coveredca.com/data-research/library/Active-Membership-Slides.pdf\" target=\"_blank\">Covered California data\u003c/a>.\u003c/p>\n\u003cp>In contrast, enrollment of whites and Asians has exceeded eligibility projections, meaning that Covered California was better able to reach those groups. The state’s enrollment data is not exact, because more than a quarter of enrollees decline to state their race.\u003c/p>\n\u003cp>[contextly_sidebar id=\"i6jYaraDnQfXmte5cZ5eZKWtJ7cBm8iG\"]While many more California Latinos and African-Americans have become insured since the passage of the Affordable Care Act, including through the state’s Medi-Cal expansion and employer-based insurance, Covered California’s experience echoes that of other states trying to ensure that their minority populations get the health coverage they need, said Larry Levitt, senior vice president at the Kaiser Family Foundation.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>About 55 percent of the nation’s remaining 32.3 million uninsured under age 65 \u003ca href=\"http://kff.org/disparities-policy/issue-brief/estimates-of-eligibility-for-aca-coverage-among-the-uninsured-by-race-and-ethnicity/\" target=\"_blank\">are people of color\u003c/a>, including 34 percent who identify as Hispanic/Latino and 14 percent who identify as black, according to Kaiser Family Foundation data.\u003c/p>\n\u003cp>In California, about \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA-CaliforniansKnowledgeoftheACA.pdf\" target=\"_blank\">2.2 million\u003c/a> Californians remain uninsured but are eligible for Medi-Cal or Covered California insurance plans, Lee said. They are more likely to be Latino and African-American, and younger and slightly more affluent than current enrollees, who may have qualified for subsidies or Medi-Cal, the state’s version of Medicaid.\u003c/p>\n\u003cp>Covered California has earmarked about \u003ca href=\"http://hbex.coveredca.com/financial-reports/PDFs/FINAL%20JUNE%202015-16%20Covered%20CA%20Budget%20Summary_KL.pdf\" target=\"_blank\">$50 million\u003c/a> for marketing and another $13 million for navigators -- trained counselors who help people learn about and sign up for coverage. The exchange unveiled \u003ca href=\"http://news.coveredca.com/2015/10/covered-california-launches-open.html\" target=\"_blank\">its new advertising campaign\u003c/a> Friday, including ads specifically targeted to Latinos and African-Americans. Covered California’s open enrollment runs from Nov. 1 to Jan. 31, 2016.\u003c/p>\n\u003cp>Explanations for the disproportionately low enrollments of eligible African-Americans and Latinos vary. “We’ve got people who don’t trust the government,” said Dan Daniels, coastal area director of the NAACP California State Conference, who oversaw Affordable Care Act outreach in his region.\u003c/p>\n\u003cp>Daniels also cited attitudes among “young invincibles,” who are healthy enough to think they don’t need coverage and are willing to pay the mandatory penalty for not having health insurance. That penalty will rise in 2016 to \u003ca href=\"https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/\" target=\"_blank\">$695 per person\u003c/a> or 2.5 percent of income, whichever is higher.\u003c/p>\n\u003cp>[contextly_sidebar id=\"D6TWOWFjS0MLbUxYid2ZhI9XmIOKCRNT\"]Among some Latinos who are legal residents, there is fear that applying for health insurance through Covered California will jeopardize the immigration status of other family members, Levitt said.\u003c/p>\n\u003cp>And affordability remains a looming concern for higher-income people of color who may not be eligible for subsidies or Medi-Cal.\u003c/p>\n\u003cp>For example, Kemisha Roston, a 38-year-old contract lawyer from Riverside, said she makes too much money to qualify for those programs, but not enough to afford Covered California unsubsidized premiums – which top $300 per month — while she pays off student debt.\u003c/p>\n\u003cp>“I’m living check to check, because the market for attorneys is very saturated,” Roston said. “My health is pretty good right now, so I don’t need to go to the doctor. When I do, I go to free clinics or Planned Parenthood. I’m dismayed, because if something does happen and I don’t have health insurance, I could be wiped out.”\u003c/p>\n\u003cp>In addition, some community leaders and health advocates have criticized Covered California’s previous marketing and outreach efforts to both African-American and Latino communities as too generalized and impersonal. The exchange has spent more money on marketing and outreach than other exchanges, with less to show for it, said Hector De La Torre, executive director of the Transamerica Center for Health Studies.\u003c/p>\n\u003cp>[contextly_sidebar id=\"O1fT4KmbMVl23QPu7yIqqfTkXntKSW9w\"]“You have these challenges in these communities and it takes a lot more than a TV commercial to make them aware of what they need to do -– you can’t do that in 30 seconds,” De La Torre said, referring to the need to educate people about the basic value of health insurance. “That’s where Covered California has not done as much as it could in reaching out to these folks. It’s a face-to-face communication effort that needs to take place.”\u003c/p>\n\u003cp>Charla Franklin, community outreach liaison for Healthy African American Families, an advocacy group in Los Angeles, said Covered California did well in reaching out to California’s black churches and community groups to get the word out. But the advertising campaign in her area was “so bland it was ridiculous,” she said. The exchange really needed to better inform people about specific community events and places where people could get in-person help with the complicated and time-consuming online enrollment process, she said.\u003c/p>\n\u003cp>Lee has told reporters recently that Covered California is stepping up its ground game and changing its messaging. Consumer surveys have shown that potential enrollees need more education on how subsidies can lower their out-of-pocket costs, he said. The U.S. Department of Health and Human Services said it will pursue a similar \u003ca href=\"http://www.nytimes.com/2015/10/30/us/politics/obama-administration-campaign-will-publicize-health-care-subsidies.html?_r=1\" target=\"_blank\">strategy\u003c/a> of publicizing financial help available to many people.\u003c/p>\n\u003cp>“We cannot take it as a given that Californians understand that health care is more affordable because subsidies are available,” he said. “We’ll be getting back to basics.”\u003c/p>\n\u003cp>The exchange is also expanding its direct outreach efforts, more than doubling the number of Covered California storefronts where people can get help to enroll to 500, Lee said.\u003c/p>\n\u003cp>But while Lee promised “a more intense ground game,” he also cautioned against overly high expectations for the exchange’s third open enrollment season.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We have millions of Californians who’ve adopted a culture of coping. They don’t understand they have subsidies available to them and are making do. It’s going to be years to change to a culture of coverage.”\u003c/p>\n\n",
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"excerpt": "Two million Californians are eligible for Obamacare benefits -- but have not signed up for insurance.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Covered California still faces major challenges in enrolling African-Americans and Latinos as the state’s health insurance exchange launched its third open enrollment period Sunday.\u003c/p>\n\u003cp>“We know we’ve come up short in who’s enrolled today,” Covered California Executive Director Peter Lee said at a recent media briefing on the exchange’s marketing and outreach plans. “Of those who are still uninsured, we want to make sure we reach them.”\u003c/p>\n\u003caside class=\"pullquote alignright\">“We know we’ve come up short in who’s enrolled today.\"\u003cbr>\n\u003ccite>Peter Lee, Covered California Executive Director \u003c/cite>\u003c/aside>\n\u003cp>About 2.4 percent of the exchange’s approximately 1.3 million enrollees are African-American, only about half of the blacks considered eligible for subsidies because of their income. Another 30 percent are Latino; 37 percent are considered eligible for subsidies, according to \u003ca href=\"http://hbex.coveredca.com/data-research/library/Active-Membership-Slides.pdf\" target=\"_blank\">Covered California data\u003c/a>.\u003c/p>\n\u003cp>In contrast, enrollment of whites and Asians has exceeded eligibility projections, meaning that Covered California was better able to reach those groups. The state’s enrollment data is not exact, because more than a quarter of enrollees decline to state their race.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>While many more California Latinos and African-Americans have become insured since the passage of the Affordable Care Act, including through the state’s Medi-Cal expansion and employer-based insurance, Covered California’s experience echoes that of other states trying to ensure that their minority populations get the health coverage they need, said Larry Levitt, senior vice president at the Kaiser Family Foundation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>About 55 percent of the nation’s remaining 32.3 million uninsured under age 65 \u003ca href=\"http://kff.org/disparities-policy/issue-brief/estimates-of-eligibility-for-aca-coverage-among-the-uninsured-by-race-and-ethnicity/\" target=\"_blank\">are people of color\u003c/a>, including 34 percent who identify as Hispanic/Latino and 14 percent who identify as black, according to Kaiser Family Foundation data.\u003c/p>\n\u003cp>In California, about \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA-CaliforniansKnowledgeoftheACA.pdf\" target=\"_blank\">2.2 million\u003c/a> Californians remain uninsured but are eligible for Medi-Cal or Covered California insurance plans, Lee said. They are more likely to be Latino and African-American, and younger and slightly more affluent than current enrollees, who may have qualified for subsidies or Medi-Cal, the state’s version of Medicaid.\u003c/p>\n\u003cp>Covered California has earmarked about \u003ca href=\"http://hbex.coveredca.com/financial-reports/PDFs/FINAL%20JUNE%202015-16%20Covered%20CA%20Budget%20Summary_KL.pdf\" target=\"_blank\">$50 million\u003c/a> for marketing and another $13 million for navigators -- trained counselors who help people learn about and sign up for coverage. The exchange unveiled \u003ca href=\"http://news.coveredca.com/2015/10/covered-california-launches-open.html\" target=\"_blank\">its new advertising campaign\u003c/a> Friday, including ads specifically targeted to Latinos and African-Americans. Covered California’s open enrollment runs from Nov. 1 to Jan. 31, 2016.\u003c/p>\n\u003cp>Explanations for the disproportionately low enrollments of eligible African-Americans and Latinos vary. “We’ve got people who don’t trust the government,” said Dan Daniels, coastal area director of the NAACP California State Conference, who oversaw Affordable Care Act outreach in his region.\u003c/p>\n\u003cp>Daniels also cited attitudes among “young invincibles,” who are healthy enough to think they don’t need coverage and are willing to pay the mandatory penalty for not having health insurance. That penalty will rise in 2016 to \u003ca href=\"https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/\" target=\"_blank\">$695 per person\u003c/a> or 2.5 percent of income, whichever is higher.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Among some Latinos who are legal residents, there is fear that applying for health insurance through Covered California will jeopardize the immigration status of other family members, Levitt said.\u003c/p>\n\u003cp>And affordability remains a looming concern for higher-income people of color who may not be eligible for subsidies or Medi-Cal.\u003c/p>\n\u003cp>For example, Kemisha Roston, a 38-year-old contract lawyer from Riverside, said she makes too much money to qualify for those programs, but not enough to afford Covered California unsubsidized premiums – which top $300 per month — while she pays off student debt.\u003c/p>\n\u003cp>“I’m living check to check, because the market for attorneys is very saturated,” Roston said. “My health is pretty good right now, so I don’t need to go to the doctor. When I do, I go to free clinics or Planned Parenthood. I’m dismayed, because if something does happen and I don’t have health insurance, I could be wiped out.”\u003c/p>\n\u003cp>In addition, some community leaders and health advocates have criticized Covered California’s previous marketing and outreach efforts to both African-American and Latino communities as too generalized and impersonal. The exchange has spent more money on marketing and outreach than other exchanges, with less to show for it, said Hector De La Torre, executive director of the Transamerica Center for Health Studies.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>“You have these challenges in these communities and it takes a lot more than a TV commercial to make them aware of what they need to do -– you can’t do that in 30 seconds,” De La Torre said, referring to the need to educate people about the basic value of health insurance. “That’s where Covered California has not done as much as it could in reaching out to these folks. It’s a face-to-face communication effort that needs to take place.”\u003c/p>\n\u003cp>Charla Franklin, community outreach liaison for Healthy African American Families, an advocacy group in Los Angeles, said Covered California did well in reaching out to California’s black churches and community groups to get the word out. But the advertising campaign in her area was “so bland it was ridiculous,” she said. The exchange really needed to better inform people about specific community events and places where people could get in-person help with the complicated and time-consuming online enrollment process, she said.\u003c/p>\n\u003cp>Lee has told reporters recently that Covered California is stepping up its ground game and changing its messaging. Consumer surveys have shown that potential enrollees need more education on how subsidies can lower their out-of-pocket costs, he said. The U.S. Department of Health and Human Services said it will pursue a similar \u003ca href=\"http://www.nytimes.com/2015/10/30/us/politics/obama-administration-campaign-will-publicize-health-care-subsidies.html?_r=1\" target=\"_blank\">strategy\u003c/a> of publicizing financial help available to many people.\u003c/p>\n\u003cp>“We cannot take it as a given that Californians understand that health care is more affordable because subsidies are available,” he said. “We’ll be getting back to basics.”\u003c/p>\n\u003cp>The exchange is also expanding its direct outreach efforts, more than doubling the number of Covered California storefronts where people can get help to enroll to 500, Lee said.\u003c/p>\n\u003cp>But while Lee promised “a more intense ground game,” he also cautioned against overly high expectations for the exchange’s third open enrollment season.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We have millions of Californians who’ve adopted a culture of coping. They don’t understand they have subsidies available to them and are making do. It’s going to be years to change to a culture of coverage.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California, Feds Reach Deal on Medicaid Reform",
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"headTitle": "State of Health | KQED News",
"content": "\u003cp>California and the federal government agreed in concept Saturday on a $6.2-billion deal to reform the Medicaid program and to help pay for care of the low-income population.\u003c/p>\n\u003cp>The largest share of the funds –- nearly $3.3 billion -– is aimed at helping public hospitals improve the safety and quality of patient care. The plan, known as the Medicaid waiver, also provides money to cover the uninsured and create pilot programs to keep high-need populations out of emergency rooms.\u003c/p>\n\u003cp>Erica Murray, CEO of the California Association of Public Hospitals and Health Systems, said that while the deal provides less than the state requested, it includes all the key policies needed to help public hospitals continue the work they started under the last waiver agreement.\u003c/p>\n\u003cp>“We are now excited to roll up our sleeves, negotiate the details and get to work,” Murray said.\u003c/p>\n\u003cp>State officials called the deal a “conceptual agreement” and said they would continue working with the federal government to work out specifics. In the meantime, the current waiver –- which would have expired Saturday -- will be extended until Dec. 31.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The funds come from both the federal and state governments and ease the rules on how to run the Medicaid program, known as Medi-Cal in California.\u003c/p>\n\u003cp>The state Department of Health Care Services submitted a proposal for the waiver, also known as \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx\" target=\"_blank\">“Medi-Cal 2020,”\u003c/a> in March and had been negotiating with the federal Centers for Medicare & Medicaid Services ever since. The original proposal was whittled down from $17 billion to $7.25 and finally to $6.2 billion during the negotiations.\u003c/p>\n\u003cp>Even so, Dr. Susan Ehrlich, CEO of San Mateo Medical Center, said Saturday that public hospitals can now keep improving access to primary care, integrating physical and mental health services and making other changes to help patients stay healthy and out of the hospital.\u003c/p>\n\u003cp>Ehrlich, who traveled to Washington earlier this week with several other hospital \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/28/billions-in-medicaid-funding-at-risk-as-california-feds-debate/\" target=\"_blank\">leaders to push for the new waiver\u003c/a>, said she and others will be watching closely to see how the details get worked out.\u003c/p>\n\u003cp>“But mostly, we are just really pleased that the overarching substance of the deal turned out the way it did,” she said.\u003c/p>\n\u003cp>Under the expiring five-year waiver, known as the “Bridge to Reform,” hospitals across the state began to overhaul the way they provided care. For example, they created programs to track chronically ill patients and expanded their primary care clinics. Other programs helped reduce deaths by sepsis infections and the number of patients with uncontrolled diabetes.\u003c/p>\n\u003cp>Hospital leaders said they expect the changes to save money for the state and federal government.\u003c/p>\n\u003cp>With the new waiver, health officials can take their efforts to the next level, Anthony Wright, executive director of Health Access California, said in a statement. Once the details are hammered out, Wright said, “we expect to see an explosion of exciting activity at the county level to improve health care.”\u003c/p>\n\u003cp>Wright added that the agreement has the potential to “spur innovation in counties across the state.”\u003c/p>\n\u003cp>The waiver also fundamentally changes the way government covers the uninsured. Instead of only covering hospital-based care, public hospitals and clinics will have more flexibility and be able to focus more on outpatient and primary care.\u003c/p>\n\u003cp>Instead of funding five years of care for the uninsured, however, the plan only specifies $236 million for the first year. Funding for the next four will depend on an outside assessment of how much hospitals need.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Affordable Care Act expanded coverage to millions of Californians. Still, more than 3 million are believed to be without insurance. Murray of the hospital association said she believes there will still be “significant need” for hospitals to receive additional funding for the uninsured population.\u003c/p>\n\n",
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"excerpt": "‘Conceptual agreement’ worth $6.2 billion a relief to California public hospitals, current Medicaid agreement was set to expire.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California and the federal government agreed in concept Saturday on a $6.2-billion deal to reform the Medicaid program and to help pay for care of the low-income population.\u003c/p>\n\u003cp>The largest share of the funds –- nearly $3.3 billion -– is aimed at helping public hospitals improve the safety and quality of patient care. The plan, known as the Medicaid waiver, also provides money to cover the uninsured and create pilot programs to keep high-need populations out of emergency rooms.\u003c/p>\n\u003cp>Erica Murray, CEO of the California Association of Public Hospitals and Health Systems, said that while the deal provides less than the state requested, it includes all the key policies needed to help public hospitals continue the work they started under the last waiver agreement.\u003c/p>\n\u003cp>“We are now excited to roll up our sleeves, negotiate the details and get to work,” Murray said.\u003c/p>\n\u003cp>State officials called the deal a “conceptual agreement” and said they would continue working with the federal government to work out specifics. In the meantime, the current waiver –- which would have expired Saturday -- will be extended until Dec. 31.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The funds come from both the federal and state governments and ease the rules on how to run the Medicaid program, known as Medi-Cal in California.\u003c/p>\n\u003cp>The state Department of Health Care Services submitted a proposal for the waiver, also known as \u003ca href=\"http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx\" target=\"_blank\">“Medi-Cal 2020,”\u003c/a> in March and had been negotiating with the federal Centers for Medicare & Medicaid Services ever since. The original proposal was whittled down from $17 billion to $7.25 and finally to $6.2 billion during the negotiations.\u003c/p>\n\u003cp>Even so, Dr. Susan Ehrlich, CEO of San Mateo Medical Center, said Saturday that public hospitals can now keep improving access to primary care, integrating physical and mental health services and making other changes to help patients stay healthy and out of the hospital.\u003c/p>\n\u003cp>Ehrlich, who traveled to Washington earlier this week with several other hospital \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/28/billions-in-medicaid-funding-at-risk-as-california-feds-debate/\" target=\"_blank\">leaders to push for the new waiver\u003c/a>, said she and others will be watching closely to see how the details get worked out.\u003c/p>\n\u003cp>“But mostly, we are just really pleased that the overarching substance of the deal turned out the way it did,” she said.\u003c/p>\n\u003cp>Under the expiring five-year waiver, known as the “Bridge to Reform,” hospitals across the state began to overhaul the way they provided care. For example, they created programs to track chronically ill patients and expanded their primary care clinics. Other programs helped reduce deaths by sepsis infections and the number of patients with uncontrolled diabetes.\u003c/p>\n\u003cp>Hospital leaders said they expect the changes to save money for the state and federal government.\u003c/p>\n\u003cp>With the new waiver, health officials can take their efforts to the next level, Anthony Wright, executive director of Health Access California, said in a statement. Once the details are hammered out, Wright said, “we expect to see an explosion of exciting activity at the county level to improve health care.”\u003c/p>\n\u003cp>Wright added that the agreement has the potential to “spur innovation in counties across the state.”\u003c/p>\n\u003cp>The waiver also fundamentally changes the way government covers the uninsured. Instead of only covering hospital-based care, public hospitals and clinics will have more flexibility and be able to focus more on outpatient and primary care.\u003c/p>\n\u003cp>Instead of funding five years of care for the uninsured, however, the plan only specifies $236 million for the first year. Funding for the next four will depend on an outside assessment of how much hospitals need.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Affordable Care Act expanded coverage to millions of Californians. Still, more than 3 million are believed to be without insurance. Murray of the hospital association said she believes there will still be “significant need” for hospitals to receive additional funding for the uninsured population.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"soldout": {
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