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"disqusTitle": "San Diego Fighting a Deadly Hepatitis Outbreak Linked to Homeless Encampments",
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"content": "\u003cp>An outbreak of \u003ca href=\"https://www.cdc.gov/hepatitis/hav/afaq.htm\" target=\"_blank\" rel=\"noopener noreferrer\">hepatitis A\u003c/a> in San Diego County that has killed 16 people and sickened hundreds of others since November \u003ca href=\"http://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/Hepatitis_A.html\" target=\"_blank\" rel=\"noopener noreferrer\">continues\u003c/a> unabated, as health officials rush to deploy containment strategies.\u003c/p>\n\u003cp>“This is an unprecedented outbreak,” said Dr. Wilma Wooten, the public health officer for San Diego County. “This is new territory.”\u003c/p>\n\u003cp>Of the 444 people in San Diego County known to have contracted the liver‐attacking virus since November, about 65 percent are homeless or use illicit drugs, according to Wooten. She declared a public health emergency on Sept. 1.\u003c/p>\n\u003cp>Hepatitis A is an acute illness of the liver, but it does not cause chronic liver disease (as is the case with \u003ca href=\"https://www.cdc.gov/hepatitis/resources/professionals/pdfs/abctable.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">hepatitis B and C\u003c/a>.) Hepatitis A isn't normally fatal, but it can be if the patient has other infections, including hepatitis B or C.\u003c/p>\n\u003cp>The California Department of Public Health says the spread of the virus in San Diego County is the largest outbreak in the U.S. that is unrelated to a contaminated food product since 1995 (when a vaccine for hepatitis A was introduced in the United States).\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Other California communities are grappling with outbreaks of hepatitis A as well. The disease has sickened 69 people in Santa Cruz County since last April. Many affected there are homeless or use illicit drugs, according to the \u003ca href=\"http://www.santacruzhealth.org/HSAHome/HSADivisions/PublicHealth/Communi%20cableDiseaseControl/HepatitisA.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Santa Cruz County Health Services Agency\u003c/a>. On Sept. 19, the County of Los Angeles \u003ca href=\"http://publichealth.lacounty.gov/acd/Diseases/HepA.htm\" target=\"_blank\" rel=\"noopener noreferrer\">announced\u003c/a> a local outbreak after 10 cases were identified among its homeless population.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health officials linked four of the L.A. cases to the San Diego outbreak and one to the Santa Cruz County outbreak. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_361174\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361174\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/SD-homeless-13-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Tents set up by homeless residents crowd portions of downtown San Diego, where a hepatitis A virus has killed 16 people and sickened nearly 450 others. \u003ccite>(Alan Horowitch)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Hepatitis A is usually spread when a person ingests fecal matter -- even in microscopic amounts -- from contact with objects, food or drinks contaminated by feces or stool from an infected person,” according to the Centers for Disease Control and Prevention (CDC).\u003c/p>\n\u003cp>Known as the “fecal‐oral” route of spread, this typically occurs when an infected person doesn’t wash their hands after going to the bathroom and then touches objects or food. In crowded homeless communities -- many of which lack public restrooms and sinks -- the virus is often spread through such person‐to‐person contact.\u003c/p>\n\u003cp>It can also spread through sexual contact with an infected person, according to the CDC.\u003c/p>\n\u003cp>For the California counties now grappling with outbreaks, slowing the spread isn’t easy. The long incubation period of the virus -- between 15 to 50 days -- and the transient nature of the homeless population make it challenging for public health agencies to find, educate and vaccinate people after an outbreak begins.\u003c/p>\n\u003cp>What’s more, the California Department of Public Health said it has no protocol to guide cities and counties on how best to deal with outbreaks associated with poor or limited sanitation, because those routes of transmission are “very rare” in the United States.\u003c/p>\n\u003cp>But the state said it it's working on gathering information from the CDC, and is working with the San Diego public health authorities to identify effective strategies.\u003c/p>\n\u003cp>Wooten said San Diego is using a variety of approaches to stem the spread.\u003c/p>\n\u003cp>“This outbreak has really resulted in us needing to be creative,” she said.\u003c/p>\n\u003cp>One approach: pairing public health workers with homeless outreach teams who have long‐established ties to those living on the streets, in the canyons and in the wildlands of San Diego County.\u003c/p>\n\u003cfigure id=\"attachment_361172\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361172\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/SD-homeless-1-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Larissa Wimberly, supervisor of outreach for the nonprofit Alpha Project in San Diego County, at a homeless encampment along a riverbed in National City. \u003ccite>(Alan Horowitch)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We go into the canyons, we go everywhere,” said Amy Gonyeau, chief operating officer for the \u003ca href=\"https://www.alphaproject.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Alpha Project\u003c/a>, a nonprofit that provides homeless services. “We go out every day. We have our own vehicles and vans … we educate people on what’s going on.”\u003c/p>\n\u003cp>On a recent morning, an Alpha Project team delivered hygiene kits -- consisting of soap, hand sanitizer and other toiletries packaged in a large plastic bag -- to a crowded encampment in downtown San Diego’s East Village.\u003c/p>\n\u003cp>“It looks like a war zone,” said Alpha Project's outreach supervisor, Larissa Wimberly. “There’s people out here with HIV, people out here with cancer, there’s people out here with heart issues. There are people who are just old and feeble and they’re not eating right. It’s really sad.”\u003c/p>\n\u003cp>Tents and shopping carts crowded the sidewalks in this section of downtown, one largely hidden from the city’s tourists and residents.\u003c/p>\n\u003cp>Wimberly explained that many who live here relieve themselves among the tents and carts.\u003c/p>\n\u003cp>“It’s everywhere,” she said of the human excrement. “It’s just really bad right now.”\u003c/p>\n\u003cp>So bad that the city -- under the direction of the county health department -- has begun power-washing heavily soiled sections of downtown sidewalks and streets with a bleach solution.\u003c/p>\n\u003cp>That follows the installation, earlier this month, of about 40 portable hand‐washing stations throughout the downtown areas hardest hit by the virus.\u003c/p>\n\u003cp>In addition, the county’s public health workers have been coming to the encampments to offer the hepatitis A vaccinations to the homeless.\u003c/p>\n\u003cp>Leslie, a 42‐year‐old homeless woman, was among the victims of the virus. She asked that her last name not be used.\u003c/p>\n\u003cp>Leslie said she's been camping out on San Diego’s streets for five years and became ill last spring.\u003c/p>\n\u003cp>“It was awful,” she said. “My skin was yellow, my pee -- my urine -- it looked like chocolate milk. And everything just hurt. I was achy all the time and tired. I couldn’t sleep enough.”\u003c/p>\n\u003cp>Leslie was hospitalized and it took more than two months for her to fully recover, but she said she’s grateful to have escaped with her life.\u003c/p>\n\u003cp>Some have criticized the more than two-month delay between the county announcing plans for hand-washing stations in downtown areas where the homeless live, and their eventual installation earlier this month.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Since that announcement, 11 people are dead and the number of hepatitis A cases has more than doubled,” the San Diego Union-Tribune editorial board wrote on Sept. 1. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Well you know, we can’t just roll them out because we don’t have jurisdiction over city property,” Wooten said of the sinks installed in downtown. “So we had to work through that process.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wooten said the county made a decision to first test a few sinks in a small pilot program, and that was necessary. “We wanted to see if people would use them,” she said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Diego, too, denied any unnecessary delays in handling the outbreak and is now working to expand the number of available public restrooms downtown, said Katie Keach, spokeswoman for the city.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Countywide, nearly 23,000 people have received vaccinations against the virus, including about a third who are homeless or use illegal drugs. Vaccination is considered the key line of defense against hepatitis A -- normally a mild illness that can become severe in those who are already suffering from other health problems, Wooten said.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Centers for Disease Control and Prevention recommends all children receive the two-part hepatitis A vaccine at 1 year of age. But California and most other states \u003ca href=\"https://www2a.cdc.gov/nip/schoolsurv/schImmRqmtReport.asp\" target=\"_blank\" rel=\"noopener noreferrer\">do not include\u003c/a> it in the required vaccinations for children entering kindergarten. \u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>An outbreak of \u003ca href=\"https://www.cdc.gov/hepatitis/hav/afaq.htm\" target=\"_blank\" rel=\"noopener noreferrer\">hepatitis A\u003c/a> in San Diego County that has killed 16 people and sickened hundreds of others since November \u003ca href=\"http://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/Hepatitis_A.html\" target=\"_blank\" rel=\"noopener noreferrer\">continues\u003c/a> unabated, as health officials rush to deploy containment strategies.\u003c/p>\n\u003cp>“This is an unprecedented outbreak,” said Dr. Wilma Wooten, the public health officer for San Diego County. “This is new territory.”\u003c/p>\n\u003cp>Of the 444 people in San Diego County known to have contracted the liver‐attacking virus since November, about 65 percent are homeless or use illicit drugs, according to Wooten. She declared a public health emergency on Sept. 1.\u003c/p>\n\u003cp>Hepatitis A is an acute illness of the liver, but it does not cause chronic liver disease (as is the case with \u003ca href=\"https://www.cdc.gov/hepatitis/resources/professionals/pdfs/abctable.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">hepatitis B and C\u003c/a>.) Hepatitis A isn't normally fatal, but it can be if the patient has other infections, including hepatitis B or C.\u003c/p>\n\u003cp>The California Department of Public Health says the spread of the virus in San Diego County is the largest outbreak in the U.S. that is unrelated to a contaminated food product since 1995 (when a vaccine for hepatitis A was introduced in the United States).\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Other California communities are grappling with outbreaks of hepatitis A as well. The disease has sickened 69 people in Santa Cruz County since last April. Many affected there are homeless or use illicit drugs, according to the \u003ca href=\"http://www.santacruzhealth.org/HSAHome/HSADivisions/PublicHealth/Communi%20cableDiseaseControl/HepatitisA.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Santa Cruz County Health Services Agency\u003c/a>. On Sept. 19, the County of Los Angeles \u003ca href=\"http://publichealth.lacounty.gov/acd/Diseases/HepA.htm\" target=\"_blank\" rel=\"noopener noreferrer\">announced\u003c/a> a local outbreak after 10 cases were identified among its homeless population.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health officials linked four of the L.A. cases to the San Diego outbreak and one to the Santa Cruz County outbreak. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_361174\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361174\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/SD-homeless-13-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-13-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Tents set up by homeless residents crowd portions of downtown San Diego, where a hepatitis A virus has killed 16 people and sickened nearly 450 others. \u003ccite>(Alan Horowitch)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Hepatitis A is usually spread when a person ingests fecal matter -- even in microscopic amounts -- from contact with objects, food or drinks contaminated by feces or stool from an infected person,” according to the Centers for Disease Control and Prevention (CDC).\u003c/p>\n\u003cp>Known as the “fecal‐oral” route of spread, this typically occurs when an infected person doesn’t wash their hands after going to the bathroom and then touches objects or food. In crowded homeless communities -- many of which lack public restrooms and sinks -- the virus is often spread through such person‐to‐person contact.\u003c/p>\n\u003cp>It can also spread through sexual contact with an infected person, according to the CDC.\u003c/p>\n\u003cp>For the California counties now grappling with outbreaks, slowing the spread isn’t easy. The long incubation period of the virus -- between 15 to 50 days -- and the transient nature of the homeless population make it challenging for public health agencies to find, educate and vaccinate people after an outbreak begins.\u003c/p>\n\u003cp>What’s more, the California Department of Public Health said it has no protocol to guide cities and counties on how best to deal with outbreaks associated with poor or limited sanitation, because those routes of transmission are “very rare” in the United States.\u003c/p>\n\u003cp>But the state said it it's working on gathering information from the CDC, and is working with the San Diego public health authorities to identify effective strategies.\u003c/p>\n\u003cp>Wooten said San Diego is using a variety of approaches to stem the spread.\u003c/p>\n\u003cp>“This outbreak has really resulted in us needing to be creative,” she said.\u003c/p>\n\u003cp>One approach: pairing public health workers with homeless outreach teams who have long‐established ties to those living on the streets, in the canyons and in the wildlands of San Diego County.\u003c/p>\n\u003cfigure id=\"attachment_361172\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361172\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/SD-homeless-1-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/SD-homeless-1-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Larissa Wimberly, supervisor of outreach for the nonprofit Alpha Project in San Diego County, at a homeless encampment along a riverbed in National City. \u003ccite>(Alan Horowitch)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“We go into the canyons, we go everywhere,” said Amy Gonyeau, chief operating officer for the \u003ca href=\"https://www.alphaproject.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Alpha Project\u003c/a>, a nonprofit that provides homeless services. “We go out every day. We have our own vehicles and vans … we educate people on what’s going on.”\u003c/p>\n\u003cp>On a recent morning, an Alpha Project team delivered hygiene kits -- consisting of soap, hand sanitizer and other toiletries packaged in a large plastic bag -- to a crowded encampment in downtown San Diego’s East Village.\u003c/p>\n\u003cp>“It looks like a war zone,” said Alpha Project's outreach supervisor, Larissa Wimberly. “There’s people out here with HIV, people out here with cancer, there’s people out here with heart issues. There are people who are just old and feeble and they’re not eating right. It’s really sad.”\u003c/p>\n\u003cp>Tents and shopping carts crowded the sidewalks in this section of downtown, one largely hidden from the city’s tourists and residents.\u003c/p>\n\u003cp>Wimberly explained that many who live here relieve themselves among the tents and carts.\u003c/p>\n\u003cp>“It’s everywhere,” she said of the human excrement. “It’s just really bad right now.”\u003c/p>\n\u003cp>So bad that the city -- under the direction of the county health department -- has begun power-washing heavily soiled sections of downtown sidewalks and streets with a bleach solution.\u003c/p>\n\u003cp>That follows the installation, earlier this month, of about 40 portable hand‐washing stations throughout the downtown areas hardest hit by the virus.\u003c/p>\n\u003cp>In addition, the county’s public health workers have been coming to the encampments to offer the hepatitis A vaccinations to the homeless.\u003c/p>\n\u003cp>Leslie, a 42‐year‐old homeless woman, was among the victims of the virus. She asked that her last name not be used.\u003c/p>\n\u003cp>Leslie said she's been camping out on San Diego’s streets for five years and became ill last spring.\u003c/p>\n\u003cp>“It was awful,” she said. “My skin was yellow, my pee -- my urine -- it looked like chocolate milk. And everything just hurt. I was achy all the time and tired. I couldn’t sleep enough.”\u003c/p>\n\u003cp>Leslie was hospitalized and it took more than two months for her to fully recover, but she said she’s grateful to have escaped with her life.\u003c/p>\n\u003cp>Some have criticized the more than two-month delay between the county announcing plans for hand-washing stations in downtown areas where the homeless live, and their eventual installation earlier this month.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Since that announcement, 11 people are dead and the number of hepatitis A cases has more than doubled,” the San Diego Union-Tribune editorial board wrote on Sept. 1. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Well you know, we can’t just roll them out because we don’t have jurisdiction over city property,” Wooten said of the sinks installed in downtown. “So we had to work through that process.” \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Wooten said the county made a decision to first test a few sinks in a small pilot program, and that was necessary. “We wanted to see if people would use them,” she said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Diego, too, denied any unnecessary delays in handling the outbreak and is now working to expand the number of available public restrooms downtown, said Katie Keach, spokeswoman for the city.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Countywide, nearly 23,000 people have received vaccinations against the virus, including about a third who are homeless or use illegal drugs. Vaccination is considered the key line of defense against hepatitis A -- normally a mild illness that can become severe in those who are already suffering from other health problems, Wooten said.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Centers for Disease Control and Prevention recommends all children receive the two-part hepatitis A vaccine at 1 year of age. But California and most other states \u003ca href=\"https://www2a.cdc.gov/nip/schoolsurv/schImmRqmtReport.asp\" target=\"_blank\" rel=\"noopener noreferrer\">do not include\u003c/a> it in the required vaccinations for children entering kindergarten. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "'Devastating' Cuts to Come: How California Would Suffer Under GOP Health Plan",
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"content": "\u003cp>State officials are sounding the alarm over a last-minute push by Republican Senators to \"replace and replace\" the Affordable Care Act. Health officials warn it's the worst proposal yet, with California set to \u003ca href=\"http://www.dhcs.ca.gov/Documents/Graham_Cassidy_Impact_Memo_DHCS_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lose billions of dollars\u003c/a>.\u003c/p>\n\u003cp>\"Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,\" said Jennifer Kent, Director of the Department of Health Care Services.\u003c/p>\n\u003cp>The two previous plans debated in Congress only partially dismantled the structures that undergird the Affordable Care Act.\u003c/p>\n\u003cp>But the new Graham-Cassidy proposal would blow up those ACA structures, and retract the money that currently pays for them, starting in 2020. After lopping off more than $200 billion from the retracted money, the federal government would use a new formula to scatter the remaining funds across the 50 states and District of Columbia.\u003c/p>\n\u003cp>Prominent losers in this scenario include states like California that eagerly embraced the Affordable Care Act. Health consulting firm Avalere \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">predicts\u003c/a> 34 states and DC would experience funding cuts, and 16 states would see an increase.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>What Graham-Cassidy does, starting in 2020:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends payments\u003c/span> for Medicaid expansion, which allowed 3.8 million Californians to join Medi-Cal.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends federal subsidies\u003c/span> for private insurance coverage sold through \"Covered California,\" which cover more than one million Californians.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Removes guarantees\u003c/span> that insurance plans cannot charge higher prices to patients with pre-existing conditions to pay more for coverage, or must offer plans that include a basic suite of services, such as prescriptions, maternity care, and mental health treatment. States could opt out of many of these protections, although most experts agree that California would try to maintain them.\u003c/p>\n\u003cp>But that could be an empty promise, warns Peter Lee, executive director of Covered California. Even if California continued the protections for sick people, the insurance market could collapse as healthy people stop buying coverage when federal subsidies end.\u003c/p>\n\u003cp>\u003cstrong>California's \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\" target=\"_blank\" rel=\"noopener noreferrer\">projected losses\u003c/a>:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Number of uninsured:\u003c/span> More than 10 million Californians will lose health coverage by 2027, according to an \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_Potential_Impacts_Graham-Cassidy-9-25-17.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">new analysis \u003c/a>by Covered California. (UC Berkeley has a \u003ca href=\"http://laborcenter.berkeley.edu/projected-health-insurance-coverage-loss-by-county-2027-under-graham-cassidy/\" target=\"_blank\" rel=\"noopener noreferrer\">breakdown\u003c/a> by Congressional district and county).\u003c/p>\n\u003cp>\u003cem>That's nearly 1 in 4 Californians under age 65, worse than pre-Obamacare levels. \u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Federal funds loss:\u003c/span> Total losses for health care in California ratchet up to $28 billion/year by 2026, then increase dramatically to $57.5 billion a year later, in 2027. That's equivalent to more than a third of all General Fund spending in California's budget.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Medi-Cal changes:\u003c/span> In addition to changes to the Affordable Care Act, the Graham-Cassidy proposal radically changes how traditional Medicaid, dating back to 1965, is funded. 14 million Californians depend on Medi-Cal coverage, and it's particularly critical for people with disabilities and residents of nursing homes.\u003c/p>\n\u003cp>California stands to lose the most money of all the states.\u003c/p>\n\u003cp>Supporters of the new plan's redistribution formulas explain that it's a matter of fairness to all states.\u003c/p>\n\u003cp>“Four states get 40 percent of the money under Obamacare: New York, California, Massachusetts, and Maryland,\" said Senator Lindsey Graham. \"Our goal is by 2026 to make sure every patient in every state gets the same contribution, roughly, from the federal government.”\u003c/p>\n\u003cp>Opponents of the repeal efforts point out that California gets more money under the law because it has the largest population in the country, and because it embraced the Affordable Care Act's funding opportunities.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Other states such as Texas didn't get as much money under the ACA not because the distribution wasn't fair, but because officials in those states refused to expand Medicaid to more residents, so they didn’t pull down the federal money to pay for that. Under the new plan, Texas will get $35 billion more in federal funds by 2026.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>State officials are sounding the alarm over a last-minute push by Republican Senators to \"replace and replace\" the Affordable Care Act. Health officials warn it's the worst proposal yet, with California set to \u003ca href=\"http://www.dhcs.ca.gov/Documents/Graham_Cassidy_Impact_Memo_DHCS_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lose billions of dollars\u003c/a>.\u003c/p>\n\u003cp>\"Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,\" said Jennifer Kent, Director of the Department of Health Care Services.\u003c/p>\n\u003cp>The two previous plans debated in Congress only partially dismantled the structures that undergird the Affordable Care Act.\u003c/p>\n\u003cp>But the new Graham-Cassidy proposal would blow up those ACA structures, and retract the money that currently pays for them, starting in 2020. After lopping off more than $200 billion from the retracted money, the federal government would use a new formula to scatter the remaining funds across the 50 states and District of Columbia.\u003c/p>\n\u003cp>Prominent losers in this scenario include states like California that eagerly embraced the Affordable Care Act. Health consulting firm Avalere \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">predicts\u003c/a> 34 states and DC would experience funding cuts, and 16 states would see an increase.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What Graham-Cassidy does, starting in 2020:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends payments\u003c/span> for Medicaid expansion, which allowed 3.8 million Californians to join Medi-Cal.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Ends federal subsidies\u003c/span> for private insurance coverage sold through \"Covered California,\" which cover more than one million Californians.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Removes guarantees\u003c/span> that insurance plans cannot charge higher prices to patients with pre-existing conditions to pay more for coverage, or must offer plans that include a basic suite of services, such as prescriptions, maternity care, and mental health treatment. States could opt out of many of these protections, although most experts agree that California would try to maintain them.\u003c/p>\n\u003cp>But that could be an empty promise, warns Peter Lee, executive director of Covered California. Even if California continued the protections for sick people, the insurance market could collapse as healthy people stop buying coverage when federal subsidies end.\u003c/p>\n\u003cp>\u003cstrong>California's \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\" target=\"_blank\" rel=\"noopener noreferrer\">projected losses\u003c/a>:\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Number of uninsured:\u003c/span> More than 10 million Californians will lose health coverage by 2027, according to an \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_Potential_Impacts_Graham-Cassidy-9-25-17.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">new analysis \u003c/a>by Covered California. (UC Berkeley has a \u003ca href=\"http://laborcenter.berkeley.edu/projected-health-insurance-coverage-loss-by-county-2027-under-graham-cassidy/\" target=\"_blank\" rel=\"noopener noreferrer\">breakdown\u003c/a> by Congressional district and county).\u003c/p>\n\u003cp>\u003cem>That's nearly 1 in 4 Californians under age 65, worse than pre-Obamacare levels. \u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Federal funds loss:\u003c/span> Total losses for health care in California ratchet up to $28 billion/year by 2026, then increase dramatically to $57.5 billion a year later, in 2027. That's equivalent to more than a third of all General Fund spending in California's budget.\u003c/p>\n\u003cp>\u003cspan style=\"text-decoration: underline\">Medi-Cal changes:\u003c/span> In addition to changes to the Affordable Care Act, the Graham-Cassidy proposal radically changes how traditional Medicaid, dating back to 1965, is funded. 14 million Californians depend on Medi-Cal coverage, and it's particularly critical for people with disabilities and residents of nursing homes.\u003c/p>\n\u003cp>California stands to lose the most money of all the states.\u003c/p>\n\u003cp>Supporters of the new plan's redistribution formulas explain that it's a matter of fairness to all states.\u003c/p>\n\u003cp>“Four states get 40 percent of the money under Obamacare: New York, California, Massachusetts, and Maryland,\" said Senator Lindsey Graham. \"Our goal is by 2026 to make sure every patient in every state gets the same contribution, roughly, from the federal government.”\u003c/p>\n\u003cp>Opponents of the repeal efforts point out that California gets more money under the law because it has the largest population in the country, and because it embraced the Affordable Care Act's funding opportunities.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Other states such as Texas didn't get as much money under the ACA not because the distribution wasn't fair, but because officials in those states refused to expand Medicaid to more residents, so they didn’t pull down the federal money to pay for that. Under the new plan, Texas will get $35 billion more in federal funds by 2026.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Tale of Two States: California Loses and Texas Wins Under GOP Health Plan",
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"content": "\u003cp>California stands to lose billions in health care funding under the GOP’s latest plan to repeal and replace the Affordable Care Act, resulting in millions of Californians losing coverage.\u003c/p>\n\u003cp>The Graham-Cassidy legislation under discussion in the Senate would redistribute the funds now used to pay for the Affordable Care Act, effectively taking money from states that embraced all aspects of the law, like California, and redistributing it to other states, that didn't, like Texas.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“For a state like California or a Massachusetts or a New York, exactly the states that might be most motivated to at least try to preserve the ACA coverage gains - those are the states that would face the deepest cuts to their federal resources,” said Aviva Aron-Dine, senior fellow at the \u003ca href=\"https://www.cbpp.org/\">Center on Budget and Policy Priorities\u003c/a>.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">The bill's Republican authors say redistributing the health funds is about fairness, and will give states more \"flexibility\" to redesign their own health systems.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">But health officials in California predict dire consequences if the measure were to pass.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,” top officials from the state Department of Health Care Services wrote in \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/09/graham_cassidy_impact_memo_dhcs_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">an analysis\u003c/a> released Friday. “If this amendment is adopted and becomes law, California will be faced with tens of billions of dollars in new costs [and] will require difficult decisions regarding the populations and benefits we choose to cover and how much we pay providers and plans for the services they provide.”\u003c/p>\n\u003cp> \u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">By 2026, California would lose $85.7 billion in federal funds, and by 2027 it would lose $138.8 billion, according to the analysis. That could cause 6.7 million Californians to lose insurance coverage, according to \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\">estimates\u003c/a> from the The UC Berkeley Labor Center.\u003c/p>\n\u003cp>A lot of those people are entrepreneurs or their employees. Under the Affordable Care Act in California, half a million self-employed entrepreneurs -- and a million employees who work for small businesses -- got health coverage because of the ACA, either through the expansion of Medi-Cal, or through a subsidized personal insurance plan on the state exchange, Covered California.\u003c/p>\n\u003cp>\"It would be very difficult for entrepreneurs and self employed folks to access some level of coverage,\" said Mark Herbert, California director for the \u003ca href=\"http://www.smallbusinessmajority.org/states/california\" target=\"_blank\" rel=\"noopener noreferrer\">Small Business Majority\u003c/a>. \"So it would be massively destabilizing to the ability of small employers to attract talent.\"\u003c/p>\n\u003cp>Beyond that, there would be damaging ripple effects, Herbert added: \"There's no way that you can remove those sorts of dollars out of our local communities and not see some sort of economic impact on small businesses.\"\u003c/p>\n\u003cp>Under the Graham-Cassidy bill’s redistribution formula, several states that shunned the Affordable Care Act would get more money, according to a \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> by health consulting firm Avalare.\u003c/p>\n\u003cp>Texas will get a windfall of $35 billion in health funding over the next ten years, more than any other state. State officials would get to decide how they want to spend that money. But advocates and analysts say more money for Texas doesn't necessarily guarantee an improved health care system.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“Regardless of the size of the block grant, there's just no assurance that it would translate into good coverage, or coverage that's as affordable as what we have today,” said Stacey Pogue with the \u003ca href=\"http://bettertexasblog.org/2017/09/harmful-medicaid-cutaca-repeal-bill-resurfaces-senate/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Public Policy Priorities \u003c/a>in Austin.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">Texas already has the highest number of uninsured folks, and Pogue says the state just doesn't have the infrastructure in place to expand coverage to more people. It didn't expand Medicaid in 2014, which was optional under the ACA, and the state didn't set up its own exchange, like California did with \"Covered California.\" Texans who wanted subsidized insurance plans had to use the federal exchange, healthcare.gov, which meant Texas had less flexibility when it came to regulating insurers.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“There's no planning and no thought put into, 'How would we create affordable coverage for low-income Texans?\" Pogue said, \"Unlike the 31 states that have expanded Medicaid, have done some central planning. And Texas would be starting from scratch.”\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">It would also take a lot of political will to make sure the state is actually expanding health care, Pogue added, and that motivation has been lacking among state lawmakers for years. In order to get the block grant, states would need to create a workable health infrastructure by 2020. For comparison, it took Massachusetts four years to set up its pre-Obamacare statewide insurance market.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We are very concerned,” said Stacy Wilson, president of the Children's Hospital Association of Texas.\u003c/p>\n\u003cp>Wilson said this pot of money from Cassidy-Graham wouldn't solve chronic problems with Medicaid, 70 percent of which covers children. Wilson explained that's because the federal government would pay a fixed amount per person, under a per capita cap. That formula locks in how much the state gets per Medicaid enrollee, no matter how much treatment those enrollees need.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We have very low per-capita costs already, and we get locked into that forever,” Wilson said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">A conservative policy group in Texas, \u003ca href=\"https://www.texaspolicy.com/press_release/detail/tppf-statement-on-graham-cassidy-health-care-bill\" target=\"_blank\" rel=\"noopener noreferrer\">The Texas Public Policy Foundation\u003c/a>, is also not happy about the bill, but their concern is that it doesn't go far enough to repeal Obamacare.\u003c/p>\n\n",
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"excerpt": "The Graham-Cassidy bill to repeal and replace the Affordable Care Act redistributes money from states that worked hard to implement Obamacare and gives it to states that refused Obamacare funding. ",
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"nprByline": "\u003cstrong>April Dembosky\u003c/strong>, KQED and \u003cstrong>Ashley Lopez\u003c/strong>, KUT",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California stands to lose billions in health care funding under the GOP’s latest plan to repeal and replace the Affordable Care Act, resulting in millions of Californians losing coverage.\u003c/p>\n\u003cp>The Graham-Cassidy legislation under discussion in the Senate would redistribute the funds now used to pay for the Affordable Care Act, effectively taking money from states that embraced all aspects of the law, like California, and redistributing it to other states, that didn't, like Texas.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“For a state like California or a Massachusetts or a New York, exactly the states that might be most motivated to at least try to preserve the ACA coverage gains - those are the states that would face the deepest cuts to their federal resources,” said Aviva Aron-Dine, senior fellow at the \u003ca href=\"https://www.cbpp.org/\">Center on Budget and Policy Priorities\u003c/a>.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">The bill's Republican authors say redistributing the health funds is about fairness, and will give states more \"flexibility\" to redesign their own health systems.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">But health officials in California predict dire consequences if the measure were to pass.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Simply stated, this proposal is the most devastating of the three federal health care proposals that we have evaluated this year,” top officials from the state Department of Health Care Services wrote in \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/09/graham_cassidy_impact_memo_dhcs_092217.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">an analysis\u003c/a> released Friday. “If this amendment is adopted and becomes law, California will be faced with tens of billions of dollars in new costs [and] will require difficult decisions regarding the populations and benefits we choose to cover and how much we pay providers and plans for the services they provide.”\u003c/p>\n\u003cp> \u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">By 2026, California would lose $85.7 billion in federal funds, and by 2027 it would lose $138.8 billion, according to the analysis. That could cause 6.7 million Californians to lose insurance coverage, according to \u003ca href=\"http://laborcenter.berkeley.edu/the-gops-last-ditch-effort-to-repeal-the-affordable-care-act-is-the-worst-one-yet-for-california/\">estimates\u003c/a> from the The UC Berkeley Labor Center.\u003c/p>\n\u003cp>A lot of those people are entrepreneurs or their employees. Under the Affordable Care Act in California, half a million self-employed entrepreneurs -- and a million employees who work for small businesses -- got health coverage because of the ACA, either through the expansion of Medi-Cal, or through a subsidized personal insurance plan on the state exchange, Covered California.\u003c/p>\n\u003cp>\"It would be very difficult for entrepreneurs and self employed folks to access some level of coverage,\" said Mark Herbert, California director for the \u003ca href=\"http://www.smallbusinessmajority.org/states/california\" target=\"_blank\" rel=\"noopener noreferrer\">Small Business Majority\u003c/a>. \"So it would be massively destabilizing to the ability of small employers to attract talent.\"\u003c/p>\n\u003cp>Beyond that, there would be damaging ripple effects, Herbert added: \"There's no way that you can remove those sorts of dollars out of our local communities and not see some sort of economic impact on small businesses.\"\u003c/p>\n\u003cp>Under the Graham-Cassidy bill’s redistribution formula, several states that shunned the Affordable Care Act would get more money, according to a \u003ca href=\"http://avalere.com/expertise/life-sciences/insights/graham-cassidy-heller-johnson-bill-would-reduce-federal-funding-to-sta\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> by health consulting firm Avalare.\u003c/p>\n\u003cp>Texas will get a windfall of $35 billion in health funding over the next ten years, more than any other state. State officials would get to decide how they want to spend that money. But advocates and analysts say more money for Texas doesn't necessarily guarantee an improved health care system.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“Regardless of the size of the block grant, there's just no assurance that it would translate into good coverage, or coverage that's as affordable as what we have today,” said Stacey Pogue with the \u003ca href=\"http://bettertexasblog.org/2017/09/harmful-medicaid-cutaca-repeal-bill-resurfaces-senate/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Public Policy Priorities \u003c/a>in Austin.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">Texas already has the highest number of uninsured folks, and Pogue says the state just doesn't have the infrastructure in place to expand coverage to more people. It didn't expand Medicaid in 2014, which was optional under the ACA, and the state didn't set up its own exchange, like California did with \"Covered California.\" Texans who wanted subsidized insurance plans had to use the federal exchange, healthcare.gov, which meant Texas had less flexibility when it came to regulating insurers.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“There's no planning and no thought put into, 'How would we create affordable coverage for low-income Texans?\" Pogue said, \"Unlike the 31 states that have expanded Medicaid, have done some central planning. And Texas would be starting from scratch.”\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">It would also take a lot of political will to make sure the state is actually expanding health care, Pogue added, and that motivation has been lacking among state lawmakers for years. In order to get the block grant, states would need to create a workable health infrastructure by 2020. For comparison, it took Massachusetts four years to set up its pre-Obamacare statewide insurance market.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We are very concerned,” said Stacy Wilson, president of the Children's Hospital Association of Texas.\u003c/p>\n\u003cp>Wilson said this pot of money from Cassidy-Graham wouldn't solve chronic problems with Medicaid, 70 percent of which covers children. Wilson explained that's because the federal government would pay a fixed amount per person, under a per capita cap. That formula locks in how much the state gets per Medicaid enrollee, no matter how much treatment those enrollees need.\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">“We have very low per-capita costs already, and we get locked into that forever,” Wilson said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp style=\"font-style: inherit;font-weight: inherit\">A conservative policy group in Texas, \u003ca href=\"https://www.texaspolicy.com/press_release/detail/tppf-statement-on-graham-cassidy-health-care-bill\" target=\"_blank\" rel=\"noopener noreferrer\">The Texas Public Policy Foundation\u003c/a>, is also not happy about the bill, but their concern is that it doesn't go far enough to repeal Obamacare.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In the Battle Against Hepatitis C, the VA Takes the Lead",
"title": "In the Battle Against Hepatitis C, the VA Takes the Lead",
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"content": "\u003cp>Junius Wilson likes to dress up when he goes in for his appointments at the \u003ca href=\"https://www.va.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Department of Veterans Affairs\u003c/a> in Martinez. On a recent visit, the 67-year-old wore a black felt fedora and a sport coat. On his lapels, he wore a handful of military medals.\u003c/p>\n\u003cp>\"All these are medals from Vietnam,\" he said. \"The three stars are for warriors ... this one's national defense.\"\u003c/p>\n\u003cp>Wilson's wife, Shelly Baker, sat beside him. She nudged him to show off one medal, which hung from a violet ribbon: a Purple Heart.\u003c/p>\n\u003cp>Wilson got that one because he was shot in the foot diving for cover during battle. He was in the infantry in South Vietnam and saw a lot of combat.\u003c/p>\n\u003cp>But Wilson, 67, isn't here for that. He's come for a monthly consultation with a specialized VA nurse who oversees his hepatitis C treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The VA has implemented an aggressive effort to screen and treat all veterans under their care for the virus. Hepatitis C experts and advocates have praised the VA for its proactive approach, and say it should be a model for other government health programs, and even private insurers.\u003c/p>\n\u003cp>While about 1 percent of the U.S. population is infected with hepatitis C, veterans who use the VA have higher rates, 4.8 percent.\u003c/p>\n\u003cp>And Vietnam-era veterans like Wilson have an even higher rate, according to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24682941\" target=\"_blank\" rel=\"noopener noreferrer\">studies\u003c/a>, VA data and physicians. Not all Vietnam veterans use the VA for health care, but among those who do, 7.5 percent have tested positive for the virus.\u003c/p>\n\u003cp>It's unclear why, but there are several theories. One is simply the demographic overlap between Vietnam veterans and baby boomers. Members of the baby-boom generation have Hepatitis C infection rates five times higher than the average American. Hepatitis C, which is blood-borne, wasn't even identified as a distinct virus until 1989, and the baby boomers grew up in an era when blood wasn’t screened, and \u003ca href=\"http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30002-0/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">before disposable needles were common in medical settings\u003c/a>.\u003c/p>\n\u003cp>Some attribute the higher rate of Hepatitis C in Vietnam veterans to the injections they received before deploying: Troops sent to Vietnam were often vaccinated assembly-line style, with something called a jet injector. Instead of a needle, a jet injector uses high pressure to force a vaccine through the skin. Later, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11427278\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> showed that older versions of the device could \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/00000744.htm\" target=\"_blank\" rel=\"noopener noreferrer\">transmit\u003c/a> a hepatitis virus from person to person, and it's no longer used in the military. While it is impossible to know if jet injectors spread the hep C virus, the VA has said it is \"\u003ca href=\"https://www.hepatitis.va.gov/provider/policy/military-blood-exposures.asp\" target=\"_blank\" rel=\"noopener noreferrer\">biologically plausible\u003c/a>.\"\u003c/p>\n\u003cp>Others point out that some veterans of this conflict used intravenous drugs while in Vietnam, or after returning to the U.S.\u003c/p>\n\u003cp>Hepatitis C is passed through the blood. About 3.5 million Americans have the virus, and it's believed that half of them do not know it. After the discovery of the virus in 1989, screening of the blood supply didn't begin until 1992.\u003c/p>\n\u003cp>The virus can lurk silently for years, slowly damaging the liver until symptoms appear, like pain, nausea and yellow skin. It kills \u003ca href=\"https://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html\" target=\"_blank\" rel=\"noopener noreferrer\">more Americans\u003c/a> than all other infectious diseases combined, including HIV. In 2014, the death toll reached an all-time high of 19,659.\u003c/p>\n\u003cfigure id=\"attachment_361111\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-361111 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg\" alt=\"VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The VA's push to find -- and cure -- every patient with the virus began three years ago.\u003c/p>\n\u003cp>This became feasible only when new hepatitis C medications came to market in late 2013. The new generation of drugs was a huge improvement over previous treatments. The older drugs required shots that were injected into the stomach, and the medications could have severe side effects: flulike symptoms and even mental health problems.\u003c/p>\n\u003cp>VA nurse Susan Bertilacchi-Green does not miss those days. A decade ago, the cure rate she observed from those older drugs was about 30 percent, she said.\u003c/p>\n\u003cp>\"That was then,\" she said. \"Now, we have new medications that are nearly 100 percent effective. They have little to no side effects. You can be treated in as little as eight weeks, and there's no shots anymore.\"\u003c/p>\n\u003cp>Since 2014, the VA has cured 96,000 patients of hepatitis C.\u003c/p>\n\u003cp>Vietnam veteran Roman Walden is one of them. He thinks he got the virus while injecting heroin in Vietnam, a habit that continued when he returned home to Oakland. Years ago, he tried treatment on the old drugs, but had to stop due to serious side effects. When the new drugs came out, he was hesitant to try treatment again. But with reassurance from Bertilacchi-Green, and other veterans who'd been cured, he yielded. This time, the treatment worked.\u003c/p>\n\u003cfigure id=\"attachment_361112\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361112\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg\" alt=\"Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of Hepatitis C. \" width=\"800\" height=\"613\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-768x588.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1020x781.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1180x904.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-960x735.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-240x184.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-375x287.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-520x398.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718.jpg 1560w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"I was really amazed at that,\" he said. \"But then what really got me was how much it cost, and that made me feel like the president of the United States. They were spending this much money on me?\"\u003c/p>\n\u003cp>Hepatitis C drugs have become notorious for their high cost. The wholesale price for a course of treatment can be over $100,000.\u003c/p>\n\u003cp>For Walden, that high price actually prompted him to take himself more seriously. He said the expense felt like an investment in him by the VA. After years on and off drugs, and in and out of jail, Walden, now 62, said he’s finally changing for the better. He said he no longer drinks or uses drugs, and is volunteering in hospitals, playing drums for patients.\u003c/p>\n\u003cp>The exorbitant prices of the new hepatitis C medications have led other health plans to hold off on treating every patient. Medi-Cal, for example, gives treatment priority to patients that show evidence of liver damage, or those who could spread the virus, like active drug users.\u003c/p>\n\u003cp>While the VA initially also had \"treatment priorities,\" this policy changed in 2016, after Congress stepped up with \u003ca href=\"https://www.va.gov/opa/pressrel/includes/viewPDF.cfm?id=2762\" target=\"_blank\" rel=\"noopener noreferrer\">billions in funding\u003c/a>, and pharmaceutical companies released new versions of drugs that were more competitively priced.\u003c/p>\n\u003cp>These days, the VA will treat \u003cem>anyone\u003c/em> with any level of veterans benefits. For the veterans, the treatment is usually free. Some have a small co-pay for the entire course of treatment, with $33 as the maximum.\u003c/p>\n\u003cp>Health officials say hepatitis C could be eliminated as a public health risk by 2030, but it will happen only if other health plans copy the VA’s lead.\u003c/p>\n\u003cp>At the VA in Martinez, Bertilacchi-Green concludes the visit by showing Junius Wilson and his wife, Shelly Baker, his latest lab tests. Even though he still has a month to go on his medication, the virus is already undetectable in his blood.\u003c/p>\n\u003cp>Wilson and Baker smile at one another.\u003c/p>\n\u003cp>\"We're happy,\" Baker said. \"We still need him around for a long time.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Additional reporting by Carrie Feibel.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Junius Wilson likes to dress up when he goes in for his appointments at the \u003ca href=\"https://www.va.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Department of Veterans Affairs\u003c/a> in Martinez. On a recent visit, the 67-year-old wore a black felt fedora and a sport coat. On his lapels, he wore a handful of military medals.\u003c/p>\n\u003cp>\"All these are medals from Vietnam,\" he said. \"The three stars are for warriors ... this one's national defense.\"\u003c/p>\n\u003cp>Wilson's wife, Shelly Baker, sat beside him. She nudged him to show off one medal, which hung from a violet ribbon: a Purple Heart.\u003c/p>\n\u003cp>Wilson got that one because he was shot in the foot diving for cover during battle. He was in the infantry in South Vietnam and saw a lot of combat.\u003c/p>\n\u003cp>But Wilson, 67, isn't here for that. He's come for a monthly consultation with a specialized VA nurse who oversees his hepatitis C treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The VA has implemented an aggressive effort to screen and treat all veterans under their care for the virus. Hepatitis C experts and advocates have praised the VA for its proactive approach, and say it should be a model for other government health programs, and even private insurers.\u003c/p>\n\u003cp>While about 1 percent of the U.S. population is infected with hepatitis C, veterans who use the VA have higher rates, 4.8 percent.\u003c/p>\n\u003cp>And Vietnam-era veterans like Wilson have an even higher rate, according to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24682941\" target=\"_blank\" rel=\"noopener noreferrer\">studies\u003c/a>, VA data and physicians. Not all Vietnam veterans use the VA for health care, but among those who do, 7.5 percent have tested positive for the virus.\u003c/p>\n\u003cp>It's unclear why, but there are several theories. One is simply the demographic overlap between Vietnam veterans and baby boomers. Members of the baby-boom generation have Hepatitis C infection rates five times higher than the average American. Hepatitis C, which is blood-borne, wasn't even identified as a distinct virus until 1989, and the baby boomers grew up in an era when blood wasn’t screened, and \u003ca href=\"http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30002-0/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">before disposable needles were common in medical settings\u003c/a>.\u003c/p>\n\u003cp>Some attribute the higher rate of Hepatitis C in Vietnam veterans to the injections they received before deploying: Troops sent to Vietnam were often vaccinated assembly-line style, with something called a jet injector. Instead of a needle, a jet injector uses high pressure to force a vaccine through the skin. Later, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11427278\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> showed that older versions of the device could \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/00000744.htm\" target=\"_blank\" rel=\"noopener noreferrer\">transmit\u003c/a> a hepatitis virus from person to person, and it's no longer used in the military. While it is impossible to know if jet injectors spread the hep C virus, the VA has said it is \"\u003ca href=\"https://www.hepatitis.va.gov/provider/policy/military-blood-exposures.asp\" target=\"_blank\" rel=\"noopener noreferrer\">biologically plausible\u003c/a>.\"\u003c/p>\n\u003cp>Others point out that some veterans of this conflict used intravenous drugs while in Vietnam, or after returning to the U.S.\u003c/p>\n\u003cp>Hepatitis C is passed through the blood. About 3.5 million Americans have the virus, and it's believed that half of them do not know it. After the discovery of the virus in 1989, screening of the blood supply didn't begin until 1992.\u003c/p>\n\u003cp>The virus can lurk silently for years, slowly damaging the liver until symptoms appear, like pain, nausea and yellow skin. It kills \u003ca href=\"https://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html\" target=\"_blank\" rel=\"noopener noreferrer\">more Americans\u003c/a> than all other infectious diseases combined, including HIV. In 2014, the death toll reached an all-time high of 19,659.\u003c/p>\n\u003cfigure id=\"attachment_361111\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-361111 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg\" alt=\"VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The VA's push to find -- and cure -- every patient with the virus began three years ago.\u003c/p>\n\u003cp>This became feasible only when new hepatitis C medications came to market in late 2013. The new generation of drugs was a huge improvement over previous treatments. The older drugs required shots that were injected into the stomach, and the medications could have severe side effects: flulike symptoms and even mental health problems.\u003c/p>\n\u003cp>VA nurse Susan Bertilacchi-Green does not miss those days. A decade ago, the cure rate she observed from those older drugs was about 30 percent, she said.\u003c/p>\n\u003cp>\"That was then,\" she said. \"Now, we have new medications that are nearly 100 percent effective. They have little to no side effects. You can be treated in as little as eight weeks, and there's no shots anymore.\"\u003c/p>\n\u003cp>Since 2014, the VA has cured 96,000 patients of hepatitis C.\u003c/p>\n\u003cp>Vietnam veteran Roman Walden is one of them. He thinks he got the virus while injecting heroin in Vietnam, a habit that continued when he returned home to Oakland. Years ago, he tried treatment on the old drugs, but had to stop due to serious side effects. When the new drugs came out, he was hesitant to try treatment again. But with reassurance from Bertilacchi-Green, and other veterans who'd been cured, he yielded. This time, the treatment worked.\u003c/p>\n\u003cfigure id=\"attachment_361112\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361112\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg\" alt=\"Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of Hepatitis C. \" width=\"800\" height=\"613\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-768x588.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1020x781.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1180x904.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-960x735.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-240x184.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-375x287.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-520x398.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718.jpg 1560w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"I was really amazed at that,\" he said. \"But then what really got me was how much it cost, and that made me feel like the president of the United States. They were spending this much money on me?\"\u003c/p>\n\u003cp>Hepatitis C drugs have become notorious for their high cost. The wholesale price for a course of treatment can be over $100,000.\u003c/p>\n\u003cp>For Walden, that high price actually prompted him to take himself more seriously. He said the expense felt like an investment in him by the VA. After years on and off drugs, and in and out of jail, Walden, now 62, said he’s finally changing for the better. He said he no longer drinks or uses drugs, and is volunteering in hospitals, playing drums for patients.\u003c/p>\n\u003cp>The exorbitant prices of the new hepatitis C medications have led other health plans to hold off on treating every patient. Medi-Cal, for example, gives treatment priority to patients that show evidence of liver damage, or those who could spread the virus, like active drug users.\u003c/p>\n\u003cp>While the VA initially also had \"treatment priorities,\" this policy changed in 2016, after Congress stepped up with \u003ca href=\"https://www.va.gov/opa/pressrel/includes/viewPDF.cfm?id=2762\" target=\"_blank\" rel=\"noopener noreferrer\">billions in funding\u003c/a>, and pharmaceutical companies released new versions of drugs that were more competitively priced.\u003c/p>\n\u003cp>These days, the VA will treat \u003cem>anyone\u003c/em> with any level of veterans benefits. For the veterans, the treatment is usually free. Some have a small co-pay for the entire course of treatment, with $33 as the maximum.\u003c/p>\n\u003cp>Health officials say hepatitis C could be eliminated as a public health risk by 2030, but it will happen only if other health plans copy the VA’s lead.\u003c/p>\n\u003cp>At the VA in Martinez, Bertilacchi-Green concludes the visit by showing Junius Wilson and his wife, Shelly Baker, his latest lab tests. Even though he still has a month to go on his medication, the virus is already undetectable in his blood.\u003c/p>\n\u003cp>Wilson and Baker smile at one another.\u003c/p>\n\u003cp>\"We're happy,\" Baker said. \"We still need him around for a long time.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Additional reporting by Carrie Feibel.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>After months of protests from families, city supervisors and public health officials, \u003ca href=\"http://www.cpmc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Pacific Medical Center\u003c/a> (CPMC) announced that it will continue to care for 28 patients with complex medical needs, instead of transferring them to other facilities outside the city.\u003c/p>\n\u003cp>In June, the patients and their families received letters from CPMC saying that the skilled nursing unit where they lived at St. Luke's Hospital, known as a \"subacute\" unit, was closing permanently. The hospital as a whole is closing because it doesn't meet earthquake codes, but CPMC officials are replacing it with a new building on the same site in the Mission district. But they did not plan to include any subacute beds in the new hospital, nor would they create a subacute unit in another new hospital under construction near Japantown.\u003c/p>\n\u003cp>But in an unexpected reversal, CPMC CEO \u003ca href=\"http://www.cpmc.org/about/browner_w.html\" target=\"_blank\" rel=\"noopener noreferrer\">Dr. Warren Browner\u003c/a> said Monday the hospital system will continue to care for the 28 patients who would have been affected. Spokesman Dean Fryer said the medical center changed course after hearing concerns about the potential impact of the transition on patients and their families. CPMC officials also changed their minds after facing challenges securing beds for patients elsewhere in the Bay Area.\u003c/p>\n\u003cp>Subacute nursing units treat patients with complex medical needs, such as those on ventilators, for months or even years. The patients don’t need as much care as a regular “acute” hospital patient, but do need a level of skilled nursing care that is difficult to provide at home.\u003c/p>\n\u003cp>The subacute unit at St. Luke's is the last one in San Francisco based at a hospital. Regionally and nationally, hospitals have been shuttering these units. The patients demand a high level of care, but reimbursements for the treatment -- typically through Medicaid -- are low compared to private insurance.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Families were concerned that the move from St. Luke’s to another facility would be difficult for patients, who are in medically fragile states, and would also impose a burden on them because of the cost and difficulty of traveling farther away for visits. The San Francisco Health Commission took the issue up as well, passing a \u003ca href=\"https://www.sfdph.org/dph/files/hc/HCAgen/HCAgen2017/17_7St_Lukes_PropQ_Reso.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">resolution \u003c/a>saying the closure of this subacute unit would \"have a detrimental impact\" on health services in the city.\u003c/p>\n\u003cp>When word circulated on Monday that the patients would stay in San Francisco, family members rejoiced. Leneta Anderson’s husband has lived in St. Luke's subacute unit for 18 months. She visits him nearly every day at dinner time.\u003c/p>\n\u003cp>\"I could cry right now. I am just thrilled, thrilled that my husband and the other patients don’t have to leave,\" Anderson said over the phone on Monday. \"It’s a victory.\"\u003c/p>\n\u003cp>The new plan is for patients to move to another CPMC facility in August 2018 -- either the new Van Ness hospital, the new Mission Bernal hospital, which will replace St. Luke's, or CPMC Davies.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Family members, subacute nurses, and city supervisors said Tuesday that their next goal is to increase access by advocating for the creation of more skilled nursing beds in San Francisco.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>After months of protests from families, city supervisors and public health officials, \u003ca href=\"http://www.cpmc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Pacific Medical Center\u003c/a> (CPMC) announced that it will continue to care for 28 patients with complex medical needs, instead of transferring them to other facilities outside the city.\u003c/p>\n\u003cp>In June, the patients and their families received letters from CPMC saying that the skilled nursing unit where they lived at St. Luke's Hospital, known as a \"subacute\" unit, was closing permanently. The hospital as a whole is closing because it doesn't meet earthquake codes, but CPMC officials are replacing it with a new building on the same site in the Mission district. But they did not plan to include any subacute beds in the new hospital, nor would they create a subacute unit in another new hospital under construction near Japantown.\u003c/p>\n\u003cp>But in an unexpected reversal, CPMC CEO \u003ca href=\"http://www.cpmc.org/about/browner_w.html\" target=\"_blank\" rel=\"noopener noreferrer\">Dr. Warren Browner\u003c/a> said Monday the hospital system will continue to care for the 28 patients who would have been affected. Spokesman Dean Fryer said the medical center changed course after hearing concerns about the potential impact of the transition on patients and their families. CPMC officials also changed their minds after facing challenges securing beds for patients elsewhere in the Bay Area.\u003c/p>\n\u003cp>Subacute nursing units treat patients with complex medical needs, such as those on ventilators, for months or even years. The patients don’t need as much care as a regular “acute” hospital patient, but do need a level of skilled nursing care that is difficult to provide at home.\u003c/p>\n\u003cp>The subacute unit at St. Luke's is the last one in San Francisco based at a hospital. Regionally and nationally, hospitals have been shuttering these units. The patients demand a high level of care, but reimbursements for the treatment -- typically through Medicaid -- are low compared to private insurance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Families were concerned that the move from St. Luke’s to another facility would be difficult for patients, who are in medically fragile states, and would also impose a burden on them because of the cost and difficulty of traveling farther away for visits. The San Francisco Health Commission took the issue up as well, passing a \u003ca href=\"https://www.sfdph.org/dph/files/hc/HCAgen/HCAgen2017/17_7St_Lukes_PropQ_Reso.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">resolution \u003c/a>saying the closure of this subacute unit would \"have a detrimental impact\" on health services in the city.\u003c/p>\n\u003cp>When word circulated on Monday that the patients would stay in San Francisco, family members rejoiced. Leneta Anderson’s husband has lived in St. Luke's subacute unit for 18 months. She visits him nearly every day at dinner time.\u003c/p>\n\u003cp>\"I could cry right now. I am just thrilled, thrilled that my husband and the other patients don’t have to leave,\" Anderson said over the phone on Monday. \"It’s a victory.\"\u003c/p>\n\u003cp>The new plan is for patients to move to another CPMC facility in August 2018 -- either the new Van Ness hospital, the new Mission Bernal hospital, which will replace St. Luke's, or CPMC Davies.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Family members, subacute nurses, and city supervisors said Tuesday that their next goal is to increase access by advocating for the creation of more skilled nursing beds in San Francisco.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Families Fight Closure of Nursing Unit in San Francisco",
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"content": "\u003cp>Every evening, San Francisco resident Leneta Anderson takes the 44-O'Shaughnessy bus from her home in Silver Terrace, near the Bayview, to \u003ca href=\"http://www.cpmc.org/about/stluke.html\" target=\"_blank\" rel=\"noopener noreferrer\">St. Luke’s Hospital\u003c/a> in the Mission. She eats dinner there with her husband of 59 years, Richard. He’s been living there for the past year and a half, in a skilled nursing unit that offers \"sub-acute\" care.\u003c/p>\n\u003cp>Sub-acute nursing units treat patients with complex medical needs, such as tracheostomies, sometimes for months or even years. The patients don't need as much care as a regular \"acute\" hospital patient, but do need a level of skilled nursing care that is difficult to provide at home. Richard, for example, has congestive heart failure and diabetes. The 83-year-old also depends on a ventilator and needs dialysis three times a week.\u003c/p>\n\u003cp>St. Luke's is the last hospital in San Francisco with a sub-acute unit, and parent company Sutter Health has plans to close it by the end of the year.\u003c/p>\n\u003cp>Anderson is worried that Richard will be transferred somewhere far away.\u003c/p>\n\u003cp>\"I don’t want Richard to have to be transported to Los Angeles, San Jose, Sacramento,\" she said. \"I need him in San Francisco where I can see him.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Anderson spoke at a press conference Tuesday on the steps of City Hall. She was joined by other family members opposed to the closure of the sub-acute unit.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cpmc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Pacific Medical Center (CPMC)\u003c/a>, a Sutter Health affiliate, operates St. Luke’s Hospital. To comply with earthquake building codes, CPMC is demolishing the old hospital, but the replacement building will not include a sub-acute unit. CPMC originally said residents would be transferred by Oct. 31, but more recently stated the process could go on until the end of the year.\u003c/p>\n\u003cp>Many of the 24 patients in the unit at St. Luke's have been there for years. Many depend on Medi-Cal for coverage, which reimburses hospitals at a lower rate than private insurance or Medicare. Opponents of the closure have speculated that CPMC is closing the sub-acute unit because of the lower reimbursements, but a spokeswoman for Sutter denied that finances were part of the decision.\u003c/p>\n\u003cp>Families are concerned that the move from St. Luke's to another facility will be difficult for patients, who are in medically fragile states, and for themselves, because of the cost and difficulty of traveling farther for visits.\u003c/p>\n\u003cp>If Richard were transferred out of the city, he would get fewer visits from family members, Leneta Anderson said: \"It will kill him if he doesn't see my face or my children.\"\u003c/p>\n\u003cfigure id=\"attachment_360956\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360956\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-800x600.jpg\" alt=\"Leneta Anderson holds photos of her husband Richard, who is a patient in the sub-acute skilled nursing facility at St. Luke's Hospital.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Leneta Anderson holds photos of her husband Richard, who is a patient in the sub-acute skilled nursing facility at St. Luke's Hospital. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Sutter is also building a new hospital on Cathedral Hill at Van Ness Avenue and Geary Street. Representatives have said neither Cathedral Hill's hospital or the new one being built on the St. Luke's Campus will have enough space for a sub-acute unit and that they'll put together appropriate transfer plans for each affected patient and their families. But Anderson said all she's received so far is a list of hospitals where Richard might end up, and she hasn't found it helpful.\u003c/p>\n\u003cp>\"We want to stay where we are,\" Anderson said, meaning she wants Richard to continue as a patient in the new hospital that will be built alongside the old building, on Cesar Chavez Street. Other relatives agree.\u003c/p>\n\u003cp>While the city can't stop the closure of the sub-acute unit at St. Luke's, San Francisco Supervisors \u003ca href=\"http://sfbos.org/supervisor-safai-district-11\" target=\"_blank\" rel=\"noopener noreferrer\">Ahsha Safaí\u003c/a> and \u003ca href=\"http://sfbos.org/supervisor-ronen-district-9\" target=\"_blank\" rel=\"noopener noreferrer\">Hillary Ronen\u003c/a> are putting pressure on Sutter to reconsider.\u003c/p>\n\u003cp>\"It's unfathomable, unconscionable, and essentially inhumane,\" Safai said. He believes moving patients out of San Francisco County would be hard on their families. \"You're talking about -- quite often -- people that essentially rely on public transportation. They would literally have no way to get to see their family member in the hospital if they were shipped out of the county.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.sfdph.org/dph/comupg/aboutdph/hc/\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco's Health Commission\u003c/a>, the governing body of the city's Department of Public Health, also issued a resolution condemning the closure of the sub-acute unit. In it, the commission says the closure would have a \"detrimental impact on the health care services in the community.\"\u003c/p>\n\u003cp>CPMC CEO Dr. Warren Browner issued a statement saying that the health system has identified sub-acute beds in Alameda and Daly City and will work to secure those for the patients currently in St. Luke's.\u003c/p>\n\u003cp>Dean Fryer, a spokesman for CPMC, said hospital administrators have been discussing the closure of the sub-acute unit with the city since 2011. But families of the patients say they didn't get notified by letter until June.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The issue will be taken up next during the Board of Supervisors meeting on Sept. 12.\u003c/p>\n\n",
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"excerpt": "As St. Luke's gets ready to replace an old hospital, the fate of two dozen patients has rekindled a fight over what a health provider owes the city. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Every evening, San Francisco resident Leneta Anderson takes the 44-O'Shaughnessy bus from her home in Silver Terrace, near the Bayview, to \u003ca href=\"http://www.cpmc.org/about/stluke.html\" target=\"_blank\" rel=\"noopener noreferrer\">St. Luke’s Hospital\u003c/a> in the Mission. She eats dinner there with her husband of 59 years, Richard. He’s been living there for the past year and a half, in a skilled nursing unit that offers \"sub-acute\" care.\u003c/p>\n\u003cp>Sub-acute nursing units treat patients with complex medical needs, such as tracheostomies, sometimes for months or even years. The patients don't need as much care as a regular \"acute\" hospital patient, but do need a level of skilled nursing care that is difficult to provide at home. Richard, for example, has congestive heart failure and diabetes. The 83-year-old also depends on a ventilator and needs dialysis three times a week.\u003c/p>\n\u003cp>St. Luke's is the last hospital in San Francisco with a sub-acute unit, and parent company Sutter Health has plans to close it by the end of the year.\u003c/p>\n\u003cp>Anderson is worried that Richard will be transferred somewhere far away.\u003c/p>\n\u003cp>\"I don’t want Richard to have to be transported to Los Angeles, San Jose, Sacramento,\" she said. \"I need him in San Francisco where I can see him.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Anderson spoke at a press conference Tuesday on the steps of City Hall. She was joined by other family members opposed to the closure of the sub-acute unit.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cpmc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Pacific Medical Center (CPMC)\u003c/a>, a Sutter Health affiliate, operates St. Luke’s Hospital. To comply with earthquake building codes, CPMC is demolishing the old hospital, but the replacement building will not include a sub-acute unit. CPMC originally said residents would be transferred by Oct. 31, but more recently stated the process could go on until the end of the year.\u003c/p>\n\u003cp>Many of the 24 patients in the unit at St. Luke's have been there for years. Many depend on Medi-Cal for coverage, which reimburses hospitals at a lower rate than private insurance or Medicare. Opponents of the closure have speculated that CPMC is closing the sub-acute unit because of the lower reimbursements, but a spokeswoman for Sutter denied that finances were part of the decision.\u003c/p>\n\u003cp>Families are concerned that the move from St. Luke's to another facility will be difficult for patients, who are in medically fragile states, and for themselves, because of the cost and difficulty of traveling farther for visits.\u003c/p>\n\u003cp>If Richard were transferred out of the city, he would get fewer visits from family members, Leneta Anderson said: \"It will kill him if he doesn't see my face or my children.\"\u003c/p>\n\u003cfigure id=\"attachment_360956\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360956\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-800x600.jpg\" alt=\"Leneta Anderson holds photos of her husband Richard, who is a patient in the sub-acute skilled nursing facility at St. Luke's Hospital.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26488_St-Lukes-Rally2-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Leneta Anderson holds photos of her husband Richard, who is a patient in the sub-acute skilled nursing facility at St. Luke's Hospital. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Sutter is also building a new hospital on Cathedral Hill at Van Ness Avenue and Geary Street. Representatives have said neither Cathedral Hill's hospital or the new one being built on the St. Luke's Campus will have enough space for a sub-acute unit and that they'll put together appropriate transfer plans for each affected patient and their families. But Anderson said all she's received so far is a list of hospitals where Richard might end up, and she hasn't found it helpful.\u003c/p>\n\u003cp>\"We want to stay where we are,\" Anderson said, meaning she wants Richard to continue as a patient in the new hospital that will be built alongside the old building, on Cesar Chavez Street. Other relatives agree.\u003c/p>\n\u003cp>While the city can't stop the closure of the sub-acute unit at St. Luke's, San Francisco Supervisors \u003ca href=\"http://sfbos.org/supervisor-safai-district-11\" target=\"_blank\" rel=\"noopener noreferrer\">Ahsha Safaí\u003c/a> and \u003ca href=\"http://sfbos.org/supervisor-ronen-district-9\" target=\"_blank\" rel=\"noopener noreferrer\">Hillary Ronen\u003c/a> are putting pressure on Sutter to reconsider.\u003c/p>\n\u003cp>\"It's unfathomable, unconscionable, and essentially inhumane,\" Safai said. He believes moving patients out of San Francisco County would be hard on their families. \"You're talking about -- quite often -- people that essentially rely on public transportation. They would literally have no way to get to see their family member in the hospital if they were shipped out of the county.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.sfdph.org/dph/comupg/aboutdph/hc/\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco's Health Commission\u003c/a>, the governing body of the city's Department of Public Health, also issued a resolution condemning the closure of the sub-acute unit. In it, the commission says the closure would have a \"detrimental impact on the health care services in the community.\"\u003c/p>\n\u003cp>CPMC CEO Dr. Warren Browner issued a statement saying that the health system has identified sub-acute beds in Alameda and Daly City and will work to secure those for the patients currently in St. Luke's.\u003c/p>\n\u003cp>Dean Fryer, a spokesman for CPMC, said hospital administrators have been discussing the closure of the sub-acute unit with the city since 2011. But families of the patients say they didn't get notified by letter until June.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The issue will be taken up next during the Board of Supervisors meeting on Sept. 12.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Kids Find Breathing Room At Asthma Camp",
"title": "Kids Find Breathing Room At Asthma Camp",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>A third of the kids had finished their pancakes when camp counselor Bryan “The Lungs” Wegley hopped up to lead them in “The Penguin Song.” The children flapped their arms and shuffled their feet like snazzy Antarctic seabirds.\u003c/p>\n\u003cp>Later, when the room had grown quiet, another camp staffer showed a Smurf movie for 15 minutes worth of giggles, before everyone dashed off to swim.\u003c/p>\n\u003cp>For the 37 children attending this annual summer camp in Salinas, Calif., days packed with fun helped make doses of asthma education go down as smoothly as sweetened cough syrup. The kids attended the camp to frolic, but also to better understand the chronic lung disease that makes breathing more difficult for them and about \u003ca href=\"http://www.kidsdata.org/topic/238/asthma/table#fmt=97&loc=2,127,1657,331,1656,171,1655,345,357,324,369,362,360,337,364,356,217,328,354,320,339,334,365,343,367,344,355,366,368,265,349,361,4,273,59,370,326,341,338,350,342,359,363,340,335&tf=89&sortColumnId=0&sortType=asc\" target=\"_blank\" rel=\"noopener noreferrer\">1 in 6 California children\u003c/a>.\u003c/p>\n\u003cp>“Dust! Cockroaches! Cigarette smoke! Pets!” the kids yelled out in response to a question about what triggers their wheezing, shortness of breath and tightness in the chest. Some of the children, who ranged in age from 6 to 12, said they’d been to the emergency room multiple times. Asthma, if not properly treated, can be fatal.\u003c/p>\n\u003cp>Most of the children had been diagnosed when they were babies or toddlers and completely dependent on their parents or guardians. As they grow older and become physically less dependent on adults, they need to take more responsibility for managing their disease. \u003ca href=\"http://www.annallergy.org/article/S1081-1206(10)60377-8/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Studies show\u003c/a> that asthma camps can instill knowledge and encourage habits that help children better control their conditions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For most of the week, parents dropped their kids off in the morning and picked them up at the end of the day. But one of the highlights of the camp is the sleepover, held at a local elementary school. That’s when kids who want to can spend the night at camp without their parents. For those who do, it’s another step in assuming responsibility for their own health.\u003c/p>\n\u003cp>“Our camp song says, ‘Your parents are not in charge of your asthma; you’re in charge of your asthma,’” said Sienna Grant, 9, as she climbed a ladder and prepared to swing rung to rung across a jungle gym. She used to be reluctant to stop playing, even for a puff of her inhaler. But now she’s learning “to take things more seriously,” she said.\u003c/p>\n\u003cp>Asthma camps sprang up in the late 1970s and early 1980s, when there were far fewer medications to treat the condition.\u003c/p>\n\u003cp>“There was no way to control or prevent asthma,” said Dr. Steven Prager, who is the camp’s medical director and a physician with the Salinas Valley Memorial Healthcare System, one of the camp’s co-sponsors.\u003c/p>\n\u003cp>Instead of shooing kids out of the house to play, nervous parents often blocked their path, relegating asthmatic children to a summer on the couch, Prager said.\u003c/p>\n\u003cp>For some children, asthma camp can provide a safe space to play and learn.\u003c/p>\n\u003cp>“I hear from prior campers and their parents all the time that the camp helped the kids take a more active, productive role in the management of their asthma,” Prager said. Parents reported a decrease in school absences and emergency room visits after their kids attended the program, he added.\u003c/p>\n\u003cp>Dr. Michael Welch, a physician at Rady Children’s Hospital-San Diego, studied the effectiveness of asthma camps a decade ago, but he said there is little research on the topic.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.annallergy.org/article/S1081-1206(10)60377-8/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">2007 study\u003c/a> co-authored by Welch found that a year after attending an asthma camp, kids had “assumed greater responsibility for taking their medication.” The study was based on a survey of nearly 1,800 participants at 24 asthma camps around the United States.\u003c/p>\n\u003cp>Welch noted that numerous camps cater to children with a wide range of chronic illnesses.\u003c/p>\n\u003cp>“Kids learn right away that they’re not the only ones with this chronic disease, so they [feel] a little less abnormal, which is good for their self-esteem,” he said.\u003c/p>\n\u003cp>Despite a profusion of camps dedicated to other conditions, the number of asthma camps is dwindling, Welch said. There are 90 asthma camps across the country — a third fewer than a decade ago — serving about 4,000 children, according to Jill Heins Nesvold, executive director of the \u003ca href=\"http://www.asthmacamps.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Consortium on Children’s Asthma Camps\u003c/a>.\u003c/p>\n\u003cp>There used to be at least five \u003ca href=\"http://www.asthmacamps.org/campdetails.cfm?longst=California&state=CA\" target=\"_blank\" rel=\"noopener noreferrer\">asthma camps in California\u003c/a>, but in the past few years, two of them — one in Los Angeles and another in San Diego — have closed.\u003c/p>\n\u003cp>“Funding has been a problem with keeping asthma camps alive,” said Welch, who was the medical director for more than three decades at the now-shuttered San Diego camp.\u003c/p>\n\u003cp>Part of the problem, he said, is that groups such as the American Lung Association have decided to focus their funding to research and lobbying, diverting it from direct community services like asthma camps.\u003c/p>\n\u003cp>The Salinas camp is funded by the Salinas Valley Memorial Healthcare System, \u003ca href=\"https://childrensmiraclenetworkhospitals.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Children’s Miracle Network\u003c/a> (CMN), a nonprofit that raises money for children’s hospitals nationwide, and individual donors. CMN gets most of its funding from corporate donors across a wide range of industries. The financial contributions help make the camp more affordable for families: Parents pay $55 per child, and scholarships are available.\u003c/p>\n\u003cp>While the Salinas camp has benefited from a solid endowment over the years, “it’s slowly being whittled down,” Prager said. “At the moment, we’re fine, but it’s going to be a challenge in the years to come.”\u003c/p>\n\u003cp>But as long as asthma camps keep their doors open, children will likely attend.\u003c/p>\n\u003cp>In the middle of the week, their confidence growing, about two-thirds of the Salinas campers tackled the overnight.\u003c/p>\n\u003cp>It sounds simple, but “many of these kids have never spent a night away from home,” Prager said. “It’s a big deal … and for the parents sometimes an even bigger deal.”\u003c/p>\n\u003cp>Dario Aldaco, 6, declared he would do the overnight even though his two older brothers — and running buddies — were skipping it.\u003c/p>\n\u003cp>“I want to do this, even if they don’t want to,” he told his mom, Aidee Aldaco.\u003c/p>\n\u003cp>“I was anxiety central,” she said. “I asked him, ‘Are you sure? Without your brothers?’”\u003c/p>\n\u003cp>On the big night, counselors stoked a fire pit near an outside play area and kids gathered around to socialize and munch s’mores. Later, inside the school’s gym, they unrolled sleeping bags and conked out on the floor, with counselors from the local YMCA and Prager nearby.\u003c/p>\n\u003cp>The next day, when the parents saw their kids had survived without them, they breathed a sigh of relief. On the final day, camp administrators asked the parents to vow that they would not curtail their children’s activities out of fear.\u003c/p>\n\u003cp>As they said their goodbyes, campers left with a better understanding of their illness, newfound confidence and backpacks full of gadgets and meds to ease their breathing.\u003c/p>\n\u003cp>Dario came home with the confidence to ask his father not to smoke on the side of the house where the fumes get inside and can trigger his and his brothers’ asthma.\u003c/p>\n\u003cp>Dario’s older brother, Aaron, 8, who also attended the camp and has mild to moderate autism, began to use a new word: “independent.”\u003c/p>\n\u003cp>The asthma camp had made him think twice about his mother’s plan to move closer to her children when they go off to college.\u003c/p>\n\u003cp>“If you move with me,” Aaron asked, “then how am I going to be independent?”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“So,” Aidee Aldaco said with a chuckle, “my husband and I are not going to be able to follow them.”\u003c/p>\n\n",
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"nprByline": "\u003ca href=\"http://californiahealthline.org/news/author/pamela-k-johnson/\">\u003cstrong>Pamela K. Johnson\u003c/strong>\u003c/a> \u003c/span>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A third of the kids had finished their pancakes when camp counselor Bryan “The Lungs” Wegley hopped up to lead them in “The Penguin Song.” The children flapped their arms and shuffled their feet like snazzy Antarctic seabirds.\u003c/p>\n\u003cp>Later, when the room had grown quiet, another camp staffer showed a Smurf movie for 15 minutes worth of giggles, before everyone dashed off to swim.\u003c/p>\n\u003cp>For the 37 children attending this annual summer camp in Salinas, Calif., days packed with fun helped make doses of asthma education go down as smoothly as sweetened cough syrup. The kids attended the camp to frolic, but also to better understand the chronic lung disease that makes breathing more difficult for them and about \u003ca href=\"http://www.kidsdata.org/topic/238/asthma/table#fmt=97&loc=2,127,1657,331,1656,171,1655,345,357,324,369,362,360,337,364,356,217,328,354,320,339,334,365,343,367,344,355,366,368,265,349,361,4,273,59,370,326,341,338,350,342,359,363,340,335&tf=89&sortColumnId=0&sortType=asc\" target=\"_blank\" rel=\"noopener noreferrer\">1 in 6 California children\u003c/a>.\u003c/p>\n\u003cp>“Dust! Cockroaches! Cigarette smoke! Pets!” the kids yelled out in response to a question about what triggers their wheezing, shortness of breath and tightness in the chest. Some of the children, who ranged in age from 6 to 12, said they’d been to the emergency room multiple times. Asthma, if not properly treated, can be fatal.\u003c/p>\n\u003cp>Most of the children had been diagnosed when they were babies or toddlers and completely dependent on their parents or guardians. As they grow older and become physically less dependent on adults, they need to take more responsibility for managing their disease. \u003ca href=\"http://www.annallergy.org/article/S1081-1206(10)60377-8/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Studies show\u003c/a> that asthma camps can instill knowledge and encourage habits that help children better control their conditions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For most of the week, parents dropped their kids off in the morning and picked them up at the end of the day. But one of the highlights of the camp is the sleepover, held at a local elementary school. That’s when kids who want to can spend the night at camp without their parents. For those who do, it’s another step in assuming responsibility for their own health.\u003c/p>\n\u003cp>“Our camp song says, ‘Your parents are not in charge of your asthma; you’re in charge of your asthma,’” said Sienna Grant, 9, as she climbed a ladder and prepared to swing rung to rung across a jungle gym. She used to be reluctant to stop playing, even for a puff of her inhaler. But now she’s learning “to take things more seriously,” she said.\u003c/p>\n\u003cp>Asthma camps sprang up in the late 1970s and early 1980s, when there were far fewer medications to treat the condition.\u003c/p>\n\u003cp>“There was no way to control or prevent asthma,” said Dr. Steven Prager, who is the camp’s medical director and a physician with the Salinas Valley Memorial Healthcare System, one of the camp’s co-sponsors.\u003c/p>\n\u003cp>Instead of shooing kids out of the house to play, nervous parents often blocked their path, relegating asthmatic children to a summer on the couch, Prager said.\u003c/p>\n\u003cp>For some children, asthma camp can provide a safe space to play and learn.\u003c/p>\n\u003cp>“I hear from prior campers and their parents all the time that the camp helped the kids take a more active, productive role in the management of their asthma,” Prager said. Parents reported a decrease in school absences and emergency room visits after their kids attended the program, he added.\u003c/p>\n\u003cp>Dr. Michael Welch, a physician at Rady Children’s Hospital-San Diego, studied the effectiveness of asthma camps a decade ago, but he said there is little research on the topic.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.annallergy.org/article/S1081-1206(10)60377-8/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">2007 study\u003c/a> co-authored by Welch found that a year after attending an asthma camp, kids had “assumed greater responsibility for taking their medication.” The study was based on a survey of nearly 1,800 participants at 24 asthma camps around the United States.\u003c/p>\n\u003cp>Welch noted that numerous camps cater to children with a wide range of chronic illnesses.\u003c/p>\n\u003cp>“Kids learn right away that they’re not the only ones with this chronic disease, so they [feel] a little less abnormal, which is good for their self-esteem,” he said.\u003c/p>\n\u003cp>Despite a profusion of camps dedicated to other conditions, the number of asthma camps is dwindling, Welch said. There are 90 asthma camps across the country — a third fewer than a decade ago — serving about 4,000 children, according to Jill Heins Nesvold, executive director of the \u003ca href=\"http://www.asthmacamps.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Consortium on Children’s Asthma Camps\u003c/a>.\u003c/p>\n\u003cp>There used to be at least five \u003ca href=\"http://www.asthmacamps.org/campdetails.cfm?longst=California&state=CA\" target=\"_blank\" rel=\"noopener noreferrer\">asthma camps in California\u003c/a>, but in the past few years, two of them — one in Los Angeles and another in San Diego — have closed.\u003c/p>\n\u003cp>“Funding has been a problem with keeping asthma camps alive,” said Welch, who was the medical director for more than three decades at the now-shuttered San Diego camp.\u003c/p>\n\u003cp>Part of the problem, he said, is that groups such as the American Lung Association have decided to focus their funding to research and lobbying, diverting it from direct community services like asthma camps.\u003c/p>\n\u003cp>The Salinas camp is funded by the Salinas Valley Memorial Healthcare System, \u003ca href=\"https://childrensmiraclenetworkhospitals.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Children’s Miracle Network\u003c/a> (CMN), a nonprofit that raises money for children’s hospitals nationwide, and individual donors. CMN gets most of its funding from corporate donors across a wide range of industries. The financial contributions help make the camp more affordable for families: Parents pay $55 per child, and scholarships are available.\u003c/p>\n\u003cp>While the Salinas camp has benefited from a solid endowment over the years, “it’s slowly being whittled down,” Prager said. “At the moment, we’re fine, but it’s going to be a challenge in the years to come.”\u003c/p>\n\u003cp>But as long as asthma camps keep their doors open, children will likely attend.\u003c/p>\n\u003cp>In the middle of the week, their confidence growing, about two-thirds of the Salinas campers tackled the overnight.\u003c/p>\n\u003cp>It sounds simple, but “many of these kids have never spent a night away from home,” Prager said. “It’s a big deal … and for the parents sometimes an even bigger deal.”\u003c/p>\n\u003cp>Dario Aldaco, 6, declared he would do the overnight even though his two older brothers — and running buddies — were skipping it.\u003c/p>\n\u003cp>“I want to do this, even if they don’t want to,” he told his mom, Aidee Aldaco.\u003c/p>\n\u003cp>“I was anxiety central,” she said. “I asked him, ‘Are you sure? Without your brothers?’”\u003c/p>\n\u003cp>On the big night, counselors stoked a fire pit near an outside play area and kids gathered around to socialize and munch s’mores. Later, inside the school’s gym, they unrolled sleeping bags and conked out on the floor, with counselors from the local YMCA and Prager nearby.\u003c/p>\n\u003cp>The next day, when the parents saw their kids had survived without them, they breathed a sigh of relief. On the final day, camp administrators asked the parents to vow that they would not curtail their children’s activities out of fear.\u003c/p>\n\u003cp>As they said their goodbyes, campers left with a better understanding of their illness, newfound confidence and backpacks full of gadgets and meds to ease their breathing.\u003c/p>\n\u003cp>Dario came home with the confidence to ask his father not to smoke on the side of the house where the fumes get inside and can trigger his and his brothers’ asthma.\u003c/p>\n\u003cp>Dario’s older brother, Aaron, 8, who also attended the camp and has mild to moderate autism, began to use a new word: “independent.”\u003c/p>\n\u003cp>The asthma camp had made him think twice about his mother’s plan to move closer to her children when they go off to college.\u003c/p>\n\u003cp>“If you move with me,” Aaron asked, “then how am I going to be independent?”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“So,” Aidee Aldaco said with a chuckle, “my husband and I are not going to be able to follow them.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Amid Uncertainty Over Health Care, Covered California Appeals to Insurers' Bottom Lines",
"title": "Amid Uncertainty Over Health Care, Covered California Appeals to Insurers' Bottom Lines",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>With ongoing uncertainty around the Affordable Care Act (ACA), the board that oversees California's health care marketplace took action to stabilize the exchange on Thursday. Their goal was to convince insurance companies to continue offering health plans through \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee praised California's overall success as a health care marketplace, but cautioned that the exchange faces significant challenges.\u003c/p>\n\u003cp>\"We think this open enrollment’s going to be the most challenging since year one,\" Lee said. \"We’re dealing with the most federal uncertainty we’ve ever had.\"\u003c/p>\n\u003cp>Lee is referring to Congress's attempts to repeal the ACA, and the Trump administration's threats not to pay subsidies to insurance companies, as required under the health care law.\u003c/p>\n\u003cp>In the meeting, the board unanimously adopted two new resolutions they believe will maintain market stability. \u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/2017-2019%20QHP%20Issuer%20Contract%20Amendment%20Resolution%20(2017-36).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The first\u003c/a> updates contracts between Covered California and insurance companies, allowing insurers who lose money in 2018 to increase profit margins in the following three years in order to recoup losses. Alternatively, if companies make unforeseen profits because of national uncertainty, those profits would go to reducing premiums in the future.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In an email, a spokesperson for Blue Shield of California, one of the exchange's providers, said the company \"supports Covered California’s program to address the pricing uncertainty and will participate to add stability in the market.\"\u003c/p>\n\u003cp>\u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/Fiscal%20Year%202017-18%20Budget%20Revision%20(Resolution%202017-37).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The second resolution\u003c/a> increases Covered California's marketing and outreach budget by over $5 million. Marketing helps convince consumers, especially healthy ones, to sign up for plans. A mix of healthy and sick participants allows health care marketplaces to maintain lower premiums.\u003c/p>\n\u003cp>Finally, the board announced it would delay a decision about whether to further increase 2018 premiums until Sept. 30.\u003c/p>\n\u003cp>[contextly_sidebar id=\"QtimBtKZJz3HyH4ttMNqWM3dVsZyKIDx\"]\u003c/p>\n\u003cp>Those increases could be necessary to make up for the insurance companies' financial losses, if the federal government withholds subsidies designed to decrease costs for low-income consumers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The board hopes that by the end of September it will better understand what will happen to the Affordable Care Act and how that will impact California.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>With ongoing uncertainty around the Affordable Care Act (ACA), the board that oversees California's health care marketplace took action to stabilize the exchange on Thursday. Their goal was to convince insurance companies to continue offering health plans through \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>.\u003c/p>\n\u003cp>Covered California Executive Director Peter V. Lee praised California's overall success as a health care marketplace, but cautioned that the exchange faces significant challenges.\u003c/p>\n\u003cp>\"We think this open enrollment’s going to be the most challenging since year one,\" Lee said. \"We’re dealing with the most federal uncertainty we’ve ever had.\"\u003c/p>\n\u003cp>Lee is referring to Congress's attempts to repeal the ACA, and the Trump administration's threats not to pay subsidies to insurance companies, as required under the health care law.\u003c/p>\n\u003cp>In the meeting, the board unanimously adopted two new resolutions they believe will maintain market stability. \u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/2017-2019%20QHP%20Issuer%20Contract%20Amendment%20Resolution%20(2017-36).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The first\u003c/a> updates contracts between Covered California and insurance companies, allowing insurers who lose money in 2018 to increase profit margins in the following three years in order to recoup losses. Alternatively, if companies make unforeseen profits because of national uncertainty, those profits would go to reducing premiums in the future.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In an email, a spokesperson for Blue Shield of California, one of the exchange's providers, said the company \"supports Covered California’s program to address the pricing uncertainty and will participate to add stability in the market.\"\u003c/p>\n\u003cp>\u003ca href=\"http://board.coveredca.com/meetings/2017/08-17/Fiscal%20Year%202017-18%20Budget%20Revision%20(Resolution%202017-37).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">The second resolution\u003c/a> increases Covered California's marketing and outreach budget by over $5 million. Marketing helps convince consumers, especially healthy ones, to sign up for plans. A mix of healthy and sick participants allows health care marketplaces to maintain lower premiums.\u003c/p>\n\u003cp>Finally, the board announced it would delay a decision about whether to further increase 2018 premiums until Sept. 30.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Those increases could be necessary to make up for the insurance companies' financial losses, if the federal government withholds subsidies designed to decrease costs for low-income consumers.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The board hopes that by the end of September it will better understand what will happen to the Affordable Care Act and how that will impact California.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Fate Of San Francisco’s Ban On Flavored Tobacco Products Is Now Up To Voters",
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"content": "\u003cp>A coalition of local business owners financed by the tobacco industry has blocked San Francisco’s new ban on menthol cigarettes and flavored tobacco products until voters decide whether to uphold or overturn it.\u003c/p>\n\u003cp>The ban, adopted unanimously by the Board of Supervisors in June, would have kicked in next year. But the city’s \u003ca href=\"http://sfgov.org/elections/measures\" target=\"_blank\" rel=\"noopener noreferrer\">Office of Elections\u003c/a> determined earlier this month that the opposition group \u003ca href=\"http://www.letsberealsf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Let’s Be Real, San Francisco\u003c/a> has gathered enough signatures for a ballot referendum, putting the ban on hold until voters decide next year.\u003c/p>\n\u003cp>“This is a freedom-of-choice issue for responsible adults,” said Jaime Rojas, a spokesman for the coalition.\u003c/p>\n\u003cp>“We believe that local government officials have overreached and the referendum will allow the voters of San Francisco to make the final decision,” he said.\u003c/p>\n\u003cp>The San Francisco Board of Supervisors will vote next month whether to overturn the ordinance themselves — which is unlikely — or put it before voters, probably in June.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The \u003ca href=\"https://sfgov.legistar.com/View.ashx?M=F&ID=5274235&GUID=86C18253-BA63-4C0F-A6A0-E881211D2CB7\" target=\"_blank\" rel=\"noopener noreferrer\">tobacco ordinance \u003c/a>would prohibit the sale of menthol cigarettes and other flavored tobacco, including hookah tobacco and small cigars, as well as most vaping products and e-cigarettes.\u003c/p>\n\u003cp>“San Francisco made history when it passed this ordinance, the strongest restrictions on flavored tobacco products in the nation,” said Stanton Glantz, professor of medicine and director of the \u003ca href=\"http://www.tobacco.ucsf.edu/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Tobacco Control Research and Education\u003c/a> at the University of California-San Francisco (UCSF).\u003c/p>\n\u003cp>According \u003ca href=\"http://sfcontroller.org/sites/default/files/Documents/Economic%20Analysis/170441_economic_impact_final.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">to a report\u003c/a> from the City Controller’s Office of Economic Analysis, 35 percent of the cigarettes sold in San Francisco are menthol and would be subject to the ban.\u003c/p>\n\u003cp>Rojas said he believes retailers would lose about $50 million in local tobacco sales annually under the ordinance.\u003c/p>\n\u003cp>Vivian New, co-owner of SF Smoke N’ Vape Shop on Fisherman’s Wharf, estimated that the ban would drive down her profits by 30 to 40 percent.\u003c/p>\n\u003cp>New, 22, said she has “never laid my lips on a cigarette.” Nonetheless, she opposes restrictions on the kinds of tobacco products her customers can buy because “it’s part of [their] rights.”\u003c/p>\n\u003cp>Let’s Be Real, San Francisco describes itself as a coalition of “concerned citizens supporting freedom of choice, adult consumers, community leaders and neighborhood small businesses.”\u003c/p>\n\u003cp>But campaign filing statements for the last half of July \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/08/document6.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">show only one donor\u003c/a>: R.J. Reynolds Tobacco Co. of Winston-Salem, N.C., which gave more than $685,000 to the effort.\u003c/p>\n\u003cp>David Howard, a spokesman for R.J. Reynolds, said the company is proud to be a part of the coalition and sees the referendum campaign “as an opportunity to educate the citizens of San Francisco on the negative impacts that this [ordinance] can have.”\u003c/p>\n\u003cp>The industry giant manufactures Newport, the nation’s leading menthol brand, which would be banned under the ordinance.\u003c/p>\n\u003cp>“It’s just a complete hoax,” Glantz said. “This organization that’s putting itself out as a bunch of free-thinking concerned local citizens is actually just a front for the tobacco companies.”\u003c/p>\n\u003cp>Supervisor Malia Cohen, who sponsored the tobacco measure, called the opposition referendum “a ridiculous attempt to put profit over people’s health.” She said R.J. Reynolds is attacking the legislation “because they know it is strong and that people will stop smoking.”\u003c/p>\n\u003cp>Flavored tobacco and menthol cigarettes, including Newport, the No. 2 cigarette brand in the nation, are popular with young people and minorities, \u003ca href=\"http://californiahealthline.org/news/sf-seeks-to-ban-sale-of-menthol-cigarettes-and-flavored-tobacco-products/\" target=\"_blank\" rel=\"noopener noreferrer\">especially African-Americans\u003c/a>.\u003c/p>\n\u003cp>“Menthol is an especially pernicious additive,” Glantz said, since it interacts with nicotine to make cigarettes easier to smoke and all tobacco products more addictive.\u003c/p>\n\u003cp>Miriam Zouzounis, a board member with the Arab American Grocers Association and member of the coalition, insisted that the campaign against the tobacco ordinance started as a grass-roots effort by working-class shop owners and their customers. She said the tobacco industry stepped in only after the ban was approved unanimously by the Board of Supervisors.\u003c/p>\n\u003cp>Zouzounis believes the ordinance is a burden for small merchants like her family of immigrants who own Ted’s Market, a corner grocery and sandwich shop south of Market Street.\u003c/p>\n\u003cp>“Basically it is a redundant policy. There’s laws already on the books to keep tobacco out of the hands of kids,” she said.\u003c/p>\n\u003cp>She pointed to a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162SB7\">law\u003c/a> signed last year by Gov. Jerry Brown that raised the legal smoking age in California from 18 to 21. Under the new rules, anyone caught giving or selling tobacco products to people under 21 could face misdemeanor charges.\u003c/p>\n\u003cp>“It’s kind of nonsense,” said Jiries Totah, an auto mechanic who buys Grizzly wintergreen-flavored chewing tobacco from Ted’s Market. “I’m 27. I pay my taxes and I do what I’m supposed to do as a citizen. How can someone tell me I can’t purchase a legal product?”\u003c/p>\n\u003cp>Zouzounis and other business owners say city officials failed to consult with them or consider amendments that addressed their concerns. The ordinance also gives out-of-state businesses that sell online an advantage over brick-and-mortar shops in the city, she said.\u003c/p>\n\u003cp>“You can buy these products they’re trying to ban online and get them delivered straight to your address in SF, and we know that an online check of an ID is not fail-proof,” she said.\u003c/p>\n\u003cp>But advocates of the ban say these arguments are diversions from the real point, which is to reduce tobacco consumption and improve health.\u003c/p>\n\u003cp>They vow to fight to keep the ordinance in place.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We’ve seen this group pop up out of nowhere,” said Valerie Yerger, an associate professor of health policy at UCSF. “Obviously it’s a concerted effort that’s getting a lot of support from R.J. Reynolds to confuse the issues.”\u003c/p>\n\n",
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"nprByline": "\u003ca href=\"http://californiahealthline.org/news/author/elaine-korry/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cstrong>Elaine Korry\u003c/strong>\u003c/a> \u003c/span>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A coalition of local business owners financed by the tobacco industry has blocked San Francisco’s new ban on menthol cigarettes and flavored tobacco products until voters decide whether to uphold or overturn it.\u003c/p>\n\u003cp>The ban, adopted unanimously by the Board of Supervisors in June, would have kicked in next year. But the city’s \u003ca href=\"http://sfgov.org/elections/measures\" target=\"_blank\" rel=\"noopener noreferrer\">Office of Elections\u003c/a> determined earlier this month that the opposition group \u003ca href=\"http://www.letsberealsf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Let’s Be Real, San Francisco\u003c/a> has gathered enough signatures for a ballot referendum, putting the ban on hold until voters decide next year.\u003c/p>\n\u003cp>“This is a freedom-of-choice issue for responsible adults,” said Jaime Rojas, a spokesman for the coalition.\u003c/p>\n\u003cp>“We believe that local government officials have overreached and the referendum will allow the voters of San Francisco to make the final decision,” he said.\u003c/p>\n\u003cp>The San Francisco Board of Supervisors will vote next month whether to overturn the ordinance themselves — which is unlikely — or put it before voters, probably in June.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The \u003ca href=\"https://sfgov.legistar.com/View.ashx?M=F&ID=5274235&GUID=86C18253-BA63-4C0F-A6A0-E881211D2CB7\" target=\"_blank\" rel=\"noopener noreferrer\">tobacco ordinance \u003c/a>would prohibit the sale of menthol cigarettes and other flavored tobacco, including hookah tobacco and small cigars, as well as most vaping products and e-cigarettes.\u003c/p>\n\u003cp>“San Francisco made history when it passed this ordinance, the strongest restrictions on flavored tobacco products in the nation,” said Stanton Glantz, professor of medicine and director of the \u003ca href=\"http://www.tobacco.ucsf.edu/\" target=\"_blank\" rel=\"noopener noreferrer\">Center for Tobacco Control Research and Education\u003c/a> at the University of California-San Francisco (UCSF).\u003c/p>\n\u003cp>According \u003ca href=\"http://sfcontroller.org/sites/default/files/Documents/Economic%20Analysis/170441_economic_impact_final.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">to a report\u003c/a> from the City Controller’s Office of Economic Analysis, 35 percent of the cigarettes sold in San Francisco are menthol and would be subject to the ban.\u003c/p>\n\u003cp>Rojas said he believes retailers would lose about $50 million in local tobacco sales annually under the ordinance.\u003c/p>\n\u003cp>Vivian New, co-owner of SF Smoke N’ Vape Shop on Fisherman’s Wharf, estimated that the ban would drive down her profits by 30 to 40 percent.\u003c/p>\n\u003cp>New, 22, said she has “never laid my lips on a cigarette.” Nonetheless, she opposes restrictions on the kinds of tobacco products her customers can buy because “it’s part of [their] rights.”\u003c/p>\n\u003cp>Let’s Be Real, San Francisco describes itself as a coalition of “concerned citizens supporting freedom of choice, adult consumers, community leaders and neighborhood small businesses.”\u003c/p>\n\u003cp>But campaign filing statements for the last half of July \u003ca href=\"https://californiahealthline.files.wordpress.com/2017/08/document6.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">show only one donor\u003c/a>: R.J. Reynolds Tobacco Co. of Winston-Salem, N.C., which gave more than $685,000 to the effort.\u003c/p>\n\u003cp>David Howard, a spokesman for R.J. Reynolds, said the company is proud to be a part of the coalition and sees the referendum campaign “as an opportunity to educate the citizens of San Francisco on the negative impacts that this [ordinance] can have.”\u003c/p>\n\u003cp>The industry giant manufactures Newport, the nation’s leading menthol brand, which would be banned under the ordinance.\u003c/p>\n\u003cp>“It’s just a complete hoax,” Glantz said. “This organization that’s putting itself out as a bunch of free-thinking concerned local citizens is actually just a front for the tobacco companies.”\u003c/p>\n\u003cp>Supervisor Malia Cohen, who sponsored the tobacco measure, called the opposition referendum “a ridiculous attempt to put profit over people’s health.” She said R.J. Reynolds is attacking the legislation “because they know it is strong and that people will stop smoking.”\u003c/p>\n\u003cp>Flavored tobacco and menthol cigarettes, including Newport, the No. 2 cigarette brand in the nation, are popular with young people and minorities, \u003ca href=\"http://californiahealthline.org/news/sf-seeks-to-ban-sale-of-menthol-cigarettes-and-flavored-tobacco-products/\" target=\"_blank\" rel=\"noopener noreferrer\">especially African-Americans\u003c/a>.\u003c/p>\n\u003cp>“Menthol is an especially pernicious additive,” Glantz said, since it interacts with nicotine to make cigarettes easier to smoke and all tobacco products more addictive.\u003c/p>\n\u003cp>Miriam Zouzounis, a board member with the Arab American Grocers Association and member of the coalition, insisted that the campaign against the tobacco ordinance started as a grass-roots effort by working-class shop owners and their customers. She said the tobacco industry stepped in only after the ban was approved unanimously by the Board of Supervisors.\u003c/p>\n\u003cp>Zouzounis believes the ordinance is a burden for small merchants like her family of immigrants who own Ted’s Market, a corner grocery and sandwich shop south of Market Street.\u003c/p>\n\u003cp>“Basically it is a redundant policy. There’s laws already on the books to keep tobacco out of the hands of kids,” she said.\u003c/p>\n\u003cp>She pointed to a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162SB7\">law\u003c/a> signed last year by Gov. Jerry Brown that raised the legal smoking age in California from 18 to 21. Under the new rules, anyone caught giving or selling tobacco products to people under 21 could face misdemeanor charges.\u003c/p>\n\u003cp>“It’s kind of nonsense,” said Jiries Totah, an auto mechanic who buys Grizzly wintergreen-flavored chewing tobacco from Ted’s Market. “I’m 27. I pay my taxes and I do what I’m supposed to do as a citizen. How can someone tell me I can’t purchase a legal product?”\u003c/p>\n\u003cp>Zouzounis and other business owners say city officials failed to consult with them or consider amendments that addressed their concerns. The ordinance also gives out-of-state businesses that sell online an advantage over brick-and-mortar shops in the city, she said.\u003c/p>\n\u003cp>“You can buy these products they’re trying to ban online and get them delivered straight to your address in SF, and we know that an online check of an ID is not fail-proof,” she said.\u003c/p>\n\u003cp>But advocates of the ban say these arguments are diversions from the real point, which is to reduce tobacco consumption and improve health.\u003c/p>\n\u003cp>They vow to fight to keep the ordinance in place.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We’ve seen this group pop up out of nowhere,” said Valerie Yerger, an associate professor of health policy at UCSF. “Obviously it’s a concerted effort that’s getting a lot of support from R.J. Reynolds to confuse the issues.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act, it's going to cost him.\u003c/p>\n\u003cp>Or, more accurately, it's going to cost taxpayers — about $194 billion over 10 years.\u003c/p>\n\u003cp>The cost is \"eye-poppingly large,\" says \u003ca href=\"https://www.law.umich.edu/FacultyBio/Pages/FacultyBio.aspx?FacID=nbagley\" target=\"_blank\" rel=\"noopener noreferrer\">Nicholas Bagley\u003c/a>, a professor of health law at the University of Michigan. \"This single policy could effectively end up costing 20 percent of the entire bill of the ACA.\"\u003c/p>\n\u003cp>The deficit figure comes from the Congressional Budget Office, which on Tuesday released an \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/reports/53009-costsharingreductions.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimate\u003c/a> of the budget impact of ending what's known as cost-sharing reduction payments. Those are payments the federal government makes to insurance companies to reimburse them for the discounts on copays and deductibles that they're required by law to give to low-income customers.\u003c/p>\n\u003cp>The reports also say premiums for benchmark plans sold on the Affordable Care Act exchanges will rise about 20 percent next year and about 25 percent by 2020. The cost to consumers, however, would stay the same or even decline, because the premium increases would be offset by tax credits, which we explain further below.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>President Trump threatened repeatedly to cut off the payments, which he's called \"bailouts,\" during the unsuccessful effort by Senate Republicans to repeal and replace the Affordable Care Act, or Obamacare.\u003c/p>\n\u003cp>More recently, the president has remained mute on the topic, and insurers have been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/08/01/540656651/trumps-tweets-threaten-to-destabilize-insurance-markets\" target=\"_blank\" rel=\"noopener noreferrer\">left to wonder\u003c/a> whether they will receive a check this month for the discounts they paid out in July.\u003c/p>\n\u003cp>Bagley says there's no good policy reason to cut off the payments. \"If you can cover roughly the same number of people for about $200 billion less, why wouldn't you want to do that?\" he asks.\u003c/p>\n\u003cp>Cutting the cost-sharing payments ends up costing the government more because insurance companies say they will raise rates in response. Under the Affordable Care Act, people with lower incomes who buy insurance on the exchanges get a tax credit, so their costs remain stable as a share of their income. That means that when premiums rise, those government subsidies rise as well.\u003c/p>\n\u003cp>The CBO says for people with incomes below 200 percent of the federal poverty level, the out-of-pocket cost of insurance would remain about the same because of the bigger tax credits. For those with incomes between 200 and 400 percent of the federal poverty level, the cost to buy insurance could actually get cheaper.\u003c/p>\n\u003cp>Last year, about \u003ca href=\"https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2016-fact-sheets-items/2016-06-30.html\" target=\"_blank\" rel=\"noopener noreferrer\">85 percent\u003c/a> of people who bought Obamacare insurance got a tax credit, according to the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>\"The CBO analysis makes clear that ending cost-sharing subsidies would be a perfect example of cutting off your nose to spite your face,\" says \u003ca href=\"http://www.kff.org/person/larry-levitt/\" target=\"_blank\" rel=\"noopener noreferrer\">Larry Levitt\u003c/a>, a vice president at the Kaiser Family Foundation. \"Premiums would rise, and the government would end up spending more in the end through tax credits that help people pay their premiums.\"\u003c/p>\n\u003cp>The CBO report confirms earlier analyses, including \u003ca href=\"http://www.kff.org/health-reform/issue-brief/the-effects-of-ending-the-affordable-care-acts-cost-sharing-reduction-payments/\">this one\u003c/a> by Kaiser and \u003ca href=\"http://health.oliverwyman.com/transform-care/2017/05/impact_defunding_CSR_payments.html\" target=\"_blank\" rel=\"noopener noreferrer\">this one\u003c/a> from the consulting firm Oliver Wyman, that suggested eliminating the cost-sharing payments could make policies \u003ca href=\"http://www.npr.org/sections/health-shots/2017/05/16/528584408/trump-refusal-to-bail-out-insurers-might-end-up-making-policies-cheaper\" target=\"_blank\" rel=\"noopener noreferrer\">cheaper\u003c/a> for some individuals.\u003c/p>\n\u003cp>Some insurers may decide to leave the ACA markets altogether if the subsidies were to disappear \"because of the substantial uncertainty about the effects of the policy on average health care costs,\" the CBO says. The agency estimates about 5 percent of the population would not have access to insurance through the ACA markets next year if Trump ends the payments.\u003c/p>\n\u003cp>But the agency says insurers would come back over the next two years.\u003c/p>\n\u003cp>\u003ca href=\"https://law.wlu.edu/faculty/emeritus-faculty/tim-jost\" target=\"_blank\" rel=\"noopener noreferrer\">Timothy Jost\u003c/a>, a professor emeritus of health care law at Washington and Lee University School of Law, says that picture may be a bit too rosy.\u003c/p>\n\u003cp>He says the CBO assumes that state insurance commissioners will allow insurance companies to set premiums in ways that would be most advantageous to them, thereby ensuring they continue to sell policies on the Obamacare exchanges. But that may not happen, Yost warns.\u003c/p>\n\u003cp>\"CBO assumes that things will work out rationally, and there will be a smooth landing,\" he says. \"It could be much more chaotic than that.\"\u003c/p>\n\u003cp>Last Friday, the Department of Health and Human Services extended the deadline for insurance companies to decide what health plans to offer on the Obamacare exchanges and what to charge.\u003c/p>\n\u003cp>The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before President Trump took office.\u003c/p>\n\u003cp>House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn't appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Now that Trump is in the White House, and Republican efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CBO+Predicts+Rise+In+Deficit+If+Trump+Cuts+Payments+To+Insurance+Companies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "The Congressional Budget Office estimates that ending what's known as cost-sharing reduction payments to insurers will raise the deficit $194 billion over 10 years.",
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"description": "The Congressional Budget Office estimates that ending what's known as cost-sharing reduction payments to insurers will raise the deficit $194 billion over 10 years.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If President Trump decides to cut off payments to insurance companies called for under the Affordable Care Act, it's going to cost him.\u003c/p>\n\u003cp>Or, more accurately, it's going to cost taxpayers — about $194 billion over 10 years.\u003c/p>\n\u003cp>The cost is \"eye-poppingly large,\" says \u003ca href=\"https://www.law.umich.edu/FacultyBio/Pages/FacultyBio.aspx?FacID=nbagley\" target=\"_blank\" rel=\"noopener noreferrer\">Nicholas Bagley\u003c/a>, a professor of health law at the University of Michigan. \"This single policy could effectively end up costing 20 percent of the entire bill of the ACA.\"\u003c/p>\n\u003cp>The deficit figure comes from the Congressional Budget Office, which on Tuesday released an \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/reports/53009-costsharingreductions.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">estimate\u003c/a> of the budget impact of ending what's known as cost-sharing reduction payments. Those are payments the federal government makes to insurance companies to reimburse them for the discounts on copays and deductibles that they're required by law to give to low-income customers.\u003c/p>\n\u003cp>The reports also say premiums for benchmark plans sold on the Affordable Care Act exchanges will rise about 20 percent next year and about 25 percent by 2020. The cost to consumers, however, would stay the same or even decline, because the premium increases would be offset by tax credits, which we explain further below.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>President Trump threatened repeatedly to cut off the payments, which he's called \"bailouts,\" during the unsuccessful effort by Senate Republicans to repeal and replace the Affordable Care Act, or Obamacare.\u003c/p>\n\u003cp>More recently, the president has remained mute on the topic, and insurers have been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/08/01/540656651/trumps-tweets-threaten-to-destabilize-insurance-markets\" target=\"_blank\" rel=\"noopener noreferrer\">left to wonder\u003c/a> whether they will receive a check this month for the discounts they paid out in July.\u003c/p>\n\u003cp>Bagley says there's no good policy reason to cut off the payments. \"If you can cover roughly the same number of people for about $200 billion less, why wouldn't you want to do that?\" he asks.\u003c/p>\n\u003cp>Cutting the cost-sharing payments ends up costing the government more because insurance companies say they will raise rates in response. Under the Affordable Care Act, people with lower incomes who buy insurance on the exchanges get a tax credit, so their costs remain stable as a share of their income. That means that when premiums rise, those government subsidies rise as well.\u003c/p>\n\u003cp>The CBO says for people with incomes below 200 percent of the federal poverty level, the out-of-pocket cost of insurance would remain about the same because of the bigger tax credits. For those with incomes between 200 and 400 percent of the federal poverty level, the cost to buy insurance could actually get cheaper.\u003c/p>\n\u003cp>Last year, about \u003ca href=\"https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2016-fact-sheets-items/2016-06-30.html\" target=\"_blank\" rel=\"noopener noreferrer\">85 percent\u003c/a> of people who bought Obamacare insurance got a tax credit, according to the Centers for Medicare and Medicaid Services.\u003c/p>\n\u003cp>\"The CBO analysis makes clear that ending cost-sharing subsidies would be a perfect example of cutting off your nose to spite your face,\" says \u003ca href=\"http://www.kff.org/person/larry-levitt/\" target=\"_blank\" rel=\"noopener noreferrer\">Larry Levitt\u003c/a>, a vice president at the Kaiser Family Foundation. \"Premiums would rise, and the government would end up spending more in the end through tax credits that help people pay their premiums.\"\u003c/p>\n\u003cp>The CBO report confirms earlier analyses, including \u003ca href=\"http://www.kff.org/health-reform/issue-brief/the-effects-of-ending-the-affordable-care-acts-cost-sharing-reduction-payments/\">this one\u003c/a> by Kaiser and \u003ca href=\"http://health.oliverwyman.com/transform-care/2017/05/impact_defunding_CSR_payments.html\" target=\"_blank\" rel=\"noopener noreferrer\">this one\u003c/a> from the consulting firm Oliver Wyman, that suggested eliminating the cost-sharing payments could make policies \u003ca href=\"http://www.npr.org/sections/health-shots/2017/05/16/528584408/trump-refusal-to-bail-out-insurers-might-end-up-making-policies-cheaper\" target=\"_blank\" rel=\"noopener noreferrer\">cheaper\u003c/a> for some individuals.\u003c/p>\n\u003cp>Some insurers may decide to leave the ACA markets altogether if the subsidies were to disappear \"because of the substantial uncertainty about the effects of the policy on average health care costs,\" the CBO says. The agency estimates about 5 percent of the population would not have access to insurance through the ACA markets next year if Trump ends the payments.\u003c/p>\n\u003cp>But the agency says insurers would come back over the next two years.\u003c/p>\n\u003cp>\u003ca href=\"https://law.wlu.edu/faculty/emeritus-faculty/tim-jost\" target=\"_blank\" rel=\"noopener noreferrer\">Timothy Jost\u003c/a>, a professor emeritus of health care law at Washington and Lee University School of Law, says that picture may be a bit too rosy.\u003c/p>\n\u003cp>He says the CBO assumes that state insurance commissioners will allow insurance companies to set premiums in ways that would be most advantageous to them, thereby ensuring they continue to sell policies on the Obamacare exchanges. But that may not happen, Yost warns.\u003c/p>\n\u003cp>\"CBO assumes that things will work out rationally, and there will be a smooth landing,\" he says. \"It could be much more chaotic than that.\"\u003c/p>\n\u003cp>Last Friday, the Department of Health and Human Services extended the deadline for insurance companies to decide what health plans to offer on the Obamacare exchanges and what to charge.\u003c/p>\n\u003cp>The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before President Trump took office.\u003c/p>\n\u003cp>House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn't appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Now that Trump is in the White House, and Republican efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=CBO+Predicts+Rise+In+Deficit+If+Trump+Cuts+Payments+To+Insurance+Companies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’",
"title": "A Long And Winding Road: Kicking Heroin In An Opioid ‘Treatment Desert’",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>Heather Menzel squirmed in her seat, unable to sleep on the Greyhound bus as it rolled through the early morning darkness toward Bakersfield, in California’s Central Valley. She’d been trapped in transit for three miserable days, stewing in a horrific sickness only a heroin addict can understand. Again, and again, she stumbled down the aisle to the bathroom to vomit.\u003c/p>\n\u003cp>She hadn’t used since Chicago. She told herself that if she could just get through this self-prescribed detox, if she could get to her mother’s house in her hometown of Lake Isabella, Calif., all her problems would be solved.\u003c/p>\n\u003cp>“I’ve been through a lot of horrible, crazy stuff,” said Menzel, now 34. “I’ve been raped. I’ve been beaten up. I’ve been in prison. But trying to kick heroin on the Greyhound on the way home was the worst experience of my entire life.”\u003c/p>\n\u003cp>When Menzel finally arrived at the Bakersfield bus station at 6 a.m. that day in February 2014, her mother and stepfather were there waiting. The two women hadn’t seen each other in years, not since Menzel stole her mom’s jewelry and fled the area. They didn’t talk much as they drove east though the twisty canyon on State Route 178 toward Lake Isabella, a two-stoplight town with a population of 3,500, nestled in the golden Sierra Nevada foothills.\u003c/p>\n\u003cp>Menzel hoped that the worst of the withdrawal was over — that a new life without heroin awaited. What she didn’t know was that heroin was now cheap and plentiful in Lake Isabella, as in so many small towns in the U.S., and that her best hope for treatment was far away.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>32 Churches, No Methadone Clinic\u003c/strong>\u003c/p>\n\u003cp>Experts recommend medication-assisted treatment for drug users like Menzel, one of nearly 2 million Americans struggling with opioid addiction, whether to prescription pills or heroin. MAT, as the therapy is known, has been proven far more effective — and less dangerous and miserable — than cold-turkey quitting. Drugs like methadone and buprenorphine can help suppress opioid cravings and stave off the physical and psychological symptoms of withdrawal.\u003c/p>\n\u003cp>When carefully managed, MAT can cut the risk of overdose death by half, research shows. But not all medical providers \u003ca href=\"http://californiahealthline.org/news/one-major-force-lacking-in-fight-against-opioid-addiction-in-rural-california-doctors/\" target=\"_blank\" rel=\"noopener noreferrer\">are properly trained\u003c/a> and approved to provide the treatments, which themselves are opioids (albeit less likely to be abused). Only state-licensed and federally approved clinics can provide methadone, and doctors need to apply for a federal Drug Enforcement Administration waiver to prescribe buprenorphine.\u003c/p>\n\u003cp>Lake Isabella sits in the Kern River Valley, home to 32 churches but not a single methadone clinic or doctor able or willing to prescribe buprenorphine. Like half the counties in California, the valley is an opioid “treatment desert.”\u003c/p>\n\u003cfigure id=\"attachment_360811\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360811\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg\" alt=\"After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In rural areas, historically, there has been a lot of stigma around addiction treatment,” said Kelly Pfeifer, a primary care doctor and opioid project director at the California Health Care Foundation. “Although the state is trying to remedy this, there are still wide treatment deserts across California.” (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>In July, the California Department of Health Care Services awarded 19 applicants part of a $90 million federal grant to improve MAT access. In addition, $6 million was dedicated to support treatment in tribal communities. The agency hopes to create a network of “oases” in the state’s vast treatment deserts, many of which are in far Northern California, as well as eastern Kern County, which encompasses Lake Isabella.\u003c/p>\n\u003cp>The grants aim to pay for clinical and educational support to rural physicians, many of whom have never been trained in addiction medicine. Local doctors will handle most buprenorphine prescriptions, and in some towns, a mini-methadone program may set up shop.\u003c/p>\n\u003cp>But eastern Kern didn’t make the cut. For now, expanding opioid treatment in this area, and eastward, will have to wait.\u003c/p>\n\u003cp>Without such help, many experts say people like Heather Menzel — whose story a reporter followed over the course of a year — barely stand a chance.\u003c/p>\n\u003cp>\u003cstrong>Hooked Again\u003c/strong>\u003c/p>\n\u003cp>From the beginning, Menzel struggled to stay clean at her mother’s. She soon fell back in with her old drug-abusing friends. Within two months of arriving home, her grand plan for getting clean slid into her veins and disappeared with the push of a plunger. She was hooked on heroin again, smoking methamphetamine and, once her mom kicked her out, homeless.\u003c/p>\n\u003cfigure id=\"attachment_360813\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"wp-image-360813 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_7_1170.jpg\" alt=\"After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>She was risking death, and she knew it. On average, 91 people a day in the United States died of an opioid overdose in 2015, the latest figures available \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">from the Centers for Disease Control and Prevention\u003c/a>, and \u003ca href=\"https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?_r=0\" target=\"_blank\" rel=\"noopener noreferrer\">projections show\u003c/a> the death rate will continue to rise. Overall, California’s opioid death rate is relatively low: 4.73 deaths per 100,000 people. Still, 1,966 Californians died of an opioid overdose in 2015. \u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\" target=\"_blank\" rel=\"noopener noreferrer\">Kern County’s rate\u003c/a> was nearly double the state’s in 2015, and some sparsely populated rural counties, mostly up north, have rates that are far higher.\u003c/p>\n\u003cp>Policymakers fear the death risk is growing as use of fentanyl moves west. A synthetic opioid \u003ca href=\"https://www.drugabuse.gov/drugs-abuse/fentanyl\" target=\"_blank\" rel=\"noopener noreferrer\">estimated to be 50 to 100 times stronger\u003c/a> than morphine, fentanyl has caused numerous overdoses and deaths on the \u003ca href=\"http://khn.org/news/another-circle-of-hell-surviving-opioids-in-the-fentanyl-era/\" target=\"_blank\" rel=\"noopener noreferrer\">East Coast\u003c/a>. Some policymakers fear the fentanyl monster is heading to California, a potentially vast market of addicts.\u003c/p>\n\u003cp>“We really feel an urgency in California to increase access to services so if and when fentanyl arrives, we are more prepared to deal with it,” said Marlies Perez, chief of the Substance Use Disorder Compliance Division at DHCS.\u003c/p>\n\u003cp>Immediate, convenient access to these treatments is key. “It is very important for someone in the middle of addiction to access treatment when they are ready,” said Pfeifer. “There are these moments when people have wake-up calls — when they are ready to seek care and get out of the chaos of trying to get drugs to feel normal again.”\u003c/p>\n\u003cp>\u003cstrong>‘What Do I Do?’\u003c/strong>\u003c/p>\n\u003cp>Menzel’s wake-up happened when she noticed that she was still sick after a morning heroin injection. After an angry call to her drug dealer to accuse him of ripping her off, Menzel soon realized it wasn’t fake heroin — she was pregnant.\u003c/p>\n\u003cp>She took the bus to the emergency room in Bakersfield. “I’m fully addicted to heroin,” she blurted out to the ER doctor. “What do I do?” The doctor told her, “If you want to save your baby, you need to get on methadone.”\u003c/p>\n\u003cp>Affording methadone wasn’t a problem for Menzel. Medi-Cal, the state’s version of the Medicaid program for the poor, covered the costs. What impeded her was the daily trip from Lake Isabella to Bakersfield — an hour-plus bus ride down the curving canyon road. A round-trip ticket cost $5, more than she could spare. And if she missed an early bus back, she had to stay most of the day in Bakersfield to catch the next one.\u003c/p>\n\u003cfigure id=\"attachment_360816\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-360816 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">After receiving her methadone dose at a clinic in Bakersfield, Calif., Heather Menzel waits for the bus to take her back home to Lake Isabella on June 6, 2016. The bus ride takes about an hour and goes through a twisty canyon into the Sierra Nevada foothills. (Brian Rinker for KHN) \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For safety’s sake, the clinic started her at a low dose, increasing the amount until it was just right for her. But that beginning dose didn’t stave off the withdrawals, so she continued to use heroin and meth. She started to miss too many days of treatment and was kicked out of the program.\u003c/p>\n\u003cp>Menzel’s mother got her back in, promising the clinic that she would drive her daughter there every day. That meant quitting her job at Meals on Wheels.\u003c/p>\n\u003cp>“The fact you have to travel an hour to two hours every day to receive treatment requires somebody to operate a vehicle, pay for gas, and for some of our patients that is impossible,” said Javier Moreno, who manages the narcotics treatment programs in the Central Valley for Aegis Treatment Centers, the state’s largest methadone provider.\u003c/p>\n\u003cp>His Bakersfield clinics serve about 20 people in the Lake Isabella area, but Moreno thinks many more residents could benefit from MAT.\u003c/p>\n\u003cp>\u003cstrong>‘I Made it’\u003c/strong>\u003c/p>\n\u003cp>Menzel didn’t take the ideal path to getting clean. But she eventually began to feel the groove of methadone, and her cravings for heroin subsided. After a couple of months, she was able to get methadone “take-home” doses for the weekend. She started riding the bus again to give her mother, who has the autoimmune disease lupus, a break.\u003c/p>\n\u003cp>“I was big and pregnant,” said Menzel, who woke up Monday through Friday at 5:30 a.m. to catch the bus. “I had to ask the bus driver to pull over and pee a lot. But I made it.”\u003c/p>\n\u003cfigure id=\"attachment_360817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-360817\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg\" alt=\"Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction.\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In May 2015, Menzel gave birth to a healthy girl and named her Bella. She said she hasn’t used heroin or any other drug, besides methadone, in more than two years. She’s on a maintenance methadone dose, just 39 milligrams compared with 140 mg she used to take and plans to cut back until she is off it completely. Now she drives herself to the clinic every other week and has enrolled in community college, hoping to become a certified drug and alcohol counselor.\u003c/p>\n\u003cp>“I don’t know if there will ever be a methadone clinic in the Kern River Valley,” Menzel said. But if one ever arrives, she said, she’d love to work there.\u003c/p>\n\u003cp>“I really want to work with other pregnant women who will be going through the same thing that I went through.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Heather Menzel squirmed in her seat, unable to sleep on the Greyhound bus as it rolled through the early morning darkness toward Bakersfield, in California’s Central Valley. She’d been trapped in transit for three miserable days, stewing in a horrific sickness only a heroin addict can understand. Again, and again, she stumbled down the aisle to the bathroom to vomit.\u003c/p>\n\u003cp>She hadn’t used since Chicago. She told herself that if she could just get through this self-prescribed detox, if she could get to her mother’s house in her hometown of Lake Isabella, Calif., all her problems would be solved.\u003c/p>\n\u003cp>“I’ve been through a lot of horrible, crazy stuff,” said Menzel, now 34. “I’ve been raped. I’ve been beaten up. I’ve been in prison. But trying to kick heroin on the Greyhound on the way home was the worst experience of my entire life.”\u003c/p>\n\u003cp>When Menzel finally arrived at the Bakersfield bus station at 6 a.m. that day in February 2014, her mother and stepfather were there waiting. The two women hadn’t seen each other in years, not since Menzel stole her mom’s jewelry and fled the area. They didn’t talk much as they drove east though the twisty canyon on State Route 178 toward Lake Isabella, a two-stoplight town with a population of 3,500, nestled in the golden Sierra Nevada foothills.\u003c/p>\n\u003cp>Menzel hoped that the worst of the withdrawal was over — that a new life without heroin awaited. What she didn’t know was that heroin was now cheap and plentiful in Lake Isabella, as in so many small towns in the U.S., and that her best hope for treatment was far away.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>32 Churches, No Methadone Clinic\u003c/strong>\u003c/p>\n\u003cp>Experts recommend medication-assisted treatment for drug users like Menzel, one of nearly 2 million Americans struggling with opioid addiction, whether to prescription pills or heroin. MAT, as the therapy is known, has been proven far more effective — and less dangerous and miserable — than cold-turkey quitting. Drugs like methadone and buprenorphine can help suppress opioid cravings and stave off the physical and psychological symptoms of withdrawal.\u003c/p>\n\u003cp>When carefully managed, MAT can cut the risk of overdose death by half, research shows. But not all medical providers \u003ca href=\"http://californiahealthline.org/news/one-major-force-lacking-in-fight-against-opioid-addiction-in-rural-california-doctors/\" target=\"_blank\" rel=\"noopener noreferrer\">are properly trained\u003c/a> and approved to provide the treatments, which themselves are opioids (albeit less likely to be abused). Only state-licensed and federally approved clinics can provide methadone, and doctors need to apply for a federal Drug Enforcement Administration waiver to prescribe buprenorphine.\u003c/p>\n\u003cp>Lake Isabella sits in the Kern River Valley, home to 32 churches but not a single methadone clinic or doctor able or willing to prescribe buprenorphine. Like half the counties in California, the valley is an opioid “treatment desert.”\u003c/p>\n\u003cfigure id=\"attachment_360811\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360811\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg\" alt=\"After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016.\" width=\"800\" height=\"534\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_2_1170.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">After riding the bus to the methadone clinic, Heather Menzel gets picked up by her brother at the bus stop in Lake Isabella, Calif., on June 6, 2016. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“In rural areas, historically, there has been a lot of stigma around addiction treatment,” said Kelly Pfeifer, a primary care doctor and opioid project director at the California Health Care Foundation. “Although the state is trying to remedy this, there are still wide treatment deserts across California.” (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>In July, the California Department of Health Care Services awarded 19 applicants part of a $90 million federal grant to improve MAT access. In addition, $6 million was dedicated to support treatment in tribal communities. The agency hopes to create a network of “oases” in the state’s vast treatment deserts, many of which are in far Northern California, as well as eastern Kern County, which encompasses Lake Isabella.\u003c/p>\n\u003cp>The grants aim to pay for clinical and educational support to rural physicians, many of whom have never been trained in addiction medicine. Local doctors will handle most buprenorphine prescriptions, and in some towns, a mini-methadone program may set up shop.\u003c/p>\n\u003cp>But eastern Kern didn’t make the cut. For now, expanding opioid treatment in this area, and eastward, will have to wait.\u003c/p>\n\u003cp>Without such help, many experts say people like Heather Menzel — whose story a reporter followed over the course of a year — barely stand a chance.\u003c/p>\n\u003cp>\u003cstrong>Hooked Again\u003c/strong>\u003c/p>\n\u003cp>From the beginning, Menzel struggled to stay clean at her mother’s. She soon fell back in with her old drug-abusing friends. Within two months of arriving home, her grand plan for getting clean slid into her veins and disappeared with the push of a plunger. She was hooked on heroin again, smoking methamphetamine and, once her mom kicked her out, homeless.\u003c/p>\n\u003cfigure id=\"attachment_360813\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"wp-image-360813 size-full\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_7_1170.jpg\" alt=\"After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_7_1170-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">After Heather Menzel takes her methadone prescription on a summer morning in 2016, she goes into the kitchen and watches her daughter, Bella, play with Menzel’s mother, Tawanna Maxwell-Cecil, at their home in Lake Isabella, Calif. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cp>She was risking death, and she knew it. On average, 91 people a day in the United States died of an opioid overdose in 2015, the latest figures available \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">from the Centers for Disease Control and Prevention\u003c/a>, and \u003ca href=\"https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?_r=0\" target=\"_blank\" rel=\"noopener noreferrer\">projections show\u003c/a> the death rate will continue to rise. Overall, California’s opioid death rate is relatively low: 4.73 deaths per 100,000 people. Still, 1,966 Californians died of an opioid overdose in 2015. \u003ca href=\"https://pdop.shinyapps.io/ODdash_v1/\" target=\"_blank\" rel=\"noopener noreferrer\">Kern County’s rate\u003c/a> was nearly double the state’s in 2015, and some sparsely populated rural counties, mostly up north, have rates that are far higher.\u003c/p>\n\u003cp>Policymakers fear the death risk is growing as use of fentanyl moves west. A synthetic opioid \u003ca href=\"https://www.drugabuse.gov/drugs-abuse/fentanyl\" target=\"_blank\" rel=\"noopener noreferrer\">estimated to be 50 to 100 times stronger\u003c/a> than morphine, fentanyl has caused numerous overdoses and deaths on the \u003ca href=\"http://khn.org/news/another-circle-of-hell-surviving-opioids-in-the-fentanyl-era/\" target=\"_blank\" rel=\"noopener noreferrer\">East Coast\u003c/a>. Some policymakers fear the fentanyl monster is heading to California, a potentially vast market of addicts.\u003c/p>\n\u003cp>“We really feel an urgency in California to increase access to services so if and when fentanyl arrives, we are more prepared to deal with it,” said Marlies Perez, chief of the Substance Use Disorder Compliance Division at DHCS.\u003c/p>\n\u003cp>Immediate, convenient access to these treatments is key. “It is very important for someone in the middle of addiction to access treatment when they are ready,” said Pfeifer. “There are these moments when people have wake-up calls — when they are ready to seek care and get out of the chaos of trying to get drugs to feel normal again.”\u003c/p>\n\u003cp>\u003cstrong>‘What Do I Do?’\u003c/strong>\u003c/p>\n\u003cp>Menzel’s wake-up happened when she noticed that she was still sick after a morning heroin injection. After an angry call to her drug dealer to accuse him of ripping her off, Menzel soon realized it wasn’t fake heroin — she was pregnant.\u003c/p>\n\u003cp>She took the bus to the emergency room in Bakersfield. “I’m fully addicted to heroin,” she blurted out to the ER doctor. “What do I do?” The doctor told her, “If you want to save your baby, you need to get on methadone.”\u003c/p>\n\u003cp>Affording methadone wasn’t a problem for Menzel. Medi-Cal, the state’s version of the Medicaid program for the poor, covered the costs. What impeded her was the daily trip from Lake Isabella to Bakersfield — an hour-plus bus ride down the curving canyon road. A round-trip ticket cost $5, more than she could spare. And if she missed an early bus back, she had to stay most of the day in Bakersfield to catch the next one.\u003c/p>\n\u003cfigure id=\"attachment_360816\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-360816 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel_4_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">After receiving her methadone dose at a clinic in Bakersfield, Calif., Heather Menzel waits for the bus to take her back home to Lake Isabella on June 6, 2016. The bus ride takes about an hour and goes through a twisty canyon into the Sierra Nevada foothills. (Brian Rinker for KHN) \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For safety’s sake, the clinic started her at a low dose, increasing the amount until it was just right for her. But that beginning dose didn’t stave off the withdrawals, so she continued to use heroin and meth. She started to miss too many days of treatment and was kicked out of the program.\u003c/p>\n\u003cp>Menzel’s mother got her back in, promising the clinic that she would drive her daughter there every day. That meant quitting her job at Meals on Wheels.\u003c/p>\n\u003cp>“The fact you have to travel an hour to two hours every day to receive treatment requires somebody to operate a vehicle, pay for gas, and for some of our patients that is impossible,” said Javier Moreno, who manages the narcotics treatment programs in the Central Valley for Aegis Treatment Centers, the state’s largest methadone provider.\u003c/p>\n\u003cp>His Bakersfield clinics serve about 20 people in the Lake Isabella area, but Moreno thinks many more residents could benefit from MAT.\u003c/p>\n\u003cp>\u003cstrong>‘I Made it’\u003c/strong>\u003c/p>\n\u003cp>Menzel didn’t take the ideal path to getting clean. But she eventually began to feel the groove of methadone, and her cravings for heroin subsided. After a couple of months, she was able to get methadone “take-home” doses for the weekend. She started riding the bus again to give her mother, who has the autoimmune disease lupus, a break.\u003c/p>\n\u003cp>“I was big and pregnant,” said Menzel, who woke up Monday through Friday at 5:30 a.m. to catch the bus. “I had to ask the bus driver to pull over and pee a lot. But I made it.”\u003c/p>\n\u003cfigure id=\"attachment_360817\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-360817\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg\" alt=\"Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction.\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/menzel-_1_1170.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Heather Menzel feeds her daughter, Bella, during a Christian-based drug recovery meeting in Wofford Heights, Calif., in June 2016. Menzel is taking a maintenance dose of methadone to treat her heroin addiction. \u003ccite>(Brian Rinker for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In May 2015, Menzel gave birth to a healthy girl and named her Bella. She said she hasn’t used heroin or any other drug, besides methadone, in more than two years. She’s on a maintenance methadone dose, just 39 milligrams compared with 140 mg she used to take and plans to cut back until she is off it completely. Now she drives herself to the clinic every other week and has enrolled in community college, hoping to become a certified drug and alcohol counselor.\u003c/p>\n\u003cp>“I don’t know if there will ever be a methadone clinic in the Kern River Valley,” Menzel said. But if one ever arrives, she said, she’d love to work there.\u003c/p>\n\u003cp>“I really want to work with other pregnant women who will be going through the same thing that I went through.”\u003c/p>\n\u003cp>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Health Care Foundation\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Funds Nonprofits to Serve Food as Medicine",
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"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>Federico Guzmán moved from Mexico to San Francisco in 1992, fleeing anti-gay sentiment and searching for AIDS treatment.\u003c/p>\n\u003cp>He couldn’t find a job and sometimes went hungry until friends introduced him to \u003ca href=\"https://www.openhand.org/about-us\" target=\"_blank\" rel=\"noopener noreferrer\">Project Open Hand\u003c/a>, a nonprofit organization that began serving free, nutritious meals to HIV patients in 1985.\u003c/p>\n\u003cp>The people there “were like angels from the sky,” said Guzmán, 50, who went home from his first visit with vegetables, eggs, bread and beans. He continues to receive medically tailored meals from the group.\u003c/p>\n\u003cp>Project Open Hand cooks 2,500 meals and provides 200 bags of groceries to sick patients every day, part of its mission to help them get healthier and stay motivated to battle their diseases. The organization has expanded beyond HIV to feed people with other chronic illnesses, including diabetes and kidney failure, and it also delivers food to adults with disabilities.\u003c/p>\n\u003cfigure id=\"attachment_360761\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360761\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/food-as-medicine9-800x533.jpg\" alt=\"Federico Guzmán, who has AIDS, has been receiving meals and groceries from Project Open Hand for 26 years. \" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9.jpg 1446w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Federico Guzmán, who has AIDS, has been receiving meals and groceries from Project Open Hand for 26 years. \u003ccite>(Kellen Browning/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The state government recently \u003ca href=\"http://healthtrust.org/2017/06/27/food-is-medicine-gov-jerry-brown-approves-6m-pilot-program-for-chronically-ill/\" target=\"_blank\" rel=\"noopener noreferrer\">awarded\u003c/a> $6 million to Project Open Hand and similar nonprofits to provide these services to sick Californians covered by Medi-Cal, the state’s version of the federal Medicaid program for low-income people.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The three-year pilot program, which begins in January, was included in the recently adopted 2017-18 state budget. Project Open Hand will lead the effort, which involves five other food nonprofits across California.\u003c/p>\n\u003cp>Through the initiative, nonprofits will be able to identify heavy Medi-Cal users — in particular, chronically ill patients who are readmitted to the hospital for preventable reasons within 30 days of being discharged, said Project Open Hand CEO Mark Ryle.\u003c/p>\n\u003cp>The pilot program will debut at hospitals, doctors’ offices and clinics in San Diego, Los Angeles, San Jose, San Francisco, Oakland and parts of Sonoma and Marin counties. It will target locations with a large number of patients who are hospitalized frequently, said Project Open Hand’s director of communications, Delfin Vigil.\u003c/p>\n\u003cp>The nonprofits will enable doctors to give their patients prepared meals before they return home. One of the nonprofits will follow up later to schedule regular food deliveries, Ryle said.\u003c/p>\n\u003cfigure id=\"attachment_360765\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-360765\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/food-as-medicine3.jpg\" alt=\"Production manager Will Matthews bags Project Open Hand’s meals and groceries for delivery.\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">Production manager Will Matthews bags Project Open Hand’s meals and groceries for delivery. \u003ccite>(Kellen Browning/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The meals will be custom-made for each patient’s medical condition.\u003c/p>\n\u003cp>For example, a patient with diabetes, who requires a diet low in carbohydrates and saturated fats, might receive chicken stew with chickpeas, whole wheat couscous and roasted broccoli.\u003c/p>\n\u003cp>“If you provide the food when [patients] leave the hospital, they have a bridge to health,” Ryle said. “If they get home and there’s no food, they don’t take their meds. If they don’t take their meds, they fall into this crater of bad health and they get readmitted faster than they need to be.”\u003c/p>\n\u003cp>Details of the project, including the specific hospitals and clinics where food will be available, are “still in the planning stages,” said Anthony Cava, a spokesman for the Department of Health Care Services, which administers Medi-Cal.\u003c/p>\n\u003cp>“Over the next three years, we hope that this program will help improve the health and quality of life of Medi-Cal recipients who are chronically ill by providing them with nutritionally rich meals tailored to their condition,” added Carol Sloan, a DHCS spokeswoman.\u003c/p>\n\u003cp>The department will measure the program’s success by analyzing its participants’ hospital readmission rates, stays at long-term care facilities and emergency room use, Cava said.\u003c/p>\n\u003cp>The experiment aims to replicate the findings of a \u003ca href=\"https://link.springer.com/article/10.1007/s11524-016-0129-7\" target=\"_blank\" rel=\"noopener noreferrer\">University of California-San Francisco study\u003c/a> published in the Journal of Urban Health in January.\u003c/p>\n\u003cp>The study, which tracked 52 Project Open Hand clients with HIV and diabetes for six months in 2014 and 2015, found a 63 percent drop in hospitalization, a 58 percent decline in emergency room visits and a 50 percent increase in medication adherence among participants.\u003c/p>\n\u003cp>Because of the small sample size, the results are not statistically significant, but the success of the treatment is promising, said Kartika Palar, one of the UCSF researchers.\u003c/p>\n\u003cp>The cost to feed each participant in the study was $1,184 over six months. By comparison, San Francisco hospitals charged patients an average of $5,761 per day in 2015 for overnight stays, according to the Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>DHCS doesn’t know how much money this program might save, but Ryle thinks it could be a significant amount, based on \u003ca href=\"http://www.mannapa.org/wp-content/uploads/2014/07/MANNA-Study.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">a study\u003c/a> of a similar effort in Philadelphia. The study showed that the average monthly health care costs for 65 chronically ill participants dropped by 28 percent during the first six months they received healthy food, compared with the prior six months.\u003c/p>\n\u003cp>Organizations like Project Open Hand have known for some time that their work “was making a difference in patients’ lives,” said Dr. Rita Nguyen, a former UCSF professor now with the San Francisco Department of Public Health.\u003c/p>\n\u003cp>“There was a lot of anecdotal evidence that folks were getting stronger, able to take their medication and doing better overall,” she said.\u003c/p>\n\u003cp>On a recent day at Project Open Hand, located in San Francisco’s Tenderloin district, longtime patient and volunteer Mario Galande took a break in the staff lunchroom after stocking the shelves of the group’s free grocery store.\u003c/p>\n\u003cfigure id=\"attachment_360767\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360767\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/food-as-medicine13-800x533.jpg\" alt=\"Galande, who has AIDS and diabetes, has been receiving meals and groceries from the nonprofit for 20 years. \" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13.jpg 1446w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Galande, who has AIDS and diabetes, has been receiving meals and groceries from the nonprofit for 20 years. \u003ccite>(Kellen Browning/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Galande, 66, has been working at the nonprofit since he regained the weight he lost from wasting syndrome, a symptom of AIDS, 20 years ago.\u003c/p>\n\u003cp>The San Francisco resident lost 45 pounds before his friend “dragged me to Project Open Hand.” Once he started getting hot meals delivered daily, Galande recovered quickly.\u003c/p>\n\u003cp>“It was the food that got me going,” said Galande, who began volunteering there soon after. “I needed to help others.”\u003c/p>\n\u003cp>Nguyen, who teams with Project Open Hand on a separate program that provides healthful meals to heart failure patients after they are discharged from the San Francisco General Hospital, thinks the Medi-Cal partnership is an encouraging step.\u003c/p>\n\u003cp>“I see it as a huge opportunity for health care to stand up, to say that they have a role in food security and in healthy eating … rather than relying on purely medications or expensive procedures to actually keep communities well,” she said.\u003c/p>\n\u003cp>Guzmán, the San Francisco resident who discovered Project Open Hand more than two decades ago, is now managing his AIDS as a chronic disease. He has eaten the group’s nutritious meals for 26 years.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“Thanks to them, I keep my health better,” Guzmán said. “And I can go on with my life.”\u003c/p>\n\n",
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"nprByline": "\u003ca href=\"http://californiahealthline.org/news/author/kellen-browning/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cstrong>Kellen Browning\u003c/strong>\u003c/a> \u003c/span>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federico Guzmán moved from Mexico to San Francisco in 1992, fleeing anti-gay sentiment and searching for AIDS treatment.\u003c/p>\n\u003cp>He couldn’t find a job and sometimes went hungry until friends introduced him to \u003ca href=\"https://www.openhand.org/about-us\" target=\"_blank\" rel=\"noopener noreferrer\">Project Open Hand\u003c/a>, a nonprofit organization that began serving free, nutritious meals to HIV patients in 1985.\u003c/p>\n\u003cp>The people there “were like angels from the sky,” said Guzmán, 50, who went home from his first visit with vegetables, eggs, bread and beans. He continues to receive medically tailored meals from the group.\u003c/p>\n\u003cp>Project Open Hand cooks 2,500 meals and provides 200 bags of groceries to sick patients every day, part of its mission to help them get healthier and stay motivated to battle their diseases. The organization has expanded beyond HIV to feed people with other chronic illnesses, including diabetes and kidney failure, and it also delivers food to adults with disabilities.\u003c/p>\n\u003cfigure id=\"attachment_360761\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360761\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/food-as-medicine9-800x533.jpg\" alt=\"Federico Guzmán, who has AIDS, has been receiving meals and groceries from Project Open Hand for 26 years. \" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine9.jpg 1446w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Federico Guzmán, who has AIDS, has been receiving meals and groceries from Project Open Hand for 26 years. \u003ccite>(Kellen Browning/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The state government recently \u003ca href=\"http://healthtrust.org/2017/06/27/food-is-medicine-gov-jerry-brown-approves-6m-pilot-program-for-chronically-ill/\" target=\"_blank\" rel=\"noopener noreferrer\">awarded\u003c/a> $6 million to Project Open Hand and similar nonprofits to provide these services to sick Californians covered by Medi-Cal, the state’s version of the federal Medicaid program for low-income people.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The three-year pilot program, which begins in January, was included in the recently adopted 2017-18 state budget. Project Open Hand will lead the effort, which involves five other food nonprofits across California.\u003c/p>\n\u003cp>Through the initiative, nonprofits will be able to identify heavy Medi-Cal users — in particular, chronically ill patients who are readmitted to the hospital for preventable reasons within 30 days of being discharged, said Project Open Hand CEO Mark Ryle.\u003c/p>\n\u003cp>The pilot program will debut at hospitals, doctors’ offices and clinics in San Diego, Los Angeles, San Jose, San Francisco, Oakland and parts of Sonoma and Marin counties. It will target locations with a large number of patients who are hospitalized frequently, said Project Open Hand’s director of communications, Delfin Vigil.\u003c/p>\n\u003cp>The nonprofits will enable doctors to give their patients prepared meals before they return home. One of the nonprofits will follow up later to schedule regular food deliveries, Ryle said.\u003c/p>\n\u003cfigure id=\"attachment_360765\" class=\"wp-caption aligncenter\" style=\"max-width: 770px\">\u003cimg class=\"size-full wp-image-360765\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/food-as-medicine3.jpg\" alt=\"Production manager Will Matthews bags Project Open Hand’s meals and groceries for delivery.\" width=\"770\" height=\"513\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3.jpg 770w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine3-520x346.jpg 520w\" sizes=\"(max-width: 770px) 100vw, 770px\">\u003cfigcaption class=\"wp-caption-text\">Production manager Will Matthews bags Project Open Hand’s meals and groceries for delivery. \u003ccite>(Kellen Browning/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The meals will be custom-made for each patient’s medical condition.\u003c/p>\n\u003cp>For example, a patient with diabetes, who requires a diet low in carbohydrates and saturated fats, might receive chicken stew with chickpeas, whole wheat couscous and roasted broccoli.\u003c/p>\n\u003cp>“If you provide the food when [patients] leave the hospital, they have a bridge to health,” Ryle said. “If they get home and there’s no food, they don’t take their meds. If they don’t take their meds, they fall into this crater of bad health and they get readmitted faster than they need to be.”\u003c/p>\n\u003cp>Details of the project, including the specific hospitals and clinics where food will be available, are “still in the planning stages,” said Anthony Cava, a spokesman for the Department of Health Care Services, which administers Medi-Cal.\u003c/p>\n\u003cp>“Over the next three years, we hope that this program will help improve the health and quality of life of Medi-Cal recipients who are chronically ill by providing them with nutritionally rich meals tailored to their condition,” added Carol Sloan, a DHCS spokeswoman.\u003c/p>\n\u003cp>The department will measure the program’s success by analyzing its participants’ hospital readmission rates, stays at long-term care facilities and emergency room use, Cava said.\u003c/p>\n\u003cp>The experiment aims to replicate the findings of a \u003ca href=\"https://link.springer.com/article/10.1007/s11524-016-0129-7\" target=\"_blank\" rel=\"noopener noreferrer\">University of California-San Francisco study\u003c/a> published in the Journal of Urban Health in January.\u003c/p>\n\u003cp>The study, which tracked 52 Project Open Hand clients with HIV and diabetes for six months in 2014 and 2015, found a 63 percent drop in hospitalization, a 58 percent decline in emergency room visits and a 50 percent increase in medication adherence among participants.\u003c/p>\n\u003cp>Because of the small sample size, the results are not statistically significant, but the success of the treatment is promising, said Kartika Palar, one of the UCSF researchers.\u003c/p>\n\u003cp>The cost to feed each participant in the study was $1,184 over six months. By comparison, San Francisco hospitals charged patients an average of $5,761 per day in 2015 for overnight stays, according to the Office of Statewide Health Planning and Development.\u003c/p>\n\u003cp>DHCS doesn’t know how much money this program might save, but Ryle thinks it could be a significant amount, based on \u003ca href=\"http://www.mannapa.org/wp-content/uploads/2014/07/MANNA-Study.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">a study\u003c/a> of a similar effort in Philadelphia. The study showed that the average monthly health care costs for 65 chronically ill participants dropped by 28 percent during the first six months they received healthy food, compared with the prior six months.\u003c/p>\n\u003cp>Organizations like Project Open Hand have known for some time that their work “was making a difference in patients’ lives,” said Dr. Rita Nguyen, a former UCSF professor now with the San Francisco Department of Public Health.\u003c/p>\n\u003cp>“There was a lot of anecdotal evidence that folks were getting stronger, able to take their medication and doing better overall,” she said.\u003c/p>\n\u003cp>On a recent day at Project Open Hand, located in San Francisco’s Tenderloin district, longtime patient and volunteer Mario Galande took a break in the staff lunchroom after stocking the shelves of the group’s free grocery store.\u003c/p>\n\u003cfigure id=\"attachment_360767\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360767\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/food-as-medicine13-800x533.jpg\" alt=\"Galande, who has AIDS and diabetes, has been receiving meals and groceries from the nonprofit for 20 years. \" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/food-as-medicine13.jpg 1446w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Galande, who has AIDS and diabetes, has been receiving meals and groceries from the nonprofit for 20 years. \u003ccite>(Kellen Browning/California Healthline)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Galande, 66, has been working at the nonprofit since he regained the weight he lost from wasting syndrome, a symptom of AIDS, 20 years ago.\u003c/p>\n\u003cp>The San Francisco resident lost 45 pounds before his friend “dragged me to Project Open Hand.” Once he started getting hot meals delivered daily, Galande recovered quickly.\u003c/p>\n\u003cp>“It was the food that got me going,” said Galande, who began volunteering there soon after. “I needed to help others.”\u003c/p>\n\u003cp>Nguyen, who teams with Project Open Hand on a separate program that provides healthful meals to heart failure patients after they are discharged from the San Francisco General Hospital, thinks the Medi-Cal partnership is an encouraging step.\u003c/p>\n\u003cp>“I see it as a huge opportunity for health care to stand up, to say that they have a role in food security and in healthy eating … rather than relying on purely medications or expensive procedures to actually keep communities well,” she said.\u003c/p>\n\u003cp>Guzmán, the San Francisco resident who discovered Project Open Hand more than two decades ago, is now managing his AIDS as a chronic disease. He has eaten the group’s nutritious meals for 26 years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Thanks to them, I keep my health better,” Guzmán said. “And I can go on with my life.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"marketplace": {
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"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
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"source": "American Public Media"
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"masters-of-scale": {
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},
"mindshift": {
"id": "mindshift",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
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"onourwatch": {
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"on-the-media": {
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"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"link": "/radio/program/on-the-media",
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},
"pbs-newshour": {
"id": "pbs-newshour",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
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},
"link": "/radio/program/pbs-newshour",
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"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
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},
"perspectives": {
"id": "perspectives",
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"order": 14
},
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"planet-money": {
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
"airtime": "SUN 3pm-4pm",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/planetmoney.jpg",
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},
"link": "/radio/program/planet-money",
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"apple": "https://itunes.apple.com/us/podcast/planet-money/id290783428?mt=2",
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},
"politicalbreakdown": {
"id": "politicalbreakdown",
"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
},
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"possible": {
"id": "possible",
"title": "Possible",
"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
"subscribe": {
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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"source": "PRI"
},
"link": "/radio/program/pri-the-world",
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"tuneIn": "https://tunein.com/podcasts/News--Politics-Podcasts/PRIs-The-World-p24/",
"rss": "http://feeds.feedburner.com/pri/theworld"
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
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