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"content": "\u003cp>OAKLAND, Calif. — The question came as a shock to Dorothy Reeves: Would she be willing to donate her husband’s brain for research?\u003c/p>\n\u003cp>She knew dementia would steadily take Levi Reeves’ memories of their 57-year marriage, his remaining lucidity and, eventually, his life. But to let scientists take his brain after he died? That seemed too much to ask.\u003c/p>\n\u003cp>“I didn’t want to deal with the idea of his death,” said Reeves, 79. “I certainly didn’t want to deal with brain donation.”\u003c/p>\n\u003cp>As an African-American and a former schoolteacher, Reeves is keenly aware of the history of racism in health care, including callous and sometimes deadly experimentation. Reeves said she never personally has had a bad experience with doctors or the medical system. But she’s old enough to remember the infamous Tuskegee Institute syphilis study, during which hundreds of mostly illiterate black sharecroppers were assured they were being treated for “bad blood” even as doctors withheld effective treatment over decades.\u003c/p>\n\u003cp>Top researchers say such wariness, while understandable, is thwarting efforts to understand and treat Alzheimer’s disease and other forms of dementia in black patients today. African-Americans suffer from these cognitive impairments at \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084964/\" target=\"_blank\" rel=\"noopener noreferrer\">two to three times the rate of non-Hispanic whites\u003c/a>, yet they are less likely to take part in research.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That has created a vexing challenge for scientists, who are trying to persuade more blacks to participate in studies — both while they are alive and after they die. A critical part of their efforts is asking for brain donations.\u003c/p>\n\u003cp>“There is a lot of terrible history that we have to acknowledge and move past,” said Lisa L. Barnes, a neuropsychologist at the Rush Alzheimer’s Disease Center in Chicago. “A lot of minority communities still feel that research involves being a guinea pig. Nobody wants to be used. Nobody wants to be a guinea pig.”\u003c/p>\n\u003cp>Shirley Fitch, who lives south of Chicago, said no thank you to Rush researchers on behalf of her husband, Clarence. The former university professor died last summer at age 86, seven years after being diagnosed with dementia.\u003c/p>\n\u003cp>“I’m hesitant because of distrust,” said Fitch. “Once my brain is donated for one purpose, who is to say it won’t be used for another purpose? It is out of your control.”\u003c/p>\n\u003cp>Although Shirley Fitch is participating in non-Alzheimer’s research at Rush, she said the historical abuses of black people have been “awful and hard to get over.”\u003c/p>\n\u003cp>Even today, blacks tend to get worse treatment from hospitals, she said. “It all gets stirred in the pot as to feelings about bias.”\u003c/p>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cfigure id=\"attachment_360754\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360754\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/brain-donation-2-800x533.jpg\" alt=\"Dorothy Reeves, 79, helps feed her husband, Levi, who has Lewy body dementia. Reeves, a former schoolteacher, initially declined brain donation but later agreed — for both her and her husband.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dorothy Reeves, 79, helps feed her husband, Levi, who has Lewy body dementia. Reeves, a former schoolteacher, initially declined brain donation but later agreed — for both her and her husband. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>The Knowledge Gap\u003c/strong>\u003c/p>\n\u003cp>The precise explanations for the disparities among blacks and whites are unknown. Until recently, most of our understanding of the pathology of dementia was largely based on studies of white patients.\u003c/p>\n\u003cp>“We have a real knowledge gap in accurately knowing if dementia is different in minorities as compared to whites,” said John Olichney, a neurologist and clinical director of the Alzheimer’s Disease Center at the University of California-Davis.\u003c/p>\n\u003cp>Scientists say blacks’ disproportionate rates of dementia may be related in part to the prevalence of disorders that raise the risk of vascular disease: diabetes and hypertension, for instance. Socioeconomic factors such as higher rates of poverty and lower levels of education also seem to play a significant role, according to \u003ca href=\"http://www.bmj.com/content/347/bmj.f7051\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> led by the University of California-San Francisco.\u003c/p>\n\u003cp>Despite advances in imaging technology that allows researchers to peer into the brains of live patients, studying the organ after death is crucial to a deeper understanding of the causes and progression of disease and to developing drug treatments, Olichney said.\u003c/p>\n\u003cp>The challenge is getting enough brains from different populations to study. It’s not just a matter of assuring potential donors that Tuskegee and other ethical debacles are in the past. To gain trust, Alzheimer’s research facilities such as UC-Davis and Rush University are also trying to diversify their staffs, collaborate with community leaders and study religious and cultural beliefs on brain donation.\u003c/p>\n\u003cp>For example, some African-Americans don’t want their brain separated from their body when they are buried, said Stephanie Monroe, director of African Americans Against Alzheimer’s, which is engaged in various efforts to educate people about the disease and its effects.\u003c/p>\n\u003cp>“Many people believe in ashes to ashes and dust to dust,” she said.\u003c/p>\n\u003cp>\u003cstrong>A Changing Mindset\u003c/strong>\u003c/p>\n\u003cp>Alzheimer’s researchers at UC-Davis recognized about 15 years ago that they needed a more representative slice of the population, especially in diverse Northern California. At the time, centers around the country were mostly studying well-educated, white people who volunteered, Olichney said.\u003c/p>\n\u003cp>So they started reaching out to both the African-American and Latino communities. “That was a real change in our mindset,” he said.\u003c/p>\n\u003cp>Today, nearly 400 patients, including about 70 African-Americans, are enrolled in its longitudinal study of the progression of dementia, and they come in yearly for memory evaluations and other tests. Of the study participants, about 270 have agreed to donate their brains after death, more than 40 of them African-American.\u003c/p>\n\u003cp>At the Rush Alzheimer’s Disease Center, doctors started following a cohort of African-Americans in 2004 and, some seven years later, began to seek brain donation for the study. Close to 500 African-Americans have signed up to donate after death, and 72 brains already have been donated, Barnes said.\u003c/p>\n\u003cp>Though she is pleased with the high rate of commitment, she noted that more works needs to be done. In another study, about 3,100 white participants agreed to brain donation, with 1,400 already donated. Recruiting African-Americans “takes a lot of effort and a lot of work,” she said. “Every year, we bring it up again and revisit it with those who are reluctant. But if someone is really firm, we don’t push the subject.”\u003c/p>\n\u003cp>Research on the donated brains has led to intriguing findings. One Rush study, published in 2015, found that blacks with Alzheimer’s disease were more likely than whites to have other disorders, such as Lewy body dementia. Twice as many blacks with Alzheimer’s as whites with the disease also had Lewy body dementia, in which protein deposits build up in nerve cells, according to the study. Blacks with dementia also had more severe disease of the arteries, the \u003ca href=\"http://europepmc.org/articles/pmc4540250\">study\u003c/a> found.\u003c/p>\n\u003cp>The number of blacks studied was relatively small — 41 compared with 81 whites — yet its findings were potentially important. That’s because the presence of other diseases in the brain means blacks may not respond as white patients do to drugs aimed specifically at Alzheimer’s.\u003c/p>\n\u003cp>Even for experienced research institutions, getting people to participate in donation remains complicated — in part, because families don’t necessarily agree about it among themselves.\u003c/p>\n\u003cfigure id=\"attachment_360755\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360755\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/brain-donation-4-800x533.jpg\" alt=\"Andrea Gourdine holds a photo of her mother, Gladys Brown, who died in 2012 after being diagnosed with Alzheimer’s. Brown donated her brain to the University of California-Davis, for research.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrea Gourdine holds a photo of her mother, Gladys Brown, who died in 2012 after being diagnosed with Alzheimer’s. Brown donated her brain to the University of California-Davis, for research. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Andrea Gourdine remembers clearly when her mother, Gladys Brown, started behaving oddly. Once, the elder woman forgot a stove burner was on and a dish exploded. Then she stopped bathing regularly. “And she was normally fastidious,” Gourdine said. “Something was really, really wrong.”\u003c/p>\n\u003cp>Brown enrolled in the research at UC-Davis, was diagnosed with Alzheimer’s in 2005 and soon after agreed to donate her brain. It won’t help me, Brown told researchers, but it could help others. She died in 2012, at 87.\u003c/p>\n\u003cp>Gourdine also signed up for the UC-Davis study and has consented to donate her brain. She does not have Alzheimer’s, but researchers are seeking brains of those without dementia for comparison.\u003c/p>\n\u003cp>She is aware of the history of medical abuse of African-Americans but says she doesn’t see any point in focusing on the past.\u003c/p>\n\u003cp>Gourdine’s sister, India Collins, disagrees with her sister and objected to her mother’s donation.\u003c/p>\n\u003cp>“I have problems with scientific research and I get very upset with scientific data and outcomes in general,” said Collins. She questions how helpful it is to African-Americans. “Why would you want to participate in their research if it does not benefit you?”\u003c/p>\n\u003cp>\u003cstrong>Expanding The Brain Trust\u003c/strong>\u003c/p>\n\u003cp>Gwen Gates, a recruiter and research coordinator at the UC-Davis center, goes to churches, health fairs and other events to build trust and develop deeper relationships among the university and minority communities. Patients and families want to know what scientists do with the brains. They worry about how relatives will react. They fear donation will interfere with funeral arrangements or their plans for an open casket.\u003c/p>\n\u003cp>She assures them it won’t. She explains that brain donations will help future generations, perhaps even in their own family.\u003c/p>\n\u003cp>Occasionally, families readily agree. Some adamantly refuse. For others, the decision is a process.\u003c/p>\n\u003cp>Dorothy Reeves declined brain donation initially but agreed to sign up herself and Levi, 81, for observational studies. Then she saw what the disease could do. Her husband, who has Lewy body dementia, went under a table one day to get a magazine and couldn’t find his way out. He forgot her name and those of his children.\u003c/p>\n\u003cp>She thought about all the other people like Levi.\u003c/p>\n\u003cp>“It affects people in ways you can’t imagine — regardless of your race,” she said. “It’s almost unbearable.”\u003c/p>\n\u003cp>Soon the researchers had their answer. Yes, she would agree to donation — for both of them.\u003c/p>\n\u003cp>\u003cem>KHN’s coverage in California is funded in part by \u003ca href=\"http://www.blueshieldcafoundation.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Blue Shield of California Foundation\u003c/a>.\u003c/em>\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>OAKLAND, Calif. — The question came as a shock to Dorothy Reeves: Would she be willing to donate her husband’s brain for research?\u003c/p>\n\u003cp>She knew dementia would steadily take Levi Reeves’ memories of their 57-year marriage, his remaining lucidity and, eventually, his life. But to let scientists take his brain after he died? That seemed too much to ask.\u003c/p>\n\u003cp>“I didn’t want to deal with the idea of his death,” said Reeves, 79. “I certainly didn’t want to deal with brain donation.”\u003c/p>\n\u003cp>As an African-American and a former schoolteacher, Reeves is keenly aware of the history of racism in health care, including callous and sometimes deadly experimentation. Reeves said she never personally has had a bad experience with doctors or the medical system. But she’s old enough to remember the infamous Tuskegee Institute syphilis study, during which hundreds of mostly illiterate black sharecroppers were assured they were being treated for “bad blood” even as doctors withheld effective treatment over decades.\u003c/p>\n\u003cp>Top researchers say such wariness, while understandable, is thwarting efforts to understand and treat Alzheimer’s disease and other forms of dementia in black patients today. African-Americans suffer from these cognitive impairments at \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084964/\" target=\"_blank\" rel=\"noopener noreferrer\">two to three times the rate of non-Hispanic whites\u003c/a>, yet they are less likely to take part in research.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That has created a vexing challenge for scientists, who are trying to persuade more blacks to participate in studies — both while they are alive and after they die. A critical part of their efforts is asking for brain donations.\u003c/p>\n\u003cp>“There is a lot of terrible history that we have to acknowledge and move past,” said Lisa L. Barnes, a neuropsychologist at the Rush Alzheimer’s Disease Center in Chicago. “A lot of minority communities still feel that research involves being a guinea pig. Nobody wants to be used. Nobody wants to be a guinea pig.”\u003c/p>\n\u003cp>Shirley Fitch, who lives south of Chicago, said no thank you to Rush researchers on behalf of her husband, Clarence. The former university professor died last summer at age 86, seven years after being diagnosed with dementia.\u003c/p>\n\u003cp>“I’m hesitant because of distrust,” said Fitch. “Once my brain is donated for one purpose, who is to say it won’t be used for another purpose? It is out of your control.”\u003c/p>\n\u003cp>Although Shirley Fitch is participating in non-Alzheimer’s research at Rush, she said the historical abuses of black people have been “awful and hard to get over.”\u003c/p>\n\u003cp>Even today, blacks tend to get worse treatment from hospitals, she said. “It all gets stirred in the pot as to feelings about bias.”\u003c/p>\n\u003cp>\u003c!--side-by-side-->\u003c/p>\n\u003cfigure id=\"attachment_360754\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360754\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/brain-donation-2-800x533.jpg\" alt=\"Dorothy Reeves, 79, helps feed her husband, Levi, who has Lewy body dementia. Reeves, a former schoolteacher, initially declined brain donation but later agreed — for both her and her husband.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-2.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dorothy Reeves, 79, helps feed her husband, Levi, who has Lewy body dementia. Reeves, a former schoolteacher, initially declined brain donation but later agreed — for both her and her husband. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>The Knowledge Gap\u003c/strong>\u003c/p>\n\u003cp>The precise explanations for the disparities among blacks and whites are unknown. Until recently, most of our understanding of the pathology of dementia was largely based on studies of white patients.\u003c/p>\n\u003cp>“We have a real knowledge gap in accurately knowing if dementia is different in minorities as compared to whites,” said John Olichney, a neurologist and clinical director of the Alzheimer’s Disease Center at the University of California-Davis.\u003c/p>\n\u003cp>Scientists say blacks’ disproportionate rates of dementia may be related in part to the prevalence of disorders that raise the risk of vascular disease: diabetes and hypertension, for instance. Socioeconomic factors such as higher rates of poverty and lower levels of education also seem to play a significant role, according to \u003ca href=\"http://www.bmj.com/content/347/bmj.f7051\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> led by the University of California-San Francisco.\u003c/p>\n\u003cp>Despite advances in imaging technology that allows researchers to peer into the brains of live patients, studying the organ after death is crucial to a deeper understanding of the causes and progression of disease and to developing drug treatments, Olichney said.\u003c/p>\n\u003cp>The challenge is getting enough brains from different populations to study. It’s not just a matter of assuring potential donors that Tuskegee and other ethical debacles are in the past. To gain trust, Alzheimer’s research facilities such as UC-Davis and Rush University are also trying to diversify their staffs, collaborate with community leaders and study religious and cultural beliefs on brain donation.\u003c/p>\n\u003cp>For example, some African-Americans don’t want their brain separated from their body when they are buried, said Stephanie Monroe, director of African Americans Against Alzheimer’s, which is engaged in various efforts to educate people about the disease and its effects.\u003c/p>\n\u003cp>“Many people believe in ashes to ashes and dust to dust,” she said.\u003c/p>\n\u003cp>\u003cstrong>A Changing Mindset\u003c/strong>\u003c/p>\n\u003cp>Alzheimer’s researchers at UC-Davis recognized about 15 years ago that they needed a more representative slice of the population, especially in diverse Northern California. At the time, centers around the country were mostly studying well-educated, white people who volunteered, Olichney said.\u003c/p>\n\u003cp>So they started reaching out to both the African-American and Latino communities. “That was a real change in our mindset,” he said.\u003c/p>\n\u003cp>Today, nearly 400 patients, including about 70 African-Americans, are enrolled in its longitudinal study of the progression of dementia, and they come in yearly for memory evaluations and other tests. Of the study participants, about 270 have agreed to donate their brains after death, more than 40 of them African-American.\u003c/p>\n\u003cp>At the Rush Alzheimer’s Disease Center, doctors started following a cohort of African-Americans in 2004 and, some seven years later, began to seek brain donation for the study. Close to 500 African-Americans have signed up to donate after death, and 72 brains already have been donated, Barnes said.\u003c/p>\n\u003cp>Though she is pleased with the high rate of commitment, she noted that more works needs to be done. In another study, about 3,100 white participants agreed to brain donation, with 1,400 already donated. Recruiting African-Americans “takes a lot of effort and a lot of work,” she said. “Every year, we bring it up again and revisit it with those who are reluctant. But if someone is really firm, we don’t push the subject.”\u003c/p>\n\u003cp>Research on the donated brains has led to intriguing findings. One Rush study, published in 2015, found that blacks with Alzheimer’s disease were more likely than whites to have other disorders, such as Lewy body dementia. Twice as many blacks with Alzheimer’s as whites with the disease also had Lewy body dementia, in which protein deposits build up in nerve cells, according to the study. Blacks with dementia also had more severe disease of the arteries, the \u003ca href=\"http://europepmc.org/articles/pmc4540250\">study\u003c/a> found.\u003c/p>\n\u003cp>The number of blacks studied was relatively small — 41 compared with 81 whites — yet its findings were potentially important. That’s because the presence of other diseases in the brain means blacks may not respond as white patients do to drugs aimed specifically at Alzheimer’s.\u003c/p>\n\u003cp>Even for experienced research institutions, getting people to participate in donation remains complicated — in part, because families don’t necessarily agree about it among themselves.\u003c/p>\n\u003cfigure id=\"attachment_360755\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360755\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/brain-donation-4-800x533.jpg\" alt=\"Andrea Gourdine holds a photo of her mother, Gladys Brown, who died in 2012 after being diagnosed with Alzheimer’s. Brown donated her brain to the University of California-Davis, for research.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4-520x347.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/08/brain-donation-4.jpg 1170w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrea Gourdine holds a photo of her mother, Gladys Brown, who died in 2012 after being diagnosed with Alzheimer’s. Brown donated her brain to the University of California-Davis, for research. \u003ccite>(Anna Gorman/KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Andrea Gourdine remembers clearly when her mother, Gladys Brown, started behaving oddly. Once, the elder woman forgot a stove burner was on and a dish exploded. Then she stopped bathing regularly. “And she was normally fastidious,” Gourdine said. “Something was really, really wrong.”\u003c/p>\n\u003cp>Brown enrolled in the research at UC-Davis, was diagnosed with Alzheimer’s in 2005 and soon after agreed to donate her brain. It won’t help me, Brown told researchers, but it could help others. She died in 2012, at 87.\u003c/p>\n\u003cp>Gourdine also signed up for the UC-Davis study and has consented to donate her brain. She does not have Alzheimer’s, but researchers are seeking brains of those without dementia for comparison.\u003c/p>\n\u003cp>She is aware of the history of medical abuse of African-Americans but says she doesn’t see any point in focusing on the past.\u003c/p>\n\u003cp>Gourdine’s sister, India Collins, disagrees with her sister and objected to her mother’s donation.\u003c/p>\n\u003cp>“I have problems with scientific research and I get very upset with scientific data and outcomes in general,” said Collins. She questions how helpful it is to African-Americans. “Why would you want to participate in their research if it does not benefit you?”\u003c/p>\n\u003cp>\u003cstrong>Expanding The Brain Trust\u003c/strong>\u003c/p>\n\u003cp>Gwen Gates, a recruiter and research coordinator at the UC-Davis center, goes to churches, health fairs and other events to build trust and develop deeper relationships among the university and minority communities. Patients and families want to know what scientists do with the brains. They worry about how relatives will react. They fear donation will interfere with funeral arrangements or their plans for an open casket.\u003c/p>\n\u003cp>She assures them it won’t. She explains that brain donations will help future generations, perhaps even in their own family.\u003c/p>\n\u003cp>Occasionally, families readily agree. Some adamantly refuse. For others, the decision is a process.\u003c/p>\n\u003cp>Dorothy Reeves declined brain donation initially but agreed to sign up herself and Levi, 81, for observational studies. Then she saw what the disease could do. Her husband, who has Lewy body dementia, went under a table one day to get a magazine and couldn’t find his way out. He forgot her name and those of his children.\u003c/p>\n\u003cp>She thought about all the other people like Levi.\u003c/p>\n\u003cp>“It affects people in ways you can’t imagine — regardless of your race,” she said. “It’s almost unbearable.”\u003c/p>\n\u003cp>Soon the researchers had their answer. Yes, she would agree to donation — for both of them.\u003c/p>\n\u003cp>\u003cem>KHN’s coverage in California is funded in part by \u003ca href=\"http://www.blueshieldcafoundation.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Blue Shield of California Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\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": "How Smartphones Are Making Kids Unhappy",
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"content": "\u003cp>For the first time, a generation of children is going through adolescence with smartphones ever-present. \u003ca href=\"http://www.psychology.sdsu.edu/people/jean-twenge/\">Jean Twenge\u003c/a>, a professor of psychology at San Diego State University, has a name for these young people born between 1995 and 2012: \"iGen.\"\u003c/p>\n\u003cp>She says members of this generation are physically safer than those who came before them. They drink less, they learn to drive later and they're holding off on having sex. But psychologically, she argues, they are far more vulnerable.\u003c/p>\n\u003cp>\"It's not an exaggeration to describe iGen as being on the brink of the worst mental health crisis in decades,\" she writes in a \u003ca href=\"https://www.theatlantic.com/magazine/archive/2017/09/has-the-smartphone-destroyed-a-generation/534198/\">story\u003c/a> in \u003cem>The Atlantic, \u003c/em>adapted from her \u003ca href=\"http://www.simonandschuster.com/books/iGen/Jean-M-Twenge/9781501151989\">forthcoming book\u003c/a>. And she says it's largely because of smartphones.\u003c/p>\n\u003cp>Twenge spoke to \u003cem>All Things Considered\u003c/em> about her research and her conclusions. This interview has been edited for length and clarity.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/542016165/542087124\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003chr>\n\u003cp>\u003cstrong>How does teen behavior now differ from generations past?\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Today's teens are just not spending as much time with their friends in person, face-to-face, where they can really read each others' emotions and get that social support. And we know from lots and lots of research that spending time with other people in person is one of the best predictors for psychological well-being and one of the best protections against having mental health issues.\u003c/p>\n\u003cp>\u003cstrong>What is this generation facing that worries you so much?\u003c/strong>\u003c/p>\n\u003cp>iGen is showing mental health issues across a wide variety of indicators. They're more likely than young people just five or 10 years ago to say that they're anxious, that they have symptoms of depression, that they have thought about suicide or have even [attempted] suicide. So across the board, there's a really consistent trend with mental health issues increasing among teens.\u003c/p>\n\u003cp>\u003cstrong>Is it specifically the smartphone, or is it social media? Or is it the number of hours per day spent on these things?\u003c/strong>\u003c/p>\n\u003cp>So, you look at the pattern of loneliness. It suddenly begins to increase around 2012. And the majority of Americans had a cell phone by the end of 2012, according to the \u003ca href=\"http://www.pewinternet.org/2013/06/05/smartphone-ownership-2013/\">Pew Center\u003c/a>.\u003c/p>\n\u003cp>Given that using social media for more hours is linked to more loneliness, and that smartphones were used by the majority of Americans around 2012, and that's the same time loneliness increases, that's very suspicious. You can't absolutely prove causation, but by a bunch of different studies, there's this connection between spending a lot of time on social media and feeling lonely.\u003c/p>\n\u003cp>\u003cstrong>How much of a factor is parenting?\u003c/strong>\u003c/p>\n\u003cp>So I was somewhat surprised when I interviewed iGen teens how many of them are deeply aware of the negative effects of smartphones. Parenting is playing a role. I think many parents are worried about their teens driving, and going out with their friends and drinking. Yet parents are often not worrying about their teen who stays at home but is on their phone all the time. But they should be worried about that. I think parents are worried about the wrong thing.\u003c/p>\n\u003cp>\u003cstrong>Can you propose solutions that might help people?\u003c/strong>\u003c/p>\n\u003cp>The first is just awareness that spending a lot of time on the phone is not harmless and that if you're spending a lot of time on the phone, then it may take away from activities that might be more beneficial for psychological well-being, like spending time with people in person.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Then for parents, I think it is [a] good idea to put off giving your child a smartphone as long as you can. If you feel they need a phone, say, for riding a bus, you can get them a flip phone. They still sell them. And then once your teen has a smartphone, there are apps that allow parents to restrict the number of hours a day that teens are on the smartphone, and also what time of day they use it.\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=How+Smartphones+Are+Making+Kids+Unhappy&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For the first time, a generation of children is going through adolescence with smartphones ever-present. \u003ca href=\"http://www.psychology.sdsu.edu/people/jean-twenge/\">Jean Twenge\u003c/a>, a professor of psychology at San Diego State University, has a name for these young people born between 1995 and 2012: \"iGen.\"\u003c/p>\n\u003cp>She says members of this generation are physically safer than those who came before them. They drink less, they learn to drive later and they're holding off on having sex. But psychologically, she argues, they are far more vulnerable.\u003c/p>\n\u003cp>\"It's not an exaggeration to describe iGen as being on the brink of the worst mental health crisis in decades,\" she writes in a \u003ca href=\"https://www.theatlantic.com/magazine/archive/2017/09/has-the-smartphone-destroyed-a-generation/534198/\">story\u003c/a> in \u003cem>The Atlantic, \u003c/em>adapted from her \u003ca href=\"http://www.simonandschuster.com/books/iGen/Jean-M-Twenge/9781501151989\">forthcoming book\u003c/a>. And she says it's largely because of smartphones.\u003c/p>\n\u003cp>Twenge spoke to \u003cem>All Things Considered\u003c/em> about her research and her conclusions. This interview has been edited for length and clarity.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/542016165/542087124\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003chr>\n\u003cp>\u003cstrong>How does teen behavior now differ from generations past?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Today's teens are just not spending as much time with their friends in person, face-to-face, where they can really read each others' emotions and get that social support. And we know from lots and lots of research that spending time with other people in person is one of the best predictors for psychological well-being and one of the best protections against having mental health issues.\u003c/p>\n\u003cp>\u003cstrong>What is this generation facing that worries you so much?\u003c/strong>\u003c/p>\n\u003cp>iGen is showing mental health issues across a wide variety of indicators. They're more likely than young people just five or 10 years ago to say that they're anxious, that they have symptoms of depression, that they have thought about suicide or have even [attempted] suicide. So across the board, there's a really consistent trend with mental health issues increasing among teens.\u003c/p>\n\u003cp>\u003cstrong>Is it specifically the smartphone, or is it social media? Or is it the number of hours per day spent on these things?\u003c/strong>\u003c/p>\n\u003cp>So, you look at the pattern of loneliness. It suddenly begins to increase around 2012. And the majority of Americans had a cell phone by the end of 2012, according to the \u003ca href=\"http://www.pewinternet.org/2013/06/05/smartphone-ownership-2013/\">Pew Center\u003c/a>.\u003c/p>\n\u003cp>Given that using social media for more hours is linked to more loneliness, and that smartphones were used by the majority of Americans around 2012, and that's the same time loneliness increases, that's very suspicious. You can't absolutely prove causation, but by a bunch of different studies, there's this connection between spending a lot of time on social media and feeling lonely.\u003c/p>\n\u003cp>\u003cstrong>How much of a factor is parenting?\u003c/strong>\u003c/p>\n\u003cp>So I was somewhat surprised when I interviewed iGen teens how many of them are deeply aware of the negative effects of smartphones. Parenting is playing a role. I think many parents are worried about their teens driving, and going out with their friends and drinking. Yet parents are often not worrying about their teen who stays at home but is on their phone all the time. But they should be worried about that. I think parents are worried about the wrong thing.\u003c/p>\n\u003cp>\u003cstrong>Can you propose solutions that might help people?\u003c/strong>\u003c/p>\n\u003cp>The first is just awareness that spending a lot of time on the phone is not harmless and that if you're spending a lot of time on the phone, then it may take away from activities that might be more beneficial for psychological well-being, like spending time with people in person.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Then for parents, I think it is [a] good idea to put off giving your child a smartphone as long as you can. If you feel they need a phone, say, for riding a bus, you can get them a flip phone. They still sell them. And then once your teen has a smartphone, there are apps that allow parents to restrict the number of hours a day that teens are on the smartphone, and also what time of day they use it.\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=How+Smartphones+Are+Making+Kids+Unhappy&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine",
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"content": "\u003cp>It was 1 am at San Francisco General Hospital. Saturday. The ambulances were rolling in one after another. Resident doctor Josie Valenzuela was near the end of her shift, trying to stay awake.\u003c/p>\n\u003cp>“I was really tired. And my back hurt a lot,” she remembers. “My mind was wandering all over the place.”\u003c/p>\n\u003cp>She was caring for a heroin addict, cutting an abscess open on her leg to drain infection. Then her pager went off. Another ambulance was coming in and this would have to wait for later.\u003c/p>\n\u003cp>“So I went to put the scalpel in some sterile towels for when I could come back,” Valenzuela says, “and I cut my left index finger.”\u003c/p>\n\u003cp>The patient had HIV and hepatitis C.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I knew this was a bad exposure, and that all of the blood and pus that was on that scalpel was now touching my bloodstream,” she says.\u003c/p>\n\u003cp>[audio src=\"http:www.kqed.org/.stream/anon/radio//2017/08/28hourworkdayDembosky.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-ultrasound-768x432.jpg\" Title=\"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine\" program=\"The California Report\"]\u003c/p>\n\u003cp>Valenzuela would have to take anti-viral medications that would make her nauseated for weeks. And she’d have to explain to her husband that she may have contracted a life-long disease.\u003c/p>\n\u003cp>“We were going to start trying to have kids soon,” she says, choking up, “and so that would make it complicated for us.”\u003c/p>\n\u003cp>That’s what she was thinking about when she finally left the hospital at 4 in the morning.\u003c/p>\n\u003cp>“I found my car and I was backing out,” she says. “And I mixed up the gas and the brake. I've never done that before, but I backed right into a concrete pole.”\u003c/p>\n\u003cp>Mistakes like these led medical experts at the Institute of Medicine to issue a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23616719\" target=\"_blank\" rel=\"noopener noreferrer\">recommendation \u003c/a>in 2009 that residents' work shifts be capped at 16 hours. Until then, they were allowed to work up to 28 hours. After a year-long review of the scientific literature, the Institute concluded that human performance begins to decline after 16 hours, and the risk of medical errors and car accidents goes up.\u003c/p>\n\u003cp>So, in 2011, the \u003ca href=\"http://www.acgme.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Accreditation Council for Graduate Medical Education\u003c/a> made a rule, saying first-year doctors could only work a maximum of 16 hours per shift.\u003c/p>\n\u003cp>But this year, the council reversed itself, and starting this summer, new doctors can again work up to 28 hours in a row.\u003c/p>\n\u003cp>“I think the majority of patients in the United States expect that their physician will be available to them whether it's daytime, nighttime, Saturday or Sunday,” says Dr. Rowen Zetterman, co-chair of the task force that reviewed and changed the rule.\u003c/p>\n\u003cfigure id=\"attachment_360682\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360682\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-microscope-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Josie Valenzuela looks through a slit lamp at work. The microscope is for examining the eye. \u003ccite>(Georgie Baumann/University of Arizona)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Patient and resident groups wanted to keep the 16-hour rule, Zetterman says. But senior doctors argued that long hours come with the profession. They complained that the shift limits cut into the time they had for teaching in the hospital, compromising the educational integrity of the residency.\u003c/p>\n\u003cp>“You ask residents a question and they'll say, ‘’I'm just covering, I don't know those things.’ That drives the more senior physicians batty,” says Adams Dudley, a pulmonologist and professor at UCSF School of Medicine. “The perception is they don't know what they're doing as well because they spend less time at the hospital.”\u003c/p>\n\u003cp>Physicians grouse that residents don’t seem as invested in the work when shift limits are in effect, he says, because they’re more focused on handing off their patients to others, rather then seeing them through the cycle of illness.\u003c/p>\n\u003cp>“Because they leave, they don't see the evolution of things, and they don't know the patients as well,” Dudley says. “If you're told you must pay attention to leaving, you have to detach yourself from the patient.”\u003c/p>\n\u003cp>Surgical residents complained about this, too.\u003c/p>\n\u003cp>“They would be in the middle of an operation that they felt like they were learning from, and they would hit the end of their 16 hours and be told that they had to leave the operation and go home,” Zetterman says.\u003c/p>\n\u003cp>This hurt morale on the health care team, he says, as other doctors watched first-year residents clock out when they had to stay, and raised patient-safety concerns.\u003c/p>\n\u003cp>“Let's say your copilot kept coming and going throughout the flight and, then was gone. Didn't come back for the remainder that flight,” Zetterman says. “It seems to me that would be disruptive.”\u003c/p>\n\u003cp>It’s unclear what’s riskier for patients: more frequent hand-offs between doctors, or doctors that are just exhausted. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26054323\" target=\"_blank\" rel=\"noopener noreferrer\">Most studies \u003c/a>show little or no change in patient outcomes after shift limits were put in place, suggesting mistakes and miscommunications that resulted from transitions in care offset any gains made from reducing doctor fatigue.\u003c/p>\n\u003cp>If that's the case, Dr. Josie Valenzuela believes there should be more focus on residents’ well-being, in addition to patients. And while the shift limit was extended to 28 hours in the regulatory, other rules require residency programs to provide more support for residents who feel burned out, stressed, or depressed, including \u003ca href=\"https://ww2.kqed.org/news/2017/07/05/physicians-are-human-beings-new-rules-aim-to-battle-burnout-in-medical-residencies/\" target=\"_blank\" rel=\"noopener noreferrer\">24/7 access\u003c/a> to a mental health professional.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Valenzuela is in her last year of residency now. She says she was lucky after that accidental cut. After nearly a year of periodic checks, she's been officially declared negative for HIV and hepatitis C. Next year, she and her husband plan to have a baby.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was 1 am at San Francisco General Hospital. Saturday. The ambulances were rolling in one after another. Resident doctor Josie Valenzuela was near the end of her shift, trying to stay awake.\u003c/p>\n\u003cp>“I was really tired. And my back hurt a lot,” she remembers. “My mind was wandering all over the place.”\u003c/p>\n\u003cp>She was caring for a heroin addict, cutting an abscess open on her leg to drain infection. Then her pager went off. Another ambulance was coming in and this would have to wait for later.\u003c/p>\n\u003cp>“So I went to put the scalpel in some sterile towels for when I could come back,” Valenzuela says, “and I cut my left index finger.”\u003c/p>\n\u003cp>The patient had HIV and hepatitis C.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Valenzuela would have to take anti-viral medications that would make her nauseated for weeks. And she’d have to explain to her husband that she may have contracted a life-long disease.\u003c/p>\n\u003cp>“We were going to start trying to have kids soon,” she says, choking up, “and so that would make it complicated for us.”\u003c/p>\n\u003cp>That’s what she was thinking about when she finally left the hospital at 4 in the morning.\u003c/p>\n\u003cp>“I found my car and I was backing out,” she says. “And I mixed up the gas and the brake. I've never done that before, but I backed right into a concrete pole.”\u003c/p>\n\u003cp>Mistakes like these led medical experts at the Institute of Medicine to issue a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23616719\" target=\"_blank\" rel=\"noopener noreferrer\">recommendation \u003c/a>in 2009 that residents' work shifts be capped at 16 hours. Until then, they were allowed to work up to 28 hours. After a year-long review of the scientific literature, the Institute concluded that human performance begins to decline after 16 hours, and the risk of medical errors and car accidents goes up.\u003c/p>\n\u003cp>So, in 2011, the \u003ca href=\"http://www.acgme.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Accreditation Council for Graduate Medical Education\u003c/a> made a rule, saying first-year doctors could only work a maximum of 16 hours per shift.\u003c/p>\n\u003cp>But this year, the council reversed itself, and starting this summer, new doctors can again work up to 28 hours in a row.\u003c/p>\n\u003cp>“I think the majority of patients in the United States expect that their physician will be available to them whether it's daytime, nighttime, Saturday or Sunday,” says Dr. Rowen Zetterman, co-chair of the task force that reviewed and changed the rule.\u003c/p>\n\u003cfigure id=\"attachment_360682\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360682\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-microscope-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Josie Valenzuela looks through a slit lamp at work. The microscope is for examining the eye. \u003ccite>(Georgie Baumann/University of Arizona)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Patient and resident groups wanted to keep the 16-hour rule, Zetterman says. But senior doctors argued that long hours come with the profession. They complained that the shift limits cut into the time they had for teaching in the hospital, compromising the educational integrity of the residency.\u003c/p>\n\u003cp>“You ask residents a question and they'll say, ‘’I'm just covering, I don't know those things.’ That drives the more senior physicians batty,” says Adams Dudley, a pulmonologist and professor at UCSF School of Medicine. “The perception is they don't know what they're doing as well because they spend less time at the hospital.”\u003c/p>\n\u003cp>Physicians grouse that residents don’t seem as invested in the work when shift limits are in effect, he says, because they’re more focused on handing off their patients to others, rather then seeing them through the cycle of illness.\u003c/p>\n\u003cp>“Because they leave, they don't see the evolution of things, and they don't know the patients as well,” Dudley says. “If you're told you must pay attention to leaving, you have to detach yourself from the patient.”\u003c/p>\n\u003cp>Surgical residents complained about this, too.\u003c/p>\n\u003cp>“They would be in the middle of an operation that they felt like they were learning from, and they would hit the end of their 16 hours and be told that they had to leave the operation and go home,” Zetterman says.\u003c/p>\n\u003cp>This hurt morale on the health care team, he says, as other doctors watched first-year residents clock out when they had to stay, and raised patient-safety concerns.\u003c/p>\n\u003cp>“Let's say your copilot kept coming and going throughout the flight and, then was gone. Didn't come back for the remainder that flight,” Zetterman says. “It seems to me that would be disruptive.”\u003c/p>\n\u003cp>It’s unclear what’s riskier for patients: more frequent hand-offs between doctors, or doctors that are just exhausted. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26054323\" target=\"_blank\" rel=\"noopener noreferrer\">Most studies \u003c/a>show little or no change in patient outcomes after shift limits were put in place, suggesting mistakes and miscommunications that resulted from transitions in care offset any gains made from reducing doctor fatigue.\u003c/p>\n\u003cp>If that's the case, Dr. Josie Valenzuela believes there should be more focus on residents’ well-being, in addition to patients. And while the shift limit was extended to 28 hours in the regulatory, other rules require residency programs to provide more support for residents who feel burned out, stressed, or depressed, including \u003ca href=\"https://ww2.kqed.org/news/2017/07/05/physicians-are-human-beings-new-rules-aim-to-battle-burnout-in-medical-residencies/\" target=\"_blank\" rel=\"noopener noreferrer\">24/7 access\u003c/a> to a mental health professional.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Valenzuela is in her last year of residency now. She says she was lucky after that accidental cut. After nearly a year of periodic checks, she's been officially declared negative for HIV and hepatitis C. Next year, she and her husband plan to have a baby.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California",
"title": "Health Premiums Go Up 12.5% in 2018, and Anthem Exits Much of California",
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"content": "\u003cp>More than half of the Californians who have an individual health insurance policy from Anthem Blue Cross will have to shop for a new plan next year.\u003c/p>\n\u003cp>The company is pulling out of the individual market in all but three regions of the state, abandoning 153,000 of its customers. Of those, 30,000 will be left with just one plan on offer through Covered California.\u003c/p>\n\u003cp>But the former Anthem customers who do have a choice of plans will be able to find reasonable alternatives.\u003c/p>\n\u003cp>“In a number of areas where consumers in Anthem will now be forced to shop, they will find much more cost-competitive options,” said Peter Lee, executive director of Covered California.\u003c/p>\n\u003cp>Statewide, premium rates will go up an average 12.5 percent in 2018 in the state’s Affordable Care Act marketplace. But in San Francisco, the average premium increase will be just 6.6 percent. In Fresno, Kings, and Madera counties, the average increase will be 4.7 percent.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Anthem customers can keep their plan if they live in the far rural northern part of the state, parts of the Central Valley, and Santa Clara County. But in areas where Anthem is one of only two plans offered for sale – like Modoc, Lassen, and Siskiyou counties in the far north – customers will pay as much as 54 percent more for their Anthem plan. The alternative, Blue Shield, will charge up to 24 percent more next year.\u003c/p>\n\u003cp>In a statement, Anthem said its price increases and partial departure from the market are due largely to federal changes and uncertainty around the future of the Affordable Care Act.\u003c/p>\n\u003cp>“Planning and pricing for ACA-compliant health plans has become increasingly difficult,” it said, because of “continual changes in federal operations, rules and guidance.”\u003c/p>\n\u003cp>The overall lack of predictability “simply does not provide a sustainable path forward to providing affordable plan choices for all California consumers,” the company said.\u003c/p>\n\u003cp>Uncertainty also affected the prices the remaining marketplace insurers plan to charge next year. Of the overall 12.5 percent average increase, 3 percent is due to uncertainty alone, Lee said.\u003c/p>\n\u003cp>Lee warned that some plans will see an additional 12 percent surcharge, on top of the 12.5 percent average increase, if President Trump makes good on his threat to stop so-called \"Cost-Sharing Reduction\" payments to insurers. These CSR payments help insurers provide discounts on co-pays and deductibles for low-income consumers, as they are required to do by the Affordable Care Act.\u003c/p>\n\u003cp>But even if the Trump administration withdraws the money, and insurers add the surcharge to premiums, Lee says most Californians won’t feel it, because the federal subsidy will also go up in kind, covering most of the premium increase.\u003c/p>\n\u003cp>“We do not want to implement this workaround,” Lee said. “It will cause unnecessary confusion, and ultimately cost the federal government billions of dollars more than they would have spent by [just] making the CSR payments directly to health plans.”\u003c/p>\n\u003cp>Covered California submitted \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_CL_2018_Rates-HHSLetter.pdf\">a letter\u003c/a> to federal health officials, saying there's an urgent need to get clarity on the future of the cost-sharing reduction payments. California will have to decide by the end of August whether to add the surcharge to monthly premiums or not. After that, it cannot make changes to \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\">2018 rates\u003c/a>.\u003c/p>\n\u003cp>\"I'm expecting to be dealing with a lot of angry and frustrated consumers as we head into 2018 open enrollment,\" said Jonathan Greer, a health insurance broker with Rockridge Health Benefits in Oakland. \"Unfortunately, many consumers will experience sticker shock this year, especially if the Trump Administration stops making the cost-sharing payments.\"\u003c/p>\n\u003cp>Insurers are also worried that the federal government will make changes to the Affordable Care Act in the middle of next year, after rates are locked in. In addition to the CSR payments, they are concerned the IRS will stop enforcing the individual mandate, the ACA's requirement that almost all Americans buy insurance. The mandate helps balance insurance \"risk pools\" by ensuring young, healthy people also buy policies, to help cover the costs of care for the sick.\u003c/p>\n\u003cp>Covered California had to fend off requests for premium increases well beyond the 12.5 percent average because of these fears.\u003c/p>\n\u003cp>“One of the things that many of the health plans said to us is ‘What if policies change mid-year? Our actuaries are saying, ‘Be really conservative and bump rates a boatload,’” Peter Lee said, recalling the tensions underlying the negotiations. “We said, ‘Take a deep breath. Before you bump up rates a boatload, instead, what can we do to help you plan over the long term?’”\u003c/p>\n\u003cp>The agency convinced insurers to keep the increases in check by drafting a plan that would allow them to make up for any 2018 losses in subsequent years. This backup plan, which still has to be approved by state regulators, wouldn’t cost the state money, Lee said. But it would allow insurers to shift costs internally so they could replenish the coffers in later years.\u003c/p>\n\u003cp>But Lee predicts the state probably won’t have to implement the backup plan. By keeping increases relatively low this year, more people will sign up for health plans, which will give insurers the stability they need to keep prices low in 2019 and beyond.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "Uncertainty around the Affordable Care Act is pushing rates higher in California and has Anthem scaling back coverage.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>More than half of the Californians who have an individual health insurance policy from Anthem Blue Cross will have to shop for a new plan next year.\u003c/p>\n\u003cp>The company is pulling out of the individual market in all but three regions of the state, abandoning 153,000 of its customers. Of those, 30,000 will be left with just one plan on offer through Covered California.\u003c/p>\n\u003cp>But the former Anthem customers who do have a choice of plans will be able to find reasonable alternatives.\u003c/p>\n\u003cp>“In a number of areas where consumers in Anthem will now be forced to shop, they will find much more cost-competitive options,” said Peter Lee, executive director of Covered California.\u003c/p>\n\u003cp>Statewide, premium rates will go up an average 12.5 percent in 2018 in the state’s Affordable Care Act marketplace. But in San Francisco, the average premium increase will be just 6.6 percent. In Fresno, Kings, and Madera counties, the average increase will be 4.7 percent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Anthem customers can keep their plan if they live in the far rural northern part of the state, parts of the Central Valley, and Santa Clara County. But in areas where Anthem is one of only two plans offered for sale – like Modoc, Lassen, and Siskiyou counties in the far north – customers will pay as much as 54 percent more for their Anthem plan. The alternative, Blue Shield, will charge up to 24 percent more next year.\u003c/p>\n\u003cp>In a statement, Anthem said its price increases and partial departure from the market are due largely to federal changes and uncertainty around the future of the Affordable Care Act.\u003c/p>\n\u003cp>“Planning and pricing for ACA-compliant health plans has become increasingly difficult,” it said, because of “continual changes in federal operations, rules and guidance.”\u003c/p>\n\u003cp>The overall lack of predictability “simply does not provide a sustainable path forward to providing affordable plan choices for all California consumers,” the company said.\u003c/p>\n\u003cp>Uncertainty also affected the prices the remaining marketplace insurers plan to charge next year. Of the overall 12.5 percent average increase, 3 percent is due to uncertainty alone, Lee said.\u003c/p>\n\u003cp>Lee warned that some plans will see an additional 12 percent surcharge, on top of the 12.5 percent average increase, if President Trump makes good on his threat to stop so-called \"Cost-Sharing Reduction\" payments to insurers. These CSR payments help insurers provide discounts on co-pays and deductibles for low-income consumers, as they are required to do by the Affordable Care Act.\u003c/p>\n\u003cp>But even if the Trump administration withdraws the money, and insurers add the surcharge to premiums, Lee says most Californians won’t feel it, because the federal subsidy will also go up in kind, covering most of the premium increase.\u003c/p>\n\u003cp>“We do not want to implement this workaround,” Lee said. “It will cause unnecessary confusion, and ultimately cost the federal government billions of dollars more than they would have spent by [just] making the CSR payments directly to health plans.”\u003c/p>\n\u003cp>Covered California submitted \u003ca href=\"http://www.coveredca.com/news/pdfs/CoveredCA_CL_2018_Rates-HHSLetter.pdf\">a letter\u003c/a> to federal health officials, saying there's an urgent need to get clarity on the future of the cost-sharing reduction payments. California will have to decide by the end of August whether to add the surcharge to monthly premiums or not. After that, it cannot make changes to \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\">2018 rates\u003c/a>.\u003c/p>\n\u003cp>\"I'm expecting to be dealing with a lot of angry and frustrated consumers as we head into 2018 open enrollment,\" said Jonathan Greer, a health insurance broker with Rockridge Health Benefits in Oakland. \"Unfortunately, many consumers will experience sticker shock this year, especially if the Trump Administration stops making the cost-sharing payments.\"\u003c/p>\n\u003cp>Insurers are also worried that the federal government will make changes to the Affordable Care Act in the middle of next year, after rates are locked in. In addition to the CSR payments, they are concerned the IRS will stop enforcing the individual mandate, the ACA's requirement that almost all Americans buy insurance. The mandate helps balance insurance \"risk pools\" by ensuring young, healthy people also buy policies, to help cover the costs of care for the sick.\u003c/p>\n\u003cp>Covered California had to fend off requests for premium increases well beyond the 12.5 percent average because of these fears.\u003c/p>\n\u003cp>“One of the things that many of the health plans said to us is ‘What if policies change mid-year? Our actuaries are saying, ‘Be really conservative and bump rates a boatload,’” Peter Lee said, recalling the tensions underlying the negotiations. “We said, ‘Take a deep breath. Before you bump up rates a boatload, instead, what can we do to help you plan over the long term?’”\u003c/p>\n\u003cp>The agency convinced insurers to keep the increases in check by drafting a plan that would allow them to make up for any 2018 losses in subsequent years. This backup plan, which still has to be approved by state regulators, wouldn’t cost the state money, Lee said. But it would allow insurers to shift costs internally so they could replenish the coffers in later years.\u003c/p>\n\u003cp>But Lee predicts the state probably won’t have to implement the backup plan. By keeping increases relatively low this year, more people will sign up for health plans, which will give insurers the stability they need to keep prices low in 2019 and beyond.\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Covered California Announces 2018 Rate Hikes, and an Anthem Exit",
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"content": "\u003cp>Covered California said Tuesday that premiums on its health insurance plans would rise by an average of 12.5 percent statewide next year, amid continuing uncertainty over the future of the Affordable Care Act.\u003c/p>\n\u003cp>The state’s Obamacare exchange also said one of its largest insurers, Anthem Blue Cross, would pull out of the exchange and the overall individual market in 16 of the 19 regions it currently serves, forcing 153,000 consumers to find new health plans.\u003c/p>\n\u003cp>The rate increases apply to people who purchase their own coverage in the individual market, not the majority of Americans who get their health insurance through work or government programs such as Medicare and Medicaid.\u003c/p>\n\u003cp>The expected 2018 rate increase is down from 2017’s average rise of 13.2 percent, and it includes a one-time increase averaging 2.8 percentage points because of the end of a “holiday” that gave health plans a break from the tax they are required to pay under the Affordable Care Act.\u003c/p>\n\u003cp>Without that one-time hit, Covered California said, the average 2018 premium increase would be lower than 10 percent. And the exchange said consumers could face increases as low as 3.3 percent if they shop for the best-priced plan at the same level of coverage they already have.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The expected California premium increases are dwarfed by some of the rates proposed in other states. In Iowa, for example, the sole carrier remaining on the exchange — Medica — has proposed a \u003ca href=\"http://www.desmoinesregister.com/story/news/health/2017/07/31/iowa-insurance-premiums-could-spike-moref-obamacare-funding-cut/526363001/\">43 percent increase \u003c/a>for next year, and it has said it would propose another increase of 12 to 20 percent on top of that if President Donald Trump decides to eliminate an important subsidy that helps some consumers reduce the cost of doctor visits, hospital stays and other medical services.\u003c/p>\n\u003cp>Blue Cross-Blue Shield of Georgia, the only insurer covering all counties in that state, is proposing a \u003ca href=\"http://www.myajc.com/news/state--regional-govt--politics/citing-uncertainty-blue-cross-seeks-big-rate-increases-georgia/hEVvZdpt6ODVmbtNokL12H/\">40.6 percent increase\u003c/a>, in large part because of the uncertainty surrounding these so-called \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/ask-emily/article2581624.html\">cost-sharing subsidies\u003c/a>.\u003c/p>\n\u003cp>Some states, however, will see more moderate rate hikes next year than in California. In \u003ca href=\"http://www.bnd.com/news/article164506387.html\">Minnesota\u003c/a>, which has been hit in the past with large increases, some consumers could see their premiums shrink by as much as 15 percent, while others could pay 11 percent more. In Pennsylvania, premiums on exchange-based plans are expected to rise by a relatively tame \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/19/538099050/uncertainty-over-obamacare-leaves-next-years-rates-in-limbo\">9 percent on average \u003c/a>if the cost-sharing subsidies continue, and by 20 percent if they don’t.\u003c/p>\n\u003cp>Covered California’s calculation of the average statewide premium increase assumes the federal government will continue to fund the subsidies — which may not be a safe assumption.\u003c/p>\n\u003cp>The exchange said there could be an additional charge averaging 12.4 percent on silver plans — the second-least-expensive type of policy among the exchange’s \u003ca href=\"http://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">four tiers\u003c/a> — if the administration under Trump decides not to continue funding them. The subsidies, paid directly to insurers, help reduce what some consumers pay out of their own pockets for medical expenses, such as physician visits, prescription drugs and hospital stays.\u003c/p>\n\u003cp>An announcement on whether the Trump administration will continue paying for them, at least for another month, was expected as early as this week. So far, Trump has let the subsidies continue on a month-to-month basis. But after Senate efforts to pass a repeal of the Affordable Care Act failed last week, he suggested in a tweet that he might pull the plug on them.\u003c/p>\n\u003cp>“We’ve prepared these rates in the midst of great uncertainty,” said Peter Lee, Covered California’s executive director. “We are doing our best to protect consumers. We hope to get clarity from the federal government before we make a decision by the end of August” on whether to tack on the silver plan surcharge to offset the loss of the federal subsidies, he said.\u003c/p>\n\u003cp>Lee said the exchange hoped not to do that, because “it will cause unnecessary confusion and ultimately cost the fed government billions of dollars more.”\u003c/p>\n\u003cp>Many Covered California consumers would not pay more out-of-pocket even if the cost of their health plans were to rise sharply, because the extra expense would be covered by federal tax credits intended to keep premiums affordable for consumers. Those subsidies, not directly threatened by Trump, are separate from the ones that help consumers with their out-of-pocket costs.\u003c/p>\n\u003cp>About 650,000 Covered California enrollees, or nearly half the exchange’s total enrollment, benefit from the cost-sharing reductions.\u003c/p>\n\u003cp>Those reduced rates are available only to Covered California enrollees who choose silver-level plans and whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four.\u003c/p>\n\u003cp>The exchange can’t wait too long before determining which rates consumers will face in 2018. State regulators need at least 60 days to review the rates, and Covered California and health plans also need to time to prepare for open enrollment, which begins Nov. 1.\u003c/p>\n\u003cp>Current enrollees will have the option to start renewing their plans sometime in October, said Covered California spokeswoman Lizelda Lopez.\u003c/p>\n\u003cp>Covered California also plans to create a new silver plan to be sold on the exchange for individuals and families who make too much money to qualify for tax credits and cost-sharing reductions. The surcharge will not be applied to that plan.\u003c/p>\n\u003cp>Covered California started offering plans in 2014. In the following two years, the agency successfully negotiated 4 percent average premium increases, far below the double-digit rate hikes that were the norm before the federal health law. That streak ended this year when rates shot up.\u003c/p>\n\u003cp>All of the rates are subject to state regulatory review and public comment. But neither of the state’s insurance regulators, the Department of Managed Health Care and Insurance Commissioner Dave Jones, has the authority to block the hikes.\u003c/p>\n\u003cp>The expansion of coverage under the Affordable Care Act has driven the percentage of uninsured Californians to a record low. The proportion of Californians lacking health insurance was 7.1 percent last year, down from 17 percent in 2013, before the coverage-expanding provisions of Obamacare began, federal data show.\u003c/p>\n\u003cp>The expansion of Medi-Cal, the state’s Medicaid program for lower-income residents, accounts for a significant part of that reduction. About 3.8 million Californians became eligible for Medi-Cal coverage under the Affordable Care Act. Total enrollment is 13.5 million, or about a third of the state’s population.\u003c/p>\n\u003cp>\u003cem>Chad Terhune contributed to this report.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "The figure could be higher if President Trump ends an important consumer subsidy, which he has threatened to do. Anthem Blue Cross also says it won't offer individual coverage in large parts of the state next year. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Covered California said Tuesday that premiums on its health insurance plans would rise by an average of 12.5 percent statewide next year, amid continuing uncertainty over the future of the Affordable Care Act.\u003c/p>\n\u003cp>The state’s Obamacare exchange also said one of its largest insurers, Anthem Blue Cross, would pull out of the exchange and the overall individual market in 16 of the 19 regions it currently serves, forcing 153,000 consumers to find new health plans.\u003c/p>\n\u003cp>The rate increases apply to people who purchase their own coverage in the individual market, not the majority of Americans who get their health insurance through work or government programs such as Medicare and Medicaid.\u003c/p>\n\u003cp>The expected 2018 rate increase is down from 2017’s average rise of 13.2 percent, and it includes a one-time increase averaging 2.8 percentage points because of the end of a “holiday” that gave health plans a break from the tax they are required to pay under the Affordable Care Act.\u003c/p>\n\u003cp>Without that one-time hit, Covered California said, the average 2018 premium increase would be lower than 10 percent. And the exchange said consumers could face increases as low as 3.3 percent if they shop for the best-priced plan at the same level of coverage they already have.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The expected California premium increases are dwarfed by some of the rates proposed in other states. In Iowa, for example, the sole carrier remaining on the exchange — Medica — has proposed a \u003ca href=\"http://www.desmoinesregister.com/story/news/health/2017/07/31/iowa-insurance-premiums-could-spike-moref-obamacare-funding-cut/526363001/\">43 percent increase \u003c/a>for next year, and it has said it would propose another increase of 12 to 20 percent on top of that if President Donald Trump decides to eliminate an important subsidy that helps some consumers reduce the cost of doctor visits, hospital stays and other medical services.\u003c/p>\n\u003cp>Blue Cross-Blue Shield of Georgia, the only insurer covering all counties in that state, is proposing a \u003ca href=\"http://www.myajc.com/news/state--regional-govt--politics/citing-uncertainty-blue-cross-seeks-big-rate-increases-georgia/hEVvZdpt6ODVmbtNokL12H/\">40.6 percent increase\u003c/a>, in large part because of the uncertainty surrounding these so-called \u003ca href=\"http://www.sacbee.com/news/local/health-and-medicine/ask-emily/article2581624.html\">cost-sharing subsidies\u003c/a>.\u003c/p>\n\u003cp>Some states, however, will see more moderate rate hikes next year than in California. In \u003ca href=\"http://www.bnd.com/news/article164506387.html\">Minnesota\u003c/a>, which has been hit in the past with large increases, some consumers could see their premiums shrink by as much as 15 percent, while others could pay 11 percent more. In Pennsylvania, premiums on exchange-based plans are expected to rise by a relatively tame \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/19/538099050/uncertainty-over-obamacare-leaves-next-years-rates-in-limbo\">9 percent on average \u003c/a>if the cost-sharing subsidies continue, and by 20 percent if they don’t.\u003c/p>\n\u003cp>Covered California’s calculation of the average statewide premium increase assumes the federal government will continue to fund the subsidies — which may not be a safe assumption.\u003c/p>\n\u003cp>The exchange said there could be an additional charge averaging 12.4 percent on silver plans — the second-least-expensive type of policy among the exchange’s \u003ca href=\"http://www.coveredca.com/individuals-and-families/getting-covered/coverage-basics/coverage-levels/\">four tiers\u003c/a> — if the administration under Trump decides not to continue funding them. The subsidies, paid directly to insurers, help reduce what some consumers pay out of their own pockets for medical expenses, such as physician visits, prescription drugs and hospital stays.\u003c/p>\n\u003cp>An announcement on whether the Trump administration will continue paying for them, at least for another month, was expected as early as this week. So far, Trump has let the subsidies continue on a month-to-month basis. But after Senate efforts to pass a repeal of the Affordable Care Act failed last week, he suggested in a tweet that he might pull the plug on them.\u003c/p>\n\u003cp>“We’ve prepared these rates in the midst of great uncertainty,” said Peter Lee, Covered California’s executive director. “We are doing our best to protect consumers. We hope to get clarity from the federal government before we make a decision by the end of August” on whether to tack on the silver plan surcharge to offset the loss of the federal subsidies, he said.\u003c/p>\n\u003cp>Lee said the exchange hoped not to do that, because “it will cause unnecessary confusion and ultimately cost the fed government billions of dollars more.”\u003c/p>\n\u003cp>Many Covered California consumers would not pay more out-of-pocket even if the cost of their health plans were to rise sharply, because the extra expense would be covered by federal tax credits intended to keep premiums affordable for consumers. Those subsidies, not directly threatened by Trump, are separate from the ones that help consumers with their out-of-pocket costs.\u003c/p>\n\u003cp>About 650,000 Covered California enrollees, or nearly half the exchange’s total enrollment, benefit from the cost-sharing reductions.\u003c/p>\n\u003cp>Those reduced rates are available only to Covered California enrollees who choose silver-level plans and whose annual income falls between 139 percent and 250 percent of the federal poverty level — about $34,200 to $61,500 for a family of four.\u003c/p>\n\u003cp>The exchange can’t wait too long before determining which rates consumers will face in 2018. State regulators need at least 60 days to review the rates, and Covered California and health plans also need to time to prepare for open enrollment, which begins Nov. 1.\u003c/p>\n\u003cp>Current enrollees will have the option to start renewing their plans sometime in October, said Covered California spokeswoman Lizelda Lopez.\u003c/p>\n\u003cp>Covered California also plans to create a new silver plan to be sold on the exchange for individuals and families who make too much money to qualify for tax credits and cost-sharing reductions. The surcharge will not be applied to that plan.\u003c/p>\n\u003cp>Covered California started offering plans in 2014. In the following two years, the agency successfully negotiated 4 percent average premium increases, far below the double-digit rate hikes that were the norm before the federal health law. That streak ended this year when rates shot up.\u003c/p>\n\u003cp>All of the rates are subject to state regulatory review and public comment. But neither of the state’s insurance regulators, the Department of Managed Health Care and Insurance Commissioner Dave Jones, has the authority to block the hikes.\u003c/p>\n\u003cp>The expansion of coverage under the Affordable Care Act has driven the percentage of uninsured Californians to a record low. The proportion of Californians lacking health insurance was 7.1 percent last year, down from 17 percent in 2013, before the coverage-expanding provisions of Obamacare began, federal data show.\u003c/p>\n\u003cp>The expansion of Medi-Cal, the state’s Medicaid program for lower-income residents, accounts for a significant part of that reduction. About 3.8 million Californians became eligible for Medi-Cal coverage under the Affordable Care Act. Total enrollment is 13.5 million, or about a third of the state’s population.\u003c/p>\n\u003cp>\u003cem>Chad Terhune contributed to this report.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>You may check Yelp reviews before deciding where to go to dinner, or which plumber to hire. Now you can use Yelp to decide where to have a baby.\u003c/p>\n\u003cp>The San Francisco-based review site is now adding clinical data on C-sections, episiotomies, and breastfeeding rates to consumer reviews of California hospitals, so women can make more informed decisions about where they deliver.\u003c/p>\n\u003cp>“Just like they’re using that kind of information to buy a car, they should be using it to think about where they’re getting their health care,” says \u003ca href=\"http://www.chcf.org/about/staff/stephanie-teleki\" target=\"_blank\" rel=\"noopener noreferrer\">Stephanie Teleki\u003c/a>, director of evaluation and impact at the California Health Care Foundation.\u003c/p>\n\u003cp>A woman’s chance of having a C-section depends, in part, on where she delivers, Teleki explains. The more C-sections a hospital does, the more likely a woman delivering there will have one.\u003c/p>\n\u003cp>That’s why the Foundation is partnering with Yelp to publish C-section rates for every hospital in the state – nearly 250 total.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/07/2017-07-27d-tcr.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS19268_IMG_6407-qut-768x576.jpg\" Title=\"Yelp Adds C-Section Rates and Childbirth Data to Reviews of California Hospitals\" program=\"The California Report\"]\u003c/p>\n\u003cp>Shannon Eis, vice president of communications at Yelp, says this would have been helpful information to have when she gave birth to her son in New York. It was her second baby, everything felt normal, when all of a sudden alarms started going off and she was rushed into an emergency C-section.\u003c/p>\n\u003cp>“I had never considered myself a C-section risk,” she says. “I later found out I gave birth at a hospital that has the highest emergency C-section rate in all of New York City.”\u003c/p>\n\u003cp>Eis says putting this data on Yelp will help women choose a hospital that is aligned with their birth plan, so they won’t have to negotiate with doctors and make tough choices while they’re in labor.\u003c/p>\n\u003cp>“All these decisions are washing over you so fast, and so if you haven’t done the research to put yourself in the right environment, where whatever your decisions are can be honored without the tremendous pressure and fear – women are trying to do more planning around that,” she says.\u003c/p>\n\u003cp>The reaction from the state’s hospital industry group was low-key.\u003c/p>\n\u003cp>“We have always supported transparency – this effort simply takes it more directly to consumers,” says Jan Emerson-Shea, from the California Hospital Association. “We’ll have to see how it works.”\u003c/p>\n\u003cp>When the data first went public on government and foundation websites a few years ago, hospitals generally responded by trying to improve care for women, Teleki says. But she’s curious to see how hospitals will respond when those statistics are put right in front of consumers, through the online megaphone of Yelp.\u003c/p>\n\u003cp>“For hospitals that are doing well, that’s a good thing,” she says. “For hospitals that need to improve, I’m sure they will feel some heat and perhaps be discouraged about the release.”\u003c/p>\n\u003cp>California is the first state where Yelp is rolling out this data. With one in eight babies born in the US born here, Eis says it’s the perfect place to test the product before rolling it out to other states.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If the state of California can do this with the biggest data set in the country, the biggest birthrate in the country, any other state can do it,” she said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You may check Yelp reviews before deciding where to go to dinner, or which plumber to hire. Now you can use Yelp to decide where to have a baby.\u003c/p>\n\u003cp>The San Francisco-based review site is now adding clinical data on C-sections, episiotomies, and breastfeeding rates to consumer reviews of California hospitals, so women can make more informed decisions about where they deliver.\u003c/p>\n\u003cp>“Just like they’re using that kind of information to buy a car, they should be using it to think about where they’re getting their health care,” says \u003ca href=\"http://www.chcf.org/about/staff/stephanie-teleki\" target=\"_blank\" rel=\"noopener noreferrer\">Stephanie Teleki\u003c/a>, director of evaluation and impact at the California Health Care Foundation.\u003c/p>\n\u003cp>A woman’s chance of having a C-section depends, in part, on where she delivers, Teleki explains. The more C-sections a hospital does, the more likely a woman delivering there will have one.\u003c/p>\n\u003cp>That’s why the Foundation is partnering with Yelp to publish C-section rates for every hospital in the state – nearly 250 total.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Shannon Eis, vice president of communications at Yelp, says this would have been helpful information to have when she gave birth to her son in New York. It was her second baby, everything felt normal, when all of a sudden alarms started going off and she was rushed into an emergency C-section.\u003c/p>\n\u003cp>“I had never considered myself a C-section risk,” she says. “I later found out I gave birth at a hospital that has the highest emergency C-section rate in all of New York City.”\u003c/p>\n\u003cp>Eis says putting this data on Yelp will help women choose a hospital that is aligned with their birth plan, so they won’t have to negotiate with doctors and make tough choices while they’re in labor.\u003c/p>\n\u003cp>“All these decisions are washing over you so fast, and so if you haven’t done the research to put yourself in the right environment, where whatever your decisions are can be honored without the tremendous pressure and fear – women are trying to do more planning around that,” she says.\u003c/p>\n\u003cp>The reaction from the state’s hospital industry group was low-key.\u003c/p>\n\u003cp>“We have always supported transparency – this effort simply takes it more directly to consumers,” says Jan Emerson-Shea, from the California Hospital Association. “We’ll have to see how it works.”\u003c/p>\n\u003cp>When the data first went public on government and foundation websites a few years ago, hospitals generally responded by trying to improve care for women, Teleki says. But she’s curious to see how hospitals will respond when those statistics are put right in front of consumers, through the online megaphone of Yelp.\u003c/p>\n\u003cp>“For hospitals that are doing well, that’s a good thing,” she says. “For hospitals that need to improve, I’m sure they will feel some heat and perhaps be discouraged about the release.”\u003c/p>\n\u003cp>California is the first state where Yelp is rolling out this data. With one in eight babies born in the US born here, Eis says it’s the perfect place to test the product before rolling it out to other states.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If the state of California can do this with the biggest data set in the country, the biggest birthrate in the country, any other state can do it,” she said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Valley Fever Cases Highest On Record",
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"content": "\u003cp>The number of Valley Fever cases in California \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CocciEpiSummary2016.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">rose to a record level\u003c/a> in 2016, with 5,372 reported — a jump of 71 percent from the previous year. Historically, about three-quarters of cases have been in the state’s heavily agricultural San Joaquin Valley.\u003c/p>\n\u003cp>The fungal infection, known as coccidioidomycosis, or “cocci,” is most common in the southern portion of the Valley and along the Central Coast of California. State health officials say they’re not sure what caused the recent increase, the largest since 2011, but “climatic and environmental factors” could have increased the risk of exposure to the airborne spores that cause the disease, according to the California Department of Public Health.\u003c/p>\n\u003cp>Climatologists and other researchers have theorized that intensified \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/2017GL073524/full\" target=\"_blank\" rel=\"noopener noreferrer\">dust storms\u003c/a> or \u003ca href=\"https://www.scientificamerican.com/article/valley-fever-on-the-rise-in-us-southwest/\" target=\"_blank\" rel=\"noopener noreferrer\">heat waves\u003c/a> linked to global warming can fuel Valley Fever infection. Human activities that stir dust into the air, such as farming and construction, also contribute.\u003c/p>\n\u003cp>An influx of new people in areas where the fungus is most prevalent, along with better reporting of the disease, also may have contributed to the increase, according to the public health department, which has tracked Valley Fever since 1995.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe id=\"datawrapper-chart-1h7jK\" src=\"//datawrapper.dwcdn.net/1h7jK/2/\" scrolling=\"no\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"100%\" height=\"500\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Nationally, \u003ca href=\"https://www.cdc.gov/fungal/diseases/coccidioidomycosis/statistics.html\" target=\"_blank\" rel=\"noopener noreferrer\">more than 11,000 cases\u003c/a> of Valley Fever were reported in 2015, the latest year for which data are available, according to the U.S. Centers for Disease Control and Prevention. That was up from 8,232 cases the previous year. Arizona and California account for the vast majority of cases. In 2015, Arizona had 7,622 cases, the most of any state. California had the second-highest number, with 3,053. Nevada, Utah and New Mexico, among other states, had smaller numbers of Valley Fever cases in 2015.\u003c/p>\n\u003cp>Deaths from Valley Fever averaged 200 a year from 1990 to 2008, according to the CDC. And since 1997, the number of deaths has changed very little from year to year.\u003c/p>\n\u003cp>The California Department of Public Health does not regularly track Valley Fever. But it said a review of death certificates found that 1,098 people in the state died of the disease from 2000 to 2013. The state’s overall incidence rate of Valley Fever in 2016, 13.7 per 100,000 people, was up sharply from the 2015 rate of 8 per 100,000.\u003c/p>\n\u003cp>“We’re horrified but not surprised when the cases increase,” said Sandra Larson, former executive director of the Valley Fever Americas Foundation, who lives just outside Bakersfield, in the San Joaquin Valley. “We’re known as endemic for Valley Fever.”\u003c/p>\n\u003cp>People contract the illness by breathing in tiny spores stirred up from dusty soil. The illness echoes the flu in its symptoms, which can include cough, severe fatigue, fever, headaches and rashes. In many cases, people recover on their own. But the infection can also spread beyond the lungs into other parts of the body, including joints, reproductive organs and teeth. In rare cases it can lead to hospitalization, and even death.\u003c/p>\n\u003cp>Kern County, an agricultural area that encompasses Bakersfield and stretches into the Mojave Desert, had the highest number of cases in 2016, with about 40 percent of the statewide total.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe id=\"datawrapper-chart-WvZvn\" src=\"//datawrapper.dwcdn.net/WvZvn/1/\" scrolling=\"no\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"100%\" height=\"500\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Dr. Royce Johnson, chief of infectious diseases at Kern Medical Center, said people have long tried to understand what causes spikes in Valley Fever, but with little success.\u003c/p>\n\u003cp>“There are so many variables — temperature, rainfall, humidity, wind — you have to have a pretty fancy computer model to try to study this,” said Johnson, who has been treating Valley Fever since 1975.\u003c/p>\n\u003cp>Although the number of California cases last year were the highest on record, Johnson said, he doubts it was the worst year for “cocci” in history. The infection also surged in the early 1990s, before the state starting following it.\u003c/p>\n\u003cp>Nonetheless, Johnson said 2016 “was a very big year” for Valley Fever in his practice, and many patients came in with the typical symptoms. The disease can be “devastating,” leaving some people disabled or unemployable, he said.\u003c/p>\n\u003cp>If Valley Fever causes severe knee swelling, for example, “you’re not going to build houses or pick grapes or be an auto mechanic,” Johnson said.\u003c/p>\n\u003cp>Juan Perez, 55, who lives in San Diego County, said he’s been unable to work since coming down with the illness, which prompted him to sell his house and sign up for disability payments.\u003c/p>\n\u003cp>Perez believes he contracted Valley Fever in 2014 while working as a power and utilities inspector in the Bakersfield area. His co-workers were digging up pipes that had been buried for 50 or 60 years, and dust was flying everywhere, he said.\u003c/p>\n\u003cp>Soon after, pneumonia-like symptoms set in.\u003c/p>\n\u003cp>“I started feeling exhausted, started having a hard time breathing. I couldn’t sleep at night,” Perez remembers. “My appetite was just not what it used to be.”\u003c/p>\n\u003cp>Perez eventually was hospitalized, and he underwent surgery to remove a mass under his lungs. Now, he says he has chronic fatigue and pain, and he takes medication to keep the fungus at bay. But there is no cure. Even going to the grocery store wears him out, Perez says. “I basically have to hold onto the cart.”\u003c/p>\n\u003cp>Though Valley Fever can be very serious, people are far more likely to be injured in a car wreck than to contract a severe case of the disease, said Larson, the former director of the Valley Fever America Foundation.\u003c/p>\n\u003cp>The organization is trying to build more awareness about the disease. Public understanding of it is still limited, but it has increased significantly in recent years, Larson said.\u003c/p>\n\u003cp>Twenty years ago, no one knew about Valley Fever, but now “there’s a national recognition of it that we never had before,” Larson said. That’s due in part to celebrities such as Los Angeles Dodgers baseball player Brandon Morrow, who has \u003ca href=\"http://www.latimes.com/sports/dodgers/la-sp-dodgers-brandon-morrow-20170703-story.html\" target=\"_blank\" rel=\"noopener noreferrer\">spoken openly\u003c/a> about his protracted battle with the disease.\u003c/p>\n\u003cp>Denise Smith, director of disease control for Kern County’s Public Health Department, said the county has also embarked on a number of public awareness initiatives. It has educated local doctors about it, and recently launched a billboard campaign to inform residents about how to recognize and prevent the illness.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When people get in treatment early, they have better outcomes,” Smith said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The number of Valley Fever cases in California \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CocciEpiSummary2016.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">rose to a record level\u003c/a> in 2016, with 5,372 reported — a jump of 71 percent from the previous year. Historically, about three-quarters of cases have been in the state’s heavily agricultural San Joaquin Valley.\u003c/p>\n\u003cp>The fungal infection, known as coccidioidomycosis, or “cocci,” is most common in the southern portion of the Valley and along the Central Coast of California. State health officials say they’re not sure what caused the recent increase, the largest since 2011, but “climatic and environmental factors” could have increased the risk of exposure to the airborne spores that cause the disease, according to the California Department of Public Health.\u003c/p>\n\u003cp>Climatologists and other researchers have theorized that intensified \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1002/2017GL073524/full\" target=\"_blank\" rel=\"noopener noreferrer\">dust storms\u003c/a> or \u003ca href=\"https://www.scientificamerican.com/article/valley-fever-on-the-rise-in-us-southwest/\" target=\"_blank\" rel=\"noopener noreferrer\">heat waves\u003c/a> linked to global warming can fuel Valley Fever infection. Human activities that stir dust into the air, such as farming and construction, also contribute.\u003c/p>\n\u003cp>An influx of new people in areas where the fungus is most prevalent, along with better reporting of the disease, also may have contributed to the increase, according to the public health department, which has tracked Valley Fever since 1995.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe id=\"datawrapper-chart-1h7jK\" src=\"//datawrapper.dwcdn.net/1h7jK/2/\" scrolling=\"no\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"100%\" height=\"500\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Nationally, \u003ca href=\"https://www.cdc.gov/fungal/diseases/coccidioidomycosis/statistics.html\" target=\"_blank\" rel=\"noopener noreferrer\">more than 11,000 cases\u003c/a> of Valley Fever were reported in 2015, the latest year for which data are available, according to the U.S. Centers for Disease Control and Prevention. That was up from 8,232 cases the previous year. Arizona and California account for the vast majority of cases. In 2015, Arizona had 7,622 cases, the most of any state. California had the second-highest number, with 3,053. Nevada, Utah and New Mexico, among other states, had smaller numbers of Valley Fever cases in 2015.\u003c/p>\n\u003cp>Deaths from Valley Fever averaged 200 a year from 1990 to 2008, according to the CDC. And since 1997, the number of deaths has changed very little from year to year.\u003c/p>\n\u003cp>The California Department of Public Health does not regularly track Valley Fever. But it said a review of death certificates found that 1,098 people in the state died of the disease from 2000 to 2013. The state’s overall incidence rate of Valley Fever in 2016, 13.7 per 100,000 people, was up sharply from the 2015 rate of 8 per 100,000.\u003c/p>\n\u003cp>“We’re horrified but not surprised when the cases increase,” said Sandra Larson, former executive director of the Valley Fever Americas Foundation, who lives just outside Bakersfield, in the San Joaquin Valley. “We’re known as endemic for Valley Fever.”\u003c/p>\n\u003cp>People contract the illness by breathing in tiny spores stirred up from dusty soil. The illness echoes the flu in its symptoms, which can include cough, severe fatigue, fever, headaches and rashes. In many cases, people recover on their own. But the infection can also spread beyond the lungs into other parts of the body, including joints, reproductive organs and teeth. In rare cases it can lead to hospitalization, and even death.\u003c/p>\n\u003cp>Kern County, an agricultural area that encompasses Bakersfield and stretches into the Mojave Desert, had the highest number of cases in 2016, with about 40 percent of the statewide total.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe id=\"datawrapper-chart-WvZvn\" src=\"//datawrapper.dwcdn.net/WvZvn/1/\" scrolling=\"no\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"100%\" height=\"500\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>Dr. Royce Johnson, chief of infectious diseases at Kern Medical Center, said people have long tried to understand what causes spikes in Valley Fever, but with little success.\u003c/p>\n\u003cp>“There are so many variables — temperature, rainfall, humidity, wind — you have to have a pretty fancy computer model to try to study this,” said Johnson, who has been treating Valley Fever since 1975.\u003c/p>\n\u003cp>Although the number of California cases last year were the highest on record, Johnson said, he doubts it was the worst year for “cocci” in history. The infection also surged in the early 1990s, before the state starting following it.\u003c/p>\n\u003cp>Nonetheless, Johnson said 2016 “was a very big year” for Valley Fever in his practice, and many patients came in with the typical symptoms. The disease can be “devastating,” leaving some people disabled or unemployable, he said.\u003c/p>\n\u003cp>If Valley Fever causes severe knee swelling, for example, “you’re not going to build houses or pick grapes or be an auto mechanic,” Johnson said.\u003c/p>\n\u003cp>Juan Perez, 55, who lives in San Diego County, said he’s been unable to work since coming down with the illness, which prompted him to sell his house and sign up for disability payments.\u003c/p>\n\u003cp>Perez believes he contracted Valley Fever in 2014 while working as a power and utilities inspector in the Bakersfield area. His co-workers were digging up pipes that had been buried for 50 or 60 years, and dust was flying everywhere, he said.\u003c/p>\n\u003cp>Soon after, pneumonia-like symptoms set in.\u003c/p>\n\u003cp>“I started feeling exhausted, started having a hard time breathing. I couldn’t sleep at night,” Perez remembers. “My appetite was just not what it used to be.”\u003c/p>\n\u003cp>Perez eventually was hospitalized, and he underwent surgery to remove a mass under his lungs. Now, he says he has chronic fatigue and pain, and he takes medication to keep the fungus at bay. But there is no cure. Even going to the grocery store wears him out, Perez says. “I basically have to hold onto the cart.”\u003c/p>\n\u003cp>Though Valley Fever can be very serious, people are far more likely to be injured in a car wreck than to contract a severe case of the disease, said Larson, the former director of the Valley Fever America Foundation.\u003c/p>\n\u003cp>The organization is trying to build more awareness about the disease. Public understanding of it is still limited, but it has increased significantly in recent years, Larson said.\u003c/p>\n\u003cp>Twenty years ago, no one knew about Valley Fever, but now “there’s a national recognition of it that we never had before,” Larson said. That’s due in part to celebrities such as Los Angeles Dodgers baseball player Brandon Morrow, who has \u003ca href=\"http://www.latimes.com/sports/dodgers/la-sp-dodgers-brandon-morrow-20170703-story.html\" target=\"_blank\" rel=\"noopener noreferrer\">spoken openly\u003c/a> about his protracted battle with the disease.\u003c/p>\n\u003cp>Denise Smith, director of disease control for Kern County’s Public Health Department, said the county has also embarked on a number of public awareness initiatives. It has educated local doctors about it, and recently launched a billboard campaign to inform residents about how to recognize and prevent the illness.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“When people get in treatment early, they have better outcomes,” Smith said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients",
"title": "On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \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\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \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\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Decides All Drinking Water Must Be Tested for a Toxin. But Who Pays?",
"title": "California Decides All Drinking Water Must Be Tested for a Toxin. But Who Pays?",
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"content": "\u003cp>It’s just after 7:30 p.m. on a recent evening as Celerina Chavez finishes the supper dishes in the Kern County home she and her husband Bartolo Chavez have owned for more than two decades. This after-dinner scene is fairly ordinary, except for the water flowing from the kitchen faucet.\u003c/p>\n\u003cp>Here in the small city of Arvin, near Bakersfield, the tap water is tainted with \u003ca href=\"https://www.epa.gov/sites/production/files/2014-03/documents/ffrrofactsheet_contaminant_tcp_january2014_final.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">1,2,3-Trichloropropane\u003c/a> (TCP). It’s a man-made chemical that California has \u003ca href=\"https://oehha.ca.gov/chemicals/123-trichloropropane)\" target=\"_blank\" rel=\"noopener noreferrer\">identified\u003c/a> as a carcinogen.\u003c/p>\n\u003cp>“TCP is actually one of the most toxic chemicals that we’re finding in water,” says Andria Ventura, toxics program manager for the nonprofit \u003ca href=\"https://www.cleanwateraction.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Clean Water Action\u003c/a>. “People should not drink TCP.”\u003c/p>\n\u003cp>But people are drinking it. Statewide, the toxic chemical has contaminated water supplies throughout the state, particularly in the agricultural communities of the Central Valley, where Celerina and Bartolo raised their two daughters, both now away at college.\u003c/p>\n\u003cp>“I would ... give them that water,” Celerina Chavez says. “I didn't know that it was contaminated.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The couple now receives tokens from the water district to receive free filtered water. Their drinking water also contains the toxins arsenic and chromium-6.\u003c/p>\n\u003cp>“But the tokens aren’t enough,” Bartolo Chavez says. “So in addition, we buy bottled water at Costco.”\u003c/p>\n\u003cp>Bartolo works in the juice industry and Celerina is a hotel worker. They pay about $50 a month for the extra bottles — a price they say they can ill afford.\u003c/p>\n\u003cp>[TCP]\u003c/p>\n\u003cp>The \u003ca href=\"https://www.waterboards.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">State Water Resources Control Board\u003c/a> on July 18 \u003ca href=\"https://www.waterboards.ca.gov/press_room/press_releases/2017/pr071817_123tcp.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">adopted\u003c/a> the strictest possible standard (5 parts per trillion or less) for the contaminant in public drinking water. That's the lowest level at which existing technology can detect the chemical and remove it.\u003c/p>\n\u003cp>Statewide, the tap water of about a million Californians is known to contain TCP at levels higher than that, according to \u003ca href=\"http://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/documents/123-tcp/tcp_mcl_presentation.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">data\u003c/a> from the state water board. \u003c/p>\n\u003cp>In California, the contamination is tied to the historic use of industrial solvent. TCP has been found in many urban areas, including Los Angeles, San Bernardino and San Mateo counties.\u003c/p>\n\u003cp>But in the agricultural Central Valley, it’s linked to a type of pesticide once made by two manufacturers, Shell Oil and Dow Chemical.\u003c/p>\n\u003cp>From at least the 1950s into the 1980s, farmers spread the pesticide on fields to kill tiny, soil-dwelling worms that attacked the roots of plants, causing millions of dollars in crop losses.\u003c/p>\n\u003cp>“It is extremely persistent,” says \u003ca href=\"http://rbwaterlaw.com/people/todd-e-robins/\" target=\"_blank\" rel=\"noopener noreferrer\">Todd E. Robins\u003c/a>, a San Francisco attorney representing more than two dozen Central Valley water suppliers that are now suing Shell and Dow for the cost of cleanup.\u003c/p>\n\u003cp>“TCP lasts in the ground and in the groundwater for literally centuries,\" he adds.\u003c/p>\n\u003cp>Starting in January 2018, all public water systems in the state -- more than 4,000 of them -- must test for TCP. If the average of four quarters of sampling shows the chemical exceeding levels of the new limit, the state will require cleanup, says Andrew DiLuccia, spokesman for the water board.\u003c/p>\n\u003cp>And that won’t be cheap.\u003c/p>\n\u003cp>“Currently we have an estimation of approximately a little over $33 million a year,” DiLuccia says. Over the next 20 years, the state estimates $500 million in cleanup may be necessary.\u003c/p>\n\u003cp>“But that could change as more systems begin to test,” he adds.\u003c/p>\n\u003cp>Attorney Robins claims some of the TCP pollution in the agricultural areas of California could have been avoided. According to the lawsuits he has filed, both Shell and Dow knew early on that TCP was \u003cem>not\u003c/em> an active ingredient in the pesticide — rather, it was a different chemical in the pesticide that actually killed the worms.\u003c/p>\n\u003cp>And yet, Robins says, both companies kept putting TCP in their pesticides as a way to get rid of their TCP inventories.\u003c/p>\n\u003cp>“Rather than spending money to dispose of this chemical waste,” Robins explains, “they could put it in barrels and sell it to farmers and have farmers dispose of the chemical waste in soil and in farm fields all around the United States.”\u003c/p>\n\u003cp>Public relations representatives for Shell and Dow wouldn’t comment on whether discarding TCP was a motive for adding it to the pesticides, citing the lawsuits.\u003c/p>\n\u003cp>Dow spokesman Jarrod Erpelding released a statement saying:\u003c/p>\n\u003cblockquote>\u003cp>\"TCP was a trace constituent associated with highly beneficial agricultural product formulations, which have not been on the market for several decades, that controlled pests that otherwise would have caused millions of dollars in annual crop losses. TCP is also associated with products that Dow did not manufacture or sell and with certain industrial processes in which Dow had no involvement. All regulations should be predicated on sound science, and the MCL [Maximum Contaminant Level] for TCP is no different.\"\u003c/p>\u003c/blockquote>\n\u003cp>Shell representatives emailed a statement:\u003c/p>\n\u003cblockquote>\u003cp>“The former Shell agricultural product, last manufactured more than 30 years ago, contained trace amounts of 1,2,3 trichloropropane (TCP). It was used to control microscopic worms that attacked crops causing millions of dollars a year of crop loss for farmers, and was approved for use by the U.S. government and the State of California.”\u003c/p>\u003c/blockquote>\n\u003cp>Many of the hardest-hit California communities are rural, with small water districts that won't be able to afford the cleanup costs. Among them is the water supplier for the city where the Chavez family lives: Arvin, on the outskirts of Bakersfield in Kern County.\u003c/p>\n\u003cp>“It’s something that’s going to place a humongous burden on the residents of Arvin,” says Raul Barraza Jr., general manager of the Arvin Community Services District. “You’re talking about very complex treatment ... each water system has its completely own personality.”\u003c/p>\n\u003cp>Barraza says water suppliers will have to decide whether to treat TCP on-site or whether to pipe the contaminated water to a central treatment facility. In either case, Barraza says, they’ll likely be running it through a granular activated carbon filter, much like a Brita filter placed in a pitcher of water – only a lot bigger.\u003c/p>\n\u003cp>“They’re generally 20,000-pound vessels,” says Lisa Koehn, assistant public utilities director for the city of Clovis, near Fresno. “And they’re about 12 foot in diameter, about 20 feet tall.” And costly to operate, she says.\u003c/p>\n\u003cp>Clovis recently settled a lawsuit against Dow Chemical for $7.5 million. The city also won a jury verdict in its favor after suing Shell Oil, then settled with the company for $15 million, says David J. Wolfe, city attorney for Clovis.\u003c/p>\n\u003cp>Koehn cautions that the settlement monies aren't likely to cover all the costs of cleanup. To do that, she says, taxpayer-funded grants and higher water fees will likely be needed.\u003c/p>\n\u003cp>The state attorney general’s office would not comment on whether it’s also pursuing legal action against the companies.\u003c/p>\n\u003cp>Robins, meanwhile, says none of this had to happen.\u003c/p>\n\u003cp>“The real tragedy is the active ingredient in these products was extremely effective,” he says. “It broke down into harmless byproducts in a matter of days after these products were injected into the soil.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"excerpt": "The state's recent decision to regulate 1,2,3-Trichloropropane means all local drinking water agencies will have to test for the carcinogen starting in 2018. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It’s just after 7:30 p.m. on a recent evening as Celerina Chavez finishes the supper dishes in the Kern County home she and her husband Bartolo Chavez have owned for more than two decades. This after-dinner scene is fairly ordinary, except for the water flowing from the kitchen faucet.\u003c/p>\n\u003cp>Here in the small city of Arvin, near Bakersfield, the tap water is tainted with \u003ca href=\"https://www.epa.gov/sites/production/files/2014-03/documents/ffrrofactsheet_contaminant_tcp_january2014_final.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">1,2,3-Trichloropropane\u003c/a> (TCP). It’s a man-made chemical that California has \u003ca href=\"https://oehha.ca.gov/chemicals/123-trichloropropane)\" target=\"_blank\" rel=\"noopener noreferrer\">identified\u003c/a> as a carcinogen.\u003c/p>\n\u003cp>“TCP is actually one of the most toxic chemicals that we’re finding in water,” says Andria Ventura, toxics program manager for the nonprofit \u003ca href=\"https://www.cleanwateraction.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Clean Water Action\u003c/a>. “People should not drink TCP.”\u003c/p>\n\u003cp>But people are drinking it. Statewide, the toxic chemical has contaminated water supplies throughout the state, particularly in the agricultural communities of the Central Valley, where Celerina and Bartolo raised their two daughters, both now away at college.\u003c/p>\n\u003cp>“I would ... give them that water,” Celerina Chavez says. “I didn't know that it was contaminated.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The couple now receives tokens from the water district to receive free filtered water. Their drinking water also contains the toxins arsenic and chromium-6.\u003c/p>\n\u003cp>“But the tokens aren’t enough,” Bartolo Chavez says. “So in addition, we buy bottled water at Costco.”\u003c/p>\n\u003cp>Bartolo works in the juice industry and Celerina is a hotel worker. They pay about $50 a month for the extra bottles — a price they say they can ill afford.\u003c/p>\n\u003cp>[TCP]\u003c/p>\n\u003cp>The \u003ca href=\"https://www.waterboards.ca.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">State Water Resources Control Board\u003c/a> on July 18 \u003ca href=\"https://www.waterboards.ca.gov/press_room/press_releases/2017/pr071817_123tcp.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">adopted\u003c/a> the strictest possible standard (5 parts per trillion or less) for the contaminant in public drinking water. That's the lowest level at which existing technology can detect the chemical and remove it.\u003c/p>\n\u003cp>Statewide, the tap water of about a million Californians is known to contain TCP at levels higher than that, according to \u003ca href=\"http://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/documents/123-tcp/tcp_mcl_presentation.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">data\u003c/a> from the state water board. \u003c/p>\n\u003cp>In California, the contamination is tied to the historic use of industrial solvent. TCP has been found in many urban areas, including Los Angeles, San Bernardino and San Mateo counties.\u003c/p>\n\u003cp>But in the agricultural Central Valley, it’s linked to a type of pesticide once made by two manufacturers, Shell Oil and Dow Chemical.\u003c/p>\n\u003cp>From at least the 1950s into the 1980s, farmers spread the pesticide on fields to kill tiny, soil-dwelling worms that attacked the roots of plants, causing millions of dollars in crop losses.\u003c/p>\n\u003cp>“It is extremely persistent,” says \u003ca href=\"http://rbwaterlaw.com/people/todd-e-robins/\" target=\"_blank\" rel=\"noopener noreferrer\">Todd E. Robins\u003c/a>, a San Francisco attorney representing more than two dozen Central Valley water suppliers that are now suing Shell and Dow for the cost of cleanup.\u003c/p>\n\u003cp>“TCP lasts in the ground and in the groundwater for literally centuries,\" he adds.\u003c/p>\n\u003cp>Starting in January 2018, all public water systems in the state -- more than 4,000 of them -- must test for TCP. If the average of four quarters of sampling shows the chemical exceeding levels of the new limit, the state will require cleanup, says Andrew DiLuccia, spokesman for the water board.\u003c/p>\n\u003cp>And that won’t be cheap.\u003c/p>\n\u003cp>“Currently we have an estimation of approximately a little over $33 million a year,” DiLuccia says. Over the next 20 years, the state estimates $500 million in cleanup may be necessary.\u003c/p>\n\u003cp>“But that could change as more systems begin to test,” he adds.\u003c/p>\n\u003cp>Attorney Robins claims some of the TCP pollution in the agricultural areas of California could have been avoided. According to the lawsuits he has filed, both Shell and Dow knew early on that TCP was \u003cem>not\u003c/em> an active ingredient in the pesticide — rather, it was a different chemical in the pesticide that actually killed the worms.\u003c/p>\n\u003cp>And yet, Robins says, both companies kept putting TCP in their pesticides as a way to get rid of their TCP inventories.\u003c/p>\n\u003cp>“Rather than spending money to dispose of this chemical waste,” Robins explains, “they could put it in barrels and sell it to farmers and have farmers dispose of the chemical waste in soil and in farm fields all around the United States.”\u003c/p>\n\u003cp>Public relations representatives for Shell and Dow wouldn’t comment on whether discarding TCP was a motive for adding it to the pesticides, citing the lawsuits.\u003c/p>\n\u003cp>Dow spokesman Jarrod Erpelding released a statement saying:\u003c/p>\n\u003cblockquote>\u003cp>\"TCP was a trace constituent associated with highly beneficial agricultural product formulations, which have not been on the market for several decades, that controlled pests that otherwise would have caused millions of dollars in annual crop losses. TCP is also associated with products that Dow did not manufacture or sell and with certain industrial processes in which Dow had no involvement. All regulations should be predicated on sound science, and the MCL [Maximum Contaminant Level] for TCP is no different.\"\u003c/p>\u003c/blockquote>\n\u003cp>Shell representatives emailed a statement:\u003c/p>\n\u003cblockquote>\u003cp>“The former Shell agricultural product, last manufactured more than 30 years ago, contained trace amounts of 1,2,3 trichloropropane (TCP). It was used to control microscopic worms that attacked crops causing millions of dollars a year of crop loss for farmers, and was approved for use by the U.S. government and the State of California.”\u003c/p>\u003c/blockquote>\n\u003cp>Many of the hardest-hit California communities are rural, with small water districts that won't be able to afford the cleanup costs. Among them is the water supplier for the city where the Chavez family lives: Arvin, on the outskirts of Bakersfield in Kern County.\u003c/p>\n\u003cp>“It’s something that’s going to place a humongous burden on the residents of Arvin,” says Raul Barraza Jr., general manager of the Arvin Community Services District. “You’re talking about very complex treatment ... each water system has its completely own personality.”\u003c/p>\n\u003cp>Barraza says water suppliers will have to decide whether to treat TCP on-site or whether to pipe the contaminated water to a central treatment facility. In either case, Barraza says, they’ll likely be running it through a granular activated carbon filter, much like a Brita filter placed in a pitcher of water – only a lot bigger.\u003c/p>\n\u003cp>“They’re generally 20,000-pound vessels,” says Lisa Koehn, assistant public utilities director for the city of Clovis, near Fresno. “And they’re about 12 foot in diameter, about 20 feet tall.” And costly to operate, she says.\u003c/p>\n\u003cp>Clovis recently settled a lawsuit against Dow Chemical for $7.5 million. The city also won a jury verdict in its favor after suing Shell Oil, then settled with the company for $15 million, says David J. Wolfe, city attorney for Clovis.\u003c/p>\n\u003cp>Koehn cautions that the settlement monies aren't likely to cover all the costs of cleanup. To do that, she says, taxpayer-funded grants and higher water fees will likely be needed.\u003c/p>\n\u003cp>The state attorney general’s office would not comment on whether it’s also pursuing legal action against the companies.\u003c/p>\n\u003cp>Robins, meanwhile, says none of this had to happen.\u003c/p>\n\u003cp>“The real tragedy is the active ingredient in these products was extremely effective,” he says. “It broke down into harmless byproducts in a matter of days after these products were injected into the soil.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, which publishes \u003ca href=\"http://californiahealthline.org/\" target=\"_blank\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\" target=\"_blank\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sighs of Relief From Health Safety-Net Providers in California After Senate Bill Collapses",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Health care workers at California hospitals and clinics that serve low-income patients are relieved but still wary after the collapse of the Senate Republican health care bill earlier this week.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">The bill proposed deep funding cuts to Medicaid, which is called Medi-Cal in California and covers one out of three state residents. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.cbo.gov/publication/52941\" target=\"_blank\" rel=\"noopener noreferrer\">Congressional Budget Office (CBO) analysis\u003c/a> predicted the latest version of the Senate bill\u003c/span>\u003cspan style=\"font-weight: 400\"> would result in 15 million people losing insurance coverage next year and 22 million by 2026. But it would reduce the federal deficit by $420 billion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There has also been discussion of reviving a bill to repeal the Affordable Care Act (ACA) outright, without a plan to replace it. But that could be difficult because the \u003ca href=\"https://www.cbo.gov/publication/52939\" target=\"_blank\" rel=\"noopener noreferrer\">CBO estimated\u003c/a> that “repeal only” would lead to a whopping 32 million Americans without insurance by 2026.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal in California\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since the implementation of the ACA and the subsequent expansion of who qualifies for Medi-Cal, safety-net providers across the state have increased their capacity to treat more patients, and have hired more staff and improved outreach programs and infrastructure. This growth is possible because clinics are getting more reimbursements for their work treating people who were uninsured before the ACA.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When the ACA was implemented, states were given the choice to expand Medicaid eligibility to those making less than 138 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\" rel=\"noopener noreferrer\">federal poverty level\u003c/a>. California, along with 30 other states, adopted this expansion.\u003c/p>\n\u003cp>\u003cb>Here's How it Affects Real Californians:\u003c/b>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\u003cul>\n\u003cli>The number of people on Medi-Cal is \u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">13.5 million as of January 2017\u003c/a>. Of those, 3.8 million got this coverage through the ACA expansion.\u003c/li>\n\u003cli>\u003ca href=\"http://calbudgetcenter.org/resources/republican-plans-end-medicaid-know-threaten-medi-cal-coverage-benefits-millions-californians/\" target=\"_blank\" rel=\"noopener noreferrer\">Half\u003c/a> of \u003ca href=\"http://www.dof.ca.gov/Forecasting/Demographics/Projections/documents/P_PressRelease.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">California's kids\u003c/a> are on Medi-Cal.\u003c/li>\n\u003cli>\u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">One out of three California residents\u003c/a> is on Medi-Cal.\u003c/li>\n\u003cli>Medi-Cal covers \u003ca href=\"http://www.kff.org/infographic/medicaids-role-in-nursing-home-care/\" target=\"_blank\" rel=\"noopener noreferrer\">62 percent of seniors in nursing homes\u003c/a>.\u003c/li>\n\u003cli>The uninsured rate has dropped sharply. Before the ACA, \u003ca href=\"http://www.chcf.org/publications/2016/12/californias-uninsured\" target=\"_blank\" rel=\"noopener noreferrer\">16 percent\u003c/a> of Californians had no coverage. As of 2016, that number shrunk to \u003ca href=\"https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">7.4 percent\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What Was on the Chopping Block\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Both the House of Representatives' American Health Care Act (AHCA) and the Senate Republicans' Better Care Reconciliation Act (BCRA) proposed a hard annual limit on the amount of federal dollars Medi-Cal recipients would get, no matter how much treatment they would need.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Since Medi-Cal is funded by both the state and federal government, less federal money \u003c/span>\u003cspan style=\"font-weight: 400\">would compel states to either make up those dollars or make cuts to current programs. With the collapse of the BCRA, states won't need to think about those difficult decisions for the time being.\u003c/span>\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/RDnews/2017/07/ACHAcollapsereax.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26032_IMG_67441-qut.jpg\" Title=\"Breathing Sigh of Relief, Safety-Net Providers Hold onto Gains for Now\" program=\"State of Health\"]\u003c/p>\n\u003cp>\u003cb>'The threat is still there for our patients'\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Tiburcio Vasquez Health Center\u003c/a> (TVHC) in Hayward and Union City, and \u003ca href=\"http://zuckerbergsanfranciscogeneral.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Zuckerberg San Francisco General Hospital\u003c/a> have traditionally served low-income patients, regardless of their ability to pay. Before the ACA, the majority of their patients were uninsured, but now that’s reversed, and most patients arrive with Medi-Cal coverage or private insurance purchased with ACA subsidies on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California.\u003c/a>\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those additional insurance dollars have been the difference between scraping by and being able to make significant improvements.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Safety-net delivery systems are traditionally very poorly resourced,\" said Dr. Alice Chen, chief medical officer for the \u003ca href=\"http://www.sfhealthnetwork.org/\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Health Network\u003c/a>, an affiliate of Zuckerberg SF General. \"We've invested the new revenues that have come in for Medicaid patients into improving our systems of care.\" She says her network has brought in $150 million in new revenues from the Medicaid expansion.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">With those dollars, Chen says SF General, where she is based, has been implementing a new electronic health record system, and is working on initiatives to integrate mental and medical health and improve the patient's overall experience. Work like this, she says, wouldn't be possible without the additional resources from Medicaid dollars.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Medical students and residents at the University of California, San Francisco also said they were tentatively happy that it appears the ACA will remain in place. Dr. Emily Thomas is a UCSF resident who has been politically active since the 2016 election. She’s fighting to keep her patients insured through the ACA. She spoke to a crowd of doctors at SF General on Tuesday, explaining why she wanted the advocacy to continue. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Even though the BCRA has collapsed at the Senate, the threat is still there for our patients,” Thomas said. “Our patients are still relying on everyone in this room to continue to advocate for their expanded access to care.”\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Across the bay, at Tiburcio Vasquez Health Center, CEO David Vliet says his clinic has increased the number of patients it can serve due to the Medicaid expansion dollars. In addition to their existing clinics in Hayward, Union City and Fremont, health center administrators have built a $12 million facility with 22 exam rooms.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Regarding the additional Medicaid money, Vliet emphasized that \"those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs.\"\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Vliet said now that changes to the ACA are on hold, he's temporarily relieved. But he will still continue to monitor what's happening in Washington, D.C. If the increased funding continues to flow through Medi-Cal, Vliet says he would like to continue to expand services over the next few years to even more residents in the East Bay. Even after all the growth, TVHC staffers are working at capacity. There are still patients in the community waiting to be seen. \u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Adding to his concern, there is a chance Senate Republicans will revive the stalled health plan and push it through, which is what happened this spring in the House of Representatives.\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Health care workers at California hospitals and clinics that serve low-income patients are relieved but still wary after the collapse of the Senate Republican health care bill earlier this week.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">The bill proposed deep funding cuts to Medicaid, which is called Medi-Cal in California and covers one out of three state residents. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.cbo.gov/publication/52941\" target=\"_blank\" rel=\"noopener noreferrer\">Congressional Budget Office (CBO) analysis\u003c/a> predicted the latest version of the Senate bill\u003c/span>\u003cspan style=\"font-weight: 400\"> would result in 15 million people losing insurance coverage next year and 22 million by 2026. But it would reduce the federal deficit by $420 billion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There has also been discussion of reviving a bill to repeal the Affordable Care Act (ACA) outright, without a plan to replace it. But that could be difficult because the \u003ca href=\"https://www.cbo.gov/publication/52939\" target=\"_blank\" rel=\"noopener noreferrer\">CBO estimated\u003c/a> that “repeal only” would lead to a whopping 32 million Americans without insurance by 2026.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal in California\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since the implementation of the ACA and the subsequent expansion of who qualifies for Medi-Cal, safety-net providers across the state have increased their capacity to treat more patients, and have hired more staff and improved outreach programs and infrastructure. This growth is possible because clinics are getting more reimbursements for their work treating people who were uninsured before the ACA.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When the ACA was implemented, states were given the choice to expand Medicaid eligibility to those making less than 138 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\" rel=\"noopener noreferrer\">federal poverty level\u003c/a>. California, along with 30 other states, adopted this expansion.\u003c/p>\n\u003cp>\u003cb>Here's How it Affects Real Californians:\u003c/b>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\u003cul>\n\u003cli>The number of people on Medi-Cal is \u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">13.5 million as of January 2017\u003c/a>. Of those, 3.8 million got this coverage through the ACA expansion.\u003c/li>\n\u003cli>\u003ca href=\"http://calbudgetcenter.org/resources/republican-plans-end-medicaid-know-threaten-medi-cal-coverage-benefits-millions-californians/\" target=\"_blank\" rel=\"noopener noreferrer\">Half\u003c/a> of \u003ca href=\"http://www.dof.ca.gov/Forecasting/Demographics/Projections/documents/P_PressRelease.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">California's kids\u003c/a> are on Medi-Cal.\u003c/li>\n\u003cli>\u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">One out of three California residents\u003c/a> is on Medi-Cal.\u003c/li>\n\u003cli>Medi-Cal covers \u003ca href=\"http://www.kff.org/infographic/medicaids-role-in-nursing-home-care/\" target=\"_blank\" rel=\"noopener noreferrer\">62 percent of seniors in nursing homes\u003c/a>.\u003c/li>\n\u003cli>The uninsured rate has dropped sharply. Before the ACA, \u003ca href=\"http://www.chcf.org/publications/2016/12/californias-uninsured\" target=\"_blank\" rel=\"noopener noreferrer\">16 percent\u003c/a> of Californians had no coverage. As of 2016, that number shrunk to \u003ca href=\"https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">7.4 percent\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What Was on the Chopping Block\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Both the House of Representatives' American Health Care Act (AHCA) and the Senate Republicans' Better Care Reconciliation Act (BCRA) proposed a hard annual limit on the amount of federal dollars Medi-Cal recipients would get, no matter how much treatment they would need.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Since Medi-Cal is funded by both the state and federal government, less federal money \u003c/span>\u003cspan style=\"font-weight: 400\">would compel states to either make up those dollars or make cuts to current programs. With the collapse of the BCRA, states won't need to think about those difficult decisions for the time being.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cb>'The threat is still there for our patients'\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Tiburcio Vasquez Health Center\u003c/a> (TVHC) in Hayward and Union City, and \u003ca href=\"http://zuckerbergsanfranciscogeneral.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Zuckerberg San Francisco General Hospital\u003c/a> have traditionally served low-income patients, regardless of their ability to pay. Before the ACA, the majority of their patients were uninsured, but now that’s reversed, and most patients arrive with Medi-Cal coverage or private insurance purchased with ACA subsidies on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California.\u003c/a>\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those additional insurance dollars have been the difference between scraping by and being able to make significant improvements.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Safety-net delivery systems are traditionally very poorly resourced,\" said Dr. Alice Chen, chief medical officer for the \u003ca href=\"http://www.sfhealthnetwork.org/\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Health Network\u003c/a>, an affiliate of Zuckerberg SF General. \"We've invested the new revenues that have come in for Medicaid patients into improving our systems of care.\" She says her network has brought in $150 million in new revenues from the Medicaid expansion.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">With those dollars, Chen says SF General, where she is based, has been implementing a new electronic health record system, and is working on initiatives to integrate mental and medical health and improve the patient's overall experience. Work like this, she says, wouldn't be possible without the additional resources from Medicaid dollars.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Medical students and residents at the University of California, San Francisco also said they were tentatively happy that it appears the ACA will remain in place. Dr. Emily Thomas is a UCSF resident who has been politically active since the 2016 election. She’s fighting to keep her patients insured through the ACA. She spoke to a crowd of doctors at SF General on Tuesday, explaining why she wanted the advocacy to continue. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Even though the BCRA has collapsed at the Senate, the threat is still there for our patients,” Thomas said. “Our patients are still relying on everyone in this room to continue to advocate for their expanded access to care.”\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Across the bay, at Tiburcio Vasquez Health Center, CEO David Vliet says his clinic has increased the number of patients it can serve due to the Medicaid expansion dollars. In addition to their existing clinics in Hayward, Union City and Fremont, health center administrators have built a $12 million facility with 22 exam rooms.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Regarding the additional Medicaid money, Vliet emphasized that \"those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs.\"\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Vliet said now that changes to the ACA are on hold, he's temporarily relieved. But he will still continue to monitor what's happening in Washington, D.C. If the increased funding continues to flow through Medi-Cal, Vliet says he would like to continue to expand services over the next few years to even more residents in the East Bay. Even after all the growth, TVHC staffers are working at capacity. There are still patients in the community waiting to be seen. \u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Adding to his concern, there is a chance Senate Republicans will revive the stalled health plan and push it through, which is what happened this spring in the House of Representatives.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown",
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"content": "\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">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/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">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/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
"title": "Close All Tabs",
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"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"meta": {
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"id": "freakonomics-radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/4s8b",
"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"rss": "https://feeds.npr.org/510313/podcast.xml"
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
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"source": "kqed",
"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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"rss": "https://feeds.megaphone.fm/KQINC2275451163"
}
},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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"source": "npr"
},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
"apple": "https://podcasts.apple.com/podcast/id1567098962",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"rss": "https://feeds.npr.org/510360/podcast.xml"
}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
"meta": {
"site": "news",
"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
"id": "perspectives",
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