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"bio": "April Dembosky is the health correspondent for KQED News and a regular contributor to NPR. She specializes in covering altered states of mind, from postpartum depression to methamphetamine-induced psychosis to the insanity defense. Her investigative series on insurance companies sidestepping mental health laws won multiple awards, including first place in beat reporting from the national Association of Health Care Journalists. She is the recipient of numerous other prizes and fellowships, including a national Edward R. Murrow award for investigative reporting, a Society of Professional Journalists award for long-form storytelling, and a Carter Center Fellowship for Mental Health Journalism.\r\n\r\nDembosky reported and produced \u003cem>Soundtrack of Silence\u003c/em>, an audio documentary about music and memory that is currently being made into a feature film by Paramount Pictures.\r\n\r\nBefore joining KQED in 2013, Dembosky covered technology and Silicon Valley for \u003cem>The Financial Times of London,\u003c/em> and contributed business and arts stories to \u003cem>Marketplace \u003c/em>and \u003cem>The New York Times.\u003c/em> She got her undergraduate degree in philosophy from Smith College and her master's in journalism from the University of California, Berkeley. She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.",
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"content": "\u003cp>Aaron Albaugh peers out from under the brim of his cowboy hat, surveying the acres of hay fields in front of him. The fourth-generation \u003ca href=\"http://www.frostyacres.net/index.html\">rancher\u003c/a> is raising about 450 cattle this year, in this remote corner of Lassen County.\u003c/p>\n\u003cp>His closest neighbor lives a half mile away. “And that’s my brother,” Albaugh says.\u003c/p>\n\u003cp>“If I want to go see a movie, it’s 70 miles round trip,” he adds. “If I want to go bowling, that’s 100 miles round trip.”\u003c/p>\n\u003cp>Living a half day’s drive from civilization, you learn to do without, he explains. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.\u003c/p>\n\u003cp>“Put a Band Aid on it,” Albaugh says. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So, when people are already used to doing without health coverage, it’s particularly annoying to have the government say you have to buy it, according to Albaugh and many of his neighbors in Lassen, Modoc and Shasta Counties.\u003c/p>\n\u003cp>While Obamacare is largely viewed as a success in California – the state marketplace, \u003ca href=\"http://www.coveredca.com/\">Covered California\u003c/a>, is one of the most financially stable in the country – it hasn’t worked as well for folks in this rural northeast corner of the state.\u003c/p>\n\u003cp>There are two insurers selling plans in each county here, but residents say that hasn’t created enough competition to bring down prices. Plus, a lot of the doctors they’re used to seeing don’t take the marketplace plans.\u003c/p>\n\u003cp>“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” says Modoc County resident Althia Cline, who decided to forego coverage – and a surgery she needed for her asthma.\u003c/p>\n\u003cp>Just like the movie theater and bowling alley, most medical specialists are miles away. In Modoc County, there’s nowhere to have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half away from home.\u003c/p>\n\u003cp>Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.\u003c/p>\n\u003cfigure id=\"attachment_353608\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-353608 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Tessa-front-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tessa Anklin says Covered California health plans are too expensive for her family. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Two years ago, they bought a plan through Covered California. With a subsidy, they paid just $2 a month for their premium, but their deductible was $10,000.\u003c/p>\n\u003cp>“We paid for all of our medical services and our prescriptions,” she says. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”\u003c/p>\n\u003cp>Then, last year, their monthly premium jumped to $600. The plan was the same, Anklin says, and their household income was the same. But they still faced the same hour and a half drive to see doctors they almost never needed.*\u003c/p>\n\u003cp>Anklin thought of all the other ways she could spend that money.\u003c/p>\n\u003cp>“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she says. “That’s a big difference, when you think about how little you actually use the health coverage.”\u003c/p>\n\u003cp>That’s the reason she decided to cancel her health plan this year and go without. But she’ll still have to pay a penalty when the next tax season comes around.\u003c/p>\n\u003cp>“It basically penalizes us one way or the other because we can’t afford the coverage,” she says. “So that’s kind of difficult, to be that middle-class person.”\u003c/p>\n\u003cp>Anklin says she’d be happy to see Republicans get rid of Obamacare.\u003c/p>\n\u003cp>“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck when they’re already trying to survive with what they have,” she says. “It should be an option.”\u003c/p>\n\u003cp>But the Republican repeal and replace plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the GOP plan, according to a recent \u003ca href=\"http://www.kff.org/health-reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/\">analysis\u003c/a> from the Kaiser Family Foundation. Anklin could end up paying more than $2,000 a month for coverage, according to Kaiser’s \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\">county-by-county projections\u003c/a>.\u003c/p>\n\u003cp>That’s not what she had in mind for a fix.\u003c/p>\n\u003cp>“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin says.\u003c/p>\n\u003cp>With the Republican bill now in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.\u003c/p>\n\u003cp>Democrats have also said if the Republican bill fails, they’d be willing to \u003ca href=\"https://www.statnews.com/2017/07/05/health-care-compromise/\">work together on solutions\u003c/a>, but it’s not clear the parties could agree on one that would help people like Anklin.\u003c/p>\n\u003cp>If they can’t, she says she has no choice but to continue to go without coverage. Financially it makes sense in the short term, but it still worries her.\u003c/p>\n\u003cp>“If I ever have a problem,” she says, “I know I will be paying for the rest of my life.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/07/2017-07-11b-tcr.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Aaron-car-768x576.jpg\" Title=\"Rural Californians Want Price Relief From GOP Health Bill – But Most Won’t Get It\" program=\"The California Report\"]\u003c/p>\n\u003cp>\u003cem>*Premiums in this region of the state went up an average of 10.6 percent in 2016, according to Covered California’s \u003ca href=\"http://www.coveredca.com/news/\" target=\"_blank\" rel=\"noopener noreferrer\">rate booklet\u003c/a>, and most premium increases are matched with an increase in subsidy, so the most likely explanation for why Anklin’s premium jumped this much is that she lost her subsidy. This can happen if customers, intentionally or unintentionally, do not check a box on their application form that allows the federal government to verify their income, or, if customers do not file tax returns.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Aaron Albaugh peers out from under the brim of his cowboy hat, surveying the acres of hay fields in front of him. The fourth-generation \u003ca href=\"http://www.frostyacres.net/index.html\">rancher\u003c/a> is raising about 450 cattle this year, in this remote corner of Lassen County.\u003c/p>\n\u003cp>His closest neighbor lives a half mile away. “And that’s my brother,” Albaugh says.\u003c/p>\n\u003cp>“If I want to go see a movie, it’s 70 miles round trip,” he adds. “If I want to go bowling, that’s 100 miles round trip.”\u003c/p>\n\u003cp>Living a half day’s drive from civilization, you learn to do without, he explains. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.\u003c/p>\n\u003cp>“Put a Band Aid on it,” Albaugh says. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So, when people are already used to doing without health coverage, it’s particularly annoying to have the government say you have to buy it, according to Albaugh and many of his neighbors in Lassen, Modoc and Shasta Counties.\u003c/p>\n\u003cp>While Obamacare is largely viewed as a success in California – the state marketplace, \u003ca href=\"http://www.coveredca.com/\">Covered California\u003c/a>, is one of the most financially stable in the country – it hasn’t worked as well for folks in this rural northeast corner of the state.\u003c/p>\n\u003cp>There are two insurers selling plans in each county here, but residents say that hasn’t created enough competition to bring down prices. Plus, a lot of the doctors they’re used to seeing don’t take the marketplace plans.\u003c/p>\n\u003cp>“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” says Modoc County resident Althia Cline, who decided to forego coverage – and a surgery she needed for her asthma.\u003c/p>\n\u003cp>Just like the movie theater and bowling alley, most medical specialists are miles away. In Modoc County, there’s nowhere to have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half away from home.\u003c/p>\n\u003cp>Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.\u003c/p>\n\u003cfigure id=\"attachment_353608\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-353608 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Tessa-front-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tessa Anklin says Covered California health plans are too expensive for her family. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Two years ago, they bought a plan through Covered California. With a subsidy, they paid just $2 a month for their premium, but their deductible was $10,000.\u003c/p>\n\u003cp>“We paid for all of our medical services and our prescriptions,” she says. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”\u003c/p>\n\u003cp>Then, last year, their monthly premium jumped to $600. The plan was the same, Anklin says, and their household income was the same. But they still faced the same hour and a half drive to see doctors they almost never needed.*\u003c/p>\n\u003cp>Anklin thought of all the other ways she could spend that money.\u003c/p>\n\u003cp>“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she says. “That’s a big difference, when you think about how little you actually use the health coverage.”\u003c/p>\n\u003cp>That’s the reason she decided to cancel her health plan this year and go without. But she’ll still have to pay a penalty when the next tax season comes around.\u003c/p>\n\u003cp>“It basically penalizes us one way or the other because we can’t afford the coverage,” she says. “So that’s kind of difficult, to be that middle-class person.”\u003c/p>\n\u003cp>Anklin says she’d be happy to see Republicans get rid of Obamacare.\u003c/p>\n\u003cp>“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck when they’re already trying to survive with what they have,” she says. “It should be an option.”\u003c/p>\n\u003cp>But the Republican repeal and replace plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the GOP plan, according to a recent \u003ca href=\"http://www.kff.org/health-reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/\">analysis\u003c/a> from the Kaiser Family Foundation. Anklin could end up paying more than $2,000 a month for coverage, according to Kaiser’s \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\">county-by-county projections\u003c/a>.\u003c/p>\n\u003cp>That’s not what she had in mind for a fix.\u003c/p>\n\u003cp>“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin says.\u003c/p>\n\u003cp>With the Republican bill now in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.\u003c/p>\n\u003cp>Democrats have also said if the Republican bill fails, they’d be willing to \u003ca href=\"https://www.statnews.com/2017/07/05/health-care-compromise/\">work together on solutions\u003c/a>, but it’s not clear the parties could agree on one that would help people like Anklin.\u003c/p>\n\u003cp>If they can’t, she says she has no choice but to continue to go without coverage. Financially it makes sense in the short term, but it still worries her.\u003c/p>\n\u003cp>“If I ever have a problem,” she says, “I know I will be paying for the rest of my life.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>*Premiums in this region of the state went up an average of 10.6 percent in 2016, according to Covered California’s \u003ca href=\"http://www.coveredca.com/news/\" target=\"_blank\" rel=\"noopener noreferrer\">rate booklet\u003c/a>, and most premium increases are matched with an increase in subsidy, so the most likely explanation for why Anklin’s premium jumped this much is that she lost her subsidy. This can happen if customers, intentionally or unintentionally, do not check a box on their application form that allows the federal government to verify their income, or, if customers do not file tax returns.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Latino Medi-Cal patients are suing the state, alleging the health program for low-income Californians is a separate and unequal system of health care.\u003c/p>\n\u003cp>Because the majority of Medi-Cal patients are Latino – 7.2 million out of 13 million total enrollees – the \u003ca href=\"http://www.seiu-uhw.org/wp-content/blogs.dir/166/files/2016/07/Medi-Cal-Complaint-2017-07-12.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lawsuit\u003c/a> alleges that delays in access to care, and denials of care, amount to civil rights violations.\u003c/p>\n\u003cp>“Medi-Cal participants suffer from greater pain, illness, and undiagnosed and untreated serious medical conditions—with significant impact to their overall health—than do their fellow Californians with other insurance,” the complaint says.\u003c/p>\n\u003cp>That’s been true for Gloria de Jesus, 16, who waited months to see a neurologist after being diagnosed with epilepsy. Her brother, Andrew, often lands in the emergency room because he can’t get his asthma prescription filled on time. Their mother, Rebecca Binsfeld, says she can’t find a pediatrician in Sacramento who takes their Medi-Cal coverage.\u003c/p>\n\u003cp>“They gave me a booklet, and in the booklet it has hundreds of doctors’ names and numbers, but you call and they’re not accepting new patients,” she says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Binsfeld, who suffers from lupus, waited 10 months to see a rheumatologist (she’s supposed to see one every four months), and a year to see an ophthalmologist (she’s supposed to go every six months, to check for blindness associated with her medications). The delays in care led to several lupus flares, episodes during which Binsfeld experiences extreme fatigue, pain in her joints, and headaches. Repeated flares can cause organ damage or kidney disease.\u003c/p>\n\u003cp>“I just want better health care. I want to be able to call the doctor if I’m not feeling well and to be able to be seen,” Binsfeld says. “I want everybody else on Medi-Cal to be treated the same as those that have private insurance.”\u003c/p>\n\u003cp>The lawsuit alleges several shortcomings in the Medi-Cal program that lead to these delays, namely “extremely low” reimbursement rates and burdensome paperwork that forces doctors to limit the number of low-income patients they see.\u003c/p>\n\u003cp>“As the number of Latinos has grown in the program, the state has cut funding,” says Darin Ranahan, an attorney from the Oakland law firm \u003ca href=\"http://feinbergjackson.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Feinberg, Jackson, Worthman and Wasow\u003c/a>, representing the plaintiffs. “Simply put, if you disinvest from a program as it’s coming to serve more and more people of color, that’s a form of race discrimination.”\u003c/p>\n\u003cp>The state is also failing to adequately monitor the program and ensure that patients are being seen in a timely manner, Ranahan says. For example, state regulations require patients to get urgent care within 48 hours, primary care within 10 days, and specialty appointments within 15 days.\u003c/p>\n\u003cp>“What we’ve seen, repeatedly, is people on Medi-Cal are not able to get appointments within these times,” Ranahan says.\u003c/p>\n\u003cp>The state Department of Health Care Services countered, saying it routinely monitors patient access to care in the Medi-Cal program, and that neither the state, nor federal health officials, had identified any systemic problems.\u003c/p>\n\u003cp>Beyond that, the state said it's position on the allegations was outlined in \u003ca href=\"///Users/aprildembosky/Downloads/AG%20Response%20Letter%205.10.16.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">a letter\u003c/a> the state attorney general wrote last year, after health advocates and union representatives from SEIU filed \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/15/advocates-allege-medi-cal-violates-latinos-civil-rights/\" target=\"_blank\" rel=\"noopener noreferrer\">a similar complaint\u003c/a> with the U.S. Department of Health and Human Services Office for Civil Rights in December 2015.\u003c/p>\n\u003cp>The letter says the state's reimbursement rates have been thoroughly reviewed and approved by federal officials, and that rates are uniform for all providers and patients. It says Latino beneficiaries are treated the same as all Medi-Cal beneficiaries.\u003c/p>\n\u003cp>“We work hard to serve all beneficiaries equally,” Jennifer Kent, director of the Department of Health Care Services, said in a 2015 statement responding to the original complaint. “We are committed to serving all vulnerable populations with vital health services.”\u003c/p>\n\u003cp>The department also cited a \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/publications/downloadable/BSCF%20Delivering%20Promise%20Full%20Report%20Web.pdf\">January 2015 survey\u003c/a> by the Blue Shield of California Foundation that showed satisfaction gaps between whites and Latinos, which were identified in 2011, have been eliminated or dramatically narrowed. Overall satisfaction with Medi-Cal was 90 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Federal officials did not act on the original complaint, and advocates say that’s why they are now filing the lawsuit directly against the state.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Latino Medi-Cal patients are suing the state, alleging the health program for low-income Californians is a separate and unequal system of health care.\u003c/p>\n\u003cp>Because the majority of Medi-Cal patients are Latino – 7.2 million out of 13 million total enrollees – the \u003ca href=\"http://www.seiu-uhw.org/wp-content/blogs.dir/166/files/2016/07/Medi-Cal-Complaint-2017-07-12.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">lawsuit\u003c/a> alleges that delays in access to care, and denials of care, amount to civil rights violations.\u003c/p>\n\u003cp>“Medi-Cal participants suffer from greater pain, illness, and undiagnosed and untreated serious medical conditions—with significant impact to their overall health—than do their fellow Californians with other insurance,” the complaint says.\u003c/p>\n\u003cp>That’s been true for Gloria de Jesus, 16, who waited months to see a neurologist after being diagnosed with epilepsy. Her brother, Andrew, often lands in the emergency room because he can’t get his asthma prescription filled on time. Their mother, Rebecca Binsfeld, says she can’t find a pediatrician in Sacramento who takes their Medi-Cal coverage.\u003c/p>\n\u003cp>“They gave me a booklet, and in the booklet it has hundreds of doctors’ names and numbers, but you call and they’re not accepting new patients,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Binsfeld, who suffers from lupus, waited 10 months to see a rheumatologist (she’s supposed to see one every four months), and a year to see an ophthalmologist (she’s supposed to go every six months, to check for blindness associated with her medications). The delays in care led to several lupus flares, episodes during which Binsfeld experiences extreme fatigue, pain in her joints, and headaches. Repeated flares can cause organ damage or kidney disease.\u003c/p>\n\u003cp>“I just want better health care. I want to be able to call the doctor if I’m not feeling well and to be able to be seen,” Binsfeld says. “I want everybody else on Medi-Cal to be treated the same as those that have private insurance.”\u003c/p>\n\u003cp>The lawsuit alleges several shortcomings in the Medi-Cal program that lead to these delays, namely “extremely low” reimbursement rates and burdensome paperwork that forces doctors to limit the number of low-income patients they see.\u003c/p>\n\u003cp>“As the number of Latinos has grown in the program, the state has cut funding,” says Darin Ranahan, an attorney from the Oakland law firm \u003ca href=\"http://feinbergjackson.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Feinberg, Jackson, Worthman and Wasow\u003c/a>, representing the plaintiffs. “Simply put, if you disinvest from a program as it’s coming to serve more and more people of color, that’s a form of race discrimination.”\u003c/p>\n\u003cp>The state is also failing to adequately monitor the program and ensure that patients are being seen in a timely manner, Ranahan says. For example, state regulations require patients to get urgent care within 48 hours, primary care within 10 days, and specialty appointments within 15 days.\u003c/p>\n\u003cp>“What we’ve seen, repeatedly, is people on Medi-Cal are not able to get appointments within these times,” Ranahan says.\u003c/p>\n\u003cp>The state Department of Health Care Services countered, saying it routinely monitors patient access to care in the Medi-Cal program, and that neither the state, nor federal health officials, had identified any systemic problems.\u003c/p>\n\u003cp>Beyond that, the state said it's position on the allegations was outlined in \u003ca href=\"///Users/aprildembosky/Downloads/AG%20Response%20Letter%205.10.16.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">a letter\u003c/a> the state attorney general wrote last year, after health advocates and union representatives from SEIU filed \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/12/15/advocates-allege-medi-cal-violates-latinos-civil-rights/\" target=\"_blank\" rel=\"noopener noreferrer\">a similar complaint\u003c/a> with the U.S. Department of Health and Human Services Office for Civil Rights in December 2015.\u003c/p>\n\u003cp>The letter says the state's reimbursement rates have been thoroughly reviewed and approved by federal officials, and that rates are uniform for all providers and patients. It says Latino beneficiaries are treated the same as all Medi-Cal beneficiaries.\u003c/p>\n\u003cp>“We work hard to serve all beneficiaries equally,” Jennifer Kent, director of the Department of Health Care Services, said in a 2015 statement responding to the original complaint. “We are committed to serving all vulnerable populations with vital health services.”\u003c/p>\n\u003cp>The department also cited a \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/publications/downloadable/BSCF%20Delivering%20Promise%20Full%20Report%20Web.pdf\">January 2015 survey\u003c/a> by the Blue Shield of California Foundation that showed satisfaction gaps between whites and Latinos, which were identified in 2011, have been eliminated or dramatically narrowed. Overall satisfaction with Medi-Cal was 90 percent.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Federal officials did not act on the original complaint, and advocates say that’s why they are now filing the lawsuit directly against the state.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "In Rural California, This New Addiction Treatment Is Being Ignored -- by the Doctors",
"title": "In Rural California, This New Addiction Treatment Is Being Ignored -- by the Doctors",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>If you want to quit heroin and you live in Quincy, California, a small pioneer town up in the Northern Sierra Nevada mountains, you’ll probably go see Dr. Mark Satterfield.\u003c/p>\n\u003cp>As far as he knows, Dr. Satterfield is the only health care provider in Plumas County who is able and willing to treat heroin users with buprenorphine, a medication that has become the new standard of care in fighting opioid addiction.\u003c/p>\n\u003cfigure id=\"attachment_353727\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-353727\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Quincy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Downtown Quincy, California.\u003c/figcaption>\u003c/figure>\n\u003cp>Before Satterfield started prescribing buprenorphine late last year, anyone seeking treatment had to travel a long way to a clinic in a more urban setting. The one in Chico is a 1½- hour drive down a windy canyon road, which can be closed off during bad weather.\u003c/p>\n\u003cp>So Satterfield, 65, embarked on a pilot program to provide medication-assisted treatment for heroin users and those with other addictions. Satterfield, Plumas County’s public health officer, squeezed the program in between his other duties, including shifts as an emergency physician at a local hospital.\u003c/p>\n\u003cp>“The need is great, and we had a sense it was not going to be easy to get other providers to do it,” said Satterfield, a tall man with delicate rimmed glasses, who has lived in the region for 28 years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Unlike methadone, which is only dispensed at substance abuse treatment facilities and requires daily visits from patients, buprenorphine can be prescribed by any local doctor who has a special license. The patient can take the medication at home.\u003c/p>\n\u003cp>The California Department of Health Care Services hopes buprenorphine will become much more widely available under a new \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=W1eCmud6DtHf6F2ciFehwsOa-Lf2xOaEtColIuEDqGwzJ7i09MjUCA..&URL=http%3a%2f%2fwww.dhcs.ca.gov%2fformsandpubs%2fpublications%2fopa%2fDocuments%2f17-01%2520SAMHSA%2520MAT%2520Grant%2520FINAL.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$90 million dollar federal\u003c/a> grant to combat opioid misuse and expand access to addiction.\u003c/p>\n\u003cp>But many health care providers in Plumas and other rural areas of California have thus far not taken the steps required to offer the addiction treatment. Because buprenorphine is itself an opioid, doctors who want to prescribe it for addiction must get eight hours of training and register with the federal Drug Enforcement Agency.\u003c/p>\n\u003cp>James Wilson, health education coordinator with Plumas County, is working as the lead coordinator for the Northern Sierra Opioid Safety Coalition. He said he has reached out to about 30 doctors in Plumas and surrounding counties ,to ask them to get authorized to offer buprenorphine. He got a lot of “nos.”\u003c/p>\n\u003cp>“For the most part, they kind of recognize the need for medication-assisted addiction treatment -- but they don’t necessarily want to be the doctors themselves that are doing it,” Wilson said.\u003c/p>\n\u003cp>Wilson said doctors or their office staffers have told him they don’t want people withdrawing from heroin or other drugs sitting in their waiting rooms, or that they are uncomfortable with the drug-seeking behaviors of that clientele.\u003c/p>\n\u003cp>That doesn’t surprise Dr. David Kan, president-elect of the California Society of Addiction Medicine.\u003c/p>\n\u003cp>“Most physicians don’t see [treating addiction] as part of their regular and routine practice,” said Kan, adding that many health care providers can’t identify the signs of addiction in a patient.\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/07/2017-07-13e-tcr.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Satterfield_patientsmall-768x512.jpg\" Title=\"In Rural California, This New Addiction Treatment Is Being Ignored -- by the Doctors\" program=\"The California Report\"]\u003c/p>\n\u003cp>A spokesperson for the California Medical Association said some physicians fear being overwhelmed by patients if they start treating addiction. Treatment also involves a good bit of coordination, such as linking patients to other services such as mental health treatment and case management.\u003c/p>\n\u003cp>That’s one of the reasons a local hospital system in Plumas County hasn’t incorporated buprenorphine into its in-house services.\u003c/p>\n\u003cp>Lindsey Morrison, care coordinator at Plumas District Hospital, said that for a few hours a month, an out-of-town physician is available via telemedicine to treat chronic pain patients addicted to prescription opioids. But the rural health system doesn’t have the time or resources to start prescribing buprenorphine to heroin users.\u003c/p>\n\u003cp>“That’s a really difficult population to work with,” said Morrison, adding that they don’t have the necessary mental health care providers and staffers to work with those patients.\u003c/p>\n\u003cp>Even if a handful of the hospital’s doctors got the training to provide buprenorphine, Morrison said “it would be like… 'Oh my god, we have a ton of work ahead of us, we got to hire more people to help with these services!'”\u003c/p>\n\u003cp>A \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=EwnaTcFvGhNZbHF-Ixw-DRgQV32IWTS-7CiyVZaVJ_ozJ7i09MjUCA..&URL=http%3a%2f%2fkhn.org%2fnews%2famount-of-opioids-prescribed-in-u-s-has-been-falling-since-2010%2f\" target=\"_blank\" rel=\"noopener noreferrer\">recent study \u003c/a>by the Centers for Disease Control and Prevention suggests Northern California doctors’ were prescribing painkillers at higher-than-average rates. In rural counties like Plumas, the rates far exceed those seen in the rest of California. More prescriptions were written in Plumas in 2015 than there were people in the county, according to California Department of Public Health \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=ZEm8Va8AOA3fXLWs-VHDmFu28svb9LiHZ2u4vAR_rrIzJ7i09MjUCA..&URL=https%3a%2f%2fpdop.shinyapps.io%2fODdash_v1%2f\">data.\u003c/a>\u003c/p>\n\u003cp>Although Plumas county is sparsely populated, it also has one of \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=ZEm8Va8AOA3fXLWs-VHDmFu28svb9LiHZ2u4vAR_rrIzJ7i09MjUCA..&URL=https%3a%2f%2fpdop.shinyapps.io%2fODdash_v1%2f\">the highest rates of opioid-related\u003c/a> deaths in the state.\u003c/p>\n\u003cp>State health officials say they hope the federal grant to combat opioid abuse will help expand treatment options and bump up the state’s overall use of buprenorphine as a treatment, \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=bmd9kdJyhZkWZei-TJRIKaaN05es5NlFSeYVV39Ae34zJ7i09MjUCA..&URL=http%3a%2f%2fcaliforniamethadone.org%2fwp-content%2fuploads%2f2017%2f02%2fCOMP-PDF.pdf\">which is low compared\u003c/a> to the rest of the U.S.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Satterfield said he would be glad if just one more doctor in his area got trained to treat addiction in this way – he said it’s a tough, but rewarding, job.\u003c/p>\n\n",
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"nprByline": "\u003cstrong> \u003ca href=\"http://californiahealthline.org/news/author/pauline-bartolone/\" target=\"_blank\">Pauline Bartolone\u003c/a>\u003c/strong>\u003c/br>California Healthline",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you want to quit heroin and you live in Quincy, California, a small pioneer town up in the Northern Sierra Nevada mountains, you’ll probably go see Dr. Mark Satterfield.\u003c/p>\n\u003cp>As far as he knows, Dr. Satterfield is the only health care provider in Plumas County who is able and willing to treat heroin users with buprenorphine, a medication that has become the new standard of care in fighting opioid addiction.\u003c/p>\n\u003cfigure id=\"attachment_353727\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-353727\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Quincy-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/Quincy-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Downtown Quincy, California.\u003c/figcaption>\u003c/figure>\n\u003cp>Before Satterfield started prescribing buprenorphine late last year, anyone seeking treatment had to travel a long way to a clinic in a more urban setting. The one in Chico is a 1½- hour drive down a windy canyon road, which can be closed off during bad weather.\u003c/p>\n\u003cp>So Satterfield, 65, embarked on a pilot program to provide medication-assisted treatment for heroin users and those with other addictions. Satterfield, Plumas County’s public health officer, squeezed the program in between his other duties, including shifts as an emergency physician at a local hospital.\u003c/p>\n\u003cp>“The need is great, and we had a sense it was not going to be easy to get other providers to do it,” said Satterfield, a tall man with delicate rimmed glasses, who has lived in the region for 28 years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Unlike methadone, which is only dispensed at substance abuse treatment facilities and requires daily visits from patients, buprenorphine can be prescribed by any local doctor who has a special license. The patient can take the medication at home.\u003c/p>\n\u003cp>The California Department of Health Care Services hopes buprenorphine will become much more widely available under a new \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=W1eCmud6DtHf6F2ciFehwsOa-Lf2xOaEtColIuEDqGwzJ7i09MjUCA..&URL=http%3a%2f%2fwww.dhcs.ca.gov%2fformsandpubs%2fpublications%2fopa%2fDocuments%2f17-01%2520SAMHSA%2520MAT%2520Grant%2520FINAL.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">$90 million dollar federal\u003c/a> grant to combat opioid misuse and expand access to addiction.\u003c/p>\n\u003cp>But many health care providers in Plumas and other rural areas of California have thus far not taken the steps required to offer the addiction treatment. Because buprenorphine is itself an opioid, doctors who want to prescribe it for addiction must get eight hours of training and register with the federal Drug Enforcement Agency.\u003c/p>\n\u003cp>James Wilson, health education coordinator with Plumas County, is working as the lead coordinator for the Northern Sierra Opioid Safety Coalition. He said he has reached out to about 30 doctors in Plumas and surrounding counties ,to ask them to get authorized to offer buprenorphine. He got a lot of “nos.”\u003c/p>\n\u003cp>“For the most part, they kind of recognize the need for medication-assisted addiction treatment -- but they don’t necessarily want to be the doctors themselves that are doing it,” Wilson said.\u003c/p>\n\u003cp>Wilson said doctors or their office staffers have told him they don’t want people withdrawing from heroin or other drugs sitting in their waiting rooms, or that they are uncomfortable with the drug-seeking behaviors of that clientele.\u003c/p>\n\u003cp>That doesn’t surprise Dr. David Kan, president-elect of the California Society of Addiction Medicine.\u003c/p>\n\u003cp>“Most physicians don’t see [treating addiction] as part of their regular and routine practice,” said Kan, adding that many health care providers can’t identify the signs of addiction in a patient.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A spokesperson for the California Medical Association said some physicians fear being overwhelmed by patients if they start treating addiction. Treatment also involves a good bit of coordination, such as linking patients to other services such as mental health treatment and case management.\u003c/p>\n\u003cp>That’s one of the reasons a local hospital system in Plumas County hasn’t incorporated buprenorphine into its in-house services.\u003c/p>\n\u003cp>Lindsey Morrison, care coordinator at Plumas District Hospital, said that for a few hours a month, an out-of-town physician is available via telemedicine to treat chronic pain patients addicted to prescription opioids. But the rural health system doesn’t have the time or resources to start prescribing buprenorphine to heroin users.\u003c/p>\n\u003cp>“That’s a really difficult population to work with,” said Morrison, adding that they don’t have the necessary mental health care providers and staffers to work with those patients.\u003c/p>\n\u003cp>Even if a handful of the hospital’s doctors got the training to provide buprenorphine, Morrison said “it would be like… 'Oh my god, we have a ton of work ahead of us, we got to hire more people to help with these services!'”\u003c/p>\n\u003cp>A \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=EwnaTcFvGhNZbHF-Ixw-DRgQV32IWTS-7CiyVZaVJ_ozJ7i09MjUCA..&URL=http%3a%2f%2fkhn.org%2fnews%2famount-of-opioids-prescribed-in-u-s-has-been-falling-since-2010%2f\" target=\"_blank\" rel=\"noopener noreferrer\">recent study \u003c/a>by the Centers for Disease Control and Prevention suggests Northern California doctors’ were prescribing painkillers at higher-than-average rates. In rural counties like Plumas, the rates far exceed those seen in the rest of California. More prescriptions were written in Plumas in 2015 than there were people in the county, according to California Department of Public Health \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=ZEm8Va8AOA3fXLWs-VHDmFu28svb9LiHZ2u4vAR_rrIzJ7i09MjUCA..&URL=https%3a%2f%2fpdop.shinyapps.io%2fODdash_v1%2f\">data.\u003c/a>\u003c/p>\n\u003cp>Although Plumas county is sparsely populated, it also has one of \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=ZEm8Va8AOA3fXLWs-VHDmFu28svb9LiHZ2u4vAR_rrIzJ7i09MjUCA..&URL=https%3a%2f%2fpdop.shinyapps.io%2fODdash_v1%2f\">the highest rates of opioid-related\u003c/a> deaths in the state.\u003c/p>\n\u003cp>State health officials say they hope the federal grant to combat opioid abuse will help expand treatment options and bump up the state’s overall use of buprenorphine as a treatment, \u003ca href=\"https://tely2.kqed.org/owa/redir.aspx?C=bmd9kdJyhZkWZei-TJRIKaaN05es5NlFSeYVV39Ae34zJ7i09MjUCA..&URL=http%3a%2f%2fcaliforniamethadone.org%2fwp-content%2fuploads%2f2017%2f02%2fCOMP-PDF.pdf\">which is low compared\u003c/a> to the rest of the U.S.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Satterfield said he would be glad if just one more doctor in his area got trained to treat addiction in this way – he said it’s a tough, but rewarding, job.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Half of Nursing Homes Scrutinized on Safety Still Treacherous",
"title": "Half of Nursing Homes Scrutinized on Safety Still Treacherous",
"headTitle": "Kaiser Health News | State of Health | KQED News",
"content": "\u003cp>In 2012, Parkview Healthcare Center’s history of safety violations led California regulators to issue an ultimatum reserved for the most dangerous nursing homes.\u003c/p>\n\u003cp>The state’s public health department designated Parkview, a Bakersfield, Calif., nursing home, a “special focus facility,” requiring it to either fix lapses in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive. After 15 months of scrutiny, the regulators deemed Parkview improved and released it from extra oversight.\u003c/p>\n\u003cp>But a few months later, Elaine Fisher, a 74-year-old who had lost the use of her legs after a stroke, slid out of her wheelchair at Parkview. Afterward, the nursing home promised to place a nonskid pad on her chair but did not, inspectors later found. Twice more, Fisher slipped from her wheelchair, fracturing her hip the final time.\u003c/p>\n\u003cp>The violation drew a $10,000 penalty for Parkview, one of 10 fines totaling $126,300 incurred by the nursing home since the special focus status was lifted in 2014.\u003c/p>\n\u003cp>While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to a Kaiser Health News analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>These nursing homes are in 46 states. Some gave patients the wrong medications, failed to protect them from violent or bullying residents and staff members, or neglected to tell families or physicians about injuries, inspection records show. Years after regulators conferred clean bills of health, levels of registered nurses tend to remain lower than at other facilities.\u003c/p>\n\u003cp>Yet, despite recurrences of patient harm, nursing homes are rarely denied Medicare and Medicaid reimbursement. Consequences can be dire for patients like Fisher.\u003c/p>\n\u003cp>“She used to go to bingo every day and she was very involved in the nursing home,” said her son-in-law, Eric Powers. He said that although Fisher moved to a different nursing home for better care, “after this whole thing, she has to be on painkillers. She’s mainly in her room all the time. It’s the saddest thing in the world.”\u003c/p>\n\u003cp>Parkview’s owner at the time of the violations, LifeHouse Health Services, did not respond to requests for comment. Dr. David Silver, who purchased Parkview last fall, said he had replaced top management and staff members who resisted a new approach.\u003c/p>\n\u003cp>“We were not happy with the level of patient care,” he said.\u003c/p>\n\u003cp>Regulators rarely return homes to the watch list, instead issuing fines for subsequent lapses. Some homes continue operating despite multiple penalties.\u003c/p>\n\u003cp>“When you’re looking at these large corporations, that’s just the cost of doing business,” said Neil Gehlawat, who is representing Fisher in her pending lawsuit against Parkview. “It doesn’t have the effect of changing behavior.”\u003c/p>\n\u003cp>\u003cstrong>‘Worst Of The Worst’\u003c/strong>\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services, or CMS, sets the federal standards for nursing homes and determines whether they are in compliance, based on inspections performed primarily by state health departments. States license facilities and have the authority to revoke the licenses.\u003c/p>\n\u003cp>Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The federal government assigns each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.\u003c/p>\n\u003cp>More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts negotiated by President Barack Obama and Congress. This year, the $2.6 million budget allows only 88 nursing homes to \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-20.pdf\">receive the designation\u003c/a>, though regulators identified 435 as warranting scrutiny. California and Texas each has six slots, the most of any state. Twenty-nine states have just one.\u003c/p>\n\u003cp>Especially troubling is that more than a third of operating nursing facilities that graduated from the watch list before 2014 still hold the lowest possible Medicare rating for health and safety: one star of five, KHN’s analysis found.\u003c/p>\n\u003cp>“You have this recidivism of nursing homes that are special focus facilities,” said Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan. “These are the worst of the worst and they’re back?”\u003c/p>\n\u003cp>CMS defended the program, saying that nursing homes on the watch list showed more improvement than did comparably struggling facilities not selected for enhanced supervision. “CMS continues to work to improve oversight to prevent any facility from regressing in performance,” the statement said.\u003c/p>\n\u003cfigure id=\"attachment_351140\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-351140\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg\" alt=\"Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-520x346.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo.jpg 1540w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators. \u003ccite>(Doug Kapustin/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Short-Term Oversight\u003c/strong>\u003c/p>\n\u003cp>Special scrutiny was lifted for about one-fourth of the nursing homes in less than a year. Facilities need to pass only two consecutive inspections without major violations or substantiated complaints.\u003c/p>\n\u003cp>“The period of time is just not long enough for them to show that they can sustain improvement,” said Robyn Grant, director for public policy at the National Consumer Voice for Quality Long-Term Care in Washington. “There needs to be some significant changes in the program.”\u003c/p>\n\u003cp>In 2010, NMS Healthcare of Hagerstown, Md., left the watch list after 10 months.\u003c/p>\n\u003cp>Last year, Maryland’s attorney general \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\">sued the facility and its owner,\u003c/a> Neiswanger Management Services, \u003ca href=\"http://www.marylandattorneygeneral.gov/Press/2016/122116.pdf\">alleging that they evicted\u003c/a> frail, infirm and mentally disabled residents “with brutal indifference” when their health coverage ran out or the facility had the opportunity to get someone with better insurance.\u003c/p>\n\u003cp>Among those was Andrew Edwards, who was told by NMS that he was being discharged to an assisted-living center, according to the lawsuit. Instead, in January 2016, the staff sent him to a crowded, unlicensed Baltimore City row house where the owner confiscated his bank card and withdrew $966 over his objections, the lawsuit said. Although NMS said it had arranged for his outpatient kidney dialysis, “that was false,” Edwards said in an interview. He ended up in an emergency room after he missed his treatment.\u003c/p>\n\u003cp>NMS maintains it stopped referring patients to that owner when told of the conditions. This month, CMS expelled the Hagerstown nursing home from Medicare and Medicaid after citing it for more violations. The company is closing the facility. NMS, which still runs other homes in Maryland, has sued state regulators, claiming they are vindictively trying to drive the chain out of business.\u003c/p>\n\u003cp>\u003cstrong>Few Terminations\u003c/strong>\u003c/p>\n\u003cp>Some nursing homes on the watch list do maintain improvements. After Evergreen Nursing Home in southern Alabama was designated a special focus facility in 2005, the owners brought in new managers and added nursing supervisors, said Kimberly Bush, the facility’s administrator.\u003c/p>\n\u003cp>Medicare now rates Evergreen a five-star facility. “I’d like to say there’s some kind of magic recipe to this, but it’s just doing the job and holding people accountable,” Bush said.\u003c/p>\n\u003cp>But even prolonged supervision does not guarantee progress. Poplar Point Health and Rehabilitation in Memphis stayed on the watch list for 2½ years until 2009. A \u003ca href=\"https://www.justice.gov/opa/pr/united-states-files-false-claims-act-complaint-against-six-vanguard-nursing-facilities-and\">federal lawsuit brought last year\u003c/a> claims that Poplar and its owner, Vanguard Healthcare, regularly provided “nonexistent, grossly substandard, worthless care” as far back as 2010. Vanguard, now in bankruptcy court, declined to comment.\u003c/p>\n\u003cp>\u003cem>(Story continues below.)\u003c/em>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/Sfw8o/12/\" scrolling=\"yes\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"600\" height=\"600\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The ultimate enforcement threats are termination from Medicare and Medicaid or closure by state or federal authorities. But only 17 percent of former special focus facilities are no longer operating, and that can include ones that went out of business for unrelated reasons, KHN found.\u003c/p>\n\u003cp>State regulators are reluctant to close nursing homes because of the upheaval it causes patients and families. In some areas, there are no alternative facilities nearby, making termination even less appealing.\u003c/p>\n\u003cp>“At the end of the day, there are those centers that cannot be corrected, can’t fix themselves, and the best thing for the patients and the residents might be for them to move to another location,” said Lyn Bentley, an executive at the American Health Care Association, a nursing facility trade group. But, she said, “it’s always difficult to close someone’s home.”\u003c/p>\n\u003cp>\u003cstrong>Lack Of Nurses\u003c/strong>\u003c/p>\n\u003cp>Too few nurses, particularly registered nurses, provide care at some of the most troubled homes, KHN’s analysis shows. Registered nurse staffing was still 12 percent lower than at other facilities, even three years after the homes were released from the watch list.\u003c/p>\n\u003cp>In 2009, Pennsylvania health regulators released Golden LivingCenter-West Shore in Camp Hill after 17 months of supervision. The company said in a recent statement that when a home was put on that list, “we mobilize the resources necessary to help get that LivingCenter back into compliance.”\u003c/p>\n\u003cp>But data from Medicare’s Nursing Home Compare website show the facility has among the worst nurse-to-patient staffing ratios in the nation, with registered nurses devoting an average of 12 minutes for each patient daily. The state average is 58 minutes daily per patient.\u003c/p>\n\u003cp>Golden LivingCenter-West Shore was fined $59,150 in 2015 after being cited for, among other violations, allowing a resident’s feeding tube to become infested with maggots, records show. Also, Golden Living agreed to pay $750,000 to settle three cases involving patient injuries from falls that occurred after extra oversight ended, court records show.\u003c/p>\n\u003cp>Last year, Golden Living sold its Pennsylvania homes to Priority Healthcare Group.\u003c/p>\n\u003cp>Priority is following a common strategy for shedding an unwanted reputation: changing the facility’s name. In California, Parkview — where Fisher slipped out of her wheelchair — is being rebranded too, as Kingston Healthcare Center.\u003c/p>\n\u003cp>[ad floatright]\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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"excerpt": "Nursing homes that have graduated from an unsafe status by Medicare and are still operating have harmed patients.",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/jordan-rau/\" target=\"_blank\">Jordan Rau\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In 2012, Parkview Healthcare Center’s history of safety violations led California regulators to issue an ultimatum reserved for the most dangerous nursing homes.\u003c/p>\n\u003cp>The state’s public health department designated Parkview, a Bakersfield, Calif., nursing home, a “special focus facility,” requiring it to either fix lapses in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive. After 15 months of scrutiny, the regulators deemed Parkview improved and released it from extra oversight.\u003c/p>\n\u003cp>But a few months later, Elaine Fisher, a 74-year-old who had lost the use of her legs after a stroke, slid out of her wheelchair at Parkview. Afterward, the nursing home promised to place a nonskid pad on her chair but did not, inspectors later found. Twice more, Fisher slipped from her wheelchair, fracturing her hip the final time.\u003c/p>\n\u003cp>The violation drew a $10,000 penalty for Parkview, one of 10 fines totaling $126,300 incurred by the nursing home since the special focus status was lifted in 2014.\u003c/p>\n\u003cp>While special focus status is one of the federal government’s strictest forms of oversight, nursing homes that were forced to undergo such scrutiny often slide back into providing dangerous care, according to a Kaiser Health News analysis of federal health inspection data. Of 528 nursing homes that graduated from special focus status before 2014 and are still operating, slightly more than half — 52 percent — have since harmed patients or put patients in serious jeopardy within the past three years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>These nursing homes are in 46 states. Some gave patients the wrong medications, failed to protect them from violent or bullying residents and staff members, or neglected to tell families or physicians about injuries, inspection records show. Years after regulators conferred clean bills of health, levels of registered nurses tend to remain lower than at other facilities.\u003c/p>\n\u003cp>Yet, despite recurrences of patient harm, nursing homes are rarely denied Medicare and Medicaid reimbursement. Consequences can be dire for patients like Fisher.\u003c/p>\n\u003cp>“She used to go to bingo every day and she was very involved in the nursing home,” said her son-in-law, Eric Powers. He said that although Fisher moved to a different nursing home for better care, “after this whole thing, she has to be on painkillers. She’s mainly in her room all the time. It’s the saddest thing in the world.”\u003c/p>\n\u003cp>Parkview’s owner at the time of the violations, LifeHouse Health Services, did not respond to requests for comment. Dr. David Silver, who purchased Parkview last fall, said he had replaced top management and staff members who resisted a new approach.\u003c/p>\n\u003cp>“We were not happy with the level of patient care,” he said.\u003c/p>\n\u003cp>Regulators rarely return homes to the watch list, instead issuing fines for subsequent lapses. Some homes continue operating despite multiple penalties.\u003c/p>\n\u003cp>“When you’re looking at these large corporations, that’s just the cost of doing business,” said Neil Gehlawat, who is representing Fisher in her pending lawsuit against Parkview. “It doesn’t have the effect of changing behavior.”\u003c/p>\n\u003cp>\u003cstrong>‘Worst Of The Worst’\u003c/strong>\u003c/p>\n\u003cp>The Centers for Medicare & Medicaid Services, or CMS, sets the federal standards for nursing homes and determines whether they are in compliance, based on inspections performed primarily by state health departments. States license facilities and have the authority to revoke the licenses.\u003c/p>\n\u003cp>Special focus facility status is reserved for the poorest-performing facilities out of more than 15,000 skilled nursing homes. The federal government assigns each state a set number of slots, roughly based on the number of nursing homes. Then state health regulators pick which nursing homes to include.\u003c/p>\n\u003cp>More than 900 facilities have been placed on the watch list since 2005. But the number of nursing homes under special focus at any given time has dropped by nearly half since 2012, because of federal budget cuts negotiated by President Barack Obama and Congress. This year, the $2.6 million budget allows only 88 nursing homes to \u003ca href=\"https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-20.pdf\">receive the designation\u003c/a>, though regulators identified 435 as warranting scrutiny. California and Texas each has six slots, the most of any state. Twenty-nine states have just one.\u003c/p>\n\u003cp>Especially troubling is that more than a third of operating nursing facilities that graduated from the watch list before 2014 still hold the lowest possible Medicare rating for health and safety: one star of five, KHN’s analysis found.\u003c/p>\n\u003cp>“You have this recidivism of nursing homes that are special focus facilities,” said Richard Mollot, executive director of the Long Term Care Community Coalition, an advocacy group in Manhattan. “These are the worst of the worst and they’re back?”\u003c/p>\n\u003cp>CMS defended the program, saying that nursing homes on the watch list showed more improvement than did comparably struggling facilities not selected for enhanced supervision. “CMS continues to work to improve oversight to prevent any facility from regressing in performance,” the statement said.\u003c/p>\n\u003cfigure id=\"attachment_351140\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-351140\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg\" alt=\"Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-1180x786.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo-520x346.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/20nursinghomes3-superjumbo.jpg 1540w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Edwards is among the patients who were harmed by nursing homes that had earlier been given a clean bill of health by Medicare and health regulators. \u003ccite>(Doug Kapustin/Kaiser Health News)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Short-Term Oversight\u003c/strong>\u003c/p>\n\u003cp>Special scrutiny was lifted for about one-fourth of the nursing homes in less than a year. Facilities need to pass only two consecutive inspections without major violations or substantiated complaints.\u003c/p>\n\u003cp>“The period of time is just not long enough for them to show that they can sustain improvement,” said Robyn Grant, director for public policy at the National Consumer Voice for Quality Long-Term Care in Washington. “There needs to be some significant changes in the program.”\u003c/p>\n\u003cp>In 2010, NMS Healthcare of Hagerstown, Md., left the watch list after 10 months.\u003c/p>\n\u003cp>Last year, Maryland’s attorney general \u003ca href=\"http://www.marylandattorneygeneral.gov/News%20Documents/State_v_NMS_Complaint.pdf\">sued the facility and its owner,\u003c/a> Neiswanger Management Services, \u003ca href=\"http://www.marylandattorneygeneral.gov/Press/2016/122116.pdf\">alleging that they evicted\u003c/a> frail, infirm and mentally disabled residents “with brutal indifference” when their health coverage ran out or the facility had the opportunity to get someone with better insurance.\u003c/p>\n\u003cp>Among those was Andrew Edwards, who was told by NMS that he was being discharged to an assisted-living center, according to the lawsuit. Instead, in January 2016, the staff sent him to a crowded, unlicensed Baltimore City row house where the owner confiscated his bank card and withdrew $966 over his objections, the lawsuit said. Although NMS said it had arranged for his outpatient kidney dialysis, “that was false,” Edwards said in an interview. He ended up in an emergency room after he missed his treatment.\u003c/p>\n\u003cp>NMS maintains it stopped referring patients to that owner when told of the conditions. This month, CMS expelled the Hagerstown nursing home from Medicare and Medicaid after citing it for more violations. The company is closing the facility. NMS, which still runs other homes in Maryland, has sued state regulators, claiming they are vindictively trying to drive the chain out of business.\u003c/p>\n\u003cp>\u003cstrong>Few Terminations\u003c/strong>\u003c/p>\n\u003cp>Some nursing homes on the watch list do maintain improvements. After Evergreen Nursing Home in southern Alabama was designated a special focus facility in 2005, the owners brought in new managers and added nursing supervisors, said Kimberly Bush, the facility’s administrator.\u003c/p>\n\u003cp>Medicare now rates Evergreen a five-star facility. “I’d like to say there’s some kind of magic recipe to this, but it’s just doing the job and holding people accountable,” Bush said.\u003c/p>\n\u003cp>But even prolonged supervision does not guarantee progress. Poplar Point Health and Rehabilitation in Memphis stayed on the watch list for 2½ years until 2009. A \u003ca href=\"https://www.justice.gov/opa/pr/united-states-files-false-claims-act-complaint-against-six-vanguard-nursing-facilities-and\">federal lawsuit brought last year\u003c/a> claims that Poplar and its owner, Vanguard Healthcare, regularly provided “nonexistent, grossly substandard, worthless care” as far back as 2010. Vanguard, now in bankruptcy court, declined to comment.\u003c/p>\n\u003cp>\u003cem>(Story continues below.)\u003c/em>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"//datawrapper.dwcdn.net/Sfw8o/12/\" scrolling=\"yes\" frameborder=\"0\" allowtransparency=\"true\" allowfullscreen=\"allowfullscreen\" webkitallowfullscreen=\"webkitallowfullscreen\" mozallowfullscreen=\"mozallowfullscreen\" oallowfullscreen=\"oallowfullscreen\" msallowfullscreen=\"msallowfullscreen\" width=\"600\" height=\"600\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>The ultimate enforcement threats are termination from Medicare and Medicaid or closure by state or federal authorities. But only 17 percent of former special focus facilities are no longer operating, and that can include ones that went out of business for unrelated reasons, KHN found.\u003c/p>\n\u003cp>State regulators are reluctant to close nursing homes because of the upheaval it causes patients and families. In some areas, there are no alternative facilities nearby, making termination even less appealing.\u003c/p>\n\u003cp>“At the end of the day, there are those centers that cannot be corrected, can’t fix themselves, and the best thing for the patients and the residents might be for them to move to another location,” said Lyn Bentley, an executive at the American Health Care Association, a nursing facility trade group. But, she said, “it’s always difficult to close someone’s home.”\u003c/p>\n\u003cp>\u003cstrong>Lack Of Nurses\u003c/strong>\u003c/p>\n\u003cp>Too few nurses, particularly registered nurses, provide care at some of the most troubled homes, KHN’s analysis shows. Registered nurse staffing was still 12 percent lower than at other facilities, even three years after the homes were released from the watch list.\u003c/p>\n\u003cp>In 2009, Pennsylvania health regulators released Golden LivingCenter-West Shore in Camp Hill after 17 months of supervision. The company said in a recent statement that when a home was put on that list, “we mobilize the resources necessary to help get that LivingCenter back into compliance.”\u003c/p>\n\u003cp>But data from Medicare’s Nursing Home Compare website show the facility has among the worst nurse-to-patient staffing ratios in the nation, with registered nurses devoting an average of 12 minutes for each patient daily. The state average is 58 minutes daily per patient.\u003c/p>\n\u003cp>Golden LivingCenter-West Shore was fined $59,150 in 2015 after being cited for, among other violations, allowing a resident’s feeding tube to become infested with maggots, records show. Also, Golden Living agreed to pay $750,000 to settle three cases involving patient injuries from falls that occurred after extra oversight ended, court records show.\u003c/p>\n\u003cp>Last year, Golden Living sold its Pennsylvania homes to Priority Healthcare Group.\u003c/p>\n\u003cp>Priority is following a common strategy for shedding an unwanted reputation: changing the facility’s name. In California, Parkview — where Fisher slipped out of her wheelchair — is being rebranded too, as Kingston Healthcare Center.\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/\">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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"disqusTitle": "Why Teens Are Smoking Less, In Their Own Words",
"title": "Why Teens Are Smoking Less, In Their Own Words",
"headTitle": "California Healthline | State of Health | KQED News",
"content": "\u003cp>When Maya Terrell saw the anti-smoking television commercial, she knew she would never try a cigarette.\u003c/p>\n\u003cp>It featured an \u003ca href=\"https://www.cdc.gov/tobacco/campaign/tips/stories/anti-smoking-champion-terrie-hall-dies.html\">ex-smoker\u003c/a> with a \u003ca href=\"https://www.youtube.com/watch?v=5zWB4dLYChM\">hole in her throat\u003c/a> where her larynx used to be.\u003c/p>\n\u003cp>“I was like, ‘Never!’” recalled Terrell, 18. “I was scared.”\u003c/p>\n\u003cp>Besides, she said, smoking is just plain gross.\u003c/p>\n\u003cp>“My friends don’t smoke cigarettes,” said Terrell, of Sacramento, Calif. “It’s nasty.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Terrell is emblematic of a generation of teenagers who appear more knowledgeable about the risks of tobacco — and are smoking fewer cigarettes than ever before.\u003c/p>\n\u003cp>When researchers first started consistently tracking teen cigarette use in 1999, 29 percent of high schoolers reported smoking a cigarette in the past 30 days. That’s compared with 8 percent in 2016, \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/wr/mm6623a1.htm?s_cid=mm6623a1_w\" target=\"_blank\" rel=\"noopener noreferrer\">according to data\u003c/a> released this month by the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Reported use of e-cigarettes, known as vaping, also fell for the first time since e-cigarette tracking began in 2011, dropping from 16 percent in 2015 to about 11 percent in 2016. However, non-Hispanic white students remained more likely to use e-cigarettes than their Hispanic or non-Hispanic black peers.\u003c/p>\n\u003cp>At the same time, \u003ca href=\"https://www.statnews.com/2016/12/13/marijuana-teens-tobacco-ecigarettes/\" target=\"_blank\" rel=\"noopener noreferrer\">other research\u003c/a> suggests kids’ marijuana use is up — a possible sign of shifting tastes and habits.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/\" target=\"_blank\" rel=\"noopener noreferrer\">Cigarette smoking\u003c/a> is known to increase the risk of cancer, heart disease, stroke, lung diseases and diabetes. Tobacco use is “the leading cause of preventable disease and death” in the U.S., according to the CDC.\u003c/p>\n\u003cp>Many smokers in past generations ignored warnings about tobacco risks amid heavy advertising by tobacco companies. Today’s teens are more aware of the perils, and seem unsurprised by the CDC’s recent findings.\u003c/p>\n\u003cp>“I’ve had family members have a lot of consequences because of smoking,” explained Juliet Brisson, 15, while shopping at a Sacramento mall. “Older people used to smoke a lot, and they get effects as they get older. [Teens] are probably seeing that happen and are realizing they shouldn’t.”\u003c/p>\n\u003cp>Brisson’s friend Angelina Campos said that observing what happens to those who smoke, as well as anti-smoking campaigns, can influence her generation.\u003c/p>\n\u003cp>“People see the campaigns, they’re seeing the consequences, they’re seeing others die from tobacco usage,” said Campos, 17.\u003c/p>\n\u003cdiv id=\"attachment_240139\" class=\"wp-caption aligncenter\" style=\"width: 780px\">\n\u003cp>\u003cimg class=\"size-khn-article-large wp-image-240139\" src=\"https://californiahealthline.files.wordpress.com/2017/06/teen-smoking-1_770.jpg?w=770&h=513&crop=1\" alt=\"\" width=\"770\" height=\"513\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Juliet Brisson, left, and Angelina Campos converse while shopping at Sacramento’s Arden Fair mall on June 19. (Kellen Browning/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>California has long led the nation in restricting access to tobacco and continues to make it harder and more expensive to use. The San Francisco Board of Supervisors recently approved a \u003ca href=\"http://www.sfexaminer.com/sf-bans-sale-menthol-cigarettes-eliminate-least-50-5m-tobacco-sales/\" target=\"_blank\" rel=\"noopener noreferrer\">city-wide ban\u003c/a> on the sale of flavored tobacco products, including menthol cigarettes. California raised the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162SB7\" target=\"_blank\" rel=\"noopener noreferrer\">minimum legal age\u003c/a> for purchasing tobacco from 18 to 21 in 2016, and voters also increased the state \u003ca href=\"https://ballotpedia.org/California_Proposition_56,_Tobacco_Tax_Increase_(2016)\" target=\"_blank\" rel=\"noopener noreferrer\">tax on tobacco\u003c/a> products by $2 per pack by approving Proposition 56 last year.\u003c/p>\n\u003cp>Such measures help decrease teen smoking rates, said Dr. Alison Chopel, the director of the Public Health Institute’s \u003ca href=\"http://www.californiateenhealth.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Adolescent Health Collaborative\u003c/a>.\u003c/p>\n\u003cp>“California is kind of leading the nation in terms of declining rates of cigarette smoking. I think part of that has been the tax, and … the age availability definitely makes a difference,” Chopel said. “Any way that you can restrict access is definitely going to be helpful.”\u003c/p>\n\u003cp>Chopel heads a project called \u003ca href=\"http://www.californiateenhealth.org/research/\" target=\"_blank\" rel=\"noopener noreferrer\">Marketing E-Cigarettes Toward Adolescents Oakland \u003c/a>(META Oakland), which employs youth researchers and journalists to study how e-cigarettes are advertised. They’ve since branched out to monitor trends with other tobacco products.\u003c/p>\n\u003cp>META Oakland found that flavors of e-cigarettes and other products, such as \u003ca href=\"http://www.whitecloudelectroniccigarettes.com/how-it-works/flavors/\" target=\"_blank\" rel=\"noopener noreferrer\">“Mango Tango”\u003c/a> and “Watermelon Wave” entice teens. Chopel said that despite the encouraging recent data, anti-smoking advocates need to “remain vigilant” to counteract tobacco companies’ advertising.\u003c/p>\n\u003cp>Flavored e-cigarette and tobacco products are \u003ca href=\"http://californiahealthline.org/news/sf-seeks-to-ban-sale-of-menthol-cigarettes-and-flavored-tobacco-products/\" target=\"_blank\" rel=\"noopener noreferrer\">heavily marketed to minorities\u003c/a>. The CDC found that menthol cigarette promotions in particular have been “targeted heavily toward African Americans through culturally tailored advertising images and messages.” Nearly 9 in 10 \u003ca style=\"background-color: #ffffff\" href=\"https://www.cdc.gov/tobacco/disparities/african-americans/index.htm\" target=\"_blank\" rel=\"noopener noreferrer\">African-Americans who smoke\u003c/a> prefer menthol cigarettes, the CDC says.\u003c/p>\n\u003cp>E-cigarettes are probably a healthier choice — but not an ideal alternative. They contain nicotine, and the \u003ca href=\"https://www.cdc.gov/vitalsigns/ecigarette-ads/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">CDC says\u003c/a> they can lead to addiction, harm brain development and encourage use of other tobacco products.\u003c/p>\n\u003cp>A recent \u003ca href=\"http://annals.org/aim/article/2599869/nicotine-carcinogen-toxin-exposure-long-term-e-cigarette-nicotine-replacement\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> found that e-cigarette and traditional cigarette smokers tested similarly for levels of nicotine, but e-cigarette smokers showed “substantially reduced levels of measured carcinogens and toxins” than cigarette smokers.\u003c/p>\n\u003cp>Mac Carroll, a 14-year-old Sacramento student, sees classmates smoke e-cigarettes at school. He suggested teenagers might be influenced to vape because it’s trendy.\u003c/p>\n\u003cp>“If everyone’s doing it, you kind of just want to do it yourself, you know?” Carroll said.\u003c/p>\n\u003cdiv id=\"attachment_240141\" class=\"wp-caption aligncenter\" style=\"width: 780px\">\n\u003cp>\u003cimg class=\"size-khn-article-large wp-image-240141\" src=\"https://californiahealthline.files.wordpress.com/2017/06/teen-smoking-3_770.jpg?w=770&h=513&crop=1\" alt=\"\" width=\"770\" height=\"513\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Andy Knox checks his phone at home in Davis, Calif., on June 19. (Kellen Browning/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>But Andy Knox, a 16-year-old Davis, Calif., resident, thinks the recent decline in teen vaping shows that e-cigarettes are past their peak popularity.\u003c/p>\n\u003cp>Vaping is “generally widely culturally viewed as pretty much ridiculous,” Knox said.\u003c/p>\n\u003cp>Many of the teens interviewed said the waning interest in cigarettes is closely linked with the increase in popularity of marijuana.\u003c/p>\n\u003cp>“Generally, if you talk to people at school, they know all the things that tobacco causes, like cancer, and they don’t see marijuana as dangerous as that,” he said. “Also, the effect that it has on you is more pleasurable with marijuana than with tobacco.”\u003c/p>\n\u003cp>Though some teens may believe that smoking marijuana isn’t as dangerous as cigarette smoking, it may cause addiction, lung damage, impaired driving and brain development problems, \u003ca href=\"https://www.cdc.gov/marijuana/health-effects.htm\" target=\"_blank\" rel=\"noopener noreferrer\">according to the CDC\u003c/a>.\u003c/p>\n\u003cp>California \u003ca href=\"https://ballotpedia.org/California_Proposition_64,_Marijuana_Legalization_(2016)\" target=\"_blank\" rel=\"noopener noreferrer\">voted last year\u003c/a> to legalize recreational use of marijuana for those 21 and older starting in 2018. Knox thinks the outcome has influenced teenagers’ behaviors as well.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“People are probably having the instinct with marijuana that, ‘Well, it’s going to be legal in a few years, so you might as well start,’” Knox said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Maya Terrell saw the anti-smoking television commercial, she knew she would never try a cigarette.\u003c/p>\n\u003cp>It featured an \u003ca href=\"https://www.cdc.gov/tobacco/campaign/tips/stories/anti-smoking-champion-terrie-hall-dies.html\">ex-smoker\u003c/a> with a \u003ca href=\"https://www.youtube.com/watch?v=5zWB4dLYChM\">hole in her throat\u003c/a> where her larynx used to be.\u003c/p>\n\u003cp>“I was like, ‘Never!’” recalled Terrell, 18. “I was scared.”\u003c/p>\n\u003cp>Besides, she said, smoking is just plain gross.\u003c/p>\n\u003cp>“My friends don’t smoke cigarettes,” said Terrell, of Sacramento, Calif. “It’s nasty.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Terrell is emblematic of a generation of teenagers who appear more knowledgeable about the risks of tobacco — and are smoking fewer cigarettes than ever before.\u003c/p>\n\u003cp>When researchers first started consistently tracking teen cigarette use in 1999, 29 percent of high schoolers reported smoking a cigarette in the past 30 days. That’s compared with 8 percent in 2016, \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/wr/mm6623a1.htm?s_cid=mm6623a1_w\" target=\"_blank\" rel=\"noopener noreferrer\">according to data\u003c/a> released this month by the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Reported use of e-cigarettes, known as vaping, also fell for the first time since e-cigarette tracking began in 2011, dropping from 16 percent in 2015 to about 11 percent in 2016. However, non-Hispanic white students remained more likely to use e-cigarettes than their Hispanic or non-Hispanic black peers.\u003c/p>\n\u003cp>At the same time, \u003ca href=\"https://www.statnews.com/2016/12/13/marijuana-teens-tobacco-ecigarettes/\" target=\"_blank\" rel=\"noopener noreferrer\">other research\u003c/a> suggests kids’ marijuana use is up — a possible sign of shifting tastes and habits.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/\" target=\"_blank\" rel=\"noopener noreferrer\">Cigarette smoking\u003c/a> is known to increase the risk of cancer, heart disease, stroke, lung diseases and diabetes. Tobacco use is “the leading cause of preventable disease and death” in the U.S., according to the CDC.\u003c/p>\n\u003cp>Many smokers in past generations ignored warnings about tobacco risks amid heavy advertising by tobacco companies. Today’s teens are more aware of the perils, and seem unsurprised by the CDC’s recent findings.\u003c/p>\n\u003cp>“I’ve had family members have a lot of consequences because of smoking,” explained Juliet Brisson, 15, while shopping at a Sacramento mall. “Older people used to smoke a lot, and they get effects as they get older. [Teens] are probably seeing that happen and are realizing they shouldn’t.”\u003c/p>\n\u003cp>Brisson’s friend Angelina Campos said that observing what happens to those who smoke, as well as anti-smoking campaigns, can influence her generation.\u003c/p>\n\u003cp>“People see the campaigns, they’re seeing the consequences, they’re seeing others die from tobacco usage,” said Campos, 17.\u003c/p>\n\u003cdiv id=\"attachment_240139\" class=\"wp-caption aligncenter\" style=\"width: 780px\">\n\u003cp>\u003cimg class=\"size-khn-article-large wp-image-240139\" src=\"https://californiahealthline.files.wordpress.com/2017/06/teen-smoking-1_770.jpg?w=770&h=513&crop=1\" alt=\"\" width=\"770\" height=\"513\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Juliet Brisson, left, and Angelina Campos converse while shopping at Sacramento’s Arden Fair mall on June 19. (Kellen Browning/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>California has long led the nation in restricting access to tobacco and continues to make it harder and more expensive to use. The San Francisco Board of Supervisors recently approved a \u003ca href=\"http://www.sfexaminer.com/sf-bans-sale-menthol-cigarettes-eliminate-least-50-5m-tobacco-sales/\" target=\"_blank\" rel=\"noopener noreferrer\">city-wide ban\u003c/a> on the sale of flavored tobacco products, including menthol cigarettes. California raised the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162SB7\" target=\"_blank\" rel=\"noopener noreferrer\">minimum legal age\u003c/a> for purchasing tobacco from 18 to 21 in 2016, and voters also increased the state \u003ca href=\"https://ballotpedia.org/California_Proposition_56,_Tobacco_Tax_Increase_(2016)\" target=\"_blank\" rel=\"noopener noreferrer\">tax on tobacco\u003c/a> products by $2 per pack by approving Proposition 56 last year.\u003c/p>\n\u003cp>Such measures help decrease teen smoking rates, said Dr. Alison Chopel, the director of the Public Health Institute’s \u003ca href=\"http://www.californiateenhealth.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Adolescent Health Collaborative\u003c/a>.\u003c/p>\n\u003cp>“California is kind of leading the nation in terms of declining rates of cigarette smoking. I think part of that has been the tax, and … the age availability definitely makes a difference,” Chopel said. “Any way that you can restrict access is definitely going to be helpful.”\u003c/p>\n\u003cp>Chopel heads a project called \u003ca href=\"http://www.californiateenhealth.org/research/\" target=\"_blank\" rel=\"noopener noreferrer\">Marketing E-Cigarettes Toward Adolescents Oakland \u003c/a>(META Oakland), which employs youth researchers and journalists to study how e-cigarettes are advertised. They’ve since branched out to monitor trends with other tobacco products.\u003c/p>\n\u003cp>META Oakland found that flavors of e-cigarettes and other products, such as \u003ca href=\"http://www.whitecloudelectroniccigarettes.com/how-it-works/flavors/\" target=\"_blank\" rel=\"noopener noreferrer\">“Mango Tango”\u003c/a> and “Watermelon Wave” entice teens. Chopel said that despite the encouraging recent data, anti-smoking advocates need to “remain vigilant” to counteract tobacco companies’ advertising.\u003c/p>\n\u003cp>Flavored e-cigarette and tobacco products are \u003ca href=\"http://californiahealthline.org/news/sf-seeks-to-ban-sale-of-menthol-cigarettes-and-flavored-tobacco-products/\" target=\"_blank\" rel=\"noopener noreferrer\">heavily marketed to minorities\u003c/a>. The CDC found that menthol cigarette promotions in particular have been “targeted heavily toward African Americans through culturally tailored advertising images and messages.” Nearly 9 in 10 \u003ca style=\"background-color: #ffffff\" href=\"https://www.cdc.gov/tobacco/disparities/african-americans/index.htm\" target=\"_blank\" rel=\"noopener noreferrer\">African-Americans who smoke\u003c/a> prefer menthol cigarettes, the CDC says.\u003c/p>\n\u003cp>E-cigarettes are probably a healthier choice — but not an ideal alternative. They contain nicotine, and the \u003ca href=\"https://www.cdc.gov/vitalsigns/ecigarette-ads/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">CDC says\u003c/a> they can lead to addiction, harm brain development and encourage use of other tobacco products.\u003c/p>\n\u003cp>A recent \u003ca href=\"http://annals.org/aim/article/2599869/nicotine-carcinogen-toxin-exposure-long-term-e-cigarette-nicotine-replacement\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> found that e-cigarette and traditional cigarette smokers tested similarly for levels of nicotine, but e-cigarette smokers showed “substantially reduced levels of measured carcinogens and toxins” than cigarette smokers.\u003c/p>\n\u003cp>Mac Carroll, a 14-year-old Sacramento student, sees classmates smoke e-cigarettes at school. He suggested teenagers might be influenced to vape because it’s trendy.\u003c/p>\n\u003cp>“If everyone’s doing it, you kind of just want to do it yourself, you know?” Carroll said.\u003c/p>\n\u003cdiv id=\"attachment_240141\" class=\"wp-caption aligncenter\" style=\"width: 780px\">\n\u003cp>\u003cimg class=\"size-khn-article-large wp-image-240141\" src=\"https://californiahealthline.files.wordpress.com/2017/06/teen-smoking-3_770.jpg?w=770&h=513&crop=1\" alt=\"\" width=\"770\" height=\"513\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Andy Knox checks his phone at home in Davis, Calif., on June 19. (Kellen Browning/California Healthline)\u003c/p>\n\u003c/div>\n\u003cp>But Andy Knox, a 16-year-old Davis, Calif., resident, thinks the recent decline in teen vaping shows that e-cigarettes are past their peak popularity.\u003c/p>\n\u003cp>Vaping is “generally widely culturally viewed as pretty much ridiculous,” Knox said.\u003c/p>\n\u003cp>Many of the teens interviewed said the waning interest in cigarettes is closely linked with the increase in popularity of marijuana.\u003c/p>\n\u003cp>“Generally, if you talk to people at school, they know all the things that tobacco causes, like cancer, and they don’t see marijuana as dangerous as that,” he said. “Also, the effect that it has on you is more pleasurable with marijuana than with tobacco.”\u003c/p>\n\u003cp>Though some teens may believe that smoking marijuana isn’t as dangerous as cigarette smoking, it may cause addiction, lung damage, impaired driving and brain development problems, \u003ca href=\"https://www.cdc.gov/marijuana/health-effects.htm\" target=\"_blank\" rel=\"noopener noreferrer\">according to the CDC\u003c/a>.\u003c/p>\n\u003cp>California \u003ca href=\"https://ballotpedia.org/California_Proposition_64,_Marijuana_Legalization_(2016)\" target=\"_blank\" rel=\"noopener noreferrer\">voted last year\u003c/a> to legalize recreational use of marijuana for those 21 and older starting in 2018. Knox thinks the outcome has influenced teenagers’ behaviors as well.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“People are probably having the instinct with marijuana that, ‘Well, it’s going to be legal in a few years, so you might as well start,’” Knox said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Kaiser Permanente Cited -- Again -- For Mental Health Access Problems",
"title": "Kaiser Permanente Cited -- Again -- For Mental Health Access Problems",
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"content": "\u003cp>Despite three warnings and a multimillion-dollar fine a few years ago, Kaiser Permanente still fails to provide members with appropriate access to mental health care, according to \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_full%20service-behavioral%20health_061217.pdf\">a recent survey\u003c/a> of the HMO by the state of California.\u003c/p>\n\u003cp>The routine survey, released by the state Department of Managed Health Care, found that Kaiser Foundation Health Plan did not provide enrollees \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\">with “timely access” to behavioral health treatment\u003c/a>, in violation of state law. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>The matter has now been referred back to the state Office of Enforcement for further action, which could include an additional fine.\u003c/p>\n\u003cp>California’s timely access laws require insurers to provide patients access to a medical appointment within 48 hours for an urgent problem, or within 10 business days for a non-urgent issue. Kaiser patients, however, often have to wait longer, according to the department.\u003c/p>\n\u003cp>The survey looked at Kaiser’s behavioral health files through Jan. 1, 2015. The department found that while the HMO had “undertaken extensive and meaningful efforts” to improve access to mental health care, the problems remain.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Headquartered in Oakland, \u003ca href=\"https://share.kaiserpermanente.org/article/fast-facts-about-kaiser-permanente/\">Kaiser Permanente\u003c/a> is one of the largest not-for-profit managed health care plans in the country, with an annual operating revenue of $64.6 billion and 8.5 million members in California.\u003c/p>\n\u003cp>In a formal response to the watchdog agency, Kaiser listed more than 10 changes it has made to improve members’ access to mental health care, including contracting with providers outside of the organization and aggressively recruiting and hiring clinicians. The plan cited internal audits finding that they complied with timely access laws more than 90 percent of the time and stated “a corrective action plan is not warranted.”\u003c/p>\n\u003cp>“We have made great progress over the nearly two years since this survey was begun to improve access by hiring over 1,030 new psychiatrists and therapists, expanding our network of community practitioners, and introducing more convenient ways to access treatment,” John Nelson, vice president of government relations for Kaiser, wrote in an email to Kaiser Health News.\u003c/p>\n\u003cp>The department, however, responded in its report that while Kaiser Permanente has been working with Office of Enforcement to correct the problems, “the access issues remain unresolved.”\u003c/p>\n\u003cp>In 2013, Kaiser agreed to pay a $4 million fine for several deficiencies in the plan’s delivery of mental health services — one of the largest ever paid by an insurer in the state. In 2015, the department found that \u003ca href=\"http://khn.org/news/kaiser-permanente-faulted-again-for-mental-health-care-in-california/\">some Kaiser patients still had to wait\u003c/a> weeks or even months to see a psychiatrist or a therapist.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_behavioral%20follow%20up_021315.pdf\">one case cited by the department\u003c/a> in a 2015 survey, a child was brought in by her father because of “aggressive behaviors, sexualized behaviors and significant behavioral problems in both the home and school environment.” The family told providers that they were “in crisis” and “pleaded for treatment.” The child, however, was not seen for therapy until seven weeks later.\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>Despite three warnings and a multimillion-dollar fine a few years ago, Kaiser Permanente still fails to provide members with appropriate access to mental health care, according to \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_full%20service-behavioral%20health_061217.pdf\">a recent survey\u003c/a> of the HMO by the state of California.\u003c/p>\n\u003cp>The routine survey, released by the state Department of Managed Health Care, found that Kaiser Foundation Health Plan did not provide enrollees \u003ca href=\"http://khn.org/news/achieving-mental-health-parity-slow-going-even-in-pace-car-state/\">with “timely access” to behavioral health treatment\u003c/a>, in violation of state law. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)\u003c/p>\n\u003cp>The matter has now been referred back to the state Office of Enforcement for further action, which could include an additional fine.\u003c/p>\n\u003cp>California’s timely access laws require insurers to provide patients access to a medical appointment within 48 hours for an urgent problem, or within 10 business days for a non-urgent issue. Kaiser patients, however, often have to wait longer, according to the department.\u003c/p>\n\u003cp>The survey looked at Kaiser’s behavioral health files through Jan. 1, 2015. The department found that while the HMO had “undertaken extensive and meaningful efforts” to improve access to mental health care, the problems remain.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Headquartered in Oakland, \u003ca href=\"https://share.kaiserpermanente.org/article/fast-facts-about-kaiser-permanente/\">Kaiser Permanente\u003c/a> is one of the largest not-for-profit managed health care plans in the country, with an annual operating revenue of $64.6 billion and 8.5 million members in California.\u003c/p>\n\u003cp>In a formal response to the watchdog agency, Kaiser listed more than 10 changes it has made to improve members’ access to mental health care, including contracting with providers outside of the organization and aggressively recruiting and hiring clinicians. The plan cited internal audits finding that they complied with timely access laws more than 90 percent of the time and stated “a corrective action plan is not warranted.”\u003c/p>\n\u003cp>“We have made great progress over the nearly two years since this survey was begun to improve access by hiring over 1,030 new psychiatrists and therapists, expanding our network of community practitioners, and introducing more convenient ways to access treatment,” John Nelson, vice president of government relations for Kaiser, wrote in an email to Kaiser Health News.\u003c/p>\n\u003cp>The department, however, responded in its report that while Kaiser Permanente has been working with Office of Enforcement to correct the problems, “the access issues remain unresolved.”\u003c/p>\n\u003cp>In 2013, Kaiser agreed to pay a $4 million fine for several deficiencies in the plan’s delivery of mental health services — one of the largest ever paid by an insurer in the state. In 2015, the department found that \u003ca href=\"http://khn.org/news/kaiser-permanente-faulted-again-for-mental-health-care-in-california/\">some Kaiser patients still had to wait\u003c/a> weeks or even months to see a psychiatrist or a therapist.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.dmhc.ca.gov/desktopmodules/dmhc/medsurveys/surveys/055_r_behavioral%20follow%20up_021315.pdf\">one case cited by the department\u003c/a> in a 2015 survey, a child was brought in by her father because of “aggressive behaviors, sexualized behaviors and significant behavioral problems in both the home and school environment.” The family told providers that they were “in crisis” and “pleaded for treatment.” The child, however, was not seen for therapy until seven weeks later.\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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"disqusTitle": "Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals",
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"content": "\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\u003c/p>\n\u003cp>[ad floatright]\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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"nprByline": "\u003ca href=\"http://khn.org/news/author/charlotte-huff/\" target=\"_blank\">Charlotte Huff\u003c/a>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures",
"title": "Nursing Homes Worry Proposed Medicaid Cuts Will Force Cuts, Closures",
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"content": "\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mrVakER0R6f0AToNbkAK83dprja2VTaO\"]\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of 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=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of 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=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal",
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"content": "\u003cp>Three years ago, Carol Morris was put in charge of a massive remodel of the new Mountain Valleys health clinic in Burney, a small town in mountains in eastern Shasta County.\u003c/p>\n\u003cp>She painted the new exam rooms in muted greens and browns, to reflect the pine forest and cattle ranches outside, and she made a series of equipment upgrades: new sonogram and retina scanning machines, a designer vaccine refrigerator, and a fleet of cushy new exam tables.\u003c/p>\n\u003cp>“Some of the staff will come in and nap on one at lunchtime,” Morris says, stroking the leather table.\u003c/p>\n\u003cp>The new Burney clinic is three times as big as the old one, Morris says. They’ve doubled the number of patients they see, and they’ve doubled their staff.\u003c/p>\n\u003cp>All thanks to money from the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I guess it's true, build it and they will come,” Morris says.\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-29a-tcr.mp3\" Image=\"https://u.s.kqed.net/2017/06/29/Stethoscope.jpg\" Title=\"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal\" program=\"The California Report\"]\u003c/p>\n\u003cp>President Obama’s signature health law provided grants for capital construction at rural clinics, and increased payments for treating patients on Medi-Cal, the state’s health program for low-income people. The law also expanded who qualified for Medi-Cal, adding close to 4 million Californians to the rolls, many of them from \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">rural, Republican counties\u003c/a> in the state, like Shasta, Lassen, and Siskiyou, where Mountain Valleys clinics operate.\u003c/p>\n\u003cp>With many of their previously uninsured patients now covered by Medi-Cal, the clinic is making money instead of losing it.\u003c/p>\n\u003cp>“That was a real boon to us,” says Dave Jones, CEO of \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys clinics\u003c/a>. “We went from struggling payday to payday, to actually having a reserve at this point.”\u003c/p>\n\u003cp>In addition to moving into the new medical clinic in Burney, Jones was able to buy a dental building next door, expand mental health and drug counseling services, and hire a range of new administrative staff.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uO0r77wi0xkfHFV79VI4jRtVOZYGMW8u\"]\u003c/p>\n\u003cp>Across Shasta County, the Obamacare Medi-Cal expansion helped create more than 900 jobs in the health care sector and beyond, according to an economic impact report commissioned by \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Partnership Health Plan\u003c/a>, the insurer that manages Medi-Cal in far northern California.\u003c/p>\n\u003cp>One of the Burney clinic’s newest hires is Laura Hodge. The clinic had noticed a lot of patients who got health coverage for the first time were going to the Emergency Room more -- for simple things, like a headache or Band-Aid.\u003c/p>\n\u003cp>They brought Hodge on to start a program aimed at reducing overuse of the ER. She sat in her office on a recent afternoon calling patients, asking them if they wanted to participate in the new program.\u003c/p>\n\u003cp>“I would be your liaison with the doctors,” she explains over the phone. “If you feel like you're not being listened to, or if you have any questions and you don't feel like you're being answered, you could come to me.”\u003c/p>\n\u003cp>The new job is a huge economic help for Hodge. Her husband is a trucker and they have three kids. Hodge’s salary is critical to keeping the household going.\u003c/p>\n\u003cp>And that’s critical to Burney. After the logging company, the clinic is one of the largest employers in town. A lot of the money Hodge and her coworkers make goes straight back into the community.\u003c/p>\n\u003cp>“The grocery store, the tire shop, the gas station,” Hodge lists the places she spends her paycheck. “Our little theater, the bowling alley, Kristi’s Unique Boutique.”\u003c/p>\n\u003cfigure id=\"attachment_348515\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-348515\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Laura-Hodge-sips-red-bull-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Laura Hodge sips a blended Red Bull at her favorite coffee shop in Burney. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hodge takes me to one of her favorite haunts, the drive-thru window of the Mt. Burney Coffee Co.\u003c/p>\n\u003cp>“I will take a blended Red Bull,” she says, mulling over the list of flavors, deciding on the Fruit Loop – club soda with passion fruit, peach, and red raspberry syrup mixed in the blender with ice and a can of Red Bull.\u003c/p>\n\u003cp>“The first time I drank one, oh my gosh,” Hodge laughs, “I went home and I cleaned everything in my house.”\u003c/p>\n\u003cp>Staff from the health clinic are regulars at the coffee shop, says barista Abby Fristine.\u003c/p>\n\u003cp>“Most of them come through everyday, before or after work,” she says.\u003c/p>\n\u003cp>The money earned and spent by the health clinic staff ripples through the local economy. And all the people they’ve hired in recent years makes a difference in a small town like this, says Jones, the clinic CEO.\u003c/p>\n\u003cp>“I'm sure over the last two or three years it's been worth a couple million dollars to the community,” he says.\u003c/p>\n\u003cp>That’s why Jones is sounding the alarm on attempts to repeal the Affordable Care Act.\u003c/p>\n\u003cp>He and other clinic directors have managed to convince conservative officials, like the Shasta County Board of Supervisors, to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">formally oppose the Republican health bill\u003c/a>, in part because of the potential economic impacts. The Siskiyou board is considering a similar move.\u003c/p>\n\u003cp>Together, both counties stand to lose close to $200 million in business revenue from a rollback to Medicaid funding, hitting not just clinics, but local shops and restaurants, too.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we have to revert back to where we were,” Jones says, “it could be disastrous.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Three years ago, Carol Morris was put in charge of a massive remodel of the new Mountain Valleys health clinic in Burney, a small town in mountains in eastern Shasta County.\u003c/p>\n\u003cp>She painted the new exam rooms in muted greens and browns, to reflect the pine forest and cattle ranches outside, and she made a series of equipment upgrades: new sonogram and retina scanning machines, a designer vaccine refrigerator, and a fleet of cushy new exam tables.\u003c/p>\n\u003cp>“Some of the staff will come in and nap on one at lunchtime,” Morris says, stroking the leather table.\u003c/p>\n\u003cp>The new Burney clinic is three times as big as the old one, Morris says. They’ve doubled the number of patients they see, and they’ve doubled their staff.\u003c/p>\n\u003cp>All thanks to money from the Affordable Care Act.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>President Obama’s signature health law provided grants for capital construction at rural clinics, and increased payments for treating patients on Medi-Cal, the state’s health program for low-income people. The law also expanded who qualified for Medi-Cal, adding close to 4 million Californians to the rolls, many of them from \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">rural, Republican counties\u003c/a> in the state, like Shasta, Lassen, and Siskiyou, where Mountain Valleys clinics operate.\u003c/p>\n\u003cp>With many of their previously uninsured patients now covered by Medi-Cal, the clinic is making money instead of losing it.\u003c/p>\n\u003cp>“That was a real boon to us,” says Dave Jones, CEO of \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys clinics\u003c/a>. “We went from struggling payday to payday, to actually having a reserve at this point.”\u003c/p>\n\u003cp>In addition to moving into the new medical clinic in Burney, Jones was able to buy a dental building next door, expand mental health and drug counseling services, and hire a range of new administrative staff.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Across Shasta County, the Obamacare Medi-Cal expansion helped create more than 900 jobs in the health care sector and beyond, according to an economic impact report commissioned by \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Partnership Health Plan\u003c/a>, the insurer that manages Medi-Cal in far northern California.\u003c/p>\n\u003cp>One of the Burney clinic’s newest hires is Laura Hodge. The clinic had noticed a lot of patients who got health coverage for the first time were going to the Emergency Room more -- for simple things, like a headache or Band-Aid.\u003c/p>\n\u003cp>They brought Hodge on to start a program aimed at reducing overuse of the ER. She sat in her office on a recent afternoon calling patients, asking them if they wanted to participate in the new program.\u003c/p>\n\u003cp>“I would be your liaison with the doctors,” she explains over the phone. “If you feel like you're not being listened to, or if you have any questions and you don't feel like you're being answered, you could come to me.”\u003c/p>\n\u003cp>The new job is a huge economic help for Hodge. Her husband is a trucker and they have three kids. Hodge’s salary is critical to keeping the household going.\u003c/p>\n\u003cp>And that’s critical to Burney. After the logging company, the clinic is one of the largest employers in town. A lot of the money Hodge and her coworkers make goes straight back into the community.\u003c/p>\n\u003cp>“The grocery store, the tire shop, the gas station,” Hodge lists the places she spends her paycheck. “Our little theater, the bowling alley, Kristi’s Unique Boutique.”\u003c/p>\n\u003cfigure id=\"attachment_348515\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-348515\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Laura-Hodge-sips-red-bull-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Laura Hodge sips a blended Red Bull at her favorite coffee shop in Burney. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hodge takes me to one of her favorite haunts, the drive-thru window of the Mt. Burney Coffee Co.\u003c/p>\n\u003cp>“I will take a blended Red Bull,” she says, mulling over the list of flavors, deciding on the Fruit Loop – club soda with passion fruit, peach, and red raspberry syrup mixed in the blender with ice and a can of Red Bull.\u003c/p>\n\u003cp>“The first time I drank one, oh my gosh,” Hodge laughs, “I went home and I cleaned everything in my house.”\u003c/p>\n\u003cp>Staff from the health clinic are regulars at the coffee shop, says barista Abby Fristine.\u003c/p>\n\u003cp>“Most of them come through everyday, before or after work,” she says.\u003c/p>\n\u003cp>The money earned and spent by the health clinic staff ripples through the local economy. And all the people they’ve hired in recent years makes a difference in a small town like this, says Jones, the clinic CEO.\u003c/p>\n\u003cp>“I'm sure over the last two or three years it's been worth a couple million dollars to the community,” he says.\u003c/p>\n\u003cp>That’s why Jones is sounding the alarm on attempts to repeal the Affordable Care Act.\u003c/p>\n\u003cp>He and other clinic directors have managed to convince conservative officials, like the Shasta County Board of Supervisors, to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">formally oppose the Republican health bill\u003c/a>, in part because of the potential economic impacts. The Siskiyou board is considering a similar move.\u003c/p>\n\u003cp>Together, both counties stand to lose close to $200 million in business revenue from a rollback to Medicaid funding, hitting not just clinics, but local shops and restaurants, too.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we have to revert back to where we were,” Jones says, “it could be disastrous.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Modoc County, in the northeast corner of California, is roughly the size of Connecticut. It's so sparsely populated, the entire county has just one stoplight. The nearest Wal-Mart is more than an hour's drive, across the Oregon border. Same with hospitals that deliver babies.\u003c/p>\n\u003cp>Greta Elliott runs a tiny health \u003ca href=\"http://canbyclinic.org/\" target=\"_blank\" rel=\"noopener noreferrer\">clinic\u003c/a> in Canby, on the edge of the national forest. \"Rural\" doesn’t begin to describe the area, she says. This is \"the frontier.\"\u003c/p>\n\u003cp>“There are more cows in Modoc than there are people,” Elliott says.\u003c/p>\n\u003cp>There's a frontier mentality, too. People take care of each other, and they take care of themselves. They don’t like being told what to do. Being forced to buy insurance made Obamacare a dirty word.\u003c/p>\n\u003cp>Even Elliott, the head of a health clinic, decided against buying coverage for herself.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It's too expensive,” she says. “I choose to put my money back into paying the bills of the whole family.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-28a-tcr.mp3\" Image=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/03/BloodPressure-768x512.jpg\" Title=\"Obamacare Inspires Unlikely Political Action in Red California\" program=\"The California Report\"]\u003c/p>\n\u003cp>Overall, the Affordable Care Act helped 25,000 people in far Northern California buy plans through the state marketplace, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>. But the law helped three times as many people, 75,000, enroll in Medi-Cal, the state’s Medicaid program that provides free health coverage for low-income residents.\u003c/p>\n\u003cp>“The data shows it's the rural communities that have greatly benefited from the Medicaid expansion. That’s the irony,” says Dean Germano, CEO of the \u003ca href=\"https://www.shastahealth.org\" target=\"_blank\" rel=\"noopener noreferrer\">Shasta Community Health Center\u003c/a>. “These are places that voted much more heavily for Donald Trump.”\u003c/p>\n\u003cp>In Modoc and Lassen counties, 70 percent of people voted for Trump in the November election. In neighboring Shasta County, Trump won 64 percent of the vote.\u003c/p>\n\u003cp>But now a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of clinics from across the Northeast corner of the state is lobbying local officials to take an unpopular position in this conservative land: defend Obamacare.\u003c/p>\n\u003cp>And the right-leaning Shasta County Board of Supervisors took them up on it.\u003c/p>\n\u003cp>[contextly_sidebar id=\"Nl4j8x6j7iRmpWflZsVooGaqsbbbOLuA\"]\u003c/p>\n\u003cp>“We thought ‘Whoa! That is really bold,’” Germano says. “I was surprised.”\u003c/p>\n\u003cp>The board sent a letter to the local Republican congressman, \u003ca href=\"https://lamalfa.house.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Doug La Malfa\u003c/a>, asking him to vote against the initial GOP repeal and replace bill, because it would hurt local people.\u003c/p>\n\u003cp>“We have an obligation to say something,” says Supervisor David Kehoe. “And if it may be mildly offensive from a political standpoint for some, well, we’re not going to be intimidated by politics.”\u003c/p>\n\u003cp>But Congressman La Malfa still voted in favor of dismantling Obamacare.\u003c/p>\n\u003cp>La Malfa didn't return calls and emails for this story, but, in May, \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">he told KQED\u003c/a> that skyrocketing premiums were the main driver behind his vote.\u003c/p>\n\u003cp>\"Unfortunately, the reality is that too many young and healthy individuals are deciding they’d rather pay the penalty than sign up for care, citing financial barriers and lack of choice,\" he said in a statement. \"A 28 year old making $45,000 a year with no major health concerns is not going to pay upwards of $400 a month for a plan that does not even work for them.\"\u003c/p>\n\u003cp>When clinic representatives met with La Malfa's staffers, they were told the Congressman's office was flooded with calls like this.\u003c/p>\n\u003cp>But poor folks on Medi-Cal didn’t call to say how much they appreciate that program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.\u003c/p>\n\u003cp>“They feel like it's a handout and they're too proud, they don’t want to,” says Carol Morris, an enrollment counselor for the \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys\u003c/a> health clinics in Shasta county.\u003c/p>\n\u003cp>One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">\"Partnership Health Plan\" \u003c/a>and may not realize they’re actually covered by a government program.\u003c/p>\n\u003cp>“It feels like it's more of an insurance,” Morris says. “It’s like a laminated, wallet-sized card that's got your numbers on it. It just looks exactly like an insurance card.”\u003c/p>\n\u003cp>One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.\u003c/p>\n\u003cp>“It did me good,” she says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"swxoiuaBwIFNHC8PbxRB3kfDYxOKFLOH\"]\u003c/p>\n\u003cp>Now she has a subsidized commercial plan through Covered California, with modest premiums and co-pays, and she likes that, too.\u003c/p>\n\u003cp>“It’s okay. 'Cause I’m at the doctor’s at least once a month,” she says.\u003c/p>\n\u003cp>But when asked what she thinks of Obamacare overall, she says she doesn’t like it.\u003c/p>\n\u003cp>“Because of Obama himself,” she says with a laugh. “I rest my case.”\u003c/p>\n\u003cp>The confusion and the contradictions are common among patients, explains Morris, the enrollment counselor.\u003c/p>\n\u003cp>“People just don't understand the different names,” she says. “But, of course, it's the same thing.”\u003c/p>\n\u003cp>Morris has seen the difference Obamacare has made for people in the region. She’s seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn’t have gotten.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Those patients won’t fight for Obamacare, Morris says, so that’s why the clinics have to.\u003c/p>\n\n",
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"excerpt": "Under the ACA, 75,000 people enrolled in Medi-Cal in the state's northeast. 'The data shows it’s the rural communities that have greatly benefited from the Medicaid expansion.'",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Modoc County, in the northeast corner of California, is roughly the size of Connecticut. It's so sparsely populated, the entire county has just one stoplight. The nearest Wal-Mart is more than an hour's drive, across the Oregon border. Same with hospitals that deliver babies.\u003c/p>\n\u003cp>Greta Elliott runs a tiny health \u003ca href=\"http://canbyclinic.org/\" target=\"_blank\" rel=\"noopener noreferrer\">clinic\u003c/a> in Canby, on the edge of the national forest. \"Rural\" doesn’t begin to describe the area, she says. This is \"the frontier.\"\u003c/p>\n\u003cp>“There are more cows in Modoc than there are people,” Elliott says.\u003c/p>\n\u003cp>There's a frontier mentality, too. People take care of each other, and they take care of themselves. They don’t like being told what to do. Being forced to buy insurance made Obamacare a dirty word.\u003c/p>\n\u003cp>Even Elliott, the head of a health clinic, decided against buying coverage for herself.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It's too expensive,” she says. “I choose to put my money back into paying the bills of the whole family.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Overall, the Affordable Care Act helped 25,000 people in far Northern California buy plans through the state marketplace, \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California\u003c/a>. But the law helped three times as many people, 75,000, enroll in Medi-Cal, the state’s Medicaid program that provides free health coverage for low-income residents.\u003c/p>\n\u003cp>“The data shows it's the rural communities that have greatly benefited from the Medicaid expansion. That’s the irony,” says Dean Germano, CEO of the \u003ca href=\"https://www.shastahealth.org\" target=\"_blank\" rel=\"noopener noreferrer\">Shasta Community Health Center\u003c/a>. “These are places that voted much more heavily for Donald Trump.”\u003c/p>\n\u003cp>In Modoc and Lassen counties, 70 percent of people voted for Trump in the November election. In neighboring Shasta County, Trump won 64 percent of the vote.\u003c/p>\n\u003cp>But now a \u003ca href=\"http://thehanc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">coalition\u003c/a> of clinics from across the Northeast corner of the state is lobbying local officials to take an unpopular position in this conservative land: defend Obamacare.\u003c/p>\n\u003cp>And the right-leaning Shasta County Board of Supervisors took them up on it.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“We thought ‘Whoa! That is really bold,’” Germano says. “I was surprised.”\u003c/p>\n\u003cp>The board sent a letter to the local Republican congressman, \u003ca href=\"https://lamalfa.house.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Doug La Malfa\u003c/a>, asking him to vote against the initial GOP repeal and replace bill, because it would hurt local people.\u003c/p>\n\u003cp>“We have an obligation to say something,” says Supervisor David Kehoe. “And if it may be mildly offensive from a political standpoint for some, well, we’re not going to be intimidated by politics.”\u003c/p>\n\u003cp>But Congressman La Malfa still voted in favor of dismantling Obamacare.\u003c/p>\n\u003cp>La Malfa didn't return calls and emails for this story, but, in May, \u003ca href=\"https://ww2.kqed.org/news/2017/05/06/what-your-california-representative-says-about-the-gop-health-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">he told KQED\u003c/a> that skyrocketing premiums were the main driver behind his vote.\u003c/p>\n\u003cp>\"Unfortunately, the reality is that too many young and healthy individuals are deciding they’d rather pay the penalty than sign up for care, citing financial barriers and lack of choice,\" he said in a statement. \"A 28 year old making $45,000 a year with no major health concerns is not going to pay upwards of $400 a month for a plan that does not even work for them.\"\u003c/p>\n\u003cp>When clinic representatives met with La Malfa's staffers, they were told the Congressman's office was flooded with calls like this.\u003c/p>\n\u003cp>But poor folks on Medi-Cal didn’t call to say how much they appreciate that program. In fact, clinics struggled getting people to sign up for Medi-Cal, at first.\u003c/p>\n\u003cp>“They feel like it's a handout and they're too proud, they don’t want to,” says Carol Morris, an enrollment counselor for the \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys\u003c/a> health clinics in Shasta county.\u003c/p>\n\u003cp>One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">\"Partnership Health Plan\" \u003c/a>and may not realize they’re actually covered by a government program.\u003c/p>\n\u003cp>“It feels like it's more of an insurance,” Morris says. “It’s like a laminated, wallet-sized card that's got your numbers on it. It just looks exactly like an insurance card.”\u003c/p>\n\u003cp>One patient at the Mountain Valleys clinic in Beiber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.\u003c/p>\n\u003cp>“It did me good,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Now she has a subsidized commercial plan through Covered California, with modest premiums and co-pays, and she likes that, too.\u003c/p>\n\u003cp>“It’s okay. 'Cause I’m at the doctor’s at least once a month,” she says.\u003c/p>\n\u003cp>But when asked what she thinks of Obamacare overall, she says she doesn’t like it.\u003c/p>\n\u003cp>“Because of Obama himself,” she says with a laugh. “I rest my case.”\u003c/p>\n\u003cp>The confusion and the contradictions are common among patients, explains Morris, the enrollment counselor.\u003c/p>\n\u003cp>“People just don't understand the different names,” she says. “But, of course, it's the same thing.”\u003c/p>\n\u003cp>Morris has seen the difference Obamacare has made for people in the region. She’s seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn’t have gotten.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Those patients won’t fight for Obamacare, Morris says, so that’s why the clinics have to.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Before Kevin Powers underwent lung cancer surgery last October, his girlfriend, Agi Orsi, meticulously checked and double-checked to be sure his Santa Monica hospital and surgeon were in his health plan’s network. They were.\u003c/p>\n\u003cp>Even in the hospital, Orsi dutifully wrote “No out-of-network doctors” across the top of Powers’ admission paperwork.\u003c/p>\n\u003cp>Her diligence was for naught.\u003c/p>\n\u003cp>Powers, 57, suffered serious complications, resulting in a two-week hospital stay that included visits from several specialists. It also resulted in a barrage of surprise medical bills from some of those specialists charging out-of-network rates.\u003c/p>\n\u003cp>The bills total about $5,600 — so far.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It’s overwhelming,” says Orsi, 64, who lives with Powers in Topanga Canyon. “I feel like consumers are at a major disadvantage.”\u003c/p>\n\u003caside class=\"alignright\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/bazar_100.jpg\" alt=\"\" width=\"100\" height=\"133\" class=\"alignleft size-full wp-image-348286\">\u003cstrong>Ask Emily\u003c/strong>\n\u003cp>Answering consumers’ questions about California’s changing medical landscape.\u003cbr>\n\u003cbr>\nSend questions for Emily to \u003ca href=\"mailto:AskEmily@kff.org\">AskEmily@kff.org\u003c/a>\u003c/p>\u003c/aside>\n\u003cp>Starting next month, many Californians will be protected against such surprise medical bills from out-of-network providers, also known as “\u003ca href=\"http://www.kff.org/private-insurance/issue-brief/surprise-medical-bills/\" target=\"_blank\" rel=\"noopener noreferrer\">balance billing\u003c/a>.”\u003c/p>\n\u003cp>Under a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB72\" target=\"_blank\" rel=\"noopener noreferrer\">new state law\u003c/a>, if you visit an in-network facility — such as a hospital, lab or imaging center — you will be responsible only for your in-network share of the cost, even if you’re seen by an out-of-network provider.\u003c/p>\n\u003cp>The \u003ca href=\"http://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactSheets/fsab72.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">law\u003c/a> applies to non-emergency services received on or after July 1.\u003c/p>\n\u003cp>“This is a very big deal,” says Tam Ma, legal and policy director for the advocacy group \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access California\u003c/a>. “We’ve heard from hundreds of consumers who were getting these surprise bills.”\u003c/p>\n\u003cp>A 2015 Consumers Union \u003ca href=\"https://consumersunion.org/wp-content/uploads/2015/05/Surprise-Bills-Survey-CA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">survey\u003c/a> found that nearly 1 in 4 Californians who visited a hospital or had surgery in the previous two years were charged an out‐of‐network rate when they thought a provider was in‐network.\u003c/p>\n\u003cp>Here’s a common scenario: A patient takes pains to ensure her hospital and surgeon are in network, only to get billed by the out-of-network anesthesiologist who appears at her bedside to put her under.\u003c/p>\n\u003cdiv id=\"attachment_239562\" class=\"wp-caption alignleft\" style=\"width: 380px\">\n\u003cp>\u003cimg class=\"wp-image-239562 size-khn-article-small\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/agikevin-770.jpg?w=370&h=247&crop=1\" alt=\"\" width=\"370\" height=\"247\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers (right) is facing more than $5,000 in surprise medical bills from his October lung cancer surgery even though his girlfriend, Agi Orsi (left) took pains to ensure his hospital and surgeon were in his health plan’s network. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>“No one gets to pick their anesthesiologist,” Ma says. “It depends on who is on duty, who is available.”\u003c/p>\n\u003cp>Surprise bills also often come from pathologists, radiologists and assistant surgeons — other providers that patients typically can’t choose, she says.\u003c/p>\n\u003cp>The new law covers Californians with private health insurance plans that are regulated by the state Department of Managed Health Care (DMHC) and the state Department of Insurance, which includes roughly 70 percent of the state’s private insurance market, according to the California Health Care Foundation. (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>It does not cover some 5.7 million people whose employer-sponsored insurance plans are regulated by the U.S. Department of Labor.\u003c/p>\n\u003cp>Insurers, health care providers and regulators are working furiously behind the scenes to hash out some details about that law, including how much out-of-network providers should be compensated for their services.\u003c/p>\n\u003cp>But that shouldn’t affect you.\u003c/p>\n\u003cp>“Is it going to be pretty as plans and providers figure this out in the background? Maybe not,” says Charles Bacchi, president of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. “But what’s important is that it’s not readily apparent to the consumer.”\u003c/p>\n\u003cp>The key point to remember is that you shouldn’t pay more than your in-network copayment, coinsurance or deductible, as long as you visited an in-network facility for non-emergency services.\u003c/p>\n\u003cp>So, if you receive what looks like a bill from a provider showing an out-of-network rate, don’t panic, says Betsy Imholz, director of special projects for \u003ca href=\"https://consumersunion.org/experts/elizabeth-betsy-imholz/\" target=\"_blank\" rel=\"noopener noreferrer\">Consumers Union\u003c/a>.\u003c/p>\n\u003cdiv id=\"attachment_239563\" class=\"wp-caption alignleft\" style=\"width: 280px\">\n\u003cp>\u003cimg class=\"wp-image-239563 size-khn-article-vertical\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/kevin-in-hospital-770.jpg?w=270&h=405&crop=1\" alt=\"\" width=\"270\" height=\"405\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers suffered serious complications after his lung cancer surgery last October, resulting in a two-week hospital stay and surprise out-of-network bills. He is shown here in the hospital after surgery. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>First, read it carefully. It may not actually be a bill. Under the law, any communication to the patient from an out-of-network provider before that provider gets the consumer’s in-network cost information must say — in bold, 12-point type — that it is “not a bill.”\u003c/p>\n\u003cp>“If it’s an out-of-network doctor, they shouldn’t be claiming that you owe anything right away,” Imholz says.\u003c/p>\n\u003cp>And don’t pay anything until you receive an Explanation of Benefits from your insurer, experts advise.\u003c/p>\n\u003cp>When you do receive it, inspect it. If you think you’re still being billed incorrectly, call your health plan and file a grievance, says Mary Watanabe, DMHC’s deputy director of health policy. Your plan will have 30 days to resolve the problem.\u003c/p>\n\u003cp>If your plan doesn’t resolve the situation within that time frame, or you’re dissatisfied with the decision, it’s time to call your regulator. For most of you, that will be DMHC: \u003ca href=\"http://www.healthhelp.ca.gov/\">www.healthhelp.ca.gov\u003c/a> or 888-466-2219. To reach the Department of Insurance, visit \u003ca href=\"http://www.insurance.ca.gov/\">www.insurance.ca.gov\u003c/a> or call 800-927-HELP.\u003c/p>\n\u003cp>You can also call your regulator \u003cem>before\u003c/em> you hear back from your health plan, particularly if out-of-network providers are hassling you for payment.\u003c/p>\n\u003cp>If you inadvertently paid an out-of-network provider more than he or she is owed, all is not lost. The doctor has to refund the overpayment within 30 days, Ma says. Otherwise, interest starts to accrue.\u003c/p>\n\u003cp>One warning: The law allows out-of-network providers to bill you out-of-network rates, but only if you voluntarily sign a form at least 24 hours before you receive care, Imholz says. The form must include an estimate of your cost and explain that you can receive care from an in-network provider instead, she says.\u003c/p>\n\u003cp>“You don’t have to sign it. It’s completely voluntary.”\u003c/p>\n\u003cp>If you actually do want to be seen by an out-of-network provider and are willing to pay the out-of-network charges, you still have to sign the consent form.\u003c/p>\n\u003cp>Since this law kicks in July 1, the surprise medical bills Powers received after his lung surgery won’t be covered. Orsi says Powers can’t afford to pay them.\u003c/p>\n\u003cp>“I don’t think it’s fair,” she says. “I’m going to keep fighting it.”\u003c/p>\n\u003cp>There may be hope. If, like that Southern California couple, you’re currently fighting a surprise bill for a service you received before July 1, Watanabe urges you to call DMHC anyway.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We can often help,” she says.\u003c/p>\n\n",
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"excerpt": "A California law that takes effect July 1 prohibits out-of-network charges if you visit a medical facility that’s in your health plan’s network.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Before Kevin Powers underwent lung cancer surgery last October, his girlfriend, Agi Orsi, meticulously checked and double-checked to be sure his Santa Monica hospital and surgeon were in his health plan’s network. They were.\u003c/p>\n\u003cp>Even in the hospital, Orsi dutifully wrote “No out-of-network doctors” across the top of Powers’ admission paperwork.\u003c/p>\n\u003cp>Her diligence was for naught.\u003c/p>\n\u003cp>Powers, 57, suffered serious complications, resulting in a two-week hospital stay that included visits from several specialists. It also resulted in a barrage of surprise medical bills from some of those specialists charging out-of-network rates.\u003c/p>\n\u003cp>The bills total about $5,600 — so far.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s overwhelming,” says Orsi, 64, who lives with Powers in Topanga Canyon. “I feel like consumers are at a major disadvantage.”\u003c/p>\n\u003caside class=\"alignright\">\u003cimg src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/bazar_100.jpg\" alt=\"\" width=\"100\" height=\"133\" class=\"alignleft size-full wp-image-348286\">\u003cstrong>Ask Emily\u003c/strong>\n\u003cp>Answering consumers’ questions about California’s changing medical landscape.\u003cbr>\n\u003cbr>\nSend questions for Emily to \u003ca href=\"mailto:AskEmily@kff.org\">AskEmily@kff.org\u003c/a>\u003c/p>\u003c/aside>\n\u003cp>Starting next month, many Californians will be protected against such surprise medical bills from out-of-network providers, also known as “\u003ca href=\"http://www.kff.org/private-insurance/issue-brief/surprise-medical-bills/\" target=\"_blank\" rel=\"noopener noreferrer\">balance billing\u003c/a>.”\u003c/p>\n\u003cp>Under a \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB72\" target=\"_blank\" rel=\"noopener noreferrer\">new state law\u003c/a>, if you visit an in-network facility — such as a hospital, lab or imaging center — you will be responsible only for your in-network share of the cost, even if you’re seen by an out-of-network provider.\u003c/p>\n\u003cp>The \u003ca href=\"http://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactSheets/fsab72.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">law\u003c/a> applies to non-emergency services received on or after July 1.\u003c/p>\n\u003cp>“This is a very big deal,” says Tam Ma, legal and policy director for the advocacy group \u003ca href=\"http://www.health-access.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Health Access California\u003c/a>. “We’ve heard from hundreds of consumers who were getting these surprise bills.”\u003c/p>\n\u003cp>A 2015 Consumers Union \u003ca href=\"https://consumersunion.org/wp-content/uploads/2015/05/Surprise-Bills-Survey-CA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">survey\u003c/a> found that nearly 1 in 4 Californians who visited a hospital or had surgery in the previous two years were charged an out‐of‐network rate when they thought a provider was in‐network.\u003c/p>\n\u003cp>Here’s a common scenario: A patient takes pains to ensure her hospital and surgeon are in network, only to get billed by the out-of-network anesthesiologist who appears at her bedside to put her under.\u003c/p>\n\u003cdiv id=\"attachment_239562\" class=\"wp-caption alignleft\" style=\"width: 380px\">\n\u003cp>\u003cimg class=\"wp-image-239562 size-khn-article-small\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/agikevin-770.jpg?w=370&h=247&crop=1\" alt=\"\" width=\"370\" height=\"247\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers (right) is facing more than $5,000 in surprise medical bills from his October lung cancer surgery even though his girlfriend, Agi Orsi (left) took pains to ensure his hospital and surgeon were in his health plan’s network. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>“No one gets to pick their anesthesiologist,” Ma says. “It depends on who is on duty, who is available.”\u003c/p>\n\u003cp>Surprise bills also often come from pathologists, radiologists and assistant surgeons — other providers that patients typically can’t choose, she says.\u003c/p>\n\u003cp>The new law covers Californians with private health insurance plans that are regulated by the state Department of Managed Health Care (DMHC) and the state Department of Insurance, which includes roughly 70 percent of the state’s private insurance market, according to the California Health Care Foundation. (California Healthline is an editorially independent publication of the California Health Care Foundation.)\u003c/p>\n\u003cp>It does not cover some 5.7 million people whose employer-sponsored insurance plans are regulated by the U.S. Department of Labor.\u003c/p>\n\u003cp>Insurers, health care providers and regulators are working furiously behind the scenes to hash out some details about that law, including how much out-of-network providers should be compensated for their services.\u003c/p>\n\u003cp>But that shouldn’t affect you.\u003c/p>\n\u003cp>“Is it going to be pretty as plans and providers figure this out in the background? Maybe not,” says Charles Bacchi, president of the \u003ca href=\"http://www.calhealthplans.org/\" target=\"_blank\" rel=\"noopener noreferrer\">California Association of Health Plans\u003c/a>. “But what’s important is that it’s not readily apparent to the consumer.”\u003c/p>\n\u003cp>The key point to remember is that you shouldn’t pay more than your in-network copayment, coinsurance or deductible, as long as you visited an in-network facility for non-emergency services.\u003c/p>\n\u003cp>So, if you receive what looks like a bill from a provider showing an out-of-network rate, don’t panic, says Betsy Imholz, director of special projects for \u003ca href=\"https://consumersunion.org/experts/elizabeth-betsy-imholz/\" target=\"_blank\" rel=\"noopener noreferrer\">Consumers Union\u003c/a>.\u003c/p>\n\u003cdiv id=\"attachment_239563\" class=\"wp-caption alignleft\" style=\"width: 280px\">\n\u003cp>\u003cimg class=\"wp-image-239563 size-khn-article-vertical\" title=\"\" src=\"https://californiahealthline.files.wordpress.com/2017/06/kevin-in-hospital-770.jpg?w=270&h=405&crop=1\" alt=\"\" width=\"270\" height=\"405\">\u003c/p>\n\u003cp class=\"wp-caption-text\">Kevin Powers suffered serious complications after his lung cancer surgery last October, resulting in a two-week hospital stay and surprise out-of-network bills. He is shown here in the hospital after surgery. (Photo courtesy of Agi Orsi)\u003c/p>\n\u003c/div>\n\u003cp>First, read it carefully. It may not actually be a bill. Under the law, any communication to the patient from an out-of-network provider before that provider gets the consumer’s in-network cost information must say — in bold, 12-point type — that it is “not a bill.”\u003c/p>\n\u003cp>“If it’s an out-of-network doctor, they shouldn’t be claiming that you owe anything right away,” Imholz says.\u003c/p>\n\u003cp>And don’t pay anything until you receive an Explanation of Benefits from your insurer, experts advise.\u003c/p>\n\u003cp>When you do receive it, inspect it. If you think you’re still being billed incorrectly, call your health plan and file a grievance, says Mary Watanabe, DMHC’s deputy director of health policy. Your plan will have 30 days to resolve the problem.\u003c/p>\n\u003cp>If your plan doesn’t resolve the situation within that time frame, or you’re dissatisfied with the decision, it’s time to call your regulator. For most of you, that will be DMHC: \u003ca href=\"http://www.healthhelp.ca.gov/\">www.healthhelp.ca.gov\u003c/a> or 888-466-2219. To reach the Department of Insurance, visit \u003ca href=\"http://www.insurance.ca.gov/\">www.insurance.ca.gov\u003c/a> or call 800-927-HELP.\u003c/p>\n\u003cp>You can also call your regulator \u003cem>before\u003c/em> you hear back from your health plan, particularly if out-of-network providers are hassling you for payment.\u003c/p>\n\u003cp>If you inadvertently paid an out-of-network provider more than he or she is owed, all is not lost. The doctor has to refund the overpayment within 30 days, Ma says. Otherwise, interest starts to accrue.\u003c/p>\n\u003cp>One warning: The law allows out-of-network providers to bill you out-of-network rates, but only if you voluntarily sign a form at least 24 hours before you receive care, Imholz says. The form must include an estimate of your cost and explain that you can receive care from an in-network provider instead, she says.\u003c/p>\n\u003cp>“You don’t have to sign it. It’s completely voluntary.”\u003c/p>\n\u003cp>If you actually do want to be seen by an out-of-network provider and are willing to pay the out-of-network charges, you still have to sign the consent form.\u003c/p>\n\u003cp>Since this law kicks in July 1, the surprise medical bills Powers received after his lung surgery won’t be covered. Orsi says Powers can’t afford to pay them.\u003c/p>\n\u003cp>“I don’t think it’s fair,” she says. “I’m going to keep fighting it.”\u003c/p>\n\u003cp>There may be hope. If, like that Southern California couple, you’re currently fighting a surprise bill for a service you received before July 1, Watanabe urges you to call DMHC anyway.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
"meta": {
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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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",
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"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",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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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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"order": 1
},
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"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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"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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"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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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"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",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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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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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"here-and-now": {
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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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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"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.",
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"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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},
"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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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",
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"order": 15
},
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},
"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",
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"order": 18
},
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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/",
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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)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"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",
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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/",
"meta": {
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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": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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