June 24, 2017

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Health June 24, 2017

What Medicaid Cuts Could Mean For The Opioid Epidemic

NPR’s Michel Martin speaks with Lynn Cooper, director of the Drug and Alcohol Division at Pennsylvania’s Rehabilitation and Community Providers Association, about the Senate GOP healthcare bill.

MICHEL MARTIN, HOST:

We wanted to take a closer look at one particular issue with the Senate’s new health care bill that has been raised by a number of skeptics and critics including President Obama in a Facebook post on Thursday. That’s the question of how the Senate GOP bill will affect efforts to combat a growing public health crisis – opioid addiction.

According to an estimate from The New York Times, drug overdoses are now the leading cause of death for Americans under 50. The Senate bill proposes $2 billion for treatment and recovery services through 2018 to offset cuts to Medicaid funding at the state level. Democrats and even some Republican lawmakers say that’s tens of billions of dollars too little to adequately address this crisis.

To hear more about this, we called Lynn Cooper. She is director of the drug and alcohol division at Pennsylvania’s Rehabilitation and Community Providers Association that oversees some 170 substance abuse related health care facilities around the state of Pennsylvania. And she’s with us now from her home in Pittsburgh. Lynn Cooper, thank you so much for speaking with us.

LYNN COOPER: Thank you. It is indeed my pleasure.

MARTIN: So I call this a crisis. Is it a crisis?

COOPER: I think it’s way past crisis. It goes beyond just a drug epidemic. It is a death epidemic all over the country. The loss of Medicaid expansion will be like the bottom dropping out for thousands of Pennsylvania citizens and their families.

MARTIN: So let’s – walk me through this. So how many people would you say are getting treatment in your network now? And have you seen a big increase in recent years? Can you just give us some numbers to help us see the scope of the thing?

COOPER: Absolutely. According to the Pennsylvania Department of Human Services, we’re talking an additional 855,000 citizens have been newly enrolled in medical assistance. And at least 100,000 of those are folks struggling with substance use disorder.

MARTIN: You said that about 850,000 people have been newly enrolled. Is that because of the Affordable Care Act?

COOPER: Oh, absolutely. That’s the Affordable Care Act. That’s because of Medicaid expansion.

MARTIN: I think you were telling us earlier that Medicaid overwhelmingly pays for. That…

COOPER: Yes.

MARTIN: …Is the major source of funding for substance abuse treatment in Pennsylvania. Why is that?

COOPER: Basically, in the state of Pennsylvania right now, we have Health Choices, which is a managed care of Medicaid. And it has been extremely effective in our state. But the problem we had before Medicaid expansion is that many people were not eligible despite the fact that they were very poor and unemployed.

Before Medicaid expansion, our counties were running out of money. Now, today, this Medicaid expansion has absolutely stopped that. And a lot of the people that the county funds were paying for are now being covered by Medicaid expansion. But I got to be honest with you. Even with Medicaid expansion, we still have people that are not able to access treatment due to the lack of funding.

And when we heard talk in Washington about adding $2 billion to this problem, I can tell you right now, $2 billion wouldn’t even be enough for the state of Pennsylvania. Eighty-five to 90 percent of all of the clients that we serve are Medicaid or program funded. And this would be devastating to our treatment programs.

MARTIN: So if the Senate bill passes in its current form, it would cap Medicaid. And that would require the states to make choices about who gets the funding. What is your worst case scenario?

COOPER: Worst case scenario. The state of Pennsylvania already has a $3 billion deficit. And if we do end up having to choose between programs, if our leaders are forced to do that, it’s unfortunate. But very often, drug and alcohol ends up the last on the totem pole. When you’re competing for funding, it’s hard. I mean, someone who needs kidney dialysis or someone who is severely intellectually disabled and then you have the drug addict.

The stigma that exists for drug addiction right now remains terrible. People have a hard time understanding that there’s a ripple effect. And part of it is an emotional and family effect. And the other part is a financial and a fiscal effect because we’re going to be increasing costs in children and youth.

Eighty percent of children that are removed from their home are removed due to a substance use disorder. Now we have displaced children that need foster care. We’re going to be increasing costs in jails and prisons. Our jails right now across the country are full of people who need drug and alcohol treatment. The opioid crisis affects everybody of all walks in life.

MARTIN: That’s Lynn Cooper. She’s director of the drug and alcohol division at Pennsylvania’s Rehabilitation and Community Providers Association. She was kind enough to join us from her home office in Pittsburgh. Lynn Cooper, thank you so much for speaking with us.

COOPER: Thank you very much.

(SOUNDBITE OF SHARON VAN ETTEN’S “JUST LIKE BLOOD”)

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Business June 24, 2017

Some U.S. States Relax Restrictions On Cladding Suspected In Grenfell Tower Fire

The cladding used in a 2016 refurbishing of Grenfell Tower in London helped last week’s fatal fire spread. The combustible material is permitted in some parts of the U.S.

Niklas Halle’n /AFP/Getty Images

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Niklas Halle’n /AFP/Getty Images

The type of siding or “cladding” used on the Grenfell Tower in London — and suspected of feeding the massive fire that killed dozens of residents — is not allowed on the exterior of tall buildings across most of the U.S.

But a few states and the District of Columbia have relaxed their building codes in recent years and have started to permit the material’s use.

The cladding installed on Grenfell Tower as part of a 2016 refurbishing project has become a focus for investigators. NPR’s Frank Langfitt has confirmed that the cladding had a combustible polyethylene core rather than a more fire-resistant mineral core.

At least 79 people died last week when the fire spread quickly through the 24-story public housing tower. Investigators say a refrigerator started the fire, which then spread to the cladding outside.

Prime Minister Theresa May told Parliament this week that similar cladding on other buildings has been found to be combustible. Reuters reports that at least 600 buildings in England use the same type of cladding and that authorities are testing the material to determine whether other buildings are at risk of fire.

In the United States, most jurisdictions don’t allow this type of cladding for buildings higher than 40 feet. That is because they’ve adopted the International Building Code, which requires cladding for tall buildings to pass a rigorous test developed by the National Fire Protection Association called “NFPA 285.” The purpose of the test is to ensure that installed cladding will be noncombustible.

In recent years, a few U.S. jurisdictions have eliminated this testing requirement. They now permit cladding similar to what was believed to be used on the Grenfell Tower, as long as the building has other fire safety measures in place, such as a working sprinkler system. (The Grenfell Tower reportedly did not have sprinklers.)

This softening of some U.S. building codes upsets Tulsa, Okla.-based fire protection engineer John Valiulis. He says D.C. and three states — Minnesota, Indiana and Massachusetts — have exempted cladding from NFPA 285 testing.

Valiulis wrote a report about the topic for the Fire Safe North America group. In it, he details a series of cladding fires around the world that were similar to the Grenfell Tower fire. None were in the U.S., and he says there is a good reason for that.

“The fire protection engineering profession in the U.S. is quite active and is often very proactive,” says Valiulis.

Thirty years ago, when it became clear builders would start using more of this type of cladding, he says, the NFPA test was developed to determine whether combustible materials used within cladding might pose a fire danger.

But that test can be expensive — potentially costing $30,000 or more. And usually a new test must be conducted for each building because the cladding specifications change.

A panel of external cladding was removed from the Dorney tower block in north London. Tower blocks across England are being tested to check whether their outer coverings pose a serious fire risk following the Grenfell Tower disaster.

Niklas Halle’n/AFP/Getty Images

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Niklas Halle’n/AFP/Getty Images

Cost is a primary reason the D.C. Construction Codes Coordinating Board, which is under the Department of Consumer and Regulatory Affairs, removed the testing requirement. DCRA spokesman Matt Orlins says that during a 2012 code review process, building designers said they were concerned about the difficulty of finding cladding that passed the NFPA 285 test.

“The board agreed that the concerns were valid and that other portions of the codes did provide safeguards,” says Orlins. So the board eliminated the requirement.

Advocates for eliminating the NFPA 285 testing requirement have said it’s a prudent cost-saving change, given the lack of dramatic fires in the United States like the Grenfell Tower fire. And they point out that most fires start inside a building, where required sprinklers are likely to keep a fire from spreading to the cladding outside.

NPR contacted firms that have pushed for code changes in the District and Minnesota, but those businesses either did not respond or declined to comment.

Valiulis doesn’t accept their argument. Like most fire protection engineers, he wants multiple safety systems in place in case one fails.

“When a code is well-written and properly anticipates problems, people observe a lack of incidents, and often assume that the code must be asking for overkill,” says Valiulis. But he says that also can be a sign that “the code got it exactly right.”

Now, at least one of the jurisdictions that relaxed its building codes may reverse course.

As more cladding options that comply with NFPA 285 have come onto the market in recent years, Orlins with the DCRA says the agency plans to put the testing requirement back into the next revision of the District’s building code.

And Orlins says, “The District is also evaluating whether the change ought to be adopted as an amendment to the current code.”

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Sports June 24, 2017

Saturday Sports: The NBA Draft

The NBA draft took center stage this week in the world of sports, and many are wondering what the new picks will mean for championship-winning teams.

MELISSA BLOCK, HOST:

Time now for sports.

(SOUNDBITE OF MUSIC)

BLOCK: The dust is settling after Thursday night’s NBA draft. Do the 60 new players selected change the landscape? Are some teams now contenders – enough to challenge the mighty Golden State Warriors? Spoiler alert – no. All right, maybe.

NPR sports correspondent Tom Goldman joins me now. Good morning, Tom.

TOM GOLDMAN, BYLINE: Good morning, Melissa.

BLOCK: And we thought we were done with the NBA after the…

GOLDMAN: (Laughter).

BLOCK: …Warriors so handily dispatched Cleveland nearly two weeks ago. But I guess there is no off switch with the NBA. Fans very fired up about Thursday’s draft. So…

GOLDMAN: Yeah.

BLOCK: …Does anything look different now?

GOLDMAN: It does. Several teams that have been bad over most, if not all, of the past decade are suddenly looking like teams that could be good. Sacramento and Philadelphia, which had the first-round pick, added to their growing rosters of young talented players. Minnesota pulled off the big draft night trade, getting a star player in his prime, Jimmy Butler from Chicago.

And Thursday was just the start. Next month, there’s the free agency period. And we’ll see established players moving to new teams trying to beef up their rosters as everyone plays the game, Melissa, Chase the Warriors.

BLOCK: Well, if that’s the game, Tom, who wins?

GOLDMAN: (Laughter) The Warriors…

BLOCK: (Laughter).

GOLDMAN: …If Golden State can stay healthy and keep its team together. They’ve got a bunch of free agents who could go elsewhere. But Golden State is expected to retain its core, which means a very good chance of more titles coming up.

BLOCK: Tom, let’s go back to the draft for a second. It looked like freshman orientation out there, a record 16 college freshmen drafted in the first round. These are the so-called one-and-done players. What’s the takeaway from that?

GOLDMAN: That more and more young men feel they’re ready to go. And NBA teams are ready to take a chance on them. Most kids that age aren’t NBA-ready, but teams are willing to invest and develop them. It has generated more conversation about, when is the right time to let these young men pursue their pro careers?

Should they be allowed to go pro out of high school? The rule has said no for the past decade. Or should they be delayed even more so they can be more mature when they get to the NBA? And if you do that, is it fair not to compensate them somehow because they’ll be missing out even longer on a big NBA payday? It does appear that change is coming. NBA Commissioner Adam Silver said recently the one-and-done system is not working for anyone.

BLOCK: Tom, let’s close with the news of the death this week of Tony DiCicco, the former coach…

GOLDMAN: Yeah.

BLOCK: …Of the U.S. women’s national soccer team, very popular guy and dying way too young. He was 68.

GOLDMAN: Yeah, very popular and very successful coach – he led the U.S. women to the 1996 Olympic gold medal and the 1999 World Cup title, which gave us that iconic Brandi Chastain moment when she scored the winning penalty kick and ripped off her jersey in celebration.

BLOCK: Who can forget?

GOLDMAN: Who can forget? And DiCicco, by the way, subbed her in in the last minute because he knew she thrived in big moments, a great decision, one of many.

BLOCK: When you think about that ’99 team…

GOLDMAN: Yeah.

BLOCK: …Anthony DiCicco – What were his gifts as coach?

GOLDMAN: Well, you know, beyond his tactical skills, he had an ability to get the most out of very talented players. You know, people think it’s easy with superteams – you just roll the ball out. But it takes more. DiCicco understood coaching a women’s team is different. You need to be tough and demanding but also you have to build relationships, which often are more important in women’s sport – women’s team sport. And he had this infectious joy. One player talked – told me that he would walk out onto the practice field and shout, I love my job, and the players would laugh and then get to work.

BLOCK: OK. NPR’s sports correspondent Tom Goldman – Tom, thanks so much.

GOLDMAN: Thank you, Melissa.

(SOUNDBITE OF CORDUROI’S “BANGARANGARANG”)

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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