A trio of toilets, photographed by Samantha Russell, a Peace Corps volunteer, in Viti Levu Island, Fiji. Samantha Russell/Courtesy of PATHhide caption
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Samantha Russell/Courtesy of PATH
How do you get people to discuss diarrhea? Ask them to write poetry about it.
That’s the idea behind Poo Haiku, a competition created by Defeat DD, a campaign dedicated to the eradication of diarrheal disease.
Although everybody’s had the runs, it’s not something most folks talk about, says Hope Randall, digital communications officer for PATH’s Center for Vaccine Innovation and Access, which created DefeatDD to bring together resources on vaccines, nutrition, oral rehydration therapy, sanitation and more.
Silence is a problem because diarrheal disease is a problem. It’s the second-leading cause of death for children under the age of five. And it disproportionately affects kids in the developing world, where it’s tougher to access safe water and medical care.
Attention translates into more resources, Randall says, which is why Defeat DD wants to get people comfortable with words like “poo.” Hence, the call for “poo-ets” to write “poo-ems.”
Turns out there are plenty of potty mouths eager to show off their creativity. For the third Poo Haiku contest, which wrapped up on Nov. 4, Twitter was flush with submissions — a record 146 poo-ems, Randall boasts. The prize? Social media fame and the chance to be featured in DefeatDD’s 2017 calendar, which will be shaped like a toilet.
Most contributions came from the global health world. Take, for example, this winning entry from Kat Kelley of the Global Health Technologies Coalition, which references a recent study published in The Lancet:
Just six pathogens
But eighty percent of kids’
Diarrheal deaths.
Currently, there’s only a vaccine for one of these six pathogens — rotavirus, Randall notes. So DefeatDD is pushing for investment in vaccines to fight two more, ETEC, a type of E. coli bacteria, and Shigella.
The other pressing item on the DefeatDD agenda, Randall says, is the need to address the fact that even kids who survive diarrhea often deal with long-term consequences. Randall herself penned an entry on that topic:
A vicious cycle,
Gut damage, malnutrition
We can halt the churn.
Some Poo Haiku are more emotional than informational. Alanna Imbach, media relations manager for WaterAid, offers a good reminder that behind the stats, there are individual children out there facing hurdles to hygiene:
She is just a girl
Out looking for a toilet
Trying not to fear.
Other “poo-ems” will put a smile on your face, promises Randall, who’s partial to this one from a fifth grader who learned about Poo Haiku at school:
Go now, Mister Poo
Hurry, quick to the toilet,
When done wash your hands.
The ultimate winner, of course, is the fight against diarrheal disease. “As simple as it sounds, these kinds of words are so rarely used in polite discourse,” Randall says, noting that anything that helps poo become public makes the campaign a success.
Although the contest is now over, Randall would love to see people continue to share poo-ems through Saturday, which is World Toilet Day — the annual reminder that 2.4 billion people don’t have access to a toilet. Check out all of the poo-ems, including some videos, by searching for the hashtag #poohaiku on Twitter.
Opened in 1816 on the old Bel-Vue estate bordering the East River, the so-called Bellevue Establishment was the largest and most expensive building project in the city’s history to date, containing an almshouse, an orphanage, a lunatic asylum, a prison and an infirmary. An infectious disease hospital would be added in 1826. Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubledayhide caption
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Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday
When he was growing up in New York, All Things Considered host Robert Siegel always knew that Bellevue Hospital was a city institution.
But it wasn’t until he read David Oshinsky’s book Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital, that he realized the hospital was a pioneering institution for all of American medicine.
The hospital, which grew out of an almshouse founded in 1736, has been in the forefront of many innovations in medicine in the U.S. Advances that started at Bellevue included ambulances, a maternity ward, nursing school, a children’s clinic and forensic pathology.
Siegal talked with Oshinsky, a professor of history at New York University, about the hospital and how it reflects the advances and failures of medicine. The interview has been edited for length and clarity.
In 1876, O.G. Mason, Bellevue’s official photographer, took a carefully staged photograph of a blood transfusion in progress. Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubledayhide caption
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Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday
Bellevue’s first class of interns, top, circa 1856. At bottom, America’s first professional nursing school opened at Bellevue in 1873. Preferring single, literate, religious women from cultivated families, it rejected most applicants on account of “bad breeding.” Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday; Courtesy of Bellevue Hospital Center Archive/Doubledayhide caption
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Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday; Courtesy of Bellevue Hospital Center Archive/Doubleday
Bellevue in the 18th century was really both a poorhouse and a pest house. It was a place you came to die. It really began with the great yellow fever epidemics of the 1790s. At that time the Bel-Vue estate, which became the hospital, was located on the East River, about two miles away from where most of New York was located down by the Battery. And you would send people who really had no chance of recovering.
On hospitals not being very good at saving lives in the first half of Bellevue’s history
Most physicians at Bellevue and elsewhere believed in the miasma theory — that clouds of bad air caused all kinds of disease. They had no concept that an invisible organism could cause so much damage, and that was what germ theory was about. Belluevue physicians were really on the forefront, particiularly the younger physicians, in pushing germ theory forward.
You also had a hospital where there was no anesthesia until the 1840s, and once anesthesia comes, postoperative infections are still extraordinarily high. It’s only when you have professional nursing and germ care and the coming of X-ray machines and the kind of pathology where you can actually do lab work within a hospital that makes a hospital better at saving a person’s life.
Applying the lessons he learned as a medical administrator in the Civil War, Edward Dalton organized the nation’s first civilian ambulance corps at Bellevue in 1869. Here, a Bellevue ambulance surgeon provides assistance to an injured New Yorker. Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubledayhide caption
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Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday
On Bellevue doctors treated two presidents — James Garfield and Grover Cleveland — with very different outcomes
Garfield was hit by two bullets, neither of which was fatal, but the lead surgeon was Frank Hamilton from Bellevue. And Hamilton came down to Washington and he put his finger into Garfield’s wound, and put dirty probes into Garfield’s wound. He didn’t die from the bullets, he died of the kind of infection was brought about by physicians who didn’t believe in germ theory.
About 15 or 20 years later, Grover Cleveland had a mass in his mouth which turned out to be cancerous. It was during the Great Panic of 1893, a serious economic depression. Cleveland did not want to alert his critics. So they hired a yacht with a number of Bellevue surgeons and physicians. They sailed up the East River to a very, very calm piece of water and they removed this mass from Cleveland’s mouth in a one and a half hour operation using every imaginable antiseptic technique available. Cleveland survived the operation and died of a heart attack many, many years later.
During the 1918-19 influenza pandemic, which killed upwards of 50 million people worldwide, patients at Bellevue slept in corridors, closets, and on beds of straw on the floors. No one was turned away. Courtesy of Bellevue Hospital Center Archive/Doubledayhide caption
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Courtesy of Bellevue Hospital Center Archive/Doubleday
How Bellevue’s response to AIDS epitomizes its ethos
Because it was the place that turned no one away, it dealt with anything that came through New York City: cholera with the Irish in the 1930s, tuberculosis with the Jews and the Italians about the turn of the century, the great influenza epidemics. Bellevue treated more AIDS patients than any hospital in the country, and more AIDS patients died at Bellevue than at any hospital in the country. Bellevue was really in crisis mode at that time.
AIDS was one of the big issues at Bellevue and hospitals across the country. Doctors were wary. There were studies done where even a percentage of young interns thought they had the right to determine whether they would treat these patients or not. In the end, and this is the important point, Bellevue prevailed. The Bellevue message prevailed. The ethos that we treat everybody, regardless of their disease, regardless of their social standing. And they did. And I think that people look back at that era with great pride.
The federal government spends more than $30 billion a year to fund the National Institutes of Health. What changes are in store under a new administration? NIH/Flickrhide caption
What could the world of medical research look like under a Trump administration?
It’s hardly an idle question.
The federal government spends more than $30 billion a year to fund the National Institutes of Health. That’s the single largest chunk of federal research funding spent outside the Pentagon’s sphere of influence.
Policy insiders confronted that question — albeit with an acute shortage of actual data — Monday at a meeting of health advocates in New York City.
The biotech and pharmaceutical companies, which are at the end of the drug-development pipeline, see encouraging signs for their enterprises. The stock market didn’t swoon. Oft-mentioned tax breaks could conceivably encourage drugmakers that have been harboring hundreds of billions of dollars in profits overseas, to bring some of that money back to the U.S.
And the Trump campaign’s anti-regulation rhetoric also rings as good news in the ears of Big Pharma.
Hillary Clinton’s campaign to rein in prescription drug prices also looks to be on the ropes, which may be more welcome news for companies than for consumers who have been shocked by rapid price increases.
At the Partnering for Cures meeting, Kay Holcombe, senior vice president of the Biotechnology Innovation Organization, a trade group, said she hoped Clinton’s drug-price campaign would fade. Holcombe told attendees that she prefers “a nonshrieking environment.”
What’s good for the pharmaceutical and biotech industry may not necessarily appeal to President-elect Donald Trump’s supporters, however. It doesn’t translate to rapid gains for struggling workers in the Rust Belt.
And there are fewer tea leaves to read when it comes to Trump’s support for universities and other government-funded parts of the nation’s biomedical enterprise. His campaign said little about research and development in general, or health research in particular.
“The fact that he did not take an ideological position may be a positive thing,” said Tanisha Carino, vice president for U.S. public policy at U.K.-based GlaxoSmithKline. Perhaps there’s a blank slate that can be influenced by people who care deeply about these issues.
She noted that science is an international endeavor (her company alone operates in 150 countries), and it could be harmed if isolationism were to hit medical research and related industries.
Antibiotic resistance, for example, is a global problem, with drug-resistant germs emerging and spreading all over the world. “We as a country can’t solve that,” she said.
And Keith Yamamoto, vice chancellor for science policy at the University of California, San Francisco, said he hopes there’s an opening to remind the Trump administration and its supporters in Congress that NIH research dollars are spent in their districts and support robust economies.
He also said he’d argue that bolstering basic biomedical research could speed up innovation and reduce the expense of drug development. “Let’s get back to the basics,” Yamamoto said. “That’s the kind of message that I would try to send.”
Yamamoto is among a group of prominent scientists who had drawn up policy plans for the next administration. Yamamoto acknowledged that he wasn’t exactly expecting to have the conversation with the Trump transition team.
There is at least one person close to Trump who has long been an advocate for a significant cash infusion for medical research: Newt Gingrich. He’s on some shortlists for a position that could direct his attention elsewhere. Even so, people at the advocates’ meeting in New York nodded in ready agreement when someone suggested that he’s one key person to watch.
You can contact Richard Harris with comments:rharris@npr.org.
President-elect Trump and Congress have a couple of options in deciding how to best repeal the Affordable Care Act, each with dramatically different impacts. NPR sorts through the options and looks at how existing Obamacare insurance plans will be affected.
KELLY MCEVERS, HOST:
Trump has said one of his top priorities as president is to repeal and replace Obamacare, but Senate Democrats could make an outright repeal tough. Trump says he’ll consider keeping two popular provisions, a requirement that insurers cover people with existing conditions and another that lets children stay on their parents’ policies until age 26.
As NPR’s Alison Kodjak reports, there are several ways to get rid of the rest of the health care law but not without creating major disruptions in the insurance market.
ALISON KODJAK, BYLINE: Democrats who supported the Affordable Care Act could use their filibuster power to block Trump and congressional Republicans from directly repealing the law. But there is a workaround. For bills related to the budget or taxes, the filibuster doesn’t apply. And Republicans in Congress gave it a test drawn earlier this year.
JOHN MCDONOUGH: Last fall and January of this year, they demonstrated quite convincingly that they could frame a budget reconciliation bill, get it through the House, get it through the Senate, get it to the president’s desk, which they did. President Obama vetoed it. President Trump would sign that bill.
KODJAK: That’s John McDonough, a professor at Harvard who is a Senate staffer who worked on Obamacare. He says if a similar bill passes next year without a replacement…
MCDONOUGH: Then we are looking at a national holy mess in the insurance market like we’ve never seen before.
KODJAK: That’s because the parts of the law that can be repealed in a budget bill are the ones that make the health insurance market function, says Karen Pollitz, a senior fellow at the Kaiser Family Foundation.
KAREN POLLITZ: The mandate to have health insurance or pay a penalty, the mandate on employers to provide health benefits and the tax credits and cost-sharing subsidies that make it affordable for people to get health insurance would be repealed.
KODJAK: What can’t be reversed that easily – the parts of the law that prevent insurers from discriminating against sick people.
POLLITZ: You can’t be turned down based on your health status. You can’t charge customers more based on their health status.
KODJAK: All of which make health insurance more expensive. Pollitz says this combination would lead healthy people who think insurance is too expensive to drop their policies and sick people to buy. Insurance companies will then raise prices to account for their sicker customer base, leaving more people to drop insurance.
POLLITZ: And that’s what sometimes is referred to as the death spiral.
KODJAK: As in killing the insurance market. An even faster way for a President Trump to deal a blow to Obamacare would be to drop an Obama administration appeal of a court ruling against the law.
Earlier this year, a federal judge ruled that subsidies designed to cut the costs in some policies are illegal. That’s because Congress didn’t appropriate money for the payments which go to health insurers. Dropping the appeal would leave the court ruling in place.
POLLITZ: That would either force them to jack up premiums or to just face tremendous losses.
KODJAK: Under either scenario, these experts say, the changes could lead to the end of the individual health insurance market. Alison Kodjak, NPR News, Washington.
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.
California Gov. Jerry Brown signed a Medicaid expansion into law as part of the state’s budget authorization in 2013. Rich Pedroncelli/APhide caption
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Rich Pedroncelli/AP
President-elect Donald Trump has vowed that he will repeal and replace Obamacare. Specifics are scarce, but one plan Trump has outlined would change how the federal government funds Medicaid, health coverage for low-income people.
Twenty-million Americans now have health coverage because of Obamacare. A full quarter of them are in California. And most of them are covered by Medi-Cal, California’s version of Medicaid.
“Winding back the clock would create all kinds of turbulence and disruption,” says Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.
Right now, the federal government shares the cost of Medicaid with the states, no matter how many people are enrolled. But Trump wants to put a limit on that funding and give states a fixed pot of money called a block grant.
“A block grant would give California greater flexibility in running the Medi-Cal program, but it would also give the state less money,” Levitt says.
California would feel the pain more than other states. “The effect is magnified in California in part because the state has been so successful in getting people signed up for coverage,” Levitt says.
And in California, 62 percent of Medi-Cal enrollees who have signed up since Obamacare allowed states to expand Medicaid are Latino, African-American, or Asian-American.
To save money, some states could pay doctors and hospitals less. But in California, payment rates are already the second lowest in the country.
“California can’t really pay much less than it does to providers,” says Gerald Kominski, a professor of health at the University of California, Los Angeles.
In the face of severe budget cuts, Kominski says, the only choice California really would have is to reduce services or reduce the number of people who get Medi-Cal.
“That would have a devastating consequence on the Medicaid expansion population in California, and would basically put everyone who’s been newly enrolled in the program back off the program,” he says.
It’s unclear how soon a Trump administration would change Medicaid funding, so health advocates are encouraging people to continue signing up for Medicaid and other coverage during the current Obamacare open enrollment season.
“California is not an island,” says Anthony Wright, executive director of Health Access, an advocacy group, adding that the state “must engage fully in the coming national debate on the future of health reform — especially as an example of what has been achieved, and what we can’t give up.”
This story is part of a reporting partnership with NPR, KQED andKaiser Health News, which is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.
Cigarette smoking continues to decline as taxes on tobacco rise. Gerald Herbert/APhide caption
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Gerald Herbert/AP
The number of cigarette smokers in the United States has dropped by 8.6 million since 2005 — and that fall could be accelerated by a tobacco tax just passed in California.
The Centers for Disease Control and Prevention says smoking rates have fallen from 21 percent of the adult population in 2005 to 15 percent in 2015, when the agency conducted its latest survey. The smoking rate fell by 1.7 percentage points between 2014 and 2015 alone — a substantial decline, according to a report Thursday in Morbidity and Mortality Weekly Report.
The proportion of cigarette smokers in the U.S. population, broken down by age, in 2005 and 2015. CDChide caption
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CDC
Smokers light up less when cigarettes are more expensive. So, more smokers may have been nudged to quit after the federal government increased tobacco taxes by 62 cents a pack in 2009. California voters approved a $2 a pack tax on Election Day, so rates there are likely to fall further.
“Raising the tobacco tax is probably the single most effective way to reduce smoking, especially among kids,” says Vincent Willmore, vice president for communication at the Center for Tobacco Free Kids. That organization and other public health advocates pressed for passage of the California tobacco tax. “The California vote was a huge victory for kids and health,” he says.
The tax will not only discourage people from purchasing cigarettes, it will also fund a renewed anti-smoking effort in the state, Willmore says.
While that initiative won, tobacco control advocates lost similar efforts in Colorado and North Dakota.
The story was topsy-turvy in Missouri, where the tobacco industry actually supported a 17-cent-per-pack tax, while advocates opposed it as too little to discourage smoking. Voters in Missouri rejected that tax.
Tobacco is the leading preventable cause of death in the United States. The CDC says it’s linked to 40 percent of all cancer cases, and 30 percent of cancer deaths. The government is striving to reduce smoking rates to 12 percent of the adult population by the year 2020, and is making progress toward that goal.
The latest drop in smoking rates was documented in the National Health Interview Study, which relies on people meeting face-to-face with survey-takers and reporting their habits. The 1.7 percentage-point drop between 2014 and 2015 is especially sharp, but it follows a recent downward trend.
In addition to the higher federal cigarette tax, there have been several national stop-smoking campaigns, such as The Truth. The Affordable Care Act has also increased access to smoking-cessation programs.
Progress nationally is uneven. The CDC’s new report notes that smoking rates are lowest in the West, even though taxes are higher elsewhere. They are highest in the Midwest.
Smoking is more common among men, and among American Indian/Native Alaskans. Smoking rates are low among Asians and people with college degrees.
Another trend has paralleled the recent decrease in cigarette smoking: Vaping has taken off in the United States. That has led some researchers to wonder whether some of the decline in cigarette use is a result of people switching to these vaping devices. At this point, there’s no data to show how much vaping is contributing to the downward trend in smoking.
E-cigarettes certainly aren’t a panacea. About 60 percent of adult people who use them also smoke cigarettes. Vaping also provides users with addictive nicotine doses. And public health officials are concerned that some youngsters who start vaping will then become smokers.
You can contact Richard Harris with comments:rharris@npr.org.
If the Trump administration decides to drop an appeal of a legal setback involving Obamacare subsidies, the insurance exchanges could be hobbled. Karen Bleier/AFP/Getty Imageshide caption
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Karen Bleier/AFP/Getty Images
Republicans have been vowing for six years now to repeal the Affordable Care Act. They have voted to do so dozens of times, despite knowing any measures would be vetoed by President Obama.
But the election of Donald Trump as president means Republican lawmakers wouldn’t even have to pass repeal legislation to stop the health law from functioning. Instead, President Trump could do much of it with a stroke of a pen.
Trump “absolutely, through executive action, could have tremendous interference to the point of literally stopping a train on its tracks,” said Sara Rosenbaum, a professor of law and health policy at George Washington University in Washington, D.C.
Trump is set to take office at a tricky time for the health law, with many Americans in both parties complaining about rising premiums and other out-of-pocket costs. The Republican-led Congress has refused to make changes to the law that would help it work better — such as offering a fix when insurers cancelled policies that individuals thought they would be able to keep. As staunch opponents of the law, they, of course, have little incentive to improve it.
When problems have arisen, Obama has often used his executive authority to try to solve them. And it’s this very mechanism Trump could use to undermine the law. As president, the Republican “can just reverse” Obama’s actions in many cases, said Nicholas Bagley, a law professor at the University of Michigan who writes about health policy. A president “can’t undo the basic architecture of the law, but you can throw sand into the gears,” he said.
Formal regulations would take time to undo, because they must follow a lengthy process allowing for public comment. But there are several measures Trump could take on Day One of his presidency to cripple the law’s effectiveness.
Perhaps Trump’s easiest action — and the one that would produce the largest impact — would be to drop the administration’s appeal of a lawsuit filed by Republican House members in 2014. That suit, House v. Burwell, charged that the Obama administration was unconstitutionally spending money that Congress hadn’t formally appropriated, to reimburse health insurers who were providing coverage to working-poor policyholders — those earning between 100 and 250 percent of the federal poverty line.
More than half of people who purchase insurance in the health exchanges get the additional help, which reduces out-of-pocket health spending on deductibles and coinsurance. While that help for consumers is required under the law, the funding was not specifically included. (Tax credits for people with incomes up to four times the poverty level to help defray the cost of premiums are a separate program and were permanently funded in the ACA.)
In April, Federal District Court Judge Rosemary Collyer ruled in favor of the House Republicans. “Such an appropriation cannot be inferred,” she wrote of the payments, and insurer “reimbursements without an appropriation thus violates the Constitution.” However, Collyer declined to enforce her decision, pending an appeal to a higher court. That appeal was filed in July and is still months away from resolution.
If Trump wanted to seriously damage the ACA, he could simply order the appeal dropped, letting the lower court ruling stand, and stop reimbursing insurers who are giving deep discounts to half their customers. That move would wreak havoc, said Michael Cannon of the libertarian Cato Institute, a longtime opponent of the health law. The insurers would still have to provide the discounts, as required by law, he said, “but they’re no longer getting subsidies from the federal government to cover the cost. So they are going to be selling insurance to these people way below the cost of that coverage.”
Even those who support the law say that mismatch would effectively shut down the health exchanges, because insurers would simply drop out. A Trump administration “really could collapse the federal exchange marketplace and the state exchanges if they end cost-sharing” payments to insurers,” said Rosenbaum, who has been a strong backer of the health law. There is already some concern about the continuing viability of the exchanges after several large insurers, including Aetna and United HealthCare, announced they would be dropping out for 2017.
Another way Trump could undermine the health law would be by simply not enforcing its provisions, particularly the individual mandate that requires most people to have insurance. That requirement is supposed to ensure that healthy as well as sick people sign up, thus spreading the costs of people with high bills across a larger population. But “executive branch non-enforcement could make a real difference to the vitality of the exchanges going forward,” Bagley said. If healthy people don’t sign up, sick people would need to pay more money for their insurance.
Aside from inflicting damage to the exchanges, the administration could also affect the law’s operations by refusing to approve states’ changes to their Medicaid programs. States rely on federal regulators to sign off on changes large and small, including which citizens are eligible, to keep their Medicaid programs operating. “There are so many things that an administration that doesn’t want a program to work can do,” Rosenbaum said.
The bigger question, though, is not what Trump could do to cripple the health law — it’s what he would do. He has addressed the issue only rarely — characterizing the health law as, simply, “a disaster” — and his plans for it aren’t clear. “It’s one thing to talk about ripping insurance from 20 million people” who are newly covered, Bagley said. “It’s another to actually do it.”
Health policy analysts on both sides of the aisle also still question where health care fits on Trump’s priority list.
“A big unknown is how aggressive Trump would remain in going beyond rhetorically opposing Obamacare,” said Thomas Miller, a resident fellow at the conservative American Enterprise Institute. “His report card as a presidential candidate reads, ‘Donald needs to improve his attention, effort, and study habits. He is easily distracted and seems to prefer just picking fights with others.’ “
Perhaps most important, Cato’s Cannon says, is not whether Trump could single-handedly undo the health law, but whether he could undermine it enough to force Congress to take action. If Trump were to do just enough to cause the insurance exchanges to fail, he said, “that would put pressure on Congress … to reopen the law.”
Editor’s note: A version of this story was first published by Kaiser Health News on Oct. 7.
Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. You can follow Julie Rovneron Twitter:@jrovner.
A court has blocked a new rule created by the Department of Health and Human Services that would preserve the right of patients and families to sue nursing homes in court. Saul Loeb/AFP/Getty Imageshide caption
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Saul Loeb/AFP/Getty Images
A federal district court in Mississippi has issued an injunction blocking a new rule that would preserve the right of patients and their families to sue nursing homes over quality-of-care disputes.
The rule, announced in September by the Centers for Medicare & Medicaid Services, would ban so-called pre-dispute binding arbitration clauses in nursing home contracts, which require patients and families to settle any dispute over care through arbitration, rather than the court system.
The rule was supposed to take effect Nov. 28, but the American Health Care Association, an industry group that represents most nursing homes in the U.S., filed a lawsuit in October to block the rule, which it called “arbitrary and capricious.”
The acting administrator for the Centers for Medicare & Medicaid Services argued in a September blog post that the rule improved the “care and safety of the nearly 1.5 million residents in the more than 15,000 long-term care facilities that participate in the Medicare and Medicaid programs.”
As we have reported, the rule applies to facilities that receive money from Medicare or Medicaid — which is nearly all of them.
The lawsuit by the AHCA also contests the authority of the Centers for Medicare & Medicaid Services to regulate how nursing homes handle disputes, saying that authority lies solely with Congress.
On Monday, a federal district court granted the injunction, even as it acknowledged that “nursing home arbitration litigation suffers from fundamental defects.”
The reason for granting the injunction, the court explained in its order, is that it believes the new rule represents “incremental ‘creep’ of federal agency authority” — in this case the Centers for Medicare & Medicaid Services — “beyond that envisioned by the U.S. Constitution.”
Last month, officials announced health care costs under the Affordable Care Act are expected to rise 22 percent. Rachel Martin speaks with Lindsay Travnicek, an Arizona woman who may forgo coverage.
UNIDENTIFIED WOMAN #1: I think most people hate to think of themselves as middle class.
UNIDENTIFIED WOMAN #2: You have what you need but maybe not everything you want.
UNIDENTIFIED MAN #1: We have a car, but we live in an apartment. That’s middle class.
UNIDENTIFIED MAN #2: If you add a boat, then you’re not middle class anymore. That’s what changes it right there.
UNIDENTIFIED MAN #3: The middle class are families who are earning six figures.
UNIDENTIFIED MAN #4: Thirty thousand, $35,000 probably.
UNIDENTIFIED MAN #5: That means me (laughter). And that means I’m in trouble (laughter).
RACHEL MARTIN, HOST:
It’s time now for our series Hanging On, where we look at some of the economic pressures of American life. Open enrollment for insurance under Obamacare began this past week. That’s after the administration announced that the cost of health care under the Affordable Care Act is expected to rise an average of 22 percent in 2017. Most people won’t actually pay that much more since federal subsidies will also go up. But those who don’t qualify for those subsidies could see a huge increase in their monthly insurance premiums.
Lindsay Travnicek is one of those people. She’s a self-employed dietitian, and she lives in Arizona. She joins us on the line now.
Lindsay, thanks for being with us.
LINDSAY TRAVNICEK: Thank you.
MARTIN: So tell me about the health insurance that you have now. What are your premiums, and what does it cover?
TRAVNICEK: So this year, I was insured through United Health Care over the exchange. And my plan was $255 a month. And I had a $2,000 deductible. So this year – my most recent research on the healthcare.gov – the lowest priced plan that I can get is $430. And the deductible is $4,200 now. And so that is the same plan that I had last year. So the deductible, it went up, you know, $2,200. And the monthly premium went up, you know, a little – you know, $210 or so.
MARTIN: So what does that mean to you? I mean, first of all – let me just ask – are you going to get a subsidy? We hear that subsidies are going to help people who are stretching to make this kind of payment.
TRAVNICEK: Yeah, I do not qualify for a subsidy. And also – I should also say I am a very healthy person. I have no chronic diseases. I take, you know, very good care of myself. And I don’t – you know, I feel that, you know – for me to pay for $430, which is a sizable chunk of disposable income, you know, for basically, sort of, just insuring that something doesn’t go wrong, I mean, that is – I guess I’m at a point now where that is a risk that I am willing to take.
I voted for Obama. And I voted for what I hoped would be a change in, you know, these insurance companies, you know, taking advantage of people and refusing to pay for care that people needed. And we are just getting – I feel like I’m getting the short end of the stick. You know, I’ve paid into the system a long time as a healthy person. And I just am choosing not to pay in any more.
MARTIN: So you’re not going to renew your health insurance for next year?
TRAVNICEK: No, I’m not.
MARTIN: Does that scare you a little bit to think about not having health care?
TRAVNICEK: Oh, my God, it’s terrifying. I come from a family of doctors and people in the medical field. And to us, you know, to go without health care is just – again, it is very risky. But I mean, this is just – I feel like, maybe I could just pay out of pocket and probably still come out ahead, even after paying the penalty for not having any coverage.
MARTIN: The presidential election is Tuesday. Arizona, where you live, is in play in a way it hasn’t been in the past. It’s a battleground state. Is this something you and your friends and family are talking about as a deciding factor when it comes to who you’re going to vote for?
TRAVNICEK: I have been in many discussions with my family, like I said, who’s in the health care field. And I’m really disappointed that neither candidate really touched on this topic in a more broad, deep way during the debates. They didn’t come up with solutions, what they would do. It was, you know, it was just, sort of, general talk about, we understand it’s not affordable. We need to change it. We need to fix it.
And so, you know, I voted for Hillary. And I don’t rescind that. But it is very – it’s very disheartening to me that neither candidate really touched on this in a – you know, a very tangible way as to what their solution was going to be.
MARTIN: Lindsay Travnicek on the line from Tempe, Ariz. We’ve been talking about the Affordable Care Act.
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Generic drugmaker Mylan is one of the companies reported to be the subject of a Justice Department investigation into pricing of generic drugs. Jeff Swensen/Getty Imageshide caption
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Jeff Swensen/Getty Images
The Justice Department is investigating the pricing practices of several generic drug manufacturers because the list prices of many older medications have risen in lockstep in recent years.
That investigation could lead to an antitrust lawsuit alleging price-fixing by the end of this year, according to a report by Bloomberg News. Bloomberg cited anonymous sources familiar with the probe.
The Justice Department declined to comment on the reported investigation for this story.
Many of the companies, including Teva, Mylan, Lannett Co., and Impax Laboratories, have disclosed in public securities filings that they are under investigation by the Justice Department and Connecticut Attorney General George Jepsen. Jepsen spokeswoman Jaclyn Falkowski declined to comment for this story.
“Mylan N.V. received a subpoena from the Antitrust Division of the U.S. Department of Justice (“DOJ”) seeking information relating to the marketing, pricing and sale of our generic Doxycycline products and any communications with competitors about such products. The company is fully cooperating with DOJ’s inquiry.”
An antibiotic, doxycycline is used to treat bacterial infections, including acne, and sometimes used to prevent malaria. The drug’s price rose more than 8,000 percent from Oct. 2013 to April 2014, according to a report that was part of a congressional inquiry.
“Mylan is and has always been committed to cooperating with the Antitrust Division’s investigation,” said spokeswoman Nina Devlin in an emailed statement. “To date, we know of no evidence that Mylan participated in price fixing.”
The other companies’ disclosures were similar, often with different medications such as digoxin, a heart failure treatment, named. The price of digoxin rose more than 800 percent to $1.10 a tablet between 2012 and 2014, according to the Congressional report. It has since declined, according to GoodRx.
Teva spokeswoman Denise Bradley said in a statement, “Teva is not aware of any facts that would give rise to an exposure to the Company with respect to these subpoenas.”
Lannett’s CEO said on a conference call that his company did nothing wrong.
The Bloomberg report comes on the same day that Sen. Bernie Sanders, (I-Vt.), and Rep. Elijah Cummings (D-Md.) sent a letter to the Justice Department asking it to investigate possible antitrust violations in the pricing of insulin. The lawmakers said the price of insulin products tripled from 2002 to 1013.
“Not only have these pharmaceutical companies raised insulin prices significantly – sometimes by double digits overnight,” the lawmakers wrote in their letter. “In many instances the prices have increased in tandem.”
