As he takes the stage Wednesday night at the Democratic National Convention in Philadelphia, vice presidential nominee Tim Kaine is firmly in Hillary Clinton’s camp — and his party’s — on the big health care issues. Now a U.S. senator from Virginia, Kaine supports the Affordable Care Act and pushed its Medicaid expansion. He also worked to overhaul the mental health system when he was governor of Virginia.

Here are highlights and a few flashpoints of controversy from Kaine’s health policy record:

Mental health

A defining moment in Kaine’s tenure as governor was the 2007 mass shooting at Virginia Tech, where 33 people, including the gunman — a student at the school — died.

Almost exactly one year later, Kaine signed a $42 million legislative package to overhaul the state’s mental health system. The money was used mostly for emergency mental health services, children’s mental health services, increased case managers and doctors and jail diversion projects, according to the Virginia Office of the Attorney General.

“Somebody shouldn’t be imprisoned because we won’t provide funding for community mental health,” Kaine said at a mental health conference in 2008, shortly after the bills were signed, according to the Virginian-Pilot in Norfolk.

The package of laws made it easier for authorities to commit someone having a mental health crisis into treatment involuntarily. They no longer had to prove the patient was in “imminent danger.” Instead, the new standard only required authorities to demonstrate a “substantial likelihood” that the person could cause serious harm to himself or others.

Together, Kaine and the state’s General Assembly made a down payment on longer-term reforms for the delivery of mental health and behavioral health services in Virginia, says Peter Cunningham, a professor of health behavior and policy at Virginia Commonwealth University.

Abortion

As a Catholic who worked with Jesuit missionaries in Honduras in 1980, Kaine says he opposes abortion personally but supports a woman’s right to choose for herself. His stance has drawn criticism over the years.

“Personally, I’m opposed to abortion and I’m opposed to the death penalty,” he said on NBC’s Meet the Press in June. “The right thing for government is to let women make their own decisions.”

That was a change from Kaine’s position in 2005, when he supported parental consent laws and bans on “partial birth” abortions, causing the Virginia chapter of NARAL Pro-Choice America to withhold an endorsement in his gubernatorial campaign. As governor, he signed a bill creating “Choose Life” license plates in Virginia, which he said was an issue of free speech.

Since then, Kaine has actively supported Planned Parenthood and opposed abortion restrictions.

In 2013, Kaine cosponsored legislation to improve access to contraception.

Affordable Care Act

Kaine did not mark himself as a health care reformer when he was Virginia’s governor, but his 2006-2010 term overlapped the recession when little change was happening anywhere at state or national levels, Cunningham points out.

“He was probably pretty typical of the middle-of-the-road Democratic governors in sort-of-purple states,” Cunningham says. “When the recession hit, that precluded any other major health reform effort that he might have contemplated.”

Kaine supported Obamacare when he ran for Senate in 2012 and has since cosponsored bills to improve the law. Kaine has pushed for Medicaid expansion in Virginia and cosponsored legislation to incentivize expansion in other states as well. Like Clinton, Kaine has proposed adjusting the federal health care law to include some low-income families that aren’t currently covered — fixing the so-called family glitch. This year, he cosponsored a bill to require more businesses to provide benefits under the ACA.

Public health

Kaine has occasionally incited controversy, as in 2007 when Virginia became the first state to require all girls to get the human papillomavirus vaccine (protection against a virus that can cause cervical cancer) before enrolling in high school. In 2009, he backed a bill that banned smoking in bars and restaurants in the tobacco-producing commonwealth.

Opioids

Since his election to the Senate four years ago, Kaine has cosponsored bills that would establish an advisory committee to help the FDA approve new opioids, reform guidelines for the VA regarding the prescription of opioids, protect first responders from lawsuits when they administer emergency drugs to counteract an overdose, and create a drug monitoring program for Medicare.

Many of those bills were rolled into CARA — the Comprehensive Addiction and Recovery Act of 2016, which was signed by President Obama in July. The bill bore Kaine’s name as a cosponsor.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Let’s block ads! (Why?)

With recent reports that drugmakers have sharply raised the prices of some prescription drugs, a reader has written in to ask why a common generic drug is also suddenly costing him more. Another reader has questions about health plans with high deductibles. Here are those readers’ questions, and what I’ve learned about the answers.

I take levothyroxine, the generic form of Synthroid, to treat a thyroid disorder. This generic has been on the list of drugs that cost $10 for a 90-day supply at my pharmacy for as long as I can remember. Starting in April, the drug was dropped from the list and the price rose 300 percent. The pharmacist tells me all the generic drug manufacturers are raising prices. How is it possible that this drug increased in price so quickly?

Generic drug price hikes have come under close scrutiny lately, as reports continue to surface of significant and seemingly inexplicable increases. Some drugs affected — including your thyroid medicine, as well as the common heart medicine digoxin — are widely used and have had relatively modest prices for years.

What gives? Health care professionals like your pharmacist often blame drug manufacturers, claiming they raise prices simply because they can. There’s no question that happens, says Dan Mendelson, president of the consulting firm Avalere Health. But there are other reasons that generic drug prices may increase as well.

For example, insurers may have simply changed the design of their health plan’s drug benefit, Mendelson says. They may have moved the drug into a higher tier — one that requires consumers to pay a bigger chunk of the cost. Drug prices also sometimes increase because the cost of manufacturing or distributing the drug has increased.

But consumers don’t have to simply pay up. Drug costs often vary widely from pharmacy to pharmacy, so shopping around makes financial sense. In addition, some retailers offer rock-bottom prices on dozens of generic drugs to consumers who pay cash. If you’re ponying up $4 in cash instead of a $30 copay for each refill, the savings can quickly add up.

Do you know of any insurance carriers that are selling high-deductible marketplace plans where once the deductible is met, the plan pays 100 percent of the costs after that? In other words, the deductible and the out-of-pocket maximum would both be the same?

It’s not unusual to find plans that are structured the way you describe, particularly among bronze-level plans, says Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute. Blumberg and colleagues analyzed the availability of these plans on the federal marketplace, which runs the insurance exchanges for about two-thirds of U.S. states.

Such a plan might have a deductible of $6,850 for individual coverage, for example, which is also the maximum that someone with an individual plan can be required to spend out of pocket for covered care in 2016.

Some insurers have touted this type of plan for its simplicity, noting that there’s only one number to keep track of. Still, at the bronze level, a health plan that picks up all costs after the deductible is met is likely to have a deductible of several thousand dollars. Bronze plans are the least generous of the four levels of coverage on the exchange.

Still, even in a high-deductible plan, some care is covered before the deductible is met, including preventive services. Under the Affordable Care Act, consumers don’t have to pay out of pocket for preventive care if it has been recommended by the U.S. Preventive Services Task Force. In addition, some insurers offer plans that cover a certain number of primary care visits or generic drugs, for example, that are exempted from the deductible.

If you’re considering a plan whose deductible and out-of-pocket maximum are the same, Blumberg says, carefully check the particulars of what’s covered.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Health care reporter Michelle Andrews’ column appears as part of NPR’s partnership with Kaiser Health News. Andrews is on Twitter: @mandrews110

Let’s block ads! (Why?)

Imagine your heart can no longer pump enough blood to your vital organs. Even minimal exercise tires you out, and you’re often short of breath when lying flat. Your lungs are accumulating fluid. Your kidneys and liver are impaired.

You’ve been hospitalized and started on an intravenous drug that improves your heart’s ability to contract. It has helped, but it is not a long-term solution. You need a new heart.

You’re a good candidate, but there is a problem: a chronic shortage of donor hearts. In 2014, for example, about 6,950 Americans were approved for heart transplants, but only about 2,250 donor hearts became available. You need to move higher up on the list.

I’m your doctor. I want to help you get you a heart. But I face an ethical dilemma: Do I ramp up your medical treatment, even beyond what I consider necessary, to bump you higher on the list?

Aiming for Status 1A

The United Network for Organ Sharing, or UNOS, has established criteria to make sure that donor hearts go to patients with the most severe disease. These criteria are based on which treatments a doctor has prescribed, on the assumption that they’re a good indication of how critical the illness is.

Generally, that’s a fair assumption. Except that the system itself creates a perverse incentive.

It works like this: Your place on the waiting list for hearts depends on your “status.” If you weren’t getting that IV drug, you’d be considered “Status 2,” and your median wait time for a heart would be 630 days. Not good.

You’re on the IV drug, though, so you’re considered “Status 1.” But “Status 1” is divided into two more categories: If you’re on a low dose of the IV drug, you’re classified as “1B,” cutting your median wait to 301 days. That’s where you are now. Better, but still not great.

But if you were in an intensive care unit, receiving a high dose of your IV drug, and you had a catheter placed in your pulmonary artery to monitor cardiac performance, you would be “Status 1A.” Your median wait would drop to 110 days.

So you’re unlikely to get a heart anytime soon unless you can be listed as 1A. And in your case, if you weren’t up for a transplant, there would be no call to implant a pulmonary-artery catheter; it’s uncomfortable (it is inserted through your neck or under your collarbone) and carries a risk of infection. There would also be no call to raise your dose of the IV drug that’s helping your heart contract; when used long term, higher doses can increase the risk of sudden cardiac death.

But I have to balance these risks against the danger of your having to wait three times as long for a transplant if you remain 1B. That means spending an additional 291 days on the waiting list, during which your condition may deteriorate. You may end up needing a mechanical pump or an artificial heart, both of which would entail major cardiac surgery and potentially serious complications. And you may die.

When I take all that into account, the risks of keeping you waiting at 1B seem higher than the risks of placing a pulmonary-artery catheter and raising the dose of your IV medication to make you 1A.

This is the system I have to navigate.

So, as your doctor, even though these measures aren’t medically indicated, do I admit you to intensive care, insert a pulmonary-artery catheter and increase your medication to qualify you for 1A status? And if I do, is it ethical?

The transplant list is a zero-sum game

The American Medical Association, in a statement on the allocation of limited medical resources, asserts that “a physician has a duty to do all that he or she can for the benefit of the individual patient.”

And dishonesty on behalf of others can be virtuous. Ludvik Wolski, a Roman Catholic priest in Otwock, Poland, forged certificates of baptism to save the lives of Jewish children during the Nazi occupation.

If I adjust your treatment to help you get a donor heart, I might be tempted to believe I’m acting similarly.

But there is an important difference between Wolski’s situation and mine: His actions had no adverse consequences for other Jewish children in the community.

In contrast, if I increase your odds, I decrease another patient’s — because the transplant list, with its vast excess of prospective recipients over donors, is functionally a zero-sum game. If I’ve bettered your chances at someone else’s expense, I’ve provided no overall benefit.

So I might be inclined to resist overtreating you here — if I can be confident that other doctors are resisting as well.

And there’s the rub: If I have reason to believe that other doctors are escalating care to move their patients up on the list, then I may be putting you at a disadvantage by refusing to do the same.

And I do have reason to believe that. I’ve read a 2013 editorial in the Journal of Heart and Lung Transplantation commenting on how invasive treatments are being overused in patients on the transplant list. And a commentary this year in the same journal noted that when the criteria for transplant status changed, medical practice evolved in step with them.

So my personal integrity ends up being in direct conflict with my responsibility as your advocate.

In the big picture, this system increases the number of medically unnecessary treatments, thereby driving up both cost and complication risk.

And perhaps worst of all: When “gaming the system” goes from being an aberration to a standard strategy — when, as the authors of the new commentary write, “treating to the priority is almost as fundamental as studying to the test” — then dishonesty becomes normal.

This cannot be good.

New rules

The United Network for Organ Sharing is now considering a new system for allocating donor hearts that has many more priority stratifications.

Among the new criteria proposed for determining a patient’s waitlist status are measures that are far more aggressive than pulmonary-artery catheters and IV drugs. They include procedures such as the insertion of an intra-aortic balloon pump, which helps the heart generate more blood flow, or the use of extracorporeal membrane oxygenation, which provides a heart-lung bypass outside the body.

Under the new criteria, we should be better able to select patients with the most severe disease.

But that’s what we thought about the original criteria. And the new proposed criteria, too, are “gameable,” so that doctors might feel pressured to take more extreme steps to improve their patient’s chances. Some transplant doctors are already expressing concerns about the potential use of intra-aortic balloon pumps that will allow patients to walk about while waiting for transplants.

The same perverse incentive to escalate care will remain — and so will the ethical dilemma it creates.

Matthew Movsesian, a cardiologist, is a professor at the University of Utah School of Medicine in the Division of Cardiovascular Disease. This essay was first published by NPR member station WBUR.

Let’s block ads! (Why?)

The Justice Department calls it the largest criminal health care fraud case ever brought against individual suspects: Three people are accused of orchestrating a massive fraud involving a number of Miami-based health care providers.

The three facing charges are all from Florida’s Miami-Dade County; they include Philip Esformes, 47, owner of more than 30 Miami-area nursing and assisted living facilities; hospital administrator Odette Barcha, 49; and physician assistant Arnaldo Carmouze, 56, the Justice Department says.

“Medicare fraud has infected every facet of our health care system,” U.S. Attorney Wifredo Ferrer said as indictments against the three were announced Friday.

The indictments accuse Esformes of leading “a complex and profitable health care fraud scheme that resulted in staggering losses — in excess of $1 billion,” said Special Agent in Charge George L. Piro of the FBI’s Miami field office.

Investigators say Esformes used his access to thousands of Medicare and Medicaid beneficiaries to perpetrate a fraud:

“Many of these beneficiaries did not qualify for skilled nursing home care or for placement in an assisted living facility; however, Esformes and his co-conspirators nevertheless admitted them to Esformes Network facilities where the beneficiaries received medically unnecessary services that were billed to Medicare and Medicaid.”

More money was in play, investigators say, in the form of kickbacks Esformes and his co-conspirators received in return for “steering beneficiaries to other health care providers — including community mental health centers and home health care providers — who also performed medically unnecessary treatments that were billed to Medicare and Medicaid.”

In addition to charges of conspiracy, money laundering and health care fraud, Esformes and Barcha were also charged with obstructing justice.

Let’s block ads! (Why?)

Patients may go to rehabilitation hospitals to recover from a stroke, injury or recent surgery. But sometimes the care makes things worse.

In a government report published Thursday, 29 percent of patients in rehab facilities suffered a medication error, bedsore, infection or some other type of harm as a result of the care they received.

Doctors who reviewed cases from a broad sampling of rehab facilities say that almost half of the 158 incidents they spotted among 417 patients were clearly or likely preventable.

“This is the latest study over a long time period now that says we still have high rates of harm,” says Dr. David Classen, an infectious disease specialist at the University of Utah School of Medicine who developed the analytic tool used in the report to identify the harm to patients.

“We’re fooling ourselves if we say we have made improvement,” Classen says. “If the first rule of health care is ‘Do no harm,’ then we’re failing.”

The oversight study, from the office of the inspector general of the U.S. Department of Health and Human Services, focused on rehabilitation facilities that were not associated with hospitals. Rehab facilities generally require that patients be able to undergo at least three hours of physical and occupational therapy per day, five days a week. Patients at these facilities are presumed to be healthier than patients in a more typical hospital or a nursing home.

Still, the findings echoed those of previous studies that found that more than a quarter of patients in hospitals and a third in skilled nursing facilities suffered harm related to their care.

“It’s important to acknowledge that harm can occur in any type of inpatient setting,” says Amy Ashcraft, a team leader for the rehabilitation hospital study. “This is one of the settings that’s most likely to be underestimated in terms of what type of harm can occur.”

For the purposes of the study, doctors and nurses identified harm by reviewing the medical records of 417 randomly selected Medicare patients who stayed in U.S. rehabilitation facilities in March 2012. The events they identified varied in severity, ranging from a temporary injury to something that required a longer stay at the facility or that led to permanent disability or death.

Almost a quarter of the harmed patients had to be admitted to an acute care hospital, at a cost of about $7.7 million for the month analyzed, the study shows.

The physicians who reviewed the cases for the OIG say substandard treatment, inadequate monitoring, and failure to provide needed care caused most of the harm. Almost half the cases, 46 percent, were related to medication errors and included bleeding from gastric ulcers due to blood thinners and a loss of consciousness linked to narcotic painkillers.

That high number indicates there’s lots of room for improvement, says Dr. Eric Thomas, director of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety.

“We know a lot about preventing medication errors,” Thomas says.

An additional 40 percent of the cases in which patients were harmed were traced to lapses in routine monitoring that led to bedsores, constipation or falls. These problems almost never contributed to a patient’s death but could mean extra days or weeks of recovery, a loss of independence or permanent disability, says Lisa McGiffert, director of the Consumers Union Safe Patient Project.

“It is a domino effect for any person who has had an adverse event,” says McGiffert, who was not involved in the study.

The inspector general is recommending that Medicare and the Agency for Healthcare Research and Quality work together to reduce harm to patients by creating a list of adverse events that occur in rehab hospitals. In their responses to the report, the agencies have pledged to follow that suggestion.

Officials from the American Medical Rehabilitation Providers Association, the trade group that represents rehab facilities, say they have not yet seen the report and decline to comment for now.

ProPublica is interested in hearing from patients who have been harmed while undergoing medical care, through its Patient Harm Questionnaire and Patient Safety Facebook Group.

Let’s block ads! (Why?)

Maryland Medicaid officials have made what appears to be a small change to the list of preferred medications to treat opioid addictions. The agency used to pay for the drug in a dissolvable film form. Now it’s steering patients to tablets, which some doctors say are not as effective for their patients.

Those doctors say the change is having a profound effect on some people struggling to stay clean.

Starting on July 1, Maryland’s Medicaid program removed Suboxone film — a drug that can be used by people addicted to opioids to keep their cravings at bay — from the state’s list of preferred drugs and replaced it with a tablet form of the medication called Zubsolv.

State officials say the change was made to stop the illicit flow of the drug into jails and prisons.

“Those Suboxone strips were diverted and smuggled into jails and later were sold or traded in criminal activity that was happening in jails,” says Shannon McMahon, deputy secretary of Maryland’s Department of Health and Mental Hygiene. “The numbers were frankly staggering, the amount of diversion that was happening in the jails.”

So far this year more than 2,300 hits of Suboxone have been seized in Maryland jails and prisons, according to Gerald Shields of the state’s Department of Public Safety and Correctional Services. That’s about 40 percent more than at this time last year, Shields says.

The drug helps people control their opioid habit. But it is also an opioid itself. It doesn’t produce a high as strong as many opioid painkillers that have turned into popular street drugs, but it does stave off cravings and can create a mild sense of euphoria.

It comes as a tiny, dissolvable film — about the size of a Listerine breath mint strip — that’s transparent and easy to hide.

“They have been cut up into multiple different pieces,” McMahon tells Shots. A single strip can be worth as much as $50 on the street and they are often divided into several “hits” that are sold individually, she says.

“They were coming into prisons through letters — backs of stamps, corners of folks’ eyeglasses,” she says. McMahon says the strips were causing problems in prisons because of illegal sales and trade.

So at the recommendation of the Department of Corrections, along with a panel that advises the state’s Medicaid program on medications, officials decided to replace the Suboxone strip with Zubsolv, made by a Swedish company called Orexo AB.

The choice is raising eyebrows because Maryland’s health secretary Van Mitchell used to work for Manis Canning & Associates, the lobbying firm that represents Orexo. Mitchell’s spokeswoman says he left the firm before Orexo became a client.

Mitchell and Steven T. Moyer, Maryland’s secretary of Public Safety and Correctional Services, argued in an article in the Baltimore Sun that the change would save lives. They said Maryland’s correctional system, since 2010, “has seen 13 fatal overdoses.” However, a spokeswoman for the state’s health department acknowledged that those were overdoses on opioids in general, and not specifically overdoses on Suboxone film.

Doctors say Suboxone film, as well as the Zubsolv pill that replaces it, actually protect against overdoses because they contain both the opioid Buprenorphine and a drug called naloxone that reverses the effects of an overdose. Naloxone is used by emergency responders to revive people who overdose.

The change has drawn broad opposition from doctors who treat people with substance abuse problems and from advocates for people who are recovering from addictions. Those include the Behavioral Health System of Baltimore, a nonprofit that oversees the city’s behavioral health system, and the Maryland Association for the Treatment of Opioid Dependence.

The change has wreaked havoc on some people with substance abuse problems who, until a few days ago used Suboxone film, says Adrienne Breidenstine, vice president for policy and communications at the Behavioral Health System of Baltimore.

One of them is Nicole, a mother of two who has been in recovery for about eight years. Nicole became addicted to painkillers after she was injured in a car accident. She was stable on Suboxone strips but switched to Zubsolv 10 days ago. She asked NPR not to use her full name because her history of addiction is not common knowledge.

“When I got on Suboxone I didn’t even have custody of my son,” she says. “After I got clean, I got put on Suboxone. I’ve got both my kids now, we have our own house, I’m working, they’re doing good in school, I finished school, and that’s why it’s so scary to me that they completely switched me over.”

Since the change, she says, she’s been feeling sick, having trouble sleeping, having cravings and symptoms of withdrawal.

“It hasn’t been working for me,” she says. “I don’t know what I’m going to do if they don’t cover it again. I just don’t want to go back to that life and I don’t want my kids to go there.”

Nicole’s doctor, Michael Fingerhood, has a primary care practice at Johns Hopkins Bayview Medical Center in Baltimore. His practice, which overlooks downtown Baltimore from across the water, welcomes people with substance abuse problems. The group treats about 450 patients who, until this month, were using Suboxone strips.

He says just two weeks into the change many of his patients, like Nicole, are struggling.

“This is taking patients who are stable, who are doing really well, and saying we’re going to do something to disturb how well you’re doing,” he tells Shots.

Fingerhood says Zubsolv is supposed to be the equivalent of Suboxone. But not all patients react the same to different medications. Many, like Nicole, have been clean for years and for the first time, they’re feeling sick again and some, he says, are in real danger.

Feeling even the slightest bit of withdrawal symptoms can be awful for someone in recovery, he says.

“In the midst of addiction people are searching for a high, they’re having withdrawal, they’re running the streets. Their lives were horrible,” Fingerhood says. “Having withdrawal brings back all those memories of how terrible life had been and it’s a terrible feeling to be in withdrawal.”

Shaking up all the Suboxone patients across the state to keep a relatively safe drug away from a handful of inmates doesn’t make sense, Fingerhood says. And the numbers are indeed pretty small.

If those 2,300 Suboxone hits seized in prison were whole strips — and prison officials say they weren’t — that’s still only the equivalent of about 10 prescriptions from January through last week.

Instead, Fingerhood says, “We should be providing treatment in the prison system.”

He says if someone who was on Suboxone gets arrested, it makes sense that family members or friends would try to get them the drugs in prison.

The only place in Maryland that inmates can legally get any medication to help get or keep them off opioids is in the Baltimore City Jail, according to Shields, the Department of Corrections spokesman. He says the system provides methadone to some inmates to help wean them off opioids before moving them to another prison.

State officials say Medicaid patients can still get Suboxone if they really need it. Doctors just fill out a form requesting a waiver, known as a prior authorization, and get an answer the next day.

Fingerhood made that request for Nicole. Five days later, he still had no response.

Let’s block ads! (Why?)

Most of the front door of Rachel Taylor’s little yellow house in White Sulphur Springs, W. Va., is pasted with paw prints where her dog struggled to get inside during the flood last month. He was too big to carry through the rising waters.

Across the street, nestled between two battered houses, an empty lot is marked by a cross with an array of flowers and photos — a small memorial for a family washed away by the torrent.

Taylor’s dog survived and is now with some of her family members in Kentucky. But those neighbors across the street, the Nicelys, were swept away when their house collapsed; they have since been confirmed dead.

“When I start feeling overwhelmed with this,” Taylor says from her front porch, “I just look across the street at that memorial and I think, there’s nothing that we have lost that can’t be replaced or mended.”

She and her husband spent seven years renovating this 1930s Craftsman house, room by room. They were just about done with renovations when their house flooded a few weeks ago. Today the living room is gutted.

“You know, the first couple of days it was very intense,” Taylor says. “It was kind of ‘crisis mode.’ Maybe that’s the way I would describe it, because you didn’t really have time to think about it and process it.”

But once the full extent of the damage set in, Taylor says, she developed severe nausea and carsickness to the point of not being able to drive.

A number of people, she says, have chalked up her symptoms to nerves. “You know, the stress level. You don’t realize your body is just having a response to this.”

Taylor worries that the houses in her neighborhood will remain abandoned and that she, her husband and her 14-year-old daughter won’t feel safe at home anymore. She plans to rebuild, but says her family will likely sell the house and move.

“The words we use when we talk about it are ‘I don’t know if I have it in me;’ ‘I’m not sure if I can do it again,’ ” she says. “Things like that. And then we just say, ‘Well, we’ll take it one day at a time.’ “

Psychologists say this kind of response is normal following natural disasters.

“It’s a physical aspect of the stress response — it will affect the body’s ability to concentrate, to rest and to be able to function,” says Marcie Vaughan, leader of the state-funded West Virginia Community Crisis Response Team. “Cognition is slowed and impaired,” she adds.

Vaughan’s team offers support, counseling and referrals for further mental health care at local behavioral health centers.

“From the behavioral health perspective, we find we are more in need after the tenth [or] twelfth day,” Vaughan says, “just because immediate needs of food, clothing and shelter take precedence.”

In the first few days following the flood, Vaughan’s team members split their time between helping people replace lost psychiatric medications and looking for signs of mental distress in people at shelters or feeding stations.

“We see fatigue, problems with cognition,” she says. “You have individuals who walk into a supply center and they have no idea what they need.”

A 2012 study published in the journal Social Psychiatry and Psychiatric Epidemiology found that while most people bounce back a few months after a disaster, if their ongoing stressors aren’t addressed — such as a lack of permanent shelter, financial challenges and repeated exposure to the trauma — affected residents will continue to struggle.

In addition to Vaughan’s team, church disaster-assistance teams and Hope Animal-Assisted Crisis Response — a support organization that uses trained therapy pets for comfort — stepped in to help.

“As the fatigue sets in and the frustration, we see an increased need for behavioral health intervention,” says Vaughan.

Unfortunately, that’s just when the work becomes hardest, Vaughan says, and it’s often after national organizations and media have lost interest. Very real, tough problems persist, though only local groups and neighbors remain to extend helping hands.

This story is part of NPR’s reporting partnership with West Virginia Public Broadcasting and Kaiser Health News.

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.
Recommended article from FiveFilters.org: Most Labour MPs in the UK Are Revolting.

The Senate is set to approve a bill intended to change the way police and health care workers treat people struggling with opioid addictions.

The bill is an amalgam of more than a dozen proposals passed through the year in the House and Senate. And while it has lots of new policies and provisions — from creating a task force to study how best to treat pain, to encouraging states to create prescription drug monitoring programs — it doesn’t have much money to put them in place.

President Obama had requested $1.1 billion to help pay for more addiction treatment programs and other initiatives. But the version agreed to by House and Senate Republicans last week didn’t include all that money. In the end, it will probably get about half that much.

“It’s clear that efforts to prevent and treat the opioid epidemic will fall short without additional investments,” Sen. Patty Murray, D-Washington, said in a statement after House and Senate negotiators hammered out the final bill.

But Sen. Lamar Alexander, R-Tenn., argued that the money for treatment has been rising for three years.

“Our friends on the other side say, you have to fund it. We are funding it,” he said in a statement on the Senate floor Friday. “And they helped fund it. We’ve increased funding for opioids already by 542 percent.”

Still, Democrats are expected to support the bill even without the additional money.

And that’s a good thing, says Linda Rosenberg, president of the National Council for Behavioral Health, because the bill helps expand treatment in significant ways.

For example, it allows nurses and physician assistants to treat people with addictions using medications, which is considered the evidence-based standard.

“Treatment capacity is really a crisis. There just isn’t enough,” Rosenberg tells Shots. “But what this bill does to address that — it expands the kinds of people who can prescribe medications for addictions. And that’s a very big deal.”

She says that provision alone can help because nonprofit treatment centers will be able to use nurse practitioners and physician assistants rather than trying to hire doctors, who are both scarce and expensive.

The bill also allows the Department of Health and Human Services to give grants to states and community organizations for improving or expanding treatment and recovery programs. It has several provisions that would allow police departments to send people with addiction problems to treatment rather than to jail.

In one of the few areas of the bill that includes funding, lawmakers authorized the Department of Justice to spend $100 million a year for five years to find alternatives to jail for opioid abusers, and to allow prisons to use methadone or buprenorphine to treat inmates with opioid addictions.

Rosenberg says these measures help change the definition of addiction from a crime to a health problem.

“It’s a health care issue and not a moral failing issue,” she says. That’s a big reversal from the “war on drugs” campaigns of a few decades ago.

And the legislation allows more people to have access to naloxone, the drug that can reverse an opioid overdose, reducing the risk of death. Access would be expanded for people working in schools and community centers.

The bill encourage pharmacies to fill standing orders for the drug so that those likely to come in contact with someone suffering an overdose will have the drug on hand, according to Mike Kelly. He is the U.S. president of Adapt Pharma, which sells Narcan, a nasal spray version of naloxone.

“This bill addresses getting Narcan out into the community, outside of emergency and first responders,” Kelly says. “The big thing here is this will fund recovery.”

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.
Recommended article from FiveFilters.org: Most Labour MPs in the UK Are Revolting.

Many babies born to mothers who are covered by Medicaid are automatically eligible for that health insurance coverage during their first year of life. In a handful of states, the same is true for babies born to women covered by the Children’s Health Insurance Program.

Yet, this approach is routinely undermined by another federal policy that requires babies’ eligibility for these programs to be re-evaluated on their first birthday. Although they’re likely still eligible for coverage, many of these toddlers don’t get it because of a tangle of red tape.

People often cycle in and out of Medicaid and CHIP, state/federal health programs for low-income residents, as their income or family circumstances change. Such churning is a long-recognized problem. The requirement that people renew their coverage annually may also cause hiccups.

“Many people lose Medicaid coverage for procedural reasons,” says Shelby Gonzales, a senior health policy analyst at the Center on Budget and Policy Priorities. “But there are all sorts of things that are unique about babies turning 1” that present extra challenges.

“You hate any baby to lose coverage,” says Jill Hanken, a lawyer with the Virginia Poverty Law Center who has worked on this issue. “A 1-year-old needs to have consistency with their health care and visits with the pediatrician.” Regular well-baby visits ensure kids are developing properly and get scheduled vaccines, among other things.

One potential snag in retaining toddlers’ coverage is that their first-year review is pegged to their date of birth, which is generally different from the annual renewal date for other family members’ coverage.

In other instances, states that don’t seek babies’ Social Security numbers until they turn 1 may have a tougher time getting the income and other data they need to process the renewal. And some states mistakenly ask for documentation proving the baby’s citizenship, which is not required if Medicaid or CHIP paid for the birth.

Antiquated computer systems sometimes automatically drop babies after their first birthday unless a renewal has been processed. This can be a problem in states that are behind in renewals, which is not uncommon, Gonzales says; some states have scrambled to implement the many requirements of the health law.

It’s hard to quantify the extent of the problem nationally. An analysis of data from the 2014 American Community Survey of 700,000 children found that children between the ages of 1 and 2 were less likely than infants to be covered by Medicaid or CHIP. That suggests “some children may be losing Medicaid/CHIP coverage at their first birthday,” says Genevieve Kenney, a co-director and senior fellow at the Urban Institute’s Health Policy Center.

The experience of the state of Connecticut offers a window on the problem. Connecticut Voices for Children, a policy research and advocacy organization, has tracked the issue closely for several years. In 2008 and 2009, 42 percent of babies who had been considered automatically eligible for Medicaid at birth lost their coverage at the end of the month they turned 1. That’s compared with roughly 6 percent of babies who were in other Medicaid coverage groups, such as those whose mothers had employer-sponsored insurance.

By 2013, when Connecticut Voices revisited coverage gaps, Medicaid and CHIP coverage retention when infants turned 1 had improved significantly. Still, nearly 23 percent of babies with guaranteed coverage for their first year were uninsured after their first birthday. That was true for less than 2 percent of other babies in the state.

During that time the state had revised confusing notices to families that, for example, announced that coverage was ending for infants because, “You are not the right age to be eligible for this program.” Advocates also played a role in improving the troubling statistics by working to alert pediatricians and community services providers about the problem.

Though coverage for 1-year-olds has improved, “the problem still persists,” says Mary Alice Lee, senior policy fellow at Connecticut Voices for Children. Advocates hope that a new eligibility management system, scheduled to roll out next year, will make a difference.

Elsewhere, advocates in Virginia are also awaiting a computer system fix so that infants who were guaranteed Medicaid coverage for the first year aren’t automatically canceled after their birthday. In the meantime, Hanken says, the state changed its policy so that the determination of a newborn’s Medicaid eligibility at 1 year of age is a streamlined renewal, instead of a totally new application for coverage.

“We’re about halfway to a solution,” Hanken says.

Outdated technology is no excuse for states not addressing this longstanding problem, says Tricia Brooks, a senior fellow at Georgetown University’s Center for Children and Families.

These newborns are easily identified, Brooks says, so “if nothing else, [state officials] could go in on a manual basis and trigger a review.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter:@mandrews110.

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.
Recommended article from FiveFilters.org: Most Labour MPs in the UK Are Revolting.

President Obama on Monday called on Congress to revisit the controversial idea of providing a government-run insurance plan as part of the offerings under the Affordable Care Act.

What’s been described as the “public option” was jettisoned from the health law in 2009 by a handful of conservative Democrats in the Senate. Every Democrat’s vote was needed to pass the bill in the face of unanimous Republican opposition.

But in a “special communication” article published Monday on the website of JAMA, the American Medical Association’s top journal, the president says a lack of competition among insurance plan offerings in some regions may warrant a new look.

“Now, based on experience with the ACA, I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited,” Obama writes.

The president calls on Congress to take more steps to rein in the cost of prescription drugs and make government assistance more generous for those who still cannot afford health coverage; he also urges the 19 states that have not yet expanded the Medicaid program under the health law to do so.

The public option has been a point of controversy from the start. It was included in the version of the health law passed by the House of Representatives, and had support from most Democrats in the Senate, before it was dropped. Many liberals hoped — and conservatives feared — that having the government provide insurance alongside private companies would be a step toward a fully government-run system.

Presumptive Democratic presidential nominee Hillary Clinton — under pressure from Sen. Bernie Sanders’ call for a single-payer government system — in February endorsed the idea of including a public option to allow people age 55 and older to purchase Medicare coverage.

On Saturday, as part of a deal with Sanders, Clinton announced she will also “pursue efforts to give Americans in every state in the country the choice of a public-option insurance plan,” which is broader than what Obama is endorsing.

But even if Clinton wins and the Democrats take back control of Congress in November, a public option remains a political long shot.

Obama’s article, titled “United States Health Care Reform: Progress to Date and Next Steps,” is apparently the first by a sitting president to be published by the prestigious medical journal.

Along with these recommendations for further action, Obama’s article includes a justification for the federal health law and statistics on how its implementation has improved insurance coverage for patients and improved health care quality.

Kristie Canegallo, the White House deputy chief of staff for implementation, says the article grew out of a comprehensive review of the law that the president requested from his staff late last year.

The review was to look at “what’s working, what’s not, and what we should do about it,” Canegallo says. Upon receiving the review, she adds, Obama “thought it was important to share some of this publicly.”

Among those parts of the law the administration says are working are the coverage provisions. “The number of uninsured individuals in the United States has declined from 49 million in 2010 to 29 million in 2015,” the president writes.

The article also says that the health law has played a substantial role in slowing the rate of health spending.

“While the Great Recession and other factors played a role in recent trends, the [president’s] Council of Economic Advisers has found evidence that the reforms introduced by the ACA helped both slow health care costs growth and drive improvements in the quality of care,” says the article.

Jason Furman, chairman of the council, says the continuing slow growth in health spending so many years out from the recession makes the argument by some other economists that the turndown in the U.S. economy was mostly responsible for the slowing of health spending “absurd at this point.”

While most of Obama’s journal article is a chart-driven, footnoted recitation of the impact of the health law, he does use his perch to suggest that the current state of politics in Washington threatens progress going forward.

“Any change is difficult, but it is especially difficult in the face of hyperpartisanship,” he writes. “Republicans reversed course and rejected their own ideas once they appeared in the text of a bill that I supported.”

Republicans are continuing their assault on the health law. Just last week, two House committees released a joint investigative report and held two hearings asserting that the administration is illegally providing funds to help lower-income individuals pay for their health coverage.

That claim is also the subject of a lawsuit in federal court.

The White House, however, remains unimpressed by the Republican claim.

“The Department of Justice … has made clear we have a permanent appropriation for this,” Canegallo says.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.
Recommended article from FiveFilters.org: Most Labour MPs in the UK Are Revolting.