Monthly Archives: January 2013

Quick Read: FDA Panel Recommends Limits On Vicodin

Drugs containing hydrocodone are at the center of an emotional debate that pits the needs of pain patients against efforts to fight widespread abuse of these and other opioid painkillers.

A key federal panel Friday recommended placing new restrictions on Vicodin and similar prescription painkillers. At the conclusion of an emotional two-day hearing, the Food and Drug Administration advisory committee voted 19-10 to recommend the agency change how drugs that contain the opioid hydrocodone are classified as controlled substances.

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Penalty on Smokers Can Spell Higher Premiums under Health Overhaul

Legislator planning law to limit penalty in California

A little-known provision in the Affordable Care Act permits insurers to charge higher premiums to smokers. (Dave Whelan: Flickr)

A little-known provision in the Affordable Care Act permits insurers to charge higher premiums to smokers. (Dave Whelan: Flickr)

WASHINGTON (AP) Millions of smokers could be priced out of health insurance because of tobacco penalties in President Barack Obama’s health care law, according to experts who are just now teasing out the potential impact of a little-noted provision in the massive legislation.

The Affordable Care Act — also known as “Obamacare” — allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums starting next Jan. 1.

For a 55-year-old smoker, the penalty could reach nearly $4,250 a year. A 60-year-old could wind up paying nearly $5,100 on top of premiums.

For a 55-year-old smoker, the penalty could reach nearly $4,250 a year.
Younger smokers could be charged lower penalties under rules proposed last fall by the Obama administration. But older smokers could face a heavy hit on their household budgets at a time in life when smoking-related illnesses tend to emerge.

Workers covered on the job would be able to avoid tobacco penalties by joining smoking cessation programs, because employer plans operate under different rules. But experts say that option is not guaranteed to smokers trying to purchase coverage individually. Continue reading

Two Soda Stories: Richmond Tax Post-Mortem, New Ally in NYC Ban

 (La Piazza Pizzeria/Flickr)

(La Piazza Pizzeria/Flickr)

The East Bay Express chose one heckuva startling headline for its article examining the fight over Measure N — Richmond’s penny-per-ounce tax on soda and sugar sweetened beverages that was defeated last November. “Race Baiting in Richmond” alleges that big business used race to fracture Richmond’s progressive community in its ultimately successful campaign to defeat the tax.

The lengthy and detailed article makes clear that race was already a factor in the anti-soda tax movement before the soda industry — and its dollars — arrived in Richmond last summer. From the East Bay Express:

Some opponents of the tax had alleged that it was racist, arguing that it would unfairly harm low-income residents in the city. And the No on Measure N campaign, bankrolled by large corporations that make a fortune from selling cheap soda to low-income consumers, nurtured that sentiment. Indeed, there is evidence that the beverage association helped keep race at the forefront of the campaign as part of a strategy that exploited Richmond’s existing tensions. And after spending at least $2.7 million — believed to be a record in East Bay politics — against Measure N, the beverage industry emerged victorious as the soda tax was beaten soundly.

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Gov. Brown’s State of the State — on the Health Care Overhaul

(Justin Sullivan/Getty Images)

In Thursday’s State of the State speech, Gov. Brown called for a special legislative session to address the Affordable Care Act. (Justin Sullivan/Getty Images)

In his State of the State speech Thursday morning, Gov. Brown spent about 60 seconds addressing health and human services — and all those seconds were devoted to the rollout of the Affordable Care Act.

Early in his speech, Brown reiterated his theme of fiscal discipline and seemed to urge caution in implementing the Affordable Care Act, stating, “The ultimate costs of expanding our health care system under the Affordable Care Act are unknown. Ignoring such known unknowns would be folly.”

Later in the speech came the bulk of his comments about the ACA. Here’s the transcript:

“California was the first in the nation to pass laws to implement President Obama’s historic Affordable Care Act. Our health benefit exchange, called Covered California, will begin next year providing insurance to nearly one million Californians. Over the rest of this decade, California will steadily reduce the number of the uninsured. Today I’m calling for a special session to deal with those issues that must be decided quickly if California is to get the Affordable Care Act started by next January. Continue reading

Quick Read: Fight Over Bloomberg’s Soda Ban Reaches Courtroom

The New York City ban on sales of sugary drinks in cups larger than 16 ounces is set to take effect in March. But the beverage industry is challenging the rule in court. In today’s action, the industry is requesting a stay on the ban of large size drinks until the lawsuit can be resolved.

The opening statements touched on Big Gulps, National Doughnut Day and the plight of a fictional pizzeria proprietor named Sal. And that was before the lawyers began arguing about Sabrett hot-dog stands. The fight over Mayor Michael R.

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Rural Husband and Wife Doctor Team Reflect on Careers in Medicine and Public Service

For more than three decades, Drs. Marcia and Oscar Sablan have served the tiny Central Valley town of Firebaugh. In an affectionate portrait today, the Los Angeles Times describes a couple who made a plan to work for three years in a rural area and walk away from all their medical school debt. As Marcia Sablan mentioned last week in a panel discussion in Fresno, she and her husband moved from Hawaii and arrived in Firebaugh in July on what turned out to be the hottest day of the year.

The couple never left Firebaugh, and today they are fixtures in the community. But what I found particularly interesting was the couple’s recognition that medicine only goes so far, as reporter Anna Gorman describes in the Times article:

… (A)s they built up their medical practice, the Sablans say, they realized that they could do only so much in the exam room. For example, they would tell their diabetic patients to exercise, but there were few places to do so. So they turned to politics. “I just saw that was the only way change could be made,” says Marcia Sablan, who is still on the city council. Continue reading

Assembly Bill Seeks to Increase Number of Abortion Providers

Regulations around abortion providers in the U.S. (American Journal of Public Health)

Regulations around abortion providers in the U.S. (American Journal of Public Health)

Tuesday afternoon, on the 40th anniversary of Roe v. Wade, a group of state lawmakers and women’s advocates announced the introduction of a bill in the California Legislature aimed at expanding a woman’s access to abortion. Currently in California, only physicians are authorized to conduct early abortions. This new bill, AB 154, would authorize other clinicians — specially-trained nurse practitioners, certified nurse midwives and physician assistants — to perform early abortions.

“As a former administrator of a health clinic, I know how important timely care is for women,” Assemblymember Toni Atkins (D-San Diego), author of AB 154, said in a statement. “This bill will ensure that early abortion care will be available for women in California who need it.”

Four other states permit nonphysician clinicians to perform early abortions. Still, clinical evidence of safety had been lacking. Last week, a new study led by researchers at UCSF showed that early abortions performed by trained nurse practitioners, certified nurse midwives and physician assistants are “clinically equivalent” to those performed by physicians.

“Early abortion is safer than we thought overall, and there’s no difference in the complication rate between the two groups,” said lead author Tracy Weitz, UCSF professor of obstetrics and gynecology. The research team found a two percent complication rate — below the four percent rate they had expected. Complications were mostly minor.

In the study, published online by the American Journal of Public Health, researchers received a waiver from the state of California to permit training of nurse practitioners, certified nurse midwives and physician assistants to perform what are called surgical or aspiration abortions. Altogether, researchers analyzed more than 11,000 procedures. Continue reading

State’s Health Insurance Exchange Lands $674 Million Grant from Feds

By David Gorn, California Healthline

California's insurance marketplace, Covered California, will open in October, 2013. People will be able to buy insurance, which will take effect January 1, 2014.

California's insurance marketplace, Covered California, will open in October, 2013. People will be able to buy health insurance, which will take effect January 1, 2014.

Peter Lee could hardly contain himself yesterday.

“In 2010, California was the first state in the nation to say we want a state-based exchange. Then, earlier this month, the federal government approved our blueprint for the exchange,” said Lee, the executive director of the state’s health insurance exchange, Covered California.

“And now,” Lee said, “the feds have given us the resources we need to launch Covered California. This is an historic moment.”

Yesterday federal officials awarded $674 million to the California exchange, a grant that funds the set-up of the exchange through the end of 2014.

It was slightly short of the $706 million originally requested for the grant, but Lee was not about to quibble.

“The feds reduced 2014 potential payment for outreach and enrollment by about $30 million,” Lee said. “But we think we have enough resources on hand to do the biggest outreach that I’ve ever seen.” Continue reading

In Fresno, the Road to Health Reform Is Bumpy

(Charles Nadeau/Flickr)

The greater Fresno area may be the most challenging region in California to implement the health care overhaul. Earlier this week a panel of experts gathered at Fresno State to review the issues and consider a path forward. Funding is always a problem, and Fresno is no exception. But in Fresno, collaboration seems to be an even bigger stumbling block.

Peter Cunningham, with the Center for Studying Health Systems Change, first outlined findings from a regional study. For starters, the region encompasses a huge geographic area: five counties (Fresno, Tulare, Kings, Madera and Mariposa) stretch across 16,000 square miles and comprise both urban and very remote rural areas.

In addition to this geographic challenge, the region also faces:

  • High poverty and high uninsurance rates — as well as a high number of undocumented residents — people who are excluded from the benefits of Affordable Care Act, but will still need health care
  • Severe, chronic physician shortages
  • Structural or bureaucratic barriers to reform, specifically a 30-year contract between one hospital and Fresno County to provide care for the poor
“There is no health care policy in Fresno County. We’re in a position of haphazardly approaching this.”

After Cunningham’s presentation, the discussion started off on a note everyone could agree on: more doctors are urgently needed. The region has 118 doctors per 100,000 people, about one-third below the state average of 174.


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Quick Read: Flu Vaccine Attitudes in Europe Differ from U.S.

Among other reasons cited in this piece, there may be an economic reason more Americans get the flu shot: one in three U.S. workers gets no paid time off for illness. In general, Europeans have more generous sick leave.

(CNN) — The flu hasn’t hit Europe as hard as it has the United States, health officials say, but when and if it does, don’t expect a call for vaccination of the entire population. Only the U.S. and Canada actually encourage everyone older than 6 months to get the flu vaccine.

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