Author Archives: Lisa Aliferis

May 3, 2013 | 3:26 PM | By

Oregonian Describes Life — and Health — After Winning Medicaid Lottery

(Fred/Flickr)

(Fred/Flickr)

For you wonks out there, Kaiser Health News has a fascinating Friday afternoon read for you.

In a piece titled “Bloggers See Own Reflections in Oregon Medicaid Study,” reporter Jordan Rau describes how this week’s news about Oregon’s Medicaid Experiment quickly became “a Rorschach test for how partisans and health policy wonks view the health care law.”

With no money for better food, no money for good shoes to go on walks, no rain gear, no walkman for listening to music as a distraction while walking, change is harder.

To quickly recap, in a New England Journal of Medicine study researchers analyzed how 10,000 people who won Medicaid coverage have fared since they gained insurance. The highlights were: no apparent affect on physical health; rates of depression 30 percent lower than those without coverage; catastrophic out-of-pocket medical expenses essentially eliminated.

In his piece, Rau publishes excerpts from seven blogs, each with a different take on the study’s highly nuanced results. But he closes with something I hadn’t seen elsewhere: a view of the experiment by someone who says he was one of the winners of the Medicaid coverage. Rau found the post on the blog Robert’s Stochastic thoughts.

Here’s the post in its entirety:

I am one of the winners in the Oregon lottery [winners could get Medicaid]. Going from no insurance to insurance is very confusing. When you have no money every health question starts with “would I rather live with this problem and have electricity, or treat this problem and keep my milk in a cooler for a month or so?” Stepping back into healthcare was like Continue reading →

FILED UNDER: Policy, Affordable Care Act, Medicaid, Obamacare, Science
May 2, 2013 | 9:45 AM | By

Quick Read: Medicaid Reduces Financial Hardship, Doesn’t Quickly Improve Physical Health

In what’s called the Oregon Experiment, 10,000 people in the state won Medicaid coverage in a lottery. Then researchers compared and contrasted the winners with the losers. As it turns out, the winners didn’t get any healthier — at least not physically. But there were other benefits. The people who won Medicaid were a whopping 30 percent less likely to be depressed. The researchers also correctly point out that health insurance is a financial product, intended to prevent financial calamity due to extraordinary medical bills. In the study, “Medicaid coverage almost completely eliminated catastrophic out-of-pocket medical expenditures.” That’s a big deal.

Let’s remember that health care does not equal health. Health comes from many places besides health care or health insurance: good schools, safe neighborhoods, and access to good jobs.


As heated fights over the health law’s Medicaid expansion engulf state legislatures, a sweeping new study indicates that the program is unlikely to quickly improve enrollees’ physical health. The research, published Tuesday in the New England Journal of Medicine, did find that low-income people who recently gained Medicaid coverage in Oregon used more health-care services.

Read more at: www.washingtonpost.com

May 1, 2013 | 3:49 PM | By

What Prisons and the Solar Industry Have in Common in California

It's all that land around the prison (Avenal State Prison seen here) that carries a health hazard, the same one that affects solar manufacturers. (Buzzbo/Flickr)

It’s all that land around the prison (Avenal State Prison seen here) that carries a health hazard, the same one that affects solar manufacturers. (Buzzbo/Flickr)

Normally, you wouldn’t put “prisons” and “solar” together when thinking about a significant health problem hitting California. But the two prisons in question are in the dry, dusty Central Valley. The solar manufacturing is on huge construction sites in the California desert. Anyone who lives in those areas of California might quickly add these two clues together and come up with an answer:

Valley Fever.

Valley Fever can cause something like a nasty flu, but some people, especially those with compromised immune systems, can die. It is not contagious. Instead the illness spreads when people inhale fungal spores carried in the dirt by the wind.

California’s prison system has been fighting a losing battle with Valley Fever since 2006. In particular, inmates in two prisons along the I-5 corridor are right in harms way. Continue reading →

FILED UNDER: Place Matters, Science, Valley Fever
April 30, 2013 | 2:59 PM | By

What President Obama Wants You To Know About Obamacare

The president talks up the health care overhaul at Tuesday’s press conference

President Obama Takes Questions From The Press During News Conference.

The health care overhaul is “a big complicated piece of business,” President Obama told reporters during Tuesday’s news conference. (Alex Wong/Getty Images)

If you’re one of the millions of people confused about Obamacare, the president took a few minutes on Tuesday to reiterate his main messages about the federal health law.

“For the 85 to 90 percent of Americans who already have health insurance, they’re already experiencing most of the benefits of the Affordable Care Act even if they don’t know it,” the president said.

He called insurance “stronger, better, more secure,” for people than before the law’s passage. ”Full stop. That’s it. Now they don’t have to worry about anything else.”

President Obama specifically mentioned three benefits of the ACA already in place:

  • Children can stay on their parents’ plan until age 26
  • Your insurance company cannot drop you if you get sick
  • You get free preventive care with no co-pay and no deductible (including many cancer screening tests)

The law also has banned lifetime caps on coverage. For people who have employer-based insurance or Medicare, most of the changes required by the law are already in place.

For people who do not have insurance — or who buy insurance for themselves or their families — “implementation issues” remain, the president said. Continue reading →

FILED UNDER: Reform, ACA, Affordable Care Act, Obamacare
April 26, 2013 | 2:23 PM | By

Berkeley Journalist Takes On The ‘Feel-Good War on Breast Cancer’

The article asks: (Photo/Getty Images)

(Photo/Getty Images)

I first saw the article Thursday night on Facebook, then stayed up until midnight reading it. In a helluva story, Peggy Orenstein addresses The Feel-Good War on Breast Cancer in this Sunday’s New York Times Magazine.

Orenstein is uniquely situated to write an article she hopes will “help change the national conversation.” She’s been treated for breast cancer twice in the last 15 years, including a mastectomy last fall, and the Times Magazine — for which she writes regularly — is one of the most powerful publications in the world.

Orenstein was first diagnosed with breast cancer in 1997 after her doctor sent her for a screening mammography. “I used to believe a mammogram saved my life,” she writes as the opening line of her piece. Today, she’s not so sure.

As she writes in the Times:

Sixteen years later, my thinking has changed. As study after study revealed the limits of screening — and the dangers of overtreatment — a thought niggled at my consciousness. How much had my mammogram really mattered? Would the outcome have been the same Continue reading →

FILED UNDER: Policy, Breast Cancer, Mammograms, Science
April 26, 2013 | 6:42 AM | By

Doctors Fear HIV Patients Will Fall Through Cracks As Obamacare Rolls Out

Public health implications as people who stop taking HIV medications can quickly become infectious

Dr. Kathleen Clanon talks to patient Andrew Solis about keeping his HIV under control. Clanon worries her patients will have disruptions in their care if they don't navigate the changes coming under federal health reform. (Mina Kim/KQED)

Dr. Kathleen Clanon talks to patient Andrew Solis about keeping his HIV under control. Clanon worries her patients will have disruptions in their care if they don’t navigate the changes coming under federal health reform. (Mina Kim/KQED)

A major goal of the federal health care law is that millions of people who currently do not have health insurance will have improved access to care. But the massive overhaul is also expected to be widely disruptive, and doctors worry that many people with chronic illness could suffer during the changeover, as KQED’s Mina Kim details today on The California Report.

Kim tells the story of 33-year-old Andrew Solis who stopped taking HIV medications more than a year ago after becoming addicted to methamphetamine while in a “rocky relationship.” He resumed treatment at the Oakland Highland Hospital HIV clinic last October after ending the relationship.

Solis has been able to get back in to treatment fairly easily, Kiim reports. But changes coming under the Affordable Care Act could complicate care for clinic patients, says Kathleen Clanon, chief medical officer at Highland Hospital. Continue reading →

FILED UNDER: Reform, ACA, HIV/AIDS, Obamacare
April 25, 2013 | 10:01 AM | By

Boston ER Doctor Finds Marathon Memories Hard to Shake

By Leana Wen, for NPR

(Jim Rogash/Getty Images)

(Jim Rogash/Getty Images)

I have a recurring nightmare where I am performing CPR on a patient who turns out to be my husband.

Last Monday, my nightmare nearly came true.

It was 2:50 p.m., and the Massachusetts General Hospital ER was filled to capacity.

In the section where I was working, my patients were critically ill, with strokes, heart attacks and overwhelming infections. Even the hallways were packed with patients receiving emergency treatments.

A call over the loudspeakers announced that there had been two explosions. Many people were injured. That’s all we knew.

Screams mixed with ambulance sirens. The loudspeaker sounded again and again, announcing that more patients were on their way.
Doctors, nurses and transporters disconnected monitors and rushed to send every patient to other areas of the hospital.

As we cleared the emergency room, there was a second call. These were bombings. There were fatalities and dozens, maybe hundreds, of injured. How many were coming to Mass General? Nobody knew.

Three minutes later, the doors flew open. Stretchers came, one after the other. Some victims had no pulse and weren’t breathing. Others had legs blown to shreds. All were covered with blood and soot.

The ER smelled of burnt flesh, and each stretcher left behind a fresh trail of blood. Continue reading →

FILED UNDER: Boston Bombings, Emergency Medicine
April 24, 2013 | 12:50 PM | By

Are Minority Kids Being Missed In ADHD Diagnosis?

(Getty Images)

(Getty Images)

For years, doctors, teachers and parents have fretted that attention deficit hyperactivity disorder (ADHD) is overdiagnosed and that children are overprescribed the stimulants that treat the brain disorder too often.

But, as EdSource Today reports, that’s not the case in California. According to new data from the National Survey of Children’s Health, California ranks 5th lowest in the country in diagnosis. The national average of children with ADHD is 7.9 percent, but in California, the rate is 5.2 percent.

That 5.2 percent rate may be a low one nationally. But globally, rates vary between 3 and 9 percent, “with the average closer to 5,” Prof. Joshua Israel told EdSource Today.

Still, within ethnic groups in California, the diagnosis rates drop dramatically. Kaiser researchers published data earlier this year which showed white children had a 5.6 percent rate — well in line with global averages. But other groups had much lower ADHD diagnosis rates as follows:

  • Black children: 4.1 percent
  • Latino children:  2.5 percent
  • Asian American children: 1.9 percent Continue reading →
FILED UNDER: Place Matters, Policy, ADHD, Overdiagnosis, Science, Underdiagnosis
April 22, 2013 | 10:24 AM | By

Sacramento Native and Her Husband Face Amputation, Rehab Together After Boston Bombings

Patrick and Jessica Kensky Downes, newlyweds, who each lost their lower left leg in the Boston bombings. (Photo from Jessica's Facebook page)

Patrick and Jessica Kensky Downes, newlyweds, who each lost their lower left leg in the Boston bombings. (Photo from Jessica’s Facebook page)

A week after the Boston Marathon bombing, only the most seriously injured are still hospitalized. Sacramento native Jessica Kensky Downes and her husband Patrick are among them. As Martha Bebinger of WBUR reports, the couple were at the finish line when the explosions ripped through the crowd. Patrick and Jessica both each lost the lower part of their left legs.

From WBUR:

Friends are having a hard time reconciling this news with memories of the joyful pair who married just last August.  Smiles in photos of Jessica and Patrick jump off the screen.

“But that’s not just a photograph,” says Leslie Kelly, who watched Jessica grow up just outside Sacramento, Calif.  “Those two are the happiest, most optimistic, wonderful people,” continues Kelly, which provides “a real good foundation for both of them going forward.” Continue reading →

FILED UNDER: Boston Bombings
April 18, 2013 | 10:28 AM | By

6 Factors That Help Save Lives In A Disaster

From Olympic Park to the Boston Marathon to Texas

The New Yorker’s Atul Gawande writes often and well about medicine. This week, he described how disaster planning and training in hospitals saves lives. This morning he added a series of tweets:

Continue reading →

FILED UNDER: Policy, Patient Safety, Science, Systems