Author Archives: state of health

June 18, 2013 | 10:13 AM | By

Despite Promises, Key Autism Therapy Cut from Medi-Cal

By Ryder Diaz, KQED

(Getty Images)

(Getty Images)

If you don’t have a child with autism, you might not know about Applied Behavioral Analysis. ABA is widely regarded as a necessary and effective treatment.

Now many poor children will lose access to this therapy under deals reached in Sacramento last week. Meanwhile, other kids — including those who become insured under the state’s new Obamacare marketplace — may well continue to have access to this therapy.

Here’s the background: under the Affordable Care Act, states can expand Medicaid, called Medi-Cal in California. People with incomes up to 138 percent of poverty will be eligible. Last week, as the legislature and the administration were wrapping up the state’s budget, the legislature was simultaneously moving forward on final bills to implement the Medi-Cal expansion.

Last Friday, after months of debate, legislators sent two final bills to the governor’s desk to approve the expansion. But for supporters of the expansion, this victory came at the cost — ABA therapy for kids on Medi-Cal was axed. Children’s advocates are frustrated. Continue reading →

FILED UNDER: Policy, Tests & Treatments, Applied Behavioral Analysis, Autism
June 14, 2013 | 10:28 AM | By

California Insurance Chief: Bar Anthem from Small Business Marketplace

By Mina Kim, KQED

California’s insurance commissioner Dave Jones says Anthem Blue Cross shouldn’t be allowed to sell small business health plans on Covered California, the state’s new health insurance marketplace being set up under the requirements of the federal health law.  Jones says Anthem, the state’s largest insurer, has been engaging in a “pattern” of “excessive” rate hikes.

“It simply cannot be the case that a health insurer can unreasonably gouge its small business customers and not face any consequences whatsoever,” Jones said.

Under state law, Jones can review health plan rate hikes and declare them unreasonable, but he lacks authority to block them. Continue reading →

FILED UNDER: KQED blogs, Obamacare, Tests & Treatments, Health Insurance Cost
June 4, 2013 | 10:04 AM | By

Thousands Expected for Rally to Block Medi-Cal Rate Cuts

By David Gorn, California Healthline

(seliaymiwell/flickr)

Protesters are calling on the governor to restore $1 billion in health care funding. (seliaymiwell/flickr)

Thousands of doctors, dentists, patients, health care professionals and other protesters are expected to gather Tuesday outside the Capitol Building to support the idea of reversing a 10 percent Medi-Cal provider rate cut. Organizers say it will be the largest health care protest in Sacramento history.

“We have people hopping on buses in Oceanside at 4 in the morning to get here,” said Molly Weedn, director of media relations for the California Medical Association. “People are coming from all over the state, and we’ve seen support from both sides in the Legislature. All of this [support] shows that the public doesn’t want Medi-Cal to be cut, so that’s why we’re doing this.”

It has been a tough couple of weeks for proponents of reversing the rate cut made in 2011 and not yet implemented because of court battles.

On May 24, the Ninth Circuit federal appeals court ruled the Medi-Cal cut to be legal, and lifted the injunctions on its implementation. That means the lawsuits to reverse the reduction now have only legal recourse, and that’s an appeal to the U.S. Supreme Court. Continue reading →

FILED UNDER: Policy, Medi-Cal, Provider Rate Cuts
May 31, 2013 | 2:30 PM | By

Want To Get People to Eat More Fresh Produce? Give Them A Little Money

By Marnette Federis

(Marnette Federis/KQED)

(Marnette Federis/KQED)

Collene Kraut says she never misses a chance to tell her 3-year-old daughter to eat vegetables and fruits. So when a farmers’ market launched in March, a block away from her home near San Diego, Kraut was eager to go.

“I don’t like it when people give my kid bad things to eat,” said Kraut. “I just want her to be healthy.”

Kraut receives funds from SNAP (formerly called food stamps), and she learned that she could use those funds at this new market. But Kraut learned about another new program while she was there, one that would help her stretch her dollars further. It’s called Fresh Fund, a grant-funded program which provides matching dollars specifically to purchase produce.

The program’s goal is to help low-income families buy accessible, affordable, nutritious produce.
That extra money is having an impact. Because of Fresh Fund, Kraut says she and other family members are now trying different varieties of fruits and vegetables. Kraut says she especially likes the different varieties of greens she finds, adding that they taste better than what she can buy at the supermarket.

“I brought some [greens] back for my dad, and he was eating it plain without salad dressing, he said it was good,” she recounts.

The Fresh Fund program helps families such as Kraut’s to stretch their food budgets so they have more room to shop for healthier food. The program’s goal is to help low-income families buy accessible, affordable, nutritious produce. Offering matching dollars for produce appears to influence people’s diets. Continue reading →

FILED UNDER: Place Matters, Policy, Farmers Markets, Food Stamps, Fresh Fund, SNAP
May 29, 2013 | 4:39 PM | By

Why California’s Obamacare Premiums Are Lower Than Expected

Dan Diamond, California Healthline

(Getty Images)

(Getty Images)

No Aetna. No United.

No Cedars-Sinai.

Covered California’s list of participating health care providers and insurers is out, and it’s possibly more notable for who isn’t partaking in the state’s new health insurance exchange rather than for who is.

The reasons for the big-name absences are manifold, ranging from payer strategy to high hospital prices to even accusations of gamesmanship. And they help explain the caution that — despite news that premiums will be far lower than expected – the exchange transition may be bumpier than some early, optimistic reports suggest.

Why Top Payers are Absent

According to representatives for Aetna, United and Cigna, the firms are sitting out California’s exchange because they’re taking a wait-and-see approach.

“We are simply taking the time to carefully evaluate and better understand how the exchanges will work to ensure we are best prepared to participate meaningfully in their development,” a United spokesperson told Chad Terhune at the Los Angeles Times. Continue reading →

FILED UNDER: Obamacare, Affordable Care Act, Covered California, Health Insurance Premiums, Obamacare
May 28, 2013 | 10:28 AM | By

Insurers Balk at Some Rare Genetic Tests for Breast Cancer

By Michelle Andrews for Kaiser Health News and NPR

Angelina Jolie's decision to have a double mastectomy after genetic testing has prompted a discussion about which other tests should be covered. (Gage Skidmore/Flickr)

Angelina Jolie’s decision to have a double mastectomy after genetic testing has prompted a discussion about which other tests should be covered. (Gage Skidmore/Flickr)

When it comes to inherited genetic mutations that increase the risk of breast cancer, BRCA1 and BRCA2 get nearly all the attention.

Inherited mutations in these genes cause from 5 to 10 percent of breast cancers as well as up to 15 percent of ovarian cancers, according to the National Cancer Institute.

There are other, rarer genetic mutations that also predispose women to breast cancer.

Other genes besides BRCA1 and BRCA2 may have mutations that predispose a woman to breast cancer.
Health insurers that cover BRCA-related testing and treatment without a hitch sometimes balk at providing coverage in these other instances. The predictive value of some of those variations isn’t always as strong or clear-cut.

When Angelie Jolie said earlier this month that she’d tested positive for a particularly harmful BRCA1 mutation and had a double mastectomy to substantially reduce her risk of getting breast cancer, she didn’t mention her insurance coverage. Continue reading →

FILED UNDER: Policy, Angelina Jolie, BRCA Genes, BRCA1, BRCA2, Breast Cancer, Genetic Testing
May 25, 2013 | 9:54 AM | By

Appeal Denied: Medi-Cal Rate Cuts Poised to Move Forward

By Judy Lin, Associated Press

A federal appeals court on Friday denied a second request by California doctors, pharmacists and hospitals seeking to undo the state’s 10 percent provider rate cut for treating the poor.

The 9th U.S. Circuit Court of Appeals denied an appeal from medical providers to rehear their case, which allows Gov. Jerry Brown to begin implementing the cuts retroactively. A three-judge panel had ruled against them in December on the grounds that trial courts cannot block the state from making cuts that were approved by the U.S. Department of Health and Human Services.

Health providers vowed they will continue to press lawmakers to restore the 10 percent reimbursement rate cut to the state’s Medicaid program, known as Medi-Cal. Continue reading →

FILED UNDER: KQED blogs, Policy, Medi-Cal, Provider Rate Cuts
May 24, 2013 | 8:05 AM | By

Young Adults Will Make or Break Obamacare in California

By Mina Kim, KQED

David Kim, brother of KQED health reporter Mina Kim, is 29-years-old and uninsured. (Mina Kim/KQED)

David Kim, brother of KQED health reporter Mina Kim, is 29-years-old and uninsured. He is considering whether to buy insurance on the health care marketplace if he doesn’t have employer-based coverage next year. (Mina Kim/KQED)

Most of us know someone who doesn’t have health insurance. In my case, it’s my little brother, David Kim.

David is 29-years-old and recently earned an advanced degree in international relations. He hasn’t been able to land a full-time job with health benefits. The two jobs he has now are temporary, and with such a precarious work situation, he just doesn’t think he can afford health insurance.

“I’m totally aware that if I get sick then I’m doomed financially,” Dave told me over a lunch break. “And maybe that’s not a very financially sound decision to make, but it is nonetheless a risk that, for the time being, I’m prepared to take.”

Young adults —18 to 34-year-olds — make up more than 40 percent of California’s uninsured, though they make up less than 30 percent of the population. And according to many health reform advocates, they’re the ones who could make or break Obamacare.

“If we get only sick people, and don’t get the young, healthy people into the insurance system, it’s going to mean premiums are much higher.” 
“The success of this law really does depend on getting young people insured, and frankly getting everyone insured,” said Larry Levitt, a health policy and insurance expert for the Kaiser Family Foundation.

In less than five months, a key piece of Obamacare will go live: state-based insurance marketplaces, called Covered California here. That means millions of Californians looking for coverage for themselves or their families will be able to go online and enroll in qualified health plans regardless of their medical history. Many will get help from federal subsidies. But if the exchange doesn’t enroll enough young, healthy people, insurers will have to hike everyone’s premiums. Continue reading →

FILED UNDER: Obamacare, You're the Boss, Affordable Care Act, Obamacare, Science, Young Adults
May 22, 2013 | 10:23 AM | By

More Single Boomers Share Homes — and Health Support

By Julie Rovner, NPR

Lorene Solivan moved into the "Golden Girls" house in October after seeing an ad on Craigslist. An event manager at a food company, Solivan says she often cooks dinner for the group. (Maggie Starbard/NPR)

Lorene Solivan moved into the “Golden Girls” house in October after seeing an ad on Craigslist. An event manager at a food company, Solivan says she often cooks dinner for the group. (Maggie Starbard/NPR)

Today more than 1 in every 3 baby boomers — that huge glut of people born between 1948 and 1964 — is unmarried. And those unmarried boomers are disproportionately women. As this vast generation rushes into retirement, there’s a growing concern among experts on aging: Who will take care of all these people when they’re too old to care for themselves?

It’s a question many of the experts take personally. “That is what scares me,” says Sara Rix, who works for the AARP Public Policy Institute, studying the economic prospects of women in the workforce. “Because I am one of those people,” she says, “and I do think about it.”

“Oh, I’ve got wonderful nieces and nephews,” Rix says, noting that’s what a lot of her boomer peers claim, too. “Well, in fact, they’ve got their families. They’ve got their in-laws. They’ve got their parents. And I don’t think it’s reasonable to expect much out of them.”

Kathleen Kelly, who runs the Family Caregiver Alliance and the National Center on Caregiving in San Francisco, says she’s seeing the same sort of concern in her social circle. “I’m in my 50s, and my friends are all talking about, ‘Could we all move in together? Could we buy an apartment building and all live together?’ There are all sorts of permutations of this conversation,” Kelly says. “But it really is something that people are thinking about, particularly women.”

And, because boomers are boomers, some are doing more than just thinking about it. Already, there’s a small but apparently growing movement of boomer women forming group houses with their single peers. Continue reading →

FILED UNDER: You're the Boss, Aging, Boomers, Long Term Care, Science
May 20, 2013 | 11:32 AM | By

Easy to Do, Inexpensive; Music Calms Some ICU Patients

By Leslie Harris O’Hanlon

(Getty Images)

(Ryan McVay/Getty Images)

The adage stems from the 18th century: music has charms to sooth the savage breast. It’s probably safe to say that someone in an intensive care unit, who needs a machine to help them breathe, is in need of soothing. Usually, doctors and nurses administer drugs, powerful sedatives to help calm patients. Now, a study shows that a different kind of intervention might help: music. The study, published Monday in the Journal of the American Medical Association, adds to a growing body of research on how listening to music has a host of health benefits.

Patients in the music group received 38 percent fewer doses of sedatives.
Researchers at Ohio State University looked at ICU patients on mechanical ventilators for respiratory failure. Those who listened to the music of their choice not only had greater reduction in anxiety but also used fewer sedation drugs and lower doses compared to patients who did not have access to music — they received usual ICU care. Mechanical ventilation, or ventilatory support, is when a patient is connected to a machine, called a ventilator, to help him or her breath.

Researchers call this “patient-directed music” because patients could select their own music and put headphones on whenever they wanted.

The “intervention empowered patients to use music to manage their own anxiety whenever they felt they needed the use of music to help them relax or when they desired some quiet time,” said lead author Professor Linda L. Chlan at Ohio State. “Music does not induce adverse side effects, which are sometimes evident with sedative agents administered to these patients.” Continue reading →

FILED UNDER: You're the Boss, ICU, Music, Science