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Shots\u003c/strong>","isLoading":false},"byline_stateofhealth_230664":{"type":"authors","id":"byline_stateofhealth_230664","meta":{"override":true},"slug":"byline_stateofhealth_230664","name":"\u003cstrong> Alison Kodjak \u003c/br> NPR \u003c/strong>","isLoading":false},"byline_stateofhealth_228587":{"type":"authors","id":"byline_stateofhealth_228587","meta":{"override":true},"slug":"byline_stateofhealth_228587","name":"\u003cstrong> Sarah Varney \u003c/br> Kaiser Health News \u003c/strong>","isLoading":false},"lklivans":{"type":"authors","id":"8648","meta":{"index":"authors_1591205172","id":"8648","found":true},"name":"Laura Klivans","firstName":"Laura","lastName":"Klivans","slug":"lklivans","email":"lklivans@kqed.org","display_author_email":true,"staff_mastheads":["news","science"],"title":"Reporter and Host","bio":"Laura Klivans is a science reporter and the host of KQED's video series about tiny, amazing animals, \u003cem>Deep Look\u003c/em>. Her work can also be heard on NPR, \u003cem>Here & Now, \u003c/em>and PRI. Before working in audio, she taught, leading groups of students abroad. One of her favorite jobs was teaching on the Thai-Burmese border, working with immigrants and refugees.\r\n\r\nLaura has won three Northern California Area Emmys along with her Deep Look colleagues. She's won the North Gate Award for Excellence in Audio Reporting and the Gobind Behari Lal Award for a radio documentary about adults with imaginary friends. She's a fellowship junkie, completing the USC Center for Health Journalism's California Fellowship, UC Berkeley's Human Rights Fellowship and the Coro Fellowship in Public Affairs. Laura has a master’s in journalism from UC Berkeley and a master’s in education from Harvard.\r\n\r\nShe likes to eat chocolate for breakfast. She's also open to eating it all day long.","avatar":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twitter":"lauraklivans","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["editor"]},{"site":"stateofhealth","roles":["contributor","editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"Laura Klivans | KQED","description":"Reporter and Host","ogImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lklivans"},"cfeibel":{"type":"authors","id":"11314","meta":{"index":"authors_1591205172","id":"11314","found":true},"name":"Carrie Feibel","firstName":"Carrie","lastName":"Feibel","slug":"cfeibel","email":"cfeibel@KQED.org","display_author_email":false,"staff_mastheads":[],"title":"KQED Contributor","bio":"Carrie Feibel is a former health editor at KQED, where she has also reported for radio and online. Her stories have appeared on the national NPR shows \u003cem>Morning Edition\u003c/em>, \u003cem>All Things Considered\u003c/em>, and \u003cem>Here & Now\u003c/em>, and on the national website, Kaiser Health News. Her print career included stints at the \u003cem>Houston Chronicle\u003c/em>, \u003cem>The (Bergen) Record,\u003c/em> and the Associated Press in New York City. A native of St. Louis, Feibel attended Cornell University, and earned a master's in journalism from Columbia University.","avatar":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twitter":"KQEDHealth","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"stateofhealth","roles":["administrator"]}],"headData":{"title":"Carrie Feibel | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/c64a7e3c9a910e1bffd4ad32a5264aa9?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/cfeibel"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_360417":{"type":"posts","id":"stateofhealth_360417","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360417","score":null,"sort":[1501719537000]},"guestAuthors":[],"slug":"feinstein-deeply-concerned-with-anthem-rollback-of-coverage","title":"Feinstein 'Deeply Concerned' With Anthem Rollback of Coverage","publishDate":1501719537,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>California Senator Diane Feinstein said Wednesday that she was \"deeply concerned\" by Anthem Blue Cross’s decision to reduce individual health plan coverage for some 150,000 Californians.\u003c/p>\n\u003cp>\"I’m unhappy, at first blush, and at second blush, I don’t understand it,\" she said in an interview with KQED.\u003c/p>\n\u003cp>Anthem said it will withdraw from 16 of the 19 California regions it covers. This means \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/08/01/health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california/\" target=\"_blank\" rel=\"noopener noreferrer\">more than half of Californians\u003c/a> with an Anthem plan through the individual market -- or 153,000 people -- will have to find a new option.\u003c/p>\n\u003cp>In an email to KQED, Anthem Blue Cross representatives said the shrinking individual market and changes in federal guidance were the reasons behind its decision to cover fewer Californians this year. These changes will not impact Californians with Anthem plans through Medicare, Medi-Cal and their employer, or plans purchased before March 2010 -- which are grandfathered in.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Anthem representatives also said they'd \"continue to advocate solutions that will stabilize the market to allow us to return to a more robust presence in the future.\"\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Feinstein said the change came as a surprise and she's puzzled by the insurer opting out of the large California market. \"I'm really surprised to see this and deeply concerned.\"\u003c/p>\n\u003cp>Anthem's announcement came as Covered California -- the state's health care marketplace -- on Tuesday released the 11 participating \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">health insurers and its 2018 rates\u003c/a>.\u003c/p>\n\u003cp>Covered California said the average health premium would increase 12.5 percent next year -- but could double if the federal government stops providing key cost-sharing subsidies that help low-income consumers. Covered California said it needs to finalize rates by Aug. 31.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lawmakers in Congress have temporarily abandoned their efforts to repeal and replace the Affordable Care Act, or Obamacare, despite President Trump's urging them to keep working on legislation.\u003c/p>\n\n","blocks":[],"excerpt":"Sen. Feinstein said the change came as a surprise and she's puzzled by the insurer opting out of the large California market. ","status":"publish","parent":0,"modified":1501781657,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":10,"wordCount":324},"headData":{"title":"Feinstein 'Deeply Concerned' With Anthem Rollback of Coverage | KQED","description":"Sen. Feinstein said the change came as a surprise and she's puzzled by the insurer opting out of the large California market. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Feinstein 'Deeply Concerned' With Anthem Rollback of Coverage","datePublished":"2017-08-03T00:18:57.000Z","dateModified":"2017-08-03T17:34:17.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"360417 https://ww2.kqed.org/stateofhealth/?p=360417","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/02/feinstein-deeply-concerned-with-anthem-rollback-of-coverage/","disqusTitle":"Feinstein 'Deeply Concerned' With Anthem Rollback of Coverage","path":"/stateofhealth/360417/feinstein-deeply-concerned-with-anthem-rollback-of-coverage","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Senator Diane Feinstein said Wednesday that she was \"deeply concerned\" by Anthem Blue Cross’s decision to reduce individual health plan coverage for some 150,000 Californians.\u003c/p>\n\u003cp>\"I’m unhappy, at first blush, and at second blush, I don’t understand it,\" she said in an interview with KQED.\u003c/p>\n\u003cp>Anthem said it will withdraw from 16 of the 19 California regions it covers. This means \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/08/01/health-premiums-go-up-12-5-in-2018-and-anthem-exits-much-of-california/\" target=\"_blank\" rel=\"noopener noreferrer\">more than half of Californians\u003c/a> with an Anthem plan through the individual market -- or 153,000 people -- will have to find a new option.\u003c/p>\n\u003cp>In an email to KQED, Anthem Blue Cross representatives said the shrinking individual market and changes in federal guidance were the reasons behind its decision to cover fewer Californians this year. These changes will not impact Californians with Anthem plans through Medicare, Medi-Cal and their employer, or plans purchased before March 2010 -- which are grandfathered in.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s1\">Anthem representatives also said they'd \"continue to advocate solutions that will stabilize the market to allow us to return to a more robust presence in the future.\"\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Feinstein said the change came as a surprise and she's puzzled by the insurer opting out of the large California market. \"I'm really surprised to see this and deeply concerned.\"\u003c/p>\n\u003cp>Anthem's announcement came as Covered California -- the state's health care marketplace -- on Tuesday released the 11 participating \u003ca href=\"http://www.coveredca.com/news/PDFs/CoveredCA_2018_Plans_and_Rates_8-1-2017.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">health insurers and its 2018 rates\u003c/a>.\u003c/p>\n\u003cp>Covered California said the average health premium would increase 12.5 percent next year -- but could double if the federal government stops providing key cost-sharing subsidies that help low-income consumers. Covered California said it needs to finalize rates by Aug. 31.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Lawmakers in Congress have temporarily abandoned their efforts to repeal and replace the Affordable Care Act, or Obamacare, despite President Trump's urging them to keep working on legislation.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360417/feinstein-deeply-concerned-with-anthem-rollback-of-coverage","authors":["8648"],"categories":["stateofhealth_1"],"tags":["stateofhealth_2698","stateofhealth_368","stateofhealth_3144","stateofhealth_28","stateofhealth_2865"],"featImg":"stateofhealth_360435","label":"stateofhealth"},"stateofhealth_356393":{"type":"posts","id":"stateofhealth_356393","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"356393","score":null,"sort":[1500486172000]},"guestAuthors":[],"slug":"trumps-big-repealing-deal-8-takeaways-on-the-senates-health-care-meltdown-moment","title":"Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown","publishDate":1500486172,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what's next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick \"repeal-and-replace\" strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">\"Nobody knew health care could be so complicated.\"\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as \"mean\"\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be \"beautiful,\"\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have \"heart\" and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill's fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already \"yes\" votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn't the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka \"Obamacare,\" is now part of its warp and woof. Ripping it out would disrupt the health care system's delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That's why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer's hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president's Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell's magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a \"public option\" format as a faster track to single-payer \"Medicare for all.\" But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state's families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue's salience will continue to grow. The average American wants good health care and has been increasingly promised \"the best.\" But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of \"single-payer\" is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of \"Medicare for all,\" government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still \"socialized medicine\" and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children's Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden's salty choice of words is more politely repeated by the initials \"BFD.\"\u003c/a> But his assessment of the moment's importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden's BFD?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n","blocks":[],"excerpt":"President Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if Trump had plunged into the trenches, his presence there might not have made the difference.","status":"publish","parent":0,"modified":1533585974,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1474},"headData":{"title":"Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown | KQED","description":"President Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if Trump had plunged into the trenches, his presence there might not have made the difference.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown","datePublished":"2017-07-19T17:42:52.000Z","dateModified":"2018-08-06T20:06:14.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"356393 https://ww2.kqed.org/stateofhealth/?p=356393","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/07/19/trumps-big-repealing-deal-8-takeaways-on-the-senates-health-care-meltdown-moment/","disqusTitle":"Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown","nprImageCredit":"Carlos Barria","nprByline":"\u003cstrong>\u003ca href=”http://www.npr.org/people/1930203/ron-elving”>Ron Elving\u003c/a>\u003cbr />\u003ca href=”https://npr.org”>NPR\u003c/a>\u003c/strong>","nprImageAgency":"Reuters","nprStoryId":"537948116","nprApiLink":"http://api.npr.org/query?id=537948116&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/2017/07/19/537948116/trumps-big-repeal-deal-8-thoughts-on-the-senate-s-meltdown-moment?ft=nprml&f=537948116","nprRetrievedStory":"1","nprPubDate":"Wed, 19 Jul 2017 09:24:00 -0400","nprStoryDate":"Wed, 19 Jul 2017 05:00:00 -0400","nprLastModifiedDate":"Wed, 19 Jul 2017 09:24:53 -0400","path":"/stateofhealth/356393/trumps-big-repealing-deal-8-takeaways-on-the-senates-health-care-meltdown-moment","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what's next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick \"repeal-and-replace\" strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">\"Nobody knew health care could be so complicated.\"\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as \"mean\"\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be \"beautiful,\"\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have \"heart\" and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill's fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already \"yes\" votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn't the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka \"Obamacare,\" is now part of its warp and woof. Ripping it out would disrupt the health care system's delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That's why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer's hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president's Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell's magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a \"public option\" format as a faster track to single-payer \"Medicare for all.\" But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state's families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue's salience will continue to grow. The average American wants good health care and has been increasingly promised \"the best.\" But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of \"single-payer\" is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of \"Medicare for all,\" government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still \"socialized medicine\" and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children's Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden's salty choice of words is more politely repeated by the initials \"BFD.\"\u003c/a> But his assessment of the moment's importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden's BFD?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/356393/trumps-big-repealing-deal-8-takeaways-on-the-senates-health-care-meltdown-moment","authors":["byline_stateofhealth_356393"],"categories":["stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_38","stateofhealth_2995","stateofhealth_2808","stateofhealth_3131","stateofhealth_2519","stateofhealth_2865","stateofhealth_365"],"featImg":"stateofhealth_356396","label":"stateofhealth"},"stateofhealth_348224":{"type":"posts","id":"stateofhealth_348224","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"348224","score":null,"sort":[1498603938000]},"guestAuthors":[],"slug":"californias-leaders-warn-health-bill-remains-a-dangerous-threat","title":"Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan","publishDate":1498603938,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Though Senate Republicans decided Tuesday to delay a vote on their controversial health plan until after the July 4 recess, Democrats in California are calling on residents to keep up their resistance to the plan.\u003c/p>\n\u003cp>Gov. Jerry Brown joined Sens. Dianne Feinstein and Kamala Harris for a call with reporters early Tuesday. Brown said the GOP bill's proposed Medicaid cuts, and its rollback of Obamacare's insurance regulations, would be disastrous for millions of Californians.\u003c/p>\n\u003cp>Feinstein said one in three Californians are covered by Medi-Cal. The loss of funding could put up to 14 million Californians at risk of losing health coverage or critical medical services, she said.\u003c/p>\n\u003cp>\"One of the things we all try not to do is never turn the haves or the have-nots against each other ... and this bill does that,\" she said.\u003c/p>\n\u003cp>\"This is a bad plan through and through and through, she added. \"There aren’t one or two amendments that can fix it. So it’s got to be defeated.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n","blocks":[],"excerpt":"Though Senate Republicans have delayed a vote on their health bill, California Dems are urging people to keep up the pressure.","status":"publish","parent":0,"modified":1498611249,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":452},"headData":{"title":"Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan | KQED","description":"Though Senate Republicans have delayed a vote on their health bill, California Dems are urging people to keep up the pressure.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan","datePublished":"2017-06-27T22:52:18.000Z","dateModified":"2017-06-28T00:54:09.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"348224 https://ww2.kqed.org/stateofhealth/?p=348224","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/27/californias-leaders-warn-health-bill-remains-a-dangerous-threat/","disqusTitle":"Feinstein: Health Care of 14 Million Californians At Risk Under GOP Plan","path":"/stateofhealth/348224/californias-leaders-warn-health-bill-remains-a-dangerous-threat","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Though Senate Republicans decided Tuesday to delay a vote on their controversial health plan until after the July 4 recess, Democrats in California are calling on residents to keep up their resistance to the plan.\u003c/p>\n\u003cp>Gov. Jerry Brown joined Sens. Dianne Feinstein and Kamala Harris for a call with reporters early Tuesday. Brown said the GOP bill's proposed Medicaid cuts, and its rollback of Obamacare's insurance regulations, would be disastrous for millions of Californians.\u003c/p>\n\u003cp>Feinstein said one in three Californians are covered by Medi-Cal. The loss of funding could put up to 14 million Californians at risk of losing health coverage or critical medical services, she said.\u003c/p>\n\u003cp>\"One of the things we all try not to do is never turn the haves or the have-nots against each other ... and this bill does that,\" she said.\u003c/p>\n\u003cp>\"This is a bad plan through and through and through, she added. \"There aren’t one or two amendments that can fix it. So it’s got to be defeated.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Brown condemned the Senate bill, saying it \"will be the most divisive maneuver, cutting right into the heart of what is already a divided nation.\"\u003c/p>\n\u003cp>He noted it would cut billions of federal dollars from the Medi-Cal budget and that if California couldn't take care of low-income people, there would be ripple effects.\u003c/p>\n\u003cp>\"There's no doubt this bill will exacerbate homelessness, crime,\" Brown said. \"[The bill hurts] the kinds of people who really need help and are getting it under the Medi-Cal program.\"\u003c/p>\n\u003cp>The Senate is expected to reconvene on July 10, and the House or Representatives on July 11.\u003c/p>\n\u003cp>Congress needs to work on improving health care, not taking it away, said Feinstein, noting Democrats' strategy was \"to defeat this [GOP bill] solidly.\"\u003c/p>\n\u003cp>\"I've always believed there are a couple of things that maybe should be fixed in Obamacare, but the basic bill is a good bill. It has worked,\" she said.\u003c/p>\n\u003cp>In a statement late Tuesday, California Republican Rep. Ken Calvert said the Senate bill was like the House legislation that passed in May, aiming \"to refocus Medicaid on the most vulnerable Americans, while not pulling the rug out from anyone who has benefited from the Medicaid expansion.\"\u003c/p>\n\u003cp>That contradicts the \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> released Monday by the nonpartisan Congressional Budget Office. That report said the number of people covered by Medicaid would decrease by 15 million over the next decade, and federal payments for Medicaid would be cut by $772 billion.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"In the long run, massive expansions of expensive government programs like Medicaid are simply not fiscally sustainable,\" Calvert said.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/348224/californias-leaders-warn-health-bill-remains-a-dangerous-threat","authors":["11314"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_2808","stateofhealth_28","stateofhealth_99","stateofhealth_218","stateofhealth_2519","stateofhealth_2865","stateofhealth_365"],"featImg":"stateofhealth_348225","label":"stateofhealth"},"stateofhealth_346819":{"type":"posts","id":"stateofhealth_346819","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"346819","score":null,"sort":[1498174450000]},"guestAuthors":[],"slug":"san-francisco-doctors-and-nurses-rally-against-senate-health-care-bill","title":"San Francisco Doctors and Nurses Rally Against Senate Health Care Bill","publishDate":1498174450,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Roughly 200 San Francisco doctors and nurses rallied Thursday outside San Francisco General Hospital to protest the \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">recently released Senate health care bill\u003c/a>.\u003c/p>\n\u003cp>Crafted in secret by Republican leadership, the bill repeals major parts of the sweeping healthcare law implemented by President Obama, known as the Affordable Care Act or Obamacare. The Republican replacement bill would phase out Medicaid expansion, cap spending on Medicaid and eliminate many taxes that fund Obamacare.\u003c/p>\n\u003cp>“This is about public health,” said Sasha Cuttler, a nurse at the hospital. “This isn’t a partisan issue. ... We have a duty to speak up against this.”\u003c/p>\n\u003cfigure id=\"attachment_346861\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346861\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">A health care professional holding up a sign at a protest at the San Francisco General Hospital against the newly proposed health care bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Matthew Hickey, resident physician and one of the organizers of the rally, said that it’s time for medical professionals to get more politically active.\u003c/p>\n\u003cp>“With the new health care bill being revealed, we felt it’s the right moment for us doctors to do more in the political sphere,” he said. Together with a group of resident doctors, Hickey created the group \"Keep America Covered\" that has organized other rallies since the elections.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>During the rally, doctors, nurses and patients spoke to the crowd and led them in chants like, “Healthcare yes, denials no, profiteers have got to go.\" Organizers encouraged attendees to tweet about their opposition of the bill, as well as to ask their friends and family in other states to call their senators.\u003c/p>\n\u003cfigure id=\"attachment_346862\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346862\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Health care professionals at the San Francisco General Hospital protested against the proposed new health care bill which is intended to replace the Affordable Care Act. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Congressional Budget Office has yet to release its report on the bill, but their report on the House’s version of the bill concluded it would leave 23 million Americans uninsured.\u003c/p>\n\u003cp>“This is not simply a despicable effort to deny essential healthcare services to 23 million Americans,” said UCSF professor Kevin Grumbach. “It is fundamentally an attack on the poor and the most vulnerable in our society and a massive transfer of wealth to the richest part of our society.”\u003c/p>\n\u003cp>One of the speakers at the rally was Troy Brunét, a patient living with HIV. He fears for fellow patients living with the decease.\u003c/p>\n\u003cp>“We are reverting back to the 1980s when the AIDS crisis hit us,\" he said. \"And to be honest, this freaks me out. From now on, things are going to change for the worse.”\u003c/p>\n\u003cfigure id=\"attachment_346860\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346860\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Troy Brunét, a patient living with HIV, addressing the crowd at the San Francisco General Hospital. Health care professionals and some patients protested against the new Senate health care bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Brunét said he’ll continue to fight.\u003c/p>\n\u003cp>“I’m going call Scott Weiner and Senator Harris to tell them to continue the fight as well,\" he said. \"And I’m going to reach out to my family back in Louisiana to tell them to also call their representatives and voice their anger.”\u003c/p>\n\u003cp>Things changed pretty dramatically at San Francisco General with the passage of Obamacare in 2010. Before it passed, nearly 35 percent of the hospital’s patients were uninsured. After, that number dropped to 3 percent for inpatient care.\u003c/p>\n\u003cp>“It means that people are going to get sick and people are going to die,” Dr. Amy Whittle said. “As a pediatrician I’m worried about preventive care and not being able to provide all the care that we know saves us money down the line.”\u003c/p>\n\u003cp>Republican leaders hope to vote on the bill as soon as next week, despite some initial \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-health-care-bill-could-be-in-jeopardy-as-conservatives-announce-opposition/\" target=\"_blank\" rel=\"noopener noreferrer\">opposition from Conservative lawmakers\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_346863\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-346863 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Matthew Hickey, resident physician at the San Francisco General Hospital poses for a photo with a sign in protest of the newly proposed senate health bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>Earlier in the week, on Wednesday, the day before the Senate released their bill, another group of health care activists and senior citizens protested the proposed legislature, staging a \"die-in\" in front of the San Francisco Federal Building. The demonstration, organized by \u003ca href=\"https://t.co/Av5dcXIzXA\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Rising\u003c/a>, was briefly interrupted when a \u003ca href=\"http://hoodline.com/2017/06/motorcyclist-in-custody-after-allegedly-attempting-to-run-over-trumpcare-protestors\" target=\"_blank\" rel=\"noopener noreferrer\">motorcyclist rode during through the group\u003c/a>, narrowly missing some of the people lying in the middle of 7th Street. Police officers at the scene detained the man and he was taken into custody. No injuries were reported.\u003c/p>\n\u003cfigure id=\"attachment_346838\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-346838 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/GettyImages-699424552-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Healthcare activists hold signs as they stage a die-in while protesting the Trumpcare bill on June 21, 2017 in San Francisco. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\n","blocks":[],"excerpt":"As details of the Senate bill came out, several demonstrations in the city showed that many in S.F. were not happy with the latest bill. ","status":"publish","parent":0,"modified":1498250770,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":790},"headData":{"title":"San Francisco Doctors and Nurses Rally Against Senate Health Care Bill | KQED","description":"As details of the Senate bill came out, several demonstrations in the city showed that many in S.F. were not happy with the latest bill. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"San Francisco Doctors and Nurses Rally Against Senate Health Care Bill","datePublished":"2017-06-22T23:34:10.000Z","dateModified":"2017-06-23T20:46:10.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"346819 https://ww2.kqed.org/stateofhealth/?p=346819","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/22/san-francisco-doctors-and-nurses-rally-against-senate-health-care-bill/","disqusTitle":"San Francisco Doctors and Nurses Rally Against Senate Health Care Bill","nprByline":"\u003cstrong>\u003ca href=\"https://ww2.kqed.org/news/author/shutson/\" target=\"_blank\">Sonja Hutson\u003c/a>\u003c/strong> and \u003cstrong>\u003ca href=\"https://twitter.com/sroosblad\" target=\"_blank\">Serginho Roosblad\u003c/a>\u003c/strong>","path":"/stateofhealth/346819/san-francisco-doctors-and-nurses-rally-against-senate-health-care-bill","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Roughly 200 San Francisco doctors and nurses rallied Thursday outside San Francisco General Hospital to protest the \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">recently released Senate health care bill\u003c/a>.\u003c/p>\n\u003cp>Crafted in secret by Republican leadership, the bill repeals major parts of the sweeping healthcare law implemented by President Obama, known as the Affordable Care Act or Obamacare. The Republican replacement bill would phase out Medicaid expansion, cap spending on Medicaid and eliminate many taxes that fund Obamacare.\u003c/p>\n\u003cp>“This is about public health,” said Sasha Cuttler, a nurse at the hospital. “This isn’t a partisan issue. ... We have a duty to speak up against this.”\u003c/p>\n\u003cfigure id=\"attachment_346861\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346861\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25779_0M6A3091-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">A health care professional holding up a sign at a protest at the San Francisco General Hospital against the newly proposed health care bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Matthew Hickey, resident physician and one of the organizers of the rally, said that it’s time for medical professionals to get more politically active.\u003c/p>\n\u003cp>“With the new health care bill being revealed, we felt it’s the right moment for us doctors to do more in the political sphere,” he said. Together with a group of resident doctors, Hickey created the group \"Keep America Covered\" that has organized other rallies since the elections.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>During the rally, doctors, nurses and patients spoke to the crowd and led them in chants like, “Healthcare yes, denials no, profiteers have got to go.\" Organizers encouraged attendees to tweet about their opposition of the bill, as well as to ask their friends and family in other states to call their senators.\u003c/p>\n\u003cfigure id=\"attachment_346862\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346862\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25780_0M6A3204-qut-1-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Health care professionals at the San Francisco General Hospital protested against the proposed new health care bill which is intended to replace the Affordable Care Act. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Congressional Budget Office has yet to release its report on the bill, but their report on the House’s version of the bill concluded it would leave 23 million Americans uninsured.\u003c/p>\n\u003cp>“This is not simply a despicable effort to deny essential healthcare services to 23 million Americans,” said UCSF professor Kevin Grumbach. “It is fundamentally an attack on the poor and the most vulnerable in our society and a massive transfer of wealth to the richest part of our society.”\u003c/p>\n\u003cp>One of the speakers at the rally was Troy Brunét, a patient living with HIV. He fears for fellow patients living with the decease.\u003c/p>\n\u003cp>“We are reverting back to the 1980s when the AIDS crisis hit us,\" he said. \"And to be honest, this freaks me out. From now on, things are going to change for the worse.”\u003c/p>\n\u003cfigure id=\"attachment_346860\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-346860\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25778_0M6A3283-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Troy Brunét, a patient living with HIV, addressing the crowd at the San Francisco General Hospital. Health care professionals and some patients protested against the new Senate health care bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Brunét said he’ll continue to fight.\u003c/p>\n\u003cp>“I’m going call Scott Weiner and Senator Harris to tell them to continue the fight as well,\" he said. \"And I’m going to reach out to my family back in Louisiana to tell them to also call their representatives and voice their anger.”\u003c/p>\n\u003cp>Things changed pretty dramatically at San Francisco General with the passage of Obamacare in 2010. Before it passed, nearly 35 percent of the hospital’s patients were uninsured. After, that number dropped to 3 percent for inpatient care.\u003c/p>\n\u003cp>“It means that people are going to get sick and people are going to die,” Dr. Amy Whittle said. “As a pediatrician I’m worried about preventive care and not being able to provide all the care that we know saves us money down the line.”\u003c/p>\n\u003cp>Republican leaders hope to vote on the bill as soon as next week, despite some initial \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-health-care-bill-could-be-in-jeopardy-as-conservatives-announce-opposition/\" target=\"_blank\" rel=\"noopener noreferrer\">opposition from Conservative lawmakers\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_346863\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-346863 size-large\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1020x680.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/RS25781_ACA-protest-1-qut-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Matthew Hickey, resident physician at the San Francisco General Hospital poses for a photo with a sign in protest of the newly proposed senate health bill. \u003ccite>(Serginho Roosblad/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003c/p>\n\u003cp>Earlier in the week, on Wednesday, the day before the Senate released their bill, another group of health care activists and senior citizens protested the proposed legislature, staging a \"die-in\" in front of the San Francisco Federal Building. The demonstration, organized by \u003ca href=\"https://t.co/Av5dcXIzXA\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Rising\u003c/a>, was briefly interrupted when a \u003ca href=\"http://hoodline.com/2017/06/motorcyclist-in-custody-after-allegedly-attempting-to-run-over-trumpcare-protestors\" target=\"_blank\" rel=\"noopener noreferrer\">motorcyclist rode during through the group\u003c/a>, narrowly missing some of the people lying in the middle of 7th Street. Police officers at the scene detained the man and he was taken into custody. No injuries were reported.\u003c/p>\n\u003cfigure id=\"attachment_346838\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-346838 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/GettyImages-699424552-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/06/GettyImages-699424552-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Healthcare activists hold signs as they stage a die-in while protesting the Trumpcare bill on June 21, 2017 in San Francisco. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/346819/san-francisco-doctors-and-nurses-rally-against-senate-health-care-bill","authors":["byline_stateofhealth_346819"],"categories":["stateofhealth_166"],"tags":["stateofhealth_3117","stateofhealth_2519","stateofhealth_2865"],"featImg":"stateofhealth_346840","label":"stateofhealth"},"stateofhealth_346757":{"type":"posts","id":"stateofhealth_346757","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"346757","score":null,"sort":[1498162582000]},"guestAuthors":[],"slug":"analysis-why-senate-health-bill-is-even-meaner-for-california","title":"Analysis: Why Senate Health Bill Is Even 'Meaner' for California","publishDate":1498162582,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"Five takeaways from the new draft bill, and why it's not really 'repeal and replace.'","status":"publish","parent":0,"modified":1498253090,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":887},"headData":{"title":"Analysis: Why Senate Health Bill Is Even 'Meaner' for California | KQED","description":"Five takeaways from the new draft bill, and why it's not really 'repeal and replace.'","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Analysis: Why Senate Health Bill Is Even 'Meaner' for California","datePublished":"2017-06-22T20:16:22.000Z","dateModified":"2017-06-23T21:24:50.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"346757 https://ww2.kqed.org/stateofhealth/?p=346757","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/06/22/analysis-why-senate-health-bill-is-even-meaner-for-california/","disqusTitle":"Analysis: Why Senate Health Bill Is Even 'Meaner' for California","path":"/stateofhealth/346757/analysis-why-senate-health-bill-is-even-meaner-for-california","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>At last, Republican senators have \u003ca href=\"https://ww2.kqed.org/news/2017/06/22/senate-republicans-reveal-obamacare-repeal-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">unveiled their crafted-in-secret health bill\u003c/a>, and everyone, including other Republican senators, are scrambling to understand the 142-page \"\u003ca href=\"https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Better Care Reconciliation Act of 2017\u003c/a>.\"\u003c/p>\n\u003cp>To know whether it's truly \"better care,\" and for which patients, if any, we still need the Congressional Budget Office to weigh in. But some California advocates say the “discussion draft” is clear enough to conclude that the bill would be “disproportionately devastating” for California’s health care system.\u003c/p>\n\u003cp>“If the House bill was mean, as the President termed it, the Senate bill was actually meaner and crueler,” said Anthony Wright, executive director of Health Access California. “It has harsher cuts, especially to the Medicaid program that covers 14 million Californians.\"\u003c/p>\n\u003cp>In the meantime, here are my five takeaways from the bill:\u003c/p>\n\u003cp>\u003cstrong>1. 'Repeal and Replace' Rhetoric Should Be … Repealed\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At this point, it’s inaccurate and misleading. The Republican bill doesn’t repeal all of President Obama's health care law known as the Affordable Care Act, or Obamacare. Nor does it replace it with anything. The bill maintains the basic mechanics of the ACA but rolls back the financial assistance and some of the consumer protections. In addition, a huge part of this bill has nothing to do with Obamacare: It proposes a radical dismemberment of Medicaid as we know it.\u003c/p>\n\u003cp>Let’s describe what the bill actually does: It’s an Obamacare \u003cem>rollback\u003c/em> and a Medicaid \u003cem>cutback\u003c/em>.\u003c/p>\n\u003cp>\u003cstrong>2. Much Less Aid for Medicaid\u003c/strong>\u003c/p>\n\u003cp>The Senate bill will phase out one of the ACA’s most visible accomplishments: the \u003cem>expansion\u003c/em> of Medicaid (Medi-Cal in California) to poor, uninsured adults. That means 3.7 million Californians who got Medi-Cal since 2014 will eventually lose it.\u003c/p>\n\u003cp>But there's more. The Senate plan will also cut funding for \u003cem>traditional\u003c/em> Medi-Cal, and the cuts will be deeper, over time, than even the House Republicans proposed.\u003c/p>\n\u003cp>In California, Medi-Cal covers one-third of all residents, half of all children, and two-thirds of seniors in nursing homes.\u003c/p>\n\u003cp>Who pays for their care if the feds pay less? The short answer is no one -- or state taxpayers.\u003c/p>\n\u003cp>\u003cstrong>3. What About Covered California? Could It help?\u003c/strong>\u003c/p>\n\u003cp>Not really. The Senate version tries to assuage pre-Medicare seniors (below age 65) who were alarmed that the House bill would have given them only a maximum tax credit of $4,000 to buy a plan, no matter the plan’s price. The Senate bill reverts to the ACA mechanism of offering tax credits based on income, not age. But, insurers can still charge older people five times what they charge younger people.\u003c/p>\n\u003cp>And tax credits would only be offered to people with incomes below 350 percent of the federal poverty level, down from the ACA’s 400 percent. Do you make $42,000-$48,000 a year? You would no longer qualify for any subsidies on Covered California.\u003c/p>\n\u003cp>That’s not all. Other complicated changes to the exchanges mean premiums and deductibles would go up, and special ACA grants that help reduce those deductibles disappear.\u003c/p>\n\u003cp>\u003cstrong>4. Winners? Or Just Losers: Pre-existing conditions vs. Planned Parenthood\u003c/strong>\u003c/p>\n\u003cp>The Senate bill appears to drop a wildly unpopular provision that is still in the House bill -- the possibility that your state might allow insurers to refuse to cover people with pre-existing conditions, or charge them much more. That seems like good news for cancer survivors and millions of others with chronic illnesses. They can't be denied coverage, or charged more up front.\u003c/p>\n\u003cp>But experts who have read the bill closely say there are loopholes that would allow individual states to loosen regulations on insurers -- enabling those insurers to carve away coverage that people with pre-existing conditions need. As Kaiser Health News \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\" target=\"_blank\">reports\u003c/a>: \u003c/p>\n\u003cblockquote>\u003cp>Somebody with cancer might be able to buy insurance but find it doesn’t cover expensive chemotherapy. A plan might pay for opioids to control pain but not recovery if a patient became addicted. People planning families might find it hard to get childbirth coverage.\u003c/p>\u003c/blockquote>\n\u003cp>The Senate bill also retains a proposal to eliminate all federal funding for Planned Parenthood, for one year. The feds never paid for abortions; this is money the organization uses for breast exams, contraception and testing for sexually transmitted diseases.\u003c/p>\n\u003cp>\u003cstrong>5. The Senate Bill Still Ignores Health Care’s Real Problem: Cost\u003c/strong>\u003c/p>\n\u003cp>The frustrations that many voters have with the Affordable Care Act are understandable. Very little in that law reduced health care spending, or got at the root causes of excessive charges -- though the ACA did slow down the growth rate compared to previous years.\u003c/p>\n\u003cp>It’s a valid criticism to point out that premiums continued to rise under the ACA, and quite sharply in some places. If you don’t qualify for any of the ACA assistance to shield you from those price increases, you -- or your employer -- are paying those increases out-of-pocket. It’s a difficult and chronic pre-existing condition of American health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you are interested in learning more about \u003cem>how\u003c/em> the U.S. health care system became so expensive for patients, I recommend \u003ca href=\"http://www.npr.org/books/titles/523005656/an-american-sickness-how-healthcare-became-big-business-and-how-you-can-take-it-\" target=\"_blank\" rel=\"noopener noreferrer\">this book\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/346757/analysis-why-senate-health-bill-is-even-meaner-for-california","authors":["11314"],"categories":["stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_38","stateofhealth_3117","stateofhealth_2808","stateofhealth_28","stateofhealth_99","stateofhealth_218","stateofhealth_2519","stateofhealth_2865","stateofhealth_365"],"featImg":"stateofhealth_346802","label":"stateofhealth"},"stateofhealth_301729":{"type":"posts","id":"stateofhealth_301729","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"301729","score":null,"sort":[1488846223000]},"guestAuthors":[],"slug":"gop-bill-would-repeal-obamacare-taxes-and-penalties-keep-some-subsidies","title":"GOP Bill Would Repeal Obamacare Taxes and Penalties, Keep Some Subsidies","publishDate":1488846223,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{},"content":"\u003cp>After years of waiting, it's finally here.\u003c/p>\n\u003cp>The \u003ca href=\"https://waysandmeans.house.gov/event/markup-budget-reconciliation-recommendations-repeal-replace-obamacare/\">Republican plan\u003c/a> to \u003ca href=\"https://energycommerce.house.gov/news-center/press-releases/energy-and-commerce-republicans-release-legislation-repeal-and-replace\">reshape \u003c/a>the Affordable Care Act — what they call \"repeal and replace\" — kills the requirement that everyone buy health insurance by eliminating the tax penalty for those who don't have coverage. It also makes significant changes in the financial assistance people can receive to buy a health plan.\u003c/p>\n\u003cp>\"Our legislation transfers power from Washington back to the states,\" said House Ways and Means Committee Chairman Kevin Brady in a statement. \"We dismantle Obamacare's damaging taxes and mandates so states can deliver quality affordable options.\"\u003c/p>\n\u003cp>The bill would offer tax credits, refundable in advance, to people with incomes below $75,000. But those credits will be lower in many cases than the subsidies now offered in the ACA.\u003c/p>\n\u003cp>The bill, which will go through many revisions and challenges, was released late Monday by two House committees, Ways and Means and Energy and Commerce. Members are expected to start voting on parts of the bill Wednesday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rep. Frank Pallone, D-N.J., and Richard Neal, D-Mass., the ranking Democrats on the Energy and Commerce and Ways and Means committees, issued a joint statement saying the bill would \"rip healthcare away from millions of Americans, ration care for working families and put insurance companies back in charge.\"\u003c/p>\n\u003cp>The legislation will need approval by the full House and the Senate before it goes to President Trump for his signature. Until then, most of what is known as Obamacare will stay in place.\u003c/p>\n\u003cp>But it's far from clear that Republicans in the House are unified in their support of the bill. Members of the far-right Freedom Caucus have said they oppose giving tax credits to people who don't pay any federal income tax.\u003c/p>\n\u003cp>And with only a slim majority in the Senate, only a few Republican defections could defeat the bill there.\u003c/p>\n\u003cp>Four Republican senators wrote a letter to Majority Leader Mitch McConnell saying they were concerned an early draft of the House plan would not adequately protect people who have insurance through Obamacare's Medicaid expansion. And Sen. Rand Paul was among three conservative Republicans who criticized an earlier version of the bill as \"Obamacare lite.\"\u003c/p>\n\u003cp>Under the proposed bill, tax credits would start at $2,000 a year for individuals under age 30, rising to $4,000 for those of 60. The proposal, first seen in a Feb. 10 draft of the bill, has been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/24/517074764/gop-health-bill-draft-would-cut-medicaid-emphasize-tax-credits\">criticized \u003c/a>as too meager to cover the full cost of a health insurance plan that provides full benefits.\u003c/p>\n\u003cp>But the proposed tax credit could potentially pay for insurance that protects only against a catastrophic health event.\u003c/p>\n\u003cp>They would begin to be phased out at incomes of $75,000 for individuals and $150,000 for families.\u003c/p>\n\u003cp>To encourage people to buy coverage, the plan allows insurers to charge a 30 percent penalty to people who let their insurance lapse, and then try to buy a new policy.\u003c/p>\n\u003cp>In states that expanded Medicaid, people who are eligible can continue to enroll until January 1, 2020, and those states would continue to benefit from the federal government paying a greater share of the health costs of those beneficiaries.\u003c/p>\n\u003cp>Several taxes contained in the ACA would be repealed at the end of this year. These include taxes on health insurers, pharmaceutical and medical device manufacturers, and a tax on high-cost employer-sponsored group health plans (aka Cadillac plans).\u003c/p>\n\u003cp>An analysis by \u003ca href=\"http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-significantly-reduce-federal-spending\">Avalere Health\u003c/a> and \u003ca href=\"https://cdn2.vox-cdn.com/uploads/chorus_asset/file/8045899/Scanned_from_a_Xerox_Multifunction_Printer.0.pdf\">McKinsey\u003c/a> of an earlier draft of the bill, which contained many of the same provisions, concluded that it would lead to millions of people losing coverage.\u003c/p>\n\u003cp>The plan offered by the House Republicans falls short of the outright repeal that has been demanded by more conservative members, including those in the House Freedom Caucus.\u003c/p>\n\u003cp>That could be due to the shift in public attitudes toward the ACA in recent weeks.\u003c/p>\n\u003cp>Public opinion has grown more favorable as major changes appeared imminent. A Kaiser Family Foundation \u003ca href=\"http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/\">tracking poll\u003c/a> in late February found 48 percent having a favorable opinion versus 42 percent viewing the law unfavorably. Kaiser says the shift is due largely to a change in the view of political independents, among which 50 percent now view the law favorably.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We will have more on this story as it develops.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Bill+Would+Repeal+Obamacare+Taxes+And+Penalties%2C+Keep+Some+Subsidies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"After weeks of internal debate, House Republicans have released their plan for the Affordable Care Act, aka Obamacare. It faces challenges from within the GOP, from interest groups — and the public.","status":"publish","parent":0,"modified":1488853545,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":734},"headData":{"title":"GOP Bill Would Repeal Obamacare Taxes and Penalties, Keep Some Subsidies | KQED","description":"After weeks of internal debate, House Republicans have released their plan for the Affordable Care Act, aka Obamacare. It faces challenges from within the GOP, from interest groups — and the public.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"GOP Bill Would Repeal Obamacare Taxes and Penalties, Keep Some Subsidies","datePublished":"2017-03-07T00:23:43.000Z","dateModified":"2017-03-07T02:25:45.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"301729 https://ww2.kqed.org/stateofhealth/?p=301729","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/03/06/gop-bill-would-repeal-obamacare-taxes-and-penalties-keep-some-subsidies/","disqusTitle":"GOP Bill Would Repeal Obamacare Taxes and Penalties, Keep Some Subsidies","source":"NPR","nprByline":"Joe Neel & Alison Kodjak \u003cbr>NPR","nprImageAgency":"Allison Shelley/Getty Images","nprStoryId":"518864390","nprApiLink":"http://api.npr.org/query?id=518864390&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/03/06/518864390/gop-bill-would-repeal-obamacare-taxes-and-penalties-keep-some-subsidies?ft=nprml&f=518864390","nprRetrievedStory":"1","nprPubDate":"Mon, 06 Mar 2017 19:18:00 -0500","nprStoryDate":"Mon, 06 Mar 2017 18:49:00 -0500","nprLastModifiedDate":"Mon, 06 Mar 2017 19:18:28 -0500","path":"/stateofhealth/301729/gop-bill-would-repeal-obamacare-taxes-and-penalties-keep-some-subsidies","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>After years of waiting, it's finally here.\u003c/p>\n\u003cp>The \u003ca href=\"https://waysandmeans.house.gov/event/markup-budget-reconciliation-recommendations-repeal-replace-obamacare/\">Republican plan\u003c/a> to \u003ca href=\"https://energycommerce.house.gov/news-center/press-releases/energy-and-commerce-republicans-release-legislation-repeal-and-replace\">reshape \u003c/a>the Affordable Care Act — what they call \"repeal and replace\" — kills the requirement that everyone buy health insurance by eliminating the tax penalty for those who don't have coverage. It also makes significant changes in the financial assistance people can receive to buy a health plan.\u003c/p>\n\u003cp>\"Our legislation transfers power from Washington back to the states,\" said House Ways and Means Committee Chairman Kevin Brady in a statement. \"We dismantle Obamacare's damaging taxes and mandates so states can deliver quality affordable options.\"\u003c/p>\n\u003cp>The bill would offer tax credits, refundable in advance, to people with incomes below $75,000. But those credits will be lower in many cases than the subsidies now offered in the ACA.\u003c/p>\n\u003cp>The bill, which will go through many revisions and challenges, was released late Monday by two House committees, Ways and Means and Energy and Commerce. Members are expected to start voting on parts of the bill Wednesday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rep. Frank Pallone, D-N.J., and Richard Neal, D-Mass., the ranking Democrats on the Energy and Commerce and Ways and Means committees, issued a joint statement saying the bill would \"rip healthcare away from millions of Americans, ration care for working families and put insurance companies back in charge.\"\u003c/p>\n\u003cp>The legislation will need approval by the full House and the Senate before it goes to President Trump for his signature. Until then, most of what is known as Obamacare will stay in place.\u003c/p>\n\u003cp>But it's far from clear that Republicans in the House are unified in their support of the bill. Members of the far-right Freedom Caucus have said they oppose giving tax credits to people who don't pay any federal income tax.\u003c/p>\n\u003cp>And with only a slim majority in the Senate, only a few Republican defections could defeat the bill there.\u003c/p>\n\u003cp>Four Republican senators wrote a letter to Majority Leader Mitch McConnell saying they were concerned an early draft of the House plan would not adequately protect people who have insurance through Obamacare's Medicaid expansion. And Sen. Rand Paul was among three conservative Republicans who criticized an earlier version of the bill as \"Obamacare lite.\"\u003c/p>\n\u003cp>Under the proposed bill, tax credits would start at $2,000 a year for individuals under age 30, rising to $4,000 for those of 60. The proposal, first seen in a Feb. 10 draft of the bill, has been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/24/517074764/gop-health-bill-draft-would-cut-medicaid-emphasize-tax-credits\">criticized \u003c/a>as too meager to cover the full cost of a health insurance plan that provides full benefits.\u003c/p>\n\u003cp>But the proposed tax credit could potentially pay for insurance that protects only against a catastrophic health event.\u003c/p>\n\u003cp>They would begin to be phased out at incomes of $75,000 for individuals and $150,000 for families.\u003c/p>\n\u003cp>To encourage people to buy coverage, the plan allows insurers to charge a 30 percent penalty to people who let their insurance lapse, and then try to buy a new policy.\u003c/p>\n\u003cp>In states that expanded Medicaid, people who are eligible can continue to enroll until January 1, 2020, and those states would continue to benefit from the federal government paying a greater share of the health costs of those beneficiaries.\u003c/p>\n\u003cp>Several taxes contained in the ACA would be repealed at the end of this year. These include taxes on health insurers, pharmaceutical and medical device manufacturers, and a tax on high-cost employer-sponsored group health plans (aka Cadillac plans).\u003c/p>\n\u003cp>An analysis by \u003ca href=\"http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-significantly-reduce-federal-spending\">Avalere Health\u003c/a> and \u003ca href=\"https://cdn2.vox-cdn.com/uploads/chorus_asset/file/8045899/Scanned_from_a_Xerox_Multifunction_Printer.0.pdf\">McKinsey\u003c/a> of an earlier draft of the bill, which contained many of the same provisions, concluded that it would lead to millions of people losing coverage.\u003c/p>\n\u003cp>The plan offered by the House Republicans falls short of the outright repeal that has been demanded by more conservative members, including those in the House Freedom Caucus.\u003c/p>\n\u003cp>That could be due to the shift in public attitudes toward the ACA in recent weeks.\u003c/p>\n\u003cp>Public opinion has grown more favorable as major changes appeared imminent. A Kaiser Family Foundation \u003ca href=\"http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/\">tracking poll\u003c/a> in late February found 48 percent having a favorable opinion versus 42 percent viewing the law unfavorably. Kaiser says the shift is due largely to a change in the view of political independents, among which 50 percent now view the law favorably.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We will have more on this story as it develops.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Bill+Would+Repeal+Obamacare+Taxes+And+Penalties%2C+Keep+Some+Subsidies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/301729/gop-bill-would-repeal-obamacare-taxes-and-penalties-keep-some-subsidies","authors":["byline_stateofhealth_301729"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_2874","stateofhealth_218","stateofhealth_105","stateofhealth_2519","stateofhealth_2865","stateofhealth_365"],"featImg":"stateofhealth_301730","label":"source_stateofhealth_301729"},"stateofhealth_251064":{"type":"posts","id":"stateofhealth_251064","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"251064","score":null,"sort":[1477071688000]},"guestAuthors":[],"slug":"std-infections-rise-to-new-highs-after-states-close-health-clinics","title":"STD Infections Rise to New Highs After States Close Health Clinics","publishDate":1477071688,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{},"content":"\u003cp>The number of people infected with three major sexually transmitted diseases is at an all-time high, according to a CDC report released Wednesday. And the increase in reported cases of chlamydia, gonorrhea and syphilis is hitting teenagers and young adults hardest.\u003c/p>\n\u003cp>Over half of gonorrhea and chlamydia cases are in people under the age of 25, says Dr. \u003ca href=\"http://www.cdc.gov/about/leadership/new-leaders/nchhstp.html\">Jonathan Mermin\u003c/a>, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention for the CDC.\u003c/p>\n\u003cp>These STDs can have serious long term health consequences, including chronic pain and fertility problems. Pregnant women can pass syphilis on to their children, leading to \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/12/455768422/more-babies-are-dying-because-of-congenital-syphilis\">stillbirth or birth defects\u003c/a>.\u003c/p>\n\u003cp>State and local budget cuts to STD care and prevention programs are major drivers in the surge in STDs, Mermin says.\u003c/p>\n\u003cp>\"Our ability to prevent STDs is only as strong as the public health infrastructure to support it,\" he says. \"More than half of state and local STD programs have experienced budget cuts. In 2012, 20 health departments reported having to close their STD clinics.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Syphilis infections have been increasing at a particularly troubling rate, \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/2016/2015-std-surveillance-report.html\">according to the report\u003c/a>. In 2015, 23,872 cases were reported, a 19 percent increase since 2014. \u003ca href=\"http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm\">Syphilis\u003c/a> cases have been going up over the past decade, while the spike in cases of chlamydia and gonorrhea is more recent.\u003c/p>\n\u003cp>There were 395,216 cases of \u003ca href=\"http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm\">gonorrhea\u003c/a> and 1.5 million cases of \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm\">chlamydia \u003c/a>reported in the same year, showing a rise of 6 and 13 percent over the past year. All three infections can be treated with antibiotics, though gonorrhea is becoming \u003ca href=\"http://www.npr.org/sections/thetwo-way/2016/08/30/491969011/u-n-health-officials-warn-gonorrhea-is-becoming-untreatable\">increasingly resistant to antibiotics\u003c/a>.\u003c/p>\n\u003cp>\"This basically tells us we have to do a better job of reach out to some of these communities that are disproportionately affected by these infections,\" says \u003ca href=\"https://internalmedicine.osu.edu/infectiousdisease/directory/faculty/josebazan/\">Dr. Jose Bazan\u003c/a>, a medical director for an STD clinic at Columbus Public Health and an assistant professor of internal medicine at Ohio State University who was not involved with the report.\u003c/p>\n\u003cp>Men who have sex with men face a greater risk of being infected with syphilis. Over 80 percent of male syphilis cases were reported among gay and bisexual males, and over 90 percent of all syphilis cases were in men. People in racial and sexual minority groups can have more than the usual trouble finding care for preventing and treating STDs.\u003c/p>\n\u003cp>According to a congressional briefing last April by Dr. Gail Bolan, the director for the CDC Division of STD Prevention, over 40 percent of health departments reduced clinic hours, screening, or tracing people who may have been infected.\u003c/p>\n\u003cp>\"If that infrastructure gets STDeroded, people are more likely to have their STDs for a longer period of time, and that can lead to increased transmission,\" Mermin says.\u003c/p>\n\u003cp>The federal government also helps fund state and local STD programs through the CDC, but federal funds have not helped make up for some of the budget cuts on the local level, according to \u003ca href=\"http://www.ncsddc.org/who-we-are/board\">David Harvey\u003c/a>, the executive director for the National Coalition of STD Directors.\u003c/p>\n\u003cp>\"We believe there's a direct relationship between budget cuts and increases in STDs in the United States. There has been no federal increases for STD programs in this country since 2003,\" he says.\u003c/p>\n\u003cp>If the trend is to be reversed, Mermin says there needs to be a real investment in STD prevention so that clinics can monitor these diseases and quickly diagnose and treat people who are infected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We've seen success in the past where investments have paid off,\" he says. \"We know what we need to do. We just need to do it more effectively than we've been able to do with this eroding infrastructure.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=STD+Infections+Rise+To+New+Highs+After+States+Close+Health+Clinics&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"More than half of state and local STD programs have experienced budget cuts, and the study shows that this is accounting for the rise in cases.","status":"publish","parent":0,"modified":1477086492,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":623},"headData":{"title":"STD Infections Rise to New Highs After States Close Health Clinics | KQED","description":"More than half of state and local STD programs have experienced budget cuts, and the study shows that this is accounting for the rise in cases.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"STD Infections Rise to New Highs After States Close Health Clinics","datePublished":"2016-10-21T17:41:28.000Z","dateModified":"2016-10-21T21:48:12.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"251064 http://ww2.kqed.org/stateofhealth/?p=251064","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/10/21/std-infections-rise-to-new-highs-after-states-close-health-clinics/","disqusTitle":"STD Infections Rise to New Highs After States Close Health Clinics","source":"NPR","nprImageCredit":"BSIP","nprByline":"\u003cstrong>Angus Chen\u003cbr>NPR Shots\u003c/strong>","nprImageAgency":"UIG via Getty Images","nprStoryId":"498719092","nprApiLink":"http://api.npr.org/query?id=498719092&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/10/20/498719092/std-infections-rise-to-new-highs-after-states-close-health-clinics?ft=nprml&f=498719092","nprRetrievedStory":"1","nprPubDate":"Thu, 20 Oct 2016 16:50:00 -0400","nprStoryDate":"Thu, 20 Oct 2016 15:33:00 -0400","nprLastModifiedDate":"Thu, 20 Oct 2016 16:50:13 -0400","path":"/stateofhealth/251064/std-infections-rise-to-new-highs-after-states-close-health-clinics","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The number of people infected with three major sexually transmitted diseases is at an all-time high, according to a CDC report released Wednesday. And the increase in reported cases of chlamydia, gonorrhea and syphilis is hitting teenagers and young adults hardest.\u003c/p>\n\u003cp>Over half of gonorrhea and chlamydia cases are in people under the age of 25, says Dr. \u003ca href=\"http://www.cdc.gov/about/leadership/new-leaders/nchhstp.html\">Jonathan Mermin\u003c/a>, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention for the CDC.\u003c/p>\n\u003cp>These STDs can have serious long term health consequences, including chronic pain and fertility problems. Pregnant women can pass syphilis on to their children, leading to \u003ca href=\"http://www.npr.org/sections/health-shots/2015/11/12/455768422/more-babies-are-dying-because-of-congenital-syphilis\">stillbirth or birth defects\u003c/a>.\u003c/p>\n\u003cp>State and local budget cuts to STD care and prevention programs are major drivers in the surge in STDs, Mermin says.\u003c/p>\n\u003cp>\"Our ability to prevent STDs is only as strong as the public health infrastructure to support it,\" he says. \"More than half of state and local STD programs have experienced budget cuts. In 2012, 20 health departments reported having to close their STD clinics.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Syphilis infections have been increasing at a particularly troubling rate, \u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/2016/2015-std-surveillance-report.html\">according to the report\u003c/a>. In 2015, 23,872 cases were reported, a 19 percent increase since 2014. \u003ca href=\"http://www.cdc.gov/std/syphilis/stdfact-syphilis.htm\">Syphilis\u003c/a> cases have been going up over the past decade, while the spike in cases of chlamydia and gonorrhea is more recent.\u003c/p>\n\u003cp>There were 395,216 cases of \u003ca href=\"http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm\">gonorrhea\u003c/a> and 1.5 million cases of \u003ca href=\"http://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm\">chlamydia \u003c/a>reported in the same year, showing a rise of 6 and 13 percent over the past year. All three infections can be treated with antibiotics, though gonorrhea is becoming \u003ca href=\"http://www.npr.org/sections/thetwo-way/2016/08/30/491969011/u-n-health-officials-warn-gonorrhea-is-becoming-untreatable\">increasingly resistant to antibiotics\u003c/a>.\u003c/p>\n\u003cp>\"This basically tells us we have to do a better job of reach out to some of these communities that are disproportionately affected by these infections,\" says \u003ca href=\"https://internalmedicine.osu.edu/infectiousdisease/directory/faculty/josebazan/\">Dr. Jose Bazan\u003c/a>, a medical director for an STD clinic at Columbus Public Health and an assistant professor of internal medicine at Ohio State University who was not involved with the report.\u003c/p>\n\u003cp>Men who have sex with men face a greater risk of being infected with syphilis. Over 80 percent of male syphilis cases were reported among gay and bisexual males, and over 90 percent of all syphilis cases were in men. People in racial and sexual minority groups can have more than the usual trouble finding care for preventing and treating STDs.\u003c/p>\n\u003cp>According to a congressional briefing last April by Dr. Gail Bolan, the director for the CDC Division of STD Prevention, over 40 percent of health departments reduced clinic hours, screening, or tracing people who may have been infected.\u003c/p>\n\u003cp>\"If that infrastructure gets STDeroded, people are more likely to have their STDs for a longer period of time, and that can lead to increased transmission,\" Mermin says.\u003c/p>\n\u003cp>The federal government also helps fund state and local STD programs through the CDC, but federal funds have not helped make up for some of the budget cuts on the local level, according to \u003ca href=\"http://www.ncsddc.org/who-we-are/board\">David Harvey\u003c/a>, the executive director for the National Coalition of STD Directors.\u003c/p>\n\u003cp>\"We believe there's a direct relationship between budget cuts and increases in STDs in the United States. There has been no federal increases for STD programs in this country since 2003,\" he says.\u003c/p>\n\u003cp>If the trend is to be reversed, Mermin says there needs to be a real investment in STD prevention so that clinics can monitor these diseases and quickly diagnose and treat people who are infected.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"We've seen success in the past where investments have paid off,\" he says. \"We know what we need to do. We just need to do it more effectively than we've been able to do with this eroding infrastructure.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=STD+Infections+Rise+To+New+Highs+After+States+Close+Health+Clinics&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/251064/std-infections-rise-to-new-highs-after-states-close-health-clinics","authors":["byline_stateofhealth_251064"],"categories":["stateofhealth_2746","stateofhealth_13"],"tags":["stateofhealth_313","stateofhealth_2519","stateofhealth_2865"],"featImg":"stateofhealth_251065","label":"source_stateofhealth_251064"},"stateofhealth_230664":{"type":"posts","id":"stateofhealth_230664","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"230664","score":null,"sort":[1472490174000]},"guestAuthors":[],"slug":"maker-of-epipen-to-sell-generic-version-for-half-the-price","title":"Maker Of EpiPen To Sell Generic Version For Half The Price","publishDate":1472490174,"format":"standard","headTitle":"Price Check | State of Health | KQED News","labelTerm":{"term":2492,"site":"stateofhealth"},"content":"\u003cp>Treatment for life-threatening allergic reactions is about to get a little cheaper.\u003c/p>\n\u003cp>Mylan, the maker of the EpiPen, said Monday that it will launch a generic version of the device for half the price of the brand-name product.\u003c/p>\n\u003cp>The company says the generic will hit the market in a few weeks and \u003ca href=\"http://newsroom.mylan.com/2016-08-29-Mylan-to-Launch-First-Generic-to-EpiPen-Auto-Injector-at-a-List-Price-of-300-per-Two-Pack-Carton-a-More-than-50-Discount-to-the-Brand-Product\">cost $300\u003c/a> for a two-pack. That's less than half the price of a two-pack of brand-name EpiPens, which are available at Target pharmacies for about \u003ca href=\"http://www.goodrx.com/epipen?drug-name=EpiPen\">$630\u003c/a>, according to GoodRX.\u003c/p>\n\u003cp>The move by Mylan comes in response to mounting \u003ca href=\"http://www.npr.org/2016/08/27/491647599/mother-calls-epipen-price-hike-a-matter-of-life-and-death\">pressure from consumers \u003c/a>and Congress to lower the drug's price. In less than 10 years, the price for a two-pack of injectors has risen from about $100 to more than $600.\u003c/p>\n\u003cp>\"This helps Mylan with its public relations battle against criticism for sharp price increases on the EpiPen,\" says \u003ca href=\"http://kff.org/person/larry-levitt/\">Larry Levitt\u003c/a>, a health policy analyst at the Kaiser Family Foundation. \"The introduction of a lower-priced generic version may keep competitors out of the market.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Mylan CEO Heather Bresch has spent the past week trying to shift blame for the increased cost of the product away from Mylan and onto insurance companies. The company argued that more people have high-deductible health plans and high copayments on medications now, so they are feeling the pain of price hikes more than they would have in the past.\u003c/p>\n\u003cp>She repeated that Monday in a statement posted on the company's website.\u003c/p>\n\u003cp>\"Because of the complexity and opaqueness of today's branded pharmaceutical supply chain and the increased shifting of costs to patients as a result of high deductible health plans, we determined that bypassing the brand system in this case and offering an additional alternative was the best option,\" the statement read.\u003c/p>\n\u003cp>But lawmakers and consumers didn't buy it. The anger over the price increases was directed solely at Mylan.\u003c/p>\n\u003cp>\"The weirdness of a generic drug company offering a generic version of its own branded but off-patent product is a signal that something is wrong,\" Robert Weissman, president of the consumer group Public Citizen, \u003ca href=\"http://www.huffingtonpost.com/robert-weissman/epipen-makers-latest-offe_b_11760170.html\">wrote in a piece published Monday\u003c/a> by Huffington Post. \"Mylan knows its $600 per set of EpiPens is unsustainable, but aims to continue ripping off some segment of the marketplace — both consumers who do not trust or know about the generic and perhaps some insurers and payers constrained from buying a generic. The announced $300 price for Mylan's generic also comes in too high; the profitable price in Canada is roughly $200 for two, and the price in France is roughly half that.\"\u003c/p>\n\u003cp>He went on to write that the company's action \"is just one more convoluted mechanism to avoid plain talk ... and just cut the price of Epipen.\"\u003c/p>\n\u003cp>The frustration with the rising costs of the EpiPen has been brewing for months. But it exploded last week when activist parents of kids with allergies started a petition called \"\u003ca href=\"http://www.petition2congress.com/20720/stop-epipen-price-gouging/\">Stop the EpiPen Price Gouging\u003c/a>\" that automatically sends letters to members of Congress complaining about the rising costs. Almost 150,000 people have signed it, as of Monday.\u003c/p>\n\u003cp>Several senators and members of Congress responded, asking the Federal Trade Commission to investigate whether the company's pricing policies violate anti-trust laws, and promising their own hearings on Capitol Hill.\u003c/p>\n\u003cp>Mylan said Thursday it would offer discounts of up to $300 to offset consumers' share of the EpiPen's price. But that \u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/25/491372193/discounts-arent-enough-to-halt-outrage-at-high-epipen-prices\">didn't quiet the criticism\u003c/a> of the company.\u003c/p>\n\u003cp>Democratic presidential nominee Hillary Clinton called on the company to lower the price \"immediately.\"\u003c/p>\n\u003cp>Mylan's latest move is meant to calm the anger of consumers and lawmakers, but it may also be a shrewd business decision.\u003c/p>\n\u003cp>By bringing a generic to the market now, it could preemptively steal some market share away from Teva Pharmaceuticals, which is developing its own generic EpiPen. That device is expected to be approved in 2017.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mylan has a complex history with Teva, which last year \u003ca href=\"http://www.tevapharm.com/news/teva_proposes_to_acquire_mylan_for_82_00_per_share_in_cash_and_stock_04_15.aspx\">tried to buy Mylan\u003c/a> in a hostile takeover. Mylan was able to fight \u003ca href=\"http://www.irishtimes.com/business/health-pharma/mylan-defends-way-it-saw-off-hostile-takeover-1.2309366\">off the acquisition\u003c/a>, in part, because it moved its legal headquarters out of the United States to the Netherlands.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Maker+Of+EpiPen+To+Sell+Generic+Version+For+Half+The+Price&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/em>\u003c/div>\n\n","blocks":[],"excerpt":"Mylan's move comes amid pressure from consumers and Congress to lower the allergy drug's price. In less than 10 years, the price has risen from about $100 to more than $600 for an injector two-pack.","status":"publish","parent":0,"modified":1472490174,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":711},"headData":{"title":"Maker Of EpiPen To Sell Generic Version For Half The Price | KQED","description":"Mylan's move comes amid pressure from consumers and Congress to lower the allergy drug's price. In less than 10 years, the price has risen from about $100 to more than $600 for an injector two-pack.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Maker Of EpiPen To Sell Generic Version For Half The Price","datePublished":"2016-08-29T17:02:54.000Z","dateModified":"2016-08-29T17:02:54.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"230664 http://ww2.kqed.org/stateofhealth/?p=230664","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/29/maker-of-epipen-to-sell-generic-version-for-half-the-price/","disqusTitle":"Maker Of EpiPen To Sell Generic Version For Half The Price","nprImageCredit":"Daniel Acker","nprByline":"\u003cstrong> Alison Kodjak \u003c/br> NPR \u003c/strong>","nprImageAgency":"Bloomberg via Getty Images","nprStoryId":"491797051","nprApiLink":"http://api.npr.org/query?id=491797051&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/08/29/491797051/maker-of-epipen-to-sell-generic-version-for-half-the-price?ft=nprml&f=491797051","nprRetrievedStory":"1","nprPubDate":"Mon, 29 Aug 2016 12:17:00 -0400","nprStoryDate":"Mon, 29 Aug 2016 11:20:00 -0400","nprLastModifiedDate":"Mon, 29 Aug 2016 12:17:33 -0400","path":"/stateofhealth/230664/maker-of-epipen-to-sell-generic-version-for-half-the-price","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Treatment for life-threatening allergic reactions is about to get a little cheaper.\u003c/p>\n\u003cp>Mylan, the maker of the EpiPen, said Monday that it will launch a generic version of the device for half the price of the brand-name product.\u003c/p>\n\u003cp>The company says the generic will hit the market in a few weeks and \u003ca href=\"http://newsroom.mylan.com/2016-08-29-Mylan-to-Launch-First-Generic-to-EpiPen-Auto-Injector-at-a-List-Price-of-300-per-Two-Pack-Carton-a-More-than-50-Discount-to-the-Brand-Product\">cost $300\u003c/a> for a two-pack. That's less than half the price of a two-pack of brand-name EpiPens, which are available at Target pharmacies for about \u003ca href=\"http://www.goodrx.com/epipen?drug-name=EpiPen\">$630\u003c/a>, according to GoodRX.\u003c/p>\n\u003cp>The move by Mylan comes in response to mounting \u003ca href=\"http://www.npr.org/2016/08/27/491647599/mother-calls-epipen-price-hike-a-matter-of-life-and-death\">pressure from consumers \u003c/a>and Congress to lower the drug's price. In less than 10 years, the price for a two-pack of injectors has risen from about $100 to more than $600.\u003c/p>\n\u003cp>\"This helps Mylan with its public relations battle against criticism for sharp price increases on the EpiPen,\" says \u003ca href=\"http://kff.org/person/larry-levitt/\">Larry Levitt\u003c/a>, a health policy analyst at the Kaiser Family Foundation. \"The introduction of a lower-priced generic version may keep competitors out of the market.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Mylan CEO Heather Bresch has spent the past week trying to shift blame for the increased cost of the product away from Mylan and onto insurance companies. The company argued that more people have high-deductible health plans and high copayments on medications now, so they are feeling the pain of price hikes more than they would have in the past.\u003c/p>\n\u003cp>She repeated that Monday in a statement posted on the company's website.\u003c/p>\n\u003cp>\"Because of the complexity and opaqueness of today's branded pharmaceutical supply chain and the increased shifting of costs to patients as a result of high deductible health plans, we determined that bypassing the brand system in this case and offering an additional alternative was the best option,\" the statement read.\u003c/p>\n\u003cp>But lawmakers and consumers didn't buy it. The anger over the price increases was directed solely at Mylan.\u003c/p>\n\u003cp>\"The weirdness of a generic drug company offering a generic version of its own branded but off-patent product is a signal that something is wrong,\" Robert Weissman, president of the consumer group Public Citizen, \u003ca href=\"http://www.huffingtonpost.com/robert-weissman/epipen-makers-latest-offe_b_11760170.html\">wrote in a piece published Monday\u003c/a> by Huffington Post. \"Mylan knows its $600 per set of EpiPens is unsustainable, but aims to continue ripping off some segment of the marketplace — both consumers who do not trust or know about the generic and perhaps some insurers and payers constrained from buying a generic. The announced $300 price for Mylan's generic also comes in too high; the profitable price in Canada is roughly $200 for two, and the price in France is roughly half that.\"\u003c/p>\n\u003cp>He went on to write that the company's action \"is just one more convoluted mechanism to avoid plain talk ... and just cut the price of Epipen.\"\u003c/p>\n\u003cp>The frustration with the rising costs of the EpiPen has been brewing for months. But it exploded last week when activist parents of kids with allergies started a petition called \"\u003ca href=\"http://www.petition2congress.com/20720/stop-epipen-price-gouging/\">Stop the EpiPen Price Gouging\u003c/a>\" that automatically sends letters to members of Congress complaining about the rising costs. Almost 150,000 people have signed it, as of Monday.\u003c/p>\n\u003cp>Several senators and members of Congress responded, asking the Federal Trade Commission to investigate whether the company's pricing policies violate anti-trust laws, and promising their own hearings on Capitol Hill.\u003c/p>\n\u003cp>Mylan said Thursday it would offer discounts of up to $300 to offset consumers' share of the EpiPen's price. But that \u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/25/491372193/discounts-arent-enough-to-halt-outrage-at-high-epipen-prices\">didn't quiet the criticism\u003c/a> of the company.\u003c/p>\n\u003cp>Democratic presidential nominee Hillary Clinton called on the company to lower the price \"immediately.\"\u003c/p>\n\u003cp>Mylan's latest move is meant to calm the anger of consumers and lawmakers, but it may also be a shrewd business decision.\u003c/p>\n\u003cp>By bringing a generic to the market now, it could preemptively steal some market share away from Teva Pharmaceuticals, which is developing its own generic EpiPen. That device is expected to be approved in 2017.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Mylan has a complex history with Teva, which last year \u003ca href=\"http://www.tevapharm.com/news/teva_proposes_to_acquire_mylan_for_82_00_per_share_in_cash_and_stock_04_15.aspx\">tried to buy Mylan\u003c/a> in a hostile takeover. Mylan was able to fight \u003ca href=\"http://www.irishtimes.com/business/health-pharma/mylan-defends-way-it-saw-off-hostile-takeover-1.2309366\">off the acquisition\u003c/a>, in part, because it moved its legal headquarters out of the United States to the Netherlands.\u003c/p>\n\u003cdiv class=\"fullattribution\">\u003cem>Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Maker+Of+EpiPen+To+Sell+Generic+Version+For+Half+The+Price&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/230664/maker-of-epipen-to-sell-generic-version-for-half-the-price","authors":["byline_stateofhealth_230664"],"series":["stateofhealth_2492"],"categories":["stateofhealth_13"],"tags":["stateofhealth_2868","stateofhealth_2865"],"featImg":"stateofhealth_230668","label":"stateofhealth_2492"},"stateofhealth_228587":{"type":"posts","id":"stateofhealth_228587","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"228587","score":null,"sort":[1472074233000]},"guestAuthors":[],"slug":"worries-as-the-for-profit-world-moves-into-elder-care","title":"Worries as the For-Profit World Moves into Elder Care","publishDate":1472074233,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>DENVER — Inside a senior center here, nestled along a bustling commercial strip, Vivian Malveaux scans her bingo card for a winning number. Her 81-year-old eyes are warm, lively and occasionally set adrift by the dementia plundering her mind.\u003c/p>\n\u003cp>Dozens of elderly men and women — some in wheelchairs, others whose hands tremble involuntarily — gather excitedly around the game tables. After bingo, there is more entertainment and activities: Yahtzee, tile-painting, beading.\u003c/p>\n\u003cp>But this is no linoleum-floored community center reeking of bleach. Instead, it’s one of eight vanguard centers \u003ca href=\"http://myinnovage.org/\">owned by InnovAge\u003c/a>, a company based in Denver with ambitious plans. With the support of private equity money, InnovAge aims to aggressively expand a little-known Medicare program that will pay to keep older and disabled Americans out of nursing homes.\u003c/p>\n\u003cp>Until recently, only nonprofits were allowed to run programs like these. But a year ago, the government flipped the switch, opening the program to for-profit companies as well, ending one of the last remaining holdouts to commercialism in health care. The hope is that the profit motive will expand the services faster.\u003c/p>\n\u003cp>Hanging over all the promise, though, is the question of whether for-profit companies are well-suited to this line of work, long the province of nonprofit do-gooders. Critics point out that the business of caring for poor and frail people is marred with abuse. Already, new ideas for lowering the cost of the program have started circulating. In Silicon Valley, for example, some eager entrepreneurs are pushing plans that call for a higher reliance on video calls instead of in-person doctor visits.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_228689\" class=\"wp-caption alignnone\" style=\"max-width: 594px\">\u003cimg class=\"size-full wp-image-228689\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS4288_121384844.jpg\" alt=\"An elderly woman pushing her walker.\" width=\"594\" height=\"418\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS4288_121384844.jpg 594w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS4288_121384844-400x281.jpg 400w\" sizes=\"(max-width: 594px) 100vw, 594px\">\u003cfigcaption class=\"wp-caption-text\">An elderly woman pushing her walker. \u003ccite>(Sean Gallup/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The business appeal is simple: A baby boom-propelled surge in government health care spending is coming. Medicare enrollment is expected to grow by 30 million people in the next two decades, and many of those people are potential future clients. Adding to the allure are hefty profit margins for programs like these — as high as 15 percent, compared with an average of 2 percent among nursing homes — and geographic monopolies that are all but guaranteed by state Medicaid agencies to ensure the solvency of providers.\u003c/p>\n\u003cp>The goal of the program, known as PACE, or the\u003ca href=\"https://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/integrating-care/program-of-all-inclusive-care-for-the-elderly-pace/program-of-all-inclusive-care-for-the-elderly-pace.html\"> Program of All-Inclusive Care for the Elderly\u003c/a>, is to help frail, older Americans live longer and more happily in their own homes, by providing comprehensive medical care and intensive social support. It also promises to save Medicare and Medicaid millions of dollars by keeping those people out of nursing homes.\u003c/p>\n\u003cp>For decades, though, the program has failed to catch on, with only 40,000 people enrolled as of January of this year.\u003c/p>\n\u003cp>“PACE is still a secret in the minds of the public,” Andy Slavitt, Medicare’s acting administrator, said at the National PACE Association meeting in April. The challenge, he said, was to make PACE “a clear part of the solution.”\u003c/p>\n\u003cp>Several private equity firms, venture capitalists and Silicon Valley entrepreneurs have jumped into the niche. F-Prime Capital Partners, a former Fidelity Biosciences group, provided seed funding for a PACE-related startup, as have well-regarded angel investors like Amir Dan Rubin, the former Stanford Health Care president, and Michael Zubkoff, a Dartmouth health care economist.\u003c/p>\n\u003cp>And no company has moved with more tenacity than InnovAge. Last year, the company overcame protests from watchdog groups to convert from a nonprofit organization to a for-profit business in Colorado. And in May, InnovAge received $196 million in backing — the largest investment in a PACE business since the rule change was made — from Welsh, Carson, Anderson & Stowe, a private equity firm with $10 billion in assets under management.\u003c/p>\n\u003cfigure id=\"attachment_228692\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228692\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS2763_elderlywalkers052411-800x505.jpg\" alt=\"Pedestrians are mirrored in a shopping window.\" width=\"800\" height=\"505\">\u003cfigcaption class=\"wp-caption-text\">Pedestrians are mirrored in a shopping window. \u003ccite>(Ralph Orlowski/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“For years we were pariahs, and no one wanted anything to do with us,” said Julie Reiskin, executive director of the Colorado Cross-Disability Coalition, a nonprofit group that advocates for people with disabilities, many of whom are eligible for PACE.\u003c/p>\n\u003cp>“Now that there’s money involved,” Reiskin said, “everyone is all interested.”\u003c/p>\n\u003cp>Even the program’s supporters acknowledge that the movement needs fresh momentum. But they worry that commercial operators will tarnish their image in the same way many for-profits eroded trust in hospice care and nursing homes.\u003c/p>\n\u003cp>Three decades ago, after Congress authorized Medicare to pay for hospice care, commercial operators displaced the religious and community groups that had championed the movement. As recently as 2014, government inspectors found that for-profit hospice companies cherry-picked patients and stinted on care.\u003c/p>\n\u003cp>In addition, elderly patients with dementia and chronic ailments have frequently been targets of abuse and neglect at nursing homes, something advocates for the elderly say is correlated with the increased commercialization of that industry.\u003c/p>\n\u003cp>“I’m not wild about every knucklehead running around trying to do PACE,” said Thomas Scully, former Medicare administrator under President George W. Bush. “I would rather keep it below the radar.”\u003c/p>\n\u003cp>\u003cstrong>Not Quite Able\u003c/strong>\u003c/p>\n\u003cp>Early last year, Malveaux was drowning. She lived alone in a tidy red-brick home in a leafy Denver neighborhood that she paid for by working shifts at a Samsonite luggage factory, now closed.\u003c/p>\n\u003cp>Laundry piled up. Bills went unpaid. Doors were left unlocked. Pans sometimes burned on the stove as her memory failed.\u003c/p>\n\u003cp>“I had lost my mind,” she recalled, sitting on her couch in a pink velour robe. “I couldn’t keep up my house.”\u003c/p>\n\u003cp>For Americans who find themselves in this situation, the next stop is often a traditional nursing home. Malveaux’s son took her instead to visit an InnovAge day center.\u003c/p>\n\u003cp>The $9 million building south of downtown Denver is designed to calm people with dementia. It has subdued lighting and winding hallways that encircle the first floor like a running track and discourage “exit-seeking behaviors,” where patients search for ways out of a building.\u003c/p>\n\u003cp>For the frightened Malveaux, it seemed like paradise: a flower garden, a beauty salon and day trips to casinos and candy factories. And, most importantly, it had a team of doctors, nurses, psychiatrists, dentists, physical therapists, nutritionists, home health aides and social workers whose purpose was to help her live safely in her beloved brick home.\u003c/p>\n\u003cp>After joining the center in June 2015, Malveaux began seeing a psychiatrist and went on medication for depression. A social worker coached her grandson, Jermaine Malveaux, on how to care for someone with dementia. Three days a week, an InnovAge van picks up Malveaux at home and takes her to the center to share lunch with other older adults and try her luck at bingo and ceramics.\u003c/p>\n\u003cp>“I make friends easily,” she said with a smile. “And the guys flirt with me.”\u003c/p>\n\u003cp>The InnovAge center, like other PACE facilities, is inspired by Britain’s much-lauded \u003ca href=\"http://www.bgs.org.uk/index.php/topresources/publicationfind/goodpractice/86-day-hospitals-for-older-people\">Day Hospitals\u003c/a>, outpatient health care facilities that arose in the 1950s that became a hub of daily life for many older people. In the United States, the earliest incarnation of PACE was started in San Francisco in 1971 by a group of Asian and Italian immigrant families seeking alternatives to the American nursing home.\u003c/p>\n\u003cp>Federal health officials allowed the group, \u003ca href=\"https://www.onlok.org/\">called On Lok\u003c/a> — Cantonese for “peaceful, happy abode” — to test what was then a novel and prophetic approach to health care financing. Instead of physicians billing Medicare each time they treated a patient, the government would pay a fixed amount to the center for each member. On Lok would assume the financial risk, similar to an insurance company. In 1990, Medicare officially sanctioned the model.\u003c/p>\n\u003cfigure id=\"attachment_228691\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228691\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS801_medical053111-800x527.jpg\" alt=\"Registered nurse JoAnn Brand examines Sham Tavakol.\" width=\"800\" height=\"527\">\u003cfigcaption class=\"wp-caption-text\">Registered nurse JoAnn Brand examines Sham Tavakol. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In exchange for a capped monthly payment from Medicare and Medicaid, PACE staff members arrange and pay for all of a patient’s doctors’ visits, medications, rehabilitation and hospitalizations. At the same time, they are supposed to pay attention to the patient’s daily needs — meals, bathing, housekeeping and transportation to day centers, where older people can ward off isolation and cognitive decline by socializing. (Studies have found that the intensive caretaking reduces costly hospital stays.)\u003c/p>\n\u003cp>Comparing the cost effectiveness of PACE against nursing homes is difficult, partly because state Medicaid agencies pay a variety of rates. But all the states are required to keep their rates below what they would pay for nursing home care. In Colorado, for example, that amounts to 7 percent less per patient.\u003c/p>\n\u003cp>On average, Medicare and Medicaid pay PACE providers $76,728 a person a year, about $5,500 less than the average cost of a nursing home. And the money going to PACE covers the all of the person’s health and social needs, unlike nursing home care, which doesn’t include hospitalizations and other expensive medical care.\u003c/p>\n\u003cp>The flat government payment pushes the organizations to invest in maintaining a patient’s health and safety to avoid big hospital bills. Dentistry — excluded from traditional Medicare coverage — is a crucial focus: Programs invest heavily to fix broken teeth and dentures to avoid costly infections or poor nutrition that can cause cascading health problems.\u003c/p>\n\u003cp>Providers are also generous with rehabilitation, setting few limits on training sessions that strengthen injured muscles and sturdy patients against falls.\u003c/p>\n\u003cp>“If you’re neglecting these patients, the odds they’ll call an ambulance and go to the hospital and spend a week there because they’re really sick is pretty high, and that all comes out of the payment,” said Bob Kocher, a former senior health care adviser to President Barack Obama.\u003c/p>\n\u003cp>Profits are in no way guaranteed, though. The centers still face major financial risk — it just takes a few patients with serious medical conditions to upend the books.\u003c/p>\n\u003cp>Dan Gray, a PACE financing consultant at Continuum Development Services, said too many trips to the emergency room or an expensive hospital stay can flip fortunes. One organization he advises had $300,000 in hospital medical claims in a month that he refers to as “Black August.”\u003c/p>\n\u003cp>“I had a nervous twitch,” he said.\u003c/p>\n\u003cp>\u003cstrong>High-Tech vs. High-Touch\u003c/strong>\u003c/p>\n\u003cp>In January, at the health care industry’s leading matchmaking event, the J.P. Morgan Healthcare Conference in San Francisco, word quickly spread that PACE programs could save states and the federal government up to 20 percent a patient. And suddenly, the program became one of the hottest topics of discussion.\u003c/p>\n\u003cp>“Every other conversation was, ‘What do you think we should do with PACE?’” said Bill Pomeranz, a managing director at Cain Brothers, who helped finance the nation’s first PACE program in the 1970s.\u003c/p>\n\u003cp>The message appeared to travel down Highway 101 as well, to the heart of the technology industry. At least eight startups have circulated PACE-related pitches to Silicon Valley venture capital firms, hoping to tap into new capital and create technology-enabled versions of the program.\u003c/p>\n\u003cp>The interest of the tech industry is so far only nascent. But the possibility that Silicon Valley, notoriously aggressive and extremely deep-pocketed, could play a significant role in PACE underscores the changes that may lie ahead.\u003c/p>\n\u003cp>Building a center requires medical offices, rehabilitation equipment, food service and fleets of handicapped-accessible vans. On average, it takes up to $12 million just to get it off the ground. That is a lot of money for most nonprofits but relatively little in the technology world. Opening new centers may become less of a hurdle.\u003c/p>\n\u003cp>The tech industry and nonprofit world are driven by different impulses. The early centers were closely tied to local cultures, making them difficult to replicate. An aversion to aggressive marketing among the center’s leaders didn’t help, either. Tech likes to move as fast as possible.\u003c/p>\n\u003cp>“PACE reminds me of religious orthodoxy,” said Mr. Pomeranz, who said he had affection for the program. The movement’s leaders come from the world of public health and have a “social work mentality,” he added.\u003c/p>\n\u003cp>The pitches circulating among investors envision technology-enabled programs that would rely, in part, on video visits and sensors. Some studies have found that telemedicine can help patients better control certain chronic conditions and reduce health care spending. But those technologies are largely untested in geriatric care.\u003c/p>\n\u003cp>“The entrepreneurs coming into this space all believe there are much lower-cost ways to check on patients every day than driving them all to one building,” said Mr. Kocher, who is now a partner at the venture capital firm Venrock, which invests in health care companies.\u003c/p>\n\u003cp>These sorts of pitches, while promising, have not been universally welcomed. They’ve even been used as evidence that opening PACE up to for-profit companies might lead to unwanted consequences.\u003c/p>\n\u003cp>Veteran PACE providers, for example, are skeptical of virtual medicine’s benefits to seniors, especially those with dementia.\u003c/p>\n\u003cp>“Socialization goes a long way to improve the health of the participants we serve,” said Kelly Hopkins, president of Trinity Health PACE, a nonprofit health system that operates PACE centers in eight states. “It’s naïve to think you can do it virtually.”\u003c/p>\n\u003cfigure id=\"attachment_228712\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228712\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS15228_nose-qut-800x533.jpg\" alt=\"Diane Schoenfeld (left) and her aunt, Lillie Manger, look at old family photos in the dining room of Berkeley's Chaparral House, the nursing home Manger lives in.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-960x640.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Diane Schoenfeld (left) and her aunt, Lillie Manger, look at old family photos in the dining room of Berkeley's Chaparral House, the nursing home Manger lives in. \u003ccite>(Rachel Dornhelm/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Supporters of the change say the necessary safeguards are in place. The for-profit centers were approved, to little fanfare, after the Department of Health and Human Services submitted the results of a pilot study to Congress in June 2015. The demonstration project, in Pennsylvania, showed no difference in quality of care and costs between nonprofit PACE providers and a for-profit allowed to operate there.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services has vowed to closely track the performance of all PACE operators by measuring emergency room use, falls and vaccination rates, among other metrics. \u003ca href=\"http://www.npaonline.org/\">The National PACE Association\u003c/a>, a policy and lobbying group, is also considering peer-reviewed accreditation to help safeguard the program. Oversight is now largely left to state Medicaid agencies.\u003c/p>\n\u003cp>Maureen Hewitt, InnovAge’s chief executive, said, “At the end of the day, we’re held to the same quality and care standards.”\u003c/p>\n\u003cp>Dr. Si France, a founder of \u003ca href=\"http://welbehealth.com/\">WelbeHealth\u003c/a>, an early-stage company based in Menlo Park, Calif., says startups can use technology to improve clinical communication, help caregivers make treatment decisions and monitor patients at home or in a hospital. But he insists even a high-tech PACE program cannot veer from its origins.\u003c/p>\n\u003cp>“It’s not a way to get rich or generate outsize returns,” said Dr. France, the former chief executive of GoHealth, a chain of urgent care centers acquired by TPG Capital, a private equity firm. “We think this is an arena for missionaries, not mercenaries.”\u003c/p>\n\u003cp>\u003cstrong>Will Money Change Things?\u003c/strong>\u003c/p>\n\u003cp>Families enrolled in InnovAge’s PACE program in Denver appeared to be unaware of its conversion into a for-profit enterprise. The company did not announce the change directly to its participants, but notified a patient advisory group.\u003c/p>\n\u003cp>Kathy Baron, 68, who lives in subsidized senior housing, was left disabled by breast cancer and debilitating nerve pain. Her daughter, Leah van Zelm, struggled to take care of her. So Baron, fearful she would be deemed unfit to stay in her apartment, signed up for InnovAge’s program.\u003c/p>\n\u003cp>“I would rather be dead than go into a nursing home,” Baron said.\u003c/p>\n\u003cp>She says InnovAge has been generous with services, echoing interviews with other patients. Each week, an InnovAge housekeeper changes the sheets on her bed, launders her clothes and cleans her apartment, a service provided to those unable to tidy their own homes. The few times her requests for special equipment or services were denied, Baron appealed and won.\u003c/p>\n\u003cp>But she worries new investors will skimp on what outsiders might view as unwarranted services. The company’s commercials, promising “Life on Your Terms” and voiced by the actress Susan Sarandon, have reinforced those concerns.\u003c/p>\n\u003cp>It’s a concern echoed by Malveaux’s family. “Anytime you involve money,” said Malveaux’s grandson Jermaine, “there’s always the concern for greed, especially with the elderly.”\u003c/p>\n\u003cp>At least in the near future, the number of companies getting into PACE programs will be limited. Most states currently cap enrollment in PACE centers. And each state — as Colorado did, opening the window for InnovAge — likely needs to amend its law to allow the for-profit companies. So far, it appears only California has done so.\u003c/p>\n\u003cp>Yet there is a growing realization among longtime PACE providers that new competition looms.\u003c/p>\n\u003cp>In a newsletter to the generally placid PACE community, one adviser warned that providers who failed to become bigger would face new entrants who “will find a way to meet the needs of persons in your community.”\u003c/p>\n\u003cp>Those needs will only grow as the adult children of baby boomers face difficult decisions about how to care for their parents.\u003c/p>\n\u003cp>In the meantime, for people like Van Zelm, the anxiety that once pervaded her daily life has diminished.\u003c/p>\n\u003cp>“When she’s stable,” Van Zelm said of her mother, “my daily life stress is reduced.”\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://khn.org/\">KHN\u003c/a>’s coverage of late-life and geriatric care is supported by The\u003ca href=\"http://www.jhartfound.org/\"> John A. Hartford Foundation\u003c/a>, and its coverage of aging and long-term care issues is supported by \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n","blocks":[],"excerpt":"PACE, a Medicare program that helps keep older people in their own homes, is allowing for-profit companies in. Tech and venture capital have expressed interest.","status":"publish","parent":0,"modified":1472074233,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":72,"wordCount":2988},"headData":{"title":"Worries as the For-Profit World Moves into Elder Care | KQED","description":"PACE, a Medicare program that helps keep older people in their own homes, is allowing for-profit companies in. Tech and venture capital have expressed interest.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Worries as the For-Profit World Moves into Elder Care","datePublished":"2016-08-24T21:30:33.000Z","dateModified":"2016-08-24T21:30:33.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"228587 http://ww2.kqed.org/stateofhealth/?p=228587","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/24/worries-as-the-for-profit-world-moves-into-elder-care/","disqusTitle":"Worries as the For-Profit World Moves into Elder Care","nprByline":"\u003cstrong> Sarah Varney \u003c/br> Kaiser Health News \u003c/strong>","path":"/stateofhealth/228587/worries-as-the-for-profit-world-moves-into-elder-care","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>DENVER — Inside a senior center here, nestled along a bustling commercial strip, Vivian Malveaux scans her bingo card for a winning number. Her 81-year-old eyes are warm, lively and occasionally set adrift by the dementia plundering her mind.\u003c/p>\n\u003cp>Dozens of elderly men and women — some in wheelchairs, others whose hands tremble involuntarily — gather excitedly around the game tables. After bingo, there is more entertainment and activities: Yahtzee, tile-painting, beading.\u003c/p>\n\u003cp>But this is no linoleum-floored community center reeking of bleach. Instead, it’s one of eight vanguard centers \u003ca href=\"http://myinnovage.org/\">owned by InnovAge\u003c/a>, a company based in Denver with ambitious plans. With the support of private equity money, InnovAge aims to aggressively expand a little-known Medicare program that will pay to keep older and disabled Americans out of nursing homes.\u003c/p>\n\u003cp>Until recently, only nonprofits were allowed to run programs like these. But a year ago, the government flipped the switch, opening the program to for-profit companies as well, ending one of the last remaining holdouts to commercialism in health care. The hope is that the profit motive will expand the services faster.\u003c/p>\n\u003cp>Hanging over all the promise, though, is the question of whether for-profit companies are well-suited to this line of work, long the province of nonprofit do-gooders. Critics point out that the business of caring for poor and frail people is marred with abuse. Already, new ideas for lowering the cost of the program have started circulating. In Silicon Valley, for example, some eager entrepreneurs are pushing plans that call for a higher reliance on video calls instead of in-person doctor visits.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_228689\" class=\"wp-caption alignnone\" style=\"max-width: 594px\">\u003cimg class=\"size-full wp-image-228689\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS4288_121384844.jpg\" alt=\"An elderly woman pushing her walker.\" width=\"594\" height=\"418\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS4288_121384844.jpg 594w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS4288_121384844-400x281.jpg 400w\" sizes=\"(max-width: 594px) 100vw, 594px\">\u003cfigcaption class=\"wp-caption-text\">An elderly woman pushing her walker. \u003ccite>(Sean Gallup/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The business appeal is simple: A baby boom-propelled surge in government health care spending is coming. Medicare enrollment is expected to grow by 30 million people in the next two decades, and many of those people are potential future clients. Adding to the allure are hefty profit margins for programs like these — as high as 15 percent, compared with an average of 2 percent among nursing homes — and geographic monopolies that are all but guaranteed by state Medicaid agencies to ensure the solvency of providers.\u003c/p>\n\u003cp>The goal of the program, known as PACE, or the\u003ca href=\"https://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/integrating-care/program-of-all-inclusive-care-for-the-elderly-pace/program-of-all-inclusive-care-for-the-elderly-pace.html\"> Program of All-Inclusive Care for the Elderly\u003c/a>, is to help frail, older Americans live longer and more happily in their own homes, by providing comprehensive medical care and intensive social support. It also promises to save Medicare and Medicaid millions of dollars by keeping those people out of nursing homes.\u003c/p>\n\u003cp>For decades, though, the program has failed to catch on, with only 40,000 people enrolled as of January of this year.\u003c/p>\n\u003cp>“PACE is still a secret in the minds of the public,” Andy Slavitt, Medicare’s acting administrator, said at the National PACE Association meeting in April. The challenge, he said, was to make PACE “a clear part of the solution.”\u003c/p>\n\u003cp>Several private equity firms, venture capitalists and Silicon Valley entrepreneurs have jumped into the niche. F-Prime Capital Partners, a former Fidelity Biosciences group, provided seed funding for a PACE-related startup, as have well-regarded angel investors like Amir Dan Rubin, the former Stanford Health Care president, and Michael Zubkoff, a Dartmouth health care economist.\u003c/p>\n\u003cp>And no company has moved with more tenacity than InnovAge. Last year, the company overcame protests from watchdog groups to convert from a nonprofit organization to a for-profit business in Colorado. And in May, InnovAge received $196 million in backing — the largest investment in a PACE business since the rule change was made — from Welsh, Carson, Anderson & Stowe, a private equity firm with $10 billion in assets under management.\u003c/p>\n\u003cfigure id=\"attachment_228692\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228692\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS2763_elderlywalkers052411-800x505.jpg\" alt=\"Pedestrians are mirrored in a shopping window.\" width=\"800\" height=\"505\">\u003cfigcaption class=\"wp-caption-text\">Pedestrians are mirrored in a shopping window. \u003ccite>(Ralph Orlowski/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“For years we were pariahs, and no one wanted anything to do with us,” said Julie Reiskin, executive director of the Colorado Cross-Disability Coalition, a nonprofit group that advocates for people with disabilities, many of whom are eligible for PACE.\u003c/p>\n\u003cp>“Now that there’s money involved,” Reiskin said, “everyone is all interested.”\u003c/p>\n\u003cp>Even the program’s supporters acknowledge that the movement needs fresh momentum. But they worry that commercial operators will tarnish their image in the same way many for-profits eroded trust in hospice care and nursing homes.\u003c/p>\n\u003cp>Three decades ago, after Congress authorized Medicare to pay for hospice care, commercial operators displaced the religious and community groups that had championed the movement. As recently as 2014, government inspectors found that for-profit hospice companies cherry-picked patients and stinted on care.\u003c/p>\n\u003cp>In addition, elderly patients with dementia and chronic ailments have frequently been targets of abuse and neglect at nursing homes, something advocates for the elderly say is correlated with the increased commercialization of that industry.\u003c/p>\n\u003cp>“I’m not wild about every knucklehead running around trying to do PACE,” said Thomas Scully, former Medicare administrator under President George W. Bush. “I would rather keep it below the radar.”\u003c/p>\n\u003cp>\u003cstrong>Not Quite Able\u003c/strong>\u003c/p>\n\u003cp>Early last year, Malveaux was drowning. She lived alone in a tidy red-brick home in a leafy Denver neighborhood that she paid for by working shifts at a Samsonite luggage factory, now closed.\u003c/p>\n\u003cp>Laundry piled up. Bills went unpaid. Doors were left unlocked. Pans sometimes burned on the stove as her memory failed.\u003c/p>\n\u003cp>“I had lost my mind,” she recalled, sitting on her couch in a pink velour robe. “I couldn’t keep up my house.”\u003c/p>\n\u003cp>For Americans who find themselves in this situation, the next stop is often a traditional nursing home. Malveaux’s son took her instead to visit an InnovAge day center.\u003c/p>\n\u003cp>The $9 million building south of downtown Denver is designed to calm people with dementia. It has subdued lighting and winding hallways that encircle the first floor like a running track and discourage “exit-seeking behaviors,” where patients search for ways out of a building.\u003c/p>\n\u003cp>For the frightened Malveaux, it seemed like paradise: a flower garden, a beauty salon and day trips to casinos and candy factories. And, most importantly, it had a team of doctors, nurses, psychiatrists, dentists, physical therapists, nutritionists, home health aides and social workers whose purpose was to help her live safely in her beloved brick home.\u003c/p>\n\u003cp>After joining the center in June 2015, Malveaux began seeing a psychiatrist and went on medication for depression. A social worker coached her grandson, Jermaine Malveaux, on how to care for someone with dementia. Three days a week, an InnovAge van picks up Malveaux at home and takes her to the center to share lunch with other older adults and try her luck at bingo and ceramics.\u003c/p>\n\u003cp>“I make friends easily,” she said with a smile. “And the guys flirt with me.”\u003c/p>\n\u003cp>The InnovAge center, like other PACE facilities, is inspired by Britain’s much-lauded \u003ca href=\"http://www.bgs.org.uk/index.php/topresources/publicationfind/goodpractice/86-day-hospitals-for-older-people\">Day Hospitals\u003c/a>, outpatient health care facilities that arose in the 1950s that became a hub of daily life for many older people. In the United States, the earliest incarnation of PACE was started in San Francisco in 1971 by a group of Asian and Italian immigrant families seeking alternatives to the American nursing home.\u003c/p>\n\u003cp>Federal health officials allowed the group, \u003ca href=\"https://www.onlok.org/\">called On Lok\u003c/a> — Cantonese for “peaceful, happy abode” — to test what was then a novel and prophetic approach to health care financing. Instead of physicians billing Medicare each time they treated a patient, the government would pay a fixed amount to the center for each member. On Lok would assume the financial risk, similar to an insurance company. In 1990, Medicare officially sanctioned the model.\u003c/p>\n\u003cfigure id=\"attachment_228691\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228691\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS801_medical053111-800x527.jpg\" alt=\"Registered nurse JoAnn Brand examines Sham Tavakol.\" width=\"800\" height=\"527\">\u003cfigcaption class=\"wp-caption-text\">Registered nurse JoAnn Brand examines Sham Tavakol. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In exchange for a capped monthly payment from Medicare and Medicaid, PACE staff members arrange and pay for all of a patient’s doctors’ visits, medications, rehabilitation and hospitalizations. At the same time, they are supposed to pay attention to the patient’s daily needs — meals, bathing, housekeeping and transportation to day centers, where older people can ward off isolation and cognitive decline by socializing. (Studies have found that the intensive caretaking reduces costly hospital stays.)\u003c/p>\n\u003cp>Comparing the cost effectiveness of PACE against nursing homes is difficult, partly because state Medicaid agencies pay a variety of rates. But all the states are required to keep their rates below what they would pay for nursing home care. In Colorado, for example, that amounts to 7 percent less per patient.\u003c/p>\n\u003cp>On average, Medicare and Medicaid pay PACE providers $76,728 a person a year, about $5,500 less than the average cost of a nursing home. And the money going to PACE covers the all of the person’s health and social needs, unlike nursing home care, which doesn’t include hospitalizations and other expensive medical care.\u003c/p>\n\u003cp>The flat government payment pushes the organizations to invest in maintaining a patient’s health and safety to avoid big hospital bills. Dentistry — excluded from traditional Medicare coverage — is a crucial focus: Programs invest heavily to fix broken teeth and dentures to avoid costly infections or poor nutrition that can cause cascading health problems.\u003c/p>\n\u003cp>Providers are also generous with rehabilitation, setting few limits on training sessions that strengthen injured muscles and sturdy patients against falls.\u003c/p>\n\u003cp>“If you’re neglecting these patients, the odds they’ll call an ambulance and go to the hospital and spend a week there because they’re really sick is pretty high, and that all comes out of the payment,” said Bob Kocher, a former senior health care adviser to President Barack Obama.\u003c/p>\n\u003cp>Profits are in no way guaranteed, though. The centers still face major financial risk — it just takes a few patients with serious medical conditions to upend the books.\u003c/p>\n\u003cp>Dan Gray, a PACE financing consultant at Continuum Development Services, said too many trips to the emergency room or an expensive hospital stay can flip fortunes. One organization he advises had $300,000 in hospital medical claims in a month that he refers to as “Black August.”\u003c/p>\n\u003cp>“I had a nervous twitch,” he said.\u003c/p>\n\u003cp>\u003cstrong>High-Tech vs. High-Touch\u003c/strong>\u003c/p>\n\u003cp>In January, at the health care industry’s leading matchmaking event, the J.P. Morgan Healthcare Conference in San Francisco, word quickly spread that PACE programs could save states and the federal government up to 20 percent a patient. And suddenly, the program became one of the hottest topics of discussion.\u003c/p>\n\u003cp>“Every other conversation was, ‘What do you think we should do with PACE?’” said Bill Pomeranz, a managing director at Cain Brothers, who helped finance the nation’s first PACE program in the 1970s.\u003c/p>\n\u003cp>The message appeared to travel down Highway 101 as well, to the heart of the technology industry. At least eight startups have circulated PACE-related pitches to Silicon Valley venture capital firms, hoping to tap into new capital and create technology-enabled versions of the program.\u003c/p>\n\u003cp>The interest of the tech industry is so far only nascent. But the possibility that Silicon Valley, notoriously aggressive and extremely deep-pocketed, could play a significant role in PACE underscores the changes that may lie ahead.\u003c/p>\n\u003cp>Building a center requires medical offices, rehabilitation equipment, food service and fleets of handicapped-accessible vans. On average, it takes up to $12 million just to get it off the ground. That is a lot of money for most nonprofits but relatively little in the technology world. Opening new centers may become less of a hurdle.\u003c/p>\n\u003cp>The tech industry and nonprofit world are driven by different impulses. The early centers were closely tied to local cultures, making them difficult to replicate. An aversion to aggressive marketing among the center’s leaders didn’t help, either. Tech likes to move as fast as possible.\u003c/p>\n\u003cp>“PACE reminds me of religious orthodoxy,” said Mr. Pomeranz, who said he had affection for the program. The movement’s leaders come from the world of public health and have a “social work mentality,” he added.\u003c/p>\n\u003cp>The pitches circulating among investors envision technology-enabled programs that would rely, in part, on video visits and sensors. Some studies have found that telemedicine can help patients better control certain chronic conditions and reduce health care spending. But those technologies are largely untested in geriatric care.\u003c/p>\n\u003cp>“The entrepreneurs coming into this space all believe there are much lower-cost ways to check on patients every day than driving them all to one building,” said Mr. Kocher, who is now a partner at the venture capital firm Venrock, which invests in health care companies.\u003c/p>\n\u003cp>These sorts of pitches, while promising, have not been universally welcomed. They’ve even been used as evidence that opening PACE up to for-profit companies might lead to unwanted consequences.\u003c/p>\n\u003cp>Veteran PACE providers, for example, are skeptical of virtual medicine’s benefits to seniors, especially those with dementia.\u003c/p>\n\u003cp>“Socialization goes a long way to improve the health of the participants we serve,” said Kelly Hopkins, president of Trinity Health PACE, a nonprofit health system that operates PACE centers in eight states. “It’s naïve to think you can do it virtually.”\u003c/p>\n\u003cfigure id=\"attachment_228712\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228712\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS15228_nose-qut-800x533.jpg\" alt=\"Diane Schoenfeld (left) and her aunt, Lillie Manger, look at old family photos in the dining room of Berkeley's Chaparral House, the nursing home Manger lives in.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/08/RS15228_nose-qut-960x640.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Diane Schoenfeld (left) and her aunt, Lillie Manger, look at old family photos in the dining room of Berkeley's Chaparral House, the nursing home Manger lives in. \u003ccite>(Rachel Dornhelm/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Supporters of the change say the necessary safeguards are in place. The for-profit centers were approved, to little fanfare, after the Department of Health and Human Services submitted the results of a pilot study to Congress in June 2015. The demonstration project, in Pennsylvania, showed no difference in quality of care and costs between nonprofit PACE providers and a for-profit allowed to operate there.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services has vowed to closely track the performance of all PACE operators by measuring emergency room use, falls and vaccination rates, among other metrics. \u003ca href=\"http://www.npaonline.org/\">The National PACE Association\u003c/a>, a policy and lobbying group, is also considering peer-reviewed accreditation to help safeguard the program. Oversight is now largely left to state Medicaid agencies.\u003c/p>\n\u003cp>Maureen Hewitt, InnovAge’s chief executive, said, “At the end of the day, we’re held to the same quality and care standards.”\u003c/p>\n\u003cp>Dr. Si France, a founder of \u003ca href=\"http://welbehealth.com/\">WelbeHealth\u003c/a>, an early-stage company based in Menlo Park, Calif., says startups can use technology to improve clinical communication, help caregivers make treatment decisions and monitor patients at home or in a hospital. But he insists even a high-tech PACE program cannot veer from its origins.\u003c/p>\n\u003cp>“It’s not a way to get rich or generate outsize returns,” said Dr. France, the former chief executive of GoHealth, a chain of urgent care centers acquired by TPG Capital, a private equity firm. “We think this is an arena for missionaries, not mercenaries.”\u003c/p>\n\u003cp>\u003cstrong>Will Money Change Things?\u003c/strong>\u003c/p>\n\u003cp>Families enrolled in InnovAge’s PACE program in Denver appeared to be unaware of its conversion into a for-profit enterprise. The company did not announce the change directly to its participants, but notified a patient advisory group.\u003c/p>\n\u003cp>Kathy Baron, 68, who lives in subsidized senior housing, was left disabled by breast cancer and debilitating nerve pain. Her daughter, Leah van Zelm, struggled to take care of her. So Baron, fearful she would be deemed unfit to stay in her apartment, signed up for InnovAge’s program.\u003c/p>\n\u003cp>“I would rather be dead than go into a nursing home,” Baron said.\u003c/p>\n\u003cp>She says InnovAge has been generous with services, echoing interviews with other patients. Each week, an InnovAge housekeeper changes the sheets on her bed, launders her clothes and cleans her apartment, a service provided to those unable to tidy their own homes. The few times her requests for special equipment or services were denied, Baron appealed and won.\u003c/p>\n\u003cp>But she worries new investors will skimp on what outsiders might view as unwarranted services. The company’s commercials, promising “Life on Your Terms” and voiced by the actress Susan Sarandon, have reinforced those concerns.\u003c/p>\n\u003cp>It’s a concern echoed by Malveaux’s family. “Anytime you involve money,” said Malveaux’s grandson Jermaine, “there’s always the concern for greed, especially with the elderly.”\u003c/p>\n\u003cp>At least in the near future, the number of companies getting into PACE programs will be limited. Most states currently cap enrollment in PACE centers. And each state — as Colorado did, opening the window for InnovAge — likely needs to amend its law to allow the for-profit companies. So far, it appears only California has done so.\u003c/p>\n\u003cp>Yet there is a growing realization among longtime PACE providers that new competition looms.\u003c/p>\n\u003cp>In a newsletter to the generally placid PACE community, one adviser warned that providers who failed to become bigger would face new entrants who “will find a way to meet the needs of persons in your community.”\u003c/p>\n\u003cp>Those needs will only grow as the adult children of baby boomers face difficult decisions about how to care for their parents.\u003c/p>\n\u003cp>In the meantime, for people like Van Zelm, the anxiety that once pervaded her daily life has diminished.\u003c/p>\n\u003cp>“When she’s stable,” Van Zelm said of her mother, “my daily life stress is reduced.”\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://khn.org/\">KHN\u003c/a>’s coverage of late-life and geriatric care is supported by The\u003ca href=\"http://www.jhartfound.org/\"> John A. Hartford Foundation\u003c/a>, and its coverage of aging and long-term care issues is supported by \u003ca href=\"http://www.thescanfoundation.org/\">The SCAN Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/228587/worries-as-the-for-profit-world-moves-into-elder-care","authors":["byline_stateofhealth_228587"],"categories":["stateofhealth_2442","stateofhealth_2746"],"tags":["stateofhealth_121","stateofhealth_2865"],"featImg":"stateofhealth_228690","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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You ask the questions. You decide what Bay Curious investigates. 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. 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