Category Archives: Health Care

“For too long, Americans paid for health insurance that did not recognize that treatment for mental health and substance use disorders is as essential as other medical treatment,” the White House stated in a Fact Sheet describing steps the Federal Parity Task Force is taking to strengthen indusrance coverage for mental health and substance use disorders. “Untreated mental health and substance use disorders can be debilitating and life-threatening. These consequences are apparent in the prescription opioid and heroin epidemic, as well as the troubling rates of suicide and severe mental illness in this country.

“One of the many important provisions of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act is to ensure that health insurance plans treat mental health and substance use disorders the same way that they treat other health conditions. In March of this year, President Obama established the Mental Health and Substance Use Disorder Parity Task Force and charged Federal Departments and Agencies to work together to ensure that Americans are benefiting from the mental health and substance use disorder parity protections under the law. Parity aims to eliminate restrictions on mental health and substance use coverage – like annual visit limits, higher copayments, or different rules on how care is managed such as frequent pre-authorization requirements or medical necessity reviews – if comparable restrictions are not placed on medical and surgical benefits.”

In its final report, the Task Force announced a series of actions and recommendations to help ensure better implementation of parity; to help consumers, providers, and plans understand how parity works; and to ensure appropriate oversight and enforcement of parity protections.

These steps are based on input the Task Force received through a series of listening sessions between March and October held with consumers, providers, employers, health plans, and State regulators, and through the more than 1,100 public comments the Task Force received from individuals with mental health and substance use disorders, families, their providers, advocates, and other stakeholders.

“These recommendations are subject to future budget and policy deliberation,” The White House noted. “Together, today’s steps build on the ongoing work of the Administration to make the treatment of mental health and substance use disorders a priority. The Affordable Care Act ended insurance discrimination based on pre-existing conditions, including mental health and substance use disorders; required coverage of mental health and substance use disorder services in non-grandfathered plans in the individual and small group insurance markets; ensured that recommended preventive screenings, including for depression and alcohol misuse, are available with no co-pays; and expanded Medicaid to millions of additional Americans, significantly improving coverage for mental health care and substance use disorder treatment. In addition, the Administration has issued final regulations providing parity protections to individuals covered through the employer and individual insurance markets, people covered through Medicaid managed care organizations and the Children’s Health Insurance Program, and service members and their families covered through TRICARE.

“Through these steps, the country has made significant progress in expanding mental health and substance use disorder coverage and parity protections for millions of Americans. The Task Force report focuses on parity-related actions and recommendations and does not include the provisions in the President’s Budget that would further expand access to care, including new investments in treatment capacity. The actions and recommendations announced today will continue to advance the Administration’s progress on parity implementation.”

The full report is available here: http://www.hhs.gov/parity

Here are the actions announced by the Task Force:

· The Centers for Medicare & Medicaid Services (CMS) is awarding $9.3 million to States to help enforce parity protections. CMS funding will help State insurance regulators work to ensure issuer compliance with the mental health and substance use disorder parity protections.

· The Department of Health and Human Services (HHS), in partnership with the Department of Labor (DOL) and other Task Force agencies, is releasing the beta version of a new parity website to help consumers find the appropriate Federal or State agency to assist with their parity complaints, appeals, and other actions. The Task Force received many comments about the challenges consumers face in identifying the appropriate agency that regulates their insurance coverage. The beta site is being released today for public comment. In the future, the Task Force Departments intend to work together to build out additional functionality on the website related to complaint and data tracking.

· The Substance Abuse and Mental Health Services Administration (SAMHSA) and DOL are releasing a Consumer Guide to Disclosure Rights: Making the Most of Your Mental Health and Substance Use Disorder Benefits to help consumers, their representatives, and providers understand what type of information to ask for when inquiring about a plan’s compliance with parity and to explain the various Federal disclosure laws that also require disclosure of information related to parity. The Guide includes 11 scenarios, each with specific suggestions for information consumers have a right to that can help, as well as timing requirements for plans and issuers providing these documents.

· DOL is announcing that it will release annual data on closed Federal parity investigations and will report on the findings, including the violations cited to ensure parity compliance and inform future policymaking efforts. This effort builds on the 1,515 investigations related to the Mental Health Parity and Addiction Equity Act and 171 violations cited by DOL since October of 2010.

· To ensure parity compliance in plans required to offer essential health benefits, CMS has added Mental Health Parity and Addiction Equity Act compliance to its review of plans subject to the essential health benefits requirement under the Affordable Care Act, and it expects State regulators to do so as well.

· DOL, HHS, and the Department of Treasury (Treasury) are issuing guidance on parity and opioid use disorder treatment to address specific questions the Departments have received related to issues such as the application of parity to opioid treatment access and coverage of court-ordered treatment.

· HHS, DOL and Treasury are soliciting feedback on how the disclosure document request process can be improved (input is being sought through the FAQ process), while continuing to ensure consumers’ rights to access all appropriate information and documentation. The request solicits input on the option of developing model forms for parity-related disclosure requests.

· SAMHSA is announcing that it will host two State Policy Academies on Parity Implementation for State Officials in Fiscal Year 2017, including one focused on the commercial market and one on parity in Medicaid and the Children’s Health Insurance Program. These policy academies will bring together national experts to provide technical assistance to teams of State officials on strategies to advance parity compliance and lessons learned from other States’ implementation efforts.

· CMS will undertake a review of mental health and substance use disorder benefits in Medicare Advantage plans and identify any necessary improvements to advance parity protections.

· DOL, HHS, and Treasury are issuing a Parity Compliance Assistance Materials Index. The Departments have issued a total of 44 Frequently Asked Questions (FAQs) over the past six years related to parity, generally as part of larger guidance documents, as well as other parity materials. Several commenters suggested to the Task Force that putting all the parity-related FAQs and guidance together in one place would make the information easier to find and use for States, plans consumers, and other stakeholders.

In addition, the Task Force made the following recommendations:

• Create a one-stop consumer web portal to help consumers navigate parity, which will build out the functionality of the beta parity website released today. The Task Force recommends that the website should help consumers solve coverage issues, file a complaint, or submit an appeal, and also be used to better inform parity oversight and enforcement efforts.

• Increase Federal agencies’ capacity to audit health plans for parity compliance. The Task Force recommends that agencies’ future budgets include funding to expand audit capacity. Given current resources, Federal parity enforcement efforts to date have generally focused on investigating consumer, provider and other parity complaints. Agencies’ capacity to expand enforcement activities, including conducting random audits, is limited by their staffing resources.

• Undertake a detailed review of the non-quantitative treatment limits applicable to substance use disorder benefits in the Federal Employees Health Benefits (FEHB) Program. The Task Force received comments suggesting that non-quantitative treatment limits in FEHB plans may need examination and modification to ensure full compliance, as well as comments suggesting that consistent definitions of terms relating to residential treatment would provide greater transparency for consumers. The U.S. Office of Personnel Management has agreed to conduct this review over the coming year, and take corrective action as indicated by the findings.

• Allow the Department of Labor to assess civil monetary penalties for parity violations. Civil monetary penalty authority would lead to more meaningful penalties for non-compliance with parity. The Task Force recommends that Congress provide the Department of Labor with this authority.

• Develop examples of parity compliance best practices and of potential warning signs of non-compliance. Building on the 2016 DOL/HHS “Warning Signs” document identifying non-quantitative treatment limitations that require additional analysis to determine if they are in compliance with parity, the Task Force recommends a Warning Signs 2.0 document and encourages the inclusion of network adequacy issues in the document. The Task Force also recommends developing further examples of parity compliance best practices to illustrate appropriate application of non-quantitative treatment limitations that are comparable between mental health/substance use disorder benefits and medical/surgical benefits.

• Provide Federal support for State efforts to enforce parity through trainings, resources, and new implementation tools, including model compliance templates. The Task Force recommends continued Federal efforts to provide training and other resources to States to support compliance efforts including partnerships between State mental health/substance use, Medicaid, and State insurance agencies. Further, the Task Force recommends that Federal regulators work with the National Association of Insurance Commissioners and the States to develop a standardized template that States might use to help assess parity compliance. The Task Force also encourages Federal regulators, the National Association of Insurance Commissioners, and other stakeholders to consider a joint effort to develop a model prior authorization form and other model forms.

• Provide simplified disclosure tools to provide consistent information for consumers, plans and issuers. To facilitate disclosure, the Task Force recommends that, in coordination with the National Association of Insurance Commissioners, templates and other sample standardized tools be developed to improve consumer access to plan information.

• Expand consumer education about parity protections. The Task Force recommends continuing and expanding the work to educate consumers about parity and partnering with consumer groups to increase consumer awareness and understanding of parity protections.

• Clarify that health plan disclosure requirements include medical and surgical benefits. The Task Force heard from commenters that it can be challenging to ensure parity compliance when information on medical and surgical benefits is not readily available to allow for comparison to mental health and substance use disorder benefits. Disclosure of the relevant information used to apply coverage limitations to medical and surgical services is currently required for plans covered under the Employee Retirement Income Security Act (ERISA). The Task Force recommends that Congress extend this requirement to non-ERISA plans.

• Implement the Medicaid and Children’s Health Insurance Program (CHIP) parity final rule in a robust manner. The Task Force recommends that implementation include the development of a parity analysis toolkit to help States assess compliance with the final rules on parity for Medicaid managed care organizations and CHIP programs. The toolkit will review key considerations for defining and classifying mental health and substance use disorder benefits (including intermediate and long term supports and services), conducting claims-based analyses for quantitative treatment limits, identifying and analyzing non-quantitative treatment limits, and considerations for Alternative Benefit Plans and CHIP.

• Expand access to mental health and substance use disorder services in TRICARE. The Task Force recommends the Department of Defense’s continued implementation of the TRICARE final rule on mental health and substance use disorders and parity through contract modifications and DOD’s monitoring of access to mental health and substance use disorder care to ensure parity with medical/surgical care.

• Eliminate the lifetime day limit on Medicare Part A treatment in psychiatric hospitals. In Medicare Part A (hospital coverage), there is a 190-day lifetime limit on inpatient treatment in psychiatric hospitals while there is no such limit on inpatient medical/surgical hospital treatment. The Task Force recommends that Congress eliminate the psychiatric hospital lifetime day limit, consistent with the President’s 2017 budget request.

• Update guidance to address the applicability of parity to opioid use disorder services. The Task Force recommends issuing guidance clarifying the application of parity to opioid use disorder treatment benefits in response to specific scenarios associated with these benefits raised by consumers and other stakeholders and updating this guidance regularly, as warranted.

• Eliminate the parity opt-out process for self-funded non-Federal governmental plans. Currently, self-funded non-Federal governmental plans have the ability to elect to not comply with certain Federal provisions including the Mental Health Parity and Addiction Equity Act, which deprives thousands of employees of State and local governments of the mental health and substance use disorder parity protections. The Task Force recommends that Congress eliminate the ability of these plans to opt out of these protections.

Health Care, Presidential Campaign 2016, Presidential Politics

Dueling Candidates on Health Care: Hillary Clinton Would Improve Upon Obamacare, Donald Trump Would Repeal, Restore Control to Insurance Companies

October 14, 2016 krubin

Donald Trump and Hillary Clinton, during presidential debate, have very different health care proposals © 2016 Karen Rubin/news-photos-features.com

Before the Affordable Care Act (ACA, better known as Obamacare), more than 50 million Americans were without any health insurance and 20,000 people were losing their health insurance each month as the Bush Great Recession hemorrhaged 850,000 jobs a month. Though employers for more than a decade have been cutting back on health benefits (making it a Hobson’s choice to leave a terrible job or an abusive marriage), 170 million people get their insurance through their employment, and insurance companies were raising premiums annually at rates five times the rate of inflation, refusing to provide insurance based on pre-existing conditions, charging women higher rates (because they have babies, don’t you know), arbitrarily denying services, capping lifetime claims, throwing people off insurance, and pocketing 25-30% of the premium, with only 70-75% going to patient care.

The Affordable Care Act, designed to make health insurance accessible to everyone, made improvements that have benefited everyone (as Hillary said), but meant the difference between life and death for the 50 million who could not afford health care at all. But to get it passed Obama had to make compromises, including giving up a public option. Then, chiefly Republican-dominated states rejected ACA, casting millions of their residents into a limbo where they could not qualify for the federally-provided exchange and didn’t have access through an employer.

Significantly, ACA (Obamacare) was a Hail Mary to get universal access to health care, with some benefits in terms of containing health care costs. But the next round of health care reform would need to address costs. Here, in the words of their own campaigns, are the candidates’ health plans – in essence, Donald Trump pledges to repeal Obamacare and replace it by returning to “market” (that is, for-profit insurance companies) control, while Hillary Clinton is vowing to make necessary improvements to Obamacare to continue the goal of universal health care, correcting the inequities between states which refused Obamacare and possibly with a public option – Karen Rubin, News & Photo Features.

Trump: Obamacare is a Disaster and Needs to be Repealed

“Obamacare Is A Disaster. You Know It We All Know It.”

During the second presidential debate, the question was asked, “What will you do to bring down the cost of health care? This is the rambling, nonsensical reply to the question, and the Trump campaign is so proud of it, they emailed it out:

TRUMP: “It is such a great question, and it’s maybe the question I get almost more than anything else. Outside of defense. Obamacare is a disaster. You know it we all know it. It is going up at numbers that nobody has ever seen worldwide. No One has ever seen numbers like this for healthcare. It is only getting worse. In seventeen, implodes by itself. Their methods of fixing it is to go and ask Congress for more money. More and more money. We right now have almost twenty trillion dollars in debt. Obama care with mother work. It is very bad, very bad health insurance. Far too expensive, and not only expensive for the person that has it, unbelievably expensive for our country. It’s got to be one of the biggest line items very shortly. We have to repeal it, and replace it with something absolutely much less expensive. And something that works. Where your plan can actually be tailored. We have to get rid of the lines around the state, and official lines. Where we stop insurance companies from coming in and competing because they wanted President Obama and whoever is working on it. They want to leave those lines because that gives the insurance companies, essentially, monopolies. We want competition. You will have the finest healthcare plan there is, she wants to go to a single-payer pan. Which would be a disaster. Somewhat similar to Canada. And if you haven’t noticed the Kitty Indians, when they need a big operations they come into the United States in many cases. Because they are system is so slow, it is catastrophic in certain ways. But she wants to go to single-payer. Which means the government basically rules everything. Hillary Clinton has been after this for years. Obamacare was the first step. Obamacare is a total disaster. And not only are your rates going up by numbers that no one has ever believed, but your deductibles are going up. So that unless you get hit by a truck, you are never going to be able to use it. It is a disastrous plan and it has to be repealed.” (Click To Watch)

Clinton’s Plan To Improve Our Health Care And Build On The Affordable Care Act

“Hillary Clinton will defend and expand on the progress made under Obama Administration toward universal coverage through the Affordable Care Act. The fact is, Hillary has never given up on the fight for universal coverage—and she won’t stop now. As First Lady, she refused to give up when the insurance industry and special interests attacked her and defeated healthcare reform. Instead, she worked with Republicans and Democrats to help create and implement the Children’s Health Insurance Program, which now provides health coverage to more than 8 million children,” Hillary for America campaign stated.

Hillary Clinton, Democratic candidate for President, advocates improving upon Obamacare toward the goal of universal health care © 2016 Karen Rubin/news-photos-features.com

As president, Hillary will build on the Affordable Care Act to expand coverage for millions of Americans.

She will lower-out-of-pocket expenses for consumers purchasing health insurance on the Obamacare exchanges. Hillary believes that in order to expand coverage for families, we need to reduce the cost of purchasing health insurance on the Affordable Care Act exchanges. Her plan will provide enhanced relief for people on the exchanges, and provide a tax credit of up to $5,000 per family to offset a portion of excessive out-of-pocket and premium costs above 5% of their income. She will enhance the premium tax credits now available through the exchanges so that those now eligible will pay less of a percentage of their income than under current law and ensure that all families purchasing on the exchange will not spend more than 8.5 percent of their income for premiums. Finally, she will fix the “family glitch” so that families can access coverage when their employer’s family plan premium is too expensive.

She will support new incentives to encourage all states to expand Medicaid. Hillary will fight for health insurance for our lowest income residents living in every state across the nation. Hillary will follow President Obama’s proposal to allow any state that signs up for the Medicaid expansion to receive a 100 percent match for the first three years, and she will continue to look for other ways to incentivize states to expand Medicaid to meet the health needs of their most vulnerable residents.

She will invest in navigators, advertising and other outreach activities to make enrollment easier. Today, as many as 16 million people or half of all those uninsured are eligible but not enrolled in virtually free Medicaid coverage or exchange coverage for as little as $100 a month or less. Hillary will ensure anyone who wants to enroll can understand their options and do so easily, by dedicating more funding for outreach and enrollment efforts. She will invest $500 million per year in an aggressive enrollment campaign to ensure more people enroll in these extremely affordable options.

She will expand access to affordable health care to families regardless of immigration status. Hillary sponsored the Immigrant Children’s Health Improvement Act in the Senate, which later became law and allows immigrant children and pregnant women to obtain Medicaid and CHIP. She believes we should let families—regardless of immigration status—buy into the Affordable Care Act exchanges. Families who want to purchase health insurance should be able to do so.

She will continue to support a “public option”—and work to build on the Affordable Care Act to make it possible. As she did in her 2008 campaign health plan, and consistently since then, Hillary supports a “public option” to reduce costs and broaden the choices of insurance coverage for every American. To make immediate progress toward that goal, Hillary will work with interested governors, using current flexibility under the Affordable Care Act, to empower states to establish a public option choice.

Going forward, Hillary will build on these efforts and fight to ensure that the savings from these reforms benefits families—not just insurance companies, drug companies, and large corporations. She will expand coverage for Americans living in rural areas and continue a lifelong commitment to protecting women’s reproductive rights.

Hillary’s plan will reduce the cost of prescription drugs. Prescription drug spending accelerated from 2.5 percent in 2013 to 12.6 percent in 2014. It’s no wonder that almost three-quarters of Americans believe prescription drug costs are unreasonable. Hillary believes we need to demand lower drug costs for hardworking families and seniors and she will hold drug companies accountable for unjustified price hikes with new penalties.

Her plan will transform our healthcare system to reward value and quality. Hillary is committed to building on delivery system reforms in the Affordable Care Act that improve value and quality care for Americans.

Hillary will also work to expand access to rural Americans, who often have difficulty finding quality, affordable health care. She will explore cost-effective ways to broaden the scope of health care providers eligible for telehealth reimbursement under Medicare and other programs, including federally qualified health centers and rural health clinics. She will also call for states to support efforts to streamline licensing for telemedicine and examine ways to expand the types of services that qualify for reimbursement.

Hillary is continuing a lifelong fight to ensure women have access to reproductive health care. As senator, she championed access to emergency contraception and voted in favor of strengthening a woman’s right to make her own health decisions. As president, she will continue defending Planned Parenthood, which provides critical health services including breast exams and cancer screenings to 2.7 million patients a year. And she will work to ensure that all women have access to preventive care, affordable contraception, and safe, legal abortion—not just in principle, but in practice, by ending restrictions like the Hyde Amendment.

Hillary for America also challenged Trump’s proposals:

Trump Would Rip Away Health Coverage From 20 Million People And Let Insurers Write The Rules

Donald Trump would immediately work to repeal Obamacare–taking health insurance away from at least 20 million people and letting the insurance companies write the rules all over again. Trump even supported shutting down the government in order to defund Obamacare.

New York Times: “Millions of low-income people have gained coverage under the Affordable Care Act and could lost it if Congress repealed the law.”
Trump saidhe supported Republicans’ efforts to shut down the government over Obamacare and that they should have stuck together.

Trump’s “plan” would cost hundreds of billions more, and does not address people with pre-existing conditions.

CNBC: More $$$, More Uninsured: Donald Trump’s Health-Care Plan
VOX: Trump’s Plan Would Take Health Insurance Away From 21 Million People. Sad!
Bloomberg: “Trump’s proposal is silent on the subject of preventing insurers from dropping coverage for those with preexisting conditions, a feature of Obamacare that Trump has said he supports.”

Meanwhile, the Trump campaign is making hay, taking a statement that President Bill Clinton made out of context:

FACT CHECK: President Clinton And The Affordable Care Act

“Don’t believe Donald Trump when he distorts what President Clinton said about the Affordable Care Act. Bill Clinton, Hillary Clinton, Tim Kaine and President Obama all agree that we have made tremendous progress because of the Affordable Care Act, delivering coverage to 20 million people who were previously uninsured — but they agree there’s more we can do.”

Politifact: “In context, it’s also worth noting that Clinton’s actual comments never mentioned the Affordable Care Act or Obamacare. In fact, as we reviewed the transcript, we noticed that much of what Clinton said addressed issues that pre-dated the 2010 health care law, including concerns about high costs and a lack of guaranteed coverage.”

Huffington Post: “Calm Down – Bill Clinton didn’t Say Obamacare is Terrible.” “That quotation, while accurate, doesn’t fully portray Bill Clinton’s argument for keeping the Affordable Care Act ― which has extended health coverage to 20 million people and cut the uninsured rate to a historic low ― and enhancing it with policies proposed by Hillary Clinton’s campaign…Despite its characterization in the CNN report, Bill Clinton’s assessment of the health care system and the Affordable Care Act mirrors Hillary Clinton’s and Obama’s own.”

Thinkprogress: “No, Bill Clinton does not think Obamacare is ‘the craziest thing in the world.’” “in a statement sent to ThinkProgress, Angel Urena, press secretary for Bill Clinton, said the former president’s remarks are being taken out of context and emphasized that Clinton has consistently supported Obamacare.”

The bottom line is Hillary will defend and expand on the progress made under Obama Administration toward universal coverage through the Affordable Care Act, while Donald Trump would immediately work to repeal Obamacare, taking health insurance away from 20 million people – and letting the insurance companies write the rules all over again. Trump’s suggested healthcare plan would cost hundreds of billions more, and does not address people with pre-existing conditions.

Health Care

Reining in Big Pharma – or Why Capitalism Doesn’t Work With Life-Saving Drugs

September 29, 2016 krubin

How much is your child’s life worth? Big Pharma is betting it is priceless © 2016 Karen Rubin/news-photos-features.com

By Karen Rubin, News & Photo Features

How much is it worth to you to save your child’s life? $1 million? $10 million? How much is it worth it to you to have the medication that will prolong your mother’s life from Multiple Myeloma, $10,000 a month? (That’s what the medication cost.)

The issue was most recently dramatized by Mylan, the drug company that has a monopolistic control over the EpiPen syringe, and over the course of but a few years, increased the price for an item that can mean the difference between a child surviving a severe allergic response from $57 to $600 (did I mention it has a year-long shelf life?)

The cost of the actual medication, epinephrine, that can stop potentially fatal anaphylactic shock that’s in the EpiPen dispenser? $1.

It’s not just families who are held up, in much the same way as a gun-wielding robber (“Your money or your life”), but school districts, volunteer fire departments and municipalities who can face a severe budgetary crunch.

And it’s not as if Mylan hasn’t already squeezed the profit out of its drug technology – as rapidly as the price has risen, so have the salaries and bonuses paid to its executives.

The steep increase in prices started when drug company Mylan acquired the rights to the EpiPen nearly a decade ago (the company did not even invest in its development). As they hiked the prices, the salaries of their top executives skyrocketed: From 2007 to 2015, Mylan CEO Heather Bresch’s total compensation went from $2.5 million to 3,456 to $18,9 million, a mind-blowing 671% increase.

“I am a for-profit business. I am not hiding from that,” Bresch declared. Indeed, Mylan also dodges paying taxes in America, by using the insidious “inversion” loophole.

In other words, Mylan charges more because it can. Its sole aim is to maximize return for management and investors.

About 40 million Americans have severe allergies to spider bites, bee stings and foods like nuts, eggs and shellfish. Last year, more than 3.6 million U.S. prescriptions for two-packs of EpiPens were filled, earning Mylan nearly $1.7 billion.

What was Mylan’s CEO’s response to the outcry? Mylan said it would expand eligibility for patient assistance, with a $300 savings card.

Mylan is only the latest example. A year ago, the rage was focused on Martin Shkreli, the founder and former chief executive of Turing Pharmaceuticals, who raised the cost of a life-saving drug (which had been available for years from a company he acquired) from an affordable $13.70 a tablet to $750 per tablet.

Another company, Valeant Pharmaceuticals International similarly raised prices of many of its drugs exponentially, including two heart medications, Nitropress and Isuprel used to treat cardiac arrest, and another to treat Wilson’s disease, a rare genetic disorder.

The cynical way they dodge this despicable behavior is to suggest that the consumers don’t actually pay the sticker price – health insurance or Medicare Part D does, or in some cases (as the advertisements like to scream), they offer some relief to the poorest patients. But the upshot is that the rest of us (“society,” if you will) still do pay because of higher premiums. Also, because insurance premiums are so costly, people are opting for cheaper policies that have higher deductibles, so a family might be out-of-pocket to begin with until insurance kicks in.

What is more, the ones who are hurt the most are those who can least afford it: “One of the cruelties of drug pricing is that the burden falls most heavily on those least able to pay it. Uninsured patients often must pay the list price of a drug, and an increasingly large share of insured customers are being asked to pay a percentage of the list price,” writes Katie Thomas in the New York Times. She quotes Pembroke Consulting’s Adam J. Fein, “We soak the poor.”

Not to mention the “donut hole” that many seniors find themselves in. Seniors are finding their costs rising by double digits, 10% in 2015 and 12% in 2014.

There are laws against price-gouging– for food, water, gasoline. There are regulations that keep utility prices – for water, water treatment, electricity – in check, where price hikes have to be justified. Why are there no checks on drug companies, beyond public shaming (which does not seem to work).

The argument is that it costs millions, even a billion dollars and years to research, develop, test and bring a drug to market and many drugs never win approval so never make it to market at all. Well, it also costs millions, even billions, to create a utility system. What is more, taxpayers already pay for a lot of that research, funding programs through universities. (My idea is that taxpayers should be shareholders in the company and get reimbursed through a percentage of the profits on the drug.)

President Obama can use his executive authority to help break Big Pharma’s monopoly power. The FDA controls whether companies can offer alternatives to products like EpiPens, and the National Institutes of Health can prevent new ones from being granted.

Medicare should be allowed to negotiate drug prices (presently inexplicably prohibited under George W. Bush era legislation written by Big Pharma). The Centers for Medicare & Medicaid Services has proposed 6 pilot projects to test possible reforms to how prescription drugs are reimbursed and how the “value” of a drug is measured under Medicare Part B.

Meanwhile, in Congress, Senator Bernie Sanders and Rep. Elijah Cummings of Maryland have introduced bills that would authorize the Secretary of Health and Human Services to negotiate drug prices and reduce barriers to the importation of lower-cost drugs from Canada and other countries.

Another measure being floated in Congress would require a drug company to show justification for any annual price hike greater than 10% (consider that the inflation rate has been running 2%).

But in the absence of Congressional action, California is proposing The California Drug Price Relief Act, which would prohibit the state from paying more for a prescription drug than the lowest price paid for the same drug by Veterans Affairs, which already negotiates lower prices for pharmaceuticals.

“It is no surprise that the pharmaceutical industry already has dedicated $50 million to defeat this ballot initiative,” Sanders said. “Their greed has no end.”

Prices for prescription medicine in the United States soared last year more than 10 percent – the third consecutive year of double digit price increases. One out of five adults between the ages of 18 and 64 – more than 35 million Americans (that’s one out of five)– cannot afford the medications that their doctors prescribe.

Price gouging on life-saving drugs is only one glaring example of why it is an absurdity to operate the health care system as a purely capitalistic, free-market commodity – and yet, this is exactly what is presented by candidates Donald Trump, who vows to repeal Obamacare and the Libertarian Gary Johnson, who thinks that what is wrong with health care system is that there isn’t enough free market forces at work, while Green Party candidate Jill Stein, an actual doctor, has said that the science on childhood vaccinations isn’t definitive.

Hillary Clinton actually has a detailed policy prescription:

Building upon the comprehensive plan she offered earlier in the campaign last year, Clinton is calling for action to protect consumers from unjustified prescription drug price increases by companies that are marketing long-standing, life-saving treatments and face little or no competition. (See: Hillary Clinton Announces Aggressive New Plan to Address Unjustified Price Hikes in Life-Saving Drugs)

Clinton would convene representatives of Federal agencies charged with ensuring health and safety and fair competition, and create a dedicated group charged with protecting consumers from outlier price increases. They will determine an unjustified, outlier price increase based on specific criteria including: 1) the trajectory of the price increase; 2) the cost of production; and 3) the relative value to patients, among other factors that give rise to threatening public health.

Should an excessive, outlier price increase be determined for a long-standing treatment, Clinton’s plan would make new enforcement tools available including:

Making alternatives available and increasing competition: Directly intervening to make treatments available, and supporting alternative manufacturers that enter the market and increase competition, to bring down prices and spur innovation in new treatments.

Emergency importation of safe treatments: Broadening access to safe, high-quality alternatives through emergency importation from developed countries with strong safety standards.

Penalties for unjustified price increase to hold drug companies accountable and fund expanded access: Holding drug makers accountable for unjustified price increases with new penalties, such as fines – and using the funds or savings to expand access and competition.

As it is the system is designed to impede research and development into new drug treatments for ailments and diseases that would not have a big enough pay-back (for example, rarer diseases).

The Obama Administration has supported an initiative which focuses on precision medicine – that is, matching appropriate treatments to genetic make up (it’s why certain asthma treatments are less effective for African-Americans and Hispanics than Caucasians), and how certain cancer treatments (such as envisioned in Biden’s Cancer Moonshot) can be much more targeted.

The Health Care Industrial Complex, however, is not designed to prevent or cure, but prolong the stream of profits.

________________________________

© 2016 News & Photo Features Syndicate, a division of Workstyles, Inc. All rights reserved. For editorial feature and photo information, go to www.news-photos-features.com, email [email protected]. Blogging at www.dailykos.com/blogs/NewsPhotosFeatures. ‘Like’ us on facebook.com/NewsPhotoFeatures, Tweet @KarenBRubin

Election 2016, Health Care, Presidential Politics

Hillary Clinton Announces Aggressive New Plan to Address Unjustified Price Hikes in Life-Saving Drugs

September 2, 2016 krubin

Hillary Clinton announced a new plan to protect Americans from unjustified price hikes of long-available prescription drugs with limited competition, like EpiPens and pyrimethamine, the drug for a disease related to AIDS that Turing Pharmaceuticals raised the price of by more than 5,000% © 2016 Karen Rubin/news-photos-features.com

Hillary Clinton has announced a new plan to protect Americans from unjustified price hikes of long-available prescription drugs with limited competition, like EpiPens and pyrimethamine, the drug for a disease related to AIDS that Turing Pharmaceuticals raised the price of by more than 5,000%. After speaking out against excessive prices for prescription drugs throughout the campaign and, last week, calling for Mylan to lower its EpiPen price, Clinton believes that Mylan’s recent actions have not gone far enough to remedy their outrageous price increase. So today, Clinton is proposing a new set of strong tools – including a consumer protection group – that will let the government take effective action in such cases where public health is put at risk by an unjustified, outlier price increase for a treatment long available on the market with limited competition.

“Over the past year, we’ve seen far too many examples of drug companies raising prices excessively for long-standing, life-saving treatments with little or no new innovation or R&D,” Clinton said. “It’s time to move beyond talking about these price hikes and start acting to address them. All Americans deserve full access to the medications they need — without being burdened by excessive, unjustified costs. Our pharmaceutical and biotech industries are an incredible source of American innovation and revolutionary treatments for debilitating diseases. But I’m ready to hold drug companies accountable when they try to put profits ahead of patients, instead of back into research and innovation.”

Today, building off the comprehensive plan she offered earlier in the campaign last year, Clinton is calling for action to protect consumers from unjustified prescription drug price increases by companies that are marketing long-standing, life-saving treatments and face little or no competition. She’ll start by convening representatives of Federal agencies charged with ensuring health and safety, as well as fair competition, to create a dedicated group charged with protecting consumers from outlier price increases. They will determine an unjustified, outlier price increase based on specific criteria including: 1) the trajectory of the price increase; 2) the cost of production; and 3) the relative value to patients,among other factors that give rise to threatening public health.

Should an excessive, outlier price increase be determined for a long-standing treatment, Clinton’s plan would make new enforcement tools available including:

Making alternatives available and increasing competition: Directly intervening to make treatments available, and supporting alternative manufacturers that enter the market and increase competition, to bring down prices and spur innovation in new treatments.

Emergency importation of safe treatments: Broadening access to safe, high-quality alternatives through emergency importation from developed countries with strong safety standards.

Penalties for unjustified price increase to hold drug companies accountable and fund expanded access: Holding drug makers accountable for unjustified price increases with new penalties, such as fines – and using the funds or savings to expand access and competition.

Her plan will establish dedicated consumer oversight at our public health and competition agencies. They will determine an unjustified, outlier price increase based on specific criteria including: 1) the trajectory of the price increase; 2) the cost of production; and 3) the relative value to patients, among other factors that give rise to threatening public health.

In combination with her broader plan – which addresses the costs facing consumers from both long-standing and patented drugs – these new tools to address price spikes for treatments available for many years will lower the burden of prescription drug costs for all Americans.

This plan would impact the many examples we’ve seen over the past year of drug companies raising prices excessively for drugs that have been available for years – from Turing raising the price of pyrimethamine for AIDS patients by over 5,500 percent, to Mylan raising the price of the EpiPen by more than 400 percent. This is not an isolated problem: Between 2008 and 2015, drug makers increased the prices of almost 400 generic drugs by over 1,000 percent. Many of these companies are an example of a troubling trend—manufacturers that do not even develop the drug themselves, but acquire it and raise the price.

The immediate protections she is offering today build on her broader plan to lower prescription drug costs for all Americans that she released last year.

The full fact sheet is available here.

Election 2016, Health Care, Presidential Politics

Hillary Clinton Unveils New Comprehensive Mental Health Policy Agenda

August 31, 2016 krubin

This week, Hillary Clinton announced her comprehensive plan to support Americans living with mental health problems and illnesses © 2016 Karen Rubin/news-photos-features.com

This week, Hillary Clinton announced her comprehensive plan to support Americans living with mental health problems and illnesses. Recognizing that nearly a fifth of all adults in the United States — more than 40 million people — are coping with a mental health problem, Hillary’s plan will integrate the mental and physical health care systems. Her goal is that within her time in office, Americans will no longer separate mental health from physical health when it comes to access to care or quality of treatment. Hillary has been talking about mental health policy throughout her campaign, since hearing directly from American parents, students, veterans, nurses, and police officers about how these challenges keep them up at night.

According to a Fact Sheet provided by the Hillary for America campaign, Hillary will convene a White House Conference on Mental Health during her first year as President. In addition, her comprehensive agenda on mental health will:

Integrate our nation’s mental and physical health care systems so that health care delivery focuses on the “whole person,” and significantly enhance community-based treatment opportunities. Hillary’s plan will foster integration between the medical and behavioral health care systems (including mental health and addiction services), so that high-quality treatment for behavioral health is widely available in general health care settings. Hillary will expand reimbursement structures in Medicare and Medicaid for collaborative care by tasking the Center for Medicare and Medicaid Innovation to create and implement new such payment models.

Promote early diagnosis and intervention, including launching a national initiative for suicide prevention. The overall rate of suicide increased by 24 percent between 1999 and 2014, and is now at its highest level in 30 years. Hillary will direct all relevant federal agencies, including Health and Human Services, Veterans Affairs, and the Department of Education, to research and develop plans for suicide prevention in their respective settings, and create a cross-government initiative headed by the Surgeon General to coordinate these efforts. She also believes we must redouble our efforts around early screening and intervention – and that means training pediatricians, teachers, school counselors, and other service providers throughout the public health system, to identify mental health problems at an early age and recommend appropriate support.

Enforce mental health parity to the full extent of the law. The Mental Health Parity and Addiction Equity Act of 2008, which Hillary co-sponsored, requires that mental health benefits under group health plans be equal to benefits for other medical conditions, and the Affordable Care Act requires insurance plans in the individual and small group markets to offer mental health coverage as an essential health benefit. But while the right laws are on the books, they are too often ignored or not enforced. As part of her commitment to fully enforcing the mental health parity law, Hillary will launch randomized audits to detect parity violations, and increase federal enforcement. She will also enforce disclosure requirements so that insurers cannot conceal their practices for denying mental health care and strengthen federal monitoring of health insurer compliance with network adequacy requirements.

Improve criminal justice outcomes by training law enforcement officers in crisis intervention, and prioritizing treatment over jail for low-level offenders. As many as 1 in every 10 police encounters may be with individuals with some type of mental health problem, and our county jails today house more individuals with mental illness than our state and local psychiatric hospitals. She will dedicate new resources to help train law enforcement officers in responding to conflicts involving persons with mental illness, and increase grant funding to support law enforcement partnerships with mental health professionals. She will also increase investments in local programs such as specialized courts, drug courts, and veterans’ treatment courts, which send people to treatment and rehab instead of the criminal justice system, and direct the Attorney General to issue guidance to federal prosecutors, instructing them to prioritize treatment over incarceration for low-level, non-violent offenders. Finally, she will work to strengthen mental health services for incarcerated individuals and ensure continuity of care so that they get the treatment they need, which will improve outcomes for them after they reenter society and will reduce recidivism.

Improve access to housing and job opportunities. As president, Hillary will expand community-based housing opportunities for individuals with mental illness and other disabilities. Hillary will launch a joint initiative between the Departments of Housing and Urban Development (HUD) and HHS to create supportive housing opportunities for thousands of people with mental illnesses and disabilities, who currently reside in or are at risk of entering institutional settings. The employment rate for people with serious mental illness is below 20 percent, even though many of these adults want to work and more than half could succeed with appropriate job supports. Hillary will work with private employers and state and local mental health authorities to share best practices around hiring and retaining individuals with mental health problems, and in adopting supported employment programs. She’ll also expand HHS’s “Transforming Lives Through Supported Employment” program, which already assists states and communities in providing supported jobs to people with mental illness.

Invest in brain and behavioral research and developing safe and effective treatments. Hillary believes we need a pioneering, multi-sector effort to transform our knowledge of this field—from mapping the human brain to generating new insights into what drives our behavior to investing in clinical and services research to understand the interventions that work best and how to deliver them to patients. As president, Hillary will significantly increase research into brain and behavioral science research. She will provide new funding for the National Institutes of Health; build on cross-collaborative basic research efforts like the BRAIN initiative; scale up critical investments in clinical, behavioral, and services research; and integrate research portfolios with pioneering work on conditions like PTSD and traumatic brain injury already underway at DoD, the VA, and HHS. She will develop new links with the private and non-profit sectors to ensure that federal government efforts are aligned with those of other sectors to ensure that progress occurs as quickly as possible. She will also commit to brain and behavioral science research based on open data.

The full comprehensive proposal is available on HillaryClinton.com here.

Climate Action, Climate Change, Environment, Health Care

Obama Administration Fact Sheet: What Climate Change Means for Your Health and Family

April 26, 2016 krubin

Extreme weather events like Superstorm Sandy which hit Breezy Point, Queens, NY, exacerbated by climate change impact public health physically and mentally © 2016 Karen Rubin/news-photos-features.com

CDC researchers have just concluded that that the virus damages fetal development, resulting in microcephaly and other serious brain anomalies. No other mosquito-borne virus has ever caused birth defects.

That’s just the tip of the iceberg of the public health impacts already being caused by climate change. That’s because changing climate is expanding the habitat for mosquitoes that carry the Zika Virus, Lyme disease and other issues.

Delivering on another commitment in the President’s Climate Action Plan, the Obama Administration released a new final report called The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment, which significantly advances what we know about the impacts of climate change on public health, and the confidence with which we know it.

Developed over three years by 100 experts in climate-change science and public health – including representatives from the Environmental Protection Agency (EPA), the Department of Health and Human Services (HHS), the National Oceanic and Atmospheric Administration (NOAA), the National Aeronautics and Space Administration (NASA), the Department of Agriculture (USDA), and U.S. Geological Survey (USGS), the Department of Defense (DOD), and the Department of Veteran’s Affairs (VA) – the Climate and Health Assessment reinforces that climate change is a significant threat to the health of Americans not just in the future but right now. As the climate continues to change, the risks to human health will grow, exacerbating existing health threats and creating new public health challenges, and impacting more people in more places. From children to the elderly to pregnant women and the disabled, every American is vulnerable to the health impacts associated with climate change, now and in the future. A few examples of the increased health risks found in the assessment include:

 Air pollution and airborne allergens will likely increase, worsening allergy and asthma conditions. Future ozone-related human health impacts attributable to climate change are projected to lead to hundreds to thousands of premature deaths, hospital admissions, and cases of acute respiratory illnesses each year in the United States by 2030, including increases in asthma episodes and other adverse respiratory effects in children. Ragweed pollen season is longer now in central North America, having increased by as much as 11 to 27 days between 1995 and 2011, which impacts some of the nearly 6.8 million children in the United States affected by asthma and susceptible to allergens due to their immature respiratory and immune systems.

 Extreme heat can be expected to cause an increase in the number of premature deaths, from thousands to tens of thousands, each summer, which will outpace projected decreases in deaths from extreme cold. One model projected an increase, from a 1990 baseline for more than 200 American cities, of more than an additional 11,000 deaths during the summer in 2030 and more than an additional 27,000 deaths during the summer in 2100.

 Warmer winter and spring temperatures are projected to lead to earlier annual onset of Lyme disease cases in the eastern United States and a generally northward expansion of ticks capable of carrying the bacteria that cause Lyme disease. Between 2001 and 2014, both the distribution and the number of reported cases of Lyme disease increased in the Northeast and Upper Midwest.

 Increase the risks of water-related illnesses. Runoff from more frequent and intense extreme precipitation events, and increased water temperatures, will increasingly compromise recreational waters, shellfish harvesting waters, and sources of drinking water, increasing risks of waterborne illness.

 Climate change, including rising temperatures and changes in weather extremes, is expected to increase the exposure of food to certain pathogens and toxins. Rising temperature and increases in flooding, runoff events, and drought will likely lead to increases in the occurrence and transport of pathogens in agricultural environments, which will increase the risk of food contamination and human exposure to pathogens and toxins. This will increase health risks and require greater vigilance in food safety practices and regulation.

 Climate change will have the largest health impact on vulnerable populations including those with low incomes, some communities of color, limited English proficiency and immigrant groups, Indigenous peoples, children, pregnant women, older adults, vulnerable occupational groups, persons with disabilities, and persons with preexisting or chronic medical conditions.

 Extreme weather and other events related to climate change will impact health by exacerbating underlying medical conditions, increasing exposure to food-borne and waterborne illness risks, and disrupting infrastructure, including power, water, transportation, and communication systems, that are essential to maintaining access to health care and emergency response services and safeguarding human health.

In addition, the Administration has announced a number of actions to respond to the critical challenges and vulnerabilities outlined in the Climate and Health Assessment. These include:

 Expanding the scope of the President’s Task Force on Environmental Health Risks and Safety Risks to Children to focus on the impacts of climate change on children’s health.

 Developing K-12 educational materials on climate change and health.

 A Climate-Ready Tribes and Territories Initiative, which will provide awards for tribal and territorial health departments to investigate, prepare for, and adapt to the health effects of climate change.

 An update to the Sustainable and Climate Resilient Health Care Facilities Toolkit,issued by the Department of Health and Human Services.

 Designating May 23-27, 2016, as Extreme Heat Week, during which Federal agencies will take a number of actions to work with community planners and public-health officials to enhance community preparedness for extreme heat events.

The findings of the Climate and Health Assessment strengthen and broaden the scientific foundation for future decision making, allowing individuals, communities, organizations, and governments to proactively manage the health risks of climate change. A better understanding of how climate change affects our health, and the health of our children and grandchildren, underscores the need for urgent action to combat the threats climate change poses on American citizens and communities.

Already, under President Obama’s leadership, the United States has done more to combat climate change and protect the health of communities than ever before. For example, the Clean Power Plan will deliver better air quality, improved public health, clean energy investment and jobs across the country. Since the historic global climate agreement was reached at COP21 in Paris last year (signed on Earth Day at the United Nations), the United States has announced plans to not only implement the agreement to reduce greenhouse gas emissions, but has also committed to adopting an amendment to the Montreal Protocol that would phase down HFCs, a potent greenhouse gas. The Administration has forged a global agreement to cut aviation emissions, and most recently taken a series of actions to reduce methane emissions from the oil and gas sector, while also helping to spur a historic increase in wind and solar energy while doubling the fuel efficiency in our cars.

HOW CLIMATE CHANGE AFFECTS HEALTH:

KEY FINDINGS AND MESSAGES FROM THE ASSESSMENT

Changes in Extreme Heat and Extreme Cold. A warmer future is projected to lead to “on the order of thousands to tens of thousands of additional premature deaths per year across the United States by the end of this century” from heat. Any reduction in cold-related deaths is projected to be smaller than the increase in heat-related deaths in most regions. High temperatures can also lead to a wide range of illnesses. Examples of illnesses associated with extreme heat include cardiovascular, respiratory, and renal illnesses; diabetes; hyperthermia; mental health issues; and preterm births. Even small differences from seasonal average temperatures result in illness and death. An increased risk for respiratory and cardiovascular death is observed in older adults during temperature extremes.

Impacts on Air Quality. Changes in the climate affect the levels and location of outdoor air pollutants such as ground-level ozone and fine particulate matter. These changes in ozone are projected to lead to hundreds to thousands of premature deaths, hospital admissions, and cases of acute respiratory illnesses per year in the United States in 2030. In addition, the area burned by wildfires in North America is expected to increase dramatically over the 21st century due to climate change. Air pollution from wildfires can affect people far downwind from the fire location,increasing the risk of premature death and hospital and emergency department visits. Higher temperatures and increasing carbon dioxide levels also promote the growth of plants that release airborne allergens.

More Frequent and Intense Extreme Events. Climate change will expose more people to increases in the frequency and/or intensity of drought, wildfires, and flooding related to extreme precipitation and hurricanes. Many types of extreme events related to climate change cause disruption of critical infrastructure, including power, water, transportation, and communication systems, that are essential to maintaining access to health care and emergency response services and safeguarding human health. Health risks may also arise long after the event, or in places outside the area where the event took place, particularly if multiple events occur simultaneously or in succession in a given location – this could be the result of damage to property, destruction of assets, loss of infrastructure and public services, social and economic disruption, and environmental degradation. Poverty also is a key risk factor, and the poor are disproportionately affected by extreme events.

Altered Timing and Location of Vector-Borne Disease. Climate change is expected to alter the geographic and seasonal distributions of existing vectors and vector-borne diseases, such as Lyme disease, West Nile virus infections, and other diseases spread by vectors like mosquitoes. Rising temperatures, changing precipitation patterns, and a higher frequency of some extreme weather events associated with climate change will influence the distribution, abundance, and prevalence of infection in the mosquitoes that transmit West Nile virus, the leading cause of mosquito-borne disease in the United States. Outdoor workers are at a greater risk for contracting Lyme disease and, if working in areas where there are infected mosquitoes, occupational exposures can also occur for West Nile virus.

Increased Risks of Water-Related Illnesses. Runoff from more frequent and intense extreme precipitation events will increasingly compromise recreational waters, shellfish harvesting waters, and sources of drinking water, increasing the risk that infrastructure for drinking water, wastewater, and stormwater will fail due to either damage or exceeding system capacity. Although the United States has one of the safest municipal drinking water supplies in the world, water-related outbreaks still occur—between 1948 and 1994, 68 percent of waterborne disease outbreaks in the United States were preceded by extreme precipitation events. Inequities in exposure to contaminated water disproportionately affects tribes and Alaska Natives, residents of low-income rural subdivisions along the U.S.–Mexico border, migrant farm workers, the homeless, and low-income communities not served by public water utilities—some of which are predominately Hispanic or Latino and African-American communities.

Increased Threats to Food Safety and Nutrition. As climate change drives changes in environmental variables, such as ambient temperature, precipitation, and weather extremes (particularly flooding and drought), increases in foodborne illnesses are expected. In the United States, the Centers for Disease Control and Prevention (CDC) estimate that there are 48 million cases of foodborne illnesses per year, with approximately 3,000 deaths. Rising levels of carbon dioxide in the atmosphere can actually lower the nutritional value of most food crops. Climate-change impacts on food production, food processing and utilization, food prices, and agricultural trade were recently addressed in a separate assessment report on Climate Change, Global Food Security, and the U.S. Food System.

Adverse Impacts on Mental Health. The cumulative and interactive effects of climate change, as well as the threat and perception of climate change, adversely impact individual and societal physical and mental health and well-being. Mental health consequences of climate change range from minimal stress and distress symptoms to clinical disorders, such as anxiety, depression, post-traumatic stress, and suicidal thoughts and behaviors. The mental health impacts of extreme events, such as hurricanes, floods, and drought, can be expected to increase as more people experience the stress—and often trauma—of these disasters. People with mental illness and those using medications to treat a variety of mental health conditions such as depression, anxiety, and other mood disorders are particularly vulnerable to extreme weather events and extreme heat.

Disproportionate Effects on Vulnerable Populations. Every American is vulnerable to the health impacts associated with climate change. People at every life stage have varying sensitivity to climate change impacts. The most vulnerable populations include individuals with low income, some communities of color, individuals with limited English proficiency and immigrant groups, Indigenous peoples, children, pregnant women, older adults, vulnerable occupational groups, persons with disabilities, and persons with preexisting or chronic medical conditions.

Communities of Color, Low Income, Immigrants, and Limited-English-Proficiency Groups. Vulnerable populations are at increased risk of exposure given their higher likelihood of living in risk-prone areas (such as urban heat islands, isolated rural areas, or coastal and other flood-prone areas), areas with older or poorly maintained infrastructure, or areas with an increased burden of air pollution. Communities of color, low income, immigrant and limited-English-proficiency groups also experience relatively greater incidence of chronic medical conditions, such as cardiovascular and kidney disease, diabetes, asthma, and chronic obstructive pulmonary disease (COPD), which can be exacerbated by climate-related health impacts.
Indigenous Peoples in the United States. Because of existing vulnerabilities, Indigenous people, especially those who are dependent on the environment for sustenance or who live in geographically isolated or impoverished communities, are likely to experience greater exposure and lower resilience to climate-related health effects.
Pregnant Women. Climate-related exposures may lead to adverse pregnancy and newborn health outcomes, including low birth weight, preterm birth, dehydration and associated renal failure, diarrhea, and respiratory disease. Estimates indicated that there were more than 56,000 pregnant women and nearly 75,000 infants directly affected by Hurricane Katrina and that pregnant women with high hurricane exposure and severe hurricane experiences were at a significantly increased risk for post-traumatic stress disorder (PTSD) and depression.
 Children. Climate change—interacting with factors such as economic status, diet, living situation, and stage of development—will increase children’s exposure to health threats. Children are vulnerable to adverse health effects associated with environmental exposures due to factors related to their immature physiology and metabolism, their unique exposure pathways, their biological sensitivities, and limits to their adaptive capacity. Children have a proportionately higher intake of air, food, and water relative to their body weight compared to adults. They also share unique behaviors and interactions with their environment that may increase their exposure to environmental contaminants.
Older Adults. The nation’s older adult population (ages 65 and older) will nearly double in size from 2015 through 2050. Between 1979 and 2004, deaths from heat exposure were reported most commonly among adults aged 65 and older. The need to evacuate an area during or after extreme events can pose increased health and safety risks for older adults, especially those who are poor or reside in nursing or assisted-living facilities. Air pollution can also exacerbate asthma and COPD and can increase the risk of heart attack in older adults, especially those who are also diabetic or obese.
Occupational Groups. Outdoor workers are often among the first to be exposed to the effects of climate change. Climate change is expected to affect the health of outdoor workers through increases in ambient temperature, degraded air quality, extreme weather, vector-borne diseases, industrial exposures, and changes in the built environment. An increased need for complex emergency responses will expose rescue and recovery workers to physical and psychological hazards. The incidence of heat illness among active duty U.S. military personnel is several-fold higher than the summertime incidence in the general U.S. population (147 per 100,000 among the military versus 21.5 per 100,000 in the general population per year)
Persons with Disabilities. An increase in extreme weather can be expected to disproportionately affect populations with disabilities, who experience higher rates of social risk factors—such as poverty and lower educational attainment—that contribute to poorer health outcomes during extreme events or climate-related emergencies. Persons with disabilities often rely on medical equipment (such as portable oxygen) that requires an uninterrupted source of electricity.
Persons with Chronic Medical Conditions. Preexisting medical conditions present risk factors for increased illness and death associated with climate-related stressors, especially exposure to extreme heat. Hospital admissions and emergency room visits increase during heat waves for people with diabetes, cardiovascular diseases, respiratory diseases, and psychiatric illnesses. Medical conditions like Alzheimer’s disease or mental illnesses can impair judgment and behavioral responses in crisis situations, which can place people with those conditions at greater risk.

NEW ADMINISTRATION ACTIONS RESPONDING TO THE

CLIMATE AND HEATH ASSESSMENT

President Obama has already taken action to combat the health impacts of climate change and protect the health of future generations. Just last year, the Administration:

 Brought together health and medical professionals, academics, and other interested stakeholders to discuss the challenges of climate change for public health through a series of convenings, workshops, and a formal White House Climate Change and Health Summit;

 Expanded access to climate and health data, involving more than 100 health-relevant datasets, to spur innovation so that communities and businesses could act to reduce the health impacts of climate change;

 Started integrating climate considerations into agency health and safety policies; and

 Created initiatives at EPA, USGS, CDC, and the Department of Defense to improve, consolidate, and better visualize data connecting climate change effects to human health.

The Administration has announced a series of additional actions to keep us on track to better understand, communicate, and reduce the health impacts of climate change on our communities, including:

 President’s Task Force on Environmental Health Risks and Safety Risks to Children Addresses Climate Change. The President’s Task Force on Environmental Health Risks and Safety Risks to Children, has expanded its scope to include climate change. The Task Force includes representatives of 17 federal departments and White House offices and focuses on environmental threats to the health and wellbeing of children that are best addressed through interagency efforts. Its priorities are asthma disparities, healthy settings, chemical exposures, and climate change and children’s health. The Task Force has made available examples of actions being taken around the country to protect children from the impacts of climate change on HHS’s new climate and health website at http://www.hhs.gov/climate/childrenshealth/index.html.

 Developing a Climate-Ready Tribes and Territories Initiative. This year, CDC’s Climate and Health Program will launch the Climate-Ready Tribes and Territories Initiative, which will provide awards for up to five tribal and territorial health departments in the U.S to support public health preparedness and resilience activities that address the health challenges of climate change in these areas. Although some state and city health departments receive guidance and funding for climate and health research and adaptation planning, no similar program has been available to assist tribal and territorial governments. CDC will work with stakeholders to develop guidance relevant to the unique challenges faced in these jurisdictions. CDC will use its disease prevention expertise to assist tribal and territorial governments in investigating, preparing for, and adapting to the health effects of climate change.

 Updating the Sustainable and Climate Resilient Health Care Facilities Toolkit.The Toolkit is undergoing pilot testing and evaluation and will be revised and expanded by the end of the year. In addition, lectures and trainings on the toolkit are being planned for a series of major conferences this year, including the NACCHO Preparedness Summit, the meeting of the American Society for Healthcare Engineering, and the CleanMed Conference. Also planned is a series of training webinars for the private sector on how to use of the toolkit by Practice Greenhealth.

 National Institute of Environmental Health Sciences (NIEHS) to Develop K-12 Educational Materials on Climate Change and Health. NIEHS is developing educational materials on climate change and health at the K-12 level based on the new Climate and Health Assessment. They will partner with the National Oceanic and Atmospheric Administration and the American Meteorological Society to help disseminate the materials and offer training. The audience for training is teachers and “train the trainer” teacher experts. The training is expected to be piloted this fall.

 Reducing the Health Impacts of Extreme Heat. The Administration is announcing that May 23 – 27 is Extreme Heat Week during which agencies will take a number of activities to prepare the nation for extreme heat. This week is a key part of America’s PrepareAthon!, the Administration’s seasonal campaign to build community-level preparedness action. The White House is planning a webinar during Extreme Heat Week focused on education and outreach to populations more vulnerable to extreme heat as well as to community planners and public health officials to enhance community preparedness to extreme heat events.

Election 2016, Health Care, Politics, Presidential Politics, Social Security, Supreme Court, Women's Rights

Brooklyn Brawl: Democrats Clinton & Sanders Debate Universal Health Care, Social Security, Supreme Court & Women’s Reproductive Rights

April 16, 2016 krubin

Democratic Presidential Candidates Hillary Clinton and Bernie Sanders meet for a debate moderated by CNN at the Brooklyn Navy Yard in Brooklyn, ahead of the April 19 New York State primary © 2016 Karen Rubin/news-photos-features.com

Ahead of the April 19 New York State Primary, the gloves came off between the two contenders for the Democratic presidential nomination, former Secretary of State and New York Senator Hillary Clinton and Vermont Senator Bernie Sanders, at what is being called “The Brooklyn Brawl” – the Democratic Debate at the Brooklyn Navy Yard.

The confrontation was the most contentious to date, but still substantive with both candidates making strong arguments on major issues.

Here are annotated highlights from the “Brooklyn Brawl” – the debate between Democratic contenders for the nomination for president, former Secretary of State and New York State Senator Hillary Clinton and Vermont Senator Bernie Sanders, based on a transcript provided by CNN, the news organization that hosted the debate, April 14.

In this section, the candidates debate universal health care, free college, the US Supreme Court, and for the first time in all the debates, what the Supreme Court means for women’s reproductive rights.

Universal Health Care, Free College, Supreme Court

Senator Sanders, you’re promising health care and free college for all, and those plans would be met with both political and practical challenges. The nonpartisan Committee for a Responsible Federal Budget says your initiatives would cost up to $28 trillion and, even after massive tax increases, that would add as much as $15 trillion to the national debt. How is this fiscally responsible?

SANDERS: Well, first of all, I disagree with that study. There are many economists who come up with very, very different numbers.

For example, we are the only country, major country on Earth, that does not guarantee health care to all people, and yet we end up spending almost three times what the British do, 50 percent more than the French. My proposal, a Medicare-for-all, single-payer program, will save (APPLAUSE) will save middle-class families many thousands of dollars a year in their health care costs. Public colleges and universities tuition free? Damn right. That is exactly what we should be doing. (APPLAUSE)

“And I’d pay for that — I’d pay for that by telling Wall Street that, yeah, we are going to have a tax on Wall Street speculation, which will bring in more than enough money to provide free tuition at public colleges and universities and lower the outrageous level of student debt.

“Wolf, we have seen in the last 30 years a massive transfer of wealth from the middle class to the top 0.1 percent. The establishment does not like this idea, but, yes, I am determined to transfer that money back to the working families of this country. (APPLAUSE)

Former Secretary of State and NYS Senator Hillary Clinton © 2016 Karen Rubin/news-photos-features.com

CLINTON: Well, again — again, I absolutely agree with the diagnosis, the diagnosis that we’ve got to do much more to finish the work of getting universal health care coverage, something that I’ve worked on for 25 years. Before there was something called Obamacare, there was something called Hillarycare. And we’re now at 90 percent of coverage; I’m going to get us to 100 percent.

“And with respect to college, I think we have to make college affordable. We are pricing out middle-class, working, and poor families. There’s no doubt about that.

But I do think when you make proposals and you’re running for president, you should be held accountable for whether or not the numbers add up and whether or not the plans (APPLAUSE) are actually going to work.

“And just very briefly, on health care, most of the people who have analyzed what Senator Sanders put out — remember, he had a plan for about, I don’t know, 18, 20 years. He changed in the middle of this campaign. He put out another plan. People have been analyzing the new plan. And there is no doubt by those who have analyzed it, progressive economists, health economists, and the like, that it would pose an incredible burden, not just on the budget, but on individuals. In fact, the Washington Post called it a train-wreck for the poor. A working woman on Medicaid who already has health insurance would be expected to pay about $2,300.

“The same for free college. The free college offer — you know, my late father said, if somebody promises you something for free, read the fine print. You read the fine print, and here’s what it says.

“The fine print says this, that it will — the federal government will cover two-thirds of the cost and require the states, even those led by Republican governors to carry out what the remaining one-third of the cost.”

SANDERS: We are not a country that has the courage to stand up to big money and do what has to be done for the working families of the country. (APPLAUSE)

CLINTON: We have a difference of opinion. We both want to get to universal health care coverage. I did stand up to the special interests and the powerful forces, the health insurance companies and the drug companies. (APPLAUSE)

“And perhaps that’s why I am so much in favor of supporting President Obama’s signature accomplishment with the Affordable Care Act, because I know how hard it was to get that passed, even with a Democratic Congress. So rather than letting the Republicans repeal it or rather starting all over again, trying to throw the country into another really contentious debate, let’s make the Affordable Care Act work for everybody let’s get to 100 percent coverage, let’s get the cost down, and let’s guarantee health care.”

Social Security

BLITZER: Secretary, let’s talk about Social Security, another critically important issue. Senator Sanders has challenged you to give a clear answer when it comes to extending the life of Social Security and expanding benefits. Are you prepared to lift the cap on taxable income, which currently stands at $118,500? Yes or no, would you lift the cap?

CLINTON: I have said repeatedly, Wolf, I am going to make the wealthy pay into Social Security to extend the Social Security Trust Fund. That is one way. If that is the way that we pursue, I will follow that.

“But there are other ways. We should be looking at taxing passive income by wealthy people. We should be looking at taxing all of their investment.

“But here’s the real issue, because I — I’ve heard this, I’ve seen the reports of it. I have said from the very beginning, we are going to protect Social Security. I was one of the leaders in the fight against Bush when he was trying to privatize Social Security.

“But we also, in addition to extending the Trust Fund, which I am absolutely determined to do, we’ve got to help people who are not being taken care of now. And because Social Security started in the 1930s, a lot of women have been left out and left behind.

“And it’s time that we provide more benefits for widows, divorcees, for caregivers, for women who deserve more from the Social Security system and that will be my highest priority.” (APPLAUSE)

Vermont Senator Bernie Sanders © 2016 Karen Rubin/news-photos-features.com

SANDERS: Now, we’ve got — here is the issue. Your answer has been the same year after year. In fact, the idea that I’m bringing forth, I have to admit it, you know, it wasn’t my idea. It was Barack Obama’s idea in 2008, the exact same idea. (APPLAUSE)

“He called for lifting the cap, which is now higher — it’s at 118 — and starting at 250 and going on up. If you do that, you’re going to extend the life of Social Security for 58 years. You will significantly expand benefits by 1,300 bucks a year for seniors and disabled vets under $16,000 a year. What’s wrong with that? Are you prepared to support it?

CLINTON: I have supported it. You know, we are in vigorous agreement here, Senator.

‘You know, we’re having a discussion about the best way to raise money from wealthy people to extend the Social Security Trust Fund. Think about what the other side wants to do. They’re calling Social Security a Ponzi scheme. They still want to privatize it. In fact, their whole idea is to turn over the Social Security Trust Fund to Wall Street, something you and I would never let happen.

“I’ve said the same thing for years. I didn’t say anything different tonight. We are going to extend the Social Security Trust Fund. There is still something called Congress. Now, I happen to support Democrats and I want to get Democrats to take back the majority in the United States Senate so a lot of — a lot of what we’re talking about can actually be implemented when I am president.”

SANDERS: — maybe I’m a little bit confused.

“Are you or are you not supporting legislation to lift the cap on taxable income and expand Social Security for 58 years and increase benefits…”

CLINTON: I am…

SANDERS: — yes or no?

CLINTON: I have said yes, we are going to pick the best way or combination…

SANDERS: Oh, you — ah. (APPLAUSE) (BOOS)

SANDERS: OK.

CLINTON: — or combination of ways… (BOOS)

CLINTON: — you know… (BOOS)

CLINTON: — it — it’s all — it’s always a little bit, uh, challenging because, you know, if Senator Sanders doesn’t agree with how you are approaching something, then you are a member of the establishment. Well, let me say then…

SANDERS: Well, look (APPLAUSE)

CLINTON: — let me say this (APPLAUSE)

CLINTON: — we are going to extend the Social Security Trust Fund. We’ve got some good ideas to do it. Let’s get a Congress elected that will actually agree with us in doing it.

SANDERS: Yes, Secretary Clinton (CROSSTALK) you are a member of the establishment.

Supreme Court

Secretary Clinton, regarding President Obama’s nomination of Merrick Garland to the Supreme Court. President Obama said earlier this week that he would not withdraw the nomination, even after the presidential election. If elected, would you ask the president to withdraw the nomination?

CLINTON: I am not going to contradict the president’s strategy on this. And I’m not going to engage in hypotheticals. I fully support the president. (APPLAUSE)

“And I believe that the president — the president is on the right side of both the Constitution and history. And the Senate needs to immediately begin to respond. So I’m going to support the president. When I am president, I will take stock of where we are and move from there.”

SANDERS: Well, there is no question. I mean, it really is an outrage. And it just continues, the seven-and-a-half years of unbelievable obstructionism we have seen from these right-wing Republicans.

“I mean, a third-grader in America understands the president of the United States has the right to nominate individuals to the U.S. Supreme Court. Apparently everybody understands that except the Republicans in Congress.

LOUIS: So, Senator Sanders, would you ask him to withdraw the nomination?

SANDERS: Yes, but here is the point, and obviously i will strongly support that nomination as a member of the Senate. But, if elected president, I would ask the president to withdraw that nomination because I think — I think this.

“I think that we need a Supreme Court justice who will make it crystal clear, and this nominee has not yet done that, crystal clear that he or she will vote to overturn Citizens United and make sure that American democracy is not undermined.” (APPLAUSE)

CLINTON: You know, there is no doubt that the only people that I would ever appoint to the Supreme Court are people who believe that Roe V. Wade is settled law and Citizens United needs to be overturned.

“And I want to say something about this since we’re talking about the Supreme Court and what’s at stake. We’ve had eight debates before, this is our ninth. We’ve not had one question about a woman’s right to make her own decisions about reproductive health care, not one question. (APPLAUSE)

“And in the meantime we have states, governors doing everything they can to restrict women’s rights. We have a presidential candidate by the name of Donald Trump saying that women should be punished. And we are never asked about this.

“And to be complete in my concern, Senator Sanders says with respect to Trump it was a distraction. I don’t think it’s a distraction. It goes to the heart of who we are as women, our rights, our autonomy, our ability to make our own decisions, and we need to be talking about that and defending Planned Parenthood from these outrageous attacks.”

SANDERS: You’re looking at a senator and former congressman who proudly has a 100 percent pro-choice voting record, who will take on those Republican governors who are trying to restrict a woman’s right to choose, who will take on those governors right now who are discriminating outrageously against the LGBT community, who comes from a state which led the effort for gay marriage in this country, proudly so. (APPLAUSE) Who not only thinks we are not going to — not defund Planned Parenthood, we’ve got to expand funding for Planned Parenthood. (APPLAUSE)

Brooklyn Brawl: Democrats Clinton & Sanders Debate Gun Violence & Criminal Justice

Brooklyn Brawl: Democrats Clinton & Sanders Debate Climate Change, Energy & Environment

Brooklyn Brawl: Democrats Clinton & Sanders Debate National Security & Foreign Policy

Brooklyn Brawl: Democrats Clinton & Sanders Debate US-Israel Relations

______________________________________
© 2016 News & Photo Features Syndicate, a division of Workstyles, Inc. All rights reserved. For editorial feature and photo information, email [email protected]. ‘Like’ us on facebook.com/NewsPhotoFeatures, Tweet @KarenBRubin

Health Care, President Obama

The Affordable Care Act: Healthy Communities Six Years Later

March 3, 2016 krubin

The Affordable Care Act made it possible for young people, striking out on their own with their own entrepreneurial enterprises, to get affordable health insurance © 2016 Karen Rubin/news-photos-features.com

I’m so sick of Republicans, especially those who would be President and promise to repeal every word of the Affordable Care Act, lying about how Obamacare has harmed jobs creation, and destroyed American freedom. Such a crock. The White House has just issued a fact sheet appraising the Affordable Care Act six years after. Republicans are a fact-free zone, but here are the facts:

FACT SHEET: The Affordable Care Act: Healthy Communities Six Years Later

President Obama promised that he would make quality, affordable health care not a privilege, but a right. After nearly 100 years of talk and decades of trying by presidents of both parties, that’s exactly what he did.

On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law, putting in place comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. Because of the ACA, 17.6 million previously uninsured people had gained coverage prior to this year’s open enrollment period, and the law has driven the uninsured rate below 10 percent for the first time since we started keeping records. The ability to buy portable and affordable plans on a competitive marketplace is giving Americans the freedom to move, leave an unsatisfying job and start businesses which is especially important as more consumers become entrepreneurs. And thanks in part to the law’s focus on reducing costs and inefficiencies, health care prices have risen at the slowest rate in 50 years since the law passed, which will benefit all of us for years to come.

These access gains are due in large part to the efforts of local and state elected officials, community organizations and leaders, and volunteers who have worked tirelessly to help their neighbors find access to quality, affordable coverage. During the most recent open enrollment period from November 1 through January 31, the Administration and its partners on the ground nationwide undertook an unprecedented local and regional effort to sign up the remaining uninsured who are eligible for Marketplace coverage.

As part of this effort, the White House launched its “Healthy Communities Challenge” to engage 20 key communities with large numbers or high percentages of uninsured in states across the country where strong federal, state, and community collaboration can have a meaningful impact on reaching the uninsured. Last month, the White House announced that the winner of the challenge is Milwaukee, Wisconsin. Under the leadership of Mayor Tom Barrett and County Executive Chris Abele, about 38,000 people in the Milwaukee area newly selected a plan through the Health Insurance Marketplace during this open enrollment period. Together with returning Marketplace consumers, about 89,000 people in the Milwaukee area selected a 2016 Marketplace plan. Nationwide, nearly 13 million Americans signed up for 2016 Marketplace coverage, including people who were previously uninsured, as well as Americans finding coverage as they go through changes in life such as being in between jobs or aging off their parents’ plans.

Because of the Affordable Care Act, This is What Health Care in America Looks Like Today:

17.6 million consumers have gained health insurance thanks to the ACA, prior to this year’s open enrollment period. From 2010 through the first nine months of 2015, the uninsured rate has fallen by more than 40 percent and, for the first time ever, more than 9 in 10 Americans now have health insurance. In Wisconsin, Gallup recently estimated that the adult uninsured rate in 2015 was 5.9 percent, down from 11.7 percent in 2013.
As many as 129 million Americans who have some type of pre-existing health condition, including up to 19 million children, are now protected from coverage denials and reduced benefits – practices that were routine before the law’s enactment.
105 million Americans, including 39.5 million women and nearly 28 million children, have benefited from annual limits on out-of-pocket spending on essential health benefits – and the elimination of lifetime and annual limits on insurance coverage. These are protections that did not exist before the ACA.
Americans now have access to critical preventive services at no cost, like flu shots, yearly check-ups, and birth control. These are benefits that did not exist before the ACA.
Over 14 million more Americans have received coverage through Medicaid since the ACA’s first open enrollment period in 2013. States have an option to expand Medicaid to all non-eligible adults with incomes under 133 percent of the federal poverty level, and to date, 31 states and the District of Columbia have chosen to expand the program. In these states that have already expanded Medicaid, 4.4 million uninsured people will gain coverage. If the remaining states expand Medicaid, over 4 million more uninsured people would gain coverage.
The ACA has provided new transparency in how health insurance plans disclose reasons for premium increases and requires simple, standardized summaries so over 170 million Americans can better understand their coverage information and compare plans. These consumer protections did not exist six years ago.
2.3 million young Americans gained coverage between 2010 and October 2013 because they could now stay covered on their parents’ health care plans until they turn 26 – a benefit that did not exist before the law.
The ACA created tax credits that, as of September 2015, have helped 7.8 million Americans who otherwise often could not afford it purchase health coverage through the Health Insurance Marketplaces.
Health insurers are now required to provide consumers with rebates if the amount they spend on health benefits and quality of care, as opposed to advertising and marketing, is too low. Last year, 5.5 million consumers received nearly $470 million in rebates. Since this requirement was put in place in 2011 through 2014, more than $2.4 billion in total refunds will have been paid to consumers.
Out-of-pocket costs have been eliminated for preventive services like immunizations, certain cancer screenings, contraception, reproductive counseling, obesity screening, and behavioral assessments for children. This coverage is guaranteed for more than 137 million Americans, including 55 million women.
Out-of-pocket costs have been eliminated for 39 million Medicare beneficiaries for preventive services like cancer screenings, bone-mass measurements, annual physicals, and smoking cessation.
The ACA expands mental health and substance use disorder benefits and parity protections to over 60 million Americans.
The ACA phases out the “donut hole” coverage gap for nearly10.7 million Medicare prescription drug beneficiaries, who have saved an average of $1,945 per beneficiary.
Accountable Care Organizations now exist, consisting of doctors and other health-care providers who come together to provide coordinated, high-quality care at lower costs to their Medicare patients. Over 477 ACOs are serving nearly 8.9 million Medicare beneficiaries nationwide.
Overpayments through the Medicare Advantage system have been phased out, while Medicare Advantage plans are required to spend at least 85 percent of Medicare revenue on patient care. Medicare Advantage enrollment has grown by 50 percent to over17.1 million while premiums have dropped by 10 percent since 2009.
Hospitals in Medicare now receive incentives to reduce hospital-acquired infections and avoidable readmissions. A collaborative health-safety learning network, the Partnership for Patients, includes more than 3,200 hospitals to promote best quality practices.

In addition, other legislation and executive actions build on this progress and advance the cause of effective, affordable and accountable health care. This includes:

Advancing innovative care delivery models and value-based payments in Medicare and Medicaid. The Administration set ambitious goals of tying 30 percent of traditional Medicare payments to alternative payment models by the end of 2016 and 50 percent by the end of 2018.
Proposals to invest in targeted research and technologies to advance the BRAIN Initiative, Precision Medicine Initiative, and cancer research.
A funding pool for Community Health Centers to build, expand and operate health-care facilities in underserved communities. Health Center grantees served 23 million patients in 2014 and received $11 billion under the health care law to offer a broader array of primary care services, extend their hours of operations, hire more providers, and renovate or build new clinical spaces.
Health provider training opportunities, with an emphasis on primary care, including a significant expansion of the National Health Service Corps. As of September 30, 2015, there were 9,600Corps clinicians providing primary care services, compared to 3,600 clinicians in 2008.

To learn more about the Healthy Communities challenges, visit: https://www.whitehouse.gov/the-press-office/2016/02/12/fact-sheet-announcing-winner-healthy-communities-challenge. For more on the President’s overall record on providing quality, affordable health care for Americans, visit: https://www.whitehouse.gov/the-record/health-care.

Health Care, Homeland Security

White House Issues Fact Sheet on Administration’s Efforts to Respond to Zika Virus

February 26, 2016 krubin

The White House has issued a Fact Sheet: Preparing for and Responding to the Zika Virus at Home and Abroad:

Since late last year, the Administration has been aggressively working to combat Zika, a virus primarily spread by mosquitoes that has recently been linked to birth defects and other concerning health outcomes. The Federal Government has been monitoring the Zika virus and working with our domestic and international public health partners to alert healthcare providers and the public about Zika; provide public health laboratories with diagnostic tests; and detect and report cases both domestically and internationally.

The Administration is taking every appropriate measure to protect the American people, and today announced that it is asking Congress for more than $1.8 billion in emergency funding to enhance our ongoing efforts to prepare for and respond to the Zika virus, both domestically and internationally. The Administration will submit a formal request to Congress shortly.

The Pan American Health Organization reports 26 countries and territories in the Americas with local Zika transmission. While we have not yet seen transmission of the Zika virus by mosquitoes within the continental United States, Puerto Rico and other U.S. territories in warmer areas with Aedes aegpyti mosquito populations are already seeing active transmission. In addition, some Americans have returned to the continental U.S. from affected countries in South America, Central America, the Caribbean and the Pacific Islands with Zika infections. The Centers for Disease Control and Prevention reports 50 laboratory-confirmed cases among U.S. travelers from December 2015- February 5, 2016. As spring and summer approach, bringing with them larger and more active mosquito populations, we must be fully prepared to mitigate and quickly address local transmission within the continental U.S., particularly in the Southern United States.

The requested resources will build on our ongoing preparedness efforts and will support essential strategies to combat this virus, such as rapidly expanding mosquito control programs; accelerating vaccine research and diagnostic development; enabling the testing and procurement of vaccines and diagnostics; educating health care providers, pregnant women and their partners; improving epidemiology and expanding laboratory and diagnostic testing capacity; improving health services and supports for low-income pregnant women, and enhancing the ability of Zika-affected countries to better combat mosquitoes and control transmission.

There is much that we do not yet know about Zika and its relationship to the poor health outcomes that are being reported in Zika-affected areas. We must work aggressively to investigate these outbreaks, and mitigate, to the best extent possible, the spread of the virus. Congressional action on the Administration’s request will accelerate our ability to prevent, detect and respond to the Zika virus and bolster our ability to reduce the potential for future infectious disease outbreaks.

Department of Health and Human Services – $1.48 billion

Centers for Disease Control and Prevention – $828 million. The request includes funding to support prevention and response strategies through the following activities:

· Support Zika virus readiness and response capacity in States and territories with mosquito populations that are known to transmit Zika virus, with a priority focus on areas with ongoing Zika transmission;

· Enhance mosquito control programs through enhanced laboratory, epidemiology and surveillance capacity in at-risk areas to reduce the opportunities for Zika transmission;

· Establish rapid response teams to limit potential clusters of Zika virus in the United States;

· Improve laboratory capacity and infrastructure to test for Zika virus and other infectious diseases;

· Implement surveillance efforts to track Zika virus in communities and in mosquitoes;

· Deploy targeted prevention and education strategies with key populations, including pregnant women, their partners, and health care professionals;

· Expand the CDC Pregnancy Risk Assessment Monitoring System, improve Guillain Barré syndrome tracking, and ensure the ability of birth defect registries across the country to detect risks related to Zika;

· Increase research into the link between Zika virus infections and the birth defect microcephaly and measure changes in incidence rates over time;

· Enhance international capacity for virus surveillance, expand the Field Epidemiology Training program, laboratory testing, health care provider training, and vector surveillance and control in countries at highest risk of Zika virus outbreaks; and

· Improve diagnostics for Zika virus, including advanced methods to refine tests, and support advanced developments for vector control.

Centers for Medicare and Medicaid Services – $250 million. The request seeks a temporary one-year increase in Puerto Rico’s Medicaid Federal Medical Assistance Percentage (FMAP) to provide an estimated $250 million in additional Federal assistance to support health services for pregnant women at risk of infection or diagnosed with Zika virus and for children with microcephaly, and other health care costs. This request does not make any changes to Puerto Rico’s underlying Medicaid program, and the additional funding will not be counted towards Puerto Rico’s current Medicaid allotment. Puerto Rico is experiencing ongoing active transmission of Zika. Unlike States, Puerto Rico’s Medicaid funding is capped, which has limited capacity to respond to these emergent and growing health needs.

Vaccine Research and Diagnostic Development & Procurement – $200 million. The request includes $200 million for research, rapid advanced development and commercialization of new vaccines and diagnostic tests for Zika virus. It includes funding for the National Institutes of Health to build upon existing resources and work to develop a vaccine for Zika virus and the chikungunya virus, which is spread by the same type of mosquito. Funding will accelerate this work and improve scientific understanding of the disease to inform the development of additional tools to combat it. The request also includes resources for the Food and Drug Administration to support Zika virus medical product development including the next generation diagnostic devices.

Other HHS Response Activities – $210 million. The request includes funding to establish a new Urgent and Emerging Threat Fund to address Zika virus and other outbreaks. This funding would be available to support emerging needs related to Zika, including additional support to States for emerging public health response needs should mosquito populations known to be potential Zika carriers migrate to additional States.

In addition, the request includes funding to support Puerto Rico’s community health centers in preventing, screening, and treating the Zika virus, expand home visiting services targeting low-income pregnant women at risk of Zika virus, and provide targeted maternal and child health.

U.S. Agency for International Development – $335 million

The request includes investments to support affected countries’ ability to control mosquitoes and the transmission of the virus; support maternal health; expand public education on prevention and response; and create new incentives for the development of vaccines and diagnostics. The request would also provide flexibility in the use of remaining USAID Ebola funds. Activities would focus particularly on South America, Central America, the Caribbean, and would:

· Implement integrated vector management activities in countries at-risk of Zika virus;

· Stimulate private sector research and development of vaccines, diagnostics, and vector control innovations through public private partnerships and mechanisms to provide incentives such as advance market commitments or volume guarantees;

· Support training of health care workers in affected countries, including providing information about best practices for supporting children with microcephaly;

· Support for pregnant women’s health, including helping them access repellant to protect against mosquitos.

· Establish education campaigns to empower communities in affected countries to take actions to protect themselves from Zika Virus as well as other mosquito-borne diseases; and

· Issue a Global Health Security Grand Challenge calling for groundbreaking innovations in diagnostics, vector control, personal protection, community engagement and surveillance for Zika and other infectious diseases.

U.S. Department of State – $41 million

The funding request includes support for U.S. citizens in affected countries, medical support for State Department employees in affected countries, public diplomacy, communications, and other operations activities. State would also support the World Health Organization and its regional arm, the Pan American Health Organization (PAHO), to minimize the Zika threat in affected countries while reducing the risk of further spreading the virus. These resources will support critical public health actions underway, including preparedness, surveillance, data collection, and risk communication. Activities would also include support for UNICEF’s Zika response efforts in Brazil; activities to bolster diagnostic capabilities through deployment of equipment and specialized training.

For more information on the Zika virus and CDC guidance about how Americans can protect themselves, visit http://www.cdc.gov/zika/.

Election 2016, Health Care, Presidential Politics

Hillary Clinton Pledges $2 Billion a Year Investment in Alzheimer’s Research to Make Cure Possible by 2025

December 22, 2015 krubin

Hillary Clinton with Chelsea Clinton and Melinda Gates. Senator Clinton is proposing to spend $2 billion a year on research into Alzheimer's which could potentially yield a cure by 2025. Two out of three Alzheimer's patients are women; 5 million are afflicted now and the number could swell to 15 million by 2050 © 2015 Karen Rubin/news-photos-features.com — Hillary Clinton with Chelsea Clinton and Melinda Gates. Senator Clinton is proposing to spend $2 billion a year on research into Alzheimer’s which could potentially yield a cure by 2025. Two out of three Alzheimer’s patients are women; 5 million are afflicted now and the number could swell to 15 million by 2050 © 2015 Karen Rubin/news-photos-features.com

by Karen Rubin/News & Photo Features

With five million Americans suffering from Alzheimer’s today, and nearly 15 million expected to be affected by 2050, Hillary Clinton is pledging a new, groundbreaking $2 billion annual commitment to prevent, effectively treat and make a cure possible for Alzheimer’s disease by 2025, if she is elected President.

Alzheimer’s is the 6th leading cause of death in the United States and is the only cause in the Top 10 that we cannot currently prevent, cure, or even slow.

But scientists say that therapies that would prevent, cure or slow the progress are in reach, provided there is adequate, predictable funding for research. There is a “budget constraint, not a knowledge constraint” that is the main obstacle to success, scientists say.

While the incidence of major diseases is falling, the incidence of Alzheimer’s is rising. “Rates of incidence will only go up in future, as the population ages. But cure is at hand, just lacks funding. Impact of disease combined with the nearness of solution is what is causing Hillary Clinton to want to increase funding.”

The $2 billion a year that Secretary Clinton pledges to devote to research – almost quadrupling the $586 million that has been allocated to the National Institutes of Health (NIH) – is a figure that comes out of the Congressional Task Force on Alzheimer’s disease which she co-chaired while in the US Senate, and from other professional panels. And the cost is miniscule compared to how much is spent now: Alzheimer’s is one of the costliest diseases in America – exceeding $200 billion in annual costs to the economy from the disease and related dementia. Recent reports suggest that by 2050 the total cost may exceed $1 trillion per year.

Women and communities of color are disproportionately affected by for this terrible disease. Two out of every three Alzheimer’s patients are women, older African Americans are twice as likely than older white individuals to be afflicted and older Latinos are 1.5 times as likely.

In developing this plan, Hillary Clinton has consulted with leading physician-scientists to understand what it would take to rapidly accelerate progress currently being made in the field.

“We owe it to the millions of families who stay up at night worrying about their loved ones afflicted by this terrible disease and facing the hard reality of the long goodbye to make research investments that will prevent, effectively treat and make a cure possible by 2025,” Clinton said. “The best scientific minds tell us we have a real chance to make groundbreaking progress on curing this disease and relieving the pain so many families feel every day. My plan will set us on that course.”

Clinton’s plan will:

Dedicate a historic, decade-long investment of $2 billion per year to Alzheimer’s research and related disorders – a fourfold increase over last year’s $586 million. Leading researchers including the research advisory council to the congressionally-authorized National Plan to Address Alzheimer’s Disease, have set out this goal of $2 billion a year to prevent and effectively treat Alzheimer’s and make a cure possible by 2025.
Ensure a reliable stream of funding for fighting Alzheimer’s between now and 2025. This plan ensures predictability of funding between now and 2025, so that researchers can work consistently towards developing effective treatments and a cure. This gives researchers greater freedom to pursue the big, creative bets – including cross-collaboration with researchers in related fields – that can result in dramatic pay-offs.
Appoint a top-flight team to oversee this initiative and consult regularly with top researchers to ensure progress towards achieving the treatment target. At each stage, this plan will embrace a range of approaches to drive new knowledge into effective treatments.

Clinton’s new research investment in preventing and effectively treating Alzheimer’s will yield results not just in the fight against this disease, but for a range of neurodegenerative illnesses, from Parkinson’s disease to Lewy body dementia to frontotemporal dementia. The plan will also help medical professionals understand the intersection of Alzheimer’s with other conditions, including the high rate of individuals with Down syndrome who experience early-onset Alzheimer’s.

This commitment to Alzheimer’s research is only part of Clinton’s overall commitment to a substantial increase in investment at the National Institutes of Health to prevent, treat, and secure cures for the broad array of diseases that afflict Americans.

In addition to investing in research, Clinton announced today new parts of her agenda to support caregivers, like those who give critical care and support to the millions of families struggling with Alzheimer’s. Her plan will fight for Medicare to cover a comprehensive, care-planning session with a clinician following every new diagnosis of Alzheimer’s or related diseases, work with Congress to reauthorize the Missing Alzheimer’s Disease Patient Alert Program and direct the Social Security Administration to raise awareness of the Medicare-covered annual wellness visits and their associated preventive and screening benefits, including the cognitive screening – which is especially critical for patients suffering from Alzheimer’s and other related dementia, by presenting this information alongside Social Security payments that beneficiaries will open and read.

“An Alzheimer’s Epidemic – and No Survivors”

The United States is facing an Alzheimer’s epidemic. And there are no survivors. and while the incidence of other diseases have gone down, the incidence of Alzheimer’s is rising.

But scientists are confident that therapies can be found – “we don’t have a knowledge problem. We have a budget problem.”

“The proposed boost in funding could not have come at a better time – last couple of years, revelations, discoveries in this field that have been unprecedented,” said Dr. Rudolph Tanzi, the Joseph P. and Rose F. Kennedy Professor of Neurology, Harvard Medical School. Dr. Tanzi is Director of the Genetics and Aging Research unit at Massachusetts General, the Chair of the Cure Alzheimer’s Fund Research Consortium and was named one of Time Magazines’ 2015 “100 Most Influential People in the World.”

“From a scientific side, it is reasonable, rational that if we can throw enough money into it, we have a chance to dramatically reduce incidence, stave off disease for folks at highest risk,” he said during a conference call hosted by the Hillary for America campaign.

This disease was described 1906 by Dr. Alzheimer after studying the pathology in the brain of a 56-year old patient and found a mutation in the brain, the same mutation as Alice portrayed in the movie, “Still Alice”.

He said that research into early onset Alzheimer’s has shown common conditions, but most importantly, that people can have the conditions for Alzheimer’s for 10, 15, and 20 years before the first symptoms emerge, but by then, it is too late to do anything about it.

Early research was done on mice brains and yielded incorrect results. The breakthrough came when researchers “grew” Alzheimer’s in a “minibrain” in a dish – a gel-like environment – “and lo and behold, after the amyloid formed, it created the tangles that kill nerve cells. This was the first proof of concept, that if we do the right experiment and use human nerve cells, not mice, the amyloid causes the tangles.”

He added, “We also learned that the third pillar of pathology of Alzheimer’s is inflammation, which is probably the most significant target in a patient who already has the disease, because the inflammation kills many of the nerve cells. Through the Alzheimer’s Genome Project we now know genes control inflammation – so the first drug target is to quell the inflammation in the brain.”

He pointed to research on “resilient brains where we see a person who dies in their 80s or 90s with no cognitive issues, but when we look at their brain, we see the tangles, but they don’t have the inflammation. So if can quell inflammation, we can better help patients.”

This could be a path to at least slowing the progress of the disease and the severity.

“If we can stave off the conversion of simply having plaques in the brain of a 50-60 years old – a picture like in a colonscopy so the brain would be assessed – for amyloid load, how much plaques – we would know if 10, 15, 20 years away the patient is at high risk of dementia (cognitive problems),” said Dr. Tanzi. “The goal would be that could be given a drug, together with lifestyle, that patient never gets to the point of dementia. You might have the precursors, but not the three -plaques, tangles, inflammation. If we can stave it off for 5 years, the savings to Medicare, Medicaid treatment, nursing home savings would be in the many, many billions of dollars. Once we have one or two of these drugs to slow down these pathologies.”

“I’m optimistic. The main bottleneck in the field is funding. We discovered the genes in the 1980s, 1990s. We discovered two dozen Alzheimer’s genes, but there has been very little work, including on genes that control the inflammation because there is no budget – the research is considered high risk because so far there has been little success. If we had more money, many more shots on goal, many more genes being studied – because most of what we know comes from studying genes,” he said, he is confident of success.

“We have budget constraint, not knowledge constraint. Hopefully with $2 billion a year, we finally can do the work we can do to stop the disease by 2025.”

The $2 billion a year that Clinton would allocate, compared to the $586 million that came from NIH last year, amounts to $20 billion commitment over 10 years.

“Our experts would validate that the predictability of funding is almost as important as the money itself,” said Robert Egge, the Executive Director of the Alzheimer’s Impact Movement. Mr. Egge previously served as Executive Director of the Alzheimer’s Study Group – a blue ribbon task force of national leaders co-chaired by former House Speaker Newt Gingrich and former Nebraska Senator Bob Kerrey. “$2 billion is the amount we know will make a difference and is what was recommended … to help get us over the finish line. We know that, but we haven’t seen the will in Congress to match the recommendation.”

The $2 billion annual commitment is part of larger plan that Senator Clinton is unveiling today at an event in Fairfield, Iowa. Other elements would bolster Medicare so a physician could follow every diagnosis of Alzheimers, working with Congress on a patient alert program (which has lapsed) and a tax credit proposal that would allow caregivers to take 20% up to $6000 in care-related costs a year.

The focus on Alzheimer’s is the first piece of a larger commitment to increase the research investment that Hillary Clinton would seek. In addition to investment in manufacturing and infrastructure, she is proposing a plan to dedicate funds for research to help innovate and lead the world in next-generation cures of diseases that are ravaging Americans. This commitment for Alzheimer’s is just the first piece of that.

The campaign also noted that plan announced today “build on Hillary Clinton’s long and strong record of advocating for patients and families who bear the burden of Alzheimer’s disease. In the U.S. Senate, she consistently pushed for greater funding for Alzheimer’s research, including federally-funded stem cell research, and she co-chaired the Congressional Task Force on Alzheimer’s disease. She also introduced legislation to restore funding for the Alzheimer’s Association 24/7 Contact Center and for Alzheimer’s disease demonstration grants. And she forged links across the aisle on the issue, appearing with former House Speaker Newt Gingrich to promote a new study group on Alzheimer’s research. This record reflects her long-time understanding that this disease not only represents a physical, psychological, and financial burden to millions of Americans, but an overwhelming economic and budgetary threat to our country that we must address.”

A full fact sheet on the new plan is available here.

_________________

© 2015 News & Photo Features Syndicate, a division of Workstyles, Inc. All rights reserved. For editorial feature and photo information, go to www.news-photos-features.com, email [email protected]. ‘Like’ us on facebook.com/NewsPhotoFeatures, Tweet @KarenBRubin