Podcast: ‘What The Health?’ The State Of The (Health) Union

Podcast: ‘What The Health?’ The State Of The (Health) Union

Image result for Podcast: ‘What The Health?’ The State Of The (Health) Union

In his first State of the Union Address, President Donald Trump told the American public that “one of my greatest priorities is to reduce the price of prescription drugs.” But that message could barely begin to sink in before other health news developed: The director of the Centers for Disease Control and Prevention was forced to resign Wednesday after conflict-of-interest reports.

Meanwhile, outside the federal government, Idaho is proposing to allow the sale of individual insurance policies that specifically violate portions of the Affordable Care Act. And three mega-companies — Amazon, Berkshire-Hathaway, and JPMorgan Chase — say they will partner to try to control costs and improve quality for their employees’ health care.

This week’s “What The Health?” panelists are Julie Rovner of Kaiser Health News, Alice Ollstein of Talking Points Memo and Julie Appleby and Sarah Jane Tribble of Kaiser Health News.

Among the takeaways from this week’s podcast:

  • Despite Trump’s strong rhetoric in the State of the Union Address, the president has taken few actions during his first year in office to reduce drug prices.
  • The president touted that Republicans had repealed the health law’s requirement that individuals get health insurance or pay a penalty. But that change in the law doesn’t go into effect until 2019, so his comments could be confusing to some taxpayers.
  • Idaho officials have announced that they are going to allow insurers to issue policies that don’t meet all the criteria of the federal health law. But it’s not clear that insurers are interested in participating in the experiment.
  • “Alexa, send me my Lipitor!” Can Amazon’s announcement that it and two other corporate behemoths are taking on employees’ health care create a new formula for keeping costs down and improving quality?


CDC director who traded tobacco stock resigns


Brenda Fitzgerald is pictured. | AP Photo

Dr. Brenda Fitzgerald’s resignation comes one day after POLITICO reported she bought shares in a tobacco company.

Trump’s top public health official resigned from her post Wednesday after mounting questions about financial conflicts of interest, HHS announced.

Dr. Brenda Fitzgerald’s resignation comes one day after POLITICO reported she bought shares in a tobacco company — the leading cause of preventable disease and death and an issue she had long championed — one month into her tenure as CDC director.

Fitzgerald, a doctor and former Georgia Department of Public Health commissioner, assumed her role as CDC director in July and was close to former HHS Secretary Tom Price, who resigned in September after POLITICO reported his use of private jets.

The stock in Japan Tobacco was one of about a dozen new investments Fitzgerald made after she took over the job, according to documents obtained by POLITICO. Fitzgerald had already come under congressional scrutiny for slow-walking divestment from older holdings that government officials said posed potential conflicts of interest and prevented her from testifying before Congress.

Fitzgerald’s purchase of stock in Japan Tobacco in August, first revealed by POLITICO, drew scrutiny from public health experts who said it goes against the mission of her agency. She sold it at the end of October.

Beside Japan Tobacco, she also purchased tens of thousands of dollars in new stock in at least a dozen companies, including between $1,001 and $15,000 each in Merck & Co, Bayer and health insurance company Humana, as well as between $15,001 and $50,000 in US Food Holding Co., according to financial disclosure documents.


Senate overwhelmingly agrees to short-term spending bill, ends government shutdown



The Senate agreed to a short-term spending bill Monday that effectively ended the government shutdown.

The 81-18 vote to approve the spending bill came after Majority Leader Sen. Mitch McConnell, R-Ky., promised Sunday to take up debate on immigration issues if the Senate hadn’t reached agreement on Deferred Action for Childhood Arrivals (DACA), which provides protections for young immigrants brought to the country by their parents without proper documentation.

The vote puts an end to the government shutdown, three days after it began at midnight Saturday when the Senate fell 10 votes short the 60 votes needed to approve a House-passed spending bill. However, the spending bill passed by the Senate is for three weeks, not the four that the House approved.

The failure to reach an earlier agreement on a spending bill that eventually led to the shutdown set a precedent as the Republican party controls the House, Senate and presidency. The White House said Saturday it would refuse to negotiate on immigration until funding was restored.

The shutdown temporarily put more than 40,000 employees who work for the Department of Health and Human Services and its related agencies and offices on furlough Monday morning. Under the HHS contingency plan the furloughs would:

  • limit disease surveillance by the Centers for Disease Control and Prevention,
  • stop work by the Office of the National Coordinator for Health Information Technology on standards coordination, and
  • halt implementation and testing required under the Health Information Technology for Economic and Clinical Health and 21st Century Cures (Cures) acts by the Office of the National Coordinator for Health Information Technology.


Senate votes to reopen government, averts major setback to health agencies


Debate on the Senate floor on Jan. 22. Credit: C-span

Here’s a look at HHS, ONC and CDC plans during a government shutdown.

The Senate voted on Monday to approve a temporary funding measure that keeps the government running through Feb. 8.

The vote came after the government had been shut down for two days with the U.S. Department of Health and Human Services contingency plans already kicking in as of Monday morning when about 50 percent of its staff stayed home on furlough.

The Office of the National Coordinator for Health Information Technology is not operating. However, the NIH is continuing care for current NIH Clinical Center patients.

A contingency staffing plan is keeping other operations going, including Medicare and Medicaid payments, though an extended shutdown could result in delays in claims processing, audits, and other administrative functions.

In the short term, the Medicare program will continue largely without disruption during a lapse in appropriations, according to HHS.

States will have sufficient funding for Medicaid through the second quarter.

The Centers for Medicare and Medicaid Services will maintain the staff necessary to make payments to eligible states from remaining Children’s Health Insurance Program (CHIP) carryover balances.

CMS is continuing key federal exchange activities, such as open enrollment verification.

Other ongoing HHS activities include substance abuse and mental health services for treatment referral and the suicide prevention lifeline.

The Administration for Children and Families and Temporary Assistance for Needy Families (TANF), along with child support and foster care services continues.

The Centers for Disease Control and Prevention is maintaining its 24/7 emergency operations center.

The CDC will continue to track the data on the flu, which has been virulent this season.

Infection Lapses Rampant In Nursing Homes But Punishment Is Rare

Infection Lapses Rampant In Nursing Homes But Punishment Is Rare

Image result for Infection Lapses Rampant In Nursing Homes But Punishment Is Rare


A Kaiser Health News analysis of federal inspection records shows that nursing home inspectors labeled mistakes in infection control as serious for only 161 of the 12,056 homes they have cited since 2014.

Basic steps to prevent infections — such as washing hands, isolating contagious patients and keeping ill nurses and aides from coming to work — are routinely ignored in the nation’s nursing homes, endangering residents and spreading hazardous germs.

A Kaiser Health News analysis of four years of federal inspection records shows 74 percent of nursing homes have been cited for lapses in infection control — more than for any other type of health violation. In California, health inspectors have cited all but 133 of the state’s 1,251 homes.

Although repeat citations are common, disciplinary action such as fines is rare: Nationwide, only one of 75 homes found deficient in those four years has received a high-level citation that can result in a financial penalty, the analysis found.

“The facilities are getting the message that they don’t have to do anything,” said Michael Connors of California Advocates for Nursing Home Reform, a nonprofit in San Francisco. “They’re giving them low-level warnings year after year after year and the facilities have learned to ignore them.”

Infections, many avoidable, cause a quarter of the medical injuries Medicare beneficiaries experience in nursing homes, according to a federal report. They are among the most frequent reasons residents are sent back to the hospital. By one government estimate, health care-associated infections may result in as many as 380,000 deaths each year.

The spread of methicillin-resistant Staphylococcus aureus (MRSA) and other antibiotic-resistant germs has become a major public health issue. While Medicare has begun penalizing hospitals for high rates of certain infections, there has been no similar crackdown on nursing homes.

As average hospital stays have shortened from 7.3 days in 1980 to 4.5 days in 2012, patients who a generation ago would have fully recuperated in hospitals now frequently conclude their recoveries in nursing homes. Weaker and thus more susceptible to infections, some need ventilators to help them breathe and have surgical wounds that are still healing, two conditions in which infections are more likely.

“You’ve got this influx of vulnerable patients but the staffing models are still geared more to the traditional long-stay resident,” said Dr. Nimalie Stone, the CDC’s medical epidemiologist for long-term care. “The kind of care is so much more complicated that facilities need to consider higher staffing.”

The Centers for Medicare & Medicaid Services (CMS), which oversees inspections, has recognized that many nursing homes need to do more to combat contagious bugs. CMS last year required long-term care facilities to put in place better systems to prevent infections, detect outbreaks early on and limit unnecessary use of antibiotics through a stewardship program.

But the agency does not believe it has skimped on penalties. CMS said in a statement that most infection-control violations have not justified fines because they did not put residents in certain danger. For instance, if an inspector observed a nurse not washing his or her hands while caring for a resident, the agency said that would warrant a lower-level citation “unless there was an actual negative resident outcome, or there was likelihood of a serious resident outcome.”


Universal health care is doable for far less cost – but at a political price


Image result for Universal health care is doable for far less cost – but at a political price

When the Legislature reconvenes and the campaigns for governor heat up next year, Californians will be hearing a lot – and a lot of hot air – about universal health care.

Making California the first state to guarantee health care for every resident has become a touchstone issue – and a divisive one – for the state’s dominant Democrats.

The state Assembly will take up – or possibly ignore – a universal health care bill that the Senate passed this year.


Assembly Speaker Anthony Rendon applied brakes to Senate Bill 562 in June, saying it “was sent to the Assembly woefully incomplete and has “potentially fatal flaws…including the fact it does not address many serious issues, such as financing, delivery of care (and) cost controls.”

That stance generated a torrent of personal invective from the measure’s advocates in the Democratic Party’s left – or Berniecrat – wing, driven by the California Nurses Association.

There’s a similar divide among the Democratic candidates for governor, with Lt. Gov. Gavin Newsom the most insistent advocate of expanding coverage.

Like Rendon, Newsom’s chief rivals, former Los Angeles Mayor Antonio Villaraigosa and Treasurer John Chiang, endorse universal health care in principle, but are leery about how it would be financed.

A Senate Appropriations Committee analysis pegs costs of universal coverage at $400 billion a year, but suggests that half could be covered by redirection of existing federal, state and local government health care spending.

It added that “about $200 billion in additional taxes would be needed to pay for the remainder,” but also noted that half or more of that burden could be offset by eliminating direct health care costs now borne by consumers and their employers.

To put that in perspective, even $100 billion in new taxes would be the equivalent of a one-third increase in the $300 billion a year now levied by state and local governments.

In theory – one advanced by advocates – the two-thirds “supermajorities” in the Legislature and the governor could levy new taxes of that magnitude.

In practice, however, even if the supermajorities survive the recent spate of sexual harassment resignations and next year’s elections, there’s virtually no chance of such a vote.

Rendon knows that passing universal health care without a system of paying for it would invite scorn from the media and the public, but passing it with immense new taxes would put some of his Democratic members in political jeopardy.

If, however, Democrats are serious about having universal health care insurance there’s another, perhaps easier, way to do it.

A new report from the federal government’s Centers for Disease Control says that with the advent of Obamacare, which expands the Medi-Cal program serving the poor and offers subsidies for others, California’s medically uninsured population has dropped from 17 percent in 2013 to 6.8 percent in 2017.

That means that there are about 2.7 million Californians still lacking some form of medical coverage, although many, if not most, receive rudimentary, albeit uncompensated, care in charity clinics and hospital emergency rooms.

As many as half of them would be eligible for government-paid or -subsidized care, and covering them is potentially doable under existing programs, according to Covered California, the state’s Obamacare implementation agency.

The remainder, mostly, are maybe a million-plus undocumented immigrant adults who are, by law, ineligible.

It’s not necessary for the state to seize control of California’s entire medical care system if the real bottom line goal is covering those undocumented immigrants. It could be done for about $10 billion a year, which is a lot less than $100 billion.

However, advocates would have to publicly acknowledge that covering them is what this conflict is all about and take whatever political heat it generates.

It’s a test of whether universal coverage is a real goal, or merely political symbolism.

Words banned at CDC were also banned at other HHS agencies: report


Words banned at CDC were also banned at other HHS agencies: report

Multiple agencies in the Department of Health and Human Services (HHS) have reportedly been told by the Trump administration that they cannot use certain phrases in official documents.

Officials from two HHS agencies, who asked that their names and agencies remain anonymous, told The Washington Post that they had been given a list of “forbidden” words similar to the one given to the Centers for Disease Control and Prevention (CDC).

A second HHS agency was told not to use the phrases “entitlement,” “diversity” and “vulnerable,” in documents. It was also told to use “ObamaCare” as opposed to the “Affordable Care Act” and to refer to “marketplaces,” where people purchase health insurance, as “exchanges.”

The Post’s new report builds on its Friday report that the CDC had been told it could no longer use the phrases “evidence-based” and “science-based” in documents being prepared for the 2019 budget.

The list of “forbidden” words and phrases given to policy analysts at the CDC also included “vulnerable,” “entitlement,” “diversity,” “transgender” and “fetus.”

The Health and Human Services Department has pushed back on the first report.

“The assertion that HHS has ‘banned words’ is a complete mischaracterization of discussions regarding the budget formulation process,” HHS spokesman Matt Lloyd told The Hill on Saturday.

“HHS will continue to use the best scientific evidence available to improve the health of all Americans. HHS also strongly encourages the use of outcome and evidence data in program evaluations and budget decisions,” the statement continued.

According to the Post, similar guidance on word choice has been issued at the State Department. Employees at the State Department have been told to call sex education “sexual risk avoidance,” which primarily refers to abstinence-only education.

The Trump administration has been repeatedly scrutinized for declining to acknowledge scientific findings, particularly related to climate change. Trump has also repeatedly expressed doubts about the scientific consensus that humans are the main cause of a warming planet. Numerous members of his administration and his appointees have also denied aspects of the scientific consensus related to global warming.