Will Healthcare.gov get a California makeover?

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California exchangeBy Pauline Bartolone
KHN

When 28-year-old Charis Hill discovered that the medication to treat her degenerative arthritis condition had risen to $2,000 a month, she chose to be in pain instead.

“I felt like an invalid,” said Hill, who lives in Sacramento and at the time had only catastrophic health coverage. She said the month without medication made it hard to get out of bed.

Paying for drugs isn’t a problem for Hill now: She has a more robust Covered California health plan, and she gets assistance from a drug company program.

And as of the first of this year, she won’t have to worry about sticker shock if she switches medications. All Covered California plans have a cap on how much patients pay for drugs: $250 a month in silver, gold and platinum plans, and $500 a month in bronze plans.

“I could try a better treatment,” said Hill, a patient advocate, who says she is exploring that because her symptoms are becoming more severe. “The $250 is something I know that I can always fall back on.”

The copay cap on drugs is just one way Covered California chose to shape the health insurance marketplace this year.

Experts say the California exchange uses more of its powers as an “active purchaser” than the vast majority of other states.

That means it can decide which insurers can join the exchange, what plans and benefits are available and at what price.

The federal government — in pending proposed rules for 2017 — has signaled it too wants to have more of a hand in crafting plans. Though there are no plans to go as far as a monthly drug copay cap, healthcare.gov would be forging ahead on a path California already paved, swapping variety for simplicity in plan design. Continue reading

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Ninety One Thousand Apple Health Medicaid Clients Affected by Data Breach | Northwest Public Radio

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State Health Care officials say they’ll be notifying 91,000 Medicaid clients they’ve been affected by a data breach.

Officials with the Washington State Health Care Authority today said they discovered that the private information of 91,000 Apple Health clients was mishandled by two employees.

The information includes clients’ Social Security numbers, dates of birth, Apple Health client ID numbers and private health information.

The agency says the breach was discovered during a whistle blower investigation into misuse of state resources.

Source: Ninety One Thousand Apple Health Medicaid Clients Affected by Data Breach | Northwest Public Radio

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Veterans’ hospital performance similar to other U.S. hospitals | Reuters

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veteran-affairs-seal-vaFor older men with heart attack, heart failure or pneumonia, being treated at a Veteran’s Affairs (VA) hospital carries similar risks of death or hospital readmission compared to other facilities, according to a new study.

Rates of death from any cause within 30 days of admission were slightly lower at VA hospitals, and hospital readmission rates were slightly higher, but the differences were very small, researchers found.

Source: Veterans’ hospital performance similar to other U.S. hospitals | Reuters

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Preventable injury deaths shorten U.S. life expectancy | Reuters

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GunAbout half of the difference in life expectancy between the U.S. and other high-income countries like Austria and the U.K. is due to injuries sustained from guns, drug poisonings and motor vehicle crashes, according to a new study.

As of 2012, U.S. life expectancy at birth was 78.7 years, compared to 81.5 years in the U.K. and 82.6 years in France, according to World Bank data.

Source: Preventable injury deaths shorten U.S. life expectancy | Reuters

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Restoring microbes in infants born by cesarean section

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By Carol Torgan
National Institutes of Health

At a Glance

  • Exposing babies delivered by C-section to fluids from the mother’s birth canal enriched the babies’ microbes to levels more typical of babies born vaginally.
  • Larger studies with further follow-up will be needed to determine the long-term health consequences of the microbial transfer procedure.

Cute Baby Boy Isolated on WhiteTrillions of microbes—including bacteria, fungi, and viruses—live in and on the human body. Some of these microbes cause illnesses, but many are necessary for good health.

Babies delivered via the birth canal acquire a microbial community (microbiota) that resembles that of their mother’s vagina. Babies born by cesarean section tend to acquire a microbial community that more closely resembles that of their mother’s skin.

The microbiota acquired by a newborn are thought to be essential for the development of a healthy immune system and metabolism. Continue reading

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A states obligated to provide expensive hepatitis C drugs?

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By Michael Ollove
Stateline

A handful of federal lawsuits against states that have denied highly effective but costly hepatitis C drugs to Medicaid patients and prisoners could cost states hundreds of millions of dollars.

The drugs boast cure rates of 95 percent or better, compared to 40 percent for previous treatments. But they cost between $83,000 and $95,000 for a single course of treatment.

The class actions, all filed in the last eight months in federal courts in Indiana, Massachusetts, Minnesota and Pennsylvania, present a series of extremes: a deadly epidemic, a treatment that can stop the disease in its tracks, and an enormous price tag.

At least 3.5 million Americans have hepatitis C, a virus spread through blood-to-blood contact that is usually contracted through the sharing of needles or other equipment to inject drugs.

Left untreated, hepatitis C slowly destroys the liver. Medicaid beneficiaries, a low-income population, have a slightly higher rate of hepatitis C infection than the privately insured, and the rate among prisoners is 30 times higher than in the general population.

The U.S. Food and Drug Administration approved the first of the new drugs, Sovaldi, in 2013. Since then, the FDA has also approved two other drugs, Viekira Pak and Harvoni.

But because the drugs are so expensive, state Medicaid programs and prisons have been restricting them to people in the advanced stages of the disease. Continue reading

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Lives at risk unless WHO reforms, U.N. report says | Reuters

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World Health Organization WHO logoThe World Health Organization needs urgent reform to boost its ability to respond to crises, and failure to act now could cost thousands of lives, according to an advance copy of a high-level U.N. report.

The report, entitled “Protecting Humanity from Future Health Crises”, is the latest in a series of reviews by global health experts which have been sharply critical of the WHO’s response to the devastating Ebola epidemic in West Africa.

“If the WHO does not successfully reform, the next major pandemic will cause thousands of otherwise preventable deaths,” the report said.

Source: Lives at risk unless WHO reforms, U.N. report says | Reuters

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Zika quarantine? Good idea or bad?

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Public Health — Seattle & King County expert weighs in

By Dr. Jeff Duchin, MD
Health Officer and Chief of Communicable Disease Epidemiology & Immunizations

DuchinExperts are still learning about Zika virus, and in this time of uncertainty, some some are calling for a quarantine on travelers from areas affected by Zika.

I don’t think it’s a good idea.

This is a transmission electron micrograph (TEM) of Zika virus, which is a member of the family Flaviviridae. Virus particles are 40 nm in diameter, with an outer envelope, and an inner dense core. Additional Information:“Zika virus is spread to people through mosquito bites. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon.”For more information on the Zika virus, follow the link below.

Zika virus — Cynthia Goldsmith/CDC

Quarantine of travelers exposed to Zika virus is neither appropriate nor feasible, and would likely have no meaningful impact on the spread on the disease – but would result in significant negative unintended consequences on travel, commerce, individuals and families.

Quarantine of returning travelers would be costly and complicated to carry out for no real benefit. Although Zika poses a real threat of continued global spread, continuing measures to protect travelers and control the outbreaks where they are occurring, although imperfect, are more appropriate responses.

This is true for a number of reasons.

  1. There is no practical way to identify or screen for who is infected with Zika and potentially capable of transmitting infection. Most infections are asymptomatic and there is no rapid diagnostic test.
  2. In addition, everything we know suggests the threat to the US is not large. Based on experience with other viruses, like dengue and chikungunya, that are transmitted by the same mosquito vectors and have reached the US after large scale epidemics expanded globally, the risk for ongoing transmission or large outbreaks in the US is thought to be low. (In much of the country including the Pacific Northwest, we don’t have the type of mosquitoes that transmit Zika, dengue and chikungunya.) In contrast, the number of persons traveling to and from Zika-affected areas would be extremely large and enter the US at many points, making implementation of quarantine unrealistic even if it was potentially useful.
  3. And, it’s likely that Zika, as dengue and chickungunya viruses have done, will become established in much of the world, meaning that quarantine would need to be continued on an ongoing basis.

Continue reading

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Test could boost newborn cystic fibrosis screening

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Illustration of the lungs in blueBy Barbara Feder Ostrov
KHN

Stanford University scientists say they’ve devised a more accurate and comprehensive DNA test to screen newborns for cystic fibrosis, the most common fatal genetic disease in the United States.

Affecting about one in 3,900 babies born in the U.S., cystic fibrosis causes mucus to build up in the lungs, pancreas and other organs, leading to frequent lung infections and often requiring lifetime treatment for patients, whose median lifespan is 37 years.

Every state screens newborns for cystic fibrosis, but the current sequence of tests can miss cases, threatening babies’ lives.

The new method described in a recent article in The Journal of Molecular Diagnostics, promises to be more efficient and cost-effective, researchers said. It may also improve screening for non-white babies, for whom cystic fibrosis is rarer and harder to diagnose.

The new method promises to be more efficient and cost-effective and may also improve screening for non-white babies in whom cystic fibrosis harder to diagnose.

“I think this is a major advance. It offers the promise of potentially eliminating the false negative results that lead to missed cases,” said Dr. Philip Farrell, a former dean of the University of Wisconsin School of Medicine and Public Health, and a nationally-known expert on cystic fibrosis screening for newborns. “If you miss a case, you’ve got a baby out there who has a significant possibility of dying undiagnosed.”

Cystic fibrosis is caused by a defect in the CFTR gene, which regulates the movement of water and salt out of the body’s cells. In California, current genetic screens look for 40 of the most common mutations of the CFTR gene in newborns.

Yet any of the more than 2,000 known mutations in that gene could play a role in the disease, and there are likely others that have not yet been discovered.

The new test uses “next generation” DNA sequencing that can quickly and more cheaply look at the entire CFTR gene, not just selected mutations. It does not require an extra blood sample. Rather, it uses the tiny amount of blood drawn from the common newborn heel stick test that’s already used to screen for a number of diseases, including cystic fibrosis.

The researchers say this advance can enable testing labs to review many newborn samples at a time and reduce costs, allowing a technology previously used only to diagnose individual cases to be applied to a large population. Continue reading

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Administration will continue to push Obamacare expansion, HHS chief says

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HHS Sec. Burwell says ‘beat goes on’ as agency seeks to expand health law’s influence

By Mary Agnes Carey
KHN

Official portrait of the Secretary of Health & Human Services Sylvia Mathews BurwellDepartment of Health and Human Services Secretary Sylvia M. Burwell on Friday hailed the health law’s 2016 enrollment gains and said the department was already beginning to gear up for the next enrollment period.

In addition to the health law, Burwell’s agency is juggling many other priorities these days, including coordinating her agency’s response to the emerging threat of the Zika virus, President Barack Obama’s “Moonshot on Cancer” initiative and the growing epidemic of opioid abuse.

“The beat goes on,” she said during a briefing with reporters at HHS headquarters. Continue reading

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Insurers should be current on emerging treatments for consumers

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MKreidlerPhotoBy Mike Kreidler
Washington State Insurance Commissioner

A growing concern for consumers and health insurers is the cost of prescription drugs and specifically, treatment for debilitating and life-threatening diseases.

Hepatitis C is a good example. New drugs are now used to cure this life-threatening liver ailment with proven success. But the pills are costly, ranging from $55,000 to almost $95,000 per patient for a standard 12-week treatment period.

Two nationwide organizations, the American Association for the Study of Liver Diseases and the Infectious Disease Society of America, now recommend that most patients receive treatment even if they are in the early stage of the disease versus waiting until it has progressed.

Last November, the federal government encouraged states to ensure that health coverage policies are “informed” by the treatment guidelines noted above. Unfortunately we do not have the authority to mandate that insurance companies abide by the guidelines. However, we do expect insurers to be current on all appropriate guidelines that best serve consumers. That is true for all types of treatments.

We recently asked health insurers in Washington if they were aware of the new guidelines and if they were making any changes to how they were treating patients with this disease. The responses were varied, but there were common themes:   Continue reading

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