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Health News

  • Egypt's education ministry has suspended the distribution of school meals nationwide after several outbreaks of food poisoning sickened hundreds of children in several provinces. The ministry said in a statement published late Wednesday that a committee will be formed to 'find out the reasons behind these occurrences ... and conduct required investigations.' Health officials Ministry said earlier this week that at least 435 children fell ill of suspected food poisoning in public schools across Egypt after consuming government-issued school meals, produced by a military-owned company. According to the government, some 3,353 children have shown similar symptoms in the southern city of Sohag last week. The mass food poisonings have been an embarrassment for the authorities amid President Abdel-Fattah el-Sissi's ambitious economic reforms to revive the country's ailing economy.
  • California would lose $24.3 billion annually in federal funding by 2027 for low-income health coverage under the current Republican plan to replace the Affordable Care Act, according to a state analysis released Wednesday. The bill, up for a vote in the House on Thursday, represents a “massive and significant fiscal shift” from the federal to state governments by setting caps on Medicaid spending, reducing the amount of money available for new enrollees and eliminating other funding for hospitals and Planned Parenthood, the analysis said. “It’s really devastating,” said Mari Cantwell, state Medicaid director with the California Department of Health Care Services, who co-wrote the analysis. “It raises some serious questions about whether we can continue to operate the program the way we do today.” Her boss, department director Jennifer Kent, went further:  “It’s challenging to see how it would not … jeopardize the entire program.” The analysis, based on internal cost, utilization and enrollment data, was done by the health care services department and the Department of Finance and was shared with California’s congressional delegation. In 2020 alone, the analysis estimated, the state would lose $6 billion; by 2027, the annual loss would reach $24.3 billion. Kent said that when faced with shortfalls in the past, the state has made cuts to optional benefits such as adult dental care. The state also could set lower provider rates, or restrict who is eligible. “These are all decisions that California and other states would have to grapple with in the future if this were to be adopted as it is proposed today,” she said. The impact would vary, of course, depending on the state’s fiscal health. The Republican bill, called the American Health Care Act, would dramatically change funding for the Medicaid program, known as Medi-Cal in California. Since its inception, Medicaid funding to states has been open-ended, based on need. Under the new bill, federal money would be capped either through block grants or fixed per-capita amounts. The Affordable Care Act allowed states to expand their Medicaid programs in 2014 to low-income childless adults, and the federal government is paying nearly all the costs for those new beneficiaries. The new bill would scale the expansion back. Sally Pipes, president of the San Francisco-based Pacific Research Institute, said the expansion of Medicaid was too costly and should have never been included in the ACA. “These programs are not sustainable, unless you are going to tremendously increase taxes on the middle class,” she said. Pipes said Medicaid funding should be converted from entitlements into block grants and states should be left to decide how to structure their programs. “More and more people are thinking they are entitled to this and entitled to that and these programs are expensive and not efficient,” she said. The cuts to Medi-Cal and the restructuring of the program will be better for the California economy, Pipes said. Meanwhile, Gov. Jerry Brown, who was attending an anniversary celebration for the Affordable Care Act in Washington, D.C., had sharp words Wednesday for President Donald Trump and what he called his “fake health care bill.” “In California, we’re not talking about a few thousand – we’re talking about millions of real people getting hurt – getting diseases that will not be cured – having heart attacks, not being able to go to a hospital or get a doctor,” the governor said in his prepared remarks. California was among the most aggressive states in the nation in implementing the Affordable Care Act, and the majority of new enrollees came through Medi-Cal. Medi-Cal now provides coverage to 13.5 million low-income residents, about half of California’s children and a third of the adults. About 3.7 million people of those became newly eligible for the publicly funded health coverage through the Medcaid expansion. That helped reduce the state’s uninsurance rate from 17 percent in 2013 to about 7 percent in 2016, according to the UC Berkeley Labor Center for Education and Research. The Medicaid program is funded jointly by California and the federal government and provides health, dental, mental health, long-term care and other services. The bill could put hospitals, clinics and other providers in a tenuous financial position by forcing them to live within the cost limits while at the same time seeing more uninsured patients, the analysis said. The California Hospital Association did its own analysis and concluded that at least three million people would lose coverage under the GOP plan, and hospitals could see their bad debt and charity care increase by $3 billion per year. “As more people lose coverage, they are still going to have health issues, and the hospital is the only place in the health care system required under federal law to provide care,” said Jan Emerson-Shea, vice president of external affairs for the association. Health officials estimated that Medi-Cal costs would exceed per-capita caps by nearly $680 million in 2020, with the gap growing to $5.28 billion by 2027. That spending limit could have a “devastating and chilling effect” on any increases in provider payments or plan rates, according to the analysis. The state also expects an additional $3.3 billion in costs in 2020, growing to $13 billion by 2027, because of a change that reduces federal funds for new enrollees and for people who have a break in coverage. The bill would require certain beneficiaries to renew coverage every six months rather than once a year, which state officials say will cause many to lose their coverage. According to the analysis, the state would face additional losses from other federal cuts, including to a program that pays for in-home care for elderly and disabled residents. In addition, the proposed freeze on federal funding to organizations that provide abortions would make the state responsible for $400 million in payments to Planned Parenthood, which serves more than 600,000 people in Medi-Cal and a state family planning program. A new study by UC Berkeley’s Labor Center released Wednesday also warned of dramatic cuts in federal Medi-Cal funding that would threaten coverage for low-income adults. The center estimated that the state would have to increase spending by $10 billion each year to maintain coverage for those who became eligible for coverage under the Affordable Care Act. Without that funding, the researchers wrote, 3.7 million people could lose coverage by 2027. Ken Jacobs, chair of the center, said the Republican plan would also result in job losses because of reduced federal funding. Jacobs said both the center’s and the state’s calculations point to a significant financial impact on California if the GOP bill becomes law. “It’s hard to see where else in the state budget this could be pulled from,” he said. “This would be a very big hit on the budget, the health system and the economy of California. … And the implications for people’s health are serious.”     This story was updated. This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
  • Renata Louwers has a hard time getting her blood drawn. The needle, the pinprick of pain, the viscous liquid flowing out of her arm — they make her queasy. So, Louwers had to steel herself when her husband, Ahmad Khoshroo, developed metastatic bladder cancer four years ago at age 72. Within months, as a tumor pressed on his spine, Khoshroo was taking heavy-duty opioids and Louwers was administering his medications. When he developed blood clots following a stay in intensive care, she injected a blood thinner into his belly. Figuring out what to do as her husband’s eventually fatal disease progressed was a nightmare. Louwers remembers getting hastily delivered, easily forgotten instructions from hospital nurses and, later, limited assistance from a home health agency. “It wasn’t much, and it was incredibly hard,” she said. Now, groups around the country are mobilizing to help family caregivers like Louwers manage medications, give injections, clean catheters, tend to wounds and perform other tasks typically handled in medical facilities by nurses or nursing assistants. In December, 15 organizations joined a new national consortium, the Home Alone Alliance, devoted to providing better training and instructional materials for family caregivers. Founding members include the AARP Public Policy Institute, the Family Caregiver Alliance, the United Hospital Fund and the Betty Irene Moore School of Nursing at the University of California, Davis. This week, the alliance released a series of 10 short videos (five each in English and Spanish) designed to help caregivers deal with seniors who use canes or walkers and need help getting up or down stairs, into a wheelchair, or in and out of a tub or a shower. Two of the videos deal with falls — the most common cause of injury among older adults. This summer, nine videos on wound care and topics will be added and include dealing with newly sutured wounds, bed sores, cellulitis and diabetic foot care, among other topics, and, by the end of the year, another 20 videos should be available. Potential topics include nutrition, the use of specialized equipment such as nebulizers, feeding tubes and oxygen tanks, and a revised series on medication management — a topic profiled in a pilot project for the alliance. Organizations across the country will be free to put the videos on their websites. The goal is to disseminate them as widely as possible and “bridge the gap between what family caregivers are expected to do and what we actually teach them to do,” said Susan Reinhard, director of AARP’s Public Policy Institute. That gap was highlighted in 2012, when AARP and the United Hospital Fund’s Families and Health Care Project published a groundbreaking report on medical and nursing tasks undertaken by caregivers. It found that 46 percent helped patients who required specialized care, but few got adequate training. After the study’s publication, AARP started compiling educational materials from around the country that addressed caregivers’ increasingly complex responsibilities. There wasn’t much available. With the United Hospital Fund, AARP convened focus groups and asked people what would be helpful. Don’t overwhelm us with information; break the material into chunks focusing on concrete tasks, they said. And tell us a story that we can relate to, involving people like us — not doctors and nurses, they requested. Ongoing research into what works, from family caregivers’ perspective, will be an integral part of the Home Alone Alliance. And while videos will be a core component of the consortium’s offering, they won’t be the only one. “It may be that within certain Asian communities, a video isn’t the best approach — we may want to partner with Asian resource centers and do ‘train the trainer’ sessions about caregiving,” said Heather Young, founding dean and a professor at the Betty Irene Moore School of Nursing at UC Davis. In African-American communities, churches are a pillar of caregiving support and the focus may be on “helping congregations build their capacity,” Young said. “You can equip one person at a time all you want, but if there isn’t a broader context of support, a net around them, it’s very difficult to sustain the caregiving.” Meanwhile, alliance members are developing plans for disseminating materials. The Family Caregiver Alliance will incorporate them in a new online platform for caregivers, FCA CareJourney — a source of support and resources that is still under development. FCA began producing videos for family caregivers about four years ago; its Caregiver College series and SafeAtHome series have been watched by about 500,000 people to date. “We’re going to a more visual information exchange society,” said Kathleen Kelly, FCA’s executive director. The U.S. Department of Veterans Affairs partnered with AARP in producing the alliance’s video series on mobility. It plans to post the videos on the VA’s caregiver website and encourage their use by patients discharged from rehabilitation and those served through its home-based primary care program, said Meg Kabat, national director of the VA’s Caregiver Support program. Recognizing the value of videos, the VA’s Office of Rural Health has created a 20-module series on caring for someone with dementia and a five-part series on managing challenging behaviors associated with dementia. An extensive compilation of materials on various health conditions, Veterans Health Library, is also online, and another valuable resource for caregivers. What’s missing from the current offerings is advice on dealing with older adults who are frail and have multiple conditions. Catherine Yanda’s 91-year-old mother, Mary, is in this situation: She has end-stage dementia, sarcopenia, heart disease, incontinence, frequent skin tears and difficulty swallowing — a set of problems that Yanda has had to figure out how to manage, largely on her own. “I learn what to do as it happens,” said Yanda, who turns to FCA’s website for support and websites for nurses for information. “You go to whatever site helps you deal with the problem you’re trying to address. I’m lucky because I have the belief system that I can do it. But for some people, it’s just too much.” We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips. KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and its coverage of aging and long-term care issues is supported by The SCAN Foundation.
  • FRESNO, Calif. — In 2012, when Jerry Goodwin showed up at a clinic with intense pain and swelling in his legs, doctors called for an ambulance even though the hospital was across the street. That generated a $900 bill — just the beginning of a nearly three-year ordeal for Goodwin, who was uninsured. Diagnosed with cellulitis and an irregular heartbeat, Goodwin managed to get his emergency care costs covered through the hospital but then faced month after month of bills for follow-up care and medications. Finally, in 2015, he was able to sign up for Medicaid coverage, which was expanded under the Affordable Care Act to cover many single adults without children. “That was a big relief,” said Goodwin, 64. Now Goodwin and people like him are worried all over again. Under Republican efforts to repeal, replace or reform the health law, many people on Medicaid — the nation’s single-largest insurer, with 72 million beneficiaries — could see their coverage slashed. The biggest chunk of them — 13.5 million — live in California. The state predicted Wednesday it could lose $24 billion in federal funding annually by 2027 under the current GOP proposal. Among the hardest hit regions would be the Central Valley, the state’s agricultural heartland, stretching hundreds of miles from Redding to Bakersfield. Toward the south, in Fresno County, about half the population of 985,000 relies on Medi-Cal, as California’s Medicaid program is known. In adjacent Tulare County, 55 percent of the more than 466,000 residents were enrolled in Medi-Cal as of January 2016. Much has been said about the plight of conservative voters in the Midwest who rely on Medicaid, a program the Trump administration and congressional Republicans are determined to shrink. But despite its reputation as a deep-blue state, California also has several red — or reddish — counties in its interior with millions of low-income people who depend heavily on Medicaid. Many live in congressional districts represented by Republicans who want to scrap or change the Affordable Care Act, also known as Obamacare. The current Republican bill, the American Health Care Act, would cut Medicaid funding by 25 percent by 2026, covering 24 million fewer people than today, according to the Congressional Budget Office. “These are remarkable estimates,” said John Capitman, the executive director at the Central Valley Health Policy Institute and a professor at California State University, Fresno, referring to the CBO projections. “The level of cuts are devastating, and for California and the Central Valley, this represents a huge loss.” The bill faces opposition from the left and right and is undergoing last-minute changes in the run-up to a House floor vote Thursday. Despite several protests in the valley and around the state, at least half of Republican lawmakers in the state appear poised to support it; several others are noncommittal. U.S. Rep. Devin Nunes, whose congressional district includes portions of Tulare and Fresno counties, likes the proposal, saying it will improve care for everyone, including current Medi-Cal participants. “Medi-Cal is a broken healthcare system that’s been completely mismanaged by the State of California,” Nunes said in a recent statement. Capitman said Medi-Cal is vital in the Central Valley because of its high poverty rate, uneven access to care and pockets with very poor health outcomes. Many of these communities also depend on the Prevention and Public Health Fund, which was established by the ACA to fight chronic diseases and also is in peril, he said. The valley suffers high rates of diabetes, obesity and heart disease. The area has some of the country’s dirtiest air, triggering epidemic levels of asthma. Wage stagnation and high unemployment contribute to stress and poor mental health. Some areas are far better off than others. Within 10 miles, Capitman said, you can find up to a 20-year difference in life expectancy. On average, life is much shorter for residents in Southwest Fresno, for instance, where heavy industry soils the air, homeless people camp on sidewalks, and fences cage in lots overgrown with grass and weeds. Not far away, Petra Martinez, a former fieldworker, recently waited to see a doctor at a crowded downtown clinic. At 86, she receives coverage from both Medi-Cal and Medicare, the federal insurance program for the elderly. She needs medication for arthritis, epilepsy and diabetes, all of which is paid for her through her dual coverage. Though the proposed House bill seemingly would not shrink spending on people with dual coverage, she is wary of what lies down the road. “I’d like to think that we [seniors] will be OK, that maybe we won’t be affected by whatever changes are coming, but who knows?” Martinez said. “I don’t want to have to ask my children for money to go to the doctor.” Dr. J. Luis Bautista, an internist at the clinic, estimates he’s seen a 20 percent increase in patient visits since the rollout of the ACA in 2014. The majority of his patients are on Medi-Cal. “These are the people who usually wait until they’re very sick to come,” Bautista said. “We’ve seen people with high blood pressure who come in when they already have eye problems and heart problems. … They waited too long.” But since the ACA rolled out, he said, preventive visits seem to have increased. Fifteen miles outside the city of Fresno is Sanger, a largely Latino town of 25,000 where almost a quarter of residents live in poverty, according to the U.S. Census. Here a neighborhood of newer houses with commuter residents isn’t far from another that lacks sidewalks and is strewn with aging or abandoned businesses and chain stores. On a recent day, a hairstylist was tending to a client in a downtown salon nestled among boutiques, cafes and other small businesses. The stylist said she and her two teenagers are on Medi-Cal — and so are most of the people she knows. A single mother, she said she works six days a week but can’t afford to buy health coverage. The salon’s owner interjected that she doesn’t oppose greater restrictions on who gets Medi-Cal — but plans on the state’s insurance exchange should be more affordable, so people will be drawn to buying coverage. The women asked that they and the business not be identified. Less than an hour southeast of Fresno, Iliana Troncoza lives in the city of Tulare, part of a heavily agricultural county of the same name. The county has one of the lowest incomes per capita in California. Troncoza, a 47-year-old homemaker who takes care of her ailing husband, gets her health care at Altura Centers for Health, which runs seven clinics in the city. The thought of Medi-Cal cutbacks fills her with anxiety. Both she and her daughter, a college freshman, rely on the program for coverage. Troncoza had gone without coverage for six years before qualifying under the ACA expansion. She traveled to Jalisco, Mexico, to remove a breast cyst because couldn’t afford the procedure in the U.S. Now, in her city, she can receive mammograms and ultrasounds, and has been able to obtain medication for her depression and anxiety, she said. “It’s horrible to think that our Medi-Cal depends on people who don’t understand our situation,” Troncoza said. Graciela Soto, CEO of Altura clinic system, said 75 percent of its patients are on Medi-Cal and 9 percent of patients are uninsured, mostly because of their immigration status. It’s quite a difference from 2012, before the ACA was implemented, when 50 percent of patients were on Medi-Cal and 35 percent uninsured, she said. “The Medicaid expansion was wonderful for our patients,” Soto said. Through the ACA, Soto said, many young women were able to access free or affordable birth control. That’s important, she said, because Tulare County has among the highest teen pregnancy rates in the state. The region has a large population of migrant farm workers, many of whom don’t qualify for Medi-Cal. But a substantial portion of Latinos do qualify, as do non-Hispanic whites like Goodwin. Among whites, the need for mental health and substance abuse services is growing, research suggests. Drug overdoses, alcohol abuse and suicide have significantly contributed to rising death rates, according to a study out of the Center on Society and Health at Virginia Commonwealth University. In Fresno County, for example, the rate at which middle-aged white adults are dying from accidental drug poisoning has tripled since 1990, according to the report. Some residents have turned to activism in their efforts to preserve ACA coverage. In January, Greg Gomez, a councilman for the city of Farmersville in Tulare County, led a small-scale protest outside Nunes’ office in Visalia. It wasn’t just about politics — it was personal. Three of Gomez’s children are covered by Medi-Cal. “The monthly premium to get my whole family covered by my employer would be about $2,000,” said Gomez, a computer systems engineer for Tulare County and former president for the local chapter of the Service Employees International Union. “That is totally out of reach. That’s why we need Medi-Cal. And that’s the story of a lot of Tulare residents.” This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
  • [protected-iframe id='e83c763689ad59c2e6d7069299b92a56-7618883-99279322' info='https://www.npr.org/player/embed/520266060/520498675' width='100%' height='250' frameborder='0' scrolling='no'] Many in Texas are keeping a close eye on the Republican bid to replace the Affordable Care Act. One of the big changes is how it would affect low-income people, seniors and people with disabilities who all get help from Medicaid. And Texans on both sides of the political spectrum say the Lone Star State is not going to fare well. As the GOP bill, the American Health Care Act, works its way through Congress, Anne Dunkelberg, with the left-leaning Center for Public Policy Priorities in Austin, said she’s a little stumped. “I have worked on Medicaid and uninsured and health care access issues in Texas for well over 20 years,” she chuckled. She said this bill leaves the fate of some current funding streams unclear, and there’s one pot of money she’s particularly concerned about. Texas has struck deals with the federal government under something known as a 1115 waiver to help reimburse hospitals for the cost of caring for people who don’t have insurance. And Texas has more uninsured residents than any other state. “About half of what Texas hospitals get from Medicaid today comes through payments that are outside from the regular Medicaid program,” she said, which adds up to $4 billion in federal funds every year. But even if Texas gets to keep all that money, there’s another issue — the GOP plan will reduce how much the federal government pays for Medicaid. It will either cap how much money states get for Medicaid from the federal government for every person they cover. That’s called a per-capita cap, and the payments under that formula would start in 2020, but would be based on how much the state spends this year. Or, in line with this week’s modification of the GOP bill, it would let states choose a lump sum, or block grant, also likely to cut the federal support Medicaid gets. Adriana Kohler with Texans Care for Children, an advocacy group based in Austin, said Texas already leaves too many people without care. “Last legislative session there were cuts to pediatric therapies for kids with disabilities enrolled in Medicaid,” she said. The cuts caused some providers to shut their doors, which left some children without services, she said. “That’s why these cuts coming down from the ACA repeal bill are very concerning to us.” In Texas, she said, children, pregnant women, seniors and people with disabilities will bear the brunt of any belt-tightening. These populations make up 96 percent of people on Medicaid in Texas. That’s why, Dunkelberg said, the program as is should not be the baseline for years to come. “They could lock Texas into a lot of historical decisions that were strictly driven by a desire to write the smallest budget possible,” she said. Some on the right agree Texas is getting a raw deal. Dr. Deane Waldman, with the right-leaning Texas Public Policy Foundation, said there are things he likes in the bill. But in general, he said, “it’s bad deal for Texas. It’s a bad deal for the American people.” He said it was the right thing for Texas not to expand Medicaid, but this bill punishes Texas for it. Under the GOP bill, states that expanded Medicaid would get more money. And because the initial Republican bill left the door open for states to expand Medicaid before 2020, he worried more states would do that to get in on the deal. “It’s going to be a huge rush — an inducement to drag in as many people as they can drag in, because the more they can drag in, the more federal dollars they can get,” he said. The GOP’s latest plan, however, makes it impossible for any new states to expand Medicaid and cuts off funding for Medicaid expansion states earlier. This story is part of a partnership that includes KUT, NPR and Kaiser Health News.
  • [protected-iframe id='fd4966220a9dca4784811877a0d1553e-7618883-99279322' info='https://www.npr.org/player/embed/520409187/521056975' width='100%' height='240' frameborder='0' scrolling='no'] Connie Dotts is a big fan of her insurance. “I like that we can choose our own doctors,” said the 60-year-old resident of Mesa, Ariz. “They also have extensive mental health coverage.” Dotts isn’t on some pricey plan, either. She’s among the nearly 2 million people enrolled in Medicaid in Arizona and one of the more than 400,000 who have signed up since the Republican-led state expanded Medicaid in 2014. Her eight prescription drugs are cheap, Dotts said, and she has no copays or premiums. The Medicaid benefits have helped her manage her emphysema, depression and osteoarthritis. But taking care of other problems has to be delayed: “I have torn ligaments in my ankles, and I can’t take the time off work to go to physical therapy or surgery.” Dotts works in retail and lives paycheck to paycheck. Without Medicaid, she said, she wouldn’t be able to afford to see a doctor. “It’s just barely above what they consider livable income. Any extensive medical issues would put an excessive burden on me,” she said. The replacement health plan the GOP leaders are pushing in Congress would gradually cut off the federal funding for Medicaid that expanded eligibility. The bill also bars any additional states from expanding Medicaid immediately. Swapna Reddy, a professor at Arizona State University’s School for the Science of Health Care Delivery, said that as Congress overhauls the health care law, a state like Arizona might particularly suffer. Unlike some states that expanded Medicaid, Arizona saw a rush of people joining the rolls, Reddy says, because it had a “high-need, uninsured” population. The Republican bill would continue to pay the higher federal rates that the ACA’s Medicaid expansion offered people like Dotts, Reddy said — but only if they’re already enrolled in Medicaid, and their personal income stays about the same. “What we know about the Medicaid population is that they kind of fall in and out of eligibility on a regular basis,” she said, because the amount of money they earn tends to fluctuate. “So it has the real potential of eradicating Medicaid expansion over a period of time,” Reddy says. The states and the federal government share the cost of Medicaid. Instead of an open-ended entitlement, the bill making its way through Congress right now would cap the federal government’s contribution or turn it into a block grant. Putting a fixed limit on the federal government’s contribution is unlikely to allow Arizona Medicaid to keep up with the growing cost of covering people, Reddy said. “The states will have to come up with the remaining money to cover these folks,” she said. The Republican health plan would eventually cost Arizona nearly half a billion dollars a year, according to calculations by the state, to keep the adults with the lowest income in the expansion population insured. It’s a group that Arizona voters actually required the state to cover in 2000 through a ballot initiative. But during the recession in later years, financial pressure led state lawmakers to freeze enrollment for those adults. Scaling back Medicaid could be a particularly risky proposition for Arizona, according to the state program’s administrators, because Arizona is already one of the most efficient, lean programs in the country. Getting locked in at the current funding rates would give other states a leg up, said Tom Betlach, who runs Medicaid in Arizona. “If they are able to achieve improved outcomes and reduced costs, they are able to capture those savings,” Betlach said. “Versus we actually get penalized for being a good steward of taxpayer funds.” Betlach said Arizona needs more control than it currently has over who and what types of treatments and procedures are covered if the federal government intends to give Arizona only a fixed amount of cash. The federal fight over health care puts the state’s Republican governor, Doug Ducey, in a tricky situation. Ducey has said he would like the ACA repealed, but he has also said he doesn’t want hundreds of thousands of people to lose coverage. He has expressed concern that the GOP bill doesn’t give the state enough flexibility. And it wasn’t even on Ducey’s watch that Arizona expanded Medicaid. The expansion happened under Jan Brewer, Arizona’s former governor and an ally of President Donald Trump. To pull that off, Brewer had to band together with Democrats and buck some of her fellow Republicans in the state Legislature, who then sued her over the expansion. In their lawsuit, the legislators claimed that the way the state pays its share — a fee on hospitals — is unconstitutional. At a recent court hearing for that long-running lawsuit, Brewer defended her controversial decision to accept the ACA’s expansion funding. “I think it was the right thing to do,” she said in an interview outside the courtroom. “It saved lives. It insured more people. It brought money into the state. It kept rural hospitals from being closed down. And today there are tens of thousands of people that are very, very grateful.” But some Republicans, like state Sen. Debbie Lesko, who was among the Arizona legislators who sued Brewer, figured the day would come when the feds would try to roll back the funding. “I voted against Medicaid expansion, not because I don’t want people to get health coverage,” Lesko said, “but because I’m a realist and I know how much we can afford in our budget.” This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News.

Health Reporter Sabrina Cupit

  • It has been just over a year since we first started hearing about Zika and its link to serious birth defects.   The Emergency Operations Center at the Centers for Disease Control and Prevention in Atlanta was activated to respond to Zika on January 22, 2016. Now the EOC is gearing up for the start of another mosquito season.   Over the past fifteen months the CDC has learned more about the mosquito borne disease. Experts have learned that 11 percent of babies born to mothers with Zika are born with birth defects.  Microcephaly is the main birth defect that is seen. It causes babies to be born with abnormally small heads. Microcephaly is also associated with incomplete brain development.   Dr. Denise Jamieson is chief of the Women’s Health and Fertility Branch at the CDC. She says, “Zika is not over, Zika will be here with us until we have an effective vaccine and all pregnant women are vaccinated.'  She says microcephaly is just the beginning. Zika is also linked to other brain abnormalities, eye defects or central nervous system problems.  “I think it's critical that people understand that we have to continue to be vigilant in our efforts to fight Zika,' Jamieson says.  Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito. These are the same mosquitoes that spread dengue and chikungunya viruses. They are very hard to control. Some experts call them 'the cockroach' of mosquitos.  Zika can also spread through sex from a person who has Zika to his or her partners.  It can be passed through sex, even if the infected person does not have symptoms at the time. Zika can be passed on from mothers to babies in the womb – which leads to babies being born with severe birth defects.  One of the best ways to prevent catching Zika is to prevent being bitten by a mosquito.  As we head into mosquito season the CDC is urging everyone to take steps to protect themselves by wearing insect repellent, long-sleeved shirts and trousers, and avoid travel to areas where the virus is spreading.
  •  That aerosol from e-cigarettes in not harmless, says the Centers for Disease Control and Prevention.   According to new government data, about one in four middle school and high school students say they have been exposed to second hand aerosol from e-cigarettes at least once in the past month. That includes about 4.4 million students who are not currently e-cigarette users.   Overall just over 24 percent of teens reported exposure to aerosol from e-smokes. More girls than boys reported being exposed.  “We know that secondhand e-cigarette aerosol is not harmless,” said Brian King, Ph.D., M.P.H., deputy director for research translation in CDC’s Office on Smoking and Health and a co-author of the study.   “It’s critical to protect our nation’s youth from this preventable health risk.”  The CDC says exposure is avoidable and is calling on more states and communities to consider e-cigarettes in smoke free policies. 
  • A deadly fungal infection is now being reported here in the United States.  The Centers for Disease Control and Prevention says more than 30 people in five states have been diagnosed with the fungus.  It's a strain of a kind of yeast known as Candida auris. Unlike the usual variety of yeast infections, this one causes serious bloodstream infections and it spreads easily from person to person.  There have been cases reported in Illinois, New Jersey, New York, Maryland and Massachusetts.   Tom Chiller with the CDC says, 'So far the patients who are infected with this organism are the sickest of the sick.'  He says because it's a bloodstream infection the patients come down with severe symptoms, like fever, low blood pressure and the organism can invade organs. Most are in hospitals or long term care facilities.  'It is certainly here, but I think it is still very rare,' says Chiller. He adds that they are aggressively working to contain the spread of this nasty invasive yeast. He says the microbe is among a group of newly emerging drug resistant threats we are facing.   The CDC issued an alert about the deadly fungus last June. Since then the government has provided additional funding and experts to help state and regional labs and hospitals identify the organism.

News

  • An off-duty Fulton County police officer shot a man after a chase in Atlanta Wednesday morning, the GBI says. The officer, whose name has not been released, was in his personal vehicle about 11 a.m., when he responded to a theft at a T-Mobile store on Mount Zion Parkway in Morrow, GBI spokesman Rich Bahan said.  The officer followed the suspect’s car into the city limits of Atlanta while reporting the incident to 911, Bahan said. At some point near Alyson Court, the two cars collided and when the driver got out of his car the off-duty officer shot him with his service weapon, Bahan said.   MORE:  Sheriff: Man out on bond for murder arrested after fighting victim’s family Ex-NFL player jailed after allegedly attacking woman in front of kids Police: Men brought ‘bag of bullets’ to shootout with alleged gang members Witness Jay Mitchell told Channel 2 Action News he thinks the man was shot in the stomach area after the police officer chased him and tried to pull him over. The suspect kept driving even after he was shot, Bahan said, and Atlanta police stopped him in the 1700 block of Lakewood Avenue. Whether the off-duty Fulton County officer stayed on the scene was not released, but his car was found parked at a store on Cleveland Avenue, Channel 2 reported. The man who was shot was taken to Grady Memorial Hospital, Bahan said. The shooting is the fourth in less than a week involving a Georgia officer. A Georgia State Patrol trooper fatally shot a man after a chase early Saturday in Polk County. Jason Dennis Watkins, 36, was taken to Polk County Hospital, where he was pronounced dead. RELATED: GSP trooper fatally shoots man after chase Willie Ivy III, 29, of Atlanta, died after a Fulton County police officer and an armed security guard shot him early Saturday in College Park, the GBI said.  RELATED: Man dead in police-involved shooting incident in College Park A Pickens County sheriff’s sergeant on Tuesday shot and critically injured Gary Lee Castle after he “moved aggressively” toward the official “with a large metal pipe in his hand,” the sheriff’s office said. RELATED: Sergeant shoots, critically injures man, Pickens County sheriff says In January and February, the GBI conducted 17 officer-involved shooting investigations, agency spokeswoman Nelly Miles said. RELATED: OVER THE LINE: Police shootings in Georgia The GBI investigated 78 police shootings in the state last year. In other news:
  • A middle school bus driver in the Valdosta area is accused of driving under the influence of alcohol while students were on her bus, according to the Lowndes County sheriff. Amanda Mullinax, 41, registered more than twice the legal limit, Lowndes County Sheriff Ashley Paulk said. A school resource officer at Hahira Middle School smelled alcohol on Mullinax, and a student said she had been drinking, the Macon Telegraph reported. The night before, deputies were called to a domestic dispute at Mullinax’s home and found she had been drinking heavily, Paulk said. RELATED: School bus driver charged in accident that injured child She could face multiple counts of child endangerment since there were about 44 students on the bus, the newspaper reported. Read more of the story here. In other news:
  • U.S. Supreme Court nominee Neil Gorsuch vowed to uphold the law if confirmed to the nation’s highest court, not tipping his hand as he sidestepped controversial political subjects, as Gorsuch directly pushed back against President Donald Trump’s criticism of federal judges. “When anyone criticizes the honesty or integrity, the motives of a federal judge, I find that disheartening; I find that demoralizing,” Gorsuch said in response to questions from Sen. Richard Blumenthal (D-CT). “Anyone including the President of the United States?” Blumenthal pressed. “Anyone is anyone,” Gorsuch replied. In a day of testimony that stretched for almost twelve hours, Gorsuch parried most questions from Democrats, who tried in vain to get him to reveal his views on issues like abortion, and items that might come before the Supreme Court, like President Trump’s travel ban. Gorsuch repeatedly refused to take the bait. “I can’t get involved in politics, and I think it would be very imprudent of judges to start commenting on political disputes,” Gorsuch said. Under questioning from Sen. Lindsey Graham (R-SC), Gorsuch was asked what he had discussed with President Trump on the issue of abortion. “In that interview did he ever ask you to overrule Roe v Wade?” Graham asked. “No, Senator,” Gorsuch replied, adding that if the President had asked that question, “I would have walked out the door.” Gorsuch was pressed about the President in a number of different ways, telling Sen. Patrick Leahy (D-VT) that, “nobody is above the law in this country, and that includes the President of the United States.” With Republicans strongly in support of Gorsuch, there was already maneuvering behind the scenes over the expected floor fight in the Senate, as Democrats have made clear they think the GOP should be forced to get 60 votes for his nomination. That has prompted GOP leaders to criticize the threat of a filibuster. “If there aren’t 60 votes for a nominee like Neil Gorsuch it’s appropriate to ask the question is there any nominee any Republican president could make that Democrats would approve,” said Senate Majority Leader Mitch McConnell. Gorsuch’s lengthy day of testimony ended on a light note, as Sen. John Kennedy (R-LA) suggested to Gorsuch that he have a cocktail before bed. “Just don’t drink vodka,” Kennedy said to chuckles from the audience. Kennedy then drew even more laughter by adding in one more surprise. “You never been to Russia, have you?” “I’ve never been to Russia,” a smiling Gorsuch said.
  • Donald Trump Jr. is facing criticism for tweeting in the hours after Wednesday's London attack a months-old comment from London Mayor Sadiq Khan that terror attacks are part of living in a big city. Trump Jr. tweeted : 'You have to be kidding me?!: Terror attacks are part of living in big city, says London Mayor Sadiq Khan.' The tweet included a link to a Sept. 22 story from Britain's Independent newspaper that includes the quote from Khan, who was asking Londoners to be vigilant following a bombing in New York City. British Member of Parliament Wes Streeting was among numerous Britons who responded to the tweet with criticism. He called Trump Jr. 'a disgrace' and accused him of using a terrorist attack for 'political gain.' When asked about Trump Jr. on Thursday, Khan told CNN: 'I'm not going to respond to a tweet from Donald Trump Jr. I've been doing far more important things over the past 24 hours.' He added that 'terrorists hate the fact' that cities including London, New York and Paris have 'diverse communities living together peacefully.