National News Content

Partial eclipse draws crowds early Thursday morning

WXXI US News - Thu, 06/10/2021 - 7:18am
Did you get to see it? The Rochester area and much of the U.S. was treated to a partial solar eclipse at sunrise Thursday morning, when 78% of the sun was obscured by the moon, creating a crescent sunrise effect. Astronomy fans gathered at several locations around greater Rochester to watch through eclipse glasses and filters. Dan Schneiderman of the Rochester Museum & Science Center organized a viewing party at Martin Road Park in Henrietta that drew a surprisingly big crowd. "I would say over 200 people. We even ran out of solar filter glasses, which I was not expecting. This is quite the crowd to see, I could not be any more pleased at how many people came out," Schneiderman said. Among the group at Martin Road Park was a group of U of R physics students, including Mary McMullin. "It's as if it's a crescent moon, but it's orange through glasses, and it's cool...I can't say if it feels dimmer, but it could very well be, I don't know,” McMullin said. If you missed Thursday’s solar

Indian Affairs Promised To Reform Tribal Jails. We Found Death, Neglect And Disrepair

WXXI US News - Thu, 06/10/2021 - 6:32am
This story was supported by the Pulitzer Center on Crisis Reporting. When police took Carlos Yazzie to jail on the Navajo Nation in New Mexico after his arrest on a bench warrant in January 2017, he needed immediate medical attention. His foot was swollen and his blood alcohol content was nearly six times the legal limit. But law enforcement decided that he was fine, jail records show. They put Yazzie in a cramped isolation cell at the Shiprock District Department of Corrections facility instead of taking him to a hospital and then left him unmonitored for six hours without periodic staff checks as required, according to an investigative report. When a guard handing out inmate jumpsuits the next morning stopped at Yazzie's cell, the 44-year-old day laborer was dead. It would later be determined in an autopsy that he died from acute alcohol poisoning, which is easily treatable by medical professionals, experts said. "These correctional officers are basically holding these lives in their

Keystone XL Pipeline Developer Cancels Project, Ending Decade-Long Battle

WXXI US News - Thu, 06/10/2021 - 6:32am
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The U.S. Capitol Police Are Adding An Emotional Support Dog To The Force

WXXI US News - Thu, 06/10/2021 - 6:20am
The U.S. Capitol Police have added a four-legged officer to their ranks. Two-year-old Lila, a black Labrador retriever, will serve as the department's full-time emotional support animal. "We are thrilled to welcome the newest member of our Department!" the announcement said. Lila joins the force several months after the Jan. 6 insurrection at the Capitol. The chaos of that day left more than 100 officers injured. Officers have reported stress, anxiety and other emotional issues following the insurrection. They've also complained of not having enough support from the department — as well as lawmakers they protect. USCP Officer Brian Sicknick died the day after the Jan. 6 riot from natural causes after suffering strokes. Two other officers, one from the Capitol Police and another from the D.C. police, died by suicide days after. Lila U.S. Capitol Police Lila's first day on the job will be July 5. If you or someone you know may be considering suicide, contact the National Suicide

El Chapo's Wife Is Expected To Plead Guilty To Helping Run The Global Drug Cartel

WXXI US News - Thu, 06/10/2021 - 6:00am
Emma Coronel Aispuro, the wife of Mexico's most notorious drug kingpin, Joaquin "El Chapo" Guzmán, is expected to plead guilty Thursday to helping him run the powerful Sinaloa cartel and aiding in his dramatic escape from a Mexican prison. Coronel was captured and arrested by U.S. officials as she arrived at Dulles International Airport in Virginia in February. The former beauty queen faces charges of participating in a conspiracy to distribute cocaine, methamphetamine, heroin and marijuana for importation into the U.S., according to the Justice Department. Investigators also allege that Coronel played a key role in Guzmán's 2015 prison break when he got out of Altiplano prison via an underground tunnel connecting a hole under his prison cell shower to a nearby warehouse stocked with guns and armored cars. According to court documents, she also tried to organize a second escape after the drug boss was imprisoned a year later. El Chapo's reign of terror put him in Supermax Guzmán

How Bitcoin Has Fueled Ransomware Attacks

WXXI US News - Thu, 06/10/2021 - 5:59am
The problem has long plagued bank robbers and drug smugglers: how to transport and hide huge sums of ill-gotten gains without getting caught? In the past few years, ransomware hackers have found an almost perfect solution — cryptocurrencies like Bitcoin. It's fast. It's easy. Best of all, it's largely anonymous and hard to trace. In the latest example, the world's largest meat processor, JBS, announced Wednesday night that it recently paid $11 million in Bitcoin after a cyber attack forced the shutdown of its plants in the U.S., Canada and Australia. The FBI has blamed the attack on a Russian criminal gang. "You now have a possibility to move millions of dollars worth of cryptocurrency across national boundaries in seconds," said Yonatan Striem-Amit , a co-founder of Cybereason, a Boston-based company that offers protection from hackers. "It really is a very powerful tool in the hands of criminals to perform money laundering, to shift currency from one state to another in a way that's

Millions Could Face Eviction With Federal Moratorium Ending And A Logjam In Aid

WXXI US News - Thu, 06/10/2021 - 5:39am
Mehran Mossaddad has spent much of the pandemic scared and lying awake at night. He's a single dad with an 10-year-old daughter living outside Atlanta. "I get panic attacks not knowing what's in store for us," he says. "I have to take care of her." Mossaddad drives Uber for a living, but when the pandemic hit he stopped because he couldn't leave his daughter home alone. As a result, he's fallen more than $15,000 behind on his rent, and his landlord has filed an eviction case against him. So back in March, when a federal moratorium on evictions got extended, and he heard Congress had approved nearly $50 billion for people to catch up on rent and avoid eviction, Mossaddad thought help was on the way. "I do believe in miracles," he told NPR back then. ""It is a relief." Now Mossaddad's miracle is evaporating. He applied for the federal aid, and was approved. But he and his legal-aid lawyer say the county where he lives caps the amount anyone can receive for back rent at just 60% of what's

A Growing Number Of Critics Raise Alarms About The Electoral College

WXXI US News - Thu, 06/10/2021 - 5:36am
It's hard to make an intellectual argument in favor of the Electoral College. Most people feel that the person who gets the most votes should become president. After all, that's how we run every other election in this country, says Jesse Wegman, the author of Let the People Pick the President . "If anything, representative democracy in the 21st century is about political equality. It's about one person, one vote — everybody's vote counting equally," he said. "You're not going to convince a majority of Americans that that's not how you should do it." Another way the Electoral College is unfair, says Harvard University political scientist Gautam Mukunda, is that each state gets electors based on its representation in the House and Senate, which means small states get extra votes. "The fact that in presidential elections people in Wyoming have roughly 44 times the power of people in California is antithetical at the most basic level to what we say we stand for as a democracy," he said.

Inflation Is Surging. The Price Of A Toyota Pickup Truck Helps Explain Why

WXXI US News - Thu, 06/10/2021 - 5:36am
Updated June 10, 2021 at 9:56 AM ET Prices for a lot of things are surging across the U.S., and John McConnell's recent car-shopping experience helps explain why. McConnell, from Colorado Springs, Colo., was recently looking for a Toyota Tacoma to replace his two-year-old Nissan Altima and was shocked to see the one he wanted priced several thousand dollars above the sticker price. He plans to buy it anyway. "I'm not going through a midlife crisis. I just kind of have an itch for this," McConnell says. "I'm willing to pay a little bit more right now, I guess, because right now I can afford to." After a year of the coronavirus pandemic, McConnell was itching to go camping more and do more outdoor activities. And like many Americans who were able to continue working through the pandemic, he had the money. "You know a little Nissan is not going to cut it on a lot of the roads around here during the winter," he explains of his decision to upgrade. The Labor Department says consumer prices

Child Labor Surges For The First Time In 20 Years. The Pandemic May Make That Worse.

WXXI US News - Thu, 06/10/2021 - 5:21am
In 2020, the world marked a rise in child labor for the first time in two decades. Additionally, with the coronavirus pandemic upending economies and closing schools, the United Nations believes by 2022, the problem will get much worse. An estimated 160 million children were involved in child labor around the world at the beginning of 2020--an increase of 8.4 million in four years, according to a new report by the UN and the International Labour Organization (ILO) . About half of those children were involved in hazardous work, like mining and farm work, that directly endangered their health and safety. Children between the ages of five to 11 now account for just over half of the total global figure. "The new estimates are a wake-up call. We cannot stand by while a new generation of children is put at risk," ILO Director-General Guy Ryder said in a statement. COVID-19 has already been linked to children working longer hours or under worsening conditions because of job and income losses

The Controversial Arizona Election Review Is Drawing Republicans From Around The U.S.

WXXI US News - Thu, 06/10/2021 - 5:01am
Republicans from a growing number of states are traveling to Maricopa County in Arizona to witness a controversial election review ordered by GOP leaders in the state Senate, a sign that similar probes may be sought elsewhere across the country. The Arizona review has the full-throated support of former President Donald Trump, who continues to make baseless claims about a stolen 2020 election. Last week, three Pennsylvania legislators toured Veterans Memorial Coliseum in Phoenix, where a hand recount of the 2020 election results in Maricopa County has been underway since late April. On Monday, officials with the Nevada Republican Party toured the recount and met with Cyber Ninjas, a Florida-based cybersecurity firm critics warn is unqualified to review the election and is run by a CEO who's spread conspiracies of election fraud. A day later, two Republican state senators from Georgia took a similar tour alongside a state representative from Alaska. So did David Shafer, chairman of the

What Causes The Northern Lights? Scientists Finally Know For Sure

WXXI US News - Thu, 06/10/2021 - 5:00am
Nothing can ruin our joy in the aurora borealis, or northern lights , those ribbons of blue, green and violet light that cascade from the sky. Not even knowing for sure what causes them. Physicists have long speculated about what gives rise to this very specific light phenomenon that occurs in the Earth's polar regions. Now they're certain. An article published in the journal Nature Communications this week suggests that the natural light show starts when disturbances on the sun pull on Earth's magnetic field. That creates cosmic undulations known as Alfvén waves that launch electrons at high speeds into Earth's atmosphere where they create the aurora. "It was sort of theorized that that's where the energy exchange is occurring," said Gregory Howes, associate professor of physics and astronomy at the University of Iowa. "But no one had ever come up with a definitive demonstration that the Alfvén waves actually accelerate these electrons under the appropriate conditions that you have in

Can a Subscription Model Fix Primary Care in the US?

Latest Updates From Kaiser Health News - Thu, 06/10/2021 - 5:00am

In April, San Francisco-based primary care company One Medical revealed an eye-popping compensation package for its chief executive and chairman, Amir Dan Rubin. His $199 million payday, particularly noteworthy at a company that has yet to turn a profit, made Rubin the second-highest-paid CEO in the United States last year — but only on paper.

About $197.5 million of his pay is in stock options. For Rubin to get all that cash, the stock of One Medical, traded as 1Life Healthcare, must rise sharply over the next seven years, to nearly triple its current price.

In short, his compensation is less a quick jackpot than a general statement of One Medical’s ambitious vision of primary care that is more accessible, technologically enabled and patient-friendly, while cutting health costs for employers and individuals.

Loads of other firms, ranging from small start-ups to larger, more established companies, are selling similar concepts of new and improved primary care.

Some offer it directly to individuals; others target Medicare enrollees. Perhaps the most promising customers are employers, who insure an estimated 157 million U.S. workers and their dependents, and have long been frustrated with spotty primary care and perpetually rising health costs.

The “direct” primary care companies, as they are often called, face stiff competition from one another as well as the large regional health systems and their affiliated physician groups, which still dominate the field.

Analysts say these emerging primary care companies have significant room for growth because of mounting frustration with the medical status quo and because they currently have only a tiny share of the $260 billion U.S. primary care market.

“I think that, ultimately, they’re going to grow in acceptance and accumulate patients and attract clinicians that want to provide a different level of care,” said Richard Close, managing director of health equity research at Canaccord Genuity in Nashville, Tennessee. But he added that “all of these companies combined could grow very significantly and just put a dent in the overall system.”

Also vying for a share of the primary care market are urgent care centers and walk-in clinics at retailers such as Target and pharmacies such as  CVS, in addition to telehealth companies like Teladoc and Doctors on Demand.

In a sharp reminder of the competitive challenges ahead, the share prices of One Medical and Teladoc sank in mid-March after Amazon announced plans to begin offering its telehealth and home visit service as an employee benefit nationwide.

“Amazon is a threat, because Amazon knows how to appeal to consumers,” said Gary Kurtzman, a Wharton Business School lecturer and managing director of Prostasia Health, a health tech investment advisory firm.

The appeal of these companies has grown as employers increasingly seek to address a shortage of high-quality primary care and reduce spending on the health of their workforce, said Ellen Kelsay, CEO and president of the Business Group on Health, which represents large employers.

Studies show a strong correlation between access to primary care and lower spending on expensive medical services such as ER visits, surgeries and hospital admissions. Yet in the United States, primary care accounts for only around 5% to 7% of total health spending, compared with 14% in the 36 member nations of the Organization for Economic Cooperation and Development.

The big bet of One Medical and companies like it is that greater spending on primary care will fatten their bottom lines while reducing overall health costs for their clients.

A study published last year in JAMA Network Open showed that employees of Hawthorne, California-based SpaceX who got most of their primary care at One Medical’s on-site health clinic generated 109% more in spending on primary care but 45% less on health care overall than those who used One Medical infrequently or not at all.

These direct primary care companies typically offer a digital platform as the first point of contact, which enables members to make appointments and text, email or video chat 24/7 with their medical providers.

They wed that technology to brick-and-mortar clinics staffed by doctors, nurse practitioners and medical staff, where members can go for checkups, prescription drugs, lab tests, scans, vaccinations, physical therapy and mental health visits. The patients generally get more time with their providers than in a traditional medical office.

One Medical’s focus is improving health care for “multiple stakeholders simultaneously,” Rubin said in a recent interview with KHN. “How do we delight consumers, serve employers and payers? How do we make medicine the best environment for providers to work in?”

Part of the company’s answer is to put doctors on salary rather than paying a fee for every visit. That eliminates the pressure to book a lot of visits, which Rubin said helps physicians spend more time with each patient.

One Medical will offer its combination of telehealth and in-person visits in 22 metropolitan areas around the United States within a year or so, up from nine in 2020, Rubin said. It had nearly 600,000 members at the end of March, up 31% from a year earlier. When One Medical started in 2007, it sold only individual memberships, for which it currently charges $199 a year. But it has since moved increasingly into the employer market. Anecdotally, its patients are happy with the care they get.

“One Medical says your appointment is at 10 a.m., and my nurse practitioner is walking out at 10 a.m. to get me,” said Kathleen Wiegand, 63, a One Medical member in Washington, D.C. “I’ve never had to wait for an appointment.”

Brentwood, Tennessee-based Premise Health is the biggest player in the employer segment of the direct care market, with over $1 billion in annual revenue, 11 million employer-sponsored members via 1,600 large corporate and municipal employers and about 850 health centers. Most of those centers are at the worksites of its corporate and local government customers.

“Our bet going forward is that it’s the combination of digital and physical access that will drive sustained value and better experience for the member, instead of pure digital or pure physical,” said Jami Doucette, president of Premise.

Doucette said his company provides an entry point to medicine that is “an alternative to primary care physicians owned by hospitals who are driven by volume of expensive procedures.”

Eden Health, a start-up headquartered in New York City, provides a similar service to small and midsize employers, and is also contracting directly with commercial real estate companies that want to provide on-site medical facilities for the businesses that are their tenants.

As the pandemic eases and many workers return to offices with safety on their minds, providing on-site medical care can help commercial landlords command higher rents, said Matt McCambridge, Eden Health’s 29-year-old co-founder and CEO. “What the landlords are trying to do is craft an amenity package that allows them to be a class-A, high-end location, and health is really a key part of that,” he said.

San Francisco-based start-up Forward Health, on the other hand, markets itself exclusively to individuals. It charges a flat monthly fee of $149 for access to digital health, in-person visits and technology the company says can scan for signs of skin cancer, perform genetic analyses and return comprehensive blood test results in 12 minutes.

While positioning themselves as “disrupters” in an industry that emphasizes volume of services over health, many direct care companies nonetheless participate in the networks of their members’ health plans, and some receive fee-for-service payments from those plans.

One Medical, for example, gets about 37% of its revenue from such payments.

“That’s just the way the U.S. health system is organized. If you want to easily serve people, you say, ‘Hey, I accept your insurance.’ And if you want to easily serve employers, you say, ‘I’m in your network,’” Rubin said.

“But the powerful thing is that without changing how the system pays, we can still reduce the cost of care,” he added. “We don’t have to wait for some mythical unicorn of a reimbursement system to get these kinds of results.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: National News Content

Lawmakers Pressure Newsom to ‘Step Up’ on Racism as a Public Health Issue

Latest Updates From Kaiser Health News - Thu, 06/10/2021 - 5:00am

SACRAMENTO — After the killing last year of George Floyd, a Black man, by a white Minneapolis police officer, Wisconsin Gov. Tony Evers declared racism a public health crisis. The governors of Michigan and Nevada quickly followed, as have legislative bodies in Minnesota, Virginia and Washington, D.C.

Yet California Gov. Gavin Newsom, who governs one of the most racially and ethnically diverse populations in the U.S., has not.

State Democratic lawmakers are not waiting for Newsom to make a declaration and are pressuring the first-term Democrat to dedicate $100 million per year from the state budget, beginning July 1, to fund new health equity programs and social justice experiments that might help break down systemic racism. Possibilities for the funding include transforming parking lots in low-income neighborhoods into green spaces and giving community clinics money to distribute fresh fruit and vegetables to their patients.

Lawmakers say covid’s disproportionate impact on California’s Black and Latino residents, who experienced higher rates of sickness and death, makes their request even more pressing.

“Covid uncovered the disparities of the segregated California of the past that still has an effect today, and that we can correct if we focus on equity,” said Assembly member Mike Gipson (D-Carson), who is spearheading the funding push. “We need to build a healthier society that works for everyone.”

Lawmakers are lobbying for the money in their negotiations with the governor over the 2021-22 state budget. The legislature must pass a budget bill by June 15 for the fiscal year beginning July 1. Once Newsom receives the bill, he has 12 days to sign it into law.

The $100 million proposal to address the health effects of racism is part of the Democratic-controlled legislature’s broader public health agenda that includes a request for $235 million annually to help rebuild gutted local public health departments, $15 million per year for transgender health care and $10 million to establish an independent “Office of Racial Equity,” which would attempt to identify and address racism in state spending and policies.

Health care advocacy groups say the investments are critical to address inequality in society and the health care system that has contributed not only to higher rates of covid within disadvantaged communities, but also chronic diseases like diabetes and heart disease.

“Those who got sick and lost jobs were mostly communities of color, so seeing no new investment from the governor to really tackle racial equity is unconscionable,” said Ronald Coleman, managing director of policy for the California Pan-Ethnic Health Network, which sent Newsom a letter last July asking him to declare racism a public health crisis.

Newsom hasn’t committed to supporting the funding but said he’d be “very mindful” in negotiations with lawmakers. One proposal Newsom and state lawmakers agree on is funding for a chief equity officer to address racial disparities within state government.

Newsom pointed to other budget proposals he has made, including $600 economic stimulus payments to households earning less than $75,000, rent and utility bill assistance, and an expansion of the state’s Medicaid program for low-income residents, called Medi-Cal, to unauthorized immigrants age 60 and older.

Dr. Georges Benjamin, executive director of the American Public Health Association, said George Floyd’s killing in May 2020 motivated state and local lawmakers to look at racism through the lens of public health — which could have helped save lives during the covid pandemic. “We’re at a tipping point,” Benjamin said. “It’s important to first acknowledge that racism is real, but then it requires you to do something about it. We’re now seeing other states beginning to put money and resources behind the words.”

Some cities and counties in California have declared racism a public health crisis, including Los Angeles and San Bernardino County. But those declarations would be more meaningful backed by an infusion of state resources, health care advocates say.

“We need to be willing to put dollars into innovative approaches to addressing racism in the same way we invest in stem cells, and we need to be willing to accept that some of the things we try will work and some won’t,” said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic Health Network.

Should Newsom sign off on the funding, grants would be available to health clinics, Native American tribes and community-based organizations to develop programs aimed at combating racism and health disparities.

The Community Coalition in South Los Angeles, a nonprofit that originally set out decades ago to address the crack epidemic, expressed interest in applying.

“There are so many vacant lots in South Los Angeles that could be turned into mini-parks. That helps not only with physical health but mental health,” said Marsha Mitchell, the organization’s communications director. “We have very few grocery stores, and if you live in Compton or South Los Angeles, your life expectancy is almost seven years lower than if you lived in Santa Monica, Beverly Hills or Malibu.”

Directing more resources to address racism could backfire, in part because voters, including some Democrats, have displayed skepticism over some of the liberal and expensive policies sought by Democrats who control Sacramento, said Mike Madrid, a Sacramento-based Republican political consultant who has also worked for Democrats.

He pointed to Proposition 16, the November 2020 ballot initiative that would have repealed California’s 1996 law banning affirmative action, which was defeated 57% to 43%.

“Racism is very much a public health problem — just look at the chronic diseases and lower life expectancies of Black and brown people, and most people believe that racism is systemic in our governance,” Madrid said. “But voters are becoming more discerning about how racism is being used by politicians to advance an agenda.”

Focusing too heavily on racism could prompt a backlash, he said, “whereas if you focused on poverty and inequality, that would solve many of the racial problems.”

But state Sen. Richard Pan (D-Sacramento), who is leading the drive to establish an Office of Racial Equity, said funding and state leadership focused intensely on structural racism are essential to ending it. Should the office not be funded in the budget, Pan said he’d press forward with a bill.

The office would work with the state’s new chief equity officer to examine the California government, including state hiring practices, proposed legislation and budget spending decisions, for evidence of racism or inequality.

It’s a priority for the legislature’s Asian & Pacific Islander Legislative Caucus, given the rise in hate crimes perpetrated against people of Asian descent, Pan said.

“We need to invest more in prevention,” Pan said. “The state needs to step up and support communities of color.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: National News Content

New Montana Laws Enshrine Health Care Alternatives, for Better or Worse

Latest Updates From Kaiser Health News - Thu, 06/10/2021 - 5:00am

When Paul Rana’s primary care physician left the VA clinic in Kalispell to open her own practice, he followed her. But instead of picking up a new health insurance policy, Rana and his partner agreed to pay a monthly fee that came with the promise of better access.

Their provider, Dr. Lexi Tabor-Manaker, opened Glacier Direct Primary Care clinic in 2018. The model known as DPC, which can also stand for direct patient care, furnishes basic health care to patients for a set fee, often billed monthly like a subscription. The arrangement offers patients unlimited access to their doctors and allows them to communicate by phone or email. But the costs are all out-of-pocket.

“We have been pleased to be able to communicate with her instantly without going through an administrative gauntlet,” as he might with the Department of Veterans Affairs, Rana said.

Direct primary care practices have been emerging around the country, but they are often criticized for not offering the patient safeguards of traditional insurance. State legislators this year, however, sought to preserve the approach and passed two new laws that prohibit direct primary care practices or health care sharing ministries — religious or ethical groups whose members pool money to cover medical costs — from being regulated as insurance.

Such arrangements, according to supporters, afford greater flexibility and lower costs for health care compared with traditional health insurance. Without these laws, “a future commissioner of insurance may deem them to be insurance and require them to come under the health insurance regulatory scheme, thus destroying their value and defining characteristics,” said Sen. Tom McGillvray (R-Billings), sponsor of the bill on health care sharing ministries.

Lack of regulation comes with risks. Patients in direct primary care and health care sharing ministries mostly miss out on consumer protections mandated by the Affordable Care Act, such as coverage of preexisting conditions and prohibitions against charging more based on gender.

Some health care sharing ministries have developed into large nationwide organizations, such as Medi-Share and Trinity HealthShare. Critics of that model say the unregulated ministries aren’t required to cap out-of-pocket costs or pay claims and can refuse coverage for certain treatments. They can also have annual and lifetime benefit caps.

In Montana, a pastor filed a lawsuit in 2007 after Medi-Share refused to pay for expenses for a member’s heart condition. A state judge ruled the group was selling insurance without registering in the state, effectively banning health care sharing ministries. That changed in 2017 when Matthew Rosendale, then insurance commissioner, declared the programs weren’t health insurance and could operate in the state.

McGillvray’s bill cements Rosendale’s ruling into state law.

Eight direct primary care facilities operate in Montana with out-of-pocket fees that typically range from $70 to $120 per month for an adult, according to DPC Frontier.

Supporters of direct primary care said the model lets doctors spend more time with patients. Physicians told lawmakers that when working with traditional insurance plans they might spend a significant chunk of their days on administrative tasks instead of patient care, according to Sen. Cary Smith (R-Billings), sponsor of the direct primary care bill.

That bill allows for any form of health care practice — therapists, dentists, physical therapists, etc. — to operate under the direct primary care model.

Direct primary care agreements don’t cover hospital visits, prescription drugs, surgery or specialized care, such as cancer treatment. Providers and supporters recommend people sign up for health insurance to cover those costs.

Another criticism, one leveled by traditional health insurers, is that the monthly fee often doesn’t save people money. Patients would have to go to the doctor several times a year to make the direct primary care monthly payments worthwhile, and people usually don’t make that many visits, said Richard Miltenberger, CEO of Mountain Health Co-Op, a nonprofit health insurance cooperative that sells health insurance in Montana, Idaho and Wyoming.

“So, it’s actually often, for many consumers, more cost-effective to just pay for the service [that isn’t covered by insurance] when you utilize it, as you utilize it, as opposed to paying a monthly membership fee,” Miltenberger said.

Rana, a retired Army veteran who lives in Woods Bay, doesn’t fully depend on direct primary care for his health care. He still uses the VA clinic for regular checkups. He also has Medicare and Tricare — a health program for military members and their families — for larger procedures he gets outside of the VA, such as when he had knee surgery in 2020.

But his first stop when he noticed something wrong with his knee was with Tabor-Manaker, who saw him quickly and referred him to a specialist. That makes the expense worth it, he said.

“I knew going in that this was all out-of-pocket for me, and I accepted that because the quality of service is far greater in its value to me than the hundred bucks a month,” Rana said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

Categories: National News Content

Change to Gilead Assistance Program Threatens PrEP Access, HIV Advocates Say

Latest Updates From Kaiser Health News - Thu, 06/10/2021 - 5:00am

Dr. John Carlo is concerned that patients at Prism Health North Texas who rely on the health care safety net will soon be struggling even more to stay on PrEP, a medication that prevents HIV transmission.

Carlo, chief executive officer of the clinic, which runs three locations in Dallas, offers free PrEP to roughly 250 patients, he said, thanks to an assistance program run by Gilead Sciences. The drugmaker currently manufactures two PrEP medications.

The program also helps Carlo generate money to cover the care people on the medication need, like regular doctor visits and lab tests.

Without Gilead’s help, Carlo said, “none of these people would be in care with us.”

Nationwide, safety-net clinics like Prism Health North Texas rely on Gilead’s Advancing Access Patient Assistance/Medication Assistance Program to fund services that keep patients in need HIV-negative.

In April, Gilead announced it will change how much it reimburses through that assistance program. For pharmacies that contract with certain safety-net clinics, like Prism Health, the change means less reimbursement cash to pass along to the clinics.

The domino-like impact of the company’s move means Prism Health may lose between $2 million and $3 million annually, Carlo estimated.

The Advancing Access program offers free medicine to the uninsured. In the simplest terms, pharmacies dispense Gilead’s drugs at no charge to qualifying patients. The pharmacies then file claims with Gilead, which reimburses them.

Shannon Stephenson, who runs a network of safety-net clinics called Cempa Community Care in Chattanooga, Tennessee, said the new policy means she will have to work with a tighter budget and find another way to afford the nearly $2,000 in yearly medical services alone each patient on PrEP needs.

“It could really cause a shift in what HIV looks like in the future,” Stephenson said. “This is not the time to be creating any more barriers to getting people into care.”

Coy Stout, Gilead’s vice president of U.S. commercial access and reimbursement, said that before it changed its policy the company did not know safety-net clinics relied on this money to fund critical services.

Gilead announced the change after discovering it was reimbursing pharmacies at a higher price than what most of them were spending to replace the drugs.

The company declined to tell how much money it will save, but Stout said the move will help keep the aid program sustainable.

In 2020, according to a Gilead press release, the company earned $24.4 billion in product sales.

“This is a program to provide free medication,” Stout said, “not free medication and other services.”

Currently, the drug company reimburses pharmacies the retail price of the drugs. For HIV prevention medications, the cost is substantial. Gilead’s PrEP medicines, Truvada and Descovy, cost more than $1,800 for a 30-day supply, said Sean Dickson, director of health policy at the West Health Policy Center.

In 2022, Gilead will give pharmacies “the amount paid” for each bottle of medicine. Certain safety-net clinics will be harmed by the change because they participate in a separate program called 340B.

The federal program requires pharmaceutical companies to sell their medications to safety-net providers at a discount. Although the size of the discounts the drugmakers offer is confidential, the government estimates they range from 25% to 50%.

In short, that means clinics that participate in the 340B program will be reimbursed for the discounted price of the drug, which will cut how much they can pocket from the Advancing Access program.

Dickson said the amount clinics keep from Gilead’s aid program is a critical source of revenue to pay for services and medicines for patients in need who can’t get them otherwise.

“These really are needy populations that are being served by them,” Dickson said.

Clinics that participate in the 340B program play a crucial role in treating patients at risk of contracting HIV, said Tim Horn, director of health care access for NASTAD, the National Alliance of State and Territorial AIDS Directors.

He’s particularly concerned about providers in the South, where rates of HIV and the uninsured are among the nation’s highest. The region accounted for over half of all HIV diagnoses in 2018, the Centers for Disease Control and Prevention reported.

Small, grassroots clinics in the South are “gonna live or die by the 340B savings,” said Horn.

The financial upheaval of Gilead’s change in reimbursement adds fodder to larger questions about the 340B program as a viable source of funding for PrEP services.

Several drugmakers have recently released generic PrEP medicines priced significantly lower than Gilead’s brand-name offerings. Dickson said lower drug prices are a positive development for patients because it makes health care more affordable for everyone.

However, he added, transitioning to generic PrEP would prevent 340B clinics from generating money off the drug company’s aid.

That said, relying on high drug pricing to fund the nation’s safety net “is not a sustainable path forward,” said Dickson. “We actually need to pay for things that work rather than paying too much for prescription drugs.”

KHN senior correspondent Sarah Jane Tribble contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

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