�������ýҕ�l

Even as the Affordable Care Act remains a political flash point, new research shows it is dramatically improving poor patients’ access to medical care in states that have used the law to expand their Medicaid safety net. After just two years of expanded coverage, patients in expansion states are going to the doctor more frequently and having less trouble paying for it. At the same time, the experience in those states suggests better access will ultimately improve patients’ health, as patients get more regular checkups and seek care for chronic illnesses such diabetes and heart disease. (Levey, 8/8)

A new study finds that ObamaCare’s Medicaid expansion led to gains in access to healthcare in two Southern states. The study, published in the Journal of the American Medical Association, finds that patients fared better in Kentucky and Arkansas — two states that accepted the expansion of Medicaid — compared to Texas, which has rejected it. (Sullivan, 8/8)

There is little doubt that the expanded Medicaid program for low-income adults under the Affordable Care Act is proving to be far more costly than originally billed by the administration. The latest Medicaid actuarial report issued late last month pegged the per enrollee cost for adults at $6,366 in 2015, up 49 percent from previous estimates. Over the coming decade, Medicaid outlays through this program will be nearly $250 billion higher than previous actuarial projections. That trend could pose serious financial challenges for the federal government, which is currently footing the cost, and the more than 30 states that have opted into the program so far that eventually must pick up ten percent or more of the overall cost of the expanded health insurance. (Pianin, 8/8)

For each dollar that Georgia would have to spend on Medicaid expansion, it would gain $8.68 to $9.42 in federal spending, a new study said Monday. The report from the Urban Institute analyzes the potential costs and benefits for the 19 states (including Georgia) that have not expanded Medicaid under the Affordable Care Act. If all those states expanded Medicaid this year, they could see a collective net increase in federal funding from years 2017 to 2026 of up to $462 billion, versus a cost of $56 billion, the study said. (Miller, 8/8)

In an effort to prevent more insurers from abandoning the Obamacare exchange in Tennessee, the state's insurance regulator is allowing health insurers refile 2017 rate requests by Aug. 12 after Cigna and Humana said their previously requested premium hikes were too low. Cigna and Humana filed to increase last year's premiums an average of 23 and 29 percent, respectively, on June 10. (Fletcher, 8/8)

As college students and their parents finalize their enrollment and pay tuition and fees for fall, many face one fewer headache than in years past: no more worrying about whether they’ve waived the optional health-insurance coverage in time to avoid being charged for it. In large part because of changes brought by the federal Affordable Care Act, a number of colleges have stopped providing student health insurance. (Edwards, 8/9)

With Donald Trump's presidential campaign faltering, Republican health policy experts are gaming out Plan B for working with a Hillary Clinton administration to achieve conservative healthcare goals. Their focus is on a possible “grand bargain” that would give conservative states greater flexibility to design market-based approaches to make coverage more affordable and reduce spending in exchange for covering low-income workers in non-Medicaid expansion states. (Meyer, 8/6)

Republican presidential candidate Donald Trump claimed in an economic speech Monday that his proposal to repeal the Affordable Care Act would “save” 2 million American jobs. But there are serious problems with that statement. The Congressional Budget Office tentatively projected in early 2014 that the ACA would reduce the total number of hours Americans work by 1.5% to 2% between 2017 and 2024—“almost entirely because workers will choose to supply less labor—given the new taxes and other incentives they will face and the financial benefits some will receive.” (Meyer, 8/8)

Federal health regulators have announced plans to crack down on nursing home employees who take demeaning photographs and videos of residents and post them on social media. The move follows a series of ProPublica reports that have documented abuses in nursing homes and assisted living centers using social media platforms such as Snapchat, Facebook and Instagram. These include photos and videos of residents who were naked, covered in feces or even deceased. They also include images of abuse. (Ornstein and Huseman, 8/8)

In hospitals, summer is the season when newly minted medical school graduates start their first year of residency, taking on patient care with little hands-on experience. For patients, that means a visit from a doctor who might look young and untested. To make sure residents ask for help from a senior doctor, more hospitals are developing formal “escalation-of-care” policies with clear guidelines on when it’s time to call one. Residents may fail to ask for help due to overconfidence, lack of knowledge or fear of seeming incompetent, studies show. (Landro, 8/8)

Many elderly patients like [Janet] Prochazka deteriorate mentally or physically in the hospital, even if they recover from the original illness or injury that brought them there. About one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived, research shows. As a result, many seniors are unable to care for themselves after discharge and need assistance with daily activities such as bathing, dressing or even walking. “The older you are, the worse the hospital is for you,” said Ken Covinsky, a physician and researcher at the University of California, San Francisco division of geriatrics. (Gorman, 8/9)

In his new book, David Barton Smith takes us back to the mid-1960s, when a small band of civil rights activists-cum-government bureaucrats toiled to get the nascent Medicare program up and running. In the process, they profoundly changed the way health care is delivered in this country. It stands in marked contrast to the political turmoil over health care of recent years. “In four months they transformed the nation’s hospitals from our most racially and economically segregated institutions to our most integrated,” Smith writes in “The Power to Heal: Civil Rights, Medicare, and the Struggle to Transform America’s Health Care System. (Andrews, 8/9)

Luis Ascanio, 61, works as a medical interpreter at La Clinica del Pueblo, a D.C.-based clinic geared toward providing health care to the surrounding Latino community. Fluent in Spanish and French, he helps doctors talk with patients with limited English skills about health care issues that range from highly technical to deeply emotional. ... But according to an analysis published Monday in Health Affairs, more than a third of the nation’s hospitals in 2013 did not offer patients similar language assistance. (Heredia Rodriguez, 8/8)

Once, doctors would gallop on horseback to care for the infirm in their own homes. In modern times, patients generally have had to transport themselves to hospitals and doctors' offices. Now, the prolonged aging of the population bulge known as the baby boomers is necessitating an upgraded return to the ways of yore, with cars instead of horses. There's just one major problem: The U.S. lacks the doctors, nurses and others to make house calls to the estimated two to four million people who need them. (Whitman, 8/8)

Around July 4, a patient entered an emergency room in Miami-Dade County with a fever, a rash and joint pain — three of the four classic symptoms of the Zika virus. By this point, there had already been about 1,600 other Zika cases in the continental United States, but it soon became clear that this one was different. All the other patients had either traveled to Latin America or the Caribbean, where Zika had been raging for months — or they had sex or close contact with someone who had been there. Not this patient. (Belluck, 8/8)

A one-square-mile area north of downtown Miami, marked by three streets and a highway, is a Zika hot zone that public health officials say pregnant women should avoid. Many people don't understand how those boundaries were picked as part of an unprecedented travel advisory from the Centers for Disease Control and Prevention. And they want to know why the advisory isn’t broader. “We’ve been asked, ‘Why not all of Miami?’” CDC Director Tom Frieden said during a visit there last week. The answer, at least for now: "There’s no evidence that there’s any Zika spreading anywhere else in Miami.” (Sun, 8/8)

The first Zika outbreak in the continental U.S. has spread to a third Florida county, the governor said on Monday, as health officials launched an investigation into a new case. But officials believe active transmission of the virus remains confined to the square-mile Wynwood neighborhood of Miami where the outbreak was first identified. Gov. Rick Scott said state Department of Health officials are investigating how an individual in Palm Beach County became the state’s 17th person believed to be infected without exposure from travel outside the U.S. to areas where Zika is circulating. (Evans, 8/8)

Florida health officials are investigating another new case of the Zika virus, marking the 16th person believed to have contracted the disease from mosquitoes in two weeks. The newest case was reported in Palm Beach County, though health officials believe the person was infected during a recent trip to Miami-Dade County, according to a statement from Florida’s Department of Health on Monday. (Ferris, 8/8)

Michael Perez, owner of Gallery 212 in the heart of Miami’s Wynwood neighborhood, decided to shut down his gallery last week after health officials announced days earlier that the area was home to the continental U.S.’s first known cases of Zika virus transmitted by mosquitoes. “It’s pretty scary for me as a business owner,” he said, sitting in his contemporary gallery in front of a glass mosaic recreation of a Claude Monet painting. Nearby, repellent sat on a desk, and a large fan hummed to drive away insects. Foot traffic had dropped; Mr. Perez worried about contracting the illness himself and later decamped to Tampa, where he remained as of Monday. (McWhirter and Evans, 8/8)

So far, at the Olympics many feared would be the Zika Games, so good. With as many as one million people expected to attend the spectacle, half of them foreigners, Rio de Janeiro has not turned out to be the Zika hothouse some athletes and visitors feared as the virus wreaked havoc in Brazil earlier this year. Despite some hot days, swings back to cooler temperatures in Brazil's winter mean that the population of the mosquito responsible for spreading the virus has dwindled. (8/8)

About a year ago, before the Zika virus grabbed global attention, there were zero vaccines for it in development. Today, according to the World Health Organization, there are 30. Some of the work has been astonishingly quick. Human trials for two experimental vaccines have already begun. But a vaccine is likely still several years off, and there are indications the wait could be lengthened by a complication that has little to do with the science of vaccine development: The world’s top-tier pharmaceutical companies are largely hanging back, reluctant to get into the race for a vaccine. (Branswell, 8/8)

Harris County Judge Ed Emmett says the state's effort to distribute free mosquito repellent to low-income girls and women of child-bearing age, to protect them from Zika virus, is too cumbersome. Starting Tuesday and running through Oct. 31, Texas Medicaid, the state Children's Health Insurance Program and some other government-paid women's health and family planning programs are providing women ages 10 to 45 and those who are pregnant with two cans of mosquito repellent a month. (Garrett, 8/8)

Some of the voices inside Caroline White’s head have been a lifelong comfort, as protective as a favorite aunt. It was the others — “you’re nothing, they’re out to get you, to kill you” — that led her down a rabbit hole of failed treatments and over a decade of hospitalizations, therapy and medications, all aimed at silencing those internal threats. At a support group here for so-called voice-hearers, however, she tried something radically different. She allowed other members of the group to address the voice, directly: What is it you want? (Carey, 8/8)

By the fall of her sophomore year at the University of Houston, Mariellee Aurelio had already thought of several ways to kill herself. ... Her struggle mirrors those of countless college students across the state who are battling depression, anxiety and other mental illnesses but are often forced to wait weeks for a counseling appointment, according to interviews with several university students and counseling center directors. Understaffed counseling centers at Texas universities say they are frustrated by their inability to reach students, but the state doesn't earmark money for mental health services, and lawmakers want to limit tuition hikes. (Pattani, 8/9)

Former Rhode Island Rep. Patrick Kennedy is calling on Americans to stop referring to Republican presidential nominee Donald Trump as “crazy” because it demeans the people who suffer from mental illnesses. “Is Donald Trump experiencing a mental illness? That’s the question making the rounds these days,” the mental health advocate wrote in an op-ed for the Washington Post on Monday. (Yilek, 8/8)

The family of a man who died at Milwaukee County's Mental Health Complex almost four years ago has sued the county and several medical staff, claiming federal civil rights violations the lawsuit says were endemic for years at the troubled complex. Brandon Johnson, 25, died October 6, 2012, after three days at the complex. He had complained of being unable to move his legs and had unsuccessfully sought a transfer to another hospital. (Vielmetti, 8/8)

Roslyn Lewis was at work at a dollar store here in Tuscaloosa, pushing a heavy cart of dog food, when something popped in her back: an explosion of pain. At the emergency room the next day, doctors gave her Motrin and sent her home. Her employer paid for a nerve block that helped temporarily, numbing her lower back, but she could not afford more injections or physical therapy. ... The experience of African-Americans, like Ms. Lewis, and other minorities illustrates a problem as persistent as it is complex: Minorities tend to receive less treatment for pain than whites, and suffer more disability as a result. (Goodnough, 8/8)

Black Americans age 65 and older enjoy shorter active lives than whites do and more of their late years are swallowed up by disabilities and unmet needs, researchers have found. The disparity is widest for elderly black women, a group that has seen no gains since the early 1980s in either the number of remaining years of active life — meaning old age free of disabilities — or the percentage of remaining life expected to be active, according to a study published Monday in Health Affairs. (Bluth, 8/8)

Philadelphia has plenty of primary-care providers overall, but there is far less access to care in communities with the highest concentrations of African American residents, according to a new study. While the general findings were not a surprise - highly segregated black (and, to a lesser extent, Hispanic) areas were known to have fewer medical practitioners - the difference was bigger than the researchers had expected. (Sapatkin, 8/9)

Michael Phelps is red, white, and black and blue all over this Olympics thanks to a scientifically questionable technique known as cupping. Phelps and other athletes are turning to cupping therapy in hopes of healing their sore muscles. It’s a procedure based in ancient medicine in which cups are placed on top of the skin. The cups create a vacuum, pulling up the skin in an effort to stimulate blood flow to the area. (Thielking, 8/8)

Swimmer Michael Phelps won Olympic gold again Sunday while covered in red — red spots, roughly medal-size, all over his shoulders and back. The marks were the result of an ancient Eastern medicinal therapy known as cupping that is achieving new popularity among some athletes in the United States, including numerous Olympians. Cupping typically involves treating muscle pain and other ailments with cups that apply suction to skin. Cupping is often combined with other forms of alternative medicine, such as acupuncture and massage. (Beans, 8/8)

Athletes have always had special ways of preparing for, and recovering from, competition. And elite athletes are no exception. Here’s a rundown of six other ways Olympic competitors hope to get an edge — and what science has to say about them. (Samuel, 8/8)

Gov. Larry Hogan announced Monday that the state will distribute $3 million in grants to fight the heroin epidemic in Maryland, but none of it will go to Baltimore — which has accounted for more than a third of the state's heroin-related overdose deaths in recent years. The city didn't apply for a share of the money, the governor's office said. A Baltimore police spokesman said the money wouldn't have helped the city. (Dresser, 8/8)

A group called Heroin is Killing my Town is trying to save Akron from a rash of overdoses this summer.The Massachusetts nonprofit called activists to Akron in a Facebook Live post Sunday, planning a rally on Main Street for Tuesday. So far more than 800 of the 11,000 invited on the group's Facebook page have indicated they will attend the "Call to Action for Summit County Heroin Crisis" at 7 on the sidewalks around the 200 block. (Conn, 8/8)

Anyone who eats out or gets groceries in Hamilton County might see a sign about the heroin epidemic soon. Hamilton County Public Health environmental health inspectors were distributing 1,500 heroin awareness posters on Monday to restaurants, from fast-food to fine-dining, grocery stores, taverns and more licensed places where people go for food. One fact on the posters: "Heroin and other opiates kill at least 23 people in Ohio every week." (DeMio, 8/8)

Gummy-ring candy laced with THC, the psychoactive ingredient in marijuana, is the suspected culprit in a weekend incident in which 19 people fell ill at a quinceañera party in the Mission District, San Francisco health officials said Monday. Partygoers who ingested the candy Saturday night reported symptoms including heart palpitations, high blood pressure, dizziness and nausea. Nineteen people were taken to hospitals, 13 of them 18 years old or younger, health officials said. (Veklerov and Lyons, 8/8)

A San Francisco birthday party took an upsetting turn on Saturday when guests began feeling ill after consuming orange candy gummy rings that were later found to contain edible marijuana. The candy sickened 19  people who unknowingly ate the marijuana-laced candy at a quinceañera party.  They were all taken to area hospitals after experiencing symptoms including rapid heart rate, high blood pressure, dilated pupils, dizziness, light-headedness, nausea, lethargy and confusion, which can occur with edible marijuana consumption, San Francisco Department of Public Health officials said. (Fine, 8/8)

Over the weekend, 24 attendees at the EST music festival experienced adverse health effects after consuming edible candies laced with THC. They were treated with Naloxone, an antidote used to treat opiate overdoses, and no deaths occurred. The Mansfield News Journal reported that, despite what some outlets claimed during the incident, no drug overdoses happened and none of the afflicted attendees lost consciousness. (Nickoloff, 8/8)

The Krupas, along with two other women, are suing the commissioner of the New Jersey Department of Banking and Insurance, claiming the mandate discriminates against their sexual orientation — essentially forcing infertile homosexual women to pay for costly procedures to try to become pregnant. ... The state mandate requires most major insurance companies to cover medically necessary treatments for infertile clients. It defines infertility as the inability to impregnate another person, the inability to carry a pregnancy to live birth or the inability to conceive after one or two years of unprotected sex, depending on the woman’s age. (Jula, 8/8)

California’s teenage birthrate continues to decline and was at a record low in 2014, the state Department of Public Health announced today. Still, racial disparities persist in the state, where African American and Hispanic adolescents are three to four times as likely to give birth as white teens. Statewide, there were 20.8 births per 1,000 girls and women between the ages of 15 and 19 in 2014. (Guzik, 8/8)

As part of a continuing effort to combat HIV – the virus that can lead to AIDS – and other sexually transmitted infections in high-risk populations, the Fulton County Board of Commissioners has renewed a $300,000 contract for custom prefilled condom packets and condoms. Fulton’s goal is to distribute 2.1 million condoms a year under a program of the county Department of Health and Wellness and the Centers for Disease Control and Prevention, according to a County Board agenda item summary.Total Access Care Inc. of Santa Ana., Calif., will deliver the devices over a one-year period beginning Oct. 7. The effort is a fully funded grant program, with no requirement for county matching funds. (Ibata, 8/8)

Refugees arriving in upstate New York in recent years have increasingly come from active conflict zones, including Syria and Iraq -- many fleeing with injuries of war and deep emotional scars. As the refugee populations in places like Buffalo change, the health care systems and cultures of U.S. cities welcoming these populations have been changing, too. (Varney, 8/8)

As Miami homicide detectives search for the missing child, or her remains, just-released Department of Children & Families records renew troubling questions about the agency’s oversight of at-risk children. The records are heavily redacted and incomplete, but show child protection workers and lawyers deliberately chose not to monitor the twins’ safety. (Miller and Ovalle, 8/8)

After receiving an unexpected diagnosis for her 4-year-old daughter Haley, Diane Kavrell felt alone and unsure of what to do next, just like many parents who learn that their child has a rare disorder. Haley was born with Prader-Willi syndrome, a genetic condition that affects one in 15,000 babies. ...Those numbers, however, didn’t stop Kavrell from seeking out other parents caring for children with the disorder who could provide guidance, or just some solidarity. (Oide, 8/8)

Obamacare has provided health insurance to some 20 million people. But are they any better off? This has been the central question as we’ve been watching the complex and expensive health law unfurl. We knew the law was giving people coverage, but information about whether it’s protecting people from debt or helping them become more healthy has been slower to emerge. (Margot Sanger-Katz, 8/9)

In July alone, three co-ops, HealthyCT in Connecticut, Community Care of Oregon, and Land of Lincoln in Illinois, announced they are closing up shop. They join 13 other failed co-ops out of the original 23 that were a centerpiece of the Affordable Care Act's vision for the future of health-care organization - an unrealistic vision based on wishful thinking and sabotaged by the ACA itself. (Joel Zinberg, 8/8)

Last week, I outlined eight possible futures for Obamacare. By curious coincidence, few of them looked like the paradise of lower premiums and better care that the law’s supporters had promised. In the best case scenarios, they looked more like what critics had warned about -- "Medicaid for all," or fiscal disaster, or a slow-motion implosion of much of the market for private insurance as premiums soared and healthy middle-class people dropped out. (Megan McArdle, 8/8)

Republican presidential candidate Donald Trump claimed in an economic speech Monday that his proposal to repeal the Affordable Care Act would “save” 2 million American jobs. But there are serious problems with that statement. The Congressional Budget Office tentatively projected in early 2014 that the ACA would reduce the total number of hours Americans work by 1.5% to 2% between 2017 and 2024—“almost entirely because workers will choose to supply less labor—given the new taxes and other incentives they will face and the financial benefits some will receive.” It updated those projections in a second report in December. (Harris Meyer, 8/8)

At a time when health care spending seems only to go up, an initiative in California has slashed the prices of many common procedures. The California Public Employees’ Retirement System (Calpers) started paying hospitals differently for 450,000 of its members beginning in 2011. It set a maximum contribution it would make toward what a hospital was paid for knee and hip replacement surgery, colonoscopies, cataract removal surgery and several other elective procedures. Under the new approach, called reference pricing, patients who wished to get a procedure at a higher-priced hospital paid the difference themselves. (Austin Frakt, 8/8)

Last month, Florida’s new law regarding price transparency requiring hospitals to publish “average charges” went into effect. But the concept of price transparency in our dysfunctional system is a scam. It misleads the public into believing help is on the way; easing political pressure from consumers who are livid over skyrocketing healthcare costs. This new law perpetuates the current abusive system in which patients are unable to determine their costs, and shopping for good value is, by design, impractical. The idea that publishing price ranges or average prices will help consumers or spur competition, insults our intelligence. (Steven I. Weissman, 8/8)

The U.S. Food and Drug Administration recently launched “This Free Life”—a first-of-its-kind anti-smoking campaign aimed directly at the LGBT community. The crusade reflects data showing that members of the LGBT community smoke at approximately twice the rate of their straight counterparts. But the FDA’s actions don’t match the message of its P.R. campaign. (Gregory T. Angelo, 8/8)

If you’ve ever wondered whether Congress really deserves its approval rating, which just barely rises into the double digits, witness lawmakers’ reaction to the Zika virus. Although the virus ordinarily is relatively harmless, if a pregnant woman is infected, it can cause microcephaly in the fetus, a serious birth defect resulting in an abnormally small head and stunted brain development. (8/8)

What’s needed to evaluate a talk like this is a combination of critical thinking skills – strong mental defenses against confirmation bias and subtle manipulation. Critical thinking would have helped investors realize much sooner that the company was headed for trouble. After all, they poured hundreds of millions of dollars into Theranos, though Holmes refused to explain how its revolutionary technology worked. Maybe they didn't know what to look for. (Faye Flam, 88)

It’s time to get the facts straight. The reality is, voters oppose the 40-year-old policy. A poll from Hart Research Associates shows 86 percent of voters agree that “however we feel about abortion, politicians should not be allowed to deny a woman’s health coverage because she is poor.” People of all ages and political stripes share this view: 90 percent of voters ages 18 to 34, 84 percent of voters 65 and over, 79 percent of Republicans, and 94 percent of Democrats all agree.

The rough questioning of Brownback administration leaders at last week’s KanCare legislative oversight panel hearings revealed bipartisan frustration with constituent experiences and official assurances. Anger is justified, as is legislative talk of rolling back the recent 4 percent reimbursement cut and blocking a worrisome proposal to consolidate seven in-home care programs. (8/9)

We all want to live in a thriving community where everyone has the chance to succeed. The building blocks of such a community include a good education, safe neighborhoods, reliable roads and healthy people – and insurance coverage is foundational for ensuring we are all healthy. Thanks to the Medicaid expansion, more and more Kentuckians’ loved ones and neighbors are able to take a stake in their own health care, and all of us will benefit because of it. (Dustin Pugel, 8/8)

With over 100,000 Baltimoreans over the age of 60, we cannot create well-being in our city without also ensuring the health and wellness of our older adults. This includes supporting the ability of residents to age in their communities with choice, independence and dignity...Beginning in 2013, the Maryland State Department of Aging reallocated funds to jurisdictions based on an area's share of the older population as a whole. While Baltimore City has fewer older adults than some jurisdictions, it has the largest proportion of those living in poverty — nearly 41 percent in the entire state. (Leana Wen, 8/8)

Summer vacation is winding down, and soon students across Kentucky will be heading back to school. To protect their own health and the health of others around them, children and teens of all ages should make sure their immunizations are up to date before beginning another academic year.The Centers for Disease Control and Prevention recommends that children start building immunity against infectious diseases at an early age. (Tracy Kielman, 8/8)

The Social Security Administration has created a potentially huge but avoidable problem for millions of account holders in an overzealous attempt to fight computer hackers. As of this month, online users have been required to own a cellphone, register that number and obtain a text-messaged security code for use when accessing the Social Security website. The rationale for tighter security is understandable. Identity theft typically involves stealing a person’s Social Security number. (8/8)

Tucked in a corner of a building on campus, the pocket-sized dental suite is equipped with an examination chair, teeth-cleaning equipment, a portable X-ray gun and a miniature camera that sends digital photos to a computer. Every Friday, a dental hygienist is on duty to clean teeth and do routine exams.The results, along the with each child’s dental record, are shipped via the internet to a local dentist, who reviews the exams and schedules full office visits for those children who require more extensive care. (Daniel Weintraub, 8/8)