Workers Who Give Care To The Homebound Often Can’t Afford To Get Their Own

For more than two decades, Celeste Thompson, 57, a home care worker in Missoula, Mont., had not had regular contact with a doctor — no annual physicals and limited sick visits. She also needed new glasses.

Like many others who work in the lower rungs of the health care system, she has worked hard to keep her clients healthy by feeding them, dressing them and helping them navigate chronic conditions.

But because of the low wages and the hourly structure of this industry — which analysts estimate is worth nearly $100 billion annually and projected to grow rapidly — workers like Thompson often don’t have health insurance. Many home health agencies, 80 percent of which are for-profit, don’t offer coverage, or their employees don’t consistently clock enough hours to be eligible. They generally earn too much to qualify for public aid but too little to afford the cost of premiums.

“It’s a social justice issue. We have a workforce that is the backbone of long-term [care] services, and they themselves don’t have coverage,” said Caitlin Connolly, who runs a campaign to increase home care wages at the National Employment Law Project, an advocacy organization.

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In 2015, Montana opted in to the 2010 health law’s expansion of Medicaid, the state-federal low-income health insurance program. Thompson, who was making about $10 an hour, immediately signed up.

Her vision care was among the first things she focused on. She had not visited an eye doctor in nine years — a problem because her job includes keeping track of patients’ pill bottles and making sure they take the right medications. “I had to use a magnifying glass to see small print,” said Thompson, who now wears bifocals. Her doctor has since warned her she may need a stronger correction soon.

The Trump administration’s attempt at replacing the Affordable Care Act would have reined in Medicaid spending in states like Montana. But the bill failed to get enough support in Congress and was withdrawn March 24. Many Republicans say repeal is still a priority, and Health and Human Services Secretary Tom Price could change key regulations affecting the current law right now, without Congress.

Thompson is part of a large population of home-based caregivers who might be affected by such changes. From 2010 to 2014, about half a million of these workers gained new health insurance through Obamacare, estimates PHI, a New York-based nonprofit that researches this slice of the labor force and advocates for improved working conditions, in a March issue brief.

Thompson worries if her Medicaid coverage is taken away that it’s not just her insurance at risk, but also her livelihood. Her medical history puts her at high risk of endometrial cancer and her doctor recommends screenings twice a year. But without insurance, that’s not feasible. (Mike Albans for KHN)

Most home care workers’ gains came from living in states that, like Montana, expanded Medicaid. But even with Obamacare in place, many home health workers — perhaps 1 in 5 — remain uninsured. By contrast, about 8.6 percent of all Americans lack coverage.

Even catching a cold is risky. Before Thompson got Medicaid, a sinus infection represented an unplanned expense. Seeing a doctor meant forgoing groceries. She would take over-the-counter pills and hope to get better. “I would go to work sick, and that’s not good,” she said, noting that her clients are frail and elderly. “But I couldn’t afford to be off. I needed the money.”

Many Republicans have long favored proposals to reduce federal costs associated with this state-federal low-income insurance program, saying that shifting funding from a per-capita basis to block grants to states would make the system more efficient.

But many advocates for these workers take a different view, and the current air of uncertainty adds an extra layer of concern. Under the 2010 law, “at least we were on a path” to addressing coverage and access concerns, said Elly Kugler, the federal policy director at the National Domestic Workers Alliance, a coalition that represents home care providers. If it goes away, she said, it’s not so clear how these workers will access health care.

We have a workforce that is the backbone of long-term [care] services, and they themselves don’t have coverage.

Caitlin Connolly

Currently, home care workers on average earn less than $20,000 per year. The federal government only recently ruled they qualify for overtime pay and minimum wage protections. And there’s another rub: Most of the money paying for long-term home care comes from Medicaid and Medicare, PHI estimates. If either of those sources is squeezed, “that will translate to hours cut,” Connolly said — because people who need home care will also have fewer resources to pay for these services.

“My clients won’t be able to afford me. I can’t make a living. It’s a vicious cycle,” said Kim Thomas, 52, a home care worker in Durham, N.C. She makes $9.75 an hour and has 32 clients — one of whom is almost fully paralyzed and needs help eating, dressing and moving. Her days start at 5:30 a.m. To make ends meet, she works nights at the local hospital. Thomas is diabetic.

For Thompson in Montana, the concern is similar. If Medicaid is revised or the health law repealed, she said, it’s not just her insurance at risk but her livelihood. Her medical history puts her at high risk of endometrial cancer, and her doctor recommends screenings twice a year. But without insurance, that’s not feasible, she said.

“We don’t have enough money at the end of the month to buy essential things, like deodorant,” she said. “We go to the food bank four times a month. Without Medicaid, it would be really hard on [our family], trying to come up with the money to go the doctor.”

KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Insurance, Medicaid, The Health Law

Tags: Long-Term Care, Medicaid Expansion, Montana

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U.S. judge invalidates Acorda multiple sclerosis drug patents

By Jan Wolfe

A federal judge in Delaware on Friday struck down key patents held by Acorda Therapeutics Inc related to its multiple sclerosis drug Ampyra, causing the stock to tumble 24 percent before trading was halted.

The ruling by U.S. District Judge Leonard Stark opens the door for generic versions of the drug by companies including Mylan Inc and Roxane Laboratories Inc.

Those companies had sought approval from the U.S. Food and Drug Administration to sell a generic version of Ampyra. Acorda responded by suing them, seeking a court declaration that its patents on the drugs were valid.

Sales of Ampyra, which is used to improve walking in MS patients, accounted for almost 90 percent of Ardsley, New York-based Acorda’s 2016 revenue of $519 million.

Stark invalidated four Acorda patents on methods of delivering the drug which were not set to expire until between 2025 and 2027. In a minor victory for Acorda, the judge upheld one patent on the extended-release formulation of Ampyra, which is set to expire in 2018.

Acorda Chief Executive Ron Cohen said in a statement the company is disappointed by the ruling and is preparing to appeal.

The company said it has developed contingency plans to address its business goals in the event Ampyra becomes available as a low-cost generic drug and will update investors when it finalizes a timeline for implementing those plans.

A total of ten drug companies have sought to sell generic versions of Ampyra. Acorda reached settlement agreements with seven of the generic companies, including Allergan plc and Par Pharmaceuticals. Mylan, Roxane Laboratories Inc and Teva Pharmaceutical Industries Ltd did not settle and challenged the validity of Acorda’s patents in court.

(Editing by Richard Chang and Bernadette Baum)


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Doctors Studio introduces noninvasive medical procedure to treat erectile dysfunction

March 30, 2017 at 8:40 PM

Boca Raton based Doctors Studio, an integrative wellness practice led by sexual wellness expert and leading author Dr. Lisbeth Roy, is proud to announce they have become the exclusive area provider of the GAINSWave™, a drug-free, noninvasive medical procedure designed to treat Erectile Dysfunction.

The GAINSWave™ therapy, sometimes referred to as shock wave therapy, uses high-frequency acoustic pulse waves to improve any man’s sexual performance. As a man ages, the blood vessels that supply the blood needed for good erectile function, begin to collapse or become clogged. Basically, the pulsating waves improve blood flow by opening existing blood vessels and stimulating the growth of new blood vessels. Increased blood flow results in improved sexual performance. Along with repairing age-worn blood vessels, it stimulates the creation of new blood vessels and the rejuvenation of erectile tissue.

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There’s over 40 clinical studies on the therapy showing significant improvement and in many cases reversal of erectile dysfunction. “The GAINSWave™ is ideal for men who cannot take Viagra, or who have tried oral ED drugs and have been disappointed with the results,” says Lisbeth Roy, DO of Doctors Studio. It has proven to be a safe and effective alternative to Viagra and other oral ED medications. GAINSWave has over an 80% improvement rate with men reporting improved function and quality of erections, increased sensitivity, decreased refractory time between orgasms, more powerful erections which has yielded in many men seeking this treatment for sexual performance in addition to erectile dysfunction.

Dr. Roy went on to say that the treatment is particularly effective when it is used in conjunction with other alternative male procedures such as the P-shot, which harnesses the power of platelet rich plasma (PRP). “These two procedures are what we call ‘synergistic,’ meaning that each one enhances the effect of the other. When we combine PRP and GAINSWave therapies together, we deliver a `one-two punch,’ that results in even better results!”

While very new in the US, this has been used successfully in Europe for years. Doctors Studio is now treating men with the GAINSWave™ in their offices at 2300 Glades Road, Suite 260W Boca Raton, FL. Schedule your consult today! 561-444-7751.

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California Doctors Again Press For More Money To Treat Poor Patients

California’s doctors and dentists have renewed their push for more money to treat Medicaid patients now that the state has been spared the drastic cuts proposed under the failed GOP health care bill.

But Democratic Gov. Jerry Brown — and some health advocates — say they have other priorities for improving the low-income health program, which serves some 14 million residents, or about a third of the state’s population.

Doctors had pinned their hopes for better pay on a new tobacco tax passed by voters in November. Proposition 56 was estimated to add about $1.2 billion to the state’s Medi-Cal fund for 2017-18. But Brown’s proposed budget in January disappointed providers: He did not recommend raising doctors’ Medi-Cal rates, instead earmarking the money to cover the program’s overall costs.

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California doctors have long decried California’s Medi-Cal rates, which are lower than those of Medicaid programs in 45 other states and the District of Columbia. They argue that skimpy pay deters many doctors and dentists from treating poor patients.

Earlier this month, the California Medical Association and the California Dental Association, representing doctors and dentists, released their own budget proposal seeking to boost those payments. The proposal suggests giving doctors annual bonuses of up to $15,000 based on the proportion of their patients on Medi-Cal. The price tag on their plan could be as much as $607.5 million.

Now that it appears unlikely California will need to cope with the massive cuts in federal Medicaid funding anticipated under the GOP health bill, discussions about how to dole out state tobacco tax money will likely restart in earnest after being in a holding pattern during the debate in Congress, said Anthony Wright, executive director of the advocacy group Health Access.

“There’s a lot of things that money could go for besides provider reimbursements,” Wright said, noting that he and other advocates also favor restoring some Medi-Cal benefits, such as vision care, that were cut during the recession.

Francisco Silva, general counsel and senior vice president for the California Medical Association, said voters approved the tobacco tax ballot measure to improve patients’ access to care and that the governor’s January budget proposal “does not follow the will of the voters.”

For patients on Medi-Cal, “if you don’t address their ability to see a provider, you don’t address access,” Silva said. “Adding more patients to the back of the line and maintaining status quo” won’t work.

Gov. Brown is scheduled to release a revised budget proposal in May that could change how the tobacco money would be spent. For now, it looks as though he won’t budge on his budget priorities. “We continue to make our views very clear that these are proper and appropriate uses of the proceeds of Prop. 56,” said the governor’s budget spokesman, H.D. Palmer.

Palmer said it’s now up to state lawmakers to define their own budget priorities, which could result in higher rates for health care providers.

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

Categories: California Healthline, Health Industry, Medicaid

Tags: Doctors, Medicaid

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Senators Demand Answers About Possible Probe Of HHS Secretary Price

Nine senators are pushing U.S. Attorney General Jeff Sessions to reveal what he knows about a reported investigation into Health and Human Services Secretary Tom Price’s stock trades that a top federal prosecutor might have begun before being fired by the Trump administration this month.

In a letter Wednesday, seven senators — six Democrats plus Vermont independent Bernie Sanders — called on Sessions to assure them that any investigation of Price — or others connected to the Trump administration — would be “allowed to continue unimpeded.” Three Democratic senators sent a different letter a day earlier, asking Sessions to “provide greater clarity” about why Manhattan’s former U.S. attorney, Preet Bharara, was fired and whether any investigation of Price was a factor in Bharara’s removal.

ProPublica, a nonprofit news organization, reported March 17 that Price was being investigated by the U.S. attorney’s office for his stock trades, though it did not specify which trades Bharara was investigating before his dismissal. The website attributed its report to an unnamed person familiar with the U.S. attorney’s office, and neither the Justice Department nor other news media organizations have confirmed its existence.

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If an investigation had begun, it would be hard to derail. But investigations of federal officials are always sensitive cases, said Donald Langevoort, a securities law professor at Georgetown University.

“The higher up the food chain you go, the more prominent the person is, the more confident you better be that you have the evidence you can present to a jury,” he said. “But I think any attempt to quash an investigation would backfire considerably.”

Price, a prominent Republican congressman until he joined President Donald Trump’s Cabinet this year, was questioned extensively at his confirmation hearings about stock purchases he made in health care, pharmaceutical and medical device companies while serving on the House of Representatives’ health subcommittee.

The activity raised conflict-of-interest concerns for some members of Congress because Price’s trades overlapped with his sponsorship of bills, advocacy or votes on issues related to those companies or their industries.

The Democrats  called attention to Price’s investment in a small Australian biotech firm, Innate Immunotherapeutics, which Price testified he learned about from another congressman, Rep. Chris Collins (R-N.Y.), Innate’s largest shareholder.

Price bought most of his shares at discounted prices in two private stock placements in 2016 offered to a small number of sophisticated investors — many with personal or professional ties to Collins.

Congressional Democrats slammed Price at his hearings for buying shares at advantageous prices not available to all investors. Some questioned whether Price had violated insider trading laws or the Stop Trading on Congressional Knowledge (STOCK) Act, which bans members of Congress from trading on stocks using information they received in carrying out their official duties.

“Despite the many unanswered questions that remained, Republicans rushed Price’s nomination through the Senate without waiting for answers,” seven senators said in Wednesday’s letter.

When he was confirmed Feb. 10, Price agreed to divest his stock holdings within 90 days of  taking his post. An HHS spokesperson said Price has completed those divestitures but declined to provide further information.

Sen. Elizabeth Warren (D-Mass.) was the only senator who signed both letters to Sessions.

Other names on Wednesday’s letter were Patty Murray (D-Wash.), Ron Wyden (D-Ore.), Bernie Sanders (I-Vt.), Al Franken (D-Minn.), Tammy Baldwin (D-Wis.) and Maggie Hassan (D-N.H.).

Tuesday’s letter was also signed by Richard Blumenthal (D-Conn.) and Jeff Merkley (D-Ore.).

Sessions’ office confirmed it had received Tuesday’s letter from the senators but declined to comment on either one. The U.S. Attorney’s Office in Manhattan also had no comment.

Categories: Health Industry

Tags: HHS, U.S. Congress

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Combining anticancer drug with antirheumatic produces improved effects against tumors

March 30, 2017 at 6:49 AM

Scientists at EPFL and NTU have discovered that combining an anticancer drug with an antirheumatic produces improved effects against tumors. The discovery opens a new path for drug-drug synergy.

One of the goals in pharmacology is to increase the efficiency of drugs by minimizing their side effects. Recently, this effort has led to combining unrelated drugs to exploit their synergistic effects. This “drug-drug synergy” relies on interactions between the individual biological pathways on which each drug acts. Scientists at EPFL and Nanyang Technological University (NTU) have now discovered a synergistic effect between an anticancer and an antirheumatic drug, improving the former’s ability to kill off cancer cells. The work is published in Nature Communications.

The labs of Paul Dyson and Ursula Röthlisberger at EPFL, together with the lab of Curtis Davey at NTU, explored the synergistic effects of two unrelated drugs: auranofin (Ridaura), a gold-containing drug that is used to alleviate the symptoms of rheumatoid arthritis, and RAPTA-T, a ruthenium-containing anticancer drug that disrupts both tumor growth and metastasis, while also reducing the side effects of chemotherapy due to its low toxicity.

Although the two drugs are used for different conditions, auranofin has recently been discovered to also act against cancer. The reason is that, often, drugs do not only bind a single site on a specific molecule, but can also bind and affect other, unrelated sites — either on the same molecule or on a different one. For example, a drug that is meant to bind and activate a receptor could also bind and block an enzyme. This off-site activity frequently gives rise to drug side effects, but separate drug-binding sites can also work together synergistically in a productive fashion.

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The researchers looked at the synergistic effects of the two drugs on packaged DNA inside cancer cells. Despite popular depictions, the long strands of DNA in the cell spend most of their time tightly wound around specialized proteins called histones. Whenever a particular sequence, e.g. a gene, is needed, that section of DNA is unwound and read by the appropriate biological machinery.

The study found that combining the two drugs had an increased effect of killing of cancer cells, while individually, the drugs have considerably less impact on cell viability. When RAPTA-T is given, it forms what are known as “adducts” with the histone proteins that package DNA. These adducts disrupt the normal function of DNA and cause the cell to die. In contrast, auranofin is much less prone to form adducts with the histone proteins, unless the two drugs are used together.

The researchers found that the binding of auranofin takes place through an allosteric, “action-over-a-distance” mechanism within the nucleosome, which is the component that contains the cell’s packaged DNA. Here, the researchers discovered that RAPTA-T helps the other drug’s ability to form histone adducts by binding on distant histone sites.

The authors conclude that this newly discovered allosteric mechanism “suggests that allosteric modulation in nucleosomes may have biological relevance and potential for therapeutic interventions.”

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March Madness Vasectomies Encourage Guys To Take One For The Team

Doctors say it all started eight years ago, when a urology clinic in Oregon ran an ad promoting the benefits of scheduling a vasectomy in March.

“You go in for a little snip, snip and come out with doctor’s orders to sit back and watch nonstop basketball,” the voice-over promised. “If you miss out on this, you’ll end up recovering during a weekend marathon of ‘Desperate Housewives’!”

Copycat ads followed. Now a sports radio show in Washington, D.C., has an annual Vasectomy Madness contest, where the prize is a free vasectomy.

Here’s how it works: Three guys come on the air to make their cases for getting snipped. The announcers ruthlessly roast them, and then listeners vote on their favorite.

“All right, let’s bring in our next contestant,” a host said. “I believe it’s Abe from Warrenton, Va. So tell us your story. Why are you here?”

Abe has three kids, ages 9, 6 and 3.

“Another one — surprise! Due in July,” Abe said. “I was shopping after the third for a vasectomy and, like a dope, dragged my feet.”

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There’s Mike, also expecting his fourth child — also a surprise.

“My wife and I have had enough,” he pleaded. “We need help to stop the flow.”

And then there’s Charles.

“Four kids. Three different women,” Charles said, inspiring a roar of jeers from the hosts.

Procrastination can be so common with the “Big V” that it takes a panel of sports jocks offering a free procedure for some guys to finally let a doctor take a scalpel to their nether regions.

That may be one reason vasectomy rates are low: About 5 percent of women rely on their partner’s vasectomy for contraception, unchanged from a decade ago. The Centers for Disease Control and Prevention’s National Survey of Family Growth compares that to 20 percent of women who have had a sterilization procedure, even though women’s surgery is more invasive and more expensive.

“Men are culturally the providers. It’s hard for them to seek care,” said Dr. Paul Turek, a California urologist. “They don’t know how to be a patient.”

Turek has clinics in San Francisco and Beverly Hills. He sees an uptick in vasectomy visits during March Madness, and he’s also noticed more guys coming in together.

“One group came in from a tech company in a limousine,” he said.

Last year, five college buddies scheduled a group vasectomy in March. They live all over the U.S. now, and one of them had an idea to reunite in San Francisco and undergo the outpatient procedure together.

“I gave ’em a deal,” Turek said. “I closed the doors. We had sports TV on. They were having fun.”

As each guy returned to the waiting room, he was greeted with fist bumps and high-fives. Then the men hobbled back to their hotel to bet on the games and yell at the television together.

Turek made an interesting observation during that bro basketball weekend: The friends seemed to recover faster than his typical patients.

“They had no complaints,” he said. “They were back at work sooner. They took fewer pain pills. It was the best anesthesia, having their buddies with them.”

Turek gives all his vasectomy patients a certificate of honor for “uncommon bravery and meritorious performance.”

There is another theory about why vasectomies aren’t more popular: the cost. The Affordable Care Act requires insurers to cover contraceptives without charging out-of-pocket costs. But vasectomies weren’t included in the rule. The procedure costs about $500, but some doctors charge up to $1,000.

That’s why Charles subjected himself to the free vasectomy contest at the D.C. radio station. His insurance covers a portion of the procedure, “but I’d still have to pay my deductible, which is, like, a thousand bucks.”

Vasectomy was overlooked in Obamacare because, under the law, birth control was considered a women’s health service.

“Right now the policy says to a couple: Your insurance will cover birth control without any out-of-pocket costs on your end, as long as it’s the woman who’s using it,” says Adam Sonfield, senior policy manager at the Guttmacher Institute.

Last year, 12,000 people signed a petition asking regulators to cover vasectomy without cost sharing. Doctors’ groups even drafted language to this effect to add to the regulations.

But when the Trump administration took over, it told the groups to stop trying, according to Aaron Hamlin, executive director of the Male Contraception Initiative.

“The birth control benefit has been under pretty much continual political attack since the ACA was enacted,” said Sonfield.

So for now that leaves guys like Charles, Mike and Abe vying for a free March Madness vasectomy. The winner in the end?

Abe — one of the guys expecting his fourth child.

His prize came with a catch, though. He will have to let one of the sportscasters come to his appointment, to broadcast a “play-by-play.”

This story is part of a partnership that includes KQED, NPR and Kaiser Health News.

Categories: Cost and Quality, Health Industry, Public Health, The Health Law

Tags: Men’s Health

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