Latest Scandal Too Much For HHS Secretary Tom Price. He’s Out.

Health and Human Services Secretary Tom Price resigned Friday, amid controversy over his use of private jets for official and personal business. He promised a day earlier to pay back some of the $400,000 spent on those flights, but the offer came too late for the Trump White House.

In a statement released Friday afternoon, the White House said President Donald Trump intends to designate Don Wright of Virginia to serve as acting secretary, effective at midnight Friday. Wright serves as the deputy assistant secretary for health at HHS and he directs the Office of Disease Prevention and Health Promotion.

Price’s four-paragraph resignation letter stated, in part: “I have spent forty years both as a doctor and public servant putting people first. I regret that the recent events have created a distraction from these important objectives.”

Read Price’s Resignation Letter To President Trump

Price, an orthopedic surgeon and former House Budget Committee chairman, was surrounded by controversy since his nomination to the nation’s top health post in January. He made questionable stock trades in health care companies while a member of the tax-writing House Ways and Means Committee and interceded on behalf of donors with federal agencies. Democrats in the Senate fought his confirmation, charging that he was too ethically challenged to serve as HHS secretary.

This summer, Price was increasingly viewed by President Donald Trump as ineffective in helping to push a GOP plan to “repeal and replace” the Affordable Care Act through Congress.

Price had been under pressure since Sept. 19, when Politico broke the news that he had taken numerous official trips via private jet, costing tens of thousands of dollars more than commercial flights.

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One of those trips involved a charter flight to Philadelphia, which can be reached by car from Washington in just over two hours. Subsequent reporting by Politico revealed that Price’s more than two dozen private plane trips cost in excess of $400,000, and that some of the trips included personal as well as official business.

He also traveled with his wife to such international destinations as Africa, Europe and Asia on military flights at a cost to taxpayers of more than $500,000 — bringing the total expense to taxpayers since May to more than a million dollars, according to Politico.

Price said last weekend he would stop using private planes pending an investigation by the HHS Inspector General, but he and his staff have repeatedly defended the trips as necessary to get him to events in a timely manner.

Pressed by reporters Wednesday about the spreading scandal, Trump said he was “not happy” about the private plane travel “and I let him know it.” Asked if he would fire Price, Trump responded, “We’ll see.”

On Thursday, Price released a statement saying he would “take no more private charter flights as Secretary of HHS. No exceptions.” Price, whose net worth has been estimated at $13.6 million, also said he would “write a personal check to the US Treasury for the expenses of my travel on private charter planes.” He added that taxpayers would not “pay a dime for my seat on those planes.”

His offer for the domestic flights — about $52,000 — was a fraction of what taxpayers paid for his entourage.

House Speaker Paul Ryan (R-Wis.) said Price was “a leader in the House and a superb health secretary. His vision and hard work were vital to the House’s success passing our health care legislation.”

Democrats had a different view.

In a statement, Sen. Ron Wyden (D-Ore.), the ranking member of the Senate Finance Committee, said Price has “repeatedly abused the public trust and betrayed the agency’s mission to improve Americans’ health care.” Wyden said he hopes this will mark “the beginning of a new chapter” for the Trump administration’s health care agenda and that Price’s replacement will “be focused on implementing the law as written by Congress.”

The new HHS secretary should keep “the president’s promise to bring down the high cost of prescription drugs,” Wyden said.

Wright, Price’s interim replacement, has worked for the federal government since at least 2003. A physician, he served in high-level positions at HHS under the George W. Bush, Obama and Trump administrations, according to his LinkedIn profile. At HHS, Wright oversaw many public health duties including development of the national dietary guidelines for Americans and the department’s health literacy agenda. He has also spearheaded efforts to reduce adverse drug interactions.

Wright represented the United States at the World Health Organization’s executive board and served on the National Cancer Institute Advisory Board.

According to the profile, he held management positions in the Office of the Surgeon General, National Vaccine Program Office, Office of HIV/AIDS Programs, Office of Minority Health, Office of Population Affairs, Office of Women’s Health and President’s Council on Physical Fitness and Sports.

From 2003 to 2007, Wright was director of the Occupational Medicine at the Office of Safety and Health Administration.

Wright has a bachelor’s degree in zoology from Texas Tech University and holds a medical degree from the University of Texas-Galveston. He completed a residency in family medicine at Baylor University in Dallas and practiced for 17 years in Texas as a doctor. He also holds a master’s in public health from the Medical College of Wisconsin in Milwaukee, according to his LinkedIn profile.

Leah Binder, president of the Leapfrog Group, a patient advocacy organization, said she was hopeful about Wright’s new role.

“I am cautiously optimistic the appointment of Don Wright signals a resurgence of federal leadership on patient safety,” she said in an email. “Don Wright led development of the influential National Action Plan on Healthcare Acquired Infections in 2013. … His work galvanized infection prevention and led to significant improvements … that saved many lives. He has also been influential in the movement to measure the problem and tie Medicare payments to hospital safety.”

KHN correspondents Phil Galewitz and Mary Agnes Carey contributed to this report.

Categories: Cost and Quality, Health Care Costs, Health Industry, Repeal And Replace Watch, The Health Law

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Out-Of-Pocket Costs Often Keep Pricey New Cholesterol Drugs Out Of Reach, Study Finds

Access to powerful new cholesterol-lowering drugs is so tightly controlled and patients’ out-of-pocket costs are so high that fewer than a third of people whose doctors prescribe the drugs get them, a new study found.

While highly effective, the new drugs cost as much as $14,000 annually, leading some insurers and pharmacy benefit managers to require doctors to get preapproval for them.

For example, only 47.2 percent of people who were prescribed the drugs, Praluent and Repatha, received that insurance green light, and just under two-thirds of those patients filled their prescriptions.

In the end, only 30.9 percent of people who were prescribed the drugs received them, researchers found.

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KHN contributing columnist Michelle Andrews writes the series Insuring Your Health, which explores health care coverage and costs.

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These injectable drugs, called PCSK9 inhibitors, dramatically reduce levels of “bad” LDL cholesterol in the bloodstream by blocking PCSK9, a protein that is involved in how cholesterol is processed in the liver.

They are aimed at people whose LDL cholesterol levels remain high even when they take the maximum dose of regular statin drugs as well as those who have familial high cholesterol.

Even with preapproval, patient copayments ranging from $0 to $2,822 per month discouraged many from filling their prescriptions, the study found.

Whether or not a patient picked up the prescription was driven almost entirely by the out-of-pocket cost, said Dr. Ann Marie Navar, a clinical cardiologist and researcher at Duke Clinical Research Institute who was the study’s lead author.

Compared with patients who had no copayment, people who had to pay $10 were 19 percent less likely to fill their prescription. People with a $100 copay were 84 percent less likely to do so, the study found.

The study, published online in JAMA Cardiology this week, analyzed pharmacy claims data for 45,029 patients who received a new PCSK9i prescription between August 2015 and July 2016. It was funded by Amgen, which makes Repatha.

Patients who have a hard time affording the cost of these drugs should investigate the drug companies’ copay-assistance programs, as 38 percent of patients in the study did, Navar said. However, those programs aren’t typically available to patients who are covered by public programs like Medicare and Medicaid.

Beyond that, Navar’s best advice for patients is to be persistent. “Most prescriptions are rejected on the first submission and not all of those are appealed,” she said.

Updated, 5:22 p.m., to correct the description of how PCSK9 inhibitors work.

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KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

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Failing Sense of Smell Tied to Dementia Risk

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News Picture: Failing Sense of Smell Tied to Dementia Risk

FRIDAY, Sept. 29, 2017 (HealthDay News) — Older adults who’ve lost their sense of smell appear to have an increased risk of dementia, a new study suggests.

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The long-term study included nearly 3,000 participants, aged 57 to 85, who were tested on their ability to identify five common odors.

At least four of the five odors were correctly identified by 78 percent of the participants, the researchers found. In addition, 14 percent identified three of the odors, 5 percent identified only two of the odors, 2 percent identified only one, and 1 percent could not identify any of the odors.

Five years after the test, the participants who weren’t able to identify at least four of the five odors were more than twice as likely to have dementia, compared to those with a normal sense of smell, the researchers said.

Nearly all of the participants who couldn’t identify a single odor had been diagnosed with dementia, along with 80 percent of those who identified only one or two of the five odors, according to the report.

“These results show that the sense of smell is closely connected with brain function and health,” study lead author Dr. Jayant Pinto, an ENT (ear, nose and throat) specialist at the University of Chicago, said in a university news release.

“We think a decline in the ability to smell, specifically, but also sensory function more broadly, may be an important early sign, marking people at greater risk for dementia,” Pinto explained.

“We need to understand the underlying mechanisms, so we can understand neurodegenerative disease and, hopefully, develop new treatments and preventative interventions,” Pinto said.

The study’s co-author, Martha McClintock, an expert in olfactory (sense of smell) and pheromonal (chemical secretion) communication, noted that the olfactory system also has stem cells that self-regenerate.

So, McClintock explained, “a decrease in the ability to smell may signal a decrease in the brain’s ability to rebuild key components that are declining with age, leading to the pathological changes of many different dementias.” McClintock is a professor of psychology at the University of Chicago.

Although the researchers found an association between an inability to identify odors and development of dementia, they couldn’t prove a cause-and-effect relationship.

The study was published Sept. 29 in the Journal of the American Geriatrics Society.

In an accompanying journal editorial, Dr. Stephen Thielke, from the Puget Sound Veterans Affairs Medical Center in Washington, added a cautionary note.

Loss of the sense of smell may be easier to measure over time than loss of mental function, which could allow for earlier assessment of brain changes, he said. “But none of this supports that smell testing would be a useful tool for predicting the onset of dementia,” Thielke said in the news release.

— Robert Preidt

Copyright © 2017 HealthDay. All rights reserved.

SOURCE: University of Chicago Medical Center, news release, Sept. 29, 2017

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Years After Silently Combating Sexual Trauma, Female Veterans Seek Help

Sheila Procella joined the Air Force in 1974 to “see the Earth,” she said. She enlisted at the tail end of the Vietnam War, shortly after graduating from high school. Although she never left her home state of Texas during eight years of service, her office job proved to be its own battlefield.

“Some of us actually went to war, some of us had war right here in the States, going to work every day knowing we are going to be harassed,” said Procella, now 62 and living in Plano, Texas.

At the time, fewer than 3 percent of service members were women. Procella recalled the daily barrage of sexual comments, gestures and men grabbing her inappropriately. And one of her superiors made it clear that her hopes of moving up the career ladder were dependent on having sex with him.

“He was kind of discreet about the way he put it, but his one advance and my one acceptance of his advance led to my promotion,” Procella said.

At the time, Procella, who served in the Air Force until 1979 and then went on to the Texas Air National Guard until 1982, accepted the common belief that reporting the incidents would be bad for her career. “It definitely wasn’t talked about, you definitely did not report your superiors for any kind of harassment,” she explained. “At the time that it happens you sweep it away like you’re going to be OK.”

But it wasn’t OK, and after her military career, Procella found herself dependent on alcohol and drugs to cope.

Eventually, she came to associate her deep depression, anxiety and panic attacks with the harassment and assaults during her military service. Procella, who had also experienced childhood sexual abuse, was diagnosed with military sexual trauma and post-traumatic stress disorder (PTSD) in 2014, nearly three decades after her service. Today she has a 70 percent disability rating from the Department of Veterans Affairs.

There are many others like Procella, who served decades ago, but are just coming to terms with their experience.

Midlife Awareness

A 2015 study published by the American Psychological Association asked 327 female veterans in Southern California about their experiences with sexual trauma. They divided the respondents into two groups — those who served before the terrorist attack on Sept. 11, 2001, and those in uniform afterward. Nearly half of those in the earlier group reported sexual contact against their will during their military service. In the later group, reports of unwanted sexual contact dropped to 30 percent.

A majority of those who reported sexual abuse met the criteria for a PTSD diagnosis, the researchers said.

And a study published last year in the journal Women’s Health Issues found that women ages 45-54 reported more sexual harassment and assault while in the military than other age groups.

“I was struck by the idea that it wasn’t just younger women,” said Carolyn Gibson, a women’s health research fellow at the San Francisco VA Medical Center and co-author of that study.

The research also found that the association between sexual trauma and its negative effects on health — such as cardiovascular disease, substance abuse and other physical and mental illnesses — was most pronounced among female veterans ages 45-64.

Gibson said these effects may be exacerbated among women in midlife because there was less awareness around the issue when they were in uniform and they felt compelled to bear the stress alone.

Midlife is also a time of great change for women, Gibson explained, both physically and emotionally, which could lead them to come forward about sexual trauma after their service ended.

“As people go through periods of transition, then those symptoms tend to pick up a lot more,” she said. More of the veterans who are younger now, she added, may go public about their struggles with sexual trauma when they enter this phase of life 10 to 15 years down the road.

Battle For Recognition

The Veterans Health Administration coined the term “military sexual trauma” in 2004, and today about 25 percent of women and 1.5 percent of men who use VA health services have the diagnosis, according to the VA. The symptoms are closely associated with PTSD and put individuals at an increased risk for other mental health conditions, including anxiety, depression and eating disorders.

But getting a disability claim based on military sexual trauma can be a long and complicated battle. A 2014 Government Accountability Office report found that disability claims related to sexual trauma during military service used to be far less likely to be approved than PTSD claims from other sources. In 2010, 46 percent of all claims related to non-sexual trauma were approved by the Veterans Benefits Administration, while 28 percent of those related to military sexual trauma were, GAO said. By 2013, half of the sexual abuse claims and 55 percent of PTSD claims were approved.

Some of us actually went to war, some of us had war right here in the States.

Sheila Procella

The GAO and veterans groups say the increase came after the VA mandated training on military sexual trauma for employees processing claims at regional centers and for health professionals providing the veterans’ evaluations.

The VA has added resources specifically for women in recent years, even separate entrances for women at some counseling facilities. Still, it’s a challenge to get women through the door to receive help. According to a 2015 VA report on barriers to women’s health care, only 19 percent of female veterans used VA services.

“During the Vietnam era, a lot of veterans who came back had a hard time getting into the VA, especially women — they were put off by the VA for several years,” said Pam Maercklein, who coordinates women’s health care for the Texas Veterans Commission and is an Air Force veteran. “Now the VA, especially here in Texas, is doing a fairly good job of gender-specific treatment.”

Anna Baker, the manager of the commission’s women’s program, said women who are now middle-aged were forgotten when it came to treatment for sexual trauma at the time of their service and afterward.

“We’ve had several nurses who served in Vietnam who are just now coming out, who are saying that for so many years they just suppressed it,” Baker said, “and they’re just now starting to have those conversations and deal with those issues that are causing them anguish.”

While there’s a tendency to associate PTSD with military combat, a 2015 study published in JAMA Psychiatry found that women who served in Vietnam had increased odds of PTSD. The effect, the report found, “appears to be associated with wartime exposures, especially sexual discrimination or harassment and job performance pressures.”

Delia Esparza, a psychiatric mental health nurse with the Vet Center in Austin, Texas, has been helping veterans — women and men — deal with sexual trauma for more than 22 years.

The Austin Vet Center is one of 300 community facilities across the country that provide veterans (and family members) with free individual and group counseling, in addition to other readjustment services.

Esparza said that even with increased attention to military sexual trauma, many of the problems that Procella and other veterans experienced persist. Among them: Women especially feel stigmatized for speaking out.

She recalled that when she first started practicing she had a female client who was a veteran from World War II.

“She was very troubled by this whole thing,” Esparza said of the veteran, who was then in her 70s, “and when she talked about it she became very tearful.

“It stays with you.”

KHN’s coverage of women’s health care issues is supported in part by The David and Lucile Packard Foundation.

Categories: Mental Health, Public Health

Tags: GAO, Military Health, Study, Texas, Veterans’ Health, Women’s Health

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U.S. invests $170 million in late-stage Ebola vaccines, drugs

CHICAGO (Reuters) – The U.S. government is investing more than $170 million to help two new vaccines against the Ebola virus and two Ebola drugs complete the steps needed for approval from the Food and Drug Administration.

The Biomedical Advanced Research and Development Authority (BARDA), part of the department of Health and Human Services, said on Friday it would buy the drugs and vaccines and keep them in a national stockpile, which would be used to protect Americans in the event of an outbreak of the deadly disease.

The investment includes the purchase of up to 1.13 million courses of vaccine, including a single-dose vaccine from Merck & Co and a two-dose vaccine from Johnson & Johnson. BARDA will also buy Ebola treatments from Mapp Biopharmaceutical Inc and Regeneron Pharmaceuticals.

The products were rushed through testing in response to the West African Ebola outbreak in 2014-2016 that infected 28,600 people and killed more than 11,000. Ebola causes severe fever, vomiting, diarrhea and bleeding.

”Today we are prepared to add four Ebola countermeasures to the stockpile, whereas three years ago, very few products were even in early stages of development,” BARDA Director Rick Bright said.

He attributed the “unprecedented speed” of products’ development to partnerships across the U.S. government, other nations and private industry.

The National Institute of Allergy and Infectious Diseases provided early-stage funding for many of the products. The new funding is through Project BioShield, which supports late-stage development toward licensure and stockpile purchases.

Under the agreements, BARDA will provide funding for each company to validate its manufacturing processes and make final preparations needed to apply for FDA approval. While that work is underway, BARDA can purchase the vaccines and drugs for potential use in a public health emergency.

Merck will get $39.2 million to finish development of its single-shot vaccine, which got initial support from the Public Health Agency of Canada. J&J’s two-dose vaccine will get $44.7 million for late-stage development and purchase from BARDA.

BARDA will also spend $45.9 million on Mapp Biopharmaceutical’s ZMapp antibody drug, which had been used experimentally on U.S. missionaries infected in the epidemic in Africa who were flown back to the U.S. for treatment. Regeneron will get $40.4 million to finish development of its antibody treatment.

Reporting by Julie Steenhuysen; editing by Susan Thomas

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U.S. judge clears way for Maryland drug price-gouging law

(Reuters) – A U.S. District Court judge on Friday cleared the way for Maryland to implement the nation’s first law designed to penalize drugmakers for price gouging by denying the generic drug industry trade group’s request for an injunction.

The state’s new law will go into effect as planned on Sunday, according to the office of Maryland Attorney General Brian Frosh.

The Association for Accessible Medicines (AAM), a generic industry trade group which represents companies like Teva Pharmaceutical Industries Ltd and Novartis AG’s Sandoz unit, argued that the law is unconstitutional because it does not define price gouging and amounts to intervention by an individual state in interstate commerce.

U.S. District Judge Marvin Garbis wrote that litigation can continue under the trade group’s argument that the law is too vague, but he dismissed other arguments.

The trade group said it will immediately appeal the court’s decision.

Under the statute, Maryland will field complaints and investigate “unconscionable increases” in prices for essential off-patent or generic medicines. The law does not apply to branded drugs that are still under patent protection.

Violations will incur a fine of up to $10,000. The attorney general can also require a manufacturer or distributor to show its records and justify a price increase.

“This law will hurt patient access to safe, affordable generic medicines in Maryland and the rest of the U.S., and will create untenable uncertainty for generic drug makers who may be left with no choice but to abandon markets altogether,” Jeff Francer, AAM general counsel, said in a statement.

Pharmaceutical companies have so far dodged stricter federal oversight of drug prices despite growing outrage over hikes by companies like Valeant Pharmaceuticals International Inc and Mylan NV. But states, struggling to cover rising healthcare costs, are taking up the fight. At least 176 bills on pharmaceutical pricing and payment have been introduced this year in 36 states, according to the National Conference of State Legislatures.

Maryland’s law was passed by the state’s Democrat-controlled legislature in April, and Governor Larry Hogan, a Republican, said in May that he would allow it to take effect without his signature.

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Podcast: ‘What The Health?’ Repeal And Replace Is Dead. What Now?

As predicted, the last-ditch GOP effort to “repeal and replace” the Affordable Care Act ended the way its predecessors did this week — in failure. With a Saturday midnight deadline fast approaching, Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) conceded Tuesday that they lacked even the 50 votes necessary to pass their bill using a truncated budget process.

So what happens next?

  • The focus is back on efforts to stabilize the individual insurance market, which has been reeling with uncertainty as the future of the Affordable Care Act remained in question. Senate Health, Education, Labor and Pensions Committee Chairman Sen. Lamar Alexander (R-Tenn.) and the panel’s ranking Democrat, Patty Murray (D-Wash.), are restarting the bipartisan negotiations they began in August.
  • The Children’s Health Insurance Program (CHIP) is still set to expire on Oct. 1. Work on CHIP’s reauthorization had begun on that in September, but was set aside in the unsuccessful effort to pass the broader Graham-Cassidy measure. It is all but certain the deadline will come and go and some states will have to begin shutting down the program.
  • Tom Price’s future as secretary of Health and Human Services appears in doubt, as more details emerge about his frequent use of private jet service, including for events that were both official and personal.

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Alice Ollstein of Talking Points Memo, Margot Sanger-Katz of The New York Times and Paige Winfield Cunningham of The Washington Post discuss these issues and more. Rovner also interviews Bruce Lesley, president of the children’s advocacy group First Focus, about efforts to renew the CHIP program.

In addition, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too:

Julie Rovner: Kaiser Health News’ “Medicaid Covers All That? It’s The Backstop Of America’s Ailing Health System,” by Phil Galewitz.

Alice Ollstein:’s “Trump Administration Abruptly Drops Out Of Obamacare Events In Mississippi,” by Dylan Scott; and BuzzFeed’s “The Trump Administration Is Pulling Out Of Obamacare Enrollment,” by Kate Nocera and Paul McLeod.

Margot Sanger-Katz:’s “HHS Hints Are Major Chances To Medicare That Could Mean Higher Costs For Patients,” by Erin Mershon.

Paige Winfield Cunningham: Cincinnati Enquirer’s “Seven Days Of Heroin: This Is What An Epidemic Looks Like,” by Enquirer and Media Network of Central Ohio staff.

To hear all our podcasts, click here.

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Why Glaring Quality Gaps Among Nursing Homes Are Likely To Grow If Medicaid Is Cut

Nursing homes that rely the most on Medicaid tend to provide the worst care for their residents — not just the people covered by the program but also those who pay privately or have Medicare coverage.

Despite the collapse of the latest Senate effort to repeal the Affordable Care Act, congressional Republicans are still keen on shrinking the amount of Medicaid money Washington sends states.

Down the line, this would create problems for the nation’s 1.4 million nursing home residents, two-thirds of whom are covered by the state-federal health care program for low-income and disabled people.

Medicaid already pays less than other forms of insurance. As a result, nursing homes make more than 10 percent on Medicare residents, but lose about 2 percent on the rest of their residents because so many have care paid for by Medicaid.

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If the feared reductions come to fruition, states would likely respond by either lowering their payment rates or restricting whom they cover and for how long. And the quality of care, experts say, would deteriorate further.

These four charts, based on a Kaiser Health News analysis of ratings from the federal government’s Nursing Home Compare website, show how care suffers in nursing homes where Medicaid is the dominant payer for residents.

The government rates nursing homes on a scale from one to five stars, based on overall quality. Factors weighed: how well each facility performs on government inspections, how many nurses and aides it employs, and how healthy its residents are as judged by such measures as how often they fall, get infections or are admitted to the hospital.

The chart below shows the big picture: Nursing homes with higher percentages of residents covered by Medicaid earn fewer stars on the federal government’s overall quality rating system. One-star homes (lowest quality) average 69 percent of residents on Medicaid; Five-star (highest quality) average 49 percent of residents on Medicaid.

A prime reason for the disparity, researchers have found, is that nursing homes with the most Medicaid residents can’t afford as many nurses and aides. Medicare assigns a second type of star rating representing staffing levels and based on the ratio of nurses to residents. As the chart below shows, the staffing differences are huge: The average five-star home has enough nurses and aides to provide 5.4 hours of care a day for each resident while the average one-star home provides 3.0 hours of daily care per resident. At the best-staffed homes (five stars), only 4 of 10 residents are on Medicaid, meaning the remainder of residents are more lucrative for those facilities. At the worst-staffed homes (one star), 7 of 10 residents are on Medicaid.

Low staffing is just one factor behind inferior quality ratings for homes that rely heavily on Medicaid, said Dr. David Gifford, senior vice president for quality and regulatory affairs at the American Health Care Association, a nursing home trade group. A home’s ability to buy medical equipment, medications and oxygen and to keep the building operating can also suffer.

The government publishes a third set of stars representing the results of health inspections. State inspectors give citations to homes that don’t protect residents from bed sores, accidents, infections and other types of harm. The third chart, below, shows how homes with more health violations usually also have more Medicaid beds. At nursing homes with worst inspection records (one star), an average 65 percent of residents are on Medicaid. Facilities with the best inspection records (five star) have an average 47 percent of residents on Medicaid.

“It’s very likely that if Medicaid payment rates freeze or decline, there would be adverse effects,” said Vincent Mor, a professor at the Brown University School of Public Health. “Nursing homes that can will get out of the Medicaid business if it’s at all possible. Those that can’t will try to keep their beds as full as possible and live with a negative margin and reduce food, reduce staff and try to struggle along.”

Mor said the Medicaid cuts might not even save the government money in the end. “When Medicaid nursing homes are poor and perform poorly, their hospitalization rate increases, and Medicare pays for those hospitalizations. If I’m a nursing home and I can barely afford my patients, I’m going to send my patients to the hospital.”

This final chart shows, by state, the percentage of nursing home residents who rely on Medicaid. In Alaska, 83 percent of nursing home residents are covered by Medicaid. Iowa is the only state where Medicaid does not cover a majority of nursing home residents.

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Senators close to bipartisan deal on health exchanges: Schumer

WASHINGTON (Reuters) – Two U.S. senators from both parties are close to finalizing a bipartisan deal to shore up the health insurance exchanges created under Obamacare, the chamber’s top Democrat said on Thursday.

The move, which Senate Democratic Leader Chuck Schumer said was “on the verge” of completion, would stabilize the market for individuals who buy their own insurance plans on the federal or state-based exchanges.

The potential agreement comes after Republicans have repeatedly failed to carry out their years-long pledge to repeal and replace the 2010 Affordable Act, former Democratic President Barack Obama’s signature healthcare overhaul.

Schumer said Senate Health, Education, Labor and Pension Committee Chairman Lamar Alexander, a Republican, and ranking Democrat Patty Murray had resurrected a bipartisan approach, which had been cast aside amid the latest near-vote on a repeal bill.

Alexander and Murray had been working to protect the government payments made to insurers to help reduce medical expenses for low-income Americans enrolled in Obamacare. Alexander also wanted states to have more flexibility to design insurance plans under the program.

“They both inform me that they’re on the verge of an agreement, a bipartisan healthcare agreement to stabilize markets and lower premiums,” Schumer said on the Senate floor on Thursday.

FILE PHOTO – Chairman Senator Lamar Alexander (R-TN) speaks prior to Dr. Scott Gottlieb testimony before a Senate Health Education Labor and Pension Committee confirmation hearing on his nomination to be commissioner of the Food and Drug Administration on Capitol Hill in Washington, D.C., U.S., April 5, 2017. REUTERS/Aaron P. Bernstein

The pact could buoy health insurance companies, which came out forcefully against the Republican repeal effort and have faced uncertainty since the November election of Republican President Donald Trump, who vowed to sink the law.

While the majority of insured Americans receive coverage through their employers or government programs such as Medicare and Medicaid, more than 10 million people have individual plans through the online exchanges, and about 11 million are expected to sign up next year.

FILE PHOTO – Sen. Patty Murray (D-WA) speaks at a press conference about the Senate health care bill on Capitol Hill in Washington, U.S., July 12, 2017. REUTERS/Aaron P. Bernstein

Most of these consumers receive income-based tax credits and subsidies to reduce costs. Insurers have filed their premium rates for 2018, many of which are expected to rise at least 20 percent because of uncertainty that the government will continue paying some of those subsidies.

Despite those worries, insurers on Wednesday signed contracts with the government that will result in every U.S. county having at least one company selling Obamacare plans.

Trump has signaled that his administration would take other action to unwind the law, and on Wednesday said he would sign an order next week allowing people to buy insurance coverage across U.S. state lines.

Republican Senator Rand Paul, who has been pushing for the move, says Trump can do this by legalizing nationwide health associations that individuals could then join.

Reporting by Susan Heavey; Editing by Lisa Von Ahn

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A single genetic glitch may explain how Zika became so dangerous

CHICAGO (Reuters) – A single genetic change that occurred in 2013 may explain how Zika acquired the ability to attack fetal nerve cells, causing a severe birth defect in babies whose mothers were infected while pregnant, Chinese and U.S. researchers reported on Thursday.

Scientists have posited many theories about why Zika, a mosquito-borne virus that had been linked with only mild symptoms since its discovery in 1947, could suddenly be associated with thousands of cases of the birth defect known as microcephaly, as it was in Brazil in 2015.

That outbreak prompted the World Health Organization to declare Zika a public health emergency in 2016, and set off a scientific quest to determine whether Zika could cause microcephaly, a condition marked by small head size.

Several teams have already traced the virus circulating in Brazil and elsewhere in South America to a strain of Zika that had been quietly circulating in Southeast Asia for decades.

In the new study, published in Science, Ling Yuan of the Chinese Academy of Sciences and colleagues compared genetic changes in samples of the South American virus with one isolated in 2010 in Cambodia.

They created seven sample viruses, each with a single genetic difference from the Cambodian strain, and tested these in brains of fetal mice. Although the viruses caused some degree of damage in all, those infected with a virus that carried a single mutation in a structural protein called prM developed severe microcephaly. That strain also proved more lethal to fetal brain cells.

The team estimates the genetic change occurred in May 2013, just before a French Polynesian outbreak of Zika in which the first cases of microcephaly and Guillain-Barre, a rare neurological disorder, were noted.

“Our findings offer an explanation for the unexpected causal link of Zika to microcephaly, and will help understand how Zika evolved from an innocuous mosquito-borne virus to a congenital pathogen with global impact,” Yuan and colleagues wrote.

One study author, Dr. Pei-Yong Shi of the University of Texas Medical Branch in Galveston, Texas, said other mutations also fueled the explosive epidemic, including one he and others reported on in May in the journal Nature that enhanced Zika’s ability to infect Aedes aegypti mosquitoes, which carry the virus.

Last November, WHO pronounced Zika no longer an international emergency, but stressed that the virus, found in at least 60 countries, will keep spreading where mosquitoes that carry Zika are present.

Reporting by Julie Steenhuysen; editing by Susan Thomas

Our Standards:The Thomson Reuters Trust Principles.

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