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September, 2017

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Thousands of NC public workers pay nothing to get health insurance. That’s changing.

In the past, about 60,000 North Carolina public workers have paid nothing for employee-only health plan premiums.

But in 2018, they will pay $300 a year – $25 a month – for the same plan, according to the State Treasurer’s Office.

State workers can begin choosing their health plan for next year starting on Sept. 30.

That increase in cost for employees who only insure themselves – and not their families – is aimed at covering increased costs for the state health plan.

Overall, state health insurance plans insure more than 700,000 N.C. residents. In Mecklenburg County alone, more than 19,000 public workers at Charlotte-Mecklenburg Schools, UNC Charlotte and other public entities participate in the program.

Increasing premium costs is more transparent than “playing games” with other insurance costs that workers don’t notice, said N.C. Treasurer Dale Folwell. For example, in the past premiums would stay the same but copays and deductibles would increase, he said.

The teachers, law enforcement officers, college employees and other public workers, who will go from paying nothing to $300 a year, participate in what’s called the state’s 70/30 plan and insure only themselves – not a spouse or children.

The 70/30 plan requires that after workers hit their deductible and copays, the costs of medical services is split 70 percent paid by the state and 30 percent by the patient, until the total coinsurance maximum is reached, according to Treasurer’s office.

Meanwhile, another 11,000 workers who have a “consumer-driven” plan and only insure themselves also do not currently pay a premium. But that plan is disappearing next year, meaning they will have to chose another plan that will cost them.

They could choose the 70/30 plan or an 80/20 plan that will cost $600 per year, up from $180.

The projected rates are based on workers completing a tobacco assessment. Smokers who don’t agree to try to quit will pay more.

While employee-only coverage is increasing, family coverage will stay about the same.

For example, annual premiums for family coverage under the 80/20 plan will cost workers $8,640 in 2018, down from $8,685 in 2017.

It was important to keep the cost of family plans the same because those plans are already not affordable, Folwell said. North Carolina has one of the lowest family plan participation rates in the United States because the plan is not affordable, he said.

“It’s the right thing when you hire a trooper or a teacher or a DOT worker, it’s the right thing to do that when you offer them a benefit that they can afford it,” Folwell said..

Signs of sanity as Murray tries for health care deal

A big lesson of Obamacare is that a one-party health care solution doesn’t work long term. Compromise is the only path forward, but today’s political arena is hardly fertile ground for that; instead, it’s a battlefield.

If a bargain is to be struck, politicians will have to step out of their trenches. But who’s courageous enough to cross party lines?

The answer is Sen. Lamar Alexander (R-Tenn.) and Washington’s own Sen. Patty Murray, both of whom seem weary of partisan blowhards obstructing good governance.

Alexander is chairman of the Health, Education, Labor and Pensions Committee. Murray is the ranking Democrat. The two worked successfully to rewrite the flawed No Child Left Behind Act in 2015.

They renewed their partnership after the Republicans’ “skinny repeal” of Obamacare was shot down in July.

The pair held four hearings on health care in September, and the results were promising. A bipartisan group of governors, insurers, state regulators and other healthcare professionals supported many of their ideas.

But the GOP put a stop to those talks a few weeks ago, insisting sole focus be on a bill sponsored by Republican Sens. Lindsey Graham and Bill Cassidy. Why continue with a collective solution, they figured, when there’s a possibility for a one-sided win?

Republicans have tried more than 60 times to repeal the Affordable Care Act in the seven years it’s been law. This is the third attempt since President Trump took office. Murray called it “the worst one yet.”

If not for the three solid “no” votes of Republican Sens. John McCain, Susan Collins and Rand Paul, the law would’ve left millions without health insurance.

Two studies estimated Washington would have forfeited about $17 billion in federal funding, resulting in more than 650,000 people losing Medicaid coverage. Washington Apple Health, which covers more than half the state’s kids, would’ve been undermined.

Once the bill failed, Murray was anxious to resume talks with her moderate colleague Alexander, saying, “Let’s pick back up right where we left off and let’s do it right now.”

Three cheers for the two leaders who are back at work trying to cut a bipartisan deal and stabilize health care markets. The fix might be short-term, but it’s a cooperative step in the right direction.

Uncertain footing has made it difficult for insurers to sell policies on the individual market. Without federal cost-sharing subsidies, the Kaiser Family Foundation estimates premiums will go up, on average, 19 percent.

Next year Washington consumers will see their premiums jump by 24 percent, the largest premium increase since the exchange was created in 2013.

But Republicans oppose stabilization, calling it a “new entitlement.” They filed a lawsuit claiming it’s unconstitutional. It’s now on appeal.

Trump called stabilization a bailout for insurance companies. Some accuse him of giving Obamacare’s demise a push. Changes in enrollment are used as evidence.

The feds cut the time of open enrollment for the ACA in half — It will run from Nov. 1 through Dec. 15 — and the website,, will be shut down on all but one Sunday morning.

And in spite of a bipartisan coalition of governors urging the administration to fund outreach and enrollment support, the advertising budget was cut by more than 90 percent.

Letting Obamacare implode would be reckless. The same goes for defunding commitments like the Children’s Health Insurance Program and Community Health Centers. Since CHIP’s 1997 inception, the uninsured rate for children fell from 13.9 percent to less than 5 percent today.

The U.S. Department of Health and Human Services estimates that failure to renew these funds would result in the loss of 51,000 jobs and the closure of 2,800 community health centers. It also would leave 8.4 million children without health care, including an estimated two million kids with chronic conditions.

For Murray and Alexander, stabilizing the insurance markets remains top priority. Lobbyists and aides listening in on the negotiations report progress.

They hint at waivers allowing states to innovate, change regulations and offer a choice of cheaper plans. But House Speaker Paul Ryan has already told the Senate an Alexander-Murray deal “isn’t viable.” He has called his troops back to the trenches.

Ryan apparently would rather see politics as usual, where a red team and a blue team go head-to-head and everyone loses.

We prefer the Murray-Alexander strategy of open hearings and open minds — not open warfare.

Health care’s secret negotiations were a major factor in their failure

There are two primary reasons why the Republican effort to repeal and replace ObamaCare failed that have been overlooked: a failure to lay the groundwork with the public, and “secret negotiations” that inhibited the ability of Republicans to continually highlight the failures of the ACA at a crucial time when the public was focused on the issue.

A failure to lay the groundwork: Republicans had seven years to produce an alternative plan but chose not to do so.

Republicans have promised that they would repeal and replace ObamaCare once they had the votes to do so.

However, instead of producing a detailed replacement plan that allowed public digestion and discussion of its pros and cons, Republicans felt that was too risky.


They were concerned that putting out a detailed plan would give opponents a continuous opportunity to attack it. Instead, they waited until the time to put a bill together was at hand, and tried to muscle a proposal through a narrow Senate majority.

Compare that approach to what Republicans have done on tax reform: while full details have yet to be announced, the general parameters of the tax reform plan have generally been publicly discussed for years, and Republicans are actively talking about the need to reform the tax code and what those reforms may look like.

There has, for example, been an active debate about how the package will be paid for — including a very contentious and public debate over the BAT. This debate has not been held behind closed doors, but has been fully transparent.

While some Republicans may not be happy that one of the results of this public discussion is the jettisoning of the BAT, it also helps ensure that a large sector of the economy won’t raise serious concerns and potentially oppose the bill at the end of the day.

Had Republicans led a constructive, public debate about the failures of the Affordable Care Act and what they intended to do to fix it, some ideas might have been scuttled, but the larger package likely would have survived.

Secret negotiations hindered the ability to continually highlight ACA shortcomings, ceding the field to ACA supporters.

Throughout the meat of the health care debate, when the press and public were intently focused on the issue, Republicans ignored the public discussion, and instead focused on extensive behind-closed-doors negotiations. That failure to continually “beat the drum” about the failures off the ACA ceded the field to supporters of the ACA and helped kill the legislation.

For example, while Republicans were busy negotiating, ACA supporters drove the public narrative and set the terms of the debate and defined the policies that Republicans were considering without any rebuttal or other real engagement from Republicans.

For instance, since the enactment of the ACA, Republicans have been continually highlighting the shortcomings of the Exchanges and significant premium increases of the ACA.

However, during these Hill discussions, the only ones talking about the ACA were supporters who highlighted the extension of protections for preexisting conditions. When the bill finally came up for a vote, the only thing the press covered was the effect that the Republican bill would have on preexisting conditions protections.

This impact can clearly be seen in polling results, which showed, for the first time, that the ACA was gaining popularity. Again, not because the policies changed, but because only supporters of the ACA were talking about it.

Lesson learned: public debate is a vital component of public policy success.

Companies that sell consumer products from cars to candy understand the importance of continually marketing their products to consumers, making sure that consumers are continually aware of their brand.

Marketers also understand that if consumers are not thinking about their product, they are likely to choose an alternative, perhaps picking up a bag of chips for a snack instead of a candy bar, and each company is constantly striving to make their product top-of-mind for consumers.

During campaign season, politicians understand that as well, as they blanket the airwaves with messages about why voters should choose them over their opponent, knowing that if they don’t define themselves, their opponents will.

Public policy is no different, particularly for issues that the press covers frequently and that most consumers think about on a regular basis, such as health care and taxes. Engagement enables policy professional to define the terms of the debate, explain what the problems are, and describe why their proposed solution would solve those problems.

Once they get a Congressional majority in Washington, however, politicians often fail to incorporate the lessons learned on the campaign trail about the need for continual communication necessary to influence public opinion, and instead believe that simply muscling a solution through on a party-line vote will work.

The failure to use basic public relations tools to continually discuss the reasoning behind certain policy choices on health care has been a key factor in why it failed. Hopefully policy advocates will take that lesson to heart in future debates.

Joe Rubin is Senior Vice President of MWWPR. The views expressed here are solely his own, and do not reflect the views of MWWPR or any clients.

Health care innovation continues despite stalemate in Washington

MADISON – The logjam in Washington, D.C., over federal health care policy might lead some people to fear the Obamacare stalemate threatens to stifle innovation from top to bottom in health care.

Not so. At least, not in Wisconsin.

The latest effort to repeal the Affordable Care Act, or Obamacare, is emblematic of deep political divisions over how best to provide health care coverage to millions of Americans. However, that debate is not keeping hospitals, medical professionals, insurers, entrepreneurs and others from working on better, more efficient ways to care for patients.

b5c51_biz-fb Health care innovation continues despite stalemate in Washingtonb5c51_biz-fb Health care innovation continues despite stalemate in Washington

That was evident last week in some massive settings, such as Epic Systems’ annual user group meeting in Verona. Chief Executive Officer Judy Faulkner challenged her company’s electronic health record customers to think about patients as not just a collection of “big data” but as people with health concerns and conditions that may be improved through emerging technologies.

Health care innovators in other settings also are not content to wait for Congress to design a better way. Another close-to-home example involves WEA Trust, a health insurance carrier for many public employees, and Kiio, a young company with a novel patient engagement platform.

WEA Trust has invested $1 million in Madison-based Kiio to further develop its platform for involving patients in their own care through mobile technology and evidence-based treatment that can prevent more expensive care while yielding better results.

The insurance company will be more than a passive investor; it will become a customer for Kiio as it expands its platform from conditions such as lower back pain, joint replacement and physical rehabilitation to other protocols.

Kiio’s lower back pain screening, assessment and exercise program has already shown results, diverting costly procedures such as imaging, surgeries and specialty visits while helping patients deal with pain and dysfunction. Because back surgeries don’t always work the first time — or at all — the process saves money and frustration for all involved.

“We see the Kiio platform as becoming an engagement tool for our members across a broad spectrum of their health needs,” said Michael Quist, president and chief executive officer for WEA Trust. “It’s really limitless in terms of how it can be used to engage with patients.”

It’s also an example of how health care is moving from a brick-and-mortar model that assumes all care takes place within a clinic or hospital to a future in which patients can get care where they work, at home or anywhere else that technology allows them to take an on-demand role in their own health.

WEA Trust was born in 1970 as an in-house insurance company for unionized Wisconsin teachers. That model changed abruptly with the passage of a 2011 law that eroded the power of the teachers union and put WEA Trust in “survival mode” for a few years. It has returned to firm financial footing by focusing on health insurance and functioning as a Voluntary Employees Beneficiaries Association, which exists solely to serve its members.

Because WEA Trust isn’t aligned with a specific health-care system, it is free to negotiate with many providers. The reimbursement strategy for the Kiio platform will rest on convincing a health-care provider that it works and can control costs while ensuring quality. For example, a pilot program might involve waiving co-pays on a back surgery if the patient follows the Kiio protocol first.

“We want to be at the forefront of figuring out reimbursement strategies,” Quist said. 

For Kiio founder Dave Grandin, the WEA Trust investment isn’t just about the money. It’s about engaging with an innovative partner.

“We believe we’re working with a partner that has a vision about the future of health care, not only in terms of managing costs but in enhancing quality and helping patients,” Grandin said. “For a young company like Kiio, that’s a great fit.”

Innovation in health care has been slow to come in some quarters, but information technology, patient choice and the need to control costs is accelerating change. That process will continue, with or without Congress.

Tom Still is president of the Wisconsin Technology Council. He can be reached at

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Marshall gets $854k grant for behavioral health training

HUNTINGTON, W.Va. (AP) — Marshall University has landed a federal grant of more than $854,000 to provide behavioral health training.

The Herald-Dispatch reports that the award comes from the U.S. Health Resources Services Administration and its Behavioral Health Workforce Education and Training Program. Marshall will receive more than $213,000 annually over four years.

Dr. Marianna Footo Linz, Marshall’s psychology department chairwoman, says the money will fund clinical internships and placements for the master’s program in psychology with clinical and school emphasis, master’s in counseling and the psychiatry residency program.

The program aims to increase the number of behavioral health providers for rural and underserved patients.

Students will attend seminars, including responding to substance abuse disorders in primary care, integrated behavioral health in primary care, trauma-related instruction, and Appalachian culture and unique service needs.


Information from: The Herald-Dispatch,

Wanted: 1 million people to study genes, habits and health

WASHINGTON (AP) — In a quest to end cookie-cutter health care, U.S. researchers are getting ready to recruit more than 1 million people for an unprecedented study to learn how our genes, environments and lifestyles interact — and to finally customize ways to prevent and treat disease.

Why does one sibling get sick but not another? Why does a drug cure one patient but only cause nasty side effects in the next?

Finding out is a tall order. Today, diseases typically are treated based on what worked best in short studies of a few hundred or thousand patients.

“We depend on the average, the one-size-fits-all approach because it’s the best we’ve got,” said Dr. Francis Collins, director of the National Institutes of Health.

That’s changing: The NIH’s massive “All Of Us” project will push what’s called precision medicine, using traits that make us unique in learning to forecast health and treat disease. Partly it’s genetics. What genes do you harbor that raise your risk of, say, heart disease or Type 2 diabetes or various cancers?

But other factors affect that genetic risk: what you eat, how you sleep, if you grew up in smog or fresh air, if you sit at a desk all day or bike around town, if your blood pressure is fine at a check-up but soars on the job, what medications you take.

Not to mention differences based on age, gender, race and ethnicity, and socioeconomics.

In this Aug. 7, 2017, photo, Kenneth Parker Ulrich, left, a research technician at the University of Pittsburgh Medical Center, prepares to collect a blood sample from Erricka Hager, a participant in the “All of Us” research program in Pittsburgh. The “All of Us” research program is run by the National Institutes of Health and plans to track the health of at least 1 million volunteers by 2019. By doing so, researchers hope to learn how to better tailor treatments and preventative care to people’s genes, environments, and lifestyle. The University of Pittsburgh is running a pilot program with some of the first enrollees in the study. (AP Photo/Dake Kang)

Layering all that information in what’s expected to be the largest database of its kind could help scientists spot patterns, combinations of factors that drive or prevent certain diseases — and eventually, researchers hope, lead to better care.

“The DNA is almost the easiest part,” Collins said. “It’s challenging to figure out how to put all that together to allow somebody to have a more precise sense of future risk of illness and what they might do about it.”

Pilot testing is under way, with more than 2,500 people who already have enrolled and given blood samples. More than 50 sites around the country — large medical centers, community health centers and other providers like the San Diego Blood Bank and, soon, select Walgreens pharmacies — are enrolling patients or customers in this invitation-only pilot phase.

If the pilot goes well, NIH plans to open the study next spring to just about any U.S. adult who’s interested, with sign-up as easy as going online .

It’s a commitment. The study aims to run for at least 10 years.

The goal is to enroll a highly diverse population, people from all walks of life — specifically recruiting minorities who have been under-represented in scientific research.

And unusual for observational research, volunteers will get receive results of their genetic and other tests, information they can share with their own doctors.

“Anything to get more information I can pass on to my children, I’m all for it,” said Erricka Hager, 29, as she signed up last month at the University of Pittsburgh, the project’s first pilot site. A usually healthy mother of two, she hopes the study can reveal why she experienced high blood pressure and gestational diabetes during pregnancy.

In this Aug. 7, 2017, photo, Stephanie Richurk, a nurse at the University of Pittsburgh Medical Center, sorts blood samples collected from participants in the “All of Us” research program in Pittsburgh. The “All of Us” research program is run by the National Institutes of Health and plans to track the health of at least 1 million volunteers by 2019. By doing so, researchers hope to learn how to better tailor treatments and preventative care to people’s genes, environments, and lifestyle. The University of Pittsburgh is running a pilot program with some of the first enrollees in the study. (AP Photo/Dake Kang)

Heading the giant All Of Us project is a former Intel Corp. executive who brings a special passion: How to widen access to the precision medicine that saved his life.

In college, Eric Dishman developed a form of kidney cancer so rare that doctors had no idea how to treat him, and predicted he had months to live. Only two studies of that particular cancer had ever been done, on people in their 70s and 80s.

“They didn’t know anything about me because they’d never seen a 19-year-old with this disease,” said Dishman.

Yet he survived for two decades, trying one treatment after another. Then, as he was running out of options, a chance encounter with a genetics researcher led to mapping Dishman’s DNA — and the stunning discovery that his kidney cancer was genetically more like pancreatic cancer. A pancreatic cancer drug attacked his tumors so he could get a kidney transplant.

“I’m healthier now at 49 than I was at 19,” said Dishman. “I was lucky twice over really,” to be offered an uncommon kind of testing and that it found something treatable.

Precision medicine is used most widely in cancer, as more drugs are developed that target tumors with specific molecular characteristics. Beyond cancer, one of the University of Pittsburgh’s hospitals tests every patient receiving a heart stent — looking for a genetic variant that tells if they’ll respond well to a particular blood thinner or will need an alternative.

The aim is to expand precision medicine.

“Why me?” is the question cancer patients always ask — why they got sick and not someone else with similar health risks, said Dr. Mounzer Agha, an oncologist at the University of Pittsburgh Medical Center.

“Unfortunately I don’t have answers for them today,” said Agha, who says it will take the million-person study to finally get some answers. “It’s going to help them understand what are the factors that led to their disease, and it’s going to help us understand how to treat it better.”

And NIH’s Collins expects surprises. Maybe, he speculates, Type 2 diabetes will turn out to be a collection of genetic subtypes that require varied treatments.

“This looks at individual responses to treatment in a way we couldn’t do previously with smaller studies.”

In this Aug. 7, 2017, photo, Kenneth Parker Ulrich, left, a research technician at the University of Pittsburgh Medical Center, inserts a needle to collect a blood sample from Erricka Hager, a participant in the “All of Us” research program in Pittsburgh. The “All of Us” research program is run by the National Institutes of Health and plans to track the health of at least 1 million volunteers by 2019. By doing so, researchers hope to learn how to better tailor treatments and preventative care to people’s genes, environments, and lifestyle. The University of Pittsburgh is running a pilot program with some of the first enrollees in the study. (AP Photo/Dake Kang)

The study starts simply: Volunteers get some standard health checks — weight, blood pressure and heart rate. They answer periodic questionnaires about their health, background and habits, and turn over electronic health records. They give a blood sample that, if they agree, will undergo DNA testing sometime next year.

Eventually, researchers will ask some participants to wear sensors that may go beyond today’s Fitbit-style health trackers, such as devices that measure blood pressure while people move around all day, or measure environmental exposures, Collins said.

In Pittsburgh, the Rev. Paul Abernathy made a health change after signing up for the pilot study: Surprised to learn his BMI was too high despite regular weightlifting, he began running.

“I’m praying I have the discipline to continue that, certainly in midst of a busy schedule,” said Abernathy, who directs the nonprofit Focus Pittsburgh that aids the poor and trauma victims.

“We have a chance really to influence history, to influence the future of our children and our children’s children,” added Abernathy, who hopes the study will help explain racial disparities such as lower life expectancies between African-Americans and whites who live in the same areas.

At NIH, Collins plans to enroll, too. He’s had his DNA mapped before but can’t pass up what he’s calling a one-in-a-million experience to be part of a monumental study rather than the scientist on the other side.

“I’m curious about what this might teach me about myself. I’m pretty healthy right now. I’d like to stay that way.”

© Copyright 2017 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

In the LGBT community, bisexual people have more health risks. Here’s what could help.

071f4_1%2Aa_V7N0NBweLY4SxyyPOoZg In the LGBT community, bisexual people have more health risks. Here's what could help.

Adapted from a story by Zachary Zane for The Washington Post.

In the past decade, there has been a slew of research consistently finding that bisexual individuals have worse health outcomes than the general population. They also have higher rates of depression and anxiety and face a higher risk of suicide than gay and lesbian folks.

Bisexual individuals are in desperate need of resources and support.

Yet, there are fewer groups and resources dedicated to bisexual individuals than to gay, lesbian and transgender individuals.

Of the $487 million that went to programs and organizations that serve the overall LGBT population from 1970 to 2010, a mere $84,000 went to groups that specifically serve bisexuals, according to the 40th annual LGBT Funders Report.

Why are bisexual individuals experiencing more mental and physical problems than the rest of the population?

Double discrimination

Perceptions of gay and lesbian individuals have improved drastically over the past two decades, and stigma has lessened. But the same can’t be said for the bisexual community, which faces double discrimination.

Sabra L. Katz-Wise, an assistant professor at Boston Children’s Hospital and Harvard Medical School, said that bisexuals are “often experiencing discrimination from both heterosexual and sexual minority communities, where the same may not be true for lesbian and gay individuals.”

Ethan Mereish, a licensed psychologist and associate professor at American University, said that this double discrimination can lead to negative health outcomes, such as increased feelings of loneliness, which can lead to depression, anxiety and suicide.

“We know that bisexual people are often invisible, invalidated and stigmatized — experiencing multiple forms of discrimination from the heterosexual community and lesbian and gay community,” Mereish said. “This creates pressure to conceal their identity as well as internalize these stigma[s].”

In a 2016 study, Brian Dodge, associate professor at Indiana University’s School of Public Health, and his fellow researchers “only saw a little shift” in attitudes toward bisexual men and women.

“The only other study similar to ours was conducted in 1999,” Dodge said, “and people in that study rated bisexual people more negatively than any other group except injecting drug users. So we moved up a little bit, from rock bottom, but still, attitudes [toward bisexuals] are ambivalent at best.”

How can we address these disparities?

We can start by changing health-care practices to address the specific needs of bisexual individuals, Katz-Wise said.

  • Providers shouldn’t make assumptions about patients’ sexuality.
  • Change how doctors ask questions to be more inclusive of bisexuality.
  • If doctors are more open, patients can tell them they’re bisexual. This might change how a doctor cares for his or her patient. For example, a doctor might assume a man is dating only women and then not test him for an STI.

Society as a whole needs to be more open about discussing bisexuality, Dodge said.

  • Address the stigma and acknowledge that biphobia exists at systemic levels.
  • Start support groups where people can share similar experiences.
  • Accurately depict bisexual individuals in the media.
071f4_1%2Aa_V7N0NBweLY4SxyyPOoZg In the LGBT community, bisexual people have more health risks. Here's what could help.

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Eye Opener: Pricey flights cost the health secretary his job

September 30, 2017, 7:08 AM|
The White House announces the departure of Tom Price after he spends hundreds of thousands of taxpayer dollars on private jets. Also, Puerto Rico struggles to fulfill basic human needs 10 days after Hurricane Maria made landfall. All that and all that matters in today’s Eye Opener. Your world in 90 seconds. Get the Eye Opener delivered straight to your inbox.

Warning: Too many warning signs are bad for your health

Starbucks, Whole Foods and about 80 other places in California that sell coffee may soon be forced to put warning labels on grande lattes and coffee bean packages to alert consumers that the product within contains acrylamide, a chemical that may be carcinogenic.

Wait a minute. Coffee causes cancer? Actually, research increasingly points to the opposite conclusion. Two large studies published earlier this year in the Annals of Internal Medicine found compelling indications that drinking coffee protects against heart disease, a number of cancers and other common ailments. Furthermore, researchers found that higher coffee consumption was associated with a lower risk of premature death. Maybe it has to do with the antioxidants present in a cup of joe that help the body heal itself, or maybe it’s some other properties of this complex brew.

But that doesn’t matter under Proposition 65. Formally known as the Safe Drinking Water and Toxic Enforcement Act of 1986, it requires businesses with 10 or more employees to warn the people when they may be exposed to any of about 850 chemicals that are confirmed or suspected carcinogens, regardless of whether that particular exposure might be dangerous.

Starbucks and some of the other businesses that were sued under the law have already put up the warnings signs the law requires, even though the case is still being argued in a Los Angeles courtroom. Consumers who pause to read the signs might reasonably conclude that their morning fix could harm or even kill them. But Proposition 65 warnings have become such a common sight in the Golden State — in parking lots, hotels, office buildings, amusement parks and gas stations, to name a few places — that they’re not so attention-grabbing any more.

Lady Gaga Shares Health Update, Assures Fans She’s ‘Gettin’ Stronger Everyday’

Lady Gaga has shared an update with her fans and assured them her health is improving since she had to postpone the European leg of her Joanne world tour due to chronic pain.

The “Bad Romance” singer, 31, tweeted on Friday, September 29, “Gettin’ stronger everyday for my #LittleMonsters can’t wait to get back on stage be w u at JoanneWorldTour.”

The A Star Is Born actress (real name Stefani Germanotta) announced earlier this month in an emotional Instagram post that she would be postponing several shows.

“I have always been honest about my physical and mental health struggles. Searching for years to get to the bottom of them. It is complicated and difficult to explain, and we are trying to figure it out,” the six-time Grammy award winner, who suffers from fibromyalgia, wrote alongside a photo of herself holding rosary beads in her hands.

A post shared by xoxo, Gaga (@ladygaga) on Sep 18, 2017 at 12:01am PDT

“As I get stronger and when I feel ready, I will tell my story in more depth, and plan to take this on strongly so I can not only raise awareness, but expand research for others who suffer as I do, so I can help make a difference,” continued the “Poker Face” singer. “I am looking forward to touring again soon, but I have to be with my doctors right now so I can be strong and perform for you all for the next 60 years or more. I love you so much.”

Gaga has received an outpouring of support from her ardent fans, who she lovingly calls “little monsters” as well as from fellow singer Beyoncé, who sent the “The Cure” crooner flowers and an Ivy Park sweatshirt from the “Sorry” singer’s clothing line.

As previously reported, Gaga’s Netflix documentary Gaga: Five Foot Two gave fans a glimpse into the singer’s battle with chronic pain. In it, she revealed that she suffers muscle spasms from the hip injury that forced her to cancel her 2013 tour, the Born This Way Ball. More recently, the songstress had to cancel a performance at the Rock in Rio music festival in Brazil after being hospitalized due to severe pain.

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Report: Cher sues an LA billionaire and Florida health care company for stock fraud

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8e51c_104077099-IMG_8335.530x298 Report: Cher sues an LA billionaire and Florida health care company for stock fraud

Cher is suing a prominent billionaire and a health care company because she allegedly felt “duped” about the value of drug stocks in which she invested, the Los Angeles Times reported.

In a lawsuit filed Friday, the entertainer accuses surgeon and entrepreneur Patrick Soon-Shiong of fraud related to investments in a Florida-based biopharmaceutical company Altor, the Times reported.

Soon-Shiong’s spokesperson told the Times that the suit had “no merit.” Soon-Shiong is also known for investing in Tronc Inc., which owns the Los Angeles Times, Chicago Tribune and other American news outlets.

In 2013, Cher bought her stake in Altor, then sold it back to the company early last year at $1.50 per share — “an unreasonably below-market price,” the Times reported the suit says.

Yet when the singer and actress was asked to sell back her stock, she claims she wasn’t informed that Altor was developing a promising drug to treat HIV/AIDS and cancer, according to the Times.

Soon-Shiong then acquired the outstanding shares of Altor, which have since skyrocketed in value. According to Cher’s suit, the company is now valued at more than $1 billion.

Other defendents include Altor Acquisition LLC, Altor cofounder Hing C. Wong and Fred Middleton, a vice chairman of Altor’s board.

Read the full story at the Los Angeles Times.

8e51c_104077099-IMG_8335.530x298 Report: Cher sues an LA billionaire and Florida health care company for stock fraud

Uncertainty in Mississippi before health insurance sign-up

The federal health insurance market for individuals won’t open for enrollment until Nov. 1, but regulators, insurers and those who help Mississippians find coverage are already dealing with waves of uncertainty.

In the latest development, the U.S. Department of Health and Human Services pulled out of meetings around the state organized by the Mississippi Health Advocacy Program. Those meetings were cancelled, with Health Advocacy Program Director Roy Mitchell citing the refusal as the latest evidence of efforts to torpedo the health law by President Donald Trump’s administration.

“This is just clearly sabotage,” Mitchell said. “It’s still the law of the land, but they’re pulling out.”

The move drew national attention, and the department wasn’t shy about it.

“The American people know a bad deal when they see one and many won’t be convinced to sign up for ‘Washington-knows-best’ health coverage that they can’t afford,” department Press Secretary Caitlin Oakley said in a statement. “As Obamacare continues to collapse, HHS is carefully evaluating how we can best serve the American people who continue to be harmed by Obamacare’s failures.”

The state’s two navigator groups, which help people sign up for individual coverage, are dealing with budget cuts, which could hurt their ability to sign up customers during an enrollment period that’s been cut from three months to six weeks. Also, the Trump administration cut its national marketing budget from $100 million to $10 million.

“It’s not just the pre-enrollment meetings,” said Caitlin Rehner, who runs a navigator program at the University of Southern Mississippi’s School of Social Work. “It feels like everything that’s happening is to provide us with less support, less resources.”

Rehner said her group’s budget was cut 10 percent, which will reduce travel across 24 south Mississippi counties that its three navigators cover.

The Rev. Michael Minor, whose Hernando-based Oak Hill Baptist Church Ministries has a total of 40 full-time and part-time navigators, won’t say by how much his budget was cut. He said his employees are relying on relationships they have built.

“I think we have trusted voices,” Minor said. “Our navigators have been working since 2013. They’re known in their communities.”

Mitchell warns that less marketing could mean fewer younger, healthier people in the pool, burdening insurers with higher average costs for older, sicker people.

Already, Mississippi is down to only one insurer statewide, with Humana Inc. pulling out after this year. Though most people get federal tax credits and won’t feel the bite, state Insurance Commissioner Mike Chaney approved a 47 percent rate increase for that company, St. Louis-based Centene Corp. Chaney said that amount was necessary to cover potential costs should the Trump administration stops paying cost-sharing reductions to insurers, as it has threatened to do.

“I think your major worry needs to be that we keep Centene in the business they’re in,” Chaney said, adding he plans to cut the rate increase to 17 percent if cost-sharing reductions continue.

For the small share of Mississippians who pay the going rate on the marketplace, that means a big jump in monthly premiums. But more than 90 percent of enrollees get tax credits and won’t be hurt. For example, the Kaiser Family Foundation says a 40-year-old nonsmoker who makes $30,000 a year will pay $201 monthly for the second-lowest priced silver plan, actually down from $208 monthly this year.

But even with aid, many Mississippians struggle to pay premiums. Kaiser says 67,000 people were enrolled in February, but Chaney said Centene and Humana tell him only about 29,000 people are currently covered, meaning a majority of people failed at some point to pay premiums.

“If there’s $30 toward health insurance or $30 toward your power bill, people are going to pick the power bill every time,” Rehner said.

But with only one insurer, Rehner and Minor said people who just stopped paying bills instead of formally terminating coverage will be required to make up missed premiums if they try to re-enroll.

“It wasn’t fair to the insurance company for someone to get coverage because they had a certain health situation, then drop it, and then re-enroll,” Minor said.

Police, clinicians look to shift mental-health response burden away from officers

SAN JOSE — Jim Tourino watched helplessly as his 280-pound son, holding a knife above his head, charged at a San Jose police officer.

Staring at the 28-year-old mentally ill man coming toward him, the officer made a split-second decision: He fired his weapon, fatally wounding Tourino’s son.

Time after time, Joseph, in the throes of a violent mental breakdown, had been brought to psychiatric emergency rooms, but he always calmed down enough to avoid being admitted. On May 2, his breakdown unfolded not at a hospital, but in front of police outside the Tourino home on Mt. Frazier Drive.

“From (ages) 18 to 28, I tried to protect him,” Jim Tourino said. “I tried to protect society.”

With increasing frequency, police across the country are the first and last resort for situations involving mentally ill people. Those volatile encounters can quickly turn deadly: One in four officer-involved fatal shootings nationwide involve the mentally ill, according to one analysis. In San Jose, nearly a third of the officer-involved shootings over the past decade involved this group.

As the deadly encounters continue, police and county officials have begun looking for new solutions. San Jose’s officers already get crisis-intervention training to help them handle situations involving the mentally ill, but training can go only so far, they say. This year alone, six of the city’s eight police shootings have involved people with mental illness.

“The onus to deal with mental illness right now comes down to a police officer, and that is unfair,” San Jose police Chief Eddie Garcia said. “In a perfect world, a clinician responds rather than a police officer with 40 hours of (mental health) training.”

Answering that call is the primary aim of new programs from Santa Clara County, including on-call response teams featuring mental health clinicians who can answer resident and police calls. Two teams, based in East San Jose and South County, are expected to go live by November.

“When a local law enforcement officer gets a 911 call and it appears that person has behavioral health issues, we want that officer to contact our mobile-crisis team,” said Toni Tullys, director of the county behavioral health department.

For more serious calls, the Psychiatric Emergency Response Team, set for a spring launch, will pair a licensed behavioral-health clinician and a crisis-trained law-enforcement officer. These ideas have garnered the support of police unions across the country.

According to a recent SJPD review of interactions with known mentally ill people, between mid-2012 and the end of 2016, city officers had repeat contacts with 5,800 people with known mental illness. Lt. Paul Spagnoli added that in 2016 alone, San Jose police referred 3,000 cases to the county’s psychiatric emergency room at Valley Medical Center.

San Jose police encounters with people with known mental illnesses or experiencing mental-health crises accounted for at least 31 percent of the 54 officer-involved shootings since 2009, according to department figures analyzed by this news organization.

That’s slightly less than the 40 percent estimated by the state and far less than San Francisco, which reported that during a recent nine-year period, 58 percent of the city’s police shootings involved mentally ill people.

“We see de-escalation as a silver bullet, but that is based on the understanding that you’re dealing with a rational person who will stop and listen to commands,” said Jim Dudley, a retired San Francisco police deputy chief and lecturer at San Francisco State University.

Vicki Showman welcomes the idea of having a clinician available in these tense encounters. Her daughter Diana was fatally shot by San Jose police in 2014, after approaching officers with a cordless drill painted black to resemble an Uzi, which she told 911 dispatchers she had.

“One of the frustrations we faced was we wanted our daughter in inpatient treatment,” Vicki Showman said. “We were told that when a crisis occurred, call 911. I would never call 911 again for any situation dealing with a mentally ill situation.”

She added: “Having someone less threatening who can offer creative solutions to whatever problem is occurring at the time could only help.”

Tullys said in October her department will open two new voluntary crisis residential programs — 15 beds apiece in San Jose and South County — that offer assessment, counseling, medication and therapy, and where the average stay would range from two to four weeks instead of the industry-standard 72-hour hold.

49539_sjm-l-mentalios-0930-90 Police, clinicians look to shift mental-health response burden away from officersThe agency is also unveiling an eight-bed crisis-stabilization facility in San Jose to provide immediate medical and psychiatric evaluation, treatment and monitoring for up to 24 hours to help the county’s emergency facilities.

“We’re trying to do things in the community to catch people before they need EPS,” Tullys said, referring to emergency psychiatric services, “and get people at a much earlier state.”

A couple of weeks before he was shot by police, Joseph Tourino tried to hang himself from a tree in his father’s front yard. Police had a history of responding to calls involving the son. But his father recalled just one instance when someone recommended long-term psychiatric care, and it was ultimately rejected.

Jim Showman said his daughter Diana was admitted twice to EPS at Valley Medical Center, but that each time she was released within 24 hours after calming down.

“It was understandable that they would let her be released,” Vicki Showman said, “but the underlying issues needed to be observed over time.”

“This is where a lot of tragedies happen,” said Kathy Forward, executive director of the Santa Clara County chapter of the National Alliance on Mental Illness. “The flaw in the system is we wait for people to get so ill.”

The national police union push for more clinician help includes a legislative component to ease medical privacy restrictions so police and mental-health professionals can more readily share information and address one of Jim Tourino’s biggest frustrations: different agencies had scattered pieces of his son’s profile.

“The biggest failure, in my thinking, was that we could not put a picture together to say, ‘This is going to happen if we don’t commit him,’” he said.

Jim Tourino is still looking for answers. He sympathizes with everyone who tried to help his son, every clinician, judge and police officer, including the one who shot Joseph.

“It’s not systemic to one piece,” he said. “The system itself is overworked too, to the point where things fall through. When (Joseph) finally got to the point where he hanged himself, he should have never been back on the street.”

He added: “It should have been automatic. He has a history, we have time, let’s put him in a safe, highly managed environment while we do a real good evaluation and figure out what to do.”

Garcia said his officers need to go back to being a last resort in these situations.

“This is about what services are offered to an individual when they are 5150’d, and who tracks this individual,” he said, referring to when someone is put on a psychiatric hold. “And what services are there before they get to these moments of crisis.”

It’s what Jim Tourino has been thinking for a while. But he knows it hinges not only on freeing up resources but a broad public commitment.

If not for his son, then someone else’s.

“I’ve got to believe that people like my son have a record,” he said. “Joseph is not a one-off.”

Santa Clara County: 800-704-0900
Alameda County: 800-491-9099
Contra Costa County: 888-678-7277
San Mateo County: 800-686-0101
San Francisco: 415-255-3737

Santa Clara County: 855-278-2404
Alameda County: 800-309-2131
Contra Costa County: 888-678-7277
San Mateo County: 650-579-0350
San Francisco: 415-781-0500


Trump seeks new health chief after Price resignation

President Donald Trump is seeking a new health secretary to take the place of Tom Price, ousted after an outcry over flying on costly private charters for official travel.

The Health and Human Services chief oversees a $1 trillion department, with 80,000 employees and jurisdiction over major insurance programs, advanced medical research, drug and food safety, public health, and disease prevention.

The administration will also have to contend with renewed scrutiny of Cabinet members’ travel. Following news reports about Price, the House Oversight and Government Reform Committee launched a governmentwide investigation of travel by top political appointees.

Trump has named Don J. Wright, a deputy assistant secretary of health, to serve as acting secretary.

Mentioned as a possible permanent successor to Price is Seema Verma, a protege of Vice President Mike Pence. She now leads the Centers for Medicare and Medicaid Services, an HHS division that runs health insurance programs covering more than 130 million Americans.

Verma’s immediate challenge is to manage the 2018 open enrollment season under the Obama-era Affordable Care Act, which Trump and the GOP-led Congress have been unable to repeal.

Another possible HHS candidate is FDA Commissioner Scott Gottlieb, who won some bipartisan support in his confirmation and is well known in policy, government and industry circles.

Price, 62, a former GOP congressman from the Atlanta suburbs, resigned Friday afternoon. His pattern of costly trips triggered investigations that overshadowed the administration’s agenda and angered his boss. Price’s regrets and a partial repayment couldn’t save his job.

Price became the first member of Trump’s Cabinet to be pushed out in a turbulent young administration that has seen several high-ranking White House aides ousted. He served less than eight months.

On Friday Trump called Price a “very fine person,” but added, “I certainly don’t like the optics” around his travels.

Price said in his resignation letter that he regretted that “recent events have created a distraction.”

Privately, Trump had been telling associates in recent days that Price was overshadowing his tax overhaul agenda and undermining his campaign promise to “drain the swamp” of corruption, according to three people familiar with the discussions who spoke on condition of anonymity.

Price’s repayment of $51,887.31 for his own travel costs did not placate the White House. The total travel cost, including the secretary’s entourage, could amount to several hundred thousand dollars.

An orthopedic surgeon turned politician, Price rose to Budget Committee chairman in the House, where he was known as a fiscal conservative. When Price joined the administration, Trump touted him as a conservative policy expert who could write a new health care bill to replace the Obama-era Affordable Care Act.

But Price became more of a supporting player in the GOP’s futile health care campaign, while Vice President Mike Pence took the lead, particularly with the Senate. The perception of Price jetting around while GOP lawmakers labored to repeal the Obama health law — including a three-nation trip in May to Africa and Europe— raised eyebrows on Capitol Hill. Price flew on military aircraft overseas.

But House Speaker Paul Ryan, R-Wis., said Friday that Price had worked hard to help that chamber pass its plan before the GOP effort reached an impasse in the Senate. “I will always be grateful for Tom’s service to this country,” he said.

Democrats were glad to see Price go. Some urged Trump to appoint an HHS secretary who would reach out to them.

“I hope President Trump learns from this mistake, and looks to appoint someone who can work in a bipartisan way to strengthen health care for all Americans,” said Rep. Frank Pallone, D-N.J.

Price used private charter flights on 10 trips with multiple segments, when in many cases cheaper commercial flights were available. His charter travel was first reported by the news site Politico.

The controversy over Price was a catalyst for Congress launching a bipartisan probe of travel by political appointees across the administration. The House oversight committee has requested travel records from the White House and 24 federal departments and agencies.

Initially, Price’s office said the secretary’s busy scheduled forced him to use charters from time to time.

But later Price’s response changed, and he said he’d heard the criticism and concern, and taken it to heart.


Associated Press writers Jonathan Lemire and Catherine Lucey contributed to this report.

‘Little Lobbyists’ Help Save the Health Care Law, for Now

The American Medical Association, the American Hospital Association, America’s Health Insurance Plans and dozens of other industry groups lined up against the Republican repeal bills. But, lawmakers said, what really sank the legislation was the outpouring from constituents, and few were as influential as the little lobbyists who pleaded for their own lives and the lives of other children with special needs.

“They are fantastic,” said Senator Tim Kaine, Democrat of Virginia. “These kids and their parents demonstrated how catastrophic the Medicaid cuts would be. They really added value to this debate and helped us win.”

Rebecca A. Wood’s family has employer-sponsored health insurance, but under a federal waiver granted to the State of Virginia, Medicaid pays about $15,000 a year for items and services that are not covered by insurance. That matters to her daughter, Charlie Wood, 5, who was born more than three months early, weighed 1 pound 12 ounces and was in the neonatal intensive care unit of a hospital for 10 weeks.

Charlie has a mild form of cerebral palsy and developmental delays, has seen more than a half-dozen medical specialists and uses a feeding tube. She still started kindergarten in Charlottesville, Va., on time this year, but her mother said she saw another threat coming: The bills passed by the House and considered in the Senate would have made deep cuts in projected Medicaid spending, imposing an annual cap on federal payments to each state.

“After the presidential election, I knew that health care would be a huge issue,” Ms. Wood said. “I wanted people to know, when you cut health care, it affects many innocent people like my daughter. I wanted them to see the faces behind the cuts.”

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“Without the Affordable Care Act,” Ms. Wood said, “Charlie would have exceeded her lifetime cap before ever coming home from the hospital and would have been uninsurable.”

The House Democratic leader, Nancy Pelosi of California, said the young lobbyists “have made all the difference in the world.” And she described the parents as formidable: “You do not want to stand in between one of these moms and the good health care of her child.”

The effort started when five families visited Senate offices in June for a day of lobbying.

“It took off from there,” said Elena Hung, a co-founder of the group, whose 3-year-old daughter, Xiomara, has chronic lung and kidney disease. Since then, nearly 300 families in 47 states have shared their stories with lawmakers through the group.


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They are relieved that the Senate shelved plans for a vote last week, but fully expect the battle to continue. President Trump predicted that the Senate would try again in the first quarter of next year and said Republicans would “have the votes.”

Five-year-old Melanie Carrigg, from Tucson, visited 60 Senate offices and met with Senator Jeff Flake, Republican of Arizona, who ended up voting for the repeal bills in July.

Melanie, one of more than 34 million children covered by Medicaid, has Down syndrome and a heart defect and is deaf, said her mother, Austin G. Carrigg.

When the latest effort to repeal the Affordable Care Act collapsed in the Senate, Ms. Carrigg was happy. But she said: “I’m a realist. I know this fight is not over.”

Ms. Carrigg and her daughter visited the offices of two Republican senators who voted against the repeal bills in July, Susan Collins of Maine and Lisa Murkowski of Alaska.

“We have given information to their staff numerous times,” Ms. Carrigg said. “When you walk in and a staffer says, ‘Oh, they were just talking about you,’ you think, maybe we are making an impression. That has been my personal goal every time. I want them to remember my daughter’s face when they go on the floor and vote.”

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Trump’s Next Move on Health Care? Choice for Secretary May Offer Clue

The White House had no comment on Saturday, but two advisers who asked not to be identified discussing internal matters said two top candidates were Scott Gottlieb, the commissioner of the Food and Drug Administration, and Seema Verma, the administrator of the Centers for Medicare and Medicaid Services. Both have previously been vetted by the White House, nominated by the president and confirmed by the Senate to their current jobs within recent months, a significant selling point.

Other names have been floated as well, including David Shulkin, the secretary of veterans affairs and a favorite of the president’s. But he has been criticized for a European trip with his wife that mixed business and sightseeing and was partially financed by taxpayers, and Mr. Trump may be reluctant to move him because he has been critical to fixing veterans’ care.

Some reports floated former Gov. Bobby Jindal of Louisiana, an assistant secretary of health and human services under President George W. Bush. But he was a caustic critic of Mr. Trump during his own brief campaign for the White House that ended in late 2015 after he called the future president a “narcissist” and “egomaniacal madman.”

Mr. Trump may not necessarily fill the post quickly. He has left the Department of Homeland Security in the hands of an acting secretary since John F. Kelly left in July to become White House chief of staff. The president appears to be in no rush to fill that post despite a series of hurricanes and a roiling immigration debate, issues managed by the Department of Homeland Security. He said on Friday that he would make a decision on that nomination “probably within a month.”

If Mr. Trump picks Ms. Verma to succeed Mr. Price at the Department of Health and Human Services, it would be taken as a sign among many that he wants to continue vigorous opposition to the Affordable Care Act, with the government doing the minimum required by the law to implement its provisions. Ms. Verma, an ally of Vice President Mike Pence, worked closely this year with Republicans in Congress on their proposals to undo the law and to cut Medicaid, the program for more than 70 million low-income people.

Still, some progressives have interpreted her work under the health care law in Indiana, where Mr. Pence was governor, to mean that while she opposed the Affordable Care Act, she was committed to finding ways to enforce it if it remained on the books.

Mr. Gottlieb has more experience in Washington and was seen at the time of his appointment as the more moderate of candidates being considered. In his first months at the F.D.A., he has deftly balanced the concerns of patients and pharmaceutical companies, while taking steps to combat the opioid epidemic and speed access to lower-cost generic drugs. His nomination would be seen as a signal that the president might want to take a different approach to the health care debate.


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“We have the votes on the substance but not necessarily on the process, which is why we’re still confident that we can move health care forward and get it done in the spring,” Sarah Huckabee Sanders, the White House press secretary, said before Mr. Price’s resignation.

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After the latest legislative failure, Mr. Trump said he would sign an executive order in the coming week intended to enable Americans to buy health insurance across state lines, a sign that he did not intend to wait for Congress. But it is not clear that he has the authority to do that on his own, and states often resist federal efforts to intrude on their regulation of insurers.

Senator Lamar Alexander of Tennessee, the Republican chairman of the Senate health committee, and Senator Patty Murray of Washington, the panel’s ranking Democrat, have resumed negotiations on bipartisan legislation intended to shore up the current insurance exchanges and prevent prices from shooting up.

The uncertainty comes at a crucial moment, just as federal and state officials are preparing for the fifth annual open enrollment period under the Affordable Care Act. The open season, when people can sign up for coverage, runs from Nov. 1 to Dec. 15. Critics say that the Trump administration has destabilized insurance markets, driving up premiums for 2018 and making it harder for people to enroll.

Mr. Price was confirmed in February by a party-line vote of 52 to 47 after giving vague, noncommittal answers about how he intended to carry out the Affordable Care Act. Confirmation of his successor could be an even sharper battle. Democrats may not have the votes to block confirmation, but they could drag out the process and make it excruciatingly difficult for the nominee and the White House.

Democrats expect to press the new nominee for more specific answers to questions like these: Will the administration support bipartisan efforts to continue critically important payments to insurance companies, payments that Mr. Trump has threatened to cut off? Why has the president slashed funds for advertising, outreach and education programs and assistance to consumers who want to sign up for health insurance this fall?

Neither Ms. Verma nor Mr. Gottlieb had easy confirmations to their current posts, but neither seems as strongly determined to undermine the Affordable Care Act as Mr. Price was.

Ms. Verma, who earned a bachelor’s degree in life sciences at the University of Maryland and a master’s degree in public health at Johns Hopkins University, founded her own health policy consulting firm, SVC, and worked with state agencies to carry out the Affordable Care Act. Working with Mr. Pence when he was governor, she was the architect of the Healthy Indiana Plan, which expanded Medicaid under the Obama-era law.

Rather than simply refusing to participate, as many Republican-led states did, Indiana under the program shaped by Ms. Verma expanded eligibility while emphasizing “personal responsibility” by requiring beneficiaries to pay premiums and contribute to health savings accounts, and giving them incentives for healthy behavior.


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Republicans saw that as a model for conservative enactment of the program, while Democrats criticized what they saw as roadblocks for low-income Americans. She was confirmed to her current post in March on a largely party-line 55-to-43 vote.

Mr. Gottlieb, who received a bachelor’s degree in economics from Wesleyan University and a medical degree from Mount Sinai School of Medicine, served in several posts during President George W. Bush’s administration, including deputy commissioner of the F.D.A. While in the private sector, he worked as a fellow at the American Enterprise Institute in Washington and served as a consultant for pharmaceutical companies.

Republicans said that experience would make him a formidable commissioner because he would understand the business better, while Democrats said it made him too cozy with the industry he would regulate. While a physician, Mr. Gottlieb has also experienced the industry as a patient, having been successfully treated for Hodgkin’s lymphoma.

After promising to divest himself from several health care companies and recuse himself for one year from decisions involving those businesses, he was confirmed in May on a 57-to-42 vote.

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Hurricane stresses Puerto Rico’s already weak health system

Martin Lopez was shot in the hand last Saturday by two thieves who made off with his precious cans of gas in the aftermath of Hurricane Maria. He was rushed to Centro Medico, a trauma center in the Puerto Rican capital where in ordinary times he would be quickly treated by surgeons and sent on his way.

But five days later, the 26-year-old cook was still waiting because only a fraction of the operating rooms were available due to an island-wide breakdown in the electrical power grid caused by the storm. He finally got the surgery and the hospital said he was on the mend Friday — but the same can’t be said for Puerto Rico’s badly stressed medical system.

“Thank God I’m fine, I’m getting better,” he told The Associated Press in an air-conditioned medical tent set up by the U.S. Department of Health and Human Services on the grounds of Centro Medico. “But Puerto Rico is destroyed. It’s really sad.”

Of all the problems unleashed by the storm, which roared over the island Sept. 20 as a Category 4 hurricane with winds up to 155 mph, the plight of overtaxed hospitals and smaller clinics — and health care in general — is one of the most worrying for officials grappling with recovery efforts.

The health system in the U.S. territory was already precarious, with a population that is generally sicker, older and poorer than that of the mainland, long waits and a severe shortage of specialists as a result of a decade-long economic recession. The island of 3.4 million people has higher rates of HIV, asthma, diabetes and some types of cancer, as well as tropical diseases such as the mosquito-borne Zika and dengue viruses.

In Maria’s wake, hospitals and their employees are wrestling with the same shortages of basic necessities as everyone else. There are people who are unable to keep insulin or other medicines refrigerated. The elderly are particularly vulnerable to the tropical heat as widespread power outages mean no air conditioning. And amid the widespread disruption, it’s often difficult to get kids to a doctor, especially for families who can’t afford to drive long distances on a tank running out of gasoline.

“Whenever there is a disaster that impacts an area to the degree that this one has, then yes, people’s lives are going to be in danger,” said Dr. James Lapkoff, an emergency room doctor in Waynesville, North Carolina, who was part of the HHS team dispatched to Puerto Rico.

Days before the hurricane hit, 56-year-old retired government worker Damaris Torres tried to find a safe place for her son, who has been bedridden for a decade after a traffic accident and depends on a ventilator, oxygen tank and feeding tube.

She has a small generator at home and a battery connected to an inverter as backup, but she didn’t want a rerun of what happened when Hurricane Irma hit just weeks earlier. Back then her son, 30-year-old Manuel Alejandro Olivencia, was transferred to three hospitals in less than 40 hours because his family was told there was no “special place” for someone on a ventilator.

“He’s in such delicate condition,” Torres said, her eyes welling with tears as she recounted how a hospital in the northern fishing town of Catano finally took him in.

That facility relies on a generator, but officials say they constantly worry about running out of fuel.

“Diesel is the one thing everyone is asking for,” Mayor Felix Delgado said as he visited the hospital on a recent morning.

Maria knocked out electricity to the entire island, and only a handful of Puerto Rico’s 63 hospitals had generators operating at full power. Even those started to falter amid a shortage of diesel to fuel them and a complete breakdown in the distribution network.

Patients were sent to Centro Medico and several other major facilities, quickly overwhelming them. The situation is starting to improve, with about half of the hospitals getting direct power or priority shipments of diesel, but that barely addresses the challenges facing the island as a whole.

Jorge Matta, CEO of the nonprofit that runs the complex of hospitals that make up Centro Medico, said progress was being made on restoring power capacity there and finding places to send patients whose homes were destroyed. He said they expected to have all 20 operating rooms at the trauma center back up this weekend. But other parts of the island are in much worse shape.

“Right now we have hospitals (elsewhere) that need diesel, they need water, they need oxygen,” Matta said.

Metro Pavia, which operates several hospital campuses across the island, warned Friday that it was closing emergency rooms in Arecibo and Ponce because it did not have enough diesel.

Meanwhile medicines are running low and obtaining fuel is an ongoing struggle, said Dr. David Lenihan, president of Ponce Health Sciences University, the only medical clinic currently serving southern Puerto Rico.

“If these things start deteriorating, there’s a significant amount of lives at risk,” he said. “We’re providing care, but it’s not optimal care.”

At the Doctors’ Center Hospital in the northern city of Bayamon, Dr. Victor Rivera said they are so overwhelmed that he has been intercepting patients in the ER waiting room and even outside while people are still in their cars, and sending them on their way with medical advice or a prescription in non-emergency cases.

Only one of the hospital’s four surgery rooms is operating because the others were contaminated when they were used as shelters after Maria ripped off the roof on the fifth floor and blew out the windows on the fourth.

Rivera said the hospital, like many others, is relying on overworked generators.

“They’ve been hit with an enormous amount of work,” he said, noting that the hospital had turned them on earlier during Hurricane Irma and increasingly worries they could fail. “This could potentially be a catastrophe for any hospital.”

With capacity maxed out, he has been sending patients who suffer from asthma, diabetes and other conditions to other hospitals nearby.

Hospitals are struggling to treat a wide variety of conditions in Maria’s wake. The first wave was people with cuts and other wounds sustained in the storm. There are also people like Lopez, who was robbed after waiting in line five hours to buy a rationed supply of gas, who have the type of non-storm-related injuries typically treated at Centro Medico.

The hospital serves as the main trauma center for many around the Caribbean, and when Maria hit, it was already treating patients from the island of St. Maarten who were injured in Hurricane Irma.

Centro Medico and a couple others are also receiving patients from all over Puerto Rico from clinics unable to handle them, straining the system.

Gov. Ricardo Rossello has ordered that all major hospitals be placed on a priority list for receiving diesel.

The U.S. Navy has also dispatched the USNS Comfort, a hospital ship that has been deployed during previous disasters such as the 2010 Haiti earthquake.

The vessel’s sailing plan was a Friday departure from Norfolk, Virginia, with up to five days before it would reach Puerto Rico.

Pimp your smartphone with this new wallpaper app

eec92_Fondo-wallpapers Pimp your smartphone with this new wallpaper app

Fondo is a new app on the market offering 4K wallpapers for your Android smartphone. Sure, there are a number of them already available, but what makes Fondo different is that all of its wallpapers are made in-house by the company’s team of designers.

There are a number of them to choose from, which you can sort by categories including abstract, typography, landscape, pattern, and minimal, just to name a few. Most are free, but there are also a few premium collections on offer with each containing between 20 and 30 wallpapers that you can unlock for a few bucks — Fondo Pro.


10 best live wallpaper apps for Android

I have downloaded the app and took a closer look at what it has to offer, and I must say I like what I see. A lot of the wallpapers are gorgeous and unique, while the app is nicely designed and simple to use. You can browse the most popular options available as well as create a list of your favorite wallpapers, so you’ll have all of them in one place — check out a few of the ones I like below.

eec92_Fondo-wallpapers Pimp your smartphone with this new wallpaper app
eec92_Fondo-wallpapers Pimp your smartphone with this new wallpaper app
eec92_Fondo-wallpapers Pimp your smartphone with this new wallpaper app

However, the app does contain ads, but I guess that’s just the price you have to pay to get your hands on some cool wallpapers. Although you can get rid of them by opting for the already mentioned Fondo Pro, which also gets you access to premium collections.

If you want to pimp your smartphone with a new wallpaper, you should consider giving the Fondo app a try. You can get it on the Play Store via the button below.



Motorola finally releases Android 7.1.1 Nougat update for Moto X Play

Well, Moto X Play owners there is some good news for you. While Moto India has already confirmed that Moto X Play would be updated to Nougat, the smartphone has reportedly started receiving Android 7.1.1 Nougat. However, the update has been rolled out in Brazil as we write this.

451c4_21-1442824904-front-camera2-30-1506776291 Motorola finally releases Android 7.1.1 Nougat update for Moto X Play

A Twitter user has spotted the update in the Moto X Play forum, and the news was first reported by The Android Soul. In any case, now that the Android 7.1.1 Nougat update seems to have started rolling out in Brazil, Moto X Play (review) units in India should also be getting the update in the coming days. Better check your notification panel once in a while. 

Users should receive a notification for the update. If not, then they can always go to Settings About Phone System updates to check for availability manually. If the update is available then they can download and install the same.

In any case, Moto X Play users will now be able to experience Android 7.1.1 Nougat hands-on. Besides, the update will bring features like split screen mode, better battery life, new emojis that reflect gender equality and support for GIF images directly from the keyboard on supported apps. The Android 7.1.1 Nougat update also brings app shortcuts which will allow users to launch actions on any apps by simply long pressing the app icon. And there’s more.

Apart from the OS upgrade, the update will most probably bring the latest security patch to the device as well. So with the new security patch, the handset will be safe and secure from malicious attacks.

Notably, the company has also announced the list of smartphones that will be getting the latest version of Android that is Oreo. Motorola has said that the update will basically be rolled out starting in fall. Besides, you can check the list here.

Meanwhile, if you have got the update then you can let us know in the comments what changes you have noticed.

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