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November, 2017

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Derek Dorsett’s NHL career may be over due to health risks from back injury

The Vancouver Canucks won’t be getting back forward Derek Dorsett anytime soon “due to health reasons and risks associated with playing,” the team announced Thursday morning. Dorsett underwent cervical disc herniation surgery in December 2016 and has been suffering recurring symptoms from that issue recently.

Dorsett opened the season with the Canucks after “successful treatment and rehabilitation,” but has been sidelined since Nov. 18. He had been playing well with seven goals in 20 games before “symptoms of neck and back stiffness” caused him to be pulled from the lineup.

While the press release doesn’t outright say that Dorsett is retiring from professional hockey, much of it suggests that’s the case. “His pre-existing conditions, combined with the recent surgery and the risks associated with continuing to play, led to a recommendation that Derek seriously consider not playing again,” team doctor Bill Regan said in a statement.

Dorsett also doesn’t sound like he’ll necessarily keep pushing to play if it means risking his long-term health. Here’s his full statement:

“I’m devastated by the news. It will take a long time for this to truly sink in. As hard as it was to hear, Dr. Watkins’ diagnosis is definitive. There is no grey area, and it gives me clarity to move forward. I have a healthy young family and a long life of opportunities ahead of me. Hockey taught me a lot and it will help me be successful in whatever I choose to do in the future.

“I still have so many thoughts to share and people to thank for all of their support,” continued Dorsett. “What I can say for certain right now is that I left it all out on the ice. I gave my heart and soul to the teams I played for and never backed down from a challenge, including this one. I am proud of the way I played. It made me successful and a good teammate. Most of all I am truly honoured and grateful to have lived the NHL dream.”

Dorsett, who turns 31 in mid-December, is currently in his 10th NHL season. He was drafted by the Blue Jackets in the seventh round in 2006, and made his debut with Columbus in 2008. The Canucks acquired him in a 2014 trade with the Rangers. In 515 career games, he’s recorded 51 goals and 76 points.

Heavy Drinking Among Women At All-Time High, Despite Health Consequences

An ever-increasing number of women in the state are drinking to excess, state and federal data show.

Statewide, female admissions to acute hospital emergency departments for alcohol-related reasons rose by 4.8 percent between fiscal years 2012 and 2016, according to the Connecticut Hospital Association. The female-only Eden Hill Recovery Retreat in Canaan fills an average of 10 to 12 beds per month; earlier in the center’s eight-year history, rarely were there more than eight beds occupied at a time. Researchers at the Yale School of Medicine note an increase in the number of women enrolling in studies that examine the effectiveness of a medication to curb one’s desire to drink alcohol.

The uptick in problem drinking among women in Connecticut mirrors a national trend. In a September 2017 study reported in JAMA Psychiatry, two national epidemiologic surveys compared drinking patterns of U.S. adults between 2001 to 2002 and again in 2012 to 2013, finding a surge of alcohol use over the 11-year period among all demographics — women in particular. Among women, the prevalence of 12-month alcohol use disorder (AUD) — characterized by a pattern of drinking that includes difficulty controlling consumption and withdrawal symptoms when stopping—rose 83.7 percent. As alcohol consumption increases among women, so too does the risk of adverse health consequences, even among moderate drinkers.

Breast cancer is one such risk. A recent meta-analysis of 199 studies reported a positive correlation between alcohol consumption and breast cancer in women. While the risk increased the more women consumed, the analysis revealed that even one drink per day appears to increase a woman’s likelihood of developing breast cancer by about 10 percent; at two drinks a day, the increase jumps to 25 percent. The meta-analysis, referred to as the Continuous Update Project, is a program of the World Cancer Research Fund International.

Rabid kitten traveled within 3 counties, NJ health department says

A newly adopted stray kitten may have exposed up to a dozen people to rabies in Mercer, Middlesex and Monmouth counties over the past two weeks, State Public Health Veterinarian Colin Campbell announced Thursday.

The owner adopted the kitten in Edison Nov. 12 and grew attached so quickly, the feline would accompany its new master to errands throughout central New Jersey over the next 11 days.

Health officials believe two students at the Branford Hall Career Institute in Hamilton may have been exposed to the kitten Nov. 13-16, Campbell’s statement said.

The owner also took the kitten to work Nov. 13-14 at an unnamed Middlesex County hospital. The state Health Department declined to identify the hospital because the cat was kept inside a carrier.

“We did not want to cause undue alarm,” department spokeswoman Nicole Kirgan said.

The owner transported the kitten for a wellness check at Canfield Pet Hospital in Manalapan on Nov. 16.

The following day, the kitten played among a dozen people at at Thanksgiving party in Old Bridge.

There were no signs the kitten was infected with the potentially deadly virus until Nov. 23, when it stopped eating and became fatigued. Paralysis in the back limbs set in the next day.

The kitten was brought to Garden State Veterinary Specialists in Tinton Falls on Nov. 25 and was euthanized on Nov. 26, Kirgan said.

Any people or animals who may have been in contact with this kitten between Nov. 13 and Nov. 23 should contact their local health department, or consult a medical or veterinary health care provider, Campbell said. 

Symptoms can develop anywhere from 12 days to six months after a bite, scratch brother exposure. 

“Human rabies cases are rare in the United States and treatment is 100 percent effective if given promptly,” Campbell said in a statement. “Treatment is a dose of rabies immune globulin and a series of rabies vaccinations over 14 days. People exposed to the rabies virus should be treated promptly to prevent infection. If untreated, rabies infections can be fatal.”

There have been 16 cats with rabies in New Jersey from January through September, according to the health department.

Susan K. Livio may be reached at slivio@njadvancemedia.com. Follow her on Twitter @SusanKLivio. Find NJ.com Politics on Facebook.

Distrust In Health-Care System Might Prevent Breast Cancer Patients From Getting Recommended Care

People who distrust the health-care system are less likely to follow doctor’s orders, suggests a new study of breast cancer patients.

The thing is, the women in this study who opted out of prescribed follow-up treatments didn’t necessarily distrust their doctors. They distrusted the faceless hospitals, laboratories, insurance companies and drug makers that constitute the health-care system.

The study, by far the largest of its type, involved 2,754 Pennsylvania and Florida women who had been diagnosed between 2005 and 2007 with invasive breast cancer that had not yet spread to distant parts of their body. The women were under age 65.

Two or three years after they were diagnosed, researchers surveyed the women by mail about whether their surgeon or oncologist had recommended radiation therapy, chemotherapy or hormonal therapy after their initial treatment for cancer. The researchers also asked the women whether they had received the recommended “adjuvant therapy,” intended to reduce the risk of a recurrence of their breast cancer and increase their chances for long-term survival.

In addition, the women completed scales to measure their distrust of the health-care system and their trust in their physician. And they provided demographic information, such as their income and whether they were married.

a405a_960x0 Distrust In Health-Care System Might Prevent Breast Cancer Patients From Getting Recommended Care

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About 30% of the women reported not pursuing at least one recommended treatment. Of those who hadn’t received the recommended treatment, more than half had opted out of hormone therapy. About half of the remainder hadn’t received the recommended radiation treatment, while the rest had skipped the recommended chemotherapy.

Patients who scored in the top third of the scale measuring distrust in the health-care system–meaning they had the most distrust–were 22% more likely to report not getting recommended treatments than those who scored in the bottom third.

On the other hand, the researchers observed no association between how much the women trusted their physician and the likelihood that they followed his or her treatment recommendations. That’s probably because they liked their physician and would have switched to another if they didn’t, Lorraine Dean, the study’s first author, told me.

Health nominee Azar is no stranger to management controversy

Alex Azar, who’s in line to replace a Trump Cabinet secretary who was forced out in controversy, is no stranger to sticky management problems.

In Washington, he’s been nominated to replace Tom Price, who resigned in September over questions about his use of private jets. Back in Indiana, Azar was an influential member of a public airport board, tasked with oversight of human resources matters, when he defended the conduct of the airport CEO who was under fire for spending public money on travel, golf fees, steak dinners and Super Bowl tickets.

Azar, a former Eli Lilly and Co. executive, served three years on the board of the Indianapolis Airport Authority as it struggled to contain CEO John D. Clark III, who by some estimates racked up more than $200,000 in publicly funded travel, according to interviews and an Associated Press review of records. Clark was hired as the airport’s CEO in 2009, around the time Azar joined the board. Azar defended Clark in public statements amid serious questions about spending, even as board members privately concluded that Clark’s behavior was causing a problem.

Senators’ skepticism at Azar’s confirmation hearing this week has focused on such issues as his willingness to stand up for consumers rather than “Big Pharma” as a former executive at Lilly, the Indiana drug giant.

But Clark’s spending and Azar’s defense of him also could hamper Republican efforts to move past the issue of Price’s own travel spending. Price, a millionaire Cabinet secretary, resigned after disclosures that he used private jets for government business trips, even for trips as short as Washington to Philadelphia. The overall cost to the government exceeded hundreds of thousands of dollars.

“It’s kind of a wild story. I see the parallels there,” says Michael Wells, a longtime former board president who was brought back in 2012 to rein Clark in. Wells, a Republican, praised Azar as “attentive, very knowledgeable and businesslike.”

Azar has been described as a well-respected business voice and chairman of the airport board’s human resources committee. He played a substantial role and helped shape policies related to employee spending, according to records and former board members.

CEO Clark, meanwhile, showed a fondness for plush hotels and steakhouses, quickly ringing up about $37,000 in expenses, records show. In the years that followed his hiring, Clark used public money to golf, attend two Super Bowls and travel to a Phoenix resort for a $2,500 event described only as a business development “boot camp” in airport records.

Airport officials told the AP they could not immediately provide a full accounting of Clark’s spending because some records were kept in a remote warehouse. A limited number of expense documents released to the AP showed he spent at least $100,000 on travel, meals and meetings during his tenure. That included a trip to New Delhi, a $2,200 conference in Bermuda and $10,080 for a three-day meeting in Zurich with officials from Comlux Aviation, a VIP flight service that already had a facility at the Indianapolis airport. In 2011, a five-day stay at the Palmeraie Golf Palace in Marrakesh, Morocco, cost $8,300, according to receipts.

In 2010, Florida authorities, too, had conducted an investigation into Clark’s spending when he worked for a Jacksonville airport, though he was not charged.

Privately Indianapolis airport board members were frustrated, though they did not take action to fire Clark. In public, Azar defended him.

“Travel, both domestic and international, for business development purposes is an essential job requirement for John,” Azar said in a statement to Indianapolis TV station WTHR in September 2010.

That statement came as the station aired a story highlighting Clark’s spending, as well as a February 2010 reckless driving arrest hours after he hosted airline representatives at a Super Bowl in Miami. Police clocked him driving 135 mph on a Florida interstate.

“Because of his forthrightness with us and because of our confidence in him, we have no plans to investigate the matter further and John remains in our complete confidence,” Azar said. As for the speeding, Azar noted that Clark “was in his personal car and on his own time.”

A spokesman for Azar declined to comment Tuesday. The airport authority did not respond to a detailed list of questions from the AP.

Clark could not be reached for comment. He stepped down as airport CEO in 2012 after accepting a $270,000 severance package, which occurred around the time Azar left the board.

Indianapolis news outlets reported at the time that his total spending on the job had topped $200,000.

As an airport board member, there was only so much Azar could do about Clark’s spending, said Kelly Flynn, a Democrat who remains on the board.

In fact, Azar helped develop stricter rules on employee expenditures, but Wells said Clark found a way around them.

“We were all in complete agreement that it was time for a new guy,” Flynn said of Clark.

Azar, like some other members of the part-time board, comes from a buttoned-down business background, Wells said. That may have made it difficult to manage an unpredictable “cowboy” like Clark, he said.

“People like John Clark don’t exist at Lilly — they wouldn’t make it in the front door,” Wells said. “They were not used to a gunslinger, and they didn’t think they had to check the guy’s expense reports with a fine-tooth comb.”

New group pregnancy care program starts at health department.

Women receiving prenatal care at the Toledo-Lucas County Health Department will now do so together, in supportive pregnancy groups meant to increase participation and decrease preterm birth and infant mortality. 

The program was announced Thursday during a community baby shower where expecting mothers enjoyed lunch, played games, and won prizes. 

The supportive group pregnancy care model allows pregnant women in similar pregnancy states to connect and attend appointments together. 

It will begin in January with groups of eight to 12 women, and is funded by a $48,000 grant from UnitedHealthcare, which also finances a program in Akron, in partnership with March of Dimes.

“The benefits of it are the sessions are typically longer, where you’d normally have 10 minutes with your provider, now the session is 90 minutes and you get the benefit of everyone sharing in the conversation,” said Lisa Amlung Holloway, state director of program services and public affairs for the March of Dimes Ohio chapter. 

“We know support structures are created, and women really like it.”

Group pregnancy care is one of eight interventions championed by March of Dimes to reduce preterm births. Preterm births for participants decrease by about a third, Ms. Amlung Holloway said. 

Celeste Smith, minority health coordinator for the Toledo-Lucas County Health Department, said she’s “ecstatic” to partner with the two entities to bring such groups to the department.

“This will be the standard of care here,” she said. “There is a lot of evidence of better outcomes, particularly in the African-American community, when women are coming together and doing group prenatal care … We’re really excited to have the support to pilot this project.”

Preterm birth before 37 weeks’ gestation is the leading cause of infant mortality in Ohio. In the United States, 9.8 percent of births were preterm in 2016; in Lucas County it was 11.2 percent. 

In Ohio and in Lucas County, black babies are far likelier to die before their first birthday than their white counterparts. In 2016, the Lucas County black infant mortality rate was 14.2 per 1,000 live births compared with 5.0 for white infants.

Health officials hope efforts like the one announced Thursday, sometimes called “centering” programs, will lead to decreased infant mortality.

“Centering pregnancy has been around for a long, long time, but it’s expensive, so for a department like ours to come up with those dollars, this is a great opportunity,” Ms. Smith said.

A similar supportive group pregnancy program runs through Neighborhood Health Association and the Ohio Department of Health. Those interested in the Toledo-Lucas County Health Department program can call the department at 419-213-4100.

Contact Lauren Lindstrom at llindstrom@theblade.com, 419-724-6154, or on Twitter @lelindstrom.


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Podcast: ‘What The Health?’ Taxes, Medicare And The Year-End Mess

 

Weeks ago, the tax bill under consideration in Congress became a health bill, too. But now it could also trigger major cuts to the Medicare program.

This week’s “What the Health?” guests are:

Julie Rovner, Kaiser Health News
Joanne Kenen, Politico
Paige Winfield Cunningham,  The Washington Post

They discuss how a little-known law prohibiting federal deficits could force big cuts to Medicare and many other defense and domestic programs if the tax bill passes as currently configured in the House and Senate.

Among the podcast’s takeaways:

A possible delay in negotiating a year-end spending bill puts the fate of the Children’s Health Insurance Program in doubt. States are starting to run out of money for the program, whose federal authorization expired Oct. 1.
A Senate committee heard from Alex Azar, a former drug company executive and President Donald Trump’s nominee to head the Department of Health and Human Services. Much of the discussion was about what he might do to contain drug prices.
The National Academy of Medicine issued its own recommendations about how to make drugs more affordable, including the idea of letting government programs negotiate with drugmakers and possibly limit which drugs the government would pay for.

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

Julie Rovner: ProPublica’s “A Hospital Charged $1,877 to Pierce a 5-Year-Old’s Ears. This Is Why Health Care Costs So Much,” by Marshall Allen.

Joanne Kenen:  The Atlantic’s “No Family Is Safe From This Epidemic,” by James Winnefeld.

Paige Winfield Cunningham: The Washington Post’s “597 days. And still waiting,” by Terrence McCoy.

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Detroit Health Department: Greektown Casino employee diagnosed with hepatitis A

DETROIT – Greektown Casino is cooperating with a Detroit Health Department investigation regarding a potential hepatitis A the gambling establishment’s for casino patrons.

The investigation began after a casino employee was diagnosed with the viral infection. The Detroit Health Department believes the risk of exposure is only for those who were in the private Platinum member card access area of the casino between Nov. 11 and Nov. 22.

The risk of catching hepatitis A from an employee is low, but infection can potentially be prevented if given a vaccination within two weeks of having come in contact with the virus.

Given the low, but potential risk, the Detroit Health Department is recommending vaccination for people who may have eaten in the private Platinum member card access area during the exposure period.

Those who consumed food and beverages at Greektown Casino in the private Platinum member card access area from the Nov. 11-22 exposure period should receive the hepatitis A vaccine as early as possible.

Greektown Casino is proactively contacting those individuals to advise them of their vaccination options.

“The safety of our guests and team members is of utmost importance to us,” Greektown CEO Jason Gregorec said. “It is significant to note that while no one else has reported any illness, we are taking all precautions to make certain that the incident remains isolated.”

Greektown Casino has been fully cooperative with the investigation, and hired a certified cleaning contractor which has thoroughly cleaned and sanitized all potentially affected areas. The casino is also working with the Detroit Health Department to notify and arrange vaccination for potentially affected people who may have eaten in the private Platinum member card access area, as well as all employees. The Detroit Health Department has notified the gaming establishment that the affected employee cannot return to work until cleared by their doctor.

“We are diligently working with our state partners, physicians, hospitals, food establishments, and community groups to educate the community, limit any potential exposures, and vaccinate those who are at risk,” said Dr. Joneigh Khaldun, director and health officer of the Detroit Health Department. 

The Detroit Health Department will offer free hepatitis A vaccines for uninsured Detroit residents who may have consumed food or beverage in the Platinum member card access area during the exposure period at both of its immunization clinics Monday, Tuesday, Thursday and Friday from 8 a.m. to 5 p.m., and on Wednesday from 9 a.m. to 6 p.m. 

 The clinics are located at:

  • The Samaritan Center
    5555 Conner St. 
    Detroit
    313-410-8142
  • The Family Place
    8726 Woodward Ave.
    Detroit
    313-410-7803

For questions, contact the Detroit Health Department at 313-876-4000.
 

Copyright 2017 by WDIV ClickOnDetroit – All rights reserved.

New platform lets patients sell their health data

There’s a new app available for healthcare patients to make some money off their medical data.

Falls Church, Va.-based healthcare IT company Health Wizz has created a patient-data-aggregation platform that allows patients to trade and sell their data to pharmaceutical companies, researchers and other organizations.

The platform, which was previously available in beta and was relaunched Thursday, runs on a mobile app through which patients can aggregate their health records.

“We provide interoperability on the phone itself as opposed to waiting for the electronic health record companies to provide interoperability,” said Raj Sharma, CEO of Health Wizz.

Patients pull the data into the Health Wizz app via EHR patient portals. They can then use the DirectTrust framework to send their data to providers.

Or they can use the blockchain to share data with organizations actively seeking it out, such as pharmaceutical companies and researchers. The blockchain does not store the actual records but instead points these organizations to the sources of a patient’s data, which they can access after getting digital permission.

The blockchain also enables the financial interactions Health Wizz encourages: Patients can charge—in a cryptocurrency similar to bitcoin—for access to their information. The patient decides whether his or her data will be anonymized or not.

Such interactions might encourage patients to download their data in the first place, Sharma said, since research and pharmaceutical organizations willing to pay would never have access to it without the patients acting first.

“That’s what makes the data so valuable and why people will pay for it,” Sharma said.

Sharma intends to facilitate a marketplace for medical-record sharing, where records are transmitted on a peer-to-peer basis, rather than through the cloud. That way, patients need only trust the recipients of the data, rather than a cloud middleman. “We don’t want to touch users’ data,” Sharma said.

Because Health Wizz doesn’t currently parse the data patients pull from patient portals, the data sharing it enables isn’t true, by-the-book interoperability of the variety called for by the 21st Century Cures Act. The company hopes to develop the ability to format records stored as PDFs so they can be accessed using the FHIR standard (Health Wizz is a founding member of HL7) and application programming interfaces. Those technologies would facilitate bringing patient data into EHRs as structured data, rather than as narrative documents.

New HIV Cases In New York City Hit Record Low, Health Department Says

The department’s HIV Surveillance Annual Report report says 2,279 people were newly diagnosed with HIV in 2016, fewer than the year earlier and a big drop from the 5,906 new cases the department logged in 2001, its first year of tracking.

Bills proposed to address underfunded pension, health plans

  • Underfunded systems could be forced to make changes
  • Republican-backed bills designed to address underfunded pension, health care liabilities
  • Bills could face stiff resistance

 Bills proposed to address underfunded pension, health plans

 Bills proposed to address underfunded pension, health plans

LANSING — Legislation proposed Thursday would require municipal pension and retiree health plans to annually report their finances to the state, and severely underfunded systems could ultimately be forced to make changes by state appointees.

The bills, introduced in both the Republican-controlled House and Senate and backed by Gov. Rick Snyder, are designed to ensure that local governments adequately address billions in unfunded pension and health care liabilities, according to GOP legislators. Democrats and police and firefighter unions, which had been concerned about potential benefit cuts, were studying the package and had no immediate reaction.

The legislation does not go as far as more sweeping bills — which died a year ago — that would have prohibited new municipal workers from qualifying for health insurance in retirement, made retiree health benefits a prohibited subject of collective bargaining and forced current retirees to pay more for health care. But the bills could still face resistance given their interplay with Michigan’s law that allows state emergency managers to run financially distressed cities.

Under a five-stage process, communities with significantly underfunded retirement plans would have to submit planned “corrective actions” to a new Local Government Retirement Stability Board comprised of three gubernatorial appointees. If the board rejected the plan or a local government could not agree on a proposal, the state treasurer would declare a financial emergency and appoint a three-person team to act as an emergency manager — with “broad powers” to rectify the underfunded status. The team, however, could choose not to impose measures if it decided they would “directly endanger the health, safety, or welfare” of residents.

Initially, a retiree health plan would be deemed inadequately funded if it is not at least 30 percent funded and costs the municipalities more than 10 percent of general fund spending. A pension plan would have to be at least 60 percent funded. The minimum thresholds would rise over time. The treasurer would issue a waiver from an underfunding status if the debt is being adequately addressed. Otherwise, the state board would become involved.

“If we don’t fix this problem now, communities with dangerously underfunded retirement systems could go bankrupt and fail to keep promises made to retirees,” said Republican Rep. Jim Lower of Cedar Lake. “This plan heads off that problem and gives local governments a warning system to prioritize and safeguard the benefits retirees and current employees expect.”

The introduction of the legislation came a day after hundreds of law enforcement officers and firefighters protested at the Capitol in support of their retirement benefits.

Senate Majority Leader Arlan Meekhof, a West Olive Republican, said the bills would give local governments and their unionized employees an incentive to live up to their retirement obligations.

“Why would a local community want somebody to have to come in and tell them what else they need to do to solve their retirement problem? They don’t want that,” Meekhof said.

Trump’s Mental Health Questioned by White House Staff, ‘Art of the Deal’ Writer Says

A former ghostwriter for President Donald Trump claimed White House staffers are worried about the billionaire Republican’s mental state and said Americans need to understand Trump is “losing his grip” on reality.

Tony Schwartz, who helped Trump pen The Art of the Deal, told MSNBC Wednesday that he learned of the staff’s concerns from someone he did not name.

“I know that two different people from the White House, or at least saying they were from the White House…have called somebody I know in the last several weeks to say, ‘We are deeply concerned about his mental health,’” Schwartz said.

Known as a vehement critic of the president, Schwartz gave his own reasons for why he believes Trump has devolved recently.

“He is more limited in his vocabulary,” Schwartz said. “He is further from, as I say—this connection to what is factual and real. He is more impulsive. He is more reactive. This is a guy in deep trouble,”

Schwartz’s comments came a day after he chastised Trump on Twitter, claiming the president is “owned” by Russian President Vladimir Putin and expressing hope that special counsel Robert Mueller would “expose” him.

“What keeps my hope alive is the deep, abiding belief that Mueller has got Trump dead to right, including his collusion with Russia. All signs suggest to me that Putin owns Trump, and it’s going to come out,” he tweeted.

Trump’s mental state, especially his comments and retweets on Twitter, also drew the ire of chief White House reporter Maggie Haberman of The New York Times.

Following his retweets of videos from a far-right group called Britain First, which many perceived as anti-Islam and anti-Muslim, she told CNN Wednesday that Trump’s recent actions appeared “a little unmoored.” 

“Something is unleashed with him lately,” Haberman said. “I don’t know what is causing it. I don’t know how to describe it.”

The president’s mental state has been a hot topic since before he was elected last year and throughout his first 11 months in office, so much so that a California congresswoman, Jackie Spier, has worked with a group of mental health professionals in an attempt to oust Trump under the 25th Amendment, Newsweek reported last month.

The amendment specifically deals with presidential succession and whether the commander in chief is healthy enough to fulfill the office’s duties.

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‘Two-year wait’ for mental health help in areas of England

a949e__99005451_c9e1b6ec-cd53-428f-8f48-475a64cea71a 'Two-year wait' for mental health help in areas of EnglandImage copyright
Getty Creative Stock

Mental health patients are having to wait for up to two years for treatment in parts of England, figures suggest.

Government guidelines call for psychological therapy to start within six weeks for 75% of referrals, rising to 95% within 18 weeks.

But a Freedom of Information request by BBC Radio 4’s World At One suggested a third of NHS trusts missed deadlines.

The Department of Health said it was overseeing a large expansion of services but there was “more to do”.

  • Call for schools mental health plan
  • Mental health issues ‘affect third of mums’
  • ‘I lost my job because of my depression’

Just over half of England’s NHS trusts replied to the request – 29 in total.

The replies suggested that in some parts of the country, more than 20% of people were waiting for more than 18 weeks.

But at five trusts, an adult patient was recorded waiting more than two years to begin specialist treatment.

That could mean waiting for help with conditions such as eating disorders, personality disorders, or cognitive behavioural therapy.

And in two trusts, patients seeking help for gender identity issues had a one in 20 chance of being seen within 18 weeks.

‘Something has to change’

Image copyright
Andrea Wade

Image caption

Ms Wade has still not been seen in the NHS

Andrea Wade, 24, is from Blackpool and was diagnosed with depression and anxiety when she was 11 years old.

In August 2017, her mental health started to decline after her nephew died when he was just 14 hours old.

But despite being referred to specialist mental health services, she was told she would need to wait six months to see a psychiatrist.

“I knew that I would need preventative care and some support to get through that so I didn’t end up in relapse,” she said. “I was referred twice to a psychiatrist, but I was told I would get no help until February.”

She began to get her symptoms back, feeling very anxious, isolated and scared that something bad was going to happen. Now, she has also started to get fresh symptoms.

“I have a lot of paranoia,” said Ms Wade. “I don’t feel safe a lot of the time and I don’t know who to trust. I have found I have locked myself in my own room because I am so frightened.”

However, a local GP told her that there were “plenty of poorly people in Blackpool” and until she made an attempt on her own life, she would not be seen.

She has now had to pay £400 to get a private appointment two hours away from her home.

“For me, I think this is terrifying,” said Ms Wade. “Something has to change.”

A statement from the Department of Health said: “It was this government that set up the first waiting times for mental health, but we know there is much more to do.

“[This] is why we are undertaking one of the largest expansions of mental health services in Europe, supported by a record £11.6bn pounds of investment in services this year.”

However, former Liberal Democrat health minister Norman Lamb said the findings were “depressing and shocking”.

He told the World at One programme he had threatened to resign to get the standards in place when he was part of the coalition government.

He added: “It just demonstrates why we need to make a reality of equality between mental health and physical health.

“The reality on the ground is very, very different. We see services under extraordinary stress across the country. If we carry on as we are, the system will slowly collapse and that is intolerable.”

UW Health to cut $80 million from budget

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CVS Nears Deal to Acquire Health Insurer Aetna

CVS Health Corp. is nearing an agreement to acquire health insurer Aetna Inc. for more than $65 billion, according to a person familiar with the negotiations, in a deal that could reshape the pharmacy and health insurance industries.

An announcement could come as soon as Monday, said the person, who asked not to be identified because the talks are private. CVS is likely to agree to pay at least $200 a share for Aetna, with more than 30 percent paid for with cash, according to the person. Talks could still be delayed or fall apart.

Timing of the potential deal was first reported by The Wall Street Journal on Thursday. Aetna and CVS declined to comment.

A deal between Aetna and CVS could upend the health insurance, pharmacy and drug benefit sectors. Many of the biggest players in those industries are also looking over their shoulders at Amazon.com Inc., which has been reported to be exploring various health-care businesses.

It would also come less than a year after two major health insurance deals — between Anthem Inc. and Cigna Corp., and Aetna and Humana Inc., fell apart amid antitrust challenges.

Unproven Rationale

Aetna’s shares are still trading well below the reported deal price, a sign that investors believe the deal may not close. Investors may be skittish about the amount of CVS stock included in the deal, since cost savings or revenue increases from the deal rely on melding two large, complex companies, said Ana Gupte, an analyst at Leerink Partners.

“It’s a vertical deal, it’s unproven, it’s defensive, it’s got more limited cost synergies, and the revenue synergies are unproven at best,” she said. “There may be some medical-cost savings or drug-cost savings, but they’d have to be likely passed on to customers” to keep them from defecting to rival companies.

478c3_60x-1 CVS Nears Deal to Acquire Health Insurer Aetna

Aetna was up 1 percent to $181.40 at 12:30 p.m. in New York. CVS was up 3.1 percent to $75.66.

A deal between the two companies could heighten speculation about the next moves of other players, including independent pharmacy chains and standalone pharmacy benefit management companies.

On Thursday, Express Scripts Holding Co.’s chief executive said he’s open to a deal with a health insurer or partnering with Amazon.com Inc. CEO Tim Wentworth’s pharmacy benefits company has been battered by departing clients and the vague specter of Amazon’s entry into the drug business.

If a major insurer was interested in a deal, “I would be open to it,” Wentworth said on the sidelines of a conference in New York sponsored by Forbes. “We don’t need to sell to be very successful in the future, but we are always open to others who may all of sudden conclude they want what we have.”

Wentworth said the company isn’t actively seeking a large deal or sale. Express Scripts shares were up 1.9 percent to $64.08.

The Tax Bill Is a Health Bill

Implications for longevity and disease go beyond people losing insurance.

Susan Collins on taxes, health care and Trump’s mental health

There is nothing better than good scheduling. Thursday morning, the Christian Science Monitor’s regular breakfast with newsmakers hosted a particularly important lawmaker at the moment: Sen. Susan Collins, R-Maine, a key swing vote in the Senate GOP conference on issues like health care and taxes.

Collins covered everything from taxes to health care to the possibility of a government shutdown to the president’s mental health and his retweets Wednesday of anti-Muslim videos. It was a lot of news. We decided to post our full notes from our spot at the table. Note: These are real-time notes, not verbatim.

What is your reaction to Bowles/Simpson conclusions about the tax bill and its effects?

Collins: CBO has estimated that just 0.4 percent increase in GDP will cause revenues to increase by $1 trillion. The purpose of this bill — about which I have a lot of concerns – is to stimulate economic growth. If we stimulate economic growth, should cause wages to rise.

What do you think about a deficit trigger?

Collins: It is still under negotiation. I’ve heard so many different versions. I’m not unmindful of the impact of the debt — the fact that if we’re wrong, it would cause interest rates to go up. That would make the debt an even greater problem.

The bulk of the of the benefits of this bill go to the rich and it would trigger cuts in programs affecting the poor, including Medicare. And it would affect health care with the individual mandate repeal. Some Republicans think one purpose is to starve government. Given that, how can you consider supporting it?

Collins: On the Medicare/paygo spending cuts, I strongly oppose that and have asked what is the plan to avert that. Senator McConnell assured me that will not be allowed to happen. We have 16 times raised the paygo requirements to prevent this from happening. I think it will be either on the [Continuing Resolution] CR or on the omnibus. But it will be done before the end of the year so the $25 billion cut in Medicare will not go into effect. I am confident of that. That has been discussed with Ryan also on the House side. If that were to occur I would not even be considering voting for this bill.

On the individual mandate: there is a huge difference between taking away insurance from people who like it and want it versus removing a fine on people who chose not to purchase insurance. 80 percent of those fines are paid by people who make $50,000 and less, so it is falling disproportionately on middle- and low-income consumers.

I am concerned about the effect on premiums. I propose: 1. Alexander-Murray. 2. [The] Nelson-Collins bill to give states funding to set up high-risk pools.

Neither are in the tax bill because they fall under [the Byrd Rule problems]. I have met three times with the president of the united states about this and gotten his endorsement. They are most likely going to be on the CR.

My scenario, assuming the bill passes the senate we then turn to the CR. Those would be put on the CR. While the tax bill is in conference, the CR would become law and then the tax bill would come back from conference. I’m going to know whether those provisions are in the bill and that matters hugely to me.

How much of a problem would it be if SALT is repealed in its entirety?

Collins: It would be very problematic for me if the SALT deduction is not in the Senate bill. I have filed an amendment to parallel what the House does. Allow up to $10,000 in property taxes to be deducted. I would pay for it by [raising] the corporate rate to 21 percent [from 20 percent in the bill now] and keep top individual rate at 39.6 percent for those filing jointly over $1,000,000. That more than pays for [the SALT $10,000 deduction]. I’ve had extensive discussions with administration officials and Senate leaders

Your last statement on the bill indicated you have warmed to it. Are you a yes? Leaning yes? And do you need your SALT amendment to pass and health care to be resolved to be a yes?

Collins: I can’t vote for it if issues of health and SALT not resolved.

Do you believe the leadership’s message that while individual tax cuts will expire in 2025, in actuality Congress will extend them eventually?

Collins: I believe there will be vote [in the vote-a-rama] to make individual tax cuts permanent or make corporate tax cuts expire at same time as individual. In other words, we ought to treat both the same. It’s on my list — I want to vote on it.

The Rubio-Lee amendment would make the child tax credit refundable and pay for that also by raising the corporate rate. Do you have any concern over the many asks out there to increase the corporate rate?

Collins: I don’t think we’ll end up with 28 or 30 percent — but I don’t think we need to go to 20 percent. I have talked with many CEO’s of large corporations with plants in Maine. I pressed them on this repeatedly. I said, look, if the corporate tax rate goes from 35 percent to 22 percent do you really mean to tell me that will influence your investment decision [over a drop to 20 percent]? With one exception all have said, no it would not, we would be delighted with a 22 percent rate.

By the way, I support the Rubio-Lee amendment but I have an even better one. I would make refundable the tax credit for childhood and adult-dependent care and I would pay for it by closing the loophole on carried interest. As America is growing older, there are more and more families caring for older parents and grandparents and it’s extremely expensive.

Are you surprised after all the things POTUS said about carried interest that that’s not in the bill?

Collins: It is addressed but in a modest way. I talked with the president about that and he said he had no problem closing that loophole. I can’t remember if I told him what I want to use the money for but he supports the idea.

What’s next after tax reform?

Collins: I believe infrastructure will be next and I’m excited about that. We need a massive investment in infrastructure in this country.

As a swing vote, how does this experience compare with the ACA debate?

Collins: The health care bills were drafted in a very closed way. There was never a committee markup in the Senate and there wasn’t much outreach to members on their ideas.

The tax bill has not been drafted in a perfect way but it’s been very different. There was a markup and there has been extensive outreach to members like me. There has been much more input than there was on the health care bill.

I would also note that over the past seven years there have been some 70 hearings on the general topic of tax reform. I think there should have been more hearings on this bill as well.
I would have liked to see more outreach to the Democratic side and we could have had a bipartisan bill.

You want to fund the CSR subsidies for health care that the president ended (and left for Congress to sort out). Critics say the CSR subsidies are an insurer bailout?

Collins: These are not bailouts to insurers. One issue in the system is the deductibles end up being so high that it is like you are uninsured. So if you don’t get help to people in that income gap, you make insurance unaffordable.

On health care, you are pushing two provisions — Alexander-Murray and reinsurance — that would mitigate some destabilizing effects. But there are other issues both from the Trump administration. And in the law itself. What do you see going forward with health care? Is there any prospect of fixing some of these greater flaws? Or will there be another round of repeal and replace?

Collins: After the repeal and replace bills failed, the Senate health committee heard from stakeholders on this. Out of that, came the Alexander-Murray bill. I saw that as the first step in fixing flaws in the ACA, of which there are a great many. My hope was there would be a series of bills going forward that would improve the ACA and fix the law.

I thought that was going to happen. I’m no longer quite as sure. It was truly exciting when we did these great hearings that produced a bipartisan bill and I thought this could be the first of many.

Now it looks like we will got back sometime in the spring to the Graham-Cassidy block grant bill. And the problem I have with that is it puts a per capita cap on Medicaid spending. The problem with that is that in a state like mine that is disproportionately low-income, less healthy and older, it gets hurt.

I’m interested in some states’ innovations, including Indiana’s.

Has the president’s leadership style changed this time [on taxes compared to health care]?

Collins: There has been so much more outreach — it is just night and day compared to the health bill.

Going back to SALT, there are differing opinions on this. Some anti-tax groups have said leave a total repeal of SALT deductions in the bill because it will force high-tax states to lower their taxes. What think of that?

Collins: First, SALT has been in the tax code since 1913. If we put the SALT deductions in it will help the distribution of the taxes [across classes]. But in addition if you don’t have the SALT deduction you are essentially making double taxation. I don’t want either of those. I want to help the middle class. This isn’t a special interest provision added lately.

There is SALT in general and then there is the $10,000 deduction on property tax. Are you arguing all of SALT or just the smaller piece?

Collins: I’m trying to be a realist. I decided the best way was to mirror what the House did. But if I had my druthers, I would expand it to include income tax as well as property tax.

We’ve seen stories in past few days about the president dabbling in conspiracy theories. How concerned are you about the mental health of the president?

Collins: First of all, let me say my conversations with the president have given me no reason to be concerned in that regard. But do I think it’s helpful that he raises these conspiracy theories or puts out a tweet of an anti-Muslim video that turns out to not even be accurate? No, I don’t and I haven’t hesitated to criticize the president when he does.

It looks like Roy Moore could win in Alabama. What do you think generally about the principle of the Senate voting to expel a member over allegations from before a member entered the Senate, that voters were aware of when they voted?

Collins: First, I have never endorsed Roy Moore. Just the fact that he was forced off the state supreme court is enough for me [to withhold endorsement]. To me the Constitution says the only reasons to not seat him [do not cover this]. So we have to seat him. Then there would be an Ethics Committee investigation. We need to see what that finds.

You raise a difficult question. If voters see these allegations and still choose to elect Roy Moore, is it appropriate for the Senate to nonetheless expel him? That’s a very difficult question and I don’t know the answer to that yet.

On the shutdown/government funding debate and particularly DACA negotiations?

Collins: It is extremely frustrating that I can’t go on the Senate floor with our appropriations bill in the normal way that we used to — have it fully debated and voted on and then go to the House.

I believe we have finished eight of the appropriations bills [in committee]. I would like to see the bills that have been reported taken to the floor, we could combine at least three together. Let’s at least get some of government funded that way and get going.

The continuing resolutions (CR’s) don’t account for programs that need more or programs that need to be terminated. It’s automatic, with no judgement.

Nevertheless, I think we are likely to have a short-term funding bill go through and an omnibus before the end of the year. That is better than a CR and better than what we did last year.

DACA?

Collins: I am very sympathetic on the DACA issue and think it should be done before the end of the year.

I talked to a student from the University of Southern Maine who did not know he was undocumented until he went to apply for his driver’s license and his family broke the news to him. He’s as American as anyone else. From Maine, worked summer jobs cleaning houses, he is a good resident of this country.

It is imperative that we act. I don’t like the idea that these young people are living in a state of panic. I talked with Jeff Flake about that yesterday. There are a lot of us — Lindsey Graham, Dick Durbin.

Would that have to be on the omnibus [to get your vote]?

Collins: I don’t know it would have to be on the omnibus. I don’t want to shut down government. But I am pushing very hard, as are many people on both sides of the aisle, to get a solution to that issue.

Without Obamacare Mandate, ‘You Open the Floodgates’ for Skimpy Health Plans

While repeal supporters argue that people would benefit by having the choice to buy less expensive plans, state regulators have been cracking down on rogue agents who have misled customers about what such inexpensive plans cover or more important don’t.

Examples abound of people who are dumped from such policies or denied coverage, mired in debt and medical bills totaling thousands, if not hundreds of thousands of dollars.

One case pending in federal court involves Kevin Conroy, who had a heart attack in 2014 and underwent triple bypass surgery, just two months after his wife, Linda, obtained a short-term policy over the telephone.

Their insurer, HHC Life, refused to pay the bills.

“We freaked out,” Ms. Conroy said. “What were we going to do? It was $900,000.”

The insurer informed the Conroys the policy was “rescinded,” to use the industry jargon. After poring through his medical records, HCC claimed Mr. Conroy failed to disclose he suffered from alcoholism and degenerative disc disease, conditions he said were never diagnosed. “When one thing didn’t work, they went to another,” Mr. Conroy said.

HCC Life, a unit of Tokio Marine HCC, says it will defend its case. The company is also the subject of a multistate review by insurance regulators to see if it engaged in unfair or deceptive acts. It says it has fully cooperated. HCC Life stopped selling short-term policies last May.

A major player in this area is UnitedHealth Group, which abandoned the Affordable Care Act market after incurring sizable losses. United offers short-term plans through its Golden Rule unit. Before the federal law, Golden Rule was among those insurers criticized for rescinding policies. The company recently told investors it was excited by the president’s executive order because that would mean an increase in business for these plans.

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Last year, a short-term policy averaged $109 a month for an individual, according to a recent analysis by eHealth, an online broker, compared with $378 a month during last year’s open enrollment period for an A.C.A. plan.

The policies are particularly attractive to the millions of people who don’t qualify for federal subsidies; only about half of the 17 million people buying coverage are subsidized, according to the Congressional Budget Office. Another target audience would be the 28 million who are uninsured. And some brokers are deliberately promoting the policies without pointing out they do not meet the same levels of coverage of A.C.A. plans, said Scott Flanders, the chief executive of eHealth. “They’re selling the hell out of it,” he said.

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66ba4_merlin_130083077_0d61a3cf-6177-4607-9908-51108befb29b-blog427 Without Obamacare Mandate, 'You Open the Floodgates' for Skimpy Health Plans

Grace Wood, a university instructor, at home in Berkeley, Calif. Her insurer left her with $150,000 in medical bills after she had a heart procedure, but ultimately paid them.

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Christie Hemm Klok for The New York Times

Jeff Smedsrud, a founder of Healthcare.com, another online broker, said, “There are companies that aggressively, and some very aggressively, market it as a panacea.”

In recent years, state regulators have investigated the marketing practices of particular brokers, and consumers have sued to expose the actions of some bad actors.

In Pennsylvania during the past two years, the state took action against seven agents for misrepresenting the plans they sold. One woman who had a stroke was left with $250,000 in unpaid medical bills because the policy did not cover prescription drugs and other basic treatment.

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While a handful of states, including New Jersey, now effectively ban short-term plans, others review rates and make sure the policies follow state law, said Dania Palanker, an assistant research professor at Georgetown University.

But other states will likely do little to prevent more sales of these policies, said Katherine Hempstead, a policy expert at the Robert Wood Johnson Foundation. “You’re going to make it easier in places where it is already easy,” she said.

Industry experts estimate as many as a million people may now have these policies, though the official tally is much lower. And others may fall under this umbrella, because it’s hard to distinguish from alternatives, like so-called limited benefit plans, which cap how much the insurer will pay, and association plans, available to small businesses, that will also be expanded under Mr. Trump’s executive order.

Several companies are poised to capitalize on a less restrictive environment. Health Insurance Innovations, which markets short-term policies, including those once offered by HCC Life, is under scrutiny by state insurance regulators. It recently told investors that there were “tens of millions” of people who could benefit from these plans. The company declined to comment.

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These plans typically offer much higher commissions to brokers selling them, and they can be much more profitable for insurers. UnitedHealth’s Golden Rule spent about half of every dollar it took in premiums for medical expenses, according to regulatory filings. Under the federal law, insurers must spend at least 80 cents of each dollar on care for their customers. UnitedHealth declined to comment.

Some experts speculate that insurers are likely to exploit the existing A.C.A. market as a way of selling short-term policies to people until they have serious medical conditions. Coverage sold under the federal law would become increasingly expensive, with people priced out of the market if they didn’t get subsidies, Mr. Laszewski, the industry consultant, said.

While the market for subsidized coverage is largely protected, the market for those who pay the full cost is already shrinking, he said.

Like the insurance that was sold before the federal health care law, people with chronic conditions or a history of illness are mostly turned away. Companies will sometimes rescind policies if an individual has high medical bills.

UnitedHealth’s Golden Rule recently won a lawsuit involving one of its short-term policies, claiming it did not have to cover $400,000 in medical bills because it said a woman with breast cancer had an abnormal mammogram before she enrolled. The case is being appealed.

“Insurance companies today are interpreting their short-term health insurance policies so as to label any condition that arises during the policy term as a pre-existing condition for which the company can exclude coverage,” said a lawyer representing Ms. Jones in a statement. UnitedHealth declined to comment.

Customers often have had to argue about whether something was a pre-existing condition. When Karen Campbell and her husband looked for insurance before Obamacare, “we had this extensive, unbelievable interview, each of us about our medical history,” she said. After rupturing her Achilles’ tendon, which required $30,000 in surgery and physical therapy, the insurer asked for medical records to make sure it wasn’t something she previously had. “They just made it really difficult,” Ms. Campbell said.

Grace Wood, an instructor at a university in San Francisco, bought a short-term plan in 2013. When she had to have a heart procedure, her insurer, HCC Life, balked, leaving her with roughly $150,000 in unpaid medical bills.

“Why should I go bankrupt?” Ms. Wood recalled asking herself. It took her a year and a half, but she appealed and turned to regulators when the insurer ignored her. HCC eventually paid the claims.

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Study: More Workers Say Financial Stress Affecting Their Health And Jobs

5756f_960x0 Study: More Workers Say Financial Stress Affecting Their Health And Jobs

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The economy may be growing and the stock market may be on a tear, but for many workers such broad measures of financial gains aren’t translating to their wallets and sense of financial security.

This year, only about a third of U.S. employees, or 35%, reported feeling satisfied with their financial situation, a drop from almost half, or 48%, two years ago according to the 2017 Global Benefits Attitudes Survey results released this week by Willis Towers Watson. This marks a reversal from improvements in employee attitudes since 2009 — during the worst of the financial crisis —when just a quarter felt that way, according to the firm. In addition, more, or 59% of those surveyed say they worry about their future financial state, an increase from 49% two years ago. (The survey was conducted in July and August and recorded views of 4,983 participants.)

“They are feeling a lot of stress — they are feeling uncertainty,” said Alan Glickstein, senior retirement consultant with Willis Towers Watson, about what he calls the cumulative effect of wages stagnating, higher health care costs and continued erosion of pension plan coverage. “This has been coming for a while in the post financial crisis period.”

Of note, too, is the growing proportion of workers who cited current financial concerns as negatively affecting their lives (34%), an increase from two years ago (21%). More, or 59%, also “worry about their future financial state,” a rise of 10 percentage points, according to the survey results. This anxiety may reflect worsening prospects related to major financial events including divorce, major health issue and borrowing, from family friends or payday loans. And it also seems to be taking a toll at work affecting productivity and health — most prevalent among a group of workers described as “struggling” numbering about 30% who reported worries about both short- and long-term finances. Within this group, 31% described “money concerns” as hindering their efforts at work, preventing them “from doing their best at work,” according to the report with seven of 10 reporting high, (37%) or above average (33%) stress levels with 30% describing their health as “poor.” In contrast, employees without money problems were also in good health (35%) or very good health (55%) with just 5% reporting high stress.

Declines in perceptions of well-being and a connection between financial pressures, poor health and worse performance at work, suggest a need for more solutions to help those who are struggling. However, it also may reflect bigger, structural issues, Glickstein says, who points to the growing effect of student loan debt as the proportion of millennials in the workplace continues to increase.

“The trend line you’d expect at some point to become more negative because we know primarily on a self-reported basis and also based on the data, how significant the looming issue of debt is and affects outlook on life and mood and productivity,” he says.

A high majority of struggling respondents, or 81%, are living paycheck to paycheck and only 20% of them pay the total due on credit cards. And most, or 69%, don’t budget.

“There are many people who are making a good income and have a good job who also feel financial stress,” Glickstein says. “And perception is reality.”

States Sound Warning That Kids’ Health Insurance Is At Risk

77c4e_gettyimages-879850932_forchip-73a068cbcfb1cc55593af61b35d711c0fdd93931-s1100-c15 States Sound Warning That Kids' Health Insurance Is At Risk

Alejandra Borunda, sits with her two children, Natalia, 11, and Raul, 8, holding the family dog at their home in Aurora, Colo. Borunda’s children are among those who would lose out if the CHIP program isn’t funded.

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Alejandra Borunda, sits with her two children, Natalia, 11, and Raul, 8, holding the family dog at their home in Aurora, Colo. Borunda’s children are among those who would lose out if the CHIP program isn’t funded.

Helen H. Richardson/Denver Post via Getty Images

This week, Colorado became the first state to notify families that children who receive health insurance through the Children’s Health Insurance Program are in danger of losing their coverage.

Nearly 9 million children are insured through CHIP, which covers mostly working-class families. The program has bipartisan support in both the House and Senate, but Congress let federal funding for CHIP expire in September.

The National Governor’s Association weighed in Wednesday, urging Congress to reauthorize the program this year because states are starting to run out of money.

In Virginia, Linda Nablo, an official with the Department of Medical Assistance Services, is drafting a letter for parents of the 66,000 Virginia children enrolled in CHIP.

“We’ve never had to do this before,” she says. “How do you write the very best letter saying, ‘Your child might lose coverage, but it’s not certain yet. But in the meantime, these are some things you need to think about.’ “

77c4e_gettyimages-879850932_forchip-73a068cbcfb1cc55593af61b35d711c0fdd93931-s1100-c15 States Sound Warning That Kids' Health Insurance Is At Risk

Children may be able to enroll in Medicaid, get added to a family plan on the Affordable Care Act’s health exchange, or be put on an employer health plan. But the options vary by state and could turn out to be very expensive.

If Congress reauthorizes CHIP funding, states are in the clear. But they can’t bank on it yet, and states have to prepare to shut down if the funding doesn’t come through. Virginia would have to do so on January 31, 2018.

“We’re essentially doing everything we would need to shut down the program at the end of January,” Nablo says. “We’ve got a work group going with all the different components of this agency, and there are many.”

77c4e_gettyimages-879850932_forchip-73a068cbcfb1cc55593af61b35d711c0fdd93931-s1100-c15 States Sound Warning That Kids' Health Insurance Is At Risk

For example, they will need to reprogram their enrollment systems, inform pediatricians and hospitals, and train staff to deal with an onslaught of confused families.

Joan Alker, who runs the Georgetown University Center for Children and Families, says most states need to give families 30 days’ notice.

“But [state officials] are hearing rumors that Congress might get this done in the next couple of weeks and they don’t want to scare families,” she says. “States are really in a bind here, it’s very tough to know what to do.”

Colorado was the first to send out a notice and other states are close behind. There are a handful that are starting to run out of money in December, Alker says, such as Oregon, Minnesota and the District of Columbia.

The exact deadline for when CHIP funding runs out in each in each state is tricky to calculate, because the amount of money they have depends on how fast states spend it — and how much stopgap help the federal government gives them.

Some states are getting creative. Oregon just announced it will spend state money to keep CHIP running, says Alker, “And they’re assuming that Congress will pass it and they’re get reimbursed retroactively. That’s what they’re hoping.”

Texas is set to run out of CHIP funds a lot sooner than was expected just a few months ago. And there’s a big reason for that: Hurricane Harvey, says Laura Guerra-Cardus with the Children’s Defense Fund in Austin.

“Natural disasters are often a way that individuals that never had to rely on programs like Medicaid and CHIP need them for the first time,” she says.

Guerra-Cardus says after Harvey, a lot of new families enrolled in CHIP and there was also a higher demand for services. “When there is such a traumatic event, health care needs also rise. There’s been a lot of post-traumatic stress in children,” she says.

And to help those families out, Texas officials also waived fees they usually have to pay to join CHIP. So, lately there’s been less money coming in and more money going out. Like Virginia, without reauthorization, Texas would have to shutter CHIP by the end of January.

For Amy Ellis in Alpine, Texas, that’s something she’s dreading. “Losing a lot of sleep,” she says. “Still losing a lot of sleep.”

Ellis has an 8-year-old daughter who has been on CHIP since she was born.

She has asthma and allergies. Ellis says health insurance is really important because her family doesn’t make a lot of money. Her daughter’s allergy medicine is expensive.

Ellis lives in rural West Texas, nearly four hours southeast of El Paso and “three hours from the closest city,” she says.

The isolation means that Ellis doesn’t have a lot of options other than CHIP, she says. One would be enrolling her daughter in the insurance plan she and her husband have through the Affordable Care Act marketplace, but Ellis says that would be expensive.

“It would cost $300 to $400 a month for us to add her to our plan, which would be a huge chunk of our income,” she says. “That’s our grocery money and our gas money.”

A lot of families in Texas could find themselves in the same situation if Congress doesn’t act soon, says Guerra-Cardus. “Kids with chronic or special health care needs, this is going to turn their lives absolutely upside down.”

Roughly 450,000 children are covered by CHIP in Texas. Officials say they are asking the federal government to give them money that will keep CHIP alive through February.

But because officials must give families 30 days’ notice if the program will end, families in Texas could get letters right around Christmas that say their children are losing their health insurance.

This story is part of a reporting partnership with NPR, local member stations and Kaiser Health News. Selena Simmons-Duffin is a producer at NPR’s All Things Considered, currently on an exchange with Washington, D.C. member station WAMU.




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