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If California wants to go all in on universal health care, Vermont’s former governor is here to help

As Republicans in Congress continue their efforts to undo Obamacare, California is going in the opposite direction.

State lawmakers are exploring how – and when – to expand coverage to all Californians, while also reining in soaring health care costs that make the U.S. the most expensive country in the world for medical care.

The best option for California is to create the nation’s first universal, taxpayer-financed health care system that gets rid of the need for private insurance companies, some Democrats said this week after hearing from a blue state governor who tried to create such a system, known as single-payer health care.

Democrat Peter Shumlin, the former three-term governor of Vermont who was succeeded in office earlier this year by a Republican, said California can learn from Vermont’s failures. He abandoned his own effort to create a universal, single-payer system in 2014 because of its sizeable cost.

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He remains a staunch proponent of the health care model and says it can drive down costs, if done right. In a wide-ranging health care hearing in Los Angeles, Shumlin outlined a political and legislative strategy for California lawmakers:

Set specific goals

“I would write a bill that sets very clear goal posts that you have to meet, before your public financing kicks in,” Shumlin said. “I’d write the bill for the next governor – not this governor – because as someone who was trying to work on this toward the end of my tenure as governor, I found that I lost a lot of political clout.”

The issue this year has vexed California Democrats, who held majorities in the state Senate and Assembly. A hastily drafted proposal that sought to establish a single-payer system for California stalled in the Assembly after earlier clearing Senate without a financing plan.

Still, lawmakers this week endorsed Shumlin’s idea, saying their efforts should be focused on writing a bill that improves on Senate Bill 562, the single-payer proposal introduced earlier this year.

Earlier, Assembly Speaker Anthony Rendon refused to bring it up for a vote, criticizing the bill as incomplete and suggesting it was politically motivated. He instead created the committee to study the issue.

RoseAnn DeMoro, head of the California Nurses Association, the bill’s chief sponsor, blasted Rendon for interfering with the legislative process and on Twitter this week, said he’s sabotaging Democratic-led efforts to create a “Medicare-for-all” type system championed by Vermont Sen. Bernie Sanders.

Assemblyman David Chiu, D-San Francisco, a co-author of the Lara-Atkins bill, said he’s open to reworking the proposal or writing a new bill.

“We have no choice but to address the skyrocketing cost of health care,” said Chiu, one of seven members of the health care committee charged with drafting a blueprint to improve California’s health care delivery system.

Assemblyman Tom Lackey of Palmdale, the sole Republican on the committee, said this week that his goal is to “listen.”

“I think we all would agree that we need to do a better job than we’re doing now,” Lackey said. “Universal coverage is certainly a goal that we need to work toward.”

Related stories from The Sacramento Bee

 If California wants to go all in on universal health care, Vermont's former governor is here to help

Universal health care debate returns to California Capitol

 If California wants to go all in on universal health care, Vermont's former governor is here to help

Newsom, Villaraigosa separate over universal health care

 If California wants to go all in on universal health care, Vermont's former governor is here to help

Time for California to get moving on universal health care bill, Gavin Newsom says

Tie the bill to cost controls

“My big mistake was not going after cost before I promised a better plan,” Shumlin said.

Any form of single-payer coverage would require a new taxing system to replace current insurance premiums, co-pays and deductibles. Shumlin, first elected governor of Vermont in 2010, made publicly funded universal health care his most ambitious campaign promise. His proposal included an 11.5 percent payroll tax on businesses and an additional income tax on employees of up to 9.5 percent.

Shumlin said that initially he didn’t understand the importance of controlling health care costs. Tied to new taxes, as those costs rise, taxes have to rise, too.

“That was my biggest make. Where I really failed is that when I ran for governor, I did not get the connection between public financing and cost,” he said. “In the end, when I had to get legislators to vote, if they had to vote to increase (taxes) at the rate that health care costs are currently occurring in Vermont, there was no way they were going to vote yes.

“They ran from me because they suddenly realized that every year the increase in premiums…would result in having to pay for an annual tax increase. So my point is simple: To pass this, you’ve got to get cost containment first.”

American health care costs have risen steadily over the past 60 years, according to an analysis of federal data by the Kaiser Family Foundation, an independent research group. In 1960, total national health care spending was about $27 billion. Today it’s 3.3 trillion.

In 2016, total spending increased by 4.3 percent from 2015. That comes to $10,430 per person in health care costs each year, according to data released this month by the Centers for Medicare and Medicaid, and the upward trend is expected to continue.

Change how providers are paid

Shumlin attributed escalating costs, primarily, to the fact that many medical providers are paid based on volume of care rather than quality. Architects of Obamacare sought through the law to change long-established incentives in the health care delivery system to pay providers based on better health outcomes in patients rather than the volume of services provided.

While states and the federal government, insurers and hospitals have slowly changed the way care is delivered to focus more on outcomes, fee-for-service medicine is still an industry-wide practice.

Shumlin suggested California adopt a model under way in some states, in part through Medicare and Medicaid, called Accountable Care Organizations. The idea is to “align provider and payer incentives to focus on value instead of volume, with the goal of keeping patients healthy and costs manageable,” according to the Center for Health Care Strategies, Inc., an advocacy group.

“Look at Vermont’s example, and quickly move away from fee-for-service to an outcome-based payment system or I don’t believe you’ll ever get number one, the savings you need or number two, the outcomes you need,” Shumlin said. “Let’s not forget we spend more money on health care than any other nation in the world. Our outcomes aren’t as good. It’s bankrupting us, and until we crack that nut, no system will work.”

Impose tighter regulations on health insurers

Vermont regulates health insurers, in part, through its Green Mountain Care Board, created by the state’s legislature in 2011. Its mission is to reduce the rate of health care cost growth while ensuring quality care and access. The state also regulates insurance companies by requiring consumers to purchase plans on the state-run exchange. California does not have such a system in place.

“You can’t buy insurance in Vermont right now, as an individual, without going through the exchange,” Shumlin said. “What that allowed me to do is have my insurance regulators push out anyone who was in the market to…cherry-pick the easy lives, the cheap lives, the safe lives, the young lives, the healthy lives and leave everybody else behind.”

To increase rates, health plans looking to sell insurance in Vermont must file requests with the state and obtain approval from the state’s health board. California Insurance Commissioner Dave Jones backed a similar statewide proposal in 2014 that would have required changes to health insurance rates be approved by the state insurance commissioner. The initiative was defeated at the ballot box. Currently, Covered California negotiates rates with insurers that sell plans on the state-run exchange. The Department of Insurance and the Department of Managed Health Care, the state’s insurance regulators, determine whether rate increases are reasonable.

“You’ve got to get the regulatory system up and running to move this from the private sector to government having the ability to say ‘no,’ whether it’s CEO salaries or what you’re paying pharma,” Shumlin said.

Improve the Affordable Care Act

Shumlin acknowledged that restructuring the state’s health care system with state and federal financing would require federal cooperation, including approval of waivers.

“You need a federal partner,” Shumlin said, but California should “start work toward a fairer system now… We worked with the Obama administration to get the first waiver in America… that allows us currently to take Medicaid, Medicare, private pay – the entire system – and move it to an outcomes-based payment system from fee-for-service. That’s an incredibly difficult thing to do.”

He recommended that California assume it will get nothing in Washington for the next three years, setting up for a new president that would be willing to work with the state.

In the meantime, he said the state should add funding to current subsidies that help Californians pay for health coverage. California lawmakers could also expand Medi-Cal to cover all undocumented people, as well as open it to the wider public for a state-run insurance option.

“Enrich the program, don’t give up on it,” Shumlin said. “The reason people are complaining about it is because it’s not adequate. So do everything you can to make it whole.”

In the end, he said, the Trump administration’s opposition to Obamacare may prove politically helpful.

“The great thing about Trumpism, if there’s one thing great …it’s making single-payer great again,” Shumlin said. “People realize that as they take away all the small bits of progress that we’ve made, most Americans actually really care about having access to affordable, quality care without having to make horrid choices to get there.”

If California wants to go all in on universal health care, Vermont’s former governor is here to help

As Republicans in Congress continue their efforts to undo Obamacare, California is going in the opposite direction.

State lawmakers are exploring how – and when – to expand coverage to all Californians, while also reining in soaring health care costs that make the U.S. the most expensive country in the world for medical care.

The best option for California is to create the nation’s first universal, taxpayer-financed health care system that gets rid of the need for private insurance companies, some Democrats said this week after hearing from a blue state governor who tried to create such a system, known as single-payer health care.

Democrat Peter Shumlin, the former three-term governor of Vermont who was succeeded in office earlier this year by a Republican, said California can learn from Vermont’s failures. He abandoned his own effort to create a universal, single-payer system in 2014 because of its sizeable cost.

Never miss a local story.

Sign up today for a free 30 day free trial of unlimited digital access.

He remains a staunch proponent of the health care model and says it can drive down costs, if done right. In a wide-ranging health care hearing in Los Angeles, Shumlin outlined a political and legislative strategy for California lawmakers:

Set specific goals

“I would write a bill that sets very clear goal posts that you have to meet, before your public financing kicks in,” Shumlin said. “I’d write the bill for the next governor – not this governor – because as someone who was trying to work on this toward the end of my tenure as governor, I found that I lost a lot of political clout.”

The issue this year has vexed California Democrats, who held majorities in the state Senate and Assembly. A hastily drafted proposal that sought to establish a single-payer system for California stalled in the Assembly after earlier clearing Senate without a financing plan.

Still, lawmakers this week endorsed Shumlin’s idea, saying their efforts should be focused on writing a bill that improves on Senate Bill 562, the single-payer proposal introduced earlier this year.

Earlier, Assembly Speaker Anthony Rendon refused to bring it up for a vote, criticizing the bill as incomplete and suggesting it was politically motivated. He instead created the committee to study the issue.

RoseAnn DeMoro, head of the California Nurses Association, the bill’s chief sponsor, blasted Rendon for interfering with the legislative process and on Twitter this week, said he’s sabotaging Democratic-led efforts to create a “Medicare-for-all” type system championed by Vermont Sen. Bernie Sanders.

Assemblyman David Chiu, D-San Francisco, a co-author of the Lara-Atkins bill, said he’s open to reworking the proposal or writing a new bill.

“We have no choice but to address the skyrocketing cost of health care,” said Chiu, one of seven members of the health care committee charged with drafting a blueprint to improve California’s health care delivery system.

Assemblyman Tom Lackey of Palmdale, the sole Republican on the committee, said this week that his goal is to “listen.”

“I think we all would agree that we need to do a better job than we’re doing now,” Lackey said. “Universal coverage is certainly a goal that we need to work toward.”

Related stories from The Sacramento Bee

 If California wants to go all in on universal health care, Vermont's former governor is here to help

Universal health care debate returns to California Capitol

 If California wants to go all in on universal health care, Vermont's former governor is here to help

Newsom, Villaraigosa separate over universal health care

 If California wants to go all in on universal health care, Vermont's former governor is here to help

Time for California to get moving on universal health care bill, Gavin Newsom says

Tie the bill to cost controls

“My big mistake was not going after cost before I promised a better plan,” Shumlin said.

Any form of single-payer coverage would require a new taxing system to replace current insurance premiums, co-pays and deductibles. Shumlin, first elected governor of Vermont in 2010, made publicly funded universal health care his most ambitious campaign promise. His proposal included an 11.5 percent payroll tax on businesses and an additional income tax on employees of up to 9.5 percent.

Shumlin said that initially he didn’t understand the importance of controlling health care costs. Tied to new taxes, as those costs rise, taxes have to rise, too.

“That was my biggest make. Where I really failed is that when I ran for governor, I did not get the connection between public financing and cost,” he said. “In the end, when I had to get legislators to vote, if they had to vote to increase (taxes) at the rate that health care costs are currently occurring in Vermont, there was no way they were going to vote yes.

“They ran from me because they suddenly realized that every year the increase in premiums…would result in having to pay for an annual tax increase. So my point is simple: To pass this, you’ve got to get cost containment first.”

American health care costs have risen steadily over the past 60 years, according to an analysis of federal data by the Kaiser Family Foundation, an independent research group. In 1960, total national health care spending was about $27 billion. Today it’s 3.3 trillion.

In 2016, total spending increased by 4.3 percent from 2015. That comes to $10,430 per person in health care costs each year, according to data released this month by the Centers for Medicare and Medicaid, and the upward trend is expected to continue.

Change how providers are paid

Shumlin attributed escalating costs, primarily, to the fact that many medical providers are paid based on volume of care rather than quality. Architects of Obamacare sought through the law to change long-established incentives in the health care delivery system to pay providers based on better health outcomes in patients rather than the volume of services provided.

While states and the federal government, insurers and hospitals have slowly changed the way care is delivered to focus more on outcomes, fee-for-service medicine is still an industry-wide practice.

Shumlin suggested California adopt a model under way in some states, in part through Medicare and Medicaid, called Accountable Care Organizations. The idea is to “align provider and payer incentives to focus on value instead of volume, with the goal of keeping patients healthy and costs manageable,” according to the Center for Health Care Strategies, Inc., an advocacy group.

“Look at Vermont’s example, and quickly move away from fee-for-service to an outcome-based payment system or I don’t believe you’ll ever get number one, the savings you need or number two, the outcomes you need,” Shumlin said. “Let’s not forget we spend more money on health care than any other nation in the world. Our outcomes aren’t as good. It’s bankrupting us, and until we crack that nut, no system will work.”

Impose tighter regulations on health insurers

Vermont regulates health insurers, in part, through its Green Mountain Care Board, created by the state’s legislature in 2011. Its mission is to reduce the rate of health care cost growth while ensuring quality care and access. The state also regulates insurance companies by requiring consumers to purchase plans on the state-run exchange. California does not have such a system in place.

“You can’t buy insurance in Vermont right now, as an individual, without going through the exchange,” Shumlin said. “What that allowed me to do is have my insurance regulators push out anyone who was in the market to…cherry-pick the easy lives, the cheap lives, the safe lives, the young lives, the healthy lives and leave everybody else behind.”

To increase rates, health plans looking to sell insurance in Vermont must file requests with the state and obtain approval from the state’s health board. California Insurance Commissioner Dave Jones backed a similar statewide proposal in 2014 that would have required changes to health insurance rates be approved by the state insurance commissioner. The initiative was defeated at the ballot box. Currently, Covered California negotiates rates with insurers that sell plans on the state-run exchange. The Department of Insurance and the Department of Managed Health Care, the state’s insurance regulators, determine whether rate increases are reasonable.

“You’ve got to get the regulatory system up and running to move this from the private sector to government having the ability to say ‘no,’ whether it’s CEO salaries or what you’re paying pharma,” Shumlin said.

Improve the Affordable Care Act

Shumlin acknowledged that restructuring the state’s health care system with state and federal financing would require federal cooperation, including approval of waivers.

“You need a federal partner,” Shumlin said, but California should “start work toward a fairer system now… We worked with the Obama administration to get the first waiver in America… that allows us currently to take Medicaid, Medicare, private pay – the entire system – and move it to an outcomes-based payment system from fee-for-service. That’s an incredibly difficult thing to do.”

He recommended that California assume it will get nothing in Washington for the next three years, setting up for a new president that would be willing to work with the state.

In the meantime, he said the state should add funding to current subsidies that help Californians pay for health coverage. California lawmakers could also expand Medi-Cal to cover all undocumented people, as well as open it to the wider public for a state-run insurance option.

“Enrich the program, don’t give up on it,” Shumlin said. “The reason people are complaining about it is because it’s not adequate. So do everything you can to make it whole.”

In the end, he said, the Trump administration’s opposition to Obamacare may prove politically helpful.

“The great thing about Trumpism, if there’s one thing great …it’s making single-payer great again,” Shumlin said. “People realize that as they take away all the small bits of progress that we’ve made, most Americans actually really care about having access to affordable, quality care without having to make horrid choices to get there.”

Governor welcomes students to Ryan Center for computer science summit

KINGSTON, R.I. – December 13, 2017 — An undersea torpedo, a drone, augmented reality glasses, video games, apps and robots were all on display on the floor of the Ryan Center at the University of Rhode Island on Wednesday as students, business leaders and educators from across the state met at the second Computer Science 4 Rhode Island Summit, hosted by Gov. Gina Raimondo.

The event celebrated the advancements of Raimondo’s CS4RI Initiative, launched in 2016 as one of the most comprehensive computer science initiatives in the country.  The initiative aims to increase students’ exposure to computer science skills and to increase access to computer science education to all communities of Rhode Island.

“I spoke with a young woman from Barrington earlier who said, ‘I never knew computer science could be so much fun,’ ” Raimondo said. “And she wasn’t taking a computer science class, she was taking a business class. It’s about integrating these kinds of skills into the curriculum.”

The summit brought together middle school, high school and college students, industry professionals, training providers and community members to showcase projects, research, education and career opportunities related to computer science and technology. Exhibitors included representatives from business and industry — such as Citizens Bank, FM Global, CVS Health, Accenture, Amica, and many more — as well as colleges, universities and K-12 schools.

Raimondo said there are 1,300 computer science jobs in the state of Rhode Island, yet only 800 students graduated from colleges and universities across the state with degrees in computer science last year. She implored students to set a goal to help double that number by the year 2025, when many of them will graduate from an institution of higher learning.

“If there are 1,300 computer science jobs here in the state, we want them to be filled by workers coming from our schools,” she said. “We’re recruiting these companies here to Rhode Island to give you a chance for a good future in our state. We want to give everyone a chance.”

One of the primary goals of Raimondo’s Office of Innovation is to increase the access students at all schools in Rhode Island have to computer science education. She said that when the Office of Innovation was created last year, only 42 students in Rhode Island participated in Advanced Placement computer science tests. Only 14 of them were girls and none were people of color. In 2017, however, 265 students took the tests, a 630 percent increase.

“I think the next Mark Zuckerberg is probably going to be a woman, probably someone of color,” Raimondo said. “That person could be here in this room, a student from Tolman, Barrington, Scituate, Classical, or any of the other schools across our state. But we have to make sure that you have access to those classes to give you an opportunity to realize your potential.”

Giving students access to those kinds of courses is the focus of the national non-profit group Girls Who Code, an organization dedicated to closing the gender gap in technology. Leah Gilliam, vice president of education, strategy and innovation at the company, said giving students that access to education is crucial to their success, particularly among women and minorities.

She stressed the need for diverse viewpoints in the computer science fields, noting that technologies inherently have the biases of their creators baked into them. For example, the airbag was created in the 1980s, designed by men and it saved many thousands of lives. However, in 2003, a group of Swedish engineers began to study the efficacy of airbags and noticed that all crash test dummies basically resembled average sized males. They determined that testing the true efficacy of airbags was impossible without accounting for different body sizes and types, to study how they move during an accident.

She also noted that the performance of voice-activated technologies suffers when used by consumers with strong accents or people who speak English as a second language. Those kinds of inherent biases can be mitigated with a more diverse workforce, she said.

Given the ever-expanding role of technology in our daily lives, she said the students at the summit are at an advantage over earlier generations of workers.

“You guys are learning now what I was learning in grad school 10 years ago,” she said. “Computer science is the new reading. You need to know how to do it to do anything. “

Barbara Cottam, chair of the Rhode Island Board of Education and an executive vice president at Citizens Bank, pointed out that opportunity abounds for careers in computer science, with 486,000 jobs nationally, and only 43,000 computer science degrees awarded by colleges and universities across the country in 2016.

She said the Rhode Island education system has poured resources into giving students access to computer science courses, training 500 teachers over the past year and half, and creating the STEM Pathway Endorsement, an achievement that students can gain to go along with their diploma by successfully completing certain coursework.

Lily O’Connor, 15, of Portsmouth, and Ethan Nappi, 16, of Tiverton, are among the students who have benefited from Rhode Island’s increased commitment to computer science education. The pair are part of a robotics team from The Met East Bay School, part of a network of six small, public high schools located in Providence and Newport.

O’Connor and Nappi designed and coded a wheeled robot that can pick up cubes and deposit them in a receptacle. The project was part of the First Tech Challenge, a Mentor-based program that builds science, engineering, and technology skills.

Though they were working on a tight timeline, O’Connor and Nappi managed to achieve their goal and they have now set about the task of coding the robot to drive itself and return to a parked position.

For O’Connor, her interest in robots and computer coding was handed down at an early age from her parents – her father is a computer scientist and her mother is a mechanical engineer.

“I’ve always loved taking things apart and figuring out how they worked,” she said. “Three years ago, I joined a robotics team and started to learn coding and my dad gave me an old javascript textbook of his, so I’ve been doing it ever since.”

For Nappi, his desire to pursue coding came from his enjoyment of video games.

“As long as I can remember, I’ve always loved playing video games, but a year ago I decided to start making them,” he said. “I started to learn coding and then I joined the robotics team and it’s really cool.”

Pennsylvania Governor: Women Can ‘Make Their Own Health Care Decisions’

The ban, known as Senate Bill 3, passed in the state’s House on Tuesday night, 121-70, after passing the state Senate back in February, 32-18.

Ball State University responds to Governor’s call for computer literacy in Indiana classrooms with proposed new …

Topic: College of Applied Sciences and Technology

December 8, 2017

To create a larger pool of workers who are prepared to meet the needs of a 21st century economy, Indiana Governor Eric J. Holcomb wants all Indiana students to have access to computer science instruction. Ball State University is answering his challenge by working to create a new undergraduate degree in Computer Science Education. A team of Ball State faculty and staff are working closely to develop a degree that aligns with the Governor’s vision to link education to workforce training. Ball State’s proposed Computer Science Education Degree will provide the requirements of a major in computer science with the core requirements of an undergraduate degree in education.

“To be prepared for the demands of our rapidly changing economy, Indiana students need quality STEM instruction throughout their K-12 educational journey,” Gov. Holcomb said. “Putting computer and information science in every Indiana school is a big part of that. A new degree in Computer Science Education from Ball State University has great potential to help us get more teachers with computer science training into our classrooms.”

The proposed degree will build on Ball State’s existing computer science curricula. Students majoring in secondary education will be encouraged to pursue a minor in Foundation of Computer Systems. This minor provides 22 to 24 credit hours in computer science, analytics, software and hardware, and it can also be packaged as a concentration in the Elementary Education degree.

“I’m proud of our team at Ball State University who saw a major gap in Indiana’s educational system and came up with a long term solution,” said President Geoffrey Mearns. “This new degree will continue Ball State’s commitment to increasing the number of Indiana students who graduate with basic computer science skills, making them better equipped to enter the workforce when they graduate high school. Although we have training activities planned for current educators this summer, we realized this issue cannot be fixed by simply having events. We knew we needed do something more strategically which led to this new degree. Eventually, this degree will have positive ramifications both here in Indiana and across the nation.”

Ball State also plans to offer computer science modules online to assist individual teachers throughout the school year and develop course-based outreach programs for elementary, middle and high school students.

The new program still must gain approval from the Ball State Board of Trustees, the Indiana Commission for Higher Education, and the college accreditor.

Mental health forum left us wanting more from Iowa governor candidates

CLOSE

Watch as candidates for governor answer questions about the state of mental health in Iowa during the Register’s mental health forum at Des Moines University.

Iowa’s crisis in mental health care is getting overdue attention, due to recent tragedies and events organized in response. But it’s clear that the candidates for governor  — and state leaders as a whole — have a lot to learn about how to reform the system.

At a forum Tuesday sponsored by the Register, Des Moines University and the Iowa Hospital Association, 12 candidates answered questions on how to improve mental health care in Iowa. A 13th, Gov. Kim Reynolds, had a scheduling conflict and provided a pre-recorded video statement.

The postmortem: The event included a dose of denial (thanks to the governor), a dearth of details and plenty of delusions. But advocates saw signs of hope from the discussion.

“There were platitudes, sure, but there were also sharp observations and specific suggestions. It was not all political talking points,” said Peggy Huppert, executive director for NAMI Iowa. “Honestly, when I compare their performance at the forum to what they had to say to me in July and August, the progress is remarkable.”

The candidates present — Democrats, Republicans, Libertarians and an independent —were nearly united in their criticism of privatized Medicaid management under Reynolds and her predecessor, Terry Branstad. Our editorial board, of course, agrees that it has been a disaster. Private managed care organizations have pulled the plug on care for some mental health patients and reduced payments for providers. An innovative crisis-stabilization program in Centerville was forced to close because state officials failed to write rules to allow Medicaid payment for such services.

Iowa’s problems go much deeper than Medicaid privatization, however. The state had barriers to care, a shortage of psychiatrists and funding issues long before the new system launched April 1, 2016. 

“They all criticized Medicaid managed care, but none of them addressed the big question on that — how would they contain costs if it went back to the state?” Huppert noted.

In fact, none of the candidates had any realistic answers on how to pay for improving mental health care. Manage the state budget better than Reynolds and Branstad have? OK, how? Establish programs to divert mentally ill Iowans from jail or psychiatric hospitals? Great – that should save money in the long run, but it still requires upfront investment. Pass single-payer health care and legalize cannabis? That might be a realistic solution in another state or nation.

Obradovich: Iowa governor candidates combat mental-illness stigmas with personal stories

Prompted by a question, some candidates agreed that the state should lift a state law that caps the amount of property taxes that counties can collect to pay for mental-health services. The cap is stuck at 1996 levels, even though some counties have seen large population increases since then. But none of the candidates addressed how to overcome the primary barrier to lifting the cap: The Iowa Farm Bureau Federation, which opposed any changes last legislative session.

Other candidates, such as Democrat Jon Neiderbach and Libertarian Marco Battaglia, questioned why Iowa ties mental-health funding to property taxes. It’s a great question, and it’s worth re-examining Iowa’s regional system that is governed by county supervisors.

A few candidates took the easy answer: reopen the Mental Health Institutes in Clarinda and Mount Pleasant. But other candidates — including Republican Ron Corbett and Democrats Fred Hubbell, Andy McGuire and John Norris — recognized that the state doesn’t necessarily need to reopen the institutes, but create more community-based approaches that include several types of beds: acute, transitional and long-term.

A separate event could be organized just to address the night’s final question, on creating a mental health system that serves children. Iowans should demand answers from all elected leaders on how we can intervene earlier to treat children.  

But sometimes it’s just better for candidates to keep their mouths closed. Independent candidate Brent Roske said it’s an “obvious correlation” that Iowa has seen an increase in violent crime and that it ranks last in its proportion of mental health beds. This comment perpetuates the unfounded stereotype that mentally ill people are violent.

Candidates and public officials have come a long way, but they must spend more time with Iowans to solve this issue — people like Leslie and Scott Carpenter of Iowa City, who were in the audience of about 400 people at DMU. In 2008, their then-16-year-old son was first hospitalized for suicidal thoughts. He’s since been diagnosed with schizo-affective disorder and other illnesses. They’ve struggled with long waits for a bed; privacy laws that prevent them from even talking with their son’s doctors without a release; a lack of continuity of care between rotating doctors and community agencies; and other holes in the system.

Their solutions include opening more psychiatric beds in regional medical centers and more efforts to recruit more psychiatrists, social workers, nurses and other care providers.

The Carpenters suggested the next event should include parents, medical professionals and others living the crisis every day. We agree. All of us must be involved in the solutions, from patients to whoever will be the next governor.

Obradovich: Here’s why Gov. Kim Reynolds and I cried at her news conference today

Iowa governor candidates lay out plans for mental health

CLOSE

Watch as candidates for governor answer questions about the state of mental health in Iowa during the Register’s mental health forum at Des Moines University.

A dozen candidates for governor gathered Tuesday night to lay out their plans for improved access, funding and treatment for mental health services across the state. 

At a public panel hosted by The Des Moines Register, the candidates voiced near-universal criticism of Iowa’s privatized Medicaid system, which has faced a tumultuous couple of months following the departure of one of the private companies hired to provide services. 

The Register hosted the panel following an outpouring of support and concern after Mary and Larry Neubauer penned an emotional obituary for their son, Sergei, who committed suicide. They called on policymakers to better address the “crisis” of declining access to mental health treatment.

“(We) believe it is a crisis facing America, one that must be acknowledged, better understood and ultimately addressed for people to have the tools to heal,” they wrote. “Iowa did not have adequate mental-health resources during Sergei’s times of crisis and he spent several months out of state this year in residential treatment.”

Every candidate for governor was in attendance, with the exception of current Gov. Kim Reynolds, a Republican, who is traveling this week. In her absence, the other candidates — Democrats, Republicans, Libertarians and independents — took turns leveling their criticism of her leadership. 

They were also nearly united in their frustration over the closing of two state mental health institutes under former Gov. Terry Branstad, which dramatically reduced the availability of mental hospital beds in the state. Iowa currently ranks 49th out of 50 states for its number of state mental hospital beds.

Many candidates also expressed hope that Iowa could move away from a system they say criminalizes mental health and unnecessarily jails and imprisons those with mental health or substance abuse issues. The focus needs to be on reducing the stigma associated with mental health, they said, and ensuring access to treatment. 

Here’s a look at some of the key points raised by each candidate.

Republicans

Ron Corbett, outgoing mayor of Cedar Rapids: Corbett said the closure of two mental health institutes in Clarinda and Mount Pleasant has resulted in compression of the system.

“The state may have saved some money on their line item, but the people didn’t evaporate,” he said. Instead, the results are being manifested as homelessness, higher rates of incarceration and overcrowded hospitals.

He said it may not make sense to reopen the two facilities now, but it would make sense to increase the number of available beds. 

Steven Ray, Boone City Councilman: “I started seeing this 30 years ago,” said Ray, who previously worked in law enforcement. “We would have requests for committals through the sheriffs’ office where I started out at. And we were often finding, even back then, that it was difficult to find a bed in this state. Sometimes deputies would have to drive 150 miles to find a bed, and that’s inexcusable.” 

He said that although closing two state mental institutions may have saved the state money, local taxpayers are still bearing the costs in other ways, including through the criminal justice system. 

“That is not where this should be dealt with, and our law enforcement people are not mental health specialists,” he said. 

Kim Reynolds, Iowa governor: In a video statement, Reynolds highlighted the states’ efforts to expand access to jail diversion programs as well as its efforts to provide a regionalized approach to mental health services.

“My administration has taken a number of steps to address the critical mental health needs in our state,” she said. “Today, Iowa’s mental health system is serving more Iowans in more modern ways with better services and more local home and community settings than ever before.”

Democrats

Nate Boulton, state senator and attorney: Boulton levied criticism of Reynolds and the Republican-controlled Legislature for presiding over a “manufactured budget crisis” that favors special interest “tax giveaways” over mental health funding.

“One of the critical problems that I can see right now is the fact that we just had an address of a video from our governor who doesn’t seem to acknowledge that there’s much of a problem here,” he said. 

Cathy Glasson, nurse and president of SEIU Local 199: Glasson, who has positioned herself as the more progressive candidate, said the state should immediately move to reverse the privatization of Medicaid, which “has been devastating to so many families and providers in the state.” In the longer term, she said Iowa should move toward a Medicare-for-all system.

“If we can’t count on the politicians in Washington, D.C. to do the right thing, I believe we need to fight and work to pass a universal single-payer health care plan right here in Iowa,” she said. “Everybody covered. Nobody left behind.”

Students, governor talk code to underscore importance of expanding computer science education

INDIANAPOLIS – Gov. Eric Holcomb took a shot at coding Tuesday, surrounded by dozens of Hooiser students, for the third annual Hour of Coding event at the Indiana Statehouse.

“Whenever you get older, a lot of the jobs will have coding and you need to know how to do it,” Haley Winderlich said, a fourth grader attending the event.

The event was hosted by the Indianapolis-based nonprofit Nextech, which aims to expand computer science classes statewide while working to train Indiana educators.

“To see this happening today, it’s a great message to the community,” Karen Jung said, Nextech president. “There’s a challenge between workforce development, and the jobs we need to fill today, and then thinking about students preparing them for whatever path.”

Indiana lawmakers are also working on ways to expand access to computer science courses as well.

“If you want to pretty much guarantee full employment for the rest of your life, learn coding,” Gov. Eric Holcomb told the group of students.

Some like the Indiana Chamber are pushing lawmakers to make computer science classes a new requirement for graduation to address a growing employment crisis for skilled workers.

“You know what, I’m not sold on the requirement piece,” Jennifer McCormick said, Superintendent of Public Instruction. “I do agree that it needs to be offered. It’s systemic, though. When we hear requirement, we think high school, but I’m talking about K-12 as far as a systemic approach to make sure it’s offered.”

Lawmakers are expected to address the issue during the upcoming session.

Health care is top issue in Minnesota governor’s race

More than a dozen DFLers and Republicans are running for governor next year, and nearly all of them agree on at least one thing after months on the campaign trail: Health care is the issue that voters throughout Minnesota want to talk about most.

“It’s absolutely the No. 1 issue I hear about, far and away,” said DFL candidate Rep. Paul Thissen.

“Health care costs, specifically, are if not the No. 1 issue, one of the dominant issues in the campaign,” said GOP candidate Keith Downey.

With nearly a year until the election, few candidates have issued detailed health care plans. But most are ready to offer strong opinions about slowing the rise of insurance premiums, expanding coverage in greater Minnesota and stabilizing the state’s health care market amid uncertainty in Washington, D.C.

On the campaign trail, Republicans have pushed for the dissolution of MNsure, Minnesota’s individual health insurance market, and a shift to health care policies where customers can pick and choose what’s covered. DFLers have lined up behind single-payer health care, in which the state would take the lead in ­providing more expansive coverage.

Across the political spectrum, candidates want to build on short-term fixes the Legislature passed earlier this year.

Between a premium subsidy and a “reinsurance” program that funnels money to insurance companies to help with major claims, lawmakers approved $868 million to prop up the state’s individual insurance market over the next two years.

Republican state Sen. David Osmek said lawmakers did right by approving reinsurance and other changes like allowing for-profit insurance companies to operate in Minnesota for the first time.

Now, Osmek wants to trim the number of people who get health coverage through Medicaid; eliminate MNsure and replace it with a high-risk insurance pool; and allow all insurance plans to shift to a “cafeteria-style” approach, in which some conditions wouldn’t have to be covered. He said people should select health plans based on “risks you believe you have in your life.”

Hennepin County Commissioner Jeff Johnson also wants to see an end to federal mandates requiring everyone to buy health coverage, and for all plans to offer a list of essential services.

He’s championing a reboot of Minnesota’s high-risk pool, which provided coverage for people with pre-existing conditions who had a hard time finding health insurance before the passage of the Affordable Care Act.

“It was expensive, but Minnesotans were willing to pay that expense,” Johnson said. “And it worked really well.”

Downey and Rep. Matt Dean, another GOP candidate, have sparred publicly over health care. Dean, the chairman of the House Health and Human Services Finance Committee, has been outspoken in favor of abandoning MNsure. He wants to replace the individual market with a system in which people who buy their own insurance could do so independently but still receive subsidies. People on public programs would sign up through counties rather than the state marketplace.

“I think people are going to make better decisions on their own,” Dean said.

Downey, a former chairman of the Minnesota Republican Party, says Dean’s plan doesn’t go far enough to get government out of health care. He wants to scrap MNsure and other programs and instead give Minnesotans “income-adjusted” vouchers with which they’d purchase health care. The vouchers and income verification would be provided by the state.

Meanwhile, all six DFL candidates say cutting the state out of the picture won’t solve persistent cost problems and won’t ensure access to insurance and quality care for rural residents.

Every DFLer favors an eventual shift to a single-payer system, though some use other terms like “Medicare for all” or “universal” health care.

Rep. Tina Liebling said cutting out insurance companies and having the state work directly with clinics and hospitals is a more specific move toward a single-payer system than some of her DFL challengers are ready to make. She said DFL voters tend to see the Affordable Care Act as the start of a remade health care system, not the end of it.

“They realize the ACA made things a little better, but it’s still an insurance-based system,” Liebling said. “And people are ready to move beyond that.”

Most DFL candidates say the first step should be a plan DFL Gov. Mark Dayton has been pushing. The idea: open up MinnesotaCare, the subsidized insurance program for low-income people, to anyone who buys their own insurance. People who make more money than the program’s income threshold would pay full premiums but sign up through the state.

Republican majorities in the Legislature rejected that this year, but Thissen said he expects it could pick up traction in 2018. Lawmakers may be wary of doling out hundreds of millions more to insurance companies to extend the reinsurance program, he said.

Rep. Erin Murphy, a nurse who frequently references her work in health care, said the MinnesotaCare “buy-in” approach would help sidestep a private insurance industry she believes has become more focused on its own success than serving people.

“I think there’s a lot of evidence that the private market … is first and foremost interested in their bottom line,” Murphy said.

State Auditor Rebecca Otto has released a 28-page health care plan. She said the state should set up a system in which all state and federal health care money would be funneled into a single fund managed by the state and potentially supplemented with a payroll tax. She’s less interested than some other candidates in starting that process by expanding MinnesotaCare.

“We need to move on to something that’s much better,” Otto said.

U.S. Rep. Tim Walz and St. Paul Mayor Chris Coleman say they support a switch to a single-payer system but believe it’s a long-term shift. Both back the MinnesotaCare buy-in as a starting point.

“I hear a lot of support for a single-payer system of some sort and the reality is that it may be the long-term solution, but it’s not something we can pivot to immediately,” Coleman said.

Walz said he’d also focus more attention on preventive measures that could help drive down health care costs, like reducing obesity rates in young people.

“As governor, I’d be talking more holistically about this,” Walz said.

Governor’s budget restores funds to health, family services

CASPER, Wyo. (AP) — Wyoming Gov. Matt Mead wants to increase spending on health and family services, saying that cuts made to withstand the economic downturn are hurting those agencies’ ability to deliver services.

The Casper Star-Tribune reports that Mead presented his budget Thursday morning.

The governor recommended state lawmakers boost spending for the Department of Family Services so the agency can renew contracts with the two tribes on the Wind River Reservation.

He also called to increase the Department of Health’s budget by $48 million and argued against a request to eliminate spending on immunizations. The Legislature asked agencies to propose cuts but Mead said some department suggestions went too far, such as allowing the Department of Health to privatize a state-run assisted living facility and nursing home.

Lawmakers convene in February.

Governor looks to emphasize computer science studies | Local …

By Eric Scicchitanoand Rick Dandes

The Daily Item

HARRISBURG — The Wolf Administration seeks the adoption of computer science standards for Pennsylvania schoolchildren, a request that comes with the support of local educators.

Gov. Tom Wolf asked the State Board of Education to adopt “Computer Science for All” standards, a set of learning objectives designed to develop a foundation for a computer science curriculum at all grade levels, kindergarten through 12th.

The standards would be voluntary for schools to adopt but the governor said he’ll seek mandates, too.

“I have asked the Department of Education to work closely with the State Board of Education to adopt Computer Science for All standards for Pennsylvania and I will work with the legislature to codify computer science standards into law,” Wolf said.

In urging the State Board to adopt the standards, the Wolf Administration pitched its push on the future of the state’s economy. According to a press release from the governor’s office, approximately 300,000 jobs will require STEM skills and knowledge by 2018 — science, technology, engineering and mathematics.

According to the Wolf Administration, seven in 10 new jobs will require computer science skills over the next decade.

An estimated 18,332 students in Pennsylvania took a computer science class in high school last year.

Standards put together by the Computer Science Teachers Association for the youngest students, ages 5 to 7, are as simple as learning about passcode, identifying hardware, breaking down problems to identify step-by-step solutions and the very basics of computing and software use.

The work — direct computer use and study of theory — becomes increasingly more complex and interactive as students ascend through grade levels. Juniors and seniors would learn to intricately manipulate algorithms of their own, including in the development and control of artificial intelligence, and would learn to plan and develop programs for broad audiences.

“Each of the 500 school districts would have the opportunity to drive toward the type of experience they’d want for their own students,” said Judd Pittman, a special advisor to the education secretary on STEM. “I think for the majority of school districts, you can do this as low-tech or high-tech as you would like. There are a lot of opportunities for public-private partnerships or accessing grant dollars.”

Officials from the Shikellamy, Milton and Selinsgrove school districts all said computer science education is offered at present. Additional coursework would prove a benefit, they said.

Cathy Keegan, superintendent of Milton schools, said computer technology is integrated throughout all curricula in every grade level. Specific to STEM, she said programs of study include introductory classes in the middle school plus high tech lab, technical drawing, drafting and computer programming at the high school.

There’s a Coders Club, too, at both the elementary and high schools.

“The true digital natives are now attending our schools. It is imperative that we recognize the need to keep pace with our students mode of learning. Put an iPhone in the hands of a 2-year-old and see what happens,” Keegan said.

Director of Education Abbey Walshaw-Wertz, Shikellamy High School

“We feel like computer science courses are important because that’s where a lot of the jobs are going to be and we already have courses in related fields,” said Abbey Walshaw-Wertz, Shikellamy’s director of education.

Shikellamy features courses in mobile app design and web design at the high school. In the sixth grade, she said a teacher teaches coding. Students with a particular interest in computer science can get a more specialized education at SUN Area Technical School, she said.

Courses in computer applications, web design and design engineering are offered in Selinsgrove.

“Increasing access to computer science education will benefit our students. The skills involved in computer science and STEM are applicable to almost every career field currently existing as well as those that are emerging,” said Chad Cohrs, Selinsgrove superintendent.

An emphasis in STEM work, particularly computer science, isn’t limited to the future. Bob Garrett, president and CEO, Greater Susquehanna Valley Chamber of Commerce, said computer knowledge in the workforce is essential right now.

“What we are finding out from employers in the Valley is that where they are finding a gap in their recruitment efforts, is in work readiness,” Garrett said.

“Most jobs today involve at least a working knowledge of how to use a computer. It’s now as basic a required skill even in entry-level jobs as knowing how to use a slide rule, or simply add and subtract used to be.”

Governor looks to emphasize computer science studies

By Eric Scicchitanoand Rick Dandes

The Daily Item

HARRISBURG — The Wolf Administration seeks the adoption of computer science standards for Pennsylvania schoolchildren, a request that comes with the support of local educators.

Gov. Tom Wolf asked the State Board of Education to adopt “Computer Science for All” standards, a set of learning objectives designed to develop a foundation for a computer science curriculum at all grade levels, kindergarten through 12th.

The standards would be voluntary for schools to adopt but the governor said he’ll seek mandates, too.

“I have asked the Department of Education to work closely with the State Board of Education to adopt Computer Science for All standards for Pennsylvania and I will work with the legislature to codify computer science standards into law,” Wolf said.

In urging the State Board to adopt the standards, the Wolf Administration pitched its push on the future of the state’s economy. According to a press release from the governor’s office, approximately 300,000 jobs will require STEM skills and knowledge by 2018 — science, technology, engineering and mathematics.

According to the Wolf Administration, seven in 10 new jobs will require computer science skills over the next decade.

An estimated 18,332 students in Pennsylvania took a computer science class in high school last year.

Standards put together by the Computer Science Teachers Association for the youngest students, ages 5 to 7, are as simple as learning about passcode, identifying hardware, breaking down problems to identify step-by-step solutions and the very basics of computing and software use.

The work — direct computer use and study of theory — becomes increasingly more complex and interactive as students ascend through grade levels. Juniors and seniors would learn to intricately manipulate algorithms of their own, including in the development and control of artificial intelligence, and would learn to plan and develop programs for broad audiences.

“Each of the 500 school districts would have the opportunity to drive toward the type of experience they’d want for their own students,” said Judd Pittman, a special advisor to the education secretary on STEM. “I think for the majority of school districts, you can do this as low-tech or high-tech as you would like. There are a lot of opportunities for public-private partnerships or accessing grant dollars.”

Officials from the Shikellamy, Milton and Selinsgrove school districts all said computer science education is offered at present. Additional coursework would prove a benefit, they said.

Cathy Keegan, superintendent of Milton schools, said computer technology is integrated throughout all curricula in every grade level. Specific to STEM, she said programs of study include introductory classes in the middle school plus high tech lab, technical drawing, drafting and computer programming at the high school.

There’s a Coders Club, too, at both the elementary and high schools.

“The true digital natives are now attending our schools. It is imperative that we recognize the need to keep pace with our students mode of learning. Put an iPhone in the hands of a 2-year-old and see what happens,” Keegan said.

Director of Education Abbey Walshaw-Wertz, Shikellamy High School

“We feel like computer science courses are important because that’s where a lot of the jobs are going to be and we already have courses in related fields,” said Abbey Walshaw-Wertz, Shikellamy’s director of education.

Shikellamy features courses in mobile app design and web design at the high school. In the sixth grade, she said a teacher teaches coding. Students with a particular interest in computer science can get a more specialized education at SUN Area Technical School, she said.

Courses in computer applications, web design and design engineering are offered in Selinsgrove.

“Increasing access to computer science education will benefit our students. The skills involved in computer science and STEM are applicable to almost every career field currently existing as well as those that are emerging,” said Chad Cohrs, Selinsgrove superintendent.

An emphasis in STEM work, particularly computer science, isn’t limited to the future. Bob Garrett, president and CEO, Greater Susquehanna Valley Chamber of Commerce, said computer knowledge in the workforce is essential right now.

“What we are finding out from employers in the Valley is that where they are finding a gap in their recruitment efforts, is in work readiness,” Garrett said.

“Most jobs today involve at least a working knowledge of how to use a computer. It’s now as basic a required skill even in entry-level jobs as knowing how to use a slide rule, or simply add and subtract used to be.”

Maryland governor promotes computer science education, workforce agenda

ANNAPOLIS, Md. — Maryland Gov. Larry Hogan has announced a plan Thursday to promote computer science education and accelerate workforce development in the field across the state.

Hogan explained the need for the initiative by saying there are nearly 20,000 openings for computer-related jobs in the state, yet in 2015, for example, there were fewer than 3,000 computer science graduates statewide.

At a news conference in the State House in Annapolis, Hogan announced he’d just signed an executive order to have the state’s Task Force on Cybersecurity and Information Technology identify what employers in those fields need in their workforce and to study ways to grow tech talent.

Hogan also announced he’d allocate $5 million dedicated to teacher training and professional development in the computer science field. He also hopes to implement computer science education standards as part of the K-12 curriculum. That will require legislation that the governor said he is working on now.

Finally, as part of his ACCESS program, which stands for Achieving Computer science Collaborations for Employing Students Statewide, Hogan announced a partnership with Girls Who Code, a nonprofit organization aimed at closing the gender gap in the fields of science, technology, engineering and mathematics, or STEM.

Hogan said there are 23 Girls Who Code clubs across the state and that he’d introduce the Governor’s Club Challenge to create a partnership to generate new clubs in communities across the state.

He also ticked off a list of concepts and terms that girls learn in the clubs: “loops, variables, conditionals and functions, which form the basis for all programming languages.” Pausing for a moment, he added, jokingly, “I should probably take that course.”

Emily Schienvar, communications associate with Girls Who Code, said the aim of the group is making sure that girls can compete in the world of computer science. “Girls Who Code is all about changing the culture, making sure that people know that girls are computer scientists, can be coders and can make a difference in this world.”

Lindsay Blocker, 15, is a student at Eleanor Roosevelt High School and takes computer science and tech classes where she’s one of few girls. “Oh, it’s intimidating, because all the guys are friends with each other,” she said, but added that she’s made friends among the boys in the class, and the girls — she’s one of three in the class — work closely with each other as well.

Blocker also said any of the guys who might have underestimated her before, don’t now. “Once you start helping people next to you, they kind of understand that you know what you’re doing, too.”

Nicole, a senior at the same high school, is excited by the climate that encourages girls to get into tech. Her advice to underclassmen, who might feel hesitant: “Continue making friends. Girls — we’re all in the same situation, so just help each other out. No one’s going to bite.”

Lastly, she added, “If you believe in yourself, you can do anything!”


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Candidates for Virginia governor weigh in on health care

The major party candidates in Virginia’s closely watched race for governor are both promising to improve the state’s health care system.

But Republican Ed Gillespie and Democrat Ralph Northam differ sharply on how to curb costs and increase care.

Their biggest difference is on Medicaid expansion. Northam wants to expand the health care program for the poor to cover more low-income Virginians, with the federal government picking up most of the cost. Gillespie opposes Medicaid expansion, saying its long-term price tag will be unsustainable.

Northam, a pediatric neurologist, has made health care a major plank of his campaign and been critical of President Donald Trump’s efforts to overhaul the country’s health care system. Gillespie has largely avoided taking positions on specific federal GOP proposals but supports repealing the Affordable Care Act.

Also running is Libertarian Cliff Hyra, an intellectual property attorney who favors less government intervention in the health care system.

___

THE ISSUE:

The next governor will have to navigate a shifting and uncertain health care market. Trump and top Republicans have not fulfilled campaign promises to repeal former President Barack Obama’s health care law, but Trump has taken steps on his own to reshape the health care market. He jolted health insurers earlier this month with an abrupt cutoff of subsidies that reduce costs for low- and middle-income earners.

Federal action or inaction causes significant ripples at the state level. State officials had to scramble earlier this year to recruit a health insurer to sell individual plans in several Virginia counties. And Gov. Terry McAuliffe wrote to the state’s congressional delegation Wednesday saying Virginia won’t have enough money to provide government-funded health care to thousands of children and pregnant women by early next year if Congress doesn’t reauthorize the Children’s Health Insurance Program.

There’s been little movement in a multi-year debate over expanding Medicaid to able-bodied low income Virginians, with most Republicans in the GOP-controlled General Assembly opposing expansion. McAuliffe, who is barred from seeking a consecutive term, has promised to put Medicaid expansion into his planned budget proposal next year before leaving office and has predicted that Republicans will pass it to avoid having to make major cuts in public education.

Other key state-level health care issues include mental health and addiction treatment, abortion regulations and whether to scrap or severely limit the state’s Certificate of Public Need law. The law regulates medical facilities’ construction plans which supporters say avoids unnecessary duplication of services. Opponents say the regulations needlessly stifle competition and limit choices.

___

WHERE THE CANDIDATES STAND:

Northam said it is “immoral” that Virginia has not yet expanded Medicaid and said he would make it a top priority of his administration. Northam said he would work to persuade Republican state leaders to switch positions.

“It’s time to put the excuses aside and take the politics out of it,” Northam said.

Republican legislators have consistently opposed Medicaid expansion and shown no sign of change.

Gillespie opposes it too, calling it a costly burden for the state. He’s said his goal as governor would be a more robust free market in the state’s health care system, which would include allowing Virginians to buy out-of-state health care plans. Gillespie wants to see Virginia enter into a compact with surrounding states to sell insurance plans across state lines.

“Bringing down costs through more competition in the insurer and provider market would make health care more affordable and more accessible to more Virginians,” Gillespie said.

Experts say there’s no guarantee that selling insurance across state lines would trigger competition that brings down premiums, partly because health insurance reflects local medical costs that vary widely around the country.

Northam and Gillespie clash on abortion issues. Northam is a strong abortion-rights advocate and said he would expand access to contraception. Gillespie opposes abortion and said he would work to stop state funding for Planned Parenthood.

Both candidates have plans to improve the state’s mental health care system and move Virginia’s response to addictions away from criminal prosecution toward more treatment options.

Gillespie and Northam both say they’re open to reforming the Certificate of Public Need law, while also voicing support for hospitals’ positions that the law not be gutted or scraped entirely.

Hyra, the Libertarian, opposes Medicaid expansion and says he favors a repeal of Certificate of Public Need regulations.

Among Democrats running for governor, single-payer health care gains support – TwinCities.com

In the midst of the divide and confusion over health insurance’s future, Minnesota Democrats who would be governor are near united in their prescriptions: Universal and single-payer is the way forward.

In a recent debate before a union-member crowd, the half-dozen Democratic-Farmer-Labor candidates gave nods to supporting universal health care, meaning everyone would be covered by health insurance. Four of the six proudly said they supported a single-payer health care model, meaning a publicly financed system. Last week, Democrat Rebecca Otto, the state’s auditor, came out with a lengthy Minnesota-based plan to finance health care.

The leading Democrats to replace DFL Gov. Mark Dayton would give the state a radically different debate than it has ever had on health insurance. The politics of health care have changed dramatically since 2010, when Minnesota had its last gubernatorial election with no incumbent.


RELATED: Who is running to be Minnesota’s next governor?


Since then, the country and state have grappled with the rocky rollout of the ACA, known as Obamacare, seen health insurance costs leap and the number of uninsured decrease. Now, in Washington, D.C., with a new president and Republican-controlled Congress, the debate is how and whether the GOP can repeal the federal health care law. So far, the repeal attempts have failed.

Dayton has long said he supports single-payer health care but on a national level and only this year came out with a public option to allow all Minnesotans to buy into a state system. The Republican Legislature rejected Dayton’s proposal.

If a Democrat wins the 2018 election, he or she may struggle with similar political realities. Earlier this year, deep blue California tabled a measure to bring single-payer health care to that state.

REPUBLICANS WAGING DIFFERENT FIGHT

Minnesota Republicans are having a debate of their own on their equally crowded side of the governor’s race. Among Republicans, the theme is getting distance from MNsure, the health exchange created after the federal government rolled out the Affordable Care Act.

In a flare-up among Republicans last month, former party chair-turned-candidate Keith Downey accused fellow candidate Matt Dean of not working hard enough to rescind MNsure at the Capitol. Dean, a state representative from Dellwood, hit back that he has “devoted my legislative priorities to killing” MNsure and called Downey’s attacks “embarrassing and tragic.”

The GOP Legislature earlier this year approved millions in state spending to subsidize those with skyrocketing increases in their health insurance costs and to fund a multimillion dollar reinsurance plan to keep costs down.

Meanwhile, through executive actions, President Donald Trump has opened the health insurance market to plans that do not meet Obamacare standards and ended certain federal subsidies for health insurance. Minnesota is suing over the latter.

“ObamaCare is a broken mess,” the president said on Twitter. “Piece by piece we will now begin the process of giving America the great HealthCare it deserves.”

National and state Republicans have dismissed Democratic support for single-payer health care as a doomed, budget-busting, big-government takeover of patients’ most crucial rights.

GROWING SINGLE-PAYER SUPPORT

For most Democrats running for governor, however, fighting to keep and improve Obamacare is not enough. That’s a reflection of the growing support for government-paid health care.

“A majority of Americans say it is the federal government’s responsibility to make sure all Americans have health care coverage. And a growing share now supports a ‘single-payer’ approach to health insurance,” a Pew Research survey found this summer.

5d4f6_ft_17-06-23_healthcare_310px Among Democrats running for governor, single-payer health care gains support - TwinCities.com
Survey results from the Pew Research Center, June 23, 2017 (Courtesy Pew Research Center)

More than half of Democrats in the national survey said they supported health care coverage through “a single national government program.” That support is likely stronger among the Minnesota DFL activists who will winnow the gubernatorial field before next November.

The idea of single-payer health care is not new. More than 40 years ago, a health care prognosticator predicted in the Atlantic Magazine that “national health care,” presumably financed by the federal government, was just a few years away.

But it is getting new life.

“I’d argue on health care, we’ve exhausted every other alternative,” said longtime state Sen. John Marty, DFL-Roseville. Marty, who has run for governor twice, has long pushed for a universal, Minnesota-based health-coverage system. He has introduced measures in the Legislature to make it happen and written a book about what he calls the “Minnesota Health Plan.”

At the DFL candidates forum in Duluth this past week, Otto and state Reps. Erin Murphy and Tina Liebling all said pointedly that they supported single-payer health care.

“I’m a single-payer supporter,” said Rep. Erin Murphy, a nurse who has long represented St. Paul in the Minnesota House. “I don’t want to wait for Congress. I don’t have a lot of faith in Congress.”

State Rep. Paul Thissen, of Minneapolis, said he supported ‘Medicare for all,” a single-payer system being pitched by U.S. Sen. Bernie Sanders, I-VT, and others in Washington.

St. Paul Mayor Chris Coleman said health care should be universal, comprehensive and affordable, and U.S. Rep. Tim Walz of Mankato said he backed “universal access to health care.”

‘A PATH’

Otto, the three-term state auditor now running for governor, has given the most detail on her plan. She proposes to funnel all the current state and federal health care dollars into a single trust fund, bolstered with cash from new taxes, and deliver health care coverage to all Minnesotans.

‘If you are a Minnesota resident, you are covered and that’s it,” she said.

Her proposal would do away with co-pays and deductibles — and much of the role insurance companies play now. Instead, health care providers would be paid quarterly per patient, with incentives to keep people healthy. She said the state would come up with a set of minimum benefits that all residents would receive and businesses or individuals could supplement those if they wished.

The plan still has some blank spaces in it. She said she would work with lawmakers and others to figure out how and on whom to raise taxes. Otto acknowledged that the federal funds Minnesota got for health care in the past may not be there in the future and that political realities at the Minnesota Capitol and in Washington, D.C., might make approval of her plan difficult or impossible.

“What I’m creating here is a path,” she said. “Somebody has to talk about this and I am willing to talk about this.”

Among Democrats, she is not alone in that willingness.

California Governor Signs Law To Make Drug Pricing More Transparent

8f2d4_pricing-medications-2-54c6c112690f1fbc6075eb6ffb8c6854c4a5a779-s1100-c15 California Governor Signs Law To Make Drug Pricing More Transparent

The new law will require pharmaceutical companies to notify the state and health insurers if they plan to raise the price of a medication by 16 percent or more over two years.

fotostorm/Getty Images


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The new law will require pharmaceutical companies to notify the state and health insurers if they plan to raise the price of a medication by 16 percent or more over two years.

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California Gov. Jerry Brown defied the drug industry Monday, signing the most comprehensive drug price transparency bill in the nation that will force drug makers to publicly justify big price hikes.

“Californians have a right to know why their medical costs are out of control, especially when pharmaceutical profits are soaring,” Brown says. “This measure is a step at bringing transparency, truth, exposure to a very important part of our lives, that is the cost of prescription drugs.”

Brown says the bill was part of a broader push toward correcting growing economic inequities in the U.S., and called on the pharmaceutical leaders “at the top” to consider doing business in a way that helps those with a lot less.

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“The rich are getting richer. The powerful are getting more powerful,” Brown says. “So this is just another example where the powerful get more power and take more… We’ve got to point to the evils, and there’s a real evil when so many people are suffering so much from rising drug profits.”

The drug lobby fiercely opposed the bill, SB 17, hiring 45 firms to try to defeat it and spending $16.8 million on lobbying against the full range of drug legislation.

The new law is intended to shine light on how drugs are priced, requiring pharmaceutical companies to notify the state and health insurers anytime they plan to raise the price of a medication by 16 percent or more over two years. And, companies will have to provide justification for the increase.

The legislation was supported by a diverse coalition, including labor and consumer groups, hospital groups and even health insurers, who agreed to share some of their own data under the bill. They will have to report what percentage of premium increases are due to drug prices.

“Health coverage premiums directly reflect the cost of providing medical care, and prescription drug prices have become one of the main factors driving up these costs,” says Charles Bacchi, CEO of the California Association of Health Plans. “SB 17 will help us understand why, so we can prepare for and address the unrelenting price increases.”

Drug companies criticized the governor’s move, saying the new law focuses too narrowly on just one part of the drug distribution chain and won’t help consumers afford their medicine.

“It is disappointing that Gov. Brown has decided to sign a bill that is based on misleading rhetoric instead of what’s in the best interest of patients,” says Priscilla VanderVeer, spokesperson for the drug industry association, the Pharmaceutical Research and Manufacturers of America (PhRMA). “There is no evidence that SB 17 will lower drug costs for patients because it does not shed light on the large rebates and discounts insurance companies and pharmacy benefit managers are receiving that are not always being passed on to patients.”

This law is part of a long game toward developing a stronger web of drug laws across the country, says Gerard Anderson, a health policy professor at Johns Hopkins Bloomberg School of Public Health who tracks drug legislation in the states. In that respect, it makes sense to start with the source of the drug prices: the drug makers themselves, he says.

“The manufacturers get most of the money — probably about three quarters or more of the money that you pay for a drug — and they’re the ones that set the price initially,” he says. “So they are not the only piece of the drug supply chain, but they are the key piece to this.”

California’s law will not stand alone, says state Sen. Ed Hernandez (D-West Covina), the bill’s author and an optometrist. “A lot of other states have the same concerns we have, and you’re going to see other states try to emulate what we did.”

Las Vegas Shooting: Nevada Governor Declares ‘Public Health and Medical Emergency’

Nevada Gov. Brian Sandoval on Monday afternoon declared a public health and medical disaster, allowing licensed out-of-state healthcare professionals to immediately assist hospitals after the mass shooting in Las Vegas, which has claimed more than 50 lives and left more than 500 people injured.

“This attack has created a public health and medical emergency in Clark County and the surrounding areas,” states the governor’s executive order directing all Nevada agencies to help the county with resources and protect its welfare.

The order temporarily suspends all necessary statutes and rules to enable licensed healthcare workers employed by a hospital “and in good standing in another state” to practice in Nevada while lending a hand in its disaster response operations.

Las Vegas-area hospitals have been crowded with patients from the deadliest mass shooting in modern U.S. history.

Sunrise Hospital and Medical Center, a level-two trauma center and the closest to the Las Vegas Strip, reported on Monday it had performed about 30 surgeries and treated 180 shooting-victim patients, 14 of whom have died.

“This has been an unprecedented response to an unprecedented tragedy,” Sunrise Hospital CEO Todd P. Sklamberg said in a statement. “Our trauma team and all supporting nursing units, critical care areas and ancillary services are all at work this morning in the aftermath of this tragedy – and most stayed throughout the night – to help the victims and to assist their loved ones.”

Sunrise Hospital and Medical Center was not facing a shortage of workers, but with “all hands on deck since last night,” workers needed a reprieve, said Amy Shogren, spokeswoman for the Nevada Hospital Association, which advocates on its member hospitals’s behalf and helped facilitate the order with the governor’s office.

“We’ve had people contact us from Florida, Ohio, Utah, California, ready to come and help us,” Shogren tells Newsweek, adding that Monday was the first time in recent memory that such an order had been granted in Nevada.

The association, which worked with the state on the order’s language, reached out to its counterpart, the Texas Hospital Association, in light of a similar order suspending statutes and rules that the Texas Governor’s Office issued after Hurricane Harvey. The Texas order was used as the “boilerplate so that we wouldn’t have uphill challenges,” Shogren said.

University Medical Center of Southern Nevada, a level-one trauma center, was “fully staffed” on Monday afternoon, spokeswoman Danita Cohen tells Newsweek in an email.

The governor’s order will remain in effect until terminated, or until the state of emergency is lifted.

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Here’s what needs to be done on health care, says Democratic governor

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864eb_104733185-2ED3-CB-HEALTH-CARE-CO-092617.600x400 Here's what needs to be done on health care, says Democratic governor


The time has come to get Republicans and Democrats, including governors, in the same room to work on a health-care solution, Gov. John Hickenlooper, D-Colo., told CNBC on Tuesday.

Earlier in the day, Republicans decided not to hold a Senate vote on their latest health-care bill this week after it failed to garner enough support for passage.

Hickenlooper, who has been working with Republican Gov. John Kasich of Ohio on a bipartisan plan, said the first step is to determine how to stabilize the private health-care markets.

Republican Sen. Lamar Alexander and Democratic Sen. Patty Murray were working on a short-term solution, but last week they said they failed to reach a bipartisan consensus. However, Hickenlooper said he’s “hopeful” they will continue their work.

“Once we get that, then I think it’s time to roll up our sleeves — Republicans and Democrats,” Hickenlooper said in an interview with “Closing Bell.”

“We have to begin looking at how do we control costs going forward. What’s it look like to really take on health care and the Affordable Care Act?” he added.

And that discussion should include governors, who have to implement the rules and regulations that come out of Washington, he said.

“Let’s get … some governors in there as well and say what can work and what can we really look at,” he said. “We all agree that we want to control this ridiculous medical inflation that we’ve been seeing for the last 30 years, long before the Affordable Care Act.”

Partisanship getting ‘worse and worse’

While there have been reports that Kasich and Hickenlooper were mulling a joint run for the White House in 2020, Hickenlooper told CNBC, “We’re trying to prove that a Republican and Democrat can work together not that they can run together.”

“The name on the ticket would just be too long. It would be impossible,” he joked.

In August, Axios and CNN reported the idea had been discussed. Both men have denied the reports.

However, Hickenlooper did say that “partisanship has gotten worse and worse,” in part because of election attack ads.

“You never see Coke and Pepsi doing attacks to each other, it would depress the product category of soft drinks,” he said. “What we’re doing is depressing the product category of democracy.”

— Reuters contributed to this report.

864eb_104733185-2ED3-CB-HEALTH-CARE-CO-092617.600x400 Here's what needs to be done on health care, says Democratic governor

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Potential Alabama governor candidates tackle health care, economy and more at forum

A trio of potential Alabama gubernatorial candidates made their early cases to a crowd of voters eager to hear the platforms and policies of those who could potentially lead the state starting next year.

Candidates and Tuscaloosa residents gathered at Capitol Park Saturday morning for Alabama Standing for Unity: A Political Forum.

Announced candidates former Alabama Chief Justice Sue Bell Cobb (Democrat) and Mark Johnston (Independent), along with Tuscaloosa Mayor Walt Maddox (Democrat), spoke to residents about their plans for the future of the state.

While Maddox has yet to formally announce his candidacy, he certainly sounded like someone who intends to enter the race.

In a forum moderated by Tamika Alexander, they addressed human rights, health care, the economy, the environment and other issues concerning the state.

Cobb’s platform says “It’s time to focus on what’s critical for Alabama’s future,” emphasizing the following as her biggest priorities: Children and families, quality jobs, roads and bridges, education and lottery, public safety and moral compass.

Johnston told supporters he believes the only way Alabama can change is to “change the system.”

“I’m offering you an opportunity to change the system by putting the first independent in the governor’s office in the history of Alabama,” he said.

Johnston said that as an independent, he will not have a political platform, but will change the role of the governor to one that gets the two parties to collaborate and work for the common good.

“If not now, when are things ever going to change? If not us, who are the ones that are going to do it?” he asked. “I have a vision and a plan for Alabama, to make Alabama the place it could be.”

Maddox followed an opening quote from Winston Churchill with, “An undeniable truth about Alabama is that our state is in crisis.”

He emphasized the importance of education, workforce development and health care, repeating that the state’s politics is broken and that the government is in crisis.

“That is why we’re considering a run for governor,” Maddox said, highlighting his record as mayor of Tuscaloosa in the face of a national recession and a natural disaster (the 2011 tornado).

“Right now, the other party is offering status-quo. The status-quo is no strategy for building a dynamic future,” Maddox said. “If we’re going to solve the crisis that’s in the state government, it’s going to take leadership that understands and demands results. That’s what we’ve been about the last 12 years here in Tuscaloosa.”

Maddox then suggested his announcement to run for governor is imminent, quoting Mark Twain.

“‘The two most important days of your life are the day that you were born and the day you found out why.  The why for me, professionally, has been serving this great city every single day,” Maddox said. “In the near future, I believe the why for me is going to be serving the great state of Alabama.”

On health care, Johnston read the letter he said he recently sent Gov. Kay Ivey, asking for expansion of Medicaid as well as opposition of the Graham-Cassidy health care bill.

“That spells disaster for Alabama’s Medicaid program,” he said.

Maddox also said that on day one, he would sign an executive order to expand Medicaid in the state of Alabama.

“If they’ll let a rural hospital close in the governor’s hometown, just imagine what will happen across the state,” he said.

Cobb agreed, saying that Alabama has “the leanest, meanest Medicaid program in the United States of America.”

“If we lose one more dime on Medicaid, we have lost it all,” she said.

Cobb said that Medicaid is one of her major priorities, with it hitting especially close to home as she’s been “in and out of the hospital with my elderly parents.”

Moderator Alexander moved on to the economy, asking the panel if they would support a living wage as determined by the local government.

“It’s important that as a state we don’t put this on local governments,” Maddox said, suggesting it would “pit one community against another.”

Maddox emphasized strengthening workforce development.

“We’ve got to train a workforce that’s going to meet the jobs of a technology-driven 21st century,” he said, as well as “expand pre-K offoerings to every child who is academically at-risk so we can have an educated workforce.”

Cobb said she wanted to get every legislator in Alabama to see if he or she can live on minimum wage.

“Not one day, week or month could they make it,” she said. “It is that important that they understand.

Cobb then said that as governor, she would go “from one end of the state to the other” to advocate for a lottery, giving Alabamians a chance to vote for it.

Her website says the following about a lottery: “Two-thirds of Alabamians want a lottery. I’ve heard you. I agree. We need it. It’s time for a lottery that will fund early childhood education programs that work, cutting-edge vocational training, and scholarships to ensure that all Alabamians can afford a college or technical education.”

Johnston then said he believes he is the most qualified person to improve Alabama’s economy thanks to his background in small business, where he said that everyone who worked for him received “well above minimum wage.”

Johnston said he also wants to fix what he calls “the most regressive tax system in the United State.”

Cobb was elected the first woman chief justice of the Alabama Supreme Court in 2006. Serving from 2007-11, Cobb was one of the last Democrats elected to statewide office in Alabama. Cobb, 61, grew up in Evergreen and attended the University of Alabama, where she got a bachelor’s in history and then a law degree in 1981.

Johnston has served as Executive Director at Camp McDowell for the past 26 years. Camp McDowell is part of the Episcopal Diocese of Alabama, located in Winston County. Johnston called his current position “the best job in the whole world,” but said he wants to start a movement in the state.

Maddox, who has been mayor since 2005, was re-elected to a fourth-term during an election in March by defeating his challenger Stepfon “Step” Lewis in a landslide. He has been praised for his economic development work and his handling of the aftermath of the deadly 2011 tornadoes that hit the city.

As Deadline Looms For GOP Health Care Push, Colorado Governor Talks Own Bipartisan Plan



MICHEL MARTIN, HOST:

Let’s talk more about the subject we just raised, which happens to be one of this country’s most pressing policy debates. That is, how to provide health care for Americans at a cost they and the country can afford. Now, President Trump and most congressional Republicans have been adamant about overturning the Obama administration’s solution to this problem – the Affordable Care Act or Obamacare.

But the GOP’s latest proposal to do that called Graham-Cassidy has ignited fierce opposition from Democrats, most major health interest groups and even some Republicans. We’re going to hear from someone who supports the GOP approach in a few minutes. But first, we’re going to hear from one of the Democratic opponents – John Hickenlooper. He is the governor of Colorado. Governor Hickenlooper, thank you so much for speaking with us.

JOHN HICKENLOOPER: No. You bet, Michel. Glad to be on.

MARTIN: Now, I understand that there is a wide range of things that you object to in this bill, but if you could summarize your major concerns.

HICKENLOOPER: By shifting the costs, you don’t have the resources and, therefore, you can’t take responsibility. That’s the biggest issue I think that most of us feel. But we also – I think there’s something to be said for process. I think governors who have to implement this – these health care programs, we should be at the table just as kind of providing our – what we’ve experienced.

And then we look at, you know, the – well, if we did Graham-Cassidy, here’s how many – in Colorado, it would be 300,000 people would probably be without coverage. Nationally, it would start out with 15 to 18 million without coverage and eventually get up to – some people say as high as 32 million people would lose coverage. That’s not strengthening our health care system.

MARTIN: But on the process point, I do recognize that last month, you along with Ohio Governor John Kasich, who is a Republican, talked about a bipartisan plan to stabilize the Affordable Care Act. What would that do?

HICKENLOOPER: What we looked at was how to just – we’re just going to focus on the private markets. And we wanted to make sure that we provided some stability. So the CSRs – the cost sharing reductions, which are the incentives that allow more people to be able to afford health insurance, we want to make sure they maintain those at least through 2019.

And then we also wanted to figure out some sort of a reinsurance program that helps states deal with the most expensive medical cases – the people that have severe illnesses and maybe spend four or five, even $6 million a year.

You know, if you’re not careful, that drives up everyone’s rates and then people drop off of insurance. Basically, we’re just looking at that narrow focus of making sure those private markets are stabilized.

MARTIN: Supporters of the Graham-Cassidy bill, the latest GOP plan, argue that one of its strengths is that it will give more power to the states.

HICKENLOOPER: Well, it gives more flexibility. And I embrace that. I mean, that’s – part of that’s got to be the next step. We have states – Massachusetts, Colorado, I think, is a good example, Oregon, Ohio – who really had begun to get our arms around controlling costs.

We agree – every governor, Republic and Democrat, recognize that we’re spending too much money on health care. And we are going to need some flexibility. That being said – and flexibility but with guardrails, right? I want to make sure people recognize that I’m not saying, you know, every state gets to write their own definition of what insurance has to be.

But beyond that, if we have the flexibility to try some of these innovative programs, I think we can begin to control costs.

MARTIN: Do you think a bipartisan compromise is harder now or easier now as a result of what’s been happening?

HICKENLOOPER: No. I think the table is set for some good bipartisan work. I think we’re ready. You know, (laughter) the time – if it’s not time now, when is it going to be time, right? (Laughter).

MARTIN: That’s Colorado Governor John Hickenlooper. Governor, thanks so much for speaking with us.

HICKENLOOPER: Thank you for having me.

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