July 2020 ~ Medical Coding Jobs

Friday 31 July 2020

Don’t Fall for This Video: Hydroxychloroquine Is Not a COVID-19 Cure

04:47

Annapoorna

Millions of people, including the president of the United States, have seen or shared a video in which a doctor falsely claims there is a cure for the coronavirus, and it’s a medley starring hydroxychloroquine.

The video shows several doctors in white coats giving a press conference outside the Supreme Court in Washington, D.C. It persists on social media despite bans from Facebook, Twitter and YouTube, and it was published by Breitbart, a conservative news site.

The July 27 event was organized by Tea Party Patriots, a conservative group backed by Republican donors, and attended by U.S. Rep. Ralph Norman, R-S.C.

In the video, members of a new group called America’s Frontline Doctors touch on several unproven conspiracy theories about the coronavirus pandemic. One of the most inaccurate claims comes from Dr. Stella Immanuel, a Houston primary care physician and minister with a track record of making bizarre medical claims, such as that DNA from space aliens is being used in medical treatments.

“This virus has a cure. It is called hydroxychloroquine, zinc, and Zithromax,” Immanuel said. “I know you people want to talk about a mask. Hello? You don’t need [a] mask. There is a cure.”

As of July 27, nearly 150,000 Americans had died because of the coronavirus. Could those deaths have been prevented by a drug that’s used to treat lupus and arthritis?

No. Immanuel’s statement is wrong on several points.

‘This Virus Has a Cure’

There is no known cure for COVID-19.

According to the Centers for Disease Control and Prevention, there is no specific antiviral treatment for the virus. Supportive care, such as rest, fluids and fever relievers, can assuage symptoms.

“There is currently no licensed medication to cure COVID-19,” according to the World Health Organization.

The Cure Is ‘Hydroxychloroquine, Zinc and Zithromax’

In spite of Immanuel’s anecdotal evidence, hydroxychloroquine alone or in combination with other drugs is not a proven treatment (or cure) for COVID-19.

The Food and Drug Administration has not approved hydroxychloroquine for the prevention or treatment of COVID-19. In mid-June, the FDA revoked its emergency authorization for the use of hydroxychloroquine and the related drug chloroquine in treating hospitalized COVID-19 patients.

“It is no longer reasonable to believe that oral formulations of HCQ and CQ may be effective in treating COVID-19, nor is it reasonable to believe that the known and potential benefits of these products outweigh their known and potential risks,” FDA Chief Scientist Denise M. Hinton wrote.

The WHO and the National Institutes of Health have also stopped their hydroxychloroquine studies. Among the safety issues associated with treating COVID-19 patients with hydroxychloroquine include heart rhythm problems, kidney injuries and liver problems.

While some studies have found that the drug could help alleviate symptoms associated with COVID-19, the research is not conclusive. Few studies have been accepted into peer-reviewed journals. And large, randomized trials — the gold standard for clinical trials — are still needed to confirm the findings of studies conducted since the pandemic began.

In the video, Immanuel cited a 2005 study that found chloroquine — not hydroxychloroquine — was “effective in inhibiting the infection and spread of SARS CoV,” the official name for severe acute respiratory syndrome. But the drug was not tested on humans, the authors wrote that more research was needed to make any conclusions, and SARS is different from COVID-19.

‘You Don’t Need a Mask’

Health officials advise everyone to wear a mask in public.

The reason has to do with how the coronavirus spreads. When an infected person coughs or sneezes, they expel respiratory droplets containing the virus. Those droplets can then land in the mouths or noses of people nearby.

Since some people infected with the coronavirus may exhibit no symptoms, public health officials say everyone should cover their face in public — even if they don’t feel sick.

“The spread of COVID-19 can be reduced when cloth face coverings are used along with other preventive measures, including social distancing, frequent handwashing, and cleaning and disinfecting frequently touched surfaces,” according to the CDC.

Our Ruling

In a viral video, Immanuel said there is a cure for COVID-19, hydroxychloroquine can treat it, and people don’t need to wear masks to prevent the spread of the virus.

All of those claims are inaccurate. There is no known cure for COVID-19, hydroxychloroquine is not a proven treatment, and public health officials advise everyone to wear a face mask in public.

Immanuel’s statement is False.

Don’t Count on Lower Premiums Despite Pandemic-Driven Boon for Insurers

04:46

Annapoorna

When COVID-19 smacked the United States in March and April, health plans feared medical costs could skyrocket, jacking up premiums drastically in 2021, when millions of the newly unemployed might still be out of work.

But something else happened: Non-COVID care collapsed as hospitals emptied beds and shut down operating rooms to prepare for an expected onslaught of patients sickened by the coronavirus, while fear of contracting it kept people away from ERs, doctors’ offices and outpatient clinics. In many regions of the country, the onslaught did not come, and the billions of dollars lost by hospitals and physicians constituted huge savings for health plans, fattening their bottom lines.

But that doesn’t mean consumers will see lower premiums next year.

Numerous insurers across the country have announced plans to hike rates next year, though some have proposed cuts.

Peter Lee, executive director of Covered California, appeared skeptical about premium reductions in the state’s Affordable Care Act exchange, which is likely to announce 2021 health plan rates next week.

“Would we like zero increases? Absolutely. Would we like them negative? Yeah — but not if that means you’re going to increase premiums in a year by 20%,” Lee said in an interview with California Healthline this week. “We’ve been leaning on them to do what we always lean on them to do, and this is to have the lowest possible rates where you won’t be on a rate roller coaster. We want health plans to price right — not to price artificially low or artificially high.”

Covered California provides coverage for about 1.5 million residents who buy their own insurance.

If the insurance exchanges in other states offer any guidance for Covered California, it is in the direction of moderate premium increases for 2021, though there is wide variation.

A KFF analysis last week of proposed 2021 rates in the exchanges of 10 states and the District of Columbia showed a median increase of 2.4%, with changes ranging from a hike of 31.8% by a health plan in New Mexico to a cut of 12% in Maryland. (Kaiser Health News, which produces California Healthline, is an editorially independent program of KFF.)

Among the roughly one-third of filings that stated how much COVID-19 added to premiums, the median was 2%, with estimates ranging from minus 1.2% at a plan in Maine to 8.6% at one in Michigan.

The proposed premiums for ACA marketplace plans do not affect job-based coverage, but they may indicate how the pandemic is affecting premiums generally.

The consensus among industry experts is that COVID-19 has generated little pressure for rate rises, and health plans should err on the side of moderation. But some fear that many insurers will hold onto the reserves they’ve built up, citing the possibility of widespread vaccinations and concerns that the care forgone in 2020 could rebound with a vengeance next year.

“The tendency of health plans, when they are faced with any degree of uncertainty, is to be very conservative and price for the worst-case scenario,” said Michael Johnson, an industry observer and critic who worked as an executive at Blue Shield of California from 2003 to 2015. “Actuaries are less likely to get fired if the plan prices too high than if the plan prices too low. But I think regulators really need to push back hard on that.”

Lee said all 11 insurers participating in the exchange this year will remain in 2021, and no new ones will be added to the mix, though some of the current carriers will extend their coverage geographically. Ninety percent of consumers who buy their own health insurance get subsidies from the federal government or the state to help pay their premiums.

In January, California became the first state to offer subsidies to middle-income people who make too much money to qualify for federal subsidies. The lion’s share of the state subsidies is earmarked for those who earn between 400% and 600% of the federal poverty level, or $51,040 to $76,560 a year for an individual and $104,800 to $157,200 for a family of four.

The rate proposals expected to be unveiled next week will be subject to scrutiny by state regulators before they are finalized. Sign-ups for the plans start Nov. 1 and run through Jan. 31. This year, the average Covered California rate increase statewide was 0.8%, the lowest since the exchange started providing coverage in 2014.

The benefits reaped by health plans so far in the pandemic can be seen in strong second-quarter earnings and reduced spending on care. UnitedHealth Group, the nation’s largest health insurer, announced earlier this month that its net profit in the April-June quarter nearly doubled from the same period a year earlier. Its medical spending plummeted from 83.1% of premium revenue to 70.2% over that period.

Anthem, the parent company of Blue Cross of California, reported Wednesday that its net profit in the second quarter doubled from the same period in 2019, also on the back of plunging medical expenses.

Anthem said it offered one-month premium credits ranging from 10% to 50% to enrollees in individual, employer and group dental policies — including its Blue Cross plans in California.

UnitedHealth said it has provided $1.5 billion worth of financial support to consumers so far, including premium credits and cost-sharing waivers, and expects to pay out $1 billion in rebates.

But UnitedHealth, which does not participate in Covered California, is seeking a rate increase of 13.8% in the New York exchange. Anthem, which covers about 80,000 people in Covered California, is planning rate hikes of 16.6% in Kentucky and 9.9% in Connecticut.

On the other hand, Kaiser Permanente, which covers more than one-third of Covered California enrollees, plans rate cuts in other states, ranging from 1% in Hawaii to 11% in Maryland. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

Lee downplayed the notion of a financial boon for California health plans, saying that, partly because of the use of telehealth, primary care has rebounded and the plans are paying for it. “So we don’t see this as being at this point a bonanza year for health plans,” he said. “Rather, it’s a year in which there are lessons learned for how we can deliver care in a pandemic.”

Still, the health plans are in a far stronger position than they had feared earlier this year.

In March, Covered California released a study showing that COVID-19’s impact on 2021 premiums for individuals and employers could range from an increase of 4% to more than 40%. But less than three months later, projections commissioned by the industry’s national advocacy group, America’s Health Insurance Plans, showed that even in the worst-case scenario of a 60% COVID infection rate — far above where it stands now — the pandemic would increase medical costs in 2020 and 2021 by 6% at most, and could even decrease them.

That moderate effect is largely attributable to what Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation, called “a kind of yin and yang: If you have a lot of COVID, you don’t have a lot of other health care spending.”

Independent of the course the pandemic takes, emergency room and outpatient visits still lag behind pre-COVID levels and will probably continue to do so next year, to the continued benefit of insurers, predicted Glenn Melnick, a professor of health care finance at the University of Southern California’s Sol Price School of Public Policy. That could be good news for consumers, he said, potentially leading to lower premium increases or even reductions next year.

On the other hand, hospitals and doctors have lost money, and the ones whose contracts with health plans are up for renewal will be looking to make up those losses, Melnick said.

“Providers could be asking for 20-25% increases next year,” he said, “and if they’ve got market power, they can make it stick.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Avoiding Care During the Pandemic Could Mean Life or Death

04:46

Annapoorna

These days, Los Angeles acting teacher Deryn Warren balances her pain with her fear. She’s a bladder cancer patient who broke her wrist in November. She still needs physical therapy for her wrist, and she’s months late for a cancer follow-up.

But Warren won’t go near a hospital, even though she says her wrist hurts every day.

“If I go back to the hospital, I’ll get COVID. Hospitals are full of COVID people,” says Warren, a former film director and author of the book “How to Make Your Audience Fall in Love With You.”

“Doctors say, ‘Come back for therapy,’ and my answer is, ‘No, thank you.’”

Many, many patients like Warren are shunning hospitals and clinics. The coronavirus has so diminished trust in the U.S. medical system that even people with obstructed bowels, chest pain and stroke symptoms are ignoring danger signs and staying out of the emergency room, with potentially mortal consequences.

A study by the Centers for Disease Control and Prevention found that emergency room visits nationwide fell 42% in April, from a mean of 2.1 million a week to 1.2 million, compared with the same period in 2019.

A Harris poll on behalf of the American Heart Association found roughly 1 in 4 adults experiencing a heart attack or stroke would rather stay at home than risk getting infected with the coronavirus at the hospital. These concerns are higher in Black (33%) and Hispanic (41%) populations, said Dr. Mitchell Elkind, president of the American Heart Association and a professor of neurology and epidemiology at Columbia University.

Perhaps even more worrisome is the drastic falloff of routine screening, especially in regions hit hard by the virus. Models created by the medical research company IQVIA predict delayed diagnoses of an estimated 36,000 breast cancers and 19,000 colorectal cancers due to COVID-19’s scrambling of medical care.

At Hoag Memorial Hospital Presbyterian in Newport Beach, California, mammograms have dropped as much as 90% during the pandemic. “When you see only 10% of possible patients, you’re not going to spot that woman with early-stage breast cancer who needs a follow-up biopsy,” said Dr. Burton Eisenberg, executive medical director of the Hoag Family Cancer Institute.

Before the epidemic, Eisenberg saw five melanoma patients a week. He hasn’t seen any in the past month. “There’s going to be a lag time before we see the results of all this missed care,” he said. “In two or three years, we’re going to see a spike in breast cancer in Orange County, and we’ll know why,” he said.

Dr. Farzad Mostashari, former national coordinator for health information technology at the U.S. Department of Health and Human Services, agreed. “There will be consequences for deferring chronic disease management,” he said.

“Patients with untreated high blood pressure, heart and lung and kidney diseases are all likely to experience a slow deterioration. Missed mammograms, people keeping up with blood pressure control — there’s no question this will all cause problems.”

In addition to fear? Changes in the health care system have prevented some from getting needed care.

Many medical offices have remained closed during the pandemic, delaying timely patient testing and treatment. Other sick patients lost their company-sponsored health insurance during virus-related job layoffs and are reluctant to seek care, according to a study by the Urban Institute.

A study by the American Cancer Society’s Cancer Action Network found that 79% of cancer patients in treatment had experienced delays in care, including 17% who saw delays in chemotherapy or radiation therapy.

“Many screening facilities were shuttered, while people were afraid to go to the ones that were open for fear of contracting COVID,” said Dr. William Cance, chief medical and scientific officer for the American Cancer Society.

And then there are patients who have fallen through the cracks because of the medical system’s fixation on COVID-19.

Dimitri Timm, a 43-year-old loan officer from Watsonville, California, began feeling stomach pain in mid-June. He called his doctor, who suspected the coronavirus and directed Timm to an urgent care facility that handled suspected COVID patients.

But that office was closed for the day. When he was finally examined the following afternoon, Timm learned his appendix had burst. “If my burst appendix had become septic, I could have died,” he said.

The degree to which non-COVID patients are falling through the cracks may vary by region. Doctors in Northern California, whose hospitals haven’t yet seen an overwhelming surge of COVID-19 cases, have continued to see other patients, said Dr. Robert Harrington, chairman of the Stanford University Department of Medicine and outgoing president of the American Heart Association. Non-COVID issues were more likely to have been missed in, say, New York during the April wave, he said.

The American College of Cardiology and American Heart Association have launched campaigns to get patients to seek urgent care and continue routine appointments.

The impact of delayed care might be felt this winter if a renewed crush of COVID-19 cases collides with flu season, overwhelming the system in what CDC Director Robert Redfield has predicted will be “one of the most difficult times that we’ve experienced in American public health.”

The health care system’s ability to handle it all is “going to be tested,” said Anthony Wright, executive director of Health Access California, an advocacy group.

But some patients who stay at home may actually be avoiding doctors because they don’t need care. Yale University cardiologist and researcher Dr. Harlan Krumholz believes the pandemic could be reducing stress for some heart patients, thus reducing heart attacks and strokes.

“After the nation shut down, the air was cleaner, the roads were less trafficked. And so, paradoxically, people say they were experiencing less stress in the pandemic, not more,” said Krumholz, who wrote an April op-ed in The New York Times headlined “Where Have All the Heart Attacks Gone?” “While sheltering in place, they were eating healthier, changing lifestyles and bad behaviors,” he said.

At least some medical experts agree.

“The shutdown may have provided a sabbatical for our bad habits,” said Dr. Jeremy Faust, a physician in the division of health policy and public health at Boston’s Brigham and Women’s Hospital. “We’re making so many changes to our lives, and that includes heart patients. If you go to a restaurant three times a week or more, do you realize how much butter you’re eating?”

While some patients may be benefiting from a COVID-19 change of regimen, many people have urgent and undeniable medical needs. And some are pressing through their fear of the virus to seek care, after balancing the risks and benefits.

In March, when the virus took hold, Kate Stuhr-Mack was undergoing a clinical trial at Hoag for her stage 4 ovarian cancer, which had recurred after a nine-month relapse.

Members of her online support group considered staying away from the facility, afraid of contracting the virus. But Stuhr-Mack, 69, a child psychologist, had no choice: To stay in the trial, she had to keep her regular outpatient chemotherapy appointments.

“We all make choices, so you have to be philosophical,” she said. “And I thought it was far more risky not to get my cancer treatment than face the off-chance I’d contract COVID on some elevator.”

Thursday 30 July 2020

KHN’s ‘What The Health?’: Republicans in COVID Disarray

16:36

Annapoorna

Can’t see the audio player? Click here to listen on SoundCloud.

President Donald Trump’s pivot to a more serious view of the coronavirus pandemic didn’t last long. This week, he was again touting hydroxychloroquine, an antimalarial drug that has not been shown to work against the virus. Meanwhile, on Capitol Hill, Republicans continue to struggle to come up with a proposal for the next round of COVID-19 relief even as earlier bills expire. That’s leaving millions of Americans without the ability to pay rent or meet other necessary expenses, as the economy continues to sink.

Also on the agenda, at least briefly, is the subject of high drug prices. Once considered a leading health issue for the 2020 elections, it has been all but wiped from the headlines by the pandemic. Trump issued a series of executive orders he said would produce an immediate impact, but experts point out they are mostly wish lists of things the president has already said he supports.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Mary Ellen McIntire of CQ Roll Call and Anna Edney of Bloomberg News.

Among the takeaways from this week’s podcast:

Despite much disarray on Capitol Hill about which coronavirus relief economic provisions Republican senators will agree on, there is largely agreement within the party and among Democrats on the health provisions, such as the need for more money for testing and for health care providers.

Senate Majority Leader Mitch McConnell insists the stimulus package must include liability protection for employers to protect businesses struck by a COVID-19 outbreak through no fault of their own. But Democrats are opposed and argue that the promise of liability waivers may keep employers from taking adequate safety precautions.

The Atlantic magazine recently explored the issue of “hygiene theater” in which people take measures they hope will keep the coronavirus at bay — such as excessive scrubbing, temperature checks, etc. — that science suggests have limited or no effect. These measures may give people comfort, but the efforts can also be dangerous in that they give a false sense of security and divert attention and resources from other, more complicated methods to stop the disease.

Much attention in recent weeks has been given to the development of a vaccine. Several options are in advanced stages of testing. But public health advocates fear that the speed of the testing and the administration’s past erroneous statements about the disease may raise fears among consumers about taking the vaccine. Nonetheless, Democrats looking ahead to the election worry that the administration will make a major announcement about vaccine availability as an October surprise.

COVID-19 has basically eclipsed efforts to make progress on several other key health issues that were expected before the election, including drug pricing and surprise medical bills.

With great fanfare this week, Trump announced orders for the administration to move toward new drug pricing policies. But the orders have little or no effect and haven’t created any momentum for advancing legislation in Congress.

The president surprised many people this week when he announced he was loaning Kodak millions of dollars to produce ingredients needed for the generic drug industry. Many of those chemicals have been made overseas, so the effort does follow the administration’s quest to establish more manufacturing in the U.S. But one reason few companies do the work here is that there is not a big profit margin on the drugs.

Also this week, Rovner interviews KHN’s Markian Hawryluk, who reported the July NPR-KHN “Bill of the Month” installment, about a surprise bill from a surprise participant in the operating room: a surgical assistant. If you have an outrageous medical bill you would like to share with us, you can do that here.

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

Julie Rovner: The New York Times’ “Disability Pride: The High Expectations of a New Generation,” by Joseph Shapiro

Alice Miranda Ollstein: Politico’s “Pelosi Mandates Wearing Masks on the House Floor After Gohmert Case,” by Heather Caygle and Sarah Ferris

Mary Ellen McIntire: The Atlantic’s “Why Can’t We Just Have Class Outside?” by Olga Khazan

Anna Edney: ProPublica’s “How to Understand COVID-19 Numbers,” by Caroline Chen

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher, Google Play, Spotify, or Pocket Casts.

Get the Data: Hollowed-Out Public Health System Faces More Cuts Amid Virus

10:26

Annapoorna

There is no comprehensive data on government public health spending and staffing in the U.S., and KHN and the Associated Press spent months gathering different datasets, each measuring a slightly different concept of “public health,” into a unique repository of public health data at the local, county and state levels.

Now, we’re releasing our public health infrastructure data on Github for journalists, researchers and interested readers to use.

The U.S. public health system has been starved for decades and lacks the resources to confront the worst health crisis in a century. Since 2010, spending for state public health departments has dropped by 16% per capita and spending for local health departments has fallen by 18%, according to a KHN and AP analysis of government spending on public health. At least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a skeletal workforce for what was once viewed as one of the world’s top public health systems.

Read the full story and methodology behind this investigation.

Some datasets track only state public health systems, not agencies that operate at a county, city or regional level. Other data, including some from the U.S. Census Bureau, covers spending on all non-hospital health care. Public health efforts are mixed in with the costs of providing local medical transportation, running community clinics and offering mental health services.

Many states don’t track local health department spending and staffing at all, but we gathered it from several states that had it available in PDF reports, Excel files and online dashboards. We’re making this cleaned and standardized data available so local journalists and others can dig into their public health systems without having to repeat the same data janitorial work.

To download the data and read the full technical methodology, visit our ‘Underfunded and Under Threat’ Github repository.

Namaste Noir: Yoga Co-Op Seeks to Diversify Yoga to Heal Racialized Trauma

04:27

Annapoorna

DENVER — Beverly Grant spent years juggling many roles before yoga helped her restore her balance.

When not doting over her three children, she hosted her public affairs talk radio show, attended community meetings or handed out cups of juice at her roving Mo’ Betta Green MarketPlace farmers market, which has brought local, fresh foods and produce to this city’s food deserts for more than a decade.

Her busy schedule came to an abrupt halt on July 1, 2018, when her youngest son, Reese, 17, was fatally stabbed outside a Denver restaurant. He’d just graduated from high school and was weeks from starting at the University of Northern Colorado.

“It’s literally a shock to your system,” Grant, 58, said of the grief that flooded her. “You feel physical pain and it affects your conscious and unconscious functioning. Your ability to breathe is impaired. Focus and concentration are sporadic at best. You are not the same person that you were before.”

In the midst of debilitating loss, Grant said it was practicing yoga and meditation daily that helped provide some semblance of peace and balance. She had previously done yoga videos at home but didn’t get certified as an instructor until just before her son’s death.

Yoga then continued to be a grounding force when the coronavirus pandemic hit in March. The lockdown orders in Colorado sent her back to long days of isolation at home, where she was the sole caregiver for her special-needs daughter and father. Then, in April, her 84-year-old mother died unexpectedly of natural causes. “I’ve been doing the best that I can with facing my new reality,” said Grant.

Beverly Grant finds peace and balance through yoga and meditation in the midst of painful losses — her son’s murder in 2018, and her mother’s death earlier this year.(Rebecca Stumpf for KHN)

As a Black woman, she believes yoga can help other people of color, who she said disproportionately share the experience of debilitating trauma and grief — exacerbated today by such disparities as who’s most at risk of COVID-19 and the racialized distress from ongoing police brutality such as the killing of George Floyd in Minneapolis.

While the country still needs much work to heal itself, she wants more people of color to try yoga to help their health. She said the ancient practice, which began in India more than 5,000 years ago and has historical ties to ancient Africa, is the perfect platform to help cope with the unique stressors caused by daily microaggressions and discrimination.

“It helps you feel more empowered to deal with many situations that are beyond your control,” said Grant.

She teaches yoga with Satya Yoga Cooperative, a Denver-based group operated by people of color that was launched in June 2019, inspired partly by the Black Lives Matter and #MeToo movements. The co-op’s mission: Offer yoga to members of diverse communities to help them deal with trauma and grief before it shows up in their bodies as mental health conditions, pain and chronic disease.

“When I think about racism, I think about stress and how much stress causes illness in the body,” said Satya founder Lakshmi Nair, who grew up in a Hindu family in Aurora, Colorado. “We believe that yoga is medicine that has the power to heal.”

Satya’s efforts are part of a growing movement to diversify yoga nationwide. From the Black Yoga Teachers Alliance to new Trap Yoga classes that incorporate the popular Southern hip-hop music style to the Yoga Green Book online directory that helps Black yoga-seekers find classes, change appears to be happening. According to National Health Interview Survey data, the percentage of non-Hispanic Black adults who reported practicing yoga jumped from 2.5% in 2002 to 9.3% in 2017.

Nair seeks to plant the seeds for more: The co-op is trying to make classes more accessible and affordable for people of color. It offers many classes on a “pay what you can” model, with $10 suggested donations per session. Satya also hosts two intensive yoga instructor training sessions for people of color per year, with hopes to offer more, in an effort to diversify the pool of yoga providers.

A Unique, Healing Experience

Blacks and Latinos consistently top national health disparities lists, with elevated risks for obesity and chronic conditions such as heart disease, diabetes and some forms of cancer, which has made them more susceptible to contracting and dying of COVID-19. They also face an elevated risk for depression and other mental health conditions.

And a growing body of research asserts that racism and discrimination may be playing a larger factor than previously thought. For example, an Auburn University study published in January concluded that Blacks experience higher levels of stress due to racism, resulting in accelerated aging and premature death. Another study, from the American Heart Association, showed a link between Black people experiencing discrimination and developing increased risk for hypertension.

Yoga is obviously not a panacea for racism, but it has shown positive results in helping people manage stress, and as a complement to therapeutic work on trauma.

Satya co-op member Taliah Abdullah, 48, said stress brought on by a toxic work environment and family problems inspired her to finally attend classes. The effect was so life-changing that she enrolled in Satya’s teacher training.

“I didn’t know I needed this, but it’s really changed my life for the better,” she said. “I feel like now I have the tools and the toolbox that I need to better navigate the world as a woman of color.”

At a Saturday morning class Grant led before the pandemic hit, five Latina and Black women and a lone Black man sat atop colorful yoga mats in a half-circle around Grant with smoke billowing around them from a copal-scented incense stick.

Beverly Grant teaches a yoga class at the Dahlia Campus of the Mental Health Center of Denver in February. She believes yoga can help people of color heal from the psychological and physical dangers of racism.(Rebecca Stumpf for KHN)

Grant spoke in hushed tones during the hourlong session, leading them through cat-cow, downward dog and boat poses. The theme was more spiritual than physical, more relaxing than vigorous, as illustrated by the mantra she used to begin the class: “We are resilient, we are grounded, we are complete. And the spirit of love is in me.”

First-time attendee Ramon Gabrielof-Parish, 42, a Black professor at Naropa University in Boulder, became so relaxed that at one point he began snoring. He said that after an exhausting week he appreciated the serene vibe.

Sarah Naomi Jones, 37, who graduated from Satya’s training, said the co-op provides a safe space to bond, vent and heal — a very different vibe from predominately white yoga spaces where many people of color often feel unwelcome. She said she felt that icy reception when, as a Black yoga newbie, she attended an intensive yoga class mostly filled with white attendees.

“When I walked in, it was kind of like, ‘What are you doing here?’” recalled Jones. “The spiritual component was totally missing. It wasn’t about healing. It felt like everyone was there just to show off how much more stretchier they were than another person.”

Moving Forward in New World

Denver-based Black yogi Tyrone Beverly, 39, said the growth of yoga among people of color is a sign of yearning for more inclusivity in the practice. His nonprofit, Im’Unique, regularly hosts “Breakin’ Bread, Breakin’ Barriers” yoga sessions with a diverse mix of attendees followed by a meal and discussion on topics such as police brutality, racism and mass incarceration.

“We believe that yoga is a great unifier that brings people together,” he said.

Because of the pandemic, Beverly has moved all his events and classes online for the foreseeable future as a safety precaution. Satya took a brief hiatus of in-person classes, Grant said, but now offers some classes outdoors in parks in addition to daily online classes. Grant said that during the pandemic, even online classes could make a difference for individuals.

“That’s the beauty of yoga,” Grant said. “It can be done in a group. It can be done individually. It can be done virtually and, most importantly, it can be done at your own pace.”

Medi-Cal Agency’s New Head Wants to Tackle Disparities and Racism

04:26

Annapoorna

When Will Lightbourne looked at the statistics behind California’s coronavirus cases, the disparities were “blindingly clear”: Blacks and Latinos are dying at higher rates than most other Californians.

As of Monday, Latinos account for 45.6% of coronavirus deaths in a state where they make up 38.9% of the population, according to data collected by the California Department of Public Health. Blacks account for 8.5% of the deaths but make up 6% of the population.

Lightbourne, who led California’s Department of Social Services under Gov. Jerry Brown, describes this pandemic as one that “rips the bandage off” a health care system long riddled with inequity.

So, when Gov. Gavin Newsom asked Lightbourne, 70, to come out of retirement in June to lead the Department of Health Care Services, he said, he couldn’t say no.

“He has committed his whole professional life to public service,” said Mike Herald, director of policy advocacy at the Western Center on Law & Poverty. “He’s not joking when he talks about the importance of these issues and the important role that government plays in addressing societal inequities.”

The Department of Health Care Services oversees the state’s Medicaid program for low-income people, called Medi-Cal, which provides health care to some 12.5 million Californians.

Lightbourne said he sees the job as a chance to refocus Medi-Cal on reducing disparities — improving people’s health not only by providing better access to doctors, but also by linking them with behavioral health programs and using health care dollars to get them into housing.

He said the department also plans to amend contracts with health providers and use routine performance reviews to make sure providers are addressing disparities.

Health care advocates say Lightbourne has a track record of getting things done.

At the Department of Social Services, he persuaded Brown, a known penny pincher, to increase cash assistance to low-income families, restoring cuts lawmakers had made in the Great Recession. And he was instrumental behind the scenes in the repeal of the contentious policy that had prohibited Californians from receiving increased welfare income if they had more children while receiving public assistance, Herald said.

“Will is very purpose-driven and has made substantive changes in every role he has ever had,” said Graham Knaus, executive director of the California State Association of Counties.

Before embarking on state service, Lightbourne served as director of the Santa Clara County Social Services Agency, the Human Services Agency of the City & County of San Francisco and the Santa Cruz County Human Services Agency.

Lightbourne’s local and state experience give him a valuable skill set as state and county officials grapple with providing health care to some of California’s most vulnerable residents during a pandemic, Knaus and other advocates said.

The task won’t be easy. The previous director of the Department of Health Care Services, Brad Gilbert, left the job after less than four months.

Lightbourne talked to California Healthline about why he returned to state government, how the department is responding to COVID-19 and how he hopes to improve access to health care for those who need it. The interview has been edited for length and clarity.

Q: Why did you come out of retirement to take a job that’s difficult under normal circumstances — and even tougher during a pandemic?

Events of the past six months have made it blindingly clear that we’ve got structural inequities that are not just immoral but are, at an existential level, unsurvivable. It’s a pandemic that landed on top of a pandemic of inequalities, opportunity and income that’s been raging since the 1980s. And that pandemic has been enabled by a pandemic of racism that has rotted in our society for generations.

I think we have to use the moment to insist that our publicly financed health care system really partners up with our public health network and with our social safety-net system to address community and population health with a laser focus on reducing disparities.

Q: How has the department responded to COVID-19 to address the most vulnerable Californians?

The growth in telehealth is something that would not have occurred without this experience. There’s work still underway to look at how we can come up with some approaches to reduce the number of people in skilled nursing facilities, where the rate of spread is so much more severe and with really mortal results.

I have the suspicion that we’re never really going to get to a point where we say the effect of COVID is over. The mere fact that so much health care utilization is down now, particularly down in the places where people who start at a disadvantage normally seek care, we’re going to find long-term health consequences into the future, even post-vaccine.

Q: In January, Gov. Newsom outlined a proposal to broaden a Medi-Cal program known as CalAIM that addresses physical and behavioral health needs in patients’ care, and even pays for their housing with health care money. Can your department still move forward with those goals even though there isn’t money in the budget for it?

We may be delayed to some extent. It was never intended initially as a big-bang system change. It was always going to be a degree of iterative development, and that remains true — whether some things have to go a little slower because of money reasons.

Q: You have talked about access to health care and how COVID-19 has really highlighted systemic disparities. In Medi-Cal, lack of access to care has long been a problem, especially in rural areas. So has inadequate care for children. Are those issues you intend to address?

One of the things we need is an adequate network of providers that really covers the medically underserved areas of the state. We need to work effectively with our rural health clinics, as well as our urban Federally Qualified Health Centers to expand access, particularly to the populations that historically haven’t had that access.

In terms of services for children, that’s a big part of that agenda both in physical and behavioral health and also the dental health system. There’s a big focus on how to improve access and preventive services for children.

Q: In the Great Recession, California lawmakers made many deep cuts to safety-net programs, some of which have been restored only recently. The governor proposed a number of health care-related cuts this year that were ultimately rejected by the legislature. How will you ensure that Medi-Cal enrollees won’t see their benefits scaled back in the future?

It’s going to be my job to make the case not to reduce services that poor people rely on. That said, we live in the real world and if we ever have to reduce things, my approach would be to try to say, “How can we reduce things we can readily rebuild rather than destroy things that are foundational?”

Goal No. 1 at this point is to work very closely with our congressional delegation to really encourage the federal government to support the core services and activities so that we can meet the needs of the people of the state.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Missourians to Vote on Medicaid Expansion as Crisis Leaves Millions Without Insurance

04:26

Annapoorna

ST. LOUIS — Haley Organ thought she had everything figured out. After graduating from a small private college just outside Boston, she earned her master’s degree, entered the workforce and eventually landed a corporate job here as a data analyst.

Life seemed to be going as planned until the national retailer that Organ worked for announced furloughs during the coronavirus pandemic. After nine weeks of mandatory leave, the 35-year-old was laid off. The company gave her a severance package and put an expiration date on her health insurance plan.

“I haven’t slept the whole night since about March,” Organ said earlier this summer. “I can’t turn my brain off, just worrying about everything.”

Organ filed for unemployment, adding her claim to more than 40 million others nationwide since the pandemic took hold in mid-March, according to the Department of Labor. That’s about 1 in 4 U.S. workers. As a result of the unemployment crisis, millions of people lost access to their private health insurance plans at a time when they might need it most.

Medicaid, the federal and state health insurance program for people with low incomes or disabilities, could have served as a safety net for Organ if she lived in one of the 38 states that have opted to expand under provisions of the Affordable Care Act. But in Missouri, Republicans who control both the governor’s office and the legislature have said the state cannot afford its share of the cost of expansion and have been adamant foes of the ACA, helping lead a lawsuit now before the U.S. Supreme Court that may nullify the law.

That opposition by state leaders has meant adults like Organ who don’t have dependent children or specific disabilities cannot qualify for Missouri’s Medicaid program — even if their incomes are well below the poverty line.

“This is literally the first time in my life I’ve had to worry about health care coverage,” Organ said. “It’s kind of been a rude awakening for me.”

Voters in Missouri will decide Tuesday whether to expand eligibility for MO HealthNet program (Missouri’s Medicaid program) to provide insurance to more than 230,000 additional people in the state, including many who find themselves newly struggling for health coverage amid a national health crisis. More than 700,000 initial unemployment claims were reported in Missouri from mid-March through the first week of July.

If Medicaid expansion passes in Missouri, coverage for those newly eligible people would begin in 2021. Advocates for the measure say Medicaid expansion would also create jobs, protect hospitals from budget cuts and bring billions of federal taxpayer dollars back to the state.

Missouri is the latest red state to try expanding Medicaid with a ballot measure to circumvent recalcitrant legislatures. Oklahoma approved a measure June 30.

But Missouri’s Republican Gov. Mike Parson, who has said he opposes expanding Medicaid, moved the ballot measure from the general election in November to the primary election on Tuesday. Democrats criticized the shift, noting that fewer voters traditionally turn out for the primary and suggesting it could be easier to defeat in August. The ongoing threat of COVID-19 could also keep some voters away from the polls.

In a statement, Parson said changing the election date will allow the state to prepare for the potential cost of expansion. But an analysis from Washington University in St. Louis suggests that expanding the program could save the state money by lowering the amount it must pay for uncompensated care and bolstering efforts to prevent certain diseases, thereby reducing treatment costs to the state. Under the terms of the Affordable Care Act, the federal government picks up 90% of the coverage costs for newly eligible enrollees, as compared with the 65% it pays for people who qualify under regular Medicaid rules.

Backers of expansion are cautiously optimistic that Missouri voters will approve the measure Tuesday, heartened by Oklahoma’s win last month and positive polling.

For people who qualify for the current Medicaid program, enrollment is open year-round, which means people can apply when needed.

“That’s why we call them safety-net programs,” said Jen Bersdale, executive director of Missouri Health Care for All, a group that has advocated for Medicaid expansion since 2012. “When you get dropped from a job, dropped from insurance, they are there to catch you until you’re back on your feet.”

Amid the pandemic, Medicaid already appears to be helping people newly out of work. In 22 states, Medicaid enrollment increased by an average 5% from February to May, according to Georgetown University Health Policy Institute data. Newer data for May in those same states suggests enrollment growth is accelerating.

Even without expanding the program, Missouri leads the group with an 8.8% increase since February in total Medicaid enrollment. While economic recessions often contribute to increasing Medicaid enrollment, the early spike in Missouri could signify reenrollment of a large number of people, mostly children, who had been dropped from the program two years in a row. A federal rule blocks disenrollment during the pandemic.

Even some Missourians already on Medicaid are worried about the ballot measure not passing. Without expansion of the program, Sally Terranova fears that her 16-year-old son, Colin, will be ineligible for Medicaid when he ages out of the kids’ coverage at age 19. He was diagnosed with Type 1 diabetes in 2016.

Terranova is concerned that her son wouldn’t be able to afford the insulin he needs without insurance. She worries even more when she hears stories about diabetics rationing their insulin.

“It’s bad enough he has this illness hanging over him,” Terranova said. “But he can live a good life and be healthy if he has access to health care.”

That’s one reason Terranova, 39, hopes to land a job with good benefits when she finishes graduate school in a year and half. She has studied social work for the past four years, so she understands the challenges low-income families face.

Terranova had moved from New York to Missouri to give her son a better life. They’ve called St. Louis home for 10 years, but the single mom is contemplating another big move for her son’s health. She’s thinking of going this time to a state that has already expanded the program.

Organ, whose health insurance expired in July, is now one of the lucky ones. She just got a new job and will get new health insurance when she starts next week. Still, she’s hoping the Medicaid measure will pass, as she now appreciates more than ever how much it could mean for others who have lost their jobs and lack coverage amid the COVID-19 pandemic. Instead of heading to a polling place Tuesday, though, Organ is planning to vote by mail.

“I’m trying to do everything I can to keep me and others safe,” Organ said. “But I want to make sure my voice is still heard.”

Wednesday 29 July 2020

Public Health Experts Fear a Hasty FDA Signoff on Vaccine

03:58

Annapoorna

The vaccine trial that Vice President Mike Pence kicked off in Miami on Monday gives the United States the tiniest chance of being ready to vaccinate millions of Americans just before Election Day.

It’s a possibility that fills many public health experts with dread.

Among their concerns: Early evidence that any vaccine works would lead to political pressure from the administration for emergency approval by the Food and Drug Administration. That conflict between science and politics might cause some people to not trust the vaccine and refuse to take it, which would undermine the global campaign to stop the pandemic. Or it could lead to a product that is not fully protective. Confidence in routine childhood vaccinations, already shaken, could decline further.

“The fear is that you wind up doing to a vaccine what [Trump has] already done with [opening] school,” said Dr. Joshua Sharfstein, a former FDA deputy commissioner and a professor at Johns Hopkins University in Baltimore. “Take an important, difficult question and politicize it. That’s what you want to avoid.”

On Monday at 6:45 a.m., the first volunteer in the landmark phase 3 trial for the Moderna Therapeutics vaccine received a shot at a clinic in Savannah, Georgia. Clinicians at 88 other sites, stretching from Miami to Seattle, also administered the experimental shot in a trial that aims to enroll 30,000 people.

Dr. Anthony Fauci, the country’s leading infectious disease expert, told reporters he hoped 15,000 could be vaccinated by the end of the week, although he provided no information about progress toward that goal. All volunteers would receive a second shot 29 days after their first inoculation. (Half will receive a placebo containing saline solution.)

Another vaccine, produced by Pfizer with the German company BioNTech, also entered a large phase 3 U.S. trial this week. It’s being tested independently of the National Institutes of Health, which is partially funding the Moderna trial as well as tests for an Oxford University/AstraZeneca vaccine trial, and others in the future. AstraZeneca has said some doses of its vaccine might be ready as early as September.

Fauci said he expects the Moderna trial to provide an answer about whether that vaccine works by the end of the year — and it’s “conceivable” an answer could come in October. “I doubt that, but we are leaving an open mind that it is a possibility.”

Such a fast pace worries some experts.

“I don’t see how that’s remotely possible unless the thing I most fear happens, a truncated phase 3 trial with just an idea of efficacy, an idea of common side effects, and then it rolls out,” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

Pence downplayed such fears Monday, telling reporters: “There will be no shortcuts. There will be no cutting corners.”

Officials are pressing for an open and transparent process.

Rep. Raja Krishnamoorthi (D-Ill.), chairman of the House Oversight and Reform Subcommittee on Economic and Consumer Policy, is preparing to release a bill requiring the FDA to have an expert panel review any COVID vaccine and issue a recommendation before FDA Commissioner Stephen Hahn makes a decision.

With past vaccines, the FDA has generally relied on such a committee, made up mostly of vaccine experts and appointed by the FDA commissioner. They typically conduct a painstaking examination of all evidence before voting on whether the FDA should approve a vaccine. The commissioner has rarely, if ever, gone against the committee’s decisions.

Hahn undercut confidence in the FDA’s independence earlier in the year, many observers felt, when he issued an Emergency Authorization Use declaration for hydroxychloroquine, a drug used to treat malaria that President Donald Trump and members of his administration have continued to tout, erroneously, as a cure for COVID-19. The FDA later revoked the authorization, which was made without consulting an independent committee.

“FDA’s independence has been threatened, no question, by the hydroxychloroquine issue,” said Dr. Jesse Goodman, a Georgetown University professor who led the FDA’s biologics division and later was chief scientific officer.

The agency must give outside scientists and the public the opportunity to see the data and the FDA’s reasoning before coming to such a decision, he said.

Concerns about political interference arose recently when Trump talked excitedly about a vaccine, and Treasury Secretary Steven Mnuchin confidently told reporters there would be a vaccine by the end of the year for emergency use.

To be sure, it’s unlikely the FDA would be tempted to issue an emergency release without data that showed a vaccine was working and not causing serious side effects.

The massive coronavirus outbreaks in Texas and other hard-hit areas where the Moderna vaccine is being tested should provide an answer, although exactly when is an open question.

In theory, scientists might get a handle on a vaccine’s efficacy before all 30,000 people are enrolled, vaccinated and studied.

In fact, an answer could become clear after only 150 to 160 cases of disease are reported among the trial participants, Fauci said. If roughly two-thirds of those cases occurred in non-vaccinated people, it would show statisticians that the vaccine had above-60% efficacy, he said.

If the vaccine is 80% to 90% effective and the annual rate of infection in the places where it’s being tested is above 4%, scientists could get a signal of efficacy in such a trial with just 50 cases, or in as little as three months, said Ira Longini, a University of Florida biostatistician who designs vaccine trials.

The Moderna vaccine trial would hit that three-month threshold on Oct. 27.

The trial’s fate is partly in the hands of its 30-member Data and Safety Monitoring Board, whose members can see unblinded data about the participants in real time — pinpointing who was vaccinated with the actual vaccine and got sick, for example. The board will alert the NIH and vaccine maker if it sees surprising data — either dangerous side effects or powerful efficacy. Some fear that if the vaccine seems to work in an early review, the FDA would be pressured to stop the trial.

Offit said NIH should not accept anything less than a completed trial of 30,000 people. Fifty cases “is a very small number” to use as evidence for releasing a vaccine that could be administered to tens of millions, he said.

The public might clamor for the release of any vaccine that seemed to work. Moderna said it has already begun producing millions of doses of vaccine “at risk,” banking on the vaccine’s success. The FDA could release those under powers provided when the country declared a public health emergency in March.

With more than half the country deeply mistrustful of Trump, according to recent polls, any federal decision could be resisted and lead to widespread rejection of even a promising vaccine. Sharfstein worries about a “knee-jerk” reaction against the vaccine by Democrats if Trump touts it before the election.

Experts also worry about releasing a vaccine that shows some positive effects but isn’t robustly protective. A slide presented by FDA deputy director Philip Krause at the World Health Organization earlier this month said a weak vaccine could fail to protect the public adequately, leading to a false sense of security in those who’ve received it, while making it harder to test future vaccines.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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