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Monthly Archives: July 2016

Report: VA Spent $20M On Decorative Artwork During Height Of Wait-Time Scandal

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First Edition: July 29, 2016

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Court Decision Leaves Undocumented Immigrants’ Health Care Options In Limbo

Erica Torres is one of the estimated 1.4 million Californians who live without health insurance largely because they are undocumented.

She was hopeful when President Barack Obama expanded deportation-relief programs for undocumented immigrants — a controversial move that would have put government-subsidized health care within her reach.

But last month’s Supreme Court decision suspending Obama’s order has derailed that aspiration, leaving Torres’ future — and her health insurance options — in limbo.

“I haven’t had insurance since my son [now 7] was born,” said the 44-year-old Torres, who lives in the Southern California suburb of Canoga Park. “I thought this was one possibility, that maybe I would qualify for Medi-Cal.”

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For undocumented immigrants, finding affordable health care has been an ongoing battle. They’ve claimed some victories — undocumented children in California, for example, can now enroll in Medi-Cal, the state’s Medicaid program.

But there are few low-cost health care options for adults who are in the country illegally.

The U.S. Supreme Court’s split decision last month, which temporarily blocked Obama’s deportation-relief programs, leaves millions of undocumented immigrants in California and across the nation facing deep uncertainty.

Miranda Dietz, a researcher at the University of California, Berkeley Center for Labor Research and Education who has studied immigrants and health care, said the Supreme Court’s ruling means that fewer undocumented people in California will have access to health insurance, either from Medi-Cal, college enrollment or employer coverage.

Torres immigrated to the United States from Mexico 17 years ago and hoped the Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) would allow her to apply for a work permit and Medi-Cal. (Heidi de Marco/KHN)

Torres immigrated to the United States from Mexico 17 years ago and hoped the Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) would allow her to apply for a work permit and Medi-Cal. (Heidi de Marco/KHN)

Torres, who came to the United States illegally 17 years ago, had set her hopes on one of the deportation-relief programs affected by the Supreme Court decision, known as Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA). The program would grant adults who have lived in the country continuously since 2010 and have a U.S.-born child protection from deportation.

Eligibility for the program would allow this group of undocumented adults to apply for work permits. And in California, they also could apply for Medi-Cal, as long as they met the income criteria.

Because her son was born in the United States, Torres would be eligible to apply for DAPA. She already had gathered the paperwork she thought she’d need.

But last month’s Supreme Court decision let stand a lower court ruling that blocked the program, which had not yet taken effect because of the legal challenges. The ruling means that, at least for now, Torres still can’t apply for Medi-Cal.

“It was disappointing and frustrating,” Torres said. She had been feeling confident that she’d soon have a sense of security, and with it, access to basic preventive care.

The Supreme Court decision also blocked, at least temporarily, Obama’s planned expansion of another program, known as Deferred Action for Childhood Arrivals (DACA), the controversial deportation-relief program for undocumented youth. The expansion would have raised the age limit for inclusion in the program, making it available to a larger group of people, who would have been eligible for Medicaid health coverage

California health advocates note that the Supreme Court’s ruling is temporary and will most likely be retried. Last week, the U.S. Department of Justice filed a petition with the Supreme Court, requesting a rehearing of the case. But if and when that rehearing will take place will likely depend on the result of presidential election.

The original DACA program, which has allowed 700,000 undocumented young people to stay in the U.S. since 2012, is not affected by the Supreme Court ruling. Current participants in that program retain their rights, including access to Medi-Cal for those living in California.

Researchers at UCLA’s Center for Health Policy Research and UC Berkeley’s Labor Center estimate that in California, between 310,000 and 440ꯠ undocumented adults could be eligible for Medi-Cal if the expansion of the two programs ultimately is allowed.

But how many immigrants actually would sign up is hard to determine, the researchers say. As of mid-2014, 154,000 people in California were granted protection under DACA, of which 125,000 were eligible for Medi-Cal. Yet fewer than 11,000 of them actually signed up for it, the UCLA and UC Berkeley research showed.

Torres reads to her U.S. born son Esau Rodriguez, 7, on the stairs of their apartment. DAPA, or Deferred Action for Parents of Americans and Lawful Permanent Residents, would allow undocumented adults like Torres to seek protection from deportation if they lived in the country continuously since 2010 and had a U.S. born child. (Heidi de Marco/CHL)

Torres reads to her U.S.-born son, Esau Rodriguez, 7, on the stairs of their apartment. DAPA, or Deferred Action for Parents of Americans and Lawful Permanent Residents, would allow undocumented adults like Torres to seek protection from deportation if they lived in the country continuously since 2010 and had a U.S.-born child. (Heidi de Marco/KHN)

But those are just estimates, UC Berkeley’s Dietz explained. There is no box that DACA participants can check allowing the California Department of Health Care Services, which runs Medi-Cal, to identify applicants who are part of the deportation-relief program.

“The best estimate we have is from early to mid 2014, and it looks pretty low,” Dietz said.” Some of that is due to people not knowing [about Medi-Cal]. In early 2014, there were a lot of changes going on in the health care system and there was some confusion about eligibility.”

Dietz said it is important to get the word out that the original DACA program still exists. The Supreme Court’s decision is a missed opportunity, said Denisse Rojas, Dietz’ colleague and a beneficiary of the DACA program. Rojas is a medical student and cofounder of Pre-Health Dreamers, an information-sharing network for undocumented students pursuing careers in health care.

“There are great programs and assistance for [undocumented] youth,” she said, “but there is not much for adults, and there is an urgency for adults who are aging, especially those with chronic conditions.”

Rojas added: “Undocumented youth have been labeled as deserving and high achieving, and therefore have different points of access [to health care]. Meanwhile adults — our parents — have been blamed.”

Back in Canoga Park, Torres worries about her health, especially with her family history of diabetes. She only visits a doctor when she’s feeling very ill, she said. Preventive checkups are not a common practice for her.

Her husband, who works at a nursery, has coverage through his job. But they can’t afford the cost of adding her to his health plan. Their son is covered through Medi-Cal.

When she was pregnant, Torres bought health insurance. She had a high-risk pregnancy and figured that she’d receive better prenatal care by paying for her coverage, rather than receiving the free coverage offered through a limited-benefit version of Medi-Cal, which pregnant women may qualify for regardless of their immigration status.

“We were paying $400 a month,” Torres said. “We can’t always afford that.”

Torres volunteers with the Coalition for Humane Immigrant Rights of Los Angeles, an advocacy group, where she learned about access to health care through county-run programs. Some coverage is available to her in Los Angeles by a county-based health care program, but it’s not offered everywhere in the state. It is not available to someone living in nearby Kern County, for example.

She has also considered purchasing a health plan through Covered California, the state insurance exchange. Although the Affordable Care Act bars people living in the country illegally from buying policies on the exchanges, that might change in California.

California officials are asking the federal government for an exemption from that rule. If granted, California would become the first state to allow undocumented immigrants to buy health coverage on the exchange, which has caused controversy with opponents who argue California must address costs and other issues with its current health care system before growing the pool.

While access to the exchange could potentially help some, others like Torres wouldn’t be able to afford it without subsidies, she said.

Torres hopes the Supreme Court will ultimately overturn its decision, allowing her to get Medi-Cal through the DAPA program.

“We won’t give up,” Torres said. “And we can’t lose hope.”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

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30 Percent Of Children’s Readmissions To Hospitals May Be Preventable: Study

One of the key indicators of the quality of a hospital’s care is how frequently its patients are readmitted within a month after being discharged. A study this month examined readmission rates for pediatric patients and found that nearly 30 percent of them may have been preventable.

The study, published online by the journal Pediatrics, reviewed the medical records and conducted interviews with clinicians and parents of 305 children who were readmitted within 30 days to Boston Children’s Hospital between December 2012 and February 2013. It excluded planned readmissions such as those for chemotherapy.

Overall, 6.5 percent of patients were readmitted during the study period.

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The study found that 29Ǒ percent of the pediatric readmissions were potentially preventable. In more than three-quarters of those cases, researchers determined that hospital-related factors played a role. A significantly smaller proportion were related to the patient (39.2 percent), often because of issues that arose after discharge, or the primary care physician (14.5 percent). (Multiple factors played a role in some patients’ readmissions, so the total exceeds 100 percent.)

The most common hospital-related reasons had to do with how patients are assessed, postoperative complications or hospital-acquired conditions.

“One of the things we need to improve upon is engaging families at the time of discharge around how we’re feeling and how they’re feeling about the status of the child at that point in time,” said Dr. Sara Toomey, the study’s lead author, who is the medical director of patient experience at Boston Children’s Hospital and an assistant professor at Harvard Medical School.

Sometimes clinicians and family members may be overly optimistic about a child’s readiness to go home, Toomey said.

When policymakers discuss the importance of reducing hospital readmissions, they typically focus on older patients, who make up a much larger proportion of hospital patients than do pediatric patients. The Medicare program, which provides health benefits for Americans age 65 and older, imposes financial penalties on hospitals whose readmission rates are too high.

The federal Centers for Medicare & Medicaid Services doesn’t penalize hospitals for pediatric readmissions, but a growing number of states are doing so, the study found.

Readmissions will never be completely avoidable, Toomey said. Still, “when you have a child coming home from the hospital, there are things you need to know, and the more active people are in creating a plan and making sure they understand it, the better that will help their children.”

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

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Seniors Who Live Alone Likeliest To Rate Their Health Highly: Study

People over 65 who live alone were more likely to describe their health as excellent or very good than were seniors who live with others, according to a study exploring connections between older Americans’ health status and their living arrangements.

Conversely, older people living with others — whether related or unrelated to them — were significantly less likely to call their health as excellent or very good, researchers reported recently in the Journal of Applied Gerontology.

That may be because when seniors encounter serious health problems and mounting physical difficulties, they often stop living by themselves and choose to live with others for support, they speculated.

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But the researchers said they drew no conclusions about whether keeping a solitary household in old age leads to a longer life.

In fact, living alone wasn’t superior in every way for people over 65, according to the study. Those who share a home with a spouse or partner were less likely to report serious psychological distress than were older people without companions, a finding that meshes with prior research.

“Their physical health was better living alone rather than with a spouse or partner, but the mental health from living alone was worse,” said Judith D. Weissman, the study’s lead author. She is an epidemiologist and research manager in the Department of Medicine at the New York University School of Medicine.

Mental health affects physical health and that’s why older adults’ psychological wellbeing deserves more attention, she said.

“From a policy standpoint, it indicates we may have to provide either emotional or mental support for seniors living alone,” Weissman said.

The study was based on data for 41,603 adults 65 and older collected in six years of federal surveys.  Researchers studied people living alone, with a spouse or partner, with others related or unrelated, or living only with children.

Researchers also discovered the relationship between living arrangements and health differed for men and women.

For instance, older men living alone were less likely to report having two or more chronic health conditions — such as cancer or diabetes — than counterparts in households with spouses or partners. They were also less likely to report their health as fair or poor.

The opposite was true for women on both counts: Those on their own were more likely to report multiple health conditions than the ones with spouses or partners. Yet, they were also more likely to describe their health as excellent or very good.

“This apparent paradox may be difficult to untangle due to the varied life experiences that lead women to live alone,” researchers said.

For example, they said, older women are more likely to be widowed and after becoming widows, they tend to live alone.

KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.

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Viewpoints: Despite Good News, Anthem May Have Worries; Health Care And Partisanship

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Longer Looks: Treating Addiction; An Ex-Con’s Biotech Venture; And Oscar Takes On Patient Choice

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State Highlights: In Mass., Lyme Disease Legislation Highlights Division; In La., Federal Judge Saves Clinic From Eviction

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UPMC Pays $2.5M To Settle Overbilling Charges In Federal Whistleblower Lawsuit

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Alabama Governor Proposes Lottery To Help Fund Medicaid, Other State Services

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