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GOP Bill Could Undercut Some Coverage In Job-Based Insurance

The GOP health care bill could affect some insurance coverage people get through their employers.

The GOP health care bill could affect some insurance coverage people get through their employers.

Would the House Republican health care bill impact insurance provided by employers? And why don’t people without insurance just go to an emergency room for regular care? Here are answers to those and other recent questions from readers.

Will employer-based health care be affected by the new Republican plan?

The American Health Care Act, which recently passed the House, would fundamentally change the individual insurance market, and it could significantly alter coverage for people who get insurance through their employers too.

The bill would allow states to opt out of some of the requirements of the Affordable Care Act, including no longer requiring plans sold on the individual market to cover 10 “essential health benefits,” such as hospitalization, medications and maternity care.

Small businesses (generally companies with 50 or fewer employees) in states that chose to do this would also be affected by the change. Plans offered by large employers have never been required to cover the essential health benefits, so the bill wouldn’t change their obligations. Many of them, however, provide comprehensive coverage that includes many of these benefits.

But here’s where it gets tricky. The ACA, also known as Obamacare, places caps on how much consumers can be required to pay out of pocket in deductibles, copays and coinsurance every year, and the caps apply to most plans, including large employer plans. In 2017, the spending limit is $7,150 for an individual plan and $14,300 for family coverage. Yet, there’s a catch: The spending limits apply only to services covered by the essential health benefits. Insurers could charge people any amount for services deemed nonessential by the states.

Similarly, the ACA prohibits insurers from imposing lifetime or annual dollar limits on services, but only if those services are related to the essential health benefits.

In addition, if any single state weakens its essential health benefits requirements, it could affect large employer plans in every state, analysts say.

What Happens To A Congressman's Health Insurance If Obamacare Goes Down?

That’s because these employers, who often operate in multiple states, are allowed to pick which state’s definition of essential health benefits they want to use in determining what counts toward consumer spending caps and annual and lifetime coverage limits.

“If you eliminate [the federal essential health benefits] requirement, you could see a lot of state variation, and there could be an incentive for companies that are looking to save money to pick a state” with skimpier requirements, says Sarah Lueck, senior policy analyst at the Center on Budget and Policy Priorities.

I keep hearing that nobody in the United States is ever refused medical care — that whether they can afford it or not, a hospital can’t refuse them treatment. If this is the case, why couldn’t an uninsured person simply go to the front desk at the hospital and ask for treatment, which by law can’t be denied, such as, “I’m here for my annual physical, or for a screening colonoscopy?”

If you are having chest pains or you just sliced your hand open while carving a chicken, you can go to nearly any hospital with an emergency department, and, under the federal Emergency Medical Treatment and Active Labor Act, the staff is obligated to conduct a medical exam to see whether you need emergency care. If so, they must try to stabilize your condition, whether or not you have insurance.

The key word here is “emergency.” If you’re due for a colonoscopy to screen for cancer, unless you have symptoms such as severe pain or rectal bleeding, emergency department personnel likely wouldn’t order the exam, says Dr. Jesse Pines, a professor of emergency medicine and health policy at George Washington University in Washington, D.C.

“It’s not the standard of care to do screening tests in the emergency department,” Pines says, noting that in that situation, the appropriate next step would be to refer you to a local gastroenterologist who could perform the exam.

Even though the law requires hospitals to evaluate anyone who comes in the door, being uninsured doesn’t let people off the hook financially. You’re still likely get bills from the hospital and physicians for any care you receive, Pines says.

The Republican [health care] proposal says people who don’t maintain continuous coverage would have to pay extra for their insurance. What does that mean?

Under the bill passed by the House, people who have a break in their health insurance coverage of more than 63 days in a year would be hit with a 30 percent premium surcharge for the year after buying a new plan on the individual market.

In contrast, under the ACA’s “individual mandate,” people are required to have health insurance or pay a fine equal to the greater of 2.5 percent of their income or $695 per adult. They’re allowed a break of no more than two continuous months every year before the penalty kicks in for the months they were without coverage.

The continuous coverage requirement is the Republicans’ preferred strategy to encourage people to get health insurance. But some analysts have questioned how effective it would be. They point out that, whereas the ACA penalizes people for not having insurance on an ongoing basis, the AHCA penalty kicks in only when people try to buy coverage after a break. It could actually discourage people from getting back into the market unless they’re sick.

In addition, the AHCA penalty, which is based on a plan’s premium, would likely have a greater impact on older people, whose premiums can be higher, and on those with lower incomes, says Sara Collins, a vice president at the Commonwealth Fund, who authored an analysis of the impact of the penalties.

Kaiser Health News is an editorially independent news service supported by the nonpartisan Kaiser Family Foundation. Email questions for future columns: KHNHelp@KFF.org. Michelle Andrews is on Twitter: @mandrews110

Article source: http://www.npr.org/sections/health-shots/2017/05/23/529565222/gop-bill-could-undercut-some-coverage-in-job-based-insurance

Medical Research, Health Care Face Deep Cuts In Trump Budget

Budget Director Mick Mulvaney holds up a copy of President Donald Trump’s proposed fiscal 2018 federal budget at the White House on Tuesday.

Andrew Harnik/AP


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Andrew Harnik/AP

Budget Director Mick Mulvaney holds up a copy of President Donald Trump’s proposed fiscal 2018 federal budget at the White House on Tuesday.

Andrew Harnik/AP

The proposed budget unveiled Tuesday by the Trump administration doubles down on major cuts to biomedical research, fighting infectious disease outbreaks, health care for the poor, elderly and disabled, and prevention of HIV/AIDS.

It restates the goals of the “skinny budget” the administration released in March, which was widely condemned by scientists and public health advocates.

Mick Mulvaney, director of the Office of Management and Budget, said Monday that the goal is to cut back on public assistance and instead put people back to work. “We are going to measure compassion and success by the number of people we help get off of those programs and get back in charge of their own lives.”

No one thinks the president’s budget will pass as proposed, since Congress has budget and spending authority. But it does provide a baseline from which negotiations may begin.

“The President is right to take a close look at spending,” says Sen. Chuck Grassley, R-Iowa. But “Congress has the power of the purse strings. I’ve never seen a president’s budget proposal not revised substantially.”

Here’s a rundown of the budget’s medical research and health care proposals.

Medicaid. The budget proposes cutting Medicaid and CHIP, the Children’s Health Insurance Program, by $616 billion over 10 years, with almost half the savings occurring in the last two years.

The joint federal-state program provides health care and support services for 75 million low-income, elderly and disabled people, about half of whom are children. In 2015, federal and state spending on Medicaid was about $545 billion.

The budget mirrors the changes in Medicaid included in the health care overhaul bill passed by the House in earlier this month. Rather than the federal government matching state spending based on beneficiaries’ health care needs, it would give states a fixed amount of money per enrollee, or alternatively offer states a fixed block grant. That would cut the program’s growth over time and reduce services, because health care costs grow faster than the broad economy.

Here Is What's In The House-Approved Health Care Bill

Medicaid benefits for the elderly and disabled. Medicaid pays for services — including personal care, shopping, or cooking for the elderly, or occupational therapy and work support for the disabled — that allow people to continue to live on their own.

Under the law, those services are considered optional. But Medicaid is required by law to pay for nursing home and institutional care.

“We’ll see a return to more people with disabilities and more older adults not having access to services that allow them to remain at home,” says Barbara Beckert, director of the Milwaukee office of Disability Rights Wisconsin. “Instead we may see people forced into institutions, forced into nursing homes.”

Refugee Benefits. The proposed budget makes the argument that the U.S. should reduce the number of refugees it brings into this country because those fleeing persecution in their home countries often end up using public assistance, including 50 percent who were on Medicaid in 2015. “The larger the number the United States admits for domestic resettlement, the fewer people the United States is able to help overall,” the budget document says.

National Institutes of Health. The NIH, which funds research into medical treatments and basic science would be cut almost $6 billion, to about $26 billion. That would include a $575 million cut to the National Heart, Lung and Blood Institute and $838 million cut to the National Institute of Allergy and Infectious Diseases, which is involved in a wide range of diseases include AIDS and Zika. The National Institute of Diabetes Digestive Kidney Diseases would be cut by $355 million.

The proposed cuts drew immediate and harsh criticism.

The cuts would “cripple our nation’s scientific efforts, undermining our economic growth, public health and national security,” Mary Sue Coleman, president of the Association of American Universities, said in a statement. The cuts could “hobble our ability to provide tomorrow’s cures and technologies.”

Centers for Disease Control and Prevention. The administration proposes trimming the CDC, which helps states and other countries fight infectious disease outbreaks, by $1.3 billion — 17 percent. That could include a $186 million cut in programs at the CDC’s center on HIV/AIDs, hepatitis and other sexually transmitted diseases. The CDC’s chronic disease prevention programs, such as diabetes, heart disease, stroke and obesity, would be cut by $222 million.

Trump Administration Proposes Big Cuts In Medical Research

The proposed cut to CDC “would be perilous for the health of the American people,” says John Auerbach, president and CEO of the Trust for America’s Health. “From Ebola to Zika to opioid misuse to diabetes to heart disease, the CDC is on the frontlines keeping Americans healthy.”

Food and Drug Administration. A 31 percent proposed cut, from $2.7 billion to $1.89 billion, would be offset by $1.3 billion in proposed increased fees to be paid by drug and device makers.

The budget shows a basic misunderstanding of how these agencies function, says Ryan Hohman, vice president of public affairs at the group Friends of Cancer Research. “To further suggest that private sector industry make up for such a significant cut to the FDA as proposed by the president shows a lack of knowledge for how user fees can be used and the scope of the FDA’s pivotal role in assuring the safety of the daily lives of Americans.”

The budget doesn’t explicitly address high drug costs, though Trump has frequently inveighed against drug prices, telling Congress in February that it should “work to bring down the artificially high price of drugs and bring them down immediately.”

Planned Parenthood. The family-planning organization has been the target of efforts to cut funding for years because it provides about one-third of the nation’s abortions.

This budget would be the first to bar a specific provider, according to Planned Parenthood. And it would not only bar the organization from Medicaid funding, but from any other Health and Human Services program, including the Title X family planning program, maternal and child health, STD testing and treatment, and Zika prevention.

Trump Signs Law Giving States Option To Deny Funding For Planned Parenthood

“From day one, President Trump has worked to keep his pro-life promises, including stopping taxpayers from being forced to fund abortion and abortion businesses,’ says Marjorie Dannenfelser, president of the anti-abortion group Susan B. Anthony List. “Taxpayers should not have to prop up Planned Parenthood’s failing, abortion-centered business model.”

Planned Parenthood officials said Tuesday that many of their clients don’t have other places to get health care. “We’ve already seen the results of these sorts of policies in Texas, so we know what would happen,” says Kevin Griffis, vice president at Planned Parenthood Federation of America. “The heartbreaking truth is that if this budget were enacted, the results would be catastrophic for countless women and their families — cancers and diseases going undetected, higher maternal mortality and more unintended pregnancies.”

Article source: http://www.npr.org/sections/health-shots/2017/05/23/529654114/medical-research-health-care-face-deep-cuts-in-trump-budget

Taiwanese minister: China is playing politics with health

Taiwan’s health minister on Monday accused China of playing politics with health after Taiwan was blocked from taking part in the annual meeting of the governing body of the World Health Organization for the first time since 2008.

Health and Welfare Minister Chen Shih-chung lashed out at China’s actions, which Beijing said was taken because Taiwan’s year-old government has reneged on the “One China” principle.

“Are we here to discuss politics, or are we here to discuss health?” Chen told supporters and journalists. “I think that all discussion should be based on the right to health, instead of anything political.”

The World Health Assembly accepted the exclusion of Taiwan without a vote at the beginning of its annual session in Geneva Monday. Taiwan isn’t a U.N. member state, but had been granted assembly “observer status” every year since 2009 under an arrangement on the “One China” principle.

On Sunday, Chen’s Chinese counterpart, Li Bin, blamed the governing party of Taiwanese President Tsai Ing-wen for the exclusion of Taiwan this year, insisting its refusal to accept the principle of a single China has torpedoed its hopes to attend.

Chen struck back at that claim.

“Since President Tsai took office, we have not done anything to proactively change the status quo,” he said, expressing “disappointment” about Li’s comments. He added he would not rule out a meeting with Li in Geneva, but that nothing was yet planned.

Chen said Taiwan has “many things to share” in the health arena.

“We have a full-coverage national health care insurance policy, high-quality medical care, powerful epidemic control, and many other successful initiatives,” Chen said. “It is not only that Taiwan needs the WHO, the WHO also needs Taiwan.”

The World Health Assembly, now in its 70th edition, brings together health ministers and other top health officials from its 194 member states. The highlight of this year is expected to be the election Tuesday of a successor for Director-General Dr. Margaret Chan, a native of Hong Kong who has led the agency for a decade.

A statement Monday from the office of U.S. Health and Human Services Secretary Tom Price said he had met with health officials from Taiwan “to discuss mutual efforts in support of global health security” — one of many bilateral meetings he has planned in Geneva.

Before taking office in January, President-elect Donald Trump — now Price’s boss — astonished many by talking directly with President Tsai by phone, the highest level U.S.-Taiwan conversation since Washington switched diplomatic recognition to Beijing in 1979. Trump further stirred the pot by questioning the need to uphold the longtime U.S. “One China” policy.

Trump has since moved to reassure Beijing that he will adhere to that policy.

China has used its clout as one of five veto-wielding members of the U.N. Security Council to exclude Taiwan from the United Nations and other world bodies that require sovereign status for membership.

Article source: http://abcnews.go.com/Health/wireStory/taiwanese-minister-china-playing-politics-health-47558870

Cash-strapped World Health Organization slammed for high travel costs

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ONDON — Dr. Margaret Chan, director-general of the World Health Organization, traveled to Guinea earlier this month to join the country’s president in celebrating the world’s first Ebola vaccine.

After praising health workers in West Africa for their triumph over the lethal virus, Chan spent the night in the presidential suite at the beach-side Palm Camayenne hotel. The suite, equipped with marble bathrooms and a dining room that seats eight, has an advertised price of 900 euros ($1,008) per night.

Some say such luxurious accommodations send the wrong message to the rest of WHO’s 7,000 staffers — and may hurt the cash-strapped health agency’s fundraising efforts to fight diseases worldwide.

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According to internal documents obtained by the Associated Press, the UN health agency routinely has spent about $200 million a year on travel expenses, more than what it doles out to fight some of the biggest problems in public health, including AIDS, tuberculosis and malaria combined.

Last year, WHO spent about $71 million on AIDS and hepatitis. It devoted $61 million to malaria. To slow the spread of tuberculosis, WHO invested $59 million. Still, some health programs do get exceptional funding — the agency spends about $450 million trying to wipe out polio every year.

WHO declined to say if it paid for Chan’s stay at the Palm Camayenne in Conakry, but noted that host countries sometimes pick up her hotel tabs.

At a time when the health agency is pleading for more money to fund its responses to health crises worldwide, it has struggled to get its travel costs under control. Senior officials have complained internally that UN staffers break new rules aimed at curbing its expansive travel costs, booking perks like business class airplane tickets and rooms in five-star hotels with few consequences.

“We don’t trust people to do the right thing when it comes to travel,” Nick Jeffreys, WHO’s director of finance, said during a September 2015 in-house seminar on accountability — a video of which was obtained by the AP.

Despite WHO’s numerous travel regulations, Jeffreys said the agency couldn’t be sure its staffers always booked the cheapest fares or that their travel was even warranted.

Ian Smith, executive director of Chan’s office, said the chair of WHO’s audit committee said the agency often did little to stop misbehavior.

“We, as an organization, sometimes function as if rules are there to be broken and that exceptions are the rule rather than the norm,” Smith said.

Earlier that year, a memorandum was sent to Chan and other top leaders with the subject line “ACTIONS TO CONTAIN TRAVEL COSTS” in capital letters. The memo reported that compliance with rules requiring travel to be booked in advance was “very low.” The document also pointed out that WHO was under pressure from its member countries to save money.

Travel would always be necessary, the memo said, but “as an organization we must demonstrate that we are serious about managing this appropriately.”

In a statement to the AP, the UN health agency said “the nature of WHO’s work often requires WHO staff to travel” and that costs were reduced 14 percent last year compared to the previous year — although the 2015 total was exceptionally high due to the 2014 Ebola outbreak in West Africa.

But staffers still are openly ignoring the rules.

An internal analysis in March, obtained by the AP, found that only two of seven departments at WHO’s Geneva headquarters met their budget targets and concluded that the compliance rate for booking travel in advance was only between 28 and 59 percent.

Since 2013, WHO has paid $803 million for travel. WHO’s approximately $2 billion annual budget is drawn from the taxpayer-funded contributions of its 194 member countries; the United States is the largest contributor.

After he was elected, President Donald Trump tweeted: “The UN has such great potential,” but had become “just a club for people to get together, talk, and have a good time. So sad!”

WHO said Sunday that nearly 60 percent of its travel costs were spent on sending outside experts to affected countries and for national representatives to attend WHO meetings.

During the Ebola disaster in West Africa, WHO’s travel costs spiked to $234 million. Although experts say on-the-ground help was critical, some question whether the agency couldn’t have shaved its costs so more funds went to West Africa. The three countries that bore the brunt of the outbreak couldn’t even afford basics such as protective boots, gloves and soap for endangered medical workers.


Dr. Bruce Aylward, who directed WHO’s outbreak response, racked up nearly $400,000 in travel expenses during the Ebola crisis, sometimes flying by helicopter to visit clinics instead of traveling by jeep over muddy roads, according to trip reports he filed.

Chan spent more than $370,000 in travel that year, as documented in a confidential 25-page analysis of WHO expenses that identified the agency’s top 50 spenders. Aylward and Chan were first and second. WHO declined requests for an interview with Chan; Aylward did not respond to a request for comment.

Three sources who asked not to be identified for fear of losing their jobs told the AP that Chan often flew in first class.

WHO said its travel policy, until February, permitted its chief “to fly first class.” It said Chan now flies business class, at her request.

Devi Sridhar, a global health professor at the University of Edinburgh, described WHO’s travel costs as “extremely high” but said the problems at WHO probably stretched across the whole United Nations.

“People know these UN jobs can be cushy and come with perks, that you get to travel business class and stay at nice hotels,” she said, adding that the lack of scrutiny of UN finances was a problem.

Other international aid agencies, including Doctors Without Borders, explicitly forbid their staff from traveling in business class. Even the charity’s president must fly in economy class. With a staff of about 37,000 aid workers versus WHO’s 7,000 staffers, Doctors Without Borders spends about $43 million on travel a year.

The US Centers for Disease Control and Prevention would not provide its travel costs, but said staffers are not allowed to fly business class unless they have a medical condition. The UN children’s agency UNICEF, which has about 13,000 staffers, said it spent $140 million on global travel in 2016.

“When you spend the kind of money WHO is spending on travel, you have to be able to justify it,” said Dr. Ashish Jha, director of the Global Health Institute at Harvard University. “I can’t think of any justification for ever flying first class.”

Jha warned that WHO’s travel spending could have significant consequences for fundraising. Several weeks ago, WHO asked for about $100 million to save people in Somalia from an ongoing drought. In April, it requested $126 million to stop the humanitarian catastrophe in Yemen.

“If WHO is not being as lean as possible, it’s going to be hard to remain credible when they make their next funding appeal,” Jha said.

— Maria Cheng

Article source: https://www.statnews.com/2017/05/21/who-spends-on-travel/

As GOP Tarries On Health Bill, Funding For Children’s Health Languishes

The federal CHIP program funds health care for almost 9 million children.

Terry Vine/Blend Images/Getty Images


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The federal CHIP program funds health care for almost 9 million children.

Terry Vine/Blend Images/Getty Images

Back in January, Republicans boasted they would deliver a “repeal and replace” bill for the Affordable Care Act to President Donald Trump’s desk by the end of the month.

In the interim, that bravado has faded as their efforts stalled and they found out how complicated undoing a major law can be. With summer just around the corner, and most of official Washington swept up in scandals surrounding Trump, the health overhaul delays are starting to back up the rest of the 2018 agenda.

One of the immediate casualties is the renewal of the Children’s Health Insurance Program. CHIP covers just under 9 million children in low- and moderate-income families, at a cost of about $15 billion a year.

Funding for CHIP does not technically end until Sept. 30, but it is already too late for states to plan their budgets effectively. They needed to know about future funding while their legislatures were still in session, but, according to the National Conference of State Legislatures, the local lawmakers have already adjourned for the year in more than half of the states.

“If [Congress] had wanted to do what states needed with respect to CHIP, it would be done already,” says Joan Alker of the Georgetown Center for Children and Families.

“Certainty and predictability [are] important,” agrees Matt Salo, executive director of the National Association of Medicaid Directors. “If we don’t know that the money is going to be there, we have to start planning to dismantle things early, and that has a real human toll.”

In a March letter urging prompt action, the Medicaid directors noted that while the end of September might seem far off, “as the program nears the end of its congressional funding, states will be required to notify current CHIP beneficiaries of the termination of their coverage. This process may be required to begin as early as July in some states.”

CHIP has long been a bipartisan program. One of its original sponsors is Sen. Orrin Hatch, R-Utah, who chairs the Finance Committee that oversees it. It was created in 1997, and last reauthorized in 2015, for two years. But a Finance hearing that was intended to launch the effort to renew the program was abruptly canceled this month, amid suggestions that Republicans might want to hold the program’s renewal hostage to force Democrats and moderate Republicans to make concessions on the bill to replace the Affordable Care Act.

“It’s a very difficult time with respect to children’s coverage,” says Alker. Not only is the future of CHIP in doubt, but also the House-passed health bill would make major cuts to the Medicaid program, and many states have chosen to roll CHIP into the Medicaid program.”

“We’ve just achieved a historic level in coverage of kids,” she says, referring to a new report finding that more than 93 percent of eligible U.S. children now have health insurance under CHIP. “Now all three legs of that coverage stool — CHIP, Medicaid and ACA — are up for grabs.”

But it’s not just CHIP at risk due to the congested congressional calendar. Congress also can’t do the tax bill Republicans badly want until lawmakers wrap up the health bill.

5 Things To Watch As GOP Health Bill Moves To The Senate

That is because Republicans want to use the same budget procedure, called reconciliation, for both bills. That procedure forbids a filibuster in the Senate and allows passage with a simple majority.

There’s a catch, though. The health bill’s reconciliation instructions were part of the fiscal 2017 budget resolution, which Congress passed in January. Lawmakers would need to adopt a fiscal 2018 budget resolution in order to use the same fast-track procedures for their tax changes.

And they cannot do both at the same time. “Once Congress adopts a new budget resolution for fiscal year 2018,” says Ed Lorenzen, a budget-process expert at the Committee for a Responsible Federal Budget, that new resolution “supplants the fiscal year 2017 resolution and the reconciliation instructions in the fiscal year 2017 budget are moot.”

Fact-Checking Republicans' Defense Of The GOP Health Bill

That would mean that if Congress wanted to continue with the health bill, it would need 60 votes in the Senate, not a simple majority.

There is, however, a loophole of sorts. Congress “can start the next budget resolution before they finish health care,” said Lorenzen. “They just can’t finish the new budget resolution until they finish health care.”

So the House and Senate could each pass its own separate budget blueprint, and even meet to come to a consensus on its final product. But they cannot take the last step of the process — with each approving a conference report or identical resolutions — until the health bill is done or given up for dead. They could also start work on a tax plan, although, again, they could not take the bill to the floor of the Senate until they finish health care and the new budget resolution.

At least that’s what most budget experts and lawmakers assume. “There’s no precedent to go on,” said Lorenzen, because no budget reconciliation bill has taken Congress this far into a fiscal year. “So nobody really knows.”

Kaiser Health News is an editorially independent part of the Kaiser Family Foundation.

Article source: http://www.npr.org/sections/health-shots/2017/05/22/529144353/as-gop-tarries-on-health-bill-funding-for-childrens-health-languishes

Health Dept. history, role: It might surprise you

 

The Mississippi State Department of Health traces its origins to 1877, with the creation of the state Board of Health to protect and advance health care in Mississippi, although a few cities and counties had created their own health departments.

Dr. Alton Cobb began working for the agency in 1957 as county health officer in Sunflower County and served as the department’s director from 1973-1993. Cobb said much of the agency’s work in early years was educational.

“In 1910, the Rockefeller Foundation provided some funding, and they provided education such as about how people could prevent getting hookworms,” Cobb said. “It was important for people to learn about disease transmission, to protect themselves.”

 

In 1912 a state sanitary inspector position was created and the Bureau of Vital Statistics was established. In 1922, a state epidemiologist was hired and two years later Dr. Felix J. Underwood became the first full-time executive officer of the Board of Health. In 1938, the first health department building was built in Pike County.

The agency has evolved over more than a century, but for much of that time has been a health care backstop — or at times a bulwark — in a state that lacks access to care and has high rates of poverty and chronic illnesses and disease.

The Hospital Reconstruction Act of 1946 provided federal money, and the state Board of Health used the money to build new county health departments and clinics and hire nurses, improving access and quality of care for much of the state. Local clinics and public health nurses battled things such as a widespread Mississippi polio outbreak in the early 1950s and high rates of tuberculosis and syphilis.

Cobb said the department also led implementation of pediatric and maternity care and immunizations. By 1954, there was a county health department in all 82 counties and at least one full-time public health nurse in each. In 1958, the Board of Health accepted responsibility for oversight of mental health services. The following year, a modern Board of Health building was constructed to house the Health Department.

In the early 1960s, 46 branch Health Department clinics were built in 29 counties, improving access to basic care in rural Mississippi and drastically reducing morbidity from tuberculosis, typhoid fever, diphtheria, smallpox, malaria and other infectious diseases that had been the leading causes of death.

In 1962, the Division of Chronic Disease was created, under Cobb’s direction, marking a shift in the public health mission to battle heart disease, diabetes and other illnesses. Public health also began to license and regulate nursing homes and focus on children’s health and development and maternal health and infant mortality.

The 1970s saw dramatic increases in teen pregnancy and sexually transmitted diseases. The Board of Health established family planning services, expanded maternity care and disease screening and began the federal Women Infants and Children Program. In 1973, the Board of Health reorganized into multi-county districts. In 1974, the state created the Department of Mental Health, transferring many duties from the Board of Health. 

In 1982, the Legislature renamed the public health agency the Mississippi State Department of Health, and passed an act requiring permits for food-handling establishments.

In 1990, public health workers successfully thwarted a Pike County outbreak of meningitis. In 1991, the Legislature passed an act for the department to implement a statewide trauma care system.

Due to state budget cuts and changes in health care access, the department is considering a major overhaul. Some service areas the department currently has:

Disease surveillance

  • Tracking and outbreak management
  • Laboratory testing for West Nile, flu, syphilis, TB, HIV and other diseases and prevention programs for communicable diseases
  • Statewide coordination of immunizations and vaccinations

Environmental protection

  • Drinking water testing
  • Restaurant permits and inspections
  • On-site wastewater and sewage system regulation

Disease and injury prevention

  • Tobacco control and cessation programs
  • Nutritional training and information
  • Chronic disease prevention and management
  • Safe biking and walking in communities
  • Car seat safety and installation
  • Fire safety

Standards of care

  • Child care facility licensing and regulation
  • Licensing and regulation of nursing homes, assisted living, hospitals and other health facilities and for audiologists, occupational therapists, speech pathologists, dietitians and others
  • Trauma care regulation
  • Immunizations
  • Required and recommended childhood immunizations
  • Meningococcal and HPV vaccinations for adolescents
  • Seasonal flu vaccinations for all ages and vaccinations for international travel

Emergency services

  • Preparing the public for disasters and public health emergencies
  • Severe weather/disaster response and training

Information services.

  • Providing health information to the media and public
  • Emergency notifications for doctors, hospitals and others in health care
  • Community training and outreach

Reproductive health

  • Educational information and counseling
  • Physical exams and contraceptive supplies
  • STD testing
  • Pregnancy care

Women, infants and children

  • Monthly supplemental food packages
  • Nutritional education classes
  • Breastfeeding support
  • Health care referrals

Licenses and records

  • Birth and marriage certificates
  • On-site wastewater permits
  • Applications for food service facilities and childcare providers

Social services

  • Education, advocacy and consultation and coordination of patients with community resources
  • Supervision and monitoring of medical treatments
  • Special care for children with chronic or disabling conditions.

Contact Geoff Pender at 601-961-7266 or gpender@gannett.com. Follow him on Twitter.

 

 

 

 

Article source: http://www.clarionledger.com/story/news/politics/2017/05/21/health-dept-history-role-might-surprise-you/333169001/

Cash-strapped World Health Organization spends big on travel

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ONDON — The World Health Organization routinely spends about $200 million a year on travel — far more than what it doles out to fight some of the biggest problems in public health including AIDS, tuberculosis or malaria, according to internal documents obtained by The Associated Press.

As the cash-strapped U.N. health agency pleads for more money to fund its responses to health crises worldwide, it has also been struggling to get its own travel costs under control. Despite introducing new rules to try to curb its expansive travel budget, senior officials have complained internally that U.N. staffers are breaking the rules by booking perks like business class airplane tickets and rooms in five-star hotels.

Last year, WHO spent about $71 million on AIDS and hepatitis. On malaria, it spent $61 million. And to slow tuberculosis, WHO invested $59 million. Still, some health programs do get exceptional funding — the agency spends about $450 million trying to wipe out polio every year.

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On a recent trip to Guinea, where WHO director-general Dr. Margaret Chan praised health workers in West Africa for triumphing over Ebola, Chan stayed in the biggest presidential suite at the Palm Camayenne hotel in Conakry. The suite has an advertised price of 900 euros ($1,008) a night. The agency declined to say who picked up the tab, noting only that her hotels are sometimes paid for by the host country.

But some say that sends the wrong message to the rest of the agency’s 7,000 staffers.
“We don’t trust people to do the right thing when it comes to travel,” said Nick Jeffreys, WHO’s director of finance, during an in-house seminar on accountability in September 2015 — a video of which was obtained by the AP.

Despite WHO’s numerous travel regulations, Jeffreys said staffers “can sometimes manipulate a little bit their travel.” He said the agency couldn’t be sure they were always booking the cheapest ticket or that the travel was even warranted.

“People don’t always know what the right thing to do is,” he said.

Ian Smith, executive director of Chan’s office, said the chair of WHO’s audit committee said the agency often did little to stop misbehavior.

“We, as an organization, sometimes function as if rules are there to be broken and that exceptions are the rule rather than the norm,” Smith said.

Earlier that year, a memorandum was sent to Chan and other top leaders with the subject, “ACTIONS TO CONTAIN TRAVEL COSTS” in all-caps. The memo reported that compliance with rules that travel be booked in advance was “very low” and also pointed out that WHO was under pressure from its member countries to save money.

Travel would always be necessary, the memo said, but “as an organization we must demonstrate that we are serious about managing this appropriately.”

In a statement to the AP, the U.N. health agency said “the nature of WHO’s work often requires WHO staff to travel” and said costs had been reduced 14 percent last year compared to the previous year — although that year’s total was exceptionally high due to the 2014 Ebola outbreak in West Africa.

But staffers are still openly ignoring the rules.

An internal analysis in March, obtained by the AP, found that only two of seven departments at WHO’s Geneva headquarters met their targets, and concluded the compliance rate for booking travel in advance was between 28 and 59 percent.

Since 2013, WHO has paid out $803 million for travel. WHO’s approximately $2 billion annual budget is drawn from the taxpayer-funded contributions of its 194 member countries, with the United States the largest contributor.

After he was elected, U.S. President Donald Trump tweeted : “The UN has such great potential,” but had become “just a club for people to get together, talk, and have a good time. So sad!”

Some health experts said while WHO’s travel costs look out of place when compared to some of its disease budgets, that doesn’t necessarily mean that travel expenses are inflated.

Michael Osterholm, an infectious diseases expert at the University of Minnesota, has frequently been flown to WHO meetings — in economy — on the agency’s dime.


“This may just speak to how misplaced international priorities are, that WHO is getting so little for these disease programs,” he said.

During the Ebola disaster in West Africa, WHO’s travel costs spiked to $234 million. Although experts say on-the-ground help was critical, some question whether the agency couldn’t have shaved costs so that more funds went to West Africa , where the three stricken countries couldn’t even afford basics like protective boots, gloves and soap for endangered medical workers or body bags for the thousands who died.

Dr. Bruce Aylward, who directed WHO’s outbreak response, racked up nearly $400,000 in travel expenses during the Ebola crisis, sometimes flying by helicopter to visit clinics instead of traveling by jeep over muddy roads, according to internal trip reports he filed.

Chan spent more than $370,000 in travel that year, as documented in a confidential 25-page analysis of WHO expenses that identified the agency’s top 50 spenders. Aylward and Chan were first and second on that list. Three sources who asked not to be identified for fear of losing their jobs told the AP that Chan often flew in first class.

WHO said the travel policy, until February, “included the possibility for the (director-general) to fly first class.” It said Chan flew business class and requested the policy be changed to eliminate the first-class option.

“There’s a huge inequality between the people at the top who are getting helicopters and business class and everyone else who just has to make do,” said Sophie Harman, an expert in global health politics at Queen Mary University in London.

Other international aid agencies, including Doctors Without Borders, explicitly forbid their staff from traveling in business class — even having the charity’s president fly in economy class, a spokeswoman said. With a staff of about 37,000 aid workers versus WHO’s 7,000 staffers, Doctors Without Borders spends about $43 million on travel a year.

The U.S. Centers for Disease Control and Prevention would not provide its travel costs but said staffers are not allowed to fly business class unless they have a medical condition that warrants it. The U.N. children’s agency UNICEF, which has about 13,000 staffers, said it spent $140 million on global travel in 2016.

“When you spend the kind of money WHO is spending on travel, you have to be able to justify it,” said Dr. Ashish Jha, director of the Global Health Institute at Harvard University. “I can’t think of any justification for ever flying first class.”

Jha warned that WHO’s travel spending could have significant consequences for fundraising. Several weeks ago, WHO asked for about $100 million to save people in Somalia from an ongoing drought. In April, it requested $126 million to stop the humanitarian catastrophe in Yemen .

“If WHO is not being as lean as possible, it’s going to be hard to remain credible when they make their next funding appeal,” Jha said.

— Maria Cheng

Article source: https://www.statnews.com/2017/05/21/who-spends-on-travel/

Health care bill gets score; retail earnings; celebrity commencement speeches

What's in the Republican health care bill

1. The health care bill gets scored. The non-partisan Congressional Budget Office is set to release on Wednesday its score of the revised version of the American Health Care Act, which was passed by House Republicans earlier this month.

The report could have a huge impact on efforts to get a version of the bill passed in the Senate, where a much slimmer majority exists for the Republicans. Earlier this year, a damning report from the CBO helped sink the first version of the bill, forcing House Republicans to call off the vote at the last minute.

Article source: http://money.cnn.com/2017/05/21/investing/stocks-week-ahead-use/

Senators run into obstacles, consider options on health bill

Remember the Republican health care bill?

Washington is fixated on President Donald Trump’s firing of FBI chief James Comey and burgeoning investigations into possible connections between Trump’s presidential campaign and Russia.

But in closed-door meetings, Senate Republicans are trying to write legislation dismantling President Barack Obama’s health care law. They would substitute their own tax credits, ease coverage requirements and cut the federal-state Medicaid program for the poor and disabled that Obama enlarged.

The House passed its version this month, but not without difficulty, and now Republicans who run the Senate are finding hurdles, too.

A look at some of those obstacles and what senators are trying to doing about them:

SHORT-TERM FIX?

GOP senators say they’re discussing a possible short-term bill if their health care talks drag on. It might include money to help stabilize shaky insurance markets with subsidies to reduce out-of-pocket costs for low-earning people and letting states offer skimpier, and therefore less expensive, policies.

It’s unclear Democrats would offer their needed cooperation, but Republicans are talking about it.

“We’ve discussed quite a bit the possibility of a two-step process,” said Sen. Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee. “In 2018 and ’19, we’d basically be a rescue team to make sure people can buy insurance.”

That could mean Republicans might even temporarily extend Obama’s individual mandate — the requirement that people to buy coverage or face tax penalties. It’s perhaps the part of Obama’s law that Republicans most detest. But it does prompt some people to purchase insurance, which helps curb premiums and make markets viable.

Alexander, R-Tenn., said there’s a “strong bias” to address short- and long-term problems in a single bill.

“If we can’t do the real thing, we’d have to do the next best thing,” Senate Finance Committee Chairman Orrin Hatch, R-Utah, said of short-term legislation.

———

TIME IS TICKING

Because Democrats oppose the repeal effort unanimously, Republicans will need 50 of their 52 senators to back their overhaul so Vice President Mike Pence’s tie-breaking vote would clinch passage. GOP senators show no signs of producing a bill soon.

Time is important, especially with Trump’s problems distracting lawmakers. Insurance companies could grow increasingly spooked by the uncertainty and make health care markets even worse by raising premiums or pulling out.

Also, the longer it takes Republicans to write the legislation, the less time they’ll have for tax cuts and other GOP priorities.

———

GOP DIVISIONS

The House version would end in 2020 the extra federal payments that states get under Obama’s law for expanding Medicaid to additional people. Senate conservatives prefer to start phasing out that money next year. But 20 GOP senators come from states that expanded Medicaid and want to protect those voters, so many would rather reduce the payments over many years.

Conservatives and moderates are also bickering over how tightly to cut future spending on the entire Medicaid program.

Many Republicans want to refocus the House’s health care tax credits, which grow with people’s ages, by boosting subsidies for lower earners. Eager to reduce premiums, many want to roll back Obama mandates such as requiring insurers to cover specified services, including substance abuse counseling, but there are questions about how far to go.

Decisions await on helping states subsidize people with costly medical conditions and keeping insurers from fleeing unprofitable markets.

Making Medicaid, the tax credits and other programs more generous than the House will cost many billions of dollars. Senators will need ways to pay for that.

———

BUDGET UNCERTAINTY

The Congressional Budget Office plans to release its estimate Wednesday of the House health care bill’s cost and how it would affect coverage. Those numbers will give senators a starting point and could be a big deal.

Congress’ nonpartisan budget analyst projected in March that an earlier House version would mean 24 million additional uninsured people. That scared off many Republicans and complicated House leaders’ job of passing their legislation.

Senators will examine whether the House bill still cuts Medicaid by $840 billion over a decade and reduces taxes — largely on higher earners and health industry sectors — by around $1 trillion. Democrats targeted both reductions as unfair.

Also being watched is whether a number of late changes in the House bill will force the House to vote again on the legislation. That would be a major problem for the GOP, which nudged the measure through the House by four votes.

The budget office said the earlier House bill had $150 billion in 10-year deficit reduction. But that was before House leaders added extra money and provisions letting states reduce coverage requirements to win votes.

Congress approved special rules that will block Democrats from using a Senate filibuster to kill the health bill. To retain the filibuster protection, the bill that the Senate receives from the House must reduce the deficit by at least $2 billion, including $1 billion each from two Senate committees, over a decade.

If the final House bill doesn’t meet those targets, the filibuster protections will vanish unless the House approves a new version that does.

That wouldn’t be easy.

Article source: http://abcnews.go.com/Health/wireStory/health-bill-faces-challenges-senators-budget-analysts-47528968

Eat more seafood for your health, right? Actually, it’s not that simple.

The Dietary Guidelines for Americans strongly suggest that adults eat two servings of seafood, or a total of eight ounces, per week. Fish and shellfish are an important source of protein, vitamins and minerals, and they are low in saturated fat. But seafood’s claim to fame is its omega-3 fatty acids, including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which are beneficial to health.

Omega-3s are today’s darling of the nutrition world. Many observational studies have indeed shown them to help alleviate a range of conditions including high blood pressure, stroke, certain cancers, asthma, Type 2 diabetes and Alzheimer’s disease. However, there isn’t complete scientific agreement on the health benefits of omega-3s, especially when considering the lack of strong evidence from randomized clinical trials, which are the gold standard for research.

So what exactly is the evidence that seafood is good for your health?

The strongest evidence exists for a cardiovascular health benefit, and from consuming seafood (not just fish oil), which is significant because heart disease is the leading cause of death in the United States.

One of the things I research is Americans’ meat and protein consumption. Though many of us are concerned about getting enough protein, most Americans actually get more than enough protein.

Rather, the problem is that most of us don’t include enough variety of protein sources in our diet. We eat a lot of poultry and red meat but not as much seafood, nuts, beans, peas and seeds. For seafood in particular, consumption is estimated at about 2.7 ounces of seafood a week per person, well below the recommended eight ounces.

So the solution might seem simple: Increase public-health messaging along the lines of “Seafood is healthy. Eat more of it.” But it’s a bit more complicated than that.

Complication #1: Omega-3 fatty acids vary from fish to fish.

Here’s the catch: If you are dutifully eating your two servings a week, but it’s from tilapia, shrimp, scallops or catfish, you won’t actually be getting much of the health benefits from the omega-3 fatty acids.

That’s because seafood varies in its omega-3 fatty acids content, and many commonly consumed seafoods are not actually that high in omega-3s. The top-five seafood products consumed in the United States are shrimp, salmon, canned tuna, tilapia and Alaskan pollock. (Think fish sticks.) Together, these seafood products total about three-fourths of U.S. seafood consumption.

Looking at the omega-3s content of these top seafood choices, salmon is one of the best omega-3 sources even though the total of omega-3s varies considerably by type of salmon (the species and whether it is farmed or wild-caught).

Canned tuna is an okay source, but it’s a bit of a mixed bag. (White tuna has more omega-3s than light tuna.)

The other top seafood products — shrimp, tilapia and Alaskan pollock — are fairly low in omega-3s.

In short, we’re not eating a lot of fish to begin with, and much of the fish we do eat is not actually that high in omega-3 fatty acids.

Complication #2: Mercury.

A naturally occurring heavy metal in rock, mercury is released into the environment primarily through human processes such as the burning of fossil fuels.

Mercury makes its way into our waterways and bioaccumulates in the marine food chain. Generally speaking, small fish and shellfish are low in mercury, while the most mercury accumulates in big, long-lived predator fish such as king mackerel, marlin, orange roughy, shark, swordfish, ahi (or yellowfin) tuna and bigeye tuna.

Humans, of course, are also part of that food chain. When we eat those big, long-lived predator fish, we ingest the mercury that’s accumulated in them.

Consuming mercury is definitely not a good thing. A little bit here and there is probably not going to harm the average adult, but with high exposure, mercury can damage key organs. Fetuses, infants and young children are vulnerable to mercury toxicity, as high exposure can cause serious, irreversible developmental and neurological damage.

To minimize mercury exposure in women and young children, the Environmental Protection Agency and the Food and Drug Administration issued new mercury-in-seafood guidelines on Jan. 18. There are three categories: Best Choices (eat two to three servings a week), Good Choices (eat one serving a week) and Choices to Avoid (highest mercury levels). While most types of seafood clearly fall into just one category, some classifications are species-specific.

Tuna shows up in all three categories: canned light tuna is a Best Choice, canned white tuna is a Good Choice, but watch out for bigeye tuna: It’s a Choice to Avoid.

For optimizing the health benefits, the best seafood choices are those high in omega-3s and low in mercury. The Department of Agriculture’s ChooseMyPlate website lists several options that fit nicely in both categories, including salmon, trout, oysters, herring and sardines, and Atlantic and Pacific mackerel.

Complication #3: Sustainability.

There is also the issue of sustainability. Let’s again take the case of tuna. For certain species, the method of harvest and the location of harvest matter a great deal. Here’s an example from the Monterey Bay Aquarium’s Seafood Watch guide: If you purchase a can of light tuna that’s trawl-caught in the East Pacific, that’s a Best Choice.

But if that canned light tuna is caught with a deep-set long line in the Hawaii Western Central Pacific, now it’s a Good Alternative. And canned light tuna caught on a purse seine — a long wall of netting used to encircle schools of fish — in the Indian Ocean? Now we’re squarely in the Avoid category.

By now you are probably asking if there are any win-win-win fish. Yes! Alaskan salmon is a popular one, but Alaskan salmon is sold at a premium price. Most of the salmon sold in the United States, though, is farmed Atlantic salmon, which typically has a poor sustainability rating.

Pacific sardines, farmed mussels, farmed rainbow trout and Atlantic mackerel (not trawled) are some other “win-win-win” options.

Making informed choices about seafood isn’t easy, and it is complicated by seafood fraud. But there are some resources to help.

Eco-certification labels can help you make a decision without doing all the research yourself. Not all eco-labels are created equal, though, so a good place to scope out what to look for is the Seafood Watch website. There, you can find a list of eco-certification labels for specific seafood products that, at a minimum, meet yellow “Good Alternative” recommendations.

There are also a number of consumer seafood guides, and with a little upfront research, these can help you make purchasing decisions when you get to the grocery store or restaurant. Many guides use a traffic-light system to clearly designate choices with green-, yellow- or red-light signs.

Additionally, the new Seafood Import Monitoring Program, a federal effort that is set to go into effect Jan. 1, will help to combat the problem of seafood fraud. But you should still always be vigilant about prices that seem too good to be true.

If your only concern is reducing mercury content, the EPA and FDA guide “Eating Fish: What Pregnant Women and Parents Should Know” should suffice. For sustainability concerns, the Monterey Bay Aquarium’s Seafood Watch guide allows you to search for options using a traffic-light system, or you can look for information by the type of seafood. If you’re looking for a fish that meets all three criteria, there are guides put out by two advocacy groups — the Environmental Working Group’s Consumer Guide to Seafood and the Environmental Defense Fund’s Seafood Selector.

When making food choices, sometimes we’re fortunate and the health and sustainability goals line up. Eating less red and processed meat, for example, is a choice that’s good for your health and better for the environment. Unfortunately, with many seafood choices, these three important considerations — omega-3s, mercury and sustainability — sometimes — but don’t often — align as we might like them to.

Szejda is a postdoctoral research associate in the Risk Innovation Lab at Arizona State University. Her position is funded by Michigan State University’s Center for Research on Ingredient Safety. This article was originally published on theconversation.com.

Article source: https://www.washingtonpost.com/national/health-science/eat-more-seafood-for-your-health-right-actually-its-not-that-simple/2017/05/19/4e0e8564-26cd-11e7-a1b3-faff0034e2de_story.html