Hundreds of thousands of newly eligible Californians have signed up for Medi-Cal through the Affordable Care Act, raising new questions about the access and availability of specialist care in the system.
Embedded in the Affordable Care Act is a cost containment feature that could sweep up doctors and hospitals everywhere, push fee-for-service medicine into a niche, and alter the patient-doctor relationships.
Mental Health hospitalizations for youth are spiking in California.
California regulators insist that the state’s 7,700 assisted living homes are not medical facilities. Yet an ongoing series has uncovered at least 80 cases of medical errors in San Diego area homes in recent years, provoking questions about whether employees can care safely for older, sicker residents.
Instead of mandating bigger staffs and better training, the California Department of Social Services has repeatedly weakened its rules so that the homes it licenses statewide can care for more medically needy seniors. The series is a joint project of the CHCF Center for Health Reporting and U-T San Diego.
Once seen as an adjunct to the new insurance marketplace established under the Affordable Care Act, independent insurance brokers are now being pressed to help get thousands of Californians signed up in time for policies to begin Jan. 1. They say they are facing long hours, low compensation, and numerous complications.
Clinics in Los Angeles and around the state anticipate hundreds, even thousands, of newly insured patients flooding their centers when Obamacare begins in 2014. With those newly insured comes an increase in demand for services, a need for more staff and more efficiency. They've also started seeing an increase in competition for patients and staff from other clinics and the private sector. Experts say the success of Obamacare hinges on the success of clinics to manage these changes.
Covered California claims that 80% of the state’s physicians will be listed under plans offered by insurers in the new exchange. But medical societies and doctors aren’t buying it, and a cursory search of doctors listed in current insurance networks compared to exchange plan networks shows dramatic reductions.
The President’s embattled health law could play the role of a lifetime for California’s arts and entertainment community. It promises to expand health coverage beyond a relative few who work enough to qualify for Screen Actors Guild insurance, or who dig deeply into their wallets for individual plans. But performers are discovering sobering realities, including limited provider networks and subsidy rules that are ill-fitted for the unpredictability of Hollywood incomes.
Home to the highest percentage of uninsured adults in the state, Tulare County, in California’s Central Valley, has much at stake in the rollout of Obamacare. And success or failure in this poor rural county will provide a real measure of the Affordable Care Act’s ability to change the health prospects of hundreds of thousands of Central Valley residents.
Clinics for the poor are still part of the state’s health landscape, but will they still be needed after the implementation of the Affordable Care Act?
While California’s lead poisoning cases have declined, especially over the last two decades, children’s advocates say without enough money to reach the finish line the most vulnerable children are still at risk.
Women have been bearing children for thousands of years. But childbirth is anything but straightforward. A woman having a baby in the US today has a lot of options for how and where to do it. And many women are choosing to give birth outside the hospital. In the US, home births still only make up less than one percent of all births, but there is a perceptible growth in the number of women giving birth outside of a hospital. In fact, births that happened at home increased 29 percent between 2004 and 2009, and they mostly took place under the care of midwives. In California, out-of-hospital births may soon become safer. State legislators are considering a bill that would make it easier for licensed midwives who deliver babies outside of hospitals to work with physicians who deliver inside of them.
Hundreds of San Diego County seniors have suffered serious injuries at assisted living homes that promised comfort and safety for their waning years. And at least 27 seniors in the county have died from injuries and neglect while in the facilities. Their deaths reveal critical failures – both public and private – in a system responsible for their well-being.
Health educators from social service organizations who are working to inform the public about Obamacare face a daunting challenge, trainers and trainees said. Many of the organizations that received $37 million in grants to sound the clarion call to health reform have traditionally focused on low-income populations. For the first time in their careers of social work, they must reach a population in many ways more skeptical of reform than the poor: California’s ethnically diverse working and middle class.
Despite promises by President Obama that people can keep the insurance they have once Obamacare is in full effect in January, millions will have to upgrade their policies. That’s because these people have “bare bones” plans that don’t meet the Affordable Care Act benefit standards.
While California’s health providers are concerned that new Affordable Care Act enrollees will overwhelm their systems, a troubling flipside has also taken hold. They are equally worried about patients who don’t enroll.
Qualified but unreached California residents could number more than a million, according to estimates by the state Legislative Analyst’s Office. Without health reform coverage, they will seek medical care where they always have: county safety net clinics and emergency rooms.
Under the Affordable Care Act, firms that employ 50 people or more must provide full-time workers with health insurance, or face thousands of dollars in penalties. California labor advocates say large companies are already cutting workers' hours to get around the Obamacare mandate. Proposed California legislation is aimed at preventing low-wage workers who lose hours - and their health care coverage - from turning to Medi-Cal, the government-funded insurance program. This bill goes further than the federal health care law in that it applies to part-time workers as well as full-time. And that could have devastating and unintended consequences for some California nonprofit businesses and family farms.
For parents of newborns – or those expecting one – congratulations. If you’re having your baby in California, expect some generous maternity and paternity benefits. They’re way better than federal benefits, which only guarantee 12 weeks of unpaid leave. The problem is, not many workers in the state know what they’re entitled to.
Modesto residents here seeking pain relief from fractured vertebrae underwent two controversial back procedures at double the statewide rate from 2005 to 2010, according to an analysis of state hospital data released earlier this month.
Just a half hour’s drive away, during the same period, Stockton residents underwent the same treatment at a frequency about half the state average, or only one fourth as often as Modestans. And while the number of these procedures around the state has dropped off in recent years, in Modesto use of them has increased. The data place Modesto in the middle of a national debate about the issue of overtreatment.
Local clergy used to patrol local hospitals and nursing homes, offering spiritual counseling and consolation to members of their faith. But while local clergy who volunteer in hospitals usually only serve patients of their own faith, today’s professional chaplains have been trained in a different multi-faith approach in providing spiritual care to patients.
Nearly one in five patients discharged from U.S. hospitals ends up returning within a month. The costs of those readmissions mounts up, and Medicare wants the rate significantly lowered.
State officials released data this month showing significant Improvement in access rates for poor Sacramento and Los Angeles County children who are part of a Medi-Cal managed care dental program. A CHCF Center for Health Reporting story published in the Sacramento Bee last February revealed that Sacramento County Medi-Cal children were forced to wait months or even years to see a dentist. The county had among the lowest access rates in the state.
Millions of uninsured Californians will soon be eligible for government-subsidized insurance. In fact, the ripples of health reform start with Monday’s tax deadline.
The government will be using your return as its first yardstick for how much money it contributes to your health coverage through a tax break. But beginning in 2014, a penalty will be added to your federal tax obligations if you don’t have that government-mandated health insurance.
And if your income goes up substantially during that yearlong span, you could have to give all, or some, of that tax break back.
Is Obamacare for me? How much does it cost? What do I have to do? Obamacare is on the way and it’s complicated. That’s why the CHCF Center for Health Reporting put award-winning journalist Emily Bazar on the case. In “Ask Emily,” a twice-a-month column, she digs for – and comes up with – answers to consumers’ questions about how this giant health overhaul will work.
Multimedia journalist Lauren M. Whaley interviews the Center's reporters on recent projects they've completed. Hear the reporters tell, in their words, what the key issues and players are on stories ranging in topic from Obamacare enrollment to deaths in assisted living facilities to business tax subsidies under health reform and more.
Plans for immigration reform are moving forward, with both Democrats and Republicans announcing plans for legalization of the country’s 11 million undocumented immigrants. But will these immigrants become eligible for health reform’s benefits? Should they?
Every day in California, about nine people die by suicide. In fact, it is the 10th leading cause of death in the state, and in the nation. But, in Sacramento, there’s a unique partnership between Sutter Medical Center's emergency departments and a clinic run by WellSpace Health that takes a hands-on approach to this devastating problem. It’s a suicide prevention arrangement that targets people who have already tried to take their own lives and find themselves alive in the Emergency Room. The outreach program aims to get them immediate treatment and also reduce hospital readmissions. It is all done over the phone. And it's working.
Wellness programs have long been part of businesses’ strategy to create a healthier workforce and reduce doctor and hospital costs. But increasingly employers have been putting some bite into their wellness offerings. Unless employees agree to one or more wellness options, some businesses are significantly raising premiums and deductibles. Unions sometimes are buying that approach, too, but not all employees are on board.
The promise of Obamacare is one thing. The reality is another. Next year, roughly 1 million poor Californians will be added to Medi-Cal, the state’s health insurance program for low-income residents. But across the state, medical providers say they are already overwhelmed trying to serve the current Medi-Cal pool. In their eyes, access could worsen when the newly insured seek treatment. State officials, meanwhile, insist there are sufficient providers to serve the increased Medi-Cal population.
About half the hospitals in Southern California have refused to provide information about their earthquake recovery plans to requesting government agencies. State and federal officials say they need the information in order to help hospitals recover from a disastrous earthquake. The refusal to cooperate has stunned some observers, noting that hospitals’ experience in the wake of Hurricane Sandy proves that government assistance is critical after a natural disaster.
One year from now, tens of thousands of uninsured Kern County residents will celebrate the bounty of health reform – they will finally have a chance at health insurance. That’s when Medi-Cal, a publicly funded health program for low-income and disabled residents, will expand statewide, bringing the promise of coverage to perhaps 1 million more Californians. But many local doctors and health care leaders fear that the promise may be hollow. In Kern, they say, it’s already difficult for poor residents to find a doctor when they need one, and that doctors and clinics already are overwhelmed. It’s a situation that could worsen, they fear, with the addition of thousands of new patients.
For years, anyone with a license could sell power wheelchairs, oxygen tanks and hospital beds to seniors on Medicare. But in 2010, the government agency tried an experiment in cost-cutting: A program that required medical supply firms in certain areas to bid for the right to sell certain pieces of medical equipment to seniors. Two years and $202 million in savings later, the government is rolling out the program nationwide. Officials expect the program could save about $42 billion for taxpayers and seniors over 10 years. But many small local medical supply businesses fear the program’s new requirements will force them to close. Two years after reporting on this test program, the Center re-visits the Southern California area where the pilot program has played out.
For most of the last century, the infant mortality disparity has widened between black and white newborns. The result has been a black infant mortality rate that compares with that of Third World countries. But in places like Oakland, new evidence suggests the disparity is narrowing. Local officials credit intensive in-home contact between county nurses and moms or moms-to-be for helping to lower the death rate for children. The trend is showing up across California, where the black infant mortality rate dropped more than 20 percent between 2008 and 2010.
California is among 16 states that licenses accredited naturopathic doctors. Supporters say the approach could strike a blow against doctor shortages in the states, along with promoting healthier lifestyles. Some naturopathic doctors say they believe their style of medicine is becoming more mainstream.
Corporate wellness programs have been around for a long time. But they’re best known for luring well-paid, white-collar workers into a company gym or exercise class. Now, though, wellness programs are expanding rapidly beyond that base, with many companies providing exercise or weight-reduction opportunities for blue-collar workers as well. Increasingly, workers will see yet another side to this healthy-living campaign – companies that slap higher health-insurance rates on workers who smoke or are overweight.
California officials lauded the outcome of Tuesday's election, saying it removes all doubt that the state will expand health insurance and bring coverage to at least 2 million people in 2014.
A brand of medical clinics is booming in California.Thanks to an infusion of federal money meant to build health-care resources in connection with the Affordable Care Act, dozens of Federal Qualified Health Centers are expanding or renovating in California. They’re seen as a first line of defense for the millions of people expected to gain health coverage under health reform. In the process, their role is broadening beyond providing care for the poorest of the poor.
C.difficile is the latest and most dangerous infection contracted primarily in health care settings like hospitals and nursing homes. But the lack of standardization of testing methods and infection reporting may have led to a serious undercount of the infection’s incidence, experts fear.
Californians now can see what the future health plan will be for individuals buying insurance or those obtaining coverage through their small-business employer. The state exchange board has approved an “essential benefits” package that all plans in those categories must emulate. These requirements will take effect in 2014 with the full flowering of the Affordable Care Act.
They're poor. They're elderly. They're disabled. But are they eligible? Advocates and state officials are struggling to determine just who among hundreds will be allowed to continue in the program that replaces Medi-Cal's Adult Day Health Care (ADHC) system. Cash-starved California slashed the optional ADHC benefit last fall and replaced it with a leaner program called Community-Based Adult Services (CBAS). The state-wide centers continue to serve about 80 percent of the original 40,000 or so participants, some of California’s frailest individuals, people who suffer from multiple disabilities including Alzheimer's, paralysis and traumatic brain injury. Advocates say the evaluation process for new participants was flawed and left many needy people without care. The state contends that the process worked and that only the most medically fragile individuals qualified, as intended.
When California health officials recently announced a 10 percent annual drop in hospital central line infections, they did not mention that they had found flaws in the facilities’ reporting of one of the most serious infections that patients can suffer while hospitalized. The mistakes highlight a major question looming in the current rush to improve patient care quality: How can states accurately count the number of infections that occur in thousands of U.S. hospitals, amid a tangle of differing definitions, counting techniques and plain human error?
With pressure rising to reduce Medicare spending, doctors and hospitals in California worry they could once again be the primary targets. The state's hospitals have particular reason for concern. A new study by the Institute of Medicine says Medicare reimbursements at California hospitals would fall 3-4 percent, on average, if the national system were made to be more equitable. That masks reductions in certain metropolitan areas that would be much higher -- such as Santa Cruz's proposed 17.3 percent reduction. In general, California rural areas would be the biggest losers.
Cash-strapped California is aggressively moving its poorest residents to managed health care. So, when Gov. Jerry Brown proposed earlier this year to transfer the nearly 900,000 poor children in the Healthy Families insurance program into Medi-Cal, he saw it as another opportunity to reduce costs by expanding dental managed care. But something happened between then and now, and that something was Sacramento. Sacramento’s poor-performing Medi-Cal dental managed care program foiled Brown’s plans, legislators say. “That failure certainly has stopped the expansion of dental managed care,” said Assemblyman Richard Pan, a Sacramento Democrat who also is a pediatrician. “Hopefully we as a state have learned from that failure, and not only on the dental side. Hopefully we can apply those lessons on the medical side.”
As one of the country’s most aggressive supporters of President Obama’s health legislation, California arguably had much to lose when the Supreme Court was asked to strike down the controversial law. Instead, the court’s backing of nearly all of the measure’s major features was a validation of the state’s rapid implementation, over two successive administrations. Through a program called Bridge to Reform, California has a head start on most of the country in providing coverage to the uninsured. Starting in 2014, nearly 3 million state residents may gain health coverage, with more than $10 billion in federal subsidies flowing into the state annually.
When President Obama’s healthcare overhaul became law two years ago, California lawmakers jumped into action. Within months, they adopted several state laws that implement or build on the federal measure. This year, the fate of those state laws, and the impact they will have on Californians, hang under what state Sen. Ed Hernandez, chair of the Senate Health Committee, calls a “cloud of uncertainty.” Before the end of the month, the U.S. Supreme Court is expected to rule on the constitutionality of the federal health law, called the Affordable Care Act. That possibility carries different implications for California, a state that took an early and aggressive approach to implementing the federal law.
Willie Miles walked into County Harbor-UCLA Medical Center at daybreak on Aug. 5, 2011, a reluctant patient braced for doctors to re-engineer his failing right knee. “I wish he’d walked right out again,” his sister, Michelle Jones, says now. Miles, 54, of Los Angeles, died six months later. What had begun as a routine knee replacement became anything but routine with the cutting of a key artery, massive blood loss, and no blood on hand to replenish his body before it was permanently damaged. How could Miles nearly bleed to death inside a major teaching hospital, surrounded by hundreds of doctors and nurses whose top priority is to save lives?
Not until 2014 are millions of Americans scheduled to receive health coverage under a key provision of the Affordable Care Act. But in California, a clear glimpse in the future is already possible. With the state’s Bridge to Reform program, hundreds of thousands are already receiving Medi-Cal coverage. They include people with no children and those making income at twice the poverty level – who until now have been ineligible for the government-provided health insurance. The program is operating in places like Orange County, where the politics of supporting “Obamacare” are decidedly mixed.
Billions in federal subsidies are available to small businesses willing to provide health insurance for their employees. But in California, as in much of the rest of the country, few companies are taking the bait. Most don’t even know about the program.
As the nation welcomes home tens of thousands of soldiers returning from war in Iraq and Afghanistan, attention focuses on the ravages of PTSD and how the Pentagon will care for the battle-scarred. In California, the issue has special resonance for the nation’s largest contingent of Native American vets. Research suggests Native Americans may suffer PTSD at higher rates than other groups, and advocates say not enough is being done to provide appropriate care.
In Stanislaus County – like many counties across California -- a faltering local economy and deep budget cuts have severely reduced government’s ability to treat adults with mental illnesses. The result? A surge in the number of people with mental illness landing behind bars and in the county’s ERs. In the past six years, the numbers of mentally ill inmates in the Stanislaus County jail has increased nearly 50 percent, according to sheriff’s department data. Around the state, many of the most seriously mentally ill inmates now wait up to six months in jail before a state hospital bed opens up.
High-deductible health plans are billed as a way for small businesses to provide coverage for their employees, mainly by shifting costs to their staffers. While this strategy has had some success, there are big downsides. Employees are often surprised by the high costs, and many employees don't really save any money.
Two serious patient treatment lapses last summer have placed Harbor-UCLA Medical Center, southern Los Angeles County’s cornerstone of emergency care, on the defensive as state inspectors documented the incidents during a surprise visit last fall. One of the cases, a psychiatric patient who refused food and water for as long as 16 days, died after the psychiatric unit failed to monitor his condition, records show. In the second lapse, a patient nearly died because of significant blood loss during elective knee replacement surgery. The death was among a string of problems at Harbor-UCLA detailed in Medicare inspection reports since 2009. Harbor-UCLA officials said last week that they have made an array of changes to improve patient care, and inspectors determined in January that problems found during earlier visits have been resolved.
The call comes in and, for the 10th, 12th, or 20th time, paramedics take a middle-aged man from the streets to the ER. Such frequent users cost the emergency medical system millions, yet don't get the help they need. This five-part series examines the problem of frequent users of emergency services. The frequent 911 users in this series are the most chronic users of the emergency room and can defy institutional, government-based, solutions. They will remain a challenge no matter what becomes of the health reform law currently under U.S. Supreme Court review.
At a time when it’s becoming harder to get a doctor’s appointment, your local school may be the place to turn. School health centers are expanding across California with the help of funding from the federal health care law. And they’re emerging as a model for improving public health in low-income areas for students and community members. An iconic high school near downtown Los Angeles houses one of these clinics that's been open for 10 years. Patients can visit the community clinic on the Abraham Lincoln High School campus and see a nurse, doctor, dentist or counselor for free.
The practice of scheduling an early childbirth may be on the way out in California and the United States. Research shows that newborns have heightened health risks when deliveries occur in the 37th and 38th weeks of pregnancy. That’s led growing numbers of hospitals to prohibit doctors from scheduling deliveries during that time, unless there is a medical reason to deliver. It’s a pendulum swing for a practice of 'elective deliveries' that had gained growing favor, among both doctors and mothers, for the convenience of having a delivery on a date certain. The new trend also is shining a spotlight on labor inductions, which are now quite common but which carry their own risks of complications.
Almost two decades ago, the state made Sacramento County the testing ground for a new model of delivering dental care to poor children. Officials envisioned a managed care system that would control costs and improve children’s ability to see a dentist. Today that model persists – but state data shows that the county has consistently produced one of California’s worst records for care. In 2010, only 30 percent of more than 110,000 Sacramento children with Medi-Cal – the government insurance program for the poor – saw a dentist, according to state data. By comparison, nearly half of their Medi-Cal peers statewide visited a dental office. That year, the county ranked third worst in terms of the percentage of kids who got care - above only rural Alpine and Trinity counties. During the three previous years, it was the state's lowest performing children's dental system, state numbers show.
The day when doctors and mothers-to-be schedule early deliveries may be coming to an end. Hospitals are cracking down on a practice that many practitioners and pregnant women have favored because of the convenience factor. But studies have demonstrated that the practice can be harmful to newborns, and inevitably drives up hospital costs. Some hospitals are telling doctors they'll have to go elsewhere if they want to schedule an early delivery.
For millions of Americans, bagged salads are a miracle food, the perfect mix of health and convenience. They don’t want to think about E. coli O157:H7, which in 2006 tainted spinach in an outbreak that killed five people and sent 100 more to the hospital. And the salad industry doesn’t want them thinking about it either. The safety of bagged greens has emerged as one of the most pressing issues in today’s fresh produce business. It’s why industry and government are investing millions to avoid debacles such as the death of 30 people last year after eating poorly washed, listeria-laced cantaloupe. It’s why food companies are rushing to find the “perfect wash.”
There are so many things Chuck Magner wishes now that he'd known about his father's illness and his doctors' proposed cure. Chief among them is this: that his father, Jerry, who had a history of vascular problems, lived in a part of Northern California where he was much more likely to be recommended for a risky surgical procedure designed to prevent strokes. Jerry Magner's story is a case study of the kinds of information patients and their families need to find out from their doctors and hospitals, but also of the difficulty they encounter trying to get the answers.
Five years after the Salinas Valley became the epicenter of a national food disaster when an E. coli outbreak was linked to spinach grown there, valley farmers have retooled almost every step in their industry to ensure the safety of their produce. One result is that they helped develop state food safety standards that are being held up as a national model.
For many years California has had the notable distinction of having the lowest reimbursement rates in the country for Medi-Cal, its program to subsidize health costs for the poor. But because of the state’s budget crisis, Medi-Cal is getting even skimpier, with a new 10 percent cut taking effect. Toby Douglas, who oversees the Medi-Cal program, argues that recipients will continue to have access to critical health services. But in a question-and-answer session with senior writer Emily Bazar, he acknowledges that they may have to see a different doctor, at a different time, at a different location.
Insurers, hospitals and government agencies say it's possible to cut health costs and improve patient care at the same time. They're using sophisticated data to identify doctors and other health providers who are using outmoded or unnecessary procedures, and pressuring them to come into line. In some cases it's choosing a non-invasive procedure over an older, invasive type. In other cases it's using new research data to discard a practice that's been found to be ineffective. But doctors are concerned that they're losing the ability to respond effectively to individual cases. The president of the Amerian Medical Association, Peter Carmel notes that, "if there are two treatments ou there in play for a given condition, most commercial interests will choose the cheaper."
State budget cuts may force thousands of poor elderly and disabled Californians to lose access to the day centers where they receive meals, therapy and medical care, as well as companionship and a sense of community. The state’s elimination of the Medi-Cal Adult Day Health Care (ADHC) benefit – slated for Dec. 1 – could endanger some of California’s frailest individuals, people who suffer from multiple disabilities including dementia, incontinence, paralysis and traumatic brain injury. As the centers are forced to close, advocates say, many will be left home alone and at high risk of landing in emergency rooms and nursing homes. Los Angeles County – especially its many ethnic minority communities –will be hit hardest by the closures. According to state data, the county is home to more than 60 percent of the program’s 38,000 enrollees statewide.
California hospitals have repeatedly bought themselves extra time to make their structures capable of withstanding a major earthquake. But even when this shoring up work is completed, it will be years and even decades before many hospitals will really be able to operate after an earthquake. That’s because California law allows them, in many cases, up to 2030 to make nonstructural upgrades. And recent quakes have shown that it’s these internal issues that mean hospitals are dead in the water after the shaking stops.
Doctors are increasingly are dealing with longtime patients who suddenly have lost their insurance or are now underinsured. The problem is particularly thorny because many practices themselves are hurting financially as patients save money by avoiding care. But some doctors are responding the old-fashioned country doctor way -- reducing or delaying fees for their services, jawboning pharmaceutical representatives to provide more drug samples, or leaning on specialists to give their patients a break. Said Dr. Eric Ramos of Modesto, "What I try to tell (longtime patients) is that until our relationship is severed by either you or me, I'm your physician."
Medical debt is at an all-time high in the United States, affecting about one in four adults under 65. Americans are being hit by a combination of higher health costs, unemployment and cutbacks in employer-provided insurance. To cope, financially strapped patients are turning to payday loans and credit cards to pay off their medical bills. Hospitals, meanwhile, are also squeezed trying to collect millions of dollars in bad debt. Some turn to collection agencies or, in a few cases, sell off patients’ debt on the markets, Wall Street-style. But hospitals’ collection rates aren’t what you might expect. So far, the government isn’t doing much to help. California has regulations in place to help protect some patients from medical debt, but many consider them weak on enforcement. And while the federal health care law could bring some relief, implementation is still a few years away – if the measure survives at all.
Residents in the Northern California town of Clearlake have been having two common heart procedures at five and six times the state average. Rates are also high across a wide swath of the Central Valley. These elevated numbers are partly a result of widespread health problems that show up in the population. But a new study suggests that the high rates go well beyond that, and researchers say the biggest cause may be clinical practice decisions made by doctors. The findings could have enormous implications for health costs and the quality of care. Insurers and government agencies are taking up the cause, increasingly using these so-called variation studies to pressure doctors to change their practices.
Thousands of California parents are choosing not to vaccinate their children, despite last year's record-setting whooping cough outbreak. And the number is growing, much to the alarm of pediatricians and state health officials. Over the past decade, "personal belief exemptions" (PBEs) have tripled. Signed by parents, the exemptions allow children to enter school missing some or all vaccines. Statewide, more than two percent of kindergarteners have such exemptions. With a 9.5 percent PBE rate -- more than four times the state average -- Santa Cruz County is close to ground zero in this often heated and emotional debate. State experts say that as long as 95 percent of a population is immunized, "herd immunity" keeps contagious diseases from spreading. But vaccine refusal tends to concentrate in geographical areas like northern Santa Cruz County, where close to 17 percent of incoming kindergarteners had PBEs on file last fall – one of California’s highest rates. "If they were scattered fairly evenly around the state, the implications would be much less concerning," said Dr. Rob Schechter, medical officer with the Immunization branch of the state Department of Public Health, which collects the statistics on student immunizations. "The fact that they are concentrated in communities, social networks and schools with much higher rates -- that allows disease to spread much more rapidly."
California’s foster care system often does a poor job of meeting foster children’s health needs, thanks to the often haphazard way their medical records are kept. By law, each time a foster youth in California is relocated, a comprehensive paper file of their medical records called a “health passport” is to be promptly forwarded with them to their new caregiver. But this doesn’t always happen, according to many foster care experts -- sometimes with potentially serious consequences. A growing number of child-welfare advocates are calling for the creation of a statewide electronic health passport system that would allow authorized health care providers to access a foster youth’s medical history online. Advocates say that such a computerized system could greatly improve medical care for already-traumatized children who have suffered more than their share of hardship and deprivation.
A flawed Medicare policy has contributed to the suffering of American kidney patients for decades. While the federal entitlement program covers a lifetime of costly dialysis treatments, it provides only 36 months of anti-rejection medications that kidney transplant recipients need the rest of their lives. Without the drugs, the kidney fails and recipients return to the dialysis regimen, sometimes waiting years for the next kidney transplant. The counter-intuitive policy keeps patients in a U.S. dialysis system with some of the worst mortality rates in the world, and wastes the precious resource of donated kidneys. It can cost taxpayers millions more in the long run. Yet, attempts by lawmakers to remedy the problem have been defeated by lobbying from a multi-billion dollar dialysis industry that wants to ensure that monies for the transplant drugs do not come from the government's dialysis budget. Among the key lobbyists is dialysis drug maker Amgen of Thousand Oaks.
California legislators are moving to delay implementation of a new vaccine requirement aimed at stopping the spread of whooping cough. School officials said it would have been impossible to meet a fall deadline for administering a vaccine to 3 million middle school and high school students.
The term "obesity epidemic" is often in the news these days. For residents of Fresno County, in the heart of the health-challenged San Joaquin Valley, that issue hits particularly close to home. About 36 percent of adolescents, ages 12 - 17, are overweight or obese. Their parents fare even worse -- fifty-seven percent of the county's adults are overweight or obese. This project includes two radio stories produced for Valley Public Radio. The first focuses on an obese teenager who says his diabetes diagnosis saved his life. The second radio piece looks at obesity prevention in Fresno. Among the voices is a nutrition educator, who is overweight herself. She is struggling to get healthier alongside her students. The project includes a Center-organized expert panel on obesity education, prevention and policy, featured on Valley Public Radio's Quality of Life program.
Every year, an estimated 200,000 Californians fall victim to an infection acquired in a hospital. For a surprisingly large number, the infection is life-ending. About 12,000 people die every year from hospital infections in California, more than three times the number of people who die from auto accidents in the state. Even so, these deaths often occur in the shadows, with little or no public accounting. Are hospitals and government regulators doing all they can to stop or limit the spread of hospital infections? Some critics say the answer is no. In California, the state's Department of Public Health comes in for particular criticism, in part because it has been slow to implement legislation passed in 2006 and 2008 addressing the problem.
One of the most important principles of federal health reform is that more health services must be delivered outside of hospitals and nursing homes. The federal government is providing billions of dollars to encourage state and local governments to achieve that aim. Simultaneously, though, cash-strapped state and local governments are slashing programs like Adult Day Health Care that are critical pieces of this initiative. The result? In some cases, people are being forced back into institutional care.
Health reform is on its way to low-income residents of rural California, including Humboldt and Del Norte counties along the northern coast. A consortium of 34 rural counties has applied to participate in the “Bridge to Health Reform,” a $10-billion federally financed expansion of statewide public health coverage. While backers are convinced it will save health care services in these sparsely populated, budget-challenged counties, skepticism abounds among Redwood Country health professionals that the new health order is not tailored to their needs.
The smallest and most isolated counties in California have banded together to implement the expanded health coverage mandated by the Patient Protection and Affordable Care Act, better known as health reform. Under the bureaucratic umbrella of the relatively obscure County Medical Services Program, they will seek to provide the state’s poorest, most isolated patients with a “medical home,” something like a publicly funded HMO. But even as they forge ahead, they ask fundamental questions: Where will we find the primary care doctors needed? The specialists? The enrollment staff? And will the state and federal officials in charge of distributing the matching funds in support of the effort do so quickly enough to keep the program alive?
Doctors in Stanislaus County say mounting numbers of out-of-work professionals and laid-off blue collar workers have joined the chronically poor and undocumented in clinic waiting rooms throughout the region, threatening to overwhelm its fragile safety net. The deep recession has pushed the ranks of Central Valley uninsured to unprecedented levels, while a dire state budget deficit has forced lawmakers to cut key health care programs for the state’s poorest residents. These two trends reveal a troubling new reality: Across class lines, people are struggling to access care -- or simply are going without.
California's new insurance commissioner promises to use every available power to scrutinize health insurers' rates, which he says are too high. But Dave Jones cautions consumers not to expect too much from his office. Most of the rate increases will take place, he says, because he lacks fundamental authority to roll them back. He renews calls for the legislature to give him new powers.
California's Latinos have by far the biggest stake in the future of health reform, accounting for more than half of the uninsured population that will be newly eligible for its publicly funded medical coverage. Even after deducting undocumented immigrants, who are excluded, approximately 2.1 million of the 3.9 million uninsured people eligible statewide are Latino, according to a recent study. If the new law clears the political and legal hurdles it faces to become a functional medical system by its 2014 full- implementation date, experts believe it could transform the long-suffering health profile of California’s Latino community. If repealed, advocates say, the state’s Latinos could be relegated to a perpetual state of limited medical access.
The South Coast Air Quality Management District rolled out a voluntary no-burn program this season for the Southland, asking fireplace owners not to light wood fires on days when air pollution is already high. Dare we say, the issue is heated.
California consumers were urged not to read too much into its first-ever report on hospital-acquired infections. In fact, though, the report suggests some wide differences in performance, and interviews with hospital officials show that many medical centers are working intensely to reduce their infection numbers. In some places, these efforts appear to be paying off.
Why do women often pay higher insurance premiums than men? According to insurance companies, it’s all based on claims experience. And partly because of the costs of child-bearing, women on average pay higher rates. But starting Jan. 1, 2011, insurers in California can no longer take differences between men and women into account. Because of a new California law, gender-based premiums join other banned categories such as race, ethnicity and religion. The upshot is that, on the private insurance market, rates will go down for many women. But for a few, especially older beneficiaries, the tables get turned and men get the lower rates.
California has the nation's oldest doctor population, and in few places is it more evident than in scenic, rural Mendocino County, where more than half the physicians are 56 or older. Hospital administrators, experts and the physicians themselves worry about who is going to care for the sick and elderly -- baby boom doctors are retiring just as members of their generation are themselves heading into old age -- and the answers are not satisfying.
With the start of 2011, the first of the nation’s 75 million baby boomers will reach age 65, setting the stage for a huge retirement rush that could swamp the health care system. Nowhere is the challenge bigger than in California, with the nation’s largest boomer population and a safety net already under enormous financial pressure. Boomers may expect to face doctor shortages, changing family dynamics that determine how they’re cared for as they age, and a health care system less centered on hospitals and nursing homes, and more focused on cost savings. With government resources tapped out, they can expect to shoulder more of their own health costs.
In January 2011, California becomes the last of the big states to disclose the incidence of hospital-caused infections. Hospital infections kill an estimated 13,500 Californians a year, but critics say the state’s hospitals and health department remain far behind other states in waging war against this largely preventable scourge. The new law doesn’t require identification of where deaths occurred and doesn’t include surgery centers, which account for a growing number of surgeries.
No county in California has a worse record than Riverside County for processing Medi-Cal applications. In a recent audit, the county failed to meet deadlines for processing new applications 30.8 percent of the time, or three times the maximum allowed by federal and state law. Riverside is the only California county that has failed to meet Medi-Cal enrollment deadlines every year since the current monitoring system began in 2004. The county has been swamped with a state-high 30 percent increase in beneficiaries for Medi-Cal, the government's health program for the poor and disabled. Its struggle to handle the influx does not bode well for the state’s ability to handle a wave of new Medi-Cal applicants that will come via health reform in 2014.
The Inland Empire is a new testing ground for whether the federal government and health consumers can finally do something about rising health costs. Medicare is rolling out a new competitive bidding program that it says will reduce the costs of certain medical equipment by 30 percent or more. Yet what would seem to be a classic, all-American way to deal with pricing – through competition – and with happy winners – taxpayers and Medicare recipients -- turns out not to be that simple. We dive into the debate over the program.
Health reform offers up a big benefit for young adults who haven’t been able to get their own health insurance. Many of them will be able to return to their parents’ insurance policies, up to age 26. This provision is expected to give hundreds of thousands of young adults a bit of breathing room in their hunt for decent medical coverage. (Also published in the LA Daily News, the San Gabriel Valley Tribune, the Whittier News, the Torrance Daily Breeze, and Neon Tommy).
Joblessness is a scourge that hits hard at workers trying to make a life for their families. But it also hits hard at the families themselves, including the children. In San Luis Obispo, children are acting up in school and at home, self-medicating with drugs and alcohol, and suffering from mental health problems such as depression and anxiety. Meanwhile, the institutions that normally serve families – schools, county agencies, churches and nonprofits – are grappling with budget cuts and are slashing services.
Since the town’s clinic closed last year, residents of tiny Doyle, California, now have to travel more than 40 miles one-way to see a doctor. We look at health access in California’s far north, where the lagging economy has forced six rural clinics to close their doors and left the poor and elderly increasingly shut out from health care.
Kern County, with some of the state’s highest rates for diabetes, heart disease and obesity, is home to a test case for the federal government’s new Health Care Coverage Initiative. We examine the successes and challenges of an innovative health care demonstration program for the county’s lower-income population that provides them with a publicly funded “medical home.”
Health reform will offer special incentives to small businesses who continue coverage for their employees – tax cuts covering up to 35 percent of their costs. But that’s of little consolation to many business owners, many of whom are getting rate increases that exceed the tax credits. Some think it’s fishy. (Also published in the Ventura County Star).
There is hope at last for tens of thousands of Californians unable to get health coverage because of pre-existing conditions. The state is establishing a new high-risk pool with more than $750 million in federal money to widen coverage. The new program is a bridge to 2014, when denials of coverage based on pre-existing conditions will be banned.
In the winter, Butte County suffers from a number of bad air quality days that have serious health consequences for the elderly and those with respiratory conditions. We examine the politics and science behind the debate over whether wood stove-generated smoke pollution constitutes a threat to residents’ health. In a county with a long history of heavy dependence on stoves as a source of heat and a bountiful supply of inexpensive wood, this is a heated question.
The nation’s 75 million baby boomers, it turns out, are not immune from the crisis in health care. Economic problems are hitting many Ventura County middle-class baby boomers with loss of jobs and health insurance, and the safety net they paid into during better times was not designed to help them. Uninsured patients ages 45-64 nearly doubled at county hospitals and clinics between 2005 and 2009.
Health reform will have its largest impact in California four years from now. But in the wake of historic passage by Congress, the health overhaul will have multiple immediate effects. Here’s a look. (Also published in the Merced Sun-Star, the Modesto Bee, the Sacramento Bee and the San Luis Obispo Tribune).
The foreclosure of a home is more than a financial transaction. It also is a hidden human drama. Merced County ranked first in California for foreclosure filings in 2009, and sixth among counties nationwide. With one in seven county homes foreclosed on since September 2006, we examine the psychological problems, including anxiety, sleeplessness and depression, wreaked by the local foreclosure crisis, which shows no sign of abating.
Santa Cruz’s Healthy Kids program was wildly successful until 2009, when the battered economy threatened its funding. Like 28 other programs in California, the county’s Healthy Kids program was lauded for providing health coverage for virtually every poor child who was not otherwise insured, regardless of immigration status. By early 2010, however, the program had reached a crossroads: it was forced to freeze enrollment and faced financial struggle.
What impact does the quality of a board of directors, selected by voters, have on the quality of care at public hospitals? It turns out it matters a lot. An analysis of hospitals in North San Diego County shows how decisions made at the ballot box can have a huge effect on a hospital’s success or distress.
The smoke inhalation from long-burning forest fires in northern California extracts a huge, frightening toll on residents’ respiratory health. We measure the ill effects and suggest potential remedies.
In the past two years, many of Santa Cruz County’s elderly and disabled patients have been shut out from a primary care system that has no room for them. Fed up with the low reimbursement rates paid by the federal insurance program for the elderly and disabled, many Santa Cruz County-based doctors have refused to accept new Medicare patients. The series investigates the breakdown in care and the prospects for fixing it.
Nowhere in California are people more likely to die of diabetes than in the eight counties that make up the state’s Central Valley. The disease has reached epidemic proportions in the valley, where it touches one of every ten residents. An analysis by the Center paints a disturbing, detailed picture of the toll diabetes reaps among the valley’s 3 million residents.
What are prospects for bringing a medical school to the University of California’s newest and smallest campus, and to a valley population of 3 million burdened by poverty and lack of access to care? We survey politicians, university officials, representatives of the valley business community, health care workers and farm workers to look at the implications such a school would have on valley health, as well as the impediments the proposal faces.