Tag Archives: health care

On Medicaid money, GOP has win-or-lose proposition for states

New England’s bucolic countryside looks much the same on either side of the Connecticut River separating Vermont from New Hampshire. But Medicaid beneficiaries are far better off in Vermont.

Vermont generously funds its Medicaid program. It provides better benefits, such as dental care, and pays doctors more than New Hampshire’s program does. That brings more doctors into the program, giving enrollees more access to care.

New Hampshire has twice Vermont’s population, but Vermont spends almost as much on Medicaid and covers more enrollees. Under the complicated formulas that set federal funding, Vermont’s substantial investment helps it capture nearly as much aid from the government as New Hampshire gets.

States’ policies differ about who or what to cover in Medicaid, and those decisions have led to historical variances in how much federal money they receive. House Republicans’ effort to shrink federal Medicaid spending would lock in the differences in a way that favors those already spending high amounts per enrollee.

“Republicans are finding out why changing Medicaid is so hard and why the easiest thing to do is to do nothing given the substantial variation in federal spending across states,” said John Holahan, a health policy expert with the nonpartisan Urban Institute.

Here’s why.

Medicaid, the national health program for low-income people that covers about 1 in 5 Americans, is 60 percent funded by the federal government and 40 percent by states. Total spending in 2015 was about $532 billion, according to the latest official data.

Federal funding is open-ended, which means the government guarantees states it will pay a fixed rate of their Medicaid expenses as spending rises.

Those matching rates are tied to average personal incomes and favor the lowest-income states. Mississippi has the highest Federal Matching Assistance Percentage — 76 — while 14 wealthy states, including New York and California, get the minimum 50 percent from the federal government.

But state Medicaid spending varies significantly, too, and that influences how much federal money each receives to fund its program. State policies about how generous benefits should be and how much to pay doctors and hospitals account for those differences.

GOP leaders want to give states a set amount of money each year based on the number of Medicaid enrollees they had in 2016, a formula known as per-capita caps.

A per-capita system would benefit high-spending states already receiving relatively rich allotments from the government, the Urban Institute said in a paper last September.

According to its estimates, if the system were in effect this year, Vermont would receive $6,067 per enrollee — one of the highest allotments in the country — while New Hampshire would get the least, just $3,084 per enrollee.

Per-capita caps would limit the government’s Medicaid spending because it would no longer be on the hook to help cover states’ rising costs. But caps also would shift costs and financial risks to the states and could force them to cut benefits or eligibility to manage their budgets.

“It would present a huge problem,” said Adam Fox, a spokesman for the Colorado Consumer Health Initiative, an advocacy group.

Under the GOP bill, federal Medicaid funding to states would be adjusted annually based on a state’s enrollment and medical inflation. But that would not be enough to keep up with rising Medicaid spending per enrollee, which would force states to put up more of their money or scale back the program, the nonpartisan Congressional Budget Office said March 13.

Other analyses of the GOP plan have reached the same conclusion.

Since 1999, however, the average annual growth rate in Medicaid spending per enrollee has risen more slowly than medical inflation, according to MACPAC, the Medicaid and CHIP Payment and Access Commission, which advises Congress.

Republicans argue that overhauling federal Medicaid spending as they propose would hold down federal costs while giving states more leeway to run their programs as they see fit. “This incentive would help encourage efficiencies and accountability with taxpayer funds,” House Speaker Paul Ryan wrote last June in his white paper, A Better Way.”

Rep. Greg Walden (R-Ore.), chairman of the powerful House Energy and Commerce Committee, which has oversight of health care matters, sounded a similar note at a press conference in Washington, D.C., when the GOP plan was announced. “I think it’s really important to empower states and to put Medicaid on a budget,” he said.

But Fox argued the opposite would happen under a per-capita system — instead of gaining more control over their Medicaid programs, states would not be able to meet their needs because they’d have fewer dollars to decide how to spend, he said.

Bill Hammond, director of health policy for the nonpartisan Empire Center for Public Policy in New York, said House leaders’ decision to tie future Medicaid funding to medical inflation could help mute concerns that funding wouldn’t keep up with rising costs, but would not address the fairness issue of giving some states higher per-capita amounts than others.

“If a low-spending state decides it wants to spend more money on paying hospitals and doctors or adding more benefits, they would have a harder time doing that without breaking the federal cap,” he said.

Medicaid advocates in New Hampshire are worried because their state has few alternatives to make up for a loss in federal funding. New Hampshire lacks an income or sales tax.

“There is a tremendous amount of fear among families here as Republicans try to dismantle the ACA,” said Martha-Jean Madison, co-director of New Hampshire Family Voices.

Published under a Creative Commons license. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Colorado House moves to set new limit on homegrown pot

Colorado is moving to curb the nation’s most generous marijuana allowance for medical patients growing their own pot plants. The state House gave preliminary approval to a bill limiting marijuana patients 16 plants in their homes, down from 99.

The measure aims to make it harder to grow pot outside the taxed and regulated commercial pot system.

Colorado regulators have tried for years to stop people from growing large amounts of pot without state taxation or oversight. But because Colorado’s constitution gives people the right to grow as much pot as their doctors recommend, the state has had a hard time making that happen.

“We need to close this loophole,” said Rep. KC Becker, a Boulder Democrat and sponsor of the bill.

This year’s effort would say that marijuana patients can’t have more than 16 plants in a residential property. The change would force those patients to either move to an industrial or agricultural area, or shop at a dispensary.

Of the 28 states with legal medical marijuana, none but Colorado currently allows more than 16 pot plants per home.

Many Colorado jurisdictions including Denver already have per-home plant limits, usually at 12. But the lack of a statewide limit makes it difficult for police to distinguish between legitimate patients and fronts for black-market weed, bill supporters argued Friday.

“The time has come for us … to give law enforcement the guidance they need,” said Rep. Cole Wist, a Centennial Republican and another bill sponsor.

Marijuana patients have been flooding lawmakers with complaints about the bill, which was introduced just last week. The first hearing on the measure lasted until near midnight.

Lawmakers softened the bill by raising its original limit from 12 plants to 16 plants, and by saying that patients caught with too much pot in the House would face a petty offense, and felony charges only later.

But those changes weren’t enough for some Democrats, who argued in vain that it shouldn’t be a felony until the third offense to have too much pot in the home. They argued that the limits won’t hurt criminal drug operations, which could simply grow their plants in areas that aren’t zoned residential.

“A lot of patients are on fixed incomes. They’re ill,” said Rep. Adrienne Benavidez, D-Commerce City. “Cartels have the money to go rent warehouses.”

The resistance effort even brought one lawmaker to tears. Rep. Steve Lebsock, D-Thornton, held a stack of patient letters and said the change would hurt people who can’t afford to shop in dispensaries.

“We’re throwing patients in jail!” Lebsock cried.

But Republicans sided with other Democrats to prevail on an unrecorded voice vote. The bill faces one more formal vote next week before heading to the Senate, where its prospects are strong.

A companion bill — to give law enforcement more money to sniff out illegal pot growers — is awaiting a House vote Monday.

Gov. John Hickenlooper backs the plant crackdown and has called on lawmakers to send him a statewide limit.

Truth and Consequence: Parsing lawmakers’ lingo on health law

 Dismayed by the results of the 2016 election, Meg Godfrey decided she needed to do more than vote, share social media posts and sign online petitions. So she went to the website of Sen. Roy Blunt, R-Missouri, and typed a note in support of the Affordable Care Act.

The email then gave a number of statistics to buttress Blunt’s position that the law is failing.

But something about the letter didn’t sit right with Godfrey, so she forwarded the email to ProPublica, asking us to fact check it. Our assessment: The note was misleading and lacked important context.

That led ProPublica to wonder about the accuracy of responses sent to constituents by other members of the House and Senate on the Affordable Care Act and its future.

Today, ProPublica is teaming with journalists at Kaiser Health News, Stat and Vox to gather those missives from our readers.

On Monday, House Republican leaders unveiled their official proposal to repeal and replace the law. As the legislative debate begins in earnest, we plan to look at the representations made by elected officials from both parties and share what we find.

ProPublica asked Timothy Jost, an ACA expert and emeritus professor at Washington and Lee University School of Law, to review Blunt’s email. “Some of this information is inaccurate, the rest of it is spin,” he concluded.

A spokesman for Blunt provided citations for the data in the senator’s note but did not respond to a follow-up email.

Jost helped us break down Blunt’s message:

Blunt’s email: “By the end of 2013, over 4.7 million Americans had their health care plans canceled.”

Analysis: The 4.7 million figure came from an Associated Press article from December 2013, Blunt’s office said. Subsequent analyses, however, showed that the figure was overstated. Two researchers from the Urban Institute, writing in the journal Health Affairs, estimated that the number was closer to 2.6 million. Moreover, Jost notes, the Obama administration said states could allow insurers to leave transitional plans in place after Jan. 1, 2014.  Missouri was one of the states that did so. “So if a plan was cancelled in Missouri, it was the decision of the insurer, not a federal requirement,” Jost wrote.

Blunt’s email: “This year, Missourians who purchase health insurance on the ObamaCare exchanges will see an average of a 25 percent increase on their premium.”

Analysis: The average premium for a Missouri plan did indeed increase by 25 percent this year, according to ACAsignups.net, a website that tracks the law and was cited by Blunt’s office. But that isn’t the entire story. First, the vast majority of marketplace enrollees in Missouri and nationwide receive hefty subsidies that reduce their cost.

Second, if you step out of the aggregate and look instead at a hypothetical person shopping for an affordable plan, the increase is lower. The Obama administration often compared monthly premiums for a 27-year-old in a benchmark plan (the plan upon which the government calculates subsidies). In Missouri, the premium actually decreased from $235 to $233 between 2014 and 2015. It increased 10 percent in 2016 and another 18 percent, to $305, for this year, according to the U.S. Department of Health and Human Services.

But most enrollees aren’t paying the sticker price. Some 78 percent of Missouri marketplace consumers in 2016 could obtain coverage for $100 or less per month in 2017, after accounting for subsidies from the government, federal data shows.

Blunt’s email: “In addition to increased costs, families in Missouri and across the nation have lost the ability to choose a plan that best suits their health care needs.   Missourians in 97 of 114 counties and the city of St. Louis will only have one option on the exchange.”

Analysis: Blunt is technically correct, but again the statistic lacks context, according to Politifact Missouri. “According to the U.S. Census Bureau, of Missouri’s roughly 6 million residents, about 63 percent live in the 17 counties and one city that will continue to have at least two provider choices,” the fact checker wrote in February.

What’s missing: Blunt’s email did not mention that more than 200,000 Missourians receive coverage through the Affordable Care Act exchanges. It also didn’t mention that health insurance premiums routinely increased by large amounts before the law took effect and that many Missourians with preexisting conditions effectively had no insurers to pick from, Jost said.

The number of people without insurance has gone down under the ACA, falling from 13 percent in 2013 to 9.8 percent in 2015, the most recent year for which data is available, according to the U.S. Census Bureau.

Blunt spokesman Brian Hart declined to say how many people have written the senator about the ACA and what percentage of them were for or against the law.

Godfrey, who wrote to Blunt, is currently employed as a brand communications manager for a lighting manufacturer. She and her husband live in Northern California but are moving to St. Louis later this year. “I’m getting a head-start on my political activism in the state,” she wrote in an email to ProPublica. “We had planned to retire and get insurance on the exchange. Now we still plan to move but will, most likely, continue to work until we are eligible for Medicare.”

Godfrey, 62, said Blunt’s response to her was “infuriating.”

“I asked about what he was doing to take care of the people who elected him and he spouted misleading statistics,” she wrote. “I am surprised he didn’t bring up death panels [which do not exist]. I hate being treated like an idiot.”

Have you corresponded with a member of Congress or a senator about the Affordable Care Act? We’d love to see the response you received. Please fill out our form .

Charles Ornstein is a senior reporter at ProPublica, a nonprofit news organization based in New York City. This story was co-published with ProPublica, Stat and Vox. It is published here under a Creative Commons license in cooperation with Kaiser Health News.

House GOP health bill jettisons insurance mandate, much of Medicaid expansion

House Republicans unveiled their much anticipated health law replacement plan Monday, slashing the law’s Medicaid expansion and scrapping the mandate that individuals purchase coverage or pay a fine. But they opted to continue providing tax credits to encourage consumers to purchase coverage, although they would configure the program much differently than the current law.

The legislation would keep the health law’s provisions allowing adult children to stay on their parents’ health insurance plan until age 26 and prohibiting insurers from charging people with preexisting medical conditions more for coverage as long as they don’t let their insurance lapse.  If they do, insurers can charge a flat 30 percent late-enrollment surcharge on top of the base premium, under the Republican bill.

In a statement, House Speaker Paul Ryan (R-Wis.) said the proposal would “drive down costs, encourage competition, and give every American access to quality, affordable health insurance. It protects young adults, patients with preexisting conditions, and provides a stable transition so that no one has the rug pulled out from under them.”

The GOP plan, as predicted, kills most of the law’s taxes and fees and would not enforce the so-called employer mandate, which requires certain employers to provide a set level of health coverage to workers or pay a penalty.

Democrats quickly condemned the bill. “Tonight, Republicans revealed a Make America Sick Again bill that hands billionaires a massive new tax break while shifting huge costs and burdens onto working families across American,” House Minority Leader Nancy Pelosi tweeted. “Republican will force tens of millions of families to pay more for worse coverage — and push millions of Americans off of health coverage entirely.”

The legislation has been the focus of intense negotiations among different factions of the Republican Party and the Trump administration since January. The Affordable Care Act passed in 2010 without a single Republican vote, and the party has strongly denounced it ever since, with the House voting more than 60 times to repeal Obamacare. But more than 20 million people have gained coverage under the law, and President Donald Trump and some congressional Republicans have said they don’t want anyone to lose their insurance.

When Republicans took control of both Congress and the White House this year, they did not have an agreement on the path for replacement, with some lawmakers from states that have expanded Medicaid concerned about the effect of repeal and the party’s conservative wing pushing hard to jettison the entire law.

Sen. Rand Paul (R-Ky.), one of those favoring a full repeal, tweeted: “Still have not seen an official version of the House Obamacare replacement bill, but from media reports this sure looks like Obamacare Lite!”

Complicating the effort is the fact that Republicans have only 52 seats in the Senate so they cannot muster the 60 necessary to overcome a Democratic filibuster. That means they must use a complicated legislative strategy called budget reconciliation that allows them to repeal only part of the ACA that affect federal spending.

Beginning in 2020, the GOP plan would provide tax credits to help people pay for health insurance based on household income and age, with a limit of $14,000 per family. Each member of the family would accumulate credits, ranging from $2,000 for an individual under 30 to $4,000 for people ages 60 and higher. The credits would begin to diminish after individuals reached an income of $75,000 — or $150,000 for joint filers.

Consumers also would be allowed to put more money into tax-free health savings accounts and would lift the $2,500 cap on flexible savings accounts beginning in 2018.

The legislation would allow insurers to charge older consumers as much as five times more for coverage than younger people. The health law currently permits a three-to-one ratio.

Community health centers would receive $422 million in additional funding in 2017 under the legislation, which also places a one-year freeze on funding for Planned Parenthood and prohibits the use of tax credits to purchase health insurance that covers abortion.

Both the Energy and Commerce and Ways and Means Committees are scheduled to mark up the legislation Wednesday. The committees do not yet have any Congressional Budget Office analysis of how much the legislation would cost or how many people it would cover.

Party leaders have said they want to have the bill to President Trump next month.

In a statement, senior Democrats on both panels said the measure would charge consumers “more money for less care. It would dramatically drive up health care costs for seniors. And repeal would ration care for more than 70 million Americans, including seniors in nursing homes, pregnant women and children living with disabilities by arbitrarily cutting and capping Medicaid,” said Rep. Frank Pallone of New Jersey and Rep. Richard Neal of Massachusetts.

The House GOP plan makes dramatic changes to Medicaid, the state-federal health insurance program that covers 70 million low-income Americans. The program began in 1965 as an entitlement — which means federal and state funding is ensured regardless of cost and enrollment. But the Republican bill would cap federal funding for Medicaid for the first time.

The federal government picks up between half and 70 percent of Medicaid costs. The percentage varies based on the relative wealth of the state.

Under the GOP plan, federal funding would be based on what the government spent in the fiscal year that ended Sept. 30. Those amounts would be adjusted annually based on a state’s enrollment and medical inflation.

Currently, federal payments to states also take into account how generous the state’s benefits are and what rate it uses to pay providers. That means states like New York and Vermont get higher funding than states like Nevada and New Hampshire and those differences would be locked in for future years.

Republicans have pushed to cap federal funding to states in return for giving them more control in running the program.

The legislation also affects the health law’s expansion of Medicaid, in which the federal government provided enhanced funding to states to widen eligibility. The bill would also end that extra funding for anyone enrolling under the expansion guidelines starting in 2020. But the legislation would let states keep the extra funding Obamacare provided for individuals already in the expansion program who stay enrolled.

About 11 million Americans have gained Medicaid coverage since 2014.

Changing the expansion program is a delicate balance for the Republicans. Four GOP senators from states that took that option said Monday they would oppose any legislation that repealed the expansion.

“We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska wrote in a letter to Majority Leader Mitch McConnell.

Provided under a creative commons license by Kaiser Health News. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation

50 nations seek to counter Trump’s ban on family planning funds

Some 50 countries have signed up to attend a family planning conference in Brussels aimed at making up the gap left by President Donald Trump’s ban on U.S. funding to groups linked to abortion.

The participants agreed to attend the conference scheduled for Thursday on short notice to discuss using pledges from other nations and the private sector to “make sure that the impact on the field is completely taken away,” Belgian Vice Premier Alexander De Croo said.

“This should not be a moment where we are taking steps back into the Dark Ages for women and girls,” De Croo said.

Trump’s decision, one of his first acts as president, withholds about half a billion dollars a year from international groups that perform abortions or provide information about abortions. Officials in many European nations and around the world say the move will hurt women and girls who need family planning most.

“This is 50 countries saying, ‘Let’s roll up our sleeves and let’s stand for the values we think are important,’” De Croo said.

Belgium and several other countries already have committed to contributing at least 10 million euros each. Beyond governments, philanthropists and private donors will be asked to contribute at the conference.

Outside of many European nations, Canada, African and Asian countries will also have representatives at the conference, as will the European Union and the United Nations.

Swedish Vice Premier Isabella Lovin told the AP that even though maternal mortality rates have declined by almost half in the last generation, “every second minute a woman or a girl dies in the world due to pregnancy.”

“The important thing now is what we can do as a progressive alliance of countries and organizations that want to do more and to make sure that we do not (go) back on progress that has been done,” Lovin said.

The U.S. ban on funding to organizations that perform abortions or discuss the procedure with clients has been instituted by Republican administrations and rescinded by Democratic ones since 1984.

Former President Barack Obama last lifted it in 2009. But Trump significantly expanded it in an executive order he signed on his first full day in office.

Instead of containing abortions, the move would increase dangerous pregnancy terminations, Lovin and De Croo said.

De Croo insisted that he was not putting up a defense of abortion, per se.

“To be clear, any abortion that takes place is one too many,” he said. “But if it has to take place, then I think it should be available, and it should be available in a safe way.”

President Trump and I take the same drugs — except one

While popping my daily dose of pills the other day — you know, the drugs guys over 60 often take to try to squeeze out another decade or two — I stumbled across a news story describing the drugs President Donald Trump takes, according to his personal physician.

The list took me aback. The 45th president and I are aging like blood brothers. We’re both using baby aspirin to stave off heart attacks, a statin to lower our cholesterol and doxycycline to control a similar skin-reddening condition called rosacea.

But there’s one drug in Trump’s reported regimen that I would never touch — a medication to prevent premature baldness called Propecia. Never mind that my hair is thinning faster than the South American rain forest. You still couldn’t pay me to take Propecia. Here’s why:

Propecia, a simple daily capsule, may help the president preserve his famous hairline. His New York physician, Harold N. Bornstein, told The New York Times recently that he, too, takes Propecia, which may foster the flowing locks the doctor sports at age 69.

But keeping one’s hair through the miracles of modern medicine comes with risk. Propecia, the brand name for drug giant Merck’s finasteride, has become a magnet for personal injury lawyers with, by one count, 1,370 lawsuits filed by plaintiffs. There’s no indication that Trump — who’s famous for enjoying a spirited lawsuit now and then — has made any legal filings against Propecia. The White House press office did not respond to phone and email requests for comment.

The stories laid out in court filings are enough to make a bald man accept a hairline in full retreat. Complaints chronicle sexual dysfunction, mood swings and ruined relationships, even suicides, allegedly linked to the pills intended to keep hair intact. “The company intends to defend against these lawsuits,” Merck said, in a statement.

Propecia was approved by the Food and Drug Administration in 1997. Its Madison Avenue-invented name rhymes with felicia, similar to the word for “happy” in Spanish.

A product label available online details how the drug works: It blocks the body’s ability to turn testosterone into dihydrotestosterone or DHT, a hormonal change that somehow keeps hair from falling out of prematurely balding male scalps (the medical term is androgenetic alopecia).

The literature reports a 48-week study of more than 200 men with androgenetic alopecia. Some participants were given placebos, but the ones taking Propecia “showed increase from baseline in total and anagen hair counts of 7 hairs and 18 hairs, respectively.” The men on placebos lost hair throughout the study.

Rival drug Rogaine, by Johnson & Johnson Consumer, also has been the subject of lawsuits, but most of those involve various allergic reactions to the minoxidil in Rogaine, not allegations of sexual dysfunction.

Many of the Propecia lawsuits allege that victims experienced sexual side effects after they stopped taking Propecia and/or Proscar — which, at 5 mg of finasteride, is five times the strength of Propecia and is specifically intended for men with enlarged prostates. About 50 lawsuits allege that Propecia caused or can cause prostate cancer, testicular cancer or male breast cancer, according to a financial statement from Merck. Others have sued Merck for memory loss or a combination of sexual side effects and memory loss.

Hundreds of these lawsuits have been consolidated into multi-district litigations. A trial, once scheduled for late 2016, has been delayed until at least September 2017.

On its website, Merck spells out three “most common side effects” of Propecia: decreased sex drive and semen count, and trouble with erections.

The company’s statement notes: “Merck stands behind the demonstrated safety and efficacy profile of Propecia (finasteride), which has been prescribed to millions of men.”

The warnings alone are enough to keep me from pondering Propecia. But then there are real-life stories such as that of Mikael Mikailian, 39, an entrepreneur who lives in Encinitas, Calif.

Mikailian started taking Propecia around the time he turned 20, and first noticed thinning hair. “I didn’t want to deal with the shame and embarrassment of being bald at a young age,” he said. A doctor prescribed Propecia and assured him it was safe. He estimates that the drug cost him about $90 per month.

The good news: His hair quickly started to grow and his bald spot disappeared.

The bad news: Within three years, Mikailian’s sex life was declining. He also noticed memory problems. One night, on a dinner date, he couldn’t remember his date’s name. He contacted Dr. Irwin Goldstein, a San Diego urologist known for mitigating the sometimes unpredictable side effects when men stop using Propecia.

Over 18 months, Goldstein slowly weaned Mikailian off of Propecia — while closely tracking his hormone and mood levels. Goldstein also prescribed a hormonal drug more commonly used by women.

“My body hadn’t produced testosterone for 20 years,” Mikailian said. “I was experiencing a complete lack of motivation and low sexual interest.”

Mikailian’s short-term memory problems worsened. “I 100 percent attribute this to the effects of Propecia,” he said.

Under care, he eventually reclaimed both his memory and his libido. But it cost him thousands of dollars that his health insurance wouldn’t cover.

Goldstein, in a phone interview, said he has more than 100 Propecia patients. “For many of them, it’s a nightmare situation,” he said. “It gets so emotional for me that I’m at a loss for words.”

Merck had no specific response to Goldstein’s criticism — nor to the negative experiences his patients say they had with Propecia.

In 2012, the FDA made Merck change the label for Propecia and Proscar to warn they may be linked to “libido disorders, ejaculation disorders, and orgasm disorders that continued after discontinuation of the drug.”

“We encourage patients to talk with their doctor if they have any questions or concerns about their health or about Propecia,” Merck said, in a statement.

Goldstein declined to specifically discuss Trump’s purported use of Propecia.

Mikailian, who is not currently involved in any of the Propecia lawsuits, said Trump should be attuned to possible memory loss.

As for me, hey, at 64, I can experience memory loss just by waking up. I don’t need drugs to exacerbate that. Nor is the potential replenishment of my hair worth jeopardizing my precious manhood.

So, I’ll stick with the baby aspirin and work toward building a healthier heart. You won’t find me counting hairs. Just blessings.

This story also ran in The Daily Beast. Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Progressive voices respond to the president’s speech

President Donald Trump delivered on Feb. 28 a speech to Congress. Here’s reaction to Trump’s remarks from progressive voices:
“The theme of tonight’s joint address to Congress — the ‘renewal of American spirit’ — felt painfully hollow as the only renewal I’ve seen since President Trump took office is a pernicious wave of nationalism, racism, misogyny, and antisemitism. Rather than detailing a plan to quell the violence and vandalism perpetrated by those who feel emboldened by his actions, President Trump touted his own perceived success while feigning concern for bipartisanship and unity.

“Much like his campaign, President Trump’s speech emphasized flash over substance, failing to provide tangible policy proposals to match his boasts and taking credit for the success of President Barack Obama. I found the president’s words empty and indicative of a weak person’s idea of what strength looks like. Not only did he fail to mention the fate of critical social safety programs that will undoubtedly suffer in the face of the president’s military spending increase, but it was also clear that vital issues like gender-based violence simply weren’t a concern of his administration.

“I find it incredulous that President Trump could claim a commitment to national security while failing to even mention how we will protect our nation’s women and daughters, especially when an average of three women are killed by a current or former partner every day in our country. Fortunately, Deborah Parker was by my side tonight as my guest to help stress our shared moral imperative to safeguard our nation’s most vulnerable. Deborah was instrumental in helping me reauthorize the Violence Against Women Act (VAWA) in 2013 to include critical provisions for Native American women and girls. With VAWA grant funding in jeopardy of being eliminated by the Trump administration, Deborah’s unique voice and steadfast advocacy is needed now more than ever.”

— U.S. Rep. Gwen Moore, D-Milwaukee

“Donald Trump claims he will ‘invest in women’s health’ but what he and the anti-abortion majority in Congress have proposed is exactly the opposite. His plans to gut Obamacare, push abortion out of reach for even more women, take away our birth control coverage, and make the Hyde Amendment permanent all amount to the same thing: taking care away from those that need it. We’re also deeply disturbed by his escalation of harmful policies against immigrant women and families and troubling statements about communities of color. We need policies that treat women — and all people — with respect and dignity, not more politics of pain and punishment.”

— Destiny Lopez, co-director of All* Above All

“Donald Trump’s address to Congress vividly illustrates just how out of touch he is with the reality of people’s lives. In his world, everything he does is ‘great’, when the reality is that his policies are causing pain, suffering, and uncertainty for millions, and most often for the most vulnerable. In just 40 days, he has aggressively used his executive powers to demonize and dehumanize immigrants, Muslims, and trans youth — and he’s just getting started. One thing that is certain though is that every time he opens his mouth, more people want to join the resistance movement against his extremism.”

Rea Carey, executive director, National LGBTQ Task Force

“The type of widespread deregulation that President Trump advocates would be detrimental to small businesses and their communities on a number of levels. Small business owners benefit from regulations that level the playing field and protect communities and investments that foster growth on Main Street.”

— Amanda Ballantyne, national director of the Main Street Alliance

“We’re disturbed by Donald Trump’s speech last night. He spoke of uniting America, but almost every idea, every proposal promises to lead to more division.

“Rather than focusing on addressing our challenges, Mr. Trump called for more policing, more immigration enforcement, and boasted progress on the Dakota Access Pipeline even as he gutted regulations for clean water — a slap in the face to indigenous people everywhere.

“And playing politics with human lives, Donald Trump and his allies in Congress seemed casually enthused about robbing 30 million people of their health care coverage, including the 13 million people who have benefited from the expansion of Medicaid.

“What we needed to hear from Donald Trump was a comprehensive economic security agenda. One that includes all the issues that impact women’s ability to survive and thrive: immigration reform, racial justice, workers’ rights, caregiving, and reproductive health care. All critical issues for women and people of color.

“We applaud several women Members of Congress who wore the colors of suffragists in protest of Trump’s ghastly agenda. The Ms.Foundation for Women joins them and will continue to lead the fight for economic and health parity. We won’t go back. Millions of lives depend on it.”

— Ms. Foundation president and CEO Teresa C. Younger

“Last night, Mr. Trump tried to trick us into believing he cares about the needs of middle income and working families all across the country. But Trump’s economic team is shamefully comprised of corporate elites from Goldman Sachs and other Wall Street firms who helped destroy our economy less than ten years ago. We will not allow these corporate bandits to loot the wealth of America’s families again.”

 Shannon Jackson, executive director, Our Revolution

“When he was elected, Donald Trump promised to be a president for all Americans, yet he continues to pursue policies that put the powerful above the people, and to attack the most vulnerable in our society. Tonight’s address, sadly, continues that trend.

“He touted his Task Force on Reducing Violent Crime, but his Justice Department has already pursued policies that fail to create a better criminal justice system.  The recent decision to continue to rely on private prisons for federal inmates is neither humane nor budget-wise. We need a justice system that can work better for all people.

“His continued push for Neil Gorsuch to serve on the highest court in the land obscures the judge’s troubling record and Trump’s own denigration of judges who disagree with him. Gorsuch has consistently shown that he puts powerful corporate interests above the rights of workers and ordinary people. The Constitution demands an independent judiciary, and the American people deserve a Supreme Court justice who will be independent and not serve as a rubber stamp for the President who appointed him.

“We urge caution on Trump’s call for immigration reform but look forward to working with lawmakers to ensure that proposed changes uphold our legacy as a nation of immigrants. The continuing attacks on immigrants and refugees that we see from our chief executive undermines this laudable goal.

“His call to Congress to repeal and replace the Affordable Care Act will not help protect the health and well-being of Americans, particularly the poor and underserved. Republican lawmakers know their constituents are benefiting from the Affordable Care Act, and yet they want to take this vital program away.

“Given the philosophy of our Secretary of Education, it was not surprising that Trump called for Congress to divert public funding for schools in private school voucher programs. Such efforts are likely to undermine federal civil rights protections and open the door to taxpayer-funded discrimination. And just a week after his administration rescinded Title IX guidance to protect transgender students, Trump called education ‘the civil rights issue of our time.’ That’s not what standing up for civil rights looks like.

“As we continue to address the challenges facing all Americans, we must do so in a manner that does the most good, consistent with our Constitution and the rule of law.”

— Wade Henderson, president and CEO of The Leadership Conference on Civil and Human Rights

Testosterone gel shows no benefit for older men’s memories

Testosterone treatment did not improve older men’s memory or mental function in the latest results from landmark government research that challenges the anti-aging claims of popular supplements.

While testosterone use for one year appeared to strengthen bones and reduce anemia, it also showed signs of worsening artery disease and questions remain about other potential risks. The researchers said more studies are needed to determine long-term effects — the kind of research the U.S. Food and Drug Administration has already asked supplement makers to conduct.

‘’I don’t think anybody would interpret these results as saying, ‘Wow, this is a fountain of youth, this is a magical anti-aging potion,”” said study co-author Susan Ellenberg, a University of Pennsylvania researcher.

The results are from the final four studies in a seven-part project mostly funded by the National Institute on Aging, involving nearly 800 U.S. men aged 65 and older with low testosterone levels. The goal was to see if rubbing testosterone gel on the skin daily for a year could treat problems linked with low levels of the male hormone, which declines with age. Half the men in each group used the real thing and half used fake gel.

Results published a year ago from the same research linked testosterone with mostly modest improvement in sexual performance, walking strength and mood.

The key new findings:

_Testosterone had no effect on memory or mental function, based on tests given before, halfway and at the end of treatment to nearly 500 men with age-related memory decline.

_Among almost 140 men who underwent heart artery imaging tests to see if the hormone slowed progression of plaque, those who used testosterone had more plaque buildup and narrower arteries after a year than the fake gel group. Those changes could signal increased chances for heart attacks although none occurred in the study. Men in this sub-study were already more vulnerable for heart problems because of conditions including artery disease, obesity and high blood pressure.

_Among about 200 men given bone imaging tests before and at the end of treatment, those on testosterone showed increases in bone density and strength, especially in the spine, while minimal changes were found in the group that used fake gel. The improvement was similar to bone changes seen with treatment for osteoporosis, although most men studied did not have that bone-thinning condition, which can lead to fractures.

_Among 126 men with anemia, a fatigue-linked condition involving inadequate red blood cells, those on testosterone showed substantial improvement. By the study’s end, anemia had vanished in almost 60 percent of men on testosterone compared with 22 percent of the fake gel group. The hormone group also reported having more energy. “The overall health benefits, however, remain to be determined,” the researchers said.

The studies were published in the Journal of the American Medical Association and JAMA Internal Medicine. AbbVie Pharmaceuticals provided its gel for the study and helped pay for the research but had no other role in the study.

The research was not designed to look at risks and does not apply to younger men or those with normal levels of testosterone, said study leader Dr. Peter Snyder, a University of Pennsylvania hormone specialist. It’s also not known if other forms of testosterone supplements would have similar effects in older men with low levels.

Prescription testosterone products including gel are approved only for men with low levels of the hormones caused by various medical conditions. Benefits and risks are unknown in men whose levels are low due only to aging, the FDA says. The agency requires testosterone labels to include possible risks for heart attacks and strokes, based on some previous studies.

A separate study published in JAMA Internal Medicine found that men using prescription testosterone gel, patches or injections had fewer heart attacks and strokes during about three years of follow-up than non-users. But this was only observational data in men aged 40 and up, not rigorous research testing the hormone against a placebo.

Clarifying testosterone’s effects on heart problems, fractures and age-related disability will require larger, longer studies, said Dr. Evan Hadley of the National Institute on Aging. He said decisions about whether to use testosterone should take into account men’s individual risks for conditions the hormone could affect.

 

Sanders announces health care rallies from coast to coast

U.S. Sen. Bernie Sanders says more than 100 rallies will take place from coast to coast on Feb. 25 to fight Republican attempts to take health care away from 20 million Americans.

Sanders, in a statement, said, “The American people will let Republicans know they are standing against their attempts to repeal the Affordable Care Act, throwing 20 million Americans off of their health insurance, privatizing Medicare, making massive cuts in Medicaid, raising the cost of prescription drugs for seniors and, at the same time, giving a massive tax break to the top 1 percent. The American people want to improve the Affordable Care Act, not destroy it.”

Sanders, the Senate Democrats’ outreach leader, and Senate Democratic Leader Chuck Schumer previously sent a letter calling for rallies to oppose efforts by President Donald Trump and Republicans in Congress to repeal the Affordable Care Act.

Said Schumer and Sanders in the letter, “The Republican Party’s plan to repeal the Affordable Care Act is in chaos. Public support for the law is at an all-time high, while the number of Americans supporting its immediate repeal without a replacement has dipped below 15 percent. It is critical we seize this momentum.”

For details on where rallies will take place, click here.

Obamacare came to Montana Indian Country and brought jobs

The Affordable Care Act created new health coverage opportunities for more than half a million Native Americans and Alaska Natives — and jobs have followed on its coattails.

In Montana, this is playing out at the Blackfeet Community Hospital. It’s the only hospital on the Blackfeet reservation and has been mostly funded — and chronically underfunded — by the Indian Health Service, which has been in charge of Native American health care since its founding in the 1950s.

But now, many Native Americans have been able to afford health insurance on the Obamacare exchange, and last year, Montana expanded Medicaid. Now, about one in seven reservation residents gets Medicaid.

Blackfeet Community Hospital needed to build an infrastructure to deal with the byzantine bureaucracy that comes with taking Medicaid and private insurance. The tribe’s community college started a new curriculum to help meet the growing demand for people in Indian country to process insurance claims.

Blackfeet tribal member Gerald Murray took the courses. “I got a contract before I graduated in April, and then the day of graduation in May it became permanent so I applied for it,” he said.

Murray’s experience is an example of the health care law’s transformative power in Native American communities, said Montana’s director of American Indian Health, Mary Lynn Billy-Old Coyote.

“To me, there’s opportunity there to not only build health care, but to build your entire community and build jobs,” said Billy-Old Coyote.

Unemployment on most of Montana’s Indian reservations is at least double the rest of the state. And people who are working don’t always get health insurance with their jobs.

So ACA subsidies that bring down the cost of insurance premiums are a big deal, Billy-Old Coyote said.

Most Montanans, Native or not, can now get policies for about $75 a month. It is a big change for the reservation communities where people are accustomed to the underfunded IHS, which often didn’t pay for care unless someone was in immediate danger of losing life or limb.

“Now you’ve got an opportunity for American Indian people to truly have access to private insurance,” she said. “You have access to greater networks of providers and specialists, and all the things we generally don’t see you have access to.”

Medicaid expansion had a lot to do with the number of health care jobs in Montana growing by 3 percent last year, according to state statistics. And schools in Montana, including tribal colleges, are offering more classes in health care fields.

At Blackfeet Community College, 23-year-old Leroy Bearmedicine is working toward certification as an emergency medical technician.

“I’d like to become a registered nurse at some point, maybe even work my way up to flight nurse — something to get the adrenaline going,” he says.

Native American leaders have seen the Affordable Care Act as a means to remedy a series of broken promises by the federal government to care for them. They now fear that promise, too, will fade. One estimate suggests Montana will lose 3,000 health care jobs if the Affordable Care Act is repealed.

This story is part of a reporting partnership with NPR, Montana Public Radio and Kaiser Health News. It is published here under a creative commons license agreement and courtesy of KHN.