Tag Archives: wellness

Many face hazards of lead as Trump eyes massive budget cuts

Laicie Manzella lived in a rundown house on Buffalo’s east side when three of her children tested with dangerously high levels of lead in their blood. Her oldest son suffered nosebleeds, body rashes and a developmental disorder requiring speech therapy.

Checking her apartment, county health inspectors found 15 lead violations, all linked to old paint in this blue collar city plagued by lead poisoning.

A Reuters investigation found at least four city zip codes here where 40 percent of children tested from 2006 to 2014 had high lead levels, making Buffalo among the most dangerous lead hotspots in America. The rate of high lead tests in these areas was far worse — eight times greater — than that found among children across Flint, Michigan, during that city’s recent water crisis.

Federal support has helped Manzella and other families in Buffalo and beyond. This month, her family moved into a gleaming, lead-free apartment renovated by a local nonprofit with funding from the U.S. Department of Housing and Urban Development.

This type of assistance may not last much longer.

President Donald Trump is advocating deep federal budget cuts that would sap billions from programs used by state and local governments to protect children from the lifelong health impacts of lead exposure.

“If they go and snatch these funds away, where are we going to get help from?” Manzella said.

It’s a question being asked in cities across the United States bracing for cuts in programs that identify and eradicate lead poisoning hazards. Awareness of lead poisoning escalated following Flint’s crisis, and more recently from Reuters reporting that has identified more than 3,300 areas with childhood lead poisoning rates at least double those found in the Michigan city.

Some of the areas slated to be hit hardest supported Trump in November’s election, though he lost Erie County, where Buffalo is the county seat.

At least eight of the nine federal agencies sharing responsibility for lead poisoning prevention face potential budget cuts. But the heaviest lifting falls to HUD, the Centers for Disease Control and Prevention and the Environmental Protection Agency. Trump’s budget would cut at least $4.7 billion from programs at HUD and the EPA that support healthy housing and lead pollution cleanup efforts, a Reuters analysis found. Funding for a CDC program that assists states with poisoning prevention is uncertain.

Cuts would be felt across the country. The Trump administration would eliminate a $27 million program that trains private contractors on lead removal, and a $21 million program that funds lead abatement projects in Alaska, Illinois, Ohio, Oklahoma and California. It would kill a program that provided funds to a Rhode Island nonprofit to upgrade housing, and end a $970 million affordable-housing program that has fixed up dilapidated homes in hundreds of U.S. cities, including Flint.

If the cuts clear Congress, some experts fear the fight against lead could stall out for years.

“We are dooming future generations,” said Dr. Gale Burstein, health commissioner in Erie County. “Exposure to high lead levels causes brain damage to kids, learning disabilities and behavioral challenges.”

Instead of saving money, the cost of inaction could spiral, Burstein said. More children would be afflicted by learning disabilities and other neurological problems, leaving localities to foot the bill for treatment programs.

White House officials declined to comment.

Decades of lead abatement have sharply curbed childhood lead levels across the United States. But studies have shown no level of lead in the blood is safe, and poisoning persists in thousands of locales.


In December, Reuters used previously undisclosed data obtained from 21 states to pinpoint nearly 3,000 U.S. neighborhoods where poisoning rates among tested children were at least twice as high as in Flint.

Reporters have since obtained testing results covering eight additional states and expanded data from two more, including New York, Louisiana, New Jersey, Virginia, New Hampshire and California. The new data reveal another 449 neighborhoods with rates that high.

The communities stretch from affluent neighborhoods in the Los Angeles area to an impoverished quarter of Shreveport, Louisiana, to a rural town in Salem County, New Jersey, where Trump won 56 percent of the vote in November.

The data paints a partial picture. Reuters has not obtained neighborhood-level testing results for 21 states and the District of Columbia. These areas cited privacy concerns or said they do not have the data.

Still, the available results show the toxic metal remains a threat to millions of children.

Federal programs fund testing for children, cleanup of industrial lead hazards and poisoning-awareness efforts. Other programs require inspections or abatement in housing built before 1978, when lead was banned from residential paint.

The few planned funding increases under Trump may not be as beneficial as they appear. HUD’s Healthy Homes and Lead Hazard Control Program is slated to receive a $20 million boost, but the agency has proposed eliminating $4.1 billion worth of grant programs local officials say play a bigger role in reducing risks.

“I think you’re going to see more children, not fewer children, exposed to lead,” said Senator Jack Reed, a Democrat who has sought more funding for lead-abatement programs on the Senate subcommittee that funds HUD.

Congress, which controls federal spending, may not go along. A spokeswoman for Senator Susan Collins described lead-based hazards as “one of the most prevalent health issues facing children today.” She said the Maine Republican would use her position as head of the subcommittee that controls HUD’s budget to oppose cuts.


Buffalo has long fought a legacy of lead contamination. Blood data shows 17 city zip codes where the rate of tested children with high lead levels was at least double that of Flint – about 8,000 children over nine years.

“Nobody’s talking about Buffalo as ground zero for the lead problem, but when it comes to the levels of lead that’s been identified in children, it’s higher than what you see in Flint,” said Erie County Executive Mark Poloncarz.

Buffalo’s problem stems from a simple equation: Old houses plus high poverty equal lead poisoning. Older homes are often blanketed with lead paint, and the water pipes and fixtures typically contain lead. In poorer neighborhoods, homes are frequently neglected, leading to exposure from peeling paint or dust. Fifty-eight percent of the city’s housing was built before 1940; nearly 40 percent of residents live below the poverty line.

Still, Buffalo and Erie County have made progress. In 2007, three city zip codes had 50 percent of tested children with high lead levels. By 2014, the prevalence in those zip codes dropped to an improved, but still worrisome, 30 percent.

Progress came thanks to millions of dollars in federal assistance flowing to local programs.

From 2012 through 2016, Buffalo was granted $27.7 million from the now-threatened HUD HOME Investment and Partnerships Program. HUD’s blessing brought far greater resources to bear, with city, county and nonprofits using the grant to attract another $200 million to revitalize or replace 1,125 housing units, making them all lead-safe.

Among those helped: The Chowdhurys, a family of five who moved to the east side of Buffalo in 2010, settling in a neighborhood with one of the highest lead poisoning rates in the country.

Within two months, their one-year-old daughter, Nabiha, was found to have a lead level about twice that of the elevated threshold set by the CDC, five micrograms per deciliter. Any child at or above CDC’s threshold warrants a public health response, the agency says.

MD Chowdhury, a restaurant waiter, and his wife, Nazneen Fatema, didn’t know how their daughter was poisoned or how to help her, but Buffalo and Erie County did.

Local officials dispatched housing inspectors, nurses and contractors to identify and repair the lead hazards in the family’s home. Replacing the lead-paint coated windows and siding and installing a new roof cost about $40,000. Federal grant programs footed the bill.

Erie County’s Health Department receives $244,000 a year from the CDC to help fund five full-time employees and three part-time employees who refer at-risk children for testing, investigate the causes of lead poisoning and conduct educational home visits. Those staffers helped the family.

Chowdhury also took EPA-funded classes on how to safely remove lead-based-paint so he could do additional work himself.

Two years ago, the couple had another daughter. She has never tested high.

“Without these programs, it’s hard to know about lead, and my income is not enough to do all of the work we needed,” Chowdhury said.

Trump’s budget proposal would kill much of the funding that helped the family through its ordeal.

Buffalo Mayor Byron Brown said the case illustrates the larger peril of potential funding cuts. “There would be people who would fall through the cracks,” he said.


While working as a pediatric neurosurgeon in Baltimore, Dr. Benjamin Carson saw the irreversible damage lead can cause in the brains of children living in substandard housing.

At his confirmation hearing in February to serve as Trump’s secretary of HUD, Carson told the Senate Banking Committee he would be “vigorous” in his efforts to reduce the tally of hundreds of thousands of poisoned children across the country.

“I’m looking forward to, you know, the Safe and Healthy Homes Program at HUD and enhancing that program very significantly,” Carson said.

But even Carson’s requested $20 million increase for HUD’s lead removal program falls short of the $29 million his agency says is needed to comply with a new policy that requires lead remediation of HUD properties where children have tested above the CDC threshold.

Other housing programs that play a bigger, if more indirect, role in protecting children’s health would be eliminated altogether.

Among them: the $125 million Choice Neighborhoods program, which provided funding to remove lead paint from New Orleans’ aging Iberville housing project, and the $970 million HOME Partnerships program, which helped the Chowdhurys clean up their house in Buffalo.

The biggest casualty could be HUD’s $3 billion Community Development Block Grant program.

Local officials use CDBG grants to fund projects from curb construction to rehabilitating old housing, with only a small portion, $10 million, directly used for lead safety standards in the most recent fiscal year.

But CDGB is crucial to poisoning prevention, since housing-related projects it helps are required to meet HUD guidelines for lead safety, said Marion McFadden, who oversaw HUD’s grant programs under President Barack Obama.

“If (cuts are) enacted, it would be a huge step backward,” McFadden said.

CDBG funds went toward lead-paint removal in cities including Milwaukee, Syracuse and Shreveport, Louisiana. All three had neighborhoods with documented lead poisoning rates at least twice Flint’s.


Health officials in the small city of York, Pennsylvania, two hours west of Philadelphia in Amish country, know how budget cuts like this can play out.

The city and surrounding York County, where Trump won 70 percent of the vote in November, have a serious lead poisoning problem. From 2005 through 2014, at least 30 percent of children tested in all but one of York’s census tracts had elevated lead exposure, according to CDC data. In one census tract, more than half of all tested children had high lead levels.

Nabiha A Chowdhury, 7, demonstrates her process for removing potential lead from her hands by washing them at her home in Buffalo, New York March 30, 2017. REUTERS/Lindsay DeDario

Trump lost the city of York, but other patches of the county hit hard by lead poisoning, including the borough of Red Lion, where 21 percent of children tested had high levels, overwhelmingly supported him.

In the mid 1990s, York had seven full-time and part-time employees working in the city’s lead prevention program who conducted screening and investigated lead exposure sources. Since then, CDC cuts have left the program with one part-time employee and no ability to conduct screening.

The results are telling. In 2005, 1,641 city children were screened for lead. In 2014, 169 kids received a lead test.

Trump’s plan to eliminate the $375,000 in Home Partnership funds the city uses to develop lead-safe housing would have dire consequences, said James Crosby, deputy director of the city’s Bureau of Housing Services.

“It would mean we would be out of business,” Crosby said. “If he eliminates the home program, we would have absolutely nothing.”

A HUD spokesman declined to comment on the impact the cuts would have. “HUD will continue to work very closely with state and local health and housing officials through targeted investments in specific programs to reduce childhood lead poisoning,” he said.


A similar pattern is emerging at the EPA, where Administrator Scott Pruitt is highlighting some lead remediation efforts while pushing to gut funding to enforce pollution laws and clean up contaminated sites.

During the confirmation process, Pruitt told lawmakers he would work to reduce exposure to lead. On Wednesday he visited East Chicago, Indiana, where the EPA has secured $42 million from chemical companies to remove contaminated soil from neighborhoods near a former lead-smelting plant. In one neighborhood, up to 20 percent of tested children had elevated lead-blood levels.

Trump’s budget proposal would preserve funding for the EPA program that helps cities like Flint buy new water pipes.

But Pruitt would slash other federal efforts, including a one-third cut of EPA’s Superfund and Brownfield programs, leaving hundreds of millions of dollars less to clean up areas contaminated by lead mining in southeast Missouri, tainted yards and parks in Omaha and old school buildings on the Standing Rock Sioux reservation in North Dakota.

Pruitt would also eliminate a $27 million program that trains private contractors on safe lead removal from buildings, internal documents show.

An EPA spokesman said the agency is weighing strategies to save taxpayers money while protecting the environment. “We’re trying to restore some accountability to these and other programs so that we can examine what has worked – and most especially, what hasn’t,” wrote spokesman J.P. Freire.

Funding levels for the CDC, which spent $17 million last year through the Childhood Lead Poisoning Prevention program to help state and local governments, have been the subject of great uncertainty.

Earlier this year Trump lobbied for a Republican health-care bill that would have repealed the Affordable Care Act. In the process, the bill would have eliminated the pool of public-health money that funds the CDC’s lead program. In March, the bill collapsed in the House of Representatives.

Last week, a White House official told Reuters the administration intends to keep funds flowing to the CDC program. By Monday, however, the official had backed away from that commitment and said the program’s fate is uncertain until the administration produces a more detailed budget proposal in May.

The last round of cuts to the CDC’s lead budget in 2011 slashed assistance to many state poisoning prevention programs.

Those cuts were a reason why Flint’s problems didn’t come to light sooner, said Mary Jean Brown, a public health specialist at Harvard University who directed CDC’s lead program at the time. Without the CDC lead program, Michigan conducted less monitoring of childhood blood levels from 2011 to 2014, and stopped reporting test results to the CDC.

This created “a big gap in data,” Brown said, contributing to Flint’s crisis going unchecked or being ignored by Michigan officials until a pediatrician, scientists and activists presented proof children had been sickened.

MD Chowdhury (R) stands with Tom Muscarella of the Erie County Health Department and points to improvements made to his lead contaminated home during an interview in Buffalo, New York March 30, 2017. REUTERS/Lindsay DeDario

Goat yoga is the latest — and perhaps unlikeliest — fitness craze


When Jessie Ryan drove from Portland to Oregon’s mid-valley region to participate in a session of goat yoga, she didn’t know what to expect.

But as she prepared to move out of her Warrior II pose, she felt a nudge on the back of her leg. Turning around, she couldn’t help but laugh at the sight of Quincy, a 1-year-old mini-goat, staring back up at her.

That was the moment she discovered the appeal of the latest nation-sweeping fitness craze.

“How can you not connect with this face?” Ryan asked as Quincy bleated back to her. “You’re in the middle of doing a pose, thinking about how terrible everything is, when a goat comes up and kisses you or steps on your fingers and all that stress goes away. It sounds like something a modern-day Lewis Carroll would write.”

Ryan went back, joining 15 other people for one of the first goat yoga classes of the new year at Corvallis’ Hanson Country Inn.

But they aren’t the only ones who have signed up for founder Lainey Morse’s sessions — the waitlist for the class grew to 2,400 people over the winter.

Goat yoga combines a one-hour yoga session with the animal-therapy of social mini-goats that wander around and interact with the class. When Morse first combined the words “goat” and “yoga” for a simple event last July, she inadvertently created a media whirlwind. Since then, her life has been anything but simple.



In the last eight months, stories have appeared in hundreds of media outlets around the world, including the Washington Post, Time magazine, The New York Times, CNN, NPR, ESPN, National Geographic, Vogue, BBC and hundreds of blogs.

Last September, the Post’s Karin Brulliard wrote, “Well, it’s about time: Someone has finally launched a yoga class with goats. … magic was made.”

Two months later, under the headline “Bring a Yoga Mat and an Open Mind. Goats Are Provided,” New York Times reporter Kirk Johnson wrote, “As you smell that grass on a yoga mat, you realize that you have entered the goats’ world, not the other way around.”

There is now a “Goat Yoga” page on Wikipedia, too.

Even Tonight Show host Jimmy Fallon covered goat yoga in a September 2016 opening monologue.

“Apparently, there’s a farm in Oregon that offers a yoga class that you can take with goats roaming around you,” he said. “They even have a special position called the downward facing (soundbite of goat bleating).”

Morse, who lives at Albany’s No Regrets Farm with her 11 Nigerian dwarf goats, had hosted several goat-centered events previously, including Goat Therapy (spending relaxing time with goats) and Goat Happy Hour (spending relaxing time with goats and wine). They were well-attended, locally popular and helped supplement her income. But Morse had no idea goat yoga would hit like it did.

“Nothing prepares you for that; it’s just absolutely mind-blowing” Morse said while preparing for a class at the Hanson Country Inn. “You always hear about something going viral but you don’t know what it means until you experience it. It’s intense. It’s like a roller coaster you can’t get off. It’s the most crazy thing you could ever do.”

The media blitz started last summer after Heather Davis, a yoga instructor at Corvallis’ Live Well Studio, suggested to Morse the farm as a fun place to host a yoga class. To drum up publicity, Morse posted photos and videos on social media featuring Davis doing a yoga pose with one of Morse’s mini-goats on her back.

“I really like yoga and I really like goats. I guess other people do too,” Davis said. “I told Lainey this felt like the most Oregonian thing ever. But neither of us expected this.”

In less than a day, the photos and videos gathered hundreds of social media “likes” and shares, attracting local and national media attention. And the more media attention the story got, the more calls Morse received for interviews and from people asking to sign up for a session.

“It got to the point where I was doing nothing but answering phone calls,” she said. “I lost 20 pounds when it all started happening. I would be so busy during the day I’d forget to eat. I just wasn’t thinking about myself.”

Morse had also been diagnosed with Sjogren’s syndrome, an immune system disorder similar to lupus.

“I think that played a part too. It just got to be a lot. Everything was going 1,000 mph,” she said. “I mean, who do you go to for advice when something goes viral? You almost feel lonely because there’s no one to go to when something hits like that.”

goat yoga
Women enjoying a session of goat yoga in Arizona. —PHOTO: Dharmesh Gohil


Morse is no stranger to marketing — it was her full-time job at Corvallis’ Henderer Design + Build in Corvallis for more than 10 years. Last November, when she was getting 30 to 40 calls each day, she realized she had to make a choice: Quit a job she loved to focus on what could be a flash-in-the-pan, blink-and-you’ll-miss-it fad; or keep her job and ignore a potentially life-changing new business idea. Morse, who came up with the name “No Regrets” for her Albany farm, said the potential was too enticing to ignore.

“I loved my job, but I love goats too. And as much as I loved what I did, when you hit the media lottery, you don’t walk away from that,” she said. “And I already had debt from medical bills and from my divorce. At that point I thought, ‘I’m going to be in debt for the rest of my life anyway.’ Now I have a glimmer of hope.”

Morse said she decided to go all in on the idea and borrowed “a big chunk of money” to start the business. In addition to previous projects and Goat Therapy and Goat Happy Hour events, she established a website (www.goatyoga.net), made deals with local businesses and farms to host goat yoga events, and bought a van (complete with goat yoga decals, pictures and a “Caution: Mini goats on board” sign) to transport her animals.

“I have a vehicle that people are constantly stopping to take pictures of and tell people about,” Morse said. “What other vehicles get attention like that other than the Batmobile or the Oscar Mayer Weinermobile? That’s pretty cool.”

Since making her decision to start the business, she’s noticed many strange side effects. She trademarked the name “Goat Yoga” and has started selling licensing agreements, but numerous copycats have also sprung up around the country.

“I heard of one place that’s trying to do yoga with bunnies now,” she said. “It’s exciting that so many people are loving this idea, but it is still weird to see businesses across the country starting because of what’s happened here.”


Morse said her Goat Therapy and Goat Happy Hour events showed her that she wasn’t alone in her love of the therapeutic and calming effects of spending time with goats. And she hoped “goat yoga would resonate like those previous events did.

“When I was first diagnosed, I would come out every day and sit here with my goats and I would feel better. It’s not healing diseases but it’s really hard to be sad when a goat comes up to snuggle you,” she said. “It’s such a simple thing, but it makes so many people so happy.”

Morse also hears the same questions every day from others trying to determine why people have responded to these sessions: Why goats? Why not dogs or cats or bunnies?

“People use horses and dogs for therapy animals, but to me goats seemed like perfect therapy animals,” she said. “They’re not as intimidating and big as horses. And dogs, what if you’re allergic or if they don’t bond with you or if they’re too shy? Goats don’t care; they just want you to pet them. They have this sense of calm and they kind of go into a meditative state. Maybe that’s why they work so well with yoga.”

Fermin Perez, of Portland, said during a Corvallis session this week that the idea of combining goats and yoga made sense.

“The goats are peaceful and it just helps you de-stress,” he said. “They’re hanging around you or doing their own thing and that’s calming, which is what the whole point of yoga is.”

Everyone who has taken part in a session has come away with positive feelings, Morse said. But, like many others, she’s still trying to piece together exactly why goat yoga’s become such a phenomenon. One possibility she suggested: an overload of negativity around the world needed to be counterbalanced with some positivity.

“I think people are so sick of that negativity,” she said. “I think the political climate especially is so insane that people are grasping for anything that’s positive and happy. And that’s hard to find nowadays.”

As with anything new and popular, however, goat yoga’s generated some negative reactions. Morse has received emails and messages critical of her business. Animal rights activists in other parts of the country have attacked her for the way she handles her goats.

“For the most part, people are supportive,” she said. “But everyone has a right to believe what they want and if they want to be unhappy they will be. I think unhappy people are going to gravitate in the direction of being negative and they’re going to continue being negative no matter what you do. You can’t fight that.”



With all of the attention, Morse said it’s sometimes difficult and stressful. Luckily, she has a business that’s all about addressing that stress.

“I know that everyone is going to have a different reaction, and for a lot of people, when they see the words ‘Goat Yoga,’ it might sound silly,” she said. “But when you see it happening and you experience it, you quickly realize it’s anything but silly.”

One of the participants in Morse’s latest classes was a woman battling breast cancer. Morse said seeing the look on the woman’s face when a goat approached her brought tears to Morse’s eyes.

“One of our babies went up to her and nuzzled her face and it made her so happy,” Morse said. “It was very powerful. I had no idea it would get this big and help someone fighting cancer and make them feel better. It’s not curing her disease, but it made her really happy. And she’s still tweeting about it. I think that’s not silly at all.”

Morse continues to receive more than 30 calls every day. Lately, many have come from other parts of the world, which means she sometimes gets calls from India or England at 3 a.m. While she could sleep through it and ignore the media buzz or let someone else handle it, Morse said she almost never passes up an opportunity to tell someone about her business.

“Everyone wants to do something they love and makes them happy. It’s a double bonus when you can see first-hand how happy it’s making so many people,” she said. “I think when you catch lightning in a bottle like that, you don’t’ ignore it or walk away from it.”

But she knows that at some point, the international media spotlight will be gone.

“It’s got to die down sometime, right? Maybe in November it did a little bit, but then another story went big and weeks later I had 1,000 people on the waitlist,” she said.

Note: This is an AP member exchange story.


PHOTO: Dharmesh Gohil

Death by 1,000 cuts: How Republicans can still alter your health coverage

The Affordable Care Act’s worst enemies are now in charge of the vast range of health coverage it created. They’re also discussing changes that could affect a wider net of employment-based policies and Medicare coverage for seniors.

Republicans failed last month in their first attempt to repeal and replace the ACA. But President Donald Trump vows the effort will continue. Even if Congress does nothing, Trump has suggested he might sit by and “let Obamacare explode.”

Health insurance for the 20 million who benefited from the ACA’s expanded coverage is especially at risk. But they’re not the only ones potentially affected. Here’s how what’s going on in Washington might touch you.

A 3-year-old lawsuit threatens many plans. A suit by the Republican-led House challenges some subsidies supporting private plans sold to individuals and families through the ACA’s online marketplaces, also called exchanges. It has already gained one court victory. By many accounts, it would wreck the market if successful, stranding up to 12 million without coverage.

“It’s the single-biggest problem facing the exchanges,” said Rachel Sachs, a health law professor at Washington University in St. Louis. “That would make insurers not only exit tomorrow but also not want to offer plans in 2018.”

The litigation involves lesser-known ACA subsidies that reduce out-of-pocket costs such as copayments and deductibles for lower-income consumers. These are different from the law’s income-linked tax credits, which help pay for premiums.

Filed in 2014, when Barack Obama was president, the suit could backfire by politically harming the Republicans now in charge. House leaders have delayed the litigation and said they won’t drop the lawsuit but will continue the subsidies while it gets considered. The administration has not said how it plans to handle the lawsuit.

Policy confusion undermines coverage.

Even if Congress doesn’t repeal the ACA, the continuing battle makes insurance companies think twice about offering marketplace policies for next year. The less clarity carriers have about subsidies and whether the administration will promote 2018 enrollment, the likelier they are to bail or jack up premiums to cover themselves.

Preserving the subsidies, which limit out-of-pocket costs for lower-income consumers, “is essential,” said Kevin Lewis, CEO of Community Health Options, a nonprofit Maine insurer. “Markets don’t like uncertainty. The ‘sword of Damocles’ hanging over our collective heads is unsettling, to say the least.”

Democrats say Republicans are sabotaging Obamacare.

Shortly after taking power, Trump officials yanked advertising designed to maximize enrollment in marketplace plans just before a Jan. 31 deadline. It was partly restored after an outcry.

Then the administration said it would scrap an Obama-regime plan of rejecting tax returns from individuals who decline to say whether they had health insurance — weakening the requirement to be covered.

Trump aide Kellyanne Conway suggested in January the administration might entirely stop enforcing that requirement — the part of the law most hated by Republicans. If officials persist with that message, plans could attract even fewer of the young and healthy members whose premiums are needed to support the ill. That would cause more rising premiums and insurer exits.

“More mischief can be done,” said Dr. Peter Kongstvedt, a health industry consultant and senior faculty member at George Mason University. “It is absolutely possible that some markets will end up with no carriers unless a combination of state and federal government act to preserve the market” with taxpayer money.

Trump officials will move to roll back ACA coverage even if Congress doesn’t repeal.

Tom Price, secretary of the Department of Health and Human Services, has signaled his intent to reverse parts of the ACA through regulation even if Congress doesn’t repeal the law.

For example, Price couldn’t unilaterally eliminate coverage for birth control or maternity care, both of which many Republicans object to on moral grounds or because of cost. But birth control might no longer be free as a preventive benefit. Maybe the administration would let states limit the number of prenatal visits in maternity coverage. Perhaps more employers could gain religious exemption from providing birth control.

Medicaid coverage for low-income people could shrink.

Obamacare’s coverage expansion included government Medicaid coverage for folks with lower incomes. Thirty-one states and the District of Columbia expanded Medicaid to most adults with incomes below about $16,000 for singles and $28,000 for a family of three — although eligibility varies.

Republicans want to reduce the growth of Medicaid spending and give more control over the program to states. Discussions for a Medicaid overhaul focus on replacing ACA provisions with fixed, less-generous federal grants to states.

But even if the ACA survives, it’s likely the administration will give states more say in who gets Medicaid coverage and how much. Many Republicans favor work requirements for Medicaid recipients and raising out-of-pocket payments for patients.

Under the failed House replacement bill, the American Health Care Act, 9 million people in those states would have lost Medicaid coverage in 2020, estimated the nonpartisan Congressional Budget Office.

At the same time, however, Republican support for the ACA’s Medicaid expansion is growing, which might mean overall cutbacks would be less severe or Medicaid coverage could increase among the 19 states that didn’t expand the program under the ACA.

Some Republicans want to overhaul Medicare for seniors.

House Speaker Paul Ryan wants to restrain Medicare growth by giving members fixed, “premium support” payments to buy plans and possibly raise the age of eligibility. Both could lead to less coverage or greater out-of-pocket expense.

But the proposal wasn’t part of the Republicans’ replacement bill. Changing Medicare likely would trigger loud objections from AARP and other powerful lobbies. And Trump doesn’t seem inclined to back a change.

“I don’t think … Trump wants to meddle with Medicare or Social Security,” White House chief of staff Reince Priebus said in January.

Job-based coverage could become less generous.

Although ditching Obamacare would end the requirement for large employers to offer health insurance, most companies would keep their plans as a way to attract workers, analysts say.

But that coverage could become less generous. The ACA limits employer-plan members’ annual out-of-pocket cost and also prohibits caps on annual and lifetime benefits. At the same time, it prohibits waiting periods for covering a new worker’s preexisting illness.

Any replacement law signed by Trump might not include those protections.

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

LGBT rights group releases health care index

The Human Rights Campaign Foundation released its 10th edition of the Healthcare Equality Index. Of the  facilities surveyed, 303 earned HRC’s “Leader in LGBTQ Healthcare Equality” designation.

HRC also assigned numerical scores to the health care facilities — three quarters of the facilities that participated in the survey scored 80 points or above.

In a press statement, HRC president Chad Griffin said the index “reminds us again that though we have made tremendous gains over the past decade, there is still much more work left for us to do.”


A look at the scores…

In the 2017 report, 303 facilities — 51 percent of those actively participating in the survey — met HRC’s criteria to earn the “Leader” designation.

Health care facilities in Wisconsin to receive the “Leader” designation include: NorthLakes Community Clinic in Iron River, American Family Children’s Hospital in Madison, University of Wisconsin Hospital and Clinics in Madison, UW Health at American Center in Madison, VA William S. Middleton Memorial Veterans Hospital in Madison, AIDS Resource Center of Wisconsin in Milwaukee, Froedtert Memorial Lutheran Hospital in Milwaukee and VA Clement J. Zablocki Medical Center in Milwaukee.

Another 144 facilities earned a “Top Performer” designation for scoring between 80 and 95 points.

In addition to the scoring criteria, the 2017 HEI included a fifth section focusing on responsible citizenship and calling out activity that would undermine LGBTQ equality or inclusive patient care. Healthcare facilities may have 25 points deducted from their score for a large-scale official or public anti-LGBTQ blemish on their records.

This year, Johns Hopkins Hospital became the first and only facility to receive this deduction.

Of the hospitals that did not actively participate in the 2017 HEI but were scored based on HRC’s research, only 61 percent have nondiscrimination policies that include both “sexual orientation” and “gender identity” and only 52 percent were found to have an LGBTQ-inclusive employment non-discrimination policy.

However, HRC said 95 percent of these facilities were committed to equal visitation, close to the rate of the facilities that actively participated in the survey.

HRC highlighted in the survey report the work taking place at two transgender youth clinics — GENECIS at Children’s Health in Dallas and the Center for Child and Adolescent Gender Care at Duke Children’s Hospital in Durham, North Carolina.

Legislative attacks on the transgender communities in both states underscore the importance of the care and affirmation these clinics are providing transgender youth, according to HRC.

Mayo Clinic faces questions over CEO’s ‘prioritized’ patients remark

Mayo Clinic is facing questions from the state of Minnesota after its CEO told employees that if patient conditions are equal, its hospitals should prioritize privately insured patients over those under government-subsidized programs such as Medicaid.

John Noseworthy’s comments were made late last year in a videotaped speech to staff but surfaced only this week after a transcript of his speech was obtained by the Star Tribune newspaper.

The Mayo Clinic has verified the transcript is accurate.

Noseworthy said in a statement that medical need will always be the top factor in scheduling an appointment.

“In an internal discussion I used the word ‘prioritized’ and I regret this has caused concerns that Mayo Clinic will not serve patients with government insurance. Nothing could be further from the truth,” he said, adding that the hospital is committed to serving patients with government insurance.

“Changing demographics, aging of Americans and budgetary pressures at state and federal government pose challenges to the fiscal sustainability in healthcare today,” he said. “While these discussions are uncomfortable, they are critical for us to be able to meet the needs of all of our patients.”

Minnesota Department of Human Services Commissioner Emily Piper said she was surprised and concerned by Noseworthy’s earlier comments and has questions about what they really mean and how Noseworthy’s directive would be carried out.

The department is looking into whether there are possible violations of civil and human rights laws.

The agency also is reviewing its contracts with Mayo Clinic to ensure the hospital is meeting its obligations to serve patients in public programs.

Last year, Noseworthy told staff that when Mayo Clinic has expertise that can’t be found elsewhere, it will always take patients, regardless of how they are paying for care.

“We’re asking. if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so . we can be financially strong at the end of the year to continue to advance our mission,” Noseworthy said in the transcript.

Mayo Clinic spokeswoman Duska Anastasijevic said the speech stressed the need to increase privately insured patients, but not at the expense of government insured patients.

Mayo Clinic said about half of the services it provides go toward those enrolled in government programs. The clinic said it provided $629.7 million in care to people in need in 2016, including $546.4 million that wasn’t covered by Medicaid or other programs for the uninsured or underinsured.

The statement said that as Mayo’s percentage of publicly funded patients has grown, to now roughly 50 percent, the health system is working to increase commercially insured patients.

“To fund its research and education mission, Mayo needs to support its commercial insurance patient numbers in order to continue to subsidize the care of patients whose insurance does not cover the cost of their care,” the statement said.

Piper said Noseworthy’s statements do not reflect routine hospital practices and she found them to be troubling.

As Human Services commissioner, Piper is focused on ensuring access to health care for those enrolled in public programs. She said providers have to follow the law and uphold agreements to provide such care. She said that in her view, nothing that is happening with the health care law on the federal level changes those requirements.

“Health insurance coverage for health insurance coverage’s sake is not the end goal,” she said. “It’s access _ that’s what’s important.”

Anastasijevic said Minnesota Medicaid patients are and will continue to be scheduled the same as patients with commercial insurance.

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

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.

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.


Dems want statewide referendum on medical marijuana

Democratic lawmakers on Feb. 6 called for a statewide referendum on legalizing medical marijuana.

State Sen. Jon Erpenbach and state Rep. Chris Taylor unveiled their medical marijuana proposals during a news conference at the Capitol. They were joined by Dr. David Olive, a medical marijuana advocate undergoing treatment for state 4 lung cancer, and Steve Acheson, a military veteran using medical marijuana to treat war injuries.

Medical marijuana is available to patients in 28 states and the District of Columbia.

Erpenbach and Taylor said as the state strives to battle opioid abuse, medical marijuana is an alternative that should be on the table.

And the Democrats want to know if Wisconsin voters feel the same way. So they propose an advisory referendum and introduced a joint resolution to place a question on ballot in an upcoming election. The question would read: Should the state of Wisconsin allow individuals with debilitating medical conditions to use and safely access marijuana for medical purposes if those individuals have a written recommendation from a licensed Wisconsin physician?”

Another measure from Erpenbach and Taylor, the Compassionate Cannabis Care Act, would legalize medical marijuana for patients with certain qualifying conditions. The legislation would allow patients to possess 12 plants and 3 ounces of leaves or flowers and would provide for the Wisconsin Department of Health Services to license dispensaries.

The lawmakers introduced the Care Act last session but Republicans failed to schedule hearings in either legislative chamber.

Assembly Speaker Robin Vos, a Republican, has said he would consider allowing medical marijuana but with Senate Majority Leader Scott Fitzgerald record as opposing legalization, the referendum measure stands a better chance of passing than the legalization bill.

Gov. Scott Walker also has said he opposes legalizing medical marijuana.

But Walker has prioritized addressing heroin and opioid abuse and studies show that legalizing medical marijuana can help bring down the number of people using or abusing opioid painkillers.

A 2016 study from the University of Michigan found a 64 percent reduction in use of opioid painkillers among patients using medical marijuana — legal to prescribe in Illinois, Minnesota and Michigan. Also, a study several years ago in the Journal of the American Medical Association showed opioid-related deaths fell by 25 percent in states that legalized prescribing medical marijuana.

At the news conference, Acheson said he uses marijuana to treat war injuries, including post-traumatic stress disorder. The Iraq War veteran said he’d been prescribed muscle relaxants, anti-inflammatory drugs, sleeping pills and opioids. The medical marijuana advocate said he was prescribed pills to counter pills but pot does a better job of treating his pain.

“When facing a growing opioid epidemic in Wisconsin, why on Earth would we ignore a viable, commonsense solution that has been shown to dramatically reduce opioid abuse?” Taylor asked. Furthermore, why are we denying our veterans, who served our country and were willing to make the ultimate sacrifice for our freedom, access to the medical care they need?”

“We will not stop this fight until it is legal in the state of Wisconsin,” Taylor said.

Erpenbach said, “I am confident a statewide referendum would provide Gov. Walker and legislators across Wisconsin with the support and peace of mind needed to advance this legislation. At a minimum, allow the publics’ voices to be heard.”


Did you know?

National polling shows about 89 percent of Americans support legalizing medical marijuana.

The following states have legalized medical marijuana: Washington, Oregon, California, Alaska, Hawaii, Nevada, Arizona, New Mexico, Colorado, Montana, North Dakota, Minnesota, Arkansas, Illinois, Michigan, Ohio, Pennsylvania, Maryland, Delaware, New York, New Jersey, Rhode Island, Connecticut, Massachusetts, Maine, New Hampshire, Vermont and Florida. Medical marijuana also is available in Washington, D.C.

Vowing to jettison Obamacare, Republicans face immediate resistance and risks

The 115th Congress started work Tuesday with Republican majorities in both the House and Senate in agreement on their top priority — to repeal and replace the 2010 health law, the Affordable Care Act, also known as Obamacare.

“The Obamacare experience has proven it’s a failure,” House Majority Leader Kevin McCarthy, R-Calif., told reporters at an opening day news conference.

But that may be where the agreement among Republicans ends.

Nearly seven years after its passage, Republicans still have no consensus on how to repeal and replace the measure.

“It is risky business,” said Thomas Miller, a conservative economist and former Capitol Hill aide now at the American Enterprise Institute.

Republicans, he said at a recent AEI forum, are “very good at fire, aim, ready.” But with more than 20 million Americans getting coverage under the law, GOP lawmakers will have to tread carefully, Miller warned. “The hard one is when you’re trying to defuse what’s already been out there, cutting the wires on the bombs sequentially” so as to avoid a messy and destructive explosion.

Republicans are reportedly discussing a range of options for disassembling Obamacare, but analysts who have been involved in the intricacies of health policy for decades warn no replacement strategy will be easy.

The most immediate problem for the GOP is that even with majorities in both chambers of Congress, they do not have the 60 votes needed to overcome Democrats’ objections in the Senate. (There are 52 Republicans in the Senate now.) That means they won’t be able to pass a full repeal of the law on their own and it is unlikely eight Democrats would join to overturn President Barack Obama’s signature legislation.

Even if they did have the votes standing by, they don’t have anything teed up to replace the health law.

“It’s not that Republicans don’t have replace bills. They have a couple dozen,” said Douglas Badger, who oversaw health policy in the White House for President George W. Bush and worked for the Senate GOP leadership prior to that. “The problem is they don’t have consensus,” he said at the AEI forum.

Still, doing nothing, or even waiting, is not an option given that these lawmakers have been vowing to repeal the law almost since the day it passed in 2010.

“You have to pass something,” said Miller, “and whatever you pass you call repeal.”

The leading option under consideration is “repeal and delay.” The idea is to use the budget process to overturn the tax-and-spending parts of the law, but delaying the effective date to buy time for Republicans to agree on a replacement bill.

But there are problems with that strategy. One is political — Democrats are already crying foul.

“It’s not acceptable to repeal the law, throw our health care system into chaos and then leave the hard work for another day,” incoming Senate Minority Leader Charles Schumer, D-N.Y., said Tuesday.

Added Sen. Richard Durbin, D-Ill., “it’s not repeal and delay, it’s repeal and retreat.”

The plan also has raised concerns in the health industry. The goal of delaying the repeal date is to let people who have obtained insurance under the health law keep it while a replacement is formulated. But that is by no means guaranteed.

Insurance analysts have said that any more uncertainty in an already fragile marketplace could easily prompt insurers to leave the individual market, which would put at risk coverage for not just the roughly 10 million people who are purchasing plans there under the health law, but also the roughly 10 million people who previously had individual policies. (Another 10 million people have gained coverage under the health law through an expanded Medicaid program for those with low incomes.)

Without specific help for insurers from Congress, which would likely include insurance payments Republicans have called bailouts, “the market will begin to crumble” quickly, said Robert Reischauer, former president of the Urban Institute.

House Majority Leader McCarthy told reporters Tuesday that “no decisions have been made yet” on how Republicans might want to help stabilize the insurance market while they seek a replacement plan.

The individual insurance market could also be rattled if the incoming Trump administration decides not to appeal a lawsuit brought by congressional Republicans who argued that the Obama administration was illegally using money to pay insurers to subsidize health costs for some low-income customers buying individual plans on the health law’s marketplaces. If the new administration bows out of the suit and those subsidies, insurers would not get reimbursed for the expenses, and some analysts predict it could force companies to leave the market.

On the other hand, attempting to repeal and replace the law in a single bill also could pose problems.

Repealing and replacing together “looks less like repealing than fixing,” said Badger. “That could cause some angst” among the GOP base that wants Obamacare to be fully eliminated.

And Democrats point out that Republicans are equally guilty of overpromising the benefits of overhauling the health care system, albeit in a very different way.

The goals currently being talked about by Republicans — including making health care more affordable, covering more people, reducing government spending and giving states more flexibility — “are impossible to achieve,” within acceptable GOP budget limits, said Reischauer at the AEI event. “There are going to have to be some tradeoffs,” he said, as Democrats found when they tried to accomplish roughly those same goals.

Made available from Kaiser Health News under a creative commons agreement. KHN is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.