Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

Saturday, April 5, 2014

The Horrifying Health Effects of Mining



Recent studies suggest that coal mining affects the health of everyone who lives nearby—not just those who work in the mines.








In the middle of a sentence, Gary Bone has to stop and gasp.


“I lose my breath,” he tells me through the phone.


Bone is 56 and suffers from asbestosis, chronic obstructive pulmonary disease (COPD), and black lung. These aren"t the only remnants of nearly 20 years working in the coal mines of West Virginia. A scar on his back marks the spot where three discs were removed from his spine after a rock fell on him.


“Any kind of injuries you can imagine, a coal mine"s going to have it,” Bone says. “I"ve seen people that"s got their eye put out, fingers mashed up, whole lot of cuts, whole lot of back injuries. Back injuries are one of the most visible things.”


Bone isn"t the only miner with stories like these. Junior Walk, an outreach coordinator with the anti-mining nonprofit organization Coal River Mountain Watch (CRMW), says his grandfather survived several injuries in the mines.


“He broke his back twice in two different rock falls underground, where the ceiling just collapsed in on him. Broke his legs once—both of his legs—getting run over by a man trip, which is how they transport you in and out of the coal mine,” Walk says. “He made me swear to him when I was a kid that I would never set foot in an underground mine.”


Today, Walk"s grandfather has black lung, and Bone"s mobility is severely limited. The biggest disasters of coal mining certainly make the news—like the Upper Big Branch Mine explosion in 2010, which killed 29 men and shook the ground beneath the house where Walk grew up. But a growing body of research suggests that the invisible threats that cause many miners to retire early—the respiratory problems, the cancer, the chronic disease—also debilitate and kill an untold number of West Virginians each year.


In recent years, research has drawn new links between coal mining and health problems in the areas where that mining takes place. In response, local groups are working to support further research and boost awareness of these problems. The chemical leak that left 300,000 West Virginians without water for more than a week in January, the 108,000-gallon slurry spill on Feb. 11, and another slurry spill just days ago have brought national attention to the issue. Local advocates hope that this attention, in combination with new research, will translate into a more open dialogue on the health dangers of coal mining.


Janet Keating, executive director at the nonprofit organization Ohio Valley Environmental Coalition, says that the spills should draw attention to the more chronic problems at hand.


“The day-to-day air and water pollution and associated health impacts from living with mountain removal and large-scale surface mining has been largely ignored by lawmakers and people in West Virginia living outside of the southern coal regions,” she wrote in an email.


Health impacts have been an everyday worry for Bone, whose wife has been by his side through all the doctor"s appointments and the difficult days. While we"re on phone, he stops to call out to her: “Peggy, put something on, it"s cold out!”


It"s one of the coldest Januaries in decades. Into the receiver, he says, “I should be doing that. I should be starting my wife"s vehicle.”


Chronic disease, birth defects, and coal


Mortality rates attributed to kidney, respiratory, and heart disease are significantly higher in Appalachian counties with high levels of coal mining, compared to non-mining areas, according to a 2009 study.


Cancer is a particular culprit. A study that compared two rural West Virginia communities, one with mining and one without, found that self-reported cancer rates were twice as high in the mining areas. In areas with mountaintop removal (or surface mining), rates of lung, bladder, kidney, and colon cancer, along with leukemia, are all higher than in non-mining areas. These findings control for other risk factors, like smoking and socioeconomic status. (Lung cancer and kidney disease hospitalization rates, though, were actually lower in areas with coal production. This may be because people aren"t necessarily hospitalized in the community where they live, the author of this study points out.)


COPD, which affects Gary Bone, has also been linked to coal mining. The odds of COPD hospitalization increase 1 percent for every additional 1,462 tons of coal mined in an area during one particular year, according to a study published in 2007. Odds of hospitalization for high blood pressure increase, too—1 percent for every 1,873 tons mined that year.


One of the most stunning findings of recent years: the risk for birth defects in areas where mountaintop-removal coal mining is prevalent is significantly higher than in non-mining areas, according to a study published in 2011. The study looked at two periods of time: 1996 to 1999, during which risk was 13 percent higher in areas with this type of mining; and 2000 to 2003, during which risk was 42 percent higher. Six of seven types of birth defects—including circulatory/respiratory, central nervous system, and gastrointestinal—were “significantly higher” in areas with mountaintop removal. This, again, is after controlling for other factors.


Dr. Michael Hendryx, a professor of applied health science at Indiana University, who co-authored the study, has been researching health issues in the coal mining areas of Appalachia since 2006. He says the research left him with little doubt about the impact of the mining industry.


“I can definitively say that there are higher levels of health problems in mining communities, especially mountaintop removal communities, than others,” he says. “To try to pretend that we don"t have enough information to try to act, that we don"t know what is happening, is unethical. It"s immoral.”


Not everyone agrees that the evidence is definitive. Nancy Gravatt, senior vice president of communications at the National Mining Association, points to several responses that she says refute the results of studies like Hendryx"s. One study by Dr. Jonathan Borak, et al., concludes that coal mining isn"t an independent risk factor for increased mortality in the Appalachian region and points to other factors such as obesity and poverty. Borak"s paper was reportedly funded by the National Mining Association , though Borak has maintained his opinions are not for hire.


Representatives of coal company Alpha Natural Resources did not respond to interview requests for this article.


An environment built by coal


Another way that scientists have tried to assess the effect of coal on public health is to measure the air and water quality near both surface and underground mines.


Several recent studies indicate that when it comes to environmental pollutants, mining areas are often much worse off than areas where no mining is taking place. One study collected particulate matter from the air within one mile of an active mountaintop removal site in southern West Virginia, and found it to be 38 percent sulfur and 24 percent silica. According to Hendryx, the silica (in this case, crystalline silica) is a particular cause for concern.


“Crystalline silica is toxic. It"s highly carcinogenic, and I think it"s the silica in particular that"s driving the health problems we"ve seen,” he says.


Another paper, authored by Dr. Laura Kurth of the National Institute for Occupational Safety and Health and slated for release soon, has documented for the first time that there is more ultrafine particulate matter in areas with surface mining. Ultrafine particles are smaller than a tenth of a micron in size, and can penetrate through the lungs into the blood system, Hendryx explains.


Water quality has also been affected by mining. A study published in the Proceedings of the National Academy of Sciencesin 2011 notes that waste rock from mountaintop removal mines is often disposed of in nearby valleys, where it comes into contact with streams. The study found that the amount of sulfate, magnesium, and selenium in the water increased in proportion to the amount of mining upstream, and in some areas, there was a “very high incidence” of selenium-linked developmental deformities in the larvae of two types of fish.


Large amounts of selenium can be toxic, though it"s unclear whether there"s enough selenium in West Virginia waterways to harm humans. Still, selenium levels in West Virginia waters have been a topic of debate between community groups and politicians for years. In 2013, a bill to weaken current maximum selenium standards and conduct more research about whether selenium is actually impacting West Virginia streams passed almost unanimously.


One possible source of water pollution is the slurry that remains after the coal frothing process in coal prep plants, in which coal dust is separated from other materials so that the dust can be used. This slurry, and the chemicals in it, is pumped into huge reservoirs, called slurry impoundments, or into underground mines.


Gravatt confirmed in an email that, “On occasion, [slurry] can be disposed of in abandoned underground mines. To do so, operators need to get a permit from the state water authority (at least in the case of WV). It should be noted that disposing of such materials in abandoned, underground mines avoids placing the same materials on the surface in impoundments.”


Walk grew up with well water, and remembers that it would sometimes run red from the faucet.


“Anybody with half a brain wouldn"t drink it. But you still have to shower in it, you"ve got to wash your clothes, wash your dishes. Sometimes my parents would even cook with it because they boiled it and when you boiled it, it looked fine, smelled fine,” Walk said. He learned later that boiling the water doesn"t make the chemicals go away.


Science and community


Local groups have generally advocated for greater awareness about coal mining"s health impacts in three ways: community education, policy work, and direct action.


In 2013, OVEC partnered with the Southern Appalachian Labor School to host a series of public meetings in Fayette County, W.V., to educate people about the impacts of coal mining.


These meetings inspired a group of citizens to organize a study in their area with Hendryx"s help. About 45 people were surveyed for self-reported illnesses. Although the sample size was small, Keating said the most important result was empowering people to defend themselves.


“People in the state have been "done to" and "done for" long enough,” she said. “It"s time that people realize that they do have power.”


Many of OVEC"s efforts have centered around raising awareness in small communities. The organization provides water testing around the state upon request, and in the last two years, has hosted a conference to open up a dialogue between people affected by fracking and others affected by mountaintop removal. At least one faith group plans to help Hendryx conduct a survey this year, Keating said.


“There are a lot of people of faith here, and it"s more difficult for politicians or industry to marginalize us when we have solid backing from the faith community,” she said.


On the policy front, Coal Mountain River Watch in collaboration with OVEC and other groups won a legal settlement in 2011 that required Alpha Natural Resources, a coal company, to construct selenium treatment facilities at a cost of more than $ 50 million.


Today, CRMW is helping to spearhead the Appalachian Community Health Emergency Act in the U.S. Congress. The act, introduced in February 2013 by Rep. John Yarmuth, a Democrat from Kentucky, would require comprehensive studies on mountaintop removal"s impact on human health. It has 45 co-sponsors in the House.


Walk is a member of at least three local advocacy groups, and is a founding member of RAMPS (Radical Action for Mountain People"s Survival), which focuses on nonviolent direct action. He recalls one of those campaigns as we walk up a muddy path through Roberts Cemetery, a small island of public land at the center of the Hobet Mountain surface mining complex. Fallen leaves coat the hillside, but when we reach the top, the scene opens up: The mountains are mostly bare of trees. Ahead of us, a thin layer of grass sprouts from a huge pile of rubble that resembles a mountain, and in the distance, a few large machines groan dully. It"s a Saturday; the site is quieter than usual.


Walk describes an event that RAMPS put together called the Mountain Mobilization, which happened here at Hobet in July 2012. “It was pretty awesome,” he says. “We just had about 50 of our good friends go with us, climb up all over their equipment, and lock ourselves to things, and generally raise havoc that day on that mine site, and shut them down.”


The site was shut down for a day, and 20 people were arrested. Their total bail amounted to $ 500,000. But Walk"s goals were to raise awareness and cost the coal companies money, and RAMPS achieved those goals.


Home in the mountains


Walk and I stop the car off the side of Route 3, which runs for miles along the base of Coal River Mountain. We"re trying to get a good look at a valley fill, where rock and debris from a nearby mine piles up between the ridges to the south. It"s hard to see through the trees, but the sun is coming out on an otherwise gray December day, and flickering off the Big Coal River below. The branches sway in a gust of wind left over from the rainfall.


“I would never live anywhere else,” says Walk. He grew up just down the road, and as a kid, spent his free time riding four-wheelers in the mountains.


“My grandpa used to collect arrowheads a lot, … and there was this one place he used to take me on Coal River Mountain called Bear Wallow, and that place doesn"t exist any more,” he says. “It was on top of a ridge. They blew it up.”


After high school, Walk worked in a coal preparation plant for six months. Walk quit working there, but then took a job as a security guard at another plant.


“I felt like I had blood on my hands when I worked that job, and I just couldn"t do it,” he says. “I knew that the people who lived below that mine site I was making money off of were going through the same things I went through when I was a little kid, and I felt miserable about it. And that"s when I started coming around the local organizations around here and seeing what I could do to help out.”


 


 

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The Horrifying Health Effects of Mining

Tuesday, April 1, 2014

Health care sign-ups surge _ will they save Dems?

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Health care sign-ups surge _ will they save Dems?

Monday, March 31, 2014

Deadline dash: Glitches slow health care sign-ups







People line up to enroll for health insurance at the Alamodome in San Antonio, Texas on Monday, March 31, 2014. The deadline is just hours away to sign up for insurance in the first enrollment period under President Barack Obama’s signature health care law. (AP Photo/San Antonio Express-News, Jerry Lara) RUMBO DE SAN ANTONIO OUT; NO SALES





People line up to enroll for health insurance at the Alamodome in San Antonio, Texas on Monday, March 31, 2014. The deadline is just hours away to sign up for insurance in the first enrollment period under President Barack Obama’s signature health care law. (AP Photo/San Antonio Express-News, Jerry Lara) RUMBO DE SAN ANTONIO OUT; NO SALES





Charles Ellis, 53, of Salt Lake City, right, works with navigator Luis Rios while seeking help to buy health insurance at the Utah Health Policy Project Monday, March 31, 2014, in Salt Lake City. Ellis said he doesn’t feel he needs insurance but was signing up to avoid a penalty. (AP Photo/Rick Bowmer)





SEIU-UHW worker Kathy Santana, left , assists Ruben Tares, 27, during a health care enrollment event at SEIU-UHW office, Monday, March 31, 2014, in Commerce, Calif. Monday marks this year’s open enrollment deadline, but consumers will get extra time to finish their applications. (AP Photo/Ringo H.W. Chiu)





Lisa Valera and her husband Manuel sign up for Obamacare at the Community Service Society, Monday, March 31, 2014 in New York. The troubled U.S. government web site for signing up for health insurance was unavailable for several hours Monday morning as the midnight deadline for buying coverage loomed. Heading into the deadline, more than 6 million Americans had signed up for health insurance, some of the policies heavily subsidized for lower income people. (AP Photo/Mark Lennihan)





A screen shows the countdown for the deadline to sign up for health insurance during a health care enrollment event at SEIU-UHW office, Monday, March 31, 2014, in Commerce, Calif. Monday marks this year’s open enrollment deadline, but consumers will get extra time to finish their applications. (AP Photo/Ringo H.W. Chiu)













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WASHINGTON (AP) — In a flood of last-minute sign-ups, hundreds of thousands of Americans rushed to apply for health insurance Monday, but deadline day for President Barack Obama’s overhaul brought long, frustrating waits and a new spate of website ills.


“This is like trying to find a parking spot at Wal-Mart on Dec. 23,” said Jason Stevenson, working with a Utah nonprofit group helping people enroll.


At times, more than 125,000 people were simultaneously using HealthCare.gov, straining it beyond its capacity. For long stretches Monday, applicants were shuttled to a virtual waiting room where they could leave an email address and be contacted later.


Officials said the site had not crashed but was experiencing very heavy volume. The website, which was receiving 1.5 million visitors a day last week, had recorded about 1.6 million through 2 p.m. EDT.


Supporters of the health care law fanned out across the country in a final dash to sign up uninsured Americans. People not signed up for health insurance by the deadline, either through their jobs or on their own, were subject to being fined by the IRS, and that threat was helping drive the final dash.


The administration announced last week that people still in line by midnight would get extra time to enroll.


The website stumbled early in the day — out of service for nearly four hours as technicians patched a software bug. Another hiccup in early afternoon temporarily kept new applicants from signing up, and then things slowed further. Overwhelmed by computer problems when launched last fall, the system has been working much better in recent months, but independent testers say it still runs slowly.


At Chicago’s Norwegian American Hospital, people began lining up shortly after 7 a.m. to get help signing up for subsidized private health insurance.


Lucy Martinez, an unemployed single mother of two boys, said she’d previously tried to enroll at a clinic in another part of the city but there was always a problem. She’d wait and wait and they wouldn’t call her name, or they would ask her for paperwork that she was told earlier she didn’t need, she said. Her diabetic mother would start sweating so they’d have to leave.


She’s heard “that this would be better here,” said Martinez, adding that her mother successfully signed up Sunday at a different location.


At St. Francis Hospital in Wilmington, Del., enrollment counselor Hubert Worthen plunged into a long day. “I got my energy drink,” he said. “This is epic, man.”


At a Houston community center, there were immigrants from Ethiopia, Nepal, Eritrea, Somalia, Iraq, Iran and other conflict-torn areas, many of them trying anew after failing to complete applications previously. In addition to needing help with the actual enrollment, they needed to wait for interpreters. Many had taken a day off from work, hoping to meet the deadline.


The White House and other supporters of the law were hoping for an enrollment surge that would push sign-ups in the new health insurance markets to around 6.5 million people. That’s halfway between a revised goal of 6 million and the original target of 7 million. The first goal was scaled back after the federal website’s disastrous launch last fall, which kept it offline during most of October.


The insurance markets — or exchanges — offer subsidized private health insurance to people who don’t have access to coverage through their jobs. The federal government is taking the lead in 36 states, while 14 other states plus Washington, D.C., are running their own enrollment websites.


New York, running its own site, reported more than 812,000 had signed up by Sunday morning, nearly 100,000 of them last week.


However, it’s unclear what those numbers may mean.


The administration hasn’t said how many of the 6 million people nationally who had signed up before the weekend ultimately closed the deal by paying their first month’s premiums. Also unknown is how many were previously uninsured — the real test of Obama’s health care overhaul. In addition, the law expands coverage for low-income people through Medicaid, but only about half the states have agreed to implement that option.


Cheering on the deadline-day sign-up effort, Health and Human Services Secretary Kathleen Sebelius planned to spend much of the day Monday working out of the department’s TV studio, conducting interviews by satellite with stations around the country.


Though March 31 was the last day officially to sign up, millions of people are potentially eligible for extensions granted by the administration.


Those include people who had begun enrolling by the deadline but didn’t finish, perhaps because of errors, missing information or website glitches. The government says it will accept paper applications until April 7 and take as much time as necessary to handle unfinished cases on HealthCare.gov. Rules may vary in states running their own insurance marketplaces.


The administration is also offering special extensions to make up for all sorts of problems that might have kept people from getting enrolled on time: Natural disasters. Domestic abuse. Website malfunctions. Errors by insurance companies. Mistakes by application counselors.


To seek a special enrollment period, contact the federal call center, at 1-855-889-4325, or the state marketplace and explain what happened. It’s on the honor system. If the extension is approved, that brings another 60 days to enroll.


Those who still don’t get health insurance run the risk that the Internal Revenue Service will fine them next year for remaining uninsured. It remains to be seen how aggressively the penalties called for in the law are enforced.


Also, the new markets don’t have a monopoly on health insurance. People not already covered by an employer or a government program can comply with the insurance mandate by buying a policy directly from an insurer. They’ll just have to pay the full premium themselves, although in a few states there may be an exception to that rule as well.


Supporters of the law held their breath early Monday when the website was taken down.


Administration spokesman Aaron Albright said the site undergoes “regular nightly maintenance” during off-peak hours and the period was extended because of a “technical problem.” He did not say what the problem was, but an official statement called it “a software bug” unrelated to application volume.


In Oakton, Va., enrollment counselor Rachel Klein said she noticed the website was running slowly.


“We all came into it understanding that today was going to be challenging,” said Klein. “We’re all relieved that there’s going to be a little extra time for people.”


House Speaker John Boehner of Ohio said Monday that Republicans remain committed to repealing Obama’s law. But its supporters are wasting no time trying to shape the next open enrollment season, starting Nov. 15. The advocacy group Families USA will announce ten recommendations Tuesday to make the system more consumer-friendly.


They range from providing more in-person assistance with sign-ups, to eliminating premium penalties for smokers, to aligning enrollment with tax-filing season.


___


Associated Press writers Connie Cass in Washington, Don Babwin in Chicago, Randall Chase in Wilmington, Del., Ramit Plushnick-Masti in Houston, Michelle Price in Salt Lake City and Carolyn Thompson in Buffalo, N.Y., contributed to this report.


Associated Press




Politics Headlines



Deadline dash: Glitches slow health care sign-ups

Deadline dash: Health care sign-ups amid glitches







Charles Ellis, 53, of Salt Lake City, right, works with navigator Luis Rios while seeking help to buy health insurance at the Utah Health Policy Project Monday, March 31, 2014, in Salt Lake City. Ellis said he doesn’t feel he needs insurance but was signing up to avoid a penalty. (AP Photo/Rick Bowmer)





Charles Ellis, 53, of Salt Lake City, right, works with navigator Luis Rios while seeking help to buy health insurance at the Utah Health Policy Project Monday, March 31, 2014, in Salt Lake City. Ellis said he doesn’t feel he needs insurance but was signing up to avoid a penalty. (AP Photo/Rick Bowmer)





SEIU-UHW worker Kathy Santana, left , assists Ruben Tares, 27, during a health care enrollment event at SEIU-UHW office, Monday, March 31, 2014, in Commerce, Calif. Monday marks this year’s open enrollment deadline, but consumers will get extra time to finish their applications. (AP Photo/Ringo H.W. Chiu)





Lisa Valera and her husband Manuel sign up for Obamacare at the Community Service Society, Monday, March 31, 2014 in New York. The troubled U.S. government web site for signing up for health insurance was unavailable for several hours Monday morning as the midnight deadline for buying coverage loomed. Heading into the deadline, more than 6 million Americans had signed up for health insurance, some of the policies heavily subsidized for lower income people. (AP Photo/Mark Lennihan)





A screen shows the countdown for the deadline to sign up for health insurance during a health care enrollment event at SEIU-UHW office, Monday, March 31, 2014, in Commerce, Calif. Monday marks this year’s open enrollment deadline, but consumers will get extra time to finish their applications. (AP Photo/Ringo H.W. Chiu)





The HealthCare.gov website is shown on a laptop in Washington, Monday, March 31, 2014. Today is the deadline to sign up for private heath insurance in the online markets created by President Obama’s heath care law or face a federal fines. (AP Photo/J. David Ake)













Buy AP Photo Reprints







WASHINGTON (AP) — In a flood of last-minute sign-ups, hundreds of thousands of Americans rushed to apply for health insurance Monday, as deadline day for President Barack Obama’s overhaul brought long waits and a new spate of website ills.


“This is like trying to find a parking spot at Wal-Mart on Dec. 23,” said Jason Stevenson, working with a Utah nonprofit group helping people enroll.


Supporters of the health care law fanned out across the country in a final dash to sign up uninsured Americans. The HealthCare.gov website, which was receiving 1.5 million visitors a day last week, had recorded about 1.2 million through noon Monday.


At times, more than 125,000 people were simultaneously using the system, straining it beyond its previously estimated capacity. People not signed up for health insurance by the deadline, either through their jobs or on their own, were subject to being fined by the IRS, and that threat was helping drive the final dash.


The administration announced last week that people still in line by midnight would get extra time to enroll.


The website stumbled early in the day — out of service for nearly four hours as technicians patched a software bug. Another hiccup in early afternoon temporarily kept new applicants from signing up, and then things slowed further as the afternoon wore on. Overwhelmed by computer problems when launched last fall, the system has been working much better in recent months, but independent testers say it still runs slowly.


At Chicago’s Norwegian American Hospital, people began lining up shortly after 7 a.m. to get help signing up for subsidized private health insurance.


Lucy Martinez, an unemployed single mother of two boys, said she’d previously tried to enroll at a clinic in another part of the city but there was always a problem. She’d wait and wait and they wouldn’t call her name, or they would ask her for paperwork that she was told earlier she didn’t need, she said. Her diabetic mother would start sweating so they’d have to leave.


She’s heard “that this would be better here,” said Martinez, adding that her mother successfully signed up Sunday at a different location.


At St. Francis Hospital in Wilmington, Del., enrollment counselor Hubert Worthen plunged into a long day. “I got my energy drink,” he said. “This is epic, man.”


At a Houston community center, there were immigrants from Ethiopia, Nepal, Eritrea, Somalia, Iraq, Iran and other conflict-torn areas, many of them trying anew after failing to complete applications previously. In addition to needing help with the actual enrollment, they needed to wait for interpreters. Many had taken a day off from work, hoping to meet the deadline.


The White House and other supporters of the law were hoping for an enrollment surge that would push sign-ups in the new health insurance markets to around 6.5 million people. That’s halfway between a revised goal of 6 million and the original target of 7 million. The first goal was scaled back after the federal website’s disastrous launch last fall, which kept it offline during most of October.


The insurance markets — or exchanges — offer subsidized private health insurance to people who don’t have access to coverage through their jobs. The federal government is taking the lead in 36 states, while 14 other states plus Washington, D.C., are running their own enrollment websites.


New York, running its own site, reported more than 812,000 had signed up by Sunday morning, nearly 100,000 of them last week.


However, it’s unclear what those numbers may mean.


The administration hasn’t said how many of the 6 million people nationally who had signed up before the weekend ultimately closed the deal by paying their first month’s premiums. Also unknown is how many were previously uninsured — the real test of Obama’s health care overhaul. In addition, the law expands coverage for low-income people through Medicaid, but only about half the states have agreed to implement that option.


Cheering on the deadline-day sign-up effort, Health and Human Services Secretary Kathleen Sebelius planned to spend much of the day Monday working out of the department’s TV studio, conducting interviews by satellite with stations around the country.


Though March 31 was the last day officially to sign up, millions of people are potentially eligible for extensions granted by the administration.


Those include people who had begun enrolling by the deadline but didn’t finish, perhaps because of errors, missing information or website glitches. The government says it will accept paper applications until April 7 and take as much time as necessary to handle unfinished cases on HealthCare.gov. Rules may vary in states running their own insurance marketplaces.


The administration is also offering special extensions to make up for all sorts of problems that might have kept people from getting enrolled on time: Natural disasters. Domestic abuse. Website malfunctions. Errors by insurance companies. Mistakes by application counselors.


To seek a special enrollment period, contact the federal call center, at 1-855-889-4325, or the state marketplace and explain what happened. It’s on the honor system. If the extension is approved, that brings another 60 days to enroll.


Those who still don’t get health insurance run the risk that the Internal Revenue Service will fine them next year for remaining uninsured. It remains to be seen how aggressively the penalties called for in the law are enforced.


Also, the new markets don’t have a monopoly on health insurance. People not already covered by an employer or a government program can comply with the insurance mandate by buying a policy directly from an insurer. They’ll just have to pay the full premium themselves, although in a few states there may be an exception to that rule as well.


Supporters of the law held their breath early Monday when the website was taken down.


Administration spokesman Aaron Albright said the site undergoes “regular nightly maintenance” during off-peak hours and the period was extended because of a “technical problem.” He did not say what the problem was, but an official statement called it “a software bug” unrelated to application volume.


In Oakton, Va., enrollment counselor Rachel Klein said she noticed the website was running slowly.


“We all came into it understanding that today was going to be challenging,” said Klein. “We’re all relieved that there’s going to be a little extra time for people.”


House Speaker John Boehner of Ohio said Monday that Republicans remain committed to repealing Obama’s law. But its supporters are wasting no time trying to shape the next open enrollment season, starting Nov. 15. The advocacy group Families USA will announce ten recommendations Tuesday to make the system more consumer-friendly.


They range from providing more in-person assistance with sign-ups, to eliminating premium penalties for smokers, to aligning enrollment with tax-filing season.


___


Associated Press writers Connie Cass in Washington, Don Babwin in Chicago, Randall Chase in Wilmington, Del., Ramit Plushnick-Masti in Houston, Michelle Price in Salt Lake City and Carolyn Thompson in Buffalo, N.Y., contributed to this report.


Associated Press




Politics Headlines



Deadline dash: Health care sign-ups amid glitches

Sunday, March 30, 2014

Health Insurance Rates Are Going Up Next Year, But It"s Nothing to Panic Over

The LA Times has a piece today about the next battleground for Obamacare: rate increases for 2015. The warnings are already coming thick and fast:


WellPoint Inc., parent of California’s leading health insurer in the exchange, Anthem Blue Cross, has already predicted “double-digit-plus” rate increases on Obamacare policies across much of the country.


…. Health insurers aren’t wasting any time sizing up what patients are costing them now and what that will mean for 2015 rates. Hunkered down in conference rooms, insurance actuaries are parsing prescriptions, doctor visits and hospital stays for clues about how expensive these new patients may be. By May, insurance companies must file next year’s rates with California’s state-run exchange so negotiations can begin.



I hope everyone manages to restrain their hysteria over this. Here in California, we’ve played this game annually for years. Health insurers in the individual market propose wild increases in their premiums—10 percent, 20 percent, sometimes even 30 percent—and then dial them back a bit after consumer outrage blankets the media and the Department of Insurance pushes back. But even then, we routinely end up with double-digit increases. Just for background, here are the average annual rate increases requested by a few of California’s biggest insurers over the last three years:


  • Anthem Blue Cross: 10.7%

  • Aetna: 12.1%

  • Blue Shield: 15.4%

  • HealthNet: 12.0%

And this doesn’t include changes in deductibles or out-of-pocket maximums. Add those in, and the annual proposed increases are probably in the range of 15-20 percent. Obamacare, of course, limits both those things, which means that in the future insurance companies will have to put everything into rate hikes instead of spreading the increases around to make them harder to add up.


Bottom line: if we end up seeing double-digit rate increases, it will be business as usual. Insurance companies will all blame it on Obamacare because that’s a convenient thing to do, but the truth is that we probably would have seen exactly the same thing even if Barack Obama had never been born. Let’s all keep our feet on the ground when the inevitable huge rate increase requests start flowing in.



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Health Insurance Rates Are Going Up Next Year, But It"s Nothing to Panic Over

Friday, March 28, 2014

Massachusetts declares public health emergency over heroin overdoses and opioids addiction

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Monday, March 24, 2014

Latinos being left behind in health care overhaul







Jane Delgado, president of the National Alliance for Hispanic Health, works in her office in Washington, Monday, March 24, 2014. The nation’s largest minority group risks being left behind by President Barack Obama’s health care overhaul. Hispanics account for nearly one-third of the nation’s uninsured, but all signs indicate that they remain largely on the sidelines as the White House races to meet a goal of 6 million sign-ups with less than a week to enroll. (AP Photo/ Evan Vucci)





Jane Delgado, president of the National Alliance for Hispanic Health, works in her office in Washington, Monday, March 24, 2014. The nation’s largest minority group risks being left behind by President Barack Obama’s health care overhaul. Hispanics account for nearly one-third of the nation’s uninsured, but all signs indicate that they remain largely on the sidelines as the White House races to meet a goal of 6 million sign-ups with less than a week to enroll. (AP Photo/ Evan Vucci)





This screenshot made Nov. 26, 2013, shows the Department of Health and Human Services’ web page for the Spanish language version HealthCare.gov. The nation’s largest minority group risks being left behind by President Barack Obama’s health care overhaul. Hispanics account for about one-third of the nation’s uninsured, but all signs indicate that they remain largely on the sidelines as the White House races to meet a goal of 6 million sign-ups by March 31. (AP Photo/U.S. Department of Health and Human Services)





Jane Delgado, president of the National Alliance for Hispanic Health, works in her office in Washington, Monday, March 24, 2014. The nation’s largest minority group risks being left behind by President Barack Obama’s health care overhaul. Hispanics account for nearly one-third of the nation’s uninsured, but all signs indicate that they remain largely on the sidelines as the White House races to meet a goal of 6 million sign-ups with less than a week to enroll. (AP Photo/ Evan Vucci)













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(AP) — The nation’s largest minority group risks being left behind by President Barack Obama’s health care overhaul.


Hispanics account for about one-third of the nation’s uninsured, but they seem to be staying on the on the sidelines as the White House races to meet a goal of 6 million sign-ups by March 31.


Latinos are “not at the table,” says Jane Delgado, president of the National Alliance for Hispanic Health, a nonpartisan advocacy network. “We are not going to be able to enroll at the levels we should be enrolling at.”


That’s a loss both for Latinos who are trying to put down middle-class roots and for the Obama administration, experts say.


Hispanics who remain uninsured could face fines, not to mention exposing their families to high medical bills from accidents or unforeseen illness. And the government won’t get the full advantage of a group that’s largely young and healthy, helping keep premiums low in the new insurance markets.


“The enrollment rate for Hispanic-Americans seems to be very low, and I would be really concerned about that,” says Brookings Institution health policy expert Mark McClellan. “It is a large population that has a lot to gain … but they don’t seem to be taking advantage.” McClellan oversaw the rollout of Medicare’s prescription drug benefit for President George W. Bush.


The Obama administration says it has no statistics on the race and ethnicity of those signing up in the insurance exchanges, markets that offer subsidized private coverage in every state. Consumers provide those details voluntarily, so federal officials say any tally would be incomplete and possibly misleading.


But concern is showing through, and it’s coming from the highest levels.


“You don’t punish me by not signing up for health care,” Obama told Hispanic audiences during a recent televised town hall. “You’re punishing yourself or your family.”


Like a candidate hunting for votes in the closing days of a campaign, Obama was back on Hispanic airwaves Monday as Univision Radio broadcast his latest pitch.


“The problem is if you get in an accident, if you get sick, or somebody in your family gets sick, you could end up being bankrupt,” the president said.


Only last September, three of five Latinos supported the national overhaul, according to the Pew Research Center. Approval dropped sharply during October, as technical problems paralyzed the health care rollout and the Spanish-language version of the HealthCare.gov website. Hispanics are now evenly divided in their views.


A big Gallup survey recently showed tepid sign-up progress. While the share of African-Americans who are uninsured dropped by 2.6 percentage points this year, the decline among Hispanics was just 0.8 percentage point.


In California, where Latinos account for 46 percent of those eligible for subsidized coverage through the exchange, they represented 22 percent of those who had enrolled by the end February and had also volunteered their race or ethnicity. The state is scrambling to improve its numbers in this week’s home stretch.


Experts cite overlapping factors behind disappointing Latino sign-ups:


— A shortage of in-person helpers to guide consumers. “In our community, trust and confidence is so important — you want to make sure it’s OK before you share all this personal information,” Delgado said. There’s been a lack of “culturally sensitive” outreach to Latinos, added Rep. Lloyd Doggett, D-Texas.


— Fear that applying for health care will bring unwelcome scrutiny from immigration authorities. The health insurance exchanges are only for citizens and legal U.S. residents, but many Hispanic families have mixed immigration status. Some members may be native born, while others might be here illegally. Obama has tried to dispel concerns, repeatedly saying that information on applications will not be shared with immigration authorities.


—The decision by many Republican-led states not to expand Medicaid, as they could under the law. With states like Texas and Florida refusing to expand Medicaid, many low-income Latinos will remain uninsured. However, Medicaid expansion is separate from coverage on the exchanges, which is available in every state. Latinos don’t seem motivated to sign up for that, either.


— Technical difficulties that delayed the federal government’s Spanish-language enrollment site. CuidadoDeSalud.gov has also had to cope with clunky translations.


Delgado’s group is asking the administration to extend the March 31 deadline for Latinos who got tangled up in website problems. Officials say that’s not likely. However, they haven’t ruled out a little extra time for anyone who started an application but wasn’t able to finish by the deadline.


A recent enrollment outreach event in Houston drew Mary Nunez, who works with her self-employed husband in the florist business. They have been uninsured since she lost her job last year. In that time, she’s only been to a doctor once — to get a refill on blood-pressure medication.


“Praise the Lord, we haven’t gotten sick,” said Nunez, adding that she knows luck eventually will run out.


She made an appointment for in-person assistance to review her options on the Texas exchange. But since the couple’s income fluctuates from month to month, she was uncertain how much they could afford. A deadline is looming, she noted, and “Hispanics always leave it for the last minute.”


___


Associated Press writer Ramit Plushnick-Masti in Houston contributed to this report.


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Latinos being left behind in health care overhaul

Thursday, March 20, 2014

Measles Are Back! Vaccine Truthers Officially a Public Health Menace

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Measles Are Back! Vaccine Truthers Officially a Public Health Menace

Tuesday, March 18, 2014

Mental health hospitalizations for children increased almost one-quarter

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Mental health hospitalizations for children increased almost one-quarter

Concerns about cancer centers under health law







This photo taken Feb. 20, 2014 showsWashington state Insurance Commissioner Mike Kreidler speaking to seniors at an annual lobby day for the group in Olympia, Wash. Cancer patients relieved that they can get insurance coverage because of the new health care law may be disappointed to learn that some of the nation’s best cancer hospitals are off limits. Only four of 19 nationally recognized comprehensive cancer centers that responded to an Associated Press survey said patients have access through all the insurance companies in their state’s exchange, or primary market. (AP Photo/Elaine Thompson)





This photo taken Feb. 20, 2014 showsWashington state Insurance Commissioner Mike Kreidler speaking to seniors at an annual lobby day for the group in Olympia, Wash. Cancer patients relieved that they can get insurance coverage because of the new health care law may be disappointed to learn that some of the nation’s best cancer hospitals are off limits. Only four of 19 nationally recognized comprehensive cancer centers that responded to an Associated Press survey said patients have access through all the insurance companies in their state’s exchange, or primary market. (AP Photo/Elaine Thompson)













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WASHINGTON (AP) — Some of America’s best cancer hospitals are off-limits to many of the people now signing up for coverage under the nation’s new health care program.


Doctors and administrators say they’re concerned. So are some state insurance regulators.


An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington’s insurance exchange. MD Anderson Cancer Center says it’s in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more.


In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP’s survey said patients have access through all the insurance companies in their states’ exchanges.


Not too long ago insurance companies would have been vying to offer access to renowned cancer centers, said Dan Mendelson, CEO of the market research firm Avalere Health. Now the focus is on costs.


“This is a marked deterioration of access to the premier cancer centers for people who are signing up for these plans,” Mendelson said.


Those patients may not be able get the most advanced treatment, including clinical trials of new medications.


And there’s another problem: it’s not easy for consumers shopping online in the new insurance markets to tell if top-level institutions are included in a plan. That takes additional digging by the people applying.


“The challenges of this are going to become evident … as cancer cases start to arrive,” said Norman Hubbard, executive vice president of Seattle Cancer Care Alliance.


Before President Barack Obama’s health care law, a cancer diagnosis could make you uninsurable. Now, insurers can’t turn away people with health problems or charge them more. Lifetime dollar limits on policies, once a financial trap-door for cancer patients, are also banned.


The new obstacles are more subtle.


To keep premiums low, insurers have designed narrow networks of hospitals and doctors. The government-subsidized private plans on the exchanges typically offer less choice than Medicare or employer plans.


By not including a top cancer center an insurer can cut costs. It may also shield itself from risk, delivering an implicit message to cancer survivors or people with a strong family history of the disease that they should look elsewhere.


For now, the issue seems to be limited to the new insurance exchanges. But it could become a concern for Americans with job-based coverage, too, if employers turn to narrow networks.


The AP surveyed 23 institutions around the country that are part of the National Comprehensive Cancer Network. Two additional institutions that joined this week were not included in the survey.


Cancer network members are leading hospitals that combine the latest clinical research and knowledge with a multidisciplinary approach to patient care. They say that patients in their care have better-than-average survival rates. The unique role of cancer centers is recognized under Medicare. Several are exempt from its hospital payment system, instituted to control costs.


AP asked the centers how many insurance companies in their state’s exchange included them as a network provider.


Of the 19 that responded, four reported access through all insurers: the Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore, Fox Chase Cancer Center in Philadelphia, Duke Cancer Institute in Durham, N.C., and Vanderbilt-Ingram Cancer Center in Nashville. One caveat: Some insurers did not include these cancer centers on certain low-cost plans.


Two centers had special circumstances. The best known is St. Jude’s Children’s Research Hospital in Memphis. Treatment there is free as long as children have a referral.


For the remaining 13, the gaps were evident.


In Buffalo, N.Y., Roswell Park Cancer Institute is included by five of seven insurers in its region. But statewide, the picture is much different: Roswell Park is not included by 11 of 16 insurers. Dr. Willie Underwood, associate professor of surgical oncology at the teaching hospital, says that’s a problem.


“Overall, when you look at the Affordable Care Act, it improves access to cancer care,” said Underwood. “When it comes down to the exchanges, there are some concerns that we have. That is not being critical, that is being intelligent. There are some things we should talk about … before they start becoming a problem.”


Melanie Lapidus, vice president for managed care at Barnes-Jewish Hospital in St. Louis, home to Siteman Cancer Center, said she doesn’t think patients realize the exchanges offer a more restrictive kind of private insurance.


Lapidus cited Anthem Blue Cross and Blue Shield, which includes Siteman in many of its plans outside the Missouri exchange, but none within the exchange.


“We have had many people say to us, ‘I picked Anthem because you guys are always in their products, and I assumed you would be in their exchange products’,” Lapidus said. “It’s still hard to tell who is in network and who is not.”


In a statement, Anthem said its network was based on research involving thousands of consumers and businesses. “What we learned was that people are willing to make trade-offs in order to have access to affordable health care,” the company said. “Our provider networks reflect this.”


Huntsman Cancer Institute in Salt Lake City is included by five of six Utah insurers, but Mark Zenger, who manages the center’s negotiations with insurance companies, said he’s concerned about getting left out by Humana, a major carrier.


“We are worried about the potential to have these Humana exchange members seek treatment and have no other option,” said Zenger.


Humana spokesman Tom Noland said patients can have access to Huntsman for complex procedures, on a case-by-case basis.


Some state insurance regulators see a problem.


“I want insurers to be able to innovate and come up with new product designs,” said Mike Kreidler, insurance commissioner for Washington state. “At the same time, there is a requirement for regulators like myself to be vigilant to make sure there aren’t unreasonable compromises.”


The Obama administration says it has notified insurers that their networks will get closer scrutiny for next year in the 36 states served by the federal exchange. Cancer care will be a priority, it says.


___


AP writers Sheila Burke in Nashville, Tenn., Kim Chandler in Montgomery, Ala., Emery Dalesio in Raleigh, N.C., Jeff Karoub in Detroit, Brady McCombs in Salt Lake City, Christine Scalora in Lincoln, Neb., and Christopher Weber in Los Angeles contributed.


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Concerns about cancer centers under health law