Jeff Cohen, WNPR, Author at �鶹Ů�� Health News

Details On Death Certificates Offer Layers Of Clues To Opioid Epidemic

Jeff Cohen, WNPR — Fri, 03 Jun 2016 09:00:40 +0000

Dr. James Gill walked through the morgue in Farmington, Connecticut, recently, past the dock where the bodies come in, past the tissue donations area, and stopped outside the autopsy room.

“We kind of have a typical board listing all of the decedents for the day,” Gill said, pointing to the list of names on a dry erase board. “Overdose, overdose, overdose, overdose overdose. That’s just for today.”

Gill is the for the state of Connecticut, and of the nine bodies in his custody that day, four were the remains of the people who likely died from an accidental drug overdose. A fifth was a probable suicide involving drugs. It was a sad, but typical day, he explained, with a practical consequence for the state’s morgue: Gill is running out of room to store bodies.

“We’ve had to buy some extra racks and things so we can store more,” he told me. “But we really probably need more cooler space. We’re kind of outgrowing the storage space here.”

In the past two years, Gill’s office has seen a more than a 50 percent increase in autopsies. That’s mostly because of the spike in accidental drug overdoses, he said. Heroin is the big player. Fentanyl deaths have surged, too.

I sat with Gill in the so-called family room just off the lobby of the examiner’s office. In explaining why good data on exactly which drugs killed exactly which people is important, Gill recalled a conversation he once had with a mother whose daughter had died of a drug overdose the previous year. The mother called Gill to learn more.

“Can you tell me, did she suffer?” the woman wanted to know. “Was she in pain?”

“And I explained to her,” Gill said, “that, with an opioid death, the person just gradually goes to sleep and it’s very painless.

Dr. James Gill, Connecticut’s chief medical examiner, says the opioid crisis has made accidental drug overdose a much more common cause of death in his state. His office is even running out of room to store bodies, he says. (Jeff Cohen/WNPR)

“And she started crying,” Gill told me, fighting tears of his own. “And it gave her some comfort.”

There’s another reason to get solid data — so you can craft a public health response to the epidemic. Specificity about a death today could help save a life tomorrow, he said. A death certificate needs to say more than something vague like “opioid intoxication” to help both law enforcement and public health officials curb the distribution — and hopefully abuse —��of opioids.

“Well, what are those opioids? Are they heroin or are they Oxycontin?’ ” he asked rhetorically. The precise answer can make a difference in figuring out what actions to take.

But not all death certificates have as much information as they could. When Gill took the job just a few years ago, only 63 percent of Connecticut’s drug deaths had . Today 99 percent do.

“I found that the doctors here, a lot of them were certifying the deaths as acute or multi-drug intoxication,” Gill told me. “And I said, ‘No, we need to spell out what the drugs are that are causing the death.’ So, it would be ‘acute intoxication due to the combined effects of heroin, diazepam and alcohol’ — and that’s how we certify the deaths now. We’re very specific about what we’re finding in the toxicology.”

In 2014 , the most recent year that data are available, only Rhode Island did better than Connecticut in getting and passing along these sorts of comprehensive details. Conversely, only about half of deaths in some other states — including Pennsylvania, Indiana, Mississippi and Louisiana — have specific information on the death certificates.

There are a lot of contributing factors that could explain the variation from state to state, Gill said.

First, not all people who certify deaths have the same training.

Second, when lots of drugs are involved, some people may not be comfortable singling out one or two as the cause of death. Custom could play a role, too — the “We’ve always done it this way” factor. So might size. Connecticut is small and centralized in the way it handles these cases.

“All of the deaths are examined here by the same group of medical examiners, the same investigators,” Gill said. “So we can kind of establish that common technique and certification ability. Whereas, in a lot of jurisdictions — New York, for example — it varies by county.”

, an injury epidemiologist with the Centers for Disease Control and Prevention, focuses on monitoring trends in mortality, using death certificate data, and she agrees that lots of variables contribute to Connecticut’s success in gathering better data. But one of them is pretty basic: clear communication with the people who determine and report the cause of death.

“The thing that’s different between 2012 and the current year,” Warner told me, “is that Dr. Gill — who knows that we want those specific drugs written down on the death certificate — is now writing them down. So some of it’s about reaching out to the certifiers to make sure that they know we want the specific drugs involved.”

The CDC is actively working on that, Warner said.

But, in Gill’s experience, not everyone wants all that information documented.

“I remember one call from a family member who was upset that we put heroin on the death certificate,” he said. “Their son had died of heroin, and they didn’t want it on the death certificate because they were afraid that the public was going to hear about it and know that that person died of heroin. And I said, ‘I’m sorry, but this is a public health issue.’ “

And, judging , it may be a big public health issue for a long time to come.

This story is part of a partnership that includes , and Kaiser Health News.

�鶹Ů�� Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at �鶹Ů��—an independent source of health policy research, polling, and journalism. Learn more about .

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A Nurse’s Lesson: Babies In Opioid Withdrawal Still Need Mom

Jeff Cohen, WNPR — Tue, 29 Mar 2016 09:00:50 +0000

HARTFORD, Conn.��—��Carolyn Rossi has been a nurse for 27 years, and she’s been fiercely protective of infants in her intensive care unit — babies born too soon, babies born with defects and, increasingly, babies born dependent on opioids.

Rossi works in the neonatal intensive care unit (NICU) at the Hospital of Central Connecticut near Hartford. Like many hospitals across the country, it has seen the number of babies born with go up dramatically in recent years. The National Institute of Drug Abuse reports more than in the U.S. were born in withdrawal from opioids in 2012, the most recent year for which data are��available. The hospital says each baby costs roughly $50,000 to treat.

These fragile and fitful babies present new challenges for hospitals. There’s research that suggests they may do best when they can be held for hours, by their mothers, in a quiet, private room as they go through the process of being weaned off the drugs. But delivering that care means changing hospital systems and attitudes about addiction among doctors and nurses.

“It was a lot about taking babies away from moms,” Rossi said, describing the way she first learned to care for babies in withdrawal. The nurses saw their role, she said, as “trying to protect the baby from the mother, basically. Like we were going to cure the baby but not cure the mother and the family.”

It wasn’t the best strategy. The babies can often be soothed best by their mothers. But mothers are struggling, too.

“So, [a mother] comes in with a stigma,” said Kate Sims, who directs the hospital’s women and children’s services. “She’s feeling guilt herself. And unfortunately, as best as we are as providers and nurses, we’re also judgmental.”

Sims said that feeling — that lack of trust between a mother and a nurse — can push that mom away, making treating the baby even harder.

So the hospital has started to retrain its nurses to think differently. The biggest change? Treating mom as a mom, and not as an addict. That means recognizing that addiction isn’t a moral failure, and that many people who are addicted come from a lifetime of trauma. Rossi said it’s been hard for nurses who are baby specialists to be mom specialists, too.

“It’s a big culture change for me personally, and I know for the NICU nurses that are in here. You really do believe you’re doing the right thing until something like this comes along.”

Along with changing a culture of nursing, it’s changing a hospital’s approach, too. Dr. Annmarie Golioto, chief of pediatrics and the head of the hospital’s nursery, says a bright, loud, bustling intensive care unit is a hard environment for a baby going through withdrawal. So she’s gotten approval to use a few rooms just outside the intensive care unit —��quiet, monitored spaces for the baby and mother to stay for as long as the baby needs it.

“We’ve had to figure out, how can we use our rooms differently?” says Golioto. “How can we use our space differently? And how we can partner with mom differently to have that relationship with her to say, ‘We expect you to stay here with your baby and take care of the baby after you’ve been discharged.'”

Golioto hopes the new setting could shorten recovery times and decrease the amount of morphine a baby needs to ease withdrawal. She’s also hopeful these moves will inspire some mothers to think differently about their newborns.

“The thinking was, ‘My baby is being taken care of. There are nurses there. There are doctors there. I don’t need to be here. They’re getting everything they need,’ ” says Golioto. “What we’re trying to change the thinking is, ‘No, they’re not getting everything they need if you’re not here. Because they need you.’ “

Nurse Rossi says she only needed to see the change in attitude and approach work once to see the culture shift pay off. It was back in December, and she gave a mother a room to stay in for more than a month while her baby went through withdrawal.

“She was just thrilled. And she wasn’t here 24/7. She couldn’t be here 24/7,” says Rossi. “She was here as much as she could and, just knowing that she had the flexibility, for me, helped me understand that she is a mom, she is a great mom, she wants to be a better mom.”

Nearly every aspect of the opioid epidemic worsened in 2014, according to the government’s . And even though this hospital’s programs are just a few months old, it’s hoping that this culture change will, at the very least, give at risk moms and babies a better start.

This story is the second��in our four-part series, “Treating the Tiniest Opioid Patients,”��a collaboration produced by Kaiser Health News, NPR and��local NPR member stations.

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Connecticut Governor Targets Hospital Funds To Close Budget Gap

Jeff Cohen, WNPR — Fri, 11 Dec 2015 19:57:52 +0000

This week Connecticut’s leaders had to close a $350 million hole in the state’s budget. One place they is hospital funding, and that’s making hospital executives furious.

The battles lines are clear. Gov. Dannel Malloy, a Democrat, says the hospitals are getting rich off taxpayers, making more money than in past years — thanks, in part, to the Affordable Care Act. So he thinks hospitals can afford to give some money back.

“If you make almost a billion dollars a year, how bad are things?” Malloy asks. “If you’re having the best results in recent history in hospital performance, why do you need the citizens of Connecticut to give you an additional $500 million?”

Malloy is making his argument personal — taking aim at the high salaries of hospital CEOs. Many of the executives of the state’s nonprofit medical institutions make at least a million dollars a year, he points out.

“If they’re hurting so bad,” Malloy says, “why are they paying their chief executives $3.5 million dollars?”

But where the governor sees bloat, the hospitals see a politician using them as easy targets. The medical institutions are paying for political-style advertising to tell constituents that his cuts will have a serious, negative effect on patient care.

“Longer wait times, fewer cancer screenings, and nurses will be let go,” one ad says. “Tell Gov. Malloy to stop cutting our hospital care. Lives depend on it.”

The hospitals say bringing up CEO pay is an irrelevant distraction. Cut it in half and you’d barely make a dent in the state’s budget problem, they say.

, who runs Western Connecticut Health Network, says there’s a bigger problem — the governor is either misrepresenting hospital economics, or he doesn’t understand them.

“If you look at, how much money did you really make — operating income? If that’s the number,” Murphy says, “and it’s a pure accounting number, we lost tens of millions of dollars last year.” As for 2015, he says, “I’m sure it’s worse.”

The governor’s staff sees the hospital’s balance sheet differently. If lower-paid hospital employees and small programs are taking a hit because of the state cuts, Malloy’s office argues the blame should be on hospital boardrooms — not the state government. It’s the board members who are prioritizing executive salaries over other financial needs.

This public fight between the state and its medical institutions is playing out largely because of what the hospitals say is a broken promise.

In 2012, the state of Connecticut implemented a new hospital tax. The hospitals would pay around $350 million a year to the state, and all of that money — if not more — was supposed to be returned to them as Medicaid payments.

But that was then. Until Tuesday, the state budget was out of balance. To help fix it, Malloy wanted to cut another $63 million to hospitals; lawmakers put about half of that back. But the numbers still seem out of whack to

target=”_blank” rel=”noopener”>Patrick Charmel

, the CEO at Griffin Hospital, an independent nonprofit in Derby, Conn.

“So, now we’re talking over half a billion dollars,” Charmel says. “That’s what hospitals are paying in terms of the tax. And, essentially, we’re not getting any of that back.”

He thinks hospitals have cut all they can, despite what Malloy thinks.

“When there’s a cut in state payments to hospitals or federal payments to hospitals, it’s got to come out of care delivery,” Charmel says. “There’s nobody else to shift it to.”

Medicaid is lurking in the of the discussion. The state says more people than ever are getting Medicaid, and Medicaid payments to hospitals have more than doubled in 10 years.

But don’t tell that to Murphy. Hospitals lose about 60 cents on every dollar of Medicaid service, the hospital CEO says. “The fact that we’re getting more Medicaid patients to take care of, and on every one of them we have financial challenges associated with that care — it really isn’t a windfall for us,” Murphy says. “In fact, it’s a greater economic burden.”

While this year’s budget may be back in balance, the hospitals are gearing up for a long-term fight. They want the tax ruled invalid — a move that could take the fight from the capitol to the courtroom.

This story is part of a partnership that includes , and Kaiser Health News.

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A Tale Of Two Obamacare Co-Op Insurers: One Standing, One Falling

John Daley, Colorado Public Radio — Mon, 30 Nov 2015 10:00:15 +0000

Thousands of Americans are again searching for health insurance after losing it for 2016. That’s because health cooperatives —��large, low-cost insurers set up as part of Obamacare —��are folding in a dozen states.

The failure of Colorado’s co-op has hit Rick and Letha Heitman hard. They are currently customers of the Colorado HealthOP, which is closing up shop at the end of the year. The couple, who own a contracting business, say the co-op proved to be a life-saver when Rick was diagnosed with aggressive prostate cancer last spring.

“I owe them for taking care of me. They helped me at a time when I needed it a lot,” he says.

About 80,000 people are in the same boat as the Heitmans, on the hunt for new insurance plans on . HealthOP’s CEO Julia Hutchins says the co-op got walloped by the equivalent of a fast-moving tornado after the federal government said it co-ops millions in subsidies they had expected.

“We were really blindsided by that,” she says. “We felt like we’d done our part in helping serve individuals who really need insurance and now we’re the one left holding the bag.”

And, she insists the co-op was on track to be profitable. Colorado HealthOp is one of in 22 states that opened after Obamacare was enacted. The startups were supposed to shake up the traditional marketplace by being member-owned and nonprofit, but it was tough to figure out how much to charge. They needed to estimate how much medical care their customers would use, and they had to do that without data from previous years and without the cushion of a reserve fund. Established insurers can use reserves and experience to recover if they underestimate premium prices in a given year.

Rick and Letha Heitman are on the hunt for a new insurance plan on Colorado’s exchange. Their current insurance through the Colorado HealthOP will end when the co-op shutters at the end of the year. (John Daley/Colorado Public Radio)

Many co-op plans were priced low, and . But these new customers had high health costs, so the co-ops had to start paying a lot of bills. The math didn’t add up. On top of that, they were counting on a variety of funding streams from the federal government, and not all of them materialized.

Linda Gorman, with the , a conservative-leaning Colorado think tank, says the new co-ops were in over their heads.

“You shouldn’t go into business counting on federal subsidies,” she says. “The notion that you should beat up on for-profit entities and then form these nonprofits and everything will be magically OK is unfortunate to begin with. We’ve wasted a lot of taxpayer money on that.”

But the HealthOP’s senior IT manager Helen Hadji, a Republican, blames conservatives in Congress for to keep the cooperatives afloat.

“This is a federal failure,” she says. “This is all a political battle to dismantle Obamacare.”

Colorado’s co-op captured 40 percent of the individual market on the state’s exchange. Now as customers, like the Heitmans, hunt for new insurance, they are finding higher prices: They paid about $500 a month last year. Next year, it could be double or triple that.

“You know, that’s a big ‘owee!’” says Letha Heitman.

But it’s the price they’ll pay to keep Rick with the doctors who are treating his cancer.

In Connecticut, the opposite story is playing out. If Colorado saw an early surge in membership because of low prices, Connecticut’s co-op nearly priced itself out of the market in its first year. With rates much higher than its competitors, HealthyCT only got 3 percent of the state’s business under the Affordable Care Act.

“In that first year, the reason we had such low market share was that consumers —��new to the industry, new to insurance —��most of those individuals bought on price,” says Ken Lalime, who runs the co-op.

And, he says, starting it was hard.

“Nobody’s built a new insurance company in the state of Connecticut in 30 years,” he says. “There’s no book that you pull off the shelf and say, ‘Let’s go do this.’”

Lalime faced the same problem as insurers across the country: He didn’t know who his customers would be, he didn’t know whether they’d be sick or healthy, and he didn’t know how much to charge. It turns out he ended up charging too much.

But even though that meant relatively few signups in year one, the slow ramp-up actually helped. He didn’t have a huge number of claims to pay right out of the gate, and the ones he did pay didn’t break the bank.

“Hindsight, yes, that didn’t hurt us. To be able to take it slowly,” he says.

In year two, he had more competitive average premiums —��and his company went from 3 percent market share to 18 percent. For 2016, HealthyCT and the state —��after some back and forth —��settled on a 7 percent premium hike for customers.

Paul Lombardo is an actuary for the state. He says that bouncing around is an indicator that setting premiums under the Affordable Care Act is still a bit of a gamble. That’s in part because there’s still no good data. So few people signed up with HealthyCT in the beginning that they didn’t have enough information to help set 2016 premiums.

“There wasn’t a lot of data to say, OK, we can use 2014 experience to project forward,” Lombardo says.

For now, at least, Lombardo says HealthyCT is holding its own.

“They’re in good standing,” he says. “The premium we think that we’re setting for 2016 —��albeit a little bit higher than they wanted it to be on the revision —��is appropriate.”

Enrollment for health insurance in the co-ops runs through Jan. 31 with just 11 of the original 23 co-ops still in business.

This story is part of a reporting partnership with , , and .

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In Louisiana, Obamacare Subsidies Mean Financial Independence For Some

Jeff Cohen, WNPR — Mon, 11 May 2015 20:50:45 +0000

The politics of the Affordable Care Act in the state of Louisiana are not subtle: It is not popular. The state was part of the lawsuit to strike down the law in 2012; it didn’t expand Medicaid and has no plans to, even as other Republican-led states have done so. And Louisiana didn’t set up its own marketplace to sell Obamacare insurance.

Nevertheless, about signed up for health insurance under the law and almost all of them got help from the federal government to pay their premiums.

The U.S. Supreme Court could soon rule illegal the insurance subsidies in Louisiana and more than 30 other states that use the federal website healthcare.gov. If the subsidies��are��eliminated, the number of uninsured people in the affected states would rise by 8.2 million in 2016, according to recent��by Linda Blumberg, a senior fellow at the Urban Institute.

Jeff Cohen from member station WNPR spent three days driving around his home state of Louisiana speaking with people who got insurance under the law.��Here are the stories of three people who say their financial independence is riding on the latest health law case before the Supreme Court.

Sheron Bazille

Sitting at her kitchen table in the Baton Rouge home she owns by herself, Sheron Bazille says she had a good job that offered benefits — like health insurance.��But she got sick and had to stop working: “It was either me or my job. And my life and my health was more important.”

Sheron Bazille pays $219.01 for her health insurance. She knows the amount down to the penny. (Photo by Jeff Cohen/WNYC)

Bazille, 62, retired early, and she says leaving that job of 10 years meant losing her insurance – and some of her dignity, too.�� Now, under Obamacare, she’s got subsidized insurance. She knows exactly how much her share is: “My monthly is 219.��And one cent.”

The coverage has given her a sense of security, because she can take care of her health and her health care bills.

“Peace. I have peace now that I know I have hospitalization [coverage],” says Bazille.��“If anything happens, I can go to the hospital.”

She worries the Supreme Court justices could take away that peace and asked what she would tell the justices if she could, she says: “Think about your kids, your family. If they could not afford to pay for health insurance.��Wouldn’t you want someone to help them?”

Jimmy See

At a coffee shop in Zachary, half an hour north of Bazille’s home in Baton Rouge, Jimmy See says he never felt like he needed health insurance – until he did.��He’s 54, a self-employed housing and maintenance worker, and he’d always felt like health insurance was too expensive. But then he started having trouble breathing and he went to the hospital: “They said, ‘Well do you have any insurance? And I said, ‘No.’”

Rather than pay a lump sum up front, he went home and got worse.�� Eventually, he collapsed and had to be hospitalized for close to two weeks for pneumonia. His remembers his bill being between $8,000 and $9,000. See negotiated with the hospital and received financial assistance to settle the bill.

Jimmy See has had medical debt in the past, and he hopes insurance means he won’t be in that position again. (Photo by Jeff Cohen/WNPR)

“If I hadn’t gotten that, I’d be looking for bill collectors after me,” See says.��“And bill collectors don’t play. They come after you.”

See’s Obamacare subsidy covers all of his premium, and he says having insurance is a relief.

“If I had a big operation or whatever, you can’t afford no $70,000, $80,000, $90,000,” he says.��“So, through the Affordable Care Act, the government’s going to help you out with all that.”

If the Supreme Court rules against subsidies, See says, for him it would be, “Back to square one. No insurance.”

James Marks

James Marks lives four hours north of Baton Rouge in Shreveport. He doesn’t want to go back to square one, either.

Marks is 36 and works as a freelance computer technician and an afterschool art teacher. Neither job provides insurance and being uninsured has been a blow to his self-esteem.

James Marks pays about $180 a month for his insurance and is happy he doesn’t have to depend on his parents for help with medical costs. (Photo by Jeff Cohen/WNPR)

“It made me feel lousy,” Marks says. “It made me feel like I was sponging off my parents.��It made me feel like I wasn’t able to take care of myself.”

Marks lives with a mental health issue – and, for the better part of 10 years, his parents paid for both his psychiatrist and his expensive medications. Now, he pays about $180 a month for a subsidized insurance policy, and he says it makes him feel like an adult.

Asked what he would tell the justices, Marks says: “I know the Supreme Court tries to decide stuff based on the law and not based on the impact that it has on America.�� But it’ll wind up making a lot of people who were insured, who had insurance, who were able to go to the doctor and pay for their pills, not be able to anymore. And that’s just pretty lousy.”

This story is part of a reporting partnership that includes , and Kaiser Health News.

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What’s At Stake In The Supreme Court Obamacare Case

Jeff Cohen, WNPR — Tue, 21 Apr 2015 09:00:07 +0000

The Affordable Care Act mandates that all Americans get health coverage or pay a penalty. To help people pay for that insurance, the federal government subsidizes insurance premiums for millions of Americans.

In just a couple of months, the Supreme Court will rule in a major case concerning those subsidies. The question is whether the law allowed for them across the country or just in the minority of states that set up their own insurance exchanges. A decision to take away those subsidies could without insurance.

Attorney Tom Goldstein, who runs , has been following the case and says the law is ambiguous. “This is a real, serious question,” he says. “The law doesn’t tell you whether Congress wanted to limit the subsidies only to those states where the state itself went to the trouble of setting up the exchange or whether Congress wanted everybody who needed the help to be able to get the subsidies.”

Louisiana is a state where a lot of people could be affected. It runs healthcare.gov and about there have used the site to buy health insurance. Nearly 90 percent of them in Louisiana get subsidies.

We traveled to the state to interview many of these people who could lose subsidies if the Supreme Court rules against them. Here are our first three profiles:

Carlton Scott, 63, at his house in Prairieville, Louisiana. Scott is too young for Medicare and Louisiana hasn’t expanded Medicaid, so Obamacare was a good option for him (Photo by Jeff Cohen/WNPR).

Carlton Scott

Carlton Scott is 63. Sitting at his kitchen table at the house he owns in Prairieville, near Baton Rouge, he says he worked at a chemical plant for 30 years before he retired. He found out last fall that his company was scaling back his retiree benefits.

“’Round October they wrote me a letter saying, in December we’ll no longer be covered,” he says.

That included his health insurance, which he was really counting on.

“I thought they would take me to my grave. I really thought the company would take me to my grave,” he says. When it went away, “That pissed me off. Because, god——, I been through 30 years and you come with this bullsh–? That pissed me off.”

And he was in a bind. At 63 he is too young for Medicare and Louisiana hasn’t expanded Medicaid. Obamacare was a good option for him.

He signed up for a BlueCross BlueShield of Louisiana plan. He says he pays $266.99 per month, “to the penny.” Like a lot of people, he could rattle off the exact amount. Money is tight and people track their expenses carefully.

Scott could be in a position to lose his subsidy and his health insurance. He says if he had to pay more, he could for a while. He gets $2,600 a month between Social Security and his pension. But he worries about his friends.

“Everybody don’t make the same amount of money, that’s what I’m saying. I got a friend of mine, stay down the street. He gets Social Security and pension, too. But it’s not as much as mine, not half as [much].”

When asked about the case in front of the Supreme Court, he laughs.

“They all got insurance, too. I guarantee you that. They all got insurance.”

He says the court should, “Leave it like it is. I mean, what are people going to do? Get sick, go to the hospital, ‘I don’t have insurance. Won’t you please help me anyway?’ Hell, no. That ain’t going to happen,” he says.

LaTasha Perry

LaTasha Perry is at the other end of her career. She’s 31 and works at the front desk of a community health center in Plaquemine, La. She got covered under Obamacare because it was cheaper than paying the penalty.

LaTasha Perry, 31, works at a community health center in Plaquemine, Louisiana. Perry says getting insured under Obamacare was cheaper than paying the penalty (Photo by Jeff Cohen/WNPR).

She says her children have Medicaid as their health coverage. Her job offers health insurance, but she says she can’t afford to buy it.

“I would pay at least $100 a month for the insurance here,” she says. “With my subsidy, I pay $13.”

Now she’s got money left over for necessities: “Food for my kids. I’m a single parent, so it’s hard.”
��

Charles Dalton

Charles Dalton wanted health coverage. He’s 64 and after he retired as a paramedic, he didn’t have health insurance. Then he got sick. He says his condition is too personal to talk about. “I’m disabled,” he says. “But I would be totally incapacitated without seeing this doctor.”

Charles Dalton, 64, a retired paramedic says losing his insurance was not an option (Photo by Jeff Cohen/WNPR).

The Affordable Care Act says insurers can’t take into account whether somebody is sick, like they used to. That made insurance unavailable or unaffordable for many sick people. And now — with subsidies — Dalton says he pays $149 a month. He hopes the Supreme Court doesn’t touch the subsidies.

“They’re just going to make a difficult situation more difficult,” he explains. “Because of the Affordable Care Act, it’s helping me to be able to make this existence more livable. You’re not asking for a handout. But if you get a helping hand, the last thing you need is for it to be snatched out from under you.”

Regardless of the politics, there are a lot of people like Dalton who could feel that the Supreme Court would be taking something away. Goldstein of SCOTUSblog says the court has a tough job.

“This is a case that requires the justices to be both lawyers and try and look at the words that Congress used, but also to struggle with the human dimension of the case,” he says. “The consequences are so real and so powerful that, if the challengers win here — and maybe they deserve to win, maybe it’s what Congress intended — but it’s hard to avoid the conclusion that millions of people would lose access to health insurance.”

This story is part of a reporting partnership that includes , NPR and Kaiser Health News.

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Tax Preparers Brace To Be Bearers Of Bad Health Law News

April Dembosky, KQED — Wed, 21 Jan 2015 13:09:50 +0000

Are you thinking about tax day yet? Your friendly neighborhood tax preparer is. IRS Commissioner John Koskinen declared this tax season one of the most complicated ever, and tax preparers from coast to coast are trying to get ready for the first year that the Affordable Care Act will show up on your tax form.

Sue Ellen Smith manages an H&R Block office in San Francisco, and she is expecting things to get busy soon.

“This year taxes and health care intersect in a brand new way,” Smith says.

An H&R Block office in Hartford, Conn., is decorated with cardboard cutouts from a national ad campaign on the health law’s tax implications. (Photo by Jeff Cohen/WNPR)

For most people, who get insurance through work, the change will be simple: checking a box on the tax form that says, “yes, I had health insurance all year.”

But it will be for an estimated 25 million to 30 million people who didn’t have health insurance or who bought subsidized coverage through the exchanges. To get ready, Smith and her team have been training for months, running through a range of hypothetical scenarios. One features “Ray” and “Vicky,” a fictional couple from an H&R Block flyer. Together they earn $65,000 a year, and neither has health insurance.

“The biggest misconception I hear people say is, ‘Oh the penalty’s only $95, that’s easy,’” says Smith, but the Rays and Vickys of the world are in for a surprise that will hit their refund. “In this situation, it’s almost $450.”

That’s because the penalty for being uninsured in 2014 is $95 or 1 percent of income, whichever is greater. Next year, it’s 2 percent. Smith says the smartest move for people to avoid those penalties is to sign up for insurance before Feb. 15, the end of the health law’s open enrollment period.

But a lot of people may not think about this until they file their taxes in April. For them, it will be too late to sign up for health insurance and too late to do anything about next year’s penalty too, says Mark Steber, chief tax officer for.

“They’re kind of stuck,” says Steber. “Quite frankly, that’s a very difficult discussion.”
Steber’s team at Jackson Hewitt is also doing role playing with tax advisors to prepare them for delivering bad news – in case taxpayers want to blame the messenger.

Lou Graham works at an H&R Block office in Hartford, Conn., and he is facing the same concerns. He is bracing to tell people who underestimated their 2014 incomes that they received too generous a subsidy and that they’ll soon have to pay the government back.

“I’m going to tell a client, ‘I’m sorry, $300 of your return is not going to be yours.’ Well, that will send them right through the roof,” Graham says.

Like his colleague Smith in California, Graham is afraid some people may be completely unaware of the penalty for not having insurance. That means Graham may have to deliver two pieces of bad news: First, he’ll tell them they owe a penalty for 2014, and then he’ll tell them it’s too late to sign up for 2015.

“So they’re going to get stymied twice,” he says.

But he also hopes to guide people to some good news. A lot of people may not know that they’re able to get an exemption from the law’s mandate to get insurance. And it’s his job to pull it out of them.

“‘I didn’t have insurance for six months, but, you know what? I had got a notice that my electricity was going to be cut off.’ Well, you fall into a hardship case,” Graham says. “Those things need to be explored and not many people want to bring that forward.”

Discussing these issues is important. Tax preparers like Graham can only help if tax filers seek them out. And most people don’t. Not in January, anyway.

“It’s real early. People don’t really start thinking about tax work until they get their W-2s in their hands,” he says.

And that presents a real time crunch. Most people won’t get those W-2 wage statements until the end of January. That gives them just two weeks before the Obamacare clock runs out on them on February 15.

This story is part of a partnership that includes , , and Kaiser Health News.

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State Health Insurance Exchanges Hope To Woo Urban Minorities

Jeff Cohen, WNPR — Fri, 14 Nov 2014 17:04:10 +0000

Tomorrow it begins again – for Obamacare. Two very successful state health insurance exchanges, Connecticut’s and California’s, are both intent on reaching people who avoided signing up last year – especially young Latinos and African-Americans.

“The big takeaway for us last year was that the uninsured were really pocketed in a couple of key, large cities,” says , the chief marketing officer of , in Connecticut. In light of that, he says, the exchange has changed its ad strategy.

“We’ve dialed up some of the more locally-focused efforts while we’ve dialed down some of the broader efforts,” he says.

In one of Access Health CT’s new video commercials, a barber explains to his clients why getting health insurance should be a priority. (Access Health CT)

The uninsured people Madrak’s trying to reach tend to be young, male, urban and Hispanic or African American. They also “aren’t really consumers of traditional media,” he says.

They don’t necessarily read the big daily newspapers and they don’t watch mainstream TV, so they can be harder to reach. So Madrak is spending his media money on ads in community newspapers and on local television and radio.

Reaching potential customers is the first half of the job. The second half is figuring out what to tell them. One emphasis is on money, like in this TV ad with a barber asking his customer if he has health insurance. When the customer says, “No, I can’t afford it,” the barber says, “Now, you can, with Access Health CT, since you may qualify��for help to pay for your coverage.”

Madrak says the messages of ads that appear later in the open enrollment period, as people are starting��to��think harder about choices, will be more specific about the cost of the insurance.

We need to go from a culture of coping to a culture of coverage.
– Peter Lee, executive director, Covered California

“If I say ‘affordable,’ nobody really knows what that means,” he says. “If I say, ‘I can get you a plan for 20 bucks a month with tax credits,’ that means something to somebody at that point.”

California health officials are also deploying a new and (they hope) improved campaign to woo Latinos. Last year, made a series of missteps. First, the exchange had only a handful of Spanish-speaking counselors at the call centers. And the Spanish advertising campaign was riddled with .

Among the worst gaffes: Some Latinos who worried that signing up would get undocumented relatives in trouble were shown a written promise from President Obama to the contrary – a note that, unfortunately, was printed on letterhead of U.S. Immigration and Customs Enforcement.

Covered California says it has learned from those mistakes. , the executive director, says this year, the agency is doubling down on making sure Latinos get the right messages.

“We’re actually spending more money on outreach, education, and marketing this year for a three-month period than we spent for six months last year,” he says.

The agency has hired 200 new call center counselors who speak languages other than English, Lee says. It is enlisting more trusted community organizations to allay fears about deportation. And it’s rolling out a new ad campaign tailored specifically to Latinos.

“Every person you see [in these advertisements] that is a Spanish speaker is a Latino who got coverage through Covered California this last year, and it made a difference in their lives,” says Lee.

This new video commercial shows pages of immigration documents flying into a safety vault – accompanied by verbal assurances that the application process is confidential.

But the main challenge, Lee says, is persuading Latinos to buy something they don’t believe they need or is worth the price.

“They’ve adjusted to a culture of coping,” he says. “We need to go from a culture of coping to a culture of coverage.”

Still, a woman in a recent focus group in Connecticut showed Madrak that even the best messages might not work.

“She said, ‘Listen, I saved everything that you guys sent me,’ ” Madrak says. ” ‘I have a box of postcards and letters that you sent me because it has the phone number on it and I wanted to save it.’ And we said, ‘Did you call?’ And she said, ‘No, I never called.’ And we said, ‘But you saved it all!’ And she said, ‘I know, I knew it was important; I just never got around to actually doing it.’ “

That, Madrak says, is the big, continuing challenge.

Open enrollment��runs from��Saturday, Nov. 15 through Feb. 15, 2015.

This story is part of a reporting partnership that includes , ,�� and Kaiser Health News.

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How One U.S. Hospital Braces For Ebola

Jeff Cohen, WNPR — Wed, 08 Oct 2014 09:00:08 +0000

This story is part of a partnership that includes WNPR,��and Kaiser Health News. It can be republished for free. ()

Dr. Jack Ross is used to seeing potentially lethal viruses, and he is used to putting��patients into isolation.��Still, Ebola is different.

Dr. Jack Ross, the director of infection control, gives a tour of Hartford Hospital’s isolation unit (Photo by Jeff Cohen/WNPR).

“I think, for any hospital today, Ebola represents one step higher than anything else, if we had to do it,” says Ross, who is the director of infection control for Hartford Healthcare’s five hospitals in Connecticut.

On a tour of one of them, Hartford Hospital, Ross explains how the layout of the building is one of the important factors in his Ebola control plan.

“This would be an area that we would close off with plastic sheeting,” Ross says. His plan ��includes the emergency room, intensive care unit and patient floors. “Right here, we’d have a security officer, because you want to restrict visitors. You want to have a log of who goes in, who goes out.”

In Connecticut, the idea of taking care of an Ebola patient is still just theoretical. However,��one of the reasons that public health officials in the U.S. are confident that American hospitals could contain an outbreak is because they��can accommodate the isolation and sanitation needed to keep the virus from spreading.

The best place to put someone who falls ill, for instance, is ideally at the end of a hall in a room with its own bathroom, anteroom, and entrance. “The rest of the floor is safe,” Ross says. “I limit the amount of traffic. I’m able to do the care there.”

Ross and his team are preparing in other ways, too. With the Centers for Disease Control and Prevention’s��help, he’s made a specific list of questions doctors and nurses will ask incoming patients about symptoms and travel.��He’s inventoried the supplies they would need to treat an Ebola patient.

Ross says he understands the concern of the general public when it comes to Ebola — the symptoms and severity of the illness are frightening. But he also says this — Ebola might frighten the general public, but the virus doesn’t threaten the American public.

“This is not something that will become established in the local general American population,” Ross says. In the United States, the medical infrastructure is strong enough to detect and diagnose the infection relatively quickly, trace contacts, isolate patients with symptoms and offer them supportive treatment. And, in comparison to flu or measles, for example, the Ebola virus is not spread through the air, and is not very contagious. The people at risk of catching Ebola are those who have been in close, unprotected contact with someone who is sick and has active symptoms of the disease.

Indeed, the only known case of Ebola that has been transmitted outside of a West African country is a ��who fell ill after caring for two missionaries who contracted the disease in Africa, came to Spain for treatment and eventually died.��While anyone in close physical contact with a symptomatic patient is at some risk, the evidence suggests that the people most likely to be exposed to these isolated cases are health care workers.

For that reason, even if the chances of running into Ebola in the U.S. are relatively small,��Ross says hospital workers have to be painstakingly vigilant. That begins with the triage questions nurses and doctors ask incoming patients get when they arrive at the emergency room, and at various other times throughout their treatment.

If a patient is diagnosed, health care workers treating an Ebola patient need to wear a face mask or goggles, and they also need a buddy with them as they put on and take off their protective clothing.��All of that is to make sure that they don’t come into any contact with bodily fluids.

The gear used to care for an Ebola patient — the goggles, the clothing, the bed linens — then becomes contaminated waste that has to be treated and sterilized in much the same way as tools being prepared for use in the operating room. Just how that’s accomplished will be done on a case-by-case basis, governed by the CDC and the federal department of transportation.

Ross’s decades of work in infectious disease make him feel prepared. Still, he says he expects to be nervous if and when he treats a person with Ebola.

“My heart may be pounding, my palms may be sweating,” he says. “I think it’s only a natural human response that we would have heightened awareness and some nervousness as we go through this.”

Ross says he’d be concerned about any caregiver treating Ebola who wasn’t nervous, too.

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New Head of Healthcare.gov Is Connecticut’s Counihan

Jeff Cohen, WNPR — Tue, 26 Aug 2014 12:04:00 +0000

This story is part of a partnership that includes , and Kaiser Health News. It can be republished for free. (details)

Kevin Counihan, the head of Connecticut’s health insurance marketplace, will be the new CEO of healthcare.gov, the website that 36 states use to sell insurance under the Affordable Care Act, the administration announced Tuesday.

Department of Health and Human Services Secretary Sylvia Burwell tapped Counihan to lead the site as part of a that aims to have the second year of Obamacare run more smoothly than the first.

Kevin Counihan (Photo by Jeff Cohen/WNPR)

Access Health CT, under Counihan’s leadership, is one of the more successful state-run exchanges. About 257,000 people got coverage, according to the state, including�� for private insurance. Surveys show that about in the state were previously uninsured.

“One of the most important things we did is we showed that government can work,” Counihan said at a press conference in Hartford Tuesday. “It can take on a highly complex social program and succeed.”

But taking the reins of healthcare.gov will be a much tougher job. Connecticut has a Democratic governor and legislature, and it embraced the law early, including the expansion of Medicaid. Healthcare.gov serves states that are actively hostile to the law in the Deep South, states that are embracing the law to some minimal degree and states that are active partners in running the exchange.

At the press conference, Connecticut Gov. Dannel Malloy said Burwell had called him to discuss Counihan. The governor joked that Counihan should have his head examined for agreeing to go to Washington.

Burwell, in a press release, said that Counihan “will be a clear, single point of contact for streamlined decision-making.” The announced several other hires as well.

Obamacare year 2 starts with enrollment opening on Nov. 15, and the challenges are many. In addition to making sure the technical glitches stay in the rearview mirror, Counihan will be responsible for keeping people who are already signed up satisfied, as well as reaching out to the millions of Americans who are eligible for coverage but not yet insured.

Counihan said he’s optimistic that it can be done. “People understand intuitively that having people uninsured is not right for them or right for the country,” he said. “Now, how we go about doing it — people can debate and there can be solid policy differences. ��But I’m fundamentally very optimistic that, even though there are some big ideological schisms, that those can be bridged.”

Counihan’s exchange excelled at marketing Obamacare insurance — taking the pitch to , jazz festivals and a storefront on a city street. And he credits some of that success to the pool of executive talent he was able to draw on in Hartford, an insurance capital.

Counihan has several decades of experience in health care, including launching complex new coverage programs. After a career in the private insurance industry (Tufts Health Plan, Cigna), he helped launch Massachusetts’ successful health exchange starting in 2006. He also helped launch a private insurance exchange in California.

Counihan is the second high-profile addition to the healthcare.gov second year team. Earlier this summer HHS brought on Andy Slavitt, who helped fix the site’s initial problems as an executive with contractor Optum.

Counihan may have caught the president’s attention a year or so ago during a conference call with the leaders of the state-based exchanges. Counihan recalls talking to the president about the marketing event at the Lil Wayne concert: “And he said, ‘Lil Wayne. ��I’ve never been to a Lil Wayne concert.’ ��And I said, ‘Well, Mr. President, neither [had] I, and I don’t think I’m exactly in the target demographic.'”

Later in the meeting, another exchange official from a different state talked about advertising their state’s exchange on coasters at bars. “My counterpart in that state had said that she felt too old or embarrassed to actually go into bars to see if it’s working,” Counihan said. “At which point the president said, ‘Well, if Kevin can go to a Lil Wayne concert, you certainly should be able to go to a bar.'”

Julie Rovner contributed.

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