Kara Lofton, West Virginia Public Broadcasting, Author at �鶹Ů�� Health News

ACA Repeal Threatens A Black Lung Provision Popular In Coal Country

Kara Lofton, West Virginia Public Broadcasting — Thu, 26 Jan 2017 10:00:08 +0000

At the Pulmonary Rehabilitation Clinic in Scarbro, W. Va., oxygen tubes dangle from the noses of three miners who are pedaling slowly on stationary bikes. All of these men have black lung — a disease caused by breathing in coal dust. Over time, the dust coats the lungs and causes them to harden. Hard lungs don’t easily expand and contract, and that makes it difficult to breath.

“You try to get air in them, and they don’t want to cooperate with you as they did before,” said retired miner James Bounds, speaking with great effort. Not every coal miner gets black lung, just as some smokers don’t get cancer. But for those who do, Bounds said, the disease is devastating.

“There’s no cure at all,” he said. “It keeps getting harder and harder until one day, I guess, you take your last breath and they won’t expand for you no more.”

Bounds is one of about 38,000 miners and widows currently receiving black lung benefits — compensation for the physical damage he sustained while doing his job. It took him four and a half years to get approved, despite the fact that his lungs are so bad he has to stop moving to talk.

But now the qualification process is supposed to move faster. The Affordable Care Act includes special provisions that make getting black lung benefits easier for coal miners. If the ACA is repealed, gaining these benefits could become much more difficult, effectively harming a group of people President Donald Trump has promised to protect.

Debbie Wills coordinates the black lung program for primary care system. She said that prior to the ACA, it was almost impossible to qualify for the compensation benefits. Coal companies pay the benefits, and also pay into a federal trust fund that pays when coal companies can’t. Wills said the for miners.

“Coal company lawyers would doctor shop around the country and find two, three, four, five, seven doctors to say, ‘Yes this miner is disabled, but it’s not because of black lung,’” she said.

The Affordable Care Act includes something called the. One shifts the burden of proof — instead of miners having to prove that mining caused their black lung, the coal companies have to prove that mining didn’t.

Retired miner Lester Burnette, who has black lung, works out at pulmonary clinic in Scarbro, W.V. (Kara Lofton/West Virginia Public Radio)

“You still have to prove the 100 percent disability, which is hard,” said Wills. “But if you can prove that, and if you’ve worked 15 years or longer in the mines, then you’re entitled to a presumption that your disease arose from your coal mine employment.”

Another part provides lifetime benefits to a dependent spouse who survives the death of a miner, if the miner had been receiving the benefits before death.

If the ACA is repealed without a replacement, cases that were approved after the ACA went into effect could be reopened, leaving the miner or surviving spouse vulnerable to losing the benefits. And, the burden of proof may shift again, making it difficult for applicants to qualify.

Earlier this month, both the and the introduced resolutions to preserve the Byrd Amendments from a broader ACA repeal. Rep. (R-W. Va.), an ACA opponent, introduced the measure in the House.

“I am a firm believer that Obamacare is already in a death spiral and desperately needs to be fixed,” Jenkins said. “While we are going to work to improve our health care system, I feel strongly about my resolution to make sure that the presumption relating to black lung is contained in whatever is the end product of this work this year.”

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

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Retired Coal Miners At Risk Of Losing Promised Health Coverage And Pensions

Kara Lofton, West Virginia Public Broadcasting — Thu, 08 Dec 2016 22:40:26 +0000

Without congressional intervention, about 16,000 retired miners in seven states will lose their health care coverage by the end of the year.

A proposal to temporarily extend the benefits is working its way through Congress. But two Senate Democrats, who have long been advocates for a more comprehensive plan, say the temporary provision isn’t enough.

They are threatening to hold up a spending bill that needs to pass by Friday night to keep the government running.

Coal mining is dangerous work. For many miners, a government-backed promise of lifelong health care for them and their dependents made the risk worth taking.

Roger Merriman, 65, worked in the coal industry for 28 years.

“When we all started in the mines, we were promised health care for life — cradle to grave,” he said. Merriman’s employer, Patriot Coal, filed for bankruptcy in 2012, then again in 2015. He is now slated to lose his pension and benefits. Merriman says that possibility of losing health benefits for his wife, who is younger than he is (at 65, he qualifies for Medicare), and their pension, is devastating.

“We’ll have to make a choice of whether [we’re] going to the doctors and buying prescriptions or paying bills and eating. It’s a life and death situation, realistically, is what it is,” he said.

In 1946, the and the U.S. government agreed that union miners who put in 20 or more years would get lifelong pension and health benefits. Patriot is one of six major coal producers in the U.S. that has sought bankruptcy protection in the last few years, a process that often includes an attempt to drop retiree benefits.

After the Patriot bankruptcy in 2012, the UMWA negotiated a $400 million payment in bankruptcy court for retirees benefits. Existing companies pay into a UMWA fund for retirees, but as those mines close, there is less money going into the pot and the number of retired miners who are drawing from it is increasing. The fund is about to run out of money.

The UMWA’s hope was that the $400 million would give federal lawmakers the time they needed to pass legislation that would protect the miners.

Senate Democrats have been working for years to pass the — a bill that would move money from the Abandoned Mine Lands Reclamation fund into a fund to pay for the pension and health care benefits of tens of thousands of coal miners and retirees.

West Virginia Sen. Joe Manchin, a Democrat, is frustrated by the benefits Band-Aid included in the temporary federal spending bill, known as the continuing resolution. “We’re asking for a permanent fix, we have a pay-for for a permanent fix, it’s the excess that we have, the surplus in the AML money,” he said Tuesday on the Senate floor.

Manchin and colleague Sherrod Brown, D-Ohio, are trying to block the spending bill on the Senate floor until miners get their full health care and pension money.

“I haven’t ever used this tactic before, but I feel so compelled that I said we are going to do whatever we can to keep this promise,” Manchin said Tuesday.

But the Miners Protection Act has met with resistance from Senate Republicans, who are wary of bailing out unionized workers.

Senate Majority Leader Mitch McConnell, R-Ky., proposed the temporary fix — tacking on $45 million taken from the existing UMWA fund to the continuing resolution that is needed to fund the federal government through April 2017. The House passed it on Thursday.

The continuing resolution must be approved by Friday. Manchin and others are frustrated that it is only a solution for a few months and that it doesn’t include any money for pensions.

Critics of the Miners Protection Act say there are many struggling pension and benefits funds and that a government bailout sets a bad precedent.

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

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West Virginia Grapples With High Drug Costs

Kara Lofton, West Virginia Public Broadcasting — Thu, 20 Oct 2016 09:00:47 +0000

Skyrocketing prices for essential medicines, like the EpiPen, are generating public outcry, congressional hearings and political promises for policy fixes. In the meantime, the increases continue to hit pocketbooks — even of people who don’t rely on these expensive drugs. In a state like West Virginia, where dire have been common over the past few years, the problem is especially pronounced.

Kimberly Earl, of Charleston, W.Va., is feeling the pinch. She has four children, all of whom need medication.

“I have a 13-year-old who’s a pediatric cancer survivor,” she said. “I have two children who are allergic to foods, medication and environmental factors, and both of those children both have asthma.”

Last year, two of her children needed new EpiPens — which come in a 2-pack. (The dose of epinephrine each pen delivers is designed to be used in an emergency, to stop a severe allergic reaction. Sometimes a second dose is necessary for particularly bad reactions.) The Earls have private health insurance but had yet to meet their $10,000 family deductible for 2015. They didn’t have enough money for two boxes of EpiPens at the $600 price — even with a $100 discount from the drug’s manufacturer. So the family improvised.

“We took the pens and we split the two pens between two kids,” Earl explained. “I actually took the pens out and wrote on the top — ‘use this one first’ on the current pens, and ‘use this one second’ on the expired pens. So each kid was walking around with one current pen and one expired pen. And we were just hoping that if there was an issue they wouldn’t have to use that second pen.”

While Earl paid for the drugs out of pocket, about a third of West Virginians are insulated from these direct costs because they are covered by Medicaid. The state under the Affordable Care Act, giving lower-income people the government-sponsored insurance. Most Medicaid patients don’t have premiums or copays.

But in the end, rising drug prices affect everybody in West Virginia. When lawmakers consider the state’s budget, they only have so much revenue to divvy up among priorities that include health care services, roads and schools, said , the medical director of Medicaid in West Virginia.

“So when the cost of a drug goes up dramatically,” he said, “that impacts our system and we have to step in and make adjustments to regulate the drug appropriately.”

The West Virginia Department of Health and Human Resources can regulate the cost of drugs by negotiating lower prices through the federal . The rebate program is a complex system but basically comes down to this: The more Medicaid patients enrolled in the program, the more bargaining power the government has to make drug companies lower their prices. Another way Medicaid manages costs is by including older, cheaper, but still effective drugs in its formulary, rather than relying on more costly new brands.

But even with these measures, the overall increase in the price of medications has forced some shifting of funds in other parts of the state budget, said , a Democrat and state senator from Boone, W.Va.

“Certainly for Medicaid funding in West Virginia, [the hike is drug prices] is a huge cost,” said Stollings, a former chairman of the state senate’s health committee. “So when we have to put money into funding Medicaid, we have to cut funding for higher education and secondary education; we have to put off paving projects, etc.”

Stollings said these rising Medicaid costs — partially due to higher drug costs — fall on the taxpayer, who may end up paying more state taxes to fund the budget.

“If you’re a taxpayer, it impacts you,” Stollings said. “If you’re an insured person it will impact your premiums, and if you are on Medicaid you may get this expensive medication, but they may be ratcheting down coverage for other things.”

Medicaid is a of the West Virginia’s budget, right behind public education. And it will probably get even bigger next year, as the state picks up more of the Medicaid expansion costs from the federal government.

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

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Emotional Healing After A Flood Can Take Just As Long As Rebuilding

Kara Lofton, West Virginia Public Broadcasting — Mon, 18 Jul 2016 09:00:05 +0000

Most of the front door of Rachel Taylor’s little yellow house in White Sulphur Springs, West Virginia, is pasted with paw prints where her dog struggled to get inside during the flood last month. He was too big to carry through the rising waters.

Across the street, nestled between two battered houses, an empty lot is marked by a cross with an array of flowers and photos — a small memorial for a family washed away by the torrent.

Taylor’s dog survived and is now with some of her family members in Kentucky. But those neighbors across the street, the Nicelys, were swept away when their house collapsed; they have since been confirmed dead.

“When I start feeling overwhelmed with this,” Taylor said from her front porch, “I just look across the street at that memorial and I think, there’s nothing that we have lost that can’t be replaced or mended.”

She and her husband spent seven years renovating this 1930s Craftsman house, room by room. They were just about done with renovations when their house a few weeks ago. Today the living room is gutted.

“You know, the first couple of days it was very intense,” Taylor said. “It was kind of ‘crisis mode.’ Maybe that’s the way I would describe it, because you didn’t really have time to think about it and process it.”

But once the full extent of the damage set in, Taylor said, she developed severe nausea and carsickness to the point of not being able to drive.

A number of people, she said, have chalked up her symptoms to nerves. “You know, the stress level. You don’t realize your body is just having a response to this.”

Rachel Taylor surveys the flood damage from her front porch in White Sulphur Springs, W.Va. Muddy paw prints on the front door still mark her dog’s panic as the waters rose. He survived, but others didn’t.

Taylor worries that the houses in her neighborhood will remain abandoned and that she, her husband and her 14-year-old daughter won’t feel safe at home anymore. She plans to rebuild, but says her family will likely sell the house and move.

“The words we use when we talk about it are ‘I don’t know if I have it in me;’ ‘I’m not sure if I can do it again,’ ” she said. “Things like that. And then we just say, ‘Well, we’ll take it one day at a time.’ “

Psychologists say this kind of response is normal following natural disasters.

“It’s a physical aspect of the stress response — it will affect the body’s ability to concentrate, to rest and to be able to function,” said , leader of the state-funded . “Cognition is slowed and impaired,” she adds.

Vaughan’s team offers support, counseling and referrals for further mental health care at local behavioral health centers.

“From the behavioral health perspective, we find we are more in need after the tenth [or] twelfth day,” Vaughan said, “just because immediate needs of food, clothing and shelter take precedence.”

In the first few days following the flood, Vaughan’s team members split their time between helping people replace lost psychiatric medications and looking for signs of mental distress in people at shelters or feeding stations.

“We see fatigue, problems with cognition,” she said. “You have individuals who walk into a supply center and they have no idea what they need.”

A 2012 published in the journal Social Psychiatry and Psychiatric Epidemiology found that while most people bounce back a few months after a disaster, if their ongoing stressors aren’t addressed — such as a lack of permanent shelter, financial challenges and repeated exposure to the trauma — affected residents will continue to struggle.

In addition to Vaughan’s team, church disaster-assistance teams and Hope Animal-Assisted Crisis Response — a support organization that uses trained therapy pets for comfort — stepped in to help.

“As the fatigue sets in and the frustration, we see an increased need for behavioral health intervention,” said Vaughan.

Unfortunately, that’s just when the work becomes hardest, Vaughan said, and it’s often after national organizations and media have lost interest. Very real, tough problems persist, though only local groups and neighbors remain to extend helping hands.

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

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Few Young Doctors Are Training To Care For U.S. Elderly

Kara Lofton, West Virginia Public Broadcasting — Wed, 13 Jul 2016 09:00:03 +0000

At Edgewood Summit retirement community in Charleston, W.Va., 93-year-old Mary Mullens is waxing eloquent about her geriatrician, .

“He’s sure got a lot to do,” she said, “and does it so well.”

West Virginia has the third oldest population in the nation, right behind Maine and Florida. But Goldberg is one of only in the state.

“With the growing elderly population across America and West Virginia, obviously we need healthcare providers,” Goldberg said.

That includes geriatricians — physicians who specialize in the treatment of adults age 65 and older — as well as nurses, physical therapists and psychologists who for this population.

“The current workforce is inadequately trained and inadequately prepared to deal with what’s been called the silver tsunami — a tidal wave of elderly people — increasing in the population in West Virginia, across America and across the world really,” Goldberg said.

The of properly trained physicians is expected to get worse. , one in five Americans will be eligible for Medicare, the government health insurance for those 65 and older.

Goldberg also teaches at the Charleston division of West Virginia University and runs one of the state’s four geriatric fellowship programs for medical residents. Geriatric fellowships are required for any physician wanting to enter the field.

For the past three years, no physicians have entered the fellowship program at WVU-Charleston. In fact, no students have enrolled in any of the four geriatric fellowship programs in West Virginia in the past three years.

“This is not just our local program, or in West Virginia,” said Goldberg. “This is a national problem.”

The United States has 130 geriatric fellowship programs, with 383 positions. In 2016, only 192 of them were filled. With that kind of competition, Goldberg laments, why would a resident apply to a West Virginia School, when they could get into a program like Yale or Harvard?

Adding to the problem, the average medical student graduates with $183,000 in debt, and every year of added education pushes that debt higher.

, head of the geriatrics department at in Huntington, W.Va., says students express interest in geriatrics almost every year. But, “they fear their debt,” she said, “and they think that they need to get into something without the fellowship year where they can start getting paid for their work.”

This trend troubles many people, including Todd Plumley, whose mother, Gladys, has dementia and lives in West Virginia.

“It’s kind of scary that [older patients] don’t have the care that they really need to help them through these times, and help them prolong their life and give them a better life,” Plumley said.

There are no geriatricians in the family’s hometown of , so Plumley drives his mother almost 45 minutes to another town, Huntington, to see one. He says seeing this specialist has helped stabilize his mother’s symptoms.

“Right now, if we didn’t have the knowledge and resource,” he said, “I believe my mother would have progressed a lot further along, quicker.”

Plumley is in his 50s. He worries that if he needs the care of a geriatrician as he gets older, driving even 45 minutes may not be an option.

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

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Hospital Workers Find Solace In Pausing After A Death

Kara Lofton, West Virginia Public Broadcasting — Mon, 28 Sep 2015 09:00:54 +0000

For trauma workers like Jonathan Bartels, a nurse who has worked in emergency care and palliative care, witnessing death over and over again takes a toll. Over time, they can become numb or burned out.

But about two years ago, after Bartels and his team at the University of Virginia Medical Center in Charlottesville tried and failed to resuscitate a patient, something happened.

Nurse Jonathan Bartels says “The Pause” after a death of a patient helps doctors and nurses cope with the loss. (Photo by Kara Lofton)

“We had worked on this patient for hours and the chaplain came in and kind of stopped everyone from leaving the room, and I’m like, ‘Wow, that’s really bold,’ ” he said. “She said, ‘I’m just going to pray over this patient and then you all can leave.’ And I watched it and I felt – it was the act of stopping people — really inspired me.”

While the prayer wasn’t totally comfortable to him because Bartels, like many at the hospital, is from a different religious tradition, the pause felt right.

“So the next time we worked on another person who didn’t make it, I decided to be bold and stop people from leaving,” he said. “I just said, ‘Can we stop just for a moment and recognize this person in the bed? You know this person before they came in here were alive, they were interacting with family, they were loved by others, they had a life.’ ”

The team did it – they stopped, just for a minute.

“When it was done, I said, ‘Thank you all and thank you all for the efforts that we did to try and save them.’ People walked out of the room and they thanked me and they thought it was really awesome,” he said.

The idea began to spread throughout the hospital, particularly to emergency department workers. The Pause, as it has become known, also is being taught as part of the curriculum at UVA nursing school. Emergency medical technician Jack Berner says it helps him handle the toughest cases.

Jack Berner, an EMT, says pausing after a patient death helps him reflect — and move on to his next case. (Photo by Kara Lofton)

“It makes it so we can actually view the person as a person rather than as a patient that we see on an everyday basis,” he said. “You can relate more to the case [knowing] it’s somebody’s father or their mother, their sister or their uncle, rather than somebody you just see for five minutes.”

Bartels hopes The Pause will help medical workers like Berner accept the loss without disconnecting emotionally.

“So you are able to feel and you are also able to sense and give back,” he said, even if it’s not a relative, a worker can have a sense of being a part of a loss. “I can also acknowledge the pain that I bore witness to in caring for that family and caring for that patient,” he explained.

The concept is spreading beyond UVA. After the dean of UVA’s school of nursing talked about the practice in a speech at a national conference, a nurse from Providence Sacred Heart Medical Center brought it across the country to Spokane, Wash.

This story is part of a reporting partnership with NPR, local member stations and Kaiser Health News.

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