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Your.MD raises $10M to grow AI-driven health information service and marketplace


Your.MD, an AI-driven health information service delivered via a bot, has raised $10 million in new funding. The round was led by Orkla Ventures, the venture arm of Orkla, a leading supplier of branded consumer goods to the health, pharmacy, and grocery sectors in the Nordics, Baltics and parts of Central Europe. Existing investor Smedvig Capital and other unnamed existing shareholders also participated.

Billed as a AI-based “pre-primary care service,” Your.MD is available for web, iOS, Android, Facebook Messenger, Skype, Slack and Telegram. It is part chatbot, helping users figure out what might be wrong with them via a conversational interface that drills down into your symptoms, and part next-generation search engine to surface detailed and verified information on various medical conditions.

Alongside this, the London-headquartered startup has developed what it calls the “OneStop Health platform,” a marketplace of trusted health service providers and products, some of which it has a commercial partnership. So, for example, if Your.MD helps you determine that you need to speak to a doctor, OneStop would connect you to video telemedicine service Push Doctor. Or if a massage could be the correct remedy, Your.MD would send you Urban Massage‘s way.

There are currently 35 international and local digital health businesses on the platform, and the company says it plans to grow this to over 100 by the end of the year. OneStop is also key to how Your.MD plans to generate revenue, for what it otherwise a free information service.

In a call with Your.MD founder and CEO Matteo Berlucchi, I likened the combination of Your.MD’s next-generation search engine combined with the OneStop Health platform to the way Google’s own search engine captures and then monetises intent. He agreed that the comparison is valid, but with one key difference.

When people search for information on a product or service they typically already know what they’re looking for and what action or intent will follow. With health, there is an extra stage needed before intent can be captured, which is helping you figure out what it is you need first. “When you do a health-related search you don’t want lots of results, you just want the correct one,” notes Berlucchi.

To date, Your.MD has garnered 2.1 million downloads and says it has nearly a million active users per month. Interestingly, 67 per cent of users are male and 33 per cent female. Who said men don’t want to talk about their health? Albeit to an AI-based chatbot.

Article source: https://techcrunch.com/2017/06/27/your-md-raises-10m/

When Cutting Access to Health Care, There’s a Price to Pay

And the American deficit has been getting worse. “Each year, other high-income countries are improving their health at a much faster rate than the United States, and the United States currently ranks lowest on a variety of health measures,” the report by the Institute of Medicine and the National Research Council noted.

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I bring this up, senators, because you are considering a bill that would drive a stake through the Affordable Care Act. As you mull the legislation over your holiday recess, think about the consequences of cutting access to care for millions of mostly poorer, sicker and older Americans.

Of course, the dismal health situation is not all the fault of the health care system — which, until the passage of the Affordable Care Act, was the only one in the developed world that routinely barred access or limited care for millions of people of modest means.That is because violence accounts for a large share of Americans’ excessive mortality, and accidents take a disproportionate toll. Nor is the health care system entirely to blame for the nation’s elevated obesity rate — a leading cause of problems like diabetes.


The High Cost of Avoiding Health Care

Americans die from noncommunicable diseases at higher rates than citizens of many other advanced countries. And many people here have at times been reluctant to see a doctor because of the cost.




Mortality rate from noncommunicable diseases

Age-standardized deaths per 100,000 people,

selected countries, 2008

0

100

200

300

400

Denmark

United States

418

Britain

Germany

Portugal

Netherlands

Finland

Austria

Norway

Sweden

Spain

Canada

Italy

France

Australia

Switzerland

Japan

Percentage who say they have

skipped seeing a doctor because of cost

Among respondents to the 2016 Commonwealth

Fund International Health Policy Survey

0%

10

20

30

40

United States

Switzerland

Canada

France

New Zealand

Australia

Netherlands

Norway

Sweden

LOW-INCOME ADULTS*

Germany

Britain

ALL OTHER ADULTS


By The New York Times

What’s more, the United States’ higher tolerance of poverty undoubtedly contributes to higher rates of sickness and death. Americans at all socioeconomic levels are less healthy than people in some other rich countries. But the disparity is greatest among low-income groups.

Still, senators, you are not off the hook. Limited access to health care may not entirely account for the poor health and the early deaths of so many of your fellow Americans. But it accounts for a good chunk.

A study about equity in access to health care for 21 countries in 2000 revealed that the United States had the highest degree of inequity in doctor use, even higher than Mexico — which is both poorer and generally more inequitable.

And as noted in a 2003 study by the Institute of Medicine, insurance status, more than any other demographic or economic factor, determines the timeliness and quality of health care, if it is received at all.

It doesn’t require an advanced degree to figure out what limited access to a doctor can do to people’s health. A review of studies published this week in Annals of Internal Medicine reported that health insurance substantially raises people’s chances of survival. It improves the diagnosis and treatment of high blood pressure, significantly cutting mortality rates. It reduces death rates from breast cancer and trauma. Over all, the review concluded that health insurance reduces the chance of dying among adults 18 to 64 years old by between 3 and 29 percent.

Another assessment, published last week in The New England Journal of Medicine, found that access to health insurance increases screenings for cholesterol and cancer, raises the number of patients taking needed diabetes medication, reduces depression, and raises the number of low-income Americans who get timely surgery for colon cancer.

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It said that expansions in three states of Medicaid, the federal health insurance for the poor whose rolls Republicans are prepared to trim by 15 million over a decade, were found to reduce mortality by 6 percent over five years, mostly by increasing low-income Americans’ access to treatment for things like H.I.V., heart disease, cancer and infections.

Photo


Annals of Internal Medicine reported that health insurance improves the diagnosis and treatment of high blood pressure, and reduces death rates from breast cancer and trauma.

Credit
Whitten Sabbatini for The New York Times

I understand, senators, that this sort of analysis may not sway all of you. I’m aware of the view on the rightmost end of the political spectrum that ensuring people’s well-being, which I assume includes their health, is a matter of personal responsibility and not the government’s job.

Yet there is a solid economic argument for protecting your fellow citizens’ access to health care that does not rely on arguments from empathy, charity or the like. A sickly, poorly insured population can be expensive.

As noted by a study from the Joint Center for Political and Economic Studies, poor health and limited access to health care not only raise the cost of providing such care but also reduce productivity, eat into wages, increase absenteeism, weigh on tax revenues and generally lower the nation’s quality of life.

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The study, which focused on the disadvantages of African-Americans, Latinos and Asians, added up the costs of inequalities in health and premature death between 2003 and 2006 and came up with a price tag of $1.24 trillion.

The good news, senators, is that solving these inequities needn’t be particularly expensive. The analysis relayed in The New England Journal of Medicine suggested that each additional life saved by expanding Medicaid costs $327,000 to $867,000. That is much cheaper than other public interventions, such as workplace safety and environmental regulations, which achieve a similar reduction in mortality for each $7.6 million spent on compliance.

Even better: Instead of taking away the health insurance of more than 20 million Americans, what if you could offer nearly universal access and still make that work within your broader agenda?

In 2015, according to the Organization for Economic Cooperation and Development, the United States government spent 8.4 percent of its gross domestic product to pay for health care for about half of all Americans, including Medicare, Medicaid and subsidies under the Affordable Care Act. That year, Britain spent 7.7 percent to cover virtually all of its citizens. Finland, Canada and Italy spent even less.

I understand, senators, that these places have what is known as single-payer systems — which tend to stick in the craws of some of you. But think about it. If your primary motivation to repeal the Affordable Care Act is to provide a large tax cut for high-income Americans, think what you could do with a full percentage point of G.D.P. It could even be worth the effort to provide health care for all.

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Article source: https://www.nytimes.com/2017/06/27/business/economy/health-care-senate-mortality.html

Senate Health Bill in Peril as CBO Predicts 22 Million More Uninsured

But the budget office put Republicans in an untenable position. It found that next year, 15 million more people would be uninsured compared with current law. Premiums and out-of-pocket expenses could shoot skyward for some low-income people and for people nearing retirement, it said.

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The legislation would decrease federal deficits by a total of $321 billion over a decade, the budget office said.

Mr. McConnell, the chief author of the bill, wanted the Senate to approve it before a planned recess for the Fourth of July, but that looks increasingly doubtful. Misgivings in the Republican conference extend beyond just a few of the most moderate and conservative members, and Mr. McConnell can lose only two Republicans.



Where Senators Stand on the Health Care Bill

A real-time count of every senator’s position.


At least some of Ms. Collins’s concerns could be shared by Senators Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia, whose rural states would face effects similar to those in Maine.

“If you were on the fence, you were looking at this as a political vote, this C.B.O. score didn’t help you,” said Senator Lindsey Graham, Republican of South Carolina. “So I think it’s going to be harder to get to 50, not easier.”

He added, “I don’t know, if you delayed it for six weeks, if anything changes.”

Under the bill, the budget office said, subsidies to help people buy health insurance would be “substantially smaller than under current law.” And deductibles would, in many cases, be higher. Starting in 2020, the budget office said, premiums and deductibles would be so onerous that “few low-income people would purchase any plan.”

Moreover, the report said, premiums for older people would be much higher under the Senate bill than under current law. As an example, it said, for a typical 64-year-old with an annual income of $26,500, the net premium in 2026 for a midlevel silver plan, after subsidies, would average $6,500, compared with $1,700 under the Affordable Care Act. And the insurance would cover less of the consumer’s medical costs.

Likewise, the report said, for a 64-year-old with an annual income of $56,800, the premium in 2026 would average $20,500 a year, or three times the amount expected under the Affordable Care Act.

The budget office report was a major setback to Senate Republican leaders, but it was too early to declare the legislation dead, and turmoil in health insurance markets could still induce Congress to take action this year. Many people thought the House repeal bill was dead after Speaker Paul D. Ryan pulled it from the floor on March 24, but a slightly revised version was narrowly approved by the House six weeks later.

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Senator John Thune of South Dakota, a member of the Republican leadership, suggested that leaders would press forward with the Senate bill. He said that an argument could be made for delaying it “if you thought you were going to get a better policy,” but that that was not the case.

“This is the best we can do to try and satisfy all the different perspectives in our conference,” Mr. Thune said, adding that he did not think the politics would improve by waiting. “It’s time to fish or cut bait.”

Video


Fact Check: The Senate Health Care Plan

Does the health care bill in the Senate live up to Republicans’ promises? We checked the facts.


By DAVE HORN and NATALIE RENEAU on Publish Date June 26, 2017.


Photo by Doug Mills/The New York Times.

Watch in Times Video »

The White House discounted the report, saying the budget office had “consistently proven it cannot accurately predict how health care legislation will impact insurance coverage.”

The Trump administration says the Senate Republican bill would not cut Medicaid because spending would still grow from year to year. But the Congressional Budget Office said that the bill would reduce projected Medicaid spending by a total of $772 billion in the coming decade, and that the number of people covered by Medicaid in 2026 would be 15 million lower than under current law.

In 2026, it said, Medicaid spending would be 26 percent lower than under current law, and enrollment of people under 65 would be 16 percent lower. Beyond 2026, Medicaid enrollment would keep declining compared with what would happen under current law.

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The Senate bill would make it much easier for states to obtain waivers exempting them from certain federal insurance standards, like those that require insurers to provide a minimum set of health benefits. The budget office said that nearly half of all Americans could be affected by these cutbacks in “essential benefits,” and that as a result, coverage for maternity care, mental health care, rehabilitation services and certain very expensive drugs “could be at risk.”

Before the budget office released its report, the American Medical Association had announced its opposition to the bill, and the National Governors Association had cautioned the Senate against moving too quickly.

The budget office’s findings immediately gave fodder to Democrats, who were already assailing the bill as cruel. Senator Chuck Schumer of New York, the Democratic leader, said Senate Republicans had been saying for weeks that their bill would be an improvement over the House bill, which President Trump had described as “mean.”

The budget office had found that under the House bill, the number of people without health insurance would increase by 23 million by 2026 — only slightly more than the 22 million projected for the Senate bill.

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“C.B.O.’s report today makes clear that this bill is every bit as mean as the House bill,” Mr. Schumer said. “This C.B.O. report should be the end of the road for Trumpcare. Republicans would be wise to read it like a giant stop sign, urging them to turn back from this path that would be disastrous for the country, for middle-class Americans and for their party.”



Graphic

The C.B.O. Did the Math. These Are the Key Takeaways From the Senate Health Care Bill.

A look at four big numbers in the C.B.O. report.


The criticism was not confined to the Democratic caucus. Mr. Johnson, one of five Senate Republicans who said last week that they could not support the bill as drafted, told a radio host that Senate leaders were “trying to jam this thing through.” He, too, suggested he would not vote even to begin debating the bill.

“I have a hard time believing I’ll have enough information for me to support a motion to proceed this week,” Mr. Johnson said later on Monday.

Beyond the number of Americans without insurance, the Senate bill’s $321 billion in deficit reduction is larger than the $119 billion that the budget office found for the bill that passed the House.

Earlier Monday afternoon, Senate Republican leaders altered their bill to penalize people who go without health insurance by requiring them to wait six months before their coverage would begin. Insurers would generally be required to impose the waiting period on people who lacked coverage for more than about two months in the previous year.

The waiting period was meant to address a notable omission in the Senate’s bill: The measure would end the Affordable Care Act’s mandate that most Americans have health insurance, but also require insurers to accept anyone who applied. The proposal is supposed to prevent people from waiting until they get sick to buy a health plan. Insurers need large numbers of healthy people, whose premiums help defray the cost of care for those who are sick.

Under one of the most unpopular provisions of the Affordable Care Act, the government can impose tax penalties on people who go without health coverage. Republicans have denounced this as government coercion.

The repeal bill passed by the House last month has a different kind of incentive. It would impose a 30 percent surcharge on premiums for people who have gone without insurance.

Mr. Trump wrote on Twitter on Monday that Republican senators were “working very hard to get there” but were not getting any help from Democrats.

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“Not easy! Perhaps just let OCare crash burn!” Mr. Trump wrote, reiterating his assertion that the Affordable Care Act would be doomed if Congress did not come to its rescue.


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Article source: https://www.nytimes.com/2017/06/26/us/politics/senate-health-care-bill-republican.html

‘Trumpcare’ would send her to Mexico for birth control

Chat with us in Facebook Messenger. Find out what’s happening in the world as it unfolds.

Article source: http://www.cnn.com/2017/06/26/health/planned-parenthood-closing-fears/index.html

Revised Senate health-care bill penalizes consumers who have gaps in coverage

<!– –>





U.S. Senate Majority Leader Mitch McConnell (R-KY).


U.S. Senate Republicans on Monday released changes to their healthcare bill, including a six-month waiting period for people who have let their insurance coverage lapse for over 63 days — about two months — and want to get insured again.

The change appeared aimed at deterring people from dropping health insurance to begin with, a concern that arose in part because the bill cancels the monetary penalty for being uninsured under the current law, known commonly as Obamacare.

Senate leaders want to hold a vote on the bill before the July 4 recess that starts at the end of this week.

The nonpartisan Congressional Budget Office said in a statement that it will release a report estimating the bill’s effects on Monday afternoon.

A spokesman for Senate Majority Leader Mitch McConnell would not comment on whether votes on whatever bill is finally crafted would be held in the full Senate on Thursday, as originally anticipated.

At least four conservative Republicans have expressed opposition to the draft legislation, saying it does not go far enough in repealing former President Barack Obama’s health-care law known as Obamacare.

Meanwhile, some moderate Republicans have either withheld judgment or expressed doubts about replacing Obamacare with legislation that is similar to a health care measure narrowly passed by the House of Representatives last month.

That measure initially was supported by President Donald Trump, who later was reported to have described it as “mean.”



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Article alleges health risks for coal ash workers

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What the Health-Care Vote Means for the Midterm Elections

WASHINGTON—This week’s expected Senate vote on the GOP health-care bill will showcase a sharp partisan divide on the issue in states where Democrats are poised to play defense in next year’s midterm elections.

All Senate Democrats are expected this week to oppose Republican legislation that would dismantle and replace much of the Affordable Care Act. Many of their potential challengers in next year’s elections are House Republicans,…

Article source: https://www.wsj.com/articles/what-the-health-care-vote-means-for-the-midterm-elections-1498388401

Health Law Repeal Leaves Nevada Republican Torn Between Lawmakers

On Saturday afternoon, Mr. Trump posted on Twitter, venting about Mr. Heller and other Republicans who are not supporting the Senate bill.

On Friday, Mr. Sandoval acknowledged the obvious. “He’s in the eye of the storm here,” Mr. Sandoval said at a news conference in Nevada as Mr. Heller stood next to him, looking vaguely miserable as Mr. Sandoval announced his opposition to the Senate bill. The legislation could affect 210,000 Nevada residents insured through the health care law’s expansion of Medicaid.

On Friday Mr. Heller said that he, too, was against the bill as it is currently drafted, leaving himself just enough wiggle room to continue his longstanding practice of being the senator in the middle, the man who wants to see the Medicaid program phased out, except when he decides he doesn’t. (Mr. Heller has taken both positions publicly.) He has also voted to take away money from Planned Parenthood, but tells some select audiences that “I have no problems with federal funding for Planned Parenthood.”

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Mr. Heller, whose spokeswoman said he was not available for an interview, said at the news conference Friday that “this bill that’s currently in front of the United States Senate is not the answer — it’s simply not the answer.” He said, “It’s going to be very difficult to get me to a yes.”

As early as Thursday, the Senate will take a momentous vote to repeal the health law, and for Republicans from states that expanded their Medicaid program, the options are anything but palatable.

If the effort fails, the party risks being tarred as feckless: in control of the House, the Senate and the White House, but unable to come through with a promise that Republicans have been making from the day Mr. Obama signed the Affordable Care Act into law in 2010.

If the effort succeeds, expansion-state Republicans face the prospects of political hellfire: blame for every potential glitch in the health care system, from premium increases to canceled health plans and benefit losses.

“The fact remains that Dean Heller owns his party’s destructive health care repeal effort,” William McCurdy II, chairman of the Nevada State Democratic Party, said in a prepared statement. He added, “The damage to Dean Heller’s flailing re-election campaign was already done long before this desperate press conference.” Mr. Heller did not respond through his spokeswoman.

Mr. Heller, 57, represents the sort of state, both rural and working class, that has much to lose from the repeal of the Affordable Care Act. Nevada was once a national leader in the number of uninsured, but now the program has insured tens of thousands of its residents.

The state, like many around the country, has suffered a prescription drug crisis, and has among the highest rates of prescription painkillers sold and drug overdose deaths per capita. It also has a growing population of residents over the age of 55, a group particularly hammered by the Senate bill. All this has led Mr. Sandoval to take an unusually aggressive position for a Republican governor to preserve the current law.

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Other Republican senators like Mr. Heller — notably Susan Collins of Maine, Lisa Murkowski and Dan Sullivan of Alaska, Shelley Moore Capito of West Virginia and Rob Portman of Ohio — come from states with similar populations and problems and have expressed skepticism about aspects of the bill.

Further complicating the matter are the four conservative Republicans — Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah and Ron Johnson of Wisconsin — who have already declared that they cannot support the health bill without changes to make it even more frugal. That put Senate leaders on notice that any move to placate the Dean Hellers of the Senate might only alienate other lawmakers still further.

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Mr. McConnell continues to project confidence, even as the enthusiasm for the bill is largely muted. “I’m pleased that we were able to arrive at a draft that incorporates input from so many different members who represent so many different constituents who are facing so many different challenges,” Mr. McConnell said last week. He added: “There will be ample time to analyze, discuss and provide thoughts before legislation comes to the floor. And I hope every senator takes that opportunity.”

In fact, on the day last week that the bill was rolled out, Mr. Heller posted on Twitter a photo of himself sitting in an ornate chair plowing through it, a considerable feat of reading given the arcana of the bill’s statutory language. But in spite of his earnest decoding of phrases like the “applicable median cost benchmark plan,” what Nevadans have to say will probably have more impact — especially Mr. Sandoval, the most popular public official in the state, to whom Mr. Heller owes much.

The governor appointed Mr. Heller to the Senate seat in 2011 after the resignation of fellow Republican John Ensign and supported him during his successful run for a full term in 2012.

“Here is one thing that people don’t talk about a lot with Heller: He doesn’t like the job,” said Jon Ralston, editor of the Nevada Independent, a nonprofit news organization. “He was planning to run for governor.’’

But Adam Paul Laxalt, the current Nevada attorney general, the grandson of former Senator Paul Laxalt of Nevada and the son of former Senator Pete Domenici of New Mexico — is widely expected to run and has more or less pushed Mr. Heller out of the way.

Mr. Heller has never been the sort of rainmaker for the state that Senator Harry Reid of Nevada, the Senate minority leader from 2015 until early this year, was. Nor has he been a legislative leader. “The bottom line with Nevadans historically had been if you took care of the home issues, then how you voted in D.C. on the other stuff was less important,” said Michael Green, an associate professor of history at the University of Nevada, Las Vegas.

Mr. Heller appears to be running for re-election on a dogged effort to prevent the Trump administration from restarting licensing activities at the Yucca Mountain nuclear waste dump outside of Las Vegas. Beyond that, he has few other issues to lean on, and is stuck swatting away at critics from the left and the right as he struggles to define himself on health care, come what may.

“Now he in this position of his own making,” Mr. Ralston said, “pressed by Trump people on one side, so he has a base problem, while the other side is running the most relentless digital protest campaign on any piece of legislation I have ever seen in this state.”

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The threat on Mr. Heller’s right flank is real, as shown by former Representative Joe Heck, who during his race for a Senate seat in Nevada last year openly opposed Mr. Trump. Conservative voters stayed home and Mr. Heck lost to a Democrat.

Democrats have already recruited a Nevada freshman, Representative Jacky Rosen, to take Mr. Heller on. Representative Dina Titus is also looking at a possible run. “This is probably going to be the last decision I make in my political career,” Ms. Titus said. “I want it to be the right one.”

In the meantime, Mr. Heller has a long week in Washington awaiting.


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Article source: https://www.nytimes.com/2017/06/24/us/politics/senator-dean-heller-affordable-care-act.html

Medicaid Cuts May Force Retirees Out of Nursing Homes

Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.

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“The states are going to make it harder to qualify medically for needing nursing home care,” predicted Toby S. Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.”

States might allow nursing homes to require residents’ families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing home care they pay for, as Medicare already does.

The 150 residents of Dogwood Village include former teachers, farmers, doctors, lawyers, stay-at-home parents and health aides — a cross section of this rural county a half-hour northeast of Charlottesville. Many entered old age solidly middle class but turned to Medicaid, which was once thought of as a government program exclusively for the poor, after exhausting their insurance and assets.

A combination of longer life spans and spiraling health care costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation.

“People are simply outliving their relatives and their resources, and fortunately, Medicaid has been there,” said Mark Parkinson, the president of the American Health Care Association, a national nursing home industry group.

With more than 70 million people enrolled in Medicaid, the program certainly faces long-term financial challenges. Federal Medicaid spending is projected to grow 6 percent a year on average, rising to $650 billion in 2027 from $389 billion this year, according to the Congressional Budget Office.

Even if Congress does not repeal the Affordable Care Act, Medicaid will remain a target for cuts, experts say.

“The Medicaid pieces of the House bill could be incorporated into other pieces of legislation that are moving this year,” said Edwin Park, a vice president at the Center on Budget and Policy Priorities, a Washington nonprofit that focuses on how government budgets affect low-income people. “Certainly, nursing homes would be part of those cuts, not only in reimbursement rates but in reductions in eligibility for nursing home care.”

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While most Medicaid enrollees are children, pregnant women and nonelderly adults, long-term services such as nursing homes account for 42 percent of all Medicaid spending — even though only 6 percent of Medicaid enrollees use them.

Photo


Ms. Jacobs in her room at Dogwood Village. Her fellow residents include former teachers, farmers, doctors, lawyers and health aides.

Credit
Khue Bui for The New York Times

“Moms and kids aren’t where the money is,” said Damon Terzaghi, a senior director at the National Association of States United for Aging and Disabilities, a group representing state agencies that manage programs for these populations or advocate on their behalf. “If you’re going to cut that much money out, it’s going to be coming from older people and people with disabilities.”

The House health care bill targets nursing home coverage directly by requiring every state to count home equity above $560,000 in determining Medicaid eligibility. That would make eligibility rules tougher in 10 states — mostly ones with expensive real estate markets, including California, Massachusetts and New York — as well as in the District of Columbia, according to an analysis by the Center for Budget and Policy Priorities.

Dogwood Village receives about half of its $13 million annual operating costs from Medicaid, with rates from $168 to $170 a day. Some residents who come to the nursing home after a hospital stay are initially covered by Medicare, but if they stay longer than 100 days, that benefit ends, and those without savings move to Medicaid.

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“You have patients who have spent their life savings, and they come here,” said Kristen Smith, the admissions coordinator. Ms. Smith said patients now are older and sicker than they used to be, frequently arriving directly from a hospital.

“It used to be hips and knee” surgeries, she said. “And now a lot of those patients are going home. What we’re seeing is more complex, sicker patients.”

With cinder-block walls brightened by pictures of horses that evoke this equestrian county, the nursing home offers crafts, bingo and other activities.

Mary Ann Mohrmann is 85, the average age of Dogwood Village residents. An elementary schoolteacher for 25 years, she has Charcot-Marie-Tooth disease, a neurological disorder that has weakened her legs, feet and thumbs and compromised her fine motor skills.

Photo


Mary Ann Mohrmann, 85, was an elementary school teacher for 25 years. She now has a neurological disorder that weakens her legs, feet and thumbs and limits her fine motor skills.

Credit
Jeff Poole/Orange County Review

Two of her children have it, too, she said. None of them can take care of her at home. “I’ve been here years,” she said. “I don’t know how many.”

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Medicaid helps pay for care for people with disabilities, like Nancy Huffstickler, 65, who has been here for four years and regards herself as “a medical disaster.”

She listed her ailments: spinal cancer in remission, restless leg syndrome, high blood pressure and multiple ulcers. She has had spinal reconstructive surgery and a hip replacement. She is undergoing physical therapy with the hope that one day she will be able to leave her wheelchair and use a walker.

Ms. Huffstickler is fearful of Republicans’ health care changes. “It may save the federal government money, but what about us?” she asked.

Major Medicaid cuts would compel Dogwood Village to cut staff, supplies and amenities — changes that would affect the quality of care for all residents, not just those on Medicaid.

If that does not save enough money, the nursing home might have to reduce the number of Medicaid residents, said Vernon Baker, who resigned as administrator in April. “It’s not like our toilet paper or paper towels are like the Ritz-Carlton’s,” he said.

Some residents do not even know they are on government insurance; administrators often complete the paperwork to start Medicaid once other insurance expires. Others are embarrassed that they are dependent on a program that still carries stigma.

They should not be, said Jennifer Harper, the assistant director of nursing. Relying on Medicaid for nursing home care has become the new normal.

“These folks have worked their whole lives, some with pretty strenuous jobs, and paid into the system,” she said. But with changes looming, she said, “it may be a system that fails them.”


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Article source: https://www.nytimes.com/2017/06/24/science/medicaid-cutbacks-elderly-nursing-homes.html

Senate Health Care Bill: How the Right and Left Reacted

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David Harsanyi in The Federalist:

“At some point conservatives are going to have to take a page from Democrats and occasionally embrace incrementalism.”

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“Pragmatism is no sin,” Mr. Harsanyi reminds readers, urging conservatives to take advantage of the chance to repeal the Affordable Care Act. The Senate bill’s imperfections pale in comparison to the mandate that Republicans have to repeal the “persistent failures of Barack Obama’s signature achievement.” Republicans were elected, he argues, to undo the health law, and they should act fast because this “might be the last chance to do anything.” Read more »

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Henry Olsen in The Washington Post:

“What is more important, saving money or saving lives? Senate and House Republicans may be surprised to learn that for their idol, Ronald Reagan, this was never a question at all.”

Mr. Olsen is the author of a book on President Reagan’s political philosophy. In trying to channel the 40th president’s potential attitude toward federally subsidized health care, he cites Mr. Reagan’s remarks to the Conservative League of Minneapolis in 1961: “As one conservative let me say any person in the United States who requires medical attention and cannot provide it for himself should have it provided for him.” Read more »

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From the Left

Zoë Carpenter in The Nation:

“The question is whether the GOP legislation improves on Obamacare and current coverage. It doesn’t come close — unless, of course, you happen to believe that we provide too much help to the poor and elderly, and not enough tax cuts to the wealthy.”

Ms. Carpenter agrees with some of her counterparts on the right when she argues that the Senate health care bill doesn’t repeal the Affordable Care Act. But she comes to a different conclusion, writing that “it just makes Obamacare worse.” Moreover, she argues, the Senate bill’s plan to phase out Medicaid is even more cruel than what was proposed in the House bill “because it affects people who are currently enrolled in the expansion, not just those who would become eligible in the future.” Read more »

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Gene B. Sperling and Michael Shapiro in The Atlantic:

“The Republican plan may not allow insurers to discriminate against a pre-existing condition through the front door, but they’ve created a backdoor way in.”

Mr. Sperling (who served as an economic policy adviser to Presidents Bill Clinton and Barack Obama) and Mr. Shapiro (who was the economic foreign policy adviser for Hillary Clinton’s 2016 campaign) write that the Senate’s bill is a disaster for Americans with pre-existing conditions. Under the bill, states will be able to force people with pre-existing conditions into “segregated markets that will lead them to pay far, far higher costs than everyone else.” The plan, they write, will take the country back to the “completely broken system” before the Affordable Care Act. Read more »

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Neal Gabler in Moyers Company:

“In the end, Susan Collins is likely to retreat and join the conservatives in trashing health insurance.”

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Senator Susan Collins, Republican of Maine, is often held up as a moderating voice in the G.O.P. But when it comes to health care, Mr. Gabler warns, Democrats should not put their faith in Ms. Collins’s ability to break from her party. For her and other moderate Republicans, he summarizes: “Polarization isn’t the problem. Orthodoxy is the problem.” Read more »

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Ian Millhiser in ThinkProgress:

“‘Death spiral’ is actually the economic term [...] for what Trumpcare will do to health insurance markets.”

You often hear partisans on the right describe the Affordable Care Act as being in a “death spiral.” In this article, Mr. Millhiser re-appropriates the term and applies it to what the “Senate Trumpcare bill” will do to insurance markets. Obamacare’s individual mandate, he writes, solves the problem of insuring people with pre-existing conditions, and prevents the very “death spiral” guaranteed by driving people out of insurance markets. Read more »

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And Finally, From the Center:

• Editorial Board in USA Today:

“It deserves the old surgeon general’s warning about cigarettes: This product may be hazardous to your health.”

While it finds the Senate health care bill “marginally better” than the one passed in the House, the editorial board of USA Today concludes that the measure is a “tax cut masquerading as a health care plan.” They warn that the secretive process by which the bill was constructed, and a potential “flurry of last minute changes” — intended to give moderate senators cover in swing states — will lead to a bill that has the potential to wreak havoc in ways we cannot predict. Read more »

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Nate Silver in FiveThirtyEight:

“Neither Democrats nor Republicans ought to be taking much for granted.”

Mr. Silver gets down to brass tacks and assesses the likelihood that the Senate will in fact pass the bill it released on Thursday. The betting markets, he notes, give roughly even odds that key provisions of the Affordable Care Act will be repealed before the end of the year. Throw in “the wild card of Trump,” and it’s anyone’s game. Read more »

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Article source: https://www.nytimes.com/2017/06/24/us/politics/gop-healthcare-bill-reactions.html