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The Health 202: Trump White House finds new reason to target Medicaid


The Trump administration is trying out a new argument to defend its support of work requirements for social safety net programs like Medicaid: The Johnson-era “War on Poverty” was victorious and now most Americans don’t need the aid. 

The White House, in a lengthy report released at the end of last week, focuses on Medicaid, food stamps and housing assistance data to make its case for why non-disabled, working-age, low-income Americans should meet some employment eligibility thresholds to qualify for the government assistance. 

As our colleagues Jeff Stein and Tracy Jan wrote over the weekend, it’s the same old Republican position with a new twist. Whereas for years the GOP’s reason for overhauling the safety net programs was because they didn’t work to bring people out of poverty, the Trump White House is now essentially saying the decades-old efforts were a success, so are no longer needed. 

The White House Council of Economic Advisers argues that “a dramatic reduction in material poverty” has “coincided with a substantial reduction in self-sufficiency of the non-disabled working-age population.” 

“Non-disabled working-age adults have become increasingly reliant on welfare and experienced stalled employment growth, in part because of the disincentives welfare programs impose on increasing one’s own income,” they write. “Program work requirements, which require recipients to work or engage in work-related activities in order to maintain benefits, can help overcome this problem.”

But critics have long countered that “work requirements impose additional barriers to receiving health care and food for those who need such assistance,” our colleagues write. “And [critics] accuse the administration of underestimating the difficulty of climbing out of poverty, even in a robust economy.”

Let’s focus here on what this debate means for Medicaid. 

Earlier this year, President Trump signed an executive order giving states more autonomy over their Medicaid programs by allowing them to request waivers from the federal government to add parameters like work requirements. So far, four states’ applications have been approved by the Centers of Medicare and Medicaid Services: Arkansas, Indiana, Kentucky and New Hampshire, while seven other states have applications pending: Arizona, Kansas, Maine, Mississippi, Utah, Ohio and Wisconsin. 

Kentucky was primed to be the first to implement the requirements before a federal judge ruled just a few weeks ago that the government hadn’t fully considered the implications and sent the plan back for further consideration. CMS Administrator Seema Verma, in a meeting with reporters last week, said she couldn’t talk about the specific case, but that the administration was committed to lifting people on Medicaid out of poverty. 

“This administration is committed to giving states flexibility . . . states are trying to do inventive things and we’re trying to be supportive of that,” she said. “[Medicaid] has evolved and changed. It was intended to be for a very vulnerable population and with the ACA it’s serving able-bodied individuals. We should give them a pathway out of poverty.”

Groups that advocate for the poor that brought the suit against Kentucky contend, among other reasons, that such substantial changes to Medicaid should go through Congress. 

If it were up to the House GOP, that wouldn’t be a problem. Adding work requirements to safety-net programs has been a long-time goal. In fact, the majority party recently released a proposal it says will balance the budget in nine years with large cuts to entitlement programs, including a work requirement for Medicaid. 

This new report from the White House doubles down on that effort by trying to paint a rosier picture of poverty in America. It points out that Medicaid, which costs $566 billion to cover 71 million people, grew from 6 percent in 1969 to 22 percent in 2017, but that poverty had fallen 90 percent since the program began. 

Suzanne Mettler, a political scientist at Cornell University, told our colleagues that the Trump officials’ take on the government’s anti-poverty efforts is “an opportunistic frame to try to advance the same end.”

“It is ironic,” she added. “For ages [Republicans have] been saying it’s a failure, and suddenly they are trying to declare victory and call it all off.”

To underscore it’s position that Medicaid disincentivizes healthy, low-income Americans from working, the administration says that 61 percent of recipients on Medicaid are non-disabled, working-age adults, yet 60 percent of that group work less than 20 hours per week. 

But the Kaiser Family Foundation has a completely different set of statistics for the Medicaid population that shows 43 percent of recipients work full-time and 19 percent work part-time. And in the states that did expand Medicaid under the Affordable Care Act, low-wage, part-time work would not be sufficient to even afford ACA marketplace health coverage, Kaiser researchers write.

In an article titled, “Implications of Medicaid Work Requirements, they wrap up what’s at stake this way:

These data points show that even among those working full-time, work can be fragile, unpredictable, and may not help people rise out of poverty. Even a temporary illness or emergency situation for those working in hourly jobs could result in failure to meet new hourly work requirements. The subsequent loss of health coverage could exacerbate financial insecurity. Finally, workers will need to verify work status regularly, and many Medicaid adults may face barriers in complying with reporting requirements due to limited experience with or access to computers. Three in ten Medicaid adults say they never use a computer, but Arkansas is requiring use of on-line accounts to verify work status, and other states may rely on online reporting.

And Eliot Fishman, senior director of Health Policy at FamiliesUSA and former head of the government’s work with states on Medicaid waivers at CMS, tweeted last night a thread about the White House’s new report, writing there’s no evidence from job numbers that Medicaid, or the expansion of it, led to less people entering the workforce. In fact, he counters, “you could make the case that extending health coverage to low income people helped them to re-enter the workforce, for example by accessing mental illness or substance use treatment.”

So, where does this all leave Medicaid? For now, exactly as its long been: A partisan football to be lobbed back and forth when politically expedient.

But President Trump’s Supreme Court nomination gives conservatives an advantage in its quest to make Medicaid access contingent on factors like employment. If a case questioning states’ right to make changes to its Medicaid program comes before the highest court, a rightward turn of the bench could result in a fragmented program wherein eligibility limits are based on where a person lives. 

This 1975 microscope image made available by the Centers for Disease Control and Prevention shows a cluster of smallpox viruses. (Fred Murphy/CDC via AP)

AHH: The Food and Drug Administration late last week approved the first drug to treat smallpox, an anti-viral pill that could potentially stop the spread of a deadly pandemic, the New York Times’s Donald G. McNeil Jr. reports.

Most people under the age of 40 have not been vaccinated for smallpox because routine administration of the vaccine stopped after it was eradicated in 1980. The approved pill, known as Tpoxx, has not yet been tested on humans with the eradicated disease. “But it was very effective at protecting animals deliberately infected with monkeypox and rabbitpox, two related diseases that can be lethal,” Donald writes. “It also caused no severe side effects when safety-tested in 359 healthy human volunteers, the F.D.A. said.”

FDA commissioner Scott Gottlieb said the advancement “affords us an additional option should smallpox ever be used as a bioweapon.” Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases told the TImes the FDA’s approval  of the drug is “definitely a good thing.”

“Research on tecovirimat — originally designated ST-246 — began at the institute after the 9/11 terrorist attack on the World Trade Center,” Donald reports. “The research accompanied efforts to stretch the national stockpile of smallpox vaccine by safely diluting it.”

Former Health and Human Services Secretary Tom Price. (Michael Reynolds/EPA-EFE/Shutterstock)

OOF: The Department of Health and Human Services’s internal iatchdog concluded in a 58-page report that former secretary Tom Price wasted at least $341,000 in government funds over the course of his tenure amid a failure to follow federal travel requirements, our Post colleagues Mark Berman and Amy Goldstein report.

Price resigned in September following criticism over his extensive use of charter flights.

“Our rigorous review of [Price]‘s use of chartered, military, and commercial aircraft found that 20 out of 21 trips did not comply with applicable federal regulations and HHS policies and procedures, resulting in waste of at least $341,000 in federal funds,” a spokesman from the inspector general’s office said in a statement. “We recommend the Office of the Secretary review the lack of compliance with federal requirements and determine appropriate actions to recoup the travel costs.”

The report found Price’s office did not compare charter flight costs with commercial travel costs, or for certain chartered flights, did not choose cheaper alternatives.

In a statement, a spokesman for Price criticized media coverage of the report, stating it “inaccurately states the report takes issue with Dr. Price’s actions… In fact, the report addresses overall functions of Department staff charged with administering travel.”

A McDonald’s in Brandon, Miss. (Rogelio V. Solis/Associated Press)

OUCH: McDonald’s has stopped selling salads at 3,000 of its restaurants nationwide over a parasite outbreak that sickened dozens of customers in multiple states, mainly in the Midwest, according to The Post’s Lindsey BeverThe salads were removed from the restaurants until McDonald’s can get a new supplier, the chain said in a statement.

“The announcement comes after public health authorities in Illinois and Iowa warned that a number of recent cyclospora infections in those states appear to be linked to the salads,” Lindsey writes. She wrote the cyclospora cayetanensis parasite can contaminate food and water and can lead to a non-life-threatening intestinal illness called cyclosporiasis, per the CDC.

“McDonald’s is committed to the highest standards of food safety and quality control,” the company said in a statement, adding it was cooperating with the outbreak investigation.

Detainees are seen inside a facility where tent shelters are being used to house separated family members at the Port of Entry in Fabens, Tex., on June 21. (Matt York/AP)

— The federal judge involved in the ongoing reunification of migrant families called out the Trump administration late last week for suggesting that expediting the process would be risky for children.

“U.S. District Judge Dana M. Sabraw in San Diego called an unscheduled, after-hours hearing via conference call Friday after a key federal official filed a sworn statement with the court saying that Sabraw’s deadlines for reuniting children were forcing the government to shorten the vetting process,” The Post’s Maria Sacchetti reports. “The statement implied that the deadlines could result in the government placing as many as 175 children with people who were not their biological parent, among other risks.”

During the call, Sabraw chided the administration for the “parade of horribles” it listed to portray the order as potentially hazardous. “That is on the government,” Sabraw said, per Sacchetti. “And that’s a failure of the process and it is inconsistent with the court’s order.”

Sabraw had also on Friday praised the administration for its “substantial” effort to reunite by last week’s deadline more than half of the 103 children in U.S. custody that had been separated.

Now, the government faces a July 26 deadline to reunify children between the ages of 5 and 17. HHS said it has identified 2,551 migrant children in that age group who are “potentially” eligible to be reunified with their parents, but officials will now have to determine whether the parents are able and fit to take the children.

Officials said they are set to return up to 200 kids a day to their parents, per our colleague. “Officials also signaled late Friday that not every family will be reunited; the same occurred with the smaller group of some 100 children age 5 or younger,” she added.

In a Friday night court filing, the Trump administration said it plans to expedite the reunification process for those 2,551 children, specifically noting it would adjust some of the methods used when reunifying children under age 5, including no longer using fingerprint and DNA testing to confirm parent identities, Politico’s Dan Diamond reports.

According to Politico’s Ian Kullgren, Sabraw also called for a 9:30 am status hearing today with attorneys for the federal government and the ACLU.

— Families who fled to the United States seeking asylum and were separated by U.S. officials may face another difficult choice once they are reunited. After migrant children are returned to their parents, parents will have to decide whether to work toward staying in the country legally, navigating a complex immigration system, or turn the children over to U.S. authorities so the kids will be allowed to stay even if parents are deported, Bloomberg’s ­­Kartikay Mehrotra explains.

“On Friday, the American Civil Liberties Union and U.S. government attorneys disclosed an agreement that leaves it up to immigrant parents to decide whether their children will stay with them in detention or be placed with social service workers,” Kartikay reports. “For the government, the agreement ensures its authority to detain adults in federal custody remains intact while families are reunified. The ACLU, meanwhile, got an assurance that if families consent to being held in custody, they aren’t waiving other legal rights going forward.”

Our Post colleague Michael Miller spoke with some of the migrant kids who have been kept in shelters after they were separated from their families.

“Experts warn that many of these children may be deeply traumatized by their experiences,” Michael writes. “Their voices have seldom been heard during the frenzied debate over family separation.”

“They always kept the boys and the girls separate,” said an 8-year-old girl from Guatemala. “And they punished us if we went near each other.”

One 11-year-old boy from Guatemala said he had to ask permission to hug his sister.

A 9-year-old boy from Brazil said: “I felt like a prisoner … I felt like a dog.”

President Trump speaks as Judge Brett Kavanaugh his Supreme Court nominee, listens in the East Room of the White House in Washington. (AP Photo/Evan Vucci)

 — In an interview with the Daily Mail’s Piers Morgan, Trump said he understood the concern that abortion-rights supporters have with his Supreme Court nominee. But he suggested it would be a “long time” before the Supreme Court may hear a case that could lead to a reversal of Roe v. Wade.

“I do understand, but I also understand that you know, that’s a 50/50 question in this country,” Trump said about the debate over Roe.

“I think he is going to be confirmed and someday in the distant future there could be a vote,” Trump added, referring to nominee Brett M. Kavanaugh. “There’s also a very good chance there won’t be a vote. We’ll have to see what happens. A case has to get up there. It could be a long time before a case ever gets up there.”

Meanwhile, our Post colleagues Robert Barnes and Ann E. Marimow detail Kavanaugh’s “first judicial hero” — the late Chief Justice William H. Rehnquist, who had a conservative record on issues including abortion.

Last year, Kavanaugh told the American Enterprise Institute in a Constitution Day speech that Rehnquist was his hero for his rejection of a “wall of separation between church and state” in his Roe v. Wade dissent. “Liberal groups, abortion rights activists and antiabortion organizations all have seized on the speech, as well as Kavanaugh’s rulings involving a undocumented teenage immigrant seeking an abortion while in federal custody,” our colleagues write.

Health and Human Services Secretary Alex Azar speaks during a Senate Finance Committee hearing. (AP Photo/Jacquelyn Martin)

— HHS is set to delete two decades of medical resources currently maintained by its Agency for Healthcare Research and Quality, also known as the National Guideline Clearinghouse.

It’s a key collection of medical guidelines and evidence-based research used by doctors and researchers, according to the Daily Beast‘s Jon Campbell, and the “” site is set to go offline after today. 

“ was our go-to source, and there is nothing else like it in the world,” Oregon Health Science University professor Valerie King told Jon. “It is a singular resource.”

“When doctors want to know when they should start insulin treatments, or how best to manage an HIV patient in unstable housing — even something as mundane as when to start an older patient on a vitamin D supplement — they look for the relevant guidelines,” Jon writes. “The documents are published by a myriad of professional and other organizations, and NGC has long been considered among the most comprehensive and reliable repositories in the world.”

“AHRQ agrees that guidelines play an important role in clinical decision making, but hard decisions had to be made about how to use the resources at our disposal,” AHRQ spokesperson Alison Hunt told Jon in an email. “The operating budget for the NGC last year was $1.2 million, Hunt said, and reductions in funding forced the agency’s hand.”

Senate Minority Leader Chuck Schumer (D-NY) speaks about healthcare during a news conference. (Mark Wilson/Getty Images)

— The Obamacare tables have turned for Democrats who are centering their campaigns around defending the same health-care law once used to target and defeat them, our Post colleague Sean Sullivan reports.

Now, Democratic candidates are pointing their fingers at Republicans’ failure to rescind the health-care law last year, and looking to rally voters around the ACA and convince them supporting Trump’s Supreme Court nominee would increase the likelihood that the high court would dismantle Obamacare.

“The strategy marks a dramatic turnabout from the previous two midterms when many Democrats avoided defending Obamacare, and illustrates the extent to which the law has taken root as millions of Americans have come to depend on it,” Sean writes “Republicans, who relentlessly attacked Democrats for supporting the ACA in 2010 and 2014, are now largely steering their campaigns toward different topics.”

“We’ve learned a lesson,” Sen. Richard J. Durbin (D-Ill.), the second-ranking Democratic senator said. “The American people are tuned in to the failure of the Republicans to come up with an alternative to Obamacare.”

Chris Wilson, a Republican pollster, told Sean Obamacare was “something to fire up our base. Now ‘protect Obamacare’ is a rallying cry for Democratic enthusiasm.”

Alexandria Ocasio-Cortez takes a moment between interviews in New York. (AP Photo/Seth Wenig)

—Alexandria Ocasio-Cortez and Sen. Bernie Sanders (I-Vt.) are heading to Kansas on July 20 to rally for Democratic congressional candidates running in red states.

“I’ve believed for years that the Democratic Party has committed political malpractice by writing off half the states in this country,” Sanders told our Post colleague Dave Weigel. “They’ve got to fight for every state in this country.”

Sanders and New York City congressional nominee Ocasio-Cortez will rally for James Thompson in the state’s 4th Congressional District and for Brent Welder in the state’s 3rd Congressional District.

Our colleague previously reported that Kansas’s 3rd district is the only one in the Great Plains that voted for Hillary Clinton in the 2016 presidential election. Welder has been endorsed by Sanders and Ocasio-Cortez and is running on a platform that includes a $15 minimum wage and a push for “Medicare for all,” Dave wrote.

“All over this country, you have people who understand that we need to [change] the minimum wage to a living wage; that health care is a right; that we need to rebuild our infrastructure,” Sanders said. “Those are popular issues in the Bronx. These are popular issues in Vermont. In Kansas, they’ve gone through the [former governor Sam] Brownback agenda, and they do not believe you should give tax breaks to the rich and cut Social Security.”

Michael Cohen, President Donald Trump’s personal attorney, walks along a sidewalk in New York. (AP Photo/Seth Wenig, File)

— A new report from Senate Democrats reveals the link between Swiss pharmaceutical giant Novartis and Trump’s personal lawyer Michael Cohen may have been broader than what the company disclosed in previous and perhaps misleading statements, Stat’s Ed Silverman and Ike Swetlitz report.

“Novartis explicitly sought to hire Cohen to gain access to ‘key policymakers’ and provided him with ideas for lowering drug costs, which later appeared in the Trump administration blueprint that was developed to address the issue,” they write. “With the findings, the report highlights a sensational series of events that have underscored concerns about the extent to which the pharmaceutical industry has attempted to influence the Trump administration. And the conclusions place Novartis in a very unflattering light, as the documents indicate the company saw the arrangement as a golden opportunity to buy access to the White House.”

Novartis said in a statement that it “disagree[s] with the report’s conclusion that we issued a misleading public statement regarding the extent of our engagement with Mr. Cohen,” according to Stat.

New York Governor Andrew Cuomo speaks during a news conference. (AP Photo/Seth Wenig)

— In a report requested by Gov. Andrew M. Cuomo, the New York State Department of Health recommended legalizing marijuana, noting that “the positive effects of a regulated marijuana market in NYS outweigh the potential negative impacts.”

Cuomo had asked for a report assessing the health, criminal justice, public safety, economic and educational impacts of a marijuana program by the state, our Post colleague Christopher Ingraham reports.

“It found that the legal regime of marijuana prohibition has ‘not curbed marijuana use and has, in fact, led to unintended consequences,’ like the disproportionate criminalization and incarceration of minorities,” Christopher writes. He adds such a program could be worth between $1.7 billion and $3.5 billion and bring in from $248 million to $677 million in tax revenue a year for New York. The report also acknowledges that pot is not as harmful as alcohol and tobacco and that legalization would lessen any limited harm.

“The report is notable for its full-throated adoption of arguments that have been put forth by legalization supporters for years,” Christopher writes.

— And here are a few more good reads from The Post and beyond: 

Coming Up

  • The House Veterans Affairs Subcommittee on Oversight and Investigations holds a joint hearing with the House Small Business Subcommittee on Investigations, Oversight and Regulations on “Achieving Government-wide Verification of Service Disabled Veteran Owned Small Businesses” on Tuesday.
  • The House Veterans Affairs Committee holds a hearing on “The VA Accountability and Whistleblower Protection Act: One Year Later” on Tuesday.  
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on health care costs on Tuesday.
  • The House Ways and Means Subcommittee on Oversight holds a hearing on combating Medicare fraud on Tuesday.
  • The House Ways and Means Subcomittee on Health holds a hearing on “Modernizing Stark Law to Ensure the Successful Transition from Volume to Value in the Medicare Program” on Tuesday.
  • PhRMA holds an event on “The State of Care: Innovation Access” on Tuesday.
  • Politico holds its second Pro Summit on Tuesday.
  • The Senate Special Committee on Aging holds a hearing on “Supporting Economic Stability and Self-Sufficiency as Americans with Disabilities and their Families Age” on Wednesday.
  • Brookings Institution holds a event with FDA Commissioner Scott Gottlieb on Wednesday.
  • The FDA’s Blood Products Advisory Committee holds an open session on Wednesday.
  • The National Academies of Sciences, Engineering, and Medicine holds a workshop on the integration of health care and social services on Thursday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on “21st Century Cures Implementation: Examining Mental Health Initiatives” on Thursday.
  • The Alliance for Health Policy holds an event on “State Responses to the Evolving Individual Health Insurance Market” on Friday.

Protesters clash with officers outside an ICE facility in Portland: Trump blames Obama for Russia’s DNC hack

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My Health Record: Your questions answered on cybersecurity, police and privacy

Every Australian will soon have a My Health Record — an online summary of their health information — unless they opt out over the next three months.

From Monday, Australians will have until October 15 to tell the Government they don’t want one. Otherwise, a record will automatically be created.

The project aims to give patients and doctors access to timely medical information — test results, referral letters and organ donation information, for starters — but there are concerns about the safety of some of our most personal, sensitive data.

We asked for your questions about the project on social media, and they ranged from police access to the platform’s cybersecurity.

The ABC sat down with Tim Kelsey, the head of the Australian Digital Health Agency (ADHA) and the man in charge of the initiative, to get them answered.

The way the record works

As a patient, how can I know if my My Health Record information is being maintained by my doctor?

You can choose to opt out and have no My Health Record.

But once you have one, doctors can upload health information into it unless you ask them not to.

A screen showing My Health Record creation options.

A screen showing My Health Record creation options.

You can set up a My Health Record through MyGov.

Screenshot: My Health Record

When you see a doctor, you can discuss adding (or not) documents such as an overview of your health, a summary of prescribed medications and referral letters.

Remember, it’s not a comprehensive picture of your health — it will only contain what you and your doctors choose to upload, and will depend on the quality of those records.

When you first access the system, you’ll be asked to decide whether you want two years of Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, Australian Immunisation Register, and Australian Organ Donor Register data to be uploaded.

But if your doctor accesses your record first before you make the selection yourself, this data will be uploaded automatically — unless you’ve opted to have no record at all.

If you want, you can delete or restrict access to those documents later.

Not all Australian hospitals and health services are connected to My Health Record yet, so that’s something to check during your next visit.

When I get a prescription, how do I know whether I need to ask to make an update to my My Health Record? Does this vary by provider?

Doctors can upload information about prescribed medications, but as discussed above, it’s worth discussing this each time you see your doctor.

What happens to your My Health Record after you die?

My Health Record information will be held for 30 years after your death. If that date isn’t known, then it’s kept for 130 years after your birth.

A person gets their blood pressure tested.

A person gets their blood pressure tested.

Australians can opt out of My Health Record from July 16.

Unsplash: rawpixel

Will any private health insurance companies have access?

Insurers shouldn’t be able to access your record — it’s reserved for people who work for a registered healthcare provider and who are authorised to provide you with care.

There are plans to use aggregated, anonymised My Health Record data for research and other purposes — this is known as “secondary use”.

“My Health Record information can be used for research and public health purposes in either a de-identified form, or in an identified form if the use is expressly consented to by the consumer,” a Department of Health spokesperson said.

Currently, users of the platform can tick a box on the web portal to opt out of secondary use.

Secondary uses must be of public benefit and cannot be “solely” commercial, and insurance agencies will not be allowed to participate.

However, “the impact of this exclusion” will be considered when the Department of Health’s framework governing secondary use of My Health Record data is reviewed, according to the framework document.

Australian organisations (and some overseas, in certain circumstances), including Australian pharmaceutical companies, will be able to apply to access My Health Record data for approved secondary purposes.

“We don’t expect any data to flow until 2020,” Mr Kelsey added.

The opt-out period

How can I opt out?

There are three key ways:

  • By visiting and opting out using the online portal.
  • Over the phone by calling 1800 723 471.
  • Or on paper by completing a form and returning it by mail. Forms will be available in 2,385 rural and remote Australia Post outlets, through 146 Aboriginal Community Controlled Health Organisations and in 136 prisons.

What happens to the people who end up with a My Health Record, and then decide to opt out?

If you don’t opt out between July 16 and October 15, then a record will be automatically created for you.

After October 15, there will be a “one-month reconciliation period” before new My Health Records are registered. These new records will be created mid-November.

You can then cancel that record, but the data it contained will still exist (although inaccessible to you or health providers) until 30 years after your death.

Can your smartphone track your mental health?

A woman holds a smartphone.

Can technology be trusted to track our mental health?

Is a record automatically generated if a doctor uploads a document during the opt-out period, even if you did not create one yourself?

According to the ADHA, doctors can’t upload any clinical documents to the My Health Record system unless the patient record exists.

What about children who aren’t born yet — can they opt out?

After the opt-out period, newly eligible healthcare recipients, such as immigrants to Australia and parents of newborn children, will be given the chance to elect not to have a My Health Record as part of their Medicare registration.

Protection of your data

Which service provider will manage the infrastructure to ensure it isn’t vulnerable to a cyber-attack?

The platform was built by the technology provider Accenture, however the ADHA is starting discussions about “re-platforming” it.

Independent third parties audit the system’s security and undertake penetration testing, according to Mr Kelsey, but security experts warn that it’s impossible to make any online database entirely bullet proof.

Remember too, that documents created or downloaded by your doctors may be stored in their local IT system too and depend on that system’s security.

If a doctor downloads files from My Health Record, what’s to stop her from sharing those files within the practice?

By default, your online documents will be accessible to your healthcare providers.

If you have privacy concerns, you can log onto My Health Record and restrict who sees it:

  • You can set a Record Access Code and give it only to healthcare professionals you want to access your record.
  • If you want to restrict certain documents, you can set a Limited Document Access Code.

These controls may be overridden in an emergency.

As mentioned above, if a document is removed from the My Health Record system, it’s beyond the reach of your access controls.

If a GP were to allow another staff member to access a record, what is the potential punishment?

If someone accesses your My Health Record without legal authorisation and the person “knows or is reckless to that fact”, criminal and civil penalties may apply.

Where can users see information about who has accessed their record?

My Health Record users will be able to see who has looked at their record by checking its access history online.

They’ll be able to see when it was accessed, which organisation accessed it and what was done — documents being added, modified or removed, for example — but not the individual doctor who accessed it.

You can also set up an email or SMS alert for when a healthcare organisation accesses your record for the first time.

The privacy commissioner recommends checking regularly for unexpected or unauthorised access. You can call the ADHA on 1800 723 471 if you think something’s gone wrong.

Several apps can connect to My Health Record. How will the ADHA ensure they are secure?

Apps such as Healthi and Health Engine, which recently ran into trouble, are authorised by the ADHA to “show” people their health record.

According to Mr Kelsey, third party app developers can only display your My Health Record — “at the moment, it’s view-only” — and cannot store that data.

A table showing Medicare information preferences

A table showing Medicare information preferences

My Health Record users can decide if they want Medicare information uploaded.

Screenshot: My Health Record

These providers undergo “strict assessment” and must abide by a Portal Operator Registration Agreement, according to the ADHA.

The agreement demands they do not download or store My Health Record information on their own system, or pass that data on to a third party.

“We are not currently planning to provide access beyond ‘view-only’ to the app community,” he said.

Police and law enforcement

Which rules and policies guide the ADHA’s decision to grant access to law enforcement?

The ADHA is authorised by law to disclose someone’s health information if it “reasonably believes” it’s necessary for preventing or investigating crimes and protecting the public revenue, among other things specified under section 70 of the My Health Records Act.

The agency was unable to provide a definition of “protecting the public revenue” by deadline.

When it receives a law enforcement request, the ADHA will need to determine that it’s a legitimate request from an enforcement body.

Law enforcement bodies will not be granted direct access to the My Health Record: The ADHA said any disclosure would be limited to what is necessary to satisfy the purpose of the request.

Has the ADHA received any requests from law enforcement to access records?

Mr Kelsey said no police requests have been received yet.

Will users be informed if their data has been released to law enforcement?

If personal information is disclosed to law enforcement, the decision about whether to notify the My Health Record holder will be decided “case-by-case”.

Likewise, healthcare provider organisations won’t be informed if their patient’s data is accessed.

The release to police will be recorded in a written note and stored by the ADHA.

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Private health insurance rankings to give consumers more information about coverage and benchmarks


July 15, 2018 14:18:11

Private health insurance premiums will be ranked in a bid to help consumers figure out exactly what they are paying for, from April next year.

The Federal Government has unveiled the new categories — gold, silver, bronze and basic — for the more than 70,000 private health insurance policies around the country, held by about 13 million Australians.

Should you have private health insurance?

Everything you need to know to understand Australia’s private health insurance system, personalised for you.

Federal Health Minister Greg Hunt argued the measure would give consumers more information about their coverage, and set benchmarks for the minimum services that would be offered under each policy regardless of insurer.

“What this means is we take the existing policies, no change in price, no change in coverage, but we make it simpler so everybody can see in one page exactly what is in place,” he said.

The changes to the system will result in more cancer treatments being covered by private health, particularly for women suffering breast and ovarian cancer.

“There’s been a disparity in the past between coverage of men and women for different types of cancers, so it’s another important day for cancer treatment for women,” Mr Hunt said.

‘Junk’ policies still a problem, argues Labor

Shadow Health Minister Catherine King welcomed the new categories, saying any measure to increase consumer knowledge was an improvement.

But Ms King argued the Government was not doing enough to get rid of low-cost policies that provided little coverage.

What it means for you

If you’re in your 20s and tossing up whether or not to buy private health insurance, take a look at what the proposed shake-up could do for you.

“What Labor has said is that we will remove the private health insurance rebate from those junk policies, in particular those ones that only offer private health insurance cover in public hospitals,” she said.

“We think that that is not warranted when you’ve got a number of consumers using that product, frankly, as an effort to minimise taxation as opposed to actually access private health insurance.

“What we’ve seen increasingly under this Government is more and more complexity in the sorts of products that are around, more exclusions, more excess payments, more gap payments in those products, and less value for money for consumers.”

The Coalition argues Labor’s approach to low-cost policies, which would be classified as “basic” under the new system, would do more harm than good.

“I know that the ALP wants to effectively knock out the basic categories, but that would lead to a 16 per cent price hike in private health insurance, which would drive hundreds of thousands, if not millions out of private health insurance,” Mr Hunt said.

Is health insurance worth it?

If you’re about to hit your 30s and you haven’t yet got private health insurance, the time to decide is now.

Private Healthcare Australia (PHA), which represents the major insurers, welcomed the new measures and said it would pass on information about the changes to customers early next year.

The organisation also defended cheaper policies.

“The basic and bronze tiers also provide affordable entry-level products for younger, healthier people who frequently go on to upgrade as they get older and their life circumstances change,” PHA chief executive Dr Rachel David said.

“The key issue with the lower cost tiers is effective communication to consumers about what is and isn’t covered so they know what they are buying.

“The new classification and information system addresses this.”







First posted

July 15, 2018 14:01:38

Contact Matthew Doran

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Is it true that ‘healthy obesity’ boosts death risk?

Metabolically healthy obesity — also known as “healthy obesity” — describes obesity not accompanied by metabolic health complications, such as diabetes, hypertension, or high cholesterol.

Is ‘healthy obesity’ tied to a heightened risk of death or not?

There are many debates about how “healthy” metabolically healthy obesity actually is, and whether it renders people more vulnerable to other health problems in the long run.

As recently as last month, Medical News Today reported on a study that suggested that healthy obesity does, in fact, put certain people at a higher risk of cardiovascular disease.

But what about the risk of premature death? This is the question asked by a team of researchers from York University in Toronto, Canada, and the University of South Carolina in Columbia.

The researchers — whose efforts were guided by Jennifer Kuk, an associate professor at the School of Kinesiology and Health Science at York University — found that obesity alone, in the absence of hypertension, dyslipidemia (high cholesterol), and diabetes, is not associated with a heightened mortality risk.

These findings — which are described in a paper published in the journal Clinical Obesity — counter previous assumptions and may pose important questions about current guidelines regarding the care of people diagnosed with obesity.

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Findings ‘in contrast with most literature’

Kuk and team specifically defined “healthy obesity” as obesity that occurs in the absence of any metabolic risk factors. The researchers analyzed health-related data from 54,089 participants — both women and men — who had been involved in five different cohort studies.

They compared the mortality risk of people with obesity but without metabolic diseases with that of people with obesity accompanied by a metabolic problem, and then again with the mortality risk of healthy people, without obesity and without metabolic risk factors.

What they found was that obesity, on its own, did not increase the risk of premature death. This was in contrast with other metabolic risk factors — including diabetes, dyslipidemia, and hypertension — all of which do increase mortality independently.

“This is in contrast with most of the literature and we think this is because most studies have defined metabolic healthy obesity as having up to one metabolic risk factor,” notes Kuk.

This is clearly problematic, as hypertension alone increases your mortality risk and past literature would have called these patients with obesity and hypertension, ‘healthy.’ This is likely why most studies have reported that ‘healthy’ obesity is still related with higher mortality risk.”

Jennifer Kuk

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Benefits of weight loss ‘questionable’

Obesity is diagnosed for individuals with a BMI of 30 or above, and the researchers point out that current recommendations advise that people aim to lose weight if they hit this mark.

However, 1 out of 20 people with obesity do not have any other metabolic problems, Kuk and team found. And if this is the case, they ask, will losing weight actually bring any benefits to people with a BMI of 30 or over?

“We’re showing that individuals with metabolically healthy obesity are actually not at an elevated mortality rate,” says Kuk. “We found that a person of normal weight with no other metabolic risk factors is just as likely to die as the person with obesity and no other risk factors,” she adds.

“This means,” Kuk stresses, “that hundreds of thousands of people in North America alone with metabolically healthy obesity will be told to lose weight when it’s questionable how much benefit they’ll actually receive.”

Below, you can watch Jennifer Kuk explaining the findings of the new study, and their possible implications for existent public health guidelines.

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Cost containment is a top priority among health system executives

When Rob Lazerow, a managing director at the Advisory Board Co., recently met with the executive team of a large health system, he noticed a construction project had been downsized from the prior year.

The organization decided to replace its aging facilities with smaller structures, which would potentially allow it to fine-tune its staffing model and reduce its inventory of excess supplies.

This development reinforces findings from the Advisory Board’s 2018 annual survey of healthcare CEOs, which discovered that cost control has become a top priority for 146 executives surveyed between December 2017 and March 2018.

While interest in revenue growth remains high, cost structure and management were the top concerns among health system executives, according to the survey.

Nearly two-thirds reported that preparing the organization for sustainable cost control was their top aim, followed by adopting innovative approaches to expense reduction and diversifying revenue streams. Half of those surveyed said their top goal was to boost outpatient market share and meet new consumer demands.

The survey indicates that hospital leaders don’t think they can grow their way out of margin challenges, Lazerow said. There is more urgency to control costs as margin pressures intensify, he said.

“They have to combine sustainable cost control with steady revenue growth,” Lazerow said. “Before, they thought that focusing on growth could mask cost challenges, but there’s not infinite room for growth. They won’t sustain margins without cost control.”

Lazerow emphasized the word “sustainable.” Previous efforts to control costs were about weathering storms, he said.

But for the past couple of years, the forces affecting provider margins have not been temporary. Caring for an older and sicker population, for instance, means that providers will have to get by on dwindling Medicare and Medicaid reimbursement levels. That requires a structural change, Lazerow said.

Not-for-profit providers saw their annual expenses eclipse annual revenue growth in 2016, which will narrow margins and could spur merger-and-acquisition activity, according to a 2017 Moody’s Investors Service report.

Annual expense growth of 7.2% outpaced annual revenue gains of 6%. The larger expense growth was driven by rising pension contributions and pharmaceutical prices, increasing labor costs amid a nursing shortage and investing in technology, according to Moody’s analysis of 323 hospitals and health systems.

Health systems are responding by reducing their hospital footprint; standardizing purchases and clinical operations; outsourcing services like laboratory, obstetrics or real estate management; slowing hiring rates; and restructuring corporate overhead.

“There is a tug of war between purchased services and labor expenses—to outsource or handle in house,” Lazerow said. It could make sense to outsource if organizations have a lot of variation in spending across facilities, he said.

That being said, executives are highly protective of maintaining their culture and employee engagement, which could deter them from making significant staffing cuts or outsourcing services, Lazerow said.

“If you sacrifice engagement along the way, you could be poisoning the well,” he said.

The survey also had C-suite executives rank high-level strategic priorities. Cost containment was the top priority, according to nearly a quarter of the executives. Revenue growth followed at 23.8%. The third most important priority for executives was population health and an accountable care organization strategy. The fourth was “systemness,” or their efforts to standardize operations and coordinate care to save money and improve quality. Physician alignment strategy rounded out the priorities.

Priorities change drastically year to year. None of the top five areas of interest from 2016 matched 2018′s list.

In last year’s survey, 57% of respondents said their top priority was increasing access to ambulatory services. The same percentage indicated that expense reduction was their primary goal. Boosting outpatient market share, minimizing clinical variation and controlling avoidable utilization followed.

There was much more focus on responding to a new wave of consumerism last year, Lazerow said.

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Advocate Aurora Health and Foxconn plan to collaborate on developing new technology for health care

Advocate Aurora Health and Foxconn Health Technology Business Group plan to work together to develop new services and products for health care.

The two organizations — one the 10th largest nonprofit health system in the country, the other one of the world’s largest technology companies — envision collaborating in areas such as managing the health of employees, analytics and artificial intelligence.

Charlie Alvarez, vice president-North America of the Foxconn Health Technology Business Group, likens Advocate Aurora Health to “a living lab” for new products and services.

Advocate Aurora Health and Foxconn don’t have a formal agreement but have signed a memorandum of understanding to work together.

“We are starting to have these conversations and have these meetings,” Alvarez said

Wellness programs for employees could be an initial focus.

“We do a really good job of managing our employees’ health care and making it easy for them to be able to track their health and wellness,” Alvarez said.

Foxconn has more than 1 million employees.

FULL COVERAGE: Foxconn updates

The company uses various platforms, including mobile apps, health measurement/assessment kiosks and remote blood pressure meters and weight scales, to collect health information from its employees, according to a document on its website.

That information is accessible through its digital platform — health to you, or h2u — to employees and health care professionals.

Advocate Aurora Health also has experience in managing the health of specific populations of patients. 

For example, before its merger this year with Aurora Health Care, Advocate Health Care Network ranked second in the country, out of 432 accountable care organizations, for its performance in a Medicare program in which hospitals and physicians share in the savings when they provide care at a lower cost while meeting quality measures for a specific group of patients.

Artificial intelligence and precision medicine

Advocate Aurora Health and Foxconn also plan to collaborate on developing software for analyzing health information to identify people who are at risk of developing medical conditions, such as diabetes or high blood pressure.

Artificial intelligence and precision medicine — two fields in which Foxconn is doing research — also could be future areas of collaboration. And Alvarez said Foxconn is making and selling products in Asia that it could bring to the U.S. market.

Numerous companies provide similar applications, software and services as those on which Advocate Aurora Health and Foxconn plan to work together. And what shape the collaboration takes hasn’t been determined.

“That amount of detail is still up in the air,” Alvarez said.

But Rick Klein, chief business development officer of Advocate Aurora Health, said the collaboration eventually could result in joint ventures or partnerships.

The collaboration creates a tie between the largest health system in Illinois and Wisconsin and a company that plans to build a $10 billion factory that eventually could employ 13,000 people.

In May, Advocate Aurora Health announced plans  to build a $250 million hospital and medical office building in Mount Pleasant, site of the future Foxconn plant, and to open several new clinics in the Racine area.

RELATED: Advocate Aurora Health plans $250 million hospital for Mount Pleasant

 The planned collaboration could also lead to other agreements in which Advocate Aurora Health would provide health care to Foxconn’s future employees and their family members.

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Editorial: Caring about children’s health after they’re born

President Donald Trump wants abortion to dominate the confirmation battle over Supreme Court nominee Brett Kavanaugh. What better way to divide Americans while distracting people from this country’s anti-children policies?

Full disclosure. I’m pro-choice. I am dismayed by the prospect that Kavanaugh’s appointment could eventually lead to overturning Roe v. Wade despite stare decisis on a woman’s right to privacy.

But I am also a realist. This isn’t 1973. Should the high court overturn Roe, close to two dozen states would quickly pass laws outlawing or further restricting abortion.

Only women in anti-abortion states unwilling or unable to travel would suffer immediate harm. Some legislatures may even outlaw the use of telemedicine and mail-order pharmacy for some forms of birth control and pregnancy termination. But such measures will not deter women with unwanted pregnancies who can afford to travel to states where abortion will remain legal.

So, as we hunker down for months of culture wars over the abortion issue, here’s a question worth pondering: Wouldn’t it be nice if the governing party in Washington cared as much about the well-being of children and their mothers during and after birth as they do about fetuses?

The news on that score is beyond depressing. The Trump administration recently extended its anti-science, pro-corporate attitudes into long-settled realms with a surreptitious campaign to scuttle a World Health Organization resolution supporting breast feeding.

News reports suggest Abbott Laboratories and Nestle, the world’s leading makers of infant formula, played no role in the effort. No wonder. There’s more than a half-century of well-documented science backing the health benefits of mother’s milk, especially in developing countries where diarrheal and infectious diseases are major baby killers.

If this administration wants to address an issue that actually worries infant formula makers, they should investigate why the U.S. birth rate fell last year to an all-time low of 1.7 children per woman. That’s well below the replacement rate of 2.1 children, thus making the long-term finances of the nation’s retirement programs dependent on, ahem, immigrants.

There’s no mystery behind why it has fallen so low. The U.S. has the least child-friendly policies in the developed world.

It is the only advanced industrial country that doesn’t require paid maternity leave. Companies do not voluntarily make up the slack. Only 6% of U.S. corporations offer time off with pay to a new parent.

Workplace day care is just as scarce, even though it more than pays for itself in terms of retention and recruitment. Only 17 of the Fortune 100 companies offer that service. It’s even rarer at smaller businesses.

Millennials just starting families are hard-pressed to pay for day care on their own. The average day-care cost per child is now $1,000 a month. That’s hard to come up with when you’re still paying off your student loans, which have skyrocketed for the younger generation.

The U.S. also lags far behind other industrialized countries in early childhood education. We’re in the bottom third in rankings by the Organisation for Economic Co-operation and Development in preschool participation for 4-year-olds, according to an analysis by the Center for American Progress.

The lack of government support harms poor children the most. Over 10 million kids age 5 and under are on Medicaid. Yet less than a million are enrolled in Head Start. Though the program got a much-needed boost from Congress in this year’s budget (Trump had asked for less), it enrolled 50,000 fewer kids last year than it did in 2011.

The healthcare system isn’t doing mothers any favors, either. The overmedicalization of childbirth has lifted the U.S. C-section rate above 30%, where it’s been for years despite guidelines encouraging vaginal births. Unnecessary C-sections lead to longer hospital stays, increased maternal mortality and more complications in future deliveries.

No doubt many senators will parse Judge Kavanaugh’s carefully crafted evasions on abortion before casting their votes. Sadly, what’s happening to the kids will go unremarked.

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Kids learn what a career in a health field is like

Kids from our area are getting a lesson on what it’s like to have a career in the health field.

More than 30 children from Coatesville and Chester are taking part in the Health Career Summer Academy.

It’s hosted by West Chester University’s College of Health Sciences.

The kids are learning about jobs such as a nutritionist, an athletic trainer, a respiratory therapist and others.

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Health Law Is an Issue in Fight Over Supreme Court Pick Brett Kavanaugh

The nomination of Judge Brett Kavanaugh to the Supreme Court is prompting a new round of fighting about the Affordable Care Act, as Democrats warn that he could imperil the health law and Republicans say the issue is a distraction from his qualifications.

Almost any nomination to the high court spurs debates about abortion, affirmative action, and similar social issues. In this case, Democrats see the health-care issue as a particularly effective way to galvanize opposition to the Kavanaugh nomination, while the judge’s supporters…

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