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Mental health staff on long-term stress leave up 22%

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Some trusts saw the number of staff taking long-term leave double in five years

The number of NHS mental health staff who have had to take sick leave because of their own mental health issues has risen by 22% in the past five years.

Those taking long-term leave of a month or more rose from 7,580 in 2012-13 to 9,285 in 2016-17, BBC freedom of information requests found.

The union Unite said cuts to staff and services were putting extra pressure on front-line mental health workers.

The Department of Health said it was transforming mental health care.

Out of 81 mental health authorities in England, Scotland, Wales and Northern Ireland, 58 provided the BBC with comparable information.

Looking after ourselves

One mental health doctor who had to take mental health leave told 5 live anonymously: “I don’t think I realised it was happening until quite a long way down the road.”

She explained that she was getting irritable with her partner, her sleep was disturbed and she couldn’t switch off from work.

“In the end, I went to my GP who offered me a sick note. I was quite taken aback that it was quite so obvious to my GP that I needed to be off work.” she said.

Media captionFormer mental health nurse on why she had to leave the NHS

“As mental health practitioners, we are pretty rubbish at putting our own mental health first. You need to put your own oxygen mask on first before putting it on to someone else.”

5 live also spoke to a group of community mental health nurses at the Leeds and York Partnership NHS Foundation Trust about how they cope with the pressure of the role.

“I think when you’re so passionate about something it’s very easy to overlook just how much you are taking on,” said Kate Ward, an occupational therapist working as a care co-ordinator in the team.

She said it was important for staff to understand what their thresholds are, recognising the early signs of their resilience getting chipped away.

“We think we are this person that can help everybody, but we have to remember that we have to help ourselves sometimes,” Julie Poole, a community mental health nurse, explained.

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Community mental health nurses spoke to 5 live about the pressures they face

Dave Munday, mental health professional lead at union Unite, which represents 100,000 health workers across the UK, said: “These figures are of real concern and they only tell part of the story.

“We know that many more mental health professionals will feel unwell but try to ‘soldier on’ or mask the real reason they’re taking leave.

“Our members tell us workplace stress is increasing and that cuts to staff and services mean they’re working longer hours with fewer resources.

“Staff themselves are feeling the impact of austerity and there’s a lack of trust in the often repeated but not fulfilled promises of the current government.”

Not good enough

A spokesman for the Royal College of Nursing said: “Mental health staff face unique challenges. The pressure to make the right decision and provide care for extremely vulnerable people against a backdrop of staff shortages, can take its toll on their health and wellbeing.

“More than 40,000 mental health staff are assaulted every year, and too often violence is seen as ‘part of the job’ by employers, and the authorities.

“This isn’t good enough. We want to see action on work-related stress, including violence at work which, as well as physical injuries, adds to burnout stress, and depression.”

The Department of Health said: “We are transforming mental health care for everyone in this country, including NHS employees, with record amounts of investment.

“There is more to do – that is why we are undertaking one of the largest expansions of mental health services in Europe, so that all staff have the time to look after themselves as well as others.”

Hear more from State of Mind, 5 live’s mental health season

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AP FACT CHECK: Kimmel’s take on health care harder to refute

Who’s right — President Donald Trump and Sen. Bill Cassidy, or late-night host Jimmy Kimmel?

None has really captured the complexity of the debate over who might lose insurance protections in the latest Republican health care bill. But of the three, the TV guy is the hardest to refute.

Trump insists in a tweet that the bill covers pre-existing conditions, a point also made by Cassidy, a sponsor of the legislation. But there’s a catch. It allows states to get a waiver from “Obamacare” requirements that insurers charge the same to people with health problems as they do to healthy people.

The potential result: unaffordable premiums for people in poor health.

Here’s a look at Trump’s assertion, the facts and the Kimmel-Cassidy feud:

TRUMP: “I would not sign Graham-Cassidy if it did not include coverage of pre-existing conditions. It does! A great Bill. Repeal Replace.”

THE FACTS: Such coverage may be included but it’s far from assured.

The health care law enacted by President Barack Obama in 2010 offers two levels of protection for people with pre-existing conditions. The GOP bill would allow states to undermine one of them. That loophole could lead to policies priced out of reach.

To start with, “Obamacare” requires insurers to take all customers, regardless of health problems. On top of that, it prohibits insurers from charging more on account of medical conditions.

Under the GOP bill moving toward a Senate vote next week, insurers would still be required to accept people with pre-existing conditions. But here’s where the catch comes in:

States could seek waivers that allow insurers to charge people more on account of health problems. That would allow insurers to offer lower-premium plans to healthier customers.

And states could also get waivers that allow insurers to tailor benefits so that people with costly conditions are discouraged from signing up. For example: plans that don’t cover treatment for substance abuse problems.

“If I was a person with a pre-existing condition, I would say I don’t have any guarantee of getting health insurance if the bill passes,” said Gary Claxton of the nonpartisan Kaiser Family Foundation, an expert on the private health insurance system.

“Insurers can charge people with pre-existing conditions much higher rates, making it essentially a denial,” added Claxton.

Dr. Michael Munger of Kansas City, Kansas, estimates that 4 in 10 of the patients in his family medicine practice have some sort of condition that could result in higher premiums.

“Individuals that I care for have had a previous cancer diagnosis, underlying diabetes complications, previous heart attacks and heart surgeries,” he said. “I am very worried about affordable coverage. We have had a lot of gains and this is certainly something I don’t want us to go backward on.”

Munger is president of the American Academy of Family Physicians, which is among the major doctors’ groups opposing the GOP legislation.

Supporters of the bill, named for its chief sponsors Sens. Lindsey Graham of South Carolina and Louisiana’s Cassidy, point out that the legislative text says states seeking federal waivers must explain how they will “maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions.”

But Claxton says there’s nothing in the text to define what “adequate and affordable” means and, as he reads it, it’s unclear if the federal government would even have authority to deny a state waiver application. The bill also reduces federal money, adding to the pressures on states.

The health insurance industry is on record saying the bill would create problems by “pulling back on protections for pre-existing conditions,” according to a letter to lawmakers from the trade group America’s Health Insurance Plans.

Cassidy is in a public battle with TV host Kimmel about whether the bill meets the “Jimmy Kimmel test.” That’s a phrase coined by the senator this year after Kimmel gave a heartfelt account of how his infant son got surgery to correct a birth defect, and declared that all American families should have access to high-level care.

Kimmel says the senator should stop using his name. “This new bill actually does pass the Jimmy Kimmel test, but a different Jimmy Kimmel test,” said Kimmel. “Your child with a pre-existing condition will get the care he needs if, and only if, his father is Jimmy Kimmel.”

Cassidy says Kimmel doesn’t understand the legislation.

Kimmel’s critique goes to the core of the issue. But it’s more nuanced than either he or Cassidy acknowledge, says insurance industry consultant and blogger Robert Laszewski. He points out that governors and legislatures would have to take action to weaken insurance protections guaranteed in federal law under Obama. Those state lawmakers would face pushback from consumers and medical groups, so it’s not a given that such protections would be lost.

Nonetheless, Laszewski says Republicans have created a problem for their legislation.

“I think they made a huge mistake by leaving a crack open,” said Laszewski. “And Jimmy Kimmel and the Democrats are going to try to drive a truck through it.”

EDITOR’S NOTE _ A look at the veracity of claims by political figures

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The Republican Health Bill Is Targeting Votes From These Two States

hope to push through the Senate next week, is stuffed with language making some states winners and others losers. Aides say the legislation is still changing as leaders hunt the 50 GOP “yes” votes they’ll need to turn this summer’s jarring Senate rejection of the party’s crusade to erase President Barack Obama’s law into an eleventh-hour triumph.

Alaska is home to GOP Sen. Lisa Murkowski, who’s among a handful of Republicans who’ve not said how they’ll vote. Sen. Ron Johnson, R-Wis., is one of the bill’s co-sponsors and his support is not in question, but the episode suggests the value of helping craft of legislation.


The bill was chiefly written by GOP Sens. Bill Cassidy of Louisiana and South Carolina’s Lindsey Graham. It would end Obama’s Medicaid expansion and subsidies for people buying private insurance and combine the money into new block grants for states.

With all Democrats opposed, Republicans controlling the Senate 52-48 can lose only two votes if they are to succeed, leaving the bill’s fate uncertain. Generally, it would shift money from states that expanded their Medicaid programs for the poor under Obama’s statute, which tend to be run by Democrats, to the largely Republican-run states that shunned that expansion.

The measure would shield Alaska from some cuts it imposes on Medicaid, according to analysts, including from the nonpartisan Kaiser Family Foundation, by limiting spending to a maximum amount per beneficiary starting in 2020. The federal-state program for low earners has always automatically provided whatever money is needed for eligible recipients. Montana would also qualify for the exemption.

It would also increase federal Medicaid funds for states with high American Indian populations, including Alaska, according to health care consultant April Grady.

Analysts offered no figures about how much money the provisions would mean for Alaska.

The provisions hardly ensure support from Murkowski, who’s said she’s studying how the measure would affect her state. The administration was pushing for her support, with Vice President Mike Pence calling into an Anchorage talk-radio show Thursday and urging listeners to contact Murkowski and ask her to “stand with President Trump” and support the bill.

According to studies released this week by Kaiser and the consulting firm Avalere Health, Alaska is among many states that would lose money overall under the bill. Alaska has unusually high health care costs because of the remoteness of many communities.

The provisions do not mention Alaska or Wisconsin by name.

But the bill allows a state that turned down extra federal funds to expand Medicaid under Obama’s statute to count the rejected money in determining how large its block grant will be, analysts say.

Grady, Avalere analyst Chris Sloan and others said they were unaware of states other than Wisconsin that would benefit from the provision. This language could mean “potentially hundreds of millions” of extra dollars for Wisconsin, said Grady.

In a written statement provided by aides, Johnson said funding formulas to correct “the grossly unfair” distribution of money under Obama’s law needed to be changed “to reflect the unique circumstances of many states, including recognizing the innovative reforms of Wisconsin.”

Wisconsin is among 19 states that declined to fully expand Medicaid under Obama’s law, which also provided generous federal reimbursements. Under Gov. Scott Walker, a GOP 2016 presidential contender, Wisconsin just partially expanded Medicaid and agreed to accept smaller federal subsidies.

The provision in the health care bill applies to states that expanded Medicaid only up to 100% of the federal poverty level and had that expansion in effect this past Sept. 1.

Since the bill’s details emerged, health industry and other groups have been lining up against it.

The National Association of Medicaid Directors, representing state officials who administer Medicaid, said it is concerned the measure would have damaging consequences on state budgets. Also announcing opposition recently was America’s Health Insurance Plans, a huge health insurers’ trade group, the American Hospital Association and the American Medical Association.

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‘Chuck and Nancy,’ Washington’s New Power Couple, Set Sights on Health Care

It will not be easy. Mr. Trump is pressing Congress to adopt the health care legislation, which would cut deeply into Medicaid and dismantle the programs and prescriptions of the Affordable Care Act.

But if the bill can be stopped, the Democratic leaders have already begun nudging the president toward another about-face: setting aside the mantra of “repeal and replace” and adopting modest measures to make his predecessor’s signature domestic achievement work better.

During a recent White House dinner, the pair pushed Mr. Trump to make permanent the subsidies, known as cost-sharing reductions, paid to insurers under the health law to help low-income customers pay for out-of-pocket health expenses like co-payments and deductibles. Mr. Trump has threatened to end such payments, raising uncertainty in insurance markets and increasing premiums for 2018.

In separate interviews, both leaders said that the president was noncommittal and that their future dealings with him would depend on whether he followed through on his pledge to protect young undocumented immigrants brought here as children — beneficiaries of the Obama-era program Mr. Trump is winding down, known as Deferred Action for Childhood Arrivals, or DACA.

“Whether he pivots or not will be one of the most fundamental questions of this administration,” Mr. Schumer said. “It’s the $64,000 question. The only way it can happen is if we have a successful negotiation on DACA, and secondly whether we get health care.”

In some respects, Ms. Pelosi and Mr. Schumer are an unlikely pair. She represents San Francisco and for years has been the subject of harsh attacks from Republicans, who caricature her as affluent, elitist and permissive. He is from Brooklyn and far more attuned to the needs of big business and Wall Street. She is button-down and always on message — at least in public. (In private, she calls Mr. Schumer “Chuckles.”) He is more freewheeling and off the cuff.

When she was House speaker, her real Senate partner was the majority leader at the time, Harry Reid, with whom she helped pass some of the biggest legislative achievements of a generation: the Affordable Care Act, the Dodd-Frank Wall Street regulatory law, the 2009 economic stimulus and President George W. Bush’s Wall Street rescue.


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But Ms. Pelosi’s former chief of staff, John Lawrence, said what while she and Mr. Reid worked well together, “I don’t have the sense it was the same instinctual harmonic relationship that she has with Chuck.”

Ms. Pelosi said she and Mr. Schumer know each other so well that “we speak in shorthand to each other.”


Ms. Pelosi said she and Mr. Schumer were still assessing whether they could trust Mr. Trump.

Tom Brenner/The New York Times

Ms. Pelosi said she and Mr. Schumer were still assessing whether they could trust Mr. Trump. “We will trust each other as long as we can,” she said, adding, “It’s one issue at a time.”

Meanwhile, some Democrats are watching with a skeptical eye.

“I hope and pray that Pelosi and Schumer are more sophisticated and smarter than everyone else that’s been duped by Donald Trump,” said Representative Luis V. Gutiérrez, Democrat of Illinois, after the Democratic leaders announced their tentative deal with Mr. Trump to pursue legislation allowing the young immigrants known as Dreamers to stay in the United States.

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Others see cause for optimism. Several Democratic senators, including Heidi Heitkamp of North Dakota and Richard Blumenthal of Connecticut, said they could foresee Ms. Pelosi and Mr. Schumer reaching an agreement with Mr. Trump on legislation to repair the nation’s crumbling infrastructure, an interest of all three of them.

Senator Richard J. Durbin of Illinois, the No. 2 Democrat in the Senate, went one step further, suggesting possible bipartisan cooperation on the budget.

“I think it’s encouraging; some people don’t,” Mr. Durbin said. “But look what we achieved with the first level of agreement. Without delay, without debate, without histrionics, we sent Hurricane Harvey relief out, we didn’t close down the government, and we extended the debt ceiling of the United States on a bipartisan basis. Pretty good work.”

In working with a president so despised by Democratic voters, especially those on the far left, the two Democrats must tread carefully. Ms. Pelosi got a taste of that this week in San Francisco, when she was shouted down by protesters during a news conference where she had intended to talk about the Dream Act, legislation to offer legal status and a path to citizenship for young unauthorized immigrants brought to the United States as children.

But some Democratic strategists say the leaders have little to lose.

“I think they are in position to make deals that are good for Democratic priorities and that have the support of the Democratic caucus,” said Geoff Garin, Mr. Schumer’s pollster. “And if the deals don’t do those things, then it’s easy for them to walk away.”


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Ms. Pelosi and Mr. Schumer were both traveling with their families on separate vacations in Italy this summer when, each said, they began to strategize on how to use a looming fight over the debt ceiling as leverage to negotiate with Mr. Trump. Mr. Schumer said he proposed urging the White House to extend the debt ceiling for three months, which would force a vote again in December, giving the Democrats leverage over other agenda items. Ms. Pelosi, he said, quickly agreed.

“We were in sync,” Ms. Pelosi said. The debt ceiling deal opened the door to the White House dinner, where the two leaders raised the issue of the young immigrants. Ms. Pelosi said it was important for the president to hear that Mr. Schumer — who became minority leader just this year — was as committed to their fate as she was.

“That’s the beauty of it,” she said. “I’m the usual suspect, and he’s the new leader coming in.”

The Pelosi-Schumer relationship dates to 1987, when Ms. Pelosi, a former chairwoman of the California Democratic Party, was a newly elected congresswoman. Her fellow Californian, Representative George Miller — who was then Mr. Schumer’s landlord and roommate — invited her to a dinner at an Italian restaurant near the Capitol. A collection of House members, including Mr. Schumer, gathered there each Tuesday night to bat around policy ideas.

Mr. Miller gave Ms. Pelosi an auspicious introduction: “You’re going to meet Nancy Pelosi,” Mr. Schumer recalls him saying. “She’s going to become the first woman speaker.”

Mr. Miller was proved correct 20 years later.

“The relationship is longtime,” said Mr. Miller, who retired from the House in 2015. “They’ve had their spats, they’ve had their agreements, they’ve had their strategies become successful and they’ve had their strategies fall flat on their face, and that’s why this is working.”

They have not always seen eye to eye. In 2014, Ms. Pelosi publicly criticized Mr. Schumer when he said it was a tactical mistake for Democrats to have put a health care overhaul on the top of their agenda in 2009 after Barack Obama was elected president. Many analysts believe public anger over the Affordable Care Act cost Democrats control of the House in 2010.

“We come here to do a job, not keep a job,” Ms. Pelosi said then. In a reference to those who gained insurance under the bill, she added, “There are more than 14 million reasons why that’s wrong.”

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Insurers Come Out Swinging Against New Republican Health Care Bill

Senate Republicans are already under pressure from 11 governors — including five fellow Republicans and a pivotal Alaskan independent — who this week urged the Senate to reject the last-ditch repeal effort.

The two major trade groups for insurers, the Blue Cross Blue Shield Association and America’s Health Insurance Plans, announced their opposition on Wednesday to the Graham-Cassidy bill. They joined other groups fighting the bill, such as the American Medical Association, the American Hospital Association, AARP and the lobbying arm of the American Cancer Society.

“The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions,’’ said Scott P. Serota, the president and chief executive of the Blue Cross Blue Shield Association. “The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.”

America’s Health Insurance Plans was even more pointed. The legislation could hurt patients by “further destabilizing the individual market” and could potentially allow “government-controlled single payer health care to grow,” said Marilyn B. Tavenner, the president and chief executive of the association. Without controls, some states could simply eliminate private insurance, she warned.

Insurers had been reluctant to speak out against the Republicans’ previous proposals in hopes that the White House and Congress would agree to stabilize insurance markets by providing critical funding for subsidies aimed at low-income Americans. But with hopes of securing that money before they finalize their rates virtually extinguished, insurers have less to lose by coming out against the proposal.

And many within the industry are worried that the next two years will be chaotic, with little support for the current market while states scramble to come up with a new way for individuals to buy policies.

“It’s just basically injecting chaos in 50 state capitals for the next two years,” said Sabrina Corlette, a research professor at Georgetown University.


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At this point, Republicans have not secured the 50 votes they would need to pass the bill, with help from Vice President Mike Pence to break a tie. But President Trump, in New York for meetings with world leaders at the United Nations, said he thought the health care bill had “a very good chance’’ of passing.

It has “tremendous support from Republicans — certainly we’re at 47 or 48 already,’’ he said, and “a lot of others are looking at it very positively.’’

“A great Bill,” Mr. Trump concluded on Twitter later Wednesday.

The latest Republican drive to repeal the Affordable Care Act has created painful choices for Republican senators from states that stand to lose money under the legislation.

The bill would eliminate penalties for people who go without insurance, and it would funnel federal funds to states in the form of block grants for health care or coverage. States could decide how to spend the money, which is now being used for the expansion of Medicaid and for subsidies to help low- and middle-income people buy private insurance.

State officials were racing to try to figure out the impact, looking to experts to help them do the calculations.

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“States such as Alaska, Connecticut, Delaware, New Hampshire, New Mexico, New York, Oregon, Vermont and Washington would see reductions of 25 percent or more over the 2020 to 2026 period,” compared with what they would receive under current law, said a monograph issued on Wednesday by Manatt Health, a unit of Manatt, Phelps Phillips, a national law firm that advises many states on health care issues.

Among the Republicans agonizing over how to vote is Ms. Murkowski, who has said the bill’s effect on her state will be her paramount consideration.

Becky Hultberg, the president and chief executive of the Alaska State Hospital and Nursing Home Association, said on Wednesday that the cuts in the bill could have a “huge impact” on Alaska.

“The cuts could be devastating to our health care system, including rural and frontier hospitals that operate on razor-thin margins,” Ms. Hultberg said in an interview. “These hospitals are often accessible only by airplane or ferry, so the loss of a hospital means an expensive and disruptive medical evacuation out of the community.”


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“Ultimately,” Ms. Hultberg said, “patients will bear the consequences, through reduced access to health care and lost insurance coverage.”

The authors of the new repeal bill, Mr. Graham and Mr. Cassidy, say decisions about health care are best made at the local level.

Mr. McCain is a close friend of Mr. Graham, but is still studying the bill and has not said how he would vote.

The other Republican senator from Arizona, Jeff Flake, had no such hesitation. “Given the choice between Arizona or Washington deciding how federal health care dollars are spent in the state,’’ he said, “I’ll take Arizona every day of the week.’’

The Manatt study said Arizona would lose money under the bill, and a study by Avalere, a health policy consulting company, reached a similar conclusion. Both studies indicated that Tennessee would gain money.

Senator Bob Corker, Republican of Tennessee, said he liked the latest repeal bill. “I’d be ecstatic if we could finally make something happen on health care’’ by passing it, he said, adding: “I’m a states’ rights kind of guy. Our state has been well run for a long time. To know that our state would have the flexibility to carry out the program with more money than it now has could be a real win for us.’’

The studies by Manatt and Avalere suggest that West Virginia would lose money under the bill. Ms. Capito “is still evaluating the proposal,” said her spokeswoman, Ashley Berrang.

But the state’s senior senator, Joe Manchin III, a Democrat, said, “The numbers do not work at all for West Virginia, with an older, sicker population and an opioid addiction problem.”

“As a former governor, I like the concept of block grants because they give you flexibility,” Mr. Manchin said. “But the cuts are deeper than the needs we have, and our needs are greater than the money we would have under the bill.”

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Jimmy Kimmel continues fight with Sen. Cassidy’s new health care bill

Jimmy Kimmel fires back at Sen. Cassidy

Jimmy Kimmel was ready for the second round of his fight with U.S. Sen. Bill Cassidy, saying on Wednesday night that the senator “either doesn’t understand his own bill or he lied to me.”

“Last night on our show I took a senator from Louisiana, Bill Cassidy, I took him to task for promising to my face that he would oppose any health care plan that allowed insurance companies to turn people with pre-existing conditions away,” Kimmel said opening his ABC broadcast on Wednesday night. “He said anything he supported would have to pass what he named the ‘Jimmy Kimmel Test,’ which was fine… but unfortunately, and puzzlingly, he proposed a bill that would allow states to do all the things he said he would not let them do.”

Kimmel then said that Cassidy made “a total about face” and that meant that “he either doesn’t understand his own bill, or he lied to me.”

The comedian then showed a clip of Cassidy telling CNN’s Chris Cuomo on “New Day” Wednesday morning that Kimmel “does not understand” the bill.

“Oh, I get it. I don’t understand because I’m a talk show host, right?” the host said before breaking down the bill in detail. “Could it be, Senator Cassidy, that the problem is that I do understand, and you got caught with your GOPenis out?”

On Tuesday night’s broadcast, Kimmel took on the senate’s new health care bill and Cassidy, saying he lied “right to my face.” The Tuesday night monologue went viral and got around-the-clock coverage on cable news networks.

Related: Jimmy Kimmel takes on new health care bill, says Sen. Cassidy lied ‘right to my face’

On Wednesday night’s show, Kimmel also used a skit called “Barista Theater” to help explain one of the more arcane parts of the Graham-Cassidy bill: block grants. In the proposed legislation, federal funding for Medicaid expansion and subsidies would be rolled into a block grant program. States would be given a lump sum of money and would have a lot of leeway over how to spend it.

In Kimmel’s sketch, he showed a barista accepting money for coffee sold in faulty coffee cups. He used the sketch to critique the bill for allowing states to accept federal money intended to make healthcare more accessible, but then keep the money without making care more available.

Kimmel jokingly said that he didn’t “want to turn this into a Kanye and Taylor Swift type situation” while also taking down others, like “Fox Friends” host Brian Kilmeade, who called Kimmel a “Hollywood elite.”

“The reason I found this comment to be particularly annoying is because this is a guy, Brian Kilmeade, who whenever I see him kisses my ass like a little boy meeting Batman,” Kimmel said. “He is dying to be a member of the ‘Hollywood elite.’”

Kimmel also made fun of Sen. Lindsay Graham, who is a co-sponser of the new health care bill with Cassidy, saying Graham “happens to look a lot like my Grandma Jane, who is now deceased.”

Kimmel also called out President Trump, saying that there’s “no way” the president read the bill and just wants to get rid of it “because Obama’s name is on it.”

“The Democrats should just rename it Ivankacare,” Kimmel said, referencing the president’s daughter. “Guaranteed he gets on board.”

Kimmel then ended his ten-minute-long monologue by encouraging Americans to call their senators about the new health care bill.

“Please, stop texting for five seconds and make a phone call,” Kimmel said. “It really does make a difference, and who knows maybe you’ll meet somebody over the phone and fall in love?”

Representatives for Cassidy, Fox News and the White House could not be reached for comment.

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Politics, Not Policy, Fueling Last-Ditch GOP Health Care Efforts …

WASHINGTON — Momentum has grown in recent days for a last-ditch GOP effort to partially repeal and replace Obamacare, movement that appears driven as much by the politics of health care as the policy behind it.

The legislation that Republicans are rallying around is seen as the final hope of repealing major parts of the Affordable Care Act, a campaign promise the party has repeated for seven years and one they have failed to deliver on so far. The lack of progress has turned into a source of great frustration to both their base voters and President Donald Trump.

“Every Republican found out from our constituents that they were pretty upset with the fact that we did not follow through on what we’ve all been running on,” Sen. Ron Johnson, R-Wisc. said. “I can only speak for the folks that I talked to in Wisconsin, but nobody blamed Trump for our failure in health care. Nobody.”

That’s why “it’s not the policy, but the politics” fueling this renewed push, said Marc Short, Trump’s legislative affairs director.

The details of the bill, known as Graham-Cassidy, don’t appear to address the policy concerns of a handful of Republican senators who either voted against the last version of the legislation or reluctantly supported it because of promises that it would be revised before becoming law.

Despite some continued misgivings, however, there is as least some fresh optimism that the majority party can bring together the 50 votes they need for the bill to pass the Senate and get sent on to the House of Representatives.

“It’s an intriguing idea and one that has a great deal of support,” said Senate Majority Leader Mitch McConnell Tuesday morning during his opening remarks on the Senate floor.

Sen. Lindsey Graham, R-S.C., one of the authors of the bill, rode on Air Force Two with Vice President Mike Pence Tuesday from New York to make it back to the Senate for the weekly Republican conference lunch.

The vice president had a message to deliver. “I want to make sure that members of the Senate know the president and our entire administration supports Graham-Cassidy. We think the American people need this.”

“This is the moment, now is the time,” Pence added.

Even though the previous Senate bill was largely unpopular among Americans in general, garnering just 17 percent support in some polls, it was far more popular with the Republican base and even GOP donors who think party leaders are wasting their opportunity to get things done.

Sen. Dan Sullivan, R-Alaska, said he heard from “a lot” of his constituents that “people are very dissatisfied with the status quo.”

But Graham-Cassidy, named for its co-authors Graham and Sen. Bill Cassidy, R-La., does little to alleviate the concerns of senators like Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, two of the three Republicans who voted against the last GOP health care bill. And the quick, closed-door process has yet to change this time around, something that has raised objections from Sen. John McCain, R-Ariz., who also voted against the last bill.

Related: Obamacare is Suddenly in Grave Danger and Here’s Why

Republicans need the support of 50 senators for the measure to pass with Pence’s tie-breaking vote. But reconciliation, the legislative vehicle that allows them to do it by a simple majority, instead of 60 votes, expires on September 30, leaving just a few days for this last-ditch effort to happen.

Meanwhile, several other senators who have had concerns with the GOP approach, including Sens. Dean Heller, R-Nev., and Johnson of Wisconsin have signed on as co-sponsors to this bill despite the lack of changes in the details.

Graham-Cassidy still cuts funding for Planned Parenthood for one year and it winds down the Medicaid expansion starting in 2020. It also maintains two proposals from the previous Senate bill that changes the Medicaid funding formula so that it is, in part, based on population and reduces the amount of money it would increase each year — two components that would likely lead to cuts to the program.

Murkowski met with McConnell to discuss health care Monday night and remains undecided on whether or not to support this bill. In Alaska, where health care costs are much higher than in other parts of the country, one-quarter of all residents rely on Medicaid as well as one out of every three children.

She received a warm reception in Alaska after her “no” vote in August, but said she would support Graham-Cassidy if the numbers work for her constituents.

“My governor has said, ‘Hey I like flexibility but if I get half as much money, flexibility doesn’t help me.’ So in fairness to my governor and in fairness to Alaskans, the numbers actually matter,” Murkowski said. “And so if it can be shown that Alaska is not going to be disadvantaged (and) we gain additional flexibility, then I can go back to Alaskans and I can say ‘O.K. let’s walk through this together.’ That’s where it could be different but I don’t have that right now.”

Sen. Collins said she still has serious concerns.

“The Maine hospital association has calculated that over the next ten years Maine would receive over $1 billion dollars less in Medicaid and other federal health care spending and that obviously is of great concern to me,” Collins said.

Collins walked on the Senate floor carrying a green folder with a chart that told how much each state was going to lose in health care funding under Graham-Cassidy. One of the people she wanted to speak to was McCain.

McCain said “it’s very important” that his Republican Governor, Doug Ducey, came out Monday in support of the bill but that he still is opposed to the process.

“I have amendments that I’d like to have considered. I’d like to have debate,” McCain said. “I’d like to have the regular order.”

McCain, however, called the process “better” after he was told the Senate Finance Committee will hold a hearing on Graham-Cassidy on Monday.

But if the Senate votes, it would happen before the Congressional Budget Office can compile a complete score of the legislation. The non-partisan scorekeepers said Monday that they would be unable to determine Graham-Cassidy’s impact on coverage, cost of premiums and impact on the debt before next week.

Still, Sen. Johnson, who complained about the process last month, has signed on as a co-sponsor to the bill. He said he’s “cautiously optimistic” about its passage.

“Anybody saying, ‘Well, it doesn’t do enough, it leaves 90 percent of Obamacare in place,’ well, a no vote leaves 100 percent of Obamacare in place,” Johnson said. “The collapsing markets [are] just a completely unstable system. So, this is far better than the alternative, so I think it’s gaining support.”

Since Republicans failed to pass health care, Trump has attacked them on Twitter and in public remarks, blaming them for not fulfilling a seven-year campaign promise to dismantle Obamacare. And polls show that despite Trump’s low approval ratings, Congressional Republicans’ poll numbers are lower.

Trump has since turned to work with Democrats on two major issues, leaving Republicans by the wayside. He struck an agreement with Democrats on hurricane relief and short-term government funding and the debt limit. He also worked out the beginnings of an agreement on undocumented children and young adults.

Still, the lack of enthusiasm is apparent as Republicans wrestle with giving health care one more shot.

“If you put a gun to my head today and said you have to vote yea or nay, I’d vote yea,” said Sen. John Kennedy, R-La.

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Health officials declare hepatitis A outbreak in LA County

Los Angeles County health officials declared a hepatitis A outbreak Tuesday, days after a public health emergency was announced in San Diego County, where at least 16 people have died of the highly contagious virus.

Case numbers are still small in L.A. County, with only 10 people infected as part of the outbreak, said Dr. Barbara Ferrer, director of the L.A. County Department of Public Health. By comparison, almost 450 people have contracted the virus in San Diego.

Ferrer said the department is ramping up prevention efforts locally so more people don’t get sick. San Diego’s outbreak has already spread to Santa Cruz, where 69 people have been diagnosed.

Officials say homeless people in California are most at risk, because the virus appears to be moving from person to person within that community. People become infected with hepatitis A, which affects the liver, by ingesting the feces of someone who’s infected, often through contaminated food or sexual contact.

Jimmy Kimmel slams senator for lying about new health care bill

Jimmy Kimmel slammed Republican Sen. Bill Cassidy of Louisiana on his show Tuesday night for proposing new health care legislation that Kimmel said fails the “Jimmy Kimmel test” that Cassidy himself had proposed in an appearance on “Jimmy Kimmel Live!” in May.

Cassidy appeared on the program earlier this year after Kimmel made an emotional plea for health care legislation that would insure affordable health coverage for all, including people with pre-existing conditions and with no lifetime caps, in the wake of Kimmel’s newborn son needing life-saving heart surgery.

But Kimmel said Wednesday night the new legislation Cassidy and co-sponsor Lindsey Graham, R-S.C., have proposed in the Senate did not meet those requirements.

“Not only did Bill Cassidy fail the Jimmy Kimmel test, he failed the Bill Cassidy test,” Kimmel said. “He failed his own test.”

Kimmel didn’t mince words for Cassidy, who Kimmel said “wasn’t very honest” when he appeared on the show in the spring.

“I don’t know what happened to Bill Cassidy, but when he was on this publicity tour he listed his demands for a health care bill very clearly. These were his words: He said he wants coverage for all, no discrimination based on pre-existing conditions, lower premiums for middle class families and no lifetime caps. And guess what? The new bill does none of those things,” Kimmel said.

The proposed plan, spearheaded by Graham and Cassidy, would give states the option to obtain waivers that would allow them to charge people with pre-existing conditions more for some plans in their states, and while it’s likely that insurers would still be required to offer choices to those with pre-existing plans, they could potentially limit coverage options as well.

Speaking directly to Cassidy, Kimmel said, “Stop using my name, all right, ’cause I don’t want my name on it. There’s a new Jimmy Kimmel test for you, it’s called a lie detector test, you’re welcome to come by the studio and take it any time.”

Kimmel also had strong words for critics on social media unhappy that he has turned his son’s health into a political cause.

“Before you post the nasty Facebook message saying I’m politicizing my son’s health problems, I want you to know, I am politicizing my son’s health problems because I have to,” he said.

Kimmel listed the many health care organizations that have opposed the legislation and called on viewers to take action saying of bill’s backers.

“They’re counting on you to be so overwhelmed with all the information, you just trust them to take care of you. But they’re not taking care of you,” Kimmel said. “They’re taking care of the people who give them money, like insurance companies, and we’re all just looking at our Instagram accounts, liking things, while they’re voting on whether people can afford to keep their children alive or not.

“Most of the Congress people who will vote this probably won’t even read it. They want to us to do the same thing,” Kimmel continued. “They want us to treat it like an iTunes service agreement. And this guy Bill Cassidy lied right to my face.”

Kimmel had nicer words for Cassidy back in May, saying he approved of the test proposed by the senator.

“I happen to like [the test] a lot,” Kimmel said at the time. “He is a doctor -– a gastroenterologist. He is married to a retired doctor — his wife Laura, was a surgeon. And he co-founded the Greater Baton Rouge Community Clinic, which provides free dental care and health care to the working uninsured. So obviously -– this is someone who cares about people’s health.”

Kimmel tweeted a photo of himself and his son Billy earlier in the day on Tuesday saying he was working on a message for Cassidy in his monologue.

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10 Foods That Science Suggests Really Do Contribute To Long-Term Health


A bad diet is now a leading cause of death across the globe. Much of this is due to the fact that people who had previously eaten much healthier, traditional diets are now eating more “Westernized” fare. And its effects on global health are, unfortunately, showing.

Here in the U.S., it can sometimes seem that dietary advice changes all the time. But that’s not really the case. With a couple of exceptions (like the famous fats vs. sugar debate), what we know about nutrition has been relatively stable in recent years, with new research mostly fleshing out the correlations between food and long-term health, and illuminating the underlying mechanisms. And there are some individual foods that are particularly well-studied and repeatedly linked to long-term health. Of course, it’s not possible to eat only these foods all the time, but the idea is just to cycle them into your diet as much as you can stand, both psychologically and economically.

Here are the foods that science shows are very much linked to the reduction of disease, both physical and neurological, over the long term, and for which the mechanisms are largely mapped out.

Watch on Forbes: New ‘Indoor Farms’ Let You Grow Veggies In Your Kitchen


This goes at the top of the list because it’s such an interesting food-drug. For those of us who drink it regularly, the positive research in the last 10 years has been heartening. One of coffee’s great benefits is that it seems to be linked to brain health: Not only does it keep us alert in the short-term, by blocking adenosine receptors, but coffee consumption has also been linked to reduced risk of depression, and even of Alzheimer’s and Parkinson’s diseases. And newer research suggests that coffee drinkers may have a longevity advantage over non-drinkers. In one recent study, people who drank four cups per day had a 64% reduced risk of death over the years of the study (it was 22% for two-cup-a-day drinkers). This is partly because compounds in coffee improve vascular health, help repair cellular damage and reduce inflammation, which itself is linked to most of the chronic diseases.

Some people find the side effects (namely, anxiety) too much to handle, so may want to do decaf instead, which seems to have many of the same benefits (so does green tea). But for those who already “use” the regular form of the substance, and are happy doing so, it seems to be a good idea to continue.

Salmon and other fatty fish (or algae)

There’s a misapprehension that all omega-3 fatty acids are created equal. They’re not. The long-chain omega-3 fatty acids found in fish are abbreviated EPA and DHA, and are known to be especially important for the brain and the heart over the long term, reducing the risk of dementia and of heart disease. One study found that DHA supplementation can even counteract the neuronal damage that a high-sugar diet can bring about. The omega-3 fatty acids found in plant sources — like walnuts and flaxseeds — are called ALA, which the body can convert into EPA and DHA, but pretty inefficiently. (For more on the difference, see this.) If you don’t eat seafood, supplements can be a good idea — and since DHA is also found in algae, vegetarians and those concerned about sustainability may want to supplement this way.

(NB: Omega-6s are another kind of fatty acids all together, and while generally healthy in moderate amounts, can lead to inflammation if eaten excessively. Don’t confuse your omegas. This is why a good balance of omega-3 to omega-6 is important, and a good balance of DHA/EPA to ALA equally important.)


Nuts deserve their own category, because they have, separately from other plant-based foods, been linked to all kinds of desirable outcomes, like heart health, reduced inflammation and reduced mortality. As mentioned above, some nuts, particularly walnuts, contain good amounts of omega-3s (though again they’re a slightly inferior version of the fats than are present in fish and algae). And nuts have lots of other benefits including essential vitamins, fiber and protein. Almonds were recently shown to improve “good” cholesterol levels. Another new study found that walnuts may reduce activity in areas of the brain associated with food craving, which may help explain their known effects on metabolic health.

Peanuts (although not technically a nut) have also been linked to heart health and longevity, but sadly for many, peanut butter hasn’t been shown to have the same benefits, possibly because of the often-added hydrogenated oils and sugar. So sticking with actual nuts — walnuts, pecans, almonds and even peanuts — in their natural form is probably smart.



Speaking of peanuts, legumes (beans, peas, lentils and peanuts) are also worth putting into your diet if you don’t already. They have high quantities of protein and fiber, as well as nutrients like folate, zinc, iron and magnesium. Their consumption has been linked to a number of health benefits, including reduced blood pressure, coronary heart disease, obesity and diabetes.

A recent study looking at over 135,000 participants in 18 countries across the globe found that eating legumes was associated with a lower risk of overall mortality and mortality from non-cardiovascular issues. “Eating even one serving per day decreases the risk of cardiovascular disease and death,” said study author Victoria Miller in a news release. “Legumes are not commonly consumed outside these geographic regions, so increased consumption among populations in Europe or North America may be favourable.”

Intensely colored vegetables

Experts have long been saying to “eat the rainbow” when it comes to vegetables: for example, dark leafy greens, sweet potatoes, red peppers, avocados, broccoli, tomatoes, purple onion and red cabbage. There’s no single reason that brightly colored vegetables are healthy — there are several ways in which they confer health or perhaps prevent poor health. For instance, the orange ones are high in beta-carotene; avocados are rich in unsaturated fats; tomatoes, especially cooked, and red peppers are high in lycopene; cruciferous vegetables, particularly broccoli, have phenolic compounds that are linked to reduction in cancer risk; dark leafy greens are high in folate, among many other vitamins, and fiber.

There are multiple mechanisms behind the connection between vegetables and reduced heart and cancer risk, so cycling in as many as you comfortably can is one of the cornerstones of healthy eating. Keep in mind that the nutrient level of vegetables is generally proportional to the richness of their color. For example, iceberg lettuce has relatively little nutritional value, whereas kale, spinach and collard greens have much more.


Berries (and other fruits)

Berries, especially blueberries, are often touted as “super foods,” for their high levels of antioxidants. In fact, blueberries are the only fruit that the MIND Diet specifically recommends, based on brain research. Otherwise, since fruits tend to be high in sugar, it’s a little unclear how much we should eat.

That said, fruits are generally high in vitamins and fiber, and a better go-to for snacking than many of the things we usually go to. Citrus fruits have been linked to reduced risk of blood cancer and esophageal cancer (and oddly, to increased risk of skin cancer, since a compound seems to make skin more sensitive to light). Apples have been also been linked to a reduced risk of several types of cancer. And grapes, with their high levels of resveratrol, have been linked to reduced risk of cancer and dementia. So again, while berries may be the true super food for their high antioxidant levels, other fruits are likely a good staple to have in our diets.

Fermented things

This category is fairly broad since fermented foods in general (not just the usual one that we think of: yogurt) are good for our microbiomes — the beneficial bacteria that live in our guts and have been linked to everything from depression risk to cancer risk to overweight/obesity. Yogurt is the obvious fermented food, since it contains relatively high levels of friendly bacteria like L. acidophilus. But other fermented foods like sauerkraut, kimchi, miso, tempeh and even pickles are thought to be good for the gut and its beneficial bacteria.

Whole grains

These get an entry, even though it’s not totally clear whether whole grains are really a super food (particularly given the definition of whole grain in the U.S.) or whether they’re just a better alterative to what most people eat — refined grains. Whole grains are those with the germ and the bran still present; refined grains have had those parts stripped away, which means they consist only of the starchy, low-nutrient endosperm. But during the processing of even whole grains the beneficial parts can be degraded, and there’s been some controversy about how to conceptualize and define whole grains in the food industry.

In epidemiological studies, whole grains have certainly been linked to beneficial health outcomes: reduced heart risk and a longer life, as well as reduced risks of diabetes and colon cancer. And they are sources of vitamins, minerals, antioxidants and, if it’s not processed away, fiber. Many people in the U.S. could probably eat fewer carbs in general, increasing vegetables, lean protein and healthy fats. But carbs are not evil, and they’re fine to eat in moderation. Just make sure your grains are as whole and fiber-rich as possible, with as little processing — and added sugar and chemicals — as possible.


Turmeric and other spices

A handful of spices have been linked to significant long-term health benefits, mainly in the way of better cognitive function, reduced dementia risk, reduced cancer risk and better glucose metabolism. Turmeric, a key component of curry, has been linked to reduced incidence of Alzheimer’s disease, presumably for its antioxidant and anti-inflammatory properties. It’s also been shown to have anti-tumor properties (however, it’s also been shown to inhibit some chemotherapies, so always talk with your doctor).

Other spices, like cinnamon, have been shown to reduce blood sugar levels, so may be helpful to diabetics or in diabetes prevention, or to anyone trying to control their weight. And spiciness itself, in the form of chili peppers’ capsaicin, has been linked to heart health, likely through its effects on the vascular system. Again, there are lots of mechanisms through which various spices may exert their effects, so keeping a varied array of spices in your life is likely a good idea for health, along with the obvious: they taste good.


It seems like this is a good one to end on. The catch is that the research suggests that for health benefits, the chocolate needs to be dark, rather than milk or white. Sweets in general are not good foods to keep in your diet (except on occasion). The Mediterranean diet, the MIND Diet, the DASH diet, and just about all the research that’s rolling in these days suggests that sugar be quite limited. Studies have shown that added sugar, particularly processed sugar, is linked to just about every chronic disease there is — cancer, diabetes, heart disease and dementia. Cocoa, very separate from sweets, is linked to cognition, heart health and neurological health, likely due to its high levels of polyphenols. And while many of these studies are done with high-potency cocoa drinks, there’s also evidence suggesting that dark chocolate might confer similar benefits. Again, the key is to choose a low-sugar, dark variety of chocolate (i.e., chocolate cake doesn’t count).

* * *

Again, it’s probably not possible to subside on only these foods all the time, but just to include them as much as you realistically can. Hopefully, the more we learn about the effects of foods on long-term health, the American diet will start to fade away — and so will the serious health risks it brings with it.

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