“Senators on the health committee are working over the weekend to try to reach an agreement on a stabilization bill for Obamacare…”

“Liberals and conservatives in Congress were planning on Wednesday to set forth two radically different proposals for health care: a huge expansion of Medicare, which would open the program to all Americans, and a rollback of the Affordable Care Act, which would give each state a lump sum of federal money with sweeping new discretion over how to use it….
Senator Bernie Sanders of Vermont, the onetime candidate for the Democratic presidential nomination, proposed what he called “a Medicare-for-all, single-payer health care system,” and he said 15 Democratic senators supported it….
At the same time, several Republican senators, led by Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, unveiled their bill, which would take money spent under the Affordable Care Act and give it to states in the form of block grants.” (A)

“Sen. Bernie Sanders, I-Vt., unveiled his Medicare-for-All bill Wednesday, with over a dozen Democratic senators coming out in support of the proposal, according to CNN….. All Americans would receive a “Universal Medicare card” that would qualify them for all patient services, including hospital stays, dental and vision care, hearing aids, substance abuse treatment and abortion.
The proposal would be phased in over a four-year period. In the first year, the Medicare eligibility age would be lowered to 55 and all children under 18 would also be eligible. Coverage would grow to include dental, vision, reproductive health and behavioral health coverage. The next year the eligible age would drop to 45, 35 the year after that and then finally cover every citizen by the fourth year. (B)

“..Graham and Cassidy have been shopping versions of their bill for months now, and submitted a detailed version as an amendment in July. As it stands, the legislation would make it virtually impossible for dozens of states to continue operating Obamacare as we know it without kicking in unrealistic amounts of their own money. That’s because, in the short term, the law is designed to penalize states that embraced the ACA while rewarding those that resisted it. Further down the line, the legislation simply zeroes out all of Obamacare’s spending, a de facto repeal of the entire program that doesn’t include a replacement. As policy, it’s a bit like walking into somebody’s house, lighting the whole ground floor on fire, then telling them, “Hey, you can keep living here—if you like it.” “ (C)

“President Trump promised Thursday to veto legislation for a single-payer, government-run health care system. “Bernie Sanders is pushing hard for a single payer healthcare plan — a curse on the U.S. & its people,” the president tweeted. “I told Republicans to approve healthcare fast or this would happen. But don’t worry, I will veto because I love our country & its people.”
There’s just one major thing to remember about this promise: He’ll never get the chance to veto the bill, because it’s never going to reach his desk during this current session of Congress. “ (D)

“Lawmakers hope to pass bipartisan legislation to steady the individual insurance market, but health plan officials aren’t optimistic that a solution will come in time for them to make strategic business decisions.
Those subsidies help lower the out-of-pocket costs for consumers with incomes below 250% of the federal poverty level. Without them, insurers will likely hike rates by as much as 20%, or stop offering coverage on the exchanges altogether. Some states are publicly releasing approved 2018 rates, while others are waiting for a signal from the Trump administration that it will pay the subsidies through next year.
The notion of funding the cost-sharing reduction subsidies is gaining momentum. Sen. Lisa Murkowski (R-Alaska), a swing vote who helped kill a partial repeal of the ACA, said what matters when it comes to appropriating money for the subsidies is that both parties agree it should be done. “Whether it’s one year, two years or perhaps longer, we can figure that out,” she said.” (E)

In his opening statement, Senator Orrin Hatch (R-UT), the (Senate Finance) committee chair, blasted the ACA, saying that it hadn’t reined in costs and was driving up premiums for many people who buy insurance on the state exchanges. He was dubious about the idea of trying to fix the law.
Alluding to the cost-sharing subsidies that some experts believe must be paid to insurers to stabilize the exchanges, he said, “In my view, an Obamacare bailout that is not accompanied by real reforms would be inadvisable. We can’t simply invest more resources into a broken system and hope that it fixes itself over time.” (F)

“A senior Democratic aide told The Hill that some Democrats in the Senate’s Health, Education, Labor and Pensions (HELP) committee are concerned that the GOP members may be trying to pull the bipartisan negotiations in a more conservative direction. The committee is hoping to hammer out a deal by the end of the week.
“Republicans appear to be pulling the negotiations in a more partisan direction from their side by pushing changes that Democrats have made clear from the start they wouldn’t agree to—like rolling back protections for patients with pre-existing conditions,” ..” (G)

“I asked six of these Obamacare opponents, policy experts at conservative and libertarian think tanks, what they learned from the spectacular failure of Obamacare repeal and what they think happens now, in this strange new reality we all occupy…
Roy described his ideal end state as one similar to the Swiss system: Universal coverage, through private insurance and subsidization, but without that country’s individual mandate or overly prescriptive federal mandates for benefits.
Still, there were some shared visions. Any wonk on the right will talk about equalizing the tax code by capping the unlimited tax break for employer-based insurance and dramatically expanding health savings accounts. Everybody wants more power returned to the states. Everybody is concerned about reining in the costs of the Medicare and Medicaid programs over the long term.” (H)

Bipartisan teams in the Senate and House are separately taking important first steps toward fixing the nation’s individual health insurance market.
Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), as well as some representatives in the House, are looking at ways to improve and strengthen state innovation waivers, which already exist in the Affordable Care Act (ACA), or ObamaCare. Also known as Section 1332 waivers, they give states flexibility to bypass some of the law’s requirements and to help develop localized ways to lower health-care costs, broaden coverage and improve treatment in their states.
Expanding this flexibility, which we have written about before, could be the key to unlocking some of the partisan gridlock surrounding health-care reform. If strengthened, these waivers could help governors and state legislatures across the nation innovate and find health insurance solutions that work best for their states. More conservative states could pursue market-oriented reforms, while more liberal states could pursue their own models. (I)

“Democrats desperately needed the Affordable Care Act to thrive while they still controlled the White House. But with President Barack Obama gone, and GOP majorities in the House and Senate, they’re pretty much off the hook — at least, according to polls showing 60 percent of Americans find Republicans responsible for the ACA.
As for Republicans, they’re still deeply bitter they weren’t able to repeal one iota of Obamacare despite their high-drama effort over the spring and summer. Many members have spent too many years characterizing the extra Obamacare subsidies now at stake as improper insurer “bailouts” to get excited about funding them, even though providing them could somewhat improve otherwise skyrocketing rates next year.” (J)

CBO directly contradicts the claim that Obamacare is in a death spiral: “The nongroup health insurance market to be stable in most areas of the country. Preliminary data for 2018 show that insurers will offer coverage in all or almost all areas. Although premiums have been increasing, most subsidized enrollees buying health insurance through the marketplaces are insulated from those increases because their out-of-pocket payments for premiums are based on a percentage of their income; the federal government pays the difference between that percentage and the premium for a benchmark plan.” Remarkably, only “one-half of one percent of people in the country” will live in areas with no individual group insurers. Interestingly, now that Obamacare is here to stay, CBO expects that “over time” more states will expand Medicaid.
CBO does find some problems — caused by the uncertainty this administration created….” (K)

“Senators on the health committee are working over the weekend to try to reach an agreement on a stabilization bill for Obamacare that they hope will temper insurer exits and premium increases expected for customers who will buy coverage on the exchanges….
“It’s going to be a tough needle to thread for both sides,” a senior GOP aide told the Washington Examiner. “We got a clear indicator on actually how interested many Democrats are in a bipartisan solution for healthcare when 17 of them introduced single payer this week.”
Like many Republicans, Democrats have not indicated whether they would sign on to a stabilization package, and many of them have laid the stability of the exchanges at the feet of Trump, who has not said whether he would fund cost-sharing reduction subsidies, a part of Obamacare they have said he must pay.” (L)

“Having failed to repeal Obamacare, President Donald Trump has said his strategy would be to let the health law “implode.” The Congressional Budget Office released a report Thursday that predicts Trump administration policies on Obamacare could help it on its way by leading to rising premiums and decreased enrollment in individual insurance markets over the next year.” (M)

(A) Medicare for All or State Control: Health Care Plans Go to Extremes, by ROBERT PEAR, https://www.nytimes.com/2017/09/13/us/politics/health-care-obamacare-single-payer-graham-cassidy.html?_r=0
(B) Bernie Sanders’ Medicare-for-All bill: 4 things to know, by Leo Vartorella, http://www.beckershospitalreview.com/hospital-management-administration/bernie-sanders-medicare-for-all-bill-4-things-to-know.html
(C) Republicans Claim That Their New Plan to Repeal Obamacare Is a Moderate Compromise. LOL., by Jordan Weissmann, https://slate.com/business/2017/09/the-new-republican-plan-to-repeal-obamacare-is-even-more-vicious-than-the-old-plan.html
(D) Trump promises to veto Bernie Sanders health care bill that will never reach his desk, by Jessica Estepa, https://www.usatoday.com/story/news/politics/onpolitics/2017/09/14/trump-promises-veto-bernie-sanders-backed-health-care-bill-never-reach-his-desk/667456001/
(E) Left in the lurch: Ongoing uncertainty is taking a toll on health insurers, by Mara Lee and Shelby Livingston, http://www.modernhealthcare.com/article/20170909/NEWS/170909887
(F) Senate Hearing on Healthcare Shows Continuing Conflicts, by Ken Terry, http://www.medscape.com/viewarticle/885593
(G) Signs of trouble in Senate’s ACA stabilization talks, by Paige Minemyer, http://www.fiercehealthcare.com/aca/democrats-fear-gop-wants-to-take-senate-healthcare-hearings-a-partisan-direction
(H) Once Obamacare repeal is dead, the GOP has no plan B, by Dylan Scott, https://www.vox.com/policy-and-politics/2017/9/11/16271168/obamacare-repeal-dead-what-now
(I) Gingrich and Daschle: Senate and House making key steps to fix health care, http://thehill.com/opinion/healthcare/350696-senate-and-house-making-key-first-steps-to-fix-health-care
(J) The Health 202: Why Congress might fail to fund extra Obamacare subsidies, by By Paige Winfield Cunningham, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/09/15/the-health-202-why-congress-might-fail-to-fund-extra-obamacare-subsidies/59bada3730fb045176650c73/?utm_term=.58a56a9d5f1a
(K) Three ways to do health-care reform, Jennifer Rubin, https://www.washingtonpost.com/blogs/right-turn/wp/2017/09/15/three-ways-to-do-health-care-reform/?utm_term=.be329bc3a55b
(L) Bipartisan Senate group prepares to present Obamacare fix, by Kimberly Leonard, http://www.washingtonexaminer.com/bipartisan-senate-group-prepares-to-present-obamacare-fix/article/2634607
(M) Trump wanted to hurt the Obamacare markets. The CBO says he’s a success, by Sam Petulla, http://www.cnn.com/2017/09/15/politics/20170915-cbo-insured-rate-uncertainty-premiums/index.html

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The rise of ‘grandfamilies’: Opioid crisis requires more Hoosier grandparents to raise children..

“When President Trump announced in early August, following a presidential commission’s recommendations, that the opioid crisis was a “national emergency,… he called it “a serious problem the likes of which we have never had.”
A month has now passed, and that urgent talk has yet to translate into urgent action. While the president’s aides say they are pursuing an expedited process, it remains to be seen how and by what mechanism Mr. Trump plans to direct government resources.” (A)

“This is a triple epidemic with rising waves of deaths due to separate types of opioids each building on top of the prior wave. The first wave of prescription opioid mortality began in the 1990s. The second wave, due to heroin, began around 2010 with heroin-related overdose deaths tripling since then. Now synthetic opioid-related overdoses, including those due to illicitly manufactured fentanyl and fentanyl analogues, are causing the third wave with these overdose deaths doubling between 2013 and 2014 .” (B)

“Nationwide in 2013, an average of 5.8 babies per 1,000 births were diagnosed with NAS. (neonatal abstinence syndrome) In Sullivan County in 2013, the rate was 54 per 1,000 and Northeast Tennessee registered 41 per 1,000….
Treating NAS babies is expensive due to lengthy stays in neonatal intensive care units. An average NAS baby costs around $65,000 to treat and the care of about 78 percent of NAS babies is charged to state Medicaid programs.
In the U.S., a third of reproductive-aged women filled a prescription for an opioid medication, and between 14 percent and 22 percent of women filled an opioid medication prescription during pregnancy.” (C)

“Drug overdoses killed roughly 64,000 people in the United States last year, according to the first governmental account of nationwide drug deaths to cover all of 2016. It’s a staggering rise of more than 22 percent over the 52,404 drug deaths recorded the previous year — and even higher than The New York Times’s estimate in June, which was based on earlier preliminary data.
Drug overdoses are expected to remain the leading cause of death for Americans under 50, as synthetic opioids — primarily fentanyl and its analogues — continue to push the death count higher. Drug deaths involving fentanyl more than doubled from 2015 to 2016, accompanied by an upturn in deaths involving cocaine and methamphetamines. Together they add up to an epidemic of drug overdoses that is killing people at a faster rate than the H.I.V. epidemic at its peak.” (D)

“Opioid use by American men may account for one-fifth of the decline in their participation in the U.S. labor force, according to a study by Princeton University economist Alan Krueger…
Krueger’s study linked county prescription rates to labor force data from the past 15 years, concluding that regional differences in prescription rates were due to variations in medical practices, not health conditions. In previous research, he found that nearly half of men in their prime worker ages not in the labor force take prescription painkillers daily.” (E)

“How easy is it for millennials to get their hands on the very drugs fueling today’s opioid crisis? Easier than you might think. According to a new national poll released by the American Psychiatric Association, 46 percent of millennials surveyed said illicitly obtaining such drugs would be a cinch in their neighborhoods — a far higher number than other adults questioned.
With stats like that, it’s no wonder so many health experts now warn pain sufferers — including millennials — to first consider drug-free, non-invasive options like chiropractic care to avoid the risk of getting hooked on potentially lethal painkillers like OxyContin.” (F)

“After years of rising opioid mortality, opioid deaths in most New York counties fell between 2015 and 2016, according to new numbers from the New York State Department of Health.
Excluding New York City, which is counted separately and where opioid deaths rose during the same period, there were 1,238 opioid deaths in New York state last year, compared to 1,520 deaths the year before. Overdose deaths take time to confirm, and it’s possible the new report’s numbers could change, but the apparent improvement comes amid growing use of the overdose reversal drug naloxone ― lending credence to the public health theory that increased access to naloxone helps prevent opioid deaths.” (G)

“Gov. Christie announced a new rule prohibiting prescribers from accepting “lavish meals and uncapped compensation for speaking engagements, consulting work, and other services from drug companies. The proposed rule, submitted to the Office of Administrative Law yesterday, will target the unnecessary prescription of prescription painkillers.
According to the Governor’s announcement, New Jersey doctors collected $69 million from drug companies and device manufacturers last year. He cited growing concerns that drug company money influences prescribing habits, especially when it comes to opioids. According to the Governor’s office, two-thirds of the $69 million received by New Jersey doctors went to just 300 physicians, with 39 each having received at least $200,000.” (H)

“That’s where prescription drug monitoring programs come in. They collect data from pharmacies to track what prescriptions for controlled substances patients have filled. The databases can be used to assess whether patients are getting more opioids than they can safely use. In addition, they can be used to tell if patients are getting other drugs, like a benzodiazepine, that are dangerous to use in combination with an opioid.
According to research summarized by the Leonard Davis Institute of Health Economics at the University of Pennsylvania, prescription drug monitoring programs can help reduce the amount or strength of opioids prescribed and dispensed. When physicians or dentists check the database and see a worrisome pattern of dispensed opioids, they can deny or change a prescription, screen for an opioid or other substance use disorder, and even counsel the patient to seek other forms of pain management or addiction treatment, if warranted.” (I)

“In 2016, the American College Health Association issued new guidelines for prescribing opioids, particularly in rural settings where students can not have access to specialized pain clinics.
‘We do very little prescribing’ “There is little evidence that opioid prescription pain medication is useful outside the treatment of cancer-related pain,” says the ACHA report. Armed with new data, some forward-looking colleges are taking a novel approach to provide support systems for students who are in recovery.
Dr. David McBride, director of the health center at the University of Maryland, said the school “sees very little” opioid use. “And we do very little prescribing,” he told NBC News. “Occasionally we prescribe in small quantities for pain.”…
Recovery dorms can be found at, among others, Augsburg College in Minnesota, Ohio State University, Baylor University in Texas, George Washington University in Washington, D.C. and Rutgers, the state university of New Jersey. (J)

“Maryland officials also have identified four strategies to:
— Raise and maintain the conversation surrounding opioid abuse to reduce stigma. — Focus energy toward a balanced approach that includes prevention, protection and recovery. — Use data to build and evaluate programs and projects. — Persevere toward long-term expectations.
Likewise, there are four ultimate goals, including prevention, access to treatment, enforcement, through police and courts, and reducing the number of overdoses. (K)

“Salt Lake City-based Intermountain Healthcare aims to achieve a 40 percent reduction in the number of opioids prescribed for acute pain systemwide by the end of 2018. “Intermountain announced the goal Tuesday, making it the first health system to formally make such a specific and substantial pledge for opioid prescription reduction.
1. To achieve the reduction, Intermountain has already trained about 2,500 prescribers in opioid reduction strategies. The system plans to extend this training to each of its 22 hospitals and 180 clinics throughout Utah and Idaho.
2. The system will also provide new tools and policies to help prescribers reduce the number of opioids prescribed by 5 million tablets annually. (L)

On July 26, at the annual shareholder meeting of McKesson, the nation’s largest distributor of pharmaceuticals, including opioid drugs, shareholders refused to approve the company’s generous executive-compensation plan after the International Brotherhood of Teamsters—which holds stock in McKesson—campaigned against it, citing the company’s “role in fueling the prescription opioid epidemic.” McKesson rejected that characterization, and denied that it had any such role. Calling the opioid, heroin, and fentanyl epidemic “complicated,” Jennifer Nelson, a spokesperson for McKesson, told me that “in our view, it is not to be laid at the feet of distributors.” The Teamsters, she charged, were trying to use the addiction crisis to their advantage in their ongoing labor dispute with the company involving the union’s efforts to represent workers at a McKesson distribution center in Florida.” (M)

“Dentists as a profession rank 4th among medical specialties for opioid prescriptions. Many of these prescriptions, historically, are written out to patients following wisdom tooth extraction, impacting children and young adults at ages when their brains are still developing and thus highly susceptible to addiction response. Patients also commonly received prescription opioids when treated at pain clinics and following surgical dental procedures. Though other medical professions also contribute to the volume of prescription opioid use and abuse in today’s society, dentists as a profession have the incredible power and knowledge to make the needed difference in response to this tragedy. (N)

“Nationally, the question becomes what this all means; such declarations of “national emergency” typically target national disasters or contagious diseases and end at a certain time. But there is no sign the epidemic is slowing down. And so the country asks: What is the administration going to do? How does the president intend to define “victory”?
Here’s hoping the president will, early in the process, identify specific goals to avoid the mission creep often associated with government programs. The alternative is the government attempting — and failing — to solve every facet of a complex challenge. A poorly executed emergency declaration creates false expectations in the public sphere, increases pressure for funding and allows political grandstanders to assume a leadership role.” (O)

Combatting this epidemic starts with conversations at home around kitchen tables, in classrooms, and on practice fields. Education is our best tool to help people stay off of drugs. We should each take responsibility for teaching our kids the dangers of heroin and opioid use and be on the lookout for signs that our kids are using drugs. Schools, libraries and police departments can aid in this effort by providing materials and training for these difficult discussions. It also means keeping an eye on the medications our family members are prescribed and taking unused medications to an approved take-back program. State and local governments can help by expanding drug takeback programs and getting the word out on programs that already exist. (P)

“Monica Slonaker, a Kokomo resident, knows well the challenges faced by grandparents thrust back into the role of day-to-day caregiver; it’s been roughly three-and-a-half years since she took in her own grandchildren. The two girls, her son’s daughters, now ages 3 and 7, were recently adopted by Slonaker and her husband, Bill – a situation, driven by opioid and alcohol abuse, that’s become commonplace across Indiana….
Then, one day, the mother showed up, dropped off the girls and “pretty much left them,” said Monica…And since the girls were dropped off at Slonaker’s home, the judicial system has determined that their father – Slonaker’s son, who suffers from alcoholism – and mother are not fit to maintain custody.
Adoption was determined to be the best option. Needless to say, it has changed the Slonakers’ lives.” (Q)

(A) A Month Has Passed Since Trump Declared an Opioid Emergency. What Next?, by By MAGGIE HABERMAN, https://www.nytimes.com/2017/09/10/us/politics/trump-opioid-emergency.html
(B) The Latest Jaw-Dropping Numbers From the Opioid Crisis, by JULIA LURIE, http://www.motherjones.com/politics/2017/09/the-latest-jaw-dropping-numbers-from-the-opioid-crisis/
(C) A HELLISH START, Babies born addicted are collateral damage of opioid crisis, by DAVID MCGEE, http://www.heraldcourier.com/news/addicted_at_birth/babies-born-addicted-are-collateral-damage-of-opioid-crisis/article_6bb6d5ec-b47b-5906-8203-c6daea1f6689.html
(D) Fentanyl Overtakes Heroin as Leading Cause of U.S. Drug Deaths, by JOSH KATZ , https://www.nytimes.com/interactive/2017/09/02/upshot/fentanyl-drug-overdose-deaths.html?_r=0
(E) Opioid use responsible for 20 percent of drop in American men from labor force, study finds, by Angel Phillip, http://www.chicagotribune.com/business/ct-opioid-use-labor-force-20170907-story.html
(F) How Millennials view the opioid crisis, http://www.philasun.com/health/millennials-view-opioid-crisis/
(G) In New York State, A Glimmer Of Good News About The Opioid Crisis, by Erin Schumaker, http://www.huffingtonpost.com/entry/new-york-opioid-crisis_us_59a94fb6e4b0dfaafcef8c26
(H) NJHA Newslink Today, September 1, 2017 Vol. 13 No. 170
(I) A Helpful Tool to Combat the Opioid Crisis, by Austin Frakt, https://www.nytimes.com/2017/09/11/upshot/a-helpful-tool-to-combat-the-opioid-crisis.html
(J) Opioid Crisis: How America’s Colleges Are Reacting to the Epidemic, by SUSAN DONALDSON JAMES, https://www.nbcnews.com/feature/college-game-plan/opioid-crisis-how-america-s-colleges-are-reacting-epidemic-n797696
(K) Official: State Needs Support to Fight Opioid Crisis, by TAMELA BAKER, https://www.usnews.com/news/best-states/maryland/articles/2017-09-01/official-state-needs-support-to-fight-opioid-crisis
(L) Intermountain to cut opioid prescriptions 40% by end of 2018: 5 things to know, by Brian Zimmerman, http://www.beckershospitalreview.com/opioids/intermountain-to-cut-opioid-prescriptions-40-by-end-of-2018-5-things-to-know.html
(M) When a Company Is Making Money From the Opioid Crisis, by BRIAN ALEXANDER, https://www.theatlantic.com/business/archive/2017/09/opioid-crisis-responsibility-profits/538938/
(N) You Are a Part of the Solution: Remedying the Opioid Crisis, Mirissa D. Price http://www.huffingtonpost.com/entry/you-are-a-part-of-the-solution-remedying-the-opioid_us_59b334cbe4b0d0c16bb52cba
(O) Defining ‘victory’ in the opioid crisis, by Robert L. Ehrlich Jr., Jim Pettit, http://www.baltimoresun.com/news/opinion/oped/bs-ed-op-0913-opioid-emergency-20170912-story.html
(P) It’s time for new approaches to the opioid and heroin crisis, by SEAN PATRICK MALONEY, http://thehill.com/opinion/healthcare/350325-its-time-for-new-approaches-to-the-opioid-and-heroin-crisis
(Q) The rise of ‘grandfamilies’: Opioid crisis requires more Hoosier grandparents to raise children, by George Myers Kokomo, http://www.kokomotribune.com/news/local_news/the-rise-of-grandfamilies-opioid-crisis-requires-more-hoosier-grandparents/article_0f4285e6-8f51-11e7-8421-f35a3787df2e.html

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After Hurricane Harvey a man in Texas says he got infected with flesh-eating bacteria

J.R. Atkins, of Missouri City, Texas, wrote in a Facebook post that he was hospitalized after what he thought was a small bug bite turned into swelling and some numbness in his hand. He had been kayaking through flooded streets to check on his neighbors, Atkins wrote, and noticed the bite when he returned home.The bacteria Atkins contracted can quickly turn deadly, according to the CDC. Diagnosing the bacteria early, getting antibiotics and surgery are important to stopping its growth.” (A)

“Floodwaters in two Houston neighborhoods have been contaminated with bacteria and toxins that can make people sick, testing organized by The New York Times has found. Residents will need to take precautions to return safely to their homes, public health experts said….
The results of The Times’s testing were troubling. Water flowing down Briarhills Parkway in the Houston Energy Corridor contained Escherichia coli, a measure of fecal contamination, at a level more than four times that considered safe.” (B)

“At least 35 hospitals in Florida, Georgia, and South Carolina have either closed entirely or ordered partial evacuations in advance of Hurricane Irma….Despite Irma’s unprecedented strength – anticipated to be even stronger than Hurricane Andrew in 1992 – the Florida Hospital Association told STAT that the vast majority of its more than 200 member hospitals, including the state’s largest hospitals, remained open as of Saturday afternoon. In total, the association says health care facilities have evacuated nearly 1,900 patients.” (C)

“One of the most common questions surfacing on Reddit and Twitter was whether workers could be fired for not showing up to work because they had left town ahead of the storm. The answer to that question, in many cases, is that they can indeed be fired. Sharon Block, the executive director of the Labor and Worklife program at Harvard Law School and a former Department of Labor employee, says a major storm, even one that yields a state of emergency, doesn’t suspend labor laws. This means that laws that protect workers’ pay still stand, but because in Florida, workers are employed at-will, it also means that (barring a collective-bargaining agreement or contract stating otherwise) workers can still be fired for their absence. “You can be fired for a good reason [or] a bad reason—as long as it’s not an unlawful reason, which is usually discrimination,” Block says.
There are also those who worry less about showing up at work and more about how long they will be stuck there….” (D)

“The NCH Healthcare System is now sheltering 1,200 family members of employees at the two hospitals who are working during the storm through Monday…The hospitals are not public shelters. A longstanding policy has been to allow employees for upcoming shifts to bring their immediate household family members to stay during hurricanes. For the first time, administrators extended the policy for employees scheduled to work two days out — on Monday — because of the magnitude of Hurricane Irma.” (E)

“Hospitals with large volumes of critically ill patients, like Tampa General Hospital, were forced to ride out the storm despite the storm surge risks, reports the Weather Channel. The hospital, located in a Level A evacuation zone, the most vulnerable, kept 800 patients and several hundred staff and family members on-site as the storm hit.
“We have at least 100 patients on ventilators and we are a burn center,” Ellen Fiss, the hospital’s public relations director, said. “Moving these patients would have put their lives more at risk.” “ (F)

““I think the most important thing we did was that after the 2005 period, when our state saw seven to eight hurricanes, we decided to spend tens of millions of dollars to fortify our facilities,” said Steve Sonenreich, chief executive of Mount Sinai Medical Center in Miami Beach. The hospital installed hurricane-proof glass in its windows, for example, and placed generators 30 feet above the flood plain and inside a structure that can withstand winds of 180 mph.
This weekend, it never lost power, Sonenreich said. In fact, staff tested backup generators Saturday afternoon and then just kept them on, even though they weren’t needed. On Monday, the worst damage to the property appeared confined to fallen trees and leaks.” (G)

“When the winds kicked up as Hurricane Irma made its way up Florida’s west coast, rescue workers watched helplessly as the 911 calls piled up on a computer screen.
They weren’t allowed to respond. Winds were so high that emergency services in many areas were suspended to protect the rescuers.
“It just stinks. You’re sitting here not be able to do your job,” said Billy Johnston, a firefighter paramedic with St. Petersburg Fire Rescue. “And we got into this job to help people.” “ (H)

About 25 percent of Florida’s population is 60 years and older. This population is more likely to suffer from a disability, chronic illness, memory impairment and mobility problems. Some care homes in Florida evacuated early to get their patients to a safe facility in the north of the state or in other states nearby. Other facilities opted to stay and got more than a week’s worth of supplies.Experts say staying put may be the best health option for the residents
‘We told them we were going on vacation, so they were all pretty willing to go on the bus with us,’ Abigail Mitchell, executive director of HarborChase of North Collier, said to The Washington Post. (I)

“Some of the dangers are obvious. For example, drowning is a top cause of hurricane-related fatalities. But there are some lesser-known health threats that Americans face.
Here are five of them:
Carbon monoxide poisoning. .. generators emit odorless, colorless carbon monoxide, which is toxic to breathe, and experts say the gas poses a poisoning risk when the devices are used improperly.
Chemicals. Mosquitoes.Chronic illnesses. Mental health. (J)

(A) Hurricane Harvey First Responder Gets Flesh-Eating Bacteria From Texas Storm Water, Abigail Abrams, http://time.com/4933050/hurricane-harvey-texas-flesh-eating-bacteria/
(B) Houston’s Floodwaters Are Tainted With Toxins, Testing Shows, by SHEILA KAPLAN and JACK HEALY, https://www.nytimes.com/2017/09/11/health/houston-flood-contamination.html?_r=0
(C) Irma forces at least 35 hospitals to evacuate patients. Here’s a rundown, by MAX BLAU, https://www.statnews.com/2017/09/09/irma-hospital-evacuations-rundown/
(D) The Uncertainties of Being Asked to Work During a Hurricane, GILLIAN B. WHITE, https://www.theatlantic.com/business/archive/2017/09/hurricane-irma-work/539295/
(E) 10 a.m. at NCH Downtown Baker Hospital, http://www.naplesnews.com/story/news/health/2017/09/09/nch-hospitals-faces-surge-employees-bringing-family-shelter/649844001/
(F) Florida hospitals continue to weather Hurricane Irma as it batters the coast; Recovery begins in the Caribbean, by Paige Minemyer, http://www.fiercehealthcare.com/population-health/florida-hospitals-continue-to-weather-hurricane-irma-as-it-batters-coast
(G) Florida’s hospitals weather the storm, by Amy Ellis Nutt, https://www.washingtonpost.com/news/to-your-health/wp/2017/09/11/floridas-hospitals-weather-the-storm/?utm_term=.3963d0a455c1
(H) Frustrated first responders have to ignore Irma 911 calls, by Elizabeth Cohen and Debra Goldschmidt, http://www.cnn.com/2017/09/11/health/first-responders-frustrated-during-irma/index.html
(I) Saving the elderly from Irma: How Florida’s hospitals and care homes made shelters for the millions of pensioners who could not get out, by DANIELLE ZOELLNER, http://www.dailymail.co.uk/health/article-4873412/Hurricane-Irma-forces-care-homes-evacuate-residents.html
(J) The Health 202: Mosquitoes, carbon monoxide and chemicals are big post-Irma health concerns, by Paige Winfield Cunningham, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/09/11/the-health-202-mosquitoes-carbon-monoxide-and-chemicals-are-big-post-irma-health-concerns/59b59f6d30fb045176650be9/?utm_term=.25d47e081a9e

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Military helicopters and jets were overhead, as President Bush was getting ready to leave. The plumes of smoke from the World Trade Center were still billowing skyward.

*written by Jonathan M. Metsch on September 14, 2001; published in the Jersey Journal on September 18, 2001

Suddenly a huge white military hospital ship with four Red Crosses steamed by and docked right across river. I thought how this hospital ship brought the war even closer to home but mostly about how the hospitals in Hudson County had responded and performed so magnificently.

Liberty HealthCare System is comprised of Jersey City Medical Center, Greenville Hospital, and Meadowlands Hospital Medical Center. The Medical Center, the County’s Trauma Center, treated 175 patients. Greenville treated 11 patients and processed over 500 volunteers who wanted to give blood; Greenville had originally been asked by the Red Cross to be a blood center but this was changed early on so donor information was passed (every volunteer was “typed and matched”) to the blood collection centers. Meadowlands treated 7 patients and was preparing to be a command center given its heliport; late Tuesday night Governor DiFrancesco used the heliport to depart from his visit to the triage center at Liberty State Park.

Every hospital in the County provided emergency services to victims. According to the Jersey Journal: Palisades Medical Center treated 12 patients; St. Francis Hospital treated 67 patients; Christ Hospital treated 54 patients; St. Mary Hospital treated 74 patients. Bayonne Hospital treated 58 patients.

At the Medical Center staff watched from windows the attack on the World Trade Center, then immediately went on Disaster Alert. Over 150 physicians covering all medical and surgical specialties were in the building as they are every day, and over 1000 other staff joined predetermined teams – trauma and surgery in the emergency room, and “walking wounded” in the auditorium. The library was organized for aftercare and rooms were set up for family members arriving from all over the metropolitan area. The injured started arriving around 10AM and suddenly, and sadly, everything stopped about 6PM. We hope and waited for more patients, and still wait “on alert”, our hope fading.

Since the New York City Command Center was in the World Trade Center complex and destroyed, good information was not available. We were told to expect somewhere between 2000 and 5000 injured.

Many others contributed to our success in handling the medical response to this act of war:

– Over 200 ambulances simply appeared from all over the state to assist. They were restocked from Medical Center inventory and dispatched by Medical Center EMS.

– New Jersey Commissioner of Health and Senior Services George DiFerdinando was in contact with us immediately and made sure we were re-supplied, and developed a plan with whereby trauma centers outside of Hudson County were on high alert so patients could be transported there to prevent Hudson County hospitals from being overwhelmed.

– Every hospital in the New Jersey was on disaster alert with elective admissions and surgery cancelled, and disaster teams ready until late Tuesday evening.

– Providers of food, IV solutions, medications, surgical supplies, and much more sent in truckloads of supplies without being asked.

– Volunteers poured in to help us in any way possible. For example with their help a “Hot Line” was set up at the Medical Center with up-to-date information on all disaster victims seen at New Jersey hospitals. This “Hot Line” was soon designated as “official” until the New York City Command Post was reestablished.

– Hudson Cradle opened its doors, wanting to help, wanting to serve.

– Mayor Cunningham and Jersey City police and fire officials coordinated all local efforts while supporting the recovery in New York City and securing the waterfront where victims were arriving by ferry in great numbers to several sites including Exchange Place and Liberty State Park. I know public officials in Hoboken, Secaucus, Bayonne and Weehauken did the same.

– And untold numbers were praying for the victims and those providing care – we could feel those prayers.

How can you help? Volunteer to give blood; blood will be needed for weeks and months to come. If you can, make a cash donation to help the families of those killed in this tragedy. Certainly go to community vigils and prayer services. Befriend someone who does not look like you and let them know that all Americans share this pain together and that the beauty of America is that we all came from somewhere else, and now live and work harmoniously side-by-side.

On a practical level we and other local hospitals can use your help. If you are a mental health worker and want to help with World Trade Center disaster Crises Counseling in hospitals, schools, and offices please call us. If you are a nurse who works outside the County or doing something else right now – particularly emergency room, critical care and operating room nurses, though all nurses are welcome – and want to be on our roster of volunteers for future emergencies please us. And if you just want to join the cadre of volunteers at our hospitals please call us. Please call 201 915-2048.

Finally I want to thank all the staff at Liberty, who once again, provided services so well. They acted heroically while worried about missing family and friends, and their children at home who had to cope with this tragedy without them nearby. I am honored to work with you.

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It appears that Hurricane Irma evacuation shelter managers may make people wait outside for hours? If so, just welcome them in and then do the registration process inside.

Making evacuees wait outside adds the anxiety of worrying about whether they made the right decision to seek shelter, to the already existing fear of temporary “homelessness” becoming permanent.

“The storm is here,” Gov. Rick Scott said Saturday morning, noting that the storm surge could reach 15 feet in some places.
“Fifteen feet is devastating and will cover your house,” he said. “Do not think the storm is over when the wind slows down. The storm surge will rush in and it could kill you.” (A)

“The key things include the basic fundamentals of making sure you have adequate power sources, backup power generation and that you can run enough power for all of your facilities to really operate in a seamless fashion. Also, make sure you have appropriate water sources…..
Then certainly supplies, staff — making sure you have a team A that stays through the storm and a team B that can come back and essentially relieve team A — are critical components to a plan like this. Preparation ahead of time makes the difference. (B)

“With many South Florida residents fleeing their homes before Hurricane Irma, hospitals in Florida’s southernmost county have put their own evacuation plans into motion.
The three hospitals in Monroe County, which includes the Keys, are in the process of shutting their doors ahead of Irma’s expected Sunday arrival. The county has also ordered a mandatory evacuation for residents.
The Lower Keys Medical Center evacuated its remaining 11 patients Wednesday night in the North Carolina National Guard’s C-130 aircraft, according to hospital spokeswoman Lynn Corbett-Winn. The patients were transported to Gadsden Regional Medical Center in Alabama. The hospital will close its emergency department at 7 a.m. Friday.
Eleven patients from the Lower Keys Medical Center were evacuated to Gadsden, Alabama, in a North Carolina National Guard aircraft.
(C)

“Jackson Health System, the county’s public hospital system, said in a statement Friday that it would start operating in a state of emergency starting Saturday at 7 a.m. It said it had already canceled its appointments at its ambulatory care and primary care centers, and that its pharmacy and urgent care centers would close at 3 p.m. Friday. Emergency rooms at all of its facilities — including the flagship Jackson Memorial Hospital, Jackson North Medical Center in North Miami Beach and Jackson South Community Hospital in South Miami-Dade — will remain open.
Mount Sinai Medical Center, whose main campus is located on Miami Beach, said as of Thursday morning that it would not evacuate patients or essential staff. The center’s emergency centers in Miami Beach and Aventura also plan to remain open, said center president and CEO Steven D. Sonenreich.
“It is important to note that Mount Sinai is not a public shelter and once we are under a Hurricane/Tropical Storm Watch, only persons with medical emergencies, third-trimester maternity patients and individuals with special needs previously assigned to Mount Sinai will be accepted,” he said. (D)

“Emptying even a modest-sized hospital during a disaster often requires a vast logistical effort and the cooperation of ambulance teams and other hospitals. Sometimes a health system has enough resources to transfer patients within its own network of hospitals. But when that is not possible, Texas has procedures in place to move patients en masse.
A catastrophic medical operations center — set up in Houston during emergencies and run by the Southeast Texas Regional Advisory Council, a regional organization that coordinates medical disaster responses — matches patients to specific hospitals that can take them. Then the center passes a request for medical transport to an emergency medical task force that coordinates ambulances and emergency service crews contributed by fire departments around the state and, in the case of Harvey, the nation.” (E)

“While many Miami hospitals are shutting down as Hurricane Irma bears down on Florida, some are offering shelter to their pregnant patients, bracing for the increase in births that often accompanies these large storms.
At least three of the city’s hospitals have plans in place to care for women with advanced or high-risk pregnancies.
They could be busy.
(F)

“The first step is to make the decision early on whether the provider should remain open or evacuate. Turner said the media can often generate a lot of hype when major storm systems hit, so it’s critical for providers to rely on solid data sources, such as the National Oceanic and Atmospheric Administration.
NOAA provides weather forecast tools and satellite views that follow the storm and its path.
Once the organization determines whether to keep operations running, providers need to review their disaster preparedness plan and test staff by running drills, explained Turner.
No matter the size of the organization, much of the preparedness checklist is the same: food and water supplies, reliability of power sources and test phone and internet connections. (G)

“Prior to Hurricane Harvey striking the Houston area, Texas was already one of the most difficult states in the nation to have an abortion, with restrictions on insurance coverage and laws that have shut down abortion clinics by the dozen. But abortion clinics in the region affected by the flooding were not immune to damages, which is why Whole Women’s Health, the organization that sued and won in a 2016 Supreme Court case that ruled TRAP laws unconstitutional, has stepped up to the occasion.
Whole Women’s Health announced in a blog post this week that with the help of the Lilith Fund, a Texas-based abortion fund, will provide cost-free abortions to Hurricane Harvey survivors — some of whom missed appointments for the procedures due to the storm, and were unable to rebook appointments also due to the storm. The costs associated with traveling to have an abortion make the procedure unaffordable to many, and fewer clinics as a result of Harvey will only exacerbate this issue.
(H)

“In the wake of the devastating impact of Hurricane Harvey, Surescripts and Allscripts (NASDAQ:MDRX) are collaborating to provide free access to patient-specific medication history data for pharmacists in Texas and Louisiana for a limited time. Pharmacists interested in utilizing the service should visit www.surescripts.com/harvey for instructions on how to become authorized to access the Allscripts application through which they can then obtain patient consent to see a 12-month view of a patient’s medication history. Prescribers who do not already utilize medication history data through their electronic health record (EHR) software can also download the free, cloud-based application to gain access.” (I)

“More than a dozen Texas chemical and refining plants reported damaged storage tanks, ruptured containment systems and malfunctioning pressure relief valves as a result of Hurricane Harvey, portending safety problems that might not become apparent for months or years, according to a Houston Chronicle review of regulatory filings….
When Harvey swept through the Gulf Coast and Houston area, it forced the shutdown of hundreds of industrial facilities across the region. Now, with waters receding, these operations will be coming back on line in the coming weeks, raising the prospect of cancer-causing gas emissions, toxic spills, fires and explosions, said Sam Mannan, director of a center that studies chemical process safety at Texas A&M University.” (J)

“Houston’s sprawling network of petrochemical plants and refineries released millions of pounds of pollutants in the days after Hurricane Harvey began barreling toward Texas.
Even under normal operations, the hundreds of industrial facilities in the area can emit harmful chemicals. But from Aug. 23 to Aug. 30, 46 facilities in 13 counties reported an estimated 4.6 million pounds of airborne emissions that exceeded state limits, an analysis by the Environmental Defense Fund, Air Alliance Houston and Public Citizen shows.
Federal and state regulators say their air monitoring shows no cause for alarm. But the extra air pollution is just the latest concern for residents and environmental groups in the days after the storm. At least 14 toxic waste sites were flooded or damaged, raising fears of waterborne contamination. And nearly 100 spills of hazardous substances have been reported.” (K)

(A) Hurricane Irma Live Updates: ‘The Storm Is Here,’ Florida Governor Says, https://www.nytimes.com/2017/09/09/us/hurricane-irma-florida.html?mcubz=0
(B) Ochsner CEO Warner Thomas on Katrina, Harvey & Irma: ‘In any sort of disaster there’s also opportunity’, by Kelly Gooch, http://www.beckershospitalreview.com/hospital-management-administration/ochsner-ceo-warner-thomas-on-katrina-harvey-irma-in-any-sort-of-disaster-there-s-also-opportunity.html
(C) South Florida hospitals closing ahead of Hurricane Irma, by Michael Nedelman, http://www.cnn.com/2017/09/06/health/hurricane-irma-florida-hospitals-closing/index.html
(D) Will hospitals close during Hurricane Irma? Some already are evacuating, by Elizabeth Koh, http://www.miamiherald.com/news/weather/hurricane/article171710102.html
(E) After Harvey Hit, a Texas Hospital Decided to Evacuate. Here’s How Patients Got Out, by SHERI FINK and ANDREW BURTON, https://www.nytimes.com/2017/09/06/us/texas-hospital-evacuation.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(F) Miami hospitals prepare for surge in births during Hurricane Irma, by Julie Steenhuysen and Jilian Mincer, https://www.yahoo.com/news/miami-hospitals-prepare-surge-births-during-hurricane-irma-204516684.html
(G) How hospitals can prepare for Hurricane Irma, by Jessica Davis, http://www.healthcareitnews.com/news/how-hospitals-can-prepare-hurricane-irma
(H) Texas Abortion Provider Offers Cost-Free Abortion Services to Hurricane Harvey Survivors, by Kylie Cheung, https://www.themarysue.com/reproductive-justice-6/
(I) Sure scripts and Allscripts Join Forces to Make Patient Medication History Data Available to Pharmacists in the Wake of Hurricane Harvey, http://www.businesswire.com/news/home/20170906006529/en/Surescripts-Allscripts-Join-Forces-Patient-Medication-History
(J) Government ill-equipped to monitor industrial plants damaged by Hurricane Harvey, by Mark Collette and Matt Dempsey, http://www.houstonchronicle.com/news/houston-texas/houston/article/Government-ill-equipped-to-monitor-industrial-12178805.php
(K) More Than 40 Sites Released Hazardous, by TROY GRIGGS, ANDREW W. LEHREN, NADJA POPOVICH, ANJALI SINGHVI and HIROKO TABUCHI, https://www.nytimes.com/interactive/2017/09/08/us/houston-hurricane-harvey-harzardous-chemicals.html

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“Republican plans to replace Obamacare are fading fast, but that doesn’t mean Congress is done with health care.

“On Wednesday, the Senate Health, Education, Labor and Pensions Committee kick(ed) off the first of four scheduled hearings this month examining the individual health care market with the goal of producing a bipartisan bill that makes modest fixes.
Ideas on the table include funding cost-sharing reduction (CSR) payments that President Donald Trump has threatened to cut off, adding a reinsurance fund to help with unexpected patient costs, and providing a backup option for counties with no insurers under the Affordable Care Act…
Despite claims of imminent collapse by Trump and other Republicans, Obamacare’s markets have stabilized somewhat. Insurer profits are up this year, and no counties are currently slated to go without coverage, although some are facing steep premium increases. (A)

“…The Senate Health Committee says Capitol Hill has no choice but to throw a lifeline to Americans facing higher prices and dwindling choices in the individual market, where roughly 20 million Americans buy insurance on their own, after GOP lawmakers failed to send President Trump a bill to repeal and replace the Affordable Care Act.
Republicans thought they’d be presiding over a “stable transition period” to a conservative health care model and fully pivoting to tax reform by now.
Instead, Health Committee chairman Lamar Alexander is urging his GOP colleagues to bless short-term fixes for consumers and insurers who’ve been left in a type of “no man’s land” ahead of this fall’s sign-up period, as Mr. Trump mulls longer-term options for pulling away from the 2010 health law.
“There are a number of issues with the American health care system, but if your house is on fire, you want to put out the fire, and the fire in this case is the individual health insurance market,” Mr. Alexander, Tennessee Republican, said in launching the effort with Sen. Patty Murray of Washington, the panel’s highest-ranking Democrat. (B)

“Millions of people who buy individual health insurance policies and get no financial help from the Affordable Care Act are bracing for another year of double-digit premium increases, and their frustration is boiling over.
Some are expecting premiums for 2018 to rival a mortgage payment.
What they pay is tied to the price of coverage on the health insurance markets created by the Obama-era law, but these consumers get no protection from the law’s tax credits, which cushion against rising premiums. Instead they pay full freight and bear the brunt of market problems such as high costs and diminished competition…
The most exposed consumers tend to be middle-class people who don’t qualify for the law’s income-based subsidies. They include early retirees, skilled tradespeople, musicians, self-employed professionals, business owners, and people such as Sharon Thornton, whose small employer doesn’t provide health insurance.
“We’re caught in the middle-class loophole of no help,” said Thornton, a hairdresser from Newark, Delaware. She said she’s currently paying about $740 a month in premiums, and expects her monthly bill next year to be around $1,000, a 35 percent increase.
“It’s like buying two new iPads a month and throwing them in the trash,” said Thornton, whose policy carries a deductible of $6,000…”(C)

“President Donald Trump and some Senate Republicans are refusing to give up on Obamacare repeal, even after this summer’s spectacular failure and with less than a month before a key deadline.
The president and White House staff have continued to work with Republican Sens. Lindsey Graham of South Carolijna and Bill Cassidy of Louisiana over the summer on their proposal to block grant federal health care funding to the states. And though the bill is being rewritten and Congress faces a brutal September agenda, Trump and his allies on health care are making a last-gasp effort.
“He wants to do it, the president does. He loves the block grants. But we’ve got to have political support outside Washington,” Graham said in an interview. He said the bill needs to have a “majority of the Republican governors behind the idea” to gain momentum in the Senate…
The Congressional Budget Office would also still need time to analyze the cost of the bill, a process that could take several weeks….(D)

The Republican chairman of the Senate health committee said Thursday that he hopes to release a bipartisan health care bill “within 10 days or so….
At the hearing, governors hailing from five states were armed with a stern and unified message: Congress and President Donald Trump had better get their acts together to strengthen Obamacare and stabilize the individual marketplace…
The most urgent topic of discussion was whether Congress would continue to fund a key set of Obamacare subsidies known as cost-sharing reduction payments. Governors, insurance commissioners and others have repeatedly urged Congress and Trump to fund the payments, which reduce deductibles and co-pays for lower-income enrollees, at least through 2018.” (E)

“A new Republican bill to replace Obamacare will be unveiled in the U.S. Senate on Monday with backing from President Donald Trump, according to one of two Republican senators who have crafted the legislation.
The lawmaker, Senator Bill Cassidy of Louisiana, told reporters he was optimistic the legislation could pass before a Sept. 30 deadline, if it can attract the bare minimum of 50 votes needed to succeed in the Republican-led Senate with tie-breaking support from Vice President Mike Pence..
The new measure, which would give more healthcare powers to the states, is a revamped version of legislation that did not gain enough support during the summer healthcare debate. (F)

“Senator Elizabeth Warren announced on Thursday she’s co-sponsoring Senator Bernie Sanders’s “Medicare for All” bill, which is set to be introduced next week in the Senate.
In a statement, Warren said, “There is something fundamentally wrong when one of the richest and most powerful countries on the planet can’t make sure that a person can afford to see a doctor when they’re sick. This isn’t any way to live.”
“I believe it’s time to take a step back and ask: What is the best way to deliver high quality, low-cost health care to all Americans? Everything should be on the table—and that’s why I’m co-sponsoring Bernie Sanders’ ‘Medicare for All’ bill that will be introduced later this month,” the senator added.” (G)

“McCain, who cast the decisive vote against a pared-down ObamaCare repeal bill that failed in the Senate in July, said Wednesday he would support legislation sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) to change Medicaid.
McCain later issued a statement qualifying his earlier interview with reporters, saying he would want to review the legislation and its impact on Arizona before making a final decision.
The White House has talked up that legislation, with counselor Kellyanne Conway this week saying Trump would sign the bill if it reached his desk…
Collins, who also voted against the Senate’s last-ditch ObamaCare repeal strategy earlier this summer, said the momentum of the health-care debate has shifted to hearings that Sen. Lamar Alexander (R-Tenn.) is overseeing in the Senate Health, Education, Labor and Pensions (HELP) Committee…
“I see the action happening in the HELP Committee, and the fact is that we’re going to have four hearings and by the end of next week I think you’ll see the outlines of a bill emerging from the committee,” Collins, a member of the committee, said.” (H)

(A) Health Care Reform Flatlined. But Lawmakers Aren’t Giving Up, by BENJY SARLIN, https://www.nbcnews.com/politics/congress/health-care-reform-flatlined-lawmakers-aren-t-giving-n797846
(B) Bipartisan group of senators pushes bill to shore up Obamacare, by Tom Howell Jr., http://www.washingtontimes.com/news/2017/sep/4/obamacare-shore-up-bill-pushed-by-bipartisan-group/
(C) Millions who buy health insurance brace for sharp increases, by Ricardo Alonso-Zaldivar, http://www.chicagotribune.com/news/nationworld/ct-health-insurance-premium-increases-20170904-story.html
(D) Trump wants one last Senate push on Obamacare repeal, by BURGESS EVERETT and JOSH DAWSEY, http://www.politico.com/story/2017/09/05/trump-obamacare-repeal-senate-242346
(E) GOP senator: Bipartisan health care bill coming in 10 days, by MJ Lee and Tami Luhby, http://www.cnn.com/2017/09/07/politics/lamar-alexander-bipartisan-health-care-bill/index.html
(F) New Senate Obamacare repeal bill due Monday: senator, https://www.reuters.com/article/us-usa-congress-healthcare/new-senate-obamacare-repeal-bill-due-monday-senator-idUSKCN1BI2N3
(G) ELIZABETH WARREN CO-SPONSORING BERNIE SANDERS’S ‘MEDICARE FOR ALL’ BILL, by BY JOHN HALTIWANGER, http://www.newsweek.com/elizabeth-warren-cosponsoring-bernie-sanders-medicare-all-bill-661050
(H) Trump: ‘Good’ Deals Reached on Debt, Harvey, http://thehill.com/homenews/senate/349550-trumps-surprise-deal-shakes-up-fall-agenda

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“Calling 911 (about Hurricane Harvey) didn’t work. Begging for help on Facebook and Instagram failed, too. “I was like, ‘Siri’s smart enough! Let me ask her!’ …

Stranded outside in the rising waters of Hurricane Harvey, feverish and in great pain, 14-year-old Tyler Frank tried desperately to think of ways to get herself and her family to safety.
And indeed, Siri was smart enough. With one inquiry to the Apple personal assistant — “Siri, call the Coast Guard” — Tyler got her whole family rescued after two days out in the storm. “(A)

“Hurricane Irma is a Category 5 storm expected to make landfall in Florida sometime this weekend, leaving local hospitals to prepare for a possible landfall and catastrophic damage.
Listed below are seven things every healthcare leader should know about the unfolding situation in Florida.
1. Florida Gov. Rick Scott (R) declared a state of emergency Monday for the entire state.
2. Three hospitals in the Florida Keys are beginning to evacuate patients: Key West, Fla.-based Lower Keys Medical Center, Tavernier, Fla.-based Mariners Hospital and Marathon, Fla.-based Fisherman’s Hospital. Monroe County, which encompasses the Keys, is also closing its health department… (B)

“Emergency disaster officials in cities like Baltimore, Boston and Seattle have spent the last week and a half monitoring how Texan government officials and storm-affected residents are responding to a crisis that destroyed homes and disrupted electricity, drinking water and communications.
The causes might be different, but the devastation and social disruption can be similar from disaster to disaster. As such, Houston is offering other cities a real-life run-through of their own emergency plans as well as a stark reminder of the inevitability of such events.” (C)

“Harvey is the first major storm since the federal government revised emergency preparedness standards for hospitals, in response to Katrina and 2012’s Superstorm Sandy. Now, health care institutions that receive Medicare or Medicaid dollars must have disaster preparedness plans, including relocation strategies for at-risk patients and mechanisms to maintain basic power.”
What kind of burden does a storm like Harvey place on local hospitals, and on the health care system?
What challenges should we expect in the storm’s wake? (D)

“Every flood disaster is also a public-health disaster, and even as Harvey dissipates over the Gulf Coast, the beginnings of that secondary calamity were on display in the Houston area…”
“A large-scale World Health Organization (WHO) study out of Europe investigated these health effects of flooding and found that the two-thirds of flood-related deaths are due to drowning, while the remainder are from trauma, electrocution, carbon monoxide poisoning, fire, or heart attacks. Weakened health care infrastructures during natural disasters make seeking care for these immediate injuries and infectious diseases even more difficult. In the case of Harvey, Houston’s biggest level one trauma center, Ben Taub Hospital, is itself being evacuated due to lack of food and flooding.
The need for immediate medical attention aside, basic necessities such as food and clean drinking water become critical for displaced flood survivors, says Koenig. Contamination of drinking water due to failures at water treatment plants and sewage system overloads can lead to outbreaks of diarrheal disease if clean water provisions are not prioritized. Even exposure to flood water itself for prolonged periods of time can lead to health risks ranging from animal bites and wound infections to electrical and chemical hazards. And according to Koenig, once the immediate crisis dissipates, the toll of the natural disaster can persist in the form of chronic disease, worsened poverty, and emotional and mental distress.” (E)

As Texas begins to rebuild its buildings and roadways in the wake of Hurricane Harvey, survivors of the catastrophic storm, along with the medical professionals who treat them, may face psychological trauma from displacement and the loss of homes, property and, especially, loved ones.
The link between a hurricane and mental health struggles has been documented through research on the survivors of Hurricane Katrina, which devastated Louisiana in 2005. A year after the storm, the Resilience in Survivors of Katrina (RISK) Project found that nearly half of the 392 low-income parents they studied reported symptoms consistent with post-traumatic stress disorder (PTSD). An associated study concluded that the rates of probable serious mental illness in low-income parents in New Orleans doubled in the aftermath of the hurricane, a rise that’s likely to be reflected in southeast Texas. (F)

The storm forced hospitals and medical centers in Houston to cancel surgeries, outpatient programs and even evacuate surgeries.
But that still wasn’t enough to help prevent shortages across the city.
Medical centers have had to reevaluate their treatment of patients as food and supply shortages left them overwhelmed.
This is only expected to get worse as more victims of Hurricane Harvey will continue to grow as the storm dies down.
The uninsured will be among them with an inability to pay for medical procedures that were caused from the damaging hurricane. (G)

“But it could have gone a lot worse. To put it into context, there are roughly 120 hospitals in the southeastern section of Texas, according to Darrell Pile, the leader of the Southeast Texas Regional Advisory Council (SETRAC), which operated the Catastrophic Medical Operations Center in charge of leading hospital responses to emergencies. Additionally, in the 25 hospitals that did evacuate, not all of the patients planned to move actually ended up moving. CNN reports that so far, roughly 1,000 patients have been transported to other hospitals. Doctors likely assessed that some patients could actually be safely treated where they are, and that supplies were more secure than they thought (no one ended up going without food at Ben Taub Hospital in Houston, Pile says). Those who were living in the flooded nursing home now are okay in the hospital in which they were placed.” (H)

“Inside the hospital, doctors, nurses, technicians and facilities and food service staff were keeping things running for more than 500 inpatients and their families…
You have a ride-out team, which refers to staff who have agreed to stay put and ride out the storm. How did that work?
We had about a thousand staff here. The unsung heroes in this disaster are our nurses, our lab techs, our pharmacy techs, our food services, our security who kept [everyone] safe.
We had 528 patients who were in the hospital on Sunday morning and probably another couple hundred family members. We were really able to care for these very sick individuals. There was no compromise in our ability to care for them….
Your staff at the hospital is obviously just as affected as everyone else. (I)

“Every flood disaster is also a public-health disaster, and even as Harvey dissipates over the Gulf Coast, the beginnings of that secondary calamity were on display in the Houston area. During the worst of the flooding, hospitals faced critical shortages of food and medicine, people with serious chronic diseases had to make difficult decisions between evacuation and sheltering in place, and hundreds of victims faced prescription shortages and mental-health issues. And based on the health problems people in New Orleans and elsewhere in the region faced after Hurricane Katrina, experts expect major public-health emergencies, environmental illnesses, and outbreaks will only intensify in the aftermath of Harvey.
“…one key public-health issue that attends the early stages of any disaster is the set of risks facing people who are disabled or elderly and face special health needs. “With our push towards home health-care and taking care of more Americans in the home,” Gentry said, “it quickly turns into ‘can we get their home health-care needs taken care of,’ with everything from oxygen to prescription meds to getting them clinical access, especially for dialysis. Those types of clinical worries compound as many days as the water stays up.” (J)

“Due to the failure of the city’s water pump, it is in the best interest of our current patients to transfer to other acute care facilities,” Baptist Hospitals of Southeast Texas said in a statement Thursday morning. “Due to the city-wide lack of services, we have no other alternative but to discontinue all services which will include emergency services. This is being done immediately.”
“The hospital needs about 50,000 gallons of water a day to run,” hospital medical director Ali Osman told weather.com. “The hospital administration tried to procure that water from water tankers, state and local resources. So far, we are unable to.”
“We started with maybe 260 patients, we are down to 193 patients,” he added. “We are evacuating the sickest of our patients first, intubated patients, patients who need dialysis. Things are serious … come Saturday or Sunday, we still don’t have any water, the bad situation will turn into a disaster.” (K)

““Just like their members, health plans are a part of their communities and deeply committed to the wellness and safety of those who live there,” America’s Health Insurance Plans said in a statement. “When a community is impacted by a tragic, disastrous event like we’re seeing unfold with this storm, plans connect immediately with state and local officials to offer support and ensure those impacted have swift access to the healthcare, resources and medical services they need.”
Here’s a look at what some major health plans are doing:
Cigna is lifting prescription refill restrictions; waiving prior authorization requirements for acute care; and forgiving late payment of premiums for customers in affected areas. It is also offering a free 24/7 telephone help line through which members can speak to a clinician about issues like coping with loss, anxiety, stress resulting from the hurricane. Finally, the insurer noted that MDLIVE, which provides telehealth services to Cigna customers, is offering one free medical consultation through Sept. 8. (L)

“Tom Bossert, the official leading the White House’s response to the disaster, estimated that 100,000 homes in Texas and Louisiana had been damaged or destroyed, and said that President Trump would soon seek billions in aid.
Mr. Bossert said that rescuers would provide aid to the estimated 500,000 undocumented immigrants in the Houston area, and that federal officials would not round up those whose only offense was entering the country illegally. But undocumented immigrants would likely not be eligible for long-term aid, he said, including subsidies to replace damaged housing.” (and what about health care?) (M)

(A) Siri saves sick girl from Harvey floodwaters, by Elizabeth Cohen and John Bonifield, http://www.cnn.com/2017/09/04/health/siri-harvey-rescue-sickle-cell/index.html
(B) Florida hospitals prepare for Hurricane Irma: 7 things to know Wednesday, by Leo Vartorella, http://www.beckershospitalreview.com/patient-flow/florida-hospitals-prepare-for-hurricane-irma-7-things-to-know-wednesday.html
(C) In Houston, a Terrifying Real-Life Lesson for Disaster-Prone Cities, by ADAM NAGOURNEY and JESS BIDGOOD, https://www.nytimes.com/2017/09/05/us/houston-harvey-disaster-lessons.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(D) A Doctor Who Weathered Katrina Now Tends Victims Of Harvey, by SHEFALI LUTHRA, http://www.npr.org/sections/health-shots/2017/09/05/548626760/a-doctor-who-survived-katrina-now-tends-victims-of-harvey
(E) Beyond infrastructure dangers, the survivors of Harvey will likely also face serious health hazards, Farah Naz Khan, https://www.self.com/story/health-crises-that-follow-horrific-floods
(F) From The Mental Health Wreckage Of Katrina, Lessons To Help Harvey’s Victims, by Kaeli Subberwal, http://www.huffingtonpost.com/entry/hurricane-harvey-mental-health_us_59a9f092e4b0354e440a7b3f
(G) Now the hospitals are going to have to figure out how to treat the many uninsured who need medical care because increased hospital admissions always happen after a natural disaster, by Danielle Zoellner, http://www.dailymail.co.uk/health/article-4840574/Hurricane-Harvey-crippled-health-system.html
(H) Houston hospitals kept patients safe during Harvey thanks to years of forced team bonding, Katherine Ellen Foley, https://qz.com/1066787/hurricane-harvey-how-houston-hospitals-handled-the-storm/
(I) An ‘Army Of People’ Helps Houston Cancer Patients Get Treatment, ANDREA HSU, http://www.npr.org/sections/health-shots/2017/08/31/547539504/an-army-of-people-helps-houston-cancer-patients-get-treatment
(J) Hurricane Harvey’s Public-Health Nightmare, https://www.theatlantic.com/politics/archive/2017/09/hurricane-harveys-public-health-nightmare/538767/
(K) Harvey Beyond Houston: Beaumont Residents Wait in Mile-Long Lines for Bottled Water, by Sean Breslin, https://weather.com/storms/hurricane/news/beaumont-texas-loses-water-supply-due-to-neches-river-flooding
(L) How health insurers are helping members, employees affected by Hurricane Harvey, by Leslie Small, http://www.fiercehealthcare.com/payer/how-insurers-are-helping-members-cope-hurricane-harvey
(M) New Hazard in Storm Zone: Chemical Blasts and ‘Noxious’ Smoke, by JULIE TURKEWITZ, HENRY FOUNTAIN and HIROKO TABUCHIA, https://www.nytimes.com/2017/08/31/us/texas-chemical-plant-explosion-arkema.html

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