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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TrumpCare. “If you don’t know (`or care`) where you’re going, any road will get you there.” – Lewis Carroll

“… Trump’s views about health care have been anything but consistent. Rather, there have been three constants: agnosticism about what a plan should look like; a fanatical desire to notch a win regardless of the quality of that win; and a refusal to give up.
In the meantime, Trump has vacillated frequently, mostly pinging between three incompatible positions: first, that Obamacare should be repealed and replaced; second, that Republicans should repeal Obamacare and worry about a replacement later; and third, as here, that Republicans should simply let Obamacare die. Let’s consider a somewhat simplified timeline of Trump’s views. (A)

Here are three promises Trump made that will not come true under the current bills moving through Congress:
‘Everybody’s got to be covered.’
‘No cuts’ to Medicaid
‘Every bit as good on pre-existing conditions as Obamacare.’ (B)

Mr. Trump usually steers clear of policy details and has grown impatient with the painstaking behind-the-scenes bargaining that has marked the health care negotiations. But he said on Wednesday that he was hopeful that the Senate would deliver a bill that he could sign. (C)

“Republicans should just REPEAL failing Obamacare now & work on a new Healthcare Plan that will start from a clean slate,” the president tweeted, adding that “Dems will join in!” (D)

“Trump’s predictions of collapse and threats to withhold critical government payments to insurers — have obscured an encouraging fact: Many of the remaining companies have sharply narrowed their losses, analysts say, and some are even beginning to prosper…
The insurers that stayed in the individual market have come to realize that the individual market was more like Medicaid than the employer business. Some customers have chronic conditions that have been poorly treated in the past, and insurers need to manage their care more closely. People shopping for a plan are very concerned about price, making it essential for insurers to find hospitals and doctors that provide care at the lowest cost. (E)

Let’s stipulate up front that congressional leaders and President Trump are unlikely to lead that effort, given that they narrowly failed to take health insurance away from millions of people. This conversation would need to be led by senators who have committed to a bipartisan approach, and by state governments, some of which have already begun to take action.
Change might not come soon enough for the 29 million people without health insurance or the many millions who struggle to afford high premiums, deductibles and other health costs.” (F)

Now, a repeal plan proposed by GOP Sens. Bill Cassidy of Louisiana, Lindsey Graham of South Carolina and Dean Heller of Nevada is, as Cassidy put it recently, “about the only game left in town” when it comes to the GOP’s hackneyed promise to repeal and replace Obamacare, as the law is also known…
There’s no compelling rationale for the changes Republicans continue to propose to the nation’s health care policies. It’s clearly not to extend health coverage to more people or to maintain it for those who currently have it. It’s clearly not to make matters easier for the states. And it’s clearly not to tackle the genuine health care problems Americans face, such as staggeringly high costs and inferior outcomes.
With clearly no helpful intentions in mind, Cassidy, Graham and Heller ought to let this Obamacare repeal plan fail like its predecessors. (G)

Next month the Senate will try a novel approach to break away from seven years of polarization on health care: actual committee hearings, with expert witnesses and input from lawmakers in both parties.
And if those go well, Congress could see an even unlikelier development—the advance of viable, bipartisan legislation to fix parts of the Affordable Care Act.
The hearings are the brainchild of Senator Lamar Alexander of Tennessee, the Republican chairman of the Health, Education, Labor, and Pensions Committee, who has been talking for months about the need to stabilize Obamacare’s individual insurance market. What makes this effort different is that following the GOP’s failure to repeal and replace the law, Alexander now has the blessing of his party’s leadership and buy-in from the committee’s top Democrat, Senator Patty Murray of Washington State…
“I’m looking for the simplest bill possible that Republicans and Democrats can agree on that will stabilize the individual insurance market,” Alexander told reporters earlier this month. (H)

“A Trump administration official said Wednesday that the administration wanted to stabilize health insurance markets, but refused to say if the government would promote enrollment this fall under the Affordable Care Act or pay for the activities of counselors who help people sign up for coverage.
The official also declined to say whether the administration would continue paying subsidies to insurance companies to compensate them for reducing deductibles and other out-of-pocket costs for low-income people. Without the subsidies, insurers say, they would sharply increase premiums.
The administration, the official suggested, will do the minimum necessary to comply with the law, which Mr. Trump has called “an absolute disaster” and threatened to let collapse.
“I don’t think we can force people to sign up for the program,” the official said. “ (I)

“But what about ideas that go beyond the oft-repeated ones? Here are five proposals that are more controversial but generating buzz.
1. Allow people into Medicare starting at age 55.
2. Allow people to ‘buy in’ to Medicaid.
3. Get younger adults off their parents’ insurance and back into the individual market.
4. Require insurers who participate in other government programs to offer marketplace coverage.
5. Let people use HSA contributions to pay health insurance premiums. (J)

“Colorado Gov. John Hickenlooper and his Republican counterpart from Ohio, John Kasich, on Thursday morning released their bipartisan plan to stabilize the individual health insurance market.
Among their recommendations:
The Trump administration should commit to making cost-sharing reduction payments to keep premiums from going up 20-25 percent and increasing the federal deficit.
Congress should create a temporary stability fund for states to create reinsurance programs that reduce premiums.
Congress should encourage health insurance companies to enter underserved counties by exempting insurers that do so from the federal health insurance tax on their exchange plans in those counties.
Keep the individual mandate (for now) to prevent the rapid exit of carriers from the market.
Maximize market participation by encouraging young people to get insurance.
Modify and strengthen federal risk-sharing mechanisms, including risk adjustments and reinsurance to stabilize risk pools. (K)

“Last fall, as consumers in Minnesota were facing health insurance rate increases of 50 percent or more, Gov. Mark Dayton, a Democrat, said the Affordable Care Act was “no longer affordable to increasing numbers of people.” The state’s top insurance regulator said the Minnesota market was “on the verge of collapse.”
The outlook now is much better. Rate increases requested for 2018 are relatively modest, thanks in part to a new program under which the state will help pay the largest claims. The program, known as reinsurance, and the efforts that led to its creation hold lessons for other states where rates are rising rapidly, and for Congress, where lawmakers are considering the introduction of a similar program…
But the program will be invisible to consumers. They will not have to file additional paperwork or do anything different from what they would ordinarily do..
Minnesota’s experience with such an effort is instructive. The bill creating its reinsurance program, the Minnesota Premium Security Plan, became law within three months of being introduced — lightning speed when compared with the pace in Congress.” (L)

“Despite the setbacks of the past eight months, including the inability of Republicans to agree on a single alternative to the ACA, it is still not too late for this Congress to pass health care reform legislation…
What united the fractured Democratic members (on ObamaCare) was that they were unified in their desire to pass something that would move the country in the direction of more government control over health care, with fewer individual choices. They differed greatly on the details, and on how far they wanted to push the agenda in that first step. But their agreed on the need to pass something.
Republicans have spent every election cycle since 2010 promising voters that they will push health care in the other direction – favoring more choice and less regulatory control, and as a result, lower costs. With that campaign agenda, they captured the House, then the Senate, and finally the Presidency. Now, with numerous proposals about how to proceed, can they at least agree on the need to pass something?
It doesn’t have to be perfect. It just has to be better than what we have now. With so many American paying so much money for so little in return, that’s really not such a high bar. “(M)

“The Trump administration is slashing spending on advertising and promotion for enrollment under the Affordable Care Act, a move some critics charged was a blatant attempt to sabotage the law.
Officials with the Department of Health and Human Services, who insisted on not being identified during a conference call with reporters, said on Thursday that the advertising budget for the open enrollment period that starts in November would be cut to $10 million, compared with $100 million spent by the Obama administration last year, a drop of 90 percent. Additionally, grants to about 100 nonprofit groups, known as navigators, that help people enroll in health plans offered by the insurance marketplaces will be cut to a total of $36 million, from about $63 million.
The officials said the administration believed that the cuts were necessary because of “diminishing returns” from advertising…” (N)

Senate Republicans will soon run out of time to rely on their slim majority to dismantle the Obama health law.
The Senate parliamentarian has determined that rules governing the effort will expire when the fiscal year ends Sept. 30, according to independent Sen. Bernie Sanders of Vermont, the ranking member of the Senate Budget Committee. The rules allow Republicans to dismantle President Barack Obama’s health care law with just 51 votes, avoiding a filibuster.
Republicans control the Senate 52-48 and were using the special filibuster-proof process in the face of unified Democratic opposition. Now, if Republicans can’t revive the repeal measure in the next four weeks, they will be forced to work with Democrats to change it.” (O)

(A) on Health Care, by David A. Graham, https://www.theatlantic.com/politics/archive/2017/07/as-i-have-always-said-trumps-ever-changing-position-on-health-care/535293/
(B) 3 promises Trump made about health care that repeal plans haven’t kept, by Eliza Collins, https://www.usatoday.com/story/news/politics/2017/06/24/promises-trump-made-health-care-repeal-plans/426089001/
(C) Trump Demands That Senators Find a Way to Replace Obamacare, By JULIE HIRSCHFELD DAVIS, THOMAS KAPLAN and MAGGIE HABERMAN, https://www.nytimes.com/2017/07/19/us/politics/donald-trump-obamacare-health-care-republicans-senators.html?mcubz=0
(D) As Health Care Bill Stalls, Trump Calls For Outright Repeal Of Obamacare, Nick Visser, http://www.huffingtonpost.com/entry/trump-health-care-bill-response_us_596d719ee4b010d7767345ff
(E) Trump’s Threats on Health Law Hide an Upside: Gains Made by Some Insurers, by REED ABELSON, https://www.nytimes.com/2017/08/26/health/obamacare-market-insurance.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(F) Looking Beyond the Obamacare Debate to Improve Health Care, https://www.nytimes.com/2017/08/26/opinion/sunday/obamacare-universal-health-coverage.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(G) Senate GOP trio offer another Obamacare repeal plan that deserves to fail, https://bangordailynews.com/2017/08/28/opinion/editorials/senate-gop-trio-offer-another-obamacare-repeal-plan-that-deserves-to-fail/?ref=OpinionBox
(H) The Senate Tests a New Approach on Obamacare: Bipartisanship, by RUSSELL BERMAN, https://www.theatlantic.com/politics/archive/2017/08/the-senate-tries-a-new-approach-on-obamacare-bipartisanship/538083/
(I) Trump Administration Wants to Stabilize Health Markets but Won’t Say How, by By ROBERT PEARAUG, https://www.nytimes.com/2017/08/30/us/politics/trump-obamacare-enrollment-markets-subsidies.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(J) 5 Outside-The-Box Ideas For Fixing The Individual Insurance Market, by Julie Rovner, http://khn.org/news/5-outside-the-box-ideas-for-fixing-the-individual-insurance-market/
(K) John Hickenlooper, Ohio Gov. John Kasich release their bipartisan plan to address health care, by JESSE PAUL, http://www.denverpost.com/2017/08/31/john-hickenlooper-ohio-gov-john-kasich-release-their-awaitied-bipartisan-plan-to-address-health-care/
(L) Minnesota Finds a Way to Slow Soaring Health Premiums, by ROBERT PEAR, https://www.nytimes.com/2017/09/02/us/politics/minnesota-health-care-reinsurance.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(M) It’s Not Too Late To Reform Health Care – The ACA Took Longer, by Robert Book, https://www.forbes.com/sites/theapothecary/2017/08/31/its-not-too-late-to-reform-health-care-the-aca-took-longer/2/#5aadf4ba1c7b
(N) Trump Administration Sharply Cuts Spending on Health Law Enrollment, by ABBY GOODNOUGH and ROBERT PEAR, https://www.nytimes.com/2017/08/31/health/affordable-care-act-trump-spending.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(O) GOP ability to dismantle health law expires at month’s end, http://abcnews.go.com/Politics/wireStory/gop-ability-dismantle-health-law-expires-months-end-49571509

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Opioid Crisis. ““We got here in part because there was a paper done in the 1980s by a well-meaning physician that said opioids are not addictive….

… and they should not be withheld from anybody with acute or chronic pain,”
“Then we came out with the fifth vital sign, that every physician was held to the standard that we would do pain scores on everyone. Based on those studies, we couldn’t restrict opioids at all. In fact, physicians from a New England state went to jail because they did not prescribe opioids for somebody with severe pain.
“This hit the medical community like a bombshell, and therefore it was easy to give opioids.”
As it turns out, it was just one of the contributing factors.
Another was the way the treatment of pain was recorded, through Press Ganey customer satisfaction scores.
“In this state and other states, the fifth vital sign became the standard of care,” Rosenberg said. “If you have pain, we have to treat it. And the goal was to get you to zero on the pain scale.
“So, if you came into my emergency department or you went to the dentist, our options for treatment were either to give you Motrin or Tylenol, something benign or easy, or I just go all out and give you opioids.”” (A)

“In December 1995, Purdue received FDA approval for Oxycontin, an opioid which was itself supposed to deter abuse, through its allegedly rush-curbing, time-release formulation. Purdue lacked anything in the way of persuasive evidence for this claim at the time, and later studies would debunk it entirely, but, as detailed in Barry Meier’s Pain Killer, that didn’t stop the FDA from allowing them to include it in the drug’s labeling—an unprecedented decision which, in Meier’s words, “threw open the door to the drug’s widespread marketing,” and in turn generated precisely the catastrophic conditions which brought us there, to that Sheraton, in the first place.” (B)

“For the last 20 years, the pharmaceutical industry has been whitewashing the lasting impact of highly addictive narcotics through its use of marketing, effectively encouraging doctors and other providers to prescribe these powerful drugs in increasing, extremely dangerous levels.
In other words, Big Pharma found a way to turn a profit at the expense of American lives. By misleading doctors to overprescribe a drug powerful enough to treat the level of pain endured by patients recovering from major surgery for more routine issues, Big Pharma made possible the addiction of thousands in Philadelphia alone. But it doesn’t stop at prescription pills manufactured and distributed by these companies.
When that prescription runs out — and it will — users who are dependent are often drawn to a substance far less expensive and, unfortunately, extremely accessible on the black market: heroin…” (C)

NO FORMAL DECLARATION OF NATIONAL OPIOID EMERGENCY YET!
Two weeks ago, President Trump declared the opioid crisis a national emergency and called it “a serious problem the likes of which we have never had.”
“We’re going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis,” the president insisted.
But so far, Trump hasn’t formally signed such a declaration and sent it to Congress.
And that means the millions the executive branch could direct towards expanding treatment facilities — or supplying police officers with the anti-overdose remedy naloxone — aren’t going anywhere because Trump has not yet followed through.
A White House spokesperson would not say when Trump would get around to it.
“The president recently instructed his administration to take all appropriate measures to confront the opioid crisis,” the spokesperson said. “Right now these actions are undergoing an expedited legal review.”” (D)

“The president’s budget ignores the findings of addiction treatment research. Recently Price suggested that Medication Assisted Treatment (MAT) was not the best way to treat opioid use disorder by saying, “if we just simply substitute buprenorphine or methadone or some other opioid-type medication for the opioid addiction, then we haven’t moved the dial much…”” (E)

MORE CONSEQUENCES
““Too many people with migraines are prescribed potentially addictive opiate painkillers, while too few may be getting recommended medications, a new study suggests.
Researchers found that of nearly 2,900 Americans who visited the doctor for migraine relief, 15 percent were prescribed opioids such as oxycodone (OxyContin or Percocet) or hydrocodone (Norco, Vicoprofen).
That’s despite the fact that the drugs should really be used only as a “last resort,” said study lead researcher Dr. Larry Charleston IV.” (F)

The number of kids placed in foster care continues to increase as the opioid crisis worsens in Ohio, but there aren’t enough foster care families to meet the need.
It’s a heartbreaking problem, many people probably don’t realize is happening all around them. There are more than 15,000 kids in Ohio’s foster care system, but only 7,200 families to take them in. (G)

The nation’s opioid crisis has hit hard in Maine, where at least one person died every day last year of drug overdoses.
It’s also penetrated the state’s lobster industry. Some fishermen are suffering in silence in a community that rarely asks for help.
Josh Kane has spent more than 15 years fishing off the coast of Maine. For 10 of those years, he struggled with an opioid addiction as his fellow lobstermen looked the other way.
“It’s one of those things that’s kind of like, ‘Don’t ask, don’t tell,'” Kane said. “As long as you show up every day and do your job, nobody is really going to say anything.”
They’re a tough, proud and private bunch with grueling hours and serious, physical demands. But the payoff can easily be in the six-figure range for the short summer season. (H)

In an unrelenting opioid epidemic, hepatitis C is infecting tens of thousands of mostly young, white injection drug users, with the highest prevalence in the same Appalachian, Midwestern and New England states that are seeing the steepest overdose death rates.
Like the opioid epidemic that is driving it, the rate of new hepatitis C cases has spiked in the last five years. After declining for two decades, new hepatitis C cases shot to an estimated 34,000 in 2015, nearly triple the number in 2010, according to a recent report from the U.S. Centers for Disease Control and Prevention (CDC).
With better screening for the bloodborne disease and more treatment using costly but highly effective new drugs, hepatitis C could be eradicated, according to a new study from the National Academies of Sciences, Engineering, and Medicine…
“We have two public health problems that are related — it’s called a syndemic — and we can’t address one without addressing the other,” said James Galbraith, an emergency room physician at the University of Alabama at Birmingham Hospital. (I)

SOLUTIONS
“Virginia Governor Terry McAuliffe announced his state’s drive to stem the state’s opioid addiction problem by crunching healthcare data. The move is the latest in a series of efforts by governments and large healthcare organizations to get a handle on the problem.
The governor’s announcement comes amid widespread concern over a deepening addiction crisis, with the state’s commissioner of health declaring opioid and heroin overdoses a public health emergency last year.
Using data currently being collected by interns from George Washington University and George Mason University, 15 teams will collaborate with a variety of subject matter experts to develop solutions to the myriad challenges facing communities and the commonwealth.
“We know that if collected and used correctly, data can help us fight this opioid epidemic by identifying the communities and populations that are most vulnerable,” said Virginia Secretary of Health and Human Resources Dr. Bill Hazel.”” (J)

“The good news is that many technology-based alternatives to opioids are already available. Spinal cord stimulation is an underutilized pain management alternative for patients struggling with chronic pain. This implanted pacemaker-like device is shown to effectively manage pain while significantly reducing opioid use. Regional pain pumps are a promising alternative for acute pain. They deliver local, non-opioid anesthetics directly to nerves feeding the surgical site, and can provide significant pain relief for several days after a procedure. These types of technologies enable what is known as multi-modal pain control, promoting a combination of devices and analgesics that have a low risk of addiction, such as ibuprofen, to manage pain – thus reserving opioids as a last resort.
But, weighing the value of these alternatives requires a shift in thinking that prioritizes investment in opioid avoidance. Today, these alternatives are often viewed as financially unviable or cumbersome to implement. And newer technologies that show promising initial results face even greater barriers. When not given a choice, clinicians have no other option but opioids. We must now create the pathways that facilitate alternative treatments.” (K)

(A) The opioid discussion: In the beginning — How did we get here? How did we become the nation with the biggest (perhaps the only) problem with opioid abuse?, http://www.njbiz.com/apps/pbcs.dll/article?AID=/20170814/NJBIZ01/170819953/the-opioid-discussion-in-the-beginning–how-did-we-get-here-how-did-we-become-the-nation-with-the-biggest-perhaps-the-only-problem-with-opioid-abuse&template=mobileart
(B) Why the FDA Can’t Fix the Opioid Crisis, by Daniel Kolitz, http://gizmodo.com/why-the-fda-cant-fix-the-opioid-crisis-1797950053
(C) Big Pharma must be held accountable for its role in opioid crisis, by Joe Torsella, http://www.philly.com/philly/opinion/commentary/big-pharma-must-be-held-accountable-for-its-role-in-opioid-crisis-20170828.html
(D) Trump Calls Opioid Crisis a National Emergency But Still Hasn’t Made It Official, by ALI VITALI and CORKY SIEMASZKO, https://www.nbcnews.com/storyline/americas-heroin-epidemic/trump-calls-opioid-crisis-national-emergency-still-hasn-t-made-n795351
(E) Trump and Tom Price are making it harder to combat opioid epidemic, BY RICHARD G. FRANK AND KEITH HUMPHREYS, http://thehill.com/blogs/pundits-blog/healthcare/348315-trump-and-tom-price-are-making-it-harder-to-combat-opioids
(F) Many Migraine Patients Given Unnecessary Opioids, Addictive painkillers should be treatment of last resort, headache expert says, by Amy Norton, http://www.webmd.com/migraines-headaches/news/20170825/many-migraine-patients-given-unnecessary-opioids#1
(G) Opioid crisis leaves thousands of kids trapped in foster care, by Shelby Miller, http://m.cleveland19.com/19actionnews/db_348172/contentdetail.htm?contentguid=sIfgvu2E
(H) Opioid crisis takes toll in Maine lobster industry, by Kenneth Craig, https://www.cbsnews.com/news/opioid-crisis-maine-lobster-industry/
(I) With Opioid Crisis, A Surge In Hepatitis C, By Christine Vestal, http://www.huffingtonpost.com/entry/with-opioid-crisis-a-surge-in-hepatitis-c_us_59a41ed5e4b0a62d0987b0c4
(J) Virginia turns to data analytics to fight opioid crisis; Intermountain Healthcare EHR effort cuts prescriptions, by Matt Kuhrt, http://www.fiercehealthcare.com/technology/virginia-turns-to-data-to-solve-opioid-crisis
(K) Are We Doing All We Can to Stop the Opioid Crisis?, by Cummings, http://health.usnews.com/health-care/for-better/articles/2017-08-31/are-we-doing-all-we-can-to-stop-the-opioid-crisis

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