When it comes to healthcare coverage in the US….well, let’s just say it hasn’t had a historically smooth path. Among the political debates have been to whom the government should provide aid, how much, and how for how long…but everyone agrees that children should be have health insurance. Politically speaking, they are an easy group to support.
CHIP, The Children’s Health Insurance Program, was created in 1997 as part of the Balance Budget Act of 1997. By 2000, every state had enrolled in CHIP-financed coverage. The cost of the program is split between states and the federal government via a formula called the Medicaid Federal Medical Assistance Percentage. But the split is actually more 71-29ish than 50-50, as Congress had also enhanced funding to match 15% more than what a state would cover–basically giving states a bigger incentive to enroll in the program.
Funding for CHIP expired on September 30th. The Affordable Care Act extended CHIP and further enhanced the federal matching rate, which should have continued through September 2019. Many states relied on this in their budgeting, and will face huge shortage if Congress does not extend federal funding.While Congress tries to pass legislation to rescue the program, states like Minnesota and Utah have already applied for emergency funding, and 27 additional states are expected to need more funds by March.
Legislation went through the Senate earlier today, but financial negotiations will need to be sorted across party lines before the vote can pass in the House.
Kaiser Health News is a reliable source to stay up-to-date on the progress of the bill. It’s unlikely that a final decision will be made before the end of this month, but the bottom line is–nearly 9 million children’s insurance status depends on a successful resolution of this bill.
This week I was reminded of the things I take for granted on a daily basis. This week I considered the luxuries I expect access to and consider a right. This week marks the second week that many citizens of the US territory of Puerto Rico lack access to clean drinking water and food.
Hurricane Maria left Puerto Rico in devastation. Before the category 4 storm hit on September 20th, the governor, Ricardo Rossello, knew that disaster was imminent releasing this video just 5 hours before impact. What no one knew, was the severity of the damage this storm would cause. Generally, after a natural disaster, the public hears about breakdowns in infrastructure and property damage. What is often missing from the conversation is a focus on health. Today, many Puerto Ricans endure the stress of not knowing from where their next meal will come. Although aid has made it to the Puerto Rican shores, many supplies remain undistributed because of damaged roads and a lack of fuel. Fuel is very important in the aftermath of natural disasters because it is needed to distribute food and medical supplies. It also allows medical staff to reach hospitals to deliver much-needed care to those in need.
It is important to consider how natural disasters affect health outcomes. Food, water, and fuel are essential for survival. The citizens of Puerto Rico are devastated but not in despair. Hope remains high and citizens are determined to rebuild.
This past week, CVS pharmacy announced another step in their response to the country’s ongoing opioid epidemic. They are expanding medication disposal options, by adding over 700 in store disposal units across the country. They also announced an expanded pharmacist counseling session for those prescribed opioids for the first time, to highlight the risks of addiction and dependence, while answering any patient questions. The CVS Health Foundation has additionally pledged $2 million to support federally qualified community health centers that deliver medication-assisted treatment.
On top of all of this, they have announced that they are limiting the prescription of opioids to seven days for acute prescriptions, limiting daily dose strengths, and requiring that immediate-release formulations of opioids to be used before prescribing extended release options. Not only does this make their practices consistent with recent CDC guidelines, but also as the largest pharmacy in the United States, CVS taking a stronger stance to limit the excess prescribing of opioids could set a precedent in the role that pharmacies play in the opioid crisis.
To combat this epidemic, we need buy in from facets of the medical industry, from individual doctors to health care systems, insurance companies and pharmacies, medication manufacturers and government officials. I commend CVS on their stance to address their role in this crisis, and hope that it serves as a moment of recognizing responsibility for this crisis. If we use evidence based interventions, and partnerships from behavioral health, to medicine, and governmental agencies, we can begin to reduce opioid dependence and addiction, and see a decrease in those lost to overdose.
CVS Health Press Release – https://cvshealth.com/thought-leadership/cvs-health-enterprise-response-opioid-epidemic/cvs-health-responds-to-nations-opioid-crisis
CDC Opioid Prescribing Guidelines – https://www.cdc.gov/drugoverdose/prescribing/guideline.html
Earlier this week the CDC released a study that shined light upon the real impact the opioid epidemic has had on the American population. According to their study published in the Journal of the American Medical Association (JAMA), the average life expectancy of American’s has gone down for the first time in a quite a while. This kind of statistical anomaly has not been seen since the early 90’s when the AIDS epidemic was at its peak.
The number of deaths from opioid overdose has nearly doubled between 2009-2015. Dr. Deborah Dowell, Senior Medical Advisor in the Division of Unintentional Injury at the CDC, analyzed the data and found that opioid overdose contributed to decreased life expectancy more than Alzheimer’s, chronic liver disease, and unintentional accidents (which included car accidents) combined.
I knew the opioid epidemic, was, well, an epidemic, but this definitely put it into perspective for me. Do you know someone who has suffered from the opioid epidemic? Or maybe know someone who knows someone? Odds are, you do. Regardless, spreading the word can only help.
What resources do you know of that are dedicated solving this problem? The more information we spread the greater impact we can have!
There has been a lot of buzz around “DACA” the last couple days; which has left many of us wondering, “what is DACA?” The Deferred Action for Childhood Arrival program, or DACA, was enacted by the Obama Administration in June 2012. The program
The program had granted undocumented immigrant children, who entered the U.S. before their 16th birthday, a renewable two-year deportation protection and work permit while they either worked, attended school, or served in the military. However, it did not provide lawful status to those within the program.
DACA had nearly 800,000 immigrants enrolled in the program before President Trump ended the program this week. Survey data shows that 91% of those in the DACA program were currently employed and that number goes up to 93% for those 25 and older.
While some have thought President Trump did this to open up more jobs for American citizens, it is obvious there was not much thought given to those who are currently enrolled in DACA. Now, without DACA, the enrollees have to reevaluate everything they had planned for their lives. How will they be able to work to provide for their family? How will they pay for schooling? How will they be eligible to keep their position in the military?
Yesterday was the 16th anniversary of the 9/11 Terror Attack, and like many Americans I can easily recount where I was at when I saw the coverage of the attack. The event dominated news media for weeks after the events unfolded, and became enshrined as a defining moment of 21st century America.
I cannot even begin to fathom the first hand experiences of people who directly impacted from the attack, but for many, the day is a permanent memory of the way they felt, perceived, and witnessed everything unfold.
Secondary Traumatic Stress occurs when an individual hears the recounting of another’s traumatic life event. Often, the symptoms are similar to that of the more commonly known Post Traumatic Stress Disorder, or PTSD. In recent years, there has been more research being done to see the effects of disasters that affect those beyond those immediately experiencing an event.
In the wake of the recent disasters of Hurricane Harvey and Irma, we have seen coverage of their destruction everywhere from major news sources to the social media that we consume for updates from loved ones. A recent New York Times piece noted that the Weather Channel, being the only network to provide 24/7 access to coverage of the recent Hurricanes, had seen its audience increase nearly tenfold. The coverage of these storms has been vast, because the scale of the destruction of these storms has been unprecedented.
Covering these events is vital, it is important that we do not sensor the news that we receive just because of the harmful effects that it may have on us. But, by being more aware, and staying informed, we can acknowledge the way that having information so freely available can help us to cope, and hopefully heal, together.
New York Times Piece: https://www.nytimes.com/2017/09/09/business/media/weather-channel-hurricane-irma.html?_r=0
Secondary Traumatic Stress: http://www.nctsn.org/resources/topics/secondary-traumatic-stress
In recent weeks, there have been several catastrophic natural disasters. Arshya recently wrote about the public health aftermath of such disasters. Recovery from natural disasters must be comprehensive in that the safety, sanitation, and welfare of the people, animals, infrastructure, and environment of the affected communities must be addressed.
It is likely that you or someone you know has been impacted by the hurricanes or earthquake, which might leave you wondering how you can help. If you cannot provide time, many local, national, international, and online organizations will accept your donations. Before committing your resources, take a few minutes to do a little research to check whether a charity is legit. Charity Navigator is a trusted source for identifying organizations responding to natural disasters.
The Federal Trade Commission (FTC) offers additional tips for wise giving after natural disasters:
- Be wary of charities that seem to have appeared overnight.
- Stick to charities that have a proven track record for dealing with disasters.
- Designate the disaster so that your funds will be used directly instead of going in to a general fund.
- When texting to donate, confirm the number with the source. Charges will show up on your phone bill but donations may not be immediate.
The FTC also offers tips for those affected by natural disasters:
- Be skeptical of people or groups promising immediate clean-up or debris removal. Some may offer overly priced quotes for work, demand payment before ever doing work, or lack the necessary licenses or skills to complete the work.
- Be on the lookout for rental listing scams that ask for sending money before actually visiting the property.
- You may need to share personal information to gain access to resources, so make sure you know exactly who you are dealing with before sharing your social security number or financial information.
Federal Trade Commission. FTC Advise for Helping Hurricane Harvey Victims. August 28, 2017. https://www.ftc.gov/news-events/press-releases/2017/08/ftc-advice-helping-hurricane-harvey-victims
Hurricane Harvey hit Texas hard last week. CNN says it was the strongest hurricane since Charlie hit the Southeast in 2004 (they have also shared some striking images of the damages and flooding if you want to click that link). New sources today have the current casualty total at least 70. As entire communities of people regather and begin to rebuild their lives, there are concerns to consider beyond immediate damage. Times of chaos, grief, and mass movement are ripe for poor health conditions. What health problems do hurricanes leave behind?
NPR interviewed Dr. Ruth Berggren, an infectious disease specialist who has had a lot of experience treating patients post-natural disasters. After all, she was a physician in New Orleans when Hurricane Katrina hit in 2005, and has been dealing with the aftermath of Hurricane Harvey this week. She talks about violence, mental health, and infectious diseases issues as being of particular concern in the immediate aftermath of such a storm.
According to the New York Post, Harvey sunk the crest of the Earth by about 0.75 inches! Combine that heavy water burden with people living in close proximity in emergency shelters in less than ideal hygienic conditions, and you can see why the IDSA (Infectious Diseases Society of America) is concerned with the spread of viruses. In particular, they are worried about infections that spread quickly like norovirus, and those that might affect unvaccinated populations who now have more exposure to pathogens. This is especially concerning as mosquitoes, temporarily scared off by the storm, come back to stagnant water, possibly carrying diseases with them. Access to medications to treat chronic illnesses is also expected to be more difficult. For some populations, like those living with HIV, it’s really important not to disrupt treatment. Finally going home to mold and disarray increases the likelihood of asthma and respiratory tract illnesses.
The Carribean Islands, currently facing similar conditions as Hurricane Irma unfolds, are witnessing similar public health crises.
As we hope for a quick and wholesome recovery to those affected by these storms, consider donating if you can—this NYT article links to some organizations, both local and national, that are gathering funds.
Unless you have been living under a rock the past few months you are well aware of the social tension amongst citizens of the United States. Don’t get me wrong, it has never been ideal, but since the election of President Trump, we have been a country far from united.
In the first month following the 2016 election, there were over 1,000 race-related incidents. While the monthly rates have decreased, the overall occurrence of these incidents continues daily. I’m not here to take sides or point fingers, but instead, look at hate crimes from an often overlooked perspective.
The psychological and physiological damage accumulated by those who face routine discrimination is now considered by many as a public health concern in and of itself. Data from the American Psychological Association shows the impact of discrimination and racism can increase rates of chronic stress, depression, and anxiety; while a meta-analysis compiled by Cambridge University has shown it increases rates of the common cold, hypertension, cardiovascular disease and breast cancer.
While data continues to develop, it is now obvious how snide remarks and hateful actions do much more than simply hurt feelings. In times like these, it’s important to take an introspective look and ask what we are doing in response to this climate of hate.
Dr. Martin Luther King Jr. said it best, “Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.”
As Hurricane Harvey continues to do damage in Texas, social media demonstrates its strong and rather novel role in times of crisis. The National Weather Service, the Coast Guard, and Houston Police have all taken to Twitter to disseminate emergency safety information. And those in need of help have been tweeting back—providing their locations and pleading for rescue. With emergency help lines overwhelmed and often ringing busy for hours, taking to Twitter or connecting through a Facebook group like “Hurricane Harvey Helping Hands” may feel like the strongest action available to self-advocate and ask for help from both official channels and private.
In comparing the communication during Hurricane Harvey to past large-scale storms such as Katrina, the utilization of social media to connect and pinpoint location stands out in my mind as a promising and potentially life-saving advancement.
From here in North Carolina, our hearts go out to those in Texas.