In Grandma’s Stocking: An Apple Watch To Monitor Falls, Track Heart Rhythms
By Rachel Bluth, Kaiser Health News For more than a decade, the latest Apple products have been the annual must-have holiday gift for the tech-savvy. That raises the question: Is the newest Apple Watch on your list — either to give or receive — this year? At first glance, the watch appears to be an ideal present for Apple’s most familiar market: the hip early adopters. Its promotional website is full of svelte young people stretching into yoga poses, kickboxing and playing basketball. But when Apple unveiled its latest model in September — the Series 4, which starts at $399 — it was clear it was expanding its target audience. This Apple Watch includes new features designed to detect falls and heart problems. With descriptions like “part guardian, part guru” and “designed to improve your health … and powerful enough to protect it,” the tech giant signaled its move toward preventive health and a much wider demographic. “The health care market is obviously important to Apple,” Andy Hargreaves, an Apple analyst with KeyBanc Capital Markets, wrote in an email. The fall prevention and electrocardiogram apps are a “play to sell people more stuff” and bring health-monitoring apps beyond just “fitness people” to baby boomers who want to keep themselves and their parents healthy, he added. This watch could be a perfect present for those older people, said Laura Martin, a senior analyst with Needham. “People who wore watches their whole lives, plus fall monitoring?” Martin said. “Voilà! It creates another on-ramp for another consumer in the Apple ecosystem.” The Inner Workings The fall-monitoring app uses sensors in the watchband, which are automatically enabled for people 65 and older after they input their age. These sensors track and record the user’s movements, and note if the wearer’s gait becomes unsteady. If a fall is detected, the watch sends its wearer a notification. If the wearer doesn’t respond within a minute by tapping a button on the watch to deactivate this signal, emergency services will be alerted that the wearer needs help. That minute also gives the wearer time to prevent false alarms, such as a dropped watch. Many geriatricians and medical experts agree that this app could help older consumers. Falls can cause fractured hips and head injuries, but even fear of falling can prevent older people from living on their own or participating in activities. Fall deaths in the U.S. increased 30 percent for older adults in the past decade, and 3 million older people go to the emergency room for fall injuries each year, according to the Centers for Disease Control and Prevention. Dr. Armin Shahrokni, an internist with Memorial Sloan Kettering Cancer Center who describes himself as “tech-savvy,” is excited that older patients might get into wearable technology. “In older cancer patients, my area of expertise, all the chemo can make them fall more,” he said, making detecting falls and balance important. The other app, the ECG monitoring app, also uses sensors in the wristband to monitor a patient’s heartbeat and send alerts if it gets too fast or too slow. Specifically, the app is meant to detect atrial fibrillation, which is a type of arrhythmia, also described as a problem with the speed or rhythm of the heartbeat. Here is how the app works: The watch’s sensors can detect a heart rhythm in 30 seconds, creating a “waveform” readout. It also allows the user to note how they are feeling — lightheaded, winded, full of energy — at that moment. This combination, according to Apple, will help people have better conversations with their doctors about symptoms and heart patterns. The Food and Drug Administration cleared this function for people 22 or older. However, it’s rare for anyone younger than 50 to be diagnosed with atrial fibrillation, noted Eric Topol, a cardiologist at the Scripps Research Institute. Doctors have expressed concern that scores of panicked Apple Watch users would flood emergency rooms with every heart rhythm notification and blip. “It’s mass use of a tool, and with that is going to come lots of unintended consequences,” Topol said. “It’ll lead to a lot of anxiety and expense and additional testing, and even then some people will get blood thinners inappropriately,” he added. “This is the opposite of individualized medicine, where you are using something on exactly, precisely the right person,” Topol said. Wearables Unleashed The watch represents the beginning of what analysts agree will be a wave of new health apps and wearable health trackers. Consumers can expect more ways to track vital signs, like blood sugar, and more apps that will use those numbers to help people prevent medical emergencies, said Ross Muken, an analyst with Evercore ISI. While health tracking isn’t a new concept, putting that data into an algorithm to help change behavior and get ahead of a health crisis is the next big frontier for wearable health technology products. Experts caution, though, that while the FDA “cleared” these new apps, it hasn’t actually “approved” them, which is a bureaucratic distinction that means they haven’t faced as much rigorous testing as something that has gained the agency’s formal OK. For example, there are no findings from studies or trials that offer evidence of the fall prevention or ECG apps’ benefits, Topol said. “We don’t have any data to review. These are unknowns.” Someday, he added, he expects the “medicalized smartphone” to be more common, cheaper and accessible to seniors. Right now we’re seeing the very beginning of this technology be put into use. “Technology is way ahead of medical practice,” Topol said. This story originally appeared on Kaiser Health News Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
Missouri Travel Nurse Needs Remain High In Wake Of Slow Flu Season
Missouri travel nurse needs have remained at a significantly high number throughout November and the first week of December, according to current market data. More than 140 travel nurse needs are active in the state, most of which are newer positions located in or around the St. Louis region, said Jennifer Pomietlo, a director of client advisory for LiquidAgents Healthcare. That includes cities like St. Charles, Chesterfield and Columbia. The most-needed specialties include medical-surgical, telemetry, ICU, step-down and OR nurses, with limited openings for other non-core or surgical specialties, Pomietlo said. Allied healthcare travel positions are also fairly limited, but certified surgical tech and rad tech opportunities are available. Contact Allie Evans with LiquidAgents Healthcare for more information about Missouri travel nurse jobs >> Flu is the main driver for hiring in the state, Pomietlo said. Normally, Missouri hospitals will aggressively hire in early fall because the state is one of a handful that typically see high levels of flu activity starting in November, according to Centers for Disease Control and Prevention records. This year’s flu season is off to a slower start for the state, with “minimal” influenza-like illness activity and sporadic spread, according to CDC data. A total of one death and 1,384 laboratory-positive influenza cases have been reported as of Nov. 24 to the Missouri Department of Health and Senior Services (DHSS). More than 300 cases were reported from the eastern region of the state, where St. Louis is located. Missouri hospitals are hiring in December in anticipation of a delayed surge in flu patient census in January and February, Pomietlo said. “They get hit hard by the flu in St. Louis, and it also hangs around longer in Missouri than in other places,” Pomietlo said. In the record-breaking 2017-18 flu season, Missouri reported 133,957 laboratory-confirmed cases of flu and more than 2,000 pneumonia and influenza-associated deaths, according to a DHSS press release. Other things travelers should know about Missouri Missouri is one of the 31 states that are part of the enhanced Nursing Licensure Compact, meaning nurses who have a compact license can work in the state without paying additional licensing fees. Travelers who don’t have a compact license can get a single state license at a low cost. The state board charges $55 for a license by endorsement or $45 by examination. Missouri is also a walk-through state, so nurses can get a temporary license within a day. You can find more Missouri licensing information on the state nursing board website.
Overshadowed By Opioids, Meth Is Back And Hospitalizations Surge
By Anna Gorman, Kaiser Health News The number of people hospitalized because of amphetamine use is skyrocketing in the United States, but the resurgence of the drug largely has been overshadowed by the nation’s intense focus on opioids. Amphetamine-related hospitalizations jumped by about 245 percent from 2008 to 2015, according to a recent study in the Journal of the American Medical Association. That dwarfs the rise in hospitalizations from other drugs, such as opioids, which were up by about 46 percent. The most significant increases were in Western states. The surge in hospitalizations and deaths due to amphetamines “is just totally off the radar,” said Jane Maxwell, an addiction researcher. “Nobody is paying attention.” Doctors see evidence of the drug’s comeback in emergency departments, where patients arrive agitated, paranoid and aggressive. Paramedics and police officers see it on the streets, where suspects’ heart rates are so high that they need to be taken to the hospital for medical clearance before being booked into jail. And medical examiners see it in the morgue, where in a few states, such as Texas and Colorado, overdoses from meth have surpassed those from the opioid heroin. Amphetamines are stimulant drugs, which are both legally prescribed to treat attention deficit hyperactivity disorder and produced illegally into methamphetamine. Most of the hospitalizations in the study are believed to be due to methamphetamine use. Commonly known as crystal meth, methamphetamine was popular in the 1990s before laws made it more difficult to access the pseudoephedrine, a common cold medicine, needed to produce it. In recent years, law enforcement officials said, there are fewer domestic meth labs and more meth is smuggled in from south of the border. As opioids become harder to get, police said, more people have turned to meth, which is inexpensive and readily available. Lupita Ruiz, 25, started using methamphetamine in her late teens but said she has been clean for about two years. When she was using, she said, her heart beat fast, she would stay up all night and she would forget to eat. Ruiz, who lives in Spokane, Wash., said she was taken to the hospital twice after having mental breakdowns related to methamphetamine use, including a monthlong stay in the psychiatric ward in 2016. One time, Ruiz said, she yelled at and kicked police officers after they responded to a call to her apartment. Another time, she started walking on the freeway but doesn’t remember why. “It just made me go crazy,” she said. “I was all messed up in my head.” The federal government estimates that more than 10,000 people died of meth-related drug overdoses last year. Deaths from meth overdose generally result from multiple organ failure or heart attacks and strokes, caused by extraordinary pulse rates and skyrocketing blood pressure. In California, the number of amphetamine-related overdose deaths rose by 127 percent from 456 in 2008 to 1,036 in 2013. At the same time, the number of opioid-related overdose deaths rose by 8.4 percent from 1,784 to 1,934, according to the most recent data from the state Department of Public Health. “It taxes your first responders, your emergency rooms, your coroners,” said Robert Pennal, a retired supervisor with the California Department of Justice. “It’s an incredible burden on the health system.” Costs also are rising. The JAMA study, based on hospital discharge data, found that the cost of amphetamine-related hospitalizations had jumped from $436 million in 2003 to nearly $2.2 billion by 2015. Medicaid was the primary payer. “There is not a day that goes by that I don’t see someone acutely intoxicated on methamphetamine,” said Dr. Tarak Trivedi, an emergency room physician in Los Angeles and Santa Clara counties. “It’s a huge problem, and it is 100 percent spilling over into the emergency room.” Trivedi said many psychiatric patients are also meth users. Some act so dangerously that they require sedation or restraints. He also sees people who have been using the drug for a long time and are dealing with the downstream consequences. In the short term, the drug can cause a rapid heart rate and dangerously high blood pressure. In the long term, it can cause anxiety, dental problems and weight loss. “You see people as young as their 30s with congestive heart failure as if they were in their 70s,” he said. Jon Lopey, the sheriff-coroner of Siskiyou County in rural Northern California, said his officers frequently encounter meth users who are prone to violence and in the midst of what appear to be psychotic episodes. Many are emaciated and have missing teeth, dilated pupils and a tendency to pick at their skin because of a sensation of something beneath it. “Meth is very, very destructive,” said Lopey, who also sits on the executive board of the California Peace Officers Association. “It is just so debilitating the way it ruins lives and health.” Nationwide, amphetamine-related hospitalizations were primarily due to mental health or cardiovascular complications of the drug use, the JAMA study found. About half of the amphetamine hospitalizations also involved at least one other drug. Because there has been so much attention on opioids, “we have not been properly keeping tabs on other substance use trends as robustly as we should,” said study author Dr. Tyler Winkelman, a physician at Hennepin Healthcare in Minneapolis. Sometimes doctors have trouble distinguishing symptoms of methamphetamine intoxication and underlying mental health conditions, said Dr. Erik Anderson, an emergency room physician at Highland Hospital in Oakland, Calif. Patients also may be homeless and using other drugs alongside the methamphetamine. Unlike opioid addiction, meth addiction cannot be treated with medication. Rather, people addicted to the drug rely on counseling through outpatient and residential treatment centers. The opioid epidemic, which resulted in about 49,000 overdose deaths last year, recently prompted bipartisan federal legislation to improve access to recovery, expand coverage to treatment and combat drugs coming across the border. There hasn’t been a similar recent legislative focus on methamphetamine or other drugs. And there simply aren’t enough resources devoted
Travel Healthcare Market: Openings, Competition High For Colorado Winter Jobs
A lot of healthcare travelers like to fly south for the winter, but there are still plenty who are looking for cold temperatures, snowy climates or a quick-start position with extension potential. For those reasons, Colorado has been a highly desired winter assignment destination in previous years, and 2018 is no exception. Agencies are seeing triple-digit needs for travel nurses and surgical techs across a wide variety of specializations, according to market data provided by Tailored Healthcare Staffing and LiquidAgents Healthcare. “Most of [the hospitals] are looking for nurses to start within a couple of weeks,” senior recruiting team lead Shelbie Summers at Tailored Healthcare Staffing said. “No pre-books for January starts as of yet.” Contact Shelbie Summers at Tailored Healthcare Staffing >> Geographically, most of the jobs are located in or within a one to two-hour drive distance from Denver, the state’s capital. This includes popular tourist cities like Boulder and Pueblo close to the Rocky Mountain range The most in-demand and higher paying specialties are for surgical positions which include OR, PACU and OR certified surgical techs, said Jamison Reitinger, a client advisor for LiquidAgents Healthcare. This falls in line with typical market trends, as more elective surgeries are scheduled near the end of the year in the U.S. Openings for more common specialties like medical-surgical, telemetry, ER and ICU are available, but pay is on the lower end for these positions, ranging from $1,200-1,300 weekly gross. PACU is significantly higher with bill rates at or near $90, which can translate to more than $2,000 weekly gross depending on the agency. Contact Jamison Reitinger at LiquidAgents Healthcare >> Competition is quite high for Colorado positions currently, with at least 15 to 20 submittals for core specialties (medical-surgical, telemetry, ER, OR and ICU) and 10 to 15 for less popular specialties, Reitinger said. Part of the competition is caused by nurses looking for a great winter vacation spot during the snowy season, Summers said. “There are a lot of nurses who enjoy traveling to Colorado this time of the year, so you may not see the same opening if you wait too long to submit for a position,” Summers said. Here are a few other things for travelers to consider before applying to work in The Centennial State. Colorado is part of the Nursing Licensure Compact Colorado joined the enhanced Nursing Licensure Compact this year, so travel nurses with compact licenses can work in the state with no wait and no extra licensing fees. For non-compact license holders, you can still apply for a temporary single-state license, but be aware it can take 10-14 business days to process. For RNs—prepare for a (potential) Prophecy exam “Quite a few CO hospitals require that you take a Prophecy exam before being submitted to the position, so be prepared to pass your core Prophecy testing,” Summers said. For surgical techs—get your Department of Regulatory Agencies (DORA) certification Colorado is unique in that surgical technologists must get their DORA certification before submitting to any jobs, Reitinger said. This will involve a fingerprint background check with the Colorado Bureau of Investigation. You can apply for a DORA certification by clicking here: https://www.colorado.gov/pacific/dora/dpo Expect good snowfall this year According to weather data from the NOAA, Colorado residents should expect to see above average precipitation totals and average temperatures, especially for those in the Southeast region of the state.
Montana’s Legislature Could Decide Medicaid Expansion’s Fate
By Eric Whitney, Montana Public Radio A ballot initiative that would have continued funding Montana’s Medicaid expansion beyond June 2019 has failed. But advocates say they’ll continue to push for money to keep the expansion going after that financial sunset. “We now turn our attention to the legislature to maintain Montana’s bipartisan Medicaid expansion and protect those enrolled from harmful restrictions that would take away health insurance coverage,” said a concession statement Wednesday from Chris Laslovich, campaign manager with the advocacy group Healthy Montana, which supported the measure. The initiative, called I-185, was the single most expensive ballot measure in Montana history. Final fundraising tallies aren’t in yet, but tobacco companies poured more than $17 million into Montana this election season to defeat the initiative. That’s more than twice as much cash as supporters were able to muster. Most of the money in favor of I-185 came from the Montana Hospital Association. “I’m definitely disappointed that big money can have such an outsized influence on our political process,” said Dr. Jason Cohen, chief medical officer of North Valley Hospital in Whitefish. The ballot measure would have tacked an additional $2-per-pack tax on cigarettes. It would have also taxed other tobacco products, as well as electronic cigarettes, which aren’t currently taxed in Montana. Part of the expected $74 million in additional tax revenue would have funded continuation of Medicaid expansion in Montana. Unless state lawmakers vote to continue funding the Medicaid expansion, it’s set to expire in June 2019. If that happens, Montana would become the first state to undo a Medicaid expansion made under the Affordable Care Act. In September, Gov. Steve Bullock, a Democrat, told the Montana Association of Counties that if the Medicaid initiative failed, “we’re going to be in for a tough [2019 legislative] session. Because if you thought cuts from last special session were difficult, I think you should brace, unfortunately, for even more.” Republican State Rep. Nancy Ballance, who opposed I-185, disagrees with Bullock’s position. “I think one of the mistakes that was made continually with I-185 was the belief that there were only two options: If it failed, Medicaid expansion would go away; if it passed, Medicaid expansion would continue forever as it was.” Ballance, who didn’t receive money to campaign against the initiative, said Medicaid expansion in Montana can be tweaked without resorting to a sweeping new tax on tobacco products. “No one was willing to talk about a middle-ground solution where Medicaid expansion is adjusted to correct some of the things that we saw as issues or deficiencies in that program,” she said. “I think now is the time to roll up our sleeves and come up with a solution that takes both sides into consideration.” Ballance said conservatives in the legislature want recipients of expansion benefits to face a tougher work requirement and means testing, so those with low incomes who also have significant assets like real estate won’t qualify. In any event, Ballance said she suspects that if the initiative had passed, it would have immediately faced a court challenge. North Valley Hospital’s Cohen said he hopes Montana will pass a tobacco tax hike someday. “We all know how devastating tobacco is to our families, our friends and our communities,” Cohen said. “And I think we also all know how important having insurance coverage is, and so I think people are dedicated to fighting this battle and winning it.” This story is part of a partnership that includes Montana Public Radio, NPR and Kaiser Health News. Montana Public Radio’s Edward O’Brien contributed to the story. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
Midterm Election Boosts Medicaid Expansion, But Challenges Remain
By Phil Galewitz, Kaiser Health News Medicaid — which has been a political football between Washington and state capitols during the past decade — scored big in Tuesday’s election. Following the vote, nearly 500,000 uninsured adults in five states are poised to gain Medicaid coverage under the Affordable Care Act, advocates estimate. Three deep-red states passed ballot measures expanding their programs and two other states elected governors who have said they will accept expansion bills from their legislatures. Supporters were so excited by the victories they said they will start planning for more voter referendums in 2020. Medicaid proponents also were celebrating the Democrats’ takeover of the House, which would impede any Republican efforts to repeal the ACA and make major cuts to the federal-state health insurance program for low-income people. “Tuesday was huge for the Medicaid program,” said Katherine Howitt, associate director of policy at Community Catalyst, a Boston-based advocacy group. “The overall message is that the electorate does not see this as a Democrat or GOP issue but as an issue of basic fairness, access to care and pocketbook issue. Medicaid is working and is something Americans want to protect.” But health experts caution that GOP opposition won’t fade away. David Jones, an assistant professor in the Department of Health Law, Policy and Management at Boston University, said ballot organizers now have a blueprint on how to expand Medicaid in states that have resisted. “I see this as a turning point in ACA politics,” he said. Still, he added‚ “it’s not inevitable.” Medicaid is the largest government health program, insuring at least 73 million low-income Americans. Half of them are children. To date, 32 states and the District of Columbia have expanded it under the ACA. Before that law, Medicaid was generally limited to children, sometimes their parents, pregnant women and people with disabilities. The ACA encouraged states to open the program to all Americans earning up to 138 percent of the poverty level ($16,753 for an individual in 2018). The federal government is paying the bulk of the cost: 94 percent this year, but gradually dropping to 90 percent in 2020. States pay the rest. GOP opposition has left about 4.2 million low-income Americans without coverage in various states. “It’s not over until it’s over is the story of Medicaid expansion and the Affordable Care Act as the politics never ends and the opportunity for obstruction never ends,” said Jones. “But the trend overall has been to increasing implementation and increasing coverage.” Montana Fails To Endorse Funding Two years after President Donald Trump carried Idaho, Nebraska and Utah by double-digit margins with a message that included repeal of the ACA, voters in those states approved the ballot referendums Tuesday. Together, the states have about 300,000 uninsured adults who would be eligible for the program. In addition, Democrats secured the governor’s offices in Kansas and Maine, which will increase the likelihood those states pursue expansion. Legislatures in both states have previously voted to expand, only to have GOP governors block the bills. Maine voters also passed a referendum in 2017 endorsing expansion, but Republican Gov. Paul LePage again refused to accept it. Current and incoming Republican governors in Utah and Idaho said they wouldn’t block implementation of the effort if voters approved it. Nebraska Gov. Pete Ricketts said Wednesday he would follow the will of the voters but would not support paying for it with a tax increase. It wasn’t a clean sweep, however, for Medicaid on Tuesday. In preliminary results, a ballot issue to fund Montana’s Medicaid expansion — which is already in place and slated to expire next July — was failing. Tobacco companies had mounted a campaign to stop the measure, which would have partially financed the expansion with taxes on tobacco products. The Montana legislature and the Democratic governor are expected to address the issue in the session that starts in January. No state has reversed its Medicaid expansion, even though GOP governors in Kansas and Arkansas have threatened to do so. Nearly 100,000 Montana residents have received Medicaid since its expansion, twice as many as expected. Nancy Ballance, the Republican chairwoman of the Montana House Appropriations Committee who opposed the bill that expanded Medicaid in 2015, said she is confident the state legislature will extend the program past July. But she expects the legislature to put some limits on the program, such as adding an asset test and work requirements. “There are some people in the state who may not have disabilities but need some help to access coverage,” she said. “I think we can pass something without people having a gap in coverage. … That will be a priority.” “It was never our intent to simply sunset the expansion and have it go away,” she said. Rather, the legislature put the sunset provision in to revisit the provision to make any changes. Chris Jacobs, a conservative health policy analyst in Washington, D.C., said the Montana results showed that when voters are given a choice of having to pay for Medicaid expansion through a new tax they were not willing to go along. But in Utah, voters did agree to fund their state plan by adding 0.15 percent to the state’s sales tax, just over a penny for a $10 purchase. Fernando Wilson, acting director of the Center for Health Policy at the University of Nebraska Medical Center, said the vote on the state’s ballot question indicated many people wanted to help 80,000 uninsured Nebraskans gain coverage. “I think it showed there was a clear need for it,” he said. The legislature likely won’t block the expansion, Wilson said, though it may try to add a conservative twist such as adding premiums or other steps. Sheila Burke, a lecturer in health policy at Harvard Kennedy School, said voters approved Medicaid expansion not just because it would help improve health coverage for their residents but to help stabilize their hospitals, particularly those in rural areas. Hospitals have said this step helps their bottom
Nebraska Voters Approve Medicaid Expansion Ballot Initiative
Nebraska joined the likes of several other states who approved Medicaid expansion Tuesday, with more than 53 percent of the vote in favor with 90 percent of precincts reporting. As many as 90,000 newly eligible residents will gain coverage and the uninsured rate could fall from to 9.6% from 12.4% next year, according to an independent study by the Urban Institute. Along with the new Medicaid patients, the state will also see a cash flow of federal dollars—as much as $68 million annually—to help cover the program’s costs. The approval is a big win for advocates who have watched attempts to expand Medicaid fail six times in the state’s legislature. Advocates successfully petitioned and got the initiative added to the ballot in July. Voters also said yes despite heavy opposition from the Republican-controlled state representatives and Gov. Pete Ricketts, who saw it as a “government entitlement program.” Depending on when Nebraska’s Medicaid expansion program is officially implemented, the state could see a new wave of job opportunities in the travel healthcare market in 2019. Studies have shown that Medicaid expansion states have increased patient demands and healthier hospital budgets, which can lead to a higher volume of traveler needs. We will update this story with the final election totals when they are made available.
Question 1: Massachusetts Nurse-To-Patient Ratio Ballot Initiative Defeated
Massachusetts’ Question 1, a ballot initiative that would have established mandatory nurse-patient ratios in hospitals was defeated during the general election Tuesday. The Massachusetts Nurses Association, a union representing nurses in 51 acute care hospitals across the state, conceded defeat around 9 p.m. Tuesday evening. At approximately 10:20 p.m., the initiative had 969,400 votes against and 416,720 votes in favor, with more than 50 of precincts reporting, according to the preliminary results. “We are all disappointed by tonight’s results and the impact this will have on the patients we care for every day,” MNA President Donna Kelly-Williams said in prepared remarks. “We know that right now – as I speak to you here – there are nurses caring for too many patients and those patients are unnecessarily being put in harm’s way. And the problem continues to grow every year. The status quo is not a solution here.” The outcome was a victory for the Massachusetts Health and Hospital Association, who opposed the initiative for fear that it would dramatically increase state healthcare costs. The association represents 70 hospitals across the state. “This is the beginning of a conversation, not the end,” MHA President and CEO Steve Walsh said in a statement to Mass Live. “Question 1 forced some difficult and necessary discussions about the future of healthcare and the future of our workforce going forward. These conversations with our care teams and in our communities have been critically important and will continue in bargaining sessions, legislative debates, board rooms and newspapers.” An independent study conducted by the state’s Health Policy Commission found that implementing the mandate would cost an estimated $676-949 million per year and potentially save $34-47 million. The study also found that hospitals would need to hire 2,286 to 3,101 additional full-time equivalent nurses to meet the mandate.
The Election’s Impact On Healthcare: Some Bellwether Races To Watch
By Julie Rovner, Kaiser Health News Voters this year have told pollsters in no uncertain terms that health care is important to them. In particular, maintaining insurance protections for preexisting conditions is the top issue to many. But the results of the midterm elections are likely to have a major impact on a broad array of other health issues that touch every single American. And how those issues are addressed will depend in large part on which party controls the U.S. House and Senate, governors’ mansions and state legislatures around the country. All politics is local, and no single race is likely to determine national or even state action. But some key contests can provide something of a barometer of what’s likely to happen — or not happen — over the next two years. For example, keep an eye on Kansas. The razor-tight race for governor could determine whether the state expands Medicaid to all people with low incomes, as allowed under the Affordable Care Act. The legislature in that deep red state passed a bill to accept expansion in 2017, but it could not override the veto of then-Gov. Sam Brownback. Of the candidates running for governor in 2018, Democrat Laura Kelly supports expansion, while Republican Kris Kobach does not. Here are three big health issues that could be dramatically affected by Tuesday’s vote. 1. The Affordable Care Act Protections for preexisting conditions are only a small part of the ACA. The law also made big changes to Medicare and Medicaid, employer-provided health plans and the generic drug approval process, among other things. Republicans ran hard on promises to get rid of the law in every election since it passed in 2010. But when the GOP finally got control of the House, the Senate and the White House in 2017, Republicans found they could not reach agreement on how to “repeal and replace” the law. This year has Democrats on the attack over the votes Republicans took on various proposals to remake the health law. Probably the most endangered Democrat in the Senate, Heidi Heitkamp of North Dakota, has hammered her Republican opponent, U.S. Rep. Kevin Cramer, over his votes in the House for the unsuccessful repeal-and-replace bills. Cramer said that despite his votes he supports protections for preexisting conditions, but he has not said what he would do or get behind that could have that effect. Polls suggest Cramer has a healthy lead in that race, but if Heitkamp pulled off a surprise win, health care might well get some of the credit. And in New Jersey, Rep. Tom MacArthur, the moderate Republican who wrote the language that got the GOP health bill passed in the House in 2017, is in a heated race with Democrat Andy Kim, who has never held elective office. The overriding issue in that race, too, is health care. It is not just congressional action that has Republicans playing defense on the ACA. In February, 18 GOP attorneys general and two GOP governors filed a lawsuit seeking a judgment that the law is now unconstitutional because Congress in the 2017 tax bill repealed the penalty for not having insurance. Two of those attorneys general — Missouri’s Josh Hawley and West Virginia’s Patrick Morrisey — are running for the Senate. Both states overwhelmingly supported President Donald Trump in 2016. The attorneys general are running against Democratic incumbents — Claire McCaskill of Missouri and Joe Manchin of West Virginia. And both Republicans are being hotly criticized by their opponents for their participation in the lawsuit. Although Manchin appears to have taken a lead, the Hawley-McCaskill race is rated a toss-up by political analysts. But in the end, the fate of the ACA depends less on an individual race than on which party winds up in control of Congress. “If Democrats take the House … then any attempt at repeal-and-replace will be kaput,” said John McDonough, a former Democratic Senate aide who helped write the ACA and now teaches at the Harvard School of Public Health. Conservative healthcare strategist Chris Jacobs, who worked for Republicans on Capitol Hill, said a new repeal-and-replace effort might not happen even if Republicans are successful Tuesday. “Republicans, if they maintain the majority in the House, will have a margin of a half dozen seats — if they are lucky,” he said. That likely would not allow the party to push through another controversial effort to change the law. Currently, there are 42 more Republicans than Democrats in the House. Even so, the GOP barely got its health bill passed out of the House in 2017. And political strategists say that, when the dust clears after voting, the numbers in the Senate may not be much different so a change could be hard there too. Republicans, even with a small majority last year, could not pass a repeal bill there. 2. Medicaid expansion The Supreme Court in 2012 made optional the ACA’s expansion of Medicaid to cover all low-income Americans up to 138 percent of the poverty line ($16,753 for an individual in 2018). Most states have now expanded, particularly since the federal government is paying the vast majority of the cost: 94 percent in 2018, gradually dropping to 90 percent in 2020. Still, 17 states, all with GOP governors or state legislatures (or both), have yet to expand Medicaid. McDonough is confident that’s about to change. “I’m wondering if we’re on the cusp of a Medicaid wave,” he said. Four states — Nebraska, Idaho, Utah and Montana — have Medicaid expansion questions on their ballots. All but Montana have yet to expand the program. Montana’s question would eliminate the 2019 sunset date included in its expansion in 2016. But it will be interesting to watch results because the measure has run into big-pocketed opposition: the tobacco industry. The initiative would increase taxes on cigarettes and other tobacco products to fund the state’s increased Medicaid costs. In Idaho, the ballot measure is being embraced by a number of Republican leaders. GOP Gov.
Tobacco Tax Battle Could Torch Montana Medicaid Expansion
By Eric Whitney, Montana Public Radio Montana legislators expanded Medicaid by a very close vote in 2015. They passed the measure with an expiration date: It would sunset in 2019, and all who went onto the rolls would lose coverage unless lawmakers voted to reapprove it. Fearing legislators might not renew funding for Medicaid’s expanded rolls, Montana’s hospitals and health advocacy groups came up with a ballot measure to keep it going — and to pay for it with a tobacco tax hike. If ballot initiative I-185 passes Tuesday, it will mean an additional $2-per-pack tax on cigarettes and levy a tax on e-cigarettes, which are currently not taxed in Montana. The tobacco tax initiative has become the most expensive ballot measure race in Montana history — drawing more than $17 million in opposition funding from tobacco companies alone — in a state with fewer than 200,000 smokers. Amanda Cahill works for the American Heart Association and is a spokeswoman for Healthy Montana, the coalition backing the measure. She said coalition members knew big tobacco would fight back. “We poked the bear, that’s for sure,” Cahill said. “And it’s not because we were all around the table saying, ‘Hey, we want to have a huge fight and go through trauma the next several months.’ It’s because it’s the right thing to do.” Most of the $17 million has come from cigarette maker Altria. According to records from the National Institute on Money in Politics, that’s more money than Altria has spent on any state proposition nationwide since the center started keeping track in 2004. Meanwhile, backers of I-185 have spent close to $8 million on the initiative, with most of the money coming from the Montana Hospital Association. “What we want to do is — No. 1 — stop Big Tobacco’s hold on Montana,” Cahill said. Also, she continued, it’s imperative that the nearly 100,000 people in Montana who have gotten Medicaid under the expansion will be able to keep their health care. Cahill said I-185 will allocate plenty of money to cover the expansion, though some lawmakers say the state can’t afford the expansion even with higher taxes. Nancy Ballance, a Republican representative in the Montana state Legislature, opposes the measure. “In general I am not in favor of what we like to refer to as ‘sin taxes,’ ” Ballance said. “Those are taxes that someone determines should be [levied] so that you change people’s behavior.” Ballance also isn’t in favor of ballot initiatives that, she said, try to go around what she sees as core functions of the Legislature: deciding how much revenue the state needs, for example, or where it should come from, or how it should be spent. “An initiative like this for a very large policy with a very large price tag — the Legislature is responsible for studying that,” Ballance said. “And they do so over a long period of time, to understand what all the consequences are — intended and otherwise.” Most citizens, she said, don’t have the time or expertise to develop that sort of in-depth understanding of a complicated issue. Montana’s initiative to keep Medicaid’s expansion going would be a “double whammy” for tobacco companies, said Ben Miller, the chief strategy officer for the nonprofit Well Being Trust. “People who are covered are more likely to not smoke than people who are uninsured,” said Miller, who has studied tobacco tax policies for years. He notes research showing that people with lower incomes are more likely than those with higher incomes to smoke; and if they’re uninsured, they’re less likely to quit. Federal law requires Medicaid to offer beneficiaries access to medical help to quit smoking. Plus, Miller added, every time cigarette taxes go up — thereby increasing the price per pack — that typically leads to a decrease in the number of people smoking. And that, he said, works against a tobacco company’s business model, “which is, ‘you need to smoke so we can make money.’ ” Ballance agrees that tobacco companies likely see ballot initiatives like I-185 as threats to their core business. But, she said, “for anybody who wants to continue smoking, or is significantly addicted, the cost is not going to prohibit them from smoking.” The U.S. Centers for Disease Control and Prevention says tobacco use is the leading cause of preventable disease and death in the U.S. Montana’s health department says that each year more than 1,600 people in the state die from tobacco-related illnesses. This story is part of a reporting partnership with Montana Public Radio, NPR and Kaiser Health News. This story originally appeared on Kaiser Health News. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.