Day: October 13, 2017

California Gov. Jerry Brown on Friday declared a state of emergency to combat a hepatitis A outbreak that has claimed 18 lives in San Diego.

Brown said the federally funded supply of vaccines is inadequate. His proclamation allows the state to buy vaccines directly from manufacturers and distribute them.

The declaration “allows us to move very swiftly,” Dr. Gil Chavez, epidemiologist at the California Department of Public Health, told reporters. He said the state would place an order Monday or Tuesday and supplies would reach the state soon after.

California has distributed 81,000 federally funded vaccine doses since the outbreak began and local jurisdictions have acquired more, but the supply is insufficient, Chavez said.

Largest outbreak since 1996

California is experiencing the largest hepatitis A outbreak in the United States transmitted from person to person, instead of by contaminated food, since the vaccine became available in 1996. The state says most of those affected are homeless, using drugs or both.

There have been 576 cases throughout California, including 490 in San Diego County, 71 in Santa Cruz County and eight in Los Angeles County. Out of those, 386 people have been hospitalized, including 342 in San Diego, 33 in Santa Cruz and six in Los Angeles. No deaths have been reported outside San Diego County.

U.S. Rep. Darrell Issa on Friday called on the federal government to provide emergency funding to halt the spread of hepatitis A. He said the outbreak has brought statewide totals to three times the number of reported cases in 2015.

“We cannot wait until more communities are infected and impacted before taking action,” the San Diego-area Republican wrote to the U.S. Health and Human Services Department and the Centers for Disease Control and Prevention.

A message seeking comment from the Centers for Disease Control and Prevention wasn’t immediately returned.

Outbreak began in March

San Diego County reported an outbreak in March as it grapples with a growing homeless population. Santa Cruz County reported its first cases the following month, and San Diego and Los Angeles counties declared local health emergencies in September.

The outbreak was caused by strains of the 1B genetic subtype, which is rare in the United States and more commonly found in the Mediterranean and South Africa. It is spread through contact with feces, putting people with inadequate access to sanitation at highest risk.

In addition to vaccination, frequent handwashing is recommended.
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Eighteen U.S. states vowed Friday to sue President Donald Trump’s administration to try to stop him from scrapping a key component of Obamacare — subsidies to insurers that help millions of low-income people pay medical expenses — even as Trump invited Democratic leaders to negotiate a deal.

One day after his administration announced plans to end the payments next week, Trump said he would dismantle Obamacare “step by step.”

His latest action raised concerns about chaos in insurance markets. The subsidies cost $7 billion this year and were estimated at $10 billion for 2018, according to congressional analysts.

“As far as the subsidies are concerned, I don’t want to make the insurance companies rich,” Trump told reporters at the White House. “They’re making a fortune by getting that kind of money.”

Trump’s action took aim at a critical element of the 2010 law, his Democratic predecessor Barack Obama’s signature domestic policy achievement. Frustrated by the failure of his fellow Republicans who control both houses of Congress to repeal and replace Obamacare, Trump has taken several steps to chip away at it.

Democrats accused Trump of sabotaging the law.

Democratic attorneys general from the 18 states as well as the District of Columbia planned to sue in federal court in California late in the day. The states — California, Connecticut, Delaware, Kentucky, Illinois, Iowa, Maryland, Massachusetts, Minnesota, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia and Washington — will ask the court to force Trump to make the next payment.

Legal experts said the states were likely to face an uphill battle in court.

‘Breathtakingly reckless’

“His effort to gut these subsidies with no warning or even a plan to contain the fallout is breathtakingly reckless,” New York Attorney General Eric Schneiderman said. “This is an effort simply to blow up the system.”

The new lawsuit would be separate from a case pending before an appeals court in the District of Columbia in which 16 Democratic state attorneys general are defending the legality of the payments.

If the subsidies vanish, low-income Americans who obtain insurance through Obamacare online marketplaces would face higher insurance premiums and out-of-pocket medical costs. It would particularly hurt lower-middle-class families whose incomes are still too high to qualify for certain government assistance.

About 10 million people are enrolled in Obamacare through its online marketplaces, and most receive subsidies. Trump’s action came just weeks before the period starting November 1 when individuals have to begin enrolling for 2018 insurance coverage through the law’s marketplaces.

The administration will not make the next payment to insurers, scheduled for Wednesday, U.S. Attorney General Jeff Sessions said.

Senate Democratic leader Chuck Schumer of New York expressed optimism about chances for a deal with Republicans to continue the subsidies.

“We’re going to have a very good opportunity to get this done in a bipartisan way” during negotiations in December on broad federal spending legislation, “if we can’t get it done sooner,” Schumer told reporters.

Trump offered an invitation for Democratic leaders to come to the White House, while also lashing out at them. “We’ll negotiate some deal that’s good for everybody. But they’re always a bloc vote against everything. They’re like obstructionists,” Trump told reporters.

The Senate failed in both July and September to pass legislation backed by Trump to repeal Obamacare because of opposition by a handful of Republican senators. One of them, Susan Collins, a moderate Republican from Maine who had been contemplating running for governor next year, on Friday said she planned to remain in the Senate and would use her voice in reforming the health care system.

Insurer, hospital shares drop

Hospitals, doctors, health insurers, state insurance commissioners and patient advocates decried Trump’s move, saying consumers would ultimately pay the price. They called on Congress to appropriate the funds needed to keep up the subsidy payments.

Shares of U.S. hospital companies and health insurers closed down on Friday after the subsidies announcement. Centene Corp. closed down 3.3 percent and Molina Healthcare closed down 3.4 percent. Among hospital shares, Tenet Healthcare finished 5.1 percent lower and Community Health Systems declined 4.0 percent.

The nonpartisan Congressional Budget Office has estimated that erasing the subsidies would increase the federal deficit by $194 billion over the next decade because the government still would be obligated under other parts of Obamacare to help lower-income people pay for insurance premiums.

Trump, who as a candidate last year promised to roll back the law formally called the Affordable Care Act, received applause for his latest action during an appearance on Friday before a group of conservative voters.

“It’s step by step by step, and that was a very big step yesterday,” Trump said. “And one by one, it’s going to come down, and we’re going to have great health care in our country.”

Earlier on Twitter, he called Obamacare “a broken mess” that is “imploding,” and referred to the “pet insurance companies” of Democrats.

Failed repeal efforts

Republicans for seven years had vowed to get rid of Obamacare, but deep intraparty divisions have scuttled their efforts to get legislation through the Senate, where they hold a slim majority.

Since taking office in January, Trump threatened many times to cut the subsidies. Health insurers that planned to stay in the Obamacare market prepared for the move in many states by submitting two sets of premium rates to regulators: with and without the subsidies.

The National Association of Insurance Commissioners said the change would drive up premium costs for consumers by at least 12 to 15 percent in 2018 and cut more than $1 billion in payments to insurers for 2017.

The White House announced the cutoff just hours after Trump signed an order intended to allow insurers to sell lower-cost, bare-bones policies with limited benefits and consumer protections.

Republicans have called Obamacare an unnecessary government intrusion into the American health care system. Democrats have said the law needs some fixes but noted that it had brought insurance to 20 million people.
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The Carter Center, a nonprofit organization run by former U.S. President Jimmy Carter, said Friday that it had helped eliminate elephantiasis, a disfiguring tropical disease, from two states in Nigeria where the problem was at its worst.

Dr. Yisa Saka of Nigeria’s Federal Ministry of Health said in the Carter Center’s announcement, “This is a great day for the people of Plateau and Nasarawa states, and all of Nigeria.” He called the disease, also known as lymphatic filariasis, “a terrible disease that has plagued good people for far too long.”

The World Health Association classified elephantiasis as a “neglected tropical disease.” In areas threatened by the disease, people must take annual doses of preventive drugs to keep the parasitic infection from spreading.

Damages lymphatic system

Elephantiasis, transmitted by mosquitoes, causes damage to the lymphatic system, often in childhood, where it can remain hidden for years. Years later, the resulting swelling, which can be significant, can cause physical disability as well as social stigma. Asymptomatic infection can remain invisible but cause damage to the lymphatic system and kidneys, affecting the body’s immune system.

Experts say more than 120 million people in Nigeria live in at-risk areas. Only India has more people at risk of catching the disease, which often causes its victims social isolation and poverty.

“Eliminating lymphatic filariasis as a public health problem in Plateau and Nasarawa states is a significant achievement that challenges everyone to broaden their appreciation of what is possible,” said Dr. Frank Richards of the Carter Center. “Success in these two states not only protects the 7 million people who live there, but it also sets a pattern for similar success throughout the rest of Nigeria, as well as in other highly endemic countries.”

Dr. Gregory Noland of the Carter Center said health professionals have been working for years to eradicate the disease in Plateau and Nasarawa, through drug treatment and use of bed nets to ward off mosquitoes at night. Testing of more than 14,000 children over the past two years has not discovered any new infections.

The milestone is seen as a step toward eradicating the disease altogether. It is one of seven diseases the Carter Center has named as potentially eradicable.
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America’s weight problem isn’t getting any better, according to new government research.

Overall, obesity figures stayed about the same: About 40 percent of adults are obese and 18.5 percent of children. Those numbers are a slight increase from the last report but the difference is so small that it could have occurred by chance.

Worrisome to experts is the rate for children and teenagers, which had hovered around 17 percent for a decade. The 2-to-5 age group had the biggest rise.

The years ahead will show if that’s a statistical blip or marks the start of a real trend, said the report’s lead author, Dr. Craig Hales of the U.S. Centers for Disease Control and Prevention.

The bad news is that the numbers didn’t go down, experts say. In recent years, state and national health officials have focused on obesity in kids, who were the target of the national Let’s Move campaign launched by former first lady Michelle Obama in 2010.

The report released Friday covers 2015 and 2016.

“This is quite disappointing. If we were expecting the trends to budge, this is when they would be budging,” said Andrew Stokes, a Boston University expert on tracking obesity.

The new figures are from an annual government survey with about 5,000 participants. The survey is considered the gold standard for measuring the nation’s waistline, because participants are put on a scale to verify their weight.

Obesity means not merely overweight, but seriously overweight, as determined by a calculation called body mass index . Until the early 1980s, only about 1 in 6 adults were obese. The rate climbed dramatically to about 1 in 3 around a decade ago, then seemed to level off for years.

More details from the report:

– The 40 percent rate for adults is statistically about the same as the nearly 38 percent in the 2013-2014 survey.

– By age, the fattest adults are in their 40s and 50s. The obesity rate for that age group is 41 percent for men and 45 percent for women.

– By race and gender, the problem is still most common in black and Hispanic women; more than half are obese.

– Among children, the rate for the 12-to-19 age group was the same at nearly 21 percent. For kids 6 to 11, it rose to 18 percent, from 17 percent.

– But for children ages 2 to 5, the rate jumped to 14 percent from about 9 percent.
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