Day: November 29, 2018

The number of uninsured children in the United States has increased for the first time in nearly a decade, placing it at 3.9 million in 2017, according to a report Thursday from Georgetown University’s Center for Children and Families. 

Nationally, the number of uninsured children increased by an estimated 276,000 in 2017, from a historic low of 4.7 percent in 2016 to 5 percent last year. Experts say about 75 percent of the newly uninsured children are clustered in states that did not expand Medicaid such as Florida, Texas and Georgia. 

Under President Obama’s Affordable Care Act, Florida and other states could take federal funding to help pay for health coverage for nearly 900,000 people, but the Republican-led Legislature in Florida voted against it. The vast majority of states have already expanded Medicaid and increased the number of residents eligible for its coverage. 

Joan Alker, executive director for Georgetown’s Center for Children and Families, has written the report for the last eight years and said she’s never seen the rates of uninsured children go up in all 50 states, which happened last year. 

Better economy, low unemployment

She said that what is perhaps most concerning is that the uninsured rate among children increased despite an improving economy and low unemployment rate that allowed more children to get private coverage through their parents. 

The study blamed the increases on the Trump administration’s repeated attempts to prompt an overhaul of publicly funded health care. There were major efforts to repeal Obama’s Affordable Care Act and cut Medicaid, and the children’s CHIP insurance funding also ran out and hung in the balance for months before Congress extended it. 

“There was a lot of confusion among families as to whether these public coverage sources were available,” Alker said.  

At the same time, the Trump administration slashed funding for advertising and enrollment counselors to help sign people up for these health insurance programs. The country’s enrollment decline was not just in Medicaid and CHIP, but also in Obamacare, or the federal marketplace where parents can purchase private health insurance and often receive a subsidy to help pay for it. 

The report noted that many of the children who do not have health insurance are eligible for coverage but just aren’t enrolled. 

‘More of a fluctuation’

Ed Haislmaier, a senior research fellow with the Heritage Foundation, a conservative think tank, said the figures were statistically insignificant. 

He did agree that there were dips in Medicaid enrollment and through the Obamacare marketplace, but noted there’s no enrollment cutoff for Medicaid, meaning families can sign up their children year-round. 

“It’s really more of a fluctuation. There’s no policy driver there,” he said, saying he didn’t think marketing cuts had any impact. 

In Florida, the uninsured rate went from 288,000 in 2016 to 325,000 in 2017.

Florida has one of the highest rates of uninsured residents in the country, and also has had the highest number of enrollees purchasing insurance through the Obamacare federal marketplace. However, Medicaid expansion in Florida is likely off the table for this upcoming legislative session. Incoming Gov.-elect Ron DeSantis, a Republican, is against it. His opponent, Democrat Andrew Gillum, campaigned heavily on his support to expand Medicaid coverage for more residents. 

The report also expressed concern that strict immigration policies and enforcement were making many immigrant families leery of enrolling, even if their children were eligible for health coverage. “We think it’s really this national unwelcome mat regarding public coverage,” Alker said. 
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The expansive court case seeking to hold drugmakers responsible for the nation’s opioid crisis has a new complication: How does it deal with claims covering the thousands of babies born addicted to the drugs?

Attorneys representing the children and their guardians want their claims separated from the federal case in Cleveland that involves hundreds of local governments and other entities such as hospitals. They told a skeptical panel of judges in New York on Thursday that they have different legal issues, a need for faster relief because the babies need services in the first years of their lives. They also told the judges that as it is, they lack the leverage to exact a settlement from drug companies.

Babies, unlike governments or businesses, have been directly harmed by the actions of drugmakers and are entitled to their own payments, said Scott Bickford, a lead lawyer for the children and their guardians.

Bickford said more than 150,000 babies were born in opioid withdrawal from 2012 through 2016, and that the number grows each year

Federal cases consolidated

He said initial hospital stays for babies born to an opioid-addicted mother can cost $200,000 to $250,000 more than other infants born without complications. 

“Then you have to address their developmental and learning problems,” Bickford said in a Tuesday interview. “A lot of them have organ problems. A lot of them have problems we don’t even know about.”

Drug manufacturers and distributors oppose creating a new structure for the lawsuits over the children and judges on the Judicial Panel on Multidistrict Litigation hearing the matter in New York on Thursday wondered what good it would do.

Opioids — including prescription painkillers, heroin and synthetic substances including fentanyl — killed nearly 48,000 Americans last year, according to the U.S Centers for Disease Control and Prevention. The cost of treatment, providing an overdose antidote, foster care, jail stays, ambulance runs and addressing a growing homeless crisis have added up for governments and taxpayers. Studies have found that opioid addiction also has depleted the workforce, harming the economy.

More than 1,400 plaintiffs have had their federal cases consolidated under a single judge. They include county and local governments, hospitals, unions, American Indian tribes and individuals. Hundreds of others have sued in state courts. Cleveland-based federal Judge Dan Polster has been pushing the parties to reach a settlement.

Children need a voice

The judicial panel’s chairwoman, Judge Sarah Vance, said it’s unlikely any settlement would be reached without considering the children.

“It’s hard for me to see how the defendants are going to settle if they’ve got 150,000 children unhappy because their needs are unmet,” Vance said.

Angela Vicari, a lawyer for the drug manufacturers, told the judge that she wasn’t aware of the lawyers for the babies seeking to negotiate.

But lawyers for the children said they don’t have a voice in the committee of plaintiffs’ lawyers leading the case, making it hard to request the information from the industry that they believe would help prove their case. Attorney Kevin Thompson said it’s essential to request information on any industry laboratory studies on the impact of drugs passed from mothers to children.

Lawyers also worry that any settlement reached by government agencies won’t go to help the people who have been hurt. “They end up paving a road with that,” Bickford said.

Other plaintiffs in the omnibus opioid litigation have not objected formally and did not speak in court Thursday, but some are cool to the idea of separating the cases involving the children. One of the lead lawyers for the local governments, Paul Farrell Jr., said he is trying to get help for children born with opioid dependency and have prenatal care funded by the drug industry.

He said in an interview that the plaintiffs share a goal: holding drug manufacturers liable for the crisis. Unless that happens, he said, no one will get the payouts they’re seeking.

“You’ve only got to shoot the pig once,” he said Tuesday.

Indian tribes allowed to go it alone

Lawyers representing the children and their guardians say there is precedent for their request to go it alone, after Polster granted the American Indian tribes a separate test trial for their claims. In August, the judge denied similar status for the cases brought on behalf of babies.

That decision prompted the lawyers to ask the panel of judges to put their cases under another judge in West Virginia or Illinois.

A ruling is expected in the next several weeks.
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After repeated food poisoning outbreaks linked to romaine lettuce, the produce industry is confronting the failure of its own safety measures in preventing contaminations.

The E. coli outbreak announced just before Thanksgiving follows one in the spring that sickened more than 200 people and killed five, and another last year that sickened 25 and killed one.

No deaths have been reported in the latest outbreak, but the dozens of illnesses highlight the challenge of eliminating risk for vegetables grown in open fields and eaten raw, the role of nearby cattle operations that produce huge volumes of manure and the delay of stricter federal food safety regulations.

A contested aspect of the regulation, for example, would require testing irrigation water for E. coli. The Food and Drug Administration put the measure on hold when the produce industry said such tests wouldn’t necessarily help prevent outbreaks. Additional regulations on sanitation for workers and equipment — other potential sources of contamination — only recently started being implemented.

FDA Commissioner Scott Gottlieb said he thinks the combination of rules, once fully in place, will make vegetables safer to eat.

“I don’t think any one element of this is going to be the magic bullet,” Gottlieb said.

Health officials say improved detection may make outbreaks seem more frequent. Still, that is intensifying pressure on growers and regulators to prevent, catch and contain contamination.

Prevention

It’s not yet known how romaine got contaminated in the latest outbreak.

The spring outbreak was traced to romaine from Yuma, Arizona. Irrigation water tainted with manure was identified as a likely culprit, and investigators noted the presence of a large animal feeding operation nearby.

Subsequently, growers in Arizona and California adjusted an industry agreement to expand buffer zones between vegetable fields and livestock. The industry says the change was in place for lettuce now being grown in Yuma, which hasn’t been implicated in the latest outbreak. But Trevor Suslow of the Produce Marketing Association said there isn’t consensus about the exact distances that might effectively prevent contamination.

He noted specific buffer zones aren’t required by the new federal rules on produce safety.

“They look to the industry to determine what is the appropriate distance,” Suslow said.

Growers in Yuma also started treating irrigation water that would touch plant leaves with chlorine to kill potential contaminants, Suslow said. But he said such treatment raises concerns about soil and human health.

Meanwhile, the proximity of produce fields to cattle operations is likely to continue posing a problem. Travis Forgues of the milk producer Organic Valley noted consolidation in the dairy industry is leading to bigger livestock operations that produce massive volumes of manure.

Testing

Already, the industry agreement in Arizona and California requires leafy green growers to test water for generic E. coli.

But James Rogers, director of food safety research at Consumer Reports, said it’s important to make water testing a federal requirement. Since romaine is often chopped up and bagged, a single contaminated batch from one farm that skips testing could make a lot of people sick, he said.

Teressa Lopez of the Arizona Leafy Greens Marketing Agreement also said federal regulation can ensure greater compliance, even though the industry agreement has stricter measures.

Despite industry measures implemented after a spinach outbreak more than a decade ago, health officials note d this month there have been 28 E. coli outbreaks linked to leafy greens since 2009.

The produce industry says the failure to prevent the Yuma outbreak could also reflect the limitations of testing water for generic E. coli.

Elizabeth Binh, a food science expert at Cornell University, said the tests look for the amount of fecal matter in water. The problem is, “some feces has pathogens in it, some feces doesn’t,” said Binh, who is part of a federal program helping farmers comply with the new produce regulations.

Testing for specific E. coli strains that are harmful is more difficult, and doesn’t rule out the possibility of other harmful bacteria, Binh said.

Containment

Whole-genome sequencing is making it easier to detect outbreaks, which is pressuring the produce industry.

The FDA warned against all romaine last week because it said it was able to identify it as a likely source early enough. The agency narrowed its warning to romaine from California’s Central Coast after the produce industry agreed to label romaine with harvest dates and regions, so people know what’s OK to eat.

The labeling is voluntary, and the industry said it will evaluate whether to extend it to other leafy greens. Gottlieb said improving traceability would allow targeted health alerts that don’t hurt the entire industry. The FDA recently hired a former Walmart executive who used blockchain technology to improve traceability in the retailer’s supply chain.

Stephen Basore, director of food safety at a Florida romaine grower, said he expects more regulations and self-imposed industry guidelines.

“Anytime there is an issue, the immediate response is saying our protocols aren’t enough,” he said.
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Suicides and drug overdoses helped lead a surge in U.S. deaths last year, and drove a continuing decline in how long Americans are expected to live.

Overall, there were more than 2.8 million U.S. deaths in 2017, or nearly 70,000 more than the previous year, the Centers for Disease Control and Prevention said Thursday. It was the most deaths in a single year since the government began counting more than a century ago.

The increase partly reflects the nation’s growing and aging population. But it’s deaths in younger age groups — particularly middle-aged people — that have had the largest impact on calculations of life expectancy, experts said.

The suicide death rate last year was the highest it’s been in at least 50 years, according to U.S. government records. There were more than 47,000 suicides, up from a little less than 45,000 the year before.

​A general decline

For decades, U.S. life expectancy was on the upswing, rising a few months nearly every year. Now it’s trending the other way: It fell in 2015, stayed level in 2016, and declined again last year, the CDC said.

The nation is in the longest period of a generally declining life expectancy since the late 1910s, when World War I and the worst flu pandemic in modern history combined to kill nearly 1 million Americans. Life expectancy in 1918 was 39.

Aside from that, “we’ve never really seen anything like this,’’ said Robert Anderson, who oversees CDC death statistics.

In the nation’s 10 leading causes of death, only the cancer death rate fell in 2017. Meanwhile, there were increases in seven others: suicide, stroke, diabetes, Alzheimer’s, flu/pneumonia, chronic lower respiratory diseases and unintentional injuries.

An underlying factor is that the death rate for heart disease, the nation’s No. 1 killer, has stopped falling. In years past, declines in heart disease deaths were enough to offset increases in some other kinds of death, but no longer, Anderson said.

The CDC’s numbers do sometimes change. This week, CDC officials said they had revised their life expectancy estimate for 2016 after some additional data came in.

What’s driving this?

CDC officials did not speculate about what’s behind declining life expectancy, but Dr. William Dietz, a disease prevention expert at George Washington University, sees a sense of hopelessness.

Financial struggles, a widening income gap and divisive politics are all casting a pall over many Americans, he suggested. 

“I really do believe that people are increasingly hopeless, and that that leads to drug use, it leads potentially to suicide,’’ he said.

Drug overdose deaths also continued to climb, surpassing 70,000 last year, in the midst of the deadliest drug overdose epidemic in U.S. history. The death rate rose 10 percent from the previous year, smaller than the 21 percent jump seen between 2016 and 2017.

That’s not quite a cause for celebration, said Dr. John Rowe, a professor of health policy and aging at Columbia University.

“Maybe it’s starting to slow down, but it hasn’t turned around yet,’’ Rowe said. “I think it will take several years.”

Accidental drug overdoses account for more than a third of the unintentional injury deaths, and intentional drug overdoses account for about a tenth of the suicides, said Dr. Holly Hedegaard, a CDC injury epidemiologist.

Other findings

The CDC figures are based mainly on a review of 2017 death certificates. The life expectancy figure is based on current death trends and other factors.

The agency also said:

A baby born last year in the U.S. is expected to live about 78 years and 7 months, on average. An American born in 2015 or 2016 was expected to live about a month longer, and one born in 2014 about two months longer than that.
The suicide rate was 14 deaths per 100,000 people. That’s the highest since at least 1975.
The percentage of suicides from drug overdose has been inching downward.
Deaths from flu and pneumonia rose by about 6 percent. The 2017-2018 flu season was one of the worst in more than a decade, and some of the deaths from early in that season appeared in the new death dates.
West Virginia was once again the state with the highest rate of drug overdose deaths. The CDC did not release state rates for suicides.
Death rates for heroin, methadone and prescription opioid painkillers were flat. But deaths from the powerful painkiller fentanyl and its close opioid cousins continued to soar in 2017.
The CDC did not discuss 2017 gun deaths in the reports released Thursday. But earlier CDC reports noted increase rates of suicide by gun and by suffocation or hanging.

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