On Wellness in WV

Justice silent on CHIP

A bipartisan group of 12 governors sent a letter to Congressional leadership Tuesday, asking governors to reauthorize the Children’s Health Insurance Program, “as quickly as possible.” Congress let the program expire Sept. 30 and still hasn’t allocated new funding. West Virginia has been using leftover funding from the previous fiscal year to continue coverage.

They wrote:

We believe covering children and pregnant women without disruption is one thing we can all agree on.

For twenty years, this program has successfully provided vital health coverage and care to about nine million children. Without it, access to essential health services like well child exams, asthma medicine, and hospitalizations will be at risk. As health insurance premiums climb at unsustainable rates, this program gives hard-working families access to otherwise unaffordable coverage.

In the absence of Congressional action, we have worked to protect coverage for children and pregnant women in each of our states, but we will need federal support to continue the program.
 
Resources are nearly exhausted and some states already have begun to inform families that their children’s coverage may end on January 31.

Governor Jim Justice did not sign the letter. His spokesman has also not responded to a request for comment about the CHIP program sent two weeks ago.

The state’s CHIP board voted last month to shut down the program Feb. 28 if Congress doesn’t allocate funding. About 21,000 children in the state are covered by CHIP, and an additional 17,000 are covered by Medicaid plans that rely on CHIP money. In a letter sent Nov. 8, the Department of Health and Human Resources told West Virginia’s representatives in Congress that CHIP will shut down Feb. 28 unless federal funding is granted by Dec. 15 — Friday.

In an email Wednesday, Allison Adler, spokeswoman for DHHR, said:

We have been working with the end of December as our timeframe for passage of a funding bill.  This is a very fluid situation which we continue to monitor very closely.

At this time, the CHIP program plans to send notifications with more specific information to families and providers by early January 2018; however, services and benefits will continue as currently available for members through the end of February 2018.

Should Congress approve funding, the WV CHIP Board will meet to rescind the closure plan and the program will continue operations as usual.

We remain hopeful that West Virginia’s congressional delegation will continue to push funding for this critical children’s program.

 

The federal government released data today showing that West Virginia still lags behind other states in selecting plans on the federal health insurance marketplace.

The health insurance marketplace is where to find plans that meet the standards of the Affordable Care Act, including the requirement to cover pre-existing conditions, offer “essential health benefits” and tax credits, and avoid a tax penalty for lack of insurance.

The Gazette-Mail reported Tuesday that West Virginia was the only state showing fewer people selecting plans on the marketplace than last year during the same time period. Most states are showing more people logging on to Healthcare.gov and picking the right plan for them, when compared to the same time period last year; that’s because open enrollment is shorter this year so people have to sign up earlier. Open enrollment ends Friday. Last year it ended Jan. 31.

The Centers for Medicare and Medicaid Services released a chart today that showed several thousand people in the state selected their plans last week, but the state still lags behind; 13,257 West Virginians have logged on and chosen their plans. By the same week last year, 14,909 people had chosen their plan.

People may be choosing to auto-enroll. Of about 34,000 West Virginians who got coverage through the marketplace last year, more than 10,000 auto-enrolled. West Virginia seemed to have a greater number of people who chose to auto-enroll, when compared to other states, according to data from the Kaiser Family Foundation.

(Another 160,000 West Virginians get coverage through Medicaid expansion, another component of the Affordable Care Act.)

But representatives of Navigator programs, which help people select insurance, in West Virginia are urging people not to auto-enroll. They may find better deals by shopping around.

The Kaiser Family Foundation warns that “letting the exchange automatically renew your coverage … could be a big mistake.”

Who’s deciding whether you can smoke marijuana?

Interested in who will be making recommendations to DHHR, and the West Virginia Legislature, on what medical conditions qualify you as a medical marijuana patient? Or who will be recommending whether marijuana dispensaries should sell marijuana in plant form?

The West Virginia Medical Cannabis Advisory Board has divided into three work groups. Following the second board meeting today, a DHHR spokesman sent me the workgroup descriptions, as well as a list of members for each group.

Advising the rest of the group on medical conditions that should qualify, we have: Dr. Arvinder Bir, Huntington; Kimberly Knuckles, a Beaver pharmacist; Dr. James Felsen, Great Cacapon; and Dr. Rudy Malayil, Huntington.

Advising on the forms of marijuana that should be permitted, we have: Michelle R. Easton, PharmD, Charleston; Dr. Joseph Selby, Morgantown; D. Keith Randolph, Boone County prosecuting attorney; and Russell A. Williams, of Nitro, who serves as the patient advocate.

And advising on how to ensure affordable access, and whether to change the number of growers, processors and dispensaries, we have: Colonel Jan Cahill, superintendent of the West Virginia State Police; W. Jesse Forbes, a Charleston lawyer; Joseph Hatton, a horticulturalist and deputy commissioner of the West Virginia Department of Agriculture, Charleston; and Michael J. Deegan, a Cross Lanes social worker.

The groups are planning to meet and report back at the next board meeting, on Dec. 14 in Morgantown. A location has not been announced. Neither have any individual group meetings.

If you’re interested in the PowerPoint presentations, on the upcoming patient and provider surveys and other info, from the meeting today, you can also find that here.

 

 

I wrote a story for today’s paper about a mindfulness training to be held in the fall for first responders from Kanawha, Putnam and Cabell counties. We have limited space in the paper, but I wanted to share more about the research being conducted on the training, and what agencies that don’t operate in Kanawha, Putnam or Cabell counties can do.

Richard Goerling, a police lieutenant in Oregon who developed a training on first responder resiliency and performance, will be leading the two-and-a-half day training. He says it’s about noticing emotions as they arise, and not spending unnecessary energy trying to control or ignore the emotion. He also says it’s about learning to pay attention to stress-related changes in the body. Goerling said participants will learn “how do we be present and create space for performance with the emotion that arises.”

“Ignoring emotion actually makes us more weak,” he said. “Typically today we wait until first responders are broken and then we try to fix them.”

Organizers have not announced where in the region the event will be held, but it is planned for late fall.

Dr. Michael Brumage, executive director and health officer for the Kanawha-Charleston Health Department, and Brittany Canady, a health psychologist at Marshall University, applied for a $49,000 grant to get the training. West Virginia Clinical and Translational Science Institute will conduct research on it, based on standardized self-assessments, and will test the presence of stress hormones in a person’s saliva before the training and then again weeks after it’s over. Researchers will measure participants’ baseline emotional physical and mental well-being through questionnaires and also measure salivary cortisol level (an indicator of stress). They predict changes in mindfulness, physical health, mental health and stress, and that those changes will be reflected in salivary cortisol levels at 4 weeks and 90 days after the intervention.

The grant application says that results “will be shared with the first responder community.” But only about 70 people will be trained.

“Our hope is that we can test out this intervention, hopefully find out that it’s helping people, and then be able to relay those results to others so the word can get out,” Canady said. “There’s really nothing that we know of that’s been done with first responders in Appalachia.”

Here’s what organizers told me about what other counties with fewer resources could do:

Goerling suggested that West Virginia agencies that lack funds to hold similar trainings could look for local yoga trainers. He also noted that in early 2018, Pacific University Graduate School of Psychology in Oregon and the University of California San Diego Center for Mindfulness will launch a peer coach training. West Virginia agencies could send representatives, who could then come back and train staff. He also recommended pooling resources with other local and regional agencies.

Brumage also noted that there are meditation and tai chi groups in the region.

“I think our best advocates for this kind of training will come from the first responder community themselves,” he said.

first-responders

 

Sometimes you can can learn a lot about someone by what they don’t say.

On July 15, we published a story I wrote about how a plan the U.S. Senate was considering to repeal and replace the Affordable Care Act would cause West Virginians to lose access to addiction treatment.

The story noted that the bill would end Medicaid expansion in West Virginia and make deep cuts to traditional Medicaid. It noted that in 2016, about 50,000 of those covered by Medicaid expansion in West Virginia had substance-use disorders, according to the Department of Health and Human Resources.

From the story:

The Congressional Budget Office hasn’t released an estimate for the newest version of the bill. But it estimated the similar previous version would cut Medicaid by $772 billion over 10 years, based mainly on ending the extra funding for states that expanded Medicaid under the Affordable Care Act and setting per-capita-based caps on traditional Medicaid payments to states. It estimated 15 million fewer people would have Medicaid in 10 years.

Medicaid is the single largest payer of substance abuse and mental health treatment in the country. Nationwide, Medicaid covered three in 10 people with opioid addiction in 2015, according to the Kaiser Family Foundation. West Virginia has the highest overdose death rate in the nation, mainly due to opioids.

The newest version of the bill could also make obtaining coverage harder for people who have been addicted to opioids to find coverage on the private market because it would allow insurers to sell plans that discriminate against people with pre-existing conditions by charging higher rates.

Dr. James Berry, addiction psychiatrist and medical director at West Virginia University’s Chestnut Ridge Center, said the bill would be “devastating to the people who don’t have the financial resources in order to take advantage of programs such as ours.”

Lois Vance, addiction care coordinator at Kanawha City Health Center, said “If they lose their insurance, the whole world is going to be looking down on them again.”

And from a previous story:

Medicaid expansion money spent on substance abuse treatment, including services and prescriptions, increased from about $25 million in 2014 to $111,767,057 in 2016.

In 2013, 5,827 people with opioid abuse diagnoses were covered by Medicaid, according to the DHHR. Medicaid paid for $6.8 million in opioid abuse-related claims that year. By 2016, the number had increased to 14,808 patients. Medicaid paid for more than $17 million in opioid abuse-related claims that year.

All three members of the U.S. House of Representatives — Reps. David McKinley, Alex Mooney, and Evan Jenkins, all Republicans — voted for a bill that would have similarly resulted in a loss of coverage among the opioid-addicted population in West Virginia. It would have cut Medicaid by an estimated $834 billion over 10 years, resulting in 14 million fewer Medicaid enrollees by 2026, the Congressional Budget Office found. States would also have been allowed not to require insurers to cover certain conditions, including mental health and substance abuse problems.

Spokesmen for Mooney and McKinley have not responded to requests for comment on how their votes could have affected the opioid-addicted population in West Virginia. Those requests were sent July 17, following the release of the latest story.

A spokeswoman for Jenkins responded to the initial request, but never sent a statement or set up an interview as requested.

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AP file photo

National news outlets are reporting that President Trump invited a group of senators to the White House tonight, to convince them to support the GOP plan to repeal the Affordable Care Act.

But at about 8:30 p.m. Monday, two additional senators, Jerry Moran of Kansas and Mike Lee of Utah, said they would not even vote to begin debate on the legislation. Two other senators, Rand Paul of Kentucky and Susan Collins of Maine, had already said they could not support the bill, and without Democratic support, GOP leaders could only lose two votes and still pass the bill.

Sen. Shelley Moore Capito, R-W.Va., who would have cast a key vote, “didn’t receive an invite” to the meeting with Trump, according to spokeswoman Ashley Berrang.

Berrang said, via email, that Capito’s absence at the meeting doesn’t indicate a position and referred to last week’s statement.

Berrang said Capito “intends to review the CBO score when it is released, and that has not happened.”

Compared to the previous version, the bill makes similarly deep cuts to Medicaid. Capito has said the previous version cut that program “too deeply.”

It adds $45 billion to combat the opioid crisis. Capito has said she advocated for that funding, but health policy experts have said it won’t be enough to make up for other detrimental provisions of the bill.

Politico reports: “Aides to key swing-vote Republicans including Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Jeff Flake of Arizona, Cory Gardner of Colorado and Ron Johnson of Wisconsin said they were not attending.”

From the Hill: “a White House official said the following GOP senators were attending: No. 2 Senate Republican John Cornyn (Texas), Lamar Alexander (Tenn.), Roy Blunt (Mo.), Steve Daines (Mont.), James Lankford (Okla.), Richard Shelby (Ala.), and John Thune (S.D.).”

 

 

 

Before Tom Price came to town to “listen”

Remember when U.S. Health and Human Services Secretary Tom Price visited Charleston in May for a “listening tour” on opioid addiction? Of course you do. West Virginia made national news when journalist Dan Heyman was arrested after attempting to ask Price a question, about whether domestic violence would count as a pre-existing condition under the GOP plan to replace Obamacare.

I found the description of the event as a “listening tour” a bit strange, because I knew from a previous open records request that state officials had already told GOP leaders supporting the bill, in letters, that it would “negatively affect the ability of West Virginians with mental, behavioral health and substance use disorders to access needed services,” and that the president’s budget would have a “dramatic impact on substance abuse and mental health services.” “Federal funding must be maintained or West Virginia’s health care infrastructure will collapse,” both Governors Jim Justice and Earl Ray Tomblin have said.

So I wanted to know more about who, exactly, thought the tour was a good idea, what the Trump administration had to say when they contacted state officials, and the planning that went into it.

If you’re interested, here are the 155 pages of emails DHHR was required to send me under state law. Some of the highlights include:

Laura Trueman, of HHS, emails the governor’s office, saying Price wants to come on Tuesday, May 9 to “highlight work being done on opioids by the states.” The email also says he wants to perhaps “meet with the Governor and his Advisory Council, and then go see something in the community – perhaps first responders, hospital visit, or a rehab place or drug court.” The governor did not attend.

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HHS officials also insisted that press not be able to attend the roundtable discussion (although we were able to attend a four-question “press conference.” Most of my time at that event was spent listening to prepared statements by various officials, not on questions.) According to emails, Butch Antolini, a spokesman for the governor, asked about making the event open to press. Trueman gives reasons why not:

no-press

HHS was apparently concerned about “losing control of the message,” which conflicts with its stated goal of a “listening tour.”

They also stated that “Candor might be compromised.” This is confusing to me, because we at the Gazette-Mail regularly speak to most of the roundtable participants about the opioid crisis.

More concerns about press:

press

Trueman sends suggested language for the invitation to the event. It begins:

suggested-language

Butch Antolini, the governor’s communications director, responds:

butch

And on May 9, the day of the event:

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There’s more here, if you’re interested. Seems like there was a lot of confusion leading up to the event, and that Congressman Evan Jenkins, who is running for Senate, was not originally supposed to be standing alongside Conway and Price at the press conference. I’m going to get back to a story I’m working on about how the GOP bill would affect the opioid epidemic killing my friends and neighbors.

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In late March, I wrote about how an adolescent abortion bill had been amended into a “compromise” in the House of Delegates.

Under current law, a physician can decide that a girl is mature enough to make the decision on her own, or that telling her parents would not be in her best interest, before a second physician performs the abortion.

The bill, House Bill 2002,  made it so physicians could no longer do so, requiring them to go to court instead for a judicial bypass – a process the American Academy of Pediatrics, among numerous other opposed medical organizations, has said “poses risks of medical and psychological harm.”

After sexual abuse survivors testified during a public hearing, three lawmakers, including Delegate Kayla Kessinger, Barbara Fleischauer, and Amy Summers, worked in a House of Delegates judiciary subcommittee to amend the bill so that most physicians could no longer waive parental notification, but that licensed psychologists and psychiatrists would be able to do so.

But as the compromise bill continued to make its way through the Legislature, leading supporters of policies restricting abortion, including Karen Cross, of the National Right to Life Committee, said they couldn’t speak to the bill because they didn’t know what was in it, and that it was moving so quickly.

So, I wondered what they were telling lawmakers, and supporters.

When the Senate reverted the bill back to its original version during a evening meeting that was not announced and was not added to the video archives that night, dispensed with another committee reference, and sent the bill to the floor for another vote, it certainly seemed like there was never a compromise.

But a few emails, obtained through an open records request, can tell us a little more about how it happened.

On March 30, Karen Cross and Mary Anne Buchanan, of West Virginians for Life, emailed lawmakers, saying there were “changes that need to be made to the bill. Please support the strike and insert.”

wvians-for-life-email-1

In a previous email to Delegate Tom Fast, R- Fayette, Cross had said she believed working with the Senate on the bill would be “easier.”

When asking senators to vote for the final bill, they said it had “undergone a number of compromises.”

The sentence wording is vague, and I don’t know if any senators took the language to mean the final bill was approved by the medical community or women’s health advocates.

It wasn’t.

I’m reminded that when the Senate passed the original version of the bill, Margaret Chapman Pomponio, executive director of WV Free, told me they had supported the amended version because compromise on abortion legislation was “almost unheard of.”

I’ve emailed both Cross and Kessinger, the lead sponsor, for comments and will update this post if/when they respond.

 

 

 

 

 

When I was 13, I developed acute appendicitis on the second day of my first band camp. I can still remember standing in the late-July sun, clenching my side and fighting the urge to pass out in the middle of practice. I remember later that afternoon, recoiling as my pediatrician palpated my abdomen, and I remember the rush of anxiety when, after asking me to stand up straight and noting that I couldn’t, he sent me next door to the hospital to confirm his suspicions.

Most of all, I remember what came after: I was sent home with a neatly stitched, two-inch incision and a 10-day prescription for hydrocodone for any lingering pain. I hadn’t actually felt any pain since before my surgery — I felt fantastic, and I made sure to tell my parents that excitedly not long after waking up — but the hydrocodone was to “keep me ahead” of any pain I might feel. It worked, of course; after a week, my mom unceremoniously trashed my remaining pills and pushed me back to camp.

It’s been more than a decade, and I can still remember what a week on opioids felt like. I recall telling my mom that I felt “taller,” and I did, but I felt other things, too — blissfully unconcerned, foggy and warmly relaxed.

It may not sound like much, but seven days may be all it takes to change the brain and foster an opioid addiction, according to Dr. Carl “Rolly” Sullivan, director of the addiction program at WVU Medicine and one of a growing number of doctors railing against an “opioid first” mentality that has come to dominate pain management in the last couple of decades. It doesn’t take long to get hooked, but leaving opioids behind can be nearly impossible for the well and truly addicted — more than half of recovering addicts will relapse at least once. That’s why news that the Centers for Disease Control and Prevention had issued guidelines  expressly discouraging prescribing the powerful narcotics in the first place was so welcome in West Virginia, where at one point, pain pills outnumbered people 100 to 1.

The CDC guidelines are a start, but they’re just one step on the road to a recovery that has as much to do with prescribers as it does with addicts. Doctors practicing today, and especially those trained in the last 20 years, were often taught about pain as “the fifth vital sign” and offered opioids as the solution for their patients’ woes. Attitudes have started to shift — the CDC’s guidelines are a good indication of that — and a number of initiatives at the federal level could coalesce into a backbone for the nation’s effort to combat opioid abuse.

Last week, the White House asked the Association of American Medical Colleges to urge medical schools to include a requirement that students be taught in line with the CDC’s new prescriber guidelines. This week, Marshall University and West Virginia University announced in turn that the schools hope to help lead the initiative, which now has the backing of roughly 60 medical schools, and would ultimately mean a new generation of doctors taught to avoid opioids as a first choice for treating non-palliative pain.

The CDC itself is not a regulatory agency, and its recommendations are meant to offer doctors a guidepost when navigating their own practice. As Dr. Tom Friedan, CDC director, said of the guidelines: “(W)e are not a regulatory agency. So these are guidelines. They are recommendations. States, the national governors’ association, health care systems, insurers may look to these guidelines, when they implement policies within their own jurisdictions or institutions but what our role is to provide the best available science to try to improve the care of patients who are suffering from chronic pain which is a very challenging situation for patients to have to live with and a very challenging condition for physicians to treat.”

That’s probably what’s most important to note with the WVU/Marshall announcement: the schools have put their support behind actual regulation that would change the way the universities, and other medical schools, approach teaching prescribing practices.

President Barack Obama discussed the proposal today, along with several others, during the National Rx Drug Abuse Summit. Highlights from the president’s announcements include a proposed rule to increase the current patient limit for qualified physicians who prescribe buprenorphine (Suboxone) from 100 to 200 patients, as well as a rule that would require Medicaid and Medicare to offer substance abuse treatment at the same level of insurance reimbursement as medical and surgical care.

Bill Nye and the science of choice

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I thought it might be interesting and appropriate, in view of the fact that celebrated science speaker Bill Nye is set to visit Charleston in November, to point  to his explanation of everything that is wrong with trying to attack women’s health services.

Nye is well-known for his no-nonsense approach to a variety of hot button topics, ranging from global warming to evolution, but since this blog is about health, and since the support for some women’s health organizations has been called into question in recent weeks, I thought this video was particularly interesting.

“Nobody likes abortion,” Nye says in the video. “But you can’t tell somebody what to do.”

I don’t know whether there will be any sort of question-and-answer period following Nye’s talk, but I’d love to hear more from him on the topic ( maybe I can sneak in, since I missed out on getting a ticket.)

Speaking of women’s health — the Planned Parenthood Clinic that West Virginia Speaker of the House Tim Armstead hopes to divert funding for serves roughly 1,000 a year who, because of the level of access in Wood County and because of the types of patients PP normally sees, would likely end up at the Mid-Ohio Valley Health Department. Dr. Drema Mace, the health officer for the health department, said the agency would likely be able to absorb those patients “with a little lead time.” She didn’t elaborate on whether expanding family planning services would cut into the time or resources for other services offered at the department, but it looks like the PP clinic in Vienna may have to survive on its own merit.