PHILADELPHIA. 'Heroin in pill form': Philly targets prescription painkillers to curtail fatal ODs

By Sam Wood

There were 907 fatal overdoses in Philadelphia last year. Opioids — heroin and prescription painkillers — were implicated in 729 of them. 

Many of those killed by heroin began their addictions with prescription opioids, so the city is launching a TV and social media campaign labeling legal painkillers as “heroin in pill form.” The aim of the $182,000 campaign, announced by the Health Department Monday at City Hall, is to save lives.

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SEATTLE. Four ways we are measuring Affordable Care Act proposals (Public Health Insider)

By Patty Hayes, Director, Public Health—Seattle & King County

This post originally appeared in Public Health Insider

As various proposals to replace the Affordable Care Act continue to circulate, here is the yardstick Public Health—Seattle & King County will use to measure any proposals and the potential impacts.

Any reform or replacement for the Affordable Care Act should help people lead healthier lives. We believe that’s the underlying purpose for health care reform (while acknowledging that there are economic and other reasons to reform, as well). We’re tracking four key areas that help us measure each proposal. Read more. 

NATIONAL. More than the ACA: We Can’t Stop Fighting Now. (Huffington Post)

By Dr. Oxiris Barbot, First Deputy Commissioner, NYC Health Department

Since the start of the new presidential administration, the onslaught of policies and executive orders have been met with outcries from communities, organizations and elected officials. In the medical community, there was an almost unprecedented bipartisan opposition to the White House’s proposed American Health Care Act. To some, the protection of the Affordable Care Act has given us a rare time to celebrate, rest and regroup.

Now is not that time.

Not one of us should have the delusion that an insurance card will be a game changer when it comes to addressing longstanding and dire health inequities. If we truly want to ensure America’s health, activists, physicians and medical organizations can’t just mobilize for preservation of the Affordable Care Act. We must respond with equal vigor to immigration reform, housing quality and segregation, civil rights and other policies that could shape the nation for generations. When 80 percent of health is determined by the context of our lives, confining advocacy to access to medical care is reckless and irresponsible.

In a brave new world, here’s how we move forward:

#1 Collect Data for Action

Medicine and health rely on facts. There can be no alternatives. The need to collect robust data and shape the narrative of health has never been more urgent. By quantifying the human toll of defunding Planned Parenthood, reducing SNAP benefits through the Farm Bill and block-granting Medicaid, we proactively treat more patients than a doctor could during a shift in the ER, or an entire career. Read more. 

DETROIT. Detroit’s new top doctor making an impact (Detroit News)

Karen Bouffard, The Detroit News

Dr. Joneigh S. Khaldun took the top job at the Detroit Health Department a little over a month ago, and has already launched two public health initiatives with others in the works.

SisterFriends, announced by Detroit Mayor Mike Duggan in his State of the City address, is an attempt to combat preterm births and infant mortality by matching young moms with volunteer mentors. The other initiative, Lead Safe Detroit, launched earlier this month, created a central clearinghouse for all of the city’s lead-related activities at detroitmi.gov/leadsafedetroit.

Joining the city’s Health Department as medical director last July was a dream come true for Khaldun, 36. She became Detroit’s top doctor on Feb. 17, when she was named executive director and health officer.

Read more. 

CHICAGO. Chicago health commissioner: The ACA saves lives and we shouldn't abandon it (The Hill)

Op-ed by Julie Morita, Commissioner, Chicago Department of Public Health

For many people, the signature accomplishment of the Affordable Care Act (ACA) is the 20 million additional Americans that gained access to health insurance.

But what is less recognized is the ACA's transformation of the entire health system. These changes included a sharper focus on preventive care, a departure from the fee for service payment models that incentivize procedures, and the adoption of payment to quality, not quantity, of care.

While we are hopeful that much of this remains in place regardless of what the future of ACA looks like, one key lever must be retained to continue the progress made toward prevention of many serious and costly diseases: the Prevention and Public Health Fund (PPHF).

This fund directs federal dollars to state and local public health agencies to conduct vital prevention initiatives ranging from preventing lead poisoning in homes, to detecting and controlling infectious disease outbreaks before they can spread.

These funds have played a critical role in combating a little recognized public health threat known as Human Papillomavirus (HPV) here in Chicago. Guided by the Centers for Disease Control and Prevention (CDC), our nation’s leading public health agency, recommendation that young girls and boys receive the first dose of the life-saving, cancer-preventing HPV vaccine at age eleven, Chicago has taken steps to protect our children from HPV-induced cancers. And we could not have done it without the PPHF funding that we received in 2013. Read more. 

BALTIMORE. I'm Pregnant. What Would Happen If I Couldn't Afford Health Care? (NPR Shots)

By Dr. Leana Wen

On Christmas Day, I found out that I was pregnant. It was the best present I could have hoped for. My husband and I have wanted to start a family for years, and we could not wait to share the news with our loved ones.

But my initial exhilaration quickly turned to anxiety. As a physician, I knew many of the things that could go wrong. I wanted to do everything I could do to have a healthy baby.

I found an obstetrician and made an appointment for my first prenatal visit. I was so relieved when I saw the baby's heartbeat on the ultrasound. My blood was drawn to check for anemia and thyroid problems. I had the rest of my recommended first trimester tests, including a Pap smear and testing for HIV and sexually-transmitted infections.

The appointment also provided other valuable information. I talked to my doctor and his nurse practitioner about combating morning sickness and eating nutritious meals. I don't smoke, but if I did (as 1 in 10 pregnant women do), they would have counseled on why and how to quit. My providers asked additional questions to assess for domestic violence, a concern for up to 1 in 6 pregnant women.

Even though I'm a relatively healthy 34-year-old, I have several medical conditions that call for more frequent monitoring. My doctor recommended that I return every two weeks for a physical exam and ultrasound. Closer to delivery, I should plan to see him every week.

I didn't hesitate to follow my doctor's recommendations. I have excellent health insurance with no copay for doctor's visits and a minimal cost for tests.

But what would I have done if I didn't have insurance?

One obstetrician visit would cost $150. With an ultrasound each time, it would be $400. A Pap smear would cost $53. One set of blood tests would add another $300. All told, my prenatal care with all visits and tests included would be over $10,000. This is not counting labor and delivery, which in my area is estimated to be up to $30,000 for a vaginal birth and $50,000 for a cesarean section.

Facing these astronomical costs, would I be forced to pick and choose care based on my ability to pay, rather than the best available medical evidence? What services would I forgo, and with what consequences?

These are not hypothetical questions.

The Republican proposal to replace the Affordable Care Act would drastically cut Medicaid, which provides health coverage for women, children, seniors, and individuals with disabilities. In Baltimore, where I serve as the health commissioner, the majority of pregnant women are insured through Medicaid. Thousands of low-income women could lose coverage and have to pay out-of-pocket for services; others who have insurance may only be able to afford bare-minimum plans that don't cover needed services. Read more. 

PHOENIX. GOP health bill would cut nearly $47 million in Arizona public health funds (The Arizona Republic)

By Ken Alltucker

Arizona could lose $46.8 million in federal public health funding over the next five years via a cut included in the House Republican health bill, likely forcing local health departments to reduce or cut public health programs.

While debate over the GOP's American Health Care Act largely focuses on how the bill seeks to remake private-sector insurance and the Medicaid program for low-income and disabled people, a less-publicized provision would eliminate a Centers for Disease Control and Prevention fund of nearly $1 billion that sustains public health programs nationwide.

The Arizona Department of Health Services received $9.3 million this fiscal year from the Prevention and Public Health Fund. The money is included in the Affordable Care Act, but the GOP plan that cleared two House committees last week would discontinue funding next fiscal year.

The fund pays for program such as providing childhood immunizations and counteracting emerging public health threats such as the Zika and Ebola viruses. It also helps pay for efforts to curb childhood lead poisoning, fight heart disease, manage diabetes, promote skin-cancer awareness and smoking cessation.

"This funding is in danger," said Dr. Cara Christ, director of the Arizona Department of Health Services. "There is no guarantee these programs would continue." Read more. 

BALTIMORE. Six reasons to fight the ACA replacement plan (Baltimore Sun)

By Dr. Leana Wen

For months, I have received questions from concerned residents about how repeal of the Affordable Care Act (ACA) would impact their health. My patients were worried about whether they could still get medications to treat their heart disease and diabetes, whether they would they lose coverage for mental health and addiction services, and whether they would continue to get basic preventive services such as mammogram, pap smears and blood pressure screenings.

This week, House Republicans issued their proposed replacement. There are six particularly concerning provisions with drastic consequences to Baltimore's health:

First, the bill punishes those with lower wages by eliminating subsidies to help pay for insurance coverage based on a person's income. As a physician who has practiced medicine before and after the ACA, I have seen patients forced to make the impossible choice between basic needs, including food and housing, and critical medications. I have seen patients forgo paying for insurance coverage because it is too expensive. I have seen the consequences when people are forced to pay for this "choice" with their lives.

The policy also drives more people to use emergency departments as a source of primary care. As an emergency physician, I am proud to deliver excellent care when people need it — but this is an inappropriate safety. Studies have shown that patients without health insurance put off their medical needs until they become so severe that they can no longer be pushed aside. At that point, when patients are very ill, their care becomes unnecessarily expensive.

Second, the bill places a cap on Medicaid spending, which limits the amount states can pay per person. This leads to inevitable cuts in coverage and will hurt those who are the most vulnerable — including seniors, women, children, people with low incomes and individuals with disabilities. These are already populations who face a disproportionate share of health disparities, which will worsen if the Medicaid safety net is weakened. Read more.

SACRAMENTO. GOP Obamacare repeal plan could hurt fight against Zika, hepatitis, other health problems (The Sacramento Bee)

By Sammy Caiola

A multibillion dollar federal fund that helps prevent disease outbreaks and fights chronic conditions may disappear with a Republican plan to revamp the Affordable Care Act, worrying local physicians and county officials who say they rely on the money to sustain community health.

The GOP legislation, as it was released Monday, proposes cutting a piece of the Affordable Care Act called the Prevention and Public Health Fund – a store of federal money created to bolster immunization rates, disease surveillance, workforce training and community health education, among other programs. If the replacement legislation passes, county and state agencies throughout California will lose millions of dollars they relied on for public health efforts. Those governments also used the grants to prepare for emergencies such as Ebola and Zika virus outbreaks, health officials said.

The Prevention and Public Health Fund has provided more than $4 billion nationally and about $290 million to California since its launch, including $4 million directly to groups in the Sacramento area. That money goes to government agencies such as the U.S. Centers for Disease Control and Prevention and the Administration for Community Living, who then distribute it to state and local health departments as well as hospitals, universities and nonprofit groups.

In the Sacramento area, the fund has supported major public health projects including:

▪ A $98,950 UC Davis effort to prevent the spread of viral hepatitis through early identification.

▪ A $101,999 project at Sierra College in Rocklin to fight suicide among college students.

▪ A $484,389 initiative from the California Center for Public Health Advocacy in Davis to reduce chronic disease in diverse communities.

▪ A $2,661,141 effort by the California Rural Indian Health Board in Sacramento to prevent diabetes among American Indians. In 2017, the fund will award more than $900 million to programs throughout the U.S. addressing Alzheimer’s disease, immunizationbreastfeedinglead poisoningyouth suicide and more.

The Republican plan proposes discontinuing the fund starting in fiscal year 2019. The Affordable Care Act, which went into effect in 2010, not only expanded insurance coverage but also started initiatives to address a range of health issues, such as high hospital readmission rates, electronic medical record adoption and rising drug prices for Medicare enrollees. Read more

NATIONAL. Threats to CDC Prevention Fund Draw Scrutiny (The American Journal of Managed Care)

By Mary Caffrey

Most of the early attention to the House Republicans’ American Health Care Act (AHCA) has focused on its potential effects on the individual market. But experts are now pointing to a cut of $931 million to the CDC’s Prevention and Public Health Fund, which may not be well-known to the average consumer but, in the words of one House member, is “more important to the average American than … the Defense Department.”

US Representative Tom Cole, R-Oklahoma, offered that assessment to STAT while noting that the typical citizen was more likely to be exposed to a pandemic than a terrorist attack. Cole oversees CDC’s budget, and when interviewed this week was not yet sure what to do about the proposed cut contained within AHCA.

Some of his fellow Republicans call the prevention dollars, which are 12% of CDC’s budget, a “slush fund” that has been misspent on things like Zumba classes. They propose a new fund that offers flexibility to the states.

Chrissie Juliano of the Big Cities Health Coalition, writing in Health Affairswarns the CDC cut scheduled to be axed from core health programs, that cover everything from tracking diseases, providing immunizations, and preventing lead poisoning.

The CDC Prevention Fund, Juliano and others note, was one of several pieces of the Affordable Care Act designed to take the nation’s health system out of the reactive posture and toward a model of care that caught problems before they got out of hand. The CDC cuts affect the nation’s ability to battle the most common chronic conditions—heart disease, diabetes, stroke, and asthma. They set back scientists’ efforts to fight the Zika virus or to help the children in Flint, Michigan.

As Juliano writes, funds in prevention are dollars well spent, with returns on investment of $17 to $221, yielding savings of $181 million to $269 million. She wrote, “Even without considering the human cost, this investment makes good fiscal sense.”  Read more 

PHILADELPHIA. Berkeley, nonprofits & more call big beverage's soda tax lawsuit 'absurd' (Philadelphia Business Journal)

By Alison Burdo

The city of Philadelphia apparently has some friends of its own – at least two dozen nonprofits and the city of Berkeley, Calif., – filed six separate amicus briefs Friday that support the administration in its legal battle over the city's beverage tax by saying the beverage industry, which "does not lose gracefully," is putting forth "absurd" arguments.

"[The plaintiffs] legal theory would invalidate not only this tax, but potentially many other taxes and nontax initiatives that further public health and welfare by encouraging citizens to reduce their consumption of unhealthy products," according to an amicus brief filed on behalf of the American Heart Association, the American Medical Association, the National Alliance for Hispanic Health, the Public Health Law Center and 10 other organizations. Read more

PHILADELPHIA. Fifteen health organizations file in Philadelphia’s sugary drink tax (AHA News)

Fifteen health organizations filed a friend-of-the-court brief Friday in hopes that the beverage industry’s appeal of a sugar tax will fall flat.

Philadelphia’s 1.5-cent-an-ounce tax on sweetened drinks survived a major challenge in December from the beverage industry, after a city judge dismissed the group’s lawsuit. The beverage industry filed an appeal last month.

The health groups’ brief was filed by the Public Health Law Center on behalf of the American Heart Association and 14 leading public health and medical organizations, including the American Medical Association and the American Cancer Society Cancer Action Network. The science-based filing outlines support for taxing sugary drinks in Philadelphia, which has some of the highest rates of heart disease, Type 2 diabetes and obesity among large cities.

While the tax is said to have a public health impact through reduced consumption, the AHA says the revenue raised by the tax will be used in a way that has a significant impact.

The tax will be levied on distributors, not consumers. It is expected to bring in about $91 million annually, which the city plans to use to expand pre-kindergarten programs, improve parks and offer tax credits for businesses that sell healthy beverages. Read more

PHILADELPHIA. Philly beverage tax is working (Philadelphia Inquirer)

By Thomas A. Farley

In the publicity about the first month's revenue from the Philadelphia beverage tax and the howls from the soda industry, the key point has been missing: The tax is working.

Children are getting educated in prekindergarten. The city is taking the first steps toward a massive rebuilding of parks, recreation centers, and libraries. Nine community schools are helping students and their families. The city is meeting its revenue projections, and the soda industry says sugary drinks sales have declined.

Mayor Kenney predicted that all of these things would happen. And opponents, at one time or another, claimed that none of them would.

The primary goal of the beverage tax was to pay for these investments in our city's children, families, and neighborhoods. And a secondary goal was to do it in a way that battled back the city's still-growing twin epidemics of obesity and diabetes.

Critics said that you couldn't do both. If people stopped drinking soda, they said, the city wouldn't have sufficient revenue for its programs or, alternatively, if revenue came in at projections, then people weren't significantly reducing their soda consumption.

But with the city's first revenue collections on track to meet annual projections and soda sellers reporting declines, the industry's predictions have been proved wrong, and so they are now shifting to fear mongering on job loss. Read more.

NATIONAL. ACA Repeal Would Mean Massive Cuts To Public Health, Leaving Cities And States At Risk

Chrissie Juliano

This blog originally appeared in Health Affairs on March 7, 2017

When the Affordable Care Act (ACA) was passed a little over six years ago, it brought with it the promise of health insurance for all Americans. It also sought to begin to shift the paradigm for health care in this country, emphasizing value over volume, and recognizing the importance of prevention coupled with appropriate access to care.

By now, it is well known that repealing the ACA could leave nearly 20 million Americans uninsured and simultaneously result in millions of job losses across the country. An associated cost that has been less discussed, but no less relevant, is what repeal could mean for the nation’s already-fragile governmental public health system. As the director of the Big Cities Health Coalition (BCHC), a membership organization of 28 governmental public health departments in the largest, most urban areas of the country, I cannot underscore the importance of these funds enough.

Without a comparable replacement, or appropriation of additional funds, at least $3 billion will be cut from state and local public health departments alone over the next five years through funds allocated by the U.S. Centers for Disease Control and Prevention (CDC). An additional $2 billion in federal resources would be lost to a number of other prevention-oriented activities across the entire public health enterprise. This $5 billion is essential to core public health programs that keep Americans healthy and safe every day and makes up 12 percent of CDC’s annual budget, supporting disease tracking, access to immunizations for those most in need, and preventing and addressing lead poisoning, among other priorities.

The Prevention and Public Health Fund was designed to provide additional dollars to support the programs that prevent disease in communities across the country, including addressing many of the leading causes of death. These are the same conditions that drive our rising health care costs, including cancer, heart disease and stroke, diabetes, and asthma. These conditions are so prevalent that they now touch almost every family in every community across the country.

Read more.

NATIONAL. GOP Health Care Plan Would Eliminate an Important Disease Prevention Fund (Route 50)

By Quinn Libson,
Staff Correspondent

MARCH 8, 2017

State and local public health departments alone stand to lose as much as $3 billion over the next five years.

WASHINGTON — Amid discussions surrounding the new health care proposal introduced by U.S. House Republicans this week, a lot of attention has been paid to the future of Medicaid, the Planned Parenthood funding freeze, and the implications of eliminating the individual mandate. But there’s one subtler—and no less crucial—change that will impact the entire fabric of the American public health system that state and local governments shouldn’t overlook.

As part of their proposal, House Republicans intend to eliminate the Prevention and Public Health Fund, the largest individual federal funding source set aside for disease prevention, by 2019.

This isn’t the first time the fund—which was established by the Affordable Care Act in 2010—has come under attack from the GOP. In 2012, House Republicans proposed a plan that would maintain a low interest rate for Stafford student loans by cutting funds from the PPHF. And, earlier that same year Congress dipped into the fund to use $5 billion to pay for a payroll tax extension. In fact, since its creation, the PPHF’s original allocation has already been cut by 50 percent.   

Setting aside the vast implications of the fact that the fund accounts for 12 percent of the U.S. Centers for Disease Control and Prevention’s entire budget, the loss of that money would be felt in communities across the country.

According to Chrissie Juliano, the director of the Big Cities Health Coalition, which is part of the National Association of County and City Health Officials, without an alternative funding source, state and local public health departments alone stand to lose as much as $3 billion over the next five years. And, an additional $2 billion could be lost to the entire public health system in that same time period.

Read more.

NATIONAL. The Affordable Care Act and Local Public Health Departments: Three Things Everyone Should Know by the National Association of County and City Health Officials (PR Newswire)

The Following is a Q&A With Laura Hanen, MPP, NACCHO Chief of Government Affairs

Q.  Ms. Hanen, NACCHO represents nearly 3,000 county and city health departments in the U.S. The new administration has vowed to repeal the Affordable Care Act. Why is preserving it so important?  

The Affordable Care Act brought about significant change to the healthcare and public health landscape.  It fundamentally shifted how we as a nation think about the meaning and value of health. The Department of Health and Human Services estimates that an impressive 17 million uninsured people have gained health insurance under the law. In addition to expanding access to care, the ACA encourages a more holistic approach to care by rewarding clinical care providers for value instead of volume. As a result, we're seeing a greater focus on quality and outcomes in the clinical setting.  If the law is repealed, millions of Americans may lose their insurance coverage.  The ACA also expanded access to clinical preventive services and disease screenings. Another crucial piece of the law to local health departments and the communities they serve is the Prevention and Public Health Fund.

Q.  What is the Prevention and Public Health Fund?

The Prevention and Public Health Fund (PPHF) is a funding stream primarily dedicated to investments in core public health programs at state and local health departments. The PPHF makes up 12% of the Centers for Disease Control and Prevention's (CDC) funding. Since 2010, the PPHF has supported efforts to combat infectious disease, prevent lead poisoning, detect causes of diseases and injury, and address the leading causes of rising health care costs. The PPHF is in jeopardy because of the proposed repeal of the Affordable Care Act.  A core principal of our organization's mission is to promote equal access to good health.  A repeal of the Affordable Care Act would severely impact access to care and maintenance of a good quality of life for Americans.

Q.  What do our leaders on Capitol Hill need to know about potential cuts to the Prevention and Public Health Fund?

With the effort to repeal the ACA, funding from PPHF is in peril. Congress can stop this from happening. NACCHO urges local health departments to take action now and call their Members of Congress to oppose cutting the PPHF.  Among the vital programs at risk at the CDC are the 317 Immunization Program, Childhood Lead Poisoning Prevention Program, Heart Disease and Stroke Prevention and Diabetes Prevention among others.

NACCHO's Board of Directors, Big Cities Health Coalition and state associations of county and city health officials will be visiting Congress members this week to let them know how vital continued funding is to the ability of our nation's local health departments to serve their communities and keep people healthy and safe.

Read more. 

NATIONAL. Top addiction news for psychiatrists (Healio)

Senate approves CARA to address national opioid epidemic, BCHC encourages passage of TREAT

The Senate recently approved the Comprehensive Addiction and Recovery Act in a nearly unanimous vote. Prior to the Senate’s approval, members of the Big Cities Health Coalition sent a letter to Sens. Mitch McConnell, R-Ky., and Harry Reid, D-Nev., requesting passage of CARA and the Recovery Enhancement for Addiction Treatment act. Read more

MINNEAPOLIS. Repeal of ACA would imperil a little-known part with a huge impact (Minneapolis Star Tribune)

By GRETCHEN MUSICANT
February 17, 2017

The debate about the future of the Affordable Care Act (ACA) is in full swing, and many know that repealing the ACA would leave almost 20 million Americans without health care coverage. This is of great concern.

But the fact that repealing the law would also decimate the already-fragile public health system in America is not known to many policymakers or members of the public.

This part of the law, which benefits every American, helps to keep all healthy and safe; it will essentially be undone with the repeal of the ACA. If there is no comparable replacement, communities across the nation are poised to lose $3 billion in federal funds over the next five years through a mechanism called the Prevention and Public Health Fund, which is currently a component of the ACA.

The Prevention and Public Health Fund was designed as an important, complementary component to the promise of insurance coverage for most Americans. It was meant to help us prevent disease instead of just treating it when it strikes, and to address many of the other factors that make us ill and cause our health care costs to keep rising.

Researchers have found that our ZIP code is actually a greater predictor of our health than our genetic code. Strategies supported by the fund are aimed at addressing our nation’s sky-high rate of chronic disease, in particular diabetes, obesity, cancer, asthma, and heart disease. These health problems now touch almost every family in every community.

The resources that flow from the ACA are now being used to backfill funding cuts to support core public health programs by funding a large portion of the Centers for Disease Control and Prevention (CDC), the part of the federal government that works 24/7 to protect America from health, safety and security threats. It is responsible for ensuring access to vaccines to protect against flu and other diseases; supporting local and state first responders in mitigating the effects of outbreaks like Zika or Ebola; and preparing for and responding to natural disasters like hurricanes and earthquakes. The CDC works to protect every American, every single day. Without the funding provided by the Affordable Care Act, its reach will be dramatically reduced.

Read more.