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The covid-19 crisis is going to get much worse when it hits rural areas

The recently closed Pickens County Medical Center in Carrollton, Ala., on March 26.

The recently closed Pickens County Medical Center in Carrollton, Ala., on March 26. (Jay Reeves/AP)

Michelle A. Williams is dean of the Harvard T.H. Chan School of Public Health. Bizu Gelaye is an assistant professor at Harvard and Massachusetts General Hospital. Emily M. Broad Leib is a law professor, director of the Harvard Law School Food Law and Policy Clinic and deputy director of the Harvard Law School Center for Health Law and Policy Innovation.

 

Over the past few weeks, our urban centers have scrambled to mobilize in response to the mounting covid-19 cases. But be forewarned: It’s only a matter of time before the virus attacks small, often forgotten towns and rural counties. And that’s where this disease will hit hardest.

 

Covid-19 is infiltrating more of the country with each passing day. Colorado, Utah and Idaho are grappling with sudden clusters in counties popular with out-of-state tourists. Cases are also skyrocketing in Southern states such as Georgia, Florida and Louisiana. So far, sparsely populated communities have been better insulated from the spread. But since no place in the United States is truly isolated, there’s simply no outrunning this virus. Every community is at imminent risk.

 

Rural communities could fare far worse than their urban and suburban counterparts. Rural populations are older on average, with more than 20 percent above the age of 65. Rural populations also tend to have poorer overall health, suffering from higher rates of chronic illnesses such as heart disease, diabetes and lung conditions, all of which put them at greater risk of becoming severely ill — or even dying — should they become infected.

 

Rural areas also already suffer from a rural mortality penalty, with a disparity in mortality rates between urban and rural areas that has been climbing since the 1980s. Chronic financial strain and the erosion of opportunity have contributed to “deaths of despair” as well as a rise in conditions such as heart disease, Type 2 diabetes and stroke. Add in prolonged social distancing and the economic downturn, and these trends will surely worsen.

 

Long before the novel coronavirus emerged as a threat, America’s rural hospitals were already in dire financial straits. About 1 in 4 are vulnerable to being shuttered, with 120 having closed in the past decade. With the pandemic looming, many of these health systems have been forced to cancel elective procedures and non-urgent services such as physical therapy and lab tests, which in some cases account for half of their revenue. As cash flow wanes, the American Hospital Association warns that even more hospitals could be forced to shut their doors exactly when patients need them most.

Rural counties have just 5,600 intensive care beds total, compared with more than 50,000 in urban counties. In fact, half of U.S. counties do not have any ICU beds at all. And even if these counties are somehow able to scale up their infrastructure, experts are afraid there will not be enough health-care workers to staff them. The time to prepare rural America is now. Fortunately, rural health systems will get some relief from the stimulus bill, which allocated $100 billion to health-care providers. But it is critical that we find additional ways to alleviate the burden on these health systems to the greatest extent possible.

 

One way to do that is by expanding telemedicine capabilities, which will allow millions of Americans to be seen by care providers even if there’s no room for them in hospitals. The Centers for Medicare & Medicaid Services recently issued guidelines that expand access to telemedicine for Americans on Medicare. That directive now includes federally qualified health centers, rural health clinics and hospices, so they, too, can be reimbursed for serving patients remotely.

 

Of course, telemedicine is far from a panacea, as broadband access remains limited in so much of rural America. The stimulus included an additional $100 million for rural broadband access, but this will not be enough. In the long term, policymakers must continue to close the “digital divide,” recognizing that Internet access is both an economic and health necessity. In the short term, Internet service providers should consider rolling out mobile Internet units and providing WiFi hotspot access to temporarily increase connectivity.

More importantly, we must expand the social safety net, especially the Supplemental Nutrition Assistance Program, child nutrition programs, Supplemental Security Income, housing assistance and Medicaid. Lawmakers must also ensure the availability of these programs to rural residents. For example, unlike their urban counterparts, many rural children cannot come to schools each day to pick up meals. The Agriculture Department launched a pilot program to deliver meals to rural children in some regions, but initiatives such as this should be more widespread.

 

It is clear the battle against covid-19 will look vastly different in the heartland than in our cities. The U.S. Navy won’t be docking a floating hospital in Nuckolls County, Neb. But if what’s happened in America’s coastal cities can teach us anything, it’s that the coming weeks will determine the trajectory of this virus. And we don’t have a moment to waste.

Waste not, want not

via Harvard Law Today

by Emily Newburger

man in green shirt holds a box of produce that reads "stay home we deliver"

Delivering food ordered online while in home isolation during quarantine. Stay home we deliver sign on box.

During a pandemic, a lot of things come to a halt, but one thing that never ceases is our need for a reliable supply of safe, nutritious food. Harvard Law School Professor Emily Broad Leib ’08, director of the HLS Food Law and Policy Clinic (FLPC), and her students have been working furiously to ensure that the most vulnerable—and ultimately the rest of us—are fed.

Broad Leib and the clinic have long been a resource for food producers, food-focused nonprofits, government agencies, legislators, policy experts, and other food system stakeholders. But since early March, as the COVID-19 crisis has grown, she and a team of students and clinic staff have worked around the clock, writing briefs aimed at saving tons of food that could feed the hungry, and working to inform the response to COVID-19, including legislation that Congress has been hammering out.

According to Feeding America, a national network of food banks, one in seven Americans relied on food banks to get enough to eat before the pandemic. The clinic is a national leader in policy efforts to prevent food waste and promote food recovery, which it undertakes by partnering to provide legal and policy support to a range of programs that pick up excess food from universities, restaurants, and other organizations and get it to food banks.

As universities suddenly began to move to online learning and close down most campus operations, and many businesses reduced hours or shut their doors, Broad Leib knew this would leave behind excess food. The clinic mobilized quickly to prepare a handout urging organizations not to shutter without passing on food that could feed the hungry, explaining liability protections and tax incentives for food donations, and providing information on where and how to donate food. Many organizations responded, including Harvard Law School, which now has a food donation program in the works.

Broad Leib also understood that the basic problem the clinic has been addressing was about to grow dramatically. “There are already so many people who were in vulnerable situations,” she says. “The crisis has exacerbated food access challenges for those people, and it has added so many more individuals and families in need. Workers are losing jobs, especially those doing hourly work—many, in fact, who work in the food industry. We are going to see a huge increase in people who suddenly need help getting basic needs met, especially food.”

COVID-19 also adds a complex new layer to concerns about food safety. Not only are more people going to need food; they also need safer ways to get it. As the emphasis on the importance of social distancing has increased, new ways must be found to deliver food directly to seniors and immunocompromised individuals in their homes.

In response, the clinic put out a brief with recommendations for federal and state governments, as well as for agencies such as FEMA and the USDA, looking at opportunities under existing government programs, including the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children, to facilitate food delivery during the COVID-19 crisis. They also have come up with proposals for getting food from food banks and other organizations delivered directly to people’s doors, and for getting Congress to supplement existing community-based food delivery organizations.

This is probably one of the most meaningful projects I have worked on since coming to law school, if not in my life.

Jesse Lazarus ’22

The clinic shared its brief with contacts in Congress on March 23 as the House and Senate, the president, executive agencies, and state governments across the country debated many of these policies. They have been working closely with members of Congress, helping support congressional requests to the USDA to use its authority to support food delivery. The team is also tracking state and local policies to stay on top of the best models for how state and local governments are ensuring vulnerable people stay fed in this crisis.

The brief also encourages investment in a growing number of technology solutions that match food donors to recovery organizations that pick up and deliver the donated foods, such as Food Rescue Hero and Replate.

“We make the point that these technologies can be really responsive to the challenges of the moment,” says Broad Leib, “but most of them have been developed by small nonprofits. Helping them scale up quickly to meet the needs of the growing number of people who need food support is going to require an investment.”

Jesse Lazarus ’22, a student in Broad Leib’s Food Law and Policy seminar, played a major role in preparing this brief, focusing on public-private partnerships, describing existing efforts, and making policy recommendations to expand home delivery. “This is probably one of the most meaningful projects I have worked on since coming to law school, if not in my life,” says Lazarus. “It is an experience I will likely recall for many years to come, as I think back on this incredibly challenging time for the U.S. and the world.”

Broad Leib and the clinic also focused on anticipated new challenges to the food system as a whole, in particular the loss of market access for the many farmers and producers who sell in farmers markets or depend on large purchases by schools and universities. The clinic collaborated with the National Sustainable Agriculture Coalition to propose legislative actions to unlock already appropriated funding to these farmers, and to redirect funds that will be underutilized during this crisis. “Local foods are now a $12 million business in the U.S.,” Broad Leib says. “We don’t want these food producers to go out of business or sell their farms.”

Brianna Johnson-King ’21, a student now in the clinic for her second semester, worked on that brief, researching what flexibility existing statutes allowed. She found, for example, that a statute that supplies vouchers to low-income seniors to purchase food at farmers markets could also allow the government to make bulk purchases directly from farmers for distribution to seniors, a step that could help ensure the money is flowing to small farmers even if farmers markets are closed during COVID-19.

Johnson-King grew up in rural Ohio and has a strong interest in agriculture and the farmer’s perspective. As she researched and wrote for the brief from home, she kept the TV on in the background. The situation worsened from hour to hour as more cities and states announced shutdowns and farmers markets voluntarily closed. She says she felt the pressure: “In the back of my mind, I’m thinking, ‘Are we going to get this out in time for Congress to have a chance to act on any of it?’”

The clinic got that brief out by March 23 and followed it up with a companion document for state governments. By March 27, both the Senate and House had passed the Coronavirus Aid, Relief, and Economic Security Act, which includes funding for direct assistance to food producers, and President Trump had signed it into law. “The act does not directly address the changes we recommended; however, it still provides funding for the local and regional producers we aim to help,” Johnson-King says.

Broad Leib believes they are gaining traction. The clinic is involved in ongoing discussions with members of Congress on other aspects of the brief that may find their way into the next relief package. She is also looking ahead to the impact that COVID-19 may have on the food supply chain as a whole. “I don’t intend to cause panic, but I am certainly thinking about that.”

“A lot of the workers harvesting our crops are coming across the border,” says Broad Leib. “We need to be sure that we are keeping them safe and taking care of them. At the same time, we hear that in agriculture and manufacturing, trying to do social distancing and keep workers safe means having fewer people work at one time. That means we will have to be creative about meeting demand.” But Broad Leib also sees opportunities: “This may be the time for us to be more thoughtful about how we are regulating food and compensating and protecting workers—supporting food from farm to fork. If what comes out of this is that we better appreciate the value of the people and the resources that go into producing our food, that will be a silver lining.”

“It’s been a really chaotic and frightening time,” Broad Leib says. “It’s as if everywhere we turn there are ways this crisis is impacting the food system.” She goes on: “I’ve been blown away at the number of our students who have reached out and asked to help, even during spring break. They dove in to this important work while they were also in the midst of moving, transitioning to remote learning, and figuring out their new lives. It’s been amazing. Our students are always amazing, but never more so than in this time.”

See the Food Law and Policy Clinic’s COVID-19 Response website for more information and resources.

Emily Broad Leib named clinical professor of law

via Harvard Law Today

photo of Emily Broad Leib sitting on a rock bench in front of a grass lawn

credit: Jessica Scranton

Emily Broad Leib ’08, founder and director of the Harvard Law School Food Law and Policy Clinic, has been named clinical professor of law at Harvard Law School. She was formerly an assistant clinical professor at HLS.

A national leader in food law and policy, Broad Leib founded the first food law and policy clinic in the country at Harvard Law School. She has used her position to advocate for improvements to the laws and policies that govern America’s food system, including in the area of food waste. She also serves as deputy director of the Harvard Law School Center for Health Law and Policy Innovation.

“Emily Broad Leib is a superb teacher and is internationally respected for her groundbreaking work on food law and policy,” said John F. Manning ’85, the Morgan and Helen Chu Dean of Harvard Law School. “Through her commitment, intellectual leadership, and teaching, she has inspired countless students and attorneys to pursue options within the legal system to improve the food system and enhance the well-being of others.”

“I am humbled by my promotion to clinical professor, and full of gratitude at the opportunity to continue working alongside the committed and inspiring faculty, staff, and students of the HLS community. It has been a pleasure to make my home at such a supportive institution that has provided the resources and vision for me to build the first clinic in food law and policy, to develop opportunities for students to learn and participate in the vital field of food law, and to see the impact the Food Law and Policy Clinic has had and will continue to have on policies that impact the environment, health, and social justice,” Broad Leib said.

Broad Leib joined HLS’s Center for Health Law and Policy Innovation in 2010 as a senior clinical fellow. The following year, in 2011, she founded the Harvard Law School Food Law and Policy Clinic (FLPC), which provides legal advice to nonprofits and government agencies, while educating law students about ways to use law and policy to impact the food system.

Broad Leib focuses her scholarship, teaching, and practice on finding solutions to some of today’s biggest food law issues, aiming to increase access to healthy foods, eliminate food waste, and support sustainable food production. She has published scholarly articles in the California Law Review, Wisconsin Law Review, the Harvard Law & Policy Review, and the Food & Drug Law Journal, among others.

In 2015, she was an inaugural recipient of Harvard University’s Climate Change Solutions Fund. Her project “Reducing Food Waste as a Key to Addressing Climate Change,” was one of seven chosen from around the university to confront the challenge of climate change by leveraging the clinic’s food law and policy expertise to identify systemic solutions to reduce food waste, which is a major driver of climate change.

Under Broad Leib’s direction, FLPC has been advocating for the standardization of date labels since the release of its 2013 report “The Dating Game: How Confusing Food Date Labels Lead to Food Waste in America.” FLPC has also worked with members of Congress on legislation to reform the expiration date system, and Broad Leib testified for Congress on date labels and other areas of federal policy that impact the amount of food that goes to waste. She led work with the two largest food trade associations to implement a voluntary standard for date labels, which will go into effect this year. Last summer, the clinic released a follow up issue brief “Date Labels: The Case for Federal Action.”

Beyond date labels, Broad Leib has led the clinic in supporting food producers, businesses, and government agencies in understanding and improving laws relevant to food waste and food recovery. The clinic’s work has included consulting to government agencies and legislators at the federal level and in nearly two dozen states, and publication of scores of policy reports and toolkits, including Opportunities to Reduce Food Waste in the 2018 Farm Bill (2017) and Food Safety Regulations and Guidance for Food Donations: a 50-State Survey of State Practices (2018) and a number of resources to support states and localities in addressing food waste through policy, including “Bans and Beyond: Designing and Implementing Organic Waste Bans and Mandatory Organics Recycling Laws” (2019) and “Keeping Food Out of the Landfill” (2016).

Drawing on this expertise, in 2019, Broad Leib launched the Global Food Donation Policy Atlas project, through which she and clinic staff and students are partnering with local food donation agencies in fifteen countries around the globe to compare and analyze the laws relevant to food donation, and make recommendations for best practices that can help more safe, wholesome food make it to those in need.

In 2016, she was named by Fortune and Food & Wine to their list of 2016’s Most Innovative Women in Food and Drink. Her groundbreaking work has been covered in such media outlets as The New York Times, the Los Angeles Times, the Boston Globe, The Guardian, TIME, Politico, and the Washington Post. She has appeared on CBS This Morning, CNN, The Today Show, and MSNBC.

In 2016, Broad Leib partnered with colleagues around the country to found the Academy of Food Law and Policy, the first-ever academic association for the growing number of faculty and scholars teaching and writing in the field of food law and policy. She served as the founding co-chair of the Academy’s Board of Trustees from 2016 to 2019.

After graduating from HLS, Broad Leib spent two years in Clarksdale, Mississippi, as the Joint Harvard Law School/Mississippi State University Delta Fellow. She directed the Delta Directions Consortium, a group of university and foundation leaders who collaborate to improve public health and foster economic development in the Delta region. In that role, she worked with community members and outside partners, and with support from more than 60 HLS students, to design and implement programmatic and policy interventions on a range of critical health and economic issues in the region.

Broad Leib’s fellowship work in Mississippi inspired the Mississippi Delta Project, a student practice organization at HLS that provides opportunities for current students to continue advocating for similar issues in the Mississippi Delta region. Broad Leib continues to support that organization as the faculty supervisor. She is also the faculty supervisor for the Harvard Law School Food Law Society.

In 2013, she was appointed deputy director of the Center for Health Law and Policy Innovation. In 2015, she was named an assistant clinical professor of law.

Broad Leib received her J.D. from Harvard Law School and her B.A. from Columbia University.

Harvard Law School clinician testifies in support of Massachusetts food and health pilot program

A wooden box with a caduceus and the inscription: 'Food is Medicine' holds fresh producevia Harvard Law Today

Food insecurity and hunger cost the Commonwealth of Massachusetts nearly $1.9 billion in avoidable health care costs every year.

Today, a team of attorneys from the Center for Health Law & Policy Innovation of Harvard Law School (CHLPI) and Community Servings, a nonprofit food and nutrition program, testified at a hearing on proposed legislation to establish a food and health pilot program in the state of Massachusetts.

Harvard Law School Clinical Instructor and CHLPI staff attorney Katie Garfield ’11 and Jean Terranova, Community Servings’ director of food and health policy, testified before the Joint Committee on Public Health at the Massachusetts State House.

The new legislation, titled An Act Relative to Establishing and Implementing a Food and Health Pilot Program, is the first major result of a report CHLPI and Community Servings released last summer—the “Massachusetts Food is Medicine State Plan.” The legislation, introduced by Massachusetts Sen. Julian Cyr (D-Truro) and Rep. Denise Garlick (D-Needham), provides a blueprint to successfully integrate nutrition services into health care delivery and financing in the Commonwealth—a proven strategy to improve health outcomes and reduce health care costs for people experiencing food insecurity and living with chronic illness.

The legislation would require the Executive Office of Health and Human Services (EOHHS) to establish a Food and Health Pilot Program that equips health care systems to connect MassHealth enrollees with diet-related health conditions to one of the three appropriate nutrition services, with the expectation that health outcomes will improve and cost of care will decrease.

“Massachusetts has long been a national leader in health care policy,” said Garfield in testimony before the committee. “However, we continue to struggle with two issues that play a fundamental role in driving health outcomes and health care costs: food insecurity and diet-related disease. … A growing body of evidence indicates that connecting these individuals to “Food is Medicine” interventions may be an effective, low-cost strategy to improve health outcomes, decrease use of expensive health care services, and improve patient quality of life.”

Published in June 2019, the “Massachusetts Food is Medicine State Plan” is a product of a two-year, community-driven initiative that engaged more than 400 people from across the state. The initiative sought to identify health and food system reforms to improve access to critical nutrition interventions and change the culture and practices of the health system.

CHLPI and Community Servings also launched Food is Medicine Massachusetts (FIMMA), a multi-sector coalition comprised of more than 50 organizations representing nutrition programs, patient advocacy groups, health care providers, health insurers, academics, and professional associations.

CHLPI advocates for legal, regulatory, and policy reforms to improve the health of underserved populations with a focus on the needs of low-income people living with chronic illnesses. Community Servings provides medically tailored, nutritious meals to chronically and critically ill individuals and their families.

Harvard Law School & NVHR Launch Updated Data on Discriminatory Hepatitis C Treatment Restrictions in 52 Medicaid Programs and Send Letter to CMS Urging an End to State Violations of Federal Medicaid Law

Via CHLPI

The National Viral Hepatitis Roundtable (NVHR) and the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) today launched an update to “Hepatitis C: State of Medicaid Access,” an interactive project grading all 50 state Medicaid programs, as well as the District of Columbia and Puerto Rico, according to access to curative treatments for hepatitis C, the nation’s deadliest infectious disease. NVHR, CHLPI and other leading viral hepatitis advocates today also sent a letter to the U.S. Centers for Medicare and Medicaid Services (CMS) urging the agency to take action to end discriminatory state treatment restrictions, which, according to CMS guidance, violate federal Medicaid law. More than half of all state Medicaid programs still impose some form of illegal restriction.

“The hepatitis C virus is the deadliest infectious disease in the U.S., killing 20,000 Americans every year, and the opioid epidemic and an increase in unsafe injection drug use have caused acute cases of hepatitis C to more than triple since 2010. Eliminating treatment access restrictions is a necessary step toward ending HCV in the United States,” said NVHR Director Lauren Canary. “The collaborative advocacy of NVHR, CHLPI, and the entire viral hepatitis community have created real momentum and led to a significant reduction in treatment restrictions; however, there is still more work to do, as some states persist in imposing these discriminatory restrictions.”

Hepatitis C: State of Medicaid Access grades each Medicaid program according to its overall “state of access.” Each grade is determined by curative treatment restrictions related to three areas: 1) liver disease progression (fibrosis) restrictions, 2) sobriety/substance use requirements, and 3) prescriber limitations – all of which contradict not only CMS guidance but also recommendations from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA). The analysis provides suggestions for each state to reduce its treatment access requirements.

“At least 2.4 million Americans are currently infected with the hepatitis C virus and HCV is contributing to an increase in liver cancer, the fastest-growing cause of cancer mortality in the U.S. We have the tools to eliminate hepatitis C, but turning the promise of a cure into reality for all requires leadership, resources, and the removal of all discriminatory HCV treatment access restrictions,” said Robert Greenwald, Clinical Professor of Law at Harvard Law School and the director of CHLPI. “CHLPI and NVHR are dedicated to ensuring that all individuals living with HCV are able to access a cure for the disease, and we urge all states to stop illegally restricting access to treatment.”

Highlights of the Hepatitis C: State of Medicaid Access analysis, as well as notable advocacy successes since the 2017 launch of the report, include:

  • When CHLPI and NVHR launched the report in 2017, more than half of Medicaid programs (52 percent) received a “D” or an “F” for imposing discriminatory restrictions on hepatitis C cures. Currently, only 15 percent of programs (8 jurisdictions) receive those grades;
  • States that received a “D” or “F” grade due to access restrictions: Alabama, Arkansas, Minnesota, Mississippi, Montana, Puerto Rico, South Dakota, and Texas;
  • States that received an “A” grade: Alaska, California, Colorado, Connecticut, Delaware, Idaho, Louisiana, Maine, Massachusetts, Missouri, Nevada, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington;
  • Washington (A) removed Medicaid restrictions after a federal court declared for the first time that widespread restrictions to hepatitis C treatments were illegal. The removal of restrictions paved the way for the state’s groundbreaking plan to eliminate the hepatitis C virus entirely;
  • In Rhode Island (A-), strong local advocacy and the threat of litigation led the state to remove liver disease restrictions and cover treatment for all beneficiaries living with HCV;
  • Illinois (B-), which once had the most severe liver disease restrictions, has since removed those restrictions. However, some managed care organizations in the state have not followed suit;

“Although the advent of highly effective curative therapies has helped avert thousands of premature deaths from hepatitis C, we are still seeing troubling trends related to the disease, including a three-fold spike in acute cases of hepatitis C since 2010; an increase in vertical transmissions of the disease from infected pregnant adults to infants – in 2017 alone, there were 18,927 newborns exposed to hepatitis C; and people from certain racial and ethnic minorities are dying at disproportionate and increased rates from hepatitis C infections,” added Canary. “The consequences of hepatitis C treatment restrictions are not academic for people living in places like Texas (Grade: D+), which has the highest liver cancer mortality rate in the country; or Montana (Grade: F), which has one of the highest rates of perinatal HCV exposure; or West Virginia (Grade: C), which has the highest rate of new HCV infections.”

Americans insured through Medicaid have a 3-fold higher prevalence of hepatitis C compared to their privately insured counterparts. In 2015, CMS issued guidance that prior authorization requirements should not result in the denial of access to treatment. NVHR, CHLPI and other leading hepatitis advocates today sent a letter to CMS urging the agency to take action to end illegal access restrictions by states.

“Since the release of Hepatitis C: State of Medicaid Access and the increased transparency to egregious treatment restrictions in state Medicaid programs, many states have loosened or removed restrictions…Unfortunately, several state Medicaid programs are still standing in the way of the medical standard of care by imposing discriminatory prior authorization criteria to restrict access based on liver disease severity, provider specialty, and substance abuse,” said the advocates in the letter. “Despite clear [CMS] guidance…state Medicare programs still deny coverage to Medicaid enrollees with hepatitis C infection…We call upon CMS to take seriously this continue state-sanctioned discrimination impacting persons living with hepatitis C throughout the United States. Please do your part to prioritize this issue and to call upon state Medicaid programs to open access to curative hepatitis C therapy.”

To view the full “Hepatitis C: State of Medicaid Access” report, visit www.stateofhepc.org

FLPC Releases Report Calling for Greater Nutrition Education in the Medical Field

Via CHLPI Blog

Source: Food Law and Policy Clinic

The Harvard Law School Food Law and Policy Clinic (FLPC) released a new report today identifying policy approaches to increase nutrition competency of U.S-trained physicians. Doctoring Our Diets: Policy Tools to Include Nutrition in U.S. Medical Training highlights the current lack of education on diet-related diseases and nutrition that doctors receive over the course of their medical careers. The report illustrates the impact of this knowledge-gap on healthcare costs and patient health, and provides a number of recommendations for federal, state, and non-governmental policymakers to tackle this issue.

Diet is the most significant risk factor for disability and premature death in the United States, and diet-related diseases, such as heart disease, cancer, stroke, and diabetes affect an unprecedented number of Americans. Patients turn to doctors for advice on how to avoid or mitigate these and other health risks arising from poor diet and nutrition. Yet, unbeknownst to patients, many doctors are no more equipped to provide this advice than patients themselves: an average medical student spends less than one percent of total classroom hours learning about food and nutrition, and seventy-three percent of physicians reported that they received no or minimal instruction on nutrition during their medical training. This gap in medical education not only represents a violation of the public trust but a missed opportunity to invest in better population health.

To bridge this divide, Doctoring Our Diet calls for relevant policymakers to take action, recommending specific policy solutions applicable at each stage of medical education. For example, policymakers can condition non-grant funding on the inclusion of nutrition education in medical school programs and residency programs, offer performance-based incentives to medical schools and residency programs that provide a baseline amount of nutrition education, and amend accreditation standards to require baseline competency in nutrition. For each recommendation, the report features a brief feasibility analysis, addressing the benefits and potential challenges associated with implementation.

As one example of the types of policies recommended in Doctoring Our Diet, the report shines a special spotlight on the government’s failure to use existing Medicare funding of GME programs to leverage nutrition education for doctors. Medicare is the single largest contributor of graduate medical education (GME) in the United States, providing $16 billion in 2015. At the same time, Medicare spending accounts for nearly 15 percent of all federal spending. As the prevalence of preventable, but costly, diet-related diseases continues to rise, so too will this percentage: over the next 10 years, Medicare spending is expected to increase from $630 billion to a projected $1.3 trillion—or more than 18% of the federal budget. Doctoring Our Diet explains that requiring Medicare-funded GME programs to educate physicians on nutrition is a logical and necessary approach to mitigating diet-related diseases and saving healthcare costs in the long-term.

This report is a product of FLPC’s ongoing involvement with the Nutrition Education Working Group (NEWG), a group of leaders in nutrition science, education and policy from FLPC, Harvard T.H. Chan School of Public Health, Harvard Medical School, and the Gaples Institute for Integrative Cardiology. FLPC has collaborated with NEWG to raise awareness about the lack of nutrition education provided in medical training, presenting the issue to policymakers, writing comments to the Accreditation Council for Graduate Medical Education (ACGME), and working with various medical boards to add nutrition-focused questions to exams. This initiative represents the latest effort in FLPC’s ongoing commitment to policy development at the intersection of food and health.

Brighter Bites to participate in industry-first Nonprofit Food Recovery Accelerator

Via The Produce News

By: Rich Dachman

ReFED announced the cohort of 10 organizations that will participate in its Nonprofit Food Recovery Accelerator, which aims to catalyze ideas and inspire actions that lead to a doubling of healthy food available to the 40 million Americans facing food insecurity.

“Brighter Bites is grateful to ReFED for this incredible, game-changing opportunity to magnify our work converting food waste into a public health opportunity,” said Rich Dachman, chief executive officer at Brighter Bites. “We are excited to work alongside the nine other exceptional organizations comprising this cohort, as well as the accelerator’s world-class Expert Network. Our participation in this program will bolster Brighter Bites’ efforts to source more produce for families in a sustainable manner, all while combatting food insecurity and teaching healthier choices to the families we serve.”

More than 125 candidates applied for the accelerator. The selected cohort range from long-standing food recovery organizations with hundreds of employees servicing thousands of donors, to newly formed innovative organizations that leverage concepts from the sharing economy and apply them to food rescue. What unites them is the desire to work together on a shared mission — to become operationally sustainable and deliver more impact at scale in a dignified and convenient way.

“The accelerator’s nationwide open call for applications confirmed ReFED’s hypothesis that this type of program will provide value in the form of helping food recovery organizations overcome some of the biggest barriers to increasing the amount of nutritious food they can deliver in a dignified manner,” said Alexandria Coari, director of capital and innovation at ReFED. “Some of these barriers include funding models dependent on grants versus earned revenue, a reliance on volunteers instead of paid staff, underutilization of technology solutions, and a lack of collaboration and best practice sharing across the sector. These are just a few of the topics we’ll tackle throughout the accelerator.” The accelerator’s one-of-a-kind, highly customized curriculum will combine a virtual classroom with in-person ReFED Learning Labs that focus on co-creating earned revenue models and technology-enabled solutions using human-centered design.

“Growing awareness about the scale of senseless food waste in this country has catalyzed existing organizations to innovate their paradigms and inspired energetic entrepreneurs to launch creative new models that use this surplus food as a resource,” said Emily Broad Leib, assistant clinical professor of law and director of the Harvard Law School Food Law & Policy Clinic. “As an Expert Network member, it has been incredible to see the response to ReFED’s Nonprofit Food Recovery Accelerator, which will build the needed network and resources for these innovators. I am excited about the announcement of the 2019 cohort, and cannot wait to see them take the next steps to address this major societal issue of our era.”

In addition to Brighter Bites, the other members of the cohort for the first-ever Nonprofit Food Recovery Accelerator are 412 Food Rescue (Pittsburgh), Boston Area Gleaners (Waltham, MA), Community Food Bank of Southern Arizona (Nogales, AZ), Eat Greater Des Moines (Des Moines, IA), Philabundance (Philadelphia), Plentiful (New York City), Replate (Berkeley, CA), Rescuing Leftover Cuisine (New York City), and Seeds That Feed (Fayetteville, AR).

Each participating organization will receive $30,000, plus an additional $100,000 will be awarded to a selected winner at the end of the accelerator. In addition, organizations will have access to a world-class group of food business and technology executives, capital providers and subject matter experts who make up the accelerator’s Expert Network, which includes Afresh, Albertsons, Aramark, Baldor Specialty Foods, Blue Apron, Bon Appetit Management Co., CalRecycle, Center for EcoTechnology, Chick-fil-a, Cisco, Claneil Foundation, ClimateWorks Foundation, Closed Loop Partners, Compass, DoorDash, Draper Richards Kaplan Foundation, EPA, Fast Forward, FDA, Feeding America, Fink Family Foundation, Food Donation Connection, Food for Soul, FoodMaven, General Mills, GoodR, Harvard Law School Food Law & Policy Clinic, HelloFresh, Imperfect Produce, Nestle, Next Course LLC, Ovio, Pisces Foundation, Posner Foundation, Rabobank, Sodexo, Spoiler Alert, Starbucks, Taylor Farms, The Ajana Foundation, The Kroger Co. Zero Hunger | Zero Waste Foundation, The Leonardo DiCaprio Foundation, The Rockefeller Foundation, The Wonderful Company, Tyson Foods, USDA, Village Capital, Wells Fargo, Whole Foods Market and World Wildlife Fund.

Health care systems turn to a ‘new’ old medicine: healthy food

Via MassLive

By: Shira Schonenberg

Source: Flickr

A few times a week, Katie Macomber, medical home care coordinator at Amherst Pediatrics, writes a “prescription” for patients and their families.

Macomber is not a doctor, and the prescription is not for medicine. Rather, it is a form from the Amherst Survival Center, designed to look like a prescription, that sends families to the center to pick up groceries, diapers or fresh produce from the food pantry, eat a free hot lunch or dinner, or get help applying for food stamps.

Amherst Pediatrics asks patients on a screening form if they have experienced food insecurity and has posters around the office telling patients to talk to a doctor if they struggled to afford food in the past year.

“Socioeconomics are such a huge part of overall health,” Macomber said. “You can’t focus on medical health if there are other issues impacting that family’s ability to care for their medical health.”

Macomber said “prescribing” food at a medical practice “really helps put it under the umbrella that this is all part of your medical health and well-being.”

The Amherst Survival Center’s Project HungeRX is part of a growing movement statewide to treat food as medicine.

On Tuesday, the Center for Health Law and Policy Innovation at Harvard Law School, and Community Servings, a nonprofit that cooks and delivers medically tailored meals to sick people at home, released the first Massachusetts Food is Medicine State Plan.

The plan examines the importance of programs that deliver medically tailored food, that provide vouchers for fresh produce and that offer healthy food to people who cannot easily access it.

One 2019 study by researchers from the University of North Carolina, Massachusetts General Hospital, Community Servings and elsewhere found that medically tailored meals were associated with fewer admissions to hospitals and nursing homes and a reduction in health care costs. A report by Children’s Healthwatch and the Greater Boston Foodbank estimated that food insecurity in Massachusetts leads to $1.9 billion in avoidable health care costs annually.

Sarah Downer of the Center for Health Law and Policy Innovation, one of the authors of the Food is Medicine plan, said the goal is to develop steps to change the state’s health system to better connect individuals with food and “set up pathways to build better overall community health.”

The report was released as the public is becoming more conscious of the need for healthy food, with farmers’ markets and buy local campaigns. MassHealth, the state’s Medicaid program, recently adopted a new structure in which some money will be available to address social factors that affect health.

In interviews, the researchers found that health care insurers and providers said they were interested in addressing food insecurity but many were unsure how to integrate that into medical care.

The report lays out multiple ways to integrate food and health care, such as by having doctors screen patients for food insecurity and by training health care providers about the importance of nutrition and about what resources are available to patients.

The report envisions connections between community-based nutrition organizations, like food pantries, and health care providers. It also envisions an increase in funding — through reimbursement from health insurers and other sources — for programs that offer medically tailored meals, mobile farmers markets, food vouchers and other nutrition services.

The report identifies 26 high-priority areas with a particular need for food services, including Agawam, Chicopee, Holyoke, North Adams, Pittsfield, Springfield and West Springfield.

Experts say the biggest barriers to people buying healthy food tend to be cost and transportation.

Read the full article here.

All in a Day’s Work

By: Alexis Farmer

The numerous clinics at Harvard Law School (HLS) are frequently successful in their pursuit of advancing justice. We often read of victories in court cases, positive reactions to dynamic presentations, and the formation of powerhouse partnerships, but how do the clinics get there? On any given day, HLS students, clinical instructors and clinical faculty are actively working on issues – preparing a brief, arguing a motion in court, giving a presentation to community leaders or clinical professionals, or collaborating with community partners on launching a policy initiative. On one particular day in early May, three clinics were in three different courts while others were fortifying partnerships on each of the coasts. The Office of Clinical Programs (OCP) got an inside scoop on what a day in a few of the clinics might look like, and they were just as busy as we suspected.

Tuesday, May 7th

Credit: Emmanuel Huybrechts
Source: Flickr

9:00am The Massachusetts Supreme Judicial Court (SJC) heard oral argument in Boston Globe Media Partners, LLC v. Chief Justice of the Trial Court, a case about whether the public has a right of access to records from show-cause hearings in which the clerk magistrate, who presides over the hearing, finds probable cause, but decides not to issue a criminal complaint. The Boston Globe sued the heads of the trial courts last fall, arguing that public access to the records allows for transparency and accountability and is useful in determining whether there is an uneven application of justice in this part of the court system. The action came after The Globe reported that Massachusetts was the only state to have these proceedings out of the public eye and keep many of the documents confidential.

In amicus briefs, the ACLU of Massachusetts, Greater Boston Legal Services (GBLS) and Harvard Legal Aid Bureau (HLAB) argued that the hearings provide privacy for subjects of criminal complaints prior to arraignment. The amici also expressed concern that opening records where no criminal complaint is issued could harm individuals’ ability to obtain housing or jobs. HLAB’s brief was written on behalf of Harvard Defenders, the only legal services organization in the state dedicated to pro bono representation of indigent defendants in criminal show cause hearings, and City Life/Vida Urbana, a grassroots community organization dedicated to fighting for racial, economic, social justice and gender equality. Executive Director of Harvard Defenders Dara Jackson-Garrett, who co-authored the brief, told Massachusetts Lawyers Weekly, “Those who take out applications for criminal complaints often do not want to see the accused go to jail. Instead, they may just want to have the person apologize or get treatment for substance abuse.” A decision in the case is expected sometime late summer/early fall.

9:30am The Harvard Immigration and Refugee Clinic (HIRC) at GBLS co-managing directors and HLS lecturers on law Nancy Kelly and John Willshire Carrera, HIRC assistant director and clinical professor Sabi Ardalan, and HIRC teaching fellow Zack Albun attended oral arguments in De Pena-Paniagua v. Barr, currently pending at the United States Court of Appeals for the First Circuit. The court held the hearing at the John Joseph Moakley United States Courthouse in Boston. Ms. De Pena-Paniagua is challenging a Board of Immigration Appeals’ decision that denied her asylum application by construing Matter of A-B-, a 2018 decision by Attorney General Jeff Sessions to categorically foreclose asylum to applicants who argue they have a well-founded fear of persecution in the form of domestic violence perpetrated on account of their membership in a “particular social group.” Along with co-counsel at Akin Gump Strauss Hauer & Feld and HIRC director Prof. Deborah Anker, the HIRC attorneys submitted an amicus brief arguing Ms. De Pena-Paniagua qualified for asylum as a victim of persecution on account of her membership in a particular social group defined by female gender. HIRC alumnus Eunice Lee (Albert M. Sacks Clinical Teaching & Advocacy Fellow 2009–11) appeared on behalf of fellow amicus the Center for Gender & Refugee Studies, arguing that Matter of A-B- itself conflicts with the applicable federal statutes and international treaties and should be overturned.

The three-judge panel expressed significant interest in the position advanced in HIRC’s briefing, asking attorneys for both Ms. De Pena-Paniagua and the Department of Justice several questions about her eligibility for relief on the basis advocated. The First Circuit has yet to issue an opinion squarely addressing the legal sufficiency of defining a particular social group by gender.

10:00am Clinical Professor of Law Dehlia Umunna of the Criminal Justice Institute (CJI) and CJI student Jillian Tancil J.D. ’19 spent the morning at Roxbury District Court representing a woman that allegedly violated a protection order. The case was scheduled for a jury trial, but was resolved with pre-trial probation.

10:30am HIRC Clinical Instructor Cindy Zapata spoke on a panel about family detention at the AALS Clinical Conference in San Francisco, CA. The panel, entitled “Learning in Baby Jail: Lessons from Law Student Engagement in Immigration Detention Centers,” was a forum for reflection and learning best practices for preparing students to engage in work within family detention centers. The other panelists included Lindsay Harris, University of the District of Columbia, David A. Clarke School of Law; Erica B. Schommer, St. Mary’s University School of Law; Sara Sherman-Stokes, Boston University School of Law.

11:20am The Emmett Environmental Law and Policy Clinic (EL&PC) submitted comments on behalf of a group of leading scientists on the Environmental Protection Agency’s (EPA) proposed Integrated Risk Information System (IRIS) Assessment Plan for methylmercury. Methylmercury is a common pollutant of air and water and highly toxic. The EL&PC’s comments provided recommendations, guidance, and support for the EPA’s reassessments and proposed studies.

Source: iStock

1:15pm The Center for Health Law and Policy Innovation’s (CHLPI) Health Law & Policy Clinic held a strategic planning call with the Transgender Law Center, as part of an initiative against the rollback of anti-discrimination protections for transgender and gender non-conforming people. The partnership, formalized in the summer of 2018, has led to conversations among legal experts about how to address and challenge reinterpretations of the Affordable Care Act and other civil rights protections. On May 24th, the Trump Administration released proposed changes to gender identity protections in health programs and activities. You can find CHLPI’s on-going analysis of the law here.

2:30pm The Legal Services Center’s Safety Net Project (LSC) and HLAB are representing a client as she appeals the Social Security Administration’s (“SSA”) decision to deny her disability benefits – the first joint representation between the programs. Despite extensive evidence of her inability to continue working due to symptoms of PTSD, anxiety, and depression stemming from abuse both in childhood and during her marriage, the client’s claims have been denied at each stage of the appeals process and are now before the United States District Court for the District of Massachusetts. On May 7th, the LSC-HLAB team filed the client’s response memorandum and asked that the case be set for oral argument. The arguments center around the Administrative Law Judge’s (ALJ) decision, without explanation, to give lesser weight to important evidence from the doctors treating the client, his mischaracterization of the record, various conclusory determinations that render judicial review impossible, and a series of findings that should have been entrusted to experts. HLAB/LSC clinical instructors Stephanie Goldenhersh and Julie McCormack and students Jeremy Ravinsky, JD ’20 and Bryan Sohn, JD ’20 are working on the case. The team is looking forward to their day in court in the fall, when Jeremy and Bryan will present the client’s argument before Judge Casper.

The John Joseph Moakley US Courthouse in Boston, MA.  Source: iStock

All day Sarah Downer and Katie Garfield, from the Center for Health Law and Policy Innovation, attended the Root Cause Coalition’s Annual Hill Day in Washington, DC. They used the event as an opportunity to educate legislators from both parties about the implications of laws like the Anti-Kickback Statute – a criminal statute that prohibits transactions to induce or reward services or items reimbursed by federal health care programs. Downer and Garfield were also invited to meet with staff from several legislative offices to discuss pathways to integrating critical food and nutrition services into the Medicaid and Medicare programs. Securing coverage of these new benefits within our public insurance programs would expand access to life-saving nutrition for vulnerable individuals living with chronic illness.

‘Food is Medicine State Plan’ to Begin Providing Services in June

Via 22 WWLP-22News

Source: Pexels

By: Jennifer Zarate

A group met on [May 22] to make sure healthy food is available to everyone in western Massachusetts.

The Franklin County Food Council brought together groups from across the state on Wednesday to talk about expanding access to food services.

Among those in attendance was the Center for Health Law and Policy Innovation of Harvard Law School, who spearheaded the Food is Medicine State Plan along with Community Servings, a Boston-based nonprofit that provides food services to people with critical and chronic illnesses.

“We want to make sure that we bring those resources to western Mass as well. And so the Food is Medicine State Plan is an attempt to do that, right, to figure out where the resources are across our state and where the need is,” said Sarah Downer from the Center for Health Law and Policy Innovation of Harvard Law School.

Downer told 22News, it’s been a year and half of gathering data to finally release the State Plan in June of this year.

“That will begin the kick off of the implementation of the recommendations and the blueprint for expansion of services that we’ve created,” she added.

The state’s Department of Agriculture Assistant Commissioner Ashley Randle told 22News, the passing of the 2018 federal farm bill helped Franklin County farms produce the food needed to help make programs like Food is Medicine possible.

“There’s a lot of growth in the area; in the amount of farmland and their production levels, and for our farmers they’re looking to produce a wholesome, healthy, high-quality product from the Berkshires down to the Cape,” said Randle.

The upcoming launch event will be held at the State House in Boston on June 18.

ACLU Vermont and Harvard Law School file class action suit on behalf of prisoners

Via Vermont Business Magazine

Door marked treatment room in hallway of old institution.

Source: iStock

After years of advocating for Vermont prisoners to have access to life-saving medication for Hepatitis C Virus (HCV), the ACLU of Vermont and the Center for Health Law and Policy Innovation at Harvard Law School, with cooperating counsel James Valente, yesterday filed a class action lawsuit challenging the state’s refusal to treat hundreds of inmates diagnosed with chronic Hepatitis C. The case was filed in the federal district court in Burlington on behalf of two Vermont prisoners, Richard West and Joseph Bruyette, who seek to represent a class of inmates who have been or will be denied treatment without medical justification.

The Plaintiffs assert the Agency of Human Services (AHS), Department of Corrections (DOC), and Centurion of Vermont’s systematic denial of the HCV cure to prisoners diagnosed with chronic HCV violates the Eighth Amendment’s prohibition on cruel and unusual punishment as well as the Americans with Disabilities Act. They are asking the court to end the Defendants’ policy of categorically denying effective, efficient, and medically appropriate HCV treatment.

ACLU of Vermont Staff Attorney Jay Diaz: “State officials are purposefully withholding the cure for Hepatitis C from hundreds of Vermont inmates, many of whom would have received it long ago it if they were not imprisoned. This is not only inhumane and short-sighted—it is unconstitutional. Vermont cannot rely on cost considerations to try to justify unlawful treatment of the people in its care and custody.”

Hepatitis C is a progressive infectious disease—identified by the CDC as the deadliest infectious disease in America—that if left untreated is likely to cause a variety of medical symptoms, including permanent liver damage, and in some cases, cancer and death. More than five years ago, the FDA approved breakthrough medication with few side effects that effectively cures the disease.

After years of advocacy by the Vermont Coalition for Access to HCV Treatment, of which the ACLU of Vermont is a member, in 2018 DOC began to provide the cure to some inmates on a more regular basis, but still denied it to the vast majority because of the associated expense. Prior to this lawsuit, Coalition members appealed to DOC to stop denying access to the HCV cure to the hundreds of other Vermont inmates who were categorically excluded. DOC refused and to date has only treated about one-fifth of the more than 300 people with chronic Hepatitis C it has identified.

Kevin Costello is the Director of Litigation for the Center for Health Law and Policy Innovation of Harvard Law School: “Hepatitis C is responsible for more deaths in the United States than any other infectious disease by a mile. There is no medical reason to actively prevent hundreds of incarcerated people from receiving curative medications for Hepatitis C. In fact, the refusal to treat prisoners needlessly prolongs suffering and heightens the risk of serious health problems for a group of people who are completely at the mercy of the State of Vermont to provide their health care.”

Similar lawsuits challenging denial of Hepatitis C treatment to individuals in state custody have been won or favorably settled by ACLU affiliates and other organizations in several states, including Colorado, Florida, Massachusetts, Missouri and others, with more cases pending in additional states.

The plaintiffs are represented by the ACLU of Vermont, Harvard Law School’s Center for Health Law and Policy Innovation, and the law firm of Costello, Valente & Gentry.

The Complaint is available here (link is external)

The Motion for Class Certification is available here

Mississippi health care providers breaking the law with large medical bills that patients don’t have to pay, report finds

Via Mississippi Today 

By: Anna Wolfe

Source: Pexels

Health care providers in Mississippi continue to break the law by sending patients large, out-of-pocket medical bills that they don’t have to pay, concludes a Harvard Law School report released Monday.

The Legislature passed a law in 2013 to prohibit what is known as “balance billing” – when a provider bills a patient for the difference between the initial charges and the amount paid after insurance benefits are assigned.

But the law contains few enforcement measures, so patients must know about the law and challenge balance bills in order to benefit from the legislation, which was enacted under the radar of many officials and health care providers. Feeble efforts to strengthen protections in the law during the 2019 legislative session were unsuccessful.

Michelle Mills received a balance bill in 2018 when her son experienced a sports injury and went to a hospital in her insurance carrier’s network, River Oaks hospital in Flowood, but was treated by an out-of-network emergency physician.

Across the country, 65 percent of hospitals contract with outside agencies for emergency room doctors who are not necessarily included in the same insurance network as the hospital, according to a 2017 report by Yale University.

The independent physician staffing group called Capital Emergency Physicians, which used River Oaks’ address when it incorporated as a business in 2013, charged Mills $1,853, all but $38 it asked her to pay out-of-pocket. Though it was an illegal bill, she challenged it with her insurance carrier, which reversed the first assignment and paid most of the bill.

Mills was successful in disputing the charges, but she said it’s “infuriating” to think about all the people who don’t know they can challenge these bills, who end up paying, or worse, whose debt turns over to collections.

Capital Emergency Physicians did not return calls to Mississippi Today.

“Unfortunately, our collective trust of the provider community is being abused to the detriment of our bank accounts,” Roy Mitchell, director of Mississippi Health Advocacy Program, said in a release announcing the Harvard report. “It is time our policymakers even the playing field for Mississippi’s health consumers.”

In its report, the Center for Health Law and Policy Innovation of Harvard Law School found that Mississippi’s anti-balance billing law, which was one of the first and strongest enacted in the country, needs revising.

“Despite the state’s leadership on this issue, Mississippians like Michelle Mills report that they are still receiving balance bills — in violation of state law. In fact, a January 2019 poll reported that 4 in 10 Mississippians have received or have a family member who received a surprise medical bill,” the report reads.

House Insurance Chairman Rep. Gary Chism, R-Columbus, authored a bill to require the attorney general’s office to enforce the law and establish binding arbitration to resolve any balance billing disputes between providers and patients.

He never brought the bill to a vote in his committee, telling Mississippi Today that several lawmakers who are also medical professionals — nurses and nurse practitioners — voiced opposition to his bill.

“They want to be able to get their money,” Chism said at the time.

According to a Mississippi Today analysis of legislative members, there is one nurse, Rep. Becky Currie, R-Brookhaven, and one nurse practitioner, Rep. Donnie Scoggin, R-Ellisville, in the House. Currie declined to comment on the legislation and Scoggins said he did not discuss the bill with Chism.

Scoggins said he has not been presented with concerns over illegal balance billing from his constituents, but said if it is still happening, he would be in favor of strengthening the enforcement measures.

The lack of knowledge surrounding the law and what exactly constitutes “balance billing” complicates the issue. What might be viewed as a loophole for a few patients who understand the law could receive pushback from the medical community if lawmakers bring it to light and force providers to comply.

Georgia’s state senate passed anti-balance billing legislation last week that would require insurers to pay these surprise, out-of-network bills at an amount determined by a database of paid bills, as opposed to simply prohibiting providers from sending these bills to patients. Mississippi’s law greatly favors insurers in this way.

The Harvard report also suggests large, surprise balance bills could be contributing to Mississippi’s high rate of people with past due medical debt — the highest in the country at 37.4 percent.

 

CHLPI’s Robert Greenwald Quoted in Bloomberg Law Article on HIV Drug Coverage

Via The Center for Health Law and Policy Innovation

A February 22, 2019 article from Bloomberg Law includes an interview with CHLPI’s Faculty Director and HLS Professor Robert Greenwald. The article, Trump’s Call to End HIV at Odds With Silence on Coverage Woes, written by reporter Jacquie Lee explores the tension between the President’s pledge to end HIV in the United States in the next ten years and the administration’s silence on discriminatory drug coverage within Medicaid.

Excerpt from the article:

“The Trump administration is promising to end AIDS within 10 years at the same time it’s staying silent on complaints accusing insurers of unfair HIV drug coverage.

Complaints protesting HIV drug coverage in Obamacare plans in counties where the infection rates are growing the most have gone unanswered by the Department of Health and Human Services for years.”

 

Read  Trump’s Call to End HIV at Odds With Silence on Coverage Woes in full.

Covering Pre-existing Conditions Isn’t Enough

Via The New York Times 

Source: Pexels

By: Dr. Douglas Jacobs

When patients enroll in health insurance, they are often met with a stark reality: Even with insurance, they can’t afford their treatment. With the Affordable Care Act and its protections for people with pre-existing conditions in limbo once again, it’s important to remember that those with such conditions need more than health insurance. They also need to be protected from discriminatory pricing so that they can afford the medications they need.

In 2015 I published a paper in The New England Journal of Medicine that detailed how some insurers were raising costs for H.I.V. medicines to dissuade H.I.V.-positive people from selecting their plans. Insurers frequently raise the price of certain medicines to encourage people to select cheaper alternatives, but these insurers raised the cost of every single H.I.V. medicine — leaving many enrollees with no affordable options.

The difference for someone with a pre-existing condition like H.I.V. was staggering (in some cases more than $10,000 annually for H.I.V. medicines in one plan compared with less than $1,000 in another). This practice was later recognized by the Department of Health and Human Services as a form of discrimination by insurers.

Unfortunately, pharmaceutical companies and insurers are still getting away with raising their prices in a way that has a disparate impact on those with pre-existing conditions. A 2019 report by Harvard Law School’s Center for Health Law and Policy Innovation found that some insurers continue to price all recommended H.I.V. regimens in a way that makes them prohibitively expensive. In Georgia, for example, three out of the four insurers place all recommended H.I.V. regimens on the most expensive tiers (costing more than $1,000 a month) or do not cover them at all.

Continue reading.

 

Tough Choices Over a Pricey but Effective Drug for Hepatitis C

Via Star Tribune

By: Glenn Howatt

Hepatitis C is one of the most common infectious diseases, with the potential to cause serious liver damage, so patients were thrilled when a set of revolutionary new medications became available five years ago.

But at $90,000 per treatment course, the drugs were pricey, and many states, including Minnesota, balked at covering them under their taxpayer-funded Medicaid programs.

Since then, however, the treatment cost has fallen dramatically — in some cases to $24,000 — and is expected to fall further after generics are introduced this year. Now advocates are urging Minnesota to drop its restrictions, which they say prevent patients from getting medications that are highly effective and stop the spread of the virus. “I am frustrated seeing my patients walking around with infections that I could treat with a snap of my finger,” said Dr. Ryan Kelly, a primary care physician at the Community-University Health Care Center in Minneapolis.

Minnesota is one of only 12 states that require patients with an addiction history to maintain a six-month period of sobriety before they can start taking hepatitis C drugs, although some can get the medication with three months’ sobriety if they are in addiction treatment. By comparison, 32 states either have no sobriety restrictions or require basic screening and counseling to weed out patients who are not good candidates for treatment.

Kelly plans to meet soon with officials at the Minnesota Department of Human Services, which runs the Medicaid program, in an effort to change its policy.

Nearly 35,000 infected

The current restrictions, which also require that the drugs be prescribed only by or in consultation with a specialist, such as a gastroenterologist or hepatologist, were introduced when the new treatments came online in 2014.

Nearly 35,000 people in Minnesota are infected with hepatitis C, according to the Minnesota Department of Health. On average, 2,200 people in the state are diagnosed with the virus every year, but the state can’t say when they acquired the infection. Disease researchers say that many more are infected but have never been tested.

Hepatitis C, which can lead to liver cirrhosis and cancer, is spread mainly through blood. Many infections are caused when street drug users share needles.

“Hepatitis C is on the rise mostly because of the rise in injecting drug users,” said Kelly. “If we treated people who are spreading the infection, more costs would be saved down the road.”

A state official says the sobriety restrictions are necessary to prevent people from becoming reinfected should they relapse after getting hepatitis C treatment.

“We want them to be treated in a way that will be successful,” said Dr. Jeff Schiff, medical director for Medicaid and MinnesotaCare. “The cost has come down significantly, but it is still a very significant cost per treatment course.”

Kelly said the decision to prescribe hepatitis C treatment drugs should be left to the doctor who knows the patient best. As with other diseases, doctors weigh many factors before writing a prescription, including the patient’s likelihood to comply with the treatment.

“It is a moral restriction that has nothing to do with [patient] health and doesn’t need to be there,” he said.

Schiff said he’s open to a discussion about the future of the state policy.

“The landscape is evolving since these [drugs] came on the market,” he said. “Through our internal conversation we have decided that we will take another look at this policy.”

Sober for his daughter

Gabriel Bliss, 31, has been waiting since April to get the medications that will cure his hepatitis C. He had been a long-term heroin user but quit after his best friend died from a batch that contained fentanyl. He learned of his hepatitis infection while in detox.

“I have a 3-year-old daughter, and she is the main reason that I am still alive and the main reason that I am sober,” he said in a recent interview at his Richfield house.

Bliss gets his insurance through one of Minnesota’s Medicaid managed-care plans, which administer benefits to about 850,000 of the 1.1 million residents who are on the program. All of them have similar restrictions to the state policy.

After quitting heroin, Bliss saw a specialist but got turned down for hepatitis meds because he had smoked marijuana.

“I figured that if I wasn’t on other hard drugs it would be OK,” he said. “Had I known that, I wouldn’t have smoked, because it is a lot more important for me to get rid of hep C.”

Now, he has to wait until March before getting treated. In the meantime, he’s concerned that he might infect others, either through an open wound or even sexual contact, which presents a low risk.

“I don’t know why there are restrictions on it,” he said. “You would think that you want people to be healthy because it would cost less in the long run.”

Nationwide, state Medicaid programs are being urged — and sometimes sued — to drop treatment barriers. Led partly by the Center for Health Law and Policy Innovation at Harvard University, 21 states have dropped or reduced requirements that patients must suffer some liver damage before they are treated, a requirement that Minnesota never used.

Nine have relaxed sobriety restrictions, and six have loosened specialist requirements.

“What we are seeing here are measures that are deliberately put in place to stop people who need medically necessary care versus cost concerns,” said Phil Waters, an attorney with the Harvard center. He said the restrictions are “discriminatory and illegal.”

An ‘early win’

Phil Gyura, a certified nurse practitioner with Minneapolis-based Livio Health, used to practice in New York. He said access to treatment expanded significantly when that state dropped most of its restrictions in 2016.

“From a public health standpoint, the more people that we cure, the less likely it is to spread,” said Gyura, director of addiction care and behavioral health integration at Livio.

He said Minnesota has a unique opportunity to expand hepatitis C treatment because so many people get drug or alcohol treatment in centers. “They have the nursing staff and they have the structure,” he said. “It can be an early win in their sobriety.”

Both Gyura and Kelly said most of their patients want to get treatment directly from a primary care doctor rather than a specialist.

“I see many people at my clinic who view our clinic as their medical home,” Kelly said. “Being referred to a different clinic to see a specialist, especially to a confusing large hospital system, is a huge barrier.”

Schiff said state policy would allow patients to consult a specialist electronically, without visiting an unfamiliar clinic or hospital. “It would be relatively easy for that provider to get on a telemedicine platform … and do that consultation in real time,” he said.

Nonetheless, critics of the specialist requirement say it hearkens back to the days when the only treatment for hepatitis C involved toxic intravenous drugs, which also weren’t as effective as the newer pills.

“It has become much less complicated to treat,” Kelly said.

Correction: Previous versions of this article misspelled the surname of Phil Waters, a Harvard attorney who is working on hepatitis C treatment and related issues.

CHLPI Welcomes New Team Member Kristin Sukys

Via the Center for Health Law and Policy Innovation

The Center for Health Law and Policy Innovation (CHLPI) and the Health Law and Policy Clinic welcome Kristin Sukys to the team as a Policy Analyst!

Kristin joined the Center for Health Law and Policy Innovation at Harvard Law School as Project Consultant in August 2018 leading the GIS analysis for the Massachusetts Food is Medicine State Plan and is currently a Policy Analyst working on HLPC’s whole-person care initiatives.

Kristin graduated in May 2018 with a Masters of Science degree in Agriculture, Food, and Environment from the Friedman School of Nutrition Science and Policy at Tufts University. Specializing in community food systems and public health, her work focused on the intersection of our health care and food systems. Prior to graduate school, she received a B.A. in International Relations specializing in Environmental Issues from Virginia Tech.

CHLPI and Health Leaders Gather to Improve Lung Cancer Policies in West Virginia

Via Center for Health Law and Policy Innovation

By: Stephanie Kwan

CHLPI and Health Leaders Gather to Improve Lung Cancer Policies in West Virginia

Lung cancer kills more West Virginians than breast, prostate, and colorectal cancers combined. On November 1st-2nd, 2018, CHLPI joined hundreds of health and policy leaders at the Second Annual Lung Cancer Conference: Catalyzing Change to Address Lung Cancer. Hosted by West Virginia University Cancer Institute, the Mountains of Hope Cancer Coalition, and the Patient Advocate Foundation, the conference saw more than 200 health and policy leaders gather at the WVU Erickson Alumni Center in Morgantown, WV to address lung cancer policy changes.

The conference was designed to raise awareness about the impact of lung cancer across West Virginia and to identify avenues to improve lung cancer screening, early detection, treatment, and survivorship. The two-day program engaged healthcare providers, community-based health workers, public health educators, advocates, and policy makers in implementing changes both in their local communities and on a statewide level.

Current policies and lung cancer in West Virginia

Sarah Downer, CHLPI’s Associate Director for Whole Person Care and Clinical Instructor on Law in the Health Care and Policy Clinic, along with second-year clinic student Stephanie Kwan, welcomed conference attendees with an overview of healthcare policy-making. The overview discussed policy formation and how advocates could work with various entities to effect change. “Even though systemic changes take a long time, keep your eyes on the long term prize and don’t stop telling local policy makers your stories, because your work in West Virginia matters and is shaping national healthcare conversations”, said Sarah.

Graphic documentation of CHILPI’s presentation on “Overview of Healthcare Policy-making”, illustrated by Nora Herting.

West Virginia Delegate Amy Summers, Vice-Chairman of Health and Human Resources Committee of WV House, who not only is a nurse but also has a long family history of cancer, reminded attendees to get to know their legislators. Doing so will allow advocates to understand the expertise, priorities, and passions of their representatives, which will help advocates tailor their policy goals and approaches.

Attendees also heard from West Virginian experts; Dr. Christopher Plein, Professor at the Department of Public Administration at West Virginia University, highlighted the historical roots of many contemporary healthcare issues, while Dr. John Deskins, Director at the Bureau of Business & Economic Research at WVU College of Business and Economics, discussed the economic costs of lung cancer in West Virginia.

Graphic documentation of the expert policy panel that comprised of CHILPI’s Sarah Downer, Christopher Plein, and John Deskins, illustrated by Nora Herting.

Dr. Camara Jones, Senior Fellow at Morehouse School of Medicine and a Past President of the American Public Health Association, addressed the crowd on social determinants of health, including poverty, racism, and institutional disparities that are often ignored by today’s healthcare system.

Healthcare practitioners driving change in the lung cancer space

Following the presentations, conference attendees participated in an interactive policy planning session, identifying local advocacy goals such as rescinding no-smoking ban, establishing primary care partnerships, and engaging insurers to pay for screening. Attendees also examined specific programs that effect lung cancer in West Virginia, including Medicare and Medicaid, lung cancer treatment case studies, opioid Rx regulations, as well as immunotherapy and the use of robotics in surgeries.

Another highlight of the conference was the Shine A Light on Lung Cancer evening reception, where speakers and attendees came together to honor lung cancer survivors, family members, caregivers, and those who have passed.

The two-day event was a highly successful initiative that brought together policy leaders and healthcare practitioners to learn, plan, and act. The conference equipped attendees to be advocates in their respective professions and communities. It was an eye-opening experience for clinic student Stephanie to speak to experienced practitioners and to witness how practitioners could work on policy goals that make a difference in the lives of people they serve.

Graphic documentation of “policy-planning in motion”; produced collaboratively by conference attendees and illustrated by Nora Herting.

The conference’s presenters included:

  • Sarah Downer, JD
  • Camara Jones, MD, MPH, PhD
  • Honorable Amy Summers, MSN
  • Ghulam Abbas, MD, MHCM, FACS
  • Mohammed Almubarak, MD
  • John Deskin, PhD
  • Monika Holbein, MD
  • Malcol Mattes, MD
  • Christopher Plein, PhD
  • Anne Swisher PT, PhD

Sarah Downer and Stephanie Kwan at the WVU Erickson Alumni Center in Morgantown, WV, speaking at the Second Annual Lung Cancer Conference.

A New Harvard Law Building Opens on Mass Ave

Via Harvard Law Today

Credit: NBBJ Boston

By: Clea Simon

Citing its future role in “innovation, deep learning, collegiality, and service,” Dean John F. Manning saluted the opening of the Harvard Law School’s newest building, at 1607 Massachusetts Avenue, on Monday evening. At a joyful reception in the open first floor, guests, faculty and community members nibbled pizza and sweets while taking in enlarged photos of the location’s previous incarnations, watching a time-lapse film of the structure’s 12 months of construction and queuing up for tours of the interior. Raising a glass of champagne, Manning thanked the many individuals from Harvard Law School and the City of Cambridge who had made the building possible, and he hailed the LEED Gold certified building as “designed to inspire and provoke collaboration.”

Indeed, the sleek wood and brick structure, which sits across Everett Street from HLS’s Wasserstein Hall, Caspersen Students Center, and Clinical Wing building, was created to foster and expand the law school’s experiential and clinical learning and tosupport research programs. Along with space for faculty offices and other future uses, 1607 Massachusetts Avenue, the first Harvard Law School project designed by Alex Krieger, a principal of NBBJ and professor at the Harvard Graduate School of Design, will provide elbow room for Harvard Law’s clinical education and research.  It will serve as the new home for the Center for Health Law and Policy Innovation, which includes the Health Law and Policy Clinic and also the Food Law and Policy Clinic. The building will also house the Criminal Justice Institute and the Harvard Defenders, a clinical program and student practice organization, respectively, in which students represent clients in criminal hearings; the Islamic Legal Studies Program: Law and Social Change; the Animal Law & Policy Program; and the Access to Justice Lab.

“This new building reflects a commitment from both former Dean Martha Minow and our current dean to having a law school curriculum that reflects the needs of our law students and the community writ large,” said Clinical Professor Robert Greenwald, director of the Center for Health Law and Policy Innovation.

Clinical or experiential learning, Greenwald said, “needs a very different kind of space” than traditional lecture halls or classrooms. As an example, he described the new Health Law and Policy Clinic space, which features open areas, where students can work collaboratively, as well as more private offices and conference rooms. “A lot of the work happens via Skype and other electronic communication,” he said. “So all of our offices are designed for that.”

 Credit: Lorin Ganger

“The new building will provide invaluable space for the clinical programs and modern facilities to engage in the lawyering advocacy and teaching that are at the heart of the clinical programs,” said Clinical Professor of Law and Vice Dean for Experiential and Clinical Education Daniel L. Nagin. “This space will promote collaboration and enhance the ability of staff and students and faculty to interact and think across boundaries,” he added.

Continue reading.

Academy of Food Law and Policy Conference at Harvard Law School

Via Center for Health Law and Policy Innovation

Written by Erika Dunyak, FLPC Clinical Fellow and AFLP Conference attendee.

On October 5th, 2018, the Academy of Food Law and Policy (AFLP) held its inaugural conference at Harvard Law School, co-hosted by Harvard Law Food Law and Policy Clinic (FLPC). The conference welcomed over 40 attendees and featured a series of workshops, moderator-led discussion groups, and a lunchtime panel led by past and current AFLP board members. The conference connected the food law and policy community and highlighted parameters of the field through group-driven discussion of scholarship, teaching, and growth of the AFLP.

Championed by Emily Broad Leib, director of the Harvard Law Food Law and Policy Clinic and Susan Schneider, director of the LL.M. Program in Agricultural & Food Law at the University of Arkansas, AFLP seeks to stimulate intellectual discourse, encourage and recognize scholarship, enhance teaching, support student interest, and promote the academic field of food law and policy. Now in its second year, the Academy connects legal faculty from across the globe to create a foundation for the long-term stability of food law as an academic discipline.

As a conference attendee, it was refreshing to be among peers and mentors in the food law space. Academy members gathered to evaluate and labor over each other’s writing in hopes of contributing meaningfully to academic discourse. The conference’s workshops helped attendees develop their positions and find new angles and new resources to strengthen their work. It was an exercise without judgment, and most importantly, will improve the research and writing of authors contributing to the food law academy.

Some AFLP members are adjuncts, teaching in undergraduate programs, clinical professors, or other non-traditional academic roles for the doctrinal legal academy. Other members are tenured faculty; the Academy even counts a dean amongst its members! But at the conference, the traditional academic barriers that exist were broken down; attendees were eager to learn from one another. Conference attendees also noted actions to increase inclusivity as an exciting next step for the legal academy and the future of food law.

Health Groups Upgrade R.I. Hepatitis C Medicaid Access to ‘A-’

Via the Center for Health Law and Policy Innovation

Source: Pexels

Originally published by the Providence News Journal on October 29, 2018. Written by Rob Borkowski.

The R.I. Executive Office of Health and Human Services removed all restrictions on curative hepatitis C treatments for its Medicaid patients on July 12, a move that the National Viral Hepatitis Roundtable and the Center for Health and Law Policy Innovation at Harvard Law School took note of in upgrading the state’s report card for the Hepatitis C: The State of Medicaid Access project from a “D-” to an “A-”.

Rhode Island’s decision improved access to the treatments for Medicaid patients in both its Fee-for-Service and Managed Care Organization Medicaid programs. Previously, the state restrictions on access to hepatitis C treatments were not in line with federal medical necessity requirements for Medicaid.

But the state worked in conjunction with the Center for Health and Law Policy Innovation, the Rhode Island Center for Justice and other community partners to make the policy change.

“We commend Rhode Island for expanding access to hepatitis C medications for all Medicaid beneficiaries, ensuring that more Rhode Islanders can receive curative treatments. CHLPI encourages other states to follow in Rhode Island’s footsteps and remove their discriminatory restrictions,” said Robert Greenwald, clinical professor of law at Harvard Law School and the director of CHLPI.

Rhode Island’s Fee-For-Service program previously required hepatitis C patients to demonstrate severe liver damage (a fibrosis score of F3 or greater), undergo screening and concurrent alcohol and substance use counseling for beneficiaries actively using, and obtain a prescription from a specialist that is approved by the R.I. Executive Office of Health and Human Services. With these restrictions in place, very few patients diagnosed with hepatitis C had access to treatment. Each year, it is estimated that only 250 Rhode Islanders who are Medicaid beneficiaries receive access to curative hepatitis C medications.

“After years of strong advocacy efforts in Rhode Island, all Medicaid patients diagnosed with hepatitis C can now receive access to treatment without restrictions. We continue to encourage all Medicaid patients at risk to undergo screening and learn about available treatment options,” said Tina Broder, interim executive director of the National Viral Hepatitis Roundtable.

National Institutes of Health will study “Food is Medicine”

Via the Center for Health Law and Policy Innovation

Source: Pexels

Written by Hanh Nguyen, Whole Person Care Project Assistant. 

When the Committee on Appropriations recently passed H.R. 6557, The Department of Defense and Labor, Health and Human Services, and Education Appropriations Act for 2019, they also submitted a report accompanying the bill that encouraged the Office of Director of the NIH to work with Institutions and Centers, including NIDDKNHLBINIA, and NICHD, to report on research that has been conducted on Food is Medicine related topics. This may include “medically tailored meals, meal nutrition therapy, produce prescription programs, the role of proper nutrition in aging, and the role of proper nutrition in reproductive health”.

The report also draws attention to the access challenges and out-of-pocket costs of prescribed medical diets. The Committee encouraged the Center for Medicaid and Medicare Services to work proactively with stakeholder communities to identify and address improper barriers to nutritious food access.

CHLPI is excited to see the language of Food is Medicine (FIM) used among policymakers. We are hopeful that a focus on nutrition research will improve our health care delivery system.

There is a growing body of research that demonstrates the impressive results of FIM interventions in improving health outcomes, increasing patient satisfaction in health care, and reducing health costs. In a recent congressional briefing, it was reported that patients who received home-delivered medically tailored meals showed a 16% net reduction in monthly healthcare spendings. Likewise, a new study from Project Angel Heart, a non-profit food and nutrition program serving individuals living with life-threatening illnesses in Colorado, reported that the provision of medically tailored meals resulted in a 13% drop in hospital admissions and 24% overall cost reduction for patients with diabetes, chronic obstructive pulmonary disease, and congestive heart failure.

Despite such results, there is still not a federal funding stream dedicated to medically tailored food and nutrition within healthcare, leaving those who chronically ill, too sick to shop and cook for themselves, or too poor to afford nutritious food at risk for life-threatening conditions that are preventable with proper nutrition.

We believe that a critical analysis of existing FIM research will set the stage for future innovative policies that will increase access to medically tailored meals. Check out our FIM State Plan to learn more about how CHLPI is working to increase access to FIM interventions in the Commonwealth!

Should We Just Ban “Best By” Labels on Food?

Via the Center for Health Law and Policy Innovation 

Source: Flickr.com 

Originally published by Modern Farmer on October 12, 2018. Written by 

Food labels, as we’ve written about before, are awful: they can be misleading, outright lies, not include enough information, or, in the case of one particular label, encourage bad habits.

Tesco, one of the UK’s biggest supermarket chains, announced this week that it will remove “best by” date labels from 116 fruit and vegetable items. The move builds on a smaller reduction in the label earlier this year. So why are those labels bad?

The “best by” label, along with its siblings “best before” and “best if used by,” are not federally regulated in any way; they are not only not required, but there aren’t even any rules about how to determine which product gets which date. (It’s sometimes done by anecdotal evidence, sometimes by lab tests, more often by just following other labels and assuming that, say, the best time to drink milk is earlier than two weeks after it was processed.)

But over the past few years, resistance to the “best by” label has grown. A 2016 survey from the Harvard Food Law and Policy Clinic found that 84 percent of respondents occasionally throw away food that’s past its labeled date, and a third of respondents “usually” or “always” do. This is a significant issue because that food isn’t actually bad; the “best by” date is not the same as a spoilage date. The “best by” label is, unexpectedly, a major contributor to food waste, and food waste is so rampant in the US that an estimated 40 percent of the entire country’s food never makes it to the plate.

Tesco’s own research indicated that 69 percent of respondents supported removing the “best by” label, with more than half stating that they believed it would reduce food waste. This isn’t a trick to get you to buy spoiled food; you can tell if a tomato is rotten, or about to be rotten, in a way that’s much more precise than a stamped generic label. It’s a way to discourage people from walking past food that’s perfectly good.

Trump administration says it’s ending ACA ‘sabotage,’ experts say it comes at great risk to patients

Via Healio.com  

Source: Ted Eytan,  Flickr.com

By: Janel Miller

The average premium for the second lowest cost silver health insurance plans — the one used to determine final premium tax credits — will drop by a “historical” 1.5% for the first-time since the implementation of the federally-facilitated exchange in 2014, according to CMS.

However, experts told Healio Family Medicine that the agency’s actions put profit over patients and puts the well-being of many Americans at risk.

CMS claims

The average change in premium costs may not seem like a lot but is significant when put into historical context, Seema Verma, CMS administrator, said in a conference call with reporters.

“This is a very positive change from the double-digit increases we have seen over the past 2 years,” she said, noting that some states had seen increases of 200% and higher. The change in premiums was just one of the health insurance-related accomplishments under the Trump administration she lauded during the call.

According to Verma, states will soon be able to use waivers to increase their flexibility in sustaining their insurance markets. In addition, for the first time in several years, there will be an increase in insurance providers on the federal health insurance exchange market, she said.

“While some have been accusing [the Trump administration] of sabotage, the reality is we have been doing everything we can to mitigate the damage caused by Obamacare,” Verma said.

Experts weigh in

Arthur Caplan, PhD, founding head of medical ethics at New York University School of Medicine, and Robert Greenwald, JD, faculty director, Center for Health Law and Policy Innovation at Harvard Law School said in interviews CMS should not be patting itself on the back.

“The idea that the Trump administration is trying to save patients is ludicrous,” Caplan said in an interview. “It has permitted lousy cheap coverage, cheap, almost worthless policies to be sold,”  adding that is the “real reason why” CMS can make an announcement like this one.

“Putting this pig in a dress by claiming they’re helping people doesn’t make what they’re really trying to do — make the Affordable Care Act a footnote in history — go away. They’re putting money over people,” Caplan added.

“In no way does the Trump administration deserve credit for the state of the marketplace,” Greenwald agreed. “They have done everything in their power to destabilize it.”

According to Greenwald, states and insurance companies positively balanced the Trump administration’s actions by funding outreach and navigation efforts to promote the marketplace, adopting their own individual mandates to assure that there is diversity among marketplace applicants, passing laws that banned or limited the introduction of “junk” insurance plans, introducing a reinsurance system that results in lower premiums in their marketplaces, and allocating premium rate increases into silver-level plan premiums only.

Greenwald added it is not too late for clinicians and others to make their thoughts about health insurance known.

“If the American people want to see a strong marketplace this year, and the years ahead, they need to voice their opposition to efforts to repeal the Affordable Care Act and the health insurance marketplace,” he told Healio Family Medicine.

When does the ‘affordable’ in the Affordable Care Act kick in?

Via The Hill 

Source: Pexels

By: Merrill Matthews

It’s a good thing Democrats made health insurance “affordable” when they passed the Patient Protection and Affordable Care Act in 2010. I’d hate to see how much health insurance would cost if it were expensive.

The Kaiser Family Foundation just released its annual survey of employer-sponsored coverage, finding that the average premium for family coverage increased 5 percent to $19,616.

To put that in perspective, the real median household income in 2017 was $61,372. Thus family health coverage costs nearly a third of the median family’s income.

But citing the average family premium of nearly $20,000, as high as that is, can be misleading. A small employer, especially a one with older-than-average employees, likely blew through $20,000 a few years ago. The premium for a couple in their 50s with a teenager can easily run $25,000. Bump that up by $4,000 or more for each additional child.

However, those outrageously high premiums would be even higher if employers and health insurers hadn’t taken a number of steps to contain the cost explosion by adjusting benefits and exposing employees to significantly higher out-of-pocket costs.

The Kaiser survey points out that since 2008, annual deductibles for covered workers have increased 212 percent — eight times the rate of inflation. And to think Democrats used to call high deductible coverage “junk insurance.” Yet, under ObamaCare deductibles have exploded.

Insurers are also taking steps to increase out-of-pocket spending in less-noticeable ways. For example, in years past insurers charged one copay for a generic drug, say $10, and a slightly higher copay for a brand name drug, say $25.

Then insurers moved to three copay tiers or more. The generic might still require a $10 copay, while some brand name drug copays could run between $25 and $250.

In addition, some insurers now require co-insurance of 20 percent to 40 percent of a drug’s cost for some of the newest and most expensive drugs. If a drug costs $5,000 a month — and some cancer drugs cost that much or more — 40 percent co-insurance could cost the patient several thousand dollars a month. And that comes on top of other health care-related expenses and premium costs.

Imposing such high co-insurance rates on specific drugs has raised concerns that insurers were trying to discourage some of the sickest patients from enrolling in their plans. As Kaiser Health News noted a few years ago:

  • In 2016, Harvard Law School’s Center for Health Law and Policy Innovation filed complaints with the U.S. Department of Health and Human Services’ Office for Civil Rights alleging that health plans “offered by seven insurers in eight states are discriminatory because they don’t cover drugs that are essential to the treatment of HIV or require high out-of-pocket spending by patients for covered drugs.”
  • Consulting company Avalere Health found that several insurers’ silver plans had been adversely targeting some of the sickest populations with higher drug costs. “An analysis found that in the case of five classes of drugs that treat cancer, HIV and multiple sclerosis, fewer silver plans in 2016 placed all the drugs in the class in the top tier with the highest cost sharing or charged patients more than 40 percent of the cost for each drug in the class.” Pulling some of the most expensive drugs from the top tier was likely due to protests and threats of legal action.

To be fair, insurers and employers felt they had to take steps in order to control their costs, otherwise premiums would likely have been even higher than they are.

Other factors are also playing a role in the premium increases. Hospital systems were consolidating prior to ObamaCare, but the ACA put that trend on steroids, enabling hospitals to demand higher reimbursements from insurers.

Consulting firm Kaufman Hall reported in January there were 115 hospital and health system mergers and acquisitions in 2017, up 13 percent from 2016, and the largest number in recent history. For comparison, there were 50 hospital M&A transitions in 2009, the year before ObamaCare passed.

Unfortunately, options for containing premium increases and coverage reductions are limited. The Trump administration is trying to provide as much insurer and state flexibility as possible under ObamaCare, but it’s unclear yet as to how much those efforts can achieve.

And there’s a new proposal, the Health Care Choices Proposal, backed by a number of health policy analysts. It seeks to block grant current federal health care spending on Medicaid and ObamaCare to the states along with some regulatory reductions.

Since Washington has done such a terrible job trying to make health insurance affordable, maybe it’s time to give the states a chance. How much worse could they do?

Lack of Planning Has Left Parts of N.J. Without Grocery Stores Nearby

Via NJ. com

Source: Pexels

By: Ekaterina Valiotis

New Jersey has 25 percent fewer supermarkets per capita than the national average, according to the Harvard University Center for Health Law and Policy Innovation. Unfortunately, the Garden State does not live up to is name for many, with 340,000 New Jersey residents living in food deserts.

Nothing could be more fundamental to our well-being than healthy food and nutrition, and people have become increasingly focused on the sourcing and quality of what they eat.

As a nation, several decades into an obesity epidemic that has brought far-reaching and negative consequences, we are waking up to the fact that the items we select at the supermarket will go a long way towards determining the quality and length of our lives.

Unfortunately, though the knowledge of how to eat better is becoming more universal, access to healthy food is not distributed evenly. For every high-end, expensive supermarket that opens in a wealthy or upper-middle class neighborhood, large parts of our population, particularly in urban areas, remain bereft of such choices.

Read the full article here.

CHLPI Associate Director Sarah Downer to Present at a Training Aimed to Get People Cooking in Community Kitchens

Calling all community kitchens…meeting Thursday

Via The Recorder 

In an effort to get people cooking in community kitchens to make better use of local foods, the Franklin Regional Council of Governments is hosting a training today from 5 to 7 p.m. at the the Western Massachusetts Food Processing Center in Greenfield.

The effort is aimed at heating up use of commercial kitchens at schools, houses of worship and other sites while working through concerns that may come up about liability, according to Phoebe Walker, the COG’s director of community services.

“We’re hoping to find ways to get people to eat better, and that means making community facilities more available,” Walker said, “but not increasing their liability.

Anyone who’s thinking of turning pounds of tomatoes into sauce for donation to a local food pantry, pickling garden vegetables or starting their own food business may be interested in the discussion, along with operators of school or church kitchens that could be shared with community cooks or food entrepreneurs.

A full dinner will be served as part of the program, which will include presentations by Rachel Stoler, the COG’s community health program manager; Randy Crochier, COG food safety agent;  Joanna Benoit, the food processing center’s food systems program manager, Stacey Wood and David Soule, co-owners of Whole Harmony, as well as Sarah Downer, associate director of Harvard Law School’s Center for Health Law and Policy Innovation;  Erica Kyzmir-McKeon, an attorney and senior fellow at Conservation Law Foundation’s Legal Food Hub’ and Cheryl Sbarra, director of policy and law with the Massachusetts Association of Health Boards.

Registration is required at  www.eventbrite.com/e/shared-use-and-community-kitchens-training-tickets-50224901031

Courts Force States to Provide Costly Hep C Treatment

Via Stateline 

Source: Pixabay

By: Michael Ollove

Recent court rulings and settlements have found that states cannot withhold potentially life-saving but expensive medications from Medicaid beneficiaries and prison inmates who have chronic hepatitis C. In the latest ruling, chief judge of the U.S. Southern District of Indiana Jane Magnus-Stinson said that withholding or delaying treatment from hepatitis C-infected inmates was unconstitutional, amounting to cruel and unusual punishment in violation of the Eighth Amendment.

CHLPI Faculty Director Robert Greenwald was quoted in the article. The excerpt can be found below:

“If there were a cure for breast cancer or Alzheimer’s or diabetes, people would be storming the White House to make sure those medicines were available to everyone, you can be sure of that,” said Robert Greenwald, a professor at Harvard Law School and the faculty director of the school’s Center for Health Law and Policy Innovation. “But we’ve responded completely differently with the cure for hepatitis C because of the stigma associated with that disease.”

Greenwald and others insist that treating prisoners with hepatitis C is an indispensable step toward eradicating the disease in the whole population.

Read the full article here.

CHLPI Welcomes Andrea Kunst

Andrea Kunst joined the Center for Health Law and Policy Innovation in July 2018 as the Foundation and Corporate Relations Officer. She has practiced philanthropic fundraising, strategic advancement, and non-profit organization management for twenty years. She is an accomplished fundraising generalist with a track record of creating successful customized advancement plans for schools and nonprofits, consistently meeting and exceeding fundraising goals. She is founder and executive director of Cushing Mill Contracting, offering development and advancement services to schools and mission driven, non-profit start-ups.

Andrea was the Director of Advancement at Boston Day and Evening Academy, a competency-based, student-centered alternative high school within Boston Public Schools for 10 years; chaired the board of Dorchester Arts Collaborative during the period that it founded Dorchester’s first community art gallery; was Director of Development for Nativity Preparatory School during their successful capital campaign; and has broad experience as a teacher, writer, and manager. Andrea currently sits on the board of PieRSquared, an after-school math tutoring non-profit in Roxbury, and is an alumnus of the Education Policy Fellowship Program. She received both her B.A. in Communications and her M.A. in Writing and Publishing from Emerson College and lives in her adopted community of Dorchester, MA.

Welcome Andrea!

CHLPI Welcomes New Team Member Rachel Landauer

Via the Center for Health Law and Policy Innovation

The Center for Health Law and Policy Innovation (CHLPI) welcomes Rachel Landauer to the team as a Clinical Fellow!

Rachel graduated from UCLA School of Law in May 2016 as a member of the David J. Epstein Program in Public Interest Law and Policy, and with a Master of Public Health degree from the UCLA Fielding School of Public Health. During law school, she worked with projects and organizations including the American Civil Liberties Union’s Reproductive Freedom Project, the National Health Law Program, and the Los Angeles HIV Law & Policy Project, and co-chaired UCLA’s Health Law Society. Immediately prior to joining the Center, Rachel was an associate at Sheppard, Mullin, Richter & Hampton LLP, focusing on health care regulatory and compliance matters.

CHLPI to present at Second annual “Food Is Medicine” symposium in Indianapolis

Via Center for Health Law and Policy Innovation

Meals on Wheels of Central Indiana will hold the second annual “Food Is Medicine” state symposium Thursday, April 12  in Indianapolis. The symposium will take an in-depth look at how medically tailored food plays a essential role in outcome-driven, cost-effective health care models.

Medically tailored food is prepared under the direction of a physician to individuals who are chronically ill with the individual patient’s specific nutritional needs in mind.

The symposium, which is in its second year, stems from Meals on Wheels’ involvement in the Food Is Medicine Coalition, a national association of medically tailored food and nutrition service providers. Meals on Wheels  joined the coalition in 2015 as part of an effort to strengthen its services to critically and chronically ill individuals.

“By partnering with medical providers, community organizations, and chronic disease experts to ensure low-income Hoosiers with critical and chronic diseases have access to medically tailored meals and more customized nutritional plans, we have the potential to positively impact their overall health while lowering health care costs,” said Barb Morris, CEO of Meals on Wheels of Central Indiana.

According to a study by The New England Journal of Medicine, food insecurity is one of the top ten causes for costly hospital readmissions. With a food intervention upon discharge, studies show this number can be reduced to as low as eight percent.  The problem is further exacerbated when patients are discharged from the hospital and return home to a bare pantry.

The symposium will bring together leaders representing health care organizations, state and local policymakers, elder care experts, academic and statewide advocacy groups.

Presenters:           

 

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