Health & Fitness (73)
NEW YORK (AP) -- The nation's record-low teen birth rate stems from robust declines in nearly every state, but most dramatically in several Mountain States and among Hispanics, according to a new government report.
All states but West Virginia and North Dakota showed significant drops over five years. But the Mountain States of Arizona, Colorado, Idaho, Nevada and Utah saw rates fall by 30 percent or more.
In 22 states, teen Hispanic birth rates plunged at least 40 percent, which was described as "just amazing," by the report's lead author, Brady Hamilton of the Centers for Disease Control and Prevention.
What's driving the declines? No one can say for sure. Experts believe the explanation is complicated and probably varies a bit from state to state. The national figure has been falling since 1991, aside from a brief interruption in 2006 and 2007.
The CDC report released Thursday is based on birth certificates for 2007 through 2011. Last year, the CDC announced the overall improvement in teen births: a record low of 31 births per 1,000 teens ages 15 to 19. That compares to 42 births per 1,000 five years earlier.
The new report focuses on state figures in 2011:
- Lowest rates are in New Hampshire, Massachusetts, Connecticut and Vermont, each with rates under 17 per 1,000.
- Highest rates overall continue to be in the South, led by Arkansas and Mississippi, each with rates of about 50 per 1,000. In Arkansas, the majority of teen births are to white moms. In Mississippi, the majority are black.
- White teens continue to have the lowest birth rate nationally - about 22 births per 1,000. Black teens saw a larger improvement, but their rate was still more than twice the white rate, at 47 per 1,000.
- Overall, the Hispanic rate plummeted from 75 to 49 per 1,000, now virtually a tie with the black rate.
The teen drop in the last five years coincided with an overall decline in births, which experts attribute to a weak economy that dampened enthusiasm for having children.
Hispanic women have been part of that trend, possibly due to the economy and to illegal immigration crackdowns in some states that reduce the number of young Hispanic females entering the country from Mexico and other nations, said John Santelli, a Columbia University professor of population and family health.
That means new immigrants are having less impact on birth statistics, and second- and third-generation families are having more influence.
As time goes on, Hispanics - like other immigrant groups before them - tend to adopt American customs and practices.
"There is more attention on education, career, and the future," said Dr. Janet Realini, head of Healthy Futures of Texas, a San Antonio-based organization focused on preventing teen and unplanned pregnancies.
Hispanic rates, though, continue to be much higher than those for blacks and whites in most of the states with the largest Hispanic populations, including California, Texas, New York, New Jersey, Arizona, Colorado, New Mexico and Georgia.
Texas has the highest number of teen births in the nation, with nearly 43,000 in 2011. Nearly two-thirds were to Hispanic moms.
The overall improvement, though, is something to celebrate, said Bill Albert, chief program officer of the National Campaign to Prevent Teen and Unplanned Pregnancy.
"Geography, politics, or policy alone simply cannot explain the widespread declines," Albert said in an email. "Credit goes to teens themselves who are clearly making better decisions about sex, contraception, and their future."
--- Online:
CDC report: HTTP://WWW.CDC.GOV/NCHS/
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
All states but West Virginia and North Dakota showed significant drops over five years. But the Mountain States of Arizona, Colorado, Idaho, Nevada and Utah saw rates fall by 30 percent or more.
In 22 states, teen Hispanic birth rates plunged at least 40 percent, which was described as "just amazing," by the report's lead author, Brady Hamilton of the Centers for Disease Control and Prevention.
What's driving the declines? No one can say for sure. Experts believe the explanation is complicated and probably varies a bit from state to state. The national figure has been falling since 1991, aside from a brief interruption in 2006 and 2007.
The CDC report released Thursday is based on birth certificates for 2007 through 2011. Last year, the CDC announced the overall improvement in teen births: a record low of 31 births per 1,000 teens ages 15 to 19. That compares to 42 births per 1,000 five years earlier.
The new report focuses on state figures in 2011:
- Lowest rates are in New Hampshire, Massachusetts, Connecticut and Vermont, each with rates under 17 per 1,000.
- Highest rates overall continue to be in the South, led by Arkansas and Mississippi, each with rates of about 50 per 1,000. In Arkansas, the majority of teen births are to white moms. In Mississippi, the majority are black.
- White teens continue to have the lowest birth rate nationally - about 22 births per 1,000. Black teens saw a larger improvement, but their rate was still more than twice the white rate, at 47 per 1,000.
- Overall, the Hispanic rate plummeted from 75 to 49 per 1,000, now virtually a tie with the black rate.
The teen drop in the last five years coincided with an overall decline in births, which experts attribute to a weak economy that dampened enthusiasm for having children.
Hispanic women have been part of that trend, possibly due to the economy and to illegal immigration crackdowns in some states that reduce the number of young Hispanic females entering the country from Mexico and other nations, said John Santelli, a Columbia University professor of population and family health.
That means new immigrants are having less impact on birth statistics, and second- and third-generation families are having more influence.
As time goes on, Hispanics - like other immigrant groups before them - tend to adopt American customs and practices.
"There is more attention on education, career, and the future," said Dr. Janet Realini, head of Healthy Futures of Texas, a San Antonio-based organization focused on preventing teen and unplanned pregnancies.
Hispanic rates, though, continue to be much higher than those for blacks and whites in most of the states with the largest Hispanic populations, including California, Texas, New York, New Jersey, Arizona, Colorado, New Mexico and Georgia.
Texas has the highest number of teen births in the nation, with nearly 43,000 in 2011. Nearly two-thirds were to Hispanic moms.
The overall improvement, though, is something to celebrate, said Bill Albert, chief program officer of the National Campaign to Prevent Teen and Unplanned Pregnancy.
"Geography, politics, or policy alone simply cannot explain the widespread declines," Albert said in an email. "Credit goes to teens themselves who are clearly making better decisions about sex, contraception, and their future."
--- Online:
CDC report: HTTP://WWW.CDC.GOV/NCHS/
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
DENVER (AP) -- In the most prominent challenge of its kind, Hobby Lobby Stores Inc. is asking a federal appeals court Thursday for an exemption from part of the federal health care law that requires it to offer employees health coverage that includes access to the morning-after pill.
The Oklahoma City-based arts-and-crafts chain argues that businesses - not just the currently exempted religious groups - should be allowed to seek exception from that part of the health law if it violates their religious beliefs.
"They ought to be able - just like a church, just like a charity - to have the right to opt out of a provision that infringes on their religious beliefs," said Kyle Duncan, who will argue before the 10th Circuit Court of Appeals on behalf of the Green family, the founders of Hobby Lobby Stores Inc. and a sister company, Christian booksellers Mardel Inc.
The Greens contend that emergency contraception is tantamount to abortion because it can prevent a fertilized egg from implanting in the womb. They also object to providing coverage for certain kinds of intrauterine devices.
Lower courts have rejected Hobby Lobby's claim, saying that for-profit businesses aren't covered by an exemption added to the law for religious organizations. That exemption applies to churches themselves, but not to affiliated nonprofit corporations, like hospitals, that do not rely primarily on members of the faith as employees.
In a decision issued late last year, a federal judge concluded simply, "Hobby Lobby and Mardel are not religious organizations."
But U.S. District Judge Joe Heaton in Oklahoma City also wrote that "the court is not unsympathetic" to Hobby Lobby's dilemma and that the question of compelling employer health coverage for certain procedures "involves largely uncharted waters."
Other businesses in multiple states are challenging the contraception mandate, too. Hobby Lobby is the most prominent company making the claim, and it is the first to be heard by a federal appeals court. The U.S. Justice Department will argue for the government that the contraception mandate should stay.
The 10th Circuit opted to hear the case before all nine judges, not the typical three-judge panel, indicating the case's importance.
In December, the 10th Circuit denied Hobby Lobby's request for an injunction to prevent it being subject to fines while its argument was on appeal. The U.S. Supreme Court also denied an injunction, with Justice Sonia Sotomayor writing that it was not "indisputably clear" that Hobby Lobby needed immediate protection.
In response, the company restructured its health insurance, Duncan said. But Hobby Lobby, which is self-insured, will face fines by July 1 if it does not provide the coverage, he said.
Hobby Lobby calls itself a "biblically founded business" and is closed on Sundays. Founded in 1972, the company now operates more than 500 stores in 41 states and employs more than 13,000 full-time employees who are eligible for health insurance.
The Hobby Lobby case has attracted broad interest from health groups and religious groups. A panel including reproductive rights organizations and the American Public Health Association banded together last year to ask the court to reject Hobby Lobby's claim. The groups argued it would be dangerous precedent to allow for-profit private businesses to use religious beliefs to deny coverage.
In a brief to the court filed last year, the health groups argued that allowing businesses not to cover some contraceptives would be like allowing businesses to tell employees they can't use wages to buy morning-after pills or other products that offend the employer's religious belief.
"Of course, no one would argue that (Hobby Lobby owners) could seek, on religious grounds, to preclude their employees from spending their wages on contraception. This same rationale requires rejecting employers' demands to impose their religious views on employees through restrictions on the use of health insurance benefits," the health groups argued.
Susan Polan, associate executive director of the American Public Health Association, said the Hobby Lobby case is an important test of how far businesses can go in seeking to exempt coverage of health procedures they don't like.
"We're talking about women's access to reproductive health. That should be a decision between a patient and her health care provider, not a patient and her employer," Polan said this week.
--- Kristen Wyatt can be reached at HTTP://WWW.TWITTER.COM/APKRISTENWYATT
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
The Oklahoma City-based arts-and-crafts chain argues that businesses - not just the currently exempted religious groups - should be allowed to seek exception from that part of the health law if it violates their religious beliefs.
"They ought to be able - just like a church, just like a charity - to have the right to opt out of a provision that infringes on their religious beliefs," said Kyle Duncan, who will argue before the 10th Circuit Court of Appeals on behalf of the Green family, the founders of Hobby Lobby Stores Inc. and a sister company, Christian booksellers Mardel Inc.
The Greens contend that emergency contraception is tantamount to abortion because it can prevent a fertilized egg from implanting in the womb. They also object to providing coverage for certain kinds of intrauterine devices.
Lower courts have rejected Hobby Lobby's claim, saying that for-profit businesses aren't covered by an exemption added to the law for religious organizations. That exemption applies to churches themselves, but not to affiliated nonprofit corporations, like hospitals, that do not rely primarily on members of the faith as employees.
In a decision issued late last year, a federal judge concluded simply, "Hobby Lobby and Mardel are not religious organizations."
But U.S. District Judge Joe Heaton in Oklahoma City also wrote that "the court is not unsympathetic" to Hobby Lobby's dilemma and that the question of compelling employer health coverage for certain procedures "involves largely uncharted waters."
Other businesses in multiple states are challenging the contraception mandate, too. Hobby Lobby is the most prominent company making the claim, and it is the first to be heard by a federal appeals court. The U.S. Justice Department will argue for the government that the contraception mandate should stay.
The 10th Circuit opted to hear the case before all nine judges, not the typical three-judge panel, indicating the case's importance.
In December, the 10th Circuit denied Hobby Lobby's request for an injunction to prevent it being subject to fines while its argument was on appeal. The U.S. Supreme Court also denied an injunction, with Justice Sonia Sotomayor writing that it was not "indisputably clear" that Hobby Lobby needed immediate protection.
In response, the company restructured its health insurance, Duncan said. But Hobby Lobby, which is self-insured, will face fines by July 1 if it does not provide the coverage, he said.
Hobby Lobby calls itself a "biblically founded business" and is closed on Sundays. Founded in 1972, the company now operates more than 500 stores in 41 states and employs more than 13,000 full-time employees who are eligible for health insurance.
The Hobby Lobby case has attracted broad interest from health groups and religious groups. A panel including reproductive rights organizations and the American Public Health Association banded together last year to ask the court to reject Hobby Lobby's claim. The groups argued it would be dangerous precedent to allow for-profit private businesses to use religious beliefs to deny coverage.
In a brief to the court filed last year, the health groups argued that allowing businesses not to cover some contraceptives would be like allowing businesses to tell employees they can't use wages to buy morning-after pills or other products that offend the employer's religious belief.
"Of course, no one would argue that (Hobby Lobby owners) could seek, on religious grounds, to preclude their employees from spending their wages on contraception. This same rationale requires rejecting employers' demands to impose their religious views on employees through restrictions on the use of health insurance benefits," the health groups argued.
Susan Polan, associate executive director of the American Public Health Association, said the Hobby Lobby case is an important test of how far businesses can go in seeking to exempt coverage of health procedures they don't like.
"We're talking about women's access to reproductive health. That should be a decision between a patient and her health care provider, not a patient and her employer," Polan said this week.
--- Kristen Wyatt can be reached at HTTP://WWW.TWITTER.COM/APKRISTENWYATT
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
LONDON (AP) -- More than a decade ago, British parents refused to give measles shots to at least a million children because of now discredited research that linked the vaccine to autism. Now, health officials are scrambling to catch up and stop a growing epidemic of the contagious disease.
This year, the U.K. has had more than 1,200 cases of measles, after a record number of nearly 2,000 cases last year. The country once recorded only several dozen cases every year. It now ranks second in Europe, behind only Romania.
Last month, emergency vaccination clinics were held every weekend in Wales, the epicenter of the outbreak. Immunization drives have also started elsewhere in the country, with officials aiming to reach 1 million children aged 10 to 16.
"This is the legacy of the Wakefield scare," said Dr. David Elliman, spokesman for the Royal College of Paediatrics and Child Health, referring to a paper published in 1998 by Andrew Wakefield and colleagues that is widely rejected by scientists.
That work suggested a link between autism and the combined childhood vaccine for measles, mumps and rubella, called the MMR. Several large scientific studies failed to find any connection, the theory was rejected by at least a dozen major U.K. medical groups and the paper was eventually retracted by the journal that published it.
Britain's top medical board stripped Wakefield of the right to practice medicine in the U.K., ruling that he and two of his colleagues showed a "callous disregard" for the children in the study, subjecting them to unnecessary, invasive tests. As part of his research, Wakefield took blood samples from children at his son's birthday party, paying them about 5 pounds each ($7.60), and later joked about the incident.
Still, MMR immunization rates plummeted across the U.K. as fearful parents abandoned the vaccine - from rates over 90 percent to 54 percent. Wakefield has won support from parents suspicious of vaccines, including Hollywood celebrities like Jenny McCarthy, who has an autistic son.
Nearly 15 years later, the rumors about MMR are still having an impact. Now there's "this group of older children who have never been immunized who are a large pool of infections," Elliman said.
The majority of those getting sick in the U.K. - including a significant number of older children and teens - had never been vaccinated. Almost 20 of the more than 100 seriously ill children have been hospitalized and 15 have suffered complications including pneumonia and meningitis. One adult with measles has died, though it's unclear if it was the disease that killed him.
The first measles vaccines were introduced in the 1960s, which dramatically cut cases of the rash-causing illness. Since 2001, measles deaths have dropped by about 70 percent worldwide; Cambodia recently marked more than a year without a single case.
Globally, though, measles is still one of the leading causes of death in children under 5 and kills more than 150,000 people every year, mostly in developing countries. Measles is highly contagious and is spread by coughing, sneezing and close personal contact with infected people; symptoms include a fever, cough, and a rash on the face.
Across the U.K., about 90 percent of children under 5 are vaccinated against measles and have received the necessary two doses of the vaccine. But among children now aged 10 to 16, the vaccination rate is slightly below 50 percent in some regions.
To stop measles outbreaks, more than 95 percent of children need to be fully immunized. In some parts of the U.K., the rate is still below 80 percent.
Unlike in the United States, where most states require children to be vaccinated against measles before starting school, no such regulations exist in Britain. Parents are advised to have their children immunized, but Britain's Department of Health said it had no plans to consider introducing mandatory vaccination.
Last year, there were 55 reported cases of measles in the United States, where the measles vaccination rate is above 90 percent. So far this year, there have been 22 cases, including three that were traced to Britain. In previous years, the U.K. has sometimes exported more cases of measles to the U.S. than some countries in Africa.
Portia Ncube, a health worker at an East London clinic, said the struggle to convince parents to get the MMR shot is being helped by the measles epidemic in Wales.
"They see what's happening in Wales, so some of them are now sensible enough to come in and get their children vaccinated," she said.
Clinic patient Ellen Christensen, mother of an infant son, acknowledged she had previously had some "irrational qualms" about the MMR vaccine.
"But after reading more about it, I know now that immunization is not only good for your own child, it's good for everyone," she said.
--- Online: Public Health England's Measles website: HTTP://WWW.HPA.ORG.UK/TOPICS/INFECTIOUSDISEASES/INFECTIONSAZ/MEASLES/ --- AP Medical Writer Mike Stobbe in New York contributed to this report. © 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
This year, the U.K. has had more than 1,200 cases of measles, after a record number of nearly 2,000 cases last year. The country once recorded only several dozen cases every year. It now ranks second in Europe, behind only Romania.
Last month, emergency vaccination clinics were held every weekend in Wales, the epicenter of the outbreak. Immunization drives have also started elsewhere in the country, with officials aiming to reach 1 million children aged 10 to 16.
"This is the legacy of the Wakefield scare," said Dr. David Elliman, spokesman for the Royal College of Paediatrics and Child Health, referring to a paper published in 1998 by Andrew Wakefield and colleagues that is widely rejected by scientists.
That work suggested a link between autism and the combined childhood vaccine for measles, mumps and rubella, called the MMR. Several large scientific studies failed to find any connection, the theory was rejected by at least a dozen major U.K. medical groups and the paper was eventually retracted by the journal that published it.
Britain's top medical board stripped Wakefield of the right to practice medicine in the U.K., ruling that he and two of his colleagues showed a "callous disregard" for the children in the study, subjecting them to unnecessary, invasive tests. As part of his research, Wakefield took blood samples from children at his son's birthday party, paying them about 5 pounds each ($7.60), and later joked about the incident.
Still, MMR immunization rates plummeted across the U.K. as fearful parents abandoned the vaccine - from rates over 90 percent to 54 percent. Wakefield has won support from parents suspicious of vaccines, including Hollywood celebrities like Jenny McCarthy, who has an autistic son.
Nearly 15 years later, the rumors about MMR are still having an impact. Now there's "this group of older children who have never been immunized who are a large pool of infections," Elliman said.
The majority of those getting sick in the U.K. - including a significant number of older children and teens - had never been vaccinated. Almost 20 of the more than 100 seriously ill children have been hospitalized and 15 have suffered complications including pneumonia and meningitis. One adult with measles has died, though it's unclear if it was the disease that killed him.
The first measles vaccines were introduced in the 1960s, which dramatically cut cases of the rash-causing illness. Since 2001, measles deaths have dropped by about 70 percent worldwide; Cambodia recently marked more than a year without a single case.
Globally, though, measles is still one of the leading causes of death in children under 5 and kills more than 150,000 people every year, mostly in developing countries. Measles is highly contagious and is spread by coughing, sneezing and close personal contact with infected people; symptoms include a fever, cough, and a rash on the face.
Across the U.K., about 90 percent of children under 5 are vaccinated against measles and have received the necessary two doses of the vaccine. But among children now aged 10 to 16, the vaccination rate is slightly below 50 percent in some regions.
To stop measles outbreaks, more than 95 percent of children need to be fully immunized. In some parts of the U.K., the rate is still below 80 percent.
Unlike in the United States, where most states require children to be vaccinated against measles before starting school, no such regulations exist in Britain. Parents are advised to have their children immunized, but Britain's Department of Health said it had no plans to consider introducing mandatory vaccination.
Last year, there were 55 reported cases of measles in the United States, where the measles vaccination rate is above 90 percent. So far this year, there have been 22 cases, including three that were traced to Britain. In previous years, the U.K. has sometimes exported more cases of measles to the U.S. than some countries in Africa.
Portia Ncube, a health worker at an East London clinic, said the struggle to convince parents to get the MMR shot is being helped by the measles epidemic in Wales.
"They see what's happening in Wales, so some of them are now sensible enough to come in and get their children vaccinated," she said.
Clinic patient Ellen Christensen, mother of an infant son, acknowledged she had previously had some "irrational qualms" about the MMR vaccine.
"But after reading more about it, I know now that immunization is not only good for your own child, it's good for everyone," she said.
--- Online: Public Health England's Measles website: HTTP://WWW.HPA.ORG.UK/TOPICS/INFECTIOUSDISEASES/INFECTIONSAZ/MEASLES/ --- AP Medical Writer Mike Stobbe in New York contributed to this report. © 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
WASHINGTON (AP) -- The decade-old law that transformed the battle against HIV and AIDS in developing countries is at a crossroads. The dream of future generations freed from epidemic is running up against an era of economic recovery and harsh budget cuts.
The President's Emergency Plan for AIDS Relief grew out of an unlikely partnership between President George W. Bush and lawmakers led by the Congressional Black Caucus. It has come to represent what Washington can do when it puts politics aside - and what America can do to make the world a better place.
President Barack Obama, speaking at the recent dedication of Bush's presidential library, praised the compassion Bush showed in "helping to save millions of lives and reminding people in some of the poorest corners of the globe that America cares."
House Democratic leader Nancy Pelosi said of Bush in a statement that "while many events may distinguish his presidency, his devotion to combatting the scourge of HIV/AIDS will certainly define his legacy."
The AIDS program's future, however, is uncertain. Obama has upped the stakes, speaking in his State of the Union address this year of "realizing the promise of an AIDS-free generation." But funding for the relief plan's bilateral efforts has dipped in recent years and it's doubtful that Congress, in its current budget-cutting mood, will reverse that trend when the current five-year program expires later this year.
The AIDS program is also trying to find a balance between its goals of reaching more people with its prevention and treatment programs and turning over more responsibility to the host nations where it operates.
"This has been an incredible achievement," said Rep. Barbara Lee, D-Calif., a senior Congressional Black Caucus member who played major roles both in passing the original 2003 act and its 2008 renewal that significantly increased funding for AIDS, malaria and tuberculosis treatment in Africa and other areas of the developing world. She spoke of the more than 5 million people now receiving life-saving antiretroviral treatment and 11 million pregnant women who received HIV testing and counseling last year. "But I'm worried that with any type of level-funding or cuts we'll go backward," she said.
The 2008 act more than tripled funding from the 2003 measure, approving $48 billion over five years for bilateral and global AIDS programs, malaria and tuberculosis. It also ended U.S. policy making it almost impossible for HIV-positive people to get visas to enter the country.
The AIDS program was the largest commitment ever by a nation to combat a single disease internationally. According to the U.N.'s UNAIDS and the Kaiser Family Foundation, in 2011 the United States provided nearly 60 percent of all international AIDS assistance.
A decade ago, almost no one in sub-Saharan Africa was receiving antiretroviral treatment. By 2008, the AIDS program had boosted that number to 1.7 million. As of last year it was 5.1 million.
The State Department says the program last year also helped provide treatment to some 750,000 HIV-positive pregnant women, allowing about 230,000 infants to be born HIV-free, supported 2 million male circumcisions and directly supported HIV testing and counseling for 46.5 million.
"This is a remarkable story that the American people should know about," Kimberly Scott of the Institute of Medicine, which recently completed an evaluation of the AIDS program, said at a forum sponsored by the Kaiser Family Foundation and the CSIS Global Health Policy Center.
According to UNAIDS, the number of people living with HIV has leveled off, standing at about 34 million at the end of 2011. New infections that year reached 2.5 million, down 20 percent from 2001. AIDS-related deaths were 1.7 million, down from 2.3 million in 2005.
Jennifer Kates, director of global health and HIV policy at Kaiser, said most countries where the program operates have yet to reach the "tipping point," where new infections occurring in a year are less than the increase in people receiving treatment. Among the success stories were Ethiopia, where the 40,000 going on treatment in 2011 was almost four times the new infections. Still with a long way to go was Nigeria, which that year had 270,000 new HIV infections and a 57,000 increase in those getting treatment.
Chris Collins, director of public policy at amfAR, The Foundation for AIDS Research, also warned of potential repercussions as the AIDS program shifts from being an emergency response to the AIDS epidemic to a more supportive role for country-based health programs.
"The countries themselves largely are avoiding the important role that key populations play in epidemics," he said, referring to gay men, those injecting drugs and sex workers. These groups face discrimination and criminal charges in many cases, and 90 percent of the money to help them now comes from external sources.
Collins also spoke of the "huge mismatch" between the positive science and rhetoric on fighting AIDS and the money available. Since 2009 the funding for bilateral and global HIV and AIDS programs has largely stalled.
Kaiser's Kates said that while there's still bipartisan support for the AIDS program in Congress, "the big question is will the financing be there to reach the goals" of treating more people and advancing toward that AIDS-free generation. "The challenge right now is that the global economic climate is different, the U.S. climate is different, but the need is still great."
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
The President's Emergency Plan for AIDS Relief grew out of an unlikely partnership between President George W. Bush and lawmakers led by the Congressional Black Caucus. It has come to represent what Washington can do when it puts politics aside - and what America can do to make the world a better place.
President Barack Obama, speaking at the recent dedication of Bush's presidential library, praised the compassion Bush showed in "helping to save millions of lives and reminding people in some of the poorest corners of the globe that America cares."
House Democratic leader Nancy Pelosi said of Bush in a statement that "while many events may distinguish his presidency, his devotion to combatting the scourge of HIV/AIDS will certainly define his legacy."
The AIDS program's future, however, is uncertain. Obama has upped the stakes, speaking in his State of the Union address this year of "realizing the promise of an AIDS-free generation." But funding for the relief plan's bilateral efforts has dipped in recent years and it's doubtful that Congress, in its current budget-cutting mood, will reverse that trend when the current five-year program expires later this year.
The AIDS program is also trying to find a balance between its goals of reaching more people with its prevention and treatment programs and turning over more responsibility to the host nations where it operates.
"This has been an incredible achievement," said Rep. Barbara Lee, D-Calif., a senior Congressional Black Caucus member who played major roles both in passing the original 2003 act and its 2008 renewal that significantly increased funding for AIDS, malaria and tuberculosis treatment in Africa and other areas of the developing world. She spoke of the more than 5 million people now receiving life-saving antiretroviral treatment and 11 million pregnant women who received HIV testing and counseling last year. "But I'm worried that with any type of level-funding or cuts we'll go backward," she said.
The 2008 act more than tripled funding from the 2003 measure, approving $48 billion over five years for bilateral and global AIDS programs, malaria and tuberculosis. It also ended U.S. policy making it almost impossible for HIV-positive people to get visas to enter the country.
The AIDS program was the largest commitment ever by a nation to combat a single disease internationally. According to the U.N.'s UNAIDS and the Kaiser Family Foundation, in 2011 the United States provided nearly 60 percent of all international AIDS assistance.
A decade ago, almost no one in sub-Saharan Africa was receiving antiretroviral treatment. By 2008, the AIDS program had boosted that number to 1.7 million. As of last year it was 5.1 million.
The State Department says the program last year also helped provide treatment to some 750,000 HIV-positive pregnant women, allowing about 230,000 infants to be born HIV-free, supported 2 million male circumcisions and directly supported HIV testing and counseling for 46.5 million.
"This is a remarkable story that the American people should know about," Kimberly Scott of the Institute of Medicine, which recently completed an evaluation of the AIDS program, said at a forum sponsored by the Kaiser Family Foundation and the CSIS Global Health Policy Center.
According to UNAIDS, the number of people living with HIV has leveled off, standing at about 34 million at the end of 2011. New infections that year reached 2.5 million, down 20 percent from 2001. AIDS-related deaths were 1.7 million, down from 2.3 million in 2005.
Jennifer Kates, director of global health and HIV policy at Kaiser, said most countries where the program operates have yet to reach the "tipping point," where new infections occurring in a year are less than the increase in people receiving treatment. Among the success stories were Ethiopia, where the 40,000 going on treatment in 2011 was almost four times the new infections. Still with a long way to go was Nigeria, which that year had 270,000 new HIV infections and a 57,000 increase in those getting treatment.
Chris Collins, director of public policy at amfAR, The Foundation for AIDS Research, also warned of potential repercussions as the AIDS program shifts from being an emergency response to the AIDS epidemic to a more supportive role for country-based health programs.
"The countries themselves largely are avoiding the important role that key populations play in epidemics," he said, referring to gay men, those injecting drugs and sex workers. These groups face discrimination and criminal charges in many cases, and 90 percent of the money to help them now comes from external sources.
Collins also spoke of the "huge mismatch" between the positive science and rhetoric on fighting AIDS and the money available. Since 2009 the funding for bilateral and global HIV and AIDS programs has largely stalled.
Kaiser's Kates said that while there's still bipartisan support for the AIDS program in Congress, "the big question is will the financing be there to reach the goals" of treating more people and advancing toward that AIDS-free generation. "The challenge right now is that the global economic climate is different, the U.S. climate is different, but the need is still great."
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
YOSEMITE NATIONAL PARK, Calif. (AP) -- Federal investigators probing the hantavirus outbreak blamed for three deaths at Yosemite National Park recommended on Monday that design changes to tent cabins and other privately run lodging first be reviewed by National Park Service officials.
The report released by the Interior Department's Office of Inspector General found that park officials responded to last summer's outbreak appropriately and within department policy.
"When the outbreak was identified, NPS mobilized to contain and remediate the outbreak and to prevent further outbreaks," Mary Kendall, a deputy inspector general, wrote in a letter attached to the report.
Still, the report found that current policy didn't require park officials to approve design changes made to the "Signature tent cabins" by concessionaire Delaware North Companies Parks and Resorts, which added rafters and wall studs to the structures.
Investigators determined that deer mice, which can carry the illness, nested inside the double walls of the new tents in Yosemite's family friendly Curry Village.
At least eight of the nine tourists who fell ill stayed in the tent cabins.
Because the changes to the cabins were considered routine maintenance, current park service policy did not require prior approval, the report found.
The report also recommended that the park service begin cyclical pest monitoring and inspections of all public accommodations.
While there is a current pest monitoring program at Yosemite, Delaware North was responsible for Curry Village, which was not considered at high risk for hantavirus.
The company issued a statement late Monday saying it would follow the recommendations in the report.
"DNC Parks & Resorts at Yosemite has consistently worked hand-in-hand with the National Park Service and public health officials on this issue," spokeswoman Lisa Cesaro said in the statement. "The Signature Tent Cabins have been removed from Curry Village. We are following the recommendations by the National Park Service, which were developed in consultation with the California Department of Public Health and the Centers for Disease Control and Prevention."
Prior to the outbreak, Delaware only responded to pests in the cabins when visitors or housekeeping staff complained, the report said.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
The report released by the Interior Department's Office of Inspector General found that park officials responded to last summer's outbreak appropriately and within department policy.
"When the outbreak was identified, NPS mobilized to contain and remediate the outbreak and to prevent further outbreaks," Mary Kendall, a deputy inspector general, wrote in a letter attached to the report.
Still, the report found that current policy didn't require park officials to approve design changes made to the "Signature tent cabins" by concessionaire Delaware North Companies Parks and Resorts, which added rafters and wall studs to the structures.
Investigators determined that deer mice, which can carry the illness, nested inside the double walls of the new tents in Yosemite's family friendly Curry Village.
At least eight of the nine tourists who fell ill stayed in the tent cabins.
Because the changes to the cabins were considered routine maintenance, current park service policy did not require prior approval, the report found.
The report also recommended that the park service begin cyclical pest monitoring and inspections of all public accommodations.
While there is a current pest monitoring program at Yosemite, Delaware North was responsible for Curry Village, which was not considered at high risk for hantavirus.
The company issued a statement late Monday saying it would follow the recommendations in the report.
"DNC Parks & Resorts at Yosemite has consistently worked hand-in-hand with the National Park Service and public health officials on this issue," spokeswoman Lisa Cesaro said in the statement. "The Signature Tent Cabins have been removed from Curry Village. We are following the recommendations by the National Park Service, which were developed in consultation with the California Department of Public Health and the Centers for Disease Control and Prevention."
Prior to the outbreak, Delaware only responded to pests in the cabins when visitors or housekeeping staff complained, the report said.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
CHICAGO (AP) -- Treating breast cancer almost always involves surgery, and for years the choice was just having the lump or the whole breast removed. Now, new approaches are dramatically changing the way these operations are done, giving women more options, faster treatment, smaller scars, fewer long-term side effects and better cosmetic results.
It has led to a new specialty - "oncoplastic" surgery - combining oncology, which focuses on cancer treatment, and plastic surgery to restore appearance.
"Cosmetics is very important" and can help a woman recover psychologically as well as physically, said Dr. Deanna Attai, a Burbank, Calif., surgeon who is on the board of directors of the American Society of Breast Surgeons. Its annual meeting in Chicago earlier this month featured many of these new approaches.
More women are getting chemotherapy or hormone therapy before surgery to shrink large tumors enough to let them have a breast-conserving operation instead of a mastectomy. Fewer lymph nodes are being removed to check for cancer's spread, sparing women painful arm swelling for years afterward.
Newer ways to rebuild breasts have made mastectomy a more appealing option for some women. More of them are getting immediate reconstruction with an implant at the same time the cancer is removed rather than several operations that have been standard for many years. Skin and nipples increasingly are being preserved for more natural results.
Some doctors are experimenting with operating on breast tumors through incisions in the armpit to avoid breast scars. There's even a "Goldilocks" mastectomy for large-breasted women - not too much or too little removed, and using excess skin to create a "just right" natural implant.
Finally, doctors are testing a way to avoid surgery altogether, destroying small tumors by freezing them with a probe through the skin.
"Breast surgery has become more minimalistic," said Dr. Shawna Willey of Georgetown's Lombardi Comprehensive Cancer Center.
"Women have more options. It's much more complex decision-making."
Breast cancer is the most common cancer in women around the world. In the U.S. alone, about 230,000 new cases are diagnosed each year.
Most can be treated by just having the lump removed, but that requires radiation for weeks afterward to kill any stray cancer cells in the breast, plus frequent mammograms to watch for a recurrence.
Many women don't want the worry or the radiation, and choose mastectomy even though they could have less drastic surgery. Mastectomy rates have been rising. Federal law requires insurers to cover reconstruction for mastectomy patients, and many of the improvements in surgery are aimed at making it less disfiguring.
Here are some of the major trends:
IMMEDIATE RECONSTRUCTION
Doctors used to think it wasn't good to start reconstruction until cancer treatment had ended - surgery, chemotherapy, radiation. Women would have a mastectomy, which usually involves taking the skin and the nipple along with all the breast tissue, followed by operations months later to rebuild the breast.
Reconstruction can use tissue from the back or belly, or an implant. The first operation often is to place a tissue expander, a balloon-like device that's gradually inflated to stretch the remaining skin and make room for the implant. A few months later, a second surgery is done to remove the expander and place the implant. Once that heals, a third operation is done to make a new nipple, followed by tattooing to make an areola, the darkened ring around it.
The new trend is immediate reconstruction, with the first steps started at the time of the mastectomy, either to place a tissue expander or an implant. In some cases, the whole thing can be done in one operation.
Nationally, about 25 to 30 percent of women get immediate reconstruction. At the Mayo Clinic, about half do, and at Georgetown, it's about 80 percent.
SPARING SKIN, NIPPLES
Doctors usually take the skin when they do a mastectomy to make sure they leave no cancer behind. But in the last decade they increasingly have left the skin in certain women with favorable tumor characteristics. Attai compares it to removing the inside of an orange while leaving the peel intact.
"We have learned over time that you can save skin" in many patients, Willey said. "Every single study has shown that it's safe."
Now they're going the next step: preserving the nipple, which is even more at risk of being involved in cancer than the skin is. Only about 5 percent of women get this now, but eligibility could be expanded if it proves safe. The breast surgery society has a registry on nipple-sparing mastectomies that will track such women for 10 years.
"You really have to pick patients carefully," because no one wants to compromise cancer control for cosmetic reasons, Attai said.
"The preliminary data are that nipple-sparing is quite good," but studies haven't been long enough to know for sure, Willey said. "It makes a huge difference in the cosmetic outcome. That makes the woman's breast recognizable to her."
Dr. Judy Boughey, a breast surgeon at the Mayo Clinic, said the new approach even has swayed patients' treatment choices.
"We're seeing women choosing the more invasive surgery, choosing the mastectomy," because of doctors' willingness to spare skin and nipples, she said.
It helped persuade Rose Ragona, a 51-year-old operations supervisor at O'Hare Airport in Chicago. She had both breasts removed on April 19 with the most modern approach: Immediate reconstruction, with preservation of her skin and nipples.
"To wake up and just see your breasts there helped me immensely," she said.
She chose to have both breasts removed to avoid radiation and future worry.
"I felt it was a safer road to go," she said. "I can't live the rest of my life in fear. Every time there's a lump I'm going to worry."
FREEZING TUMORS
Attai, the California breast surgeon, is one of the researchers in a national study testing cryoablation. The technique uses a probe cooled with liquid nitrogen that turns tumors into ice balls of dead tissue that's gradually absorbed by the body. This has been done since 2004 for benign breast tumors and the clinical trial is aimed at seeing if it's safe for cancer treatment.
"The technology is amazing. This is done in the office under local anesthesia, a little skin puncture," Attai said.
In the study, women still have surgery at some point after the freezing treatment to make sure all the cancer is destroyed. If it proves safe and effective, it could eliminate surgery for certain cancer patients.
"I'd love to see the day when we can offer women with small breast tumors a completely non-operative approach, and I do think that's coming soon," Attai said.
---
Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
It has led to a new specialty - "oncoplastic" surgery - combining oncology, which focuses on cancer treatment, and plastic surgery to restore appearance.
"Cosmetics is very important" and can help a woman recover psychologically as well as physically, said Dr. Deanna Attai, a Burbank, Calif., surgeon who is on the board of directors of the American Society of Breast Surgeons. Its annual meeting in Chicago earlier this month featured many of these new approaches.
More women are getting chemotherapy or hormone therapy before surgery to shrink large tumors enough to let them have a breast-conserving operation instead of a mastectomy. Fewer lymph nodes are being removed to check for cancer's spread, sparing women painful arm swelling for years afterward.
Newer ways to rebuild breasts have made mastectomy a more appealing option for some women. More of them are getting immediate reconstruction with an implant at the same time the cancer is removed rather than several operations that have been standard for many years. Skin and nipples increasingly are being preserved for more natural results.
Some doctors are experimenting with operating on breast tumors through incisions in the armpit to avoid breast scars. There's even a "Goldilocks" mastectomy for large-breasted women - not too much or too little removed, and using excess skin to create a "just right" natural implant.
Finally, doctors are testing a way to avoid surgery altogether, destroying small tumors by freezing them with a probe through the skin.
"Breast surgery has become more minimalistic," said Dr. Shawna Willey of Georgetown's Lombardi Comprehensive Cancer Center.
"Women have more options. It's much more complex decision-making."
Breast cancer is the most common cancer in women around the world. In the U.S. alone, about 230,000 new cases are diagnosed each year.
Most can be treated by just having the lump removed, but that requires radiation for weeks afterward to kill any stray cancer cells in the breast, plus frequent mammograms to watch for a recurrence.
Many women don't want the worry or the radiation, and choose mastectomy even though they could have less drastic surgery. Mastectomy rates have been rising. Federal law requires insurers to cover reconstruction for mastectomy patients, and many of the improvements in surgery are aimed at making it less disfiguring.
Here are some of the major trends:
IMMEDIATE RECONSTRUCTION
Doctors used to think it wasn't good to start reconstruction until cancer treatment had ended - surgery, chemotherapy, radiation. Women would have a mastectomy, which usually involves taking the skin and the nipple along with all the breast tissue, followed by operations months later to rebuild the breast.
Reconstruction can use tissue from the back or belly, or an implant. The first operation often is to place a tissue expander, a balloon-like device that's gradually inflated to stretch the remaining skin and make room for the implant. A few months later, a second surgery is done to remove the expander and place the implant. Once that heals, a third operation is done to make a new nipple, followed by tattooing to make an areola, the darkened ring around it.
The new trend is immediate reconstruction, with the first steps started at the time of the mastectomy, either to place a tissue expander or an implant. In some cases, the whole thing can be done in one operation.
Nationally, about 25 to 30 percent of women get immediate reconstruction. At the Mayo Clinic, about half do, and at Georgetown, it's about 80 percent.
SPARING SKIN, NIPPLES
Doctors usually take the skin when they do a mastectomy to make sure they leave no cancer behind. But in the last decade they increasingly have left the skin in certain women with favorable tumor characteristics. Attai compares it to removing the inside of an orange while leaving the peel intact.
"We have learned over time that you can save skin" in many patients, Willey said. "Every single study has shown that it's safe."
Now they're going the next step: preserving the nipple, which is even more at risk of being involved in cancer than the skin is. Only about 5 percent of women get this now, but eligibility could be expanded if it proves safe. The breast surgery society has a registry on nipple-sparing mastectomies that will track such women for 10 years.
"You really have to pick patients carefully," because no one wants to compromise cancer control for cosmetic reasons, Attai said.
"The preliminary data are that nipple-sparing is quite good," but studies haven't been long enough to know for sure, Willey said. "It makes a huge difference in the cosmetic outcome. That makes the woman's breast recognizable to her."
Dr. Judy Boughey, a breast surgeon at the Mayo Clinic, said the new approach even has swayed patients' treatment choices.
"We're seeing women choosing the more invasive surgery, choosing the mastectomy," because of doctors' willingness to spare skin and nipples, she said.
It helped persuade Rose Ragona, a 51-year-old operations supervisor at O'Hare Airport in Chicago. She had both breasts removed on April 19 with the most modern approach: Immediate reconstruction, with preservation of her skin and nipples.
"To wake up and just see your breasts there helped me immensely," she said.
She chose to have both breasts removed to avoid radiation and future worry.
"I felt it was a safer road to go," she said. "I can't live the rest of my life in fear. Every time there's a lump I'm going to worry."
FREEZING TUMORS
Attai, the California breast surgeon, is one of the researchers in a national study testing cryoablation. The technique uses a probe cooled with liquid nitrogen that turns tumors into ice balls of dead tissue that's gradually absorbed by the body. This has been done since 2004 for benign breast tumors and the clinical trial is aimed at seeing if it's safe for cancer treatment.
"The technology is amazing. This is done in the office under local anesthesia, a little skin puncture," Attai said.
In the study, women still have surgery at some point after the freezing treatment to make sure all the cancer is destroyed. If it proves safe and effective, it could eliminate surgery for certain cancer patients.
"I'd love to see the day when we can offer women with small breast tumors a completely non-operative approach, and I do think that's coming soon," Attai said.
---
Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
WASHINGTON (AP) -- Cancer patients could face high costs for medications under President Barack Obama's health care law, industry analysts and advocates warn.
Where you live could make a huge difference in what you'll pay.
To try to keep premiums low, some states are allowing insurers to charge patients a hefty share of the cost for expensive medications used to treat cancer, multiple sclerosis, rheumatoid arthritis and other life-altering chronic diseases.
Such "specialty drugs" can cost thousands of dollars a month, and in California, patients would pay up to 30 percent of the cost. For one widely used cancer drug, Gleevec, the patient could pay more than $2,000 for a month's supply, says the Leukemia & Lymphoma Society.
New York is taking a different approach, setting flat dollar copayments for medications. The highest is $70, and it would apply to specialty drugs as well.
Critics fear most states will follow California's lead, and that could defeat the purpose of Obama's overhaul, because some of the sickest patients may be unable to afford their prescriptions.
"It's important that the benefit design not discriminate against people with chronic illness, and high copays do that," said Dan Mendelson, president of Avalere Health, a data analysis firm catering to the health care industry and government.
Avalere's research shows that 1 in 4 cancer patients walks away from the pharmacy counter empty-handed when facing a copay of $500 or more for a newly prescribed drug.
"You have to worry about a world where if you happen to contract cancer or multiple sclerosis, you are stuck with a really big bill," Mendelson said. "It's going to be very important for states to take a long, hard look at their benefit design."
Although the money for covering uninsured Americans is coming from Washington, the heath care law gives states broad leeway to tailor benefits, and the local approach can also allow disparities to emerge.
A spokesman for Covered California said state officials are trying to balance between two conflicting priorities: comprehensive coverage and affordable premiums.
"We are trying to keep the insurance affordable across the board," said Dana Howard, the group's spokesman. "This is just part of trying to manage the overall risk of the pool." Covered California is one of the new state marketplaces where people who don't get coverage on the job will be able to shop for private insurance starting this fall. Coverage takes effect Jan. 1.
Insurers are forecasting double-digit premium increases for individual policies, as people with health problems flock to buy coverage previously denied them. The Obama administration says the industry warnings are overblown, and that for many consumers, premium increases will be offset by tax credits to help buy insurance. And officials say it's important to realize that the law sets overall limits on patients' liability, even if those seem high to some people. Still, a full picture of costs and benefits isn't likely to come into focus until the fall.
Howard said California officials are aware of the concerns about drug costs and are trying to make medications more affordable.
Meanwhile, he said consumers will be protected because the law limits total out-of-pocket costs - the deductibles and copayments that policy holders are responsible for, apart from monthly premiums. In California, the annual out-of-pocket limit for an individual is $6,400, although it can be as low as $2,250 for low-income people. Once that limit is reached, insurance pays 100 percent.
That's still a lot of money, and such reassurances haven't dispelled the concerns.
"The intent of the Affordable Care Act is to make sure that all Americans have access to quality, affordable health care," said Brian Rosen, a senior vice president of the Leukemia & Lymphoma Society. He adds that there is a danger that the insurance marketplaces "will discriminate against the patients with the highest medical need. That would completely undermine the spirit of the ACA."
The group has been joined by Rep. Doris Matsui, D-Calif., in urging state officials to reconsider the policy. The high copays "could prevent many patients from receiving the lifesaving treatments they need because of prohibitively high cost," Matsui wrote to the state.
The problem with costly drugs is similar to another money issue with the health care law - a provision that could price millions of smokers out of coverage. Insurers are allowed to charge tobacco users buying an individual policy up to 50 percent higher premiums. For a 55-year-old smoker, the penalty could reach nearly $4,250 a year, on top of the standard premium. California is trying to override that problem by passing its own law. There's also pending state legislation to address some issues with prescription costs, but its prospects are unclear.
Meanwhile, leukemia patient Lisa Lusk worries about what will happen to her. A nursing assistant who lives near Fresno, Lusk is hoping to return to work in the next few months. When that happens, she expects to lose emergency coverage she's now getting through the state. And the medication Lusk takes to manage her chronic form of the disease costs more than $5,000 a month.
"I'm scared that when I get a job my copay may be more than $1,500 a month," said Lusk. "I'll just be working to pay for my medications."
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Where you live could make a huge difference in what you'll pay.
To try to keep premiums low, some states are allowing insurers to charge patients a hefty share of the cost for expensive medications used to treat cancer, multiple sclerosis, rheumatoid arthritis and other life-altering chronic diseases.
Such "specialty drugs" can cost thousands of dollars a month, and in California, patients would pay up to 30 percent of the cost. For one widely used cancer drug, Gleevec, the patient could pay more than $2,000 for a month's supply, says the Leukemia & Lymphoma Society.
New York is taking a different approach, setting flat dollar copayments for medications. The highest is $70, and it would apply to specialty drugs as well.
Critics fear most states will follow California's lead, and that could defeat the purpose of Obama's overhaul, because some of the sickest patients may be unable to afford their prescriptions.
"It's important that the benefit design not discriminate against people with chronic illness, and high copays do that," said Dan Mendelson, president of Avalere Health, a data analysis firm catering to the health care industry and government.
Avalere's research shows that 1 in 4 cancer patients walks away from the pharmacy counter empty-handed when facing a copay of $500 or more for a newly prescribed drug.
"You have to worry about a world where if you happen to contract cancer or multiple sclerosis, you are stuck with a really big bill," Mendelson said. "It's going to be very important for states to take a long, hard look at their benefit design."
Although the money for covering uninsured Americans is coming from Washington, the heath care law gives states broad leeway to tailor benefits, and the local approach can also allow disparities to emerge.
A spokesman for Covered California said state officials are trying to balance between two conflicting priorities: comprehensive coverage and affordable premiums.
"We are trying to keep the insurance affordable across the board," said Dana Howard, the group's spokesman. "This is just part of trying to manage the overall risk of the pool." Covered California is one of the new state marketplaces where people who don't get coverage on the job will be able to shop for private insurance starting this fall. Coverage takes effect Jan. 1.
Insurers are forecasting double-digit premium increases for individual policies, as people with health problems flock to buy coverage previously denied them. The Obama administration says the industry warnings are overblown, and that for many consumers, premium increases will be offset by tax credits to help buy insurance. And officials say it's important to realize that the law sets overall limits on patients' liability, even if those seem high to some people. Still, a full picture of costs and benefits isn't likely to come into focus until the fall.
Howard said California officials are aware of the concerns about drug costs and are trying to make medications more affordable.
Meanwhile, he said consumers will be protected because the law limits total out-of-pocket costs - the deductibles and copayments that policy holders are responsible for, apart from monthly premiums. In California, the annual out-of-pocket limit for an individual is $6,400, although it can be as low as $2,250 for low-income people. Once that limit is reached, insurance pays 100 percent.
That's still a lot of money, and such reassurances haven't dispelled the concerns.
"The intent of the Affordable Care Act is to make sure that all Americans have access to quality, affordable health care," said Brian Rosen, a senior vice president of the Leukemia & Lymphoma Society. He adds that there is a danger that the insurance marketplaces "will discriminate against the patients with the highest medical need. That would completely undermine the spirit of the ACA."
The group has been joined by Rep. Doris Matsui, D-Calif., in urging state officials to reconsider the policy. The high copays "could prevent many patients from receiving the lifesaving treatments they need because of prohibitively high cost," Matsui wrote to the state.
The problem with costly drugs is similar to another money issue with the health care law - a provision that could price millions of smokers out of coverage. Insurers are allowed to charge tobacco users buying an individual policy up to 50 percent higher premiums. For a 55-year-old smoker, the penalty could reach nearly $4,250 a year, on top of the standard premium. California is trying to override that problem by passing its own law. There's also pending state legislation to address some issues with prescription costs, but its prospects are unclear.
Meanwhile, leukemia patient Lisa Lusk worries about what will happen to her. A nursing assistant who lives near Fresno, Lusk is hoping to return to work in the next few months. When that happens, she expects to lose emergency coverage she's now getting through the state. And the medication Lusk takes to manage her chronic form of the disease costs more than $5,000 a month.
"I'm scared that when I get a job my copay may be more than $1,500 a month," said Lusk. "I'll just be working to pay for my medications."
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
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