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Trump's Medicaid Plan Could Hurt Opioid Abusers He Promised to Help

President Donald Trump promised on the campaign trail to "expand access to drug treatment, strengthen prevention options and address the scourge of drug addiction after hearing about many Americans' struggle with opiate abuse," CNN's Dan Merica reports. But the Republican health care plan Trump backs would end the requirement that states that have expanded Medicaid cover addiction-treatment services and mental health treatment.

Dr. Andrew Kolodny, the director of the Opioid Policy Research Collaborative at Brandeis University, told CNN the proposed change is a "step in the wrong direction at a time when America's most urgent public health crisis is an addictive disorder."


Health Care Transformation May Be an Enduring Legacy for Obama

The New York Times' Abby Goodnough and Robert Pear and The Washington Post's Kelsey Snell and Mike DeBonis both have pieces about how the Affordable Care Act is likely to endure to some extent despite the plans of President-elect Donald Trump and Congressional Republican leaders to repeal it.

The Washington Post reporters note that "Democratic opposition and complex Senate rules mean that core pieces of the 2010 health-care overhaul are likely to remain, including the legal framework for the individual mandate and pieces of the state exchanges the law created. Furthermore, President-elect Donald Trump has vowed to preserve other key aspects, such as a ban on insurers denying coverage because of preexisting conditions and a requirement that insurers cover children under 26 on their parents’ plans."

The New York Times reporters profiled a hospital system in Indiana where, because of Obamacare,  "its leaders have started moving away from fee-for-service medicine, where every procedure, examination and prescription fetches a price. The emphasis now is on preventive care, on taking responsibility for the health of patients not only in the hospital, but also in the community." The impact from the ACA on how medical care is delivered is not likely to change.

With Health Care Repeal, Hospitals in Poor Neighborhoods Face Financial Gloom

The New York Times' Abby Goodnough reports that Temple University Hospital in Philadelphia and other hospitals serving poor neighborhoods face a financial crisis if the Affordable Care Act is repealed. President-elect Donald Trump and Republican Congressional leadership have vowed to do exactly that.

The hospital industry predicts that "hospitals stood to lose $165 billion through 2026 if more than 20 million people lose the insurance they gained under the law. They predicted widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings."

Prior to the Affordable Care Act, the hospitals had to absorb the cost of caring for uninsured patients. Hospitals who serve a large number of poor and uninsured patients also agreed to funding cuts in exchange for getting more patients with Medicaid and other insurance coverage. If Medicaid expansion is rolled back, hospitals like Temple are hoping that supplemental funds to defray the costs of caring for the uninsured will be restored.

Study: Medicaid Expansion Has Lowered Consumers' Medical Debt

The expansion of Medicaid under the Affordable Care Act has lowered the burden of medical debt for some low-income consumers, according to a study from the National Bureau of Economic Research. The study looked at the medical-debt collection balances referred out to debt collectors in areas with high populations of low-income patients. The study's authors' estimates "'imply a reduction in collection balances of around $600 to $1,000 among those who gain Medicaid coverage.'"

After Standoff, Arkansas Medicaid Expansion Survives

A showdown between bitter opponents of the Affordable Care Act and Republican Governor Asa Hutchinson has resulted in the state preserving its expansion of Medicaid, AJMC's Mary Caffrey reports. As a result, Medicaid will continue for 267,000 residents who earn up to 138 percent of the federal poverty level. The expansion includes a waiver from the Centers for Medicaid and Medicare Services with provisions to require "more personal responsibility."

Kentucky Dems Try to Preserve Health Care Exchange

Kentucky Democratic legislators have passed legislation to try to maintain that state's Kynect health care exchange and its Medicaid expansion, the Courier-Journal's Tom Loftus reports. However, the legislation doesn't have a chance of passing the Republican-controlled state Senate.

Republican Governor Matt Bevin is doing away with Kynect and shifting to the federal healthcare insurance exchange. Bevin is also asking for a waiver from federal regulators for how Kentucky runs its Medicaid expansion.

CDC Warns Doctors About Risk of Opioid Painkillers

For the first time, the Centers for Disease Control and Prevention has come out against doctors prescribing highly addictive opioid painkillers, The Washington Post's Karoun Demirjian and Lenny Bernstein report.

The nonbinding guidelines from the federal government recommend that doctors prescribe alternative courses of treatment before resorting to opioid painkillers to treat chronic pain. The guidelines have been developed in light of the national public health crisis of addiction to heroin and narcotic painkillers.

The CDC estimates that almost 28,700 people died from overdoes from prescription opiods and heroin in 2014, The Post reports.

Judge Rejects Legislators' Challenge to Alaska Medicaid Expansion

An Alaska judge has ruled that state's governor had the authority to expand Medicaid, without legislative approval, to cover people between the ages of 19 and 64 who are not caring for dependent children, not disabled and not pregnant, and who earn up to 138 percent of the federal poverty level, The Associated Press' Becky Bohrer reports. 

Legislators argued that the group is not a mandatory group to be covered under Medicaid. The judge, however, ruled that state law needs to be changed for that population not to have to be covered.


Ohio Supreme Court Shields Data On Kids with Lead Poisoning From Law Firm

The Ohio Supreme Court has ruled that a law firm submitted too broad of a records request for data about residences where children were found to have elevated levels of lead in their bodies, the Associated Press' Andrew Welsh-Huggins reports.

The court ruled that Lipson O'Shea Legal Group's public records request was too specific and the Board of Health couldn't comply with the request without revealing the identity of the children. The law firm asked for documentation of all homes “'where a minor child was found to have elevated blood lead levels.'"

Court Overturns Employment Ban for People with Criminal Convictions

Submitted by Amaris Elliott-Engel on Sun, 02/21/2016 - 22:11

How do you overcome the ax murderer taking care of Grandma problem?

Lawyer Peter H. “Tad” LeVan knows a thing or two about that.

A few weeks ago, the Pennsylvania Commonwealth Court, sitting en banc, ruled that the state's ban on former convicts working in elder care was unconstitutional.

LeVan gave me a recent interview about this litigation. It started with a challenge to the law's constitutionality on an individual basis; the Pennsylvania Supreme Court ruled that the law’s “employment ban was not rationally related to the Commonwealth’s legitimate interest in protection elderly citizens.” LeVan won that case in 2003. But then the Pennsylvania General Assembly never moved to amend the law after the court’s ruling.

So, in the spring of 2015, Levan, his co-counsel and his clients challenged the law on its face as unconstitutional.

It's always easier to attack the constitutionality of law by arguing that it’s unconstitutional “as applied” to particular plaintiffs, than arguing that the law is unconstitutional for everyone on its face.

The Pennsylvania Older Adults Protective Services Act was passed in the 1990s to create a lifetime ban on employment for convicted murderers and rapists in healthcare facilities; people convicted of felony drug violations and several other crimes were banned for a decade from working in healthcare facilities. The law, which was amended in 1997, required anyone who had been working at an eldercare facility for a year or less to be fired. However, people who had been working for a year or more could keep on working for their present employer.

By 2015, the social science had developed enough on reintegration and recidivism to support a challenge that the ban on people with criminal convictions working in elder care had zero “scope of rationality,” LeVan said.

“Social science research conducted subsequent to the [prior case] shows that the lifetime employment ban is built on a faulty premise because the risk of recidivism declines over time and eventually ‘loses any meaningful value in predicting future criminal conduct,’” Judge Mary Hannah Leavitt wrote for the Commonwealth Court.

The court ruled that the employment ban violates the Pennsylvania Constitution.

“There is simply no rational basis to treat those employed for a year in a facility providing services to older adults as of July 1, 1998, as having rehabilitated themselves following their criminal convictions solely because of the amount of time they worked in one facility such that they do not pose a threat to older adults, but treat all other employees and applications as incapable of rehabilitation and forever a threat to adults,” Leavitt opined.

The two sides also disagreed on the correct standard for considering the plaintiffs’ challenge to the constitutionality of the employment ban.

Lawyers for the Commonwealth of Pennsylvania argued that a law can be declared facially unconstitutional only if there is no set of circumstances under which the statute would be valid. LeVan argued on behalf of his clients that a statute is facially unconstitutional if a substantial number of its potential applications are unconstitutional.

The Commonwealth Court followed the U.S. Supreme Court’s ruling in Washington State Grange v. Washington State in State Republican Party in deciding that challengers who argue that a law is unconstitutional on its face need only demonstrate that a substantial number of the “‘challenged statute’s potential applications are unconstitutional.’”


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