www.charlestondailymail.com Health http://www.charlestondailymail.com Daily Mail feed en-us Copyright 2015, Charleston Newspapers, Charleston, WV Newspapers Patients say Alzheimer's cases go undiagnosed http://www.charlestondailymail.com/article/20150324/DM01/150329637 DM01 http://www.charlestondailymail.com/article/20150324/DM01/150329637 Tue, 24 Mar 2015 06:27:35 -0400 By Whitney Burdette According to new statistics from the Alzheimer's Association, only 45 percent of patients are told from the get-go they suffer from the debilitating disease.

Physicians delay telling patients they suffer from Alzheimer's disease for a variety of reasons, researchers found. But any delay in making an accurate diagnosis is detrimental to the patient, said Beth Kallmyer, senior director of constituent relations for the Alzheimer's Association.

"It's an issue when people are told later because they lose the ability to plan for the future, make legal plans, name health care advanced directives, even make decisions on how they want to live their lives," Kallmyer said in a conference call with reporters. "As the disease goes on, they may be unable to participate in those decisions."

Physicians often delay making the diagnosis for fear of causing families emotional stress, researchers found. But Kallmyer pointed out doctors are forced to give grim news to patients all the time about a variety of ailments. Alzheimer's should be treated no differently.

"Nobody wants to give this diagnosis," she said. "If you've seen Alzheimer's, you know it's a tragic and awful disease to watch. They don't want to give the diagnosis of pancreatic cancer either which generally means the person will die in a couple of months. There are other fatal diagnoses the doctors are giving, but Alzheimer's is different."

Uncertainty, lack of support and stigma are other reasons doctors delay giving a diagnosis, according to the report. Kallmyer said doctors' attitudes toward Alzheimer's is similar to the low rates of cancer diagnoses in the 1950s and '60s.

"These really low diagnosis disclosure rates are reminiscent of what happened in the '50s and '60s into the '70s with cancer," Kallmyer said. "It was called the 'C-word.' It wasn't talked about in doctors' offices, it wasn't talked about in public. ... it is that way for Alzheimer's disease. It's not something people are talking about."

Although Alzheimer's cases aren't diagnosed right away, the number of Americans living with the disease continues to grow. As of this year, 5.3 million Americans have been diagnosed, including about 200,000 cases of early-onset Alzheimer's. But by 2050, things are projected to change drastically if a cure is not found by then.

"By the time we get to 2050, if nothing is done to delay the onset of Alzheimer's disease or to find a cure for Alzheimer's disease, we estimate this number will nearly triple and by 2050, there will be 13.8 million people in the united states with Alzheimer's disease," said Dr. Keith Fargo, director of Scientific Programs and Research for the Alzheimer's Association.

About 500,000 people each year develop Alzheimer's disease, or one person every 67 seconds.

"By 2050, given the growing number of people who will develop Alzheimer's disease as the population ages, we estimate that to be every 33 seconds," Fargo said.

As the number of diagnosed cases increases, so does the economic impact. Alzheimer's disease is the most costly to the American economy, Fargo said, in terms of health care costs associated directly to the patient, and also their caregivers.

"Unless something is done to stop Alzheimer's disease or at least delay its onset, it is expected to cost more than $1 trillion by 2050," Fargo said. "That's in today's dollars." Alzheimer's currently costs about $226 billion.

Kallmyer said research has found each Alzheimer's patient has an average of three caregivers, usually unpaid family members.

"The estimated value of that (care) is $217 billion at an hourly rate of just over $12 an hour," she said. "A lot of time and energy is put toward caring for someone with Alzheimer's disease."

The Alzheimer's Association is asking the federal government to increase the funding it receives for research. Comparatively, Fargo said, Alzheimer's research is "woefully underfunded."

"Alzheimer's disease research this year is expected to receive only $586 million in federal funding whereas federal spending on care for people with Alzheimer's disease ... is $153 billion, which we think is out of line."

Kallmyer said increased federal funding and more research will help patients already living with the disease and those at risk of developing it some time in the future.

"We need to make it a different story so people can talk about the disease," she said. "It is a disease. It's nothing to be ashamed of."

Contact writer Whitney Burdette at 304-348-7939 or whitney.burdette@dailymailwv.com. Follow her at www.Twitter.com/wburdette_DM.

USDA program hopes to partner with housing agencies http://www.charlestondailymail.com/article/20150323/DM01/150329671 DM01 http://www.charlestondailymail.com/article/20150323/DM01/150329671 Mon, 23 Mar 2015 20:42:55 -0400 By Whitney Burdette Low-income children in West Virginia may soon not have to go very far to receive nutritious meals.

The U.S. Department of Agriculture is hoping to facilitate a partnership with the state's housing agencies in an effort to allow students better access to healthful meals when school is not in session. Schools, child care centers and churches already serve as feeding sites in West Virginia.

"We have a special challenge in rural areas - getting students to come to sites that offer these meals," said James Harmon, regional director of the USDA's Food and Nutrition Service. "This partnership started about two years ago with Rural Development to bring the meals to where the children are. We saw a perfect opportunity to have the meals come to these feeding sites, the housing developments where these children are."

Harmon will speak Tuesday to property managers at a conference put on by the West Virginia Housing Development Fund. He'll join officials with the West Virginia Department of Education, which serves as the state administering agency for the program.

"We want to encourage the property managers here in West Virginia to participate in our program."

Food and Nutrition Service focuses mainly on providing healthful meals to children during the summer months when school is not in session. Throughout the school year, children are served nutritious breakfasts and lunches that meet federal guidelines, but some children, especially those from low-income families, don't have access to healthy meals when school is out for the summer. Harmon said his agency has been working with housing authorities since December to facilitate a partnership.

"We've had a number of meetings already, but this is the first time to get them all in one room together," Harmon said.

West Virginia has been identified as a "Strike Force" state. Strike Force is yet another USDA program that supports rural America by creating job opportunities and strengthening the rural structure of America. Part of that includes increasing the number of meals served to children both in the summer and during the school year.

USDA partners with a variety of nonprofit entities, including school districts, government agencies and churches, to serve prepare and send meals to feeding sites that serve children. Those agencies then receive federal funding. Feeding sites include individual schools, community centers and eventually housing agencies.

"There is an application process and they go to the state Department of Education," Harmon said. "As a federal agency, we oversee the program but we have state administering agencies and here in West Virginia it's the Department of Education. So anybody interested in becoming a sponsor should contact the state Department of Education."

Last summer, 560,000 meals were served to children in West Virginia. Harmon said the USDA compares the number of meals served during the summer to the number of children served during the school year. West Virginia runs in the middle of the pack in terms of meals served during the summer.

Harmon said there's a huge gap in the number of children eating healthful meals during the school year versus the summer.

"Nationally, we serve about 22 million free and reduced priced meals in schools, but in the summer we're only reaching about 3.6 million," he said. "We're reaching only 16 or 17 percent of children in the summer program, so there is our challenge we're trying to overcome, in particularly in rural areas where it's so difficult. So that's why we're reaching out and it's such a great opportunity here for rural development and multi-family housing units."

Contact writer Whitney Burdette at 304-348-7939 or whitney.burdette@dailymailwv.com. Follow her at www.Twitter.com/wburdette_DM.

New director named for Kanawha-Charleston Health Department http://www.charlestondailymail.com/article/20150323/DM01/150329714 DM01 http://www.charlestondailymail.com/article/20150323/DM01/150329714 Mon, 23 Mar 2015 16:26:26 -0400 Dr. Michael R. Brumage has accepted the position of executive director for the Kanawha-Charleston Health Department.

He is currently Col. Brumage serving as deputy commander at BG Crawford F. Sams U.S. Army Health Clinic Camp Zama, Japan. Brumage, a Fairmont native, is retiring from the U.S. Army in August when he will begin his new position with KCHD.

The announcement was made in a press release from the Health Department. Brumage is now in Japan and could not immediately be reached for comment.

Power Walking 150 program returns for a second year http://www.charlestondailymail.com/article/20150317/DM01/150319229 DM01 http://www.charlestondailymail.com/article/20150317/DM01/150319229 Tue, 17 Mar 2015 15:09:35 -0400 By Charlotte Ferrell Smith A joint effort is kicking off the second year of Power Walking 150, an initiative to move Charleston toward better health.

A news conference was held Tuesday morning with Mayor Danny Jones and other officials involved in the effort to get area residents involved in 150 days of exercise. The program officially begins April 6 when participants are encouraged to log 150 miles in 150 days by walking, running or biking.

“In our first season last year, more than 1,100 people registered for the program, and together, we took big steps toward better health individually and as a community,” Jones said. “Power Walking 150 is about getting people moving by walking, jogging, running, or cycling, and I hope that by the end of the season, we will be adding up the hundreds of thousands of miles we move together toward better health.”

The 150-mile, 150-day challenge coincides with the West Virginia Power baseball season from April 6 when the players are scheduled to arrive for spring training to the last home game of the regular season on Sept. 2.

“The Power is once again thrilled to be involved with the city of Charleston and so many great partners,” said Adam Marco, director of marketing and media for the West Virginia Power. “Year one was very good. Now it is time to get Charleston moving forward and get more people involved with this healthy initiative.”

Participants may register for $10 and will receive a commemorative T-shirt upon completion of the program. A T-shirt design competition was held this year and the winner was Roch Herrick, a graphic artist originally from New Martinsville who now who now lives in Kansas. He learned about the contest on the West Virginia Power Facebook page.

The shirts are being produced at cost by Tgraphics where President Claudette Hudson said she is happy to be involved in a program that is so important to the people of Charleston.

“We hope to build on the 1,132 people who registered last year, and get everyone who participates to register their mileage for a final, and impressive, grand total,” said Jordan Paul, a University of Charleston student who is serving an internship in the mayor's office and is this year's coordinator for the walking program. “We are encouraging our sponsors and other groups to set regularly scheduled group walks, runs, and rides, so we can reach the goal together and get even more people past the 150-mile finish line.”

Paul, a quarterback on the University of Charleston football team, said exercising together is motivational.

One of last year's participants said his most faithful walking companion was his dog.

The Rev. Monty Brown, pastor of St. Marks United Methodist Church, lost 40 pounds last year through diet and exercise. He said enrolling in Power Walking 150 gave him extra incentive to keep moving.

The program is sponsored by the city of Charleston, West Virginia Power, Tgraphics, University of Charleston, Charleston Area Medical Center, BrickStreet Insurance, Charleston Town Center, and West Virginia Radio stations V100, 58WCHS, 98.7 the Beat and 96.1 the Wolf.

Ashley Showen, media buyer for CAMC, was on hand at the news conference and said holding each other accountable contributes to the success of an exercise program.

CAMC also helps sponsor the Mall Walkers Program at Charleston Town Center. At the Mall Walkers next monthly meeting 8:30 a.m. April 21 additional information will be available about Power Walking 150.

More information and updates on the program may be found on the PowerWalking150.com website.

Also, at 5:30 p.m. April 6 participants are encouraged to meet at Power Park to register and walk the first mile together.

Contact writer Charlotte Ferrell Smith at charlotte@dailymailwv.com or 304-348-1246.

Feds say number of uninsured dropping http://www.charlestondailymail.com/article/20150316/DM01/150319289 DM01 http://www.charlestondailymail.com/article/20150316/DM01/150319289 Mon, 16 Mar 2015 19:44:33 -0400 By Whitney Burdette More than 16 million adults have gained health insurance coverage since the Affordable Care Act became law, according to a new report from the U.S. Department of Health and Human Services.

The report, released Monday, shows the number of uninsured American adults has dropped 35 percent since October 2013, and 2.3 million young adults between the ages of 19 and 25 gained insurance under the provision of the law that allows them to remain on a parent's policy until the age of 26.

"That's quite simply a historic reduction in the uninsured rate," said Dr. Meena Seshamani, director of DHHS' Office of Health Reform.

Health insurance gains were larger in Medicaid expansion states, which saw a 7.6 percent drop in the uninsured rate. As of Monday, 154,783 West Virginia residents are enrolled in the expanded program, according to the state Department of Health and Human Resources.

Information available earlier in March from DHHS showed 33.421 West Virginians enrolled or were automatically re-enrolled in Affordable Care Act marketplace plans as of Feb. 22. State residents also are covered under plans available on the private market and through employers, so the number of West Virginians who have health care coverage is likely much greater.

The report also found that the number of uninsured is dropping across all demographics, with 6.6 million whites, 2.3 million African Americans and 4.2 million Latinos gaining coverage since the first quarter of 2014. Additionally, a total of 5.7 million young adults between the ages of 19 and 25 have signed up for some form of health insurance coverage since 2010.

"The reason is actually quite simple," said Dr. Richard Frank, DHHS assistant secretary for Planning and Evaluation. "The drop in the uninsured rate is because of the Affordable Care Act, both through the marketplace and Medicaid expansion."

The DHHS report comes a week ahead of the five-year anniversary of the Affordable Care Act's passage. Experts say the statistics in the report show Americans benefit from the controversial law.

"As we approach the five year anniversary of the Affordable Care Act on March 23, we continue to see signs the law is working," Seshamani said.

Frank said information about the number of children now insured is not yet available, but he expects more figures to be available by the end of the year. Government officials also aren't sure how the numbers will change going forward.

"We're in entirely new territory here," he said. "We've never come close to this. We're treading new areas and we're just really starting to understand who we really brought in and who is left uncovered. As we develop that understanding in more detail, we'll probably have a better fix of where we can land the plane in a sense."

Congress passed the Patient Protection and Affordable Care Act on March 23, 2010, in an effort to expand the availability of affordable health care coverage. The law includes several provisions, such as requiring maternity coverage for women and prohibiting insurance companies for denying coverage because of pre-existing conditions. It hasn't been without controversy, however. In 2012, the U.S. Supreme Court upheld the constitutionality of the law's individual mandate, but later found states cannot lose their Medicaid funding if they refuse to participate in Medicaid expansion.

A case before the Supreme Court now, King v. Burwell, challenges the law's tax subsidy language. Plaintiffs argue the text of the law only allows for subsidies on state-run exchanges and the IRS' regulations allowing for subsidies on both state and federal exchanges exceeds congressional authority. Defendants claim if the Court rules in favor of King, millions of Americans could lose their tax subsidies and their health insurance coverage. It hasn't yet been announced when the Court will issue its ruling.

West Virginia is one of just a few states that opted to establish its own marketplace exchanges.

Contact writer Whitney Burdette at 304-348-7939 or whitney.burdette@dailymailwv.com. Follow her at www.Twitter.com/wburdette_DM.

Coalition digging against West Side drug abuse http://www.charlestondailymail.com/article/20150315/DM02/150319379 DM02 http://www.charlestondailymail.com/article/20150315/DM02/150319379 Sun, 15 Mar 2015 19:56:49 -0400


daily mail staff

The Partnership of African American Churches is digging into Charleston's West Side to help substance abuse recovery and prevention. And, they could use a little help.

"There are a lot of needs that aren't really being met here," said Wendy Lewis, director of the substance abuse program with the partnership's West Side Ward 4 Substance Abuse Prevention Coalition.

That coalition is a community-based extension of the group's presence on the West Side. It aims to bring community members, clergy, law enforcement, educators, medical professionals and others together to combat the rampant drug abuse in the area.

"The coalition is a policy and environmental studies driven coalition," Lewis said. They use what they learn about needs in the community and use that information to facilitate recovery and abuse prevention.

Recovery coaches on staff help recovering addicts take advantage of their desires to quit.

"I just help people with barriers, what they need to move forward," said Tony Lee, a recovery coach. "I check up on 'em, make sure they're doing what they're supposed to."

Lee started working for the coalition six months ago, and he himself is in long-term recovery. He celebrates eight years of sobriety in June.

"God delivered me from alcohol," he said.

"We see a lot of people who've been in the system so long that they think there's no other way," he said. "The coalition supports all forms of recovery."

Lee primarily works with men. Kelly Chandler, another recovery coach, works with women.

"My passion is these women," she said. Part of the process is helping the addicts learn to love themselves again.

"I was an addict for almost 24 years," she said. "I've been in long-term recovery for almost six years now."

The recovery coaches aren't counselors or therapists; they help by connecting people with the resources they need to recover.

"We're going to help them determine what pathway they're going to choose for their recovery," Lewis said.

The coaches are certified through a five-day-long academy that provides participants with "the tools and resources necessary in providing recovery support services," according to a Recovery Coach Academy pamphlet.

"They're pretty much resource agents," Lewis said.

"(Recovery coaches) have been trained through the Connecticut Community for Addiction and Recovery Program," Lewis said. "And, they also have been trained to train other recovery coaches."

The Partnership office at 1514 Kanawha Blvd. W. hosts Narcotics Anonymous meetings Thursdays at 8 p.m. and Sundays at 10 p.m.

The Substance Abuse Prevention Coalition hosts community meetings every other Tuesday at 6:30 p.m. to get feedback from residents, and has a children's room for visitors with kids.

Despite all they offer now, the church group expects to expand its services. They presently have almost 20 employees, about 10 to 12 of which work specifically with their after-school programs.

The Partnership's original goal was simply to provide tutoring, said Rev. James Patterson, chief executive officer. He helped found the group in 2000.

"We wanted to help kids that were struggling and help kids that were doing well do better," he said. The organization eventually grew and decided to take on health issues, specifically smoking.

"People would say, 'Smoking is a problem, but the real problem is drugs,'" Patterson said. "The church has to have some answers when they ask, 'What am I supposed to do?'"

The organization has since garnered support from numerous governmental and non-governmental agencies.

"We partner with a lot of organizations to get things done," he said.

And, they need that help to keep up with their ambitions.

The substance abuse coalition wants to create its own recovery housing by the end of this year, and looks to launch a low-power FM radio station next month.

The housing is for people in emergency situations, he said, to prevent them from slipping into relapse after - for instance - release from a treatment program. He expects about four to eight units.

The FM station is part of a broader goal.

"We were awarded a construction permit for a low-power FM station here in the West Side," Patterson said. They'd use the station to promote advocacy and inform the public. "The challenge to that is going to be raising the funds to get it up and running by the deadline,"

That deadline is April 15.

"We have to be on air by then," he said. "We need people to make contributions."

Check PAAC2.org or search on Facebook for Partnership of African American Churches for more information, or call 304-768-7688.

"We're on the West Side because we want to be," Patterson said.

New cholesterol medicines promising http://www.charlestondailymail.com/article/20150315/ARTICLE/150319393 ARTICLE http://www.charlestondailymail.com/article/20150315/ARTICLE/150319393 Sun, 15 Mar 2015 18:35:25 -0400



SAN DIEGO - New research boosts hope that a highly anticipated, experimental class of cholesterol drugs can greatly lower the risk for heart attacks, death and other heart-related problems. The government will decide this summer whether to allow two of these drugs on the market.

People taking one of these drugs had half the risk of dying or suffering a heart problem compared to others who were given usual care - typically one of the statin drugs such as Lipitor or Zocor, doctors found. Many people cannot tolerate statins or get enough help from them, so new medicines are badly needed.

The results are "really impressive and very encouraging" for the new drugs, said one independent expert, Dr. Judith Hochman of NYU Langone Medical Center.

The studies were published online Sunday by the New England Journal of Medicine and discussed at an American College of Cardiology conference in San Diego.

They are fresh analyses from older studies designed to look at how much the drugs lower cholesterol, so they can only suggest that the drugs also lower heart problems, not prove that point. Definitive studies will take about two more years, so the federal Food and Drug Administration will be deciding the drugs' fates with only results like this in hand.

The drugs are evolocumab, which Amgen Inc. wants to call Repatha, and alirocumab, which Regeneron Pharmaceuticals Inc. and Sanofi SA have named Praluent.

They lower LDL or bad cholesterol more powerfully and in a different way than existing drugs, by blocking PCSK9, a substance that interferes with the liver's ability to remove cholesterol from the blood.

Side effects remain a question, though, especially on thinking, confusion and memory - problems the FDA has already voiced concern about and asked the companies to track.

The problems affected only 1 or 2 percent of patients and may be temporary, but they were twice as common among people taking one of the new drugs and need to be closely monitored as studies continue, said Dr. Anthony DeMaria, a University of California at San Diego heart specialist and past president of the American College of Cardiology. As a patient facing potential side effects, "the last one I want" is one that affects the brain, he said.

Dr. Eric Topol, a cardiologist at Scripps Clinic in La Jolla, California, said the new results show "an unquestionable signal" of a potential safety issue. More side effects typically turn up once a drug is approved and used in a wider population, he said.

Two other heart experts - Drs. Neil Stone and Daniel Lloyd-Jones of Northwestern University in Chicago - wrote in the medical journal that "it would be premature to endorse these drugs for widespread use" until the definitive studies are done in a couple of years. Other drugs that initially seemed good failed when put to the most rigorous test, they wrote.

Still, the results so far suggest that the drugs "appear to be on track" to be important new medicines, they wrote.

Dr. Clyde Yancy, cardiology chief at Northwestern University in Chicago and a former American Heart Association president, agreed.

"Science has revealed a brand new approach to treating cholesterol," and there is "reasonable enthusiasm" it will be a big boon to patients, he said.

House passes amended immunizations bill http://www.charlestondailymail.com/article/20150315/DM0104/150319459 DM0104 http://www.charlestondailymail.com/article/20150315/DM0104/150319459 Sun, 15 Mar 2015 00:01:00 -0400 By Whitney Burdette UPDATE:

The House voted to concede it's position and pass Senate Bill 286 as it arrived from the Senate, rejecting Lane's amendment. The bill passed 87-10 and will now go to the governor.


Although the state's top health officer has aired concerns about provisions in an immunizations bill, the West Virginia House of Delegates on Saturday passed the legislation.

Senate Bill 286 passed 62-36. Delegate Patrick Lane, R-Kanawha, offered a controversial amendment to the bill adopted by the Judiciary Committee that Dr. Rahul Gupta, commissioner of the state's Bureau for Public Health, called problematic. The amendment changes the way parents can obtain medical exemptions for their children and prohibits the Bureau for Public Health from adding to the list of required immunizations for school children without legislative ruling.

Democrats joined Gupta in opposing the bill, saying changing the exemption process puts children at an increased risk.

"Now we want to pass a bill that says because of a court case that was not won, we're going to use a piece of legislation as a tool to upend the good statistics we have on immunization," said Delegate Nancy Guthrie, D-Kanawha. "We don't have a whole lot of good public health statistics in this state. This is one of them. The Senate bill accomplished the task. If we cannot take the Senate bill, leave it alone. We should just kill this bill right now."

Lane, however, argued the bill does nothing to change the immunization time line or prevent the Department of Health and Human Resources from acting in emergency situations. Delegate Erikka Storch, R-Ohio, said the arguments against the bill are "fallacies" and the version of the bill passed by the House actually broadens the scope of mandated vaccinations to children in day care centers.

"I think its absolutely irresponsible to pontificate that we're trying to spread measles or rubella or other things," she said.

West Virginia has a 97 percent vaccination rate among school-aged children, among the best in the country, but an even lower rate among preschoolers. Under current law, children attending day care centers aren't required to be fully vaccinated, but children entering school must have received numerous immunizations in order to enroll.

Lane's amendment, among other things, allows for a child's doctor to submit a medical exemption request to the county health officer, who can then approve or deny the request. If the request is denied, it is reported to the state Bureau for Public Health. The Bureau has 10 days to investigate the child's health records and conduct any necessary testing. If that 10-day period runs out before the Bureau rules, the child's exemption becomes permanent.

Under current law, the decision to approve or deny a medical exemption lies solely with the Bureau for Public Health. Gupta said under the amended version, the Bureau wouldn't be able to track the number of unvaccinated children and collect other data because approved medical exemptions would not have to be reported to the state.

Contact writer Whitney Burdette at 304-348-5149 or whitney.burdette@dailymailwv.com. Follow her at www.Twitter.com/wburdette_DM.

Gupta says amended vaccine bill presents challenges http://www.charlestondailymail.com/article/20150311/DM0104/150319736 DM0104 http://www.charlestondailymail.com/article/20150311/DM0104/150319736 Wed, 11 Mar 2015 20:33:28 -0400 By Whitney Burdette The state's top health officer is concerned changes to an immunization bill making its way through the Legislature will leave state agencies virtually helpless to protect school-aged kids from communicable disease outbreaks.

Dr. Rahul Gupta, commissioner of the Bureau for Public Health, said an amendment offered to Senate Bill 286 will strip the bureau of its authority to enact interpretive or emergency rules regarding immunizations. The amendment, offered by Delegate Patrick Lane, R-Kanawha, and adopted by the House Judiciary Committee Monday evening prevents the Department of Health and Human Resources from adding or removing mandatory vaccines for school-aged children without legislative approval. Gupta said that presents several problems.

"So what happens then is we've had so much success adding vaccines to protect 7th and 12th graders when they're going off to college from meningococcal (meningitis), pertussis and others," Gupta said. "We would not be able to provide those protections to our populations in the future, ever."

In offering the amendment, Lane suggested the Bureau for Public Health used its rule-making authority to overstep its bounds. Lane said he's not against vaccines, but continuing to add to the list of mandated immunizations could preclude some kids from attending school.

Lane, an attorney, in 2012 brought a case on behalf of six families alleging the DHHR's authority to enact rules without legislative oversight is illegal. A circuit court judge ruled against Lane's clients, who then appealed to the state Supreme Court of Appeals. However, the Supreme Court declined to hear the case, upholding the initial ruling.

Not only does Lane's amendment affect the department's rule-making authority, but it also changes how parents can go about getting medical exemptions on behalf of their children. Currently, a physician would see the child, fill out a two-page form including information about why the exemption is being requested and the evidence supporting that request, which is then submitted to the local health officer who will grant or deny the request. If the local health department denies the request, it then goes to the Bureau for Public Health.

"It's a very sound process, it's time-tested," Gupta said. "We've improved it significantly in recent years."

The amendment would allow a child to go to a doctor and request an exemption for any medical reason, eliminating use of the two-page form and the ability of local health officers to approve or deny exemption requests. It's up to the Bureau for Public Health to disprove why the child needs a medical exemption.

"If we are not able to disprove that, the child's exemption becomes permanent," Gupta said. "The ability of the public health officials who are experts in vaccines and the community physician to work collaboratively as has been done for decades is being taken away."

Gupta said research shows community physicians are likely to give in to delaying vaccinations when pressured. He said by working collaboratively with the local physicians, the Bureau for Public Health is able to offer science-based evidence to help them make the best decisions. Without that collaboration, the Bureau for Public Health will not have access to information to help officials keep track of who is immunized and who isn't.

"That process is basically gone. That's all very concerning," Gupta said. "We won't be able to track who has an exemption, why they have an exemption or the basis of that exemption. It's a very random process that will cause confusion to children, to parents, to physicians and to the Bureau for Public Health because now the children will be going to school, we will be under pressure within 10 days to find out medical records and get that data and see if that's legitimate or not."

In some cases, children do benefit from exemptions. Those with autoimmune disease or severe allergies can't always be immunized, Gupta said.

"If a child, let's say they were given the polio vaccine or MMR, the measles vaccine, and they had a severe allergic reaction or Guillain-Barre syndrome, there are specific precautions we know of in science," Gupta said. "Those would form the reasons for giving a medical exemption for that child. Crying for four hours after a vaccine is not one of those."

Gupta said it is important for children, and adults, to be vaccinated for a number of reasons. Not only will they themselves be less likely to contract a communicable disease such as pertussis or measles, but so will those around them through what's called herd immunity.

"What happens when a child is vaccinated and multiple children are vaccinated in that community, we have what's called herd immunity," Gupta said. "We understand there are some children and adults who are unable to mount an immune response to vaccines, so we're talking about kids who have leukemia and are undergoing treatment for that or have other immunosuppressed conditions, a woman who is pregnant and teaches or lives in the communities."

Other vulnerable groups include the elderly who may have multiple health issues and infants who in many cases can't receive vaccines before the age of 1.

"I think there's no debate we need to be most protective of our most vulnerable populations," Gupta said.

The amended version of Senate Bill 286 has been reported to the House floor. If it passes, it must go back to the Senate so lawmakers there can approve or reject any changes.

Contact writer Whitney Burdette at 304-348-5149 or whitney.burdette@dailymailwv.com. Follow her at www.Twitter.com/wburdette_DM.

W.Va. grant money going to 'Growing Healthy' projects http://www.charlestondailymail.com/article/20150311/ARTICLE/150319838 ARTICLE http://www.charlestondailymail.com/article/20150311/ARTICLE/150319838 Wed, 11 Mar 2015 12:06:02 -0400 CHARLESTON, W.Va. (AP) - Seven West Virginia projects are sharing funding totaling more than $135,000 under the Growing Healthy Communities Grant Program.

The program provides competitive grants for activities that increase community health and wellness while also providing opportunities for downtown revitalization and development.

Recipients announced Tuesday by Gov. Earl Ray Tomblin include the town of Sutton, $11,630 to promote bicycling and to enhance a farmer's market; Elkins, $25,000 for a project to connect the rail yard to downtown attractions; Main Street Morgantown, $25,000 for signage to connect trails, the Wharf district and the downtown area.

House approves raw milk bill http://www.charlestondailymail.com/article/20150310/DM0104/150319945 DM0104 http://www.charlestondailymail.com/article/20150310/DM0104/150319945 Tue, 10 Mar 2015 14:10:20 -0400 By Whitney Burdette State residents now are a step closer to gaining access to raw milk after a bill allowing herd-sharing for milk advanced in the West Virginia Legislature.

The House of Delegates on Tuesday passed Senate Bill 30, which allows for a group of individuals to purchase shares of a cow and consume the unpasteurized milk from that cow. West Virginia currently has some of the heaviest restrictions on raw milk, only allowing farmers who directly own cows to consume unpasteurized milk from their cows.

The House passed the legislation 81-19 after about 45 minutes of debate. Supporters of the bill argue the government shouldn't tell residents what they can or can't do with their personal property.

"This is not about the widespread distribution of raw milk," said Delegate Chris Stansbury, R-Kanawha. "This is about individuals or families who own a share of a cow taking the milk and consuming it."

However, opponents argue allowing the consumption of raw milk is a step backward and could have a negative effect on public health. Delegate Jim Morgan, D-Cabell, said he once owned a small dairy farm and pasteurized the milk his cows produced under stringent regulation from the local health department. Not all farms are regulated so heavily, he said.

"If you have seen farming conditions other than the ones subject to health department rules, I feel it is a step backward in public health and for those conditions to be met it would be difficult," he said.

But Stansbury pointed out the majority of food borne illness outbreaks in recent years stem from produce, not raw milk, including lettuce and cantaloupe.

"This is stuff you're going to Kroger or your favorite grocery store and picking off the shelf," Stansbury said. "You think it's clean and safe and healthy.

"There are risks associated with our very, very tightly regulated public food system here in the United States."

Delegate Kelli Sobonya, R-Cabell, pointed out people often eat foods associated with illness, including sushi, safely and legally.

"People are sickened by cantaloupe. What about sushi? Raw oysters? The list goes on," she said. "West Virginia has one of the most restrictive laws when it comes to the consumption of raw milk. This bill does not legalize the sale of raw milk."

Delegates Peggy Smith, D-Lewis, and Lynne Arvon, R-Raleigh, spoke of growing up on dairy farms and consuming raw milk. Both said their families remained healthy and never suffered bacterial infections from the milk.

"I think people need to remember this bill is not about selling raw milk," Arvon said. "This is about people owning their own cow, their own goat and using the milk as they choose."

According to statistics presented by Delegate John Ellington, R-Mercer, the Centers for Disease Control reports less than 1 percent of milk consumed in the United States is unpasteurized and only two deaths related to raw milk have been reported in the past 25 years. A number of states, including Ohio, have herd share laws similar to the one passed by the Legislature.

The bill gives the Department of Agriculture rule-making authority, which must be approved by the Legislature. An amendment removed the Department of Health and Human Resources from rule-making, but health officials are encouraged to collaborate with the Department of Agriculture. Delegate Nancy Guthrie, D-Kanawha, said removal of the DHHR prompted her to change her vote.

"Let our two agencies that govern health and safety and agriculture work together," Guthrie said. "I didn't think that was an unreasonable request. I think we're going forward just because we don't like regulation this year. We think everyone should operate in a free and unfettered environment where no one has any oversight.

"I don't think my freedom should be infringed upon by your being unreasonable," she added.

The amended bill will now go back to the Senate.

Contact writer Whitney Burdette at 304-348-5149 or whitney.burdette@dailymailwv.com. Follow her at www.Twitter.com/wburdette_DM.

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W.Va. closes 3 pain management clinics for noncompliance http://www.charlestondailymail.com/article/20150310/ARTICLE/150319960 ARTICLE http://www.charlestondailymail.com/article/20150310/ARTICLE/150319960 Tue, 10 Mar 2015 11:21:33 -0400 BECKLEY, W.Va. (AP) - State officials have closed three chronic pain management clinics this year for failing to comply with a law aimed at reducing substance abuse.

The 2012 law gave the Department of Health and Human Resources oversight over pain clinic licensure and codified patient and health safety.

Since January, The Register-Herald reports that the department's Office of Health Facilities Licensure and Certification has revoked the licenses of the Hope Clinic's Charleston branch, Beckley Pain Clinic and the pain management operation of Med-Surg Group in Beckley.

Health and Human Resources spokeswoman Allison Adler tells the newspaper that the licensing office will continue a review of applicants until all facilities either achieve compliance or transition patients to other facilities.

Report says health care coverage cost falling http://www.charlestondailymail.com/article/20150309/ARTICLE/150309137 ARTICLE http://www.charlestondailymail.com/article/20150309/ARTICLE/150309137 Mon, 9 Mar 2015 18:49:05 -0400


The Washington Post

WASHINGTON - The cost of President Barack Obama's signature health care law is continuing to fall.

The Congressional Budget Office announced on Monday that the Affordable Care Act will cost $142 billion, or 11 percent less, over the next 10 years, compared to what the agency had projected in January.

The nonpartisan agency said the Affordable Care Act will cost less for two essential reasons: health insurance premiums are rising more slowly, and slightly fewer people are now expected to sign up for Medicaid and for subsidized insurance under the law's marketplaces.

More people aren't expected to sign up for the law because, the agency added, fewer employers than anticipated are canceling coverage and more people than earlier estimated had private coverage. By 2025, the CBO estimates "the total number of people who will be uninsured ... is now expected to be smaller than previously projected."

All around, it's positive news for health care act, which has been accused by Republicans of killing jobs and draining federal coffers. Indeed, the CBO itself warned last year the health care law could reduce full time employment as some chose to give up jobs that provided health care as they relied instead on the government's subsidies. The administration's own poor handling of the ACA's online launch in the fall of 2013, combined with other errors, also have tarnished the law's image among many Americans. And to be sure, the law is still expensive - expected to cost $1.2 trillion over 10 years.

But the cost of the law has been falling for several years, and now analysts are beginning to assess the evidence of the law's impact from its first-full year of implementation.

In March 2010, the CBO predicted that the law would cost $710 billion during the period from 2015 to 2019, without trying to come up with projections beyond that. After several revisions, the law is now expected to cost $506 billion - 29 percent less - during those same five years, as shown in the chart.

CBO issued its new estimates less than a week after the Supreme Court heard a case challenging a crucial provision of the law. It's unclear how the justices will rule, and a decision against the Obama administration could make these estimates irrelevant.

In revising their estimates, the agencies noted two trends.

The first is the relatively modest increase in how much private insurance companies spend on their policyholders' health care. Between 1998 and 2005, spending on health care increased by an average of 5 percent per year, adjusting for inflation and demographics. That figure fell to 1.8 percent per year for the period from 2006 to 2013, the latest year for which data are available.

The administration has said that this decline in spending on medical care is at least partly a result of cost-saving measures in the Affordable Care Act. Critics have argued on the contrary that the decline was due to the recession, and that health care costs could begin to rise again. Independent experts have suggested that much of the effect is due to the weak economy, but not all of it.

The CBO had previously expected that the pace of increasing spending would rise fast again, but now they predict that "such a bounce back seems less likely in light of the further slowing of spending growth observed in the most recent data."

The agencies also revised their estimates in response to new data on who was insured and how before the law took effect.

They concluded that fewer people were employed by firms that might stop offering coverage as a result of the law's passage, since their employees are now able to buy coverage individually through the exchanges. And they realized that fewer people were uninsured to begin with than they had thought.

As a result, fewer people will need to purchase insurance through the exchanges or need federal help to do so.

The agencies also concluded that the number of people who rely on Medicaid is smaller than they had anticipated, which is another source of savings.

These revisions mean that while fewer people will gain coverage as a result of the health care act, the number of people who will still lack insurance despite the law's passage is also lower than previously anticipated.

Nurse union, 2 W.Va. hospitals begin bargaining http://www.charlestondailymail.com/article/20150309/ARTICLE/150309180 ARTICLE http://www.charlestondailymail.com/article/20150309/ARTICLE/150309180 Mon, 9 Mar 2015 07:58:36 -0400

BECKLEY, W.Va. (AP) - A union representing registered nurses has begun bargaining with two Southern West Virginia hospitals.

National Nurses United representative Michelle Mahon tells The Register-Herald that negotiations with Greenbrier Valley Medical Center began Feb. 27. Another session is scheduled Monday.

Negotiations with Bluefield Regional Medical Center began March 2. Another session is scheduled April 7 or April 8.

Mahon says nurses are concerned about nurse-to-patient ratios, turnover rates and other safety issues.

The National Labor Relations Board ordered the hospitals last December to recognize and bargain with the union.

Both hospitals are owned by Tennessee-based Community Health Systems.

Health group announces new director http://www.charlestondailymail.com/article/20150305/DM01/150309439 DM01 http://www.charlestondailymail.com/article/20150305/DM01/150309439 Thu, 5 Mar 2015 18:09:52 -0400 By Whitney Burdette After nearly 10 years as executive director of advocacy group West Virginians for Affordable Health Care, Perry Bryant has announced his plans to retire this month.

"I am grateful to have spent nearly a decade with this amazing organization, and honored to have had the opportunity to lead it," Bryant said in a statement. "I am very proud of what my WVAHC colleagues and I have accomplished together during a decade of both successes and challenges."

Replacing Bryant as head of the organization is Terri Giles, who has worked in the public sector as well as for nonprofits with "a proven track record of success." Giles has a master's degree in communication management from the University of Southern California, and a bachelor's in social work from Concord University.

"We are thrilled to have Terri join our team," said Sam Hickman, vice president of West Virginians for Affordable Health Care. "She is an incredibly vibrant, smart and strategic advocate. We look forward to Terri applying her knowledge, creativity and energy to help WVAHC to achieve even greater success."

West Virginians for Affordable Health Care is a nonprofit organization that formed in 2005 by a group of individuals concerned about the rising costs of health care and insurance coverage.

The group has advocated for and supported the Affordable Care Act and Medicaid expansion in West Virginia. Members worked to educate the public and help them navigate the insurance marketplace to allow West Virginians access to health care plans.

Bryant, 68, announced his intentions to retire in September. In an interview with the Daily Mail, he commented on the health needs of West Virginians going forward.

"In West Virginia, you absolutely have to deal with chronic illness to make health care affordable," he said at the time. "That's where we spend most of our money."

Educating people about health care reaches beyond helping them apply for insurance. The group's Coverage to Care initiative helps the newly insured learn about the health care system and how to use it appropriately. Another initiative, called Choosing Wisely, encourages physicians to have in-depth conversations with their patients on topics such as using antibiotics wisely and other things of value.

Dr. Dan Foster, president of West Virginians for Affordable Health Care's board of directors, said development of those initiatives and Bryant's work in other areas has set the group on a path of success.

"WVAHC is well positioned, due in large part to Perry's vision, his tremendous leadership skills and his commitment to making our health care system more efficient, effective and affordable," Foster said. "He will be greatly missed by WVAHC members and the Board of Directors. Perry has the Board's appreciation and we are indebted to him for his many years of exemplary service to WVAHC's mission."

A reception honoring Bryant is scheduled for 5 pm. March 6 at the Women's Club of Charleston. Reservations are not required.

Contact writer Whitney Burdette at 304-348-5149 or whitney.burdette@dailymailwv.com. Follow her at www.Twitter.com/wburdette_DM.

High court takes up health law fight http://www.charlestondailymail.com/article/20150304/ARTICLE/150309571 ARTICLE http://www.charlestondailymail.com/article/20150304/ARTICLE/150309571 Wed, 4 Mar 2015 18:21:33 -0400


the Associated Press

WASHINGTON - The Supreme Court is hearing arguments in a major test of President Barack Obama's health overhaul that threatens insurance coverage for millions of people.

The justices are meeting Wednesday to try to determine whether the law makes people in all 50 states eligible for federal tax subsidies to cut the cost of insurance premiums. Or does it limit tax credits only to people who live in states that created their own health insurance marketplaces?

A ruling that limits where subsidies are available would have dramatic consequences because roughly three dozen states opted against their own marketplace, or exchange, and instead rely on the U.S. Health and Human Services Department's healthcare.gov. Independent studies estimate that 8 million people could lose insurance coverage.

Opponents of the Affordable Care Act failed to kill the law in an epic, election-year Supreme Court case in 2012. Chief Justice John Roberts joined with the court's liberal justices and provided the crucial vote to uphold the law in the midst of Obama's re-election campaign.

The new case, part of a long-running political and legal fight to get rid of the law also known as Obamacare, focuses on four words - "established by the state" - in a law that runs more than 900 pages. The challengers say those words are clear and conclusive evidence that Congress wanted to limit subsidies only to those consumers who get their insurance through a marketplace, or exchange, that was established by the state.

The administration counters that the law was written to dramatically reduce the ranks of uninsured, and that it would make no sense to condition subsidies on where people live. The phrase "established by the state," is what the administration calls a "term of art" that takes both state- and federally run exchanges. The administration also says the term cannot be read in isolation, and that other parts of the law show that subsidies should be widely available.

Both sides in the case argue that the law unambiguously supports only its position. One other option for the court is to declare the law is ambiguous when it comes to subsidies and defer to the Internal Revenue Service's regulations making tax credits available nationwide.

Partisan and ideological divisions remain stark for a law that passed Congress in 2010 with no Republican votes. Of the judges who have ruled on lawsuits over the subsidies, Democratic appointees have sided with the administration and Republican appointees have been with the challengers.

Roberts was the only justice to essentially cross party lines with his vote in 2012. His fellow conservatives on the court voted to strike down Obamacare in its entirety.

The lawyers arguing the case Wednesday also squared off three years ago. Michael Carvin argued part of the broad challenge to the health care law in 2012. Solicitor General Donald Verrilli Jr., the administration's chief Supreme Court lawyer, successfully defended it.

A decision in King v. Burwell, 14-114, is expected by late June.

Bill aims to fill social worker vacancies http://www.charlestondailymail.com/article/20150302/DM0104/150309864 DM0104 http://www.charlestondailymail.com/article/20150302/DM0104/150309864 Mon, 2 Mar 2015 16:59:21 -0400 By Whitney Burdette Social workers employed by the state Department of Health and Human Resources may soon be exempt from licensure.

The House Government Organization Committee on Monday advanced Senate Bill 559. It seeks to add DHHR employees with "sufficient standards of qualification, education, training and experience" to a list of others exempted from licensure, including social service administration directors, those holding licenses in other fields, such as physicians, and students and interns studying social work courses, among others.

Supporters of the bill say the legislation will help recruit and retain social workers, but opponents argue it doesn't fix the problems of low pay and high turnover.

"I can tell you the problem is we are paying social workers, as a state $22,000, $23,000 a year," Delegate Isaac Sponaugle, D-Pendleton, said. "A lot of them get chewed up in Child Protective Services. You send them out in all hours of the night in the worst of circumstances. They take children from their parents and get caught up in litigation for nine, 12 months.

"This is basically putting a band-aid on the situation," he added. "We need to increase pay if we want to get good people."

Delegate Gary Howell, R-Mineral and chairman of the House Government Organization Committee, said his county at one point had the worst CPS investigation rates in the state with only 23 percent of cases actually being investigated. That's because, he said, there aren't enough licensed social workers to handle the caseload.

"We knew we had a problem," Howell said. "And part of the problem is the retention of people in the field. Some of the work they were doing, you don't really need to be a social worker, you could be trained to do the work. But the code said you have to be a (licensed) social worker. So you have all these unfilled positions."

According to a Feb. 22 story in the Sunday Gazette-Mail, DHHR social workers are handling about twice as many cases as standards outline. According to those standards, which were mandated in 1997 but not implemented until 2011, workers in the child support specialist group are recommended to have between 300 and 466 cases, depending on the county. However, workers in that group have an average of 573 cases each.

In addition, West Virginia Child Protective Services had an employee turnover rate of 37 percent last year with a 16 percent vacancy rate.

Senate Bill 559 was drafted to change that by allowing those with four-year degrees to become provisionally licensed social workers. But officials from the social work programs at West Virginia University, Marshall University and West Virginia State University argued social workers need to have training. Howell said he was urged to remove the bill from his committee's Monday agenda, but he declined. After a public hearing Monday morning, he met with interested parties and hashed out an agreement.

"Any time you get these bills, you drag it out and no one wants to give," Howell said. "But you put a deadline over their head and everybody will start giving a little bit because they're afraid they won't like it at all."

Howell said more than a dozen people crammed into his office after the hearing to discuss a fix to the bill.

"When we left, everybody seems to actually be happy," he said. "When you do that, most of the time everybody gets mad, but this was the other way around. Everybody seems to be happy."

Taking people with four-year degrees, in any field, will fill the immediate need. But provisionally licensed social workers will have to go through an 18-month training program that eventually will lead to board certification. DHHR will promulgate emergency rules to get the program up and running immediately but will come back to the Legislature through the regular rule-making process for the body to sign off on it.

The program will be developed in consultation with the Higher Education Policy Commission, WVU and Marshall so provisionally licensed social workers will earn college credit while moving through the program. The program will be audited by 2020.

A provision in code that enabled temporary social workers from obtaining a provisional license only twice was also removed. That allows DHHR to rehire some people who may have let their license lapse.

DHHR employs more than 1,000 social workers, Howell said. Of those, more than 900 deal specifically with children and families while the remainder are employed in state-run nursing homes.

"They're running a big shortage, especially in CPS," Howell said.

Although the bill aims to fill the immediate needs of DHHR, opponents to the bill argue the provisional licensure of social workers puts kids at risk.

"The best way to deal with a recruitment problem is not to put vulnerable children at risk and lower the wages of social workers, but to offer competitive compensation that will increase the supply of social workers in the state," said Ted Boettner, executive director of the West Virginia Center on Budget and Policy.

Delegate Jeff Eldridge, D-Lincoln, has a degree in social work. He said he hesitates to support the bill, but voted to pass it out of committee because he recognizes the need.

"There is a dire need to have social workers in the field, whether it be a temporary social worker or a fully licensed social worker," he said. "I feel like we're going backward. In the early 2000s, we said anyone in social work must have a social work license and go to school for social work. Now it's just the opposite. Are we treating the ones with master's degrees in social work with an incentive to go to school and get their social work degree? I don't know. I'm voting for this hesitantly because I know we need social workers in the field. Social workers now are overwhelmed by way too many cases. The pay isn't there and it's a hard job."

Senate Bill 559 will now go to the full House.

Contact writer Whitney Burdette at 304-348-5149 or whitney.burdette@dailymailwv.com. Follow her at www.Twitter.com/wburdette_DM.

WVSU, University of Sharjah partner on health conference http://www.charlestondailymail.com/article/20150302/ARTICLE/150309873 ARTICLE http://www.charlestondailymail.com/article/20150302/ARTICLE/150309873 Mon, 2 Mar 2015 16:07:40 -0400 INSTITUTE, W.Va. (AP) - West Virginia State University is partnering with the University of Sharjah on an international health conference.

The "Solutions for Better Life" conference will be held Nov. 15-19 at the University of Sharjah in the United Arab Emirates.

West Virginia State said Monday in a news release that participants will include world health experts and high school and university students from 100 countries. The goal is to identify innovative solutions to global health problems.

During the conference, student participants will present their solutions to scholars and health experts. There also will be an academic symposium that will include research findings, paper presentations, panel discussions and workshops.

The conference will be sponsored by the Dubai-based nonprofit The Tekha Group.

Bill to increase prescriptive powers of nurses discussed http://www.charlestondailymail.com/article/20150226/DM01/150229368 DM01 http://www.charlestondailymail.com/article/20150226/DM01/150229368 Thu, 26 Feb 2015 18:37:07 -0400 By Joel Ebert A bill that sought to make what some called necessary changes to help advanced-practice registered nurses in West Virginia underwent serious debate and alterations during nearly three hours of discussion among state lawmakers on Thursday.

Despite the bill's passage, proponents of the legislation remained vigilant in their desire to make changes that were introduced by Senate Health and Human Resources Committee vice-chairman Tom Takubo, R-Kanawha.

Throughout two separate committee meetings - one in the early afternoon and another that latest until 8 p.m. - Takubo, who is a pulmonologist expressed discomfort with Senate Bill 516, which seeks to expand the prescriptive power of advanced-practice registered nurses, or APRNs.

Nurse practitioners, nurse midwives, certified nurse anesthetists and clinical nurse specialists all are defined as advanced-practice registered nurses.

Proponents of the bill say the legislation would allow those nurses to expand their ability to practice nursing to meet the needs of the state. The bill would put West Virginia in line with 19 other states that have lifted restrictions on advanced-practice nurses.

Current state law requires a physician to sign off on work performed by an advanced-practice nurse. The legislation in the Senate health committee would eliminate such requirements.

Citing the state's ongoing battle against prescription drug abuse, Takubo questioned former state Sen. Dan Foster, who testified in front of the committee Thursday afternoon. Takubo asked whether Foster anticipated seeing an increase in prescription drug abuse if there were more people able to provide medication to patients.

"It's an interesting question," Foster said. "No, I'm not certain that would have any negative effect."

Foster said despite significant contention between doctors and nurses over the bill, he felt comfortable with the current version of the legislation, which also would establish a new governing board, specifically for advanced-practice nurses.

"I understand my medical colleagues and their sincere belief that enacting this type of legislation could conceivably affect the quality of care of patients in the state - I just respectfully disagree with that belief," he said.

Sen. Ed Gaunch, R-Kanawha, who described himself as a "fence-rider" on the issue, asked Foster how an advanced-practice nurse's practice would differ from a regular family practice.

"They should know the extent of their competency," Foster said of advanced-practice nurses. He also said that type of nurse generally fits into a newer model of medical practice, which involves more of a collaborative effort from a variety of experts, rather than one expert, as is the case with more traditional family practices.

"Nurse practitioners are trained to practice independently," he said.

Gaunch concluded that one of the purposes of the bill would be to make medical treatment more available to rural areas, which he said he supported.

"I think it's time that we start bringing this good health care that's available to the citizens of West Virginia," said Sen. Kent Leonhardt, R-Monongalia, the bill's sponsor.

Despite Leonhardt's support, Takubo raised several questions about the bill.

"The issue is when we make a broad law and we give this ability to all APRNs, are they all equipped the same to practice independently?" he asked.

Takubo sought input from any nurse midwives in attendance to weigh in on the legislation. Angelita Nixon, a certified midwife, said most practicing nurses, including certified midwives, are working in collective relationships with physicians.

"The majority of advance practice nurses would not need to have any separation based on their employment setting," she said. But Nixon said several groups, including the American College of Obstetricians and Gynecologists and the International Confederation of Midwives, recommends that all jurisdictions consider midwives to practice autonomously.

Even if midwives receive the designation, Nixon said that midwives will always work with obstetrician and gynecologist specialists.

Toward the end of the afternoon meeting, Takubo launched into a 10-minute speech, in which he challenged several arguments being cited as reasons to support the bill.

"I think a lot of the reasons why you don't see a lot of physicians in rural West Virginia is similar to why you don't see chain restaurants and car dealerships and everything else," he said. "The business model is very, very difficult to sustain."

Takubo also voiced concern about the degree of training for advanced-practice nurses, which he said was significantly less than a physician.

During the evening meeting, Nixon challenged Takubo's assertion that advanced-practice nurses don't have enough training, saying nurse midwives have masters degrees.

When the committee reconvened in the evening, several other speakers spoke to the bill, including Legislative Auditor Aaron Allred, who's office released a report in January 2014. The auditor's findings indicator there was no public safety concern with the prescribing and clinical practice of experienced advanced-practice nurses. The report also noted that the vast majority of medical organizations support an expanded scope of advanced-practice nurses, with the exception of the American Medical Association and the American Osteopathic Association.

As the evening progress, Takubo advanced an amendment that would do away with the proposed advance-practice registered nurse board. Takubo's amendment also sought to keep advanced-practice nurses under the nursing board for certification and licensing and transfers the prescriptive authority to the state Board of Medicine or the state Board of Osteopathic Medicine, whichever the nurse prefers.

Leonhardt altered Takubo's amendment by adding an advanced-practice nurse to both boards that have prescriptive authority. The committee then approved the amended bill and sent it to the Senate Finance Committee.

Although disappointed with the end result, Aila Accad, past president of the West Virginia Nurses Association, said, "This compromise is not favorable."

Accad said nurses would agree with the compromise if there was a separate advanced-practice registered nurse board.

"To put a part of this under the board of medicine is outrageous. It's such an insult to the nurses practicing," she said.

Even though he was frustrated with the changes to the bill, Leonhardt said he ultimately voted in favor of its passage in order to allow the advanced-practice nurses to have a chance to further amend the bill.

"It's a step forward," Leonhardt said. "We have to start thinking about getting the health care to our rural communities and that's what this is all about."

Contact writer Joel Ebert at 304-348-4843 or joel.ebert@dailymailwv.com. Follow him on twitter.com/joelebert29.

Health care law divides parties http://www.charlestondailymail.com/article/20150225/ARTICLE/150229479 ARTICLE http://www.charlestondailymail.com/article/20150225/ARTICLE/150229479 Wed, 25 Feb 2015 20:22:58 -0400


the Associated Press

WASHINGTON - Twenty-two out of 24. And 206 to 96.

Those numbers tell much about the political impact of a Supreme Court case in which conservatives and Republicans hope to demolish a pillar of President Barack Obama's health care overhaul. The justices hear arguments next week.

The plaintiffs say subsidies that help millions of Americans afford private insurance are illegal. They say the law limits that aid, paid as tax credits, to people buying coverage from marketplaces established by states, not the federal government.

Democrats disagree. But with a June decision expected, the King v. Burwell case tosses political risks at both parties.

Only 13 states run their own insurance marketplaces, where people who don't get coverage through work but earn too much to qualify for Medicaid can purchase policies. The federal government's HealthCare.gov serves 37 states, which are mostly Republican-run and decided against establishing their own systems.

Of the 11.4 million people who the Health and Human Services Department says have enrolled for coverage for this year, 8.6 million live in states using HealthCare.gov. Some may eventually not receive policies, but many who do stand to lose them if the plaintiffs win because without federal aid, they couldn't afford coverage.

That pressures Republicans, who uniformly oppose the law, to help the recipients or risk alienating lots of voters.

Here's why. Of the 24 GOP senators facing re-election in 2016, 22 are from states using the federal marketplace. That includes Sens. Marco Rubio of Florida, a possible presidential candidate, whose state saw a national high 1.6 million enroll for coverage; Richard Burr of North Carolina, where 559,000 signed up; and Patrick Toomey of Pennsylvania, where 472,000 enrolled.

No politician enjoys confronting thousands of constituents who have lost something. Nor do they like facing insurance companies, hospitals and others who would suffer if billions in subsidies for millions of customers vanish.

Perhaps a third of those 22 GOP senators face competitive races next year - enough to put Senate control in play. Republicans have a 54-46 Senate majority, including two Democratic-leaning independents.

One of those GOP lawmakers, Ohio Sen. Rob Portman, learned Wednesday that he will face a re-election challenge from Democrat Ted Strickland, a former governor.

In addition, in the 37 federal marketplace states, 206 House members are Republicans and 96 are Democrats, including one GOP vacancy. All House seats are up for re-election next year, though continued GOP control is likely.

GOP response

Should the court overturn the subsidies, few Republicans would favor declaring victory and letting millions of people lose federal aid and their health coverage. But so far, Republicans are divided over what to do.

"The response can't be, 'Well, some people won't have insurance,'" said Mike Leavitt, a Republican and health secretary under President George W. Bush.

Leading congressional Republicans say they are readying plans to help subsidy recipients temporarily, perhaps until the GOP can permanently revamp the law. They've said little about what benefits they're considering and how they'd pay for them.

Sen. John Barrasso, R-Wyo., is among top GOP senators crafting a proposal he says would retain some level of subsidies, let people buy narrower policies than the law currently requires and give states more say on health coverage. He concedes a broad rewrite of the law is unlikely soon.

"To do a full repeal and replace, you really don't accomplish that until 2017 with a new occupant of the White House," Barrasso says.

Democratic risks

If the plaintiffs win, Obama and Democrats will want to keep subsidies flowing and protect the law that they enacted unilaterally in 2010. While many Republicans seem willing to help those beneficiaries temporarily, it's unclear what trade-offs they would seek.

The GOP might demand changes like those Barrasso is considering or others like increasing the size of businesses that must offer health coverage. Negotiations could draw in other issues like the impending expiration of health services for children from lower-income families.

Should Obama refuse such demands as undermining his health care overhaul, he risks looking unreasonable in the shadow of a Supreme Court finding that his administration was implementing the law too aggressively.

"I'd sure hope the president was interested in helping those people who have been harmed by his illegal action," Barrasso says.

Congressional Democrats might split, with liberals demanding no concessions but moderates like Sen. Heidi Heitkamp, D-N.D., open to some health law changes. Only three Senate Democrats from states using HealthCare.gov face 2016 re-election, including Minority Leader Harry Reid of Nevada, where 72,000 people enrolled for coverage.

If Democrats win, no easy path

If the court dismisses the challenge, Democrats will have little incentive to revamp the law. But they will face another campaign season of defending a law that still lacks majority public support.

Another complication: The ever-unpopular IRS' role in the health care law. It distributes health insurance subsidies to people in the form of tax credits.

But it also fines people, by raising their tax liability, if they flout the law's requirement that they purchase coverage. Coupled with episodes like last week's disclosure that the IRS sent inaccurate tax information to 800,000 HealthCare.gov customers, the agency reinforces some people's distaste for the law.