Health care – Press Herald Thu, 23 Nov 2017 09:00:57 +0000 en-US hourly 1 Maine has nation’s highest rate of increased Affordable Care Act enrollment Wed, 22 Nov 2017 18:04:28 +0000 Maine is leading the nation with a more than 72 percent increase over last year in Affordable Care Act enrollment, according to data released Wednesday.

A health policy analyst says that reflects the ACA’s enduring popularity in Maine despite the Trump administration’s efforts to undermine the law. Sign-ups in Maine through the first 18 days of open enrollment, Nov. 1-18, totaled 19,880, or 72.4 percent higher than the same period last year. The next closest state was Wyoming, with a 60.7 percent increase in enrollment. Most states have experienced enrollment surges of 40 to 50 percent over last year.

In total, 80,000 Mainers signed up for a 2017 ACA insurance plan through the individual marketplace. The ACA marketplace is where those who don’t have access to health insurance through an employer – often part-time workers or the self-employed, can purchase subsidized insurance.

Nationally, 2.3 million people have signed up so far for ACA insurance for 2018, according to numbers released by the U.S. Centers for Medicare and Medicaid Services. When open enrollment ended for 2017, 9.2 million Americans had ACA individual insurance.

Mitchell Stein, a Maine-based independent health policy analyst, said Maine Sen. Susan Collins’ key vote to preserve the ACA got a lot of media attention in the state, and may have contributed to a greater awareness of the ACA, boosting enrollment.

Collins was one of three Republican senators – Lisa Murkowski of Alaska and John McCain of Arizona were the others – who voted July 27 against the party’s attempts to repeal the law, keeping it intact by one vote. Collins’ vote and subsequent opposition to a similar attempt in September vaulted her into the national spotlight. The Maine Medicaid expansion referendum also shined a light on the ACA, as Mainers decisively voted in favor of expanding Medicaid, 59 to 41 percent.

Recently, Collins has expressed strong reservations about the Republican leadership’s inserting a clause to repeal the ACA individual mandate in the pending tax reform bill. She also criticized other provisions of the bill, such as sunsetting tax cuts for individuals while making corporate tax cuts permanent. The Senate tax reform bill touted by Republican leadership would result in a tax increase for about 50 percent of Americans by 2027 – according to the Tax Policy Center, a Washington-based think tank – trigger cuts to Medicare and increase marketplace health insurance premiums by $2,300 on average. Tax cuts would largely go to the top 1 percent of wage earners. A vote on the Senate tax bill could happen as early as next week.

The ACA’s individual mandate imposes a tax penalty on people who don’t obtain insurance. The mandate brings more healthy and younger people into the insurance pool, keeping premiums in check, health policy experts say.

Stein said another factor in Maine’s strong enrollments may be the emergence of new zero-premium plans developed after the Trump administration’s decision to withhold certain subsidy payments to insurers. Maine and other states took steps to keep insurance companies from losing money, with the effect that companies are now offering zero-premium basic plans.

About half of the Mainers who are eligible for subsidies – those who earn between 100 and 400 percent of the federal poverty level – would also qualify for a zero-premium bronze plan for 2018. The bronze plans have fewer benefits and higher deductibles than silver and gold plans, but lower premiums.

Kevin Lewis, president and CEO of Community Health Options, one of the insurers on the Maine marketplace, said enrollees are choosing bronze plans in greater numbers, and it’s likely being driven by the zero-premium plans.

“We’ve seen a definite increase in members choosing bronze plans. Almost half of the bronze plans being chosen (at CHO) have zero premiums. It’s a significant factor,” Lewis said.

He said business has been brisk over the past few weeks, with many people choosing plans.

Other factors in Maine’s increased enrollment rate may be the state’s relatively high levels of self- and part-time employment, the people the marketplace was intended for because they were more likely to lack affordable options for health insurance.

Maine also ramped up outreach efforts in the face of Trump administration cuts to advertising and outreach, which may have also helped, Stein said. Maine’s health insurance navigators did not experience the steep cutbacks applied to other states, and the Maine Health Access Foundation contributed $200,000 in outreach funding. Nationally, the Trump administration cut advertising funding by 90 percent.

Even with a surge in sign-ups, the enrollment period was slashed in half this year, from 12 weeks to six weeks. So total enrollment will likely be lower in 2018, even in Maine, which is largely a reflection of the compressed enrollment period.

“So there’s good news and bad news. The law is still working,” Stein said. “The sabotage by the Trump administration has been effective, but not as effective as (Trump) hoped.”

Joe Lawlor can be contacted at 791-6376 or at:

Twitter: @joelawlorph

]]> 0 website is seen on a computer screen. The government says more than 600,000 people signed up for Affordable Care Act coverage in the first week of open enrollment season, and nearly 8 in 10 of those were current customers renewing their coverage.Wed, 22 Nov 2017 20:46:28 +0000
Timing may be less of an issue in treating of stroke victims, study finds Sat, 18 Nov 2017 22:05:58 +0000 Patients and doctors long have relied on a simple rule of thumb for seeking care after an ischemic stroke: “Time is brain.”

In other words, the longer it takes for patients to seek medical care after a stroke, the more their brain tissue is likely to be starved of blood and die – significantly raising the risk of permanent disability. The general rule is to seek care within six hours.

But a study published this month in the New England Journal of Medicine found that the window may be as long as 24 hours for some stroke patients. The study also indicated that outcomes were less likely to include a disability when treated with a combination of surgery and clot-busting medication.

Though doctors still agree that earlier treatment is better, the study offers hope to patients who have a stroke in their sleep or who live in rural areas where it can take longer to reach medical care, said Dr. Dileep Yavagal, chief of interventional neurology for the University of Miami Health System and a practicing physician at Jackson Memorial Hospital.

“It’s going to be quite impactful because of how many strokes happen in sleep and how many stroke patients get missed in the first few hours,” Yavagal said, adding that about 25 percent of strokes occur during sleep.

“In the past, we couldn’t offer them much because they would go to bed and then wake up with a stroke and that would mean basically more than seven or eight hours since they were last well,” he said. “And what that then meant was that they were out of luck, in terms of getting any therapy. But this study showed us that there were a number of people who, when they wake up with a stroke, had a fair amount of salvageable brain.”

The study followed the progress of 206 patients who had received medical care six to 24 hours after a stroke at medical centers around the world.

]]> 0 Sat, 18 Nov 2017 17:20:09 +0000
MaineCare had barred payments to Lewiston oral surgeon accused of restraining patients Fri, 17 Nov 2017 17:20:00 +0000 AUGUSTA — A Lewiston oral surgeon fighting to keep his license in the face of allegations of incompetence and a lack of professionalism acknowledged at a hearing before the Maine Board of Dental Practice on Friday that he’s no longer allowed to treat patients on MaineCare.

During six hours on the stand, Dr. Jan Kippax said that because about half of his patients rely on MaineCare to pay for dental work, the move is making it difficult for him to stay in business.

“My numbers have gone way, way down,” he told five members of the board.

He said that given the charges levied against him and the publicity about them, it is difficult to continue his Main Street practice.

Almost two years after the first of a handful of complaints lodged against him, Kippax testified at a hearing that may force him out of the profession entirely.

It marked the third day of testimony in the ongoing administrative trial by the dental board members who are weighing the testimony of patients, experts and Kippax. It will continue Saturday when expert witnesses are expected to weigh in.

During the first two days of testimony in September, five of Kippax’s former patients detailed experiences with him that left them so shaken they reported his actions to the dental board for possible sanction.

They alleged that Kippax had failed to control their pain, allowed bleeding to go untreated, restrained them improperly and refused to stop extractions when they pleaded with him to cease.

Kippax strongly denied he’d done anything improper, and two of his assistants, including one who worked at his side on all five cases, backed him up Friday. Each of the aides said the testimony of the five former patients was off the mark.

One patient who had eight teeth pulled, Joshua Robbins, said he woke up to find Kippax holding him down as he yelled and pleaded for the dentist to stop.

But Mindy LeMont, who was in the room to keep an eye on his breathing, said Robbins didn’t stir until the procedure was finished. Only after Kippax left the room, she said, did Robbins begin waking up.

“He was very agitated. He was yelling,” LeMont said, and she felt so frightened that she stepped back to escape his attention.

Kippax said part of the problem he faced is that he was willing to take low-income, sometimes troubled patients, about a quarter of whom were current or former drug addicts. They don’t always react well to the drugs required to sedate them, he said.

They “act out and see things” sometimes, he said. “These people have serious issues that are behind the drugs.”

“These people have a real set of baggage that’s going on in their brains and you don’t know how they’re going to react,” he said. “These are difficult, combative patients.”

Kippax suggested that some of his accusers were upset because he wouldn’t give them addictive drugs that are much sought-after on the streets. He said he took great care to try to balance the desire to combat pain with the responsibility he felt to keep opioids out of the hands of people who might abuse them.

At one point, attorney James Belleau, who represents Kippax, raised questions about a March 2016 inspection report by an investigator for the board, Dr. David Moyer.

Moyer apparently included some positive remarks about Kippax and his office in the report that were subsequently edited out of a final version passed on by the board’s executive director, Penny Vaillancourt.

“I don’t know why she would do that and it’s concerning,” Kippax said.

Vaillancourt has said she can’t talk about anything related to the case. The exhibits shown to board members, including the report, have not made been made available despite a Freedom of Access Act request from the Sun Journal weeks ago.

The board has the power to censure or fine Kippax or to pull his license to practice. Last winter, it agreed to suspend him temporarily pending the outcome of the hearing, but didn’t move ahead on the proceedings until long after the 30-day suspension expired.

Kippax began to practice again last summer and is fighting to preserve both his license and his reputation. He is also licensed to practice in Massachusetts and Vermont.

]]> 0 Jan Kippax, at a hearing Sept. 29 before the Maine Board of Dental Examiners, was accused of failing to comply with the standards of care when treating a Minot man whose jaw became infected after tooth extractions.Fri, 17 Nov 2017 20:14:19 +0000
Neighbors wary as Maine Med seeks zoning change for its big expansion Fri, 17 Nov 2017 09:00:00 +0000

Maine Medical Center plans to expand the hospital’s footprint by about 25 percent, including a 270,000-square-foot building along Congress Street that would serve as the main entrance. Staff photo by Ben McCanna

Maine Medical Center’s request for a special zoning designation covering surrounding neighborhoods in Portland’s West End has prompted concerns among neighbors about the hospital’s long-term development plans.

The hospital’s request for an “Institutional Overlay Zone,” a crucial step in the hospital’s proposed $512 million expansion plan, will go before the City Council on Monday night. Representatives from the Libbytown and St. John and Valley street neighborhood associations are expected to express concerns, including how the hospital’s long-range plans might affect housing and other development in the area.

The expansion plan calls for increasing the footprint of the hospital’s main campus by about 25 percent and adding 19 new operating rooms and 128 single-occupancy patient rooms. The cornerstone would be a 270,000-square-foot building along Congress Street that would serve as the hospital’s main entrance and include 64 inpatient beds and the operating rooms, replacing an existing parking garage.

But it’s the hospital’s long-term plans, which could include expanding Maine Med’s footprint by adding medical offices on surrounding streets, that have become a growing point of contention.

In September, the state approved Maine Med’s “Certificate of Need,” a critical step toward beginning the project in spring 2018. The most extensive renovation in Maine Med’s history is scheduled to be completed by 2022, but first it must go through the city’s approval process, which includes allowing the zoning change.

An overlay zone gives city planners and an institution – such as a hospital or a university – a design blueprint covering the surrounding area so future development meshes with the neighborhood, said Jeff Levine, Portland’s planning and urban development director.

“This gives us a chance to create an overall plan that fits in with the neighborhood, and not just go one building at a time,” Levine said.


A map released in advance of Monday’s meeting shows future sites eyed by the hospital for potential long-term developments between Vaughan and Chadwick streets, Congress and A streets and Forest and Gilman streets. The map was included in Maine Med’s institutional development plan, a guidebook for how the overlay zone would work that is prepared by the city and the hospital.

Zack Barowitz, representing the Libbytown Neighborhood Association, said he’s concerned that the overlay zone would give Maine Med preferential treatment for future development, and could potentially dissuade other developers.

“It’s like leaving a seat open in a crowded movie theater for a date that may or may not show up,” Barowitz said.

He said other developers might shy away from proposing projects, such as retail or housing, perceiving the overlay zone as a “sweetheart deal” between Maine Med and the city.

But Levine said the overlay zone would not preclude other businesses from locating in those areas, as long as they comply with existing zoning requirements.

John Porter, spokesman for MaineHealth, the parent company of Maine Med, said the City Council vote simply means that if Maine Med were to build in those areas, it would have to follow the 144-page institutional development plan, which includes design guidelines and building height restrictions and even regulates how the buildings would affect shadows and wind.

“We don’t own or control those properties,” Porter said. “There’s no restrictions in place for others to come in and develop those properties.”


Porter said Maine Med has identified several parcels for potential long-term development. Maine Med, for example, might want to include outpatient services near the hospital for the convenience of patients who need to go back and forth between the two facilities. But it’s unlikely the hospital would develop all or even most of the properties identified in the plan, Porter said. The selection gives the hospital flexibility in case some building owners don’t want to sell to the hospital, he said.

Barowitz, with the Libbytown group, said another concern is that Maine Med might buy up popular restaurants and replace them with sterile medical office buildings.

But Levine said the overlay zone strongly encourages Maine Med to reserve the first floors of future medical office buildings for retail or other “active uses.”

“We didn’t want to require retail on the first floor because we don’t know what the market is going to be long-term in those areas,” Levine said. “But we don’t want pedestrians walking past large blank walls.”

Porter noted that in response to neighborhood concerns, Maine Med did revise its parking plans and is now proposing a 10-story garage at 222 St. John St., about a quarter mile from the hospital. The new garage, with about 2,000 spaces, would be on property that the hospital already leases for surface parking for employees.

The existing parking garage on the Maine Med campus will be demolished. The original plan for a 13-story garage at Congress and Gilman streets was dropped after neighbors complained it would be too tall for the neighborhood.

Joe Lawlor can be contacted at 791-6376 or at:

Twitter: joelawlorph

]]> 0 Medical Center, seen in September, had to <a href="">divert non-emergency ambulances</a> to other medical facilities for several hours Wednesday and Thursday as it struggled with bed capacity. Maine's largest hospital has 647 beds, but many of them were unavailable because they can't accommodate certain types of medical equipment. In other cases, units with two beds were occupied by people too sick to have a roommate. The hospital is seeking a $512 million expansion. (Staff photo by Ben McCanna)Fri, 17 Nov 2017 09:47:24 +0000
Health care for millions at risk as Republican tax writers look for revenue Thu, 16 Nov 2017 14:17:40 +0000 The Republican tax plans are suddenly looking a lot more like health-care bills, with provisions that may affect coverage and increase medical expenses for millions of families.

The House version of the tax bill, which President Trump endorsed on Tuesday, would end a deduction that allows families of disabled children and elderly people to write off large medical expenses. The Senate plan would repeal the Obamacare requirement that most Americans carry insurance, a move that insurers promise would raise premiums in the nationwide individual insurance market.

The provisions would help offset the cost of large tax cuts for corporations and individuals. But the move has sparked a new wave of opposition from the health-care industry and others who are concerned about its impact – the same political headwinds that tanked Republican efforts to repeal the Affordable Care Act earlier this year.

Either proposal, if signed into law, “could be devastating for some families with disabilities,” said Kim Musheno, vice president of public policy at the Autism Society, a Bethesda, Maryland, organization that advocates for people with autism. “Families depend on that deduction. And if they deal with the individual mandate, that’s going to cut 13 million people from their health care,” she said, citing a Congressional Budget Office estimate.

Republicans and some conservative groups, though, argue that removing the penalty for uninsured individuals would represent a tax cut for many low-income people who pay it now. Americans for Tax Reform, the group led by anti-tax crusader Grover Norquist, said that Internal Revenue Service data from tax year 2015 show that 79 percent of households that paid the penalty earned less than $50,000 a year.

Most Americans already think the tax legislation is designed to benefit the rich and oppose the bill by a two-to-one margin, according to a Quinnipiac University poll released on Wednesday. The survey was conducted between Nov. 7 and Nov. 13 – before the repeal of the Obamacare mandate was introduced – and has a margin of error of 3 percentage points. Some of the details in both tax plans have changed since the survey, and the Senate tax-writing committee is still working on its draft.

Few Republicans have spoken out about the House bill’s repeal of the medical-expense break. The bill faces a vote on the House floor Thursday. But some criticism has begun to surface as advocacy groups including the AARP and the American Cancer Society have highlighted the harm the House bill could have on families battling diseases and on the elderly. People with tens of thousands of dollars in annual medical expenses often rely on the tax deduction to make ends meet.

Rep. Walter Jones, a North Carolina Republican, said Wednesday he’ll vote against the House bill in part because it eliminates the deduction for out-of-pocket medical expenses.

“There are a lot of seniors in my district and this is life and death for them,” he said.

The deduction is allowed under current law if medical expenses exceed 10 percent of a taxpayer’s adjusted gross income. Almost 9 million taxpayers deducted about $87 billion in medical expenses for the 2015 tax year, according to the IRS.

Rep. Greg Walden, an Oregon Republican who chairs the Energy and Commerce Committee, said some of his constituents who live in expensive elder-care facilities could be harmed if the deduction is scrapped.

“I think it’s one we have to continue to massage a bit,” he said. “There’s a lot of things out there and there’s maybe going to be an opportunity to adjust some of them.”

He declined to elaborate.

On the other side of the Capitol, Senate Republican leaders’ sudden decision to add a partial Obamacare repeal to their bill has energized Democratic opposition.

“You don’t fix the health insurance system by throwing it into a tax bill and causing premiums to go up 10 percent,” Sen. Sherrod Brown, an Ohio Democrat, told reporters Wednesday.

Were the ACA’s insurance mandate repealed absent a new policy to compel the purchase of coverage, the CBO projects that premiums would rise 10 percent for people who buy insurance on their own and more than 13 million Americans would lose or drop their coverage.

But a reduction in the number of people with insurance also translates to less taxpayer money spent to provide subsidies for premiums under the ACA. Ending the requirement as of 2019 would save the government an estimated $318 billion, helping to offset the cost of lowering the corporate tax rate.

In addition, the Senate’s tax plan could trigger sharp cuts to Medicare and other programs in order to meet budget deficit rules, according to CBO.

The move to target Obamacare comes after Republicans lost elections in Virginia and other states earlier this month. Health care was a significant factor in those races and Republicans will face punishing campaign ads if they try to chip away at Obamacare or end the medical-expense deduction while cutting taxes, said political analyst David Axelrod, a former top adviser to President Barack Obama.

“The thing that makes it more of a potent issue is that it’s all being done to facilitate what essentially is a massive corporate tax cut and an individual tax cut that’s skewed to wealthy Americans,” he said in an interview. “You don’t have to work very hard to make those ads.”

The White House argues that the ACA’s insurance mandate isn’t popular and disproportionately affects low- and middle-income Americans who are forced to buy insurance that may be more expensive than they can afford.

“The President’s priorities for tax reform have been clear from the beginning: make our businesses globally competitive, and deliver tax cuts to the middle class,” White House spokesman Raj Shah said in a statement. “He is glad to see the Senate is considering including the repeal of the onerous mandates of Obamacare in its tax reform legislation and hopes that those savings will be used to further reduce the burden it has placed on middle-class families.”

Trump, though, has said proceeds from repealing the insurance mandate should be used to cut taxes even further for wealthy people.

“How about ending the unfair & highly unpopular Indiv Mandate in OCare & reducing taxes even further?” Trump said Monday in a tweet. “Cut top rate to 35% w/all of the rest going to middle income cuts?”

Like Republicans’ failed attempts to repeal the ACA, the tax plan is amassing a growing list of opponents from the world of medicine.

Insurers, hospital groups and disability advocates have spoken out forcefully against the health-care proposals in the bill. Hospitals and insurance groups wrote a letter to congressional leaders on Tuesday warning of dire health-care outcomes if the tax measure becomes law.

“Repealing the individual mandate without a workable alternative will reduce enrollment, further destabilizing an already fragile individual and small group health insurance market on which more than 10 million Americans rely,” said the letter, signed by six health-care groups, including the American Hospital Association and America’s Health Insurance Plans.

]]> 0, 16 Nov 2017 09:49:24 +0000
Costly long-term care insurance isn’t for everyone Thu, 16 Nov 2017 02:16:25 +0000 Health care costs are rising rapidly, and for older adults or people who need help with some daily activities, costs can easily run thousands of dollars.

A 2015 cost of care survey from insurance company Genworth Financial estimated the national median cost of care for a home health aide is $45,760 annually, while the national median cost for a private nursing room home is $91,250 annually.

With costs like that, some people are turning to long-term care insurance to cover these bills. People who are considering purchasing this insurance should know it’s costly, is very complex and not everyone will qualify. We hit some key points that potential buyers should keep in mind.


Financial planner Lacey Manning, founder of LTG Financial in Ocala, Florida, said people should speak to an estate planner, elder law attorneys and accountants to see if these policies make financial sense. They can look at a person’s assets and any other coverage he or she may have from Medicare, Medicaid and other state and federal programs designed to support the sick and elderly.

The reason many people opt for these policies is that they have some financial assets they want to bequeath rather than use that money in case they are sick, said Martin Grace, the Harry Cochran professor of risk at Temple University.

For people without a lot of assets, these policies are too costly, said Mary Alice Hughes, insurance agent at Insurance Advantage & LMA Financial Services in Jacksonville, Ark. People who own a home and have more than $250,000 in other assets can better afford these policies.

“If you only have $200,000 in the bank, then you don’t need long-term care insurance because … the premiums are going to eat into that money,” Hughes said.


These policies are not cheap, but they are less expensive for younger and healthier people. Grace and Hughes said the cheapest options are for people in their 40s without any significant illnesses. Policies are designed so that buyers purchase a set amount of benefit for a certain time frame. Most policies allow buyers access to a pool of money for three or four years.

For example, a healthy person in her 40s may buy a policy with a $7,000 monthly benefit for 48 months (four years), which gives her access to a total of $336,000. This type of policy costs anywhere from $200 to $225 a month, about $2,500 a year, Hughes said. Buyers can add riders, such as inflation protection, so that their benefits grow by 4 percent to keep up with the cost of living.

The premiums can go up significantly as people age, Grace said, which is why someone buying a policy in their 40s will spend less than someone in their 50s or 60s.

“The premiums almost double from your 40s to your 50s to your 60s. It’s really substantial,” Grace said, adding that he recently bought a policy himself and went through this process.

Because premiums can rise, the buyer needs to think about whether he will have future assets to cover premium increases, Hughes said. Some policies have optional nonforfeiture riders buyers can purchase that will protect what they paid for if they no longer can afford the premiums.

“They don’t get the money back, but they just are assured they can use what they have paid,” Hughes said.

These policies require medical underwriting, Grace and Hughes said, and having illnesses will increase the cost.

“There are a lot of situations where … the agent won’t even take an application. Cognitive impairment – dementia, Parkinson’s, Alzheimer’s – will definitely knock you out,” Hughes said.


Long-term care policies don’t last forever. Once they end, people need to tap their other assets if they still need care.

The policies kick in when someone needs help with two or more daily activities, like bathing or dressing, Hughes said, after a waiting period. They can be used for short-term events in which a doctor expects the person’s care to last 90 days or more, or they can be used for when someone enters a permanent facility.

It’s also important to look at how the benefits are structured, whether the buyer gets a daily maximum benefit or a monthly benefit, Manning said. Daily benefits cap how much the person can withdraw on a daily basis, while monthly benefits let the person tap funds as needed during the month to the monthly limit.

“If the daily benefit is only $300 a day, that’s different than a $9,000 monthly benefit,” even though the money is the same, she said.

]]> 0 Americans have a blind spot when it comes to retirement planning: long-term care costs. Even though the majority of Americans will at some point need long-term care, few are budgeting for it.Wed, 15 Nov 2017 23:37:41 +0000
In a first, scientists edit DNA inside patient’s body Thu, 16 Nov 2017 02:05:01 +0000 OAKLAND, Calif. — Scientists for the first time have tried editing a gene inside the body in a bold attempt to permanently change a person’s DNA to cure a disease.

The experiment was done Monday in California on 44-year-old Brian Madeux. Through an IV, he received billions of copies of a corrective gene and a genetic tool to cut his DNA in a precise spot.

“It’s kind of humbling” to be the first to test this, said Madeux, who has a metabolic disease called Hunter syndrome. “I’m willing to take that risk. Hopefully it will help me and other people.”

Signs of whether it’s working may come in a month; tests will show for sure in three months.

If it’s successful, it could give a major boost to the fledgling field of gene therapy. Scientists have edited people’s genes before, altering cells in the lab that are then returned to patients. There also are gene therapies that don’t involve editing DNA.

But these methods can only be used for a few types of diseases. Some give results that may not last. Others supply a new gene like a spare part, but can’t control where it inserts in the DNA, possibly causing a new problem like cancer.

This time, the gene tinkering is happening in a precise way inside the body. It’s like sending a tiny surgeon along to place the new gene in exactly the right location.

“We cut your DNA, open it up, insert a gene, stitch it back up. Invisible mending,” said Dr. Sandy Macrae, president of Sangamo Therapeutics, the California company testing this for two metabolic diseases and hemophilia. “It becomes part of your DNA and is there for the rest of your life.”

That also means there’s no going back, no way to erase any mistakes the editing might cause.

“You’re really toying with Mother Nature” and the risks can’t be fully known, but the studies should move forward because these are incurable diseases, said one independent expert, Dr. Eric Topol of the Scripps Translational Science Institute in San Diego.

Protections are in place to help ensure safety, and animal tests were very encouraging, said Dr. Howard Kaufman, a Boston scientist on the National Institutes of Health panel that approved the studies.

He said gene editing’s promise is too great to ignore. “So far there’s been no evidence that this is going to be dangerous,” he said. “Now is not the time to get scared.”


Fewer than 10,000 people worldwide have these metabolic diseases, partly because many die very young. People with Hunter syndrome lack a gene that makes an enzyme that breaks down certain carbohydrates. These build up in cells and cause havoc throughout the body.

Patients may have frequent colds and ear infections, distorted facial features, hearing loss, heart problems, breathing trouble, skin and eye problems, bone and joint flaws, bowel issues and brain and thinking problems.

Weekly intravenous doses of the missing enzyme can ease some symptoms, but cost $100,000 to $400,000 a year and don’t prevent brain damage.

Madeux, who now lives near Phoenix, is engaged to a nurse, Marcie Humphrey. He met her 15 years ago in a study that tested this enzyme therapy at UCSF Benioff Children’s Hospital Oakland, where the gene editing experiment took place.

Gene editing won’t fix damage he’s already suffered, but he hopes it will stop the need for weekly enzyme treatments.

Initial studies will involve up to 30 adults, but the goal is to treat children very young, before much damage occurs.


A gene-editing tool called CRISPR has gotten a lot of attention, but this study used a different tool called zinc finger nucleases. They’re like molecular scissors that seek and cut a specific piece of DNA.

The therapy has three parts: The new gene and two zinc finger proteins. DNA instructions for each part are placed in a virus that’s been altered to not cause infection but to ferry them into cells. Billions of copies of these are given through a vein. They travel to the liver, where cells use the instructions to make the zinc fingers and prepare the corrective gene. The fingers cut the DNA, allowing the new gene to slip in. The new gene then directs the cell to make the enzyme the patient lacked.

Only 1 percent of liver cells would have to be corrected to successfully treat the disease, said Madeux’s physician and study leader, Dr. Paul Harmatz at the Oakland hospital.

“How bulletproof is the technology? We’re just learning,” but safety tests have been very good, said Dr. Carl June, a University of Pennsylvania scientist who has done other gene therapy work but was not involved in this study.


Safety issues plagued some earlier gene therapies. One worry is that the virus might provoke an immune system attack. In 1999, 18-year-old Jesse Gelsinger died in a gene therapy study from that problem, but the new studies use a different virus that’s proved much safer in other experiments.

Another worry is that inserting a new gene might have unforeseen effects on other genes. That happened years ago, when researchers used gene therapy to cure some cases of the immune system disorder called “bubble boy” disease. Several patients later developed leukemia because the new gene inserted into a place in the native DNA where it unintentionally activated a cancer gene.

“When you stick a chunk of DNA in randomly, sometimes it works well, sometimes it does nothing and sometimes it causes harm,” said Hank Greely, a Stanford University bioethicist. “The advantage with gene editing is you can put the gene in where you want it.”

Finally, some fear that the virus could get into other places like the heart, or eggs and sperm where it could affect future generations. Doctors say built-in genetic safeguards prevent the therapy from working anywhere but the liver, like a seed that only germinates in certain conditions.

This experiment is not connected to other, more controversial work being debated to try to edit genes in human embryos to prevent diseases before birth – changes that would be passed down from generation to generation.

]]> 0 Madeux, who has Hunter syndrome, waits with Marcie Humphrey, at the Oakland, Calif., hospital where an experimental gene therapy took place Monday to combat his disease.Wed, 15 Nov 2017 23:33:16 +0000
Digital pill that tracks use when swallowed gets FDA approval Tue, 14 Nov 2017 15:31:43 +0000 U.S. regulators approved the first medicine with an embedded sensor to help keep track of whether patients with mental illness are adhering to their prescriptions.

The decision marks a milestone in the convergence of technology and health care that also raises privacy concerns.

The so-called digital pill is a version of Otsuka Pharmaceutical Co.’s Abilify, which treats depression, bipolar disorder and schizophrenia. The sensor, developed by Proteus Digital Health, is activated by stomach fluids, sending a signal to a patch worn on the patient’s torso and transmitting the information to a smartphone app.

“This is the first time we’ll have an objective measurement of adherence,” said Kabir Nath, chief executive officer for North America at Otsuka Pharmaceutical. By allowing physicians to track a patient’s use, Nath said he hopes to avert “dramatic and immediate health-care crises, such as for schizophrenia patients where missing medicines can result in a psychotic break which will land them in an ER.”

The Food and Drug Administration’s approval late Monday comes as the technology sector increasingly turns to health care to test advances like machine learning, artificial intelligence and micro-electronics for everything from drug development to insurance.

“Being able to track ingestion of medications prescribed for mental illness may be useful for some patients,” Mitchell Mathis, director of the Division of Psychiatry Products in the FDA’s Center for Drug Evaluation and Research, said in a statement. Through an app, patients can also opt to report activity, rest and mood information to share with their caregiver, the companies said.

While many in the health industry are embracing new technology, others worry about protecting patient privacy as more data is generated and shared.

Patients who are prescribed the product, called Abilify MyCite, have to agree that their physicians can see the data. They can also choose whether or not to share information with caregivers, such as family members. Otsuka Pharmaceutical and certain insurers also plan to gather anonymized, aggregated data from patients who consent.

“We know some people don’t have relief of symptoms, and we don’t know if that’s just because they’re not taking their medication,” Nath said.

Otsuka Pharmaceutical, which is a unit of Tokyo-based Otsuka Holdings Co., plans to start the program with just a handful of health systems and gather evidence on the drug’s effects on adherence, he said.

Not all patients will appreciate such monitoring, says Lucia Savage, chief privacy and regulatory officer at Omada Health Inc., a startup focused on digital counseling programs for chronic conditions like diabetes.

“It creates a looking-over-your-shoulder effect,” Savage said.

Information about mental illness is particularly sensitive, said Savage, who previously was a privacy officer at the Department of Human and Health Services.

She suggested patients and their physicians ask questions like, “How is the data flowing? Where does the signal go? If it goes to somebody’s server, whose server is that? What are the business arrangements?”

Bob McQuade, Otsuka Pharmaceutical’s chief strategic officer, said patients will have a choice. The company will continue to sell regular Abilify, he said, and generic versions of the drug are available as well.

Closely held Proteus is based in Redwood City, California.

]]> 0 U.S. Food & Drug Administration approved the first drug in the United States with a digital ingestion tracking system, in an unprecedented move to ensure that patients with mental illness take the medicine prescribed for them. The drug Abilify MyCite was developed by Otsuka Pharmaceutical Co., Ltd. (AP Photo/Andrew Harnik, File)Tue, 14 Nov 2017 10:42:34 +0000
Fears, language barrier add to problems with lead poisoning for new Mainers Mon, 13 Nov 2017 11:55:29 +0000 LEWISTON —”Kadra Ahmed” already had four children when her youngest son was born. She knew a healthy child from a sick one.

Her baby was a few months old when he started crying incessantly. He seemed constantly irritable, wouldn’t eat.

As he grew older, he struggled to walk. He didn’t talk. He didn’t sleep well. Ahmed, who asked that her real name not be used, quit her job to care for him.

“All our life is dependent on his sickness,” Ahmed said through an interpreter as she held close her now-2-year-old son. “Our life is just changing.”

A routine blood test, done at his doctor’s office, told why.

“They came to me and said, ‘Your son has lead poisoning,'” Ahmed said.

The family was living in an apartment on Bates Street in Lewiston. Lead was common in the downtown buildings.

It still is.

After years of attention and millions of dollars spent on mitigating problem areas, lead paint continues to chip off walls and fill the air with fine lead dust. Lewiston remains the worst area in the state for lead poisoning.

While lead is a potential problem for all children, it can be particularly difficult for new immigrant families to deal with. Parents usually have no knowledge of lead before they move into the city. They don’t know their rights when renting an apartment that could have lead. They fear speaking up, even when their child is sick — sometimes especially when their child is sick, because they don’t want to look like they can’t take care of their children.

The New Mainers Public Health Initiative, a Lewiston nonprofit created in 2014 to help immigrants and refugees with health issues, has encountered child after child damaged by lead poisoning. No firm numbers are available, but officials with the group feel the problem is pervasive.

“You see in every family there is one child who is acting weirdly in that family and if they test for lead it’s always high,” said Sahal Jimale with the New Mainers Public Health Initiative.

While city leaders and health professionals work to keep all of L-A’s youngest residents safe in their own homes, some renters say it’s not enough. Hundreds of apartments are being made lead safe, but thousands remain potential hazards with no solution anytime soon.

Ahmed’s family moved, but it was too late.

“Look at my son,” Ahmed said he started to cry. “All the people out there have the same situation. In one family there’s one or two kids that are getting lead poisoning. All moms have a concern.”


Lead was commonly added to paint in the past century for durability, color and faster drying. It coated doors and windowsills, stairs and banisters, inside walls and the outsides of homes.

The federal government banned the consumer use of lead paint in 1978, but by then it had been in use for decades and covered millions of houses and apartments.

As paint deteriorates — chipping, peeling, cracking or dampened — lead becomes a health hazard. Babies crawl on floors peppered with lead paint dust and then put their hands in their mouths. Teething toddlers gum painted windowsills or eat flakes found around the house. Children play outside in lead-contaminated dirt or breathe air filled with lead dust that someone released by opening a window, walking upstairs or sweeping the floor.

In children, even very low-level lead poisoning can impair development, intelligence and learning, stunt growth and damage hearing.

Peeling paint on the railing of the side entrance at 144 Walnut Street in Lewiston frames a warning notice of the lead hazard on the storm door. Sun Journal/Russ Dillingham

In 2015, Maine, following national standards, lowered the level at which a person is considered to have lead poisoning. Today it stands at 5 micrograms of lead per deciliter of blood, down from 15 micrograms. Advocates, however, say no level of lead is safe.

The older the home, the more likely it is to contain lead paint, and a lot of it.

Lewiston homes, especially downtown apartments, skew old.

Between 2011 and 2015, according to the state, an estimated 241 Lewiston children 3 years old and younger had lead poisoning — almost 8 percent of those tested. That’s more than any other place in the state, including Portland, Maine’s largest city.

Auburn added an estimated 92 children during that time, making L-A’s total even greater.

In 2015 alone, Lewiston-Auburn accounted for nearly 18 percent of the state’s lead poisoning cases for children 3 and younger.

The area’s high rate has concerned people for years.

“I think originally when they started this thing (in the late 1990s), we were going to eliminate lead by 2010,” said Sandy Albert, director of housing improvement services for Community Concepts in Lewiston, which partners with Lewiston-Auburn and the Maine State Housing Authority on lead inspections. “I remember that when I started at the agency, that was the goal. I don’t think they realized how big of an issue it was.”

Multiple organizations have spent years and millions of dollars on the problem, but lead-abatement workers are few and the work they do is time-consuming and expensive. And many homes have lead.

Albert has seen progress over the years, she said, but the breadth of the problem and the work still needed “can be overwhelming.”

“I think that we’re moving where we need to. It will take a long time to get rid of all the lead paint,” she said.

Lewiston and Auburn received their own $3 million federal grant three years ago, money that helped make 207 housing units lead-safe and is expected to help 34 more by the end of the year.

This past summer, the Lewiston-Auburn Lead Program got another $3.4 million from the federal government for lead abatement, money that will help hundreds of homes and apartments in downtown Lewiston and Auburn over the next three years.

The problem? City officials estimate that 9,000 units are in need.

“So I’ve got, like, a hundred years of work at this pace,” said Travis Mills, manager of the Lewiston-Auburn Lead Program.


Within Lewiston, the highest lead rate is downtown — an area filled with 100-year-old apartment buildings and poor families with young children. Some residents are native Mainers, others are first-generation immigrants.

“It affects all Mainers,” said Fowsia Musse, a community health outreach worker for Healthy Androscoggin’s lead poisoning prevention program. “It affects equally.”

But while lead can affect anyone, new immigrant families have a especially hard time dealing with it.

A lead paint notice on the storm door on the side porch entrance at 144 Walnut Street in Lewiston. Sun Journal/Russ Dillingham

“They don’t understand lead as much as we may, and I don’t think we even understand it as much as some parents should,” Albert said. “(Immigrants) are facing a poison they don’t even know.”

When families first move to Lewiston, they often don’t realize lead is a problem, so they don’t ask about it when considering an apartment. Parents may not speak the language or understand their rights when it comes to lead abatement. They fear if they speak up about a sick child, it will look like they can’t take care of their family and their children will be taken from them.

Even if a child is diagnosed with lead poisoning, parents may avoid the early interventions that could help with developmental delays and cognitive problems because they don’t want their child stigmatized.

“Sometimes some of the parents, they don’t come out,” said Hassan Abdi, a case manager at the New Mainers Public Health Initiative. “They keep just locked in the house. They say, ‘If I tell the community, they’re going to shame me because of my child.’ There is no access of special needs (help) until they’re school-aged.”

That leads to even bigger problems in school. Officials with the New Mainers Public Health Initiative believe Lewiston’s schoolchildren are too often diagnosed as having autism, attention-deficit disorder, behavioral problems or other issues when they’re actually suffering from the effects of lead poisoning.

Superintendent Bill Webster agrees.

“I can’t answer that with any hard data, but I have no doubt that exists,” he said.

Lewiston spends more than any other school system in the state on special education.

In 2015-16, a full quarter of the Lewiston School Department budget — $15.9 million — went to special education. In comparison, Portland spent $13.8 million, about 14.5 percent of its budget.

While Webster said lead doesn’t account for all special needs, he believes it’s a factor.

“The research is clear that lead significantly impacts kids’ ability to learn and function well in school or in life,” he said. “I wish that there were no lead in any houses that had children in Lewiston, or anywhere, for that matter.”

Ahmed wishes that, too.


Ahmed moved to the United States on Jan. 1, 2015. She was from Somalia and had been living with her husband and four children, now ages 9 to 18, in a refugee camp in Ethiopia.

Her husband is still there, waiting to come to the U.S.

Ahmed’s youngest son was born not long after the family settled in Maine. He was healthy, they were living in an apartment on Bates Street, everything seemed fine.

When he was a few months old, he started to get sick.

“Since then, he is still now sick,” Ahmed said through an interpreter.

The family left the Bates Street apartment for a lead-safe apartment on Knox Street just over a year ago. His lead levels have dropped, Ahmed said, but the damage is done.

At 2 he doesn’t walk well, won’t eat much and speaks only a word or two — one of them “Mommy.” He seems especially irritated by lights, covering his eyes and crying if they’re too bright. He’s anemic.

Ahmed was called home so often that she had to leave her job to care for her son. She’s found it impossible to get a baby sitter willing to care for a sick toddler.

Ahmed has no idea whether he’ll get better. She worries about his future.

“It depends on God’s hand,” she said. “Only God knows. I cannot predict now.”

Ahmed said she, like so many others living downtown, had no idea about lead when she moved into the city.

“They don’t know about the lead poisoning; they are new,” she said. “If I knew, I wouldn’t deliver him in that house.”

Immigrant groups and health care providers have worked to educate people about lead. Word has also spread among the downtown community — some of whom believe too little is being done to address the lead in their neighborhoods.

“In April we had (National) Public Health Week. For us, our role was to talk about the social determinant of health, how well we’re living, where we’re working is affecting our health,” said Hibo Omer, program director at the New Mainers Public Health Initiative. “And then, out of that discussion came an angry crowd of 30, who all of them were directly or indirectly affected by lead.”

A representative from U.S. Sen. Angus King’s office, touring the area for National Public Health week, took the brunt of residents’ frustrations as the closest government official.

“They would say through an interpreter, ‘Tell her! Tell her!’ I’m like, ‘She didn’t do it,'” Omer said. “I felt so bad because all the anger that the community had was geared toward her.”


Government officials and public health groups say they’re working on the lead problem as fast as they can. And they have made progress.

More Lewiston-Auburn babies and toddlers are getting screened for lead, up 18 percent, from 580 in 2003 to 686 in 2012, the last year those numbers are available.

Statewide, lead poisoning among infants and toddlers has plummeted, from 1,189 cases in 2003 to 314 in 2015. Lewiston-Auburn’s numbers have gone up and down during that time, but the cities saw a dip from 2013 to 2015, the last year figures are available.

When a child tests positive for lead, doctors must notify state health officials, who then order an inspection of the child’s home. If lead is found, according to new state rules, landlords have 30 days to take steps to correct the problem or face penalties of up to $500 per day, per unit. That has helped spur Lewiston-Auburn building owners to take action.

The Lewiston Area Public Health Committee is discussing new rental regulations that it hopes to present to the Lewiston City Council at some point. The proposal is still forming, but based on their research into other cities, members say a new policy could require landlords to pay to register their rental units, with that money funding local lead inspections. Lead-safe units could be noted on the registry, helping tenants and landlords find each other.

But even with the progress, problems remain.

Lead inspectors currently post notices on apartment buildings that have tested positive for lead, but landlords or tenants sometimes pull them down.

Building owners are required to disclose lead hazards to tenants. However, many tenants don’t know that. And even if they’re handed a technical lead report, they may not understand it.

Lead abatement is expensive, so landlords often apply for one of the grants available to them. But even if they get that help, few contractors in Maine are trained to do the work and their waiting lists are long.

“Personally, I can tell you if I have an application that comes in right now and everything looks good to go, it’ll probably be six to nine months before somebody shows up at the apartment and fixes it,” said Mills with the Lewiston-Auburn Lead Program.

In the meantime, tenants are not required to move out. And while one Lisbon Street landlord, local legislator Bettyann Sheats, decided on her own to put her tenants up in a hotel for two months while she waited for workers to deal with lead in the building, such a move is unusual.

“The state does not require that,” Mills said. “Case-by-case basis, they may try to compel that if they think there’s a severe risk.”

The Maine State Housing Authority and the Maine Department of Health and Human Services created an online search tool for people looking for rentals. In a search this week, the site listed 34 Lewiston apartments that were lead-safe or completely free from lead paint, but only five were actually available. One of the five was reserved for seniors only. Two took Section 8 housing subsidies.

Even when a unit is made “lead-safe,” that doesn’t mean it’s lead-free. In abatement, lead paint is typically painted over. That stops lead dust and paint chips, but as soon as the area is damaged — a scratch on the wall or a nail hole, for example — lead becomes a problem again.

That leaves downtown residents anxious.

“These are future Mainers. These kids are being born in Lewiston; they are being affected in Lewiston,” Omer said. “Somebody has to do something.”

After the Lewiston-Auburn Lead Program announced its latest $3.4 million lead-abatement grant, the head of the New Mainers Public Health Initiative reached out to city officials. I hope, he said, this means we’ll see improvement.

Lewiston-Auburn Lead Program and New Mainers Public Health Initiative leaders have met a couple of times since to discuss the lead problem and what’s being done.

Both sides agree lead is a problem that needs to be solved.

“As one mom with a child with lead poisoning, I am representing all the moms,” Ahmed said. “I’m just telling you to tell to the government to change the housing for rent.”

]]> 0, 13 Nov 2017 07:16:23 +0000
Lewiston legislator introduces bill to restore student health centers in 15 schools across the state Mon, 13 Nov 2017 09:00:00 +0000 Maine lawmakers will take up a bill in the next legislative session to unwind the impacts of a last-minute state budget deal that slashed funding unexpectedly to more than a dozen school-based student health centers.

The proposal by Rep. Jim Handy, D-Lewiston, would restore 15 school-based health clinics that lost funding last July.

Thousands of students are served in the health care centers, which provide dental and medical care, chronic illness management for diseases such as diabetes and asthma, counseling services for suicide prevention and drug and alcohol prevention services, routine physical exams and immunizations, prescriptions and laboratory testing.

Educators say having the services on-site helps students without access to a doctor, and allows students to get medical care without missing too much class time or their parents having to miss work.

The direct cuts to the health centers last July were the result of the final state budget redirecting $10 million over two years from the Fund for a Healthy Maine to maintain reimbursement rates for primary care physicians under MaineCare, the state’s version of the federal Medicaid program.

The cuts have meant dropping services at some of the centers, and forcing school districts to use their local school budgets to make up for the lost state funding.

In Lewiston and Auburn, the four school-based health centers have dropped medical care services to salvage mental health counseling services. In addition, the Lewiston School Department is providing its own funding to pay for one nurse practitioner to work at multiple schools, said Joan Churchill, chief executive officer of St. Mary’s Hospital’s community clinical services, which runs the centers. They lost a $200,000 contract, which makes up one-third to one-half of the centers’ budgets.

“(We) cannot do full (school-based health center) model but this is much better than nothing,” Churchill said.

In Portland, the cuts killed $191,000 out of a $330,000 budget for four health centers at Portland, Casco Bay and Deering high schools and at King Middle School that serve almost 1,000 students.

To fill the gap, the school board voted to allocate $145,000 to Greater Portland Health, which runs the centers. The center plans to make up the rest of the gap with efficiencies and fundraising, Superintendent Xavier Botana said.

The district drew those funds from additional education funding – $2.7 million for Portland – that was also in the state budget agreement, which provided an extra $162 million statewide over two years.

In Calais, the health care center used by 80 percent of middle and high school students lost $46,200.

Calais School District Superintendent Ron Jenkins said he’s had to “move some numbers around” to keep the center operating this year – but it’s not clear just yet whether he’ll get to the end of the year, financially.

“We are still short a third, or about half, of what we need to replace the $46,000,” he said. “I’m relatively confident we will find it for this year. We simply decided we’re going to keep everything we had as intact as possible.”

But if the funding isn’t restored, that will have to change, he said. The first cut will probably be to counseling services, he said.

“We will do whatever we can to keep the program,” he said. “You never miss anything until it’s gone.”

Lawmakers will take up Handy’s bill in the new session, which will get down to business in January.

]]> 0 Handy, LewistonMon, 13 Nov 2017 06:37:58 +0000
Tick-borne anaplasmosis surging in Maine – and it’s worse than Lyme Mon, 13 Nov 2017 09:00:00 +0000 Reported cases of a tick-borne disease are swelling in Maine this year, but it’s not Lyme disease.

Cases of anaplasmosis, an illness with flu-like symptoms that are similar to Lyme but typically more severe, have jumped from 52 a year in Maine five years ago to 433 this year, through Oct. 24, according to the Maine Center for Disease Control and Prevention. Of this year’s 433 cases, 113 were hospitalized, according to Maine CDC statistics.

The deer tick, the same tick that’s a carrier for the bacteria that cause Lyme disease, is also a carrier for anaplasmosis.

Lyme – of which there have been more than 1,000 cases per year in Maine since 2011 – has established a long-term presence inMaine the state, but anaplasmosis has remained under the radar.

Until now.

Mark Elwin sips coffee on his screened-in porch at his home. Elwin tested positive for anaplasmosis in 2015, was hospitalized, and he said he’s been suffering from the tick-borne disease ever since. He cannot work and many days cannot even leave his bed. Staff photo by Brianna Soukup

Anaplasmosis cases are also rising in other New England states: Massachusetts had 828 cases in 2016 compared to about 200 in 2012, while New Hampshire, Vermont and Rhode Island are also reporting increases. Lyme cases remain strong in Maine, but the 1,039 cases through September of this year are below five-year averages. Another tick-borne disease, babesiosis, is also increasing, but still at much lower rates than Lyme or anaplasmosis, with 93 cases through September.

Anaplasmosis symptoms are flu-like and can include fever, chills, fatigue and joint pain. About 25-30 percent of all anaplasmosis cases result in hospitalizations, compared to about 5 percent of Lyme cases.

Mark Elwin, 52, of Walpole – a village in South Bristol – said anaplasmosis sent him to the hospital in 2015, and he’s been infected since then.

“I was miserable. I could barely roll over in bed it hurt so much,” Elwin said of the symptoms that led him to the hospital.

Mainers are more at risk of anaplasmosis, experts say, for a number of reasons.

Part of the issue is greater awareness and more testing by people who fall ill. But also, more deer ticks are infected with anaplasmosis and passing the bacteria on to humans, said Chuck Lubelczyk, a field biologist with the Maine Medical Center Research Institute in Scarborough.

“It certainly is spreading,” Lubelczyk said.

Several years ago, in southern Maine 5 percent or fewer of ticks that were tested had anaplasmosis, he said. Now, it’s doubled, and about 10 percent of the ticks are infected with anaplasmosis.

In the midcoast and points north, it was extremely rare for a deer tick to have anaplasmosis bacteria. A few percent of the tested ticks along the midcoast now have it, about the same rates as southern Maine five to seven years ago, Lubelczyk said.

In comparison, more than 50 percent of deer ticks – sometimes more than 65 percent – carry Lyme disease in Maine.

Lubelczyk said ticks seem to be out earlier and longer than previously, emerging earlier in the spring and lingering into the fall, and he sees more nymph-stage ticks, which are small and difficult to detect.

“We may be having two different tick populations, one that arrives earlier and another that arrives later. It’s not clear yet,” he said.

Sara Robinson, a Maine CDC epidemiologist, said anaplasmosis is more difficult to detect than Lyme, as anaplasmosis does not have the “bull’s-eye” rash that appears in some infected with Lyme, signaling that they have the disease.

Robinson said the best way to tell is if you’re feeling like you have the flu outside of flu season, which is typically October to May.

Mark Elwin thumbs though his file of medical records on his screened-in porch. Staff photo by Brianna Soukup

“If you feel like you’re getting the flu in the summer, call your doctor,” Robinson said.


Elwin, who went to the hospital with anaplasmosis in 2015, said the infection sent his life spiraling downward.

“It’s been devastating,” said Elwin, whose home is in the woods, surrounded by towering pines and birch trees, a natural habitat for ticks.

Elwin said he first started feeling fatigued and getting flu-like symptoms on a Friday in mid-September 2015. By the weekend he could barely move, with symptoms that included fever, chills, sweating, and aches and pains.

“I was lying in bed all day because of the pain in my shoulders, arms and head,” he said. “Everything hurt.”

He went to his primary care doctor on Monday, where he tested positive for anaplasmosis, and was given antibiotics. He spent a few hours at Miles Memorial Hospital’s emergency department later that week after he felt dehydrated. He was given fluids and sent home. Later, he also tested positive for Lyme.

Elwin in his woodworking workshop at his parents house. Before contracting anaplasmosis in 2015, Elwin made furniture, toolboxes and other things with wood, but now it takes him months, if not years, to complete something. Staff photo by Brianna Soukup

Elwin said he didn’t know he had been bitten by a tick.

Elwin said ever since his anaplasmosis diagnosis, he’s felt terrible and been unable to work full time at carpentry, which was how he made his living. He is still trying to do carpentry as a hobby but finds activities beyond reading difficult. Elwin also tested positive for anaplasmosis in October 2016, according to medical records he provided to the Press Herald.

“I’ve read all the Greek tragedies. I never knew I wanted to do that, but now I have,” Elwin said.

Dr. Heidi Heap-Chester, Elwin’s primary care doctor, said Elwin has tested positive for “multiple tick-borne diseases.”

“Anaplasmosis is becoming more frequent in Maine and particularly emergency room and urgent care sites need to be aware that a ‘summer flu’ in an endemic area is anaplasmosis until proven otherwise,” Heap-Chester said.

Anaplasmosis responds well to antibiotic treatment if caught early, but it’s difficult to catch early.

Prevention is also key. Wear long clothing and repellents when in tick habitat, such as the woods, and when picking up dead wood or leaves. Check often for ticks, which are difficult to see. Lubelczyk said one of the more common ways to pick up a tick is from your pet. The tick that’s on your pet can drop off after feeding and crawl on you.

People who do find a tick on them should remove it immediately and have it tested. In most cases, ticks need to be attached to a human for 36 hours before diseases can be transmitted.

]]> 0 Elwin poses for a portrait near his home in Walpole. He was hospitalized for tick-borne anaplasmosis in 2015. Still unable to work, he says of his downward spiral, "It's been devastating." Experts recommend wearing long clothing and checking for ticks often.Fri, 17 Nov 2017 16:56:01 +0000
Schwarzenegger tells climate activists to focus on health threats Mon, 13 Nov 2017 03:29:50 +0000 Movie star and former California governor Arnold Schwarzenegger wants environmental activists to give more attention to immediate health hazards like air and water pollution.

Schwarzenegger spoke Sunday at a global climate meeting in Bonn, Germany, where diplomats from around the world are discussing implementing the Paris climate accord.

He said: “It’s time we wake up and talk about what really matters: 25,000 people dying every day because of pollution.”

Schwarzenegger also criticized the environmental community for “missing the point” with its messaging on global warming.

He said: “People do not focus as much on 2 degrees energy increases in temperatures or increases in sea levels rising.”

Schwarzenegger thinks calling attention to concrete issues, like “so many people having problems with cancer and kids with asthma,” is a better approach.

]]> 0 Schwarzenegger arrives at a climate conference Sunday in Bonn, Germany.Mon, 13 Nov 2017 00:23:44 +0000
Study suggests women less likely to get CPR from bystanders Sun, 12 Nov 2017 23:18:53 +0000 ANAHEIM, Calif. — Women are less likely than men to get CPR from a bystander and more likely to die, a new study suggests, and researchers think reluctance to touch a woman’s chest might be one reason.

Only 39 percent of women suffering cardiac arrest in a public place were given CPR versus 45 percent of men, and men were 23 percent more likely to survive, the study found.

It involved nearly 20,000 cases around the country and is the first to examine gender differences in receiving heart help from the public versus professional responders.

“It can be kind of daunting thinking about pushing hard and fast on the center of a woman’s chest” and some people may fear they are hurting her, said Audrey Blewer, a University of Pennsylvania researcher who led the study.

Rescuers also may worry about moving a woman’s clothing to get better access, or touching breasts to do CPR, but doing it properly “shouldn’t entail that,” said another study leader, Dr. Benjamin Abella. “You put your hands on the sternum, which is the middle of the chest. In theory, you’re touching in between the breasts.”

The study was discussed Sunday at an American Heart Association conference in Anaheim.

Cardiac arrest occurs when the heart suddenly stops pumping, usually because of a rhythm problem. More than 350,000 Americans each year suffer one in settings other than a hospital. About 90 percent of them die, but CPR can double or triple survival odds.

“This is not a time to be squeamish, because it’s a life-and-death situation,” Abella said.

Researchers had no information on why rescuers may have been less likely to help women. But no gender difference was seen in CPR rates for people who were stricken at home, where a rescuer is more likely to know the person needing help.

The findings suggest that CPR training may need to be improved. Even that may be subtly biased toward males – practice mannequins (they’re not called “woman-nequins”) are usually male torsos, Blewer said.

“All of us are going to have to take a closer look at this” gender issue, said the Mayo Clinic’s Dr. Roger White, who co-directs the paramedic program for the city of Rochester, Minnesota. He said he has long worried that large breasts may impede proper placement of defibrillator pads if women need a shock to restore normal heart rhythm.

The Heart Association and the National Institutes of Health funded the study.

]]> 0 Sun, 12 Nov 2017 18:38:32 +0000
Even one drink a day can increase risk of cancer, new report says Sat, 11 Nov 2017 22:32:11 +0000 Do you enjoy the occasional cocktail?

Beware, because even moderate consumption of alcohol can increase your risk of cancer, according to a new report.

Researchers from the American Society of Clinical Oncology recently conducted an experiment, published in the Journal of Clinical Oncology, to determine the link between drinking and the disease.

To do so, they looked at several studies that found a strong correlation between alcohol and cancer.

After gathering all the data, they concluded that about 3.5 percent of all cancer-related deaths were because of alcohol consumption.

Furthermore, in 2012, they discovered that about 5.5 percent of all new cancer occurrences and 5.8 percent of all cancer deaths worldwide were attributable to drinking alcohol.

“The importance of alcohol drinking as a contributing factor to the overall cancer burden is often underappreciated,” the organization said.

“Associations between alcohol drinking and cancer risk have been observed consistently regardless of the specific type of alcoholic beverages.”

While researchers noted the greatest risk was among those with heavy and long-term use and those who also smoked cigarettes, moderate drinking is risky, too. Scientists described moderate as up to one drink per day for women and up to two drinks per day for men.

This was particularly the case with oropharyngeal and breast cancer.

“A meta-analysis that focused solely on cancer risks associated with drinking one drink or fewer per day observed that this level of alcohol consumption was still associated with some elevated risk for … oropharyngeal cancer and breast cancer,” the authors wrote.

]]> 0 Sat, 11 Nov 2017 17:32:11 +0000
Trying to unravel the mystery of a 1918 veteran and the flu pandemic Fri, 10 Nov 2017 21:22:39 +0000 Vaccination is underway for the 2017-2018 seasonal flu, and next year will mark the 100-year anniversary of the 1918 flu pandemic, which killed roughly 40 million people. It is an opportune time to consider the possibility of pandemics – infections that go global and affect many people – and the importance of measures aimed at curbing them.

The 1918 pandemic was unusual in that it killed many healthy 20- to 40-year-olds, including millions of World War I soldiers. In contrast, people who die of the flu are usually under 5 years old or over 75.

The factors underlying the virulence of the 1918 flu are still unclear. Modern-day scientists sequenced the DNA of the 1918 virus from lung samples preserved from victims. However, this did not solve the mystery of why so many healthy young adults were killed.

I started investigating what happened to a young man who immigrated to the U.S. and was lost during World War I. Uncovering his story also brought me up to speed on hypotheses about why the immune systems of young adults in 1918 did not protect them from the flu.


Certificates picturing the goddess Columbia as a personification of the U.S. were awarded to men and women who died in service during World War I. One such certificate surfaced many decades later. This one honored Adolfo Sartini and was found by grandnephews who had never known him: Thomas, Richard and Robert Sartini.

The certificate was a message from the past. It called out to me, as I had just received the credential of certified genealogist and had spent most of my career as a scientist tracing a gene that regulates immune cells. What had happened to Adolfo?

A bit of sleuthing identified Adolfo’s ship listing, which showed that he was born in 1889 in Italy and immigrated to Boston in 1913. His draft card revealed that he worked at a country club in the Boston suburb of Newton. To learn more, Robert Sartini bought a 1930 book entitled “Newton War Memorial” on eBay. The book provided clues: Adolfo was drafted and ordered to report to Camp Devens, 35 miles from Boston, in March of 1918. He was later transferred to an engineer training regiment.

To follow up, I posted a query on the “U.S. Militaria Forum.” Here, military history enthusiasts explained that the Army Corps of Engineers had trained men at Camp A. A. Humphreys in Virginia. Perhaps Adolfo had gone to this camp?

While a mild flu circulated during the spring of 1918, the deadly strain appeared on U.S. soil on Tuesday, Aug. 27, when three Navy dockworkers at Commonwealth Pier in Boston fell ill. Within 48 hours, dozens more men were infected. Ten days later, the flu was decimating Camp Devens. A renowned pathologist from Johns Hopkins, William Welch, was brought in. He realized that “this must be some new kind of infection or plague.” Viruses, minuscule agents that can pass through fine filters, were poorly understood.

With men mobilizing for World War I, the flu spread to military installations throughout the U.S. and to the general population. It hit Camp Humphreys in mid-September and killed more than 400 men there over the next month. This included Adolfo Sartini, age 29½. Adolfo’s body was brought back to Boston.

His grave is marked by a sculpture of the lower half of a toppled column, epitomizing his premature death.


The quest to understand the 1918 flu fueled many scientific advances, including the discovery of the influenza virus. However, the virus itself did not cause most of the deaths. Instead, a fraction of individuals infected by the virus were susceptible to pneumonia due to secondary infection by bacteria. In an era before antibiotics, pneumonia could be fatal.

Recent analyses revealed that deaths in 1918 were highest among individuals born in the years around 1889, like Adolfo. An earlier flu pandemic emerged then, and involved a virus that was likely of a different subtype than the 1918 strain. These analyses engendered a novel hypothesis, discussed below, about the susceptibility of healthy young adults in 1918.

Exposure to an influenza virus at a young age increases resistance to a subsequent infection with the same or a similar virus. On the flip side, a person who is a child around the time of a pandemic may not be resistant to other, dissimilar viruses. Flu viruses fall into groups that are related evolutionarily. The virus that circulated when Adolfo was a baby was likely in what is called “Group 2,” whereas the 1918 virus was in “Group 1.” Adolfo would therefore not be expected to have a good ability to respond to this “Group 1” virus. In fact, exposure to the “Group 2” virus as a young child may have resulted in a dysfunctional response to the “Group 1” virus in 1918, exacerbating his condition.

Support for this hypothesis was seen with the emergence of the Hong Kong flu virus in 1968. It was in “Group 2” and had severe effects on people who had been children around the time of the 1918 “Group 1” flu.


What causes a common recurring illness to convert to a pandemic that is massively lethal to healthy individuals? Could it happen again? Until the reason for the death of young adults in 1918 is better understood, a similar scenario could reoccur. Experts fear that a new pandemic, of influenza or another infectious agent, could kill millions. Bill Gates is leading the funding effort to prevent this.

Flu vaccines are generated each year by monitoring the strains circulating months before flu season. A time lag of months allows for vaccine production. Unfortunately, because the influenza virus mutates rapidly, the lag also allows for the appearance of virus variants that are poorly targeted by the vaccine. In addition, flu pandemics often arise upon virus gene reassortment. This involves the joining together of genetic material from different viruses, which can occur suddenly and unpredictably.

An influenza virus is currently killing chickens in Asia, and has recently killed humans who had contact with chickens. This virus is of a subtype that has not been known to cause pandemics. It has not yet demonstrated the ability to be transmitted from person to person. However, whether this ability will arise during ongoing virus evolution cannot be predicted.

The chicken virus is in “Group 2.” Therefore, if it went pandemic, people who were children around the time of the 1968 “Group 2” Hong Kong flu might have some protection. I was born much earlier, and “Group 1” viruses were circulating when I was a child. If the next pandemic virus is in “Group 2,” I would probably not be resistant.

It’s early days for understanding how prior exposure affects flu susceptibility, especially for people born in the last three to four decades. Since 1977, viruses of both “Group 1” and “Group 2” have been in circulation. People born since then probably developed resistance to one or the other based on their initial virus exposures. This is good news for the near future since, if either a “Group 1” or a “Group 2” virus develops pandemic potential, some people should be protected. At the same time, if you are under 40 and another pandemic is identified, more information would be needed to hazard a guess as to whether you might be susceptible or resistant.

This article was originally published on The Conversation. Read the original article here. The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.

]]> 0 with patients in an emergency hospital in Camp Funston, Kansas, during the influenza epidemic around 1918. National Museum of Health and Medicine., CC BYFri, 10 Nov 2017 17:18:51 +0000
Massachusetts to study cost of single-payer health insurance Fri, 10 Nov 2017 18:15:02 +0000 BOSTON – The Massachusetts Senate approved a wide-ranging health care reform bill late Thursday that includes a call for the state to study how much a single-payer insurance system would cost.

Final passage came on a 33-6 vote shortly before midnight after two days of debate and dozens of amendments. All six Republicans in the Democratic-controlled chamber voted against the final bill, which faces an uncertain road ahead.

The legislation seeks to lessen the wide price disparities between large hospitals, like those in Boston, and smaller community hospitals around the state. The smaller providers have long complained that they are paid significantly less for providing the same or similar services to patients as the bigger facilities.

Following objections from Partners Healthcare, the state’s largest provider, the Senate modified a provision that originally sought to penalize the state’s three biggest hospitals if they failed to hit benchmarks for controlling spending.

The bill also seeks to address rising drug costs by requiring pharmaceutical companies to submit pricing data to the state’s Center for Health Information and Analysis. And it would require hospitals to formulate strategies for reducing the number of patients who are readmitted for care within 30 days of their original discharge.

The Senate voted 35-3 to adopt an amendment proposed by Sen. Julian Cyr, a freshman Democrat from Truro, calling for a study of what it would cost Massachusetts to implement a government single-payer health care system, along the lines of what Vermont U.S. Sen. Bernie Sanders advocated for on the federal level during his 2016 presidential campaign.

If the annual cost estimate was lower than the overall cost of the current market-based system, the state would then be directed to begin laying groundwork for a single-player plan.

Another of the bill’s provisions allows licensing of dental therapists, who wouldn’t be dentists but could perform some common procedures such as fillings and tooth extractions in community settings.

The bill now moves to the House, where Democratic leaders have indicated plans to write their own reform bill, and one that may be narrower in scope that then Senate.

Republican Gov. Charlie Baker, who supports some of the Senate’s initiatives, has been critical of senators for not pursuing many of the cost-saving measures he proposed for MassHealth, the state’s Medicaid system.

“My big concern about the Senate health care bill is it doesn’t save the state any money,” Baker told reporters Thursday.

Senate Ways and Means Chairman Karen Spilka has estimated the Senate bill would trim annual MassHealth spending by $114 million, while reducing overall health care costs from $475 million to $525 million by 2020.

Health Care for All, a group that advocates for affordable universal care, praised the Senate approach.

“This comprehensive bill takes bold action to reduce health costs, protect consumers in health insurance plans, advance oral health, and improve the quality of our care,” said Amy Rosenthal, the group’s executive director, in a statement prior to final passage.

]]> 0 lift up a sheet of skin in a lab at St Josef-Hospital in Bochum, Germany. A boy treated two years ago with genetically modified skin is doing well today, doctors say.Fri, 10 Nov 2017 18:45:39 +0000
Medicaid expansion may strain Maine’s budget, credit rating agency says Thu, 09 Nov 2017 17:59:11 +0000 The credit rating agency Moody’s Investors Service has warned that the decision by Maine voters to expand Medicaid might make it more difficult for the state to keep its budget balanced.

The statewide referendum Tuesday made about 70,000 low-income citizens eligible for Medicaid. Thirty-one other states have already expanded Medicaid, but Maine was the first to do it through a public vote, despite opposition from Republicans such as Gov. Paul LePage.

Moody’s released a report Wednesday that said the move “may increase budget pressure for the state.” The expansion will increase the state’s Medicaid costs by at least $55 million when it’s fully implemented in 2021, reported Moody’s, a New York-based business considered one of the “Big Three” credit rating agencies.

The state could also face risk based on what happens at the federal level, Moody’s said.

“The larger risk to the state is that the federal government could reduce Medicaid funding,” the agency said. “If funding for the federal expansion program is cut or eliminated, Maine would face budget pressure if it decides to maintain similar levels of coverage.”

LePage has said he won’t implement the voter-approved expansion until it’s fully funded by the state Legislature. His office said Wednesday it expects to see more critical reviews of the expansion from credit agencies. LePage called expansion “fiscally irresponsible” and “ruinous to Maine’s budget” Wednesday.

About 268,000 people currently receive Medicaid in the state. Medicaid expansion supporters in at least two other states, Idaho and Utah, are also looking to get the question on public ballots.

A spokesman for Mainers For Health Care, which campaigned for the Medicaid question to pass, said LePage is touting the Moody’s report to drum up unfounded fears about the cost of expanding health coverage.

“National, multi-state and single-state studies show that states expanding Medicaid under the ACA have realized budget savings, revenue gains and overall economic growth,” said the spokesman, David Farmer.

]]> 0 strong vote in favor of Medicaid expansion should send lawmakers the message that most Mainers don't side with the governor on this issue.Thu, 09 Nov 2017 20:50:06 +0000
Maine DHHS misspent $13 million intended for low-income families Thu, 09 Nov 2017 15:53:55 +0000 AUGUSTA — The Maine Department of Health and Human Services unlawfully spent over $13 million in federal funds in 2015 and 2016, but is unlikely to face a penalty for the misuse.

DHHS spent $13.4 million in welfare funds on services for elderly and disabled Maine residents. The Bangor Daily News reports federal law requires states to use money on programs for low-income families with children.

A 2016 report by State Auditor Pola Buckley highlighted the “improper management” of federal funds. Federal officials are currently reviewing the audit report. Maine DHHS is unlikely to face a penalty as it reversed its unlawful spending and retroactively returned the funding, meeting a 2016 deadline to return the funds.

DHHS has maintained it misspent the funds because department officials were unclear on federal rules.

]]> 0 Maine DHHS says it already had taken steps to address some of the issues raised in a highly critical federal audit.Thu, 09 Nov 2017 13:57:08 +0000
Maine’s ballot-box expansion of Medicaid likely to inspire referendums elsewhere Thu, 09 Nov 2017 01:43:25 +0000 When Maine voters overwhelmingly said “yes” to Medicaid expansion Tuesday, Luke Mayville was closely tracking the results from 2,900 miles away in Moscow, Idaho.

“We were eagerly awaiting Maine’s vote,” said Mayville, co-founder of Reclaim Idaho, a grassroots group that’s attempting to get Medicaid expansion on Idaho’s statewide ballot in 2018. “We see the campaign in Maine as something to emulate.”

Maine became the first state in the nation to approve Medicaid expansion by referendum, making an estimated 70,000 low-income Mainers eligible for Medicaid.

Mayville said the margin of victory – 59 percent to 41 percent – is providing momentum for the effort in Idaho, considered a much more conservative state.

“The win was nearly 20 points. We don’t have to win by 20. If you win by 5 that’s still a win,” Mayville said. “The Maine vote is the best support yet for our argument. It didn’t just win. It won by a landslide.”


The Maine vote was closely watched both in Idaho and across the country as an indicator of what could happen to Medicaid expansion efforts in other states. The national media highlighted the Maine vote in the run-up to the election – including stories by The New York Times and The Wall Street Journal – at a time when President Trump and congressional Republicans were working to repeal or undermine the Affordable Care Act, which subsidizes Medicaid expansion.

With Tuesday’s vote, Maine will become the 32nd state to expand Medicaid – although Gov. Paul LePage is trying to block implementation. Other states considering expansion ballot initiatives include Utah and Kansas.

States that choose to go the referendum route could see an infusion of out-of-state political money, as happened in Maine. The “yes” campaign in Maine benefited from an outpouring of funds from progressive groups.

Washington, D.C.-based The Fairness Project, a liberal advocacy group, contributed about $700,000 to the $2 million Mainers for Health Care campaign. Another Washington liberal advocacy group, the Sixteen Thirty Fund, pitched in $600,000, according to campaign filings with the Maine Commission on Governmental Ethics and Election Practices.

Jonathan Schleifer, executive director of The Fairness Project, said the group’s experience working on the Maine minimum wage campaign in 2016 propelled it to get involved in Medicaid expansion. Maine voters approved a $12 minimum wage a year ago.

The Fairness Project, which has a $2.8 million operating budget, was launched two years ago and is primarily funded by a California public employees union and Dr. Bronner’s, a California company known for making soap.

In an interview Wednesday with the Portland Press Herald, Schleifer said he was in Maine on Saturday through Tuesday to help knock on doors, organize and attend the election night party at the Bayside Bowl in Portland.

“What Maine did was historic,” he said.

He said that when Mainers for Health Care reached out to him this year to work on Medicaid expansion, “we didn’t hesitate.”

“We were so impressed with the grassroots infrastructure they had in Maine from the minimum wage campaign that when they said they had a plan to expand Medicaid and would we back them, we said ‘Absolutely,’ ” Schleifer said.


David Farmer, spokesman for Mainers for Health Care, said national progressive organizations support statewide ballot initiatives that they believe will succeed, and for issues that “matter in people’s lives.” Increasingly, states that allow citizen referendums are seeing more of them when issues stall out in the Legislature. LePage vetoed Medicaid expansion five times.

Diane Rowland, executive vice president of the Kaiser Family Foundation, said she sees the Maine results reverberating across the nation, spurring other states to try it.

“A lot of people were looking at Maine to see what the results would be,” she said. “If Maine had success, it would give them the impetus to do it. They have a victory to talk about now.”

Once Medicaid expansion is implemented, Mainers who are jobless or earn up to 138 percent of the federal poverty level will be eligible for the free insurance. The Affordable Care Act made Medicaid expansion attractive to states by funding 90 percent or more of the cost of expansion.

For Maine, that means spending about $54 million in state money annually and receiving $525 million per year in federal money. The funding is expected to boost rural hospitals, expand treatment options for substance use recovery and mental health programs, and create jobs in the health field. States that have expanded Medicaid have experienced a bigger drop in the uninsured rate when compared with non-expansion states, the Kaiser Family Foundation said.


The vote in favor of expansion was widespread, as voters in rural, suburban and urban Maine supported the referendum.

Brian Duff, associate professor of political science at the University of New England, said Maine is a “moderate” state, so for the electorate to approve the expansion by a big margin shows a “shift in thinking” about health care. Duff said rural communities may see how Medicaid expansion could benefit the population and the workforce by protecting jobs and services at rural hospitals.

“Medicaid helps the working poor, and generally in America there’s a lot of respect for the working poor,” Duff said. “These are people who are out there hustling at their jobs.”

The expansion will come after a major contraction in Maine’s Medicaid population, caused in part by the LePage administration’s tightening of eligibility requirements. About 265,000 Mainers currently have Medicaid. The LePage administration’s Medicaid cutbacks resulted in about 36,000 Mainers losing Medicaid, including childless adults and some low-income parents.

Mitchell Stein, a Maine-based health policy expert, said the Maine vote likely will have national ramifications. Not only could other states adopt expansion, but the ACA is more likely to survive future repeal attempts now that there’s evidence of how much support it has at the polls, Stein said.

“I think the vote ultimately shows that people are decent, and that people are interested in healing their neighbors,” he said.

Joe Lawlor can be contacted at 791-6376 or at:

Twitter: joelawlorph

]]> 0 Pirkl, campaign manager for Mainers for Health Care, at the microphone, is joined by other supporters of the expansion of Medicaid in Maine, as they celebrate Tuesday night at Bayside Bowl in Portland.Thu, 09 Nov 2017 00:18:18 +0000
Suit of new skin saves dying boy’s life Thu, 09 Nov 2017 01:32:12 +0000 LONDON — Doctors treating a critically ill boy with a devastating skin disease used experimental gene therapy to create an entirely new skin for most of his body in a desperate attempt to save his life.

Two years later, the doctors report the boy is doing so well that he doesn’t need any medication, is back in school and even playing soccer.

“We were forced to do something dramatic because this kid was dying,” said Dr. Michele De Luca of the University of Modena in Italy, who got a call for help from the German doctors treating the boy.

The boy, then 7, was hospitalized in June 2015 with blisters on his limbs, back and elsewhere. He quickly lost about 60 percent of the outer layer of his skin and was put into an induced coma to spare him further suffering. Doctors at Children’s Hospital at Ruhr University in Bochum, Germany, tried skin grafts from his father and donor skin, but all failed.

“He was in severe pain and asking a lot of questions,” the boy’s father said in a video provided by the hospital ” ‘Why do I suffer from this disease? Why do I have to live this life? All children can run around and play, why am I not allowed to play soccer?’ I couldn’t answer these questions.”

The boy’s parents asked about experimental treatments, and De Luca and his colleagues were contacted. They had previously used gene therapy to produce a small piece of skin in a similar case. They told the family that the boy’s precarious state meant that he might not survive the complicated surgeries needed to save him.

“It was a tough decision for us, but we wanted to try for (our son),” the boy’s father said. The family asked that their names not be used to protect the boy’s privacy.

The boy had a rare, incurable skin disease called junctional epidermolysis bullosa, caused by genetic mutations. People with the disease lack critical proteins that attach the outer layer of the skin to the inner layer, resulting in fragile skin with almost constant blisters and open sores.

To fix that, the doctors took a small piece of the boy’s skin from an area that was OK. In the lab, they added a normal version of his bad gene to his skin cells. They grew sheets of the boy’s skin, in much the same way skin grafts are grown for burn victims.

In total, they grew close to 3 square feet of skin. The lab-grown skin was then transplanted onto the boy in three operations, ultimately covering 80 percent of his body. Ten days later, the new skin was already beginning to grow, De Luca said. After eight months, the doctors said that nearly all of the boy’s skin had been generated by the modified stem cells.

So far, no problems have been detected. De Luca said the boy will be monitored closely for skin cancer and other potential issues.

“This kid is back to his normal life again,” one of the German doctors, Dr. Tobias Rothoeft, said Wednesday. “That’s what we dreamed of doing and it was possible.”

Details of the case were published Wednesday in the journal Nature. “This takes us a huge step forward,” said Dr. Peter Marinkovich of Stanford University School of Medicine, who has done related work. He said it was impressive that De Luca and colleagues were able to make such large amounts of viable skin after correcting the genetic defect.

]]> 0 lift up a sheet of skin in a lab at St Josef-Hospital in Bochum, Germany. A boy treated two years ago with genetically modified skin is doing well today, doctors say.Wed, 08 Nov 2017 23:51:16 +0000
In election glow, Democrats nationally see health care as a winning issue Wed, 08 Nov 2017 20:54:55 +0000 WASHINGTON – Emboldened by election wins, Democrats are starting to see a political edge in health care, particularly widening Medicaid access for more low-income people.

In Virginia, Democrat Ralph Northam promised a vigorous push as governor to expand Medicaid. Voters who said health care was important went decisively for Northam, according to political analysts. In Maine, voters defied Republican Gov. Paul LePage’s determined opposition by passing a referendum to expand Medicaid to cover an estimated 70,000 more residents.

“Democratic voters have a lot of reasons they are angry at President Trump and Republicans in Congress,” said Republican pollster Bill McInturff. “These voters are intensely focused on wanting to see health care coverage expanded, not cut back, and efforts to repeal and replace the Affordable Care Act have contributed to their intensity and turnout.”

During Barack Obama’s presidency, health care was often seen as a political liability for Democrats. In 2010, they lost their House majority following the bitter battle to pass the ACA with no Republican support. In 2014, Democrats gave up the Senate a year after the Obama administration fumbled the rollout of And candidate Donald Trump seized on rising “Obamacare” premiums as part of his closing argument in the 2016 presidential campaign.

But public opinion seems to have shifted amid widespread opposition to Trump-backed “repeal and replace” bills that would have left millions uninsured and made it harder for people with pre-existing health problems to get coverage. The Republican bills not only would have repealed the ACA’s Medicaid expansion, but also would have limited future federal financing for the entire program, even prompting opposition from some Republican governors.

“I think health care is a driving motivator for Democrats to elect people who will not take it away,” Sen. Patty Murray of Washington, ranking Democrat on the Senate health committee, said Wednesday. “What’s happened in the past six months is that Medicaid went from a hidden thing to something everyone has heard about. Before, nobody said, ‘I’m on Medicaid.’ Now we know it’s our next-door neighbor.”

Medicaid is a federal-state health program that covers about 75 million Americans, or about 1 in 5. Beneficiaries include elderly nursing home residents, severely disabled people of any age, and many newborns and pregnant women. Under the ACA, it was expanded to cover more low-income adults, who in many cases work jobs that don’t provide health insurance.

Before Maine’s vote, 31 states and Washington, D.C., had expanded Medicaid under ACA. Now Maine-style referendum campaigns are planned in at least three states – Alaska, Idaho and Utah. In Alaska, which has expanded Medicaid, voters will be asked if they want to preserve the expansion even if Washington decides to roll back federal financing.

Medicaid expansion has the support of the hospital industry and the medical community, influential interest groups in just about every state.

“I honestly believe that if you had a referendum on expanding Medicaid in most of the states that don’t have it, it would win,” said Rep. Frank Pallone of New Jersey, the senior Democrat on the House committee that oversees the program. “People know the value of Medicaid in a way that they didn’t before.”

Polling expert Robert Blendon says what’s changing is not so much that Americans have suddenly fallen for “Obamacare,” but that there’s a growing belief that government does have a responsibility to make coverage available and affordable.

“The Obamacare weapon was great for Republicans until you debated what the Republican alternative was,” said Blendon, who teaches at the Harvard T.H. Chan School of Public Health. “The alternative can’t be dropping people and taking away protection for pre-existing conditions.”

Using Medicaid to cover low-wage workers is popular with the public, he added, at a time when many jobs don’t come with benefits once considered standard. Separately, studies have shown that Medicaid coverage is associated with fewer financial problems and better emotional health.

The Trump administration seems to be moving in a different direction, however.

In an Election Day speech to state Medicaid officials, the top administration official overseeing the program took issue with Medicaid expansion.

“The thought that a program designed for our most vulnerable citizens should be used a vehicle to serve working age, able-bodied adults does not make sense,” Seema Verma, head of the Centers for Medicare and Medicaid Services, said Tuesday.

Verma said the goal should be to help working-age adults “move up, move on, and move out,” underscoring the administration’s willingness to approve state requests for work requirements for Medicaid beneficiaries.

“We shouldn’t just celebrate an increase in the rolls, or more Medicaid cards handed out,” she said.

Associated Press writer Patrick Whittle in Portland, Maine, contributed to this report.

]]> 0 Gov.-elect, Ralph Northam gestures during a news conference at the Capitol in Richmond, Va., Wednesday, Nov. 8, 2017. Northam defeated Republican Ed Gillespie in Tuesday's election. (AP Photo/Steve Helber)Thu, 09 Nov 2017 08:10:05 +0000
Hospitals at center stage of Medicaid expansion debate Sun, 05 Nov 2017 08:00:00 +0000 Hospitals would gain about $260 million in annual revenue if voters approved Medicaid expansion, with hospital officials making the case that it would be a much-needed boost to the bottom line, especially for rural hospitals struggling to stay afloat.

The extra revenue would more than erase hospitals’ total operating losses. Excluding Maine Medical Center, Maine’s hospitals lost a total of $50 million in fiscal year 2016, according to the Maine Hospital Association.

Nineteen of the state’s 36 hospitals are losing money, the association says. The 23 rural hospitals are under the greatest threat of closure or cutting vital services because of financial pressures caused by a number of factors.

A key factor in the losses is the increase in unreimbursed care stemming from people who don’t have health insurance.

If voters say “yes” to Medicaid expansion on Nov. 7, Maine would become the 32nd state to do so, and about 70,000 Mainers would become eligible for free insurance.

Advocates say people would be better cared for and rural hospitals could keep their doors open and maintain services if voters approved Medicaid expansion.

“It will provide critical support for rural hospitals,” said Robyn Merrill, executive director of Maine Equal Justice Partners, the nonprofit that got Medicaid expansion on the ballot. “A number of hospitals are operating in the red and are truly struggling and at risk of closing their doors. It has implications for all of us, and especially for communities that rely on rural hospitals.”


Opponents of Medicaid expansion are pointing to hospitals as a reason to reject the referendum, saying that hospital CEOs make high salaries and that hospitals already enjoy tax-exempt status as nonprofits. Gov. Paul LePage has frequently attacked hospitals during public statements in the weeks before the election.

“Don’t be misled by hospitals. They only want to expand Medicaid to put more money in their pocket and the wallets of their CEOs. It has nothing to do with improving healthcare,” LePage said in his weekly radio address Wednesday.

The governor is a steadfast Medicaid expansion opponent who has vetoed five attempts by the Legislature to broaden the program, which operates in Maine as MaineCare.

The debate over Question 2 on Tuesday’s ballot has put hospitals at center stage in the run-up to the voting.

If Maine expanded Medicaid, the state would pay $54 million per year while receiving $525 million annually in federal money, according to the non-partisan Office of Fiscal and Program Review. The federal government pays for 90 percent or more of the cost of expansion.

Medicaid expansion is a major component of how the Affordable Care Act provides health insurance to low-income Americans. But a 2012 U.S. Supreme Court decision made Medicaid expansion voluntary, which is why some states, like Maine, have not expanded Medicaid.


Rural hospitals have more patients with Medicaid, Medicare or who are uninsured when compared to urban hospitals like Maine Med, which have more private insurance patients. Medicaid and Medicare reimburses at lower levels than private insurance, but more than the uninsured, who usually can pay little or none of their hospital bills.

When the LePage administration cut Medicaid after the governor assumed office in 2011, rural hospitals ended up with more uninsured patients instead of patients with private insurance, according to hospital officials. Maine’s Medicaid population has plummeted from 356,000 in 2011 to 268,000 in 2017, according to the Maine Department of Health and Human Services. About 36,000 people lost coverage as LePage cut eligibility, including childless adults and parents with minor children who earned between 100 percent and 200 percent of the poverty level.

“It’s been a direct hit to our bottom line,” said Tom Moakler, CEO of Houlton Regional Hospital.

Moakler said in 2011, the hospital was in the black by $20,000. For the 2016-17 fiscal year, the hospital lost $690,000, and is only able to make payroll by taking out a line of credit.

During that same time period, Moakler said “bad debt” or charity care for patients who are uninsured, ballooned from $1.4 million to $3.4 million.

In an attempt to stay solvent, Houlton closed its skilled nursing center, cut back on administration costs and eliminated positions through attrition, in areas such as case management and radiology.

“We did all that, and we’re still in the red,” Moakler said.

Moakler said if Medicaid expansion were approved, Houlton would be in much better financial shape and be able to invest in capital improvements, such as replacing outdated technology.

Calais Regional Hospital closed its obstetrics unit in August in a move that hospital officials said was necessary because the hospital is in danger of closing. The hospital’s annual revenues are about $30 million and it has lost an average of $1.8 million per year over the past seven years. Closing maternity services saves about $500,000 per year. Penobscot Valley Hospital eliminated maternity services in 2015 as a cost-cutting measure.

Andrew Coburn, a public health professor at the University of Southern Maine and an expert on rural health care, said Medicaid expansion will help alleviate financial problems at rural hospitals, but it’s not the solution.

“Rural hospitals are facing many financial threats,” Coburn said. “Medicaid expansion will help, but they will still be under a lot of financial pressure.”

He said low volume and changing demographics are also hurting some hospitals. For instance, when people retire, they convert from private insurance – which pays hospitals more – to Medicare, which has a lower reimbursement rate.


At Franklin Community Health Network, which includes Franklin Memorial Hospital in Farmington, the hospital operated with a $4.9 million loss in 2016.

Tim Churchill, CEO at Franklin Community, said cutbacks to Medicaid, job loss in Franklin County and other issues facing rural Maine added up to a “perfect storm” of financial problems for the hospital. Recruiting physicians is difficult, and in order to maintain services, they have to hire traveling doctors, which are much more expensive than a full-time staff physician.

“We would be greatly helped by Medicaid expansion,” Churchill said.

Franklin is part of MaineHealth, which is overall in the black by $47 million out of $2.2 billion in operating revenue. MaineHealth owns 10 hospitals in Maine and is the parent company of Maine Medical Center. Maine Med is in the black by $61 million.

Al Swallow, executive vice president and treasurer of MaineHealth, said continued large losses such as what Franklin is going through, is “unsustainable” even though as a whole MaineHealth is in the black.

“Long term, our ability to maintain access to care is dependent on each entity being fiscally sound going forward,” Swallow said.

Swallow said Medicaid expansion would be “extremely helpful” for hospital finances.

“Yes, Medicaid does not pay as much as private insurance does. But it’s still better than nobody being paid,” Swallow said.

Reductions in uncompensated care by having more people with Medicaid would nearly double MaineHealth’s operating surplus, from $47 million to $89 million, according to financial statements released by MaineHealth.

Coburn said it’s unrealistic to expect networks to take on more struggling independent rural hospitals in Maine.

“Hospitals are not looking to add more debt and financial weight to their bottom line,” Coburn said.


Meanwhile, opponents refer to Maine’s 2002 Medicaid expansion as a reason to vote “no.” The previous expansion pre-dated the ACA, and federal money to help pay for more services was less generous. Budget problems in Medicaid, exacerbated by the recession, caused the Legislature to delay reimbursement payments to hospitals. LePage successfully advocated paying off $105 million in hospital debt in 2013.

Brent Littlefield, a political consultant and spokesman for the Welfare to Work PAC, which opposes Medicaid expansion, said hospitals in Maine enjoy tax-free status for a reason. Hospitals are saving a bundle on property taxes alone, he said. Littlefield also pointed out that hospitals can afford to pay administrators handsomely, with the average hospital CEO earning more than $300,000, according to a 2013 Press Herald article.

And not all rural hospitals are losing money. The Welfare to Work PAC criticized Medicaid advocates Maine Equal Justice Partners, the nonprofit that supports expansion, for highlighting financial issues at Down East Community Hospital in Machias.

Down East released a statement on its Facebook page, saying that “(although) there are many hospitals that are struggling and there are legitimate reasons to expand Medicaid, Down East Community Hospital is doing well at this time. Our operating margins are positive and have been so for several years now.”

Littlefield said for hospitals to ask for additional government help by expanding Medicaid is “sort of like having your cake and eating it too.”

“They are supposed to take money that they would have spent on taxes and spend that money instead on providing care for those in need,” Littlefield said. “If the hospitals want taxpayers to pick up this cost, are they then open to say they’re willing to be taxed?”

Joe Lawlor can be reached at 791-6376 or at:

Twitter: joelawlorph

]]> 0 Maine Health Care in Biddeford amassed $15.5 million in uncompensated care in fiscal year 2016.Sun, 05 Nov 2017 17:51:23 +0000
Poll shows American adults clueless on obesity Sat, 04 Nov 2017 02:46:50 +0000 Nearly 40 percent of American adults and 20 percent of children carry enough extra weight to warrant a diagnosis of obesity. That’s the highest obesity rate among the world’s affluent nations, and it’s already shortening Americans’ lifespans by driving up rates of diabetes, heart disease, stroke, cancers, arthritis and dementia.

If that constitutes an urgent threat to the nation’s health, you’d scarcely know it from reading the results of a newly published survey called ACTION.

The new poll paints a picture of obese adults who are clueless and feel utterly on their own when it comes to losing weight and of physicians who are often too busy, too embarrassed or too ill-equipped to help them.

The nation’s obesity crisis has been roughly four decades in the making. The ACTION report is a humbling reminder that, at this rate, it will not be quickly reversed.

ACTION stands for Awareness, Care and Treatment in Obesity Management. During two weeks in the fall of 2015, survey-takers assessed how obesity was viewed, experienced and treated by 3,008 obese adults and 606 doctors who provide medical care to such patients.

What they found is a medical establishment still navigating its role in addressing obesity, and a population of patients not yet sure they need – or have a right to demand – help in shedding extra pounds. The results were presented at this week’s meeting of the Obesity Society and published in the journal Obesity.

The American Medical Association formally recognized obesity as a “disease” in June 2013. That medical consensus has not fully penetrated the ranks of doctors: Only 80 percent said they believe obesity is a disease, and only 72 percent said they have a responsibility to actively contribute to their patients’ weight loss.

Awareness among patients with obesity was even worse. Some 65 percent of obese patients said they believed obesity was a disease that warranted compassionate treatment. But only 54 percent said a person’s weight would affect his or her future health “a lot” or an “extreme amount.”

Strikingly, only half of those with obesity actually perceived themselves as “obese” or “extremely obese.” Among the rest, 48 percent considered themselves “overweight” and 2 percent believed they were “normal weight.”

Small wonder perhaps, since only 71 percent said they had discussed their weight with their doctor in the last five years, and only 55 percent reported they had been diagnosed with obesity.

Just 24 percent were offered follow-up care meant to treat their obesity, and 18 percent had committed to a weight-loss plan.

]]> 0 40 percent of American adults and 20 percent of children warrant a diagnosis of obesity. That's the highest obesity rate among the world's affluent nations.Fri, 03 Nov 2017 22:46:50 +0000
Several Maine dental offices will offer free services today Thu, 02 Nov 2017 18:11:50 +0000 Several dental offices in Maine will offer free services Friday as part of the ninth annual Dentists Who Care for ME event.

Dentists, hygienists and other staff members will volunteer their time to provide teeth cleanings, fillings and extractions for people who can’t afford regular dental care and don’t have dental insurance.

Patients will be seen on a first-come, first-served basis. People who plan to seek treatment should arrive early to secure an appointment because slots tend to fill quickly. Appointments won’t be taken before Friday. Referral vouchers for free services by dental specialists will be given to patients who need more comprehensive procedures.

Through the years, the program has served more than 3,500 people and provided about $1.2 million in services, said Dr. Demi Kouzounas, event organizer. Participating dentists had hoped to grow the numbers this year, but some dental offices still don’t have power because of Monday’s storm.

“We’re absolutely delighted to welcome new volunteers to the Dentists Who Care for ME family,” Kouzounas said. “We couldn’t see all these patients without the help of the volunteer staff. We really appreciate them, and so do the patients.”

Participating offices are: Falmouth Dentistry, 8 Leighton Road, Falmouth, 8 a.m. to 1 p.m.; Falmouth Dental Arts, 202 U.S. Route 1, Falmouth, 8 a.m. to 2 p.m.; Lisbon Family Dentistry, 568 Lisbon St., Lisbon Falls, 9 a.m. to noon; Dr. Alan Chebuske, 110 Auburn St., Portland, 8 a.m. to 1 p.m.; Ravin Family Dental, 40 Hannaford Drive, Scarborough, 8 a.m. to 1 p.m.; Northwoods Dental, 27 North Ave., Skowhegan, 8 a.m. to noon; Dunstan Dental Center, 618 Route 1, Suite 4, Scarborough, 8 a.m. to 2 p.m.

Please check or for updates.

]]> 0, 03 Nov 2017 05:49:21 +0000
Mercy Hospital to pay $1.5 million to settle federal complaint Thu, 02 Nov 2017 00:48:53 +0000 Mercy Hospital in Portland has agreed to pay $1,514,000 to settle allegations that it violated federal and state false claims laws by overbilling Medicare and Medicaid for urinalysis drug-screening tests.

Those tests were ordered and performed at the former Mercy Recovery Center in Westbrook from 2011 to 2013, according to documents filed in federal court. Mercy Hospital, located at 144 State St., was acquired in October 2013 by Eastern Maine Healthcare Systems.

“The conduct the complaint describes occurred prior to Mercy joining EMHS. When EMHS became aware of the conduct it ceased,” Mercy Hospital said in a statement released Wednesday night through its spokesman, Ed Gilman. “Mercy and EMHS cooperated completely with the government’s investigation. The billing manager who was primarily responsible is no longer employed by Mercy/EMHS.”

The settlement agreement, which was announced Wednesday in a statement issued by U.S. Attorney Halsey B. Frank, avoids what court documents predicted could have been “protracted litigation.” Court records also point out that once the false billing was detected, Mercy Hospital cooperated with the investigation.

Frank said the settlement will resolve allegations that Medicare and MaineCare, Maine’s Medicaid program, were overbilled for urinalysis drug screening tests conducted at Mercy Recovery Center.

Mercy closed the substance abuse recovery center in May 2015, in part because of low reimbursement rates for addiction services. Most of the 250 clients served at the Westbrook facility were being treated for opioid addiction.

Frank said the federal government alleged that Mercy falsely used a billing modifier code that enabled the recovery center to bill Medicare and MaineCare for multiple urinalysis drug screening tests performed the same day on the same patient.

“The urinalysis drug screening tests should have been bundled and billed as one claim per each single patient encounter. Instead, Mercy separately billed for the urinalysis drug screening tests on a per test basis. As a result, Medicare and MaineCare overpaid Mercy on multiple claims,” Frank said in his statement.

Medicare and MaineCare pay for bundled claims at a lower rate. The incorrect billing practice was used for about 85 percent of Medicare urinalysis drug screen tests and 65 percent of MaineCare tests. Frank said Mercy Hospital implemented “enhanced internal compliance measures” in response to the overbilling issue.

The complaint filed in U.S. District Court in Portland states that federal and state officials received an anonymous tip in April 2013 alleging that Mercy was engaging in a potentially fraudulent test-billing system. The complaint says Mercy “habitually” used an improper billing code for drug-testing urinalysis that allowed it to receive “substantial overpayments from Medicare and MaineCare to which it was not entitled.”

The case was investigated by the Office of the Inspector General for the federal Department of Health and Human Services.

Dennis Hoey can be contacted at 791-6365 or at:

]]> 0 Hospital is reviving plans to consolidate at its Fore River campus.Wed, 01 Nov 2017 23:06:09 +0000
Cost of 2018 premiums for many Mainers’ ACA plans: $0 Wed, 01 Nov 2017 08:00:00 +0000 More than 40,000 Mainers who begin signing up Wednesday for Affordable Care Act insurance may do a double take when selecting a plan on the individual marketplace. Many of those plans will offer free monthly premiums.

Health experts say that’s an unintended consequence of the Trump administration’s decision this year to end payments to insurance companies for cost-sharing reductions, which had helped low-income people buy health insurance.

“It’s good for now,” said Steve Butterfield, public policy director for Consumers for Affordable Health Care, an Augusta-based health advocacy group. “It’s hard to be optimistic when the repeatedly stated and tweeted goal of this administration is to destroy the ACA. But here’s a decision that for this year, for a lot of people, their premiums will be going down.”

That’s because insurance companies and states devised workarounds to counteract the Trump administration’s moves, which resulted in free premium options for many low-income residents in Maine and across the country.

About 80,000 Mainers bought health insurance last year on the ACA individual marketplace, which is designed to provide subsidized coverage for those who don’t have access to employer-based insurance, such as the self-employed, part-time workers or those employed by small businesses. The ACA, through the marketplace and the expansion of Medicaid, has resulted in more than 20 million Americans gaining health insurance.

President Trump and congressional Republicans have been trying to repeal and replace the law since he took office in January, but those efforts have so far failed in Congress. Maine Sen. Susan Collins, a moderate Republican, was one of three Republicans to buck the party and preserve the ACA by one vote during a dramatic late-night session in July.

Trump then took executive actions to undermine the law, cutting the enrollment period in half – it now opens Wednesday and runs through Dec. 15 – and slashing advertising and outreach budgets.

He also ended payments to insurance companies for cost-sharing reductions, which lowered out-of-pocket costs such as deductibles and co-payments for low-income people. Trump said in an October media availability that “Obamacare is finished. It’s dead.”

More than 40 states – including Maine – responded with a workaround. In Maine, insurers filed a set of rates that anticipated the payments ending. The rates offset the loss of payments by increasing the premiums for “silver” plans, the middle tier in the three-tiered system of bronze, silver and gold plans offered on the ACA marketplace. Bronze plans have the lowest premiums and highest deductibles, while gold plans have the highest premiums, lowest deductibles and most benefits. Silver plans are in the middle.

“We didn’t issue an order saying insurance companies had to do this, but we all took a step back and looked at what was the most equitable decision we could make,” said Eric Cioppa, who heads the Maine Bureau of Insurance.

Because the gold and bronze plans’ subsidies are based on the cost of the second-lowest silver plan, that resulted in flat premiums but more generous subsidies for gold and bronze plans. The larger subsidies led to free bronze plans at some income levels and to lower-cost gold plans.

A 40-year-old single Mainer earning about $12,000 to $27,000 a year can get a free bronze plan, based on a Press Herald review of plans offered at Community Health Options, a Maine-based cooperative insurer. The zero-premium bronze plans are available regardless of age, family size or place of residence in Maine, as long as the person signing up earns between 100 percent and 225 percent of the federal poverty level. The insurance itself is not entirely free, because there are co-payments and deductibles. For one free-premium bronze plan, for example, generic prescription drugs cost $5 and the annual deductible is $4,000.

About half of the 80,000 Mainers in the marketplace would be eligible for free premiums, according to enrollment data published by the Kaiser Family Foundation.

Butterfield, at Consumers for Affordable Health Care, said the free plans will be a good choice for many with low incomes. He said the prospect of free coverage also may encourage young and healthy people with low incomes to sign up.

“There’s very clear research that indicates that cost is not a barrier to getting smarter care, cost is a barrier to getting any care. Anything we can do to remove cost barriers is a win,” Butterfield said.

Depending on how enrollment goes, the free bronze plans may help the individual marketplace by attracting the young and healthy. Those who don’t sign up for insurance are required to pay a penalty when they file their taxes.

“If it’s free, it becomes a question of ‘why not sign up?’ ” said Mitchell Stein, a Maine-based health insurance expert. “The administration’s actions may result in drawing more young, healthy people to the market.”

Stein cautioned that a zero-premium bronze plan may not be the best for everyone. People who are older or have more health needs may still wish to purchase a silver or gold plan, he said. Gold plans could be especially attractive for Mainers earning between 250 percent and 400 percent of the federal poverty level, because people in that category, while eligible for subsidies, do not qualify to receive other reductions that help people purchase silver plans.

Another unintended effect of the Trump administration’s decision will be an increase in ACA costs for the federal government. Paying insurers the cost-sharing reductions was less expensive, according to the Congressional Budget Office, and ending them will cost federal taxpayers an extra $194 billion over the next 10 years.

Kevin Lewis, president and CEO of Community Health Options, said enrollees need to shop carefully for plans because the cost of premiums has changed so much.

“They really need to shop and think through all the options,” Lewis said. “There are some really good values in bronze plans and gold plans.”

Community Health Options has about 30,000 of the 80,000 enrollees in the 2017 marketplace.

A bipartisan bill supported by Sen. Collins is attempting to restore the cost-sharing reductions, but it’s unclear whether it will pass Congress or whether Trump would support the deal. Collins also partnered with Sen. Bill Nelson, D-Florida, to introduce a reinsurance bill that would help stabilize the ACA marketplace.

The new premium structure has not resolved the problem of rising costs for people who earn more than 400 percent of the federal poverty level, or $97,200 for a family of four. Those who earn that much don’t qualify for subsidies and bear the full brunt of premium increases.

Butterfield said that until there’s an administration and Congress that’s intent on supporting the ACA, the unintended consequences of ending the cost-sharing reduction payments is not much comfort to those who want to expand insurance coverage. He said other efforts to undermine the ACA are more likely to have the desired effect. In October, Trump signed an executive order to create “association health plans” that may destabilize the individual market.

“There are some benefits to doing this, but this is a really messed up way to get there when you have an administration doing whatever they can to sabotage the law left, right and center,” Butterfield said. “This may have backfired on the Trump administration, but my concern is not everything they are going to do is going to backfire.”

Joe Lawlor can be contacted at 791-6376 or at:

Twitter: joelawlorph

]]> 0 Wednesday through Dec. 15, Americans can sign up for health care coverage on the website, shown above. The Trump administration cut the enrollment period for 2018 by half.Wed, 01 Nov 2017 00:12:50 +0000
Falmouth psychiatrist’s license permanently revoked Tue, 31 Oct 2017 16:07:03 +0000 A Falmouth psychiatrist can no longer practice medicine in Maine after he signed a consent agreement that permanently revokes his license, the Maine state medical board announced on Tuesday.

Dr. Reinaldo de los Heros, who operated a practice in Portland, had his license suspended Oct. 10 by the Maine Board of Licensure in Medicine for falsifying records and other reasons. De los Heros signed an agreement Oct. 23 with the licensing board, and it was finalized on Tuesday. The agreement says that the board concluded there was evidence of de los Heros committing “fraud, deceit or misrepresentation.”

“Previously, on October 10, 2017, the Board issued an Order of Immediate Suspension of Dr. de los Heros’ medical license based upon a finding that he issued a prescription for a controlled substance for a patient he knew was incarcerated and created a medical record indicating that there was an in-person 25-minute office visit regarding the incarcerated patient. At that time, the Board concluded that Dr. de los Heros’s continued ability to practice medicine, including prescribing controlled substances, represented an immediate jeopardy to the public,” according to a statement issued Tuesday.

A permanent license revocation by the Maine medical board is extremely rare. The last time was in 2011, when it permanently revoked the license of a former Brunswick psychiatrist, Dr. John M. Dorn, for having inappropriate romantic relationships with patients and for failing to disclose previous sexual relationships with patients in other states when he applied for a Maine license in 2007.

The licensing board typically imposes 25 to 30 licensing sanctions on medical doctors each year, according to the board’s website, which lists 24 “adverse licensing actions” so far in 2017. Most of the disciplinary actions are less stringent than license revocation, and typically involve a temporary license suspension, practice restrictions, requirements for counseling and supervision by a peer, and occasional fines.

De los Heros prescribed Adderall, which is used to control attention-deficit disorder, to a patient who was in the Cumberland County Jail. The doctor had been operating under supervision since 2016 and has a record of disciplinary actions in Maine and Massachusetts dating back to the 1990s.

In February 2016, the board placed de los Heros on probation for the way he practiced medicine leading up to the drug overdose of one of his patients. Kelly Deyo, 39, took her life on April 19, 2015, and 19 mostly empty prescription pill bottles and a suicide note were found by her side at her apartment in Westbrook. The bottles, including refills, had contained pills from nine prescriptions written by de los Heros. Deyo had struggled with heroin addiction and many mental health problems, her mother, Elizabeth Marquis, told the Press Herald.

The 2016 licensing board sanctions were for failing to coordinate Deyo’s care with her primary care physicians and poor documentation of her visits, including incomplete or illegible treatment notes, according to the agreement.

In April 2017, the licensing board and de los Heros agreed to an amendment to his license. The amendment required the doctor to allow the state to select 10 patient records for the board’s review.

The Massachusetts licensing board punished de los Heros in the 1990s and 2000s for Medicaid fraud, and for fraudulently trying to regain his medical license.

His license to practice in Massachusetts was revoked in 1997 for Medicaid billing fraud, according to Massachusetts medical board records. He failed to disclose his disciplinary history on forms in Massachusetts when trying to regain his license in 2007, the records show, including that his license was revoked in other states, that he had a 2006 consent agreement in Maine with the state licensing board, and that his medical malpractice insurance company had imposed a surcharge on his policy.

In 2009, de los Heros signed a consent agreement with the Maine board that required him to practice under the supervision of another psychiatrist.

The Maine licensing board consists of six physicians, three members of the public and a physician assistant. All 10 are appointed by the governor.

]]> 0 practice in PortlandWed, 01 Nov 2017 00:51:08 +0000
On the health care precipice: ACA sign-ups to begin amid cutbacks, turmoil Mon, 30 Oct 2017 23:57:10 +0000 WASHINGTON — It’s sign-up season for the Affordable Care Act, but the Trump administration isn’t making it easy – cutting the enrollment period in half, slashing advertising and dialing back on counselors who help consumers get through the process.

Many people already faced fewer choices and higher premiums. But President Trump’s decision to cancel a subsidy to insurers that lowers consumer costs compounded the turmoil, pushing premiums even higher.

Add it all up and the number of uninsured people may start rising again, eroding gains that drove the uninsured rate to a historic low.

“It certainly is a hostile takeover,” said health policy expert Joe Antos of the right-leaning American Enterprise Institute. “We are going to see a decline in enrollment. The people who will drop out in droves are the ones who are not getting a premium subsidy.”

Open enrollment starts Wednesday and ends Dec. 15 in most states, a sign-up period six weeks shorter than last year’s.

Nine million to 10 million people currently have private plans through the ACA’s government-sponsored markets. More than eight in 10 receive subsidized premiums and are cushioned from rate increases. Federal help paying premiums is still available despite Republican efforts to repeal the health law.

In states served by the website, premiums will go up 37 percent for a hypothetical 27-year-old picking a standard plan called “second-lowest-cost silver,” the U.S. Department of Health and Human Services said Monday.

With insurers exiting the market, about half of counties will only have one participating carrier offering plans. Eight states have only one insurer.

But subsidies for premiums are also going up – by 45 percent on average. That means current customers receiving financial help have a strong incentive to renew.

How many new people will join remains an open question, even if they’re eligible for help with premiums. New enrollees are vital because healthier, younger people are needed to keep rising premiums from destabilizing the marketplaces.

Already this year there was a big drop-off among consumers who buy individual coverage outside the government markets and aren’t eligible for premium subsidies. Their costs, however, are generally tied to rising “Obamacare” rates. Monthly premiums can be as a high as a mortgage payment in some cases.

Polls show widespread consumer confusion. Some are unsure if the health law has been repealed.

Trump administration officials say they’re aiming for smooth and efficient sign-ups. has new features intended to make it more user-friendly, and the call center is fully staffed.

Officials say they cut ads because spending so much money wasn’t warranted, and the scaled-back counseling programs weren’t enrolling many consumers. The programs take issue with that.

Consumers who already have “Obamacare” are worried.

“It’s gone beyond what I would have called the politics of the normal,” said Elizabeth Stone, a real estate agent in the Washington, D.C., suburbs. She was diagnosed with lymphoma in her mid-20s, and with treatment has kept the cancer in check for five years. She doesn’t qualify for subsidized premiums, but without the ACA she questions if any insurer would have covered her.

“People have forgotten that everyone can get sick,” Stone said. “This battle has become so politicized that they’re not thinking of the consequences for themselves, for their friends and their families.”

Karen Vied coaches people in treatment for substance abuse. She and her husband, David, live in Millsboro, Delaware, a short drive from the shore.

Vied said she voted for Trump because she believed he would deal with the opioid epidemic. Now she’s scared, she says, because she and her husband rely on their subsidized ACA coverage for treatment of her rheumatoid arthritis and his heart problems. David, a marine technician, has not been physically able to work as much lately.

“I literally wonder from day to day, am I going to have insurance next month?” said Karen Vied, who’s not yet 60. “I can’t turn around and go from paying $450 a month for premiums to $2,000. That’s just not going to happen.”

Her husband said that without insurance, one hospitalization could wipe out their home equity. “I’m not asking the government to give me insurance, but I am asking them to do what they need to make it affordable,” said David Vied. He voted for Hillary Clinton.

Trump’s own words leave little doubt where his administration stands.

“ObamaCare is a broken mess,” the president tweeted recently. And Sunday, he said: “As usual, the ObamaCare premiums will be up (the Dems own it), but we will repeal & replace and have great health care soon after tax cuts.”

While repeal remains Trump’s goal, he also abruptly stopped paying a “cost sharing” subsidy to insurers. Officials say the payments were never properly approved by Congress, although they are called for under the ACA.

Those payments offset reduced copays and deductibles for people with modest incomes, and unless they’re restored, insurers will lose an estimated $1 billion in the remainder of this year. State regulators have approved premium increases in the double digits to compensate insurers.

Despite all the problems, there’s an effort around the country to drum up enrollment. Nonprofits that don’t rely on federal grants are ramping up. Some insurers plan to pay for advertising. States running their own insurance markets remain focused on growing enrollment.

In Austin, Texas, a nonprofit that provides support services for the working poor is trying to prove Trump wrong. Foundation Communities has helped more than 22,800 enroll for coverage since 2014.

“We’re hoping to enroll about 5,000 people; of course, we have to do that in half the time,” said insurance program director Elizabeth Colvin. “Full steam ahead.”

]]> 0, 30 Oct 2017 20:02:23 +0000
State enhances website that lets Mainers compare medical costs by provider Fri, 27 Oct 2017 08:00:00 +0000

A state-run database that compares average prices and patient satisfaction levels for dozens of procedures and tests performed at Maine health care facilities has been updated to give consumers more information.

The information that’s now available at helps Mainers become better consumers of health care in a state where the total cost of a common procedure such as a colonoscopy can range from $850 to more than $4,000.

Thursday’s changes represent the fourth major update to the website since it was launched in the fall of 2015, said Karynlee Harrington, executive director of the Maine Health Data Organization and Maine Quality Forum. Among the updates are new indicators of the average quality of care, and updated pricing through the end of 2016.

“It’s a work in progress – it’s going to get better with each release,” Harrington said. “We’re going to make updates twice a year.”

As of Thursday, the site allows Mainers to compare prices for about 200 common medical procedures at roughly 175 health care facilities throughout the state. It is the product of over 1 billion health care records collected by Maine Health Data as allowed by state statute.

All of the average prices are based on records of patients with commercial insurance, including Aetna, Cigna, Anthem Blue Cross and Blue Shield, Harvard Pilgrim Health Care and Maine Community Health Options. It does not include data for Medicare and Medicaid patients.

Data for each procedure can be sorted by insurance provider, so users of the site can see how much each provider was charged on average by a particular medical facility for a particular procedure.

Harrington said the online database is populated with common, non-emergency procedures that can be scheduled in advance. It does not compare average prices for treatment of, say, cardiac arrest, because patients suffering from a heart attack don’t have time to shop for the least-expensive treatment.


New to Thursday’s 4.0 update is the ability to see a breakdown of costs between the health care facility and the medical professionals that perform the test or procedure. The prices shown on CompareMaine represent the average total charge for each procedure, including the amount paid by both patient and insurance provider. It does not list patients’ average out-of-pocket costs, but that information may be added in a future update, Harrington said.

According to CompareMaine, prices for common medical procedures in Maine vary widely from one provider to another.

For example, it says Maine Centers for Healthcare in Westbrook, a specialty practice of six physicians, charges an average of $850 for a colonoscopy without biopsy, the least expensive average price in the state. Meanwhile, Charles A. Dean Memorial Hospital in Greenville and Mayo Regional Hospital in Dover-Foxcroft each charge an average of more than $4,000 for the same procedure, the most expensive average price in the state. The state average for that type of colonoscopy is $1,712, according to the website.

The total average cost of a gallbladder removal in Maine ranges from a low of $10,257 at Pen Bay Medical Center in Rockport to a high of $20,504 at The Aroostook Medical Center in Presque Isle, according to CompareMaine. The average cost statewide for the procedure is $14,562, it says.

Harrington said that, unlike most types of commerce, consumers of health care rarely are given the opportunity to compare prices before undergoing a medical procedure or test. Hospitals often are reluctant to provide cost estimates in advance to their patients because complications during a procedure can dramatically affect the final bill, she said.


The reasons why prices can vary so much from one health care provider to another are complicated, Harrington said. They can include things like the mix of public and private payers among patients, different cost structures and other market factors.

“This is one of the reasons why I think transparency sites like this are so important,” she said.

In addition to average price, CompareMaine also provides three indicators of quality for each procedure at each facility: patient experience, preventing serious complications and preventing health care-associated infections. All ratings range from one (the worst) to five (the best).

Patient experience ratings are provided by patients and indicate how satisfied they were overall with the quality of their care. Ratings for preventing serious complications and health care-associated infections are based on data provided by the health care institutions themselves.

Harrington said the quality ratings show that the most expensive medical facilities in Maine do not necessarily offer the best patient experience.

“Higher cost in health care does not equate to higher quality,” she said.

Harrington said many of the updates to CompareMaine are based on requests from consumers. The website includes an online survey that anyone can fill out to influence future updates, she said.

For example, as a result of customer requests, site updates in 2018 will include the addition of price comparisons for echocardiograms and chiropractic services, Harrington said.

“We’ve also been asked to add cataract surgery,” she said.

J. Craig Anderson can be contacted at 791-6390 or at:

Twitter: jcraiganderson

]]> 0, 27 Oct 2017 00:53:09 +0000
Addicts may benefit from an expansion of Medicaid Sun, 22 Oct 2017 08:00:00 +0000 Medicaid expansion would substantially jump-start access to opioid addiction treatment for low-income Mainers at a time when the state is struggling to reduce drug overdoses and contain the opioid epidemic.

But whether a positive vote on the Nov. 7 ballot question would translate into reduced overdose deaths or an overall alleviation of the opioid crisis is difficult to predict, health experts say.

“Medicaid expansion gives people an on-ramp for medication-assisted treatment, which is the gold standard for opioid treatment,” said Dr. Richard Frank, a Harvard Medical School professor of health economics and former Obama administration official who helped implement the Affordable Care Act.

Frank said many factors contribute to the opioid crisis, so it’s not certain yet whether states that have expanded Medicaid have a head start on mitigating the epidemic. Part of the problem, he said, is that the opioid problem was generally worse in Medicaid expansion states before the Affordable Care Act went into effect in 2013.

“We haven’t been able to sort that out yet,” Frank said. “This crisis has been 20 years in the making. This is not something you can turn around quickly.”

If voters approve the referendum, Maine would join 31 other states that have expanded Medicaid. Maine Gov. Paul LePage, a steadfast opponent of expansion, has vetoed five attempts by the Legislature to approve expansion, which is a cornerstone of the ACA but voluntary for states.

Proponents of expansion view access to opioid treatment as one of the tangible benefits of expansion. Opponents say Medicaid expansion would bust the state’s budget, pointing to a previous expansion that was followed by repeated budget deficits.

About 70,000 Mainers would be eligible for benefits if voters approve the ballot question. Currently, about 265,000 Mainers have Medicaid coverage.

It’s difficult to say how many of those 70,000 need treatment for opioid addiction. A study of four states by the Government Accountability Office estimated that 13 percent to 35 percent of the Medicaid expansion population in the states of New York, West Virginia, Iowa and Washington abused or were dependent on opioids.

If 15 percent to 35 percent of the expansion population in Maine had an opioid problem, that would translate to 10,000 to 25,000 people who could seek medication-assisted treatment under Medicaid.

Medication-assisted treatment pairs counseling with drugs such as Suboxone, methadone and Vivitrol, which reduce the cravings associated with addiction. Research shows that this is the most effective treatment method to prevent people from relapsing into opioid use. In Maine, 376 people died of a drug overdose in 2016 – a record high – and 2017 is shaping up to be similar, with 185 deaths through June 30.


Access to medication-assisted treatment in Maine is difficult to come by. In Scarborough, the police department’s Operation Hope sends many people out of state for treatment because of the lack of options in Maine.

Those in the treatment community say that without insurance, addicts find themselves on a “hamster wheel,” in which they overdose and, if they survive, go to a hospital emergency room before being sent home. The cycle then repeats, and paramedics and hospitals often see the same people struggling with addiction and no access to treatment.

This cycle is straining the resources of hospitals – especially rural hospitals that are already struggling financially, according to federal data. Nationally, there were about 140,000 opioid-related hospital visits in the fourth quarter of 2014, but visits by uninsured patients declined in that time period from 41,150 in 2013 to 29,000 as most states expanded Medicaid.

In Maine, opioid-related visits totaled 1,100 in the fourth quarter of 2014, but those without insurance grew from 300 in 2013 to 400 in 2014, according to the U.S. Department of Health and Human Services.

Jeffrey Austin, vice president of government affairs for the Maine Hospital Association, said hospitals’ emergency departments have an “uncompensated care burden” when the uninsured overdose.

“Coverage is a good thing for all medical conditions, but there is clearly a need for more coverage for those in need of help with substance use disorders, particularly those that are opioid-related,” Austin said. The hospital association supports Medicaid expansion.

The uninsured dynamic is pronounced at Milestone Recovery, which operates a detox center in Portland.

Bob Fowler, Milestone’s executive director, said the center used to get patients with Medicaid, but now more patients are uninsured, as their addictions make them unstable and they lose their jobs. The LePage administration tightened eligibility for Medicaid so that childless adults would not qualify, and made it more difficult for parents to qualify for Medicaid.

These are “the very same people who are coming to Milestone, and they don’t have Medicaid anymore,” Fowler said.


The agency had a $3.7 million budget in 2011, before the Medicaid cutbacks, and that has dwindled to $3.1 million in 2017, Fowler said. Medicaid funding declined from $1.9 million to $586,000 during that time.

“It has had a strangling effect,” Fowler said, as Milestone has had to cut staffing. The program’s Old Orchard Beach residential recovery program often has empty beds because not enough people have Medicaid, and the program can’t afford to give too many people free care.

Fowler said people discharged from detox would have more options with Medicaid, including residential and outpatient treatment programs, instead of going home and falling into the trap of using again.

Kirk Carlsen, a housing navigator at Milestone, said he was one of the lucky ones. His heroin addiction was at its worst when he checked in to Milestone’s detox program on New Year’s Day 2013. As a childless adult, he had Medicaid, but it was set to be cut off by the LePage administration in 2014.

Carlsen had a year to straighten his life out, and having Medicaid – called MaineCare in the state – gave him access to counseling and Suboxone. After a year, he got a part-time job working for Milestone and was able to obtain insurance through the Affordable Care Act, and now he has a full-time job and employer-based insurance.

“MaineCare was a lifesaver for me,” said Carlson, 53. “I would be dead or in jail right now.”

Many in the expansion population can get insurance now through the Affordable Care Act, a point emphasized by state Rep. Karen Vachon, R-Scarborough, an expansion opponent. The Kaiser Family Foundation has estimated that about 21,000 Mainers who earn between 100 and 150 percent of the federal poverty limit have ACA insurance. If Maine approves expansion, those earning between 0 and 138 percent of the poverty limit would go on Medicaid.

Vachon said it would be better for that group to stay on private insurance through the ACA.

“People would rather have private insurance and have a job, rather than be on welfare,” she said.


Vachon maintains that a bill she has proposed to help the uninsured would be a better solution than Medicaid. The bill, which she said stalled out this year in the Legislature but will be reconsidered in the next session, would devote more than $6 million a year to expand opioid treatment to help the uninsured.

She said the idea would be to give medication-assisted treatment to people struggling with addiction and then get them working as quickly as possible, so they would then qualify for ACA insurance. Those who are unemployed but find jobs qualify for “special enrollment” and can fairly quickly get ACA insurance, Vachon said.

“With private insurance, people would have access to a stronger provider network, the insurance has better reimbursement rates for doctors and better access to care,” she said. “We can move them off of welfare, get them jobs and help more people.”

But Dr. Lisa Letourneau, a public health expert who previously served on the Maine Opioid Collaborative, said that Medicaid expansion is by far the best option to provide access to treatment. The federal government would pay for more than 90 percent of the cost of expansion, and Letourneau said the state would tap into that money for treatment.

The Legislature’s nonpartisan Office of Fiscal and Program Review estimated the state would spend $93 million in state tax dollars on expansion through 2019, but receive nearly $1.2 billion in federal funds.

“There is no magical money for treatment without doing expansion,” Letourneau said. “Providing access to treatment for people with addiction is critically important both to the state as a whole and to those individuals and families. They have real and significant barriers to care. These are evidence-based treatments that we know will help them with their recovery.”

Joe Lawlor can be contacted at 791-6376 or at:

Twitter: joelawlorph

]]> 0 Carlsen is a housing coordinator at Milestone Foundation on India Street. He is also in recovery from opioid addiction. He received help from Medicaid to help him toward sobriety. (Staff photo by Ben McCanna/Staff Photographer)Sat, 21 Oct 2017 20:46:56 +0000
‘Stand Down’ gives Maine veterans a respite from homelessness Sat, 21 Oct 2017 23:48:54 +0000 AUGUSTA — Robert Lindie looked out nervously at the crowd of dozens of homeless veterans gathered in the theater at the VA Maine Healthcare System at Togus, uncomfortable speaking publicly but doing so nonetheless, to give his message to the men and women who now sat where he had sat just three years ago.

“I was sitting four rows back,” the Augusta man, who walks with a cane, said as the 20th annual Homeless Veteran Stand Down got underway Saturday morning. “I was homeless. I had no place to go, and no way to get there. I was kind of at the end of my rope.”

Knowing Lindie was a veteran, a friend had asked him whether he wanted to go to Togus. He said “not really” but relented, and he went. He later was admitted to the veterans’ hospital and, after three or four weeks there during which he said he “just needed to get my running gear in shape,” he moved into the Bread of Life Ministries’ Veterans Shelter in Augusta. Then Togus staff members helped him find an apartment, also in Augusta, where he has lived since. Sober for three years, he volunteers at Togus, including Saturday at the Homeless Veteran Stand Down, a daylong event in which military veterans from across the state can get free services as well as free clothing and other items.

“I like volunteering because that’s what makes the world go round,” he told his fellow veterans. “There is absolutely nothing wrong with asking for help, nothing at all. You’re in a good place. You’ve got to take that first step. And you know what, folks? This is a good first step.”

Veterans were offered free services or goods at 32 stations set up in multiple buildings of the Togus campus, including a wide array of health care services; transportation to and from Togus from designated pickup locations; child care; food and drinks; haircuts; boots and clothing; personal care items; women’s services; information on housing, employment, training and veteran benefits; legal services; assistance with taxes; flu shots; and food stamp and MaineCare applications. All of it was free.

Anthony Ward, who served in the Army in the early 1980s until a blasting cap blew his hand apart as he was setting up targets in the Mojave Desert, got a pair of reading glasses, underwent oral cancer screening, and inquired about getting dentures at the Stand Down on Saturday morning. He’s living in transitional housing with Veterans Inc. in Lewiston, after having lived at a Tedford shelter in Brunswick. Now he is looking for an apartment.

Ward said it was the first time he’d attended the Stand Down, which he said was “really cool.”

Tom Baker, who recently moved from Florida to Maine and who served in the Army from 1970 to 1973, said he’s a recovering alcoholic and drug addict and he came to Maine because he thought he could stay off drugs better in Maine.

Saturday he underwent oral cancer screening, was looking to set up a dental appointment, and visited a podiatrist to have his feet checked out.

“Stand down” is a military term that refers to active-duty personnel being taken off a battlefield to a safe place. Saturday’s annual event, according to organizers, is meant to allow homeless veterans to “stand down” from homelessness for a day, and to help them connect with services and supports to help end their homelessness.

Susie Whittington, a social worker who works with homeless veterans at Togus, applauded homeless veterans for coming and urged them, even though they didn’t want to ask for help, to let the roughly 200 volunteers and Togus staff at the event help them. She said she doesn’t want to see the homeless veterans back again next year, still homeless.

Dan Dunker, associate director of the VA at Togus, said 25 to 30 organizations had volunteers at the event. He told the homeless veterans, before they dispersed around the facility to get services, the goal was not just to give them a bit of information or an application for a program that might help them but, rather, to help them with their problems on the spot, or get them into programs that can help them.

“We’re going to take care of your business today. We’re not going to give you an application and send you on your way,” he said.

Keith Edwards can be contacted at 621-5647 or at:

Twitter: kedwardskj

]]> 0 Jenny Miedema, a dental resident, screens Anthony Ward of Lewiston for oral cancer. Staff photo by Joe PhelanSun, 22 Oct 2017 18:00:59 +0000
On cigarette tax hikes, tobacco lobby powerful foe Sat, 21 Oct 2017 22:57:07 +0000 For more than a decade, Kristin Page-Nei begged Montana lawmakers to raise cigarette prices. As a health advocate for the American Cancer Society, she watched year after year as other states increased their cigarette taxes and lowered their smoking rates. “What they’re doing is saving lives,” she kept saying.

Finally, this spring, she helped convince state senators to raise cigarette taxes for the first time in 12 years. Then came the tobacco lobbyists.

Bankrolled by the country’s two biggest cigarette companies, they swarmed the halls of the state capitol, wined and dined Republican leaders, launched a sophisticated call-in campaign and coached witnesses for hearings. The tobacco companies poured more than $200,000 into Montana, a state with barely a million residents.

It took them just one week to kill the bill – from the time it passed the state Senate to its last gasps in a state House committee. The tobacco lobby was so effective that, in the end, eight of the bill’s original co-sponsors voted against it.

“It was incredible. Just brutal,” Page-Nei said. “I’d never seen this amount of money being poured into a session in my 17 years here.”

Health experts agree that raising taxes is the most effective way to reduce tobacco use. The U.S. surgeon general, the World Health Organization and the Centers for Disease Control and Prevention have all concluded that raising taxes helps large numbers of smokers to quit and have advocated loudly for it.

But many states – Missouri, Kentucky and Georgia among them – have not significantly increased their cigarette fees in decades, bowing to pressure from tobacco lobbyists and an ingrained antipathy among conservatives to raising taxes of any kind.

As a result, America’s smokers are increasingly concentrated in states where cigarettes are cheap. A pack of cigarettes will soon cost $13 in New York City, where a tax hike of $2.50 was recently passed. But in Kentucky – the state with the highest rate of smokers, at 25.9 percent, compared to the national rate of 15 percent – you can buy that same pack for $4.77 on average.

“People around here just don’t like the ‘tax’ word,” said Ellen Hahn, a tobacco control expert at the University of Kentucky who has struggled for years to raise Kentucky’s 60 cents per pack cigarette tax. “Between that and the grip of the tobacco industry on our legislature, it’s hard to convince anyone, especially politicians.”

The huge gap in prices is the result of a long-running war between tobacco companies and health advocates. It is also, experts say, one of the biggest reasons low-tax states now suffer from high rates of cancer, heart disease, diabetes and a multitude of other tobacco-related diseases.

“It’s incredibly frustrating because unlike so many other problems in the country, this is one case where we know the solution,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids. “Not only that. It’s a solution that’s widely popular, doesn’t cost the government anything, yet these states refuse to do it.”

In the 1980s, some states started aggressively raising cigarette taxes to combat smoking. Over the years, overwhelming research has proved it works. But there’s one wrinkle: The tax increase has to be large, or else it has little effect on smokers.

As a result, the battle has increasingly focused on not just whether states should increase taxes, but by how much.

Health advocates regularly fight for $1 to $2 increases, while cigarette companies push to limit them to hikes of 25 to 50 cents. That has led, at times, to bizarre conflicts.

Last year, when Missouri considered raising its cigarette tax for the first time in more than two decades, tobacco companies actually supported the increase, while health groups such as the American Cancer Society strongly opposed it.

The reason? The proposed increase was so low – either a gradual 23-cent hike or a 60-cent increase over four years – that researchers concluded smokers would pay it and keep smoking.

The Missouri fight was particularly important because the state has the lowest cigarette tax in the country. These days, Missouri smokers pay only 17 cents per pack, plus the nationwide federal tax of $1.01 cents.

Health advocates accused tobacco companies of backing the small bump to avoid larger hikes in the future.

Tobacco giant R.J. Reynolds, which spent $12.5 million for the cause, denied that motive, saying it promoted the tax because it didn’t hurt consumers and retailers and because the money would go to a good cause – early-childhood education. “We thought it was a reasonable, common-sense proposal,” R.J. Reynolds spokesman David Howard said.

]]> 0 Sat, 21 Oct 2017 20:38:49 +0000
Senate Democrats rebuff changes to health care deal Sat, 21 Oct 2017 00:22:39 +0000 WASHINGTON — Top Senate Democrats rejected White House demands Friday to add provisions weakening the Obama health care law to a bipartisan deal on steadying unsettled insurance markets. The compromise already faced an uphill path and this was the latest blow.

Senate Minority Leader Chuck Schumer, D-N.Y., said the Trump administration was involved in the negotiations that produced the accord and “should support it instead of floating other ideas that would further the sabotage both parties are trying to reverse.”

Sen. Patty Murray of Washington, lead Democratic author of the agreement, said, “I’m certainly not interested in changing our bipartisan agreement to move health care in the wrong direction.”

The two Democrats were reacting to a White House official who said the measure must provide language lifting the tax penalties President Barack Obama’s Affordable Care Act imposes on people who don’t buy coverage and employers who don’t offer plans to employees. The White House also wants provisions making it easier for people to buy low-premium policies with less coverage, said the official, who was not authorized to describe the demands on the record.

Such language would be a clear deal-breaker for Democrats, who have helped defeat repeated Republican efforts this year to scuttle Obama’s 2010 statute, one of his crowning achievements.

Murray reached agreement last week with Sen. Lamar Alexander, R-Tenn., for a two-year extension of federal payments to insurers that President Trump has blocked. The measure would also give states modest new flexibility to let insurers sidestep some coverage requirements under Obama’s law.

Failure to restore the money is already leading many insurers to boost premiums and is threatening to chase others out of unprofitable markets around the country.

Obama’s statute requires carriers to lower out-of-pocket costs for poorer customers and the government to reimburse them. A federal judge has found the payments weren’t properly approved by Congress, but Obama and Trump continued them until Trump halted them last week.

Trump’s position on the bipartisan deal has confounded Democrats and Republicans alike. He’s alternately praised and condemned the effort.

]]> 0 Patty Murray, D-Wash., on Friday rejected a White House effort to change a bipartisan agreement on health care. (AP PhotoFri, 20 Oct 2017 20:38:54 +0000
Nominee to head DHHS expected to face tough questions at confirmation hearing Fri, 20 Oct 2017 08:00:00 +0000 AUGUSTA — Gov. Paul LePage’s nominee for commissioner of the Department of Health and Human Services will likely face intense questioning about the agency’s accountability and responsiveness at his confirmation hearing Friday.

Ricker Hamilton, a longtime DHHS administrator, could also be questioned about a recent federal audit that faulted the agency for, among other things, failing to investigate the deaths of 133 intellectually disabled adults being cared for in state-sanctioned group homes from January 2013 to June 2015.

Democrats in particular have long complained that DHHS withholds information and refuses to cooperate with the Legislature, especially under Hamilton’s former boss Mary Mayhew, a Republican now running for governor.

Sen. Ben Chipman, D-Portland, the ranking Senate Democrat on the Health and Human Services Committee, said he wants Hamilton to be candid with legislators.

“This is one of our largest departments – it’s over a third of our state budget, and we ought to get good answers and we ought to have accountability for the taxpayers of the state and for the citizens and residents that are served by the various agencies in the department,” Chipman said Thursday. “I’m hoping he will do a better job in general than we saw under the previous commissioner. I’m hoping for straightforward answers to things the committee wants answers to.”

Mayhew resigned in June and Hamilton was nominated by LePage this month to replace her. If the committee supports his nomination, the full Senate is expected to hold a confirmation vote early next week, when the Legislature returns for a brief special session.


Committee members from both parties said they expect a broad range of questions for Hamilton, who would head a department dogged by controversy and frequently in the public spotlight.

Some of the questioning will focus on the audit released in August by the federal Office of Inspector General, which found that DHHS failed to adequately protect developmentally disabled Medicaid patients in Maine, neglected to investigate deaths and did not properly report incidents such as sexual assault, suicidal acts and serious injuries.

Many of the audit’s criticisms are directed at DHHS offices under Hamilton’s oversight while he was deputy commissioner for programs, before Mayhew departed and he was appointed acting commissioner in June.

Still, Rep. Patricia Hymanson, D-York, the House chair of the Health and Human Services Committee, said she doesn’t expect the hearing to focus solely on the audit.

“We have many topics to talk with him about and that’s one of them,” Hymanson said. “I don’t want one topic to eat up all the time of the committee.”

Hymanson said she would focus on “what is his philosophy regarding the relationship between the Legislature and the executive branch – I think a lack of transparency is an overarching theme. There is a need for a better working relationship.”

She emphasized that the hearing is about Hamilton, not Mayhew, although some have speculated that it might be politicized in an attempt to either promote or impede Mayhew’s campaign.

Hymanson said it’s more important to hear what Hamilton considers successes over his long career and what “he’s seen as challenges or things he would have done differently.”


Since he was named acting commissioner, Hamilton has improved the flow of information to the committee and Legislature, said state Sen. Eric Brakey, R-Auburn, the committee’s Senate co-chair.

“And he has made himself accessible and has been reaching out to all the members of the committee, including the Democrat members of the committee, regarding this OIG report and around other issues and questions that people have had in the last few months,” Brakey said.

He said he expects testimony in support of Hamilton’s nomination from both parties. “Of course, it is an election year, so you never know what kind of political games will be played,” Brakey said.

He said committee Democrats should consider who LePage might nominate if they oppose Hamilton. “I think they will have to ask themselves, ‘If not Ricker, then who?’ ” Brakey said.

Hamilton served as deputy commissioner of programs at DHHS from 2013 until June. He has managed the Offices of Aging and Disability Services, Child and Family Services, Substance Abuse and Mental Health Services, the Dorothea Dix Psychiatric Center and the Riverview Psychiatric Center.

He also was program administrator for adult protective services at DHHS and an instructor at the Maine Criminal Justice Academy. He earned a bachelor’s degree from Saint Anselm College in 1976 and a master’s degree in social work from Boston College in 1984.


State Rep. Deb Sanderson, R-Chelsea, the ranking House Republican on the committee, said she too believes the confirmation hearing will focus on Hamilton’s career, his qualifications and on how he would lead the department.

Sanderson said the federal audit had become “highly politicized” and she hoped questions would focus on what DHHS has done to improve on the issues it highlighted.

“I would hope (Friday) we are not looking to the past but looking to the future and on who is going to lead the department into the future,” Sanderson said.

The confirmation hearing is scheduled to begin at 9 a.m. in the Cross Office Building next to the State House in Augusta.

Scott Thistle can be contacted at 713-6720 or at:

Twitter: thisdog

]]> 0 Hamilton, center, served as deputy commissioner of programs at DHHS from 2013 until June. If confirmed as commissioner, he would head a department dogged by controversy and frequently in the public spotlight.Fri, 20 Oct 2017 00:25:38 +0000
Bipartisan plan to curb health insurance premiums gets strong support Thu, 19 Oct 2017 23:28:04 +0000 WASHINGTON — A bipartisan proposal to calm churning health insurance markets gained momentum Thursday when enough lawmakers rallied behind it to give it potentially unstoppable Senate support. But its fate remained unclear as some Republicans sought changes that could threaten Democratic backing.

Republican Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington said their plan had 24 sponsors, divided evenly between both parties, for resuming federal subsidies to insurers. Trump has blocked the money and, without it, insurers are already raising premiums for many buying individual coverage and could flee unprofitable markets.

Senate Minority Leader Chuck Schumer said all 48 Democrats — including two independents who support them — would back the measure in a vote. That meant that combined with the dozen Republican sponsors there would be 60 votes for the plan, the number needed to overcome a filibuster, a delaying tactic meant to kill legislation.

“Every Democrat’s voting for it. Do the math, baby,” an exultant Schumer, D-N.Y., told reporters.

The politically compelling arithmetic raises pressure on Majority Leader Mitch McConnell, R-Ky., who’s been noncommittal so far, to let the Senate consider the legislation. A McConnell spokesman offered no new statement from him.

The growing Senate support also improved the chances that the proposal would become law, perhaps later this year as part of a must-pass measure financing the entire government.

The measure would still have to clear the House, where Speaker Paul Ryan, R-Wis., and many conservatives have been cold to the idea, and win Trump’s signature.

Two supporters of the bipartisan plan, Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, said in a statement that it “will not pass unless concerns of the House are addressed.” They said they were seeking agreement on provisions adding flexibility for states to ease some requirements of the Affordable Care Act.

In an interview, Graham suggested making tax-favored health savings accounts more generous and giving consumers more information about medical prices. He also mentioned letting insurers sell a wider range of lower-cost policies, which Democrats have resisted as a weakening of Obama’s law.

Sen. Ron Johnson, R-Wis., has been working with House conservatives on proposals like suspending enforcement of Obama’s tax penalties on people who don’t buy coverage and companies that don’t offer it to workers. Democrats have stood by those two cornerstones of Obama’s law, which curb premiums by pulling more healthy customers into the marketplace.

Murray spokeswoman Helen Hare said the senator “believes this is a good bill, which she’s already negotiated.” She said Murray is open to changes that retain “the core patient protections” of Obama’s law.

Alexander said Trump has encouraged him in four recent conversations to seek a bipartisan deal on the proposal.

Graham and Cassidy led their party’s failed effort in September to dismantle Obama’s health care law and instead send federal health care dollars directly to states as block grants. Party leaders have discussed trying anew in 2018.

Obama’s Affordable Care Act requires insurers to reimburse poorer customers for out-of-pocket costs like deductibles and co-pays. It helps around 6 million people.

The law also obliges the government to repay carriers for those costs, around $7 billion this year. A federal judge concluded that Congress never properly approved the money, but Obama and Trump continued the payments until Trump halted them last week.

The Alexander-Murray agreement extends the payments for two years. It gives states additional flexibility under Obama’s law and allows consumers of any age to buy low-cost catastrophic coverage plans.

When the two senators unveiled their agreement earlier this week, the president initially reacted favorably but then condemned the deal as a bailout for insurers.

Questioned in the Oval Office on Thursday, the president again sounded lukewarm.

“It’ll be absolutely short term,” Trump said of the bipartisan plan, “because, ultimately, we will be, it’s going to be repeal and replace.”

Trump added, “I don’t want the insurance companies making any more money … than they have to.”

Anticipating that Trump would block the subsidies, many insurers have already boosted premiums for 2018 policies to recoup the difference. Some Republicans say restoring the federal payments would give insurers a windfall.

Alexander and Murray have built rebates and other mechanisms into their bill to ensure consumers get the funds and say they are open to changes to satisfy Trump.

Johnson gave voice to Republicans’ frustration with the president’s inconsistent response.

“It’s always best for the president to be completely consistent in terms of what he’s supporting or not supporting,” Johnson told reporters at the Capitol. “And let’s face it, he’s not been particularly consistent here.”

]]> 0 Patty Murray, D-Wash., ranking member, and Sen. Lamar Alexander, R-Tenn., chairman of the Health, Education, Labor and Pensions Committee, confer about the health proposal.Thu, 19 Oct 2017 21:06:01 +0000
Kennebunk man who got new genetic cancer treatment looking forward to a long life Thu, 19 Oct 2017 00:20:15 +0000 KENNEBUNK — Michael Delia calls himself a GMO, a genetically modified organism. It’s a play on words equating GMO-produced food to how a cutting-edge immune therapy procedure may have saved Delia’s life.

Delia’s T-cells were “genetically engineered” and re-inserted back into him to fight an aggressive form of non-Hodgkin lymphoma. The experimental treatment soon will be more widely available to patients.

Delia, 73, a Kennebunk retiree, has been in full remission for more than a year. He participated in a clinical trial, and the therapy, called CAR T, was approved on Wednesday by the Food and Drug Administration.

“I’m a GMO,” Delia said, smiling. “They inserted the good cops into me, and they’ve gone in my body and taken out the bad guys.”

Doctors removed his T-cells, which were genetically engineered in a lab in California and re-injected back into him during a procedure at Dana-Farber Cancer Institute in Boston in July 2016.

After eight days in the hospital to recover from extreme fatigue and other side effects, Delia has been cancer free for more than a year. He went golfing about two months after he got out of the hospital, and spent last winter skiing.

“I’ve been feeling completely normal, saying a lot of prayers,” said Delia, a former U.S. Air Force colonel and helicopter pilot during the Vietnam War. Delia said he was exposed to Agent Orange while in Vietnam and the Veterans Administration has considered him disabled from the chemical. He said he can’t prove that it’s what caused his cancer, but he believes it did.

Delia had tried chemotherapy and radiation in 2014 and 2015 to treat a tumor on his right leg and cancerous cells that were in a lymph node. But the cancer kept coming back, and in 2016 he and his doctors decided to try something different.

“I was told that they could keep trying chemotherapy, but that it probably wouldn’t get good results,” Delia said.

Video: Doctors using patients’ genes to guide cancer care

Delia said Maine Medical Center doctors told him that he would be a candidate for a clinical trial at Dana-Farber. Maine Med and Dana-Farber deepened their partnership in 2015, including giving Maine Med patients more access to Dana-Farber clinical trials.

“I consider myself very fortunate,” Delia said. “Maine Med just happened to have this association with Dana-Farber. I said, ‘Let’s do it and see what happens. Let’s kick this thing.'”

About 20,000 patients each year are diagnosed with the type of non-Hodgkin lymphoma Delia had, said Dr. Caron Jacobson, the Dana-Farber physician who headed up the clinical trial. Of that group, Jacobson said a few thousand do not respond well to traditional cancer treatment, and for those patients the immune therapy now has proven to be a viable choice.

“This is really changing the way we treat these patients who otherwise would have very few resources,” Jacobson said. She said the results of the clinical trial are “incredibly encouraging.”

The clinical trial involved 101 patients across the country, with 82 responding positively to treatment and 54 percent in “complete” recovery, according to a Dana-Farber news release.

The FDA approval of the Kite Pharma therapy is a major step toward getting the treatment in broader use. The next steps would be to get Medicare to cover the procedure and private insurance companies to then follow suit.

While it’s not yet known how much it would cost, a similar CAR T immune therapy to treat a form of pediatric leukemia costs $475,000, raising alarms among consumer health advocates.

But Gary Claxton, co-director of the program for the study of health reform and private insurance at the Kaiser Family Foundation, a Washington-based think tank, said that there’s a difference in paying high costs to fund for research for new therapies and funding disputes over existing treatments, such as a controversy over a spike in costs for EpiPen, a life-saving device for allergies.

And Claxton said that as exclusive patents expire and more companies develop therapies that are as effective or better, the prices will likely come down.

“Things that are expensive now tend to become less expensive later,” he said.

Also, a highly specialized drug can be extremely expensive, but if it’s not in wide use, it won’t have much of an overall effect on the cost of health care in comparison to a drug or medical device that would be used by millions.

“When a new drug comes out and it’s expensive, some might say it costs too much. In this country, we don’t have any way to mediate these prices. This can be a problem,” Claxton said.

But he said that when the drug or therapy is approved by the FDA, it clears an important hurdle. If the doctor can prove that the new therapy is medically necessary, backed up by FDA approval they can usually get Medicare to agree to pay for it, and it’s also easier to get an insurance company to pay for it. Claxton said the patient may have to file appeals with insurance. But he said over time, if the therapy continues to prove it’s effective, the barriers to access will lessen.

Delia said that the high cost for the leukemia immune therapy does make him worry about access for people who are not able to participate in a clinical trial and have their costs covered as he did.

But Delia, who moved to Maine 20 years ago with his wife, Bettianne, said he sees the results as a positive step and hopes that others like him with aggressive non-Hodgkin lymphoma soon can try the immune therapy.

Bettianne said her husband is “brave” and “never had one negative word” during the trying time.

Jacobson said Delia was “incredibly fit and saw the bright side of everything. That’s a good recipe for going through any kind of treatment.”

Delia said he has good health, and his father and uncles lived into their 90s, and that’s his goal as well.

“We got through this, so I intend to be skiing into my 80s and I plan to live well into my 90s,” he said.

Joe Lawlor can be contacted at 791-6376 or at:

Twitter: @joelawlorph

]]> 0, 19 Oct 2017 00:22:00 +0000
Trump reverses course on emerging Senate health care deal Wed, 18 Oct 2017 12:33:06 +0000 WASHINGTON — President Trump became the subject of an unusual public lobbying campaign over the fate of the Affordable Care Act on Wednesday as Senate Democrats and a key Republican sought to salvage a bipartisan health deal while conservatives pressured the president to disavow the agreement.

In a morning tweet, Trump appeared to distance himself from the compromise, which would authorize payments to insurers that help offset millions of lower-income Americans’ health costs in exchange for granting states greater flexibility to regulate coverage. But the president later told reporters that he was not closing the door on a deal altogether, and proponents of the plan developed by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., sought to keep him on board.

President Trump applauds members of the audience before speaking at the Heritage Foundation’s annual President’s Club meeting Tuesday in Washington. Trump first praised a bipartisan deal on ACA subsidies, then backed off his support. Associated Press/Pablo Martinez Monsivais

The convoluted campaign, in which Senate Minority Leader Charles Schumer, D-N.Y., insisted that a deal remained in reach even as he blasted the president’s “zigging and zagging,” underscored the unpredictable nature of dealmaking in Trump’s Washington. With constantly shifting alliances, the city’s key political players are jockeying to win the president’s support one issue at a time.

For Senate Democrats, trying to sway Trump to back the plan carries both potential risks and rewards. Working with a president despised by their base and prone to changing his mind could drag them into a political quagmire with unpredictable outcomes.

For conservatives who are pressing for a different deal or oppose the idea of propping up the Affordable Care Act, the moment presents a test of how much influence they have with the president, who has suggested a greater willingness to hash out deals with Democrats and become more and more frustrated with his own party.

On Wednesday Trump tweeted about the deal:

For both sides, the president’s conflicting signals have created a chaotic situation where even some of Trump’s aides have found themselves scrambling to keep up with the latest developments.

He began the morning by warning that the new agreement might be tantamount to an insurance giveaway. “I am supportive of Lamar as a person & also of the process, but I can never support bailing out ins co’s who have made a fortune w/ O’Care,” Trump wrote on Twitter.

Sen. Patty Murray, D-Wash., the ranking member, and Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor, and Pensions Committee, meet before the start of a hearing Wednesday, the morning after they reached a deal to resume federal payments to health insurers that President Donald Trump had halted. Associated Press/J. Scott Applewhite

But shortly afterward, Alexander – who chairs the Health, Education, Labor and Pensions Committee and was encouraged by the president to pursue a deal – said in an interview that Trump expressed an openness to preserving it in a phone call Wednesday morning.

“He told me that he wanted to encourage me but that he will review it, as I would expect a president to do,” Alexander said. “He may want to add something to it. It may come up as part of the end-of-the-year negotiations. We’ll see.”

Speaking later to reporters in the Cabinet Room, Trump praised Alexander’s efforts, saying, “If something can happen, that’s fine, but I won’t do anything to enrich the insurance companies.

“They’ve been enriched by Obamacare like nothing anybody’s ever seen before,” the president added.

Although Trump has repeatedly described cost-sharing payments as a “bailout” to insurers, the money directly covers the discounts that low-income Americans on Affordable Care Act plans receive for deductibles and other out-of-pocket costs. This group includes about 7 million Americans earning up to 250 percent of the federal poverty level.

Insurers are obligated to provide the discounts, which totaled about $7 billion this year and are estimated to reach $10 billion next year, even if the federal payments are cut off. According to the National Association of Insurance Commissioners, Trump’s decision last week to end the subsidies will cost insurance carriers more than $1 billion this year.

Facing the prospect for months that the Trump administration would cut off the payments, most insurers have opted to factor this shortfall into their 2018 premium rates for their customers. The cutoff in cost-sharing payments has translated into premium increases of 12 percent to 20 percent, according to several analyses.

Alexander suggested that he may change the language of the proposal to address Trump’s concerns that insurers would benefit from the cost-sharing reduction payments. He added that during their Wednesday call, he told Trump that he was about to tell reporters, “They’re underestimating your leadership on health care, because what you’ve done is you’ve created a bipartisan option for the Senate and for the country.”

Alexander said that the compromise already has language to ensure that the subsidy “benefits go to consumers, not to insurance companies,” but he was open to making it stronger.

Schumer, for his part, alternated between attacking Trump’s inconsistent policy positions and arguing for why the president and the deal’s proponents agreed on a short-term health-care fix.

Trump ended the cost-sharing reduction payments, known as CSRs, last week, arguing that they were illegal because they were not explicitly authorized under the Affordable Care Act. He left it to Congress to decide whether to fund them.

Schumer, who discussed the prospect of a bipartisan deal with Trump less than two weeks ago when the president called him in the Senate gym, said in a floor speech that the allegations of an insurance bailout show that “the president doesn’t know what he’s talking about.”

“It helps people who are sick and need health care. It keeps their premiums low,” Schumer said of the funding, adding that there is language in the agreement that bars insurers from pocketing the money.

During the negotiations, Democrats had proposed delaying the open enrollment period for Affordable Care Act plans, which is set to begin Nov. 1, for a month after the bill’s enactment to ensure that firms could lower their 2018 premium rates to reflect the fact that the government would keep funding the subsidies. White House Domestic Policy Council Director Andrew Bremberg opposed that provision, Schumer said, but he added that Democrats are willing to insert stronger language to guarantee that insurers pass on the payments to their customers.

“We’re all of the same mind,” Schumer said of Trump, Senate Democrats and Alexander. “And we can do that.”

In a brief interview Wednesday afternoon, Murray brushed aside the president’s hostile rhetoric.

“This is not about the president. This is about just doing the right thing so the American people’s rates don’t go up, and that’s where we’re focused,” she said.

Asked whether she was willing to alter the terms of the agreement, Murray replied: “No. We have a deal; we’re moving it forward.”

Some Democrats said they have no reservations about trying to solve a problem that, in their view, was created by Trump and for which his party will be blamed if Congress takes no action.

“We know doing this will be good for the country,” said Sen. Sherrod Brown, D-Ohio. “I hope that people here aren’t that cynical, that, ‘Why would you do it just because it’s good for the country?’ ”

But conservatives were already mobilizing to block the measure, which would authorize CSR payments for two years. The framework would also allow insurers to offer catastrophic insurance plans to consumers 30 and older on Affordable Care Act exchanges while maintaining a single risk pool. It would shorten the period for federal review of state waiver applications; expedite reviews for states in emergency circumstances and those with waiver proposals that have already been approved for other states; and allow governors to approve state waiver applications rather than require state legislative approval.

Susan B. Anthony List President Marjorie Dannenfelser, whose political action committee backs antiabortion candidates, described the proposal Wednesday as “an inadequate, shortsighted approach which fails to address the abortion funding problems created by the health-care overhaul.”

“Right now nearly 900 health-care plans subsidized by taxpayer dollars cover abortion, forcing taxpayers to be complicit in the destruction of human life,” she said. “In no way does the Alexander-Murray bill fulfill Republicans’ campaign promise to repeal and replace the ACA.”

A handful of Senate Republicans have expressed support for the plan, including Mike Rounds, S.D., John McCain, Ariz., and Bill Cassidy, La. But Senate Majority Leader Mitch McConnell, Ky., has not committed to bringing it up for a floor vote, and some GOP senators questioned Wednesday why they should keep funding the subsidies.

“Well, I don’t want to just vote to put paint on rotten wood,” Sen. John Neely Kennedy, R-La., told reporters. “I just want to understand what the benefits are. I understand the money going out the door.”

Several key House Republicans said they don’t see how the bill would win passage in their chamber.

Many senior White House officials oppose the bill, according to administration officials and Republicans who have been briefed on the matter. At times, Trump’s aides have been sidelined as he has conferred with Alexander, according to one Republican, fueling confusion about the state of negotiations.

The bipartisan plan does enjoy support among patient rights groups, although they have raised concerns about whether the flexibility it offered could raise health-care costs. On Wednesday, the American Cancer Society Cancer Action Network endorsed it.

“This deal offers important, immediate action to stabilize the individual insurance market,” said the group’s president, Chris Hansen. “Restoring $106 million per year in outreach and education programming would help to reduce public confusion over the law and ensure more people who need health coverage get it.”

Even as elected officials and interest groups debated in Washington how to handle cost-sharing payments, attorneys general from 18 states and the District of Columbia filed a motion in the U.S. District Court for the Northern District of California seeking a temporary restraining order and a preliminary injunction that would require the administration to continue making the payments to insurers. The attorneys general argued that the court order was needed “to prevent immediate and irreparable harm to the Plaintiff states and the millions of Americans who benefit from affordable health coverage under the ACA.”

]]> 0 Donald Trump applauds members of the audience before speaking at the Heritage Foundation's annual President's Club meeting, Tuesday, Oct. 17, 2017 in Washington. (AP Photo/Pablo Martinez Monsivais)Wed, 18 Oct 2017 22:18:33 +0000
Key senators strike short-term deal to reinstate ACA payments to health insurers Tue, 17 Oct 2017 18:56:56 +0000 WASHINGTON – Republican and Democratic senators joined in announcing a plan Tuesday aimed at stabilizing America’s health insurance markets in the wake of President Trump’s order to terminate “Obamacare” subsidies. Trump himself spoke approvingly of the deal, but some conservatives denounced it as an insurance company bailout, making its future uncertain.

The agreement followed weeks of negotiations between Republican Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington that sought to address health insurance markets that have been in limbo following Republican failures to repeal and replace the Affordable Care Act. The talks took on added urgency when Trump announced last week that he would end monthly “cost sharing reduction” payments the government makes to help insurance companies reduce costs for lower-income people.

Without that money, premiums for some people buying individual health plans would spike, and some insurers would flee the markets, industry officials warn.

The Alexander-Murray deal would continue the insurer payments for two years, while establishing new flexibility for states under former President Obama’s law.

“This would allow the Senate to continue its debate about the long term of health care, but over the next two years I think Americans won’t have to worry about the possibility of being able to buy insurance in counties where they live,” Alexander said in announcing the deal after a closed-door lunch where he presented it to Republican senators.

“This agreement avoids chaos. I don’t know a Republican or Democrat who benefits from chaos,” he said.

Alexander said the president had encouraged his efforts in phone calls over the past two weeks. And at the White House, Trump responded positively, expressing optimism that Republicans would ultimately succeed in repealing Obamacare, but until then: “For one year, two years, we’re going to have a very good solution.”

Trump’s position may seem contradictory in that he himself ordered an end to the payments, calling them a bailout, but is now encouraging legislation to reinstitute them. Indeed, White House officials had said they would want more in exchange than the additional state flexibility offered in the Alexander-Murray agreement.

Just minutes before Alexander announced the deal, White House legislative director Marc Short emerged from the Senate Republican lunch saying that “a starting point” in exchange for restoring the cost-sharing payments “is eliminating the individual mandate and employer mandate” – the central pillars of Obamacare.

That suggested some disagreement within the administration on the issue. If so, it does not bode well for ultimate passage of Alexander-Murray, since the president’s full support will be crucial in persuading Republicans to get on board.

Initially as president, Trump continued making the payments though resisting, but he declared last week he would pull the plug. The payments, which cost around $7 billion this year, lower expenses like co-payments and deductibles for more than 6 million people. But discontinuing them would actually cost the government more money under Obamacare’s complicated structure, because some people facing higher premiums would end up getting bigger tax subsidies to help pay for them.

The Alexander-Murray deal does include a host of provisions allowing states faster and easier access to waivers that would allow them to shape their own marketplace plans under Obamacare. It also would provide for a new low-cost catastrophic coverage insurance option for all consumers.

Reaction from the Republican was decidedly mixed. For many conservatives it’s practically unthinkable to sign off on federal payments that would arguably prop up a law they’ve been vowing for seven years to destroy.

Rep. Mark Walker of North Carolina, chairman of the conservative Republican Study Committee in the House, quickly denounced the deal over Twitter: “The Republican should focus on repealing & replacing Obamacare, not trying to save it. This bailout is unacceptable.”

Freedom Caucus Chairman Rep. Mark Meadows, who’s been at work on a proposal of his own, was slightly more positive, calling the Alexander-Murray bill “a good start” but saying much more work needed to be done.

Republican leaders in the House and Senate have also been cool to the Alexander-Murray negotiations, the more so since after their failures on Obamacare they are eager to turn their full attention to tax overhaul legislation. Senate Majority Leader Mitch McConnell was noncommittal, telling reporters: “We haven’t had a chance to think about the way forward yet.”

Alexander said he and allies including Sen. Mike Rounds, R-S.D., would spend the next several days trying to build up support with the goal of formally introducing legislation later this week. If the legislation does pass, it would almost certainly be as part of a larger package including must-pass spending or disaster relief bills and that might not be until the end of the year.

Murray lauded the effort, saying, “When Republicans and Democrats take the time … we can truly get things done” for the American people.

Even more than other aspects of the law, the cost-sharing payments have been in dispute ever since the Affordable Care Act became law. House Republicans sued in 2014 to block the payments, arguing they were illegal because Congress, which has power over government spending under the Constitution, had never specifically authorized them. The Obama administration tried unsuccessfully to get the Republican lawsuit dismissed, but the Republicans won favorable rulings from lower-court judges, putting the payments in legal jeopardy even before Trump won the White House.

]]> 0 Lamar Alexander, R-Tenn., left, accompanied by Sen. Mike Rounds, R-S.D., right, speaks to reporters on Capitol Hill in Washington, Tuesday, Oct. 17, 2017, after he and Sen. Patty Murray, D-Wash., say they have the "basic outlines" of a bipartisan deal to resume payments to health insurers that President Donald Trump has blocked. (AP Photo/Andrew Harnik)Wed, 18 Oct 2017 00:17:59 +0000
Minot man awarded $300,000 in malpractice claim against Lewiston dentist Mon, 16 Oct 2017 19:04:55 +0000 AUGUSTA — A Minot man who developed a massive infection following oral surgery was awarded $300,000 in damages Monday after a jury found that Dr. Jan Kippax and his Lewiston practice were negligent during the patient’s treatment in 2011.

The verdict followed 2½ hours of deliberation on the fifth day of the civil trial at the Capital Judicial Center.

Steven Darnell Jr., 35, charged that Kippax failed to comply with applicable standards of care when Darnell developed the infection just days after Kippax extracted two of his molars in January 2011.

In closing arguments, Scott Lynch, Darnell’s attorney, asked jurors to find that both Kippax and Androscoggin Oral & Maxillofacial Surgeons, P.A., negligent and suggested jurors award Darnell $48,266.82 for his medical bills, and $295,000 for pain and suffering during a week at home, two weeks in the hospital and three months of daily trips to an infusion lab to receive antibiotics.

Lynch held up for jurors a color photo of Darnell’s face at the time showing the lower portion of his jaw swollen to twice its normal size.

Lynch said doctors had to operate on Darnell’s jaw and put in drains to eliminate the pus that had built up from the infection.

Lynch also told jurors to decide for themselves on an amount to compensate Darnell for the scar he now bears and the lasting effects to the left side of his face.

“This changed Steven’s life,” Lynch said.

Kippax’s attorney, Mark Lavoie, said Kippax treated Darnell properly, seeing him on Jan. 3, 2011, when Darnell complained that he remained in severe pain three days after the teeth were extracted.

Lavoie said Kippax saw no evidence of infection at that point and that Darnell failed to follow Kippax’s discharge instructions to rinse his mouth with salt water and to avoid smoking.

Lavoie also said that Darnell did not return for help after that one follow-up visit and instead chose to go to the emergency room at Central Maine Medical Center on Jan. 5, 2011, and then on Jan. 7, 2011, when he was admitted.

“It’s not an infection Dr. Kippax gave him,” Lavoie said. “It’s not an infection that Dr. Kippax failed to see.”

He added, “In the end, Dr. Kippax provided good care. He took out teeth that needed to come out, he did it expertly, and he saw the patient when he requested a follow-up.”

A number of experts testified on both sides.

After the jury verdict, Lavoie said, “We accept their decision. We disagree with it.”

He added. “It’s very disappointing to the doctor, obviously.”

Lavoie said the money will come from Kippax’s malpractice insurer.

The verdict was returned in an unusual form. Instead of sending a note indicating the jury had reached a verdict, the jury sent the verdict to Justice MaryGay Kennedy, who presided at the trial. She told the lawyers just prior to the jury’s return that she had not looked at it, and a clerk read it aloud once the jury returned.

Jurors voted 8-1 to award the $300,000 in damages.

After the verdict, Lynch said, “Obviously the Darnell family is delighted they had the opportunity to present Steven’s story to the jury. We just wanted to expose Dr. Kippax’s office practices.”

Lynch referred to Kippax’s estimation that he had treated 97,000 people and extracted 400,000 to 500,000 teeth. Lynch said it was “an extraction mill.”

The case, which originated in Androscoggin County Superior Court, was moved to Kennebec County for trial because of pre-trial publicity.

Kippax’s license to practice dentistry was suspended for 30 days earlier this year by an order of the Maine Board of Dental Practice, which is reviewing a number of complaints filed against him by patients. In the meantime, Kippax continues to practice.

Lynch said, “We’re hoping that the state dental board will take a look at this verdict and what the average person can do if they just stand up and tell their story.”

Kippax was the defendant in a similar malpractice lawsuit brought in Kennebec County by a Hallowell woman in 2009. Kippax prevailed in that case, and the Maine Supreme Judicial Court affirmed that verdict.

Betty Adams — 621-5631

Twitter: @betadams

]]> 0 Jan Kippax, at a hearing Sept. 29 before the Maine Board of Dental Examiners, was accused of failing to comply with the standards of care when treating a Minot man whose jaw became infected after tooth extractions.Tue, 17 Oct 2017 00:19:43 +0000
About 70,000 low-income Mainers await crucial state vote on expanding Medicaid Sun, 15 Oct 2017 08:00:00 +0000 LEWISTON — Donna Wall sprinted into the night, newspaper in hand and pointy elbows flapping at right angles from her sides. She made her way to the back porch of one of the 160 customers on her delivery route.

It was 2 a.m. on a weekday in October, but it could be any day of the year, as Wall’s only day off is Christmas.

She slipped back into her red Nissan Versa – Sly and the Family Stone playing on the car radio – and laughed ruefully. She wore a blue and white football jersey that said “Meet Me in the Tropics.” Did she get her shirt on a cruise?

“Ha! I wish,” Wall said as she put her car in park, grabbed another Sun Journal and ran into an apartment complex.

Wall is one of about 70,000 Mainers who stand to benefit from Medicaid expansion, which is on the Nov. 7 ballot.

Conservatives like Republican Gov. Paul LePage are steadfastly against Medicaid expansion, while liberals and all major health care groups, such as groups representing hospitals, doctors and nurses, are arguing in favor of expansion.

The vote matters personally for people in Wall’s circumstances.

Wall, 60, is uninsured, and she worries about how long she can keep doing what she’s doing before she falls ill.

“I work nonstop. That’s all I do. I don’t have a life. I don’t hardly even have adult conversations,” said Wall, who lives nearby in a modest apartment.

Wall took the overnight job – if she runs she can finish it in three hours, although snow and rain can make it take up to five hours – because she needed the extra money.

A single mother, Wall takes care of three adult autistic children. Her 18-year-old twin boys are nonverbal and have the intellectual development of toddlers. Her 21-year-old daughter is high-functioning but still developmentally disabled.

The Nov. 7 vote asks whether taxpayers should take care of low-income Mainers who need health insurance.


The liberal advocacy group Maine Equal Justice Partners gathered voter signatures to put the question on the ballot after expansion bills passed by the Legislature had been vetoed five times by LePage.

Brent Littlefield, LePage’s political adviser and a spokesman for the Welfare to Work PAC that opposes Medicaid expansion, pointed to Maine’s history of expanding Medicaid in the 2000s as a reason not to accept the federal money to do so this time.

“We already tried this experiment. Our argument is that this experiment failed,” Littlefield said, pointing to state budget problems caused by Medicaid cost overruns. “The results were disastrous. The uninsured percentage hardly budged despite massive amounts of additional spending.”

But Ann Woloson, public policy director for Maine Equal Justice Partners, said with the federal government footing 90 percent or more of the bill for the expansion, it’s a “good deal” for Maine.

“This is more than providing health care coverage to people in the gaps. This will improve the Maine economy. It’s going to create good-paying jobs,” she said.

Woloson agreed that Maine’s uninsured rate stayed relatively the same in the 2000s and early 2010s, but she pointed out that at the same time, in most other states the uninsured rate was increasing because employers were dropping coverage as health care costs increased and the recession hit.

The Medicaid question comes on the heels of dramatic votes on efforts to repeal the Affordable Care Act in the U.S. Senate – with moderate Maine Republican Sen. Susan Collins casting a decisive “no” vote – and a near-vote in September when Collins’ opposition was again crucial.

Last week, the Trump administration took additional steps to undermine the ACA’s individual marketplace, including cutting back on subsidy payments to insurance companies and setting the wheels in motion to create a separate insurance market that health experts say would weaken the ACA.

WHO ARE THE 70,000?

The 70,000 people who would directly benefit from an expansion of Medicaid, called MaineCare here, are residents who earn between 0 and 138 percent of the federal poverty limit, about $28,000 for a family of three.

Many of these people previously had Medicaid coverage, under an expansion that took place in 2002. But LePage scaled back the program after he won the gubernatorial election and took office in 2011. The 2002 expansion provided health care coverage to parents earning up to 200 percent of the federal poverty level and 100 percent for childless adults.

Total Medicaid enrollment has declined from 356,000 in 2011 to 268,000 in 2017, according to the Maine Department of Health and Human Services. About 36,000 people lost eligibility under LePage’s cuts – including childless adults and parents with minor children who earned between 100 and 200 percent of the poverty level.


Medicaid is a federal program operated by the states that’s funded with a blend of state and federal dollars. In Maine, about two-thirds of the funding comes from the federal government, and the state kicks in the rest for the $2.6 billion program.

Nationally, Medicaid expansion was a cornerstone of the ACA. In response to a legal challenge, the U.S. Supreme Court ruled that Congress cannot require states to expand, but for those who chose to do so, the federal government pays for 90 percent or more of the cost for at least the first three years. So far, 31 states have expanded Medicaid, and Maine may become the next state to do so if the referendum passes.

It’s difficult to determine how many of the 70,000 who would be eligible for Medicaid expansion earn less than 100 percent of the federal poverty level, Woloson said, but it’s safe to say it’s in the tens of thousands.

Wall lost her insurance coverage after her twin boys turned 18. In the eyes of the program, she was a childless adult and no longer eligible for MaineCare.

“I still take care of them just as much, if not more, than I did two years ago and when they were little,” she said.

Wall earns about $7,000 a year from her newspaper route. The $700 a month she receives from Social Security for her children’s disabilities bumps her annual income to about $17,000 to $18,000.

Wall falls into a coverage gap where she doesn’t qualify for Medicaid coverage and also is not eligible for subsidies to obtain Affordable Care Act marketplace insurance. She would need to make $24,600 to qualify for ACA subsidies.

And she’s not yet old enough for Medicare, which kicks in at age 65.

Wall said she works nearly around the clock and yet can’t afford to see the doctor. She’s put off some chronic health problems, forgoing needed checkups for her eyes. She had to discontinue counseling and the antidepressants she was taking when she was dropped off Medicaid a few years ago.

And she worries that if she is injured in a fall at work she would plummet into bankruptcy. Last winter, she fell hard on her tailbone, but it didn’t cause any medical problems other than soreness.


The ACA was designed to have Medicaid expansion mandatory in all states. That would have provided coverage to those earning up to 138 percent of the poverty level, at which point ACA marketplace coverage would take over. That way, Medicaid or subsidized insurance would be available to everyone from 0 to 400 percent of the poverty limit.

But the Supreme Court made Medicaid expansion voluntary, and Maine is one of 19 states that have refused expansion.

The uninsured rate declined an average of 48 percent in expansion states and 28 percent in nonexpansion states from 2013 to 2016, according to a 2017 Gallup poll. Maine’s uninsured rate dropped from 16 percent in 2013 to 9 percent in 2016.


In nonexpansion states, the poorest residents fall into an unusual category that was a byproduct of the Supreme Court decision.

If they earn less than 100 percent of the poverty limit, they make too little to qualify for ACA subsidies that make coverage affordable. A plan that would cost $200-$300 in monthly premiums for someone making 98 percent of the poverty limit would drop to about $10-$20 a month for someone earning just over the poverty limit, depending on the plan chosen.

According to the Kaiser Family Foundation – a nonpartisan Washington think tank – about 21,000 of the 80,000 people who have ACA marketplace coverage in Maine earn between 100 and 150 percent of the poverty limit. Most of the remaining 59,000 earn 151 percent to 400 percent, where the subsidies end.

Since the expansion covers those earning up to 138 percent of the poverty level, roughly 15,000 or fewer Mainers who currently have ACA insurance would instead be transitioned to Medicaid.

Rep. Karen Vachon, R-Scarborough, an insurance agent who favors bipartisan fixes to the ACA but is against Medicaid expansion in Maine, said having private insurance is superior to Medicaid because the reimbursement rates are higher and so more doctors accept private insurance patients. She said for people earning just above the poverty level, it’s better to have private insurance than Medicaid.

The current system in Maine gives people an incentive to take on more hours and earn more than 100 percent of the poverty limit and qualify for the subsidies, Vachon said.

“We have ‘Help wanted’ signs all over the state,” Vachon said. “We should always be trying to get people on a pathway to work.”

A single person living alone only needs to earn slightly more than $12,000 to qualify for ACA subsidies, she said, a relatively low bar to clear in order to qualify for good insurance.

But Medicaid expansion advocates say there are many reasons why people earn less than the poverty level, and they should also have access to insurance.

“There’s so many, many people who end up in the coverage gap,” said Emily Brostek, executive director of Consumers for Affordable Health Care, an Augusta-based advocacy group. “We hear from these folks all the time on our help line. They’re going back to school or can only work part time for a number of reasons. They’re caring for a family member or maybe they’re too sick to work full time but not sick enough to qualify for disability.”

Brostek said another category that could be helped are self-employed people starting their own businesses who often have a lean year or two before their business generates enough income to outpace expenses.

“There’s a lot of security knowing that if you have zero income for a while, there’s a program that will provide coverage for you while you get back on your feet,” Brostek said.

Woloson said for people just barely above the poverty level, paying even modest premiums is a barrier to having health insurance, because they’re often choosing between basic necessities or paying their premiums.


Chris Bemis, 39, of Winslow said his household income for a family of five is about $25,000, which is $4,000 short of crossing the threshold to make enough for ACA subsidies. So he’s temporarily uninsured, after being dropped off Medicaid in 2016. Bemis said he moved in with his girlfriend in Winslow about a year ago.

Household size is a determining factor in what income is needed to make it over the poverty level and qualify for ACA subsidies. While a single person living alone only has to earn slightly more than $12,000 to qualify for ACA subsidies, the threshold rises with the number of people in the household. So a family of five has to make nearly $29,000 to qualify, and a family of six needs about $33,000 in annual income.

Although parents are eligible for Medicaid if they make less than 100 percent of the poverty limit, if there are nonworking adults in the household, such as those who are disabled, it becomes harder to qualify. Nontraditional families, such as a significant other moving in with a single parent – as in Bemis’ case – also face eligibility problems.

Bemis works part time as a bus driver for the Kennebec Valley Community Action Program. His girlfriend works full time, but they need someone at home to care for a special needs child in the afternoon.

“People don’t want to hire you full time if you have to be home with the kids,” Bemis said.

He said their family’s situation is likely temporary – within the next few months or a year they will figure out a way to earn more money and then he would qualify for ACA insurance if the Medicaid expansion doesn’t pass.


But in the meantime, Bemis, a skin cancer survivor, said he feels vulnerable. Medical checkups have been put off, and he let an ear infection worsen rather than go to the doctor because he was uninsured.

“It does make me feel a little uneasy,” he said. “If I got really sick or was in an accident, I don’t know where the money would come from.”

He said he had Medicaid when he got sick with skin cancer several years ago.

“If it wasn’t for MaineCare, I would still be in debt,” Bemis said.

Woloson said the costs of caring for sick people are shifted to other parts of the system when people are uninsured. If they have access to insurance, they’ll take care of health problems sooner and are more likely to get preventive screenings.

“When people aren’t getting the health care they need when they need it, they let their health issues become worse and end up in the emergency rooms. We all end up paying higher premiums when that happens,” Woloson said.

Wall said she hopes she makes it through this winter without a major accident, and meanwhile, she’s rooting for voters to approve the expansion so she can sign up for Medicaid.

She said she sells plasma so her family has enough money for Sunday trips to McDonald’s for a meal.

“There’s nothing for me, or people like me. There should be. So many people need help, not just me,” Wall said as she stopped to deliver a newspaper on a dead-end street. She wrapped the paper in a plastic bag and hung it on a doorknob, because that’s how the customer prefers to get the morning paper.

Joe Lawlor can be contacted at 791-6376 or at:

Twitter: joelawlorph

]]> 0 Wall of Lewiston, 60, who takes care of three adult children with autism, puts in Christopher's eye drops. He and his brother, Brandon, have the cognitive abilities of toddlers. Wall lost her MaineCare insurance when the boys turned 18, and she's now in a coverage gap where she neither qualifies for Medicaid nor Affordable Care Act marketplace subsidies.Sat, 14 Oct 2017 19:14:32 +0000
Many states jump to block Trump’s halt of ACA insurer payments Sat, 14 Oct 2017 03:04:30 +0000 WASHINGTON — The Trump administration’s decision to halt payments to insurers that help millions of lower-income Americans afford coverage under the Affordable Care Act roiled the law’s insurance marketplaces Friday and sparked an immediate legal challenge from nearly 20 state attorneys general.

The administration’s move, which officials formalized through a filing in a federal appeals court, could throw the ACA sign-up season that begins Nov. 1 into disarray. Some insurers and state regulators are scrambling to reconsider rates for next year, and the uncertainty is sure to make an already challenging enrollment period even more so.

Yet it is unclear whether either the litigation or vehement opposition by a broad swath of the health-care industry has any chance of stopping what the president and his top aides portrayed as integral to their broader effort to dismantle the 2010 health law.

“ObamaCare is a broken mess,” Trump tweeted Friday. “Piece by piece we will now begin the process of giving America the great HealthCare it deserves!”

Both supporters and critics of the ACA see the “cost-sharing reduction” payments, which help offset deductibles and other out-of-pocket expenses for roughly 7 million Americans earning up to 250 percent of the federal poverty level, as crucial for individuals buying coverage under the law.


Insurers are obligated to provide these discounts for eligible customers, even if the federal government does not fund the CSRs, as they’re called; ending the payments is grounds for any company to back out of its federal contract to sell health plans for 2018. Their only other option is to raise premium rates.

In recent months, some state regulators directed ACA insurers to add a surcharge to their 2018 rates in case the payments would not be made, but insurers elsewhere may have to absorb the costs.

On Friday morning, the two main health insurance industry trade groups, America’s Health Insurance Plans and the Blue Cross Blue Shield Association, issued a rare joint statement calling the payments “critical” and saying “there will be real consequences” to ending them. Consumers’ insurance choices will shrink, costs will rise and the marketplaces will become unstable, they warned.

The Congressional Budget Office projected in August that eliminating the payments would increase taxpayer costs by $6 billion in 2018 and $21 billion in 2020 because federal tax credits for many Americans covered under the ACA rise when their premiums increase. The CBO also said that “5 percent of people live in areas that would have no insurers” next year if subsidies ended, but the “slightly higher number of uninsured” would be temporary. By 2020, it estimated, the uninsured rate would be “slightly lower” as more Americans took advantage of more generous premium tax credits.

A major fear among insurers is that the White House’s announcement, combined with other efforts to undermine the marketplaces, will scare customers away if they see rising premiums. Many people may not understand when signing up for insurance that although the premiums may have spiked, the amount they actually pay may not be much higher because of those tax credits – which are available to people who make as much as four times the federal poverty level, or up to $97,200 in income for a family of four in 2017.

“I think it’s unfortunate, because I think it can frighten consumers who may feel there isn’t an opportunity for them to have affordable health care,” said Diane Holder, president of the University of Pittsburgh Medical Center Health Plan.

Other parts of the health-care industry also voiced sharp alarm Friday.

The American Medical Association said in a statement that it was “deeply discouraged by the administration’s decision” and urged Congress to “accelerate” its efforts to “reinstate these payments before further damage is done.”

The move to cut off the subsidies quickly triggered a new round of litigation: Attorneys general from 18 states and the District of Columbia challenged it collectively late Friday in the U.S. District Court for the Northern District of California, with a request for a preliminary injunction to ensure that federal officials maintain the payments. In part, the states are concerned about the potential for rising numbers of uninsured residents and the impact that could have on health-care costs.


“It’s long past time that Donald Trump learns he doesn’t just get to choose what laws he’ll follow or what bills he’ll pay,” California Attorney General Xavier Becerra, D, told reporters.

Many of Trump’s top health-care advisers – including former Health and Human Services secretary Tom Price, Domestic Policy Council Director Andrew Bremberg, and Centers for Medicare and Medicaid Services Administrator Seema Verma – had privately warned for months that stopping the payments could disrupt the individual insurance marketplace and lead to coverage losses. But others, such as Office of Management and Budget Director Mick Mulvaney, backed the move, and several federal lawyers argued that the administration lacked the legal authority to continue making the payments.

House GOP leaders have long contended that the ACA does not include specific language providing appropriations to cover the government’s cost, and they sued HHS when President Barack Obama was in office. A federal court agreed that the payments were illegal, and the case has been pending before the U.S. Court of Appeals for the District of Columbia Circuit.

In their filing to the court Friday, administration officials endorsed the House GOP’s position. The documents include a Wednesday legal opinion from Attorney General Jeff Sessions, informing HHS and the Treasury Department that he believes “the best interpretation of the law” indicates that money appropriated to HHS “cannot be used to fund” the subsidies.

Speaking to reporters on Friday, Trump said that the money for CSRs “is going to insurance companies . . . to lift up their stock price” – although companies must provide the offsets to eligible individuals even without any federal reimbursement.

]]> 0 Donald Trump with first lady Melania Trump, speaks to reporters on the South Lawn of the White House in Washington, Friday, Oct. 13, 2017. (AP)Fri, 13 Oct 2017 23:39:28 +0000
Descendants of woman misused by doctors speak at USM on medical ethics Fri, 13 Oct 2017 22:15:44 +0000 Decades after doctors took Henrietta Lacks’ cancer cells without her knowledge, her heirs urged today’s nursing students to behave ethically in their work.

“You have to talk to people in a way they understand. If you don’t, you’re stealing their rights from them, you’re stealing their knowledge,” said Veronica Robinson, Lacks’ great-granddaughter. “Those are some of the things that were stolen from my great-grandmother.”

Lacks, a poor black tobacco farmer in Virginia, astonished doctors when her cancer cells, taken by doctors at Johns Hopkins in 1951, became a medical miracle. They were the first “immortal” cells – those capable of reproducing and dividing outside the body. Scientists had previously tried to cultivate cells that would reproduce but they had always died.

Unknown to her, the cells, renamed HeLa cells, were shipped all over the world and used to develop some of the most important medical advances in history: the polio vaccine, cancer treatments, cloning and in vitro fertilization, among innumerable other medical treatments.

Her family was never compensated, but Lacks’ identity was revealed in a scientific journal in 1971 in reference to the landmark accomplishment. Her story was subsequently told in a BBC documentary in 1997, and in the 2010 best-selling book, “The Immortal Life of Henrietta Lacks” by Rebecca Skloot, which spent 75 weeks on The New York Times paperback nonfiction best-seller list. The book was made into an HBO movie released earlier this year, starring Oprah Winfrey.

On Friday in Portland, Robinson and Alfred Carter Jr., Lacks’ grandson, spoke about the family’s legacy and medical ethics at Hannaford Hall at University of Southern Maine as part of the campus’ yearlong discussion on race and participatory democracy.

“There was an injustice done in 1951,” said Carter. “For years, her legacy was kept under wraps – they even attempted to change her name,” he said, referring to doctors saying the cells were taken from someone named “Helen Lane.”

“We all know it was done because of her race.”

Carter and Robinson urged nursing students not to repeat the mistakes and unethical behavior of the doctors who took Lacks’ cells without her permission or knowledge.

“Just remember when you start working with people, they are not subjects. They are mothers, grandmothers, aunts,” said Robinson, herself a nursing student at Baltimore City College. “Treat them the way you want (nurses) to treat your family.”

“Don’t look at your patients as a number. They’re people,” said Carter.

That was inspiring to hear for nursing student Dontavis Hines, 26, who also works as a clinical nursing assistant at Maine Medical Center.

“It motivated me,” said Hines, as he stood in line to get an autograph for his copy of “The Immortal Life of Henrietta Lacks.” “There are not a lot of people who look like me in the health care industry. There’s so much I want to do. It’s not just nursing, it’s ethics. That’s why we need to talk about it.”

Carter said he heard about his grandmother from family members growing up, but didn’t learn about her full medical legacy until the 1990s, when he was grown.

Today, he runs the Henrietta Lacks House of Healing, which provides housing and services for men coming out of incarceration. Roughly a dozen men spend six months to a year at the home, and Carter said it is in honor of Lacks’ well-known hospitality.

“My grandmother would let everyone come stay at her house,” he said. “It’s natural.”

Robinson is executive director of the Henrietta Lacks Legacy Foundation, which focuses on education surrounding vaccinations, she said. She is a Lacks Family representative on a panel for the National Institutes of Health responsible for reviewing applications for the use of HeLa cells in research.

“Normally people who look like me are a topic of discussion at the table, but now I sit at the table,” Robinson said, to applause from the crowd. “So they get a better understanding of where we’re coming from.”

Johns Hopkins never patented the HeLa cells, and didn’t sell or profit from their distribution. But some family members say they should be compensated by the hospital or pharmaceutical companies that used them to develop medical treatments.

Carter laughed Friday when asked about whether the family feels like compensation should be given.

“I feel like they should just give us a check,” he said, before continuing with a more altruistic response.

“Honestly, I think that the family was treated disrespectfully, but it’s people like you all that keep us pushing forward,” he said. “To find the good that came from the bad. It created a platform to be able to give back and help.”

Noel K. Gallagher can be contacted at 791-6387 or at:

Twitter: noelinmaine

]]> 0, ME - OCTOBER 13: As part of its yearlong discussion on race, the University of Southern Maine hosts a lecture by the descendants of Henrietta Lacks. Alfred Carter and Veronica Robinson, both grandchildren of Henrietta Lacks, pose for a portrait before taking the stage at University of Southern Maine's Hannaford Hall to speak on Friday, Oct. 13, 2017. Lacks was a poor black tobacco farmer whose cells were taken without her knowledge in 1951 and used to develop medical advancements such as the polio vaccine, cloning, gene mapping, in vitro fertilization, and more. (Photo by Derek Davis/Staff photographer)Sat, 14 Oct 2017 09:31:27 +0000
Trump’s move to stop payments to ACA insurance providers will push premiums higher in Maine Fri, 13 Oct 2017 17:34:23 +0000 Thousands of Mainers will see their individual health insurance premiums rise even higher in 2018 as a result of President Trump’s decision to eliminate federal reimbursement of a key Affordable Care Act subsidy.

However, Maine’s two remaining ACA insurance providers, Community Health Options and Harvard Pilgrim Health Care, said the White House’s move to eliminate cost-sharing reduction reimbursements to insurers would not prompt them to drop out of the marketplace entirely. They said the decision was expected, and that the state’s roughly 90,000 policyholders shouldn’t panic.

The average premium increase in Maine for individual buyers of mid-tier “silver” policies in 2018 will be nearly 50 percent, according to the state Bureau of Insurance. Community Health’s top executive said about two-thirds of that increase is directly attributable to the elimination of cost-sharing reduction reimbursements.

“Our silver rates went up by about 17 percent in the (original) filing, but they are up by about 50 percent in the unreimbursed filing,” Community Health President and CEO Kevin Lewis said. “That’s a 33 (percentage point) jump in premium.”

The average monthly premium for individual, on-exchange silver plans for a 45-year-old non-smoker in Cumberland County in 2017 was $424.44. In 2018, the average premium for a comparable plan will be $620.14 – an increase of 46.1 percent. That increase factors in the impact of Trump’s decision to eliminate the subsidy reimbursement along with other, unrelated factors.

According to The Washington Post, the White House confirmed late Thursday that it will stop making monthly payments to insurers for cost-sharing reductions, although it did not specify when. Two people briefed on the decision told the Post that the payments would be cut off as of November.

Cost-sharing reduction subsidies are designed to cover part of the cost of medical care for policyholders with household incomes up to 250 percent of the federal poverty level. They reduce the out-of-pocket costs associated with co-payments, deductibles and coinsurance payments for qualified policyholders.

The cost-sharing reduction subsidies only apply to holders of silver ACA policies. They differ from advance premium tax credit subsidies, which apply to holders of all types of individual ACA policies with household incomes of up to 400 percent of the federal poverty level. Advance premium tax credit subsidies will continue to be paid by the federal government and are expected to increase with the rise in premiums.

Insurers in Maine said eligible policyholders will continue to receive the cost-sharing reduction subsidies through their insurance providers in 2018. However, the federal government no longer will reimburse insurers for providing the subsidies.

As a result, insurers will raise premiums to cover the additional costs. For example, Harvard Pilgrim Health Care was planning to raise premiums for its individual bronze, silver and gold ACA plans by an average of 27.1 percent if the subsidy reimbursement continued. Now, it will raise premiums by an average of 38.3 percent.

ACA policyholders in Maine with household incomes up to 400 percent of the federal poverty level will continue to receive tax credits to offset the cost of their premiums and should not see a significant increase in their out-of-pocket costs, said Lewis, the Community Health chief executive. About 90 percent of Mainers who have individual plans under the ACA qualify for tax credit subsidies.

However, 10 percent of the state’s policyholders, roughly 9,000 people, are not eligible for the tax credits because they have higher incomes and likely would pay a lot more if they decide to enroll. Many small business owners with individual ACA plans in Maine fall into that category. Lewis noted that ACA small group plans for employees will be largely unaffected by the elimination of cost-sharing reduction reimbursements.

As a result of the premium increases, Lewis said Community Health expects more Mainers with individual plans to switch from silver to bronze plans in 2018. Bronze plans tend to be cheaper but provide less coverage.

Maine Insurance Superintendent Eric Cioppa released a statement Tuesday advising Maine consumers to consider changing plans as a result of the then-expected White House decision on cost-sharing reduction payments.

“The important thing for consumers to know is that because the CSR program has not been funded, silver plans might no longer be the best choice for many consumers, particularly those who are not eligible for CSRs,” Cioppa said. He advised consumers to carefully consider all the costs of a plan, including the premium, deductible, co-payments, coinsurance and any other out-of-pocket expenses.

Edward Kane, vice president at Harvard Pilgrim, said Maine insurers already were anticipating that cost-sharing reduction payments would cease and had priced their plans accordingly. For that reason, he said, Thursday’s confirmation by President Trump didn’t really change anything.

“I’m not saying they (policyholders) shouldn’t be alarmed by a rate increase,” Kane said. “I’m saying they shouldn’t be alarmed by this news.”

Lewis said Community Health already had priced its plans for 2018 with the assumption that cost-sharing reimbursements would cease. However, he noted that a lack of reimbursement for the remaining two months of 2017 would cause an unanticipated loss of revenue that had not been priced into the current year’s plans.

“We’re left holding the bag on a legal commitment to our members,” Lewis said.

Attorneys general of least a dozen states have said they plan to sue the Trump administration over the president’s decision to stop the reimbursement payments. Maine Attorney General Janet Mills does not plan to sign on as a co-plaintiff but supports the case, said her spokesman, Andy Roth-Wells.

Community Health has about 41,400 individual plan policyholders in Maine, and Harvard Pilgrim has about 20,800. Anthem has about 28,700 individual plan policyholders but is exiting the ACA marketplace in Maine. Both Community Health and Harvard Pilgrim expect to pick up a portion of Anthem’s ACA policyholders when open enrollment begins in November.

Average individual plan premiums in Maine have shot up more than 50 percent since the ACA was implemented in 2010, and they have more than doubled nationally.

J. Craig Anderson can be contacted at 791-6390 or at:

Twitter: @jcraiganderson

]]> 0, 14 Oct 2017 09:06:17 +0000
New Hampshire doctor, 85, may lose practice because she doesn’t use computer Fri, 13 Oct 2017 10:35:06 +0000 NEW LONDON, N.H. – An 85-year-old New Hampshire doctor who has practiced medicine for more than 30 years is now in danger of losing her practice.

The state Board of Medicine is threatening the closure over Anna Konopka’s record keeping and medical practices at her New London office. WMUR-TV reports Konopka does not use a computer at her practice and therefore doesn’t participate in a state-regulated prescription drug monitoring program.

Konopka says she is fighting the decision in hopes keeping her nearly 300 patients. Her doors are supposed to close Friday if she does not receive a court injunction.

The doctor says she has written to Republican Gov. Chris Sununu in hopes of getting help.

]]> 0, 13 Oct 2017 21:04:01 +0000
Trump’s executive order could alter Maine insurance market Fri, 13 Oct 2017 08:00:00 +0000 President Trump’s latest executive order could make health insurance more costly for older, sicker Mainers by enticing younger, healthier individuals to purchase cheaper and less-regulated plans.

Still, it could be some time before the rule-making needed to enforce the proposed changes goes into effect.

“As of the signing of the executive order, absolutely nothing changes,” said Mitchell Stein, an independent insurance industry expert. “It only instructs agencies to look at making changes, but any changes would require standard rule-making, which is a lengthy process. It’s likely nothing would happen for the 2018 calendar year.”

The wild card, Stein said, is how individual insurance companies – most of which are already plagued with uncertainty – react to another layer of uncertainty.

“There certainly is potential to undercut the individual market,” he said.

The way insurance pools work is simple: Everybody in the pool pays in roughly the same amount. Some need benefits more than others. In that sense, younger and healthier people help subsidize older, sicker people with the understanding that those who are younger and healthier will be old and sick at some point and will need another generation of young and healthy people to subsidize them.


At the heart of the president’s executive order is expanded access to so-called association health plans. These allow small businesses to band together and purchase insurance plans, sometimes across state lines and usually at a lower cost. While those plans are cheaper, they often don’t offer broad coverage and they lack the protections required by the ACA for maternity care, mental health, certain cancer treatments and other more costly benefits.

Kevin Lewis, president and CEO of Community Health Options, one of three companies that offers insurance plans in Maine under the ACA, said creating a parallel marketplace of association health plans would be disruptive.

“This is what has been happening in the market in general, the departure of younger, healthier people is a good part of what’s driving the rate increase for 2018,” he said.

Maine Bureau of Insurance Superintendent Eric Cioppa did not return a call for comment Thursday about the potential impact.

Republicans, though, long have bristled at the mandates imposed by the ACA. Even though the insurance marketplaces have a wide variety of options, and price points, and even though there are subsidies to help level the playing field, Republicans would rather see the marketplace, not government, set pricing and features.

Demi Kouzounas, chair of the Maine Republican Party, praised the president’s action in a statement.

“I have witnessed firsthand the harm the law has done to individuals and small businesses such as my dental practice,” she said. “The president’s action will allow Maine workers and small businesses to pool their money and exercise leverage over insurance companies to get the quality, affordable plans they want and need.”

Maine Democratic Party Chairman Phil Bartlett had a different view.

“This order is just another reckless attempt to sabotage health care markets, force working Maine people to pay more money for less care, and strip away protections for people with pre-existing conditions,” he said.


The idea of association health plans might be attractive to small businesses – simply because of lower costs and fewer mandates – but Amanda Ballantyne, national director of Main Street Alliance, a national network of small-business owners, said it’s a ruse.

“Small-business owners won’t benefit from a proliferation of substandard insurance plans and market destabilization that will emerge as the result of this executive order,” she said in a statement. “Eliminating these vital protections will allow insurance companies to peddle low-quality, junk plans, while at the same time raising premiums on small businesses whose employees have a diverse set of healthcare needs.”

Most of the reaction Thursday, though, was speculative. Stein said even if the executive order leads to rule-making changes at the federal level, states can either agree with those or make changes that offer protections or lessen the harm.

The unknown, he said, remains with the insurers.

Lewis, who runs Community Health Options, said insurers ultimately have to be accountable to their customers.

“If this is going to create a migration or departure from the individual market, that is going to have a major impact on our risk pool,” he said.

Emily Brostek of Consumers for Affordable Healthcare, a Maine advocacy group, said the current debate is a reminder that not enough people think about their insurance and what it covers until they need it.

“When people were able to purchase cheap plans before the ACA we heard from people who would end up in the hospital for whatever reason and then not understand that their plan didn’t cover it,” she said. “Even if you’re healthy today, in the future you’ll find shortcomings. People ask, ‘Why should I pay for someone else’s care?’ The answer is: Because you’ll want someone to pay for you too.”

Eric Russell can be contacted at 791-6344 or at:

Twitter: PPHEricRussell

]]> 0, 13 Oct 2017 10:00:53 +0000
Additional health insurer to sell Maine plans in 2018 Thu, 12 Oct 2017 18:17:13 +0000 Health insurer UnitedHealthcare of New England is entering the Maine market in 2018.

The Rhode Island-based company, which provides health insurance coverage to about 1.5 million people across New England, said it will begin offering large and small group plans to employers in Maine.

UnitedHealthcare is not joining Maine’s Affordable Care Act marketplace for individual health insurance. All of the plans it is introducing to the state are for employer-based coverage.

Company spokesman Chris Raia said the insurer will participate in the upcoming open enrollment period for Maine employers selecting their health insurance plans for 2018.

“Beginning Oct. 15, Maine’s small and large business owners will have the opportunity to select from a complete suite of UnitedHealthcare affordable, consumer-focused health plans with access to UnitedHealthcare’s largest network of providers as well as innovative health and wellness programs,” Raia said.

]]> 0, ME - SEPTEMBER 21: Dr. Jay Paul watches a transesophageal echo ultrasoun of patient Paul Rice's heart as Rice undergoes a procedure at Maine Medical Center in Portland on Thursday, September 21, 2017 in which doctors inserted a device in his heart to alleviate his risk of stroke. Powers helps to guide doctors Andrew Corsello and Samip Vasaiwala through parts of the Watchman implant procedure they were performing on Rice. (Staff Photo by Gregory Rec/Staff Photographer)Thu, 12 Oct 2017 20:38:39 +0000
Trump to end federal subsidies that help low-income consumers buy health insurance Thu, 12 Oct 2017 16:06:03 +0000 WASHINGTON — President Trump is throwing a bomb into the insurance marketplaces created under the Affordable Care Act, choosing to end critical payments to health insurers that help millions of lower-income Americans afford coverage. The decision follows an executive order on Thursday to allow alternative health plans that skirt the law’s requirements.

The White House confirmed late Thursday that it would halt federal payments for cost-sharing reductions, although a statement did not specify when. According to two people briefed on the decision, the cutoff will be as of November. The subsidies total about $7 billion this year.

Trump has threatened for months to stop the payments, which help eligible consumers afford their deductibles and other out-of-pocket expenses, but held off while other administration officials warned him that such a move would cause an implosion of the ACA marketplaces that could be blamed on Republicans.

Health insurers and state regulators have been in a state of high anxiety over the prospect of the marketplaces cratering because of such White House action. The fifth year’s open-enrollment season for consumers to buy coverage through ACA exchanges will open in less than three weeks, and insurers have said that stopping the cost-sharing payments would be the single greatest step the Trump administration could take to harm the marketplaces – and the law.

Ending the payments is grounds for any insurer to back out of its federal contract to sell health plans for 2018.

The cost-sharing reductions have long been the subject of a political and legal seesaw. Congressional Republicans argued that the sprawling 2010 health-care law that established the subsidies does not include specific language providing appropriations to cover the government’s cost. House Republicans sued HHS over the payments during former President Barack Obama’s second term. A federal court agreed that they were illegal, and the case has been pending before the U.S. Court of Appeals for the D.C. Circuit.

“The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system,” a statement from the White House said. “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.”

For months, administration officials have debated privately about what to do. The president has consistently pushed to cut them off, according to officials and advisers who spoke on the condition of anonymity to discuss private conversations. Some top health officials within the administration, including former Health and Human Services secretary Tom Price, cautioned that this could exacerbate already escalating premiums on the ACA market, these Republicans said.

But some government lawyers also argued that the payments were not authorized under the existing law, according to one administration official, and would be difficult to keep defending in court.

While the administration will now argue that Congress should appropriate the funds if it wants them to continue, such a proposal will face a serious hurdle on Capitol Hill. In a recent interview, Rep. Tom Cole, R-Okla., who chairs the House Appropriations Subcommittee overseeing HHS, said it would be difficult to muster support for such a move among House conservatives.

One person familiar with the president’s decision said that HHS officials and Trump’s domestic policy advisers had urged him to continue the payments at least through the end of the year.

The cost-sharing payments are separate from a different subsidy that provides federal assistance on premiums to more than four-fifths of the 10 million Americans with ACA coverage.

Word of the president’s decision, which was first reported by Politico, came just hours after he signed the executive order intended to circumvent the ACA by making it easier for individuals and small businesses to buy alternative types of health insurance with lower prices, fewer benefits and weaker government protections.

The White House and allies portrayed the president’s move as wielding administrative powers to accomplish what congressional Republicans have failed to achieve: fostering more coverage choices while tearing down the law’s insurance marketplaces. Until the White House’s announcement late Thursday, the executive order represented Trump’s biggest step to date to reverse the health-care policies of the Obama administration, a central promise since last year’s presidential campaign.

Critics, who include state insurance commissioners, most of the health-insurance industry and mainstream policy specialists, predict that a proliferation of these other kinds of coverage will have damaging ripple effects, driving up costs for consumers with serious medical conditions and prompting more insurers to flee the law’s marketplaces. Part of Trump’s action, they say, will spark court challenges over its legality.

The most far-reaching element of the order instructs a trio of Cabinet departments to rewrite federal rules for “association health plans” – a form of insurance in which small businesses of a similar type band together through an association to negotiate health benefits. These plans have had to meet coverage requirements and consumer protections under the 2010 health-care law, but the administration is likely to exempt them from those rules and let such plans be sold from state to state without insurance licenses in each one.

In addition, the order is designed to expand the availability of short-term insurance policies, which offer limited benefits as a bridge for people between jobs or young adults no longer eligible for their parents’ health plans. The Obama administration ruled that short-term insurance may not last for more than three months; Trump wants to extend that to nearly a year.

Trump’s action also is intended to widen employers’ ability to use pretax dollars in “health reimbursement arrangements” to help workers pay for any medical expenses, not just for health policies that meet ACA rules – another reversal of Obama policy.

In a late-morning signing ceremony in the White House’s Roosevelt Room, surrounded by supportive small-business owners, Cabinet members and a few Republicans from Capitol Hill, the president spoke in his characteristic superlatives about the effects of his action and what he called “the Obamacare nightmare.”

Trump said that Thursday’s move, which will trigger months of regulatory work by federal agencies, “is only the beginning.” He promised “even more relief and more freedom” from ACA rules. And although leading GOP lawmakers are eager to move on from their unsuccessful attempts this year to abolish central facets of the 2010 law, Trump said that “we are going to pressure Congress very strongly to finish the repeal and replace of Obamacare.”

The executive order will fulfill a quest by conservative Republican lawmakers, especially in the House, who have tried for more than two decades to expand the availability of association health plans by allowing them to be sold, unregulated, across state lines. On the other hand, Trump’s approach conflicts with what he and GOP leaders in Congress have held out as a main health-policy goal – giving each state more discretion over matters of insurance.

Health policy experts in think tanks, academia and the health-care industry pointed out that the order’s language is fairly broad, so the ensuing fine print in agencies’ rules will determine whether the impact will be as sweeping or quick as Trump boasted – his directive will provide “millions of people with Obamacare relief,” he said.

Significant questions that remain include whether individuals will be able to join associations, a point that could raise legal issues; whether the administration will start to let association health plans count toward the ACA’s requirement that most Americans carry insurance; and whether such plans can charge higher prices to small businesses with sicker workers – or refuse to insure them.

The president issued the directive less than three weeks before the Nov. 1 start of the fifth open-enrollment season in ACA marketplaces for people who do not have access to affordable health benefits through a job. Trump noted that about half of the nation’s counties will have just one insurer in their exchange, and he claimed that “many will have none.” However, the most recent canvass shows that there will be no “bare” counties in 2018.

A senior administration official, speaking to reporters on the condition of anonymity shortly before Trump signed the order, said that the policy changes it sets in motion will require agencies to follow customary procedures to write new rules and solicit public comment. That means new insurance options will not be available in time for coverage beginning in January, he said.

Even so, with a shortened sign-up period and large cuts in federal funds for advertising and enrollment help already hobbling the marketplaces, “if there’s a lot of hoopla around new options that may be available soon, it could be one more thing that discourages enrollment,” said Larry Levitt, the Kaiser Family Foundation’s senior vice president.

Other aspects of the executive order include commissioning a six-month study, to be led by federal health officials, of ways to limit consolidation within the insurance and hospital industries. Trump also directed agencies to find additional means to increase competition and choice in health care to improve its quality and lower its cost.

The order produced predictable reactions in Congress, with Republican leaders praising the move and Democrats accusing the White House of sabotaging the law.

Among policy experts, critics warned that young and healthy people who use relatively little insurance will gravitate to association health plans because of their lower price tags. That would concentrate older and sicker customers in ACA marketplaces with spiking rates.

Mike Consedine, chief executive of the National Association of Insurance Commissioners (NAIC) said Thursday that the group has long opposed such plans and is concerned that the administration will allow ones that can bypass state licenses and have such weak financial underpinnings that some will collapse, leaving customers stranded and state insurance regulators “picking up the pieces.”

Short-term health insurance makes up a tiny fraction of the policies sold, with fewer than 30 companies covering only about 160,000 people nationwide at the end of last year, according to NAIC data.

Experts could not point to figures for how many association health plans exist or how many people they insure. Such arrangements have existed for decades, and scandals have on occasion exposed “multi-employer welfare arrangements” started by unscrupulous operators who took members’ money and either did not have enough reserves to cover hospital bills or absconded with premiums.

The National Federation of Independent Business, a small-business lobby, has pressed Congress to allow use of association plans, arguing that they can be less expensive and give workers more insurance choices. Sen. Rand Paul, R-Ky., has promoted the idea, and he stood just behind Trump at the morning ceremony. After nearly walking out of the room without signing the order, the president returned to affix his signature to the document and then hand Paul the pen.

Selling health plans from state to state without separate licenses – the idea underlying much of the president’s order – has long been a Republican mantra. It has gained little traction in practice, however.

Half a dozen states – before the ACA was passed in 2010 as well as since then – have passed laws permitting insurers to sell health policies approved by other states. And since last year, the ACA has allowed “compacts” in which groups of states can agree that health plans licensed in any of them could be sold in the others. Under such compacts, federal health officials must make sure the plans offer at least the same benefits and are as affordable as those sold in the ACA marketplaces.

As of this summer, “no state was known to actually offer or sell such policies,” according to a report by the National Conference of State Legislatures. A main reason, experts say, is insurers’ difficulty in arranging networks of doctors and other providers of care far from their home states.

]]> 0 Trump signs his executive order on health care on Thursday at the White House.Fri, 13 Oct 2017 01:13:29 +0000
Portland psychiatrist with history of penalties is suspended over prescription practices Wed, 11 Oct 2017 13:54:05 +0000 The state has suspended the medical license of a Portland psychiatrist who was placed on probation in 2016 after the suicide of one of his patients.

Dr. Reinaldo de los Heros’ license was suspended for 30 days starting Oct. 10, the Maine Board of Licensure in Medicine announced Wednesday. After reviewing de los Heros’ practices, the board concluded that his ability to prescribe controlled substances represented “immediate jeopardy” to the public.

The board said in a written statement that it will schedule an adjudicatory hearing within 30 days to determine whether to revoke or take other actions regarding de los Heros’ license. De los Heros, who practices in Portland and lives in Falmouth, has a history of medical board disciplinary problems in Massachusetts and Maine dating to the 1990s.

It’s not clear how de los Heros could keep his license to practice medicine if the board has concluded he presents an “immediate jeopardy” to the public. A spokesman for the medical board did not respond Wednesday to the Portland Press Herald’s requests for more information about the license suspension.

In its statement, the board said its review included information that showed de los Heros issued a prescription for a patient he knew was incarcerated and created a false medical record indicating there was a 25-minute, in-person office visit.

De los Heros did not respond to telephone and email messages seeking comment Wednesday.

In February 2016, the board placed de los Heros on probation for the way he practiced medicine leading up to the drug overdose of one of his patients. Kelly Deyo, 39, took her life on April 19, 2015, and 19 mostly empty prescription pill bottles and a suicide note were found by her side at her apartment in Westbrook.

The bottles, including refills, had contained pills from nine prescriptions written by de los Heros. Deyo had struggled with heroin addiction and many mental health problems, her mother, Elizabeth Marquis, told the Press Herald.

Marquis said Wednesday that although she’s pleased with the board’s action, it should have revoked de los Heros’ license years ago.

“It’s been a long time coming,” she said. “Why didn’t they put a stop to this? I consider it the licensing board’s fault that my daughter died. It made me so mad that he was allowed to continue practicing medicine after my daughter died.”

Marquis said she filed a malpractice suit against de los Heros in late spring for the incidents leading up to her daughter’s death.

In a July 2015 letter defending his practices, de los Heros said Marquis’ daughter was responding well to his treatment after complaining of numerous mental health conditions, including paranoia, insomnia, agitation, hyperactivity, mood swings, panic attacks and obsessive compulsive behaviors.

De los Heros was placed on probation under a Feb. 24, 2016, consent agreement with the licensing board for failing to coordinate Deyo’s care with her primary care physicians and poor documentation of her visits, including incomplete or illegible treatment notes, according to the agreement.

In April 2017, the licensing board and de los Heros agreed to an amendment to his license. The amendment required the doctor to allow the state to select 10 patient records for the board’s review. It was not immediately clear whether the recent 30-day license suspension was related to the review of patient records.

De los Heros had been sanctioned by the Massachusetts licensing board in the 1990s and 2000s for Medicaid fraud, and for fraudulently trying to regain his medical license.

De los Heros’ license to practice in Massachusetts was revoked in 1997 for Medicaid billing fraud, according to Massachusetts medical board records. He failed to disclose his disciplinary history on forms in Massachusetts when trying to regain his license in 2007, the records show, including that his license was revoked in other states, that he had a 2006 consent agreement in Maine with the state licensing board, and that his medical malpractice insurance company had imposed a surcharge on his policy.

In 2009, de los Heros signed a consent agreement with the Maine board that required him to practice under the supervision of another psychiatrist who was to review his patient interactions, prescribing practices and consultations with other mental health providers. The consent agreement does not specify what concerns or actions by de los Heros prompted the board’s actions, except to refer to a 2008 complaint that was not immediately available for review Wednesday.

The Maine licensing board consists of six physicians, three members of the public and a physician assistant. All 10 are appointed by the governor.

Contact Joe Lawlor at 791-6376 or at:

Twitter: joelawlorph

]]> 0 practice in PortlandThu, 12 Oct 2017 00:50:54 +0000
Ex-patient cites ‘excruciating’ pain, infection in trial of Lewiston oral surgeon Wed, 11 Oct 2017 04:58:16 +0000 AUGUSTA — Oral surgeon Jan Kippax was in court Tuesday defending himself against a civil claim that he failed to comply with the standards of care when treating a Minot man whose jaw became infected after tooth extractions.

The embattled Lewiston doctor also is facing questioning before the Maine Board of Dental Practice in its effort to determine whether Kippax should keep his license to practice in Maine in the wake of patients’ complaints.

Steven Darnell Jr., 35, filed a complaint against Kippax in Androscoggin County Superior Court in Auburn claiming he failed to treat Darnell for a post-operative infection that led to weeks of hospitalization and long-term treatment for a bone infection.

Through his lawyer, Kippax claims Darnell didn’t have an infection during the times he visited Kippax’s office, then refused to see Kippax after he had developed an infection.

In opening statements in Kennebec County Superior Court, the opposing attorneys previewed their respective cases before the seven women and three men who composed the jury. The Androscoggin County case was moved to Augusta because of pretrial publicity.

Scott Lynch, who represents Darnell, said Tuesday his client had no infection nor disease when he came to Kippax’s Lewiston office on Friday Dec. 31, 2010, to have two molars removed.

The simple extractions took only minutes. Darnell was in and out of the office in less than an hour.

Three days later, Darnell was in “excruciating” pain, Lynch said. His left cheek and jaw had started to swell. A bad odor emanated from his mouth and he couldn’t keep down solid foods and had been vomiting.

He had followed Kippax’s instructions to gargle with saltwater, use an ice pack for swelling and take prescribed pain medication.

But Darnell’s symptoms had him back in Kippax’s office on Jan. 3, after repeated calls to his office to be seen.

Kippax told Darnell to keep taking his pain medication. He didn’t schedule him for a follow-up visit, Lynch said.

“Kippax does nothing,” Lynch told the jury.

Despite Darnell’s plea, Kippax didn’t prescribe antibiotics for the apparent infection.

Darnell’s condition worsened, Lynch said.

He developed a tingling in his numbing lower lip and was unable to open his jaw.

Darnell called Kippax’s office, but the only response he got was a prescription for pain medication.

On Jan. 7, after getting no response from Kippax’s office, Darnell was rushed by his sister to the emergency room at Central Maine Medical Center in Lewiston (he had been seen there on Jan. 5) as his symptoms continued to worsen.

Doctors admitted Darnell for an infection, putting him on an intravenous drip of antibiotics. He underwent two surgeries to drain pus from his swollen jaw.

Darnell was released from the hospital two weeks later, still taking antibiotics, Lynch said. A week later, Darnell was told he would need regular antibiotic infusions at the hospital until April 21 to treat a bone infection.

“That’s how concerned they were about the extent of the infection,” Lynch told the jury.

As a result of that infection, Darnell lost several more teeth, Lynch said.

Mark Lavoie, attorney for Kippax, told the jury that medical care only works when there’s a good partnership between doctor and patient.

“When that breaks down, then problems result,” he said.

The medical records in Darnell’s case show he hadn’t developed an infection when he visited Kippax on Jan. 3 and that his symptoms were typical of someone who’d recently had teeth extracted.

Darnell had been made aware of possible complications from tooth extractions at the time of his Dec. 31, 2010, visit and had signed a document acknowledging them.

“A doctor can’t promise everything will be perfect” and can’t guarantee or assure “complete satisfaction,” Lavoie said.

Kippax responded to Darnell’s complaint of symptoms by seeing him Jan. 3. He noticed no signs of infection, so he didn’t prescribe antibiotics, Lavoie said. Kippax also checked for other signs of complications and saw none.

A CMMC physician assistant noted in a document from Darnell’s Jan. 5 emergency room visit that his vital signs had been normal and there had been no sign of infection at the extraction site, Lavoie said.

It was apparently a couple of days later that Darnell’s status had changed, Lavoie said. But Darnell and his family had requested that Kippax no longer be involved in his medical care, Lavoie said.

The trial is expected to take four days, with experts testifying for both sides.

]]> 0 Jan Kippax attends a hearing before the Maine Board of Dental Examiners in Augusta on Friday.Wed, 11 Oct 2017 10:38:34 +0000
Gene therapy helps people with inherited blindness Tue, 10 Oct 2017 02:47:07 +0000 A girl saw her mother’s face for the first time. A boy tore through the aisles of Target, marveling at toys he never knew existed. A teen walked onto a stage and watched the stunned expressions of celebrity judges as he wowed “America’s Got Talent.”

All had mere glimmers of vision and were destined to lose even that because of an inherited eye disease with no treatment or cure.

Until now.

On Thursday, U.S. Food and Drug Administration advisers will consider whether to recommend approval of a gene therapy that improved vision for these three youths and some others with hereditary blindness.

It would be the first gene therapy in the U.S. for an inherited disease, and the first in which a corrective gene is given directly to a patient. Only one gene therapy is sold in the U.S. now, a cancer treatment approved in August that engineers patients’ blood cells in the lab.


Children, parents, doctors and scientists will tell the FDA panel what it’s like to lack and then gain one of our most primal senses.

Cole Carper, an 11-year-old boy who got the therapy when he was 8, describes how sight changed what he knew of the world. When he returned to his home in Little Rock, Arkansas, after treatment, “I looked up and said, ‘What are those light things?’ And my mom said, ‘Those are stars.’ ”

His sister, 13-year-old Caroline Carper, treated when she was 10, said that afterward, “I saw snow falling and rain falling. I was completely surprised. I thought of water on the ground or snow on the ground. I never thought of it falling,” because the sky was something she couldn’t see, along with other things like her mother’s smile.

The treatment, Luxturna, is made by Philadelphia-based Spark Therapeutics. It does not give 20-20 vision or work for everyone, but a company-funded study found it improved vision for nearly all of those given it and seemed safe. The company’s Nasdaq ticker symbol is ONCE, for how often it hopes the therapy is needed.

“It’s exciting” and in some cases might be a cure, although how long the benefits last isn’t known, said Dr. Paul Yang, an eye specialist at Oregon Health & Science University who is testing gene therapies for other companies. “There’s nothing else for these kids.”


The therapy has wider implications but was tested for Leber congenital amaurosis, or LCA, caused by flaws in a gene called RPE65. Those with it can’t make a protein needed by the retina , tissue at the back of the eye that converts light into signals to the brain that lets us see. People often see only bright light and blurry shapes and eventually lose all sight.

Parents are carriers of the flawed gene and it can lurk undetected for generations, suddenly emerging when an unlucky combination gives a child two copies of it.

“It’s usually a surprise that they have a blind child,” said Dr. Jean Bennett, a University of Pennsylvania researcher who with her husband, Dr. Albert Maguire, led testing at Children’s Hospital of Philadelphia. The couple designed an obstacle course to test vision after treatment, and the FDA accepted it as a valid measure of success.

“The maze was actually Al’s idea. I put it together first in our driveway,” using white tiles with arrows, foam rolls and cones, and black spaces to simulate holes that kids should avoid, Bennett said.

Maguire did many of the 45-minute operations to deliver the gene therapy; the rest were done at the University of Iowa. It involves puncturing the white part of the eye and injecting a modified virus that contains the corrective gene into the retina. Benefits appear within a month.


Eighteen of 20 treated study participants improved on the mobility maze a year later, and 13 passed the test at the lowest light level. None in a comparison group of nine patients did. That group was allowed to get the therapy after waiting one year, so in all, 29 were treated, plus more in earlier studies. The two who did not improve may not have had enough healthy retinal cells to respond to treatment; one improved on other tests and another stopped deteriorating.

About half of those treated were able to read three or more additional lines on an eye chart, but the variability between the groups was too big to be sure, statistically, that they were different on this measure.

Many are no longer legally blind and gained independence.

“There were children who were able to move from a Braille classroom to a sighted classroom. One person who had never worked was able to get a job,” said Dr. Katherine High, president of Spark Therapeutics and the scientist who pioneered the therapy when previously at the children’s hospital.

There were two serious side effects, both deemed unrelated to the gene therapy itself. One was due to a drug given afterward and another was a complication of the surgery.


Ashley Carper recalled when her children were diagnosed with the disease.

“The doctor came out with tears in his eyes. He said it was the same condition and they will be blind, and nothing could be done. Nothing.”

Cole and Caroline used canes and went to a school for the blind.

“Cole played football but he played center,” and just stood on the field after the snap to the quarterback because he couldn’t see well enough to do more, his mother said.

Ten years ago, she went to a support group conference and happened to sit next to Bennett. It took two years for gene testing to determine whether the Carper kids would qualify for the study, and insurance wouldn’t pay because there was no established treatment. A Dallas hospital picked up the tab.

Finally, the siblings were enrolled in the study, but they landed in the comparison group so they had to wait a year to be treated. About a week after Cole’s treatment, they went shopping at Target.

“When we got to the Nerf aisle I was like, ‘Whoa, mom, what is THAT? Can I get this? Can I get that? Because I had never seen what that stuff looked like,” Cole said.

Caroline has had her own delights.

“Oh yikes, colors. Colors are super fun,” she said. “And the sunshine is blinding.”


For Christian Guardino, a senior at Patchogue-Medford High School on Long Island, the most remarkable part about performing on “America’s Got Talent” a day before his 17th birthday earlier this year wasn’t winning the golden buzzer that showered gold confetti on him and sent him into further competition. It was seeing the confetti thanks to his gene therapy several years ago.

“I walked out on that stage all by myself,” he said. “I saw the judges. It was incredible.”

His mother, Beth Guardino, said the judges didn’t know about Christian’s blindness and gene therapy until after his audition.

Before treatment, “It was dark, life without light,” Christian said. “I found a way to work through it, to cope with it, and that was music.”

Since treatment, “I’ve been able to see the most incredible things. I’m able to see stars, I’m able to see fireworks, snow falling,” he said. His favorite? “The moon. Most definitely. I’m a huge astronomy fan.”


The FDA must decide by Jan. 18 whether to approve Luxturna. What it might cost is a worry. One gene therapy sold in Europe cost $1 million and was used by only one or two people; another has had few takers.

Spark’s chief executive, Jeff Marrazzo, would not give an estimate for cost, which companies usually announce only after approval. Some rare disease treatments run a quarter to three-quarters of a million dollars a year. Spark has talked with insurers and “there is a clear path for it to be reimbursed one time per eye,” he said.

More than 260 genes can cause inherited retinal disorders, affecting 3 million worldwide. RPE65 mutations can cause other vision diseases besides LCA, so if the treatment is approved, it should be for people with the flawed gene rather than a specific disease, said Dr. Eric Pierce at Harvard-affiliated Massachusetts Eye and Ear, who was involved in its early testing.

Laura Manfre founded Sofia Sees Hope, a group named for her 14-year-old daughter, Sofia Priebe, who has LCA but not the gene Luxturna targets. The Connecticut woman will represent families at the FDA hearing.

Sofia said she longs for a therapy that would let her “drive a car, walk into a room and be able to identify my friends, to be able to do my own makeup and to read a book in print … and see the night sky.”

Marilynn Marchione can be followed at MMarchioneAP.

This Associated Press series was produced in partnership with the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

]]> 0 Guardino and her son, Christian, 17, talk about his life before and after gene therapy treatment for his hereditary blindness during an Oct. 2 interview in Patchogue, N.Y.Tue, 10 Oct 2017 00:07:24 +0000