WASHINGTON — The Trump administration on Friday set up new obstacles for women seeking abortions, barring taxpayer-funded family planning clinics from making abortion referrals. The new policy is certain to be challenged in court.
The final rule released Friday by the Health and Human Services Department also would prohibit federally funded family planning clinics from being housed in the same locations as abortion providers, and require stricter financial separation. Clinic staff would still be permitted to discuss abortion with clients.
The move was decried by women’s groups and praised by religious conservatives, but it could be some time before women served by the federal family program feel the full impact.
Women’s groups, organizations representing the clinics, and Democratic-led states are expected to sue to block the policy from going into effect. Administration officials told abortion opponents on a call Friday that they expect legal action, according to a participant.
Planned Parenthood, whose affiliates are major providers of family planning services as well as abortions, said the administration is trying to impose a “gag rule,” and launched a full campaign to block it.
“We’re going to fight this rule through every possible avenue,” said Emily Stewart, the organization’s vice president for policy.
Planned Parenthood and other groups representing the clinics say the new requirements for physical separation of facilities would be all but impossible to fulfill. Planned Parenthood said the administration action is another attempt to drive it out of business, after efforts to deny it funding failed in Congress.
Religious conservatives said the administration’s policy is a major step toward breaking down what they see as an indirect taxpayer subsidy of abortion providers.
Tony Perkins, president of the Family Research Council, called it “a major step toward the ultimate goal of ending taxpayers’ forced partnership with the abortion industry.”
The regulation was published Friday on an HHS website. It’s not official until it appears in the Federal Register and the department said there could be “minor editorial changes.” A department official confirmed it was the final version.
Known as Title X, the family-planning program serves about 4 million women annually through independent clinics, many operated by Planned Parenthood affiliates, which serve about 40 percent of all clients. The grant program costs taxpayers about $260 million a year.
Abortion is a legal medical procedure, but federal laws prohibit the use of taxpayer funds to pay for abortions except in cases of rape, incest, or to save the life of the woman.
An umbrella group representing family planning clinics also decried the administration’s decision.
“This rule intentionally strikes at the heart of the patient-provider relationship, inserting political ideology into a family planning visit, which will frustrate and ultimately discourage patients from seeking the health care they need,” Clare Coleman, head of the National Family Planning & Reproductive Health Association, said in a statement.
Although abortion remains politically divisive, the U.S. abortion rate has dropped significantly, from about 29 per 1,000 women of reproductive age in 1980 to about 15 in 2014. Better contraception, fewer unintended pregnancies and state restrictions may have played a role, according to a recent scientific report. Polls show most Americans do not want the Supreme Court to overturn Roe v. Wade, the 1973 ruling that legalized abortion.
EDWARDS — They are already gathering in the quiet room, where a glass wall reveals the arresting New York Range. Sitting in a circle of chairs, the therapists at All Points North Lodge are counseling the ailing as dozens of workers next door scramble to build a one-of-a-kind addiction treatment facility in the heart of the Eagle Valley.
“This will be the new model. The best-of-the-best in terms of behavioral health and integrated care,” said Jeff Brooks, the soft-spoken behavioral scientist and addiction therapist tasked with developing an addiction-treatment program for a 72-room luxury facility inside what was a once a five-star resort hotel. “It’s definitely a new vision for integrating biological, psychological, social and spiritual care under one roof.”
Therapists have already began to gather in a quiet meeting room at All Points North Lodge at Cordillera, even as renovations continue to convert the posh spa and hotel into an holistic addiction treatment facility. All Points recently received its addiction treatment certification two weeks ago and are aiming to open doors to locals in the sober living community on April 1. (Nina Riggio, Special to The Colorado Sun)
It’s a long, winding road past the guarded gatehouse to the 69,000-square-foot lodge that stands like a castle atop the Cordillera community. Noah Nordheimer knows it well, both literally and figuratively.
The investor and recovering addict whose struggle with pain medication after an injury spurred him to build a thriving public-service treatment program in Baltimore, Maryland, has spent several years laboring to buy and convert the former Cordillera Lodge & Spa into a drug addiction treatment center. The journey has seen him navigating and winning four lawsuits filed by irked homeowners lamenting the loss of their resort community’s centerpiece. Now he’s corralled deep-pocketed investors and is building what he promises will be the most progressive approach to stemming the country’s addiction crisis.
“It took a while for us to get here, but now we are focusing on people’s health,” Nordheimer said. “Many of our guests are coming to us because they have a dependence to a substance or a behavioral health issue that they want us to help solve. We are not looking at these things in a silo. We are looking at overall health, from nutrition to fitness to primary and preventative care needs. I really think this place is going to do a lot of people a lot of good.”
The plan is big. Nordheimer and his investors are spending $136 million on the project, starting with a $20 million renovation of the lodge, which opened in 1988 and was made famous — or rather infamous — in 2003 when a 19-year-old concierge accused basketball superstar Kobe Bryant of sexual assault following an encounter at the tony hotel.
The project involves converting the 56-room hotel into a 72-room, 110-patient treatment center with a mix of single- and double-occupancy rooms.
Brooks’ team has signed a long-term lease on a 10,000-square-foot mansion that will house six patients in a more intimate therapeutic environment. Plans are underway to develop additional acreage below the lodge into what they call an “all-inclusive, holistic healthcare campus,” for patients who have graduated from more intensive care. When the renovation is complete, the lodge will employ about 100 people full-time, making it one of the larger private employers in the region.
Projects like All Points North Lodge help diversify Eagle County’s economy with high-paying jobs that attract and retain skilled workers, said Chris Romer, the head of the Vail Valley Partnership.
“Construction also remains a large part of our economy and requires a vibrant economy across all other sectors – from tourism to medical to outdoor recreation – to continue to thrive,” Romer said. “The issues seem to have been well vetted through the public process and the court system, and we hope the Eagle County community welcomes and embraces them moving forward.”
The lodge’s evidence-based addiction recovery program — meaning it deploys a science-based intervention with health, fitness, medicine and psychiatry, versus the traditional 12-step approach — is targeting high-level executives, athletes, musicians and entertainment superstars, with prices ranging from more than $40,000 a month for double-occupancy to $120,000 a month for spots in the private home. A second-track — called the day sober-living program — offers sessions for local patients in recovery.
“Holistic and integrated care are words we frequently use here,” explains All Points North Chief Operating Officer Jeff Brooks, who has been clean and sober for 27 years. “Our model we’re forging is one of the first of its kind because it a more synthesized way of treating patients– all under one roof.” (Nina Riggio, Special to The Colorado Sun)
Brooks said there is a “seriously underserved population” of wealthy people struggling with addiction.
“A lot of market research shows that there is a strong demand for this type of service,” Brooks said, noting All Points North Lodge’s five-star hotel services offered alongside behavioral health addiction treatment “in an area that provides the amenity level, but also enough seclusion to offer privacy and discretion.”
Five lawsuits
Residents of Cordillera — which spans several communities across 7,000 mountainous acres above the Eagle Valley — fought for three years to block Nordheimer, filing five lawsuits in federal and state courtrooms. Their arguments included a $100 million class-action lawsuit arguing the rehab center would hurt property values in the remote, gated community where stone-and-beam palaces sell for many millions.
The Cordillera Lodge and Spa, where rooms rented for more than $900 a night, was described as a unique and irreplaceable asset by a buyer who renovated it after he purchased it for $35 million in 2007. Two years later, Cordillera’s planning agreement was amended to include medical uses and in 2013, the posh complex was offered for sale again. In 2016, it was sold to Concerted Care Group for $9.6 million. (Nina Riggio, Special to The Colorado Sun)
Those were heady times in the resort real estate world, with buyers spending record amounts on homes. The 2007-08 home sales in the Colorado mountains hit highs that linger today. But the boom didn’t last.
By 2009, the economy was withering and the high-end real estate market collapsed. That year Behringer approached the county with amendments to Cordillera’s Planned Unit Development guide, hoping to weather the downturn by expanding the potential uses of the struggling lodge to include 34 options, including office space and medical facilities. The county approved the amendment and Behringer, which renovated the lodge in 2008, put the property on the market in 2013, after membership to the Cordillera golf club declined to 53 residents, occupancy at the lodge plummeted and Cordillera real estate activity stalled.
Behringer called Nordheimer’s Baltimore-based Concerted Care Group the “only serious” buyer that looked at the property. In 2016, CCG bought the lodge and surrounding acreage for $9.6 million. That’s when residents noticed the 2009 PUD amendment allowed for an addiction-treatment center. They railed against the plan, challenging the county’s approval of the amendment in Colorado federal district court, Eagle County District Court and, most recently in the 10th U.S. Circuit Court of Appeals. They lost every challenge.
Residents expected the lodge would be redeveloped, said Rachel Oys, the general manager of the Cordillera Property Owners Association and Cordillera Metropolitan District, both of which joined several local homeowners in the five lawsuits seeking to stop the rehab center plan.
Oys said her boards disagree with “several points” in the Court of Appeals opinion, but they are glad to see the court confirm that “inpatient uses” are not allowed. The issue gets into some semantics here, because the investors behind All Points North Lodge refer to it as a “residential outpatient facility,” separated into distinct parts with a clinic and hotel-like rooms. The Court of Appeals’ November decision focused on that word, “inpatient.” The court noted that Eagle County’s commissioners — who forbid inpatient use of the clinic portion of the lodge following homeowner appeals of its 2009 PUD amendment — determined the project fit into allowed uses because it planned an outpatient facility with a separate residential component. Homeowners argued the two separate uses constitute inpatient use. The appeals court declined to overturn the lower court’s support of the county approval for the rehab center, ruling the homeowners can argue the alleged zoning issue to the board of commissioners if they think All Points North Lodge violates the regulations.
Nordheimer, through his CSMN Investments, in October 2017 sued several Cordillera homeowners and their two associations, arguing the residents violated the Americans with Disabilities Act as well as fair housing and anti-discrimination laws in their opposition to the development of the former hotel.
The $20 million renovation of the Cordillera Lodge & Spa into a drug addiction treatment center began in July 2018. The work included converting a 56-room hotel into 72 single- and double-occupancy rooms that will accommodate as many as 110 people seeking treatment. Fees start at about $40,000 a month for a shared room. Two “sample” rooms soon will be available for viewing by potential clients. (Nina Riggio, Special to The Colorado Sun)
With the legal issues settled, dozens of workers from mountain construction firm RA Nelson now scramble across the lodge. Not a single area remains untouched. The former restaurant and bar are becoming a smoothie bar and cafe. Every pod of units has its own common room adjacent to counselor offices. The new owners donated $300,000 worth of furniture and furnishings to the local Habitat for Humanity as they develop a more modern appeal.
Nordheimer said marketing and advertising efforts are underway and his team is assembling a waiting list of patients. His team recently had actors and models gather in the glass-walled carriage house to film a commercial for the lodge. The models were talking with the lodge’s counselors for the video depicting a group session “and a couple of them had some breakthrough moments,” Nordheimer said.
“With the team and the setting there, you could just see how it put people at ease,” he said. “That certainly gave us some insight into what we are expecting to happen there. It’s just such a unique, amazing setting.”
A California model
The luxury addiction treatment lodge will be a first for Colorado, but it’s a progression of a well-established model in California, where there are almost 2,000 licensed treatment centers, many in residential settings. The explosion of neighborhood addiction rehabilitation in luxury communities in Southern California prodded state and local lawmakers last fall to craft a raft of regulations.
Many of the new California laws addressed operations, like forbidding patient brokering, in which rehab centers pay patients with hefty insurance coverage or pay agents to recruit amply insured patients. One new law requires doctors to more closely study the risks of opioids.
One law signed by Gov. Jerry Brown in September 2018 targets the increasing practice of for-profit rehabilitation companies buying several homes on a single street, creating a sort-of addiction treatment campus in the middle of high-end neighborhoods. That law — Assembly Bill 3162 — places restrictions on new rehab facilities in communities like Malibu, where dozens of addiction treatment centers are based in luxury homes. Another new law requires new facilities in residential homes to create plans for parking and medical waste disposal.
Ripple effects
About half of All Points North Lodge’s 100 employees will be on the service side: concierges, cleaners, maintenance workers, chefs and restaurant staff. The other 50 employees will be a team of nurses, physician assistants, addiction counselors and behavioral health specialists working under a psychiatrist and a doctor.
A second treatment track will offer outpatient services for valley residents who can drive up for regular sessions with counselors. The full lodge is slated to open in October while those outpatient services are set to begin in April.
Brooks, himself 27 years sober, said many of the peer counselors he’s hiring are in recovery, making them better able to connect with patients at the lodge. The ripple effects rolling down from the facility will help reduce the stigma of addiction in the community, Brooks said.
Brooks said All Points North Lodge’s workers and local clients will help to “raise the recovery IQ” in the Eagle Valley by mingling in the community and sharing stigma-dashing perspectives about addiction and relapse.
“As this social web unfolds, the community gets these new insights, and this informed process lowers the stigma and really raises the health of the community as people start to talk more about what they may be dealing with,” Brooks said.
A series of measles outbreaks in the U.S. is putting a spotlight on the state with the lowest rate of vaccinations in the nation: Colorado.
Less than 89 percent of the state’s kindergarten-aged children have received the vaccines needed to prevent illnesses such as measles, mumps, whooping cough and chickenpox — far below the national median and the 95 percent threshold needed to prevent an outbreak.
The state ranks at the bottom because the law allows parents to claim exemptions for medical, religious or personal reasons, which is “essentially the easiest exemption policy in the country,” said Dr. Sean O’Leary, an associate professor in pediatrics and infectious diseases at the University of Colorado School of Medicine. “We need to do something about it.”
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A Colorado lawmaker is drafting legislation to eliminate the personal-belief exemption and make the process harder for parents to opt out. But it’s meeting an unexpected obstacle: Gov. Jared Polis.
The Democrat is making his opposition clear from the start, and the governor’s office initially told the state’s public health agency not to help lawmakers with the legislation, an extraordinary move even for a hands-on governor.
The vaccine issue is a sensitive one in Colorado, where conservatives and vaccine critics believe parents should make decisions about whether to immunize their children, but health professionals worry the state is ripe for an outbreak.
“For Colorado, for a measles outbreak, it’s not a matter of if — it’s a matter of when,” O’Leary said.
In January, Denver Public Health issued a warning about measles exposure, and in February, state health officials began investigating multiple reports of mumps infections. The Colorado alerts followed a measles outbreak in Washington state that led the governor to declare a state of emergency.
“We see outbreaks happening all over the country right now,” said state Rep. Kyle Mullica, D-Northglenn. “I’d rather be proactive, than reactive on something. We shouldn’t have to wait for a kid to die, to declare a state of emergency, before we act on something.”
Mullica, an emergency room nurse and father of three, is leading the effort to restrict exceptions to a state law that requires all children at schools and licensed child care facilities to receive vaccinations. He said he’s approaching the issue “from a student safety perspective.”
“As a dad, I want to do all we can to protect my kids, and I want to do all we can as a legislature to protect our kids,” he said. “I feel like we have to address this. We are last in the country.”
Click image to see full-resolution chart. DATA: CDC
The low rates are evident in the Centers for Disease Control and Prevention report that analyzed data from the 2017-18 school year. The federal numbers also show that more parents claim exemptions in Colorado than any other state tracked.
The vast majority — 88 percent — of the annual opt outs from vaccines were attributed to the “personal beliefs” of parents. Religious reasons accounted for just 8 percent of exemptions and medical cases were less than 5 percent, according to state-level data from the same school year.
Colorado is one of 17 states that allow personal-belief or philosophical exemptions for kindergarten students, according to the National Conference of State Legislatures, which is based in Denver. All but three states have exceptions for religious beliefs.
The new legislation in Colorado — which is expected to debut as soon as next week — would eliminate the personal exemption and make the process to claim other exemptions less convenient for parents, who can file statements at a child care and school facilities.
“We are trying to figure out how to balance that … to make sure we are not impeding on people’s religious liberty, but at the same time make sure we are creating a safe environment for kids,” Mullica said.
Opposition is mounting, and that includes the governor
Even before the bill is finalized, the opposition is mounting. Earlier this month, Mullica — who said he’s received threatening messages from opponents — hosted a forum with critics that drew more than 250 people.
Pam Long of Castle Rock is one of those who attended. She spoke about her 15-year-old son who suffers from a lifelong brain injury related to a rare adverse reaction to a vaccine when he was younger.
Long, who is a board member at Colorado Health Choice Alliance, an organization dedicated to protecting opt-out rights for parents, expressed concern about doctors not being willing to write medical exemptions and the lack of disclosure about potential complications from vaccines. Her older son used a personal-belief exemption.
“(Vaccines) are not immune to all the other risk pharmaceuticals have, and we in our minds want to believe they have no risk and they are effective for all people,” she said in an interview. “There is no drug that doesn’t have risk.”
State Rep. Marc Catlin, a Montrose Republican on the health committee, said he supports the personal-belief exemption.
State Rep. Marc Catlin, R-Montrose, listens during the legislative session Jan. 4, 2019. (Kathryn Scott, Special to The Colorado Sun)
“Because we are Americans, that’s the main reason,” he said. “We can’t just continue to take pieces of what people can decide for themselves, no matter what side of the aisle you sit on. We still have to be responsible for ourselves to a certain degree.”
The objection in Polis’ mind is similar. The former five-term congressman from Boulder opposed mandatory vaccinations at the federal level, even though he immunized his two children and thinks it’s the best course. And now he objects to efforts to tighten the exemptions in Mullica’s bill.
“I am concerned about low vaccine rates and how low rates can affect public health,” Polis said in a statement issued by his office. “I think there are strategies we can employ to foster greater vaccination rates, through smart policymaking and greater public awareness, but I worry that a restrictive or top-down approach may actually backfire.”
The governor’s office did not respond to questions about what other strategies Polis would suggest, nor what he meant when he said it could backfire.
Experts tell parents: “Vaccinations are incredibly safe”
California eliminated its personal-belief exemption in 2015 only to see medical exemptions for vaccines rise — often for bogus reasons and offered at a high price, a study found.
O’Leary, an expert in vaccines at the CU Medical School, said a medical exemption is necessary only for the rarest of cases. And leading authorities, such as the American Medical Association, do not support any other exceptions.
“The facts are that vaccinations are incredibly safe and that the benefits of vaccines far outweigh the risks. And most parents see that and accept that,” O’Leary said.
In many cases, he added, “the parents who take a nonmedical exemption are doing so based on misinformation, and it’s putting children at risk,” he said.
A report from the Colorado Children’s Immunization Coalition, in coordination with Children’s Hospital Colorado, found that 558 children were hospitalized in 2017 for an illness that could have been prevented by a vaccine at a cost of more than $55 million. The majority were related to the flu, but the report also noted low rates for other immunizations, such as the measles, mumps and rubella vaccine.
“I’m an ER nurse … and I have had to take care of (children) because they had preventable things,” Mullica said.
“There’s a concern about parental rights and kind of that personal liberty piece,” he added. “But you also have to bring into the equation community safety — and that has to be addressed as well.”
Recent measles outbreaks in states such as Washington, New York and New Jersey have cast a spotlight on a group of Americans who receive exemptions from immunizing their children on the grounds that the vaccines violate their religious freedoms.
Now the states that suffered outbreaks are taking aim at those exemptions. In recent weeks, lawmakers in the New Jersey, New York, Iowa, Maine and Vermont state legislatures have proposed eliminating religious exemptions for vaccines. A Washington state representative has proposed tightening the state’s religious exemption while eliminating a separate law that allows for a personal or philosophical exemption from immunization.
Vaccination proponents and anti-vaccination activists are watching to see whether some states will follow California, which got rid of religious and personal exemptions for vaccines after a Disneyland-linked outbreak of measles that began in 2014. The only students there who can go without a vaccination without a doctor’s signature are those who are home-schooled.
High percentages of vaccinated children results in “herd immunity,” which helps prevent prevent contagious diseases from spreading. But some doctors fear that eliminating states’ religious exemptions won’t adequately address the risk of outbreaks tied to geographic clusters of parents who are opting out of vaccinating their children.
That’s partly because just a very small percentage of parents who opt out of vaccines for their children are doing so for religious reasons, according to Daniel Salmon, a professor at Johns Hopkins Bloomberg School of Public Health and director of the Institute for Vaccine Safety. Exemptions from vaccines have gradually grown in the past three years to a median 2.2 percent of kindergartners among all states. It’s unclear whether and by how much religious exemptions may have grown nationally, but researchers such as Salmon say more parents are using personal exemptions.
“People think of the Amish as the classic group that doesn’t want to vaccinate,” he said. (However, many Amish in Ohio began vaccinating after a measles outbreak there in 2014.) “Most people who have concerns aren’t ideologically opposed to vaccines. They just don’t trust the science, they’ve been misinformed, or they hold different values.”
Nearly every state has carved out religious exemptions for parents who wish not to vaccinate their children (West Virginia and Mississippi, in addition to California, have not). West Virginia is considering a new proposal to add personal and religious exemptions.
Washington, which is one of the least religious states in the country, is one of the 17 states that allow a personal or philosophical exemption for the vaccine, which means that most anyone can opt out for any reason. In 2018, just 0.3 percent of Washington’s families with kindergarteners used a religious exemption, while 3.7 percent of families used a personal exemption and 0.8 percent used a medical exemption.
Large majorities of Americans from all major religious groups say healthy children should be required to receive vaccinations to attend school, according to the Pew Research Center. Scholars believe no major religious group advocates against vaccinations on the basis of official doctrine. However, some individuals from various faith traditions believe vaccinating goes against their personal religious beliefs.
The United States experienced 17 measles outbreaks in 2018, according to the Centers for Disease Control and Prevention. Outbreaks in New York and New Jersey occurred primarily among unvaccinated people in ultra-Orthodox Jewish communities where many believe vaccines cause diseases.
Mat Staver, founder of Liberty Counsel, a group that focuses on religious freedom issues, says he has worked with clients who object to vaccines originally made using cells of tissue from aborted fetuses, which some religious institutions have addressed.
The Catholic Church has approved the use of vaccines – such as the rubella vaccine – that may be developed from descendant cells of tissue from aborted fetuses. No fetal tissue has been added since the cell lines were originally created to produce the vaccines. The Southern Baptist Ethics and Religious Liberty Commission compares such use to using organs from a person who was murdered, saying that such vaccines are justifiable.
Staver also said some of his clients have had a general objection based on a biblical passage that says the body is the temple of the Holy Spirit and do not want vaccines, some of which include small amounts of weak or dead germs to help bodies fight off infections.
Staver is concerned that some people who oppose vaccines on the basis of religion get lumped into the rest of the anti-vaccination movement. The last time Staver’s Liberty Counsel litigated a case, he said, was in 2003-2004 on behalf of a New York seventh-grader. Child Protective Services wanted to take her out of her home, and state officials were going to prohibit her from going to school.
“They were strongly opposed and had reasons consistent with their faith rather than just checking the box,” Staver said of the child’s parents. “That’s different than, ‘I just don’t want to comply.’ ”
Around the country, how parents receive religious exemptions vary from state to state. Parents in Maryland sign a statement that says, “Because of my bona fide religious beliefs and practices, I object to any vaccine(s) being given to my child. This exemption does not apply during an emergency or epidemic of disease.” Parents in the District must write to the chief official of the school that immunization would violate his or her religious beliefs. And parents in Virginia must sign a notarized form stating that vaccinating conflicts with their religious beliefs and that they understand that their child could be excluded from school if an outbreak were to occur.
Researchers believe some parents use states’ religious exemptions even though they don’t necessarily have a religious objection, said Peter Hotez, a vaccination proponent and dean of the National School of Tropical Medicine at the Baylor College of Medicine.
“As the anti-vaccine movement grows in strength and power, they could use the religious exemption loophole,” he said. “Right now I don’t see it as significant as an issue.”
Tara McMillan, 40, has a notarized religious exemption in her files in case of an outbreak, when she might need to show that she doesn’t vaccinate her four home-schooled children in Woodbridge, Virginia, about 20 miles south of the District. She said she stopped vaccinating her children when her oldest son, who is now 13, showed signs of a reaction in 2008.
She believes that her son’s autism, which was diagnosed when he was 3, is linked to the vaccines he received as a baby. (Many who oppose vaccines cite autism based on a 1998 study that used falsified data and was later retracted. The idea has been widely completely rejected by overwhelming scientific evidence but persists in some circles.) McMillan said she tried to get a medical exemption, which is available in all 50 states, but couldn’t get a doctor to sign the form.
“We have to go the religious route even though it’s more medical,” she said. “There’s always a fear that [lawmakers will] try to sneak something in to take the religious exemption away.”
Later, McMillan says she began to read more about vaccines and developed a general religious belief opposing them, in part because she learned some are made using aborted fetal cells.
“I think it’s sacrilegious because it tries to take away what God has already given us,” said McMillan, who goes to an independent fundamental Baptist church. “When we put vaccines in our body, it disrupts your body’s system. You put things in your body, and bad things are going to happen. It’s like the Bible verse – you reap what you sow.”
The biggest battleground for vaccine advocates, Hotez said, is in states that have personal exemptions, not just religious ones. States that have both a personal exemption and a religious exemption have higher rates of whooping cough than states that just have a religious exemption.
The type of exemption a parents uses to opt out of immunization is not as important as the the state’s process for getting one, said Saad Omer, a professor of global health, epidemiology and pediatrics at Emory University.
“What often makes the difference is how easy it is to get an exemption,” he said. In some states, he noted, it’s much easier for a parent to check off a box for an exemption than to spend time in a pediatrician’s waiting room.
State guidelines could be stricter if more documentation were required to obtain an exemption on the grounds of conscientious objection, said Charles Haynes, founder of the Religious Freedom Center at the Newseum.
“It may be politically easier to get rid of all exemptions rather than taking a more nuanced approach that continues to protect sincere claims of conscience,” he said. “Since the vast majority of parents who object do so for reasons that are not explicitly ‘religious,’ the minority who refuse based on religious conviction may get lost in a rush to change laws.”
When Colorado began to consider expanding Medicaid under the Affordable Care Act, some advocates pitched what they believed would be a key benefit: Hospital prices and premiums for people covered by private policies would drop once more people were insured.
The theory was that by increasing Medicaid payments and reducing Colorado’s uninsured rate, hospitals would no longer need to shift as much of their costs to individuals with private insurance, thereby bringing their rates down.
But in the decade since the state expanded Medicaid, costs have not gone down for Coloradans with private insurance and overall health care expenses have yet to be reined in, according to two reports released in recent weeks.
Instead, Colorado hospitals’ costs grew 60.3 percent during a nine-year period, while payments to hospitals for the care they provide exceeded that, jumping by about 66 percent, according to a draft report by the state Department of Health Care Policy and Financing.
“Medicaid expansion was definitely not a failure, but it also did not bring down costs for people outside of Medicaid,” said Joe Hanel, managing director of communications for the Colorado Health Institute.
“Hospitals made strategic decisions and the strategic decisions enabled profits to go up and expenses to go up,” said Kim Bimestefer, executive director of the Colorado Department of Health Care Policy and Financing.
Had hospitals taken steps to curtail costs, as much as $11.5 billion in savings could have been extended to Coloradans with private insurance during the nine-year period that ended in 2017, according to the state agency.
The association said in a statement that costs continue to be shifted to those on commercial insurance plans, in part because government payers — such as Medicare and Medicaid — pay less than the cost of services provided. And now more Coloradans are covered by Medicaid.
“Colorado hospitals recognize that the cost of health care for Coloradans are unsustainably high,” said Colorado Hospital Association spokeswoman Julie Lonborg in an interview. “And we are absolutely committed to being a solution to that.”
“I think that we would say,” she added, “that the debate around cost shift is probably less important than the focus on what we ought to be doing to lower health costs.”
The recent findings that health care costs have not dropped since Medicaid was expanded is noteworthy in that it is coming from a state agency, Hanel said. The institute released its own report on the topic last week.
“For the longest time, the idea of the cost shift was one that was promoted by, well, senior officials in our state governments and a lot of advocates for expanding Medicaid,” Hanel said.
After first expanding Medicaid in 2009, Colorado extended the program further after the passage of the federal Affordable Care Act, also known as Obamacare. Since the expansion, the state’s uninsured rate for low-income adults has decreased by 29 percent.
To help hospitals cover the costs of caring for patients on Medicaid, the state also created the hospital provider fee program.
There was a “hope” that these policies would curb costs, but it was not a “well-designed hope,” said Cari Frank, a spokeswoman with Center for Improving Value in Health Care.
“There’s no motivation for them to bring down costs on the commercial” insurance side, Frank said, adding that “from a business perspective, it makes tons of sense for them to continue to do what they are doing.”
The prices set by hospitals are also influenced by “market dynamics,” such the rates facilities negotiate with insurers, according to the report by the Colorado Health Institute.
“We’ve really begun to realize we have a problem with prices in our health care economy,” Hanel said.
While you were eating, some of the biggest controversies over genetically modified foods have largely been settled.
At least nine out of 10 kernels of corn grown in Colorado are GMO, as are 98 percent of the sugar beets and much of the alfalfa, canola and other commodity foods. Modified potatoes that can better handle aphids or a good bruising are on the way to the San Luis Valley. Altered super-growth salmon are now on the Canadian market, soon to ship over the border to the U.S.
Consumers who eat foods made with corn syrup, most cooking oils or refined sugar — just about everyone — are ingesting materials grown from GMO seeds.
New U.S. Department of Agriculture labels are designed to help consumers recognize food products that have been genetically modified.
With many of the most common commodities nearly exclusively GMO, “there isn’t much room for growth above 90 percent,” said Patrick Byrne, a professor of plant breeding and genetics at Colorado State University in Fort Collins.
That doesn’t mean food and safety advocates have given up. They are still fighting to toughen up the federal labeling rules announced in December, and seeking stringent government review of the relatively new food production process of “gene editing.”
“GMO foods should absolutely be labeled. The issue is incredibly simple, if GMOs are safe there is no reason not to label products that contain them and the industry would have absolutely nothing to hide,” said Elana Amsterdam, a popular Colorado food blogger and cookbook author at elanaspantry.com.
“The new labeling law is not enough since it allows highly refined ingredients from GMO crops to be used in food products without labeling them as such,” Amsterdam said. “This is the opposite of transparency for the consumer.”
Gene editing versus genetic modification
In gene editing, one existing DNA trait is turned off — for example, to stop potatoes from turning brown. Genetically modified foods, by contrast, add traits from a different species — in salmon, for example, adding genes from a less-desirable fish that eats and grows faster year-round.
Battles also are brewing over Roundup, the pesticide most associated with the GMO controversy. Most corn and some other crops use seeds modified to survive when Roundup is applied to fields as a weedkiller. Food advocates and some European health officials have raised alarms about the cancer-causing potential of Roundup’s key ingredient, glyphosate.
A $289 million jury judgment in August for a California groundskeeper who said Roundup’s glyphosate caused his cancer further fueled public activism against the chemical. In statements after the verdict, Monsanto said it was appealing and that “researchers have conducted more than 800 scientific studies and reviews that support the safe use of glyphosate.”
CoPIRG embarked on the food testing as part of a strategic campaign to educate consumers before “going city to city” demanding laws, said Colorado director Danny Katz. “We’re heading in that direction as we try to better demonstrate this is really dangerous.”
Colorado farmers, meanwhile, feel they are on an education campaign of their own: Teaching consumers that they employ GMOs and genetic editing to produce healthy, cheaper food, and to lower their pesticide use.
Plant and animal breeding for characteristics
GMO defenders are also eager to point out that genetic modifications are as old as agriculture itself. Humans have always tried to speed up the mutation-and-natural-selection cycle by cross-breeding plants, grafting trees and selectively breeding animals for better traits. The newer science does not taint the genetics of consumable food, they point out.
“There have been so many scientific studies that there’s no difference” for health or nutrition between GMO crops and traditional seeds, said Nikki Weathers, whose family raises cattle and grows corn for silage, alfalfa and other hay outside of Yuma. She said she is proud that her generation and her father-in-law’s generation “embraced that technology.”
Nikki Weathers poses for a photo in a field of last year’s corn crop on her farm near Yuma, Colorado, on Feb. 13, 2019. Weathers and her family raise cattle and grow both GMO and non-GMO corn. (Austin Humphreys, Special to The Colorado Sun)
“That’s what we have to do to raise enough food for a growing population, and to afford enough corn to feed our cattle,” Weathers said.
As for labeling, Weathers said she was previously skeptical because there’s no nutritional difference, and so it just seemed like a marketing tactic for some holistic foods companies to raise their prices for a “non-GMO” label. She would know — her family raises non-GMO popcorn sold under the Snappy brand name with that fact highlighted, even though there is not currently any GMO popcorn grown in the U.S.
Now that the federal rules will label GMOs, Weathers hopes consumers will return her trust to a U.S. food system that has “the safest food in the world.”
“As a mom I would only ever feed my family things that are safe, and raise food the same way,” she said.
National labeling does not satisfy food safety advocates, who wanted states to be allowed to develop their own stringent labeling laws before President Barack Obama signed a pre-empting federal bill in 2016. The rules don’t require a GMO label if the food is so refined that GMO markers can no longer be detected, which means large volumes of consumer goods with corn syrup, sugar and cooking oils won’t have the label, said Food & Water Watch’s Patty Lovera.
The U.S. Department of Agriculture, which wrote the final rules, is also allowing various forms of a “label” with options including a scannable code that says nothing about GMO, or an offer to get an explanatory text from the manufacturer.
“You shouldn’t have to have a smart phone and a digital plan that’s not maxed out in order to find out what’s in your food,” Lovera said. “It’s not strong enough to give people what they need.”
Still unclear is how USDA will handle the new generation of modified foods that are genetically “edited.” Developers of those seeds say there’s no need for the foods to go through the extensive USDA and FDA reviews given to GMO crops because there is no cross-species introduction, only a canceled-out gene. Food & Water Watch and allies want all such foods to have full government review.
“We’d like to know more about what else did this ‘switch’ do that you turned off,” Lovera said. “We feel there’s a lot more to the genetic code than that.”
Incoming products with genetic modifications include potatoes that don’t turn brown when they are bruised, primarily raised in the U.S. northwest; a new variety of corn made drought tolerant by switching off a defensive marker; non-browning mushrooms; and salmon, referred to derisively by Alaskan members of Congress as “frankenfish,” that has been approved in Canada and is on its way to U.S. markets.
“That would be huge for us,” he said. The growers are talking about funding research projects on the idea with Colorado State University specialists.
As for labeling, Ehrlich said he is personally in favor of promoting transparency and consumer comfort, though valley farmers debate whether the labels raise more questions than they answer.
Potato growers would be happy to show curious consumers how farms work in the valley, he added. “If they want to know what’s in their food, they should visit farmers.”
RIMINI, Mont. — Every day many millions of gallons of water loaded with arsenic, lead and other toxic metals flow from some of the most contaminated mining sites in the U.S. and into surrounding lakes and streams without being treated, The Associated Press has found.
That torrent is poisoning aquatic life and tainting drinking water sources in Montana, California, Colorado, Oklahoma and at least five other states.
The pollution is a legacy of how the mining industry was allowed to operate in the U.S. for more than a century. Companies that built mines for silver, lead, gold and other “hardrock” minerals could move on once they were no longer profitable, leaving behind tainted water that still leaks out of the mines or is cleaned up at taxpayer expense.
Using data from public records requests and independent researchers, the AP examined 43 mining sites under federal oversight, some containing dozens or even hundreds of individual mines.
The records show that at average flows, more than 50 million gallons (189 million liters) of contaminated wastewater streams daily from the sites. In many cases, it runs untreated into nearby groundwater, rivers and ponds — a roughly 20-million-gallon (76-million-liter) daily dose of pollution that could fill more than 2,000 tanker trucks.
The remainder of the waste is captured or treated in a costly effort that will need to carry on indefinitely, for perhaps thousands of years, often with little hope for reimbursement.
The volumes vastly exceed the release from Colorado’s Gold King Mine disaster in 2015, when an EPA cleanup crew inadvertently triggered the release of 3 million gallons (11.4 million liters) of mustard-colored mine sludge, fouling rivers in three states.
At many mines, the pollution has continued decades after their enlistment in the federal Superfund cleanup program for the nation’s most hazardous sites, which faces sharp cuts under President Donald Trump.
Federal officials fear that at least six of the sites examined by AP could have blowouts like the one at Gold King.
Some sites feature massive piles or impoundments of mine waste known as tailings. A tailings dam collapse in Brazil last month killed at least 169 people and left 140 missing. A similar 2014 accident in British Columbia swept millions of cubic yards of contaminated mud into a nearby lake, resulting in one of Canada’s worst environmental disasters.
But even short of a calamitous accident, many mines pose the chronic problem of relentless pollution.
Tainted Wells
In mountains outside the Montana capital of Helena, about 30 households can’t drink their tap water because groundwater was polluted by about 150 abandoned gold, lead and copper mines that operated from the 1870s until 1953.
The community of Rimini was added to the Superfund list in 1999. Contaminated soil in residents’ yards was replaced, and the EPA has provided bottled water for a decade. But polluted water still pours from the mines and into Upper Tenmile Creek.
“The fact that bottled water is provided is great,” said 30-year Rimini resident Catherine Maynard, a natural resources analyst for the U.S. Department of Agriculture. “Where it falls short is it’s not piped into our home. Water that’s piped into our home is still contaminated water. Washing dishes and bathing — that metal-laden water is still running through our pipes.”
Estimates of the number of such abandoned mine sites range from 161,000 in 12 western states to as many as 500,000 nationwide. At least 33,000 have degraded the environment, according to the Government Accountability Office, and thousands more are discovered every year.
Officials have yet to complete work including basic risk analyses on about 80 percent of abandoned mining sites on federal lands. Most are controlled by the Bureau of Land Management, which under Trump is seeking to consolidate mine cleanups with another program and cut their combined 2019 spending from $35 million to $13 million.
Perpetual pollution
Problems at some sites are intractable.
Among them:
In eastern Oklahoma’s Tar Creek mining district, waterways are devoid of life and elevated lead levels persist in the blood of children despite a two-decade effort to clean up lead and zinc mines. More than $300 million has been committed since 1983, but only a small fraction of the impacted land has been reclaimed and contaminated water continues to flow.
At northern California’s Iron Mountain Mine, cleanup teams battle to contain highly acidic water that percolates through a former copper and zinc mine and drains into a Sacramento River tributary. The mine discharged six tons of toxic sludge daily before an EPA cleanup. Authorities now spend $5 million a year to remove poisonous sludge that had caused massive fish kills, and they expect to keep at it forever.
In Colorado’s San Juan Mountains, site of the Gold King blowout, some 400 abandoned or inactive mine sites contribute an estimated 15 million gallons (57 million liters) of acid mine drainage per day.
This landscape of polluted sites occurred under mining industry rules largely unchanged since the 1872 Mining Act.
State and federal laws in recent decades have held companies more accountable than in the past, but critics say huge loopholes all but ensure that some of today’s mines will foul waterways or require perpetual cleanups.
To avoid a catastrophe like Gold King, EPA officials now require advance approval for work on many mining sites. But they acknowledge they’re only dealing with a small portion of the problem.
“We have been trying to play a very careful game of prioritization,” said Dana Stalcup, deputy director of the Superfund program. “We know the Superfund program is not the answer to the hundreds of thousands of mines out there, but the mines we are working on we want to do them the best we can.”
Questions over who should pay
To date, the EPA has spent an estimated $4 billion on mining cleanups. Under Trump, the agency has identified a small number of Superfund sites for heightened attention after cleanup efforts stalled or dragged on for years. They include five mining sites examined by AP.
Former EPA assistant administrator Mathy Stanislaus said more money is needed to address mining pollution on a systematic basis, rather than jumping from one emergency response to another.
“The piecemeal approach is just not working,” said Stanislaus, who oversaw the Superfund program for almost eight years ending in 2017.
Democrats have sought unsuccessfully to create a special cleanup fund for old hardrock mine sites, with fees paid by the mining industry. Such a fund has been in place for coal mines since 1977, with more than $11 billion in fees collected and hundreds of sites reclaimed.
The mining industry has resisted doing the same for hardrock mines, and Republicans in Congress have blocked the Democratic proposals.
Montana Mining Association director Tammy Johnson acknowledged abandoned mines have left a legacy of pollution, but added that companies still in operation should not be forced to pay for those problems.
“Back in the day there really wasn’t a lot known about acid mine drainage,” she said. “I just don’t think that today’s companies bear the responsibility.”
In 2017, the EPA proposed requiring companies still operating mines to post cleanup bonds or offer other financial assurances so taxpayers don’t end up footing cleanup bills. The Trump administration halted the rule, but environmental groups are scheduled to appear in federal court next month in a lawsuit that seeks to revive it.
“When something gets on a Superfund site, that doesn’t mean it instantly and magically gets cleaned up,” said Earthjustice attorney Amanda Goodin. “Having money immediately available from a responsible party would be a game changer.”
When Christine Levi thinks about her “maternity leave” after having her baby girl, she starts to stress out all over again.
Levi, who was working as a paralegal for a small, downtown Denver law firm, resumed work the same day she left the hospital. She had zero days of paid leave and thought that if she asked for time off, her boss would fire her.
As a consolation, and because she had a C-section and wasn’t medically cleared to move around much, Levi’s boss let her work from home for six weeks. She put in full days, from 8 a.m. to 5 p.m., pausing only to make her newborn a bottle or change her diaper.
“It was really the worst experience,” she said. “It was a trip. I feel like I missed a lot of moments as a new mom.”
Levi quit a few months later, as soon as she found a new job. Her former workplace is small enough that it’s not subject to the federal Family and Medical Leave Act, which allows workers to take up to 12 weeks off — unpaid — after having a baby or to care for a sick loved one. Fewer than 40 percent of employees in Colorado work at a place large enough to meet the 50-employee threshold that mandates leave time under the federal law, according to legislative staff research.
The federal law doesn’t require that employers pay workers who take time off — that’s up to each employer. In Colorado, the vast majority of workers — about 80 percent — do not get paid leave, according to the working women’s advocacy group 9to5 and the Colorado Fiscal Institute.
That’s why one in four women in Colorado and the rest of the country return to work just two weeks after having a baby, sometimes before their first postpartum doctor visit.
But this could change under legislation coming to the statehouse later this month that will propose a family-leave program to provide paid leave to any worker in Colorado who needs time off to have a baby, adopt a baby, care for a loved one or sit beside a hospice bed. Paycheck deductions and employer contributions — totaling about 0.4 percent of a worker’s salary — would go into a state account to fund time off for people who applied.
Christine Levi carries her daughter, Aaliyah, into the toddler’s home daycare early one morning last week in Denver. (Marvin Anani, Special to The Colorado Sun)
Similar legislation has come up four times, mostly recently last year when it was rejected by the Republican-majority Senate over concerns raised by small-business owners. This year, though, with Democratic control in the House, Senate and governor’s office, the measure is likely to pass.
Sen. Faith Winter, a Democrat from Westminster, said she is bringing the legislation back on behalf of a woman who took three weeks off work to care for a loved one only to lose her job and her house. Winter, a mom, said she is also running the bill for the 25 percent of mothers who return to work two weeks after giving birth.
“I can’t imagine that,” she said. “Where are the babies going? Day care doesn’t even start until they are 6-weeks old.”
Colorado, she said, “can figure out a way that people can be good at both” — at being employees and family members. “People have babies and cancer and dying parents.”
This year’s bill will look similar to last year’s, although the 2018 version called for employee-only contributions and now Winter wants an employee-employer split.
For a worker earning $20,000 per year, the employer and employee each would contribute about $50 per year to the family-leave fund. The contribution for a worker earning $100,000 would total about $400 per year, $200 apiece from the worker and the employer, under this year’s proposal.
To gather support from the business community, Winter and co-sponsor Sen. Angela Williams, a Denver Democrat, have been meeting with everyone from chambers of commerce to Colorado Ski Country USA to labor unions.
Still, full support from small businesses is unlikely, even though “the olive branch is out there to the business community from both sides of the aisle,” said Kevin Hougen, president of the Aurora Chamber of Commerce.
It’s not that business owners don’t believe in the sentiment. It’s that employers already have trouble finding workers while the unemployment rate is at historically low levels, he said. Hospitals and companies in Aurora are struggling to fill hundreds of positions, Hougen said.
If a worker goes on paid leave for three months, the employer is unlikely to find someone willing to take a temporary position. “In a perfect world, we all want that,” he said. “We are just in desperate shape for employees.”
The chamber has about 980 members, the majority of which are small businesses that do not have to follow the federal family-leave act.
The business advocacy group NFIB, which has about 7,000 members in Colorado, hasn’t taken a position on the legislation, but it has similar concerns. The average size of an NFIB member business is from five to nine employees.
“This is a big concern of ours,” said Tony Gagliardi, the Colorado director for NFIB. “I bring in a temporary worker, and at the end of 12 weeks, the regular worker comes back. Then what do I do with the temporary worker?”
Besides, he said, about 70 percent of NFIB members offer some paid leave. A state law could become an “intrusion” to employer-employee negotiations, which are “usually better than a one-size-fits-all” requirement, Gagliardi said.
“This is going to be instrumental”
New York, California, New Jersey, Rhode Island, Washington and Washington, D.C., have family-leave laws. People in Rhode Island use the law the most, but the percentage is still small, at 0.08 percent of eligible workers, according to University of Denver research.
Rhode Island pays about 60 percent of a worker’s salary for up to four weeks, while California will pay 60 to 70 percent for up to six weeks, according to the Society for Human Resource Management.
The maximum benefit allowed in Colorado, under last year’s legislation, was $1,000 per week for up to 12 weeks. An employee would have been eligible for paid leave after working 680 hours in the past year, or at least 17 40-hour weeks.
In Colorado, an estimated 2.7 million workers could qualify under the proposal, according to the fiscal note for the bill prepared by legislative staff last year. The research estimated that about 3.5 percent of workers would file claims, resulting in 93,388 of them. The fund would grow to about $500 million in its first year, according to the fiscal note estimate.
“It’s a little bit of extra cash that we all have to chip in, and for those families that need it, this is going to be instrumental,” said Jennifer Greenfield, an assistant professor in DU’s Graduate School of Social Work.
Greenfield is studying whether paid time off for mothers affects the health outcomes of premature babies who spend their first weeks in neonatal intensive-care units. She and her team have interviewed about 100 mothers at NICUs in three hospitals.
Among them, just 12 percent had paid leave to visit and care for their babies, and the average was two weeks of paid time off. Half of the mothers worked full time, and 16 percent of them had two part-time jobs. Researchers are recording the babies’ weight, oxygen needs and other health measures at various points in their growth.
Greenfield plans to interview 300 mothers, but she’s worried she won’t find enough of them that have paid time off to prove whether it affects babies’ progress. Greenfield, a mother of 5-year-old twins who were once in NICU, was motivated to study the issue after watching working moms rush into the hospital before work to drop off breast milk and hug their babies, stressed out and sad they could not stay.
“It’s a broken system”
Kelsey Rivera is among the few working moms who can bring her baby to the office, per the policy of Jefferson County Public Health. She was also able to take time off under the federal family-leave act, although she had to use up her sick and vacation days to get paid.
Many of her clients aren’t that fortunate. Rivera, a lactation consultant and nutritionist for the Women, Infants and Children program, said many women in the program — most often those who work for hotels and restaurants — return to work within two weeks of having a baby.
Some go back before they’ve even seen a doctor for a postpartum checkup. Most aren’t covered by the federal family-leave act, and even among those who are, some are afraid to take the time, Rivera said.
Rivera’s baby, Evalyn, can keep coming to work until she is mobile, and the time is quickly coming to an end as the 7-month-old is rolling over and about to crawl. “She’s technically not mobile yet!” Rivera said.
Kelsey Rivera, a lactation consultant and nutritionist for the Women, Infants and Children program in Jefferson County, takes her 7-month-old baby Evalyn to work with her some days. Many of her clients return to work within two weeks of giving birth, she said. (Marvin Anani, Special to The Colorado Sun)
The debate over whether Colorado should enact a family-leave law comes as federal policymakers discuss competing proposals on the issue, including one backed by White House adviser and first daughter Ivanka Trump. The debate is part of a larger question that’s raged for decades, the one about how women can actually accomplish “having it all” on a daily basis.
“For me, it’s been hard to feel like I’m choosing between working and what’s best for my child,” said Kristin Hugen, a 32-year-old mother of a 5-month-old boy and a litigation paralegal at a large Denver law firm she did not want identified. “I like what I do. I’m respected at my job, but it was ridiculously hard to be away from him. There were some tears for a while.”
The firm offered two weeks of paid maternity leave, but Hugen couldn’t imagine leaving her son at two weeks. Instead, she pieced together four more weeks of partial pay through short-term disability and accrued time off. Still, she missed three full paychecks. And the kicker for her was that her human resources department, a few weeks before she gave birth, asked her to write the firm a check to cover her benefits — including short-term disability and health-insurance premiums — for when she was off without pay.
“I think they’ve been very generous to me, but I think it’s a broken system,” she said. “There is enough responsibility and pressure on new moms that they shouldn’t also have to worry about how they are not getting a paycheck.
“Luckily, we weren’t in a situation where we live paycheck to paycheck,” she said, “but what if you were?”
Kelsey Rivera is among the few working moms who can bring her baby to the office, per the policy of Jefferson County Public Health. She was also able to take time off under the federal family-leave act. (Marvin Anani, Special to The Colorado Sun)
“I was never doing enough”
The family-leave proposal would not only cover paid leave for new babies or adoptions or foster children, but would allow Coloradans to apply for funds while they take care of an elderly parent, sick loved one, or even a neighbor or friend. That last part is why Zoey Palmer is passionate about the issue and is now volunteering for 9to5 Colorado, an advocacy group for working women.
At 25, she was working as a barista, worried that the adoptive mother who took her in as a girl was going to die. Palmer worried, too, that she would lose a job that she desperately needed if she took time off.
So, she spent nights in Louisville to take care of her two adoptive brothers while their mother was in the hospital having open-heart surgery, then rose at 4 a.m. to make it to work on time in Denver.
Her adoptive mother, who took Palmer in after her mother died of amyotrophic lateral sclerosis in 2001, survived the lung cancer and heart problems that resulted from months of radiation treatments. But Palmer still wishes she could have been there for her, to hold her hand and to sit by her hospital bed.
“The exhaustion was pretty relentless and hard to describe,” said Palmer, now 31 and working as a medical assistant. “I had a lot of guilt and feeling like I was never doing enough, wasn’t doing a good-enough job at my work and wasn’t doing a good-enough job for my family. I was definitely very depressed and scared and on edge through that whole experience.
“Even being able to take that one week off comfortably would have been a huge help.”
Palmer’s adoptive mother didn’t have paid leave, either. She returned to work three weeks after open-heart surgery.
CASPER — A bankruptcy judge says Englewood-based Westmoreland Coal Co. can eliminate health care for retirees and its union contract to sell a southwestern Wyoming mine to a Virginia businessman.
The Casper Star-Tribune reports that Friday’s ruling will likely mean retired miners who worked at the Kemmerer mine will lose their company health benefits. However, the judge delayed entering a final order until Tuesday to give the United Mine Workers of America and the company time to negotiate a deal.
Westmoreland, one of the nation’s oldest coal operators, filed for bankruptcy in October.
The man trying to buy the mine, Tom Clarke, says the changes in employee benefits are “painful” but necessary.
The vice president of the union in Kemmerer, Mike Dalpiaz, says the contract must remain strong or miners will refuse to work.
Beneath green surgical sheets and a tangle of tubes, a healthy young ewe is undergoing a heart-lung bypass procedure to help answer one of several urgent questions about a pillar of modern medicine: anesthesia.
Almost two centuries after anesthetics revolutionized surgery, a growing body of research is pointing to disturbing side effects that range from delirium to cancer-proliferating immune suppression. Researchers knocked out the sheep last month at the University of Melbourne to try to understand why common open-heart procedures lead to acute kidney injury in up to a third of patients — part of a broader effort to study the impact of anesthesia on the immune system, brain and other major organs.
The findings are already undermining decades of soothing messages about the harmlessness of being put into a sleep-like state. “Anesthetists are now trying to say actually it’s not that safe,” said Andrew Davidson, head of anesthesia research at the Murdoch Children’s Research Institute in Melbourne. “You don’t die on the table, but quite a lot of you don’t get home.”
Of the 200 million adults worldwide who undergo non-cardiac surgery annually, more than 1 million will die within 30 days. That risk jumps to 1 in 20 for patients 70 years and older.
Less than a mile from Davidson’s center at the Royal Children’s Hospital in Melbourne, separate groups at the Florey Institute of Neuroscience and Mental Health and the Peter MacCallum Cancer Centre are working to understand whether inhaled volatile gases such as isoflurane and sevoflurane — used by anesthetists to render some 80 percent of patients unconscious — may be more harmful than intravenous agents, such as propofol and fentanyl.
With 313 million operations undertaken each year, the findings may have significant global economic and social implications, and could herald a paradigm shift in surgical care, researchers say.
The science is conflicting and incomplete. A study by Davidson and colleagues, published late Thursday in the Lancet medical journal, found an hour of general anesthesia in early infancy has no lasting impact on the developing human brain. But some surgery may last longer, and Mayo Clinic doctors found an association between anesthesia and attention-deficit hyperactivity disorder in children.
The ADHD link is “scientifically plausible, but the evidence is not strong,” according to Davidson.
On the fourth floor of a University of Melbourne laboratory building, scientists at the Florey Institute are using fiber optic probes to measure blood flow and oxygen levels in different regions of the kidney of the 2-year-old Merino undergoing open-heart surgery.
The research, conducted by a team of clinicians and scientists under human surgical conditions, is designed to track kidney changes before, during and after the procedure, as well as identify risks attributable to two kinds of anesthetic agents, and find ways to protect the blood-filtering organ.
As many as 30 percent of patients who undergo open-heart surgery develop an acute kidney injury that increases their risk of chronic kidney disease and death, according to Yugeesh Lankadeva, a researcher studying the interaction.
Lankadeva and colleagues showed in a paper published last month that volatile-gas anesthesia was associated with higher activity in a key nerve that corresponded with a potentially damaging reduction in blood flow to the kidneys of sheep during abdominal surgery. Intravenous anesthesia had less impact.
Lankadeva’s current study aims to understand the mechanism in the context of heart-lung bypass procedures — routinely used for cardiac grafts and valve replacements — when the kidney is susceptible to further injury due to a rush of blood after normal circulation resumes.
It’s possible that the nerve activation associated with anesthesia — especially the inhaled gas form — is also impairing the immune system, according to Clive May, head of the Florey Institute’s preclinical critical care unit, who developed the kidney probe technique.
“There is a well-known link between the nervous system and the immune system, and activation of the nervous system can inhibit the immune system,” May said.
That link is being explored across the road at the Peter MacCallum Cancer Centre. Researchers there will lead an international clinical trial this year involving 5,700 patients randomized to receive either type of anesthesia for lung or colorectal cancer surgery, and followed for five years to compare cancer recurrence and survival.
Laboratory research and clinical observations indicate volatile gases may be harmful, said Bernhard Riedel, who is leading the study. “But what we really need is a big prospective, randomized study to look at the body of evidence where we can change guidelines.”
Previous research suggests that inhaled anesthetics have a pro-inflammatory effect that may paralyze the immune system for about a week around the time of surgery, Riedel said. That could provide an opportunity for any cancer cells remaining in the body to gain a foothold at the same time as the gas anesthesia inadvertently encourages blood-vessel growth to support nascent tumors.
Propofol, on the other hand, may have an anti-inflammatory effect, causing less immune perturbation, he said.
When it comes to anesthetic’s effects on the brain, both anesthesia types appear to be implicated in damage to neurons, the organ’s basic working units — similar to what occurs from a concussion or a minor acute brain injury, according to Lis Evered, a University of Melbourne researcher.
Evered, who is also a neuroscientist at the city’s St. Vincent’s Hospital, and colleagues showed last year increases in two biomarkers of neurological injury — neurofilament light and tau protein — in patients 60 years and older undergoing anesthesia on whom blood samples were taken before and sequentially up to 48 hours after surgery.
Studies in elderly patients have also linked a longer duration of anesthesia to an increased risk of post-surgery delirium — a transient complication associated with poorer neurocognitive function longer term. These raise questions about the risk-versus-benefit of some surgeries in older adults, Evered said.
“For 140 years, we were just concerned about safety,” she said. “In the last 30 years, we’ve actually become a bit more concerned about other sorts of impacts because people are living longer. Now, we want people to survive the procedure and have a good quality of life for the next 10 to 20 years.”
The findings of neurotoxicity are further challenging traditionally held beliefs that general anesthesia simply “turns the brain off” for a period after which it reverts to its pre-anesthesia state, said Davidson at the Murdoch Children’s Research Institute.
“Anesthesia is a very abnormal state for the brain to be in,” he said. “So it makes sense that your brain circuitry is actually not the same after the anesthetic as it was before.”
That probably doesn’t matter for young adult patients, Davidson said. “But if you’re old or very young, then maybe it does begin to matter.”
WASHINGTON — Sen. Ron Wyden, D-Ore., is asking the chief executives of Apple and Google to immediately stop offering a Saudi e-government app that allows men in Saudi Arabia to track and control the movement of women.
In a letter sent to the tech giants Monday, Wyden urged them to prevent their app stores from being used by the Saudi government to continue the “abhorrent surveillance and control of women.”
Human rights groups are also calling on Apple and Google to consider the abuse and discrimination that the app could fuel.
Absher, an app people can download on the Google Play store and Apple’s app store, works as an e-government portal and general services software for the Saudi Interior Ministry. It allows Saudi citizens to process a host of personal status issues such as getting a passport, a birth certificate or vehicle registration.
But the app, according to human rights advocates, also facilitates Saudi Arabia’s patriarchal guardianship system.
It remains illegal for women in Saudi Arabia to travel without permission from a so-called male guardian. Under this system of laws and practices, women in the kingdom need the approval of a “guardian” — typically a male relative — for a range of decisions and actions, including marriage, employment with private companies, certain types of health care and release from prison, said Adam Coogle, a Middle East researcher at Human Rights Watch.
Using Absher, Saudi men can restrict the travel of Saudi women by first allowing or disallowing them to leave the country, and the men can also limit the dates and places women are permitted to travel.
“We call on Apple and Google to assess the risk of human rights abuses on women, which is facilitated by the App, and mitigate the harm that the App has on women,” Amnesty International said in a statement to The Washington Post on Tuesday. “The use of the Absher app to curtail the movement of women once again highlights the disturbing system of discrimination against women under the guardianship system and the need for genuine human rights reforms in the country, rather than just social and economic reforms.”
The Saudi Embassy in Washington did not immediately respond to a request for comment.
Apple does not include the number of downloads for apps, but according to the Google Play store, Absher has been installed on devices more than 1 million times. The Interior Ministry says on its website that Absher platforms for individuals and businesses have more than 11 million users.
On both Apple and Google’s app stores, the app preview states: “Absher has been designed and developed with special consideration to security and privacy of user’s data and communication. So, you can safely browse your profile or your family members, or labors [sic] working for you, and perform a wide range of eServices online.”
Google and Apple did not immediately respond to requests for comment.
Coogle of Human Rights Watch said: “The Saudi government uses this app to discriminate against women, and therefore those who are providing the app should ensure that their app complies with their terms of service and perhaps even look into advocating with Saudi Arabia to change the laws and change the app.”
Criticism of the app follows the high-profile case of Rahaf Muhammad, a Saudi teenager who fled from the kingdom and was granted asylum in Canada. Her escape and criticism of the Saudi government have drawn heightened attention to the country’s male guardianship laws. The calls for change come amid an enduring scandal over the killing of journalist Jamal Khashoggi in the Saudi Consulate in Istanbul in October.
Walmart workers can now see a doctor for only $4. The catch? It has to be a virtual visit.
The retail giant recently rolled back the $40 price on telemedicine, becoming the latest big company to nudge employees toward a high-tech way to get diagnosed and treated remotely.
But patients have been slow to embrace virtual care. Eighty percent of mid-size and large U.S. companies offered telemedicine services to their workers last year, up from 18 percent in 2014, according to the consultant Mercer. Only 8 percent of eligible employees used telemedicine at least once in 2017, most recent figures show.
“There’s an awful lot of effort right now focused on educating the consumer that there’s a better way,” said Jason Gorevic, CEO of telemedicine provider Teladoc Health.
Widespread smartphone use, looser regulations and employer enthusiasm are helping to expand access to telemedicine, where patients interact with doctors and nurses from afar, often through a secure video connection. Supporters say virtual visits make it easier for patients to see a therapist or quickly find help for ailments that aren’t emergencies. But many still fall back to going to the doctor’s office when they’re sick.
Health care experts have long said that changing behavior can be hard. In telemedicine’s case, patients might learn about it from their employer and then forget about it by the time they need care a few months later. Plus emotions can complicate health care decisions, said Mercer’s Beth Umland.
“My little kid is sick, I want them to have the best of care right away, and for some people that might not register as a telemedicine call,” she said.
Some patients — especially older ones — also just prefer an in-person visit.
“Going to the doctor’s office is a big event in their life and something they look forward to,” said Geoffrey Boyce, CEO of InSight Telepsychiatry, which provides virtual mental health services.
Tom Hill is among that crowd. The 66-year-old from Mooresville, Ind., said he’s never used telemedicine and has no plans to.
“I believe in a handshake and looking a guy in the eye,” Hill said during a recent shopping break at a downtown Indianapolis mall. “I don’t buy anything online either.”
But the practice does gain fans once patients try it.
Julie Guerrero-Goetsch has opened her MDLive telemedicine app several times since first using it about a year ago to get help for a sinus infection.
The Fallon, Nev., resident was skeptical, but she didn’t have time to go in person. MDLive connected her to a doctor soon after she opened the app. She said he started asking questions about symptoms “just as if I was sitting in a doctor’s office” and prescribed an antibiotic.
Caitlin Powers tried telemedicine recently after hearing about it through a friend. The Columbia University graduate student was feeling stuffed up and worried she might be coming down with the flu. She said her appointment started on time, lasted 10 minutes, and she spoke by video with a doctor in Florida while never leaving her Brooklyn apartment.
“As a student, I don’t really have time to spend three hours waiting to see a doctor, and this was so easy,” she said.
Doctors have used telemedicine for years to monitor patients or reach those in remote locations. Now, more employers are encouraging people covered under their health plans to seek care virtually for several reasons.
Telemedicine can reduce time spent away from the job, and it also can cost half the price of a doctor’s visit, which might top $100 for someone with a high-deductible plan. However, those savings can be negated if telemedicine’s convenience causes people to overuse it.
Walmart said it cut the cost for virtual visits to give another care option to the more than one million people covered by its health benefits.
Employers aren’t the only ones pushing the technology.
The drugstore chains CVS Health and Walgreens are promoting apps that let customers connect to doctors. Some insurers such as Oscar Health are offering it for free to customers as a first line of treatment.
Ease of use is one of the reasons researchers and telemedicine providers think the practice will become more widespread in several areas of care. Those include dermatology and follow-up doctor visits after a surgery or medical procedure.
Mental health visits are another area ripe for virtual care because patients can feel more comfortable talking to a therapist in their own home, said Boyce of InSight Telepsychiatry, which delivers mental health care in about 30 states.
Boyce said people also like the anonymity of a virtual visit.
Mental health visits were the most common use of telemedicine by patients until primary care overtook that specialty a few years ago, Harvard’s Dr. Ateev Mehrotra and other researchers found in a recent study of claims data from a large insurer.
Research firm IHS Markit estimates that telemedicine visits in the U.S. will soar from 23 million in 2017 to 105 million by 2022. But even then, they will probably amount to only about one out of every 10 doctor visits, said senior analyst Roeen Roashan.
MDLive CEO Rich Berner said telemedicine is like the digital video recorder TiVo, which took a while to catch on with viewers.
“People were so used to doing things the other way that it just took a little while to kind of really go mainstream,” he said. “But when it did, it went mainstream big-time.”
FRISCO — To Devon Howe-Czar, it was a nightmare scenario:
A few weeks ago, one of her twin 7-year-old daughters fell while skiing. She was raced down the hill on a toboggan to a nurse’s station at the base, but from there Howe-Czar had to make a choice that confronts far too many families living in Colorado’s mountains. What to do now?
She and her husband couldn’t afford the $1,200-a-month premiums for health insurance through his job, and the rates on the state’s health insurance exchange weren’t much better. They decided to try to get by without insurance, but now she was confronted with one of the decisions she feared the most. She listened closely as the nurse asked her daughter, “Do you think it’s broken?”
“I had to make that decision of, ‘do I go to get it X-rayed or do we wait and see if it’s a sprain?’” Howe-Czar said, her voice cracking with emotion. “I figured within a week we would know.”
An analysis by Summit County leaders found that privately insured patients are, on average, charged five times more in the county for outpatient services than what Medicare pays in the same place for the same services. For emergency services, privately insured patients are charged eight times more than what Medicare pays.
“It’s to the point where some of our clients are spending 30 to 40 percent of their income on health care expenses,” said Tamara Drangstveit, the executive director of the Family and Intercultural Resource Center in Silverthorne, which helps people find health coverage, among other services.
Summit officials have tried for years to find a solution, with little success. But now they have hit on an idea they think might actually work: a radical reordering of the health care marketplace. And it also could become a statewide model for how consumers buy health coverage.
How it works
It’s called the Peak Health Alliance, and its innovation is in how it tries to flip the leverage in health care price negotiations.
In the typical system, hospitals and doctors set their prices, insurance companies negotiate the best deal they can get below those prices, and then insurers pass on those costs to consumers. The only involvement the consumer has is deciding whether to pay the premiums and deductibles sets by insurance companies.
The Peak Health Alliance brings together employers and individuals into a kind of nonprofit cooperative, overseen by a board. As a group of consumers, the alliance then goes to hospitals and doctors and negotiates prices directly. Once it has pricing agreements in place, it then asks insurers to bid for its business — meaning consumers have leverage with both hospitals and insurers. They can negotiate bargains with providers, and they can get insurers competing to offer the best deal on coverage.
The ability to create these kinds of cooperatives has existed in state law for years, but Colorado Insurance Commissioner Michael Conway said, “Everybody forgot about this law.” If it works in Summit County, Conway said, he hopes to take the idea statewide.
“There is a good opportunity if we put the consumer at the table with the hospital that we can drive that conversation and we can lower health care costs,” he said. “And if we lower health care costs, we lower premiums.”
Conway has worked with leaders in Summit County to create the Peak Health Alliance, and he says it has one big advantage over the health cost-sharing plans popping up in other Colorado mountain communities. While cost-sharing plans might deny claims if they believe the member engaged in unhealthy behavior, Conway said the Peak Health Alliance’s program is full-fledged insurance and will guarantee coverage for all the things that Obamacare plans have to cover.
So far, the town governments of Breckenridge and Silverthorne, as well as Summit County government and a Breckenridge timeshare company have signed onto the alliance for their employees’ health coverage. Sarah Vaine, an assistant county manager for Summit County, said the alliance’s negotiations with medical providers are going well — “I think we’re feeling really positive,” she said — but there is also an urgency to get deals in place within the next few weeks so that coverage through the alliance could start next year.
Other groups of businesses in Colorado have banded together before to buy health coverage, but what makes the Peak Health Alliance so unique is that it also hopes to allow individuals to buy into the alliance on their own — hopefully providing a more affordable option for health coverage than what is currently on the market.
People in Summit County are desperate for one.
“One accident away”
Inside the senior center in Frisco, every seat was taken. People crowded in the back, up against the wall, leaning into door frames.
The event earlier this month was a town hall meeting, where Gov. Jared Polis and several state lawmakers discussed their proposals for cutting health care costs. In his remarks, Polis praised the idea for the Peak Health Alliance — “It’s an exciting model,” he said — and called Summit County a hotbed of innovative health care ideas.
Colorado Gov. Jared Polis speaks on Feb. 1, 2019, at a town hall meeting in Frisco about the high cost of health care in Colorado’s mountain communities. (John Ingold, The Colorado Sun)
But local residents got their say, too, and they told the officials about annual health care bills that, between premiums and deductibles, could top $40,000. One woman said her best option to find affordable coverage was to work less and take a pay cut — dropping her earnings down enough that she would be eligible for a subsidy on the health insurance exchange.
Residents worried they would have to move elsewhere to find coverage. Health care cost them more than housing, they said. People are skipping regular doctor’s visits, neglecting preventative care.
“It really is a life-and-death situation,” resident Gini Bradley said.
Howe-Czar, who was not at the meeting, echoed that fear. A Colorado native, she said she can’t see herself leaving.
“The mountains are in my blood,” she said.
But she said many don’t realize the struggle it is for most people to live in some of Colorado’s most glamorous places. She and her husband work in Summit County, but they live on the other side of Hoosier Pass, in Park County — a treacherous commute in winter.
For awhile, her husband worked as an independent contractor, and they were on Medicaid. But since he started a new job, they fell into a common high-country limbo: making too much to qualify for meaningful assistance and too little to actually afford coverage.
They’re responsible people, she said. They pay their bills. They take good care of their kids. They’re healthy.
And, still, they’re teetering on the edge of a financial disaster.
Fortunately, Howe-Czar said, her daughter’s ankle injury wasn’t that. After about a week and a half on crutches, her daughter is putting weight on the ankle again. It was just a sprain.
“So I’m thankful,” she said, hesitantly. “But that’s one of my concerns. We don’t make enough money to have medical bills. We’re current on all of our bills. But we are one accident away from having a really tough time.
A bill that would let law enforcement agencies across Colorado remove firearms from people a judge deems a high risk for harming themselves or others was reintroduced at the statehouse Thursday.
It’s called a “red flag” or extreme risk protection order bill, and House Majority Leader Alec Garnett, D-Denver, is again sponsoring it in memory of Douglas County sheriff’s deputy Zackari Parrish, who was killed at a Highlands Ranch apartment complex in 2017 while he tried to negotiate with a man in the midst of a mental health crisis.
“What we are doing with this bill is giving law enforcement a tool that they need to save lives,” said Rep. Tom Sullivan, D-Centennial, the bill’s other main sponsor. “It gets the people who are having these difficult times the help that they need and protects their families and the community from them having a problem.”
The way an extreme risk protection order would work under this bill is that law enforcement, family member or a household member could petition a judge for the removal of a person’s firearms. The judge would hold a hearing — without the gun owner being present — to decide whether to grant a temporary order for up to 14 days.
During those two weeks, the gun owner and the person who asked for the order would tell the judge why those weapons should or shouldn’t be returned. The judge could extend the order for up to 364 days.
That’s about double the length of time in the 2018 bill. Garnett said people in law enforcement asked for the longer time frame. The biggest changes to the bill, however, came from discussions with the criminal defense bar.
The bill would provide the gun owner with a lawyer free of charge if he or she wanted one. It would also give judges the discretion to hold additional hearings and potentially lift the order early. The previous iteration of this bill only gave judges one opportunity for review beyond the first hearing.
“We provided the judges opportunities for mental health and drug and alcohol evaluations,” Garnett said. “It’s kind of an intervention point where the judge can help people get treatment.”
Those changes haven’t prompted any Republicans to co-sponsor the bill, but Sullivan and Garnett both think there’s potential to bring some of their counterparts on board. Two Republican House members voted for the 2018 version. That bill never got a vote in the full Senate, though, as a Republican-controlled committee voted it down.
Rocky Mountain Gun Owners, a gun rights group, characterized the 2018 bill as the “Gun Confiscation Act” and actively campaigned against any Republican who supported it.
House Minority Leader Patrick Neville, R-Castle Rock, said he opposed the previous bill because of a concern that it would make people — especially veterans — more reluctant to seek mental health treatment.
Colorado lawmakers haven’t passed a major piece of gun legislation since 2013 — the last time Democrats controlled both the House and Senate. Democrats passed universal background checks, required people to pay for those checks and banned high-capacity magazines. Voters recalled two Democratic senators for their support of those bills.
“We’re confident,” said Sullivan, who lost his son, Alex, in the Aurora theater shooting. “We have a story to tell, and this is what the story is: We’re here to save lives.”
The bill was introduced on the first anniversary of the mass shooting at Marjory Stoneman Douglas High School in Florida. That gunman, like the one who killed Parrish, was known by local law enforcement as a troubled person.
Florida passed an extreme risk protection order law in the wake of that shooting, and the state’s Republican governor signed it. Sullivan said he firmly believes a bill like this could have saved Parrish’s life here in Colorado.
“There’s no doubt in my mind,” Sullivan said. “So now we’re on the clock again to save more lives.”
A month after state health officials reported Colorado’s first childhood death from flu this season, a second youth has died from the respiratory illness.
The second childhood death from influenza was confirmed by a spokesperson with the Colorado Department of Public Health and Environmenton Wednesday. Fox31 reported that Selina Nguyen, a 7-year-old from Denver, died Sunday.
So far, 1,851 Coloradans have been hospitalized with influenza during the 2018-19 flu season. Children up to the age of 4 years old are being hospitalized at a higher rate than others, according to a weekly report from the state health department.
Influenza, which can cause mild to severe illness, has symptoms such as fever, cough, body aches and fatigue. This flu season, most hospitalizations are caused by the H1N1 strain, which caused the flu pandemic of 2009.
A month after state health officials reported Colorado’s first childhood death from flu this season, a second youth has died from the respiratory illness.
The second childhood death from influenza was confirmed by a spokesperson with the Colorado Department of Public Health and Environment on Wednesday. Fox31 reported that Selina Nguyen, a 7-year-old from Denver, died Sunday.
So far, 1,851 Coloradans have been hospitalized with influenza during the 2018-19 flu season. Children up to the age of 4 years old are being hospitalized at a higher rate than others, according to a weekly report from the state health department.
Influenza, which can cause mild to severe illness, has symptoms such as fever, cough, body aches and fatigue. This flu season, most hospitalizations are caused by the H1N1 strain, which caused the flu pandemic of 2009.
Adele Marshall’s daughter, Taryn Elkins, was seven months pregnant with her first baby when she died in January 2017 after high blood pressure brought on a seizure that filled her lungs with fluid.
Anna Staver, The Denver Post
Adele Marshall holds a photo of her daughter Taryn Elkins, who died when she was seven months pregnant, after testifying to the Colorado House on Feb. 13, 2019.
Marshall told a Colorado House committee she believes her daughter and grandson would be celebrating his second birthday rather than the second anniversary of their deaths if the state’s Maternal Mortality Review Committee had the same powers that 41 other states already have.
“My family died that day in that hospital when Taryn stopped breathing,” Marshall told the committee through tears. “Please don’t let this happen to anybody else.”
House Bill 19-1122 would make several significant changes to Colorado’s Maternal Mortality Review Committee. The most important change, according to the bill’s sponsors, is giving committee members protection from being subpoenaed in malpractice lawsuits, which means they could get better, more honest answers and review deaths as they happen rather than waiting at least three years to investigate.
The death of Marshall’s daughter still hasn’t been reviewed by the committee for this reason.
The bill would require the committee to standardize their data and submit annual reports to the legislature with recommendations on how to improve maternal care both before and after the baby is born. Postpartum depression-related suicides are counted as a maternal mortality deaths.
The bill would also reimburse committee members’ travel, lodging and other costs like child care to encourage people from diverse backgrounds to participate. Rural mothers and women of color both have a higher risk of dying in childbirth than Caucasian women in the Denver metro area, Colorado Children’s Campaign Vice President Erin Miller said.
But the number that stuck with Rep. Jonathan Singer, D-Longmont, is that the American College of Obstetrics and Gynecologists believes 80 percent of maternal mortality deaths in Colorado from 2008 to 2013 were preventable. That means 116 mothers could still be alive today.
“Those words are going to stick with me for a while,” Singer said.
The bill passed out of committee unanimously and heads to the House appropriations committee to get approval for the funding it needs to reimburse committee members.
If it becomes law, Marshall told the bill’s sponsor, Rep. Janet Buckner, D-Aurora, that she would be interested in serving on it.
Marshall’s daughter had a higher risk for blood pressure problems because of a medical issue she had as a teenager, and she believes doctors overlooked those risks. She also didn’t learn that her daughter got fluid in her lungs during her seizure — a complication Marshall believes could have been easily prevented by turning Elkins on her side — until months after her death.
“It didn’t have to happen,” Marshall said. “If we had taken the baby the week before, they both would be here today.”
Colorado Sen. Michael Bennet had a message for fellow Democrats this weekend as two more White House contenders formally jumped into the 2020 presidential race: Don’t forget about me.
“We’ve got a million people that are going to run, which I think is great,” Bennet said Sunday on NBC’s “Meet the Press.” But, he added, “I think having one more voice in that conversation that’s focused on America’s future, I don’t think would hurt.”
Bennet, 54, cast himself as a centrist Democrat who would bring business and managerial experience to the crowded field, should he decide to run. Before being appointed to the Senate in 2009, Bennet, an attorney, served as superintendent of Denver Public Schools and worked for a large private company.
“I’ve got a different set of experiences than the other folks in the race, many of whom are my friends and people that I like,” Bennet said. “I spent time in business and time as a schools superintendent before I was in the in the job that I’m in now.”
Speaking with moderator Chuck Todd, Bennett criticized President Donald Trump for the rising federal deficit. In another gesture toward the center, Bennet declined to embrace the call for “Medicare-for-all,” a single-payer proposal where Medicare benefits would be offered to all Americans. The idea has become popular among some Democratic voters and 2020 presidential candidates.
Bennet said he would support a “public option” on health care, but does not want to eliminate private insurance.
“Now what Democrats are saying is, ‘If you like your insurance, we’re going to take it away from you,’ from 180 million people that get their insurance from their employer and like it, where 20 million Americans who are on Medicare Advantage and love it. That seems like a bad opening offer for me,” he said.
A Bennet campaign would face many challenges. While he has a deep national network of donors from his time running the Senate Democrats’ campaign arm and was close to many Obama administration figures, Bennet is best known as a soft-spoken lawmaker who usually avoids the spotlight.
Bennet’s late father, Douglas J. Bennet, led National Public Radio in the ’80s and early ’90s and worked in the Johnson, Clinton and Carter administrations. Bennet’s brother, James, is the editorial page editor of The New York Times.
Bennet has been moving toward a possible campaign for months, albeit slowly. In the fall, the Associated Press reported that his team had been in touch with influential Iowa Democrats, and at the Capitol, Bennet has been stepping out with fiery speeches that have won him attention.
In January, Bennet’s nearly 25-minute floor remarks that were sharply critical of Sen. Ted Cruz, R-Texas, amid the then-ongoing government shutdown were widely shared on social media and drew hundreds of thousands of views online.
The Democratic field is growing fast, putting pressure on Bennet and others, such as former Vice President Joe Biden, to make a decision. Sens. Kamala D. Harris of California, Kirsten Gillibrand of New York and Cory Booker of New Jersey are already in the race. Sen. Elizabeth Warren of Massachusetts officially launched her 2020 bid on Saturday at a rally in Lawrence, Massachusetts. Sen. Amy Klobuchar of Minnesota was expected to announce her presidential campaign Sunday in Minneapolis.
One of Bennet’s longtime allies, former Colorado Democratic Gov. John Hickenlooper, is also moving toward a run and will visit New Hampshire this week.
Hickenlooper, Biden, former New York Mayor Michael Bloomberg and former Virginia Gov. Terry McAuliffe would all likely compete with Bennet for support from moderate Democrats, should they run.
Bennet has previously competed in a heated primary. His 2010 Senate primary race against former Colorado House speaker Andrew Romanoff drew national interest, with Bennet’s business record and his decisions as superintendent scrutinized in ads. As Bennet fended off Romanoff’s insurgent campaign, President Barack Obama boosted Bennet and helped him stave off defeat.
In the general election that year, as Republicans made gains nationally, Bennet was able to use strong backing from Hispanic voters and women to beat a conservative Republican Senate nominee.
UCHealth University of Colorado Hospital plans to build an 11-story tower at its location at Anschutz Medical Campus in Aurora, a roughly $388 million expansion that will add 103 inpatient beds.
“Capacity challenges” are driving the expansion, with the hospital saying it has an average occupancy rate of 93 percent. Construction on the tower, which will open in 2022, is expected to begin this year, according to a news release.
“Patients throughout our multi-state region have been requesting our care in record numbers while our state’s population continues to grow at one of the nation’s fastest rates,” said Dr. Jean Kutner, chief medical officer, in a statement.
UCHealth said in the release that it is seeing demand for services involving oncology (cancer), bone marrow and organ transplants, neurology and neurosurgery.
The expansion will add beds to the intensive care unit, along with medical and surgical beds.
The project also will include nine operating rooms, and space for renovations or expansions in other parts of the hospital, including the emergency department, spokeswoman Jessica Berry said.
Kaiser Permanente Colorado, the largest insurer in the state, is laying off about 200 employees — again.
The latest round of layoffs, which follows 200 jobs cut in November, is the result of Kaiser shaking up its operations after recording millions of dollars in losses.
“An important part of this effort is having the right people in the right jobs to best serve our members,” Kaiser officials said an emailed statement. “To achieve this goal, we have made some changes to our organizational structure that will result in the elimination of some staff positions.”
Kaiser has more than 7,000 employees in Colorado, along with 217,000 workers nationwide.
Last year, Kaiser reported losses of $65 million for three years, prompting a broad review of its operations. The insurer has attributed the losses to rising hospital prices.
Employees were told of the latest round of layoffs last week. Those affected by the cuts will receive severance and other benefits, Kaiser said in the statement.
“The reductions will not impact the high quality of care and service we provide our members,” the statement said.
Gov. Jared Polis’ office announced two new executive directors for state government Friday, leaving one cabinet position open a month after taking office.
Food Bank of the Rockies interim president Michelle Barnes will become executive director of the Colorado Department of Human Services, which oversees the state’s child welfare division, youth corrections and mental hospitals.
Michelle Barnes (Handout)
Barnes, who has worked in the for-profit and nonprofit worlds, spent two decades in the tech industry and a dozen years in nonprofit leadership, according to her Food Bank of the Rockies biography. The temporary job at the food bank was the latest of several interim chief executive positions Barnes held.
She founded an organization called Interim Leadership Solutions, which helped various organizations through transition as Barnes stepped in to lead them. In 2014, she wrote an essay for The Washington Post about carrying an Ebola-like disease into the United States after a trip to Uganda.
Kara Veitch
At the Department of Personnel and Administration, deputy director Kara Veitch is stepping into the top job. Veitch became deputy director of the agency in 2013 and previously was an attorney for Children’s Voices and an associate director of Colorado Forum.
Polis has yet to announce an executive director of the state Department of Revenue.
The cabinet positions announced Friday were among three Gov. Jared Polis had yet to fill a month after taking office. Workers at the departments knew of the hirings but were not allowed to confirm them and referred questions to the governor’s office, which emailed a press release.
Scientists think they have achieved the first gene editing inside the body, altering DNA in adults to try to treat a disease, although it’s too soon to know if this will help.
Preliminary results suggest that two men with a rare disorder now have a corrective gene at very low levels, which may not be enough to make the therapy a success.
Still, it’s a scientific milestone toward one day doctoring DNA to treat many diseases caused by faulty genes.
“This is a first step,” said Dr. Joseph Muenzer of the University of North Carolina at Chapel Hill, who helped test the treatment. “It’s just not potent enough.”
He gave the results Thursday at a conference in Orlando, Florida, and has consulted for the therapy’s maker, California-based Sangamo Therapeutics. Researchers are working on a stronger version of the treatment.
Gene editing is intended as a more precise way to do gene therapy, to disable a bad gene or supply a good one that’s missing. Trying it in adults to treat diseases is not controversial and the DNA changes do not pass to future generations, unlike the recent case of a Chinese scientist who claims to have edited twin girls’ genes when they were embryos.
Sangamo’s studies involve men with Hunter or Hurler syndrome, diseases caused by a missing gene that makes an enzyme to break down certain sugar compounds. Without it, sugars build up and damage organs, often killing people in their teens.
In 2017, Brian Madeux of Arizona became the first person to try it. Through an IV, he received many copies of a corrective gene and an editing tool called zinc finger nucleases to insert it into his DNA.
Results on him and seven other Hunter patients, plus three with Hurler syndrome, suggest the treatment is safe, which was the main goal of these early experiments. Three problems — bronchitis, an irregular heartbeat and a hernia — were deemed due to the diseases, not the treatment.
Tissue samples showed evidence of gene editing at very low levels in two Hunter patients who were given a middle dose but not in one given a low dose. Tests are expected later this year on patients who received the highest dose and on Hurler patients.
Blood tests detected slightly higher levels of the missing enzyme in a few of the Hunter patients but none of them reached normal levels. One patient had a larger increase but also showed signs that his immune system might be attacking the therapy. He was treated for that and symptoms resolved.
More encouraging results were seen in Hurler patients — enzyme levels rose to normal in all three after treatment, tests on certain blood cells showed.
“This is very promising” for Hurler patients, said Dr. Paul Harmatz of UCSF Benioff Children’s Hospital Oakland, who presented those results.
None of the patients with either disease showed a sustained decline in urine levels of the troubling sugar compounds, though, and some other tests also did not detect intended effects of the therapy.
The key test will be stopping the patients’ weekly enzyme treatments to see if their bodies can now make enough of it on their own. Three have gone off treatments so far and one was recently advised to resume them because of fatigue and rising levels of the sugar compounds. The others have not been off long enough to know how they will fare.
“It looks like it’s safe … that’s a very positive sign,” said one independent expert, Dr. Kiran Musunuru of the University of Pennsylvania. He called the early results promising but said “it’s hard to be sure it’s doing any good” until patients are studied longer.
“What they’re trying to do with gene editing is very challenging,” he said. “It’s much harder to make a correction or insert a gene” than to disable one.
Dr. Tyler Reimschisel of Vanderbilt University agreed.
“It’s not discouraging, it’s just early and on a small amount of people,” he said. “This is definitely a novel and innovative treatment” but it’s not clear if it’s going to help.
Sangamo’s president, Dr. Sandy Macrae, said a more potent version is being manufactured. Because the treatment seems safe, regulators recently agreed to allow teens with Hunter syndrome to join the study. The ultimate goal is to treat children at a young age, before the disease causes much damage. He said the company will wait for more results on current patients before deciding how to proceed.
“We’ve done something important” by achieving gene editing, he said. “There is a foundation to build on.”
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Marilynn Marchione can be followed at @MMarchioneAP
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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.
The Colorado House of Representatives has passed a bill allowing medical marijuana use to treat autism spectrum disorders.
The legislation had strong bipartisan support, passing 63-0 on Thursday.
The bill now heads to the Senate where lawmakers in that chamber are expected to clear the measure, too. Gov. Jared Polis has pledged to sign the legislation if it makes it to his desk.
Autism spectrum disorders include autism, Asperger syndrome and other developmental disorders whose symptoms range from mild to severe.
Current law allows medical marijuana use for cancer, glaucoma, HIV, PTSD, seizures and severe pain.
The legislation, House Bill 1028, streamlines procedures for minors to be added to Colorado’s medical marijuana registry. It also encourages state research into ovarian cancer, dementia and other medical conditions.
Then-Gov. John Hickenlooper vetoed a similar bill last year, angering the policy’s supporters — including state lawmakers. He cited a need for more research into marijuana’s benefits for patients with an autism spectrum disorder.
Lawmakers this year are also weighing a bill that would allow doctors to prescribe medical marijuana for acute pain instead of opioids.
Colorado Sun staff writer Jesse Paul contributed to this report.
The Denver Post is hosting an event, following our latest series on Alzheimer’s disease called Mourning the Living. The panel and live stream will start at 7 p.m. tonight.
The Denver Post’s Jessica Seaman will moderate a panel featuring some of Colorado’s leading experts on Alzheimer’s.
The panel and discussion will touch on what families can do after getting a diagnosis, the potential genetic risk of the disease and the toll it takes on loved ones. Panelists will also take questions from the audience.
Provided by Amelia Schafer, Dr. Hillary Lum and Dr. Jonathan Woodcock
Amelia Schafer, Dr. Hillary Lum and Dr. Jonathan Woodcock.
The panelists include:
Amelia Schafer, executive director of the Alzheimer’s Association Colorado Chapter
Dr. Jonathan Woodcock, clinical director of the Rocky Mountain Alzheimer’s Disease Center at CU Anschutz and clinical director of the Memory Disorders Clinic with UCHealth
Dr. Hillary Lum, a geriatrician and palliative care physician at the Seniors Clinic at University of Colorado Hospital, University of Colorado School of Medicine, and the VA Eastern Colorado Geriatric Research Education and Clinical Center
DENVER — Colorado’s House has passed a bill allowing medical marijuana use to treat autism spectrum disorders.
The bill had strong bipartisan support, passing 63-0 on Thursday.
The Senate is expected to do the same, and Gov. Jared Polis has pledged to sign it.
Autism spectrum disorders include autism, Asperger syndrome and other developmental disorders whose symptoms range from mild to severe.
Current law allows medical marijuana use for cancer, glaucoma, HIV, PTSD, seizures and severe pain.
The legislation streamlines procedures for minors to be added to Colorado’s medical marijuana registry. It also encourages state research into ovarian cancer, dementia and other medical conditions.
Then-Gov. John Hickenlooper vetoed a similar bill last year. He cited a need for more research into marijuana’s benefits for patients with an autism spectrum disorder.
Even as lawsuits across the country continue to churn out revelations about the aggressive marketing practices of opioid-maker Purdue Pharma, the company has asked a judge to dismiss the state of Colorado’s lawsuit against it.
Its argument: All of its marketing was consistent with the Food and Drug Administration’s approval of its blockbuster pain pill Oxycontin.
“The FDA has approved, and continues to approve, opioids, including Purdue’s opioid pain medications, for the treatment of chronic pain,” Purdue states in a motion, filed late last year, to dismiss the Colorado case. “… Therefore, as a matter of law, Purdue cannot have fraudulently or deceptively promoted its opioids for their FDA-approved use.”
Purdue also argues in its motion that it is being unfairly singled out for causing the opioid-overdose epidemic and says Colorado is ignoring “the many intervening actors and events that break the causal chain and make any alleged harm too remote to be attributed to Purdue as a matter of law.”
In its response to the motion, the Colorado Attorney General’s Office said Purdue mischaracterized the lawsuit in an attempt to dodge the allegations leveled specifically against the company.
“Contrary to Purdue’s assertions,” the AG’s office wrote, “the State’s claims arise from, and seek relief for, a host of deceptive marketing practices beyond simply promoting opioids as a treatment for chronic pain.”
The judge has not yet ruled on Purdue’s motion, and there is no timeline for a ruling.
Colorado is one of at least 36 states that have sued Purdue. Several cities and counties around Colorado have filed separate suits against the company.
All the lawsuits allege that Purdue fanned the opioid epidemic through an aggressive, manipulative marketing campaign that sought to portray Oxycontin as more effective and less addictive than it really is. For instance, Colorado’s lawsuit alleges that Purdue invented the diagnosis of “pseudoaddiction” to explain away why so many pain patients were becoming dangerously hooked on its pills. The cure for pseudoaddiction, according to Purdue, was to prescribe higher doses of opioids.
Newly unredacted documents in a lawsuit filed by Massachusetts have revealed more details of Purdue’s business strategy.
The company hired a consulting firm for advice on how to sell more of the potentially deadly pain pills. One member of the billionaire family that owns Purdue personally instructed staff to place greater value on higher-dose prescriptions. And, as addiction to opioids such as Oxycontin boomed across the country, Purdue talked about jumping into the addiction-treatment market.
Purdue’s motion to dismiss Colorado’s lawsuit addresses none of this. Instead, the company says Colorado failed to prove that its marketing led to reckless prescribing by doctors and said it should not be held responsible for illegal prescribing practices by doctors running pill mills. (The motion does not address the state’s allegation that Purdue representatives failed to notify authorities when they spotted suspicious prescribing patterns, as they are required to do by federal law.)
Purdue also downplays Oxycontin’s place in the opioid universe, arguing that Oxycontin tablets account for only about 2 percent of all opioid prescriptions in the country.
“In short, the State asks the Court to accept that there is a direct causal link between Purdue’s alleged conduct and all of the harm caused in Colorado by lawful opioids and illegal drugs,” Purdue argues in its motion. “… The State would have the Court ignore or distort traditional legal principles well beyond their breaking point and to assume a role in addressing this complex public-health issue that is better left to expert regulators and elected officials.”
New Colorado Attorney General Phil Weiser has said he will continue pursuing the Purdue lawsuit aggressively, while also looking at possibly suing others involved in the epidemic. But Purdue has had some recent success in getting cases dismissed.
A judge in Connecticut this year tossed out a lawsuit against Purdue brought by several communities on the grounds that the communities didn’t have standing to bring the specific types of complaints they filed. Utah’s attorney general last week dropped his state’s suit against Purdue, saying that it would be quicker to pursue an administrative action against the company and also noting that restructuring at Purdue could potentially limit any payouts won under lawsuits.
Meanwhile, Colorado’s overdose epidemic continues apace, already certain to have claimed more lives in 2018 than car crashes even though the final tally of overdose deaths won’t be available for months.
This Jan. 10, 2013 file photo shows vials of flu vaccines in Philadelphia.
More than 9,400 children visited hospitals and emergency departments in 2017 for diseases that could have been prevented by a vaccine, leading to parents and insurers being charged $55.5 million, according to a new report by Children’s Hospital Colorado.
Rising health care costs and a severe flu season drove up the costs of treating children without vaccinations in the state, which was $35 million in 2015, said Dr. Jessica Cataldi, author of the report and a pediatrician at the hospital.
Most of the children treated for a vaccine-preventable illness in 2017 visited a hospital or emergency department for influenza. About 460 children were hospitalized and 8,656 kids were treated in emergency rooms for the flu, resulting in $42 million in charges, the report said.
Two of the children hospitalized — an infant and a toddler — died with influenza, according to the report.
Each year, only about half of the children in Colorado get the flu shot, which is recommended for everyone 6 months and older, Cataldi said.
“When we look at our youngest kids we know that we still are not doing great,” she said.
Last year’s flu season, which ran from fall 2017 to spring 2018, was the worst the state has seen with 4,650 children and adults hospitalized for the respiratory illness. So far, this year’s flu season hasn’t been as harsh, partly because the strain being circulated — H1N1 — is less aggressive than the 2017-2018 virus, H3N2.
The report, released by Children’s Hospital this week, only looks at the charges that come from treating children for vaccine-preventable diseases at the hospital and emergency departments. It does not examine “actual costs,” which include doctor’s visits, medication, lost wages and decreased productivity.
Overall, about 29 percent of children between 19 and 35 months were under-immunized in the state in 2017, according to Children’s Hospital.
The report comes as Washington state is dealing with a measles outbreak, and last month a Denver resident was diagnosed with measles after traveling abroad. In Colorado, there were one to two cases of measles reported per year between 2013 and 2017,.
So let’s just get this out there: This is a story ostensibly about health insurance regulations — which normally wouldn’t send a tingle up many people’s spines. But really it’s a story about an ongoing, hidden battle camouflaged in hundreds of pages of regulatory documents.
Last summer, the Trump administration fired a shot at the Affordable Care Act with a new rule that will allow people to use short-term health plans for longer periods of time.
There’s a lot of backstory here, but, big-picture, this was widely seen as an attempt to weaken the ACA because short-term plans in many places don’t have to provide the level of coverage that ACA-compliant plans do and, thus, don’t cost as much. If people abandoned the ACA plans for cheaper short-term plans, the entire law — also known as Obamacare — could collapse.
Last month, though, Colorado’s insurance commissioner fought back against this rule, adopting a regulation that will make short-term plans here abide by almost all ACA requirements. That, in turn, means short-term plans will likely make little dent in Colorado’s insurance market.
It was guerilla warfare through rulemaking, a back-and-forth exchange of regulatory grenades. And it revealed an often-overlooked front in how states — mostly those led by Democrats — are using normally tedious legal processes to undermine Trump administration policies locally.
The Colorado Air Quality Control Commission’s decision last year on low-emission vehicles is one such example. So, too, was new Colorado Attorney General Phil Weiser’s announcement that he would withdraw the state’s legal objection to the Obama administration’s Clean Power Plan and would instead work to support it.
But the fight over short-term health plans provides a textbook example of how these battles are being fought.
The first shot
In August, after repeated, unsuccessful attempts to repeal the ACA, the Trump administration announced that it would allow people to use short-term health plans for up to a year — with the possibility of renewing those plans for up to three years. Previously, short-term plans had been just that, brief plans that got people between spells of regular coverage.
In the world of Democratic health policy, this rule was a mortar blast.
The ACA rests on the premise that insurers should have to provide a certain level of coverage. It requires insurers to sell plans to anyone. It prohibits insurers from charging people more money based on their health history. It dictates a list of medical services — like maternity care — that insurers have to cover.
Short-term plans, though, operated in Colorado and many other places like all insurance did prior to the ACA. Short-term plans could refuse to cover services that ACA plans must cover. They could deny all coverage to people based on pre-existing conditions.
The case for short-term plans
To conservatives, the ACA imposes regulations that provide people more coverage than they may need and that drive up the costs for everybody. Short-term plans, then, are more flexible and allow people to choose insurance that meets their needs and budget. According to an analysis by the nonpartisan Kaiser Family Foundation, short-term plans can have premiums that are more than 50 percent cheaper than ACA-compliant plans.
“President Trump is bringing more affordable insurance options back to the market,” U.S. Health and Human Services Secretary Alex Azar said in a statement announcing the new rule. “…These plans aren’t for everyone, but they can provide a much more affordable option for millions of the forgotten men and women left out by the current system.”
Returned fire
But, sitting in his Denver office, Colorado Insurance Commissioner Michael Conway saw these plans as junk that would fall apart on people as soon as they needed to use them.
“We can’t drive the affordability conversation by telling people we’re going to give them garbage coverage,” Conway — who was originally appointed by Gov. John Hickenlooper and was just re-appointed to his spot by Gov. Jared Polis — said in a recent interview.
Michael Conway (Courtesy of the Colorado Division of Insurance)
Colorado already limited short-term plans under state law. For instance, people here can only be on a short-term plan for up to six months, with the option for a single renewal taking them up to a year of short-term coverage. The Trump administration’s rule didn’t change that.
But Conway saw an opportunity to further strengthen the rules for short-term plans.
The state’s response
Back in 2013, Colorado lawmakers aligned state law with the ACA — meaning that, even if the ACA were repealed, insurers here would still have to provide the same level of protections for their regular plans. Under the regulation adopted last month, Conway said short-term plans are “health benefit plans,” the same as insurers’ regular plans and subject to almost all the same rules.
This was the return salvo.
When the new rule officially goes into effect in April, insurance companies will have to file new information about their short-term plans with the state and comply with the same requirements limiting their profits and administrative expenses. They will have to cover all the things ACA-compliant plans have to cover. They can’t charge people more or less based on how healthy they are.
“I think that’s the base level of coverage that people need,” Conway said.
The only major difference is that, while insurance companies have to sell short-term plans to anybody who wants them, they can still exclude coverage for pre-existing conditions. (That provision for short-term plans is specifically written into state law.)
The wonky war
To conservatives, the new state rule restricts the choice that the Trump administration was trying to create.
“Don’t make assumptions on what people need or what they want,” said Jesse Mallory, the Colorado state director of Americans for Prosperity. “Allow consumers to make these choices.”
But left-leaning health policy groups praised the rule, with Debra Judy, the policy director at the Colorado Consumer Health Initiative, saying in a statement, “We are happy to see that these plans will now provide coverage beyond the catastrophic.”
The insurance commissioner, meanwhile, downplayed the idea that this was part of an overall effort to fight back against Trump administration rules.
“When we see these things coming down from the federal level,” Conway said, “we just want to say, ‘We’re going to think this through and see if it makes sense.’”
But AFP’s Mallory said he has little doubt that state regulators will continue the wonky war against Trump priorities.
“I don’t think this will be the last thing we see,” he said.
On a mild January morning in Lafayette, Colorado, 22 residents and five dogs gathered for a walk along the Coal Creek Trail. Bundled in puffy coats and fleece hats, they explored the great outdoors, taking in views of snow-covered Longs Peak.
Two thousand miles away, in Naples, Florida, a cluster of walkers put in laps on the fitness trail around Lake Avalon. Meanwhile, outside the New Brunswick train station in New Jersey, dozens of people huddled together before setting off on the Delaware and Raritan Canal State Park Trail.
St. Louis; Chicago; Cleveland; Tacoma, Wash. — similar walks took place in 20 cities across America that day. The events were organized by EverWalk, a movement to get Americans out and about – on foot.
EverWalk is the brainchild of endurance athlete Diana Nyad, who swam from Cuba to Florida at age 64, and her trainer, Bonnie Stoll.
The two friends are determined to transform a nation of couch potatoes and screen addicts into those who walk everywhere: with a dog, with kids to school, with neighbors after dinner, with a list of errands around town, with colleagues during business meetings.
The social walks on the first Saturday of each month are part of EverWalk’s Ambassador Club, led by people committed to building a walking community in their region. Set on a loop or an out-and-back course, walkers can begin with one or two miles and work their way up to 10.
Walking groups help adults reduce body fat and lower blood pressure, and can improve mood, according to a meta-study in the British Journal of Sports Medicine.
Social walking also provides accountability. Ninety-five percent of those who worked out with a group completed a weight-loss program compared with 76 percent who exercised alone, one study showed. Plus, it offers camaraderie.
“You have wonderful conversations with people you’d never meet otherwise,” EverWalker Denise Onuskanich says.
Yet walking offers more than just health perks. “It’s unbelievably beautiful, this planet,” Nyad says. “There’s an enlightenment and empowerment to walking it.”
And nearly everyone can do it.
Entrepreneur Susan Bateman, 62, assumed her days of physical activity were over. In 2008, she had back surgery. Two years later, she needed a hysterectomy to treat uterine cancer. “I thought: I’m getting older, my body’s slowing down.” But last year, she read Nyad’s memoir, “Find a Way,” and her mind-set shifted. She may never ski again, but she could get in shape by walking – and motivate others. Bateman now serves as EverWalk ambassador for the group in Lafayette, Louisiana.
Walking’s one downside? “It takes so darn much time,” Nyad admits.
“Start with 12 minutes,” Stoll suggests, a short walk. Keep up short walks during the week and save a long walk for Saturday.
Lawyer David Ascher, another EverWalk ambassador who also represents the FreeWalkers (a similar organization), says walking is a sport that can be taken up easily and that most people will notice a drastic improvement in a short amount of time.
“People say, ‘I can only walk two or three miles,’ but when you get out there and develop a routine, they find they can stretch themselves to five or 10 miles,” he says.
Ascher was an avid cyclist who became interested in long-distance walking after participating in the 50-Mile Kennedy Walk, an annual event that retraces then-U.S. Attorney General Robert F. Kennedy’s 1963 trek from Potomac, Maryland, to Harpers Ferry, West Virginia. The walk was inspired by Kennedy’s brother, President John F. Kennedy, who encouraged physical fitness. This year, it takes place Saturday.
Ascher challenged himself further in 2017 when he walked 134 miles over seven days from Boston to Cape Elizabeth, Maine, on one of EverWalk’s epic events, a city-to-city walk in a different place each year for those who want to attempt an extreme endurance event that doesn’t require as much intense training as a marathon or Ironman Triathlon.
Training is recommended, however; and EverWalk sends out a four-month training plan for the epic walks. EverWalk’s next one will follow a course from Philadelphia to Washington, D.C., from Aug. 26 to Sept. 1. EverWalk also hosts a service event once a year in Key West, Florida, that includes a 10-mile walk in the morning and work for Habitat for Humanity in the afternoon.
Ascher likes how walking is safer than cycling, easier on the knees than running and virtually hassle-free.
“I’m always sitting around in sneakers. If I want to go on a walk, 30 seconds later, I’m walking.”
To find out if there is a group in your city, check the Ambassador Map at everwalk.com; to create a new group in your area, email info@everwalk.com.
In an effort to drive down insurance premiums in the state, Colorado lawmakers will once again consider creating a program to help insurers cover their sickest — and therefore most expensive — patients.
Legislators introduced a bill Friday in the House to create a reinsurance program.
The legislation, if passed, would create a state fund to help insurance companies cover high-cost claims. By controlling costs for insurers, lawmakers hope to lower premiums for everyone buying health insurance on the individual market by as much as 35 percent.
“I know of families in my community who are priced out of the individual insurance market place,” said Rep. Julie McCluskie, a Democrat sponsoring the bill. “The premiums are so high that they are scrambling to try to find other alternatives to make sure they have the coverage they need for good health.”
The bill will be able to be repealed after five years — a provision added because lawmakers view reinsurance as a method to lower premiums while they tackle the “deeper needs in our health care system,” she said.
A similar bill was presented last session, but failed to get through the Republican-controlled Senate amid concerns that a reinsurance program does not tackle the direct causes driving high premiums, said spokesman Sage Naumann.
It was among the initiatives Gov. Jared Polis called for during his campaign, including it in his 100-day plan.
How it would work
If the bill passes, it will create a state fund that will help insurers cover costs once a patient incurs a certain amount of health care claims. The threshold for when the program begins to pay out has not yet been determined.
Once it kicks in, the fund will contribute to a unknown percentage of the individual claims, with a cap on the amount of reimbursements it pays.
By the time the fund begins to help cover costs, a patient will have already reached their deductible and out-of-pocket maximum, meaning any expenses not covered by the program will fall on insurance companies.
If the bill passes, Coloradans could see monthly insurance premiums cut by 10 percent to 35 percent, depending on where they live, McCluskie said.
And they could see those reductions, she said, by the start of the next open enrollment period later this year.
How it would be funded
The state Division of Insurance is working on a study, which will be finished by the spring, that will provide better insight into how much the reinsurance program would cost.
But estimates place the cost between $270 million and $340 million, said Michael Conway, the state’s interim insurance commissioner.
The cost of the program will be shared by the state and federal government.
By lowering the cost consumers pay for premiums on the individual market, the federal government will not spend as much on subsidies. So if the bill passes, Colorado will request a waiver from the federal government to allow the state to shift those tax savings into the reinsurance program, Conway said.
The state’s share of the program cost would be an estimated $80 million to $130 million, he said.
The state would pay for its share via savings created by reducing the amount of reimbursements paid to hospitals and other health providers.
What it means for health care providers
Under the bill, hospitals and other providers would see the amount they are paid for health services slashed as the program will create a fee schedule — a list of prices that will be determined by the commissioner of insurance.
The fee schedule would be used once the reinsurance fund starts to contribute to individual claims.
With the fee schedule, hospitals will be paid at a lower rate than if an insurance company was solely responsible for costs. But the reimbursements will be higher than payments from government programs, such as Medicaid and Medicare, Conway said.
The rate the reinsurance fund would pay has not yet been determined.
The reinsurance bill is already drawing concern from the Colorado Hospital Association, which does not take official positions on bills until they are introduced.
“Without a question, there will be hospitals that will have to face tough decisions on how to bear these cuts,” including through layoffs or getting rid of services, said Katherine Mulready, senior vice president and chief strategy officer for the organization.
Anticipating the struggles some facilities might face under the program, lawmakers have included a provision in the bill to exclude primary care and behavioral health providers from reinsurance, McCluskie said.
“The commissioner of insurance would be charged to develop some sort of metric on how we protect those providers that might not be able to sustain their services under the reinsurance program,” she said.
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