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This document cheap catapres is unpublished. It is scheduled to be published on 09/18/2020. Once it is published it will be available on this page in an official form.

Until then, you can download the unpublished PDF cheap catapres version. Although we make a concerted effort to reproduce the original document in full on our Public Inspection pages, in some cases graphics may not be displayed, and non-substantive markup language may appear alongside substantive text. If you are using public inspection listings for legal research, you should verify the contents of documents against a final, official edition of the Federal Register.

Only official editions of the Federal Register provide legal notice to the public and judicial notice to the courts under 44 U.S.C cheap catapres. 1503 &. 1507.

Learn more here.Start Preamble cheap catapres Centers for Medicare &. Medicaid Services (CMS), HHS. Extension of timeline for publication of final rule.

This notice announces an extension of the timeline for publication of a Medicare final rule in accordance with the Social cheap catapres Security Act, which allows us to extend the timeline for publication of the final rule. As of August 26, 2020, the timeline for publication of the final rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021. Start Further Info Lisa O.

Wilson, (410) 786-8852 cheap catapres. End Further Info End Preamble Start Supplemental Information In the October 17, 2019 Federal Register (84 FR 55766), we published a proposed rule that addressed undue regulatory impact and burden of the physician self-referral law. The proposed rule was issued in conjunction with the Centers for Medicare &.

Medicaid Services' (CMS) Patients over Paperwork initiative and the Department of Health and Human Services' (the Department or HHS) cheap catapres Regulatory Sprint to Coordinated Care. In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician.

A new exception for donations of cybersecurity technology and related services cheap catapres. And amendments to the existing exception for electronic health records (EHR) items and services. The proposed rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by the physician self-referral statute and regulations.

This notice cheap catapres announces an extension of the timeline for publication of the final rule and the continuation of effectiveness of the proposed rule. Section 1871(a)(3)(A) of the Social Security Act (the Act) requires us to establish and publish a regular timeline for the publication of final regulations based on the previous publication of a proposed regulation. In accordance with section 1871(a)(3)(B) of the Act, the timeline may vary among different regulations based on differences in the complexity of the regulation, the number and scope of comments received, and other relevant factors, but may not be longer than 3 years except under exceptional circumstances.

In addition, in accordance with section 1871(a)(3)(B) of the cheap catapres Act, the Secretary may extend the initial targeted publication date of the final regulation if the Secretary, no later than the regulation's previously established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation. We announced in the Spring 2020 Unified Agenda (June 30, 2020, www.reginfo.gov) that we would issue the final rule in August 2020. However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date.

This notice cheap catapres extends the timeline for publication of the final rule until August 31, 2021. Start Signature Dated. August 24, 2020.

Wilma M cheap catapres. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature End Supplemental Information [FR Doc.

2020-18867 Filed 8-26-20 cheap catapres. 8:45 am]BILLING CODE 4120-01-PWelcome to this week's edition of Healthcare Career Insights. This weekly roundup highlights healthcare career-related articles culled from across the Web to help you learn what's next.Ericka L.

Adler, JD, cautions practices and physicians wanting to offer wellness services to make sure these services comply with state and federal laws -- Wellness services may pose compliance risk (Physicians Practice)Lisa Grabl is president of the locum tenens division of CompHealth, the nation's largest locum tenens physician staffing company and a leader in permanent and temporary allied healthcare staffing.

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Minnesota marketplace highlights and updatesOpen enrollment where to buy cheap catapres for 2021 health plans. November 1, 2020 where to buy cheap catapres through December 22, 2020. Residents with qualifying events can still enroll or make changes to their 2020 coverage.Insurers implementing modest rate increases for 2021, after three straight years of average rate decreases. Quartz has joined the exchange for 2021, bringing total number of insurers where to buy cheap catapres to five.117,520 people enrolled for 2020, a new record for MNsure.Insurer participation in MNsure.

2014 to 2021.Reinsurance program received federal approval, began operation in 2018.With reinsurance, rates decreased for 2018 and again, even more significantly, for 2019. But reinsurance also reduced funding for MinnesotaCare.The elimination of CSR funding further reduced MinnesotaCare funding, but this has been partly restored by a court ruling.MN provided premium relief for non-subsidy-eligible enrollees for 2017 only.Governor vetoed a proposed 2019 switch to HealthCare.gov.MNsure’s small business exchange no longer has any participating insurers.Minnesota health exchange overviewMinnesota’s one of the states fighting the hardest to preserve the Affordable Care Act’s where to buy cheap catapres gains. See actions Minnesota has taken.Minnesota’s state-run exchange, MNsure, has five participating insurers for 2021, up from four in 2020. The exchange has more than 117,000 individual market enrollees as of 2020.As a where to buy cheap catapres result of the COVID-19 pandemic, MNsure joined most of the other state-run exchanges in offering a special enrollment period during which people who were uninsured could enroll in a health plan.

MNsure’s special enrollment period began March 23, and continued through April 21. Nearly 9,500 Minnesota residents enrolled in private plans through MNsure during this window, as well as another 13,700 who enrolled in MinnesotaCare or Medicaid (enrollment in those programs is open year-round for eligible residents).Allison O’Toole, who led MNsure as CEO for three years, announced where to buy cheap catapres her resignation in March 2018, and the exchange named Nate Clark, the MNsure COO, as acting CEO. A few months later, the MNsure board named Clark as the permanent CEO. O’Toole left MNsure to work as director of state affairs for United States of Care, a non-profit created by Andy Slavitt, who was the acting administrator of CMS under the Obama Administration.Throughout 2017, Minnesotans who bought their own health insurance (on or off-exchange) and weren’t eligible for ACA subsidies were provided with 25 percent premium rebates where to buy cheap catapres from the state as a result of S.F.1, signed into law by Governor Dayton in early 2017.

The subsidies helped to offset the large premium increases that applied in Minnesota in 2017, and helped to stabilize the individual health insurance market in 2017. But the premium rebate program expired at the where to buy cheap catapres end of 2017.Thanks in large part to the new reinsurance program that Minnesota created (details below), premiums decreased in Minnesota’s individual market in 2018, 2019, and again in 2020, although rates are increasing modestly for 2021. In May 2019, Minnesota leaders reached an agreement on a budget that included an extension of the reinsurance program through 2020 and 2021 (it has already been granted federal approval through the end of 2022, but the state has to continue to cover its share of the cost. Minnesota Governor Tim Walz had hoped where to buy cheap catapres to implement a premium subsidy program and a new tax credit in Minnesota starting in 2020.

But a compromise in the budget ended up with the state opting to continue the existing reinsurance program for two more years instead.).But the waiver that provides federal pass-through funding for reinsurance also resulted in a sharp and unexpected decrease in federal funding for MinnesotaCare, the Basic Health Program that provides coverage for people with income between 138 percent and 200 percent of the poverty level (between $16,642 and $24,120 for a single person).In addition, the elimination of federal funding for cost-sharing reductions (CSR) in October 2018 resulted in a funding cut for MinnesotaCare, since the program is funded in large part by federal funds that would otherwise have been used to pay for premium subsidies and cost-sharing reductions in the exchange for the population that is instead eligible for MinnesotaCare. After an ensuing legal battle, a judge ordered HHS to restore funding for MinnesotaCare, although a resolution of the situation is ongoing, where to buy cheap catapres and the amount that HHS agreed to pay was still less than MinnesotaCare would have received if CSR funding had continued.Open enrollment for 2021 health plans extended through December 22, 2020. Insurers implementing modest rate increases for 2021, after three years of overall rate decreasesMNsure enabled window shopping for 2021 health plans as of October 12, 2020. This gives residents a few weeks to browse the available plans before open enrollment starts on November 1, where to buy cheap catapres 2020.

And MNsure has announced that open enrollment will continue through December 22, 2020. That’s a week where to buy cheap catapres longer than the open enrollment period that will apply in states that use the federally-run exchange. The flexibility to extend open enrollment is often cited as one of the benefits of having a fully state-run exchange. (MNsure had a similar extension last December, for 2020 health plans).For where to buy cheap catapres 2021, Quartz is joining the Minnesota marketplace.

Quartz currently offers plans in Illinois and Wisconsin, and is expanding into Minnesota for 2021. And two of the existing insurers — HealthPartners and UCare — are expanding their coverage areas for 2021 (BluePlus and Medica offer coverage statewide, and will continue to do where to buy cheap catapres so in 2021).The following average rate changes have been approved for MNsure’s insurers:Blue Plus. 4.21 percent increase (down from an initially proposed 7.12 where to buy cheap catapres percent increase)Group Health/Health Partners (GHI). 0.67 percent increase (down from an initially proposed 4.15 percent increase)Medica.

2.42 percent where to buy cheap catapres increase (down from an initially proposed 7.06 percent increase)UCare. 1.6 percent increase (up from an initially proposed 1.39 percent decrease)Quartz. New for 2021, so no applicable where to buy cheap catapres rate changePreferredOne Insurance Company, which offers plans outside the exchange, is increasing premiums by 1.05 percent (down from an initially proposed average increase of 5.09 percent). Rate changes in previous years2015.

Average increase of where to buy cheap catapres 4.5 percent. MNsure critics characterized the official announcement as misleading as it failed to take into account low-cost 2014 plans from PreferredOne. Consumers who bought a PreferredOne plan through MNsure for where to buy cheap catapres 2014 could only renew their policies for 2015 by working directly with the insurer, since PreferredOne stopped offering plans in the exchange at the end of 2014. However, PreferredOne rates went up an average of 63 percent, and consumers didn’t qualify for subsidies if they shopped outside the exchange.

2016. Average increase of 41.4 percent for the individual market, and about 38.5 for plans sold in MNsure (ie, not counting PreferredOne). Rates increased significantly in 2016 across the entire individual market in Minnesota — including plans sold through MNsure, the state-run exchange.Approved rates for 2016 were announced on October 1, 2015, ranging from about 15 percent for Medica to 49 percent for Blue Cross Blue Shield of Minnesota. In general, the carriers cited higher-than-expected claims costs over the past year, along with the impending phase-out of the ACA’s reinsurance program as justification for their 2016 rate requests.

But Governor Mark Dayton called some of the higher proposed increases “outrageous,” and promised a rigorous review of the filed rate changes and justifications. Ultimately, regulators were able to limit the highest rate increases to 49 percent — as opposed to the 54 percent that had been requested by Blue Plus and BCBS of MN — but the final weighted average rate increase in the individual market in Minnesota still ended up being the highest in the nation. But Minnesota still had the lowest overall premiums in the upper midwest (although Minnesota had the highest average rate increase in the country for 2016, they had the lowest overall rates in the country in 2014 and 2015).Minnesota Commerce Commissioner Mike Rothman called the rate increases “unacceptably high,” and Gov. Dayton noted that he was “extremely unhappy” with the rate changes.

But Rothman noted that his office “objected to all of the rates across the board,” and “squeezed out everything we could that was not actuarial justified.” In other words, the final rates, although much higher than officials and policyholders would have liked, were justified based on medical claims costs — the population enrolled in individual health plans in Minnesota was sicker than expected, and drug costs had been particularly onerous.Only about 55 percent of people who had 2015 coverage through MNsure received premium subsidies. But due to the sharp premium increases, that had increased to about 63 percent for the people who had purchased or renewed coverage as of June 2016.2017. When the Minnesota Department of Commerce announced health insurance rates for 2017 for the individual and small group markets, the rate hikes were somewhat reasonable in the small group market (ranging from a decrease of 1 percent to an increase of 17.8 percent), but the individual market was “experiencing serious disruptions in 2017” and “on the verge of collapse.” The four carriers that offered plans through MNsure had the following average rate increases in 2017:Blue Plus = 55 percentHealthPartners/Group Health (GHI) = 50 percent (HealthPartners is only offering plans in 10 of the 67 counties where they offered plans in 2016. Their enrollment cap is 72,000 for 2017)Medica = 57.5 percent (enrollment cap is 50,000 for 2017)UCare = 66.8 percent (UCare capped enrollment at 30,000 for 2017, but only had 16,000 enrollees in 2016)The enrollment caps that HealthPartners, Medica, and UCare employed for 2017 were approved as part of the rate review process, and are designed to protect carriers from further financial losses as they absorb BCBSMN’s enrollees who are shopping for new coverage during open enrollment.In a news release relating to the rate announcement for 2017, the Minnesota Department of Commerce didn’t mince words.

They noted that the individual market in the state was on the brink of collapse, and that they did everything in their power to save the market. While they succeeded in keeping the state’s individual market viable for 2017, with only one carrier exiting (BCBSMN, although their HMO affiliate, Blue Plus, remained in the exchange), they reiterated very clearly that substantial reforms would be needed to keep the market stable in future years, and highlighted the fact that rates would be sharply higher and that carriers would limit enrollment in 2017.2018. Final rates for 2018 were approved in October 2017 (comprehensive information about the approved rates is here), based on the Minnesota Premium Security Plan (MSPS) being implemented but cost-sharing reductions (CSR) not being funded by the federal government (the cost of CSRs was added to on-exchange Silver plans). Average approved rate changes for MNsure insurers ranged from a 13.3 percent decrease for UCare to a 2.8 percent increase for Blue Plus.

Three of the four MNsure insurers decreased their average premiums for 2018.On September 21, MNsure had posted a notice indicating that if the reinsurance program were not approved, rates would be about 20 percent higher than they would otherwise be in 2018. Fortunately for Minnesota residents, the reinsurance program did receive federal approval, and average rates declined slightly for 2018.But some enrollees who don’t get ACA premium subsidies still experienced a rate increase, due to the termination of the one-year, state-funded 25 percent premium rebates at the end of 2017.PreferredOne, which exited MNsure at the end of 2014 and only offers coverage in the off-exchange market, proposed dramatically lower rates for 2018. A 38 percent average decrease if MSPS were to be approved, and a 23 percent average decrease if not. The 38 percent decrease was implemented, and no adjustments were necessary to account for CSR funding, since PreferredOne does not offer plans in the exchange, and CSRs are only available on silver exchange plans.2019.

Average premium decrease of 12.4 percent. Average premiums dropped for all five insurers in the individual market in 2019. This was the second year in a row of declining rates in Minnesota, but Blue Plus had a small rate increase for 2018, so 2019 was the first year that all five insurers decreased their average rates. Minnesota insurance regulators noted that rates in 2019 were about 20 percent lower than they would have been without the reinsurance program.But most of Minnesota’s insurers charged higher rates in 2019 than they would have if the individual mandate penalty hadn’t been eliminated, and if access to short-term plans and association health plans hadn’t been expanded by the Trump administration.

For example, UCare’s rate filing notes that while average rates were decreasing by about 10 percent, the rate decrease would have been nearly 15 percent if the individual mandate penalty had remained in place.At ACA Signups, Charles Gaba calculated a weighted average rate decrease of 12.4 percent for 2019 in Minnesota, but noted that the average decrease would have been nearly 19 percent without those changes at the federal level.2020. Average premium decrease of 1 percent. Four of the five insurers (including PreferredOne, which only offers coverage off-exchange) in Minnesota’s individual market decreased their average premiums for 2020. This was the third year in a row that average individual market premiums dropped in Minnesota’s individual market, due in large part to the reinsurance program that the state has established.The following average rate changes were implemented for 2020:Blue Plus.

1.5 percent decrease (Blue Plus had originally proposed a 4.8 percent increase)Group Health/Health Partners (GHI). 1.26 percent decrease (GHI had originally proposed a 2.1 percent increase)Medica. 1.01 percent decrease (Medica had originally proposed an average decrease of 1.4 percent)UCare. 0.18 percent increase (UCare originally proposed a 0.3 percent increase)PreferredOne, which only offers off-exchange coverage, reduced their rates by an average of 20 percent, on the heels of an 11 percent decrease in 2019.

MNsure enrollment exceeded 116k in 2018, dropped to 113k for 2019, but grew to more than 1117k in 2020From 2014 through 2018, enrollment in MNsure’s individual market plans increased every year, reaching 116,358 people by 2018. That was the highest open enrollment total in MNsure’s history, despite the shorter enrollment period, which ended in mid-January instead of the end of January (open enrollment for 2018 coverage ended on December 15, 2017 in states that use HealthCare.gov, but MNsure opted to extend their enrollment window that year, and have also extended subsequent enrollment windows).Enrollment dropped for the first time in 2019, when 113,552 people enrolled in individual market plans through MNsure. In most states that use HealthCare.gov, enrollment peaked in 2016 and has been dropping since then. But MNsure’s drop-off in 2019, which amounted to only a 2.4 percent reduction in enrollment, is the only time year-over-year enrollment has declined.

Notably, the ACA’s individual mandate penalty was eliminated as of 2019, and regulations that the Trump administration implemented in late 2018 now make it more feasible for healthy people to use short-term plans instead of ACA-compliant plans (Minnesota has its own rules for short-term plans, but they’re more relaxed than the Obama-era federal rules that applied in 2017 and most of 2018).And for 2020, enrollment grew again, reaching a record high of 117,520 enrollees.Here’s a look at the number of people who have signed up for individual market plans through MNsure during each year’s open enrollment period. These numbers all represent total enrollment at the end of open enrollment. Effectuated enrollment is always lower, and MNsure provides periodic effectuated enrollment data on their board meeting materials page. Insurer participation in MNsure.

2014-20212014. Five insurers offered individual policies through MNsure for 2014. Blue Cross Blue Shield of Minnesota, HealthPartners/Group Health, Medica, PreferredOne, and UCare. Kaiser Health News reported that Minnesota offered some of the lowest premiums for silver (mid-level) plans in the U.S.

Four of Minnesota’s nine regions made Kaiser’s list of the 10 least expensive places to buy health insurance.2015. But PreferredOne, which offered the lowest rates in the nation in 2014 and captured a large portion of 2014 enrollees, withdrew from MNsure for 2015. PreferredOne said remaining on the exchange was “not administratively and financially sustainable.” A Star Tribune business writer attributed PreferredOne’s departure as a market dynamics issue rather than a problem with MNsure.However, Blue Plus (an affiliate of Blue Cross Blue Shield of MN, offering HMO plans) joined the exchange for 2015, so there were still five insurers offering plans for 2015. Blue Cross Blue Shield of Minnesota, Blue Plus, Health Partners/Group Health, Medica, and UCare.

MNsure offered 84 plans statewide, up from 78 for 2014.2016. BCBSMN, Blue Plus, Health Partners/Group Health, Medica, and UCare offered individual market plans through MNsure for 2016.2017. In an effort to recruit more carriers to offer plans through MNsure for 2017 — particularly outside the Twin Cities metro area — state regulators sent out a request for proposals from health insurers on August 15, 2016. Regulators noted that insurers could propose waivers of regulations in order to make it feasible for them to offer coverage through MNsure, although any such waiver requests would have to be approved by regulators.Steven Parente, a health insurance expert at the University of Minnesota, called the state’s effort to recruit insurers to MNsure a “distress call” and noted that August 15 is awfully late in the year to be putting out a request for insurer participation, given that open enrollment begins November 1.

And ultimately, no new insurers opted to join MNsure for 2017.Blue Cross Blue Shield of MN dropped their individual market PPO plans at the end of 2016 due to significant financial losses. That left Blue Plus (which offered HMOs and covered roughly 13,000 people in 2016 in the individual market) as the only BCBSMN affiliate in the exchange. Roughly 103,000 people had to select new plans during open enrollment.Most of those BCBSMN enrollees had off-exchange coverage, though. There were only about 20,400 MNsure enrollees (a little more than one in five MNsure enrollees) with coverage under BCBSMN who needed to switch to another plan during open enrollment.

BCBSMN had individual PPO options available in all 87 counties in Minnesota through MNsure in 2016, while the Blue Plus coverage area — comprised of four separate HMO networks — was available in 77 of the state’s counties.Nationwide, carriers have been shifting away from PPOs and towards HMOs and EPOs. In Colorado, Anthem Blue Cross Blue Shield also dropped their PPOs at the end of 2016. In Indiana, there were no PPOs available in the individual market by 2017. Blue Cross Blue Shield of New Mexico dropped all of their individual market plans at the end of 2015 except one off-exchange HMO.

Blue Cross Blue Shield of Texas dropped their individual market PPO plans at the end of 2015.The broad network offered by PPOs tends to be attractive to enrollees who have health problems. They’re often willing to pay higher premiums in trade for access to broad network of hospitals and specialists. But PPOs are expensive for carriers, as enrollees don’t need primary care referrals to see specialists, and it’s more challenging for carriers to hold down costs when there are more providers in the network.All of the MNsure carriers except Blue Plus are also limiting their total enrollment for 2017. By November 11, 2016, less than two weeks into open enrollment for 2017 coverage, Medica had hit their 50,000 member enrollment cap for 2017 (including on and off-exchange enrollments, and also accounting for expected renewals of 2016 Medica plans), and their policies were no longer available in the individual market in Minnesota, on or off-exchange.

The only exception was five counties (Benton, Crow Wing, Mille Lacs, Morrison, and Stearns) where Medica agreed not to limit enrollment, as all of the other available carriers in those counties have imposed enrollment caps too. In those five counties, Medica plans continued to be available.At that point, Medica’s market share in MNsure for 2017 stood at 34.2 percent. By December 14, Medica’s market share had dropped to 27.7 percent, as enrollments had continued to climb for the remaining carriers.On January 31, Medica re-opened enrollment for 2017. This was because a smaller-than-expected number of 2016 Medica enrollees renewed their plans for 2017, meaning that the carrier still had some wiggle room under their 50,000 member cap.

At that point, they had room for about 7,000 more enrollees. Medica plans were thus available throughout the duration of the special enrollment period that was added on at the end of open enrollment, and continue to be available for people with qualifying events.2018. Plans continued to be available from Blue Plus, Health Partners/Group Health (GHI), Medica, UCare. In the months before a decision was reached regarding an extension of the open enrollment window for 2018 plans (the first year that the federal government imposed a shorter, month-and-a-half enrollment window), two of MNsure’s participating insurers had differing positions.

UCare believed the exchange should add an additional two-week special enrollment period, while Medica did not want the exchange to have the option to extend the newly-scheduled six-week enrollment window. Notably, Medica capped their enrollment very early during the 2017 open enrollment period, and while UCare also had an enrollment cap, it was set with a target of nearly doubling their 2016 enrollment. But Medica is the only MNsure insurer that didn’t set an enrollment cap for 2018.As was the case for 2017, enrollment caps were used in the individual market in Minnesota for 2018 by all insurers other than Medica (Medica did have an enrollment cap for 2017, which they hit very early in open enrollment. However, they resumed enrollments at the end of January 2017).

Details about the insurers’ enrollment caps are in the plan binders in SERFF. For 2018, MNsure insurers implemented the following enrollment caps:Blue Plus. 55,000 member cap (aiming for a target of 50,000 effectuated enrollees, but effectuated enrollment is always lower than the number of people who initially enroll)Health Partners/Group Health (GHI). 73,400 member cap (aiming for a target of 70,000 effectuated enrollees)Medica.

No enrollment capUCare. 35,000 member cap (aiming for a target of 30,000 effectuated enrollees)MNsure confirmed in May 2018 that none of their insurers had hit their enrollment caps for 2018.Outside the exchange, PreferredOne had an enrollment cap of 3,000 members, although their 2017 membership was only about 300 people.2019 and 2020. Blue Plus, Health Partners/Group Health, UCare, and Medica have continued to offer plans through MNsure, and all of them continued to participate in 2020 as well. Blue Plus expanded to once again offer statewide coverage in 2020, for the first time since 2016.2021.

Quartz joined the exchange for 2021, joining the four existing insurers. HealthPartners and UCare are both expanding their coverage areas for 2021.Minnesota Premium Security Plan. 1332 waiver proposal approved by CMS, but with a significant funding cut for MinnesotaCareIn May 2017, Minnesota Governor Mark Dayton submitted a 1332 waiver proposal to CMS. The 1332 waiver was based on H.F.5, which was enacted without Dayton’s signature in April 2017 (Dayton had proposed an alternative measure that would have allowed people in Minnesota to buy into MinnesotaCare.

That measure was not able to pass the state’s Republican-dominated legislature).[For more than two decades, MinnesotaCare was a state program subsidizing health insurance for low-income residents. As of January 1, 2015, it transitioned to a Basic Health Program under the ACA, becoming the first BHP in the nation.]H.F.5 created the Minnesota Premium Security Plan (MPSP), which is a state-based reinsurance program (similar to the one the ACA implemented on a temporary basis through 2016, and that Alaska created for 2017. Several other states have since implemented reinsurance programs). The reinsurance program, which took effect in Minnesota in 2018, covers a portion of the claims that insurers face, resulting in lower total claims costs for the insurers, and thus lower premiums (average individual market premiums in Minnesota decreased from 2017 to 2018 as a result of the reinsurance program).

The reinsurance kicks in once claims reach $50,000, and covers them at 80 percent up to $250,000 (this is similar to the coverage under the transitional reinsurance program that the ACA provided from 2014 through 2016).H.F.5 was contingent upon approval of the 1332 waiver, because it relies partially on federal funding, in addition to state funding. Under the federal approval that was granted in September 2017, the federal government is giving Minnesota the money that they save on premium tax credits, and that money is combined with state funds to implement the reinsurance program (lower premiums — as a result of the reinsurance program — result in the federal government having to pay a smaller total amount of premium tax credits, since the tax credits are smaller when premiums are smaller).It was expected that CMS would approve the state’s 1332 waiver proposal, and Governor Dayton requested that the approval process be swift so that the state could move forward with the implementation of the Minnesota Premium Security Plan in time for the 2018 plan year. Dayton indicated that his office had been told that approval would come in August 2017, but CMS didn’t approve the waiver until September 22. And the waiver approval letter noted that the federal savings for MinnesotaCare (the state’s Basic Health Program, or BHP) resulting from the reinsurance program would not be eligible to be passed along to the state — in other words, CMS would keep those savings instead.[Federal BHP funding is equal to 95 percent of the amount that the federal government would have otherwise spent on premium subsidies and cost-sharing reductions for the population that ends up being eligible for the BHP.

So lower premiums — as a result of reinsurance — for qualified health plans in the exchange means that the amount the federal government would have had to spend on premium subsidies for that population is lower. That translates into a smaller amount of funding for the state’s BHP, according to the approach that HHS took for Minnesota’s waiver approval.]And based on the scathing letter that Dayton sent CMS a few days earlier, it appeared at that point that Minnesota could actually lose money on the deal — losing more in federal funding for MinnesotaCare than they gain in reinsurance funding. Dayton noted in his letter that the 1332 waiver approval process had been “nightmarish,” and that Minnesota went to great lengths to follow instructions from CMS at every turn, throughout the process of drafting H.F.5 and the 1332 waiver proposal. He explains that CMS provided Minnesota with explicit guidance in terms of how to draft the reinsurance program while maintaining full federal funding for MinnesotaCare, and highlighted the fact that the state never deviated from the instructions that were provided.The StarTribune editorial board called out then-Secretary of HHS, Tom Price and the Trump Administration for their lack of clarity on the issue, for apparently misleading the state during the 1332 waiver drafting process, and for effectively punishing the state of Minnesota for taking an innovative approach to ensuring that as many people as possible have health insurance.Insurers filed rates based on reinsurance being available.

And by the time the waiver was approved, there was very little time to evaluate the potential impacts of the funding changes, as rates had to be finalized by October 2 in Minnesota. The finalized rates did incorporate the reinsurance program. The state has accepted the approved waiver, but Gov. Dayton sent a letter to HHS on October 3, asking them to reconsider the MinnesotaCare funding cuts, but the issue has remained unresolved.Elimination of CSR funding results in additional funding cut for MinnesotaCare, but a lawsuit has partially restored that fundingNationwide, 54 percent of exchange enrollees benefit from cost-sharing subsidies.

But in Minnesota, only 13 percent of exchange enrollees are receiving cost-sharing subsidies. This is because of MinnesotaCare, which covers all enrollees with income up to 200 percent of the poverty level. That’s the same group that would otherwise benefit the most from cost-sharing subsidies, so the fact that MinnesotaCare is available means that most of the people who would otherwise be enrolled in cost-sharing subsidy plans are instead enrolled in MinnesotaCare.At first glance, this would appear to have made the uncertainty surrounding cost-sharing subsidy funding in 2017 a little less of a pressing issue in Minnesota than it was in many other states, since private insurers weren’t facing the sort of losses that insurers in other states were facing without federal funding for CSR. But when the Trump Administration eliminated federal funding for CSR in October 2017, HHS took the position tha t since CSR funding had been eliminated, the CSR portion of the federal funding for the BHPs in New York and Minnesota would be reduced to $0.

This was not a cut-and-dried conclusion, however, as explained earlier in 2017 by Michael Kalina.In January 2018, the Attorneys General for New York and Minnesota filed a lawsuit against the US Department of Health and Human Services, seeking to restore funding for their Basic Health Programs. A judge ruled in favor of the states in May 2018, ensuring that MinnesotaCare would continue to receive at least some CSR-based funding. The amount awarded to the state for the first quarter of 2018 was just over half of what the state had initially expected in CSR-related funding, but a larger chuck of the funding was restored later in 2018. According to the Star Tribune, however, Minnesota still ended up losing $161 million in federal funding for MinnesotaCare due to the CSR funding cuts.In early 2019, the Trump administration proposed yet another funding cut (a third, after the cuts imposed by the reinsurance program and the elimination of CSR funding) as part of a new methodology for calculating BHP funding.

This one was much smaller than the other two cuts, but taken together the funding reductions are pushing MinnesotaCare towards a looming budget shortfall. SHOP exchange. Down to one carrier as of 2016, zero by 2018 (and still zero in 2019)In 2015, there were two carriers in MNsure’s SHOP exchange for small businesses. Blue Cross Blue Shield of Minnesota, and Medica.

But Medica announced in 2015 that they would exit the SHOP exchange in Minnesota, North Dakota, and Wisconsin at the end of the year. That left BCBS as the only small group carrier available through MNsure in 2016, but it didn’t change much from a practical standpoint, since 83 percent of MNsure’s small groups were enrolled in plans through BCBS in 2015. Indeed, Medica’s reason for exiting the small business exchange was based on low enrollment in the first two years.Blue Cross Blue Shield of Minnesota continued to be the only insurer offering SHOP coverage via MNsure in 2017, but announced in July 2017 that they would no longer offer SHOP coverage in 2018, and would instead transition their SHOP enrollees to small business coverage outside the exchange. At that point, there were only 3,287 people enrolled in SHOP coverage in Minnesota — far below the 155,000 people that were originally projected to have coverage through MNsure’s SHOP program by 2016 (this much lower-than-anticipated enrollment has been the case in nearly every state’s SHOP exchange.

This situation is not unique to Minnesota). State law provided 25% premium rebate in 2017. Amendment to allow plans without essential benefits was cut from final legislationThroughout 2016, then-Governor Dayton called for a state-funded premium rebate for people who buy their own insurance but aren’t eligible for the ACA’s premium subsidies (those are only available for people with income up to 400 percent of the poverty level, or $100,400 for a family of four in 2019).Governor Dayton also noted that the government needed to act quickly to stabilize the individual market in Minnesota, and by late November 2016, his patience with lawmakers was wearing thin. In a November 23 press conference, Dayton said that House Republicans needed to “stop dilly-dallying” and decide whether to move forward with Dayton’s rebate proposal.Dayton had also indicated that he was considering calling a special session of the legislature after election day to address the situation, and that was being negotiated for December 20.

But the talks fell through when Dayton and Republican House Speaker Kurt Daudt couldn’t agree on the three bills that would have been addressed in the special session. As a result, there was no special session.Instead, the issue was taken up by lawmakers as soon as the 2017 legislative session began. On January 5, Minnesota Senators Michelle Benson (R, 31st District) and Gary Dahms (R, 16th District) introduced S.F.1. The bill called for using $300 million in state funding to provide a 25 percent rebate to roughly 125,000 people in Minnesota.S.F.1 passed the Minnesota Senate by a 35-31 vote on January 12.

Only one DFL Senator (Melisa Franzen, from Edina) voted with Republicans in favor of the legislation. It was then sent to the House, where an amendment was added that stripped out the requirement that health plans provide various mandated benefits (see “Journal of the Day” section “Top of page 154” in this version of the bill. Under the terms of the amendment, as long as a carrier offered at least one plan with all the mandated benefits, they would have been allowed to offer others without mandated benefits).The amended bill was sent back to the Senate on January 23. Differences between the bills that the two chambers passed had to be reconciled before being sent to Governor Dayton for his signature.

By that point, the amendment to allow less-robust plans to be sold had garnered national attention, and public outrage helped to push lawmakers away from the provision. S.F.1 had also called for $150 million to be appropriated for fiscal year 2018 (through June 30, 2019) from the state general fund to a state-based reinsurance program to stabilize the individual market (Alaska did something similar in 2016, preventing a market collapse), but that provision was also removed in the final version (Minnesota did ultimately set up a reinsurance program, effective in 2018, which has served to stabilize the market and reduce premiums).A Conference Committee in the Senate recommended that the House “recede from its amendments” and the Conference Committee report passed the Senate on a 47-19 vote. The House passed the bill a few hours later, 108-19. It was sent to Governor Dayton, who immediately signed it into law.

DFLers did have to compromise on one issue during the process. S.F.1 allows for-profit HMOs to begin operating in Minnesota’s individual market, which had long been limited to non-profit HMOs.Consumers were told to expect the premium rebates to show up by April 2017, but they were retroactively effective to January 2017. So a person who had been paying full price for a plan since January 2017 saw a substantial premium reduction on the April or May invoice. Going forward, for the remainder of the year, a 25 percent rebate applied each month.Since S.F.1 was signed into law with only a few days remaining in open enrollment (it ended January 31 that year), Governor Dayton and exchange officials were worried that there wouldn’t be enough time for people to learn about the rebate and apply for coverage before January 31.

In December, Dayton had asked HHS to allow MNsure to extend its enrollment deadline to February 28 (instead of January 31) in order to allow lawmakers more time to work out the details of a state-based premium rebate while still allowing people to enroll after the legislative process is complete.HHS denied the request for a blanket extension, but MNsure used their own authority on January 28 to grant a one-week special enrollment period (February 1 to February 8) due to exceptional circumstances. Although the state-based 25 percent premium rebate was available on or off the exchange, the one-week extension was only valid through MNsure. Health insurers did not have to accept off-exchange enrollments without a qualifying event after January 31.The 25 percent premium rebate program in Minnesota was only authorized for one year, so the rebates did not continue into 2018. And although almost 100,000 people received premium relief through the program in 2017, it ended up costing less than the legislature had allocated, and about $100 million was returned to the state’s budget at the end of 2017.Protecting Medicaid enrollees from estate liensIn every state, Medicaid is jointly funded by the state and the federal government.

Longstanding federal regulations, which predate the ACA, require states to “seek recovery of payments from the individual’s estate for nursing facility services, home and community-based services, and related hospital and prescription drug services” for any Medicaid enrollee over the age of 55. This applies essentially to long-term care services, but states also have the option to go after the individual’s estate to recover costs for other care that was provided by Medicaid after age 55.Prior to 2014, this wasn’t typically an issue, as Medicaid eligibility was generally restricted by asset tests or requirements that applicants be disabled or pregnant (although Minnesota did have much more generous Medicaid eligibility guidelines than most states prior to 2014). But as of 2014, in states that expanded Medicaid under the ACA, the only eligibility guideline is income. Applicants with income that doesn’t exceed 138 percent of the poverty level are directed to Medicaid, regardless of any assets they might have.When applicants use the health insurance exchange — MNsure in Minnesota — they’re automatically funneled into Medical Assistance (Medicaid) if their income is under 138 percent of the poverty level.

But what these enrollees didn’t know was that the state also had a program in place to put liens on estates for Medicaid-provided services for people age 55 and older.The combination of these systems caught numerous residents off guard. They were enrolled in Medical Assistance through MNsure based on their income, but were not aware that liens were being placed on their homes so that the state could recoup the costs upon their deaths.State Senator Tony Lourey (DFL, District 11) addressed the issue with language included in HF2749, the Omnibus supplemental budget bill, which was signed into law by Governor Dayton on June 1, 2016. The legislation limits estate recovery to just what’s required under federal Medicaid rules (ie, essentially, long-term care costs for people age 55 or older), and makes the provision retroactive to January 1, 2014.Early tech strugglesMNsure opened for business in the fall of 2013, but technological issues persisted well into 2015, despite numerous improvements throughout 2014. Given MNsure’s difficult launch, the state conducted a series of audits and reviews.

The first audit reviewed how MNsure spent state and federal money. Auditors concluded that the exchange has generally adequate internal controls and found no fraud or abuse. The review was conducted by the state Office of the Legislative Auditor, and the report was published in October 2014.Another audit, also conducted by the Office of the Legislative Auditor and released in November 2014, found that the MNsure system in some cases incorrectly determined who qualified for public health benefits. The errors occurred during the first open enrollment period, before a series of system fixes were implemented.

The audit did not quantify the total financial impact of the errors. The state Human Services commissioner said a consultant working on technical fixes to MNsure concluded that the eligibility functionality was working correctly as of June 2014.A third audit, a performance evaluation report released in February 2015, said “MNsure’s failures outweighed its achievements.” Among other criticisms, auditors said MNsure staff withheld information from the board of directors and state officials, the enrollment website was seriously flawed and launched without adequate testing, and the first-year enrollment target was unrealistically low.In April 2014, MNsure hired Deloitte Consulting to audit MNsure’s technology and improve the website to make enrolling in coverage and updating life events easier and more streamlined. Deloitte has been involved in successful state-run marketplaces for Connecticut, Kentucky, Rhode Island and Washington.Software upgrades were installed in August 2014, and system testing continued right up until the start of open enrollment. To reduce wait times for consumers and insurance professionals, MNsure increased its call center and support staff and launched a dedicated service line for agents and brokers.More in-person assisters were available in Minnesota for the 2015 open enrollment period.

MNsure encourages residents to utilize the exchange’s assister directory to find local navigators and brokers who can help with the enrollment process.MNsure has improved dramatically in terms of its technology since the early days of ACA implementation, and enrollment increased every year from 2014 through 2019.Lawmakers approved switching to HealthCare.gov as of 2019, but governor vetoedOn May 9, 2017, lawmakers in Minnesota passed SF800, an omnibus health and human services bill. Among many other things, the legislation called for switching from MNsure to the federally-run marketplace (HealthCare.gov) starting in 2019 (see Section 5). But Governor Dayton vetoed it.Gov. Dayton has long been supportive of MNsure, and had previously clarified that he would veto the bill.

In noting his plans to veto the legislation, Dayton made no mention of the transition to HealthCare.gov that was included in the legislation, but focused instead on the sharp budget cuts in the bill. But his veto ensured that MNsure would remain in place, at least for the time being.The Senate’s original version of SF800 did not call for scrapping MNsure, but the bill went through considerable back-and-forth between the two chambers, and the version that passed was the 4th engrossment of the bill.In March 2015, Dayton had asked the legislature to create a Task Force on Health Care Financing that would study MNsure along with possible future alternatives. Dayton noted in his letter that he supported making MNsure “directly accountable to the governor and subject to the same legislative oversight as other state agencies” and his budget included half a million dollars devoted to the task force. The spending bill was approved by the legislature in May, and the 29-member task force was appointed in the summer.One of the possibilities that the task force considered was the possibility of switching to Healthcare.gov, but it’s clear that there was no cut-and-dried answer to the question of whether Minnesota is better served by having a state-run exchange, switching to a federally-run exchange, or teaming up with the federal government on either a supported state-based marketplace or partnership exchange.In a December 2015 meeting of the task force, the MN Department of Human Services presented a financial analysis of the alternatives available to MNsure.

They determined that switching entirely to Healthcare.gov would cost the state an additional $5.1 million in one-time costs from June 2016 to June 2017. And switching to a supported state-based marketplace would cost an additional $6.6 million during that same time frame. If the state had opted to switch to Healthcare.gov, the soonest it could have happened was 2018, since HHS requires a year’s notice from states wishing to transition to Healthcare.gov, and Minnesota wouldn’t have been in a position to make a decision until sometime in 2016.There were significant reservations about making that switch prior to the Supreme Court’s ruling on King v. Burwell.

The Court ruled in June 2015 that subsidies are legal in every state, including those that use Healthcare.gov. Prior to the decision, a switch to Healthcare.gov could have jeopardized subsidies for tens of thousands of Minnesota residents. But once it was clear that Healthcare.gov’s subsidies are safe, some stakeholders began calling for Minnesota to scrap its state-run exchange and use Healthcare.gov instead. Because the MNsure task force was included in the 2016 budget, no hasty decisions were made.In January 2016, the task force submitted their recommendations to the legislature.

They covered a broad range of issues, but did not recommend that MNsure transition to the federal enrollment platform. Lawmakers essentially left the exchange alone during the 2016 legislative session.The magnitude of the 2016 rate increases that were announced in October resulted in MNsure opponents renewing their calls to switch to Healthcare.gov. But it’s important to keep in mind that the 41 percent weighted average rate hike in Minnesota was market-wide, and did not just apply to MNsure enrollees. In fact, the off-exchange carrier (PreferredOne) had among the highest rate hikes in the state for 2016, at 39 percent, and the exchange’s weighted average rate increase (38.5 percent) was lower than the weighted average rate increase for the whole individual market (41 percent).Minnesota health insurance exchange linksMNsure855-3MNSURE (855-366-7873)State Exchange Profile.

MinnesotaThe Henry J. Kaiser Family Foundation overview of Minnesota’s progress toward creating a state health insurance exchange.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Key takeaways Medicaid expansion in HawaiiHawaii adopted Medicaid expansion through the Affordable Care Act, extending eligibility for Medicaid to adults with income up to 133 percent of the poverty level (138 percent with the automatic 5 percent income disregard).

Medicaid expansion took effect in January 2014.According to the Kaiser Family Foundation, about 70,000 Hawaii residents were uninsured in 2015. With Medicaid expansion now covering low-income, nonelderly adults, 50 percent of Hawaii’s remaining uninsured population at that point was eligible for Medicaid – although they may not realize that they’re eligible. According to U.S. Census data, only 3.5 percent of Hawaii residents were uninsured as of 2016, down from 6.7 percent in 2013.

Although the state’s uninsured rate was reduced by nearly half from 2013 to 2016, it was already less than half of the national average uninsured rate even in 2013, before the bulk of the ACA’s provisions had taken effect. Hawaii’s Prepaid Health Care Act, which has been in place since the 1970s, had already resulted in nearly all of the state’s population having insurance coverage, even before the ACA took effect. However, with the coronavirus outbreak, job losses and the subsequent loss of employer-provided insurance have contributed to a jump in the uninsured rate across the U.S. As of May 2020, Hawaii’s uninsured rate was 10 percent.Medicaid expansion helped cement top-ranking health scores Federalpoverty levelcalculator 0.0% of Federal Poverty Level Hawaii has a long history of supporting initiatives to make health insurance broadly available to residents.

Hawaii was among the first six states that implemented a Medicaid program in January 1966, just six months after federal legislation authorizing the program was enacted. In 1974, Hawaii implemented its Prepaid Health Care Act, which mandated that most employers make health insurance available to employees who work at least 20 hours a week.In conjunction with the Affordable Care Act (ACA), Hawaii initially implemented a state-run health insurance marketplace and adopted Medicaid expansion. The marketplace transitioned to a federally-supported state-run marketplace for 2016, and transitioned again to a fully federally-run exchange for 2017, largely in an effort to take advantage of the economies of scale that the federally-run exchange could bring to a state with low overall enrollment in the individual market (because of Hawaii’s Prepaid Health Care Act, nearly all non-elderly Hawaii residents get coverage from an employer, and relatively few need coverage under individual market plans). Nothing changed about Medicaid with the switch to Healthcare.gov though.

The expanded Medicaid eligibility guidelines are still in effect in Hawaii.Through its efforts, Hawaii consistently has low uninsured rates and high overall health scores. As of 2015, Hawaii was ranked the healthiest state in the nation according to the Gallup Healthways Physical Wellbeing Index, and the state consistently scores near the top in other ranking systems (number 2 the America’s Health Rankings 2017 survey, and number 3 in the Commonwealth Fund’s 2017 Scorecard on State Health System Performance).Who is eligible for Medicaid in Hawaii?. Hawaii’s Medicaid eligibility levels for children are much higher than the national average and about average for pregnant women and parents.Children ages 0-18 qualify with family income levels up to 308 of the federal poverty level (FPL)Pregnant women qualify with family income up to 191 percent of FPLParents and other adults qualify with family income up to 138 percent of FPLHawaii also uses Medicaid funds to help cover premium costs for Hawaii residents who aren’t U.S. Citizens but who are citizens of nations that have entered into the Compact of Free Association (COFA) with the U.S.How do I enroll in Medicaid in Hawaii?.

Hawaii’s Medicaid program is called MED-QUEST (MQD). QUEST stands for Quality care, Universal access, Efficient utilization, Stabilizing costs, and Transforming the way health care is provided to recipients.You can apply for MED-QUEST. Hawaii Medicaid enrollment numbersMore than 351,000 people were enrolled in Hawaii’s Medicaid and CHIP programs as of June 2020. This figure is a 22% increase over 2013 (pre-ACA) enrollment, when about 288,000 people were enrolled.

Accordingly to the Kaiser Family Foundation, 107,300 of those enrolled in Hawaii Medicaid are part of the ACA-authorized expansion as of June 2019.Hawaii Medicaid historyHawaii implemented its Medicaid program in January 1966.In the early 1990s, Hawaii implemented the State Health Insurance Program (SHIP) to cover people who weren’t eligible for Medicaid. Then, in 1994, CMS approved Hawaii’s section 1115 Medicaid waiver (one of the first in the nation) to wrap SHIP in with Medicaid in an effort to achieve universal insurance coverage (in combination with the state’s Prepaid Health Care Act). The result of the waiver was the creation of Hawaii’s MED-QUEST program, which initially covered low-income women and children, but has since expanded (as of 2009) to cover nearly all of Hawaii’s Medicaid beneficiaries. The MED-QUEST waiver is subject to renewal every five years.Medicaid in Hawaii is separated into two different methods of providing services.

The fee-for-service (FFS) program and the managed care program, called MED-QUEST or MQD. Under the FFS program, doctors and other healthcare providers bill Medicaid directly to be reimbursed for services provided to Medicaid beneficiaries. Under MED-QUEST, the state contracts with managed care plans who in turn provide healthcare services to Medicaid beneficiaries.As of 2011, more than 98 percent of the people enrolled in Hawaii’s Medicaid program were covered through managed care. By March 2015, Kaiser Family Foundation reported that 335,007 Medicaid enrollees in Hawaii were covered under managed care programs.

That’s higher than the August 2015 total Medicaid/CHIP enrollment count, but KFF notes that the managed care number includes people who are covered under Hawaii’s fully-state-funded Medicaid program, in addition to the majority of enrollees who are in regular Medicaid that’s funded partially by the state and partially by the federal government.In August 2017, Hawaii submitted a waiver amendment to CMS in order to gain federal approval to use Medicaid funding to provide housing services to qualified Medicaid enrollees who are homeless and also have behavioral health and/or substance abuse problems. That waiver request was still pending as of February 2018.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

Minnesota marketplace highlights and updatesOpen enrollment for cheap catapres 2021 health plans. November 1, 2020 cheap catapres through December 22, 2020. Residents with qualifying events can still enroll or make changes to their 2020 coverage.Insurers implementing modest rate increases for 2021, after three straight years of average rate decreases.

Quartz has joined the exchange for 2021, bringing total number of insurers to five.117,520 people enrolled for 2020, a new record for MNsure.Insurer participation cheap catapres in MNsure. 2014 to 2021.Reinsurance program received federal approval, began operation in 2018.With reinsurance, rates decreased for 2018 and again, even more significantly, for 2019. But reinsurance also reduced funding for cheap catapres MinnesotaCare.The elimination of CSR funding further reduced MinnesotaCare funding, but this has been partly restored by a court ruling.MN provided premium relief for non-subsidy-eligible enrollees for 2017 only.Governor vetoed a proposed 2019 switch to HealthCare.gov.MNsure’s small business exchange no longer has any participating insurers.Minnesota health exchange overviewMinnesota’s one of the states fighting the hardest to preserve the Affordable Care Act’s gains.

See actions Minnesota has taken.Minnesota’s state-run exchange, MNsure, has five participating insurers for 2021, up from four in 2020. The exchange has more than 117,000 individual market enrollees as of 2020.As a result of the COVID-19 pandemic, MNsure joined most of the other state-run exchanges in offering a special enrollment period during which cheap catapres people who were uninsured could enroll in a health plan. MNsure’s special enrollment period began March 23, and continued through April 21.

Nearly 9,500 Minnesota residents enrolled in private plans through MNsure during this window, as well as another 13,700 who enrolled in MinnesotaCare or Medicaid (enrollment in those programs is open year-round for eligible residents).Allison O’Toole, who led MNsure as CEO for three years, announced her resignation in March 2018, cheap catapres and the exchange named Nate Clark, the MNsure COO, as acting CEO. A few months later, the MNsure board named Clark as the permanent CEO. O’Toole left MNsure to work as director of state affairs for United States of Care, a non-profit created by Andy Slavitt, who was the acting administrator of CMS under the Obama Administration.Throughout 2017, Minnesotans who bought their own health insurance (on or off-exchange) and weren’t eligible for ACA subsidies were provided with 25 percent premium rebates from the state as a result of S.F.1, signed into law by Governor Dayton cheap catapres in early 2017.

The subsidies helped to offset the large premium increases that applied in Minnesota in 2017, and helped to stabilize the individual health insurance market in 2017. But the premium rebate program expired at the end of 2017.Thanks in large part to the cheap catapres new reinsurance program that Minnesota created (details below), premiums decreased in Minnesota’s individual market in 2018, 2019, and again in 2020, although rates are increasing modestly for 2021. In May 2019, Minnesota leaders reached an agreement on a budget that included an extension of the reinsurance program through 2020 and 2021 (it has already been granted federal approval through the end of 2022, but the state has to continue to cover its share of the cost.

Minnesota Governor Tim Walz had hoped to implement a premium subsidy program and a new tax credit in Minnesota cheap catapres starting in 2020. But a compromise in the budget ended up with the state opting to continue the existing reinsurance program for two more years instead.).But the waiver that provides federal pass-through funding for reinsurance also resulted in a sharp and unexpected decrease in federal funding for MinnesotaCare, the Basic Health Program that provides coverage for people with income between 138 percent and 200 percent of the poverty level (between $16,642 and $24,120 for a single person).In addition, the elimination of federal funding for cost-sharing reductions (CSR) in October 2018 resulted in a funding cut for MinnesotaCare, since the program is funded in large part by federal funds that would otherwise have been used to pay for premium subsidies and cost-sharing reductions in the exchange for the population that is instead eligible for MinnesotaCare. After an ensuing legal battle, a judge ordered HHS to restore funding for MinnesotaCare, although a resolution of the situation is ongoing, and the amount that HHS agreed to pay was still less than MinnesotaCare would have received if CSR funding had continued.Open enrollment cheap catapres for 2021 health plans extended through December 22, 2020.

Insurers implementing modest rate increases for 2021, after three years of overall rate decreasesMNsure enabled window shopping for 2021 health plans as of October 12, 2020. This gives residents a few weeks to cheap catapres browse the available plans before open enrollment starts on November 1, 2020. And MNsure has announced that open enrollment will continue through December 22, 2020.

That’s a week longer than the open enrollment period that cheap catapres will apply in states that use the federally-run exchange. The flexibility to extend open enrollment is often cited as one of the benefits of having a fully state-run exchange. (MNsure had a similar cheap catapres extension last December, for 2020 health plans).For 2021, Quartz is joining the Minnesota marketplace.

Quartz currently offers plans in Illinois and Wisconsin, and is expanding into Minnesota for 2021. And two of the existing insurers — HealthPartners and UCare — are expanding their coverage areas for 2021 (BluePlus and Medica offer coverage statewide, and will continue to do so in 2021).The following average rate changes have been cheap catapres approved for MNsure’s insurers:Blue Plus. 4.21 percent increase cheap catapres (down from an initially proposed 7.12 percent increase)Group Health/Health Partners (GHI).

0.67 percent increase (down from an initially proposed 4.15 percent increase)Medica. 2.42 percent increase (down from an cheap catapres initially proposed 7.06 percent increase)UCare. 1.6 percent increase (up from an initially proposed 1.39 percent decrease)Quartz.

New for 2021, so no applicable rate changePreferredOne Insurance Company, which offers plans outside the exchange, is increasing premiums by cheap catapres 1.05 percent (down from an initially proposed average increase of 5.09 percent). Rate changes in previous years2015. Average increase cheap catapres of 4.5 percent.

MNsure critics characterized the official announcement as misleading as it failed to take into account low-cost 2014 plans from PreferredOne. Consumers who bought a PreferredOne plan through MNsure for 2014 could only renew their policies for 2015 by working directly with the insurer, since PreferredOne stopped offering plans in the exchange at the end cheap catapres of 2014. However, PreferredOne rates went up an average of 63 percent, and consumers didn’t qualify for subsidies if they shopped outside the exchange.

2016. Average increase of 41.4 percent for the individual market, and about 38.5 for plans sold in MNsure (ie, not counting PreferredOne). Rates increased significantly in 2016 across the entire individual market in Minnesota — including plans sold through MNsure, the state-run exchange.Approved rates for 2016 were announced on October 1, 2015, ranging from about 15 percent for Medica to 49 percent for Blue Cross Blue Shield of Minnesota.

In general, the carriers cited higher-than-expected claims costs over the past year, along with the impending phase-out of the ACA’s reinsurance program as justification for their 2016 rate requests. But Governor Mark Dayton called some of the higher proposed increases “outrageous,” and promised a rigorous review of the filed rate changes and justifications. Ultimately, regulators were able to limit the highest rate increases to 49 percent — as opposed to the 54 percent that had been requested by Blue Plus and BCBS of MN — but the final weighted average rate increase in the individual market in Minnesota still ended up being the highest in the nation.

But Minnesota still had the lowest overall premiums in the upper midwest (although Minnesota had the highest average rate increase in the country for 2016, they had the lowest overall rates in the country in 2014 and 2015).Minnesota Commerce Commissioner Mike Rothman called the rate increases “unacceptably high,” and Gov. Dayton noted that he was “extremely unhappy” with the rate changes. But Rothman noted that his office “objected to all of the rates across the board,” and “squeezed out everything we could that was not actuarial justified.” In other words, the final rates, although much higher than officials and policyholders would have liked, were justified based on medical claims costs — the population enrolled in individual health plans in Minnesota was sicker than expected, and drug costs had been particularly onerous.Only about 55 percent of people who had 2015 coverage through MNsure received premium subsidies.

But due to the sharp premium increases, that had increased to about 63 percent for the people who had purchased or renewed coverage as of June 2016.2017. When the Minnesota Department of Commerce announced health insurance rates for 2017 for the individual and small group markets, the rate hikes were somewhat reasonable in the small group market (ranging from a decrease of 1 percent to an increase of 17.8 percent), but the individual market was “experiencing serious disruptions in 2017” and “on the verge of collapse.” The four carriers that offered plans through MNsure had the following average rate increases in 2017:Blue Plus = 55 percentHealthPartners/Group Health (GHI) = 50 percent (HealthPartners is only offering plans in 10 of the 67 counties where they offered plans in 2016. Their enrollment cap is 72,000 for 2017)Medica = 57.5 percent (enrollment cap is 50,000 for 2017)UCare = 66.8 percent (UCare capped enrollment at 30,000 for 2017, but only had 16,000 enrollees in 2016)The enrollment caps that HealthPartners, Medica, and UCare employed for 2017 were approved as part of the rate review process, and are designed to protect carriers from further financial losses as they absorb BCBSMN’s enrollees who are shopping for new coverage during open enrollment.In a news release relating to the rate announcement for 2017, the Minnesota Department of Commerce didn’t mince words.

They noted that the individual market in the state was on the brink of collapse, and that they did everything in their power to save the market. While they succeeded in keeping the state’s individual market viable for 2017, with only one carrier exiting (BCBSMN, although their HMO affiliate, Blue Plus, remained in the exchange), they reiterated very clearly that substantial reforms would be needed to keep the market stable in future years, and highlighted the fact that rates would be sharply higher and that carriers would limit enrollment in 2017.2018. Final rates for 2018 were approved in October 2017 (comprehensive information about the approved rates is here), based on the Minnesota Premium Security Plan (MSPS) being implemented but cost-sharing reductions (CSR) not being funded by the federal government (the cost of CSRs was added to on-exchange Silver plans).

Average approved rate changes for MNsure insurers ranged from a 13.3 percent decrease for UCare to a 2.8 percent increase for Blue Plus. Three of the four MNsure insurers decreased their average premiums for 2018.On September 21, MNsure had posted a notice indicating that if the reinsurance program were not approved, rates would be about 20 percent higher than they would otherwise be in 2018. Fortunately for Minnesota residents, the reinsurance program did receive federal approval, and average rates declined slightly for 2018.But some enrollees who don’t get ACA premium subsidies still experienced a rate increase, due to the termination of the one-year, state-funded 25 percent premium rebates at the end of 2017.PreferredOne, which exited MNsure at the end of 2014 and only offers coverage in the off-exchange market, proposed dramatically lower rates for 2018.

A 38 percent average decrease if MSPS were to be approved, and a 23 percent average decrease if not. The 38 percent decrease was implemented, and no adjustments were necessary to account for CSR funding, since PreferredOne does not offer plans in the exchange, and CSRs are only available on silver exchange plans.2019. Average premium decrease of 12.4 percent.

Average premiums dropped for all five insurers in the individual market in 2019. This was the second year in a row of declining rates in Minnesota, but Blue Plus had a small rate increase for 2018, so 2019 was the first year that all five insurers decreased their average rates. Minnesota insurance regulators noted that rates in 2019 were about 20 percent lower than they would have been without the reinsurance program.But most of Minnesota’s insurers charged higher rates in 2019 than they would have if the individual mandate penalty hadn’t been eliminated, and if access to short-term plans and association health plans hadn’t been expanded by the Trump administration.

For example, UCare’s rate filing notes that while average rates were decreasing by about 10 percent, the rate decrease would have been nearly 15 percent if the individual mandate penalty had remained in place.At ACA Signups, Charles Gaba calculated a weighted average rate decrease of 12.4 percent for 2019 in Minnesota, but noted that the average decrease would have been nearly 19 percent without those changes at the federal level.2020. Average premium decrease of 1 percent. Four of the five insurers (including PreferredOne, which only offers coverage off-exchange) in Minnesota’s individual market decreased their average premiums for 2020.

This was the third year in a row that average individual market premiums dropped in Minnesota’s individual market, due in large part to the reinsurance program that the state has established.The following average rate changes were implemented for 2020:Blue Plus. 1.5 percent decrease (Blue Plus had originally proposed a 4.8 percent increase)Group Health/Health Partners (GHI). 1.26 percent decrease (GHI had originally proposed a 2.1 percent increase)Medica.

1.01 percent decrease (Medica had originally proposed an average decrease of 1.4 percent)UCare. 0.18 percent increase (UCare originally proposed a 0.3 percent increase)PreferredOne, which only offers off-exchange coverage, reduced their rates by an average of 20 percent, on the heels of an 11 percent decrease in 2019. MNsure enrollment exceeded 116k in 2018, dropped to 113k for 2019, but grew to more than 1117k in 2020From 2014 through 2018, enrollment in MNsure’s individual market plans increased every year, reaching 116,358 people by 2018.

That was the highest open enrollment total in MNsure’s history, despite the shorter enrollment period, which ended in mid-January instead of the end of January (open enrollment for 2018 coverage ended on December 15, 2017 in states that use HealthCare.gov, but MNsure opted to extend their enrollment window that year, and have also extended subsequent enrollment windows).Enrollment dropped for the first time in 2019, when 113,552 people enrolled in individual market plans through MNsure. In most states that use HealthCare.gov, enrollment peaked in 2016 and has been dropping since then. But MNsure’s drop-off in 2019, which amounted to only a 2.4 percent reduction in enrollment, is the only time year-over-year enrollment has declined.

Notably, the ACA’s individual mandate penalty was eliminated as of 2019, and regulations that the Trump administration implemented in late 2018 now make it more feasible for healthy people to use short-term plans instead of ACA-compliant plans (Minnesota has its own rules for short-term plans, but they’re more relaxed than the Obama-era federal rules that applied in 2017 and most of 2018).And for 2020, enrollment grew again, reaching a record high of 117,520 enrollees.Here’s a look at the number of people who have signed up for individual market plans through MNsure during each year’s open enrollment period. These numbers all represent total enrollment at the end of open enrollment. Effectuated enrollment is always lower, and MNsure provides periodic effectuated enrollment data on their board meeting materials page.

Insurer participation in MNsure. 2014-20212014. Five insurers offered individual policies through MNsure for 2014.

Blue Cross Blue Shield of Minnesota, HealthPartners/Group Health, Medica, PreferredOne, and UCare. Kaiser Health News reported that Minnesota offered some of the lowest premiums for silver (mid-level) plans in the U.S. Four of Minnesota’s nine regions made Kaiser’s list of the 10 least expensive places to buy health insurance.2015.

But PreferredOne, which offered the lowest rates in the nation in 2014 and captured a large portion of 2014 enrollees, withdrew from MNsure for 2015. PreferredOne said remaining on the exchange was “not administratively and financially sustainable.” A Star Tribune business writer attributed PreferredOne’s departure as a market dynamics issue rather than a problem with MNsure.However, Blue Plus (an affiliate of Blue Cross Blue Shield of MN, offering HMO plans) joined the exchange for 2015, so there were still five insurers offering plans for 2015. Blue Cross Blue Shield of Minnesota, Blue Plus, Health Partners/Group Health, Medica, and UCare.

MNsure offered 84 plans statewide, up from 78 for 2014.2016. BCBSMN, Blue Plus, Health Partners/Group Health, Medica, and UCare offered individual market plans through MNsure for 2016.2017. In an effort to recruit more carriers to offer plans through MNsure for 2017 — particularly outside the Twin Cities metro area — state regulators sent out a request for proposals from health insurers on August 15, 2016.

Regulators noted that insurers could propose waivers of regulations in order to make it feasible for them to offer coverage through MNsure, although any such waiver requests would have to be approved by regulators.Steven Parente, a health insurance expert at the University of Minnesota, called the state’s effort to recruit insurers to MNsure a “distress call” and noted that August 15 is awfully late in the year to be putting out a request for insurer participation, given that open enrollment begins November 1. And ultimately, no new insurers opted to join MNsure for 2017.Blue Cross Blue Shield of MN dropped their individual market PPO plans at the end of 2016 due to significant financial losses. That left Blue Plus (which offered HMOs and covered roughly 13,000 people in 2016 in the individual market) as the only BCBSMN affiliate in the exchange.

Roughly 103,000 people had to select new plans during open enrollment.Most of those BCBSMN enrollees had off-exchange coverage, though. There were only about 20,400 MNsure enrollees (a little more than one in five MNsure enrollees) with coverage under BCBSMN who needed to switch to another plan during open enrollment. BCBSMN had individual PPO options available in all 87 counties in Minnesota through MNsure in 2016, while the Blue Plus coverage area — comprised of four separate HMO networks — was available in 77 of the state’s counties.Nationwide, carriers have been shifting away from PPOs and towards HMOs and EPOs.

In Colorado, Anthem Blue Cross Blue Shield also dropped their PPOs at the end of 2016. In Indiana, there were no PPOs available in the individual market by 2017. Blue Cross Blue Shield of New Mexico dropped all of their individual market plans at the end of 2015 except one off-exchange HMO.

Blue Cross Blue Shield of Texas dropped their individual market PPO plans at the end of 2015.The broad network offered by PPOs tends to be attractive to enrollees who have health problems. They’re often willing to pay higher premiums in trade for access to broad network of hospitals and specialists. But PPOs are expensive for carriers, as enrollees don’t need primary care referrals to see specialists, and it’s more challenging for carriers to hold down costs when there are more providers in the network.All of the MNsure carriers except Blue Plus are also limiting their total enrollment for 2017.

By November 11, 2016, less than two weeks into open enrollment for 2017 coverage, Medica had hit their 50,000 member enrollment cap for 2017 (including on and off-exchange enrollments, and also accounting for expected renewals of 2016 Medica plans), and their policies were no longer available in the individual market in Minnesota, on or off-exchange. The only exception was five counties (Benton, Crow Wing, Mille Lacs, Morrison, and Stearns) where Medica agreed not to limit enrollment, as all of the other available carriers in those counties have imposed enrollment caps too. In those five counties, Medica plans continued to be available.At that point, Medica’s market share in MNsure for 2017 stood at 34.2 percent.

By December 14, Medica’s market share had dropped to 27.7 percent, as enrollments had continued to climb for the remaining carriers.On January 31, Medica re-opened enrollment for 2017. This was because a smaller-than-expected number of 2016 Medica enrollees renewed their plans for 2017, meaning that the carrier still had some wiggle room under their 50,000 member cap. At that point, they had room for about 7,000 more enrollees.

Medica plans were thus available throughout the duration of the special enrollment period that was added on at the end of open enrollment, and continue to be available for people with qualifying events.2018. Plans continued to be available from Blue Plus, Health Partners/Group Health (GHI), Medica, UCare. In the months before a decision was reached regarding an extension of the open enrollment window for 2018 plans (the first year that the federal government imposed a shorter, month-and-a-half enrollment window), two of MNsure’s participating insurers had differing positions.

UCare believed the exchange should add an additional two-week special enrollment period, while Medica did not want the exchange to have the option to extend the newly-scheduled six-week enrollment window. Notably, Medica capped their enrollment very early during the 2017 open enrollment period, and while UCare also had an enrollment cap, it was set with a target of nearly doubling their 2016 enrollment. But Medica is the only MNsure insurer that didn’t set an enrollment cap for 2018.As was the case for 2017, enrollment caps were used in the individual market in Minnesota for 2018 by all insurers other than Medica (Medica did have an enrollment cap for 2017, which they hit very early in open enrollment.

However, they resumed enrollments at the end of January 2017). Details about the insurers’ enrollment caps are in the plan binders in SERFF. For 2018, MNsure insurers implemented the following enrollment caps:Blue Plus.

55,000 member cap (aiming for a target of 50,000 effectuated enrollees, but effectuated enrollment is always lower than the number of people who initially enroll)Health Partners/Group Health (GHI). 73,400 member cap (aiming for a target of 70,000 effectuated enrollees)Medica. No enrollment capUCare.

35,000 member cap (aiming for a target of 30,000 effectuated enrollees)MNsure confirmed in May 2018 that none of their insurers had hit their enrollment caps for 2018.Outside the exchange, PreferredOne had an enrollment cap of 3,000 members, although their 2017 membership was only about 300 people.2019 and 2020. Blue Plus, Health Partners/Group Health, UCare, and Medica have continued to offer plans through MNsure, and all of them continued to participate in 2020 as well. Blue Plus expanded to once again offer statewide coverage in 2020, for the first time since 2016.2021.

Quartz joined the exchange for 2021, joining the four existing insurers. HealthPartners and UCare are both expanding their coverage areas for 2021.Minnesota Premium Security Plan. 1332 waiver proposal approved by CMS, but with a significant funding cut for MinnesotaCareIn May 2017, Minnesota Governor Mark Dayton submitted a 1332 waiver proposal to CMS.

The 1332 waiver was based on H.F.5, which was enacted without Dayton’s signature in April 2017 (Dayton had proposed an alternative measure that would have allowed people in Minnesota to buy into MinnesotaCare. That measure was not able to pass the state’s Republican-dominated legislature).[For more than two decades, MinnesotaCare was a state program subsidizing health insurance for low-income residents. As of January 1, 2015, it transitioned to a Basic Health Program under the ACA, becoming the first BHP in the nation.]H.F.5 created the Minnesota Premium Security Plan (MPSP), which is a state-based reinsurance program (similar to the one the ACA implemented on a temporary basis through 2016, and that Alaska created for 2017.

Several other states have since implemented reinsurance programs). The reinsurance program, which took effect in Minnesota in 2018, covers a portion of the claims that insurers face, resulting in lower total claims costs for the insurers, and thus lower premiums (average individual market premiums in Minnesota decreased from 2017 to 2018 as a result of the reinsurance program). The reinsurance kicks in once claims reach $50,000, and covers them at 80 percent up to $250,000 (this is similar to the coverage under the transitional reinsurance program that the ACA provided from 2014 through 2016).H.F.5 was contingent upon approval of the 1332 waiver, because it relies partially on federal funding, in addition to state funding.

Under the federal approval that was granted in September 2017, the federal government is giving Minnesota the money that they save on premium tax credits, and that money is combined with state funds to implement the reinsurance program (lower premiums — as a result of the reinsurance program — result in the federal government having to pay a smaller total amount of premium tax credits, since the tax credits are smaller when premiums are smaller).It was expected that CMS would approve the state’s 1332 waiver proposal, and Governor Dayton requested that the approval process be swift so that the state could move forward with the implementation of the Minnesota Premium Security Plan in time for the 2018 plan year. Dayton indicated that his office had been told that approval would come in August 2017, but CMS didn’t approve the waiver until September 22. And the waiver approval letter noted that the federal savings for MinnesotaCare (the state’s Basic Health Program, or BHP) resulting from the reinsurance program would not be eligible to be passed along to the state — in other words, CMS would keep those savings instead.[Federal BHP funding is equal to 95 percent of the amount that the federal government would have otherwise spent on premium subsidies and cost-sharing reductions for the population that ends up being eligible for the BHP.

So lower premiums — as a result of reinsurance — for qualified health plans in the exchange means that the amount the federal government would have had to spend on premium subsidies for that population is lower. That translates into a smaller amount of funding for the state’s BHP, according to the approach that HHS took for Minnesota’s waiver approval.]And based on the scathing letter that Dayton sent CMS a few days earlier, it appeared at that point that Minnesota could actually lose money on the deal — losing more in federal funding for MinnesotaCare than they gain in reinsurance funding. Dayton noted in his letter that the 1332 waiver approval process had been “nightmarish,” and that Minnesota went to great lengths to follow instructions from CMS at every turn, throughout the process of drafting H.F.5 and the 1332 waiver proposal.

He explains that CMS provided Minnesota with explicit guidance in terms of how to draft the reinsurance program while maintaining full federal funding for MinnesotaCare, and highlighted the fact that the state never deviated from the instructions that were provided.The StarTribune editorial board called out then-Secretary of HHS, Tom Price and the Trump Administration for their lack of clarity on the issue, for apparently misleading the state during the 1332 waiver drafting process, and for effectively punishing the state of Minnesota for taking an innovative approach to ensuring that as many people as possible have health insurance.Insurers filed rates based on reinsurance being available. And by the time the waiver was approved, there was very little time to evaluate the potential impacts of the funding changes, as rates had to be finalized by October 2 in Minnesota. The finalized rates did incorporate the reinsurance program.

The state has accepted the approved waiver, but Gov. Dayton sent a letter to HHS on October 3, asking them to reconsider the MinnesotaCare funding cuts, but the issue has remained unresolved.Elimination of CSR funding results in additional funding cut for MinnesotaCare, but a lawsuit has partially restored that fundingNationwide, 54 percent of exchange enrollees benefit from cost-sharing subsidies. But in Minnesota, only 13 percent of exchange enrollees are receiving cost-sharing subsidies.

This is because of MinnesotaCare, which covers all enrollees with income up to 200 percent of the poverty level. That’s the same group that would otherwise benefit the most from cost-sharing subsidies, so the fact that MinnesotaCare is available means that most of the people who would otherwise be enrolled in cost-sharing subsidy plans are instead enrolled in MinnesotaCare.At first glance, this would appear to have made the uncertainty surrounding cost-sharing subsidy funding in 2017 a little less of a pressing issue in Minnesota than it was in many other states, since private insurers weren’t facing the sort of losses that insurers in other states were facing without federal funding for CSR. But when the Trump Administration eliminated federal funding for CSR in October 2017, HHS took the position tha t since CSR funding had been eliminated, the CSR portion of the federal funding for the BHPs in New York and Minnesota would be reduced to $0.

This was not a cut-and-dried conclusion, however, as explained earlier in 2017 by Michael Kalina.In January 2018, the Attorneys General for New York and Minnesota filed a lawsuit against the US Department of Health and Human Services, seeking to restore funding for their Basic Health Programs. A judge ruled in favor of the states in May 2018, ensuring that MinnesotaCare would continue to receive at least some CSR-based funding. The amount awarded to the state for the first quarter of 2018 was just over half of what the state had initially expected in CSR-related funding, but a larger chuck of the funding was restored later in 2018.

According to the Star Tribune, however, Minnesota still ended up losing $161 million in federal funding for MinnesotaCare due to the CSR funding cuts.In early 2019, the Trump administration proposed yet another funding cut (a third, after the cuts imposed by the reinsurance program and the elimination of CSR funding) as part of a new methodology for calculating BHP funding. This one was much smaller than the other two cuts, but taken together the funding reductions are pushing MinnesotaCare towards a looming budget shortfall. SHOP exchange.

Down to one carrier as of 2016, zero by 2018 (and still zero in 2019)In 2015, there were two carriers in MNsure’s SHOP exchange for small businesses. Blue Cross Blue Shield of Minnesota, and Medica. But Medica announced in 2015 that they would exit the SHOP exchange in Minnesota, North Dakota, and Wisconsin at the end of the year.

That left BCBS as the only small group carrier available through MNsure in 2016, but it didn’t change much from a practical standpoint, since 83 percent of MNsure’s small groups were enrolled in plans through BCBS in 2015. Indeed, Medica’s reason for exiting the small business exchange was based on low enrollment in the first two years.Blue Cross Blue Shield of Minnesota continued to be the only insurer offering SHOP coverage via MNsure in 2017, but announced in July 2017 that they would no longer offer SHOP coverage in 2018, and would instead transition their SHOP enrollees to small business coverage outside the exchange. At that point, there were only 3,287 people enrolled in SHOP coverage in Minnesota — far below the 155,000 people that were originally projected to have coverage through MNsure’s SHOP program by 2016 (this much lower-than-anticipated enrollment has been the case in nearly every state’s SHOP exchange.

This situation is not unique to Minnesota). State law provided 25% premium rebate in 2017. Amendment to allow plans without essential benefits was cut from final legislationThroughout 2016, then-Governor Dayton called for a state-funded premium rebate for people who buy their own insurance but aren’t eligible for the ACA’s premium subsidies (those are only available for people with income up to 400 percent of the poverty level, or $100,400 for a family of four in 2019).Governor Dayton also noted that the government needed to act quickly to stabilize the individual market in Minnesota, and by late November 2016, his patience with lawmakers was wearing thin.

In a November 23 press conference, Dayton said that House Republicans needed to “stop dilly-dallying” and decide whether to move forward with Dayton’s rebate proposal.Dayton had also indicated that he was considering calling a special session of the legislature after election day to address the situation, and that was being negotiated for December 20. But the talks fell through when Dayton and Republican House Speaker Kurt Daudt couldn’t agree on the three bills that would have been addressed in the special session. As a result, there was no special session.Instead, the issue was taken up by lawmakers as soon as the 2017 legislative session began.

On January 5, Minnesota Senators Michelle Benson (R, 31st District) and Gary Dahms (R, 16th District) introduced S.F.1. The bill called for using $300 million in state funding to provide a 25 percent rebate to roughly 125,000 people in Minnesota.S.F.1 passed the Minnesota Senate by a 35-31 vote on January 12. Only one DFL Senator (Melisa Franzen, from Edina) voted with Republicans in favor of the legislation.

It was then sent to the House, where an amendment was added that stripped out the requirement that health plans provide various mandated benefits (see “Journal of the Day” section “Top of page 154” in this version of the bill. Under the terms of the amendment, as long as a carrier offered at least one plan with all the mandated benefits, they would have been allowed to offer others without mandated benefits).The amended bill was sent back to the Senate on January 23. Differences between the bills that the two chambers passed had to be reconciled before being sent to Governor Dayton for his signature.

By that point, the amendment to allow less-robust plans to be sold had garnered national attention, and public outrage helped to push lawmakers away from the provision. S.F.1 had also called for $150 million to be appropriated for fiscal year 2018 (through June 30, 2019) from the state general fund to a state-based reinsurance program to stabilize the individual market (Alaska did something similar in 2016, preventing a market collapse), but that provision was also removed in the final version (Minnesota did ultimately set up a reinsurance program, effective in 2018, which has served to stabilize the market and reduce premiums).A Conference Committee in the Senate recommended that the House “recede from its amendments” and the Conference Committee report passed the Senate on a 47-19 vote. The House passed the bill a few hours later, 108-19.

It was sent to Governor Dayton, who immediately signed it into law. DFLers did have to compromise on one issue during the process. S.F.1 allows for-profit HMOs to begin operating in Minnesota’s individual market, which had long been limited to non-profit HMOs.Consumers were told to expect the premium rebates to show up by April 2017, but they were retroactively effective to January 2017.

So a person who had been paying full price for a plan since January 2017 saw a substantial premium reduction on the April or May invoice. Going forward, for the remainder of the year, a 25 percent rebate applied each month.Since S.F.1 was signed into law with only a few days remaining in open enrollment (it ended January 31 that year), Governor Dayton and exchange officials were worried that there wouldn’t be enough time for people to learn about the rebate and apply for coverage before January 31. In December, Dayton had asked HHS to allow MNsure to extend its enrollment deadline to February 28 (instead of January 31) in order to allow lawmakers more time to work out the details of a state-based premium rebate while still allowing people to enroll after the legislative process is complete.HHS denied the request for a blanket extension, but MNsure used their own authority on January 28 to grant a one-week special enrollment period (February 1 to February 8) due to exceptional circumstances.

Although the state-based 25 percent premium rebate was available on or off the exchange, the one-week extension was only valid through MNsure. Health insurers did not have to accept off-exchange enrollments without a qualifying event after January 31.The 25 percent premium rebate program in Minnesota was only authorized for one year, so the rebates did not continue into 2018. And although almost 100,000 people received premium relief through the program in 2017, it ended up costing less than the legislature had allocated, and about $100 million was returned to the state’s budget at the end of 2017.Protecting Medicaid enrollees from estate liensIn every state, Medicaid is jointly funded by the state and the federal government.

Longstanding federal regulations, which predate the ACA, require states to “seek recovery of payments from the individual’s estate for nursing facility services, home and community-based services, and related hospital and prescription drug services” for any Medicaid enrollee over the age of 55. This applies essentially to long-term care services, but states also have the option to go after the individual’s estate to recover costs for other care that was provided by Medicaid after age 55.Prior to 2014, this wasn’t typically an issue, as Medicaid eligibility was generally restricted by asset tests or requirements that applicants be disabled or pregnant (although Minnesota did have much more generous Medicaid eligibility guidelines than most states prior to 2014). But as of 2014, in states that expanded Medicaid under the ACA, the only eligibility guideline is income.

Applicants with income that doesn’t exceed 138 percent of the poverty level are directed to Medicaid, regardless of any assets they might have.When applicants use the health insurance exchange — MNsure in Minnesota — they’re automatically funneled into Medical Assistance (Medicaid) if their income is under 138 percent of the poverty level. But what these enrollees didn’t know was that the state also had a program in place to put liens on estates for Medicaid-provided services for people age 55 and older.The combination of these systems caught numerous residents off guard. They were enrolled in Medical Assistance through MNsure based on their income, but were not aware that liens were being placed on their homes so that the state could recoup the costs upon their deaths.State Senator Tony Lourey (DFL, District 11) addressed the issue with language included in HF2749, the Omnibus supplemental budget bill, which was signed into law by Governor Dayton on June 1, 2016.

The legislation limits estate recovery to just what’s required under federal Medicaid rules (ie, essentially, long-term care costs for people age 55 or older), and makes the provision retroactive to January 1, 2014.Early tech strugglesMNsure opened for business in the fall of 2013, but technological issues persisted well into 2015, despite numerous improvements throughout 2014. Given MNsure’s difficult launch, the state conducted a series of audits and reviews. The first audit reviewed how MNsure spent state and federal money.

Auditors concluded that the exchange has generally adequate internal controls and found no fraud or abuse. The review was conducted by the state Office of the Legislative Auditor, and the report was published in October 2014.Another audit, also conducted by the Office of the Legislative Auditor and released in November 2014, found that the MNsure system in some cases incorrectly determined who qualified for public health benefits. The errors occurred during the first open enrollment period, before a series of system fixes were implemented.

The audit did not quantify the total financial impact of the errors. The state Human Services commissioner said a consultant working on technical fixes to MNsure concluded that the eligibility functionality was working correctly as of June 2014.A third audit, a performance evaluation report released in February 2015, said “MNsure’s failures outweighed its achievements.” Among other criticisms, auditors said MNsure staff withheld information from the board of directors and state officials, the enrollment website was seriously flawed and launched without adequate testing, and the first-year enrollment target was unrealistically low.In April 2014, MNsure hired Deloitte Consulting to audit MNsure’s technology and improve the website to make enrolling in coverage and updating life events easier and more streamlined. Deloitte has been involved in successful state-run marketplaces for Connecticut, Kentucky, Rhode Island and Washington.Software upgrades were installed in August 2014, and system testing continued right up until the start of open enrollment.

To reduce wait times for consumers and insurance professionals, MNsure increased its call center and support staff and launched a dedicated service line for agents and brokers.More in-person assisters were available in Minnesota for the 2015 open enrollment period. MNsure encourages residents to utilize the exchange’s assister directory to find local navigators and brokers who can help with the enrollment process.MNsure has improved dramatically in terms of its technology since the early days of ACA implementation, and enrollment increased every year from 2014 through 2019.Lawmakers approved switching to HealthCare.gov as of 2019, but governor vetoedOn May 9, 2017, lawmakers in Minnesota passed SF800, an omnibus health and human services bill. Among many other things, the legislation called for switching from MNsure to the federally-run marketplace (HealthCare.gov) starting in 2019 (see Section 5).

But Governor Dayton vetoed it.Gov. Dayton has long been supportive of MNsure, and had previously clarified that he would veto the bill. In noting his plans to veto the legislation, Dayton made no mention of the transition to HealthCare.gov that was included in the legislation, but focused instead on the sharp budget cuts in the bill.

But his veto ensured that MNsure would remain in place, at least for the time being.The Senate’s original version of SF800 did not call for scrapping MNsure, but the bill went through considerable back-and-forth between the two chambers, and the version that passed was the 4th engrossment of the bill.In March 2015, Dayton had asked the legislature to create a Task Force on Health Care Financing that would study MNsure along with possible future alternatives. Dayton noted in his letter that he supported making MNsure “directly accountable to the governor and subject to the same legislative oversight as other state agencies” and his budget included half a million dollars devoted to the task force. The spending bill was approved by the legislature in May, and the 29-member task force was appointed in the summer.One of the possibilities that the task force considered was the possibility of switching to Healthcare.gov, but it’s clear that there was no cut-and-dried answer to the question of whether Minnesota is better served by having a state-run exchange, switching to a federally-run exchange, or teaming up with the federal government on either a supported state-based marketplace or partnership exchange.In a December 2015 meeting of the task force, the MN Department of Human Services presented a financial analysis of the alternatives available to MNsure.

They determined that switching entirely to Healthcare.gov would cost the state an additional $5.1 million in one-time costs from June 2016 to June 2017. And switching to a supported state-based marketplace would cost an additional $6.6 million during that same time frame. If the state had opted to switch to Healthcare.gov, the soonest it could have happened was 2018, since HHS requires a year’s notice from states wishing to transition to Healthcare.gov, and Minnesota wouldn’t have been in a position to make a decision until sometime in 2016.There were significant reservations about making that switch prior to the Supreme Court’s ruling on King v.

Burwell. The Court ruled in June 2015 that subsidies are legal in every state, including those that use Healthcare.gov. Prior to the decision, a switch to Healthcare.gov could have jeopardized subsidies for tens of thousands of Minnesota residents.

But once it was clear that Healthcare.gov’s subsidies are safe, some stakeholders began calling for Minnesota to scrap its state-run exchange and use Healthcare.gov instead. Because the MNsure task force was included in the 2016 budget, no hasty decisions were made.In January 2016, the task force submitted their recommendations to the legislature. They covered a broad range of issues, but did not recommend that MNsure transition to the federal enrollment platform.

Lawmakers essentially left the exchange alone during the 2016 legislative session.The magnitude of the 2016 rate increases that were announced in October resulted in MNsure opponents renewing their calls to switch to Healthcare.gov. But it’s important to keep in mind that the 41 percent weighted average rate hike in Minnesota was market-wide, and did not just apply to MNsure enrollees. In fact, the off-exchange carrier (PreferredOne) had among the highest rate hikes in the state for 2016, at 39 percent, and the exchange’s weighted average rate increase (38.5 percent) was lower than the weighted average rate increase for the whole individual market (41 percent).Minnesota health insurance exchange linksMNsure855-3MNSURE (855-366-7873)State Exchange Profile.

MinnesotaThe Henry J. Kaiser Family Foundation overview of Minnesota’s progress toward creating a state health insurance exchange.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Key takeaways Medicaid expansion in HawaiiHawaii adopted Medicaid expansion through the Affordable Care Act, extending eligibility for Medicaid to adults with income up to 133 percent of the poverty level (138 percent with the automatic 5 percent income disregard). Medicaid expansion took effect in January 2014.According to the Kaiser Family Foundation, about 70,000 Hawaii residents were uninsured in 2015. With Medicaid expansion now covering low-income, nonelderly adults, 50 percent of Hawaii’s remaining uninsured population at that point was eligible for Medicaid – although they may not realize that they’re eligible.

According to U.S. Census data, only 3.5 percent of Hawaii residents were uninsured as of 2016, down from 6.7 percent in 2013. Although the state’s uninsured rate was reduced by nearly half from 2013 to 2016, it was already less than half of the national average uninsured rate even in 2013, before the bulk of the ACA’s provisions had taken effect.

Hawaii’s Prepaid Health Care Act, which has been in place since the 1970s, had already resulted in nearly all of the state’s population having insurance coverage, even before the ACA took effect. However, with the coronavirus outbreak, job losses and the subsequent loss of employer-provided insurance have contributed to a jump in the uninsured rate across the U.S. As of May 2020, Hawaii’s uninsured rate was 10 percent.Medicaid expansion helped cement top-ranking health scores Federalpoverty levelcalculator 0.0% of Federal Poverty Level Hawaii has a long history of supporting initiatives to make health insurance broadly available to residents.

Hawaii was among the first six states that implemented a Medicaid program in January 1966, just six months after federal legislation authorizing the program was enacted. In 1974, Hawaii implemented its Prepaid Health Care Act, which mandated that most employers make health insurance available to employees who work at least 20 hours a week.In conjunction with the Affordable Care Act (ACA), Hawaii initially implemented a state-run health insurance marketplace and adopted Medicaid expansion. The marketplace transitioned to a federally-supported state-run marketplace for 2016, and transitioned again to a fully federally-run exchange for 2017, largely in an effort to take advantage of the economies of scale that the federally-run exchange could bring to a state with low overall enrollment in the individual market (because of Hawaii’s Prepaid Health Care Act, nearly all non-elderly Hawaii residents get coverage from an employer, and relatively few need coverage under individual market plans).

Nothing changed about Medicaid with the switch to Healthcare.gov though. The expanded Medicaid eligibility guidelines are still in effect in Hawaii.Through its efforts, Hawaii consistently has low uninsured rates and high overall health scores. As of 2015, Hawaii was ranked the healthiest state in the nation according to the Gallup Healthways Physical Wellbeing Index, and the state consistently scores near the top in other ranking systems (number 2 the America’s Health Rankings 2017 survey, and number 3 in the Commonwealth Fund’s 2017 Scorecard on State Health System Performance).Who is eligible for Medicaid in Hawaii?.

Hawaii’s Medicaid eligibility levels for children are much higher than the national average and about average for pregnant women and parents.Children ages 0-18 qualify with family income levels up to 308 of the federal poverty level (FPL)Pregnant women qualify with family income up to 191 percent of FPLParents and other adults qualify with family income up to 138 percent of FPLHawaii also uses Medicaid funds to help cover premium costs for Hawaii residents who aren’t U.S. Citizens but who are citizens of nations that have entered into the Compact of Free Association (COFA) with the U.S.How do I enroll in Medicaid in Hawaii?. Hawaii’s Medicaid program is called MED-QUEST (MQD).

QUEST stands for Quality care, Universal access, Efficient utilization, Stabilizing costs, and Transforming the way health care is provided to recipients.You can apply for MED-QUEST. Hawaii Medicaid enrollment numbersMore than 351,000 people were enrolled in Hawaii’s Medicaid and CHIP programs as of June 2020. This figure is a 22% increase over 2013 (pre-ACA) enrollment, when about 288,000 people were enrolled.

Accordingly to the Kaiser Family Foundation, 107,300 of those enrolled in Hawaii Medicaid are part of the ACA-authorized expansion as of June 2019.Hawaii Medicaid historyHawaii implemented its Medicaid program in January 1966.In the early 1990s, Hawaii implemented the State Health Insurance Program (SHIP) to cover people who weren’t eligible for Medicaid. Then, in 1994, CMS approved Hawaii’s section 1115 Medicaid waiver (one of the first in the nation) to wrap SHIP in with Medicaid in an effort to achieve universal insurance coverage (in combination with the state’s Prepaid Health Care Act). The result of the waiver was the creation of Hawaii’s MED-QUEST program, which initially covered low-income women and children, but has since expanded (as of 2009) to cover nearly all of Hawaii’s Medicaid beneficiaries.

The MED-QUEST waiver is subject to renewal every five years.Medicaid in Hawaii is separated into two different methods of providing services. The fee-for-service (FFS) program and the managed care program, called MED-QUEST or MQD. Under the FFS program, doctors and other healthcare providers bill Medicaid directly to be reimbursed for services provided to Medicaid beneficiaries.

Under MED-QUEST, the state contracts with managed care plans who in turn provide healthcare services to Medicaid beneficiaries.As of 2011, more than 98 percent of the people enrolled in Hawaii’s Medicaid program were covered through managed care. By March 2015, Kaiser Family Foundation reported that 335,007 Medicaid enrollees in Hawaii were covered under managed care programs. That’s higher than the August 2015 total Medicaid/CHIP enrollment count, but KFF notes that the managed care number includes people who are covered under Hawaii’s fully-state-funded Medicaid program, in addition to the majority of enrollees who are in regular Medicaid that’s funded partially by the state and partially by the federal government.In August 2017, Hawaii submitted a waiver amendment to CMS in order to gain federal approval to use Medicaid funding to provide housing services to qualified Medicaid enrollees who are homeless and also have behavioral health and/or substance abuse problems.

That waiver request was still pending as of February 2018.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

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Before you take clonidine, tell your doctor if you have heart disease or severe coronary artery disease, a heart rhythm disorder, slow heartbeats, low blood pressure, a history of heart attack or stroke, kidney disease, or if you have ever had an allergic reaction to a Catapres TTS transdermal skin patch.

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This story is part of a partnership that includes NPR and catapres reviews Kaiser Health News. This story can be republished for free (details). After shutting down in the spring, America’s empty gyms are beckoning a cautious public back for catapres reviews a workout. To reassure wary customers, owners have put in place — and now advertise — a variety of coronavirus control measures.

At the same time, the fitness industry is trying to rehabilitate itself by pushing back against what it sees as a misleading narrative that gyms have no place during a pandemic.In the first months of the coronavirus outbreak, most public health leaders advised closing gyms, erring on the side of caution catapres reviews. As infections exploded across the catapres reviews country, states ordered gyms and fitness centers closed, along with restaurants, movie theaters and bars. State and local officials consistently branded gyms as high-risk venues for infection, akin to bars and nightclubs.

In early catapres reviews August, New York Gov. Andrew Cuomo called gym-going a “dangerous activity,” saying he would keep them shut — only to announce later in the month that most gyms could reopen in September at a third of the capacity and under tight regulations.New York, New Jersey and North Carolina were among the last state holdouts — only recently allowing fitness facilities to reopen. Many states catapres reviews continue to limit capacity and have instituted new requirements.The benefits of gyms are clear.

Regular exercise staves off depression and catapres reviews improves sleep, and staying fit may be a way to avoid a serious case of COVID-19. But there are clear risks, too. Lots of catapres reviews people moving around indoors, sharing equipment and air, and breathing heavily could be a recipe for easy viral spread.

There are scattered reports of coronavirus cases traced back to catapres reviews specific gyms. But gym owners say those are outliers and argue the dominant portrayal overemphasizes potential dangers and ignores their brief but successful track record of safety during the pandemic. Email Sign-Up Subscribe to KHN’s free Morning catapres reviews Briefing.

A Seattle gym struggles to comply with new rules and surviveAt NW Fitness in Seattle, everything from a set of squats to a run on the treadmill requires a mask. Every other cardio machine is catapres reviews off-limits. The owners have marked up the floor with blue tape to show where each catapres reviews person can work out.Esmery Corniel, a member, has resumed his workout routine with the punching bag.“I was honestly just losing my mind,” said Corniel, 27.

He said he feels comfortable in the gym with its new safety protocols.“Everybody wears their mask, everybody socially distances, so it’s no problem here at all,” Corniel said.There’s no longer the usual morning “rush” of people working out before heading to their jobs.Under Washington state’s coronavirus rules, only about 10 to 12 people at a time are permitted in this 4,000-square-foot gym.“It’s drastically reduced our ability to serve our community,” said John Carrico. He and his wife, Jessica, purchased NW Fitness at the end of last year.John catapres reviews and Jessica Carrico run NW Fitness, a small gym in Seattle that has struggled to stay afloat during the pandemic. Their membership has plummeted in recent months, in part because the gym has been closed and subject to strict coronavirus requirements.(Will Stone)Meanwhile, the cost of running the businesses has gone up dramatically.

The gym now needs to be staffed round-the-clock to catapres reviews keep up with the frequent cleaning requirements, and to ensure people are wearing masks and following the rules.Keeping the gym open 24/7 — previously a big selling point for members — is no longer feasible. In the past three months, they’ve lost more than a catapres reviews third of their membership.“If the trend continues, we won’t be able to stay open,” said Jessica Carrico, who also works as a nurse at a homeless shelter run by Harborview Medical Center.Given her medical background, Jessica Carrico was initially inclined to trust the public health authorities who ordered all gyms to shut down, but gradually her feelings changed.“Driving around the city, I’d still see lines outside of pot shops and Baskin-Robbins,” she said. €œThe arbitrary decision that had been made was very clear, and it became really frustrating.”Even after gyms in the Seattle area were allowed to reopen, their frustrations continued — especially with the strict cap on operating capacity.

The Carricos believe that falls catapres reviews hardest on smaller gyms that don’t have much square footage.“People want this space to be safe, and will self-regulate,” said John Carrico. He believes he could responsibly operate catapres reviews with twice as many people inside as currently allowed. Public health officials have mischaracterized gyms, he added, and underestimated their potential to operate safely.“There’s this fear-based propaganda that gyms are a cesspool of coronavirus, which is just super not true,” Carrico said.Gyms seem less risky than bars.

But there’s very little research either wayThe fitness industry has catapres reviews begun to push back at the pandemic-driven perceptions and prohibitions. €œWe should not be lumped with bars and restaurants,” said Helen Durkin, an executive vice president for the International Health, Racquet &. Sportsclub Association catapres reviews (IHRSA).John Carrico called the comparison with bars particularly unfair.

€œIt’s almost catapres reviews laughable. I mean, it’s almost the exact opposite. €¦ People catapres reviews here are investing in their health.

They’re coming in, they’re focusing on what they’re trying to do catapres reviews as far as their workout. They’re not socializing, they’re not sitting at a table and laughing and drinking.”Since the pandemic began, many gyms have overhauled operations and now look very different. Locker rooms are often catapres reviews closed and group classes halted.

Many gyms check everyone for symptoms upon arrival. They’ve spaced out equipment and begun intensive catapres reviews cleaning regimes.Gyms have a big advantage over other retail and entertainment venues, Durkin said, because the membership model means those who may have been exposed in an outbreak can be easily contacted.A company that sells member databases and software to gyms has been compiling data during the pandemic. (The data, drawn from 2,877 catapres reviews gyms, is by no means comprehensive because it relies on gym owners to self-report incidents in which a positive coronavirus case was detected at the gym, or was somehow connected to the gym.) The resultant report said that the overall “visits to virus” ratio of 0.002% is “statistically irrelevant” because only 1,155 cases of coronavirus were reported among more than 49 million gym visits.

Similarly, data collected from gyms in the United Kingdom found only 17 cases out of more than 8 million visits in the weeks after gyms reopened there.Only a few U.S. States have publicly available information on outbreaks linked to the fitness catapres reviews sector, and those states report very few cases. In Louisiana, for example, the state has identified five clusters originating in “gym/fitness settings,” with a total of 31 cases.

None of the people catapres reviews died. By contrast, 15 clusters were traced to “religious services/events,” sickening 78, and killing five of them.“The whole idea that it’s a risky place to be … around the world, we just aren’t seeing those numbers anywhere,” said IHRSA’s Durkin.A study from South Korea published by the Centers for Disease Control and Prevention is often cited as evidence of the inherent hazards of group fitness activities.The study traced catapres reviews 112 coronavirus infections to a Feb. 15 training workshop for fitness dance instructors.

Those instructors went on to teach classes at 12 sports facilities in February and March, transmitting the virus to students in the dance classes, but also to co-workers and family members.But defenders of the fitness industry point out that the outbreak began before South Korea instituted social distancing measures.The study authors note that the classes were crowded and the pace of the dance workouts was fast, and conclude that “intense physical exercise in densely populated sports facilities could increase the risk for infection” and “should be minimized during outbreaks.” They also found that no transmission occurred in classes with fewer than catapres reviews five people, or when an infected instructor taught “lower-intensity” classes such as yoga and Pilates.Linda Rackner with PRO Club in Bellevue, Washington, says the enormous, upscale gym has adapted relatively easily to the new coronavirus rules. The fitness club’s physical size, extensive budget and catapres reviews technology have helped staffers maintain a fairly normal experience for their members.(Will Stone)Public health experts continue to urge gym members to be cautiousIt’s clear that there are many things gym owners — and gym members — can do to lower the risk of infection at a gym, but that doesn’t mean the risk is gone. Infectious disease doctors and public health experts caution that gyms should not downplay their potential for spreading disease, especially if the coronavirus is widespread in the surrounding community.“There are very few [gyms] that can actually implement all the infection control measures,” said Saskia Popescu, an infectious disease epidemiologist in Phoenix.

€œThat’s really catapres reviews the challenge with gyms. There is so much variety that it makes it hard to put them into a single box.”Popescu and two colleagues developed a COVID-19 risk chart for various activities. Gyms were classified as “medium high,” on par with eating indoors at a restaurant or getting a haircut, but less risky than going to a bar or riding public catapres reviews transit.Popescu acknowledges there’s not much recent evidence that gyms are major sources of infection, but that should not give people a false sense of assurance.“The mistake would be to assume that there is no risk,” she said.

€œIt’s just that catapres reviews a lot of the prevention strategies have been working, and when we start to loosen those, though, is where you’re more likely to see clusters occur.”Any location that brings people together indoors increases the risk of contracting the coronavirus, and breathing heavily adds another element of risk. Interventions such as increasing the distance between cardio machines might help, but tiny infectious airborne particles can travel farther than 6 feet, Popescu said.The mechanics of exercising also make it hard to ensure people comply with crucial preventive measures like wearing a mask.“How effective are masks in that setting?. Can they catapres reviews really be effectively worn?.

€ asked Dr. Deverick Anderson, director catapres reviews of the Duke Center for Antimicrobial Stewardship and Infection Prevention. €œThe combination of sweat and exertion is one unique thing about the gym setting.”“I do think that, in the big picture, gyms would be riskier than restaurants because of the type of activity and potential for interaction there,” Anderson said.The primary way people could catch the virus at a gym would be coming close to catapres reviews someone who is releasing respiratory droplets and smaller airborne particles, called “aerosols,” when they breathe, talk or cough, said Dr.

Dean Blumberg, chief of pediatric infectious diseases at UC Davis Health.He’s less worried about people catching the virus from touching a barbell or riding a stationary bike that someone else used. That’s because scientists now think “surface” catapres reviews transmission isn’t driving infection as much as airborne droplets and particles.“I’m not really worried about transmission that way,” Blumberg said. €œThere’s too much attention being paid catapres reviews to disinfecting surfaces and ‘deep cleaning,’ spraying things in the air.

I think a lot of that’s just for show.”Blumberg said he believes gyms can manage the risks better than many social settings like bars or informal gatherings.“A gym where you can adequately social distance and you can limit the number of people there and force mask-wearing, that’s one of the safer activities,” he said.Adapting to the pandemic’s prohibitions doesn’t come cheapIn Bellevue, Washington, PRO Club is an enormous, upscale gym with spacious workout rooms — and an array of medical services such as physical therapy, hormone treatments, skin care and counseling. PRO Club has managed catapres reviews to keep the gym experience relatively normal for members since reopening, according to employee Linda Rackner. €œThere is plenty of space for everyone.

We are seeing about 1,000 people a day and have capacity for catapres reviews almost 3,000,” Rackner said. €œWe’d love to have more people in the club.”The gym uses the same air-cleaning units as hospital ICUs, deploys ultraviolet robots to sanitize the rooms and requires temperature checks to enter catapres reviews. €œI feel like we have good compliance,” said Dean Rogers, one of the personal trainers.

€œFor the most part, people who come to a gym are in it for their catapres reviews own health, fitness and wellness.”But Rogers knows this isn’t the norm everywhere. In fact, catapres reviews his own mother back in Oklahoma believes she contracted the coronavirus at her gym.“I was upset to find out that her gym had no guidelines they were following, no safety precautions,” he said. €œThere are always going to be some bad actors.”This story is part of a partnership that includes NPR and Kaiser Health News.

Carrie Feibel, an editor for the catapres reviews NPR-KHN reporting partnership, contributed to this story. Related Topics Multimedia Public Health States Audio COVID-19 WashingtonThis story also ran on CNN. This story can be republished for free (details). CLEVELAND — Families skipping or delaying pediatric appointments for their young children because of the pandemic are missing out on more than vaccines. Critical testing for lead poisoning has plummeted in many parts of the country.In the Upper Midwest, Northeast and parts of the West Coast — areas with historically high rates of lead poisoning — catapres reviews the slide has been the most dramatic, according to the Centers for Disease Control and Prevention.

In states such as Michigan, catapres reviews Ohio and Minnesota, testing for the brain-damaging heavy metal fell by 50% or more this spring compared with 2019, health officials report.“The drop-off in April was massive,” said Thomas Largo, section manager of environmental health surveillance at the Michigan Department of Health and Human Services, noting a 76% decrease in testing compared with the year before. €œWe weren’t quite prepared for that.” Don't Miss A Story Subscribe to KHN’s free Weekly Edition newsletter. Blood tests for lead, the only way to tell if a child has been exposed, are typically performed by pricking a finger or heel or tapping a vein at 1- and 2-year-old catapres reviews well-child visits.

A blood test with elevated lead levels triggers the next critical steps in accessing early intervention for the behavioral, learning and health effects of lead poisoning and also identifying the source of the lead to prevent further harm.Because of the pandemic, though, the drop in blood tests means referrals for critical home inspections plus medical and educational services are falling, too. And that means help catapres reviews isn’t reaching poisoned kids, a one-two punch, particularly in communities of color, said Yvonka Hall, a lead poisoning prevention advocate and co-founder of the Cleveland Lead Safe Network. And this all comes amid COVID-related school and child care closures, meaning kids who are at risk are spending catapres reviews more time than ever in the place where most exposure happens.

The home.“Inside is dangerous,” Hall said.The CDC estimates about 500,000 U.S. Children between catapres reviews ages 1 and 5 have been poisoned by lead, probably an underestimate due to the lack of widespread testing in many communities and states. In 2017, more than 40,000 children had elevated blood lead levels, defined as higher than 5 micrograms per deciliter of blood, in the 23 states that reported data.While preliminary June and July data in some states indicates lead testing is picking up, it’s nowhere near as high as it would need to be to catch up on the kids who missed appointments in the spring at the height of lockdown orders, experts catapres reviews say.

And that may mean some kids will never be tested.“What I’m most worried about is that the kids who are not getting tested now are the most vulnerable — those are the kids I’m worried might not have a makeup visit,” said Stephanie Yendell, senior epidemiology supervisor in the health risk intervention unit at the Minnesota Department of Health.Lifelong ConsequencesThere’s a critical window for conducting lead poisoning blood tests, timed to when children are crawling or toddling and tend to put their hands on floors, windowsills and door frames and possibly transfer tiny particles of lead-laden dust to their mouths.Children at this age are more likely to be harmed because their rapidly growing brains and bodies absorb the element more readily. Lead poisoning catapres reviews can’t be reversed. Children with lead poisoning are more likely to fall behind in school, end up in jail or suffer lifelong health problems such as kidney and heart disease.That’s why lead tests are required at ages 1 and 2 for children receiving federal Medicaid benefits, the population most likely to be poisoned because of low-quality housing options.

Tests are also recommended for all children living in high-risk ZIP codes with older housing stock and historically high levels of lead exposure.Testing fell far short of recommendations in many parts of the country even before the pandemic, though, with one recent study estimating that in some states 80% of poisoned children catapres reviews are never identified. And when tests are required, there has been little enforcement of the rule.Early in the pandemic, officials in catapres reviews New York’s Erie County bumped up the threshold for sending a public health worker into a family’s home to investigate the source of lead exposure from 5 micrograms per deciliter to 45 micrograms per deciliter (a blood lead level that usually requires hospitalization), said Dr. Gale Burstein, that county’s health commissioner.

For all other cases during that period, officials inspected only the outside of the child’s home for potential hazards.About 700 fewer catapres reviews children were tested for lead in Erie County in April than in the same month last year, a drop of about 35%.Ohio, which has among the highest levels of lead poisoning in the country, recently expanded automatic eligibility for its Early Intervention program to any child with an elevated blood lead test, providing the opportunity for occupational, physical and speech therapy. Learning supports for catapres reviews school. And developmental assessments.

If kids with lead poisoning don’t get tested, though, they won’t be referred for help.In early April, there were only three referrals for elevated catapres reviews lead levels in the state, which had been fielding nine times as many on average in the months before the pandemic, said Karen Mintzer, director of Bright Beginnings, which manages them for Ohio’s Department of Developmental Disabilities. €œIt basically was a complete stop,” she said. Since mid-June, referrals have recovered and are now above pre-pandemic levels.“We catapres reviews should treat every child with lead poisoning as a medical emergency,” said John Belt, principal investigator for the Ohio Department of Health’s lead poisoning program.

€œNot identifying them is going to delay the available services, and in some cases lead to a cognitive deficit.”Pandemic Compounds WorriesOne of the big worries about the drop in lead testing is that it’s happening at a time when exposure to lead-laden paint chips, soil and dust in homes may be catapres reviews spiking because of stay-at-home orders during the pandemic.Exposure to lead dust from deteriorating paint, particularly in high-friction areas such as doors and windows, is the most common cause of lead exposure for children in the U.S.“I worry about kids in unsafe housing, more so during the pandemic, because they’re stuck there during the quarantine,” said Dr. Aparna Bole, a pediatrician at Cleveland’s University Hospitals Rainbow Babies &. Children’s Hospital.The pandemic may also compound exposure to lead, experts fear, as both catapres reviews landlords and homeowners try to tackle renovation projects without proper safety precautions while everyone is at home.

Or the economic fallout of the crisis could mean some people can no longer afford to clean up known lead hazards at all.“If you’ve lost your job, it’s going to make it difficult to get new windows, or even repaint,” said Yendell.The CDC says it plans to help state and local health departments track down children who missed lead tests. Minnesota plans to identify pediatric clinics with particularly steep drops in lead testing to figure out why, said Yendell.But, Yendell said, that will catapres reviews likely have to wait until the pandemic is over. €œRight now I’m spending 10-20% of my time on lead, and the rest is COVID.”The pandemic has stretched already thinly staffed local health departments to the brink, health officials say, and it may take catapres reviews years to know the full impact of the missed testing.

For the kids who’ve been poisoned and had no intervention, the effects may not be obvious until they enter school and struggle to keep up. Brie Zeltner catapres reviews. @BrieZeltner catapres reviews Related Topics Public Health CDC Children's Health COVID-19 Michigan Minnesota New York Ohio StudyCan’t see the audio player?.

Click here to listen on SoundCloud. The headlines from this week will be about how President Donald Trump knew early on how serious the coronavirus catapres reviews pandemic was likely to become but purposely played it down. Potentially more important during the past few weeks, though, are reports of how White House officials have pushed scientists at the federal government’s leading health agencies to put politics above science.Meanwhile, Republicans appear to have given up on using the Affordable Care Act as an electoral cudgel, judging, at least, from its scarce mention during the GOP convention.

Democrats, on the other hand, particularly catapres reviews those running for the U.S. House and Senate, are doubling down on catapres reviews their criticism of Republicans for failing to adequately protect people with preexisting health conditions. That issue was key to the party winning back the House in 2018.This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Sarah Karlin-Smith of the Pink Sheet.Among the takeaways from this week’s podcast:The Affordable Care Act has become a political vulnerability for Republican officials, who have no interest in reopening the debate on it during this campaign.

Trump vowed catapres reviews before his 2016 election to repeal the law immediately after taking office and members of Congress had berated it for years. But they could not gain the political capital to overturn Obamacare.Trump’s comments to journalist-author Bob Woodward about holding back information on the risks of the coronavirus pandemic from the public may not have a major effect on the election since so many voters’ minds are already set on their choices. For many, the president’s statements are seen by partisans as identifying catapres reviews what they already believe.

For Trump’s supporters, that he is protecting the public catapres reviews. For his critics, that he is a liar.The number of COVID-19 cases appears to have hit another plateau, but it’s still twice as high as the count last spring. Officials are catapres reviews waiting to see if end-of-the-summer activities over the Labor Day holiday will create another surge.The stalemate on Capitol Hill over coronavirus relief funding shows no sign of easing soon.

Republicans in the Senate are resisting Democrats’ insistence on a massive package, catapres reviews but it’s not exactly clear what the GOP can agree on.The vaccine being developed by AstraZeneca ran into difficulty this week as experts seek to determine whether a neurological problem that developed in one volunteer was caused by the vaccine. Some public health officials, such as NIH Director Francis Collins, said this helps show that even with the compressed testing timeline, safeguards are working.Nonetheless, another vaccine maker, Pfizer, said it might still have its vaccine ready before the election.The recent controversy at the FDA over the emergency authorization of plasma to treat COVID patients and the awkward decision at the Centers for Disease Control and Prevention to change guidelines for testing asymptomatic people have created a credibility gap among some Americans and played into concerns that the administration is undercutting science.Also this week, Rovner interviews KHN’s Elizabeth Lawrence, who reported the August NPR-KHN “Bill of the Month” installment, about an appendectomy gone wrong, and the very big bill that followed. If you have an outrageous medical bill you would like to share with us, you can do that here.Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:Julie Rovner catapres reviews.

ProPublica’s “A Doctor Went to His Own Employer for a COVID-19 Antibody Test. It Cost $10,984,” catapres reviews by Marshall AllenJoanne Kenen. The Atlantic’s “America Is Trapped in a Pandemic Spiral,” by Ed YongSarah catapres reviews Karlin-Smith.

Politico’s “Emails Show HHS Official Trying to Muzzle Fauci,” by Sarah OwermohleMary Ellen McIntire. The Atlantic’s catapres reviews “What Young, Healthy People Have to Fear From COVID-19,” by Derek ThompsonTo hear all our podcasts, click here.And subscribe to What the Health?. on iTunes, Stitcher, catapres reviews Google Play, Spotify, or Pocket Casts.

Related Topics Elections Multimedia Public Health The Health Law CDC COVID-19 FDA KHN's 'What The Health?. ' NIH catapres reviews Podcasts Trump Administration U.S. Congress VaccinesSOBRE NOTICIAS EN ESPAÑOLNoticias en español es una sección de Kaiser Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que vive en los Estados Unidos.

Use Nuestro Contenido Este contenido puede usarse catapres reviews de manera gratuita (detalles). El gobernador de Florida, Ron DeSantis, trató de aliviar el temor a volar durante la pandemia en un evento catapres reviews con ejecutivos de aerolíneas y compañías de alquiler de autos.“Los aviones simplemente no han sido vectores cuando se observa la propagación del coronavirus”, dijo DeSantis en el encuentro en el Aeropuerto Internacional Fort Lauderdale-Hollywood el 28 de agosto. “La evidencia es la evidencia.

Y creo que es algo que la gente puede hacer con seguridad “, agregó.¿La evidencia es realmente tan clara? catapres reviews. La afirmación de DeSantis de que los aviones no han sido “vectores” de la propagación del coronavirus es falsa, según expertos. Un “vector” disemina el virus de un lugar a otro, y catapres reviews los aviones han transportado a pasajeros infectados a través de distintas regiones, lo que hace que los brotes de COVID-19 sean más difíciles de contener.Joseph Allen, profesor asociado en la Universidad de Harvard y experto en exposiciones a virus, calificó a los aviones como “excelentes vectores para la propagación viral” en una llamada de prensa.En contexto, DeSantis parecía estar haciendo hincapié en la seguridad de volar en avión en lugar del papel que desempeñaron los aviones en la propagación del virus de un lugar a otro.Cuando se le consultó a la oficina del gobernador sobre datos que respaldaran los comentarios de DeSantis, el secretario de prensa Cody McCloud no presentó ningún estudio ni estadística.

En cambio, citó el programa de rastreo de contactos del Departamento de Salud de Florida y escribió que “no ha proporcionado catapres reviews ninguna información que sugiera que algún paciente se haya infectado mientras viajaba en un vuelo comercial”.El programa de rastreo de contactos de Florida se ha visto envuelto en una controversia sobre informes que denuncian que no tiene suficiente personal y que es ineficaz. CNN llamó a 27 residentes del estado que dieron positivo para COVID-19 y descubrió que solo cinco habían sido contactados por las autoridades de salud. (El Departamento de Salud de Florida no respondió a las solicitudes de entrevista).Expertos aseguran que, en general, los aviones brindan ambientes seguros en lo catapres reviews que respecta a la calidad del aire, pero agregaron que el riesgo de infección depende en gran medida de las políticas que las aerolíneas puedan tener sobre los asientos de los pasajeros, el uso de máscaras y el tiempo de embarque.Según indicaron, el riesgo de contraer el coronavirus en un avión es relativamente bajo si la aerolínea sigue los procedimientos de salud pública.

Hacer cumplir la regla de usar máscara, espaciar los asientos catapres reviews disponibles y examinar a los pasajeros enfermos.“Si observas otras enfermedades, ves pocos brotes en aviones”, dijo Allen. €œNo son los semilleros de infección que la gente cree que son”.Las aerolíneas señalan con frecuencia que los aviones comerciales están equipados con filtros de aire HEPA, recomendados por los Centros para el Control y Prevención de Enfermedades (CDC), que se utilizan en las salas de aislamiento de los hospitales.Los filtros HEPA capturan el 99,97% de las partículas en el aire y reducen sustancialmente el riesgo de propagación viral. Además, el aire en las cabinas se renueva por completo entre 10 y 12 veces por hora, elevando la calidad del aire por encima de la de un edificio normal.Debido a la alta tasa de renovación del aire, es poco probable que se contraiga el coronavirus de alguien sentado a varias filas de distancia catapres reviews.

Sin embargo, sí podría ocurrir el contagio de alguien cercano.“El mayor riesgo durante el vuelo sería si el pasajero se sienta cerca de alguien que pueda infectar”, dijo Richard Corsi, quien estudia la contaminación del aire en interiores y es decano de Ingeniería en Universidad Estatal de Portland.También es importante señalar que los sistemas de filtración de alta potencia de los aviones no son suficientes por sí solos para prevenir brotes. Si una aerolínea no mantiene libres los asientos del medio ni hace cumplir rigurosamente el uso catapres reviews de máscaras, volar puede ser bastante peligroso. Actualmente, las aerolíneas nacionales que mantienen abiertos los asientos intermedios incluyen Delta, Hawaiian, Southwest y JetBlue.La razón de esto es que las personas infectadas envían partículas virales al aire catapres reviews a un ritmo más rápido que el que los aviones las expulsan fuera de la cabina.

€œSiempre que tose, habla o respira, está enviando gotitas”, dijo Qingyan Chen, profesor de ingeniería mecánica en la Universidad Purdue. €œEstas gotas están en la cabina todo el tiempo”.Esto hace que las medidas de protección adicionales, como el uso de máscaras, catapres reviews sean aún más necesarias.Chen citó dos vuelos internacionales anteriores a la pandemia donde las tasas de infección variaron según el uso de mascarillas. En el primer catapres reviews vuelo, ningún pasajero llevaba máscaras y un solo pasajero infectó a 14 personas mientras el avión viajaba de Londres a Hanoi, Vietnam.

En el segundo vuelo, de Singapur a Hangzhou, en China, todos los pasajeros llevaban máscaras faciales.Aunque 15 pasajeros eran residentes de Wuhan con casos sospechosos o confirmados de COVID-19, el único hombre infectado en el recorrido se había aflojado la máscara en pleno vuelo y había estado sentado cerca de cuatro residentes de Wuhan que luego dieron positivo para el virus.Pero, aunque volar es una actividad de riesgo relativamente bajo, se debe evitar viajar a menos que sea absolutamente necesario.“Cualquier cosa que te ponga en contacto con más personas aumentará el riesgo”, dijo Cindy Prins, profesora clínica asociada de Epidemiología en la Escuela de Salud Pública y Profesiones de la Salud de la Universidad de Florida.El verdadero peligro de viajar no es el vuelo en sí. Sin embargo, pasar por el control de seguridad y esperar en la puerta de embarque es probable que ponga a la catapres reviews persona en contacto cercano con otros y aumente sus posibilidades de contraer el virus.Además, abordar, cuando el sistema de ventilación del avión no está funcionando y las personas no pueden mantenerse alejadas entre sí, es una de las partes más riesgosas. €œReducir este tiempo es importante para bajar la exposición”, escribió Corsi.

€œHay que llegar al asiento con la máscara y sentarse lo más rápido posible”.Con todo, catapres reviews es demasiado pronto para determinar cuánta transmisión de persona a persona ha ocurrido en vuelos.Julian Tang, profesor asociado honorario en el Departamento de Ciencias Respiratorias de la Universidad de Leicester, en Inglaterra, dijo que está al tanto de varios grupos de infecciones relacionadas con los viajes aéreos. Sin embargo, es un desafío demostrar que las personas contrajeron el virus en un vuelo.“Alguien que presenta síntomas de COVID-19 varios días después de llegar a su destino podría haberse infectado en casa antes de llegar al aeropuerto, mientras estaba en el aeropuerto o en el vuelo, o incluso al llegar al aeropuerto de destino, porque todo el mundo tiene un período de incubación variable”, dijo Tang.Katherine Estep, catapres reviews vocera de Airlines for America, un grupo comercial de la industria centrado en Estados Unidos, dijo que los CDC no han confirmado ningún caso de transmisión a bordo de una aerolínea estadounidense.La ausencia de transmisión confirmada no es necesariamente una prueba de que los viajeros estén seguros. En cambio, la falta de datos refleja el hecho de que Estados Unidos tiene una tasa de infección más alta en comparación con otros países, dijo Chen.

Dado que catapres reviews tiene tantos casos confirmados, es más difícil determinar exactamente dónde alguien contrajo el virus. Related Topics Noticias En Español Public Health COVID-19 KHN &. PolitiFact HealthCheckThis story also ran on NPR. This story can be republished for free (details). Nurses at Alta Bates Summit Medical Center were on edge as early as March when catapres reviews patients with COVID-19 began to show up in areas of the hospital that were not set aside to care for them.

Explore Our Database KHN and The Guardian are tracking health care workers who died from catapres reviews COVID-19 and writing about their lives and what happened in their final days. The Centers for Disease Control and Prevention had advised hospitals to isolate COVID patients to limit staff exposure and help conserve high-level personal protective equipment that’s been in short supply.Yet COVID patients continued to be scattered through the Oakland hospital, according to complaints to California’s Division of Occupational Safety and Health. The concerns included the sixth-floor medical unit where veteran nurse catapres reviews Janine Paiste-Ponder worked.COVID patients on that floor were not staying in their rooms, either confused or uninterested in the rules.

Staff was not provided highly protective N95 respirators, said Mike catapres reviews Hill, a nurse in the hospital intensive care unit and the hospital’s chief representative for the California Nurses Association, which filed complaints to Cal/OSHA, the state’s workplace safety regulator. “It was just a matter of time before one of the nurses died on one of these floors,” Hill said.Two nurses fell ill, including Paiste-Ponder, 59, who died of complications from the virus on July 17.The concerns raised in Oakland also have swept across the U.S., according to interviews, a review of government workplace safety complaints and health facility inspection reports. A KHN investigation found that dozens of nursing homes and hospitals ignored official guidelines to separate COVID patients from those without the coronavirus, in some places fueling its spread and leaving staff unprepared and infected or, in some cases, catapres reviews dead.As recently as July, a National Nurses United survey of more than 21,000 nurses found that 32% work in a facility that does not have a dedicated COVID unit.

At that time, the coronavirus had reached all but 17 U.S. Counties, data collected by Johns Hopkins University shows.California Nurses Association members had complained to Cal/OSHA about COVID patients being spread throughout Alta Bates Summit Medical Center and say the practice was a factor in Janine Paiste-Ponder’s illness catapres reviews and death.(National Nurses United)KHN discovered that COVID victims have been commingled with uninfected patients in health care facilities in states including California, Florida, New Jersey, Iowa, Ohio, Maryland and New York.A COVID-19 outbreak was in full swing at the New Jersey Veterans Home at Paramus in late April when health inspectors observed residents with dementia mingling in a day room — COVID-positive patients as well as others awaiting test results. At the time, the center had already reported COVID infections among 119 residents and 46 virus-related deaths, according to a Medicare inspection report.The assistant director of nursing at an Iowa nursing home insisted April 28 that they did “not have any COVID in the building” and overrode the catapres reviews orders of a community doctor to isolate several patients with fevers and falling oxygen levels, an inspection report shows.By mid-May, the facility’s COVID log showed 61 patients with the virus and nine dead.Federal work-safety officials have closed at least 30 complaints about patient mixing in hospitals nationwide without issuing a citation.

They include a claim that a Michigan hospital kept patients who tested negative for the virus in the COVID unit in May. An upstate New York hospital also had COVID patients in the same unit as those with no infection, catapres reviews according to a closed complaint to the federal Occupational Safety and Health Administration. Email Sign-Up Subscribe to KHN’s free Morning Briefing.

Federal Health and Human Services officials have called on hospitals to tell them each day if they have a patient who came in without COVID-19 but had an catapres reviews apparent or confirmed case of the coronavirus 14 days later. Hospitals filed 48,000 reports catapres reviews from June 21 through Aug. 28, though the number reflects some double or additional counting of individual patients.COVID patients have been mixed in with others for a variety of reasons.

Some hospitals report having limited tests, so patients carrying the virus are identified catapres reviews only after they had already exposed others. In other cases, catapres reviews they had false-negative test results or their facility was dismissive of federal guidelines, which carry no force of law.And while federal Medicare officials have inspected nearly every U.S. Nursing home in recent months and states have occasionally levied fines and cut off new admissions for isolation lapses, hospitals have seen less scrutiny.The Scene Inside SutterAt Alta Bates in Oakland, part of the Sutter Health network, hospital staff made it clear in official complaints to Cal/OSHA that they wanted administrators to follow the state’s unique law on aerosol-transmitted diseases.

From the start, some staffers wanted all the state-required protections for a virus that has been increasingly shown to be transmitted by catapres reviews tiny particles that float through the air.The regulations call for patients with a virus like COVID-19 to be moved to a specialized unit within five hours of identification — or to a specialized facility. The rules say those patients should be in a room with a HEPA filter or with negative air pressure, meaning that air is circulated out a window or exhaust fan instead of drifting into the hallway.Initially, in March, the hospital outfitted a 40-bed COVID unit, according to Hill. But when a surge of patients failed to materialize, that unit was pared to 12 beds.Since then, a steady stream of virus patients have been admitted, he said, catapres reviews many testing positive only days after admission — and after they’d been in regular rooms in the facility.From March 10 through July 30, Hill’s union and others filed eight complaints to Cal/OSHA, including allegations that the hospital failed to follow isolation rules for COVID patients, some on the cancer floor.So far, regulators have done little.

Gov. Gavin Newsom had ordered workplace safety officials to “focus on … supporting compliance” instead of enforcement except on the “most serious violations.”State officials responded to complaints by reaching out by mail and phone to “ensure the proper virus prevention measures are in place,” according to Frank Polizzi, a spokesperson for Cal/OSHA.A third investigation related to transport workers not wearing N95 respirators while moving COVID-positive or possible coronavirus patients at a Sutter facility near the hospital resulted in a $6,750 fine, Cal/OSHA records show.The string of complaints also says the hospital did not give staff the necessary personal protective equipment (PPE) under state law — an N95 respirator or something more protective — for caring for virus patients.Nurse Janine Paiste-Ponder died July 17 of COVID-19. Her colleagues held a vigil for her on July 21.(National Nurses United)Instead, Hill said, staff on floors with COVID patients were provided lower-quality surgical masks, a concern reflected in complaints filed with Cal/OSHA.Hill believes that Paiste-Ponder and another nurse on her floor caught the virus from COVID patients who did not remain in their rooms.“It is sad, because it didn’t really need to happen,” Hill said.Polizzi said investigations into the July 17 death and another staff hospitalization are ongoing.A Sutter Health spokesperson said the hospital takes allegations, including Cal/OSHA complaints, seriously and its highest priority is keeping patients and staff safe.The statement also said “cohorting,” or the practice of grouping virus patients together, is a tool that “must be considered in a greater context, including patient acuity, hospital census and other environmental factors.”Concerns at Other HospitalsCDC guidelines are not strict on the topic of keeping COVID patients sectioned off, noting that “facilities could consider designating entire units within the facility, with dedicated [staff],” to care for COVID patients.That approach succeeded at the University of Nebraska Medical Center in Omaha.

A recent study reported “extensive” viral contamination around COVID patients there, but noted that with “standard” infection control techniques in place, staffers who cared for COVID patients did not get the virus.The hospital set up an isolation unit with air pumped away from the halls, restricted access to the unit and trained staff to use well-developed protocols and N95 respirators — at a minimum. What worked in Nebraska, though, is far from standard elsewhere.Cynthia Butler, a nurse and National Nurses United member at Fawcett Memorial Hospital in Port Charlotte, on Florida’s west coast, said she actually felt safer working in the COVID unit — where she knew what she was dealing with and had full PPE — than on a general medical floor.She believes she caught the virus from a patient who had COVID-19 but was housed on a general floor in May. A similar situation occurred in July, when another patient had an unexpected case of COVID — and Butler said she got another positive test herself.She said both patients did not meet the hospital’s criteria for testing admitted patients, and the lapses leave her on edge, concerns she relayed to an OSHA inspector who reached out to her about a complaint her union filed about the facility.“Every time I go into work it’s like playing Russian roulette,” Butler said.A spokesperson for HCA Healthcare, which owns the hospital, said it tests patients coming from long-term care, those going into surgery and those with virus symptoms.

She said staffers have access to PPE and practice vigilant sanitation, universal masking and social distancing.The latter is not an option for Butler, though, who said she cleans, feeds and starts IVs for patients and offers reassurance when they are isolated from family.“I’m giving them the only comfort or kind word they can get,” said Butler, who has since gone on unpaid leave over safety concerns. €œI’m in there doing that and I’m not being protected.”Given research showing that up to 45% of COVID patients are asymptomatic, UCSF Medical Center is testing everyone who’s admitted, said Dr. Robert Harrison, a University of California-San Francisco School of Medicine professor who consults on occupational health at the hospital.It’s done for the safety of staff and to reduce spread within the hospital, he said.

Those who test positive are separated into a COVID-only unit.And staff who spent more than 15 minutes within 6 feet of a not-yet-identified COVID patient in a less-protective surgical mask are typically sent home for two weeks, he said.Outside of academic medicine, though, front-line staff have turned to union leaders to push for such protections.In Southern California, leaders of the National Union of Healthcare Workers filed an official complaint with state hospital inspectors about the risks posed by intermingled COVID patients at Fountain Valley Regional Hospital in Orange County, part of for-profit Tenet Health. There, the complaint said, patients were not routinely tested for COVID-19 upon admission.One nursing assistant spent two successive 12-hour shifts caring for a patient on a general medical floor who required monitoring. At the conclusion of the second shift, she was told the patient had just been found to be COVID-positive.The worker had worn only a surgical mask — not an N95 respirator or any form of eye protection, according to the complaint to the California Department of Public Health.

The nursing assistant was not offered a COVID test or quarantined before her next two shifts, the complaint said.The public health department said it could not comment on a pending inspection.Barbara Lewis, Southern California hospital division director with the union, said COVID patients were on the same floor as cancer patients and post-surgical patients who were walking the halls to speed their recovery.She said managers took steps to separate the patients only after the union held a protest, spoke to local media and complained to state health officials.Hospital spokesperson Jessica Chen said the hospital “quickly implemented” changes directed by state health authorities and does place some COVID patients on the same nursing unit as non-COVID patients during surges. She said they are placed in single rooms with closed doors. COVID tests are given by physician order, she added, and employees can access them at other places in the community.It’s in contrast, Lewis said, to high-profile examples of the precautions that might be taken.“Now we’re seeing what’s happening with baseball and basketball — they’re tested every day and treated with a high level of caution,” Lewis said.

€œYet we have thousands and thousands of health care workers going to work in a very scary environment.”Nursing Homes Face Penalties More than 40% of the people who’ve died of COVID-19 lived in nursing homes or assisted living facilities, researchers have found.Patient mixing has been a scattered concern at nursing homes, which Medicare officials discovered when they reviewed infection control practices at more than 15,000 facilities.News reports have highlighted the problem at an Ohio nursing home and at a Maryland home where the state levied a $70,000 fine for failing to keep infected patients away from those who weren’t sick — yet.Another facing penalties was Fair Havens Center, a Miami Springs, Florida, nursing home where inspectors discovered that 11 roommates of patients who tested positive for COVID-19 were put in rooms with other residents — putting them at heightened risk.Florida regulators cut off admissions to the home and Medicare authorities levied a $235,000 civil monetary penalty, records show.The vice president of operations at the facility told inspectors that isolating exposed patients would mean isolating the entire facility. Everyone had been exposed to the 32 staff members who tested positive for the virus, the report says.Fair Havens Center did not respond to a request for comment.In Iowa, Medicare officials declared a state of “immediate jeopardy” at Pearl Valley Rehabilitation and Care Center in Muscatine. There, they discovered that staffers were in denial over an outbreak in their midst, with a nursing director overriding a community doctor’s orders to isolate or send residents to the emergency room.

Instead, officials found, in late April, the assistant nursing director kept COVID patients in the facility, citing a general order by their medical director to avoid sending patients to the ER “if you can help it.”Meanwhile, several patients were documented by facility staff to have fevers and falling oxygen levels, the Medicare inspection report shows. Within two weeks, the facility discovered it had an outbreak, with 61 residents infected and nine dead, according to the report.Medicare officials are investigating Menlo Park Veterans Memorial Home in New Jersey, state Sen. Joseph Vitale said during a recent legislative hearing.

Resident council president Glenn Osborne testified during the hearing that the home’s residents were returned to the same shared rooms after hospitalizations.Osborne, an honorably discharged Marine, said he saw more residents of the home die than fellow service members during his military service. The Menlo Park and Paramus veterans homes — where inspectors saw dementia patients with and without the virus commingling in a day room — both reported more than 180 COVID cases among residents, 90 among staff and at least 60 deaths.A spokesperson for the homes said he could not comment due to pending litigation.“These deaths should not have happened,” Osborne said. €œMany of these deaths were absolutely avoidable, in my humble opinion.” Christina Jewett.

ChristinaJ@kff.org, @by_cjewett Related Topics California Health Industry Public Health States CDC COVID-19 Hospitals Lost On The Frontline Nursing Homes.

This story is part of a partnership cheap catapres that includes NPR and Kaiser Health News. This story can cheap catapres be republished for free (details). After shutting down in the spring, America’s empty gyms are beckoning a cautious public back for a workout. To reassure wary customers, owners have put in place — and now advertise — a variety of coronavirus control measures. At the same time, the fitness industry is trying to rehabilitate itself by pushing back against what it sees as a misleading narrative that cheap catapres gyms have no place during a pandemic.In the first months of the coronavirus outbreak, most public health leaders advised closing gyms, erring on the side of caution. As infections exploded across the country, states ordered gyms and fitness centers closed, along with restaurants, movie theaters cheap catapres and bars.

State and local officials consistently branded gyms as high-risk venues for infection, akin to bars and nightclubs. In early cheap catapres August, New York Gov. Andrew Cuomo called gym-going a “dangerous activity,” saying he would keep them shut — only to announce later in the month that most gyms could reopen in September at a third of the capacity and under tight regulations.New York, New Jersey and North Carolina were among the last state holdouts — only recently allowing fitness facilities to reopen. Many states continue to limit capacity and have instituted new requirements.The benefits of cheap catapres gyms are clear. Regular exercise cheap catapres staves off depression and improves sleep, and staying fit may be a way to avoid a serious case of COVID-19.

But there are clear risks, too. Lots of people moving around indoors, sharing equipment and air, and breathing heavily cheap catapres could be a recipe for easy viral spread. There are scattered reports of coronavirus cases cheap catapres traced back to specific gyms. But gym owners say those are outliers and argue the dominant portrayal overemphasizes potential dangers and ignores their brief but successful track record of safety during the pandemic. Email Sign-Up Subscribe to KHN’s free cheap catapres Morning Briefing.

A Seattle gym struggles to comply with new rules and surviveAt NW Fitness in Seattle, everything from a set of squats to a run on the treadmill requires a mask. Every other cardio cheap catapres machine is off-limits. The owners have marked up the floor with blue tape to show where each person can cheap catapres work out.Esmery Corniel, a member, has resumed his workout routine with the punching bag.“I was honestly just losing my mind,” said Corniel, 27. He said he feels comfortable in the gym with its new safety protocols.“Everybody wears their mask, everybody socially distances, so it’s no problem here at all,” Corniel said.There’s no longer the usual morning “rush” of people working out before heading to their jobs.Under Washington state’s coronavirus rules, only about 10 to 12 people at a time are permitted in this 4,000-square-foot gym.“It’s drastically reduced our ability to serve our community,” said John Carrico. He and his cheap catapres wife, Jessica, purchased NW Fitness at the end of last year.John and Jessica Carrico run NW Fitness, a small gym in Seattle that has struggled to stay afloat during the pandemic.

Their membership has plummeted in recent months, in part because the gym has been closed and subject to strict coronavirus requirements.(Will Stone)Meanwhile, the cost of running the businesses has gone up dramatically. The gym now needs to be staffed round-the-clock to keep up with the frequent cleaning requirements, and to ensure people are wearing masks and following the rules.Keeping the gym open 24/7 — previously a big selling point for cheap catapres members — is no longer feasible. In the past three cheap catapres months, they’ve lost more than a third of their membership.“If the trend continues, we won’t be able to stay open,” said Jessica Carrico, who also works as a nurse at a homeless shelter run by Harborview Medical Center.Given her medical background, Jessica Carrico was initially inclined to trust the public health authorities who ordered all gyms to shut down, but gradually her feelings changed.“Driving around the city, I’d still see lines outside of pot shops and Baskin-Robbins,” she said. €œThe arbitrary decision that had been made was very clear, and it became really frustrating.”Even after gyms in the Seattle area were allowed to reopen, their frustrations continued — especially with the strict cap on operating capacity. The Carricos believe that falls hardest on smaller gyms cheap catapres that don’t have much square footage.“People want this space to be safe, and will self-regulate,” said John Carrico.

He believes he cheap catapres could responsibly operate with twice as many people inside as currently allowed. Public health officials have mischaracterized gyms, he added, and underestimated their potential to operate safely.“There’s this fear-based propaganda that gyms are a cesspool of coronavirus, which is just super not true,” Carrico said.Gyms seem less risky than bars. But there’s very cheap catapres little research either wayThe fitness industry has begun to push back at the pandemic-driven perceptions and prohibitions. €œWe should not be lumped with bars and restaurants,” said Helen Durkin, an executive vice president for the International Health, Racquet &. Sportsclub Association cheap catapres (IHRSA).John Carrico called the comparison with bars particularly unfair.

€œIt’s almost laughable cheap catapres. I mean, it’s almost the exact opposite. €¦ People here cheap catapres are investing in their health. They’re coming in, they’re focusing cheap catapres on what they’re trying to do as far as their workout. They’re not socializing, they’re not sitting at a table and laughing and drinking.”Since the pandemic began, many gyms have overhauled operations and now look very different.

Locker rooms are often closed and group classes cheap catapres halted. Many gyms check everyone for symptoms upon arrival. They’ve spaced cheap catapres out equipment and begun intensive cleaning regimes.Gyms have a big advantage over other retail and entertainment venues, Durkin said, because the membership model means those who may have been exposed in an outbreak can be easily contacted.A company that sells member databases and software to gyms has been compiling data during the pandemic. (The data, drawn from cheap catapres 2,877 gyms, is by no means comprehensive because it relies on gym owners to self-report incidents in which a positive coronavirus case was detected at the gym, or was somehow connected to the gym.) The resultant report said that the overall “visits to virus” ratio of 0.002% is “statistically irrelevant” because only 1,155 cases of coronavirus were reported among more than 49 million gym visits. Similarly, data collected from gyms in the United Kingdom found only 17 cases out of more than 8 million visits in the weeks after gyms reopened there.Only a few U.S.

States have publicly available information on outbreaks cheap catapres linked to the fitness sector, and those states report very few cases. In Louisiana, for example, the state has identified five clusters originating in “gym/fitness settings,” with a total of 31 cases. None of cheap catapres the people died. By contrast, 15 clusters were traced to “religious services/events,” sickening 78, and killing five of them.“The whole idea that it’s a cheap catapres risky place to be … around the world, we just aren’t seeing those numbers anywhere,” said IHRSA’s Durkin.A study from South Korea published by the Centers for Disease Control and Prevention is often cited as evidence of the inherent hazards of group fitness activities.The study traced 112 coronavirus infections to a Feb. 15 training workshop for fitness dance instructors.

Those instructors went on to teach classes at 12 sports facilities in February and March, transmitting the virus to students in the dance classes, but also to co-workers and family members.But defenders of the fitness industry point out that the outbreak began before South Korea instituted social distancing measures.The study authors note that the classes were cheap catapres crowded and the pace of the dance workouts was fast, and conclude that “intense physical exercise in densely populated sports facilities could increase the risk for infection” and “should be minimized during outbreaks.” They also found that no transmission occurred in classes with fewer than five people, or when an infected instructor taught “lower-intensity” classes such as yoga and Pilates.Linda Rackner with PRO Club in Bellevue, Washington, says the enormous, upscale gym has adapted relatively easily to the new coronavirus rules. The fitness club’s physical size, extensive budget and technology have helped staffers maintain cheap catapres a fairly normal experience for their members.(Will Stone)Public health experts continue to urge gym members to be cautiousIt’s clear that there are many things gym owners — and gym members — can do to lower the risk of infection at a gym, but that doesn’t mean the risk is gone. Infectious disease doctors and public health experts caution that gyms should not downplay their potential for spreading disease, especially if the coronavirus is widespread in the surrounding community.“There are very few [gyms] that can actually implement all the infection control measures,” said Saskia Popescu, an infectious disease epidemiologist in Phoenix. €œThat’s really the challenge cheap catapres with gyms. There is so much variety that it makes it hard to put them into a single box.”Popescu and two colleagues developed a COVID-19 risk chart for various activities.

Gyms were classified as “medium high,” on par with eating indoors at a restaurant or getting a haircut, but less risky than going to a bar or riding public transit.Popescu acknowledges there’s not much recent evidence that cheap catapres gyms are major sources of infection, but that should not give people a false sense of assurance.“The mistake would be to assume that there is no risk,” she said. €œIt’s just that a lot of the prevention strategies have been working, and when we start to loosen those, cheap catapres though, is where you’re more likely to see clusters occur.”Any location that brings people together indoors increases the risk of contracting the coronavirus, and breathing heavily adds another element of risk. Interventions such as increasing the distance between cardio machines might help, but tiny infectious airborne particles can travel farther than 6 feet, Popescu said.The mechanics of exercising also make it hard to ensure people comply with crucial preventive measures like wearing a mask.“How effective are masks in that setting?. Can they really be effectively cheap catapres worn?. € asked Dr.

Deverick Anderson, director of the Duke Center for cheap catapres Antimicrobial Stewardship and Infection Prevention. €œThe combination of sweat and exertion is one unique thing about the gym setting.”“I do think that, in the big picture, gyms would be riskier than restaurants because of the type of activity and potential for interaction there,” Anderson said.The primary way people could catch cheap catapres the virus at a gym would be coming close to someone who is releasing respiratory droplets and smaller airborne particles, called “aerosols,” when they breathe, talk or cough, said Dr. Dean Blumberg, chief of pediatric infectious diseases at UC Davis Health.He’s less worried about people catching the virus from touching a barbell or riding a stationary bike that someone else used. That’s because scientists now think “surface” transmission isn’t driving infection as much cheap catapres as airborne droplets and particles.“I’m not really worried about transmission that way,” Blumberg said. €œThere’s too much attention being paid to disinfecting surfaces and ‘deep cleaning,’ spraying cheap catapres things in the air.

I think a lot of that’s just for show.”Blumberg said he believes gyms can manage the risks better than many social settings like bars or informal gatherings.“A gym where you can adequately social distance and you can limit the number of people there and force mask-wearing, that’s one of the safer activities,” he said.Adapting to the pandemic’s prohibitions doesn’t come cheapIn Bellevue, Washington, PRO Club is an enormous, upscale gym with spacious workout rooms — and an array of medical services such as physical therapy, hormone treatments, skin care and counseling. PRO Club has managed to keep cheap catapres the gym experience relatively normal for members since reopening, according to employee Linda Rackner. €œThere is plenty of space for everyone. We are cheap catapres seeing about 1,000 people a day and have capacity for almost 3,000,” Rackner said. €œWe’d love cheap catapres to have more people in the club.”The gym uses the same air-cleaning units as hospital ICUs, deploys ultraviolet robots to sanitize the rooms and requires temperature checks to enter.

€œI feel like we have good compliance,” said Dean Rogers, one of the personal trainers. €œFor the most part, people who come to a gym are in it for their own health, fitness and wellness.”But Rogers knows this isn’t the norm cheap catapres everywhere. In fact, his own mother back in Oklahoma believes she contracted the coronavirus cheap catapres at her gym.“I was upset to find out that her gym had no guidelines they were following, no safety precautions,” he said. €œThere are always going to be some bad actors.”This story is part of a partnership that includes NPR and Kaiser Health News. Carrie Feibel, an editor cheap catapres for the NPR-KHN reporting partnership, contributed to this story.

Related Topics Multimedia Public Health States Audio COVID-19 WashingtonThis story also ran on CNN. This story can be republished for free (details). CLEVELAND — Families skipping or delaying pediatric appointments for their young children because of the pandemic are missing out on more than vaccines. Critical testing for lead poisoning has plummeted in many parts of the country.In the Upper Midwest, Northeast and parts of the West Coast — areas with historically high rates of lead poisoning — cheap catapres the slide has been the most dramatic, according to the Centers for Disease Control and Prevention. In states such as Michigan, Ohio and Minnesota, testing for the brain-damaging cheap catapres heavy metal fell by 50% or more this spring compared with 2019, health officials report.“The drop-off in April was massive,” said Thomas Largo, section manager of environmental health surveillance at the Michigan Department of Health and Human Services, noting a 76% decrease in testing compared with the year before. €œWe weren’t quite prepared for that.” Don't Miss A Story Subscribe to KHN’s free Weekly Edition newsletter. Blood tests for lead, the only way to tell if a child has been exposed, are cheap catapres typically performed by pricking a finger or heel or tapping a vein at 1- and 2-year-old well-child visits.

A blood test with elevated lead levels triggers the next critical steps in accessing early intervention for the behavioral, learning and health effects of lead poisoning and also identifying the source of the lead to prevent further harm.Because of the pandemic, though, the drop in blood tests means referrals for critical home inspections plus medical and educational services are falling, too. And that means help isn’t reaching poisoned kids, a one-two punch, particularly in communities of color, said Yvonka Hall, a lead poisoning cheap catapres prevention advocate and co-founder of the Cleveland Lead Safe Network. And this all comes amid COVID-related school and child care closures, meaning kids who are at cheap catapres risk are spending more time than ever in the place where most exposure happens. The home.“Inside is dangerous,” Hall said.The CDC estimates about 500,000 U.S. Children between ages 1 and 5 have been poisoned by lead, probably an underestimate due to the lack of widespread testing in many communities and cheap catapres states.

In 2017, more than 40,000 children had elevated blood lead levels, defined as higher than 5 micrograms per deciliter of blood, in the 23 states that reported data.While preliminary June and July data in some states indicates lead testing is picking up, it’s nowhere near as high as it would need to be to catch up on the kids who missed appointments in the cheap catapres spring at the height of lockdown orders, experts say. And that may mean some kids will never be tested.“What I’m most worried about is that the kids who are not getting tested now are the most vulnerable — those are the kids I’m worried might not have a makeup visit,” said Stephanie Yendell, senior epidemiology supervisor in the health risk intervention unit at the Minnesota Department of Health.Lifelong ConsequencesThere’s a critical window for conducting lead poisoning blood tests, timed to when children are crawling or toddling and tend to put their hands on floors, windowsills and door frames and possibly transfer tiny particles of lead-laden dust to their mouths.Children at this age are more likely to be harmed because their rapidly growing brains and bodies absorb the element more readily. Lead poisoning can’t be reversed cheap catapres. Children with lead poisoning are more likely to fall behind in school, end up in jail or suffer lifelong health problems such as kidney and heart disease.That’s why lead tests are required at ages 1 and 2 for children receiving federal Medicaid benefits, the population most likely to be poisoned because of low-quality housing options. Tests are also recommended for all children living in high-risk ZIP codes with older housing cheap catapres stock and historically high levels of lead exposure.Testing fell far short of recommendations in many parts of the country even before the pandemic, though, with one recent study estimating that in some states 80% of poisoned children are never identified.

And when tests are required, there has been little enforcement of the rule.Early in the pandemic, officials in New York’s Erie County bumped up the threshold for sending a public cheap catapres health worker into a family’s home to investigate the source of lead exposure from 5 micrograms per deciliter to 45 micrograms per deciliter (a blood lead level that usually requires hospitalization), said Dr. Gale Burstein, that county’s health commissioner. For all other cases during that period, officials inspected only the outside of the child’s home for potential hazards.About 700 fewer children were tested for lead in Erie County in April than in the same month last year, a drop of about cheap catapres 35%.Ohio, which has among the highest levels of lead poisoning in the country, recently expanded automatic eligibility for its Early Intervention program to any child with an elevated blood lead test, providing the opportunity for occupational, physical and speech therapy. Learning supports for cheap catapres school. And developmental assessments.

If kids with lead poisoning cheap catapres don’t get tested, though, they won’t be referred for help.In early April, there were only three referrals for elevated lead levels in the state, which had been fielding nine times as many on average in the months before the pandemic, said Karen Mintzer, director of Bright Beginnings, which manages them for Ohio’s Department of Developmental Disabilities. €œIt basically was a complete stop,” she said. Since mid-June, referrals have recovered and are now above pre-pandemic levels.“We should treat every child with lead poisoning as a medical emergency,” said John Belt, principal investigator for the Ohio Department of cheap catapres Health’s lead poisoning program. €œNot identifying them is going to delay the available services, and in some cases lead to a cognitive deficit.”Pandemic Compounds WorriesOne of the big worries about the drop in lead testing is that it’s happening at a time when exposure to lead-laden cheap catapres paint chips, soil and dust in homes may be spiking because of stay-at-home orders during the pandemic.Exposure to lead dust from deteriorating paint, particularly in high-friction areas such as doors and windows, is the most common cause of lead exposure for children in the U.S.“I worry about kids in unsafe housing, more so during the pandemic, because they’re stuck there during the quarantine,” said Dr. Aparna Bole, a pediatrician at Cleveland’s University Hospitals Rainbow Babies &.

Children’s Hospital.The pandemic may also compound exposure to cheap catapres lead, experts fear, as both landlords and homeowners try to tackle renovation projects without proper safety precautions while everyone is at home. Or the economic fallout of the crisis could mean some people can no longer afford to clean up known lead hazards at all.“If you’ve lost your job, it’s going to make it difficult to get new windows, or even repaint,” said Yendell.The CDC says it plans to help state and local health departments track down children who missed lead tests. Minnesota plans to identify pediatric clinics with particularly steep drops in lead testing to figure out why, said Yendell.But, Yendell cheap catapres said, that will likely have to wait until the pandemic is over. €œRight now I’m spending 10-20% of my time on lead, and the rest is COVID.”The pandemic has stretched already thinly staffed local health departments to the brink, health officials say, and it may take years to know the full impact of the missed testing cheap catapres. For the kids who’ve been poisoned and had no intervention, the effects may not be obvious until they enter school and struggle to keep up.

Brie Zeltner cheap catapres. @BrieZeltner Related Topics Public Health CDC Children's Health COVID-19 Michigan cheap catapres Minnesota New York Ohio StudyCan’t see the audio player?. Click here to listen on SoundCloud. The headlines from this cheap catapres week will be about how President Donald Trump knew early on how serious the coronavirus pandemic was likely to become but purposely played it down. Potentially more important during the past few weeks, though, are reports of how White House officials have pushed scientists at the federal government’s leading health agencies to put politics above science.Meanwhile, Republicans appear to have given up on using the Affordable Care Act as an electoral cudgel, judging, at least, from its scarce mention during the GOP convention.

Democrats, on the other hand, cheap catapres particularly those running for the U.S. House and Senate, cheap catapres are doubling down on their criticism of Republicans for failing to adequately protect people with preexisting health conditions. That issue was key to the party winning back the House in 2018.This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Sarah Karlin-Smith of the Pink Sheet.Among the takeaways from this week’s podcast:The Affordable Care Act has become a political vulnerability for Republican officials, who have no interest in reopening the debate on it during this campaign. Trump vowed cheap catapres before his 2016 election to repeal the law immediately after taking office and members of Congress had berated it for years. But they could not gain the political capital to overturn Obamacare.Trump’s comments to journalist-author Bob Woodward about holding back information on the risks of the coronavirus pandemic from the public may not have a major effect on the election since so many voters’ minds are already set on their choices.

For many, the president’s statements are seen by partisans as identifying cheap catapres what they already believe. For Trump’s supporters, cheap catapres that he is protecting the public. For his critics, that he is a liar.The number of COVID-19 cases appears to have hit another plateau, but it’s still twice as high as the count last spring. Officials are waiting cheap catapres to see if end-of-the-summer activities over the Labor Day holiday will create another surge.The stalemate on Capitol Hill over coronavirus relief funding shows no sign of easing soon. Republicans in the Senate are resisting Democrats’ insistence on a massive package, but it’s not exactly clear what the GOP can agree on.The vaccine being developed by AstraZeneca ran into difficulty this week as experts cheap catapres seek to determine whether a neurological problem that developed in one volunteer was caused by the vaccine.

Some public health officials, such as NIH Director Francis Collins, said this helps show that even with the compressed testing timeline, safeguards are working.Nonetheless, another vaccine maker, Pfizer, said it might still have its vaccine ready before the election.The recent controversy at the FDA over the emergency authorization of plasma to treat COVID patients and the awkward decision at the Centers for Disease Control and Prevention to change guidelines for testing asymptomatic people have created a credibility gap among some Americans and played into concerns that the administration is undercutting science.Also this week, Rovner interviews KHN’s Elizabeth Lawrence, who reported the August NPR-KHN “Bill of the Month” installment, about an appendectomy gone wrong, and the very big bill that followed. If you have an outrageous medical bill you would like to share with us, you can do that here.Plus, for extra credit, the panelists cheap catapres recommend their favorite health policy stories of the week they think you should read too:Julie Rovner. ProPublica’s “A Doctor Went to His Own Employer for a COVID-19 Antibody Test. It Cost $10,984,” cheap catapres by Marshall AllenJoanne Kenen. The Atlantic’s “America Is Trapped cheap catapres in a Pandemic Spiral,” by Ed YongSarah Karlin-Smith.

Politico’s “Emails Show HHS Official Trying to Muzzle Fauci,” by Sarah OwermohleMary Ellen McIntire. The Atlantic’s “What Young, Healthy People Have to Fear From COVID-19,” by Derek ThompsonTo hear all our podcasts, click here.And cheap catapres subscribe to What the Health?. on iTunes, Stitcher, Google Play, Spotify, or Pocket cheap catapres Casts. Related Topics Elections Multimedia Public Health The Health Law CDC COVID-19 FDA KHN's 'What The Health?. ' NIH Podcasts Trump Administration U.S cheap catapres.

Congress VaccinesSOBRE NOTICIAS EN ESPAÑOLNoticias en español es una sección de Kaiser Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que vive en los Estados Unidos. Use Nuestro Contenido Este contenido puede usarse de manera cheap catapres gratuita (detalles). El gobernador de Florida, Ron DeSantis, trató de aliviar el temor a volar durante la pandemia en un evento con ejecutivos de aerolíneas y compañías de alquiler de autos.“Los aviones simplemente no han sido vectores cuando se observa la propagación del coronavirus”, dijo DeSantis en el encuentro en el cheap catapres Aeropuerto Internacional Fort Lauderdale-Hollywood el 28 de agosto. “La evidencia es la evidencia. Y creo que es algo cheap catapres que la gente puede hacer con seguridad “, agregó.¿La evidencia es realmente tan clara?.

La afirmación de DeSantis de que los aviones no han sido “vectores” de la propagación del coronavirus es falsa, según expertos. Un “vector” disemina el virus de un lugar a otro, y los cheap catapres aviones han transportado a pasajeros infectados a través de distintas regiones, lo que hace que los brotes de COVID-19 sean más difíciles de contener.Joseph Allen, profesor asociado en la Universidad de Harvard y experto en exposiciones a virus, calificó a los aviones como “excelentes vectores para la propagación viral” en una llamada de prensa.En contexto, DeSantis parecía estar haciendo hincapié en la seguridad de volar en avión en lugar del papel que desempeñaron los aviones en la propagación del virus de un lugar a otro.Cuando se le consultó a la oficina del gobernador sobre datos que respaldaran los comentarios de DeSantis, el secretario de prensa Cody McCloud no presentó ningún estudio ni estadística. En cambio, citó el programa de rastreo de contactos del Departamento de Salud de Florida y escribió que “no ha proporcionado ninguna información cheap catapres que sugiera que algún paciente se haya infectado mientras viajaba en un vuelo comercial”.El programa de rastreo de contactos de Florida se ha visto envuelto en una controversia sobre informes que denuncian que no tiene suficiente personal y que es ineficaz. CNN llamó a 27 residentes del estado que dieron positivo para COVID-19 y descubrió que solo cinco habían sido contactados por las autoridades de salud. (El Departamento de Salud de Florida no respondió a las solicitudes de entrevista).Expertos aseguran que, en general, los aviones brindan ambientes seguros en lo que respecta a la calidad del aire, pero agregaron que el riesgo de infección depende en gran medida de las políticas que las aerolíneas puedan tener sobre los asientos de los pasajeros, el uso de máscaras y el tiempo de embarque.Según indicaron, cheap catapres el riesgo de contraer el coronavirus en un avión es relativamente bajo si la aerolínea sigue los procedimientos de salud pública.

Hacer cumplir la regla de usar máscara, espaciar los asientos disponibles y examinar a los pasajeros enfermos.“Si observas cheap catapres otras enfermedades, ves pocos brotes en aviones”, dijo Allen. €œNo son los semilleros de infección que la gente cree que son”.Las aerolíneas señalan con frecuencia que los aviones comerciales están equipados con filtros de aire HEPA, recomendados por los Centros para el Control y Prevención de Enfermedades (CDC), que se utilizan en las salas de aislamiento de los hospitales.Los filtros HEPA capturan el 99,97% de las partículas en el aire y reducen sustancialmente el riesgo de propagación viral. Además, el aire en las cabinas se renueva por completo entre 10 y 12 veces por hora, elevando la calidad del aire por cheap catapres encima de la de un edificio normal.Debido a la alta tasa de renovación del aire, es poco probable que se contraiga el coronavirus de alguien sentado a varias filas de distancia. Sin embargo, sí podría ocurrir el contagio de alguien cercano.“El mayor riesgo durante el vuelo sería si el pasajero se sienta cerca de alguien que pueda infectar”, dijo Richard Corsi, quien estudia la contaminación del aire en interiores y es decano de Ingeniería en Universidad Estatal de Portland.También es importante señalar que los sistemas de filtración de alta potencia de los aviones no son suficientes por sí solos para prevenir brotes. Si una aerolínea no mantiene libres los asientos del medio ni hace cumplir rigurosamente el cheap catapres uso de máscaras, volar puede ser bastante peligroso.

Actualmente, las aerolíneas cheap catapres nacionales que mantienen abiertos los asientos intermedios incluyen Delta, Hawaiian, Southwest y JetBlue.La razón de esto es que las personas infectadas envían partículas virales al aire a un ritmo más rápido que el que los aviones las expulsan fuera de la cabina. €œSiempre que tose, habla o respira, está enviando gotitas”, dijo Qingyan Chen, profesor de ingeniería mecánica en la Universidad Purdue. €œEstas gotas están en la cabina todo el tiempo”.Esto hace que las medidas de protección adicionales, como el uso de máscaras, sean aún más necesarias.Chen citó dos vuelos internacionales anteriores cheap catapres a la pandemia donde las tasas de infección variaron según el uso de mascarillas. En el primer vuelo, ningún pasajero llevaba cheap catapres máscaras y un solo pasajero infectó a 14 personas mientras el avión viajaba de Londres a Hanoi, Vietnam. En el segundo vuelo, de Singapur a Hangzhou, en China, todos los pasajeros llevaban máscaras faciales.Aunque 15 pasajeros eran residentes de Wuhan con casos sospechosos o confirmados de COVID-19, el único hombre infectado en el recorrido se había aflojado la máscara en pleno vuelo y había estado sentado cerca de cuatro residentes de Wuhan que luego dieron positivo para el virus.Pero, aunque volar es una actividad de riesgo relativamente bajo, se debe evitar viajar a menos que sea absolutamente necesario.“Cualquier cosa que te ponga en contacto con más personas aumentará el riesgo”, dijo Cindy Prins, profesora clínica asociada de Epidemiología en la Escuela de Salud Pública y Profesiones de la Salud de la Universidad de Florida.El verdadero peligro de viajar no es el vuelo en sí.

Sin embargo, pasar por cheap catapres el control de seguridad y esperar en la puerta de embarque es probable que ponga a la persona en contacto cercano con otros y aumente sus posibilidades de contraer el virus.Además, abordar, cuando el sistema de ventilación del avión no está funcionando y las personas no pueden mantenerse alejadas entre sí, es una de las partes más riesgosas. €œReducir este tiempo es importante para bajar la exposición”, escribió Corsi. €œHay que llegar al asiento con la máscara y sentarse lo más rápido posible”.Con todo, es demasiado pronto para determinar cuánta transmisión de persona a persona ha ocurrido en vuelos.Julian Tang, profesor cheap catapres asociado honorario en el Departamento de Ciencias Respiratorias de la Universidad de Leicester, en Inglaterra, dijo que está al tanto de varios grupos de infecciones relacionadas con los viajes aéreos. Sin embargo, es un desafío demostrar que las personas contrajeron el virus en un vuelo.“Alguien que presenta síntomas de COVID-19 varios días después de llegar a su destino podría haberse infectado en casa antes de llegar al aeropuerto, mientras estaba en el aeropuerto o en el vuelo, o incluso al llegar al aeropuerto de destino, porque todo el mundo tiene un período de incubación variable”, dijo Tang.Katherine Estep, vocera de Airlines for America, un grupo comercial de la industria centrado en Estados Unidos, dijo que los CDC no han confirmado ningún caso de transmisión a bordo de una cheap catapres aerolínea estadounidense.La ausencia de transmisión confirmada no es necesariamente una prueba de que los viajeros estén seguros. En cambio, la falta de datos refleja el hecho de que Estados Unidos tiene una tasa de infección más alta en comparación con otros países, dijo Chen.

Dado que cheap catapres tiene tantos casos confirmados, es más difícil determinar exactamente dónde alguien contrajo el virus. Related Topics Noticias En Español Public Health COVID-19 KHN &. PolitiFact HealthCheckThis story also ran on NPR. This story can be republished for free (details). Nurses at Alta Bates Summit Medical Center were on edge as early as March when patients with COVID-19 began to show up in areas of the cheap catapres hospital that were not set aside to care for them. Explore Our Database KHN and cheap catapres The Guardian are tracking health care workers who died from COVID-19 and writing about their lives and what happened in their final days. The Centers for Disease Control and Prevention had advised hospitals to isolate COVID patients to limit staff exposure and help conserve high-level personal protective equipment that’s been in short supply.Yet COVID patients continued to be scattered through the Oakland hospital, according to complaints to California’s Division of Occupational Safety and Health.

The concerns included the sixth-floor medical unit where cheap catapres veteran nurse Janine Paiste-Ponder worked.COVID patients on that floor were not staying in their rooms, either confused or uninterested in the rules. Staff was not provided highly protective N95 respirators, said Mike Hill, a nurse in the hospital intensive care unit and the hospital’s chief representative for the California Nurses Association, which filed complaints to cheap catapres Cal/OSHA, the state’s workplace safety regulator. “It was just a matter of time before one of the nurses died on one of these floors,” Hill said.Two nurses fell ill, including Paiste-Ponder, 59, who died of complications from the virus on July 17.The concerns raised in Oakland also have swept across the U.S., according to interviews, a review of government workplace safety complaints and health facility inspection reports. A KHN investigation found that dozens of nursing homes and hospitals ignored official guidelines to separate COVID patients from those without the coronavirus, in some places fueling its spread and leaving staff unprepared and infected or, in some cases, dead.As recently as July, a National Nurses United survey of more than 21,000 nurses found that 32% work in a facility that does not have a dedicated cheap catapres COVID unit. At that time, the coronavirus had reached all but 17 U.S.

Counties, data collected by Johns Hopkins University shows.California Nurses Association members had complained to Cal/OSHA about COVID patients being spread throughout Alta Bates Summit Medical Center and say the practice was a factor in Janine Paiste-Ponder’s illness and death.(National Nurses United)KHN discovered that COVID victims have been commingled with uninfected patients in health cheap catapres care facilities in states including California, Florida, New Jersey, Iowa, Ohio, Maryland and New York.A COVID-19 outbreak was in full swing at the New Jersey Veterans Home at Paramus in late April when health inspectors observed residents with dementia mingling in a day room — COVID-positive patients as well as others awaiting test results. At the time, the center had already reported COVID infections among 119 residents and 46 virus-related deaths, according to a Medicare inspection report.The assistant director of nursing at an Iowa nursing home insisted April 28 that they did “not have any COVID in the building” and overrode the orders of a community doctor to isolate several patients with fevers and falling oxygen levels, an inspection report shows.By mid-May, the facility’s COVID log showed 61 patients with the virus and nine dead.Federal work-safety officials have closed at least 30 complaints about patient cheap catapres mixing in hospitals nationwide without issuing a citation. They include a claim that a Michigan hospital kept patients who tested negative for the virus in the COVID unit in May. An upstate New York hospital also had COVID patients in the same unit as those with no infection, according to cheap catapres a closed complaint to the federal Occupational Safety and Health Administration. Email Sign-Up Subscribe to KHN’s free Morning Briefing.

Federal Health and Human Services officials cheap catapres have called on hospitals to tell them each day if they have a patient who came in without COVID-19 but had an apparent or confirmed case of the coronavirus 14 days later. Hospitals filed 48,000 reports from June 21 through Aug cheap catapres. 28, though the number reflects some double or additional counting of individual patients.COVID patients have been mixed in with others for a variety of reasons. Some hospitals report having limited tests, so patients carrying the virus are identified only after they had already cheap catapres exposed others. In other cases, they cheap catapres had false-negative test results or their facility was dismissive of federal guidelines, which carry no force of law.And while federal Medicare officials have inspected nearly every U.S.

Nursing home in recent months and states have occasionally levied fines and cut off new admissions for isolation lapses, hospitals have seen less scrutiny.The Scene Inside SutterAt Alta Bates in Oakland, part of the Sutter Health network, hospital staff made it clear in official complaints to Cal/OSHA that they wanted administrators to follow the state’s unique law on aerosol-transmitted diseases. From the start, some staffers wanted all the state-required protections for a virus that has been increasingly shown to be transmitted by tiny particles that float through the air.The regulations call for patients with a virus like COVID-19 to be moved to a specialized unit within five hours of identification — or to cheap catapres a specialized facility. The rules say those patients should be in a room with a HEPA filter or with negative air pressure, meaning that air is circulated out a window or exhaust fan instead of drifting into the hallway.Initially, in March, the hospital outfitted a 40-bed COVID unit, according to Hill. But when a surge of patients failed to materialize, that unit was pared cheap catapres to 12 beds.Since then, a steady stream of virus patients have been admitted, he said, many testing positive only days after admission — and after they’d been in regular rooms in the facility.From March 10 through July 30, Hill’s union and others filed eight complaints to Cal/OSHA, including allegations that the hospital failed to follow isolation rules for COVID patients, some on the cancer floor.So far, regulators have done little. Gov.

Gavin Newsom had ordered workplace safety officials to “focus on … supporting compliance” instead of enforcement except on the “most serious violations.”State officials responded to complaints by reaching out by mail and phone to “ensure the proper virus prevention measures are in place,” according to Frank Polizzi, a spokesperson for Cal/OSHA.A third investigation related to transport workers not wearing N95 respirators while moving COVID-positive or possible coronavirus patients at a Sutter facility near the hospital resulted in a $6,750 fine, Cal/OSHA records show.The string of complaints also says the hospital did not give staff the necessary personal protective equipment (PPE) under state law — an N95 respirator or something more protective — for caring for virus patients.Nurse Janine Paiste-Ponder died July 17 of COVID-19. Her colleagues held a vigil for her on July 21.(National Nurses United)Instead, Hill said, staff on floors with COVID patients were provided lower-quality surgical masks, a concern reflected in complaints filed with Cal/OSHA.Hill believes that Paiste-Ponder and another nurse on her floor caught the virus from COVID patients who did not remain in their rooms.“It is sad, because it didn’t really need to happen,” Hill said.Polizzi said investigations into the July 17 death and another staff hospitalization are ongoing.A Sutter Health spokesperson said the hospital takes allegations, including Cal/OSHA complaints, seriously and its highest priority is keeping patients and staff safe.The statement also said “cohorting,” or the practice of grouping virus patients together, is a tool that “must be considered in a greater context, including patient acuity, hospital census and other environmental factors.”Concerns at Other HospitalsCDC guidelines are not strict on the topic of keeping COVID patients sectioned off, noting that “facilities could consider designating entire units within the facility, with dedicated [staff],” to care for COVID patients.That approach succeeded at the University of Nebraska Medical Center in Omaha. A recent study reported “extensive” viral contamination around COVID patients there, but noted that with “standard” infection control techniques in place, staffers who cared for COVID patients did not get the virus.The hospital set up an isolation unit with air pumped away from the halls, restricted access to the unit and trained staff to use well-developed protocols and N95 respirators — at a minimum. What worked in Nebraska, though, is far from standard elsewhere.Cynthia Butler, a nurse and National Nurses United member at Fawcett Memorial Hospital in Port Charlotte, on Florida’s west coast, said she actually felt safer working in the COVID unit — where she knew what she was dealing with and had full PPE — than on a general medical floor.She believes she caught the virus from a patient who had COVID-19 but was housed on a general floor in May. A similar situation occurred in July, when another patient had an unexpected case of COVID — and Butler said she got another positive test herself.She said both patients did not meet the hospital’s criteria for testing admitted patients, and the lapses leave her on edge, concerns she relayed to an OSHA inspector who reached out to her about a complaint her union filed about the facility.“Every time I go into work it’s like playing Russian roulette,” Butler said.A spokesperson for HCA Healthcare, which owns the hospital, said it tests patients coming from long-term care, those going into surgery and those with virus symptoms.

She said staffers have access to PPE and practice vigilant sanitation, universal masking and social distancing.The latter is not an option for Butler, though, who said she cleans, feeds and starts IVs for patients and offers reassurance when they are isolated from family.“I’m giving them the only comfort or kind word they can get,” said Butler, who has since gone on unpaid leave over safety concerns. €œI’m in there doing that and I’m not being protected.”Given research showing that up to 45% of COVID patients are asymptomatic, UCSF Medical Center is testing everyone who’s admitted, said Dr. Robert Harrison, a University of California-San Francisco School of Medicine professor who consults on occupational health at the hospital.It’s done for the safety of staff and to reduce spread within the hospital, he said. Those who test positive are separated into a COVID-only unit.And staff who spent more than 15 minutes within 6 feet of a not-yet-identified COVID patient in a less-protective surgical mask are typically sent home for two weeks, he said.Outside of academic medicine, though, front-line staff have turned to union leaders to push for such protections.In Southern California, leaders of the National Union of Healthcare Workers filed an official complaint with state hospital inspectors about the risks posed by intermingled COVID patients at Fountain Valley Regional Hospital in Orange County, part of for-profit Tenet Health. There, the complaint said, patients were not routinely tested for COVID-19 upon admission.One nursing assistant spent two successive 12-hour shifts caring for a patient on a general medical floor who required monitoring.

At the conclusion of the second shift, she was told the patient had just been found to be COVID-positive.The worker had worn only a surgical mask — not an N95 respirator or any form of eye protection, according to the complaint to the California Department of Public Health. The nursing assistant was not offered a COVID test or quarantined before her next two shifts, the complaint said.The public health department said it could not comment on a pending inspection.Barbara Lewis, Southern California hospital division director with the union, said COVID patients were on the same floor as cancer patients and post-surgical patients who were walking the halls to speed their recovery.She said managers took steps to separate the patients only after the union held a protest, spoke to local media and complained to state health officials.Hospital spokesperson Jessica Chen said the hospital “quickly implemented” changes directed by state health authorities and does place some COVID patients on the same nursing unit as non-COVID patients during surges. She said they are placed in single rooms with closed doors. COVID tests are given by physician order, she added, and employees can access them at other places in the community.It’s in contrast, Lewis said, to high-profile examples of the precautions that might be taken.“Now we’re seeing what’s happening with baseball and basketball — they’re tested every day and treated with a high level of caution,” Lewis said. €œYet we have thousands and thousands of health care workers going to work in a very scary environment.”Nursing Homes Face Penalties More than 40% of the people who’ve died of COVID-19 lived in nursing homes or assisted living facilities, researchers have found.Patient mixing has been a scattered concern at nursing homes, which Medicare officials discovered when they reviewed infection control practices at more than 15,000 facilities.News reports have highlighted the problem at an Ohio nursing home and at a Maryland home where the state levied a $70,000 fine for failing to keep infected patients away from those who weren’t sick — yet.Another facing penalties was Fair Havens Center, a Miami Springs, Florida, nursing home where inspectors discovered that 11 roommates of patients who tested positive for COVID-19 were put in rooms with other residents — putting them at heightened risk.Florida regulators cut off admissions to the home and Medicare authorities levied a $235,000 civil monetary penalty, records show.The vice president of operations at the facility told inspectors that isolating exposed patients would mean isolating the entire facility.

Everyone had been exposed to the 32 staff members who tested positive for the virus, the report says.Fair Havens Center did not respond to a request for comment.In Iowa, Medicare officials declared a state of “immediate jeopardy” at Pearl Valley Rehabilitation and Care Center in Muscatine. There, they discovered that staffers were in denial over an outbreak in their midst, with a nursing director overriding a community doctor’s orders to isolate or send residents to the emergency room. Instead, officials found, in late April, the assistant nursing director kept COVID patients in the facility, citing a general order by their medical director to avoid sending patients to the ER “if you can help it.”Meanwhile, several patients were documented by facility staff to have fevers and falling oxygen levels, the Medicare inspection report shows. Within two weeks, the facility discovered it had an outbreak, with 61 residents infected and nine dead, according to the report.Medicare officials are investigating Menlo Park Veterans Memorial Home in New Jersey, state Sen. Joseph Vitale said during a recent legislative hearing.

Resident council president Glenn Osborne testified during the hearing that the home’s residents were returned to the same shared rooms after hospitalizations.Osborne, an honorably discharged Marine, said he saw more residents of the home die than fellow service members during his military service. The Menlo Park and Paramus veterans homes — where inspectors saw dementia patients with and without the virus commingling in a day room — both reported more than 180 COVID cases among residents, 90 among staff and at least 60 deaths.A spokesperson for the homes said he could not comment due to pending litigation.“These deaths should not have happened,” Osborne said. €œMany of these deaths were absolutely avoidable, in my humble opinion.” Christina Jewett. ChristinaJ@kff.org, @by_cjewett Related Topics California Health Industry Public Health States CDC COVID-19 Hospitals Lost On The Frontline Nursing Homes.

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Concord Hospital’s $341 million redevelopment is on track for completion, with the eight-storey Clinical Services Building set to transform best online catapres healthcare in the inner west.Health Minister Brad Hazzard and Member for Drummoyne John Sidoti visited the site for a traditional topping out ceremony to mark the building reaching its highest point. Mr Hazzard said the Clinical Services Building will have more best online catapres than 200 inpatient beds, with just over 550 beds across the campus, an increase of more than 100 from previously. €œThe NSW Government’s $341 million commitment to Concord Hospital has created more than 700 best online catapres construction jobs to build this modern, state-of-the-art facility,” Mr Hazzard said. €œNot only does it house the nation’s first dedicated veterans’ health service, a comprehensive cancer centre and an aged care centre, over two-thirds of the best online catapres new inpatient beds in the new Clinical Services Building are in single rooms with daybeds for carers.” Mr Sidoti said the National Centre for Veterans’ Healthcare has been successfully operating as a pilot service since August last year.

To date 128 people have been referred to the service and 54 have completed their care. €œThis Centre is critical to our veteran community and continues Concord Hospital’s proud 80-year best online catapres history of supporting veterans and their families,” Mr Sidoti said. Concord Hospital’s new best online catapres Clinical Services Building will include. the Rusty Priest Centre for Rehabilitation and Aged CareNational Centre for Veterans’ Healthcare a comprehensive Cancer Care Centre with 28 beds and 48 chemotherapy, infusion and haematology chairsa new concourse linking the new building to the existing hospital, providing direct access to operating theatres, radiology and emergency care.Construction of a new $32.4 million multistorey best online catapres car park will begin following the completion of the Clinical Services Building expected in late 2021.

The NSW Government also spent $1.3 million in 2019 refurbishing two theatres at Concord Hospital that are best online catapres now fully digitally integrated. €‹â€‹â€‹The concept design for the new, seven-storey Acute Services Building for John Hunter and John Hunter’s Children’s hospitals has been unveiled, marking a milestone for the NSW Government’s $780 million health precinct.Premier Gladys Berejiklian said the John Hunter Health and Innovation Precinct would drive significant economic growth in the Greater Newcastle region, generating jobs in construction and health.“John Hunter hospital is one of the busiest hospitals in NSW and this investment will provide enhanced health facilities ensuring the region has a world-class hospital to cater to its growing population,” Ms Berejiklian said.“Construction of the precinct will support more than 3,000 jobs over the life of the project helping stimulate the economy, a key component of the NSW Government’s COVID-19 recovery plan.”Health Minister Brad Hazzard said the redevelopment will significantly increase critical care capacity, with a 60 per cent increase in the Intensive Care Unit capacity and almost 50 per cent more theatres, interventional suites and procedural spaces.“The Precinct will drive innovative collaborations between the health, education and research sectors, ultimately improving patient outcomes for communities in the Hunter region,” Mr Hazzard said.The new Acute Services Building will include:a new emergency departmentcritical care services (adult and paediatric)operating theatres, interventional and imaging servicesbirthing suite and inpatient maternity unitneonatal intensive care and special care nurserylarger and redeveloped inpatient units androoftop helipad.Stage 1 of an interim Emergency Department expansion has also been completed early as part of NSW Government’s COVID-19 response.“I’m also pleased the Emergency Department expansion was delivered five months ahead of schedule, providing an additional 12 dedicated paediatric treatment areas and additional capacity to deal with the pandemic, with Stage 2 scheduled for completion early next year,” Mr Hazzard said.Parliamentary Secretary for the Hunter, Catherine Cusack, said the new Acute Services Building will serve the Hunter region for many years to come.“This is a great opportunity to share the future vision of the Precinct, which will transform health care in the Hunter, bringing expanded, enhanced health services closer to home,” Ms Cusack said.Early works on the new Acute Services Building are expected to commence in 2021 with main works construction scheduled to commence in 2022..

Concord Hospital’s $341 million cheap catapres redevelopment is on track for completion, with the eight-storey Clinical Services Building set to transform healthcare in the inner west.Health Minister Brad Hazzard and Member for Drummoyne John Sidoti visited the site for a traditional topping out ceremony to mark the building reaching its highest point. Mr Hazzard said the Clinical Services Building will have more than 200 inpatient beds, with just over 550 beds across the campus, an increase of more than 100 from cheap catapres previously. €œThe NSW Government’s $341 million commitment to Concord Hospital has created cheap catapres more than 700 construction jobs to build this modern, state-of-the-art facility,” Mr Hazzard said.

€œNot only does it house the nation’s first dedicated veterans’ health service, a comprehensive cancer centre and an aged care centre, over two-thirds of the new inpatient beds in the new Clinical Services Building are in single rooms with daybeds for carers.” Mr Sidoti said the National Centre for Veterans’ Healthcare has been successfully operating as a pilot service since cheap catapres August last year. To date 128 people have been referred to the service and 54 have completed their care. €œThis Centre is critical to our veteran community and continues Concord Hospital’s proud 80-year history cheap catapres of supporting veterans and their families,” Mr Sidoti said.

Concord Hospital’s new Clinical Services Building will include cheap catapres. the cheap catapres Rusty Priest Centre for Rehabilitation and Aged CareNational Centre for Veterans’ Healthcare a comprehensive Cancer Care Centre with 28 beds and 48 chemotherapy, infusion and haematology chairsa new concourse linking the new building to the existing hospital, providing direct access to operating theatres, radiology and emergency care.Construction of a new $32.4 million multistorey car park will begin following the completion of the Clinical Services Building expected in late 2021. The NSW Government also spent $1.3 million in 2019 refurbishing two theatres at Concord Hospital that are now fully digitally cheap catapres integrated.

€‹â€‹â€‹The concept design for the new, seven-storey Acute Services Building for John Hunter and John Hunter’s Children’s hospitals has been unveiled, marking a milestone for the NSW Government’s $780 million health precinct.Premier Gladys Berejiklian said the John Hunter Health and Innovation Precinct would drive significant economic growth in the Greater Newcastle region, generating jobs in construction and health.“John Hunter hospital is one of the busiest hospitals in NSW and this investment will provide enhanced health facilities ensuring the region has a world-class hospital to cater to its growing population,” Ms Berejiklian said.“Construction of the precinct will support more than 3,000 jobs over the life of the project helping stimulate the economy, a key component of the NSW Government’s COVID-19 recovery plan.”Health Minister Brad Hazzard said the redevelopment will significantly increase critical care capacity, with a 60 per cent increase in the Intensive Care Unit capacity and almost 50 per cent more theatres, interventional suites and procedural spaces.“The Precinct will drive innovative collaborations between the health, education and research sectors, ultimately improving patient outcomes for communities in the Hunter region,” Mr Hazzard said.The new Acute Services Building will include:a new emergency departmentcritical care services (adult and paediatric)operating theatres, interventional and imaging servicesbirthing suite and inpatient maternity unitneonatal intensive care and special care nurserylarger and redeveloped inpatient units androoftop helipad.Stage 1 of an interim Emergency Department expansion has also been completed early as part of NSW Government’s COVID-19 response.“I’m also pleased the Emergency Department expansion was delivered five months ahead of schedule, providing an additional 12 dedicated paediatric treatment areas and additional capacity to deal with the pandemic, with Stage 2 scheduled for completion early next year,” Mr Hazzard said.Parliamentary Secretary for the Hunter, Catherine Cusack, said the new Acute Services Building will serve the Hunter region for many years to come.“This is a great opportunity to share the future vision of the Precinct, which will transform health care in the Hunter, bringing expanded, enhanced health services closer to home,” Ms Cusack said.Early works on the new Acute Services Building are expected to commence in 2021 with main works construction scheduled to commence in 2022..

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A bagel shop with two successful storefronts in Westchester County has opened a new Connecticut location.Lenny's Bagels, eponymously named after owner Lenny Damato, has used the same Manhattan bagel recipe for 35 years at its Rye catapres for sale Brook and Pelham shops. Its process involves steaming uncooked bagels before they are baked. After its catapres for sale Friday, Oct.

2 opening, Nutmeggers in Greenwich can taste their tried-and-true bagels at their new establishment.Among the types of bagels offered are. Onion, sesame, blueberry, salt, oat bran, bialys, pumpernickel, marble rye, cinnamon raisin,classic plain option. The eatery also carries 10 cream cheese varieties, including olive and pimento, scallion and lox, and sundried tomato.In addition, it offers a non-dairy, tofu-based version of many of these cream cheeses catapres for sale is also available to lactose-intolerant customers, vegans, or curious eaters.

Customers aren't just limited to bagels, also on the menu are:Egg sandwiches, coffee, grilled foods, muffins, croissants, various pastries, sandwiches, wraps,cheesesteaks. Click here to sign up for Daily Voice's free daily emails and news alerts..

A bagel shop cheap catapres with two successful storefronts in Westchester County has opened a new Connecticut location.Lenny's Bagels, eponymously named after owner Lenny Damato, has used the same Manhattan bagel recipe for 35 years at its Rye Brook and Pelham shops. Its process involves steaming uncooked bagels before they are baked. After its Friday, cheap catapres Oct. 2 opening, Nutmeggers in Greenwich can taste their tried-and-true bagels at their new establishment.Among the types of bagels offered are.

Onion, sesame, blueberry, salt, oat bran, bialys, pumpernickel, marble rye, cinnamon raisin,classic plain option. The eatery also carries 10 cream cheese varieties, cheap catapres including olive and pimento, scallion and lox, and sundried tomato.In addition, it offers a non-dairy, tofu-based version of many of these cream cheeses is also available to lactose-intolerant customers, vegans, or curious eaters. Customers aren't just limited to bagels, also on the menu are:Egg sandwiches, coffee, grilled foods, muffins, croissants, various pastries, sandwiches, wraps,cheesesteaks. Click here to sign up for Daily Voice's free daily emails and news alerts..

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