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Hepatitis C epidemic among Iowans between 20 and 30 years of age

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The number of diagnosed hepatitis C cases in Iowa has increased more than 200 percent in the past 16 years.

“We have about 2200 people per year getting a diagnosis of hepatitus C now. That makes it third on our list of reportable infectious diseases in the state,” said Randy Mayer of the Iowa Department of Public Health.

He warns tens of thousands of Iowans who have hepatitis C are not yet diagnosed. Hepatitis C is a blood-borne illness that can cause liver failure. Sharing needles is one way the disease is spread. Mayer said that’s why it’s connected to the opioid epidemic, as people turn to injecting heroin after their supplies of pain pills run out.

“If you look at the demographics of people who are diagnosed with hepatitus C, what you see is that more than any other infectious disease it looks like the population of Iowa,” Mayer said. “…Eighty-eight percent of the people are white and it’s about evenly split between men and women.”

Sixty percent of Iowans diagnosed with hepatitis C are “Baby Boomers” — but Mayer said there’s an “epidemic of ongoing transmission” among Iowans between the ages of 20 and 30.

Mayer testified today before a legislative committee reviewing data about the opioid crisis and potential policy solutions. Medicaid will cover treatment of patients who’re diagnosed with both HIV and hepatitis C, but not for Medicaid patients who just have hepatitis C. State public health officials plan to apply for federal funds that may be used to support “syringe exchange” programs. That federal money may be used for expenses like staff and rent, but it cannot be used to buy new syringes.

Legislators open two-day hearing on opioid crisis

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Two hundred people died of opioid overdoses in Iowa last year. Experts say the wait for getting into a drug treatment program in Iowa is sometime as long as 10 weeks.

“It’s literally like telling somebody that’s having a heart attack to come back in 10 weeks when your bed’s available,” Malissa Spranger of Mercy Turning Point Treatment Center in Dubuque said Monday. “What we’re seeing is patients returning to their communities and, unfortunately, ending up deceased.”

Iowa legislators conveneded a two-day hearing on the opioid epidemic yesterday. Deborah Thompson of the Iowa Department of Public Health told lawmakers her personal story.

“Today would have been my seventh wedding anniversary and so I felt compelled to speak to you all about this issue because I have a unique perspective on it,” Thompson said. “My husband, Joe Thompson, passed away from an accidental heroin overdose last September. He left me and his one-year-old son, Lincoln.”

Joe became addicted to pain killers after a serious auto accident. Deborah said the doctor treated her husband’s pain with a “fire hose” of pain killers. The number of opioid pills sold in Iowa is predicted to decline this year, but — still — about 90 opioid pills will be sold for each man, woman and child in the state.

Some physicians resist limiting the number of pain pills per prescription. Kathie Lyman, executive director of the Polk County Medical Society, was among those who testified yesterday.

“This isn’t the way to treat this opioid crisis that we have,” she said, expressing doctors’ opinion that: “I know better how to prescribe medicines for the patient than the insurance company does.”

Lawmakers will hear another full day of testimony today about the opioid epidemic and policy prescriptions to deal with the crisis.

(Reporting by Iowa Public Radio’s Joyce Russell)

Ernst expects feds’ waiver decision between October 20th and 30th

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Senator Joni Ernst.

Republican Senator Joni Ernst this weekend said she’s talked directly with the head of the federal agency reviewing Iowa’s “stopgap” plan to shore up the state’s individual insurance market.

“We should know the administration’s decision, somewhere between the 20th and the 30th,” Ernst said. “I have been on calls with Seema Verma. I just talked to her last week. We’ll continue to push just how important this is to Iowa.”

Verma heads the Centers for Medicare and Medicaid Services. That’s the federal agency that must grant a waiver for the state’s plan to help 72,000 Iowans buy individual insurance policies for 2018.

“We may get all the measures approved, maybe not all of them,” Ernst said. “But one way or another, we expect that we’ll see a difference for Iowans.”

The state’s insurance commissioner is asking for permission to redirect federal subsidies to ensure younger, healthier people buy insurance — and send more of ObamaCare subsidies to two insurance companies to cover the costs of care for older, sicker individuals. If the waiver is granted, Medica and Wellmark have said they’ll sell individual policies to Iowans. Without the waiver, an estimated 20,000 Iowans will be unable to afford to buy health insurance next year.

Ernst said she’s still hoping a bipartisan effort in the U.S. Senate can come up with a wide-ranging health care reform measure.

“We have to correct the deficiencies out there,” Ernst said. “We find a way forward. It’s going to have to be bipartisan at this point.”

GOP efforts to repeal and replace ObamaCare have failed to get the support of enough Republicans in the Senate to pass.

Ernst made her comments Saturday after a townhall meeting in the northwest Iowa community of Brunsville. About 50 people attended the event and Ernst answered questions about a variety of topics, including health care, immigration policy and legalizing gun suppressors.

(Reporting by Dennis Morrice, KLEM, Le Mars)

Loebsack bill creates national commission to focus on diabetes

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Congressman Dave Loebsack.

Iowa Congressman Dave Loebsack is co-sponsor of a bill headed to the president’s desk that would coordinate the federal response to a disease estimated to cost the U.S. more than $322 billion a year. The bill would create a new public-private commission on diabetes.

“Passage of this legislation will help the nation undertake more pro-active and innovate approaches to diabetes and its disease complications,” Loebsack said during remarks on the House floor.

Loebsack, who is a Democrat from Iowa City, co-sponsored the bill with a Republican congressman from Texas. The bill cleared the U.S. House by a voice vote earlier this week. If President Trump signs the bill, the new National Clinical Care Commission would be charged with eliminating duplication and conflicts within federal agencies that deal with diabetic patients and research about the disease. The commission is to come up with ways to speed up federal approval of devices and medications for diabetics, too.

“The work of the commission will help improve the lives of the tens of millions of Americans living with diabetes,” Loebsack said, “while simultaneously beginning the process of reducing the staggering impact of diabetes and its disease complications.”

According to the latest estimate from the Iowa Department of Public Health, 42 percent of Iowa adults have diabetes or prediabetes. Blood sugar levels are elevated in people with prediabetes, but those levels are not yet high enough to classified as type 2 diabetes.

Iowa’s ObamaCare waiver not impacted by Thursday’s subsidy decision

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A spokeswoman for Governor Kim Reynolds says Iowa’s plan to try to stabilize the state’s individual insurance market would not be affected by President Trump’s decision to end ObamaCare subsidies for insurance companies.

Brenna Smith, a spokeswoman for the governor, issued a written statement this morning, indicating last night’s decision by the federal government “does not impact Iowa’s Stopgap Measure one way or the other.”

State officials are still waiting for a federal waiver to implement that plan. It aims to help 72,000 Iowans buy individual insurance policies for 2018. Smith said the funding for Iowa’s “stopgap measure” would come from the premium subsidies for individuals. President Trump has not ended those.

The White House announced late Thursday night that it cannot legally pay insurance companies the subsidies that were outlined in the Affordable Care Act. The governor’s spokeswoman said state officials “assumed” those wouldn’t exist anyway when they designed the Iowa Stopgap plan.

Smith’s written statement is below:

Iowa’s Stopgap Measure funding is based on one funding source, which is Advanced Premium Tax Credits or better known as premium subsidies.

Iowa’s Stopgap Measure assumed the second funding source known as Cost Sharing Reductions (CSRs) would not exist with the uncertainty on Cost Sharing Reduction funding.

This decision by the federal government does not impact Iowa’s Stopgap Measure one way or the other.

 

New state website to be used if feds grant ObamaCare waiver

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The State of Iowa has built a new website that will be used if federal officials approve a new approach to helping about 72,000 Iowans buy new individual health insurance policies.

Chance McElhaney, a spokesman for the Iowa Insurance Commissioner, says if the feds approve Iowa’s waiver, those Iowans will use a new state website to see if they’re eligible to buy insurance from one of the two companies that have agreed to sell 2018 policies.

“That is online now,” McElhaney says. “The eligibility portal will flip once open enrollment hits November 1.”

However, those 72,000 Iowans won’t be able to buy insurance on that website on November 1. McElhaney says a consumer will answer a number of questions there to determine if they are eligible to buy an individual health insurance policy through the process set up by the state.

“They will get a letter in the mail once eligibility is determined,” McElhaney says. “That letter will have the amount of their premium credit and it will have an eligibility code.”

That means — if Iowa gets the federal waiver to set up this system — those 72,000 Iowans will have to wait for delivery of the letter and use the code in that letter to buy policies from either Medica or Wellmark. McElhaney says his agency has “marketing ready to go” if Iowa gets the federal waiver — to help the 72,000 Iowans navigate the new system.

“We’ve done about everything that we possibly can and have been working tirelessly on this,” McElhaney says. “…We’re going to get this over the goal line.”

On Tuesday, Governor Kim Reynolds told reporters that if Iowa gets the go-ahead to launch its alternative plan for individual insurance policies, she’s confident the state website will handle all the traffic from those 72,000 Iowans.

Find the website here.

Governor asked for a conversation with Trump about stop-gap insurance plan

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Governor Kim Reynolds

Governor Kim Reynolds today said her staff and the state’s insurance commissioner are in “constant contact” with federal officials considering Iowa’s plan to stabilize the individual insurance market for 72,000 Iowans.

The Washington Post reported President Trump has told the federal agency reviewing Iowa’s waiver request to “tell Iowa no.” Reynolds said Trump hasn’t told her that.

“I haven’t spoken directly to the president,” Reynolds said during her weekly news conference. “I’ve asked for a conversation.”

Yesterday, the governor’s staff had a conference call with the head of the federal agency that will make the ruling on Iowa’s waiver request.

“So our indication is they’ve been very receptive,” Reynolds told reporters today. “They continue to work with us.”

According to a spokesman for the state insurance commissioner, if federal officials do not approve the state’s “stop gap” measure to fix Iowa’s collapsing individual insurance market, about 70,000 Iowans will face rate hikes of up as much as 85 percent for their 2018 health care policies. Chance McElhaney of the Iowa Insurance Division spoke with a state legislative committee this morning about the request for federal approval of Iowa’s “stop gap” plan.

“We have worked tirelessly,” McElhaney told lawmakers on the Administrative Rules Review Committee. “…We are knocking at the door and just waiting for approval.”

Senator Pam Jochum, a Democrat from Dubuque, quoted from the recent Washington Post report, suggesting President Trump has directed federal officials to reject Iowa’s waiver request.

“Has the president softened his position from August, when he said: ‘Tell Iowa no,’?” Jochum asked.

McElhaney answered: “I don’t want to speak for the president.”

Governor Reynolds, who hopes to speak with the president, told reporters an hour later that it’s important to frame Iowa’s proposal as a “short-term” fix for people who are trying to buy individual insurance policies.

“I think it’s really important to refer to it in that manner,” Reynolds said, “because we still need congress to act to put in place a long-term solution.”

An eastern legislator is fielding “two or three phone calls” per day from constituents who are worried they won’t be able to buy or even afford an individual health insurance policy next year. Republican Representative Dawn Pettengill of Mount Auburn, the chairwoman of the Administrative Rules Review Committee, said those folks are depending on federal bureaucrats to give the go-ahead for the one-year plan.

“I just hope and pray that they come through,” Pettengill said.

The governor indicated many of the 72,000 Iowans who are in limbo are calling her office, too, pleading for help. The enrollment period for their 2018 insurance policies begins November 1.

Iowa Democratic Party chairman Troy Price said Reynolds has “dropped the ball” by failing since June to talk directly with President Trump about Iowa’s health insurance problems and her administration’s stop gap plan to stabilize the system.

AUDIO of Reynolds’ weekly news conference

Report: Trump opposes Iowa fix for individual insurance

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Insurance Commissioner Doug Ommen.

The Washington Post is reporting that President Trump told federal officials to deny Iowa’s request to stabilize the individual health insurance market.

The Washington Post reports Trump became outraged after he read a Wall Street Journal account of what has become called the state’s “stop gap” plan. It’s an attempt to help up to 72,000 Iowans buy individual insurance policies for 2018 through the Affordable Care Act exchange. Trump reportedly directed the federal agency in charge of reviewing the state’s request to tell Iowa no.

Iowa officials say there’s been no denial delivered. The only notice they’ve gotten is that Iowa’s waiver request has been “deemed….complete.” That triggered a required public comment period that ends October 19.

Crowd cheers Ernst’s negative prognosis on GOP’s latest health care bill

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Senator Joni Ernst. (file photo)

Republican Senator Joni Ernst faced a loud crowd at the University of Iowa Friday afternoon as she took questions at a town-hall-style meeting.

Republican efforts to repeal and replace the Affordable Care Act were the hot topic. The audience cheered when Ernst said it’s unlikely the GOP’s latest proposal will pass.

“We do have two members that have stated firmly they will not be supporting. There are likely others that will not be supporting,” Ernst said, as the crowd applauded.

The event was punctuated with lots of shouting and booing. A group of protesters gathered outside. Ernst told reporters afterwards that she expected it to be worse.

“I that know that tensions are running high,” she said. “There’s a lot of passionate feelings in this area, but Iowa has once again proven that we can have civil discourse.”

Ernst visits each of Iowa’s 99 counties annually, but this was the first time since Ernst became a senator in 2015 that she held a public forum in the state’s most Democratic county. The latest data indicates there are more than twice as many registered Democratic voters as there are Republicans in the county.

(Reporting by Iowa Public Radio’s Katarina Sostaric)

ACLU of Iowa to sue over denial of Medicaid coverage for transgender care

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Rita Bettis (file photo0

The ACLU of Iowa will go to court to try to lift the state’s ban on Medicaid coverage for transgender surgical care. Joe Freund is a family practice doctor in Des Moines who treats transgender patients.

“I’m passionate about this,” Freund said, “because I’ve lost patients to suicide because of the inability to get this care that they have needed.”

The plaintiffs in the case are two transgender women. EerieAnna Good lives in the Quad Cities and Carol Ann Beal is from northwest Iowa. Beal said she began taking hormone therapy when she was 14 and has lived as a woman since then. Beal said she’s joined the legal battle because someone needed to be a trailblazer.

“You go through so many years of transitioning and now I hit a brick wall with the Iowa discriminatory ban on Medicaid coverage and transition-related care,” Beal said.

Beal has an appeal pending at the administrative level of state government. Once that process has run its course, the ACLU will take its lawsuit to district court.

(By  Rob Dillard, Iowa Public Radio)