San Diego: Hepatitis A Outbreak: At Least 421 Sickened And 16 Dead So Far

(THIS ARTICLE IS COURTESY OF THE EPOCH TIMES)

(Epoch Times is based in New York City and mainly focuses on China news)

 

At least 421 people have been sickened and 16 have been killed during an outbreak of Hepatitis A in San Diego as of Sept. 12, 2017.

Some 292 people of the 421 were hospitalized due to the illness, according to the San Diego County Health and Human Services Agency’s latest figures, released Tuesday.

“This is an outbreak of unprecedented proportion, and we have not seen an outbreak of this nature as relates to hepatitis A before,” said Dr. Wilma Wooten, San Diego County’s public health director, CNN reported.

Most of the infections—65 percent—are occurring among homeless people, those who use illegal drugs, or both. Another 23 percent of cases occurred in people who associate with homeless people, Wooten explained to the news network.

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“Basically, if an individual is infected with hepatitis A and they use the bathroom and don’t wash their hands, and then they can spread or contaminate the environment: door handles, ATMs or whatever they touch,” Wooten said.

Symptoms of the illness—which can be “mild to severe”—can include “fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine, and jaundice,” according to the World Health Organization.

Wooten was forced to declare a state of emergency in the county on Sept. 1.

“The local emergency was declared to increase and heighten awareness of the seriousness of the outbreak,” she said.

As NPR reported, San Diego officials started washing down sidewalks down with bleach to kill off the bug. The areas sprayed down with bleach are frequented by homeless people.

Mike Saag, a professor of medicine at the University of Alabama, Birmingham, told the broadcaster that San Diego’s bleaching approach is a reasonable one.

Geographic distribution of Hepatitis A prevalence — Red: High : prevalence higher than 8%; orange: Intermediate : between 2% and 7%; grey: Low : less than 2% (Wikipedia)

“If there’s a sanitation problem, then the thing to do is clean up the area, and bleach is probably the best disinfectant that we have for this type of viral infection,” he said.

Wooten, meanwhile, added that more than 21,000 people have been vaccinated.

According to the World Health Organization, the risks are higher where there is:

  • poor sanitation;
  • lack of safe water;
  • use of recreational drugs;
  • living in a household with an infected person;
  • being a sexual partner of someone with acute hepatitis A infection; and
  • travelling to areas of high endemicity without being immunized.

According to San Diego officials, here is how it’s transmitted:

  • Touching objects or eating food that someone with HAV infection handled.
  • Having sex with someone who has a HAV infection.

V.P. Pence Is Floating His ‘Healthy Indiana 2.0’ Program To Replace Obamacare

(THIS ARTICLE IS COURTESY OF THE NEWS SITE POLITICO)

When former Indiana Gov. Mike Pence embraced Obamacare’s Medicaid expansion with conservative twists — such as requiring enrollees to contribute to their care — critics lamented poor people would be locked out while backers cheered the program’s focus on personal responsibility.

Neither side’s expectations were quite borne out. Two years later, as the program emerges as a national model thanks to Pence’s role in the Trump administration, the reality on the ground shows what happens when political philosophy collides with the practical challenges of providing health care to tens of thousands of people, many of them in crisis.

Advocates for the poor in Indiana argue that liberal fears of depressed enrollment were overblown. More than 400,000 Hoosiers are enrolled, despite state requirements that low-income residents make nominal monthly contributions to their care or face stiff penalties.

Likewise, Republicans’ contention that the system would promote personal responsibility and prod beneficiaries to ration their care and make better decisions about what treatments to seek also turned out to be overly optimistic.

By all accounts, the expansion — known as the Healthy Indiana Plan 2.0 — has made a difference. Health officials in Scott County, Ind., a poverty-stricken community about 30 miles from Louisville, Ky., paint a picture of a program that’s bolstered a patchy social safety net — especially during a major HIV outbreak triggered by the opioid epidemic — without bankrupting the Hoosier State or punishing enrollees.

To be sure, the program isn’t perfect, they say. But they overwhelmingly give more positive reviews than not.

“I feel that it has been a good success,” said Dawn Sanders, an outreach worker for Covering Kids & Families of Indiana, a statewide consumer group working in Scott County. “It’s working.”

Healthy Indiana’s influence is expected to increase in the months ahead whether or not Obamacare survives, as state officials and the Trump administration look to replicate some of its conservative features, potentially unleashing a wave of new state restrictions on how non-disabled adults get coverage without any action from Congress.

“The Healthy Indiana Plan has long been, and continues to be, a national model for state-led Medicaid reforms,” HHS Secretary Tom Price wrote in response to senators after his confirmation hearing.

“It is important that Medicaid’s design helps its members to transition successfully from the program into commercial health insurance plans, as [Healthy Indiana’s] consumer-driven approach and underlying incentive structures encourage,” he told lawmakers.

Seema Verma, meanwhile, a Pence ally who helped design the program before she was tapped to run CMS, now has the power to give states greater flexibility to reshape their own programs according to conservative principles.

Kentucky and Arizona have already borrowed aspects of Indiana’s plan while others, including Wisconsin, could move to enact new limits that resemble the approach.

Indiana’s plan also provides a measure of political cover to lawmakers in red states where supporting Obamacare’s coverage expansion is still deeply controversial. Republicans across the country have found it easier to back an expansion of government-funded health care for the poor if it more closely resembles a private insurance market. Yet liberals remain deeply skeptical because of the way the system is designed to cut people off who don’t make monthly payments, at least temporarily.

Both sides could find their assumptions challenged based on the experience in places like Scott County.

The Indiana plan does punish people above the poverty line who stop making monthly contributions by locking them out of coverage for six months. But because most enrollees have incomes below the poverty line, lockouts have been rare, according to state evaluations of the first year of the program. Instead, those below the poverty line who don’t pay are bumped from plans with more generous benefits — including coverage of vision and dental care and better prescription drug benefits into skimpier plans with higher out-of-pocket costs.

“It sounds like, ‘Oh my gosh, people are going to have to pay.’ But people that were uninsured were paying for it already,” if they go to the doctor, said Beth Wrobel, who runs a federally qualified health center in Valparaiso, in the northern part of the state.

Diabetic patients who visited Wrobel’s clinic before the start of Healthy Indiana incurred significantly higher costs paying for their regular medical supplies and routine testing, she said. Now, under the more generous benefit package, “the most you have to pay is $26 a month, and that’s at the high end. Most of our patients pay between $1 and $10 a month,” Wrobel said.

“For the same amount that you were paying at that moment for your diabetic care, you could get medical, dental, behavioral health, optometry and pharmacy. [Healthy Indiana] treated the whole body,” she said.

Randy White, CEO of Fayette Regional Health System in Connersville, in the east-central part of the state, agreed that Healthy Indiana “is not harsh.”

If the liberal specter of a punitive system pushing out enrollees hasn’t quite materialized, neither has conservatives’ vision of a market-like system where patients with “skin in the game” make hard choices about their own health spending. That’s because family members, health workers and nonprofits are helping cover their out-of-pocket costs.

“With some people, I think [personal responsibility] might be a little bit lost,” Sanders said in her office at the Scott County Partnership, a nonprofit. “We try and do what we can in the little bit of time we have with them. But you can only give them so many pamphlets.”

About 2,100 of the enrollees who gained coverage through Indiana’s expansion live in Scott County, a poor, sparsely populated area that gained notoriety where an HIV outbreak took off two years ago, fueled by needle sharing and opioid abuse.

Sanders recalled how a man with substance abuse problems signed up for health coverage in the small town of Austin, Ind., which had set up a “one-stop shop” to get people enrolled and provide medical services like HIV screenings and vaccinations.

“He knew he had hit rock bottom. And he knew he needed help,” Sanders said. “He no longer lives in the area, but he had to be able to get away from this. He has stayed clean this whole time. He now has his children back. We have quite a few success stories, as far as that’s concerned.”

As of early April, there were 216 county residents with HIV, according to Scott County Health Department Administrator Michelle Goodin, but roughly three-quarters of the patients don’t have enough of the virus in their blood to spread it to others. New cases are still being diagnosed.

“We’ve got about 30 to 40 people usually that are HIV-positive in our facility,” said Sheriff Dan McClain, whose staff helps prisoners apply for Medicaid so that they can receive benefits, including mental health and substance abuse treatment, as soon as they are released. “We offer them a test for HIV and … we offer to sign them up for HIP 2.0,” he said.

With an ad-hoc support network fortifying the safety net, some liberal groups and Democratic lawmakers question whether the conservative tweaks are really adding value or simply burdening enrollees with unnecessary complications. Without those hurdles, they say enrollment would be even higher.

Progressives also fear that if the Indiana model is embraced in states that initially did traditional expansions of Medicaid, it would erode enrollment gains.

“Work requirements, lock-out periods, time limits and imposition of onerous premiums and cost-sharing on Medicaid families, who are generally living on a budget of roughly less than $15,000 per year, are not only punitive but also counterproductive in the long-term,” Sen. Ron Wyden (D-Ore.) and Rep. Frank Pallone (D-N.J.) wrote in a letter to HHS last month to discourage it from approving additional restrictions, many of which would be program firsts. “Requiring poor families to pay more than they can afford for care makes them less likely to access the care they need and less likely to maintain their coverage.”

State surveys of how Healthy Indiana is working present a fragmentary picture, and despite the program’s popularity in Indiana, there are some signs of hampered enrollment because of its complex structure and broader concerns about affordability. For example, roughly half of the enrollees in the more comprehensive benefit package worried about being able to afford their monthly payments. Left-leaning groups have used the data to raise flags about harmful implications for other states.

The first-year report also estimated that roughly 1,240 enrollees received financial help from nonprofits to pay their premiums, a paltry slice of overall enrollment. But residents here believe many more enrollees likely rely on family members, friends and others sources undetected by official surveys. Sanders and others pointed out that the premium cost of keeping someone covered in the program’s more generous benefit package — which includes vision and dental benefits as well as more robust coverage of prescriptions — is as little as $12 for an entire year.

“We’ve paid it out of our pocket many times at the office just to get them hooked up,” said Jeanni McCarty, a nurse at Foundations Family Medicine in Austin. McCarty said she has four family members affected by HIV and five relatives who have passed away from drug abuse-related problems.

Indiana officials by the end of the month will send CMS two more reports, including one that specifically examines the use of health savings-like accounts to help beneficiaries cover their costs. Pence’s successor, Republican Gov. Eric Holcomb, has already asked the Trump administration to extend the program through January 2021 with a handful of tweaks — though notably absent is a request to institute a work requirement as a condition of receiving benefits.

“We don’t want to put policies and programs in place that are not member-centric,” said Jennifer Walthall, secretary of Indiana’s Family and Social Services Administration. “Increasing barriers is not the name of the game.”

If You’re A Poor Person In America, Trump’s Budget Is Not For You

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

If you’re a poor person in America, Trump’s budget is not for you

March 16 at 11:40 AM

If you’re a poor person in America, President Trump’s budget proposal is not for you.

Trump has unveiled a budget that would slash or abolish programs that have provided low-income Americans with help on virtually all fronts, including affordable housing, banking, weatherizing homes, job training, paying home heating oil bills, and obtaining legal counsel in civil matters.

During the presidential campaign last year, Trump vowed that the solution to poverty was giving poor people incentives to work. But most of the proposed cuts in his budget target programs designed to help the working poor, as well as those who are jobless, cope.

And many of them carry out their missions by disbursing money to the states, which establish their own criteria.

“This is a budget that pulled the rug out from working families and hurts the very people who President Trump promised to stand up for in rural America and in small towns,” said Melissa Boteach, vice president of the poverty to prosperity program at the Center for American Progress, a liberal think tank in Washington.

The White House budget cuts will fall hardest on the rural and small town communities that Trump won, where one in three people are living paycheck to paycheck — a rate that is 24 percent higher than in urban counties, according to a new analysis by the center.

The budget proposes housing “reforms” that add up to more than $6 billion in cuts while promising to continue assisting the nation’s 4.5 million low-income households. If enacted, the proposed budget would result in the most severe cut to the Department of Housing and Urban Development since the early 1980s, according to the National Low Income Housing Coalition.

Trump’s budget plan, by the numbers

President Trump just released his budget plan for the next fiscal year, which proposes some big changes in government spending. Here’s a look at what agencies are helped and hurt by the proposal. (Video: Jenny Starrs/Photo: Jabin Botsford/The Washington Post)

It would also eliminate the U.S. Interagency Council on Homelessness, which coordinates the federal response to homelessness across 19 federal agencies.

The administration’s reforms include eliminating funding for a $3 billion Community Development Block Grant program, one of the longest continuously run HUD programs that’s been in existence since 1974.

The program provides cities with money to address a range of community development needs such as affordable housing, rehabilitating homes in neighborhoods hardest hit by foreclosures, and preventing or eliminating slums and community blight. It also provides funding for Meals on Wheels, a national nonprofit that delivers food to homebound seniors.

Robert Rector, a senior fellow who focuses on welfare at the Heritage Foundation, a conservative Washington-based think tank, calls the community block grants a “slush fund for urban government.”

The White House touts its cuts to what the administration characterizes as “a number of lower priority programs” as a way to “promote fiscal responsibility.” In actuality, it guts federal funding for affordable housing and kicks the financial responsibility of those programs to states and local governments.

Gone would be $35 million in funding for well-known programs such as Habitat for Humanity and Youth Build USA, fair housing planning, and homeless assistance, among other housing help for needy Americans.

Other targets include funding for neighborhood development and a home-buying program through which low-income individuals help build their own homes. Trump also plans to cut the Home Investment Partnership Program, the largest federal grant to state and local governments that is designed to create affordable housing.

“There is no coordinated plan for how to fulfill the same mission. Saying states, local governments and philanthropy are going to help is just passing the buck,” said a HUD official who is not authorized to speak to the media.

The official said workers at the agency Thursday morning were feeling “demoralized” and “worried.”

“This is just a tough, tough time,” the official said. “HUD is no different from any other domestic agency in just feeling as though these cuts are all very arbitrary and unnecessary.”

Poor people need not lean on community banks for financial help, either, because Trump plans to eliminate the $210 million now dedicated toward Community Development Financial Institutions. The program, administered through the Treasury Department, invests in community banks that provide loans and financial services to people living in some of the most distressed communities of the country.

“Cutting that program would be nothing short of a disaster, and the ripple effect would be felt in urban areas and some rural areas all over America,” said Michael A. Grant, president of the National Bankers Association, a lobbying group for black-owned banks.

The administration would also eliminate the Energy Department’s weatherization assistance program, which dates back to 1976 when Gerald Ford was president. Since then, it has provided states with grants that have helped insulate the homes of about 7 million families, using low-cost techniques that have large payoffs, saving money for those families and curtailing U.S. energy consumption. It has also helped establish weatherization job training centers in states such as Utah and New York.

Also on the chopping block: the Low Income Home Energy Assistance Program, known widely by its acronym LIHEAP. This program, part of the Health and Human Services budget, helps homeowners cover monthly energy costs, or repair broken or inefficient furnaces and air conditioners. The program is usually underfunded; LIHEAP says that on average, only about 20 percent of the households that qualify for assistance receive benefits before the money runs out. Congress sometimes adds funding during emergencies or energy shortages when costs spike.

Trump’s proposed budget would eliminate the Community Services Block Grant, a $715 million program within HHS that funds more than 1,000 local anti-poverty organizations around the country. The organizations provide services ranging from job training to food assistance to more than 16 million people in 3,000 counties. The grants also help communities respond quickly to natural disasters, plant closures and other economic shifts.

Without the grants, there would be little coordination between faith groups, local governments, private companies and nonprofits in addressing the needs of the poor — “just a few unconnected programs that don’t have nearly the impact they have now,” said David Bradley, who founded the National Community Action Foundation and wrote the legislation behind the grants in the early ’80s.

Bradley, though, is “absolutely confident” that Congress will reject the proposal.

“This is the work of a radical right that goes hard after anti-poverty programs,” he said.

The Trump budget would also target the Legal Services Corp., an independent agency that provided $343 million to 134 legal aid organizations for the poor who are tangled up in cases of wrongful eviction, custody disputes, child support or domestic violence.

Legal Services was launched as part of President Lyndon B. Johnson’s war on poverty with the support of the American Bar Association led by Lewis F. Powell Jr., who later served on the Supreme Court. President Richard Nixon later created a free-standing corporation to administer legal aid funds.

“Here each day the old, the unemployed, the underprivileged, and the largely forgotten people of our Nation may seek help,” Nixon wrote in a 1971 message to Congress. “Perhaps it is an eviction, a marital conflict, repossession of a car, or misunderstanding over a welfare check — each problem may have a legal solution. These are small claims in the Nation’s eye, but they loom large in the hearts and lives of poor Americans.”

In 2015, Legal Services offices closed 755,774 cases — more than 100 for every lawyer and paralegal employed. About 70 percent of its clients are women, and the majority of its clients are white and between the ages of 36 and 59. The program provides lawyers only to people earning no more than 125 percent of the federal poverty guideline, which is currently $15,075 for an individual and $30,750 for a family of four.

“We have a legal system that was created by lawyers for lawyers and assumes you have a lawyer,” said James J. Sandman, president of Legal Services Corp. “If you’re a tenant facing eviction and you’re up against a landlord who has a lawyer, if you’re the victim of domestic violence from someone who has a lawyer, you are not playing on a level field. Legal aid is about fairness in the justice system.”

Alaska’s rural poor get hit by the budget proposal, too, despite having two Republican senators. The Agriculture budget would eliminate the Denali Commission, designed to deliver services to remote, rural communities in Alaska, including Native Americans. The commission, established in 1998, contributes to the construction of health-care facilities, water and sewer systems, power generation and communication systems.

The budget would also zero out funds to help native Alaskan villages obtain access to clean drinking water and modern sewage systems.

Cuts to the Agriculture budget also eliminate the Appalachian Regional Commission and the Delta Regional Authority that encourage economic growth in distressed rural communities. And while the budget allocates $6.2 billion to “serve all projected participants” in the Special Supplemental Nutrition Program for Women, Infants and Children, that is $150 million less than USDA had budgeted.

The White House proposed shrinking Job Corps, a program administered by the Labor Department that provides education and job training to more than 60,000 young people and disadvantaged youth. The proposal called for closing centers that do a “poor job” of preparing students for the workforce, but did not elaborate on how many of the 125 centers nationwide would be targeted.

Job Corps, which was created in 1965 as part of President Johnson’s anti-poverty agenda, helps young adults between the ages of 16 and 24 earn high school diplomas and receive vocational training.

The program faced scrutiny several years ago for going over budget and has been forced to freeze enrollment multiple times since 2011 because of the monetary shortfalls. In 2013, a report from the Office of Inspector General found that the budgetary missteps were caused by inaccurate cost estimates and inconsistent monitoring of actual costs. But since then, the program has taken several steps to keep better track of costs and payments.

The Trump administration would also ax the Senior Community Service Employment Program, which aims to help low-income job seekers age 55 and up find work by pairing them with nonprofit organizations and public agencies. The loss of the program could serve as another setback for older Americans who are still struggling to find steady work after the Great Recession.

The unemployment rate for workers 55-plus was 3.4 percent in February, according to the most recent jobs report. But the rate rises to 7.1 percent if workers with part-time jobs who want to be working full-time, and those who have given up on the job search within the past year, are included, according the Schwartz Center for Economic Policy Analysis at the New School.

The goal of the senior employment program is to help participants find permanent work by providing them with training and job experience. Workers are assigned part-time jobs and paid the minimum wage, with the hope that the experience can help them find jobs that are not subsidized by the government. In its budget proposal, the Trump administration called the approach “ineffective” because up to one-third of participants do not complete the program. Of those who do finish, about half succeed in finding more permanent jobs.

Not everyone, though, believes the cuts will be a disaster for the poor.

Rector, of the Heritage Foundation, said the cuts cannot be evaluated in isolation when they represent less than 1 percent of the $1.1 trillion the government spent on more than 80 poverty programs last year.

“The basic line from the left is ‘this program alone is standing between the poor and destitution,’” Rector said. “We have a very large welfare state, and there is waste in that welfare state. It’s important to prune the waste and make these programs much more effective.”

Jonnelle Marte and Caitlin Dewey contributed to this article.

Read more on the budget: 

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