Medicine Man

U.S. District Judge Christina Snyder has amended her order reversing a 10% reduction in Medi-Cal reimbursement rates for health care providers to require repayment only for services performed on or after Aug. 18, which effectively "spares the state from tens of millions of dollars" in reimbursements, the San Francisco Chronicle reports (Egelko, San Francisco Chronicle, 9/4).

In February, California lawmakers and Gov. Arnold Schwarzenegger (R) approved the reduction as part of an effort to address the estimated $15.2 billion state budget deficit. The reduction took effect on July 1. Snyder on Aug. 18 issued an injunction requiring California to reverse the reduction. According to Snyder, California lawmakers did not consider the effect that the reduction would have on quality and access to care for beneficiaries, as required by federal law (Kaiser Daily Health Policy Report, 8/27). State officials had estimated that the original injunction would cost the state $500 million annually. Under the amended ruling, the state would save an estimated $65 million and the loss to health care providers would total $130 million, according to the Chronicle.

Lynn Carman, a lawyer for pharmacists, patients and community organizations that challenged the cuts, said he would ask the appeals court to enforce Snyder's original ruling that would have required reimbursement of services from July 1 onward. Norman Williams, spokesperson for the state Department of Health Care Services, said the department has told its workers and contractors to "fully comply with the order" unless Snyder agrees to suspend the injunction during the state's appeal of the decision (San Francisco Chronicle, 9/4).

The Press Trust of India on Tuesday examined HIV/AIDS among Indian populations on the island of Mauritius.

According to Audrey dHotman de Villiers, an advocate working with an HIV/AIDS prevention group in Mauritius, Hindu leaders have not been vocal in the community or taken responsibility to fight HIV/AIDS, despite signs of increased drug use and risky sexual behavior. De Villiers said her organization believes that "sufficient work was done" by the end of last year for HIV/AIDS awareness and prevention on the island, except among Indian populations, particularly in rural areas.

UNAIDS estimates that about 14,000 people are living with HIV in Mauritius, but the country has recorded only 3,417 cases of the virus since 1987. According to the Press Trust of India, there are no data available about HIV/AIDS among specific ethnic groups, and de Villiers said that health authorities on the island are hesitant to release such information. She added that about 89% of HIV cases are the result of injection drug use and that 25% of drug users who access rehabilitation services are Hindu. According to de Villiers, there also are few HIV/AIDS statistics for rural areas of Mauritius, which have large Indian populations, because of a lack of sustained HIV testing campaigns (Meherally, Press Trust of India, 9/2).

Many U.S. residents with illnesses who must travel frequently or long distances for treatment are forgoing, cutting back or delaying appointments and support groups or applying for grants to offset high gasoline prices, USA Todayreports.

According to USA Today, people who travel for treatment multiple times per week, such as cancer patients undergoing chemotherapy or patients in need of dialysis, are the "hardest hit." The average price of one gallon of gasoline in the U.S. on Wednesday was $3.68, about 90 cents higher than the price one year ago.

According to USA Today, Paratransit, a Sacramento, Calif.-based ride service for elderly and disabled patients that offers $4 rides to appointments, experienced an 11% increase over the number of projected ride requests. Mary Steinert, Paratransit's deputy executive director, said, "People are going to depend on us more because their friends and family can't afford to transport them in their cars."

The American Kidney Fund, which offers dialysis patients transportation grants up to a maximum of $175 twice annually, has distributed 12,842 grants totaling $2.2 million through July, 31% more than in the same period in 2007. CancerCare, a patient support organization, in the last fiscal year has spent $4.1 million in patient assistance, $500,000 more than the previous fiscal year; 90% of the grants were for transportation. In addition, CancerCare Executive Director Diane Blum said some cancer patients are looking for physicians or treatment centers closer to home.

USA Today also profiled patients with psoriasis and ALS, and the effect higher gas prices has had on their treatments (Bazar, USA Today, 9/4).

Thousands of African refugees have been released from the Ketziot detention center in the Negev region of Israel without being tested for tuberculosis or receiving preventive treatment despite a rise in TB cases among detainees, Haaretz.comreports.

According to a custody tribunal, which works with migrants, 12 cases of active TB have been reported among refugees who were once held at Ketziot, and the percentage of all active TB cases in Israel among refugees has doubled from 14% in 2006 to 28% in 2008. According to the tribunal, the rate of active TB among detainees at Ketziot is 13.3 times greater than the rate in 1997. In addition, Israel's Prisons Service and Ministry of Health at the end of July reported that 22 TB cases have been detected this year among refugees detained at Ketziot. Among the 22 people, four had active TB and were transferred to a medical facility (Reznick, Haaretz.com, 9/3). Although Itamar Grotto, head of public health for the health ministry, told the tribunal that the ministry's recommendations include "filling a medical questionnaire" and "conducting a chest X-ray for every inmate," the tribunal has called the ministry's response "wrong and misleading" (Reznick, Haaretz.com, 9/4).

In response to the increase in reported TB cases among refugees, the tribunal declared that several tests and vaccinations, including TB screenings, be administered to all detainees before their release from the facility. The tribunal also criticized the lack of TB screenings by appropriate authorities. "Despite the significant rise in the number of active TB patients among the refugees, the health ministry is responding late to events and is not providing the solutions that show the epidemic has been stopped," the tribunal said. The tribunal added that the "main challenges to ensuring public health in Israel, and particularly in controlling TB, were not medical but political and administrative."

According to the tribunal, the Ministry of the Interior and Israel Defense Forces on March 31 released refugees from Ketziot to make room for new detainees, and those released did not undergo medical tests before moving to population centers in Israel. The tribunal said the ministry's "massive and unmonitored releases" were made without "good judgment with regard to the welfare and health of the public." Daniel Shem-Tov, head of the Health Ministry's TB and AIDS Department, in May testified before the tribunal that the lack of testing constitutes a "danger to public health" (Haaretz.com, 9/3).

The Wall Street Journal on Thursday examined the record of Republican vice presidential nominee Alaska Gov. Sarah Palin on health care and other issues as mayor of Wasilla, Alaska, and as governor of the state.

As governor, "Palin didn't make health care one of her top priorities, but where she did take a strong stand on health, it was for the free market," with her "overall approach" similar to the position of presumptive Republican presidential nominee Sen. John McCain (Ariz.) -- "loosen government regulations to allow for greater competition, along with more information for patients to make good choices," according to the Journal. Palin in January said, "Health care must be market- and business-driven, rather than restricted by government."

According to the Journal, expansion of health insurance "was less of an issue for Gov. Palin, much as it is less significant for Sen. McCain," as she "was reluctant to support a significant expansion" of Denali KidCare, the state version of SCHIP. Palin increased the eligibility requirement for Denali KidCare to children in families with annual incomes up to 175% of the federal poverty level -- "stingy compared with other states," the Journal reports.

Palin does not support embryonic stem cell research, which McCain has said he supports (Carlton et al., Wall Street Journal, 9/4).

Opinion Piece

A report released recently by the U.S. Census Bureau offers the latest indication that "rising health spending is eroding take-home pay" and that "immigrants are boosting both poverty and the lack of health insurance," but neither McCain nor Democratic presidential nominee Sen. Barack Obama (Ill.) "seriously [address] these problems," Washington Post columnist Robert Samuelson writes. "Unless we control health spending and immigration, the economic report card will continue to disappoint," according to Samuelson.

"Low-skilled immigrants, concentrated among Hispanics, outnumber the high-skilled," and they "drag down median incomes and raise poverty and the number of uninsured" because they "can't get well-paid jobs with insurance," Samuelson writes. He adds, "Immigration's effects on poverty and health insurance coverage are greater," as "immigrants represented 55% of the increase of the uninsured from 1994 to 2006."

Samuelson writes, "If health care spending remains uncontrolled, Americans will see more of their compensation diverted from take-home pay into insurance that mainly benefits (as insurance should) a small proportion of very sick people," and "if the immigration of low-skilled workers continues unabated -- whether they're legal or illegal -- the ranks of the poor will swell, as will the uninsured or the costs of providing government insurance" (Samuelson, Washington Post, 9/3).