www.wvgazettemail.com Health http://www.wvgazettemail.com Gazette archive feed en-us Copyright 2017, Charleston Newspapers, Charleston, WV Newspapers WV Board of Pharmacy dismisses director http://www.wvgazettemail.com/article/20170718/GZ0115/170719603 GZ0115 http://www.wvgazettemail.com/article/20170718/GZ0115/170719603 Tue, 18 Jul 2017 18:04:54 -0400 Eric Eyre By Eric Eyre The West Virginia Board of Pharmacy has dismissed its executive director amid a review of rules that require drug distributors to report on pharmacies that order a "suspicious" number of painkillers and other powerful prescription medications.

David Potters, who also was the pharmacy board's general counsel, departed after 10 years with the agency.

Asked for the reason for Potters' dismissal, board Chairman Dennis Lewis said, "I'm not at liberty to discuss that. You just don't do that."

The board has appointed Mike Goff, an agency administrator and former West Virginia State Police trooper, as acting executive director. Goff oversees the state's prescription monitoring database. The board plans to advertise for a new general counsel to handle legal matters.

Earlier this year, the pharmacy board hired a chief financial officer for the first time - a move designed to lessen Potters' workload. The board dismissed Potters during an emergency meeting late last month. He declined to comment Tuesday.

In December, a Gazette-Mail investigation found that the pharmacy board failed to enforce rules to report suspicious orders for controlled substances in West Virginia. Potters acknowledged that the rules, which were adopted years before he was hired, weren't on the agency's radar.

Those same years, the pharmacy board was giving spotless inspection reviews to small-town pharmacies that ordered more pills than could be possibly taken by people who really needed medicine for pain, the newspaper found.

In response, the board has spent the past six months developing a reporting system to flag suspect drug orders.

Drug wholesale distributors - companies that ship drugs from manufacturers to pharmacies - are cooperating with the review, Lewis said.

"We've been pushing very hard on the suspicious orders, to get that up and as strong as possible," Lewis said. "We've been working on that as hard as we can. It takes more time than we would like."

The board is developing a standard form for drug distributors to report suspicious orders from pharmacies for painkillers and anti-anxiety medications, Lewis said. The reporting system is designed to curb the proliferation of controlled substances.

Drug distributors must submit the reports monthly, according to the board's proposed rules.

"We'll use the reports to make an evaluation of what is really going on," Lewis said. "We want something that is readable and usable."

The proposed changes also will require wholesalers to disclose whether they have had any questionable drug orders from pharmacies.

"We're wanting them to do 'zero' reporting if they don't have any suspicious orders, or if they do have them, we want them," Lewis said. "And we want to be able to pin down what the suspicious order is for."

Also, the board plans to require wholesalers to report when they refuse to ship controlled substances to specific pharmacies.

"If they're going to cut off a pharmacy, we want to know about it," Lewis said.

The pharmacy board is expected to discuss the proposed rules to track suspicious drug orders at a meeting next week.

Reach Eric Eyre at ericeyre@wvgazettemail.com, 304-348-4869 or follow @ericeyre on Twitter.

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Capito, Manchin oppose repealing ACA without replacement plan http://www.wvgazettemail.com/article/20170718/GZ0115/170719604 GZ0115 http://www.wvgazettemail.com/article/20170718/GZ0115/170719604 Tue, 18 Jul 2017 17:55:39 -0400 Jake Zuckerman By Jake Zuckerman Both West Virginia Senators said Tuesday they are not on board with the new tack of repealing the Affordable Care Act without any replacement.

Sens. Joe Manchin and Shelley Moore Capito said they will not vote for Senate Majority Leader Mitch McConnell's latest plan to pull the plug on the law, also known as Obamacare, and leave two years to transition to an unknown replacement.

A statement released from McConnell's office does not offer details on what the replacement would entail.

Capito, a Republican, released a statement Tuesday morning after four U.S. senators had already come out against the replacement bill, dooming its chances of a passing vote. She said she does not support McConnell's idea of repealing without immediately replacing.

"My position on this issue is driven by its impact on West Virginians," she said. "With that in mind, I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians."

In 2015, Capito voted in favor of an Obamacare repeal bill that then-President Barack Obama vetoed. Ashley Berrang, a spokeswoman for Capito, said the senator needs a working replacement before she votes for a repeal, and the most recent versions are not up to snuff.

Berrang also pointed to a 2015 statement from Capito issued after her ACA repeal vote.

"Americans deserve a health care system that works for them, and Obamacare is not it," she said. "I have consistently voted to repeal and replace this disastrous health care law, and I am glad that a repeal bill will finally reach the president's desk. This legislation will enable us to revisit the problems caused by Obamacare and replace them with reforms that provide quality, affordable care for all Americans."

Before news of McConnell's new plan broke, Berrang said Monday evening that Capito was still considering the Better Care Reconciliation Act - the ACA replacement - although her statement Tuesday suggests she was leaning against it.

"I have serious concerns about how we continue to provide affordable care to those who have benefited from West Virginia's decision to expand Medicaid, especially in light of the growing opioid crisis," she said. "All of the Senate health care discussion drafts have failed to address these concerns adequately."

Along with Captio, Manchin said in a conference call Tuesday that he would not vote in favor of an ACA repeal, but instead is working to build bipartisan consensus around making repairs to pieces of the law.

"I understand that Senator Capito just came out and said that she would oppose repealing, which I'm very, very pleased to hear, and that's great news, and we'll see," he said. "I know, over the years here, since Obamacare, or the Affordable Care Act, has been in place, Republicans have voted for a total repeal many, many times. I don't know if they have the 50 votes that they need. Senator Capito and Senator [Susan] Collins said they would not repeal, so they can't afford to lose another one. I'm hoping for another one or two, that will stop the repeal process, and maybe, eventually, they will sit down and start talking to us."

As of Tuesday afternoon, The Washington Post reported that Sens. Collins, R-Maine, and Lisa Murkowski, R-Alaska, would not get behind the repeal either, casting doubt over its viability.

Manchin said he questions whether a repeal vote will go the distance, and that he's planning to work with the other senators who used to serve their states as governors to find an approach to reform the ACA with people who are used to working in a bipartisan fashion.

"Maybe we can get them together and find a pathway. We're going to try anything and everything," he said. "I'm hoping repeal is taken off the table, because it would be truly devastating for our state and our country if they just went down the repeal, thinking in 24 months they could fix something. They couldn't even get 50 votes to fix something now."

He said he had not spoken to Capito yet on the new tactic but that she is invited in on the brainstorming sessions.

Although its successful trek is unlikely, an Obamacare repeal bill could blow a massive hole in coverage rolls, according to analysis by the Congressional Budget Office. In January, it calculated that the repeal would eliminate coverage for 32 million people, who would be insured under Obamacare, by 2026, and premiums would double during that same time.

Staff writer Erin Beck contributed to this report.

Reach Jake Zuckerman at jake.zuckerman@wvgazettemail.com, 304-348-4814 or follow @jake_zuckerman on Twitter.

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Trump blasts Congress over failure of GOP health care bill http://www.wvgazettemail.com/article/20170718/GZ0101/170719627 GZ0101 http://www.wvgazettemail.com/article/20170718/GZ0101/170719627 Tue, 18 Jul 2017 10:29:18 -0400 By Alan Fram and Erica Werner The Associated Press By By Alan Fram and Erica Werner The Associated Press WASHINGTON - President Donald Trump blasted congressional Democrats and "a few Republicans" Tuesday over the collapse of the GOP effort to rewrite the Obama health care law. Senate Majority Leader Mitch McConnell proposed a vote on a backup plan simply repealing the statute, but that idea was on the brink of rejection, too.

Republican Sens. Susan Collins of Maine and Shelley Moore Capito of West Virginia said they opposed McConnell's Plan B. If a third GOP senator opposes it - and several are expected to - it would be defeated, and that might send a message to conservative Republicans that it is time to abandon efforts to tear down Obama's law.

All Senate Democrats are opposed.

Trump's early morning tweet led off a barrage of Republican criticism of Congress over the party's failure on its flagship legislative priority. For seven years, the GOP has pledged to repeal President Barack Obama's law.

"Most Republicans were loyal, terrific & worked really hard," Trump tweeted Tuesday morning. "We were let down by all of the Democrats and a few Republicans."

He added, "As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!"

Two GOP senators - Utah's Mike Lee and Jerry Moran of Kansas - sealed the measure's doom late Monday when they announced they would vote "no" in an initial, critical vote that had been expected as soon as next week. That meant that at least four of the 52 GOP senators were ready to block the measure - two more than Majority Leader Mitch McConnell, R-Ky., had to spare in the face of unanimous Democratic opposition.

On the Senate floor Tuesday, McConnell conceded that the legislation repealing the 2010 law and replacing it with GOP-preferred programs "will not be successful," essentially waving a white flag.

He said instead, the Senate would vote on legislation dismantling much of Obama's statute that would take effect in two years, which Republicans say would give Congress time to approve replacement legislation. But such legislation seems unlikely to be approved, with many Republicans concerned the two-year gap would roil insurance markets and produce a political backlash against the GOP.

Moderate Republican Sen. Capito said she'd oppose scuttling Obama's statute "without a replacement plan that addresses my concerns and the needs of West Virginians." She's criticized the GOP bill's cuts in Medicaid, the health insurance program for low-income people that her state relies on heavily.

Another moderate, Susan Collins, also said she'd oppose McConnell's measure. She said repealing the law without an immediate replacement would produce "great anxiety for individuals" who benefit from Obama's statute and "cause the insurance markets to go into turmoil."

This is the second stinging setback on the issue in three weeks for McConnell, whose reputation as a legislative mastermind has been marred as he's failed to unite his chamber's Republicans behind a health overhaul package that highlighted jagged divides between conservatives and moderates. In late June, he abandoned an initial package after he lacked enough GOP support to pass.

The episode has also been jarring for Trump, whose intermittent lobbying and nebulous, often contradictory descriptions of what he's wanted have shown he has limited clout with senators. That despite a determination by Trump, McConnell and House Speaker Paul Ryan, R-Wis., to demonstrate that a GOP running the White House and Congress can govern effectively.

McConnell's failed bill would have left 22 million uninsured by 2026, according to the nonpartisan Congressional Budget Office, a number that many Republicans found unpalatable. But the vetoed 2015 measure would be even worse, the budget office said last January, producing 32 million additional uninsured people by 2026 - figures that seemed likely to drive a stake into that bill's prospects for passing Congress.

That would seem to leave McConnell with an option he described last month - negotiating with Senate Minority Leader Chuck Schumer, D-N.Y. That would likely be on a narrower package aimed more at keeping insurers in difficult marketplaces they're either abandoning or imposing rapidly growing premiums.

"The core of this bill is unworkable," Schumer said in a statement. He said Republicans "should start from scratch and work with Democrats on a bill that lowers premiums, provides long-term stability to the markets and improves our health care system."

Similar to legislation the House approved in May after its own setbacks, McConnell's bill would repeal Obama's tax penalties on people who don't buy coverage and cut the Medicaid program for the poor, elderly and nursing home residents. It rolled back many of the statute's requirements for the policies insurers can sell and eliminated many tax increases that raised money for Obama's expansion to 20 million more people, though it retained the law's tax boosts on high earners.

Besides Lee and Moran, two other GOP senators had previously declared their opposition to McConnell's bill: Collins and conservative Rand Paul of Kentucky. And other moderates were wavering and could have been difficult for McConnell and Trump to win over because of the bill's Medicaid cuts: Alaska's Lisa Murkowski, Cory Gardner of Colorado, Rob Portman of Ohio, Capito of West Virginia and Dean Heller of Nevada, probably the most endangered Senate Republican in next year's elections.

The range of objections lodged by the dissident senators underscored the warring viewpoints within his own party that McConnell had to try patching over. Lee complained that the GOP bill didn't go far enough in rolling back Obama's robust coverage requirements, while moderates like Collins berated its Medicaid cuts and the millions it would leave without insurance.

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Morrisey joins antitrust suit against Mylan, other drug companies http://www.wvgazettemail.com/article/20170717/GZ03/170719649 GZ03 http://www.wvgazettemail.com/article/20170717/GZ03/170719649 Mon, 17 Jul 2017 17:40:50 -0400 Jake Zuckerman By Jake Zuckerman The West Virginia attorney general joined a multistate lawsuit alleging antitrust violations against six generic drug manufacturers.

According to a news release sent from his office Monday, Patrick Morrisey filed a companion case with the state of Connecticut's lawsuit against Aurobindo Pharma USA, Citron Pharma, Heritage Pharmaceuticals, Mayne Pharma, Mylan Pharmaceuticals and Teva Pharmaceuticals.

According to the complaint, filed in the U.S. District Court of Connecticut, Connecticut's ongoing, non-public investigation into price increases for certain generic pharmaceuticals, "uncovered evidence of a broad, well-coordinated and long-running series of schemes to fix the prices and allocate markets for a number of generic pharmaceuticals in the United States."

In the release, Morrisey said the allegations, if true, harm consumers.

"Failure to comply with antitrust laws hurts consumers and drives up prices," he said. "The allegations raised in this lawsuit are troubling and will be pursued vigorously in court."

Along with West Virginia, Arkansas, Washington D.C., Missouri and New Mexico are signed on to the companion case.

The complaint alleges the pharmaceutical companies engaged in practices and conspiracies that artificially inflated prices of doxycycline hyclate delayed release and glyburide in the U.S. It states the defendants conspired to fix prices and pre-determine market shares and customer bases, and deliberately concealed their communications while doing so.

The complaint states drug manufacturers have said in the past that price increases have been the result of industry consolidation, FDA-mandated plant closures or elimination of unprofitable generic drug product lines. However, Connecticut's investigation allegedly revealed deliberate collusion among the generic drug providers.

"When entering a generic drug market, Heritage and other Defendants routinely sought out their competitors in an effort to reach agreement to allocate market share, maintain high prices and/or avoid competing on price," the complaint states. "These agreements had the effect of artificially maintaining high prices for a large number of generic drugs and creating an appearance of competition when in fact none existed."

Doxycycline hyclate delayed release, known by the brand name Doryx, is an antibacterial drug.

The second generic drug in question, glyburide, known by brand names DiaBeta or Micronase, is used in medications to control blood sugar levels for people diagnosed with Type 2 diabetes.

The complaint also alleges the defendants were aware their actions were illegal and worked to conceal their conversations.

Connecticut Attorney General George Jepsen announced his suit against the companies in December 2016.

The suit is not Morrisey's first legal action against Mylan. In 2016, he launched a Medicaid fraud investigation on the company due to sharp price increases of its EpiPen auto-injectors.

Mylan's chief executive officer, Heather Bresch, is the daughter of U.S. Sen. Joe Manchin, D-W.Va. Morrisey announced his candidacy for the senate seat held by Manchin last week.

Mylan has contributed thousands of dollars to Manchin's campaigns since 2010. The company's controversy has become a common attack target from conservatives hoping to unseat Manchin.

Jonathan Kott, a spokesman for Manchin, declined to comment on the lawsuit.

When asked for comment on the suit, Nina Devlin, head of global communications for Mylan, said the company knows of no evidence to suggest it violated antitrust laws.

"To date, we know of no evidence that Mylan engaged in price fixing," she said.

Also, Denise Bradley, senior vice president of global corporate reputation for Teva denied wrongdoing as well.

"Teva denies having engaged in any conduct that would give rise to liabillity with respect to this lawsuit," she said.

Press teams from each of the remaining defendant companies could not be reached for comment.

9:24 a.m. July 18: This story has been updated with an additional comment from a defendant.

Reach Jake Zuckerman at jake.zuckerman@wvgazettemail.com, 304-348-4814 or follow @jake_zuckerman on Twitter.

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'It's raining needles': Drug crisis creates pollution threat http://www.wvgazettemail.com/article/20170717/GZ0115/170719651 GZ0115 http://www.wvgazettemail.com/article/20170717/GZ0115/170719651 Mon, 17 Jul 2017 16:31:34 -0400 By Michael Casey The Associated Press By By Michael Casey The Associated Press LOWELL, Mass. (AP) - They hide in weeds along hiking trails and in playground grass. They wash into rivers and float downstream to land on beaches. They pepper baseball dugouts, sidewalks and streets. Syringes left by drug users amid the heroin crisis are turning up everywhere.

In Portland, Maine, officials have collected more than 700 needles so far this year, putting them on track to handily exceed the nearly 900 gathered in all of 2016. In March alone, San Francisco collected more than 13,000 syringes, compared with only about 2,900 the same month in 2016.

People, often children, risk getting stuck by discarded needles, raising the prospect they could contract blood-borne diseases such as hepatitis or HIV or be exposed to remnants of heroin or other drugs.

It's unclear whether anyone has gotten sick, but the reports of children finding the needles can be sickening in their own right. One 6-year-old girl in California mistook a discarded syringe for a thermometer and put it in her mouth; she was unharmed.

"I just want more awareness that this is happening," said Nancy Holmes, whose 11-year-old daughter stepped on a needle in Santa Cruz, California, while swimming. "You would hear stories about finding needles at the beach or being poked at the beach. But you think that it wouldn't happen to you. Sure enough."

They are a growing problem in New Hampshire and Massachusetts, two states that have seen many overdose deaths in recent years.

"We would certainly characterize this as a health hazard," said Tim Soucy, health director in Manchester, New Hampshire's largest city, which collected 570 needles in 2016, the first year it began tracking the problem. It has found 247 needles so far this year.

Needles turn up in places like parks, baseball diamonds, trails and beaches - isolated spots where drug users can gather and attract little attention, and often the same spots used by the public for recreation. The needles are tossed out of carelessness or the fear of being prosecuted for possessing them.

One child was poked by a needle left on the grounds of a Utah elementary school. Another youngster stepped on one while playing on a beach in New Hampshire.

Even if adults or children don't get sick, they still must endure an unsettling battery of tests to make sure they didn't catch anything. The girl who put a syringe in her mouth was not poked but had to be tested for hepatitis B and C, her mother said.

Some community advocates are trying to sweep up the pollution.

Rocky Morrison leads a cleanup effort along the Merrimack River, which winds through the old milling city of Lowell, and has recovered hundreds of needles in abandoned homeless camps that dot the banks, as well as in piles of debris that collect in floating booms he recently started setting.

He has a collection of several hundred needles in a fishbowl, a prop he uses to illustrate that the problem is real and that towns must do more to combat it.

"We started seeing it last year here and there. But now, it's just raining needles everywhere we go," said Morrison, a burly, tattooed construction worker whose Clean River Project has six boats working parts of the 117-mile river.

Among the oldest tracking programs is in Santa Cruz, California, where the community group Take Back Santa Cruz has reported finding more than 14,500 needles in the county over the past 4 1/2 years. It says it has gotten reports of 12 people getting stuck, half of them children.

"It's become pretty commonplace to find them. We call it a rite of passage for a child to find their first needle," said Gabrielle Korte, a member of the group's needle team. "It's very depressing. It's infuriating. It's just gross."

Some experts say the problem will ease only when more users get treatment and more funding is directed to treatment programs.

Others are counting on needle exchange programs, now present in more than 30 states, or the creation of safe spaces to shoot up - already introduced in Canada and proposed by U.S. state and city officials from New York to Seattle.

Studies have found that needle exchange programs can reduce pollution, said Don Des Jarlais, a researcher at the Icahn School of Medicine at Mount Sinai hospital in New York.

But Morrison and Korte complain poor supervision at needle exchanges will simply put more syringes in the hands of people who may not dispose of them properly.

After complaints of discarded needles, Santa Cruz County took over its exchange from a nonprofit in 2013 and implemented changes. It did away with mobile exchanges and stopped allowing drug users to get needles without turning in an equal number of used ones, said Jason Hoppin, a spokesman for Santa Cruz County.

Along the Merrimack, nearly three dozen riverfront towns are debating how to stem the flow of needles. Two regional planning commissions are drafting a request for proposals for a cleanup plan. They hope to have it ready by the end of July.

"We are all trying to get a grip on the problem," said Haverhill Mayor James Fiorentini. "The stuff comes from somewhere. If we can work together to stop it at the source, I am all for it."

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Business group warns Republican health-care bill could cost companies http://www.wvgazettemail.com/article/20170717/GZ0101/170719664 GZ0101 http://www.wvgazettemail.com/article/20170717/GZ0101/170719664 Mon, 17 Jul 2017 09:45:24 -0400 By Carolyn Y. Johnson The Washington Post By By Carolyn Y. Johnson The Washington Post A leading business coalition has warned that employers could pick up the tab if millions of people lose their coverage under the Republican plan to repeal the Affordable Care Act.

David Lansky, president and chief executive of the Pacific Business Group on Health, a nonprofit organization whose members include Boeing, Chevron, Hewlett-Packard Enterprise, Intel, Walmart and the Walt Disney Company, told The Washington Post that the Senate proposal to repeal the Affordable Care Act could push the costs of providing health care to uninsured people onto employers and their workers.

"There are a couple of specific reasons continuing to support an effective Medicaid program and an individual market is important, and one of those is its importance to business," Lansky said .

Approximately 177 million Americans receive insurance through employers. Until now those plans have been largely left out of the debate over the future of the Senate health bill, which would make long-term cuts to Medicaid, the government health program for the poor, and reshape the individual market where people buy their own coverage.

But if the bill is passed and more people are uninsured, or public sector programs facing federal funding cuts decrease their reimbursements, Lansky said hospitals will simply shift those costs onto commercially insured patients - namely employers and employees.

He added that if Medicaid is cut and the individual market doesn't provide affordable, comprehensive coverage, new workers may delay care until they get a job - which could make workers less productive and also create an initial surge in health-care costs that could increase premiums.

"Any additional cuts to public programs are likely to make additional increases [on costs] to the employer and the employee - at a time that most of us are worried about what we're spending on health care," Lansky said.

Until now, big employers have praised elements of the health-care bill that would benefit them and been restrained in any criticism. The U.S. Chamber of Commerce has been one of the few major industry groups to come out in support of the bill. The National Business Group on Health has praised the delay of the Cadillac tax that would have been leveled on generous health-care plans and the greater flexibility in how health savings accounts could be used.

"The biggest impact on employers are the taxes and the added administrative requirements that have been imposed by the Affordable Care Act. We see the changes in those provisions, since they alleviate our concerns, as a good thing," said Steve Wojcik, vice president of public policy at the National Business Group on Health.

But Lansky said despite those benefits, employers are becoming aware that insurance markets aren't as siloed as it was once thought.

Commercially insured patients generally pay higher rates for health care - in part to compensate for shortfalls created by public health-care programs and the uninsured. Lansky argued the cost-shifting would likely increase if millions more Americans were to lose coverage, as has been predicted. That could push health-care costs higher in the employer market.

(The most recent version of the Senate health bill has not yet been scored by the Congressional Budget Office, but a previous iteration was predicted to result in 22 million people becoming uninsured within a decade.)

Employers have a natural interest in a healthy workforce. If people delay health care while they are unemployed, they could be less productive - or need more health services - once they do start a new job.

Most large employers have been reluctant to be vocal about any health-care concerns. It's not their primary business or expertise - and many have other, industry-specific issues pending before lawmakers or the White House that are bigger priorities, so they do not want to use up their political capital by taking a side.

"They're a little uncomfortable to be in this space; it's very politically charged. And these companies have no desire to get in the midst of a partisan debate that isn't their primary issue," Lansky said. "I think the stakes are very high, and they realize with this issue, it's at least important to share our perspective - to educate policymakers there are some effects of these bills that may have a larger effect."

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Revised GOP health bill doesn't do enough to combat opioid epidemic, experts say http://www.wvgazettemail.com/article/20170715/GZ0115/170719717 GZ0115 http://www.wvgazettemail.com/article/20170715/GZ0115/170719717 Sat, 15 Jul 2017 18:05:02 -0400 Erin Beck By Erin Beck They are adults when they show up, but Lois Vance watches them grow.

When they first arrive at the Kanawha City Health Center, they are hunched over, and the men wear their baseball hats tipped low.

Vance, addiction care coordinator, tells them to get that hat out of their face and look her in the eye. There is no shame here.

She recently sat in a meeting room at the center, surrounded by four of the 24 people in the addiction treatment program, and they talked about what the GOP plan to repeal the Affordable Care Act would mean for them.

The version of the Senate plan released last week, like the previous versions of the bill before it, would disproportionately hurt the opioid-addicted population.

"If they lose their insurance, the whole world is going to be looking down on them again," she said.

Three of the four, who all live in Kanawha County and asked that only first names be used, are on Medicaid.

The Congressional Budget Office hasn't released an estimate for the newest version of the bill. But it estimated the similar previous version would cut Medicaid by $772 billion over 10 years, based mainly on ending the extra funding for states that expanded Medicaid under the Affordable Care Act and setting per-capita-based caps on traditional Medicaid payments to states. It estimated 15 million fewer people would have Medicaid in 10 years.

When states spend money on Medicaid, the federal government pays a matching rate that varies by state. West Virginia has the highest matching rate in the country at 73 percent. Health policy experts say a per-capita-based cap would cut that payment because the cost of health care expenditures would grow faster than the maximum payments.

The current version makes similarly deep cuts to Medicaid. Like previous versions, it would end Medicaid expansion in West Virginia, which covers nearly 10 percent of the population and sets per-capita based caps, although they could be removed during a public health emergency.

Medicaid is the single largest payer of substance abuse and mental health treatment in the country. Nationwide, Medicaid covered three in 10 people with opioid addiction in 2015, according to the Kaiser Family Foundation. West Virginia has the highest overdose death rate in the nation, mainly due to opioids.

Phil, who is older than the others in the program, gets excited talking about the young people he's watched get better.

"They get employed," he said. "They start taking care of their children. They start paying taxes and being a contributing member of society.

"If an addict is lucky, they might have one opportunity in their life to find a program of this caliber," he said.

Chad got to be there for his daughter's 7th birthday party.

"We all got one more high in us," he said. "But I don't think we got one more recovery left."

nnn

The last version of the GOP bill had about $2 billion in grant funding for opioid treatment. The current version provides $45 billion over 10 years for grants to states to combat the opioid crisis.

Health policy and health economics experts have said that still wouldn't be enough to protect the opioid-addicted population.

Sen. Shelley Moore Capito, R-W.Va., and several other senators have been advocating for $45 billion, a figure based on an estimate released by Richard Frank, a health economist at Harvard Medical School, and Sherry Glied, dean of New York University's School of Public Service.

Frank noted they had estimated $4.5 billion was spent on mental health and addiction treatment among the Medicaid expansion population in 2016. Senators multiplied that number by 10 and asked for $45 billion over 10 years.

Frank, who also served as assistant secretary for Planning and Evaluation at the U.S. Department of Health and Human Services, noted people who are addicted to opioids tend to have higher rates of Hepatitis C, HIV and other health problems - conditions associated with both poverty and drug addiction.

He also noted the epidemic is rapidly growing.

"To think that what was good in 2016 is going to be good in 2026 is both incomplete and a stretch," he said.

Frank estimated the federal government would need to spend $183 billion instead. Medicaid spends, on average, $11,000 to $12,000 a year on each person addicted to opioids and $3,000 to $4,000 on the average person.

And according to the Agency for Healthcare Research and Quality, opioid-related hospitalizations are growing at a rate of 5.7 percent per year, and opioid-related emergency room visits grew at a rate of 8 percent per year since 2005.

Frank estimated that if the epidemic continues to grow at 5.7 percent per year, covering the health care needs of the opioid-addicted population currently covered by Medicaid expansion would cost $14 billion in the first year and in excess of $183 billion over 10 years.

"We're looking at triple the cost, and so to say that you're just going to carve out the addictions piece and not take into account all the other things that go wrong when someone's addicted seems like it's not going to be solving the problem," he said.

nnn

Medicaid expansion, a provision of the Affordable Care Act, brought Medicaid in most states to people who made up to 138 percent of the poverty line ($16,643 per year for an individual in 2017). For those people, the federal government pays a matching rate of about 90 percent.

State officials have said the cuts would end Medicaid expansion in West Virginia, taking coverage away from 170,000 people. GOP leaders in Congress have said Medicaid expansion would be "phased out," but state officials have said expansion was contingent on the extra dollars.

Before the Affordable Care Act, Medicaid mainly covered people with children, the elderly and the physically disabled. Substance abusers - often able to work but making little money, or unable to work but not about to tell the government why - often were not covered.

"People liken the withdrawal to the flu times 10, which is the only apt way to describe it, but it really doesn't fit," said Greg, one of the men at Kanawha City Health Center. "Unless you've felt it, there's no way to accurately describe it. That's why you're not able-bodied."

In 2016, about 50,000 of those covered by Medicaid expansion in West Virginia had substance-use disorders, according to the Department of Health and Human Resources.

"That was the whole idea of the expansion," said Craig Robinson, executive director of Cabin Creek Health Systems. "This was about the working poor that don't have health coverage. That's the West Virginia population - low-income working people. That's what we are."

Cabin Creek Health Systems is made up of several rural health providers, including Kanawha City Health Center.

"In some cases, it's hard to know which came first, the addiction or the poverty," Vance said.

Phil, one of the program participants at Kanawha City Health Center, was injured working in a coal mine in 1986. A doctor at a pain clinic prescribed opioids, he built up a tolerance and he eventually became addicted.

"Ninety percent of people I know, it wasn't some trauma," he said. "It was a matter of growing up here in West Virginia. It's everywhere you go."

He later started working as a teacher.

"For 20-some years I looked like I was a dead man - like a typical junkie you'd see every day, except I had to get up every day and put on a tie and go to work," he said.

Before he found the Kanawha City Health Center, he looked for treatment, but most places accepted only cash.

"If I lose my insurance, you're looking at a dead man," he said.

Greg said his boss fired him when he asked if he could take a different day off for treatment.

He had known the man his entire life. He worked there five and a half years.

"I think it was just the stigma of addiction," he said.

As he walked out the door of the center, he repeated how grateful he was someone listened to him.

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As a federally qualified health center, Kanawha City Health Center is required to serve the low-income. So if the bill passed, it would serve people who lost Medicaid using a sliding-scale payment system.

"Many of them would find they couldn't pay that," Vance said.

"The bus fare is a barrier," added Emily Selby-Nelson, director of behavioral health services.

The loss in funding would also mean, according to Robinson, the center would likely lose more than 20 employees. The bulk of its patients are covered by Medicaid.

"It would go back to the days we were scratching around, trying to get people in specialty care, trying to help them avoid bankruptcy," Robinson said. "It's a miserable way to live."

The National Institute on Drug Abuse considers poverty a "risk factor" for drug addiction.

"It's a principal determinant for addiction," Robinson said. "It's not the only one, but it's important because of the stress it means to children and families."

A 10-year grant, Robinson said, "doesn't fit the nature of the problem."

"There's broader health implications for this," he said. "There's the mental health piece. There's all the chronic problems that accompany addiction. It requires from childhood to adulthood care to be able to address it."

State officials have also said West Virginia's entire health care infrastructure would collapse if federal funding declines. Under a previous version of the bill, they estimated West Virginia would lose more than 10,000 jobs.

"I think the economic distress that would cause would mean the problem of addiction would be aggravated," Robinson said. "It both means that there'd be more addiction, and that we'd have a much more difficult time treating it."

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Keith Humphreys, professor of psychiatry and behavioral health sciences at Stanford School of Medicine, also pointed out grants wouldn't cover other problems.

"They have all the problems that everyone else has," he said. "As people get older they have multiple conditions - not because they're addicted, because they're human."

Humphreys, who is from West Virginia, also noted states and treatment providers would have to apply for the grants, and smaller, rural health care providers "would have to know how."

"You would never go into a hospital and say, 'I have cancer,' and expect someone to say, 'Well, we didn't apply for a cancer grant this year,'" he said. "It'd be a separate program. It'd be separate paperwork and all that, and some places wouldn't do it."

The newest version of the bill could also make obtaining coverage harder for people who have been addicted to opioids to find coverage on the private market because it would allow insurers to sell plans that discriminate against people with pre-existing conditions by charging higher rates.

"Who's going to want to cover people who have in their record that they were opioid addicted?" Humphreys said.

People with Hepatitis C could also be denied coverage or charged more.

"I think there's probably no state in the union that would lose more than West Virginia if this passed," he said.

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"I think that, logically, to me, if you're taking away people's ability to pay for treatment, then you can continue to throw money at different target areas, but it's ultimately not going to really make enough changes for the whole person that's going to be necessary," said Dr. James Berry, addiction psychiatrist and medical director at West Virginia University's Chestnut Ridge Center.

"The problem with the new bill is that it would provide grants rather than actual Medicaid insurance," he continued. "With Medicaid insurance, it allows doctors, such as myself, to treat a whole range of diseases that people have who are affected by addictions.

"For instance, we would not be able to treat all the psychiatric problems that are associated with addiction - depression, anxiety, in very severe cases, schizophrenia, medical complications, infectious disease, Hepatitis C, Hepatitis B, HIV, endocarditis, which is an infection of the heart valves.

"None of this would be able to be managed if people do not have the actual insurance to treat this full range of conditions," he said.

Berry estimated one-third to one-half of his patients have Hepatitis C.

He predicted if the bill passed, the center would go back to treating patients "acutely" like it did before the Affordable Care Act. In other words, treating overdoses or offering detox - making sure the patient doesn't die, at least right now.

It was more discouraging back then, he said. Doctors would start patients on medications, but they'd relapse quickly because they couldn't continue to pay for them.

"We're able to provide the full range of services," he said. "We just see people get better."

WVU's program will continue to exist, he said. But the bill will be "devastating to the people who don't have the financial resources in order to take advantage of programs such as ours.

"This is not a hopeless condition, as long as people have the opportunity," he said.

nnn

At Kanawha City Health Center, about 80 percent of patients in the medication-assisted treatment program have Hepatitis C, according to Vance.

Depression, anxiety and post-traumatic stress disorder are common as well, according to Selby-Nelson.

An estimated 39 percent of people with substance-use disorders have a co-occurring mental health diagnosis, according to the 2014 National Survey on Drug Use and Health.

The medication-assisted treatment program involves both mental health treatment and suboxone, which is used to treat opioid dependence.

Cabin Creek Health Systems didn't begin offering medication-assisted treatment until after the Affordable Care Act was enacted. It modeled West Virginia University's program.

"Given the high rate of co-morbid psychiatric diagnoses observed in this study population, it is important to identify treatments that can address both the mental health and substance abuse symptoms," said Keith Zullig, chair of the department of social and behavioral sciences at WVU's School of Public Health.

Cabin Creek Health Systems hoped to begin offering medication-assisted treatment at its other rural sites. Sissonville was scheduled to be next.

Billy, one of the program participants, takes medication for diabetes, high blood pressure and anxiety.

"Why bother to treat your addiction if you can't treat your diabetes?" Vance said.

There are a limited number of spaces in the program - 30 at current funding levels.

Vance noticed some of the men seemed to be taking up more room.

"This is what recovery looks like," she said.

To Vance, Billy looks about 4 inches taller than the day he walked in about a year and a half ago.

"I thought he was dead, and someone forgot to tell him to lie down," she said.

About three weeks in, he started walking straighter.

"It's like a different man, and I've seen that in all of these men," she said.

"If it wasn't for them, I would have blown my head off," Billy said. "If they take it away, that's where I'll go back to."

Reach Erin Beck at 304-348-5163,

erin.beck@wvgazettemail.com,

Facebook.com/erinbeckwv or follow @erinbeckwv on Twitter.

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Charleston professor, physician Alfred Pfister dies http://www.wvgazettemail.com/article/20170715/GZ0115/170719722 GZ0115 http://www.wvgazettemail.com/article/20170715/GZ0115/170719722 Sat, 15 Jul 2017 15:35:30 -0400 Dr. Alfred Pfister, a long-time Charleston physician and medical professor, died this week after a battle with cancer.

Pfister, who was 80, practiced medicine in Charleston for more than 50 years.

"He was an adored physician in this region," Dr. Brittain McJunkin, an internal medicine colleague of Pfister's at the WVU Health Sciences Center-Charleston Division/CAMC. "He had probably thousands of loyal patients over a 50-year career."

McJunkin described Pfister as humble, devoted and always upbeat. He was a brilliant physician and a gifted teacher and educator, he said.

"He inspired every medical resident and student who worked with him. Everyone was inspired to be like Dr. Pfister," McJunkin said.

In addition to medicine, Pfister loved the southwest, particularly Arizona and the Navajo people, McJunkin said. He also loved running and participated in the Charleston Distance Run.

Pfister was born in Wheeling. Prior to settling in Charleston, Pfister served as the lieutenant commander in the U.S. Public Health Service on the Navajo Reservation in Arizona.

Over his career, some of his awards and achievements included a Fellowship in the American College of Physicians, Outstanding Clinician Teaching Award, Attending Physician of the Year, Special Recognition Award for Unsurpassed Approach to Medicine and Exceptional Capabilities as a Teacher in the Department of Internal Medicine, the Shawn Chillag, MD Attending of the Year Award, and the West Virginia University School of Medicine Dean's Award, according to his obituary.

He is the namesake the Alfred K. Pfister Award in Internal Medicine given to medical students at the Charleston Division.

Dr. William Carter, a cardiologist and professor at the Charleston Division, said he considered Pfister a mentor even though the men are around the same age. Carter said Pfister had incredible knowledge of medicine, even from a young age.

"He just loved medicine so much and loved keep up with journals and sharing his knowledge with other people," Carter said. "He had a great sense of humor."

Carter said though Pfister had been ill, he kept coming into the office to work on research.

"He will be missed greatly," Carter said.

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Relocated VA outpatient center hopes to provide 'warm' environment for veterans http://www.wvgazettemail.com/article/20170714/GZ0115/170719766 GZ0115 http://www.wvgazettemail.com/article/20170714/GZ0115/170719766 Fri, 14 Jul 2017 14:29:02 -0400 Erin Beck By Erin Beck He didn't talk about it for years. Now he wants people to listen.

Ernest Willey, who is from Charleston, was about 20 years old when he served in the U.S. Army in Vietnam.

"It's funny how one year can change your whole life," he said.

When he got back, he would crash through stoplights. He talked loud and he drank himself into oblivion. He didn't care if he lived or died.

"Would you tell your wife?" he said. "Would you tell your kids what you've done?"

Willey has been going to the Charleston Vet Center for 17 years. He felt comfortable enough in 2005 to start talking about his own experiences in Vietnam.

"This is not a cure," he said. "But it's a way that you got to deal with it. I would have been dead or in jail if this hadn't been here."

The Charleston Vet Center recently moved from a 2,800-square-foot, older facility on Central Avenue in Charleston to a 4,100 square feet new building at 200 Tracy Way. A ribbon cutting is planned for July 19.

The building has more light and more space. It's modern, and there is more parking.

"We try to create an environment that's warm and welcoming for people," said Gary Jarrell, a licensed social worker who leads the center.

"In this building, I think we give veterans the service they deserve," he said.

The building also has more room for group therapy and a space for providers to offer telehealth services.

All services are free. They see veterans who served in combat zones, are survivors of military sexual trauma, family of people killed in action, drone pilots, those who provided mortuary services and veterans who worked in mental health.

About 330 vet centers operate nationwide, Jarrell said.

Jarrell had planned to pursue engineering after serving as a staff sergeant in Iraq, but changed his mind during a work study helping other veterans.

"I fell in love with what they do," he said.

The Vet Center doesn't have a waiting list of people who couldn't be served in the previous location. But Jarrell said he knows, based on the number of veterans living in the area, that many are not being served.

In the new building, he hopes to be able to expand marriage and family services and PTSD counseling. Staff members at the center encourage veterans and their families to work through adjustment back into civilian life together, but the center also offers counseling services for individuals, groups, couples and families to promote growth and sustainment.

Some veterans circle the parking lot, but never take that first step inside.

For Willey, his time in Vietnam had affected his family and his life long enough.

The children would be five minutes late to leave the house, and he'd rage.

"Five minutes in Vietnam would get you killed," he said.

He kept his gun in his bed.

He worked for the postal service, but he couldn't work inside and instead worked as a mail carrier.

He didn't figure out why until he started coming to the Vet Center.

"I'm boxed in," he said.

Eventually, they began to talk about how there were words for his symptoms - anxiety. Post-traumatic stress disorder.

Willey recently sat in Jarrell's office and he gestured to a tree a few feet outside the window.

In Vietnam, people would die for those few feet of ground.

"Tomorrow, you'd have to take that tree back again," he said.

"This place here allows you to go back there," he said.

When he came back, people called him a "baby-killer." They threw bananas at him.

"What did we prove?" he said. "We proved we couldn't fit in."

The last four years, he started wearing a hat with a Vietnam veteran emblem.

He never talked about the day he saw butterflies, flying off a field of bodies.

"It took me 17 years to realize a butterfly's a butterfly," he said.

His grandbabies don't know that story. They'll point them out and say how pretty they are.

"I don't want to see no butterfly," he said, "but through the Vet Center, I say, 'Yes honey, it looks pretty.'"

For more information on the Vet Center, call 304-343-3825.

The clinic accepts walk-ins and same day appointments are available during business hours, which are 8 a.m. to 4:30 p.m. Monday through Friday.

After hours help is available by appointment. The center offers an around the clock confidential call center where veterans can connect to other veterans to talk about their experiences or any other issues they're having in adjusting.

The call center is staffed 24 hours a day, seven days a week and can be reached at 1-877-WAR-VETS (927-8387).

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Capito reviewing revamped GOP health bill; medical groups urge 'no' vote http://www.wvgazettemail.com/article/20170713/GZ0101/170719785 GZ0101 http://www.wvgazettemail.com/article/20170713/GZ0101/170719785 Thu, 13 Jul 2017 19:19:07 -0400 Jake Zuckerman By Jake Zuckerman With all eyes on Sen. Shelley Moore Capito, R-W.Va., as she reviews the latest draft of the GOP-backed Affordable Care Act replacement, a coalition of health care groups held a news conference Thursday where they urged her to hold her position in opposing the bill.

Speakers at Charleston Area Medical Center's Cancer Center offered research, projections and personal anecdotes detailing how the bill could harm West Virginians at the Thursday morning conference, just hours before Senate leadership released the newest tweaks to their Better Care Reconciliation Act.

Thursday's changes include reintroducing taxes on the wealthy, Sen. Ted Cruz's idea of allowing insurance providers to offer plans that do not comply with the Affordable Care Act, as long as they also offer plans that do, and adding $45 billion in funding to combat the nation's opioid epidemic.

Capito came out against the original version of the bill, citing cuts to the ACA's Medicaid expansion and insufficient funding to handle the opioid epidemic. In a later interview, she said she also opposed Cruz's proposal.

Since the new bill does not substantially alter what the Congressional Budget Office estimated to be $772 billion in cuts to Medicaid expansion, contains the Cruz-backed language and the opioid funding, Capito's vote could be up-in-the-air, as well as pivotal, given the Republican party's two-seat Senate majority.

In a statement from her press office, Capito said she is still reviewing the legislation.

"Any health care bill to replace Obamacare must provide access to affordable health care coverage for West Virginians, including our large Medicaid population and those struggling with drug addiction," she said. "I opposed the previous draft because it did not ensure access to affordable health care in West Virginia, did not do enough to combat the opioid epidemic that is devastating my state, cut Medicaid too deeply, and harmed rural health care providers. I look forward to reviewing the revised Senate health care legislation and forthcoming CBO report to determine the impact on West Virginians, but continue to have serious concerns about the Medicaid provisions."

Meanwhile, in Charleston, speakers from groups such as AARP, the American Hospital Association and the American Cancer Society spoke out against the bill and urged Capito, despite enormous political pressure, to vote against it.

Dr. Rahul Gupta, state Health Officer and Commissioner for the Bureau of Public Health, said the bill would not solve skyrocketing health care costs and will lower insurance costs only by removing people from coverage.

"What it will basically do is either shift costs or throw those people in an arena that they will not know how to get charity care, and they will be at the mercy of charity care systems, which we actually have worked to wind down in a lot of ways since the Affordable Care Act," he said. "We've been working a different direction, and this is actually going to take us in a 180 degree turn."

He pointed out that, of the roughly 170,000 West Virginians covered under the Medicaid expansion from the ACA, 50,000 of them have a substance abuse disorder.

"We're not only talking about bringing insurance costs down, we're talking about bringing insurance costs down by getting people off the rolls," he said. "What's costing America is not that there's too many people on insurance, that's not the reason. The reason is the cost of insurance and cost of health care is too expensive. This impacts nothing on that end."

He said, while everyone should get behind finding a solution to reduce the costs of health care, this bill is not the answer, and whatever policy choice is made, it should be done thinking about patients first, in a careful, deliberate manner.

Likewise, Toni DiChiacchio, president of the West Virginia Nurses Association and a former nurse practitioner, said expanding Medicaid to cover people making up to 138 percent of the federal poverty level was paramount to the health of West Virginians, and rolling it back could be devastating.

"As West Virginians, the expansion has been incredible," she said. "We are the most successful in the nation with getting people covered, and we fear what will happen with those people, should these [bills] pass. We're not really hearing about options for this group of people other than high-risk pools, which traditionally have not worked well. We also have, as was mentioned here, this significant opiate problem, and that is not just a singular, as Dr. Gupta says, issue. There are physical and mental issues that go along with that. Without insurance to help pay for those services that those folks need, we'll never have a healthy West Virginia."

Along with the medical professionals, Lora Wilkerson spoke at the conference about her granddaughter, Elinor. The child was diagnosed with Rhabdomyosarcoma, a form of cancer, when she was 18 months old.

Elinor is 3 years old now and cancer-free, after 43 rounds of chemotherapy and six rounds of radiation. However, Wilkerson said she still has a long road ahead of her in physical, occupational and speech therapy, given the damage the cancer did to her.

Wilkerson said she's worried what would happen to her granddaughter if insurance providers can up-charge people with pre-existing conditions or impose lifetime caps on coverage, practices that were outlawed under the ACA.

She said she just hopes Capito and other senators are thinking about who will feel the effects of the bill.

"Please stop and think about our West Virginians, children, the elderly, your family members, neighbors and co-workers. Stop and think about them, and do what's right for them," she said. "Let's create something better, not throw everyone off. Work on something. Let's fix it - don't get rid of it."

Reach Jake Zuckerman at jake.zuckerman@wvgazettemail.com, 304-348-4814 or follow @jake_zuckerman on Twitter.

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McConnell unveils new GOP health bill http://www.wvgazettemail.com/article/20170713/GZ01/170719792 GZ01 http://www.wvgazettemail.com/article/20170713/GZ01/170719792 Thu, 13 Jul 2017 17:19:09 -0400 By Alan Fram The Associated Press By By Alan Fram The Associated Press WASHINGTON - Senate Majority Leader Mitch McConnell released his new health care bill Thursday, bidding for conservative support by letting insurers sell low-cost, minimal policies and reaching for moderates with added billions to combat opioid abuse and help states rein in consumers' skyrocketing insurance costs.

However, allowing insurers to offer bare-bones plans threatens to alienate moderates and perhaps other conservatives. And the measure retains cuts to the expansion of Medicaid - the health insurance plan for the poor, disabled and nursing home patients - that moderate Republican senators have fought.

The 172-page legislation, the Senate GOP's plan for rolling back much of President Barack Obama's Affordable Care Act, faces a do-or-die vote next week on which McConnell has no margin for error. Since Democrats uniformly oppose the effort, McConnell needs the votes of 50 of the 52 GOP senators to prevail, and two have already said they will vote "no" - conservative Sen. Rand Paul of Kentucky and moderate Sen. Susan Collins of Maine.

Underscoring the measure's dicey prospects, No. 3 Senate Republican leader John Thune of South Dakota said, "We've got a long way ahead of us yet. The floor is going to be a wild place next week."

Sen. Shelley Moore Capito, R-W.Va., said she will review the new proposal but still has "serious concerns" about its Medicaid provisions.

In a statement issued Thursday, Capito said any replacement bill "must provide access to affordable health care coverage for West Virginians, including our large Medicaid population and those struggling with drug addiction."

Capito opposed the previous draft, saying it cut traditional Medicaid too deeply.

About 525,000 of West Virginia's 1.8 million people are enrolled in the program. Around 175,000 joined under the ACA's expansion.

Capito told The Associated Press that she is not interested in having them dropped out of the system, although changes are needed in Medicaid and the program's commercial insurance.

Seeking to rally support, McConnell, R-Ky., reminded GOP senators that obliterating the 2010 ACA has been a central tenet for the party's candidates.

"This is our chance to bring about changes we've been talking about since Obamacare was forced on the American people," he said.

But Democrats chose a different word to describe the measure, one which President Donald Trump himself used to describe the House-passed version of the measure, despite having applauded it previously.

"The new Republican Trumpcare bill is every bit as mean as the old one," said Senate Minority Leader Chuck Schumer of New York.

He said the provision allowing limited coverage makes it "even meaner."

Conservative Sen. Ted Cruz, R-Texas, has demanded language letting insurers sell plans with minimal coverage, as long as they also sell policies that meet strict coverage requirements set by Obama's statute. Moderate Republicans have objected that the idea would make policies too costly for people with serious illnesses because healthy people would flock to the cheaper coverage.

Sen. Mike Lee of Utah, who'd partnered with Cruz, tweeted that the version they crafted wasn't put in the bill, adding, "Something based on it has, but I have not seen it or agreed to it."

A summary of the bill said some minimal policies would cover three primary care visits per year and limit out-of-pocket costs, and said consumers could use federal tax credits to help pay for them.

But the Cruz provision appeared in the legislative text in brackets, meaning specific language was still being composed. That could give McConnell, Cruz and other conservatives time to work out a provision with broader support.

The retooled measure retains McConnell's plan to phase out the extra money 31 states have used to expand Medicaid under Obama's statute, and to tightly limit the overall program's future growth. Since its creation in 1965, the program has provided open-ended federal funds to help states pay the program's costs.

The rewritten package would add $70 billion to the $112 billion McConnell originally sought that states could use to help insurers curb the growth of premiums and consumers' other out-of-pocket costs.

It has an added $45 billion for states to combat the misuse of drugs like opioids. That's a boost over the $2 billion in the initial bill and an addition demanded by Republicans from states in the Midwest and Northeast that have been ravaged by the drugs.

To help pay for the added spending, the measure would retain three tax increases Obama's law placed on higher- earning people to help finance the ACA's expansion of coverage. Under the existing statute, families earning more than $250,000 annually got a 3.8 percent boost on their investment income tax and a 0.9 percent increase in their payroll tax. Obama also imposed a tax on the salaries of high-paid insurance executives.

The measure would eliminate tax increases Obama levied on insurers, pharmaceutical producers and other health industry companies.

The revised bill also would allow people to use money from tax-favored health savings accounts to pay health insurance premiums, another favorite proposal of conservatives.

McConnell's new bill offers only modest departures from the original version, which he yanked off the Senate floor two weeks ago to avoid certain defeat at the hands of several unhappy Republicans.

The reworked measure's key elements remain. It would ease Obama's requirements that insurers cover specified services, like hospital care, erase Obama's penalties on people who don't buy coverage and make federal health care subsidies be less generous.

Trump said Wednesday he would be "very angry" if the Senate fails to pass the health care measure. He said McConnell must "pull it off."

Paul told reporters the revised measure has nothing "remotely resembling repeal." Collins and Capito have long complained that the measure will toss millions off coverage and object to its Medicaid expansion cuts.

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Kanawha health director to join WVU School of Public Health http://www.wvgazettemail.com/article/20170712/GZ0115/170719890 GZ0115 http://www.wvgazettemail.com/article/20170712/GZ0115/170719890 Wed, 12 Jul 2017 09:03:54 -0400 Erin Beck By Erin Beck The executive director and health officer of the Kanawha-Charleston Health Department will take on an additional role as an assistant dean at the West Virginia University School of Public Health.

This month, Dr. Michael Brumage joins the WVU School of Public Health as assistant dean for public health practice and service, according to a news release from the university.

Brumage will maintain his role at the Kanawha-Charleston Health Department.

The release states that Brumage "will help provide faculty and students the opportunity to teach, learn and engage in public health practice" and "will assist the school in building partnerships with health departments around the state and enhancing professional practice opportunities for faculty and students."

"He has always been a friend to the school and Health Sciences," Dr. Jeffrey Coben, dean of the WVU School of Public Health, said in a prepared statement. "Now, in this official role with WVU, Dr. Brumage will open doors to new practice-based experiences for students and find additional ways for faculty to engage in projects that enhance the clinical and health enterprise of West Virginia."

Brumage has served WVU as an assistant clinical professor in behavioral medicine and psychiatry in the WVU School of Medicine, an adjunct faculty member in the WVU School of Public Health and co-chairman of the WVU Health Sciences Center Mindfulness Committee.

Brenda Isaac, president of the Kanawha-Charleston Board of Health, said in a statement: "As the state's first nationally accredited local health department, we're delighted Dr. Brumage is lending his expertise and knowledge to WVU and other state and community organizations dealing with public health. This affiliation will allow Dr. Brumage to determine barriers to care by participating in public health education on a statewide basis. By his example and teaching, he will encourage students and those entering the program to pursue public health careers."

Dr. Clay Marsh, vice president and executive dean of WVU Health Sciences, said, in a statement, that Brumage's "work in addressing major public health problems in West Virginia - such as the opioid and heroin epidemic, the damaging effects of obesity and tobacco-related illnesses - make him uniquely qualified to serve as a skilled collaborator, mentor and educator in public health and medicine."

Prior to joining the Kanawha-Charleston Health Department, Brumage retired as a colonel after a 25-year career in the U.S. Army Medical Corps.

Reach Erin Beck at erin.beck@wvgazettemail.com, 304-348-5163, Facebook.com/erinbeckwv, or follow @erinbeckwv on Twitter.

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Research on mountaintop removal health effects adequate, panel told http://www.wvgazettemail.com/article/20170711/GZ01/170719912 GZ01 http://www.wvgazettemail.com/article/20170711/GZ01/170719912 Tue, 11 Jul 2017 18:13:55 -0400 Ken Ward Jr. By Ken Ward Jr. Dozens of studies already published about mountaintop removal coal mining's effects on public health provide adequate evidence to support ending the practice to protect coalfield residents, a former West Virginia University researcher and leading author on the subject told a National Academy of Sciences panel on Tuesday.

"We know enough," researcher Michael Hendryx told the panel during a meeting in Washington. "If all we do is call for more research, we're asking people to be research subjects without their consent."

While at WVU, Hendryx became a target for coal industry criticism when he published dozens of peer-reviewed papers that found coalfield residents living near mountaintop removal operations faced increased risks of cancer, birth defects and premature death, among other health problems.

The National Academy of Sciences, with funding from the U.S. Office of Surface Mining Reclamation and Enforcement, is conducting a two-year study of the issue, an exercise that in many ways amounts to a review of scientific papers that Hendryx either authored or inspired with his work at WVU. Hendryx, who is not on the academy panel, now is an assistant professor of public health at the University of Indiana Bloomington.

The project was announced in August 2016 and funding was in place before the Donald Trump administration - which has promised to roll back regulations on the coal industry - took office. State Public Health Commissioner Dr. Rahul Gupta and former state Department of Environmental Protection Secretary Randy Huffman had asked the U.S. Interior Department for help on the issue, and Interior's OSM provided $1 million in funding for the academy review.

West Virginia political and governmental leaders have mostly either ignored the growing body of science on mountaintop removal's health effects or tried to belittle the work. Coal industry officials have, likewise, attacked the studies, funding a large effort to discredit the work.

Abee Boyles, a health scientist with the National Toxicology Program, told the academy panel on Tuesday that her agency's review of existing literature on the subject - a related, but separate project from the academy panel's efforts - found that published papers that have found no adverse health effects from mountaintop removal "had energy sector funding."

"There is something going on here with funding because we see differences," Boyles said of the industry-backed research. "There was definitely a difference by funding source."

Boyles, though, also said that the literature review found that more research was needed, and that the published work so far lacked some important data, such as details about specific human exposures to pollutants and other potential factors in illnesses, such as smoking or poor diet.

"There was not enough evidence to say there were health effects," Boyles said. "There was definitely not enough evidence to say there were no health effects. The evidence was inadequate."

Hendryx, though, said that scientists serving on the panel should remember and follow the "precautionary principle," which holds that when an activity raises threats of harm to the environment or public health, precautionary measure should be taken even if some complicated cause-and-effect relationships are not fully established yet.

"There's always going to be some doubt," Hendryx said. "We know there is a problem in health. We know there is a problem in the environment. For us to just call for more research is unethical."

Reach Ken Ward Jr. at kward@wvgazettemail.com, 304-348-1702 or follow @kenwardjr on Twitter.

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Ditching Obamacare might make poor Americans even poorer http://www.wvgazettemail.com/article/20170711/GZ0115/170719945 GZ0115 http://www.wvgazettemail.com/article/20170711/GZ0115/170719945 Tue, 11 Jul 2017 08:52:36 -0400 By John Tozzi Bloomberg By By John Tozzi Bloomberg Jane Harrod, a landscaper in central Kentucky, was installing a hog fence on her family farm with a "spud bar," a long, iron tool often used as a lever to move rocks. Suddenly, she recalled, it "came like a rocket and hit me in my forehead."

The blow, back in November 2014, didn't leave a bruise, but the next morning she couldn't see out of half of her right eye. Harrod's retina was detaching, and a doctor told her she needed urgent surgery to avoid permanent blindness.

"I don't have insurance, and I don't have a lot of money," she told him.

Harrod, 64, makes about $14,000 a year from landscaping, care-giving jobs, and working on the farm with her siblings. It's been in her family since 1804. Baptist Health Hospital in Lexington, Kentucky, helped her sign up for a health plan under the Affordable Care Act that cost about $125 per month. The coverage paid for most of the $6,000 eye surgery, months of follow-up care, and an additional cataract procedure a year later that restored her vision.

"No doubt, that was a lot of financial help right there," Harrod said. The insurance allowed her to stay in the workforce and return to the tough, outdoor labor she's done her whole life. "I would cost the system a lot more if I were on disability and on food stamps, and if I went in and said I just can't function anymore," she said.

Since the 1970s, as America's income gap has widened, one of the most powerful drivers of inequality has been the growing cost of health care. The ACA, President Barack Obama's signature domestic achievement, expanded the safety net for people such as Harrod, who lived one bad turn away from financial disaster, extending coverage to about 20 million Americans and cutting the share of uninsured by almost half since 2013.

Soon, it may be a thing of the past. Senate Republicans, having returned from their July 4 break, resumed negotiations to replace Obamacare with legislation that could lead to 15 million fewer people being insured next year, and 22 million fewer by 2026, according to the non-partisan Congressional Budget Office.

Some insurers are exiting the state marketplaces created by the ACA, leaving parts of the country with no insurers selling Obamacare plans. Republicans cite these departures as evidence that the law is failing and needs to be replaced. Senate Majority Leader Mitch McConnell, a Kentucky Republican, has said that a bipartisan plan to stabilize the marketplaces will be needed if his divided caucus can't agree on a replacement. Democrats counter that the shaky state of Obamacare is directly related to a refusal by Republicans to support it since its passage.

If the current GOP effort to roll back the law succeeds, it's not just health care that may suffer. Economic inequality and health disparities are linked, and replacing Obamacare is likely to make the twin problems of financial insecurity and poor health worse for those at the bottom of the income ladder. "We do know that people who are healthier are more productive and are more likely to work," said Barbara Wolfe, a health economist at the University of Wisconsin-Madison. "We also know that the people who are most affected by the expansion [of health coverage], and would be most affected by cutbacks, are people with lower incomes."

The Senate bill in its current form would cut taxes on the wealthy and the medical industry, reduce subsidies for insurance coverage, and, for the first time in U.S. history, cap the growth of federal Medicaid spending. The proposed reductions in this state-federal program for low income and disabled people, created under President Lyndon Johnson as part of his Great Society initiatives, "dwarf the increases that occurred through the ACA," said Henry Aaron, a Brookings Institution economist.

In 2014, Aaron estimated that Obamacare would have a clear economic effect, boosting the incomes of the bottom fifth of Americans by from 3.4 to 5.3 percent, depending on how health insurance is valued. If the Senate bill's cuts to Medicaid become law, those gains would be reversed and then some. The CBO estimated that, in 20 years, federal funding for Medicaid would be reduced by 35 percent (PDF) compared with current law.

The country's lopsided income distribution is mirrored in its vital statistics. The top 1 percent of Americans by this measure live an average of almost 15 years longer than the bottom 1 percent, according to a study of tax and death records published last year in JAMA. Like income gains, health improvements have been concentrated at the top. From 2001 to 2014, life expectancy for men in the top 5 percent by income increased two years and four months; for women, by almost three years. In the bottom 5 percent, men gained fewer than four months, and women's average life expectancy increased by just two weeks.

Some conservatives argue that expanding health insurance hasn't been shown to improve health. In fact, having coverage wasn't meaningfully linked to longer life expectancy in the JAMA analysis. A rigorous study in Oregon of people who were randomly selected to get Medicaid coverage failed to find gains in physical health over two years. Medicaid did, however, improve people's mental health, leading to lower rates of depression. It also improved their finances, reducing out-of-pocket spending, medical debt, and catastrophic costs.

In Ohio, more than a million people have gotten Medicaid coverage over some period of time since 2014 under Obamacare. "Medicaid expansion is really about getting people ready to work," says Ohio Medicaid Director Barbara Sears. Three-quarters of those newly covered who were looking for work said being on Medicaid made it easier to look for jobs. Moreover, a majority of those employed said having access to Medicaid helped them stay on the job, according to a state survey.

What's the connection? Perhaps America's opioid epidemic plays a role: Sears said she's heard hundreds of stories of Ohioans struggling with addiction who were able to return to the workforce after getting treatment paid for by Medicaid.

"If I have a mental health or addiction issue, I may be able-bodied but not work-ready," Sears said. She added that rolling back the expansion, which is funded mostly by the federal government, would trigger larger state expenditures under other, more expensive programs for the disabled.

Ohio's Republican governor, John Kasich, has urged Senate Republicans to keep Obamacare's protections for the poor. He and six other governors of both parties sent a letter to Senate leaders last month saying that the plan passed by the House, which is similar to the Senate plan, "calls into question coverage for the vulnerable and fails to provide the necessary resources to ensure that no one is left out, while shifting significant costs to the states."

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Photos: Health department machine grinds used needles for disposal http://www.wvgazettemail.com/article/20170710/GZ0115/170719958 GZ0115 http://www.wvgazettemail.com/article/20170710/GZ0115/170719958 Mon, 10 Jul 2017 18:28:08 -0400 Employees at the Kanawha-Charleston Health Department in Charleston demonstrated their new Sterilis machine Monday at the Charleston office. The machine, which is about the size of an office copy machine, sterilizes needles and syringes and then grinds them up into a confetti-like substance, according to a news release from the agency. The health department started a harm reduction clinic in December 2015 to address the number of hepatitis C and HIV occurrences in the state. About 300 people attend the clinic weekly and about 85 percent of returning patients bring syringes back. The health department said nearly 200,000 needles have been returned since the clinic began.

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Teamsters urge McKesson shareholders to reject CEO pay plan amid opioid probe http://www.wvgazettemail.com/article/20170710/GZ03/170719959 GZ03 http://www.wvgazettemail.com/article/20170710/GZ03/170719959 Mon, 10 Jul 2017 18:13:38 -0400 Eric Eyre By Eric Eyre The International Brotherhood of Teamsters union is urging shareholders of drug giant McKesson Corp. to vote down the company's proposed executive pay plan amid lawsuits and a congressional investigation into the firm's role in the nation's opioid epidemic.

The Teamsters also have called for McKesson stock owners to support a proposal to appoint an independent chairman to lead the company's board of directors, according to a letter the union recently sent to McKesson shareholders. McKesson CEO John Hammergren doubles as board chairman. McKesson will hold its annual shareholders meeting July 26 in Irving, Texas.

Earlier this year, McKesson paid a record $150 million fine to the U.S. Justice Department to settle allegations that the company failed to report "suspicious" prescription drug orders to the Drug Enforcement Administration. Meanwhile, Hammergren - one of the highest paid executives in the nation - got a $1.1 million boost to his bonus, according to the union, which is a minor McKesson shareholder.

"The opioid epidemic isn't just a tragedy of human loss - it also reflects a profound lack of corporate responsibility and accountability at the highest levels," said Teamsters General Secretary-Treasurer Ken Hall, who lives in West Virginia. "As the largest wholesale drug distributor, McKesson must confront the business practices and structures that helped fuel the crisis, rather than reward those that perpetuate them."

Hammergren has made more than $368 million since 2012 and has a guaranteed pension of $114 million when he retires, according to an executive compensation analytics firm cited by the Teamsters. The union says the company insulates executive pay from legal and regulatory liabilities, such as a spate of recent lawsuits and the congressional probe.

"Until the costs of the opioid crisis shows up in CEO Hammergren's paycheck, we don't expect there to be meaningful change," said Hall, who also serves as president of Teamsters Local 175 in South Charleston.

Hall said McKesson's "entanglement" in the opioid epidemic - a record number of Americans died last year after overdosing on heroin, fentanyl and prescription painkillers - requires independent oversight.

"In view of mounting legal, financial and reputational risks, McKesson's board needs independent leadership to safeguard the interests of the company and our country," Hall said.

In a statement, McKesson said shipping controlled substances, which include prescription pain medications, is only a small part of the company's business. The firm said it has taken numerous steps to help combat the opioid epidemic under Hammergren's leadership.

"McKesson and its shareholders have been well served during John Hammergren's service as both CEO and chairman of the board," the company said. "John's in-depth knowledge of the healthcare industry and of the complex businesses and operations of the company allows him to lead the board's work and focus, ultimately helping deliver long-term value to our investors."

McKesson is the fifth-highest revenue-generating company in the United States, according to Forbes.

Earlier this month, a congressional committee directed McKesson and two other drug wholesalers to turn over records that show the companies' shipments of prescription pain pills to West Virginia. The House Energy and Commerce Committee, in May, gave McKesson until June 8 to disclose the number of oxycodone and hydrocodone pills sold in West Virginia from 2007 to 2016.

Also, McKesson has hired an outside law firm to investigate allegations in a lawsuit filed last year by West Virginia Attorney General Patrick Morrisey that accuses the company of flooding the state with highly addictive prescription painkillers. The investigation came at the request of the Teamsters union, which has pension and benefit funds that invest in McKesson.

After finishing the investigation, McKesson's special review committee plans to issue recommendations on how to respond to the Teamsters' demands. McKesson's full board will have the final say on the company's response. The review committee also has the power to hire advisers.

McKesson has appointed three of its board members to oversee the investigation.

In January 2016, Morrisey filed suit against McKesson, alleging the company awarded bonuses and commissions to sales managers while "West Virginia was drowning in millions of doses of highly addictive prescription painkillers."

Between 2007 and 2012, McKesson shipped 54.3 million oxycodone pills (typically sold under the brand name OxyContin) and 46.2 million hydrocodone tablets (Lortab, Vicodin) to West Virginia, according to the state's lawsuit.

Only two drug wholesalers shipped more prescription opioids to West Virginia during those years.

In November, Hall predicted that Morrisey's lawsuit might "trigger an avalanche of follow-on" lawsuits against McKesson. During the past five months, about a dozen counties, cities and towns in West Virginia have filed suit against McKesson - or announced their intention to do so. The lawsuits also name other drug wholesalers as defendants.

Reach Eric Eyre at ericeyre@wvgazettemail.com, 304-348-4869 or follow @ericeyre on Twitter.

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Putnam residents: Mosquito problem has become 'unbearable' http://www.wvgazettemail.com/article/20170710/GZ0115/170719966 GZ0115 http://www.wvgazettemail.com/article/20170710/GZ0115/170719966 Mon, 10 Jul 2017 16:54:15 -0400 Carlee Lammers By Carlee Lammers ELEANOR - Officials from the Kanawha-Charleston and Putnam County health departments were in Eleanor on Monday, trying to remedy a mosquito issue that at least one resident said has become "unbearable."

Stan Mills, director of environmental services for the Kanawha-Charleston Health Department, said residents who live along Nutmeg and Maple streets are likely facing the worst of the mosquito issue because of the neighborhood's proximity to Buffalo Creek. The two roads border a wooded area that includes the creek, where mosquitoes are common.

Some residents, though, say the problem is getting worse.

"Buffalo Creek doesn't flow all year long. Some of the residents who have lived here 70 years said that it doesn't take long for there to be pools of water everywhere after it rains," Mills said. "That's probably conducive to mosquito breeding. It doesn't take but about five or six days for these mosquitoes to show up. It only takes a tablespoon of water to get these things going."

James Moore, who has lived on Nutmeg Street for 15 years, said he's seen the issue get worse throughout his time living in the neighborhood.

"You can't go outside at dusk, at night and definitely not in the morning. Trying to mow your lawn in the lower areas, even midday sometimes - it's just unbearable. You get attacked so much," he said. "I have a little pool in the yard and I can't even go out at night to swim in the pool because you just get attacked."

Mills, along with four interns from the two health departments, spent Monday setting mosquito traps. Several residents in the area now have battery-operated traps that sit on the ground near weeded or wooded areas on their property. Every two days, Mills returns to the properties to change the batteries and remove and replace the netting that holds the trapped mosquitoes.

The traps will help health department officials identify the types of mosquitoes in the area, send the insects to a lab to be tested for disease and, hopefully, identify the source of the insects, Mills said.

A mosquito in Cabell County recently tested positive for West Nile virus, so Mills said officials are testing as many mosquitoes as they can in surrounding areas. No diseases have been detected in Putnam or Kanwha counties this year.

Stephanie Curry, an intern for the Kanawha-Charleston Health Department, used a vacuum-like aspirator tool to collect nearly a dozen mosquitoes Monday.

Curry said officials have found several species of mosquito in Eleanor - but primarily those in the Aedes and Culex genera. Both of which can carry diseases, including West Nile, she said.

The West Nile virus was first detected in West Virginia in 2002, and typically affects the elderly the most. West Nile can cause fever, headache, body aches, joint pains, vomiting, diarrhea or body rash, according to information from the health department.

So far, the majority of the area's mosquitoes are what are known as "flood plain mosquitoes," Mills said.

"When the water is there, they are active and lay eggs," he said. "Then they dry up and, as soon as it rains again, you have a new hatch."

However, officials have found some "container mosquitoes," which breed in things like swimming pools, tires and trash cans or other containers with pools of water in them.

"We're hoping to find a source, but mostly what we're finding are flood plain mosquitoes," Mills said. "It doesn't take much water for these container-breeder mosquitoes, and those are the ones we worry about carrying disease. For instance, one tire is worth several acres of swamp land to mosquitoes."

Because trapping and testing the mosquitoes won't solve the infestation issue, Mills said part of his goal is to educate the town on deterrent methods to help minimize the issue. Mosquito larvae can be found in things like tires, garbage piles, bird baths and dog bowls sitting in yards. Residents also can use deterrents, like DEET, he said.

"The best thing for people to do, unfortunately, is to try to find out how to live with the mosquitoes. Cutting the grass helps, don't be real active at dusk and dawn. That's when they are the worst," he said.

"Keep your yard free of tires and garbage piles. If you've got a dog bowl or bird bath out, change it every few days, dump it and clean it. The mosquito lay these little black dots that can stick to the surface."

Town Councilman Cam Clendenin has been updating residents about the town's mosquito issue on his official Facebook page for several weeks.

Because many of the properties with mosquito issues are not owned by the town, he said, the town can't intervene or spray for mosquitoes.

Clendenin, who has been working with Mills for several weeks, said he's helping spread information to Eleanor residents so they can try their own deterrent or trapping methods.

"It's a nusiance. To hear people say they can't go outside is just awful," Clendenin said. "Once [Mills] gives an action plan, it'll be up to the residents."

Reach Carlee Lammers at Carlee.Lammers@wvgazettemail.com, 304-348-1230 or follow @CarleeLammers on Twitter.

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WV School of Osteopathic Medicine looking for new president http://www.wvgazettemail.com/article/20170710/GZ0114/170719971 GZ0114 http://www.wvgazettemail.com/article/20170710/GZ0114/170719971 Mon, 10 Jul 2017 16:19:36 -0400 Staff reports By Staff reports The West Virginia School of Osteopathic Medicine plans to find a new president to lead the school next year after its current president retires.

The school's governing board launched a search for a person to replace Dr. Michael Adelman, according to a Monday news release. The board hopes to find a replacement by July 1, 2018.

The release says Adelman is retiring at the end of 2018, concluding 16 years of service to the school.

To apply or to nominate someone to lead the school, visit www.wvsom.edu/president online. Application materials received by Sept. 15 will receive the highest consideration.

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FDA chief to toughen doctor-training rules on opioid manufacturers http://www.wvgazettemail.com/article/20170710/GZ0115/170719983 GZ0115 http://www.wvgazettemail.com/article/20170710/GZ0115/170719983 Mon, 10 Jul 2017 13:52:06 -0400 By Laurie Mcginley The Washington Post By By Laurie Mcginley The Washington Post WASHINGTON - Food and Drug Administration Commissioner Scott Gottlieb, stepping up the agency's efforts against the nation's opioid epidemic, announced plans Monday to require manufacturers of painkillers to provide more extensive education for physicians and other health-care professionals who prescribe the drugs.

In remarks that opened a two-day FDA meeting on painkiller abuse, Gottlieb said the agency will now require makers of immediate-release opioids to provide the training. These frequently prescribed formulations, which account for 90 percent of the opioids prescribed in the United States, include hydrocodone as well as oxycodone/acetaminophen combinations.

Currently, only makers of extended-release products, which make up the other 10 percent of prescriptions, are required to provide such training.

"America is simply awash in immediate-release opioid products," Gottlieb said. The new education requirements "will be aimed at making sure providers who write prescriptions for the opioids are doing so for properly indicated patients and under appropriate clinical circumstances."

The FDA does not require doctors to undergo the training, but Gottlieb has said repeatedly that he wants to pursue that possibility - a point he again made on Monday.

"Based on the feedback we've received from two public meetings over the past year," he said, "we're actively exploring the question of whether, in the future, there should be mandatory provider education, and how we'd operationalize such a condition."

Gottlieb also said the agency is making drugmakers broaden the information provided to prescribers to include more about pain management and to detail non-medication therapies as well as drug treatments.

The updated requirements represent the latest step by Gottlieb and other FDA officials to try to put a dent in new opioid addictions.

Last week, drug manufacturer Endo Pharmaceuticals agreed to withdraw its opioid painkiller Opana ER from the market, acceding to a request the FDA made in June that represented the first time the agency had asked for an opioid to be pulled because of the public health consequences of abuse. The FDA said the Opana ER's benefits no longer outweighed the risks and that its abuse-deterrent technology didn't prevent abuse.

Also last week, a new court filing against Endo and another drug company, Purdue Pharma, were added to lawsuits initially brought in 2014 by two counties in California. The lawsuits were some of the first in a growing wave of legal actions against drug manufacturers, distributors and retailers. Filed by states, counties and cities across the country, the suits seek to make the drug industry pay for the costs of addressing the opioid epidemic.

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Republicans say Medicaid is 'broken,' but users give it good marks http://www.wvgazettemail.com/article/20170710/GZ0115/170719984 GZ0115 http://www.wvgazettemail.com/article/20170710/GZ0115/170719984 Mon, 10 Jul 2017 11:47:27 -0400 By Carolyn Y. Johnson The Washington Post By By Carolyn Y. Johnson The Washington Post Politicians call the Medicaid program that provides health care for the poor "broken." Academic studies have reported on its limited health benefits or the longer appointment wait times that people with Medicaid face.

But as Republicans feverishly work to revise a health-care bill that would trigger deep cuts to the program over time, a massive new survey reveals that people enrolled in Medicaid rate their health care pretty high.

On a scale of 0 ("the worst health care possible") to 10 ("the best health care possible"), more than 270,000 people covered by Medicaid in 46 states rated their health care at an average of 7.9, according to an analysis in the journal JAMA Internal Medicine. That's just slightly worse than how Medicare enrollees rated their health care - and not far behind how privately insured patients feel about their coverage.

"The future of Medicaid is just the hottest topic in the health policy world. But it's been, for a long time, a lot of rhetoric," said Michael Barnett, assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health. Missing from the debate, Barnett said, is what people covered by the program feel.

"If they're satisfied, it's really an argument: Does reducing those benefits, having fewer people on Medicaid, really improve population health?" Barnett said.

The survey took place from December 2014 to July 2015 and included a sample of people who were enrolled in Medicaid as of fall of 2013. That means it did not capture people who received coverage as a result of the Medicaid expansion of the Affordable Care Act.

The survey can't show how the health law changed Medicaid, but it provides a snapshot across a broad swath of enrollees - including the elderly, disabled people and adults. Nearly half of the people rated their Medicaid coverage a 9 or 10, while less than 10 percent gave it a score less than 5. Older adults rated the care a bit higher than others, but their scores were strikingly consistent overall.

The vast majority of people - 84 percent - reported being able to get the care they needed over the last six months.

A common critique of Medicaid has been that the program costs the federal government a lot of money but doesn't provide much access to health care because people struggle to get appointments or find many physicians decline to accept their coverage.

Various barriers to care have been documented, but the survey found that only 3 percent of enrollees reported not being able to get care because of waiting times or doctors not accepting their coverage.

Another issue that policymakers worry about is whether people have a "usual source of care," meaning a primary care doctor or another kind of clinic where they can seek care in non-emergency situations.

The goal is to have people manage chronic diseases such as diabetes and prevent illness altogether, instead of waiting until they are acutely sick and must rely on the emergency room. Only 2 percent of respondents said they lacked a usual source of care because they couldn't find a physician who took their insurance.

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