MAHENTO

This Week in History: Obamacare Clears Final Legal Hurdle in 2010

“This legislation will not fix everything that ails our health care system, but it moves us decisively in the right direction.”

Those were the words of then-President Barack Obama just after the U.S. House of Representatives voted 219-212 to overhaul the nation’s health care system seven years ago this week.

“This is what change looks like,” Obama added.

From President Harry Truman in 1948 to President Bill Clinton in 1993, making healthcare affordable to all Americans had been a struggle. Efforts to reform the complex, patchwork health care system, marked by skyrocketing costs and unaffordable insurance premiums, failed.

The Affordable Care Act (ACA), widely known as “Obamacare,” was designed to grant access to health care to millions of uninsured Americans.

Reform meant cobbling together the interests of politicians, for-profit hospitals, medical professionals, insurance and pharmaceutical companies — not to mention ordinary Americans.

Obama staked his first term in office on health care reform; it became his signature issue shortly after taking office in 2009.

From the start, the backlash was immediate. After winning passage of the bill — without a single Republican vote — then House minority leader John Boehner warned, “If we pass this bill, there will be no turning back….It will be the last straw for the American people.”

Opposition to Obamacare also prompted this nasty outburst during a joint address before Congress in September 2009.  

South Carolina Republican Joe Wilson accusation “You lie!”  was unprecedented. Wilson later apologized, but received a formal reprimand by his colleagues in the House nonetheless. 

That vehement opposition to the ACAwould come back to haunt the White House in 2016, when business mogul and then-presidential candidate Donald Trump made the repeal of Obamacare a key part of his platform.

Individual mandate

Among the most controversial parts of the former president’s bill was a measure that penalized Americans who did not buy into a so-called online health care exchange to buy insurance. 

Here’s how the Obama administration explained it on its own ACA website:

“If you can afford health insurance but choose not to buy it, you must pay a fee called the individual shared responsibility payment. (The fee is sometimes called the “penalty,” “fine,” or “individual mandate.”)”

One of the main promises of the bill, which did not go into effect until 2014, was affordable insurance premiums. Under Obamacare, adult children are allowed to stay on their parents’ health insurance plans until the age of 26, and insurance companies are barred from refusing to cover people with “pre-existing conditions.”

But the reality of the cost of Obamacare ended up being far less simple than that — and political opposition grew as some people who signed up for Obamacare found their premiums were far more expensive than expected. 

Once in place, it also was unclear as to exactly how many Americans who previously were not covered now had insurance because of the ACA.

Estimates on the number of Americans who remained uninsured after Obamacare went into effect ranged from 20 million to more than 31 million, depending on who was calculating and how.

The website Obamacare Facts, run by Media Solutions, an independent group that claims to have no ties to any political party, states the following:

“The ACA has increasingly reduced the uninsured rate each year, 20 million plus is a good current answer to how many are covered between all coverage provisions. The specifics change based on what report we are discussing, what methodology they are using, and what demographics are being considered.”

Uphill task of repeal

President Trump has stood by his promise to roll back Obamacare, calling the legislation “a mess.”  

Even before his swearing-in back in January, Trump acknowledged the difficulty of doing so, and even said he is considering keeping parts of the ACA intact, in an exclusive interview with The Wall Street Journal. 

Trump made the same policy shift during an appearance on CBS’ “60 Minutes,” which aired three days after the November election.

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Obamacare is still in effect.

But, earlier this month, Republicans introduced its replacement: the American Health Care Act, and after sharp criticism from some conservatives, have offered modifications.

Still, most experts agree the president and the Republican Party are going to make changes — perhaps little by little, and not in one sweeping legislative gesture, as predicted by former Republican House Speaker and Trump adviser Newt Gingrich. 

“I think this bill has to be seen as the first of three or four bills and, therefore, it will not satisfy someone who wants a full blown repeal,” Gingrich said during an interview on The New York Times’ “The Daily” podcast. 

“But to get something thru [sic] the Senate with 52 senators, I think you have to write a narrower bill, and try to come back this fall and write a bill that can get 60 votes.”
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Trump Signs NASA Funding Bill

U.S. President Donald Trump has signed into law a bill to increase the budget of the National Aeronautics and Space Administration (NASA), maintain the agency’s earth science program, and add human exploration of Mars as a goal.

The new law increases NASA’s budget for 2018 by $19.5 billion.

Trump said the law will reinforce NASA’s core mission of human space exploration while continuing to transition activities to private aerospace companies. “I hope they will pay us a lot of money,” Trump said in an Oval Office signing ceremony attended by a bi-partisan group of lawmakers.

The new law also directs the agency to manage programs to help get humans to other destinations.

A manned mission to Mars had been widely viewed as NASA’s next great challenge.  The agency is expected to develop new technology to achieve the mission by relying heavily on private aviation companies.

SpaceX, owned by Elon Musk, is scheduled to launch an unmanned spaceship to Mars as soon as 2018.

 
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Stephen Hawking Calls for EPA Chief Ouster

Celebrity physicist Stephen Hawking, a vocal critic of U.S. President Donald Trump, said Trump’s environmental policies are particularly concerning, going so far as to call for Scott Pruitt, the Environmental Protection Agency’s chief, to be replaced.

“He should replace Scott Pruitt at the Environment Protection Agency,” Hawking said in an interview on the Good Morning Britain television show, adding that climate change is a danger. “It affects America badly, so tackling it should win votes for his second term. God forbid.”

In the wide ranging interview, Hawking said he would like to visit the U.S. but fears he “may not be welcome” though there don’t appear to be any calls to bar the 75-year-old Cambridge scientist from coming to the U.S.

He also touched on space exploration and British politics.

Pruitt has been skeptical of the manmade impact on the climate.

“I think that measuring with precision human activity on the climate is something very challenging to do and there’s tremendous disagreement about the degree of impact, so no, I would not agree that it’s a primary contributor to the global warming that we see,” he told CNBC.

Hawking’s views about climate change are echoed by some in the Trump administration, including defense secretary James Mattis, who called it a threat to national security in recent senate testimony.

“Climate change is impacting stability in areas of the world where our troops are operating today,” Mattis’ prepared statement said.

In 2009, then-president Barack Obama awarded Hawking the Presidential Medal of Freedom.
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Mars May Have Had Rings, and May Once Again

Mars may have had Saturn-like rings in the past and may have them again, a new study suggests.

According to models developed by researchers at Purdue University, the Red Planet was likely hit by an asteroid or other body about 4.3 billion years ago. The debris from the impact might have become a ring before accreting and becoming a moon.

Researchers have long theorized that the planet’s North Polar Basin or Borealis basin was created by the impact. The basin covers about 40 percent of the planet’s surface.

“That large impact would have blasted enough material off the surface of Mars to form a ring,” said Andrew Hesselbrock, a doctoral student at Purdue who helped develop the model.

After forming a moon, researchers think Mars’ gravity would start to pull the moon closer and closer to the planet. At some point, however, the Martian gravity would “break apart” the moon, researchers theorize.

In fact, Phobos, one of Mars’ two moons (Deimos is the other), is getting closer to the Red Planet, and researchers think that in about 70 million years, it will break apart, potentially creating more rings. This cycle, researchers think, could have repeated over billions of years.

With each successive iteration, researchers think successor moons would have been five times smaller than the previous moon, with some debris raining down on the Martian surface. There are unexplained sedimentary deposits near the planet’s equator, researchers say.

“You could have had kilometer-thick piles of moon sediment raining down on Mars in the early parts of the planet’s history, and there are enigmatic sedimentary deposits on Mars with no explanation as to how they got there,” said Purdue’s David Minton, assistant professor of Earth, atmospheric and planetary sciences. “And now it’s possible to study that material.”

The study was published in the journal Nature Geoscience.
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Europe’s Biggest Construction Project Unearths 8,000 Years of London History

The biggest construction project in Europe is taking place beneath the British capital, London.

The largely subterranean Crossrail route linking Heathrow airport to the eastern financial district and beyond is designed to ease congestion as London’s population grows; but, it has also unearthed a trove of archaeological finds that provide a fascinating window on eight thousand years of the city’s history.

“The great thing about the Crossrail project is that it’s allowed us to basically sort of take a slice through London. We’ve been amazed at the quantity, tens of thousands of artifacts,” said Jackie Keily, curator of “The Archaeology of Crossrail” exhibition at the Museum of London – itself housed in a 200-year-old shipping warehouse in the old docks next to the River Thames.

Among the highlights is a bronze medallion dating from the year 245 AD, when southern Britain was ruled by the Romans.

“It would have been given by the emperor to a high-ranking official, probably in Rome. And it’s quite fascinating that it’s traveled right across the Empire to be here in London,” Keily said.

Nearby, a glass case contains a dozen carefully worked metal discs. These “hipposandals” were an early form of horse shoe designed to aid pack animals as they negotiated the rain-soaked streets of Roman London.

Many of the finds hint at macabre rituals. Hundreds of skulls were found beneath what is now the financial heart of London. Could the victims have been executed and put on display as a warning? Were they the losers of gladiatorial battles at the nearby Roman amphitheater?

One of the most striking exhibits is the decapitated skeleton of a Roman woman found buried beneath what is now Liverpool Street station. The skull is placed between the leg bones.

“To have placed the head between the legs one feels was almost certainly sending some sort of message, either about the person or was some kind of ritual associated with the burial,” Keily said.

The Crossrail route tunnels through several graveyards, many dating to major disease outbreaks such as the “Black Death” in the mid-1300s. That plague pandemic wiped out much of London’s population and killed an estimated 1.5 million people across Britain.

Despite the panic that swept across Europe at the time, archaeologists have noted that burials appear to have been conducted with as much dignity as possible. There are few mass graves and most burial sites were dug in an orderly fashion. Some held up to 20,000 bodies.

Lighter aspects of London life are also on display: a bowling ball found in the moat of a 16th century manor house, perhaps lost beneath the murky water during a high society summer party. Laws prevented lower class peasants from partaking in such revelry.

A collection of leather shoes has survived five centuries buried in the London mud. Some are plain with rounded toes, patched up and well worn. Others appear to have barely been used, their tapering ends suggestive of the modern stiletto heel.

“So very fashionable shoes that Londoners were wearing. It connects us in a way with people in the past,” Keily noted.

Despite the painstaking archaeological work each time something new is unearthed, construction of Crossrail remains on schedule. The first trains are due to take passengers through the tunnels in late 2018.
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New Hospital to Serve 50,000 Impoverished Haitians

Fifty thousand Haitians will have access to quality health care for the first time after a modern new hospital opened Monday in the isolated and impoverished Cotes-de-Fer region.

The Bishop Joseph M. Sullivan Center for Health will serve those who, until now, had to travel for hours on rough roads for treatment.

The new hospital is a project of the nonprofit charity Catholic Medical Mission Board. The U.S.- based group Mercy Health contributed $2 million for construction costs.

“With active involvement of the community and an emphasis on training and knowledge sharing, the health center will strengthen the local health system in a long-term and sustainable way,” said CMMB’s director in Haiti, Dr. Dianne Jean-Francois.

Along with an emergency room and pharmacy, the new hospital will give pregnant women a place to deliver their babies, along with postnatal and pediatric care.

The hospital also has plans for expansion for dental and ophthalmology clinics.
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Experimental Vaccine Protects Against Two Strains of Malaria

An experimental anti-malaria vaccine has been developed that protects against more than one strain of the malaria parasite that causes the mosquito-borne illness.  

The vaccine — tested by principal investigator Kirsten Lyke and colleagues — is called PfSPZ and uses whole, live weakened early versions of the most common form of malaria Plasmodium falciparum (P. Falciparum), called sporozoites.

This early form of the parasite is what’s first injected into humans by an infected mosquito.  

By using the entire sporozoite in the vaccine, the immune system responds to more of the parasite, according to Lyke.

15 healthy adults tested

A study of the vaccine conducted by Lyke and colleagues — published in Proceedings of the National Academy of Sciences — enrolled 15 healthy adults who were assigned to receive three doses of the vaccine over several months.  

Nineteen weeks after receiving the final dose, the volunteers were exposed to bites of mosquitoes carrying one strain of parasite from Africa.

A second group of six controls that was not vaccinated also got exposed to the mosquitoes. They showed signs of malaria and were promptly treated.

Nine of 14 vaccinated participants, or 64 percent, showed no signs of infection after exposure.  

Of the nine, six participants were selected and exposed to a different strain, 33 weeks after the final immunization.

This time, five of the six were protected against this second strain, according to Lyke.

‘Great’ is not good enough

“Which is great, but not good enough,” said Lyke. “I mean, you don’t want to take a vaccine that’s going to give you a two out of three chance of being protected. So we have to improve on that and get it up to as close to 100 percent as we can. But at least we’ve established that we can get very high protection in six months and we’re seeing cross-strain protection.”

The agent would offer broader protection against a disease that kills mostly young children in sub-Saharan Africa.  

According to the World Health Organization, 212 million people were infected with the mosquito-carrying parasite in 2015, and 429,000 died.  

There are four types of malaria parasite that typically infect people. The most common and deadly is Plasmodium falciparum, which goes through a number of life-cycle stages during which the parasite evolves into a different form.  

That is what makes it difficult to develop a vaccine.  

Multiple strains a problem

The problem is further complicated by the fact that P. falciparum can mutate and develop into multiple strains.

Lyke said this is particularly true in Africa, in places where the disease is common.

“The falciparum malaria that is so endemic, there’s a lot of genetic change that occurs because it’s so prevalent in the population. And that contributes to different strains of the falciparum malaria so that you know any vaccine that we’d want to introduce we would want to make sure that it broadly covers multiple different strains of falciparum malaria,” said Lyke.

Clinical trials of the early vaccine, produced by the company Sanaria, also are going on in Africa, including in Burkina Faso, Kenya and Bioko Island off of Africa’s west coast.
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Tanzania Doctors to Help Kenya Recover from Health Sector Strike

Tanzania has announced a plan to send 500 doctors to Kenya after a doctors’ strike paralyzed health services in the neighboring country for months. Kenyan doctors, however, say the government should not hire any foreign doctors but instead employ the more than 1,000 trained physicians who are unemployed.

Tanzanian President John Magufuli announced the plan to dispatch the doctors after a recent meeting in Dar es Salaam with a visiting Kenyan delegation that included Kenya’s health cabinet secretary, Cleopa Mailu.

Mailu said this was a deal that would benefit both countries.

“We have so many government health centers that need doctors,” said Mailu. “Yes, we have doctors in our country; we recently had a doctors’ strike and one of their reasons for their strike was that there were not enough doctors to attend to patients. The doctors were spending a lot of hours attending to the patients.”

Doctors from public hospitals in Kenya went on strike last December to demand a pay raise and improved working conditions for physicians and patients.

A deal struck by the doctors’ union and the government opened the way to negotiations that ended the 100-day-old strike.

According to Mailu, it is because of the doctors’ demands that the push to recruit foreign physicians was realized.

“There is so much work and we will continue looking for more doctors; we will continue negotiations with the government to see if they will provide us with more doctors so that we can strengthen our health services here in Kenya,” said Mailu.

Dr. Elly Nyaim of the Kenya Medical Practitioners and Dentists Board says the move may not have been clearly thought out.

“As per the World Health Organization recommendation, we still have a shortage even with the ones we produce from our universities, that state actually cuts across the entire East Africa… so Tanzania is actually even worse off than we are in terms of the doctor-patient ratio,” said Nyaim.

The physician’s union says Kenya currently has 1,400 doctors who have not been absorbed into the workforce.

Low doctor-to-patient ratio

According to the World Health organization, the Tanzanian doctor-to-patient ratio stands at 1 doctor for every 20,000 patients. In Kenya, it’s 1 doctor for every 16,000. The recommended doctor-patient ratio is one to 300.

“It would be very unfortunate that you are actually exporting when you do not have enough yourself; it should not be done at the expense of denying qualified Kenyans positions because you are bringing foreigners,” said Nyaim.

In a press briefing held after the meeting with the Kenyan delegation, Tanzania’s president welcomed the new deal with the Kenyan government.

“By good luck our friends have said they will pay good salaries and the payment will be in dollars. They will be given accommodation and security,” said Magufuli.

Health Secretary Mailu says the Tanzanian doctors will start working in Kenya in April and will be given two to three-year contracts.

And he says there are plan underway to also hire doctors from Cuba.

 
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Brewery Makes Beer from ‘Toilet Water’

Would you drink beer made from toilet water?

The brewers at one popular brewery in California are betting you would.

Stone Brewing of San Diego unveiled a new beer made from water that “comes from the toilet,” according to ABC 10 News in San Diego.

Granted, the water for the brew, called Full Circle Pale Ale, is not made from water directly from the toilet, but it does use recycled water from the Pure Water San Diego program, the channel reported.

At the unveiling of the new beer Thursday, San Diego mayor Kevin Faulconer called the beer “delicious,” while Stone’s senior manager of brewing and innovation, Steve Gonzalez, said it was among the best pale ales the brewery he has ever made.

Gonzalez told News 10 drinkers would “get some caramel notes, some tropical fruit notes. It’s a very clean tasting beer.”

According to News 10, some attendees at the unveiling were a little sceptical of the beer, but after a taste, they were converted.

“[I thought] that it would have an off taste or be something different to it … it’s outstanding,” Shane Trussell said.

The beer is not yet available to the public, but the brewery said it would be soon.

The Pure Water San Diego program aims to supply one-third of San Diego’s water supply through recycled wastewater.
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Minimum-wage Increases Could Deepen Shortage of Health Aides

Only 17 snowy miles from the Canadian border, Katie Bushey’s most basic needs are met by traveling health aides who come into her home to change her diapers, track her seizures, spoon-feed her fettucine Alfredo and load her wheelchair into the shower.

But that’s only if someone shows up.

Bushey, 32, who lost her vocal and motor skills shortly after birth, is one of more than 180,000 Medicaid patients in New York who are authorized to receive long-term, in-home care, the most in the state’s history. But there are increasingly too few aides to go around, especially in remote, rural areas.

When there aren’t enough aides for Bushey — over a recent two-day stretch there were workers for only four of the 26 hours of care for which she is authorized — her mother must stay home from her job at an elementary school, forgoing a day’s wages and scraping her savings to pay the bills.

Minimum wage

It’s a national problem advocates say could get worse in New York because of a phased-in, $15-an-hour minimum wage that will be statewide by 2021, pushing notoriously poorly paid health aides into other jobs, in retail or fast food, that don’t involve hours of training and the pressure of keeping someone else alive.

“These should not be low-wage jobs,” said Bruce Darling, executive director at the Center for Disability Rights. “We’re paying someone who gives you a burger the same as the person who operates your relative’s ventilator or feeding tubes.”

There are currently 2.2 million home health aides and personal care aides in the U.S., with another 630,000 needed by 2024 as the Baby Boomer generation ages, according to the nonprofit research and consulting group PHI. New York state employs about 326,000 home health workers but is predicted to need another 125,000 by 2024.

For now, home health aides in New York state earn an average of about $11 an hour, though wages are lower in upstate regions. Advocates say the system needs a complete overhaul that focuses on higher pay, worker retention and finding methods of compensation beyond what is provided through Medicaid.

Democratic Gov. Andrew Cuomo has committed nearly $6 billion in funding for home health care reimbursements in coming years as the agencies transition to the $15 minimum wage.

Statewide initiative

The state’s health department has said it is developing an initiative to attract, recruit and retain home health workers.

New York lawmakers have held hearings on the issue, and both the Senate and Assembly have so far included language in their budgets that would review and restructure how the state transfers Medicaid dollars to the providers, agencies and workers with the aim of providing workers and hours where they are needed most.

Other states are grappling with how to address the dwindling workforce as their minimum wages climb.

In Maine, legislation in 2015 attempted to make personal care worker wages more competitive with specific reimbursements for worker compensation. But a popular initiative will raise the minimum wage to $12 by 2020, minimizing those differences.

In Arizona, minimum wage increases have been accompanied by increased reimbursement rates, and in Washington state, workers negotiated a $15 wage for some home-care workers for when the state minimum increases to $13.50 in 2020.

New York advocates say a higher state minimum wage won’t attract any extra workers in rural regions such as Clinton County, where Bushey lives.

A single agency, North Country Home Services, hires and trains about 300 home health aides and personal care aides for about 1,000 people throughout a mountainous region the size of Connecticut. In any given week, the agency says, it leaves 400 hours of state-authorized care unfilled due to staffing shortages.

Special type of worker

The aides who continue despite the wages are a special breed, said Erica Stranahan, of Plattsburgh, who has worked as a home health aide with North Country for nine years and earns about $12 an hour. Stranahan said several of her co-workers have recently left home care for less-intensive professions that will soon have similar wages.

Stranahan acknowledged she makes it work only by sharing rent and living expenses with her boyfriend. She said she feels a responsibility to those she cares for, and would rather find a second job than quit caring for others.

“I enjoy helping people,” she said. “We’re with them for so many hours. It’s almost like we’re a second family for them,” Stranahan said.

But Rosalie Kline, a personal care aide in Canandaigua for nearly 13 years who also struggles to make ends meet, said that if worse came to worst, she would find another job that paid more.

“I wouldn’t want to. I love my job,” she said. “But I might need to.”
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Film Looks at Plastics in the Oceans

Eight million metric tons of plastic wind up each year in the oceans, harming marine life and entering the food chain. Mike O’Sullivan reports a new documentary film called “A Plastic Ocean” looks at the problem, and its solutions.
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