Dems Call For Immediate PFAS Hearings; They Won’t Happen

House Democrats called on Republicans to hold hearings this week, specifically in the Natural Resources and Oversight committees, to have the Department of Environmental Quality present what it knows about PFAS contamination and how extensive the problem is in Michigan.

Eight Democrats, led by Minority Floor Leader Christine Greig (D-Farmington Hills), held a press conference Sept. 4 to demand the hearings and that lawmakers take immediate action to strengthen water quality standards for perfluoroalkyl and polyfluoroalkyl substances (PFAS), a diverse group of compounds resistant to heat, water and oil. Such chemicals have been used in hundreds of consumer products and industrial applications including carpeting, apparels, upholstery, food paper wrappings, fire-fighting foams and metal plating.

The chairs of those committees, Rep. Gary Howell (R-North Branch) and Rep. Joseph Graves (R-Linden), called the press conference “political” and said hearings won’t be happening in early September. Howell said he is committed to holding hearings, but will wait until after the election.

“It is a pattern of indifference. That’s why we need the public pressure right now to call for hearings, call for oversight, and get back to an empowered DEQ that understands the issue, listens to the scientific data, listens to the public health concerns, and actually takes action,” Greig said in the press conference.

“I think the big concern is we have very few session days left,” said Rep. Kevin Hertel (D-St. Clair Shores). “They have already cancelled a few weeks between now and the election and our concern is that we are here this week. There is no reason we cannot have hearings this week. The Oversight Committee meets at 9 a.m. on Thursdays and legislators will be here this Thursday. So, let’s bring the department in and ask them the important questions.”

Howell was not convinced.

“I don’t see, in the current atmosphere, it being a productive hearing. I’m not wanting to hear people demagogue this issue one way or the other. I want calm, clear testimony from scientifically qualified people to explain what the level should be going forward. And I just believe that we are not in the right atmosphere, at the moment, to have that kind of calm discussion and work out the best possible solution. But I am committed to doing hearings in November,” Howell said.

Graves noted the state legislature gave the DEQ $23 million a few months ago to study the problem.

“We want to give the DEQ an opportunity to do their job, conduct a study, take the proper empirical measurements, be analytical because this is a new animal . . . We need to know what this is. They are doing their testing. They are working with the feds. And we want to make sure they understand what’s a safe level and what’s an unsafe level,” he said.

Acceptable levels of PFAS in drinking water are a key issue. Rep. Winnie Brinks (D-Grand Rapids) noted that currently there are 30 communities in Michigan which have PFAS levels above the current advisory level of no more than 70 parts per trillion.

“Even more troubling is that that level is only an advisory. We still do not have an enforceable drink water standard established in law to protect our citizens from PFAS contamination,” Brinks said. She introduced legislation last year to set a much lower level for drinking water of 5 ppt. She said that is more in line with new recommendations from the Centers for Disease Control of no more than 7 to 11 ppt.

Brinks also said Democrats are proposing to increase the funding for PFAS response to $39 million. She noted Gov. Rick SNYDER originally asked for that amount in the budget. She said Republicans in the legislature cut the amount to $23 million.

And Democrats have called for the Legislature to provide communities with alternate water supplies in cases of contamination, instead of relying on impractical bottled water for washing, bathing and cooking.

Since the introduction of legislation in December, House Democrats say they have repeatedly called on the chairman of House Oversight to hold hearings on PFAS contamination, yet their calls for action have gone unanswered.

Both Howell and Graves said they had not been contacted by Democrats about the call for hearings the week of Sept. 4.
“We are finally back in session tomorrow,” Greig said. “The time for excuses is past. This administration and legislative Republicans have an opportunity to show that they can do more than the bidding of the wealthy corporate donors. As the Great Lake State, our water is part of our collective identity. Yet, even as we are surrounded by the most abundant freshwater source on Earth, we are unable to assure the water coming out of our taps is safe for us to drink or bathe in. Pure Michigan has to be more than a marketing slogan.”

This story presented in cooperation with MIRS, a Lansing-based news and information service.

Toxic Déjà Vu – PBBs And Now PFAS

By GERALD NATZKE, JR., DO
Do you remember Polybrominated Biphenyls (PBBs) sowing fear and disease into the lives of Michigan citizens approximately 43 years ago? Those PBB’s entered the larger food chain through a single error made by a Gratiot County chemical company worker when a ton of Firemaster (a toxic fire retardant) was added to cattle feed. PBB’s were ingested by cattle throughout this area and spread throughout Michigan and the Midwest, producing one of the largest chemical poisonings in the Western world. Another much larger and more dangerous toxic chemical exposure has been discovered. This family of toxins, through ignorance, and poor oversight has been introduced to Michigan’s and U.S. citizens in multiple insidious ways. These chemicals are called Per- and Polyfluoroalkyl Substances (or PFAS and PFOS).

U.S. Rep. Dan Kildee said that “the seriousness of PFAS contamination cannot be overstated.” Frankly, like the PBB issue in the ‘70s the PFAS poisoning ushers in another era of ecologic crisis. These perfluorinated compounds are linked to cancer, liver damage, birth defects, infertility, thyroid and autoimmune disease, neurologic disorders and hypercholesterolemia. According to Kildee at a recent meeting with physicians, these compounds have been found in more than 30 sites throughout Michigan and are entering aquifers and the Great Lakes. Recently, large amounts have been measured in Lake St. Clair, near 1,000 parts per trillion. Because of this, there is a fish consumption advisory and concern among the cities supplied by water from this lake. All of the Great Lakes will eventually be affected.

The State of Michigan was warned back in 2012 by Superfund section specialist Bob Delaney, a Department of Environmental Quality employee. Not until five years later did Gov. Rick Snyder’s office set up a PFAS response team.

These chemicals have been used in military installations and businesses for a variety of purposes. Some of the most common are water repellant clothing, non-stick pans (Teflon), stain resistant fabrics including carpets, tanning products, cosmetics and fire-fighting foam. There are more than 3,000 of these man-made fluorinated organic chemicals. M-Live reported that it had been found in high concentrations in both Flint’s Gilkey Creek and the Coldwater Road landfill. The EPA has set the concentration for a lifetime consumption limit for humans at 70 ppt. Like with the Lead and Copper Rule used by the federal government, many feel these toxic exposure limits should be lower.

Should physicians desire further information regarding these chemicals for their patients, laboratory tests exist that will evaluate levels of these chemical families in the water and in the blood. Water testing can be done with Pace Analytical Lab, Watercheck and TapScore, to name a few. For testing blood samples there are at least two labs available, NMS and Vista Analytical Laboratory.

The Precautionary Principle was not applied to the PFAS family of chemicals. This is a rule that is used in other countries and Europe but not often in the United States. It is also part of an accepted resolution by the AMA produced by the Genesee County Medical Society. It states that prior to the release of a new chemical into an environment the chemical must be studied and its potential for harm thoroughly understood. In the United States, traditionally many chemicals are released first with little safety evaluation and if significant harm comes, then they are removed. Unfortunately, the fines are much less in many cases than the profits gained.

PFAS contamination was a disaster just waiting to happen. It was not adequately studied for disease-causing potential in people, animals or fish. The sad thing is that people will be injured and die because the Precautionary Principle had not been applied.

In both environmental disasters, PBBs and now PFAS chemicals, serious mistakes were made with their testing, handling and use. It is clear that an in-depth study of chemical safety prior to release into the environment of all chemicals are required. Following this, strict regulation of all discovered toxins needs to be enforced. Perhaps by doing so the ecosystem our children and grandchildren inherit will be healthier than the one that we now share.

This column comes to Healthcare Michigan courtesy of the Genesee County Medical Society. Natzke is GCMS President. The article was previously published in the Genesee County Medical Society Bulletin and appears here with permission.

I’m Voting For Healthcare Interoperability In November. How About You?

By EWA MATUSZEWSKI
We know that “Fix the Damn Roads” is a critical imperative for one of Michigan’s gubernatorial candidates—and hopefully for both. But is “Fix the damn interoperability problem with electronic health records” another? The intersection of healthcare and politics is obviously not new. I would contend it’s more visible—and viscious—than ever. Still, the focus tends to be on access to care and delivery of care, and I understand that. Interoperability of EHR hardly pulls at the heartstrings or incites passionate conversation from either side of the aisle. Accordingly, it doesn’t garner much attention from the consumer media either. That is why it is important for healthcare decision makers to individually and collectively raise awareness of the issue, not just in the healthcare community, but with our elected officials.

To make sure we’re clear on the topic (and in case some politicians are reading this,) interoperability in this context refers to the ability to share and interpret patient data and information electronically across systems and devices among hospitals, insurers, clinics and private practice physicians.

I’ve said it before, and I’ll say it again: there ought to be a law. While I disdain the proliferation of excessive laws that seemingly aim to control our every move, legislation embraced by both parties to establish requirements for the interoperability of individual healthcare records is critical element of health reform. It empowers both patients and their providers to get sensible, timely care without excessive testing, over-testing and re-testing. It is patient-focused and cost conscious, while consistent with population health goals.

If I’m hospitalized and then transferred to another hospital, the assumption is that my records will be immediately available electronically to the receiving hospital. Let’s also touch on emergency room or urgent care activities. These “urgent” encounters become part of the patient’s permanent health record seamlessly. Right? Similarly, if I had an ultrasound done at hospital “X” last year, the ultrasound results should be available online, with my permission, at hospital “Y” this year, correct? The response to all these scenarios is, “Not necessarily.” Similarly, unless a physician practice uses a registry or an EHR that “speaks” to a data repository, health plans are also forced to send auditors to the provider to extract much needed HEDIS information, which can get needlessly complicated when the physician doesn’t use a registry at all. (Yes, some physician practices still rely on paper documentation.) Why is this lack of patient data transfer acceptable in 2018?

Surprising to many, interoperability also plays a role in chronic illness surveillance and treatment. Among our organization’s patient population, primary care physicians have dramatically increased compliance with diabetic patients for retinal eye exams, thanks to the affordability of a mobile eye scanning device that allows the scan to be taken in the PCPs office. The scans are then immediately sent electronically to a retinal specialist for interpretation; a referral to a local retinal specialist is provided when merited.

Despite multiple state-wide initiatives in recent years to make interoperability a reality, including those spearheaded by state agencies, none of our collective efforts have moved the needle far enough. Rather than getting all the players to the table to discuss interoperability, new silos are being created to mask communication inefficiencies. Maybe legislation would help us finally achieve the goal?

Updated Opioid Laws Enact More Stringent Reporting And Usage Requirements

By JESSE A. MARKOS, ESQ.
Wachler & Associates, P.C.
The Michigan Opioid Laws include a 10-bill package of legislation passed in December, 2017, to help curb Michigan’s increasing substance abuse and drug diversion problem. The majority of these provisions came into effect on June 1, 2018 and healthcare providers must become familiar with and incorporate these provisions in to their practice to ensure they are compliant with the changes.

Healthcare providers use the Michigan Automated Prescription System (MAPS) to review a history of any Schedule 2-5 controlled substances that a patient has legally obtained. Not only does MAPS list the prescriber and type of controlled substance that has been prescribed, but it also lists the location of the pharmacy it has been dispensed at. MAPS data assists healthcare providers in identifying evidence of potential diversion such as: obtaining controlled substance prescriptions from more than one provider, filling prescriptions early, filling prescriptions at multiple different pharmacies, and filling prescriptions at distant pharmacies. In the past, providers were not required to register for or use MAPS, although it was highly encouraged and likely to be considered the standard of care when prescribing a controlled substance. Nevertheless, while it was largely considered the standard of care to run and review a MAPS report when prescribing a controlled substance, the issue of how frequent such reports should be run for a chronic patient was less certain. The new laws make it both an express requirement that a prescribing healthcare provider register with MAPS and that they run and review such data every single time a prescription is written that exceeds a three-day supply.

Another important provision in the Michigan Opioid Laws is the “Start Talking” consent form, which must be filled out whenever a prescriber issues a controlled substance containing an opioid to a minor or adult. This form not only has signatures from all involved parties, but it contains all of the relevant information about the risks of taking the opioid, such as: acknowledgement that the drug has potential for abuse, how to properly dispose of an expired or unused controlled substance, and that the delivery of a controlled substance is a felony, among other things. Again, although obtaining prior consent was certainly a standard of care requirement previously, the new laws make it an express requirement that the specific notice listed in the new laws must be adopted in any Consent Form being utilized by a health care provider moving forward.

The Michigan Opioid Laws contain ten (10) new provisions that were passed by the Michigan Legislature, and providers who prescribe or dispense controlled substances must familiarize themselves with these new laws in order to remain compliant and protect their licensees. For additional information or assistance, contact Jesse A. Markos, Esq., of Wachler & Associates, P.C., at (248) 544-0888.

IRS: The Good, Bad and Ugly for Health Care Providers

By RALPH LEVY
In early August, the Internal Revenue Service issued proposed regulations that provide guidance to owners of pass-through businesses as to eligibility for a federal tax deduction of 20 percent of the income generated by the businesses. This deduction was part of the Tax Cuts and Jobs Act (TCJA). Although the stated purpose of the proposed regulations is to provide clarity on eligibility for and the means to compute the deduction, this guidance is lengthy and complex. However, for healthcare providers, there are two important takeaways.

Takeaway No. 1: Guidance on whether a healthcare business is a “specified service trade or business.”

One of the important limitations to the pass-through deduction in the TCJA is that owners of pass-through businesses that conduct a specified service trade or business (SSTB) and whose income exceed the so-called income limitation ($207,500 for single taxpayers and $415,000 for married taxpayers who file jointly) are not entitled to claim the 20 percent deduction. The TCJA provides that a SSTB includes a trade or business that involves the performance of services in the health field.

The proposed regulations provide guidance as to what types of businesses involve the performance of health services:

The performance of services in the field of health means the provision of medical services by physicians, pharmacists, nurses, dentists, veterinarians, physical therapists, psychologists, and other similar healthcare professionals who provide medical services directly to a patient (emphasis supplied).
Prop Reg. 1.199A – 5(b)(2)(ii).

Providers of certain types of healthcare services might be able to avoid the SSTB limitation if their services are not provided directly to patients. For example, radiologists who are partners in a professional limited liability company and who merely read test results may be eligible for the deduction but the treating physician will not be entitled to the deduction since the treating physician provides services “directly to patients.”

Similarly, if an orthopedic group also owns a physical therapy clinic, because that clinic’s services are directly related to the medical field, it is likely that the clinic will be deemed to be engaged in a SSTB. However if the same physician group also operates a health clinic “that provide[s] physical service or conditioning to their customers (i.e., not medical related)”, the clinic will not be engaged in a SSTB.

Takeaway No. 2: The use of a “captive MSO” will not work.
Prior to issuance of the proposed regulations, one of the planning suggestions that many advisors had recommended for consideration by owners of healthcare businesses whose income exceeded the income limitation was segregation of the billing, collection, accounting and other “back office” activities of the practice into a separate legal entity under common ownership with the practice group. This new legal entity would in reality be a management service organization (MSO) that provides services only to the affiliated practice group. Such a new entity was referred to by some as a “captive MSO”.

Under the proposed regulations, if the captive MSO provides services only to the practice group under common control, the MSO would be deemed to conduct a SSTB. This of course eliminates the tax advantage of establishment for the MSO.

By contrast, if more than 20 percent of the income of the MSO is generated from providing management services to other payors such as unrelated medical practice groups, the MSO would not be found to engage in a SSTB.

Similarly, if a dentist is the sole member of a limited liability company that owns a two story office building and rents the first floor to the dentist’s dental practice but leases the second floor to an unrelated business, half of the income generated by the LLC from the building will be deemed to be generated from a SSTB.

Although the proposed regulations limit the ability of health care providers to use affiliated entities to maximize the 20 percent deduction, planning opportunities still exist if the ancillary business is owned by a trust or other entities not under “common control” or if the business provides services to unrelated service providers.

In summary, even though they are complex and cut-off some available planning opportunities, the newly issued proposed regulations do not eliminate all planning opportunities to maximize the 20 percent deduction for owners of pass-through businesses that provide health care services.

LANSING LINES

Lyon’s Attorneys Seek To Dismiss Criminal Case
As expected, attorneys for Michigan Department of Health and Human Services Director Nick Lyon are asking the Genesee County Circuit Court to quash the bind over from district court and dismiss all criminal charges.
In court filings Sept. 10, defense attorneys John J. Bursch, Larry Willey and Charles “Chip” Chamberlain Jr. say Genesee County District Judge David Goggins’ made his “decision by closing (his) eyes to numerous principles well-settled in Michigan law” and that his decision to send Lyon to trial on two counts of involuntary manslaughter and misconduct in office is the first in the state’s history to hold a director criminally liable for subordinates.

“The families of Mr. (Robert) Skidmore and Mr. (John) Snyder desire justice, as do the people of Flint,” Bursch wrote. “But that desire cannot be satisfied subjecting Director Lyon to a trial for criminal charges that fail as a matter of law. That would be the exact opposite of justice.”

A 9 a.m. Sept. 26 hearing was set, but it’s unclear if Circuit Judge Joseph J. Farah will hear the defense’s motions that day.

The state had not filed a response as of Sept. 10.

The state argued at a preliminary examination that Lyon’s failure to notify the public about Legionnaires’ disease in the Flint area in 2014 and 2015 led to the deaths of Skidmore, 85, of Genesee Township, and Snyder, 83, of Flint-area.

Lyon also faces one count of misconduct in office for allegedly misleading and withholding information about Flint’s Legionnaires’ disease outbreaks and directing a health official to discontinue analysis to find the source.

In a separate motion, the defense also seeks to dismiss a misdemeanor count of willful neglect of duty, which automatically moved to Circuit Court with the felonies when Goggins didn’t make a ruling on the defense’s motion to dismiss the charge.

The defense says Lyon had no ministerial duty and any alleged duty to “protect the public health” is too vague to be enforceable. To support their argument, the defense points to preliminary examination testimony in which witnesses testified whether, when and how to give notice of an outbreak is professional judgment and discretion.

“As far as the MDHHS director is concerned personally, the statute requires only that he ‘be qualified in the general field of health administration.’ . . . Indeed, the MDHHS director’s oversight of his epidemiologist and health officers in the event of a Legionnaires’ outbreak is the epitome of discretion,” Bursch wrote.

“Based on this legal defect in the charge, the lack of any evidence of willful neglect, and the additional reasons described below, the defense moves to dismiss (the charge),” he added.

Health Policy Considers Creation Of Statewide Mental Health Hotline
A state-wide mental health hotline—which would connect callers experiencing a mental health crisis to facilities that have psychiatric beds available and other service providers — would be created under legislation taken up Sept. 5 in the House Health Policy Committee.
Rep. Mary Whiteford (R-Casco Twp.) told the committee her HB 6202 was inspired by an experience she had with a friend who had become depressed after the death of her grandmother. Whiteford said she contacted local mental health services, one of which said if her friend was not suicidal there was nothing they could do. Another behavioral help group said it usually takes three to five months for new patients to see a provider.

Eventually, Whiteford took her friend to an emergency room where the friend was admitted. After a one-week stay, the bill was $10,000, Whiteford said, of which the friend owed $5,000.

How many would persevere after getting turned away twice, she asked.

“The answer is most people don’t know where to go. They don’t know who to ask for help. They do nothing. What happens to the struggling person? They hurt themselves. They commit suicide. They hurt others. What would have helped? What can help others in the same situation?” she said.

Such a hotline was called for in the House CARES (Community, Access, Resources, Education, and Safety) task force report members worked on last year and was unveiled in January. The task force reviewed the status of mental health services across the state, and found that availability of services is inconsistent from county to county.

Rep. Daniela Garcia (R-Holland) had several questions. For one, Community Mental Health services in counties are required now to have hotlines. Why is that not sufficient? she asked.

“Did you know that it is easier for somebody on Medicaid to access services than it is for someone who is uninsured, or someone who is insured. This allows access to everybody,” Whiteford answered.

Garcia also asked who would be assigned to answer that hotline, how they would be trained and evaluated.

“At this point, I don’t want to be so prescriptive that we lose innovation that we lose the ability for a company to make those judgment calls. So, the way I see it, is that the department will put out a request for proposals,” Whiteford responded.

Under the bill, the Department of Health and Human Services would contract for the design, operation, and maintenance of the hotline. DHHS would work with the contractor as well as the Department of Licensing and Regulatory Affairs to tap into existing databases and lists of service providers. Any operator company would be expected to run the hotline using various methods of communication including phone calls, texts, e-mails and internet chats.

Garcia put the estimated cost of creating the hotline at around $6 million. The bill analysis states the annual cost of operation would likely be similar to other hotlines the state operates, which range between $1 million and $2.5 million.

The committee ran out of time for further testimony. No vote on the bill was taken.

Proposal 1 On November Ballot: Marijuana Legalization
Michigan Director of Elections Sally Williams released Aug. 31 draft ballot language for the Coalition to Regulate Marijuana Like Alcohol’s initiative to legalize marijuana.
The proposal, 18-1, would initiate a law to “authorize possession, use and cultivation of marijuana products by individuals who are at least 21 years of age and older, and commercial sales of marijuana through state-licensed retailers.”

The Board of State Canvassers was expected to consider the recommended language at its 10 a.m. Sept. 6 meeting at Delta Charter Township Hall, 7710 W. Saginaw Highway, Lansing.

In addition, the proposal would:

– Allow individuals age 21 and older to grow up to 12 marijuana plants for personal consumption;

– Impose a 10-ounce limit for marijuana kept at residences and require that amounts over 2.5 ounces be secured in locked containers;

– Create a state licensing system for marijuana businesses including growers, processors, transporters and retailers;

– Allow municipalities to ban or restrict marijuana businesses.

– Permit commercial sales of marijuana and marijuana-infused edibles through state-licensed retailers, subject to a new 10 percent tax earmarked for schools, roads and municipalities where marijuana businesses are located.

CRMLA was formed this year to support the ballot initiative to end marijuana prohibition in Michigan and establish a system in which it is regulated and taxed, similar to alcohol.

In April, the Board of State Canvassers approved the coalition’s petition.

In June, the Michigan Legislature didn’t have the votes to pass the legalization ballot initiative, which means the issue appears on the Nov. 6 ballot.

If approved, Michigan would become the 10th state to legalize, regulate and tax marijuana, according to CRMLA’s website.

Agencies, businesses and organizations opposing recreational marijuana legalization have mobilized in recent months.

Witness: Finding Cause of Flint Water Crisis ‘A Luxury’
A former state epidemiologist testified Aug. 30 that finding the cause of elevated blood-lead levels in Flint’s children during the water crisis would have been “a luxury.”
Cristin Larder returned to the stand for the fourth time in the preliminary examination for Nancy Peeler, director of Michigan Department of Health and Human Services Program for Maternal, Infant, and Early Childhood Home Visiting, and Robert Scott, data manager for the department’s Healthy Homes and Lead Prevention program. The hearing, which will determine if there is probable cause to send criminal charges to Circuit Court for trial, resumes Sept. 20.

The state alleges Peeler hid Larder’s report and joined Scott to create a second report that falsely indicated no statistically significant rise in blood-lead levels of children in July, August or September 2014.

Larder’s testimony remains consistent that Peeler asked her in February 2015 to analyze data to determine if there was an uptick in blood-lead levels in Flint children during the water crisis, which began in April 2014 when the city switched its drinking water source to the Flint River, and that she learned during a Freedom of Information Act file dump that her report wasn’t in the state files.

Larder also maintained that she didn’t have enough raw data to explore more thoroughly or to reach a conclusion about the cause.

“I cannot say and I couldn’t say at the time,” she said.

Larder was the only witness today and at times the proceedings felt slow as Special Prosecutor Todd Flood sparred with Scott’s attorney, Mary Chartier, who carefully questioned Larder about emails she wrote in 2015 about her analysis and whether Peeler and Scott were recipients of those emails.

Chartier argued that information Larder penned in a February 2016 email wasn’t sent to Peeler or Scott and therefore, isn’t relevant, but Flood countered that the email shows Larder’s report “was basically suppressed,” which is the basis for the charges against Peeler and Scott.

“Bob Scott is not misleading anyone,” Chartier told the court as she questioned Larder.

“Bob Scott is not in charge of anyone. He’s there to provide data and what I’m trying to get from Miss Larder is smart people are looking at a challenging issue and trying to come up with ideas,” the attorney added. “He’s not directing what they do or don’t do and that goes to the heart of what Mr. Flood is trying to put on the shoulders of my client, who is not even involved in these matters.”

Peeler and Scott are each charged with misconduct in office and conspiracy, both of which are felonies. They are also charged with misdemeanor count of willful neglect of duty in connection with the Flint water crisis.

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

LETTER

Editor:

Just A Few Questions
How can it be expected that all physicians and all citizens will succumb to the idea of socialized medicine without inquiring as to why they should? Is it somehow mandatory that we U.S. citizens duplicate the socialist-lite bloated welfare states that are the examples of how the rest of the “advanced” world’s approaches healthcare? How is it always correct to increasingly subvert the medical profession by employing ever more restrictive regulatory shackles? Isn’t it interesting to witness how the left-leaning elites write a check with money they do not have that comes from our bank accounts so that they can snoot and virtue signal? Isn’t social justice great when some elites can redistribute wealth to achieve equal outcomes in a world of humanity with individual cultures and aspirations? It seems I read somewhere that God created each person as unique and in His own likeness.

As the cadre of newly enlightened devotees to the alleged equality of their social justice platform prescribe socialized medicine for all of us, will this not steal coveted freedoms from physicians and citizens? Critical thinking versus emotional feel-good stuff?

You know, let these great new falsely pious warriors have at it. But leave the rest of the doctors and patients out of their unfunded, freedom-sapping never in history workable plans for us all.

Is not the pitifully decreasing physician morale in this country sufficient? Does it need to be at the pathetic levels of physicians functioning in those socialized medicine havens of provider underpayment for rationing care their governments can increasingly not afford? We already have two physician suicides a day in the United States.

Duplicating failure seems a strange goal, does it not?

The ‘Right’ To Healthcare?
When healthcare is presumed a right, the provider, doctor, has no rights. That someone would expect a service from another without payment seems much like the scourge of slavery that was belatedly banished from this country in the mid-19th century. There seems a hypocrisy here as the loud screams of the virtue signalers for social justice are joined by equally loud screams for physician services on demand for “free.” Is it not abusive to expect care without any expectation of payment or even a hint of appreciation? Explain the moral basis of those who want healthcare for “free” and those who benefit from this politically. There seems a loud and clear message here regarding the progressive movement and the duplicity of virtue signaling and social justice.

Then there is a mandatory obligation to preach false magnanimity devoid of any relationship to economic realities. With government-run healthcare, would there be any incentive for capital investment? Let me give a unambiguous answer, ‘no.’ Without capital investment, innovation disappears. Entrepreneurs are eradicated. And remember, financial capital effects human capital in direct correlation, and this includes the number, type and quality of future physicians. You cannot stave off voluntary and intelligent capital flow to the innovators in exchange for political favoritism, mercantilism, and expect anything other than the status quo at best. The emotional “feel good high” of the Medicare for all crowd can’t have it both ways, progress versus increasing government control.

Yes, for a person to share the most private aspects of their life often with nothing covering them other then a drape, this truly is a special bond, “a sacred relationship.” It cannot be legislated. In fact legislation has consistently eroded it. God help us if the bureaucrat elites are able to destroy it. The profession of medicine will be lost. This is a tragedy for all of us who will at some point need healthcare. You can meet your favorite bureaucrat or hospital administrator in the ER. The real doctors are likely a rapidly diminishing group in an environment of mandatory capitulation. There must be consequences, and these will most assuredly be negative.

—Allan Dobzyniak, MD

The opinions expressed above are those of the author and not necessarily those of Healthcare Michigan or its advisors.

PFAS Firefighting Foam Still Used Because It Works Better

The firefighting foam linked to the group of chemicals known as PFAS—which is believed to be harmful to infants, toddlers and pregnant women—is still being used because firefighters say the alternative extinguishing products don’t work as well.

Detection of PFAS has led to the creation of the Michigan PFAS Action Response Team, a multi-agency organization dedicated to understanding the far-reaching effects of the chemical and educating the public on the threat it poses.

The discovery of high concentrations of PFAS in the drinking water near Camp Grayling, Kent County and Parchment has spurred public and political concern. Most recently, U.S. Reps. Debbie Dingell (D-Dearborn), Fred Upton (R-St. Joseph) and Tim Walberg (R-Tipton) are pulling together a public meeting on the subject.

House Democrats are working with the League of Conservation Voters in demanding Republican legislative leaders hold hearings on the issue.

“It’s reason for concern because it’s an issue of public health,” said Katie Parrish, communications director for the Michigan League of Conservation Voters.

The Michigan PFAS Action Response Team has asked State Fire Marshal Kevin Sehlmeyer to survey over 1,000 fire departments to identify the amount of PFAS in firefighting foam, according to the Michigan Department of Licensing and Regulatory Affairs.

Although the survey has not been completed, the response team and other agencies have evidence that the foam has been used to contain fuel and electrical fires and in training drills.

Firefighters and certain military personnel are required to use the foam. The response team believes the military’s heavy use of it contributed to elevated levels of the chemicals in Lake Margrethe, a lake adjacent to Camp Grayling. About a dozen similar sites are also affected.

Because of the danger, many newer firefighting foams don’t contain PFAS, said David Glotzbach, president of the Michigan Association of Fire Chiefs and a 33-year veteran firefighter.

“However,” Glotzbach said in an email, “these products are not effective in extinguishing flammable liquid fires.”

The Department of Environmental Quality has 35 active investigations for potential PFAS contamination across the state. It has begun testing public drinking water for the contaminant throughout the state, said Scott Dean, the agency’s communications director.

The testing will be finished by the end of the year and the agency has only found one public drinking supply—in Parchment—with dangerous levels of the chemical, he said.

Some commercial businesses have fought the testing. In May, the managers of Gerald R. Ford International Airport attempted to deny DEQ testing, claiming government overreach. The DEQ eventually tested the airport and found elevated levels of the chemical.

PFAS is dangerous in part because it does not break down in the environment or the human body, leading to its designation as a “forever chemical” by the LCV.

The chemical is produced across the country and used not just for firefighting but for products such as stain-resistant shoes and no-stick pans. Waste from these production sites cannot always be treated by generic wastewater treatment plants, according to the Michigan Environmental Council. Specifically, when several industrial buildings discharge waste directly into a treatment plant, the chemicals will still survive.

Meghan Swain, executive director of the Michigan Association for Local Public Health, says the federal government should be more proactive in regulating PFAS.

“Michigan is the only state talking about PFAS chemicals,” Swain said referring to the formation of the state’s PFAS Action Response Team. “The EPA should have sounded the alarm years ago.”

The EPA says 70 parts per trillion is the limit on PFAS for safe drinking water. But some groups, such as the LCV, say that it is too lenient and want limits set at 5 ppt.

“The state is using the EPA’s standard but it’s critical to understand that this EPA standard is an unenforceable, advisory-only recommendation and only covers two of the many PFAS chemicals,” Parrish said.

(Contributed by Capital News Service correspondent Jeremy WAHR.)

This story presented in cooperation with MIRS, a Lansing-based news and information service.

In Trump’s First Year, Nation’s Uninsured Rate Unchanged

By PHIL GALEWITZ
Despite Republican resistance to the federal health law, the percentage of Americans without health insurance in 2017 remained the same as during the last year of the Obama administration, according to a closely watched report from the Census Bureau.

However, the uninsured rate did rise in 14 states. It was not immediately clear why, because the states varied dramatically by location, politics and whether they had expanded Medicaid under the federal health law. Those states included Texas, Florida, Vermont, Minnesota and Oregon.

The uninsured rate fell in three states: California, New York and Louisiana.

An estimated 8.8 percent of the population, or about 28.5 million people, did not have health insurance coverage at any point in 2017. That was slightly higher than the 28.1 million in 2016, but did not affect the uninsured rate. The difference was not statistically significant, according to the Census report.
About 17 percent of Americans were uninsured in 2010, the year the Affordable Care Act was enacted. The Census numbers are considered the gold standard for tracking who has insurance because the survey samples are so large.

Analysts credit the health law with helping drive down the number of uninsured. But also a factor: The proportion of people without insurance typically falls as unemployment rates decline. That’s because more people can get health coverage at work or can better afford buying insurance on their own.

The nation’s unemployment rate has generally been falling since before 2011 and was 4.1 percent for the last quarter of 2017, the lowest level since before the Great Recession began in December 2007.

Critics of the health law said the report emphasized its deficiencies. “Today’s report is another reminder that Obamacare has priced insurance out of the reach of millions of working families,” Marie Fishpaw and Doug Badger of the Heritage Foundation said in a statement. “Despite a growing economy and very low unemployment rate, the uninsured rate remains virtually unchanged.”

But the law’s supporters instead saw the glass as half full.

“These numbers show the resilience of the Affordable Care Act,” said Judith Solomon, senior fellow at the Center on Budget and Policy Priorities. She said people still value the coverage they receive from the health law even as it’s been under attack by President Donald Trump and Republicans who want to repeal it. “It’s good news because the numbers show the strength of the ACA but bad news in that we have not seen further progress.”

Solomon expressed concern, though, about the large number of states seeing uninsured rates increase.
Uninsured rates last year ranged from a high of more than 17 percent in Texas to low of just under 3 percent in Massachusetts.

West Virginia had one of the sharpest increases in uninsured.

About 14 percent of the state’s residents were uninsured in 2013 before the ACA’s premium subsidies and Medicaid expansion began. That rate fell by nearly two-thirds by 2016. Last year, however, West Virginia’s uninsured rate crept up 0.8 percentage points to 6.1 percent, according to the Census report.
Carol Bush, who has worked as a health insurance navigator the past three years in West Virginia, expects to be uninsured by month’s end. She is losing her job amid Trump administration cuts to the Affordable Care Act navigator program.

Carol Bush, 58, of Elkins, W.Va., expects to lose coverage Oct. 1 because her job is ending.
It’s an unfortunate irony: Elkins has served for the past three years as a navigator helping people in her community find coverage in the health law marketplaces. Federal officials have largely scrapped that program.

The Trump administration cut funding by more than 80 percent during the past two years, saying it had no proof that navigators were helping people find coverage. Only if consumers signed up in the presence of the navigator was a session considered a success.

Bush had coverage through the University of West Virginia, which has a navigator contract that ends at the end of this month. Without employer coverage, Bush said, the cheapest insurance she could find would be about $1,100 a month. She won’t qualify for a federal subsidy to lower her premium because of her family’s income. Her husband is insured through Medicare.

Although she said she has strongly considered going without insurance because of the cost, she knows she needs it.

“In all honesty, I’ve always had some kind of health insurance, and the thought of being without it worries me,” she said. “I can’t risk getting seriously ill and incurring enormous debt at this point in my life. Peace of mind has a value too.”

Shenandoah Community Health Center, a federally funded health clinic in Martinsburg, W.Va., has started to see an increase in uninsured patients the past year, although it’s still below levels it saw before the health law’s coverage expansion began in 2014, said CEO Michael Hassing. Hassing said he believes many patients have dropped coverage, thinking the ACA’s individual mandate was repealed.

“Folks say, ‘I don’t need to have it anymore,’ and they let it go,” he said.

While the GOP failed last year to repeal the law, Congress was able to strip out one of its key features — the individual penalty for not having coverage. The vote last December eliminated that penalty starting in 2019 — meaning Americans are still required this year to have health coverage or face the consequences on their 2018 taxes.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. http://www.kaiserhealthnews.com

McCain’s Complicated Health Care Legacy: He Hated the ACA. He Also Saved It.

By EMMARIE HUETTEMAN
There are many lawmakers who made their names in health care, seeking to usher through historic changes to a broken system.

John McCain was not one of them.

And yet, the six-term senator from Arizona and decorated military veteran leaves behind his own health care legacy, seemingly driven less by his interest in health care policy than his disdain for bullies trampling the “little guy.”

He was not always successful. While McCain was instrumental in the passage of the Americans with Disabilities Act in 1990, most of the health initiatives he undertook failed after running afoul of traditional Republican priorities. His prescriptions often involved more government regulation and increased taxes.

In 2008, as the Republican nominee for president, he ran on a health care platform that dumbfounded many in his party who worried it would raise taxes on top of overhauling the U.S. tradition of workplace insurance.

Many will remember McCain as the incidental savior of the Affordable Care Act, whose late-night thumbs-down vote halted his party’s most promising effort to overturn a major Democratic achievement — the signature achievement, in fact, of the Democrat who beat him to become president. It was a vote that earned him regular — and biting — admonishments from President Donald Trump.
McCain died Saturday, following a battle with brain cancer. He was 81. Coincidentally, his Senate colleague and good friend Ted Kennedy died on the same date, Aug. 25, nine years ago, succumbing to the same type of rare brain tumor.

Whether indulging in conspiracy theories or wishful thinking, some have attributed McCain’s vote on the ACA in July 2017 to a change of heart shortly after his terminal cancer diagnosis.

But McCain spent much of his 35 years in Congress fighting a never-ending supply of goliaths, among them health insurance companies, the tobacco industry and, in his estimation, the Affordable Care Act, a law that extended insurance coverage to millions of Americans but did not solve the system’s ballooning costs.

His prey were the sort of boogeymen that made for compelling campaign ads in a career stacked with campaigns. But McCain was “always for the little guy,” said Douglas Holtz-Eakin, the chief domestic policy adviser on McCain’s 2008 presidential campaign.

“John’s idea of empathy is saying to you, ‘I’ll punch the bully for you,’” he said in an interview before McCain’s death.

McCain’s distaste for President Barack Obama’s health care law was no secret. While he agreed that the health care system was broken, he did not think more government involvement would fix it. Like most Republicans, he campaigned in his last Senate race on a promise to repeal and replace the law with something better.

After Republicans spent months bickering amongst themselves about what was better, McCain was disappointed in the option presented to senators hours before their vote: hobble the ACA and trust that a handful of lawmakers would be able to craft an alternative behind closed doors, despite failing to accomplish that very thing after years of trying.

What bothered McCain more, though, was his party’s strategy to pass their so-called skinny repeal measure, skipping committee consideration and delivering it straight to the floor. They also rejected any input from the opposing party, a tactic for which he had slammed Democrats when the ACA passed in 2010 without a single GOP vote. He lamented that Republican leaders had cast aside compromise-nurturing Senate procedures in pursuit of political victory.

In his 2018 memoirs, “The Restless Wave,” McCain said even Obama called to express gratitude for McCain’s vote against the Republican repeal bill.

“I was thanked for my vote by Democratic friends more profusely than I should have been for helping save Obamacare,” McCain wrote. “That had not been my goal.”

Better known for his work on campaign finance reform and the military, McCain did have a hand in one landmark health bill — the Americans with Disabilities Act of 1990, the country’s first comprehensive civil rights law that addressed the needs of those with disabilities. An early co-sponsor of the legislation, he championed the rights of the disabled, speaking of the service members and civilians he met in his travels who had become disabled during military conflict.

McCain himself had limited use of his arms due to injuries inflicted while he was a prisoner of war in Vietnam, though he was quicker to talk about the troubles of others than his own when advocating policy.
Yet two of his biggest bills on health care ended in defeat.

In 1998, McCain introduced a sweeping bill that would regulate the tobacco industry and increase taxes on cigarettes, hoping to discourage teenagers from smoking and raise money for research and related health care costs. It faltered under opposition from his fellow Republicans.

McCain also joined an effort with two Democratic senators, Kennedy of Massachusetts and John Edwards of North Carolina, to pass a patients’ bill of rights in 2001. He resisted at first, concerned in particular about the right it gave patients to sue health care companies, said Sonya Elling, who served as a health care aide in McCain’s office for about a decade. But he came around.

“It was the human, the personal aspect of it, basically,” said Elling, now senior director of federal affairs at Eli Lilly. “It was providing him some of the real stories about how people were being hurt and some of the barriers that existed for people in the current system.”

The legislation would have granted patients with private insurance the right to emergency and specialist care in addition to the right to seek redress for being wrongly denied care. But President George W. Bush threatened to veto the measure, claiming it would fuel frivolous lawsuits. The bill failed.

McCain’s health care efforts bolstered his reputation as a lawmaker willing to work across the aisle. Sen. Chuck Schumer of New York, now the Senate’s Democratic leader, sought his help on legislation in 2001 to expand access to generic drugs. In 2015, McCain led a bipartisan coalition to pass a law that would strengthen mental health and suicide prevention programs for veterans, among other veterans’ care measures he undertook.

It was McCain’s relationship with Kennedy that stood out, inspiring eerie comparisons when McCain was diagnosed last year with glioblastoma — a form of brain cancer — shortly before his vote saved the Affordable Care Act.

That same aggressive brain cancer killed Kennedy in 2009, months before the passage of the law that helped realize his work to secure better access for Americans to health care.

“I had strenuously opposed it, but I was very sorry that Ted had not lived to see his long crusade come to a successful end,” McCain wrote in his 2018 book.

While some of his biggest health care measures failed, the experiences helped burnish McCain’s résumé for his 2000 and 2008 presidential campaigns.

In 2007, trailing other favored Republicans, such as former New York City mayor Rudy Giuliani in early polling and fundraising, McCain asked his advisers to craft a health care proposal, said Holtz-Eakin. It was an unusual move for a Republican presidential primary.

The result was a remarkable plan that would eliminate the tax break employers get for providing health benefits to workers, known as the employer exclusion, and replace it with refundable tax credits to help people — not just those working in firms that supplied coverage — buy insurance individually. He argued employer-provided plans were driving up costs, as well as keeping salaries lower.

The plan was controversial, triggering “a total freakout” when McCain gained more prominence and scrutiny, Holtz-Eakin said. But McCain stood by it.

“He might not have been a health guy, but he knew how important that was,” he said. “And he was relentless about getting it done.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. http://www.kaiserhealthnews.com