By STEPHEN SHAVER
The outbreak of COVID-19 sent shockwaves through the healthcare industry. Drastic declines in the hospital and healthcare provider revenue have hamstrung their ability to response to the outbreak and, in some cases, caused providers to shut down entirely. In response, Congress passed the Coronavirus Aid, Relief and Economic Security (CARES) Act, which included the creation of the Provider Relief Fund. The fund’s goal is to provide direct financial relief to hospitals and healthcare providers. The Department of Health and Human Services (HHS) has been charged with distributing the fund’s $175 billion war chest.

The fund’s distributions have been divided into general allocations, to be distributed to a wide range of providers, and targeted allocations, to be distributed to areas of need to address the COVID-19 outbreak. To be eligible for a portion of the $50 billion general allocations, a provider must have billed Medicare in 2019 and provided care for actual or possible cases of COVID-19 after Jan. 31, 2020. Guidance indicates HHS considers all patients to be possible cases of COVID-19. Most of this allocation was deposited in early- and mid-April 2020 directly into bank accounts associated with each qualifying recipient’s Tax Identification Number (TIN). Additional general allocation funds were made available [Read More]

(EDITOR’S NOTE: Opinions expressed here are those of the author and not necessarily those of Healthcare Michigan or its publisher)

By ALLAN DOBZYNIAK, MD
The reaction to the COVID-19 virus hysteria is financially devastating to Michigan’s hospitals and many others throughout the country and world. The burning question is whether all of this is necessary. Hospitals have been devastated by erroneous assumptions based on incomplete, premature and error-laden data. This has led to flawed models, given credence from a consensus of two physicians. Finally, politics has warped clear analysis and solutions. The idea that there might be a middle ground regarding hospitals’ economic vulnerabilities and that of the livelihoods of millions of others in the United States is totally absent from discussions. Factually, there were many fewer cases, many fewer deaths, plenty of ventilators and plenty of hospital beds.

Worse, as increasingly reliable data is available, reasonable change in policy has lagged. The flu season just ending has caused more infections, more deaths and more hospitalizations, but it did not cause the public health and financial destruction of COVID-19. Any job is a vital job to the person who has lost it. Does anybody really know the death number, death rate, number of infections or recoveries? Does anybody [Read More]

By RACHANA PRADHAN & CHRISTINA JEWETT
A high-ranking federal official in late February warned that the United States needed to plan for not having enough personal protective equipment for medical workers as they began to battle the novel coronavirus, according to internal emails obtained by Kaiser Health News.

The messages provide a sharp contrast to President Donald Trump’s statements at the time that the threat the coronavirus posed to the American public remained “very low.” In fact, concerns were already mounting, the emails show, that medical workers and first responders would not have enough masks, gloves, face shields and other supplies, known as PPE, to protect themselves against infection when treating COVID-19 patients.

The emails, part of a lengthy chain titled “Red Dawn Breaking Bad,” includes senior officials across the Department of Veterans Affairs, the State Department, the Department of Homeland Security and the Department of Health and Human Services, as well as outside academics and some state health officials. KHN obtained the correspondence through a public records request in King County, Washington, where officials struggled as the virus set upon a nursing home in the Seattle area, eventually killing 37 people. It was the scene of the first major outbreak in the nation.

“We should plan assuming we [Read More]

By EWA MATUSZEWSKI
Despite its high-tech sounding name and implications, telehealth is not new. Our own organization was using it years ago for a very challenged subset of society—teems who had urgent and ongoing mental health needs living in rural areas underserved by behavior health specialists.The grant-funded program was offered with the assistance of Michigan Medicine and I strongly believe it was a lifesaver for some teens. Despite relatively early adoption in this and other select cases, though, I certainly can’t brag that all of our practices were using—or even remotely interested (pun intended) in—telehealth. It was a continuum from zero awareness to occasional use. What a difference a pandemic makes!

Interestingly, one of the earliest adopters of telehealth in mid-March 2020 was a “senior” internal medicine physician in our organization who still uses paper charts. He saw 30 patients in one day using telehealth. Moreover, many of these patients were elderly. The practice team, frequently the receptionist (thank goodness for high performing teams), walked patients who were amenable to it through the relatively easy telehealth set-up process.

Wait! Doesn’t a practice need an EHR to use telehealth? Surprisingly no. Any device can be used for “video chat” in a pinch, although it’s not advisable long-term, for reasons [Read More]

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

Multiple southeast Michigan hospitals are at capacity with COVID-19 patients and several more expect to hit capacity the first week of April as the number of patients continues to climb, according to the president and CEO of the Michigan Health and Hospital Association.

Michigan’s COVID-19 cases jumped to 6,498 by 3 p.m. March 30 with 81 percent still in the three-county region of Macomb, Oakland, and Wayne counties. Detroit continues to be the epicenter with 1,801 cases and 52 deaths.

With 134 hospitals statewide and roughly half in Southeast Michigan, Gov. Gretchen Whitmer is accepting the U.S. Army Corps of Engineers’ recommendation to move 900 bed spaces into TCF Center, formerly Cobo Hall, to address imminent capacity issues.

Even with the extra capacity, MHA President Brian Peters continues to have concerns. The first is what happens if the coronavirus spreads outstate and there is not a large facility like the TCF Center available to convert into a field hospital.

“Southeast Michigan, Detroit is experiencing the brunt of that now,” Peters said. “Our greatest concern is that we’re going to see that occurring in communities throughout the state of Michigan in the days and weeks ahead.”

One projection [Read More]

By RALPH LEVY
A recent Tax Court Memorandum decision, S. Ghadiri-Asli v. Comm’r, T.C. Memo 2019-149, serves as a reminder for healthcare providers to report properly all gross receipts and to substantiate business expenses claimed as deductions.

One of the two taxpayers, a physician, practiced medicine as a sole practitioner who specialized in infectious diseases. During the years in question, the physician’s billing and collection functions were performed by a third party outside billing service. All payments were remitted directly to the physician. Using the information provided by the physician to the billing service that included explanation of benefit (EOB) forms, patient face sheets and other correspondence received by the physician, the billing service would bill both third-party payors and patients for medical services provided by the physician. Each month the billing service would send the physician a summary of billings and collections received using the EOB’s and the other information provided by the physician. Each summary included an invoice for the services provided by the billing service based on a percentage of the total monthly payments received by the physician during the prior month. Although occasionally the physician questioned discrepancies between the monthly summaries and the physician’s bank statements, the physician always paid the amount [Read More]

By JONEL ALLECIA
An outbreak of coronavirus disease in a nursing home near Seattle is prompting urgent calls for precautionary tactics at America’s elder care facilities, where residents are at heightened risk of serious complications from the illness because of the dual threat of age and close living conditions.

The emergence of the novel contagious illness at the Life Care Center of Kirkland, Washington, has left one resident dead and four others hospitalized, with three in critical condition, local health officials said late last month. A health care worker in her 40s also remained in satisfactory condition. The resident who died was a man in his 70s with underlying health conditions, officials said.

Officials previously said that of the nursing home’s 108 residents and 180 staff members, more than 50 have shown signs of possible COVID-19 infections, the name given the illness caused by a novel coronavirus that emerged from Wuhan, China, late last year. Visits from families, volunteers and vendors have been halted and new admissions placed on hold, according to a statement from Ellie Basham, the center’s executive director.

“Current residents and associates are being monitored closely, and any with symptoms or who were potentially exposed are quarantined,” she wrote.

The cluster of illness is the first of [Read More]

Michigan Chief Medical Officer Joneigh S. Khaldun told a Senate committee Feb. 27 that while there is no drug to attack the coronavirus, she and the Michigan Department of Health and Human Services are working to utilize the tools they do have—screening, communication and education.

Khaldun told the Senate Health Policy and Human Services Committee, “If this were to come to Michigan, we’d be focusing on non-pharmaceutical intervention.”

Khaldun noted that the state is closely monitoring the spread of the virus. The Detroit Metro Airport is one of 11 airports across the country where U.S. citizens who are considered at high risk based on their travels can re-enter the United States.

A process exists at Detroit Metro to identify those who need to be monitored. Currently, there are no confirmed cases in Michigan where travelers have been diverted from the airport to a hospital and quarantined. However, in one case a traveler was taken to the hospital, but later confirmed to not have the virus.

Sen. Paul Wojno (D-Warren) asked Khaldun if a university or college would need to be quarantined if the virus were detected on campus.

“We’ll have to take that on a case-by-case basis,” Khaldun responded.

Talk of quarantine led Sen. Kim La Sata (R-St. Joseph) to ask [Read More]

By EWA MATUSZEWSKI
The venture capitalist will see you now. Unfortunately, it’s not the lead-in to a joke. It’s the next inevitable step in usurping the role of primary care. As those of us long invested in the health-centered goals of the primary care community mark wins with the patient-centered medical home, team-based care and care management strategies; as we dive deeper into the role that social determinants of health play in limiting access to care and optimal health and wellness – and offer practical solutions; as we find success with data-driven, population health strategies…the business people see dollar signs, instead.

The impetus for this blog is the early February news that Humana entered into an arrangement with a private equity firm (okay maybe not venture capitalist – but outsiders, nonetheless) to create primary care clinics focused on the Medicare Advantage and dual-eligible population. Doing so will add to Humana’s existing senior primary care clinics, which have a multi-state footprint and were designed to lower healthcare costs while grabbing market share among the mighty senior population. It’s not just Humana, though, it’s a trend among large insurers and health systems. (I must add here that it irks me that the venture capitalists, private equity firms and other [Read More]

JESSE A. MARKOS, ESQ.
Wachler & Associates, P.C.

Licensed Medical Professionals generally experience the same risk of developing problems with alcohol or drugs as those in other professions. An estimated 10 to 14 percent of medical professionals develop such problems at some point during their careers. However, they are five times more likely to misuse prescription medications such as opioid pain medications and benzodiazepine anti-anxiety drugs. Medical professionals are uniquely vulnerable to these medications due to a combination of stress, long hours and increased access. Those struggling with prescription medication abuse should immediately seek treatment. One option available is the Michigan Health Professional Recovery Program (HPRP). However, this particular recovery program may not be the right choice for all and some degree of caution should be exercised when considering a self-referral to the program.

The purpose of HPRP is generally to promote the health and well-being of medical professionals with substance abuse and mental health issues and also to protect patients from impaired providers. Medical professionals can self-refer to HPRP and seek help with a substance abuse or mental health issue. However, there is no assurance that voluntarily seeking treatment will not result in disciplinary action by the Michigan Department of Licensing and Regulatory Affairs.

After a medical professional [Read More]

By ELISABETH ROSENTHAL
It has been nearly three months since the first cases of a new coronavirus pneumonia appeared in Wuhan, China, and it is now a global outbreak. Yet, despite nearly 90,000 infections worldwide (most of them in China), the world still does not have a clear picture of some basic information about this outbreak.

In recent weeks, a smattering of scientific papers and government statements have begun to sketch the outlines of the epidemic. The Chinese national health commission has reported that more than 1,700 medical workers in the country had contracted the virus as of Feb 14—that is alarming. The Chinese Center for Disease Control and Prevention estimated that some 80 percent of those infected have a mild illness—that is comforting. Last month, a joint World Health Organization-China mission announced that the death rate in Wuhan was 2 percent to 4 percent, but only 0.7 percent in the rest of China — a difference that makes little scientific sense.

In recent days, the WHO has complained that China has not been sharing data on infections in health care workers. Last month, the editors of the journal Nature called on researchers to “ensure that their work on this outbreak is shared rapidly and openly.”

Much more could [Read More]

By JEREMY BELANGER with L. PAHL ZINN
Many providers are familiar with compliance in a health care context. They know to make agreements compliant with the Stark Law and the Anti-Kickback Statute, for instance. But the keys to a good compliance system (policies and procedures, designation of a compliance officer/committee, training and education, communication, ethics and culture, top-down compliance, enforcement, auditing and monitoring, and corrective action) apply to areas outside of health care as well, including the operation of a business. This article will discuss two areas in which a business should apply the principles of compliance to their business practices: antitrust and tax.

Broadly speaking, antitrust laws are about protecting and promoting competition in the marketplace. Section 1 of the Sherman Act prohibits agreements between parties that unreasonably restrain trade. Two types of analyses are employed in evaluating whether agreements between competitors constitute unreasonable restraints: per se and rule of reason. Certain agreements are so likely to harm competition with no immediately discernable procompetitive benefit are subject to challenge as per se unlawful. Examples include price-fixing, bid-rigging, or agreements between competitors to divide markets. The rule of reason is a factual inquiry into the agreement’s overall competitive effect to determine whether procompetitive benefits of an [Read More]

Gov Encourages Fist Bumps, ‘Smart’ Hygiene As MI Preps For Coronavirus

If you see Gov. Gretchen Whitmer giving people fist bumps instead of handshakes, here’s why.

Replacing handshakes with fist bumps or “elbow bumps” were among the suggestions made by Whitmer as she and state officials outlined what they are doing to prepare for any potential coronavirus outbreak in Michigan and how the general public can prevent against it.

There are still no active cases in Michigan. No one is currently under investigation for coronavirus. And the five people in Michigan who were tested for it previously all came up negative.

The governor Feb. 28 announced the activation of the State Emergency Operations Center to begin coordinating state, local and federal agencies on preventing any spread of the disease.

The SEOC is typically activated during state emergencies, such as during the extreme cold temperatures from early 2019. The Governor said today that by activating the SEOC, “we’re ensuring that every branch of state government is on alert, and actively coordinating to prevent the spread of Coronavirus if it comes to Michigan. We are taking this step out of an abundance of caution.”

The actual SEOC itself is a large room within the Michigan State Police headquarters where representatives from state agencies—including [Read More]

The state’s new approach to revamp mental health services proposes to unite elements offered by entities that have been at odds with each other—private insurance companies and public behavioral health organizations.

Roughly two months after the Department of Health and Human Services ended the direct blending of physical and mental healthcare, DHHS Director Robert Gordon briefed lawmakers on a new physical-mental health integration approach.

Part of the proposal is the idea of creating multiple “specialty integrated plans” or SIPs, which the DHHS said in a press release today would “bring together the management skills of traditional insurance companies with the expertise and depth of behavioral health organizations.”

The association for the state’s Community Mental Health agencies would run at least one plan offering these services to the public.

Gordon also suggested other plans be created, like one controlled by private Medicaid health plans and another one led by providers and hospitals, as examples.

The DHHS director stressed to a joint hearing of the House and Senate DHHS appropriations subcommittees that many details of the plan are to be determined and that the department plans to get feedback during four public forums in 2020 to fully design the plan. He wants the whole system to be implemented by 2022.

Bob Sheehan, CEO [Read More]

By CARMEN HEREDIA RODRIGUEZ
Kathleen Hambleton once used to spend $100 a week on Marlboro Reds.
The 43-year-old nurse from Saxtons River, Vt., paid a high price for her addiction to smoking, undergoing multiple throat surgeries. The financial hit was also a big burden.

After lozenges, patches and hypnosis failed to help Hambleton quit, she tried vaping. She is convinced she is healthier now and spends less than $40 per month on her vaping supplies.

Vermont recently passed a 92 percent wholesale tax on vaping and e-cigarette products. Hambleton believes the sudden and sharp price hike is prohibitively expensive.

“When they imposed the 92 percent tax, I can’t affordably pay that,” she said. “No one can.”

Historically, taxation has been an effective tool in reducing the number of people who smoke.

The World Health Organization estimates that a 10 percent rise in prices causes overall smoking rates to drop about 4 percent in high-income countries. Some states are relying on this strategy to work again ― this time to discourage consumers, especially teenagers and young adults, from using e-cigarettes and vaping products.

Twenty states and the District of Columbia have passed those taxes, according to the Campaign for Tobacco-Free Kids, a nonprofit advocacy group. But whether taxes would be as effective in combating [Read More]

Get Real On Pre-authorizations: Interoperability Is Key

By EWE MATUSZEWSKI
There is much left unsaid in the discussion of new Michigan legislation (“Health Can’t Wait”) that would curb insurance pre-approval rules in health care. Pre-authorizations are used not only to keep costs down, but to ensure that unnecessary testing (and physician shopping) is not performed on patients, especially a repeat diagnostic test where the initial test results are available.

Our organization submits at least 1,500 requests for pre-authorizations to payers per quarter, and denials are rare, sometimes zero. That’s because we use the primary care physician to coordinate patient care with specialists, as directed by those who follow the principles of the patient-centered medical home. As much as we need and respect our specialty physicians, they have a reputation of not providing much needed supporting documentation in a timely fashion. Frequently, primary care physicians wait weeks to receive reports on consultations that were completed. Those are often the only items needed to receive the authorization for additional services. I must remind my colleagues that NCQA has specific turn-around times for payers to act on pre-authorization requests. Also, as a primary care physician recently admitted to me, she has some gaps in knowledge on more advanced and often new [Read More]

MAPS Policy Leads To Drop In Controlled Substances Dispensed In Michigan

By JESSE ADAM MARKOS, ESQ.
Wachler & Associates, P.C.
Required registration and use of the Michigan Automated Prescription System (MAPS) has proven helpful in decreasing the amount of controlled substances dispensed in Michigan. Beginning last year, physicians in Michigan are required to register with MAPS and review MAPS patient-specific data before prescribing or dispensing a Schedule 2-5 controlled substance to a patient in a quantity that exceeds a three-day supply. These requirements, combined with other efforts to fight the opioid epidemic, have led to a dramatic decrease in the amounts of controlled substances dispensed in Michigan.

The Department of Licensing and Regulatory Affairs (LARA) publicly releases the dispensing and prescribing data collected by MAPS in their annual Drug Utilization Report. The most recent findings from last year confirm that MAPS has proven remarkably effective in reducing the amount of controlled substances dispensed in Michigan. For example, compared to 2015, opioid prescriptions dispensed fell by 24 percent while the overall number of schedule 2-5 controlled substance prescriptions decreased by 18 percent. Moreover, a review of the data shows a sizeable reduction in the dispensing of seven of the most commonly abused controlled substances. For example, compared to 2015, [Read More]

Double Your Signing Bonus, Double Your . . . Prison Dentists?
If the prospect of polishing prisoner teeth is not tantalizing enough to get more dentists at the Michigan Department of Corrections, the state is now looking to sweeten the deal by doubling the bonus money available for new hires.

Dentists hired for state prisons have been allowed a $5,000 bonus for several years now, but the DOC is now seeking approval for an additional $5,000 to be available once dentists complete their initial one-year probationary periods, meaning they can earn an extra $10,000 within the first year of employment.

DOC spokesperson Holly Kramer said the bonuses would be funded out of existing appropriations. And, in addition to the bonuses, prison dentists remain eligible for a 5 percent performance bonus each year.

“While it’s still a challenge for us to compete with private sector pay rates, these are good careers within the MDOC and we are hoping this might provide some incentive,” Kramer said.

The DOC has been trying to attract more dentists, and seeking additional incentive money from the Michigan Civil Service Commission was one way to do it.

The move to allow the additional $5,000 bonus, which was also requested by the Michigan Department of Health and Human Services, [Read More]

Language added to the state budget to trigger the statewide implementation of blended physical and mental health services is designed to put to rest the debate about how the blending of care should be done, according to the state’s health plans that favor the language.

“Everybody is tired of the issue. They’re tired of the persistent debate. They want action, they want integration, and they want, more importantly, improved outcomes,” said Dominick Pallone, executive director of the Michigan Association of Health Plans (MAHP), adding later, “The boilerplate debate is getting pretty old for everybody.”

But the state’s community mental health (CMH) organizations see the language as paving the way to “a full state carve in to a privatized system” and the abandonment of the “core premise” of pilot programs testing the integration model that were approved last year.

Bob Sheehan, CEO of Community Mental Health Association (CMHA) of Michigan, said the “constant debate” is about the health plans wanting “to hold the money and walk away with the savings and walk away with the profit” and that is what is causing the “logjam.”

For the past few years, MAHP and the CMHs have been duking it out in a particular piece of boilerplate language deep within the Michigan Department [Read More]

By JORDAN RAU
Medicare cut payments to 2,583 hospitals Oct. 1, continuing the Affordable Care Act’s eight-year campaign to financially pressure hospitals into reducing the number of patients who return for a second stay within a month.

The severity and broad application of the penalties, which Medicare estimates will cost hospitals $563 million over a year, follows the trend of the past few years. Of the 3,129 general hospitals evaluated in the Hospital Readmission Reduction Program, 83 percent received a penalty, which will be deducted from each payment for a Medicare patient stay over the fiscal year that began Oct. 1.

Although Medicare began applying the penalties in 2012, disagreements continue about whether they have improved patient safety. On the positive side, they have encouraged hospitals to focus on how their patients recuperate, and some now assist them in procuring medications and follow-up appointments.

The hospital industry and some academics have raised concerns that some hospitals may be avoiding readmitting patients who require additional inpatient care out of fear of the financial repercussions, while others have said the program is not showing major benefits.
“A lot of hard work has gone into trying to reduce readmissions, and the needle has not moved very far,” said Dr. Karen Joynt Maddox, co-director [Read More]

Pay Raises For Health Workers Abound In DHHS Budget
A number of workers employed in state human services-related fields will be getting raises under the Fiscal Year 2020 budget approved for the Michigan Department of Health and Human Services by the Legislature Sept. 24.

SB 0139 earned the most Democratic support in the House, where it passed 64-44. The Democrats who crossed over to vote yes with Republicans were Reps. John Cherry (D-Flint), Abdullah Hammoud (D-Dearborn), Jon Hoadley (D-Kalamazoo), Rachel Hood (D-Grand Rapids), Leslie Love (D-Detroit), Laurie Pohutsky (D-Livonia), Karen Whitsett (D-Detroit) and Angela Witwer (D-Delta Twp.).

Rep. Steven Johnson (R-Wayland) voted no with most of the Dems. Reps. Brenda Carter (D-Pontiac) and Larry Inman (R-Williamsburg) did not vote.

The DHHS budget cleared the full Senate 24-14, with Sens. Winnie Brinks (D-Grand Rapids) and Sean McCann (D-Kalamazoo) joining the Republicans in voting yes.

Sen. Erika Geiss (D-Taylor) specifically flagged a $15 million cut in programs that fund medical services and juvenile justice facility maintenance. She also pointed at $15 million needed to get Michigan to comply with the new Lead and Copper Rule, saying those “lack of investments are additional missed opportunities for our children and our communities.”

The Legislature went along with Gov. Gretchen Whitmer’s’s request for $16 million to [Read More]

By ANDREW B. WACHLER & KAITLIN A. NUCCI
Wachler & Associates, P.C

The Centers for Medicare and Medicaid Services has released its final rule with comment period regarding the disclosure of affiliations in the provider enrollment process. This rule will take effect on November 4, 2019. This rule provides the authority to revoke or deny enrollment based on the disclosure of any affiliations that CMS determines poses an undue risk of fraud, waste, or abuse. Although the plan is to have this rule be applicable to all providers, CMS is starting out with a phase-in approach, where the rule will be applied to initially enrolling or revalidating providers that CMS has specifically determined may have one or more applicable affiliations.

The Final Rule requires providers and suppliers to disclose any current or previous direct or indirect affiliation with a provider or supplier that has a “disclosable event”:
• Has an uncollected debt;
• Has been or is subject to a payment suspension under a federal health care program
• Has been or is excluded by the Office of Inspector General (OIG) from Medicare, Medicaid, or CHIP; or
• Has had its Medicare, Medicaid or CHIP billing privileges denied or revoked.

If any of these affiliations are present, the Secretary is authorized to deny [Read More]

By ALLAN DOBZYNIAK, MD
We are developing new technological gimmicks to measure every activity throughout our day, blood pressure (BP), pulse (P), respirations, stairs climbed, walking time, calorie burn, sleep time, and on and on. Soon we will be device-covered from head to toe. To what end? There are shelves upon shelves of magical elixirs and pills to cure any symptom, prevent aging and definitely improve on God’s or nature’s original design. Can you imagine the size of the bag necessary to carry all of these magical medicinals?

Our health care providers are obsessing over preventive care, with hardly time anymore to treat sick people. Our government is determined to turn primary care into a lecture series on what is politically intuitive rather than scientifically based. Our elected and appointed officials are certain that the effort at demanding “good” personal behavior—as defined by bureaucrats, lobbyists for “healthy stuff,” global warming fanatics—will improve outcomes. I am never sure what “improved outcomes” means; does anybody, really? Of course, we must race forward to legalize pot, never wasting another opportunity to tax something else.

I know I am going way out on a limb here, but perhaps the path to good health and the best outcome for each unique individual is [Read More]

Gov. Gretchen Whitmer offered three emergency rules Sep. 4 banning all flavored vaping products from Michigan shelves amid what Chief Medical Executive Dr. Joneigh Khaldun said is a youth vaping “public health emergency.”

“This is a health crisis and in a health crisis, I have the ability to take action and we’re taking it,” Whitmer said. “There are 13-year-olds who are vaping fruit loops right now. They are doing life-long damage and have no idea they are engaging in a substance that they’re going to be addicted to maybe for the rest of their lives,” she said.

The governor said she is the nation’s first chief executive to move against the vaping industry, which she described as “an industry notorious for deceiving the public and for putting their bottom line before the public health.”

Her three-step ban includes taking all flavored e-cigarettes and vaporizing products off the shelves, including such flavors as bubble gum and apple sauce. She is going after the marketing strategies that she argues “are focusing on our kids and they are targeting and making money off of them and they’re hurting them.”

She reported products are sold next to candy on the store shelves.

The governor’s unprecedented action comes after she signed legislation earlier this year [Read More]

By PHIL GALEWITZ
For the first time in a decade, the number of Americans without health insurance has risen — by about 2 million people in 2018 — according to the annual U.S. Census Bureau report released this month.

The Census found that 8.5 percent of the U.S. population went without medical insurance for all of 2018, up from 7.9 percent in 2017. By contrast, in 2013, before the Affordable Care Act took full effect, 13.3 percent were uninsured. It was the first year-to-year increase since 2008-09, Census officials said.

Census officials said most of drop in health coverage was related to a 0.7 percent decline in Medicaid participants. The number of people with private insurance remained steady and there was a 0.4 percent increase in those on Medicare.

Many of those losing coverage were non-citizens, a possible fallout from the Trump administration’s tough immigration policies and rhetoric. About 574,000 non-citizens lost coverage in 2018, a drop of about 2.3 percent, the report found.

“Uninsured non-citizens account for almost a third of the increase in uninsured, which may reflect the administration’s more aggressive stance on immigration,” said Joseph Antos, a health economist at the American Enterprise Institute.

The increase in the number of uninsured people in 2018 was remarkable because uninsured [Read More]