‘Lives of our patients are at stake’ as concerns about Senate health care bill mount

Originally published by healio.com on Tuesday, June 27, 2017. Written by Robert Linnehan and Katrina Altersitz.

 
The cost savings that would be realized under the Senate’s proposed health care bill would have a dramatic negative effect on the quality of health care offered in the United States, according to policy experts and physicians.

“What we knew qualitatively was that the bill was more about cutting taxes, slashing the social safety net and shifting health care costs onto average Americans,” Caitlin McCormick Brault, associate director of the Center for Health Law and Policy Innovation at Harvard Law School, told Healio.com. “[The Congressional Budget Office] has now quantified the depth and severity of those cuts.”

The Senate’s Better Care Reconciliation Act — publicly introduced on June 22 — would reduce the federal deficit by more than $321 billion by 2026, according to estimates from the nonpartisan Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation. That is approximately $202 billion more in savings than would be realized under the House-proposed American Health Care Act.

The largest savings would result from reductions in outlays for Medicaid, as spending would be reduced by 26% by 2026. The CBO estimated Medicaid enrollment under the Senate’s health care legislation would fall 16% by that time. Also, the number of uninsured Americans would increase to 49 million if the Senate’s health care bill becomes law, the CBO estimated.

Eugenia Pierson, senior health policy adviser in the Arnold & Porter Kaye Scholer LLP Legislative Practice Group, told Healio.com that the enhanced savings of the Senate proposal are a plus and “definitely gives them some wiggle room to negotiate last-minute deals” to get the required number of votes for passage.

However, the anticipated loss of health coverage for millions of Americans remains a considerable problem. “Senate leadership is still working to corral the votes they need,” Pierson told Healio.com. “I am just hearing from [Capitol] Hill staff that they are postponing the vote until after the July 4 recess, so it’s clear these issues are a real challenge.”

The New England Journal of Medicine today published an online editorial from the journals editors, who argued there is “good reason” why a majority of the public finds the approach Republicans in both the House and Senate have taken toward health care reform “deeply unpopular.”

The Senate bill would effectively raise insurance costs for millions, force 22 million Americans to lose health insurance, and give insurers the option to drop coverage for many critical health care services, according to the editorial authors.

“Under the [Senate bill], states could easily receive waivers to drop many of the insurance regulations created by the Affordable Care Act (ACA),” Jeffrey M. Drazen, MD, professor in the department of environmental health at Harvard T.H. Chan School of Public Health and the journal’s editor-in-chief, and colleagues wrote. “Although the ACA requirement that insurers take all comers would nominally remain intact, states could reject the ACA’s mandated essential benefits, allowing insurers to refuse to cover such critical services as emergency care, mental health care, maternity care, chemotherapy, and prescription drugs, among others.”

The editorial writers said they share the same concerns as the many other physician and hospital organizations that have already criticized the Senate proposal.

“We wholeheartedly oppose sacrificing Americans’ health care and health to further enrichment of the wealthy,” Drazen and colleagues wrote. “The future of our health care system and the lives of our patients are at stake.”

The American Medical Association criticized the Senate proposal after its public introduction, prior to the CBO report.

Legislators should work to develop a health care plan that is more inclusive, James L. Madara, MD, CEO and executive vice president of the AMA, wrote in a letter to Senate leaders. “We sincerely hope that the Senate will take this opportunity to change the course of the current debate and work to fix problems with the current system,” Madara wrote. “We believe that Congress should be working to increase the number of Americans with access to quality, affordable health insurance instead of pursuing policies that have the opposite effect, and we renew our commitment to work with you in that endeavor.”

The American Academy of Family Practitioners also cited the CBO report in its criticism of the Senate legislation.

References:

  • Congressional Budget Office. H.R. 1628, Better Care Reconciliation Act of 2017. Available at: www.cbo.gov/publication/52849. Accessed on June 27, 2017.
  • Malina D, et al. N Engl J Med. 2017;doi:10.1056/NEJMe1708506.

 

CA Governor Signs Food is Medicine Pilot into Law

Thousands of Californians who struggle with serious illness will soon find it easier to eat healthy meals that are just right for the nutrition challenges unique to their diseases. Today, Governor Jerry Brown signed California SB 97 into law, funding a first-of-its-kind healthy food pilot project for low-income Californians with chronic health diseases. The program will use $6 million over three years to help Medi-Cal recipients who suffer from congestive heart failure, cancer, diabetes, or renal disease access medically-tailored, high-quality meals.

The pilot is modeled off a medically-tailored meal intervention implemented by Philadelphia-based nonprofit MANNA, which showed that health costs for 65 patients with serious chronic illness dropped dramatically once the patients started eating medically-tailored meals and were 55% lower than for a control group.

“All of the emerging research points to nutrition as a core component of outcome-driven, cost-effective health care,” said Robert Greenwald, Clinical Professor of Law and Faculty Director of the Center for Health Law & Policy Innovation of Harvard Law School, which monitors, researches and promotes efforts to integrate food and nutrition interventions into health care. “To have this type of innovation implemented within a state’s Medicaid program is a huge step forward, and will truly help those who are most in need while reducing costs to the state over time.”

To provide these complex meals to patients, Medi-Cal will rely on California nonprofits with years of expertise in preparing and delivering medically-tailored meals, including:

  • Project Open Hand in San Francisco
  • Mama’s Kitchen in San Diego
  • Project Angel Food in Los Angeles
  • Ceres Community Project and Food for Thought in the North Bay Area
  • Health Trust in San Jose

Together (and with sister organizations in other states), these organizations form the Food is Medicine Coalition which serves meals to those who are seriously ill. Coalition members are engaged in research across the country to further prove the efficacy and value of the medically-tailored meal intervention.

California Senator Mike McGuire credits his meetings with the Food is Medicine Coalition for inspiring his crusade that has now secured state funding for this critical pilot. “The bottom line,” said Senator McGuire, “[is that] we believe, over the next three years, we’ll demonstrate enhanced health outcomes for chronically ill Medi-Cal patients and save millions in health care costs.” California State Assemblymembers David Chiu and Blanca E. Rubio also provided critical support for the pilot.

“This is an exciting time for our agencies and those very vulnerable, critically ill Californians we serve,” said Project Open Hand CEO Mark Ryle. “We are particularly thrilled that the California legislature had the vision to launch the very first statewide, medically-tailored meal program in the United States. California is once again leading the nation in implementing low cost/high return medical interventions to improve the health of our most marginalized and underserved citizens.”

 

Webinar on the “Blueprint for a National Food Strategy” Available Online

On June 15, 2017, Harvard Law School Food Law and Policy Clinic and the Center for Agriculture and Food Systems at Vermont Law School held a webinar to explore the recently released Blueprint for a National Food Strategy. FLPC's Emily Broad Leib and Emma Clippinger, and Vermont Law School's Laurie Beyranevand hosted the webinar, which explained the research and findings in the report in more detail, and provided an opportunity to start a dialogue about making the idea of a national food strategy into a reality.

Watch the Blueprint for a National Food Strategy online now!

 

CHLPI’s Associate Director Speaks to Healio.com on the Senate Health Care Bill

CHLPI's Associate Director, Caitlin McCormick-Brault, was interviewed by healio.com for a June 22, 2017 story on the newly released Senate version of the health care bill meant to replace the Affordable Care Act. The article, Senate health care bill takes slower approach to House bill, expert concerns persist, looks at the key differences between the Senate and House health care bills.

Excerpt from the article:

"'Despite calling itself the "Better Care" Act, the Senate bill would actually be worse for patients, particularly vulnerable patients such as older Americans, patients with chronic illnesses, and those enrolled in Medicaid,' Caitlin McCormick-Brault, associate director, Center for Health Law and Policy Innovation at Harvard Law, said in a statement to Healio.com. 'The Senate bill makes even deeper cuts to Medicaid that the House’s American Health Care Act (AHCA) does, although they phase them in over the next several years to delay the pain until after the next election cycle.'

According to McCormick-Brault, the Senate bill would result in patients facing higher insurance costs with less robust benefits and higher cost-sharing requirements. She advises physicians that the bill would make patients, particularly those under Medicaid, less likely to seek treatment or follow doctors’ orders when additional care is needed.

'Doctors who see Medicaid patients will be significantly impacted as many of their patients will lose insurance altogether,' she said."

Read Senate health care bill takes slower approach to House bill, expert concerns persist at healio.com.

 

Grasping those ‘best by’ labels

Originally published by The Columbian on June 19, 2017. Written by Marissa Harshman, Columbian Health Reporter.

 

An estimated 160 billion pounds of food is wasted in the U.S. every year—and much of the food may be perfectly fine to eat. A recent survey found 84 percent of people at least sometimes throw away food solely because the “best by” date stamped on the package has passed.

The problem: Those dates aren’t an indicator of food spoilage or safety.

“The whole dating thing is kind of confusing, because people want to throw away things after these dates,” said Sandra Brown, food safety and nutrition faculty at Washington State University Clark County Extension. “The key to all of those dates is all about quality.”

Federal law only requires a “use by” date on infant formula under inspection of the U.S. Food and Drug Administration. Baby formula should not be used after its “use by” date, according to the FDA, because the quality of the formula may deteriorate and not meet the nutritional claims on the label.

The dates stamped on all other food products—and the varying descriptions, such as “best before,” “best if used by” and “sell by”—are done voluntarily and at the discretion of food manufacturers.

And they have nothing to do with whether the food is safe to eat or not.

“Best if used by/before” indicates when a product will be of best flavor or quality. Likewise, a “use by” date is the last date recommended for the use of the product at its peak quality. A “sell by” date, on the other hand, is for the stores and indicates when the store should no longer display the product, according to the FDA.

A May 2016 survey by the Harvard Food Law and Policy Clinic highlighted the confusion over date labels. About 70 percent of people believed “best if used by” referred to food quality and 13 percent thought it indicated safety. But only 40 percent thought “use by” was pertaining to quality, while 42 percent believed it related to food safety.

That confusion may be leading people to throw away perfectly safe food, the researchers concluded. Of the survey participants, more than one-third said they always discard food close to or past the date on the label; 84 percent said they do so at least occasionally.

Foods not showing signs of spoilage should still be wholesome and can be sold, purchased, donated and consumed beyond the labeled “best by” date, according to the FDA. So how do you know if a food product is safe to eat?

“In general, if it looks bad, smells bad, has a poor texture, of course you won’t eat it,” Brown said.

But food can look OK and still make you sick. The key, Brown said, is to properly handle perishable foods to prevent bacteria growth.

There are two types of bacteria that grow in food. The pathogenic bacteria causes foodborne illness that can make you sick. Spoilage bacteria causes food to deteriorate but doesn’t cause illness.

To prevent pathogenic bacteria growth, perishable foods shouldn’t be out of the refrigerator more than two hours. That includes both store-bought food and homemade dishes. In addition, use clean utensils, particularly with products that will be used multiple times, such as containers of mayonnaise or yogurt, Brown said.

There are also general timelines for how long an opened food item is safe in the refrigerator. Opened milk and cottage cheese, for example, should be consumed within one week. Refrigerated eggs, on the other hand, are good for three to five weeks from the date of purchase, according to the FDA.

Opened packages of lunch meat are good for three to five days, whereas unopened packages last for two weeks. Fresh poultry and ground meats should be consumed within one to two days, while fresh beef, lamb and pork is good for three to five days in the refrigerator, according to the FDA.

The length of time is considerably longer when it comes to shelf-stable foods. Canned foods, for example, will be good 12 to 18 months beyond those stamped dates on the cans. And some lower acidity canned foods, such as tuna or chicken, can last two to five years past the date, Brown said.

With those items, the concern is more about quality than safety. If you’re concerned about the quality of canned foods that are well past their “best by” dates, consider using them in stews or casseroles where the texture isn’t as important, Brown said.

Following these guidelines and using some common sense can help you to avoid throwing away food that is perfectly safe to eat, Brown said.

“There is a lot of food that people throw away that is fine,” she said. “Really check out food before you throw it away.”

 

 

FLPC Director Emily Broad Leib, along with Vermont Law Professor Laurie Beyranevand, Make the Case for a National Strategy in Georgetown’s Food & Drug Law Journal

In the most recent issue of Georgetown’s Food and Drug Law Journal, HFLPC’s Director Emily Broad Leib and Laurie Beyranevand, the Senior Faculty Fellow for Food Law and Policy at the Center for Agriculture and Food Systems (CAFS) at Vermont Law School, lay out their arguments for a comprehensive, national food strategy.  Food encompasses such a wide spectrum of issues—touching public and environmental health, immigration and labor, trade, and safety, among others—and is regulated by dozens of government agencies and a web of laws and regulations. This complexity requires a more efficient and effective approach than the status quo in order to improve our food system outcomes related to the environment, health, safety, and access.

The Harvard Law School Food Law and Policy Clinic and Center for Agriculture and Food Systems at Vermont Law School have been working together to draft a Blueprint for a National Food Policy Strategy, and released a report with that very title in March of 2017. In it, they make the case that we can and should commit to a national food strategy that addresses and prioritizes food-related issues, and which sets goals that take into account food’s unique cross-section of interests and challenges.

The FDLJ article follows up on the report with an analysis about how such a strategy would tackle some of the hot-button issues at the heart of the most recent presidential campaign, such as reducing regulatory inefficiency, promoting economic development, and incorporating stakeholders’ perspectives—especially those from rural communities—who feel that policymakers in Washington are out of touch with their challenges. The ideal national strategy, they write, should be transparent, accountable, durable, and resilient. The authors argue that the strategy should be created or endorsed by the US government, but concede that if this administration won't create one, a People's Food Strategy, similar to the one created in Canada, would be a welcome start. However, they argue that ultimately such a strategy will need government buy-in or endorsement in order to be successful.

The full article is available online here.

 

 

America Needs To Get More Strategic About Food Policy

Originally published on huffingtonpost.com on June 14, 2017. Written by Emily Broad Leib, Assistant Clinical Professor of Law, Director of the Harvard Law School Food Law and Policy Clinic, Deputy Director of the Center for Health Law and Policy Innovation, and Laurie Beyranevand, Professor of Law, and Senior Faculty Fellow, Food Law and Policy at the Center for Agriculture and Food Systems at Vermont Law School.

 

“Eat your fruits and vegetables” is a simple-enough piece of nutritional advice most Americans have heard since they were young. When you look at America’s food policies, however, that straightforward missive gets incredibly complicated. Though our national nutrition guidance recommends that fruits and vegetables make up more than 50% of our dietary intake, the lion’s share of federal funding for farmers goes to soy, cotton, and corn. In fact, as a nation we produce 24% fewer servings of fruits and vegetables than would be necessary for us to meet that nutrition guidance.

There are many such head-scratching discrepancies all across our country’s food policy landscape. The web of food law in the United States is incredibly complex; for example, on the issue of food safety alone, there are over 15 federal agencies administering 30 different laws! Yet, at present, none of these laws or agencies are coordinated. For an administration that has pushed to reduce the role of regulatory agencies and save taxpayer dollars, the inefficiency of our food policies and laws is even more glaring.

At the Harvard Law School Food Law and Policy Clinic and the Center for Agriculture and Food Systems at Vermont Law School, we’re committed to streamlining and improving our food policies. Earlier this year, we published Blueprint for a National Food Strategy which makes the case for laying all the pieces of our food policy on the table, together, so that we set goals and priorities, and fit them together in the way that works best. This week, we are hosting a webinar about our Blueprint report; the webinar will explain our research and findings in more detail, and provide an opportunity to kickstart a dialogue about making the idea of a national food strategy into a reality.

A national food strategy is not only beneficial, but also completely feasible - our research found that there are countless models from which we can draw inspiration: from Brazil to the United Kingdom, other nations around the world have created national food strategies to better coordinate among competing agencies, interests, and priorities. Brazil cut child malnutrition by 61% and rural poverty by 15%, largely through their support of local farmers; at the same time, they’ve become one of the world’s top food exporters. However, we don’t even have to look abroad to see how a coordinated system of laws and policies can be effective. In the United States, our government has created national strategies to address a wide variety of pressing issues of national concern such as HIV/AIDS, antibiotic resistance, and national security.

We are hardly the first to call for a national food strategy: In November 2014, some of our top food policy thought leaders penned an op-ed in the Washington Post calling for the creation of a national food policy. In it, they focused on a host of food-related crises, including type 2 diabetes, a dwindling farm economy, and climate change, and argued that a national food policy could address these challenges and more. Yet despite the data that shows how beneficial it would be, we’re still no closer to a comprehensive plan for our food system in the United States.

A national food strategy could save lives, and it could also be a boon for the American economy. Our food and agricultural system employs 10% of the population, and 100% of the population participate in the food system as consumers. The current state of the food system in our country is clearly a matter of national concern that touches all of us—from farmers in rural America who are struggling to make ends meet to children and adults battling obesity, diabetes, and other diet-related diseases. Each piece of the food system impacts another, and they all impact American lives. We need to start taking a strategy seriously—if not, we risk continued inefficiencies and poor outcomes that will be far too costly.

Advocacy in Action

Written by Michael Cunniff, Spring 2017 student in the Health Law and Policy Clinic.

 

Seeing advocacy in action was the thing that stuck with me the most at the Tackling Lung Cancer in Kentucky Workshop. I was there to present with CHLPI students and staff about current proposals to repeal and replace the Affordable Care Act and how those proposals could impact the lives of patients living with lung cancer. Our presentation was designed merely to set the backdrop for the more targeted discussions to follow – developing concrete steps to fight lung cancer in Kentucky.

One of the steps that participants quickly coalesced around was one for which the clock was ticking. The latest session of the Kentucky legislature was ending the following week and there was a bill related to tobacco cessation on the docket that advocates in the room hoped to see approved. The bill—SB 89: An Act relating to health benefit coverage for tobacco cessation treatment—would require insurers to provide barrier-free access to tobacco cessation services to its consumers. The bill had passed the Senate nearly unanimously, and was set to pass the House too—if it ever hit the floor. Advocates at the summit were worried that the bill would stall it in the Health and Family Services Committee and the session would expire without a vote.

They were determined not to let this happen. Advocates quickly organized a plan for what to do—namely, have the Kentucky residents in the room call their legislators to discuss the importance of the bill. The issue wasn’t convincing legislators to vote for the bill (it had passed the Senate 35-2). The issue was convincing legislators to make it a priority to pass that bill over other legislation during a period in which time was a scarce resource. The atmosphere in the room was energizing as people realized that their efforts could help score a win on this issue.

I don’t know how many people in the room ended up calling their legislator. I don’t know how many convinced other people to call their legislators. But I do know that the bill passed out of committee and was approved 90-1 in the House.

Their efforts worked, and now it’ll be just a little bit easier to quit smoking in Kentucky.

 

 

The Diné Bich’iya (Navajo Food Sovereignty) Summit

Written by Erik Federman, Spring 2017 student in the Food Law and Policy Clinic.

 

“Food has been used as a weapon against the Navajo Nation.”

 

With those words, Amber Crotty, a delegate to the Navajo Nation Council, began her closing remarks for the Diné Bich’iya (Navajo Food Sovereignty) Summit. “We’re in the remembering phase,” she continued; the Navajo people have to reconnect with their traditional food ways. The Food Law and Policy Clinic had flown me and my teammate, Katie, and our supervisor, Christina, to Arizona, so that we could attend the summit. All semester, we had been studying the 2014 Farm Bill, to see how the programs authorized by it could be used, or altered, to help the Navajo Nation regain control over its food system.

Regions of the Navajo Nation have obesity rates ranging from 23-60 percent, and 25 percent of people living on the reservation, which stretches across New Mexico, Arizona, and Utah, are diabetic. There’s a lot of fast food, and few grocery stores. Hot Cheetos are the best selling snack across the reservation. Traditional foods and other healthy foods are harder to come by than highly processed alternatives, and are far more expensive. At the same time, Navajo farmers face barriers gaining access to land and water, and a lack of infrastructure makes it difficult for them to bring their products to market.

Local advocates have risen to face these challenges, and are working to achieve food sovereignty for the Navajo Nation. As a part of this effort, Navajo Vice President Jonathan Nez sponsored the Diné Bich’iya Summit to create an opportunity for stakeholders to come together, identify issues facing the Navajo food system, and brainstorm solutions.

The summit ran for three days. Christina, Katie, and I spent them flitting from one break out session to another, trying to soak up as much information as we could. We heard from Navajo politicians, like Council Delegate Crotty and Vice President Nez, community organizers, public health professionals, botanists, farmers, and anyone else interested in the Navajo food system. It was exciting to be around so many motivated people eager to make a change. We learned a lot, too!

We weren’t just there to listen, though, and Katie and I spoke at a breakout session on the second day. We presented a food policy toolkit that the Clinic had put together in 2015 (Putting Food Policy to Work in Navajo Nation) and the Clinic’s 2016 report on how to expand farm to school in Navajo Nation (Growing Farm to School Programs on the Navajo Nation). We were joined by two exceptional women, our host, Sonlatsa Jim-Martin of Community Outreach and Patient Empowerment, and Pam Roy, of New Mexico Farm to Table.

Although the summit kept us plenty busy, we still found time to enjoy its setting. We stayed in Chinle, Arizona, which sits right at the lip of the Canyon de Chelly – a deep, dramatic canyon that native peoples have called home for millennia. We hiked to the canyon floor one evening, where the sunset bathed the sheer sandstone walls in golden light. We’d gotten selfie-sticks in our welcome bags at the summit, and they got plenty of use.

It was a privilege to work on this project and to travel to Navajo Nation. I met so many amazing people there, and learned so much about the challenges they face and the work they’re doing to overcome them. It was an inspirational experience, and one I won’t soon forget.

 

Edible Manhattan Applauds FLPC’s U.S. Food Waste Policy Finder

A May 22, 2017 story published on Edible Manhattan applauds the recent creation of tools to help reduce food waste across the nation. The article, These 2 Tools Will Help Us Reduce Food Waste by 50 Percent by 2030, says "These new tools equip leaders across sectors to identify solutions with the largest impact, and prioritize efforts to help the nation reach its goal of 50 percent reduction in food waste by 2030."

 

Image and caption from Edible Manhattan: In Bushwick, BK ROT works at the intersection of environmental and social justice by employing local youth in a community-supported, bike-transported composting operation.

Excerpt from article:

 

"Forty percent of food produced in the United States is wasted, and while problems in our food system abound—greenhouse gas emissions, farmworker rights, land degradation, affordable access to nutritious food—focusing on food waste is an efficient way to tackle some of our most pressing challenges. ReFED—a multi-stakeholder nonprofit committed to reducing U.S. food waste—recognizes this and have released two new tools to help do just that: the Innovator Database and the Food Waste Policy Finder."

 

Read  These 2 Tools Will Help Us Reduce Food Waste by 50 Percent by 2030 in full.