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          Women outliving men around the world because they’re more likely to seek health care: WHO      Comment   Translate Page      
iStock/Thinkstock(NEW YORK) -- Women, particularly those living in wealthy countries like the United States, are outliving men around the world accord...
          Home Health Care a Rewarding Choice      Comment   Translate Page      
Many times home health care is only thought of on a “We’ve Got to Do Something Now” basis. As we baby boomers are getting older and are now on the receiving end of the spectrum it is important for us to look for ways to make our lives simpler and more convenient not only for […]
          Health Care Corporations Flooded Political Campaigns With Cash in 2017      Comment   Translate Page      
The nation’s largest health care corporations spent at least $61 million in 2017 to influence politics.

The post Health Care Corporations Flooded Political Campaigns With Cash in 2017 appeared first on Truthout.


          Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study.      Comment   Translate Page      
Icon for Elsevier Science Icon for Elsevier Science Icon for PubMed Central Related Articles

Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis and rifampicin resistance: a prospective multicentre diagnostic accuracy study.

Lancet Infect Dis. 2018 01;18(1):76-84

Authors: Dorman SE, Schumacher SG, Alland D, Nabeta P, Armstrong DT, King B, Hall SL, Chakravorty S, Cirillo DM, Tukvadze N, Bablishvili N, Stevens W, Scott L, Rodrigues C, Kazi MI, Joloba M, Nakiyingi L, Nicol MP, Ghebrekristos Y, Anyango I, Murithi W, Dietze R, Lyrio Peres R, Skrahina A, Auchynka V, Chopra KK, Hanif M, Liu X, Yuan X, Boehme CC, Ellner JJ, Denkinger CM, study team

Abstract
BACKGROUND: The Xpert MTB/RIF assay is an automated molecular test that has improved the detection of tuberculosis and rifampicin resistance, but its sensitivity is inadequate in patients with paucibacillary disease or HIV. Xpert MTB/RIF Ultra (Xpert Ultra) was developed to overcome this limitation. We compared the diagnostic performance of Xpert Ultra with that of Xpert for detection of tuberculosis and rifampicin resistance.
METHODS: In this prospective, multicentre, diagnostic accuracy study, we recruited adults with pulmonary tuberculosis symptoms presenting at primary health-care centres and hospitals in eight countries (South Africa, Uganda, Kenya, India, China, Georgia, Belarus, and Brazil). Participants were allocated to the case detection group if no drugs had been taken for tuberculosis in the past 6 months or to the multidrug-resistance risk group if drugs for tuberculosis had been taken in the past 6 months, but drug resistance was suspected. Demographic information, medical history, chest imaging results, and HIV test results were recorded at enrolment, and each participant gave at least three sputum specimen on 2 separate days. Xpert and Xpert Ultra diagnostic performance in the same sputum specimen was compared with culture tests and drug susceptibility testing as reference standards. The primary objectives were to estimate and compare the sensitivity of Xpert Ultra test with that of Xpert for detection of smear-negative tuberculosis and rifampicin resistance and to estimate and compare Xpert Ultra and Xpert specificities for detection of rifampicin resistance. Study participants in the case detection group were included in all analyses, whereas participants in the multidrug-resistance risk group were only included in analyses of rifampicin-resistance detection.
FINDINGS: Between Feb 18, and Dec 24, 2016, we enrolled 2368 participants for sputum sampling. 248 participants were excluded from the analysis, and 1753 participants were distributed to the case detection group (n=1439) and the multidrug-resistance risk group (n=314). Sensitivities of Xpert Ultra and Xpert were 63% and 46%, respectively, for the 137 participants with smear-negative and culture-positive sputum (difference of 17%, 95% CI 10 to 24); 90% and 77%, respectively, for the 115 HIV-positive participants with culture-positive sputum (13%, 6·4 to 21); and 88% and 83%, respectively, across all 462 participants with culture-positive sputum (5·4%, 3·3 to 8·0). Specificities of Xpert Ultra and Xpert for case detection were 96% and 98% (-2·7%, -3·9 to -1·7) overall, and 93% and 98% for patients with a history of tuberculosis. Xpert Ultra and Xpert performed similarly in detecting rifampicin resistance.
INTERPRETATION: For tuberculosis case detection, sensitivity of Xpert Ultra was superior to that of Xpert in patients with paucibacillary disease and in patients with HIV. However, this increase in sensitivity came at the expense of a decrease in specificity.
FUNDING: Government of Netherlands, Government of Australia, Bill & Melinda Gates Foundation, Government of the UK, and the National Institute of Allergy and Infectious Diseases.

PMID: 29198911 [PubMed - indexed for MEDLINE]


          Bernie Sanders’ ‘Medicare-for-all’ plan includes health care for illegal immigrants      Comment   Translate Page      

Sen. Bernie Sanders’, I-Vt., newly unveiled ‘Medicare-for-all’ plan, backed by a host of other 2020 Democratic presidential hopefuls, would open the door to giving health care to illegal immigrants — a marked left-wing departure from past [...]

The post Bernie Sanders’ ‘Medicare-for-all’ plan includes health care for illegal immigrants appeared first on KID Newsradio.


          More hospitals will not cure Australia’s ailing health-care system. There’s a more efficient way      Comment   Translate Page      
There needs to be more focus on treating people before they need a hospital. Shutterstock Steven Bond-Smith, Curtin University; Alan Duncan, Curtin University; Astghik Mavisakalyan, Curtin University, and Yashar Tarverdi, Curtin University The federal government has just promised to increase spending on public hospitals from A$21.7 billion in 2018 to A$26.2 billion by 2023. Expect […]
          Know Key Things About Mental Health Care Policies In The UK      Comment   Translate Page      

Are you really concerned for the elderly loved ones of your home? Then, you must opt for a care home where you can register the names of your elder people. The efficient staffs here will take care of the needs and requirements of your loved ones. Learn more about their services, today!


          Health-care law more popular despite Trump’s repeated attempts to destroy it      Comment   Translate Page      
Forum: General Political Discussion Posted By: JacksinPA Post Time: 04-13-19 at 09:16 PM
          LA Doctor Experimenting on Children as Young as 8 for Transgender Therapy with Government Funding      Comment   Translate Page      
Dr. Michael Laidlaw, an endocrinologist from Rocklin, California, recently discovered via a Freedom of Information Act that a government-supported research program at the Children’s Hospital Los Angeles was experimenting on children as young as 8 years old with cross-sex hormones.

Dr. Johanna Olson-Kennedy, who runs the Los Angeles study, received a $5.7 million grant from the National Institutes of Health (NIH).

There are currently more than 30 clinics for transgender children in the U.S.

Olson-Kennedy’s clinic, the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, is the country’s largest, treating 725 children.

Dr. Johanna Olson-Kennedy of Children’s Hospital Los Angeles. 
(Photo: Sandy Hooper, USA TODAY)

Read Entire Article »
          Voyage Care Ltd: Health Care Assistant      Comment   Translate Page      
Up to £8.80 per hour: Voyage Care Ltd: Shift patterns - Days, Nights and Weekend work available both full and part time posts. Bank & 16 hour permanent contracts available Starting Wage - £8.80 About this Job - An exciting opportunity has arisen for Community Health Care Assistant to provide c Middlesbrough
           Comment on In India, Initially Who Implemented Traffic System? by Anonymous       Comment   Translate Page      
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          Affordable Health Care       Comment   Translate Page      

Prescription drugs are vitally important to all Americans – every one of us included.  Advances in science and technology have opened the doors to treat or cure thousands of diseases which not too long ago would have been considered a death sentence. 

However, as the cost of health care continues to rise, consumers have grown frustrated with the price tag on some of their prescriptions.  Patients are especially frustrated when the price of a medicine they have been using for an extended period goes up over time, as opposed to many other innovative products like mobile phones or televisions which get cheaper as their time on the market grows.   

Ensuring access to affordable, quality prescriptions drugs has been getting more attention in Washington.  In fact, President Trump, in his State of the Union address, promised to tackle prescription drug prices by asking Congress to pass legislation which “delivers fairness and price transparency for American patients.”  The House of Representatives has responded to the President’s charge by holding numerous hearings to examine drug prices.

This week, the House Ways and Means Committee, on which I serve, delivered on the President’s request and unanimously passed the bipartisan Prescription Drug Sunshine, Transparency, Accountability and Reporting (STAR) Act.  This legislation is designed to improve transparency and accountability to help patients navigate the prescription drug market. 

The Prescription Drug STAR Act represents an important first step in bringing much needed transparency to a complicated issue. This transparency will help both Congress and the public to better understand the impacts of prescription drug spending and shortages, and the reasons behind significant price swings.

However, this is just the first step in a longer process. As Congress continues to work on this issue, we must make sure our efforts actually result in tangible savings to patients.  We should take a close look to ensure the standards we set bring useful information to consumers while incentivizing robust competition in the marketplace and continued innovation.  We must not discourage the millions or billions of dollars which go into the research, development, and approval process for each groundbreaking new cure or treatment. 

As the legislative and implementation processes continue for these transparency initiatives, I am eager to hear from Nebraska providers and patients on these efforts. We are fortunate to live in a country where new treatments are available and lifesaving advances in pharmaceutical research are encouraged, and I am glad to have the opportunity to work on these issues for the benefit of consumers.


          MDS Nurse Case Manager #350, Registered Nurse I & II #172 or #176, Nurse Supervisor-Interim #199      Comment   Translate Page      
Posted on: 2019-04-14

Vermont Veterans' Home

MDS Nurse Case Manager

This position requires specialized nursing work at a professional level assessing, evaluating, documenting, and/or authorizing clinical service delivery. Knowledge of the MDS 3.0 and the reimbursement processes.

Reference Job Requisition #350.

Bennington-Full-Time, Application Deadline-Open Until Filled.

Registered Nurse I & II

We are seeking to hire Registered Nurses on the evening and night shift to become part of our health-care team where we focus on resident-centered care. You will work with resident providers and oversee the care and services provided while honoring our Veterans. The positions are being recruited at two levels.

Starting hourly rate for an RN I on the evening shift is $30.78; nights is $32.03; RN II on evenings is $33.69; nights is $34.94.

Reference Job Requisition #172 or #176.

Location: Bennington.

Status: Full Time.

Application Deadline: Continuous

Nurse Supervisor-Interim

We are seeking to hire a day Nursing Supervisor for an interim position. We desire a candidate who will promote a teamwork environment and have a strong positive leadership philosophy. You must possess strong supervisory skills, along with effective organizational and communication skills in a large clinical setting.

Reference job requisition #199.

Bennington-Full-Time, Application Deadline: Open Until Filled.

Licensed Nursing Assistants

Full-time openings on our evening shift are available. Starting salary is $16.88 per hour.

Reference Job Requisition #170.

Location: Bennington. Status: Full Time, Evenings.

Application Deadline: Continuous.

Temporary Positions

We also have temporary (per diem) positions in Nursing on all shifts for RN I & RN IIs (job req #174 & #177), LPNs (job req #171), & LNAs (job req #168).

The State of Vermont offers an excellent total compensation package.

For questions related to your application, please contact the Department of Human Resources, Recruitment


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          Democrats’ Foolishness Sweepstakes      Comment   Translate Page      

Democrats’ Foolishness SweepstakesThe Democrats' presidential aspirants seem determined to prove that their party's 2016 achievement -- the election of the current president -- was not a fluke that cannot be repeated. But the Republican party, whose last remaining raison d'être is to frustrate Democrats, seems to be thinking: We are determined to lose the 2020 election in order to foil Democrats' attempts to lose it.The Democratic aspirants radiate unseriousness about things they discuss with notable solemnity. By their words of endorsement, many of them said that the Green New Deal is a matter of life and death -- for the planet, no less. But their actions -- zero Senate votes for the GND -- say something else.Among the reasons these aspirants give for promising to abolish the Electoral College is one reason that virtually guarantees that it will not be abolished: Because each state gets two electoral votes for its senators, the system advantages the least populous states. Opposition by 13 states will extinguish any constitutional amendment. If the legislatures of any of the 13 least-populous states (Wyoming, Vermont, Alaska, North Dakota, South Dakota, Delaware, Rhode Island, Montana, Maine, New Hampshire, Hawaii, Idaho, West Virginia) fail to oppose an amendment abolishing the electoral-vote system, other legislatures -- those of, for example, Nebraska, Kansas, Arkansas, Utah, Mississippi -- probably will ensure defeat.Competition in the Democrats' frivolity sweepstakes is intense. Beto O'Rourke contemplates amending the Constitution "to show that corporations are not people." Conceivably, he has not thought through why corporate personhood has been in Anglo-American law for centuries: For-profit and nonprofit (including almost all progressive advocacy groups) corporations are accorded rights as "artificial persons" (William Blackstone's phrase) to enable them to have lives, identities, and missions that span generations and produce a robust civil society of freely cooperating citizens.Donald Trump must secretly admire Massachusetts senator Elizabeth Warren's thoroughly Trumpian proposal -- made where pandering is perfected: Iowa -- to ban foreigners from buying U.S. farmland. Lest diabolical foreigners take our loam home? No, Warren says foreigners threaten "food security," hence "national security," too. Warren and Trump -- he who sees a national-security threat from imported Audis -- are together at last."I wore my Planned Parenthood pink!" exclaimed Minnesota senator Amy Klobuchar at a recent Washington cattle call for Democratic candidates. She, who is supposed to represent the sensibility of flyover country in her disproportionately coastal party, told the conclave that a "major priority" for her, one that she would emphasize in her presidency's first 100 days, is statehood for the District of Columbia, a peculiar promise to facilitate retaking Wisconsin, Michigan, and Pennsylvania. Julian Castro -- former mayor of San Antonio, former secretary of Housing and Urban Development -- said that when he is the 46th president, he will favor making Congress subject to the Freedom of Information Act. This is perhaps a good goal but not uppermost in the electorate's mind.The Financial Times notes that in 2018, exit polls showed that a plurality of voters – 41 percent -- ranked health care as their foremost concern. That was the year when it became obligatory for all candidates to promise that health insurance shall not be denied because of a person's preexisting health problems. But Trump ("Nobody knew health care could be so complicated") evidently is going to seek reelection saying: Trust me, there will be "a really great" Republican health-care plan -- after the election, and after my administration has convinced a court to overturn the entire Affordable Care Act (including guaranteed insurance coverage for those with preexisting conditions), which now enjoys the support of a narrow majority.Voters might wonder why the coming health plan's greatness will not be unveiled as an election asset. And voters might remember that in 1968 Richard Nixon said: Trust me, I have a plan to end the Vietnam War. When, seven years later, in April 1975, the last helicopter lifted off the roof of the besieged U.S. Embassy in Saigon, more than 21,000 Americans had died in combat since Nixon's inauguration -- approximately 37 percent of those killed in the war since the early 1960s.The eventual Democratic nominee is probably among the many already running. So the party, with its mosaic of factions to placate (affluent progressives, faculty-club socialists, suburban women, African Americans, Hispanics, climate worriers, identity-politics warriors, etc.) and its aversion to winner-take-all primaries, should remember 1972 or 1984. Its nominees, George McGovern and Walter Mondale won 25 percent and 38 percent, respectively, of the nominating electorate's votes. In the two general elections, they lost 98 states.© 2019, Washington Post Writers Group



          In health care debate, price control techniques weighed      Comment   Translate Page      
By BOB SALSBERG BOSTON - State Rep. Jon Santiago, a Boston emergency room doctor, recalled an elderly patient named Mike who recently came to the hospital with life-threatening...
          Children’s Health Care of Batesville and Greensburg officially opens      Comment   Translate Page      
Batesville, In. — Children’s Health Care of Batesville and Greensburg is officially open for business on State Road 46 just of the intersection of State Road 229. The 10,000-square foot facility was built by Shelbyville-based Runnebohm [...]
          (USA-DC-Washington) Physician Assistant      Comment   Translate Page      
* Duties Help ## Duties ### Summary Physician Assistant (PA) practices in the Pulmonary Section within the Medical Service Line. The PA provides clinical support to patients while working closely with physicians of the Pulmonary and Critical Care Section and their duties and responsibilities will be at the direction of the Chief, Pulmonary and Critical Care. The PA is fully qualified and certified, providing a full range of patient care services in the Pulmonary Section. The PA functions in both a clinical and administrative role. Learn more about this agency ### Responsibilities * Provides urgent and non-urgent care to patients presenting to the Pulmonary Section. * Assists with all clinical aspects of care to the patients assigned to the Pulmonary Section or referred to the Pulmonary Section, according to scope of practice. * Has the authority to order all lab tests, PFT and other diagnostic studies, radiologic tests, prescription drugs. * Initiates and accepts referrals to clinics within VA Medical Centers. Collaborates with other health-care resources to ensure timely and appropriate care of patients. * Performs procedures and duties in the Pulmonary Section that are consistent with training as a Physician Assistant. * Addresses all pulmonary needs of veterans including acute and chronic pulmonary illnesses and preventive care. * Manages MyHealtheVet for the Pulmonary Section. * Teaches a COPD Education Class in collaboration with cardiopulmonary rehabilitation department. * Manages 4 PA outpatient pulmonary clinics which will include patients on home oxygen and lung nodule referrals. Maintain a lung nodule registry of patients with lung nodules. * Participates in the department?s weekly pulmonary conference and Tumor Board Conference. * Coordinates referrals and evaluation of Veterans at the DC Veteran Affairs Medical Center in addition to outside VA?s and private sector referrals of Veterans to the Pulmonary Section and the Medical Center. * Facilitates response/actions to patient inquires for care and treatment provided by the Pulmonary Section. * Maintains a registry of lung nodule patients. * Routinely responds to numerous telephone messages from patients with health concerns, prescriptions needs, etc. throughout the week. * Other administrative duties as assigned by the Chief of Pulmonary and CCM. ### Travel Required Not required ##### Supervisory status No ##### Promotion Potential None * #### Job family (Series) 0603 Physician Assistant #### Similar jobs * Assistants, Physician * Physician Assistants * Requirements Help ## Requirements ### Conditions of Employment * You must be a U.S. Citizen to apply for this job * Designated and/or random drug testing may be required * Selective Service Registration is required for males born after 12/31/1959 * You may be required to serve a probationary period * Subject to a background/security investigation * Must be proficient in written and spoken English * Selected applicants will be required to complete an online onboarding process ### Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 04/25/2019. **Basic Requirements**: * **United States Citizenship**: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. * **Education.** The candidate must meet the following: (1) Graduate of a PA training program, or of a surgical assistant program which is accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) or one of its predecessor organizations; and (2) A Bachelor's degree from an accredited PA training program or in another health sciences related field from an accredited college or university recognized by the U.S. Department of Education. * **Certification**(1) Current and continuous certification by the National Commission on Certification of Physician Assistants (NCCPA) is required for employment in VHA.(2) Recent PA graduates who are eligible to take the Physician Assistant National Certifying Examination (PANCE) may be employed by VA on a temporary basis (38 U.S.C. 7405), for a period not to exceed two years, as provided in VA Handbook 5005, Part II, Chapter 3, Section G, Paragraph 5.(3) If a PA's NCCPA certification is suspended, revoked or expires, the PA must be removed from the occupation which may result in termination of employment. **Preferred Experience:** Experience in working with COPD patients, lung cancer screening, and lung nodule patients. **Grade Determinations**: **Chief Grade**. In addition to meeting the basic requirements under paragraph 2 above, candidates must meet all requirements described in this standard for Senior Grade through VA employment or non- VA PA positions with equivalent scope and complexity. Appointment or promotion to Chief Grade is based on the individual's demonstrated high level of clinical expertise, leadership ability, and the ability to function with a high degree of autonomy. Further, the PA candidate for Chief Grade will have demonstrated all the requirements of one or more of the following categories: Management/Administrative, Clinical Proficiency, Professional Development and Research. (1) **Experience / Education** (a) Generally, an individual in this grade is able to demonstrate the behaviors listed in the areas below after** 5 years of professional practice as a PA**; and, (b) **The minimum education for this grade is a Master's Degree from a PA training program accredited by ARC-PA or in a health-related field of study.** However, experience as a PA may be substituted for the Master's degree where the individual has an equivalent knowledge of the profession and has successfully undertaken a combination of difficult or complex assignments in several clinical, administrative, research and educational arenas which required a high degree of competence. (2) **Management/Administrative** (a) Accepts substantial and continuing responsibility for managing or coordinating a healthcare program including follow-up actions to ensure compliance with regulatory bodies required by internal and external review organizations and accrediting bodies, and; (b) Successfully integrates the activities of the employee's assignment with other patient care programs at the facility or with similar programs on a broader geographic basis, and; (c) Develops policies and procedures and participates in executive level decision making deliberations, and; (d) Participates in long range program planning and model development for effective delivery of services, and; (e) Performs a full range of administrative duties relative to the assignment. (3) **Clinical Competencies** (a) **Clinical Proficiency** 1. Evaluates facility patient care delivery systems and validates or identifies barriers to safe, effective care. Presents findings and recommendations to appropriate management officials and participates in implementation of changes, and; 2. Exhibits leadership in initiating changes in patient care programs based on current concepts and findings from research and/or studies, and; 3. Facilitates the delivery of patient care in collaboration with health professionals, health managers and other health care personnel, and; 4. Exhibits exceptional clinical skills and consistently demonstrates a high level of expertise in diagnosing and treating seriously ill, multi-symptomatic patients. (b) **Professional Development** 1. Develops and implements education and training programs involving a variety of specialties in widely diversified activities, and; 2. Provides personnel with the vital link between education and practice. 3. Coordinates clinical training of healthcare students including facilitation of clinical rotations, recruitment preceptors and evaluation of student, and; 4. Maintains close relationships with affiliated schools and healthcare training programs and coordinates clinical rotations with curriculum needs, and; 5. Serves on education and training committees, advisory groups and special task forces concerned with managing education and career development activities. (c) **Ethics** 1. Provides leadership in addressing ethical issues that impact patients and staff at the medical facility and the local health care community. 2. Participates in the education of facility staff in ethical concepts and encourages staff participation in ethics educational programs. (d) **Interpersonal Skills** 1. Demonstrates leadership in developing productive working relationships with groups in other programs, services, academic settings, and community agencies. 2. Effectively collaborates and interacts with other regional medical facilities to enhance seamless coordination of inter-facility patient care. (e) **Research** 1. Conducts approved, merit-reviewed research projects; performs independent research; serves as a contributing member of a research team or serves as a member of a research committee; formulates research proposals and protocol submissions for merit review; and develops publishable material for appropriate professional journals or speaks to peer groups, and; 2. Effectively researches problems of major scope; directs independent research of considerable interest and value, where the research contribution is highly productive and of such quality and originality as to have marked the PA as a significant contributor to advances in patient care and services. 5. **DEVIATIONS** a. The Facility Director may approve a waiver of the grade requirements at Chief Grade and below for PAs whose accomplishments, performance, qualifications, and demonstrated competence warrant such action. b. Under no circumstances can the requirement for certification be waived. c. The placement of individuals in grade levels or assignments not described in this qualification standard must be approved by the Under Secretary for Health or designee in VHA Central Office. **References:** VA HANDBOOK 5005/78, PART II, APPENDIX G8 The full performance level of this vacancy is GS-13. **Physical Requirements:**Use and function of all normal motor and sensory anatomy for provision of patient care, reading, writing, listening, observing/seeing, heavy lifting, bending, pulling, pushing, stooping, squatting, walking, standing, use of fine motor muscles; visual an auditory acuity; emotional intelligence to respond to stressful and/or emergent situations and crises appropriately and calmly; self-care skills to maintain physical, psychological, and emotional health. Examples include: heavy lifting of 45 pounds and over, heavy carrying of 45 pounds and over, near vision correctable at 13" to 16" to Jaeger 1-4, far vision correctable in one eye to 20/20 and to 20-40 in the other. **Work Schedule:** 8:00 am - 4:30 pm, Monday - Friday **Fi****nancial Disclosure Report:** Not required **Recruitment/Relocation Incentives:**Not authorized **PCS Expenses:**Not authorized ### Education **IMPORTANT:**A transcript (not a diploma) showing degree conferment **MUST** be submitted with your application. **Note:**Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html. ### Additional information This job opportunity announcement may be used to fill additional vacancies. It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment. This position is in the Excepted Service and does not confer competitive status. VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority. Veterans and Transitioning Service Members: Please visit the VA for Vets site for career-search tools for Veterans seeking employment at VA, career development services for our existing Veterans, and coaching and reintegration support for military service members. If you are unable to apply online view the following link for information regarding an Alternate Application. Read more ### How You Will Be Evaluated You will be evaluated for this job based on how well you meet the qualifications above. **IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Your application, résumé, C.V., and/or supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect consideration for employment.** **NOTE:** The Professional Standards Board (a peer-review group) will review the selected candidate's education and experience and recommend the grade and salary at which the candidate will be placed. For internal selectees eligible for promotion, the board will determine grade and HR will determine step in accordance with policy. Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Read more ### Background checks and security clearance ##### Security clearance Other ##### Drug test required No * Required Documents Help ## Required Documents To apply for this position, you must provide a complete Application Package which includes: * VA Form 10-2850a AND copy of current PA certification showing expiration date. * Resume * SF-50 * Transcript VA Form 10-2850c Application for Associated Health Occupations can be found at: http://www.va.gov/vaforms/searchaction.asp?FormNo=2850&tkey;=&Action;=Search. **Required at time of application** The following documents are accepted, and may be required if applicable to your eligibility and/or qualifications for this position. Please use this checklist to ensure you have included all documents required for your application, such as a copy of your transcript (if using education to qualify), SF-50's (current/former Federal employees), etc. * Cover Letter * DD-214 * OF-306 * VA Form 10-2850a AND copy of current PA certification showing expiration date. * Other Veterans Document * Resume * SF-15 * SF-50 * Transcript **Veterans' Preference:** When applying for Federal Jobs, eligible Veterans should claim preference for 5pt (TP), 10pt (CP/CPS/XP), or for Sole Survivor Preference (SSP) in the questionnaire. You must provide a legible copy of your DD214(s) which shows dates and character of service (honorable, general, etc.). If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separation. Additionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible Veterans) must also submit an SF-15 "Application for 10 Point Veteran Preference" with required proof as stated on the form. Documentation is required to award preference. For more information on Veterans' Preference, please visit http://www.fedshirevets.gov/job/vetpref/index.aspx. #### If you are relying on your education to meet qualification requirements: Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education. Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating. * Benefits Help ## Benefits A career with the U.S. Government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Learn more about federal benefits. Review our benefits Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time, or intermittent. Contact the hiring agency for more information on the specific benefits offered. * How to Apply Help ## How to Apply All applicants are encouraged to apply online. To apply for this position, you must complete the full questionnaire and submit the documentation specified in the Required Documents section below. The complete application package must be submitted by 11:59 PM (ET) on 04/25/2019 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/10475155. 1. To begin, click Apply Online to create a USAJOBS account or log in to your existing account. Follow the prompts to select your USA JOBS resume and/or other supporting documents and complete the occupational questionnaire. 2. Click Submit My Answers to submit your application package. **NOTE:** It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date. To verify your application is complete, log into your USA JOBS account, https://my.usajobs.gov/Account/Login, select the Application Status link and then select the more information link for this position. The Details page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process. To return to an incomplete application, log into your USA JOBS account and click Update Application in the vacancy announcement. You must re-select your resume and/or other documents from your USA JOBS account or your application will be incomplete. **NOTE**: Participation in the seasonal influenza program is a condition of employment and a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). HCP are individuals who, during the influenza season, work in VHA locations where patients receive care or who come into contact with VA patients as part of their duties. VHA locations include, but are not limited to, VA hospitals and associated clinics, community living centers (CLCs), community-based outpatient clinics (CBOCs), domiciliary units, Vet centers and VA-leased facilities. HCP include all VA licensed and unlicensed, clinical and administrative, paid and unpaid, full- and part-time employees, intermittent employees, fee basis employees, VA contractors, students, researchers, volunteers, and trainees who work at these facilities. HCPs that are unable to receive or otherwise decline a flu shot will be expected to wear a face mask throughout the influenza season. Read more ### Agency contact information ### VHA National Recruitment Center ##### Phone (844)456-5208 ##### Email VHANationalRecruitmentCenter@va.gov ##### Address Washington VA Medical Center 50 Irving Street, Northwest Washington, DC 20422 US Learn more about this agency ### Next steps Once your online application is submitted you will receive a confirmation notification by email. After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made. You may check the status of your application at any time by logging into your USA Jobs account and clicking on Applications. Information regarding your application status can be found in the USAJobs Help Center. Read more * Fair & Transparent ## Fair & Transparent The Federal hiring process is setup to be fair and transparent. Please read the following guidance. ### Equal Employment Opportunity Policy The United States Government does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor. * Equal Employment Opportunity (EEO) for federal employees & job applicants Read more ### Reasonable Accommodation Policy Federal agencies must provide reasonable accommodation to applicants with disabilities where appropriate. Applicants requiring reasonable accommodation for any part of the application process should follow the instructions in the job opportunity announcement. For any part of the remaining hiring process, applicants should contact the hiring agency directly. Determinations on requests for reasonable accommodation will be made on a case-by-case basis. A reasonable accommodation is any change to a job, the work environment, or the way things are usually done that enables an individual with a disability to apply for a job, perform job duties or receive equal access to job benefits. Under the Rehabilitation Act of 1973, federal agencies must provide reasonable accommodations when: * An applicant with a disability needs an accommodation to have an equal opportunity to apply for a job. * An employee with a disability needs an accommodation to perform the essential job duties or to gain access to the workplace. * An employee with a disability needs an accommodation to receive equal access to benefits, such as details, training, and office-sponsored events. You can request a reasonable accommodation at any time during the application or hiring process or while on the job. Requests are considered on a case-by-case basis. Learn more about disability employment and reasonable accommodations or how to contact an agency. Read more #### Legal and regulatory guidance * Financial suitability * Social security number request * Privacy Act * Signature and false statements * Selective Service * New employee probationary period This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/GetJob/ViewDetails/530493800. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered. *Open & closing dates:* 04/12/2019 to 04/25/2019 *Service:* Excepted *Pay scale & grade:* GS 13 *Salary:* $99,172 to $128,920 per year *Appointment type:* Permanent *Work schedule:* Full-Time
          Decoding Dog Gas — When Is It a Problem?      Comment   Translate Page      

The post Decoding Dog Gas — When Is It a Problem? by Jackie Brown appeared first on Dogster. Copying over entire articles infringes on copyright laws. You may not be aware of it, but all of these articles were assigned, contracted and paid for, so they aren't considered public domain. However, we appreciate that you like the article and would love it if you continued sharing just the first paragraph of an article, then linking out to the rest of the piece on Dogster.com.

Is that dog gas an issue or just a smelly annoyance? Are certain breeds more prone to dog gas? Can you take steps to prevent dog gas in the first place?

The post Decoding Dog Gas — When Is It a Problem? by Jackie Brown appeared first on Dogster. Copying over entire articles infringes on copyright laws. You may not be aware of it, but all of these articles were assigned, contracted and paid for, so they aren't considered public domain. However, we appreciate that you like the article and would love it if you continued sharing just the first paragraph of an article, then linking out to the rest of the piece on Dogster.com.


          Dog Scooting: Why It Happens and When to See a Vet      Comment   Translate Page      

The post Dog Scooting: Why It Happens and When to See a Vet by Jackie Brown appeared first on Dogster. Copying over entire articles infringes on copyright laws. You may not be aware of it, but all of these articles were assigned, contracted and paid for, so they aren't considered public domain. However, we appreciate that you like the article and would love it if you continued sharing just the first paragraph of an article, then linking out to the rest of the piece on Dogster.com.

Why does dog scooting happen? Should you treat dog scooting at home or go to the vet? What does dog scooting have to do with dog anal gland issues?

The post Dog Scooting: Why It Happens and When to See a Vet by Jackie Brown appeared first on Dogster. Copying over entire articles infringes on copyright laws. You may not be aware of it, but all of these articles were assigned, contracted and paid for, so they aren't considered public domain. However, we appreciate that you like the article and would love it if you continued sharing just the first paragraph of an article, then linking out to the rest of the piece on Dogster.com.


          Is Your Dog Hiding? What to Do About It      Comment   Translate Page      

The post Is Your Dog Hiding? What to Do About It by Stephanie Osmanski appeared first on Dogster. Copying over entire articles infringes on copyright laws. You may not be aware of it, but all of these articles were assigned, contracted and paid for, so they aren't considered public domain. However, we appreciate that you like the article and would love it if you continued sharing just the first paragraph of an article, then linking out to the rest of the piece on Dogster.com.

Is your dog hiding? This behavior is usually a response to changes in the environment or health issues. Here’s how to handle dog hiding.

The post Is Your Dog Hiding? What to Do About It by Stephanie Osmanski appeared first on Dogster. Copying over entire articles infringes on copyright laws. You may not be aware of it, but all of these articles were assigned, contracted and paid for, so they aren't considered public domain. However, we appreciate that you like the article and would love it if you continued sharing just the first paragraph of an article, then linking out to the rest of the piece on Dogster.com.


          68W Health Care Specialist      Comment   Translate Page      
PA-DANVILLE, 68W Health Care Specialist Job Description Be the first line of defense against injury and illness of civilians after natural disasters, and the Soldiers who serve and protect our Nation every day. As a Health Care Specialist in the Army National Guard, you will experience a fulfilling role as an expert caretaker on and off the battlefield. You will address the health care needs of civilians after
          68W Health Care Specialist      Comment   Translate Page      
PA-ANNVILLE, 68W Health Care Specialist Job Description Be the first line of defense against injury and illness of civilians after natural disasters, and the Soldiers who serve and protect our Nation every day. As a Health Care Specialist in the Army National Guard, you will experience a fulfilling role as an expert caretaker on and off the battlefield. You will address the health care needs of civilians after
          As Dems debate Medicare for All, a less radical idea stalls in blue states      Comment   Translate Page      
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          Health-care law more popular despite Trump’s repeated attempts to destroy it      Comment   Translate Page      
Thirty-six states and the District of Columbia have expanded Medicaid, and millions more are insured under the law, which is more enmeshed in the country’s health-care system.
          How the healing power of Irish soil may help fight superbugs      Comment   Translate Page      
How the hunt for new life-saving antibiotics led scientists to an area of Northern Ireland known for ancient healing traditions.
          KCK artist struggles to stay insured as disease could rob him of his eyesight      Comment   Translate Page      
In a small back room of his Kansas City, Kansas, art studio, Michael Brantley pointed out a painting stretching across one wall. It was a bird’s-eye view of a man … Click to Continue »
          Top 5 Companies in the Managed Health Care Industry With the Lowest EBITDA Growth (HUM, ANTM, UNH, CI, WCG)      Comment   Translate Page      
Below are the three companies in the Managed Health Care industry with the lowest EBITDA Growth (next year estimate vs. LTM). EBITDA Growth can be valuable in predicting future...
          Premier Inc-Cl A is Among the Companies in the Health Care Services Industry With the Lowest EBITDA Growth (PINC, ESRX, CVS, MD, DGX)      Comment   Translate Page      
Below are the three companies in the Health Care Services industry with the lowest EBITDA Growth (next year estimate vs. LTM). EBITDA Growth can be valuable in predicting future...
          Masimo Corp has the Lowest EBITDA Growth in the Health Care Equipment Industry (MASI, MDT, DHR, SRDX, BCR)      Comment   Translate Page      
Below are the three companies in the Health Care Equipment industry with the lowest EBITDA Growth (next year estimate vs. LTM). EBITDA Growth can be valuable in predicting future...
          Shares of Genesis Healthca Rank the Lowest in Terms of EBITDA Growth in the Health Care Facilities Industry (GEN, USPH, HCA, UHS, ACHC)      Comment   Translate Page      
Below are the three companies in the Health Care Facilities industry with the lowest EBITDA Growth (next year estimate vs. LTM). EBITDA Growth can be valuable in predicting future...
          Top 5 Companies in the Health Care Distributors Industry With the Lowest EBITDA Growth (MCK, PDCO, HSIC, CAH, ABC)      Comment   Translate Page      
Below are the three companies in the Health Care Distributors industry with the lowest EBITDA Growth (next year estimate vs. LTM). EBITDA Growth can be valuable in predicting future...
          Healthstream Inc is Among the Companies in the Health Care Technology Industry With the Lowest EBITDA Growth (HSTM, CERN, HMSY, ATHN, MDRX)      Comment   Translate Page      
Below are the three companies in the Health Care Technology industry with the lowest EBITDA Growth (next year estimate vs. LTM). EBITDA Growth can be valuable in predicting future...
          Shares of Anika Therapeuti Rank the Lowest in Terms of EBITDA Growth in the Health Care Supplies Industry (ANIK, RTIX, NEOG, WST, COO)      Comment   Translate Page      
Below are the three companies in the Health Care Supplies industry with the lowest EBITDA Growth (next year estimate vs. LTM). EBITDA Growth can be valuable in predicting future...
          Here's why doctors should worry about the feds' novel approach to prosecuting health care kickback cases      Comment   Translate Page      
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          Man Convicted in America’s Greatest Health Care Fraud Described as "Parasite" by Investigators      Comment   Translate Page      

Miami-based Orthodox Jew Philip Esformes has been convicted of America’s largest ever health care fraud which saw him steal more than $1.3 billion from American taxpayers. He has been officially described as a “parasite” by investigators from the US Department of Justice. According to a statement released by the US Department of Justice, a federal […]

The post Man Convicted in America’s Greatest Health Care Fraud Described as "Parasite" by Investigators appeared first on The European Union Times - World News, Breaking News.


          UPDATE: Holy Smokes...did Washington State just pass a full-blown ACA Public Option??      Comment   Translate Page      

Back in January, 2nd-term Washington Governor and Democratic Presidential candidate Jay Inslee jumped fully onboard the Public Option train:

Inslee proposes ‘public option’ health-insurance plan for Washington

The proposal, which Inslee said is the first step toward universal health care, is geared in part to help stabilize the exchange, which has wrestled with double-digit premium increases and attempts by Republicans in Congress and President Donald Trump to dismantle the Affordable Care Act.

...The proposal would have the state Health Care Authority contract with at least one health-insurance carrier to offer qualified health coverage on the Washington Health Benefit Exchange, according to a summary of the proposal.

The plan would be designed with transparent and consistent deductibles, copays and coinsurance, according to the summary, and would “compete on premium price, provider networks, customer service, and quality.”

...Washington state Insurance Commissioner Mike Kreidler said getting the legislation passed will be difficult, but is necessary, especially for people buying health insurance on the individual market who don’t qualify for a subsidy.

...Cody said insurance companies know about the proposed legislation and are not “overjoyed” about the plan.

As I noted at the time:

Well no, they wouldn't be, would they (except for whichever carrier wins the state contract, I presume).

Since January, however, I haven't really written much about Inslee's proposal. I obviously hoped it would be serious, but figured it was mostly just meant to bolster his progressive street cred for his Presidential run.

Well, guess what just happened?

Democrats in Olympia push through governor’s 'green' agenda and public healthcare coverage bills

...Another key item on the governor’s agenda is the so-called “public option” socialized health care coverage measure, SB 5526. This bill would create subsidized state-funded public health plans managed by regulated insurance companies. It would require the State Insurance Commissioner and the Health Care Authority to set up the socialized plans by 2021.

Side note: The term "socialized" is being misused here in my opinion, since the proposal would be neither socialized medicine (i.e., the healthcare providers wouldn't actually work for the government), nor would it be single payer (since enrollees would still be paying premiums, deductibles & co-pays).

These plans would be available through the state’s health care exchange to all residents, but the state would pay subsidies to individuals with incomes of up to five times the poverty level. Premiums would be limited to no more than ten percent of adjusted gross income, and payments to doctors and other health care providers would be restricted to Medicare-level limits.

That's like a trifecta of what progressives were dreaming of a decade ago when the ACA itself was originally being developed and voted on: A true public option, more subsidies available to more people and perhaps most significantly, Medicare-level rate setting. I didn't even know about the "bumping up subsidies to 500% FPL" part, but that's obviously welcome as well! For comparison California is hoping to bump APTC assistance up to 600% FPL, and the federal House Dems ACA 2.0 bill would remove the upper-threshold cap altogether...but 500% would still be better than 400%, especially if the policies were priced based on Medicare-level reimbursement rates.

In other words, if this actually goes into effect, it would be huge.

So, what actually happened this week?

The bill passed the Senate last month by a 36-13 vote, after a House version of the proposal, HB 1523, passed the House on a 57-41 party-line vote. The final proposal of the bill was incorporated in SB 5526 and passed the House on Wednesday by a 54-38 vote, with six members excused.

Changes to the bill made by the House will have to be approved by the Senate before it goes to the governor for his signature.

Holy crap on a stick! How did I not hear about any of these developments over the past month?? If I'm understanding this correctly, all that stands between Washington State and a full-blown, robust Public Option being added to their ACA Healthcare Exchange is for Gov. Jay Inslee a final vote in the state Senate and a signature by Gov. Inslee...and voila???

Well, ok, as noted above, it wouldn't go into effect until 2021, but still...this seems like a potentially massive healthcare development.

Here's the actual text of the bill itself (or at least of the "original" version...there's also a "Substitute" version and an "Engrossed Substitute"...I have no idea which one actually passed, but they're alll about the same length. It's surprisingly brief, actually...just four pages:

AN ACT Relating to increasing the availability of quality, 2 affordable health coverage in the individual market; adding a new 3 section to chapter 43.71 RCW; adding a new section to chapter 42.56 4 RCW; adding a new section to chapter 41.05 RCW; creating a new section; and providing an expiration date.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1

A new section is added to chapter 43.71 RCW to read as follows:

(1) The exchange, in consultation with the commissioner, the authority, an independent actuary, and other stakeholders, must establish up to three standardized health plans for each of the bronze, silver, and gold levels.

(a) The standardized health plans must be designed to reduce deductibles, make more services available before the deductible, provide predictable cost sharing, maximize subsidies, limit adverse premium impacts, reduce barriers to maintaining and improving health, and encourage choice based on value, while limiting increases in health plan premium rates.

(b) The silver standardized health plan must have an actuarial value between sixty-eight and seventy percent.

(c) The exchange may update the standardized health plans annually.

(d) The exchange must provide a notice and public comment period before finalizing each year's standardized health plans.

(e) The exchange must provide written notice of the standardized health plans to licensed health carriers by January 31st before the year in which the health plans are to be offered on the exchange.

(2)(a) Beginning January 1, 2021, any health carrier offering a qualified health plan on the exchange must offer one silver standardized health plan and one gold standardized health plan on the exchange. If a health carrier offers a bronze health plan on the exchange, it must offer one bronze standardized health plan on the exchange.

(b) For plan years 2021 through 2024, a health carrier offering a standardized health plan under this section may also offer nonstandardized health plans on the exchange subject to the following:

(i) For plan years 2021 and 2022, a health carrier may offer an unlimited number of nonstandardized health plans on the exchange;

(ii) For plan years 2023 and 2024, a health carrier may not offer more than three nonstandardized health plans in each of the bronze, silver, and gold levels on the exchange; and

(iii) The actuarial value of nonstandardized silver health plans offered on the exchange may not be less than the actuarial value of the standardized silver health plan.

(c) For health plan years beginning in 2025, a health carrier may not offer nonstandardized health plans in any metal level on the exchange.

(d) A health carrier offering a standardized health plan on the exchange under this section must continue to meet all requirements for qualified health plan certification under RCW 43.71.065 32 including, but not limited to, requirements relating to rate review and network adequacy.

NEW SECTION. Sec. 2.

A new section is added to chapter 42.56 RCW to read as follows:

Any data submitted by health carriers to the health benefit exchange for purposes of establishing standardized benefit plans under section 1 of this act are confidential and exempt from disclosure under this chapter.

NEW SECTION. Sec. 3.

A new section is added to chapter 41.05 RCW to read as follows:

(1) The authority, in consultation with the health benefit exchange, must contract with one or more health carriers to offer silver and gold qualified health plans on the Washington health benefit exchange for plan years beginning in 2021. A qualified health plan offered under this section must meet the following criteria:

(a) The qualified health plan must be a standardized health plan established under section 1 of this act;

(b) The qualified health plan must meet all requirements for qualified health plan certification under RCW 43.71.065 including, but not limited to, requirements relating to rate review and network adequacy;

(c) The qualified health plan must incorporate recommendations of the Robert Bree collaborative and the health technology assessment program; and

(d) The qualified health plan's fee-for-service rates for providers and facilities may not exceed the medicare rates for the same or similar covered services in the same or similar geographic area. For reimbursement methodologies other than fee-for-service, the aggregate amount the qualified health plan pays to providers and facilities may not exceed the equivalent of the aggregate amount the qualified health plan would have reimbursed providers and facilities using fee-for-service medicare rates.

(2) When implementing this section, the director must use a request for qualifications process. The director must review the qualifications of health carriers seeking to offer qualified health plans under this section and may negotiate with the health plans to the extent necessary to refine the health carriers' responses. The director must contract with all health carriers who meet the minimum qualifications.

(3) Nothing in this section prohibits a health carrier offering qualified health plans under this section from offering other health plans in the individual market.

NEW SECTION. Sec. 4.

(1) The Washington health benefit exchange, in consultation with the health care authority and the insurance commissioner, must develop a plan to implement and fund premium subsidies for individuals whose modified adjusted gross incomes are less than five hundred percent of the federal poverty level and who are purchasing individual market coverage on the exchange. The goal of the plan is to enable participating individuals to spend no more than ten percent of their modified adjusted gross incomes on premiums. The plan must also include an assessment of providing cost-sharing reductions to plan participants.

(2) The Washington health benefit exchange must submit the plan, along with proposed implementing legislation, to the appropriate committees of the legislature by November 15, 2020.

(3) This section expires January 1, 2021.

I keep thinking that I must be missing something here. The bill is only four typed pages, it seems to have quietly flown through both the WA state House and Senate with little notice outside the state, and there's zero details on where the funding for either the public option itself or the subsidies for those earning 400-500% FPL would come from.

There's nothing about submitting a 1332 waiver approval request to the Centers for Medicare & Medicaid, which either means a) it wouldn't be needed since WA operates their own exchange and they intend on financing the entire PO using state funds, or b) that's covered by a separate document.

It's worth noting that Nevada actually pulled off a similar hat trick a couple of years ago (it was a Medicaid buy-in bill, not a Medicare-level Public Option)...and like this Washington development, that one also somehow flew under the radar until it was actually mostly through the process:

The Nevada state legislature quietly, and surprisingly, passed a Medicaid buy-in option for anyone in the state. I wrote about this back in April, but even I didn't think much of it at the time--I assumed it was more of a symbolic proposal than anything, or that it would die in committee at most. The details are important, of course, but assuming they make sense, this is exactly the sort of approach I would recommend in trying to gradually transition to some type of universal single-payer like system.

The biggest questions I'd want answered are 1) What type of coverage does Medicaid actually have in Nevada? It varies widely from state to state, so if NV's is pretty comprehensive, awesome, but if it's skimpy, that's not very helpful; 2) What sort of premiums/deductibles/co-pays would buy-in enrollees be looking at?; 3) What sort of impact would this have on the state budget?; and most significantly, 4) How many Nevada doctors/hospitals would accept these enrollees? Remember, the reason a significant chunk of healthcare providers don't accept Medicaid patients is because it only reimburses them around 50¢ on the dollar compared to private insurance.

Unfortunately, while the bill passed quickly through both the Nevada House and Senate, it was ultimately vetoed by then-GOP Governor Brian Sandoval.

The difference in Washington State, of course, is that not only do they have a progressive Democratic Governor...he's the one who actually proposed the Public Option in the first place.

In terms of funding...again, I see nothing.

How much would it actually cost? I'll run some very rough estimates tomorrow.

UPDATE: So how much would Inslee's proposal actually cost assuming it passes the final state Senate vote (it will), is signed by Inslee (it will be) and goes into effect starting in January 2021 (still highly questionable for several reasons)? Again, this assumes that the state does indeed establish a full-blown individual market public option carrier on the state ACA exchange, state-wide, which is able to contract with a decent-sized network of hospitals, doctors and so forth. It also assumes those providers sign contracts accepting Medicare-level reimbursement rates for non-Medicare enrollees, which would be...a hell of a development and is probably the most thing to watch about this, to put it mildly.

Again, these are some very crude numbers, but it seems to me that the main expenses involved would be 1) setup/establishment of the program itself; 2) annual administrative expenses; and 3) the enhanced subsidies for exchange enrollees earning 400-500% of the Federal Poverty Line. It's important to note that the 400-500% subsidy expansion would apply to all exchange enrollees, not just those who choose the new PO plans.

  • Startup funding: I have no idea how much it would cost to ramp up a program like this, but it'd be a one-time expense.
  • Annual operational/administrative costs: Well, the closest parallel I can think of would be Minnesota's MinnesotaCare Basic Health Plan program. Like the proposed WA PO, MinnesotaCare also contracts with private insurance carriers to provide subsidized heatlh policies. Around 90,000 - 100,000 Minnesotans are enrolled in MinnesotaCare every year. The big difference is that MinnesotaCare is only available for individual market enrollees earning 138 - 200% FPL (low-income), while the WA PO would be available for anyone (although subsidies would, again, only be available for those earning 138 - 500% FPL).
  • According to this 2019-2020 budget report from Minnesota, in 2015 the state spent $76.3 million in administrative/operational costs for both their Medicaid and MinnesotaCare programs combined (page 10). Let's assume that 2/3 of this goes to administer Medicaid (yes, 10x as many people are enrolled in Medicaid, but many administrative expenses are the same regardless of how many people are utilizing the program). That would mean MinnesotaCare costs perhaps $25 million/year to operate/administer...let's call it $30 million/year (?) to account for inflation and so forth. Again, I could be way off on this and will update if/when I receive more accurate information.
  • That leaves the additional 400-500% FPL subsidies, which would apply to all exchange enrollees in that income bracket. How much might that cost?
  • That would average around $4,900/month apiece or $58.8 million/month total, or over $705 million in federal subsidies for the year, assuming all 143,000 stick it out for the full year, which of course won't happen; there's always some amount of attrition and churn throughout the year. Historically, monthly effectuated exchange enrollment averages around 80% of the number who originally signed up, or perhaps $564 million/year in Washington State.
  • That would mean a total of 150,000 additional subsidized enrollees on exchange plans in WA (reducing their uninsured rate by another 2 percentage points, I should also note).
  • OK, so how much in state-funded subsidies would those 150,000 people receive? Let's assume the average income of these enrollees is around 450% FPL, or $56,000/year for a single adult. At 10% of income, the additional subsidies would kick in at around $5,600.
  • The average unsubsidized premium in WA this year is $551/mo or $6,612/year, so a single adult earning $56K would be eligible for around $1,000/year in subsidies. That would amount to roughly $150 million/year which Washington State would have to come up with.
  • Add that to the $30 million (?) in operational/administrative costs and you're looking at perhaps $180 million/year.
  • There'd also have to be significant cash reserves set aside for the state to actually pay claims to the providers, even at Medicare rates. This is where the spectre of adverse selection comes in, although I presume the narrow network of providers willing to accept Medicare rates would limit that problem somewhat. I have to imagine they'd need at least another $1,000/enrollee to make sure the fund was solvent, or $150 million/year. That'd bring the grand total up to around $330 million per year.

Again, these estimates could be wildly off:

  • They don't account for premium increases for non-PO carriers between now and 2021 (or after that).
  • They assume that all 150,000 are individual enrollees (when most would likely be grouped into households).
  • They assume that the average ages and plan metal levels picked would be fairly close to what they are this year.
  • Most importantly, they assume that the PO premiums would be similar to what they are for private carriers instead of being based on the PO paying Medicare rates, which average perhaps 60% as much as private insurance.
  • They assume 150,000 enrollees who'd fall into the 400-500% FPL range...it could obviously be higher or lower than that.
  • They assume that those 150K average 450% FPL
  • They assume that only 150,000 people enrolled specifically in PO policies...when in fact it's likely that there'd be a huge shift towards it from the competing private carriers who have to reimburse providers a good 50% more and thus price premiums accordingly.

So really, the actual cost could be higher or lower...possibly significantly so. Still, Washington State has a total annual budget in the $50 billion range (Inslee's proposed 2019 budget is $54.4 billion), so we aren't talking about a massively expensive new program...it'd likely be perhaps 0.6% of the total budget, or perhaps as much as 1%, give or take.

It's important to keep in mind that even if this goes through, the policies themselves wouldn't necessarily be that much better than existing exchange plans. The Silver and Gold plans would still only cover 70% or 80% of healthcare expenses on average. There'd still presumably be large deductibles for Silver enrollees, and so on. In fact, the networks would likely be worse than current exchange plans, since I can't imagine too many hospitals, doctors, clinics etc. are thrilled about taking on more patients who they only get paid ~60% as much for as the rest of their patients.

It's also worth noting that while bumping up subsidies to the 500% threshold is important, it wouldn't do much for those earning over 500% FPL. On the other hand, assuming premiums were indeed based on Medicare rates, folks earing >500% would presumably have the option of plans costing a good 1/3 less than they'd otherwise have access to anyway, which would still be hugely helpful to many of them.

HOWEVER, the precedent which would be set would still be hugely important...and if it led to another 2% of Washington's population receiving decent (if not fantastic) healthcare coverage, so much the better.

Stay tuned...


          B.C.'s system for regulating health-care workers is failing patients, report says      Comment   Translate Page      
Liver and kidney transplant surgery

When Harry Cayton started looking into the dysfunction at the College of Dental Surgeons of B.C., he discovered something alarming, and the problem persisted even after a major shift in leadership.


          Prestige Nursing Ltd: Health Care Assistant      Comment   Translate Page      
£8.50 - £10.50 per hour: Prestige Nursing Ltd: About Prestige Nursing Care Prestige Nursing Care is a private care agency offering you a better way to work in care. We are looking for experienced, friendly Healthcare Assistants to join our local team. Working with Prestige Nursing Care is a better way Ipswich
          68W Health Care Specialist      Comment   Translate Page      
WV-PARKERSBURG, 68W Health Care Specialist Job Description Be the first line of defense against injury and illness of civilians after natural disasters, and the Soldiers who serve and protect our Nation every day. As a Health Care Specialist in the Army National Guard, you will experience a fulfilling role as an expert caretaker on and off the battlefield. You will address the health care needs of civilians after
          68W Health Care Specialist      Comment   Translate Page      
WI-WISCONSIN RAPIDS, 68W Health Care Specialist Job Description Be the first line of defense against injury and illness of civilians after natural disasters, and the Soldiers who serve and protect our Nation every day. As a Health Care Specialist in the Army National Guard, you will experience a fulfilling role as an expert caretaker on and off the battlefield. You will address the health care needs of civilians after
          68W Health Care Specialist      Comment   Translate Page      
WI-MADISON, 68W Health Care Specialist Job Description Be the first line of defense against injury and illness of civilians after natural disasters, and the Soldiers who serve and protect our Nation every day. As a Health Care Specialist in the Army National Guard, you will experience a fulfilling role as an expert caretaker on and off the battlefield. You will address the health care needs of civilians after
          68W Health Care Specialist      Comment   Translate Page      
WI-EAU CLAIRE, 68W Health Care Specialist Job Description Be the first line of defense against injury and illness of civilians after natural disasters, and the Soldiers who serve and protect our Nation every day. As a Health Care Specialist in the Army National Guard, you will experience a fulfilling role as an expert caretaker on and off the battlefield. You will address the health care needs of civilians after
          68W Health Care Specialist      Comment   Translate Page      
WI-CHIPPEWA FALLS, 68W Health Care Specialist Job Description Be the first line of defense against injury and illness of civilians after natural disasters, and the Soldiers who serve and protect our Nation every day. As a Health Care Specialist in the Army National Guard, you will experience a fulfilling role as an expert caretaker on and off the battlefield. You will address the health care needs of civilians after
          Etonm Motor co., limited      Comment   Translate Page      
Etonm Motor Co.,Ltd is specially designing and manufacturing Micro DC Motor and Micro Pump, especially DC Gear Motor and DC Air Pump according to customers'' needs. With well-trained workers, excellent R&D Team, ISO9001 Quality-Control system, we output 12 millions sets of Motors and Pumps. We have been entering Micro DC Motor industry since the beginning of 2001. Utill now, we have more than 100 series of products. These products are widely used in Home Electronic Appliance, Office Equipment, Health-care Appliance, Sanitation Industry, High-class Toy, Banking System, Electronic and Elcetrical Tools, and Automotive industry and so on... Now, we are selling motor for customers from more than 30 countires, most of our Motors and Pumps are designed and manufactured for West European and US cutomers. Welcome to send us enquiry!
          Italian Court Censors Atheist Group’s Ads Promoting Health Care Awareness      Comment   Translate Page      
There is no way this ad is "offensive" to religious people.
          68W Health Care Specialist      Comment   Translate Page      
WI-WISCONSIN RAPIDS, 68W Health Care Specialist Job Description Be the first line of defense against injury and illness of civilians after natural disasters, and the Soldiers who serve and protect our Nation every day. As a Health Care Specialist in the Army National Guard, you will experience a fulfilling role as an expert caretaker on and off the battlefield. You will address the health care needs of civilians after
          In New Ebola Outbreak, Health-Care Workers Come Under Attack      Comment   Translate Page      
Assailants in Democratic Republic of Congo are attacking treatment centers and medical staff, fueling the second-deadliest outbreak of the highly contagious disease Adriane Ohanesian WSJ.com April 14, 2019 BUTEMBO, Democratic Republic of Congo—The smell of burning plastic and the clatter of gunshots caught Pamela Kiyangaliya in the shower, where she was decontaminating after a long […]
          Monitor Stand: A Perfect Health Care Solution for Computer Users      Comment   Translate Page      
A life without any health problem is everyone's dream. Simple ailments like cold or neck pain could affect your daily routines. Many illnesses like neck pain, shoulder pain, and spondylitis are due to wrong sitting posture while working on the computers during long working hours. How you can avoid such illness? Using accessories such as monitor stand can help you in a significant way.
          4/14/2019: World: Stop taxing electric bicycles      Comment   Translate Page      
Since it is provincial government policy to encourage people to engage in healthy activities, thereby reducing health-care expenses for the province, why does it impose a provincial sales tax on electrically assisted bicycles (e-bikes)? A large...
          Health of a nation      Comment   Translate Page      
none
          Health Care Assistant      Comment   Translate Page      
I am currently recruiting for a number of experienced Health Care Assistants to join an NHS Hospital in the Welwyn area. The hospital is able to offer shifts from Monday Sunday with both days and nights available. You will be working on the wards providing high standards of care to community rehab patients. To be considered, it is essential that you have previous experience as a Health Care Assistant within either an NHS, private or residential setting. Shift Patterns 07:15 19:45 19:45 07:15 7:30 20:00 Salary and Benefits Monday to Friday 8.28- 9.90ph Sat/Nights 11.00- 13.00ph Sun/Bank Holidays 13.00- 15.00ph Free Uniform To be able to work on this project, you will need the following compliance: Registrations forms (These will be sent to you and need to be hand signed) Training (BLS MH) - httpshttps:// - Course CSTF DBS (on update service) Immunisations or Bloods (MMR & Hep B & TB) Online Training X2 References If you would be interested in joining this NHS hospital to work as a Health Care Assistant, please send a copy of your CV immediately and one of our consultants will contact you.
           Comment on MT Senate: “Lets deny health care to thousands to prop up obsolete coal plants” by *Eric       Comment   Translate Page      
It’s nice to see you finally admit it, that the Dems couldn’t care less about all those Union jobs created by the mine and the power plant. Do not doubt me - the voters will remember. Hopefully this turn to the left the Dems think is popular should ensure that they are a permanent minority in Helena.
          THANKS, DONALD!      Comment   Translate Page      
Health-care law more popular despite Trump's repeated attempts to destroy it (Paige Winfield Cunningham April 13, 2019, Washington Post)

[T]rump and Republicans face a major problem: The 2010 law known as Obamacare has become more popular and enmeshed in the country's health-care system over time. Thirty-six states and the District of Columbia have expanded Medicaid -- including more than a dozen run by Republicans -- and 25 million more Americans are insured, with millions more enjoying coverage that is more comprehensive because of the law.

Even Republicans who furiously fought the creation of the law and won elections with the mantra of repeal and replace speak favorably of President Barack Obama's signature domestic achievement.

"Quite obviously, more people have health insurance than would otherwise have it, so you got to look at it as positive," Sen. Charles E. Grassley (R-Iowa) said in a recent interview.

Ten years ago, Grassley was at the forefront of GOP opposition to the law, ominously pushing the debunked claim that it would allow the government to "pull the plug on grandma" by creating "death panels."

Today, Grassley is chairman of the Senate Finance Committee, the panel that would be responsible for drafting a new health-care law, and he has shown little enthusiasm for Trump's call for congressional Republicans to produce a replacement for the ACA.

Republicans from states that embraced the law's Medicaid expansion also concede that it has benefited large portions of the low-income population, many of whom were previously uninsured.

          5 Ways To Make Your Life Easier      Comment   Translate Page      
 Life Easier
 Life Easier

Make my life easier, yeah right I hear you say, but it's really not impossible to have an easier life and although I'm not claiming that you can click your fingers and make life perfect there are various ways you can make some simple changes to improve life for the better.


1. Consider If Your Work-Life Balance Is Working For You

Work-Life Balance, it's a phrase that is creeping into our vocabulary and more and more of my contemporaries are talking of this. If you look at your work situation and analyse it based on what you get out of it and what it costs you. I found this out by making some changes in my life, I was running a very complicated business, and trying to raise a family at the same time, but since I've changed my schedule to work from home, taking more time with the kids it's giving me a much greater sense of purpose, less tired and more happy. Yes, I miss the extra money but almost everything else has improved. Cutting down your hours can be achieved in many professions such as this article shows in teaching.


2. Use New Technologies In Everyday Life

New technologies can make life incredibly easier and this can be seen with obvious examples such as health-care to smart technology and online business becoming easier. Think of your very own smartphone, it can act as a shopping mall, a phone, a translator, a newspaper, a social venue,a games machine, a video player, a personal stereo to name but a few devices from the past that it replaces, this would have been the stuff of science fiction fantasy just a decade or two ago!


3. Lease Rather Than Buy Your Vehicle

This is a really good way these days to make your life easier as one of the biggest hassles of life can be the ongoing hassle of arranging car repairs, servicing etc and this can all be lessened severely if you can find the right personal car leasing deal. What to do is ask your leasing agent if they can advise which deals include servicing and repairs and this is the key to a road to an easy, hassle-free motoring life.


4. Hire A Cleaner &/Or A Gardener

It's the household chores that take up so much of our time and takes away our personal and family time that on top of work makes life more stressful and less than ideal. But why not hire someone to do these tasks for you? It can be surprisingly affordable and frees up so much time that it's definitely worth it.


5. Cook Meals In Batches Ahead Of The Week

Maybe not the most exciting trick in the book but batch cooking and freezing ahead is a great way of freeing up time later in the week and can be done for lunches as well. It may seem like a hassle to do on say a Sunday afternoon but if you get the kids to help it can be a great way of spending family time together while freeing up more time later in the week for extra leisure time as well so it's a win-win situation.
          Union members protest outside Jordan Health Care meeting      Comment   Translate Page      
In Canandaigua, Jordan Health provides services at Canandaigua Churches in Action.
          THANKS, DONALD!      Comment   Translate Page      
Health-care law more popular despite Trump's repeated attempts to destroy it (Paige Winfield Cunningham April 13, 2019, Washington Post)

[T]rump and Republicans face a major problem: The 2010 law known as Obamacare has become more popular and enmeshed in the country's health-care system over time. Thirty-six states and the District of Columbia have expanded Medicaid -- including more than a dozen run by Republicans -- and 25 million more Americans are insured, with millions more enjoying coverage that is more comprehensive because of the law.

Even Republicans who furiously fought the creation of the law and won elections with the mantra of repeal and replace speak favorably of President Barack Obama's signature domestic achievement.

"Quite obviously, more people have health insurance than would otherwise have it, so you got to look at it as positive," Sen. Charles E. Grassley (R-Iowa) said in a recent interview.

Ten years ago, Grassley was at the forefront of GOP opposition to the law, ominously pushing the debunked claim that it would allow the government to "pull the plug on grandma" by creating "death panels."

Today, Grassley is chairman of the Senate Finance Committee, the panel that would be responsible for drafting a new health-care law, and he has shown little enthusiasm for Trump's call for congressional Republicans to produce a replacement for the ACA.

Republicans from states that embraced the law's Medicaid expansion also concede that it has benefited large portions of the low-income population, many of whom were previously uninsured.

          In health care debate, price control techniques weighed      Comment   Translate Page      
BOSTON (AP) — State Rep. Jon Santiago, a Boston emergency room doctor, recalled an elderly patient named Mike who recently came to the hospital with life-threatening complications from diabetes. Conversations with the man's family revealed he had not been keeping up with his insulin — it was too expensive.
          LETTERS TO THE EDITOR: 'Health care for all' a lie      Comment   Translate Page      

"Waiting for surgery and medical treatment" (Web, April 11) is another so-called health-care-country comparison that completely misses the point. Whether it is Canada, the United Kingdom, Australia or any of a number of socialized-medicine countries, all are abject failures when it comes to public health.

Medical care can be broken ...

           Comment on What to Do About a Collapsed Trachea in Dogs by Judith       Comment   Translate Page      
Pancreatitis can be helped with Homeopathic medicines... CEONANTHUS and NUX VOMICA ( taken a few mins apart) these have helped 2 dogs I know of who had it. Liquid, 6c strength, 5 drops on tongue several times a day until better then only used if the dog has another attack . The dogs I refere to have never had another attack as long as the diet is kept fairly fat free....
           Comment on What to Do About a Collapsed Trachea in Dogs by Judith       Comment   Translate Page      
WHAT IS THE HOMEOPATHIC COUGH SUPPRESSANT


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