HHS Announces New Conscience and Religious Freedom Division  January 18, 2018

The U.S. Department of Health and Human Services (HHS) is pleased to announce the formation of a new Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR). The announcement will take place at an event at HHS headquarters from 10:30 a.m. to noon on January 18, 2018. Speakers will include Acting Secretary Eric D. Hargan, House Majority Leader Kevin McCarthy, Representative Vicky Hartzler, Senator James Lankford, OCR Director Roger Severino, and special guests.

The Conscience and Religious Freedom Division has been established to restore federal enforcement of our nation’s laws that protect the fundamental and unalienable rights of conscience and religious freedom. OCR is the law enforcement agency within HHS that enforces federal laws protecting civil rights and conscience in health and human services, and the security and privacy of people’s health information. The creation of the new division will provide HHS with the focus it needs to more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom, the first freedom protected in the Bill of Rights.

OCR already has enforcement authority over federal conscience protection statutes, such as the Church, Coats-Snowe, and Weldon Amendments; Section 1553 of the Affordable Care Act (on assisted suicide); and certain federal nondiscrimination laws that prohibit discrimination on the basis of religion in a variety of HHS programs. 

OCR Director Severino said, “Laws protecting religious freedom and conscience rights are just empty words on paper if they aren’t enforced. No one should be forced to choose between helping sick people and living by one’s deepest moral or religious convictions, and the new division will help guarantee that victims of unlawful discrimination find justice. For too long, governments big and small have treated conscience claims with hostility instead of protection, but change is coming and it begins here and now.”

Acting HHS Secretary Hargan said, “President Trump promised the American people that his administration would vigorously uphold the rights of conscience and religious freedom.  That promise is being kept today. The Founding Fathers knew that a nation that respects conscience rights is more diverse and more free, and OCR’s new division will help make that vision a reality.”

To learn more about the new Conscience and Religious Freedom Division, visit us at www.hhs.gov/conscience.

To file a complaint with OCR based on a violation of civil rights, conscience or religious freedom, or health information privacy, visit us at https://www.hhs.gov/ocr/complaints.

OCR Announces New Conscience and Religious Freedom Division. It will restore federal enforcement of our nation’s laws that protect the fundamental rights of conscience and religious freedom. https://go.usa.gov/xnvfJ

Turmoil In Long-Term Insurance Industry Hits Customers Hard     January 18, 2018

Almost every insurer in the business badly underestimated how many claims would be filed and how long people would draw payments before dying. People are living and keeping their policies much longer than expected, which is making the business unsustainable for the companies. In other marketplace news, some of Humana's employees will be getting a wage increase thanks to the Republicans' tax plan, and Aetna has agreed to settle claims over a privacy breach.

The Wall Street Journal: Millions Bought Insurance To Cover Retirement Health Costs. Now They Face An Awful Choice Long-term-care insurance was supposed to help pay for nursing homes, assisted living and personal aides for tens of millions of Americans when they became unable to take care of themselves. Now, though, the industry is in financial turmoil, causing misery for many of the 7.3 million people who own a long-term-care policy, equal to about a fifth of the U.S. population at least 65 years old. Steep rate increases that many policyholders never saw coming are confronting them with an awful choice: Come up with the money to pay more—or walk away from their coverage. (Scism, 1/17)

Opioid Crisis Affects All Americans, Rural and Urban

Posted by Ahlishia Shipley, Division of Family and Consumer Sciences, National Institute of Food and Agriculture (NIFA), USDA      January 11, 2018      

Every day, more than 90 Americans die after overdosing on opioids. That’s three people every hour.

As if the death rate wasn’t bad enough, the Centers for Disease Control and Prevention (CDC) estimates that the “economic burden” of prescription opioid misuse in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, and addiction treatment.

Despite the grim subject matter depicted in TV and movies, opioid addiction is not confined to big cities. The effects of the opioid epidemic are more intense in rural communities where employment opportunities are often limited and isolation is pervasive. Between 1999 and 2015, opioid death rates in rural areas have quadrupled among those 18-to-25-year-olds and tripled for females.

FDA Identifies Four Priority Areas for Additional Policy Activity in 2018 - January 2018

1. Reduce the burden of addiction crises that are threatening American families
2. Leverage innovation and competition to improve healthcare, broaden access, and advance public health goals
3. Empower consumers to make better and more informed decisions about their diets and health; and expand the opportunities to use nutrition to reduce morbidity and mortality from disease
4. Strengthen FDA’s scientific workforce and its tools for efficient risk management

10 Ways Health Care in America Changed in 2017 by Shanoor Seervai & David Blumenthal, M.D.

While many issues and crises competed for the public’s attention in 2017, health care captured headlines throughout the year. Perhaps as a result, almost half of Americans say health care is their top concern going into 2018, according to a new Associated Press-NORC poll. Here, we look at 10 critical events in health care during the past year.


The Hague Protocol: Identifying kids at risk by interviewing parents in the ER by Rob Waters

In the summer of 2007, a woman was brought by ambulance to the emergency department of the Medical Center Haaglanden, a hospital that serves an inner city area of The Hague. The woman was drunk and had a severe head injury. Her 8-year-old son was with her.

Hester Diderich, an emergency nurse, and other hospital staff members looked after the boy while they attended to his mother. “We were very nice to him,” Diderich remembers.

After treating the woman’s injuries, they were ready to release her and her son. What happened next led Diderich and her colleagues to realize they needed a better way to protect children and evaluate the risks they face. They created a new process, known as The Hague Protocol, and started a study to evaluate it. The protocol is now in use throughout the Netherlands and is being adopted by other European countries as well.

The idea is that hospital emergency departments are places where, by asking adults a few of the right questions, families in which children may be experiencing violence or abuse can be identified with surprising accuracy and ease.

Full interview of ER nurse, Hester Diderich, by Rob Waters is at:

This is Your Brain on Walking, by Jenna Birch - August 14, 2017
The general wellness perks of getting fresh air and exercise might be reason enough for you to tie up your shoes and get some steps. But here’s more good news about walking: a new study shows walking can benefit the brain. In research findings presented at Experimental Biology 2017, scientists found that the foot-to-ground impacts created during a walk may send pressure waves surging through your arteries, and ultimately increase the amount of blood sent to the brain.

Healthy Children, Healthy Communities -- Missoula, MT
An intervention to prevent childhood obesity has blossomed into a communitywide effort led by a local hospital. Providence St. Patrick Hospital helped launch CATCH -- Coordinated Approach to Child Health -- in Missoula, Mont. Based on the CDC's Whole School, Whole Community, Whole Child model, CATCH is an evidence-based program to encourage physical activity and healthy food choices by elementary schoolchildren. After a successful two-year pilot, St. Patrick Hospital, the Missoula City-County Health Department and the school district expanded the initiative. The hospital funded a part-time registered dietitian and community health specialist to provide on-site training for all school staff and to help add salad bars and new fruit to the school lunch program. The community health specialist also works with local organizations and offers CATCH support to other hospitals. Missoula's Parks and Recreation department, Food Bank and YMCA also have embraced CATCH in their programs and activities. Pilot results showed that students? knowledge about how to eat a healthy diet increased by more than 30%, and the number of children reporting they ate fruit daily increased by nearly 40%. Providence St. Patrick Hospital now has guided 10 school districts in implementing CATCH. Identifying dedicated hospital champions to coordinate and spread the program has been critical to success as well as partnering with a broad range of community stakeholders for support. 

Stakeholder Perspectives on a Culture of Health
Since 2013, the Robert Wood Johnson Foundation (RWJF) has embarked on a pioneering effort to advance a Culture of Health. The Culture of Health action framework is founded on a vision in which "everyone in our diverse society leads healthier lives now and for generations to come." To put the Culture of Health vision into action, RWJF asked RAND Health to support the development of an action framework and measurement strategy. This report summarizes the stakeholder engagement efforts that RAND used to inform this work. It draws on a series of interviews and focus groups that RAND researchers conducted with stakeholders both within and outside the United States. It should be of interest to RWJF, as well as to those individuals and organizations interested in advancing the Culture of Health action framework. Given that RWJF is focused on using the Culture of Health action framework and measures to catalyze national dialogue about content and investments to improve population health and well-being, the report should be beneficial to a range of national, state, and local leaders across a variety of sectors that contribute to health as described by the Culture of Health action framework. 

Medicaid Suspension Policies for Incarcerated People: 50-State Map 
Medicaid eligibility for people getting out of prison is smart policy. People who are in prison are generally not eligible for Medicaid. But making sure they can get health care when they are released is smart policy. States can adopt a policy to suspend-rather than terminate-a person's Medicaid coverage while he or she is incarcerated. The map below shows which states suspend and which states terminate Medicaid for people entering jail or prison. Suspending Medicaid makes it easier for a person leaving the criminal justice system to regain health coverage. This ensures quicker access to mental health services, prescribed medicines, and other needed care. It also helps the economy, improves the health of local communities, and reduces the chance of people returning to prison. 

Building a Culture of Health Equity at the Federal Level
The United States spends significantly more resources on health care than any other nation. Despite this fact and the remarkable improvements in the quality of health care over the past century, the nation's relative standing in health outcomes and life expectancy continues to erode. "Americans die sooner and experience more illness than residents in many other countries," a 2013 report from the National Research Council and Institute of Medicine bluntly noted (NRC and IOM, 2013). The report identifies six actionable opportunities for stakeholders focused on advancing a health equity agenda at the federal level: (1) Develop a "Health Equity Learning Community" of federal mid- and senior-level civil servants in partnership with philanthropy; (2) Develop a federal "Healthy Communities" designation, employing Promise Zone design principles; (3) Collaborate with the National Institute on Minority Health and Health Disparities (NIMHD) to expand research linked to place-based initiatives around how social and economic conditions are linked to health outcomes; (4) Facilitate increased coordination at the local level around Community Health Needs Assessments (CHNAs) through federal funder encouragement and information sharing; (5) Increase collaboration between the National Prevention Strategy (NPS), the Federal Interagency Health Equity Team (FIHET), and the Convergence Partnership; and, (6) Embed equity as a value in Executive Core Qualifications for Senior Executive Service. 

Strengthening Our Future: Key Elements to Developing a Trauma-Informed Juvenile Justice Diversion Program for Youth with Behavioral Health Conditions
Developed by the National Center for Mental Health and Juvenile Justice (NCMHJJ) and the Technical Assistance Collaborative, Inc. (TAC) as part of the 2014-15 Policy Academy-Action Network Initiative, this report: (1) presents the current understanding of child trauma in the context of juvenile justice; (2) identifies 9 implementation domains essential to achieving a trauma-informed juvenile justice diversion approach; and, (3) highlights case examples from each state involved in the initiative (Georgia, Indiana, Massachusetts, and Tennessee). The 2014-15 Policy Academy Action Network Initiative was a joint effort supported by the John D. and Catherine T. MacArthur Foundation (as part of Models for Change: Systems Reform in Juvenile Justice) and the Substance Abuse and Mental Health Services Administration. The overall goal of the initiative was to facilitate implementation of innovative strategies for probation-intake diversion and improved outcomes for youth in contact with the justice system who have behavioral health and trauma-related conditions. 

Walking: A simple route to improving your health
The path to good health through fitness can be a challenging but rewarding journey. But if you?re looking for a simple way to break into getting fit, look no further than your own two feet and the path outside your door. Walking is an easy and accessible way for people of all ages to get fit. Depending on where you live, walking can even be the healthier alternative to places you normally drive, such as your job or the grocery store. 

Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails
The National Association of Counties (NACo), the Council of State Governments (CSG) Justice Center, and the American Psychiatric Association Foundation (APAF) have come together to lead a national initiative to help advance counties' efforts to reduce the number of adults with mental and co-occurring substance use disorders in jails. With support from the U.S. Justice Department's Bureau of Justice Assistance, the initiative will build on the many innovative and proven practices being implemented across the country.​ In May 2015, NACo and partners at the CSG Justice Center and APAF launched Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails and announced a Call to Action demonstrating strong county and state leadership and a shared commitment to a multi-step planning process that can achieve concrete results for jails in counties of all sizes. As part of this Call to Action, county elected officials are being asked to pass a resolution and work with other leaders (e.g., the sheriff, judges, district attorney, treatment providers, and state and local policymakers), people with mental illnesses and their advocates, and other stakeholders to reduce the number of people with mental illnesses in jails. 

What is a Culture of Health?
The Robert Wood Johnson Foundation is committed to building a national Culture of Health that enables all in our diverse society to lead healthier lives now and for generations to come. A Culture of Health is broadly defined as one in which good health and well-being flourish across geographic, demographic, and social sectors; fostering healthy equitable communities guides public and private decision making; and everyone has the opportunity to make choices that lead to healthy lifestyles. The exact definition of a Culture of Health can look very different to different people. A national Culture of Health must embrace a wide variety of beliefs, customs and values. Ultimately it will be as diverse and multifaceted as the population it serves. 

Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities 
One out of every two U.S. adults is living with a chronic disease, such as heart disease, cancer, or diabetes. These diseases contribute to disability, premature death, and health care costs. Increasing people's physical activity levels will significantly reduce their risk of chronic diseases and related risk factors. Because physical activity has numerous other health benefits-such as supporting positive mental health and healthy aging-it is one of the most important actions people can take to improve their overall health. Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities recognizes the importance of physical activity for people of all ages and abilities. It calls on Americans to be more physically active through walking and calls on the nation to better support walking and walkability. Improving walkability means that communities are created or enhanced to make it safe and easy to walk and that pedestrian activity is encouraged for all people. The purpose of the Call to Action is to increase walking across the United States by calling for improved access to safe and convenient places to walk and wheelchair roll and by creating a culture that supports these activities for people of all ages and abilities. The Call to Action includes five strategic goals to promote walking and walkable communities in the United States: make walking a national priority; design communities that make it safe and easy to walk for people of all ages and abilities; promote programs and policies to support walking where people live, learn, work, and play; provide information to encourage walking and improve walkability; and fill surveillance, research, and evaluation gaps related to walking and walkability. Action by multiple sectors of society, as well as by families and individuals, will be needed to achieve these goals. 

Healthy Youth Website
CDC's Division of Adolescent and School Health is excited to announce that the Healthy Youth website has a new look! The new Healthy Youth website is in a responsive web design, which means that the content can be easily accessed via multiple devices, including smart phones, tablets, laptops, and desktop computers. In addition, the website has been reorganized to make it easier to find information. 

What Really Makes Us Healthy? Health Beyond Healthcare
The top contributors to long-term health may be surprising to most. As it turns out, only a fraction of what affects our health is actually related to healthcare. To truly improve outcomes, we need to look beyond healthcare at a variety of factors that impact health. 

Pets help knit community together
We know pets calm us down and cheer us up, but now researchers have found they can good for us in ways we could never have imagined. Not only do pets help develop friendships between people, but they can increase the amount of physical and emotional support that people give each other, says Associate Professor Lisa Wood from the University of Western Australia's School of Population Health. There is good evidence that pets can boost our mental health by providing companionship and improve our physical health by reducing our blood pressure and stress levels. But Wood and colleagues were interested in looking at the role that pets might play in creating connections between people and reducing social isolation. 

The Facts behind Medicaid Estate Recovery
Under federal law, states are required to bill estates for the cost of an individual's long-term care costs while on Medicaid. But recovering the costs of health services is not required by federal law, and most states simply aren't interested in doing so because they fear the high administrative costs of collecting money from a broad Medicaid expansion population. As a case in point, only 10 states have indicated a willingness to pursue the recovery of health care costs from estates. What is very real is the immediate financial risk of not signing up for Medicaid and consequently remaining uninsured. Someone who passes up Medicaid coverage and remains uninsured because they are concerned that the state might recoup some health care from their estate sometime in the future runs the risk of incurring large medical debts today. If that happens, creditors won't wait until the person dies. Medical debt is the leading cause of personal bankruptcies in the U.S. And that's a serious risk that can cause long-term financial damage to families. Someone who is currently uninsured and eligible for Medicaid should sign up for the program. 

Our New Rankings Are Out Today
Our new Rankings are now live, with new data, new measures, new resources, and a new look and feel to our website. So what's new for 2015? Visit your county's Snapshot and see for yourself. Income Inequality is a new measure we've added for 2015, and our measures have been updated with new data. We've also rolled out new measure maps that more accurately show where on the spectrum of health your area falls. See the data for your community on our website. Our Roadmaps to Health Action Center has not only been given a new look, we've added new tools and resources to help you improve health where you live. We've also added some new ways to interact with What Works for Health, our searchable database of strategies and evidence, and to see the inspiring things communities are doing across the country to improve health via the RWJF Culture of Health Prize. 

Get ready to enroll in Marketplace coverage
Starting November 15th, you'll be able to apply and enroll in 2015 Marketplace coverage. If you're eligible, the Health Insurance Marketplace can help you find affordable health coverage. Most people who apply qualify for premium tax credits and other savings based on their income. If you already have 2014 Marketplace coverage, you'll be receiving important information about how to keep your coverage for 2015. Here are some things you can do now to get ready for November 15th: (1) Learn about important dates and deadlines for Marketplace coverage; (2) Download this Marketplace checklist to gather the documents you'll need to apply; (3) Find someone in your community to help you apply and answer your questions; and, (4) Be the first to know! Sign up for timely text message updates and connect with us on social media. 

From Coverage to Care
The Centers for Medicare & Medicaid Services (CMS) have launched From Coverage to Care, an "initiative to help people with new health care coverage understand their benefits and connect to primary care and the preventive services that are right for them". This initiative includes written resources, images, videos, and various ways to connect with CMS. 

CMS: Health spending to grow average 5.7% annually through 2023
National health spending is expected to grow an average 5.7% annually through 2023, due to coverage expansions under the Affordable Care Act, anticipated economic growth and an aging population, the Centers for Medicare & Medicaid Services reported today in Health Affairs. That?s up from an anticipated 3.6% growth rate in 2013, but down from an average 7.2% between 1990 and 2008, the agency said. Health care spending is expected grow an average of 1.1 percentage points faster than the economy between 2013 and 2023, raising the health care share of gross domestic product from 17.2% to 19.3%. CMS expects spending growth for hospital care to slow from 4.9% in 2012 to 4.1% in 2013, then increase to 4.5% in 2014 and 5.1% in 2015 as the ACA?s coverage expansions increase use of services. Medicare spending on hospital care is expected to slow from 4.5% in 2012 to 2.5% in 2013 due to the effects of sequestration and slower growth in utilization. 

NIC's Health Reform Webinar Series . . . Health Literacy: Enhancing Access to Health Care for Justice-Involved Individuals 
With the advent of the Patient Protection and Affordable Care Act, it is now possible for millions of low-income justice-involved individuals to obtain insurance coverage for their physical and behavioral health care needs. This far- reaching systems change will impact every component of the criminal justice system from pretrial to reentry, from corrections health to behavioral health. Criminal Justice professional and Health professionals alike have a role in helping these individuals develop the capacity to obtain and understand basic health information to make appropriate health care decisions. In this one and half hour presentation you will hear from national correctional health care and health literacy experts. The content of this webinar on July 22, 2014,will meet the following objectives: Objectives: 1. Understand the health needs and incidence of chronic disease in the CJ population 2. Understand the importance of maintaining a continuum of care as inmates transition from jails to the community 3. Understand the barriers to access to care for this population, i.e., health literacy 4. Understand the role of criminal justice professionals, (corrections health, transition counselors, and probation/parole) in incorporating linkage to health care into case managements 5. Provide strategies for establishing linkages / maintaining continuum of care 

Health Reform and Public Safety: New Opportunities, Better Outcomes 
Research shows that there are a disproportionate number of justice involved individuals suffering from chronic illness and/ or mental health and substance abuse disorders. We also know that a majority of the justice-involved individuals are young adults and unemployed or earn an income that is well below the federal poverty line leaving them without the ability to obtain health care. There is now an opportunity to enhance collaboration between the criminal justice/corrections and healthcare systems. Early estimates indicate a significant number of justice-involved individuals may be eligible for provisions under the Patient Protection and Affordable Care Act (ACA), specifically; enrollment in Medicaid or the ability to purchase health care coverage through state health insurance exchanges. Because of the many health care expansion possibilities for this population we are witnessing an unprecedented opportunity to help connect the justice population to healthcare coverage and the associated healthcare services. Federal, state and local criminal justice systems are poised to change the way they do business with the advent of the ACA. It is now possible for millions of low income, justice- involved individuals to obtain healthcare or insurance coverage for their physical and behavioral health needs. This far reaching system change will impact every decision point in the criminal justice system from arrest to individuals returning to the community upon release. Presented on June 18, 2014, this program informed and increased awareness around this historic healthcare expansion opportunity. The broadcast highlighted promising practices by providing resources and strategies to expand healthcare coverage to justice-involved individuals. During this national discussion and broadcast by the National Institute of Corrections, presenters: ? Established the relevance of the Affordable Care Act to the criminal justice system. ? Provided concrete examples for collaboration and system linkages between the criminal justice system and healthcare system. ? Provided healthcare enrollment strategies to increase informed decision-making between criminal justice and healthcare stakeholders. SOURCE: National Institute of Corrections (NIC) (Washington, DC). 

Health Happens in Libraries
Health Happens in Libraries seeks to improve public library eHealth services and increase library staff capacity to respond to patron requests for information regarding the Affordable Care Act (ACA). This work acknowledges the growing intersection of digital technologies and individual health management (eHealth), and the opportunities for libraries to provide digital access to health information in their communities. We will engage several states to more thoroughly assess the context of ACA and other eHealth needs in public libraries. These partnerships will inform the development of customized resources and promising practices for state and public libraries nationwide to utilize in related patron services. Resources will be posted here as they are developed. 

A Reader Asks: If I Am On COBRA, Do I Have To Buy A New Marketplace Plan? 
By Michelle Andrews Feb 14, 2014 Q. I am currently insured under COBRA. It expires in August 2014. I have a pre-existing condition and I'm unemployed. Can I apply for a plan under the ACA sometime in June for coverage that will start in September? Is there something I should do now before the end of March? A. When consumers lose or leave their jobs, they can opt to continue their work-based health insurance under a federal law known as COBRA. Those insurance policies qualify as health coverage under the health law, so you don?t have to do anything before the open enrollment period for coverage on the federal and state marketplaces ends March 31. But you may want to check out marketplace plans to see if you could find similar coverage for a better price, says Laurel Lucia, a policy analyst at the University of California-Berkeley Labor Center. Since you have a pre-existing condition, you may be concerned that marketplace plans could involve switching doctors or high deductibles. You may be surprised, though, says Lucia. "I think people have heard about the high deductibles on bronze plans, and they may not realize that the platinum and gold level plans available may have lower cost sharing," she says. In addition, you may be eligible for premium tax credits and cost-sharing subsidies on the exchange if your income is less than 400 percent of the federal poverty level (currently $45,960 for an individual). Under COBRA, in contrast, you're likely paying the entire premium plus a small administrative fee. 

Libraries Serve As Health Insurance Info Hubs 
By Elana Gordon, WHYY Feb 14, 2014 What can't librarians do? Many are now becoming health insurance guides. The buzz at the American Library Association's winter meeting recently wasn't just about the annual awards (a.k.a. the book award "super bowl"); the Affordable Care Act was also on the agenda. Libraries across the country have been trying to meet a growing demand for health insurance information. At the Free Library of Philadelphia's central branch, library coordinator Nani Manion has started running twice-weekly enrollment clinics in the technology lab. Manion is one of 33 librarians in the Philly system who have undergone a five-hour training session to become certified application counselors. 

Get Covered America
Your pets want you to take care of your health. And they've created a video to tell you.Watch and share! Then change your social media profile picture to your favorite pet to get the word out!