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Shots - Health News

State Health Insurance Exchanges Hope To Woo Urban Minorities

With the HealthCare.gov website working for consumers much more smoothly than last year, health officials are focused on reaching out to potential customers.

For starters, they want to people who bought insurance last year to take another look at those plans. And, of course, the exchange wants to bring in new customers who didn't need or skipped insurance last year.

Among them, are minority groups that didn't sign up in the numbers that state officials hoped for last year. In Montana and Georgia the minorities differ but face similar challenges.

Native Americans are among the uninsured Montana officials would like to reach. It's a hard sell, since they are actually exempt from the health law's requirement to have insurance coverage. They're eligible for health care through the Indian Health Service since the federal government promised in treaties to provide health care in exchange for tribes giving up their land.

But Montana Sen. Jon Tester, who sits on the Committee for Indian Affairs, says the IHS "is really in tough shape, basically runs out of money about 9 months into the fiscal year. There's a real issue getting health care professionals into Indian country. I mean, it's really in crisis."

The IHS budget crisis means tribal members can often only get health care when they're in immediate danger of losing life or limb, says Lesa Evers, a member of the Turtle Mountain tribe who works for Montana's state health department.

"If you have an individual who really requires knee surgery from trying to play basketball with their kids, or whatever they tried to do, they may never have that opportunity to have that knee surgery," she says.

Buying private health coverage on the exchanges would give them access to more health care providers, and subsidies under the health care law are making insurance affordable for many Indians. But efforts to get them to enroll in private coverage aren't bearing much fruit yet. Fewer than than half a percent of people who enrolled last year in Obamacare plans were Native American.

In Georgia, efforts will focus on getting Asians, Hispanics and African Americans to sign up.

"It's a big undertaking, for sure," says Cindy Zeldin, executive director of the nonprofit Georgians for a Healthy Future.

And, there's a catch for both these states. Neither Montana nor Georgia expanded Medicaid under the Affordable Care Act.

That means it's possible that people will try to sign up for health coverage and find out they earn too little to qualify for a subsidy for an exchange plan, but too much to get covered by Medicaid.

"Until Georgia closes the coverage gap by expanding Medicaid, we are going to continue to have a very large number of people without health insurance," says Zeldin.

Montana navigator Amanda Harrow says she saw it firsthand last year. "There are people that came in here really excited to get health insurance, and we have to tell them that they're not eligible, and they're devastated, and it's just so hard," Harrow says.

An estimated 282,000 Georgians fall into the gap, and about 35,000 people in Montana.

The second group – those who bought last year – are being encouraged to shop again. That includes customers like Michael Lappin and husband John West

They are happy with their coverage, but Lappin says they're back on HealthCare.gov because premiums for their platinum-level Humana plan went up by about 19 percent. Subsidy amounts and available plans will almost certainly change for most people.

Marketing and outreach efforts to all groups this year will focus on affordability and available subsidies. An analysis by Georgia Health News finds insurance premiums were the biggest predictor whether or not someone purchased a policy.

This story is part of a reporting partnership that includes NPR, local member stations and Kaiser Health News.

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Measles might be preparing for a comeback tour.

Unlike Ebola, measles easily leaps between people. Virus-filled droplets linger, floating in the air or coating a coffee table for up to two hours after a contagious person coughs or sneezes. If you're susceptible to the disease and you breath that air or touch a contaminated surface and then rub your eyes, you're screwed. Measles infects 90 percent of those who are not immune.

And it's not just a week of misery that results. Before a vaccine was developed in the 1960s, measles caused more than two million deaths per year, typically when the virus severely infects the lungs or brain.

That's why the globe has tried so hard since 2000 to eliminate the disease. Since 2000, vaccination initiatives have prevented 15.6 million deaths, mostly of children under age 5.

So measles had been on a steady decline. But since 2007, the numbers have stayed about the same. Last year, the global death tally jumped to 145,000 deaths versus 122,000 in 2012, according to a new report published by the World Health Organization.

That means nearly 400 kids die from measles each day. In 2013, more than 70 percent of measles deaths were confined to six countries: the Democratic Republic of Congo (DRC), Ethiopia, India, Indonesia, Nigeria and Pakistan. Even survivors can pay a price, with long-term consequences like blindness, brain damage and hearing loss. The West Pacific is losing ground, too, says the report. For instance, The Philippines has recorded a tremendous outbreak in 2014 with over 50,000 cases.

One reason for this trend is the global recession.

Even though a measles vaccine costs only $1 per child in developing countries, the economic downturn has taken a toll. Rather than hold a measles vaccination campaign every two to three years, some countries stretch every to five years, says James Goodson, a measles epidemiologist with the Centers for Disease Control and Prevention who coauthored last week's report. The result is a greater pool of susceptible children — and more cases.

"We've seen a large outbreak in the DRC for example that started in 2010 and continued through 2012, as a result of a delayed campaign," says Goodson.

The other hitch has been the infamous anti-vaccine movement. Back in 1998, an article by a British doctor named Andrew Wakefield tied the measles, mumps and rubella vaccine to autism. The article has been debunked over and over and Wakefield lost his medical license, yet some parents never stopped believing it.

Europe is now reporting measles cases in older children and young adults — and Goodson blames the article, as do British officials. In early 2012, the U.K. recorded 2,000 among adolescents, ages 10-16, the highest number in almost two decades. To quell future outbreaks in teens, a nationwide vaccination campaign was launched, which cut cases by 80 percent the following year.

The U.S. is also breaking measles records. This year has seen 603 cases so far, more than in any single year in the past two decades. William Moss, an epidemiologist at Johns Hopkins University, says some parents won't vaccinate their children no matter what is said, but others may have forgotten the risks of measles and so are swayed by anti-vaccine hokum.

Measles Hits Amish Communities, And U.S. Cases Reach 20-Year High May 29, 2014

WHO's plan had been to eliminate measles altogether by 2020. That goal is now in peril. "For example, the African region, Eastern Mediterranean region, and the European region are not on track to achieve their measles elimination target by 2020," says Goodson.

Moss doesn't expect measles to rebound to pre-2000 levels but warns: "Unless we make further investments into vaccine campaigns, we'll continue to see large outbreaks."

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With the Louisiana Senate run-off driving votes in both chambers of Congress on the Keystone XL pipeline, here's a question: How many of those jobs will actually be in Louisiana?

How about: zero.

"I don't think it goes through that state," laughed Sean Sweeney, a Cornell University researcher who co-authored a 2012 report that questioned many of the justifications for the project. "This is less about jobs numbers than it is about advancing the fossil fuel industry's agenda."

Keystone proponents include both Democratic incumbent Sen. Mary Landrieu and GOP challenger Rep. Bill Cassidy. Cassidy's bill passed the House easily on Friday. Landrieu's version is scheduled for a Senate vote Tuesday evening.

Both argue that finishing the remaining, 1,179-mile section of the pipeline from the oil sands of Alberta, Canada, to Steele City, Nebraska, will create 42,000 new jobs nationally. That figure is cited by the State Department, but it may be misleading out of context.

The State Department's Final Supplemental Environmental Impact Statement on the Keystone XL pipeline defines a job as lasting for only one year. United States Department of State hide caption

itoggle caption United States Department of State

The State Department's final environmental impact report earlier this year found the project would support 42,100 jobs, but then defined those jobs as lasting just one year. In other words, there would be only 21,050 jobs that last the entirety of the two-year construction period – and the majority of those are not construction jobs (there would be no more than 1,950 of those in each of the two years), but rather are "induced" by construction workers spending their earnings on goods and services in the area.

As far as permanent jobs to operate the pipeline – there would be a total of 35 of those, according to the State Department report.

Ian Goodman, an energy industry consultant who co-authored the Cornell report, said it's possible Louisiana residents could benefit. "Louisiana has a big oil and gas sector. It is conceivable that some of those pipeline workers could come from Louisiana," he said.

That number, though, is not likely to be large, he said. "We're talking about tiny numbers here.... A rounding off error. You're not going to notice it," he said.

So why, then, all the Louisiana-based attention on Keystone by and for Landrieu and Cassidy?

"This is mostly symbolic," said Edward Chervenak, director of the Survey Research Center at the University of New Orleans. "This is an oil and gas state, so any vote that supports the industry would tend to go over well. They're both trying to show how much clout they have."

Sen. Mary Landrieu

Keystone XL Pipeline

Two bills that would authorize building the controversial Keystone XL pipeline will soon come to a vote in Congress, as their sponsors — Sen. Mary Landrieu, D-La., and Rep. Bill Cassidy, R-La. — head toward a runoff election next month to decide who will win the Senate race.

NPR's Debbie Elliott reports:

"On the Senate floor, Landrieu called for action on the Canada-to-Texas pipeline project, saying, 'I believe with a push we could actually get the votes that we need to pass the Keystone pipeline.'

"Soon after, Republican leaders in the House scheduled a vote Thursday on a Keystone bill sponsored by Landrieu's rival, Cassidy.

"The two face off in a Dec. 6 runoff. The pipeline is a key issue in Louisiana, where the oil and gas industry dominates."

Energy company TransCanada's Keystone XL pipeline would carry tar sands oil from Canada to Texas; it has been a polarizing issue, pitting those who say it would create thousands of jobs against environmentalists who say tar sands oil is too expensive and toxic to refine. Where one side says the plan would bolster the energy industry, the other says it would increase greenhouse gases.

Wary landowners along its path have also spoken out, complaining that the pipeline would disrupt their property and damage farms — particularly if it ever sprang a leak. As the Two-Way has reported, "In February, a Nebraska judge struck down a 2012 law that allowed part of the pipeline to run through the state."

The AP notes that the Obama administration isn't welcoming news of a vote on the matter:

"While the White House stopped short of directly threatening a veto, spokesman Josh Earnest said President Barack Obama takes a 'dim view' of legislative efforts to force action on the project. Earnest reiterated Obama's preference for evaluating the pipeline through a long-stalled State Department review."

From NPR's StateImpact project comes this background:

"The Keystone Pipeline already exists. What doesn't exist fully yet is its proposed expansion, the Keystone XL Pipeline. The existing Keystone runs from oil sand fields in Alberta, Canada, into the U.S., ending in Cushing, Okla.

"The 1,700 new miles of pipeline would offer two sections of expansion. First, a southern leg would connect Cushing, where there is a current bottleneck of oil, with the Gulf Coast of Texas, where oil refineries abound."

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