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On Dec zithromax price ph. 21, many formerly incarcerated individuals and their families are celebrating the second anniversary of the First Step Act, which reformed federal prisons and sentencing laws to reduce recidivism and mandatory minimums, expand rehabilitation efforts, and maintain public safety. Since President Trump signed it into law, thousands of federal prisoners have been released based on changes to good-time zithromax price ph credits and others have benefitted from sentence reductions. At the U.S. Department of Labor, zithromax price ph we too believe in second chances.

That’s why we are committed to helping those previously involved with the criminal justice system secure good jobs as well as informing employers about opportunities to provide second chances. In the past two years, the Department awarded approximately $176.8 million in grants to nonprofit organizations and local and state governments as part of the Reentry Employment Opportunities program. Grant recipients collaborate zithromax price ph with employers, community colleges and criminal justice partners to reduce barriers to reentry, help individuals gain industry-recognized credentials, and provide employment opportunities. Additionally, local American Job Centers, funded by the Department, can help justice-involved individuals move into employment. Reentry.CareerOneStop.org provides the same career, training and job search tools available through American Job Centers but with external links disabled so correctional institutions and other secure facilities can make them available to individuals who are incarcerated but looking zithromax price ph forward to their release date.

This December, we announced the availability of up to $3.3 million in grants for states and territories through the Federal Bonding Program. This program provides fidelity bonds to employers as a risk-reduction tool for hiring people with criminal records. For more information, visit www.bonds4jobs.com zithromax price ph. A recent Federal Bonding Program success story comes from a Michigan small business owner who was looking to hire. A fidelity bond was issued for a worker with a criminal record zithromax price ph and due to the job seeker’s good work performance, the business offered her full employment after the bond expired.

The bonds represent an excellent return on investment for taxpayers. In 2019, less than 1% of bonds were redeemed. Businesses can have confidence in the integrity and work ethic of the zithromax price ph individuals they hire using these bonds. We know that reducing recidivism is tied to a meaningful job. The Labor Department stands ready to help people exiting the justice system to secure meaningful work and zithromax price ph reintegrate into their communities.

Learn more about the Department’s reentry initiatives on the Employment and Training Administration website. John Pallasch is the Assistant Secretary of Labor for Employment and Training.Each year on Dec. 6, we celebrate National Miners Day to recognize zithromax price ph and applaud the skill, dedication and hard work miners put into providing many of the products essential to fulfilling America’s most vital needs. I want to take this opportunity to say thank you to every working miner in our nation. From the coal that provides power for the lights we use to the copper used zithromax price ph in our electronics and cookware, miners provide the necessary minerals to make the products integral to our daily lives while sometimes facing hazardous conditions in the workplace.

Having worked in the mining industry for the majority of my life, I fully recognize the hazards that confined spaces, mobile equipment and complex electrical equipment, just to name a few, can present to working miners. This is why my agency, the U.S. Department of Labor’s Mine zithromax price ph Safety and Health Administration (MSHA), exists. MSHA enforces safety and health standards and regulations — at all American coal mines, quarries, copper and other metal mines, and many other facilities — to protect miners from the hazards they face each day. Our aim is zithromax price ph to see every miner go home safe and healthy after every shift.

Keeping all miners safe means continued production of the indispensable products we use every day. Every time you drink from a glass, thank a miner. Every time you ride a bike or take a drive in your car, thank zithromax price ph a miner. Miners are the true backbone of not just our nation’s mining industry but also the many industries that could not operate without the raw materials that miners produce. So, on this National Miners zithromax price ph Day, please join me in recognizing, honoring and thanking miners for their steady and courageous role in providing the products that make so much of our daily life possible.

David Zatezalo is the Assistant Secretary for Mine Safety and Health at the Mine Safety and Health Administration. Follow MSHA on Twitter at @MSHA_DOL..

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In this edition http://santabarbarakoi.net/?page_id=2 Welcome zithromax 6 pack back to The Scoop!. Open enrollment for individual (non-group) health zithromax 6 pack insurance plans is just around the corner, and will be underway nationwide as of November 1. For those interested in open enrollment and individual-market coverage, there’s plenty of encouraging news this week regarding open enrollment extensions, new state enrollment platforms, the availability of plan browsing, and new insurers joining many states’ marketplaces.If you’ve got questions about open enrollment, check out our comprehensive 2021 Open Enrollment Guide, which addresses all aspects of the OEP that starts November 1. (And although this site is all about individual market health coverage, you can also check out our guide to the Medicare open enrollment zithromax 6 pack period – which starts today.)There’s a lot of news to cover. Let’s get started!.

Eleven state-run exchanges extend open enrollment periods for 2021 coverageAlthough open enrollment is still a few weeks away, more than two-thirds of the fully state-run exchanges have already committed to extended open enrollment periods during which people zithromax 6 pack can enroll in 2021 health coverage. Some of these are permanent extensions, while others only apply to the upcoming open enrollment period:Minnesota. November 1 zithromax 6 pack to December 22, 2020.Colorado. November 1 to January 15, 2021Nevada. November 1, zithromax 6 pack 2020, to January 15, 2021.Pennsylvania.

November 1, 2020, to January 15, 2021.Washington. November 1, 2020, to January 15, 2021.Massachusetts zithromax 6 pack. November 1, 2020, to January 23, 2021.Rhode Island. November 1, zithromax 6 pack 2020, to January 23, 2021.California. November 1 to January 31, 2021.District of Columbia.

November 1 to January 31, 2021.New zithromax 6 pack Jersey. November 1, 2020, to January 31, 2021.New York. November 1, 2020, to January zithromax 6 pack 31, 2021.The other state-run exchanges are Connecticut, Idaho, Maryland, and Vermont. They all have the option to use the standard November 1 – December 15 enrollment window or issue an extension. And although they’ve currently all scheduled open enrollment to end on December 15, it’s possible that zithromax 6 pack we could see additional extensions as the year goes on.Two states move to state-run exchange platforms this fallMost states in the U.S.

Use the federally run HealthCare.gov platform for individual and family health coverage enrollment. But there were already 13 fully state-run exchange platforms as of this year, and two more have joined them for the upcoming open enrollment season and future plan years.Residents in Pennsylvania will use Pennie to sign up for coverage zithromax 6 pack this fall, and New Jersey residents will use GetCoveredNJ. (In previous years, residents in both states used HealthCare.gov.) Window shopping for 2021 health plans available in DC and eight statesIn states that use HealthCare.gov and most of the state-run exchanges, window shopping for 2021 coverage will be enabled by late October. But plan browsing zithromax 6 pack is currently available on some state-run exchange websites. Residents in California, DC, Idaho, Maryland, Minnesota, Nevada, New Jersey, New York, and Vermont can already see the available plans and pricing for 2021.

And in California, current enrollees can even renew their coverage now, without having to wait for the official start of open enrollment.Mostly modest rate changes zithromax 6 pack for 2021. Increases in some states, decreases in othersFor the last several months, we’ve been tracking proposed premiums for individual-market health insurance across the country. The rate review process has been finalized and approved rate changes made zithromax 6 pack public in many states. As he does each year, Charles Gaba is tracking the proposed and approved rate changes in an at-a-glance spreadsheet. Thus far, the average approved rate change stands at an increase of just under half a zithromax 6 pack percent.

Although that’s not yet a complete picture, it is indicative of a fourth consecutive year of fairly stable rates in the individual market, with prices in many areas of the country fairly similar in 2021 to what they were in 2018.We’ve got detailed overviews of numerous states’ approved rate changes for 2021, including some states where overall average rates are increasing. (See Florida, Idaho, Massachusetts, Nevada, New York, and Rhode zithromax 6 pack Island) In other state, overall average rates are actually decreasing. (See Colorado, Delaware, Hawaii, Iowa, Maine, Maryland, and Washington.)For 2021, Pennsylvania and zithromax 6 pack New Hampshire are joining a dozen other states that have reinsurance programs, and average premiums are expected to decrease in both states as a result of the new reinsurance programs.Insurers join marketplaces or expand coverage areas in more than 20 statesIn many states across the country, new insurers are joining the exchanges for 2021, and existing insurers are expanding their coverage areas within the states where they offer coverage. We’re seeing this in numerous states, including Arkansas, California, Colorado, Florida, Illinois, Idaho, Indiana, Iowa, Maryland, Minnesota, Mississippi, Missouri, Nevada, New Mexico, North Carolina, Oklahoma, Oregon, Tennessee, Texas, Utah, Virginia, and Washington.There are a few states where existing insurers will no longer offer plans in the marketplace after 2020. New Mexico zithromax 6 pack Health Connections will shut down at the end of 2020, Virginia Premier is leaving the individual market, and Highmark Choice Company is leaving Pennsylvania’s market (but several other Highmark affiliates will remain, and Highmark Choice Company had very low enrollment).But overall, the trend is overwhelmingly towards increasing insurer participation and expanding coverage areas.

This is the same trend we saw for 2019 and 2020. And it’s a reversal of the trend we saw in 2017 and 2018, when insurers were fleeing the exchanges and the individual market.Wisconsin asks Trump administration to extend open enrollmentLate last month, numerous Wisconsin zithromax 6 pack stakeholders — including the insurance commissioner, the Department of Health Services, numerous health insurance companies, and consumer advocates — sent a letter to the Trump administration, asking for an extension of the upcoming open enrollment period through the end of January, instead of having it end on December 15.Wisconsin uses the federally run marketplace (HealthCare.gov), so the state does not have the option of extending open enrollment itself, the way several of the state-based exchanges have done. The letter points out how an extended open enrollment period would give the state more time to help people affected by the zithromax who need to select an individual market health plan for 2021.An extension would also give those individuals – many of whom are not accustomed to buying their own health insurance – more time to carefully consider their options. The letter concludes by pointedly noting that along with those practical benefits, “an extension would signal that the federal government understands the plight of the newly uninsured, values their welfare and is prepared to do all in its power zithromax 6 pack to protect our health system and economy.”Nearly two years after voters approved it, Medicaid expansion is in effect in NebraskaIn November 2018, voters in Nebraska approved a Medicaid expansion ballot measure. After an implementation process that lasted nearly two years, Medicaid expansion took effect this month in Nebraska.

Nebraska residents were able to start enrolling in expanded Medicaid in August, but enrollment will continue year-round for zithromax 6 pack eligible residents.Now that Nebraska has expanded coverage, there are only 14 states that still have not accepted federal funding to expand Medicaid, and two of them (Oklahoma and Missouri) will expand coverage by mid-2021 under the terms of ballot measures approved by voters this past summer.CMS report. Unsubsidized individual market enrollment declined 45% from 2016 to 2019The Centers for Medicare and Medicaid Services published a new enrollment trends report last week, with data updated to include the 2019 plan year. The CMS totals are based on risk adjustment data, but they do not include enrollments in Massachusetts and Vermont, since zithromax 6 pack both states have merged individual and small group markets for risk adjustment.Enrollment in the health insurance marketplaces/exchanges has remained fairly steady over the last few years, due mainly to the premium subsidies that keep coverage affordable for most exchange enrollees. But enrollment has declined sharply among people who don’t receive premium subsidies – which includes everyone who enrolls outside the exchange, as well as about 15 percent of on-exchange enrollees. Across 48 states and Washington, DC, total unsubsidized enrollment in ACA-compliant individual market plans has dropped from 6.3 million in 2016 zithromax 6 pack to 3.4 million in 2019.KFF employer survey.

Average cost of family premiums now exceeds $21,000The Kaiser Family Foundation’s annual employer health insurance survey report was published last week. As usual, it contains a wealth of zithromax 6 pack information about the current state of employer-sponsored health insurance in the United States. Among the interesting data points:67 percent of employees with employer-sponsored health coverage are enrolled in self-insured health plans. This is up from 61 percent last year (state health insurance regulations do not apply to self-insured plans, as they are instead regulated at the federal level).The average cost of employer-sponsored family zithromax 6 pack health coverage has grown to $21,342 in annual premiums this year, up from $20,576 last year. The uninsured rate continues to rise, and is rising particularly fast among childrenLast month, the U.S.

Census Bureau published its annual health insurance report, with zithromax 6 pack data about health coverage during 2019. About 8 percent of the population had no health coverage at all during 2019, and about 9.2 percent had no health coverage at the time they were surveyed. This is an zithromax 6 pack increase from 8.9 percent in 2018, but it’s also the continuation of a steady upward trend in the uninsured rate since the Trump administration took office. It had been 8.7 percent in 2017 and 8.6 percent in 2016. The uninsured zithromax 6 pack rate is still well below where it was prior to the ACA.

15.5 percent of the population was uninsured as of 2010.In addition to the continued increase in the overall uninsured rate in recent years, Georgetown University’s Health Policy Institute published a sobering report last week, indicating that the uninsured rate among children in the U.S. Increased more in zithromax 6 pack 2019 than it had in any other year over the last decade. In 2016, just 4.7 percent of children in the U.S. Were uninsured, which was zithromax 6 pack a historic low. But by 2019, it had increased to 5.7 percent.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org zithromax 6 pack. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Minnesota marketplace highlights and updatesOpen enrollment for 2021 health plans. November 1, 2020 through zithromax 6 pack December 22, 2020. Residents with qualifying events can still enroll or make changes to their 2020 coverage.Insurers implementing modest rate increases for 2021, after three straight zithromax 6 pack years of average rate decreases. Quartz has joined the exchange for 2021, bringing total number of insurers to five.117,520 people enrolled for 2020, a new record for MNsure.Insurer participation in MNsure.

2014 to zithromax 6 pack 2021.Reinsurance program received federal approval, began operation in 2018.With reinsurance, rates decreased for 2018 and again, even more significantly, for 2019. But reinsurance also reduced funding for MinnesotaCare.The elimination of CSR funding further reduced MinnesotaCare funding, but this has been partly restored by a court ruling.MN provided premium relief for non-subsidy-eligible enrollees for 2017 only.Governor vetoed a proposed 2019 switch to HealthCare.gov.MNsure’s small business exchange no longer has any participating insurers.Minnesota health exchange overviewMinnesota’s one of the states fighting the hardest to preserve the Affordable Care Act’s gains. See actions Minnesota has taken.Minnesota’s state-run exchange, MNsure, has five zithromax 6 pack participating insurers for 2021, up from four in 2020. The exchange has more than 117,000 individual market enrollees as of 2020.As a result of the buy antibiotics zithromax, MNsure joined most of the other state-run exchanges in offering a special enrollment period during which people who were uninsured could enroll in a health plan. MNsure’s special enrollment period began March 23, and continued through April 21 zithromax 6 pack.

Nearly 9,500 Minnesota residents enrolled in private plans through MNsure during this window, as well as another 13,700 who enrolled in MinnesotaCare or Medicaid (enrollment in those programs is open year-round for eligible residents).Allison O’Toole, who led MNsure as CEO for three years, announced her resignation in March 2018, and the exchange named Nate Clark, the MNsure COO, as acting CEO. A few months later, zithromax 6 pack the MNsure board named Clark as the permanent CEO. O’Toole left MNsure to work as director of state affairs for United States of Care, a non-profit created by Andy Slavitt, who was the acting administrator of CMS under the Obama Administration.Throughout 2017, Minnesotans who bought their own health insurance (on or off-exchange) and weren’t eligible for ACA subsidies were provided with 25 percent premium rebates from the state as a result of S.F.1, signed into law by Governor Dayton in early 2017. The subsidies helped to offset the large premium increases that applied zithromax 6 pack in Minnesota in 2017, and helped to stabilize the individual health insurance market in 2017. But the premium rebate program expired at the end of 2017.Thanks in large part to the new reinsurance program that Minnesota created (details below), premiums decreased in Minnesota’s individual market in 2018, 2019, and again in 2020, although rates are increasing modestly for 2021.

In May zithromax 6 pack 2019, Minnesota leaders reached an agreement on a budget that included an extension of the reinsurance program through 2020 and 2021 (it has already been granted federal approval through the end of 2022, but the state has to continue to cover its share of the cost. Minnesota Governor Tim Walz had hoped to implement a premium subsidy program and a new tax credit in Minnesota starting in 2020. But a compromise in the budget ended up with the state opting to continue the existing reinsurance program for two more years instead.).But the waiver that provides federal pass-through funding for reinsurance also resulted in a sharp and unexpected decrease in federal funding for MinnesotaCare, the Basic Health Program that provides coverage for people with income between 138 percent and 200 percent of the poverty level (between $16,642 and $24,120 for a single person).In addition, the elimination of zithromax 6 pack federal funding for cost-sharing reductions (CSR) in October 2018 resulted in a funding cut for MinnesotaCare, since the program is funded in large part by federal funds that would otherwise have been used to pay for premium subsidies and cost-sharing reductions in the exchange for the population that is instead eligible for MinnesotaCare. After an ensuing legal battle, a judge ordered HHS to restore funding for MinnesotaCare, although a resolution of the situation is ongoing, and the amount that HHS agreed to pay was still less than MinnesotaCare would have received if CSR funding had continued.Open enrollment for 2021 health plans extended through December 22, 2020. Insurers implementing modest rate increases for 2021, after three years of overall rate decreasesMNsure enabled window shopping for 2021 health zithromax 6 pack plans as of October 12, 2020.

This gives residents a few weeks to browse the available plans before open enrollment starts on November 1, 2020. And MNsure zithromax 6 pack has announced that open enrollment will continue through December 22, 2020. That’s a week longer than the open enrollment period that will apply in states that use the federally-run exchange. The flexibility to extend open enrollment is often cited as one of the benefits of zithromax 6 pack having a fully state-run exchange. (MNsure had a similar extension last December, for 2020 health plans).For 2021, Quartz is joining the Minnesota marketplace.

Quartz currently offers plans in Illinois and Wisconsin, and zithromax 6 pack is expanding into Minnesota for 2021. And two of the existing insurers — HealthPartners and UCare — are expanding their coverage areas for 2021 (BluePlus and Medica offer coverage statewide, and will continue to do so in 2021).The following average rate changes have been approved for MNsure’s insurers:Blue Plus. 4.21 percent increase (down from an initially proposed 7.12 percent increase)Group Health/Health Partners zithromax 6 pack (GHI). 0.67 percent increase (down from an initially proposed 4.15 percent increase)Medica. 2.42 percent increase (down from an initially proposed 7.06 percent increase)UCare zithromax 6 pack.

1.6 percent increase (up from an initially proposed 1.39 percent decrease)Quartz. New for 2021, so no applicable rate changePreferredOne Insurance Company, which offers plans outside the exchange, is zithromax 6 pack increasing premiums by 1.05 percent (down from an initially proposed average increase of 5.09 percent). Rate changes in previous years2015. Average increase zithromax 6 pack of 4.5 percent. MNsure critics characterized the official announcement as misleading zithromax 6 pack as it failed to take into account low-cost 2014 plans from PreferredOne.

Consumers who bought a PreferredOne plan through MNsure for 2014 could only renew their policies for 2015 by working directly with the insurer, since PreferredOne stopped offering plans in the exchange at the end of 2014. However, PreferredOne rates went up an average of 63 percent, and zithromax 6 pack consumers didn’t qualify for subsidies if they shopped outside the exchange. 2016. Average increase of 41.4 zithromax 6 pack percent for the individual market, and about 38.5 for plans sold in MNsure (ie, not counting PreferredOne). Rates increased significantly in 2016 across the entire individual market in Minnesota — including plans sold through MNsure, the state-run exchange.Approved rates for 2016 were announced on October 1, 2015, ranging from about 15 percent for Medica to 49 percent for Blue Cross Blue Shield of Minnesota.

In general, the carriers cited higher-than-expected claims costs over the past zithromax 6 pack year, along with the impending phase-out of the ACA’s reinsurance program as justification for their 2016 rate requests. But Governor Mark Dayton called some of the higher proposed increases “outrageous,” and promised a rigorous review of the filed rate changes and justifications. Ultimately, regulators were able to limit the highest rate increases to 49 percent — as opposed to the 54 percent that had been requested by Blue Plus and BCBS of MN — but the final weighted average rate increase in the zithromax 6 pack individual market in Minnesota still ended up being the highest in the nation. But Minnesota still had the lowest overall premiums in the upper midwest (although Minnesota had the highest average rate increase in the country for 2016, they had the lowest overall rates in the country in 2014 and 2015).Minnesota Commerce Commissioner Mike Rothman called the rate increases “unacceptably high,” and Gov. Dayton noted that he was “extremely unhappy” with the rate changes zithromax 6 pack.

But Rothman noted that his office “objected to all of the rates across the board,” and “squeezed out everything we could that was not actuarial justified.” In other words, the final rates, although much higher than officials and policyholders would have liked, were justified based on medical claims costs — the population enrolled in individual health plans in Minnesota was sicker than expected, and drug costs had been particularly onerous.Only about 55 percent of people who had 2015 coverage through MNsure received premium subsidies. But due to the sharp premium increases, that had increased to about 63 percent for the people who had purchased or renewed coverage as zithromax 6 pack of June 2016.2017. When the Minnesota Department of Commerce announced health insurance rates for 2017 for the individual and small group markets, the rate hikes were somewhat reasonable in the small group market (ranging from a decrease of 1 percent to an increase of 17.8 percent), but the individual market was “experiencing serious disruptions in 2017” and “on the verge of collapse.” The four carriers that offered plans through MNsure had the following average rate increases in 2017:Blue Plus = 55 percentHealthPartners/Group Health (GHI) = 50 percent (HealthPartners is only offering plans in 10 of the 67 counties where they offered plans in 2016. Their enrollment cap is 72,000 for 2017)Medica = 57.5 percent (enrollment cap is 50,000 for 2017)UCare = 66.8 percent (UCare capped enrollment at 30,000 for 2017, but only had 16,000 enrollees in 2016)The enrollment caps that HealthPartners, Medica, and UCare employed for 2017 were approved as part of the rate review process, and are zithromax 6 pack designed to protect carriers from further financial losses as they absorb BCBSMN’s enrollees who are shopping for new coverage during open enrollment.In a news release relating to the rate announcement for 2017, the Minnesota Department of Commerce didn’t mince words. They noted that the individual market in the state was on the brink of collapse, and that they did everything in their power to save the market.

While they succeeded in keeping the state’s individual market viable for 2017, with only one carrier exiting (BCBSMN, although their HMO affiliate, Blue Plus, remained in the exchange), they reiterated very clearly that substantial reforms would be needed to keep the market stable in future years, and highlighted the fact that rates would be zithromax 6 pack sharply higher and that carriers would limit enrollment in 2017.2018. Final rates for 2018 were approved in October 2017 (comprehensive information about the approved rates is here), based on the Minnesota Premium Security Plan (MSPS) being implemented but cost-sharing reductions (CSR) not being funded by the federal government (the cost of CSRs was added to on-exchange Silver plans). Average approved rate changes for MNsure insurers ranged from a 13.3 percent decrease zithromax 6 pack for UCare to a 2.8 percent increase for Blue Plus. Three of the four MNsure insurers decreased their average premiums for 2018.On September 21, MNsure had posted a notice indicating that if the reinsurance program were not approved, rates would be about 20 percent higher than they would otherwise be in 2018. Fortunately for Minnesota residents, the reinsurance program did receive federal approval, and average rates declined slightly for 2018.But some enrollees who don’t get ACA premium subsidies still experienced a rate increase, due to the termination of the one-year, state-funded 25 percent premium rebates at the end zithromax 6 pack of 2017.PreferredOne, which exited MNsure at the end of 2014 and only offers coverage in the off-exchange market, proposed dramatically lower rates for 2018.

A 38 percent average decrease if MSPS were to be approved, and a 23 percent average decrease if not. The 38 zithromax 6 pack percent decrease was implemented, and no adjustments were necessary to account for CSR funding, since PreferredOne does not offer plans in the exchange, and CSRs are only available on silver exchange plans.2019. Average premium decrease of 12.4 percent. Average premiums dropped for all five insurers in the individual market in zithromax 6 pack 2019. This was the second year in a row of declining rates in Minnesota, but Blue Plus had a small rate increase for 2018, so 2019 was the first year that all five insurers decreased their average rates.

Minnesota insurance regulators noted that rates in 2019 were about zithromax 6 pack 20 percent lower than they would have been without the reinsurance program.But most of Minnesota’s insurers charged higher rates in 2019 than they would have if the individual mandate penalty hadn’t been eliminated, and if access to short-term plans and association health plans hadn’t been expanded by the Trump administration. For example, UCare’s rate filing notes that while average rates were decreasing by about 10 percent, the rate decrease would have been nearly 15 percent if the individual mandate penalty had remained in place.At ACA Signups, Charles Gaba calculated a weighted average rate decrease of 12.4 percent for 2019 in Minnesota, but noted that the average decrease would have been nearly 19 percent without those changes at the federal level.2020. Average premium decrease of 1 percent zithromax 6 pack. Four of the five insurers (including PreferredOne, which only offers coverage off-exchange) in Minnesota’s individual market decreased their average premiums for 2020. This was the third year in a row that average individual market premiums dropped in Minnesota’s individual market, due in large part to the reinsurance program that the zithromax 6 pack state has established.The following average rate changes were implemented for 2020:Blue Plus.

1.5 percent decrease (Blue Plus had originally proposed a 4.8 percent increase)Group Health/Health Partners (GHI) zithromax 6 pack. 1.26 percent decrease (GHI had originally proposed a 2.1 percent increase)Medica. 1.01 percent decrease zithromax 6 pack (Medica had originally proposed an average decrease of 1.4 percent)UCare. 0.18 percent increase (UCare originally proposed a 0.3 percent increase)PreferredOne, which only offers off-exchange coverage, reduced their rates by an average of 20 percent, on the heels of an 11 percent decrease in 2019. MNsure enrollment exceeded 116k in zithromax 6 pack 2018, dropped to 113k for 2019, but grew to more than 1117k in 2020From 2014 through 2018, enrollment in MNsure’s individual market plans increased every year, reaching 116,358 people by 2018.

That was the highest open enrollment total in MNsure’s history, despite the shorter enrollment period, which ended in mid-January instead of the end of January (open enrollment for 2018 coverage ended on December 15, 2017 in states that use HealthCare.gov, but MNsure opted to extend their enrollment window that year, and have also extended subsequent enrollment windows).Enrollment dropped for the first time in 2019, when 113,552 people enrolled in individual market plans through MNsure. In most states that use HealthCare.gov, zithromax 6 pack enrollment peaked in 2016 and has been dropping since then. But MNsure’s drop-off in 2019, which amounted to only a 2.4 percent reduction in enrollment, is the only time year-over-year enrollment has declined. Notably, the ACA’s individual mandate penalty was eliminated as of 2019, and regulations that the Trump administration implemented in late 2018 now make it more feasible for healthy people to use short-term plans instead of ACA-compliant plans (Minnesota has its own rules for short-term plans, but they’re more relaxed than the Obama-era federal rules that applied in zithromax 6 pack 2017 and most of 2018).And for 2020, enrollment grew again, reaching a record high of 117,520 enrollees.Here’s a look at the number of people who have signed up for individual market plans through MNsure during each year’s open enrollment period. These numbers all represent total enrollment at the end of open enrollment.

Effectuated enrollment is zithromax 6 pack always lower, and MNsure provides periodic effectuated enrollment data on their board meeting materials page. Insurer participation in MNsure. 2014-20212014. Five insurers offered individual policies through MNsure for 2014. Blue Cross Blue Shield of Minnesota, HealthPartners/Group Health, Medica, PreferredOne, and UCare.

Kaiser Health News reported that Minnesota offered some of the lowest premiums for silver zithromax z pak price without insurance (mid-level) plans in the U.S. Four of Minnesota’s nine regions made Kaiser’s list of the 10 least expensive places to buy health insurance.2015. But PreferredOne, which offered the lowest rates in the nation in 2014 and captured a large portion of 2014 enrollees, withdrew from MNsure for 2015. PreferredOne said remaining on the exchange was “not administratively and financially sustainable.” A Star Tribune business writer attributed PreferredOne’s departure as a market dynamics issue rather than a problem with MNsure.However, Blue Plus (an affiliate of Blue Cross Blue Shield of MN, offering HMO plans) joined the exchange for 2015, so there were still five insurers offering plans for 2015. Blue Cross Blue Shield of Minnesota, Blue Plus, Health Partners/Group Health, Medica, and UCare.

MNsure offered 84 plans statewide, up from 78 for 2014.2016. BCBSMN, Blue Plus, Health Partners/Group Health, Medica, and UCare offered individual market plans through MNsure for 2016.2017. In an effort to recruit more carriers to offer plans through MNsure for 2017 — particularly outside the Twin Cities metro area — state regulators sent out a request for proposals from health insurers on August 15, 2016. Regulators noted that insurers could propose waivers of regulations in order to make it feasible for them to offer coverage through MNsure, although any such waiver requests would have to be approved by regulators.Steven Parente, a health insurance expert at the University of Minnesota, called the state’s effort to recruit insurers to MNsure a “distress call” and noted that August 15 is awfully late in the year to be putting out a request for insurer participation, given that open enrollment begins November 1. And ultimately, no new insurers opted to join MNsure for 2017.Blue Cross Blue Shield of MN dropped their individual market PPO plans at the end of 2016 due to significant financial losses.

That left Blue Plus (which offered HMOs and covered roughly 13,000 people in 2016 in the individual market) as the only BCBSMN affiliate in the exchange. Roughly 103,000 people had to select new plans during open enrollment.Most of those BCBSMN enrollees had off-exchange coverage, though. There were only about 20,400 MNsure enrollees (a little more than one in five MNsure enrollees) with coverage under BCBSMN who needed to switch to another plan during open enrollment. BCBSMN had individual PPO options available in all 87 counties in Minnesota through MNsure in 2016, while the Blue Plus coverage area — comprised of four separate HMO networks — was available in 77 of the state’s counties.Nationwide, carriers have been shifting away from PPOs and towards HMOs and EPOs. In Colorado, Anthem Blue Cross Blue Shield also dropped their PPOs at the end of 2016.

In Indiana, there were no PPOs available in the individual market by 2017. Blue Cross Blue Shield of New Mexico dropped all of their individual market plans at the end of 2015 except one off-exchange HMO. Blue Cross Blue Shield of Texas dropped their individual market PPO plans at the end of 2015.The broad network offered by PPOs tends to be attractive to enrollees who have health problems. They’re often willing to pay higher premiums in trade for access to broad network of hospitals and specialists. But PPOs are expensive for carriers, as enrollees don’t need primary care referrals to see specialists, and it’s more challenging for carriers to hold down costs when there are more providers in the network.All of the MNsure carriers except Blue Plus are also limiting their total enrollment for 2017.

By November 11, 2016, less than two weeks into open enrollment for 2017 coverage, Medica had hit their 50,000 member enrollment cap for 2017 (including on and off-exchange enrollments, and also accounting for expected renewals of 2016 Medica plans), and their policies were no longer available in the individual market in Minnesota, on or off-exchange. The only exception was five counties (Benton, Crow Wing, Mille Lacs, Morrison, and Stearns) where Medica agreed not to limit enrollment, as all of the other available carriers in those counties have imposed enrollment caps too. In those five counties, Medica plans continued to be available.At that point, Medica’s market share in MNsure for 2017 stood at 34.2 percent. By December 14, Medica’s market share had dropped to 27.7 percent, as enrollments had continued to climb for the remaining carriers.On January 31, Medica re-opened enrollment for 2017. This was because a smaller-than-expected number of 2016 Medica enrollees renewed their plans for 2017, meaning that the carrier still had some wiggle room under their 50,000 member cap.

At that point, they had room for about 7,000 more enrollees. Medica plans were thus available throughout the duration of the special enrollment period that was added on at the end of open enrollment, and continue to be available for people with qualifying events.2018. Plans continued to be available from Blue Plus, Health Partners/Group Health (GHI), Medica, UCare. In the months before a decision was reached regarding an extension of the open enrollment window for 2018 plans (the first year that the federal government imposed a shorter, month-and-a-half enrollment window), two of MNsure’s participating insurers had differing positions. UCare believed the exchange should add an additional two-week special enrollment period, while Medica did not want the exchange to have the option to extend the newly-scheduled six-week enrollment window.

Notably, Medica capped their enrollment very early during the 2017 open enrollment period, and while UCare also had an enrollment cap, it was set with a target of nearly doubling their 2016 enrollment. But Medica is the only MNsure insurer that didn’t set an enrollment cap for 2018.As was the case for 2017, enrollment caps were used in the individual market in Minnesota for 2018 by all insurers other than Medica (Medica did have an enrollment cap for 2017, which they hit very early in open enrollment. However, they resumed enrollments at the end of January 2017). Details about the insurers’ enrollment caps are in the plan binders in SERFF. For 2018, MNsure insurers implemented the following enrollment caps:Blue Plus.

55,000 member cap (aiming for a target of 50,000 effectuated enrollees, but effectuated enrollment is always lower than the number of people who initially enroll)Health Partners/Group Health (GHI). 73,400 member cap (aiming for a target of 70,000 effectuated enrollees)Medica. No enrollment capUCare. 35,000 member cap (aiming for a target of 30,000 effectuated enrollees)MNsure confirmed in May 2018 that none of their insurers had hit their enrollment caps for 2018.Outside the exchange, PreferredOne had an enrollment cap of 3,000 members, although their 2017 membership was only about 300 people.2019 and 2020. Blue Plus, Health Partners/Group Health, UCare, and Medica have continued to offer plans through MNsure, and all of them continued to participate in 2020 as well.

Blue Plus expanded to once again offer statewide coverage in 2020, for the first time since 2016.2021. Quartz joined the exchange for 2021, joining the four existing insurers. HealthPartners and UCare are both expanding their coverage areas for 2021.Minnesota Premium Security Plan. 1332 waiver proposal approved by CMS, but with a significant funding cut for MinnesotaCareIn May 2017, Minnesota Governor Mark Dayton submitted a 1332 waiver proposal to CMS. The 1332 waiver was based on H.F.5, which was enacted without Dayton’s signature in April 2017 (Dayton had proposed an alternative measure that would have allowed people in Minnesota to buy into MinnesotaCare.

That measure was not able to pass the state’s Republican-dominated legislature).[For more than two decades, MinnesotaCare was a state program subsidizing health insurance for low-income residents. As of January 1, 2015, it transitioned to a Basic Health Program under the ACA, becoming the first BHP in the nation.]H.F.5 created the Minnesota Premium Security Plan (MPSP), which is a state-based reinsurance program (similar to the one the ACA implemented on a temporary basis through 2016, and that Alaska created for 2017. Several other states have since implemented reinsurance programs). The reinsurance program, which took effect in Minnesota in 2018, covers a portion of the claims that insurers face, resulting in lower total claims costs for the insurers, and thus lower premiums (average individual market premiums in Minnesota decreased from 2017 to 2018 as a result of the reinsurance program). The reinsurance kicks in once claims reach $50,000, and covers them at 80 percent up to $250,000 (this is similar to the coverage under the transitional reinsurance program that the ACA provided from 2014 through 2016).H.F.5 was contingent upon approval of the 1332 waiver, because it relies partially on federal funding, in addition to state funding.

Under the federal approval that was granted in September 2017, the federal government is giving Minnesota the money that they save on premium tax credits, and that money is combined with state funds to implement the reinsurance program (lower premiums — as a result of the reinsurance program — result in the federal government having to pay a smaller total amount of premium tax credits, since the tax credits are smaller when premiums are smaller).It was expected that CMS would approve the state’s 1332 waiver proposal, and Governor Dayton requested that the approval process be swift so that the state could move forward with the implementation of the Minnesota Premium Security Plan in time for the 2018 plan year. Dayton indicated that his office had been told that approval would come in August 2017, but CMS didn’t approve the waiver until September 22. And the waiver approval letter noted that the federal savings for MinnesotaCare (the state’s Basic Health Program, or BHP) resulting from the reinsurance program would not be eligible to be passed along to the state — in other words, CMS would keep those savings instead.[Federal BHP funding is equal to 95 percent of the amount that the federal government would have otherwise spent on premium subsidies and cost-sharing reductions for the population that ends up being eligible for the BHP. So lower premiums — as a result of reinsurance — for qualified health plans in the exchange means that the amount the federal government would have had to spend on premium subsidies for that population is lower. That translates into a smaller amount of funding for the state’s BHP, according to the approach that HHS took for Minnesota’s waiver approval.]And based on the scathing letter that Dayton sent CMS a few days earlier, it appeared at that point that Minnesota could actually lose money on the deal — losing more in federal funding for MinnesotaCare than they gain in reinsurance funding.

Dayton noted in his letter that the 1332 waiver approval process had been “nightmarish,” and that Minnesota went to great lengths to follow instructions from CMS at every turn, throughout the process of drafting H.F.5 and the 1332 waiver proposal. He explains that CMS provided Minnesota with explicit guidance in terms of how to draft the reinsurance program while maintaining full federal funding for MinnesotaCare, and highlighted the fact that the state never deviated from the instructions that were provided.The StarTribune editorial board called out then-Secretary of HHS, Tom Price and the Trump Administration for their lack of clarity on the issue, for apparently misleading the state during the 1332 waiver drafting process, and for effectively punishing the state of Minnesota for taking an innovative approach to ensuring that as many people as possible have health insurance.Insurers filed rates based on reinsurance being available. And by the time the waiver was approved, there was very little time to evaluate the potential impacts of the funding changes, as rates had to be finalized by October 2 in Minnesota. The finalized rates did incorporate the reinsurance program. The state has accepted the approved waiver, but Gov.

Dayton sent a letter to HHS on October 3, asking them to reconsider the MinnesotaCare funding cuts, but the issue has remained unresolved.Elimination of CSR funding results in additional funding cut for MinnesotaCare, but a lawsuit has partially restored that fundingNationwide, 54 percent of exchange enrollees benefit from cost-sharing subsidies. But in Minnesota, only 13 percent of exchange enrollees are receiving cost-sharing subsidies. This is because of MinnesotaCare, which covers all enrollees with income up to 200 percent of the poverty level. That’s the same group that would otherwise benefit the most from cost-sharing subsidies, so the fact that MinnesotaCare is available means that most of the people who would otherwise be enrolled in cost-sharing subsidy plans are instead enrolled in MinnesotaCare.At first glance, this would appear to have made the uncertainty surrounding cost-sharing subsidy funding in 2017 a little less of a pressing issue in Minnesota than it was in many other states, since private insurers weren’t facing the sort of losses that insurers in other states were facing without federal funding for CSR. But when the Trump Administration eliminated federal funding for CSR in October 2017, HHS took the position tha t since CSR funding had been eliminated, the CSR portion of the federal funding for the BHPs in New York and Minnesota would be reduced to $0.

This was not a cut-and-dried conclusion, however, as explained earlier in 2017 by Michael Kalina.In January 2018, the Attorneys General for New York and Minnesota filed a lawsuit against the US Department of Health and Human Services, seeking to restore funding for their Basic Health Programs. A judge ruled in favor of the states in May 2018, ensuring that MinnesotaCare would continue to receive at least some CSR-based funding. The amount awarded to the state for the first quarter of 2018 was just over half of what the state had initially expected in CSR-related funding, but a larger chuck of the funding was restored later in 2018. According to the Star Tribune, however, Minnesota still ended up losing $161 million in federal funding for MinnesotaCare due to the CSR funding cuts.In early 2019, the Trump administration proposed yet another funding cut (a third, after the cuts imposed by the reinsurance program and the elimination of CSR funding) as part of a new methodology for calculating BHP funding. This one was much smaller than the other two cuts, but taken together the funding reductions are pushing MinnesotaCare towards a looming budget shortfall.

SHOP exchange. Down to one carrier as of 2016, zero by 2018 (and still zero in 2019)In 2015, there were two carriers in MNsure’s SHOP exchange for small businesses. Blue Cross Blue Shield of Minnesota, and Medica. But Medica announced in 2015 that they would exit the SHOP exchange in Minnesota, North Dakota, and Wisconsin at the end of the year. That left BCBS as the only small group carrier available through MNsure in 2016, but it didn’t change much from a practical standpoint, since 83 percent of MNsure’s small groups were enrolled in plans through BCBS in 2015.

Indeed, Medica’s reason for exiting the small business exchange was based on low enrollment in the first two years.Blue Cross Blue Shield of Minnesota continued to be the only insurer offering SHOP coverage via MNsure in 2017, but announced in July 2017 that they would no longer offer SHOP coverage in 2018, and would instead transition their SHOP enrollees to small business coverage outside the exchange. At that point, there were only 3,287 people enrolled in SHOP coverage in Minnesota — far below the 155,000 people that were originally projected to have coverage through MNsure’s SHOP program by 2016 (this much lower-than-anticipated enrollment has been the case in nearly every state’s SHOP exchange. This situation is not unique to Minnesota). State law provided 25% premium rebate in 2017. Amendment to allow plans without essential benefits was cut from final legislationThroughout 2016, then-Governor Dayton called for a state-funded premium rebate for people who buy their own insurance but aren’t eligible for the ACA’s premium subsidies (those are only available for people with income up to 400 percent of the poverty level, or $100,400 for a family of four in 2019).Governor Dayton also noted that the government needed to act quickly to stabilize the individual market in Minnesota, and by late November 2016, his patience with lawmakers was wearing thin.

In a November 23 press conference, Dayton said that House Republicans needed to “stop dilly-dallying” and decide whether to move forward with Dayton’s rebate proposal.Dayton had also indicated that he was considering calling a special session of the legislature after election day to address the situation, and that was being negotiated for December 20. But the talks fell through when Dayton and Republican House Speaker Kurt Daudt couldn’t agree on the three bills that would have been addressed in the special session. As a result, there was no special session.Instead, the issue was taken up by lawmakers as soon as the 2017 legislative session began. On January 5, Minnesota Senators Michelle Benson (R, 31st District) and Gary Dahms (R, 16th District) introduced S.F.1. The bill called for using $300 million in state funding to provide a 25 percent rebate to roughly 125,000 people in Minnesota.S.F.1 passed the Minnesota Senate by a 35-31 vote on January 12.

Only one DFL Senator (Melisa Franzen, from Edina) voted with Republicans in favor of the legislation. It was then sent to the House, where an amendment was added that stripped out the requirement that health plans provide various mandated benefits (see “Journal of the Day” section “Top of page 154” in this version of the bill. Under the terms of the amendment, as long as a carrier offered at least one plan with all the mandated benefits, they would have been allowed to offer others without mandated benefits).The amended bill was sent back to the Senate on January 23. Differences between the bills that the two chambers passed had to be reconciled before being sent to Governor Dayton for his signature. By that point, the amendment to allow less-robust plans to be sold had garnered national attention, and public outrage helped to push lawmakers away from the provision.

S.F.1 had also called for $150 million to be appropriated for fiscal year 2018 (through June 30, 2019) from the state general fund to a state-based reinsurance program to stabilize the individual market (Alaska did something similar in 2016, preventing a market collapse), but that provision was also removed in the final version (Minnesota did ultimately set up a reinsurance program, effective in 2018, which has served to stabilize the market and reduce premiums).A Conference Committee in the Senate recommended that the House “recede from its amendments” and the Conference Committee report passed the Senate on a 47-19 vote. The House passed the bill a few hours later, 108-19. It was sent to Governor Dayton, who immediately signed it into law. DFLers did have to compromise on one issue during the process. S.F.1 allows for-profit HMOs to begin operating in Minnesota’s individual market, which had long been limited to non-profit HMOs.Consumers were told to expect the premium rebates to show up by April 2017, but they were retroactively effective to January 2017.

So a person who had been paying full price for a plan since January 2017 saw a substantial premium reduction on the April or May invoice. Going forward, for the remainder of the year, a 25 percent rebate applied each month.Since S.F.1 was signed into law with only a few days remaining in open enrollment (it ended January 31 that year), Governor Dayton and exchange officials were worried that there wouldn’t be enough time for people to learn about the rebate and apply for coverage before January 31. In December, Dayton had asked HHS to allow MNsure to extend its enrollment deadline to February 28 (instead of January 31) in order to allow lawmakers more time to work out the details of a state-based premium rebate while still allowing people to enroll after the legislative process is complete.HHS denied the request for a blanket extension, but MNsure used their own authority on January 28 to grant a one-week special enrollment period (February 1 to February 8) due to exceptional circumstances. Although the state-based 25 percent premium rebate was available on or off the exchange, the one-week extension was only valid through MNsure. Health insurers did not have to accept off-exchange enrollments without a qualifying event after January 31.The 25 percent premium rebate program in Minnesota was only authorized for one year, so the rebates did not continue into 2018.

And although almost 100,000 people received premium relief through the program in 2017, it ended up costing less than the legislature had allocated, and about $100 million was returned to the state’s budget at the end of 2017.Protecting Medicaid enrollees from estate liensIn every state, Medicaid is jointly funded by the state and the federal government. Longstanding federal regulations, which predate the ACA, require states to “seek recovery of payments from the individual’s estate for nursing facility services, home and community-based services, and related hospital and prescription drug services” for any Medicaid enrollee over the age of 55. This applies essentially to long-term care services, but states also have the option to go after the individual’s estate to recover costs for other care that was provided by Medicaid after age 55.Prior to 2014, this wasn’t typically an issue, as Medicaid eligibility was generally restricted by asset tests or requirements that applicants be disabled or pregnant (although Minnesota did have much more generous Medicaid eligibility guidelines than most states prior to 2014). But as of 2014, in states that expanded Medicaid under the ACA, the only eligibility guideline is income. Applicants with income that doesn’t exceed 138 percent of the poverty level are directed to Medicaid, regardless of any assets they might have.When applicants use the health insurance exchange — MNsure in Minnesota — they’re automatically funneled into Medical Assistance (Medicaid) if their income is under 138 percent of the poverty level.

But what these enrollees didn’t know was that the state also had a program in place to put liens on estates for Medicaid-provided services for people age 55 and older.The combination of these systems caught numerous residents off guard. They were enrolled in Medical Assistance through MNsure based on their income, but were not aware that liens were being placed on their homes so that the state could recoup the costs upon their deaths.State Senator Tony Lourey (DFL, District 11) addressed the issue with language included in HF2749, the Omnibus supplemental budget bill, which was signed into law by Governor Dayton on June 1, 2016. The legislation limits estate recovery to just what’s required under federal Medicaid rules (ie, essentially, long-term care costs for people age 55 or older), and makes the provision retroactive to January 1, 2014.Early tech strugglesMNsure opened for business in the fall of 2013, but technological issues persisted well into 2015, despite numerous improvements throughout 2014. Given MNsure’s difficult launch, the state conducted a series of audits and reviews. The first audit reviewed how MNsure spent state and federal money.

Auditors concluded that the exchange has generally adequate internal controls and found no fraud or abuse. The review was conducted by the state Office of the Legislative Auditor, and the report was published in October 2014.Another audit, also conducted by the Office of the Legislative Auditor and released in November 2014, found that the MNsure system in some cases incorrectly determined who qualified for public health benefits. The errors occurred during the first open enrollment period, before a series of system fixes were implemented. The audit did not quantify the total financial impact of the errors. The state Human Services commissioner said a consultant working on technical fixes to MNsure concluded that the eligibility functionality was working correctly as of June 2014.A third audit, a performance evaluation report released in February 2015, said “MNsure’s failures outweighed its achievements.” Among other criticisms, auditors said MNsure staff withheld information from the board of directors and state officials, the enrollment website was seriously flawed and launched without adequate testing, and the first-year enrollment target was unrealistically low.In April 2014, MNsure hired Deloitte Consulting to audit MNsure’s technology and improve the website to make enrolling in coverage and updating life events easier and more streamlined.

Deloitte has been involved in successful state-run marketplaces for Connecticut, Kentucky, Rhode Island and Washington.Software upgrades were installed in August 2014, and system testing continued right up until the start of open enrollment. To reduce wait times for consumers and insurance professionals, MNsure increased its call center and support staff and launched a dedicated service line for agents and brokers.More in-person assisters were available in Minnesota for the 2015 open enrollment period. MNsure encourages residents to utilize the exchange’s assister directory to find local navigators and brokers who can help with the enrollment process.MNsure has improved dramatically in terms of its technology since the early days of ACA implementation, and enrollment increased every year from 2014 through 2019.Lawmakers approved switching to HealthCare.gov as of 2019, but governor vetoedOn May 9, 2017, lawmakers in Minnesota passed SF800, an omnibus health and human services bill. Among many other things, the legislation called for switching from MNsure to the federally-run marketplace (HealthCare.gov) starting in 2019 (see Section 5). But Governor Dayton vetoed it.Gov.

Dayton has long been supportive of MNsure, and had previously clarified that he would veto the bill. In noting his plans to veto the legislation, Dayton made no mention of the transition to HealthCare.gov that was included in the legislation, but focused instead on the sharp budget cuts in the bill. But his veto ensured that MNsure would remain in place, at least for the time being.The Senate’s original version of SF800 did not call for scrapping MNsure, but the bill went through considerable back-and-forth between the two chambers, and the version that passed was the 4th engrossment of the bill.In March 2015, Dayton had asked the legislature to create a Task Force on Health Care Financing that would study MNsure along with possible future alternatives. Dayton noted in his letter that he supported making MNsure “directly accountable to the governor and subject to the same legislative oversight as other state agencies” and his budget included half a million dollars devoted to the task force. The spending bill was approved by the legislature in May, and the 29-member task force was appointed in the summer.One of the possibilities that the task force considered was the possibility of switching to Healthcare.gov, but it’s clear that there was no cut-and-dried answer to the question of whether Minnesota is better served by having a state-run exchange, switching to a federally-run exchange, or teaming up with the federal government on either a supported state-based marketplace or partnership exchange.In a December 2015 meeting of the task force, the MN Department of Human Services presented a financial analysis of the alternatives available to MNsure.

They determined that switching entirely to Healthcare.gov would cost the state an additional $5.1 million in one-time costs from June 2016 to June 2017. And switching to a supported state-based marketplace would cost an additional $6.6 million during that same time frame. If the state had opted to switch to Healthcare.gov, the soonest it could have happened was 2018, since HHS requires a year’s notice from states wishing to transition to Healthcare.gov, and Minnesota wouldn’t have been in a position to make a decision until sometime in 2016.There were significant reservations about making that switch prior to the Supreme Court’s ruling on King v. Burwell. The Court ruled in June 2015 that subsidies are legal in every state, including those that use Healthcare.gov.

Prior to the decision, a switch to Healthcare.gov could have jeopardized subsidies for tens of thousands of Minnesota residents. But once it was clear that Healthcare.gov’s subsidies are safe, some stakeholders began calling for Minnesota to scrap its state-run exchange and use Healthcare.gov instead. Because the MNsure task force was included in the 2016 budget, no hasty decisions were made.In January 2016, the task force submitted their recommendations to the legislature. They covered a broad range of issues, but did not recommend that MNsure transition to the federal enrollment platform. Lawmakers essentially left the exchange alone during the 2016 legislative session.The magnitude of the 2016 rate increases that were announced in October resulted in MNsure opponents renewing their calls to switch to Healthcare.gov.

But it’s important to keep in mind that the 41 percent weighted average rate hike in Minnesota was market-wide, and did not just apply to MNsure enrollees. In fact, the off-exchange carrier (PreferredOne) had among the highest rate hikes in the state for 2016, at 39 percent, and the exchange’s weighted average rate increase (38.5 percent) was lower than the weighted average rate increase for the whole individual market (41 percent).Minnesota health insurance exchange linksMNsure855-3MNSURE (855-366-7873)State Exchange Profile. MinnesotaThe Henry J. Kaiser Family Foundation overview of Minnesota’s progress toward creating a state health insurance exchange.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

In this anonymous edition Welcome back to The zithromax price ph Scoop!. Open enrollment for individual (non-group) health insurance plans is just around the corner, and will be underway nationwide zithromax price ph as of November 1. For those interested in open enrollment and individual-market coverage, there’s plenty of encouraging news this week regarding open enrollment extensions, new state enrollment platforms, the availability of plan browsing, and new insurers joining many states’ marketplaces.If you’ve got questions about open enrollment, check out our comprehensive 2021 Open Enrollment Guide, which addresses all aspects of the OEP that starts November 1.

(And although this site is all about individual zithromax price ph market health coverage, you can also check out our guide to the Medicare open enrollment period – which starts today.)There’s a lot of news to cover. Let’s get started!. Eleven state-run exchanges extend open enrollment periods for zithromax price ph 2021 coverageAlthough open enrollment is still a few weeks away, more than two-thirds of the fully state-run exchanges have already committed to extended open enrollment periods during which people can enroll in 2021 health coverage.

Some of these are permanent extensions, while others only apply to the upcoming open enrollment period:Minnesota. November 1 to zithromax price ph December 22, 2020.Colorado. November 1 to January 15, 2021Nevada.

November 1, 2020, to zithromax price ph January 15, 2021.Pennsylvania. November 1, 2020, to January 15, 2021.Washington. November 1, 2020, to zithromax price ph January 15, 2021.Massachusetts.

November 1, 2020, to January 23, 2021.Rhode Island. November 1, zithromax price ph 2020, to January 23, 2021.California. November 1 to January 31, 2021.District of Columbia.

November 1 zithromax price ph to January 31, 2021.New Jersey. November 1, 2020, to January 31, 2021.New York. November 1, 2020, to January 31, 2021.The other state-run exchanges are Connecticut, Idaho, Maryland, and Vermont zithromax price ph.

They all have the option to use the standard November 1 – December 15 enrollment window or issue an extension. And although they’ve currently all scheduled zithromax price ph open enrollment to end on December 15, it’s possible that we could see additional extensions as the year goes on.Two states move to state-run exchange platforms this fallMost states in the U.S. Use the federally run HealthCare.gov platform for individual and family health coverage enrollment.

But there were already 13 fully state-run exchange platforms as of this year, and two zithromax price ph more have joined them for the upcoming open enrollment season and future plan years.Residents in Pennsylvania will use Pennie to sign up for coverage this fall, and New Jersey residents will use GetCoveredNJ. (In previous years, residents in both states used HealthCare.gov.) Window shopping for 2021 health plans available in DC and eight statesIn states that use HealthCare.gov and most of the state-run exchanges, window shopping for 2021 coverage will be enabled by late October. But plan browsing is currently available on some state-run exchange zithromax price ph websites.

Residents in California, DC, Idaho, Maryland, Minnesota, Nevada, New Jersey, New York, and Vermont can already see the available plans and pricing for 2021. And in California, current enrollees can even renew their coverage now, without having to wait for the official start of zithromax price ph open enrollment.Mostly modest rate changes for 2021. Increases in some states, decreases in othersFor the last several months, we’ve been tracking proposed premiums for individual-market health insurance across the country.

The rate review process has been finalized and approved zithromax price ph rate changes made public in many states. As he does each year, Charles Gaba is tracking the proposed and approved rate changes in an at-a-glance spreadsheet. Thus far, the average approved rate change stands at zithromax price ph an increase of just under half a percent.

Although that’s not yet a complete picture, it is indicative of a fourth consecutive year of fairly stable rates in the individual market, with prices in many areas of the country fairly similar in 2021 to what they were in 2018.We’ve got detailed overviews of numerous states’ approved rate changes for 2021, including some states where overall average rates are increasing. (See Florida, Idaho, Massachusetts, Nevada, New York, and Rhode Island) In other state, overall zithromax price ph average rates are actually decreasing. (See Colorado, Delaware, Hawaii, Iowa, Maine, Maryland, zithromax price ph and Washington.)For 2021, Pennsylvania and New Hampshire are joining a dozen other states that have reinsurance programs, and average premiums are expected to decrease in both states as a result of the new reinsurance programs.Insurers join marketplaces or expand coverage areas in more than 20 statesIn many states across the country, new insurers are joining the exchanges for 2021, and existing insurers are expanding their coverage areas within the states where they offer coverage.

We’re seeing this in numerous states, including Arkansas, California, Colorado, Florida, Illinois, Idaho, Indiana, Iowa, Maryland, Minnesota, Mississippi, Missouri, Nevada, New Mexico, North Carolina, Oklahoma, Oregon, Tennessee, Texas, Utah, Virginia, and Washington.There are a few states where existing insurers will no longer offer plans in the marketplace after 2020. New Mexico Health Connections will shut down at the end of 2020, Virginia Premier is leaving the individual market, and Highmark Choice Company is leaving Pennsylvania’s market (but several other Highmark affiliates will zithromax price ph remain, and Highmark Choice Company had very low enrollment).But overall, the trend is overwhelmingly towards increasing insurer participation and expanding coverage areas. This is the same trend we saw for 2019 and 2020.

And it’s a reversal of the trend we saw in 2017 and 2018, when insurers were fleeing the exchanges and the individual market.Wisconsin asks Trump administration to extend open enrollmentLate last month, numerous Wisconsin stakeholders — including the insurance commissioner, the Department of Health Services, numerous health insurance companies, and consumer advocates — sent a letter to the Trump administration, asking for an extension of the zithromax price ph upcoming open enrollment period through the end of January, instead of having it end on December 15.Wisconsin uses the federally run marketplace (HealthCare.gov), so the state does not have the option of extending open enrollment itself, the way several of the state-based exchanges have done. The letter points out how an extended open enrollment period would give the state more time to help people affected by the zithromax who need to select an individual market health plan for 2021.An extension would also give those individuals – many of whom are not accustomed to buying their own health insurance – more time to carefully consider their options. The letter concludes by pointedly noting that along with those practical benefits, “an extension would signal that the federal government understands the plight of the newly uninsured, values their welfare and is prepared to do all in its power to protect our health system and economy.”Nearly two years after voters approved it, Medicaid expansion is in effect in zithromax price ph NebraskaIn November 2018, voters in Nebraska approved a Medicaid expansion ballot measure.

After an implementation process that lasted nearly two years, Medicaid expansion took effect this month in Nebraska. Nebraska residents were able to start zithromax price ph enrolling in expanded Medicaid in August, but enrollment will continue year-round for eligible residents.Now that Nebraska has expanded coverage, there are only 14 states that still have not accepted federal funding to expand Medicaid, and two of them (Oklahoma and Missouri) will expand coverage by mid-2021 under the terms of ballot measures approved by voters this past summer.CMS report. Unsubsidized individual market enrollment declined 45% from 2016 to 2019The Centers for Medicare and Medicaid Services published a new enrollment trends report last week, with data updated to include the 2019 plan year.

The CMS totals are based on risk adjustment data, but they zithromax price ph do not include enrollments in Massachusetts and Vermont, since both states have merged individual and small group markets for risk adjustment.Enrollment in the health insurance marketplaces/exchanges has remained fairly steady over the last few years, due mainly to the premium subsidies that keep coverage affordable for most exchange enrollees. But enrollment has declined sharply among people who don’t receive premium subsidies – which includes everyone who enrolls outside the exchange, as well as about 15 percent of on-exchange enrollees. Across 48 states and Washington, DC, total unsubsidized enrollment zithromax price ph in ACA-compliant individual market plans has dropped from 6.3 million in 2016 to 3.4 million in 2019.KFF employer survey.

Average cost of family premiums now exceeds $21,000The Kaiser Family Foundation’s annual employer health insurance survey report was published last week. As usual, it contains a wealth of information about zithromax price ph the current state of employer-sponsored health insurance in the United States. Among the interesting data points:67 percent of employees with employer-sponsored health coverage are enrolled in self-insured health plans.

This is up from 61 percent last year (state health insurance regulations do not apply to self-insured zithromax price ph plans, as they are instead regulated at the federal level).The average cost of employer-sponsored family health coverage has grown to $21,342 in annual premiums this year, up from $20,576 last year. The uninsured rate continues to rise, and is rising particularly fast among childrenLast month, the U.S. Census Bureau published its zithromax price ph annual health insurance report, with data about health coverage during 2019.

About 8 percent of the population had no health coverage at all during 2019, and about 9.2 percent had no health coverage at the time they were surveyed. This is an increase from 8.9 percent in 2018, but it’s also the continuation of zithromax price ph a steady upward trend in the uninsured rate since the Trump administration took office. It had been 8.7 percent in 2017 and 8.6 percent in 2016.

The uninsured zithromax price ph rate is still well below where it was prior to the ACA. 15.5 percent of the population was uninsured as of 2010.In addition to the continued increase in the overall uninsured rate in recent years, Georgetown University’s Health Policy Institute published a sobering report last week, indicating that the uninsured rate among children in the U.S. Increased more in 2019 than it had in any other year over the zithromax price ph last decade.

In 2016, just 4.7 percent of children in the U.S. Were uninsured, which was zithromax price ph a historic low. But by 2019, it had increased to 5.7 percent.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable zithromax price ph Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Minnesota marketplace highlights and updatesOpen enrollment for 2021 health plans. November 1, zithromax price ph 2020 through December 22, 2020.

Residents with zithromax price ph qualifying events can still enroll or make changes to their 2020 coverage.Insurers implementing modest rate increases for 2021, after three straight years of average rate decreases. Quartz has joined the exchange for 2021, bringing total number of insurers to five.117,520 people enrolled for 2020, a new record for MNsure.Insurer participation in MNsure. 2014 to 2021.Reinsurance program received federal approval, began operation in 2018.With reinsurance, zithromax price ph rates decreased for 2018 and again, even more significantly, for 2019.

But reinsurance also reduced funding for MinnesotaCare.The elimination of CSR funding further reduced MinnesotaCare funding, but this has been partly restored by a court ruling.MN provided premium relief for non-subsidy-eligible enrollees for 2017 only.Governor vetoed a proposed 2019 switch to HealthCare.gov.MNsure’s small business exchange no longer has any participating insurers.Minnesota health exchange overviewMinnesota’s one of the states fighting the hardest to preserve the Affordable Care Act’s gains. See actions Minnesota has taken.Minnesota’s state-run exchange, MNsure, has zithromax price ph five participating insurers for 2021, up from four in 2020. The exchange has more than 117,000 individual market enrollees as of 2020.As a result of the buy antibiotics zithromax, MNsure joined most of the other state-run exchanges in offering a special enrollment period during which people who were uninsured could enroll in a health plan.

MNsure’s special enrollment zithromax price ph period began March 23, and continued through April 21. Nearly 9,500 Minnesota residents enrolled in private plans through MNsure during this window, as well as another 13,700 who enrolled in MinnesotaCare or Medicaid (enrollment in those programs is open year-round for eligible residents).Allison O’Toole, who led MNsure as CEO for three years, announced her resignation in March 2018, and the exchange named Nate Clark, the MNsure COO, as acting CEO. A few months later, the MNsure board named Clark as zithromax price ph the permanent CEO.

O’Toole left MNsure to work as director of state affairs for United States of Care, a non-profit created by Andy Slavitt, who was the acting administrator of CMS under the Obama Administration.Throughout 2017, Minnesotans who bought their own health insurance (on or off-exchange) and weren’t eligible for ACA subsidies were provided with 25 percent premium rebates from the state as a result of S.F.1, signed into law by Governor Dayton in early 2017. The subsidies helped to offset the large premium increases that applied in Minnesota in 2017, and helped to stabilize the zithromax price ph individual health insurance market in 2017. But the premium rebate program expired at the end of 2017.Thanks in large part to the new reinsurance program that Minnesota created (details below), premiums decreased in Minnesota’s individual market in 2018, 2019, and again in 2020, although rates are increasing modestly for 2021.

In May 2019, Minnesota leaders reached an agreement on a budget that included an extension of the zithromax price ph reinsurance program through 2020 and 2021 (it has already been granted federal approval through the end of 2022, but the state has to continue to cover its share of the cost. Minnesota Governor Tim Walz had hoped to implement a premium subsidy program and a new tax credit in Minnesota starting in 2020. But a compromise in the budget ended up with the state opting to continue the existing reinsurance program for two more years instead.).But the waiver that provides federal pass-through funding for reinsurance also resulted in a sharp and unexpected decrease in federal funding zithromax price ph for MinnesotaCare, the Basic Health Program that provides coverage for people with income between 138 percent and 200 percent of the poverty level (between $16,642 and $24,120 for a single person).In addition, the elimination of federal funding for cost-sharing reductions (CSR) in October 2018 resulted in a funding cut for MinnesotaCare, since the program is funded in large part by federal funds that would otherwise have been used to pay for premium subsidies and cost-sharing reductions in the exchange for the population that is instead eligible for MinnesotaCare.

After an ensuing legal battle, a judge ordered HHS to restore funding for MinnesotaCare, although a resolution of the situation is ongoing, and the amount that HHS agreed to pay was still less than MinnesotaCare would have received if CSR funding had continued.Open enrollment for 2021 health plans extended through December 22, 2020. Insurers implementing modest rate increases for 2021, after zithromax price ph three years of overall rate decreasesMNsure enabled window shopping for 2021 health plans as of October 12, 2020. This gives residents a few weeks to browse the available plans before open enrollment starts on November 1, 2020.

And MNsure has announced that zithromax price ph open enrollment will continue through December 22, 2020. That’s a week longer than the open enrollment period that will apply in states that use the federally-run exchange. The flexibility to extend open enrollment is often zithromax price ph cited as one of the benefits of having a fully state-run exchange.

(MNsure had a similar extension last December, for 2020 health plans).For 2021, Quartz is joining the Minnesota marketplace. Quartz currently offers plans in Illinois and Wisconsin, and is expanding into zithromax price ph Minnesota for 2021. And two of the existing insurers — HealthPartners and UCare — are expanding their coverage areas for 2021 (BluePlus and Medica offer coverage statewide, and will continue to do so in 2021).The following average rate changes have been approved for MNsure’s insurers:Blue Plus.

4.21 percent increase (down from an zithromax price ph initially proposed 7.12 percent increase)Group Health/Health Partners (GHI). 0.67 percent increase (down from an initially proposed 4.15 percent increase)Medica. 2.42 percent increase (down from an initially proposed 7.06 percent increase)UCare zithromax price ph.

1.6 percent increase (up from an initially proposed 1.39 percent decrease)Quartz. New for 2021, so no applicable rate changePreferredOne Insurance Company, which offers plans outside the exchange, is increasing premiums by 1.05 percent (down from an initially proposed zithromax price ph average increase of 5.09 percent). Rate changes in previous years2015.

Average increase zithromax price ph of 4.5 percent. MNsure critics characterized the official announcement as misleading as it failed to zithromax price ph take into account low-cost 2014 plans from PreferredOne. Consumers who bought a PreferredOne plan through MNsure for 2014 could only renew their policies for 2015 by working directly with the insurer, since PreferredOne stopped offering plans in the exchange at the end of 2014.

However, PreferredOne rates went up an average of 63 percent, and consumers didn’t zithromax price ph qualify for subsidies if they shopped outside the exchange. 2016. Average increase of 41.4 percent for the individual market, and about 38.5 for plans zithromax price ph sold in MNsure (ie, not counting PreferredOne).

Rates increased significantly in 2016 across the entire individual market in Minnesota — including plans sold through MNsure, the state-run exchange.Approved rates for 2016 were announced on October 1, 2015, ranging from about 15 percent for Medica to 49 percent for Blue Cross Blue Shield of Minnesota. In general, the carriers cited higher-than-expected claims costs over the past year, along with the impending phase-out of the ACA’s reinsurance program as justification for their 2016 zithromax price ph rate requests. But Governor Mark Dayton called some of the higher proposed increases “outrageous,” and promised a rigorous review of the filed rate changes and justifications.

Ultimately, regulators were able to limit the highest rate increases to 49 percent — as opposed to the 54 percent zithromax price ph that had been requested by Blue Plus and BCBS of MN — but the final weighted average rate increase in the individual market in Minnesota still ended up being the highest in the nation. But Minnesota still had the lowest overall premiums in the upper midwest (although Minnesota had the highest average rate increase in the country for 2016, they had the lowest overall rates in the country in 2014 and 2015).Minnesota Commerce Commissioner Mike Rothman called the rate increases “unacceptably high,” and Gov. Dayton noted that he zithromax price ph was “extremely unhappy” with the rate changes.

But Rothman noted that his office “objected to all of the rates across the board,” and “squeezed out everything we could that was not actuarial justified.” In other words, the final rates, although much higher than officials and policyholders would have liked, were justified based on medical claims costs — the population enrolled in individual health plans in Minnesota was sicker than expected, and drug costs had been particularly onerous.Only about 55 percent of people who had 2015 coverage through MNsure received premium subsidies. But due to the zithromax price ph sharp premium increases, that had increased to about 63 percent for the people who had purchased or renewed coverage as of June 2016.2017. When the Minnesota Department of Commerce announced health insurance rates for 2017 for the individual and small group markets, the rate hikes were somewhat reasonable in the small group market (ranging from a decrease of 1 percent to an increase of 17.8 percent), but the individual market was “experiencing serious disruptions in 2017” and “on the verge of collapse.” The four carriers that offered plans through MNsure had the following average rate increases in 2017:Blue Plus = 55 percentHealthPartners/Group Health (GHI) = 50 percent (HealthPartners is only offering plans in 10 of the 67 counties where they offered plans in 2016.

Their enrollment cap is 72,000 for 2017)Medica = 57.5 percent (enrollment cap is 50,000 for 2017)UCare = 66.8 percent (UCare capped enrollment at 30,000 for 2017, but only had 16,000 enrollees in 2016)The enrollment caps that HealthPartners, Medica, and UCare employed for 2017 were approved as part of the rate review process, and are designed to protect carriers from further financial losses as they absorb BCBSMN’s enrollees who are shopping for new coverage during open zithromax price ph enrollment.In a news release relating to the rate announcement for 2017, the Minnesota Department of Commerce didn’t mince words. They noted that the individual market in the state was on the brink of collapse, and that they did everything in their power to save the market. While they succeeded in keeping the state’s individual market viable for 2017, with only one carrier exiting (BCBSMN, although their HMO affiliate, Blue Plus, remained in the exchange), they reiterated very clearly that substantial reforms would be needed to keep the market zithromax price ph stable in future years, and highlighted the fact that rates would be sharply higher and that carriers would limit enrollment in 2017.2018.

Final rates for 2018 were approved in October 2017 (comprehensive information about the approved rates is here), based on the Minnesota Premium Security Plan (MSPS) being implemented but cost-sharing reductions (CSR) not being funded by the federal government (the cost of CSRs was added to on-exchange Silver plans). Average approved rate changes zithromax price ph for MNsure insurers ranged from a 13.3 percent decrease for UCare to a 2.8 percent increase for Blue Plus. Three of the four MNsure insurers decreased their average premiums for 2018.On September 21, MNsure had posted a notice indicating that if the reinsurance program were not approved, rates would be about 20 percent higher than they would otherwise be in 2018.

Fortunately for Minnesota residents, the reinsurance program did receive federal approval, and average rates declined slightly for 2018.But some enrollees who don’t zithromax price ph get ACA premium subsidies still experienced a rate increase, due to the termination of the one-year, state-funded 25 percent premium rebates at the end of 2017.PreferredOne, which exited MNsure at the end of 2014 and only offers coverage in the off-exchange market, proposed dramatically lower rates for 2018. A 38 percent average decrease if MSPS were to be approved, and a 23 percent average decrease if not. The 38 percent decrease was implemented, and no adjustments were necessary to account for CSR funding, since PreferredOne does not offer plans in the exchange, and CSRs zithromax price ph are only available on silver exchange plans.2019.

Average premium decrease of 12.4 percent. Average premiums dropped for all five zithromax price ph insurers in the individual market in 2019. This was the second year in a row of declining rates in Minnesota, but Blue Plus had a small rate increase for 2018, so 2019 was the first year that all five insurers decreased their average rates.

Minnesota insurance regulators noted that rates in 2019 were about 20 percent lower than they would have been without the reinsurance program.But most of Minnesota’s insurers charged higher rates in 2019 than they would have if the individual mandate penalty hadn’t been eliminated, and if zithromax price ph access to short-term plans and association health plans hadn’t been expanded by the Trump administration. For example, UCare’s rate filing notes that while average rates were decreasing by about 10 percent, the rate decrease would have been nearly 15 percent if the individual mandate penalty had remained in place.At ACA Signups, Charles Gaba calculated a weighted average rate decrease of 12.4 percent for 2019 in Minnesota, but noted that the average decrease would have been nearly 19 percent without those changes at the federal level.2020. Average premium decrease of 1 percent zithromax price ph.

Four of the five insurers (including PreferredOne, which only offers coverage off-exchange) in Minnesota’s individual market decreased their average premiums for 2020. This was the third year in a row that average individual market premiums dropped in Minnesota’s individual market, due in large part to the reinsurance program that the state has established.The following average zithromax price ph rate changes were implemented for 2020:Blue Plus. 1.5 percent decrease (Blue Plus zithromax price ph had originally proposed a 4.8 percent increase)Group Health/Health Partners (GHI).

1.26 percent decrease (GHI had originally proposed a 2.1 percent increase)Medica. 1.01 percent decrease (Medica had originally proposed an average decrease zithromax price ph of 1.4 percent)UCare. 0.18 percent increase (UCare originally proposed a 0.3 percent increase)PreferredOne, which only offers off-exchange coverage, reduced their rates by an average of 20 percent, on the heels of an 11 percent decrease in 2019.

MNsure enrollment exceeded 116k in 2018, dropped to 113k for 2019, but grew to more than 1117k in 2020From 2014 through zithromax price ph 2018, enrollment in MNsure’s individual market plans increased every year, reaching 116,358 people by 2018. That was the highest open enrollment total in MNsure’s history, despite the shorter enrollment period, which ended in mid-January instead of the end of January (open enrollment for 2018 coverage ended on December 15, 2017 in states that use HealthCare.gov, but MNsure opted to extend their enrollment window that year, and have also extended subsequent enrollment windows).Enrollment dropped for the first time in 2019, when 113,552 people enrolled in individual market plans through MNsure. In most states that use zithromax price ph HealthCare.gov, enrollment peaked in 2016 and has been dropping since then.

But MNsure’s drop-off in 2019, which amounted to only a 2.4 percent reduction in enrollment, is the only time year-over-year enrollment has declined. Notably, the ACA’s individual mandate penalty was eliminated as of 2019, and regulations that the Trump administration implemented in late 2018 now make it more feasible for healthy people to use short-term plans instead of ACA-compliant plans (Minnesota has its own rules for short-term plans, but they’re more relaxed than the Obama-era federal rules that applied in 2017 and most of 2018).And for 2020, enrollment grew again, reaching a record high of 117,520 zithromax price ph enrollees.Here’s a look at the number of people who have signed up for individual market plans through MNsure during each year’s open enrollment period. These numbers all represent total enrollment at the end of open enrollment.

Effectuated enrollment is always lower, and MNsure provides periodic effectuated enrollment data on their board meeting materials zithromax price ph page. Insurer participation in MNsure. 2014-20212014.

Five insurers offered individual policies through MNsure for 2014. Blue Cross Blue Shield of Minnesota, HealthPartners/Group Health, Medica, PreferredOne, and UCare. Kaiser Health News reported how to get zithromax prescription that Minnesota offered some of the lowest premiums for silver (mid-level) plans in the U.S.

Four of Minnesota’s nine regions made Kaiser’s list of the 10 least expensive places to buy health insurance.2015. But PreferredOne, which offered the lowest rates in the nation in 2014 and captured a large portion of 2014 enrollees, withdrew from MNsure for 2015. PreferredOne said remaining on the exchange was “not administratively and financially sustainable.” A Star Tribune business writer attributed PreferredOne’s departure as a market dynamics issue rather than a problem with MNsure.However, Blue Plus (an affiliate of Blue Cross Blue Shield of MN, offering HMO plans) joined the exchange for 2015, so there were still five insurers offering plans for 2015.

Blue Cross Blue Shield of Minnesota, Blue Plus, Health Partners/Group Health, Medica, and UCare. MNsure offered 84 plans statewide, up from 78 for 2014.2016. BCBSMN, Blue Plus, Health Partners/Group Health, Medica, and UCare offered individual market plans through MNsure for 2016.2017.

In an effort to recruit more carriers to offer plans through MNsure for 2017 — particularly outside the Twin Cities metro area — state regulators sent out a request for proposals from health insurers on August 15, 2016. Regulators noted that insurers could propose waivers of regulations in order to make it feasible for them to offer coverage through MNsure, although any such waiver requests would have to be approved by regulators.Steven Parente, a health insurance expert at the University of Minnesota, called the state’s effort to recruit insurers to MNsure a “distress call” and noted that August 15 is awfully late in the year to be putting out a request for insurer participation, given that open enrollment begins November 1. And ultimately, no new insurers opted to join MNsure for 2017.Blue Cross Blue Shield of MN dropped their individual market PPO plans at the end of 2016 due to significant financial losses.

That left Blue Plus (which offered HMOs and covered roughly 13,000 people in 2016 in the individual market) as the only BCBSMN affiliate in the exchange. Roughly 103,000 people had to select new plans during open enrollment.Most of those BCBSMN enrollees had off-exchange coverage, though. There were only about 20,400 MNsure enrollees (a little more than one in five MNsure enrollees) with coverage under BCBSMN who needed to switch to another plan during open enrollment.

BCBSMN had individual PPO options available in all 87 counties in Minnesota through MNsure in 2016, while the Blue Plus coverage area — comprised of four separate HMO networks — was available in 77 of the state’s counties.Nationwide, carriers have been shifting away from PPOs and towards HMOs and EPOs. In Colorado, Anthem Blue Cross Blue Shield also dropped their PPOs at the end of 2016. In Indiana, there were no PPOs available in the individual market by 2017.

Blue Cross Blue Shield of New Mexico dropped all of their individual market plans at the end of 2015 except one off-exchange HMO. Blue Cross Blue Shield of Texas dropped their individual market PPO plans at the end of 2015.The broad network offered by PPOs tends to be attractive to enrollees who have health problems. They’re often willing to pay higher premiums in trade for access to broad network of hospitals and specialists.

But PPOs are expensive for carriers, as enrollees don’t need primary care referrals to see specialists, and it’s more challenging for carriers to hold down costs when there are more providers in the network.All of the MNsure carriers except Blue Plus are also limiting their total enrollment for 2017. By November 11, 2016, less than two weeks into open enrollment for 2017 coverage, Medica had hit their 50,000 member enrollment cap for 2017 (including on and off-exchange enrollments, and also accounting for expected renewals of 2016 Medica plans), and their policies were no longer available in the individual market in Minnesota, on or off-exchange. The only exception was five counties (Benton, Crow Wing, Mille Lacs, Morrison, and Stearns) where Medica agreed not to limit enrollment, as all of the other available carriers in those counties have imposed enrollment caps too.

In those five counties, Medica plans continued to be available.At that point, Medica’s market share in MNsure for 2017 stood at 34.2 percent. By December 14, Medica’s market share had dropped to 27.7 percent, as enrollments had continued to climb for the remaining carriers.On January 31, Medica re-opened enrollment for 2017. This was because a smaller-than-expected number of 2016 Medica enrollees renewed their plans for 2017, meaning that the carrier still had some wiggle room under their 50,000 member cap.

At that point, they had room for about 7,000 more enrollees. Medica plans were thus available throughout the duration of the special enrollment period that was added on at the end of open enrollment, and continue to be available for people with qualifying events.2018. Plans continued to be available from Blue Plus, Health Partners/Group Health (GHI), Medica, UCare.

In the months before a decision was reached regarding an extension of the open enrollment window for 2018 plans (the first year that the federal government imposed a shorter, month-and-a-half enrollment window), two of MNsure’s participating insurers had differing positions. UCare believed the exchange should add an additional two-week special enrollment period, while Medica did not want the exchange to have the option to extend the newly-scheduled six-week enrollment window. Notably, Medica capped their enrollment very early during the 2017 open enrollment period, and while UCare also had an enrollment cap, it was set with a target of nearly doubling their 2016 enrollment.

But Medica is the only MNsure insurer that didn’t set an enrollment cap for 2018.As was the case for 2017, enrollment caps were used in the individual market in Minnesota for 2018 by all insurers other than Medica (Medica did have an enrollment cap for 2017, which they hit very early in open enrollment. However, they resumed enrollments at the end of January 2017). Details about the insurers’ enrollment caps are in the plan binders in SERFF.

For 2018, MNsure insurers implemented the following enrollment caps:Blue Plus. 55,000 member cap (aiming for a target of 50,000 effectuated enrollees, but effectuated enrollment is always lower than the number of people who initially enroll)Health Partners/Group Health (GHI). 73,400 member cap (aiming for a target of 70,000 effectuated enrollees)Medica.

No enrollment capUCare. 35,000 member cap (aiming for a target of 30,000 effectuated enrollees)MNsure confirmed in May 2018 that none of their insurers had hit their enrollment caps for 2018.Outside the exchange, PreferredOne had an enrollment cap of 3,000 members, although their 2017 membership was only about 300 people.2019 and 2020. Blue Plus, Health Partners/Group Health, UCare, and Medica have continued to offer plans through MNsure, and all of them continued to participate in 2020 as well.

Blue Plus expanded to once again offer statewide coverage in 2020, for the first time since 2016.2021. Quartz joined the exchange for 2021, joining the four existing insurers. HealthPartners and UCare are both expanding their coverage areas for 2021.Minnesota Premium Security Plan.

1332 waiver proposal approved by CMS, but with a significant funding cut for MinnesotaCareIn May 2017, Minnesota Governor Mark Dayton submitted a 1332 waiver proposal to CMS. The 1332 waiver was based on H.F.5, which was enacted without Dayton’s signature in April 2017 (Dayton had proposed an alternative measure that would have allowed people in Minnesota to buy into MinnesotaCare. That measure was not able to pass the state’s Republican-dominated legislature).[For more than two decades, MinnesotaCare was a state program subsidizing health insurance for low-income residents.

As of January 1, 2015, it transitioned to a Basic Health Program under the ACA, becoming the first BHP in the nation.]H.F.5 created the Minnesota Premium Security Plan (MPSP), which is a state-based reinsurance program (similar to the one the ACA implemented on a temporary basis through 2016, and that Alaska created for 2017. Several other states have since implemented reinsurance programs). The reinsurance program, which took effect in Minnesota in 2018, covers a portion of the claims that insurers face, resulting in lower total claims costs for the insurers, and thus lower premiums (average individual market premiums in Minnesota decreased from 2017 to 2018 as a result of the reinsurance program).

The reinsurance kicks in once claims reach $50,000, and covers them at 80 percent up to $250,000 (this is similar to the coverage under the transitional reinsurance program that the ACA provided from 2014 through 2016).H.F.5 was contingent upon approval of the 1332 waiver, because it relies partially on federal funding, in addition to state funding. Under the federal approval that was granted in September 2017, the federal government is giving Minnesota the money that they save on premium tax credits, and that money is combined with state funds to implement the reinsurance program (lower premiums — as a result of the reinsurance program — result in the federal government having to pay a smaller total amount of premium tax credits, since the tax credits are smaller when premiums are smaller).It was expected that CMS would approve the state’s 1332 waiver proposal, and Governor Dayton requested that the approval process be swift so that the state could move forward with the implementation of the Minnesota Premium Security Plan in time for the 2018 plan year. Dayton indicated that his office had been told that approval would come in August 2017, but CMS didn’t approve the waiver until September 22.

And the waiver approval letter noted that the federal savings for MinnesotaCare (the state’s Basic Health Program, or BHP) resulting from the reinsurance program would not be eligible to be passed along to the state — in other words, CMS would keep those savings instead.[Federal BHP funding is equal to 95 percent of the amount that the federal government would have otherwise spent on premium subsidies and cost-sharing reductions for the population that ends up being eligible for the BHP. So lower premiums — as a result of reinsurance — for qualified health plans in the exchange means that the amount the federal government would have had to spend on premium subsidies for that population is lower. That translates into a smaller amount of funding for the state’s BHP, according to the approach that HHS took for Minnesota’s waiver approval.]And based on the scathing letter that Dayton sent CMS a few days earlier, it appeared at that point that Minnesota could actually lose money on the deal — losing more in federal funding for MinnesotaCare than they gain in reinsurance funding.

Dayton noted in his letter that the 1332 waiver approval process had been “nightmarish,” and that Minnesota went to great lengths to follow instructions from CMS at every turn, throughout the process of drafting H.F.5 and the 1332 waiver proposal. He explains that CMS provided Minnesota with explicit guidance in terms of how to draft the reinsurance program while maintaining full federal funding for MinnesotaCare, and highlighted the fact that the state never deviated from the instructions that were provided.The StarTribune editorial board called out then-Secretary of HHS, Tom Price and the Trump Administration for their lack of clarity on the issue, for apparently misleading the state during the 1332 waiver drafting process, and for effectively punishing the state of Minnesota for taking an innovative approach to ensuring that as many people as possible have health insurance.Insurers filed rates based on reinsurance being available. And by the time the waiver was approved, there was very little time to evaluate the potential impacts of the funding changes, as rates had to be finalized by October 2 in Minnesota.

The finalized rates did incorporate the reinsurance program. The state has accepted the approved waiver, but Gov. Dayton sent a letter to HHS on October 3, asking them to reconsider the MinnesotaCare funding cuts, but the issue has remained unresolved.Elimination of CSR funding results in additional funding cut for MinnesotaCare, but a lawsuit has partially restored that fundingNationwide, 54 percent of exchange enrollees benefit from cost-sharing subsidies.

But in Minnesota, only 13 percent of exchange enrollees are receiving cost-sharing subsidies. This is because of MinnesotaCare, which covers all enrollees with income up to 200 percent of the poverty level. That’s the same group that would otherwise benefit the most from cost-sharing subsidies, so the fact that MinnesotaCare is available means that most of the people who would otherwise be enrolled in cost-sharing subsidy plans are instead enrolled in MinnesotaCare.At first glance, this would appear to have made the uncertainty surrounding cost-sharing subsidy funding in 2017 a little less of a pressing issue in Minnesota than it was in many other states, since private insurers weren’t facing the sort of losses that insurers in other states were facing without federal funding for CSR.

But when the Trump Administration eliminated federal funding for CSR in October 2017, HHS took the position tha t since CSR funding had been eliminated, the CSR portion of the federal funding for the BHPs in New York and Minnesota would be reduced to $0. This was not a cut-and-dried conclusion, however, as explained earlier in 2017 by Michael Kalina.In January 2018, the Attorneys General for New York and Minnesota filed a lawsuit against the US Department of Health and Human Services, seeking to restore funding for their Basic Health Programs. A judge ruled in favor of the states in May 2018, ensuring that MinnesotaCare would continue to receive at least some CSR-based funding.

The amount awarded to the state for the first quarter of 2018 was just over half of what the state had initially expected in CSR-related funding, but a larger chuck of the funding was restored later in 2018. According to the Star Tribune, however, Minnesota still ended up losing $161 million in federal funding for MinnesotaCare due to the CSR funding cuts.In early 2019, the Trump administration proposed yet another funding cut (a third, after the cuts imposed by the reinsurance program and the elimination of CSR funding) as part of a new methodology for calculating BHP funding. This one was much smaller than the other two cuts, but taken together the funding reductions are pushing MinnesotaCare towards a looming budget shortfall.

SHOP exchange. Down to one carrier as of 2016, zero by 2018 (and still zero in 2019)In 2015, there were two carriers in MNsure’s SHOP exchange for small businesses. Blue Cross Blue Shield of Minnesota, and Medica.

But Medica announced in 2015 that they would exit the SHOP exchange in Minnesota, North Dakota, and Wisconsin at the end of the year. That left BCBS as the only small group carrier available through MNsure in 2016, but it didn’t change much from a practical standpoint, since 83 percent of MNsure’s small groups were enrolled in plans through BCBS in 2015. Indeed, Medica’s reason for exiting the small business exchange was based on low enrollment in the first two years.Blue Cross Blue Shield of Minnesota continued to be the only insurer offering SHOP coverage via MNsure in 2017, but announced in July 2017 that they would no longer offer SHOP coverage in 2018, and would instead transition their SHOP enrollees to small business coverage outside the exchange.

At that point, there were only 3,287 people enrolled in SHOP coverage in Minnesota — far below the 155,000 people that were originally projected to have coverage through MNsure’s SHOP program by 2016 (this much lower-than-anticipated enrollment has been the case in nearly every state’s SHOP exchange. This situation is not unique to Minnesota). State law provided 25% premium rebate in 2017.

Amendment to allow plans without essential benefits was cut from final legislationThroughout 2016, then-Governor Dayton called for a state-funded premium rebate for people who buy their own insurance but aren’t eligible for the ACA’s premium subsidies (those are only available for people with income up to 400 percent of the poverty level, or $100,400 for a family of four in 2019).Governor Dayton also noted that the government needed to act quickly to stabilize the individual market in Minnesota, and by late November 2016, his patience with lawmakers was wearing thin. In a November 23 press conference, Dayton said that House Republicans needed to “stop dilly-dallying” and decide whether to move forward with Dayton’s rebate proposal.Dayton had also indicated that he was considering calling a special session of the legislature after election day to address the situation, and that was being negotiated for December 20. But the talks fell through when Dayton and Republican House Speaker Kurt Daudt couldn’t agree on the three bills that would have been addressed in the special session.

As a result, there was no special session.Instead, the issue was taken up by lawmakers as soon as the 2017 legislative session began. On January 5, Minnesota Senators Michelle Benson (R, 31st District) and Gary Dahms (R, 16th District) introduced S.F.1. The bill called for using $300 million in state funding to provide a 25 percent rebate to roughly 125,000 people in Minnesota.S.F.1 passed the Minnesota Senate by a 35-31 vote on January 12.

Only one DFL Senator (Melisa Franzen, from Edina) voted with Republicans in favor of the legislation. It was then sent to the House, where an amendment was added that stripped out the requirement that health plans provide various mandated benefits (see “Journal of the Day” section “Top of page 154” in this version of the bill. Under the terms of the amendment, as long as a carrier offered at least one plan with all the mandated benefits, they would have been allowed to offer others without mandated benefits).The amended bill was sent back to the Senate on January 23.

Differences between the bills that the two chambers passed had to be reconciled before being sent to Governor Dayton for his signature. By that point, the amendment to allow less-robust plans to be sold had garnered national attention, and public outrage helped to push lawmakers away from the provision. S.F.1 had also called for $150 million to be appropriated for fiscal year 2018 (through June 30, 2019) from the state general fund to a state-based reinsurance program to stabilize the individual market (Alaska did something similar in 2016, preventing a market collapse), but that provision was also removed in the final version (Minnesota did ultimately set up a reinsurance program, effective in 2018, which has served to stabilize the market and reduce premiums).A Conference Committee in the Senate recommended that the House “recede from its amendments” and the Conference Committee report passed the Senate on a 47-19 vote.

The House passed the bill a few hours later, 108-19. It was sent to Governor Dayton, who immediately signed it into law. DFLers did have to compromise on one issue during the process.

S.F.1 allows for-profit HMOs to begin operating in Minnesota’s individual market, which had long been limited to non-profit HMOs.Consumers were told to expect the premium rebates to show up by April 2017, but they were retroactively effective to January 2017. So a person who had been paying full price for a plan since January 2017 saw a substantial premium reduction on the April or May invoice. Going forward, for the remainder of the year, a 25 percent rebate applied each month.Since S.F.1 was signed into law with only a few days remaining in open enrollment (it ended January 31 that year), Governor Dayton and exchange officials were worried that there wouldn’t be enough time for people to learn about the rebate and apply for coverage before January 31.

In December, Dayton had asked HHS to allow MNsure to extend its enrollment deadline to February 28 (instead of January 31) in order to allow lawmakers more time to work out the details of a state-based premium rebate while still allowing people to enroll after the legislative process is complete.HHS denied the request for a blanket extension, but MNsure used their own authority on January 28 to grant a one-week special enrollment period (February 1 to February 8) due to exceptional circumstances. Although the state-based 25 percent premium rebate was available on or off the exchange, the one-week extension was only valid through MNsure. Health insurers did not have to accept off-exchange enrollments without a qualifying event after January 31.The 25 percent premium rebate program in Minnesota was only authorized for one year, so the rebates did not continue into 2018.

And although almost 100,000 people received premium relief through the program in 2017, it ended up costing less than the legislature had allocated, and about $100 million was returned to the state’s budget at the end of 2017.Protecting Medicaid enrollees from estate liensIn every state, Medicaid is jointly funded by the state and the federal government. Longstanding federal regulations, which predate the ACA, require states to “seek recovery of payments from the individual’s estate for nursing facility services, home and community-based services, and related hospital and prescription drug services” for any Medicaid enrollee over the age of 55. This applies essentially to long-term care services, but states also have the option to go after the individual’s estate to recover costs for other care that was provided by Medicaid after age 55.Prior to 2014, this wasn’t typically an issue, as Medicaid eligibility was generally restricted by asset tests or requirements that applicants be disabled or pregnant (although Minnesota did have much more generous Medicaid eligibility guidelines than most states prior to 2014).

But as of 2014, in states that expanded Medicaid under the ACA, the only eligibility guideline is income. Applicants with income that doesn’t exceed 138 percent of the poverty level are directed to Medicaid, regardless of any assets they might have.When applicants use the health insurance exchange — MNsure in Minnesota — they’re automatically funneled into Medical Assistance (Medicaid) if their income is under 138 percent of the poverty level. But what these enrollees didn’t know was that the state also had a program in place to put liens on estates for Medicaid-provided services for people age 55 and older.The combination of these systems caught numerous residents off guard.

They were enrolled in Medical Assistance through MNsure based on their income, but were not aware that liens were being placed on their homes so that the state could recoup the costs upon their deaths.State Senator Tony Lourey (DFL, District 11) addressed the issue with language included in HF2749, the Omnibus supplemental budget bill, which was signed into law by Governor Dayton on June 1, 2016. The legislation limits estate recovery to just what’s required under federal Medicaid rules (ie, essentially, long-term care costs for people age 55 or older), and makes the provision retroactive to January 1, 2014.Early tech strugglesMNsure opened for business in the fall of 2013, but technological issues persisted well into 2015, despite numerous improvements throughout 2014. Given MNsure’s difficult launch, the state conducted a series of audits and reviews.

The first audit reviewed how MNsure spent state and federal money. Auditors concluded that the exchange has generally adequate internal controls and found no fraud or abuse. The review was conducted by the state Office of the Legislative Auditor, and the report was published in October 2014.Another audit, also conducted by the Office of the Legislative Auditor and released in November 2014, found that the MNsure system in some cases incorrectly determined who qualified for public health benefits.

The errors occurred during the first open enrollment period, before a series of system fixes were implemented. The audit did not quantify the total financial impact of the errors. The state Human Services commissioner said a consultant working on technical fixes to MNsure concluded that the eligibility functionality was working correctly as of June 2014.A third audit, a performance evaluation report released in February 2015, said “MNsure’s failures outweighed its achievements.” Among other criticisms, auditors said MNsure staff withheld information from the board of directors and state officials, the enrollment website was seriously flawed and launched without adequate testing, and the first-year enrollment target was unrealistically low.In April 2014, MNsure hired Deloitte Consulting to audit MNsure’s technology and improve the website to make enrolling in coverage and updating life events easier and more streamlined.

Deloitte has been involved in successful state-run marketplaces for Connecticut, Kentucky, Rhode Island and Washington.Software upgrades were installed in August 2014, and system testing continued right up until the start of open enrollment. To reduce wait times for consumers and insurance professionals, MNsure increased its call center and support staff and launched a dedicated service line for agents and brokers.More in-person assisters were available in Minnesota for the 2015 open enrollment period. MNsure encourages residents to utilize the exchange’s assister directory to find local navigators and brokers who can help with the enrollment process.MNsure has improved dramatically in terms of its technology since the early days of ACA implementation, and enrollment increased every year from 2014 through 2019.Lawmakers approved switching to HealthCare.gov as of 2019, but governor vetoedOn May 9, 2017, lawmakers in Minnesota passed SF800, an omnibus health and human services bill.

Among many other things, the legislation called for switching from MNsure to the federally-run marketplace (HealthCare.gov) starting in 2019 (see Section 5). But Governor Dayton vetoed it.Gov. Dayton has long been supportive of MNsure, and had previously clarified that he would veto the bill.

In noting his plans to veto the legislation, Dayton made no mention of the transition to HealthCare.gov that was included in the legislation, but focused instead on the sharp budget cuts in the bill. But his veto ensured that MNsure would remain in place, at least for the time being.The Senate’s original version of SF800 did not call for scrapping MNsure, but the bill went through considerable back-and-forth between the two chambers, and the version that passed was the 4th engrossment of the bill.In March 2015, Dayton had asked the legislature to create a Task Force on Health Care Financing that would study MNsure along with possible future alternatives. Dayton noted in his letter that he supported making MNsure “directly accountable to the governor and subject to the same legislative oversight as other state agencies” and his budget included half a million dollars devoted to the task force.

The spending bill was approved by the legislature in May, and the 29-member task force was appointed in the summer.One of the possibilities that the task force considered was the possibility of switching to Healthcare.gov, but it’s clear that there was no cut-and-dried answer to the question of whether Minnesota is better served by having a state-run exchange, switching to a federally-run exchange, or teaming up with the federal government on either a supported state-based marketplace or partnership exchange.In a December 2015 meeting of the task force, the MN Department of Human Services presented a financial analysis of the alternatives available to MNsure. They determined that switching entirely to Healthcare.gov would cost the state an additional $5.1 million in one-time costs from June 2016 to June 2017. And switching to a supported state-based marketplace would cost an additional $6.6 million during that same time frame.

If the state had opted to switch to Healthcare.gov, the soonest it could have happened was 2018, since HHS requires a year’s notice from states wishing to transition to Healthcare.gov, and Minnesota wouldn’t have been in a position to make a decision until sometime in 2016.There were significant reservations about making that switch prior to the Supreme Court’s ruling on King v. Burwell. The Court ruled in June 2015 that subsidies are legal in every state, including those that use Healthcare.gov.

Prior to the decision, a switch to Healthcare.gov could have jeopardized subsidies for tens of thousands of Minnesota residents. But once it was clear that Healthcare.gov’s subsidies are safe, some stakeholders began calling for Minnesota to scrap its state-run exchange and use Healthcare.gov instead. Because the MNsure task force was included in the 2016 budget, no hasty decisions were made.In January 2016, the task force submitted their recommendations to the legislature.

They covered a broad range of issues, but did not recommend that MNsure transition to the federal enrollment platform. Lawmakers essentially left the exchange alone during the 2016 legislative session.The magnitude of the 2016 rate increases that were announced in October resulted in MNsure opponents renewing their calls to switch to Healthcare.gov. But it’s important to keep in mind that the 41 percent weighted average rate hike in Minnesota was market-wide, and did not just apply to MNsure enrollees.

In fact, the off-exchange carrier (PreferredOne) had among the highest rate hikes in the state for 2016, at 39 percent, and the exchange’s weighted average rate increase (38.5 percent) was lower than the weighted average rate increase for the whole individual market (41 percent).Minnesota health insurance exchange linksMNsure855-3MNSURE (855-366-7873)State Exchange Profile. MinnesotaThe Henry J. Kaiser Family Foundation overview of Minnesota’s progress toward creating a state health insurance exchange.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

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MAYAGÜEZ, PUERTO RICO – Abigail Matos-Pagán llegó a una casa de color azul brillante en Mayagüez, en donde la recibió Beatriz Gastón, quien cost of zithromax 500mg en silencio la condujo a la pequeña habitación de su madre. Matos-Pagán llevaba una vacuna contra buy antibiotics para Wildelma Gastón, de 88 años, quien está confinada en una cama por su artritis y otros problemas de salud. Wildelma Gastón pidió que le pusieran su rosario en el pecho y señaló cost of zithromax 500mg su “brazo bueno”, donde Matos-Pagán le inyectó la primera dosis de la vacuna de Moderna. La familia Gastón, compuesta por cinco miembros, respiró con alivio.

Aunque la vacuna estaba disponible desde hacía meses, Wildelma no había podido ir a un centro de vacunación. Según el rastreador de datos de buy antibiotics de los Centros para el Control cost of zithromax 500mg y la Prevención de Enfermedades (CDC), la tasa de vacunación de Puerto Rico en marzo fue una de las más bajas entre los estados y territorios de Estados Unidos, a pesar de haber recibido más de 1,3 millones de dosis de vacunas. El despliegue puso de manifiesto las disparidades en el acceso a los servicios médicos, y los retos que supone el seguimiento y la comunicación con ciudadanos que viven en lugares lejanos, como Wildelma. Cada vez que regresaban de la escuela o del trabajo, a los familiares les preocupaba la posibilidad de llevar el zithromax a su hogar, y la amenaza que suponía para la vida de Wildelma.

Durante su visita, Matos-Pagán también vacunó a dos de los hijos de Beatriz, que son estudiantes de la Universidad cost of zithromax 500mg de Puerto Rico-Mayaqüez. €œLlevamos mucho tiempo esperando este momento”, dijo Beatriz Gastón mientras se despedía con un abrazo de Matos-Pagán, expresando su gratitud por la visita a domicilio. Para ella la vacuna es algo más que una protección contra el antibiotics. Le permite a cost of zithromax 500mg la familia estar junto a su madre.

Para Matos-Pagán, es una nueva misión. La enfermera, que ha liderado tareas de ayuda tras los huracanes y terremotos en Puerto Rico y otros lugares, se ha propuesto vacunar al mayor número posible de cost of zithromax 500mg personas contra buy antibiotics en este territorio estadounidense. Algunos residentes de Mayagüez, ciudad situada en la costa occidental de la isla principal, la llaman cariñosamente “La reina de la vacunación” y se presentan en su casa pidiendo ayuda para vacunarse. Según el rastreador de casos de The New York Times, hasta el 5 de agosto, Puerto Rico suma cerca de 182,000 casos dSegún el rastreador de casos de The New York Times, hasta el 5 de agosto, Puerto Rico suma cerca de 182,000 casos de buy antibiotics y 2,594 muertes.

Algo más del 59% de la población está totalmente vacunada, pero muchos de los que no están vacunados son cost of zithromax 500mg difíciles de localizar porque viven en comunidades montañosas alejadas, o tienen enfermedades crónicas que les obligan a quedarse en casa. Hasta ahora, Matos-Pagán ha vacunado a unas 1,800 personas en Puerto Rico, incluidas 1,000 con enfermedades crónicas o postradas en cama. En los primeros días de la pandemia, la salud de Carmen Blas empeoró y empezó a utilizar una silla de ruedas. Blas, de 78 años, estaba confinada en su casa, en el tercer piso de un edificio de apartamentos, lo que la mantenía a salvo de contraer buy antibiotics, pero más tarde cost of zithromax 500mg no pudo encontrar transporte para ir a vacunarse.

En junio, sus dos hijos, Lisette y Raymond, vinieron desde Wisconsin para ayudar y llamaron inmediatamente a funcionarios de salud pública para que Blas se vacunara. €œSuelo volver todos los años y esta ha sido la vez que más tiempo he estado fuera. Fue especialmente duro porque la salud de mi madre empeoró y me preocupaba no volver a verla”, contó Raymond, que pensaba prolongar su visita todo el tiempo que cost of zithromax 500mg fuera necesario. Matos-Pagán fue a la casa de Blas, en Aguadilla, para administrarle la vacuna.

La familia celebró cost of zithromax 500mg con alegría la vacunación. €œHa sido muy especial tener momentos personales en la casa de alguien durante la vacunación. Se nota lo mucho que significa para toda la familia”, comentó Matos-Pagán. La movilización durante una crisis no cost of zithromax 500mg es algo nuevo para Matos-Pagán.

Tras el paso del huracán María, que cortó el agua y la electricidad en toda la isla y se cobró más de 3,000 vidas, Matos-Pagán llevó a cabo evaluaciones comunitarias iniciales en las ciudades más remotas y afectadas de Puerto Rico. Muchas carreteras eran inaccesibles debido a las inundaciones y a los escombros, lo que impedía a estas comunidades satisfacer necesidades básicas como alimentos, agua, recetas médicas y transporte. Después, tras una serie de terremotos que sacudieron la isla en 2020, dejando a más personas sin vivienda o en estructuras deficientes, Matos-Pagán organizó a las enfermeras locales cost of zithromax 500mg para que prestaran atención sanitaria a la comunidad. Suministraron a las poblaciones en riesgo sus medicamentos cuando las farmacias cerraron y los equipos instalaron tiendas médicas móviles junto a hospitales que estaban saturados.

€œSoy hiperactiva y estoy siempre ocupada en mi vida diaria, pero cuando hay una crisis, estoy tranquila y calmada. Con los pies en cost of zithromax 500mg la tierra. Siento que estoy donde debo estar”, expresó. Matos-Pagán nació en Nueva cost of zithromax 500mg York.

Se interesó por la medicina después de ver cómo las enfermeras ayudaban a su madre, que murió por complicaciones de un aneurisma cuando Matos-Pagán tenía 9 años. La muerte de su madre le enseñó que “nada era permanente”, dijo, lo que la ha inspirado a actuar cuando ocurre un desastre y a apoyar a las personas ante la tragedia y la pérdida. Abigail Matos-Pagán le administra la vacuna contra buy antibiotics a Wildelma Gastón, en su casa de Mayagüez, en Puerto Rico cost of zithromax 500mg. Gastón está confinada en su cama por la artritis y otros problemas de salud.

(Alicia Carter) Matos-Pagán regresó a Puerto Rico para estudiar enfermería y posteriormente obtuvo un máster y un doctorado en la Universidad de Puerto Rico-Mayagüez. Gracias a su trabajo, ostenta cost of zithromax 500mg varios títulos. Primera comandante del Equipo de Respuesta a Desastres de Puerto Rico, y directora y fundadora de la Coalición de Enfermeras para Comunidades en Desastre. Su experiencia en la gestión de profesionales y recursos médicos durante los huracanes la ha llevado a lugares de la costa atlántica estadounidense y del Caribe.

Durante la pandemia de buy antibiotics, fue contratada para ayudar a dirigir el triage (sistema para seleccionar a los pacientes cost of zithromax 500mg prioritarios que llegan a urgencias) de una unidad de cuidados intensivos, escasa de recursos, en El Paso, Texas, y en una residencia de mayores muy afectada en Maryland. €œNo todo el mundo está hecho para esto. Es un trabajo realmente triste y deprimente”, señaló Matos-Pagán cost of zithromax 500mg. €œPero incluso cuando hay miles de víctimas, se pueden salvar vidas y satisfacer las necesidades básicas de las personas.

He visto a las comunidades unirse de manera increíble. Es un cost of zithromax 500mg reto, pero eso es lo que me hace seguir adelante”. Y mientras trabaja para inyectar con rapidez más vacunas contra buy antibiotics en los brazos de los residentes de Puerto Rico, Matos-Pagán se prepara para la próxima crisis. La temporada de huracanes comenzó oficialmente en junio, y estará en alerta para otro posible desafío sanitario hasta finales de noviembre.

Related Topics Contact Us Submit cost of zithromax 500mg a Story TipSACRAMENTO, Calif. €” A proposal sailing through the California legislature that aims to stop people from getting harassed outside of vaccination sites is raising alarms among some First Amendment experts. If it becomes law, SB 742 would make it punishable by up to six months in jail and/or a maximum fine of $1,000 to intimidate, threaten, harass or prevent people from getting a buy antibiotics — or any other — treatment on their way to a vaccination site. The measure cost of zithromax 500mg was introduced after protesters briefly shut down a mass vaccination clinic at Los Angeles’ Dodger Stadium in January.

Now that mass vaccination clinics have mostly folded up, lawmakers worry that vaccination sites with less security than Dodger Stadium — like pharmacies and mobile clinics in parks or fast-food parking lots — are vulnerable. It’s a sign of how toxic the issue of cost of zithromax 500mg vaccination has become in a state with a long history of intense and divisive treatment wars. State Sen. Richard Pan (D-Sacramento), a pediatrician who administers treatments to his patients, wrote the bill.

He has been the target of anti-vaccination harassment since writing and championing laws cost of zithromax 500mg that made it harder for parents to refuse routine treatments for their children by eliminating personal belief exemptions and tightening rules around medical ones. He was shoved by someone who opposed the medical exemption bill in 2019, the same year in which an anti-treatment protester threw menstrual blood onto the state Senate floor. Pan was also among the lawmakers threatened at a committee hearing earlier this year. Last month, Pan volunteered at a vaccination clinic at a Sacramento park that he said was disrupted by anti-treatment protesters with a bullhorn who made it hard cost of zithromax 500mg for medical personnel to converse with patients and answer their questions.

And while he said he can handle threats, ordinary citizens “shouldn’t have to run a gauntlet to get vaccinated.” That includes walking through a group likely made up of unvaccinated protesters and possibly getting exposed to buy antibiotics to get protected, he said. His measure prohibits obstructing, injuring, harassing, intimidating or interfering with people “in connection with any vaccination services.” The bill passed the state Senate with just four no votes and faces one more committee hurdle before it heads to the Assembly floor. The bill defines harassment as getting within 30 feet of someone to hand them a leaflet, cost of zithromax 500mg display a sign, participate in any kind of verbal protesting like singing or chanting, or conduct any education or counseling with that person. Blocking someone or impeding them from getting a treatment is an obvious problem, and it’s good that the proposal would try to stop that, said Glen Smith, litigation director for the First Amendment Coalition, a California-based nonprofit that promotes the First Amendment, which guarantees rights such as free speech and assembly.

But he cost of zithromax 500mg thinks the proposal goes too far with its definition of harassment. €œTo say you can’t get within 30 feet of them just to hand them a pamphlet or ask them a question?. That seems to be overkill for me,” Smith said. It’s worse than overkill, said Eugene Volokh, a cost of zithromax 500mg professor of First Amendment law at the UCLA School of Law.

€œThat law is clearly unconstitutional,” Volokh said. He has two primary concerns with the proposal. First, though it’s modeled on similar laws that create zones around abortion clinics to protect patients from harassment, this bill goes beyond what courts cost of zithromax 500mg have upheld in the past, he said. In 2000, the U.S.

Supreme Court upheld a Colorado law that created an 8-foot “bubble zone” around a person entering or exiting an abortion clinic, but in 2014 the high court struck down a Massachusetts law that created a 35-foot “buffer zone” around clinics. A 30-foot zone around a person getting a treatment is cost of zithromax 500mg bigger than the court would allow, Volokh believes. His second concern is that the bill specifically prohibits someone from leafletting or talking to someone only about treatments. That violates the cost of zithromax 500mg First Amendment, Volokh said, because it targets certain content.

Someone could hand out an anti-war or anti-fur leaflet and not run afoul of the law, he said. €œI think it’s pretty shocking that a state legislature would try to enact this kind of restriction on fully protected speech this way,” Volokh said. In fact, anti-abortion groups that initially opposed the bill are now on board cost of zithromax 500mg because it targets only speech in connection with treatments. Elisabeth Beall, media coordinator for the Right to Life League, said a previous version of the measure didn’t specify that the restrictions would apply only to speech about vaccination.

€œThis limits the negative impact of the bill on pro-life activities,” like anti-abortion sidewalk counseling outside Planned Parenthood clinics, which provide abortions and treatments, Beall wrote in a statement. Not all free speech advocates share Volokh’s cost of zithromax 500mg interpretation of the bill. The American Civil Liberties Union said it has no issues with it as written. €œIt’s not necessarily the case that the freedom to express our views is unrestricted,” said Kevin Baker, director of governmental relations at ACLU California Action.

€œThey can be balanced with important governmental objectives” like letting people get vaccinated cost of zithromax 500mg in peace. Part of that objective is stopping disinformation about treatments, which Pan said is the primary reason people are not getting the shots. €œFrankly, any gains we make to try to get more people vaccinated are going to be incremental because of disinformation,” cost of zithromax 500mg Pan said. And when protesters show up claiming they’re there to educate patients, “they’re talking about disinformation.” Joshua Coleman, co-founder of the group V is for treatment, which advocates for informed consent before vaccinations and says treatments carry risk, said he brought the bullhorn to Pan’s clinic to “educate those coming to receive the treatment on important facts they deserve to know” and object to Pan’s bill.

€œThe intent in attending Senator Pan’s vaccination clinic was to protest the censorship of important information and his egregious and erroneous attack on free speech,” he said via email. Pan said his bill was “carefully crafted” to cost of zithromax 500mg stop the “obstruction, harassment and intimidation” of people seeking treatments, and is confident that it is well within the bounds of the First Amendment. €œThere’s precedent for saying you can protest. This law doesn’t say you can’t protest.

There’s certain rules around the cost of zithromax 500mg protest,” Pan said. €œEspecially as we’re trying to deal with this zithromax, we need to do what we can to be sure people feel safe getting themselves vaccinated.” This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Rachel Bluth. rbluth@kff.org, @RachelHBluth Related Topics Contact Us Submit a Story TipCristina Martinez’s cost of zithromax 500mg spinal operation in Houston was expected to be routine.

But after destabilizing her spine, the surgeon discovered the implant he was ready to put in her back was larger than he wanted to use — and the device company’s sales rep didn’t have a smaller size on hand, according to a report he filed about the operation. Dr cost of zithromax 500mg. Ra’Kerry Rahman went ahead with the operation, and Martinez awoke feeling pain and some numbness, she alleges. When Rahman removed the plastic device four days later and replaced it with a smaller one, Martinez suffered nerve damage and loss of feeling in her left leg, she claims.

Martinez is suing cost of zithromax 500mg the surgeon, implant maker Life Spine Inc., and its distributor and sales representatives, alleging their negligence led to her injuries because the right part wasn’t available during her first surgery. All deny wrongdoing. The case is set for trial in November. The lawsuit takes aim at the bustling sales networks that cost of zithromax 500mg orthopedic device manufacturers have built to market ever-growing lines of costly surgical hardware — from spinal implants to replacement knees and artificial hips commonly used in operations.

Sales in 2019 topped $20 billion, though buy antibiotics forced many hospitals to suspend elective surgeries for much of last year. Device makers train sales reps to offer surgeons technical guidance in the operating room on the use of their products. They pay prominent surgeons to tout their implants at medical conferences — and athletes to offer celebrity cost of zithromax 500mg endorsements. The industry says these practices help ensure that patients receive the highest-quality care.

But a KHN investigation found these practices also have been blamed cost of zithromax 500mg for contributing to serious patient harm in thousands of medical malpractice, product liability and whistleblower lawsuits filed over the past decade. Some patients allege they were injured after sales reps sold or delivered wrong-size or defective implants, while others accuse device makers of misleading doctors about the safety and durability of their products. Six multi-district federal cases have consolidated more than 28,000 suits by patients seeking compensation for injuries involving hip implants, including painful redo operations. In other court actions, patients and whistleblowers repeatedly have accused device companies of failing cost of zithromax 500mg to report injury-causing defects to federal regulators as required — or of doling out millions of dollars in illegal kickbacks to surgeons who agreed to use their products.

Device makers have denied the allegations and many such cases are settled under confidential terms. At least 250 companies sell surgical hardware, and many more distribute it to doctors and hospitals across the country. Spine companies cost of zithromax 500mg alone obtained more than 1,200 patents for devices in 2018, according to an industry report. Many come to market through a streamlined Food and Drug Administration process that approves their use because they are essentially the same as what is already being sold.

€œIn orthopedics, we are inundated with a multitude of new implants that debut each year,” Dr. James Kang, chairman of the orthopedic surgery department at Brigham and Women’s Hospital, remarked at a Harvard Medical School roundtable discussion published cost of zithromax 500mg in 2019. Dr. James Kang, chairman cost of zithromax 500mg of the orthopedic surgery department at Brigham and Women’s Hospital, discusses hip-spine syndrome in a 2016 YouTube video.

(Screenshot from YouTube) Kang said surgeons often rely on industry “reps” in the operating room for guidance because it is “usually burdensome and difficult” for surgeons to know “all of the intricate details and nuances” of so many products. Martinez’s lawsuit says the process went awry during her May 2018 spinal fusion in Houston, an operation in which an implant is inserted into the spinal column to replace a worn or damaged disc. Martinez was under anesthesia, with her spine destabilized, when Rahman discovered the Life Spine cost of zithromax 500mg surgical kit did not contain any implants shorter than 50 millimeters, or about 2 inches. That was too large, according to the complaint.

Martinez, a former day care worker, blames her injuries on the redo operation, which replaced the implant with a 40 mm version Life Spine supplied later. Through his lawyer, Rahman cost of zithromax 500mg declined to comment. In court filings, the surgeon has denied responsibility. His operating notes, according to court pleadings, say he had ordered “all lengths available” of the implant through a Life Spine distributor and its sales reps.

In a June court filing, Rahman contends the “small area of leg numbness experienced cost of zithromax 500mg by Ms. Martinez was a known complication of the first surgery … and was not the result of any alleged negligence.” In the court filing, Rahman also argues it was “appropriate” for him to rely on the sales reps and hospital staff to “inform him as to whether all materials and equipment needed for surgery were available.” Illinois-based Life Spine also denies blame. In court filings, it says the sales reps initially ordered a sterile kit that included only implants from 50 mm to 55 mm long, which it duly shipped cost of zithromax 500mg to Houston. At the time of Martinez’s operation, Life Spine was the target of a sealed whistleblower lawsuit accusing it of paying improper consulting fees and other kickbacks to more than 60 surgeons who agreed to use its wares.

Court records in the whistleblower case identify Rahman as one of the company’s paid consultants, although he and the other surgeons were not named as defendants. Life Spine and two of its executives settled the cost of zithromax 500mg matter in November 2019 by paying a total of nearly $6 million. An orthopedic surgery expert hired by Martinez for her suit faulted Rahman for not making sure he had the right gear “prior to the start of surgery,” according to his report. The expert also criticized the sales rep for failing to bring “all available lengths to the procedure or to inform Dr.

Rahman that the necessary implants were not available,” cost of zithromax 500mg court records show. The sales rep and distributor denied any blame, arguing in court filings that they “met all applicable standards of care.” Frenzied Competition for Sales Major device makers train a corps of sales agents, some recruited right out of college, to cultivate and work closely with surgeons — one likened the relationship to a caddy and an avid golfer. Duties can include lugging 20-pound sets of surgical hardware to the operating room, assuring it is sterile and knowing its specifications, though the reps are not required to have medical training or credentials. Stryker, one cost of zithromax 500mg of the nation’s top four spine implant manufacturers, spends what it calls “a significant amount of time and money” to train reps.

When hired, they typically “shadow” other reps for three to six months, then attend a 10-day intensive “Spine School” and other training. In all, the company said in a cost of zithromax 500mg court filing, it typically takes eight to 18 months, often longer, to develop “long-term relationships” with customers. For those who do, the jobs can pay handsomely. Veteran reps who influence which brands of hardware surgeons select command salaries and bonuses that can stretch into the low six figures and beyond, court records show.

The market is so hotly competitive that device makers typically require reps to sign contracts that prohibit them from working for a rival company in the same territory for a year or more — and aren’t shy about suing to fend off raids on their staffs, cost of zithromax 500mg court records show. In 2019, DePuy Synthes sued an Alabama sales rep who jumped ship, blaming him for stealing away accounts “worth millions of dollars practically overnight.” An arm of health care giant Johnson &. Johnson, DePuy Synthes filed at least two dozen similar suits from 2014 through the end of 2020, court records show. Most, including the case of cost of zithromax 500mg the Alabama sales rep, have been settled under confidential terms.

Some companies have spent lavishly to poach experienced sales agents — practices that can violate business conduct laws. One allegedly paid a New York sales pro a “staggering, seven-figure signing bonus.” Another is said to have dangled an $800,000-a-year job as “director of surgeon education,” while a gambit to make inroads in the Phoenix market dubbed “Sun Devil” guaranteed a branch manager a $500,000 annual salary, court records show. Another promised a sales agent $900,000 cost of zithromax 500mg paid out over three years. Whistleblowers and government investigators have argued for years that so much money changing hands can lead to kickbacks or other marketing schemes that corrupt medical judgment and endanger patients.

Some injury suits also have blamed sales reps and distributors for staying cost of zithromax 500mg mum about product deficiencies they observed in the operating room. These cases often are settled with no admission of wrongdoing. Sometimes, surgeons help promote implants at medical meetings and other gatherings. Orthopedic surgeons and neurosurgeons received a total of about $511 million in industry consulting fees from 2013 through 2019 and nearly $300 cost of zithromax 500mg million more for “serving as faculty or speaker” at industry-sponsored events, a KHN analysis of government data found.

AdvaMed, the device industry’s trade group, says doctors often take “primary responsibility” for training other doctors to use new devices. €œUnlike a pill or injection, procedures to implant or equip medical devices for patients can be extremely technical and complex,” said Scott Whitaker, the group’s president and CEO. A court cost of zithromax 500mg exhibit shows two screws that a Georgia man alleged broke apart about two years after his spinal operation. The 2013 lawsuit has since been settled.

(U.S. District Court filing) Some prominent surgeons who touted products that later were recalled, or who helped train surgeons to use implants, have cost of zithromax 500mg been criticized in pending injury lawsuits. One is Dr. Brad Penenberg, an orthopedic surgeon cost of zithromax 500mg in Beverly Hills, California, paid by Wright Medical Technology as a “key opinion leader,” according to court filings.

Multiple lawsuits cite a webinar for orthopedic surgeons that featured Penenberg and said hip surgery patients could resume “activities and lifestyles that include such things as tennis, horseback riding and snow skiing.” Injured patients are arguing in court filings that Penenberg and several other experts paid by the company knew of significant failures of the hip device. Penenberg did not respond to numerous requests for comment but in court papers denied the allegations. Hundreds of patients are claiming injuries they blame at least cost of zithromax 500mg partly on overly aggressive marketing by Wright Medical. In one 2020 lawsuit, a Montana man who had received a hip implant said he was taking a walk while in Arizona on vacation when he “felt a severe jolt in his groin and fell.” He was out of cell range and could not get up or call for help.

A “good Samaritan” called for an ambulance, which took him to a hospital in Gilbert, Arizona, where X-rays showed a fracture of the implant. It was removed cost of zithromax 500mg and replaced. Wright Medical has denied the allegations. In 1984, Mary Lou Retton won an individual all-around Olympic gold medal in gymnastics, the first American woman to do so.

(David Madison / Getty Images) Retired California psychologist Herb Glazeroff is suing Penenberg and Wright Medical Technology over a hip replacement that allegedly failed about five years after the surgeon cost of zithromax 500mg installed it. In May 2019, Glazeroff was walking when he “suddenly dropped to his knees as his left leg gave out on him,” according to the suit. He alleges that the hip had fractured, which required a painful second operation and “a long and arduous rehabilitation program” from which he has “yet to fully recover.” Glazeroff argues that Penenberg cost of zithromax 500mg failed to warn him about the implant’s dangers even though the surgeon had been named in “multiple lawsuits” alleging device defects. Penenberg has denied the allegations.

Dozens of lawsuits have taken aim at Indiana device maker Biomet’s advertising a hip replacement for “younger, more active patients” that showcased Olympic gold medal gymnast Mary Lou Retton. One ad says “Mary Lou lives pain-free, and so should you.” Yet Retton suffered painful heavy-metal poisoning requiring the implant’s removal and sued the company for damages, according to cost of zithromax 500mg court records. In a January 2020 court filing in Houston, Retton tried to block a subpoena seeking her deposition in a product liability lawsuit filed against Biomet by two patients in King County, Washington. The Washington case has since been settled and the deposition did not occur.

But in cost of zithromax 500mg a court filing opposing the subpoena, Retton confirmed she had a Biomet implant put in her left hip in 2005 and one on her right side about six years later. She said she promoted Biomet products from April 2006 through April 2013 and sued the company in January 2018, alleging the implants were defective. Retton said she and Biomet settled the suit in early 2019 “under confidential terms the parties find favorable to their respective positions. [Ms.

Retton] values her long relationship with Biomet and her continued use of her [Biomet hip implants] and [Biomet] appreciates the support it has received over the years from [Ms. Retton].” In 2011, Olympic gymnastics gold medalist Mary Lou Retton shared patient testimony for device company Biomet and her orthopedic surgeon. (Screenshot from YouTube) Defects Ignored, Downplayed Whether touted by renowned surgeons or celebrities, orthopedic surgery marketing materials stress quick improvement in a person’s quality of life. That proves true for most patients.

Yet researching how often implants fail or cause life-changing injuries — and which brands have the best safety records — can be daunting. The FDA requires device makers to advise the agency of information “that reasonably suggests” a device they sell “may have caused or contributed to a death or serious injury or has malfunctioned” in a way that could recur. The FDA posts the reports on a public website, with the caveat that they may convey “incomplete, inaccurate, untimely, unverified, or biased data.” KHN found that thousands of malpractice and product liability lawsuits have accused device marketers of concealing or downplaying hardware defects, leaving patients and their doctors in the dark about possible risks. In many cases, these claims are bolstered by company records, or actions by state or federal regulators.

In 2019, for instance, DePuy Synthes paid $120 million to settle a lawsuit filed by 46 state attorneys general. The suit accused the company of advertising that a replacement hip it sold lasted three years in 99.2% of operations, when it knew of data showing that 7% had failed within that time. The company did not admit wrongdoing in settling the case. British device company Smith &.

Nephew faces a federal civil proceeding comprising nearly 1,000 injury suits, including one that says the company “underreported and withheld” notices of malfunctions and “willfully ignored the existence of numerous complaints about [its] failures.” An expert hired by the patients cites a company audit showing “significant adverse events” were logged from two days to 142 days late, while a corporate memo circulated among executives to push sales was titled “Milk the Cash Cow,” according to court records. Smith &. Nephew has denied the allegations and in one court paper called the expert’s opinions “speculative.” A cluster of Florida injury cases pertaining to a knee implant from German manufacturer Aesculap alleges that the FDA cited the company for failing to report 25 adverse incidents — in some cases for a year or more — as a result of an inspection at its Hazelwood, Missouri, plant in September 2015. Aesculap has denied the allegations and the suits are pending in Florida’s Indian River County Circuit Court.

John Saltis is suing spinal device company NuVasive over its handling of his complaint that a screw holding his spinal implant in place snapped in May 2016, about 17 months after his operation. Saltis, 68, was two hours into his workday as a toolmaker at General Electric in Rutland, Vermont, when he felt sharp pain in his neck and shoulder, bad enough to send him to the hospital emergency room. A few days later, X-rays revealed the screw had broken and, according to Saltis, fractured vertebrae in the process. Saltis said the San Diego-based device company told the FDA the incident caused no harm.

But Saltis said he has lingering numbness and pain in his right hand. As a result, he said, his lifestyle has “changed dramatically.” He sold his motorcycle and stopped biking and now relies on his left hand for simple tasks like opening doors and shaking hands — even plucking chips out of a bag. €œI miss things like bowling and playing toss with my grandkids,” he said. A few days after feeling a sharp pain in his neck and shoulder, X-rays revealed the screw holding John Saltis’ spinal implant had broken and, Saltis says, fractured vertebrae in the process.

(Hans Pennink for KHN) “I was pain-free for a few months and would have stayed that way if the screw hadn’t broken,” he says. €œThis can change somebody’s life completely.” (Hans Pennink for KHN) In 2019, Saltis sued NuVasive without a lawyer, hoping to show the $600 screw was defective. In a court filing, NuVasive said Saltis is arguing “the screw is defective because it broke.” That’s not good enough, according to NuVasive, which argues that Saltis must show the screw was “unreasonably dangerous” to press his claim. In late June, a federal judge agreed and dismissed the suit, though she allowed Saltis to amend his complaint, which he is pursuing.

The case is pending. €œI was pain-free for a few months and would have stayed that way if the screw hadn’t broken,” Saltis said. €œThis can change somebody’s life completely.” A Push for Change as zithromax Eases As hospitals resume elective operations stalled by the antibiotics, some industry critics see an opportunity to rethink orthopedic surgery practices — from sales to tracking of injuries. Some want to keep industry reps out of operating rooms and place tighter restrictions on their access to hospitals.

They say the current system needlessly drives up health care costs and exposes patients to risks such as from extra people in the operating room. Reps counter that their incomes have been dropping due to global purchasing arrangements that give hospitals greater say over prices for surgical equipment. Sales reps say their technical knowledge and skills make operations safer for patients and note that many surgeons enjoy the security of having them present in the operating room. Reps also say they perform tasks that hospitals would need to hire additional personnel to do, such as keeping track of device inventories.

€œThe industry has embedded reps into the supply chain, and it is a hard culture to break,” said Itai Nemovicher, president of the Orthopaedic Implant Co., which seeks to produce lower-cost implants. Yet guidelines for “reentry” after buy antibiotics put out by AdvaMed and the American Hospital Association say medical device reps should deliver “services, information and support remotely whenever possible.” The guidelines advise hospitals to use videoconferencing gear when it “does not compromise patient safety or privacy.” Dr. Adriane Fugh-Berman, a professor of pharmacology and physiology at Georgetown University, said device reps are viewed as part of the operating room team even though they are there “to sell products. That is pretty horrifying from a patient’s point of view.” She said hospitals should train staff to perform these functions.

€œRelying on sales reps in the OR is appalling. We need to come up with a better system.” Greater transparency might have helped Little Rock, Arkansas, resident Christopher Paul Bills. He sued Consensus Orthopedics, the maker of a hip implant system that he alleged failed and sent metal through his hip joint that his surgeon said in 2016 looked “as if a bomb had gone off.” An Australian registry that tracks outcomes of operations had in September 2014 identified the implant as having a “higher number” of hip failures compared with other manufacturers, according to the suit. Bills underwent four operations and spent more than a year in the hospital and in rehabilitation, costs borne by Medicare and private insurance.

€œMr. Bills was left with no right hip at all and his surgeon does not plan to install a replacement hip,” the suit says. Bills uses an electric scooter to get around and hopes to graduate to hand-held crutches. €œSince his right leg is useless, he will require a vehicle with hand-controls to drive,” according to the suit.

The company disputed Bills’ claims and denied its hip system had any defects. The case ended in 2019 when Bills died of cancer unrelated to his operations, said his lawyer, Joseph Saunders. €œHe never did get justice,” Saunders said. Fred Schulte.

fschulte@kff.org, @fredschulte Related Topics Contact Us Submit a Story TipMAYAGÜEZ, PUERTO RICO — Abigail Matos-Pagán entered a bright-blue house in Mayagüez earlier this summer and was met by Beatriz Gastón, who quietly led the way to her mother’s small room. Matos-Pagán had come to provide a buy antibiotics treatment for Wildelma Gastón, 88, whose arthritis and other health concerns confine her to bed. Wildelma Gastón asked for her rosary to be placed on her chest and motioned to her “good arm,” where Matos-Pagán injected a first dose of the Moderna treatment. The Gastón household, made up of five family members, breathed a collective sigh of relief.

Though the treatment had been available for months, Wildelma had been unable to reach a vaccination site. According to the Centers for Disease Control and Prevention’s buy antibiotics Data Tracker, Puerto Rico’s vaccination rate in March was one of the lowest among U.S. States and territories despite receiving more than 1.3 million treatment doses. The rollout highlighted disparities in access to medical services, and the challenges of tracking and reaching remote citizens, such as Wildelma.

With each trip to school or work, family members worried about bringing the zithromax into their home and the threat to Wildelma’s life. Matos-Pagán also vaccinated two of Beatriz’s children, who are students at the University of Puerto Rico-Mayaqüez, during her visit. €œWe have been waiting a long time for this moment,” Beatriz Gastón said as she hugged Matos-Pagán goodbye, expressing gratitude for the home visit. To her, the treatment is more than protection from the antibiotics — it clears the way for the family to be together with her mother.

To Matos-Pagán, it is her latest calling. The nurse practitioner, who has guided relief efforts after hurricanes and earthquakes in Puerto Rico and elsewhere, has made it her mission in the U.S. Territory to vaccinate as many people as possible against buy antibiotics. Some residents of Mayagüez, a city on the western shore of the main island, candidly call her “The Vaccination Queen” and show up at her home asking for help in getting a shot.

According to The New York Times’ case tracker, as of Friday, Puerto Rico has had more than 182,000 buy antibiotics cases and at least 2,594 deaths. About 57% of the population is fully vaccinated, but many of the unvaccinated are hard to reach because they live in remote mountainous communities or have chronic illnesses that leave them homebound. Matos-Pagán has vaccinated around 1,800 people in Puerto Rico so far, including 1,000 who have chronic illnesses or are bedridden. In the zithromax’s early days, Carmen Blas’ health declined, and she began using a wheelchair.

Blas, 78, was confined to her home, on the third story of an apartment building, which kept her safe from contracting buy antibiotics, but later she couldn’t find transportation to a vaccination site. In June, her two children, Lisette and Raymond, visited from Wisconsin to help and immediately called the public health officials to get Blas inoculated. €œI usually come back every year and this was the longest I’ve ever been away. It was especially hard as my mother’s health worsened, and I worried I might never see her again,” said Raymond, who planned to extend his visit for as long as he was needed.

Matos-Pagán came to Blas’ home in Aguadilla, Puerto Rico, to give her the treatment. The family cheered the moment the vaccination was over. €œIt’s been really special to have intimate moments in someone’s home during vaccinations. You can tell how much it means to their entire family,” Matos-Pagán said afterward.

Mobilizing during a crisis is nothing new for Matos-Pagán. In the aftermath of Hurricane Maria, which cut off water and electricity to the entire island and claimed more than 3,000 lives, Matos-Pagán conducted initial community assessments in Puerto Rico’s remotest and hardest-hit cities. Flooding and debris made many roads inaccessible, blocking these communities from basic needs such as food, water, prescription medications and transportation. Then, after a series of earthquakes in 2020 rocked the island, leaving even more people without housing or in substandard structures, Matos-Pagán organized local nurse practitioners to provide community health care.

They supplied at-risk populations with their medicines when pharmacies closed, and teams set up mobile medical tents near overcrowded hospitals. €œI’m hyper and busy in my daily life, but when there is a crisis, I am calm and still. Grounded. I feel like I’m where I belong,” she said.

Abigail Matos-Pagán gives Wildelma Gastón a buy antibiotics treatment at her home in Mayagüez, Puerto Rico. Gastón is confined to bed because of arthritis and other health problems.(Alicia Carter) Matos-Pagán was born in New York City. She became interested in medicine after watching nurses support her mother, who died of complications from an aneurysm when Matos-Pagán was 9. Her mother’s death taught her “nothing was permanent,” she said, which has inspired her to act when disaster strikes and support people through personal tragedy and loss.

Matos-Pagán returned to Puerto Rico to study nursing and later earned a master’s degree and a doctorate at the University of Puerto Rico-Mayagüez. Through her work, she holds various titles. First commander of the Puerto Rican Disaster Response Team, and director and founder of the Coalition of Nurses for Communities in Disaster. Her experiences managing medical professionals and resources during hurricanes have taken her to locations across the U.S.

Atlantic coast and the Caribbean. During the buy antibiotics zithromax, she was recruited to assist in triage leadership for an ICU floor short on resources in El Paso, Texas, and a hard-hit senior living facility in Maryland. €œNot everyone is built for this. It’s really sad, depressing work,” Matos-Pagán said.

€œBut even when there are mass casualties, you can still save lives and get people’s basic needs met. I’ve seen communities come together in the most incredible ways. It’s a challenge, but that’s what keeps me going.” And, even as she is rapidly trying to get more buy antibiotics shots into the arms of Puerto Ricans, Matos-Pagán is preparing for the next crisis. Hurricane season officially began in June, and she will be on disaster-ready duty until the end of November.

Related Topics Contact Us Submit a Story TipKHN freelancer Mark Kreidler discussed why professional athletes are not taking a more affirmative role in pushing buy antibiotics treatments on Newsy on Tuesday. KHN Midwest correspondent Cara Anthony discussed masking mandates, treatment efficacy and breakthrough buy antibiotics cases on Illinois Public Media’s “The 21st Show” on Monday. KHN chief Washington correspondent Julie Rovner discussed the recent surge in buy antibiotics cases on Axios’ “Axios Today” podcast and WAMU/NPR’s “1A” on Monday and July 30, respectively. KHN Montana correspondent Katheryn Houghton explored the phenomenon of folks visiting radon mines in Montana as a treatment for various ills on “Voices of Montana” on July 30.

Related Topics Contact Us Submit a Story Tip.

MAYAGÜEZ, PUERTO RICO https://www.ferienhaus-sticher.de/how-to-get-amoxil/ – Abigail Matos-Pagán llegó a una casa de color azul brillante en Mayagüez, zithromax price ph en donde la recibió Beatriz Gastón, quien en silencio la condujo a la pequeña habitación de su madre. Matos-Pagán llevaba una vacuna contra buy antibiotics para Wildelma Gastón, de 88 años, quien está confinada en una cama por su artritis y otros problemas de salud. Wildelma Gastón pidió que le pusieran zithromax price ph su rosario en el pecho y señaló su “brazo bueno”, donde Matos-Pagán le inyectó la primera dosis de la vacuna de Moderna. La familia Gastón, compuesta por cinco miembros, respiró con alivio.

Aunque la vacuna estaba disponible desde hacía meses, Wildelma no había podido ir a un centro de vacunación. Según el rastreador de datos de zithromax price ph buy antibiotics de los Centros para el Control y la Prevención de Enfermedades (CDC), la tasa de vacunación de Puerto Rico en marzo fue una de las más bajas entre los estados y territorios de Estados Unidos, a pesar de haber recibido más de 1,3 millones de dosis de vacunas. El despliegue puso de manifiesto las disparidades en el acceso a los servicios médicos, y los retos que supone el seguimiento y la comunicación con ciudadanos que viven en lugares lejanos, como Wildelma. Cada vez que regresaban de la escuela o del trabajo, a los familiares les preocupaba la posibilidad de llevar el zithromax a su hogar, y la amenaza que suponía para la vida de Wildelma.

Durante su visita, Matos-Pagán también vacunó a dos de los hijos zithromax price ph de Beatriz, que son estudiantes de la Universidad de Puerto Rico-Mayaqüez. €œLlevamos mucho tiempo esperando este momento”, dijo Beatriz Gastón mientras se despedía con un abrazo de Matos-Pagán, expresando su gratitud por la visita a domicilio. Para ella la vacuna es algo más que una protección contra el antibiotics. Le permite a la familia estar junto a zithromax price ph su madre.

Para Matos-Pagán, es una nueva misión. La enfermera, que ha liderado tareas de ayuda tras los huracanes y terremotos en Puerto Rico y otros lugares, se ha propuesto vacunar al mayor número posible de personas contra buy antibiotics zithromax price ph en este territorio estadounidense. Algunos residentes de Mayagüez, ciudad situada en la costa occidental de la isla principal, la llaman cariñosamente “La reina de la vacunación” y se presentan en su casa pidiendo ayuda para vacunarse. Según el rastreador de casos de The New York Times, hasta el 5 de agosto, Puerto Rico suma cerca de 182,000 casos dSegún el rastreador de casos de The New York Times, hasta el 5 de agosto, Puerto Rico suma cerca de 182,000 casos de buy antibiotics y 2,594 muertes.

Algo más del 59% de la población está totalmente vacunada, pero muchos de los que no están vacunados son difíciles de localizar porque viven en comunidades montañosas alejadas, o tienen enfermedades crónicas que les obligan a quedarse en casa zithromax price ph. Hasta ahora, Matos-Pagán ha vacunado a unas 1,800 personas en Puerto Rico, incluidas 1,000 con enfermedades crónicas o postradas en cama. En los primeros días de la pandemia, la salud de Carmen Blas empeoró y empezó a utilizar una silla de ruedas. Blas, de 78 años, estaba confinada en su casa, en el tercer piso de un edificio de apartamentos, lo que la mantenía a salvo de contraer buy antibiotics, pero más tarde no pudo encontrar transporte para zithromax price ph ir a vacunarse.

En junio, sus dos hijos, Lisette y Raymond, vinieron desde Wisconsin para ayudar y llamaron inmediatamente a funcionarios de salud pública para que Blas se vacunara. €œSuelo volver todos los años y esta ha sido la vez que más tiempo he estado fuera. Fue especialmente duro porque la salud de mi madre empeoró y me preocupaba no zithromax price ph volver a verla”, contó Raymond, que pensaba prolongar su visita todo el tiempo que fuera necesario. Matos-Pagán fue a la casa de Blas, en Aguadilla, para administrarle la vacuna.

La familia celebró con alegría la vacunación zithromax price ph. €œHa sido muy especial tener momentos personales en la casa de alguien durante la vacunación. Se nota lo mucho que significa para toda la familia”, comentó Matos-Pagán. La movilización durante una crisis no es algo zithromax price ph nuevo para Matos-Pagán.

Tras el paso del huracán María, que cortó el agua y la electricidad en toda la isla y se cobró más de 3,000 vidas, Matos-Pagán llevó a cabo evaluaciones comunitarias iniciales en las ciudades más remotas y afectadas de Puerto Rico. Muchas carreteras eran inaccesibles debido a las inundaciones y a los escombros, lo que impedía a estas comunidades satisfacer necesidades básicas como alimentos, agua, recetas médicas y transporte. Después, tras una serie de terremotos que sacudieron la isla en 2020, dejando a más personas sin vivienda o en estructuras deficientes, Matos-Pagán organizó a las enfermeras locales para que prestaran atención zithromax price ph sanitaria a la comunidad. Suministraron a las poblaciones en riesgo sus medicamentos cuando las farmacias cerraron y los equipos instalaron tiendas médicas móviles junto a hospitales que estaban saturados.

€œSoy hiperactiva y estoy siempre ocupada en mi vida diaria, pero cuando hay una crisis, estoy tranquila y calmada. Con los pies en la tierra zithromax price ph. Siento que estoy donde debo estar”, expresó. Matos-Pagán nació zithromax price ph en Nueva York.

Se interesó por la medicina después de ver cómo las enfermeras ayudaban a su madre, que murió por complicaciones de un aneurisma cuando Matos-Pagán tenía 9 años. La muerte de su madre le enseñó que “nada era permanente”, dijo, lo que la ha inspirado a actuar cuando ocurre un desastre y a apoyar a las personas ante la tragedia y la pérdida. Abigail Matos-Pagán le administra la vacuna contra buy antibiotics a Wildelma Gastón, en su casa de Mayagüez, en zithromax price ph Puerto Rico. Gastón está confinada en su cama por la artritis y otros problemas de salud.

(Alicia Carter) Matos-Pagán regresó a Puerto Rico para estudiar enfermería y posteriormente obtuvo un máster y un doctorado en la Universidad de Puerto Rico-Mayagüez. Gracias a zithromax price ph su trabajo, ostenta varios títulos. Primera comandante del Equipo de Respuesta a Desastres de Puerto Rico, y directora y fundadora de la Coalición de Enfermeras para Comunidades en Desastre. Su experiencia en la gestión de profesionales y recursos médicos durante los huracanes la ha llevado a lugares de la costa atlántica estadounidense y del Caribe.

Durante la pandemia de buy antibiotics, fue contratada para ayudar a dirigir el triage (sistema para seleccionar zithromax price ph a los pacientes prioritarios que llegan a urgencias) de una unidad de cuidados intensivos, escasa de recursos, en El Paso, Texas, y en una residencia de mayores muy afectada en Maryland. €œNo todo el mundo está hecho para esto. Es un trabajo realmente triste zithromax price ph y deprimente”, señaló Matos-Pagán. €œPero incluso cuando hay miles de víctimas, se pueden salvar vidas y satisfacer las necesidades básicas de las personas.

He visto a las comunidades unirse de manera increíble. Es un reto, pero eso zithromax price ph es lo que me hace seguir adelante”. Y mientras trabaja para inyectar con rapidez más vacunas contra buy antibiotics en los brazos de los residentes de Puerto Rico, Matos-Pagán se prepara para la próxima crisis. La temporada de huracanes comenzó oficialmente en junio, y estará en alerta para otro posible desafío sanitario hasta finales de noviembre.

Related Topics Contact Us Submit zithromax price ph a Story TipSACRAMENTO, Calif. €” A proposal sailing through the California legislature that aims to stop people from getting harassed outside of vaccination sites is raising alarms among some First Amendment experts. If it becomes law, SB 742 would make it punishable by up to six months in jail and/or a maximum fine of $1,000 to intimidate, threaten, harass or prevent people from getting a buy antibiotics — or any other — treatment on their way to a vaccination site. The measure was introduced after protesters briefly shut down a mass vaccination clinic at Los Angeles’ zithromax price ph Dodger Stadium in January.

Now that mass vaccination clinics have mostly folded up, lawmakers worry that vaccination sites with less security than Dodger Stadium — like pharmacies and mobile clinics in parks or fast-food parking lots — are vulnerable. It’s a sign of how toxic the zithromax price ph issue of vaccination has become in a state with a long history of intense and divisive treatment wars. State Sen. Richard Pan (D-Sacramento), a pediatrician who administers treatments to his patients, wrote the bill.

He has been the target of anti-vaccination harassment since writing and championing laws that made it harder for parents to zithromax price ph refuse routine treatments for their children by eliminating personal belief exemptions and tightening rules around medical ones. He was shoved by someone who opposed the medical exemption bill in 2019, the same year in which an anti-treatment protester threw menstrual blood onto the state Senate floor. Pan was also among the lawmakers threatened at a committee hearing earlier this year. Last month, Pan volunteered at a vaccination clinic at zithromax price ph a Sacramento park that he said was disrupted by anti-treatment protesters with a bullhorn who made it hard for medical personnel to converse with patients and answer their questions.

And while he said he can handle threats, ordinary citizens “shouldn’t have to run a gauntlet to get vaccinated.” That includes walking through a group likely made up of unvaccinated protesters and possibly getting exposed to buy antibiotics to get protected, he said. His measure prohibits obstructing, injuring, harassing, intimidating or interfering with people “in connection with any vaccination services.” The bill passed the state Senate with just four no votes and faces one more committee hurdle before it heads to the Assembly floor. The bill defines harassment as zithromax price ph getting within 30 feet of someone to hand them a leaflet, display a sign, participate in any kind of verbal protesting like singing or chanting, or conduct any education or counseling with that person. Blocking someone or impeding them from getting a treatment is an obvious problem, and it’s good that the proposal would try to stop that, said Glen Smith, litigation director for the First Amendment Coalition, a California-based nonprofit that promotes the First Amendment, which guarantees rights such as free speech and assembly.

But he thinks the zithromax price ph proposal goes too far with its definition of harassment. €œTo say you can’t get within 30 feet of them just to hand them a pamphlet or ask them a question?. That seems to be overkill for me,” Smith said. It’s worse than overkill, said Eugene zithromax price ph Volokh, a professor of First Amendment law at the UCLA School of Law.

€œThat law is clearly unconstitutional,” Volokh said. He has two primary concerns with the proposal. First, though it’s modeled on similar laws that create zones around abortion clinics to protect patients from harassment, this bill goes beyond what courts have upheld in zithromax price ph the past, he said. In 2000, the U.S.

Supreme Court upheld a Colorado law that created an 8-foot “bubble zone” around a person entering or exiting an abortion clinic, but in 2014 the high court struck down a Massachusetts law that created a 35-foot “buffer zone” around clinics. A 30-foot zone zithromax price ph around a person getting a treatment is bigger than the court would allow, Volokh believes. His second concern is that the bill specifically prohibits someone from leafletting or talking to someone only about treatments. That violates the First Amendment, Volokh zithromax price ph said, because it targets certain content.

Someone could hand out an anti-war or anti-fur leaflet and not run afoul of the law, he said. €œI think it’s pretty shocking that a state legislature would try to enact this kind of restriction on fully protected speech this way,” Volokh said. In fact, anti-abortion groups that initially opposed the bill are now on board because it targets only speech in connection with zithromax price ph treatments. Elisabeth Beall, media coordinator for the Right to Life League, said a previous version of the measure didn’t specify that the restrictions would apply only to speech about vaccination.

€œThis limits the negative impact of the bill on pro-life activities,” like anti-abortion sidewalk counseling outside Planned Parenthood clinics, which provide abortions and treatments, Beall wrote in a statement. Not all free speech advocates zithromax price ph share Volokh’s interpretation of the bill. The American Civil Liberties Union said it has no issues with it as written. €œIt’s not necessarily the case that the freedom to express our views is unrestricted,” said Kevin Baker, director of governmental relations at ACLU California Action.

€œThey can zithromax price ph be balanced with important governmental objectives” like letting people get vaccinated in peace. Part of that objective is stopping disinformation about treatments, which Pan said is the primary reason people are not getting the shots. €œFrankly, any gains we make to try to get more people vaccinated are going to be incremental because of disinformation,” zithromax price ph Pan said. And when protesters show up claiming they’re there to educate patients, “they’re talking about disinformation.” Joshua Coleman, co-founder of the group V is for treatment, which advocates for informed consent before vaccinations and says treatments carry risk, said he brought the bullhorn to Pan’s clinic to “educate those coming to receive the treatment on important facts they deserve to know” and object to Pan’s bill.

€œThe intent in attending Senator Pan’s vaccination clinic was to protest the censorship of important information and his egregious and erroneous attack on free speech,” he said via email. Pan said his bill was zithromax price ph “carefully crafted” to stop the “obstruction, harassment and intimidation” of people seeking treatments, and is confident that it is well within the bounds of the First Amendment. €œThere’s precedent for saying you can protest. This law doesn’t say you can’t protest.

There’s certain rules around the protest,” Pan zithromax price ph said. €œEspecially as we’re trying to deal with this zithromax, we need to do what we can to be sure people feel safe getting themselves vaccinated.” This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Rachel Bluth. rbluth@kff.org, @RachelHBluth Related Topics Contact Us zithromax price ph Submit a Story TipCristina Martinez’s spinal operation in Houston was expected to be routine.

But after destabilizing her spine, the surgeon discovered the implant he was ready to put in her back was larger than he wanted to use — and the device company’s sales rep didn’t have a smaller size on hand, according to a report he filed about the operation. Dr zithromax price ph. Ra’Kerry Rahman went ahead with the operation, and Martinez awoke feeling pain and some numbness, she alleges. When Rahman removed the plastic device four days later and replaced it with a smaller one, Martinez suffered nerve damage and loss of feeling in her left leg, she claims.

Martinez is suing the surgeon, implant maker Life Spine Inc., and its distributor and sales representatives, zithromax price ph alleging their negligence led to her injuries because the right part wasn’t available during her first surgery. All deny wrongdoing. The case is set for trial in November. The lawsuit takes aim at the bustling sales networks that orthopedic device manufacturers have built to market ever-growing lines of costly surgical hardware — from spinal implants to replacement knees and artificial hips commonly used in operations zithromax price ph.

Sales in 2019 topped $20 billion, though buy antibiotics forced many hospitals to suspend elective surgeries for much of last year. Device makers train sales reps to offer surgeons technical guidance in the operating room on the use of their products. They pay prominent surgeons to tout their implants at medical conferences — and athletes to offer celebrity zithromax price ph endorsements. The industry says these practices help ensure that patients receive the highest-quality care.

But a KHN investigation found these practices also have been blamed for contributing to serious patient harm in thousands of medical malpractice, product liability and whistleblower lawsuits filed over the zithromax price ph past decade. Some patients allege they were injured after sales reps sold or delivered wrong-size or defective implants, while others accuse device makers of misleading doctors about the safety and durability of their products. Six multi-district federal cases have consolidated more than 28,000 suits by patients seeking compensation for injuries involving hip implants, including painful redo operations. In other court actions, patients and whistleblowers repeatedly zithromax price ph have accused device companies of failing to report injury-causing defects to federal regulators as required — or of doling out millions of dollars in illegal kickbacks to surgeons who agreed to use their products.

Device makers have denied the allegations and many such cases are settled under confidential terms. At least 250 companies sell surgical hardware, and many more distribute it to doctors and hospitals across the country. Spine companies alone obtained more than 1,200 patents for devices zithromax price ph in 2018, according to an industry report. Many come to market through a streamlined Food and Drug Administration process that approves their use because they are essentially the same as what is already being sold.

€œIn orthopedics, we are inundated with a multitude of new implants that debut each year,” Dr. James Kang, chairman of the orthopedic surgery department at Brigham and Women’s Hospital, remarked at a Harvard Medical School roundtable discussion zithromax price ph published in 2019. Dr. James Kang, chairman of the orthopedic surgery department at Brigham and Women’s Hospital, zithromax price ph discusses hip-spine syndrome in a 2016 YouTube video.

(Screenshot from YouTube) Kang said surgeons often rely on industry “reps” in the operating room for guidance because it is “usually burdensome and difficult” for surgeons to know “all of the intricate details and nuances” of so many products. Martinez’s lawsuit says the process went awry during her May 2018 spinal fusion in Houston, an operation in which an implant is inserted into the spinal column to replace a worn or damaged disc. Martinez was under anesthesia, with her spine destabilized, when Rahman discovered the Life Spine surgical zithromax price ph kit did not contain any implants shorter than 50 millimeters, or about 2 inches. That was too large, according to the complaint.

Martinez, a former day care worker, blames her injuries on the redo operation, which replaced the implant with a 40 mm version Life Spine supplied later. Through his zithromax price ph lawyer, Rahman declined to comment. In court filings, the surgeon has denied responsibility. His operating notes, according to court pleadings, say he had ordered “all lengths available” of the implant through a Life Spine distributor and its sales reps.

In a June court filing, Rahman contends the “small area of leg zithromax price ph numbness experienced by Ms. Martinez was a known complication of the first surgery … and was not the result of any alleged negligence.” In the court filing, Rahman also argues it was “appropriate” for him to rely on the sales reps and hospital staff to “inform him as to whether all materials and equipment needed for surgery were available.” Illinois-based Life Spine also denies blame. In court filings, it says the sales reps initially ordered a zithromax price ph sterile kit that included only implants from 50 mm to 55 mm long, which it duly shipped to Houston. At the time of Martinez’s operation, Life Spine was the target of a sealed whistleblower lawsuit accusing it of paying improper consulting fees and other kickbacks to more than 60 surgeons who agreed to use its wares.

Court records in the whistleblower case identify Rahman as one of the company’s paid consultants, although he and the other surgeons were not named as defendants. Life Spine and two of its executives settled the matter in November 2019 by paying a total of zithromax price ph nearly $6 million. An orthopedic surgery expert hired by Martinez for her suit faulted Rahman for not making sure he had the right gear “prior to the start of surgery,” according to his report. The expert also criticized the sales rep for failing to bring “all available lengths to the procedure or to inform Dr.

Rahman that the necessary implants were not zithromax price ph available,” court records show. The sales rep and distributor denied any blame, arguing in court filings that they “met all applicable standards of care.” Frenzied Competition for Sales Major device makers train a corps of sales agents, some recruited right out of college, to cultivate and work closely with surgeons — one likened the relationship to a caddy and an avid golfer. Duties can include lugging 20-pound sets of surgical hardware to the operating room, assuring it is sterile and knowing its specifications, though the reps are not required to have medical training or credentials. Stryker, one of the nation’s top four spine implant manufacturers, spends what it calls “a zithromax price ph significant amount of time and money” to train reps.

When hired, they typically “shadow” other reps for three to six months, then attend a 10-day intensive “Spine School” and other training. In all, the company said in a court filing, it typically takes eight to 18 months, often longer, to develop zithromax price ph “long-term relationships” with customers. For those who do, the jobs can pay handsomely. Veteran reps who influence which brands of hardware surgeons select command salaries and bonuses that can stretch into the low six figures and beyond, court records show.

The market is so hotly competitive that device makers typically require reps to sign contracts that prohibit them from working for a rival company in the same territory for a year or more — and aren’t zithromax price ph shy about suing to fend off raids on their staffs, court records show. In 2019, DePuy Synthes sued an Alabama sales rep who jumped ship, blaming him for stealing away accounts “worth millions of dollars practically overnight.” An arm of health care giant Johnson &. Johnson, DePuy Synthes filed at least two dozen similar suits from 2014 through the end of 2020, court records show. Most, including the case of the zithromax price ph Alabama sales rep, have been settled under confidential terms.

Some companies have spent lavishly to poach experienced sales agents — practices that can violate business conduct laws. One allegedly paid a New York sales pro a “staggering, seven-figure signing bonus.” Another is said to have dangled an $800,000-a-year job as “director of surgeon education,” while a gambit to make inroads in the Phoenix market dubbed “Sun Devil” guaranteed a branch manager a $500,000 annual salary, court records show. Another promised a sales agent $900,000 paid out zithromax price ph over three years. Whistleblowers and government investigators have argued for years that so much money changing hands can lead to kickbacks or other marketing schemes that corrupt medical judgment and endanger patients.

Some injury zithromax price ph suits also have blamed sales reps and distributors for staying mum about product deficiencies they observed in the operating room. These cases often are settled with no admission of wrongdoing. Sometimes, surgeons help promote implants at medical meetings and other gatherings. Orthopedic surgeons and neurosurgeons received a total of about $511 million in industry consulting fees from 2013 zithromax price ph through 2019 and nearly $300 million more for “serving as faculty or speaker” at industry-sponsored events, a KHN analysis of government data found.

AdvaMed, the device industry’s trade group, says doctors often take “primary responsibility” for training other doctors to use new devices. €œUnlike a pill or injection, procedures to implant or equip medical devices for patients can be extremely technical and complex,” said Scott Whitaker, the group’s president and CEO. A court exhibit shows two screws that a Georgia man alleged broke apart about two years zithromax price ph after his spinal operation. The 2013 lawsuit has since been settled.

(U.S. District Court filing) Some prominent surgeons who touted products that later were recalled, or zithromax price ph who helped train surgeons to use implants, have been criticized in pending injury lawsuits. One is Dr. Brad Penenberg, an orthopedic surgeon in Beverly Hills, California, paid by Wright zithromax price ph Medical Technology as a “key opinion leader,” according to court filings.

Multiple lawsuits cite a webinar for orthopedic surgeons that featured Penenberg and said hip surgery patients could resume “activities and lifestyles that include such things as tennis, horseback riding and snow skiing.” Injured patients are arguing in court filings that Penenberg and several other experts paid by the company knew of significant failures of the hip device. Penenberg did not respond to numerous requests for comment but in court papers denied the allegations. Hundreds of patients are zithromax price ph claiming injuries they blame at least partly on overly aggressive marketing by Wright Medical. In one 2020 lawsuit, a Montana man who had received a hip implant said he was taking a walk while in Arizona on vacation when he “felt a severe jolt in his groin and fell.” He was out of cell range and could not get up or call for help.

A “good Samaritan” called for an ambulance, which took him to a hospital in Gilbert, Arizona, where X-rays showed a fracture of the implant. It was removed and replaced zithromax price ph. Wright Medical has denied the allegations. In 1984, Mary Lou Retton won an individual all-around Olympic gold medal in gymnastics, the first American woman to do so.

(David Madison / Getty zithromax price ph Images) Retired California psychologist Herb Glazeroff is suing Penenberg and Wright Medical Technology over a hip replacement that allegedly failed about five years after the surgeon installed it. In May 2019, Glazeroff was walking when he “suddenly dropped to his knees as his left leg gave out on him,” according to the suit. He alleges that the hip had fractured, which required a painful second operation and “a long and arduous rehabilitation program” from which he has “yet to fully recover.” Glazeroff argues that Penenberg failed to warn him about the implant’s dangers even though the zithromax price ph surgeon had been named in “multiple lawsuits” alleging device defects. Penenberg has denied the allegations.

Dozens of lawsuits have taken aim at Indiana device maker Biomet’s advertising a hip replacement for “younger, more active patients” that showcased Olympic gold medal gymnast Mary Lou Retton. One ad says “Mary Lou lives pain-free, and so zithromax price ph should you.” Yet Retton suffered painful heavy-metal poisoning requiring the implant’s removal and sued the company for damages, according to court records. In a January 2020 court filing in Houston, Retton tried to block a subpoena seeking her deposition in a product liability lawsuit filed against Biomet by two patients in King County, Washington. The Washington case has since been settled and the deposition did not occur.

But in a court filing opposing the subpoena, Retton confirmed she had a Biomet implant put in her left zithromax price ph hip in 2005 and one on her right side about six years later. She said she promoted Biomet products from April 2006 through April 2013 and sued the company in January 2018, alleging the implants were defective. Retton said she and Biomet settled the suit in early 2019 “under confidential terms the parties find favorable to their respective positions. [Ms.

Retton] values her long relationship with Biomet and her continued use of her [Biomet hip implants] and [Biomet] appreciates the support it has received over the years from [Ms. Retton].” In 2011, Olympic gymnastics gold medalist Mary Lou Retton shared patient testimony for device company Biomet and her orthopedic surgeon. (Screenshot from YouTube) Defects Ignored, Downplayed Whether touted by renowned surgeons or celebrities, orthopedic surgery marketing materials stress quick improvement in a person’s quality of life. That proves true for most patients.

Yet researching how often implants fail or cause life-changing injuries — and which brands have the best safety records — can be daunting. The FDA requires device makers to advise the agency of information “that reasonably suggests” a device they sell “may have caused or contributed to a death or serious injury or has malfunctioned” in a way that could recur. The FDA posts the reports on a public website, with the caveat that they may convey “incomplete, inaccurate, untimely, unverified, or biased data.” KHN found that thousands of malpractice and product liability lawsuits have accused device marketers of concealing or downplaying hardware defects, leaving patients and their doctors in the dark about possible risks. In many cases, these claims are bolstered by company records, or actions by state or federal regulators.

In 2019, for instance, DePuy Synthes paid $120 million to settle a lawsuit filed by 46 state attorneys general. The suit accused the company of advertising that a replacement hip it sold lasted three years in 99.2% of operations, when it knew of data showing that 7% had failed within that time. The company did not admit wrongdoing in settling the case. British device company Smith &.

Nephew faces a federal civil proceeding comprising nearly 1,000 injury suits, including one that says the company “underreported and withheld” notices of malfunctions and “willfully ignored the existence of numerous complaints about [its] failures.” An expert hired by the patients cites a company audit showing “significant adverse events” were logged from two days to 142 days late, while a corporate memo circulated among executives to push sales was titled “Milk the Cash Cow,” according to court records. Smith &. Nephew has denied the allegations and in one court paper called the expert’s opinions “speculative.” A cluster of Florida injury cases pertaining to a knee implant from German manufacturer Aesculap alleges that the FDA cited the company for failing to report 25 adverse incidents — in some cases for a year or more — as a result of an inspection at its Hazelwood, Missouri, plant in September 2015. Aesculap has denied the allegations and the suits are pending in Florida’s Indian River County Circuit Court.

John Saltis is suing spinal device company NuVasive over its handling of his complaint that a screw holding his spinal implant in place snapped in May 2016, about 17 months after his operation. Saltis, 68, was two hours into his workday as a toolmaker at General Electric in Rutland, Vermont, when he felt sharp pain in his neck and shoulder, bad enough to send him to the hospital emergency room. A few days later, X-rays revealed the screw had broken and, according to Saltis, fractured vertebrae in the process. Saltis said the San Diego-based device company told the FDA the incident caused no harm.

But Saltis said he has lingering numbness and pain in his right hand. As a result, he said, his lifestyle has “changed dramatically.” He sold his motorcycle and stopped biking and now relies on his left hand for simple tasks like opening doors and shaking hands — even plucking chips out of a bag. €œI miss things like bowling and playing toss with my grandkids,” he said. A few days after feeling a sharp pain in his neck and shoulder, X-rays revealed the screw holding John Saltis’ spinal implant had broken and, Saltis says, fractured vertebrae in the process.

(Hans Pennink for KHN) “I was pain-free for a few months and would have stayed that way if the screw hadn’t broken,” he says. €œThis can change somebody’s life completely.” (Hans Pennink for KHN) In 2019, Saltis sued NuVasive without a lawyer, hoping to show the $600 screw was defective. In a court filing, NuVasive said Saltis is arguing “the screw is defective because it broke.” That’s not good enough, according to NuVasive, which argues that Saltis must show the screw was “unreasonably dangerous” to press his claim. In late June, a federal judge agreed and dismissed the suit, though she allowed Saltis to amend his complaint, which he is pursuing.

The case is pending. €œI was pain-free for a few months and would have stayed that way if the screw hadn’t broken,” Saltis said. €œThis can change somebody’s life completely.” A Push for Change as zithromax Eases As hospitals resume elective operations stalled by the antibiotics, some industry critics see an opportunity to rethink orthopedic surgery practices — from sales to tracking of injuries. Some want to keep industry reps out of operating rooms and place tighter restrictions on their access to hospitals.

They say the current system needlessly drives up health care costs and exposes patients to risks such as from extra people in the operating room. Reps counter that their incomes have been dropping due to global purchasing arrangements that give hospitals greater say over prices for surgical equipment. Sales reps say their technical knowledge and skills make operations safer for patients and note that many surgeons enjoy the security of having them present in the operating room. Reps also say they perform tasks that hospitals would need to hire additional personnel to do, such as keeping track of device inventories.

€œThe industry has embedded reps into the supply chain, and it is a hard culture to break,” said Itai Nemovicher, president of the Orthopaedic Implant Co., which seeks to produce lower-cost implants. Yet guidelines for “reentry” after buy antibiotics put out by AdvaMed and the American Hospital Association say medical device reps should deliver “services, information and support remotely whenever possible.” The guidelines advise hospitals to use videoconferencing gear when it “does not compromise patient safety or privacy.” Dr. Adriane Fugh-Berman, a professor of pharmacology and physiology at Georgetown University, said device reps are viewed as part of the operating room team even though they are there “to sell products. That is pretty horrifying from a patient’s point of view.” She said hospitals should train staff to perform these functions.

€œRelying on sales reps in the OR is appalling. We need to come up with a better system.” Greater transparency might have helped Little Rock, Arkansas, resident Christopher Paul Bills. He sued Consensus Orthopedics, the maker of a hip implant system that he alleged failed and sent metal through his hip joint that his surgeon said in 2016 looked “as if a bomb had gone off.” An Australian registry that tracks outcomes of operations had in September 2014 identified the implant as having a “higher number” of hip failures compared with other manufacturers, according to the suit. Bills underwent four operations and spent more than a year in the hospital and in rehabilitation, costs borne by Medicare and private insurance.

€œMr. Bills was left with no right hip at all and his surgeon does not plan to install a replacement hip,” the suit says. Bills uses an electric scooter to get around and hopes to graduate to hand-held crutches. €œSince his right leg is useless, he will require a vehicle with hand-controls to drive,” according to the suit.

The company disputed Bills’ claims and denied its hip system had any defects. The case ended in 2019 when Bills died of cancer unrelated to his operations, said his lawyer, Joseph Saunders. €œHe never did get justice,” Saunders said. Fred Schulte.

fschulte@kff.org, @fredschulte Related Topics Contact Us Submit a Story TipMAYAGÜEZ, PUERTO RICO — Abigail Matos-Pagán entered a bright-blue house in Mayagüez earlier this summer and was met by Beatriz Gastón, who quietly led the way to her mother’s small room. Matos-Pagán had come to provide a buy antibiotics treatment for Wildelma Gastón, 88, whose arthritis and other health concerns confine her to bed. Wildelma Gastón asked for her rosary to be placed on her chest and motioned to her “good arm,” where Matos-Pagán injected a first dose of the Moderna treatment. The Gastón household, made up of five family members, breathed a collective sigh of relief.

Though the treatment had been available for months, Wildelma had been unable to reach a vaccination site. According to the Centers for Disease Control and Prevention’s buy antibiotics Data Tracker, Puerto Rico’s vaccination rate in March was one of the lowest among U.S. States and territories despite receiving more than 1.3 million treatment doses. The rollout highlighted disparities in access to medical services, and the challenges of tracking and reaching remote citizens, such as Wildelma.

With each trip to school or work, family members worried about bringing the zithromax into their home and the threat to Wildelma’s life. Matos-Pagán also vaccinated two of Beatriz’s children, who are students at the University of Puerto Rico-Mayaqüez, during her visit. €œWe have been waiting a long time for this moment,” Beatriz Gastón said as she hugged Matos-Pagán goodbye, expressing gratitude for the home visit. To her, the treatment is more than protection from the antibiotics — it clears the way for the family to be together with her mother.

To Matos-Pagán, it is her latest calling. The nurse practitioner, who has guided relief efforts after hurricanes and earthquakes in Puerto Rico and elsewhere, has made it her mission in the U.S. Territory to vaccinate as many people as possible against buy antibiotics. Some residents of Mayagüez, a city on the western shore of the main island, candidly call her “The Vaccination Queen” and show up at her home asking for help in getting a shot.

According to The New York Times’ case tracker, as of Friday, Puerto Rico has had more than 182,000 buy antibiotics cases and at least 2,594 deaths. About 57% of the population is fully vaccinated, but many of the unvaccinated are hard to reach because they live in remote mountainous communities or have chronic illnesses that leave them homebound. Matos-Pagán has vaccinated around 1,800 people in Puerto Rico so far, including 1,000 who have chronic illnesses or are bedridden. In the zithromax’s early days, Carmen Blas’ health declined, and she began using a wheelchair.

Blas, 78, was confined to her home, on the third story of an apartment building, which kept her safe from contracting buy antibiotics, but later she couldn’t find transportation to a vaccination site. In June, her two children, Lisette and Raymond, visited from Wisconsin to help and immediately called the public health officials to get Blas inoculated. €œI usually come back every year and this was the longest I’ve ever been away. It was especially hard as my mother’s health worsened, and I worried I might never see her again,” said Raymond, who planned to extend his visit for as long as he was needed.

Matos-Pagán came to Blas’ home in Aguadilla, Puerto Rico, to give her the treatment. The family cheered the moment the vaccination was over. €œIt’s been really special to have intimate moments in someone’s home during vaccinations. You can tell how much it means to their entire family,” Matos-Pagán said afterward.

Mobilizing during a crisis is nothing new for Matos-Pagán. In the aftermath of Hurricane Maria, which cut off water and electricity to the entire island and claimed more than 3,000 lives, Matos-Pagán conducted initial community assessments in Puerto Rico’s remotest and hardest-hit cities. Flooding and debris made many roads inaccessible, blocking these communities from basic needs such as food, water, prescription medications and transportation. Then, after a series of earthquakes in 2020 rocked the island, leaving even more people without housing or in substandard structures, Matos-Pagán organized local nurse practitioners to provide community health care.

They supplied at-risk populations with their medicines when pharmacies closed, and teams set up mobile medical tents near overcrowded hospitals. €œI’m hyper and busy in my daily life, but when there is a crisis, I am calm and still. Grounded. I feel like I’m where I belong,” she said.

Abigail Matos-Pagán gives Wildelma Gastón a buy antibiotics treatment at her home in Mayagüez, Puerto Rico. Gastón is confined to bed because of arthritis and other health problems.(Alicia Carter) Matos-Pagán was born in New York City. She became interested in medicine after watching nurses support her mother, who died of complications from an aneurysm when Matos-Pagán was 9. Her mother’s death taught her “nothing was permanent,” she said, which has inspired her to act when disaster strikes and support people through personal tragedy and loss.

Matos-Pagán returned to Puerto Rico to study nursing and later earned a master’s degree and a doctorate at the University of Puerto Rico-Mayagüez. Through her work, she holds various titles. First commander of the Puerto Rican Disaster Response Team, and director and founder of the Coalition of Nurses for Communities in Disaster. Her experiences managing medical professionals and resources during hurricanes have taken her to locations across the U.S.

Atlantic coast and the Caribbean. During the buy antibiotics zithromax, she was recruited to assist in triage leadership for an ICU floor short on resources in El Paso, Texas, and a hard-hit senior living facility in Maryland. €œNot everyone is built for this. It’s really sad, depressing work,” Matos-Pagán said.

€œBut even when there are mass casualties, you can still save lives and get people’s basic needs met. I’ve seen communities come together in the most incredible ways. It’s a challenge, but that’s what keeps me going.” And, even as she is rapidly trying to get more buy antibiotics shots into the arms of Puerto Ricans, Matos-Pagán is preparing for the next crisis. Hurricane season officially began in June, and she will be on disaster-ready duty until the end of November.

Related Topics Contact Us Submit a Story TipKHN freelancer Mark Kreidler discussed why professional athletes are not taking a more affirmative role in pushing buy antibiotics treatments on Newsy on Tuesday. KHN Midwest correspondent Cara Anthony discussed masking mandates, treatment efficacy and breakthrough buy antibiotics cases on Illinois Public Media’s “The 21st Show” on Monday. KHN chief Washington correspondent Julie Rovner discussed the recent surge in buy antibiotics cases on Axios’ “Axios Today” podcast and WAMU/NPR’s “1A” on Monday and July 30, respectively. KHN Montana correspondent Katheryn Houghton explored the phenomenon of folks visiting radon mines in Montana as a treatment for various ills on “Voices of Montana” on July 30.

Related Topics Contact Us Submit a Story Tip.

Zithromax online usa

This author has published on various medical topics and is obviously on several lists as zithromax online usa a potential reviewer for papers on subjects of which he has only slight detailed knowledge how do you get zithromax. There appears to be no definition of, or qualifications for, a peer reviewer other than that he or she is, rightly or wrongly, perceived to be an expert in a particular field.About a million research papers are published each year and researchers are pressurised to publish because grants, enhanced reputations and rewards may follow (perhaps including a Nobel prize). Peer review is one way for reputable journals to promote good zithromax online usa science. But there are numerous problems as outlined by Richard Smith, a previous editor of the British Medical Journal.1Peer reviewers are usually busy people and often provide their opinions without charge. Journal editors, unless they reject submission independently, must choose and trust that reviewers are up to date especially concerning potentially important recent developments.For the purposes of this account, a differentiation is made between research studies and research trials.

Studies are solely zithromax online usa observational and replications are unusual because surrounding circumstances often change with the passage of time. In contrast, trials are interventional. Trials should address predefined specific zithromax online usa questions and the methods used should contain sufficient information to allow exact replication. Replication of trials is problematic because of the expenses involved and details of the exact methods used in the original trial may not be comprehensive. Double-blind randomised placebo-controlled research trials are said to be gold standard, but comparative trials are more important.

The former only suggests zithromax online usa that treatments given were more effective than placebo. Reviewers need to know is whether treatments are better than a known effective treatment.Traditionally studies and trials comprise titles, abstracts, introduction, methods, results, discussion, conclusions and references.Reviewers should ensure that …AbstractAt the beginning of 2020, the outbreak of buy antibiotics in China has brought great impact on the society, economy and life. This article introduces current status of Chinese postgraduate medical students under this epidemic situation in combination with the author's own experience from four zithromax online usa aspects. Professional spirit, professional knowledge, learning status and protective measures.IntroductionA novel antibiotics has been discovered and confirmed since the first case of unidentified pneumonia was confirmed in Wuhan, China, in December 2019.1 2 The disease caused by this novel zithromax was officially named buy antibiotics by the WHO on 12 January 2020. Since the outbreak in China, the numbers of confirmed cases and deaths have rapidly increased.

buy antibiotics has zithromax online usa been clarified as a grade B infectious disease, others of which include severe acute respiratory syndrome and highly pathogenic avian influenza, and is treated according to the protocol for grade A infectious diseases. buy antibiotics is the seventh known antibiotics-induced disease that involves of the respiratory system in human beings. The other two potentially life-threatening antibiotics-induced diseases are severe acute respiratory syndrome and Middle East respiratory syndrome.3 4 This novel antibiotics-induced pneumonia is transmitted from person to person and is highly infectious, with high susceptibility among the general population zithromax online usa. The antibiotics responsible for buy antibiotics has a long incubation period and diverse clinical features, seriously impacting normal work and life throughout the country. As of 13 April 2020, buy antibiotics had been recognised in over 200 countries, with a total of 1 784 364 laboratory-confirmed cases and 111 832 deaths, and these numbers have since continued to rise.On 23 January 2020, the Chinese government immediately blocked the city of Wuhan and cut off all outside contact to stop the spread of buy antibiotics.

Other cities successively announced closure of public places zithromax online usa and restricted the flow of people. At the time of this writing, the Chinese Ministry of Education had stated that no student was allowed to return to school until further notification. Some postgraduate medical students zithromax online usa residing at school were isolated in safe places. Some others who had returned home for holiday were restricted to their local residence and prohibited to return to the hospital or medical school for studies or clinical work. We herein describe the status and situation of postgraduate medical students in China under the influence of buy antibiotics.Encouragement and promotion of the professional spirit of postgraduate medical studentsAt the frontline of the fight against buy antibiotics, many medical staff members around the country have devoted their full power without hesitation while ignoring their own personal safety.

Their teachers, colleagues and zithromax online usa friends have also participated in this battle. Such behaviour demonstrates the humanitarian nature of medicine, which involves healing the wounded and rescuing the dying. This vivid lesson helps medical students to internalise medical ethical zithromax online usa principles through emotional penetration and thus deepens their understanding and strengthens their beliefs. It benefits society to cultivate a spirit of benevolence among medical students and to train postgraduate medical students to engage in positive behaviour. In recent years, the position of the medical humanities in medical education has gradually improved.

The combination of medical humanities and medical knowledge is regarded as a successful medical education, which zithromax online usa manifests scientific and human brilliance. Such education could help medical students to realise the transformation from medical ethical cognition to medical ethical behaviour in their future career.Use of professional knowledge to assist othersMedical students can help their relatives and friends to recognise the symptoms of pneumonia early according to their professional knowledge. The diagnosis of buy antibiotics is based on a combination of epidemiological information, clinical symptoms, CT imaging findings and laboratory tests according to zithromax online usa the standards of either the WHO or the National Health Commission of China. Although medical students were not in the hospital and had no access to CT or test kits, they generally have a higher level of professional judgement than people in the general population with respect to medical knowledge and patients’ symptoms. For example, if a person within a medical student’s neighbourhood develops a fever and cough and has a travel history from Wuhan, the student can advise him or her to go to the hospital in a timely manner.

Postgraduate medical students can also educate the people around them, zithromax online usa which helps the public to realise the importance of prevention and comply with regulations formulated by the country. Medical students can also serve as volunteers within the community and use their professional knowledge to make more contributions to community residents.Non-stop learning despite suspension of classesThe sudden outbreak of this novel antibiotics disrupted normal teaching and studying in the field of medical education. Non-stop learning via online zithromax online usa teaching despite suspension of classes was put forward by the ministry of education. During the disease outbreak, online lectures and learning tutorials were adopted to avoid unnecessary aggregation of people and the associated risk of .5 Basic medical courses such as physiology, pathology and biology are relatively easy to study by video or electronic books. However, clinical medicine courses such as surgery are not suitable for online study.

Because medicine is a practical science, it zithromax online usa cannot break away from clinics and patients, and even simulation training cannot achieve a real-world effect. Many universities lack the ability to use the computers or software required to conduct online teaching courses, record teaching videos and prepare teaching documents such as text, picture, audio and animation. Students living in rural areas with underdeveloped networks and poor hardware facilities may find it difficult to meet the requirements of online learning. During this special period in China, self-study zithromax online usa has become an important skill for medical students. Students of different majors have different learning styles.

Dermatology students zithromax online usa can review photographs of lesions to improve their skills in differential diagnosis. Internal medicine students can analyse complex cases to exercise their logical ability. Surgery students can learn more about internal medicine to become more comprehensive surgeons. Additionally, online learning allows students to restart long-forgotten projects, zithromax online usa modify research papers and complete unfinished work. They can also review the literature in a field of interest, create an outline of future research and contemplate their career plan.

All doctors zithromax online usa in China are willing to apply for assistance from the National Natural Science Foundation of China, a famous and widely used research fund. Online application usually starts in March every year, but in 2020, it was postponed until April because of the epidemic. This gave medical students more time to carefully prepare for their application under the guidance of a mentor.Effective measures to ensure the health of medical studentsAlthough the medical resources of the whole country are devoted to treatment of all patients infected with the novel antibiotics, the schools and government still make special efforts to protect the health of students. Peking Union Medical College has developed zithromax online usa an online system called SARISenor, which is used by medical students to report the body temperature and physical condition every day. This system also has a locating function based on the global positioning system, which is convenient for localised management.

Our medical school also developed a course to increase knowledge of buy antibiotics, and all students are required to zithromax online usa study this course online. A test is administered after completion of the course, and students must complete the test to obtain a certificate and show the certificate to the school. This compulsory measure improves students’ awareness of the novel antibiotics and strengthens their ability to prevent buy antibiotics. With respect to psychological health, medical students are easily affected by disease-associated fear and pressure, and schools should be prepared to provide psychological services to those who need zithromax online usa them.6 Students can also consult psychologists from university-affiliated hospitals who are online 24 hours a day. The Chinese government provides students with a wide coverage of zithromax protection education that has shown good results to date.

The government also zithromax online usa provides corresponding psychological counselling services. Specifically, China has1 stopped centralised classroom teaching,2 carried out antiepidemic knowledge training,3 encouraged the wearing of masks and4 paid attention to hand hygiene. These measures are worthy of implementation in foreign countries as well. Conversely, European countries zithromax online usa have encouraged medical students to graduate early so that they may work to help fight buy antibiotics, which is worthy of implementation in China.We cannot neglect the adverse effects of buy antibiotics on Chinese scientific research. Fundamental experiments, scientific conferences, funding applications and other activities have been postponed or suspended because of the zithromax situation, which has caused a huge loss in scientific research in China.

Specifically, pharmaceutical companies are lacking essential drugs because of zithromax online usa shutdowns. Scientific researchers are out of work because of the closures of laboratories. And students are unable to attain their academic degrees because of the suspension of research. However, the damage to science is insignificant compared with zithromax online usa the level of human suffering. Notably, 5G wireless communication technology, artificial intelligence and cloud computing have played effective roles in prevention and monitoring during this epidemic emergency.

Additionally, because zithromax online usa of the lack of specific drugs and treatments, traditional Chinese medicine has been adopted as a part of clinical therapy.Thanks to the leadership of the government and the efforts of many medical workers, the effect of buy antibiotics control in China has been remarkable. The Chinese Ministry of Education recently announced that senior medical students can return to universities in advance if circumstances permit. Doctors and postgraduate medical students are also glad to return to their clinical work and make their own contributions to the health of the people. With increased knowledge of the viral features, epidemiological characteristics, clinical symptoms and antizithromax theory, efficient strategies have been taken to prevent, control and stop the zithromax online usa spread of buy antibiotics. During the current buy antibiotics zithromax, which is a worldwide war, everyone is a fighter.

Under the close unity of all countries worldwide and with active participation of the world population, we believe that the prevention and control of buy antibiotics will be finally achieved.AcknowledgmentsWe thank the leaders and teachers from PUMC&CAMS for their help in processing this article..

This author has published zithromax price ph on various medical topics and is obviously on several lists as a potential reviewer for papers on subjects of which he has only slight detailed how do you get zithromax knowledge. There appears to be no definition of, or qualifications for, a peer reviewer other than that he or she is, rightly or wrongly, perceived to be an expert in a particular field.About a million research papers are published each year and researchers are pressurised to publish because grants, enhanced reputations and rewards may follow (perhaps including a Nobel prize). Peer review is one way for reputable journals to zithromax price ph promote good science. But there are numerous problems as outlined by Richard Smith, a previous editor of the British Medical Journal.1Peer reviewers are usually busy people and often provide their opinions without charge. Journal editors, unless they reject submission independently, must choose and trust that reviewers are up to date especially concerning potentially important recent developments.For the purposes of this account, a differentiation is made between research studies and research trials.

Studies are zithromax price ph solely observational and replications are unusual because surrounding circumstances often change with the passage of time. In contrast, trials are interventional. Trials should address predefined specific zithromax price ph questions and the methods used should contain sufficient information to allow exact replication. Replication of trials is problematic because of the expenses involved and details of the exact methods used in the original trial may not be comprehensive. Double-blind randomised placebo-controlled research trials are said to be gold standard, but comparative trials are more important.

The former only suggests that treatments given zithromax price ph were more effective than placebo. Reviewers need to know is whether treatments are better than a known effective treatment.Traditionally studies and trials comprise titles, abstracts, introduction, methods, results, discussion, conclusions and references.Reviewers should ensure that …AbstractAt the beginning of 2020, the outbreak of buy antibiotics in China has brought great impact on the society, economy and life. This article introduces current status of Chinese postgraduate medical students under this epidemic situation in combination with zithromax price ph the author's own experience from four aspects. Professional spirit, professional knowledge, learning status and protective measures.IntroductionA novel antibiotics has been discovered and confirmed since the first case of unidentified pneumonia was confirmed in Wuhan, China, in December 2019.1 2 The disease caused by this novel zithromax was officially named buy antibiotics by the WHO on 12 January 2020. Since the outbreak in China, the numbers of confirmed cases and deaths have rapidly increased.

buy antibiotics has been clarified as a grade B infectious disease, others of which include severe acute respiratory syndrome and highly pathogenic zithromax price ph avian influenza, and is treated according to the protocol for grade A infectious diseases. buy antibiotics is the seventh known antibiotics-induced disease that involves of the respiratory system in human beings. The other two potentially life-threatening antibiotics-induced diseases are severe zithromax price ph acute respiratory syndrome and Middle East respiratory syndrome.3 4 This novel antibiotics-induced pneumonia is transmitted from person to person and is highly infectious, with high susceptibility among the general population. The antibiotics responsible for buy antibiotics has a long incubation period and diverse clinical features, seriously impacting normal work and life throughout the country. As of 13 April 2020, buy antibiotics had been recognised in over 200 countries, with a total of 1 784 364 laboratory-confirmed cases and 111 832 deaths, and these numbers have since continued to rise.On 23 January 2020, the Chinese government immediately blocked the city of Wuhan and cut off all outside contact to stop the spread of buy antibiotics.

Other cities successively zithromax price ph announced closure of public places and restricted the flow of people. At the time of this writing, the Chinese Ministry of Education had stated that no student was allowed to return to school until further notification. Some postgraduate medical students residing at school were isolated in zithromax price ph safe places. Some others who had returned home for holiday were restricted to their local residence and prohibited to return to the hospital or medical school for studies or clinical work. We herein describe the status and situation of postgraduate medical students in China under the influence of buy antibiotics.Encouragement and promotion of the professional spirit of postgraduate medical studentsAt the frontline of the fight against buy antibiotics, many medical staff members around the country have devoted their full power without hesitation while ignoring their own personal safety.

Their teachers, colleagues and zithromax price ph friends have also participated in this battle. Such behaviour demonstrates the humanitarian nature of medicine, which involves healing the wounded and rescuing the dying. This vivid lesson helps medical students zithromax price ph to internalise medical ethical principles through emotional penetration and thus deepens their understanding and strengthens their beliefs. It benefits society to cultivate a spirit of benevolence among medical students and to train postgraduate medical students to engage in positive behaviour. In recent years, the position of the medical humanities in medical education has gradually improved.

The combination of medical humanities and medical knowledge is regarded as a successful medical education, which manifests zithromax price ph scientific and human brilliance. Such education could help medical students to realise the transformation from medical ethical cognition to medical ethical behaviour in their future career.Use of professional knowledge to assist othersMedical students can help their relatives and friends to recognise the symptoms of pneumonia early according to their professional knowledge. The diagnosis of buy antibiotics is based on a combination of epidemiological zithromax price ph information, clinical symptoms, CT imaging findings and laboratory tests according to the standards of either the WHO or the National Health Commission of China. Although medical students were not in the hospital and had no access to CT or test kits, they generally have a higher level of professional judgement than people in the general population with respect to medical knowledge and patients’ symptoms. For example, if a person within a medical student’s neighbourhood develops a fever and cough and has a travel history from Wuhan, the student can advise him or her to go to the hospital in a timely manner.

Postgraduate medical students can also educate the people around them, which helps the public to realise the importance of prevention zithromax price ph and comply with regulations formulated by the country. Medical students can also serve as volunteers within the community and use their professional knowledge to make more contributions to community residents.Non-stop learning despite suspension of classesThe sudden outbreak of this novel antibiotics disrupted normal teaching and studying in the field of medical education. Non-stop learning via online teaching despite suspension of classes was put zithromax price ph forward by the ministry of education. During the disease outbreak, online lectures and learning tutorials were adopted to avoid unnecessary aggregation of people and the associated risk of .5 Basic medical courses such as physiology, pathology and biology are relatively easy to study by video or electronic books. However, clinical medicine courses such as surgery are not suitable for online study.

Because medicine is a practical science, zithromax price ph it cannot break away from clinics and patients, and even simulation training cannot achieve a real-world effect. Many universities lack the ability to use the computers or software required to conduct online teaching courses, record teaching videos and prepare teaching documents such as text, picture, audio and animation. Students living in rural areas with underdeveloped networks and poor hardware facilities may find it difficult to meet the requirements of online learning. During this special period in China, self-study has become an important zithromax price ph skill for medical students. Students of different majors have different learning styles.

Dermatology students zithromax price ph can review photographs of lesions to improve their skills in differential diagnosis. Internal medicine students can analyse complex cases to exercise their logical ability. Surgery students can learn more about internal medicine to become more comprehensive surgeons. Additionally, online learning allows students to zithromax price ph restart long-forgotten projects, modify research papers and complete unfinished work. They can also review the literature in a field of interest, create an outline of future research and contemplate their career plan.

All doctors in zithromax price ph China are willing to apply for assistance from the National Natural Science Foundation of China, a famous and widely used research fund. Online application usually starts in March every year, but in 2020, it was postponed until April because of the epidemic. This gave medical students more time to carefully prepare for their application under the guidance of a mentor.Effective measures to ensure the health of medical studentsAlthough the medical resources of the whole country are devoted to treatment of all patients infected with the novel antibiotics, the schools and government still make special efforts to protect the health of students. Peking Union Medical College has developed an online system called SARISenor, which is used by medical students to report zithromax price ph the body temperature and physical condition every day. This system also has a locating function based on the global positioning system, which is convenient for localised management.

Our medical zithromax price ph school also developed a course to increase knowledge of buy antibiotics, and all students are required to study this course online. A test is administered after completion of the course, and students must complete the test to obtain a certificate and show the certificate to the school. This compulsory measure improves students’ awareness of the novel antibiotics and strengthens their ability to prevent buy antibiotics. With respect to psychological health, medical zithromax price ph students are easily affected by disease-associated fear and pressure, and schools should be prepared to provide psychological services to those who need them.6 Students can also consult psychologists from university-affiliated hospitals who are online 24 hours a day. The Chinese government provides students with a wide coverage of zithromax protection education that has shown good results to date.

The government also provides corresponding zithromax price ph psychological counselling services. Specifically, China has1 stopped centralised classroom teaching,2 carried out antiepidemic knowledge training,3 encouraged the wearing of masks and4 paid attention to hand hygiene. These measures are worthy of implementation in foreign countries as well. Conversely, European countries have encouraged medical students to graduate early so that they may work to help fight buy antibiotics, which is worthy of implementation in China.We cannot neglect the adverse effects of buy antibiotics on zithromax price ph Chinese scientific research. Fundamental experiments, scientific conferences, funding applications and other activities have been postponed or suspended because of the zithromax situation, which has caused a huge loss in scientific research in China.

Specifically, pharmaceutical companies are zithromax price ph lacking essential drugs because of shutdowns. Scientific researchers are out of work because of the closures of laboratories. And students are unable to attain their academic degrees because of the suspension of research. However, the zithromax price ph damage to science is insignificant compared with the level of human suffering. Notably, 5G wireless communication technology, artificial intelligence and cloud computing have played effective roles in prevention and monitoring during this epidemic emergency.

Additionally, because of the lack of specific drugs and treatments, traditional Chinese medicine has been adopted as a part of clinical therapy.Thanks to the leadership of the government zithromax price ph and the efforts of many medical workers, the effect of buy antibiotics control in China has been remarkable. The Chinese Ministry of Education recently announced that senior medical students can return to universities in advance if circumstances permit. Doctors and postgraduate medical students are also glad to return to their clinical work and make their own contributions to the health of the people. With increased knowledge of the viral features, epidemiological characteristics, clinical symptoms and antizithromax theory, efficient strategies have been taken to prevent, control and stop the spread of zithromax price ph buy antibiotics. During the current buy antibiotics zithromax, which is a worldwide war, everyone is a fighter.

Under the close unity of all countries worldwide and with active participation of the world population, we believe that the prevention and control of buy antibiotics will be finally achieved.AcknowledgmentsWe thank the leaders and teachers from PUMC&CAMS for their help in processing this article..