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HEALTH CARE NEWS

US Congress extends CHIP, funds opioid crisis response following temporary shutdown

Publish date: February 9, 2018

By 

Gregory Twachtman 

Oncology Practice

 

 

 

 

 

 

 

 

 

Congress, despite a second shutdown in less than a month, was able to pass a number of financial extenders to fund key health care programs.

The bipartisan spending bill (H.R. 1892), passed in the early morning hours on Feb. 9 by a 71-28 vote in the Senate (16 Republicans and 12 Democrats voted against it, and Sen. John McCain [R-Ariz.] was not present) and a 240-186 vote in the House (67 Republicans and 119 Democrats voted against and 5 representatives did not vote). President Trump signed the bill later that morning.

 

The spending bill and continuing resolution to fund the government through March 23 includes $6 billion to fund treatment for opioid addiction and other mental health issues, $2 billion in additional funding for the National Institutes of Health, and 4 additional years of funding for the Children’s Health Insurance Program. The additional CHIP funding extends the program for a total of 10 years.

The funding bill also made a technical correction to the Merit-based Incentive Payment System (MIPS) track of the Medicare Quality Payment Program. It removes Part B drug reimbursement from the MIPS payment adjustment, so any positive or negative change to physician payments based on the MIPS score will only be applied to physician fee schedule payments.

The bill also repeals the Independent Payment Advisory Board, a panel created by the Affordable Care Act that would have the power to slash Medicare spending under certain budget circumstances. That board was never convened.

The funding legislation also accelerates closure of the Medicare Part D “donut hole,” the coverage gap in which beneficiaries must pay 100% of medication costs prior to entering catastrophic coverage.

Just over $7 billion was provided for community health centers and Medicare’s therapy caps were repealed.

While the funding bill was written in the Senate with bipartisan input and received bipartisan support, Sen. Rand Paul (R-Ky.) held up votes over objections to the more than $1 trillion it will add to the nation’s debt, as well as for the fact that there was no opportunity to introduce and vote on amendments, leading to an hours-long government shutdown.

There also were concerns about two issues that could have derailed the vote in the House. Democrats wanted to add language to address immigrants brought to this nation illegally as children, while some Republicans did not want to increase the federal debt. However, there were enough votes to pass the funding legislation.

gtwachtman@frontlinemedcom.com

Why Long-term Separation Harms Kids

Drotumdi O

June 6, 2018 by David Rosenberg, The Conversation
Children are often sad when separated from their parents for a short time, but the effects are pronounced if the separation is long. Credit: Eakachai Lessin/Shutterstock.com

As a society, we often wax eloquent about how important it is to nurture, support and protect our children. The sad reality, however, is that all too often major, life-changing decisions are made without any consideration of their potential lifelong and devastating impact on kids.

Case in point: separated from their parents at borders as new immigration policies are debated. Separation from for even short periods can cause disorders that can last a long time.

I wish to underscore that my explanation here is apolitical. Instead, I am writing as a child and adolescent psychiatrist, parent, and member of our society, who would prefer that we be proactive rather than reactive when it comes to protecting vulnerable children at high risk for separation anxiety disorder and other emotional and behavior problems.

Separation anxiety disorder is a disorder that is marked by unusually strong, and clinically significant, fear and distress related to separation from the home, a parent or other attachment figure. The fear and distress exceed levels appropriate for the individual's age and developmental level, and lasts at least four weeks in children.

Symptoms can include persistent fears of parents being killed or kidnapped, worries about a parent getting sick and being afraid to go to school. Abdominal pain, nausea and other physical symptoms are also common.

Uncertainty and pathological doubting can dominate. These children with separation anxiety disorder never get the "all clear signal" that they or their loved ones are safe unless they are physically together. Even then, safety is precarious as there is always the risk for future separation.

Low socioeconomic status, a family history of anxiety or depression, and other environmental, hereditary and genetic factors appear to increase the risk of developing separation anxiety disorder. However, some of the most common precipitants of separation anxiety symptoms are stress, trauma or a sudden change in environment, such as a divorce or death in the family, a move to a new house or school, or from being forcibly separated from a parent or loved one.

It is important to point out that it is perfectly normal for young children to experience separation anxiety. It is a normal developmental milestone. For example, it is common for young children to get nervous and scared when their parent leaves and says goodbye.

This usually gets better in children as they get older, but in about 4-5 percent of children and adolescents separation anxiety persists and requires therapeutic intervention.

Treatment for separation anxiety disorder includes therapy, reassurance of the child and caregivers, and psychoeducation to provide the family with information about this disorder and the available treatment services that they can receive. However, medication may also be required for severe cases.

Separation anxiety disorder also increases the risk for developing depression, other anxiety , post-traumatic stress disorder, and a dependent personality disorder in adulthood.

While it is true that children can be resilient and either persevere or recover, it is never easy and the hidden scars remain.

Explore further: Parental touch may reduce social anxiety in children