Among adults in California, those with Medicaid coverage have highest increase in emergency department visits

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Article Date: 17 Sep 2013 - 13:00 PDT Current ratings for:
Among adults in California, those with Medicaid coverage have highest increase in emergency department visits

"Emergency department (ED) use has been affected by insurance patterns over time and will likely be further affected by expansions of coverage from health care reform." Uninsured patients are often thought of as high and frequently inappropriate ED users, but insured patients, particularly those with Medicaid coverage, may have difficulties accessing primary care and may rely on EDs more frequently than uninsured patients, write Renee Y. Hsia, M.D., M.Sc., of the University of California, San Francisco, and colleagues.

In a Research Letter appearing in the September 18 issue of JAMA, the authors investigated recent trends in the association between insurance coverage and ED use. The study was a retrospective analysis of California ED visits by adults 19 to 64 years of age from 2005-2010 that used the nonpublic versions of data from the California Office of Statewide Health Planning and Development's Emergency Discharge Data and Patient Discharge Data. To study variations by insurance coverage, ED visits were grouped into 4 categories based on expected source of payment: Medicaid, private insurance, self-pay or uninsured, and other. The authors also looked at ED visits for ambulatory care sensitive conditions (ACSCs).

The researchers found that between 2005 and 2010, the number of visits to California EDs by adults overall increased by 13.2 percent from 5.4 to 6.1 million per year. The largest increase in visits occurred in 2009. The share of total visits increased among adults with Medicaid coverage and uninsured adults, whereas the share decreased among adults with private insurance. Visit rates to the ED among adult Medicaid beneficiaries were higher than uninsured and privately insured patients.

"Increasing ED use by Medicaid beneficiaries could reflect decreasing access to primary care, which is supported by our findings of high and increasing rates of ED use for ambulatory care sensitive conditions by Medicaid patients. The increase in ED visits was highest in 2009, likely due to the H1N1 pandemic and the influence of the economic downturn on coverage transitions and access to care," the authors write.

Article adapted by Medical News Today from original press release. Source:

JAMA - doi:10.l001/ jama.2013.228331

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Tesla staring down California dealer ad probe request

Months after the confusing announcement of Tesla's lease-like financing program, the electric vehicle maker could face an advertisement probe that has been requested by the California New Car Dealers Association, Automotive News reports, which claims that consumers are being mislead by advertised monthly payments that are lower than what most people would experience.

The ordeal can be traced back to April 2, when Tesla made an announcement specifying tiered monthly payments for the three versions of the Model S assuming a 66-month term. But then Tesla revised the numbers upward overnight because, it claimed, it meant to say it offered a 63-month finance term, not a 66-month term. The automaker also claimed that factoring in the "true cost of ownership" of a Model S compared to a conventional fuel-burning car could drive monthly costs to below $500.

In May, it added an available finance term of 72 months, which, factoring in only gasoline savings, the company said could lower monthly payments to $580. But the underlying issue at hand is that the means which can potentially lower monthly payments from $1,000+ dollars (depending on the model) to under $600 can't be realized by the majority of Americans, the CNCDA says.

Tesla provides an online calculator that does the payment math for you. It takes into account the $7,500 federal incentive and $2,500 California incentive (state incentives differ) for EVs, what your time is worth, how much time and money are saved away from the gas station, shortened commuting time with carpool lane access (in participating states), and even business tax benefits. But the "packed external incentives," as the dealer association calls them, don't apply to everybody. Most people can't realize monthly payments below $500 unless they have the right mix of true-cost-of-ownership deductions. CNCDA also claims that only 20-percent of Americans can claim the full $7,500 federal incentive, which is based on findings by the Congressional Budget Office, according to Automotive News.

Brian Maas, president of the dealer association, sees Tesla's advertisement strategy in this way: "It's misleading. If you checked every box on their true cost of ownership series of inquiries, they claim you can get a Model S for $114 a month, which is lower than the cheapest [new] car available in the United States, the Nissan Versa - which would cost you, with a lease deal, about $139 a month," Automotive News reports.

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California city backs plan to seize negative equity mortgages

By Jim Christie

RICHMOND, Calif | Wed Sep 11, 2013 6:00am EDT

RICHMOND, Calif (Reuters) - Richmond, California's leaders approved on Wednesday morning a plan for the city to become the first in the nation to acquire mortgages with negative equity in a bid to keep local residents in their homes.

The power of 'eminent domain' allows governments to seize private property for a public purpose. Critics say the plan threatens the market for private-label mortgage-backed securities.

Richmond's city council voted 4 to 3 for Mayor Gayle McLaughlin's proposal for city staff to work more closely with Mortgage Resolution Partners to put the plan crafted by the investor group for the city to work.

Richmond can now invoke eminent domain if trusts for more than 620 delinquent and performing "underwater" mortgages reject offers made by the city to buy the loans at deep discount pegged to their properties' current appraised prices to refinance them and reduce their principal.

A mortgage is under water when its unpaid balance is greater than its property's market value.

MRP has failed to get similar plans approved by local governments elsewhere - most recently in North Las Vegas, Nevada and earlier this year in San Bernardino County in Southern California - as the mortgage industry and local real estate businesses rallied against them.

But in Richmond, MRP found an ally in a Wall Street-bashing Green Party mayor of one of the San Francisco region's poorest cities who sees working with the investor group to acquire mortgages as a public purpose if it makes the loans more affordable, averts foreclosures and alleviates blight.

Richmond's residents have been "badly harmed by this housing crisis," McLaughlin said, defending the plan and partnership with MRP during an often contentious city council meeting that began Tuesday evening and ended early Wednesday morning. "Too many have already lost their homes."

City council members opposed to the plan countered that using eminent domain would put Richmond at risk of expensive lawsuits that could destroy the city's finances.

"A 1 percent chance of bankruptcy from this program is a deal-breaker for me," Councilman Jim Rogers told a crowd of about 300 people at the meeting, moved to a city auditorium from the council's chamber.

Other council members warned of a backlash from financial institutions, noting Richmond had no takers last month when the successor to its redevelopment agency put $34 million of bonds up for sale to refinance previous debt. The eminent domain plan had been disclosed to the U.S. municipal bond market.

While housing advocates urged support for the plan, realtor Jeffrey Wright warned that going through with eminent domain could prompt a clampdown in mortgage lending in Richmond or push up mortgage interest rates in the city of about 104,000 residents.

Responding to the plan, the Federal Housing Finance Agency recently said it would press Fannie Mae and Freddie Mac to limit or cease its business where such proposals get approved, effectively closing off most mortgage financing there.

Investors holding the mortgages targeted by Richmond dispute altruism motivates the plan and charge the city would lend its eminent domain power to San Francisco-based MRP to split profits from refinancings.

The investors have sued through trustees Wells Fargo & Co and Deutsche Bank AG in U.S. District Court to block the plan, which they say relies on them swallowing losses. The two sides square off in court in person for the first time on Thursday.

McLaughlin's proposal directs city staff to work with other local governments interested in the plan, calls for city staff and MRP to resolve its legal issues and confirms the city council would hold votes to seize mortgages by eminent domain if necessary. That would require a supermajority vote of the council.

(Reporting by Jim Christie; Editing by Toby Chopra)

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Firefighters holding line against massive California wildfire

n">(Reuters) - Firefighters battling a colossal California wildfire that has eaten away at the Yosemite National Park backcountry managed overnight to largely stem the spread of the flames, authorities said on Sunday.

The fire sent heavy smoke on Saturday into the popular touristic Yosemite Valley, an area famed for towering granite rock formations, waterfalls and pine forests, obscuring views of popular landmarks on a holiday weekend at the end of the summer tourist season.

Despite footage from cameras posted on the park's website showing continued smoky conditions in the park, no further road closures within Yosemite were reported, and containment lines held steady at 40 percent.

"We have been able to hold the line. It's just trying to figure out how to wrap this thing up and put a bow around it," said fire incident spokeswoman Leslie Auriemmo, adding that there were no fresh closures in the park.

The Rim Fire had charred nearly 223,000 acres by early on Sunday, mostly in the Stanislaus National Forest which spreads out from Yosemite's western edge although the blaze has blackened about 6 percent of Yosemite's wilder backcountry.

The Yosemite Valley has been open to visitors since the fire broke out two weeks ago, but smoke began spreading to the area on Friday ahead of the Labor Day holiday weekend that in the past years has seen the park fill with visitors.

The smoke from the fire, whose footprint now exceeds the area of Dallas, was expected to at least partially clear on Sunday afternoon as winds shift, fire managers said.

Some 4 million people visit Yosemite each year, most going during the peak months of June through August. Some 620,000 normally visit the park in August alone, but due to the fire, attendance has dropped.

Close to 5,000 people are working to put out the fire, including firefighters from agencies across California and nearly 700 specially trained California prison inmates.

Among the landmarks potentially in the path of the blaze are two groves of the park's famed sequoia trees.

"We are working very hard to protect that. All the lines are in place so it doesn't go into those groves," Auriemmo said.

Firefighters have carried out controlled burns around the groves to clear away debris that could otherwise fuel a fire to such an intensity that it dangerously licks at the trees' crowns.

Lower-intensity fires, on the other hand, play a vital role in the reproductive cycle of the tough-barked sequoia, many of which bear the scars of past wildfires, by releasing the seeds from their cones and clearing the soil in which they germinate.

The blaze has edged out the 1932 Matilija wildfire in Ventura County to become the fourth-largest California wildfire on record, according to figures from the California Department of Forestry and Fire Protection.

The cause of the fire remains under investigation.

(Editing by Cynthia Johnston and Sandra Maler)

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California wildfire threatening Yosemite is now size of Dallas

By Jonathan Allen

Sat Aug 31, 2013 3:11pm EDT

n">(Reuters) - A massive wildfire that has charred the northwestern edge of California's Yosemite National Park is heading towards two groves of the park's famed sequoia trees, National Park Service Director Jonathan Jarvis said as firefighters battled the blaze on Saturday.

The so-called Rim Fire, which now has an overall footprint that exceeds the area of Dallas, has burned about six percent of Yosemite's wilder backcountry but the vast majority of the park was still unaffected, Jarvis said.

The sequoias are expected to survive if the fire spreads through the groves of the towering redwoods that are among the park's most famous features, Jarvis said in a telephone interview.

"This is not a catastrophe for Yosemite National Park," he said in a telephone interview after surveying the affected areas. "These trees are very old and it's not the first fire they've ever seen."

Firefighters have been carrying out controlled burnings at night around the groves to clear away debris from the forest floor that could otherwise fuel a fire to such an intensity that it dangerously licks at the trees' crowns.

Lower-intensity fires, on the other hand, play a vital role in the reproductive cycle of the tough-barked sequoia, many of which bear the scars of past wildfires, by releasing the seeds from their cones and clearing the soil in which they germinate.

The so-called Rim Fire has continued to spread, having now consumed nearly 220,000 acres by Saturday, according to a U.S. Forest Service spokesman. Most of the damage is in the Stanislaus National Forest that spreads out from Yosemite's western edge.

Firefighters have contained about a third of that area.

"We're very, very cautious about the potential today," Timothy Evans, the spokesman, said. "Yesterday was very hot, there was some wind, and the same was somewhat predicted for today."

The blaze is now approximately tied with the Matilija wildfire in Ventura County of 1932 as the fourth-largest California wildfire on record.

Jarvis estimated that firefighting efforts had so far cost state and federal agencies about $54 million. He criticized a decline in federal funding for fire-prevention work, including the practice of controlled fires that make the chance of a wildfire of this intensity less likely.

Nearly 5,000 people are working to put out the fire, including firefighters from agencies across California and nearly 700 specially trained California prison inmates.

Tourism-dependent businesses around the park have bemoaned a slump in visitors at the peak of the late-summer tourist season. Jarvis said there was no need to for visitors to stay away.

"Yosemite Valley is open to the public and is gorgeous," he said, referring to one of the park's most scenic and visited areas, adding that it is more than 20 miles from the edge of the fire.

The cause of the fire remains under investigation.

(Reporting By Jonathan Allen; Editing by Scott Malone and Sandra Maler)

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Failure to thin brush may have worsened California wildfire

By Jonathan Kaminsky

Sun Sep 1, 2013 11:40am EDT

n">(Reuters) - A cluster of controlled fire and tree-thinning projects approved by forestry officials but never funded might have slowed the progress of the massive Rim Fire in California, a wide range of critics said this weekend.

The massive blaze at the edge of Yosemite National Park in the Sierra Nevada mountains has scorched an area larger than many U.S. cities - with some of that land in the very location pinpointed by the U.S. Forest service for eight projects aimed at clearing and burning brush and small trees that help fuel wildfire.

The projects, which were approved by the U.S. Forest Service but never funded by Congress, would have thinned the woods in about 25 square miles (65 square km) in the Groveland District of the Stanislaus National Forest, much of which was incinerated by the Rim Fire.

About 9,000 acres were suitable to be deliberately burned as fire prevention buffer zones in 2012, the Forest Service said in a document provided to Reuters.

But reductions in funding for fire prevention efforts by Congress in recent years coupled with stringent air quality standards that limit the timeframe for such burns have hampered efforts to carry them out on a larger scale.

Last year, the Forest Service had funding to burn 449 acres in the Groveland District but did not reach that target, said District Ranger Maggie Dowd.

The wildfire is the sixth-largest on record in California. It burned over 220,000 acres over the past two weeks while penetrating Yosemite National Park and threatening to befoul the Hetch Hetchy reservoir providing the lion's share of water to San Francisco.

"This is a colossal unfunded backlog of critically important fuel reduction work," said John Buckley, executive director of the Central Sierra Environmental Resource Center and a former Forest Service fire fighter. The projects "would have inarguably made the Rim Fire far easier to contain, far less expensive and possibly not even a major disaster."

Over the past several years, wildfires in the U.S. West have become increasingly frequent and at times deadly. Earlier this year, 19 firefighters were killed in a blaze in Arizona, and wildfires have raged in several states, including Nevada, Alaska and New Mexico.

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Federal fire figures show an average of 7.6 million acres (3.1 million hectares) charred per year between 2004 and 2012, up from 3.6 million acres (1.46 million hectares) annually in the preceding 20 years.

Part of the problem, experts and many fire officials say, is that funding has been low for the controlled burns and forest-thinning work that makes it harder for a wildfire to spread.

In recent years, Jarvis said, the trend has been to shift money from fire prevention to firefighting.

"We've got to invest up front in terms of controlling and managing these fires," said Jonathan Jarvis, director of the National Park Service from his smoke-filled post in Yosemite National Park. "Just waiting for the big fire and then throwing everything you've got at it makes no sense."

The massive blazes are fueled by high temperatures, said U.S. Forest Service geographer Carl Skinner.

Mike Albrecht, co-owner of the logging company Sierra Resource Management, which operates on public land in the Sierra Nevada mountains said that the backlogged projects would likely have helped limit the Rim Fire.

The "one-two punch" of thinning the forest through logging and prescribed burns is essential for stemming the tide of catastrophic wildfires across the American West, he said.

Craig Thomas, conservation director for the environmental coalition group Sierra Forest Legacy, said such a course would help reduce the intensity of wildfires enough to spare the largest trees, while clearing space and providing nutrients for grasses and wildflowers.

In addition to perennial funding shortfalls for prevention efforts, Thomas faults federal and state air quality regimes that limit the timeframe for prescribed burns by counting the smoke they generate along with industrial and auto emissions - while not counting the smoke from an actual wildfire.

There is also skepticism over the relative importance of planned burning among some lawmakers, including Congressman Tom McClintock, a third-term conservative Republican in whose district the Rim Fire has burned.

More dire than a backlog of Forest Service controlled burns, McClintock says, is the precipitous, 25-year decline in logging of bigger, money-making trees on public lands.

"If we were harvesting the same amount of timber we once did, we'd have fewer fires but also a revenue stream for the treatment of many thousands of acres (hectares) that we're not treating today," he said.

Dowd, the Forest Service Ranger, said that with containment lines built around less than half of the still-burning Rim Fire, it is too early to know how much the prevention projects might have helped.

But she said that the several dozen acres of prescribed burns carried out in her district over the past two years, are insufficient.

"It's not enough," Dowd said.

(Additional reporting by Jonathan Allen; Editing by Sharon Bernstein and Sandra Maler)

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