- Kaiser Health News Original Stories 3
- Medicare To Test New Payment Approaches For Some Prescription Medications
- Using Data To Help Home Health Workers Manage Patients’ Conditions
- Housing Project Takes On Seniors' Health
- Political Cartoon: 'Disappointing, But No Copay'
- Administration News 2
- U.S. To Test The Waters With Medicare Drug Reimbursement Proposal
- Expensive Specialty Drugs Help Drive Up U.S. Drug Spending
- Health Law 2
- Tax Time Crunch: Health Law Penalties Catching Up To Many Taxpayers
- Administration Official, Seeking To Allay Insurers' Concerns, Says Market Is Stabilizing
- State Watch 3
- A Growing Problem For Hospitals, Medical Practices: Unpaid Bills
- Mass. Legislators Compromise On Bill To Restrict First-Time Opioid Prescriptions
- State Highlights: Wisconsin Outbreak Of Deadly Blood Infections Gains Urgency; Synthetic Pot Causing Police Alarm In Washington
From Kaiser Health News - Latest Stories:
Regulators unveiled a two-part plan that will change payments and test ways in which the Medicare Part B program can change the incentives that some policy experts say encourage doctors to choose higher-cost medications. (Julie Appleby, 3/9)
A market is emerging for products that enlist data and technology to identify patients who might be at risk for hospitalization or readmission. (Julie Appleby, 3/9)
An innovative new approach in Oakland combines low-income housing and a health program for seniors. (David Gorn, 3/9)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Disappointing, But No Copay'" by Dan Piraro.
Here's today's health policy haiku:
IT‘S LIKE ‘BRINGING A POCKET NURSE’ ON THE VISIT
For some home health aides
These tablets add expertise
To what they can do.
If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
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Summaries Of The News:
The proposal affects drugs administered in doctors offices or outpatient clinics. It is aimed at current reimbursement incentives that may encourage doctors to select higher-priced medications but not add benefits for patients.
The New York Times:
U.S. To Test Ways To Cut Drug Prices In Medicare
The Obama administration said on Tuesday that it would test new ways to pay for prescription drugs in an effort to slow the growth of Medicare spending on medicines while encouraging doctors to choose the most effective treatments for their patients. The announcement comes as presidential candidates including Hillary Clinton, Senator Bernie Sanders and Donald J. Trump are calling for government action to protect consumers against high drug prices. Federal officials said the government spent $20 billion last year under Part B of Medicare for prescription drugs administered in doctors’ offices and hospital outpatient departments. (Pear, 3/8)
Kaiser Health News:
Medicare To Test New Payment Approaches For Some Prescription Medications
Currently, Medicare Part B pays the average sales price of the drug, plus 6 percent. Under the proposal that would start later this year, doctors and hospital outpatient centers would get the average price plus 2.5 percent, along with a flat fee of $16.80 per drug per day. (Appleby, 3/9)
The Wall Street Journal:
U.S. Officials Propose Test Program Aimed At Lowering Medicare Drug Costs
The development could lead to an overhaul of reimbursements under Medicare Part B, a program that pays about $19 billion a year to providers—and is outlined in a proposed rule issued Tuesday by the Centers for Medicare and Medicaid Services, which runs the program. The initiative is part of a strategy by the Obama administration and Congressional lawmakers to tackle health-care spending that is driven in part by rising prescription-drug prices, an issue that has loomed in the presidential race and ranks high among public concerns in polls. The administration has sought information on pricing from pharmaceutical companies and has been probing ways to help consumers keep their drug costs in check. (Armour, 3/8)
The Washington Post:
Medicare Considers Overhaul Of Doctors’ Payments For Drugs
Patrick Conway, chief medical officer for CMS, said in a telebriefing that the plan isn’t designed to save money. But he left little doubt that the ultimate aim is to eliminate incentives that may encourage doctors to select higher-priced medications that benefit their bottom lines but not their patients. Conway called the current system — in which doctors are paid the average sales price plus 6 percent for handling and administration costs — a “perverse incentive structure that doesn’t benefit patients or the system.” He said oncologists have told CMS they sometimes feel pressure from their health-care systems to pick more expensive drugs to bolster profits. (McGinley, 3/8)
The Associated Press:
Medicare To Test New Payment Model For Some Outpatient Drugs
Under the elaborate experiment being proposed by Medicare, parts of the country would operate under different payment rules for physician-administered medications. The results would then be compared, and if new approaches can maintain or improve quality while showing potential to curb costs, permanent changes could follow across the whole country. ... It's unclear how doctors and hospitals will respond. In the past, smaller oncology clinics have complained that Medicare cuts have a disproportionate impact on them. (Alonso-Zaldivar, 3/8)
Los Angeles Times:
Obama Administration Proposes New Effort To Combat High Drug Prices
Facing skyrocketing drug prices, the Obama administration is proposing potentially major changes in how Medicare pays for some medications, including high-priced specialty drugs used to treat cancer and other costly diseases. The proposed regulations, unveiled Tuesday, would initially affect a relatively small share of the nation’s nearly $500-billion drug tab. But if widely implemented, they could overhaul the way Medicare, America’s largest insurer, pays for drugs, by linking payments to the effectiveness of medications, not just their prices. (Levey, 3/8)
CMS Wants To Overhaul Part B Drug Payments. Oncologists Call The Plan 'Absurd.'
Ted Okon, executive director of the Community Cancer Alliance, tweeted soon after the announcement that the pilot “is the most contrived, absurd experiment on cancer care I have seen.” ... The American Society of Clinical Oncology lashed out at the Innovation Center's intent to “modify drug reimbursement based on Zip codes,” calling it “inappropriate for CMS to manipulate choice of treatment for cancer patients using heavy-handed reimbursement techniques.” ASCO added that physicians “did not create the problem of drug pricing and its solution should not be on their backs.” (Dickson, 3/8)
After years of slower growth, drug spending rose a "remarkable" 12.6 percent in 2014, according to a new federal report.
The Wall Street Journal:
U.S. Prescription Drug Spending Is On The Rise
Prescription drug spending in the U.S. is rising and is projected to continue to climb faster than overall health spending, federal officials said Tuesday. Drug spending rose an estimated sharp 12.6% in 2014 after years of unusually slow growth—it rose about 2% a year between 2008 and 2012. The increase is largely due to higher-priced specialty medications and the fact that millions of people have gained insurance coverage through the Affordable Care Act, according to a report released Tuesday by the Department of Health and Human Services. (Armour, 3/8)
U.S. Health Agency Estimates 2015 Prescription Drug Spend Rose To $457 Billion
Spending on prescription drugs is projected to have risen to $457 billion in 2015 and will likely continue to grow as a percentage of overall healthcare spending, a U.S. government health agency said on Tuesday. ... The agency forecast that total drug spending will grow to $535 billion in 2018 and represent about 16.8 percent of all healthcare spending. The figures are based in part on National Health Expenditure Accounts estimates from the Centers for Medicaid and Medicare Services. (Humer, 3/8)
Feds Call Prescription Drug Price 2014 Increase 'Remarkable'
Fast-rising drug prices coupled with the use of costlier specialty drugs were the main reasons for a nearly 13% uptick in prescription drug spending in 2014, federal health officials said Tuesday. The Department of Health and Human Services called drug growth in 2013 “subdued,” but said 2014’s increase was “remarkable” and that it remained elevated during 2015 based on preliminary estimates. (O'Donnell, 3/8)
Higher Prices, Changing Preferences Driving An Increase In Drug Spending
Rising prices and a shift toward more expensive medications are driving the increases in prescription drug spending, according to a new report from the US Department of Health and Human Services. ... In a statement, Pharmaceutical Researchers and Manufacturers of America, the main industry trade group, said the report overlooks the contribution of new medications that have helped people live longer lives. The report “ignores the tremendous value medicines provide to patients, including many that offer improved treatment options for conditions that previously had few or no options, such as cancer and multiple sclerosis,” said PhRMA spokeswoman Holly Campbell. (Scott, 3/8)
Meanwhile, the pharmaceutical industry is spending billions on ad buys —
Drug Spenders Now Spend $5 Billion A Year On Advertising. Here's What That Buys.
Under fire for spending so much on advertising, drug makers are doubling down. Even as politicians and physicians press for strict limits on prescription drug ads, the pharmaceutical industry is pouring billions into new TV and print campaigns. Ad spending soared more than 60 percent in the last four years, hitting $5.2 billion last year. (Robbins, 3/9)
H&R Block reports that among its customers, 60 percent of filers who were getting tax credits to help pay their health insurance premiums in 2015 end up owing money back to the government and the average fine for people who didn't buy insurance is doubling.
The Wall Street Journal:
Repayment Of Health-Insurance Tax Credits Threatens Refunds
Most people who got tax credits to buy insurance under the federal health law will be repaying part of them for the second year in a row, according to a leading tax preparer. H&R Block Inc. executives said Tuesday that, to date, 60% of 2015 tax filers with the credit have found that they owe the government money because they had been credited too much. That is up from 52% last year, the first year in which filers had to reckon with reporting the credit and figuring out if their income projections had been accurate. (Radnofsky, 3/8)
The Associated Press:
Health Law Fines Double For Many Uninsured At Tax Time
Many people who went without health insurance last year are now seeing fines more than double under President Barack Obama's health care law, tax preparation company H&R Block said Tuesday. Among its customers who owe a penalty for the 2015 tax year, the average fine is $383, compared with $172 for 2014, the company said. Separately, among those who complied with the law and took advantage of its taxpayer-subsidized private health insurance, 6 in 10 are now having to pay back to the IRS some portion of their financial assistance. (Alonso-Zaldivar, 3/8)
The Detroit Free Press:
Upfront Affordable Care Act Credit Hits Some Tax Refunds
Tax filers who obtained money-saving tax credits upfront to buy health insurance are now finding they have to pay back an average $579 this tax season, according to data from H&R Block. ... At the same time, more than one in three taxpayers who claimed the Advance Premium Tax Credit actually overestimated their income and ended up qualifying for a bigger credit. This group is receiving an additional refund — more than $450 on average. (Tompor, 3/8)
The Chicago Tribune:
Will You Have To Pay An Obamacare Tax Penalty?
If you bought health insurance last year through Obamacare, you may be pleasantly surprised at tax time to find out you have money coming to you. But it's just as likely the surprise will go the other way: You might owe Uncle Sam some money if the government subsidy you received for buying insurance through the Affordable Care Act marketplace was too large based on your income. And if you skipped buying health insurance entirely, you probably will face a penalty. On average, those penalties this year are running $383 among H&R Block customers. That's an increase from $172 a year ago. (MarksJarvis, 3/8)
Kevin Counihan, the Obama administration’s top insurance exchange official, told a forum of insurance executives, “We’re seeing the maturing of a marketplace — people getting a bit more experienced and comfortable on how to buy coverage.” Also, a poll examines attitudes about the law in Florida.
ObamaCare Official Touts 'Maturing' Marketplace Amid Insurer Anxiety
A top ObamaCare official on Tuesday touted the increasingly stable healthcare marketplace, looking to assuage concerns from an insurance industry that remains jittery about some parts of the law. Addressing the nation’s largest insurance group, HealthCare.gov CEO Kevin Counihan highlighted the younger and healthier customers who signed up in the most recent enrollment season. Ticking off statistics about the latest open enrollment season, he said the figures are showing “just want you want to see in a risk pool.” (Ferris, 3/8)
Health News Florida:
Poll Shows Health Care Divide In Florida
A new poll shows that Floridians are divided about how their health care has changed in the two years since much of the Affordable Care Act has gone into effect. By contrast, nationwide, a majority said their personal health care has pretty much stayed the same in the past two years, according to the national poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. (Watts, 3/8)
In a recent poll, 26 percent of people said health care expenses have taken a serious toll on their finances, with 7 percent of those respondents ending up in bankruptcy.
Medical Bills Still Take A Big Toll, Even With Insurance
For Barbara Radley, there is "before" and "after." Before was when she could work — moving furniture, and driving a long-haul truck. "It was nothing for me to throw a couch on my back and carry it up a flight of stairs," says the 58-year-old from Oshkosh, Wis. Then there's after. After she herniated five disks in her back. And after, she says, her blood pressure medicine destroyed her pancreas. Now Radley is disabled, suffering from diabetes, liver failure and scleroderma. And she is bankrupt. (Kodjak, 3/8)
NPR also looks at how illegal immigrants aren't able to afford dialysis because of Medicaid rules —
Medicaid Rules Can Thwart Immigrants Who Need Dialysis
Carla can't afford private health insurance. And like the estimated 5,500 immigrants in the U.S. illegally who need dialysis, the only publicly funded insurance she's eligible for is a government program called Emergency Medicaid. But in most states, including Indiana, hospitals can't bill Emergency Medicaid until they know for sure they're dealing with an emergency. So for kidney disease, doctors will often wait until there are dangerous levels of potassium in the blood or fluid in the lungs — levels they deem urgent enough to merit hospitalization. (Harper, 3/8)
Apps are becoming a larger part of the health care landscape -- one-fifth of smartphone users had health apps in 2012 -- but it's rare for them to have privacy policies that actually protect patient data, a study finds. In other health technology news, a simple wand could make it easier for doctors to receive updates on their patients, and new software lets home care aides and non-medical workers spot potential problems before they get worse.
Health Apps Often Lack Privacy Policies And Share Our Data
The Associated Press:
This Wand Can Transmit Medical Data To A Doctor From Inside Your Home
Doctors could keep better tabs on their patients between visits with a simple wave of a magic wand-like device being developed at Dartmouth College. The prototype, dubbed "Wanda," is part of a multi-university project to develop ways to protect patient confidentiality as health care increasingly moves out of hospitals and doctors' offices and into the home. But beyond safety, simplicity also is a key goal, said doctoral student Tim Pierson, Wanda's creator. (3/6)
Kaiser Health News:
Using Data To Help Home Health Workers Manage Patients’ Conditions
There is little in Ruby’s life that is easy. Nearly blind and unable to walk more than a step or two, the 39-year-old struggles to raise three sons while dealing with a daunting array of health conditions, from diabetes that recently landed her in the hospital to pain from bulging spinal disks. Without support, odds are she’ll end up back in a hospital. But Ruby, who asked that her last name not be used to protect her family’s privacy, is part of a growing effort to reduce those odds by arming home care aides and other non-medical workers with the power of data. (Appleby, 3/9)
The Tennessean examines the issue of unpaid medical bills. Also in the news, more than a million doses of controlled drugs have been stolen from Emory University Hospital Midtown, and a controversial ballot issue in Massachusetts is causing a split within the hospital industry.
USA Today/The Tennessean:
Why More Than Half Of Hospital Bills Don’t Get Paid
Hospitals and medical practices share a growing problem with those they treat: Patients aren’t paying their bills. Working people are on the hook for an increasingly large portion of the cost of their care, as insurance policies pay for less. It’s a trend that is not reversing — and it’s causing financial distress for families and CEOs alike. (Fletcher, 3/8)
Georgia Health News:
Years Of Large-Scale Drug Thefts Reported At An Emory Hospital
Two pharmacy employees at Emory University Hospital Midtown illegally diverted more than 1 million doses of controlled drugs in a scheme that lasted more than four years, according to a Georgia Board of Pharmacy consent order. (Miller, 3/8)
The Boston Globe:
Steward, Hospital Industry Titans Butt Heads On Ballot Question
Steward Health Care System is breaking ranks with the rest of the hospital industry and throwing its support behind a controversial ballot proposal to take hundreds of millions of dollars from the state’s wealthiest hospitals and give them to lower-paid community hospitals. (Dayal McCluksey, 3/9)
Gov. Charlie Baker had pushed for a three-day limit, but the bill released this week caps it at seven days. The legislation contains other provisions to try to fight Massachusetts' growing painkiller epidemic. In Florida, the legislature plans to reform the way mental health is handled in the criminal justice system.
Compromise Opioid Bill Caps First-Time Prescriptions At 7 Days
A compromise opioid bill released by a House and Senate conference committee Tuesday evening rejects stricter controls proposed by Gov. Charlie Baker, but still imposes new limits opioid prescriptions. (Bebinger, 3/8)
Health News Florida:
State Lawmakers Hope To Reform Mental Health In Criminal Justice System
Since the 1970s, the hard on crime ethos has fueled the era of mass incarceration. Simultaneously, the country defunded public mental health services. A ballooning criminal justice system came in to fill that vacuum. Now the Florida Legislature is poised to reform the way mental illness is handled in that system. (Payne, 3/9)
Meanwhile, other state legislatures consider measures that would impact vaccinations, nursing homes and e-cigarettes —
The Kansas Health Institute News Service:
Bill Would Allow Kansas Pharmacists To Administer More Vaccines To Children
Allowing pharmacists to give more vaccines to children became a debate about access versus the fracturing of health care Tuesday in the House Health and Human Services Committee. House Bill 2646 drew support from pharmacist associations while groups representing doctors opposed it, citing concerns about record-keeping and continuity of care. (Kite, 3/8)
The Kansas Health Institute News Service:
Nursing Home Group: Facilities Will Close Without Bed Tax Increase
The leader of a group that represents Kansas nursing homes told state senators Tuesday that facilities will have to close if a bed tax increase doesn’t pass. The bill would increase a “bed tax” on nursing homes and use the proceeds to draw down more federal Medicaid funds, which would go back to the nursing homes in the form of payments for services provided to residents on Medicaid. (Marso, 3/8)
USA Today/The Indianapolis Star:
E-Cig Makers Face Increased Regulation In Indiana
Much of the controversy over electronic smoking focuses on whether health risks are associated with it. But in Indiana much more esoteric concerns could significantly narrow the number of vape shops open in the Hoosier state. This week the Indiana General Assembly adopted a measure that would increase regulations on manufacturers of e-liquids, the inhaled substance inside the cigarette or vaporizer. In addition to requiring that mixing be done in a clean room and that business owners undergo background checks, the measure also stipulates that manufacturers adhere to rigorous security requirements that some in the industry fear could wind up putting many out of business. (Rudavsky, 3/8)
News outlets report on health issues in Wisconsin, Washington, Ohio, New Jersey and California.
The Milwaukee Journal-Sentinel:
Deadly Infection Outbreak In Wisconsin Gaining Urgency
Calling it the largest outbreak of its kind and stressing the urgency of finding the source, the CDC has identified two more suspected cases of deadly blood infections and sent additional investigators to Wisconsin. (Rutledge, 3/8)
The Seattle Times:
Drivers Are Blacking Out On Synthetic Pot, Alarming Police, Health Experts
The speeding car ran a red light, flew over the intersection and struck Scott Braymer on the sidewalk near Pike Place Market a week before Christmas in 2010. He came to with 12 broken bones and a gash across his scalp that would need 17 staples to close. The driver told police he had smoked spice, a form of synthetic marijuana, 15 minutes before the crash and blacked out. He later pleaded guilty to vehicular assault, reckless driving and reckless endangerment. (Thompson, 3/9)
The Cleveland Plain Dealer:
Pediatricians Urged To Screen For Poverty
In the fall, the nation's largest pediatricians' group urged its members to ask their patients if they regularly had enough to eat or ever went hungry. Now, the same group, the American Academy of Pediatrics, is asking its 64,000 members to pose another question during doctor visits: "Do you have difficulty making ends meet at the end of the month?" (Zeltner, 3/9)
U.S. Women Push Back Against Stigma, Cost Of Mensturation
Sixteen-year-old Emma Joy and her younger sister Quinn recently spent an evening stuffing bags with a full year's supply of tampons or sanitary pads for women who often miss work or school because they cannot afford menstrual products. The South Orange, New Jersey, residents got the idea for their charity, Girls Helping Girls Period, when Emma learned that federal assistance programs for the indigent do not cover menstruation products, leaving many low-income and homeless women to cope with their cycles on their own. (Goldberg, 3/9)
Kaiser Health News:
Housing Project Takes On Seniors' Health
Hui-Zhen Li doesn't speak English, but here she can speak freely. She's standing amid more than 150 Chinese seniors, all perched on metal folding chairs or slouching in wheelchairs, packed wall to wall in the main lobby of the Hotel Oakland. ... The gathering at this low-income housing project in downtown Oakland, California, is called Neighbors Helping Neighbors. It's part of an ambitious plan to help elderly residents, many of them Asian immigrants, take control of their health — in part by joining at least one of 14 groups intended to enhance their physical and mental well-being. This particular meeting focuses on improving memory and warding off dementia. Other groups range from healthy eating to karaoke singing. (Gorn, 3/9)
A selection of opinions from around the country.
Health Affairs Blog:
Today’s Medicare Is Built On 50 Years Of Robust Compromise. Now What?
If the Presidential race is any guide, many Americans do not like “politicians.” Weak-kneed and compromised by campaign contributions, “politicians” imperil our virtuous Republic. Or so we are told by ideologues on the Right and Left and by a distressing number of citizens whose interest in politics is but a quadrennial event. “Compromised.” A troubling word. Yet our system of government, with its divided powers, cannot function without “compromise” among competing interests and philosophies. Can we “compromise” without being “compromised”? Yes, and the resulting hybrid may even be superior to ideologically pure alternatives. (Glenn Hackbarth, 3/8)
Why Consumerism Is No Panacea For Our Healthcare Problems
American politicians and policymakers often tout consumer-based approaches, such as price transparency, comparison shopping, retail clinics, and high-deductible health plans featuring health savings accounts as answers to the nation's pressing healthcare cost and access problems. But recent evidence suggests that these types of market-based solutions have severe limits. (Harris Meyer, 3/8)
Health Care Quality Measures Should Matter To Patients
Defining and measuring quality in health care isn’t easy. New yardsticks from the Core Quality Measurement Collaborative are a step in the right direction ... They include things like whether a doctor has done a specific test or recommended a specific treatment. But they ignore things that matter to most of us. (Mitch Rothschild, 3/8)
The Cleveland Plain Dealer:
Bernie Sanders Has Rehabilitated The Idea Of Democratic Socialism
Put simply, Sanders has promised to democratize access to our national resources. This includes our hospitals and medical facilities, our universities, our political system, and our economy. For Sanders, this is what true democracy entails – allowing all to participate and benefit regardless of location in the socio-economic hierarchy. (Tom Gill, 3/9)
The Wall Street Journal:
Donald Trump’s Mexican Imports
Mr. Trump released a 10-paragraph health plan last week, perhaps in response to the criticism that he has no policy details ... one detail that leapt out for comment is his endorsement of foreign pharmaceutical importation—an idea even liberals left for dead a decade ago. (3/8)
Will Congress Get Serious About Zika?
The more doctors learn about the Zika virus, the more dangerous it appears. Is it too much to hope that this research will prod the U.S. Congress to take action? Of course, congressional action on any issue has been hard to come by lately. In the case of Zika, however, it’s worth examining what science says about its potential for harm. (3/8)
The Columbus Dispatch:
Needle Exchanges Curb Disease
Coping with a public-health issue such as drug addiction is complicated, and when success is achieved in one area, new problems can arise elsewhere as a result. This is the case with efforts in recent years to shut down “pill mills,” in which some unscrupulous doctors made a practice of prescribing opioid painkillers to virtually anyone. When government and law enforcement successfully cracked down on such operations and increased monitoring of painkiller prescriptions, many of those who were addicted to pain pills turned to illegal drugs such as heroin instead. (3/9)
The Ethical Challenges Of Compassionate Use
Granting access to drugs, vaccines, biologics, and devices that have not yet been approved by governmental regulatory authorities is a growing challenge for physicians, public officials, patient advocacy groups, institutional review boards (IRBs), and patients.1 Although the issue of rapid access to investigational agents is not new, tracing back to the early days of the human immunodeficiency virus pandemic, the pace of requests has increased. This is attributable to many factors, including greater awareness of compassionate use on the part of patients and their physicians; more information available through the Internet and websites describing clinical trials; an increase in promising interventions, including genetic markers, immunotherapies, and recombinant vaccines; threats from potential epidemics such as Ebola, cholera, and influenza; and an increased willingness to try novel agents by patients who are chronically ill or dying. (Arthur R. Caplan and Amrit Ray, 3/8)
The Washington Post:
New School Lunch Standards Are Working. So Why Does Congress Want To Knock Them Down?
The new standards are among the most important efforts to improve children’s health in the past two decades. Since 1980, obesity has more than doubled in children and quadrupled in adolescents. Nearly a third of children and adolescents are either obese or overweight. In some states, the combined rate is close to 40 percent; among African American and Latino children, these rates are particularly high. And millions more children consume more sugar and empty calories than is healthy. (Steven Czinn, 3/8)
Los Angeles Times:
Partisan Politics On Air Pollution Are Helping To Make L.A. Smoggy Again
Last Friday was a bad day for clean air. First, the board of the South Coast Air Quality Management District voted to fire its longtime executive officer. Then, it reconfirmed its support for a plan to let oil refiners, power plants and other major polluters keep spewing emissions. (3/8)