The genome editor CRISPR has morphed over the past 6 years from an obscure bacterial immune mechanism into the rock star tool of biology, allowing researchers to alter DNA with greater precision and ease than ever before. But the most popular version of CRISPR is simply too big, which complicates reaching some targets—and limits the ability of this powerful technology to create new therapies. Now, researchers have devised a way to put CRISPR on a diet and still retain its core functions.
Standard CRISPR methods have appropriated a DNA-snipping protein called SpCas9 from the Streptococcus pyogenes bacterium. Another CRISPR component guides the enzyme to targeted places on the genome. SpCas9 binds the DNA and its molecular scissors clip the double-stranded helix. But this lab darling, which has 1368 amino acids, is too chunky for many biomedical applications. So a team led by David Savage of the University of California, Berkeley, has devised a huge library of slimmer Cas9s using a “directed evolution” scheme.
“This is an amazing story because it’s a reversal of the actual evolutionary process,” says Kira Makarova, a pioneering CRISPR researcher at the National Center for Biotechnology Information in Bethesda, Maryland, who was not involved in the new work.
Savage, a structural biologist who presented his group’s work last week at the annual Cold Spring Harbor Laboratory CRISPR meeting here, calls the protein engineering method Minimization by Iterative Size-Exclusion Recombination (MISER). The technique uses two enzymes to systematically snip the DNA of the SpCas9 gene, pulling out chunks encoding different parts of the protein. Savage and colleagues then test those genetic sequences to see whether their resultant proteins still retain Cas9’s ability to bind to DNA targets. They then combine the ones that succeed, to add to the unique truncated options. So far, they have made half a million variants. “Shockingly, it works really well,” Savage says. “I didn’t expect it to be so flexible that it could tolerate enormous deletions and those could be stacked together.”
The MISER mutants won’t necessarily be able do everything that the typical CRISPR-Cas9 system can. One handicap is that some of the mutant Cas9s can lock onto an exact spot in the genome but cannot cut the DNA. But researchers earlier found that these “dead” Cas9s are handy tools, too, as they can ferry other molecules to specific destinations; one particularly powerful CRISPR technology called base editing exploits this to shuttle an enzyme to a target site that can convert one DNA base into another. The smallest MISER Cas9 mutant created to date—which can’t cut—has only 880 amino acids, about two-thirds the size of the original SpCas9.
Harvard University chemist David Liu, whose lab invented the base editor system, says Savage’s work with MISER is an “an outstanding early application of this exciting new method—and moves the genome editing field closer to a long-standing goal.”
Many investigators using CRISPR to design biomedical treatments package the genes for Cas9 and its other component inside a harmless virus that can shuttle them to specific cells to repair genetic defects. But the viruses have a limit to how much genetic cargo they can carry, and that’s where the skinny Cas9 could help tremendously—especially if its scissors work. “We have to finish this story,” says Savage, whose team is now sifting through its creations to find out which ones get the biggest bang for the smallest size.
When molecular biologist Darren Baker was winding up his postdoc studying cancer and aging a few years ago at the Mayo Clinic in Rochester, Minnesota, he faced dispiritingly low odds of winning a National Cancer Institute grant to launch his own lab. A seemingly unlikely area, however, beckoned: Alzheimer’s disease. The U.S. government had begun to ramp up research spending on the neurodegenerative condition, which is the sixth-leading cause of death in the United States and will afflict an estimated 14 million people in this country by 2050. “There was an incentive to do some exploratory work,” Baker recalls.
Baker’s postdoc studies had focused on cellular senescence, the cellular version of aging, which had not yet been linked to Alzheimer’s. But when he gave a drug that kills senescent cells to mice genetically engineered to develop an Alzheimer’s-like illness, the animals suffered less memory loss and fewer of the brain changes that are hallmarks of the disease. Last year, those data helped Baker win his first independent National Institutes of Health (NIH) research grant—not from NIH’s National Cancer Institute, which he once expected to rely on, but from the National Institute on Aging (NIA) in Bethesda, Maryland. He now has a six-person lab at the Mayo Clinic, working on senescence and Alzheimer’s.
Baker is the kind of newcomer NIH hoped to attract with its recent Alzheimer’s funding bonanza. For years, patient advocates have pointed to the growing toll and burgeoning costs of Alzheimer’s as the U.S. population ages. Spurred by those projections and a controversial national goal to effectively treat the disease by 2025, Congress has over 3 years tripled NIH’s annual budget for Alzheimer’s and related dementias, to $1.9 billion. The growth spurt isn’t over: Two draft 2019 spending bills for NIH would bring the total to $2.3 billion—more than 5% of NIH’s overall budget.
Such a dramatic increase in research funding for a disease has no precedent at NIH aside from the War on Cancer, an effort launched in 1971, and an explosion of AIDS funding in the late 1980s. With the largesse come logistical challenges. Overworked NIH staff are scrambling to review and process thousands of grant proposals, including those for this year’s $414 million bolus—a sum that equals the entire budget of some smaller NIH institutes—which Congress approved in March.
NIA, which oversees the new funds, doesn’t just want to plump up existing Alzheimer’s labs, says Director Richard Hodes. The institute is also luring investigators, such as Baker, from other fields to bring in fresh ideas. Many are answering the call. “Nearly everyone I know is putting the words ‘Alzheimer’s disease’ in their grants in an effort to tap into the money,” says Matt Kaeberlein of the University of Washington in Seattle, who studies aging.
The funding blitz targets a problem that looks more intractable than ever. The only approved drugs for Alzheimer’s don’t stop the neurodegeneration, but merely treat symptoms—and not very well. In the past year, several major clinical trials based on the field’s leading hypothesis—that reducing the level of β-amyloid plaques that riddle the brains of Alzheimer’s patients would halt disease progression—have flopped. An antibody that targets β-amyloid recently delivered seemingly promising results in a phase II trial. Yet given past failures for other eagerly watched compounds, many researchers remain skeptical and want to see a larger phase III trial.
Nearly everyone I know is putting the words ‘Alzheimer’s disease’ in their grants in an effort to tap into the money.
Those setbacks have amplified concerns that U.S. officials and some scientists have oversold the plan for a treatment by the middle of the next decade. “I am convinced that we are destined to fail to make the 2025 goal and therefore look like we have failed at our promise,” says Alzheimer’s researcher Samuel Gandy of the Icahn School of Medicine at Mount Sinai in New York City. Some researchers also worry about focusing so much money on just Alzheimer’s. The biomedical community “has mixed feelings” about such targeted funding, says biogerontologist Judy Campisi of the Buck Institute for Research on Aging in Novato, California, who wonders whether more should go to basic research.
Even Baker has qualms. “I think it is great that there’s all of this funding. I just hope it’s not at the expense of something interesting in the cancer realm.”
But naysayers are few. “Overall, what is wrong with it? Nothing,” says biochemist Rozalyn Anderson of the University of Wisconsin in Madison, who studies caloric restriction in monkeys to slow aging and is now tying that work to Alzheimer’s. “It’s a great experiment underway: By increasing funding and access to resources, can we bring on a game-changer in research in a particular area?”
A “confluence of factors” unleashed the funding surge, says Sue Peschin, president and CEO of the Alliance for Aging Research in Washington, D.C. Families became more open about the once-hidden disease, and advocates became savvier. In the late 1990s, the Alzheimer’s Association in Chicago, Illinois, and later other groups began to frame care for Alzheimer’s patients as a financial crisis looming as the large baby boomer population ages. Alzheimer’s already costs Medicare and Medicaid $186 billion per year, and the figure will balloon to $750 billion by 2050, according to the Alzheimer’s Association.
Advocates also argued that Alzheimer’s is underfunded in the United States in comparison with major killers such as cancer and heart disease. That’s especially true for AIDS, which until recently received a fixed 10% of NIH’s overall budget—it now gets $3 billion per year—yet affects far fewer Americans. “Neurodegenerative diseases have historically never really had the same funding. In a sense this is a correction,” says Alzheimer’s researcher John Hardy of University College London.
Those messages resonated with U.S. lawmakers, including Senator Susan Collins (R–ME) and then-Representative (now Senator) Edward Markey (D–MA), who in 1999 co-founded the Congressional Task Force on Alzheimer’s Disease. In 2011, they co-sponsored the National Alzheimer’s Project Act, which called for a U.S. plan to improve research and care for people with Alzheimer’s and related dementias. After Congress passed the bill, the Department of Health and Human Services (HHS), NIH’s parent department, outlined ambitious goals, the most striking being to “prevent and effectively treat Alzheimer’s disease by 2025.” Some Alzheimer’s researchers had misgivings about the deadline, says David Holtzman of Washington University School of Medicine in St. Louis, Missouri: “I don’t think most thought it was realistic.”
The Mayo Clinic’s Ronald Petersen, who chaired the advisory board that drafted the HHS plan, defends the 2025 goal: “We wanted to make a bold statement. Not ‘We hoped to make progress.’ That isn’t going to inspire anybody.”
As more lawmakers joined the cause, Congress in 2015 mandated that NIH prepare a “professional judgment” budget on Alzheimer’s research, a wish list of needs to meet the 2025 target that would bypass the federal budget process and go directly to the president and Congress. Until then, only cancer and AIDS had enjoyed that special treatment. Alzheimer’s advocates also lobbied the administration of former President Barack Obama to include extra funding in the White House budget request, Peschin says.
The lobbying began to pay off as early as 2012 when then–HHS Secretary Kathleen Sebelius held a press conference to announce modest increases in funding for Alzheimer’s research. That gained the attention of some scientists, including Baker, who submitted his grant proposal to NIA in 2015. However, the big ramp up began only in 2016 after Obama and lawmakers struck a deal to lift federal spending caps and Congress boosted NIH’s overall budget after a decade of stagnation. That fiscal year, the share of NIH money going to Alzheimer’s shot up 56% to $986 million, including $57 million for separate research on three related dementias, such as vascular dementia. By now, 3 years of such funding boosts have transformed NIA—once a midsize NIH institute and “almost a backwater,” as one official put it on a blog—to the fifth-largest of NIH’s 27 institutes and centers with a $2.6 billion overall budget. “Our continued investment will pay dividends for the millions of families affected by Alzheimer’s,” Collins said in a statement to Science.
The windfall is incredible, says Eliezer Masliah, director of NIA’s Division of Neuroscience. “I’ve been in this field for over 30 years, and I’ve never seen anything like this. This is really a golden era for [studying] Alzheimer’s disease.”
Now, the onus is on NIA and the research community not to waste the money. Under the national plan, NIH holds summits every 3 years to guide its Alzheimer’s efforts, targeting the most promising lines of research. Some 140 treatment or prevention trials are underway, testing both drugs and preventive interventions such as exercise. The funding has supported a consortium working on novel mouse models, genetically engineered to mimic the common, late-onset form of the disease. Other money goes to modeling the disease by editing Alzheimer’s risk genes in neural cells derived from stem cells.
Basic researchers are exploring new hypotheses. Some of NIA’s recent funding opportunities invite research on alternatives to the long-dominant idea that β-amyloid deposits outside brain cells and “tangles” of the protein tau inside neurons are the key drivers of Alzheimer’s disease and the best treatment targets. The announcements call for proposals in less-explored areas, such as the role of protective genes, how neurodegeneration affects other animal species, and how metabolic changes might contribute to Alzheimer’s. “This brought in many people who were reluctant to submit an Alzheimer’s application in part because they thought, ‘We’re never going to do well, we’re going to be outsiders,’” Hodes says. At a recent Senate hearing, he pointed out that of 452 investigators who won new Alzheimer’s and related dementia grants from 2015 to 2017, 27% were receiving their first independent NIH grant, like Baker, and 36% were established researchers who had never had NIH support for Alzheimer’s. (Some had funding from Alzheimer’s foundations, however.) “We’re not just repeating the things that failed and hoping we get a different result,” Hodes says.
Masliah says that compared with a few years ago, when less than half of NIH’s portfolio in Alzheimer’s was devoted to areas other than β-amyloid or tau, it’s now more than 60% for translational studies and about 70% for basic research. “I do believe there is more money available for us to explore these other ideas,” says Carol Colton of Duke University in Durham, North Carolina, who studies inflammation as a possible cause of Alzheimer’s. She and others add, however, that the academics called on to review NIH grant proposals are sometimes less open-minded than NIA staff and nix proposals in new areas. They “need to catch up,” Colton says.
To cast an even wider net, NIA is offering 1-year funding supplements to researchers already funded by NIH in other areas who want to add an Alzheimer’s component to their research. The hope is that the extra money will lead to full-fledged proposals.
Alzheimer’s grants are now much easier to get than other NIA grants: For most Alzheimer’s proposals this year, those ranked in the top 28th percentile by peer-review panels get money. For non-Alzheimer’s grants, that pay line is the 19th percentile. The competition for grants is still stiff, Hodes stresses. After all, he notes, high-quality applications for the Alzheimer’s pool of money have “increased dramatically” in the last couple years “as word got out.”
NIA grantees in fields with scarcer funding aren’t complaining, so far. Some recipients even suggest they’re benefiting because competitors in the field of aging are shifting into Alzheimer’s. “Paradoxically, the new funding injection could improve everyone’s chances of funding,” says Duke psychologist Terrie Moffitt, a member of NIA’s advisory council.
NIAhas had to be creative to cope with the tide of applications for the Alzheimer’s bounty, agency officials say. After a crushing scramble to process grant proposals last summer, this year NIA called early for proposals and scheduled peer-review panels even before it knew its final 2018 budget. Adding to the pressure, President Donald Trump’s administration imposed a federal hiring freeze last year that was only recently lifted at NIH. “I think our staff has managed heroically to still be doing an extremely conscientious job. … Where we’ve compromised probably is the quality of life of a lot of our staff,” Hodes says.
At the NIH Center for Scientific Review in Bethesda, which arranges peer-review panels for much of the funding, “We’re handling the load as best we can,” says acting Director Noni Byrnes. The pool of potential reviewers—U.S. Alzheimer’s researchers who aren’t applying for the new funding themselves and so don’t have a conflict of interest—is limited. So, for NIA-organized review panels, the institute is also using Alzheimer’s experts in Canada and Europe, says Ramesh Vemuri, NIA’s chief of scientific review.
Senator Susan Collins (right), visiting a retirement home specializing in dementia care, co-sponsored a bill that made research on Alzheimer’s disease a national priority.
PORTLAND PRESS HERALD/CONTRIBUTOR/GETTY IMAGES
Clinical trials won’t be easy to staff either. Clinical researchers and neuropathologists focused on dementia are in short supply, says Alzheimer’s Association Chief Science Officer Maria Carrillo. NIA is trying to attract them by funding fellowships. Another huge problem is finding enough subjects for trials—especially those who are at high risk for the disease but still without symptoms, the population on which some researchers think amyloid-busting drugs could yet work. NIA plans to launch a national recruitment strategy that includes raising awareness about trials.
Looming over the massive research push is the 2025 goal. It was set when optimism ran high that drug trials based on the β-amyloid hypothesis would pan out, Carrillo and others say. But if patients must begin antiamyloid treatments well before symptoms set in, seeing clinical benefits could take decades, Gandy notes. And the chances of meeting the deadline by targeting a different disease mechanism are small; such treatments remain far off. Still, Holtzman hopes for good news from an antiamyloid treatment trial. “Something is likely to be approved by 2025. It won’t be the be all, end all,” he says, but he hopes it will keep everyone motivated. “Because we don’t just need money from the NIH, we need the pharmaceutical industry to not drop out”—as Pfizer did this year when it announced it was abandoning Alzheimer’s research.
Some researchers point to the mixed success of NIH’s other disease “wars”: AIDS funding hasn’t led to a cure or a vaccine, though it has yielded drugs that allow people infected with HIV to lead nearly normal lives. The war on cancer has led to treatments that are improving survival, but cancer remains the second-leading cause of death in the United States.
That history makes former NIH Director Harold Varmus cautious about the 2025 goal. “No one denies the enormous need to make progress against Alzheimer’s,” he says. But, “I wish a date were not attached.”
Hodes concedes that, like real wars, disease wars can last far longer than anyone imagined—or feared. But that doesn’t mean it was a mistake to launch an all-out offensive against Alzheimer’s disease, he says. “If 2025 comes and we haven’t achieved all we wanted, I’m not going to stop there and declare failure.”
Unilever’s factory in the outskirts of the northern Venezuelan city of Valencia once bustled with activity as it produced everything from soap to toothpaste for one of South America’s wealthiest economies.
Now, with Venezuela struggling with a fifth year of recession and its economy wracked by hyperinflation, there are few signs of activity. A handful of workers loiter inside the compound with only the occasional truck passing through its gates.
The Anglo-Dutch conglomerate has quietly scaled back its output in the crisis-stricken oil-producing nation to a single product – Tio Rico ice cream – produced in Valencia and at another plant in Barquisimeto, some 90 miles (145 km) to the west.
Production of Tio Rico ice cream halted at another factory in the sweltering city of Maracaibo in western Venezuela over a year ago.
“Until last year, we were producing 800 containers of 1,000 litres of ice cream per month,” said one worker at the Valencia plant, who asked not to be identified because he was not authorized to speak to the media. “Now, we’re sending out 40 per month.”
Slashing product portfolios has allowed the handful of multinationals that remain in Venezuela to survive shrinking demand and could pave the way for some to make an exit, according to a dozen advisors to large companies.
Unilever Plc (ULVR.L) said it was staying in Venezuela and was focussed on strengthening its ice cream unit. A spokesman for the company said its “production is in line with market demand.”
But the gradual exodus of companies, from cleaning products firm Clorox Co (CLX.N) to cereal maker Kellogg Co (K.N), along with diminishing hope for political change, has led to speculation among company advisors that more will follow suit.
That is true more than ever after President Nicolas Maduro announced this month higher corporate taxes and a 60-fold minimum wage increase, advisors say.
On Monday, workers protested at the Venezuelan unit of tire-maker Pirelli after they arrived to find the factory gates locked. It was not immediately clear if the plant was temporarily shut or closing for good. “Transnational companies are not putting new money into Venezuela. And if they stay, it is because they found a financial balance to sustain themselves,” said Luis Vicente Leon a well-known pollster, economist and business adviser.
“But if this balance is severely disrupted, you will most likely see more companies leaving this market.”
‘SIGNIFICANT DECREASE’
Some multinationals have stopped selling some of their best-known products due to currency controls that left them struggling to import raw materials and a ban on price hikes despite inflation projected to reach 1,000,000 percent this year.
Ford Motos Co’s (F.N) plant, already operating at severely reduced capacity, scaled back in July to a single model, one of its sport utility vehicles, said union leader Eliecer Cohen.
Ford said in a statement it had no plans to leave Venezuela, but acknowledged that it had “faced a significant decrease in demand” in recent months.
General Motors Co (GM.N) left Venezuela last year after a protracted court case with two former auto dealers who ended taking control of the plant as part of a concession dispute.
Consumer goods giant Johnson & Johnson (JNJ.N) has for more than a year only produced a feminine hygiene product called panty liners after halting its production of sanitary napkins and Q-tips, according to a union representative who asked not be identified.
Johnson & Johnson did not respond to a request for comment.
Companies have provided less advance notice about plans to shut down Venezuela operations, in part to minimize potential government blowback, according to business leaders and consultants interviewed by Reuters.
When Clorox Co (CLX.N) and Kimberly Clark Corp (KMB.N) closed their operations, top management had already left the country, according to union leaders.
Kimberly Clark said its operations had suffered from high inflation and difficulty in obtaining raw materials due to currency controls.
Kellogg still had three weeks worth of raw material on hand when it closed operations in May, according to a employee who asked not to be identified. Employees and managers alike were taken by surprised when they arrived at the factory gates to find them padlocked.
The company said at the time that it discontinued operations due to “economic and social deterioration.”
The plant was taken over by the government. State television days later broadcast images of production being restarted by the governor of the state of Aragua.
Such state administrators often fall behind on paying suppliers, according to business advisors, which is bad news for providers like packaging and cereal box maker Smurfit Kappa Group Plc (SKG.I).
Government officials last week occupied Smurfit Kappa’s unit on the grounds it was not following labour legislation, was refusing to sell to state-run companies and was charging too much for its products.
Venezuelan military intelligence arrested two of the company’s executives, according to state price control agency Sundde.
Smurfit Kappa denied the allegations and said it was seeking the release of the executives.
Union leaders said one of Smurfit’s plants had not been operational since July and had sent its workers home – a strategy of many foreign companies who want to maintain a presence in Venezuela to avoid lengthy processes of obtaining permits if they later decide to return.
Benefits Include Domestic & International Market Deployments, Improved Inventory Utilization, and Profit Margin Contributions; Company’s Fiscal Third Quarter to Relfect Impact of New IT/ERP System Installation
Lakeland Industries, Inc. (LAKE) (the “Company” or “Lakeland”), a leading global manufacturer of protective clothing for industry, healthcare and to first responders on the federal, state and local levels, today announced its comprehensive e-commerce strategy with the implementation of sales and distribution on Amazon.com (AMZN).
“Amazon.com represents an essential component to our long-term revenue growth strategy,” stated Christopher J. Ryan, President and Chief Executive Officer of Lakeland Industries. ”Our e-commerce strategy utilizes Amazon.com as the cornerstone of our cloud-based platform for online distribution. While we are presently experimenting to determine the ideal product mix, our efforts thus far confirm that this strategy serves as an ideal complement to our longstanding practices of sales and marketing on a business-to-business basis and through third-party distributors. We are in effect leveraging alternative distribution channels, principally with Amazon, for retail and small business customer sales.
“We believe our e-commerce strategy and Amazon distribution platform enables expansion into new and existing territories while improving the quality of our earnings to deliver sustainable long-term improvements in financial performance. Our e-commerce sales which have been smaller quantity orders are being pulled from our traditional product lines where we can gain leverage in inventory management. These efforts contribute to diversifying our revenue streams, penetrating and generating increased market share and presence in our core operating regions around the world, and capitalizing on our resources for improvements in long-term operational performance.”
As previously disclosed, Lakeland began distributing a limited set of products earlier this year on Amazon.com in the United States. This followed investments made by the Company last year for development of fulfillment capabilities for same day/next day delivery in connection with Amazon. The Company has made additional information technology investments to accommodate its e-commerce strategy as part of a complete global management information, enterprise resource planning and inventory system installation that began in 2017 and recently commenced.
The Company’s global IT infrastructure implementation uses the SAGE X3 platform to aid in the digital evolution of Lakeland by leveraging cloud technologies. With SAGE X3, Lakeland staff around the world will be able to increase efficiency by accelerating all core business processes with one business management solution and gain visibility across the business with real-time information which will assist in management decision-making. In addition to inventory and supply chain management enhancements, there will be simplified compliance and automated reporting as the system supports global laws and restrictions across currencies, regions and regulations when the system is fully implemented.
The implementation and inventory change-over in the USA for the new system took full effect toward the end of the Company’s fiscal 2019 second quarter ended July 31, 2018 and into the third quarter. For the second quarter financial results which will be announced on September 10, 2018, Lakeland expects to report revenue growth from the prior year period even though there were several days in which shipments were delayed and not recorded as sales. This delay as well as other related factors adversely impacted gross profits as a percentage of sales and operating profits as a percent of sales. In this regard, the Company incurred elevated expenses associated with the inventory and ERP transition.
With the completion of the USA portion of the Company’s global inventory and IT system installation, distribution on the Amazon platform will be rolled out by Lakeland in multiple subsidiaries during the fiscal year ending January 31, 2019. From a standing still position approximately 9 months ago, Lakeland has completed the investment in marketing and fulfillment capabilities for its US launch on Amazon. Twenty pages of Lakeland branded products have been populated on the Amazon website in the US. The Company launched Amazon distribution in Canada with a limited number of products during the fiscal second quarter ended July 31, 2018.
The percentage of people without health insurance remained relatively steady over the past year despite efforts to repeal the Affordable Care Act and attempts to curb coverage in Washington and at state levels.
The latest statistics from the CDC show that from January to March of this year 28.3 million people (8.8%) were uninsured. That’s compared to 29.3 million people (9.1%) a year ago. There are 20 million fewer people without insurance compared to 2010, when the ACA was enacted.
More consumers shifted to high-deductible health plans (HDHPs) in the first quarter. The report found that nearly half (47%) of Americans under age 65 with private health insurance had a high-deductible plan, an upward trend since 2010.
CDC said 12.5% of adults aged 18-64 didn’t have insurance in the first three months of 2018. Nearly 20% had public coverage and 70% were covered by private health insurance. Of the 138.6 million adults with private health insurance, 8.3 million of them (4.2%) received coverage through ACA exchanges.
Nearly 5% of children were uninsured, 42% had public insurance and almost 55% had private health insurance coverage.
A person’s race continues to play a factor in health insurance. Nearly one-quarter of Hispanics lacked coverage in the first quarter. The Hispanic population has seen significant decreases in the percentage of uninsured adults since 2013 when it stood at more than 40%, but the percentage is still higher than other groups. The percentage decreased another three percentage points over the past year from 27.2% to 24.2%. The uninsured rates for other groups remained consistent from last year.
CDC also found that people in Medicaid expansion states were less likely to be uninsured compared to non-expansion states. The percentage of uninsured adults in expansion states decreased from 18.4% in 2013 to 8.7% in 2018. Non-expansion states’ rates fell from 22.7% in 2013 to 17.5% in 2015 before increasing to 19% in 2017. There was a slight percentage drop in 2018 (18.4%), which is still more than double the percentage in expansion states.
Meanwhile, in private insurance, payers and employers increasingly turn to HDHPs, which have higher out-of-pocket costs and usually lower premiums. Payers and employers have moved more people into those plans as a way to contain costs and give consumers “more skin in the game.”
CDC found that of the 47% of people enrolled in an HDHP, only 21.3% were in a consumer-directed health plan with a health savings account. About one-quarter had a plan without an HSA, which lets people save tax-free funds for their healthcare. Employers often contribute to those accounts.
CDC said the number of people in a consumer-directed plan tripled from 7.7% in 2010 to 21.3% in 2018, including a jump from 18.2% in 2017 to 21.3% this year. The percentage of people without an HSA didn’t change significantly over the past year. This shows that employers and payers are increasingly providing tools like HSAs to help people afford care.
Out-of-pocket costs remain a concern for Americans and can result in delaying care.
A recent Commonwealth Fund report found that one-third of American adults aren’t very or somewhat confident they can afford to pay for a serious illness. Only about half of people who earn less than $30,150 are confident they can afford that care.
They have reason to worry. Peterson-Kaiser Health System Tracker recently reported that payments for deductibles and coinsurance increased faster than the total cost for covered costs between 2006 and 2016. The report showed that total out-of-pocket spending increased by 54% in that period from an average of $525 in 2006 to $806 in 2016.
CMS has begun searching for a company capable of building and maintaining a digital platform for comparing healthcare prices.
The notice seeks information from organizations with specific experience in healthcare price comparisons and online bidding for healthcare services and interactions between consumers and providers.
Depending on the responses, CMS could issue a formal request for proposals for a company to develop an online comparative pricing tool.
CMS has been pressing hospitals to be more transparent in their pricing of procedures and services. The agency’s final rule on the Inpatient Prospective Payment System, issued earlier this month, requires hospitals to post a list of their standard charges online in a “readable machine format” and update the information at least once a year.
While the transparency provision only cements what CMS already requires of hospitals, a supplementary request for information seeks input on further pricing transparency.
In addition to comparative pricing and online bidding, CMS wants a company experienced in handling personally identifiable information and protected health information, as well as transmitting and storing healthcare supplier information. Potential contractors should be capable of using healthcare price comparison data and bid or auction data for healthcare procedures, the Sources Sought notice says.
“Responding organizations should have specific experience supporting provider/supplier pricing and transparency efforts in the healthcare exchange and/or commercial insurer health care market who currently offer support for the development and maintenance of web-based price comparison tools, bidding systems, and applications,” the notice adds.
Creating a mechanism for consumers to comparison shop for healthcare goes a step beyond just requiring hospitals to publish basic charges online. A handful of states have launched initiatives to help consumers find affordable healthcare online. Maryland’s Wear the Cost program lets consumers compare prices for four common nonemergency procedures at hospitals and was recently expanded to include price and quality data based on commercial insurer data from 2015 and 2016.
Still, studies have shown Americans aren’t good about shopping for healthcare. In a study published in Health Affairs, just 13% of respondents responsible for cost-sharing in their last healthcare encounter sought cost information before receiving care and only 3% compared prices of different providers.
Supermarket chain Publix is recalling some ground beef products shipped to Florida stores over concerns of E. coli contamination, the Agriculture Department says.
An undetermined amount of potentially-contaminated products made with ground chuck were shipped to two dozen counties in Florida including Brevard, Citrus, Hillsborough, Sarasota and St. Lucie. They were purchased by consumers between June 25 and July 31, the USDA says. Publix has 788 stores in Florida and a total of 1,191 stores across the U.S.
The products being recalled by the USDA include bacon and cheddar burgers, blue cheese meatballs, ground chuck for chili and meat loaf, jalapeno and cheddar sliders, mesquite seasoned ground chuck burger, (oven-ready) stuffed peppers, Spanish meatballs, and swiss and mushroom sliders.
An investigation began after 18 people, predominantly from Florida, became ill between July 5 and July 25, according to the USDA’s Food Safety and Inspection Service. All consumed ground chuck products purchased at various Publix stores and supplied by an as yet undetermined source, the service says.
Sickness from this strain of E. coli usually happens two to eight days after exposure. Most people have vomiting and diarrhea (often bloody), the USDA says. Most people recover within a week, but in rare cases some may develop a more severe infection.
Consumers who have purchased these products and may have frozen them are urged not to consume them, the USDA says. These products should be thrown away or returned to the place of purchase.
This week, Cargill recalled about 12 tons of ground beef for possible E. coli contamination. Those ground beef products were produced Aug. 16 and shipped to warehouses in California and Colorado.
