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May 16 2024 KFF Health News

For much of his young life, Jorge Sanchez regularly gasped for air, at times coughing so violently that he'd almost throw up. His mother whisked him to the emergency room late at night and slept with him to make sure he didn't stop breathing.

"He's had these problems since he was born, and I couldn't figure out what was triggering his asthma," Fabiola Sandoval said of her son, Jorge, now 4. "It's so hard when your child is hurting. I was willing to try anything."

In January, community health workers visited Sandoval's home in Turlock, a city in California's Central Valley where dust from fruit and nut orchards billows through the air. They scoured Sandoval's home for hazards and explained that harsh cleaning products, air fresheners, and airborne dust and pesticides can trigger an asthma attack.

The team also provided Sandoval with air purifiers, a special vacuum cleaner that can suck dust out of the air, hypoallergenic mattress covers, and a humidity sensor — goods that retail for hundreds of dollars. Within a few months, Jorge was breathing easier and was able to run and play outside.

The in-home consultation and supplies were paid for by Medi-Cal, California's Medicaid health insurance program for low-income residents. Gov. Gavin Newsom is spearheading an ambitious $12 billion experiment to transform Medi-Cal into both a health insurer and a social services provider, one that relies not only on doctors and nurses, but also community health workers and nonprofit groups that offer dozens of services, including delivering healthy meals and helping homeless people pay for housing.

These groups are redefining health care in California as they compete with businesses for a share of the money, and become a new arm of the sprawling Medi-Cal bureaucracy that serves nearly 15 million low-income residents on an annual budget of $158 billion.

But worker shortages, negotiations with health insurance companies, and learning to navigate complex billing and technology systems have hamstrung the community groups' ability to deliver the new services: Now into the third year of the ambitious five-year experiment, only a small fraction of eligible patients have received benefits.

"This is still so new, and everyone is just overwhelmed at this point, so it's slow-going," said Kevin Hamilton, a senior director at the Central California Asthma Collaborative.

The collaborative has served about 3,650 patients, including Sandoval, in eight counties since early 2022, he said. It has years of experience with Medi-Cal patients in the Central Valley and has received about $1.5 million of the new initiative's money.

By contrast, CalOptima Health, Orange County's primary Medi-Cal insurer, is new to offering asthma benefits and has signed up 58 patients so far.

"Asthma services are so difficult to get going" because the nonprofit infrastructure for these services is virtually nonexistent, said Kelly Bruno-Nelson, CalOptima's executive director for Medi-Cal. "We need more community-based organizations on board because they're the ones who can serve a population that nobody wants to deal with."

Newsom, a Democrat in his second term, says his signature health care initiative, known as CalAIM, seeks to reduce the cost of caring for the state's sickest and most vulnerable patients, including homeless Californians, foster children, former inmates, and people battling addiction disorders.

In addition to in-home asthma remediation, CalAIM offers 13 broad categories of social services, plus a benefit connecting eligible patients with one-on-one care managers to help them obtain anything they need to get healthier, from grocery shopping to finding a job.

The 25 managed-care insurance companies participating in Medi-Cal can choose which services they offer, and contract with community groups to provide them. Insurers have hammered out about 4,300 large and small contracts with nonprofits and businesses.

So far, about 103,000 Medi-Cal patients have received CalAIM services and roughly 160,000 have been assigned personal care managers, according to state data, a sliver of the hundreds of thousands of patients who likely qualify.

"We're all new to health care, and a lot of this is such a foreign concept," said Helena Lopez, executive director of A Greater Hope, a nonprofit organization providing social services in Riverside and San Bernardino counties, such as handing out baseball cleats to children to help them be active.

Tiffany Sickler runs Koinonia Family Services, which offers California foster children mental health and other types of care, and even helped a patient pay off parking tickets. But the program is struggling on a shoestring budget.

"If you want to do this, you have to learn all these new systems. It's been a huge learning curve, and very time-consuming and frustrating, especially without adequate funding," she said.

Brandon Richards, a Newsom spokesperson, defended CalAIM, saying that it was "on the cutting edge of health care" and that the state was working to increase "awareness of these new services and support."

For nonprofits and businesses, CalAIM is a money-making opportunity — one that top state health officials hope to make permanent. Health insurers, which receive hefty payments from the state to serve more people and offer new services, share a portion with service providers. Related StoriesStudy links higher-potency cannabis use in youth to increased risk of psychotic experiencesUncovering the psychological toll of entrenched school practices on childrenClinical trial in Seattle aims to transform treatment approaches for pediatric IBD

In some places, community groups are competing with national corporations for the new funding, such as Mom's Meals, an Iowa-based company that delivers prepared meals across the United States.

Mom's Meals has an advantage over neighborhood nonprofit groups because it has long served seniors on Medicare and was able to immediately start offering the CalAIM benefit of home-delivered meals for patients with chronic diseases. But even Mom's Meals isn't reaching everyone who qualifies, because doctors and patients don't always know it's an option, said Catherine Macpherson, the company's chief nutrition officer.

"Utilization is not as high as it should be yet," she said. "But we were well positioned, because we already had departments to do billing and contracting with health care."

Middleman companies also have their eye on the billions of CalAIM dollars and are popping up to assist small organizations to go up against established ones like Mom's Meals. For instance, the New York-based Nonprofit Finance Fund is advising homeless service providers how to get more contracts and expand benefits.

Full Circle Health Network, with 70 member organizations, is helping smaller nonprofit groups develop and deliver services primarily for families and foster children. Full Circle has signed a deal with Kaiser Permanente, allowing the health care giant to access its network of community groups.

"We're allowing organizations to launch these benefits much faster than they've been able to do and to reach more vulnerable people," said Camille Schraeder, chief executive of Full Circle. "Many of these are grassroots organizations that have the trust and expertise on the ground, but they're new to health care."

One of the biggest challenges community groups face is hiring workers, who are key to finding eligible patients and persuading them to participate.

Kathryn Phillips, a workforce expert at the California Health Care Foundation, said there isn't enough seed money for community groups to hire workers and pay for new technology platforms. "They bring the trust that is needed, the cultural competency, the diversity of languages," she said. "But there needs to be more funding and reimbursement to build this workforce."

Health insurers say they are trying to increase the workforce. For instance, L.A. Care Health Plan, the largest Medi-Cal insurer in California, has given $66 million to community organizations for hiring and other CalAIM needs, said Sameer Amin, the group's chief medical officer.

"They don't have the staffing to do all this stuff, so we're helping with that all while teaching them how to build up their health care infrastructure," he said. "Everyone wants a win, but this isn't going to be successful overnight."

In the Central Valley, Jorge Sanchez is one of the lucky early beneficiaries of CalAIM.

His mother credits the trust she established with community health workers, who spent many hours over multiple visits to teach her how to control her son's asthma.

"I used to love cleaning with bleach" but learned it can trigger breathing problems, Sandoval said.

Since she implemented the health workers' recommendations, Sandoval has been able to let Jorge sleep alone at night for the first time in four years.

"Having this program and all the things available is amazing," said Sandoval, as she pointed to the dirty dust cup in her new vacuum cleaner. "Now my son doesn't have as many asthma attacks and he can run around and be a normal kid."

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism. Source:

KFF Health News

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Entertainment

Why is Warner Bros for sale, what are the controversial bids – and how is Trump involved?

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Why is Warner Bros for sale, what are the controversial bids – and how is Trump involved?

A huge takeover that would rock the entertainment industry looks imminent, with Netflix and Paramount fighting over Warner Bros Discovery (WBD).

Streaming giant Netflix announced it had agreed a $72bn (£54bn) deal for WBD’s film and TV studios on 5 December, only for Paramount to sweep in with a $108.4bn (£81bn) bid several days later.

The takeover saga isn’t far removed from a Hollywood plot; with multi-billionaires negotiating in boardrooms, politicians on all sides expressing their fears for the public and the US president looming large, expected to play a significant role.

“Whichever way this deal goes, it will certainly be one of the biggest media deals in history. It will shake up the established TV and film norms and will have global implications,” Sky News’ US correspondent Martha Kelner said on the Trump 100 podcast.

So what do we know about the bids, why are they controversial – and how is Donald Trump involved?

Why is Warner Bros up for sale?

WBD’s board first announced it was open to selling or partly selling the company in October after a summer of hushed speculation.

Back in June, WBD announced its plan to split into two companies: one for its TV, film studios, and HBO Max streaming services, and one for the Discovery element of the business, primarily comprising legacy TV channels that air cartoons, news, and sports.

It came amid the cable industry’s continued struggles at the hands of streaming services, and CEO David Zaslav suggested splitting into two companies would give WBD’s brands the “sharper focus and strategic flexibility they need to compete most effectively in today’s evolving media landscape”.

The company’s long-term strategic initiatives have also been stifled by its estimated $35bn of debt. This wasn’t helped by the WarnerMedia and Discovery merger in 2022, which led to it becoming Warner Bros Discovery.

WBD's announced it was open to selling or partly selling the company in October. Pic: iStock
Image:
WBD’s announced it was open to selling or partly selling the company in October. Pic: iStock

What we know about the bids

The $72bn bid from Netflix is for the first division of the business, which would give it the rights to worldwide hits like the Harry Potter and Game of Thrones franchises – and Warner Bros’ extensive back catalogue of movies.

If the deal were to happen, it would not be finalised until the split is complete, and Discovery Global, including channels like CNN, will not form part of the merger.

Paramount’s $108.4bn offer is what’s known as a hostile bid. This means it went directly to shareholders with a cash offer for the entirety of the company, asking them to reject the deal with Netflix.

Ted Sarandos, CEO of Netflix. Pic: Reuters
Image:
Ted Sarandos, CEO of Netflix. Pic: Reuters

This deal would involve rival US news channels CBS and CNN being brought under the same parent company.

Netflix’s cash and stock deal is valued at $27.75 (£20.80) per Warner share, giving it a total enterprise value of $82.7bn (£62bn), including debt.

But Paramount says its deal will pay $30 (£22.50) cash per share, representing $18bn (£13.5bn) more in cash than its rivals are offering.

Paramount claims to have tried several times to bid for WBD through its board, but said it launched the hostile bid after hearing of Netflix’s offer because the board had “never engaged meaningfully”.

David Zaslav, CEO and president of Warner Bros Discovery. Pic: Reuters
Image:
David Zaslav, CEO and president of Warner Bros Discovery. Pic: Reuters

Why are politicians and experts concerned?

The US government will have a big say on who ultimately buys WBD, as Paramount and Netflix will likely face the Department of Justice’s (DOJ) Antitrust Division, a federal agency which scrutinises business deals to ensure fair competition.

Republicans and Democrats have voiced concerns over the potential monopolisation of streaming and the impact it would have on cinemas if Netflix – already the world’s biggest streaming service by market share – were to take over WBD.

Democratic senator Elizabeth Warren said the deal “would create one massive media giant with control of close to half of the streaming market – threatening to force Americans into higher subscription prices and fewer choices over what and how they watch, while putting American workers at risk”.

Similarly, Representative Pramila Jayapal, who co-chairs the House Monopoly Busters Caucus, called the deal a “nightmare,” adding: “It would mean more price hikes, ads, and cookie-cutter content, less creative control for artists, and lower pay for workers.”

Read more:
Netflix could yet get its way in Trump’s America

Netflix’s business model of prioritising streaming over cinemas has caused consternation in Hollywood.

The screen actors union SAG-AFTRA said the merger “raises many serious questions” for actors, while the Directors Guild of America said it also had “concerns”.

Experts suggest there’s less of a concern with the Paramount deal when it comes to a streaming monopoly, because its Paramount+ service is smaller and has less of an international footprint than Netflix.

How is Trump relevant?

After Netflix announced its bid, the president said of its path to regulatory clearance: “I’ll be involved in that decision.”

And while Mr Trump himself will not be directly involved, he appointed those in the DOJ Antitrust Division, and they have the authority to block or challenge takeovers.

However, his potential influence isn’t sitting well with some experts due to his ties with key players on the Paramount side.

Larry Ellison (centre left) in the White House with Trump. Pic: Reuters
Image:
Larry Ellison (centre left) in the White House with Trump. Pic: Reuters

Paramount is run by David Ellison, the son of the Oracle tech billionaire (and world’s second-richest man) Larry Ellison, who is a close ally of Mr Trump.

Additionally, Affinity Partners, an investment firm run by Mr Trump’s son-in-law Jared Kushner, would be investing in the deal.

Also participating would be funds controlled by the governments of three unnamed Persian Gulf countries, widely reported as Saudi Arabia, Abu Dhabi and Qatar – countries the Trump family company has struck deals with this year.

David Ellison, CEO of Paramount Skydance.  Pic: Reuters
Image:
David Ellison, CEO of Paramount Skydance. Pic: Reuters

Critics of the Trump’s administration has accused it of being transactional, with the president known to hold grudges over those who are critical of him, however, Mr Trump told reporters on 8 December that he has not spoken with Mr Kushner about WBD, adding that neither Netflix nor Paramount “are friends of mine”.

John Mayo, an antitrust expert at Georgetown University, suggested the scrutiny by the Antitrust Division would be serious whichever offer is approved by shareholders, and that he thinks experts there will keep partisanship out of their decisions despite the politically charged atmosphere.

What happens next?

WBD must now advise shareholders whether Paramount’s offer constitutes a superior offer by 22 December.

If the company decides that Paramount’s offer is superior, Netflix would have the opportunity to match or beat it.

WBD would have to pay Netflix a termination fee of $2.8bn (£2.10bn) if it decides to scrap the deal.

Shareholders have until 8 January 2026 to vote on Paramount’s offer.

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Business

Revenues of water company to be cut by regulator Ofwat

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Revenues of water company to be cut by regulator Ofwat

The UK’s biggest water supplier has been dealt another blow as the regulator decided to reduce its income.

Thames Water, which supplies 16 million people in England, has been told by the watchdog Ofwat its revenues will be cut by more than £187m.

It comes as the utility struggles under a £17.6bn debt pile and the government has lined up insolvency practitioners for its potential collapse.

Money blog: Nine-year-old set up Christmas tree business to pay for university

Overall, water firms face a sector-wide revenue reduction of nearly £309m as a result of Ofwat’s determination. Thames Water’s £187.1m cut is the largest revenue reduction.

This will take effect from next year and up to 2030 as part of water companies’ regulator-approved five-year spending and investment plans.

The downward revenue revision has been made as Ofwat believes the companies will perform better than first thought and therefore require less money.

More on Thames Water

Better financial performance is ultimately good news for customers.

The change published on Wednesday is a technical update; the initial revenue projections published in December 2024 were based on projected financial performance but after financial results were published in the summer and Ofwat was able to apply these figures.

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Is Thames Water a step closer to nationalisation?

Thames Water and industry body Water UK have been contacted for comment.

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Business

Why is Warner Bros for sale, what are the controversial bids – and how is Trump involved?

Published

on

By

Why is Warner Bros for sale, what are the controversial bids – and how is Trump involved?

A huge takeover that would rock the entertainment industry looks imminent, with Netflix and Paramount fighting over Warner Bros Discovery (WBD).

Streaming giant Netflix announced it had agreed a $72bn (£54bn) deal for WBD’s film and TV studios on 5 December, only for Paramount to sweep in with a $108.4bn (£81bn) bid several days later.

The takeover saga isn’t far removed from a Hollywood plot; with multi-billionaires negotiating in boardrooms, politicians on all sides expressing their fears for the public and the US president looming large, expected to play a significant role.

“Whichever way this deal goes, it will certainly be one of the biggest media deals in history. It will shake up the established TV and film norms and will have global implications,” Sky News’ US correspondent Martha Kelner said on the Trump 100 podcast.

So what do we know about the bids, why are they controversial – and how is Donald Trump involved?

Why is Warner Bros up for sale?

WBD’s board first announced it was open to selling or partly selling the company in October after a summer of hushed speculation.

Back in June, WBD announced its plan to split into two companies: one for its TV, film studios, and HBO Max streaming services, and one for the Discovery element of the business, primarily comprising legacy TV channels that air cartoons, news, and sports.

It came amid the cable industry’s continued struggles at the hands of streaming services, and CEO David Zaslav suggested splitting into two companies would give WBD’s brands the “sharper focus and strategic flexibility they need to compete most effectively in today’s evolving media landscape”.

The company’s long-term strategic initiatives have also been stifled by its estimated $35bn of debt. This wasn’t helped by the WarnerMedia and Discovery merger in 2022, which led to it becoming Warner Bros Discovery.

WBD's announced it was open to selling or partly selling the company in October. Pic: iStock
Image:
WBD’s announced it was open to selling or partly selling the company in October. Pic: iStock

What we know about the bids

The $72bn bid from Netflix is for the first division of the business, which would give it the rights to worldwide hits like the Harry Potter and Game of Thrones franchises – and Warner Bros’ extensive back catalogue of movies.

If the deal were to happen, it would not be finalised until the split is complete, and Discovery Global, including channels like CNN, will not form part of the merger.

Paramount’s $108.4bn offer is what’s known as a hostile bid. This means it went directly to shareholders with a cash offer for the entirety of the company, asking them to reject the deal with Netflix.

Ted Sarandos, CEO of Netflix. Pic: Reuters
Image:
Ted Sarandos, CEO of Netflix. Pic: Reuters

This deal would involve rival US news channels CBS and CNN being brought under the same parent company.

Netflix’s cash and stock deal is valued at $27.75 (£20.80) per Warner share, giving it a total enterprise value of $82.7bn (£62bn), including debt.

But Paramount says its deal will pay $30 (£22.50) cash per share, representing $18bn (£13.5bn) more in cash than its rivals are offering.

Paramount claims to have tried several times to bid for WBD through its board, but said it launched the hostile bid after hearing of Netflix’s offer because the board had “never engaged meaningfully”.

David Zaslav, CEO and president of Warner Bros Discovery. Pic: Reuters
Image:
David Zaslav, CEO and president of Warner Bros Discovery. Pic: Reuters

Why are politicians and experts concerned?

The US government will have a big say on who ultimately buys WBD, as Paramount and Netflix will likely face the Department of Justice’s (DOJ) Antitrust Division, a federal agency which scrutinises business deals to ensure fair competition.

Republicans and Democrats have voiced concerns over the potential monopolisation of streaming and the impact it would have on cinemas if Netflix – already the world’s biggest streaming service by market share – were to take over WBD.

Democratic senator Elizabeth Warren said the deal “would create one massive media giant with control of close to half of the streaming market – threatening to force Americans into higher subscription prices and fewer choices over what and how they watch, while putting American workers at risk”.

Similarly, Representative Pramila Jayapal, who co-chairs the House Monopoly Busters Caucus, called the deal a “nightmare,” adding: “It would mean more price hikes, ads, and cookie-cutter content, less creative control for artists, and lower pay for workers.”

Read more:
Netflix could yet get its way in Trump’s America

Netflix’s business model of prioritising streaming over cinemas has caused consternation in Hollywood.

The screen actors union SAG-AFTRA said the merger “raises many serious questions” for actors, while the Directors Guild of America said it also had “concerns”.

Experts suggest there’s less of a concern with the Paramount deal when it comes to a streaming monopoly, because its Paramount+ service is smaller and has less of an international footprint than Netflix.

How is Trump relevant?

After Netflix announced its bid, the president said of its path to regulatory clearance: “I’ll be involved in that decision.”

And while Mr Trump himself will not be directly involved, he appointed those in the DOJ Antitrust Division, and they have the authority to block or challenge takeovers.

However, his potential influence isn’t sitting well with some experts due to his ties with key players on the Paramount side.

Larry Ellison (centre left) in the White House with Trump. Pic: Reuters
Image:
Larry Ellison (centre left) in the White House with Trump. Pic: Reuters

Paramount is run by David Ellison, the son of the Oracle tech billionaire (and world’s second-richest man) Larry Ellison, who is a close ally of Mr Trump.

Additionally, Affinity Partners, an investment firm run by Mr Trump’s son-in-law Jared Kushner, would be investing in the deal.

Also participating would be funds controlled by the governments of three unnamed Persian Gulf countries, widely reported as Saudi Arabia, Abu Dhabi and Qatar – countries the Trump family company has struck deals with this year.

David Ellison, CEO of Paramount Skydance.  Pic: Reuters
Image:
David Ellison, CEO of Paramount Skydance. Pic: Reuters

Critics of the Trump’s administration has accused it of being transactional, with the president known to hold grudges over those who are critical of him, however, Mr Trump told reporters on 8 December that he has not spoken with Mr Kushner about WBD, adding that neither Netflix nor Paramount “are friends of mine”.

John Mayo, an antitrust expert at Georgetown University, suggested the scrutiny by the Antitrust Division would be serious whichever offer is approved by shareholders, and that he thinks experts there will keep partisanship out of their decisions despite the politically charged atmosphere.

What happens next?

WBD must now advise shareholders whether Paramount’s offer constitutes a superior offer by 22 December.

If the company decides that Paramount’s offer is superior, Netflix would have the opportunity to match or beat it.

WBD would have to pay Netflix a termination fee of $2.8bn (£2.10bn) if it decides to scrap the deal.

Shareholders have until 8 January 2026 to vote on Paramount’s offer.

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