Health Policy Solutions

By Katie Kerwin McCrimmon

Many Coloradans with jobs say they can no longer afford health insurance, a new analysis from the Colorado Health Access Survey has found.

Nearly one-third of Coloradans — more than 1.5 million people — are either uninsured or underinsured, according to the initial survey results that were released in November.

New analysis shows that 85 percent of uninsured Coloradans say they don’t have health insurance because it’s too expensive.

Job loss and poverty used to be the key causes for poor health coverage. But the landscape in Colorado is changing dramatically. Today, a good job no longer guarantees affordable health insurance.

Nearly 58 percent of the uninsured in Colorado have jobs. Of that group, more than half said they were offered insurance, but turned it down because it was too expensive.

Some employers may also be dropping benefits. In just two years, from 2009 to 2011, 163,000 fewer working Coloradans had employer-sponsored insurance. The number of people who lost insurance is greater than all the people who work for Colorado’s top 25 businesses.

“I really see this as a wake-up call,” said Dr. Ned Calonge, president and CEO of The Colorado Trust, which is funding the survey of more than 10,000 households across the state every other year through at least 2017.

“Where’s the tipping point where it’s just unaffordable for everyone and we have to start making emergency policy decisions?” he said. “These are people who are working, but still can’t afford or are unwilling to pay for insurance.”

Lack of health insurance affects everyone because when uninsured people get sick, they usually seek care in hospital emergency departments, where costs are the highest. One-third of Colorado’s uninsured people said they usually go to ERs rather than seeking less expensive preventive care from a primary care provider.

In addition to hiking costs for everyone, uninsured people are sacrificing their health. Among the uninsured:

• Half put off seeing a dentist
• Forty percent delayed or skipped a trip to the doctor
• One quarter did not pick up prescribed medication

As a result of delaying or forgoing care, about one quarter of uninsured Coloradans described their health status as fair or poor — the lowest ranking — compared with 10 percent of Coloradans who are adequately insured.

Calonge said other issues like the economy and jobs have diverted the attention of policymakers from health challenges. But rising costs, the growing population of uninsured people and an impending ruling from the U.S. Supreme Court may soon put health issues back on the front burner.

Calonge says that no matter how the justices rule, the survey results show that Colorado has to proceed with a health exchange and policies that boost health coverage.

“We understand the issues enough and need to start making policy decisons that will keep us from hitting emergency levels,” he said.

If more healthy people opt out of health insurance, that leaves sicker, more expensive people in coverage pools, thus sending insurance costs even higher.

Already, the survey found that many healthy people don’t value insurance. Sick people are most willing to pay more. But many healthy people are opting out altogether, saying the premiums simply cost too much.

Among the lowest-income uninsured Coloradans, 75 percent were willing to pay something for health insurance. But, the survey found that as incomes rose, people were not necessarily willing to devote a large chunk of their paycheck to health insurance premiums.

Analysts continue to mine the health survey data. Next, they’ll be looking at how being uninsured affects people from different ethnic and racial groups, along with age and gender. They will also be probing ER use. So far, it appears that even insured people are overusing ERs, that perhaps they see them as convenient clinics rather than places of last resort.

The Colorado Health Institute conducts the health access survey and analyzes the data. The survey of 10,000 Colorado households is weighted to represent the more than 5 million people who live in Colorado. The Colorado Trust has pledged to spend more than $4.5 million on the survey to provide critical information to policymakers on health challenges the state faces.

By Mark Wolf

Eleven cantaloupes rested on the produce display in a suburban supermarket earlier this week.  Steps away, sliced cantaloupe was among the fruit arrayed in a ready-to-eat party tray.

Soon, surely, a shopper will heft one of the cantaloupes, inspect it briefly to make sure the stem end isn’t rough and there are no soft spots, then place it into a cart next to a bunch of asparagus. Perhaps the shopper’s mind will flash back to last summer when cantaloupes made headlines for all the wrong reasons: recall, outbreak, listeria, illness, death.

These cantaloupes bear stickers indicating they are from Honduras. The domestic season is still a few months away, but reminders of last year’s deadly outbreak continue to surface. The deaths of two Colorado residents in recent weeks were tied to the tainted cantaloupes.

A congressional report in January linked the outbreak to cantaloupes produced by Jensen Farms of Holly.

Inspectors from the Food and Drug Administration identified potential problems at Jensen Farms, including the failure to properly chill the melons before moving them into cold storage and not using chlorinated water to wash the cantaloupes.

The farm also reportedly had purchased potato processing equipment and retrofitted it as a hydrocooler for melons, the report said. It concluded that the outbreak likely could have been prevented if the producer had maintained its facilities according to FDA guidelines.

Farmers worried

Cantaloupe growers in the Rocky Ford area famous for its sweet melons were dismayed that even though the tainted cantaloupes were grown about 90 miles away, their product was associated with the contaminated fruit.

Even more than worrying about the weather and growing conditions, this year farmers in the region are consumed by one question:  When Rocky Ford cantaloupes begin appearing in stores this summer will consumers believe the product is safe?

A collaboration involving the state Department of Agriculture, Colorado State University and the growers aims to ensure that the harvest is safe and that consumers are reassured. Cantaloupe is an $8 million segment of Colorado’s $20 billion agriculture economy.

Officials from CSU will visit the farms of each grower in the newly formed Rocky Mountain Cantaloupe Association to assist them in assembling and implementing good handling policies.

“We got word of a new technology to help identify pathogens on the cantaloupe before it’s loaded on the truck. We want to work with CSU to validate that,” said John Salazar, Colorado agriculture commissioner. “That will instill consumer confidence that anything on the truck has been sampled to be free of listeria and if there’s something that’s not good it can be thrown back into the wash.”

John Salazar

Salazar and the growers expect to inaugurate a program that would place a label/sticker on each cantaloupe certifying that the producer was from a defined Rocky Ford geographic area and met GAP (Good Agricultural Practices) standards via an inspection by CSU. The program would be funded by a one-cent levy on each cantaloupe produced in the Rocky Ford region.

Third party auditors — private firms who conduct inspections of farm operations — came under criticism in the government report, and the state is prepared to take over that inspection function for any producer who requests it.

Planting season weeks away

Farmers will be planting cantaloupe by mid- to late-April.

“We’re on the fast track. We have to get it done,” said Salazar. “We already have CSU out in the field.”

Michael Hirakata, a partner in Hirakata Farms in Rocky Ford and president of the new growers’ association, said he was “very concerned” about the viability of the cantaloupe market. “That’s the way we make our living.”

His family has been farming in the region for nearly a century and has been packing and shipping produce for 40 years. He said the farm is building a new packing shed, installing new coolers and providing better traceability at their operation, which produces about a million cantaloupes each year.

He is fully supportive of the state’s plan to assure the public that the cantaloupe crop is safe.

The group, with help from the state, plans to survey consumers to determine their attitude about buying Rocky Ford cantaloupe this summer. Hirakata said he has spoken to representatives of King Soopers and Walmart and both want to stock cantaloupe from Rocky Ford.

“The first priority is educating the public that we’ve had a safe product for 100-plus years,” he said.

Hirakata hasn’t decided if his operation will reduce production this year.

“We’re still sort of looking at that. We have to talk to some of the buyers and see what the public is feeling,” he said.

The outbreak

Last summer, the deadliest food-borne illness outbreak in more than a quarter-century caused 140 illnesses, 34 deaths and one miscarriage across 28 states. Colorado was the hardest-hit state with 40 cases, and nearby states Texas with 18; New Mexico, 15; Oklahoma, 12; and Kansas, 11, also reported double-digit incidences. The vast majority of the cases in Colorado were along the Front Range.

While most healthy adults under age 60 show few if any affects from listeriosis, those with compromised immune systems, cancer patients, pregnant women, unborn babies and newborns are at risk for serious complications and death. The incubation period can range from three to 70 days. Common symptoms are fever, muscle aches and diarrhea.

Sharon Jones of Castle Rock, who was twice elected Douglas County Treasurer, was 62 years old, recovering from a fall and preparing to resume treatments for breast cancer when she became ill last September, said her son, W.B. “Dub” Jones.

“She never got out of bed again after Sept. 14,” said her son. “She was so incredibly weak. She said, ‘Just imagine the worst cold or flu you ever had and multiply it by 100.’ ”

Doctors at first feared she had meningitis, but Tri-County Health Department matched samples from her blood with the DNA from tainted cantaloupe from Jensen Farms, said her son.

Sharon Jones died Jan. 29.

“If there’s a lesson to be learned from these things it’s that we need to pay a lot more attention to what happened and use them to come up with strategies,” said Bill Marler, a Seattle attorney and food safety advocate who represents 14 of the outbreak’s victims, including Sharon Jones, as well as 25 persons who were sickened but survived.

By Katie Kerwin McCrimmon

The battle over contraception has escalated in Colorado with Planned Parenthood officials calling out Colorado’s Attorney General for opposing federal birth control mandates.

Attorney General John Suthers signed a letter this month along with 11 other attorneys general demanding a reversal of the U.S. Department of Health and Human Services’ new requirement that health plans offer birth control coverage.

“We strongly oppose the unconstitutional approach taken by the proposed contraceptive coverage mandate,” the letter reads. “We believe it represents an impermissible violation of the Constitution’s First Amendment virtually unparalleled in American history.”

Tapping into the rage among women that is sweeping the nation as birth control has become a hot topic in the race for president, Planned Parenthood Votes Colorado, the political arm of Planned Parenthood of the Rocky Mountains, quickly took aim at Suthers. They demanded that he abide by Colorado law, which since 2010 has required employers that offer health plans to include contraception.

“To many Colorado women, the discussions about what politicians want to do with women’s health care have been extremely insulting,” Cathy Alderman, vice president of public affairs for Planned Parenthood Votes Colorado, the group’s political arm, said in a press release. “To see Suthers join in opposition against President Obama’s new path forward simply demonstrates how out of touch he is with Colorado voters.”

Suthers’ spokesman, Mike Saccone, said the letter is a non-issue.

Attorney General John Suthers

“He did sign the letter. That said, we’re not litigating it. The Attorney General does believe there are serious First Amendment issues with it, but he does not believe the states have standing to raise them. The religious institutions that are affected are able to (fight this) themselves.”

Seven states last week sued to try to block federal requirements that would guarantee birth control benefits for employees, even those who work for religious-affiliated hospitals, schools and outreach programs that might oppose birth control.

Nebraska Attorney General Jon Bruning is leading the court fight along with attorneys general from Florida, Michigan, Ohio, Oklahoma, South Carolina and Texas.

The lawsuit alleges that the new federal rule will effectively force religious employers and organizations to drop health insurance coverage, which will cause spikes in enrollment in publicly-funding health insurance programs like Medicaid.

Planned Parenthood officials contend that nearly all women, including Catholic women, have used birth control at some point in their lives. Polls have shown strong support for contraception coverage since it can cost as much as $50 per month, a price that some women say is difficult to afford.

“Bottom line, Suthers just doesn’t get it,” said Alderman. “Health care reform should ensure that women are better off after health care reform than they are today; not take away benefits women already rely on.”

Planned Parenthood officials say Colorado is one of 28 states that requires contraception coverage in health insurance plans. Colorado’s requirement stems from HB 10-1021, which former Gov. Bill Ritter signed into law. It guarantees contraception coverage in the individual and small-group health insurance markets.

The most recent tempest erupted over birth control when a Congressional oversight committee composed mostly of men took on the issue. President Obama also stirred the ire of conservatives when he declared that insurance companies will be required to offer contraception benefits even if religious employers oppose them.

Now, two measures are pending in Congress that seek to undo Obama’s ruling. Sen. Roy Blunt, R-Mo., has sponsored an amendment that would allow employers to excluded any insurance benefit that they deem immoral.

And Sen. Marco Rubio, R-Florida and Sen. Joe Manchin, D-West Virginia, have a separate bipartisan measure seeking to undo the new regulations.

“This has opened somewhat of a Pandora’s box of state and federal legislation,” said Monica McCafferty, spokeswoman for Planned Parenthood Votes Colorado.

“What we’re seeing are pieces of legislation that are undermining the principle of health care reform in the first place,” she said. “A lot of women are frustrated and irritated that this discussion is even taking place in 2012. This is taking women backward.”

By Katie Kerwin McCrimmon of Solutions

He’s 16 but his baby face makes him look a little older than 10, his age when he first tried marijuana.

“I smoke marijuana every single day all day long,” the teen said during a lunch period spent hanging out in a park outside his downtown Colorado Springs high school.

“It develops brain cells. That is a complete and true fact,” he said. “It kills weak brain cells. It does affect your lungs … but it’s better than smoking cigarettes.”

Dozens of students interviewed across Colorado as part of an investigation by Education News Colorado, Solutions and the I-News Network made similar statements:

Marijuana is healthy. It helps me focus in class. And, hey, it’s better than alcohol or cigarettes.

“It’s less damaging to smoke weed,” said a 15-year-old girl getting high over lunch near her Denver high school. “I’m not trying to mess with my body.”

The investigation found a 45 percent increase in drug violations reported by schools statewide in the past four years, even as violations in nearly every other category – including alcohol and tobacco use – declined.

School officials and health care workers repeatedly cited the location of medical marijuana dispensaries near schools and the saturation of marijuana in surrounding communities.

They say Colorado’s thriving cannabis industry and its advertising —online and on storefronts at more than 700 dispensaries — have emboldened young people to justify abuse and claim health benefits from marijuana.

But contrary to perceptions among students, doctors say marijuana is especially harmful to kids for two key reasons:

Dr. Chris Thurstone meets with a young patient at the STEP drug treatment program at Denver Health. He said said increased use of marijuana among teens is coming at the worst possible time as new research shows it's especially toxic to the teen brain. He said 95 percent of young people in the STEP program are dealing with marijuana abuse or dependence. Photo by Joe Mahoney - I-News Network.

First, new research shows adolescence is a crucial time for brain development and marijuana use can permanently change the teen brain. Second, young people who start using marijuana before age 18 are much more likely than adults to become addicted to the drug.

“It’s an ironic play of events that use is going up at the same time that the science is coming out about its possible brain toxicity,” said Dr. Chris Thurstone, an adolescent psychiatrist who runs a substance abuse treatment program at Denver Health.

“We need to tell people that youth are the most likely to become addicted to marijuana and that when they become addicted, they are at higher risk for every bad outcome a teenager can face.”

Doctors interviewed across the spectrum, from vocal marijuana opponents to those who recommend it for patients, agreed that marijuana can be addictive. And the diagnostic bible for health providers, the “Diagnostic and Statistical Manual of Mental Disorders,” lists cannabis abuse and cannabis dependence as possible diagnoses.

“There is no debate in the scientific community,” Thurstone said. “It’s physically and mentally addictive.”

Research findings grim for young cannabis users

Few teens heed such warnings, however. While adolescents have always been impulsive thrill seekers, Thurstone and other researchers have found that all the most dangerous behaviors escalate when teens use marijuana.

It’s no different than when they use alcohol or other drugs.

The more often teens use and the greater the dose, the more reckless their behavior becomes. So regular marijuana use puts them at greater risk for dropping out of school, engaging in risky sex behaviors and getting in accidents, the leading cause of death for adolescents.

Research paints a grim picture for marijuana users who start at a young age:

• Teens using marijuana before age 18 are two to four times more likely to develop psychosis as young adults compared to those who do not.
• The teen brain is much more vulnerable to addiction. One in 6 kids who try marijuana before age 18 will either abuse it or become addicted to it compared with 1 in 25 adults.
• Studies show that heavy doses of THC, the key chemical in marijuana, during adolescence change the way the brain develops. In particular, marijuana’s harmful effects strike the hippocampus, which is critical for learning and memory.

“We know that adolescents who start using marijuana between the ages of 14 and 22 – and stop by 22 – have many more cognitive deficits at age 27 compared to non-using peers,” said Dr. Paula Riggs, director of the Division of Substance Dependence in the psychiatry department at the University of Colorado School of Medicine.

“It affects brain processing, decision-making, impulsivity and memory.”

Riggs said there’s little question among doctors that marijuana can be beneficial for a small percentage of patients who have cancer, multiple sclerosis, glaucoma or nausea from HIV treatment.

But that doesn’t mean it’s safe or healthy for kids.

“There’s no medical indication for medical marijuana in young people at all,” she said. “It’s not a medication. There are 400 other chemicals and many carcinogens in smoked marijuana.”

The revolution in brain science has only increased concerns about harm to the teen brain.

Experts used to think that the brain was fully formed by about age 6.

But new brain scan research has found that nerve cells don’t finish developing until young people reach their mid-20s. Teen brain cells don’t have as much of a fatty coating called myelin which helps messages travel from neuron to neuron efficiently. The brain also sheds unnecessary connections during adolescence.

A student from Palmer High School in Colorado Springs spends his lunch break in nearby Acacia Park. He says he uses marijuana regularly. Behind him is the Indispensary, one of 23 medical marijuana dispensaries across Colorado, that were targeted for being too close to schools by U.S. Attorney, John Walsh. Photo by Joe Mahoney, I-News Network.

It turns out that one of the last parts of the brain to fully mature is the prefrontal cortex, which governs complex decision-making and analysis.

“In other words, the adolescent brain craves pleasure, but it doesn’t know how to weigh risks, determine and plan for consequences or say ‘enough is enough,’ ” said Thurstone, who is conducting a five-year study on medical marijuana in Colorado for the National Institute on Drug Abuse.

Debating a rise in marijuana use among teens 

Blaming marijuana for increasing risky teen behavior is a leap, said Dan Rees, an economics professor at the University of Colorado Denver.

“It turns out that kids who use marijuana also drink alcohol and get in car accidents and have sex without condoms. It’s impossible to distinguish the effect of the marijuana and the effect of personalities,” said Rees, who has been studying the impacts of marijuana legalization throughout the United States.

He’s not surprised if young people are now getting medical marijuana rather than street weed. But he’s not convinced that overall use is up among kids or that marijuana is any more dangerous than other drugs that kids abuse.

Several studies show that alcohol use declines when marijuana use increases. One of Rees’ studies found that traffic fatalities went down by 9 percent in 13 states, including Colorado, that have legalized medical marijuana. The researchers don’t know why. It’s possible that people drive more when they’re drunk than stoned.

The study used data through 2009, just as dispensaries began spreading across Colorado. So it’s unclear how the boom in dispensaries has affected marijuana use or driving here.

Another study by Rees shows that, in states that have legalized medical marijuana, use increases dramatically among young adults. But that did not hold true for those under 18.

Rees described the finding as “puzzling.” The study, which is not yet published, also used data through 2009.

“My strong suspicion is that there’s diversion from the legal market to the illegal market. The fact that kids are ending up with marijuana that was originally intended for the legal market doesn’t surprise me,” he said.

“There’s just no evidence that medical marijuana affected the percent of youth who said they smoked marijuana in the last month.”

Surveys in Colorado and nationally, however, appear to indicate marijuana use is rising.

In Colorado, a survey of more than 27,000 students through the Adams County Youth Initiative found a jump in use. In 2008, 19 percent of students in various Adams County middle and high schools said they had used marijuana in the last month. That number increased to 22 percent in 2009 and 30 percent in 2010.

And the Monitoring the Future study, the largest national survey of students and drug use, found in 2011 that marijuana use has risen for the fourth straight year after consistent declines in the past decade. The study also found one in 15 high school seniors now uses marijuana daily. That marked a 30-year peak for daily use, a finding that sparked great concern for Riggs.

“People will say, ‘I smoked in the ’60s and I didn’t become addicted,’ ” she said. But, “Adolescents who are daily users are at much higher risk for becoming dependent. And the marijuana, by and large, is more potent today.”

State-by-state data for marijuana use should be available for the first time in the next couple of years. Riggs said that information will be critical because, unlike Rees, she suspects access to marijuana in the 16 states that have legalized it may be driving the increased use found in national survey results.

Here in Colorado, teens that Riggs sees through her clinical trials often repeat claims such as marijuana helps them “focus.” When she probes further, she finds their grades are going down.

“What they mean is ‘I’m totally lost. I can tolerate sitting there lost (in class),’ ” Riggs said. “It’s zoning them out.”

“They often come in and say, ‘It’s not addictive. It’s natural. It’s an herb.’ But you wouldn’t go out and pick poisonous mushrooms, would you?”

Recreational pot for teens ‘absolutely’ not healthy

 Dr. Alan Shackelford recommends marijuana to some of his patients and advises lawmakers around the country on medical marijuana legislation. He maintains a business and website, Amarimed of Colorado, devoted to medical marijuana.

In very rare cases, Shackelford said he has recommended marijuana for children, including a toddler who was dying of a brain tumor.

“Her oncologist at Children’s was in complete agreement. We know that cannabis makes opiates much more effective. Judicious cannabis use allowed the parents to decrease the amounts of morphine and also got rid of horrific pain,” Shackelford said.

Recommending marijuana to some patients, however, and endorsing recreational use among kids is not the same thing.

“Do I think kids ought to say that it’s healthy and use it recreationally? Absolutely, I do not,” Shackelford said.

But he believes a narrow focus on marijuana abuse among kids distracts from the more harmful effects of other drugs they’re using, including tobacco, alcohol and prescription medications.

“Cannabis is much safer than those things,” Shackelford said. “I’m not demonizing alcohol or opiate prescription medications. Used correctly, alcohol can be no more lethal than Percocet. But both have the potential to kill people.”

Shackelford says marijuana is a valuable tool for some patients. He has found it particularly helpful for patients with migraines and elderly patients with rheumatoid arthritis.

He never recommends that patients smoke it and declines to say how many recommendations he gives per year for medical marijuana or what percentage of his patients seek it.

And he has a message for young people who claim marijuana is healthy.

“Don’t kid yourselves. Don’t use terms to rationalize something when we don’t know what the consequences are,” he said.

“It’s certainly not healthy like eating an apple and probably not healthy in teenagers, not in someone who is still developing.”

The same applies to abuse of Ritalin, Percocet, alcohol or methamphetamine, all of which Shackelford views as much more dangerous.

While debate is fierce over the relative harm of various drugs, Thurstone said the No. 1 drug his patients are abusing is marijuana. He has treated patients as young as 11 for its use.

Nationally, in substance abuse treatment programs, two-thirds of patients are dealing with marijuana abuse or dependence. At Thurstone’s Denver Health program, the figure is 95 percent.

“Many lives are being destroyed by this,” Thurstone said. “(Teens) are dropping out of life. They’re dropping out of school or if they’re not, they’re doing really badly.

“They’ve dropped away from their family, their friends and their sports to smoke marijuana every day, all day. We see that all the time.”

By Katie Kerwin McCrimmon of Solutions

COLORADO SPRINGS – An attack seizes Chaz Moore’s body, stealing much of his breath. Spasms in his throat, lungs and diaphragm cause the 17-year-old to speak in hiccups, one syllable at a time.

He says it feels like a grown man is jumping on his chest as the muscles in his belly roll like waves.

Chaz opens a jar labeled MMJ, pulls out some fresh green buds and crumbles the marijuana into a small pipe. He lights up the bowl and inhales as deeply as possible through the spasms, turning to blow smoke out his bedroom window.

A second puff, a deep cough and the attack passes.

Chaz is one of 41 children under 18 in Colorado who have a medical marijuana license, according to the most recent data available from the Colorado Department of Public Health and Environment.

By Terrance R. Kelly

The most important issue today in health care morality is crystal clear.  It has nothing to do with birth control insurance coverage for employees of Catholic universities and hospitals, the Catholic hierarchy or Republican presidential candidates.

Several cancer drugs that are the “mainstay of treatment regimens used to cure” several cancers,
are not being manufactured in sufficient quantities to meet the life-and-death needs of cancer patients.  Dr. Michael Link, the president of the American Society of Clinical Oncology, states, “If you are a pediatric oncologist, you know how to cure 70 to 80 percent of patients. But without these drugs you are out of business.” The children will die.

Our present health care system, awash in its anti-socialist, free market, capitalistic principles, has blown a British Petroleum-sized hole in the fragile membrane of U.S. health care.  Why are these life-saving drugs not available?  Because drug manufacturers can make more money— a lot more money— manufacturing other drugs.

So guess what? The manufacturers opt to make more money.  They produce “newer brand-name cancer drugs that do not cure anyone, but just extend life for a few months, at costs of up to $90,000 per patient. Only the older but curative cancer drugs — drugs that can cost as little as $3 per dose — have become unavailable.”

We haven’t read anything about Catholic-bishop rage over this latest “oops” moment in health care supply-and-demand capitalism.  It appears that the bishops’ moral indignation is engaged elsewhere, defending a supposed attack upon their finely calibrated collective conscience.

The bishops have taken to arms against women and President Obama, against those who are making “War on Catholics” and “War on religious freedom and the Constitution.”   That according to those great religious thinkers of the day, Romney, Gingrich, Santorum, Charles Colson and Foster Friess.

As near as one can understand, the bishops’ heroism is the only thing that stands between the First Amendment’s protection of the Catholic Church’s right to preach an anti-contraceptive doctrine, and health insurers from providing contraceptive coverage to employees of Catholic universities and hospitals.

Let me modestly suggest that (1) the prohibition of contraceptive birth control is not a viable teaching of the Catholic Church, and (2) the First Amendment’s religious exercise freedoms do not include a hierarchical shield from the government compelling contraceptive insurance coverage for women.

Catholic teaching, sourced in the bible and in tradition, is not and never has been a fixed collection.  Because of its developmental life, the Catholic community no longer presses its kings and governors to murder heretics, no longer considers belief in the Copernican theory of solar movements as heresy, no longer includes charging interest on a loan to be mortal sin — it’s an old religion and there is a long list of discarded teachings.

Development in church doctrine, changes in church doctrine, has seldom been initiated by hierarchical promulgations.  Our bishops have not been the type of people who are comfortable saying, “We were wrong.”  They are much more likely to claim, “We are not wrong.  We are never wrong. We are the church and the church is infallible.”

Change in moral doctrine generally bubbles out of the culture, from the “people.”  At some time, it becomes clear that the people have rejected a teaching— under those circumstances, slavery becomes an unacceptable human condition, religious liberty is seen as a fundamental right of all humans including heretics, some marriages actually can be dissolved.

The bishops’ claims for making contraceptive birth control an evil is not believed by the laity.  The entire teaching authority of the Church – popes, three ecumenical councils, bishops and theologians – universally proclaimed and enforced this doctrine. This teaching has gone the way of biblical and episcopal proscriptions that condemned for over 500 years those who would charge interest on a loan.  The entire teaching authority of the Church – popes, three ecumenical councils, bishops and theologians – universally proclaimed and enforced this doctrine.

The birth control teaching has likewise been massively rejected, through the powerful witness of daily lives lived.  It has been abandoned de facto, as we say in Latin.

Regarding the bishops’ constitutional analysis, the First Amendment to the U.S. Constitution provides that “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.”  The bishops’ claim that a law requiring health insurers to provide coverage for contraceptive birth control to employees of Catholic universities and hospitals violates the bishops’ right to freely impose its religious “doctrine” on employees of all institutions affiliated with the Catholic religion.

We are in an age when the methodologies for interpreting our Constitution are sources of great debate.  Invoking the basic fundamentalist interpretive methodology— pursuing the “original intent” of the authors of the Constitution— is no help.  Post-colonial medical care in the United States did not have much in its reproductive bag, especially for women who were 50 years away from being allowed to vote.  The concept of medical insurance, let alone insurance coverage of birth control contraceptives, was unknown.  In this present political circus, groping for religious “freedom to exercise” answers from James Madison is a farce.

Ultimately, we are left to our own communities to determine whether the principles expressed in our Constitution’s religious freedom clause repulse President Obama’s health care reform provision for assuring free access to contraceptive birth control.  We study the question through various lenses — factors such as text, context, purpose, results and consequences, history and precedent are often raised by constitutional jurists such as Justice Stephen Breyer.

What is clear is that the connection between the principle of religious freedom and the exemption that Catholic bishops demand is so attenuated, so distant, so stretched as to be logically unsustainable.  No one is stopping people from exercising their religion.

In this age, when the parents and caregivers of children suffering from leukemia are being informed that life-giving drugs are not available, it would be appropriate for Catholic religious authorities to shift their focus, to redirect their rage.  Such a change is particularly needed in light of the bishops’ documented prolonged, massive indifference to and the aiding and abetting of the sexual abuse of children by Catholic clergy.

But that’s not how things work in the world of the infallible.  Galileo did get a papal apology 400 years after he died.  And he was a man.

Terrance R. Kelly is Of Counsel to the Denver law firm Lass Moses Ramp, LLC.

By Katie Kerwin McCrimmon of Solutions

She’s not the stereotypical stoner, zoned out in a haze of smoke and flunking out of school.

Emma is a graduate of Palmer High School in Colorado Springs, known for its prestigious International Baccalaureate program and for attracting a diverse student body.

But Palmer holds another distinction and so does Emma, whose name has been changed to protect her identity.

The downtown Springs school posted one of the highest increases in drug violations reported by any Colorado school in the past four years. In 2007-08, Palmer reported two drug violations; in 2010-11, it was 45.

And Emma, now a successful college student mulling a career in law, is also a regular user of medical marijuana who frequently got high in Palmer’s “party parking lot” during lunch or other breaks from school.

“It’s a lot of fun. You go out to your car, get high and go back,” she said. “We weren’t worried about getting busted.”

Although she’s old enough at 19 to seek an “M” card, a state-issued license for medical marijuana, Emma hasn’t done so. She thinks it’s intellectually dishonest to fabricate an illness to buy marijuana.

“The term ‘medical’ isn’t fooling anyone,” she said. “I don’t think most of the people who have their cards think of it as medicine.”

But most young people don’t get medical marijuana directly from the dispensaries anyway, she said. Instead, they get an older friend or sibling to buy for them or they get it straight from licensed growers with extra product.

“They are growing so much marijuana legally that they will go out and find other people to sell it. That’s where the kickback is,” she said.

Connecting with a dealer is simple.

“They find you,” she said. “If you’re downtown and trying to solicit somebody to buy cigarettes outside a gas station, it’s safe to assume you also smoke pot.”

Perhaps the easiest way to buy is through an older friend or sibling.

“Certain dispensaries have coupons where you can get two ounces for the price of one,” she said. “If a kid can search through High Times magazine and find a coupon, then you find a friend who can cash it in.”

She described her high school friends who smoked as discriminating shoppers who searched for bargain prices on medical marijuana because it’s generally less expensive, higher quality and perceived to be safer than street pot.

INEWS011-Judy Negley, left, co-owner of Indispensary, a medical marijuana dispensary in Colorado Springs, talks to manager Christy Kress. The U.S.Judy Negley, left, a co-owner of the Indispensary in Colorado Springs, received a letter from federal officials ordering her to move or close her dispensary near Palmer High School in downtown Colorado Springs. Photo by Joe Mahoney - I-News Network.

One thing they didn’t do, Emma said, was walk in to a dispensary near Palmer. She mapped them for a school project last year, but said the dispensaries won’t sell to kids and too many people would see a teen loitering outside.

An investigation by Education News Colorado, Solutions and the I-News Network found as many as eight dispensaries are located within a mile of Palmer.

One, called Indispensary, is kitty-corner from the school’s front door, separated by a small park.

Indispensary co-owner Judy Negley said hers was among the 23 medical marijuana facilities located within 1,000 feet of a school that were recently targeted in a federal crackdown.

Negley said her shop doesn’t sell to anyone under 18 without a state-issued marijuana card. Statewide, fewer than 50 cards have been issued to youth that age.

Students without cards have zero access to their product, she said.

“It would be so difficult for them to get in. They could break in,” she said. “But in our dispensary, they have to go through two locked doors. There’s surveillance everywhere. They have to present credentials in a neutral area.

“I don’t think dispensaries are the problem,” Negley added. “The kids are smart enough to know that.”

Emma and other students interviewed said they don’t believe the proximity of dispensaries to schools has made marijuana easier to buy.

“I haven’t heard of a single dispensary anywhere selling to somebody without a card,” she said. “The kids who are smoking weed and getting high at Palmer are not getting it from the dispensaries.”

So what do students like Emma think policymakers should do about the spike in drug violations at schools?

“Regardless of the legality of pot, we will continue to smoke it,” she said. “I don’t think people see it as positive or as medicine. It’s still a drug. People do it more to get high … but it’s viewed as safer than the alternatives.”

By Rebecca Jones of Education News Colorado and Katie Kerwin McCrimmon of Solutions

Sometime on Saturday, Steve Ackerman sold his last joint.

His Organic Alternatives, a medical marijuana dispensary in Fort Collins, is one of 23 in this laid-back university town forced to close by Tuesday after residents voted to ban dispensaries.

“I won’t continue in the medical marijuana industry,” said Ackerman, who opened his comfortable saloon-like dispensary two years ago. “But I will continue to support it, and I’ll continue to help fight for what I think is right. Marijuana should not be prohibited.”

Cruise south a little less than 150 miles and you’ll find the opposite scenario, one of Colorado’s medical marijuana capitals in a city known as a conservative stronghold.

Neon green crosses signifying medical marijuana businesses now light up so many shops in Colorado Springs that they rival the number of churches in a town where evangelical Christians often dominate.

Welcome to the new Tale of Two Cities, a real-life drama playing out as Coloradans wrestle with how to handle the resurgence in popularity of this ancient plant.

Voters narrowly approved the use of marijuana for limited medicinal purposes in 2000. But it wasn’t until 2009, when more than 700 medical marijuana dispensaries began sprouting in neighborhoods across the state, that the issue became kitchen-table conversation.

Since then, more than 80 communities have banned dispensaries, outlawing them from Alamosa to Greeley. School leaders lament a 45 percent spike in drug offenses, an increase sparking a federal crackdown on dispensaries near campuses.

Colorado has become a national focal point in the debate over efforts to legalize medical marijuana, as over a dozen states weigh legislation to approve its use and join the 16 states where those laws are already on the books.

Fort Collins and Colorado Springs — the college town that banned dispensaries and the conservative city that didn’t — illustrate how different communities grapple with the results.

Later this month, Fort Collins will be the focus of a new TV series, “American Weed,” shot by a National Geographic crew that spent months filming the battle over the ban.

Birds fly past a church steeple in conservative Colorado Springs where the number of marijuana dispensaries now rivals the number of churches. Photo by Joe Mahoney - I-News Network.

“They viewed Colorado in general and Fort Collins in particular as a real litmus test for the rest of the country as it relates to medical marijuana,” said Fort Collins resident Scoot Crandall, who championed the ban. “They wanted to show a complete picture of what happens in a community when medical marijuana is being debated.”

In the Springs, focus on “liberties and choices”

In Colorado Springs, libertarians squared off against religious conservatives in drafting medical marijuana regulations in 2010.

Much to the dismay of medical marijuana opponents, the libertarians won.

“Colorado Springs residents still want government out of their hair. They believe in individual liberties and choices, everything from gun rights to medical marijuana,” said Sean Paige, a former city councilman who oversaw regulations that allow dispensaries as close as 400 feet from schools, and day care and drug rehab centers.

State law suggests a 1,000-foot buffer around schools but allows local authorities to deviate.

Superintendents of three school districts – Colorado Springs, Cheyenne Mountain and Academy – urged adoption of the bigger buffer zone but were unsuccessful.

“Yes, there was a lot of fear and a lot of parental anxiety, but the sky hasn’t fallen,” Paige said. “It hasn’t led to Sodom and Gomorrah in Colorado Springs. It hasn’t been the destruction of our city and our culture. People drive by the dispensaries just like the 7-Elevens and the Walgreens without even noticing them.”

Not everyone is oblivious.

Religious conservatives say they are watching the marijuana experiment play out and waiting for an opportunity to intervene.

Focus on the Family, the giant among Colorado Springs’ evangelical groups, opposed the legalization of medical marijuana in 2000 and plans to fight any ballot measure this year to allow recreational use of the drug.

For now, Focus leaders have had little choice but to tolerate the dispensaries in their backyard.

“Like many, we are unhappy with the current marijuana dispensary situation in Colorado Springs. However, we are not aware that there are any current options to ‘fight’ these dispensaries as they are here legally and to date, efforts to limit them have been unsuccessful,” said Carrie Gordon Earll of CitizenLink, Focus’ advocacy arm.

“If an opportunity to reverse the law or close down dispensaries presents itself, we’ll examine it for future involvement.”

State law allows local governments or local voters to regulate or ban marijuana-related business. A listing from the Colorado Municipal League shows, as of November, 37 of 85 community bans have been approved by voters while the other 48 were enacted by local governments such as city councils.

A proposal to ban dispensaries in Colorado Springs has never made it to the city ballot. In Fort Collins, a citizens’ initiative split the city for much of 2011.

Anti-marijuana campaign in “Fort Fun” emphasizes kids

Dubbed “Fort Fun” by college kids and known for its forestry students and earth-friendly microbreweries, Fort Collins came late to the idea of a ban.

A 'For Lease" sign at Organic Alternatives, one of 23 medical marijuana dispensaries forced to close in Fort Collins this week after citizens voted in favor of a ban.

Activists say they watched one nearby community after another prohibit dispensaries. The home of Colorado State University seemed destined to become the region’s marijuana mecca.

“The dispensaries sprang up like crazy,” said Crandall, who is executive director of Team Fort Collins, a substance abuse prevention coalition. “At one point, they outnumbered our pharmacies. I believe they even outnumbered our Starbucks.”

The city council initially passed restrictions barring dispensaries from locating within 1,000 feet of schools. But like many communities, they planned to allow those who were already there to stay. Nearly all of the 23 existing dispensaries violated the new regulations.

“That was the straw that broke the camel’s back,” said City Councilman Wade Troxell, who helped lead the campaign for the ban. “We allowed 21 medical marijuana dispensaries to be adjacent to our neighborhoods, next to our schools, surrounding the CSU campus, up and down our main avenue.”

Troxell said he was walking downtown to get a cup of coffee one morning when he stepped on a dispensary vial.

Meanwhile, Poudre Valley schools posted increasing numbers of drug violations. During 2007-08, schools reported 74 drug violations to the state; during 2010-11, that number was 200.

Ultimately, the rallying cry behind Initiative 300 became “Save our kids!”

But while 52 percent of Fort Collins residents agreed to the ban, those who pushed it say it’s uncertain whether they’ll see a decline in reported drug use at schools.

Steve Ackerman of Organic Alternatives in Fort Collins closed his shop on Saturday after citizens enacted a ban.

“We feel like the damage has been done to our kids,” said Crandall. “The perception of harm is low. Even though we’ve been able to secure the passage of this ballot initiative, we have a lot of educating to do with our kids.”

Ackerman, who’s been forced to shut down his dispensary on Fort Collins’ Mountain Avenue, happens to share concerns about marijuana use – or any drug use – among teens.

He just doesn’t agree that prohibition is the answer.

“Anything we can do to keep kids away from all substances – including alcohol and prescription drugs – is a good thing,” said the father of two. “But I think having medical marijuana centers is a better way to keep kids away from it than having no regulation at all.”

Police cite concerns about “seepage in the system”

With the dispensaries closing, Fort Collins will give up an estimated $250,000 a year in tax revenue. Troxell says the city will never miss the money.

“Given the trade-off of social ills they bring, we’re coming out far ahead,” he said. “It doesn’t take more than a few families not being destroyed to recover the cost of that sales tax.”

Critics of the Fort Collins ban say marijuana has always been easy to get and, if anything, dispensaries undermine the black market.

There’s nothing to suggest dispensaries themselves are selling directly to minors – or to anyone without a medical marijuana card.

But police say more marijuana is making its way into the community.

“There’s a lot of seepage in the system. There’s just a lot of pot being grown, and it’s very difficult to track where it’s all going,” said Capt. Jerry Schiager, former commander of the narcotics unit of the Fort Collins Police Department. “The whole medical marijuana system has increased access to marijuana.”

Patrons of dispensaries are limited to purchasing no more than 2 ounces of marijuana at a time from a single outlet, because state law says that’s the maximum amount a medical marijuana patient should have at any one time.

But there is no system of tracking purchases from one dispensary to the next, and medical marijuana patients can buy products from any dispensary at any time.

“It’s possible, for an individual who wanted to, to obtain 2 ounces at 23 dispensaries in a single day,” said Bob Powell, a retired Fort Collins businessman who worked on Initiative 300. “They can get a lot of marijuana that way, which can get into the hands of our kids.”

But is that happening? Law enforcement officials have a difficult time connecting the dots.

Unlike many other drugs – or other prescription medications – marijuana is an agricultural product, not something cooked up in a laboratory with definitive markers. It’s difficult to determine where a given ounce of marijuana came from or to track where it’s going.

Springs school officials confiscate dispensary vials

In Colorado Springs, school officials say at least some medical marijuana is flowing into the hands of teens.

Schools in District 11, the core-city district, have posted some of the highest increases statewide in drug violations. Palmer High School reported two drug incidents in 2007-08, one in 2008-09, 75 in 2009-10 and 45 in 2010-11.

Greg Ecks, director of the district’s Office of Student Discipline Services, sees every student found with drugs. He said almost all have been caught with marijuana.

The newest trend he’s noticing is edibles like marijuana-infused gums. He also sees plenty of little brown dispensary jars.

“It has a dispensary label on it. That would lead us to the conclusion that it’s coming from dispensaries,” Ecks said. “It’s passing hands. The students say they don’t know where it came from. But the jars are quite common.

“It’s serious and it’s a growing problem. Even before it was legally allowed for medicinal purposes, it was growing in popularity,” he added. “Now it’s filtering down into the middle schools.”

At Palmer, located in downtown Colorado Springs, students flood into nearby Acacia Park during lunch and other breaks. It’s a small, gritty park where homeless people hang out and kids say it’s easy to score street weed.

But their preferred method is to buy wholesale, not from dealers in the park.

“The favored way for kids to get it pretty much is to go through a grower because that way you can keep up with the grower’s plants,” said a 17-year-old Palmer High School junior.

“You’d be able to see the quality of it, how it’s made and be able to trust that person to get you the highest quality you can get.”

Fourth Judicial District Attorney Dan May remains convinced medical marijuana businesses near schools are leading to increased use among young people.

He said that medical marijuana is the No. 1 drug that juveniles in his crime diversion program, which covers El Paso and Teller counties, report using.

In 2010, Colorado Springs was so broke that national media outlets such as ABC and CNN covered city leaders selling police helicopters online and urging residents to mow municipal parks, among other measures.

May believes city officials have failed to protect young people while scooping up more than $770,000 in revenues during 2011 from medical marijuana businesses.

“They built their establishments in residential areas, next to schools. They’re next to churches. They’re next door to each other,” he said. “Our city council failed this community.”

By Diane Carman

Listening to the candidates vying for the Republican presidential nomination might lead your average health care consumer to think the system is on the verge of collapse.

While the Affordable Care Act is not yet fully implemented and remains in large part unproven, some health care systems around the country are demonstrating the potential for significant improvements in cost control, access to care and better outcomes. They also are acting as testing grounds for such health care reform concepts as medical homes, virtual health care, electronic medical records, integrated behavioral health care and revenue pooling across care organizations.

“U.S. Health Care: The Good News,” a documentary produced with support from Rocky Mountain PBS and grants from several local foundations, tells the story of health care systems in Grand Junction, Seattle and Everett, Wash., that all have found ways to expand coverage, improve care and cut costs.

The film, produced by Colorado filmmaker Lisa Hartman and featuring Colorado journalist and author T.R. Reid,  will be broadcast on RMPBS at 9 p.m. Thursday. It also will air nationally on PBS.

Among the local health care professionals featured in the film is Steve ErkenBrack, who is president and CEO of Rocky Mountain Health Plans.

“Here’s the scoop,” said ErkenBrack in one segment of the film, “healthy people cost less than sick people.”

The emphasis in the Rocky Mountain Health Plans program, he said, is to use the medical home model, which is designed to provide comprehensive care to patients to manage chronic conditions and avoid acute problems that result in expensive emergency room visits or hospitalizations.

The organization also exploits electronic medical records to manage patients more efficiently and reduce unnecessary diagnostic procedures, and it pools revenues to pay providers salaries instead of compensating them by the number of procedures they perform.

The filmmakers credit the Grand Junction model with “saving lives … and saving money.”

Group Health in Seattle, a co-op model, and the Everett Clinic both also have made dramatic progress toward universal health care at lower cost, according to the film, which uses data assembled in the Dartmouth Atlas of Health Care.

Group Health and the Everett Clinic focus intensely on prevention and management of costly chronic conditions such as diabetes, heart disease and obesity, and have produced significant cost savings for their subscribers. Boeing, for example, reportedly cut health care costs for its employees by 20 percent by enrolling in the programs.

In his narration of the film, Reid said that care costs in Grand Junction were one-third those of health care organizations in Miami, Fla. Overall, he said, the United States could cut its health care spending by 30 percent if the country moved toward the practices in place in these organizations, which represent some of the lowest-spending regions of the country.

“Thirty percent of health care spending is devoted to unnecessary care,” he said.

During a panel discussion following a preview of the film last week, Patricia Gabow, CEO of Denver Health, pointed out that health care in the U.S. is “a $2.7 trillion industry. If it was a country, it would be the fifth-largest economy in the world.”

One reason for the lack of progress in cutting costs, she said, is that “if we get rid of waste, it’s money out of somebody’s pocket.”

Reid emphasized that “there is a fundamental conflict” in a system where shareholders expect to get the highest dividends possible on their investments while taxpayers and consumers want care provided at low cost.

Still, “all of these things are doable,” said Marguerite Salazar, director of Region VIII of the U.S. Department of Health and Human Services. “We’re watching what’s going on around the country. Grand Junction is on our radar as a pioneering health care organization.”

The health care organizations profiled in the film have identified a wide range of practices that can improve care and reduce costs in every community, and even without mandates for change, “the federal government can provide incentives and disincentives,” she said.

“The Good News” hardly breaks new ground in profiling the Grand Junction model as an example for controlling costs, increasing access and improving health outcomes, but the film illustrates the concepts and practices employed there in a clear and understandable way.

No advance degrees are required to see why these programs are effective, and Reid’s avuncular style contributes to the success of the filmmaker’s persuasive case for the need for dramatic systemic change in health care.

Diane Carman is editor of Solutions.