Study: Drug coverage to vary under health law


WASHINGTON (AP) — A new study says basic prescription drug coverage could vary dramatically from state to state under President Barack Obama's health care overhaul.


That's because states get to set benefits for private health plans that will be offered starting in 2014 through new insurance exchanges.


The study out Tuesday from the market analysis firm Avalere Health found that some states will require coverage of virtually all FDA-approved drugs, while others will only require coverage of about half of medications.


Consumers will still have access to essential medications, but some may not have as much choice.


Connecticut, Virginia and Arizona will be among the states with the most generous coverage, while California, Minnesota and North Carolina will be among states with the most limited.


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Online:


Avalere Health: http://tinyurl.com/d3b3hfv


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4 arrested in Las Vegas in Northridge slayings









Los Angeles police detectives Tuesday arrested four people at a Las Vegas casino in connection with a quadruple homicide at a Northridge house over the weekend.


The four people were taken into custody without incident at the Silverton Hotel and Casino, LAPD Chief Charlie Beck announced at a news conference.


Beck declined to answer specific questions about the case, including any possible motive for the slayings.





But law enforcement sources told The Times the killings appeared to stem from a dispute over personal property, although they would not say what kind of items were involved. The sources, who spoke on the condition of anonymity because the case was ongoing, said detectives were surprised that the dispute would have led to multiple deaths.


City Councilman Mitchell Englander said one of the suspects was believed to have lived at the Northridge home, which authorities said had been converted into an illegal boardinghouse. It's unclear whether any of the victims lived at the home.


LAPD officials identified the suspects as Ka Pasasouk, 31, of Los Angeles; Howard Alcantara, 30, of Glendale; Donna Rabulan, 30, of Los Angeles; and Christina Neal, 33, of Los Angeles.


Pasasouk was arrested on suspicion of murder, Beck said.


Court records show Pasasouk has an extensive criminal record and was on probation at the time of the killings. He has several convictions dating back to at least 2004. Pasasouk pleaded no contest to possession of methamphetamine in 2011. The year before that, he pleaded no contest to unlawful taking of a vehicle and was sentenced to state prison. In 2006, he pleaded guilty to second-degree robbery and assault likely to produce great bodily injury and sentenced to state prison. In 2004, he pleaded guilty and no contest in separate cases again involving unlawful taking of a vehicle.


The three others faced charges of aiding a felon; Alcantara faced an additional charge of robbery.


All four suspects remained in Clark County jail and were expected to be extradited to Los Angeles in the coming days, Beck said. The FBI assisted with the arrests, along with Las Vegas and Henderson, Nev., police.


Officers went to the home in the 17400 block of Devonshire Street about 4:25 a.m. Sunday after a 911 caller reported hearing yelling and shots fired, police said. Authorities found four people — two men and two women — shot dead outside.


Three of the victims — a man and two women — were shot on the walkway on the left side of the home, a source familiar with the case told The Times on Monday. They were wearing hooded sweat shirts and were about two feet apart. All three had at least one bullet wound to the head.


One victim was crumpled on her knees, the source said, her face buried in the palms of her hands, "almost like she was praying." The other two victims on the walkway were face down.


The fourth victim — a man — was farther away and appeared as if he was trying to run to the backyard when he was shot. He had at least one gunshot wound, according to the source.


"It looked like a quick kill," said the source, who spoke on the condition of anonymity because the case is ongoing.


The names of the victims have not been released. Police said the women were in their mid-20s; one man was in his mid-30s and the other man in his late 40s.


Authorities said that up to 17 people lived at the home, with conditions that Englander described as "deplorable." City inspectors red-tagged parts of the property Tuesday after finding "numerous code violations," said Department of Building and Safety spokesman David Lara.


The owner of the home, Yag Kapil, said he rented out rooms but denied he was running a boardinghouse. Kapil, 78, who lives at the home, said he was bedridden and was asleep at the time of the shootings. He said he didn't hear anything and didn't know the victims.


andrew.blankstein@latimes.com


kate.mather@latimes.com





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British Business Hesitant to Defend Staying in European Union


LONDON — The chairman of the London Stock Exchange, Chris Gibson-Smith, simply does not have the time to speak. Christopher North, the boss of Amazon in Britain, is too busy as well. And Charles Dunstone, the founder of the mobile phone retailer Carphone Warehouse, also has an exceptionally full agenda.


All three are among a dozen or so top business and financial leaders concerned enough about Britain’s future in the European Union to join the advisory council of a group campaigning to keep the country in the bloc.


But not many of them seem ready to explain why in public.


Bringing access to an economic area of about 500 million people, membership in the European Union is vital to many British businesses. Yet with the public divided over Britain’s ties to the bloc, most business leaders prefer a discreet silence to risking criticism.


Recently the stakes have increased, with Prime Minister David Cameron promising to loosen British ties to the bloc and possibly hold a referendum after negotiating a more arm’s-length relationship. After almost three years of crisis in the euro zone, there is more speculation than ever about a possible British withdrawal.


Britons have never been enthusiastic about the idea of European integration. So pro-Europeans are frustrated by the reluctance of business to stress the commercial benefits, particularly since, in private, company bosses can be outspoken about the risks of withdrawal.


“What they say to me when I meet them is this would be disastrous for British business,” said Glenis Willmott, leader of the British Labour Party’s members of the European Parliament.


Last month, Roger Carr, chairman of the main business lobbying organization, the Confederation of British Industry, appealed to his colleagues to break their silence or risk a possibility that now goes by the shorthand “Brixit”: British exit.


On Europe it was “essential that the voice of British business is loud and clear in extolling the virtues of future engagement,” he said.


A poll of business leaders by Ipsos MORI, commissioned in 2011 by Business for New Europe, a lobbying group campaigning for continued British membership, showed that 33 percent said they strongly agreed that a British exit from the European Union would damage business.


So why the silence when the stakes are so high?


“I ask myself, Why are these people not willing to be more outspoken?” said Phillip Souta, director of Business for New Europe. Its advisory council includes Mr. Gibson-Smith, Mr. North and Mr. Dunstone — all of whom declined to be interviewed.


“But I understand why they are not willing to be more outspoken is because it is so politically divisive,” he added. “Boards are divided on all of these issues. If you don’t have consensus they will agree not to talk.”


Some business leaders who supported earlier pro-European initiatives have been compromised by having advocated British membership in the now struggling euro.


Martin Sorrell, chief executive of the advertising group WPP and one of a handful of business figures happy to go on television to make a pro-European case, says many colleagues find the European Union too politically charged.


“Business leaders don’t want to speak out on these controversial issues,” he said. “They’ve got enough to do trying to run their own businesses and focusing on their own businesses and challenges.”


And even pro-European company bosses tend to have some reservations about the way the European Union is run, including the level of bureaucracy, the “more extreme” pieces of European legislation and the increases demanded by some in the bloc’s budget, he said.


Nevertheless, Mr. Sorrell says he believes that Europe’s internal market is “a major economic opportunity that we would live to regret passing up” and Britain has a better chance of resolving its problems with the union if it argues from within.


With the debate moving so swiftly in a euro-skeptic direction, pro-union campaigners are beginning to organize a counteroffensive.


If there is a referendum on Britain’s relations with the union, Mr. Sorrell says he believes that his business colleagues will stir.


Ms. Willmott thinks there’s no time like the present. “They say this to us privately, why not say it publicly?” she said. “It’s about time we heard these arguments.”


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PHOTO: See Molly Mesnick's Baby Belly

Jason and Molly Mesnick Pregnant: Baby Bump Photo
Noah Graham


Happy holidays! Celebrities gathered to celebrate the season Saturday, attending the Second Annual Santa’s Secret Workshop in West Hollywood, Calif. Presented by Bill Horn and Scout Masterson and held at the Andaz Hotel, the event benefitted L.A. Family Housing.


Among the revelers: Bachelor alums Jason and Molly Mesnick — whose first child together is due in March — attending their first event since announcing the happy news.


“I’m just about six months and feeling really good,” Molly tells PEOPLE.


“I’m at a perfect stage now so I’m trying to get as much done around the house as I possibly can while I have the energy.”

Also in attendance? Tori Spelling, Malin Akerman, Tiffani Thiessen, Ali LandryDavid Boreanaz, Marla Sokoloff, Kaitlin Olson and Rob McElhenney, Angela Bassett, Ian Ziering, Amanda Righetti, Marshall and Jamie Anne Allman, Kimberly Van Der Beek, Spencer Grammer and more.


Guests enjoyed manicures from Mom.me, cookie decorating with Jenny Cookies, photos with Santa from HP, create-a-card with Snapfish.com, and a craft bar from Jo-Ann Fabrics and Crafts.


Styled by Sybarite Designs, the event featured companies such as  SodaStream, Corolle, Stokke, Orbit Baby, Ergo Baby, Teddy Needs a Bath, Funktion, Numi Numi Design, Ju-Ju-Be, Innobaby and Joovy showcasing their latest products — be sure to enter this week’s giveaway for a chance to win them all!


Tori Spelling
Noah Graham


It was a family affair for Tori Spelling, who brought the whole gang for their first public event since 3-month-old Finn‘s birth in August.


Joining the actress, husband Dean McDermott and their newborn are Hattie, 13 months, Stella, 4, and Liam, 5½.


“I’m not going to lie. It’s a little crazy. It’s hard work,” Spelling tells PEOPLE.


“I think three was safe. Four tips you over the edge a little bit. Maybe it’s because they’re 10 months apart — but we’re so blessed. It keeps you on your toes.”


Malin Akerman
Noah Graham


With her first child on the way in April, Malin Akerman was all smiles at the event, posing with her growing belly.


“I’m feeling great,” the actress tells PEOPLE. “I’m closing in on five months now so it’s getting more and more exciting as time goes by.”


Tiffani Thiessen
Noah Graham


White Collar star Tiffani Thiessen gave 2-year-old daughter Harper Renn a leg up at the event.


On the Landry-Monteverde family’s list? Meeting Santa! PEOPLE.com blogger Ali Landry held 13-month-old son Marcelo Alejandro while husband Alejandro Monteverde snuggled in behind 5-year-old daughter Estela Ines.


Ali Landry
Noah Graham


Amanda Righetti
Tiffany Rose/WireImage


Ravishing redhead Amanda Righetti showed off her growing belly at the event — The Mentalist star is due this winter with her first child.


David Boreanaz
Noah Graham


No Bones about it – David Boreanaz‘s children look like him! The actor and wife Jaime Bergman brought kids Jaden, 10, and Bella, 3, to meet Santa.


Always Sunny in Philadelphia stars Kaitlin Olson and Rob McElhenney brought their elder son Axel, 2, to the event, but little Leo, 7 months, sat this one out.


Kaitlin Olson
Tiffany Rose/WireImage


Angela Bassett
Noah Graham


Meeting Santa was twice as nice for Angela Bassett and Courtney B. Vance, who brought along their 6-year-old twins Bronwyn Golden and Slater Josiah (peace out, dude).


Kimberly Van Der Beek
Tiffany Rose/WireImage


Who cares about photos — it’s time for a snack! PEOPLE.com blogger Kimberly Van Der Beek gives 2-year-old daughter Olivia (plus her doll!) a lift.


Picture perfect! Ian Ziering gets daughter Mia, 19 months, in the frame while enjoying the craft table. The actor and wife Erin expect their second child in May.


Ian Ziering
Meagan Reidinger


Marla Sokoloff
Meagan Reidinger


With a baby doll in tow, PEOPLE.com blogger Marla Sokoloff and her little lady, 9-month-old Elliotte, check out the event.


Spencer Grammer arrived with her main men — husband James Hesketh and their son, 13-month-old Emmett.


Spencer Grammer
Tiffany Rose/WireImage


Marshall and Jamie Ann Allman
Tiffany Rose/WireImage


The event was a baby bump debut for Marshall and Jamie Anne Allman as well — the True Blood and Killing stars just announced that they’re expanding their family — by two. Twins are on the way this spring!


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Fossil fuel subsidies in focus at climate talks

DOHA, Qatar (AP) — Hassan al-Kubaisi considers it a gift from above that drivers in oil- and gas-rich Qatar only have to pay $1 per gallon at the pump.

"Thank God that our country is an oil producer and the price of gasoline is one of the lowest," al-Kubaisi said, filling up his Toyota Land Cruiser at a gas station in Doha. "God has given us a blessing."

To those looking for a global response to climate change, it's more like a curse.

Qatar — the host of U.N. climate talks that entered their final week Monday — is among dozens of countries that keep gas prices artificially low through subsidies that exceeded $500 billion globally last year. Renewable energy worldwide received six times less support — an imbalance that is just starting to earn attention in the divisive negotiations on curbing the carbon emissions blamed for heating the planet.

"We need to stop funding the problem, and start funding the solution," said Steve Kretzmann, of Oil Change International, an advocacy group for clean energy.

His group presented research Monday showing that in addition to the fuel subsidies in developing countries, rich nations in 2011 gave more than $58 billion in tax breaks and other production subsidies to the fossil fuel industry. The U.S. figure was $13 billion.

The Paris-based Organization for Economic Cooperation and Development has calculated that removing fossil fuel subsidies could reduce carbon emissions by more than 10 percent by 2050.

Yet the argument is just recently gaining traction in climate negotiations, which in two decades have failed to halt the rising temperatures that are melting Arctic ice, raising sea levels and shifting weather patterns with impacts on droughts and floods.

In Doha, the talks have been slowed by wrangling over financial aid to help poor countries cope with global warming and how to divide carbon emissions rights until 2020 when a new planned climate treaty is supposed to enter force. Calls are now intensifying to include fossil fuel subsidies as a key part of the discussion.

"I think it is manifestly clear ... that this is a massive missing piece of the climate change jigsaw puzzle," said Tim Groser, New Zealand's minister for climate change.

He is spearheading an initiative backed by Scandinavian countries and some developing countries to put fuel subsidies on the agenda in various forums, citing the U.N. talks as a "natural home" for the debate.

The G-20 called for their elimination in 2009, and the issue also came up at the U.N. earth summit in Rio de Janeiro earlier this year. Frustrated that not much has happened since, European Union climate commissioner Connie Hedegaard said Monday she planned to raise the issue with environment ministers on the sidelines of the talks in Doha.

Many developing countries are positive toward phasing out fossil fuel subsidies, not just to protect the climate but to balance budgets. Subsidies introduced as a form of welfare benefit decades ago have become an increasing burden to many countries as oil prices soar.

"We are reviewing the subsidy periodically in the context of the total economy for Qatar," the tiny Persian gulf country's energy minister, Mohammed bin Saleh al-Sada, told reporters Monday.

Qatar's National Development Strategy 2011-2016 states it more bluntly, saying fuel subsides are "at odds with the aspirations" and sustainability objectives of the wealthy emirate.

The problem is that getting rid of them comes with a heavy political price.

When Jordan raised fuel prices last month, angry crowds poured into the streets, torching police cars, government offices and private banks in the most sustained protests to hit the country since the start of the Arab unrest. One person was killed and 75 others were injured in the violence.

Nigeria, Indonesia, India and Sudan have also seen violent protests this year as governments tried to bring fuel prices closer to market rates.

Iran has used a phased approach to lift fuel subsidies over the past several years, but its pump prices remain among the cheapest in the world.

"People perceive it as something that the government is taking away from them," said Kretzmann. "The trick is we need to do it in a way that doesn't harm the poor."

The International Energy Agency found in 2010 that fuel subsidies are not an effective measure against poverty because only 8 percent of such subsidies reached the bottom 20 percent of income earners.

The IEA, which only looked at consumption subsidies, this year said they "remain most prevalent in the Middle East and North Africa, where momentum toward their reform appears to have been lost."

In the U.S., environmental groups say fossil fuel subsidies include tax breaks, the foreign tax credit and the credit for production of nonconventional fuels.

Industry groups, like the Independent Petroleum Association of America, are against removing such support, saying that would harm smaller companies, rather than the big oil giants.

In Doha, Mohammed Adow, a climate activist with Christian Aid, called all fuel subsidies "reckless and dangerous," but described removing subsidies on the production side as "low-hanging fruit" for governments if they are serious about dealing with climate change.

"It's going to oil and coal companies that don't need it in the first place," he said.

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Associated Press writers Abdullah Rebhy in Doha, Qatar, and Brian Murphy in Dubai, United Arab Emirates, contributed to this report

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Karl Ritter can be reached at www.twitter.com/karl_ritter

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Chino Hills seeks to close home used by pregnant Chinese women









A Chino Hills residence allegedly housing women from China who want to give birth to U.S.-citizen children is on the verge of being shut down by the city after complaints about traffic and a sewage spill.

The home is on a hilltop at the end of a long driveway on Woodglen Drive, an area zoned for single family houses. City officials have issued a cease and desist order, alleging that the site is being used as a hotel in a rural residential zone. They plan to take the property owner to court.

"Who the customer base is, is not our concern," said city spokeswoman Denise Cattern. "Our concern is that it's a hotel."








A website that city officials believe is associated with the business describes a full range of services, from shopping trips for pregnant women to assistance obtaining American passports for newborns.

A 30-day stay at the Chino Hills facility, along with a month of prenatal care, costs $10,500 to $11,500, according to the Chinese-language website, http://www.asiamchild.com.

Asiam Child is based in Shanghai, with branches in Anhui province and Nanjing, the website says.

The property owner, Hai Yong Wu, did not return a call seeking comment. A man who left the hotel in a black BMW on Monday afternoon would not speak to reporters.

So-called birth tourism appears to be an active but largely under-the-radar industry in Southern California. One local Chinese phone book has five pages of listings for birthing centers, where women from China and Taiwan stay for a month or so before going home with their U.S.-citizen babies. When the children get older, they may return here to study, perhaps paving the way for the rest of the family to immigrate more easily.

In San Gabriel last year, code enforcement officials shut down a facility where about 10 mothers and seven newborns were staying.

Federal immigration officials say there is no law prohibiting pregnant women from entering the U.S. But obtaining a visa through fraud would be a crime, said Virginia Kice, a spokeswoman for U.S. Immigration and Customs Enforcement.

Chino Hills officials have notified federal authorities about the residence. Kice said she could not confirm whether ICE is investigating.

Neighbors report seeing groups of pregnant women walking along the quiet cul de sac. Cars from the residence sometimes drive down the street at unsafe speeds, they said.

In addition to the single-family zoning violation, the city has cited the owner for allegedly constructing additional rooms without a permit. A sewage spill estimated at 2,000 gallons also prompted a cease and desist order.

"It would be nice to have my neighborhood back. It was a quiet little street," said neighbor Sonya Valez.

On Saturday, a group called Not in Chino Hills staged a street-corner protest against the site.

"They go back," said Rossana Mitchell, a co-founder of the group. "They don't pay taxes, they don't assimilate."

cindy.chang@latimes.com





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Attackers at U.S.-Afghan Base Wore Coalition Uniforms





KABUL, Afghanistan — Taliban forces attacked a large coalition airfield in eastern Afghanistan early Sunday, detonating three car bombs near the entrance and engaging in a two-hour gun battle that killed nine insurgents, four Afghan guards and at least four civilians whose vehicle was caught in the cross-fire, Afghan officials and witnesses said.







Noorullah Shirzada/Agence France-Presse — Getty Images

Afghan forces blocked the road to Forward Operating Base Fenty after an assault. Nine insurgents were killed, officials said.






Disguised in coalition military uniforms, the Taliban fighters attempted to enter the airfield, known as Forward Operating Base Fenty, after the initial explosions, which occurred just before 6 a.m., but were repelled by firepower that included helicopter gunships, officials said. Fewer than 10 coalition service members were wounded, according to official reports, though by late Sunday it remained unclear exactly how many had been hurt, and how severely. At least one of the guards killed in the fighting was a member of the Afghan military.


The Taliban quickly claimed responsibility for the operation, saying they had killed “tens” of foreign forces, though the insurgents routinely overstate the deadliness of their attacks.


But the coordinated assault, which left the entry to the base strewn with the remains of the bombers, was a potent reminder of the Taliban’s determination to continue the fight. As the coalition forces wind down the 11-year war, and with Western combat troops already withdrawing, the attacks serve as a reminder that the Taliban are not going anywhere, and that their firepower remains undiminished. How successful the nation’s defenses will be after the 2014 withdrawal of coalition forces is a question asked by many Afghans.


Forward Operating Base Fenty is primarily run by Americans and is one of the larger airfields in eastern Afghanistan. Like other large coalition bases, Fenty has been attacked before, including in February, when a suicide blast killed nine Afghans. The assaults have, in most cases, been repulsed before the insurgents could fight their way inside bases, and coalition casualties have been minimal, as appears to have been the case on Sunday.


But the Afghans who work or live near the base have not been so fortunate. Afghan officials said that two of the civilians killed were doctors, their car riddled by gunfire about 50 yards from the base. The doctors had been on their way to work in Jalalabad, the capital of Nangarhar Province, said Hajji Niamatullah Khan, the district governor of Behsood. In addition, at least three private security guards on duty at the outer perimeter were killed, he said.


Coalition forces had few details about the extent of the damage from the Taliban assault.


Zabiullah Mujahid, a Taliban spokesman, said medical evacuation helicopters could be seen ferrying dead and wounded American soldiers from the scene, “which shows that heavy casualties were inflicted” by the attackers.


He also claimed that a Toyota sport utility vehicle packed with explosives had leveled one of the guard towers. He said that some of the attackers were wearing “foreign” military uniforms, a tactic that the Taliban have employed in previous assaults on coalition bases. An official from the American-led coalition confirmed that at least some of the attackers wore coalition uniforms.


The last major assault against a coalition base was in September, when the Taliban blew up eight Harrier attack jets and killed two Marines at Camp Bastion in Helmand Province. The militants, wearing United States Army uniforms, caused more than $200 million in damage in that attack.


Sharifullah Sahak contributed reporting.



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Kellan Lutz, Hugh Jackman Take Bites and Swipes & More Casting News















12/02/2012 at 07:00 PM EST







Kellan Lutz (left) and Hugh Jackman


Christopher Polk/Getty, Han Myung-Gu/WireImage


It's comeback time. Whether seeking revenge or reprising beloved roles, a fresh crop of movies shows that the best characters always come back for more.

Twilight's Kellan Lutz feasts on others as a vampire, but this time, he's utilizing his own body for powers, Zimbio reports.

The actor will star in Tatua as a tattooed assassin whose weapons are extracted from the ink on his body. The process is a strain on the hit man, but he must put that aside when his son is kidnapped by a dangerous foe.

Hugh Jackman is set to reprise his role as Wolverine in
X-Men: Days of Future Past, the Hollywood Reporter. Ian McKellen (Magneto) and Patrick Stewart (Professor Xavier), will also be joining Jennifer Lawrence, James McAvoy, Michael Fassbender and Nicholas Hoult.

Charlize Theron will star in an adaptation of the final installment of a South Korean revenge trilogy, the Hollywood Reporter also says. The original movie revolves around a woman wrongfully imprisoned for 13 years who then sets out to seek her long-awaited revenge. Writer William Monahan says the English-language remake will be "very American – and very unexpected."

The made-for-TV Disney channel movie Life-Size is getting a sequel, Variety reports. Tyra Banks will reprise her role as Eve, the doll who comes to life, and also executive produce the movie. No word yet on whether Lindsay Lohan, who played Eve's owner, will be making a return.

Also coming soon:

Beyoncé won't be slowing down after her Super Bowl performance in February. Just a couple weeks later, she'll introduce her still untitled, feature-length documentary on HBO, Deadline reports. The documentary airs Feb. 16.

Bridesmaids' Rose Byrne will be going through the motions as a newlywed in I Give it a Year, Zimbio reports. As if being newly married wasn't tough enough, the "too perfect" ex Anna Faris will be shaking up an already teetering balance.

Cate Blanchett will be stirring up her wicked ways as the evil stepmother in a live-action adaptation of Disney's Cinderella, also according to Zimbio.

And George Clooney is sticking to his winning formula by joining forces with his Argo team to produce an untitled crime drama, Variety reports.

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Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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Healthcare law will have new California Legislature scrambling









SACRAMENTO — When state lawmakers are sworn in Monday for the new legislative session, they will have little time to enjoy the pomp and circumstance.


Facing a federal deadline, the Legislature must move quickly to pass measures to implement President Obama's healthcare law and revamp the state's insurance market. New legislation will help extend coverage to millions of uninsured Californians and solidify the state's reputation as a key laboratory for the federal law.


Legislative leaders have said they also want to overhaul environmental regulations, curb soaring tuition at public colleges, and tweak the state's tax structure and ballot-initiative system.





But healthcare remains one of the largest and most immediate challenges.


The federal Affordable Care Act takes effect in January 2014, when most Americans face the requirement to buy health insurance or pay a penalty. State lawmakers must pass a series of rules to clear the way for enrollment in a new state-run insurance market next fall, including a requirement for insurers to cover consumers who have preexisting medical conditions and limits on how much they can charge based on age.


Gov. Jerry Brown is expected to call a special session of the Legislature next month — concurrent with the regular session — so healthcare bills that he signs can take effect within 90 days rather than the next year.


"It's a very, very big undertaking to make the promise of the Affordable Care Act a reality," said state Health and Human Services Secretary Diana Dooley. "We are working as hard and as fast as we can in a very complex area with a lot of conflicting information."


As an early adopter of the Affordable Care Act, California has already laid much of the groundwork.


It was the first state to establish an insurance exchange after Congress passed the legislation in 2010. More than 30 other states have since sought federal help in enacting their own. Millions of Californians will be able to purchase coverage, with federal subsidies earmarked for families earning about $92,000 or less annually.


One of the most significant proposals will be an expansion of Medi-Cal, the state's health insurance program for the poor. About 2 million low-income Californians would be newly eligible under the expansion, with the federal government subsidizing costs for the first three years. The state would then shoulder a portion of the bill.


According to a Kaiser Family Foundation study, the expansion could cost the state $6.3 billion over a decade, meaning a 1.7% increase in the amount California spends on Medi-Cal.


California got a head start on the effort by signing up more than 550,000 low-income people in a temporary program. They are expected to automatically move into Medi-Cal in 2014.


Lawmakers will also consider legislation that would create a health plan for people who cannot afford insurance on the open market but make too much money to qualify for Medi-Cal. The option, known as the Basic Health Plan, would provide coverage for individuals with incomes between 133% and 200% of the federal poverty level, or between $15,000 and $21,800 a year.


State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and author of the proposal, said the plan was needed to help California's working poor. "I don't think they should be choosing between putting food on the table and buying health insurance," he said.


Insurers urged lawmakers to resist requirements that could make policies offered through the exchange unaffordable.


"We think the Affordable Care Act does much to get millions of people coverage, but new insurance taxes, costly benefit requirements and age pricing restrictions all have the potential of driving up costs," said Nicole Evans, a spokeswoman for the California Assn. of Health Plans.


Healthcare advocates said it was critical for the Legislature to promote policies that would ensure a mix of healthy and sick policyholders to keep premiums affordable.


"It should be a goal of the state to have millions of people enrolled on Day 1," said Anthony Wright, executive director of the consumer group Health Access California, "to bring in those federal dollars and make healthcare cheaper for everybody."


michael.mishak@latimes.com





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