DAVID ESPO, Associated Press
NEDRA PICKLER, Associated Press

WASHINGTON (AP) — President Barack Obama is asking Congress to formally authorize war against Islamic State militants and says the group could threaten the U.S. homeland if left unchecked.

Full text of President Barack Obama’s letter to lawmakers accompanying draft war powers resolution:

To the Congress of the United States:

The so-called Islamic State of Iraq and the Levant (ISIL) poses a threat to the people and stability of Iraq, Syria, and the broader Middle East, and to U.S. national security. It threatens American personnel and facilities located in the region and is responsible for the deaths of U.S. citizens James Foley, Steven Sotloff, Abdul-Rahman Peter Kassig, and Kayla Mueller. If left unchecked, ISIL will pose a threat beyond the Middle East, including to the United States homeland.

I have directed a comprehensive and sustained strategy to degrade and defeat ISIL. As part of this strategy, U.S. military forces are conducting a systematic campaign of airstrikes against ISIL in Iraq and Syria. Although existing statutes provide me with the authority I need to take these actions, I have repeatedly expressed my commitment to working with the Congress to pass a bipartisan authorization for the use of military force (AUMF) against ISIL. Consistent with this commitment, I am submitting a draft AUMF that would authorize the continued use of military force to degrade and defeat ISIL.

My Administration’s draft AUMF would not authorize long-term, large-scale ground combat operations like those our Nation conducted in Iraq and Afghanistan. Local forces, rather than U.S. military forces, should be deployed to conduct such operations. The authorization I propose would provide the flexibility to conduct ground combat operations in other, more limited circumstances, such as rescue operations involving U.S. or coalition personnel or the use of special operations forces to take military action against ISIL leadership. It would also authorize the use of U.S. forces in situations where ground combat operations are not expected or intended, such as intelligence collection and sharing, missions to enable kinetic strikes, or the provision of operational planning and other forms of advice and assistance to partner forces.

Although my proposed AUMF does not address the 2001 AUMF, I remain committed to working with the Congress and the American people to refine, and ultimately repeal, the 2001 AUMF. Enacting an AUMF that is specific to the threat posed by ISIL could serve as a model for how we can work together to tailor the authorities granted by the 2001 AUMF.

I can think of no better way for the Congress to join me in supporting our Nation’s security than by enacting this legislation, which would show the world we are united in our resolve to counter the threat posed by ISIL.

By Dave Ranney

In Kansas, the state’s Medicaid program tells doctors which medications they can prescribe for heart disease, diabetes, asthma or cancer. It’s been that way for as long as most policymakers can remember.

Mental health drugs are different. Since 2002, state law has allowed Medicaid patients access to whatever behavioral health drugs their physician or psychiatrist sees fit to prescribe.

Gov. Sam Brownback’s administration wants to change that.

During a recent appearance before the House Social Services Budget Committee, Kansas Department of Health and Environment Acting Secretary Susan Mosier said mental health drugs ought to be subject to the same or similar scrutiny as drugs used to treat physical health issues.

“With the (state) statute that’s currently in place, we have no ability to manage behavioral health drugs like we do any other drug class,” Mosier said.

Regulating mental health drugs, she said, will lead to better health care outcomes and allow the state to rein in some of its ever-increasing Medicaid costs.

Controlling costs
According to KDHE records, the state’s Medicaid program spent $92.1 million on mental health drugs in 2013.

The state’s mental health advocates say that while restricting access to the behavioral health drugs may result in some short-term savings, it also could wreak havoc with the lives of many patients and their families.

The long-term costs associated with this havoc — emergency room visits, admissions to one of the state-run psychiatric hospitals, prison sentences — will outweigh any short-term savings, they say.

“What this all boils down to is money,” said David Wiebe, president of the Kansas Mental Health Coalition advocacy group and recently retired executive director of the Johnson County Mental Health Center.

“Our concern is, and always has been, that the best choice of drug therapy decisions are made between the prescriber and the consumer; not by someone who’s looking at a piece of paper somewhere saying, ‘No, you have to try this (drug) first because it’s cheaper,’” Wiebe said.

On Wednesday, the Senate Public Health and Welfare Committee is scheduled to have an hourlong hearing on Senate Bill 123, an administration-backed measure to repeal the protections now in state statute.

At least 20 opponents — a mix of advocates, lobbyists, consumers and family members — have signed up to testify. Mosier is expected to outline KDHE’s concerns as well.

SB 123 consists of two sentences. The first says it would repeal current law; the second says the repeal would “take effect and be in force” upon its publication in the state statute book, meaning July 1.

The bill does not indicate how behavioral health drugs would be regulated if the current law were to be repealed. That would depend on new rules and regulations to be developed by the state’s Medicaid agencies.

“We’ve picked up clues from testimony in various committees, and (Department for Aging and Disability Services Secretary) Kari Bruffett came to one of our meetings and spoke in rather general terms about their concerns,” said Amy Campbell, director of the Kansas Mental Health Coalition. “But at this point, it’s absolutely unclear what the (administration’s) initiatives are.”

Mosier has said KDHE supports exposing behavioral health drug prescriptions to prior authorization, preferred drug lists, step therapies that require patients to fail on one drug before being prescribed another and “hard and soft safety edits.”

“Soft edits” would allow the three managed care organizations now charged with administering the state’s Medicaid program to call questionable prescriptions to the attention of their patients’ pharmacists, who would review the prescription and uphold or overrule the company’s concern.

A “hard edit” would require physicians to first check with the managed care organizations before filling certain psychotropic medications.

According to KDHE projections, tighter regulation of behavioral health drugs would save the state $8.3 million.

Mosier and Bruffett have assured legislators that if SB 123 were to pass, patients with chronic and persistent mental illnesses would be exempt from any prior authorization requirements. And the managed care companies, they said, would not change any current patient’s drug regimen if it’s considered successful.

To buttress their case, administration officials have cited concerns raised in a 2009 report by the now defunct Kansas Health Policy Authority. Among its findings:

More than 200 children enrolled in the state’s Medicaid program had been prescribed and were thought to be taking five or more psychotropic medications.
Many psychotropic drugs prescribed for children were “off-label” prescriptions that in subsequent studies had been linked to side effects that included inordinate weight gain, obesity, diabetes and increased risk of suicide.
More than half of the children in the state’s foster care system were known to be taking mental health medications, either antipsychotics or antidepressants.
Almost two-thirds of the mental health drugs in Kansas were prescribed by general practice physicians and other medical professionals rather than psychiatrists.

In recent months, similar concerns have been raised about mental health drugs being inappropriately prescribed to control the behavior of some Kansas nursing home residents.

The health policy authority was a semi-autonomous state agency created by former Gov. Kathleen Sebelius to develop state health care policies. Gov. Sam Brownback and the Legislature shut it down in 2011. It was replaced by the Division of Health Care Finance within KDHE.

National debate
The state’s community mental health centers oppose SB 123.

“The thing that we’re trying to get people to understand is that when someone has a psychotic episode, it doesn’t affect just them. It affects everyone around them,” said Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas. “It affects their families, their community, their hospital, their community mental health center and local law enforcement, probably. And there are costs associated with every one of those encounters.

“So you stand back and say, ‘We can save $1,000 by putting this person on this medication instead of that medication,’” he said. “But that doesn’t take into consideration how changing that person’s medication may have caused them to stop taking it because they’d been on it before and they hated it, and then they’re hospitalized, which ends up costing the system $10,000.”

Kessler said his members doubt that passing SB 123 will generate the $8.3 million savings the administration has predicted.

“The last time we had this discussion with the Legislature was in 2010, and the health policy authority was saying this would save the state $800,000. So, somehow, that figure increased tenfold in less than five years,” Kessler said.

Most state Medicaid programs regulate access to mental health drugs, Kessler said. Kansas is one of about a dozen states that does not.

North Carolina’s Medicaid program regulates its patients’ access to behavioral health drugs. “We went to what’s called a ‘fail first policy’ last year,” said David Swann, a former director at Crossroads Behavioral Healthcare, a regional mental health center in North Carolina. He later ran the region’s managed care company.

“It means we want you to try a cheaper drug first to see if it works,” he said. “If it doesn’t, you can move on to whatever’s the next most expensive.” The change in policy, he said, reduced expenditures for behavior health drugs but increased costs overall.

“When you’re having this discussion in Kansas, you need to ask yourselves what it is you hope to accomplish,” Swann said. “Because if the goal is to reduce your Medicaid pharmacy budget, this will do that. “But if your goal is to save Medicaid money overall, this isn’t likely to do that, because some of the people we’re talking about here are not going to do well on the more conventional medications.

They’re going to relapse, and they’re going to have acute episodes. Some of them are likely going to end up being hospitalized, and that’s going to cost you more than what you’re going to save on prescriptions.” Andrew Sperling, director of legislative advocacy with the National Alliance on Mental Illness office in Washington, D.C., has been following the deliberations in Kansas and other states that have considered or are considering the repeal of laws that prohibit restrictions on mental health drugs. Kansas, he said, should resist repealing its protections. “

You want to have a process in place that allows a physician to work with individual patients, to work with the different comorbidities that they’re experiencing and with their individual histories of which medication works best for them,” Sperling said. “Restricting access to that full range of therapies is not helpful and will actually cost you more in the long run, because we know that when people don’t get access to the treatment they need or they’re not adhering to treatments, you get bad outcomes that are more expensive,” he said. Matt Salo, executive director of the National Association of Medicaid Directors, also is monitoring the Kansas debate from Washington, D.C.

He said tighter regulation of mental health drugs is about more than saving money. “The current state of affairs in Kansas is that there are no rules, no real ability to manage access or costs,” he said. “That’s really a recipe for unnecessary care and unnecessary utilization. It isn’t good from the perspective of patient health or the program’s bottom line.” Salo said his association is especially troubled by the reports of young children being prescribed antipsychotics and some children in foster care taking five or more psychotropic medications.

“That’s a real problem,” he said. “I think it’s safe to say there needs to be some common-sense parameters in place that would kind of force a conversation that would start with, ‘Oh, hey, are you sure you really want to be prescribing this drug to this patient?’”

Salo said he hoped Kansas legislators, policymakers and mental health advocates are able to find some middle ground. “You need to find that sweet spot,” he said. “You want the relationship between the physician and patient to be strong, but at the same time you need to recognize that there is a role in this for thoughtful and science-informed guidance.

“You can have policies that say that for X drug where the science is unquestionably good for these patients, let’s get him access without any hurdles,” Salo said. “But for X,Y and Z drugs where there are 14 different drugs in a category and they’re all pretty much scientifically proved to be equivalent, then it’s probably OK to be thinking about what kind of parameters you want to put in there.”

The problem for advocates is that the “sweet spot” that Salo said should be the goal of Kansas policymakers lies in the regulations. And those regulations won’t be written until after the protections now in place have been repealed.

 

Dave Ranney is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.

LEAVENWORTH, Kan. (AP) — A court document says a 5-year-old girl who died during a police chase was shot by the man she was with, not by police officers.

Cadence Harris was found dead inside a car driven by Marcas McGowan after he exchanged gunfire with Leavenworth police last July. Prosecutors allege McGowan took the girl from her mother’s home in Atchison and led police on a chase that ended in Leavenworth County.

Investigators had not previously said whether McGowan or police shot the girl. Details were released Tuesday after a judge ordered the release of an affidavit supporting felony first-degree murder and other charges against McGowan. He has pleaded not guilty.

Investigators concluded that a “defect” inside the car was consistent with a bullet hitting the girl from inside the vehicle.

Great Bend Post

GREAT BEND -The fate of Jeffrey Wade Chapman is now in the jury’s hands after closing arguments were heard Tuesday at the Barton County Courthouse. After hearing those final arguments and getting instructions from District Judge Ron Svaty, the jury deliberated just over an hour but did not reach a verdict in the first-degree murder case.

Chapman is accused of killing 25-year old Damon Galyardt in November of 2011. Hunters in a field West of Great Bend found Galyardt’s body.

Chapman testified on his own behalf yesterday and said he did not seek out Galyardt with the intent to kill him. Instead, Chapman says he only wanted to talk to Galyardt, but the Great Bend man came at him with a knife forcing him to shoot.

The jury will resume deliberations this morning. In his instructions to jurors Tuesday, Judge Svaty informed the panel that they could opt for the charge of premeditated first degree murder or lesser charges, such as second degree murder, involuntary manslaughter or voluntary manslaughter as well as not guilty.

WICHITA, Kan. (AP) — A Kansas state senator wants to offer more money under a proposed foster care program to married couples who don’t have alcohol and tobacco in their homes and regularly attend church.

The Wichita Eagle reports Republican Sen. Forrest Knox says he’s looking to provide more stability for children. His bill would set up the CARE family program, in which those eligible would be paid more than other foster care homes.

Qualification requirements include a husband and a wife being married for at least seven years. One of them also can’t work outside the home.

Under the planned program, families could receive state money to help homeschool their foster kids or send them to a private school.

A Senate panel is expected to discuss the bill Thursday.

KANSAS CITY, Mo. (AP) — Kansas City’s largest private company is moving from Missouri to Kansas after its new, $30 million headquarters in the Village West area of Wyandotte County is completed.

Dairy Farmers of America is owned by 15,000 dairy farmers nationwide and had $18 billion in revenues last year. Farmers promote milk and export dairy products and powders to nearly 50 countries through the DFA.

The Kansas City Star  reports the company was formed in 1998 and has leased 72,000 square feet near Kansas City International Airport since then. The new building will be 100,000 square feet with an open floor plan to house the cooperative’s 325 employees.

DFA spokeswoman Monica Massey says the decision was made after looking at all options based on its commitment to remain in the metropolitan area.

TOPEKA, Kan. (AP) — Lawmakers worried that it’s too easy for Kansas couples to divorce have scheduled two days of hearings on marriage.

The House Federal and State Affairs Committee kicks off the informational hearings Wednesday. Rep. Jan Pauls, a Hutchinson Republican who serves on the committee, has said the state will consider mandated counseling or longer waiting periods for people seeking divorce, provided domestic violence was not an issue.

Either person in a marriage can petition for divorce in Kansas and only has to prove the two are “incompatible.”

Kansas does not have a mandatory waiting period for divorce petitioners, nor does it require couples to go through counseling before a divorce. Judges have the discretion to order counseling and do so in some cases when children are involved.