The Wall Street Journal - 11.09.2019

THE WALL STREET JOURNAL. ***** Wednesday, September 11, 2019 |A

sent to a clinician for in-depth

assessment, said Dr. Marti Jett,

the chief scientist in systems

biology for the U.S. Army Medi-

cal Research and Development

Command.

“The Army’s concern is that

soldiers tend not to report, and

they don’t want to have PTSD,”

Dr. Jett said. “If we can begin

to correct those things early

enough, it helps to avert the

self isolation that is a major

concern early on.”

The test, which will ulti-

mately require Food and Drug

Administration approval, could

be used for police and other

first responders as well as ci-

vilians who have experienced

trauma, Dr. Jett said.

The test isn’t foolproof, and

can’t definitively diagnose

PTSD or eliminate the need for

extensive clinical examination.

Researchers said their goal is

flagging potential problems

rather than definitive diagnosis.

Researchers say 77% of the

time, a positive blood test cor-

responds with what troops or

clinicians report. The small

sample size for this study—

fewer than 200 male combat

veterans—means the test needs

much more development before

it can be implemented or ap-

proved by the FDA.

“We didn’t design this line

of research to replace clinicians

or to replace an in-depth clini-

cal assessment,” said Dr.

Charles Marmar, chair of the

school of Psychiatry at NYU

School of Medicine and senior

author of the study. “We devel-

oped it for a high-throughput

screening.”

Approximately 11% to 20% of

veterans from Iraq and Afghan-

istan have PTSD in a given

year, according to the Depart-

ment of Veterans Affairs. Not

all of those cases are from

combat; a large number result

from military sexual trauma

and other experiences.

Researchers whittled down a

million potential biomarkers

and found just over two dozen,

said Frank Doyle, dean of the

Harvard School of Engineering

and Applied Sciences, a corre-

sponding author of the study.

This test might not work for

everyone with PTSD, Dr. Doyle

said. PTSD could end up being

similar to diabetes, he said,

where doctors have to identify

different types that affect dif-

ferent people at different times

in their lives.

The test could help break

down the stigma behind men-

tal-health issues in the military,

Dr. Jett said, because it has the

potential to show troops how

widespread problems are

among their ranks. And once

those problems are found and

addressed, recovery is possible.

Researchers said these types

of tests could lead to predic-

tively assessing if a soldier was

at risk for developing PTSD,

though the priority for now is

getting treatment for those

who need it. Researchers are

now gathering data on a cohort

of paratroopers to be able to

compare their blood chemistry

before and after potentially

traumatic experiences.

A team of researchers from
top medical schools is moving
closer to developing a blood
test that promises to quickly
and accurately help diagnose
combat troops with post-trau-
matic stress disorder, even
those who try to hide the ef-
fects, the team said in a journal
article released Monday.
The Pentagon-funded effort
has pinpointed a handful of
telltale indicators at the molec-
ular level that the body pro-
duces when soldiers have been
exposed to battlefield trauma
and are likely to have problems
coping with lingering stress,
according to the study, pub-
lished in the peer-reviewed
journal Molecular Psychiatry.
An accurate blood test
would mean all troops who re-
turn from combat would get an
objective screening. If tests
came back positive for poten-
tial disorder, they would be

BYBENKESLING

has often spelled the end of fi-

nancial institutions.

Many of the targets also

operate in Turkey, highlighting

a major concern among U.S.

officials. The Turkish Embassy

in Washington didn’t respond

to a request to comment.

IRGC and other groups.

Under the new powers, any

foreign financial institution

that is found to have conducted

terror-linked transactions risks

losing access to the dollar and

the world’s most important fi-

nancial system, a sanction that

rency for another as part of an

alleged attempt to hide the in-

tended source and intended

terror-financing recipients.

Those exchange houses, U.S.

officials and terror experts

say, are key conduits for fi-

nancing Hezbollah, Hamas, the

States and our allies, and will

hold foreign financial institu-

tions who continue to do busi-

ness with them accountable,”

Mr. Mnuchin said.

Many of the targets of

Tuesday’s sanctions are com-

panies that exchange one cur-

terterrorism executive order

helps the administration tar-

get the financial networks

used by terror groups.

“These new authorities will

allow the U.S. government to

starve terrorists of resources

they need to attack the United

tically significant, but it cut

against the employment trend

in a strong economy.

“It’s a very troubling begin-

ning to an erosion of coverage,”

said John Gorman, a former

health-care consultant who is

now an investor. “We’ve got a

growing economy and you’d ex-

pect the number of the unin-

sured would go down.”

The report did point to an

important bright spot: the con-

tinued growth of Medicare, as

baby boomers increasingly age

into the program. As with Med-

icaid, private companies play a

growing role in the federal pro-

gram, with about one-third of

beneficiaries enrolled in insur-

ers’ Medicare Advantage plans.

Democratic presidential can-

didates have made expanding

coverage beyond the ACA a

campaign plank. That comes as

some Republican-led states

have moved to tighten Medic-

aid eligibility requirements and

as the Trump administration

has worked to undercut the

law, including by supporting a

multistate lawsuit aimed at

striking down the entire law.

“The relentless effort by Re-

publicans to sabotage our

health-care system has resulted

in millions of fewer Americans

with health insurance and sky-

rocketing costs for American

families,” said Senate Minority

Leader Chuck Schumer (D.,

N.Y.).

The rise in uninsured comes

despite strong wage growth

and thousands of new jobs.

Earlier data had indicated an

uptick in the number of unin-

sured, so the findings didn’t

surprise some policy analysts.

They said a host of factors are

at play, including the new Med-

U.S. NEWS

them out of Medicaid but not

enough for job-based cover-

age,” said Rachel Garfield, a

vice president at the nonprofit

Kaiser Family Foundation.

The ACA, which mostly went

into effect in 2014, reduced the

number of uninsured in large

part through the expansion of

Medicaid, the federal-state pro-

gram for low-income and un-

employed people. Enrollment in

the program rose by 14.7 mil-

lion people between 2013 and

2019, with most of the increase

coming in states that expanded

the program. Several Republi-

can-led states haven’t expanded

their Medicaid eligibility.

Some 91.5% of Americans

had health-insurance coverage

for all or part of 2018, com-

pared with 92.1% in 2017.

The growth in the uninsured

population is bad news for the

health-insurance industry. In-

surers have benefited from

overall expansion in their en-

rollment under the 2010 law,

much of it in Medicaid, because

states increasingly turn to pri-

vate companies to manage the

program. According to the Kai-

ser Family Foundation, pay-

ments to Medicaid managed-

care companies added up to

$264 billion in fiscal 2017, or

around 46% of total Medicaid

spending.

Employment-based insur-

ance, insurers’ bread and but-

ter, also stagnated in 2018, as

did the share of people buying

their own plans. The change in

private coverage wasn’t statis-

icaid restrictions by some GOP

states that may have resulted

in some people losing coverage.

Congressional Republicans also

ended the ACA’s penalty on

people who don’t have insur-

ance, which also prodded some

people to forgo coverage.

Republicans who have long

opposed the ACA blame the

law’s regulations, including a

mandate that insurers can’t

deny coverage based on con-

sumers’ pre-existing health

conditions, for driving up pre-

miums that they say lead to

coverage losses.

In 2018, the average pre-

mium for a benchmark health

plan bought on one of the

ACA’s exchanges—a gross

amount not including any pre-

mium tax credits—was about

34% higher than it was in 2017,

according to a report by the

Congressional Budget Office,

though people who get subsi-

dies on coverage that they buy

through ACA exchanges are

largely protected from the im-

pact of the higher costs.

“It’s just too expensive,” said

Grace-Marie Turner, president

of the Galen Institute, a public-

policy free-market research or-

ganization. “People are siphon-

ing themselves off.”

About 11% of Americans pur-

chased their health coverage

directly last year, the Census

Bureau said, a group that in-

cludes those who bought cover-

age on the ACA exchanges.

—Anna Wilde Mathews

contributed to this article.

The number of Americans
without health insurance
climbed to 27.5 million in
2018, according to federal data
that show the first year-to-
year increase in a decade, be-
fore the Affordable Care Act
began reducing the ranks of
the uninsured.
The increase, which follows
years of steady declines in the
number of uninsured, appears
to have been driven by a de-
cline in coverage under public-
health programs such as Medic-
aid, according to the report.
The number of uninsured rose
by nearly two million people
overall, the Census Bureau said,
which is about how many fewer
people were covered under
Medicaid compared with 2017.
The number of people covered
by private insurance didn’t sig-
nificantly change.
The 27.5 million people with-
out coverage represents 8.5% of
Americans, up from 7.9%, or
25.6 million people, in 2017, ac-
cording to the census data. The
percentage increase is the first
since one from 2008 to 2009.
“As the economy continues
to slowly improve, people’s in-
comes were maybe going up a
bit and that was enough to pull

BYSTEPHANIEARMOUR

Insured Rate Logs First Drop in a Decade

The decline in health

coverage, to 91.5%, is

largely driven by lower

Medicaid enrollment

WASHINGTON—The Trump
administration unveiled new
counterterrorism powers on
the eve of the 18th anniver-
sary of the Sept. 11 attacks and
imposed sanctions on dozens
of individuals and entities al-
legedly involved with terror
groups.
Secretary of State Mike
Pompeo said on Tuesday that
the new powers created by an
executive order by President
Trump bolster authorities cre-
ated in the wake of the at-
tacks. The administration said
the changes represent the
most significant expansion of
counterterrorism powers since
they were originally ordered
by then-President George W.
Bush in the days after the
World Trade Center and Pen-
tagon were struck.
The U.S. Treasury and State
Department blacklisted dozens
of people, currency-exchange
houses and companies alleg-
edly associated with U.S.-des-
ignated terror groups, includ-
ing Hamas, al Qaeda, Islamic
State, Hezbollah and the Quds
Force of Iran’s Islamic Revolu-
tionary Guard Corps.
Besides cutting off the tar-
gets’ access to the U.S., the
sanctions also mean any indi-
vidual or company doing busi-
ness with them also risk being
cut off from the world’s most
powerful economy.
Treasury Secretary Steven
Mnuchin, who appeared with
Mr. Pompeo at a press brief-
ing, said the modernized coun-

BYIANTALLEY

Wider Counterterror Powers Include New Sanctions

The Pepperdine Wave of Flags display in Malibu, Calif., marks victims of the Sept. 11 attacks. The Trump administration unveiled new counterterrorism powers on Tuesday.

FREDERIC J. BROWN/AGENCE FRANCE-PRESSE/GETTY IMAGES

Blood Test Identifies

Military Veterans

Suffering From PTSD

Soldiers of the 48th Infantry Brigade Combat Team bow in prayer at Fort Stewart, Ga., after returning froman Afghanistan deployment.

CURTIS COMPTON/ATLANTA JOURNAL-CONSTITUTION/ZUMA PRESS

Rebates Under ACA

To Total $743 Million

Health insurers are ex-

pected to pay out a record

$743 million to consumers this

month under an Affordable

Care Act rule that requires re-

funds if the companies don’t

spend a big enough share of

premium dollars on health care.

The sum, which will go to

about 2.7 million consumers

who bought individual health

policies from insurers, will be

more than four times the

amount paid out last year. The

payout also dwarfs the next-

highest total, $399 million in

2012, the first year of the re-

funds, according to a new anal-

ysis from the Kaiser Family

Foundation, which calculated

the total rebate payments by

reviewing federal filings.

Consumers who get the re-

bates are expected to receive

about $270 on average, but

some policyholders could get as

much as around $2,000. The

payments, which will often

come in the form of checks,

must be sent to consumers by

the end of September. For a

family with a shared policy, the

insurer issues one rebate.

Consumers will get the re-

batesevenifmostorallof

their premium costs were cov-

ered by federal subsidies.

Insurers will pay out an ad-

ditional $534 million to employ-

ers this year under the same

ACA rule, and many employers

are expected to pass along a

portion of that to workers.

Under the ACA, insurers

must spend the lion’s share of

the revenue they get from pre-

mium payments on health-care

costs. For people who buy their

own health insurance, if that

proportion falls below 80%, the

insurer must refund the differ-

ence to policyholders.

The large rebate total for

2019 largely reflects steep rate

increases that took effect in

2018 for ACA plans, said Cynthia

Cox, a vice president at the Kai-

ser Family Foundation. “It’s really

driven by individual market in-

surers in 2018 overpricing their

plans,” she said. The increases

bolstered insurer profits but

overshot the ACA’s guardrails.

The outlays aren’t likely to

have much effect on insurers’

earnings because they have

generally accrued for them in

advance, said Matthew Borsch,

an analyst with BMO Capital

Markets.