The Washington Post as part of a four-day series, titled "Careless Detention," is examining how some immigrants to the U.S. do not receive needed health care while in immigration detention centers. The Post on Tuesday in the third article in the series examined how immigrants in detention centers who are mentally ill are "relegated to the darkest and most neglected corners of the system," and some "undergo months and sometimes years of undermedication or overmedication, misdiagnosis or no diagnosis." For example, the Post reports that some immigrants are "labeled psychotic when they are not" and that "all they need are interpreters so they can explain themselves."According to the Post, suicide is the most common cause of death in immigrant detention centers, and "suicide attempts seem to be on the rise." Since 2003, when the Department of Homeland Security's Immigration and Customs Enforcement agency took over immigration detainment centers in the U.S., 15 of 83 immigrant deaths were suicides. Internal documents obtained by the Post show that there were 16 suicide attempts in June 2007, 21 in July 2007 and 20 in August 2007.Although the Division of Immigration Health Services does not have a firm estimate of the number of mentally ill immigrants in the detainment system, internal documents obtained by the Post estimate that about 15% of about 33,000 detainees on any given day, or about 4,500, have a mental illness. That estimate is higher than the publicly disclosed mental illness rate given by ICE, according to the Post. In addition, the Post reports that internal documents show that the number of mentally ill immigrants in detainment centers is on the rise. Dennis Slate, a top mental health official in the immigrant detainment system, said that the increasing number of mentally ill immigrants in the system has pushed the ratio of staff to mentally ill detainees far lower than in other prison settings. Slate in a May 31, 2007, memo wrote that there is one staff member to 1,142 mentally ill detainees in the immigrant detention system, compared with one to 400 in the Bureau of Prisons and one to 10 in prisons for people with mental illnesses (Priest/Goldstein, Washington Post, 5/13).The Post also profiles five of the 15 detainees who have committed suicide since 2003 (Goldstein/Priest, Washington Post, 5/13). WAMU's "The Diane Rehm Show " on Tuesday in the first hour of the program was scheduled to include a discussion about the Post series and medical care for detainees. Scheduled guests included Dana Priest, a Post investigative reporter and co-writer of the series; Amy Goldstein, national social policy reporter for the Post and co-writer of the series; Gary Mead, acting director of detention and removal operations for ICE; and Tom Jawetz, immigration detention staff attorney at the American Civil Liberties Union's National Prison Project ("The Diane Rehm Show" Web site, 5/13).

A national health insurance "connector" program that allows individuals and small businesses to buy public and private health coverage could provide insurance for up to 44 million uninsured U.S. residents, according to an article by the Commonwealth Fund published in the May/June issue of the journal Health Affairs, CQ HealthBeat reports. Under the proposal, the government-operated connector authority would offer lower-cost health plans, including a "Medicare Extra" plan built on the existing Medicare system (Nylen, CQ HealthBeat, 5/13). All employers would be required to provide coverage for workers or contribute up to 7% of their payrolls into a fund to generate about $45 billion (Dixon, Reuters , 5/13). Tax credits would be used to ensure that premiums account for no more than 5% of income for lower-income families and 10% for higher-income families. People who remained uninsured would automatically be enrolled in a plan when their taxes are filed.According to a Commonwealth Fund release, if the plan is adopted, the number of uninsured U.S. residents could be reduced from 48.3 million people in 2008 to four million people in the first year the plan is implemented. The article estimates that as many as 60 million people would enroll in coverage offered through the connector program.

Comments Cathy Schoen, lead author of the article and senior vice president of the Commonwealth Fund, said, "This approach will eliminate wasteful administrative costs, enable people to keep their coverage if jobs or circumstances change, and provide affordable health insurance with good access to health care and financial protection for all." She estimated that the plan could save $1.6 trillion over 10 years if implemented in combination with new health information technology and negotiated prescription drug prices. The proposal would require about $15 billion in new spending, with the rest offset by reduced administrative costs (CQ HealthBeat, 5/13).Commonwealth Fund President Karen Davis said, "Each of these features certainly has elements that will give pause to some groups," but "I think the basic bottom line is that if everyone will give a little, it means you can get universal coverage." According to Davis, those who would experience increased costs as a result of the plan include employers not currently offering coverage, health care providers not treating beneficiaries of current public health programs and companies selling individual health plans (Reuters, 5/13). Dallas Salisbury, president of the Employee Benefit Research Institute , said businesses likely would support some of the article's proposals, including maintaining current tax exemptions for employer-sponsored coverage. "There's a consensus that an employer-based system should continue to be part of [the] overall approach," he said, adding that employers "want to continue to be part of the system" (CQ HealthBeat, 5/13). The May/June issue of Health Affairs includes a number of articles that focus on prospects for health care reform in the current election cycle. The issue contains articles and perspectives by political pollsters, scholars and lawmakers, who examine the political climate surrounding health insurance, proposals for overhauling the health care system and past attempts at instituting a national health insurance program. The journal also includes articles that discuss important elements to be considered when evaluating health care proposals (Health Affairs release, 5/13).

Fifty-five percent of U.S. adults trust Democratic presidential candidate Sen. Barack Obama (Ill.) more than presumptive Republican nominee Sen. John McCain (Ariz.) to address the issue of health care, compared with 31% who trust McCain more than Obama to address the issue, according to a recent Washington Post-ABC News poll, the Post reports.For the poll, conducted between May 8 and 11, TNS interviewed by telephone a random sample of 1,122 adults nationwide. The poll had a margin of sampling error of plus or minus three percentage points (Washington Post graphic, 5/13). The poll found that fewer than 10% of adults cited health care as their most important issue in the election, compared with 36% who cited the economy and 21% who cited the war in Iraq.In addition, the poll asked adults about their opinions on the direction of the nation and other issues, as well as which candidates they considered most able to address various concerns. The poll also examined who would win a general election between Obama and McCain or an election between Democratic presidential candidate Sen. Hillary Rodham Clinton (N.Y.) and McCain (Cohen/Balz, Washington Post , 5/13).

Opinion Pieces Summaries of an editorial and an opinion piece on health care in the presidential election appear below.Baton Rouge Advocate : "As the candidates talk about health care in this election year," much of the discussion "will be on the uninsured," but U.S. residents with health insurance also are "seeing an erosion of coverage that is causing pain in many households," an Advocate editorial states. "Hospitals and doctors are turning to credit card companies or other means of providing credit" to patients without health insurance, as well as those enrolled in high-deductible health plans, the editorial states, adding, "Upfront costs are one thing, but fear of medical debt" can prompt those with health insurance to "delay or forgo health care they might otherwise get." The editorial states, "At its core ... health insurance is intended to shield -- by spreading around risk and premiums -- families from financial devastation caused by health problems." The editorial concludes, "When candidates talk about health care this year, we hope that they look at all sides of this issue" (Baton Rouge Advocate, 5/13).Grace-Marie Turner, Seattle Post-Intelligencer : Obama and McCain have begun "gearing up for a general election battle" in which they will "offer very different visions for health care reform," Turner, president of the Galen Institute , writes in a Post-Intelligencer opinion piece. According to Turner, Obama, who "sees a much larger role for government" in the health care system, would require health insurance for children, require employers to "pay for insurance for their workers," expand public health insurance programs and "impose significant new federal regulation over health insurance." McCain, who has a "very different vision," would "focus on new financing tools to help people buy health insurance that would be portable from job to job, new mechanisms for those with pre-existing conditions to get coverage" and "prevention and better care coordination," Turner writes. However, she writes, Obama and McCain "agree the key to health reform is getting costs under control." Congress will "wrestle with the intricacies of reform, but in this election year, the vision is the key, and the contrast between the visions that Obama and McCain offer is stark," Turner writes, adding, "The bottom line question will be whether individuals or government will be in control of health care in the future" (Turner, Seattle Post-Intelligencer, 5/12).

Updated fact sheets, Kaiser Family Foundation : The fact sheets provide information about the impact of HIV/AIDS on blacks , Latinos and women in the U.S. Each fact sheet includes data about trends and current cases, as well as population-specific information on HIV transmission patterns and access to care (Kaiser Family Foundation release, 5/12).

The Chicago Tribune Magazine on Sunday examined HIV/AIDS among children and adolescents in the U.S. According to the Tribune, there are about 6,000 children and young adults living with HIV/AIDS in the country.The development of antiretroviral drugs in the 1990s has improved the lives of children living with HIV/AIDS and reduced the number of infants born with the virus from about 1,700 annually in the 1990s to about 150 annually today. Ram Yogev, founder of the HIV program at Children's Memorial Hospital in Chicago, said it is "unbelievable" that children with HIV now live into adulthood, adding that HIV-positive children had a life expectancy of three to four years in the late 1980s and eight or nine years in 1990. Although the life expectancies and health of HIV-positive children have improved, children living with the virus "often are left to handle their HIV on their own and carry around this unseen burden that most people don't know about," Linda Walsh, a nurse practitioner at the infectious diseases clinic at the University of Chicago Medical Center , said. Kenneth Boyer, chair of pediatrics at Rush University Medical Center , added that HIV is a "constant and a very tough burden" for children living with the virus.According to John Marcinak, medical director of the Adolescent HIV program at the University of Chicago, HIV-positive children "have more complications" than adults living with the virus "because they have been on medicine a much longer time." He added that the virus "can develop resistance to the medication" and that some children "can't use some of the new" antiretrovirals. Robert Garofalo, director of adolescent HIV services at CMH, said that children living with HIV/AIDS are "a forgotten group" because the "sense of community" for other groups "does not exist" for them. "The youth who are born with HIV have very different issues with their family, parents and mothers," Garofalo said, adding, "But like all adolescents, they are still struggling to establish autonomy from their parents, to understand their emerging sexuality." Lori Wiener, coordinator of the National Cancer Institute 's Pediatric HIV Psychosocial Support Program, added that the "stress is tremendous" for children living with HIV. "The stress of HIV appears to increase beginning with adolescence," Wiener said, adding that HIV-positive adolescents "fear social rejection more than many of them fear dying" of AIDS-related causes. Children and adolescents living with HIV/AIDS "who have done the best psychologically are those who have people in their lives that they share their diagnosis with and can talk to openly" about HIV/AIDS, Wiener said (Breu, Chicago Tribune Magazine, 5/11).

HIV/AIDS is hindering Mozambique's efforts to alleviate poverty, Glauco Calzuola, head of the European Union delegation in Mozambique, said Sunday, Reuters reports. Calzuola added that corruption and bureaucracy also are obstacles in the country's efforts to eradicate poverty.Calzuola called on the Mozambican government to "redouble" its efforts to fight HIV/AIDS and corruption. "HIV and AIDS is a big problem, despite the fact that the government is fully aware about this, while corruption is a problem that the government is trying to face with strong support from the international community," Calzuola said, adding that the government is "well aware that this can be an obstacle to development and growth."At least 16% of the country's economically active population age 14 to 29 is living with HIV/AIDS, and at least 500 people contract HIV daily, according to the country's Ministry of Health (Mangwiro, Reuters, 5/11).

Officials from Yemen and the United Nations Development Programme on Monday signed a $10.6 million, three-year agreement to strengthen efforts to fight HIV/AIDS in the country, SABA News reports. The agreement was signed by Abdul-Karim al-Arhabi, Yemen's minister of Planning and International Cooperation, and UNDP Acting Resident Representative Selva Ramachandran. The program -- which is supported by the Global Fund To Fight AIDS, Tuberculosis and Malaria -- aims to bolster the government's efforts to control the spread of HIV/AIDS within the general population and high-risk groups. It seeks to ensure that the rights of people living with HIV/AIDS, including the right to appropriate medical care, are guaranteed by 2010. The program also aims to expand coverage of safe blood for transfusions and to create national blood safety standards. In addition, the program plans to scale up HIV/AIDS awareness among officials at all levels, the general population and high-risk groups. Civil society organizations are expected to play an important role in increasing awareness and advocacy under the program, SABA News reports.Yemen was one of the first countries in the Middle East and North Africa to include HIV/AIDS in its national development agenda, SABA News reports. The government approved a national HIV/AIDS strategy in 2001 and created a national HIV/AIDS task force in 2003 (SABA News, 5/12).

Health officials in Cuba this year will focus HIV prevention messages at men who have sex with men, Rosaida Ochoa, director of the National Center for the Prevention of Sexually Transmitted Diseases and HIV, said recently, EFE News Service reports. Ochoa, who was speaking ahead of the International Day Against Homophobia on May 17, said that about 80% of people living with HIV in Cuba are men. She added that 84% of men living with HIV in the country are MSM.According to Ochoa, four men contract HIV for every one woman who contracts the virus, leading health officials to focus prevention efforts on MSM while maintaining efforts aimed at women. A study conducted last year by the National Statistics Office found that HIV-positive people experience more stigma and discrimination because of their sexual orientation than their HIV status, Ochoa said. She added that one of the goals of this year's prevention campaign is to increase awareness about sexual identity in the general population. "Everything we can do to educate (people) about sexual diversity directly influences the HIV/AIDS epidemic," Ochoa said. As of December 2007, Cuba had recorded a total of 9,304 HIV/AIDS cases, according to EFE News Service (EFE News Service, 5/11).

CDC needs a $600 million increase in funding for effective HIV/AIDS prevention and surveillance programs, advocates said Monday at a briefing hosted by the AIDS Institute to assess the agency's efforts to fight HIV/AIDS in the U.S., CQ HealthBeat reports. The $600 million increase would nearly double CDC's current HIV/AIDS prevention budget, CQ HealthBeat reports. According to Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors , CDC's HIV prevention and surveillance programs account for 3% of all federal HIV/AIDS funding. NASTAD members spend about 50% of the agency's $692 million domestic HIV prevention funding, according to CQ HealthBeat. Scofield said that HIV cases decreased by nearly 75% as CDC's budget increased between the late 1980s and early 1990s but that new cases remained stagnant when funding increases were halted.According to CQ HealthBeat, CDC publishes 49 targeted "interventions" aimed at reducing the risk of HIV among specific groups, and state and localities apply for money to institute the interventions. Four of the 49 interventions target men who have sex with men of all races, even though this group accounted for 71% of new HIV cases among men in 2005. Forty-three percent of the interventions target women, who accounted for 26% of new cases in 2006, CQ HealthBeat reports. Currently, there are no established interventions for black and Hispanic MSM, female prison inmates, crystal methamphetamine users, commercial sex workers, veterans, people older than age 50 and homeless people. Carl Schmid, director of federal affairs for the AIDS Institute, said that a lack of funding has undermined CDC's efforts to establish more interventions. Some advocates at the forum "roundly criticized" the Bush administration and Congress for neglecting to fund needle-exchange programs and prison-based programs, as well as for diverting money to programs such as abstinence-only education, CQ HealthBeat reports. The panel also criticized how funds are distributed through the Ryan White Program . Scofield noted that recent modifications in the law have forced CDC to shift $30 million in HIV funding to mother-to-child HIV transmission efforts, which already receive money from other grant programs."We're holding the epidemic at bay," Majorie Hill, CEO of the Gay Men's Health Crisis , said, adding, "The only way we're going to make a real dent is allocating realistic resources." Officials from NIH 's National Institute of Allergy and Infectious Diseases , which oversees HIV/AIDS funding, were not available for comment (Walker, CQ HealthBeat, 5/12). A Webcast of the event is available online at kaisernetwork.org . In addition, C-SPAN's "Washington Journal " on Monday included a discussion with Schmid about the forum and U.S. HIV/AIDS policy ("Washington Journal," C-SPAN, 5/12).

The AP/Miami Herald on Sunday looked at the health plans proposed by Democratic presidential candidates Sens. Hillary Rodham Clinton (N.Y.) and Barack Obama (Ill.). While likely Republican nominee Sen. John McCain said the Democratic plans would "move closer to a nationalized health system," AP/Herald describes that characterization as "a stretch."Both Clinton and Obama would use the federal government to establish a marketplace in which residents could purchase private or public health insurance, with subsidies for lower-income residents, and would prohibit health insurers from rejecting applicants because of pre-existing medical conditions. The most significant difference in the proposals involves the question of whether to mandate that all residents obtain health insurance. Clinton would implement such a mandate, but Obama would require coverage only for children.However, a "vast distance" exists between the Clinton and Obama health care proposals and a nationalized health care system, as neither candidate is "proposing government hospitals or government doctors," the AP/Herald reports. In addition, both candidates would "continue the split system that the U.S. has when it comes to health coverage," with coverage for some residents funded in large part by government and for others funded in part by employers, according to the AP/Herald. Karen Davis, president of the Commonwealth Fund , said of the Democratic candidates, "Their approach is not taking any other country's system. It's building on what we have in the U.S." Heather Higginbottom, policy director for the Obama campaign, said, "We don't eliminate the employer-based side of the equation. We don't dismantle private insurance." She added, "We still have competition and choice and all the things that would lead to adequate supply and good care." Neera Tanden, policy director for the Clinton campaign, said that Clinton would "build on the system we have rather than radically reshape it" (Freking, AP/Miami Herald, 5/11).

Health Care Important Issue for Voters Concerns among voters about access to health insurance and health care costs have become an "important part of how they choose presidential candidates, the Miami Herald reports. "Ask voters about their top domestic concern, and most name the economy, then quickly mention health care," according to the Herald.Andrew Kohut, president of the Pew Research Center , said, "The economy overall is the most important issue" for voters, and, "to a certain extent, health care is a component of that."According to the Herald, although the candidates "find it easy to get voters' attention" on health care, "convincing a voter" that their proposals "can help ease his or her specific problem is a more difficult matter," and, "because the solutions are so complex -- involving affordability, better care, access to care and so on -- it's hard to judge just what motivates people to support one candidate over another" (Lightman, Miami Herald, 5/11).

Poll About 11% of U.S. adults cite health care as their most important election issue, compared with 56% who cite the economy and 34% who cite the war in Iraq, according to a recent Los Angeles Times/Bloomberg poll, the Times reports. The poll, conducted earlier this month, included telephone interviews of 2,208 adults, 1,986 of whom are registered voters. Researchers asked adults to cite as many as two issues as their most important election concerns.In addition, the poll asked adults about their opinions on the state of the economy and other issues, as well as which candidates they considered most able to address various concerns. The poll also examined who would win a general election between Clinton and McCain or an election between Obama and McCain (Alonso-Zaldivar, Los Angeles Times, 5/10). The results of the poll are available online (.pdf).

Editorial "You've heard a lot ... about which presidential candidate is best qualified to answer that 3 a.m. phone call in the White House," but, "if the caller were asking about health care reform, there's no doubt" Clinton "could give the best answers, even in her sleep," according to a Salt Lake Tribune editorial. "Despite what you may have heard," Clinton has not proposed a "single-payer government-financed health plan," according to the editorial. Her proposal "retains private insurance companies and competition but makes a number of major reforms in tax policy and the market," and the plan "does attempt to achieve universal coverage," the editorial states. The Obama proposal "largely mirrors" her plan but would not require all residents to obtain health insurance, and the McCain plan "likely would fall far short of universal coverage," fail to "rein in cost-shifting" and do "nothing to prevent insurers from cherry-picking their insureds." According to the editorial, without an individual mandate, "it will be impossible to end cost-shifting and get a handle on costs," and "HillaryCare shows the most promise for accomplishing these linked goals." The editorial concludes, "This is one area where Hillary Clinton's experience with an issue would pay off for all Americans" (Salt Lake Tribune, 5/9).