MONEY Health Care

Why Getting Mental-Health Coverage Can Be So Tough

Despite rules mandating better insurance benefits, finding care remains a challenge, a new 50-state report concludes.

Even though more Americans have access to health insurance because of the health law, getting access to mental health services can still be challenging.

A new report concludes that despite the 2008 mental health parity law, some state exchange health plans may still have a way to go to even the playing field between mental and physical benefits. The report, released by the advocacy group Mental Health America, was paid for by Takeda Pharmaceuticals U.S.A. and Lundbeck U.S.A, a pharmaceutical company that specializes in neurology and psychiatric treatments.

The report listed the states with the lowest prevalence of mental illness and the highest rates of access to care as Massachusetts, Vermont, Maine, North Dakota, and Delaware. Those with the highest prevalence of mental illness and most limited access are Arizona, Mississippi, Nevada, Washington, and Louisiana.

Among its other findings:

•42.5 million of adults in America, 18.19%, suffer from a mental health issue.

•19.7 million, or 8.46%, have a substance abuse problem.

•8.8 million, or 3.77% of Americans have reported serious thoughts of suicide.

•The highest rates of emotional, behavioral or developmental issues among young people occur just west of the Appalachian Mountains, where poverty and social inequality are pervasive.

Part of MHA’s examination focused on the exchange market and its essential health benefit requirements that guided 2014 coverage. The group found that, while information provided through plans’ “explanation of benefits” might show that there aren’t limits on mental health coverage, limitations including treatment caps and other barriers still exist.

“Parity is in its infancy. Most plans know the numerical requirements around cost-sharing, but few have taken seriously the requirements around equity—around access through networks and barriers to care through prior authorization,” said Mike Thompson, health care practice leader at PricewaterhouseCoopers. “And, in practice, we have a history of imposing much more stringent medical necessity standards on mental health care than other health care.”

However, Susan Pisano, vice president of communications for America’s Health Insurance Plans, an insurance trade group, said the report doesn’t reflect the fact that many health plans have rolling renewals. That means the plans have until Jan. 1, 2015, to fully comply with the parity law.

“Our members are committed to mental health parity, and we’re supportive of legislation, and what isn’t apparent is that benchmark plans represented a snapshot in time … so that doesn’t give us the full picture,” Pisano said. “Our plans have really been working to get in compliance.”

Chuck Ingoglia, senior vice president of public policy at the National Council for Behavioral Health, a Washington-based trade group for community mental health and substance use treatment organizations, said the report’s findings aren’t surprising — though they are troubling. Implementation of the parity law remains a work in progress, he said.

“The law is based on a sound policy premise — that addiction and mental health treatment decisions and management should be comparable to physical health conditions,” he said. “But this also creates a tremendous barrier to proving violations as it requires a consumer to obtain access to plan documents for both types of care, which is frequently handled by different plans,” Ingoglia said.

In addition, the report found that some plans didn’t set out what and how many services were covered. That means consumers would only find out a treatment wouldn’t be paid for by their insurer after they’d already received care.

Americans with mental disorders have the lowest rates of health insurance coverage, so obtaining insurance is a good first step, according to Al Guida, a Washington, D.C.-based lobbyist who works on mental health issues with Guide Consulting Services. But the only way a denial can be reversed is through an appeal, which can be a long and arduous process.

“The vast majority of insurance plans offered on Affordable Care Act federal and state exchanges have close to no transparency, which could lead to abrupt changes in both mental health providers and psychotropic drug regimens with the potential for serious clinical consequences,” Guida said.

Meanwhile, there is a shortage of mental health care professionals—nationally there is only one provider for every 790 people, according to the report.

All of these factors can cause minor mental illnesses to grow more severe, according to Mental Health America CEO Paul Gionfriddo.

He suggested that mental illness should be screened for and covered in the same way cancer, kidney disease, and other illnesses are.

“Right now we’re trapped in a stage where we wait for a crisis, when they’re in advanced stages and then we treat it, and we wonder why it’s so hard to treat it more cheaply,” Giofriddo said.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

TIME Health Care

Number of Uninsured Americans Near Historic Low

Marketplace guide Jim Prim works on the Healthcare.gov federal enrollment website as he helps a resident sign up for a health insurance plan under the Affordable Care Act at an enrollment event in Milford, Delaware on March 27, 2014.
Marketplace guide Jim Prim works on the Healthcare.gov federal enrollment website as he helps a resident sign up for a health insurance plan under the Affordable Care Act at an enrollment event in Milford, Del. on March 27, 2014. Andrew Harrer—Bloomberg/Getty Images

Just 11.3 percent of Americans were uninsured in the second quarter

New federal government data shows the percentage of Americans without health insurance was at or near historic lows this year following the roll-out of the Affordable Care Act, and appears certain to fall to record levels next year.

The data released Thursday from the National Center for Health Statistics’ National Health Interview Survey found that 11.3 percent of Americans were without coverage in the second quarter of 2014, down from 13.1 percent in the first quarter and 14.4 percent throughout 2013. An analysis by the White House Council of Economic Advisers finds the drop in the uninsured to be the largest in four decades, amounting to roughly 9.7 million Americans getting insurance, consistent with other Affordable Care Act estimates.

“As this week’s data confirm, 2014 has seen dramatic coverage gains, gains matched or exceeded only by those seen in the decade of rapid progress that followed the creation of Medicare and Medicaid,” wrote Council of Economic Advisers Chairman Jason Furman and CEA Senior Economist Matt Fiedler in a blog post on the White House website. “Following this year’s gains, we estimate that the Nation’s uninsured rate is now at or near the lowest levels ever recorded across the 50 years for which we have data.”

Council of Economic Advisers

The new data does not include the nearly 2.5 million who have newly selected or re-enrolled for coverage in the latest round of open enrollment which began last month. Nor does it include those who’ve gained coverage in Medicaid or the Children’s Health Insurance Program since the second quarter—including 400,000 from September to October, according to new data from the Centers for Medicare & Medicaid Services—as more states expand access to the program with federal money under the law.

“These data imply that the uninsured rate will continue to fall in the year ahead, reaching low levels unprecedented in the Nation¹s history,” the economists wrote.

MONEY Health Care

4 Smart Year-End Strategies for Maximizing Your Health Benefits  

Tray of dental instruments
Dental plans often have annual coverage caps. Have you used up yours yet? Peter Dazeley—Getty Images

In these winter months, don't overlook these valuable health perks—and the crucial deadlines for getting your money's worth.

The first and last months of the year can be the best time to use your health insurance benefits. Here’s how to make the most of four common scenarios:

You’ve Met Your Deductible

This is the amount you must pay for your own health care before your insurance starts covering a larger portion of the costs. If you’re close to that cut-off, consider a last-minute appointment, says Carrie McLean, director of customer care at online insurance exchange eHealth.com.

“If you’ve already met your deductible for 2014, or are close to it, medical care rendered before the end of the year may be covered at a lower out-of-pocket cost,” McLean says. “Conversely, if you expect to have a lot of health care expenses in 2015, you may want to schedule non-emergency medical care for early next year so you can fulfill your deductible as soon as possible.”

You Have Unused Dental Benefits

In most cases, dental coverage works differently from regular health insurance. This benefit is often capped at $1,000 to $3,000 annually, according to the American Dental Association. If you have unused benefits remaining, now may be the time to schedule a last-minute appointment, especially if you might need serious dental work soon. That way, you can spread the cost over both years and pay less out of pocket for dental care.

You Have an Leftover FSA Money

If you set up a flexible spending account, or FSA, through your employer as a supplemental benefit to your health insurance, you were able to contribute pre-tax money to it each year and use that money for qualifying health expenses. Now’s the time to check your balance.

Some FSAs allow you to roll over up to $500 of unused funds into the following year, or give you a 2 1/2-month grace period to spend the money, but many don’t. In that case, you’ll forfeit your remaining balance.

If you have funds left in your FSA, or you are over your rollover limit, it’s time to spend the money. The good news is that a lot of expenses qualify, starting with purchases you’ve already made. If you can prove it, you can reimburse yourself for health costs you paid earlier in the year, says Craig Rosenberg, benefits specialist at human resource firm Aon Hewitt.

“Check to see if there are any out-of-pocket health care expenses you haven’t submitted for reimbursement. It’s easy to forget co-pays, prescription drug expenses, or certain medical supplies,” says Rosenberg.

“December can be a good time to stock up on health supplies,” he adds, and that goes for a lot of expenses, from bandages to braces and more.

If your FSA has a grace period, you have until March 15, 2015 to use your 2014 funds. In that case, it might be a good idea to schedule checkups for January so the costs count toward next year’s deductible. Check your FSA summary of benefits first, because in some cases that grace period is only for vision and dental expenses.

You Have an HSA

Whatever you do, don’t confuse your health savings account, or HSA, with an FSA and hurry to spend it, Rosenberg says. “FSAs have ‘use-it-or-lose-it’ rules that apply each year, but HSAs do not,” he says. “Any funds in your HSA are yours to keep indefinitely, even if you change jobs.”

Some even look at HSAs as a retirement savings vehicle since the funds can be used to pay for Medicare premiums and medical costs in retirement. That’s a big deal: Fidelity Investments estimates that the average couple retiring this year will face $220,000 in medical costs in retirement.

You may even want to add funds to your HSA now, McLean says. “Maximize on your tax saving by funding [the HSA] fully before year’s end,” she says, but know the limit. The contribution cap for HSAs in 2014 is $3,300 for individuals, or $6,550 for families.

Lacie Glover writes for NerdWallet Health, a website that helps consumers lower their medical bills.

TIME People

Multiple Babies Born at 10:11 on 12/13/14

Matthew and Jennie Keane pose with newborn daughter, Claire Elizabeth, Dec. 14, 2014.
Matthew and Jennie Keane pose with newborn daughter, Claire Elizabeth, Dec. 14, 2014. Christine Peterson—AP

When Jennie started having contractions Friday night the time and date became part of the plan

A Massachusetts couple is celebrating the birth of their daughter with a numerically unusual birth time and date.

Clare Elizabeth Keane was born at 10:11 a.m. Saturday – making her birth time and date 10:11, 12-13-14.

Parents Jennie and Matthew Keane, of Uxbridge, hadn’t even thought of the possible numerical feat until a nurse at UMass Memorial Medical Center in Worcester mentioned the combination.

When Jennie started having contractions Friday night the time and date became part of the plan.

“We were laughing the whole time that she was pretty close,” Matthew tells The Telegram & Gazette.

Jennie Keane says she’s just glad the 7 lbs., 2 oz. Clare wasn’t 8 lbs., 9 oz..

Babies were also born in Billings, Montana, and Cleveland at the same time on Saturday.

This article originally appeared on People.com

MONEY Health Care

5 Things You Need to Know for Today’s Health Care Coverage Deadline

Today is the deadline to buy individual health insurance if you want to have coverage on Jan. 1.

Since open enrollment began on Nov. 15, almost 1.4 million people have signed up for health coverage through the federal insurance exchange, and another 183,000 through state exchanges. With nearly 7 million people already participating, signups are on pace to meet the government’s projection of 9 million enrollees in 2015, according to the Kaiser Family Foundation.

If you’re one of the many who still need to enroll for 2015 coverage, here are five keys things you need to know before you visit your state’s health exchange website.

1. If you want health insurance on Jan. 1, you must enroll today. You still have until Feb. 15 to buy a 2015 plan, but you will have a gap in coverage if you enroll after today’s deadline. Coverage begins on Feb. 1 for people who enroll between Jan. 1 and Jan. 15. Sign up between Jan. 16 and the end of the month, and coverage won’t begin until March 1.

2. Some states are giving you more time and extending the deadline to get coverage by Jan. 1. For example, New York and Idaho’s exchanges will allow users to sign up until Dec. 20. To find out whether you’re eligible for an extension, visit your state’s marketplace exchange website through healthcare.gov.

3. You’ll be automatically re-enrolled if you bought on an exchange last year and do not renew coverage by today. If the health plan you signed up for is no longer offered, insurers can automatically enroll you in another policy similar to the one you have now. But you can opt out of any plan you’re automatically enrolled in and choose another up until Feb. 15.

4. Skip automatic enrollment and shop again, even if you liked your 2014 policy. The Department of Health and Human Services found that more than 70% of people who currently have insurance through the health law’s federal online marketplace could pay less for comparable coverage if they are willing to switch plans.

5. Costs have changed. Many plans will have out-of-pocket spending limits that are lower than the maximums allowed under the health law, according to an analysis by Avalere Health. But the tradeoff for those lower maximums may be a higher deductible, so be sure to pay attention to both figures when choosing your plan. You can also expect to see your premium change. Depending on where you live, that may be a good or bad thing. The premium for the second-lowest-cost silver plan in Nashville jumped 8.7%, while it dropped 15.6% in Denver, according to a study by the Kaiser Family Foundation.

TIME politics

How Obama Bungled Obamacare’s Success Stories

The president's health care plan has saved many lives. So why hasn't he told us about them?

By now, there are thousands of people who can make Barack Obama and the Democrats’ case for the Affordable Care Act. Across the nation, there must be countless tales of Americans who would be broke and broken were it not for Obamacare. They have to exist in all walks of life, in every state, of all political persuasions.

And yet this week, as Monday’s deadline approached for signing up for 2015 health plans, none of those people appeared as part of the pitch. The most frequently aired TV ad features a racially diverse cast of young people speaking in generalities about how their Obamacare plans provided “peace of mind” at a surprisingly low, low price. These folks, none of whom seem to have been sick, gush about the heckuva deal they got and how happy it makes them.

But why? Why is America still being asked to take it on faith that the ACA is a social and moral good? Why does the Obama Administration continue, even after these many years of largely unanswered attacks by Republican opponents, with a failed marketing effort that amounts to, “Trust us! You’ll love it!”

Here’s the ACA ad they should make: a grizzled, Duck Dynasty-like Alabaman stands outside a neonatal intensive care unit. “I was against Obamacare,” he tells the camera. “I sure didn’t vote for Obama, either. And, man, I liked my health plan, wanted to keep it. When I found out I couldn’t, boy was I pissed.” The camera pans to a wriggling baby, tubes everywhere, the man’s wife gazing longingly into the incubator holding their child. “Then my daughter was born, and she almost died,” he says, choking up a little. “My old plan wouldn’t have covered this. We would’ve lost the house, probably would’ve had to go bankrupt. It’s all still pretty dang expensive, I can’t lie. But my Obamacare coverage really saved us. Thanks, Obamacare!”

You think that’s some liberal, nanny-state fever dream? It’s not. This is not conjecture; it is a statistical certainty based on all the data used by insurance carriers to set rates. A certain chunk of the 8 million people who signed on to Obamacare plans – or the millions more whose existing plans were bolstered to comply with the ACA – suffered health catastrophes in 2014. Many opposed the law and were angry when Obama’s “like it, keep it” promise was broken. But without the reform that required comprehensive plans and eliminated rejections of coverage based on pre-existing conditions, many would have met the same fate of so many in recent decades.

That is, lest anyone forget, how it was. Obama, strangely, really never told those stories back then, either. In 2009, when he stood before a joint session of Congress to make his case for health insurance reform, the political genius who campaigned in 2008 with such art and eloquence failed to use the moment to introduce skeptics to a parade of average, hard-working Americans who endured the all-too-common financial devastation of a serious illness. Can’t you see those people, their wheelchairs and colostomy bags and adorable kids, festooning the dais as Obama made his case? How could a purported Judeo-Christian nation see those faces and hear those stories and not agree that something had to change? Instead, the president gave a boring, wonky speech that nobody remembers, a teaser for the incompetent public relations effort to come.

And there they go again. The current marketing effort also failed to appeal to anyone’s emotions or sense of justice. Rather, it insisted that having good insurance makes you feel good about yourself the way, say, eating tofu or reading Tolstoy might. Perhaps Obama once had to rely on unproven predictions, but that ended on Jan. 1, 2014. Since then, ACA supporters have had their pick of uplifting stories of tragedy averted by this law.

Rep. Jan Schakowsky, D-Ill., knows this. Last month, in a Chicago Sun-Times essay, she cited several specific cases of ACA success. Cancer-stricken David Price, for instance, saved $4,000 this year on his meds versus 2013. Gary Wood, bankrupted 18 years ago by the cost of care from a heart attack and then shut out of coverage ever since, underwent a life-saving quintuple bypass in 2014 paid for by the Obamacare Medicaid expansion. And so on. It’s not hard to find these people. They’re everywhere, even in the deepest red of states.

The gang behind this year’s campaign offered up just one limp trick: rebranding. The TV ad, for instance, opens with a woman who says, “Healthcare.gov allows me to continue on with my life.” In other words, it’s not Obamacare. It’s not even the ACA. It’s now just “healthcare-dot-gov,” as if that’s a policy or a government program rather than a place on the Internet. Given that the rollout of the website was among the biggest PR disasters of any sort in recent history, it’s an odd and ineffectual choice.

Stop being so cute. This is really, really easy; just tell the story. It goes like this: Obamacare has successes. It has already saved many Americans from financial doom. It has improved the health care of millions. It has given many entrepreneurs the courage to quit jobs they hated and start new businesses. Here, meet some of these folks. They’re just like you. You could be next.

The evidence is now on Obama’s side. It is mystifying that he doesn’t seem to know it.

Steve Friess is an Ann Arbor, Mich.-based freelance writer and former senior writer covering technology for Politico.

MONEY Health Care

The Key Numbers to Look for When You’re Picking a Health Plan

pill bottle with numbered pills around it
Tim Robberts—Getty Images

Monday is the deadline to buy insurance if you want it on January 1. But don't shop solely on the premium. A new study finds that many exchange-sold plans have lower-than-expected out-of-pocket caps, a boon for some health care consumers. But deductibles are up.

Consumers shopping on the health insurance marketplaces will find many plans with out-of-pocket spending limits that are lower than the maximums allowed under the health law, according to an analysis by Avalere Health.

Seventy-four percent of 2015 silver level plans’ out-of-pocket spending caps are below the $6,600 spending limit allowed for individual plans and $13,200 maximum for family plans, according to Avalere, a consulting firm. The average out-of-pocket maximum for 2015 individual silver plans will be $5,853, says Caroline Pearson, a vice president at Avalere. Silver was the most popular plan type this year, selected by about two-thirds of enrollees.

After a policyholder reaches the out-of-pocket spending limit during the year, the insurer pays all the bills, unless, for example, they involve doctors and hospitals not in the health plan’s network.

The vast majority of other plans also feature lower limits on out-of-pocket spending—which includes deductibles, copayments, and co-insurance, but not premiums. Seventy-one percent of bronze plan spending limits were below the allowed maximum (with an average spending limit for single coverage of $6,381), as were 94% of gold plans (average limit, $4,458) and 98% of platinum plans (average limit, $2,145).

Avalere said the average spending limits for single coverage were in most cases close to those for 2014 plans: bronze ($6,330); silver ($5,877); gold ($4,443) and platinum, $2,795.

Avalere’s analysis included plans sold on the federal marketplace that serves 37 states, as well as data from the California and New York state marketplaces. Consumers have until Feb. 15 to enroll.

The tradeoff for lower out-of-pocket spending maximums may be a higher deductible, says Pearson. The average deductible for silver plans will increase 7% in 2015, to $2,658. Other metal-level average plan deductibles are increasing as well.

Higher deductibles are likely helping keep premiums low, and low premiums are what consumers are looking for, Pearson says.

For people who are generally healthy, a lower premium may be more attractive than a lower deductible. They’re never going to meet their deductible anyway, so they’d prefer to save on monthly premiums.

But for people with chronic conditions, “the lower out-of-pocket maximum helps you because you’re going to exceed your deductible no matter what,” says Pearson.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

MONEY Ask the Expert

How to Pick a Medigap Policy That’s Right for You

140603_FF_QA_Obamacare_illo_1
Robert A. Di Ieso, Jr.

Q: “I’m looking into Medigap insurance policies with very limited success. The information is very scarce. It is difficult to choose an insurance company. What criteria should I use to decide among carriers?” — Ray, Henderson, Nev.

A: Medigap, an insurance policy that supplements Medicare, helps pay for some of the medical costs that Medicare doesn’t cover, such as your co-payments, co-insurance, and deductible. Some policies even help with services Medicare doesn’t touch, like medical care outside the U.S.

You can choose from 10 standard Medigap policies, each named for a letter in the alphabet. The government mandates what features the 10 plans must offer, but the policies are sold through private insurers. (If you live in Massachusetts, Minnesota, or Wisconsin, the standard benefits on the Medigap policies sold in your state differ.)

Medigap Plan A is the most basic policy, while Plan F offers the most extensive coverage, picking up almost all of your out-of-pocket expenses. Plan F is also the most popular, accounting for 55% of plans sold, according to America’s Health Insurance Plans, the health insurance industry trade group.

The fastest growing Medigap policy, Plan N, is a newer option that has cost-sharing requirements but is typically less expensive than Plan F.

To shop for a Medigap plan, start with the Medigap policy search tool at the Medicare website. Enter your zip code, and you’ll see the standardized plans available to you, details about what they cover, the estimated costs, and a list of insurers selling those plans in your area. For price quotes, you’ll have to call each company directly.

Usually the only difference between same-letter policies is cost—and the price range can be shockingly large. According to a survey of rates by Weiss Ratings, the annual premium on a Medigap Plan F ranged from $162 to $5,674.

“I recommend that people get Plan F if they can afford it because it offers the most coverage,” says Fred Riccardi, client services director for the Medicare Rights Center. If you can’t swing a Plan F, pick the option that offers the most coverage within your budget.

Once you settle on a letter, you can shop on price alone. “Since the policy itself is standardized, premiums are really the only thing that will vary across insurance companies,” says Riccardi. “The only reason I see people go with a more expensive policy is if they prefer a certain insurance company.”

However, you do need to pay attention to the insurer’s pricing system too. Some plans are “issue age,” meaning the premiums rise with medical inflation. Others are “attained age” policies, with the price increasing each year with your age as well as medical inflation. You’ll also see “community rate” policies, which charge every policyholder the same premium regardless of age.

Attained age policies may appear to be the cheapest initially, but in the long run they could cost you more. “People should be aware that if they buy an attained age rated policy, their premiums will increase as they get older,” says Riccardi. “They may be better off considering a community rated or issue age rated policy if these options are available in their state.”

To get the lowest price and ensure that you won’t be denied, apply for a policy during the six-month open enrollment period that begins the month you turn 65, says Riccardi. Under federal law, insurers cannot deny you coverage during that window, and they must offer you the best available rates regardless of your health.

If you’re shopping for a Medigap plan outside of this window, you can be turned down or charged more for a pre-existing condition, unless you live in a state that offers extra consumer protections.

TIME Health Care

California Battles Worst Whooping Cough Epidemic in 70 years

Officials blame poor vaccine introduced in the 1990s for rise in cases

SAN DIEGO — California officials are battling the worst whooping cough epidemic to hit the state in seven decades as a recent rebound in cases raises questions about the effectiveness of the pertussis vaccine.

Doctors emphasize that the inoculation has led to fewer deaths than in the past and in instances where people do get sick, their illnesses aren’t as severe. But California officials say the limited protection of the vaccine introduced in the 1990s has led to the rise in cases. Research has shown it doesn’t last as long as the one it replaced, and a new study suggests the vaccine may not prevent the spread of the disease.

Whooping cough peaks every three to five years, and California’s last epidemic was in 2010. But despite an aggressive public health campaign in response, the current outbreak is worse.

A total of 9,935 cases were reported to the California Department of Public Health from Jan. 1 to Nov. 26 — the highest number in 70 years. The cases included one infant who died. Elementary, middle and high school outbreaks have occurred across the state.

The bacterial infection causes uncontrollable, violent coughing, which often makes it hard to breathe. People often take deep breaths which result in a “whooping” sound.

San Diego County is among the hardest hit areas with 1,819 cases reported so far this year.

“We’d have to go way back to the 1940s to find more cases,” said Dr. Eric McDonald, medical director of the epidemiology and immunization branch for public health services in San Diego County.

That’s when whooping cough was common, causing hundreds of thousands of illnesses annually and thousands of deaths. But after a vaccine was introduced in the 1940s, cases dropped to fewer than 5,000 a year.

That vaccine was replaced in the 1990s because of side effects, which included pain and swelling from the shot and fever. The newer vaccine is part of routine childhood vaccinations as well as adult booster shots.

Last year was the nation’s worst year for whooping cough in six decades— U.S. health officials received reports of more than 48,000 cases, including 18 deaths. This year the number of reported cases nationwide dropped to about 20,000.

After the 2010 epidemic, California launched a campaign about the importance of rapid diagnosis and treatment, especially in young infants. The state also started providing free vaccines for children, pregnant and postpartum women.

Dr. Gil Chavez, epidemiologist with the California Department of Public Health, said while more people, especially pregnant women, need to get vaccinated, he does not believe low inoculation rates are the primary cause of the current epidemic: Of this year’s pediatric cases that had information on the child’s vaccination history, only 10 percent of those infected in 2014 had not been vaccinated against pertussis.

Chavez says the new vaccine’s limitations and better tests have led to the increase in cases.

Cases are likely to continue going up as doctors do a better job at detecting the illness, officials say.

More than two years ago, Kathryn Riffenburg, who lives outside Boston, said doctors told her that her newborn son, Brady, likely had a cold. A week and a half later, she took him to the emergency room as he struggled to breathe.

By the time, he was diagnosed with pertussis it was too late to save the 2-month-old boy.

“It made us angry, because we felt more should have been done,” said Riffenburg, who know advocates for pregnant women and anyone else in contact with infants to get vaccinated.

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