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White House chief of staff John Kelly will be leaving his position at the end of the year, President Donald Trump told reporters at the White House on Saturday afternoon.CNN on Friday reported that Kelly was expected to announce his departure in the coming days."John Kelly will be leaving at the end of the year," Trump told reporters before departing the White House for the Army-Navy game.Trump noted Kelly had been with him for almost two years in his roles as chief of staff and secretary of homeland security."I appreciate his service very much," Trump said.Seventeen months in, Kelly and Trump have reached a stalemate in their relationship, which is no longer seen as tenable by either of them, CNN has reported. Though Trump asked Kelly over the summer to stay on as chief of staff for two more years, the two have stopped speaking in recent days.CNN reported on Friday that Trump had been discussing a replacement plan. Potential replacements include Vice President Mike Pence's chief of staff, Nick Ayers, who is still seen as a leading contender. 1071

With health care costs on the rise, a growing number of Americans are throwing out the old way of seeing a doctor and turning to a membership model. A monthly or annual fee gets you direct access to a doctor, no insurance needed.Twenty years into her career, bogged down by red tape, too many patients and long days, Dr. Shaila Pai-Verma was looking for a better way to practice medicine.“I was just miserable,” she said. “The joy of medicine is gone and then you're just doing paperwork.”So, a year ago, she started a new primary care practice with a new business model.“The patient basically has a direct contract with the physician and they take insurance companies out of it,” she explained.Patients pay a flat monthly or yearly fee. In exchange, they receive a broad range of primary care services and quick, unlimited access to their doctor via in-person office visits, phone or by text.“Everyone wants everything immediate. And so, I think this is it. It's good, especially in this time for people to have access,” said Pai-Verma.Membership fees range from about 5 to 0 per month on average – about 0 less than having typical health insurance. Most patients still carry catastrophic coverage for emergency treatments and hospitalizations, but that insurance is usually only -100 a month, so patients still save money.For Bonnie Micheli and her family, it was all about access.“With this, it's just so much easier to just know that I can contact directly here within a few hours for any issues that I'm having,” said Micheli.In late September, a bipartisan proposal was introduced in Congress that would expand access to the model and allow people to use their health savings account for direct primary care (DPC).Because they see fewer patients than traditional practices, some critics say the model could worsen the shortage of primary care physicians, a trend that’s already driven by burnout.But according to a recent study, DPC members had 25% lower hospital admissions and the cost of emergency room claims was reduced by 54%.“There's less ER visits and you know, better health care for the patient,” said Pai-Verma.While there is still debate, for a growing number of Americans, like Micheli, it’s becoming a simplified health insurance alternative.“Honestly, it’s just so nice to know what I'm paying every month or if you do the annual, what you're getting for that money, and you know exactly who to go to when you have a problem.” 2467

When he was diagnosed with two autoimmune diseases, Joel Hechler knew he’d be in for a battle. He didn’t realize maybe his toughest one would be with his insurance company.“I think they put the dollars ahead of a patient’s health,” Hechler said. “I don’t think they fully understand the impact the medicine will have on my long-term health and well-being."Hechler suffers from Crohn’s disease and ulcerative colitis, diseases that attack the lining of his digestive tract. Autoimmune conditions like his can’t be cured but, with the right medication, the symptoms can be controlled.  Finding the right medicine can be hard for those suffering from autoimmune diseases. Even if there are scores of drugs on the market, some patients might only respond to one. In Joel’s case, his doctor thought he’d have a better chance trying a drug called Remicade.“I received a letter from my insurance company that denied the Remicade on the basis that I have to try a different drug before I can get to Remicade," Hechler said.Hechler's insurance company, Premera Blue Cross, wouldn’t approve the drug his doctor prescribed because they wanted him to try a cheaper one first.It’s part of a program that health insurers nationwide use called step therapy, requiring that patients try less-costly drugs before “stepping up” to more expensive ones — even if doctors believes the cheaper drug won’t work.Dr. Larry Adler is president of Huron Gastro in Ypsilanti, Michigan and says he spends virtually every day battling insurance companies over step therapy drugs.“They have to fail this medicine first before they get the new drug,” Adler said. “That doesn’t make any sense.”Adler says it's common for patients to get sicker while waiting for step therapy to run its course.In Hechler's case, it took six weeks of fighting with his insurer to convince them that the cheaper drug wouldn’t be effective. As he was waiting, he was getting worse.“It got to the point where I had to be admitted to the hospital,” Hechler said. "I was very, very sick.”Step therapies are used by insurers to try to control skyrocketing prescription medicine costs, says Glen Perry, Director of Pharmacy Contracting and Sales for Blue Cross Blue Shield of Michigan.“These drugs can cost up to 0,000 per year. These are not cheap medications,” Perry said.“It seems like you’re telling patients that, in many cases, your insurer knows what’s best for you, rather than your doctor,” Jones said.“We are trying to provide the most cost effective and safe medication use,” Perry said, adding that when a doctor and insurer disagree over a drug, they can usually resolve the case within a few days without putting a patient at serious risk.“A delay of one or two days I don’t think is really going to make that much of a difference for the medical outcome of the patient," he said.But for many patients, like Phyllis Toole, the delay is longer than a few days.Phyllis suffers from rheumatoid arthritis, a condition where her body attacks her joints. When her doctor wanted to put her on Orencia, her insurance company HAP said she needed to first try a less expensive drug, Humira.But Phyllis’ doctor was worried about possible side effects and thought Humira could be risky.After battling for months, Phyllis says the whole thing made her feel more like a number than a patient. With her doctor and insurer in a standoff, she was forced to rely on samples of the drug she got from her doctor. HAP never approved her prescription.“They’re playing doctor, is what it feels like,” Toole said. “They’re saying this is what you can have for the symptoms you have. It may make you sicker, but this is what you can have.”HAP issued the following statement to Scripps station WXYZ in Detroit: 3800

When Linda Beigel Schulman heard that a geography teacher was among the victims of the Parkland shooting, she knew it was her son. And she knew she had to be with him.Schulman, her husband and her brother rushed to look for flights out of the New York area. They couldn't find an open seat with a commercial airline, so they called Talon Air, a charter jet company, to fly to Scott's side.The company's clients include Martha Stewart and Lebron James, according to their website."I had no idea what the charge was at the time. It really didn't matter what the charge was," she told CNN. "I was convinced in my mind that my son was in the hospital and I needed to get to him as fast as possible."What Schulman did not expect, however, was that she would be charged an additional ,000 for the empty plane's return to New York the next day, bumping the bill up to a total of ,459.13 dollars.Once she landed, Schulman learned her son, Scott J. Beigel, had died that February day after unlocking his classroom door to allow students to seek shelter. He was one of the 17 people who lost their lives after Nikolas Cruz opened fire in the halls of Marjory Stoneman Douglas High School.The family promptly paid the whole amount with funds from Scott's life insurance policy. But they asked Talon Air to reconsider the return flight charge since they did not travel back on the plane. The company refunded ,000 dollars and told them it was all they could do. 1475

When students of Marjory Stoneman Douglas return to class after spring break next week, they'll be required to carry clear backpacks.The move is meant to ramp up security measures after last month's deadly shooting and a series of breaches since then."Clear backpacks are the only backpacks that will be permitted on campus," said Broward County School Superintendent Robert Runcie said in a letter sent to parents. 423