How Your Health Insurance Company Can Still Screw You, Despite Obamacare

No law has done more to reform health insurance and protect consumers against the industry's most heinous practices than the Affordable Care Act. But Obamacare didn't magically transform insurers into benevolent entities solely devoted to taking care of sick people.

Health insurance companies, even those that are not-for-profit, have to collect more money in premiums than they shell out in claims for medical care. That means they have a financial incentive not to pay for things.

And since health insurance companies can no longer shun the sick to maximize profits -- either by denying coverage to people based on their medical histories or by rescinding the policies of paying customers who fall ill and rack up bills -- insurers are employing other tactics to shift costs to sick people and make it harder to get health care, consumer advocates say.

"One of the things that occurred to me, even as the bill was working its way through Congress, was that once it was passed, insurers would do all they could to try to preserve profit margins," said Wendell Potter, a former Cigna executive turned industry critic.

Here are a few of the tactics that consumers and advocates have complained about:

Refusing to pay for medical care that should be covered

Nothing in Obamacare says insurance companies have to pay any bill that comes their way. That's fine, because doctors and patients want things all the time that are wasteful and unnecessary, and everyone shares the cost for that.

But it means the law doesn't prevent stuff like this from happening:

"Coverage denied...doesn't meet criteria for medical necessity". I WOULD CALL SAVING MY HUSBAND'S LIFE A MEDICAL NECESSITY YOU FUCKERS

— Zoe Keating (@zoecello) May 28, 2014

Zoë Keating is a musician with more than 1 million followers on Twitter. Her husband, Jeffrey Rusch, had been diagnosed with cancer at the emergency room, hospitalized and given chemotherapy. The insurance company refused to cover it -- until Keating told her story to a San Francisco television station, according to reports on KPIX.

While the Affordable Care Act beefed up patients' right to appeal denials by insurance companies, people still have to fight, which is to the insurer's advantage. "A lot of people just simply don't understand their appeals rights and don't appeal, or think that they just don't have a chance of getting something overturned," Potter said. "The insurance companies know that." Most people don't have a million Twitter followers, either.

Making patients pick up a bigger share of the bill

To keep premiums as low as possible, insurance companies are pushing more of the cost of actual care on to their customers in the form of things like high deductibles and "coinsurance," which requires patients to pay a percentage of the cost of their care, instead of making a flat copayment.

"Okay, Ashley, you've got diabetes, so you have to pay half the tab. Oh, and Brittany had a second glass of wine."

And it's virtually impossible to learn in advance how much medical care will actually cost, meaning patients are left in the dark.

"What this means for someone with cancer is that they may end up being directed away from a plan because they can't find out whether their doctor is in the network, or whether the plan covers their drugs, on what tier and how much they have to pay out of pocket," said Kirsten Sloan, senior director policy at the American Cancer Society Cancer Action Network. Sending a cancer patient to a competitor would count as a win in the insurance industry.

Designing benefits to make the sickest patients pay more for drugs

Advocates for patients with serious medical conditions have been incensed by the practice of "tiered" drug lists, which have become a popular way for insurers to limit their expenses. Under this mechanism, the amount patients pay at the pharmacy is generally lower for cheap generic medicines and "preferred" brand-name drugs, higher for other brand-name drugs and higher still for the most expensive specialty medications.

The good stuff is always on a high shelf. Almost got it!

High cost-sharing and top-tier status for drugs that treat ailments like HIV and multiple sclerosis are common in insurance policies bought via the Obamacare exchanges, the consulting firm Avalere Health reported last month. That looks an awful lot like insurers discriminating against sick people, the AIDS Institute claimed in a complaint filed against four Florida insurers with the federal government in May.

"Where we've seen the problems is putting every single HIV drug, including generics, on the highest tier, and that with very high coinsurance, like 40 or 50 percent," said Carl Schmid, deputy executive director of the AIDS Institute. "There's plenty of plans in Florida that don't do this, and charge $10, $20 a copay for the same drugs."

Limiting access to doctors and hospitals

Health insurance plans sold via Obamacare exchanges often have "narrow networks," or shorter lists of medical providers that accept those plans than people with job-based insurance or Medicare might expect. Insurers need to keep costs down, and tough negotiating with high-priced doctors and hospitals can do that. This ends up saving the whole health care system money, including insurance customers.

The trouble is, when those networks don't include enough of the specialty care providers that take care of the sickest, most expensive patients -- like, say, cancer centers -- it has the effect of denying care to those very sick people because they can't get appointments.

"Sorry, bro. Not on the list."

"Insurers might try to avoid people with HIV or cancer or expensive conditions by avoiding the doctors that tend to treat those people, but otherwise their network looks robust," said Karen Pollitz, a senior fellow at the Henry J. Kaiser Family Foundation. "Whether it's happening -- no way to know yet." The Obama administration and state regulators are poised to take action to compel insurers to beef up their networks, The New York Times reported.

Rolling out the red tape

To save money, insurance companies will be stricter about approving and paying for medical treatments, said Carmen Balber, executive director of the nonprofit organization Consumer Watchdog. "I have no doubt that claims denials or delays will be the new discriminatory tactic of the industry," she said.

In Seattle, one doctor said she has to work harder to get treatments approved this year. "There are more hoops that the provider has to jump through," said Grace Wang, the medical director of the International Community Health Services Holly Park Medical and Dental Clinic.

"We'll gladly pay your claim -- after you perform a death-defying escape, Houdini."

Wang returned to the clinic after Memorial Day weekend and attempted to follow up on a request she'd made to refer a patient to a specialist. The insurance company said her request already had been rejected because she hadn't called back quickly enough.

"Their clock started ticking on Sunday. Monday was a national holiday, and so when 48 hours went by, they denied," said Wang. "A conspiracy theorist would wonder."

Subway Worker Claims She Was Forced To Work While Vomiting

A Subway worker in Freeport, Texas, claims she was forced to continue working her shift while suffering from a stomach bug, then was fired the same day.

Elizabeth Taff, 24, says she was so sick she could barely stand up straight and vomited several times during her shift on July 11, but her manager refused to let her leave unless she found someone to cover her shift.

"About 40 minutes into my shift I felt nauseous. My mouth started watering, and I knew I was about to vomit. I ran into the restroom and vomited repeatedly," Taff told The Huffington Post. "I went and let my manager know, [but] she told me to find my own replacement after lunch rush."

Taff says she then summoned enough strength to get through the lunch rush, hoping to track down another employee to fill in for her. But no one else was available, she said.

She noticed vomit on her work clothes and, rather than take a pay cut for a new work shirt, phoned home for someone to bring her a clean outfit, she said. She also maintains she didn't leave work for fear of getting fired and losing her paycheck.

This is a common dilemma facing many hourly wage workers. Because paid sick leave largely doesn't exist in the food service industry, workers may risk their health and the health of customers by coming in to work when they should be staying home. A 2011 survey conducted in part by the Centers for Disease Control and Prevention revealed almost 12 percent of 500 food workers had come in to work while suffering vomiting or diarrhea on two or more shifts in the previous year.

Speaking to local news outlet KPRC, Taff expressed concern for the impact her sickness could have had on customers.

"I was touching everybody’s sandwiches," she said. "I’m like, ‘This ain’t right.’ I had gloves on but that doesn’t matter."

Ultimately, though, she was fired that day. Subway asserts the decision was due to her "poor performance and insubordination," reports KPRC.

Taff remembers it differently.

"I was on my knees [on the grass outside the restaurant], while [the manager] berated me with remarks such as 'you're so stupid, if you cant handle working while feeling ill you don't need to work here, all you had to do was switch shirts and finish your shift,'" Taff told HuffPost. "She told me I was fired since I was unable to talk, due to vomiting all over the place."

Employees from a nearby business rushed to Taff's aid when they saw her reeling on the ground behind the fast-food restaurant. Taff said she eventually passed out, and one of the employees who came to her side called an ambulance.

(Story continues below.)

Employees from a nearby business came to Taff's side.

"When the [ambulance] arrived, they [the emergency medical technicians] were livid and wanted to know why [my boss] had kept me there for so long," Taff told HuffPost.

Later, one of the employees who had attended to her took to Facebook to post a photo of Taff lying on her side in the grass behind the restaurant. The photo's caption reads:

If you planned on eatin Freeport Subway today i'd advice you not to. I witnessed an employee vomiting and her manager tellin her just to switch shirts..after calling ems it was discovered she had been breathing and serving food with a stomach bug that is contagious!!!!! Then they had the nerve to fire her for calling the ambulance after shaking and passing out!! Sad part she didn't call them, we did [all sic].

According to the Food and Drug Administration's Food Code, the person in charge of a food establishment shall "exclude or restrict a food employee from a food establishment" if they exhibit symptoms including vomiting or diarrhea. Taff's story highlights a kink in the fast-food chain's enforcement of proper food handling safety and adds to a growing list of labor violations against the company. Between 2000 and 2013, the franchise was found to have committed 17,000 Fair Labor Standards Act violations, resulting in a $3.8 million payout to workers, CNN Money reports.

Taff says she hopes her story will fuel change in workplace standards.

"I'm hoping what comes of this whole situation is a new law or better training on workplace etiquette," she told HuffPost.

UPDATE: 4:30 p.m. -- Subway forwarded The Huffington Post a statement from the Freeport franchisee, Dinesh Agrawa, who said that Taff's "allegations are not true."

A rep for Subway also commented on the situation:

The Freeport franchisee, who owns and operates his locations independently, as do all franchisees in our system, worked with his store management team to review all of the circumstances surrounding staffing matters and ensured us that all employee relations protocols were followed.

Someone Left A Loaded Gun In A Walmart Bathroom

Walmart could be the next battleground in the fight over gun rights in retail chains after a loaded revolver was found in the bathroom of a South Carolina store.

On the afternoon of Saturday, July 12, a man with a concealed carry permit left his gray Smith & Wesson revolver, loaded with five live .38 caliber rounds, atop the toilet paper dispenser in a stall of the rear men's bathroom of a York, South Carolina Walmart, according to a police report.

The gun was returned to its owner on Monday, York police Captain Brian Trail told The Huffington Post.

York police provided photos of the gun and bullets to The Huffington Post. Trail said the station's camera was recently reset and the date in the bottom right corner had not yet been updated.

Although a growing number of corporations have taken a stance against guns in their stores, Walmart has declined to follow suit.

"Our policy is to comply with all state, federal and local laws as it pertains to carrying firearms," Walmart spokesman Brian Nick told HuffPost on Thursday. "We're not considering any changes at this time."

Walmart -- the world's largest retailer, and the nation's biggest seller of firearms -- is no stranger to gun trouble. Last month, two shooters went on a rampage that ended in a Las Vegas Walmart, where shopper Robert Wilcox, 31, was killed after he engaged one of the gunmen with the concealed pistol he carried. In April, a narcotics officer was shot outside a Walmart in New Jersey. And in a similar restroom incident, this one in 2012, a man in Mesa, Arizona accidentally fired a shot in the bathroom of a Walmart after he dropped his gun.

The York incident also comes just a few weeks after a loaded handgun was found in the toy aisle of a Target store in Myrtle Beach, South Carolina, roughly four hours southeast of York.

Moms Demand Action for Gun Sense in America, the social media-savvy gun-control group that recently pressured Chipotle, Sonic and Chili's into adopting no-gun policies, amplified the Myrtle Beach story nationally.

Weeks later, Target caved to mounting pressure from the group and announced a national policy of asking customers not to bring firearms in its stores. Difficult to enforce, the new rule is seen by many as a largely symbolic move.

A spokeswoman for Moms Demand Action did not immediately respond to a request for comment Thursday.

In gun-friendly South Carolina, Target and Walmart play opposite characters in a tale of two big-box retailers.

"Target has fashioned itself as the place you go if you're a savvy, cosmopolitan shopper," Saul Cornell, a Fordham University professor and legal historian of firearm regulation, told HuffPost. "Walmart has cultivated more of a folksy, all-American persona."

Headquartered in Minneapolis, Target is "part of the progressive Midwest," said Cornell. Arkansas-based Walmart, on the other hand, is deeply entrenched in the South, where, over the last quarter-century, the National Rifle Association has propagated a strong Second Amendment orthodoxy.

"This is an interesting one, to see if the Moms' social media campaign can crack South Carolina and crack Walmart," Cornell said. "It's an uphill battle, but if they could, that would be monumental."

Reporter Whose Rant Helped Launch Tea Party Gets Put In His Place

The CNBC reporter whose rant helped launch America's tea party movement was told off Monday amid -- what else -- one of his epic rants.

As Rick Santelli shouted from the floor of the Chicago Board of Trade against the Federal Reserve's policies on "Fast Money Halftime Report," CNBC reporter Steve Liesman took him down a peg.

"It's impossible for you to have been more wrong, Rick," Liesman said. "Your call for inflation, the destruction of the dollar, the failure of the U.S. economy to rebound... The higher interest rates never came, the inability of the U.S. to sell bonds never happened, the dollar never crashed Rick, there isn't a single one that's worked for you."

“I wasn’t wrong on inflation," Santelli declared. "I didn’t know policy would be so bad that we’d get no velocity after five-and-a-half years.”

TIME explained Santelli's argument in its deconstruction of the on-screen fight:

By velocity, he basically means that no one is spending money, even though the Fed’s QE program has, in a sense “printed” a lot of it. Santelli has claimed before that he didn’t actually predict high inflation. As Business Insider has pointed out, the record says otherwise.

"Every single bit of advice you gave would've lost people money," Liesman told Santelli. "There is no piece of advice you've given that's worked."

Click here to watch the full CNBC video.

Hobby Lobby Wants To Control Which Bathroom A Transgender Woman Can Use, Too

Meggan Sommerville

In the days after the Supreme Court handed Hobby Lobby a sweeping victory in its fight to not provide employee health insurance that covers certain kinds of birth control, many customers came into the store in Aurora, Illinois, where Meggan Sommerville works, and offered their congratulations.

Hobby Lobby is a chain of craft stores whose founder says he tries to run the company in accordance with his Christian principles. Sommerville has worked there for 16 years. She loves her job and the store, which she said pays a good wage and carries supplies that she’s used for many of her own crafting projects.

Still, the congratulations from customers were hard to swallow. "I'd smile and nod and say, 'Yes, it's a victory for the company,' and then I'd push my real feelings down and not think about it anymore."

Sommerville is a transgender woman, and back in 2011, she filed a complaint against Hobby Lobby with the Illinois Department of Human Rights after the company refused to allow her to use the women's bathroom either as a customer or an employee.

She was never given an explanation. But Sommerville said she sees a connection with Hobby Lobby's argument that Christian principles should excuse it from covering some contraceptives.

"I don't believe that any company has the right to deny access to appropriate medical care, same as the reason why I don't believe that they have the right to deny me access to the washroom," she said in a recent phone call with The Huffington Post. "No company has the right to dictate what is decided between me and my doctor."

Sommerville transitioned to living as a woman in 2010. For the most part, colleagues and management were supportive, trying their best to use her new name and the right pronoun. That summer, she formally changed her name in court and received a new Social Security card and driver's license. A month later, Hobby Lobby provided her with a new name tag that finally matched how she saw herself.

But management refused to budge on one issue: They insisted that Sommerville continue to use the men's restroom. According to Sommerville, she was told she would only be allowed to use the women's restroom if she provided proof that she had undergone genital reconstructive surgery. Neither the state of Illinois nor the federal government require this surgery for a person to legally change his or her gender.

"I was devastated," Sommerville said. "I just want to be treated like all the other women. To do anything else diminishes who I am in the eyes of customers and employees."

Going to the bathroom became an embarrassing ordeal, where she was constantly worried about outing herself to customers or colleagues who didn't know her history. "There have been a few times when a customer has come in and I have essentially been trapped in the stall while I wait for the person to leave," she said. "The stories of trans women that have come under attack are always on my mind when I am forced to use the men's room. At the very least, I don't want to make a scene."

Sommerville's human rights complaint alleges that the company discriminated against her and "subjected her to unequal terms and conditions due to her gender identity." Through a representative, Hobby Lobby declined to comment on her case, which is still awaiting a ruling from the Illinois Human Rights Commission.

Hobby Lobby has not argued that religious principles influenced its refusal to allow Sommerville to use the women's bathroom. But her lawyer, Jacob Meister, pointed to a recent Salon.com article on how Hobby Lobby, its executives and affiliated companies are pouring millions of dollars into organizations and causes that seek to advance conservative Christian values and oppose lesbian, gay, bisexual and transgender rights.

"I think the facts speak for themselves. Hobby Lobby has very actively sought to impose what it believes the law should be wherever possible, and it has thrown a lot of money behind these efforts," Meister said.

"I have absolutely no possible explanation for why they would so flagrantly ignore what's very clear in Illinois law," Meister continued. "Meggan is a female, she's been full-time for many years, and they will not allow her to use the women's restroom, which is something that is afforded to every female employee that they have except for Meggan, every female customer they have except for transgender folk."

In the weeks since the Supreme Court's June 30 ruling in Burwell v. Hobby Lobby Stores, LGBT advocates and legal experts have picked over Justice Samuel Alito Jr.'s majority opinion, trying to gauge whether it gives corporations or institutions with religious affiliations carte blanche to discriminate against LGBT individuals.

Ilona Turner, legal director at the Transgender Law Center, said she thinks that it does not. Still, she said, "I could imagine that employers will attempt nonetheless to try to push the boundaries of that decision, to argue that their religious values give them a right to discriminate."

Sommerville's issue is one of the most common faced by transgender people in the workplace, Turner said. While religion is not often mentioned explicitly in connection with lawsuits arising from similar scenarios, it is often "in the background," she said.

Last year, California passed a law allowing transgender students to use facilities and participate in programs in accordance with their gender identity. That has fueled fears among conservative Christian groups that the rest of the states would soon follow.

After Phoenix, Arizona, passed a similar law in February 2013, Joseph LaRue, a lawyer with the Alliance Defending Freedom, a national Christian legal organization, wrote a blog post calling the measure "appalling" and arguing that it "provided voyeurs and other sexual predators easy access to the places where children and women are most vulnerable." According to Salon, the Alliance Defending Freedom is one of the groups heavily funded by Hobby Lobby profits.

Sommerville, a Christian herself, hopes that her human rights complaint may help change the culture at Hobby Lobby, at least on this particular issue. "I think any time somebody stands up for their rights to be respected, to be treated equally, it can make a change."

Apple Patent Hints The 'iPhone 6' Will Be Made Of Indestructible Glass

A new Apple patent gives more weight to rumors that the next iPhone will be made of a nearly indestructible type of glass.

Apple won a patent this week for “fused glass device housings," a new method of fusing together pieces of glass, which could be used to make casings for devices like the iPhone and iPad, Apple Insider reports.

The patent award comes amid rumors that the front panel of Apple's next phone, which may or may not be called the "iPhone 6," will be built with a super-durable substance known as sapphire glass. Tech vlogger Marques Brownlee on Monday uploaded a YouTube video demonstrating just how unbreakable iPhone's sapphire-glass front could be. Brownlee scratched it with a knife and a set of keys and bent it to more than 90 degrees under his shoe, all without leaving a mark.

The new patent suggests that the entire "iPhone 6" outer casing could be made of sapphire glass, Apple Insider points out. Apple applied a while back for a patent for "sapphire laminates," a hint it was trying to figure out how to use sapphire glass to make casings.

According to the new patent, Apple has figured out a way to build an all-glass device that would still be durable and lightweight, essentially by fusing multiple pieces of glass together rather than designing casings out of a single slab. Rough sketches from the filing show how the glass can be fused together to create boxy or rounded casings, with cutouts for buttons and charger ports.

This drawing from the patent filing shows an electronic device and supporting stand made of the fused glass casing.

A frontal view of an "an illustrative portable electronic device such as a cellular telephone," according to the patent.

A sketch of a media player with the fused glass casing.

The patent, which can be viewed in full here, lists Apple Senior Vice President of Design Jonathan Ive as one of the inventors. It was filed in January 2012 but was only awarded on Tuesday.

A sapphire-glass casing could ease fears about Apple returning to the famously breakable glass construction of the iPhone 4 and 4S (it switched to metal bodies for the 5 and 5S).

If the piece of glass Brownlee tested actually was a prototype of a new iPhone's sapphire-glass front panel, it appears to be a vast improvement on the shatter-prone Gorilla Glass that Apple has long used. Apple may be betting that sapphire glass can offer both the aesthetic pleasure of early iPhones and the durability of the newer ones.

No guarantees, but butterfingered Apple fans might want to be cautiously optimistic.

Read an excerpt from the patent filing below:

Washington Is Just Hours Away From Legalized Recreational Pot

SEATTLE (AP) — Washington state issued its first retail marijuana licenses Monday a day ahead of the start of legal sales, and 21 hours before the only store licensed to sell in Seattle was set to open, a line was already forming.

At Cannabis City, where the owner wasn't planning to open his doors until noon Tuesday, a 65-year-old retiree named Deb Greene, showed up just before 3 p.m. Monday. She had a chair, sleeping bag, food, water and a 930-page book.

"I voted for it, and I'm just so excited to see it come to be in my lifetime," she said. "I'm not a heavy user, I'm just proud of our state for giving this a try."

The start of legal pot sales in Washington Tuesday marks a major step that's been 20 months in the making. Washington and Colorado stunned much of the world by voting in November 2012 to legalize marijuana for adults over 21, and to create state-licensed systems for growing, selling and taxing the pot. Sales began in Colorado on Jan. 1.

Businesses including Cannabis City, which will be the first and, for now, only recreational marijuana shop in Seattle, got word early Monday morning from the state that they were licensed marijuana dealers.

Owner James Lathrop had already worked into the night Sunday placing no-parking signs in front of his building, hoisting a grand-opening banner and hanging artwork.

"I've had a long day. It really hasn't sunk in yet," he said.

In a 2:30 a.m. Pacific time interview with The Associated Press, John Evich, an investor in Bellingham's Top Shelf Cannabis, which will also open Tuesday morning, said they were "pretty stoked."

"We haven't had any sleep in a long time, but we're excited for the next step," Evich said.

Randy Simmons, the state Liquor Control Board's project manager for legal marijuana, said the first two dozen stores were notified so early to give them an extra few hours to get cannabis on their shelves before they are allowed to open their doors at 8 a.m. Tuesday. The store openings are expected to be accompanied by high prices, shortages and celebration.

An AP survey of the licensees showed that only about six planned to open Tuesday, including two stores in Bellingham, one in Seattle, one in Spokane, one in Prosser and one in Kelso. Some were set to open later this week or next, while others said it could be a month or more before they could acquire marijuana to sell.

Officials eventually expect to have more than 300 recreational pot shops across the state.

As soon as the stores were notified Monday, they began working to place their orders with some of the state's first licensed growers. As soon as the orders were received, via state-approved software for tracking the bar-coded pot, the growers could place the product in a required 24-hour "quarantine" before shipping it early Tuesday morning.

The final days before sales have been frenetic for growers and retailers alike. Lathrop and his team hired an events company to provide crowd control, arranged for a food truck and free water for those who might spend hours waiting outside, and rented portable toilets to keep his customers from burdening nearby businesses with requests to use the restrooms.

At Nine Point Growth Industries, a marijuana grower in Bremerton, owner Gregory Stewart said he and his director celebrated after they worked through some glitches in the pot-tracking software early Monday and officially learned they'd be able to transport their weed 24 hours later, at 2:22 a.m. Tuesday.

"It's the middle of the night and we're standing here doing high-fives and our version of a happy dance," he said. "It's huge for us."

Pot prices were expected to reach $25 a gram or higher on the first day of sales — twice what people pay in the state's unregulated medical marijuana dispensaries. That was largely due to the short supply of legally produced pot in the state. Although more than 2,600 people applied to become licensed growers, fewer than 100 have been approved — and only about a dozen were ready to harvest by early this month.

Nevertheless, Evich said his shop in Bellingham wanted to thank the state's residents for voting for the law by offering $10 grams of one cannabis strain to the first 50 or 100 customers. The other strains would be priced between $12 and $25, he said.

The store will be open at 8 a.m. Tuesday, he said, but work remained: trimming the bathroom door, cleaning the floors, wiping dust off the walls and, of course, stocking the shelves.

At Cannabis City, despite the line already beginning to form, Lathrop wasn't planning to open before noon.

"Know your audience: We're talking stoners here," he said. "I'd be mean to say they need to get up at 5 a.m. to get in line."

___

Follow Johnson at https://twitter.com/GeneAPseattle

Foster Farms Recalls Chicken Linked To Salmonella Outbreak

LOS ANGELES (AP) — A California chicken producer has issued its first recall since being linked to an outbreak of an antibiotic-resistant strain of salmonella that has been making people sick for more than a year, company and federal food officials said Thursday night.

The U.S. Department of Food and Agriculture said it has found evidence directly linking Foster Farms boneless-skinless chicken breast to a case of Salmonella Heidelberg, an antibiotic-resistant strain of the disease that has sickened more than 500 people in the past 16 months and led to pressure from food safety advocates for federal action against the company.

As a result, Foster Farms issued a recall for 170 different chicken products that came from its Fresno facilities in March.

The USDA said its investigators first learned of the salmonella case on June 23, and the recall was issued as soon as the direct link was confirmed. The location of the case and identity of the person were not released.

Foster Farms says the products have "use or freeze by" dates from March 21 to March 29 and have been distributed to California, Hawaii, Washington, Arizona, Nevada, Idaho, Utah, Oregon and Alaska.

The long list of products in the recall include drumsticks, thighs, chicken tenders and livers. Most are sold with the Foster Farms label but some have the labels FoodMaxx, Kroger, Safeway, Savemart, Valbest and Sunland. No fresh products currently in grocery stores are involved.

The USDA said it was working with the company to determine the total amount of chicken affected by the recall.

The company emphasized that the recall was based on a single case and a single product but the broad recall is being issued in an abundance of caution.

"Our first concern is always the health and safety of the people who enjoy our products, and we stand committed to doing our part to enhance the safety of our nation's food supply," Foster Farms said in a statement.

The federal Centers for Disease Control says 574 people from 27 states and Puerto Rico have been sickened since the outbreak began in 2013, leading to increasing pressure from food safety advocates for a recall or even an outright shutdown of Foster Farms facilities.

Bill Marler, a Seattle attorney who specializes in class-action food-safety lawsuits, commended both Foster Farms and the USDA for "doing the right thing for food safety."

"Recalling product is both embarrassing and hard, but is the right thing to do for your customers," Marler said.

The company was linked to previous salmonella illnesses in 2004 and in 2012.

Recalls of poultry contaminated with salmonella are tricky because the law allows raw chicken to have a certain amount of salmonella — a rule that consumer advocates have long lobbied to change. Because salmonella is so prevalent in poultry and is killed if consumers cook it properly, the government has not declared it to be an "adulterant," or illegal, in meat, as is E. coli.

In a letter from USDA to Foster Farms last October, the department said inspectors had documented "fecal material on carcasses" along with "poor sanitary dressing practices, insanitary food contact surfaces, insanitary nonfood contact surfaces and direct product contamination."

Foster Farms said in May that it had put new measures in place, including tighter screening of birds, improved safety on the farms where the birds are raised and better sanitation in its plants.