Friday, March 29, 2013
Thursday, March 21, 2013
Obama health law anniversary finds two Americas - Yahoo! News
Obama health law anniversary finds two Americas - Yahoo! News
WASHINGTON (AP) — Three years, two elections, and one Supreme Court decision after President Barack Obama signed the Affordable Care Act, its promise of health care for the uninsured may be delayed or undercut in much of the country because of entrenched opposition from many Republican state leaders.
In half the states, mainly led by Democrats, officials are racing deadlines to connect uninsured residents to coverage now only months away. In others it's as if "Obamacare" — signed Mar. 23, 2010 — had never passed.
Make no mistake, the federal government will step in and create new insurance markets in the 26 mostly red states declining to run their own. Just like the state-run markets in mostly Democratic-led states, the feds will start signing up customers Oct. 1 for coverage effective Jan. 1. But they need a broad cross-section of people, or else the pool will be stuck with what the government calls the "sick and worried" — the costliest patients.
Insurance markets, or exchanges, are one prong of Obama's law, providing subsidized private coverage for middle-class households who currently can't get their own. The other major piece is a Medicaid expansion to serve more low-income people. And at least 13 states have already indicated they will not agree to that.
"It could look like two or three different countries," said Robert Blendon, a Harvard School of Public Health professor who studies public opinion on health care. "The political culture of a state is going to play an important role in getting millions of people to voluntarily sign up."
Civic leadership — from governors, legislators, mayors and business and religious groups — is shaping up as a huge factor in the launch of Obama's plan, particularly since the penalty for ignoring the law's requirement to get coverage is as low as $95 the first year.
People-to-people contacts will be key, and the potential for patchwork results is real.
"Obviously it's a possibility in terms of there being some real difficulties," said Sen. Bob Casey, D-Pa., whose efforts helped pass the law. Casey also said he believes the Obama administration will be ready to lead in states holding back.
Disparities already are cropping up.
Town Meeting Day — the first Tuesday in March — is a storied tradition in Vermont, and this year it provided a platform to educate residents about their options under the health care law. As many as 250,000 may eventually get coverage through Vermont Health Connect, as the state's marketplace is known.
"Even before we were a state, these town meetings existed," said Sean Sheehan, director of education and outreach. "It's a way people come together as a community, and we are counting on those community connections to get the word out." The health care plan was on the agenda at about 100 town meetings, and other local gatherings are taking place.
Texas residents are entitled to the same benefits as Vermonters, but in the state with the highest proportion of its population uninsured, Gov. Rick Perry will not be promoting the federal insurance exchange, a spokeswoman said. Nor does Perry plan to expand Medicaid.
The result is a communications void that civic and political groups, mayors, insurers and hospitals will try to fill.
"You have people who aren't really charged up about it because they don't even know that they would qualify," said Durrel Douglas, spokesman for the Texas Organizing Project, an activist group. A national poll this week by the nonpartisan Kaiser Family Foundation found that two of every three uninsured people don't know enough about the law to understand how it will affect them.
Supporters of Obama's law in Texas say the federal government hasn't shown up yet to launch the state's insurance exchange and no one is sure when that will happen.
"It is a much bigger lift here," said Anne Dunkelberg, associate director of the Austin-based Center for Public Policy Priorities, which advocates for low-income people. "The sooner the federal exchange can get engaged and working with all the folks here who want to promote enrollment, the better."
The Congressional Budget Office predicts a slow start overall, with only 7 million gaining coverage through the exchanges next year, rising to 24 million in 2016.
At a recent insurance industry meeting, federal officials directing the rollout rattled off a dizzying list of deadlines. Public outreach will begin in earnest this summer and early fall, said Gary Cohen, head of the Center for Consumer Information and Insurance Oversight.
The government sees three main groups of potential customers for the new insurance markets, he said.
There's the "active sick and worried," people who are uninsured or have pre-existing medical conditions. Under the law, insurers will no longer be able to turn the sick away.
There's the healthy and young. "They feel invincible, they don't feel a need for health insurance," said Cohen.
Finally, there's the passive and unengaged. "For these people, a significant education effort needs to happen," he said.
To keep premiums affordable, the government will need to sign up lots of people from the last two groups to balance those in poor health, who will have a strong motivation to join.
The official heading consumer outreach for the rollout, Julie Bataille, acknowledges the challenge but says she's confident.
"This is a really an enormous opportunity for us to change the conversation around health care and help individuals understand the benefits they can get," she said.
Monday, March 18, 2013
Weighty Matters: Is Sugar a Worse Offender Than Fat?
Weighty Matters: Is Sugar a Worse Offender Than Fat?
(HealthCastle.com) In the battle of the bulge, fat has historically been perceived as the enemy. As we learn that not all types of fats are created equal, the culprit now more often mentioned is added sugar. How much added sugar is in the American diet? 2010 USDA estimates put the consumption level at a staggering 132 lbs of sweeteners per year per person (66 lbs of cane sugar, 64.5 lbs of corn-derived sweeteners, and 1.5 lbs of honey or other edible syrups).
Where to Find Added Sugars in the Diet
Clearly, we aren't shoveling in mouthfuls of sugar, honey, or corn syrup daily to get to such a high level of consumption. So where is all this sugar coming from? A 2013 study in the Journal of the Academy of Nutrition and Dietetics looked at the consumption patterns of sugar-sweetened beverages (excluding artificial sweeteners) from several cycles of the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2008 and found the following:
- Soda is still a major contributor of sugar, although the overall prevalence of consumption has declined.
- An increasing amount of sugar is being consumed through sports/energy drinks, particularly among adolescents (12 to 19 years old). Alarmingly, the prevalence of sports/energy drinks tripled during the time period studied.
- The prevalence of sugar-sweetened beverages increased among children. Heavy consumption is defined as contributing up to 500 kcal/day.
- Among some subgroups, there was a significant increase in the consumption of sweetened fruit drinks.
In addition to added sugars coming from sweetened beverages, added sugar has also found its way into many processed goods, such as cakes, cookies, ready-to-bake mixes, and commercial desserts, as well as breakfast cereals, energy bars, granola bars, and pre-packaged snacks.
What Does Excessive Sugar Intake Do?
Using the USDA estimates of 132 lbs of sugar per person per year, this translates to 3/4 cup of added sugar, or 580 kcal per day! This level of consumption will set you up for a pound-a-week rate of weight gain. Besides contributing excess calories that lead to weight gain over time, high sugar intake may have metabolic effects. Another study looking at children aged 3 to 11 participating in the NHANES found that increased consumption of sugar-sweetened beverages was associated with increased C-reactive protein concentrations, increased waist circumference, and decreased HDL ("good" cholesterol) levels. These are all markers for cardiovascular disease risk.
How Much Weight Can be Lost by Cutting Sugar?
The actual impact of cutting sugar intake will vary from one individual to the next. In a February 2013 article in the Journal of the Academy of Nutrition and Dietetics, U.S. researchers estimated that switching from sugar-sweetened drinks or flavored milk to plain low-fat (1%) milk or water between meals saved an average of 205 kcal per day from a child's daily intake. That's almost half a pound of weight loss each week!
The Bottom Line
Be on the lookout for added sugar in the foods you eat and your beverage choices. Better yet, make it a point to prepare your foods and drinks yourself (including smoothies) to manage how much sweetener you add.
Interestingly, the temperature of what you drink may influence your perception of sweetness. Drinking beverages that are room temperature or hot may intensify the perception of sweetness, which may help decrease the amount of sugar needed. A 2012 study jointly conducted by researchers at University of Arkansas and the French National School of Agricultural Science and Engineering evaluated the "sensory intensity" and overall liking of two different foods: dark chocolate and cheddar cheese. They gave volunteers water to drink at different temperatures (iced, room temperature, or hot) and then rated the volunteers' perception of the foods. They found that ice cold water decreased the perception of sweetness, creaminess, and "chocolateyness" of the dark chocolate.
Friday, March 15, 2013
Employers Blast Fees From New Health Law - Yahoo! Finance
Employers Blast Fees From New Health Law - Yahoo! Finance
Insurance companies, which helped put the fee in the law, say the fee is essential to prevent rates from skyrocketing when insurers get an influx of unhealthy customers next year. The fee is part of a new insurance landscape created by the health law that will forbid insurers from denying coverage to people with pre-existing conditions.
Employers are bracing for a little-noticed fee in the federal health-care law that will charge them $63 for each person they insure next year, one of the clearest cost increases companies face when the law takes full effect.
Companies and other plan providers will together pay $25 billion over three years to create a fund for insurance companies to offset the cost of covering people with high medical bills.
The fees will hit most large U.S. employers, and several have been lobbying to change the program, contending the levy is unfair because it subsidizes individually purchased plans that won't cover their workers. Boeing Co. and a union health plan covering retirees of General Motors, Ford Motor Co. and Chrysler, among other groups, have asked federal regulators to exclude or shield their insurance recipients from the fee.
Insurance companies, which helped put the fee in the law, say the fee is essential to prevent rates from skyrocketing when insurers get an influx of unhealthy customers next year. The fee is part of a new insurance landscape created by the health law that will forbid insurers from denying coverage to people with pre-existing conditions.The $63 fee will apply to plans covering millions of Americans in 2014. It applies to employers that assume the risk for workers' medical bills, and many private plans sold by insurers. The fee will be smaller for 2015 and 2016, though regulators haven't set those amounts.
Few noticed the fee when the 2010 Affordable Care Act passed. Employers have spent recent months trying to peel it back, but final regulations published Monday in the Federal Register left it largely intact.
"It's caught most employers, if not all employers, by surprise," said Steve Wojcik, vice president of public policy at the National Business Group on Health in Washington, which represents large employers. "They're very upset about it."
The fee comes on top of other costs employers expect to face. Proponents of the law say it eventually will lower employers' health costs by expanding insurance coverage to 30 million Americans, meaning employers won't subsidize their unpaid medical bills.
Administrators for employee health plans have warned federal regulators they could pare insurance benefits to absorb the fee. Some benefits experts expect employers will at least partially pass on the $63 to workers.
Boeing estimates the fee will apply to about 405,000 workers and dependents it insures, costing the Chicago-based plane maker an estimated $25 million in 2014. The company spends $2.5 billion annually on health and insurance-related benefits.
Doug Kight, a Boeing vice president of strategy, compensation and benefits, told Health and Human Services Secretary Kathleen Sebelius in a December letter the aircraft maker was "concerned about the significant cost impact" of the fee. Among other things, he effectively asked her to reduce the levy to account for the fact that Boeing's workers aren't part of the insurance system that can tap the reimbursement fund.
The UAW Retiree Medical Benefits Trust, which covers 806,000 retirees of General Motors, Ford, Chrysler and their dependents, asked HHS to exempt all its beneficiaries from the levy. It argued the trust, which is independent from the auto makers, shouldn't face the fee because its plans operate under terms set in federal district and bankruptcy courts in 2009.
The top lobbying groups for large employers, including the U.S. Chamber of Commerce and the Business Roundtable, also voiced concerns about the fee and asked regulators to delay its collection.
In the regulations published Monday, HHS declined to whittle down the levy for firms such as Boeing, citing the law's requirements. It said the fee wouldn't apply to the plans of retirees whose primary coverage is Medicare, which would exclude many retired autoworkers, but it declined to categorically exempt workers in court-structured benefits plans.
A Boeing spokesman said the final regulations don't appear to address the major issues it raised with regulators. A spokeswoman for the UAW trust declined to comment.
Federal regulators say they have heeded employers' complaints about the fee and tweaked details of the program. They opted to collect the levy nationally instead of through each state, moved the collection date to the end of next year and calculated the fee on a per capita basis instead of as a percentage of premiums.
"We've tried to really work with the employers and issuers in trying to make the application of this program as least burdensome as possible," said Michael Hash, director of the HHS Office of Health Reform.
In 2014, insurers will be able to tap part of the $25 billion to offset medical costs from high-risk individual-market consumers that total between $60,000 and $250,000 a year. Employers and other insurance issuers will pay $63 in 2014 for every worker, spouse, child and certain retirees they cover.
Of the fees collected, $20 billion will go toward paying high medical claims. HHS says the remaining $5 billion will be used to retroactively offset an earlier program that reimbursed employers insuring early retirees through 2011. Under that program, Boeing received $50 million and the UAW trust received $387 million, according to a federal summary of the payouts.
A Boeing spokesman said the retiree program "was not advertised as a program prefunded by the government to be paid back at a later time," and that the law's net financial impact on Boeing is negative. The UAW trust declined to comment.
HHS says the high-risk program will lower premiums for people who buy plans through the individual insurance market by between 10% and 15%. For insurance plans overall, the fee is expected to raise premiums next year by about 1%, and less in the subsequent two years of the program.
Insurance companies defend the fees, saying they will indirectly benefit employers. Companies subsidize the cost of caring for the uninsured by paying higher medical and insurance prices for workers. Moving high-risk consumers into insurance policies will minimize that problem, they say.
These uninsured "had been the individuals going to the emergency room," said Karen Ignagni, president of America's Health Insurance Plans, an insurer trade group in Washington. "The employers definitely were picking that up."
Other health plans that tried and failed to win a federal exemption from the fee include so-called multiemployer insurance plans, jointly run by unions and employers. About 20 million Americans are covered by such plans.
Thursday, March 14, 2013
Study: Radiation for breast cancer can harm hearts - Yahoo! News
Study: Radiation for breast cancer can harm hearts - Yahoo! News
Women treated with radiation for breast cancer are more likely to develop heart problems later, even with the lower doses used today, troubling new research suggests. The risk comes from any amount of radiation, starts five years after treatment and lasts for decades, doctors found.
Patients shouldn't panic — radiation has improved cancer survival, and that is the top priority, doctors say. The chance of suffering a radiation-induced heart problem is fairly small.
For example, 4 to 5 of every 100 women who are 50 years old and free of heart risks will develop a major cardiac problem by age 80, and radiation treatment would add one more case, the research suggests.
Women also can do a lot to cut their risk by keeping weight, cholesterol and blood pressure under control.
Still, the study reveals that the potential harm from radiation runs deeper than many medical experts may have realized, especially for women who already have cardiac risk factors such as diabetes.
And it comes amid greater awareness of overtreatment — that many women are being treated for cancers that would never prove fatal, leading to trouble down the road such as heart disease.
Some chemotherapy drugs are known to harm the heart muscle, but the new study shows radiation can hurt arteries, making them prone to harden and clog and cause a heart attack. Women who receive both treatments have both types of risk.
The study "will raise the antenna" about the need to do more to prevent this, said Dr. David Slosky, a cardiologist at Vanderbilt University, one of the growing number of medical centers with special "cardio-oncology" programs for cancer survivors.
With today's lower radiation doses, "it is less of a problem, but it is not going away," he said.
The artery-related problems that the study tracked may be just the most visible of many risks because radiation also can cause valve, rhythm and other heart troubles, said Dr. Javid Moslehi. He is co-director of the cardio-oncology program at the Dana-Farber Cancer Institute in Boston.
Like cancer, heart disease develops after "a number of strikes that go against you," such as high cholesterol, he said. "The radiation is just another hit."
He wrote in an editorial that appears with the study in Thursday's New England Journal of Medicine. British government agencies and private foundations paid for the research.
Breast cancer is the most common cancer in women — more than a million cases are diagnosed each year worldwide. When it's confined to the breast, most women get surgery to remove the lump, followed by several weeks of radiation to kill any lingering cancer cells and sometimes hormone or chemotherapy.
What heart disease risks come from what specific doses isn't known. The new study, led by Dr. Sarah Darby of the University of Oxford in England, sought to measure that.
It involved 2,168 breast cancer patients from Sweden and Denmark diagnosed between 1958 and 2001 and treated with radiation. They included 963 women who suffered a heart attack, needed an artery-opening procedure or died of heart artery-related causes in the years after their radiation treatment. The other 1,205 were similar patients who did not develop these heart problems.
Researchers compared the women's radiation exposures using gray units, a measure of how much is absorbed by the body. They used hospital records and treatment plans to figure how many gray units actually reached each woman's heart and one artery often involved in heart attacks.
Most women treated today get doses that result in 1 to 5 gray units reaching the heart — more if the cancer is in the left breast. Patients in the study got an average of five gray units; the doses ranged from 1 to 28.
The risk of a heart attack, need for an artery-opening procedure or dying of heart disease rose about 7 percent per gray unit and no "safe" level was seen. The risk started to rise within five years of treatment and continued for at least 20 years.
What to do?
Don't forgo radiation if it's recommended because it is lifesaving and doctors increasingly have ways to shield the heart from exposure, said Dr. Bruce Haffty, associate director of the Cancer Institute of New Jersey and president-elect of ASTRO, the American Society for Radiation Oncology.
"Whatever cardiac risks may be there, they are outweighed by the cancer benefit," he said.
Some centers have special tables that women lie on face-down with holes for the breast to hang through. That allows radiation to be delivered just to that tissue rather than the wider chest area that gets irradiated when a woman lies face-up on a table.
Women need to tell any doctor treating them about radiation they have received in the past. It may mean they should avoid diagnostic tests that use radiation and instead have ultrasounds and MRI, or magnetic resonance imaging, whenever possible, Slosky said.
Some places are starting to use electronic medical records to track radiation exposure over a patient's lifetime, so the cumulative dose is known regardless of who ordered what test and when.
"I'd like to have a personal record like a personal dosimeter" for each patient, Slosky said. "Then you'd know" what risks they face and what tests are safe for them in the future.
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