Category Archives: Child & Youth Health

Firearm retailers join with King County to promote safe gun storage

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GunFrom Public Health – Seattle & King County: 

New research into youth firearm deaths in King County has prompted a partnership with ten national and local retailers to promote the secure storage of guns as a means of preventing deadly shootings.

“Gun violence is a public safety crisis. It is also a public health crisis, and I directed our staff to develop innovative strategies to reduce gun violence using a data-driven public health approach,” said King County Executive Dow Constantine. “The evidence is clear: Safe storage can save lives.”

The “Safe Storage Saves Lives” campaign, developed by Public Health – Seattle & King County, also includes 20 participating law enforcement agencies.

The new data is contained in a report released today by Public Health – Seattle & King County, The Impact of Firearms on King County’s Children: 1999 – 2012, which documents the current risk of suicides and accidental shootings in King County and urges local leaders to promote safe storage:

  • More than 30,000 King County homes have a loaded and unlocked firearm.
  • More than 5,000 of King County’s children live in homes where firearms are loaded and unlocked.
  • The risk of a youth suicide in King County is nine times higher in homes where firearms are kept unlocked, compared to homes where firearms are locked.

“Protecting our communities from gun violence is one of our top priorities. Making it easier for people to safely store a gun helps us reach that goal,” said Seattle Mayor Mike McGinn.

How the partnership will reach out to gun owners

The “Safe Storage Saves Lives” campaign features the LOK-IT-UP website and key partners who will expand the use of safes and lockboxes:

  • Retailers will offer 10 to 15 percent discounts on select firearm-storage devices when they mention LOK-IT-UP or Public Health from November 25, 2013 through the end of 2014. Retailers will also distribute information about how to store a firearm safely.
  • Law enforcement agencies will promote locking devices to anyone seeking a Concealed Pistol License or visiting their customer service desks. Officers and deputies will also promote safe storage at community events.

“We are thrilled to have firearm retailers involved in the safety message, and we hope this partnership helps change the norms around storing firearms,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County.

Participating retailers include national chains such as Sports Authority and Costco, along with prominent local stores.

“We are glad to partner with King County to offer reduced-price safe-storage devices to make it easier for gun owners to make their homes and communities safer – and protect their investment, too,” said Mike Coombs, co-owner of Outdoor Emporium, Sportco and FARWEST Sports.

A secure lockbox can prevent thefts as well as suicides. Last year, more than $4.5 million worth of firearms were reported stolen in Washington state, according to the Washington State Association of Sheriffs and Police Chiefs.

“It’s time for lockboxes and gun safes to become as normal as wearing a seatbelt – which would reduce firearm thefts and prevent school-based threats. That improves community safety,” said King County Sheriff John Urquhart.

Law enforcement officers all too often are the first-responders who witness tragedy when firearms are left loaded and unlocked – and a curious or impulsive child is nearby.

“I have never forgotten when I responded to a 9-1-1 call and found a boy had unintentionally shot and killed his best friend with a rifle they were playing with and thought was unloaded,” said Bothell Police Chief Carol Cummings. “What was so tragic to me was that this death could have been averted by safely storing the firearm.”

Developing innovative strategies using a data-driven public health approach

In his State of the County address earlier this year, Executive Constantine directed Public Health – Seattle & King County to develop innovative strategies to reduce gun violence using a data-driven “public health approach,” a process that’s proven effective with other safety and prevention challenges, such as automobile and boating safety. Key facts from the report include:

  • Between 1999 and 2012, 68 children in King County under the age of 18 died from gun violence, and 25 of those were suicides.
  • Another 125 children were injured by firearms and had to be hospitalized.
  • In King County, nearly one-quarter of all households have at least one firearm, and among those with firearms, an estimated 17% (31,200 households) stored them loaded and unlocked.
  • During the 2011–2012 school year, 52 King County students were suspended or expelled for possessing a firearm on public school grounds.

The report also finds that further progress on reducing firearm violence is hampered by scattered and incomplete data on gun violence, especially pertaining to children.  Basing new policies and programs on data and evidence will depend on creating new systems for sharing data across agencies.

In the meantime, the report says safe storage is an important first step toward eliminating firearm deaths among King County’s youth. Research has shown that parents can become complacent as their children get older and don’t realize it could be their child or a friend who accesses their firearms.

“We want gun retailers to talk as much about safe-storage as a car dealer talks about the air-bags and safety features in a new car,” said Dr. Fleming.

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Teens and steroids: a dangerous combo

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anabolic steroids DEA

Contraband anabolic steroids seized by the Drug Enforcement Agency. (Photo: DEA)

US Food and Drug Administration
Consumer Update

The abuse of anabolic steroids can cause both temporary and permanent injury to anyone using them.

Teenagers, whose bodies are still developing, are at heightened risk. An alarming number of them are trying steroids in hopes of improving their athletic prowess or their appearance.

Ali Mohamadi, M.D., a medical officer in the Food and Drug Administration’s Division of Metabolism and Endocrinology Products, warns teens and parents about the dangers of steroid use.

Q: What are anabolic steroids and how many teens use them?

A: They are drugs that mimic the actions of the male sex hormone testosterone. This includes promoting the growth of cells, especially in muscle, and maintaining or increasing male physical characteristics. Various studies have been conducted and generally reflect the findings of a Youth Risk and Behavior Surveillance System study, which estimated that among U.S. high school students, 4.9% of males and 2.4% of females have used anabolic steroids at least once in their lives. That’s 375,000 young men and 175,000 young women.

Q. What are the side effects of taking anabolic steroids?

A: They are known to have a range of serious adverse effects on many organ systems, and in many cases the damage is not reversible. They include fertility problems, impotence, high blood pressure and cholesterol, and heart and liver abnormalities. Boys may experience shrinkage of the testes or the development of breast tissue; girls may experience menstrual irregularities and development of masculine qualities such as facial and body hair. Both may experience acne. Both boys and girls may also experience mood swings and aggressive behavior, which can impact the lives not only of those taking steroids, but of everyone around them.

Q: Are prescriptions needed to get steroids?

A: Yes, in fact anabolic steroids are classified as Schedule III Controlled Substances by the U.S. Drug Enforcement Administration with strict regulations, meaning that not only is a prescription required, but there are extra controls. For example, it is illegal to possess them without a prescription in the United States, and in most circumstances the prescription must be in written form and cannot be called in to a pharmacist. Labels on some steroids recommend testing of hormone levels during use.

The number of FDA-approved uses is limited. Most are prescribed as a replacement for sub-normal levels of steroids. They are also prescribed for conditions such as muscle wasting, poor wound healing, and very specific pulmonary or bone marrow disorders.

A health care professional can prescribe steroids off-label, meaning for conditions other than those that are FDA-approved. But children, particularly teens, are getting access to steroids and taking them for reasons far outside of their intended use.

Q: So how are teens getting access?

A: Some get prescriptions from a licensed practitioner for such purposes as introducing puberty to boys who are “late bloomers” or to stimulate growth among teens who are failing to grow. Some may be dealing with unscrupulous clinics or street dealers on the black market. Unfortunately, a number of vendors sell anabolic steroids online without a prescription. Individuals should also be aware that some dietary supplements advertised for body building may unlawfully include steroids or steroid-like substances, and the ingredient statement on the label may not include that information.

Q: What is the FDA doing to prevent those illegal sales?

A: FDA is taking a number of steps to discourage these practices. Action has been taken against illegal online distributors who sell steroids without valid prescriptions, but an ongoing problem is that you can take one site down and another pops up.

The challenge is intensified by the fact that many online providers don’t accurately advertise the contents of the products they sell, they may be operating outside the U.S., and the drugs aren’t prescribed by a licensed practitioner who can help individuals weigh the risks and benefits. In such cases, individuals may have no idea what they are taking, what the appropriate dose should be, or what levels of control and safety went into the manufacturing process. These facts make the risks of taking anabolic steroids bought without a prescription even greater than they otherwise would be.

Q: What would you say to a teen you knew was tempted by steroids?

A: I would emphasize both the short and long-term potential for serious harm to their health. Rather than making you look or perform better, steroids will more likely cause unfavorable results that could affect you for life. I would also remind them that there are a number of ways to increase muscle mass and athletic performance, including a sensible regimen of exercise and diet, without resorting to extreme and dangerous therapies.

Q: What would you like to say to parents?

A: Parents tend not to believe their teens would consider taking anabolic steroids, but the truth is that the frequency of steroid use in this age group is far greater than many would guess.

During this time of year, when children are in school and getting back into their athletic routines, parents should watch for potential signs of abuse. Mood swings are among the first side effects to show up, and steroid use may lead to mania or depression. Acne is also an early side effect and can be followed by breast development in boys or increased body hair in girls. A surprising gain of muscle mass should also raise questions. It’s a problem that is as real as it is surprising.

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Nov. 4, 2013

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Pedestrian injuries on the rise amongst teens due to inattention

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Walklight_phasesFrom the Washington State Department of Health

Inattention can be just as dangerous for pedestrians as it is for drivers. And as more teens tune into music, text, and check the Internet while on the go, they’re tuning out potential hazards — prompting the state Department of Health to ask kids to tune out those devices.

Nationally, pedestrian injuries among 16 to 19-year-olds have increased 25 percent in the past five years according to Safe Kids, which works to prevent accidental injuries to children. That late-teen group accounts for half of all pedestrian deaths among youths 19 and younger.

A new Safe Kids study of more than 34,000 middle and high school students showed that of those who were distracted, about 40 percent were texting, about 40 percent were wearing headphones, and 20 percent were talking on phones.

From 2006 to 2010, the most recent period for which figures are available, Washington had 43 teen pedestrian deaths, ranking number 18 among the 37 states with more than 10 such deaths. It’s close to the national per capita average.

“Those texts and calls can wait, and kids can listen to music at other times,” said State Health Officer Dr. Maxine Hayes, a pediatrician. “It’s more important to walk safely. And if you’re driving, of course, keep your eyes on the road and your hands on the wheel.”

With daylight saving time nearing an end for the year, it’s darker outside when many teens go to or from school. That makes it even more important to pay close attention while walking.

Safe Kids Washington suggests that parents talk to kids, especially teens, about the danger of distracted walking. Start the discussion early about safe use of technology — and keep talking about it. Parents can set a good example by showing what crossing the street safely looks like, and by avoiding texting while driving and other distractions.

Teens should put devices down and turn headphones off; look, listen, and make eye contact with drivers before crossing a street. They should also be on the lookout for cars that are turning or backing up. Driveways and parking lots can be especially dangerous.

Other safety tips for teens while walking:

  • Use sidewalks or paths, and cross at street corners with traffic signals and crosswalks when possible.
  • Be aware of others who may be distracted — and speak up when you see someone who is distracted.

Some Washington kids already get the message. The Rams in Action Club at Lacey’s North Thurston High School won the Safe Kids Worldwide Pedestrian Safety high school contest for its members’ work to educate peers.

Illustration courtesy of Brett Caven

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Public Health – Seattle & King County offers free flu shot clinics – Saturday, Nov. 2nd

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Flu virus - courtesy of NAIAD

Public Health – Seattle & King County is offering free flu vaccination clinics on Saturday, November 2 to make flu vaccine more widely available to people without health insurance or who are unable to pay.

“Flu vaccine offers the single best protection against the flu,” said Dr. Jeff Duchin, Chief of Communicable Disease Epidemiology & Immunization for Public Health – Seattle & King County. “Getting vaccinated is especially important for pregnant women, people in contact with infants who are too young to vaccinate, and also to people with health conditions that put them at greater risk for severe illness and hospitalization.”

Health experts recommend flu vaccine for all people six months and older, especially for pregnant women and people who have long-term health problems, like diabetes, asthma, and heart or lung problems.

Anyone who lives with or cares for an infant younger than six months should also get vaccinated to protect the infant from getting flu.

Where to get free vaccine

The free flu vaccination clinics will be held at Public Health Centers at the following locations on Saturday, November 2 from 10 a.m. to 1 p.m.:

Columbia Public Health Center

4400 37th Ave S, Seattle, 206-296-4650

Eastgate Public Health Center

14350 SE Eastgate Way, Bellevue, 206-296-4920

Federal Way Public Health Center

33431 13th Place S, Federal Way, 206-296-8410

Renton Public Health Center

3001 NE 4th St., Renton, 206-296-4700

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‘Lucky 13′ tips for a safe Halloween

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Bats across the moon

A Consumer Update from the US Food and Drug Administration

Whether you’re goblin or ghoul, vampire or witch, poor costume choices—including decorative contact lenses and flammable costumes—and face paint allergies can haunt you long after Halloween if they cause injury.

Enjoy a safe and happy Halloween by following the “lucky 13” guidelines from FDA, the Consumer Product Safety Commission, and the Centers for Disease Control and Prevention:

Photo Credit: Lynne Lancaster

  1. Wear costumes made of fire-retardant materials; look for “flame resistant” on the label. If you make your costume, use flame-resistant fabrics such as polyester or nylon
  2. Wear bright, reflective costumes or add strips of reflective tape so you’ll be more visible; make sure the costumes aren’t so long that you’re in danger of tripping.
  3. Wear makeup and hats rather than masks that can obscure your vision.
  4. Test the makeup you plan to use by putting a small amount on the arm of the person who will be wearing it a couple of days in advance. If a rash, redness, swelling, or other signs of irritation develop where the makeup was applied, that’s a sign of a possible allergy.
  5. Check FDA’s list of color additives to see if makeup additives are FDA approved. If they aren’t approved for their intended use, don’t use it.
  6. Don’t wear decorative contact lenses unless you have seen an eye care professional and gotten a proper lens fitting and instructions for using the lenses.

Safe Treats

Eating sweet treats is also a big part of the fun on Halloween. If you’re trick-or-treating, health and safety experts say you should remember these tips:

  1. Don’t eat candy until it has been inspected at home.
  2. Trick-or-treaters should eat a snack before heading out, so they won’t be tempted to nibble on treats that haven’t been inspected.
  3. Tell children not to accept—or eat—anything that isn’t commercially wrapped.
  4. Parents of very young children should remove any choking hazards such as gum, peanuts, hard candies, or small toys.
  5. Inspect commercially wrapped treats for signs of tampering, such as an unusual appearance or discoloration, tiny pinholes, or tears in wrappers. Throw away anything that looks suspicious.

For partygoers and party throwers, FDA recommends the following tips for two seasonal favorites:

  1. Look for the warning label to avoid juice that hasn’t been pasteurized or otherwise processed, especially packaged juice products that may have been made on site. When in doubt, ask! Always ask if you are unsure if a juice product is pasteurized or not. Normally, the juice found in your grocer’s frozen food case, refrigerated section, or on the shelf in boxes, bottles, or cans is pasteurized.
  2. Before bobbing for apples—a favorite Halloween game—reduce the amount of bacteria that might be on apples by thoroughly rinsing them under cool running water. As an added precaution, use a produce brush to remove surface dirt.

Eye Safety

FDA joins eye care professionals—including the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the Contact Lens Association of Ophthalmologists and the American Optometric Association—in discouraging consumers from using decorative contact lenses.

These experts warn that buying any kind of contact lenses without an examination and a prescription from an eye care professional can cause serious eye disorders and infections, which may lead to permanent vision loss. Despite the fact that it’s illegal to sell decorative contact lenses without a valid prescription, FDA says the lenses are sold on the Internet and in retail shops and salons—particularly around Halloween.

The decorative lenses make the wearer’s eyes appear to glow in the dark, create the illusion of vertical “cat eyes,” or change the wearer’s eye color.

“Although unauthorized use of decorative contact lenses is a concern year-round, Halloween is the time when people may be inclined to use them, perhaps as costume accessories,” says FDA eye expert Bernard Lepri, O.D., M.S., M.Ed.. “What troubles us is when they are bought and used without a valid prescription, without the involvement of a qualified eye care professional, or without appropriate follow-up care. This can lead to significant risks of eye injuries, including blindness.”

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Posted October 19, 2011; reviewed October 24, 2013

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I don’t have children, so why do I have to buy pediatric dental insurance?

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Question marksBy Michelle Andrews

Q: My husband is self-employed and currently has an individual plan. I recently received a letter that said that he must purchase pediatric dental insurance, and if he doesn’t provide proof that he has it they will automatically enroll him in a plan. We don’t have children, so why would we have to have pediatric dental insurance?

A. Under the health care law, starting in January new individual and small-group health plans must cover 10 so-called essential health benefits. The list of required benefits was developed following a process that solicited input from consumer groups and members of the public, employers, states, insurers, and medical and policy experts.

The final list reflects a core package of benefits that it was determined everyone should have access to, even though most people may not use every single benefit. It includes hospitalization and prescription drugs, maternity and newborn care, mental health and substance abuse services, emergency care and doctor visits, as well as pediatric services, including vision and dental services for children.

Pediatric dental coverage is sometimes offered as part of a regular health plan, but it’s also often sold on a standalone basis. So even though the health law requires that children in individual and small group plans have access to dental coverage, people are not required to buy separate pediatric dental coverage if they buy a plan on the state health insurance marketplaces, or exchanges, unless their state specifically requires it.

But people who buy plans outside the state marketplace may not have the same flexibility, says Colin Reusch, a senior policy analyst at the Children’s Dental Health Project.

Outside the exchange, “There’s no exemption for that requirement to have pediatric dental coverage,” he says. “So if you’re buying insurance outside the exchange you may have to meet it.”

It sounds as if your husband’s plan is a non-exchange plan. If that’s the case, he could shop for a plan on the exchange if he wants to avoid buying pediatric dental coverage.

Please send comments or ideas for future topics for the Insuring Your Health column toquestions@kaiserhealthnews.org. We regret that we can’t respond to individual requests for health insurance advice or information. Please visit healthcare.gov to locate a health insurance expert in your area.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Polio eradication within out reach – Infographic from the CDC

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Description of Infographic

The Time to Eradicate Polio is Now.

  • Worldwide in 2012, there were 223 polio cases in 3 endemic countries. Worldwide in 1988, there were 350,000 polio cases in 125 endemic countries.
  • Year and Polio Cases:
    1988: 350,000
    1989: 261,000
    1990: 233,000
    1991: 134,000
    1992: 137,000
    1993: 76,000
    1994: 73,000
    1995: 60,000
    1996: 33,000
    1997: 18,000
    1998: 10,000
    1999: 10,000
    2000: 4,000
    2001: 548
    2002: 1,922
    2003: 784
    2004: 1,258
    2005: 2,033
    2006: 2,022
    2007: 1,387
    2008: 1,732
    2009: 1,782
    2010: 1,409
    2011: 650
    2012: 223
  • Children still need to be vaccinated against polio. If we were to stop our current vaccination efforts, within a decade we would see a resurgence of polio that could paralyze more than 200,000 children worldwide every year.
  • Since 1988, polio vaccine has prevented more than 10 million cases of paralysis.
  • Since 1988, more than 500,000 deaths from polio have been prevented.
  • The economic benefits of polio eradication are $40-50 billion through the year 2035 – over 80% of these savings will be in developing countries.
  • The net benefit of other services such as vitamin A delivery alongside polio vaccination: up to $90 billion in additional savings and the prevention of up to 5.4 million child deaths.
  • Polio eradication is within our reach. It will save money. It will prevent disability. It will save lives.
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Understanding obesity in children – AHRQ summary for parents

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Kids 1From the US Agency for Healthcare Research and Quality

How do I know if my child is at a healthy weight?

young boy on scaleYour child’s doctor will track your child’s height and weight over time and can tell you if your child is at a healthy weight. During wellness checkups, be sure to talk with your child’s doctor about your child’s weight.

Your child’s doctor may ask you about:

  • Your child’s eating habits
  • Whether you have places to get healthy food for your child
  • How much physical activity your child gets
  • Whether there are safe places for your child to run around and play
  • How much screen time your child has each day (time spent watching television, playing video games, or sitting in front of a computer, cell phone, or tablet such as an iPad)
  • Any health problems your child has
  • Your family’s medical history

What is BMI and what are BMI percentiles?

To find out if your child is in a healthy weight range, your child’s doctor may use something called BMI, or “body mass index.” BMI is a measurement based on your child’s height and weight. BMI helps the doctor estimate how much body fat your child has. The doctor can use BMI to see if your child is at a healthy weight for his or her height. A healthy BMI is different for girls and boys and changes by age.

Your doctor may compare your child’s BMI to the typical BMI range for children of the same sex and age. To do so, doctors may use what is called a “BMI percentile.” This can help the doctor figure out if a child is underweight, at a healthy weight, overweight, or obese.

According to the Centers for Disease Control and Prevention (CDC), children are considered:

  • At a healthy weight if their BMI is between the 5th and 85th percentile
  • Overweight if their BMI is between the 85th and 95th percentile
  • Obese if their BMI is in the 95th percentile or above

To calculate your child’s BMI and BMI percentile, go to http://apps.nccd.cdc.gov/dnpabmi/.

What health problems can being overweight or obese cause for a child?

Children who are overweight or obese are more likely to be overweight or obese as adults. They are also more likely to develop serious health problems such as:

  • High blood sugar or diabetes
  • High blood pressure
  • High cholesterol (a type of fat in the blood)
  • Sleep apnea (a condition in which you stop breathing for brief periods of time while you sleep)
  • Heart problems (such as heart attack or heart failure) or a stroke as an adult
  • Extra pressure on bones and joints, which could lead to bone and joint problems both as a child and as an adult
  • Nonalcoholic fatty liver disease (a disease caused by too much fat in the liver)
  • Low self-esteem or depression
  • Eating disorders such as binge eating and purging

What might lead to a child becoming overweight or obese?

Many things can lead to a child becoming overweight or obese, including:

  • Unhealthy eating habits. Children may eat too much, eat too many unhealthy foods, or drink too many sugary drinks.
  • Not getting enough sleep. Children who do not get enough sleep each night are more likely to become overweight.
  • Family history. Children from overweight families may be more likely to become overweight. This could be due to a child’s genes or learned family eating habits.
  • Not enough physical activity. Children may not get enough physical activity. Children should be active for at least 1 hour each day.
  • Too much screen time. Children may have too much screen time during the day. Some children may eat while watching television or playing on the computer.
  • Environment. Children may spend time in an environment (such as with relatives, with friends, in childcare, or at school) where healthy eating choices or opportunities for physical activity are not available.Keeping Your Child From Becoming Overweight or Obese

How can I keep my child from becoming overweight or obese?

To help keep your child from becoming overweight or obese, make sure your child eats healthy and is physically active. There are many things that can be done at home, in school, and in the community to help keep children at a healthy weight. Some examples of each are listed below.

At Home

There are many things you can do at home as a family. Some examples include:

Eat healthy
  • Cook healthy meals at home with foods from each food group.
    • The food groups include fruits, vegetables, grains, protein foods (such as meats, eggs, fish, tofu, and beans), and low-fat or nonfat dairy.
  • Be sure to eat a healthy breakfast every day.
  • Eat at the table as a family instead of in front of a screen (television, computer, cell phone, or tablet).
  • Limit or do not keep unhealthy foods and drinks at home.
    • Replace unhealthy snacks such as cookies, candy, or chips with healthy snacks such as fruits and vegetables.
    • Replace unhealthy sugary drinks such as sodas, sports drinks, or juices with healthy drinks such as water and low-fat or nonfat milk.
  • Eat most meals at home instead of at restaurants. At home, you are better able to limit the amount of fat, sugar, and salt in your meals.
  • Be sure to eat the right amount of food.
For more information about healthy foods, eating the right amount, and sample menus, go to http://choosemyplate.gov.
father swimming with his childrenBe physically active
  • Give your child a chance to run around and play – at least 1 hour a day.
  • Plan fun activities like bicycling, walking to the park, playing ball, or swimming.
  • Encourage everyone in the family to be active during the day.
    • For example, take the stairs instead of the elevator and walk or bike places instead of driving or taking the bus.
  • Limit the amount of screen time each day.
  • In addition to being physically active, make sure your child gets enough sleep each night.

Let’s Go! is a program to keep children from becoming obese. The program focuses on healthy eating and physical activity.

Let’s Go! recommends the “5-2-1-0” healthy habits for each day:

  • 5 fruits and vegetables
  • 2 hours or less of screen time for recreation
  • 1 hour or more of physical activity
  • 0 sugary drinks

Let’s Go! also recommends keeping television and computers out of your child’s bedroom and not allowing screen time for children younger than 2 years.

Let’s Go! is a State of Maine program that also supplies resources to communities outside of the State. These graphics and messages are adapted from Let’s Go! at www.letsgo.orgExit Disclaimer

In School

Girl in cafeteria line

In addition to eating healthy and being physically active at home, school programs can help keep children at a healthy weight. School programs could include things such as:

  • Lessons about the importance of healthy eating and physical activity
  • Information sessions for parents to learn ways to help keep their child at a healthy weight
  • Healthy breakfast and lunch options in the cafeteria with the right portion sizes
  • Healthy snacks and drinks in vending machines and at parties and events
  • Filtered water coolers to encourage drinking water instead of soft drinks or sports drinks
  • Adult-led walk-to-school or bike-to-school groups
  • A longer physical education (PE) period in which children are physically active
  • Gym equipment such as balls and jump ropes for use during recess

Let’s Go! also has resources for schools to help children eat healthy and be physically active. For more information and toolkits for your child’s school, go to www.letsgo.org/toolkits/Exit Disclaimer

To find out what your child’s school is doing to help keep children from becoming overweight or obese, talk with your child’s principal, school nurse, or school counselor. You can also ask how to become involved in the school’s Parent-Teacher Association (PTA) or Parent-Teacher Organization (PTO).

In the Community

In addition to home and school, things can also be done in the community to help keep children at a healthy weight. Communities and community centers can:

  • Improve community parks, sidewalks, and biking paths.
  • Take steps to make parks, sidewalks, and biking paths safe.
  • Advertise community events such as health fairs, 5K walks, sports events at local parks, community garden programs, and local farmers markets. This can be done on posters, in local newspapers, and on local television and radio stations.
  • Offer programs in which families can get advice on healthy eating and being physically active.

For other resources to help keep your child at a healthy weight, go to:

For more information about improving parks, sidewalks, and biking paths in your area, contact your local parks and recreation department.

For more information about events or programs in your community, contact your local community or recreation centers (such as the YMCA, Boys and Girls Club, or local religious community centers).

What have researchers found about doing things at home, in school, and in the community to help keep children from becoming overweight or obese?

Healthy eating and physical activity are very important in keeping children from becoming overweight or obese.

Researchers found that:

  • Programs at schools to help children eat healthy and be physically active can keep children from becoming overweight or obese.
  • Along with school programs, additional steps at home and in the community can also help.
  • More research is needed to know which particular programs or steps work the best.
  • Talking With Your Child’s Doctor, School, and Community Centers

Examples of Questions To Ask Your Child’s Doctor

  • Is my child at a healthy weight?
  • What are the most important things for me to do at home to help keep my child at a healthy weight?
  • How can I get my child to eat healthy foods?
  • How much of each type of food should my child eat?
  • How much physical activity does my child need each day?
  • What are the best types of physical activity for my child?
  • How much screen time should I allow my child each day?
  • How much sleep should my child get each night?
  • Do you have any resources that can help me keep my child at a healthy weight?
  • Do you know of any community resources that can help?
  • If there are no grocery stores nearby or healthy food is too expensive for me, do you know of any resources that could help me?
  • If there is no safe place for my child to play outside, how can I help my child stay active?

Examples of Questions To Ask Your Child’s School Principal, Nurse, or Counselor

  • Does the school offer programs to help keep children from becoming overweight or obese? If not, how can we start some?
  • In the cafeteria and in vending machines, are healthy foods such as fruits and vegetables available instead of sugary drinks and salty or fatty foods?
  • How much time is my child given during PE, recess, and throughout the day to be physically active?
  • Does the school ever use PE or other physical activity as punishment?
  • Do you have adult-led walk-to-school or bike-to-school programs or other physical activity programs for children?
  • Are there information sessions that I can attend to learn more about helping my child stay at a healthy weight?
  • What can I do at home to help reinforce what my child is taught about healthy eating and physical activity at school?
  • Do you know of any community resources that can help?

Examples of Questions To Ask Your Local Community or Recreation Center

  • Do you have any resources or programs on healthy eating or physical activities for children?
  • Do you keep a calendar of community events such as health fairs, 5K walks, or sports events at local parks?
  • Do you have a list of local community gardens or farmer’s markets?
  • Do you know of any programs that can give me advice on how to help my family eat healthy and be physically active?Sources

The information in this summary comes from the report Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis, June 2013. The report was produced by the Johns Hopkins University Evidence-based Practice Center through funding by the Agency for Healthcare Research and Quality (AHRQ).

Additional information came from the MedlinePlus® Web site, a service of the National Library of Medicine and the National Institutes of Health. The site is available at www.nlm.nih.gov/medlineplus.

This summary was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX. It was written by Amelia Williamson Smith, M.S., Jason A. Mendoza, M.D., M.P.H., and Michael Fordis, M.D. Parents of children between the ages of 2 and 18 reviewed this summary.

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Dental and vision care part of ‘essential benefits’ for kids – FAQ

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Eye-chartBy Marissa Evans
KHN Staff Writer

One part of the Affordable Care Act is intended to improve dental coverage for children, an extension of effort by public health advocates that followed the 2007 death of a Maryland boy named Deamonte Driver, who was killed by a bacterial infection that spread from an abscessed tooth to his brain.

The 12-year-old’s family was uninsured, and the family had lost its Medicaid coverage. His mother focused on getting his brother’s six rotting teeth taken care of before turning to Deamonte’s dental care, but by then the infection had spread. After two surgeries and weeks of hospital care, he died.

Supporters of better dental care for children fought to have dental and vision services for children included as part of pediatric services, one of 10 categories of essential benefits.

With the Affordable Care Act, more Americans will have the opportunity to purchase dental insurance on the new health care exchanges starting Oct. 1.

Here are some basic questions and answers about dental and vision coverage.

Q. Will I be required to buy pediatric dental care if I purchase insurance on the exchange?

A. Most likely, no. Children’s dental care may be included in some plans offered on the marketplaces as part of the medical coverage you are required to buy.

But many insurers may offer it as a stand-alone policy, which you are not required to buy under byfederal law but may be required by states.

At least two — Nevada and Washington — are requiring this coverage. For children the insurance will help pay for the cost of visits to a dentist for basic or preventive services, like teeth cleaning, X-rays and fillings and medically necessary orthodontics.

Q. Will I be required to buy pediatric vision coverage by the Affordable Care Act?

A. Yes, it will be included in the Medical plan, and at least partially covers vision care, like eye exams and glasses.

Q. Are adults required to get dental coverage?

A. No, but insurers may offer stand-alone dental policies for adults and families. These will not be subsidized, however.

Q. Is it common for health insurers to not offer dental care as part of comprehensive health insurance?

A. Overwhelmingly, dental benefits are contracted and sold separately from medical plans in the current market. The National Association of Dental Plans says 99 percent of dental benefits are sold under a policy that is separate from medical coverage, according to its July 2013 ACA and Dental Coverage report.

Q. How likely are buyers to add stand-alone dental coverage for children to their purchase of a medical policy?

A. It’s hard to say how it will play out. Consumers will be looking for dental plans that best meet their own needs and those of their children at the right price.

If purchased from a federally run exchange as a stand-alone policy, pediatric dental care can include out-of-pocket expenses as high as $700 per child or $1,400 per family, according to Colin Reusch, a senior policy analyst with the Children’s Dental Health Project.

And the cost of stand-alone coverage won’t count toward the medical out-of-pocket limit built into the health care insurance policy, nor will the premium tax credits families receive to help them purchase coverage be calculated to include premiums for stand-alone plans.

Those costs may cause families to go without coverage, advocates fear.

However, the Delta Dental Plans Association notes that stand-alone dental plans are likely to have much lower deductibles than medical plans that also include child dental care, or possibly no deductibles.

They will also have a lower limit on out-of-pocket expenses than plans that combine medical and pediatric dental care.

That might benefit many families, particularly those that include children with acute dental care needs or those who want paid preventive care without waiting to spend enough to meet a higher deductible.

Q. How many children may benefit from expanded coverage?

A. Approximately 8.7 million children are expected to gain some form of dental benefits by 2018 as a result of the ACA. This will reduce the number of children without dental benefits by about 55 percent compared with 2010, according to a report from the American Dental Association.

About a third of these children will be covered through their parents’ employer-sponsored insurance, while about another third will be covered through Medicaid. The remainder will be covered by new policies from  the health insurance exchanges.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Seattle Children’s sues to be included in more of the new health exchange plans

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Seattle Children’s is filing suit to be included in more healthcare plans on Washington’s Health Benefit Exchange.

Here is their press release:

Today, Seattle Children’s Hospital filed suit citing the failure of Washington state’s Office of the Insurance Commissioner (OIC) to ensure adequate network coverage in several Washington’s Health Benefit Exchange (Exchange) plans.

We believe strongly that the OIC and the majority of plans on the Exchange have failed to meet their mandate, as they do not currently cover care provided at Children’s.

Children’s is the only pediatric hospital in King County and the preeminent provider of many pediatric specialty services in the Northwest.

Some of these specialized services not available elsewhere in our area or region include acute cancer care, level IV neonatal intensive care and heart, liver and intestinal transplantation.

Without inclusion of Children’s, current and future patients and families who obtain insurance from several plans offered will not be able to access care at Children’s as an in-network provider.

This lack of suitable access to pediatric services means that families enrolled in these plans may not receive the most timely, appropriate care, and face larger out-of-pocket amounts.

“Every child should have access to essential healthcare and the intent of the new Exchange is to make it available to all families,” said Thomas Hansen, MD, CEO, Seattle Children’s. “However, we are very concerned about the limited networks being offered by some Exchange insurance plans. Omitting coverage for care at a facility like Children’s prevents families from accessing vital services they may desperately need.”

Children’s is committed to working with the OIC and Exchange insurers, and we hope a solution to this concerning situation can be found soon for Washington families.

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WIC services in Washington given 30-day reprieve during federal shutdown

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WIC WashingtonOLYMPIA – Despite the federal government shutdown, Washington’s Women, Infants, and Children food and nutrition program has funding to continue service through October. The United States Department of Agriculture (USDA) reallocated funding to cover the costs for the month.

The reprieve comes just in time for Washington’s WIC Nutrition Program, which had only enough remaining funds to operate the program statewide until Oct. 9.

WIC provides important nutrition assistance and health referrals along with breastfeeding support to pregnant and breastfeeding women and their children up to age five, whose family income is at or below 185 percent poverty level.

The state Department of Health contracts with local health organizations and tribes to provide WIC services in all 39 counties in Washington. The program also authorizes certain grocery stores to accept WIC vouchers for the purchase of approved healthy foods.

If the federal government shutdown continues through this month, USDA will not have funding to re-allocate for services in November, and Washington WIC may not have funding to continue operations.

The Department of Health had been working on contingency plans in the event that WIC services had to end in October when reallocation was announced. Agency officials now have more time to develop a strategy in the event the shutdown does not end by Nov.1.

“WIC helps low-income families feed their children. We hope a budget will be passed and this important program can continue beyond October 31,” said Janet Jackson Charles, director of Nutrition Services at the Washington State Department of Health.

  • For questions about local WIC services call the state WIC office, 1-800-841-1410.
  • The Washington WIC Nutrition Program website has information about local WIC clinics
  • Related services around the state can be found at ParentHelp123.org or by calling the Family Health Hotline at 1-800-322-2588.
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Take concussions out of play: Learn to prevent, recognize and respond to concussions

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From the Centers for Disease Control and Prevention

BrainCDC estimates 173,285 sports- and recreation-related traumatic brain injuries (TBIs)including concussions, among children and adolescents are treated in U.S. emergency departments each year.

A bump, blow, or jolt to the head can cause a concussion, a type of TBI. Concussions can also occur from a blow to the body that causes the head to move rapidly back and forth. Even a “ding,” “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious.

Concussions can occur in any sport or recreation activity. So, all coaches, parents, and athletes need to learn concussion signs and symptoms and what to do if a concussion occurs.

CDC’s “Heads Up: Concussion in High School” and “Heads Up: Concussion in Youth Sports” initiatives include materials and information to help coaches of all sports to help identify concussions and take immediate steps to respond when one is suspected.

Prevention and Preparation

Check with your league or school about concussion policies.Concussion policy statements can be developed to include the league or school’s commitment to safety, a brief description about concussion, and information on when athletes can safely return to play. Parents and athletes should sign the concussion policy statement before the first practice.

Insist that safety comes first. No one technique or safety equipment is 100 percent effective in preventing concussion, but there are things you can do to help minimize the risks for concussion and other injuries.

For example, to help prevent injuries:

  • Enforce no hits to the head or other types of dangerous play.
  • Practice safe playing techniques and encourage athletes to follow the rules of play.
  • Make sure players wear approved and properly-fitted protective equipment. Protective equipment should be well-maintained and be worn consistently and correctly.

Learn about concussion. Before the first practice, talk your athlete(s) and others about the dangers of concussion and potential long-term consequences of concussion. Review the signs and symptoms of concussion and keep the four-step action plan with you at games and practices.

More Information

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What options do parents have to get coverage for their kids?

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An umbrella sheltering medicines - credit MicrosoftBy Michelle Andrews

As the October launch of the state health insurance marketplaces approaches, parents have many questions about covering their children.

Q. Why is it that the adult children of retired members of the military cannot stay on their parents’ insurance? My husband served for 22 years in the Marine Corps. My adult children are still in college, but they have been dropped from our insurance, Tricare Prime.

A. The Affordable Care Act allows adult children to stay on their parents’ health plan until they reach age 26 in most cases.

But Tricare, the health plan for military service members, is governed by a different set of statutes, and the ACA’s provisions that expand young adult coverage don’t apply to it.

Tricare allows dependent children to remain on their parents’ plan until they turn 21, or until they turn 23 if they’re full-time students who are supported financially by their parents, according to Austin Camacho, chief of the benefit information and outreach branch of Tricare Management Activity.

Once adult children are no longer eligible for regular Tricare, they can enroll in the Tricare Young Adult program, which provides coverage for children up to age 26 who are unmarried and don’t have employer coverage available to them, says Camacho.

Unlike regular Tricare, however, the young adult program is a premium-based plan that costs up to $180 per month.

Q. I am a divorced dad who has responsibility for maintaining my 15-year-old daughter’s health insurance. It was easy when I was working and had a corporate health plan. Now that I am retired and in the Medicare program, I am looking for alternatives when the new exchanges open in October. Can I buy health insurance for just my underage daughter on these new exchanges?

A. Yes, you can. The new health insurance marketplaces, also called exchanges, are required to sell child-only policies for children up to age 21.

If you claim your daughter as a dependent on your tax return and your income is less than 400 percent of the federal poverty level ($62,040 for a family of two in 2013), you may qualify for a premium tax credit to reduce the cost of coverage.

If your ex-wife claims your daughter as a dependent, however, in order to receive the tax credit she would have to apply for it based on her household income, says Brian Haile, a senior vice president for health policy at Jackson Hewitt Tax Service in Nashville.

Depending on your income, your daughter might qualify for health insurance through your state’s Medicaid or CHIP programs for lower income people.

As of January 2013, all but four states covered children in families with incomes up to at least 200 percent of the federal poverty level ($31,020 for a family of two in 2013) through one of those programs, according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Q. My 21-year-old son is a college student, and I know the Affordable Care Act has made him eligible to remain on my employer-based insurance plan until age 26. However, if it’s cheaper for him to get subsidized coverage through the health insurance marketplace, can he do so?

A. It depends. Almost anyone can shop for coverage on the health insurance marketplace. But your son will only be eligible for subsidies to reduce the cost of coverage under certain circumstances.

If you don’t claim him as a dependent on your tax return and his own income is between 100 and 400 percent of the federal poverty level ($11,490 and $45,960 in 2013), he could be eligible for premium tax credits on the exchange.

But if you do claim him as a dependent, his eligibility for subsidies will be based on your family’s income, not just his own.

It’s also worth looking into Medicaid eligibility for your son. Roughly half of states have decided to expand Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level ($15,856 for an individual in 2013) as provided for under the Affordable Care Act. Medicaid would be even less expensive than a private plan on an exchange.

But if you claim your son as a dependent on your tax return, your family’s income would have to be no more than 138 percent of poverty in order for him to qualify, says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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The $13 Test That Saved My Baby’s Life. Why Isn’t it Required For Every Newborn?

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by Michael Grabell
ProPublica

On July 10, my wife gave birth to a seemingly healthy baby boy with slate-blue eyes and peach-fuzz hair. The pregnancy was without complications. The delivery itself lasted all of 12 minutes. After a couple of days at Greenwich Hospital in Connecticut, we were packing up when a pediatric cardiologist came into the room.

We would not be going home, she told us. Our son had a narrowing of the aorta and would have to be transferred to the neonatal intensive care unit at NewYork-Presbyterian Hospital at Columbia, where he would need heart surgery.

It turned out that our son was among the first in Connecticut whose lives may have been saved by a new state law that requires all newborns to be screened for congenital heart defects.

It was just by chance that we were in Connecticut to begin with. We live in New York, where such tests will not be required until next year. But our doctors were affiliated with a hospital just over the border, where the law took effect Jan. 1.

As we later learned, congenital heart problems are the most common type of birth defect in the United States. The Centers for Disease Control and Prevention estimate that about one in 555 newborns have a critical congenital heart defect that usually requires surgery in the first year of life.

Many cases are caught in prenatal ultrasounds or routine newborn exams. But as many as 1,500 babies leave American hospitals each year with undetected critical congenital heart defects, the C.D.C. has estimated.

Typically, these babies turn blue and struggle to breathe within the first few weeks of life. They are taken to hospitals, often in poor condition, making it harder to operate on them.

By then, they may have suffered significant damage to the heart or brain. Researchers estimate that dozens of babies die each year because of undiagnosed heart problems.

The new screening is recommended by the United States Department of Health and Human Services, the American Heart Association and the American Academy of Pediatrics. Yet more than a dozen states — including populous ones like Massachusetts, Pennsylvania, Florida, Georgia, Wisconsin and Washington — do not yet require it.

The patchy adoption of the heart screening, known as the pulse oximetry test, highlights larger questions about public health and why good ideas in medicine take so long to spread and when we should legislate clinical practice.

Newborns are already screened for hearing loss and dozens of disorders using blood drawn from the heel. The heart test is even less invasive: light sensors attached to the hand and foot measure oxygen levels in the baby’s blood. This can cost as little as 52 cents per child.

Our son’s heart defect was a coarctation of the aorta, a narrowing of the body’s largest artery. This made it difficult for blood to reach the lower part of his body, which meant that the left side of his heart had to pump harder.

A: Coarctation (narrowing) of the aorta. 1:inferior caval vein, 2:right pulmonary veins, 3: right pulmonary artery, 4:superior caval vein, 5:left pulmonary artery, 6:left pulmonary veins, 7:right ventricle, 8:left ventricle, 9:main pulmonary artery, 10:Aorta.

A: Coarctation (narrowing) of the aorta. 1: inferior caval vein, 2: right pulmonary veins, 3: right pulmonary artery, 4: superior caval vein, 5: left pulmonary artery, 6:left pulmonary veins, 7: right ventricle, 8: left ventricle, 9: main pulmonary artery, 10: aorta. – Source: Wikipedia

In the hospital, though, he appeared completely healthy and normal because of an extra vessel that newborns have to help blood flow in utero. But that vessel closes shortly after birth, sometimes revealing hidden heart problems only after parents bring their babies home.

Depending on the heart defect, the onset of symptoms can be sudden.

This is what happened to Samantha Lyn Stone, who was born in Suffern, N.Y., in 2002. A photograph taken the day before she died shows a wide-eyed baby girl lying next to a stuffed giraffe. The next morning, her mother, Patti, told me, she was wiping Samantha’s face when she heard a gurgle from the baby’s chest.

Before her eyes, Samantha was turning blue. Blood began to spill from her mouth. Ms. Stone dialed 911, and minutes later, a doctor who heard the call over a radio was there performing CPR. Samantha went to one hospital and was flown to another.

But the damage was irreparable. Samantha had gone 45 minutes without oxygen: She lapsed into a coma and died six days later.

It wasn’t until several years later that Ms. Stone learned about the pulse oximetry test. “This could have saved my daughter,” she told me. “There is no parent that should ever have to go through what I went through.”

Pulse oximetry is not a costly, exotic procedure. Most hospitals already have oximeters and use them to monitor infants who suffer complications. You can buy one at Walmart for $29.88.

A recent study in New Jersey, the first state to implement the screening, estimated that the test cost $13.50 in equipment costs and nursing time. If hospitals use reusable sensors similar to those found on blood-pressure cuffs, the test could cost roughly fifty cents.

As medical technology advances, few screenings will be so cheap or simple. Recent years have seen controversy over prostate cancer and mammography screenings. Medical ethicists have to weigh the costs of each program and the agony caused by a false positive against the lives saved.

But with pulse oximetry, the false positive rate is less than 0.2 percent — lower than is seen for screenings newborns already get. The follow-up test is usually a noninvasive echocardiogram, or an ultrasound of the heart. A federal advisory committee came down in favor — three years ago.

“There’s really no question, scientifically, this is a good idea,” said Darshak Sanghavi, a pediatric cardiologist and a fellow at the Brookings Institution. “The issue is, how do we change culture?”

Opposition has taken two forms. One is from doctors who believe policy makers shouldn’t interfere with how medical professionals do their jobs. The other is from smaller hospitals, which worry about access to echocardiograms and the costs of unnecessary transfers.

These concerns can be addressed fairly easily. Nurses in New Jersey and elsewhere have been able to work the test into their normal routines. A rural hospital should already have a protocol to transfer a newborn in serious condition. If Alaska can do it, less remote states can, too.

But this is not simply a rural health care problem. Cardiologists and neonatologists I’ve spoken with said they knew of hospitals in New York City, Boston and metropolitan Atlanta that weren’t screening newborns for heart defects.

“It’s completely the luck of the draw of where you deliver,” said Annamarie Saarinen, who has pushed for the screening since her daughter narrowly avoided leaving the hospital with an undetected heart defect.

Fortunately, our son’s condition was also caught and corrected. The only lasting effects are a three-inch scar on his side and checkups with a cardiologist. He will live a normal life. He will be able to play sports and climb things he’s not supposed to.

Shouldn’t every baby have that chance?

Want to know more? Follow ProPublica on Facebook and Twitter, and get ProPublica headlines delivered by e-mail every day.

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Health reform’s ‘Family Glitch’ could hurt families who need CHIP

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By Christine Vestal
Stateline Staff Writer

The Affordable Care Act is primarily aimed at insuring more adults, including parents. In the process, a substantial number of uninsured children may also get coverage as their parents learn more about federal and state subsidies.

Just how many will depend on whether states maintain their existing Children’s Health Insurance Program (CHIP).

“Now, more than ever, it is crucial that states continue or expand coverage of children,” said Bruce Lesley, president of the children’s advocacy group First Focus. Without CHIP, the federal-state health care program for kids, he and others worry about potential harm the ACA may do to children.

A main concern is a provision known as the “family glitch” that could make employer-sponsored insurance too costly for low-income workers.

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According to a study by the Urban Institute, Obamacare could result in new coverage for as many as 3.2 million uninsured children because of tax credits on health insurance exchanges and overall outreach efforts.

But if CHIP is not reauthorized by Congress when it expires in 2015, or states decide not to continue it, the ACA could result in fewer children covered by insurance.

Children could fall through the cracks as the massive health care law is rolled out, said Catherine Hess of the National Academy for State Health Policy. The 15-year-old CHIP program, Hess wrote in a recent report, “has been exceedingly successful in finding uninsured children and providing them with quality, affordable coverage.”

She and other advocates for children insist that the program should continue well after the ACA is fully implemented.

What Is the Family Glitch?

An apparent mistake in the ACA makes the future of CHIP particularly important.

The so-called family glitch in the health law requires employers to provide “affordable” insurance only for the workers themselves – not for their families.

Premiums for individual coverage must not exceed 9.5 percent of a worker’s income. But there is no limit on the employee’s share of premiums for family coverage, which typically costs close to three times as much as individual coverage.

In addition, federal subsidies for people with incomes below 400 percent of the federal poverty level ($45,600 for an individual) will be unavailable for anyone who receives an affordable offer of insurance from an employer.

That means workers who can’t afford employer-offered premiums for family coverage will have nowhere to go except the Children’s Health Insurance Programs (CHIP) or Medicaid, if they qualify.

At least two states preparing for the ACA have already discontinued their CHIP programs and more may follow as a way to reduce administrative costs and make enrollment simpler for families. “Looking ahead,” said Joan Alker of Georgetown University’s Center for Children and Families, “the ACA does raise questions about the future of the CHIP program.”

The CHIP Provision

Although most of the ACA focuses on adults, one provision requires states to shift children ages 6 to 19 in families with incomes between the poverty level ($11,490 for an individual and $23,550 for a family of four) and 138 percent of poverty ($15,860 and $32,499) out of CHIP and into Medicaid by Jan. 1.

Children under 6 in families in this income bracket will stay under Medicaid. Those 6 to 19 are covered by Medicaid only if their family income is at or below poverty level.

The CHIP program was started in 1997 to cover these older children in families slightly over the poverty level, as well as kids of all ages in families with incomes too high to qualify for Medicaid but who can’t afford private insurance.

The federal government gave states a higher federal match for CHIP than Medicaid to encourage them to sign up as many children as possible.

Total federal and state spending on CHIP in 2009 – the most recent numbers from the Kaiser Family Foundation   – is $10.6 billion. State expenditures range from Vermont, which spends the least at $7 million, to California’s $1.8 billion.

When it was created, critics said it would result in socialized medicine. But it is now viewed as widely successful and has bipartisan support. Since enactment, CHIP has reduced the uninsured rate among low-income children from 23 percent to 10 percent.

Today, CHIP covers 8 million children and Medicaid covers nearly 36 million. Together, the programs insure more than half of all children in the country. According to the U.S. Census Bureau’s latest data, only 8.9 percent of all children remain uninsured, compared to 15.7 percent of people of all ages.

When CHIP was launched, 21 states chose to create separate CHIP programs. The remaining states opted to cover children under an expanded Medicaid program. The new federal health law requires states with separate programs to shift nearly 30 percent of CHIP kids into Medicaid.

An important difference between CHIP and Medicaid is that CHIP is a block grant, not an entitlement. That means states can create waiting lists for the program when state revenues run short.

Medicaid, on the other hand, must be offered to all comers no matter what the cost. For this reason, Republican governors tend to favor CHIP over Medicaid. Many states have a great deal of pride in their CHIP programs.

For example, Pennsylvania Gov. Tom Corbett, a Republican, has asked the federal government for an exemption to the transfer requirement. He also added state funding to cover 9,300 more children this year, a 3.4 percent increase, according to Kaiser.

The ACA says states will continue to get a higher federal match for former CHIP kids who are moved to Medicaid, averaging about 71 percent nationwide compared to 57 percent for Medicaid.

“Stairstep” Kids

The rationale for the ACA transfer was that parents and children would be best served if they were covered by the same insurance plan, with the same doctors and hospitals and the same enrollment rules.

Since the federal health law assumed that all states would expand Medicaid to adults with incomes up to 138 percent of poverty level, it made sense to cover their children under the same program.

Otherwise, parents would have to deal with separate enrollment and renewal rules for what is known as “stairstep” children who have grown out of Medicaid. When the Supreme Court made the Medicaid expansion optional for states, the justices made clear that the provision requiring states to transfer children to Medicaid was not affected.

The requirement spurred California and New Hampshire to stop running separate CHIP programs, and instead move all low-income children to Medicaid. New York and Colorado chose to make the transfer ahead of the deadline because of projected cost savings.

Nationwide, the transition from CHIP to Medicaid will affect more than 1.5 million low-income children. In California alone, nearly 900,000 kids are moving under Medicaid. New Hampshire will shift about 9,000 children.

In states that are transferring only the required number of children – those older than 6 in families whose incomes range from poverty to 138 percent of poverty – the reduction in CHIP enrollment will be nearly 30 percent.

CHIP vs. Medicaid

There’s no consensus on whether kids and families would be better off if states maintained a separate CHIP program, Alker of the Georgetown center said. Medicaid generally has a stronger benefits package and lower cost-sharing for families.

But it may be easier to get an appointment with CHIP doctors, because Medicaid tends to pay pediatricians and hospitals lower fees.

“Integrating CHIP into Medicaid is tricky,” Lesley of First Focus said. “Kids could be left worse off unless you pay attention to a variety of issues, including benefits and services, out-of-pocket costs, access to care and quality of care.”

California Gov. Jerry Brown’s decision to end the state’s CHIP program was largely fiscal. A legislative analysis showed the state will save $43 million in 2014, primarily due to Medicaid’s lower reimbursement rates.

Florida, which will transfer about 71,000 kids into Medicaid by the end of the year, expects to save $18 million in 2014. A few states have reported small increases in costs due to higher benefits costs under Medicaid, according to a new report from Kaiser. But most expect to see some savings.

Although advocates are not certain whether kids would be better off in CHIP or Medicaid, they are clear about one thing. Any move to shut down a state CHIP program should not be undertaken hastily. According to Hess of the National Academy for State Health Policy, “it makes sense to get all the new ACA systems up and running and see how it goes first.”

Children’s advocate Kristen Golden Testa said California moved way too fast in shutting down CHIP. She and other advocates in the state had nothing against the Medicaid program, but they worried that kids, especially those in treatment, would lose access to their doctors.

In addition to a series of mishaps and confusion during the transition, the state met with a storm of protests when parents of kids with autism found that Medicaid – renowned for its rich benefits package – did not cover the same autism treatments as CHIP did.

Brown, a Democrat, rejected demands to add autism coverage to Medicaid, because it would have cost as much as $50 million, more than the state estimated it would save by ending CHIP.
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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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