From the Office of Research on Women’s Health
A stroke, also called a brain attack, occurs when blood flow to the brain suddenly stops. Blocked or damaged vessels are the two major causes of stroke.
During a stroke, brain cells begin to die because oxygen and nutrients cannot reach them. The longer blood flow is cut off to the brain, the greater the damage.
Every minute counts when someone is having a stroke. Immediate treatment can save a person’s life and enhance the chance for a successful recovery.
There are two kinds of stroke: Continue reading
From the National Cancer Institute
Adults with extreme obesity have increased risks of dying at a younger age from cancer and many other causes including heart disease, stroke, diabetes, and kidney and liver diseases, according to a new study.
The study, led by researchers from the National Cancer Institute (NCI), part of the National Institutes of Health, found that people with class III (or extreme) obesity had a dramatic reduction in life expectancy compared with people of normal weight. The findings appeared July 8, 2014, in PLOS Medicine.
Six percent of US adults are now classified as extremely obese
The number of Washington state residents who obtained prescriptions for a lethal dose of drugs under the state’s Death with Dignity Act rose from 121 in 2012 to 175 in 2013, a 43% increase over the previous year.
Of the 159 who died
- 77 percent had cancer
- 15 percent had a neuro-degenerative disease, including amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease).
- 8 percent had other conditions, including heart and respiratory disease,
Their ages ranged from 29 to 95 years. Ninety-seven percent were white, and 76% had some college education. Ninety-five percent lived west of the Cascades.
Of the 159 who died, 119 ingested the medication and 26 did not. In 14 cases, it is unknown whether they took the medicines.
Reasons that patients gave for obtaining the lethal prescriptions included
- Concerns about loss of autonomy – 91 percent
- Concerns about loss of dignity – 79 percent
- Concerns about loss of the ability to participate in activities that make life enjoyable – 89 percent.
Under the state’s Death with Dignity Act, terminally ill adult patients have had the right to ask their physician to prescribe a lethal dose of medication to end their life. Since the law’s enactment, 550 people have acted on that right since the law went into effect.
The 2013 Death with Dignity Act Report and information about the Washington State Death with Dignity Act are on the agency website.
Someone who has a cardiac arrest in King County has a greater chance of survival than anyone else in the world, according an analysis by county officials.
The survival rate for cardiac arrest in King County hit an all-time high of 62 percent in 2013, the analysis found.
By comparison, the cardiac survival rates in New York City, Chicago, and other urban areas have been recorded in the single digits.
According to the analysis, the cardiac survival rate in King County has risen over the past decade or so, from an above-average 27 percent in 2002 to 62 percent in 2013.
Strategies that have contributed to the rise include: Continue reading
By Milly Dawson
Health Behavior News Service
May 15, 2014
A new study in the American Journal of Preventive Medicine finds that many smokers still find accurate and detailed facts about the dangers of tobacco both new and motivating in terms of their desire to quit. Continue reading
An FDA Consumer Update
Can an aspirin a day help you ward off a heart attack or stroke?
Scientific evidence shows that taking an aspirin daily can help prevent a heart attack or stroke in some people, but not in everyone. It also can cause unwanted side effects. Continue reading
The health law set national rules for appealing a denied claim, and advocates say consumers should take advantage of them
By Pauline Bartolone, Capital Public Radio
APR 14, 2014
SACRAMENTO, Calif. — Federal rules ensure that none of the millions of people who signed up for Obamacare can be denied insurance — but there is no guarantee that all health services will be covered.
To help make sure a patient’s claims aren’t improperly denied, the Affordable Care Act creates national standards allowing appeals to the insurer and, if necessary, to a third-party reviewer.
For Tony Simek, a software engineer in El Mirage, Ariz., appealing was the only way he was able to get additional treatment for sleep apnea. Continue reading
By Richard Knox
MARCH 20TH, 2014
When sweeping new advice on preventing heart attacks and strokes came out last November, it wasn’t clear how many more Americans should be taking daily statin pills to lower their risk.
From the Office of Research on Women’s Health
Blood pressure is the amount of force exerted by the blood against the walls of the arteries. Your blood pressure allows the blood to reach all of the body’s organs. Continue reading
From the Office of Research on Women’s Health
Heart disease is the leading cause of death among American women. The good news is that you can greatly reduce your chances of developing heart disease.
By April Dembosky, KQED
Health insurance companies are on the prowl for more customers. There are still three months to go for people to enroll in health plans under the Affordable Care Act, but insurers don’t want to rely solely on state or federal websites to find them.
Some are finding a path to new customers by partnering with companies that operate health-screening kiosks –- those machines in supermarkets and drug stores where people check their blood pressure or weight.
One of these kiosks sits in aisle 10 of a Safeway grocery store in a city near San Francisco. Sitting down at the machine is like slipping into the cockpit of a 1980s arcade game. Continue reading
Money grab, health concerns, or both? Absent guidance from Washington, states are pressing ahead with their own agendas on electronic cigarettes.
Heading into legislative sessions next year, policymakers, industry representatives, health advocates and tax wonks expect electronic cigarettes — or e-cigarettes for short — to be among the top issues at state capitols.
Legislatures are expected to tackle how to classify, regulate and, perhaps most importantly, tax the relatively new products.
The debates in states come as the federal government considers its own answers to similar questions. The Food and Drug Administration is considering classifying e-cigarettes as “tobacco products,” which would extend its reach and potentially subject e-cigarettes to a host of rules and regulations that apply to tobacco cigarettes.
“States are scrambling to figure out how to deal with this,” Ohio Attorney General Mike DeWine said in an interview. “It’s going to be fought out in 50 states; it’s going to be fought out in one jurisdiction after another.”
DeWine was a lead author of an Oct. 23 letter sent by 40 attorneys general to the FDA pushing for federal rules and for e-cigarettes to be treated as “tobacco products” for regulatory purposes.
So far, Washington hasn’t decided how to proceed with e-cigarettes. A proposed rule, expected to be released for public comment in November, was delayed by the government shutdown and is still pending.
That has left a patchwork of rules, regulations and product definitions across the nation, often at the urging of anti-tobacco advocates. “We think it’s really important that states act,” said Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.
More than half the states, for example, have banned the sale of e-cigarettes to minors, but others have no restrictions. Currently four states — Utah, North Dakota, Arkansas and New Jersey — have lumped the products in with tobacco under indoor smoking bans, even as research about possible ill-effects from second-hand vapor smoke, if there even are any, remains limited.
Some local governments have taken similar steps on their own, enacting rules for e-cigarettes that sometimes go beyond those in place at the state level.
The intensity of the debate illustrates both the lack of good research on e-cigarettes as well as the money at stake. Often, those considering limits don’t even agree on whether applying tobacco regulations is appropriate, given how different the products are. Like tobacco cigarettes, nicotine levels in the “cartridges” that are loaded into the e-cigarette device can vary widely, complicating efforts to agree on a standard approach to regulation and taxation.
E-cigarettes first appeared about a decade ago, and sales have grown exponentially in recent years. The number of American adults who said they have tried them doubled to one in five in just one year (from 2010 to 2011), according to a Centers for Disease Control survey.
Use among middle and high school students also doubled from 2011 to 2012, according to the CDC, with nearly 1.8 million students saying they’ve used them.
In an era of revenue-hungry state governments — some still dealing with declining revenue from traditional tobacco taxes and recovering from the Great Recession — taxing e-cigarettes seems likely to get the most attention from state lawmakers in 2014. Questions of advertising limits, health claims and ingredient disclosure will likely remain federal issues.
So far, only Minnesota has put in place a specific state tax policy for e-cigarettes, a decision reached in 2012. The products are subject to a 95 percent tax that functions like a sales tax, tacked onto the wholesale cost of the product.
That generally means they are taxed at a higher rate than traditional cigarettes, which are subject to a $1.29-per-pack levy. The state expects to collect $1.16 billion from all tobacco taxes in the 2014-2015 fiscal year.
For now, most other states apply only a sales tax – if they have one – to e-cigarettes. But at least 30 others are considering e-cigarette taxes of some kind next year.
“I will be watching to see if more proposals like Minnesota are replicated in the states,” said Scott Drenkard of the Tax Foundation, an anti-tax research group, “But I hope they are not.”
What this is is a money grab.
“There is zero, emphasis on zero, justification for taxing e-cigarettes right now,” said David Brunori of the group Tax Analysts, a nonprofit tax analysis group that provides insight to private firms and government agencies. “What this is is a money grab. It’s a way of trying to find revenue to replace lost tobacco taxes.”
According to the nonpartisan Tax Policy Center, state and local tax revenues have somewhat leveled off in recent years as smoking has declined. Collections grew from $7.7 billion in 1997 to $15.8 billion in 2007, but reached just $17.6 billion in 2011, the most recent year available.
Tobacco companies that don’t produce e-cigarettes have often pushed tax parity so their own products are not at a disadvantage. In Minnesota’s case, the state simply said that under its laws, the tax must apply.
But the most popular argument is deterrence—higher taxes might make the product less attractive and less affordable to young people looking for nicotine.
“It has nothing to do with revenue,” Ohio’s DeWine said. “It has everything to do with discouraging use.”
An Alternative to Tobacco
Discouraging use, however, is exactly the opposite goal lawmakers should have, said Ray Story of the Tobacco Vapor Electronic Cigarette Association. It’s an opinion shared by some outside of the industry as well, especially with regard to those already smoking.
“Cigarettes are sold everywhere in the world, and we want to make sure that the e-cigarette is sold as a less-harmful alternative right there next to it,” Story said.
“We should expand the use, not restrict it,” he added, saying that if e-cigarettes can greatly reduce cigarette use the industry “will have made the greatest impact on humanity ever.”
The contrasting approach reflects two key differences in thinking about e-cigarettes: as a new recreational product similar to tobacco cigarettes, or as a potentially less-unhealthy alternative that could even help smokers quit entirely.
E-cigarette producers themselves are divided. Some welcome traditional cigarette-style regulations to a degree, content to play by similar rules as tobacco producers, especially if it saves them from more onerous limits applied to drug manufacturers, for example. Others argue that even thinking about e-cigarettes through the same frame of reference as tobacco is a flawed approach.
Federal officials in Washington will likely be the ones to eventually settle the dispute, and that decision could still be months away. Meanwhile, debates in the states over two key issues within their control – taxes and sales to minors – are likely to rage in 2014.
But the eventual decision from the FDA is sure to affect those debates. “If the FDA says these are essentially tobacco products,” said Brunori of Tax Analysts, “that will give all kinds of cover to state politicians.”
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.
I’d like to start a long-term relationship with a health plan, but all I’ve had are flings — seven insurers in the last 13 years. Is it something I said? Nope, it’s something I am: a self-employed, 45-year-old single guy with a heart that beats funny.
Take Cigna. We seemed to click until the company wanted me to pay $11,000 a year in premiums. Another insurer came calling but turned out to be a scam, defrauding me and thousands of others. The high-risk plan in California — my home state — took me on, but I had to cough up $700-plus a month for paltry coverage.
Another couple of government-run plans were supposed to get me through this year with cheaper rates, but a bureaucratic snafu snuffed my coverage.
At least my misery has company. People with pre-existing medical conditions “face every kind of possible hassle,” said Nancy Metcalf, a senior program editor with Consumer Reports. Many can’t find coverage at all.
Now 2014 is fast approaching, and I suddenly have suitors. Six companies are offering me 34 plan options through my state’s marketplace, which was created under the federal health law. Insurance coverage, at last, is guaranteed. And, for now, so is confusion.
It’s A Long Story Involving A Scam, An $11,000 Annual Premium And Relief (Kinda)
My endless insurance drama began in 2001, when my COBRA coverage expired from my previous newspaper job. I needed to find new coverage on the individual market as a self-employed freelance writer who didn’t have access to a guaranteed group health plan. But insurer after insurer rejected me because I had a pre-existing condition: an irregular heartbeat I’d developed in my 20s.
The condition, known as atrial fibrillation, slightly raises my risk of stroke. It also requires occasional cardiologist checkups and costs about $260 in medication each year. That was enough to make me one of the millions of people on the individual market who can’t get coverage because insurers don’t want to risk paying extra for their health problems. (I like to imagine that insurance companies ran screaming into the night when they received my applications).
I needed to find the individual insurance market’s Holy Grail — an insurer who’d take all comers, pre-existing condition or no. I discovered it through a writers’ group that sold an Aetna insurance policy, no health questions asked. But then Aetna spiked its rates, and the group found replacement insurance through a company called Employers Mutual. This did not go well.
Coverage through Cigna came next via a firm that provides coverage to members of associations representing artists, performers and writers. But in 2006, when I was 38, I faced a prohibitive increase in my monthly premium from $509 to $928.
(The Cigna rates are even worse now. My annual premium for 2013 if I bought a Cigna point-of-service plan through the same company: $3,028 a month, or $36,336 for the year, plus a $24 service fee.)
A lack of options forced me to enroll in California’s high-risk pool, and it cost me big-time. My monthly premium grew over time and by 2008 it was more than $700 a month for coverage with an annual benefit limit of $75,000 and a lifetime limit of $750,000.
As Metcalf of Consumer Reports puts it, that level of coverage is “terrible.” Indeed, a serious car accident or bout with cancer could wipe that out quickly. I worried that an expensive medical catastrophe would mean bankruptcy for me.
So I paid.
Left In The Lurch Once Again
Fast forward to the Affordable Care Act. For me, it is shaping up to be a blessing — sort of — in my case.
The health law set up a new state insurance plan for high-risk people – the California Pre-Existing Condition Insurance Plan – that offered me the opportunity to get fantastic benefits at less than half the cost of my existing coverage. But I had to go without any insurance for six months to qualify.
That brought more trouble. I’ve been paying the $287 monthly premiums for the transition plan, but a visit to the doctor’s office this month for a flu shot revealed that the feds cancelled my coverage back in August. The system seems to believe I’m eligible for Medicare. Actually, I have another 20 years. Now, I’m working through a bureaucratic maze of phone calls and emails to restore my coverage for the remainder of this year.
That’s just one spot of bother for me to resolve. There’s another: Now I need to wade through 34 insurance options from Covered California, the state’s online health insurance marketplace, which was created as a result of the health law, and figure out which one to purchase for 2014.
Choices, Choices And More Choices
Fortunately, I live in one of the 14 states that operate their own marketplaces and don’t rely on healthcare.gov, the trouble-prone federal website. Unfortunately, the Covered California website has had its own glitches, including a buggy doctor search feature and shutdowns of the enrollment section for repairs.
So far in my efforts to enroll, which began shortly after the Oct. 1 launch, I’ve faced numerous impediments — blackouts when the site was shut down for scheduled maintenance, a disappearing enrollment section and other technical hiccups, including broken links and HTML coding problems.
Still, I’ve found the website easy to use when it’s actually working. It says 34 plans are available to me ranging in price and particulars from $263 a month for “bronze” level coverage in an exclusive provider organization to $548 a month for a “platinum” level health maintenance organization.
The “metal” levels — bronze, silver, gold and platinum — refer to the level of coverage offered by a plan. They range from platinum plans that cover an average of 90 percent of health care costs to bronze plans, which have significantly cheaper premiums but cover only 60 percent of costs and have higher deductibles. (They pay for 100 percent of costs after a policyholder reaches a set out-of-pocket spending limit.)
The state standardized the four general types of coverage levels so they share the same deductibles and co-pays, said Anthony Wright, executive director of Health Access California, a non-profit advocacy group. “This is a huge benefit for consumers because it creates a situation where people can actually make apple-to-apple comparisons, and it removes the fear of the fine print.”
34 Different Of Apples
But I’ve still got to compare 34 different apples. And it’s not just Granny Smith versus Red Delicious, even with California’s user-friendly modifications.
There are many factors to consider just to choose the best metal level. Platinum plans cover a lot with no deductible and a low, $4,000 maximum out-of-pocket expense for an individual, but they’re mighty pricey and a bad deal if I don’t need much care.
Bronze plans could save me thousands of dollars a year in premiums versus platinum plans, but they don’t cover much and have a higher out-of-pocket maximum — $6,350.
(My income is too high for me to be eligible for subsidies to reduce my premium or costs like co-pays. The Covered California website says I’d get an $11 a month subsidy if I made $45,000 in “Modified Adjusted Gross Income” a year or a whopping $207 monthly subsidy if I made $25,000.)
The Covered California website had a handy feature that asked me how much I typically spend on medical costs annually and then estimated how much I’d spend each year, per plan, on premiums and out-of-pocket costs. But that feature seems to have disappeared for the moment, along with the enrollment section.
Then there are the other factors: HMO, PPO or EPO? If I’d like an HMO, I could go with Kaiser Permanente, which insures 7 million Californians and is well-respected, but would require me to dump my current doctors. HealthNet has by far the cheapest gold-level HMO plan at $347 a month, a savings of $552 a year over the next cheapest one.
But the website’s failure to provide a working database of the physicians covered by the various plans leaves me in the dark about whether HealthNet HMOs include the doctors I’ve seen for a decade or longer.
And I know HealthNet has tried to lower costs to policyholders by sharply limiting the number of doctors who are covered by its plans. So has Blue Shield of California, which will make about half of its doctors off limits to those who buy coverage through the marketplace, the LA Times reported.
Soon, though, I should have coverage set up for 2014 that will be thousands of dollars cheaper a year than what it once was — although more than I’m paying now — and cover much more.
Who knows, maybe an insurer and I will finally start going steady.
Randy Dotinga is a freelance writer based in San Diego.
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.